What to do after cardiac rehabilitation programs: the role of the general practitioner in cardiovascular prevention

This paper will review the current role of general practitioners (GPs) in providing cardiovascular prevention for patients after attendance at a cardiac rehabilitation program. Long-term implementation of preventive strategies is needed for continued impact on reducing risk of cardiovascular events and GPs have a major role in providing ongoing continuing medical care. Awareness of patients’ social, cultural and physical circumstances allows the GP to identify individuals’ needs for support in engaging in secondary prevention: relevant brief interventions can promote behaviour change in physical activity, diet and smoking habits, as well as promoting mental health and adherence to optimal medical therapy. Collaborative multidisciplinary working with community and hospital services provides best opportunities for timely referral to specialist expertise to maximise patients’ well-being

Systematic review of rehabilitation programmes initiated within 90 days of a transient ischaemic attack or 'minor' stroke: a protocol.

Introduction Transient ischaemic attacks (TIAs) and strokes are highly prevalent conditions. Stroke killed 5.7 million people worldwide in 2005 and is estimated to cause 6.5 million deaths globally in 2015. Stroke survivors are often left with considerable disability. Many strokes are preceded by a TIA/‘minor’ stroke in the previous 90 days and therefore the immediate period after a TIA/minor’ stroke is a crucial time to intervene to tackle known vascular risk factors. Although rehabilitation following a TIA/minor stroke is widely recommended, there is a paucity of research that offers an evidence base on which the development or optimisation of interventions can be based, particularly for home-based approaches and non-pharmacological interventions in the acute period following the initial TIA/‘minor’ stroke. This systematic review will investigate the effect of rehabilitation programmes initiated within 90 days of the diagnosis of a TIA or ‘minor’ stroke aimed at reducing the subsequent risk of stroke. Methods/design This systematic review will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses(PRISMA) guidance. Randomised and quasi-randomised controlled trials of rehabilitation programmes initiated within 90 days of a TIA or ‘minor’ stroke will be included. Articles will be identified through a comprehensive search of the following databases, guided by a medical librarian: the Cochrane Library, Web of Science, MEDLINE, Embase, CINAHL and PsycINFO. Two review authors will independently screen articles retrieved from the search for eligibility and extract relevant data on methodological issues. A narrative synthesis will be completed when there is insufficient data to permit a formal meta-analysis. Discussion This review will be of value to clinicians and healthcare professionals working in TIA and stroke services as well as to general practitioners/family physicians who care for these patients in the community and to researchers involved in designing and evaluating rehabilitation interventions

UNISTEP (University Students Exercise and Physical Activity) Study: A Pilot Study of the Effects of Accumulating 10,000 Steps on Health and Fitness Among University Students

Background:Recent public health initiatives have promoted accumulating 10,000 steps per day. Little previous research has evaluated its effects in young adults. The aim of this study was to determine the effects of taking 10,000 steps per day on fitness and cardiovascular risk factors in sedentary university students.Methods:Healthy, sedentary students (mean age 21.16 ± SD 6.17) were randomly allocated to take 10,000 steps per day or to a control group who maintained their habitual activity. Members of the 10,000 step group wore a pedometer and reported daily step count in a diary. Outcome measurements (20-meter multistage shuttle run, BMI, and blood pressure) were measured before and after 6 weeks.Results:There were no significant differences between the groups at baseline. After 6 weeks, the 10,000 steps group were taking significantly more steps (8824.1 ± SD 5379.3 vs. 12635.9 ± SD 6851.3; P = .03).No changes were observed in fitness, or BMI (P &gt; .05). Significant reductions in blood pressure (P = .04) in the 10,000 step group.Conclusions:A daily target of 10,000 steps may be an appropriate intervention in sedentary university students to increase their physical activity levels. The positive health benefits of simple everyday physical activity should be promoted among health professionals.<br/

Do practitioners and friends support patients with coronary heart disease in lifestyle change? a qualitative study.

BACKGROUND: Healthy lifestyles help to prevent coronary heart disease (CHD) but outcomes from secondary prevention interventions which support lifestyle change have been disappointing. This study is a novel, in-depth exploration of patient factors affecting lifestyle behaviour change within an intervention designed to improve secondary prevention for patients with CHD in primary care using personalised tailored support. We aimed to explore patients\u27 perceptions of factors affecting lifestyle change within a trial of this intervention (the SPHERE Study), using semi-structured, one-to-one interviews, with patients in general practice. METHODS: Interviews (45) were conducted in purposively selected general practices (15) which had participated in the SPHERE Study. Individuals, with CHD, were selected to include those who succeeded in improving physical activity levels and dietary fibre intake and those who did not. We explored motivations, barriers to lifestyle change and information utilised by patients. Data collection and analysis, using a thematic framework and the constant comparative method, were iterative, continuing until data saturation was achieved. RESULTS: We identified novel barriers to lifestyle change: such disincentives included strong negative influences of social networks, linked to cultural norms which encouraged consumption of \u27delicious\u27 but unhealthy food and discouraged engagement in physical activity. Findings illustrated how personalised support within an ongoing trusted patient-professional relationship was valued. Previously known barriers and facilitators relating to support, beliefs and information were confirmed. CONCLUSIONS: Intervention development in supporting lifestyle change in secondary prevention needs to more effectively address patients\u27 difficulties in overcoming negative social influences and maintaining interest in living healthily