Abstract
Background: The risk of recurrent cardiac events can be reduced by 30-50% through regular, structured exercise; however, there remains a high rate of inactivity in post myocardial infarction (MI) patients. Forgetting to exercise may be a contributor to inactivity. This study assessed the hypothesis that text message reminders may be an effective strategy to reduce forgetfulness and inactivity. Methods: In this one year, single center study, we recruited 50 cardiac rehabilitation patients within 2 weeks of their MI. Participants were randomized to usual care or to receive text message reminders 4 times daily which stated "Please remember to exercise 45 minutes today". The outcomes measured were the frequency and total duration of exercise (assessed by log books) and physical endurance/ aerobic fitness (assessed by exercise stress testing at months 1, 3 and 12). Results: Intervention and control patients had similar baseline characteristics with an average age of 64. In the control group, monthly duration of exercise fell from an average of 683 minutes over 17 days at month 1 to 416 minutes over 11 days at month 12. Patients randomized to text message reminders exercised 772 minutes over 18 days at month 1 and 794 minutes over 18 days in month 12 (p<0.01 for duration of exercise, control versus intervention, month 12). Baseline aerobic fitness and cardiac endurance was similar between control and intervention groups. However, there was a significant improvement in aerobic fitness and cardiac endurance at month 12 with text reminders (7.4 versus 6.1 METS achieved month 12, p<0.01). In all sub-groups analyzed this intervention significantly improved exercise adherence and fitness. Conclusions: In summary, this system improved frequency and duration of exercise, and objective measures of cardiac endurance and aerobic fitness. While this study was not designed to assess clinical outcomes, this text message reminder system represents a simple and scalable method for improving adherence to exercise regimens among post-MI patients.
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