J. Med. Internet Res. - A web-based program improves physical activity outcomes in a primary care angina population: randomized controlled trial.


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CKGROUND: Angina affects more than 50 million people worldwide. Secondary prevention interventions such as cardiac rehabilitation are not widely available for this population. An Internet-based version could offer a feasible alternative.OBJECTIVE: Our aim was to examine the effectiveness of a Web-based cardiac rehabilitation program for those with angina.METHODS: We conducted a randomized controlled trial, recruiting those diagnosed with angina from general practitioners (GPs) in primary care to an intervention or control group. Intervention group participants were offered a 6-week Web-based rehabilitation program ("ActivateYourHeart"). The program was introduced during a face-to-face appointment and then delivered via the Internet (no further face-to-face contact). The program contained information about the secondary prevention of coronary heart disease (CHD) and set each user goals around physical activity, diet, managing emotions, and smoking. Performance against goals was reviewed throughout the program and goals were then reset/modified. Participants completed an online exercise diary and communicated with rehabilitation specialists through an email link/synchronized chat room. Participants in the control group continued with GP treatment as usual, which consisted of being placed on a CHD register and attending an annual review. Outcomes were measured at 6-week and 6-month follow-ups during face-to-face assessments. The primary outcome measure was change in daily steps at 6 weeks, measured using an accelerometer. Secondary outcome measures were energy expenditure (EE), duration of sedentary activity (DSA), duration of moderate activity (DMA), weight, diastolic/systolic blood pressure, and body fat percentage. Self-assessed questionnaire outcomes included fat/fiber intake, anxiety/depression, self-efficacy, and quality of life (QOL).RESULTS: A total of 94 participants were recruited and randomized to the intervention (n=48) or the usual care (n=46) group; 84 and 73 participants completed the 6-week and 6-month follow-ups, respectively. The mean number of log-ins to the program was 18.68 (SD 13.13, range 1-51), an average of 3 log-ins per week per participant. Change in daily steps walked at the 6-week follow-up was +497 (SD 2171) in the intervention group and -861 (SD 2534) in the control group (95% CI 263-2451, P=.02). Significant intervention effects were observed at the 6-week follow-up in EE (+43.94 kcal, 95% CI 43.93-309.98, P=.01), DSA (-7.79 minutes, 95% CI -55.01 to -7.01, P=.01), DMA (+6.31 minutes, 95% CI 6.01-51.20, P=.01), weight (-0.56 kg, 95% CI -1.78 to -0.15, P=.02), self-efficacy (95% CI 0.30-4.79, P=.03), emotional QOL score (95% CI 0.01-0.54, P=.04), and angina frequency (95% CI 8.57-35.05, P=.002). Significant benefits in angina frequency (95% CI 1.89-29.41, P=.02) and social QOL score (95% CI 0.05-0.54, P=.02) were also observed at the 6-month follow-up.CONCLUSIONS: An Internet-based secondary prevention intervention could be offered to those with angina. A larger pragmatic trial is required to provide definitive evidence of effectiveness and cost-effectiveness.TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 90110503; http://www.controlled-trials.com/ISRCTN90110503/ISRCTN90110503 (Archived by WebCite at http://www.webcitation.org/6RYVOQFKM).

Resumo Limpo

ckground angina affect million peopl worldwid secondari prevent intervent cardiac rehabilit wide avail popul internetbas version offer feasibl alternativeobject aim examin effect webbas cardiac rehabilit program anginamethod conduct random control trial recruit diagnos angina general practition gps primari care intervent control group intervent group particip offer week webbas rehabilit program activateyourheart program introduc facetofac appoint deliv via internet facetofac contact program contain inform secondari prevent coronari heart diseas chd set user goal around physic activ diet manag emot smoke perform goal review throughout program goal resetmodifi particip complet onlin exercis diari communic rehabilit specialist email linksynchron chat room particip control group continu gp treatment usual consist place chd regist attend annual review outcom measur week month followup facetofac assess primari outcom measur chang daili step week measur use acceleromet secondari outcom measur energi expenditur ee durat sedentari activ dsa durat moder activ dma weight diastolicsystol blood pressur bodi fat percentag selfassess questionnair outcom includ fatfib intak anxietydepress selfefficaci qualiti life qolresult total particip recruit random intervent n usual care n group particip complet week month followup respect mean number login program sd rang averag login per week per particip chang daili step walk week followup sd intervent group sd control group ci p signific intervent effect observ week followup ee kcal ci p dsa minut ci p dma minut ci p weight kg ci p selfefficaci ci p emot qol score ci p angina frequenc ci p signific benefit angina frequenc ci p social qol score ci p also observ month followupconclus internetbas secondari prevent intervent offer angina larger pragmat trial requir provid definit evid effect costeffectivenesstri registr intern standard random control trial number isrctn httpwwwcontrolledtrialscomisrctnisrctn archiv webcit httpwwwwebcitationorgryvoqfkm

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