Similarly , there was no clear evidence of effect for cardiovascular risk factors , although again the number of studies reporting these was small .
There was some evidence for beneficial effects on HRQOL , dietary outcomes , and physical activity , although firm conclusions can not yet be made .
The effects on healthcare utilisation and cost-effectiveness are also inconclusive , and trials are yet to measure the impact of  Internet interventions on compliance with medication .
BACKGROUND The Internet could provide a means of delivering secondary prevention programmes to people with coronary heart disease ( CHD ) .
OBJECTIVES To determine the effectiveness of Internet-based interventions targeting lifestyle changes and medicines management for the secondary prevention of CHD .
Therapeutic benefit of preventive telehealth counseling in the Community Outreach Heart Health and Risk Reduction Trial.
We evaluated whether telehealth counseling augments lifestyle change and risk factor decrease in subjects at high risk for primary or secondary cardiovascular events compared to a recommended guideline for brief preventive counseling . Subjects at high risk or with coronary heart disease ( 35 to 74 years of age , n = 680 ) were r and omized to active control ( risk factor feedback , brief advice , h and outs ) or telehealth lifestyle counseling ( active control plus 6 weekly 1-hour teleconferenced sessions to groups of 4 to 8 subjects ) . Primary outcome was question naire assessment of adherence to daily exercise/physical activity and diet ( daily vegetable and fruit intake and restriction of fat and salt ) after treatment and at 6-month follow-up . Secondary outcomes were systolic and diastolic blood pressures , ratio of total to high-density lipoprotein cholesterol , and 10-year absolute risk for coronary disease . After treatment and at 6-month follow-up , adherence increased for telehealth versus control in exercise ( 29.3 % and 18.4 % vs 2.5 % and 9.3 % , respectively , odds ratio 1.60 , 95 % confidence interval 1.2 to 2.1 ) and diet ( 37.1 % and 38.1 % vs 16.7 % and 33.3 % , respectively , odds ratio 1.41 , 95 % confidence interval 1.1 to 1.9 ) . Telehealth versus control had greater 6-month decreases in blood pressure ( mean ± SE , systolic -4.8 ± 0.8 vs -2.8 ± 0.9 mm Hg , p = 0.04 ; diastolic -2.7 ± 0.5 vs -1.5 ± 0.6 mm Hg , p = 0.04 ) . Decreases in cholesterol ratio and 10-year absolute risk were significant for the 2 groups . In conclusion , telehealth counseling augments therapeutic lifestyle change in subjects at high risk for cardiovascular events compared to a recommended guideline for brief preventive counseling
Similarly , there was no clear evidence of effect for cardiovascular risk factors , although again the number of studies reporting these was small .
There was some evidence for beneficial effects on HRQOL , dietary outcomes , and physical activity , although firm conclusions can not yet be made .
The effects on healthcare utilisation and cost-effectiveness are also inconclusive , and trials are yet to measure the impact of  Internet interventions on compliance with medication .
BACKGROUND The Internet could provide a means of delivering secondary prevention programmes to people with coronary heart disease ( CHD ) .
OBJECTIVES To determine the effectiveness of Internet-based interventions targeting lifestyle changes and medicines management for the secondary prevention of CHD .