Dose and timing of text messages for increasing physical activity among pregnant women: a randomized controlled trial
Text4baby (T4b), a free nation-wide mobile health information service, delivers health-related text messages (SMS) to pregnant women. The objective of this study was to determine the effectiveness of physical activity (PA) specific SMS to improve PA in pregnant women (vs standard T4b) and the most effective dose/timing of PA-specific SMS to improve PA. Pregnant women (N = 80) were randomized to one of four groups that differed in frequency and time of SMS. The Fitbit™ Flex measured PA. Data were analyzed using mixed model analyses. There were no increases in PA regardless of frequency or time. Those that received six PA SMS/week had greater decreases in activity and greater increases in sedentary time. SMS may not be a “potent” enough strategy to improve PA. Future studies should explore a modified focus on behavior change (e.g., decrease sedentary activity, increase light activity) and incorporate SMS as part of a multi-level approach with other evidence-based strategies.
KeywordsMobile health Physical activity Pregnancy Women
This work was supported by the Virginia G. Piper Charitable Trust. The authors would like to acknowledge Ryan Eckert, BS, Arizona State University for his contributions to the revisions of this manuscript.
Compliance with ethical standards
The authors report that Ms. Jessica Bushar was an employee of the ZERO TO THREE one of the founding partners of Text4baby (the Healthy Mothers, Healthy Babies operation of Text4baby was transitioned to ZERO TO THREE in 2015), at the time of this work and no other authors report any conflicts of interest.
“All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”
Statement of funding sources
The Virginia G. Piper Charitable Trust provided funding in support of this work.
Statement of findings
These findings have not been reported elsewhere. Additionally, this manuscript is solely submitted to the journal of Translational Behavioral Medicine and is not simultaneously submitted elsewhere.
Statement of data control
The authors of this manuscript have full control of the data and agree to allow the journal of Translational Behavioral Medicine to review their data upon request.
All study participants were required to complete an informed consent prior to participating in the study. Animals were not included in this study.
- 3.Melzer K, Schutz Y, Soehnchen N, et al. Effects of recommended levels of physical activity on pregnancy outcomes. Obstet Gynecol. 2010; 202(266): e1-266. e6.Google Scholar
- 5.Poyatos-León R, García-Hermoso A, Sanabria-Martínez G, Álvarez-Bueno C, Sánchez-López M, Martínez-Vizcaíno V. Effects of exercise during pregnancy on mode of delivery: a meta-analysis. Acta Obstet Gynecol Scand. 2015Google Scholar
- 9.Garber CE, Blissmer B, Deschenes MR, et al. Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise. Medicine & Science in Sports & Exercise. 2011;43Google Scholar
- 11.Huberty J, Buman M, Leiferman J, Rowedder L, Bushar J. Trajectory of physical activity during pregnancy. Prev Med. In review.Google Scholar
- 17.Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol (New York 1953). 2015; 126: e135-142.Google Scholar
- 18.Stengel MR, Kraschnewski JL, Hwang SW, Kjerulff KH, Chuang CH. “What my doctor didn’t tell me”: examining health care provider advice to overweight and obese pregnant women on gestational weight gain and physical activity. Womens Health Issues. 2012; 22: e535-e540.CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Leiferman J, Sinatra E, Huberty J. Pregnant Women’s Perceptions of Patient-Provider Communication for Health Behavior Change during Pregnancy. Open Journal of Obstetrics and Gynecology. 2014;2014.Google Scholar
- 23.Smith A. US Smartphone Use in 2015.Pew Research Center. 2015.Google Scholar
- 24.Fjeldsoe B, Miller YD, Marshall AL. Text messaging interventions for chronic disease management and health promotion. eHealth Applications: Promising Strategies for Health Behavior Change. 2012:167-186.Google Scholar
- 27.U.S. Department of Health and Human Services. Promoting Maternal and Child Health Through Health Text Messaging: An Evaluation of the Text4baby Program - Final Report. 2015.Google Scholar
- 30.Text4baby Enrollment Data. Available at: https://partners.text4baby.org/index.php/partner-resources/105-text4baby-enrollment-data.
- 32.Physical Activity Guidelines Advisory Committee report. 2008: to the secretary of health and human services. Washington, DC: U.S. Dept. of Health and Human Services; 2008.Google Scholar
- 33.Aaron D, Kriska A. Modifiable activity questionnaire for adolescents. Med Sci Sports Exerc. 1997; 29: 79-82.Google Scholar
- 35.National Healthy Mothers, Health Babies Coalition. Available at: http://www.hmhb.org/.
- 37.Huberty J, Rowedder L, Hekler E, et al. Development and design of an intervention to improve physical activity in pregnant women using Text4baby. Translational Behavioral Medicine. 1-10.Google Scholar
- 40.Health On the Net Foundation. The HON Code of Conduct for medical and health Web sites. 2009.Google Scholar
- 43.Ainsworth B, Haskell W, Herrmann S, et al. The Compendium of Physical Activities Tracking Guide; Healthy Lifestyles Research Center, College of Nursing & Health Innovation, Arizona State University. Available at: https://sites.google.com/site/compendiumofphysicalactivities/.
- 44.Help Article: What are active minutes? Fitbit Web site. Available at: http://help.fitbit.com/articles/en_US/Help_article/What-are-very-active-minutes/. 2015.
- 48.Pearce EE, Evenson KR, Downs DS, Steckler A. Strategies to Promote Physical Activity During Pregnancy: A Systematic Review of Intervention Evidence. American journal of lifestyle medicine. 2013;7.Google Scholar
- 52.Adams MA, Sallis JF, Norman GJ, Hovell MF, Hekler EB, Perata E. An adaptive physical activity intervention for overweight adults: a randomized controlled trial. 2013.Google Scholar
- 56.Schwerdtfeger AR, Schmitz C, Warken M. Using text messages to bridge the intention-behavior gap? A pilot study on the use of text message reminders to increase objectively assessed physical activity in daily life. Frontiers in psychology. 2012;3Google Scholar
- 57.Hovell M, Wahlgren D, Adams M. The logical and empirical basis for the behavioral ecological model. Emerging Theor Health Promot Prac Res. 2009; 2: 347-385.Google Scholar