S. Rhodes1, D. Waters2, B. Brockway2, M. Skinner1
1University of Otago, School of Physiotherapy, Dunedin, New Zealand, 2University of Otago, Department of Medicine, Dunedin, New Zealand
Background: Obstructive sleep apnoea (OSA) is associated with an increase in cardiovascular disease-related morbidity and mortality. Physical inactivity is a risk factor for moderate-severe OSA and increasing physical activity reduces symptoms and severity of OSA. However, motivation to be active is difficult for an individual where fatigue and excessive daytime sleepiness are common OSA symptoms.
Purpose: Investigation of the feasibility of personalised text messaging interventions to enhance motivation and support physical activity behaviour change in adults with OSA.
Methods: 30 adults (aged 22 to 74), at high risk of OSA and scheduled for an overnight sleep study, were recruited from the local Sleep Clinic. Exclusion criteria was unstable angina and/or poorly controlled hypertension. The primary outcome was a change in six-minute walk distance (6MWD) over the 24 week study period.
A quasi-experimental study design randomized participants into three groups:
(1) group-based exercise;
(2) group-based exercise with personalised text messaging; or
(3) personalised text messaging with individualised exercise prescription (unsupervised).
Text messages were sent five times a week for weeks 1-12, with a reduced number over weeks 13-24. Text messages were constructed around initial interviews and incorporated behavioural change techniques. Physical activity was measured using 6MWD and accelerometery at baseline, 12 and 24 weeks. Secondary outcomes included: the SF-36, Self-Efficacy for Exercise scale and the Physical Activity Stages of Change questionnaire. At study completion, all participants were given the opportunity to participate in a telephone exit interview.
A quasi-experimental study design randomized participants into three groups:
(1) group-based exercise;
(2) group-based exercise with personalised text messaging; or
(3) personalised text messaging with individualised exercise prescription (unsupervised).
Text messages were sent five times a week for weeks 1-12, with a reduced number over weeks 13-24. Text messages were constructed around initial interviews and incorporated behavioural change techniques. Physical activity was measured using 6MWD and accelerometery at baseline, 12 and 24 weeks. Secondary outcomes included: the SF-36, Self-Efficacy for Exercise scale and the Physical Activity Stages of Change questionnaire. At study completion, all participants were given the opportunity to participate in a telephone exit interview.
Results: In the two groups receiving text messages mean 6MWD increased by 30.4m (95%CI -1.9-62.7) and 33.7m (95% CI -1.4-68.7) respectively over a 24 week period.
Secondary outcomes demonstrated positive trends in SF-36 and Self- Efficacy for Exercise scores over the same period. These findings were further supported by results of thematic analysis of the 17 exit interviews. The key theme to emerge was participants’ motivation to increase fitness levels. Motivations included future health: “I’m at an age where I really do need to get my act together.” and better quality of life: “I don’t want to be a spectator; I want to be a participator.”
Secondary outcomes demonstrated positive trends in SF-36 and Self- Efficacy for Exercise scores over the same period. These findings were further supported by results of thematic analysis of the 17 exit interviews. The key theme to emerge was participants’ motivation to increase fitness levels. Motivations included future health: “I’m at an age where I really do need to get my act together.” and better quality of life: “I don’t want to be a spectator; I want to be a participator.”
Conclusion(s): Personalised text messaging was feasible and effective in motivating adults with OSA to increase their physical activity behaviour. The emerging trends identified, including an increase in exercise self-efficacy and readiness to exercise, support interventions such as personalised text messaging, to increase motivation in adults with OSA to become more physically active. Feedback from participants suggests the intervention was beneficial and valued in terms of enhancing motivation and improving health and quality of life. A larger scale statistically powered trial is warranted.
Implications: Findings from a larger scale trial may provide justification for funding for physiotherapy input at the Sleep Clinic to support patients diagnosed with OSA to address lifestyle factors, including physical inactivity.
Funding, acknowledgements: This work was undertaken as part of a PhD and was funded by a University of Otago PhD scholarship.
Keywords: Physical activity, Behaviour change, Telehealth
Topic: Health promotion & wellbeing/healthy ageing/physical activity
Did this work require ethics approval? Yes
Institution: NZ Ministry of Health
Committee: NZ Health and Disability Ethics Committee (HDEC)
Ethics number: 17/STH/105
All authors, affiliations and abstracts have been published as submitted.
