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Background
Current cardiac rehabilitation programs (CRPs) employ pharmacological management, smoking cessation, nutrition, and exercise and behavioural counselling to effectively manage ischemic heart disease (IHD) risk factors and to promote favourable lifestyle changes. Previous research has demonstrated that CRPs can reduce morbidity and mortality as well as cost of care. [1–5] Studies such as the Stanford Coronary Risk Intervention Project (SCRIP) and the Lifestyle Heart Trial have demonstrated that long-term lifestyle and risk factor management results in regression of atherosclerosis and reduction in cardiovascular events.[3, 4] Despite this finding, many North American programs are of only 3 to 4 months duration, due to budgetary and resource constraints, in addition to insurance coverage limitations. The Multi-fit trial tried to address this issue by conducting a post-MI nurse case-managed intervention consisting of counselling sessions and telephone follow-up that take place immediately following patients' cardiac events. The program, however, was not overwhelmingly successful in demonstrating long-tem comprehensive effectiveness.[6] Therefore, current CRPs face the daunting task of teaching life-long risk factor and lifestyle management within a short time frame.
Lifestyle adherence is difficult to achieve. Based on one report, less than one third of women were exercising the recommended three times per week within one year of completing a CRP.[7] Corresponding worsening of risk factors following completion of a CRP has also been described (body mass index [BMI], total cholesterol [TC], LDL-C and triglycerides [TG] deteriorated in the years following a CRP, with some risk factors reported to be worse than the pre-CRP values.[8, 9]
At the time of the current study's development, no previous reports had investigated a CRP follow-up intervention. We therefore conducted our own pilot study to investigate lifestyle adherence and risk factors for six months following a CRP.[10] Thirty-six men and women were randomized to either a comprehensive lifestyle and risk factor intervention or to usual care. After a six-month intervention of six cardiac rehabilitation exercise sessions and two telephone follow-up calls, we reported significant decreases in TC and LDL-C in the intervention group only.
These findings provided the impetus for undertaking the current Extensive Lifestyle Management Intervention (ELMI), a four-year study of 302 men and women with IHD. We hypothesize that patients with IHD who have been randomized to the four-year ELMI program following a...