Effects of a structured lifestyle program for individuals with high cardiovascular risk

Cardiovascular disease (CVD) is the leading cause of death in Sweden as well as in the rest of the world. CVD is mainly caused by unhealthy lifestyle habits and lifestyle-related risk factors. National and international guidelines for the prevention and treatment of CVD highlight the importance of implementing preventive programs, with focus on lifestyle changes, in clinical practice. However, scientific evaluations of such programs are still sparse. Aims To evaluate a structured lifestyle program in individuals with high cardiovascular risk by investigating: - effects on lifestyle habits and quality of life - effects on cardiovascular risk factors and cardiovascular risk - participants’ experiences - the influence of educational level based on university degree or not and living in different socio-economic areas Methods The lifestyle intervention program was launched at a department of cardiology. Patients with increased cardiovascular risk, with or without pre-existing CVD, were referred to the program by physicians in primary health care or at hospitals. The program had a multidisciplinary approach with three individual visits to a nurse at baseline, after six months and one year, for a health check-up (physical examination and blood sampling) and person-centred lifestyle counselling. The program also comprised five group educational sessions with a physician and a nurse covering: nicotine, alcohol, physical activity, food habits, stress, sleeping habits, and behavioural change. Lifestyle habits and quality of life were assessed by questionnaires, the changes in cardiovascular risk factors and cardiovascular risk were measured at each of the three health check-ups, and participants’ experiences were investigated through structured interviews. Results One hundred participants (64 women, age 58+11 years) were enrolled between 2008 and 2014. Significant and favourable changes in lifestyle habits were observed after one year. Exercise levels increased, and sedentary time decreased. The participants’ food habits improved and the number with a high consumption of alcohol decreased. Significant improvements in quality of life were noted after one year. Favourable changes in cardiovascular risk factors, such as waist circumference, systolic and diastolic blood pressure and total cholesterol were noted. In parallel, cardiovascular risk, according to the cardiovascular risk profile based on the Framingham 10-year risk prediction model, decreased by 15%. The risk reduction was seen in both men and women, and in participants with or without previous cardiovascular disease. Educational level based on univeristy degree or not and the socioeconomic area of residence, were not barriers for the capability to change lifestyle habits and decrease cardiovascular risk over one year. From interviews with fifteen participants (13 women, age 58+9 years), three categories of experiences were noted:“How to know” - based on both individual counselling and group sessions, with focus on health-related tools to strengthen self-care, an individual visit with shared goal setting, group educational sessions with interactive discussions ;”Staff who know how” - the meeting and the importance of competent, well-educated and respectful health professionals who give continuous feedback, and ”Why feedback is essential” - the participants’ views on, and effects of, feedback to support self-care at home between visits. Conclusion It was possible to launch a structured, multidisciplinary lifestyle program at a cardiology unit for individuals at high cardiovascular risk. Improvements in several lifestyle habits, quality of life, multiple CVD risk factors, reduced cardiovascular risk in both men and women as well as in participants with or without CVD, were observed after one year. Educational level and living in different socioeconomic areas did not seem to have any major influence on the capability to change lifestyle habits and decrease cardiovascular risk. Also, they did not influence the changes in quality of life following the lifestyle intervention program. Three different categories about the structure, staff and feed-back based on experiences of the lifestyle program were noted among the participants

Perceptions of delay when afflicted by an acute myocardial infarction during the first wave of the COVID-19 pandemic

AIMS: To describe the perceptions of delay in medical care-seeking, when afflicted by an acute myocardial infarction (AMI) during the first wave of the pandemic. METHODS AND RESULTS: A qualitative descriptive study with an inductive approach. Fourteen semi-structured interviews were conducted, analysed by qualitative content analysis with a manifest approach. One category and six sub-categories emerged. The decision was reached when the health threat was perceived as critical, which made the earlier thoughts of the pandemic fade away. The risk of infection during medical visits caused fear of contracting the disease. This resulted in hesitation, neglect of symptoms, and avoidance of healthcare visits. Following recommendations from authorities and media about personal responsibility was motivated by fear, affecting the care-seeking. CONCLUSION: It appears that the COVID-19 pandemic raised the threshold for deciding to seek medical care when presenting with an AMI. The pandemic led to increased patient delay due to several reasons among which fear of contracting the disease was prominent. The emotion of fear was related to the external threat to one's own health, due to COVID-19, and not fear of symptoms related to an AMI. The media reporting the healthcare system as overloaded increased insecurity and may have had an influence on delay

"We were all together"- families' experiences of the health-promoting programme - A Healthy Generation.

BACKGROUND: Healthy lifestyle habits, including physical activity (PA), are associated with a broad range of positive psychosocial and physical health benefits. However, there are challenges involved in reaching vulnerable groups in socioeconomically disadvantaged areas. There is a lack of research on family-based PA interventions, specifically considering psychosocial health. The purpose of this study was to explore how families experienced psychosocial aspects of health after participation in a family-based programme, A Healthy Generation. METHODS: A Healthy Generation is a health-promoting, family-based programme delivered in collaboration with local municipalities and sport associations in socioeconomically disadvantaged areas in Sweden. Families with children in grade 2 (8-9 years), including siblings, participate in health-promoting activities, including activity sessions, healthy meals, health information and parental support groups. Data was collected through interviews with parents and children (n = 23) from a controlled pilot trial of the programme. Interviews were audio recorded, transcribed and analysed using a phenomenological hermeneutical method. RESULTS: Three themes and seven sub-themes emerged. The themes were: "A sense of belonging", "Awareness of one's role as a parent" and "Inspiration towards new and healthier behaviours". In terms of A sense of belonging, participation in the programme was the families own free zone, where they also had the opportunity of being together with other families in the programme. For participants that were isolated and lacked a social network, their participation helped them towards social participation. During the programme, parents created an Awareness of one's role as a parent, with new insights on how to act as a parent and they also negotiated differences between each other. Participation in the programme contributed to Inspiration towards new and healthier behaviours such as experience-based insights and healthy lifestyle changes. CONCLUSIONS: This study highlights the importance of co-participation in family-based health-promoting programmes to enhance psychosocial health among families in socioeconomically disadvantaged areas. The results give new insights into participants' experiences of psychosocial aspects of health after participation in a family-based PA programme. This knowledge can contribute to the understanding of how to design health-promoting, family-based interventions to promote psychosocial health in socioeconomically disadvantaged areas. TRIAL REGISTRATION: ISRCTN ISRCTN11660938 . Retrospectively registered 23 September 2019

Effectiveness of a Family Intervention to Increase Physical Activity in Disadvantaged Areas-A Healthy Generation, a Controlled Pilot Study.

There are large social inequalities in health. The purpose of this study was to evaluate the effects of a family intervention on physical activity (PA) and sedentary time (ST) in children and their parents. In this controlled pilot study, all 8-9-year-old children from four schools from a socioeconomically disadvantaged area in Sweden were invited and 67 children and 94 parents were included. The intervention was run by a foundation in co-operation with the municipality. The 9-month program included: (1) activity sessions, (2) healthy meals, (3) health information and (4) parental support groups. PA was primary outcome and ST was secondary outcome, measured by accelerometry. In total, 40 of the children (60%) and 45 of the adults (50%) had at least one day of valid accelerometer data at both baseline and follow-up. Significant intervention effects for the whole group were found in total PA (p = 0.048, mean difference (MD) intervention/control 150 counts per minute) and in vigorous PA (p = 0.02, MD 8 min/day) during the weekends. There were no differences between groups in the other PA variables or ST. This pilot study shows that it is possible to influence PA in families from a disadvantaged area through a family program

Effects of Structured Lifestyle Education Program for Individuals With Increased Cardiovascular Risk Associated With Educational Level and Socioeconomic Area

Background. Differences in socioeconomic status contribute to inequalities in lifestyle habits and burden of noncommunicable diseases. We aimed to examine how the effects of a 1-year structured lifestyle education program associate with the participant's educational level and socioeconomic area (SEA) of residence. Methods. One hundred individuals (64% women) with high cardiovascular risk were included. Education level (nonuniversity vs university degree) was self-reported and SEA (low vs high) defined by living in different SEAs. Lifestyle habits and quality of life were self-reported, cardiovascular risk factors and Framingham 10-year cardiovascular disease risk were measured at baseline and after 1 year. Results. Sedentary behavior decreased in both nonuniversity degree and low SEA group over 1 year, with a significantly greater improvement in daily activity behavior in low- compared with high-SEA group. Abdominal obesity decreased significantly more in the nonuniversity compared with the university degree group. Cardiovascular risk and quality of life improved in all groups, however, with greater discrimination when using educational level as the dichotomization variable. Conclusion. The results are clinically and significantly relevant, suggesting that low socioeconomic status measured both as educational level and SEA are no barriers for changing unhealthy lifestyle habits and decreasing cardiovascular risk after participation in a lifestyle program.Livsstilsmottagningen på Karolinska universitetssjukhuset, Soln

Negative associations between step-up height and waist circumference in 8-year-old children and their parents.

AIM: To study cross-sectional relationships between step-up height and waist circumference (WC), a potential proxy for sarcopenic obesity, in Swedish children and parents. METHODS: Participants were recruited from Swedish schools in disadvantaged areas in 2017. Height, body weight, WC and maximal step-up height were measured in 67 eight-year-old children and parents: 58 mothers, with a mean age of 38.5 and 32 fathers, with a mean age of 41.3. Sedentary time and physical activity were registered by an accelerometer. Associations between maximal step-up height and WC were analysed using Pearson's correlation and adjusted linear regression. RESULTS: Abdominal obesity, WC ≥ 66 centimetres (cm) in children, ≥88 cm in women and ≥102 cm in men, was observed in 13% and 35% of girls and boys, and in 53% and 34% among mothers and fathers, respectively. Negative associations between maximal step-up height and WC were found for children (r = -0.37, p = 0.002) and adults (mothers r = -0.58, p < 0.001, fathers r = -0.48, p = 0.006). The associations remained after adjustments for height, body mass index (BMI) and physical activity in adults. Reduced muscle strength clustered within families (r = 0.54, p < 0.001). CONCLUSION: Associations between reduced muscle strength and abdominal obesity were observed in children and parents. Sarcopenic obesity may need more attention in children. Our findings support family interventions

O9-2 Participants' and leaders' experiences of a family-based health promotion programme : A Healthy Generation

BACKGROUND: Family-based interventions may be a promising solution to increase children's physical activity, but there is a lack of knowledge on how to facilitate such interventions, specifically in socioeconomically disadvantaged areas. The aim of this study was to explore participants' and leader's experiences of the content and delivery of the family-based programme A Healthy Generation. METHOD: A Healthy Generation is a health-promoting programme, for families with children in grade 2 (8-9 years) including siblings. Intervention components are: activity sessions, parental support groups, healthy meals and health information. The programme is delivered twice a week for one school year in collaboration with local municipalities, health coordinators and a variation of invited sport organisations in socioeconomically disadvantaged areas. Data was collected through participant observations during activity sessions, interviews with leaders (n = 11), and four focus groups with parents (n = 27) who had participated in the programme. Data was transcribed verbatim and analysed using content analysis. RESULTS: Leaders' and participants' experienced the programme to have an appealing ?Family-concept for joy, activity and integration?. The variation of activities provided opportunities and challenges to new interests, and the family approach were perceived as valuable for parental engagement and integration. To be ?A suitable programme for all participants?, activities directed to whole families needed to be simple and fun to keep all participants engaged, but also provide a progression for learning. Free and locally situated activities, meals and equipment for whole families facilitated participation, whereas lack of time and socio-cultural differences were barriers. The programme delivery consisted of ?A fruitful leadership collaboration? where health coordinators played an important role as coordinators of a heterogeneous group, so the invited leaders could focus on the content of their sport. They also provided participants with continuity and important reminders for participation during and in-between activity sessions. CONCLUSIONS: Participants' and leaders' experiences of a family-based health promoting programme give insight to the importance of local involvement, collaborative leadership and a well-adjusted family programme for health promotion. The study also draws attention to opportunities and barriers for increased integration through health promotion aimed at families in socioeconomically disadvantaged areas

Effectiveness of a family intervention on health-related quality of life-a healthy generation, a controlled pilot trial.

BACKGROUND: Physical activity is associated with better health, but knowledge about health promoting interventions, including physical activity for families in disadvantaged areas and the impact on health-related quality of life (HRQOL) is sparse. The aim of this study was to assess HRQOL in children and their parents after participation in the programme "A Healthy Generation". METHODS: The programme is delivered in socioeconomically disadvantaged areas in Sweden and offers physical activity and a healthy meal or fruit twice a week from August to May to families with children in grade 2. Children (n = 67), aged 8-9 years, and their parents (n = 90) participated in this controlled study conducted in four schools, two control and two intervention schools. HRQOL of children and adults was assessed at baseline and follow-up after the intervention with the Pediatric Quality of Life Inventory (PedsQL) 4.0 and the Gothenburg Quality of Life scale, respectively. Analyses of covariance (ANCOVAs), linear regression and Pearson's correlation were conducted. RESULTS: There were no significant differences between intervention and control in HRQOL among children or adults after the intervention. However, in a subgroup of children (n = 20) and adults (n = 29) with initial low HRQOL scores at baseline, there was a significant difference between the intervention group and control group after the intervention (children (total score): p = 0.02; adults (social domain) p = 0.04). Furthermore, within the intervention group, there was a significant relationship between level of participation in "A Healthy Generation" and the physical domain of HRQOL among girls (r = 0.44, p = 0.01), but not boys (r = - 0.07, p = 0.58). CONCLUSION: Participation in the programme "A Healthy Generation" did not show a significant intervention effect on HRQOL in general. However, the findings suggest that HRQOL may be increased for children and adults with low HRQOL in disadvantaged areas. This knowledge can contribute to the development of health promoting interventions in such areas, and to more equitable health. TRIAL REGISTRATION: ISRCTN ISRCTN11660938. Retrospectively registered 23 September 2019