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 .
Psychodynamic Motivation and Training program (PMT) for the secondary prevention in patients with stable coronary heart disease: study protocol for a randomized controlled trial of feasibility and effects
Background Nonpharmacological secondary prevention of coronary heart disease is considered a safe and effective measure to substantially reduce mortality . Despite the effectiveness of lifestyle changes , the compliance rate of patients is very low mainly due to psychosocial barriers . Psychotherapeutic approaches that address how persons think about themselves and their behaviors appear to have a significant potential for improving health behavior . Methods / design Against this background , our study aims to examine the feasibility and effects of a Psychodynamic Motivation and Training program ( PMT ) as compared to one session of advice in exercise training ( EX ) and treatment as usual ( TAU ) . For that purpose , 90 patients with stable coronary heart disease and a physically inactive lifestyle will be r and omly assigned to the three groups ( each with n = 30 ) . The primary outcome is the change in the individual anaerobic threshold as determined by spiroergometry from baseline to six month follow-up . Secondary endpoints include change in endothelial function , biomarkers of inflammation and oxidative stress , quality of life , symptoms of fatigue , illness perception and feasibility of the treatment approach . We hypothesize that physical fitness will improve more in PMT than in EX and TAU , with PMT and EX more than TAU , and that the effects will be more pronounced for participants with current mental or psychosocial distress . Discussion The results of the study will help to determine the effectiveness of a psychodynamic lifestyle change approach and to identify measures for design ing specifically tailored interventions to improve compliance with cardiovascular prevention . Trial registration Clinical Trials.gov Identifier :
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 .