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Doctors’ texts can spur patients to exercise

Emoji/Globe Staff Illustration

Texting isn’t just a way to flirt, make plans, or check in with friends. Evidence has shown that text messages can also work in a more practical way, to help patients remember to take medications, stop smoking, and request help at the first sign of medical problems.

The latest study of a texting intervention finds that patients at risk of heart disease who received encouraging notes from a doctor significantly increased their physical activity levels. The finding, published in the Journal of the American Heart Association, suggests even a simple, automated messaging service could nudge patients toward healthier choices.


“There’s a really big opportunity here to use new technologies to further strengthen the clinician-patient relationship and help people lead healthier lives,” says study coauthor Dr. Seth Martin, a cardiologist at Johns Hopkins Hospital in Baltimore.

But few doctors or clinics are making use of this technology. Five days before the publication of the Hopkins study, a Nielsen survey of 5,014 US residents and 626 US physicians found that only 2 percent of medical providers use mobile communication as part of health care interventions. Fewer than 11 percent of patients receive any type of online or text communication from their doctors, even appointment reminders.

“Most patients weren’t even aware of what’s possible, and most doctors didn’t feel any necessity to provide it to their patients,” says Robert Pearl, CEO of the Permanente Medical Group and chair of the Council of Accountable Physician Practices (CAPP), a national consortium of medical groups and health systems that promotes the use of technology in health care and commissioned the Nielsen survey.

While 39 percent of physicians in the Nielsen survey said they believed telecommunication was good for patients, 21 percent said its use was not good for their personal income. That’s the rub, says Pearl: Most insurance companies are fee-for-service and therefore do not reimburse doctors for digital communication or implementing new technologies. If, instead, physicians were prepaid or paid based on positive outcomes — “pay-for-value,” as CAPP advocates — more physicians would integrate technology into their practices, he believes.


Recognizing physicians’ lack of time and reimbursement for this service, Martin and colleagues at Johns Hopkins designed a system to automatically send personalized texts to patients, who had been outfitted with fitness trackers, to encourage them to be physically active. The “smart texts” incorporate the patient’s name and personal details to provide praise or encouragement based on their current level of activity. One text, for example, read, “Jon, you are on track to have a VERY ACTIVE day! Outstanding! We might as well call you LeBron James!”

Of 48 men and women in the study, all of whom had risk factors for heart disease, 81 percent of those receiving text messages reached their 10,000-steps-a-day goal, compared with 44 percent of two control groups. Overall, those who received texts walked an average of 2,534 more steps per day than those who did not.

The trial was only a two-week intervention, so Martin’s team is now looking to generate a longer-term program that is easy for physicians to implement, both for preventive heart care and in other areas of health, such as treating depression. “This is applicable well beyond the walls of a cardiology clinic,” says Martin. “Stay tuned.”