The Impact of Text Messaging on Medication Adherence and Exercise Among Postmyocardial Infarction Patients: Randomized Controlled Pilot Trial

Background Adherence to evidence-based therapies such as medications and exercise remains poor among patients after a myocardial infarction (MI). Text message reminders have been shown to improve rates of adherence to medication and exercise, but the existing studies have been of short duration. Objective Two single-center randomized controlled pilot trials were conducted to evaluate the impact of text message reminders over 12 months on adherence to cardiac medications and exercise among patients receiving cardiac rehabilitation after hospitalization for MI. Methods In the medication adherence trial, 34 patients were randomized to receive usual care alone or usual care plus daily text message reminders delivered at the time of day at which medications were to be taken. In the exercise adherence trial, 50 patients were randomized to receive usual care alone or usual care plus 4 daily text messages reminding them to exercise as directed. Results The text message reminders led to a mean 14.2 percentage point improvement in self-reported medication adherence over usual care (P<.001, 95% CI 7-21). In the exercise trial, text message reminders resulted in an additional 4.2 days (P=.001, 95% CI 1.9-6.4) and 4.0 hours (P<.001, 95% CI 2.4-5.6) of exercise per month over usual care and a nonsignificant increase of 1.2 metabolic equivalents (METS; P=.06) in exercise capacity as assessed by a BRUCE protocol at 12 months. Conclusions Text message reminders significantly increased adherence to medication and exercise among post-MI patients receiving care in a structured cardiac rehabilitation program. This technology represents a simple and scalable method to ensure consistent use of evidence-based cardiovascular therapies. Trial Registration Clinicaltrials.gov NCT02783287; https://clinicaltrials.gov/ct2/show/NCT02783287 (Archived by WebCite at http://www.webcitation.org/6sBnvNb05)

TITLE AND ABSTRACT 1a) TITLE: Identiᬤcation as a randomized trial in the title 1a) Does your paper address CONSORT item 1a? * I.e does the title contain the phrase "Randomized Controlled Trial"? (if not, explain the reason under "other") yes Other: 1a-i) Identify the mode of delivery in the title Identify the mode of delivery. Preferably use "web-based" and/or "mobile" and/or "electronic game" in the title. Avoid ambiguous terms like "online", "virtual", "interactive". Use "Internet-based" only if Intervention includes non-web-based Internet components (e.g. email), use "computer-based" or "electronic" only if oᲠine products are used. Use "virtual" only in the context of "virtual reality" (3-D worlds). Use "online" only in the context of "online support groups". Complement or substitute product names with broader terms for the class of products (such as "mobile" or "smart phone" instead of "iphone"), especially if the application runs on different platforms. 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 1a-i? * Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Our intervention was daily, automated text message reminders sent by converting emails to text messages.

1a-ii) Non-web-based components or important co-interventions in title
Mention non-web-based components or important co-interventions in title, if any (e.g., "with telephone support").
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 1a-ii?
Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study There was no other intervention used in this study.
1a-iii) Primary condition or target group in the title Mention primary condition or target group in the title, if any (e.g., "for children with Type I Diabetes") Example: A Web-based and Mobile Intervention with Telephone Support for Children with Type I Diabetes: Randomized Controlled Trial 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 1a-iii? * Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Our target group was "postmyocardial infarction patients".
1b) ABSTRACT: Structured summary of trial design, methods, results, and conclusions NPT extension: Description of experimental treatment, comparator, care providers, centers, and blinding status.

1b-i) Key features/functionalities/components of the intervention and comparator in the METHODS section of the ABSTRACT
Mention key features/functionalities/components of the intervention and comparator in the abstract. If possible, also mention theories and principles used for designing the site. Keep in mind the needs of systematic reviewers and indexers by including important synonyms. (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 1b-i? * Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study The intervention used in this study was daily text message reminders sent via email to text. We designed a computer program that would automatically send emails to specific email addresses provided by the cell phone provider which converted emails to text messages sent to a patients cell phone. The comparator (control) in this study was usual care which consisted in no text message reminders.
1b-ii) Level of human involvement in the METHODS section of the ABSTRACT Clarify the level of human involvement in the abstract, e.g., use phrases like "fully automated" vs. "therapist/nurse/care provider/physician-assisted" (mention number and expertise of providers involved, if any). (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 1b-ii?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study The text message reminders sent for this study were fully automated. The nurse who enrolled the patients entered their information into the text message reminder application and it automatically sent them daily messages afterward. Patients in the study attended weekly cardiac rehabilitation classes on site where they interacted with 2 kinesiologists and 1 cardiac nurse. This was not different between patients in the intervention group and patients in the control group.
1b-iii) Open vs. closed, web-based (self-assessment) vs. face-to-face assessments in the METHODS section of the ABSTRACT Mention how participants were recruited (online vs. oᲠine), e.g., from an open access website or from a clinic or a closed online user group (closed usergroup trial), and clarify if this was a purely web-based trial, or there were face-to-face components (as part of the intervention or for assessment). Clearly say if outcomes were self-assessed through questionnaires (as common in web-based trials). Note: In traditional oᲠine trials, an open trial (open-label trial) is a type of clinical trial in which both the researchers and participants know which treatment is being administered. To avoid confusion, use "blinded" or "unblinded" to indicated the level of blinding instead of "open", as "open" in web-based trials usually refers to "open access" (i.e. participants can self-enrol). (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 1b-iii?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Patients were recruited offline from Cambridge Cardiac Rehab in Cambridge, Ontario, Canada. There were face to face components to this study including recruitment, pickup of logbooks and weekly cardiac rehabilitation classes. The primary outcomes of the study were self assessed (adherence to medications and exercise measured by logbooks) but a secondary outcome (cardiopulmonary fitness) was conducted in person. Patients were unblinded to their group allocation. The investigators and health care providers were blinded to their group allocation.
1b-iv) RESULTS section in abstract must contain use data Report number of participants enrolled/assessed in each group, the use/uptake of the intervention (e.g., attrition/adherence metrics, use over time, number of logins etc.), in addition to primary/secondary outcomes. (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 1b-iv?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Two concurrent trials were conducted, examining medication adherence and exercise adherence. In the medication trial, 17 patients were enrolled in the intervention and control groups. In the exercise trial, 25 patients were enrolled in the intervention group and control groups. In the intervention groups of both the adherence and exercise trials, daily text message reminders were automatically sent to patients for one year.
1b-v) CONCLUSIONS/DISCUSSION in abstract for negative trials Conclusions/Discussions in abstract for negative trials: Discuss the primary outcome -if the trial is negative (primary outcome not changed), and the intervention was not used, discuss whether negative results are attributable to lack of uptake and discuss reasons. (Note: Only report in the abstract what the main paper is reporting. If this information is missing from the main body of text, consider adding it) 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 1b-v?
Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study subitem not at all important essential Does your paper address subitem 2a-ii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study "Acute myocardial infarction (MI) remains a leading cause of death and disability worldwide. The use of evidencebased therapies, including exercise and medications, has contributed to substantial reductions in cardiovascular morbidity and mortality. Whereas the prescription of these highly effective therapies is now nearly universal, many patients do not adhere to their medications or exercise regimens over the longterm, with negative consequences for cardiovascular outcomes and spending. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study "Accordingly, we sought to assess the impact of structured daily text message reminders on adherence to postMI medications and exercise in two randomized controlled trials." METHODS 3a) Description of trial design (such as parallel, factorial) including allocation ratio Does your paper address CONSORT subitem 3a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study We conducted two trials. The first was a parallel randomized control trial comparing adherence to medications among patients sent text message reminders and those not sent text message reminders. The second was a parallel randomized control trial comparing exercise adherence among patients sent text message reminders and those not sent text message reminders.
3b) Important changes to methods after trial commencement (such as eligibility criteria), with reasons Does your paper address CONSORT subitem 3b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study There were no changes to methods after trial commencement.
3b-i) Bug ᬤxes, Downtimes, Content Changes Bug ᬤxes, Downtimes, Content Changes: ehealth systems are often dynamic systems. A description of changes to methods therefore also includes important changes made on the intervention or comparator during the trial (e.g., major bug ᬤxes or changes in the functionality or content) (5-iii) and other "unexpected events" that may have inuenced study design such as staff changes, system failures/downtimes, etc. [2].
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 3b-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study There were no bugs, downtimes or content changes in this study.

4a) Eligibility criteria for participants
Does your paper address CONSORT subitem 4a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study "The trials were conducted at Cambridge Cardiac Rehab in Ontario, Canada. Both trials enrolled consecutive patients 18 years and older who, within the preceding two weeks, had been discharged from hospital after MI and enrolled in a structured cardiac rehabilitation program. In the medication adherence trial, we included patients who were receiving treatment with medications from all four of the following classes: anti platelets, betablockers, angiotensin converting enzyme inhibitors (ACE I) or angiotensin receptor blockers (ARB), and HMGCOA reductase enzyme inhibitors (statins). Since the trial involved daily text 4a-i) Computer / Internet literacy Computer / Internet literacy is often an implicit "de facto" eligibility criterion -this should be explicitly clariᬤed.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 4a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Patient participants only needed to own a cell phone and know how to open and read text message reminders. No computer or internet literacy was necessary for eligibility.
4a-ii) Open vs. closed, web-based vs. face-to-face assessments: Open vs. closed, web-based vs. face-to-face assessments: Mention how participants were recruited (online vs. oᲠine), e.g., from an open access website or from a clinic, and clarify if this was a purely web-based trial, or there were face-to-face components (as part of the intervention or for assessment), i.e., to what degree got the study team to know the participant. In online-only trials, clarify if participants were quasianonymous and whether having multiple identities was possible or whether technical or logistical measures (e.g., cookies, email conᬤrmation, phone calls) were used to detect/prevent these.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 4a-ii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Patients were recruited offline from Cambridge Cardiac Rehab in Cambridge, Canada. There were face to face components to this study including recruitment, pickup of logbooks and weekly cardiac rehabilitation classes. The primary outcomes of the study were selfassessed (adherence to medications and exercise measured by logbooks) but a secondary outcome (cardiopulmonary fitness) was conducted in person.
Patients were unblinded to their group allocation. The investigators and health care providers were blinded to their group allocation.

4a-iii) Information giving during recruitment
Information given during recruitment. Specify how participants were briefed for recruitment and in the informed consent procedures (e.g., publish the informed consent documentation as appendix, see also item X26), as this information may have an effect on user self-selection, user expectation and may also bias results.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 4a-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Patients were given the written informed consent form which detailed the study protocol and procedures. They were able to ask a nurse working at the cardiac rehab center if they had any questions or needed clarification.
4b) Settings and locations where the data were collected Does your paper address CONSORT subitem 4b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study All data was collected at Cambridge Cardiac Rehab in Cambridge, Ontario, Canada.

4b-i) Report if outcomes were (self-)assessed through online questionnaires
Clearly report if outcomes were (self-)assessed through online questionnaires (as common in web-based trials) or otherwise.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 4b-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Outcomes were not assessed through online questionnaires.

4b-ii) Report how institutional aᲠliations are displayed
Report how institutional aᲠliations are displayed to potential participants [on ehealth media], as aᲠliations with prestigious hospitals or universities may affect volunteer rates, use, and reactions with regards to an intervention.(Not a required item -describe only if this may bias results) 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 4b-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study All patients had to be enrolled in cardiac rehabilitation at Cambridge Cardiac Rehab. This is a free center which patients are referred to after a cardiac event.
5) The interventions for each group with suᲠcient details to allow replication, including how and when they were actually administered 5-i) Mention names, credential, aᲠliations of the developers, sponsors, and owners Mention names, credential, aᲠliations of the developers, sponsors, and owners [6] (if authors/evaluators are owners or developer of the software, this needs to be declared in a "Conict of interest" section or mentioned elsewhere in the manuscript).
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 5-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study The text message reminder program used in this study was developed by the study investigators. It automatically sends emails to an email to text address from the cell phone provider which converts it to a free text message sent to the patients cell phone. Patients in the intervention group (of both the exercise and medication trials) were sent daily text message reminders. Patients in the control group were sent no text message reminders.

5-ii) Describe the history/development process
Describe the history/development process of the application and previous formative evaluations (e.g., focus groups, usability testing), as these will have an impact on adoption/use rates and help with interpreting results.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 5-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study The text message reminder system in this study was developed by the study investigators. It has been previously tested in two prior clinical trials: one in healthy volunteers and one in stable coronary artery disease patients. No problems were found in these studies.

5-iii) Revisions and updating
Revisions and updating. Clearly mention the date and/or version number of the application/intervention (and comparator, if applicable) evaluated, or describe whether the intervention underwent major changes during the evaluation process, or whether the development and/or content was "frozen" during the trial.
Describe dynamic components such as news feeds or changing content which may have an impact on the replicability of the intervention (for unexpected events see item 3b).
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 5-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study No revisions or updates of the application were conducted.

5-iv) Quality assurance methods
Provide information on quality assurance methods to ensure accuracy and quality of information provided [1], if applicable.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 5-iv?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Patients were asked periodically if there were any issues with the text message reminders. No problems were identified. The text message reminder system had an audit trail which automatically recorded all text message reminders successfully sent and any errors. No errors were identified.

5-v)
Ensure replicability by publishing the source code, and/or providing screenshots/screencapture video, and/or providing owcharts of the algorithms used Ensure replicability by publishing the source code, and/or providing screenshots/screen-capture video, and/or providing owcharts of the algorithms used. Replicability (i.e., other researchers should in principle be able to replicate the study) is a hallmark of scientiᬤc reporting.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 5-v?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study This program is not specific and easy to replicate. It is based on a free service already provided by Canadian cell phone providers. The source code was thus not published.

5-vi) Digital preservation
Digital preservation: Provide the URL of the application, but as the intervention is likely to change or disappear over the course of the years; also make sure the intervention is archived (Internet Archive, webcitation.org, and/or publishing the source code or screenshots/videos alongside the article). As pages behind login screens cannot be archived, consider creating demo pages which are accessible without login.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 5-vi?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study The intervention is not available online.

5-vii) Access
Access: Describe how participants accessed the application, in what setting/context, if they had to pay (or were paid) or not, whether they had to be a member of speciᬤc group. If known, describe how participants obtained "access to the platform and Internet" [1]. To ensure access for editors/reviewers/readers, consider to provide a "backdoor" login account or demo mode for reviewers/readers to explore the application (also important for archiving purposes, see vi).
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 5-vii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Participants did not access the application. They did not have to pay to participate and were not obligated to be a part of either group. Group allocation was randomized. The application is not available online for viewing. subitem not at all important essential Does your paper address subitem 5-viii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study

5-viii)
The intervention was delivered by text message reminder sent to the cell phone of participants in the intervention group. Patients in the control group did not receive text message reminders. "In the medication adherence trial, patients randomized to intervention received daily text messages at the time they preferred to take their medications. The text messages simply indicated that patients should remember to take their medications and contained no identifiable information including medications names or classes. For example, patients who took their medication in the morning read: 'Please

5-ix) Describe use parameters
Describe use parameters (e.g., intended "doses" and optimal timing for use). Clarify what instructions or recommendations were given to the user, e.g., regarding timing, frequency, heaviness of use, if any, or was the intervention used ad libitum. not in the ms, or briey explain why the item is not applicable/relevant for your study This is not applicable to this study.

5-x) Clarify the level of human involvement
Clarify the level of human involvement (care providers or health professionals, also technical assistance) in the e-intervention or as co-intervention (detail number and expertise of professionals involved, if any, as well as "type of assistance offered, the timing and frequency of the support, how it is initiated, and the medium by which the assistance is delivered". It may be necessary to distinguish between the level of human involvement required for the trial, and the level of human involvement required for a routine application outside of a RCT setting (discuss under item 21 -generalizability).
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 5-x?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study The text message reminders sent for this study were fully automated. The nurse who enrolled the patients entered their information into the text message reminder application and it automatically sent them daily messages afterward. Patients in the study attended weekly cardiac rehabilitation classes on site where they interacted with 2 kinesiologists and 1 cardiac nurse. This was not different between patients in the intervention group and patients in the control group.

5-xi) Report any prompts/reminders used
Report any prompts/reminders used: Clarify if there were prompts (letters, emails, phone calls, SMS) to use the application, what triggered them, frequency etc. It may be necessary to distinguish between the level of prompts/reminders required for the trial, and the level of prompts/reminders for a routine application outside of a RCT setting (discuss under item 21 -generalizability).
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 5-xi? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study The intervention consisted of daily text message reminders automatically sent to the patients cell phone. Thus it was not necessary to remind patients to use the intervention.

5-xii) Describe any co-interventions (incl. training/support)
Describe any co-interventions (incl. training/support): Clearly state any interventions that are provided in addition to the targeted eHealth intervention, as ehealth intervention may not be designed as stand-alone intervention. This includes training sessions and support [1]. It may be necessary to distinguish between the level of training required for the trial, and the level of training for a routine application outside of a RCT setting (discuss under item 21 -generalizability.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 5-xii? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study "All patients in both trials participated in the structured outpatient cardiac rehabilitation program in which they were enrolled. The program consisted of one week of education about diet, proper exercise technique, heart disease and myocardial infarction, smoking cessation and stress management and was followed by two sessions per week of onsite exercise under the supervision of kinesiologists and nurses." 6a) Completely deᬤned pre-speciᬤed primary and secondary outcome measures, including how and when they were assessed Does your paper address CONSORT subitem 6a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study In the medication adherence trial, the primary outcome was adherence to medications measured by logbooks. Medication adherence was measured by doses taken divided by doses prescribed each month. In the exercise adherence trial, the primary outcome was frequency measured by logbooks. Frequency of exercise was determined by the number of sessions of exercise logged each month. The secondary outcomes were duration of exercise (measured by the number of minutes of exercise logged each month) and aerobic fitness measured by METS achieved on Bruce Protocol treadmill stress test.
6a-i) Online questionnaires: describe if they were validated for online use and apply CHERRIES items to describe how the questionnaires were designed/deployed If outcomes were obtained through online questionnaires, describe if they were validated for online use and apply CHERRIES items to describe how the questionnaires were designed/deployed [9]. In person exit interviews were conducted at the end of the study.
6b) Any changes to trial outcomes after the trial commenced, with reasons Does your paper address CONSORT subitem 6b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study There were no changes to the trial outcomes after the trial commenced.
7a) How sample size was determined NPT: When applicable, details of whether and how the clustering by care provides or centers was addressed 7a-i) Describe whether and how expected attrition was taken into account when calculating the sample size Describe whether and how expected attrition was taken into account when calculating the sample size.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 7a-i?
Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study "Two pilot studies were conducted to determine sample size prospectively. For the medication adherence pilot study, we conducted a 2 month 30 patient crossover study in CAD patients at the Cambridge Cardiac Care Center in Cambridge, Ontario. Patients were randomized to receive to receive text message reminders for one month (either the first or second month) and to receive no text message reminders the other month. For the exercise adherence study, we conducted a 2 month parallel study in 16 postMI patients participating in onsite cardiac rehabilitation at Cambridge Cardiac Rehab in Cambridge, 7b) When applicable, explanation of any interim analyses and stopping guidelines Does your paper address CONSORT subitem 7b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study There were no interim analyses or stopping guidelines.
8a) Method used to generate the random allocation sequence NPT: When applicable, how care providers were allocated to each trial group Does your paper address CONSORT subitem 8a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Patients were sequentially randomized using a random number generator (random.org).
8b) Type of randomisation; details of any restriction (such as blocking and block size) Does your paper address CONSORT subitem 8b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Simple randomization was used in this study. 9) Mechanism used to implement the random allocation sequence (such as sequentially numbered containers), describing any steps taken to conceal the sequence until interventions were assigned Does your paper address CONSORT subitem 9? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Patients were sequentially randomized using a random number generator (random.org). Patients randomized to the intervention group were entered into the text message reminder application to receive daily text message reminders. Care providers were not notified about which group patients were allocated to.
10) Who generated the random allocation sequence, who enrolled participants, and who assigned participants to interventions Does your paper address CONSORT subitem 10? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Patients were enrolled, randomly allocated to a group (intervention or control) by a nurse working at Cambridge Cardiac Rehab.
11a) If done, who was blinded after assignment to interventions (for example, participants, care providers, those assessing outcomes) and how NPT: Whether or not administering co-interventions were blinded to group assignment 11a-i) Specify who was blinded, and who wasn't Specify who was blinded, and who wasn't. Usually, in web-based trials it is not possible to blind the participants [1, 3] (this should be clearly acknowledged), but it may be possible to blind outcome assessors, those doing data analysis or those administering co-interventions (if any). Does your paper address subitem 11a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Care providers, those assessing outcomes and the study investigators were blinded to the group allocation. Patients were not blinded.
11a-ii) Discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator" Informed consent procedures (4a-ii) can create biases and certain expectations -discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator".
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 11a-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study The intervention in the study was daily text message reminder sent to patients. Patients knew if they were in the control group or the intervention group based on if they received text message reminders or not.

11b) If relevant, description of the similarity of interventions
(this item is usually not relevant for ehealth trials as it refers to similarity of a placebo or sham intervention to a active medication/intervention) Does your paper address CONSORT subitem 11b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study This is not relevant to this study. The intervention in this study was text message reminders compared to usual care (no text message reminders).
12a) Statistical methods used to compare groups for primary and secondary outcomes NPT: When applicable, details of whether and how the clustering by care providers or centers was addressed Does your paper address CONSORT subitem 12a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study "All analyses were performed based on intentiontotreat principles. We calculated means and frequencies of prerandomization variables separately by study arm. For the medication adherence trial, we evaluated the impact of text messaging on average adherence and optimal adherence using linear and logistic regression, respectively. For the exercise adherence trial, all outcomes were evaluated using linear regression. After performing these analyses, we ran multivariable models adjusting for characteristics that were imbalanced by chance at baseline." 12a-i) Imputation techniques to deal with attrition / missing values Imputation techniques to deal with attrition / missing values: Not all participants will use the intervention/comparator as intended and attrition is typically high in ehealth trials. Specify how participants who did not use the application or dropped out from the trial were treated in the statistical analysis (a complete case analysis is strongly discouraged, and simple imputation techniques such as LOCF may also be problematic [4]).
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 12a-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study In the medication trial, if patients did not log a dose of a medication, it was treated as missed. In the exercise trial, if a patient did not log that they exercised on a given day, it was assumed they did not exercise that day. There was one dropout in this study and this took place early on prior to data collection. They were excluded from the analysis.

12b) Methods for additional analyses, such as subgroup analyses and adjusted analyses
Does your paper address CONSORT subitem 12b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Informed consent was received in person. Patients recruited for the study were asked to read the written informed consent document which outlined the study protocol and procedures. They then signed the document with a witness present.

X26-iii) Safety and security procedures
Safety and security procedures, incl. privacy considerations, and any steps taken to reduce the likelihood or detection of harm (e.g., education and training, availability of a hotline) 1 2 3 4 5 subitem not at all important essential Does your paper address subitem X26-iii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study No private or identifiable information was sent over text messages. There was no additional potential for harm in this study.

RESULTS
13a) For each group, the numbers of participants who were randomly assigned, received intended treatment, and were analysed for the primary outcome NPT: The number of care providers or centers performing the intervention in each group and the number of patients treated by each care provider in each center Does your paper address CONSORT subitem 13a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study This was a single center study. Two concurrent trials were conducted, examining medication adherence and exercise adherence. In the medication trial, 17 patients were enrolled in the intervention and control groups. There was one dropout in the control group. All 17 patients in the intervention group received the text message reminders. The 33 patients who completed the study were analysed for the primary outcome. In the exercise trial, 25 patients were enrolled in the intervention group and control groups. All 25 patients in the intervention group received the text message reminders. The 50 patients who 13b) For each group, losses and exclusions after randomisation, together with reasons Does your paper address CONSORT subitem 13b? (NOTE: Preferably, this is shown in a CONSORT ow diagram) * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study This is shown in a CONSORT flow diagram.

13b-i) Attrition diagram
Strongly recommended: An attrition diagram (e.g., proportion of participants still logging in or using the intervention/comparator in each group plotted over time, similar to a survival curve) or other ᬤgures or tables demonstrating usage/dose/engagement.

2 3 4 5
subitem not at all important essential Does your paper address subitem 13b-i?
Copy and paste relevant sections from the manuscript or cite the ᬤgure number if applicable (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study No attrition diagram was included in this study. This is because participants could not use the text message reminder intervention independently. All messages were automatically sent from the text message reminder system to the patients. There was only 1 dropout from the study in the control group of the medication adherence trial.

14a) Dates deᬤning the periods of recruitment and followup
Does your paper address CONSORT subitem 14a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Study recruitment took place between December 1st, 2012 and February 28th, 2013. The study followup was 1 year for all participants.
14a-i) Indicate if critical "secular events" fell into the study period Indicate if critical "secular events" fell into the study period, e.g., signiᬤcant changes in Internet resources available or "changes in computer hardware or Internet delivery resources" 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 14a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study No secular events fell into the study period.
14b) Why the trial ended or was stopped (early) Does your paper address CONSORT subitem 14b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study The trial was not stopped early. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study

15) A
Tables showing baseline demographic information for each group in the medication and exercise trials are included in the manuscript.

15-i) Report demographics associated with digital divide issues
In ehealth trials it is particularly important to report demographics associated with digital divide issues, such as age, education, gender, social-economic status, computer/Internet/ehealth literacy of the participants, if known.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 15-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Age and education demographics were collected for this study. All patients in the study had to own and be competent with a cell phone during recruitment.
16) For each group, number of participants (denominator) included in each analysis and whether the analysis was by original assigned groups 16-i) Report multiple "denominators" and provide deᬤnitions Report multiple "denominators" and provide deᬤnitions: Report N's (and effect sizes) "across a range of study participation [and use] thresholds" [1], e.g., N exposed, N consented, N used more than x times, N used more than y weeks, N participants "used" the intervention/comparator at speciᬤc pre-deᬤned time points of interest (in absolute and relative numbers per group). Always clearly deᬤne "use" of the intervention.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 16-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Analysis was only conducted on patients who were randomized and not lost to followup (a complete case itt analysis).

16-ii) Primary analysis should be intent-to-treat
Primary analysis should be intent-to-treat, secondary analyses could include comparing only "users", with the appropriate caveats that this is no longer a randomized sample (see 18-i).
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 16-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study "All analyses were performed based on intentiontotreat principles." 17a) For each primary and secondary outcome, results for each group, and the estimated effect size and its precision (such as 95% conᬤdence interval) Does your paper address CONSORT subitem 17a? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study outcome "mean days of exercise per month during followup" in the exercise trial was 17.2 in the text message reminder group compared to 13.1 in the usual care group (p= 0.0005 at 95% confidence). The secondary outcome "mean hours of exercise per month during follow up" in the exercise trial was 12.5 in the text message reminder group compared to 8.5 in the usual care group (p<0.0001 at 95% confidence). The secondary outcome "cardiopulmonary fitness at month 12 (METs)" in the exercise trial was 7.4 in the text message reminder group compared to 6.2 in the usual care group (p=0.06 at 95% confidence).

17a-i) Presentation of process outcomes such as metrics of use and intensity of use
In addition to primary/secondary (clinical) outcomes, the presentation of process outcomes such as metrics of use and intensity of use (dose, exposure) and their operational deᬤnitions is critical. This does not only refer to metrics of attrition (13-b) (often a binary variable), but also to more continuous exposure metrics such as "average session length". These must be accompanied by a technical description how a metric like a "session" is deᬤned (e.g., timeout after idle time) [1] (report under item 6a).
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 17a-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study from statins and the threshold used by most quality measures." "The primary outcome for this trial was the average number of days per month that a patient exercised over twelve months, calculated as the mean of each of the twelve monthly measurements of the days per months exercised. Secondary outcomes included the average number of hours of exercise per month and cardiopulmonary fitness as assessed by a BRUCE protocol, twelve months after randomization. Cardiopulmonary fitness was measured in metabolic equivalents (METS), which were calculated based on number of minutes achieved on a BRUCE protocol stress test. Patients participated in a treadmill 17b) For binary outcomes, presentation of both absolute and relative effect sizes is recommended Does your paper address CONSORT subitem 17b? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study We measured only absolute effect sizes 18) Results of any other analyses performed, including subgroup analyses and adjusted analyses, distinguishing pre-speciᬤed from exploratory Does your paper address CONSORT subitem 18? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study Subgroups for subgroup analyses performed in this study were identified prospectively.

18-i) Subgroup analysis of comparing only users
A subgroup analysis of comparing only users is not uncommon in ehealth trials, but if done, it must be stressed that this is a self-selected sample and no longer an unbiased sample from a randomized trial (see 16-iii).
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 18-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study This is not applicable to this study.

19) All important harms or unintended effects in each group
(for speciᬤc guidance see CONSORT for harms) Does your paper address CONSORT subitem 19? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study There were no harms or unintended effects observed.

19-i) Include privacy breaches, technical problems
Include privacy breaches, technical problems. This does not only include physical "harm" to participants, but also incidents such as perceived or real privacy breaches [1], technical problems, and other unexpected/unintended incidents. "Unintended effects" also includes unintended positive effects [2]. There were no privacy breaches or technical problems in this study.
19-ii) Include qualitative feedback from participants or observations from staff/researchers Include qualitative feedback from participants or observations from staff/researchers, if available, on strengths and shortcomings of the application, especially if they point to unintended/unexpected effects or uses. This includes (if available) reasons for why people did or did not use the application as intended by the developers.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 19-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study "Patients were surveyed following the end of the study to discuss their experience with daily text message reminders. The majority of patients reported that the reminders were helpful in maintaining adherence to their therapies. Additionally, most patients also reported that the text message reminders were not overly intrusive. More formalized polling of patient participants in future studies may provide further insight into patient experience with reminder systems like the one examined in this study." DISCUSSION 22) Interpretation consistent with results, balancing beneᬤts and harms, and considering other relevant evidence NPT: In addition, take into account the choice of the comparator, lack of or partial blinding, and unequal expertise of care providers or centers in each group 22-i) Restate study questions and summarize the answers suggested by the data, starting with primary outcomes and process outcomes (use) Restate study questions and summarize the answers suggested by the data, starting with primary outcomes and process outcomes (use). Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study "In this pair of randomized control trials of text message reminders delivered to postmyocardial infarction patients participating in cardiac rehabilitation, we found significant improvement in both adherence to medications and the frequency and duration of exercise over 12 months of followup, as measured by patient selfreport. In addition, the secondary outcome of the trial focusing on exercise adherence showed a non significant trend to improved cardiopulmonary fitness as measured by exercise stress testing."

22-ii) Highlight unanswered new questions, suggest future research
Highlight unanswered new questions, suggest future research.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 22-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study "More formalized polling of patient participants in future studies may provide further insight into patient experience with reminder systems like the one examined in this study." " Future research may seek to evaluate whether specific messaging is more effective than generic messaging and how these messages may affect patients taking more classes of medications compared to those taking fewer classes of medications." "While further research is required to validate our results in larger and more diverse settings, texting appears to represent a simple and scalable strategy for improving adherence to medications 20) Trial limitations, addressing sources of potential bias, imprecision, and, if relevant, multiplicity of analyses

20-i) Typical limitations in ehealth trials
Typical limitations in ehealth trials: Participants in ehealth trials are rarely blinded. Ehealth trials often look at a multiplicity of outcomes, increasing risk for a Type I error. Discuss biases due to non-use of the intervention/usability issues, biases through informed consent procedures, unexpected events.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 20-i? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study classes of medications compared to those taking fewer classes of medications. Also, due to the long followup of the study during which time patients continued to complete daily logbooks, the results of the study may only be generalizable to patients willing to commit to longer term logbook use. Finally, there were baseline imbalances in the treatment arms in potentially important characteristics, notably sex, although our overall results remained unchanged in multivariable and subgroup analyses. Further research should be conducted in larger and more diverse populations." 21) Generalisability (external validity, applicability) of the trial ᬤndings NPT: External validity of the trial ᬤndings according to the intervention, comparators, patients, and care providers or centers involved in the trial

21-i) Generalizability to other populations
Generalizability to other populations: In particular, discuss generalizability to a general Internet population, outside of a RCT setting, and general patient population, including applicability of the study results for other organizations 1 2 3 4 5 subitem not at all important essential Does your paper address subitem 21-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study "Our medication adherence trial included only patients on onceaday regimens of the four classes of medications studied. While all four medication classes we studied are widely available with this dosing strategy, our results may not be generalizable to all postMI patients. The main impact of this decision is on generalizability of the results to patients with two or three daily dose regimens."

21-ii) Discuss if there were elements in the RCT that would be different in a routine application setting
Discuss if there were elements in the RCT that would be different in a routine application setting (e.g., prompts/reminders, more human involvement, training sessions or other co-interventions) and what impact the omission of these elements could have on use, adoption, or outcomes if the intervention is applied outside of a RCT setting.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem 21-ii?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study This study took place in a real world setting as part of patient care in cardiac rehabilitation.

OTHER INFORMATION
23) Registration number and name of trial registry Does your paper address CONSORT subitem 23? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study clinicaltrials.gov : NCT02783287 24) Where the full trial protocol can be accessed, if available Does your paper address CONSORT subitem 24? * Cite a Multimedia Appendix, other reference, or copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study The full trial protocol is not available.

25)
Sources of funding and other support (such as supply of drugs), role of funders Does your paper address CONSORT subitem 25? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study There was no funding for this study.

X27) Conicts of Interest (not a CONSORT item)
X27-i) State the relation of the study team towards the system being evaluated In addition to the usual declaration of interests (ᬤnancial or otherwise), also state the relation of the study team towards the system being evaluated, i.e., state if the authors/evaluators are distinct from or identical with the developers/sponsors of the intervention.
1 2 3 4 5 subitem not at all important essential Does your paper address subitem X27-i?
Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briey explain why the item is not applicable/relevant for your study There are no conflicts of interests related to this study.

About the CONSORT EHEALTH checklist
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