Text to Move: A Randomized Controlled Trial of a Text-Messaging Program to Improve Physical Activity Behaviors in Patients With Type 2 Diabetes Mellitus
Open accessAbstract
Background: Text messages are increasingly being used because of the low cost and the ubiquitous nature of mobile phones to engage patients in self-care behaviors. Self-care is particularly important in achieving treatment outcomes in type 2 diabetes mellitus (T2DM). Objective: This study examined the effect of personalized text messages on physical activity, as measured by a pedometer, and clinical outcomes in a diverse population of patients with T2DM. Methods: Text to Move (TTM) incorporates physical activity monitoring and coaching to provide automated and personalized text messages to help patients with T2DM achieve their physical activity goals. A total of 126 English- or Spanish-speaking patients with glycated hemoglobin A1c (HbA1c) >7 were enrolled in-person to participate in the study for 6 months and were randomized into either the intervention arm that received the full complement of the intervention or a control arm that received only pedometers. The primary outcome was change in physical activity. We also assessed the effect of the intervention on HbA1c, weight, and participant engagement. Results: All participants (intervention: n=64; control: n=62) were included in the analyses. The intervention group had significantly higher monthly step counts in the third (risk ratio [RR] 4.89, 95% CI 1.20 to 19.92, P=.03) and fourth (RR 6.88, 95% CI 1.21 to 39.00, P=.03) months of the study compared to the control group. However, over the 6-month follow-up period, monthly step counts did not differ statistically by group (intervention group: 9092 steps; control group: 3722 steps; RR 2.44, 95% CI 0.68 to 8.74, P=.17). HbA1c decreased by 0.07% (95% CI –0.47 to 0.34, P=.75) in the TTM group compared to the control group. Within groups, HbA1c decreased significantly from baseline in the TTM group by –0.43% (95% CI –0.75 to –0.12, P=.01), but nonsignificantly in the control group by –0.21% (95% CI –0.49 to 0.06, P=.13). Similar changes were observed for other secondary outcomes. Conclusion: Personalized text messaging can be used to improve outcomes in patients with T2DM by employing optimal patient engagement measures.
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Pedometers provide an objective measure of ambulatory physical activity.
“Overall, pedometers provide an objective measure of ambulatory physical activity.”
Agboola et al.'s text-message intervention led to increased walking in the intermediate follow-up period.
“In the study by Agboola et al., the text-message intervention led to increased walking in the intermediate follow-up period, highlighting the importance of sustained engagement strategies [20].”
Several studies reported withdrawals due to technical issues, including software malfunctions, connectivity problems, or failures in data transmission.
“Several studies reported withdrawals due to technical issues, including software malfunctions, connectivity problems, or failures in data transmission [20,32].”
The effectiveness of wearable devices appears to depend largely on how they are integrated into the overall intervention, particularly in relation to the level of structure, the consistency and nature of behavioural support, and the presence of clearly defined, measurable objectives.
“Their effectiveness appears to depend largely on how they are integrated into the overall intervention, particularly in relation to the level of structure, the consistency and nature of behavioural support, and the presence of clearly defined, measurable objectives [17,20,21,22,23,26,28].”
Wearables are most effective when combined with regular prompts, personalized feedback, and adaptive communication strategies.
“The review shows that wearables are most effective when combined with regular prompts, personalized feedback, and adaptive communication strategies: features that help maintain motivation and reinforce habits [8,20,21,32,38].”
In the absence of such structure, the device's ability to support sustained clinical improvement may be significantly reduced.
“In the absence of such structure, the device’s ability to support sustained clinical improvement may be significantly reduced [8,12,20,31,32,35].”
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- Authors
- Agboola, S., Jethwani, K., Lopez, L., Searl, M., O’Keefe, S., & Kvedar, J.
- Affiliations
- Brigham and Women's Hospital (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Agboola, Stephen
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2016-11-18
- Volume
- 18
- Issue
- 11
- Pages
- e307
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC5135731
- OpenAlex
- W2550584327
- Cited by
- 82
- References
- 27
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 10 · 2023: 11 · 2022: 6 · 2021: 7 · 2020: 7 · 2019: 10 · 2018: 15 · 2017: 6
- FWCI
- 19.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK098280)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 2 diabetes, text messaging, mobile health, physical activity, pedometers, HbA1c, self-care, step count, weight, patient engagement, Spanish-speaking patients, diabetes self-management education, glycemic control, weight loss, rural patients, health disparities
- MeSH terms
- Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Exercise, Treatment Outcome, Cell Phone, Text Messaging
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