title: The Electronic CardioMetabolic Program (eCMP) for Patients With Cardiometabolic Risk: A Randomized Controlled Trial.
abstract: BACKGROUND
  Effective lifestyle interventions targeting high-risk adults that are both practical for use in ambulatory care settings and scalable at a population management level are needed.
  
  
  OBJECTIVE
  Our aim was to examine the potential effectiveness, feasibility, and acceptability of delivering an evidence-based Electronic Cardio-Metabolic Program (eCMP) for improving health-related quality of life, improving health behaviors, and reducing cardiometabolic risk factors in ambulatory care high-risk adults.
  
  
  METHODS
  We conducted a randomized, wait-list controlled trial with 74 adults aged ≥18 years recruited from a large multispecialty health care organization. Inclusion criteria were (1) BMI ≥35 kg/m(2) and prediabetes, previous gestational diabetes and/or metabolic syndrome, or (2) BMI ≥30 kg/m(2) and type 2 diabetes and/or cardiovascular disease. Participants had a mean age of 59.7 years (SD 11.2), BMI 37.1 kg/m(2) (SD 5.4) and were 59.5% female, 82.4% white. Participants were randomized to participate in eCMP immediately (n=37) or 3 months later (n=37). eCMP is a 6-month program utilizing video conferencing, online tools, and pre-recorded didactic videos to deliver evidence-based curricula. Blinded outcome assessments were conducted at 3 and 6 months postbaseline. Data were collected and analyzed between 2014 and 2015. The primary outcome was health-related quality of life. Secondary outcomes included biometric cardiometabolic risk factors (eg, body weight), self-reported diet and physical activity, mental health status, retention, session attendance, and participant satisfaction.
  
  
  RESULTS
  Change in quality of life was not significant in both immediate and delayed participants. Both groups significantly lost weight and reduced waist circumference at 6 months, with some cardiometabolic factors trending accordingly. Significant reduction in self-reported anxiety and perceived stress was seen in the immediate intervention group at 6 months. Retention rate was 93% at 3 months and 86% at 6 months post-baseline. Overall eCMP attendance was high with 59.5-83.8% of immediate and delayed intervention participants attending 50% of the virtual stress management and behavioral lifestyle sessions and 37.8-62.2% attending at least 4 out of 7 in-person physical activity sessions. The intervention received high ratings for satisfaction.
  
  
  CONCLUSIONS
  The technology-assisted eCMP is a feasible and well-accepted intervention and may significantly decrease cardiometabolic risk among high-risk individuals.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT02246400; https://clinicaltrials.gov/ct2/show/NCT02246400 (Archived by WebCite at http://www.webcitation.org/6h6mWWokP).
authors.affiliation: Sutter Health Research, Development and Dissemination, Walnut Creek, CA, United States. azark@sutterhealth.org.
authors.forename: Kristen M J
authors.identifier: http://orcid.org/0000-0002-5040-8595
authors.initials: KM
authors.lastname: Azar
authors.forename: Suneil
authors.identifier: http://orcid.org/0000-0002-7367-1054
authors.initials: S
authors.lastname: Koliwad
authors.forename: Tak
authors.identifier: http://orcid.org/0000-0002-0069-938X
authors.initials: T
authors.lastname: Poon
authors.forename: Lan
authors.identifier: http://orcid.org/0000-0002-1265-7494
authors.initials: L
authors.lastname: Xiao
authors.forename: Nan
authors.identifier: http://orcid.org/0000-0002-4100-8821
authors.initials: N
authors.lastname: Lv
authors.forename: Robert
authors.identifier: http://orcid.org/0000-0002-2715-4494
authors.initials: R
authors.lastname: Griggs
authors.forename: Jun
authors.identifier: http://orcid.org/0000-0001-7996-6454
authors.initials: J
authors.lastname: Ma
mesh_terms: D001835:Body Weight; D002318:Cardiovascular Diseases / Q000150:complications*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D010865:Pilot Projects; D011788:Quality of Life; D012307:Risk Factors
keywords: behavior change; cardiovascular disease; health technology; lifestyle; metabolic syndrome; prevention