Text-based mobile health intervention may increase physical activity in adults with PAH

Use of an automated, text message-based mobile health intervention helped to increase physical activity levels in adults with pulmonary arterial hypertension, researchers reported in Chest.

“Exercise interventions to increase functional capacity are effective in patients with pulmonary hypertension. However, most interventions have involved intensive inpatient and outpatient protocols,” Anna R. Hemnes, MD, associate professor of medicine in the division of allergy, pulmonary and critical care medicine at Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues wrote. “... Supervised exercise training in pulmonary rehabilitation is also efficacious but is not universally reimbursed by insurers and facilities are not widely available, particularly in rural areas. These observations underscore the need for practical, sustainable and affordable interventions to improve physical activity in PAH.”

The researchers conducted a randomized, parallel-arm, single-blind clinical trial that included 42 participants (mean age, 47 years) with PAH. Participants were randomly assigned to the text message-based intervention group (n = 20; 75% women) or a usual care group (n = 22; 95% women) for 12 weeks. Those in the intervention group received three automated text messages per day with updates on real-time step count and encouraging messages based on behavioral change theory. The usual care arm received no specific instructions regarding physical activity outside recommendations from their physicians. Step count targets for each participant increased 20% every 4 weeks.

The primary outcome was mean step counts at 12 weeks. Secondary outcomes included 6-minute walk test, quality of life, right ventricular function and body composition.

Researchers observed a higher change in raw steps from baseline to 12 weeks in the intervention group (1,409 steps vs. –149 steps; P = .02) compared with the usual care group. This change continued even after adjusting for age, sex, baseline step counts and functional class (P = .03).

From day 9 to 84, participants in the intervention group had a higher average number of steps (P < .05 for all days).

Researchers also observed improvements in the emPHasis-10 score (adjusted change, –4.2; P = .046), reduced visceral fat volume (adjusted change, –170 mL; P = .023) and tricuspid annular plane systolic excursion (estimated difference, 1.2 mm; P = .051).

There was no difference in 6-minute walk distance at 12 weeks.

“We demonstrated the feasibility of an automated, text-based, unsupervised mobile health intervention to increase step counts in patients with PAH. The intervention was inexpensive, safe, well tolerated and met with high enthusiasm by the target population as evident by enrollment of over half of those approached. ... Future, adequately powered studies are warranted to test the effects of the intervention on clinical outcomes, particularly patient-reported quality of life, in a geographically diverse PAH population,” the researchers wrote.