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The public is informed on lifestyle from many sources. In contrast to drug therapy, consumers do not necessarily recognise their physician as being the most authoritative source of information on physical activity. While some physicians are naturally gifted in effecting behavioural change in patients, many of us are not and the track record of obtaining long-term adherence to healthy lifestyle measures is not good. The media provides advice on numerous effective and ineffective lifestyle measures, much of which derive from vested interests. In this context, it is not surprising that physicians have difficulty in getting patients to take up useful lifestyle measures in hypertension and that a bewildered community has decided that medical researchers cannot make their minds up on which lifestyle measures are worthwhile (table 1).
Nevertheless, the benefits of success in improving physical activity levels in hypertension are great. The possibility of shifting the frequency distribution of blood pressure in the whole population through physical activity and of achieving the challenging present-day targets for blood pressure by supplementing drug therapy is a major incentive.
Efficacy of lifestyle measures
Research on efficacy of physical activity and other lifestyle measures has generally focussed on the effect of a single intervention, independent of others. However, single lifestyle interventions are almost unknown in real life. Increase in physical activity is always associated with altered diet.1 A fundamental difference to drug prescription, therefore, is that the recommendation of an apparently simple lifestyle change is always a multiple intervention involving significant effects on daily life. Choosing suitable interventions is therefore the first step, and the challenge of inducing and maintaining change is such that efforts should not be wasted on useless and unproven measures. The scientific framework for contemporary recommendations on physical activity for hypertension has …
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