Background A high sedentary time is associated with increased mortality risk. Previous studies indicate that replacement of sedentary time with light- and moderate-to-vigorous physical activity attenuates the risk for adverse outcomes and improves cardiovascular risk factors. Patients with cardiovascular disease are more sedentary compared to the general population, while daily time spent sedentary remains high following contemporary cardiac rehabilitation programmes. This clinical trial investigated the effectiveness of a sedentary behaviour intervention as a personalised secondary prevention strategy (SIT LESS) on changes in sedentary time among patients with coronary artery disease participating in cardiac rehabilitation. Methods Patients were randomised to usual care (n = 104) or SIT LESS (n = 108). Both groups received a comprehensive 12-week centre-based cardiac rehabilitation programme with face-to-face consultations and supervised exercise sessions, whereas SIT LESS participants additionally received a 12-week, nurse-delivered, hybrid behaviour change intervention in combination with a pocket-worn activity tracker connected to a smartphone application to continuously monitor sedentary time. Primary outcome was the change in device-based sedentary time between pre- to post-rehabilitation. Changes in sedentary time characteristics (prevalence of prolonged sedentary bouts and proportion of patients with sedentary time ≥ 9.5 h/day); time spent in light-intensity and moderate-to-vigorous physical activity; step count; quality of life; competencies for self-management; and cardiovascular risk score were assessed as secondary outcomes. Results Patients (77% male) were 63 ± 10 years and primarily diagnosed with myocardial infarction (78%). Sedentary time decreased in SIT LESS (− 1.6 [− 2.1 to − 1.1] hours/day) and controls (− 1.2 [ ─1.7 to − 0.8]), but between group differences did not reach statistical significance (─0.4 [─1.0 to 0.3]) hours/day). The post-rehabilitation proportion of patients with a sedentary time above the upper limit of normal (≥ 9.5 h/day) was significantly lower in SIT LESS versus controls (48% versus 72%, baseline-adjusted odds-ratio 0.4 (0.2–0.8)). No differences were observed in the other predefined secondary outcomes. Conclusions Among patients with coronary artery disease participating in cardiac rehabilitation, SIT LESS did not induce significantly greater reductions in sedentary time compared to controls, but delivery was feasible and a reduced odds of a sedentary time ≥ 9.5 h/day was observed.
BACKGROUND: Secondary prevention of coronary artery disease (CAD) is increasingly provided by nurse-coordinated prevention programs (NCPP). Little is known about nurses' perspectives on these programs.AIM: To investigate nurses' perspectives/experiences in NCPPs in acute coronary syndrome patients.METHODS: Thirteen nurses from NCPPs in 11 medical centers in the RESPONSE trial completed an online survey containing 45 items evaluating 3 outcome categories: (1) conducting NCPP visits; (2) effects of NCPP interventions on risk profiles and (3) process of care.RESULTS: Nurses felt confident in counseling/motivating patients to reduce CAD risk. Interventions targeting LDL, blood pressure and medication adherence were reported as successful, corresponding with significant improvements of these risk factors. Improving weight, smoking and physical activity was reported as less effective. Screening for anxiety/depression was suggested as an improvement.CONCLUSIONS: Nurses acknowledge the importance and effectiveness of NCPPs, and correctly identify which components of the program are the most successful. Our study provides a basis for implementation and quality improvement for NCCPs.
Background: Self-management interventions are considered effective in patients with chronic disease, but trials have shown inconsistent results, and it is unknown which patients benefit most. Adequate self-management requires behaviour change in both patients and health care providers. Therefore, the Activate intervention was developed with a focus on behaviour change in both patients and nurses. The intervention aims for change in a single self-management behaviour, namely physical activity, in primary care patients at risk for cardiovascular disease. The aim of this study is to evaluate the effectiveness of the Activate intervention. Methods/design: A two-arm cluster randomised controlled trial will be conducted to compare the Activate intervention with care as usual at 31 general practices in the Netherlands. Approximately 279 patients at risk for cardiovascular disease will participate. The Activate intervention is developed using the Behaviour Change Wheel and consists of 4 nurse-led consultations in a 3-month period, integrating 17 behaviour change techniques. The Behaviour Change Wheel was also applied to analyse what behaviour change is needed in nurses to deliver the intervention adequately. This resulted in 1-day training and coaching sessions (including 21 behaviour change techniques). The primary outcome is physical activity, measured as the number of minutes of moderate to vigorous physical activity using an accelerometer. Potential effect modifiers are age, body mass index, level of education, social support, depression, patient-provider relationship and baseline number of minutes of physical activity. Data will be collected at baseline and at 3 months and 6 months of follow-up. A process evaluation will be conducted to evaluate the training of nurses, treatment fidelity, and to identify barriers to and facilitators of implementation as well as to assess participants’ satisfaction. Discussion: To increase physical activity in patients and to support nurses in delivering the intervention, behaviour change techniques are applied to change behaviours of the patients and nurses. Evaluation of the effectiveness of the intervention, exploration of which patients benefit most, and evaluation of our theory-based training for primary care nurses will enhance understanding of what works and for whom, which is essential for further implementation of self-management in clinical practice.
Micro and macro algae are a rich source of lipids, proteins and carbohydrates, but also of secondary metabolites like phytosterols. Phytosterols have important health effects such as prevention of cardiovascular diseases. Global phytosterol market size was estimated at USD 709.7 million in 2019 and is expected to grow with a CAGR of 8.7% until 2027. Growing adoption of healthy lifestyle has bolstered demand for nutraceutical products. This is expected to be a major factor driving demand for phytosterols. Residues from algae are found in algae farming and processing, are found as beachings and are pruning residues from underwater Giant Kelp forests. Large amounts of brown seaweed beaches in the province of Zeeland and are discarded as waste. Pruning residues from Giant Kelp Forests harvests for the Namibian coast provide large amounts of biomass. ALGOL project considers all these biomass residues as raw material for added value creation. The ALGOL feasibility project will develop and evaluate green technologies for phytosterol extraction from algae biomass in a biocascading approach. Fucosterol is chosen because of its high added value, whereas lipids, protein and carbohydrates are lower in value and will hence be evaluated in follow-up projects. ALGOL will develop subcritical water, supercritical CO2 with modifiers and ethanol extraction technologies and compare these with conventional petroleum-based extractions and asses its technical, economic and environmental feasibility. Prototype nutraceutical/cosmeceutical products will be developed to demonstrate possible applications with fucosterol. A network of Dutch and African partners will supply micro and macro algae biomass, evaluate developed technologies and will prototype products with it, which are relevant to their own business interests. ALGOL project will create added value by taking a biocascading approach where first high-interest components are processed into high added value products as nutraceutical or cosmeceutical.
Over a million people in the Netherlands have type 2 diabetes (T2D), which is strongly related to overweight, and many more people are at-risk. A carbohydrate-rich diet and insufficient physical activity play a crucial role in these developments. It is essential to prevent T2D, because this condition is associated with a reduced quality of life, high healthcare costs and premature death due to cardiovascular diseases. The hormone insulin plays a major role in this. This hormone lowers the blood glucose concentration through uptake in body cells. If an excess of glucose is constantly offered, initially the body maintains blood glucose concentration within normal range by releasing higher concentrations of insulin into the blood, a condition that is described as “prediabetes”. In a process of several years, this compensating mechanism will eventually fail: the blood glucose concentration increases resulting in T2D. In the current healthcare practice, T2D is actually diagnosed by recognizing only elevated blood glucose concentrations, being insufficient for identification of people who have prediabetes and are at-risk to develop T2D. Although the increased insulin concentrations at normal glucose concentrations offer an opportunity for early identification/screening of people with prediabetes, there is a lack of effective and reliable methods/devices to adequately measure insulin concentrations. An integrated approach has been chosen for identification of people at-risk by using a prediabetes screening method based on insulin detection. Users and other stakeholders will be involved in the development and implementation process from the start of the project. A portable and easy-to-use demonstrator will be realised, based on rapid lateral flow tests (LFTs), which is able to measure insulin in clinically relevant samples (serum/blood) quickly and reliably. Furthermore, in collaboration with healthcare professionals, we will investigate how this screening method can be implemented in practice to contribute to a healthier lifestyle and prevent T2D.
The reclaiming of street spaces for pedestrians during the COVID-19 pandemic, such as on Witte de Withstraat in Rotterdam, appears to have multiple benefits: It allows people to escape the potentially infected indoor air, limits accessibility for cars and reduces emissions. Before ordering their coffee or food, people may want to check one of the many wind and weather apps, such as windy.com: These apps display the air quality at any given time, including, for example, the amount of nitrogen dioxide (NO2), a gas responsible for an increasing number of health issues, particularly respiratory and cardiovascular diseases. Ships and heavy industry in the nearby Port of Rotterdam, Europe’s largest seaport, exacerbate air pollution in the region. Not surprisingly, in 2020 Rotterdam was ranked as one of the unhealthiest cities in the Netherlands, according to research on the health of cities conducted by Arcadis. Reducing air pollution is a key target for the Port Authority and the City of Rotterdam. Missing, however, is widespread awareness among citizens about how air pollution links to socio-spatial development, and thus to the future of the port city cluster of Rotterdam. To encourage awareness and counter the problem of "out of sight - out of mind," filmmaker Entrop&DeZwartFIlms together with ONSTV/NostalgieNet, and Rotterdam Veldakademie, are collaborating with historians of the built environment and computer science and public health from TU Delft and Erasmus University working on a spatial data platform to visualize air pollution dynamics and socio-economic datasets in the Rotterdam region. Following discussion of findings with key stakeholders, we will make a pilot TV-documentary. The documentary, discussed first with Rotterdam citizens, will set the stage for more documentaries on European and international cities, focusing on the health effects—positive and negative—of living and working near ports in the past, present, and future.
