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Master of Public Health

A Mobile Health Intervention to Increase Physical Activity in Pulmonary Arterial Hypertension

AUTHORS

Hemnes AR , Silverman-Loyd L , Huang S , MacKinnon G , Annis J , Whitmore CS , Mallugari R , Oggs RN , Hekmat R , Shan R , Huynh PP , Yu C , Martin SS , Blaha MJ , Brittain EL , . Chest. 2021 4 17; ().

ABSTRACT

BACKGROUND: Supervised exercise training improves outcomes in patients with pulmonary arterial hypertension (PAH). The effect of an unsupervised activity intervention has not been tested.

RESEARCH QUESTION: Can a text-based mobile health intervention increase step counts in patients with PAH?

STUDY DESIGN AND METHODS: We performed a randomized, parallel arm, single-blind clinical trial. We randomized patients to usual care or a text message-based intervention for 12 weeks. The intervention arm received three automated text messages per day with real-time step count updates and encouraging messages rooted in behavioral change theory. Individual step targets increased by 20% every four weeks.

MEASUREMENTS: The primary endpoint was mean Week 12 step counts. Secondary endpoints included the six minute walk test, quality of life, right ventricular function, and body composition.

RESULTS: Among 42 randomized participants, the change in raw steps between baseline and Week 12 was higher in the intervention group (1409 steps (IQR -32, 2220) vs. -149 steps (IQR -1010, 735); p=0.02), which persisted after adjustment for age, sex, baseline step counts, and functional class (model estimated difference 1250 steps, P = 0.03). The intervention arm took a higher average number of steps on all days between days 9 to 84 (P <0.05 all days). There was no difference in Week 12 six minute walk distance. Analysis of secondary endpoints suggested improvements in the emPHasis-10 score (adjusted change -4.2, P =0.046), a reduction in visceral fat volume (adjusted change -170ml, p=0.023), and nearly significant improvement in tricuspid annular plane systolic excursion (Model estimated difference 1.2mm, P = 0.051).

INTERPRETATION: This study demonstrated the feasibility of an automated text message-based intervention to increase physical activity in patients with PAH. Additional studies are warranted to examine the effect of the intervention on clinical outcomes.

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