改变生活方式对心血管疾病预防非常重要，但却未被充分利用。移动健康管理策略可能有助于这种方法的应用，但尚缺乏获益的证据。因此，澳大利亚学者们开展了一项随机临床试验，旨在探讨聚焦于生活方式的手机短信发送是否能改善冠状动脉性心脏病(简称冠心病)患者的危险因素。

该平行组、单中心随机临床试验(烟草、运动和饮食信息试验，简称“TEXT ME”试验)共入组了澳大利亚悉尼一大型三级医院710例确诊为冠心病的患者(有心肌梗死病史或冠脉造影证实)，平均年龄58岁，男性82%，当前吸烟者53%。干预组患者(352例)在常规护理基础上接受为期6个月的短信发送提醒(4条/周)，内容包括咨询信息、激发性的提醒和改变生活方式的行为支持。对照组患者(358例)接受常规护理。根据基线特征从信息库里筛选每位受试者的信息，并通过自动计算机信息管理系统发送。该程序无相互作用。

主要终点为6个月时受试者的低密度脂蛋白胆固醇(LDL-C)水平;次要终点为收缩压、体质指数(BMI)、体力活动和吸烟状态。

结果显示，6个月时，干预组的LDL-C水平显著较低，同时伴有收缩压和BMI的降低，体力活动显著增加以及吸烟的显著减少。大多数记录显示短信发送是有用的(91%)，易于理解(97%)并且发送频率合适(86%)。

该研究表明，与常规护理相比，应用聚焦于生活方式的手机短信发送服务可适度改善冠心病患者的LDL-C水平，并可较大程度改善其他心血管疾病危险因素。这些影响的持续时间和因此是否导致临床转归改善尚需进一步探讨。相关文章近期发表于《美国医学会杂志》(简称JAMA)。

参考文献：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.