title: A systematic review of internet-based worksite wellness approaches for cardiovascular disease risk management: outcomes, challenges & opportunities.
abstract: BACKGROUND
  The internet is gaining popularity as a means of delivering employee-based cardiovascular (CV) wellness interventions though little is known about the cardiovascular health outcomes of these programs. In this review, we examined the effectiveness of internet-based employee cardiovascular wellness and prevention programs.
  
  
  METHODS
  We conducted a systematic review by searching PubMed, Web of Science and Cochrane library for all published studies on internet-based programs aimed at improving CV health among employees up to November 2012. We grouped the outcomes according to the American Heart Association (AHA) indicators of cardiovascular wellbeing--weight, BP, lipids, smoking, physical activity, diet, and blood glucose.
  
  
  RESULTS
  A total of 18 randomized trials and 11 follow-up studies met our inclusion/exclusion criteria. Follow-up duration ranged from 6-24 months. There were significant differences in intervention types and number of components in each intervention. Modest improvements were observed in more than half of the studies with weight related outcomes while no improvement was seen in virtually all the studies with physical activity outcome. In general, internet-based programs were more successful if the interventions also included some physical contact and environmental modification, and if they were targeted at specific disease entities such as hypertension. Only a few of the studies were conducted in persons at-risk for CVD, none in blue-collar workers or low-income earners.
  
  
  CONCLUSIONS
  Internet based programs hold promise for improving the cardiovascular wellness among employees however much work is required to fully understand its utility and long term impact especially in special/at-risk populations.
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America.
authors.forename: Ehimen C
authors.initials: EC
authors.lastname: Aneni
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America.
authors.forename: Lara L
authors.initials: LL
authors.lastname: Roberson
authors.affiliation: Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, United States of America.
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Agatston
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America.
authors.forename: Theodore
authors.initials: T
authors.lastname: Feldman
authors.affiliation: Baptist Health South Florida, Miami, Florida, United States of America.
authors.forename: Maribeth
authors.initials: M
authors.lastname: Rouseff
authors.affiliation: Baptist Health South Florida, Miami, Florida, United States of America.
authors.forename: Thinh H
authors.initials: TH
authors.lastname: Tran
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, United States of America.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, United States of America.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Blaha
authors.affiliation: Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts, United States of America.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: King Abdul Aziz Cardiac Center, Riyadh, Saudi Arabia.
authors.forename: Mouaz H
authors.initials: MH
authors.lastname: Al-Mallah
authors.affiliation: Los Angeles Biomedical Research Institute, Torrance, California, United States of America.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, Florida, United States of America ; Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, United States of America ; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, United States of America ; Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D006293:Health Promotion; D006801:Humans; D020407:Internet; D039781:PubMed; D012308:Risk Management; D016896:Treatment Outcome; D017132:Workplace