Promoting physical activity and lifestyle changes in primary health care. Interviews, randomised controlled trial and cohort studies examining lifestyle factors and venous thromboembolism.

Research output: ThesisDoctoral Thesis (compilation)

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Abstract

Background: Unhealthy lifestyle habits, low socioeconomic status, and low self-rated health (SRH) increase the risk of non-communicable diseases, such as cardiovascular disease. There are shared risk factors between arterial and venous thrombosis (VTE), and they predispose for one another. Targeted health dialogues have proven to be an effective method for finding those at risk. The Swedish healthcare system uses physical activity on prescription (PAP) to motivate increased physical activity. Mindfulness seems to facilitate lifestyle changes through increased motivation. The Swedish PAP has a suggested effectiveness of 60% but the effect is not sustainable over time, and the best effect is seen among the already physically active. Therefore, it is important to study methods to increase physical activity among inactive individuals. But also, whether there is a connection between factors affected by physical activity (SRH and mitochondrial DNA copy number (mtDNA-CN)), and whether these factors, that predict the risk of arterial blood clots, also can predict blood clots in venous vessels. Aim: The overall aim of the thesis was to study lifestyle changes among primary care patients, both in terms of their perception of lifestyle changes and the effect of a physical activity intervention. The thesis also investigated if poor SRH, lifestyle, and low mtDNA-CN were associated with an increased risk of VTE. Methods: Focus group interviews (paper I) with 14 patients after visiting a nurse-led lifestyle clinic, analysed with content analysis. A pilot-study with 88 participants (paper II & III) with 3 groups containing mindfulness training, PAP, or a combination. Feasibility was assessed by recruitment rate, dropouts, and adherence to mindfulness intervention. Activity was measured with accelerometers and self-rated. Cox regression (paper IV) to examine the association between SRH and incident VTE in a cohort containing 6917 women between 50-64 years. Finally, the association between mtDNA-CN and incident VTE (paper V) in a cohort containing 2521women between 50-64 years. Results: Paper I revealed both unfulfilled expectations and the sense of security among the interviewed patients. Paper II described the design of the three-armed randomised intervention study and paper III showed a high recruitment rate, a low number of dropouts, but low adherence to the mindfulness intervention. Highest increase of physical activity was found in the combination group. Paper IV confirmed already well-known risk factors of VTE and showed a non-significant small increase of risk when self-rated health was considered as poor. Paper V showed no significant association between mtDNA-CN and VTE. Conclusion: Prevention in primary health care through nurse-led lifestyle clinics requires frequent recurrent training in Motivational Interviewing. Visits to lifestyle clinics should be preceded by screening forms, and blood sampling, fulfilled before the appointment and include the assessment of both the risk for arterial cardiovascular diseases and VTE as they predispose for each other and share many risk factors. There should be follow-ups among those who are in need of changing a lifestyle habit and require help with the modification. The pilot-study seems possible to conduct after adjustments of the mindfulness intervention. The web-based training should be shorter than in the pilot-study, as a suggestion with SMS reminders each day, and maybe web-based group meetings. There may be an additional effect on PAP with regular mindfulness training. This may also affect SRH rating more than both only PAP, or only mindfulness. Neither poor SRH nor low mtDNA-CN seem to be useful predictors of incident VTE.
Original languageEnglish
QualificationDoctor
Awarding Institution
  • Department of Clinical Sciences, Malmö
Supervisors/Advisors
  • Zöller, Bengt, Supervisor
  • Sundquist, Kristina, Assistant supervisor
  • Calling, Susanna, Assistant supervisor
  • Stenman, Emelie, Assistant supervisor
  • Ekvall Hansson, Eva, Assistant supervisor
  • Memon, Ashfaque, Assistant supervisor
Thesis sponsors
Award date2021 Sep 17
Place of PublicationLund
Publisher
Print ISBNs978-91-8021-045-4
Publication statusPublished - 2021

Bibliographical note

Defence details
Date: 2021-09-17
Time: 09:00
Place: Agardh föreläsningssal, CRC, Jan Waldenströms gata 35, Skånes Universitetssjukhus i Malmö. Join by Zoom: https://lu-se.zoom.us/j/68886502255
External reviewer(s)
Name: Östgren, Carl Johan
Title: professor
Affiliation: Linköping University

Subject classification (UKÄ)

  • Family Medicine

Keywords

  • Primary health care, Physical activity, mindfulness, venous thromboembolism, Self-rated health, mitochondria-DNA copy-number, accelerometers, randomised trial, pilot-study.

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