UKCRC Centre of Excellence for Public Health (Northern Ireland), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
UKCRC Centre of Excellence for Public Health (Northern Ireland), School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Belfast, Northern Ireland, UK; Public Health Agency Northern Ireland, Belfast, Northern Ireland, UK.
Prev Med. 2018 Sep;114:24-38. doi: 10.1016/j.ypmed.2018.05.019. Epub 2018 May 24.
Cardiovascular disease (CVD) is the leading cause of death worldwide, and its prevalence is increasing; with limited healthcare resources, secondary prevention programmes outside traditional hospital settings are needed, but their effectiveness is unclear. We aimed to assess the effectiveness of secondary prevention cardiovascular risk reduction programmes delivered in venues situated within the community on modification of behavioural risk factors. We searched five databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane library) to identify trials of health behaviour interventions for adults with CVD in community-based venues. Primary outcomes were changes in physical activity, diet, smoking and/or alcohol consumption. Two reviewers independently assessed articles for eligibility and risk of bias; statistical analysis used Revman v5.3. Of 5905 articles identified, 41 articles (38 studies) (n = 7970) were included. Interventions were mainly multifactorial, educational, psychological and physical activity-based. Meta-analyses identified increased steps/week (Mean Difference (MD): 7480; 95% CI 1,940, 13,020) and minutes of physical activity/week (MD: 59.96; 95% CI 15.67, 104.25) associated with interventions. There was some evidence for beneficial effects on peak VO, blood pressure, total cholesterol and mental health. Variation in outcome measurements reported for other behavioural risk factors limited our ability to perform meta-analyses. Effective interventions were based in homes, general practices or outpatient settings, individually tailored and often multicomponent with a theoretical framework. Our review identified evidence that interventions for secondary CVD prevention, delivered in various community-based venues, have positive effects on physical activity; such opportunities should be promoted by health professionals.
心血管疾病 (CVD) 是全球范围内的主要死因，其发病率正在上升；由于医疗资源有限，需要在传统医院环境之外开展二级预防计划，但这些计划的效果尚不清楚。我们旨在评估在社区场所开展的二级预防心血管风险降低计划对行为危险因素改变的有效性。我们在五个数据库（MEDLINE、EMBASE、CINAHL、PsycINFO、Cochrane 图书馆）中搜索了针对社区场所中患有 CVD 的成年人的健康行为干预试验。主要结局是体力活动、饮食、吸烟和/或饮酒习惯的变化。两名评审员独立评估文章的合格性和偏倚风险；统计分析使用 Revman v5.3。在确定的 5905 篇文章中，有 41 篇文章（38 项研究）（n=7970）符合纳入标准。干预措施主要是多因素、教育、心理和基于体力活动的。荟萃分析确定干预措施与每周增加的步数（MD：7480；95%CI 1940，13020）和每周增加的体力活动分钟数（MD：59.96；95%CI 15.67，104.25）有关。干预措施对峰值 VO2、血压、总胆固醇和心理健康有一定的有益影响。由于其他行为危险因素的报告结果测量方法存在差异，我们无法进行荟萃分析。有效的干预措施基于家庭、全科医生或门诊环境，个体化量身定制，通常多组分且具有理论框架。我们的综述确定了在各种社区场所开展的二级 CVD 预防干预措施对体力活动有积极影响的证据；健康专业人员应推广这些机会。
