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Table 2 Summary of the coding system for the lifestyle change outcomes

From: Lifestyle change in the cancer setting using ‘the teachable moment’: protocol for a proof-of-concept pilot in a urology service

Behaviour/outcome Units of measurement Comment Worse No change Moderate change Substantial change Evidence for choices
Smoking status Current smoker, ex-smoker, non-smoker   Ex- and non-smoker became a smoker No change to current smokers smoking status n/a From initial smoker status becomes ex-smoker at follow-up  
Smoking amount How many smoked per day (including cigarettes, roll-ups, cigars, pipes)? Only relevant to current smokers Increased number smoked per day at follow-up No change to number smoked per day at follow-up ≥50 % reduction to number smoked per day at follow-up From initial smoker status becomes ex-smoker at follow-up NICE (2013) guidance on harm reduction for tobaccoa
Alcohol status Drink alcohol?
Most weeks,
Occasion-ally,
No
  Non-drinker became occasional/most weeks drinker
OR
Occasional drinker became most weeks drinker
No change to current drinking status Occasional drinker becomes non-drinker
OR
Most weeks drinker becomes occasional or non-drinker Recommendation from the European Code Against Cancerb
Alcohol units Most units drunk per day Only relevant to current drinkers Increased number of units per day at follow-up No change to units drunk Some reduction—≤50 % in units drunk per day at follow-up Drinker exceeding daily limit at baseline is under daily limit at follow-up (i.e. ≤4 units per day)
OR
≥50 % reduction in units drunk per day at follow-up
Alcohol unit guidelines from UK Governmentc
Alcohol units Total units drunk per week Only relevant to current drinkers Increased number of units per day at follow-up No change to units drunk Some reduction—≤ 50 % in units drunk per week at follow-up Drinker exceeding weekly limit at baseline is under weekly limit at follow-up (i.e. ≤21 units per week)
OR
≥50 % reduction in units drunk per week at follow-up
Alcohol unit guidelines from UK Governmentc
Weight loss % weight loss (in kg) All men—but particularly relevant to overweight/obese men Increase in weight No change to weight Some reduction in weight (<5 % at follow-up) Reduction in weight is ≥5 % at follow-up Research showing a 5 % reduction in weight leads to health benefitd
Body mass index BMI (i.e. weight (kg)/height (m2)) All men—but particularly relevant to overweight/obese men Increase in BMI No change to BMI Reduction in BMI maps onto a <5 % reduction in weight at follow-up Change in BMI category (i.e. from Obese to overweight or from overweight to healthy weight range)
OR
Reduction in BMI maps onto a ≥5 % reduction in weight at follow-up
Research showing a 5 % reduction in weight leads to health benefitd
Physical activity (cardiovascular) Number of days active for at least 30 min (≥moderate intensity) All men Any reduction in number of active days (CV) No change to number of active days (MS) Increase in number of active days (CV) by 1 Increase in number of active days (CV) by >1 day
OR
Achieves weekly physical activity (CV) guidelines day at follow-up (only those not achieving them at baseline)
UK physical activity guidelines for adultse
Physical activity (muscle strengthening) Number of days any muscle strengthening activity All men Any reduction in number of active days (MS) No change to number of active days (MS) Increase in number of active days (MS) by 1 Increase in number of active days (MS) by >1 day
OR
Achieves weekly physical activity (MS) guidelines day at follow-up (only those not achieving them at baseline)
UK physical activity guidelines for adultse
Fruit and vegetable intake Total daily portions of fruit and vegetables All men Any reduction in number of fruits and vegetables eaten No change to number of fruits and vegetables eaten Increase in portions of fruits and vegetable by 1 per day Increase in portions of fruits and vegetable by >1 per day
OR
Achieves five portions FV per day at follow-up (only those not achieving 5 a day at baseline)
Current NHS guidance plus research evidencef
  1. aAccording to NICE [32], it is currently unknown how great the health benefits of smoking reduction are (by substituting some cigarettes with licensed nicotine-containing products) compared to stopping smoking. This is a research area they recommended. However, it is also noted that people from routine and manual groups are more likely to cut down first, rather than stop ‘abruptly’, and intervention studies showed a positive effect where the primary outcome was to help people cut down prior to stopping smoking (mainly cognitive behavioural therapy and counselling)
  2. bAccording to the European code against cancer [34], if you drink alcohol of any type, limit your intake. Not drinking alcohol is better for cancer prevention
  3. cThe Royal College of Physicians evidence base for alcohol guidelines [35]
  4. dThe following studies have shown significant decreases in triglycerides, waist circumference, glucose, insulin and blood pressure following a minimum 5 % weight-loss [36, 37]
  5. eRecommendations from the four Chief Medical Officer’s in the UK [38] include 2½ h CV per week (i.e. 5 * 30 min). Adults should also undertake physical activity to improve muscle strength on at least 2 days a week. There are also guidelines for older adults (including balance exercises); this was not included in the lifestyle survey. Sedentary time was not included either despite being part of the new guidelines
  6. fWang et al. [39] showed a threshold for all-cause mortality from fruits and vegetable consumption of five per day
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