title: A web-based program improves physical activity outcomes in a primary care angina population: randomized controlled trial.
abstract: BACKGROUND
  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.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number (ISRCTN): 90110503; http://www.controlled-trials.com/ISRCTN90110503/ISRCTN90110503 (Archived by WebCite at http://www.webcitation.org/6RYVOQFKM).
authors.affiliation: Coventry University, Applied Research Centre in Health and Lifestyle Interventions, Coventry, United Kingdom. reena.devi@coventry.ac.uk.
authors.forename: Reena
authors.identifier: http://orcid.org/0000-0003-2834-8597
authors.initials: R
authors.lastname: Devi
authors.forename: John
authors.identifier: http://orcid.org/0000-0002-1456-4857
authors.initials: J
authors.lastname: Powell
authors.forename: Sally
authors.identifier: http://orcid.org/0000-0002-9834-0366
authors.initials: S
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000534:rehabilitation*; D004734:Energy Metabolism; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D011320:Primary Health Care; D011788:Quality of Life; D055502:Secondary Prevention / Q000379:methods*; D011795:Surveys and Questionnaires; D016138:Walking
keywords: Web-based interventions; cardiac rehabilitation; physical activity; primary health care; secondary prevention; stable angina