Behavioral counseling for cardiovascular disease prevention in 36 low-income and middle-income countries.

BACKGROUND: Given the substantial prevalence of cardiovascular disease (CVD) in low-income and middle-income countries (LMICs), evaluation of behavioral counseling for prevention of CVD is important. METHODS: We pooled nationally representative cross-sectional surveys from 36 LMICs between 2013 and 2020. The population was divided into three groups according to CVD risk: the potential risk group, the risk group and the CVD group. We estimated the prevalence of six types of behavioral counseling among the three groups separately: smoking, salt reduction, fruit and vegetable intake, dietary fat reduction, physical activity and body weight. RESULTS: There were 16,057 (25.4%) in the potential risk group, 43,113 (49.9%) in the risk group, and 7796 (8.6%) in the CVD group. The prevalence of receiving at least four types of counseling in the three groups was 15.6% (95% CI 13.9 to 17.5), 14.9% (95% CI 14.0 to 15.9), and 19.8% (95% CI 17.7 to 22.2), respectively. The lowest prevalence was for tobacco use counseling: 24.5% (95% CI 22.5 to 26.4), 23.2% (95% CI 22.1 to 24.3), and 32.1% (95% CI 29.5 to 34.8), respectively. The prevalence of counseling was higher in upper-middle-income countries than in lower-middle-income countries. Women, older people, those with more education, and those living in urban areas were more likely to receive counseling. CONCLUSION: The prevalence of behavioral counseling for CVD is low in LMICs, especially among potentially at-risk populations and in low-income countries. These findings highlight the current urgent need to improve CVD prevention and management systems to enhance behavioral counseling and intervention.

Needs for information about lifestyle and rehabilitation in long-term young adult cancer survivors.

BACKGROUND: Healthy lifestyle and rehabilitation may mitigate late effects after cancer treatment, but knowledge about lifestyle and rehabilitation information needs among long-term young adult cancer survivors (YACSs) (≥ 5 years from diagnosis) is limited. The present study aimed to examine such information needs among long-term YACSs, and identify characteristics of those with needs. MATERIAL AND METHODS: The Cancer Registry of Norway identified long-term YACSs diagnosed with breast cancer, colorectal cancer, non-Hodgkin lymphoma, leukemia, or malignant melanoma at the age of 19-39 years, between 1985 and 2009. Survivors were mailed a questionnaire, in which respondents reported their information needs on physical activity, diet, and rehabilitation services 5-30 years post-diagnosis. Descriptive statistics and logistic regression analyses were used to examine the prevalence of information needs and associated factors. RESULTS: Of 1488 respondents (a response rate of 42%), 947 were included. Median age at diagnosis was 35 years (range 19-39) and median observation time since diagnosis was 14 years (range 5-30). In total, 41% reported information needs for information about physical activity, 45% about diet, and 47% about rehabilitation services. Information needs were associated with higher treatment intensity, increasing number of late effects, and an unhealthy lifestyle. CONCLUSION: A large proportion of long-term YACSs report information needs regarding lifestyle and/or rehabilitation more than a decade beyond treatment. Assessments of such information needs should become a part of long-term care of these cancer survivors.

A cross-sectional survey study on the nutrition patterns of patients with peripheral artery disease.

Background: Even though nutrition was demonstrated to have an impact on chronic atherosclerotic disease, there is a paucity of corresponding recommendations for patients with peripheral artery disease (PAD). A Mediterranean Diet based on daily intake of fruits and vegetables with high fibre, vegetable oil, and unsalted nuts including fish several times a week may have protective effects. This cross-sectional survey aimed to determine nutritional patterns amongst inpatients with PAD. Methods: All inpatients with symptomatic PAD who underwent revascularisation at a single centre between 1st May 2018 and 31st December 2021 were asked to fill out a questionnaire on nutritional intake. An 8-item frequency rating scale (from never to three times a day) was used for 15 food groups. For 11 of them, an adapted Mediterranean Diet score was calculated using the answers. The descriptive results were stratified by sex and disease stage (intermittent claudication vs. chronic limb-threatening ischaemia). Results: A total of 319 patients (31.7% female, 69.4 years in mean) were included. Thereof, 71.8% reported they did never receive any nutritional information considering their PAD disease. The mean adapted Mediterranean Diet score was 2.7 points (of maximum 11) with most patients not achieving the recommended servings per week for fruits (1.6%), vegetables (1.0%), and unsalted nuts (12.2%). The intake of cereals was sufficient (43.3%). When compared with men, women consumed more fruits and less meat. Conclusions: This survey demonstrated that although healthy nutrition may have a positive impact on patients with PAD, the education and adherence to a Mediterranean Diet was inappropriate. Nutritional patterns should be more focused in future PAD studies to derive specific recommendations and nutritional programmes as well as patient education in clinical practice.

Systematic review of international clinical guidelines for the promotion of physical activity for the primary prevention of cardiovascular diseases.

BACKGROUND: Cardiovascular diseases are the world's leading cause of morbidity and mortality. An active lifestyle is one of the cornerstones in the primary prevention of cardiovascular disease. An initial step in guiding primary prevention programs is to refer to clinical guidelines. We aimed to systematically review clinical practice guidelines on primary prevention of cardiovascular disease and their recommendations regarding physical activity. METHODS: We systematically searched Trip Medical Database, PubMed and Guidelines International Network from January 2012 up to December 2020 using the following search strings: 'cardiovascular disease', 'prevention', combined with specific cardiovascular disease risk factors. The identified records were screened for relevance and content. We methodologically assessed the selected guidelines using the AGREE II tool. Recommendations were summarized using a consensus-developed extraction form. RESULTS: After screening, 27 clinical practice guidelines were included, all of which were developed in Western countries and showed consistent rigor of development. Guidelines were consistent about the benefit of regular, moderate-intensity, aerobic physical activity. However, recommendations on strategies to achieve and sustain behavior change varied. Multicomponent interventions, comprising education, counseling and self-management support, are recommended to be delivered by various providers in primary health care or community settings. Guidelines advise to embed patient-centered care and behavioral change techniques in prevention programs. CONCLUSIONS: Current clinical practice guidelines recommend similar PA lifestyle advice and propose various delivery models to be considered in the design of such interventions. Guidelines identify a gap in evidence on the implementation of these recommendations into practice.

Text message-based lifestyle intervention in primary care patients with hypertension: a randomized controlled pilot trial.

OBJECTIVE: To evaluate the feasibility of a randomized controlled pilot study with lifestyle-promoting text messages as a treatment for hypertension in primary care. DESIGN: Randomized controlled pilot trial. SETTING: Three primary health care centers in southern Sweden. SUBJECTS: Sixty patients aged 40-80 years with hypertension were included. MAIN OUTCOME MEASURES: Feasibility of the pilot study, i.e. recruitment rate, dropout rate and eligibility criteria. Secondary outcomes were change in blood pressure and other cardiovascular risk factors. METHODS: Thirty participants were randomized to the intervention group with four lifestyle-promoting text messages sent every week for six months. The control group received usual care. The baseline and follow-up visits for all 60 patients included measurements of blood pressure, anthropometrics, blood tests and a self-reported questionnaire. RESULTS: All feasibility criteria (recruitment rate (≥55%), dropout rate (≤15%) and eligibility (60 eligible patients during the four-month inclusion period) for the pilot study were fulfilled. This means that a larger study with a similar design may be conducted. After six months, there were no significant improvements in cardiovascular risk factors. However, we found favorable trends for all secondary outcomes in the intervention group as compared to the control group. CONCLUSION: Lifestyle modification in patients with hypertension is important to reduce cardiovascular risk. However, primary healthcare has limited resources to work with modifying lifestyle habits. This is the first pilot study to test the feasibility of text message-based lifestyle intervention in patients with hypertension in Swedish primary healthcare. Whether significant improvement in cardiovascular risk factors may be achieved in a larger study population remains to be evaluated. Key points This pilot randomized controlled trial (RCT) is the first study to evaluate the feasibility of text message-based lifestyle advice to patients with hypertension in Swedish primary healthcare. •All feasibility criteria for the pilot study were fulfilled. This outcome means that a larger study with a similar design may be conducted. •The study was not powered to find significant changes in cardiovascular risk factors. Nevertheless, after six months we found favorable trends for all secondary outcomes in the intervention group compared to control. •If a future larger study can show significant results, this intervention could serve as a useful tool in everyday primary healthcare.

Exploring the provision of alcohol advice by clinicians to breast cancer patients.

Interactions between clinicians and patients along the cancer trajectory provide an opportunity to deliver key messages regarding drinking behaviours and long-term health. This study aimed to explore the extent and nature of clinician-patient discussions regarding alcohol intake and cancer outcomes in the clinical breast cancer setting, using a qualitative research design involving semi-structured interviews. Purposive sampling was used to recruit 27 breast cancer clinicians (eight dietitians, nine breast care nurses, 10 oncologists) across Victoria, Australia. Interview data were analysed using descriptive statistics and a content analysis approach. Clinicians' knowledge of national alcohol recommendations was found to be inconsistent. Clinicians reported a lack of patient awareness of the link between alcohol and breast cancer. Current frameworks for assessing and advising on patient alcohol intake were felt to be impractical. The extent and nature of advice provided about alcohol was influenced by several patient and clinician factors. The provision of alcohol advice in the clinical breast cancer setting is not practiced systematically by any professional group. New approaches are needed to support patient education about alcohol intake and survivorship in the clinical oncology setting.

Study protocol for a randomized controlled trial to explore the effects of personalized lifestyle advices and tandem skydives on pleasure in anhedonic young adults.

BACKGROUND: Anhedonia is generally defined as the inability to feel pleasure in response to experiences that are usually enjoyable. Anhedonia is one of the two core symptoms of depression and is a major public health concern. Anhedonia has proven particularly difficult to counteract and predicts poor treatment response generally. It has often been hypothesized that anhedonia can be deterred by a healthy lifestyle. However, it is quite unlikely that a one-size-fits-all approach will be effective for everyone. In this study the effects of personalized lifestyle advice based on observed individual patterns of lifestyle behaviors and experienced pleasure will be examined. Further, we will explore whether a tandem skydive following the personalized lifestyle advice positively influences anhedonic young adults' abilities to carry out the recommended lifestyle changes, and whether this ultimately improves their self-reported pleasure. METHODS: Our study design is an exploratory intervention study, preceded by a cross-sectional survey as a screening instrument. For the survey, 2000 young adults (18-24 years old) will be selected from the general population. Based on survey outcomes, 72 individuals (36 males and 36 females) with persistent anhedonia (i.e., more than two months) and 60 individuals (30 males and 30 females) without anhedonia (non-anhedonic control group) will be selected for the intervention study. The non-anhedonic control group will fill out momentary assessments of pleasure and lifestyle behaviors three times a day, for one month. The anhedonic individuals will fill out momentary assessments for three consecutive months. After the first month, the anhedonic individuals will be randomly assigned to (1) no intervention, (2) lifestyle advice only, (3) lifestyle advice plus tandem skydive. The personalized lifestyle advice is based on patterns observed in the first month. DISCUSSION: The present study is the first to examine the effects of a personalized lifestyle advice and tandem skydive on pleasure in anhedonic young adults. Results of the present study may improve treatment for anhedonia, if the interventions are found to be effective. TRIAL REGISTRATION: Dutch Trial Register, NTR5498 , registered September 22, 2015 (retrospectively registered).

Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: We evaluated the effect of adding pelvic floor muscle training (PFMT) to a structured lifestyle advice program. METHODS: This was a single-blinded randomized trial of women with symptomatic pelvic organ prolapse (POP) stage ≥ II. Participants were randomized to a structured lifestyle advice program with or without PFMT. Both groups received similar lifestyle advice in six separate group sessions. The combined group performed group PFMT after an individual assessment. Primary outcome was a global improvement scale at six-month follow-up. Secondary outcomes were the global scale and objective POP at three-month follow-up, symptoms and quality of life including sexuality, at three and six-month follow-up. A clinically relevant change of symptoms was defined as ≥ 15 %. RESULTS: We included 109 women. Eighty-nine women (82 %) completed three months follow-up; 85 (78 %) completed six-month follow-up. At both follow-ups, significantly more women in the combined group reported improvement in the global scale. At the three-month follow-up, the combined group only had significant improvement of POP symptoms while only the lifestyle advice group had significant improvement of quality of life. Change in objective POP and sexuality was nonsignificant. The symptom score improved 17 % in the combined group and 14 % in the lifestyle advice group (P = 0.57). Significantly more women in the lifestyle advice group had sought further treatment at the six-month follow-up. CONCLUSION: Adding PFMT to a structured lifestyle advice program gave superior results in a global scale and for POP symptoms. Overall effect of either intervention barely reached clinical relevance.

The 12-month effects of structured lifestyle advice and pelvic floor muscle training for pelvic organ prolapse.

INTRODUCTION: We evaluated the 12-month effects of adding pelvic floor muscle training to a lifestyle advice program in women with symptomatic pelvic organ prolapse stage II-III and the number of women who had sought further treatment. MATERIAL AND METHODS: This study was a 12-month follow up of a randomized controlled trial comparing a structured lifestyle advice program alone (lifestyle group) or in combination with pelvic floor muscle training (training and lifestyle group). Both programs consisted of six separate group sessions within 12 weeks. RESULTS: Data were available from 83 (76%) of the 109 originally included women. At the 12-month follow up, 34/83 (41%) had not sought further treatment, 13/43 (30%) in the lifestyle group and 21/40 (52%) in the training and lifestyle group, and these could be included for analysis. The lifestyle group had significantly improved bladder symptoms compared with baseline on single-item analysis (p = 0.01). The training and lifestyle group had significantly improved pelvic organ prolapse symptoms on single-item analysis (p = 0.02) and of bowel-related quality of life (p = 0.04). No significant between-group differences were found in the symptom and quality of life scores. All together 49 women (59%) had sought further treatment, 70% in the lifestyle group, and 48% in the training and lifestyle group (p = 0.05). Twenty-six in the lifestyle group, and 15 in the training and lifestyle group had sought conservative treatment. Four women in each group had received surgery. More severe anterior prolapse and more bladder symptoms at the 3-month follow up were significantly associated with having sought further treatment in both groups. CONCLUSIONS: At 12-month follow up, the effects of adding pelvic floor muscle training to a structured lifestyle advice program were limited.

Exploring strategies to reach individuals of Turkish and Moroccan origin for health checks and lifestyle advice: a mixed-methods study.

BACKGROUND: Low participation rates among ethnic minorities in preventive healthcare services are worrisome and not well understood. The objective of this study was to explore how adults of Turkish and Moroccan origin living in the Netherlands, aged 45 years and older, can be reached to participate in health checks for cardio-metabolic diseases and follow-up (lifestyle) advice. METHODS: This mixed-methods study used a convergent parallel design, to combine data of one quantitative study and three qualitative studies. Questionnaire data were included of 310 respondents, and interview data from 22 focus groups and four individual interviews. Participants were recruited via a research database, general practitioners and key figures. Quantitative data were analysed descriptively and qualitative data were analysed using a thematic approach. RESULTS: Regarding health checks, 50 % (95 % CI 41;59) of the Turkish questionnaire respondents and 66 % (95 % CI 57;76) of the Moroccan questionnaire respondents preferred an invitation from their general practitioner. The preferred location to fill out the health check questionnaire was for both ethnic groups the general practitioner's office or at home, on paper. Regarding advice, both groups preferred to receive advice at individual level rather than in a group, via either a physician or a specialised healthcare professional. It was emphasised that the person who gives lifestyle advice should be familiar with the (eating) habits of the targeted individual. Sixty-one percent (95 % CI 53;69) of the Turkish respondents preferred to receive information in their native language compared to 37 % (95 % CI 29;45) of the Moroccan respondents. Several participants mentioned a low proficiency in the local language as an explanation for their preference to fill out the health check questionnaire at home, to receive advice from an ethnic-matched professional, and to receive information in their native language. CONCLUSIONS: The general practitioner is considered as a promising contact to reach adults of Turkish and Moroccan origin for health checks or (lifestyle) advice. It might be necessary to provide information in individuals' native language to overcome language barriers. In addition, (lifestyle) advice must be tailored. The obtained insight into preferences of Turkish and Moroccan adults regarding reach for preventive healthcare services could help professionals to successfully target these groups.

Lifestyle advice and lifestyle change: to what degree does lifestyle advice of healthcare professionals reach the population, focusing on gender, age and education?

Health promotion practice in health care has a high priority in the endeavour to achieve equal opportunities for health and diversity in health among the population. The purpose of the study was to investigate whether there is any connection between the lifestyle advice given by healthcare professionals and the lifestyle change of the population, focusing on age, gender and education level. The study is based on the data from a national population survey in Sweden in which 52 595 patients who had attended health care were interviewed by phone. The participants were asked whether healthcare professionals had raised the subject of lifestyle during the visit and whether the advice they gave had contributed to a lifestyle change. The results indicated that lifestyle issues were raised with 32.2% of those who attended health care, particularly among men, younger patients and those with a high education level. When lifestyle issues were raised, the advice contributed to 39.2% of patients making a lifestyle change, to a higher extent among men, older patients and those with a low education level. The study shows that lifestyle advice given by healthcare professionals, during both emergency and outpatient healthcare visits, is an important contributor to patients' lifestyle change.

Understanding the disconnect between lifestyle advice and patient engagement: a discourse analysis of how expert knowledge is constructed by patients with CHD.

OBJECTIVE: Adherence to healthy lifestyle advice is effective in prevention of non-communicable diseases like coronary heart disease (CHD). Yet patient disengagement is the norm. We take a novel discursive approach to explore patients' negotiation of lifestyle advice and behaviour change. METHOD: A discourse analysis was performed on 35 longitudinal interviews with 22 heterosexual British people in a long-term relationship, where one had a diagnosis of CHD. The analysis examined the relationships between patients' constructions of expert knowledge and the implications of these accounts for patients' dis/engagement with lifestyle advice. RESULTS: Expert knowledge was constructed in four ways: (1) Expert advice was valued, but adherence created new risks that undermined it; (2) expert knowledge was problematised as multiple, contradictory, and contested and therefore difficult to follow; (3) expert advice was problematised as too generalised to meet patients' specific needs; and (4) expert advice was understood as limited and only one form of valued knowledge. CONCLUSION: Patients and partners simultaneously valued and problematised expert knowledge, drawing on elaborate lay epistemologies relating to their illness which produced complex patterns of (dis)engagement with expert lifestyle advice. Recognition of the multiple and fluid forms of knowledge mobilised by CHD patients could inform more effective interventions.

Lifestyle advice for hypertension or diabetes: trend analysis from 2002 to 2017 in England.

BACKGROUND: Guidelines recommend that GPs give patients lifestyle advice to manage hypertension and diabetes. Increasing evidence shows that this is an effective and practical treatment for these conditions, but it is unclear whether GPs offer this support. AIM: To investigate trends in the percentage of patients with hypertension/diabetes receiving lifestyle advice versus medication. DESIGN AND SETTING: This was a trend analysis of self-reported data from the annual Health Survey for England (HSE) (2003-2017) and GP-recorded data from the QResearch database (2002-2016). METHOD: The percentage of patients with hypertension or diabetes who received lifestyle advice or medication was calculated in each year. Associations between likelihood of receiving lifestyle advice and characteristics were assessed using multivariable logistic regression. RESULTS: The percentage of patients receiving lifestyle advice was consistently lower than those receiving medication in both self-reported and medical records. There was consistent evidence of increasing trends in the percentage of patients with hypertension receiving lifestyle advice (HSE 13.8% to 20.1%; Ptrend <0.001; QResearch 11.0% to 22.7%; Ptrend <0.001). For diabetes, there was a non-significant decline in self-reported receipt of lifestyle advice (45.0% to 27.9%; Ptrend = 0.111) and a significant increase in medically recorded delivery of this advice (20.7% to 40.5%; Ptrend <0.001). Patients with hypertension who were overweight or obese were more likely to receive lifestyle advice than those of a healthy weight, whereas the opposite was true for diabetes. CONCLUSION: Only a minority of patients with diabetes or hypertension report receiving lifestyle advice or have this recorded in their medical records. Interventions beyond guidelines are needed to increase the delivery of behavioural interventions to treat these conditions.

Nutrition Patterns and Their Gender Differences among Rheumatoid Arthritis Patients: A Descriptive Study.

Dietary factors probably play a role in the pathogenesis and clinical course of rheumatoid arthritis (RA). There is a paucity of specific dietary guidelines for RA patients and little information on their implementation in daily life. Therefore, this study aimed to determine the nutritional status and provision of nutritional education among outpatients with RA. Here, 61 patients were included with a sex ratio of 2.03 (f/m). Based on BMI, 22% of women were overweight and 32% obese, whereas 50% of men were overweight and 30% obese. Fasting blood and a 3-day estimated dietary record were collected. Additionally, patients were asked whether they had already received information about a specific diet as part of their disease treatment plan. Elevated total cholesterol levels were found in 76% of women and in 60% of men caused by increased non-HDL-C levels. The dietary intake assessment showed a lower self-reported intake of energy, polyunsaturated fat, carbohydrates, fiber, and several micronutrients than recommended. Regarding healthy eating, all patients reported familiarity with dietary recommendations, but found it difficult to implement the recommendations into their diets. These findings suggested that RA patients need more specific recommendations and education in clinical practice to improve the quality of their diet.

Personalized lifestyle advice alters affective reactivity to negative events in anhedonic young adults.

BACKGROUND: Anhedonia is a common symptom of several disorders, but cost-effective treatments that focus on anhedonia specifically have been lacking. Therefore, personalized lifestyle advice has recently been investigated as a suitable means of enhancing pleasure and positive affect (PA) in young adults with anhedonia. This intervention provided individuals with a personalized lifestyle advice which was based on observed individual patterns of lifestyle behaviors and experienced pleasure in daily life. The present study extends this previous work by examining a potential mechanism of treatment success, affective reactivity. METHODS: We explored changes in affective reactivity to events in daily life from pre- to post-intervention in a subclinical sample of young adults with anhedonia (N = 69). Using the Experience Sampling Method (ESM), participants answered questions on their activities, their pleasure levels, PA and negative affect (NA) before and after the intervention. RESULTS: Multilevel analysis revealed that participants did not experience an altered affective reactivity to positive events after the intervention. The affective reactivity to negative events depended on the level of improvement in mean-PA after the lifestyle advice intervention. LIMITATIONS: The present study used a subclinical sample with the majority of participants being female which limited the generalizability of the findings. CONCLUSION: This study suggests that an altered affective reactivity to negative events is an underlying mechanism of the effectiveness of a personalized lifestyle advice.

Physicians' lifestyle advice on primary and secondary cardiovascular disease prevention in Germany: A comparison between the STAAB cohort study and the German subset of EUROASPIRE IV.

BACKGROUND: We assessed prevalence and determinants in appropriate physician-led lifestyle advice (PLA) in a population-based sample of individuals without cardiovascular disease (CVD) compared with a sample of CVD patients. METHODS: PLA was assessed via questionnaire in a subsample of the population-based Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort free of CVD (primary prevention sample) and the German subset of the fourth EUROASPIRE survey (EUROASPIRE-IV) comprising CVD patients (secondary prevention sample). PLA was fulfilled if the participant reported having ever been told by a physician to: stop smoking (current/former smokers), reduce weight (overweight/obese participants), increase physical activity (physically inactive participants) or keep to a healthy diet (all participants). Factors associated with receiving at least 50% of the PLA were identified using logistic regression. RESULTS: Information on PLA was available in 665 STAAB participants (55 ± 11; 55% females) and in 536 EUROASPIRE-IV patients (67 ± 9; 18% females). Except for smoking, appropriate PLA was more frequently given in the secondary compared with the primary prevention sample. Determinants associated with appropriate PLA in primary prevention were: diabetes mellitus (odds ratio (OR) 4.54; 95% confidence interval (CI) 1.88-10.95), hyperlipidaemia (OR 3.12; 95% CI 2.06-4.73) and hypertension (OR 1.74; 95% CI 1.15-2.62); in secondary prevention: age (OR per year 0.96; 95% CI 0.93-0.98) and diabetes mellitus (OR 2.33; 95% CI 1.20-4.54). CONCLUSIONS: In primary prevention, PLA was mainly determined by the presence of vascular risk factors, whereas in secondary prevention the level of PLA was higher in general, but the association between CVD risk factors and PLA was less pronounced.

Health Care Providers' Advice on Lifestyle Modification for Older Adults.

OBJECTIVES: To describe the pattern of health care providers' advice on lifestyle modification to older adults, and identify correlates of receiving such advice. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: Data from the National Health and Nutrition Examination Survey study from 2007-2016 on adults ≥65 years (n = 3758) were analyzed. METHODS: We estimated the weighted prevalence and correlates of receiving advice on the following lifestyle modifications: (1) increase physical activity, (2) reduce fat/calories, (3) control/lose weight, and (4) a combination of control/lose weight and physical activity. Data were analyzed according to level of comorbidity (number of chronic conditions including high blood pressure, high blood cholesterol, type 2 diabetes mellitus, coronary heart disease, and arthritis) and body mass index (BMI). RESULTS: Physical activity was the most widely prescribed lifestyle modification, reported by 15.7% of older adults free of chronic conditions and 28.9%, 35.4%, and 52.6% of older adults with 1, 2, and ≥3 comorbidities. Advice on reducing fat/calories was reported by 9.2%, 18.5%, 26.3%, and 40.9% of older adults with 0, 1, 2, and ≥3 comorbidities, respectively, and advice on weight loss/control was reported by 6.5%, 19.1%, 20.8%, and 37.5%, respectively. The combination of advice on weight loss/control and physical activity was least commonly reported: 5.1%, 13.5%, 16.6%, and 32.0%, respectively. Overall, lifestyle modifications were more frequently advised to older adults who were overweight, obese, or Hispanic. CONCLUSIONS AND IMPLICATIONS: In the United States, lifestyle modifications are not routinely recommended to older adults, particularly those free of chronic conditions, presenting a missed opportunity for chronic disease prevention and management. Among those advised to lose or manage weight, concurrent advice to increase physical activity is not consistently provided.

Patients with osteoarthritis are least likely to receive lifestyle advice compared with patients with diabetes and hypertension: A national health survey study from Denmark.

Objectives: To investigate the association between having osteoarthritis (OA), hypertension, or diabetes, either alone or in combination, and receiving guideline-recommended exercise or weight-reduction advice. Design: Cross-sectional study. Methods: We applied logistic regression to analyse self-reported data from the 2017 Danish National Health survey (DNHS). We calculated the proportions and odds ratios of receiving exercise advice and weight-reduction advice (if BMI>30) from the general practitioner (GP) in seven patient groups: those with OA or hypertension or diabetes or any combination of these diseases. Results: From the 183,372 DNHS responders, we included 71,717 patients (≥45 years) who reported consulting a GP during the previous year. Among patients with only one disease, those with OA were least likely to receive exercise advice (13%, 1441/11,024) and weight-reduction advice (27%, 504/1877), while those with diabetes were most likely to receive these advice (32%, 387/1200 and 55%, 160/289, respectively).For OA-only patients, the adjusted odds ratios of receiving exercise advice and weight-reduction advice were 1.4 (95% CI 1.3 to 1.5) and 1.6 (95% CI 1.4 to 1.8), respectively, compared with patients with none of the three diseases. For diabetes-only patients, the adjusted odds ratios were 4.2 (95% CI 3.7 to 4.7) and 5.4 (95% CI 4.2 to 7.0), respectively. Conclusion: Few patients with OA self-reported having received guideline-recommended exercise advice, or weight-reduction advice if obese, from their GP. Furthermore, patients with OA were less likely to report having received these advice compared with patients with other chronic diseases.

Effect of physical exercise and medication on enhancing cognitive function in older adults with vascular risk.

AIM: To examine the association of physical exercise (PE) and medication on cognitive function in older adults with vascular risk. METHODS: This was a cross-sectional study of 478 non-demented participants aged ≥60 years with vascular risk. Management strategy included PE (mind-body exercise and/or strenuous exercise), medication, PE combined with medication and no management at all. Participation of PE was determined by self-reporting exercise engagement in the past year. Cognitive preservation was defined as a global composite z-score that was equal to or above the age and educational adjusted mean of cognitively normal older adults. Binary logistic regression was carried out to examine the association between management strategy and cognitive preservation in each exercise modality adjusted by sociodemographic, physical, mental and genetic factors. RESULTS: An association was found in preserved cognitive function for those who managed their vascular risk through PE (OR 2.5, 95% CI 1.2-5.3, P = 0.015) and in combination with medication (OR 2.1, 95% CI 1.0-4.6, P = 0.05). A similar pattern was also found in each exercise subtype. A significant short-term (OR 3.6, 95% CI 1.0-12.4, P = 0.042) to lifelong (OR 3.5, 95% CI 1.4-8.5, P = 0.006) cognitive benefit was found in MB exercise. CONCLUSION: Medication alone may be insufficient to preserve cognitive function in older adults with vascular risk. In our sample, medication in combined with PE is found to have significant impact on cognitive improvement. Mind-body exercise might be better than strenuous exercise, as a more sustainable cognitive effect is observed. Geriatr Gerontol Int 2020; 20: 1067-1071..