title: The effectiveness of email-based exercises in promoting psychological wellbeing and healthy lifestyle: a two-year follow-up study.
abstract: BACKGROUND
  Web-based interventions provide a possibility to enhance well-being in large groups of people. Only a few studies have studied the effectiveness of the interventions and there is no information on the sustainability of the effects. Study aims were to investigate both the short (2-month) and long-term (2-year) effects of email-based training for mental health and lifestyle.
  
  
  METHODS
  Persons who completed an 'Electronic Health Check', as advertised in a TV program, were offered a chance to participate in email-based interventions. The baseline questionnaire was completed by 73 054 people, with 42 761 starting interventions, and 16 499 people participating in at least one of the follow-ups. Persons who did not choose to start the interventions served as controls.
  
  
  RESULTS
  At baseline, the intervention group had a higher level of stress and lower gratitude and confidence in the future than the control group. Both groups showed improvement in the level of stress, but improvement was more marked in the intervention group (P < .001 for both time points). In confidence in the future and gratitude, people who chose interpersonal interventions showed significant improvements at both time points (P < .001), whereas those choosing lifestyle interventions showed improvement only at the 2-month follow-up. Participants who had done the exercises according to instructions had the most sustained improvements in measures of psychological health at the 2-year follow-up. As for lifestyle, people who had started lifestyle interventions increased their exercise (P < .001 at both time points).
  
  
  CONCLUSIONS
  Internet-based interventions are feasible for mental health promotion and should be available for people interested in improving their psychological well-being and lifestyle.
authors.affiliation: Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland. minna.torniainen@thl.fi.|Institute for Molecular Medicine Finland FIMM, University of Helsinki, P.O. Box 30, FIN-00271, Helsinki, Finland. minna.torniainen@thl.fi.
authors.forename: Minna
authors.initials: M
authors.lastname: Torniainen-Holm
authors.affiliation: Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Maiju
authors.initials: M
authors.lastname: Pankakoski
authors.affiliation: Duodecim Medical Publications Ltd, Helsinki, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Lehto
authors.affiliation: Duodecim Medical Publications Ltd, Helsinki, Finland.
authors.forename: Osmo
authors.initials: O
authors.lastname: Saarelma
authors.affiliation: Duodecim Medical Publications Ltd, Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Mustonen
authors.affiliation: Duodecim Medical Publications Ltd, Helsinki, Finland.|Department of Psychiatry, The Hospital District of Helsinki and Uusimaa, Peijas Hospital, Vantaa, Finland.
authors.forename: Kaisla
authors.initials: K
authors.lastname: Joutsenniemi
authors.affiliation: Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Suvisaari
mesh_terms: D000328:Adult; D034742:Electronic Mail; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion; D000070497:Healthy Lifestyle; D006801:Humans; D020407:Internet; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010549:Personal Satisfaction; D013315:Stress, Psychological / Q000517:prevention & control; D017216:Telemedicine
keywords: Happiness; Intervention; Online; Web-based; Wellbeing