改變生活方式對心血管疾病預防非常重要，但卻未被充分利用。移動健康管理策略可能有助於這種方法的應用，但尚缺乏獲益的證據。因此，澳大利亞學者們開展了一項隨機臨床試驗，旨在探討聚焦於生活方式的手機短信發送是否能改善冠狀動脈性心髒病(簡稱冠心病)患者的危險因素。

該平行組、單中心隨機臨床試驗(煙草、運動和飲食信息試驗，簡稱“TEXT ME”試驗)共入組了澳大利亞悉尼一大型三級醫院710例確診為冠心病的患者(有心肌梗死病史或冠脈造影證實)，平均年齡58歲，男性82%，當前吸煙者53%。幹預組患者(352例)在常規護理基礎上接受為期6個月的短信發送提醒(4條/周)，內容包括谘詢信息、激發性的提醒和改變生活方式的行為支持。對照組患者(358例)接受常規護理。根據基線特征從信息庫裏篩選每位受試者的信息，並通過自動計算機信息管理係統發送。該程序無相互作用。

主要終點為6個月時受試者的低密度脂蛋白膽固醇(LDL-C)水平;次要終點為收縮壓、體質指數(BMI)、體力活動和吸煙狀態。

結果顯示，6個月時，幹預組的LDL-C水平顯著較低，同時伴有收縮壓和BMI的降低，體力活動顯著增加以及吸煙的顯著減少。大多數記錄顯示短信發送是有用的(91%)，易於理解(97%)並且發送頻率合適(86%)。

該研究表明，與常規護理相比，應用聚焦於生活方式的手機短信發送服務可適度改善冠心病患者的LDL-C水平，並可較大程度改善其他心血管疾病危險因素。這些影響的持續時間和因此是否導致臨床轉歸改善尚需進一步探討。相關文章近期發表於《美國醫學會雜誌》(簡稱JAMA)。

參考文獻：Clara K. Chow, MBBS,et al. JAMA. 2015;314(12):1255-1263. doi:10.1001/jama.2015.10945

Original Investigation | September 22/29, 2015
Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart DiseaseA Randomized Clinical Trial
Clara K. Chow, MBBS, PhD1,2; Julie Redfern, PhD1; Graham S. Hillis, MBChB, PhD3,4,5; Jay Thakkar, MBBS2,3; Karla Santo, MBBS3; Maree L. Hackett, PhD3; Stephen Jan, PhD3; Nicholas Graves, PhD6; Laura de Keizer, BSc (Nutr)3; Tony Barry, BSc2; Severine Bompoint, BSc (Stats)3; Sandrine Stepien, MBiostat3; Robyn Whittaker, MPH7; Anthony Rodgers, MBChB, PhD3; Aravinda Thiagalingam, MBChB, PhD2,8
[+] Author Affiliations
JAMA. 2015;314(12):1255-1263. doi:10.1001/jama.2015.10945.

ABSTRACT
ABSTRACT | INTRODUCTION | METHODS | RESULTS | DISCUSSION | CONCLUSIONS |ARTICLE INFORMATION | REFERENCES
Importance Cardiovascular disease prevention, including lifestyle modification, is important but underutilized. Mobile health strategies could address this gap but lack evidence of therapeutic benefit.
Objective To examine the effect of a lifestyle-focused semipersonalized support program delivered by mobile phone text message on cardiovascular risk factors.
Design and Setting The Tobacco, Exercise and Diet Messages (TEXT ME) trial was a parallel-group, single-blind, randomized clinical trial that recruited 710 patients (mean age, 58 [SD, 9.2] years; 82% men; 53% current smokers) with proven coronary heart disease (prior myocardial infarction or proven angiographically) between September 2011 and November 2013 from a large tertiary hospital in Sydney, Australia.
Interventions Patients in the intervention group (n = 352) received 4 text messages per week for 6 months in addition to usual care. Text messages provided advice, motivational reminders, and support to change lifestyle behaviors. Patients in the control group (n=358) received usual care. Messages for each participant were selected from a bank of messages according to baseline characteristics (eg, smoking) and delivered via an automated computerized message management system. The program was not interactive.
Main Outcomes and Measures The primary end point was low-density lipoprotein cholesterol (LDL-C) level at 6 months. Secondary end points included systolic blood pressure, body mass index (BMI), physical activity, and smoking status.
Results At 6 months, levels of LDL-C were significantly lower in intervention participants (mean difference, −5 mg/dL [95% CI, −9 to 0]; P = .04). There were concurrent reductions in systolic blood pressure (−7.6 mm Hg [95% CI, −9.8 to −5.4]; P < .001) and BMI (−1.3 [95% CI, −1.6 to −0.9]; P < .001), significant increases in physical activity (+293 metabolic equivalent task min/wk [95% CI, 102 to 485]; P = .003), and a significant reduction in smoking (26% vs 44%; relative risk, 0.61 [95% CI, 0.48 to 0.76]; P < .001). The majority reported the text-message program to be useful (91%), easy to understand (97%), and appropriate in frequency (86%).
Conclusions and Relevance Among patients with coronary heart disease, the use of a lifestyle-focused text messaging service compared with usual care resulted in a modest improvement in LDL-C level and greater improvement in other cardiovascular disease risk factors. The duration of these effects and hence whether they result in improved clinical outcomes remain to be determined.