title: Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics Comparative effectiveness of lifestyle interventions on cardiovascular risk factors among a Dutch overweight working population: A randomized controlled trial Randomized trial of an internet-based computer-tailored expert system for physical activity in patients with heart disease Effects on cardiovascular disease risk of a web-based health risk assessment with tailored health advice: a follow-up study Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised controlled trial Behavioral treatment for weight gain prevention among black women in primary care practice: a randomized clinical trial. Increasing the medium-term clinical benefits of hospital-based cardiac rehabilitation by physical activity telemonitoring in coronary artery disease patients A short message service (SMS) intervention to prevent diabetes in Chinese professional drivers with pre-diabetes: a pilot single-blinded randomized controlled trial. [Effectiveness of an intervention to provide information to patients with hypertension as short text messages and reminders sent to their mobile phone (HTA-Alert)]. Effect of Home-Based Telemonitoring Using Mobile Phone Technology on the Outcome of Heart Failure Patients After an Episode of Acute Decompensation: Randomized Controlled Trial Using an online, personalized program reduces cardiovascular risk factor profiles in a motivated, adherent population of participants. No significant improvement of cardiovascular disease risk indicators by a lifestyle intervention in people with Familial Hypercholesterolemia compared to usual care: results of a randomised controlled trial Live well: a practical and effective low-intensity dietary counseling intervention for use in primary care patients with dyslipidemia - a randomized controlled pilot trial Evaluation of mobile phone and Internet intervention on waist circumference and blood pressure in post-menopausal women with abdominal obesity Effectiveness of a quality improvement intervention targeting cardiovascular risk factors: are patients responsive to information and encouragement by mail or post? Web-Based Targeted Nutrition Counselling and Social Support for Patients at Increased Cardiovascular Risk in General Practice: Randomized Controlled Trial Managing hypertension in urban underserved subjects using telemedicine--a clinical trial. Impact of Home-Based Exercise Training with Wireless Monitoring on Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention [Liveonline aftercare in patients with abdominal obesity in cardio-diabetological rehabilitation: findings of a randomized controlled study]. Comparing the effectiveness of two cardiovascular prevention programmes for highly educated professionals in general practice: a randomised clinical trial A randomized controlled trial on the efficacy of carbohydrate-reduced or fat-reduced diets in patients attending a telemedically guided weight loss program A randomized trial of an intervention to improve use and adherence to effective coronary heart disease prevention strategies Cardiovascular Health Effects of Internet-Based Encouragements to Do Daily Workplace Stair-Walks: Randomized Controlled Trial Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial One-year follow-up of a therapeutic lifestyle intervention targeting cardiovascular disease risk A pilot-study to identify the feasibility of an Internet-based coaching programme for changing the vascular risk profile of high-risk patients. Effect of a cardiovascular prevention program on health behavior and BMI in highly educated adults: a randomized controlled trial. Comparative effectiveness of weight-loss interventions in clinical practice. Utilization of the internet to deliver cardiac rehabilitation at a distance: a pilot study. Therapeutic benefit of internet-based lifestyle counselling for hypertension. Therapeutic benefit of preventive telehealth counseling in the Community Outreach Heart Health and Risk Reduction Trial. Web-based weight loss in primary care: a randomized controlled trial. Effectiveness of home telehealth in comorbid diabetes and hypertension: a randomized, controlled trial. Effect of a Web-Based Intervention to Promote Physical Activity and Improve Health Among Physically Inactive Adults: A Population-Based Randomized Controlled Trial Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Clinical trial of an Internet-based case management system for secondary prevention of heart disease. A low intensity, community based lifestyle programme to prevent weight gain in women with young children: cluster randomised controlled trial Effect of a telemonitoring-facilitated collaboration between general practitioner and heart failure clinic on mortality and rehospitalization rates in severe heart failure: the TEMA-HF 1 (TElemonitoring in the MAnagement of Heart Failure) study. Evaluation of a Telemedicine Service for the Secondary Prevention of Coronary Artery Disease
abstract: Lowering blood pressure reduces cardiovascular risk , yet hypertension is poorly controlled in diabetic patients . In a pilot study we demonstrated that a home blood pressure telemonitoring system , which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading , improved blood pressure control . Messages were based on care paths defined by running averages of transmitted readings . The present study tests the system 's effectiveness in a r and omized , controlled trial in diabetic patients with uncontrolled systolic hypertension . Of 244 subjects screened for eligibility , 110 ( 45 % ) were r and omly allocated to the intervention ( n=55 ) or control ( n=55 ) group , and 105 ( 95.5 % ) completed the 1-year outcome visit . In the intention-to-treat analysis , mean daytime ambulatory systolic blood pressure , the primary end point , decreased significantly only in the intervention group by 9.1±15.6 mmHg ( SD ; P<0.0001 ) , and the mean between-group difference was 7.1±2.3 mmHg ( SE ; P<0.005 ) . Furthermore , 51 % of intervention subjects achieved the guideline recommended target of < 130/80 mmHg compared with 31 % of control subjects ( P<0.05 ) . These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians . Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale ( baseline , 4.1±3.76 ; exit , 5.2±4.30 ; P=0.014 ) . This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension  and improved hypertension control . Home blood pressure monitoring alone had no effect on blood pressure . Promoting patient self-care may have negative psychological effects Background Overweight ( Body Mass Index [ BMI ] ≥ 25 kg/m2 ) and obesity ( BMI ≥ 30 kg/m2 ) are associated with increased cardiovascular risk , posing a considerable burden to public health . The main aim of this study was to investigate lifestyle intervention effects on cardiovascular risk factors in healthy overweight employees . Methods Participants were 276 healthy overweight employees ( 69.2 % male ; mean age 44.0 years [ SD 9.2 ] ; mean BMI 29.7 kg/m2 [ SD 3.1 ] ) . They were r and omized to one of two intervention groups receiving a six month lifestyle intervention with behavior counseling by phone ( phone group ) or e-mail ( Internet group ) , or to a control group receiving usual care .  Body weight , height , waist circumference , sum of skinfolds , blood pressure , total cholesterol level and predicted aerobic fitness were measured at baseline , at 6 and at 24 months . Regression analyses included the 141 participants with complete data . Results At 6 months a significant favorable effect on total cholesterol level ( -0.2 mmol/l , 95%CI -0.5 to -0.0 ) was observed in the phone group and a trend for improved aerobic fitness ( 1.9 ml/kg/min , 95%CI -0.2 to 3.9 ) in the Internet group . At two years , favorable trends for body weight ( -2.1 kg , 95%CI -4.4 to 0.2 ) and aerobic fitness ( 2.3 ml/kg/min , 95%CI -0.2 to 4.8 ) were observed in the Internet group . Conclusions The intervention effects were independent of the used communication mode . However short-term results were in favor of the phone group and long-term results in favor of the internet group . Thus , we found limited evidence for our lifestyle intervention to be effective in reducing cardiovascular risk in a group of apparently healthy overweight workers . Trial registration IS RCT Background : The CardioFit internet-based expert system was design ed to promote physical activity in patients with coronary heart disease ( CHD ) who were not participating in cardiac rehabilitation . Design : This r and omized controlled trial compared CardioFit to usual care to assess its effects on physical activity following hospitalization for acute coronary syndromes . Methods : A total of 223 participants were recruited at the University of Ottawa Heart Institute or London Health Sciences Centre and r and omly assigned to either  CardioFit  ( n = 115 ) or  usual care ( n = 108 ) . The CardioFit group received a personally tailored physical-activity plan upon discharge from the hospital and access to a secure website for activity planning and tracking . They completed five online tutorials over a 6-month period and were in email contact with an exercise specialist . Usual care consisted of physical activity guidance from an attending cardiologist .  Physical activity was measured by pedometer and self-reported over a 7-day period , 6 and 12 months after r and omization . Results : The CardioFit internet-based physical activity expert system significantly increased objective ly measured ( p = 0.023 ) and self-reported physical activity ( p = 0.047 ) compared to usual care . Emotional ( p = 0.038 ) and physical ( p = 0.031 ) dimensions of heart disease health-related quality of life were also higher with CardioFit compared to usual care . Conclusions : Patients with CHD using an internet-based activity prescription with online coaching were more physically active at follow up than those receiving usual care . Use of the CardioFit program could extend the reach of rehabilitation and secondary -prevention services Introduction : A large proportion of the cardiovascular disease ( CVD ) burden can potentially be prevented by primary prevention programs addressing major causal risk factors . A Web-based health risk assessment ( HRA ) with tailored feedback for individual health promotion is a promising strategy . We evaluated the effect on CVD risk of such a program among employees of a Dutch worksite . Methods : We conducted a prospect i ve follow-up study among 368 employees who voluntarily participated in a Web-based HRA program at a single Dutch worksite in 2008 . The program included a multicomponent HRA through a Web-based electronic question naire , biometrics , and laboratory evaluation . The results were combined with health behavior change theory to generate tailored motivational and educational health advice . On request , a health counseling session with the program physician was available . Follow-up data on CVD risk were collected 1 year after initial participation . The primary outcome was a change in Framingham CVD risk at 6 months relative to baseline . We checked for a possible background effect of an increased health consciousness as a consequence of program introduction at the worksite by comparing baseline measurements of early program participants with baseline measurements of participants who completed the program 6 months later . Results : A total of 176 employees completed follow-up measurements after a mean of 7 months . There was a grade d relation between CVD risk changes and baseline risk , with a relative reduction of 17.9 % ( P = 0.001 ) in the high-risk category ( baseline CVD risk ≥20 % ) . Changes were not explained by additional health counseling , medication , or an increase in health consciousness within the company . Conclusions : Voluntary participation in a Web-based HRA with tailored feedback at the worksite reduced CVD risk by nearly 18 % among participants at high CVD risk and by nearly 5 % among all participants . Web-based HRA could improve CVD risk in similar population s. Future research should focus on the persistence of the effects underlying the CVD risk reduction Objective To investigate whether an internet based , nurse led vascular risk factor management programme promoting self management on top of usual care is more effective than usual care alone in reducing vascular risk factors in patients with clinical ly manifest vascular disease . Design Prospect i ve r and omised controlled trial . Setting Multicentre trial in secondary and tertiary healthcare setting . Participants 330 patients with a recent clinical manifestation of atherosclerosis in the coronary , cerebral , or peripheral arteries and with at least two treatable risk factors not at goal . Intervention Personalised website with an overview and actual status of patients ’ risk factors and mail communication via the website with a nurse practitioner for 12 months ; the intervention combined self management support , monitoring of disease control , and drug treatment . Main outcome measures The primary endpoint was the relative change in Framingham heart risk score after 1 year . Secondary endpoints were absolute changes in the levels of risk factors and the differences between groups in the change in proportion of patients reaching treatment goals for each risk factor . Results Participants ’ mean age was 59.9 ( SD 8.4 ) years , and most patients ( n=246 ; 75 % ) were male . After 1 year , the relative change in Framingham heart risk score of the intervention group compared with the usual care group was −14 % ( 95 % confidence interval −25 % to −2 % ) . At baseline , the Framingham heart risk score was higher in the intervention group than in the usual care group ( 16.1 ( SD 10.6 ) v 14.0 ( 10.5 ) ) , so the outcome was adjusted for the separate variables of the Framingham heart risk score and for the baseline Framingham heart risk score . This produced a relative change of −12 % ( −22 % to −3 % ) in Framingham heart risk score for the intervention group compared with the usual care group adjusted for the separate variables of the score and −8 % ( −18 % to 2 % ) adjusted for the baseline score . Of the individual risk factors , a difference between groups was observed in low density lipoprotein cholesterol ( −0.3 , −0.5 to −0.1 , mmol/L ) and smoking ( −7.7 % , −14.9 % to −0.4 % ) . Some other risk factors tended to improve ( body mass index , triglycerides , systolic blood pressure , renal function ) or tended to worsen ( glucose concentration , albuminuria ) . Conclusion An internet based , nurse led treatment programme on top of usual care for vascular risk factors had a small effect on lowering vascular risk and on lowering of some vascular risk factors in patients with vascular disease . Trial registration Clinical trials NCT00785031 IMPORTANCE Few weight loss treatments produce clinical ly meaningful weight loss outcomes among black women , particularly in the primary care setting . New weight management strategies are necessary for this population . Weight gain prevention might be an effective treatment option , with particular benefits for overweight and class 1 obese black women . OBJECTIVE To compare changes in weight and cardiometabolic risk during a 12-month period among black women r and omized to a primary care-based behavioral weight gain prevention intervention , relative to usual care . DESIGN , SETTING , AND PARTICIPANTS Two-arm r and omized clinical trial ( the Shape Program ) . We recruited patients from a 6-site community health center system . We r and omized 194 overweight and class 1 obese ( body mass index [ calculated as weight in kilograms divided by height in meters squared ] , 25 - 34.9 ) premenopausal black women aged 25 to 44 years . Enrollment began on December 7 , 2009 ; 12- and 18-month assessment s were completed in February and October 2 , 2012 . INTERVENTIONS The medium-intensity intervention included tailored behavior change goals , weekly self-monitoring via interactive voice response , monthly counseling calls , tailored skills training material s , and a gym membership . MAIN OUTCOMES AND MEASURES Twelve-month change in weight and body mass index and maintenance of change at 18 months . RESULTS Participants had a mean age of 35.4 years , a mean weight of 81.1 kg , and a mean body mass index of 30.2 at baseline . Most were socioeconomically disadvantaged ( 79.7 % with educational level less than a college degree ; 74.3 % reporting annual income < $ 30,000 ) . The 12-month weight change was larger among intervention participants ( mean [ SD ] , -1.0 [ 0.5 ] kg ) , relative to usual care ( 0.5 [ 0.5 ] kg ; mean difference , -1.4 kg [ 95 % CI , -2.8 to -0.1 kg ] ; P = .04 ) . At month 12 , 62 % of intervention participants were at or below their baseline weights compared with 45 % of usual-care participants ( P = .03 ) . By 18 months , intervention participants maintained significantly larger changes in weight ( mean difference , -1.7 kg ; 95 % CI , -3.3 to -0.2 kg ) . CONCLUSIONS AND RELEVANCE A medium-intensity primary care-based behavioral intervention demonstrated efficacy for weight gain prevention among socioeconomically disadvantaged black women . A " maintain , do n't gain " approach might be a useful alternative treatment for reducing obesity-associated disease risk among some premenopausal black women . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00938535 Background The purpose of this study was to evaluate the effect of a physical activity telemonitoring program on daily physical activity level , oxygen uptake capacity ( VO2peak ) , and cardiovascular risk profile in coronary artery disease ( CAD ) patients who completed phase II cardiac rehabilitation ( CR ) . Methods Eighty CAD patients who completed phase II CR were r and omly assigned to an additional telemonitoring intervention or st and ard CR . The patients in the intervention group ( n = 40 ) wore a motion sensor continuously for 18 weeks . Each week these patients received a step count goal , with the aim to gradually increase the patients ’ physical activity level . In the control group ( n = 40 ) , the patients wore an unreadable motion sensor for seven days for measurement purpose s only ( at start of follow-up , and after six and 18 weeks ) . At start of follow-up and after 18 weeks blood lipid profile , glycemic control , waist circumference and body mass index was assessed . VO2peak was assessed at start of follow-up , and after six and 18 weeks . Re-hospitalisation rate was followed during this timeframe . Results In the intervention group , VO2peak increased significantly during follow-up ( P = 0.001 ) , in the control group it did not ( P = 0.273 ) . A significant correlation was found between daily aerobic step count and improvement in VO2peak ( P = 0.030 , r = 0.47 ) . Kaplan-Meier curve analysis showed a trend towards fewer re-hospitalisations for patients in the telemonitoring group ( P = 0.09 ) . Conclusions The study showed that , to maintain exercise tolerance and lower re-hospitalisation rate after hospital-based CR in CAD patients , a physical activity telemonitoring program might be an effective intervention AIM To determine the efficacy of delivering short-message service ( SMS ) to provide diabetes-related information in reducing the risk of developing diabetes in Chinese professional drivers with pre-diabetes . METHODS A pilot single-blinded r and omized controlled trial was conducted in Hong Kong between 05/2009 and 04/2012 . Professional drivers with impaired glucose tolerance ( IGT ) were r and omly allocated to either a SMS group receiving messages comprising knowledge and lifestyle modification on diabetes or to a control group with usual care . Primary outcomes were the incidence rate of diabetes mellitus over 12 and 24 months period . RESULTS Fifty-four , out of 104 professional drivers recruited , were r and omly allocated to intervention group . Fewer subjects developed diabetes at 12 months in intervention group ( 5.56 % ) compared to control group ( 16.00 % ) . Relative risk ( RR ) of diabetes onset was 0.35 ( 95%CI : 0.10–1.24 ) and the number needed to treat ( NNT ) for preventing one diabetes was 9.57 . At 24 months , RR increased to 0.62 ( 95%CI : 0.24–1.61 ) with a NNT of 10.58 . Logistic regression showed a significant odds ratio of 0.04 ( P = 0.021 ) for intervention group compared to control group at 12-month follow-up for completers and a non-significant odds ratio of 0.34 ( P = 0.303 ) at 24-month follow-up . CONCLUSIONS The SMS program proved to have potential to reduce the risk of developing diabetes at 12 months but additional measures should be integrated to prevent or delay disease progression OBJECTIVE To analyze the effect of an intervention to provide information with mobile phone text messages to patients with hypertension on compliance with therapy for hypertension . DESIGN Comparative , controlled , multicenter , r and omized cluster study . SETTING 26 primary care health centers in Spain . PARTICIPANTS 26 research ers were r and omized to a control group or an intervention group ( 52 patients each , for a total of 104 patients ) . All patients were receiving monotherapy for uncontrolled hypertension . INTERVENTION Patients in the control group received their physician 's usual interventions . Patients in the intervention group received messages and reminders sent to their mobile phones 2 days per week during 4 months . MAIN OUTCOME MEASURES Tablets were counted and blood pressure was measured at the start of the study and 1 , 3 , and 6 months later . The percentage of compliers , mean percentage of compliance and degree of control of hypertension were compared . The reduction in absolute and relative risk was calculated , as was the number of individuals needed to treat to avoid noncompliance . RESULTS The results were evaluated for a total of 67 individuals ( 34 in the intervention group and 33 in the control group ) . The rate of compliance was 85.1 % ( CI , 74.9%-95.3 % ) overall , 85.7 % ( CI , 70.5%-100.9 % ) in the control group and 84.4 % in the intervention group ( CI , 70.7%-95.3 % ) ( P = NS ) . Mean percentage compliance was 90.2%+/-16.3 % overall , 88.1%+/-20.8 % in the control group and 91.9%+/-11.6 % in the intervention group ( P = NS ) . The percentage of patients whose hypertension was controlled at the end of the study was 51.5 % ( CI , 34.4%-68.6 % ) in the control group and 64.7 % ( CI , 48.6%-80.8 % ) in the intervention group ( P = NS ) . CONCLUSIONS The telephone messaging intervention with alerts and reminders sent to mobile phones did not improve compliance with therapy in patients with hypertension Background Telemonitoring of patients with chronic heart failure ( CHF ) is an emerging concept to detect early warning signs of impending acute decompensation in order to prevent hospitalization . Objective The goal of the MOBIle TELemonitoring in Heart Failure Patients Study ( MOBITEL ) was to evaluate the impact of home-based telemonitoring using Internet and mobile phone technology on the outcome of heart failure patients after an episode of acute decompensation . Methods Patients were r and omly allocated to pharmacological treatment ( control group ) or to pharmacological treatment with telemedical surveillance for 6 months ( tele group ) . Patients r and omized into the tele group were equipped with mobile phone – based patient terminals for data acquisition and data transmission to the monitoring center . Study physicians had continuous access to the data via a secure Web portal . If transmitted values went outside individually adjustable borders , study physicians were sent an email alert . Primary endpoint was hospitalization for worsening CHF or death from cardiovascular cause . Results The study was stopped after r and omization of 120 patients ( 85 male , 35 female ) ; median age was 66 years ( IQR 62 - 72 ) . The control group comprised 54 patients ( 39 male , 15 female ) with a median age of 67 years ( IQR 61 - 72 ) , and the tele group included 54 patients ( 40 male , 14 female ) with a median age of 65 years ( IQR 62 - 72 ) . There was no significant difference between groups with regard to baseline characteristics . Twelve tele group patients were unable to begin data transmission due to the inability of these patients to properly operate the mobile phone ( “ never beginners ” ) . Four patients did not finish the study due to personal reasons . Intention-to-treat analysis at study end indicated that 18 control group patients ( 33 % ) reached the primary endpoint ( 1 death , 17 hospitalizations ) , compared with 11 tele group patients ( 17 % , 0 deaths , 11 hospitalizations ; relative risk reduction 50 % , 95 % CI 3 - 74 % , P = .06 ) . Per- protocol analysis revealed that 15 % of tele group patients ( 0 deaths , 8 hospitalizations ) reached the primary endpoint ( relative risk reduction 54 % , 95 % CI 7 - 79 % , P= .04 ) . NYHA class improved by one class in tele group patients only ( P < .001 ) . Tele group patients who were hospitalized for worsening heart failure during the study had a significantly shorter length of stay ( median 6.5 days , IQR 5.5 - 8.3 ) compared with control group patients ( median 10.0 days , IQR 7.0 - 13.0 ; P= .04 ) . The event rate of never beginners was not higher than the event rate of control group patients . Conclusions Telemonitoring using mobile phones as patient terminals has the potential to reduce frequency and duration of heart failure hospitalizations . Providing elderly patients with an adequate user interface for daily data acquisition remains a challenging component of such a concept BACKGROUND Cardiovascular disease ( CVD ) is the leading cause of morbidity , mortality , and cost in Western society . Employer-sponsored work health programs ( WHPs ) and Web-based portals for monitoring and providing guidance based on participants ' health risk assessment s are emerging , yet online technologies to improve CVD health in the workplace are relatively unproven . We hypothesized that an online WHP , comprehensively addressing multiple facets of CVD , can be successfully implemented and improve the health of participants . METHODS A cohort of employees in Tennessee ( n = 1,602 ) was subjected to a health risk assessment at baseline . Those who did not meet all 5 healthy benchmarks ( n = 836)-body mass index , blood pressure , glucose , total cholesterol , and smoking status-were prospect ively assigned to a Web-based personal health assistant and had repeat measurements taken at 90 days . RESULTS Of those who both completed the personal health assistant program and underwent baseline plus 90-day assessment s ( 508/836 , 61 % ) , 75 % were female , mean age was 46.5 ± 11.1 years , and the mean number of risk factors  at baseline was 1.1 ± 0.9 with a mean 10-year Framingham Risk Score of 2.9 % . This cohort demonstrated a significant reduction in total cholesterol ( P < .0001 ) , low-density lipoprotein cholesterol ( P < .0001 ) , triglycerides ( P < .0001 ) , systolic blood pressure ( P = .009 ) , glucose ( P = .004 ) , weight ( P = .001 ) , and body mass index ( P = .001 ) . Most of the participants improved at least 1 risk factor . Framingham Risk 10-year cardiovascular risk percentages were significantly reduced ( P = .003 ) . CONCLUSIONS This study in a prospect i ve cohort of community-dwelling employees suggests that an online WHP can provide a viable means to improve surrogates of CVD risk factors Background People with Familial Hypercholesterolemia ( FH ) may benefit from lifestyle changes supporting their primary treatment of dyslipidaemia . This project evaluated the efficacy of an individualised tailored lifestyle intervention on lipids ( low density lipoprotein cholesterol ( LDL-C ) , high density lipoprotein cholesterol ( HDL-C ) , total cholesterol ( TC ) and triglycerides ) , systolic blood pressure , glucose , body mass index ( BMI ) and waist circumference in people with FH . Methods Adults with FH ( n = 340 ) , recruited from a Dutch cascade screening program , were r and omly assigned to either a control group or an intervention group . The personalised intervention consisted of web-based tailored lifestyle advice and personal counselling . The control group received care as usual .  Lipids , systolic blood pressure , glucose , BMI , and waist circumference were measured at baseline and after 12 months . Regression analyses were conducted to examine differences between both groups . Results After 12 months , no significant between-group differences of cardiovascular disease ( CVD ) risk indicators were observed . LDL-C levels had decreased in both the intervention and control group . This difference between intervention and control group was not statistically significant . Conclusions This project suggests that an individually tailored lifestyle intervention did not have an additional effect in improving CVD risk indicators among people with FH . The cumulative effect of many small improvements in all indicators on long term CVD risk remains to be assessed in future studies .Trial registration NTR1899 at Background Diet is the first line of treatment for elevated cholesterol . High-intensity dietary counseling ( ≥360 minutes/year of contact with providers ) improves blood lipids , but is expensive and unsustainable in the current healthcare setting s. Low-intensity counseling trials ( ≤ 30 minutes/year ) have demonstrated modest diet changes , but no improvement in lipids . This pilot study evaluated the feasibility and the effects on lipids and diet of a low-intensity dietary counseling intervention provided by the primary care physician ( PCP ) , in patients at risk for cardiovascular diseases . Methods Six month study with a three month r and omized-controlled phase ( group A received the intervention , group B served as controls ) followed by three months of intervention in both groups . Sixty-one adults age 21 to 75 years , with LDL-cholesterol ≥ 3.37 mmol/L , possessing Internet access and active email accounts were enrolled . Diet was evaluated using the Rate-Your-Plate question naire . Dietary counseling was provided by the PCP during routine office visits , three months apart , using printed educational material s and a minimally interactive counseling website . Weekly emails were sent reminding participants to use the dietary counseling re sources . The outcomes were changes in LDL-cholesterol , other lipid subclasses , and diet quality . Results At month 3 , group A ( counseling started at month 1 ) decreased their LDL-cholesterol by −0.23 mmol/L , ( −0.04 to −0.42 mmol/L , P = 0.007 ) and total cholesterol by −0.26 mmol/L , ( −0.05 to −0.47 mmol/L , P = 0.001 ) . At month 6 , total and LDL-cholesterol in group A remained better than in group B ( counseling started at month 3 ) . Diet score in group A improved by 50.3 points ( 38.4 to 62.2 , P < 0.001 ) at month 3 ; and increased further by 11.8 ( 3.5 to 20.0 , P = 0.007 ) at month 6 . Group B made the largest improvement in diet at month 6 , 55 points ( 40.0 to 70.1 , P < 0.001 ) , after having a small but significant improvement at month 3 , 22.3 points ( 12.9 to 31.7 , P < 0.001 ) . No significant changes occurred in HDL-cholesterol in either group . Conclusions A low-intensity dietary counseling provided by the PCP in patients at risk for cardiovascular diseases produced clinical ly meaningful improvements in both diet and lipids of magnitude similar to changes reported with high intensity interventions .Trial registration Clinical Trials.gov : PURPOSE The present study evaluated whether an intervention using a short message service ( SMS ) by personal cellular phone and Internet would reduce cardiovascular risk factors in post-menopausal women with abdominal obesity over 12 weeks . METHODS This is a quasi-experimental design with pre and post tests . Participants were recruited from the gynecology outpatient and family medicine departments of a tertiary care hospital located in an urban city of South Korea . Only 67 subjects completed the entire study , 34 in the intervention group and 33 controls . The goal of intervention was to reduce waist circumference ( WC ) , body weight ( BW ) and blood pressure ( BP ) levels . Before the intervention , demographic variables , WC , BW , BP , fasting plasma glucose ( FPG ) and serum lipids were measured as pre-test data . The WC , BW , BP , FPG and serum lipids were measured again 12 weeks later . Patients in the intervention group were requested to record their WC , BW , BP , type and amount of diet and exercise  in a weekly web-based diary through the Internet or by cellular phone . The research ers sent weekly recommendations on diet and exercise as an intervention to each patient , by both cellular phone and Internet . The intervention was applied for 12 weeks . RESULTS WC and BW significantly decreased by 3.0 cm and 2.0 kg , respectively , at 12 weeks compared with the baseline in the intervention group . However , the mean changes in the control group significantly increased by 0.9 cm and 0.7 kg . Systolic BP ( SBP ) and diastolic BP ( DBP ) significantly decreased by 6.5 and 4.6 mmHg in the intervention group , respectively . The mean changes in the control group were not significant in either SBP or DBP . A significant mean decrease in total cholesterol ( TC ) was observed for the intervention group by 12.9 mg/dl , while the control group showed a significant mean increase by 1.5mg/dl . Low-density lipoprotein-cholesterol ( LDL-C ) for the intervention group showed a significant mean decrease 11.3mg/dl . The mean change in the control group was , however , not significant . CONCLUSION Web-based individual intervention using both SMS and Internet improved WC , BW , BP , TC , and LDL-C during 12 weeks in post-menopausal women with abdominal obesity Introduction There is important evidence on the beneficial effects of treatment of cardiovascular risk factors in terms of morbidity and mortality , but important challenges remain in motivating patients to adhere to their treatment regimen . This study aim ed to describe the effectiveness of a quality improvement intervention that included information and regular encouragement by email or letter on cardiovascular risk factors for patients at high risk for cardiovascular disease . Methods This r and omized single-blind study included patients of both sexes aged between 45 and 80 years old who had increased cardiovascular risk . Patients were r and omly allocated to either a usual care group ( UCG ) or advanced care group ( ACG ) . Patients in the UCG received regular care while patients in the ACG received usual care plus regular information and encouragement on cardiovascular risk factors by email or letter . Visits for both groups were planned at 0 , 3 , and 6 months . The outcome measures were blood pressure , weight , body mass index ( BMI ) , waist circumference ( WC ) , and smoking status . Results Out of 178 eligible patients from one single primary care practice , 55 participated in the study , three of whom dropped out . After 6 months , there was a significant decrease in mean systolic and diastolic blood pressure in the UCG and ACG ( P < 0.05 ) . The decreases were already significant after 3 months , except for systolic blood pressure in the UCG . There was also a significant increase in the proportion of patients who met the target values for blood pressure in the UCG and ACG . There was a nonsignificant decrease of the average weight in the ACG , but significantly more patients lost weight in the UCG ( P = 0.02 ) . BMI , WC , and smoking status did not change in either group . Conclusion This study found that there was a significant decrease of systolic and diastolic blood pressure in both study groups . Weight , BMI , WC , and smoking did not improve in either group . Information on cardiovascular risk factors and encouragement by means of letters or email did not provide additional benefits . Thus , effective patient empowerment probably requires more behaviorally sophisticated support to increase self-management , self-efficacy , and self-esteem in patients Background Using the Internet may prove useful in providing nutrition counselling and social support for patients with chronic diseases . Objective We evaluated the impact of Web-based nutrition counselling and social support on social support measures , anthropometry , blood pressure , and serum cholesterol in patients at increased cardiovascular risk . Methods We conducted a r and omized controlled trial among patients with increased cardiovascular risk in Canadian family practice s. During 8 months , patients in the intervention group and control groups received usual care . Patients in the intervention group also had access to a Web-based nutrition counselling and social support tool ( Heartweb ) . Site use during the study was monitored . We measured social support , body mass index , waist/hip ratio , blood pressure , and cholesterol levels at baseline and at 4 and 8 months to assess the effectiveness of the intervention . Results We r and omized 146 patients into the Web-based intervention ( n=73 ) or the control group ( n=73 ) . Within the Web-based intervention group , Heartweb was used by only 33 % ( 24/73 ) of patients , with users being significantly younger than nonusers ( P=.03 ) . There were no statistically significant differences between the intervention group and the control group in changes in social support , anthropometry , blood pressure , and serum cholesterol levels . Conclusions Uptake of the Web-based intervention was low . This study showed no favourable effects of a Web-based nutrition counselling and social support intervention on social support , anthropometry , blood pressure , and serum cholesterol . Improvements in reach and frequency of site use are needed to increase the effectiveness of Web-based interventions BACKGROUND We evaluated an Internet- and telephone-based telemedicine system for reducing blood pressure ( BP ) in underserved subjects with hypertension . METHODS A total of 241 patients with systolic BP ≥140 mm Hg were r and omized to usual care ( C ; n = 121 ) or telemedicine  ( T ; n = 120 ) . The T group reported BP , heart rate , weight , steps/day , and tobacco use twice weekly . The primary outcome was BP control at 6 months . RESULTS Average age was 59.6 years , average body mass index was 33.7 kg/m(2 ) , 79 % were female , 81 % were African American , 15 % were white , 53 % were at or below the federal poverty level , 18 % were smokers , and 32 % had diabetes . Six-month follow-up was achieved in 206 subjects ( C : 107 , T : 99 ) . Goal BP was achieved in 52.3 % in C and 54.5 % in T ( P = .43 ) . Systolic BP change ( C : -13.9 mm Hg , T : -18.2 ; P = .118 ) was similar in both groups . Subjects in the T group reported BP 7.7 ± 6.9 d/mo . Results were not affected by age , sex , ethnicity , education , or income . In nondiabetic T subjects , goal BP was achieved in 58.2 % compared with 45.2 % of diabetic T subjects ( P = .024 ) . Nondiabetic T subjects demonstrated a greater reduction in systolic BP ( T : -19 ± 20 mm Hg , C : -12 ± 19 mm Hg ; P = .037 ) . No difference in BP response between C and T was noted in patients with diabetes . CONCLUSION In hypertensive subjects , engagement in a system of care with or without telemedicine result ed in significant BP reduction . Telemedicine for nondiabetic patients result ed in a greater reduction in systolic BP compared with usual care . Telemedicine may be a useful tool for managing hypertension particularly among nondiabetic subjects Recent studies have suggested a favorable effect of cardiac rehabilitation ( CR ) on patients with cardiovascular disease . This study aim ed to evaluate the impact of home-based exercise training with wireless monitoring on acute coronary syndrome ( ACS ) patients undergoing percutaneous coronary intervention ( PCI ) . A total of 55 ACS patients undergoing PCI were r and omly divided into home based exercise training with wireless monitoring cardiac rehabilitation ( CR , n = 26 ) and usual care ( UC , n = 29 ) . Exercise capacity and quality of life ( QOL ) were evaluated at baseline and after 12 weeks . Change of metabolic equivalent of the tasks , maximal exercise time and QOL were significantly increased ( + 2.47 vs + 1.43 , P = 0.021 ; + 169.68 vs + 88.31 sec , P = 0.012 ; and + 4.81 vs + 0.89 , P = 0.022 , respectively ) , and the change of submaximal rate pressure product , and of submaximal rate of perceived exertion were significantly decreased ( -28.24 vs -16.21 , P = 0.013 ; and -1.92 vs -1.62 , P = 0.018 , respectively ) in the CR group compared to the UC group after 12 weeks . CR using home-based exercise training with wireless monitoring led to improvement of exercise capacity and QOL relative to conventional care in ACS patients undergoing PCI . Our findings suggest that early scheduled CR may be considered in ACS patients undergoing PCI Obese patients were coached after inpatient medical rehabilitation with a 6 units comprehensive multimodal Liveonline aftercare program . In the r and omized controlled study design , significant improvements in all outcome criteria were found both in treatment and control group . The improvements in the treatment group , however , were only partially superior to the control group , especially in the area of food habits . A statistically significant superiority of the treatment group concerning the primary targets waist circumference and body mass index could not be determined . The Liveonline aftercare was evaluated positively by the participants . Future research is discussed Background Cardiovascular disease is a major cause of mortality and morbidity and its prevalence is set to increase . While the benefits of medical and lifestyle interventions are established , the effectiveness of interventions which seek to improve the way preventive care is delivered in general practice is less so . The aim was to study and to compare the effectiveness of 2 intervention programmes for reducing cardiovascular risk factors within general practice . Methods A r and omised controlled trial was conducted in Belgium between 2007 - 2010 with 314 highly educated and mainly healthy professionals allocated to a medical ( MP ) or a medical + lifestyle ( MLP ) programme . The MP consisted of medical assessment s ( screening and follow-up ) and the MLP added a tailored lifestyle change programme ( web-based and individual coaching ) to the MP . Primary outcomes were total cholesterol , blood pressure , and body mass index ( BMI ) . The secondary outcomes were smoking status , fitness-score , and total cardiovascular risk . Results The mean age was 41 years , 95 ( 32 % ) participants were female , 7 had a personal cardiovascular event in their medical history and 3 had diabetes . There were no significant differences found between MP and MLP in primary or secondary outcomes . In both study conditions decreases of cholesterol , systolic blood pressure , and diastolic blood pressure were found . Unfavourable increases were found for BMI ( p < .05 ) . A significant decrease of the overall cardiovascular risk was reported ( p < .001 ) . Conclusions Both interventions are effective in reducing cardiovascular risk . In our population the combined medical and lifestyle programme was not superior to the medical programme . Trial registration IS RCT Background We investigated whether macronutrient composition of energy-restricted diets influences the efficacy of a telemedically guided weight loss program . Methods Two hundred overweight subjects were r and omly assigned to a conventional low-fat diet and a low-carbohydrate diet group ( target carbohydrate content : > 55 % energy and < 40 % energy , respectively ) . Both groups attended a weekly nutrition education program and dietary counselling by telephone , and had to transfer actual body weight data to our clinic weekly with added Bluetooth ® technology by mobile phone . Various fatness and fat distribution parameters , energy and macronutrient intake , and various biochemical risk markers were measured at baseline and after 6 , and 12 months . Results In both groups , energy intake decreased by 400 kcal/d compared to baseline values within the first 6 months and slightly increased again within the second 6 months . Macronutrient composition differed significantly between the groups from the beginning to month 12 . At study termination , weight loss was 5.8 kg ( SD : 6.1 kg ) in the low-carbohydrate group and 4.3 kg ( SD : 5.1 kg ) in the low-fat group ( p = 0.065 ) . In the low-carbohydrate group , triglyceride and HDL-cholesterol levels were lower at month 6 and waist circumference and systolic blood pressure were lower at month 12 compared with the low-fat group ( P = 0.005–0.037 ) . Other risk markers improved to a similar extent in both groups . Conclusion Despite favourable effects of both diets on weight loss , the carbohydrate-reduced diet was more beneficial with respect to cardiovascular risk factors compared to the fat-reduced diet . Nevertheless , compliance with a weight loss program appears to be even a more important factor for success in prevention and treatment of obesity than the composition of the diet . Trial registration Clinical trials.gov as Background Efficacious strategies for the primary prevention of coronary heart disease ( CHD ) are underused , and , when used , have low adherence . Existing efforts to improve use and adherence to these efficacious strategies have been so intensive that they are impractical for clinical practice . Methods We conducted a r and omized trial of a CHD prevention intervention ( including a computerized decision aid and automated tailored adherence messages ) at one university general internal medicine practice . After obtaining informed consent and collecting baseline data , we r and omized patients ( men and women age 40 - 79 with no prior history of cardiovascular disease ) to either the intervention or usual care . We then saw them for two additional study visits over 3 months . For intervention participants , we administered the decision aid at the primary study visit ( 1 week after baseline visit ) and then mailed 3 tailored adherence reminders at 2 , 4 , and 6 weeks . We assessed our outcomes ( including the predicted likelihood of angina , myocardial infa rct ion , and CHD death over 10 years ( CHD risk ) and self-reported adherence ) between groups at 3 month follow-up . Data collection occurred from June 2007 through December 2009 . All study procedures were IRB approved . Results We r and omized 160 eligible patients ( 81 intervention ; 79 control ) and followed 96 % to study conclusion . Mean predicted CHD risk at baseline was 11.3 % . The intervention increased self-reported adherence to chosen risk reducing strategies by 25 percentage points ( 95 % CI 8 % to 42 % ) , with the biggest effect for aspirin . It also changed predicted CHD risk by -1.1 % ( 95 % CI -0.16 % to -2 % ) , with a larger effect in a pre-specified subgroup of high risk patients . Conclusion A computerized intervention that involves patients in CHD decision making and supports adherence to effective prevention strategies can improve adherence and reduce predicted CHD risk . Clinical trials registration number Clinical Trials.gov : Background Although the hazardous health effects of a sedentary lifestyle are well known , many adults struggle with regular physical activity . Simple and efficient encouragements for increased physical activity are needed . Objective To determine the effect on cardiovascular health of email-based encouragements to do daily stair-walks at work together with colleagues among adults in sedentary occupations . Methods A single-blind r and omized controlled trial was performed at a large administrative company in Copenhagen , Denmark . Participants were 160 office workers ( 125 women , 35 men ; mean age 42 years , SD 10 ; sitting 89.5 % of work time ) . At baseline , aerobic fitness was 37 mL/min/kg ( SD 9 ) , mean blood pressure was 118/79 mmHg ( SD 14/9 ) , and mean body mass index ( BMI ) was 23 kg/m2 ( SD 4 ) . Participants were r and omly assigned ( 2:1 ratio ) to an email group receiving weekly email-based encouragements to walk the stairs for 10 minutes a day or to a control group receiving weekly reminders to continue their usual physical activities . The primary outcome was the change from baseline to 10-week follow-up in aerobic fitness determined from a maximal cycle test . The examiner was blinded to group allocation . Results Adherence to the email encouragements  was fairly high with 82.7 % of the participants performing at least 3 sessions of 10-minute stair-walks per week ( mean 3.3 , SD 1.3 ) . Mean heart rate reached 167 beats/min ( SD 10 ) during stair-walks . In the intention-to-treat analysis , aerobic fitness increased 1.45 mL/min/kg ( 95 % CI 0.64 - 2.27 ) at 10-week follow-up in the email group compared with the control group . In participants with low aerobic fitness at baseline ( n=56 ) , aerobic fitness increased 1.89 mL/min/kg ( 95 % CI 0.53 - 3.24 ) , and systolic and diastolic blood pressure decreased 4.81 mmHg ( 95 % CI 0.47 - 9.16 ) and 2.67 mmHg ( 95 % CI 0.01 - 5.32 ) , respectively , in the email group compared with the control group . Body weight decreased in the email group of those with low aerobic fitness compared with the control group , but this was not statistically significant . Conclusions Simple and inexpensive email-based encouragements to do daily stair-walks together with colleagues at work improves cardiovascular health among adults in sedentary occupations . There exists an enormous potential to prevent the hazardous health effects of a sedentary lifestyle through the use of email-based encouragements to do short bouts of physical activity at the workplace . Trial Registration Clinical trials.gov NCT01293253 ; http:// clinical trials.gov/ct2/show/NCT01293253 ( Archived by WebCite at http://www.webcitation.org/6HWG2jw68 ) BACKGROUND Control of blood pressure is a key component of cardiovascular disease prevention , but is difficult to achieve and until recently has been the sole preserve of health professionals . This study assessed whether self-management by people with poorly controlled hypertension result ed in better blood pressure control compared with usual care . METHODS This r and omised controlled trial was undertaken in 24 general practice s in the UK . Patients aged 35 - 85 years were eligible for enrolment if they had blood pressure more than 140/90 mm Hg despite antihypertensive treatment and were willing to self-manage their hypertension . Participants were r and omly assigned in a 1:1 ratio to self-management , consisting of self-monitoring of blood pressure and self-titration of antihypertensive drugs , combined with telemonitoring of home blood pressure measurements or to usual care . R and omisation was done by use of a central web-based system and was stratified by general practice with minimisation for sex , baseline systolic blood pressure , and presence or absence of diabetes or chronic kidney disease . Neither participants nor investigators were masked to group assignment . The primary endpoint was change in mean systolic blood pressure between baseline and each follow-up point ( 6 months and 12 months ) . All r and omised patients who attended follow-up visits at 6 months and 12 months and had complete data for the primary outcome were included in the analysis , without imputation for missing data . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N17585681 . FINDINGS 527 participants were r and omly assigned to self-management ( n=263 ) or control ( n=264 ) , of whom 480 ( 91 % ; self-management , n=234 ; control , n=246 ) were included in the primary analysis . Mean systolic blood pressure decreased by 12.9 mm Hg ( 95 % CI 10.4 - 15.5 ) from baseline to 6 months in the self-management group and by 9.2 mm Hg ( 6.7 - 11.8 ) in the control group ( difference between groups 3.7 mm Hg , 0.8 - 6.6 ; p=0.013 ) . From baseline to 12 months , systolic blood pressure decreased by 17.6 mm Hg ( 14.9 - 20.3 ) in the self-management group and by 12.2 mm Hg ( 9.5 - 14.9 ) in the control group ( difference between groups 5.4 mm Hg , 2.4 - 8.5 ; p=0.0004 ) . Frequency of most side-effects did not differ between groups , apart from leg swelling ( self-management , 74 patients [ 32 % ] ; control , 55 patients [ 22 % ] ; p=0.022 ) . INTERPRETATION Self-management of hypertension in combination with telemonitoring of  blood pressure measurements represents an important new addition to control of hypertension in primary care . FUNDING Department of Health Policy Research Programme , National Coordinating Centre for Research Capacity Development , and Midl and s Research Practice s Consortium Background : In this study , we tested the efficacy of a low-intensity lifestyle intervention aim ed at reducing the risk of cardiovascular disease among mid-life individuals . Methods : We conducted a r and omized controlled trial in which participants were r and omly assigned either to receive a health report card with counselling ( from a Telehealth nurse ) on smoking , exercise , nutrition and stress or to receive usual care . The patients were divided into 2 groups on the basis of risk : the primary prevention group , with a Framingham risk score of 10 % or higher ( intervention , n = 157 ; control , n = 158 ) , and the secondary prevention group , who had a diagnosis of coronary artery disease ( intervention , n = 153 ; control , n = 143 ) . The primary outcome was a change in the Framingham global risk score between baseline and 1-year follow-up . Data were analyzed separately for the 2 prevention groups using an intention-to-treat analysis controlling for covariates . Results : Within the primary prevention group , there were statistically significant changes for the treatment group relative to the controls , from baseline to year 1 , in Framingham score ( intervention , –3.10 [ 95 % confidence interval ( CI ) –3.98 to –2.22 ] ; control , –1.30 [ 95 % CI –2.18 to –0.42 ] ; p < 0.01 ) and scores for total cholesterol ( intervention , –0.41 [ 95 % CI –0.59 to –0.23 ] ; control , –0.14 [ 95 % CI –0.32 to 0.04 ] ; p < 0.05 ) , systolic blood pressure ( intervention , –7.49 [ 95 % CI –9.97 to –5.01 ] ; control , –3.58 [ 95 % CI –6.08 to –1.08 ] ; p < 0.05 ) , nutrition level ( intervention , 0.30 [ 95 % CI 0.13 to 0.47 ] ; control , –0.05 [ 95 % CI –0.22 to 0.12 ] ; p < 0.01 ) , and health confidence ( intervention , 0.20 [ 95 % CI 0.09 to 0.31 ] ; control , 0.04 [ 95 % CI –0.07 to 0.15 ] ; p < 0.05 ) , with adjustment for covariates . No significant changes in outcome variables were found for the secondary prevention group . Interpretation : We found evidence for the efficacy of an intervention addressing multiple risk factors for primary prevention at 1 year using Framingham risk score report cards and telephone counselling . ( Requirement for clinical trial registration waived [ enrolment completed before requirement became applicable ] . OBJECTIVE To evaluate the feasibility of a web-based coaching programme for vascular risk factor treatment , to describe the patterns of use and to measure changes in risk factors . METHODS Patients with a clinical manifestation of arterial disease and Internet access were asked to participate in the nurse-led Internet-based risk factor management programme . At the first clinic visit , a personalized action plan was made for the treatment of risk factors . Patients were instructed on communication with a specialized nurse through Internet and encouraged to enter self-measured risk factor levels at their personalized website . The nurse practitioner replied on working days and gave feedback , support , and recommendations on lifestyle and medical treatment . After 6 months , risk factors were re-measured . RESULTS Fifty patients participated , 70 % were overweight , 64 % had hypertension , 42 % hyperlipidemia , and 24 % smoked at baseline . During 6 months , the log-in average at the individual website was 35 times per patient ( 1.3 log-ins/week ) ; while the nurse practitioner logged-in at the overall website 23 times/week . The website was hardly used by five patients . Most e-mail messages were sent by patients for hypertension ( 211 times ) and obesity ( 203 times ) , whereas the nurse practitioner sent nearly twice as many e-mail messages for hypertension ( 400 times ) and obesity ( 455 times ) . The level of most risk factors decreased and the fraction of achieved treatment goals increased ( blood pressure from 36 to 58 % , LDL-cholesterol from 58 to 64 % , glucose from 64 to 82 % ) . CONCLUSIONS A web-based vascular risk factor intervention programme is feasible ; it is frequently used by patients and suitable to decrease the level of several risk factors . It has the promise of being an efficacious intervention for risk factor sanitation in patients with symptomatic vascular disease . PRACTICE IMPLICATION S An Internet-based individualised risk management programme could make patients aware of their self-management capability and may contribute to risk factor reduction OBJECTIVE To examine the effects and dose-response effects of an intervention on health behavior ( fat intake , physical activity , and smoking ) and Body Mass Index ( BMI ) in a sample of highly educated adults . METHODS Participants were r and omized to a ' usual care ' condition ( = medical assessment ) ( n=106 ) and an intervention condition ( = cardiovascular prevention program )  that additionally included a website and one-on-one coaching ( by e-mail , telephone , and /or face-to-face ) ( n=208 ) . The participants could select their own intervention dose and delivery mode . RESULTS Participants completed question naires at baseline ( n=93 ; n=194 ) and 6 months post-baseline ( n=84 ; n=168 ) . The intervention was not more effective than ' usual care ' but a higher intervention dose led to better outcomes for fat intake and physical activity , independent of baseline motivation . Furthermore , the effect of combining different delivery modes was dependent on the behavioral context . CONCLUSION A higher intervention dose led to better results but allowing people to select their own intervention dose probably undermined the potential intervention effect . PRACTICE IMPLICATION S The present study highlights the importance of intervention dose and delivery mode for the development , evaluation , and optimization of health promotion programs BACKGROUND Obesity and its cardiovascular complications are extremely common medical problems , but evidence on how to accomplish weight loss in clinical practice is sparse . METHODS We conducted a r and omized , controlled trial to examine the effects of two behavioral weight-loss interventions in 415 obese patients with at least one cardiovascular risk factor . Participants were recruited from six primary care practice s ; 63.6 % were women , 41.0 % were black , and the mean age was 54.0 years . One intervention provided patients with weight-loss support remotely -- through the telephone , a study -specific Web site , and e-mail . The other intervention provided in-person support during group and individual sessions , along with the three remote means of support . There was also a control group in which weight loss was self-directed . Outcomes were compared between each intervention group and the control group and between the two intervention groups . For both interventions , primary care providers reinforced participation at routinely scheduled visits . The trial duration was 24 months . RESULTS At baseline , the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) for all participants was 36.6 , and the mean weight was 103.8 kg . At 24 months , the mean change in weight from baseline was -0.8 kg in the control group , -4.6 kg in the group receiving remote support only ( P<0.001 for the comparison with the control group ) , and -5.1 kg in the group receiving in-person support ( P<0.001 for the comparison with the control group ) . The percentage of participants who lost 5 % or more of their initial weight was 18.8 % in the control group , 38.2 % in the group receiving remote support only , and 41.4 % in the group receiving in-person support . The change in weight from baseline did not differ significantly between the two intervention groups . CONCLUSIONS In two behavioral interventions , one delivered with in-person support and the other delivered remotely , without face-to-face contact between participants and weight-loss coaches , obese patients achieved and sustained clinical ly significant weight loss over a period of 24 months . ( Funded by the National Heart , Lung , and Blood Institute and others ; Clinical Trials.gov number , NCT00783315 . ) Less than 25 % of eligible patients attend cardiac rehabilitation programs ( CRP )  , with geographical proximity being a predominant barrier . Therefore , we undertook a pilot study to assess the feasibility and safety of using the Internet as a medium for delivery of an interactive " virtual " CRP ( vCRP ) to patients at a distance . Fifteen patients on the waiting list for a local hospital-based CRP were r and omized to either an Internet-based vCRP or observational control . The vCRP consisted of on-line intake forms , one-on-one chat sessions with a nurse , dietitian , and exercise specialist , downloadable exercise heart rate monitoring , education and data monitoring of blood pressure , weight , and glucose . Participants were assessed for exercise capacity , risk factors , and lifestyle behaviors at baseline and at 12 weeks . Those in the vCRP logged onto the Internet-based CRP an average of 4.2 times per week . There were no adverse events in the vCRP participants . The vCRP group significantly improved their HDL-C , triglycerides , total cholesterol : HDL-C ratio , exercise capacity as assessed in metabolic equivalents , weekly physical activity , and exercise specific self-efficacy ( p < 0.05 ) . There were no significant improvements in the control group . Improvements in the vCRP group were similar to historical controls in a st and ard CRP . Feedback from exit interviews of the vCRP participants was unanimously positive . This Internet-based CRP result ed in clinical ly significant improvements in risk factors and exercise capacity similar to that of a st and ard CRP . The high user acceptance indicated that this program may have the potential to effectively manage patients who do not have access to traditional hospital-based CRP BACKGROUND Preventive electronic (e)-counselling has been shown to reduce cardiovascular risk factors . However , heterogeneity in outcomes is commonly reported due to differences in e- protocol s. We incorporated key features of an established behavioural therapy , motivational interviewing , to help st and ardize e-counselling in order to reduce blood pressure in patients with hypertension . METHODS Subjects ( n = 387 , mean age = 56 years , 59 % female , 72 % taking ≥ 1 antihypertensive drug ) were diagnosed with stage 1 or 2 hypertension . Subjects were r and omized to a 4-month protocol of e-counselling ( beta version of the " Blood Pressure Action Plan " , Heart and Stroke Foundation of Canada ) vs waitlist control ( general e-information on heart-healthy living ) . Outcomes were systolic , diastolic , and pulse pressures , and total lipoprotein cholesterol after treatment . RESULTS Intention to treat analysis did not find a significant group difference in outcomes due to contamination across the 2 arms of this trial . However , per protocol analysis indicated that subjects receiving ≥ 8 e-counselling messages ( a priori therapeutic dose ) vs 0 e-counselling messages ( control ) demonstrated greater reduction in systolic blood pressure ( mean , -8.9 mm Hg ; 95 % confidence interval [ CI ] , -11.5 to -6.4 vs -5.0 mm Hg ; 95 % CI , -6.7 to -3.3 , P = 0.03 ) , pulse pressure ( -6.1 mm Hg ; 95 % CI , -8.1 to -4.1 vs -3.1 mm Hg ; 95 % CI , -4.3 to -1.8 , P = 0.02 ) and total cholesterol ( -0.24 mmol/L ; 95 % CI , -0.43 to -0.06 vs 0.05 mmol/L ; 95 % CI , -0.06 to 0.16 , P = 0.03 ) , but not diastolic blood pressure . CONCLUSIONS These findings support the merit of evaluating whether e-counselling can improve blood pressure control and reduce cardiovascular risk over the long-term We evaluated whether telehealth counseling augments lifestyle change and risk factor decrease in subjects at high risk for primary or secondary cardiovascular events compared to a recommended guideline for brief preventive counseling . Subjects at high risk or with coronary heart disease ( 35 to 74 years of age , n = 680 ) were r and omized to active control ( risk factor feedback , brief advice , h and outs ) or telehealth lifestyle counseling ( active control plus 6 weekly 1-hour teleconferenced sessions to groups of 4 to 8 subjects ) . Primary outcome was question naire assessment of adherence to daily exercise/physical activity and diet ( daily vegetable and fruit intake and restriction of fat and salt ) after treatment and at 6-month follow-up . Secondary outcomes were systolic and diastolic blood pressures , ratio of total to high-density lipoprotein cholesterol , and 10-year absolute risk for coronary disease . After treatment and at 6-month follow-up , adherence increased for telehealth versus control in exercise ( 29.3 % and 18.4 % vs 2.5 % and 9.3 % , respectively , odds ratio 1.60 , 95 % confidence interval 1.2 to 2.1 ) and diet ( 37.1 % and 38.1 % vs 16.7 % and 33.3 % , respectively , odds ratio 1.41 , 95 % confidence interval 1.1 to 1.9 ) . Telehealth versus control had greater 6-month decreases in blood pressure ( mean ± SE , systolic -4.8 ± 0.8 vs -2.8 ± 0.9 mm Hg , p = 0.04 ; diastolic -2.7 ± 0.5 vs -1.5 ± 0.6 mm Hg , p = 0.04 ) . Decreases in cholesterol ratio and 10-year absolute risk were significant for the 2 groups . In conclusion , telehealth counseling augments therapeutic lifestyle change in subjects at high risk for cardiovascular events compared to a recommended guideline for brief preventive counseling Evidence is lacking regarding effective and sustainable weight loss approaches for use in the primary care setting . We conducted a 12-week r and omized controlled trial to evaluate the short-term efficacy of a web-based weight loss intervention among 101 primary care patients with obesity and hypertension . Patients had access to a comprehensive website that used a moderate-intensity weight loss approach design ed specifically for web-based implementation . Patients also participated in four ( two in-person and two telephonic ) counseling sessions with a health coach . Intent-to-treat analysis showed greater weight loss at 3 months ( -2.56 kg ; 95 % CI -3.60 , -1.53 ) among intervention participants ( -2.28 + /- 3.21 kg ) , relative to usual care ( 0.28 + /- 1.87 kg ) . Similar findings were observed among intervention completers ( -3.05 kg ; 95 % CI -4.24 , -1.85 ) . High rates of participant retention ( 84 % ) and website utilization were observed , with the greatest weight loss found among those with a high frequency of website logins ( quartile 4 vs. 1 : -4.16 kg ; 95 % CI -1.47 , -6.84 ) . The intervention 's approach promoted moderate weight loss at 12 weeks , though greater weight loss was observed among those with higher levels of website utilization . Efficacious web-based weight loss interventions can be successfully offered in the primary care setting BACKGROUND Increased emphasis is being placed on the critical need to control hypertension ( HTN ) in patients with diabetes . OBJECTIVE The objective of this study was to evaluate the efficacy of a nurse-managed home telehealth intervention to improve outcomes in veterans with comorbid diabetes and HTN . DESIGN A single-center , r and omized , controlled clinical trial design comparing two remote monitoring intensity levels and usual care in patients with type 2 diabetes and HTN being treated in primary care was used . MEASUREMENTS Primary outcomes were hemoglobin A1c and systolic blood pressure ( SBP ) ; secondary outcome was adherence . RESULTS Intervention subjects experienced decreased A1c during the 6-month intervention period compared with the control group , but 6 months after the intervention was withdrawn , the intervention groups were comparable with the control group . For SBP , the high-intensity subjects had a significant decrease in SBP compared with the other groups at 6 months and this pattern was maintained at 12 months . Adherence improved over time for all groups , but there were no differences among the three groups . LIMITATIONS Subjects had relatively good baseline control for A1c and SBP ; minorities and women were underrepresented . CONCLUSIONS Home telehealth provides an innovative and pragmatic approach to enhance earlier detection of key clinical symptoms requiring intervention . Transmission of education and advice to the patient on an ongoing basis with close surveillance by nurses can improve clinical outcomes in patients with comorbid chronic illness Background Many people in Western countries do not follow public health physical activity ( PA ) recommendations . Web-based interventions provide cost- and time-efficient means of delivering individually targeted lifestyle modification at a population level . Objective To examine whether access to a website with individually tailored feedback and suggestions on how to increase PA led to improved PA , anthropometrics , and health measurements . Methods Physically inactive adults ( n = 12,287 ) participating in a nationwide eHealth survey and health examination in Denmark were r and omly assigned to either an intervention ( website ) ( n = 6055 ) or a no-intervention control group ( n = 6232 ) in 2008 . The intervention website was founded on the theories of stages of change and of planned behavior and , apart from a forum page where a physiotherapist answered questions about PA and training , was fully automated . After 3 and again after 6 months we emailed participants invitations to answer a Web-based follow-up question naire , which included the long version of the International Physical Activity Question naire . A subgroup of participants ( n = 1190 ) were invited to a follow-up health examination at 3 months . Results Less than 22.0 % ( 694/3156 ) of the participants logged on to the website once and only 7.0 % ( 222/3159 ) logged on frequently . We found no difference in PA level between the website and control groups at 3- and 6-month follow-ups . By dividing participants into three groups according to use of the intervention website , we found a significant difference in total and leisure-time PA in the website group . The follow-up health examination showed no significant reductions in body mass index , waist circumference , body fat percentage , and blood pressure , or improvements in arm strength and aerobic fitness in the website group . Conclusions Based on our findings , we suggest that active users of a Web-based PA intervention can improve their level of PA . However , for unmotivated users , single-tailored feedback may be too brief . Future research should focus on developing more sophisticated interventions with the potential to reach both motivated and unmotivated sedentary individuals . Trial Registration Clinical trials.gov NCT01295203 ; http:// clinical trials.gov/ct2/show/NCT01295203 ( Archived by WebCite at http://www.webcitation.org/6B7HDMqiQ BACKGROUND Few evidence -based weight loss treatment options exist for medically vulnerable patients in the primary care setting . METHODS We conducted a 2-arm , 24-month r and omized effectiveness trial in 3 Boston community health centers ( from February 1 , 2008 , through May 2 , 2011 ) . Participants were 365 obese patients receiving hypertension treatment ( 71.2 % black , 13.1 % Hispanic , 68.5 % female , and 32.9 % with less than a high school educational level ) . We r and omized participants to usual care or a behavioral intervention that promoted weight loss and hypertension self-management using eHealth components . The intervention included tailored behavior change goals , self-monitoring , and skills training , available via a website or interactive voice response ; 18 telephone counseling calls ; primary care provider endorsement ; 12 optional group support sessions ; and links with community re sources . RESULTS At 24 months , weight change in the intervention group compared with that in the usual care group was -1.03 kg ( 95 % CI , -2.03 to -0.03 kg ) . Twenty-four-month change in body mass index ( calculated as weight in kilograms divided by height in meters squared ) in the intervention group compared with that in the usual care group was -0.38 ( 95 % CI , -0.75 to -0.004 ) . Intervention participants had larger mean weight losses during the 24 months compared with that in the usual care group ( area under the receiver operating characteristic curve , -1.07 kg ; 95 % CI , -1.94 to -0.22 ) . Mean systolic blood pressure was not significantly lower in the intervention arm compared with the usual care arm . CONCLUSION The intervention produced modest weight losses , improved blood pressure control , and slowed systolic blood pressure increases in this high-risk , socioeconomically disadvantaged patient population . Trial Registration clinical trials.gov Identifier : NCT00661817 PURPOSE Despite demonstrated benefits of cardiac rehabilitation and risk factor reduction , only 11 % to 38 % of eligible patients with cardiovascular disease ( CVD ) participate in cardiac rehabilitation programs .  Women and older adults are particularly less likely to participate in cardiac rehabilitation . In an effort to broaden access to cardiac rehabilitation , the authors developed an alternative Internet-based program that allows nurse case managers to provide risk factor management training , risk factor education , and monitoring services to patients with CVD . METHODS The evaluation consisted of a r and omized , clinical trial involving 104 patients with CVD , 53 of whom used the program as a special intervention ( SI ) for 6 months and 51 of whom received usual care ( UC ) .  RESULTS The results indicate that fewer cardiovascular events occurred among the SI subjects ( 15.7 % ) than among the UC subjects ( 4.1 % ) ( P = .053 ) , result ing in a gross cost savings of $ 1418 US dollars per patient . With a projected program cost of $ 453 USD per patient , the return on investment is estimated at 213 % . More weight loss occurred in the SI group ( -3.68 pounds ) than in the UC group ( + .47 pounds ) ( P = .003 ) . The differences between the two groups in terms of blood pressure , lipid levels , depression scores , minutes of exercise , and dietary habits were not statistically significant . CONCLUSION An Internet-based case management system could be used as a cost-effective intervention for patients with CVD , either independently or in conjunction with traditional cardiac rehabilitation Objective To develop and evaluate the effectiveness of a community behavioural intervention to prevent weight gain and improve health related behaviours in women with young children . Design Cluster r and omised controlled trial . Setting A community setting in urban Australia . Participants 250 adult women with a mean age of 40.39 years ( SD 4.77 , range 25 - 51 ) and a mean body mass index of 27.82 kg/m2 ( SD 5.42 , range 18 - 47 ) were recruited as clusters through 12 primary ( elementary ) schools . Intervention Schools were r and omly assigned to the intervention or the control . Mothers whose schools fell in the intervention group ( n=127 ) attended four interactive group sessions that involved simple health messages , behaviour change strategies , and group discussion , and received monthly support using mobile telephone text messages for 12 months . The control group ( n=123 ) attended one non-interactive information session based on population dietary and physical activity guidelines . Main outcome measures The main outcome measures were weight change and difference in weight change between the intervention group and the control group at 12 months . Secondary outcomes were changes in serum concentrations of fasting lipids and glucose , and changes in dietary behaviours , physical activity , and self management behaviours . Results All analyses were adjusted for baseline values and the possible clustering effect . Women in the control group gained weight over the 12 month study period ( 0.83 kg , 95 % confidence interval ( CI ) 0.12 to 1.54 ) , whereas those in the intervention group lost weight ( −0.20 kg , −0.90 to 0.49 ) . The difference in weight change between the intervention group and the control group at 12 months was −1.13 kg ( −2.03 to −0.24 kg ; P<0.05 ) on the basis of observed values and −1.11 kg ( −2.17 to −0.04 ) after multiple imputation to account for possible bias created by missing values . Secondary analyses after multiple imputation showed a difference in the intervention group compared with the control group for total cholesterol concentration ( −0.35 mmol/l , −0.70 to −0.001 ) , self management behaviours ( diet score 0.18 , 0.13 to 0.33 ; physical activity score 0.24 , 0.05 to 0.43 ) , and confidence to control weight ( 0.40 , 0.11 to 0.69 ) . Regular self weighing was associated with weight loss in the intervention group only ( −1.98 kg , −3.75 to −0.23 ) . Conclusions Weight gain  in women with young children could be prevented using a low intensity self management intervention delivered in a community setting . Self management of health behaviours improved with the intervention . The response rate of 12 % , although comparable with that in other community studies , might limit the ability to generalise to other population s. Trial registration Australian New Zeal and Clinical Trials Registry number ACTRN12608000110381 AIMS Chronic heart failure ( CHF ) patients are frequently rehospitalized within 6 months after an episode of fluid retention . Rehospitalizations are preventable , but this requires an extensive organization of the healthcare system . In this study , we tested whether intensive follow-up of patients through a telemonitoring-facilitated collaboration between general practitioners ( GPs ) and a heart failure clinic could reduce mortality and rehospitalization rate . METHODS AND RESULTS One hunderd and sixty CHF patients [ mean age 76 ± 10 years , 104 males , mean left ventricular ejection fraction ( LVEF ) 35 ± 15 % ] were block r and omized by sealed envelopes and assigned to 6 months of intense follow-up facilitated by telemonitoring ( TM ) or usual care ( UC ) . The TM group measured body weight , blood pressure , and heart rate on a daily basis with electronic devices that transferred the data automatically to an online data base . Email alerts were sent to the GP and heart failure clinic to intervene when pre-defined limits were exceeded . All-cause mortality was significantly lower in the TM group as compared with the UC group ( 5 % vs. 17.5 % , P = 0.01 ) . The total number of follow-up days lost to hospitalization , dialysis , or death was significantly lower in the TM group as compared with the UC group ( 13 vs. 30 days , P = 0.02 ) . The number of hospitalizations for heart failure per patient showed a trend ( 0.24 vs. 0.42 hospitalizations/patient , P = 0.06 ) in favour of TM . CONCLUSION Telemonitoring-facilitated collaboration between GPs and a heart failure clinic reduces mortality and number of days lost to hospitalization , death , or dialysis in CHF patients . These findings need confirmation in a large trial PURPOSE : Efficient ways are needed to implement the secondary prevention ( SP ) of coronary heart disease . Because few studies have investigated Web-based SP programs , our aim was to determine the usefulness of a new Web-based telemonitoring system , connecting patients provided with self-measurement devices and care managers via mobile phone text messages , as a tool for SP . METHODS : A single-blind , r and omized controlled , clinical trial of 203 acute coronary syndrome ( ACS ) survivors , was conducted at a hospital in Madrid , Spain . All patients received lifestyle counseling and usual-care treatment . Patients in the telemonitoring group ( TMG ) sent , through mobile phones , weight , heart rate , and blood pressure ( BP ) weekly , and capillary plasma lipid profile and glucose monthly . A cardiologist accessed these data through a Web interface and sent recommendations via short message service . Main outcome measures were BP , body mass index ( BMI ) , smoking status , low-density lipoprotein-cholesterol ( LDL-c ) , and glycated hemoglobin A1c ( HbA1c ) . RESULTS : At 12-month followup , TMG patients were more likely ( RR = 1.4 ; 95 % CI = 1.1−1.7 ) to experience improvement in cardiovascular risk factors profile than control patients ( 69.6 % vs 50.5 % , P = .010 ) . More TMG patients achieved treatment goals for BP ( 62.1 % vs 42.9 % , P = .012 ) and HbA1c ( 86.4 % vs 54.2 % , P = .018 ) , with no differences in smoking cessation or LDL-c . Body mass index was significantly lower in TMG ( −0.77 kg/m2 vs + 0.29 kg/m2 , P = .005 ) . CONCLUSIONS : A telemonitoring program , via mobile phone messages , appears to be useful for improving the risk profile in ACS survivors and can be an effective tool for secondary prevention , especially for overweight patients
target: Overall , these aggregations of data provide evidence that DHIs can reduce CVD outcomes and have a positive impact on risk factors for CVD
background: OBJECTIVE To assess the potential benefit of digital health interventions ( DHIs ) on  cardiovascular disease ( CVD ) outcomes ( CVD events , all-cause mortality , hospitalizations ) and risk factors compared with non-DHIs .