Text Messages Can Successfully Increase Step Counts for Patients With PAH

A text message–based intervention successfully increased step counts for patients with pulmonary arterial hypertension (PAH).

Patients with pulmonary arterial hypertension (PAH) often find their exercise is limited, but exercising can also increase functional capacity. Patients with PAH who received a text message–based intervention successfully increased their physical activity, according to a study published online ahead of print in CHEST.

“Supervised exercise training in pulmonary rehabilitation is also efficacious but is not universally reimbursed by insurers and facilities are not widely available, particularly in rural areas,” the authors explained. They added that there is a “need for practical, sustainable, and affordable interventions to improve physical activity in PAH.”

The study was conducted between October 2017 and April 2020. Patients aged 18 years or older were recruited from the Vanderbilt Center for Pulmonary Vascular Disease. During a 2-week run-in period, the daily step counts of participating patients were collected. Patients were randomized after baseline testing on Day 0 to either the intervention arm (n = 20) or usual care (n = 22).

Patients in both arms were encouraged to comply with the study through daily reminders to sync their devices if the device had not been synced in more than 24 hours and contact from the study team if no data had been transmitted for more than 48 hours. Their activity was monitored using the Fitbit Charge HR.

Patients in the intervention arm received 3 texts per day that had real-time progress toward their daily step count target and encouraging messages. After 12 weeks, there was a 3-week washout period where the patients in the intervention group stopped receiving messages but continued to wear the device.

At baseline, wear time was the same between the 2 groups, but during Week 12, the intervention group had a higher wear time (112.2 hours vs 103.8 hours, P = .04). The intervention group met daily step count targets on 41% of protocol days, compared with 24% of protocol days for the control arm. At Week 12, the intervention group had an average number of steps that was 1409 steps greater than it was at baseline, while the control group was 149 less than baseline.

During the 3-week washout period, the average number of daily steps was higher in the intervention group compared with the control group, but not significantly so (5509 steps vs 4011 steps, P = .21).

There was no significant different in raw or adjusted 6-minute walk distance (6MWD) between the groups, and there was a nonsignificant reduction in adjusted resting heart rate during the 6MWD for the intervention group. The emPHasis-10 survey, which was developed to assess health-related quality of life in PAH, showed a significant improvement in quality of life due to the intervention.

There were several limitations of note. First, it is unclear the generalizability of the results to the larger PAH population. The enrolled patients were higher functioning and patients with higher functional capacity or who already engage in regular physical activity may have been more likely to enroll in an exercise study. Second, commercially available devices were used and worn on the wrist, which may have reduced accuracy.

“We demonstrated the feasibility of an automated text-based, unsupervised mobile health intervention to increase step counts in patients with PAH,” the authors concluded. “The intervention was inexpensive, safe, well-tolerated, and met with high enthusiasm by the target population as evident by enrollment of over half of those approached.”


Hemnes AR, Silverman-Loyd L, Huang S, et al. A mobile health intervention to increase physical activity in pulmonary arterial hypertension Chest. Published online April 17, 2021. doi:10.1016/j.chest.2021.04.012

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