title: The Extensive Lifestyle Management Intervention (ELMI) after cardiac rehabilitation: a 4-year randomized controlled trial.
abstract: BACKGROUND
  Previous reports indicate risk factors and lifestyle behaviors may deteriorate early after completion of a cardiac rehabilitation program (CRP). We hypothesized that a modest risk factor and lifestyle management intervention after a CRP would significantly reduce overall cardiovascular risk using the Framingham risk score compared with usual care after 4 years.
  
  
  METHODS
  Patients with ischemic heart disease (n = 302) were randomized after a CRP to either usual care or intervention (exercise sessions, telephone follow-ups, counseling sessions, and reports to the participants' family physicians). The Framingham risk score, risk factors, and lifestyle behaviors were compared after 4 years.
  
  
  RESULTS
  Data were available for 130 intervention and 119 usual care participants. The intervention resulted in 15.5 hours of direct participant contact. Framingham score, total cholesterol, low-density lipoprotein cholesterol, and systolic blood pressure were significantly improved in the intervention group after adjusting for baseline factors. There were no significant differences with respect to lifestyle factors between the groups.
  
  
  CONCLUSIONS
  A modest risk factor and lifestyle management intervention resulted in a significant reduction to global risk compared with usual care and should be considered after CRP.
authors.affiliation: School of Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada. slear@providencehealth.bc.ca
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lear
authors.forename: John J
authors.initials: JJ
authors.lastname: Spinelli
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Linden
authors.forename: Anka
authors.initials: A
authors.lastname: Brozic
authors.forename: Marla
authors.initials: M
authors.lastname: Kiess
authors.forename: Jiri J
authors.initials: JJ
authors.lastname: Frohlich
authors.forename: Andrew
authors.initials: A
authors.lastname: Ignaszewski
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003920:Diabetes Mellitus / Q000453:epidemiology; D005081:Exercise Therapy; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000453:epidemiology / Q000534:rehabilitation*; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors