Hypertension Treatment Using an Internet-based Lifestyle Intervention

Lifestyle change is important to blood pressure (BP) management. A health care challenge is to extend the reach of these lifestyle programs without over taxing health care resources. The rapid growth of Internet use presents an opportunity to tackle this challenge. However, meta-analytic data examining the efficacy of Internet-based lifestyle interventions to reduce BP in patients with hypertension is lacking. The optimal design strategies of effective Internet-based interventions also remain unclear; specifically, the effectiveness of clinical methods used (User- vs. Expert-driven protocols). Furthermore, self-monitoring of physical activity (PA) can help participants improve adherence to PA and reduce BP. Thus, it is important to find a user-friendly, low-cost and valid tool to measure PA that can be used in an Internet-based intervention. To address these questions, the first study examined the efficacy of Internet-based interventions in reducing BP in a meta-analysis and identified key components of an Internet-based intervention that are associated with BP control. The second study validated the XL-18 pedometer, which was a critical instrument in measuring daily steps used in the third study. The third study examined the influence of User- vs. expert-driven approaches used in an Internet-intervention aimed at promoting BP control and adherence to lifestyle changes. The first study showed that self-guided Internet-based lifestyle programs can be effective in reducing BP; specifically, interventions may be more efficacious when they were 6 months or longer, delivered proactively, and provided at least five behavioural techniques. The second study found that the XL-18 pedometer is a suitable tool to measure steps under controlled and free-living conditions. The third study demonstrated that it may be advisable to integrate an expert-driven e-counselling procedure into future Internet-based interventions in order to accommodate participants with greater levels of motivation for behaviour change. Overall, these findings have significant implications in designing the next generation of Internet-based lifestyle interventions.Ph.D