• Graded lifestyle advice is appropriate for everyone

  • Based on behavioural counselling approach

  • self-monitoring

  • training to overcome bommon barriers

  • goal setting

  • providing guidance in shopping and food prep

  • role playing

  • arranging support or referral

Diet

Heart foundation's nine steps to eating for a healthy heart

  • Enjoy three meals a day: little or no diary fat, meat fat or deep-fried foods

  • Fruits and/or vegetables at every meal and for most snacks

  • Whole grains, whole-grain breads or high-fibre breakfast cereals

  • Fish or dried peas, beans and soy products or a small serving of lean meat or skinned poultry at one or two meals each day

  • Low-fat milk/milk products, soy or legume every day

  • Use nuts, seeds, avocado, oils or marg instead of animal and coconut fats

  • Drink plenty of fluids each day - esp. water

  • Use only small amounts of sugar or salt when cooking and preparing meals, snacks or drinks

  • Mostly avoid or rarely include: butter, deep-fried and fatty foods

Physical activity

  • aim is for minimum of 30 minutes moderate-intensity physical activity on most days of the week

  • can accumulate throughout the day

  • history of CVD should consult doctor before they undertake vigorous physical activity

  • Vigorous activity not encouraged if:

    • Impaired LV function

    • Severe coronary artery disease

    • Recent MI

    • Significant ventricular arrhythmias

    • Stenotic valve disease

    • People with coronary artery disease should begin with low intensity and gradually increase over several weeks

    • search physical activity MoH

Weight

  • if BMI >25 guidelines recommend combination of changes in:

    • food/nutrition

    • physical activity

    • behavioural strategies to support these changes

  • aim WC \<100cm M, \<90cm F

  • set achievable goals

    • 5-10% weight loss

    • discourage use of weight loss programes that promote exclusion of food groups form cardioprotective dietary pattern or that increase saturated fatty acid intakes

    • reduce fatty foods

    • reduce white flour

    • reduce added sugars

  • 4 set;

    • engage and raise awareness

    • identify the need and context for action

    • determine options for action - largely based on BMI

    • arrange ongoign contact and supprt

Smoking cessation

smoking cessation

  • Ask about smoking status

  • Brief advice to stop and make an offer of help to quit to all smokers (NNT 40)

  • Cessation support

  • Document your intervention

  • cutting down = doens’t lead to significant health benefits

    • smoke more intensively

    • “stop completely”

  • “How soon after wake up?”

    • within 30min

      • higher degree of smoking dependence

Effective smoking interventions

  • Breief advice from health pro vs. no intervention

  • Proactive telephone support vs. reactive telephone support

  • Automated text messagign vs messaging not realted to smoking

  • Face-Face, indiviidual behavioural support vs. breif advice or written materials

  • Face-face, group-based behavioural support vs breif advice or written materials