ترکیب رژیم غذایی و فعالیت بدنی در بهبود نتایج سلامتی برای بیماران نیوزیلند Combined diet and physical activity is better than diet or physical activity alone at improving health outcomes for patients in New Zealand’s primary care intervention

Background A lack of physical activity, tobacco smoking and an unhealthy diet contribute to almost 80% of the world’s risk of cardiovascular disease and type 2 diabetes [1]. Positioned as the leading cause of premature death globally [2], cardiovascular disease is an epidemic driven by type 2 diabetes and the metabolic syndrome [3]. Empirical evidence suggests that the co-occurrence of behavioral risk factors yield greater risks for chronic diseases than the sum of their individual independent effects [4, 5]. For instance, individuals who are diagnosed with metabolic syndrome show a 50-60% higher risk of having a cardiovascular disease than those without metabolic syndrome [6]. With an estimated 20-25% of the world’s adult population presenting metabolic syndrome [3], multiple disease risk factors are increasingly common in adults [7]. Major risk factors of cardiovascular disease and metabolic syndrome are physical inactivity and poor diet [8] with physical inactivity positioned as the primary cause of most chronic diseases [9]. Although compelling evidence exists for the efficacy of improving physical activity and diet [10] in treating individuals with multiple risk factors [11], usual care relies on pharmacotherapies which merely address disease symptoms [12]. Cardiovascular disease is the number one single cause of death in New Zealand, accounting for 33% per annum [13]. In 1998, New Zealand actively addressed this concern by initiating a primary-care intervention strategy called Green Prescription, whereby general practitioners and practice nurses refer or prescribe eligible patients to trained personnel [14]. Nearly 40,000 Green Prescription referrals were written by clinicians in New Zealand from 2013 to 2014 [15]. Green Prescription patients might receive an exercise prescription for any combination of cardiorespiratory, metabolic, physiological or psychological reasons. Once enroled, patients meet with physical activity specialists who customise a physical activity routine which is catered to the patients’ needs and lifestyles while addressing barriers such as asthma, injury, back pain, etc.