Use of text messages to increase positive affect and promote physical activity in patients with heart disease

Abstract

Adherence to physical activity in patients with serious heart disease is critical to recovery and survival. In-person programs to promote activity in cardiac patients have been poorly attended, and increasingly patients are focused on mobile, self-management-based approaches to health. Accordingly, we completed a one-arm trial of a novel one-way 14-day text message intervention among 40 patients with a prior acute coronary syndrome (ACS). The two-pronged psychological-behavioral intervention alternated daily messages focused on promoting psychological well-being with messages providing specific education/advice regarding physical activity. All messages were successfully transmitted, and nearly all participants found the intervention to be helpful (n = 37; 92.5%) and performed at least one specific health-related action in response to a text message (n = 35; 87.5%). Post-intervention, participants had improvements in happiness (Cohen’s d = 0.25), determination (d = 0.37), depression (d = −0.01), and anxiety (d = −0.13), though not optimism. Moreover, participants reported an increase in moderate physical activity of 105 min/week (baseline: 261 [SD 265] minutes/week, follow-up: 366 [SD 519]; d = 0.25). These improvements were largely maintained two weeks later, with further increases in physical activity (414 [SD 570] minutes/week). Text messaging focused on well-being and physical activity was well-accepted and associated with improvements in activity and mental health in this high-risk clinical population.