Text messaging program lowers blood pressure, cholesterol, BMI

Getting motivating and informative text messages led patients with coronary heart disease to make behavior changes like exercising more and smoking less with concrete results, according to a study published in JAMA, the journal of the American Medical Association.

In a randomized clinical trial, more than 700 patients with coronary heart disease were split into two groups: half received four text messages per week for six months plus usual care, while the other half received just usual care. At the end of the six-month study, patients who had received the text messages had reduced their cholesterol, blood pressure and body mass index.

"I have to say, we were pretty surprised that it worked," Clara Chow, MBBS, PhD, lead author of the study and program director of community-based cardiac services at Westmead Hospital in Sydney, Australia, said in an interview with NPR.

Patients received semi-personalized texts, based on their background information, such as smoking status, preferred name and whether they are vegetarian. Sample texts include: "Hi, Elizabeth. Have you gone for your walk today?" and "Have you taken your medications yet today? It's important to take them at the same time each day."

While there is a lot of hype over mobile health interventions these days, Chow says, "Everyone thinks it has a lot of potential, but there's actually very little evidence."

Despite the explosion of health apps, so far there is little evidence about whether the apps are safe or effective, according to Zubin Eapen, MD, a cardiologist and assistant professor of medicine at Duke University School of Medicine. Eapen coauthored an editorial, along with Eric Peterson, MD, MPH, the Fred Cobb Distinguished Professor of Medicine in the division of cardiology at Duke and an associate editor of JAMA, about the study.

"We [as physicians] are always looking for evidence to make sure that we are recommending the right things for our patients, whether it's a drug, a device or a digital product, like an app," says Eapen, who is also medical director of the Duke Heart Failure Same-Day Access Clinic.

Eapen and Peterson noted that the simple, low-cost text messaging was successful which means similar programs can easily access more people.

The study's limitations include an inability to know whether the positive health outcomes would continue after the six months. Yet patients in Chow's study resoundingly said that the text messaging helped them make the necessary changes – more than 90 percent of the participants found the program useful.

"People said things like, 'It wasn't actually what the messages said, it was that someone was there supporting me, thinking about me,'" Chow said.

And although Chow and her colleagues told study participants that they did not need to reply to the text messages, many of them still did. "Heaps of them replied to us," she says. "They would say, 'Thanks for the message. I've been on my walk, my blood pressure is better.'"