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Dose and timing of text messages for increasing physical activity among pregnant women: a randomized controlled trial

Abstract

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.

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References

  1. Ferraro ZM, Gaudet L, Adamo KB. The potential impact of physical activity during pregnancy on maternal and neonatal outcomes. Obstet Gynecol Surv. 2012; 67: 99-110.

    Article  PubMed  Google Scholar 

  2. Hegaard HK, Pedersen BK, Bruun Nielsen B, Damm P. Leisure time physical activity during pregnancy and impact on gestational diabetes mellitus, preeclampsia, preterm delivery and birth weight: a review. Acta Obstet Gynecol Scand. 2007; 86: 1290-1296.

    Article  PubMed  Google Scholar 

  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 

  4. Nascimento SL, Surita FG, Cecatti JG. Physical exercise during pregnancy: a systematic review. Curr Opin Obstet Gynecol. 2012; 24: 387-394.

    Article  PubMed  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. 2015

  6. Mudd LM, Owe KM, Mottola MF, Pivarnik JM. Health benefits of physical activity during pregnancy: an international perspective. Med Sci Sports Exerc. 2013; 45: 268-277.

    Article  PubMed  Google Scholar 

  7. Artal R, O’Toole M. Guidelines of the American college of obstetricians and gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med. 2003; 37: 6-12. discussion 12.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. ACOG Committee on Obstetric Practice. Committee opinion# 267: exercise during pregnancy and the postpartum period. Obstet Gynecol. 2002; 99: 171-173.

    Article  Google 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;43

  10. Gaston A, Cramp A. Exercise during pregnancy: a review of patterns and determinants. J Sci Med Sport. 2011; 14: 299-305.

    Article  PubMed  Google Scholar 

  11. Huberty J, Buman M, Leiferman J, Rowedder L, Bushar J. Trajectory of physical activity during pregnancy. Prev Med. In review.

  12. Nascimento SL, Surita FG, Godoy AC, Kasawara KT, Morais SS. Physical activity patterns and factors related to exercise during pregnancy: a cross sectional study. PLoS One. 2015; 10, e0128953.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Campbell F, Johnson M, Messina J, Guillaume L, Goyder E. Behavioural interventions for weight management in pregnancy: a systematic review of quantitative and qualitative data. BMC Public Health. 2011; 11: 491.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chang M, Nitzke S, Guilford E, Adair CH, Hazard DL. Motivators and barriers to healthful eating and physical activity among low-income overweight and obese mothers. J Am Diet Assoc. 2008; 108: 1023-1028.

    Article  PubMed  Google Scholar 

  15. Huberty J, Dinkel D, Beets MW, Coleman J. Describing the use of the internet for health, physical activity, and nutrition information in pregnant women. Matern Child Health J. 2013; 17: 1363-1372.

    Article  PubMed  Google Scholar 

  16. Szwajcer EM, Hiddink GJ, Maas L, Koelen MA, van Woerkum CM. Nutrition-related information-seeking behaviours of women trying to conceive and pregnant women: evidence for the life course perspective. Fam Pract. 2008; 25(Suppl 1): i99-104.

    Article  PubMed  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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Furness PJ, McSeveny K, Arden MA, Garland C, Dearden AM, Soltani H. Maternal obesity support services: a qualitative study of the perspectives of women and midwives. BMC Pregnancy Childbirth. 2011; 11: 69.

    Article  PubMed  PubMed Central  Google 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.

  21. Kieffer EC, Willis SK, Arellano N, Guzman R. Perspectives of pregnant and postpartum latino women on diabetes, physical activity, and health. Health Educ Behav. 2002; 29: 542-556.

    Article  PubMed  Google Scholar 

  22. Yan AF, Stevens P, Wang Y, et al. mHealth text messaging for physical activity promotion in college students: a formative participatory approach. Am J Health Behav. 2015; 39: 395-408.

    Article  PubMed  Google Scholar 

  23. Smith A. US Smartphone Use in 2015.Pew Research Center. 2015.

  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.

  25. Demiris G, Afrin LB, Speedie S, et al. Patient-centered applications: use of information technology to promote disease management and wellness. A white paper by the AMIA knowledge in motion working group. J Am Med Inform Assoc. 2008; 15: 8-13.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Buchholz SW, Wilbur J, Ingram D, Fogg L. Physical activity text messaging interventions in adults: a systematic review. Worldviews Evid-Based Nurs. 2013; 10: 163-173.

    Article  PubMed  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.

  28. Evans WD, Wallace Bihm J, Szekely D, et al. Initial outcomes from a 4-week follow-up study of the Text4baby program in the military women’s population: randomized controlled trial. J Med Internet Res. 2014; 16, e131.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Jordan ET, Bushar JA, Kendrick JS, Johnson P, Wang J. Encouraging influenza vaccination among Text4baby pregnant women and mothers. Am J Prev Med. 2015; 49: 563-572.

    Article  PubMed  Google Scholar 

  30. Text4baby Enrollment Data. Available at: https://partners.text4baby.org/index.php/partner-resources/105-text4baby-enrollment-data.

  31. Bell R, Tennant PWG, McParlin C, et al. Measuring physical activity in pregnancy: a comparison of accelerometry and self-completion questionnaires in overweight and obese women. Eur J Obstet Gynecol Reprod Biol. 2013; 170: 90-95.

    Article  PubMed  Google Scholar 

  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 

  34. Evans W, Nielsen PE, Szekely DR, et al. Dose-response effects of the text4baby mobile health program: randomized controlled trial. JMIR Mhealth Uhealth. 2015; 3, e12.

    Article  PubMed  PubMed Central  Google Scholar 

  35. National Healthy Mothers, Health Babies Coalition. Available at: http://www.hmhb.org/.

  36. Whittaker R, Matoff-Stepp S, Meehan J, et al. Text4baby: development and implementation of a national text messaging health information service. Am J Public Health. 2012; 102: 2207-2213.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

  38. Bandura A. Social cognitive theory of self-regulation. Organ Behav Hum Decis Process. 1991; 50: 248-287.

    Article  Google Scholar 

  39. Rovniak LS, Anderson ES, Winett RA, Stephens RS. Social cognitive determinants of physical activity in young adults: a prospective structural equation analysis. Ann Behav Med. 2002; 24: 149-156.

    Article  PubMed  Google Scholar 

  40. Health On the Net Foundation. The HON Code of Conduct for medical and health Web sites. 2009.

  41. Patel MS, Burwick HA, Case MA, Volpp KG. Accuracy of Smartphone applications and wearable devices for tracking physical activity data. JAMA. 2015; 313: 625-626.

    Article  PubMed  Google Scholar 

  42. Takacs J, Pollock CL, Guenther JR, Bahar M, Napier C, Hunt MA. Validation of the fitbit One activity monitor device during treadmill walking. J Sci Med Sport. 2014; 17: 496-500.

    Article  PubMed  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.

  45. Network SBR. Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab. 2012; 37: 540-542.

    Article  Google Scholar 

  46. Raudenbush SW, Xiao-Feng L. Effects of study duration, frequency of observation, and sample size on power in studies of group differences in polynomial change. Psychol Methods. 2001; 6: 387.

    CAS  Article  PubMed  Google Scholar 

  47. Pearce EE, Evenson KR, Downs DS, Steckler A. Strategies to promote physical activity during pregnancy. Am J Lifestyle Med. 2013; 7: 38-50.

    Article  Google Scholar 

  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.

  49. Evenson KR, Savitz A, Huston SL. Leisure‐time physical activity among pregnant women in the US. Paediatr Perinat Epidemiol. 2004; 18: 400-407.

    Article  PubMed  Google Scholar 

  50. Leiferman J, Swibas T, Koiness K, Marshall JA, Dunn AL. My baby, my move: examination of perceived barriers and motivating factors related to antenatal physical activity. J Midwifery Womens Health. 2011; 56: 33-40.

    Article  PubMed  Google Scholar 

  51. Evenson KR, Moos M, Carrier K, Siega-Riz AM. Perceived barriers to physical activity among pregnant women. Matern Child Health J. 2009; 13: 364-375.

    Article  PubMed  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.

  53. Silva P, Alves O, Abreu S, et al. Impact of compliance with different guidelines on physical activity during pregnancy and perceived barriers to leisure physical activity. J Sports Sci. 2014; 32: 1398-1408.

    Article  PubMed  Google Scholar 

  54. Poorman E, Gazmararian J, Parker RM, Yang B, Elon L. Use of text messaging for maternal and infant health: a systematic review of the literature. Matern Child Health J. 2015; 19: 969-989.

    Article  PubMed  Google Scholar 

  55. Evans WD, Wallace JL, Snider J. Pilot evaluation of the text4baby mobile health program. BMC Public Health. 2012; 12: 1031.

    Article  PubMed  PubMed Central  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;3

  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 

  58. Eyler AA. Personal, social, and environmental correlates of physical activity in rural Midwestern white women. Am J Prev Med. 2003; 25: 86-92.

    Article  PubMed  Google Scholar 

  59. Eyler AA, Matson-Koffman D, Young DR, et al. Quantitative study of correlates of physical activity in women from diverse racial/ethnic groups: the Women’s cardiovascular health network project summary and conclusions. Am J Prev Med. 2003; 25: 93-103.

    Article  PubMed  Google Scholar 

  60. Joseph RP, Keller C, Adams MA, Ainsworth BE. Print versus a culturally-relevant facebook and text message delivered intervention to promote physical activity in African American women: a randomized pilot trial. BMC Womens Health. 2015; 15: 30.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

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.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Jennifer L. Huberty PhD.

Ethics declarations

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.

Ethical approval

“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.

Informed consent

All study participants were required to complete an informed consent prior to participating in the study. Animals were not included in this study.

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Implications

Practice: Enhanced PA SMS alone may not improve PA behavior in pregnant women. Pregnant women should consider using self-monitoring tools (e.g., fitbits and pedometers) for PA feedback while receiving SMS.

Policy: mHealth initiatives using SMS to improve PA in pregnant women may need to incorporate more motivational strategies (i.e., goal-setting) within SMS to encourage actual improvements in PA.

Research: Future studies should explore a modified focus on behavior change (e.g., decrease sedentary activity, increase light activity) or incorporate SMS-based education as part of a multi-level approach with other evidence-based strategies to improve PA in pregnant women.

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Huberty, J.L., Buman, M.P., Leiferman, J.A. et al. Dose and timing of text messages for increasing physical activity among pregnant women: a randomized controlled trial. Behav. Med. Pract. Policy Res. 7, 212–223 (2017). https://doi.org/10.1007/s13142-016-0445-1

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  • DOI: https://doi.org/10.1007/s13142-016-0445-1

Keywords

  • Mobile health
  • Physical activity
  • Pregnancy
  • Women