title: Internet programs targeting multiple lifestyle interventions in primary and secondary care are not superior to usual care alone in improving cardiovascular risk profile: a systematic review.
abstract: OBJECTIVE
  To review the effects of Internet delivered multiple modifiable lifestyle interventions complementary to usual care on cardiovascular risk factors in the primary and secondary healthcare setting.
  
  
  METHODS
  PubMed, EMBASE.com, CINAHL, PsycINFO, and the Cochrane Library were searched up to June 2012 for English written studies that 1) addressed multiple lifestyle interventions, 2) used Internet intervention through websites or email, 3) included at least one usual care group not using Internet, 4) aimed to improve any of cardiovascular risk factors and 5) targeted patients aged 18 or older.
  
  
  RESULTS
  Our systematic search yielded 1857 citations of which 9 were selected for this review. Three studies reported significant differences in weight loss in favor of the intervention group and five studies reported non-significant differences between groups. From the 7 studies reporting on blood pressure (BP) measurements, two found significant improvement in favor of the intervention group, while the other studies found no significant differences. Only one study found a significant improvement of LDL-C in the intervention group compared to usual care. Another study found a significant improvement of HDL-C in the usual care group compared to the intervention group.
  
  
  CONCLUSIONS
  The addition of a multiple modifiable lifestyle Internet intervention in primary or secondary care is not superior to usual care with respect to prevention and treatment of cardiovascular risk factors. However, an Internet delivered program does have the potential of being successful in reducing the number of doctor's visits and may therefore be cost-effective when applied in large scale.
authors.affiliation: Department of Internal Medicine, VU University Medical Centre, De Boelelaan 1117, P.O. Box 7057, 1007MB Amsterdam, The Netherlands.
authors.forename: I L
authors.initials: IL
authors.lastname: Vegting
authors.affiliation: Department of Internal Medicine, VU University Medical Centre, De Boelelaan 1117, P.O. Box 7057, 1007MB Amsterdam, The Netherlands.
authors.forename: E J M
authors.initials: EJ
authors.lastname: Schrijver
authors.affiliation: Medical Library, VU University Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
authors.forename: R H J
authors.initials: RH
authors.lastname: Otten
authors.affiliation: Department of Internal Medicine, VU University Medical Centre, De Boelelaan 1117, P.O. Box 7057, 1007MB Amsterdam, The Netherlands. Electronic address: p.nanayakkara@vumc.nl.
authors.forename: P W B
authors.initials: PW
authors.lastname: Nanayakkara
mesh_terms: D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D006801:Humans; D020407:Internet; D008019:Life Style; D011320:Primary Health Care / Q000379:methods*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D063127:Secondary Health Care / Q000379:methods*; D015431:Weight Loss
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL
keywords: Cardiovascular diseases; Internet; Lifestyle behavior; Lifestyle intervention; Prevention; Web-based