Personalized texts a promising tool to improve step count among patients in cardiac rehab
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Key takeaways:
- Smartwatch text messages improved step counts for patients in cardiac rehab.
- After 30 days of daily reminders, improvement began to wane.
- This trial may inform development of future mobile health technologies.
Text messages delivered to patients’ smartwatches show promise to improve physical activity for those undergoing cardiac rehabilitation, but sustained behavioral change over time may remain a challenge, researchers reported.
The results of the VALENTINE trial were published in Circulation: Cardiovascular Quality and Outcomes.
“Cardiac rehabilitation is lifesaving for patients with cardiovascular disease. It reduces their chance of having a second cardiac event and dying from cardiovascular disease. But despite its overwhelming benefits, people often fail to maintain the lifestyle behaviors that they learn in cardiac rehabilitation,” Jessica R. Golbus, MD, MS, assistant professor of internal medicine-cardiology at University of Michigan Medical School and member of the University of Michigan Precision Health Initiative, told Healio. “When they graduate from cardiac rehabilitation, there’s often behavioral recidivism, and people stop doing what they know is good for their health. The motivation for this study was, can we use mobile technology to augment the benefits of cardiac rehabilitation to help people stay active and then extend the benefits of cardiac rehabilitation after they graduate from the program?”
VALENTINE was a micro-randomized trial for which Golbus and colleagues evaluated the efficacy of text messages sent via smartwatch (Apple Watch or Fitbit Versa) to patients in cardiac rehabilitation.
Four times per day over a 6-month period, participants were randomly assigned at each time point to receive a text message encouraging physical activity or no text message.
Golbus said two types of tailored text messages were delivered in the study.
“One type of text message encouraged lower levels of physical activity and were appropriate for participants’ current environment. Text messages accounted for factors relevant for spontaneous physical activity: the weather outside, time of day, time in the study, and weekday or weekend,” she said. “The other type of text message encouraged exercise planning. The current analysis focuses on the results of those lower-level physical activity messages.”
Results of the VALENTINE trial
Overall, 108 patients were included with more than 70,000 randomizations over the 6-month period (mean age, 60 years; 32% women; 63% Apple Watch users).
The primary outcome was step count in the 60 minutes after delivery of the text messages.
The researchers evaluated the results of the intervention separately based on smartwatch brand during three periods: cardiac rehab initiation (0 to 30 days); maintenance (31 to 120 days); and completion (121 to 180 days).
During days 0 to 30, tailored text messages led to a 10% increase in step count (95% CI, –1 to 20) in the 60 minutes after message delivery among Apple users and a 17% (95% CI, 7-28) increase among Fitbit users.
“While there were modest differences in the results by smartwatch type, what was consistent across device types was that text messages increased physical activity levels early in the study,” Golbus told Healio. “That speaks to the potential promise of mobile technology for supporting physical activity and other health behaviors.”
Despite initial promise, in Apple users, the text message intervention did not promote physical activity from 31 to 120 days (mean increase, 1%; 95% CI, –4 to 5), but conferred a slight increase in steps during days 121 to 182 for (mean increase, 6%; 95% CI, 0-11).
After 30 days, FitBit users no longer showed any increase in step count associated with the text messages.
The researchers noted that a limitation of this study was that participants had a baseline average daily step count of more than 7,000 steps per day, which means the results may not be generalizable to frail, older patients or those not enrolled in center-based cardiac rehabilitation.
‘Change behavior in the moment for these users’
“Text messages can help with changing behavior early, but that benefit decrements over time for many people. This is potentially a powerful tool for increasing physical activity, but we need to learn how we can adapt and change these text messages over time so that they remain salient to patients and they remain engaged in the intervention,” Golbus told Healio.
“The VALENTINE study was a nice example of how mobile health technology can support patients with CVD longitudinally outside of episodic clinical encounters,” she said. “While this study was conducted in cardiac rehabilitation, we’re interested in thinking about how we can take some of these lessons learned from this study and apply them to other CVD populations. Obviously, this is very early work, but it’s exciting to think about how we can change behavior in the moment for these users.”
For more information:
Jessica R. Golbus, MD, MS, can be reached at 1425 E. Ann St., Floor 3 Reception C, Ann Arbor, MI 48109.
Reference:
- Fromson N. Physical activity improves early with customized text messages in patients with heart problems. Michigan Medicine – University of Michigan. https://www.michiganmedicine.org/health-lab/physical-activity-improves-early-customized-text-messages-patients-heart-problems. Published July 24, 2024. Accessed Aug. 9, 2024.
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