• Seth S Martin, David I Feldman, Roger S Blumenthal, Steven R Jones, Wendy S Post, Rebeccah A McKibben, Erin D Michos, Chiadi E Ndumele, Elizabeth V Ratchford, Josef Coresh, and Michael J Blaha.
• Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M., D.I.F., R.S.B., S.R.J., W.S.P., R.A.M.K., E.D.M., C.E.N., E.V.R., M.J.B.) Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (S.S.M., W.S.P., R.A.M.K., E.D.M., C.E.N., J.C.).
• J Am Heart Assoc. 2015 Nov 9; 4 (11).

BackgroundWe hypothesized that a fully automated mobile health (mHealth) intervention with tracking and texting components would increase physical activity.Methods And ResultsmActive enrolled smartphone users aged 18 to 69 years at an ambulatory cardiology center in Baltimore, Maryland. We used sequential randomization to evaluate the intervention's 2 core components. After establishing baseline activity during a blinded run-in (week 1), in phase I (weeks 2 to 3), we randomized 2:1 to unblinded versus blinded tracking. Unblinding allowed continuous access to activity data through a smartphone interface. In phase II (weeks 4 to 5), we randomized unblinded participants 1:1 to smart texts versus no texts. Smart texts provided smartphone-delivered coaching 3 times/day aimed at individual encouragement and fostering feedback loops by a fully automated, physician-written, theory-based algorithm using real-time activity data and 16 personal factors with a 10 000 steps/day goal. Forty-eight outpatients (46% women, 21% nonwhite) enrolled with a mean±SD age of 58±8 years, body mass index of 31±6 kg/m(2), and baseline activity of 9670±4350 steps/day. Daily activity data capture was 97.4%. The phase I change in activity was nonsignificantly higher in unblinded participants versus blinded controls by 1024 daily steps (95% confidence interval [CI], -580 to 2628; P=0.21). In phase II, participants receiving texts increased their daily steps over those not receiving texts by 2534 (95% CI, 1318 to 3750; P<0.001) and over blinded controls by 3376 (95% CI, 1951 to 4801; P<0.001).ConclusionsAn automated tracking-texting intervention increased physical activity with, but not without, the texting component. These results support new mHealth tracking technologies as facilitators in need of behavior change drivers.Clinical Trial RegistrationURL: http://ClinicalTrials.gov/. Unique identifier: NCT01917812.© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

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