Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Nov 19;20(11):e12052.
doi: 10.2196/12052.

Evaluation of a Web-Based Intervention for Multiple Health Behavior Changes in Patients With Coronary Heart Disease in Home-Based Rehabilitation: Pilot Randomized Controlled Trial

Yan Ping Duan  1 , Wei Liang  1 , Lan Guo  2 , Julian Wienert  3 , Gang Yan Si  4 , Sonia Lippke  3
Affiliations
Randomized Controlled Trial

Evaluation of a Web-Based Intervention for Multiple Health Behavior Changes in Patients With Coronary Heart Disease in Home-Based Rehabilitation: Pilot Randomized Controlled Trial

Yan Ping Duan et al. J Med Internet Res. .

Abstract

Background: Web-based and theory-based interventions for multiple health behaviors appears to be a promising approach with respect to the adoption and maintenance of a healthy lifestyle in cardiac patients who have been discharged from the hospital. Until now, no randomized controlled trials have tested this assumption among Chinese rehabilitation patients with coronary heart disease using a Web-based intervention.

Objective: The study aim was to evaluate the effect of an 8-week Web-based intervention in terms of physical activity (PA), fruit and vegetable consumption (FVC), lifestyle changes, social-cognitive outcomes, and health outcomes compared with a waiting control group in Chinese cardiac patients. The intervention content was theory-based on the health action process approach. Self-reported data were evaluated, including PA, FVC, healthy lifestyle (the synthesis of PA and FVC), internal resources (combination of intention, self-efficacy, and planning), and an external resource (social support) of PA and FVC behaviors, as well as perceived health outcomes (body mass index, quality of life, and depression).

Methods: In a randomized controlled trial, 136 outpatients with coronary heart disease from the cardiac rehabilitation center of a hospital in China were recruited. After randomization and exclusion of unsuitable participants, 114 patients were assigned to 1 of the 2 groups: (1) the intervention group: first 4 weeks on PA and subsequent 4 weeks on FVC and (2) the waiting control group. A total of 2 Web-based assessments were conducted, including 1 at the beginning of the intervention (T1, N=114), and 1 at the end of the 8-week intervention (T2, N=83). The enrollment and follow-up took place from December 2015 to May 2016.

Results: The Web-based intervention outperformed the control condition for PA, FVC, internal resources of PA and FVC, and an external resource of FVC, with an eta-squared effect size ranging from 0.06 to 0.43. Furthermore, the intervention effect was seen in the improvement of quality of life (F1,79=16.36, P<.001, η2=.17). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR 145.60, 95% CI 11.24-1886; P<.001) and the intervention (OR 21.32, 95% CI 2.40-189.20; P=.006) were found to be significant predictors. Internal resources for FVC mediated the effect of the intervention on the adoption of a healthy lifestyle (R2adj=.29; P=.001), indicating that if the intervention increased the internal resource of behavior, the adoption of a healthy lifestyle was more likely.

Conclusions: Patients' psychological resources such as motivation, self-efficacy, planning, and social support as well as lifestyle can be improved by a Web-based intervention that focuses on both PA and FVC. Such an intervention enriches extended rehabilitation approaches for cardiac patients to be active and remain healthy in daily life after hospital discharge.

Trial registration: ClinicalTrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6pHV1A0G1).

Keywords: cardiac rehabilitation; diet; eHealth; health resources; physical activity.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flowchart of participant progress throughout the study phases. FVC: fruit and vegetable consumption; PA: physical activity.
Figure 2
Figure 2
Mean values for intervention group (solid line) and waiting control group (dotted line) at T1 and T2. (A) Performed physical activity (PA) (minutes/week). (B) Internal resources for PA (combination of intention, self-efficacy, and planning). (C) External resources for PA (social-support). (D) Fruit and vegetable consumption (FVC) behaviour (portions/day). (E) Internal resources for FVC (combination of intention, self-efficacy, and planning). (F) External resources for FVC (social-support).
Figure 3
Figure 3
Mean values of health outcomes (Body mass index, quality of life, and depression) for intervention group (solid line) and waiting control group (dotted line) at T1 and T2. (A) Body mass index. (B) Quality of life. (C) Depression.
Figure 4
Figure 4
Mediation of the effect of the intervention on lifestyle changes by internal and external resources. Significant changes are indicted by an asterisk.
See this image and copyright information in PMC

References

    1. World Health Organization. [2018-10-28]. World health statistics 2018: monitoring health for the SDGs, sustainable development goals http://www.who.int/gho/publications/world_health_statistics/2018/en/
    1. Chen WW, Gao RL, Liu LS, Zhu ML, Wang W, Wang YJ, Hu SS. China Cardiovascular Disease Report 2017 (Summary) [In Chinese] Chin Circ J. 2018 Jan;33(1):1–8. doi: 10.3969/j.issn.1000-3614.2018.01.001. http://www.chinacirculation.org/Admin/Upload/FileDownload/?ContentID=125... - DOI
    1. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004 May 15;116(10):682–92. doi: 10.1016/j.amjmed.2004.01.009.S0002934304001238 - DOI - PubMed
    1. Williams MA, Ades PA, Hamm LF, Keteyian SJ, LaFontaine TP, Roitman JL, Squires RW. Clinical evidence for a health benefit from cardiac rehabilitation: an update. Am Heart J. 2006 Nov;152(5):835–41. doi: 10.1016/j.ahj.2006.05.015.S0002-8703(06)00453-4 - DOI - PubMed
    1. Wenger NK. Current status of cardiac rehabilitation. J Am Coll Cardiol. 2008 Apr 29;51(17):1619–31. doi: 10.1016/j.jacc.2008.01.030. https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)00593-7 S0735-1097(08)00593-7 - DOI - PubMed

Publication types

Associated data