Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: A randomized clinical trial

C.K. Chow*, J. Redfern, G.S. Hillis, J. Thakkar, K. Santo, M.L. Hackett, S. Jan, N. Graves, L. De Keizer, T. Barry, S. Bompoint, S. Stepien, R. Whittaker, A. Rodgers, A. Thiagalingam

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

508 Citations (Scopus)



Cardiovascular disease prevention, including lifestyle modification, is important but underutilized. Mobile health strategies could address this gap but lack evidence of therapeutic benefit. 


To examine the effect of a lifestyle-focused semipersonalized support program delivered by mobile phone text message on cardiovascular risk factors. DESIGN AND SETTING The Tobacco, Exercise and Diet Messages (TEXT ME) trial was a parallel-group, single-blind, randomized clinical trial that recruited 710 patients (mean age, 58 [SD, 9.2] years; 82%men; 53%current smokers) with proven coronary heart disease (prior myocardial infarction or proven angiographically) between September 2011 and November 2013 from a large tertiary hospital in Sydney, Australia. 


Patients in the intervention group (n = 352) received 4 textmessages per week for 6 months in addition to usual care. Textmessages provided advice, motivational reminders, and support to change lifestyle behaviors. Patients in the control group (n=358) received usual care.Messages for each participant were selected from a bank of messages according to baseline characteristics (eg, smoking) and delivered via an automated computerized message management system. The program was not interactive. 


The primary end pointwas low-density lipoprotein cholesterol (LDL-C) level at 6 months. Secondary end points included systolic blood pressure, body mass index (BMI), physical activity, and smoking status. 


At 6 months, levels of LDL-C were significantly lower in intervention participants, with concurrent reductions in systolic blood pressure and BMI, significant increases in physical activity, and a significant reduction in smoking. The majority reported the text messages to be useful (91%), easy to understand (97%), and appropriate in frequency (86%). 


Among patients with coronary heart disease, the use of a lifestyle-focused text messaging service compared with usual care resulted in a modest improvement in LDL-C level and greater improvement in other cardiovascular disease risk factors. The duration of these effects and hence whether they result in improved clinical outcomes remain to be determined. 

Original languageEnglish
Pages (from-to)1255-1263
Number of pages9
JournalJAMA - Journal of the American Medical Association
Issue number12
Publication statusPublished - 22 Sept 2015
Externally publishedYes


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