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The guideline aims to harmonize recommendations from 11 different groups to make it easier for clinicians to manage their patients through updated treatment, screening and guidance, among other things. But patients themselves continue to hold some of the keys to lowering their risk and improving their health for a number of related illnesses, says Dr. Peter Liu, chief scientific officer at the University of Ottawa Heart Institute and a senior author of the latest C-CHANGE (Canadian Cardiovascular Harmonized National Guideline Endeavour) guideline.
“It doesn’t make any difference how wonderful the medications are, nothing is as wonderful as exercise,” he said. The guideline also puts a new focus on understanding and treating depression related to cardiovascular health. Published Monday in the Canadian Medical Association Journal, the guideline offers a more holistic approach to caring for patients with cardiovascular disease and related illnesses, said Liu. “In medicine, we like to segregate (care) into body parts,” he said. The updated guideline recognizes that treating patients is not just done one organ at a time or one risk factor at a time, but more holistically. “Typical patients with multiple illnesses require the access to many guidelines at the same time, and some recommendations are not harmonized and often seem contradictory,” he said.
Behaviour-based recommendations have always been part of the guidance document. The latest one — the first in four years — suggests any exercise is better than none and recommends water as the drink of choice. It includes a recommendation of 30-60 minutes of moderate to vigorous physical activity most days of the week to achieve optimal health benefits, but notes that some activity is better than none. “Starting physical activity at any level compared with remaining inactive provides the greatest increment in health benefits, and there are important health benefits even at a lower volume or intensity of physical activity,” the guideline says. People who only meet half the recommended activity levels still had a 14 per cent lower risk of coronary artery disease than those who are inactive.
“Therefore, rather than aiming for the maximal amount from the start, clinicians should target any physical activity or exercise that patients are willing to begin, support them to generate solutions to perceived barriers.” Liu said new guidance also recommends people be active throughout the day, not exercise and then remain inactive for the rest of the day. The guidance includes recommendations for people with obesity, which is now recognized as a chronic disease, including highlighting evidence that walking an average of 45 minutes four times a week at a moderate intensity results in weight loss, reduced BMI and a reduction in waist circumference. The guideline contains 83 recommendations and is described in the medical journal as a one-stop guideline, “which takes a 360-degree approach to managing heart disease in Canadian patients”. Half of the recommendations are new or updated since the last version four years ago.
Dr. Rahul Jain, co-chair of C-CHANGE and family physician at Sunnybrook Health Sciences Centre, noted that since the last guidance document there have been many new evidence-based recommendations, from changes in medication management to new thresholds for lipid levels in secondary prevention. “We hope this resource helps primary care clinicians stay up to date with many constantly evolving cardiovascular guidelines, so their patients can get the best care possible.” The document can be found at: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.220138
3 thoughts on “Exercise, healthy behaviours still key to managing risk of heart disease — but depression can interfere – Ottawa Citizen”
Aha, now I see… I didn’t understand the connection with the title at first…
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