***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Many patients do not maintain physical activity levels after completion of phase III exercise-based cardiac rehabilitation . Design This study determined the effect of an exercise consultation on maintenance of physical activity and cardiorespiratory fitness 12 months after completion of a phase III exercise programme . Seventy cardiac patients were r and omized to the experimental ( exercise consultation and exercise information ) or control groups ( exercise information only ) . Methods Outcomes recorded at baseline , 6 and 12 months were : physical activity ( stage of change , 7-day recall , accelerometer ) , cardiorespiratory fitness , lipids , quality of life , anxiety and depression . Results Both groups were regularly active at baseline . The between-group difference for the change in total activity ( min/week ) assessed by the 7-day recall was significant from baseline to 12 months [ 98 % confidence interval ( CI ) −295 , −20 ] . Total activity was maintained in the experimental group ( 98 % CI −63 , 154 ) and significantly decreased in the control group ( 115 min/week ; 98 % CI −228 , −28 ) from baseline to 12 months . The between-group difference for the change in accelerometer counts/week was not significant from baseline to 6 ( 98 % CI −1143 720 , 607430 ) or 12 months ( 98 % CI −1131 128 , 366 473 ) . A comparable , significant decrease in peak oxygen uptake occurred from baseline to 12 months in experimental ( 1.8 ml/kg per min ; 98 % CI −3.2 , −0.3 ) and control participants ( 2.3 ml/kg per min ; −3.8 , −0.8 ) . Lipids , quality of life , anxiety and depression were normal at baseline and did not significantly change in either group over time . Conclusion Exercise consultation was effective in maintaining self-reported physical activity , but not peak oxygen uptake , for 12 months after completion of phase III . Eur J Cardiovasc Prev Rehabil 14 : 114 - 121 © 2007 The European Society of Background Cardiovascular disease ( CVD ) is the leading cause of death worldwide . Secondary prevention is essential , but participation rates for cardiac rehabilitation are low . Furthermore , current programmes do not accomplish that patients with CVD change their lifestyle in a way that their individual risk factors for recurrent events decrease , therefore more effective interventions are needed . In this study , the effectiveness of the Hartcoach-programme , a telephonic secondary prevention program focussing on self management , is studied . Methods / design A multicenter , r and omised parallel-group study is being conducted . Participants are 400 patients with acute myocardial infa rct ion ( STEMI , NSTEMI , ) and patients with chronic or unstable angina pectoris ( IAP ) . Patients are recruited through the participating hospitals and r and omly assigned to the experimental group ( Hartcoach-programme plus usual care ) or the control group ( usual care).The Hartcoach-programme consists of a period of six months during which the coach contacts the patient every four to six weeks by telephone . Coaches train patients to take responsibility for the achievement and maintenance of the defined target levels for their particular individual modifiable risk factors . Target levels and treatment goals are agreed by the nurse and patient together . Data collection is blinded and occurs at baseline and after 26 weeks ( post-intervention ) . Primary outcome is change in cardiovascular risk factors ( cholesterol , body mass index , waist circumference , blood pressure , physical activity and diet ) . Secondary outcomes include chances in glucose , HbA1c , medication adherence , self-management and quality of life . Discussion This study evaluates the effects of the Hartcoach-programme on the reduction of individual risk factors of patients with CVDs . Patients who are not invited to follow a hospital based rehabilitation programme or patients who are unable to adhere to such a programme , may be reached by this home based Hartcoach-programme . If positive results are found , the implementation of the Hartcoach-programme will be extended , having implication s for the management of many people with CVD.Trial registration Background Cardiovascular disease ( CVD ) is the leading cause of death worldwide . Cardiac rehabilitation ( CR ) is aim ed at improving health behaviors to slow or reverse the progression of CVD disease . Exercise is a central element of CR . Technologies such as mobile phones and the Internet ( mHealth ) offer potential to overcome many of the psychological , physical , and geographical barriers that have been associated with lack of participation in exercise-based CR . We aim to trial the effectiveness of a mobile phone delivered exercise-based CR program to increase exercise capacity and functional outcomes compared with usual CR care in adults with CVD . This paper outlines the rationale and methods of the trial . Methods A single-blinded parallel two-arm r and omized controlled trial is being conducted . A total of 170 people will be r and omized at 1:1 ratio either to receive a  mHealth CR program  or usual care .  Participants are identified by CR nurses from two metropolitan hospitals in Auckl and , New Zeal and through outpatient clinics and existing data bases . Consenting participants are contacted to attend a baseline assessment . The intervention consists of a theory-based , personalized , automated package of text and video message components via participants ' mobile phones and the Internet to increase exercise behavior , delivered over six months . The control group will continue with usual CR . Data collection occurs at baseline and 24 weeks ( post-intervention ) . The primary outcome is change in maximal oxygen uptake from baseline to 24 weeks . Secondary outcomes include post-intervention measures on self-reported physical activity ( IPAQ ) , cardiovascular risk factors ( systolic blood pressure , weight , and waist to hip ratio ) , health related quality of life ( SF-36 ) , and cost-effectiveness . Discussion This manuscript presents the protocol for a r and omized controlled trial of a mHealth exercise-based CR program . Results of this trial will provide much needed information about physical and psychological well-being , and cost-effectiveness of an automated telecommunication intervention . If effective , this intervention has enormous potential to improve the delivery of CR and could easily be scaled up to be delivered nationally ( and internationally ) in a very short time , enhancing the translational aspect of this research . It also has potential to extend to comprehensive CR ( nutrition advice , smoking cessation , medication adherence).Trial Registration Background Grade d health benefits of physical activity have been demonstrated for the reduction of coronary heart disease , some cancers , and type-2 diabetes , and for injury reduction and improvements in mental health .  Older adults are particularly at risk of physical inactivity , and would greatly benefit from successful targeted physical activity interventions . Methods / Design The Healthy Steps study is a 12-month r and omized controlled trial comparing the efficacy of a pedometer-based Green Prescription with the conventional time-based Green Prescription in increasing and maintaining physical activity levels in low-active adults over 65 years of age . The Green Prescription interventions involve a primary care physical activity prescription with 3 follow-up telephone counselling sessions delivered by trained physical activity counsellors over 3 months . Those in the pedometer group received a pedometer and counselling based around increasing steps that can be monitored on the pedometer , while those in the st and ard Green Prescription group received counselling using time-based goals . Baseline , 3 month ( end of intervention ) , and 12 month measures were assessed in face-to-face home visits with outcomes measures being physical activity ( Auckl and Heart Study Physical Activity Question naire ) , quality of life ( SF-36 and EQ-5D ) , depressive symptoms ( Geriatric Depression Scale ) , blood pressure , weight status , functional status ( gait speed , chair st and s , and t and em balance test ) and falls and adverse events ( self-report ) . Utilisation of health services was assessed for the economic evaluation carried out alongside this trial . As well , a process evaluation of the interventions and an examination of barriers and motives for physical activity in the sample were conducted . The perceptions of primary care physicians in relation to delivering physical activity counselling were also assessed . Discussion The findings from the Healthy Steps trial are due in late 2009 . If successful in improving physical activity in older adults , the pedometer-based Green Prescription could assist in reducing utilisation of health services and improve cardiovascular health and reduction of risk for a range of non-communicable lifestyles diseases . Trial registration Australian and New Zeal and Clinical Trials Registry In cardiac rehabilitation programs , patients learn how to adopt a healthier lifestyle , including regular , strenuous physical activity . Long-term success is only modest despite good intentions . To improve exercise adherence , a 3-group experiment was design ed that included innovative psychological interventions . All 3 groups underwent a st and ard care rehabilitation program . Patients in the 2 treatment groups were instructed not only to produce detailed action plans but also to develop barrier-focused mental strategies . On top of this , in 1 of these groups a weekly diary was kept for 6 weeks to increase a sense of action control . At the end of a st and ard cardiac rehabilitation program , 240 patients were r and omly assigned to these treatment groups plus a st and ard care control group . Treatments result ed in more physical activity at follow-up and better adherence to recommended levels of exercise intensity . Moreover , self-regulatory skills such as planning and action control were improved by the treatments . Follow-up analyses demonstrated the mediating mechanisms of self-regulatory skills in the process of physical exercise maintenance . Findings imply that interventions targeting self-regulatory skills can enable postrehabilitation patients to reduce behavioral risk factors and facilitate intended lifestyle changes The purpose of the study was to investigate the effect of nursing care based on Orem 's nursing theory on nutritional self-care of myocardial infa rct ion patients . Self-efficacy was explored as a disposition which may motivate behavioral change . One hundred and four subjects were r and omly assigned to treatment or  control groups . The nursing intervention , which took place during the first 6 weeks following hospital discharge , was effective in supporting healthy low-fat eating behavior .  Nursing care influenced patients ' self-care agency but lacked impact on self-efficacy for healthy eating The purpose of this pilot study was to test the initial efficacy , feasibility , and safety of a specially design ed postacute care transitional rehabilitation intervention for cardiac patients .  Cardiac Transitional Rehabilitation Using Self-Management Techniques ( Cardiac TRUST ) is a family-focused intervention that includes progressive low-intensity walking and education in self-management skills to facilitate recovery following a cardiac event . Using a r and omized two-group design , exercise self-efficacy , steps walked , and participation in an outpatient cardiac rehabilitation ( CR ) program  were compared in a sample of 38 older adults ( 17 Cardiac TRUST , 21 usual care ) . At discharge from postacute care , the intervention group trended toward higher levels of self-efficacy for exercise outcomes than the usual care group . During the 6 weeks following discharge , the intervention group had greater attendance in outpatient CR and a trend toward more steps walked during the first week . The feasibility of the intervention was better for the home health care participants than for those in the skilled nursing facility . The provision of CR during postacute care has the potential to bridge the gap in transitional services from hospitalization to outpatient CR for these patients at high risk for future cardiac events . Further evidence of the efficacy of Cardiac TRUST is warranted Background Maintaining a healthy weight and undertaking regular physical activity are important for the secondary prevention of cardiovascular disease ( CVD ) . However , many people with CVD are overweight and insufficiently active . In addition , in Australia only 20 - 30 % of people requiring cardiac rehabilitation ( CR ) for CVD actually attend . To improve outcomes of and access to CR the efficacy , effectiveness and cost-effectiveness of alternative approaches to CR need to be established . This research will determine the efficacy of a telephone-delivered lifestyle intervention , promoting healthy weight and physical activity , in people with CVD in urban and rural setting s. The control group will also act as a replication study of a previously proven physical activity intervention , to establish whether those findings can be repeated in different urban and rural locations . The cost-effectiveness and acceptability of the intervention to CR staff and participants will also be determined . Methods / Design This study is a r and omised controlled trial . People referred for CR at two urban and two rural Australian hospitals will be invited to participate . The intervention ( healthy weight ) group will participate in four telephone delivered behavioural coaching and goal setting sessions over eight weeks . The coaching sessions will be on weight , nutrition and physical activity and will be supported by written material s , a pedometer and two follow-up booster telephone calls . The control ( physical activity ) group will participate in a six week intervention previously shown to increase physical activity , consisting of two telephone delivered behavioural coaching and goal setting sessions on physical activity , supported by written material s , a pedometer and two booster phone calls . Data will be collected at baseline , eight weeks and eight months for the intervention group ( baseline , six weeks and six months for the control group ) . The primary outcome is weight change . Secondary outcomes include physical activity , sedentary time and nutrition habits . Costs will be compared with outcomes to determine the relative cost-effectiveness of the healthy weight and physical activity interventions . Discussion This study addresses a significant gap in public health practice by providing evidence for the efficacy and cost-effectiveness of a low cost , low contact , high reach intervention promoting healthy weight and physical activity among people with CVD in rural and urban areas in Australia . The replication arm of the study , undertaken by the control group , will demonstrate whether the findings of the previously proven physical activity intervention can be generalised to new setting s. This population -based approach could potentially improve access to and outcomes of secondary prevention programs , particularly for rural or disadvantaged communities . Trial Registration Background : Despite participation in a cardiac rehabilitation program , there is a downward trajectory of exercise participation during the year following a cardiac 
    Output:
    
AUTHORS ' CONCLUSIONS There is some evidence to suggest that interventions to increase the uptake of cardiac rehabilitation can be effective .
Interventions targeting patient identified barriers may increase the likelihood of success .