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Lifestyle changes also impact relatives, partners, and friends, so they should be involved in patient support.1139 Physical activity can be incorporated flexibly, either daily, or limited to specific days. Activity patterns limited to 1–2 sessions per week but meeting recommended levels of physical activity have been shown to reduce or postpone all-cause, CVD, and cancer mortality risk.477 Importantly, maintaining changed behaviour over time is a challenge. Some trials have shown an impact of lifestyle intervention on cardiovascular health and behavioural metrics, which became attenuated in the long term as the intensity of the intervention declined.1145

6.2.1.3 Digital and mHealth

Behavioural change and habit formation can be facilitated through technology such as wearable devices, the internet, and smartphones. In 27 studies including 5165 patients with CAD or cerebrovascular disease, text messaging and smartphone apps resulted in a greater ability to reach BP targets and exercise goals, less anxiety, and increased awareness of diet and exercise compared with control.1146 Nevertheless, there was no significant difference in smoking cessation, LDL-C, and hospital readmissions.1146 Digital interventions mainly stimulate healthy behavioural factors but are less effective in reducing unhealthy behavioural factors (smoking, alcohol intake, sedentary behaviour, and unhealthy diet) and clinical outcomes.1146,1147

The use of wearable devices has significantly increased physical activity and decreased waist circumference, systolic BP, and LDL-C among individuals with chronic conditions including CVD.491 Younger age has been associated with a higher increase in physical activity, and CVD has been associated with a lower increase. Wearable activity trackers have shown effectiveness, but the effect was greater when

ealthy diet H

xercise E

chieve normal weight A

eave smoking L

ake control of cholesterol and blood pressure T

andle alcohol consumption H

ield to stress management Y

Supporting adherence

Good communication, structured tools and

visual images Multidisciplinary

behavioural interventions

mHealth and telehealth Fixed dose combination pills

and simplified medication regimens

PROMs and feedback

Cardiovascular risk reduction

Figure 17 Strategies for long-term adherence to a healthy lifestyle. mHealth, mobile device-based healthcare; PROMs, patient-reported outcome measures.

ESC Guidelines                                                                                                                                                                                          3491

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