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Evaluating Causal and Noncausal Text Messages to Promote Physical Activity in Adults: Randomized Pilot Study.

Elena Korshakova1, Samantha Kleinberg1

  • 1Stevens Institute of Technology, Hoboken, NJ, United States.

JMIR Formative Research
|November 24, 2025
PubMed
Summary

Explaining the health benefits of physical activity (PA) in text messages significantly increased activity levels in US adults. Causal messages promoting PA were more effective than noncausal messages, highlighting their value in intervention design.

Keywords:
causal informationhealth communicationmHealthphysical activitytext messaging

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Area of Science:

  • Behavioral Science
  • Public Health
  • Digital Health

Background:

  • Physical inactivity is a major risk factor for chronic diseases and mortality.
  • Adherence to physical activity guidelines is suboptimal.
  • SMS text messages show potential for promoting physical activity, but message effectiveness varies.

Purpose of the Study:

  • To compare the effectiveness of causal versus noncausal SMS text messages in promoting physical activity among US adults.

Main Methods:

  • A pilot study randomized 28 US adults (18-64 years) to receive causal or noncausal SMS messages for 2 weeks.
  • Physical activity was measured using wristbands (Empatica) and the International Physical Activity Questionnaire - Short Form (IPAQ-SF).
  • Primary outcome was change in mean metabolic equivalent of tasks (METs) per minute; secondary outcomes included PA differences on message vs. non-message days, self-reported PA, and participant satisfaction.

Main Results:

  • The causal message group showed a significantly greater increase in mean METs per minute compared to the noncausal group (P=.01; Cohen d=0.54).
  • In the causal group, physical activity was higher on message days (2.46 METs/min) versus non-message days (2.25 METs/min; P=.02).
  • No significant differences were found between groups for self-reported PA or satisfaction.

Conclusions:

  • SMS text messages incorporating causal information linking physical activity to health outcomes enhance message effectiveness.
  • These findings support the use of causal information in designing just-in-time physical activity interventions.
  • Further research is needed to personalize message content and timing for sustained engagement.