The Electronic CardioMetabolic Program (eCMP) for Patients With Cardiometabolic Risk: A Randomized Controlled Trial

• Published in: Journal of medical Internet research Vol. 18; no. 5; p. e134
• Main Authors: Azar, Kristen M J, Koliwad, Suneil, Poon, Tak, Xiao, Lan, Lv, Nan, Griggs, Robert, Ma, Jun
• Format: Journal Article
• Language: English
• Published: Canada Gunther Eysenbach MD MPH, Associate Professor 27.05.2016; JMIR Publications
• Subjects: Adults; Ambulatory care; Ambulatory health care; Attendance; Body mass index; Body Weight; Cardiovascular diseases; Cardiovascular Diseases - complications; Clinical outcomes; Clinical trials; Curricula; Delayed; Diabetes; Diet; Feasibility; Female; Gestational diabetes; Health Behavior; Health status; High risk; Humans; Intervention; Life Style; Lifestyles; Male; Mental health; Metabolic syndrome; Metabolic Syndrome - complications; Metabolism; Middle Aged; Original Paper; Physical activity; Pilot Projects; Quality of Life; Risk Factors; Video conferencing; metabolic syndrome; cardiovascular disease; health technology; behavior change; prevention; lifestyle
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/jmir.5143

Effective lifestyle interventions targeting high-risk adults that are both practical for use in ambulatory care settings and scalable at a population management level are needed. Our aim was to examine the potential effectiveness, feasibility, and acceptability of delivering an evidence-based Electronic Cardio-Metabolic Program (eCMP) for improving health-related quality of life, improving health behaviors, and reducing cardiometabolic risk factors in ambulatory care high-risk adults. We conducted a randomized, wait-list controlled trial with 74 adults aged ≥18 years recruited from a large multispecialty health care organization. Inclusion criteria were (1) BMI ≥35 kg/m(2) and prediabetes, previous gestational diabetes and/or metabolic syndrome, or (2) BMI ≥30 kg/m(2) and type 2 diabetes and/or cardiovascular disease. Participants had a mean age of 59.7 years (SD 11.2), BMI 37.1 kg/m(2) (SD 5.4) and were 59.5% female, 82.4% white. Participants were randomized to participate in eCMP immediately (n=37) or 3 months later (n=37). eCMP is a 6-month program utilizing video conferencing, online tools, and pre-recorded didactic videos to deliver evidence-based curricula. Blinded outcome assessments were conducted at 3 and 6 months postbaseline. Data were collected and analyzed between 2014 and 2015. The primary outcome was health-related quality of life. Secondary outcomes included biometric cardiometabolic risk factors (eg, body weight), self-reported diet and physical activity, mental health status, retention, session attendance, and participant satisfaction. Change in quality of life was not significant in both immediate and delayed participants. Both groups significantly lost weight and reduced waist circumference at 6 months, with some cardiometabolic factors trending accordingly. Significant reduction in self-reported anxiety and perceived stress was seen in the immediate intervention group at 6 months. Retention rate was 93% at 3 months and 86% at 6 months post-baseline. Overall eCMP attendance was high with 59.5-83.8% of immediate and delayed intervention participants attending 50% of the virtual stress management and behavioral lifestyle sessions and 37.8-62.2% attending at least 4 out of 7 in-person physical activity sessions. The intervention received high ratings for satisfaction. The technology-assisted eCMP is a feasible and well-accepted intervention and may significantly decrease cardiometabolic risk among high-risk individuals. Clinicaltrials.gov NCT02246400; https://clinicaltrials.gov/ct2/show/NCT02246400 (Archived by WebCite at http://www.webcitation.org/6h6mWWokP).