Lifestyle-Based Primary-Prevention Program Results in Weight Loss, Other Changes

May 04, 2012

May 4, 2012 (Dublin, Ireland) — An aggressive and comprehensive cardiac rehabilitation program by clinicians in the west of Ireland resulted in significant reductions in body weight and improved other lifestyle behaviors in a cohort of patients and their partners at high risk for cardiovascular disease events.

The multidisciplinary program includes physicians, nurses, physical-activity specialists, social workers, dieticians, and targeted patients referred by family physicians as high risk for cardiovascular events based on their risk-factor profile. The results of the study, which included changes in diet and physical-activity levels, were presented this week here at EuroPrevent 2012 by Dr Gerard Flaherty (National University of Galway, Ireland).

Dr Gerard Flaherty

"We would hope that policymakers would be influenced by the success of the program and by its inherent simplicity," said Flaherty. "We hope that they would look to this as a useful model of prevention that they could employ in their own setting or perhaps in primary-care centers where there is a multidisciplinary team available."

The 12- to 16-week primary-prevention program included 296 patients and 143 partners or spouses. The family-based program was designed to alter the lifestyle behaviors of spouses/partners because aberrant behavior, especially in terms of diet and physical-activity patterns, tends to be shared, explained Flaherty.

Overall, mean body-mass index and waist-circumference measurements were reduced in the high-risk patients and their partners. In addition, there was greater adherence to the Mediterranean diet; a larger proportion of individuals reaching the daily recommended targets of fruit, vegetable, and fish consumption; and a reduction in salt use. There were dramatic improvements in physical-activity levels, with more than 60% of patients and their partners meeting the daily requirement for physical activity, up from 11% of patients and 20% of partners who were exercising before the intervention.

Summary of Outcomes for Patients and Partners

Variable Patients, baseline (n=296) Patients, end of program (n=296) p, from baseline Partners, baseline (n=143) Partners, end of program (n=143) p, from baseline
Mean BMI 33.3 31.8 <0.001 30.5 29.0 <0.001
Waist circumference (cm)            
Men 116 111 <0.001 113 108 <0.001
Women 108 103 <0.001 95 94 <0.001
Mean Mediterranean diet score 4.1 8.2 <0.001 4.3 8.6 <0.001
Percent achieving fruits/vegetables goal (>400 g/day) 10.9 37.9 <0.001 17.6 38.9 <0.001
Percent achieving physical activity targets 11.1 62.2 <0.001 20.1 61.1 <0.001

Speaking with heartwire , Flaherty said their group has data showing that patients continue to adhere to the lifestyle and behavioral recommendations out to one year. The group is conscious of the decay effect, where people drop off and stop the heart-healthy behaviors once the program is completed, so the community-based program has "step-down" physical-activity classes that the participants and their partners can participate in to maintain their physical-activity levels.

Flaherty noted that patients might not be ready to change their diet, start exercising, or stop other unhealthy habits after referral from the family physician, but they become more engaged in the rehabilitation program as time goes on. This is another reason the group might be seeing durable results at one year, he said.

In other data, also presented at EuroPrevent, Flaherty and his colleagues showed that the lifestyle-based primary-prevention program modestly increased HDL-cholesterol levels, findings that are in line with the increased physical-activity levels in this analysis [1]. Sustainable and simple, "this is a model of a primary-prevention practice that we would hope would be disseminated throughout Ireland," said Flaherty.


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