Healthy Lifestyle Interventions in General Practice. Part 3: Lifestyle and Chronic Respiratory Disease

Chronic respiratory diseases, in particular chronic obstructive pulmonary disease (COPD), can be classified as a part of the chronic diseases of lifestyle. A lifestyle intervention programme is therefore an essential component of the non-pharmacological management of COPD and other chronic respiratory diseases. The main indication for referral to a lifestyle intervention programme is any symptomatic patient with either COPD or any other chronic respiratory disease, and who also has limited functional capacity. Following a comprehensive initial assessment, patients are recommended to attend either a group-based programme (medically supervised or medically directed, depending on the severity of the disease and the presence of any co-morbidities) or a home-based intervention programme. The main elements of the intervention programme are smoking cessation, exercise training (minimum of three times per week), education, psychosocial support and nutritional support. Regular monitoring should be conducted during training sessions, and a follow-up assessment is indicated after 2-3 months to assess progress and to re-set goals. Longer-term (56 months) intervention programmes are associated with better long-term outcomes. South African Family Practice Vol. 50 (6) 2008: pp. 6-

Healthy lifestyle interventions in general practice: Part 15: Lifestyle and lower back pain

Lower back pain (LBP) is one of the most common medical problems in the adult population. LBP can be defined as pain, muscle tension or stiffness that is localised below the costal margin (inferior rib cage) and above the inferior gluteal folds and that can present either with or without leg pain (sciatica), and it can be classified as “specific” or “non-specific”. LBP has a high lifetime prevalence and is associated with a substantial direct and indirect cost to the individual and society. In this review, the focus is on the identification of lifestyle risk factors and interventions that are associated with mainly non-specific chronic LBP. In addition to pharmacotherapy, the best treatment approach is exercise therapy (including physical reconditioning), psychosocial and behavioural intervention and therapeutic education. Other lifestyle changes include nutritional intervention and smoking cessation

Healthy lifestyle interventions in general practice: Part16: Lifestyle and fibromyalgia

Fibromyalgia is a chronic disorder, characterised by chronic widespread musculoskeletal pain, and the presence of multiple tender points as well as a host of associated symptomatology. Optimal management of patients with fibromyalgia requires a multidisciplinary approach, with a combination of pharmacological and non-pharmacological interventions that are tailored to the patient's pain, dysfunction and associated features, including depression, sleep disorder and fatigue. Non-pharmacological lifestyle-based interventions to treat this disorder include exercise therapy, dietary modification, and psychosocial interventions. This review outlines these three forms of lifestyle intervention in patients with fibromyalgia

Healthy lifestyle interventions in general practice. Part 2: Lifestyle and cardiovascular disease

This article forms the second part of the series on the role of lifestyle modification in general practice with specific reference to chronic cardiovascular disease. Whilst the major risk factors which constitute an unhealthy lifestyle were discussed in part 1 of this series, the focus of part 2 will give specific practical guidelines which the general practitioner may incorporate into their practice when counselling patients with chronic cardiovascular disease

Healthy lifestyle interventions in general practice Part 4: Lifestyle and diabetes mellitus

Diabetes mellitus, in particular Type 2 diabetes, can be classified as a chronic disease of lifestyle. A lifestyle intervention programme is therefore an essential component of the primary and secondary prevention (management) of diabetes mellitus. The main indication for referral to a lifestyle intervention programme is any patient with either pre-diabetes or established diabetes mellitus. Following a comprehensive initial assessment, patients are recommended to attend either a group-based programme (medically supervised or medically directed, depending on the severity of the disease and the presence of any co-morbidities) or a home-based intervention programme. The main elements of the intervention programme are nutritional intervention, exercise training (minimum of 150 minutes at moderate intensity per week), psychosocial support and education. Regular monitoring should be conducted during training sessions, and a follow-up assessment is indicated after 2–3 months to assess progress and to re-set goals. Longer-term (5–6 months) intervention programmes are associated with better long-term outcomes

Working on wellness (WOW): a worksite health promotion intervention programme

Background: Insufficient PA has been shown to cluster with other CVD risk factors including insufficient fruit and vegetable intake, overweight, increased serum cholesterol concentrations and elevated blood pressure. This paper describes the development of Working on Wellness (WOW), a worksite intervention program incorporating motivational interviewing by wellness specialists, targeting employees at risk. In addition, we describe the evaluation the effectiveness of the intervention among employees at increased risk for cardiovascular disease. Methods: The intervention mapping (IM) protocol was used in the planning and design of WOW. Focus group discussions and interviews with employees and managers identified the importance of addressing risk factors for CVD at the worksite. Based on the employees preference for individual counselling, and previous evidence of the effectiveness of this approach in the worksite setting, we decided to use motivational interviewing as part of the intervention strategy. Thus, as a cluster-randomised, controlled control trial, employees at increased risk for CVD (N = 928) will be assigned to a control or an intervention group, based on company random allocation. The sessions will include motivational interviewing techniques, comprised of two face-to-face and four telephonic sessions, with the primary aim to increase habitual levels of PA. Measures will take place at baseline, 6 and 12 months. Secondary outcomes include changes in nutritional habits, serum cholesterol and glucose concentrations, blood pressure and BMI. In addition, healthcare expenditure and absenteeism will be measured for the economic evaluation. Analysis of variance will be performed to determine whether there were significant changes in physical activity habits in the intervention and control groups at 6 and 12 months. Discussion: The formative work on which this intervention is based suggests that the strategy of targeting employees at increased risk for CVD is preferred. Importantly, this study extends the work of a previous, similar study, Health Under Construction, in a different setting. Finally, this study will allow an economic evaluation of the intervention that will be an important outcome for health care funders, who ultimately will be responsible for implementation of such an intervention. Trial registration: United States Clinical Trails Register NCT 01494207

Healthy lifestyle interventions in general practice Part 10: Lifestyle and arthritic conditions - Osteoarthritis

Chronic musculoskeletal disease is one of the most common causes of disability worldwide with considerable economic impact in health care. Osteoarthritis (OA) is the most common chronic musculoskeletal disease affecting a large proportion of the population with an increasing predicted prevalence in the next two decades. Regular physical exercise, nutritional intervention, psychological support and other lifestyle interventions are very important components of the nonpharmacological management of patients with OA. The main rationale to include regular exercise as part of a lifestyle intervention programme for OA is to improve muscle strength and proprioception, and to promote the other general health benefits of participating in regular physical activity. Nutritional intervention should focus on weight reduction while basic nutrients that are required for healthy joints should be provided. Glucosamine and chondroitin supplemention is commonly used and may reduce pain, improve function and reduce or arrest disease progression. Psychological intervention has a particular role in assisting with pain management

Healthy lifestyle interventions in general practice Part 13: Lifestyle and osteoporosis

Osteoporosis is defined as a systemic skeletal disease that is characterised by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures. Therefore, the diagnosis of osteoporosis is based on measurement of bone mineral density (BMD) using central (axial) dual energy X-ray absorptiometry (DXA), and clinical evidence of a fragility fracture (history or radiological evidence). Osteoporosis is a major public health problem, affecting about 30% of postmenopausal women of Caucasian origin, and 70% of those aged 80 years. The risk factors for osteoporosis include lifestyle factors, genetic/ethnic factors, specific diseases causing secondary osteoporosis, ageing factors, qualitative factors, and drugs that are toxic to bone. In addition, there are specific additional risk factors for falls that need to be considered. It is well established that lifestyle factors, including physical activity, nutritional intervention, psychosocial intervention, smoking cessation and other lifestyle factor interventions are key elements in the prevention and management of osteoporosis. Guidelines for these lifestyle interventions in the prevention and management of osteoporosis are reviewed

Chronic disease risk factors, healthy days and medical claims in South African employees presenting for health risk screening

<p>Abstract</p> <p>Background</p> <p>Non-communicable diseases (NCD) accounts for more than a third (37%) of all deaths in South Africa. However, this burden of disease can be reduced by addressing risk factors. The aim of this study was to determine the health and risk profile of South African employees presenting for health risk assessments and to measure their readiness to change and improve lifestyle behaviour.</p> <p>Methods</p> <p>Employees (n = 1954) from 18 companies were invited to take part in a wellness day, which included a health-risk assessment. Self-reported health behaviour and health status was recorded. Clinical measures included cholesterol finger-prick test, blood pressure and Body Mass Index (BMI). Health-related age was calculated using an algorithm incorporating the relative risk for all case mortality associated with smoking, physical activity, fruit and vegetable intake, BMI and cholesterol. Medical claims data were obtained from the health insurer.</p> <p>Results</p> <p>The mean percentage of participation was 26% (n = 1954) and ranged from 4% in transport to 81% in the consulting sector. Health-related age (38.5 ± 12.9 years) was significantly higher than chronological age (34.9 ± 10.3 yrs) (p < 0.001). Both chronological and risk-related age were significantly different between the sectors (P < 0.001), with the manufacturing sector being the oldest and finance having the youngest employees. Health-related age was significantly associated with number of days adversely affected by mental and physical health, days away from work and total annual medical costs (p < 0.001). Employees had higher rates of overweight, smoking among men, and physical inactivity (total sample) when compared the general SA population. Increased health-related expenditure was associated with increased number of risk factors, absenteeism and reduced physical activity.</p> <p>Conclusion</p> <p>SA employees' health and lifestyle habits are placing them at increased risk for NCD's, suggesting that they may develop NCD's earlier than expected. Inter-sectoral differences for health-related age might provide insight into those companies which have the greatest need for interventions, and may also assist in predicting future medical expenditure. This study underscores the importance of determining the health and risk status of employees which could assist in identifying the appropriate interventions to reduce the risk of NCD's among employees.</p