What is the clinical evidence from this study?

Study design: RCT. Population: ischaemic heart disease (n=302). Intervention: Extensive Lifestyle Management Intervention (ELMI) vs. usual care. Primary outcome: global cardiovascular risk using the Framingham and Procam risk scores (p=0.138 (Framingham), 0.089 (Procam)).

What does this research mean for the field?

A one-year extensive lifestyle management intervention following cardiac rehabilitation provides no significant benefit to global cardiovascular risk compared to usual care, largely because patients receiving usual care no longer experience the previously reported post-rehabilitation deterioration. Novelty: ClaimNovelty.CONTRADICTORY. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

The aim is to examine the effectiveness of an Extensive Lifestyle Management Intervention (ELMI) in reducing cardiovascular risk after cardiac rehabilitation.

June 7, 2026

The Extensive Lifestyle Management Intervention (ELMI) following cardiac rehabilitation trial

Key Result

A one-year Extensive Lifestyle Management Intervention following cardiac rehabilitation yielded non-significant changes in Framingham (P=0.138) and Procam (P=0.089) risk scores compared to usual care.

Key Points

The aim is to examine the effectiveness of an Extensive Lifestyle Management Intervention (ELMI) in reducing cardiovascular risk after cardiac rehabilitation.
302 individuals with ischaemic heart disease were randomized to either ELMI or usual care.
ELMI included exercise sessions, telephone follow-ups, and risk factor/lifestyle counseling.
Primary outcome assessed was global cardiovascular risk using Framingham and Procam risk scores.
ELMI showed a non-significant reduction in the Framingham score (P=0.138).
Procam score showed a non-significant trend (P=0.089) compared to usual care.
No significant differences in secondary outcomes between groups.

Study Design

Type

RCT (n=302)

Structured PICO

Does a one-year Extensive Lifestyle Management Intervention (ELMI) improve global cardiovascular risk in patients with ischaemic heart disease following completion of a cardiac rehabilitation program?

Population

302 men and women with ischaemic heart disease who had completed a cardiac rehabilitation program, followed for one year.

Intervention

One-year Extensive Lifestyle Management Intervention (ELMI) consisting of exercise sessions, telephone follow-ups, and risk factor and lifestyle counselling

Comparator

Usual care

Outcome

Global cardiovascular risk using the Framingham and Procam risk scoressurrogate

A one-year multi-factorial post-cardiac rehabilitation lifestyle intervention resulted in modest, non-significant benefits to global cardiovascular risk compared to usual care.

Main Result

p-value: p=0.138 (Framingham), 0.089 (Procam)

Limitations

Improved practices in usual care may have prevented expected deterioration in the control group

Abstract

AIM: Previous studies have reported lifestyle and risk factor deterioration following completion of a cardiac rehabilitation program (CRP). We report the results of a one-year Extensive Lifestyle Management Intervention (ELMI) aimed at preventing these adverse changes. METHODS AND RESULTS: A total of 302 men and women with ischaemic heart disease were recruited following completion of a CRP and randomized to either the ELMI (consisting of exercise sessions, telephone follow-ups and risk factor and lifestyle counselling) or usual care. The primary outcome was global cardiovascular risk using the Framingham and Procam risk scores. Secondary outcomes included risk factors and lifestyle behaviours. Baseline characteristics were similar between the two groups. Adherence to the ELMI was high. There was a non-significant trend in favour of the ELMI between for both the Framingham (6.6+/-3.1 to 6.2+/-2.9 vs 6.6+/-3.2 to 6.7+/-3.2, P=0.138) and Procam (20.0+/-20.0 to 20.6+/-19.5 vs 19.1+/-18.7 to 21.8+/-19.1, P=0.089) scores. There were no differences in secondary outcomes. CONCLUSIONS: A one-year multi-factorial post-CRP intervention results in modest, non-significant benefits to global risk compared to usual care. The absence of deterioration in the usual care group may be due to improved practices in usual care.

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