Effectiveness of a nurse-led physical activity intervention to decrease cardiovascular disease risk in middle-aged adults: A pilot randomized controlled study

Akgöz, Ayşe Dağıstan; Gözüm, Sebahat

doi:10.1016/j.jvn.2020.05.002

Cited by 8 publications

(3 citation statements)

References 21 publications

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“…Of the RCTs, 76 studies (4,658 participants) explored the effects of long-term PA on TGs, 79 studies (4,512 participants) described the effects of PA on TC, 84 studies (5,018 participants) investigated the effect of PA on HDL, and 78 studies (4,757 participants) described the effects of PA on LDL ( Table 1 ). Most studies reported fasting lipids; only two studies ( 41 , 42 ) reported non-fasting lipids. We pooled the WMD effect sizes according to a fixed model or a random model.…”

Section: Resultsmentioning

confidence: 99%

Association between sedentary behavior, physical activity, and cardiovascular disease-related outcomes in adults—A meta-analysis and systematic review

Liang

Zhang²,

Wang³

et al. 2022

Front. Public Health

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BackgroundSedentary behavior (SB) and physical activity (PA) are modifiable risk factors for cardiovascular disease (CVD); however, previous research on the effects of PA and SB on CVD has been relatively homogeneous. Our study investigated the association between PA, SB, and CVD-related outcomes.MethodsA comprehensive search strategy was conducted in the MEDLINE, Embase, Cochrane Library, and Web of Science databases from their inception to September 2022. We identified eligible studies according to PICOS: the populations comprised healthy adults, the interventions or exposures were PA or SB, the outcomes were CVD-related outcomes, and the study designs were randomized controlled trials (RCTs) and longitudinal studies (LS). Outcomes were pooled using fixed or random effects models, and the quality of individual studies was assessed by the Cochrane Risk of Bias Instrument and the Newcastle Ottawa Scale.ResultsA total of 148 RCTs and 36 LS were included, comprising a total of 75,075 participants. The study quality was rated as low to moderate. We found an increased hazard ratio (HR) for CVD in the population with SB (HR = 1.34; 95% confidence interval [CI]: 1.26 to 1.43; I2 = 52.3%; Pheterogeneity < 0.001, random model) and a decreased HR for CVD in those who performed long-term PA (HR = 0.71; 95% CI: 0.66 to 0.77; I2 = 78.0%, Pheterogeneity < 0.001, random model). Long-term PA improved the lipid profiles in healthy adults; participants in this group exhibited increased high-density lipoprotein (weighted mean difference [WMD] = 2.38; 95% CI: 1.00 to 3.76; I2 = 84.7%; Pheterogeneity < 0.001, random model), decreased triglycerides (WMD = −7.27; 95% CI: −9.68 to −4.87; I2 = 0%, Pheterogeneity = 0.670, fixed model), and lower total-cholesterol (WMD = −6.84; 95% CI: −9.15 to −4.52; I2 = 38.4%, Pheterogeneity < 0.001, random model).ConclusionsLong-term SB increases the risk of CVD in healthy adults, whereas PA reduces the risk of CVD and improves indicators associated with CVD. However, the ability of PA to improve blood lipids appeared to be limited. The detailed association of SB and PA on CVD needs to be further investigated in the future.

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Section: Resultsmentioning

confidence: 99%

Association between sedentary behavior, physical activity, and cardiovascular disease-related outcomes in adults—A meta-analysis and systematic review

Liang

Zhang²,

Wang³

et al. 2022

Front. Public Health

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“…In several systematic reviews and meta-analyses, nurse-led interventions resulted in better control of hypertension, conformation to treatment guidelines and protocols, better patient satisfaction, and improved access to care [ 12 – 19 ]. Additionally, nurse-led management also leads to better control of diabetes [ 20 ] and CVD [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a nurse-led management intervention on systolic blood pressure among type 2 diabetes patients in Uganda: a cluster randomized trial

Lumu,

Bahendeka,

Kibirige

et al. 2024

Clin Diabetes Endocrinol

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Background Hypertension (HT) is an orchestrator of atherosclerotic cardiovascular disease (ASCVD) in people living with type 2 diabetes (T2D). Control of systolic blood pressure (SBP) and HT as a whole is suboptimal in diabetes, partly due to the scarcity of doctors. While nurse-led interventions are pragmatic and cost-effective in the control of HT in primary health care, their effectiveness on SBP control among patients with T2D in Uganda is scantly known. Aim We evaluated the effectiveness of a nurse-led management intervention on SBP among T2D patients with a high ASCVD risk in Uganda. Methods A two-armed cluster randomized controlled trial compared the nurse-led management intervention with usual doctor-led care. The intervention involved training nurses to provide structured health education, protocol-based HT/CVD management, 24-h phone calls, and 2-monthly text messages for 6 months. The primary outcome was the mean difference in SBP change among patients with T2D with a high ASCVD risk in the intervention and control groups after 6 months. The secondary outcome was the absolute difference in the number of patients at target for SBP, total cholesterol (TC), fasting blood glucose (FBG), glycated hemoglobin (HbA1C), low-density lipoprotein (LDL), triglycerides (TG), and body mass index (BMI) after the intervention. The study was analyzed according to the intention-to-treat principle. Generalized estimating equations were used to assess intra-cluster effect modifiers. Statistical significance was set at 0.05 for all analyses. Results Eight clinics (n = 388 patients) were included (intervention 4 clinics; n = 192; control 4 clinics; n = 196). A nurse-led intervention reduced SBP by -11.21 ± 16.02 mmHg with a mean difference between the groups of -13.75 mmHg (95% CI -16.48 to -11.02, p < 0.001). An increase in SBP of 2.54 ± 10.95 mmHg was observed in the control group. Diastolic blood pressure was reduced by -6.80 ± 9.48 mmHg with a mean difference between groups of -7.20 mmHg (95% C1 -8.87 to -5.48, p < 0.001). The mean differences in the change in ASCVD score and glycated hemoglobin were -4.73% (95% CI -5.95 to -3.51, p = 0.006) and -0.82% (95% CI -1.30 to -0.35, p = 0.001), respectively. There were significant absolute differences in the number of patients at target in SBP (p = 0.001), DBP (p = 0.003), and TC (p = 0.008). Conclusion A nurse-led management intervention reduces SBP and ASCVD risk among patients with T2D. Such an intervention may be pragmatic in the screening and management of HT/ASCVD in Uganda. Trial registration Pan African Clinical Trial Registry, PACTR202001916873358, registered on 6th October 2019.

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“…Currently, there is evidence for nurse-led interventions resulting into better clinical outcomes among patients with hypertension. In several systematic reviews and meta-analyses, nurse led interventions resulted into better control of hypertension, conformation to treatment guidelines and protocols ,better patient satisfaction and improved access to care (12)(13)(14)(15)(16)(17)(18)(19).Additionally, nurse-led management also leads to better control of diabetes (20) and CVD (21).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a nurse-led management intervention on systolic blood pressure among type 2 diabetes patients in Uganda: a cluster randomized trial

LUMU,

Bahendeka,

Kibirige

et al. 2023

Preprint

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Background Hypertension (HT) is an orchestrator of atherosclerotic cardiovascular disease (ASCVD) in persons living with type 2 Diabetes (T2D). Control of systolic blood pressure (SBP) and HT as a whole is suboptimal in diabetes partly due to scarcity of doctors. While nurse-led interventions are pragmatic and cost-effective in the control of HT in primary health care, their effectiveness on SBP control among patients with T2D in Uganda is scantly known. Aim We evaluated the effectiveness of a nurse-led management intervention on SBP among T2D patients with a high ASCVD risk in Uganda. Methods A two-armed cluster randomized controlled trial was conducted to compare the nurse-led management intervention with usual doctor-led care. The intervention involved training of nurses to provide structured health education, protocol based HT/CVD management, 24-hour phone calls and 2 monthly text messages for 6 months. The primary outcome was mean change in SBP between baseline and after 6 months. The secondary outcome was change in proportion of patients reaching treatment targets for SBP, total cholesterol (TC), fasting blood sugar (FBS), glycated hemoglobin (HbA1C), low density lipoprotein cholesterol (LDL), triglycerides (TG) and body mass index (BMI). The study was analyzed with intention to treat principle. Generalized estimating equations were used to assess for intra-cluster effect modifiers. Statistical significance was set at 0.05 for all analyses. Results Eight clinics (n = 388 patients) were included (intervention 4 clinics; n = 192, control 4 clinics; n = 196).A nurse-led intervention reduced SBP by 11.21 ± 16.02mmhg with a mean difference between the groups of -13.75mmHg (95% CI-16.48 to 11.02, P < 0.001).Diastolic blood pressure was reduced by 6.77 ± 9.48mmHg with a mean difference between groups of -7.17mmHg (95%C1 -8.87 to -5.48, p < 0.001). An increase in SBP of 2.53 ± 10.95mmhg was noted in the control group. The proportions of patients reaching target for SBP(95%CI -0.234 to 0.077,p < 0.001),diastolic blood pressure(95% CI-0.359 to 0.137,p < 0.001),LDL(95% -0.075 to 0.007,p < 0.001)and TGs(95% -0.0155 to 0.032,p = 0.002) increased while those of FBS (P = 0.66), HbA1c (P = 0.710) and BMI (P = 0.414) did not change. Conclusion A nurse-led management intervention reduces SBP and ASCVD risk among patients with T2D.Such an intervention may be pragmatic in screening and management of HT/ASCVD in Uganda. Trial Registration: Pan African Clinical Trial Registry, PACTR202001916873358, registered 6th October 2019.

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Effectiveness of a nurse-led physical activity intervention to decrease cardiovascular disease risk in middle-aged adults: A pilot randomized controlled study

Cited by 8 publications

References 21 publications

Association between sedentary behavior, physical activity, and cardiovascular disease-related outcomes in adults—A meta-analysis and systematic review

Association between sedentary behavior, physical activity, and cardiovascular disease-related outcomes in adults—A meta-analysis and systematic review

Effectiveness of a nurse-led management intervention on systolic blood pressure among type 2 diabetes patients in Uganda: a cluster randomized trial

Effectiveness of a nurse-led management intervention on systolic blood pressure among type 2 diabetes patients in Uganda: a cluster randomized trial

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