Non-pharmacological intervention

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Non-pharmacological intervention (NPI) is any type of healthcare intervention which is not primarily based on medication. Some examples include exercise, [1] sleep improvement, [2] and dietary habits. [3]

Contents

Non-pharmacological interventions may be intended to prevent or treat (ameliorate or cure) diseases or other health-related conditions, or to improve public health. They can be educational and may involve a variety of lifestyle or environmental changes. [4] Complex or multicomponent interventions use multiple strategies, [5] and they often involve the participation of several types of care providers. [6]

Non-pharmacological interventions can call on various fields of expertise, such as surgery, medical devices, rehabilitation, psychotherapy, and behavioral interventions. [6]

Examples

Hypertension

The first line of treatment for hypertension is lifestyle changes, including dietary changes, physical exercise, and weight loss. Although these have all been recommended in scientific advisories, [7] a Cochrane systematic review of available relevant studies found that although weigh-loss diets did reduce body weight and blood pressure, beneficial effects of those changes could not be demonstrated, owing to the small number of participants and studies, and that therefore the impact of weigh loss on mortality and morbidity is unknown. [8] Their potential effectiveness is similar to and at times exceeds a single medication. [9] If the blood pressure is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction. Dietary changes shown to reduce blood pressure include diets containing low amounts of sodium, [10] [11] the DASH diet (Dietary Approaches to Stop Hypertension), [12] vegetarian diets, [13] and green tea consumption. [14] [15] [16] [17] Physical exercise regimens that reduce blood pressure include isometric resistance exercise, aerobic exercise, resistance exercise, and device-guided breathing. [18]

See also

Related Research Articles

<span class="mw-page-title-main">Hypertension</span> Long-term high blood pressure in the arteries

Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms itself. It is, however, a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia. Hypertension is a major cause of premature death worldwide.

<span class="mw-page-title-main">Type 2 diabetes</span> Form of diabetes mellitus

Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, fatigue and unexplained weight loss. Other symptoms include increased hunger, having a sensation of pins and needles, and sores (wounds) that heal slowly. Symptoms often develop slowly. Long-term complications from high blood sugar include heart disease, stroke, diabetic retinopathy, which can result in blindness, kidney failure, and poor blood flow in the lower-limbs, which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

<span class="mw-page-title-main">Weight loss</span> Reduction of the total body mass

Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat, or lean mass. Weight loss can either occur unintentionally because of malnourishment or an underlying disease, or from a conscious effort to improve an actual or perceived overweight or obese state. "Unexplained" weight loss that is not caused by reduction in calorific intake or increase in exercise is called cachexia and may be a symptom of a serious medical condition.

<span class="mw-page-title-main">Mediterranean diet</span> Diet inspired by the Mediterranean region

The Mediterranean diet is a concept first invented in 1975 by the American biologist Ancel Keys and chemist Margaret Keys. The diet took inspiration from the eating habits and traditional food typical of Crete, much of the rest of Greece, and southern Italy, and formulated in the early 1960s. It is distinct from Mediterranean cuisine, which covers the actual cuisines of the Mediterranean countries, and from the Atlantic diet of northwestern Spain and Portugal. While inspired by a specific time and place, the "Mediterranean diet" was later refined based on the results of multiple scientific studies.

<span class="mw-page-title-main">Cardiovascular disease</span> Class of diseases that involve the heart or blood vessels

Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.

<span class="mw-page-title-main">Plant-based diet</span> Diet consisting mostly or entirely of plant-based foods

A plant-based diet is a diet consisting mostly or entirely of plant-based foods. It encompasses a wide range of dietary patterns that contain low amounts of animal products and high amounts of fiber-rich plant products such as vegetables, fruits, whole grains, legumes, nuts, seeds, herbs, and spices. Plant-based diets may also be vegan or vegetarian but do not have to be, as they are defined in terms of high frequency of plants and low frequency of animal food consumption.

<span class="mw-page-title-main">Chlortalidone</span> Thiazide-like diuretic drug

Chlortalidone, also known as chlorthalidone, is a thiazide-like diuretic drug used to treat high blood pressure, swelling, diabetes insipidus, and renal tubular acidosis. Because chlortalidone is effective in most patients with high blood pressure, it is considered a preferred initial treatment. It is also used to prevent calcium-based kidney stones. It is taken by mouth. Effects generally begin within three hours and last for up to three days. Long-term treatment with chlortalidone is more effective than hydrochlorothiazide for prevention of heart attack or stroke.

<span class="mw-page-title-main">Eplerenone</span> Chemical compound

Eplerenone, sold under the brand name Inspra, is an aldosterone antagonist type of potassium-sparing diuretic that is used to treat chronic heart failure and high blood pressure, particularly for people with resistant hypertension due to elevated aldosterone. It is a steroidal antimineralocorticoid of the spirolactone group and a selective aldosterone receptor antagonist (SARA).

The Dietary Approaches to Stop Hypertension or the DASH diet is a diet to control hypertension promoted by the U.S.-based National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH), an agency of the United States Department of Health and Human Services. The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods. It includes meat, fish, poultry, nuts, and beans, and is limited in sugar-sweetened foods and beverages, red meat, and added fats. In addition to its effect on blood pressure, it is designed to be a well-balanced approach to eating for the general public. DASH is recommended by the United States Department of Agriculture (USDA) as a healthy eating plan. The DASH diet is one of three healthy diets recommended in the 2015–20 U.S. Dietary Guidelines, which also include the Mediterranean diet and a vegetarian diet. The American Heart Association (AHA) considers the DASH diet "specific and well-documented across age, sex and ethnically diverse groups."

<span class="mw-page-title-main">Salt substitute</span> Low-sodium table salt alternative

A salt substitute, also known as low-sodium salt, is a low-sodium alternative to edible salt marketed to reduce the risk of high blood pressure and cardiovascular disease associated with a high intake of sodium chloride while maintaining a similar taste.

In medicine, systolic hypertension is defined as an elevated systolic blood pressure (SBP). If the systolic blood pressure is elevated (>140) with a normal (<90) diastolic blood pressure (DBP), it is called isolated systolic hypertension. Eighty percent of people with systolic hypertension are over the age of 65 years old. Isolated systolic hypertension is a specific type of widened pulse pressure.

Prehypertension, also known as high normal blood pressure and borderline hypertensive (BH), is a medical classification for cases where a person's blood pressure is elevated above optimal or normal, but not to the level considered hypertension. Prehypertension is now referred to as "elevated blood pressure" by the American College of Cardiology (ACC) and the American Heart Association (AHA). The ACC/AHA define elevated blood pressure as readings with a systolic pressure from 120 to 129 mm Hg and a diastolic pressure under 80 mm Hg, Readings greater than or equal to 130/80 mm Hg are considered hypertension by ACC/AHA and if greater than or equal to 140/90 mm Hg by ESC/ESH. and the European Society of Hypertension defines "high normal blood pressure" as readings with a systolic pressure from 130 to 139 mm Hg and a diastolic pressure 85-89 mm Hg.

A low sodium diet is a diet that includes no more than 1,500 to 2,400 mg of sodium per day.

<span class="mw-page-title-main">Weight management</span> Techniques for maintaining body weight

Weight management comprises behaviors, techniques, and physiological processes that contribute to a person's ability to attain and maintain a healthy weight. Most weight management techniques encompass long-term lifestyle strategies that promote healthy eating and daily physical activity. Weight management generally includes tracking weight over time and identifying an individual's ideal body weight.

Management of obesity can include lifestyle changes, medications, or surgery. Although many studies have sought effective interventions, there is currently no evidence-based, well-defined, and efficient intervention to prevent obesity.

<span class="mw-page-title-main">Salt and cardiovascular disease</span> Association between salt consumption and cardiovascular disease

Salt consumption in excess has been extensively studied for its role in human physiology and impact on human health. Chronic, high intake of dietary salt is associated with hypertension and cardiovascular disease, among other adverse health outcomes. Major health and scientific organizations, such as the World Health Organization, the US Centers for Disease Control and Prevention, and the American Heart Association, have established high salt consumption as a major risk factor for cardiovascular diseases and stroke.

<span class="mw-page-title-main">Health effects of salt</span> Conditions associated with the consumption of either too much or too little salt

The health effects of salt are the conditions associated with the consumption of either too much or too little salt. Salt is a mineral composed primarily of sodium chloride (NaCl) and is used in food for both preservation and flavor. Sodium ions are needed in small quantities by most living things, as are chlorine ions. Salt is involved in regulating the water content of the body. Both sodium and chlorine ions are used for electrical signaling in the nervous system, among other biological roles.

Isabelle Boutron is a professor of epidemiology at the Université Paris Cité and head of the INSERM- METHODS team within the Centre of Research in Epidemiology and Statistics (CRESS). She was originally trained in rheumatology and later switched to a career in epidemiology and public health. She is also deputy director of the French EQUATOR Centre, member of the SPIRIT-CONSORT executive committee, director of Cochrane France and co-convenor of the Bias Methods group of the Cochrane Collaboration.

Hypertension is managed using lifestyle modification and antihypertensive medications. Hypertension is usually treated to achieve a blood pressure of below 140/90 mmHg to 160/100 mmHg. According to one 2003 review, reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34% and of ischaemic heart disease by 21% and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease.

A renal diet is a diet aimed at keeping levels of fluids, electrolytes, and minerals balanced in the body in individuals with chronic kidney disease or who are on dialysis. Dietary changes may include the restriction of fluid intake, protein, and electrolytes including sodium, phosphorus, and potassium. Calories may also be supplemented if the individual is losing weight undesirably.

References

  1. ↑ Hilfiker, Roger; Meichtry, Andre; Eicher, Manuela; Nilsson Balfe, Lina; Knols, Ruud H.; Verra, Martin L.; Taeymans, Jan (2018). "Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis". British Journal of Sports Medicine. 52 (10): 651–658. doi:10.1136/bjsports-2016-096422. ISSN   1473-0480. PMC   5931245 . PMID   28501804.
  2. ↑ Zoremba, N.; Coburn, M.; Schälte, G. (2018). "[Delirium in intensive care patients: A multiprofessional challenge]". Der Anaesthesist. 67 (11): 811–820. doi:10.1007/s00101-018-0497-3. ISSN   1432-055X. PMID   30298270.
  3. ↑ McKennon, Skye A. (2000), Feingold, Kenneth R.; Anawalt, Bradley; Boyce, Alison; Chrousos, George (eds.), "Non-Pharmaceutical Intervention Options For Type 2 Diabetes: Diets And Dietary Supplements (Botanicals, Antioxidants, and Minerals)", Endotext, South Dartmouth (MA): MDText.com, Inc., PMID   25905290 , retrieved 2020-11-24
  4. ↑ Abraha I, Rimland JM, Trotta FM, et al. (2017). "Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series". BMJ Open. 7 (3): e012759. doi:10.1136/bmjopen-2016-012759. PMC   5372076 . PMID   28302633.
  5. ↑ Boutron I, Ravaud P (2012). "Introduction". In Boutron I, Ravaud P, Moher D (eds.). Randomized clinical trials of nonpharmacological treatments. Boca Raton: CRC Press. pp. xi–xii. ISBN   9781420088021.
  6. 1 2 Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P (2017). "CONSORT Statement for Randomized Trials of Nonpharmacologic Treatments: A 2017 Update and a CONSORT Extension for Nonpharmacologic Trial Abstracts". Annals of Internal Medicine. 167 (1): 40–47. doi: 10.7326/M17-0046 . PMID   28630973.
  7. ↑ Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, Sanchez E (April 2014). "An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention". Hypertension. 63 (4): 878–85. doi: 10.1161/HYP.0000000000000003 . PMC   10280688 . PMID   24243703.
  8. ↑ Semlitsch, Thomas; Krenn, Cornelia; Jeitler, Klaus; Berghold, Andrea; Horvath, Karl; Siebenhofer, Andrea (2021-02-08). "Long-term effects of weight-reducing diets in people with hypertension". The Cochrane Database of Systematic Reviews. 2021 (2): CD008274. doi:10.1002/14651858.CD008274.pub4. ISSN   1469-493X. PMC   8093137 . PMID   33555049.
  9. ↑ Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. (July 2013). "2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". European Heart Journal. 34 (28): 2159–219. doi: 10.1093/eurheartj/eht151 . hdl: 1854/LU-4127523 . PMID   23771844.
  10. ↑ He FJ, Li J, Macgregor GA (April 2013). "Effect of longer-term modest salt reduction on blood pressure". The Cochrane Database of Systematic Reviews (Systematic Review & Meta-Analysis). 30 (4): CD004937. doi:10.1002/14651858.CD004937.pub2. PMC   11537250 . PMID   23633321. S2CID   23522004.
  11. ↑ Huang, Liping; Trieu, Kathy; Yoshimura, Sohei; Neal, Bruce; Woodward, Mark; Campbell, Norm R C; Li, Qiang; Lackland, Daniel T; Leung, Alexander A; Anderson, Cheryl A M; MacGr 2020; He, Feng J (2020). "Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials". BMJ. 368: m315. doi: 10.1136/bmj.m315 . PMC   7190039 . PMID   32094151.{{cite journal}}: CS1 maint: numeric names: authors list (link)
  12. ↑ Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin PH (January 2001). "Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group". The New England Journal of Medicine. 344 (1): 3–10. doi: 10.1056/NEJM200101043440101 . PMID   11136953.
  13. ↑ Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, Okamura T, Miyamoto Y (April 2014). "Vegetarian diets and blood pressure: a meta-analysis". JAMA Internal Medicine. 174 (4): 577–87. doi:10.1001/jamainternmed.2013.14547. PMID   24566947.
  14. ↑ Hartley L, Flowers N, Holmes J, Clarke A, Stranges S, Hooper L, Rees K (June 2013). "Green and black tea for the primary prevention of cardiovascular disease" (PDF). The Cochrane Database of Systematic Reviews (Systematic Review and Meta-Analysis). 2013 (6): CD009934. doi:10.1002/14651858.CD009934.pub2. PMC   7433290 . PMID   23780706. Archived (PDF) from the original on 3 July 2018. Retrieved 3 July 2018.
  15. ↑ Liu G, Mi XN, Zheng XX, Xu YL, Lu J, Huang XH (October 2014). "Effects of tea intake on blood pressure: a meta-analysis of randomised controlled trials". The British Journal of Nutrition (Meta-Analysis). 112 (7): 1043–54. doi: 10.1017/S0007114514001731 . PMID   25137341.
  16. ↑ Khalesi S, Sun J, Buys N, Jamshidi A, Nikbakht-Nasrabadi E, Khosravi-Boroujeni H (September 2014). "Green tea catechins and blood pressure: a systematic review and meta-analysis of randomised controlled trials". European Journal of Nutrition (Systematic Review and Meta-Analysis). 53 (6): 1299–311. doi:10.1007/s00394-014-0720-1. hdl: 10018/1239907 . PMID   24861099. S2CID   206969226.
  17. ↑ Peng X, Zhou R, Wang B, Yu X, Yang X, Liu K, Mi M (September 2014). "Effect of green tea consumption on blood pressure: a meta-analysis of 13 randomized controlled trials". Scientific Reports (Meta-Analysis). 4: 6251. Bibcode:2014NatSR...4.6251P. doi:10.1038/srep06251. PMC   4150247 . PMID   25176280.
  18. ↑ Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, Fuchs FD, Hughes JW, Lackland DT, Staffileno BA, Townsend RR, Rajagopalan S (June 2013). "Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the american heart association". Hypertension. 61 (6): 1360–83. doi: 10.1161/HYP.0b013e318293645f . PMID   23608661.

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