Outcomes of a virtual comprehensive lifestyle intervention program for cardiovascular risk reduction in India

Abstract Background The global burden of cardiovascular disease (CVD) has increased dramatically in the recent past with low- and middle-income countries contributing the majority of cases and India being at the epicentre of the crisis. Coordinated primordial, primary, secondary and tertiary prevention strategies focused on health behaviour modification and cardiovascular risk reduction are needed to halt the ongoing CVD epidemic. Purpose This study aims to analyse the outcomes of a comprehensive lifestyle intervention program (CLIP) provided predominantly virtually during and after the COVID-19 pandemic in India. Methods This retrospective study included all patients who completed a comprehensive lifestyle intervention program (CLIP) from 2020 to 2025. The assessments done pre- and post-program were health behaviour score using an internally-validated questionnaire, physical and mental component scores (PCS, MCS) using the SF-12 quality of life (QoL) questionnaire, heart rate, systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI) and 6-minute walk distance (6MWD) in all patients and left ventricular ejection fraction (LVEF) in heart failure patients. A multidisciplinary team comprising a physician, physiotherapist and dietitian delivered the CLIP using tele-health platforms, either as fully home-based or hybrid with some in-person sessions. The health behaviour score was a composite of daily fruit, vegetable and whole grain intake, weekly exercise frequency and duration, daily sleep hours and self-perceived chronic stress. Participants attended two to three sessions per week, combining multicomponent exercise with dietary guidance, health education and psychosocial counselling including return to work and sexual counseling. Results The study cohort (n=102) was 54±12 years, 81% male, 72% in the cardiac rehab group and 36% in the fully home-based group (Table 1). Overweight/obesity was the most prevalent risk factor (55%) followed by hypertension (53%), dyslipidemia (47%), type 2 diabetes mellitus (41%) and current tobacco use (10%). Heart failure was documented in 22%. A significant improvement was noted in health behaviour score, PCS, MCS, SBP, DBP, BMI, 6MWD and LVEF (Table 2) and no adverse events were reported upon completion of CLIP in the study subjects. All tobacco smokers quit; 1 tobacco chewer failed to quit. A significant positive correlation was observed between number of sessions attended and PCS (r=0.25, p=0.011), 6MWD and PCS (r=0.21, p=0.03), and health behaviour score and MCS (r=0.43, p0.001). Conclusions Participation in a virtual comprehensive lifestyle intervention program was safe and resulted in significant improvements in various behavioural, clinical and QoL parameters in our patients, demonstrating clear potential to be integrated in the care pathways of patients with CVD risk or diagnosis.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.