Implementation Of Lifestyle Modification Research Articles

Enhancing current guidance for psoriatic arthritis and its comorbidities: recommendations from an expert consensus panel.

Existing guidelines for psoriatic arthritis (PsA) cover many aspects of management. Some gaps remain relating to routine practice application. An expert group aimed to enhance current guidance and develop recommendations for clinical practice that are complementary to existing guidelines. A steering committee comprising experienced, research-active clinicians in rheumatology, dermatology and primary care agreed on themes and relevant questions. A targeted literature review of PubMed and Embase following a PICO framework was conducted. At a second meeting, recommendations were drafted and subsequently an extended faculty comprising rheumatologists, dermatologists, primary care clinicians, specialist nurses, allied health professionals, non-clinical academic participants and members of the Brit-PACT patient group, was recruited. Consensus was achieved via an online voting platform when 75% of respondents agreed in the range of 7-9 on a 9-point scale. The guidance comprised 34 statements covering four PsA themes. Diagnosis focused on strategies to identify PsA early and refer appropriately, assessment of diagnostic indicators, use of screening tools and use of imaging. Disease assessment centred on holistic consideration of disease activity, physical functioning and impact from a patient perspective, and on how to implement shared decision-making. For comorbidities, recommendations included specific guidance for high-impact conditions such as depression and obesity. Management statements (which excluded extant guidance on pharmacological therapies) covered multidisciplinary team working, implementation of lifestyle modifications and treat-to-target strategies. Minimising corticosteroid use was recommended where feasible. The consensus group have made evidence-based best practice recommendations for the management of PsA to enhance the existing guidelines.

Knowledge and Prevalence of Risk Factors for Coronary Artery Disease in Patients after Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting.

Background: Percutaneous coronary intervention (PCI) is associated with a short hospital stay and fast recovery. However, it might be related to insufficient implementation of lifestyle changes after the procedure. Conversely, coronary artery bypass grafting (CABG) is a highly invasive technique that requires a prolonged hospital stay and long rehabilitation with more opportunities for education. This study aimed to evaluate the impact of CABG on adherence to lifestyle modifications and knowledge about coronary artery disease (CAD) in comparison with PCI. We also evaluated the level of education and tried to define groups of patients that might require targeted education. Methods: Data was collected using a self-designed 56-item questionnaire. Questions assessed the knowledge of CAD risk factors and the level of their control. Results: The study group consisted of 155 consecutive patients admitted to the Cardiology Department. Patients with a history of PCI (68%) (at least 8 weeks before) were included in the prior-PCI group, and patients with previous surgical revascularization (also at least 8 weeks before) were assigned to the prior-CABG group (32%). The knowledge score was higher in the prior-CABG group. The median (IQR) results in the prior-PCI vs. prior-CABG group were, respectively: 20 (12–24) vs. 22 (19–25) [points, per 31 max.]; p = 0.01. Similar results were obtained in the level of risk control (prior-PCI vs. prior-CABG, respectively: 6 (4–7) vs. 7 (6–8) [points, per 15 max.]; p = 0.002). Conclusions: The method of treatment of CAD might impact the implementation of lifestyle modifications after the procedure. More effort is required to improve secondary prevention, especially in PCI patients.

Clinical opportunities and healthcare impact of optimal treatment in the post-ACS patient

Despite the improvement of revascularization procedures, patients with acute coronary syndrome often develop recurrent ischemic events, suggesting a high residual cardiovascular risk in these patients, which requires a strict clinical monitoring as well as an optimal control of modifiable risk factors. To this aim, an optimal management of index event and appropriate preventive measures are equally important. Hospital care by cardiologists should be followed by outpatient management by general practitioners, as established by specific diagnostic and therapeutic pathways, which should warrant an optimal support to the patient. A strict collaboration between hospital and primary care is crucial to monitor and adapt drug therapy after the acute event and improve adherence of the patients to prescribed treatments and implementation of life-style modifications, with benefits also in term of cost-effectiveness. In this context, individualized rehabilitation programs should also be offered to patients with acute coronary syndromes, in order to improve survival and quality of life.

Older age does not influence the success of weight loss through the implementation of lifestyle modification.

ObjectiveAge is sometimes a barrier for acceptance of patients into a hospital‐based obesity service. Our aim was to explore the effect of age on the ability to lose weight through lifestyle interventions, implemented within a hospital‐based obesity service.DesignRetrospective study.PatientsWe included a cohort of randomly selected patients with morbid obesity (n = 242), who attended our hospital‐based obesity service during 2005‐2016 and received only lifestyle weight loss interventions.MeasurementsPrimary outcome measures were percentage weight loss (%WL) and percentage reduction in body mass index (%rBMI) following implemented lifestyle interventions. Data were stratified according to patient age at referral: group 1 (age < 60 years, n = 167) and group 2 (age ≥ 60 years, n = 75). Weight loss was compared between groups, and correlations with age at referral were explored.ResultsThe duration of hospital‐based weight loss interventions ranged between 1 and 143 months (mean: 38.9 months; SD: 32.3). Baseline BMI at referral differed significantly between groups 1 and 2 (49.7 kgm−2 [SD: 8.7] vs 46.9 kgm−2 [SD: 6.1], respectively; P < .05). Following implemented lifestyle interventions, between groups 1 and 2 there were no differences in %WL (6.9% [SD: 16.7] vs 7.3% [SD: 11.60], respectively; P = NS) or %rBMI (8.1% [SD: 14.9] vs 7.8% [SD: 11.7], respectively; p = NS). Overall, there was no significant correlation between patient age at referral and %WL (r = −.13, p = NS).ConclusionsOlder age does not influence the success of weight loss through the implementation of lifestyle modification within a hospital‐based obesity service. Therefore, age per se should not influence clinical decisions regarding acceptance of patients to hospital‐based obesity services.

Tietze syndrome

Tietze syndrome, first described in 1921 by Prof. Alexander TIETZE, is characterized with tender nonsuppurative swelling, pain, and tissue edema in the second or third costosternal cartilage. Differential diagnosis of Tietze syndrome includes diverse diseases, and its diagnosis relies on clinical examination, not the use of additional diagnostic techniques. The treatment of Tietze syndrome includes the use of anti-inflammatory medication and implementation of lifestyle modifications during the attacks. Surgical treatment is reserved for refractory cases and often is not necessary. Tietze syndrome can easily be diagnosed and treated in primary care medicine practice due to its benign nature.

Experience on statin therapy in paediatric age: retrospective study in a Portuguese referral centre.

The use of statins in children, although not frequent, is recommended in specific clinical contexts, namely, familial hypercholesterolaemia, conditions carrying a moderate-high cardiovascular risk and sub-optimal cholesterol levels after implementation of lifestyle modifications. The aim of this study is to characterise children with dyslipidaemia managed with statins, followed at a tertiary referral centre in central Portugal. The authors carried out a retrospective and descriptive study made up of 66 patients (50% males, mean age of therapy onset 11.9 years) followed up at the Cardiovascular Clinic of a tertiary referral centre between January, 2012, and May, 2018. Clinical, analytical, and echocardiographic parameters were analysed. About 60.6% had clinical and/or molecular diagnosis of familial hypercholesterolaemia. On average, each patient had three cardiovascular risk factors, obesity (31%) being most prevalent, followed by arterial hypertension (14%). Statin therapy showed a statistically significant reduction in the lipid profile, particularly in the total cholesterol (23%) and low-density lipoprotein cholesterol (30%) levels, as well as in the carotid intima-media thickness (p=0.015). Hepatic and muscle integrity markers were within normal range. Statins are safe and efficient in the management of children with hypercholesterolaemia. Our study showed that apart from its lipid-lowering properties, it also reduced significantly the carotid intima-media thickness and, implicitly, the cardiovascular risk of these patients.

Lifestyle modification and hypertension: prescription patterns of Nigerian general practitioners.

IntroductionImplementation of lifestyle modification (LM), a cornerstone of hypertension control has been reported to be more challenging than pharmacotherapy. We studied the LM prescription patterns of general medical practitioners (GPs) in Lagos, Nigeria for blood pressure control.MethodsGPs were assessed using anonymous self-administered questionnaire on the prescription of salt restriction, weight management, cessation of tobacco use, physical exercise, and consumption of DASH-like diet for blood pressure control. Chi-square, Fisher's exact and Student t-test were used to test for differences as appropriate. Logistic regression model was constructed to identify the determinants of adequate LM prescription.ResultsA total of 213 GPs (38% females) participated in the survey. LM prescription was over 90% for the following: salt restriction (96.7%), tobacco cessation (94.8%), weight management (94.4%). The remaining were 81.2% and 75.1% for healthy diet and physical activity respectively. The median LM prescription score (of the GPs) was 18.0 [15.0-50.0]. The single significant predictor of adequate LM prescription was total patient load of the GPs (AOR:0.98, 95% CI: 0.97-0.99, p=0.006). Eleven (5.2%), 190 (89.2%), and 12 (5.6%) GPs initiated LM prescription at blood pressure values >140/90mmHg, =140/90mmHg and <140/90mmHg respectively. LM initiation at BP <140/90mmHg was associated with female gender, shorter work experience, working in tertiary care facility and ignorance about hypertension prevention (p<0.05).ConclusionLM is widely prescribed for the treatment of hypertension, but rarely prescribed for its prevention in Nigeria. Interventions to reduce physician's patient load may engender improved LM prescription.

Effectiveness of Life Style Modification on Lipid Profile for Patients with Hyperlipidemia

Background: Major predisposing factors of Coronary artery diseases were urbanized lifestyles and growth of ageing populations in developing country like Egypt. The modifiable risk factors for cardiovascular disease (CVD) such as hyperlipidemia, diabetes mellitus, and obesity are likely to increase in the future, but they can be controlled through lifestyle modification. Aim of the study: This study was carried out to examine the effect of life style modification for patients with hyperlipidemia on their lipids profile. Design: Quasi experimental design was utilized. Setting This study was conducted among the patients attending at cardiac outpatient department, Menoufia University Hospital, Menoufia Governorate, Egypt. Subject: A purposive sample of 100 men and women attending cardiac outpatient clinic were selected. The subjects were divided equally into study and control groups. Instrumentations: a. Structured interview questionnaire: it consists of sociodemographic and medical data b. Bio-physiological measurement: Fasting venous blood samples for Glycosylated hemoglobin level, Lipid profile were obtained from all participants, and sent to biochemistry laboratories. Blood pressure assessment and BMI for all patients were compiled. Results: Statistical analysis showed that there were statistical differences among study and control group regard to total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol and their arterial blood pressure level. Conclusion: The need for tailoring and following up of intervention for coronary artery diseases is an essential maneuver to reduce their risk factors occurrence. Recommendations: Implementation of lifestyle modification for at risk patient for coronary artery diseases by modifying their lifestyle. Routine screening for all subjects above the age of forty to detect abnormal lipid profile early and to increase their awareness to prevent and control of cardiovascular disease (CVD) is recommended.

Current treatment options for nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in the United States and is strongly associated to the metabolic syndrome. In this review, we will discuss the evidence behind the current recommendations on lifestyle modifications and available treatment options for NAFLD. The unrelenting rise in obesity and diabetes epidemic has led to a large healthcare burden from NAFLD and it is projected to continue to grow over the next two decades. Lifestyle modification that leads to weight loss is effective at treating NAFLD, but these modifications require a multidisciplinary approach for success in the real world. Multiple pharmacologic treatment options have been studied with promising results, but none have been approved for treatment in the United States. Clinical trials are on-going to study further pharmacologic treatment alternatives. NAFLD is the most common chronic liver disease in United States, and an independent risk factor for mortality. Implementation of lifestyle modifications through a multidisciplinary approach and careful selection of patients for pharmacologic interventions will be essential for successful management of NAFLD.

Qualitative study of patient experiences of responsibility in warfarin therapy.

Results of a study to characterize the experiences of warfarin-treated patients, including their experiences in taking medication, communicating with clinical pharmacists, and International Normalized Ratio (INR) monitoring, are reported. A qualitative analysis of data obtained during interviews with 40 patients at a Veterans Affairs medical center warfarin clinic was conducted. In semistructured interviews, the patients were asked to describe the process whereby their INR values were monitored by pharmacists and their understanding of self-management responsibilities, including medication adherence and implementation of lifestyle modifications that might influence the effectiveness of anticoagulation therapy. Analysis of interview results indicated that patients' experience in the event of variation in INR levels is characterized by misperceptions of the instructions regarding appropriate dietary and lifestyle behaviors, misattribution of responsibility for abnormal readings, and provider uncertainty in ascertaining causation for out-of-range INR values. Patients frequently reported that they interpret pharmacist questions to imply that they are responsible for variable INR values. This perception may indirectly lead to adverse consequences such as withholding of information from anticoagulation care providers and skipping clinic appointments, which could in turn result in suboptimal clinical outcomes. Analysis of results of qualitative interviews of patients receiving warfarin indicated that patients may interpret routine questioning about INR variation as implying that they are to blame for poor anticoagulation control.

Abstract OT3-07-03: Positive behavior change and weight loss in breast cancer survivors on hormonal adjuvant therapy: An energy balance research in cancer (EnBaR) prospective study

Abstract BACKGROUND: Observational studies have repeatedly linked obesity to increased cancer incidence, recurrence, and mortality, leading to cancer treatment guidelines that call for maintenance of a healthy body weight, regular physical activity (PA) regardless of body mass index (BMI), and modest weight loss for overweight and obese cancer survivors (CS). Despite these recommendations, newly published reports suggest that more than 70% of CS are overweight or obese, and only 1/3 engage in the recommended levels of PA. Although trials have demonstrated that energy balance (EB) interventions are feasible in CS, it has been concluded that ongoing behavioral support is needed to implement and sustain changes in weight and PA. Through the subsequent Energy Balance Research (EnBaR) the incorporation of a weight management and PA program focused on ongoing behavioral support for breast cancer survivors (BCS) as an effective method for implementation of lifestyle modifications will be investigated. TRIAL DESIGN: This is a single-arm prospective observational study investigating if implementation of an EB Program for BCS is an effective intervention for producing lifestyle behaviors. Eligible subjects must be female BCS ≥18 years with BMI ≥25 who are initiating hormonotherapy (HT) as their only oncology treatment modality. Subjects will consult with a Registered Dietitian (RD) to establish goals based on specified interventions for reducing overall BMI at the time of initiating their prescribed HT. Subjects will subsequently receive telephone calls from the RD at bi-monthly intervals to discuss the established points of intervention, answering questions proposed by the RD from a set intervention measurement scale. Patients will also report for body composition analysis performed by the RD via InBody at Baseline, Day 90, and Day 180. InBody is a validated tool that utilizes direct segmental multi-frequency bioelectrical impedance analysis (DSM-BIA) to provide a highly accurate report of an individual's body composition. AIMS: Determine change in Percent Body Fat (PBF) and BMI during adjuvant hormone treatment for breast cancer patients. STATS/TARGET ACCRUAL: To assess % change in BMI and PBF between baseline and 180 days, one-sample t-tests will be used. Assuming an average (avg) baseline BMI of 33.7 with a standard deviation of 8.5; a sample of 120 patients will yield 89.4% power using a two-sided t-test to detect a 13% reduction in BMI to an avg of 29.32 and 82.8% power to detect a 12% reduction to an avg BMI of 29.656. Similarly, a t-test will have 83.7% power to detect a 12% decrease in % change in PBF assuming an avg baseline PBF of 41.36 with a standard deviation 10.5. The power calculations were accomplished by generating simulations of size 10,000 replications conducted at the 0.025 significance level using the TTEST procedure of SAS 9.4 [SAS Institute Inc., Cary, NC, USA]. The calculations assume a linear correlation of 0.5 between the baseline and Day 180 measurements and are Bonferroni corrected to maintain a familywise error of 0.05 for the primary analysis. All statistical analyses will be conducted using SAS 9.4. Statistical significance will be defined as p &amp;lt; 0.05. Citation Format: Scheuer R, Bendinger GM, Ensor Jr. JE, Nixon D, Randolph K, McGuirec E, Rados K, McNight JE, Pabbathi H, Panicker R, Johnson AT, Langlois C, Lammersfeld C, Alvarez RH. Positive behavior change and weight loss in breast cancer survivors on hormonal adjuvant therapy: An energy balance research in cancer (EnBaR) prospective study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-07-03.

Lack of Impact of a Comprehensive Intervention on Hypertension in the Primary Care Setting

The implementation of lifestyle modifications, home blood pressure (BP) measurement, and optimization of antihypertensive drug therapy have been shown to improve BP control in tightly controlled research settings. Our objective was to determine the effect of these interventions in a primary care setting, with the family practitioners and nurses serving as the interventionists. Two hundred twenty hypertensive patients were recruited from 2 health centers that operated in the same building and covered similar populations, with the health centers randomized to function as intervention or control sites. Participants in the intervention group received repeated individual and group counseling from the centrally trained staff of the health center on healthy lifestyles. In addition, their antihypertensive drug therapy was guided by home BP measurements performed at 3-month intervals instead of by conventional office measurements. After 12 months of follow-up, the between-group differences in the changes of lifestyle variables (body mass index, physical activity, dietary recalls, and urinary sodium/potassium) were nonsignificant. Antihypertensive treatment intensity increased in both groups, but the between-group difference was nonsignificant (P = 0.63). Office systolic/diastolic BP decreased significantly in the intervention (8/6 mm Hg; P < 0.001) and control (11/7 mm Hg; P < 0.001) groups, but the between-group differences were nonsignificant (P = 0.25/0.16). Our intervention did not improve BP control as suggested by many prior studies performed in controlled academic settings. This result could be attributed to a lack of motivation and incentives among the staff or because the population was relatively unselected. Greater attention to education and financial incentives might be required in typical primary care settings to obtain better results. NCT01915199.

Identifying health‐related quality of life (HRQL) domains for multiple chronic conditions (diabetes, hypertension and dyslipidemia): patient and provider perspectives

To examine patient and provider perspectives about the impact of having diabetes, hypertension and/or dyslipidemia (DHD) on health-related quality of life (HRQL) in order to identify domains for an HRQL instrument focusing on specific chronic diseases (DHD). Exploratory qualitative design was used to elicit patient and provider responses. Patient survey contained 11 demographic and nine content questions inquiring how the disease(s) affected patient HRQL. Provider survey examined how the disease(s) affected their patient's HRQL and crucial factors for improvement. Patients were included if they had DHD and spoke English. Providers working with DHD patients were identified among university faculty and community practitioners. Thirty-eight patients (24.7%) completed the interviews. Three judges content analysed patient responses and proposed seven categories (patients ranked physical functioning first followed by diet, emotional well-being (E), general well-being, social functioning (S), 'no change in HRQL' and medications). One question about medications had four categories (medication inconvenience, medication side effects, forgetfulness and general well-being). Index for reliability was greater than 80% for all categories. Providers ranked lifestyle modification (LM), first followed by complications, medication, self-care, E, education, S, physical activity and resources (ability to pay) as components that impact HRQL. Patient and provider perspectives were similar in four areas (E, S, medication and diet); however, the differences were in how these impacted HRQL - patients focused on activities relevant to daily life that were affected, while providers based it on processes of therapy management and self-care (education and implementation of LM).

Optimizing management of metabolic syndrome to reduce risk: focus on life-style

The prevalence of metabolic syndrome (MS) is increasing all over the world and its incidence is expected to rise in the next years. Although genetic predisposition appears to play an important role in the regulation of metabolic parameters and in particular of body weight, the rapid increase in the prevalence of obesity and MS suggests that ecological factors (social, economic, cultural and physical environment) are promoting those conditions in susceptible individuals. People with MS are at increased risk of type 2 diabetes and cardiovascular disease and therefore they represent a priority target for preventive strategies. Life-style modifications based on healthy diet and increased physical activity are an effective preventing and therapeutic approach. Unfortunately, implementation of life-style modification and maintenance of effects is a difficult task both at personal and social level, thus drug therapy can be taken into account.

Hypertension Treatment Guidelines: Is It Time for an Update?

Hypertension Treatment Guidelines: Is It Time for an Update?

The “Good Cholesterol”

Atherosclerosis is an insidious and dangerous disease: a progressive chemical and structural injury to the blood vessels in such critical organs as the heart, brain, and kidney. The hallmark feature of atherosclerosis is the buildup of cholesterol into lesions called plaques that can reduce the flow of blood. When the delivery of blood to heart muscle drops enough, this can result in the development of chest pain or angina. Angina indicates that the heart muscle is not receiving enough oxygen to carry out its pumping functions. Atherosclerotic plaques can also suddenly rupture, develop a blood clot on their surface, and completely choke off a portion of heart muscle. This chain of events frequently results in heart attack or sudden death without warning. Atherosclerotic disease also predisposes people to stroke, peripheral vascular disease, lower-extremity amputation, and loss of kidney function, among other devastating outcomes. Despite all that we have learned in the past 50 years, atherosclerosis remains the No. 1 killer of men and women and the chief reason for loss of quality of life in Western countries. We are, however, gaining ground. Considerable research has revealed the importance of factors that increase an individual’s risk for developing this disease. Among the most important of these risk factors are elevated blood pressure, diabetes mellitus, obesity, inactivity, smoking, and cholesterol levels. When your physician measures your cholesterol level, he or she is looking at your lipid profile, which comprises low-density lipoprotein cholesterol (LDL-C, or the “bad” cholesterol), triglycerides (blood fats), and high-density lipoprotein cholesterol (HDL-C, or the “good” cholesterol). In a general way, when it comes to measurement of your LDL-C and triglyceride values, a lower value is better because these lipids drive the development and progression of atherosclerosis. In sharp contrast, when it …

The natural treatment of hypertension.

The goal of this review is to evaluate the efficacy of commonly available dietary supplements in the treatment of hypertension, using the average blood pressure reduction achieved with the implementation of lifestyle modifications as a standard. For this reason, the authors focus on the antihypertensive potential of these agents rather than pharmacology, pharmacokinetics, adverse effects, or supplement-drug interactions. For the purpose of this review, dietary supplements are defined as exhibiting some evidence of benefit if a systolic blood pressure reduction of 9.0 mm Hg or greater and/or a diastolic blood pressure reduction of 5.0 mm Hg or greater has been observed in previously published, peer-reviewed trials. These defining limits are based on the average blood pressure reduction associated with the implementation of certain lifestyle modifications. Agents with some evidence of benefit include coenzyme Q10, fish oil, garlic, vitamin C, and L-arginine.