A population-based lifestyle intervention to promote healthy weight and physical activity in people with cardiac disease

Cardiovascular disease is the leading cause of death and the most expensive disease group treated in Australia. Only one-third of clinically eligible patients attend cardiac rehabilitation (CR), leaving the majority with unmet health needs. Non-attendees are socio-economically disadvantaged, have higher cardiovascular risk and live further from health services. Many CR attendees do not achieve their weight or physical activity targets. Innovative models of secondary prevention for cardiac disease are needed to address these gaps. Research aimed to determine:1.The efficacy of a telephone-delivered pedometer-based intervention on weight and physical activity for urban and rural people referred to CR. 2.If the findings on physical activity previously reported are replicated in the control group of this trial.3.The costs and cost-effectiveness of the interventions. Rural and urban patients (n=313) referred to CR were randomised to a healthy weight (HW) intervention (four telephone coaching sessions on weight and physical activity) or a physical activity (PA) comparison group (two telephone coaching sessions on physical activity). Self-reported weight and physical activity were assessed at baseline, short-term (6-8 weeks) and medium-term (6-8 months). The physical activity outcomes of the PA group were also compared to a reference randomised controlled trial that had previously showed the same intervention was efficacious for cardiac patients in one semi-rural setting. A cost-utility analysis assessed the incremental cost-effectiveness of the HW intervention over the PA intervention. The HW group decreased their weight (p=0.005) and HW participants with a BMI ≥ 25 kg/m2 had a mean weight loss of 1.6 kg (p=0.01), compared to the PA group, over the medium-term. Both groups increased their physical activity short-term and the PA group maintained this increase medium-term. Increases in physical activity in the PA group were comparable to those of the reference study. The cost-utility analysis showed the HW intervention dominated the PA intervention and was more cost-effective for patients who did not attend CR and rural participants.The low-contact, low-cost, telephone-based interventions tested are an effective and feasible means of delivering lifestyle interventions for underserved rural communities, for CR non-attendees, or as an adjunct to existing CR programs