Philippine Clinical Practice Guidelines for Periodic Health Examination: Lifestyle Interventions for Adults and Adolescents

Abstract

Background. Lifestyle has a considerable impact on the prevalence and prognosis of noncommunicable diseases, which continue to be the leading causes of morbidity and mortality in the country and around the world. Cardiovascular disease, cancer, chronic lung disease, and diabetes are universally recognized as being significantly related to modifiable behaviors such as tobacco smoking, physical inactivity, and poor diet. Alzheimer's disease, multiple sclerosis, depression, and anxiety disorders have also been linked to lifestyle factors. Interventions to encourage healthy lifestyles and discourage hazardous behaviors among individuals aim to lower the burden of noncommunicable illnesses, improve survival, and improve individuals’ and communities’ overall quality of life.

Objective. This Philippine clinical practice guideline (CPG) was developed to provide recommendations on nonpharmacologic approaches to promote healthy lifestyles among adults and adolescents.

Methods. The Periodic Health Examination 2 (PHEX2) Lifestyle Advice Task Force proceeded through the preparation and prioritization, CPG generation, CPG appraisal, and implementation based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to CPG development recommended by the Department of Health (DOH). Nonpharmacological interventions of interest for this guideline were clinical interventions that pertain to strategies done or recommended by individual providers to patients, likely in a clinic setting. Evidence review experts systematically reviewed existing clinical practice guidelines, appraised, and summarized the evidence. For questions on specific advice on healthy diet and physical activity, the ADAPTE methodology was applied after appraising existing CPGs with the AGREE II instrument. A multisectoral panel formulated recommendations through a formal consensus based on the evidence summaries. The CPG was externally reviewed prior to publication. In addition to general questions on financial and intellectual conflicts of interest (COI), typically associated with the pharmaceutical industry, specific questions related to lifestyle, such as involvement with weight loss clinics or programs, wellness centers, tobacco, and e-cigarettes, were included.

Results. Nineteen (19) recommendations were made by the consensus panel, including adopting the WHO guidelines on physical activity and diet. During the consensus panel meetings, the impact of lifestyle-focused interventions on disease prevention was primarily considered, as well as the effect of these interventions on the prognosis of established diseases.

Conclusions. The Philippine Guidelines on PHEX Phase 2 Lifestyle Advice CPG is a systematic synthesis of evidence to address lifestyle or nonpharmacologic interventions in preventing diseases and promoting better health. More evidence on the effectiveness and safety outcomes of lifestyle-related interventions, direct evidence for the prevention of internet addiction and internet gaming disorder, longer follow-ups for effects of electronic nicotine delivery systems (ENDS), and studies on cost-effectiveness, patients’ preferences, and health equity impact assessments are needed to make more robust recommendations on a healthy lifestyle.