Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey. Globalization of Diabetes Randomised controlled trial of a healthy lifestyle intervention among smokers with psychotic disorders: Outcomes to 36 months Physical activity trajectories and mortality: population based cohort study Effectiveness of community-based comprehensive healthy lifestyle promotion on cardiovascular disease risk factors in a rural Vietnamese population: a quasi-experimental study Design and baseline characteristics of the 10 Small Steps Study: a randomised controlled trial of an intervention to promote healthy behaviour using a lifestyle score and personalised feedback An evaluation of Choose to Move 1999: an American Heart Association physical activity program for women. A school-based intervention to teach third grade children about the prevention of heart disease. The economic burden of physical inactivity in Canada. Design of a randomized controlled trial for multiple cancer risk behaviors among Spanish-speaking Mexican-origin smokers Psychodynamic Motivation and Training program (PMT) for the secondary prevention in patients with stable coronary heart disease: study protocol for a randomized controlled trial of feasibility and effects Combined impact of traditional and non-traditional health behaviors on mortality: a national prospective cohort study in Spanish older adults Prevention of type 2 diabetes - where is the evidence? Impact of dietary and lifestyle factors on the prevalence of hypertension in Western populations. What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol A culturally adapted lifestyle intervention addressing a Middle Eastern immigrant population at risk of diabetes, the MEDIM (impact of Migration and Ethnicity on Diabetes In Malmö): study protocol for a randomized controlled trial Change in lifestyle factors and their influence on health status and all-cause mortality. The effect of a smartphone-based coronary heart disease prevention (SBCHDP) programme on awareness and knowledge of CHD, stress, and cardiac-related lifestyle behaviours among the working population in Singapore: a pilot randomised controlled trial Community-based physical activity as adjunctive smoking cessation treatment: Rationale, design, and baseline data for the Lifestyle Enhancement Program (LEAP) randomized controlled trial Mental health symptoms in relation to socio-economic conditions and lifestyle factors – a population-based study in Sweden ALIFE@Work: a randomised controlled trial of a distance counselling lifestyle programme for weight control among an overweight working population [ISRCTN04265725] Effect of lifestyle modifications on blood pressure by race, sex, hypertension status, and age Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease: A Randomized Clinical Trial.
BACKGROUND Physical activity , diet , smoking , and alcohol consumption have been shown to be related to mortality . We examined prospect ively the individual and combined influence of these risk factors on total and cause-specific mortality . METHODS The prospect i ve cohort study included 4886 individuals at least 18 years old from a United Kingdom-wide population in 1984 to 1985 . A  health behavior score  was calculated , allocating 1 point for each poor behavior : smoking ; fruits and vegetables consumed less than 3 times daily ; less than 2 hours physical activity per week ; and weekly consumption of more than 14 units of alcohol ( in women ) and more than 21 units ( in men ) ( range of points , 0 - 4 ) . We examined the relationship between health behaviors and mortality using Cox models and compared it with the mortality risk associated with aging . RESULTS During a mean follow-up period of 20 years , 1080 participants died , 431 from cardiovascular diseases , 318 from cancer , and 331 from other causes . Adjusted hazard ratios and 95 % confidence intervals ( CIs ) for total mortality associated with 1 , 2 , 3 , and 4 poor health behaviors compared with those with none were 1.85 ( 95 % CI , 1.28 - 2.68 ) , 2.23 ( 95 % CI , 1.55 - 3.20 ) , 2.76 ( 95 % CI , 1.91 - 3.99 ) , and 3.49 ( 95 % CI , 2.31 - 5.26 ) , respectively ( P value for trend , < .001 ) . The effect of combined health behaviors was strongest for other deaths and weakest for cancer mortality . Those with 4 compared with those with no poor health behaviors had an all-cause mortality risk equivalent to being 12 years older . CONCLUSION The combined effect of poor health behaviors on mortality was substantial , indicating that modest , but sustained , improvements to diet and lifestyle could have significant public health benefits Type 2 diabetes is a global public health crisis that threatens the economies of all nations , particularly developing countries . Fueled by rapid urbanization , nutrition transition , and increasingly sedentary lifestyles , the epidemic has grown in parallel with the worldwide rise in obesity . Asia 's large population and rapid economic development have made it an epicenter of the epidemic . Asian population s tend to develop diabetes at younger ages and lower BMI levels than Caucasians . Several factors contribute to accelerated diabetes epidemic in Asians , including the “ normal-weight metabolically obese ” phenotype ; high prevalence of smoking and heavy alcohol use ; high intake of refined carbohydrates ( e.g. , white rice ) ; and dramatically decreased physical activity levels . Poor nutrition in utero and in early life combined with overnutrition in later life may also play a role in Asia 's diabetes epidemic . Recent advances in genome-wide association studies have contributed substantially to our underst and ing of diabetes pathophysiology , but currently identified genetic loci are insufficient to explain ethnic differences in diabetes risk . Nonetheless , interactions between Westernized diet and lifestyle and genetic background may accelerate the growth of diabetes in the context of rapid nutrition transition . Epidemiologic studies and r and omized clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications . Translating these findings into practice , however , requires fundamental changes in public policies , the food and built environments , and health systems . To curb the escalating diabetes epidemic , primary prevention through promotion of a healthy diet and lifestyle should be a global public policy priority Objective : People living with psychotic disorders ( schizophrenia spectrum and bipolar disorders ) have high rates of cardiovascular disease risk behaviours , including smoking , physical inactivity and poor diet . We report cardiovascular disease risk , smoking cessation and other risk behaviour outcomes over 36 months following recruitment into a two-arm r and omised controlled trial among smokers with psychotic disorders . Methods : Participants ( N = 235 ) drawn from three sites were r and omised to receive nicotine replacement therapy plus ( 1 ) a Healthy Lifestyles intervention  delivered over approximately 9 months or ( 2 ) a largely telephone-delivered intervention ( design ed to control for nicotine replacement therapy provision , session frequency and other monitoring ) . The primary outcome variables were 10-year cardiovascular disease risk and smoking status , while the secondary outcomes included weekly physical activity , unhealthy eating , waist circumference , psychiatric symptomatology , depression and global functioning . Results : Significant reductions in cardiovascular disease risk and smoking were detected across the 36-month follow-up period in both intervention conditions , with no significant differences between conditions . One-quarter ( 25.5 % ) of participants reported reducing cigarettes per day by 50 % or more at multiple post-treatment assessment s ; however , few ( 8.9 % ) managed to sustain this across the majority of time points . Changes in other health behaviours or lifestyle factors were modest ; however , significant improvements in depression and global functioning were detected over time in both conditions . Participants experiencing worse ‘ social discomfort ’ at baseline ( e.g. anxiety , mania , poor self-esteem and social disability ) had on average significantly worse global functioning , lower scores on the 12-Item Short Form Health Survey physical scale and significantly greater waist circumference . Conclusion : Although the telephone-delivered intervention was design ed as a comparison condition , it achieved excellent retention and comparable outcomes . Telephone-delivered smoking cessation support may potentially help to reduce smoking rates among people with psychotic disorders . Discomfort in social situations may also be a useful target for future health interventions , addressing confidence and social skills , and promoting social networks that reduce inactivity Abstract Objective To assess the prospect i ve associations of baseline and long term trajectories of physical activity on mortality from all causes , cardiovascular disease , and cancer . Design Population based cohort study . Setting Adults from the general population in the UK . Participants 14 599 men and women ( aged 40 to 79 ) from the European Prospect i ve Investigation into Cancer and Nutrition-Norfolk cohort , assessed at baseline ( 1993 to 1997 ) up to 2004 for lifestyle and other risk factors ; then followed to 2016 for mortality ( median of 12.5 years of follow-up , after the last exposure assessment ) . Main exposure  Physical activity energy expenditure ( PAEE ) derived from question naires , calibrated against combined movement and heart rate monitoring . Main outcome measures Mortality from all causes , cardiovascular disease , and cancer . Multivariable proportional hazards regression models were adjusted for age , sex , sociodemographics , and changes in medical history , overall diet quality , body mass index , blood pressure , triglycerides , and cholesterol levels . Results During 171 277 person years of follow-up , 3148 deaths occurred . Long term increases in PAEE were inversely associated with mortality , independent of baseline PAEE . For each 1 kJ/kg/day per year increase in PAEE ( equivalent to a trajectory of being inactive at baseline and gradually , over five years , meeting the World Health Organization minimum physical activity guidelines of 150 minutes/week of moderate-intensity physical activity ) , hazard ratios were : 0.76 ( 95 % confidence interval 0.71 to 0.82 ) for all cause mortality , 0.71 ( 0.62 to 0.82 ) for cardiovascular disease mortality , and 0.89 ( 0.79 to 0.99 ) for cancer mortality , adjusted for baseline PAEE , and established risk factors . Similar results were observed when analyses were stratified by medical history of cardiovascular disease and cancer . Joint analyses with baseline and trajectories of physical activity show that , compared with consistently inactive individuals , those with increasing physical activity trajectories over time experienced lower risks of mortality from all causes , with hazard ratios of 0.76 ( 0.65 to 0.88 ) , 0.62 ( 0.53 to 0.72 ) , and 0.58 ( 0.43 to 0.78 ) at low , medium , and high baseline physical activity , respectively . At the population level , meeting and maintaining at least the minimum physical activity recommendations would potentially prevent 46 % of deaths associated with physical inactivity . Conclusions Middle aged and older adults , including those with cardiovascular disease and cancer , can gain substantial longevity benefits by becoming more physically active , irrespective of past physical activity levels and established risk factors . Considerable population health impacts can be attained with consistent engagement in physical activity during mid to late life Background Health promotion is a key component for primary prevention of cardiovascular disease ( CVD ) . This study evaluated the impact of healthy lifestyle promotion campaigns on CVD risk factors ( CVDRF )  in the general population in the context of a community-based programme on hypertension management . Methods A quasi-experimental intervention study was carried out in two rural communes of Vietnam from 2006 to 2009 . In the intervention commune , a hypertensive-targeted management programme integrated with a community-targeted health promotion was initiated , while no new programme , apart from conventional healthcare services , was provided in the reference commune . Health promotion campaigns focused on smoking cessation , reducing alcohol consumption , encouraging physical activity and reducing salty diets . Repeated cross-sectional surveys in local adult population aged 25 years and over were undertaken to assess changes in blood pressure ( BP ) and behavioural CVDRFs ( smoking , alcohol consumption , physical inactivity and salty diet ) in both communes before and after the 3-year intervention . Results Overall 4,650 adults above 25 years old were surveyed , in four r and omly independent sample s covering both communes at baseline and after the 3-year intervention . Although physical inactivity and obesity increased over time in the intervention commune , there was a significant reduction in systolic and diastolic BP ( 3.3 and 4.7 mmHg in women versus 3.0 and 4.6 mmHg in men respectively ) in the general population at the intervention commune . Health promotion reduced levels of salty diets but had insignificant impact on the prevalence of daily smoking or heavy alcohol consumption . Conclusion Community-targeted healthy lifestyle promotion can significantly improve some CVDRFs in the general population in a rural area over a relatively short time span . Limited effects on a context -bound CVDRF like smoking suggested that higher intensity of intervention , a supportive environment or a gender approach are required to maximize the effectiveness and maintain the sustainability of the health intervention Background Non-communicable diseases ( NCDs ) are the leading causes of death globally and are associated with a limited set of common , modifiable health behaviours : tobacco use , physical inactivity , harmful use of alcohol and unhealthy diet . General practice offers an ideal avenue for addressing such health behaviours on a population -wide basis . This paper describes the protocol of a multiple health behaviour change intervention design ed for implementation in general practice and summarises the baseline characteristics of its participants . Method / Design The 10 Small Steps ( 10SS ) study , a r and omised controlled trial , involved 4,678 adult general practice patients in Queensl and , Australia .  Self-reported data were collected to establish the proportion of participants meeting recommended guidelines for ten health behaviours : physical activity , body mass index , alcohol , smoking and six dietary behaviours . Participants were r and omised to four groups : contact at baseline only ( ' single intervention ' and corresponding control group ) and contact at baseline and 3 months ( ' dual intervention ' and corresponding control group ) . At each contact the participants received a computer-tailored feedback and one page information sheet according to their allocation to intervention or control groups . Change in the intervention group compared to the control group was assessed at 3 and 12 months after baseline data collection .Responses were summed to calculate an individual lifestyle score ( the Prudence Score ) , which ranged from 0 to 10 . The baseline response was 56.5 % ( 4678 of 8343 invited participants ) and the study sample was primarily female ( 68.7 % ) with an average age of 47 years . The mean Prudence Score was 5.8 ( 95%CI 5.75 - 5.85 ) . Discussion Baseline data from the 10SS study show that nearly all participants engage in some health behaviours but relatively few adhere simultaneously to a core set of dietary and lifestyle behaviours associated with risk of NCDs . Ample scope exists to improve health behaviour to reduce NCDs in the general practice setting and the 10SS study trial will provide data on the extent to which a minimal computer-tailored intervention can meet this objective . The protocol developed for the 10SS study has potential for translation into routine general practice as it has minimal impact on practice routine whilst contributing to primary prevention objectives .Trial Registration The Australian New Zeal and Clinical Trials Registry BACKGROUND Rates of physical inactivity and poor nutrition , which are 2 of the most important modifiable risk factors for cardiovascular disease in women , are substantial . Even so , studies of interventions design ed to improve lifestyle behaviors in women have been limited and often confined to particular geographical areas . OBJECTIVE To evaluate the effect of Choose to Move on increasing women 's physical activity , improving their knowledge of heart disease and stroke , and improving their nutrition . PARTICIPANTS AND METHODS A prospect i ve , nonr and omized , 12-week educational intervention design ed by the American Heart Association for women across the United States . Participants received a welcome kit and manual with weekly information about how to manage cardiovascular disease risk factors and how to build a support system for lifestyle change . Women ( N = 23 171 ) aged 25 years or older were recruited by direct mail , the media , health care providers , and other means . Follow-up evaluations were returned from 6389 women at 2 weeks , 5338 at 4 weeks , 4209 at 8 weeks , 3916 at 10 weeks , and 3775 at 12 weeks . Participants self-reported their physical activity , diet , and knowledge about heart disease , stroke , and related symptoms . RESULTS Ninety percent of the participants were white and 56 % were aged between 35 and 54 years . Among the participants who completed the week 12 follow-up evaluation , the percentage who reported being active ( at least moderate exercise > or = 5 times per week or > 2(1/2 ) hours per week for the past 1 to 6 months ) increased from 32 % at baseline to 67 % at the program 's end ( P = .001 ) . Participants currently limiting excess calories or fat increased from 72 % to 91 % at week 10 follow-up evaluation ( P = .001 ) . The proportion correctly identifying heart disease as the leading cause of death increased from 84 % to 91 % at week 10 follow-up evaluation ( P<.001 ) . CONCLUSIONS Women who completed the Choose to Move program evaluation reported that they significantly increased their levels of physical activity , reduced their consumption of high-fat foods , and increased their knowledge and awareness of cardiovascular disease risk and its symptoms . This program provides an important model for public health , voluntary , and other health organizations of population -based , targeted low-cost self-help programs that support the Healthy People 2010 objectives for physical activity , nutrition , and cardiovascular health Coronary heart disease continues to be a leading cause of death in adults . Because many risk factors for heart disease make their first appearance in childhood , early intervention is an attractive strategy for this disease . A convenience sample of 58 third grade children participated in a year-long , quasi-experimental study to compare a school-based educational program , HeartPower ! , to the st and ard health education curriculum . Variables examined included knowledge , hypercholesterolemia , obesity , sedentary lifestyle , hypertension , exposure to cigarette smoke , and parental participation . The students who participated in the HeartPower ! Program showed improvement ( p < 0.05 ) in their knowledge of healthy lifestyles . Modest improvements in hypertension and exposure to tobacco smoke were observed . These results indicate that focused instruction on important health issues may be preferable to a broad approach BACKGROUND About two-thirds of Canadians are physically inactive . As a risk factor for several chronic diseases , physical inactivity can potentially be a substantial public health burden . We estimated the direct health care costs attributable to  physical inactivity  in Canada , the number of lives lost prematurely each year that are attributable to a sedentary lifestyle and the effect that a reduction of 10 % in inactivity levels ( a Canadian objective for 2003 ) could have on reducing direct health care costs . METHODS We calculated summary relative risk ( RR ) estimates from prospect i ve longitudinal studies of the effects of physical inactivity on coronary artery disease , stroke , colon cancer , breast cancer , type 2 diabetes mellitus and osteoporosis . We then computed the population -attributable fraction ( PAF ) for each illness from the summary RR and the prevalence of physical inactivity ( i.e. , 62 % ) and applied the PAF to the total direct health care expenditures for 1999 and to the number of deaths in 1995 associated with each disease to determine the health care costs and lives lost prematurely that were directly attributable to physical inactivity . RESULTS About $ 2.1 billion , or 2.5 % of the total direct health care costs in Canada , were attributable to physical inactivity in 1999 . A sensitivity analysis ( simultaneously varying each of the health care costs and PAF by + /- 20 % ) indicated that the costs could be as low as $ 1.4 billion and as high as $ 3.1 billion . About 21,000 lives were lost prematurely in 1995 because of inactivity . A 10 % reduction in the prevalence of physical inactivity has the potential to reduce direct health care expenditures by $ 150 million a year . INTERPRETATION Physical inactivity represents an important public health burden in Canada . Even modest reductions in inactivity levels could result in substantial cost savings Background Smoking , poor diet , and physical inactivity account for as much as 60 % of cancer risk . Latinos experience profound disparities in health behaviors , as well as the cancers associated with them . Currently , there is a dearth of controlled trials addressing these health behaviors among Latinos . Further , to the best of our knowledge , no studies address all three behaviors simultaneously , are culturally sensitive , and are guided by formative work with the target population . Latinos represent 14 % of the U.S. population and are the fastest growing minority group in the country . Efforts to intervene on these important lifestyle factors among Latinos may accelerate the elimination of cancer-related health disparities . Methods / design The proposed study will evaluate the efficacy of an evidence -based and theoretically-driven Motivation And Problem Solving ( MAPS ) intervention , adapted and culturally-tailored for reducing cancer risk related to smoking , poor diet , and physical inactivity among high-risk Mexican-origin smokers who are overweight/obese ( n = 400 ) . Participants will be r and omly assigned to one of two groups : Health Education ( HE ) or MAPS ( HE + up to 18 MAPS counseling calls over 18 months ) . Primary outcomes are smoking status , servings of fruits and vegetables , and both self-reported and objective ly measured physical activity . Outcome assessment s will occur at baseline , 6 months , 12 months , and 18 months . Discussion The current study will contribute to a very limited evidence base on multiple risk factor intervention studies on Mexican-origin individuals and has the potential to inform both future research and practice related to reducing cancer risk disparities . An effective program targeting multiple cancer risk behaviors modeled after chronic care programs has the potential to make a large public health impact because of the dearth of evidence -based interventions for Latinos and the extended period of support that is provided in such a program . Trial registration National Institutes of Health Clinical Trials Registry # Background Nonpharmacological secondary prevention of coronary heart disease is considered a safe and effective measure to substantially reduce mortality . Despite the effectiveness of lifestyle changes , the compliance rate of patients is very low mainly due to psychosocial barriers . Psychotherapeutic approaches that address how persons think about themselves and their behaviors appear to have a significant potential for improving health behavior . Methods / design Against this background , our study aims to examine the feasibility and effects of a Psychodynamic Motivation and Training program ( PMT ) as compared to one session of advice in exercise training ( EX ) and treatment as usual ( TAU ) . For that purpose , 90 patients with stable coronary heart disease and a physically inactive lifestyle will be r and omly assigned to the three groups ( each with n = 30 ) . The primary outcome is the change in the individual anaerobic threshold as determined by spiroergometry from baseline to six month follow-up . Secondary endpoints include change in endothelial function , biomarkers of inflammation and oxidative stress , quality of life , symptoms of fatigue , illness perception and feasibility of the treatment approach . We hypothesize that physical fitness will improve more in PMT than in EX and TAU , with PMT and EX more than TAU , and that the effects will be more pronounced for participants with current mental or psychosocial distress . Discussion The results of the study will help to determine the effectiveness of a psychodynamic lifestyle change approach and to identify measures for design ing specifically tailored interventions to improve compliance with cardiovascular prevention . Trial registration Clinical Trials.gov Identifier : Background Data on the combined effect of lifestyles on mortality in older people have generally been collected from highly selected population s and have been limited to traditional health behaviors . In this study , we examined the combined impact of three traditional ( smoking , physical activity and diet ) and three non-traditional health behaviors ( sleep duration , sedentary time and social interaction ) on mortality among older adults . Methods A cohort of 3,465 individuals , representative of the Spanish population aged ≥60 years , was established in 2000/2001 and followed-up prospect ively through 2011 . At baseline , the following positive behaviors were self-reported : never smoking or quitting tobacco > 15 years , being very or moderately physically active , having a  healthy  diet score ≥ median in the cohort , sleeping 7 to 8 h/d , spending < 8 h/d in sitting time , and seeing friends daily . Analyses were performed with Cox regression and adjusted for the main confounders . Results During an average nine-year follow-up , 1,244 persons died . Hazard ratios ( 95 % confidence interval ) for all-cause mortality among participants with two , three , four , five and six compared to those with zero to one positive behaviors were , respectively , 0.63 ( 0.46 to 0.85 ) , 0.41 ( 0.31 to 0.55 ) , 0.32 ( 0.24 to 0.42 ) , 0.26 ( 0.20 to 0.35 ) and 0.20 ( 0.15 to 0.28 ) ( P for trend < 0.001 ) . The results were similar regardless of age , sex and health status at baseline . Those with six vs. zero to one positive health behaviors had an all-cause mortality risk equivalent to being 14 years younger . Adding the three non-traditional to the four traditional behaviors improved the model fit ( likelihood ratio test , P < 0.001 ) and the accuracy of mortality prediction ( c-statistic : + 0.0031 , P = 0.040 ) . Conclusions Adherence to some traditional and non-traditional health behaviors may substantially reduce mortality risk in older adults Diabetes is an “ old disease ” . The first description of diabetes written on papyrus about 3500 years ago is found in the Ebers papyrus  , which was discovered in Egypt in 1873 by the German archeologist Georg Ebers . Humans , like most mammals , may develop diabetes , if sufficient environmental exposure to physical inactivity , unhealthy diet and obesity are present . Genetic effects are important for the individual risk of type 2 diabetes ( T2D ) but twin studies have shown that the genetic effects combined explain less than 50 % of the risk of T2D ( 1 ) . Today we know almost 100 susceptibility genes associated with T2D but the relative importance of each of these genes is low ( 2 ) , and together they explain only a small part of the disease risk . Thus , genetic screening can not be used for the prediction of T2D for individuals . On the other h and , healthy lifestyle can also prevent T2D in people who are genetically at high risk , e.g. those with positive family history ( 3 ) . Thus , the importance of lifestyle factors for the development and prevention of T2D is overwhelming . The strongest evidence in medicine is considered to come from r and omized controlled trials ( RCTs ) . They are also important in providing the link to causal inference that in most observational studies can not be derived . At the same time , observational studies are necessary for the identification of factors associated with an increased or decreased risk of a disease , and for generation of hypotheses on potential means for prevention based on modifiable risk factors . Observational studies have by now identified a large number of factors that are associated with the development of T2D or with the protection against it . Most of them are related to physical activity , diet and obesity . It has also been shown unequivocally that exposures ( poor nutrition , infections , smoking , etc . ) during fetal life and early infancy result ing in insufficient development ( often shown as low birth weight ) also predict T2D later in life ( 4 ) . Traditionally , T2D has been considered to be a disease of the elderly . However , with increasing obesity and sedentary lifestyle in children , there are increasing numbers of cases of T2D already occurring at a young age in many population s ( 5 ) . In the past two decades several innovative RCTs have repeatedly shown that interventions on modifiable risk factors can reduce the incidence of diabetes in high-risk groups . The evidence has been summarized in several systematic review s and meta-analyses ( 6,7 ) . There is compelling scientific evidence from RCTs that T2D can be prevented or its onset delayed . The key for prevention is a multimodal package of lifestyle changes that is a sum outcome of dietary and physical activity behaviours . The power of lifestyle was dramatically illustrated by the Finnish Diabetes Prevention Study ( DPS ) that explicitly showed that when the study participants with impaired glucose tolerance reached all five modest lifestyle intervention targets , none of them progressed to T2D ( 8) . Importantly , lifestyle intervention lasting for 3–6 years has been shown to have a carry-over effect on T2D incidence that lasts for several years ; up to 15 in the Finnish Diabetes Prevention Study ( 9 ) and 20 years in the China Da Qing Diabetes Prevention Study ( 10 ) . The observed sustained risk reduction seems to be a result of sustained lifestyle changes , but the legacy effect of improved glycaemia during the early intervention may also have contributed to the long-term effect . The follow-up data from the Chinese study indicate moreover that vascular risks are also reduced by lifestyle management . Several prognostic question naires exist for detecting people at risk of T2D ( 11 ) . One of the screening tools with an adequately high sensitivity and specificity is the Finnish Diabetes Risk Score ( FINDRISC ) developed in Finl and ( 12 ) . The FINDRISC has been successfully implemented in the Finnish primary health care system and used also in many other countries . The FINDRISC was also tested in the Omani population and as a result a slightly modified Omani Diabetes Risk Score was developed ( 13 ) which may be a suitable screening tool for the Arab population s in the Middle East . Lifestyle interventions aim ing at translating evidence from efficacy RCTs on T2D prevention into “ real world ” intervention programmes have also been carried out in various population s. Such data were recently combined in a meta- analysis considering the relationship between intervention effectiveness and adherence to guidelines ( 14 ) . The primary meta- analysis included 22 studies with outcome data for weight loss at 12 months . The pooled result of the direct pairwise meta- analysis shows that BACKGROUND Data on the impact of the many dietary and lifestyle factors on the prevalence of  hypertension  in Western societies are lacking . This study quantified the contributions of body weight , physical inactivity and dietary factors to the prevalence of hypertension in Finl and , Italy , the Netherl and s , United Kingdom ( UK ) and USA . METHODS Distributions of blood pressure ( BP ) and risk factors in Western population s were obtained from nationwide surveys . The effect of risk factors on BP was assessed by meta-regression analysis of r and omized trials , published between 1966 and March 2001 . Population attributable risk percentages ( PAR% ) for hypertension ( i.e. systolic BP > or = 140 mmHg ) were computed for all risk factors in the five countries . RESULTS Being overweight made the largest contribution to hypertension , with PAR% between 11 % ( Italy ) and 25 % ( USA ) . PAR% were 5 - 13 % for physical inactivity , 9 - 17 % for high sodium intake , 4 - 17 % for low potassium intake and 4 - 8 % for low magnesium intake . The impact of alcohol was small ( 2 - 3 % ) in all population s. PAR% varied among population s for inadequate intake of calcium ( 2 - 8 % ) , magnesium ( 4 - 8 % ) , coffee ( 0 - 9 % ) and fish fatty acids ( 3 - 16 % ) . CONCLUSIONS Diet and lifestyle have a substantial impact on  hypertension  in Western societies , with being overweight , physical inactivity , high sodium intake and low potassium intake being the main contributors . The relative significance of different risk factors varies among population s , which is important for preventative strategies Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) Background Studies have shown that lifestyle interventions are effective in preventing or delaying the onset of  type 2 diabetes in high-risk patients . However , research on the effectiveness of lifestyle interventions in high-risk immigrant population s with different cultural and socioeconomic background s is scarce . The aim was to design a culturally adapted lifestyle intervention for an immigrant population and to evaluate its effectiveness and cost-effectiveness . Methods / design In this r and omized controlled trial , 308 participants ( born in Iraq , living in Malmö , Sweden and at high risk of type 2 diabetes ) will be allocated to either a culturally adapted intervention or a control group . The intervention will consist of 10 group counseling sessions focusing on diet , physical activity and behavioral change over 6 months , and the offer of exercise sessions . Cultural adaptation includes gender-specific exercise sessions , and counseling by a health coach community member . The control group will receive the information about healthy lifestyle habits provided by the primary health care center . The primary outcome is change in fasting glucose level . Secondary outcomes are changes in body mass index , insulin sensitivity , physical activity , food habits and health-related quality of life . Measurements will be taken at baseline , after 3 and 6 months . Data will be analyzed by the intention-to-treat approach . The cost-effectiveness during the trial period and over the longer term will be assessed by simulation modeling from patient , health care and societal perspectives . Discussion This study will provide a basis to measure the effectiveness of a lifestyle intervention design ed for immigrants from the Middle East in terms of improvement in glucose metabolism , and will also assess its cost-effectiveness . Results from this trial may help health care providers and policy makers to adapt and implement lifestyle interventions suitable for this population group that can be conducted in the community . Trial registration Clinical Trials.gov , BACKGROUND The purpose of this study was to analyse both cross-sectional associations and how longitudinal changes in lifestyle factors from one state in 1980 - 1981 to another in 1988 - 1989 influence self-reported health status . Another aim was to estimate the hazard ratios for all-cause mortality for the changes in lifestyle factors and self-reported hypertension during the same period of time . METHOD The cross-sectional and the longitudinal analyses are based on the same simple r and om sample of 3,843 adults , aged 25 - 74 , interviewed in 1980 - 1981 and 1988 - 1989 and is part of the Swedish Annual Level-of-Living Survey . About 85 % of the respondents in the first interview participated in a second interview in 1988 - 1989 . Cross-sectional odds ratios , based on a marginal model , were estimated using the generalized estimating equations . The transitional models were analysed using unconditional logistic regression . A proportional hazard model was applied to investigate the influence of lifestyle transitions on mortality . RESULTS Physical inactivity , being a current or former smoker and obesity ( women only ) were strong risk factors for poor health either as main effects and /or combined ( interactions ) . There was a strong interaction between physical activity and smoking , and for women , also between body mass index ( BMI ) and physical activity . Smoking , physically inactive and obese women had about a ten times higher risk of poor health status than non-smoking , physically active , and normal-weight women . The corresponding risk for men was about five times higher . Physically active , but smoking and obese individuals showed only moderately increased risks for poor health status . The transitional model showed that those who were physically inactive in 1980 - 1981 , but did exercise in 1988 - 1989 , improved their health after adjustments for sociodemographic and other lifestyle factors . Continuing to smoke or being physically inactive or having hypertension at both points in time were all associated with higher hazard ratios for all-cause mortality ( 1.6 , 1.9 and 1.8 , respectively ) than those who reported that they were in good status at both points in time . CONCLUSIONS We found that physical activity protects against poor health irrespective of an increased BMI and smoking . The major clinical implication s are the long-st and ing benefits of physical activity and not smoking Abstract Background Coronary heart disease ( CHD ) is the most prevalent type of cardiac disease among adults worldwide , including those in Singapore . Most of its risk factors , such as smoking , physical inactivity and high blood pressure , are preventable . mHealth has improved in the last decade , showing promising results in chronic disease prevention and health promotion worldwide . Our aim was to develop and examine the effect of a 4-week Smartphone-Based Coronary Heart Disease Prevention ( SBCHDP ) programme in improving awareness and knowledge of CHD , perceived stress as well as cardiac-related lifestyle behaviours in the working population of Singapore . Methods The smartphone app “ Care4Heart ” was developed as the main component of the programme . App content was review ed and vali date d by a panel of experts , including two cardiologists and two experienced cardiology-trained nurses . A pilot r and omised controlled trial was conducted . Eighty working people were recruited and r and omised to either the intervention group ( n = 40 ) or the control group ( n = 40 ) . The intervention group underwent a 4-week SBCHDP programme , whereas the control group were offered health promotion websites only . The participants ’ CHD knowledge , perceived stress and behavioural risk factors were measured at baseline and on the 4th week using the Heart Disease Fact Question naire-2 , Perceived Stress Scale , and Behavioural Risk Factor Surveillance System . Results After the SBCHDP programme , participants in the intervention group had a better awareness of CHD being the second leading cause of death in Singapore ( X2 = 6.486 , p = 0.039 ) , a better overall CHD knowledge level ( t = 3.171 , p = 0.002 ) , and better behaviour concerning blood cholesterol control ( X2 = 4.54 , p = 0.033 ) than participants in the control group . Conclusion This pilot study partially confirmed the positive effects of the SBCHDP programme in improving awareness and knowledge of CHD among the working population . Due to the small sample size and short follow-up period , this study was underpowered to detect significant differences between groups . A full-scale longitudinal study is required in the future to confirm the effectiveness of the SBCHDP programme Despite advances in behavioral and pharmacological treatment for tobacco use and dependence , quit rates remain suboptimal . Increasing physical activity has shown some promise as a strategy for improving cessation outcomes . However , initial efficacy studies focused on intensive , highly structured exercise programs that may not be applicable to the general population of smokers . We describe the rationale and study design and report baseline participant characteristics from the Lifestyle Enhancement Program ( LEAP ) , a two-group , r and omized controlled trial . Adult smokers who engaged in low levels of leisure time physical activity were r and omly assigned to treatment conditions consisting of an individualized physical activity intervention delivered by health fitness instructors in community-based exercise facilities or an equal contact wellness control . All participants received st and ard cognitive behavioral smoking cessation counseling combined with nicotine replacement therapy . The primary outcomes are seven-day point prevalence abstinence at seven weeks , six- and 12 months . Secondary outcomes include self-reported physical activity , dietary intake , body mass index , waist circumference , percent body fat , and nicotine withdrawal symptoms .  Participants consist of 392 sedentary smokers ( mean [ st and ard deviation ] age = 44.6 [ 10.2 ] = years ; 62 % female ; 31 % African American ) . Results reported here provide information regarding experiences recruiting smokers willing to change multiple health behaviors including smoking and physical activity Background Poor mental health has large social and economic consequences both for the individual and society . In Sweden , the prevalence of mental health symptoms has increased since the beginning of the 1990s . There is a need for a better underst and ing of the area for planning preventive activities and health care . Methods The study is based on a postal survey question naire sent to a r and om sample of men and women aged 18–84 years in 2004 . The overall response rate was 64 % . The area investigated covers 55 municipalities with about one million inhabitants in central part of Sweden . The study population includes 42,448 respondents .  Mental health was measured with self-reported symptoms of anxiety/depression ( EQ-5D , 5th question ) . The association between socio-economic conditions , lifestyle factors and mental health symptoms was investigated using multivariate multinomial logistic regression models . Results About 40 % of women and 30 % of men reported that they were moderately or extremely anxious or depressed . Younger subjects reported poorer mental health than older subjects , the best mental health was found at ages 65–74 years . Factors that were strongly and independently related to mental health symptoms were poor social support , experiences of being belittled , employment status ( receiving a disability pension and unemployment ) , economic hardship , critical life events , and functional disability . A strong association was also found between how burdensome domestic work was experienced and anxiety/depression . This was true for both men and women . Educational level was not associated with mental health symptoms . Of lifestyle factors , physical inactivity , underweight and risk consumption of alcohol were independently associated with mental health symptoms . Conclusion Our results support the notion that a ground for good mental health includes balance in social relations , in domestic work and in employment as well as in personal economy both among men and women . In addition , physical inactivity , underweight and risk consumption of alcohol are associated with mental health symptoms independent of socio-economic factors Background The prevalence of overweight is increasing and its consequences will cause a major public health burden in the near future . Cost-effective interventions for weight control among the general population are therefore needed . The ALIFE@Work study is investigating a novel lifestyle intervention , aim ed at the working population , with individual counselling through either phone or e-mail . This article describes the design of the study and the participant flow up to and including r and omisation . Methods / Design ALIFE@Work is a controlled trial , with r and omisation to three arms : a control group , a phone based intervention group and an internet based intervention group . The intervention takes six months and is based on a cognitive behavioural approach , addressing physical activity and diet . It consists of 10 lessons with feedback from a personal counsellor , either by phone or e-mail , between each lesson . Lessons contain educational content combined with behaviour change strategies . Assignments in each lesson teach the participant to apply these strategies to every day life . The study population consists of employees from seven Dutch companies . The most important inclusion criteria are having a body mass index ( BMI ) ≥ 25 kg/m2 and being an employed adult . Primary outcomes of the study are body weight and BMI , diet and physical activity . Other outcomes are : perceived health ; empowerment ; stage of change and self-efficacy concerning weight control , physical activity and eating habits ; work performance/productivity ; waist circumference , sum of skin folds , blood pressure , total blood cholesterol level and aerobic fitness . A cost-utility- and a cost-effectiveness analysis will be performed as well . Physiological outcomes are measured at baseline and after six and 24 months . Other outcomes are measured by question naire at baseline and after six , 12 , 18 and 24 months . Statistical analyses for short term ( six month ) results are performed with multiple linear regression . Analyses for long term ( two year ) results are performed with multiple longitudinal regression . Analyses for cost-effectiveness and cost-utility are done at one and two years , using bootstrapping techniques . Discussion ALIFE@Work will make a substantial contribution to the development of cost-effective weight control- and lifestyle interventions that are applicable to and attractive for the large population at risk Recommendations for control of high blood pressure ( BP ) emphasize lifestyle modification , including weight loss , reduced sodium intake , increased physical activity , and limited alcohol consumption . The Dietary Approaches to Stop Hypertension ( DASH ) dietary pattern also lowers BP . The PREMIER r and omized trial tested multicomponent lifestyle interventions on BP in demographic and clinical subgroups . Participants with above-optimal BP through stage 1 hypertension were r and omized to an Advice Only group or one of two behavioural interventions that implement established recommendations ( Est ) or established recommendations plus DASH diet ( Est plus DASH ) . The primary outcome was change in systolic BP at 6 months . The study population was 810 individuals with an average age of 50 years , 62 % women , 34 % African American ( AA ) , 95 % overweight/obese , and 38 % hypertensive . Participants in all the three groups made lifestyle changes . Mean net reductions in systolic ( S ) BP in the Est intervention were 1.2 mmHg in AA women , 6.0 in AA men , 4.5 in non-AA women , and 4.2 in non-AA men . The mean effects of the  Est Plus DASH intervention were 2.1 , 4.6 , 4.2 , and 5.7 mmHg in the four race – sex subgroups , respectively . BP changes were consistently greater in hypertensives than in nonhypertensives , although interaction tests were nonsignificant . The Est intervention caused statistically significant BP reductions in individuals over and under age 50 . The Est Plus DASH intervention lowered BP in both age groups , and significantly more so in older individuals . In conclusion , diverse groups of people can adopt multiple lifestyle changes that can lead to improved BP control and reduced CVD risk IMPORTANCE Cardiovascular disease prevention , including lifestyle modification , is important but underutilized . Mobile health strategies could address this gap but lack evidence of therapeutic benefit . OBJECTIVE To examine the effect of a lifestyle-focused semipersonalized support program delivered by mobile phone text message on cardiovascular risk factors . DESIGN AND SETTING The Tobacco , Exercise and Diet Messages ( TEXT ME ) trial was a parallel-group , single-blind , r and omized clinical trial that recruited 710 patients ( mean age , 58 [ SD , 9.2 ] years ; 82 % men ; 53 % current smokers ) with proven coronary heart disease ( prior myocardial infa rct ion or proven angiographically ) between September 2011 and November 2013 from a large tertiary hospital in Sydney , Australia . INTERVENTIONS Patients in the intervention group ( n = 352 ) received 4 text messages per week for 6 months in addition to usual care . Text messages provided advice , motivational reminders , and support to change lifestyle behaviors . Patients in the control group ( n=358 ) received usual care . Messages for each participant were selected from a bank of messages according to baseline characteristics ( eg , smoking ) and delivered via an automated computerized message management system . The program was not interactive . MAIN OUTCOMES AND MEASURES The primary end point was low-density lipoprotein cholesterol ( LDL-C ) level at 6 months . Secondary end points included systolic blood pressure , body mass index ( BMI ) , physical activity , and smoking status . RESULTS At 6 months , levels of LDL-C were significantly lower in intervention participants , with concurrent reductions in systolic blood pressure and BMI , significant increases in physical activity , and a significant reduction in smoking . The majority reported the text messages to be useful ( 91 % ) , easy to underst and ( 97 % ) , and appropriate in frequency ( 86 % ) . [ table : see text ] . CONCLUSIONS AND RELEVANCE Among patients with coronary heart disease , the use of a lifestyle-focused text messaging service compared with usual care result ed in a modest improvement in LDL-C level and greater improvement in other cardiovascular disease risk factors . The duration of these effects and hence whether they result in improved clinical outcomes remain to be determined . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12611000161921
Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified , providing a set of specific evidence -based strategies that deserve close attention and prioritization for wider implementation .
Effective interventions included specific approaches in all 6 domains evaluated for improving diet , increasing activity , and reducing tobacco use .
The writing group also identified several specific interventions in each of these domains for which current evidence was less robust , as well as other inconsistencies and evidence gaps , informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies .
This systematic review identified and grade d the evidence for a range of population -based strategies to promote lifestyle change .
BACKGROUND Poor lifestyle behaviors , including suboptimal diet , physical inactivity , and tobacco use , are leading causes of preventable diseases globally .
Although even modest population shifts in risk substantially alter health outcomes , the optimal population -level approaches to improve lifestyle are not well established .