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Although there is no clarity on the precise definition of the metabolic syndrome, there is consensus that it is a cluster of inter-related risk factors (elevated blood pressure, elevated plasma glucose, atherogenic dyslipidaemia) that are due to mainly abdominal obesity and insulin resistance, and which appear to directly promote the development of atherosclerotic cardiovascular disease (ASCVD), and increase the risk for developing type 2 diabetes mellitus. The prevalence of the metabolic syndrome is increasing globally, including in the adolescent population. In developed countries the prevalence of the metabolic syndrome is about 30% of the adult population. The cornerstone of management of this syndrome is lifestyle intervention. Following a comprehensive initial assessment to risk-stratify patients, they are recommended to attend either a group-based programme (medically supervised or medically directed, depending on the severity of the disease and the presence of any co-morbidities) or a home-based intervention programme. The main elements of a lifestyle intervention programme for metabolic syndrome are nutritional intervention (mainly for weight loss and to improve the atherogenic dyslipidaemia), exercise training (minimum of 30-60 minutes at moderate intensity on most days of the week), and psychosocial interventions. Regular monitoring should be conducted and a follow-up assessment is indicated after three months to assess progress and to re-set goals. Longer-term (5-6 months) and supervised intervention programmes are associated with better long-term outcomes.

Fibromyalgia is a chronic disorder, characterised by chronic widespread musculoskeletal pain, and the presence of multiple tender points as well as a host of associated symptomatology. Optimal management of patients with fibromyalgia requires a multidisciplinary approach, with a combination of pharmacological and non-pharmacological interventions that are tailored to the patient's pain, dysfunction and associated features, including depression, sleep disorder and fatigue. Non-pharmacological lifestyle-based interventions to treat this disorder include exercise therapy, dietary modification, and psychosocial interventions. This review outlines these three forms of lifestyle intervention in patients with fibromyalgia.

Diabetes mellitus, in particular Type 2 diabetes, can be classified as a chronic disease of lifestyle. A lifestyle intervention programme is therefore an essential component of the primary and secondary prevention (management) of diabetes mellitus. The main indication for referral to a lifestyle intervention programme is any patient with either pre-diabetes or established diabetes mellitus. Following a comprehensive initial assessment, patients are recommended to attend either a group-based programme (medically supervised or medically directed, depending on the severity of the disease and the presence of any co-morbidities) or a home-based intervention programme. The main elements of the intervention programme are nutritional intervention, exercise training (minimum of 150 minutes at moderate intensity per week), psychosocial support and education. Regular monitoring should be conducted during training sessions, and a follow-up assessment is indicated after 2-3 months to assess progress and to re-set goals. Longer-term (5-6 months) intervention programmes are associated with better long-term outcomes.

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This article forms the seventh part of the series on the role of lifestyle modification in general practice with specific reference to hypertension. Hypertension is defined as sustained resting blood pressure (BP) above 140/90 mmHg. Approximately 17% of the adult westernised population suffer from this disease. In most cases (> 90%) the cause is unknown and this is referred to as essential or primary hypertension. Untreated hypertension is associated with an increased risk of cerebrovascular disease, heart failure, kidney disease, and coronary artery disease. Lifestyle modifications to introduce healthy behavior are important in both the prevention and management of hypertension 3 and details of these interventions are provided in this article.