Cardiovascular diseases (CVD) are the leading cause of mortality globally, with
developing countries bearing a disproportionate burden of associated risk factors.
Alarmingly, the age of onset of CVD is decreasing in these settings. Despite the
significant burden, preventive strategies targeting modifiable risk factors often receive
insufficient attention. Pakistan, as the fifth most populous country in the world and a
low and middle-income country (LMIC) with a fragile healthcare system, relies heavily on
out-of-pocket payments for healthcare (73% of the population). In this context,
addressing CVD risk factors at the population level and targeting high-risk populations
becomes an essential strategy for combating CVD.

The banking sector in particular has been facing a tremendous change for several years
due to the increasing number of new entrants, which has increased competition among the
banks. Economic uncertainties and political instability have also affected the industry
and consequently the health outcomes of its employees who are considered high risk urban
sedentary workers as they spend more than 8 hours of their daytime sitting with minimal
physical activity (PA) and consuming high lipid diet. This behavior predisposes them to
CVD unless they take preventive health behaviors (engage in regular PA, increase fruit
and vegetable intake, and reduce fatty meals, sugar, and salt intake). Lifestyle
modification aimed at improving PA and dietary habits is the first-line approach to
reducing cardiovascular risk. However, the feasibility of implementing such strategies in
urban environments needs to be examined. Currently, little is known about which
intervention components would be most effective in improving the lifestyle behaviors of
bank employees.

Pertinently, the workspaces of most bank branches in Pakistan lack suitable areas for
relaxation or PA, further exacerbating the sedentary nature of their work. Consequently,
this high-risk group requires targeted efforts to increase their knowledge and address
their lifestyle behaviors for effective CVD prevention. Therefore, the development and
testing of strategies specifically tailored to this occupational group are of utmost
importance.

The overall aim of this research project is to develop and assess the feasibility of
m-LIfE (mHealth-based Lifestyle Intervention for Employees) to improve lifestyle in
high-risk urban sedentary employees (bank employees) from Karachi, Pakistan. The specific
objectives are (1) To explore awareness (perception and preferences) about CVD and its
prevention among high-risk sedentary employees, and design m-LIfE (2) To assess
feasibility of m-LIfE versus routine care among high-risk sedentary employees. The
secondary objective is to report potential efficacy on lifestyle (PA and dietary intake)
in both m-LIfE and routine arm.

This study will employ a mixed-methods approach, beginning with an exploratory
qualitative phase and followed by a pilot cluster randomized controlled trial (cRCT). The
qualitative component will explore awareness, perceptions, and preferences regarding CVD
and its prevention. Following this, m-LIfE app will be developed using human centered
design approach.

The pilot cRCT will evaluate the feasibility and potential efficacy of the m-LIfE over a
12-week intervention period, with a 4-week follow-up. Eight clusters (bank branches) will
be randomly selected out of 313 branches across Karachi, out of which four will be
randomized to the m-LIfE intervention, and four clusters will serve as the routine care
arm. The study will be conducted in branches of three commercial banks (one public and
two private) located in urban Karachi, Pakistan.