Effects of a structured lifestyle program for individuals with high cardiovascular risk

Cardiovascular disease (CVD) is the leading cause of death in Sweden as well as in the rest of the world. CVD is mainly caused by unhealthy lifestyle habits and lifestyle-related risk factors. National and international guidelines for the prevention and treatment of CVD highlight the importance of implementing preventive programs, with focus on lifestyle changes, in clinical practice. However, scientific evaluations of such programs are still sparse.

Aims: To evaluate a structured lifestyle program in individuals with high cardiovascular risk by investigating: effects on lifestyle habits and quality of life; effects on cardiovascular risk factors and cardiovascular risk; participants’ experiences; and the influence of educational level based on university degree or not and living in different socio-economic areas.

Methods: The lifestyle intervention program was launched at a department of cardiology. Patients with increased cardiovascular risk, with or without pre-existing CVD, were referred to the program by physicians in primary health care or at hospitals. The program had a multidisciplinary approach with three individual visits to a nurse at baseline, after six months and one year, for a health check-up (physical examination and blood sampling) and person-centred lifestyle counselling. The program also comprised five group educational sessions with a physician and a nurse covering: nicotine, alcohol, physical activity, food habits, stress, sleeping habits, and behavioural change. Lifestyle habits and quality of life were assessed by questionnaires, the changes in cardiovascular risk factors and cardiovascular risk were measured at each of the three health check-ups, and participants’ experiences were investigated through structured interviews.

Results: One hundred participants (64 women, age 58+11 years) were enrolled between 2008 and 2014. Significant and favourable changes in lifestyle habits were observed after one year. Exercise levels increased, and sedentary time decreased. The participants’ food habits improved and the number with a high consumption of alcohol decreased. Significant improvements in quality of life were noted after one year. Favourable changes in cardiovascular risk factors, such as waist circumference, systolic and diastolic blood pressure and total cholesterol were noted. In parallel, cardiovascular risk, according to the cardiovascular risk profile based on the Framingham 10-year risk prediction model, decreased by 15%. The risk reduction was seen in both men and women, and in participants with or without previous cardiovascular disease. Educational level based on univeristy degree or not and the socioeconomic area of residence, were not barriers for the capability to change lifestyle habits and decrease cardiovascular risk over one year. From interviews with fifteen participants (13 women, age 58+9 years), three categories of experiences were noted: “How to know” - based on both individual counselling and group sessions, with focus on health-related tools to strengthen self-care, an individual visit with shared goal setting, group educational sessions with interactive discussions ;”Staff who know how” - the meeting and the importance of competent, well-educated and respectful health professionals who give continuous feedback, and ”Why feedback is essential” - the participants’ views on, and effects of, feedback to support self-care at home between visits.

Conclusion: It was possible to launch a structured, multidisciplinary lifestyle program at a cardiology unit for individuals at high cardiovascular risk. Improvements in several lifestyle habits, quality of life, multiple CVD risk factors, reduced cardiovascular risk in both men and women as well as in participants with or without CVD, were observed after one year. Educational level and living in different socioeconomic areas did not seem to have any major influence on the capability to change lifestyle habits and decrease cardiovascular risk. Also, they did not influence the changes in quality of life following the lifestyle intervention program. Three different categories about the structure, staff and feed-back based on experiences of the lifestyle program were noted among the participants.

List of scientific papers

I. Lidin M, Ekblom-Bak E, Rydell Karlsson M, Hellenius ML. Long-term effects of a Swedish lifestyle intervention program on lifestyle habits and quality of life in people with increased cardiovascular risk. Scandinavian journal of public health. 2018 aug,46(6)613-622.
https://doi.org/10.1177/1403494817746536

II. Lidin M, Hellenius ML, Rydell Karlsson M, Ekblom-Bak E. Long-term effects on cardiovascular risk of a structured multidisciplinary lifestyle program in clinical practice. BMC cardiovascular disorders. 2018 apr 18 (1):59.
https://doi.org/10.1186/s12872-018-0792-6

III. Lidin M, Hellénius M-L, Ekblom-Bak E, Rydell Karlsson M. Experience of a lifestyle program in participants with high cardiovascular risk – a qualitative interview study. [Submitted]

IV. Lidin M, Hellénius M-L, Rydell Karlsson M, Ekblom-Bak E. Are educational level and socioeconomic area of residence associated with effects of a structured program on lifestyle habits, cardiovascular risk and quality of life among individuals with increased cardiovascular risk? [Manuscript]