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European Heart Journal 2003 24(21):1920-1927; doi:10.1016/j.ehj.2003.08.015
Copyright © 2003 by the European Society of Cardiology.
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Clinical research

The Extensive Lifestyle Management Intervention (ELMI) following cardiac rehabilitation trial

Scott A. Leara,b,*, Andrew Ignaszewskib, Wolfgang Lindenc, Anka Brozicd, Marla Kiesse, John J. Spinellif, P. Haydn Pritchardg and Jiri J. Frohlichg

a School of Kinesiology, Simon Fraser University, Vancouver, Canada
b Healthy Heart Program, Division of Cardiology, Department of Medicine, St. Paul’s Hospital, University of British Columbia, British Columbia, Canada
c Department of Psychology, University of British Columbia, British Columbia, Canada
d Healthy Heart Program, Vancouver General Hospital, Vancouver, Canada
e Department of Medicine and Radiology, University of British Columbia, British Columbia, Canada
f Cancer Control Research Program, British Columbia Cancer Agency, British Columbia, Canada
g Department of Pathology and Laboratory Medicine, University of British Columbia, British Columbia, Canada

* Corresponding author. Dr S. A. Lear, Healthy Heart Program, St. Paul’s Hospital, 180–1081 Burrard Steet, Vancouver, BC, CanadaV6Z 1Y6. Tel.: +1-604-682-2344 ext. 62778; fax: +1-604- 806-8590
E-mail address: slear{at}providencehealth.bc.ca

Received 16 February 2003; revised 22 July 2003; accepted 28 August 2003

Abstract

Aim Previous studies have reported lifestyle and risk factor deterioration following completion of a cardiac rehabilitation program (CRP). We report the results of a one-year Extensive Lifestyle Management Intervention (ELMI) aimed at preventing these adverse changes.

Methods and results A total of 302 men and women with ischaemic heart disease were recruited following completion of a CRP and randomized to either the ELMI (consisting of exercise sessions, telephone follow-ups and risk factor and lifestyle counselling) or usual care. The primary outcome was global cardiovascular risk using the Framingham and Procam risk scores. Secondary outcomes included risk factors and lifestyle behaviours. Baseline characteristics were similar between the two groups. Adherence to the ELMI was high. There was a non-significant trend in favour of the ELMI between for both the Framingham (6.6±3.1 to 6.2±2.9 vs 6.6±3.2 to 6.7±3.2, P=0.138) and Procam (20.0±20.0 to 20.6±19.5 vs 19.1±18.7 to 21.8±19.1, P=0.089) scores. There were no differences in secondary outcomes.

Conclusions A one-year multi-factorial post-CRP intervention results in modest, non-significant benefits to global risk compared to usual care. The absence of deterioration in the usual care group may be due to improved practices in usual care.

Key Words: Ischaemic heart disease • Cardiac rehabilitation • Lifestyle management • Risk factors


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