Movement as medicine for cardiovascular disease prevention: A pilot feasibility study of a physical activity promotion intervention for at-risk patients in primary care (Preprint)

2021 ◽  
Author(s):  
Keegan Knittle ◽  
Sarah J Charman ◽  
Sophie O'Connell ◽  
Leah Avery ◽  
Michael Catt ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Motivational Interviewing ◽  
Self Efficacy ◽  
Healthcare Professionals ◽  
Online Course ◽  
Cvd Risk ◽  
Activity Promotion ◽  
Cvd Prevention

BACKGROUND Physical activity (PA) can reduce cardiovascular disease (CVD) risk factors, and while primary care settings offer a large reach to promote PA and reduce cardiovascular disease risk, primary healthcare professionals may lack self-efficacy and tools to effectively promote PA in practice. Movement as Medicine for CVD Prevention is a suite of two theory-based online behavioural interventions – one for healthcare professionals and one for patients – that may offer a pathway for promoting PA and reducing CVD risk in primary care. OBJECTIVE To examine the feasibility and possible effects of Movement as Medicine for CVD Prevention. METHODS This non-randomized pilot recruited participants from primary care organisations in Northeast England. Enrolled healthcare professionals followed a theory-based online course in PA counselling and motivational interviewing techniques. After the course, healthcare professionals delivered behaviour change consultations based on motivational interviewing to inactive individuals with >20% risk of developing CVD within 10 years. Patients were then given access to a website based on self-determination and self-regulation theories which targeted increased levels of PA. Outcomes were assessed at baseline and 3 months. RESULTS Recruitment rates of primary care organisations fell below expectations. Eleven healthcare professionals from three enrolled primary care organisations completed the online course and reported increases in important theoretical determinants of PA promotion in practice (e.g. self-efficacy (d=1.24; 95%CI: 0.67-1.80) and planning (d=0.85; 95%CI: -0.01-1.69)). Eighty-three patients enrolled in the study, and 58 (70%) completed both baseline and three-month assessments. From baseline to 3 months, patients reported significant increases in objective (d=0.26; 95%CI: 0.04-0.48) and subjective (d=0.31; 95%CI: 0.04-0.58) moderate-to-vigorous PA, and in the PA determinants intention, action planning, action control and knowledge of CVD prevention (effect sizes ranged from d=0.26 to d=0.47). CONCLUSIONS Recruitment rates of primary care organisations would need to increase for Movement as Medicine for CVD Prevention to be feasible as a primary care PA promotion pathway. However, the program seems to have effects on important determinants of healthcare professional’s PA promotion and on patient PA behaviours. CLINICALTRIAL ISRCTN, ISRCTN14582348. Registered 3 October 2012.http://www.isrctn.com/ISRCTN14582348

scholarly journals Reducing weight and increasing physical activity in people at high risk of cardiovascular disease: a randomised controlled trial comparing the effectiveness of enhanced motivational interviewing intervention with usual care

Heart ◽  
2019 ◽  
Vol 106 (6) ◽  
pp. 447-454 ◽  
Author(s):  
Khalida Ismail ◽  
Adam Bayley ◽  
Katherine Twist ◽  
Kurtis Stewart ◽  
Katie Ridge ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Motivational Interviewing ◽  
Controlled Trial ◽  
Mean Difference ◽  
Behaviour Change Techniques ◽  
Cvd Risk ◽  
Secondary Outcomes ◽  
Randomised Controlled

ObjectiveThe epidemic of obesity is contributing to the increasing prevalence of people at high risk of cardiovascular disease (CVD), negating the medical advances in reducing CVD mortality. We compared the clinical and cost-effectiveness of an intensive lifestyle intervention consisting of enhanced motivational interviewing in reducing weight and increasing physical activity for patients at high risk of CVD.MethodsA three-arm, single-blind, parallel-group randomised controlled trial was conducted in consenting primary care centres in south London. We recruited patients aged 40–74 years with a QRisk2 score ≥20.0%, which indicates the probability of having a CVD event in the next 10 years. The intervention was enhanced motivational interviewing which included additional behaviour change techniques and was delivered by health trainers in 10 sessions over 1 year, in either group (n=697) or individual (n=523) format. The third arm received usual care (UC; n=522). The primary outcomes were physical activity (mean steps/day) and weight (kg). Secondary outcomes were changes in low-density lipoprotein cholesterol and CVD risk score. We estimated the relative cost-effectiveness of each intervention.ResultsAt 24 months, the group and individual interventions were not more effective than UC in increasing physical activity (mean difference=70.05 steps, 95% CI −288.00 to 147.90 and mean difference=7.24 steps, 95% CI −224.01 to 238.50, respectively), reducing weight (mean difference=−0.03 kg, 95% CI −0.49 to 0.44 and mean difference=−0.42 kg, 95% CI −0.93 to 0.09, respectively) or improving any secondary outcomes. The group and individual interventions were not cost-effective at conventional thresholds.ConclusionsEnhancing motivational interviewing with additional behaviour change techniques was not effective in reducing weight or increasing physical activity in those at high CVD risk.

What people really know about hypertension and other cardiovascular disease risk factors. Recommendations vs reality

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Wierzowiecka ◽  
A Niklas ◽  
W Drygas ◽  
A Pajak ◽  
T Zdrojewski ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
Pharmacological Treatment ◽  
Overweight And Obesity ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Cvd Prevention ◽  
Vegetables And Fruits

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The WOBASZ II project was financed by the resources available to the Minister of Health as part of the POLKARD National Program to Equalise Accessibility to Cardiovascular Disease Prevention and Treatment for 2010–2012, the goal of which was to monitor the epidemiological situation in Poland in the field of cardiovascular diseases. Cyclically, new guidelines are developed to prevent cardiovascular diseases (CVD). But unfortunately their implementation in clinical practice is poor. The aim of the study was 1)  to evaluate the awareness of CVD prevention principles in a representative sample of adult residents of Poland with diagnosed hypertension (HT); 2) to investigate the prevalence of modifiable CVD risk factors such as obesity, hyperlipemia, smoking, low physical activity, excessive intake of sodium, insufficient fruit and vegetable consumption in the daily diet, and to determine the extent to which recommendations for CVD prevention are implemented in everyday practice; 3) to evaluate how knowledge of CVD risk factors affects the control of HT. The study covered 2783 individuals with diagnosed HT. 72,2% knew the term ‘risk factor’. Spontaneously listed risk factors for CVD: HT 36,8%, smoking 43,3%, overweight and obesity 28,5%, unhealthy food 30,9%, increased cholesterol level 25,3%, and low physical activity 25,1%. Complications that can be caused by untreated HT, were listed by 72,6% to be a stroke, heart diseases by 57,8%, atherosclerotic lesions in the arteries by 17,7%, kidney disease by 9,5%, and vision disorder by 9,2%. Prevention methods other than medication were listed by more physical activity 38,8%, reduction of body weight in overweight people 45,5%, stop smoking 43,7%, conducting a regular lifestyle 42,1%, limiting fat intake 38,3%, restrictions on drinking alcohol 37,5%, daily consumption of vegetables and fruits 20,6%. No prevention method has been mentioned by 10,5% of patients. 73.2% declared knowledge of the upper limits of the correct blood pressure (BP), but only 10.2% gave the correct values. Overweight was found in 39% of patients, obesity in 36.7%, smoking in 21.3%, low physical activity (<30 min 4-7/week) in 33.4%, sodium intake >1.5g/day in 58.0%, low (<200g/day) consumption of fruits in 84.1%, and vegetables in 70.6%. Controlled BP was only found in 23% and controlled hyperlipidemia only in 11.2% of subjects. During medical visits, about 9.2% of patients did not receive any recommendations for pharmacological treatment even if their BP did not reach the therapeutic goal. Knowledge about CVD risk factors [hypercholesterolemia OR 1,63; HT 1,53; low physical activity 1,24, overweight and obesity 1,23, knowledge about complications of HT [stroke or cerebral ischemia 1,77, heart disease 1,52, nephropathy 1,51, atherosclerosis 1,48, retinopathy 1,38, knowledge about non-pharmacological treatment like regular consumption of vegetables and fruits 1,33 increases the chance of achieving BP control. The knowledge about CVD risk factors and possible complications of HT in patients with HT is low. Factors that have a significant impact on a BP control are: knowledge of CVD risk factors, possible complications of HT and the recommendations given during visits about increasing physical activity and a healthy diet, as well as home and office BP measurements.

scholarly journals NCCN Guidelines Insights: Survivorship, Version 2.2020

2020 ◽  
Vol 18 (8) ◽  
pp. 1016-1023 ◽  
Author(s):  
Crystal S. Denlinger ◽  
Tara Sanft ◽  
Javid J. Moslehi ◽  
Linda Overholser ◽  
Saro Armenian ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Primary Care ◽  
Weight Management ◽  
Healthcare Professionals ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Adult Onset ◽  
Nccn Guidelines

The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for consequences of adult-onset cancer and its treatment, with the goal of helping healthcare professionals who work with survivors, including those in primary care. The guidelines also provide recommendations to help clinicians promote physical activity, weight management, and proper immunizations in survivors and facilitate care coordination to ensure that all of the survivors’ needs are addressed. These NCCN Guidelines Insights summarize additions and changes made to the guidelines in 2020 regarding cardiovascular disease risk assessment and screening for subsequent primary malignancies.

The impact of participant pathways on the effectiveness of a community-based physical activity intervention grounded in motivational interviewing

2020 ◽  
Author(s):  
Matthew Wade ◽  
Nicola Brown ◽  
James Steele ◽  
Steven Mann ◽  
Bernadette Dancy ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Motivational Interviewing ◽  
Social Action ◽  
Multilevel Models ◽  
Physical Activity Intervention ◽  
Mental Wellbeing ◽  
Community Based ◽  
The Impact ◽  
Time Point

Background: Brief advice is recommended to increase physical activity (PA) within primary care. This study assessed change in PA levels and mental wellbeing after a motivational interviewing (MI) community-based PA intervention and the impact of signposting [SP] and Social Action [SA] (i.e. weekly group support) pathways. Methods: Participants (n=2084) took part in a community-based, primary care PA programme using MI techniques. Self-reported PA and mental wellbeing data were collected at baseline (following an initial 30-minute MI appointment), 12-weeks, six-months, and 12-months. Participants were assigned based upon the surgery they attended to the SP or SA pathway. Multilevel models were used to derive point estimates and 95%CIs for outcomes at each time point and change scores. Results: Participants increased PA and mental wellbeing at each follow-up time point through both participant pathways and with little difference between pathways. Retention was similar between pathways at 12-weeks, but the SP pathway retained more participants at six-months and 12-months. Conclusions: Both pathways produced similar improvements in PA and mental wellbeing, suggesting the effectiveness of MI based PA interventions. However, due to lower resources required yet similar effects, SP pathways are recommended over SA to support PA in primary care settings.

Experiences in physical activity promotion in health care settings for primary prevention in the UK

2014 ◽  
Vol 62 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Professionals ◽  
Controlled Trial ◽  
Full Range ◽  
Tertiary Care ◽  
Physical Activity Promotion ◽  
Community Based ◽  
Activity Promotion ◽  
Randomised Controlled

In addition to the delivery of primary care services, recent changes to the NHS in the United Kingdom have placed increasing responsibility on GPs for the commissioning of the full range of health services from prevention through to clinical interventions and rehabilitation. Whilst historically there has always been an expectation that primary care professionals were ideally placed to provide support for prevention as well as treatment, their active engagement in the promotion of physical activity has remained largely superficial. With notable exceptions where individuals have a personal interest or commitment, the majority of health professionals tend to limit themselves to peremptory non-specific advice at best, or frequently don’t broach the subject at all. There are a number of reasons for this including increasing time pressures, a general lack of knowledge, limited evidence and concerns about litigation in the event of an adverse exercise induced event. However in the 1990s there was a surge of interest in the emerging “Exercise on Prescription” model where patients could be referred to community based exercise instructors for a structured “prescription” of exercise in community leisure centres. Despite the continuing popularity of the model there remain problems particularly in getting the active support of health professionals who generally cite the same barriers as previously identified. In an attempt to overcome some of these problems Wales established a national exercise referral scheme with an associated randomised controlled trial. The scheme evaluated well and had subsequently evolved with new developments including integration with secondary and tertiary care pathways, accredited training for exercise instructors and exit routes into alternative community based exercise opportunities.

The Evolution of Physical Activity on Prescription (FaR) in Sweden

2014 ◽  
Vol 62 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Healthcare Professionals ◽  
Systems Approach ◽  
Ecological Model ◽  
Controlled Trial ◽  
Professional Associations ◽  
Successful Implementation ◽  
Surgeon General ◽  
Positive Effects

In 1996, the first Report of the US Surgeon General on Physical Activity and Health provided an extensive knowledge overview about the positive effects of physical activity (PA) on several health outcomes and PA recommendations. This contributed to an enhanced interest for PA in Sweden. The Swedish Professional Associations for Physical Activity (YFA) were appointed to form a Scientific Expert Group in the project “Sweden on the Move” and YFA created the idea of Physical Activity on Prescription (FaR) and the production of a handbook (FYSS) for healthcare professionals. In Swedish primary care, licensed healthcare professionals, i.e. physicians, physiotherapists and nurses, can prescribe PA if they have sufficient knowledge about the patient’s current state of health, how PA can be used for promotion, prevention and treatment and are trained in patient-centred counselling and the FaR method. The prescription is followed individually or by visiting local FaR providers. These include sport associations, patient organisations, municipal facilities, commercial providers such as gyms, sports clubs and walking clubs or other organisations with FaR educated staff such as health promoters or personal trainers. In clinical practice, the FaR method increases the level of PA in primary care patients, at 6 and at 12 months. Self-reported adherence to the prescription was 65% at 6 months, similar to the known compliance for medications. In a randomised controlled trial, FaR significantly improved body composition and reduced metabolic risk factors. It is suggested that a successful implementation of PA in healthcare depends on a combination of a systems approach (socio-ecological model) and the strengthening of individual motivation and capability. General support from policymakers, healthcare leadership and professional associations is important. To lower barriers, tools for implementation and structures for delivery must be readily available. Examples include handbooks such as FYSS, the FaR system and the use of pedometers.

scholarly journals Papás Activos: Associations between Physical Activity, Sedentary Behavior and Personal Networks among Fathers Living in Texas Colonias

2020 ◽  
Vol 17 (24) ◽  
pp. 9243
Author(s):  
Tyler Prochnow ◽  
M. Renée Umstattd Meyer ◽  
Megan S. Patterson ◽  
Megan E. McClendon ◽  
Luis Gómez ◽  
...  
Keyword(s):  
Physical Activity ◽  
Sedentary Behavior ◽  
Self Efficacy ◽  
Ecological Model ◽  
Family Members ◽  
Family Systems Theory ◽  
Number Of Children ◽  
Activity Promotion ◽  
Familial Influences ◽  
The Impact

Despite growing health disparities in Latino populations related to lack of physical activity (PA), little is known regarding the impact of social networks on PA and sedentary behavior among a sample of Latino fathers residing in functionally rural colonias. Fathers wore accelerometers and responded to questions regarding their self-efficacy and characteristics of who they were active with most often. Fathers (n = 47) attained a mean of 73.3 min of moderate-to-vigorous PA (SD = 23.8) per day and were sedentary for a mean of 364.0 min (SD = 74.4) per day. In total, fathers reported 205 alters and significantly more family members (M = 3.60, SD = 1.64) than friends (M = 0.77, SD = 1.37). Sedentary time was positively associated with number of peers and inversely related to the number of children reported. Minutes of moderate-to-vigorous PA was significantly associated with greater self-efficacy and number of family members reported. This study contributes to the evidence by further examining PA correlates of Latino fathers from functionally rural colonia communities. Additionally, this study supported both family systems theory and the socio–ecological model as it details the interpersonal and familial influences of PA behavior. Thus, supports for family activity promotion and programs which impact familial norms and activity at the family level may be particularly useful.

scholarly journals Reducing cardiovascular disease risk among families with familial hypercholesterolaemia by improving diet and physical activity: a randomised controlled feasibility trial

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e044200
Author(s):  
Fiona Jane Kinnear ◽  
Fiona E Lithander ◽  
Aidan Searle ◽  
Graham Bayly ◽  
Christina Wei ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Familial Hypercholesterolaemia ◽  
Disease Risk ◽  
Pilot Trial ◽  
Feasibility Trial ◽  
Cvd Risk ◽  
Sedentary Behaviours ◽  
Diet And Physical Activity ◽  
Randomised Controlled

ObjectiveFamilial hypercholesterolaemia (FH) elevates low-density lipoprotein cholesterol (LDL-C) and increases cardiovascular disease (CVD) risk. This study aimed to provide evidence for the feasibility of conducting a randomised controlled trial to evaluate the efficacy of an intervention designed to improve diet and physical activity in families with FH.DesignA parallel, randomised, waitlist-controlled, feasibility pilot trial.SettingThree outpatient lipid clinics in the UK.ParticipantsFamilies that comprised children (aged 10–18 years) and their parent with genetically diagnosed FH.InterventionFamilies were randomised to either 12-week usual care or intervention. The behavioural change intervention aimed to improve dietary, physical activity and sedentary behaviours. It was delivered to families by dietitians initially via a single face-to-face session and then by four telephone or email follow-up sessions.Outcome measuresFeasibility was assessed via measures related to recruitment, retention and intervention fidelity. Postintervention qualitative interviews were conducted to explore intervention acceptability. Behavioural (dietary intake, physical activity and sedentary time) and clinical (blood pressure, body composition and blood lipids) outcomes were collected at baseline and endpoint assessments to evaluate the intervention’s potential benefit.ResultsTwenty-one families (38% of those approached) were recruited which comprised 22 children and 17 adults with FH, and 97% of families completed the study. The intervention was implemented with high fidelity and the qualitative data revealed it was well accepted. Between-group differences at the endpoint assessment were indicative of the intervention’s potential for improving diet in children and adults. Evidence for potential benefits on physical activity and sedentary behaviours was less apparent. However, the intervention was associated with improvements in several CVD risk factors including LDL-C, with a within-group mean decrease of 8% (children) and 10% (adults).ConclusionsThe study’s recruitment, retention, acceptability and potential efficacy support the development of a definitive trial, subject to identified refinements.Trial registration numberISRCTN24880714.

Physical activity less than the recommended amount may prevent the onset of major biological risk factors for cardiovascular disease: a cohort study of 198 919 adults

2018 ◽  
Vol 54 (4) ◽  
pp. 238-244 ◽  
Author(s):  
David Martinez-Gomez ◽  
Irene Esteban-Cornejo ◽  
Esther Lopez-Garcia ◽  
Esther García-Esquinas ◽  
Kabir P Sadarangani ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Highly Active ◽  
Atherogenic Dyslipidaemia

ObjectivesWe examined the dose–response relationship between physical activity (PA) and incidence of cardiovascular disease (CVD) risk factors in adults in Taiwan.MethodsThis study included 1 98 919 participants, aged 18–97 years, free of CVD, cancer and diabetes at baseline (1997–2013), who were followed until 2016. At baseline, participants were classified into five PA levels: inactive’ (0 metabolic equivalent of task (MET)-h/week), ‘lower insufficiently active’ (0.1–3.75 MET-h/week), ‘upper insufficiently active’ (3.75–7.49 MET-h/week), ‘active’ (7.5–14.99 MET-h/week) and ‘highly active’ (≥15 MET-h/week]. CVD risk factors were assessed at baseline and at follow-up by physical examination and laboratory tests. Analyses were performed with Cox regression and adjusted for the main confounders.ResultsDuring a mean follow-up of 6.0±4.5 years (range 0.5–19 years), 20 447 individuals developed obesity, 19 619 hypertension, 21 592 hypercholesterolaemia, 14 164 atherogenic dyslipidaemia, 24 275 metabolic syndrome and 8548 type 2 diabetes. Compared with inactive participants, those in the upper insufficiently active (but not active) category had a lower risk of obesity (HR 0.92; 95% CI 0.88 to 0.95), atherogenic dyslipidaemia (0.96; 0.90 to 0.99), metabolic syndrome (0.95; 0.92 to 0.99) and type 2 diabetes (0.91; 0.86 to 0.97). Only highly active individuals showed a lower incidence of CVD risk factors than their upper insufficiently active counterparts.ConclusionCompared with being inactive, doing half the recommended amount of PA is associated with a lower incidence of several common biological CVD risk factors. Given these benefits, half the recommended amount of PA is an evidence based target for inactive adults.

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