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

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Translational Behavioral Medicine


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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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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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.

Additional information


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).

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