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. Drivers for successful long-term lifestyle change, the role of e-health: a qualitative interview study Maintenance of cardiovascular risk factor changes among middle-aged women in a lifestyle intervention trial. Lifestyle‐Based Prediction Model for the Prevention of CVD: The Healthy Heart Score Multiple health behaviors in an ethnically diverse sample of adults with risk factors for cardiovascular disease. Cardiovascular prevention in the Hartslag Limburg project: effects of a high-risk approach on behavioral risk factors in a general practice population. Barriers to a healthy lifestyle among patients attending primary care clinics at a university hospital in Riyadh Long-term effects of the Mediterranean lifestyle program: a randomized clinical trial for postmenopausal women with type 2 diabetes Methodological challenges in designing dementia prevention trials — The European Dementia Prevention Initiative (EDPI) Motivational interviewing and problem solving treatment to reduce type 2 diabetes and cardiovascular disease risk in real life: a randomized controlled trial A cluster-randomized trial of task shifting and blood pressure control in Ghana: study protocol Information and Risk Modification Trial (INFORM): design of a randomised controlled trial of communicating different types of information about coronary heart disease risk, alongside lifestyle advice, to achieve change in health-related behaviour Effects of Comprehensive Lifestyle Modification on Diet, Weight, Physical Fitness, and Blood Pressure Control: 18-Month Results of a Randomized Trial The positive effect of an intervention program on the hypertension knowledge and lifestyles of rural residents over the age of 35 years in an area of China Lifestyle intervention and one-year prognosis of patients following open heart surgery: a randomised clinical trial. Adherence to healthy lifestyle and risk of gestational diabetes mellitus: prospective cohort study Combined effect of low-risk dietary and lifestyle behaviors in primary prevention of myocardial infarction in women. The impact of a brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial) Rotating night shift work and adherence to unhealthy lifestyle in predicting risk of type 2 diabetes: results from two large US cohorts of female nurses A 30‐month worksite‐based lifestyle program to promote cardiovascular health in middle‐aged bank employees: Design of the TANSNIP‐PESA randomized controlled trial Population-based intervention for cardiovascular diseases related knowledge and behaviours in Asian Indian women. Heart Healthy and Ethnically Relevant (HHER) Lifestyle trial for improving diet and physical activity in underserved African American women. A parent focused child obesity prevention intervention improves some mother obesity risk behaviors: the Melbourne inFANT Program A randomized non-pharmacological intervention study for prevention of ischaemic heart disease: baseline results Inter99 (1) Racial and Ethnic Approaches to Community Health (REACH) Detroit partnership: improving diabetes-related outcomes among African American and Latino adults. Physical activity and nutrition programs for couples: a randomized controlled trial. NHS health checks through general practice: randomised trial of population cardiovascular risk reduction Lifestyle intervention development study to improve physical function in older adults with cancer: outcomes from Project LEAD. Exercise-induced increase in lipoprotein (a). Lifestyle Interventions Reduce Coronary Heart Disease Risk: Results From the PREMIER Trial The Heartfile Lodhran CVD Prevention Project- end of Project Evaluation Health Promotion Through Primary Care: Enhancing Self-Management With Activity Prescription and mHealth Early lifestyle intervention in patients with non-insulin-dependent diabetes mellitus and impaired glucose tolerance. Trial of prevention and reduction of obesity through active living in clinical settings: a randomized controlled trial. Obesity, Behavioral Lifestyle Factors, and Risk of Acute Coronary Events Lifestyle Characteristics and Gastroesophageal Reflux Disease: A Population-Based Study in Albania The South Asian Heart Lifestyle Intervention (SAHELI) study to improve cardiovascular risk factors in a community setting: design and methods. A cluster randomised school-based lifestyle intervention programme for the prevention of childhood obesity and related early cardiovascular disease (JuvenTUM 3) Rationale and design of the Investigation of Motivational Interviewing and Prevention Consults to Achieve Cardiovascular Targets (IMPACT) trial. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. Improving diet, physical activity and other lifestyle behaviours using computer-tailored advice in general practice: a randomised controlled trial Lifestyle factors and mortality among adults with diabetes: findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam study*. Diet, physical activity, and gallstones--a population-based, case-control study in southern Italy. Lifestyle Factors and Risk for New-Onset Diabetes Daily physical activity in adults with mild and moderate learning disabilities: is there enough? The community health educator referral liaison (CHERL): a primary care practice role for promoting healthy behaviors. A community health worker-led lifestyle behavior intervention for Latina (Hispanic) women: feasibility and outcomes of a randomized controlled trial. Meeting recommendations for multiple healthy lifestyle factors. Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. The Downstart Program: a hospital-based pediatric healthy lifestyle program for obese and morbidly obese minority youth. Obstructive Sleep Apnea and Type 2 Diabetes: Is There a Link? Worksite intervention effects on physical health: a randomized controlled trial. Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial Long-term outcomes from a multiple-risk-factor diabetes trial for Latinas: ¡Viva Bien! Heart disease prevention for Alaska Native women: a review of pilot study findings. Combined effect of alcohol consumption and lifestyle behaviors on risk of type 2 diabetes. Lifestyle and breast cancer recurrences: the DIANA-5 trial. Lifestyle intervention in general practice for physical activity, smoking, alcohol consumption and diet in elderly: a randomized controlled trial. Risk and preventive factors for prostate cancer in Japan: The Japan Public Health Center-based prospective (JPHC) study A pragmatic cluster randomized clinical trial of diabetes prevention strategies for women with gestational diabetes: design and rationale of the Gestational Diabetes’ Effects on Moms (GEM) study Training YMCA Wellness Instructors to Deliver an Adapted Version of the Diabetes Prevention Program Lifestyle Intervention Combined impact of lifestyle factors on mortality: prospective cohort study in US women Feasibility of a telephone and web-based physical activity intervention for women shift workers Attempts at changing dietary and exercise habits to reduce risk of cardiovascular disease: who's doing what in the community? Walking away from type 2 diabetes: trial protocol of a cluster randomised controlled trial evaluating a structured education programme in those at high risk of developing type 2 diabetes
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 Objectives Assisting patients in lifestyle change using collaborative e-health tools can be an efficient treatment for non-communicable diseases like diabetes , cardiovascular disease and chronic obstructive lung disease that are caused or aggravated by unhealthy living in the form of unhealthy diet , physical inactivity or tobacco smoking . In a prospect i ve pilot study , we tested an online collaborative e-health tool in general practice . The aim of this study was to identify drivers of importance for long-term personal lifestyle changes from a patient perspective when using a collaborative e-health tool , including the support of peers and healthcare professionals . Setting General practice clinics in the Region of Southern Denmark . Participants 10 overweight patients who had previously successfully used a hybrid online collaborative e-health tool with both face-to-face and online consultations  to lose weight . Results The main themes identified were facilitators , barriers and support from family and peers . Establishment of a trustworthy relationship with the healthcare professionals was of paramount importance . It was important for the patients to monitor the measurable outcomes with realistic goals and feedback from a trusted person . Often , significant life events were identified as catalysts for successful long-term lifestyle changes . Dominant barriers to change were perception of insurmountable obstacles , experience of lack of self-efficacy and excess eating of high-calorie food . Finally , experiencing of trustworthy person-to-person forums , need for acknowledgement from referent others and support from family and peers were important drivers for long-term lifestyle change . Conclusion The most important driver in long-term weight loss was a strong relationship with a healthcare professional . Collaborative e-health tools can support the relationship and behavioural changes through monitoring and providing relevant feedback . The support from family and peers also matters , and long-term success depends on the ability to establish strong , positive support on a day-to-day basis The Women 's Healthy Lifestyle Project is a 5-year r and omized clinical testing whether a behavioral intervention aim ed at lifestyle changes in diet and physical activity can prevent the rise in weight and low-density lipoprotein cholesterol ( LDL-c ) observed during menopause . Cardiovascular risk factor and behavioral data from 489 participants ( intervention group n = 236 ; control group n = 253 ) who attended baseline , 6-month , and 18-month clinical assessment s were analyzed to determine how well initial improvements achieved at 6 months were maintained over the subsequent year of follow-up . Results indicated that the treatment effect persisted at 18 months for weight , body mass index , total cholesterol , LDL-c , systolic blood pressure ( SBP ) , and glucose levels . Intervention participants maintained improvements in physical activity , caloric intake , dietary cholesterol , SBP , and glucose levels between 6 and 18 months , although weight , total cholesterol , and LDL-c began to rise during this period . Eighty percent of intervention participants compared to 45 % of controls were at or under baseline weight at 18 months , suggesting that promoting modest weight loss may be an effective approach to preventing weight gain in these women Background Clinical practice focuses on the primary prevention of  cardiovascular ( CV ) disease ( CVD ) through the modification and pharmacological treatment of elevated risk factors . Prediction models based on established risk factors are available for use in the primary prevention setting . However , the prevention of risk factor development through healthy lifestyle behaviors , or primordial prevention , is of paramount importance to achieve optimal population ‐wide CV health and minimize long‐term CVD risk . Methods and Results We developed a  lifestyle‐based CVD prediction model among 61 025 women in the Nurses ’ Health Study and 34 478 men in the Health Professionals Follow‐up Study , who were free of chronic disease in 1986 and followed for ≤24 years .  Lifestyle factors  were assessed by question naires in 1986 . In the derivation step , we used the Bayes Information Criterion to create parsimonious 20‐year risk prediction models among a r and om two thirds of participants in each cohort separately . The scores were vali date d in the remaining one third of participants in each cohort . Over 24 years , there were 3775 cases of CVD in women and 3506 cases in men . The Healthy Heart Score included age , smoking , body mass index , exercise , alcohol , and a composite diet score . In the validation cohort , the risk score demonstrated good discrimination ( Harrell 's C‐index , 0.72 ; 95 % confidence interval [ CI ] , 0.71 , 0.74 [ women ] ; 0.77 ; 95 % CI , 0.76 , 0.79 [ men ] ) , fit , and calibration , particularly among individuals without baseline hypertension or hypercholesterolemia . Conclusions The Healthy Heart Score accurately identifies individuals at elevated risk for CVD and may serve as an important clinical and public health screening tool for the primordial prevention of CVD BACKGROUND Health behaviors of adults living with cardiovascular disease ( CVD ) risk factors affect additional risk , where lifestyle behavioral choices become even more important in controlling disease and preventing additional negative health outcomes . In addition , both lifestyle behaviors and CVD risk factor prevalence can vary by ethnicity . OBJECTIVE We compared multiple health behaviors of adults with diabetes , hypertension , high cholesterol , and obesity to the behaviors of adults without those conditions in a diverse ethnic sample to determine if significant differences existed between groups . METHODS Data were obtained from  30-minute r and om-digit-dial telephone surveys in 2007 ( n = 3607 ) . All data were self-reports . Healthy behaviors  included meeting recommendations for intake of fruits and vegetables ; consuming low or very low amounts of dietary fat ; eating breakfast six or seven days per week ; having a healthy diet ; and meeting recommendations for walking , moderate , and vigorous physical activity . Unhealthy behaviors included  frequent consumption of soda and fast food , smoking , binge drinking ,  and high stress .  RESULTS More than 6 % of respondents had diabetes , 15.9 % had hypertension , 16.4 % had high cholesterol , and 18.5 % were obese . Significantly fewer healthy and more unhealthy behaviors were reported for those who had CVD risk factors than were reported by those who did not have such conditions . Ethnic differences in CVD risk factor prevalence and health behaviors existed as well ( p < 0.001 ) . Logistic regression models indicated that not eating a healthy diet ( odds ratio [ OR ] = 1.82 ) was a significant predictor for diabetes ; not eating a healthy diet ( OR = 1.52 ) and not doing vigorous physical activity ( OR = 1.79 ) were significant predictors for hypertension ; consumption of high amounts of dietary fat ( OR = 1.70 ) and of fast food ( OR = 1.51 ) were significant predictors for high cholesterol levels ; and not eating a healthy diet ( OR = 1.52 ) , high consumption of dietary fat ( OR = 2.20 ) , not eating breakfast ( OR = 1.33 ) and not performing vigorous physical activity ( OR = 1.63 ) , but less consumption of fast food ( OR = 0.64 ) were significant predictors for obesity . CONCLUSIONS Specifically tailored and culturally sensitive interventions that address multiple health behaviors may be necessary for these high-risk population BACKGROUND This study describes a general- practice -based high-risk cardiovascular prevention approach in Maastricht , The Netherl and s ( 1999 - 2003 ) . The intervention consisted of a complete registration of risk factors , optimization of medical treatment and health counseling on high fat consumption , smoking and physical inactivity . METHODS Behavioral effects were assessed in a trial , r and omization by practice and usual care as control . Vali date d question naires were completed by 1300 patients at baseline , 1174 after 4 months ( 90.3 % ) and 1046 ( 80.5 % ) after 18 months . RESULTS After 4 months , intention-to-treat analyses revealed a decrease in saturated fat intake of 1.3 points ( scale ranging from 7 to 30 points , p=0.000 ) . This was partly sustained after 18 months ( -0.5 points , p=0.014 ) . After 18 months , obese intervention patients were more likely to be sufficiently physically active than their control counterparts ( OR=1.90 , p=0.023 ) . No intervention effects were found for smoking . CONCLUSION Given the multiple factor and multiple component high-risk approach , the intervention had modest effects on only some of the behavioral risk factors addressed . Process data showed that the registration of risk factors and the optimization of medical treatment were only partly implemented , that the health counseling component could be further improved and that the intervention could benefit from additional health promoting strategies Background And Objectives : The occurrence and progress of chronic non-communicable diseases ( NCDs ) is associated with unhealthy lifestyles and behaviors . Modification of barriers to healthy lifestyle can produce great benefits . The objective of this study was to identify barriers to physical activity and healthy eating among patients attending primary health care clinics in Riyadh city . Patients and Methods : A cross-sectional study was conducted at King Khalid University Hospital ( KKUH ) in Riyadh city . Four hundred and fifty participants attending primary health care clinics ( PHCC ) from 1 March to 30 April 2007 were r and omly selected . A question naire about barriers to physical activity and healthy eating was adapted from the CDC web site . Results : The  prevalence of physical inactivity among the Saudi population in the study was 82.4 % ( 371/450 ) . Females were more physically inactive ( 87.6 % , 268/306 ) compared to males ( 71.5 % , 103/144 ) ( P < .001 ) . The most common barrier to physical activity was lack of re sources ( 80.5 % , 326/405 ) , which was significantly higher among females than males and among the lower income versus the higher income group . The most common barrier to healthy diet was lack of willpower . More than four-fifths ( 80.3 % , 354/441 ) of the study group stated that they did not have enough will to stick to a diet . Conclusion : Lack of re sources was the most important barrier for physical activity , while lack of willpower and social support were both barriers for adherence to physical activity and a healthy diet Background Multiple-risk-factor interventions offer a promising means for addressing the complex interactions between lifestyle behaviors , psychosocial factors , and the social environment . This report examines the long-term effects of a multiple-risk-factor intervention . Methods Postmenopausal women ( N = 279 ) with type 2 diabetes participated in the  Mediterranean Lifestyle Program ( MLP ) , a r and omized , comprehensive lifestyle intervention study . The intervention targeted healthful eating , physical activity , stress management , smoking cessation , and social support . Outcomes included lifestyle behaviors ( i.e. , dietary intake , physical activity , stress management , smoking cessation ) , psychosocial variables ( e.g. , social support , problem solving , self-efficacy , depression , quality of life ) , and cost analyses at baseline , and 6 , 12 , and 24 months . Results MLP participants showed significant 12- and 24-month improvements in all targeted lifestyle behaviors with one exception ( there were too few smokers to analyze tobacco use effects ) , and in psychosocial measures of use of supportive re sources , problem solving , self-efficacy , and quality of life . Conclusion The MLP was more effective than usual care over 24 months in producing improvements on behavioral and psychosocial outcomes . Directions for future research include replication with other population Recent epidemiological studies have indicated numerous associations between vascular and lifestyle related risk factors and incident dementia . However , evidence from r and omised controlled trials ( RCT ) showing effectiveness of interventions aim ed at these risk factors in preventing or postponing dementia onset is still lacking . Three large RCTs on multi-component interventions to prevent dementia ( preDIVA , FINGER , MAPT ) have been initiated in Europe to address these issues . Irrespective of some method ological differences , all three studies target cardiovascular and lifestyle related risk factors . Collaboration within the newly founded ' European Dementia Prevention Initiative ' ( EDPI ) will allow for a comprehensive exploration of optimal target population , intervention and outcome measures , which are currently unknown . Combining data of the ongoing studies and running simulation analyses will facilitate determining the optimal design including accurate sample -size calculations for future multi-national clinical trials on dementia prevention . Interventions aim ing at dementia prevention should be pragmatic and easy to implement on a large scale in different health care systems , without generating high additional costs or burden on participants or physicians . As the optimal age for intervention precedes the optimal age for outcome assessment , traditional trial design s might lead to suboptimal timing of either of the two . Separation of intervention and outcome assessment in time is a potential solution , but requires studies with very long follow-up . International collaboration of research groups with experience in dementia prevention studies and well-organised logistics for these major projects is pivotal to success for future large-scale dementia prevention studies . Founding of EDPI is an important first step in this direction Background Intensive lifestyle interventions in well-controlled setting s are effective in lowering the risk of chronic diseases such as type 2 diabetes ( T2DM ) and cardiovascular diseases ( CVD ) , but there are still no effective lifestyle interventions for everyday practice . In the Hoorn Prevention Study we aim ed to assess the effectiveness of a primary care based lifestyle intervention to reduce the estimated risk of developing T2DM and for CVD mortality , and to motivate changes in lifestyle behaviors . Methods The Hoorn Prevention Study is a parallel group r and omized controlled trial , implemented in the region of West-Friesl and , the Netherl and s. 622 adults with ≥10 % estimated risk of T2DM and /or CVD mortality were r and omly assigned and monitored over a period of 12 months . The intervention group ( n=314 ) received a theory-based lifestyle intervention based on an innovative combination of motivational interviewing and problem solving treatment , provided by trained practice nurses in 12 general practice s. The control group ( n=308 ) received existing health brochures . Primary outcomes was the estimated diabetes risk according to the formula of the Atherosclerosis Risk In Communities ( ARIC ) Study , and the estimated risk for CVD mortality according to the Systematic COronary Risk Evaluation ( SCORE ) formula . Secondary outcomes included lifestyle behavior ( diet , physical activity and smoking ) . The research assistants , the principal investigator and the general practitioners were blinded to group assignment . Linear and logistic regression analysis was applied to examine the between-group differences in each outcome measure , adjusted for baseline values . Results 536 ( 86.2 % ) of the 622 participants ( age 43.5 years ) completed the 6-month follow-up , and 502 ( 81.2 % ) completed the 12-month follow-up . The mean baseline T2DM risk was 18.9 % ( SD 8.2 ) and the mean CVD mortality risk was 3.8 % ( SD 3.0 ) . The intervention group participated in a median of 2 sessions . Intention-to-treat analyses showed no significant differences in outcomes between the two groups at 6 or 12-months follow-up . Conclusions The lifestyle intervention was not more effective than health brochures in reducing risk scores for T2DM and CVD or improving lifestyle behavior in an at-risk population .Trial registration Current Controlled Trials : IS RCT Background Countries in sub-Saharan Africa ( SSA ) are experiencing an epidemic of cardiovascular disease ( CVD ) propelled by rapidly increasing rates of hypertension . Barriers to hypertension control in SSA include poor access to care and high out-of-pocket costs . Although SSA bears 24 % of the global disease burden , it has only 3 % of the global health workforce . Given such limited re sources , cost-effective strategies , such as task shifting , are needed to mitigate the rising CVD epidemic in SSA . Ghana , a country in SSA with an established community health worker program integrated within a national health insurance scheme provides an ideal platform to evaluate implementation of the World Health Organization ( WHO ) task-shifting strategy . This study will evaluate the comparative effectiveness of the implementation of the WHO Package targeted at CV risk assessment versus provision of health insurance coverage , on blood pressure ( BP ) reduction . Methods Using a cluster r and omized design , 32 community health centers ( CHCs ) and district hospitals in Ghana will be r and omized to either the  intervention  group ( 16 CHCs ) or the control group ( 16 CHCs ) . A total of 640 patients with uncomplicated hypertension ( BP 140–179/90–99 mm Hg and absence of target organ damage ) will be enrolled in this study ( 20 patients per CHC ) . The intervention consists of WHO Package of CV risk assessment , patient education , initiation and titration of antihypertensive medications , behavioral counseling on lifestyle behaviors , and medication adherence every three months for 12 months . The primary outcome is the mean change in systolic BP from baseline to 12 months . The secondary outcomes are rates of BP control at 12 months ; levels of physical activity , percent change in weight , and dietary intake of fruits and vegetables at 12 months ; and sustainability of intervention effects at 24 months . All outcomes will be assessed at baseline , six months and 12 months . Trained community health nurses will deliver the intervention as part of Ghana ’s community-based health planning and services ( CHPS ) program . Discussion Findings from this study will provide policy makers and other stakeholders needed information to recommend scalable and cost-effective policy with respect to comprehensive CV risk reduction and hypertension control in re source -poor setting s . Trial registration NCT01802372 Background Cardiovascular disease ( CVD ) remains the leading cause of death globally . Primary prevention of CVD requires cost-effective strategies to identify individuals at high risk in order to help target preventive interventions . An integral part of this approach is the use of CVD risk scores . Limitations in previous studies have prevented reliable inference about the potential advantages and the potential harms of using CVD risk scores as part of preventive strategies . We aim to evaluate short-term effects of providing different types of information about coronary heart disease ( CHD ) risk , alongside lifestyle advice , on health-related behaviours . Methods / Design In a parallel-group , open r and omised trial , we are allocating 932 male and female blood donors with no previous history of CVD aged 40–84 years in Engl and to either no intervention ( control group ) or to one of three active intervention groups : i ) lifestyle advice only ; ii ) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic characteristics ; and iii ) lifestyle advice plus information on estimated 10-year CHD risk based on phenotypic and genetic characteristics . The primary outcome is change in objective ly measured physical activity . Secondary outcomes include : objective ly measured dietary behaviours ; cardiovascular risk factors ; current medication and healthcare usage ; perceived risk ; cognitive evaluation of provision of CHD risk scores ; and psychological outcomes . The follow-up assessment takes place 12 weeks after r and omisation . The experiences , attitudes and concerns of a subset of participants will be also studied using individual interviews and focus groups . Discussion The INFORM study has been design ed to provide robust findings about the short-term effects of providing different types of information on estimated 10-year CHD risk and lifestyle advice on health-related behaviours . Trial registration Current Controlled Trials IS RCT N17721237 . Registered 12 January 2015 Context Can adults make sustained changes in unhealthy lifestyle behaviors ? Content In this multicenter trial , 810 adult volunteers with prehypertension or stage 1 hypertension were r and omly assigned to a multicomponent behavioral intervention group , a group combining the behavioral intervention plus the Dietary Approaches to Stop Hypertension ( DASH ) diet , or an advice only group . At 18 months , participants in both behavioral intervention groups had less hypertension , more weight loss , and better reduction in sodium and fat intake than those receiving advice only . The participants in the DASH diet group also increased their intake of fruits , vegetables , and fiber . Implication s Motivated adults can sustain several lifestyle changes over 18 months , which might reduce their risk for cardiovascular disease . The Editors The public health burden of chronic diseases related to suboptimal diet and physical inactivity is enormous . It has been estimated that these lifestyle factors contribute to approximately 20 % of deaths in the United States ( 1 ) . Incidence of atherosclerotic cardiovascular disease , overweight and obesity , elevated blood pressure and lipid levels , diabetes , osteoporosis , and cancer is increased by unhealthy lifestyles ( 2 - 8 ) . Multiple lifestyle factors , such as physical inactivity ; excessive intake of calories , sodium , saturated fat , and cholesterol ; and inadequate intake of fruits , vegetables , and low-fat dairy products , are etiologically related to the development of these diseases ( 4 , 5 , 8 - 10 ) . To reduce the burden of chronic disease , increased physical activity and changes in diet are needed , yet few intervention studies have attempted to achieve many lifestyle changes simultaneously . The PREMIER r and omized trial tested the effects of 2 multicomponent behavioral interventions on blood pressure ( 11 ) . Both interventions promoted increased physical activity , weight loss , and reduced sodium intake , each of which is recommended by the 2005 Dietary Guidelines Scientific Advisory Committee ( 12 ) . One intervention also added the Dietary Approaches to Stop Hypertension ( DASH ) diet ( 13 ) . This diet , which is high in fruits , vegetables , and low-fat dairy products and low in saturated fat , total fat , and cholesterol , meets each of the major nutrient recommendations that were established by the Institute of Medicine ( 14 - 18 ) . We report the effects of the PREMIER interventions on lifestyle changes and blood pressure status at 18 months . The main results of PREMIER , namely change in blood pressure at 6 months , were reported previously ( 11 ) . Methods The PREMIER study design and rationale ( 19 ) and intervention methods ( 11 ) have been described previously . The institutional review boards at each clinical center ; an external protocol review committee appointed by the National Heart , Lung , and Blood Institute ( NHLBI ) ; and the NHLBI review ed and approved the protocol ( available at www.kpchr.org/public/premier/intervention/default.asp ) . The NHLBI also appointed a data and safety monitoring board to monitor the trial . Each participant provided written informed consent . The trial was conducted from January 2000 through November 2002 . Study Participants Participants were generally healthy adults , age 25 years or older , who had prehypertension or stage 1 hypertension and met the Joint National Committee VI ( JNC VI ) criteria for a 6-month trial of nonpharmacologic therapy ( 2 ) . Targeted recruitment methods were used to ensure adequate representation of clinical ly important subgroups , in particular , African-American persons . Specific methods varied from site to site but included direct mailings , radio and newspaper advertisements , and networking within the local African-American communities . Eligibility criteria included not taking antihypertensive medication and having a systolic blood pressure of 120 to 159 mm Hg and a diastolic blood pressure of 80 to 95 mm Hg , based on the average of 3 screening visits . Persons with prehypertension ( systolic blood pressure of 120 to 139 mm Hg or diastolic blood pressure of 80 to 89 mm Hg ) were included because of the excess risk for cardiovascular disease in those with blood pressure within this range ( 20 ) . Major exclusion criteria were a body mass index less than 18.5 kg/mg2 or greater than 45.0 kg/m2 , use of antihypertensive drugs or other drugs that affect blood pressure , JNC VI risk category C ( target organ damage or diabetes ) , use of prescription weight loss medications , previous cardiovascular event , congestive heart failure , angina , cancer , and consumption of more than 21 alcoholic drinks per week . Trial Conduct Eligible participants were r and omly assigned , with equal probability , to 1 of 3 groups : an advice only comparison group ( advice only ) ; an intervention group that targeted established , guideline -recommended lifestyle recommendations ( established ) ( 2 ) ; or an intervention group targeting the established recommendations and adding the DASH dietary pattern ( established plus DASH ) ( 13 ) . Computer-generated treatment assignments were stratified by clinic and hypertension status and were assigned in blocks of varying sizes to provide balance over time . The actual assignments were administered by using a password-protected , Web-based application developed by the coordinating center and accessible only by authorized individuals . All clinic measurement staff were blinded to treatment assignment , and all intervention staff were blinded to clinic measurements . Hypertension was defined by using the JNC VI criteria for hypertension treatment : an average systolic blood pressure of 140 mm Hg , a diastolic blood pressure greater than 90 mm Hg , or use of antihypertensive medication . Normal blood pressure was defined as systolic blood pressure less than 120 mm Hg , diastolic blood pressure less than 80 mm Hg , and no use of antihypertensive medication ( 21 ) ( Figure ) . Intervention was provided by master 's degreelevel counselors ( dietitians and health educators trained in behavioral methods ) . The counselors were central ly trained before the start of the study , attended annual 3-day training sessions , and participated in monthly conference calls . Figure . Flow diagram of enrollment , measurements , and visit completion . Advice Only  Group Participants in the advice group  received advice to follow the National High Blood Pressure Education Program lifestyle recommendations for blood pressure control ( 2 ) . Lifestyle recommendations included reducing weight ( if overweight ) , following a reduced-sodium diet , engaging in regular moderate-intensity physical activity , and eating a heart-healthy diet , including the DASH diet . This advice was provided in two 30-minute individual sessions , 1 immediately after r and om assignment and 1 after the 6-month data collection visit . A PREMIER counselor review ed the guidelines with the participant and provided printed educational material s and information about community re sources . This intervention did not include advice to keep a food or exercise diary . Behavioral Interventions in the Established and Established plus DASH Groups Participant goals for the established and established plus DASH groups included weight loss of at least 6.8 kg ( 15 lb ) for those with a body mass index of 25 kg/m2 or greater , at least 180 minutes per week of moderate-intensity physical activity , no more than 100 mmol per day of dietary sodium , and alcohol consumption of no more than 30 mL ( 1 oz ) per day ( 2 drinks ) for men and 15 mL ( 0.5 ) oz per day ( 1 drink ) for women . Participants assigned to the established plus DASH group ( but not those in the established group ) also received counseling on the DASH diet , with goals for increased consumption of fruits and vegetables ( 9 to 12 servings/d ) and low-fat dairy products ( 2 to 3 servings/d ) and reduced consumption of saturated fat ( 7 % of energy ) and total fat ( 25 % of energy ) . The intervention format , contact pattern , and behavior change strategies for the established and established plus DASH groups were identical . During the first 6 months , participants in both behavioral intervention groups attended 14 group sessions and 4 individual sessions ; during months 7 to 18 , they attended monthly group sessions supplemented with 3 individual counseling sessions . Throughout the trial , participants in the established and established plus DASH groups ( but not those in the advice group ) kept food diaries , monitored dietary calorie and sodium intakes , and recorded minutes of physical activity . Self-monitoring was used to provide individualized feedback , reinforcement , problem solving , and support . Social support for initial behavior changes and maintenance of change was provided during the group sessions . More detailed descriptions of the behavorial intervention methods are available ( 22 ) . Measurements Blood pressure was assessed twice at each measurement , and systolic and diastolic blood pressures were calculated by using the mean of all available measurements ( 4 sets before r and om assignment , 3 sets at 6 and 18 months , and 1 set at 3 and 12 months ) . For 4 participants who were started on antihypertensive drug therapy between the 12- and 18-month visits , we obtained an official set of blood pressure measurements before initiation of therapy and used these as our 18-month blood pressure values for analysis . A similar procedure was used to obtain the 6-month blood pressure value for the 1 participant who began taking antihypertensive drugs between the 3- and 6-month visits . Two 24-hour dietary recalls , 1 obtained on a weekday and the other obtained on a weekend , were collected at baseline and at 6 and 18 months by telephone interview ( 23 ) . Intakes of nutrients and food groups were calculated by using the Nutrition Data System for Research , version NDS-R 1998 ( University of Minnesota , Minneapolis , Minnesota ) . Urinary excretion of sodium ( reflecting salt intake ) and potassium ( reflecting fruit and vegetable intake ) was obtained from 24-hour urinary collection s at baseline Hypertension ( HTN ) is a leading cause of cardiovascular and cerebrovascular diseases . Lifestyle modification may be the preferential approach to prevent and control HTN . The purpose of this study was to evaluate the effects of a community intervention program , which focused on improving the HTN knowledge , diets and lifestyles in a rural Chinese area . The study was carried out in a rural area of the Hubei Province from May 2003 to April 2006 . A total of 1632 participants were recruited . Of the participants , 826 from the town of Xiaoxita and 806 from the town of Fenxiang were assigned to the intervention group ( group I ) and to the control group ( group C ) , respectively . Group I participants underwent an intervention that included HTN education and dietary and lifestyle guidance . Group C participants were not subjected to an intervention . The outcome measures included HTN knowledge , dietary and lifestyle behaviors , and prevalence , awareness , treatment and control rates of HTN . Along with the changes in HTN education ( P<0.05 ) , the participants in group I exhibited a significantly greater improvement in dietary habits and lifestyle behaviors , including reducing salty food intake ( 13.6 % ) , fat intake ( 22.9 % ) and alcohol consumption ( 9.6 % ) , after 3 years in comparison with those in group C ( 21.7 , 31.9 and 18 % , respectively ) . The prevalence of HTN was significantly lower in group I ( 22.5 % ) than in group C ( 36 % ) after the intervention strategies . The study showed that the implementation of a community intervention program involving HTN education and lifestyle modifications for rural residents is a powerful approach to reduce HTN prevalence and improve long-term health outcomes AIMS AND OBJECTIVES To evaluate the one-year prognosis of a lifestyle counselling intervention ( diet , smoking cessation and exercise ) among patients who had open heart surgery . BACKGROUND Cardiovascular disease is the leading cause of morbidity worldwide in both developing and developed countries . Lifestyle modification plays an important role for patients who are at a high risk of developing cardiovascular disease and for those with an established cardiovascular disease . DESIGN R and omised , nonblind and lifestyle counselling intervention study with a one-year follow-up . METHODS A r and omised , nonblind intervention study was performed on 500 patients who had open heart surgery . After hospital discharge , 250 patients ( intervention group ) were r and omly allocated lifestyle counselling according to the recent guidelines provided by the European Society of Cardiology ( European Journal Preventive Cardiology , 19 , 2012 , 585 ) . The remaining 250 patients ( control group ) received the regular instructions . Primary end-point was the development of a cardiovascular disease ( nonfatal event ) during the first year ; secondary end-points included fatal events , smoking abstinence , dietary habits and a physical activity evaluation . RESULTS According to the primary end-point , the odds of having a nonfatal cardiovascular disease event are 0·56-times ( 95%CI 0·28 , 0·96 , p = 0·03 ) lower for the intervention group compared to the control group . One-year after surgery , it was found that participants in the intervention group were 1·96-times ( 95%CI 1·31 , 2·93 , p < 0·001 ) more likely to achieve dietary recommendations , 3·32-times ( 95%CI 2·24 , 4·91 , p < 0·001 ) more likely to achieve physical activity recommendations and 1·34-times ( 95%CI 1·15 , 1·56 , p < 0·001 ) more likely to return to work . CONCLUSION Lifestyle counselling intervention following open heart surgery can improve health outcomes and reduce the risk of a new cardiac event . Health care services must recommend and organise well-structured cardiac rehabilitation programmes adjusted to the patient 's needs . RELEVANCE TO CLINICAL PRACTICE A well-structured cardiac rehabilitation programme adjusted to the patient 's profile is a safe and cost-effective way to improve patients ' outcome Objective To quantify the association between a combination of healthy lifestyle factors before pregnancy ( healthy body weight , healthy diet , regular exercise , and not smoking ) and the risk of gestational diabetes . Design Prospect i ve cohort study . Setting Nurses ’ Health Study II , United States . Participants 20 136 singleton live births in 14 437 women without chronic disease . Main outcome measure Self reported incident gestational diabetes diagnosed by a physician , vali date d by medical records in a previous study . Results Incident first time gestational diabetes was reported in 823 pregnancies . Each lifestyle factor measured was independently and significantly associated with risk of gestational diabetes . The combination of three low risk factors ( non-smoker , ≥150 minutes a week of moderate to vigorous physical activity , and healthy eating ( top two fifths of Alternate Healthy Eating Index-2010 adherence score ) ) was associated with a 41 % lower risk of gestational diabetes compared with all other pregnancies ( relative risk 0.59 , 95 % confidence interval 0.48 to 0.71 ) . Addition of body mass index ( BMI ) < 25 before pregnancy ( giving a combination of four low risk factors ) was associated with a 52 % lower risk of gestational diabetes compared with all other pregnancies ( relative risk 0.48 , 0.38 to 0.61 ) . Compared with pregnancies in women who did not meet any of the low risk lifestyle factors , those meeting all four criteria had an 83 % lower risk of gestational diabetes ( relative risk 0.17 , 0.12 to 0.25 ) . The population attributable risk percentage of the four risk factors in combination ( smoking , inactivity , overweight , and poor diet ) was 47.5 % ( 95 % confidence interval 35.6 % to 56.6 % ) . A similar population attributable risk percentage ( 49.2 % ) was observed when the distributions of the four low risk factors from the US National Health and Nutrition Examination Survey ( 2007 - 10 ) data were applied to the calculation . Conclusions Adherence to a low risk lifestyle before pregnancy is associated with a low risk of gestational diabetes and could be an effective strategy for the prevention of gestational diabetes BACKGROUND Limited data are available on the benefit of combining healthy dietary and lifestyle behaviors in the prevention of  myocardial infa rct ion ( MI ) in women . METHODS We used factor analysis to identify a low-risk behavior-based dietary pattern in 24 444 postmenopausal women from the population -based prospect i ve Swedish Mammography Cohort who were free of diagnosed cancer , cardiovascular disease , and diabetes mellitus at baseline ( September 15 , 1997 ) . We also defined 3 low-risk lifestyle factors : nonsmoking , waist-hip ratio less than the 75th percentile ( < 0.85 ) , and being physically active ( at least 40 minutes of daily walking or bicycling and 1 hour of weekly exercise ) . RESULTS During 6.2 years ( 151 434 person-years ) of follow-up , we ascertained 308 cases of primary MI . Two major identified dietary patterns , " healthy " and " alcohol , " were significantly associated with decreased risk of MI . The low-risk  diet  ( high scores for the healthy dietary pattern ) characterized by a high intake of vegetables , fruit , whole grains , fish , and legumes , in combination with moderate alcohol consumption ( > /= 5 g of alcohol per day ) , along with the 3 low-risk lifestyle behaviors , was associated with 92 % decreased risk ( 95 % confidence interval , 72%-98 % ) compared with findings in women without any low-risk diet and lifestyle factors . This combination of healthy behaviors , present in 5 % , may prevent 77 % of MIs in the study population . CONCLUSION Most MIs in women may be preventable by consuming a healthy diet and moderate amounts of alcohol , being physically active , not smoking , and maintaining a healthy weight Background The risk factors for chronic disease , smoking , poor nutrition , hazardous alcohol consumption , physical inactivity and weight ( SNAPW ) are common in primary health care ( PHC ) affording opportunity for preventive interventions . Community nurses are an important component of PHC in Australia . However there has been little research evaluating the effectiveness of lifestyle interventions in routine community nursing practice . This study aim ed to address this gap in our knowledge . Methods The study was a quasi-experimental trial involving four generalist community nursing ( CN ) services in New South Wales , Australia . Two services were r and omly allocated to an ‘ early intervention ’ and two to a ‘ late intervention ’ group . Nurses in the early intervention group received training and support in identifying risk factors and offering brief lifestyle intervention for clients . Those in the late intervention group provided usual care for the first 6 months and then received training .  Clients aged 30–80 years who were referred to the services between September 2009 and September 2010 were recruited prior to being seen by the nurse and baseline self-reported data collected . Data on their SNAPW risk factors , readiness to change these behaviours and advice and referral received about their risk factors in the previous 3 months were collected at baseline , 3 and 6 months . Analysis compared changes using univariate and multilevel regression techniques . Results 804 participants were recruited from 2361 ( 34.1 % ) eligible clients . The proportion of clients who recalled receiving dietary or physical activity advice increased between baseline and 3 months in the early intervention group ( from 12.9 to 23.3 % and 12.3 to 19.1 % respectively ) as did the proportion who recalled being referred for dietary or physical activity interventions ( from 9.5 to 15.6 % and 5.8 to 21.0 % respectively ) . There was no change in the late intervention group . There a shift towards greater readiness to change in those who were physically inactive in the early but not the comparison group . Clients in both groups reported being more physically active and eating more fruit and vegetables but there were no significant differences between groups at 6 months . Conclusion The study demonstrated that although the intervention was associated with increases in advice and referral for diet or physical activity and readiness for change in physical activity , this did not translate into significant changes in lifestyle behaviours or weight . This suggests a need to facilitate referral to more intensive long-term interventions for clients with risk factors identified by primary health care nurses . Trial registration Abstract Objectives To prospect ively evaluate the joint association of duration of rotating night shift work and lifestyle factors with risk of type 2 diabetes risk , and to quantitatively decompose this joint association to rotating night shift work only , to lifestyle only , and to their interaction . Design Prospect i ve cohort study . Setting Nurses ’ Health Study ( 1988 - 2012 ) and Nurses ’ Health Study II ( 1991 - 2013 ) . Participants 143 410 women without type 2 diabetes , cardiovascular disease , or cancer at baseline . Exposures Rotating night shift work was defined as at least three night shifts per month in addition to day and evening shifts in that month . Unhealthy lifestyles included current smoking , physical activity levels below 30 minutes per day at moderate to vigorous intensity , diet in the bottom three fifths of the Alternate Healthy Eating Index score , and body mass index of 25 or above . Main outcome measures Incident cases of type 2 diabetes were identified through self report and vali date d by a supplementary question naire . Results During 22 - 24 years of follow-up , 10 915 cases of incident type 2 diabetes occurred . The multivariable adjusted hazard ratios for type 2 diabetes were 1.31 ( 95 % confidence interval 1.19 to 1.44 ) per five year increment of duration of rotating night shift work and 2.30 ( 1.88 to 2.83 ) per unhealthy lifestyle factor ( ever smoking , low diet quality , low physical activity , and overweight or obesity ) . For the joint association of per five year increment rotating night shift work and per unhealthy lifestyle factor with type 2 diabetes , the hazard ratio was 2.83 ( 2.15 to 3.73 ) with a significant additive interaction ( P for interaction < 0.001 ) . The proportions of the joint association were 17.1 % ( 14.0 % to 20.8 % ) for rotating night shift work alone , 71.2 % ( 66.9 % to 75.8 % ) for unhealthy lifestyle alone , and 11.3 % ( 7.3 % to 17.3 % ) for their additive interaction . Conclusions Among female nurses , both rotating night shift work and unhealthy lifestyle were associated with a higher risk of type 2 diabetes . The excess risk of rotating night shift work combined with unhealthy lifestyle was higher than the addition of risk associated with each individual factor . These findings suggest that most cases of type 2 diabetes could be prevented by adhering to a healthy lifestyle , and the benefits could be greater in rotating night shift workers Background Cardiovascular disease ( CVD ) is the leading cause of death worldwide . With atherosclerosis as the underlying cause for many CVD events , prevention or reduction of sub clinical atherosclerotic plaque burden ( SAPB ) through a healthier lifestyle may have substantial public health benefits . Objective The objective was to describe the protocol of a r and omized controlled trial investigating the effectiveness of a 30‐month worksite‐based lifestyle program aim ed to promote cardiovascular health in participants having a high or a low degree of SAPB compared with st and ard care . Methods We will conduct a r and omized controlled trial including middle‐aged bank employees from the Progression of Early Sub clinical Atherosclerosis cohort , stratified by SAPB ( high SAPB n = 260 , low SAPB n = 590 ) . Within each stratum , participants will be r and omized 1:1 to receive a lifestyle program or st and ard care . The program consists of 3 elements : ( a ) 12 personalized lifestyle counseling sessions using Motivational Interviewing over a 30‐month period , ( b ) a wrist‐worn physical activity tracker , and ( c ) a sit‐st and workstation . Primary outcome measure is a composite score of blood pressure , physical activity , sedentary time , body weight , diet , and smoking ( ie , adapted Fuster‐BEWAT score ) measured at baseline and at 1‐ , 2‐ , and 3‐year follow‐up . Conclusions The study will provide insights into the effectiveness of a 30‐month worksite‐based lifestyle program to promote cardiovascular health compared with st and ard care in participants with a high or low degree of SAPB BACKGROUND & OBJECTIVES There is poor knowledge and behaviors regarding chronic diseases related nutritional and lifestyle factors among women in low income countries . To evaluate efficacy of a multilevel population -based intervention in improving knowledge and practice s for related factors we performed a study in India . METHODS Population based study among women 35 - 70 years was performed in four urban and five rural locations . Stratified sampling was performed and we enrolled 4624 ( rural 2616 , urban 2008 ) of eligible 8000 women ( 58 % ) .  Demographic details , medical history , diet , physical activity and anthropometry were recorded and blood hemoglobin , glucose and total cholesterol determined . Knowledge and behaviors regarding diet in chronic diseases were inquired in a r and omly selected 100 women at each site ( n = 900 ) . A systematic multilevel population based intervention ( using posters , h and outs , street plays , public lectures , group lectures and focused group discussion s ) was administered over 6 months at each site . The question naire was re-administered at the end in r and om 100 women ( n = 900 ) and differences determined . Descriptive statistics are reported . Comparison of parameters before and after intervention was assessed using Mann Whitney test . RESULTS Prevalence ( % ) of chronic disease related lifestyles and risk factors in rural/urban women , respectively , was illiteracy in 63.6/29.4 , smoking/tobacco use 39.3/18.9 , high fat intake 93.6/93.4 , high salt intake 18.2/12.6 , low physical activity 59.5/70.2 , overweight/obesity 22.5/45.6 , truncal obesity 13.0/44.3 , hypertension 31.6/48.2 , hypercholesterolemia 13.5/27.7 , and diabetes in 4.3/15.1 percent . Composite chronic diseases knowledge at baseline vs after intervention increased significantly in overall ( 32.0 vs 62.0 ) , rural ( 29.0 vs 63.5 ) and urban ( 39.5 vs 60.5 ) groups ( p < 0.001 ) . Significant increase in knowledge regarding diet in hypertension , diabetes , heart disease and anemia as well as importance of dietary proteins , fats , fibres and fruits was observed ( p < 0.001 ) . There was insignificant change in most of the practice s regarding intake of low fat , high protein , high fibre diet except sieving the flour which declined significantly ( 80.1 vs 53.6 , p < 0.001 ) . CONCLUSIONS A short-term multilevel population -wide intervention among women in rural and urban locations in India increased chronic disease knowledge but failed to influence practice BACKGROUND African American women are at increased risk for CVD morbidity and mortality relative to white women . Physical inactivity and poor dietary habits are modifiable health behaviors shown to reduce CVD risk . Community health centers have the potential to reach large numbers of African Americans to modify their risk for CVD , yet few lifestyle counseling interventions have been conducted in this setting . METHODS The HHER Lifestyle trial is a r and omized controlled trial to compare the effects of a st and ard care intervention ( provider counseling , nurse goal setting , and educational material s ) to a comprehensive intervention ( st and ard care intervention plus 12 months of telephone counseling and tailored print material s ) on changes in physical activity and dietary fat consumption in financially disadvantaged African American women at 6 and 12 months . Secondary outcomes are body mass index , central adiposity , and total cholesterol . Potential mediators of outcome are self-efficacy for overcoming barriers , social support , and decisional balance . RESULTS African American women ( N=266 ; 130 st and ard care , 136 comprehensive intervention ) 35 years and older from nine clinics within two community health centers were enrolled . Most participants were overweight or obese with existing chronic health conditions . CONCLUSION The HHER Lifestyle trial is unique in that it targets financially disadvantaged African American women from community health centers , incorporates a st and ard care intervention into a routine clinical appointment , and includes a comprehensive process evaluation . The design will permit further research examining the added effect of regular telephone counseling and tailored print material s to a primary care provider and nurse intervention Background The diets , physical activity and sedentary behavior levels of both children and adults in Australia are suboptimal . The family environment , as the first ecological niche of children , exerts an important influence on the onset of children ’s habits . Parent modeling is one part of this environment and a logical focus for child obesity prevention initiatives . The focus on parent ’s own behaviors provides a potential opportunity to decrease obesity risk behaviors in parents as well . Objective To assess the effect of a parent-focused  early childhood obesity prevention  intervention on  first-time mothers ’ diets , physical activity and TV viewing time .  Methods The Melbourne InFANT Program is a cluster-r and omized controlled trial which involved 542 mothers over their newborn ’s first 18 months of life . The intervention focused on parenting skills and strategies , including parental modeling , and aim ed to promote development of healthy child and parent behaviors from birth , including healthy diet , increased physical activity and reduced TV viewing time . Data regarding mothers ’ diet ( food frequency question naire ) , physical activity and TV viewing times ( self-reported question naire ) were collected using vali date d tools at both baseline and post-intervention . Four dietary patterns were derived at baseline using principal components analyses including frequencies of 55 food groups . Analysis of covariance was used to measure the impact of the intervention . Results The scores of both the " High-energy snack and processed foods " and the " High-fat foods " dietary patterns decreased more in the intervention group : -0.22 ( −0.42;-0.02 ) and −0.25 ( −0.50;-0.01 ) , respectively . No other significant intervention vs. control effects were observed regarding total physical activity , TV viewing time , and the two other dietary patterns , i.e. “ Fruits and vegetables ” and “ Cereals and sweet foods ” . Conclusions These findings suggest that supporting first-time mothers to promote healthy lifestyle behaviors in their infants impacts maternal dietary intakes positively . Further research needs to assess ways in which we might further enhance those lifestyle behaviors not impacted by the InFANT intervention Background Various strategies have been used to induce lifestyle changes to reduce ischaemic heart disease ( IHD ) with various successes . The aim of Inter99 is to assess the effect on IHD incidence of individually tailored non-pharmacological intervention on lifestyle using a newly developed computer-based health educational tool . The article describes the study and baseline results . Methods From a population of 61,301 individuals two r and om sample s ( high intensity intervention group ( A ) , n = 11,708 ; low intensity intervention group ( B ) , n = 1308 ) are screened to assess their absolute risk of IHD . Those at high risk receive individual lifestyle counselling . Individuals in group A are furthermore offered lifestyle counselling in groups on smoking cessation or physical activity/diet over a 6-month period . Individuals in group B are referred to their GP . High-risk persons are re-counselled after 1 and 3 years and the whole group is re-invited after 5 years . The remaining 48,285 ( group C ) are followed by question naire . The total population is followed through central registers . Intermediate end-points are changes in lifestyle , cholesterol , blood pressure and body mass index . Final end-point is reduction in incidence of IHD . Results The r and omization leads to comparable groups . Participation rate was 52.5 % . A total of 60 % fulfilled the predetermined criteria for being at high risk for developing IHD . After an individual lifestyle counselling 41 % accepted group-based counselling . Conclusion This large r and omized population based trial discloses a noticeable need for and acceptance of lifestyle intervention in the general population . Eur J Cardiovasc Prevention Rehab 10:377 - 386 © 2003 Lippincott Williams & Wilkins OBJECTIVES We sought to determine the effects of a community-based , culturally tailored diabetes lifestyle intervention on risk factors for diabetes complications among African Americans and Latinos with type 2 diabetes . METHODS One hundred fifty-one African American and Latino adults with diabetes were recruited from 3 health care systems in Detroit , Michigan , to participate in the Racial and Ethnic Approaches to Community Health ( REACH ) Detroit Partnership  diabetes lifestyle intervention . The curriculum , delivered by trained community residents , was aim ed at improving dietary , physical activity , and diabetes self-care behaviors . Baseline and postintervention levels of diabetes-specific quality -of-life , diet , physical activity , self-care knowledge and behaviors , and hemoglobin A1C were assessed . RESULTS There were statistically significant improvements in postintervention dietary knowledge and behaviors and physical activity knowledge . A statistically significant improvement in A1C level was achieved among REACH Detroit program participants ( P<.0001 ) compared with a group of patients with diabetes in the same health care system in which no significant changes were observed ( P=.160 ) . CONCLUSIONS A culturally tailored diabetes lifestyle intervention delivered by trained community residents produced significant improvement in dietary and diabetes self-care related knowledge and behaviors as well as important metabolic improvements Diet and physical activity habits may deteriorate after cohabitation , leading to weight gain and increased risk of lifestyle diseases . We carried out a 4-month , r and omized controlled trial of a diet and physical activity program for couples with a 1-year follow-up , comparing two methods of delivery . The program used six modules , which , after an initial group session , were mailed to the low-level intervention group .  In the high-level intervention group , half of the modules were mailed , and the others were delivered at interactive group sessions . A control group received no intervention . Postintervention and at follow-up , physical fitness improved in the high-level group , saturated fat intake decreased in both intervention groups , and low-density lipoprotein cholesterol fell in the high-level group . Fewer participants in the high-level group became overweight or obese . Health promotion for couples can improve health behaviors and potentially lower the risk of lifestyle diseases in participants and their future families Background The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century . The Department of Health in Engl and has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk . The aims of this study were to monitor population changes in cardiovascular disease ( CVD ) risk factors over the first year of the new service and to assess the value of tailored lifestyle support , including motivational interview with ongoing support and referral to other services . Methods R and omised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent , Engl and . Thirty eight general practice s and 601 ( 365 usual care , 236 additional lifestyle support ) patients were recruited and r and omised independently between September 2009 and February 2010 . Changes in population CVD risk between baseline and one year follow-up were compared , using intention-to-treat analysis . The primary outcome was the Framingham 10 year CVD risk score . Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories . Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for : weight management , physical activity , cook and eat and positive thinking . Results Average population CVD risk decreased from 32.9 % to 29.4 % ( p < 0.001 ) in the NHS Health Check only group and from 31.9 % to 29.2 % ( p < 0.001 ) in the NHS Health Check plus additional lifestyle support group . There was no significant difference between the two groups at either measurement point . Prevalence of high blood pressure , high cholesterol and smoking were reduced significantly ( p < 0.01 ) in both groups . Prevalence of central obesity was reduced significantly ( p < 0.01 ) in the group receiving additional lifestyle support but not in the NHS Health Check only group . Conclusions The NHS Health Check service in Stoke on Trent result ed in significant reduction in estimated population CVD risk . There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction PURPOSE Declines in physical functioning ( PF ) among elderly cancer patients threaten quality of life and the ability to maintain independence . Adherence to healthy lifestyle behaviors may prevent functional decline . PATIENTS AND METHODS Project Leading the Way in Exercise and Diet ( LEAD ) , an intervention development study of the Pepper Older Americans Independence Center , aim ed to determine whether breast and prostate cancer survivors ( age 65 + years ) assigned to a 6-month home-based diet and exercise intervention  experienced improvements in PF when compared with an attention control arm receiving general health information . An accrual target was set at 420 , and PF ( Short Form-36 subscale ) , physical activity ( Community Healthy Activities Models Program for Seniors ) , and diet quality ( index from 3-day recalls ) were assessed at baseline and at 6 and 12 months ( 6 months after intervention ) . RESULTS This developmental project did not achieve its accrual target ( N = 182 ) ; however , PF change scores were in the direction and of the magnitude projected . Baseline to 6-month change scores in the intervention versus the control arms were as follows : PF , + 3.1 v -0.5 ( P = .23 ) ; physical activity energy expenditure , + 111 kcal/wk v -400 kcal/wk ( P = .13 ) ; and diet quality index , + 2.2 v -2.9 ( P = .003 ) , respectively . Differences between arms diminished during the postintervention period . CONCLUSION These findings suggest that home-based diet and exercise interventions hold promise in improving lifestyle behaviors among older cancer survivors , changes that trend toward improved PF . Future studies should incorporate larger sample sizes and interventions that sustain long-term effects and also take into account secular trends ; these efforts will require adequate planning and re sources to overcome the numerous barriers to intervening in this difficult to reach yet vulnerable population In the Oslo Diet and Exercise Study ( ODES ) 219 healthy middle-aged physically inactive persons with moderately deranged risk factor levels ( increased bodyweight , diastolic blood pressure , serum cholesterol , triglycerides , decreased HDL-cholesterol ) were r and omized to 4 intervention groups : dietary intervention , exercise , diet + exercise and control . The purpose of the study was to test if these interventions maintained for a year , isolated or in combination , would change coronary risk factor levels as compared to control . One of the risk factors included was lipoprotein ( a ) ( Lp(a ) ) . The hypothesis to be tested was if physical exercise would be associated with increased levels of Lp(a ) as a result of intervention . Those who exercised increased their Lp(a ) levels with 15.4 ( S.E. = 8.0 ) mg/l as compared to no exercise ( P < 0.05 ) . Also , dietary intervention tended to increase Lp(a ) , but the increase did not reach statistical significance . There was no detectable interaction on the effect on Lp(a ) of the two intervention modalities . A dose-response relationship was found between change in the exercise-specific variables heart rate and peak oxygen uptake , and Lp(a)-change and this dose-response was most pronounced in the exercise group . Change in Lp(a ) was associated to change in several lifestyle related variables such as alcohol intake and waist circumference , pointing to the possibility that Lp(a ) , at least in some sub population s , is more amenable to change through lifestyle alterations than reported so far Background — Although trials of lifestyle interventions generally focus on cardiovascular disease risk factors rather than hard clinical outcomes , 10-year coronary heart disease ( CHD ) risk can be estimated from the Framingham risk equations . Our objectives were to study the effect of 2 multicomponent lifestyle interventions on estimated CHD risk relative to advice alone and to evaluate whether differences can be observed in the effects of the lifestyle interventions among subgroups defined by baseline variables . Methods and Results — A total of 810 healthy adults with untreated prehypertension or stage I hypertension were r and omized to 1 of 3 intervention groups : An “ advice-only ” group , an “ established ” group that used established lifestyle recommendations for blood pressure control ( sodium reduction , weight loss , and increased physical activity ) , or an “ established-plus-DASH ” group that combined established lifestyle recommendations with the DASH ( Dietary Approaches to Stop Hypertension ) diet . The primary outcome was 10-year CHD risk , estimated from follow-up data collected at 6 months . A secondary outcome was 10-year CHD risk at 18 months . Of the 810 participants , 62 % were women and 34 % were black . Mean age was 50 years , mean systolic/diastolic blood pressure was 135/85 mm Hg , and median baseline Framingham risk was 1.9 % . The relative risk ratio comparing 6-month to baseline Framingham risk was 0.86 ( 95 % confidence interval 0.81 to 0.91 , P<0.001 ) in the established group and 0.88 ( 95 % confidence interval 0.83 to 0.94 , P<0.001 ) in the established-plus-DASH group relative to advice alone . Results were virtually identical in sensitivity analyses , in each major subgroup , and at 18 months . Conclusions — The observed reductions of 12 % to 14 % in estimated CHD risk are substantial and , if achieved , should have important public health benefits Mainstream preventive interventions often fail to reach poor population s with a high risk of cardiovascular diseases ( CVDs ) in Pakistan . A community-based CVD primary prevention project aim ed at developing approaches to reduce risk factors in such population s was established by Heartfile in collaboration with the National Rural Support Program in the district of Lodhran . The project implemented a range of activities integrated with existing social and health service mechanisms during a three year intervention period 2000/01 - 03/04 . These were targeted in 4 key setting s : community health education , mass media interventions , training of health professionals and health education through Lady Health Workers . The project received support from the Department for International Development , UK . At the community level , a pre-test-post-test quasi-experimental design was used for examining project outcomes related to the community component of the intervention . Pre and post-intervention ( training ) evaluations were conducted involving all health care providers in r and omly selected workshops in order to determine baseline levels of knowledge and the impact of training on knowledge level . In order to assess practice s of physician and non-physician health care providers patient interviews , with control comparisons were conducted at each health care facility . Significant positive changes were observed in knowledge levels at a community level in the district of intervention compared with baseline knowledge levels particularly in relation to a heart healthy diet , beneficial level of physical activity , the causes of high blood pressure and heart attack and the effects of high blood pressure and active and passive smoking on health . Significant changes in behaviors at a practice level were not shown in the district of intervention . However the project played a critical role in spurring national action for the prevention and control of non-communicable diseases and introducing sustainable public health interventions for poor communities in Pakistan Abstract Background : It is well established in the literature that regular participation in physical activity is effective for chronic disease management and prevention . Remote monitoring technologies ( ie , mHealth ) hold promise for engaging patients in self-management of many chronic diseases . The purpose of this study was to test the effectiveness of an mHealth study with tailored physical activity prescription targeting changes in various intensities of physical activity ( eg , exercise , sedentary behavior , or both ) for improving physiological and behavioral markers of lifestyle-related disease risk . Methods : Forty-five older adults ( aged 55–75 years ; mean age 63 ± 5 years ) were r and omly assigned to receive a personal activity program targeting changes to either daily exercise , sedentary behavior , or both . All participants received an mHealth technology kit including smartphone , blood pressure monitor , glucometer , and pedometer . Participants engaged in physical activity programming at home during the 12-week intervention period and su bmi tted physical activity ( steps/day ) , blood pressure ( mm Hg ) , body weight ( kg ) , and blood glucose ( mmol/L ) measures remotely using study -provided devices . Results : There were no differences between groups at baseline ( P > 0.05 ) . The intervention had a significant effect ( F(10 488 ) = 2.947 , P = 0.001 , ηP2 = 0.057 ) , with similar changes across all groups for physical activity , body weight , and blood pressure ( P > 0.05 ) . Changes in blood glucose were significantly different between groups , with groups prescribed high-intensity activity ( ie , exercise ) demonstrating greater reductions in blood glucose than the group prescribed changes to sedentary behavior alone ( P < 0.05 ) . Conclusions : Findings demonstrate the utility of pairing mHealth technologies with activity prescription for prevention of lifestyle-related chronic diseases among an at-risk group of older men and women . Results support the novel approach of prescribing changes to sedentary behaviors ( alone , and in conjunction with exercise ) to reduce risk of developing lifestyle-related chronic conditions Non-insulin-dependent diabetes mellitus ( NIDDM ) is preceded by impaired glucose tolerance ( IGT ) lasting for years before manifesting as overt hyperglycaemia . Both genetic and environmental factors contribute to the development of IGT and NIDDM . Obesity , physical inactivity and high-fat diet have been found to predict IGT and NIDDM . Therefore , a diet and exercise intervention from diagnosis of NIDDM could improve the treatment outcome and prognosis of patients with NIDDM . Furthermore , because subjects with IGT are at increased risk for diabetes and atherosclerotic vascular disease , it is reasonable to assume that in terms of reducing the incidence and longterm consequences of NIDDM an intervention at this phase is more effective than in overt diabetes . Although the nonpharmacological approach is generally accepted as the first-line treatment of NIDDM its efficacy has often been question ed . Therefore , it is important to carry out long-term controlled studies to find out to what extent lifestyle modification could improve the metabolic control and level of major cardiovascular risk factors known to be associated with poor outcome in NIDDM . This kind of study also gave relevant experience in planning studies aim ing at primary prevention of NIDDM . One-year dietary and exercise intervention on newly diagnosed NIDDM patients in Kuopio , Finl and result ed in a better metabolic control and a moderate reduction in cardiovascular risk factors as compared to the conventional treatment group . After the second year of follow-up only 12.5 % in the intervention group were receiving  oral antidiabetic drugs  vs. 34.8 % in the conventional treatment group . Weight reduction and a reduced use of saturated fats appeared to be the main determinants of successful treatment results . Good aerobic capacity was associated with an increase in HDL cholesterol . A multicentre primary prevention study on IGT patients is continuing in Finl and applying the same principles of intervention as used in the study on newly diagnosed NIDDM patients . Pilot results show that glucose tolerance can be improved by lifestyle changes BACKGROUND The efficacy of physical activity with a healthful diet to reduce obesity is established ; however , little is known about the translation of effective lifestyle strategies for obesity reduction in primary care setting s. METHODS We assessed the effectiveness of a 2-year behaviorally based physical activity and diet program implemented entirely within clinical practice s to reduce obesity . A total of 490 sedentary , obese adults were r and omized to usual care ( n = 241 ) or to the behavioral intervention ( n = 249 ) . The usual care group received advice from their physicians about lifestyle as a strategy for obesity reduction . The behavioral intervention included individual counseling from health educators to promote physical activity with a healthful diet . The primary outcome was change in waist circumference ( WC ) . RESULTS A total of 396 participants completed the trial ( 80.8 % ) . A significant main effect was observed for WC change within the intervention compared with usual care ( P < .001 ) that was sustained at 24 months ( mean [ SE ] , -0.9 [ 0.4 ] vs 0.2 [ 0.4 ] cm ; P = .05 ) . Secondary analyses revealed significant main effects for change in WC in men ( P = .009 ) and women ( P = .02 ) . In men , the mean ( SE ) reduction in WC at 24 months was greater with behavioral intervention compared with usual care ( -1.6 [ 0.6 ] vs 0.1 [ 0.6 ] cm ; P = .049 ) . In women , the behavioral intervention was associated with differences in WC compared with usual care at 6 and 12 months ( P ≤ .01 ) but not at 24 months ( P = .10 ) . CONCLUSIONS Behavioral intervention in clinical setting s is associated with modest reductions in WC during a 2-year study in obese patients . However , the effectiveness of the intervention is restricted to men . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00665158 Background — Whether physical activity reduces the impact of obesity on the risk of acute coronary events is much debated . However , little is known about the role of other potentially modifiable lifestyle factors in combination with obesity . Methods and Results — We followed up 54 783 women and men from the prospect i ve Danish Diet , Cancer and Health study who were 50 to 64 years at baseline ( 1993 to 1997 ) and free of coronary artery disease and cancer . During a median of 7.7 years , 1127 incident cases of acute coronary syndrome ( ACS ) occurred . After multivariable adjustments , each unit of body mass index was associated with a 5 % and 7 % higher risk of ACS among women and men , respectively ( both P<0.0001 for trend ) . Overweight ( body mass index , 25 to 29.9 kg/m2 ) and obesity ( body mass index ≥30 kg/m2 ) were associated with a higher risk of ACS among the physically active and inactive , in nonsmokers and smokers , and among those who adhered more or less to a heart-healthy dietary pattern . Obese individuals who were active 1 to 3.5 h/wk had a lower risk than sedentary , obese individuals . In addition , obese nonsmokers had a lower risk than obese smokers . Adherence to a healthy diet  was associated with a lower risk of ACS ; however , the relative risk was not different among obese individuals with the most healthy diet versus obese individuals with a less healthy diet . Conclusions — Obesity confers an elevated risk of ACS in both healthy and less healthy subgroups of lifestyle behaviors . Adherence to healthy lifestyle behaviors was associated with a lower risk even among obese individuals Aim . We aim ed to assess the prevalence and lifestyle correlates of gastroesophageal reflux disease ( GERD ) in the adult population of Albania , a Mediterranean country in Southeast Europe which has experienced major behavioral changes in the past two decades . Methods . A cross-sectional study , conducted in 2012 , included a population -representative sample of 845 individuals ( ≥18 years ) residing in Tirana ( 345 men , mean age : 51.3 ± 18.5 ; 500 women , mean age : 49.7 ± 18.8 ; response rate : 84.5 % ) .  Assessment of GERD was based on Montreal definition . Covariates included socioeconomic characteristics , lifestyle factors , and body mass index . Logistic regression was used to assess the association of socioeconomic characteristics and lifestyle factors with GERD . Results . The overall prevalence of GERD was 11.9 % . There were no significant sex differences , but a higher prevalence among the older participants . In fully adjusted models , there was a positive relationship of GERD with smoking , physical inactivity , fried food consumption , and obesity , but not so for alcohol intake and meat consumption . Conclusion . We obtained important evidence on the prevalence and lifestyle correlates of GERD in a Western Balkans ' country . Smoking , physical inactivity , and obesity were strong “ predictors ” of GERD in this population . Findings from this study should be replicated in prospect i ve studies in Albania and other transitional setting Disseminating and implementing evidence -based , cardiovascular disease ( CVD ) prevention lifestyle interventions in community setting s and in ethnic minority population s is a challenge . We describe the design and methods for the South Asian Heart Lifestyle Intervention ( SAHELI ) study , a pilot study design ed to determine the feasibility and initial efficacy of a culturally-targeted , community-based lifestyle intervention to improve physical activity and diet behaviors among medically underserved South Asians ( SAs ) . Participants with at least one CVD risk factor will be r and omized to either a lifestyle intervention or a control group .  Participants in both groups will be screened in a community setting and receive a primary care referral after r and omization . Intervention participants will receive 6weeks of group classes , followed by 12weeks of individual telephone support where they will be encouraged to initiate and maintain a healthy lifestyle goal . Control participants will receive their screening results and monthly mailings on CVD prevention . Primary outcomes will be changes in moderate/vigorous physical activity and saturated fat intake between baseline , 3- , and 6-month follow-up . Secondary outcomes will be changes in weight , clinical risk factors , primary care visits , self-efficacy , and social support . This study will be one of the first to pilot-test a lifestyle intervention for SAs , one of the fastest growing racial/ethnic groups in the U.S. and one with disparate CVD risk . Results of this pilot study will provide preliminary data about the efficacy of a lifestyle intervention on CVD risk in SAs and inform community-engaged CVD prevention efforts in an increasingly diverse U.S. population Background Childhood obesity is not only associated with adult obesity but also with increased risk of adult onset of type 2 diabetes and subsequent coronary heart disease . The potential effects of school-based health intervention programmes on cardiovascular risk and surrogate markers are unclear , as only few studies have attempted to investigate a complete risk profile including a detailed laboratory analysis or micro- and macrovascular function . In this study a comprehensive school-based r and omized intervention programme will be investigated in 10 - 14-year old children addressing the influence of lifestyle intervention on inactivity , cardiometabolic risk factors and early signs of vascular disease . Methods / Design 15 secondary schools in Southern Germany are r and omly assigned to intervention or control schools . Children in the fifth grade ( 10 - 11 years ) will be observed over four years . The study combines a school-based with a home-based approach , aim ing at children , teachers and parents . The main components are weekly lifestyle-lessons for children , taught by regular classroom teachers to increase physical activity in- and outside of school , to improve eating patterns at school and at home , to reduce media consumption and to amplify well-being . In 4 - 6 annual meetings , teachers receive information about health-related topics with worksheets for children and supporting equipment , accounting for school-specific needs and strategies . Parents ' trainings are provided on a regular basis . All examinations are performed at the beginning and at the end of every school year . Anthropometry includes measurements of BMI , waist and upper arm circumferences , skinfold thickness as well as peripheral blood pressure . Blood sampling includes lipid parameters , insulin , glucose , hsCRP , adiponectin , and IL-6 as well as testosteron and estrogen to determine maturation status . Vascular function is non-invasively assessed by measuring arterial stiffness in large arteries using a sphygmograph and by analysing arteriolar and venular diameters in the retinal microcirculation using a non-mydriatric vessel analyser . A question naire is filled out to determine daily physical activity , motivational factors , dietary habits , quality of life ( KINDL-R ) and socio-economic data . Physical fitness is assessed by a six-item test battery . Discussion Our study aims to provide a feasible long-term intervention strategy to re-establish childhood health and to prevent obesity-related cardiovascular dysfunction in children . Trial Registration BACKGROUND Patients undergoing cardiovascular procedures remain at increased risk for myocardial infa rct ion , stroke , and cardiovascular death . Risk factor control in this patient population remains suboptimal and would likely benefit from strategies targeting education , lifestyle , and healthy behaviors . DESIGN The IMPACT trial is a 400-subject prospect i ve r and omized trial design ed to compare different cardiovascular prevention strategies in subjects following a cardiovascular intervention . The trial began enrollment in the Spring of 2012 and is r and omizing subjects in a 1:1:1 manner to usual care , a one-time cardiovascular prevention consult , or a one-time cardiovascular prevention consult plus behavioral intervention program ( telephone-based motivational interviewing and tailored text messages ) over a 6-month period . The primary end point is non-high-density lipoprotein cholesterol . Secondary end points include other plasma lipid values , metabolic risk , smoking cessation , physical activity , dietary intake , medication use and adherence , and quality of life . CONCLUSIONS The IMPACT trial provides data on different management strategies for risk factor optimization in subjects following cardiovascular procedures . The results will provide a platform for the continued development of novel multidisciplinary interventions in this high-risk population CONTEXT Weight loss , sodium reduction , increased physical activity , and limited alcohol intake are established recommendations that reduce blood pressure ( BP ) . The Dietary Approaches to Stop Hypertension ( DASH ) diet also lowers BP . To date , no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations . OBJECTIVE To determine the effect on BP of 2 multicomponent , behavioral interventions . DESIGN , SETTING , AND PARTICIPANTS R and omized trial with enrollment at 4 clinical centers ( January 2000-June 2001 ) among 810 adults ( mean [ SD ] age , 50 [ 8.9 ] years ; 62 % women ; 34 % African American ) with above-optimal BP , including stage 1 hypertension ( 120 - 159 mm Hg systolic and 80 - 95 mm Hg diastolic ) , and who were not taking antihypertensive medications . INTERVENTION Participants were r and omized to one of 3 intervention groups : ( 1 ) " established , " a behavioral intervention that implemented established recommendations ( n = 268 ) ; ( 2 ) " established plus DASH,"which also implemented the DASH diet ( n = 269 ) ; and ( 3 ) an " advice only " comparison group ( n = 273 ) . MAIN OUTCOME MEASURES Blood pressure measurement and hypertension status at 6 months . RESULTS Both behavioral interventions significantly reduced weight , improved fitness , and lowered sodium intake . The established plus DASH intervention also increased fruit , vegetable , and dairy intake . Across the groups , gradients in BP and hypertensive status were evident . After subtracting change in advice only , the mean net reduction in systolic BP was 3.7 mm Hg ( P<.001 ) in the established group and 4.3 mm Hg ( P<.001 ) in the established plus DASH group ; the systolic BP difference between the established and established plus DASH groups was 0.6 mm Hg ( P = .43 ) . Compared with the baseline hypertension prevalence of 38 % , the prevalence at 6 months was 26 % in the advice only group , 17 % in the established group ( P = .01 compared with the advice only group ) , and 12 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .12 compared with the established group ) . The prevalence of optimal BP ( < 120 mm Hg systolic and < 80 mm Hg diastolic ) was 19 % in the advice only group , 30 % in the established group ( P = .005 compared with the advice only group ) , and 35 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .24 compared with the established group ) . CONCLUSION Individuals with above-optimal BP , including stage 1 hypertension , can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk Background The adoption and maintenance of healthy behaviours is essential in the primary prevention of chronic non-communicable diseases . This study evaluated the effectiveness of a minimal intervention on multiple  lifestyle factors such as  diet , physical activity , smoking and alcohol  , delivered through general practice , using computer-tailored feedback . Methods Adult patients visiting 21 general practitioners in Brisbane , Australia , were surveyed about ten health behaviours that are risk factors for chronic , non-communicable diseases . Those who completed the self-administered baseline question naire entered a r and omised controlled trial , with the intervention group receiving computer-tailored printed advice , targeting those health behaviours for which respondents were not meeting current recommendations . The primary outcome was change in summary lifestyle score ( Prudence Score ) and individual health behaviours at three months . A repeated measures analysis compared change in these outcomes in intervention and control groups after adjusting for age and education . Results 2306 patients were r and omised into the trial . 1711 ( 76 % ) returned the follow-up question naire at 3 months . The Prudence Score ( 10 items ) in the intervention group at baseline was 5.88 , improving to 6.25 at 3 months ( improvement = 0.37 ) , compared with 5.84 to 5.96 ( improvement = 0.12 ) in the control group ( F = 13.3 , p = 0.01 ) . The intervention group showed improvement in meeting recommendations for all individual health behaviours compared with the control group . However , these differences were significant only for fish intake ( OR 1.37 , 95 % CI 1.11 - 1.68 ) , salt intake ( OR 1.19 , 95 % CI 1.05 - 1.38 ) , and type of spread used ( OR 1.28 , 95 % CI 1.06 - 1.51 ) . Conclusion A minimal intervention using computer-tailored feedback to address multiple lifestyle behaviours can facilitate change and improve unhealthy behaviours . Although individual behaviour changes were modest , when implemented on a large scale through general practice , this intervention appears to be an effective and practical tool for population -wide primary prevention . Trial Registration The Australian New Zeal and Clinical Trials Registry : BACKGROUND Healthy lifestyle behaviors are among the cornerstones of diabetes self-management , but the extent to which healthy lifestyle factors could potentially prevent premature mortality among people with diabetes remains unknown . The aim of the present study was to estimate the reduction in mortality that could be achieved if people with diabetes did not smoke , had a body mass index < 30 kg/m(2 ) , performed physical activity for ≥3.5 h/week , reported better dietary habits , and consumed alcohol moderately . METHODS A prospect i ve cohort study of 1263 German men and women with diabetes aged 35 - 65 years who were followed for an average of 7.8 years was used and multivariate Cox regression models for all-cause and cause-specific mortality were calculated . RESULTS Approximately 7 % of study participants had no favorable factors , 24 % had one , 35 % had two , and 34 % had three or more . Compared with participants who had no favorable factors , the reduction in risk was 34 % [ 95 % confidence interval ( CI ) 19 % , 63 % ] for those with one favorable factor , 49 % ( 95 % CI 9 % , 71 % ) for those with two , and 63 % ( 95 % CI 31 % , 80 % ) for those with three or more . Furthermore , a competing risk analysis did not show any difference in the inverse associations with mortality due to cardiovascular disease , cancer , or other causes . CONCLUSIONS Favorable lifestyle factors can potentially achieve substantial reductions in premature mortality among people with diabetes . Our results emphasize the importance of helping people with diabetes optimize their lifestyle behaviors BACKGROUND Gallstones are a highly prevalent condition ; however , the nutritional and lifestyle risk factors of this disease are not well understood . OBJECTIVE We evaluated the association between  diet , physical activity  , and incident cases of gallstones diagnosed by ultrasound in a population -based , case-control study . DESIGN One hundred patients with newly diagnosed gallstones and 290 r and omly selected control subjects without gallstones were enrolled in the study . The presence of gallstones was determined by ultrasonography . Both patients and control subjects completed a question naire about their usual diet and physical activity for the 12 mo before the ultrasonography . The association between  diet and physical activity and risk of gallstone formation was analyzed by using multiple logistic regression . RESULTS Body mass index and intake of refined sugars were directly associated with risk of gallstone formation , whereas physical activity , dietary monounsaturated fats , dietary cholesterol , and dietary fibers from cellulose  were inversely associated with risk of gallstone formation . Saturated fats were a risk factor for gallstone formation and the association appeared to be stronger for men than for women . CONCLUSION These findings suggest that a sedentary lifestyle and a diet rich in animal fats and refined sugars and poor in vegetable fats and fibers are significant risk factors for gallstone formation BACKGROUND Epidemiologic data on the combined influence of several lifestyle factors on diabetes risk are rare , particularly among older adults . OBJECTIVE To examine how combinations of lifestyle risk factors relate to the 11-year risk for incident diabetes . DESIGN Population -based prospect i ve cohort study . SETTING National Institutes of Health (NIH)-AARP Diet and Health Study . PARTICIPANTS 114,996 men and 92,483 women , aged 50 to 71 years in 1995 to 1996 , without evidence of heart disease , cancer , or diabetes . MEASUREMENTS A comprehensive survey of demographic characteristics and lifestyle factors  , including dietary intake , body weight and height , physical activity , smoking , and alcohol consumption  at baseline ( 1995 to 1996 ) . Low-risk groups were formed by dichotomizing each lifestyle factor . Incident self-reported , physician-diagnosed diabetes was identified with a follow-up survey in 2004 to 2006 . RESULTS 11,031 men ( 9.6 % ) and 6969 women ( 7.5 % ) developed new-onset diabetes . For each additional lifestyle factor in the low-risk group , the odds for diabetes were 31 % lower ( odds ratio [ OR ] , 0.69 [ 95 % CI , 0.68 to 0.71 ] ) among men and 39 % lower ( OR , 0.61 [ CI , 0.60 to 0.63 ] ) among women . Men and women whose diet score , physical activity level , smoking status , and alcohol use were all in the low-risk group had ORs for diabetes of 0.61 ( CI , 0.56 to 0.66 ) and 0.43 ( CI , 0.34 to 0.55 ) , respectively . When absence of overweight or obesity was added , the respective ORs were 0.28 ( CI , 0.23 to 0.34 ) and 0.16 ( CI , 0.10 to 0.24 ) for men and women . Results did not differ by family history of diabetes or level of adiposity . LIMITATION The study was observational , with potential for residual confounding . CONCLUSION Lifestyle factors , when considered in combination , are associated with a substantial reduction in risk for diabetes . PRIMARY FUNDING SOURCE The NIH-AARP Diet and Health Study was supported by the Intramural Research Program of the NIH PURPOSE Whilst the health benefits associated with regular physical activity are well known , little objective evidence exists regarding the activity profiles of adults with mild and moderate learning disabilities . The aims of the present study were to establish 7 day physical activity profiles for 24 adults with mild and moderate learning disabilities and to compare them with the general population and current Department of Health recommendations for physical activity . METHOD A descriptive study was used , based on interviews with 24 adults with learning disabilities ( mean age 34 years ) triangulated by daytime and residential care workers . Participants volunteered from two residential homes and one social education centre ( SEC ) in a city in the North of Engl and . RESULTS The physical activity profiles show that the participants led sedentary lifestyles that were more exaggerated than those of the general population . Twenty-two participants ( 93 % ) performed significantly less than the minimum daily levels of physical activity recommended by the Department of Health . CONCLUSIONS Few adults with learning disabilities can choose to walk to work , go for a run or visit the local swimming pool without adequate support . This study suggests that there may not be enough moderate or vigorous physical activity choices available in day and residential care setting s to empower adults with mild and moderate learning disabilities to meet the minimum recommendations of the Department of Health . Hence some people with learning disabilities have no alternatives to a sedentary lifestyle and the health risks associated with physical inactivity BACKGROUND Tobacco use , unhealthy diet , physical inactivity , and risky alcohol use are leading causes of preventable death . As there are many barriers that prevent primary care clinicians from effectively assisting patients with these behaviors , connecting patients with health behavior re sources may reduce these unhealthy behaviors . METHODS A new adjunct role in primary care practice , the community health educator referral liaison ( CHERL ) , was tested in 15 practice s in three Michigan communities . All practice s were advised how to access this liaison , and nine practice s were r and omly selected to receive support to develop a systematic referral process . Adult patients needing improvement in at least one of the four unhealthy behaviors were eligible for referral . The CHERL contacted referred patients by telephone ; assessed health risks ; provided health behavior-change counseling , referral to other re sources , or both ; and sent patient progress reports to referring clinicians . Data were collected from February 2006 through July 2007 . RESULTS The CHERLs received 797 referrals over 8 months , a referral rate of 0%-2 % per practice . Among referred patients , 55 % enrolled , and 61 % of those participated in multiple-session telephone counseling ; 85 % were referred to additional re sources . Among patients enrolling , improvements ( p<0.001 ) were reported at 6 months for BMI , dietary patterns , alcohol use , tobacco use , health status , and days of limited activity in the past month . CONCLUSIONS The results of this study suggest that through relationships with practice s , patients , and community re sources , these liaisons successfully facilitated patients ' behavior change . The CHERL role may fill a gap in promoting healthy behaviors in primary care practice s and merits further exploration BACKGROUND Low-income Latinas ( Hispanics ) face risk for cardiovascular disease due to high rates of overweight/obesity , sedentary lifestyle , and other factors . Limited access to health care and language barriers may prevent delivery of health promotion messages . Targeted approaches , including the integration of community health workers , may be required to promote healthy lifestyle and prevent chronic disease in underserved ethnic minority groups . The term commonly used to refer to female community health workers in Latino communities is " promotora(s ) . " OBJECTIVES This study evaluates the outcomes and feasibility of a promotora-led lifestyle behavior intervention for overweight , immigrant Latinas . METHODS A community prevention model was employed in planning and implementing this study . A r and omized controlled trial design was used . A Community Advisory Board provided expertise in evaluating feasibility of study implementation in the community and other important guidance . The sample was comprised of 223 women aged 35 - 64 years , predominantly with low income and ≤8th grade education . The culturally tailored Lifestyle Behavior Intervention included group education ( 8 classes based upon Su Corazon , Su Vida ) , followed by 4 months of individual teaching and coaching ( home visits and telephone calls ) . The control group received a comparable length educational program and follow-up contacts . Evaluations were conducted at baseline and at 6 and 9 months using a dietary habits question naire , accelerometer readings of physical activity , and clinical measures ( body mass index , weight , waist circumference , blood pressure , lipids , blood glucose ) . Data were collected between January 2010 and August 2012 . RESULTS Women in the intervention group improved significantly in dietary habits , waist circumference , and physical activity in comparison to those in the control group . A treatment dosage effect was observed for weight and waist circumference . Knowledge about heart disease increased . High attendance at classes and participation in the individual teaching and counseling sessions and high retention rates support the feasibility and acceptability of the promotora-led lifestyle behavior intervention . CONCLUSIONS Our findings demonstrate that lifestyle behaviors and other risk factors of overweight Latina women may be improved through a promotora-led lifestyle behavior intervention . Feasibility of implementing this intervention in community setting s and engaging promotoras as facilitators is supported BACKGROUND Whereas much is known about single lifestyle-related health risk factor prevalence and covariates , more research is needed to eluci date the interactions among multiple healthy lifestyle factors and variables that may predict adherence to these factors . Such data may guide both clinical and health policy decision making and person-centered approaches to population health improvement . METHODS We document the prevalence and cluster patterns of multiple healthy lifestyle factors among a r and om sample of adolescents ( n = 616 ) , adults ( n = 585 ) , and seniors ( n = 685 ) from a large Midwestern health plan . Modifiable , lifestyle-related health factors assessed included  physical activity , nonsmoking , high- quality diet , and healthy weight for all subjects ; adults and seniors were also asked about their alcohol consumption . Second , we sought to identify characteristics associated with the likelihood of meeting recommendations for healthy lifestyle factors . The healthy lifestyle factors sum score was categorized into three levels , that is , 0 to 2 , 3 , or 4 to 5 healthy lifestyle factors ( 4 for adolescents ) , and we used ordinal logistic regression to estimate the odds of meeting each of these criteria from several demographic characteristics and disease states . RESULTS Overall , only 14.5 % of adolescent , adult , and senior health plan members meet recommended guidelines for four common healthy lifestyle factors . Only 10.8 % of adults and 12.8 % of seniors met all five behavior-related factors . For adolescents , only being nondepressed was associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors  ( odds ratio [OR]=2.15 ; p < 0.05 ) . For adults , being in the 50- to 64-year-old cohort ( OR=1.46 , p<0.05 ) , having a college degree ( OR=1.65 ; p < 0.05 ) , and having no chronic disease ( OR=1.92 ; p < 0.05 ) were all associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors . For seniors , having a college degree ( OR=1.61 ; p < 0.05 ) , was the only variable associated with an increased likelihood to be in adherence to multiple healthy lifestyle factors . CONCLUSIONS A small proportion of health plan members meet multiple recommended healthy lifestyle guidelines at once . This analysis identifies population subgroups of specific interest and importance based on adherence to multiple healthy lifestyle factors , and predictors for increased likelihood to be in adherence to multiple healthy lifestyle factors . It presents a potentially useful summary measure based on person-centered measures of healthy lifestyle factors . Clinicians may derive meaningful information from analyses that address adherence to multiple healthy lifestyle factors . Health systems administrators may use this information to influence health policy and re source allocation decisions . Further studies are needed to assess the usefulness of this comprehensive lifestyle-related health measure as a metric of progress toward public health goals , or as a clinical metric that conveys information on future health status and directs interventions at the individual level Although obesity affects all cultures , ethnic groups and social strata , this disorder affects African Americans , Hispanics and the poor at a disproportionate rate . The Downstart Pediatric Healthy Lifestyle Program was developed to provide a multi-disciplinary behavioral modification program for inner city families in Brooklyn , New York interested in leading a healthier , more active lifestyle . The Downstart Program uses a four-pronged approach of medical evaluation , exercise , nutritional education and lifestyle modification . A psychological evaluation is performed to determine the individual 's ability and readiness to participate in group activities . Baseline physical fitness , flexibility and muscle strength are measured , followed by a twice-weekly karate/martial arts/dance program , incorporating principles established by the President 's Council on Exercise . Nutritional and behavioral modification aspects of the program consist of weekly education about food groups , portion control , goal setting and appropriate rewards for attaining goals . Our preliminary results indicate that the Downstart Program may be a viable intervention for weight loss . Further study is needed to improve strategies for motivating patients and means and criteria for assessing long-term effects on health and lifestyle Type 2 diabetes is a chronic illness that is increasing in epidemic proportions worldwide . Major factors contributing to the development of type 2 diabetes include obesity and poor lifestyle habits ( e.g. , excess dietary intake and limited physical activity ) . Despite the proven efficacy of lifestyle interventions and the use of multiple pharmacological agents , the economic and public health burden of type 2 diabetes remains substantial .  Obstructive sleep apnea ( OSA ) is a treatable sleep disorder that is pervasive among overweight and obese adults , who represent about two thirds of the U.S. population today . An ever-growing number of studies have shown that OSA is associated with insulin resistance , glucose intolerance and type 2 diabetes , independent of obesity . Evidence from animal and human models that mimic OSA provides potential mechanisms for how OSA may alter glucose metabolism . Up to 83 % of patients with type 2 diabetes suffer from unrecognized OSA and increasing severity of OSA is associated with worsening glucose control . However , it is still unclear whether OSA may lead to the development of diabetes over time . More data from large-scale longitudinal studies with rigorous assessment s of diabetes and OSA are needed . In addition , there is still controversy whether continuous positive airway pressure ( CPAP ) treatment of OSA  improves glucose metabolism . Large-scale r and omized-controlled trials of CPAP treatment of OSA with well-vali date d assessment s of insulin sensitivity and glucose tolerance are needed . These studies may reveal that OSA represents a novel , modifiable risk factor for the development of prediabetes and type 2 diabetes Overweight and physical inactivity are risk factors for increased disease burden and health care expenditure . Well- design ed studies are still needed to determine the treatment efficacy of worksite interventions targeting such risk factors . This r and omized controlled trial was conducted at one of Australia 's casinos in 2002 - 2003 , to investigate the effects of a comprehensive exercise and lifestyle intervention on physical fitness . Only 6.4 % of the workforce expressed interest in being study participants . Seventy-three employees ( aged 32 + /- 8 years , 51 % overweight/obese , 73 % shift workers and 52 % women ) were recruited and r and omized to treatment or wait-list control groups for 24 weeks , 44 of whom completed the intervention . Components of the intervention include supervised moderate-to-high intensity exercise including combined aerobic ( at least 20 min duration 3 days/week ) and weight-training ( for an estimated 30 min completed 2 - 3 days/week ) , and dietary/health education ( delivered via group seminars , one-on-one counselling and literature through the provision of a worksite manual ) . ANCOVA , by intention-to-treat and of study completers , found significant between-group differences in the mean waist circumference and predicted maximal oxygen uptake ( VO2max ) , favouring the intervention , but effects were concentrated in one subject . For study completers , between-group differences in the mean waist circumference ( 82.3 + /- 9.2 versus 90.5 + /- 17.8 cm , p = 0.01 ) and predicted VO2max ( 47 versus 41 ml/kg/min , p < 0.001 ) remained significant without the outlier , favouring the intervention . Higher intervention compliance predicted greater improvements in physical fitness . No significant effects on body mass or body mass index were found . This worksite intervention significantly improved waist circumference and aerobic fitness in healthy but sedentary employees , most of whom were shift workers .  Worksite interventions have the potential to counter the increasing burden of overweight and obesity , particularly visceral adiposity , as well as physical inactivity ; however , substantial barriers to adoption/adherence need to be overcome for greater feasibility and impact on employee physical health Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 Latinas with type 2 diabetes are in need of culturally sensitive interventions to make recommended long-term lifestyle changes and reduce heart disease risk . To test the longer-term ( 24-month ) effects of a previously successful , culturally adapted , multiple-health-behavior-change program , ¡ Viva Bien ! , 280 Latinas were r and omly assigned to usual care or ¡ Viva Bien!.  Treatment included group meetings to promote a culturally adapted Mediterranean diet , physical activity , supportive re sources , problem solving , stress-management practice s , and smoking cessation . ¡ Viva Bien ! participants achieved and maintained some lifestyle improvements from baseline through 24 months , including significant improvements for psychosocial outcomes , fat intake , social – environmental support , body mass index , and hemoglobin A1c . Effects tended to diminish over time . The ¡ Viva Bien ! multiple-behavior program was effective in improving and maintaining some psychosocial , behavioral , and biological outcomes related to heart health across 24 months for Latinas with type 2 diabetes , a high-risk , underserved population ( Clinical Trials.gov number , NCT00233259 ) BACKGROUND Although historically Alaska Native women have had a relatively low incidence of cardiovascular disease ( CVD ) , this pattern has changed dramatically in recent years . Alaska Native leaders have identified decreasing cardiovascular risk as an intervention priority . METHODS From October 2000 to April 2001 , South central Foundation , an Alaska Native-owned and managed health corporation in Anchorage , conducted a pilot r and omized controlled trial of a heart disease prevention program tailored for Alaska Native women . The aim was to assess feasibility and cultural acceptability and to develop enrollment procedures . Of 76 women who enrolled , 44 were r and omized to the intervention group . Thirty-seven of 44 attended at least two intervention sessions , 23 completed pre question naires and post question naires , and 27 returned for 12-month follow-up screening . Thirty of 32 control group participants returned for 12-month follow-up screening . The intervention included 12 weekly sessions on lifestyle change and goal setting . At baseline and 12 months , participants ' height , weight , resting blood pressure , fasting lipid levels , and blood glucose were measured . At sessions 1 and 12 , participants completed assessment s regarding diet , physical activity , tobacco use , and psychosocial status . RESULTS At 12 weeks , significant improvements were noted in moderate walking and physical activity self-efficacy . Also observed was substantial movement from the contemplation and preparation stages to the action stage regarding physical activity and heart-healthy eating . CONCLUSIONS Although the small sample size precludes drawing conclusions about the intervention 's effect , participants reported lifestyle and psychosocial changes . The pilot study result ed in protocol changes that improved the design and implementation of a subsequent large-scale study BACKGROUND It has been suggested that the inverse association between alcohol and type 2 diabetes could be explained by moderate drinkers ' healthier lifestyles . OBJECTIVE We studied whether moderate alcohol consumption is associated with a lower risk of type 2 diabetes in adults with combined low-risk lifestyle behaviors . DESIGN We prospect ively examined 35,625 adults of the Dutch European Prospect i ve Investigation into Cancer and Nutrition ( EPIC-NL ) cohort aged 20 - 70 y , who were free of diabetes , cardiovascular disease , and cancer at baseline ( 1993 - 1997 ) . In addition to moderate alcohol consumption ( women : 5.0 - 14.9 g/d ; men : 5.0 - 29.9 g/d ) , we defined low-risk categories of 4 lifestyle behaviors : optimal weight [ body mass index ( in kg/m(2 ) ) < 25 ] , physically active ( > or = 30 min of physical activity/d ) , current nonsmoker , and a healthy diet [ upper 2 quintiles of the Dietary Approaches to Stop Hypertension ( DASH ) diet ] . RESULTS During a median of 10.3 y , we identified 796 incident cases of type 2 diabetes . Compared with teetotalers , hazard ratios of moderate alcohol consumers for risk of type 2 diabetes in low-risk lifestyle strata after multivariable adjustments were 0.35 ( 95 % CI : 0.17 , 0.72 ) when of a normal weight , 0.65 ( 95 % CI : 0.46 , 0.91 ) when physically active , 0.54 ( 95 % CI : 0.41 , 0.71 ) when nonsmoking , and 0.57 ( 95 % CI : 0.39 , 0.84 ) when consuming a healthy diet . When > or =3 low-risk lifestyle behaviors were combined , the hazard ratio for incidence of type 2 diabetes in moderate alcohol consumers after multivariable adjustments was 0.56 ( 95 % CI : 0.32 , 1.00 ) . CONCLUSION In subjects already at lower risk of type 2 diabetes on the basis of multiple low-risk lifestyle behaviors , moderate alcohol consumption was associated with an approximately 40 % lower risk compared with abstention AIMS AND BACKGROUND The DIANA ( Diet and And rogens)-5 study is a multi-institutional r and omized controlled trial of the effectiveness of a diet based on Mediterranean and macrobiotic recipes and principles , associated with moderate physical activity , in reducing additional breast cancer events in women with early stage invasive breast cancer at high risk of recurrence because of metabolic or endocrine milieu . The intervention is expected to reduce serum insulin and sex hormones , which were associated with breast prognosis in previous studies . METHODS Between 2008 and 2010 , the study r and omly assigned 1208 patients to an intensive diet and exercise intervention or to a comparison group , to be followed-up through 2015 . General lifestyle recommendations for the prevention of cancer are given to both groups , and the intervention group is being offered a comprehensive lifestyle intervention , including cooking classes , conferences , common meals and exercise sessions . Adherence assessment s occurred at baseline and at 12 months and are planned at 36 and 60 months . They include food frequency diaries , anthropometric measures , body fat distribution assessed with impedance scale , one week registration of physical activity with a multisensor arm-b and monitor , metabolic and endocrine blood parameters . Outcome breast cancer events are assessed through self report at semi annual meetings or telephone interview and are vali date d through medical record verification . RESULTS The r and omized groups were comparable for age ( 51.8 years ) , proportion of ER-negative tumors ( 22 % ) , axillary node metastasis ( 42 % ) , reproductive variables , tobacco smoking , blood pressure , anthropometric measurements and hormonal and metabolic parameters . CONCLUSIONS DIANA-5 has the potential to establish whether a Mediterranean-macrobiotic lifestyle may reduce breast cancer recurrences . We will assess evidence of effectiveness , first by comparing the incidence of additional breast cancer events ( local or distant recurrence , second ipsilateral or contralateral cancer ) in the intervention and in the control group , by an intention-to-treat analysis , and second by analyzing the incidence of breast cancer events in the total study population by compliance assessment score The purpose of the study was to compare the effectiveness of programmed and intensified intervention on lifestyle changes , including physical activity , cigarette smoking , alcohol consumption and diet , in patients aged ≥ 65 with the usual care of general practitioners ( GP ) . In this multicenter r and omized controlled trial , 738 patients aged ≥ 65 were r and omly assigned to receive intensified intervention ( N = 371 ) or usual care ( N = 367 ) of a GP for lifestyle changes , with 18-month follow-up . The main outcome measures were physical activity , smoking , alcohol consumption and diet . The study was conducted in 59 general practice s in Croatia between May 2008 and May 2010 . The patients ' mean age was 72.3 ± 5.2 years . Significant diet correction was achieved after 18-month follow-up in the intervention group , comparing to controls . More patients followed strictly Mediterranean diet and consumed healthy foods more frequently . There was no significant difference between the groups in physical activity , tobacco smoking and alcohol consumption or diet after the intervention . In conclusion , an 18-month intensified GP 's intervention had limited effect on lifestyle habits . GP intervention managed to change dietary habits in elderly population , which is encouraging since elderly population is very resistant regarding lifestyle habit changes . Clinical trial registration number . IS RCT N31857696 The incidence of prostate cancer is much lower in Asian than in Western population s. Lifestyle and dietary habits may play a major role in the etiology of this cancer . Given the possibility that risk factors for prostate cancer differ by disease aggressiveness , and the fact that 5-year relative survival rate of localized prostate cancer is 100 % , identifying preventive factors against advanced prostate cancer is an important goal . Using data from the Japan Public Health Center-based Prospect i ve Study , the author eluci date s various lifestyle risk factors for prostate cancer among Japanese men . The results show that abstinence from alcohol and tobacco might be important factors in the prevention of advanced prostate cancer . Moreover , the isoflavones and green tea intake in the typical Japanese diet may decrease the risk of localized and advanced prostate cancers , respectively Background Women with gestational diabetes ( GDM ) are at high risk of developing diabetes later in life . After a GDM diagnosis , women receive prenatal care to control their blood glucose levels via diet , physical activity and medications . Continuing such lifestyle skills into early motherhood may reduce the risk of diabetes in this high risk population . In the Gestational Diabetes ’ Effects on Moms ( GEM ) study , we are evaluating the comparative effectiveness of diabetes prevention strategies for weight management design ed for pregnant/postpartum women with GDM and delivered at the health system level . Methods / Design The GEM study is a pragmatic cluster r and omized clinical trial of 44 medical facilities at Kaiser Permanente Northern California r and omly assigned to either the intervention or usual care conditions , that includes 2,320 women with a GDM diagnosis between March 27 , 2011 and March 30 , 2012 . A Diabetes Prevention Program-derived print/telephone lifestyle intervention of 13 telephonic sessions tailored to pregnant/postpartum women was developed . The effectiveness of this intervention added to usual care is to be compared to usual care practice s alone , which includes two pages of printed lifestyle recommendations sent to postpartum women via mail . Primary outcomes include the proportion of women who reach a postpartum weight goal and total weight change . Secondary outcomes include postpartum glycemia , blood pressure , depression , percent of calories from fat , total caloric intake and physical activity levels . Data were collected through electronic medical records and surveys at baseline ( soon after GDM diagnosis ) , 6 weeks ( range 2 to 11 weeks ) , 6 months ( range 12 to 34 weeks ) and 12 months postpartum ( range 35 to 64 weeks ) . Discussion There is a need for evidence regarding the effectiveness of lifestyle modification for the prevention of diabetes in women with GDM , as well as confirmation that a diabetes prevention program delivered at the health system level is able to successfully reach this population . Given the use of a telephonic case management model , our Diabetes Prevention Program-derived print/telephone intervention has the potential to be adopted in other setting s and to inform policies to promote the prevention of diabetes among women with GDM.Trial registration Clinical Trials.gov number , NCT01344278 Purpose The purpose of this article is to describe efforts to develop and administer a formal curriculum to train community workers to deliver a group-based adaptation of the Diabetes Prevention Program ( DPP ) lifestyle intervention in YMCA setting s. The DPP demonstrated that a structured diet and physical activity intervention that achieves and maintains modest weight loss for overweight adults with impaired glucose tolerance can significantly reduce the development of diabetes . Although tens of millions of American adults could benefit from access to the DPP lifestyle intervention , there currently is no available model for nationwide dissemination of this highly beneficial and cost-effective approach to diabetes prevention . A description of 2 ongoing r and omized pilot studies provides information about the feasibility and effectiveness of future efforts to apply this new training curriculum on a national scale . Conclusions Diabetes educators are challenged to partner with community organizations and other health care workers for extensive distribution of the DPP lifestyle intervention messages Objective To evaluate the impact of combinations of lifestyle factors on  mortality in middle aged women . Design Prospect i ve cohort study . Setting Nurses ’ health study , United States . Participants 77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980 . Main outcome measure Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors ( cigarette smoking , being overweight , taking little moderate to vigorous physical activity , no light to moderate alcohol intake , and low diet quality score ) . Results 8882 deaths were documented , including 1790 from cardiovascular disease and 4527 from cancer . Each lifestyle factor independently and significantly predicted mortality . Relative risks for five compared with zero lifestyle risk factors were 3.26 ( 95 % confidence interval 2.45 to 4.34 ) for cancer mortality , 8.17 ( 4.96 to 13.47 ) for cardiovascular mortality , and 4.31 ( 3.51 to 5.31 ) for all cause mortality . A total of 28 % ( 25 % to 31 % ) of deaths during follow-up could be attributed to smoking and 55 % ( 47 % to 62 % ) to the combination of smoking , being overweight , lack of physical activity , and a low diet quality . Additionally considering alcohol intake did not substantially change this estimate . Conclusions These results indicate that adherence to lifestyle guidelines is associated with markedly lower  mortality in middle aged women . Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified INTRODUCTION Shift work ( an occupation requiring work between 2200 and 0500H ) comprises approximately 20 % of the workforce in Europe and North America [ 1 ] . This is likely to increase , with many shift workers ( SWs ) in emergency services , retail , hospitality , healthcare , transportation and manufacturing [ 2 ] . SWs are at increased risk for negative health outcomes , including cancer and other chronic diseases [ 3 , 4 ] . Biological changes from poor lifestyle habits related to shift work ( e.g. low physical activity ( PA ) , poor nutrition , obesity ) are thought to contribute to this risk ; these factors are also amenable to lifestyle intervention [ 5 ] . PA in particular , reduces cancer risk [ 6 ] , and has many positive physical and psychological benefits [ 7 ] . It is a simple , cost-effective strategy that may be implemented by individual workers or within workplaces to mitigate risk . Unfortunately , SWs are unlikely to engage in regular PA [ 8 ] . In Canada , only 15.9 % of SWsmeet the PA guidelines and have lower levels of aerobic fitness than those of day workers [ 9 ] . Few behavioural interventions improving health outcomes in SWs have been published [ 10 ] . In a targeted PA intervention , nurses r and omised to 4 months of supervised PA  improved aerobic fitness , muscular strength , fatigue and musculoskeletal symptoms . However , authors reported low adherence and large loss to follow-up , perhaps due to the supervised scheduled sessions [ 11 , 12 ] . Sustained behaviour change is a challenge and requires targeted efforts to encourage individuals to reach an adequate dose of PA to change health outcomes [ 13 ] . Due to irregular schedules and time constraints , SWs may be less likely to adhere to a traditional supervised PA intervention with face-to-face behavioural support [ 12 ] . Women SWs cite work schedule interference and lack of time as PA barriers and report scheduling flexibility as the most important in PA [ 14 ] . This highlights the need for a creative and innovative programming to promote PA in SWs . Distance-based interventions , in which individuals exercise independent of study staff or participants , may include telephone counselling and website or smart phone app-based technology . These interventions are highly flexible and may help overcome barriers related to timing and scheduling that are important for SWs . In a review of telephone-based PA interventions , 14 of 17 found evidence for behaviour change [ 15 ] . These may be a way to implement scalable , individuallytailored interventions in SWs . The primary objective of this study was to test the feasibility of a distance-based PA intervention in women SWs . Feasibility studies are important for establishing effective processes and underst and ing re sources required before attempting a r and omised controlled trial ( RCT ) , in order to put forward interventions that are most likely to be efficacious [ 16 ] . As this work was funded by a grant to examine the role of lifestyle in reducing breast cancer risk in SWs , only women were included . A secondary objective was to conduct a preliminary evaluation of intervention efficacy , to estimate effect size for future studies The objective of this study was to characterize adults in Olmsted County , MN who were attempting to change both their dietary and physical activity habits . A r and om digit-dial telephone survey was taken of 1232 adults , with questions about lifestyle , medical conditions , demographics , and receipt of previous lifestyle advice from a health care professional .  Respondents were grouped in four categories : 1 ) changing neither diet nor exercise habits ( 22 % ) ; 2 ) changing diet habits only ( 20 % ) ; 3 ) changing exercise habits only ( 9 % ) ; and 4 ) changing both diet and exercise habits ( 49 % ) . Along with several demographic and behavioral factors , receipt of physician advice to change exercise and dietary habits was a strong predictor of attempts to change both lifestyle habits . Only a minority of the population ( 23 % ) , however , reported having received such advice . These results support the positive impact of health professional advice on dietary and exercise change in the population . Public health campaigns should be aim ed at increasing the provision of such advice Background The prevention of  type 2 diabetes  is a recognised health care priority globally . Within the United Kingdom , there is a lack of research investigating optimal methods of translating diabetes prevention programmes , based on the promotion of a healthy lifestyle , into routine primary care . This study aims to establish the behavioural and clinical effectiveness of a structured educational programme design ed to target perceptions and knowledge of diabetes risk and promote a healthily lifestyle , particularly increased walking activity , in a multi-ethnic population at a high risk of developing type 2 diabetes . Design Cluster r and omised controlled trial undertaken at the level of primary care practice s. Follow-up will be conducted at 12 , 24 and 36 months . The primary outcome is change in objective ly measured ambulatory activity . Secondary outcomes include progression to type 2 diabetes , biochemical variables ( including fasting glucose , 2-h glucose , HbA1c and lipids ) , anthropometric variables , quality of life and depression . Methods 10 primary care practice s will be recruited to the study ( 5 intervention , 5 control ) . Within each practice , individuals at high risk of impaired glucose regulation will be identified using an automated version of the Leicester Risk Assessment tool . Individuals scoring within the 90th percentile in each practice will be invited to take part in the study . Practice s will be assigned to either the control group ( advice leaflet ) or the intervention group , in which participants will be invited to attend a 3 hour structured educational programme design ed to promote physical activity and a healthy lifestyle . Participants in the intervention practice s will also be invited to attend annual group-based maintenance workshops and will receive telephone contact halfway between annual sessions . The study will run from 2010–2014 . Discussion This study will provide new evidence surrounding the long-term effectiveness of a diabetes prevention programme run within routine primary care in the United Kingdom . Trial Registration Clinical Trials . Gov identifier :
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 .