Web-Based Interventions Targeting Cardiovascular Risk Factors in Middle-Aged and Older People: A Systematic Review and Meta-Analysis

Cathrien R L Beishuizen, Blossom C M Stephan, Willem A van Gool, Carol Brayne, Ron J G Peters, Sandrine Andrieu, Miia Kivipelto, Hilkka Soininen, Wim B Busschers, Eric P Moll van Charante, Edo Richard, Cathrien R L Beishuizen, Blossom C M Stephan, Willem A van Gool, Carol Brayne, Ron J G Peters, Sandrine Andrieu, Miia Kivipelto, Hilkka Soininen, Wim B Busschers, Eric P Moll van Charante, Edo Richard

Abstract

Background: Web-based interventions can improve single cardiovascular risk factors in adult populations. In view of global aging and the associated increasing burden of cardiovascular disease, older people form an important target population as well.

Objective: In this systematic review and meta-analysis, we evaluated whether Web-based interventions for cardiovascular risk factor management reduce the risk of cardiovascular disease in older people.

Methods: Embase, Medline, Cochrane and CINAHL were systematically searched from January 1995 to November 2014. Search terms included cardiovascular risk factors and diseases (specified), Web-based interventions (and synonyms) and randomized controlled trial. Two authors independently performed study selection, data-extraction and risk of bias assessment. In a meta-analysis, outcomes regarding treatment effects on cardiovascular risk factors (blood pressure, glycated hemoglobin A1c (HbA1C), low-density lipoprotein (LDL) cholesterol, smoking status, weight and physical inactivity) and incident cardiovascular disease were pooled with random effects models.

Results: A total of 57 studies (N=19,862) fulfilled eligibility criteria and 47 studies contributed to the meta-analysis. A significant reduction in systolic blood pressure (mean difference -2.66 mmHg, 95% CI -3.81 to -1.52), diastolic blood pressure (mean difference -1.26 mmHg, 95% CI -1.92 to -0.60), HbA1c level (mean difference -0.13%, 95% CI -0.22 to -0.05), LDL cholesterol level (mean difference -2.18 mg/dL, 95% CI -3.96 to -0.41), weight (mean difference -1.34 kg, 95% CI -1.91 to -0.77), and an increase of physical activity (standardized mean difference 0.25, 95% CI 0.10-0.39) in the Web-based intervention group was found. The observed effects were more pronounced in studies with short (<12 months) follow-up and studies that combined the Internet application with human support (blended care). No difference in incident cardiovascular disease was found between groups (6 studies).

Conclusions: Web-based interventions have the potential to improve the cardiovascular risk profile of older people, but the effects are modest and decline with time. Currently, there is insufficient evidence for an effect on incident cardiovascular disease. A focus on long-term effects, clinical endpoints, and strategies to increase sustainability of treatment effects is recommended for future studies.

Keywords: aging; cardiovascular disease; eHealth; meta-analysis; older people; prevention; systematic review.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Prisma flowchart illustrating literature search.
Figure 2
Figure 2
Effect on systolic blood pressure (26 studies).
Figure 3
Figure 3
Effect on diastolic blood pressure (26 studies).
Figure 4
Figure 4
Effect on glycated hemoglobin (21 studies).
Figure 5
Figure 5
Effect on weight (17 studies).
Figure 6
Figure 6
Effect on low-density lipoprotein cholesterol (17 studies).
Figure 7
Figure 7
Effect on physical activity (14 studies).
Figure 8
Figure 8
Effect on cardiovascular composite scores (9 studies).
Figure 9
Figure 9
General effect on primary outcomes (37 studies).
Figure 10
Figure 10
Effect on cardiovascular event rates (6 studies).
Figure 11
Figure 11
Association between study duration and effect size (Hedges' g). One outlier study (Ideatel) was removed from analysis.

References

    1. Meier CA, Fitzgerald MC, Smith JM. eHealth: extending, enhancing, and evolving health care. Annu Rev Biomed Eng. 2013;15:359–382. doi: 10.1146/annurev-bioeng-071812-152350.
    1. World Health Organization. National Institute on Aging. National Institutes of Health . Global Health and Aging. Geneva: World Health Organization; 2011. [2016-02-22]. .
    1. [No authors listed] An epidemic of risk factors for cardiovascular disease. Lancet. 2011 Feb 12;377(9765):527. doi: 10.1016/S0140-6736(11)60182-7.
    1. Chow CK, Jolly S, Rao-Melacini P, Fox KA, Anand SS, Yusuf S. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation. 2010 Feb 16;121(6):750–758. doi: 10.1161/CIRCULATIONAHA.109.891523.
    1. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665.
    1. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ. 2003 Jun 28;326(7404):1423. doi: 10.1136/bmj.326.7404.1423.
    1. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009 Apr;16(2):121–137. doi: 10.1097/HJR.0b013e3283294b1d.
    1. Nieuwlaat R, Schwalm J, Khatib R, Yusuf S. Why are we failing to implement effective therapies in cardiovascular disease? Eur Heart J. 2013 May;34(17):1262–1269. doi: 10.1093/eurheartj/ehs481.
    1. Al Hamid A, Ghaleb M, Aljadhey H, Aslanpour Z. A systematic review of qualitative research on the contributory factors leading to medicine-related problems from the perspectives of adult patients with cardiovascular diseases and diabetes mellitus. BMJ Open. 2014;4(9):e005992. doi: 10.1136/bmjopen-2014-005992.
    1. Sabaté E. Adherence to Long-Term Therapies: Evidence for Action. Geneva: World Health Organization; 2003.
    1. Griffiths F, Lindenmeyer A, Powell J, Lowe P, Thorogood M. Why are health care interventions delivered over the internet? A systematic review of the published literature. J Med Internet Res. 2006;8(2):e10. doi: 10.2196/jmir.8.2.e10.
    1. McManus RJ, Mant J, Bray EP, Holder R, Jones MI, Greenfield S, Kaambwa B, Banting M, Bryan S, Little P, Williams B, Hobbs FD. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet. 2010 Jul 17;376(9736):163–172. doi: 10.1016/S0140-6736(10)60964-6.
    1. Briasoulis A, Agarwal V, Tousoulis D, Stefanadis C. Effects of antihypertensive treatment in patients over 65 years of age: a meta-analysis of randomised controlled studies. Heart. 2014 Feb;100(4):317–323. doi: 10.1136/heartjnl-2013-304111.
    1. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, Stoyanovsky V, Antikainen RL, Nikitin Y, Anderson C, Belhani A, Forette F, Rajkumar C, Thijs L, Banya W, Bulpitt CJ. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008 May 1;358(18):1887–1898. doi: 10.1056/NEJMoa0801369.
    1. Peters R, Beckett N, Forette F, Tuomilehto J, Clarke R, Ritchie C, Waldman A, Walton I, Poulter R, Ma S, Comsa M, Burch L, Fletcher A, Bulpitt C. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol. 2008 Aug;7(8):683–689. doi: 10.1016/S1474-4422(08)70143-1.
    1. Ritchie K, Carrière I, Ritchie CW, Berr C, Artero S, Ancelin M. Designing prevention programmes to reduce incidence of dementia: prospective cohort study of modifiable risk factors. BMJ. 2010;341:c3885.
    1. Seybert H. Eurostat: Industry, Trade and Services. 2012. Dec 13, [2016-02-22]. Internet use in households and by individuals in 2012 .
    1. Civljak M, Stead LF, Hartmann-Boyce J, Sheikh A, Car J. Internet-based interventions for smoking cessation. Cochrane Database Syst Rev. 2013;7:CD007078. doi: 10.1002/14651858.CD007078.pub4.
    1. Liu S, Dunford SD, Leung YW, Brooks D, Thomas SG, Eysenbach G, Nolan RP. Reducing blood pressure with Internet-based interventions: a meta-analysis. Can J Cardiol. 2013 May;29(5):613–621. doi: 10.1016/j.cjca.2013.02.007.
    1. Wieland LS, Falzon L, Sciamanna CN, Trudeau KJ, Brodney S, Schwartz JE, Davidson KW. Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people. Cochrane Database Syst Rev. 2012;8:CD007675. doi: 10.1002/14651858.CD007675.pub2.
    1. Pal K, Eastwood SV, Michie S, Farmer AJ, Barnard ML, Peacock R, Wood B, Inniss JD, Murray E. Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2013;3:CD008776. doi: 10.1002/14651858.CD008776.pub2.
    1. Fifth Joint Task Force of the European Society of Cardiology. European Association of Echocardiography. European Association of Percutaneous Cardiovascular Interventions. European Heart Rhythm Association. Heart Failure Association. European Association for Cardiovascular Prevention & Rehabilitation. European Atherosclerosis Society. International Society of Behavioural Medicine. European Stroke Organisation. European Society of Hypertension. European Association for the Study of Diabetes. European Society of General Practice/Family Medicine. International Diabetes Federation Europe. European Heart Network European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) Eur J Prev Cardiol. 2012 Aug;19(4):585–667. doi: 10.1177/2047487312450228.
    1. Pearson TA, Palaniappan LP, Artinian NT, Carnethon MR, Criqui MH, Daniels SR, Fonarow GC, Fortmann SP, Franklin BA, Galloway JM, Goff DC, Heath GW, Frank AT, Kris-Etherton PM, Labarthe DR, Murabito JM, Sacco RL, Sasson C, Turner MB, American Heart Association Council on Epidemiology and Prevention American Heart Association Guide for Improving Cardiovascular Health at the Community Level, 2013 update: a scientific statement for public health practitioners, healthcare providers, and health policy makers. Circulation. 2013 Apr 23;127(16):1730–1753. doi: 10.1161/CIR.0b013e31828f8a94.
    1. Ritterband LM, Thorndike F. Internet interventions or patient education web sites? J Med Internet Res. 2006;8(3):e18; author reply e19. doi: 10.2196/jmir.8.3.e18.
    1. Bennett GG, Glasgow RE. The delivery of public health interventions via the Internet: actualizing their potential. Annu Rev Public Health. 2009;30:273–292. doi: 10.1146/annurev.publhealth.031308.100235.
    1. Southard B, Southard D, Nuckolls J. Clinical trial of an internet-based case management system for secondary prevention of heart disease. J Cardiopulm Rehabi. 2003;23(5):341–348.
    1. Vernooij W, Kaasjager H, Van Der Graaf Y, Wierdsma J, Grandjean H, Hovens M. Internet based vascular risk factor management for patients with clinically manifest vascular disease: randomised controlled trial. BMJ (Online) 2012;344(7863):e3750.
    1. Bennett G, Warner E, Glasgow R, Askew S, Goldman J, Ritzwoller D, Emmons KM, Rosner BA, Colditz GA, Be Fit‚ Be Well Study Investigators Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Arch Intern Med. 2012 Apr 9;172(7):565–574. doi: 10.1001/archinternmed.2012.1.
    1. Green B, Cook A, Ralston J, Fishman P, Catz S, Carlson J, Carrell D, Tyll L, Larson EB, Thompson RS. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA. 2008 Jun 25;299(24):2857–2867. doi: 10.1001/jama.299.24.2857.
    1. Reid R, Morrin L, Beaton L, Papadakis S, Kocourek J, McDonnell L, Slovinec DM, Tulloch H, Suskin N, Unsworth K, Blanchard C, Pipe AL. Randomized trial of an internet-based computer-tailored expert system for physical activity in patients with heart disease. Eur J Prev Cardiol. 2012 Dec;19(6):1357–1364. doi: 10.1177/1741826711422988.
    1. Keyserling TC, Sheridan SL, Draeger LB, Finkelstein EA, Gizlice Z, Kruger E, Johnston LF, Sloane PD, Samuel-Hodge C, Evenson KR, Gross MD, Donahue KE, Pignone MP, Vu MB, Steinbacher EA, Weiner BJ, Bangdiwala SI, Ammerman AS. A comparison of live counseling with a web-based lifestyle and medication intervention to reduce coronary heart disease risk: a randomized clinical trial. JAMA Intern Med. 2014 Jul;174(7):1144–1157. doi: 10.1001/jamainternmed.2014.1984.
    1. Quinn C, Shardell M, Terrin M, Barr E, Ballew S, Gruber-Baldini A. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011 Sep;34(9):1934–1942. doi: 10.2337/dc11-0366.
    1. Ross S, Moore L, Earnest M, Wittevrongel L, Lin C. Providing a web-based online medical record with electronic communication capabilities to patients with congestive heart failure: randomized trial. J Med Internet Res. 2004 May 14;6(2):e12. doi: 10.2196/jmir.6.2.e12.
    1. Shea S, Weinstock R, Teresi J, Palmas W, Starren J, Cimino J, Lai AM, Field L, Morin PC, Goland R, Izquierdo RE, Ebner S, Silver S, Petkova E, Kong J, Eimicke JP, IDEATel Consortium A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel study. J Am Med Inform Assoc. 2009;16(4):446–456. doi: 10.1197/jamia.M3157.
    1. Appel L, Clark J, Yeh H, Wang N, Coughlin J, Daumit G, Miller ER, Dalcin A, Jerome GJ, Geller S, Noronha G, Pozefsky T, Charleston J, Reynolds JB, Durkin N, Rubin RR, Louis TA, Brancati FL. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011 Nov 24;365(21):1959–1968. doi: 10.1056/NEJMoa1108660.
    1. Ma J, Yank V, Xiao L, Lavori PW, Wilson SR, Rosas LG, Stafford RS. Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial. JAMA Intern Med. 2013 Jan 28;173(2):113–121. doi: 10.1001/2013.jamainternmed.987.
    1. Maddison R, Pfaeffli L, Whittaker R, Stewart R, Kerr A, Jiang Y, Kira G, Leung W, Dalleck L, Carter K, Rawstorn J. A mobile phone intervention increases physical activity in people with cardiovascular disease: Results from the HEART randomized controlled trial. Eur J Prev Cardiol. 2015 Jun;22(6):701–709. doi: 10.1177/2047487314535076.
    1. McKinstry B, Hanley J, Wild S, Pagliari C, Paterson M, Lewis S, Sheikh A, Krishan A, Stoddart A, Padfield P. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial. BMJ. 2013;346:f3030.
    1. Tang PC, Overhage JM, Chan AS, Brown NL, Aghighi B, Entwistle MP, Hui SL, Hyde SM, Klieman LH, Mitchell CJ, Perkins AJ, Qureshi LS, Waltimyer TA, Winters LJ, Young CY. Online disease management of diabetes: engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial. J Am Med Inform Assoc. 2013 May 1;20(3):526–534. doi: 10.1136/amiajnl-2012-001263.
    1. Svetkey L, Stevens V, Brantley P, Appel L, Hollis J, Loria C, Vollmer WM, Gullion CM, Funk K, Smith P, Samuel-Hodge C, Myers V, Lien LF, Laferriere D, Kennedy B, Jerome GJ, Heinith F, Harsha DW, Evans P, Erlinger TP, Dalcin AT, Coughlin J, Charleston J, Champagne CM, Bauck A, Ard JD, Aicher K, Weight Loss Maintenance Collaborative Research Group Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial. JAMA. 2008 Mar 12;299(10):1139–1148. doi: 10.1001/jama.299.10.1139.
    1. Wing R, Tate D, Gorin A, Raynor H, Fava J. A self-regulation program for maintenance of weight loss. N Engl J Med. 2006 Oct 12;355(15):1563–1571. doi: 10.1056/NEJMoa061883.
    1. Bond G, Burr R, Wolf F, Price M, McCurry S, Teri L. The effects of a web-based intervention on the physical outcomes associated with diabetes among adults age 60 and older: a randomized trial. Diabetes Technol Ther. 2007 Feb;9(1):52–59. doi: 10.1089/dia.2006.0057.
    1. Glasgow R, Boles S, McKay H, Feil E, Barrera JM. The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results. Prev Med. 2003 Apr;36(4):410–419.
    1. Glasgow R, Kurz D, King D, Dickman J, Faber A, Halterman E, Woolley T, Toobert DJ, Strycker LA, Estabrooks PA, Osuna D, Ritzwoller D. Twelve-month outcomes of an Internet-based diabetes self-management support program. Patient Educ Couns. 2012 Apr;87(1):81–92. doi: 10.1016/j.pec.2011.07.024.
    1. McMahon G, Gomes H, Hickson HS, Hu T, Levine B, Conlin P. Web-based care management in patients with poorly controlled diabetes. Diabetes Care. 2005 Jul;28(7):1624–1629.
    1. Avdal E, Kizilci S, Demirel N. The effects of web-based diabetes education on diabetes care results: a randomized control study. Comput Inform Nurs. 2011 Feb;29(2):101–106. doi: 10.1097/NCN.0b013e3181fcbdc6.
    1. Cho J, Chang S, Kwon H, Choi Y, Ko S, Moon S, Yoo SJ, Song KH, Son HS, Kim HS, Lee WC, Cha BY, Son HY, Yoon KH. Long-term effect of the Internet-based glucose monitoring system on HbA1c reduction and glucose stability: a 30-month follow-up study for diabetes management with a ubiquitous medical care system. Diabetes Care. 2006 Dec;29(12):2625–2631. doi: 10.2337/dc05-2371.
    1. Lorig K, Ritter P, Laurent D, Plant K, Green M, Jernigan VB, Case Siobhan. Online diabetes self-management program: a randomized study. Diabetes Care. 2010 Jun;33(6):1275–1281. doi: 10.2337/dc09-2153.
    1. Grant R, Wald J, Schnipper J, Gandhi T, Poon E, Orav E, Williams DH, Volk L, Middleton B. Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2008 Sep 8;168(16):1776–1782. doi: 10.1001/archinte.168.16.1776.
    1. McMahon G, Fonda S, Gomes H, Alexis G, Conlin P. A randomized comparison of online- and telephone-based care management with internet training alone in adult patients with poorly controlled type 2 diabetes. Diabetes Technol Ther. 2012 Nov;14(11):1060–1067. doi: 10.1089/dia.2012.0137.
    1. Ralston J, Hirsch I, Hoath J, Mullen M, Cheadle A, Goldberg H. Web-based collaborative care for type 2 diabetes: a pilot randomized trial. Diabetes Care. 2009 Feb;32(2):234–239. doi: 10.2337/dc08-1220.
    1. Kwon H, Cho J, Kim Hee-Soo, Song Bok-Re, Ko Seung-Hyun, Lee Jung-Min, Kim Sung-Rae, Chang Sang-Ah, Kim Hee-Seung, Cha Bong-Yun, Lee Kwang-Woo, Son Ho-Young, Lee Jin-Hee, Lee Won-Chul, Yoon Kun-Ho. Establishment of blood glucose monitoring system using the internet. Diabetes Care. 2004 Feb;27(2):478–483.
    1. Fisher L, Hessler D, Glasgow RE, Arean PA, Masharani U, Naranjo D, Strycker LA. REDEEM: a pragmatic trial to reduce diabetes distress. Diabetes Care. 2013 Sep;36(9):2551–2558. doi: 10.2337/dc12-2493.
    1. Nolan R, Liu S, Shoemaker J, Hachinski V, Lynn H, Mikulis D, Wennberg RA, Moy LM, Zbib A. Therapeutic benefit of internet-based lifestyle counselling for hypertension. Can J Cardiol. 2012 May;28(3):390–396. doi: 10.1016/j.cjca.2012.02.012.
    1. Bove AA, Homko CJ, Santamore WP, Kashem M, Kerper M, Elliott DJ. Managing hypertension in urban underserved subjects using telemedicine--a clinical trial. Am Heart J. 2013 Apr;165(4):615–621. doi: 10.1016/j.ahj.2013.01.004.
    1. Madsen LB, Kirkegaard P, Pedersen EB. Blood pressure control during telemonitoring of home blood pressure. A randomized controlled trial during 6 months. Blood Press. 2008;17(2):78–86. doi: 10.1080/08037050801915468.
    1. Magid DJ, Olson KL, Billups SJ, Wagner NM, Lyons EE, Kroner BA. A pharmacist-led, American Heart Association Heart360 Web-enabled home blood pressure monitoring program. Circ Cardiovasc Qual Outcomes. 2013 Mar 1;6(2):157–163. doi: 10.1161/CIRCOUTCOMES.112.968172.
    1. Thiboutot J, Sciamanna CN, Falkner B, Kephart DK, Stuckey HL, Adelman AM, Curry WJ, Lehman EB. Effects of a web-based patient activation intervention to overcome clinical inertia on blood pressure control: cluster randomized controlled trial. J Med Internet Res. 2013;15(9):e158. doi: 10.2196/jmir.2298.
    1. Bennett G, Herring S, Puleo E, Stein E, Emmons K, Gillman M. Web-based weight loss in primary care: a randomized controlled trial. Obesity (Silver Spring) 2010 Feb;18(2):308–313. doi: 10.1038/oby.2009.242.
    1. Kraschnewski J, Stuckey H, Rovniak L, Lehman E, Reddy M, Poger J, Kephart DK, Coups EJ, Sciamanna CN. Efficacy of a weight-loss website based on positive deviance. A randomized trial. Am J Prev Med. 2011 Dec;41(6):610–614. doi: 10.1016/j.amepre.2011.08.012.
    1. Webber KH, Tate DF, Michael BJ. A randomized comparison of two motivationally enhanced Internet behavioral weight loss programs. Behav Res Ther. 2008 Sep;46(9):1090–1095. doi: 10.1016/j.brat.2008.06.008.
    1. Yardley L, Ware LJ, Smith ER, Williams S, Bradbury KJ, Arden-Close EJ, Mullee MA, Moore MV, Peacock JL, Lean ME, Margetts BM, Byrne CD, Hobbs RF, Little P. Randomised controlled feasibility trial of a web-based weight management intervention with nurse support for obese patients in primary care. Int J Behav Nutr Phys Act. 2014;11:67. doi: 10.1186/1479-5868-11-67.
    1. Richardson C, Buis L, Janney A, Goodrich D, Sen A, Hess M, Mehari Kathleen S, Fortlage Laurie A, Resnick Paul J, Zikmund-Fisher Brian J, Strecher Victor J, Piette John D. An online community improves adherence in an internet-mediated walking program. Part 1: results of a randomized controlled trial. J Med Internet Res. 2010;12(4):e71. doi: 10.2196/jmir.1338.
    1. Ferney S, Marshall A, Eakin E, Owen N. Randomized trial of a neighborhood environment-focused physical activity website intervention. Prev Med. 2009 Feb;48(2):144–150. doi: 10.1016/j.ypmed.2008.10.022.
    1. Irvine AB, Gelatt VA, Seeley JR, Macfarlane P, Gau JM. Web-based intervention to promote physical activity by sedentary older adults: randomized controlled trial. J Med Internet Res. 2013;15(2):e19. doi: 10.2196/jmir.2158.
    1. Wijsman CA, Westendorp RG, Verhagen EA, Catt M, Slagboom PE, de Craen AJ, Broekhuizen K, van Mechelen MW, van Heemst HD, van der Ouderaa F, Mooijaart SP. Effects of a web-based intervention on physical activity and metabolism in older adults: randomized controlled trial. J Med Internet Res. 2013;15(11):e233. doi: 10.2196/jmir.2843.
    1. Suboc Tisha B, Strath Scott J, Dharmashankar Kodlipet, Coulliard Allison, Miller Nora, Wang Jingli, Tanner Michael J, Widlansky Michael E. Relative importance of step count, intensity, and duration on physical activity's impact on vascular structure and function in previously sedentary older adults. J Am Heart Assoc. 2014;3(1):e000702. doi: 10.1161/JAHA.113.000702.
    1. Peels DA, Bolman C, Golsteijn RH, de Vries H, Mudde AN, van Stralen MM, Lechner L. Long-term efficacy of a printed or a Web-based tailored physical activity intervention among older adults. Int J Behav Nutr Phys Act. 2013;10:104. doi: 10.1186/1479-5868-10-104.
    1. Bloch MJ, Armstrong DS, Dettling L, Hardy A, Caterino K, Barrie S. Partners in lowering cholesterol: comparison of a multidisciplinary educational program, monetary incentives, or usual care in the treatment of dyslipidemia identified among employees. J Occup Environ Med. 2006 Jul;48(7):675–681. doi: 10.1097/01.jom.0000205997.18143.6c.
    1. Kulick D, Langer RD, Ashley JM, Gans KM, Schlauch K, Feller C. Live well: a practical and effective low-intensity dietary counseling intervention for use in primary care patients with dyslipidemia--a randomized controlled pilot trial. BMC Fam Pract. 2013;14:59. doi: 10.1186/1471-2296-14-59.
    1. Lindsay S, Bellaby P, Smith S, Baker R. Enabling healthy choices: is ICT the highway to health improvement? Health (London) 2008 Jul;12(3):313–331. doi: 10.1177/1363459308090051.
    1. Brennan PF, Casper GR, Burke LJ, Johnson KA, Brown R, Valdez RS, Sebern M, Perez OA, Sturgeon B. Technology-enhanced practice for patients with chronic cardiac disease: home implementation and evaluation. Heart Lung. 2010;39(6 Suppl):S34–546. doi: 10.1016/j.hrtlng.2010.09.003.
    1. Hughes S, Seymour R, Campbell R, Shaw J, Fabiyi C, Sokas R. Comparison of two health-promotion programs for older workers. Am J Public Health. 2011 May;101(5):883–890. doi: 10.2105/AJPH.2010.300082.
    1. Winett R, Anderson E, Wojcik J, Winett S, Bowden T. Guide to health: nutrition and physical activity outcomes of a group-randomized trial of an Internet-based intervention in churches. Ann Behav Med. 2007 Jun;33(3):251–261. doi: 10.1080/08836610701358045.
    1. Verheijden M, Bakx J, Akkermans R, van den Hoogen H, Godwin N, Rosser W, van Staveren W, van Weel C. Web-based targeted nutrition counselling and social support for patients at increased cardiovascular risk in general practice: randomized controlled trial. J Med Internet Res. 2004 Dec 16;6(4):e44. doi: 10.2196/jmir.6.4.e44.
    1. Bove A, Santamore W, Homko C, Kashem A, Cross R, McConnell T, Shirk Gail, Menapace Francis. Reducing cardiovascular disease risk in medically underserved urban and rural communities. Am Heart J. 2011 Feb;161(2):351–359. doi: 10.1016/j.ahj.2010.11.008.
    1. Zullig LL, Sanders LL, Shaw RJ, McCant F, Danus S, Bosworth HB. A randomised controlled trial of providing personalised cardiovascular risk information to modify health behaviour. J Telemed Telecare. 2014 Apr;20(3):147–152. doi: 10.1177/1357633X14528446.
    1. Devi R, Powell J, Singh S. A web-based program improves physical activity outcomes in a primary care angina population: randomized controlled trial. J Med Internet Res. 2014;16(9):e186. doi: 10.2196/jmir.3340.
    1. Green BB, Anderson ML, Cook AJ, Catz S, Fishman PA, McClure JB, Reid RJ. e-Care for heart wellness: a feasibility trial to decrease blood pressure and cardiovascular risk. Am J Prev Med. 2014 Apr;46(4):368–377. doi: 10.1016/j.amepre.2013.11.009.
    1. Greene J, Sacks R, Piniewski B, Kil D, Hahn JS. The impact of an online social network with wireless monitoring devices on physical activity and weight loss. J Prim Care Community Health. 2013 Jul 1;4(3):189–194. doi: 10.1177/2150131912469546.
    1. Holbrook A, Thabane L, Keshavjee K, Dolovich L, Bernstein B, Chan D, Troyan Sue, Foster Gary, Gerstein Hertzel. Individualized electronic decision support and reminders to improve diabetes care in the community: COMPETE II randomized trial. CMAJ. 2009 Jul 7;181(1-2):37–44. doi: 10.1503/cmaj.081272.
    1. Jennings CA, Vandelanotte C, Caperchione CM, Mummery WK. Effectiveness of a web-based physical activity intervention for adults with Type 2 diabetes-a randomised controlled trial. Prev Med. 2014 Mar;60:33–40. doi: 10.1016/j.ypmed.2013.12.011.
    1. Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM, American HA. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension. 2006 Feb;47(2):296–308. doi: 10.1161/01.HYP.0000202568.01167.B6.
    1. Aalbers T, Baars MA, Rikkert MG. Characteristics of effective Internet-mediated interventions to change lifestyle in people aged 50 and older: a systematic review. Ageing Res Rev. 2011 Sep;10(4):487–497. doi: 10.1016/j.arr.2011.05.001.
    1. Schwingshackl L, Dias S, Hoffmann G. Impact of long-term lifestyle programmes on weight loss and cardiovascular risk factors in overweight/obese participants: a systematic review and network meta-analysis. Syst Rev. 2014;3:130. doi: 10.1186/2046-4053-3-130.
    1. Mellen PB, Gao SK, Vitolins MZ, Goff DC. Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004. Arch Intern Med. 2008 Feb 11;168(3):308–314. doi: 10.1001/archinternmed.2007.119.
    1. Fjeldsoe B, Neuhaus M, Winkler E, Eakin E. Systematic review of maintenance of behavior change following physical activity and dietary interventions. Health Psychol. 2011 Jan;30(1):99–109. doi: 10.1037/a0021974.
    1. Ebrahim S, Taylor F, Ward K, Beswick A, Burke M, Davey SG. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev. 2011;(1):CD001561. doi: 10.1002/14651858.CD001561.pub3.
    1. Fifty-eighth World Health Assembly, Geneva, 16-25 May 2005. Geneva: World Health Organization; 2005. [2015-10-08]. Resolutions and decisions: eHealth (WHA58/2005/REC/1) .
    1. Kroes N. European Commission. 2014. May 12, Shaping a healthier, stronger future .

Source: PubMed

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