title: A population-based lifestyle intervention to promote healthy weight and physical activity in people with cardiac disease: the PANACHE (Physical Activity, Nutrition And Cardiac HEalth) study protocol.
abstract: BACKGROUND
  Maintaining a healthy weight and undertaking regular physical activity are important for the secondary prevention of cardiovascular disease (CVD). However, many people with CVD are overweight and insufficiently active. In addition, in Australia only 20-30% of people requiring cardiac rehabilitation (CR) for CVD actually attend. To improve outcomes of and access to CR the efficacy, effectiveness and cost-effectiveness of alternative approaches to CR need to be established.This research will determine the efficacy of a telephone-delivered lifestyle intervention, promoting healthy weight and physical activity, in people with CVD in urban and rural settings. The control group will also act as a replication study of a previously proven physical activity intervention, to establish whether those findings can be repeated in different urban and rural locations. The cost-effectiveness and acceptability of the intervention to CR staff and participants will also be determined.
  
  
  METHODS
  This study is a randomised controlled trial. People referred for CR at two urban and two rural Australian hospitals will be invited to participate. The intervention (healthy weight) group will participate in four telephone delivered behavioural coaching and goal setting sessions over eight weeks. The coaching sessions will be on weight, nutrition and physical activity and will be supported by written materials, a pedometer and two follow-up booster telephone calls. The control (physical activity) group will participate in a six week intervention previously shown to increase physical activity, consisting of two telephone delivered behavioural coaching and goal setting sessions on physical activity, supported by written materials, a pedometer and two booster phone calls. Data will be collected at baseline, eight weeks and eight months for the intervention group (baseline, six weeks and six months for the control group). The primary outcome is weight change. Secondary outcomes include physical activity, sedentary time and nutrition habits. Costs will be compared with outcomes to determine the relative cost-effectiveness of the healthy weight and physical activity interventions.
  
  
  CONCLUSIONS
  This study addresses a significant gap in public health practice by providing evidence for the efficacy and cost-effectiveness of a low cost, low contact, high reach intervention promoting healthy weight and physical activity among people with CVD in rural and urban areas in Australia. The replication arm of the study, undertaken by the control group, will demonstrate whether the findings of the previously proven physical activity intervention can be generalised to new settings. This population-based approach could potentially improve access to and outcomes of secondary prevention programs, particularly for rural or disadvantaged communities.
  
  
  BACKGROUND
  ACTRN12610000102077.
authors.affiliation: Health Promotion Service, South Eastern Sydney and Illawarra Area Health, NSW, Australia. janice.sangster@gsahs.health.nsw.gov.au
authors.forename: Janice
authors.initials: J
authors.lastname: Sangster
authors.forename: Susan
authors.initials: S
authors.lastname: Furber
authors.forename: Margaret
authors.initials: M
authors.lastname: Allman-Farinelli
authors.forename: Marion
authors.initials: M
authors.lastname: Haas
authors.forename: Philayrath
authors.initials: P
authors.lastname: Phongsavan
authors.forename: Andy
authors.initials: A
authors.lastname: Mark
authors.forename: Adrian
authors.initials: A
authors.lastname: Bauman
mesh_terms: D001242:Assertiveness; D001315:Australia; D001521:Behavior Therapy; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D009043:Motor Activity; D012424:Rural Population; D011795:Surveys and Questionnaires; D013689:Telephone; D016896:Treatment Outcome; D014505:Urban Population; D015431:Weight Loss