Randomised controlled trial of a healthy lifestyle intervention among smokers with psychotic disorders: Outcomes to 36 months Multiple health behaviors in an ethnically diverse sample of adults with risk factors for cardiovascular disease. Improving diet, physical activity and other lifestyle behaviours using computer-tailored advice in general practice: a randomised controlled trial Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study. Combined impact of traditional and non-traditional health behaviors on mortality: a national prospective cohort study in Spanish older adults Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: the United Kingdom health and lifestyle survey. Life-style and cancer: from epidemiological evidence to public behavior change to mortality reduction of target cancers. Knowledge of dietary and behaviour-related determinants of non-communicable disease in urban Senegalese women. Effects of Comprehensive Lifestyle Modification on Diet, Weight, Physical Fitness, and Blood Pressure Control: 18-Month Results of a Randomized Trial Prevalence of physical inactivity in nine rural INDEPTH Health and Demographic Surveillance Systems in five Asian countries Factors influencing consumer dietary health preventative behaviours The Behavioral and Clinical Effects of Therapeutic Lifestyle Change on Middle-aged Adults Change in lifestyle factors and their influence on health status and all-cause mortality. Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study. Behavioural risk factors for non communicable diseases among adults in Kerala, India. Combined effect of low-risk dietary and lifestyle behaviors in primary prevention of myocardial infarction in women. 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
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 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 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 : IMPORTANCE Little is known about adoption of healthy lifestyle behaviors among individuals with a coronary heart disease ( CHD ) or stroke event in communities across a range of countries worldwide . OBJECTIVE To examine the prevalence of avoidance or cessation of smoking , eating a healthy diet  , and undertaking regular physical activities  by individuals with a CHD or stroke event . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve Urban Rural Epidemiology ( PURE ) was a large , prospect i ve cohort study that used an epidemiological survey of 153,996 adults , aged 35 to 70 years , from 628 urban and rural communities in 3 high-income countries ( HIC ) , 7 upper-middle-income countries ( UMIC ) , 3 lower-middle-income countries ( LMIC ) , and 4 low-income countries ( LIC ) , who were enrolled between January 2003 and December 2009 . MAIN OUTCOME MEASURES Smoking status ( current , former , never ) , level of exercise ( low , < 600 metabolic equivalent task [MET]-min/wk ; moderate , 600 - 3000 MET-min/wk ; high , > 3000 MET-min/wk ) , and diet ( classified by the Food Frequency Question naire and defined using the Alternative Healthy Eating Index ) . RESULTS Among 7519 individuals with self-reported CHD ( past event : median , 5.0 [ interquartile range { IQR } , 2.0 - 10.0 ] years ago ) or stroke ( past event : median , 4.0 [ IQR , 2.0 - 8.0 ] years ago ) , 18.5 % ( 95 % CI , 17.6%-19.4 % ) continued to smoke ; only 35.1 % ( 95 % CI , 29.6%-41.0 % ) undertook high levels of work- or leisure-related physical activity , and 39.0 % ( 95 % CI , 30.0%-48.7 % ) had healthy diets ; 14.3 % ( 95 % CI , 11.7%-17.3 % ) did not undertake any of the 3 healthy lifestyle behaviors and 4.3 % ( 95 % CI , 3.1%-5.8 % ) had all 3 . Overall , 52.5 % ( 95 % CI , 50.7%-54.3 % ) quit smoking ( by income country classification : 74.9 % [ 95 % CI , 71.1%-78.6 % ] in HIC ; 56.5 % [ 95 % CI , 53.4%-58.6 % ] in UMIC ; 42.6 % [ 95 % CI , 39.6%-45.6 % ] in LMIC ; and 38.1 % [ 95 % CI , 33.1%-43.2 % ] in LIC ) . Levels of physical activity increased with increasing country income but this trend was not statistically significant . The lowest prevalence of eating healthy diets was in LIC ( 25.8 % ; 95 % CI , 13.0%-44.8 % ) compared with LMIC ( 43.2 % ; 95 % CI , 30.0%-57.4 % ) , UMIC ( 45.1 % , 95 % CI , 30.9%-60.1 % ) , and HIC ( 43.4 % , 95 % CI , 21.0%-68.7 % ) . CONCLUSION AND RELEVANCE Among a sample of patients with a CHD or stroke event from countries with varying income levels , the prevalence  of healthy lifestyle behaviors  was low , with even lower levels in poorer countries 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 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 Cigarette smoking , alcohol consumption , and diet are of essential importance in modulating risks of cancer of selected sites , as demonstrated by various epidemiological methods . Examples include demographic studies on changing cancer risk , correlation studies on dietary fat and cancers of breast and colon , and case-control studies on highly salted food and gastric cancer . Evidence was also obtained by cohort studies including a census- population -based large-scale prospect i ve study in Japan . Results included elevated risk from cigarette smoking for cancers of most sites ; from alcohol consumption for cancers of the upper and lower digestive tract , liver , and prostate ; and from daily  meat consumption  for cancers of the pancreas , colon , lung , and breast . Daily consumption of green-yellow vegetables  reduced risk for cancer of the stomach , colon , lung , cervix , and prostate . Reports of these results and intensive public education and public guidance by governmental and nongovernmental organizations such as cancer societies , consumer groups , and mass media result ed in a notable change in public behavior in most cases in Japan OBJECTIVE To assess knowledge of dietary and behaviour-related determinants of non-communicable disease ( NCD ) of urban Senegalese women . DESIGN A cross-sectional , population study using an interviewer-administered knowledge question naire , developed and vali date d for this study . The question naire consisted of 24 items with six scores measuring knowledge of : ( 1 )  diet- and behaviour-related causes of NCD ; ( 2 ) diet quality -NCD relationship ; ( 3 )  fruit and vegetable link with NCD ; ( 4 ) health consequences of obesity ; ( 5 ) causes of cardiovascular disease ( CVD ) ; and ( 6 ) causes of certain cancers . SUBJECTS A r and om sample of 301 women aged 20 - 50 years . RESULTS The knowledge scores developed suggest that the health consequences of obesity ( mean score of 65.4 % ) were best understood followed by causes of CVD ( mean score of 60.6 % ) , because obesity , smoking , high blood cholesterol and dietary fat were well recognised as risk factors for CVD . Subjects scored least for their knowledge of the protective effect of fruit and vegetables ( mean score of 19.9 % ) . Knowledge of causes of certain cancers ( mean score of 36.1 % ) was also low . Women who worked outside the home had better knowledge for two scores but otherwise no relationship was found between knowledge and literacy , formal education or body mass index . CONCLUSIONS Findings suggest reasonable overall knowledge concerning diet and behaviour with NCD , especially given the relatively new context of the obesity epidemic in Senegal . However , there was poor knowledge of the benefit of eating fruit and vegetables and other preventable causes of certain cancers . Education targeting the benefits of vegetables and fruit may have the greatest impact on NCD prevention 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 Background : Physical inactivity leads to higher morbidity and mortality from chronic non-communicable diseases ( NCDs ) such as stroke and heart disease . In high income countries , studies have measured the population level of physical activity , but comparable data are lacking from most low and middle-income countries . Objective : To assess the level of physical inactivity  and its associated factors in selected rural sites in five Asian countries . Methods : The multi-site cross-sectional study was conducted in nine rural Health and Demographic Surveillance System ( HDSS ) sites within the INDEPTH Network in Bangladesh , India , Indonesia , Thail and , and Vietnam . Using the methodology from the WHO STEPwise approach to Surveillance ( STEPS ) , about 2,000 men and women aged 25–64 years were selected r and omly from each HDSS sampling frame .  Physical activity at work and during leisure time , and on travel to and from places , was measured using the Global Physical Activity Question naire version 2 ( GPAQ2 ) . The total activity was calculated as the sum of the time spent in each domain of activities in metabolic equivalent-minutes per week , and was used to determine the level of physical activity . Multivariable logistic regression was used to assess demographic factors associated with a low level of physical activity . Results : The prevalence of physical inactivity ranged from 13 % in Chililab HDSS in Vietnam to 58 % in Filabavi HDSS in Vietnam . The majority of men  were physically active , except in the two sites in Vietnam . Most of the respondents walked or cycled for at least 10 minutes to get from place to place , with some exceptions in the HDSSs in Indonesia and Thail and . The majority of respondents , both men and women , were inactive during their leisure time . Women , older age , and high level of education were significantly associated with physical inactivity . Conclusion : This study showed that over 1/4 men and 1/3 women in Asian HDSSs within the INDEPTH Network are physically inactive . The wide fluctuations between the two HDSS in Vietnam offer an opportunity to explore further urbanisation and environmental impacts on physical activity . Considering the importance of physical activity in improving health and preventing chronic NCDs , efforts need to be made to promote physical activity particularly among women , older people , and high education groups in these setting Background The deterioration of the health status of the Romanian population during the economic transition from a central ly planned to a free market economy has been linked to lifestyles factors ( e.g. diet ) regarded as a main determinants of the disparity in life expectancy between Eastern and Western Europe . Reforms in the health care system in this transition economy aim to focus on preventive action . The purpose of this study was to identify the factors that impact on the individual decision to engage in  Dietary Health Preventive Behaviour  ( DHPB ) and investigate their influence in the context of an adapted health cognition model . Methods A population -based study recruited 485 adult respondents using r and om route sampling and face-to-face administered question naires .  Results and discussion Respondents ' health motivation , beliefs that diet can prevent disease , knowledge about nutrition , level of education attainment and age have a positive influence on DHPB . Perceived barriers to healthy eating have a negative impact on alcohol moderation . The information acquisition behaviour ( frequency of reading food labels ) is negatively predicted by age and positively predicted by health motivation , education , self-reported knowledge about nutrition and household financial status . A significant segment of respondents believe they are not susceptible to the elicited diseases . Health promotion strategies should aim to change the judgments of health risk . Conclusion The adaptation of the Health Belief Model and the Theory of Health Preventive Behaviour represents a valid framework of predicting DHPB . The negative sign of perceived threat of disease on DHPB may suggest that , under an income constraint , consumers tend to trade off long-term health benefits for short-term benefits . This caution s against the use of negative messages in public health campaigns . Raising the awareness of diet-disease relationships , knowledge about nutrition ( particularly sources and risks associated with dietary fat and cholesterol ) may induce people to adopt preventive dietary habits Introduction Chronic diseases such as cancer , cardiovascular disease , stroke , and diabetes are responsible for most deaths in the United States . Lifestyle factors — poor nutrition , sedentary living , and tobacco use — appear to play a prominent role in the development of many chronic diseases . This study determined the behavioral and clinical impact of a therapeutic lifestyle-modification intervention on a group of community volunteers . Methods Participants included 348 volunteers aged 24 to 81 years from the Rockford , Ill , metropolitan area who participated in a r and omized clinical trial . The intervention group attended a 40-hour educational course delivered as lectures during a 4-week period . Participants learned the importance of making better lifestyle choices and how to make improvements in nutrition and physical activity . Changes in nutrition , physical activity behavior , and several chronic disease risk factors were assessed at baseline and 6 months . Results Intervention participants showed significant 6-month improvement in all nutrition and physical activity measures except calories from protein and whole-grain servings and all clinical measures except blood glucose , total cholesterol , triglycerides , and high-sensitivity C-reactive protein . Total cholesterol and low-density lipoprotein cholesterol were worse after 6 months in both groups but only significantly worse in the control group . The control group experienced small but significant improvements in systolic and diastolic blood pressure and high-density lipoproteins . Change-score comparisons between the intervention and control groups were significant for all nutrition and physical activity variables except total steps per week and daily sodium intake and were also significant for the clinical measures of weight , body fat , and body mass index . Conclusion This therapeutic lifestyle-modification program can significantly improve nutrition and physical activity behavior and can reduce many of the risk factors associated with common chronic diseases 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 BACKGROUND Our objective was to describe the reduction in relative risk of developing major chronic diseases such as cardiovascular disease , diabetes , and cancer associated with 4 healthy lifestyle factors among German adults . METHODS We used data from 23,153 German participants aged 35 to 65 years from the European Prospect i ve Investigation Into Cancer and Nutrition-Potsdam study . End points included confirmed incident type 2 diabetes mellitus , myocardial infa rct ion , stroke , and cancer . The 4 factors were never smoking , having a body mass index lower than 30 ( calculated as weight in kilograms divided by height in meters squared ) , performing 3.5 h/wk or more of physical activity , and adhering to healthy dietary principles ( high intake of fruits , vegetables , and whole-grain bread and low meat consumption ) . The 4 factors ( healthy , 1 point ; unhealthy , 0 points ) were summed to form an index that ranged from 0 to 4 . RESULTS During a mean follow-up of 7.8 years , 2006 participants developed new-onset diabetes ( 3.7 % ) , myocardial infa rct ion ( 0.9 % ) , stroke ( 0.8 % ) , or cancer ( 3.8 % ) . Fewer than 4 % of participants had zero healthy factors , most had 1 to 3 healthy factors , and approximately 9 % had 4 factors . After adjusting for age , sex , educational status , and occupational status , the hazard ratio for developing a chronic disease decreased progressively as the number of healthy factors increased . Participants with all 4 factors at baseline had a 78 % ( 95 % confidence interval [ CI ] , 72 % to 83 % ) lower risk of developing a chronic disease ( diabetes , 93 % [ 95 % CI , 88 % to 95 % ] ; myocardial infa rct ion , 81 % [ 95 % CI , 47 % to 93 % ] ; stroke , 50 % [ 95 % CI , -18 % to 79 % ] ; and cancer , 36 % [ 95 % CI , 5 % to 57 % ] ) than participants without a healthy factor . CONCLUSION Adhering to 4 simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases BACKGROUND & OBJECTIVE Cardiovascular and other chronic diseases are becoming the major causes of morbidity and mortality in most of the third world countries including India , especially in the southern Indian States , like Kerala , where most of the health indicators match closely with those of any developed country . Various behavioural risk factors ( BRF ) namely smoking , unhealthy diet , stress at home and work place , consumption of alcohol , sedentary life style , etc . , are known to be risk factors for many such diseases . The present study was carried out to estimate the prevalence of various behavioural risk factors for chronic diseases , and to identify their biosocial correlates . METHODS A cross-sectional study was done in which the data were collected from a sample of 6579 individuals of age 30 to 74 yr , r and omly selected following a stratified multi-stage cluster sampling design covering Kerala State . The important factors investigated include various behavioural risk factors , presenting chronic diseases and family histories among close relatives . The data were analysed using both univariate and multivariate analyses . RESULTS The two major risk factors observed among males were smoking and alcohol consumption . About two fifths ( 40 % ) of them were current smokers as well as current users of alcohol ( 41 % ) . The median age at initiation was 21 yr for both smoking habits and for alcohol consumption . Nearly a quarter of the target population were inactive ( 23 % males and 22 % females ) based on work and leisure time activities . More than one-fifth of them ( 23 % ) reported stress . Obesity was found more among females ( 33 % ) than males ( 17 % ) . Low socio-economic background was found to be a high predictor ( high risk group ) for habit of smoking , alcohol consumption , stress and unhealthy diet . INTERPRETATION & CONCLUSION Substantially high levels of the various behavioural risk factors among adults in Kerala suggests an urgent need for adopting healthy life style modifications among the population in general . The increased risk observed among the younger generation for behavioural risk factors such as smoking and alcohol consumption calls for urgent corrective steps and measures for long-term monitoring of all major risk factors as well as the major chronic disease conditions 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 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
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 .