The HEART Mobile Phone Trial: The Partial Mediating Effects of Self-Efficacy on Physical Activity among Cardiac Patients

Background: The ubiquitous use of mobile phones provides an ideal opportunity to deliver interventions to increase physical activity levels. Understanding potential mediators of such interventions is needed to increase their effectiveness. A recent randomized controlled trial of a mobile phone and Internet (mHealth) intervention was conducted in New Zealand to determine the effectiveness on exercise capacity and physical activity levels in addition to current cardiac rehabilitation (CR) services for people (n = 171) with ischemic heart disease. Significant intervention effect was observed for self-reported leisure-time physical activity and walking, but not peak oxygen uptake at 24 weeks. There was also significant improvement in self-efficacy. Objective: To evaluate the mediating effect of self-efficacy on physical activity levels in an mHealth delivered exercise CR program. Methods: Treatment evaluations were performed on the principle of intention to treat. Adjusted regression analyses were conducted to evaluate the main treatment effect on leisure-time physical activity and walking at 24 weeks, with and without change in self-efficacy as the mediator of interest. Results: Change in self-efficacy at 24 weeks significantly mediated the treatment effect on leisure-time physical activity by 13%, but only partially mediated the effect on walking by 4% at 24 weeks. Conclusion: An mHealth intervention involving text messaging and Internet support had a positive treatment effect on leisure-time physical activity and walking at 24 weeks, and this effect was likely mediated through changes in self-efficacy. Future trials should examine other potential mediators related to this type of intervention.