prevention and management of non-communicable disease: the ioc consensus statement, lausanne 2013

Preventable, unpreventable morbidity and mortality
Chronic infectious diseases (NCD)
It threatens the health of our people and our economy.
The accumulation of a lot of scientific knowledge has not changed this.
New innovative thinking is essential to foster new creative approaches that benefit and integrate evidence through the support of big data, technology, and design thinking.
The purpose of this paper is to summarize the results of the Consensus Meeting on the prevention of non-communicable diseases hosted by the International Olympic Committee in April 2013.
In the context of advocating a multifaceted system change, the IOC\'s focus is on creating solutions that are attractive in the healthcare system.
Participants attending the meeting reached a consensus on strategies for chronic disease prevention and management, which included the following :(1)
Behavioral change is a central component of all clinical protocols to prevent and manage chronic diseases. (2)
Establish practical centres to design, implement, study and improve prevention programmes for chronic diseases. (3)Use human-
Design-centric in creating prevention schemes that tend to action, rapid prototyping, and multiple iterations. (4)
Expand knowledge and skills in sports and sports medicine (SEM)
Professionals establish new programs for the prevention and treatment of chronic diseases focusing on physical activity, diet and lifestyle. (5)
Mobilize resources to expand and distribute prevention programmes using the network.
The real innovation lies in being able to think around these core strategies to ensure the successful implementation of NCD prevention and management programmes in healthcare.
The IOC and the SEM community are ideally positioned to lead this disruptive change.
The result of the consensus meeting was the establishment of the International Olympic Committee
The ad hoc working group on infectious diseases responsible for advancing this agenda. Introduction non
Infectious Diseases (NCD, box 1)
60% of all deaths and 44% of premature deaths.
1, 2 non-communicable diseases are now the cause of the highest incidence and mortality, and even in developing countries, the number of deaths is double that of HIV/AIDS, tuberculosis, malaria and all other infectious diseases.
1-3 they are obstacles to achieving the United Nations Millennium Development Goals 4, and in addition to our health, they are a global threat to our economy.
A report by the World Economic Forum and Harvard University estimates that chronic diseases currently account for 2% of global gross domestic product (GDP)
In the next 20 years, the global economy will lose $30 trillion, or 48% of global GDP in 2010.
However, chronic diseases are largely preventable.
The main reason is related to the way of life, that is, physical inactivity (
Recently labeled pandemi by The Lancet
Unhealthy eating and alcohol abuse.
Box 1 non
Infectious respiratory emergency/osteopossisisgenerative disc emergency and frailtycogtive impact emergency disaster relief 2010, who signed a memorandum of understanding with the International Olympic Committee, jointly Promote activities and policy options aimed at reducing the risk of non-communicable diseases.
6. Subsequently, the president of the International Olympic Committee delivered a landmark speech at the 66 plenary session of the United Nations General Assembly on September 19, 2011;
\"Watershed events\" of \"replacing ignorance and inertia with consciousness and right action \".
Dr Jacques Rogge, president of the International Olympic Committee, said at the conference: \"The problem is very serious and the solution is at hand.
But one thing, this is a grim picture of what we can do about it.
\"Low-cost, efficient solutions to prevent and manage non-communicable diseases can be found.
The president of the International Olympic Committee stressed that the WHO proposal on sports activities is at the heart of the prevention of non-communicable diseases.
He called for the provision of safe and accessible public spaces for sports activities and sports, partnerships with transport and urban planning, strengthening physical education, and improving physical education infrastructure and organization so as to be comprehensive and extensivebased, long-
Methods of terminology recommended by the International Institute of Physical Activity and Health (ISPAH)
Global Partnership, who, European Commission (EC (EC)
World Economic Forum (WEF)
Active Canada, sports is the organization of medical and economic cooperation
Business development (OECD)
1-3 8-13 and many others.
So far, efforts to promote prevention in the field of health care have largely failed.
It is unrealistic to wait for the comprehensive and urgent reform of the dysfunctional health care system.
Similarly, the results of the restoration study have not been successfully implemented and expanded to create a populationwide impact.
Current approaches to chronic disease prevention and management involving public health and global health strategy 14 may need to work with humans-Center design (HCD).
The latter approach is used as a catalyst for change in other industries, focusing on the importance of human factors in behavioral change.
7 successful implementation of a testable, novel approach will require determined and visionary leadership, willing to revisit the issue from a practical, human perspective
While adhering to a clear strategy, mobilize the resources and capabilities needed for change from a design perspective.
The purpose of this IOC Consensus Meeting is to agree on a strategy to design a sustainable action plan for the prevention and management of non-communicable diseases, combining existing scientific evidence with human infectious diseases, pay special attention to physical activity/exercise and behavior change.
In order to achieve this goal, Sports and Sports Medicine (SEM)
Communities must overcome considerable inertia resulting from the problem of non-communicable diseases and the complexity and scale of their context.
The SEM community must integrate its efforts to embrace a new, creative approach that aligns with a clear, concrete and user-friendly strategycentred.
Most of the problems in human history are that people need physical activity to survive.
Today, for example, only 20% of Norwegian people are 15 years old and 8 years old.
2% of USA16 and 5% of UK17 adults are in line with the sports guide. Over a four-
During the ten-year period, sports activities in the United States fell by 32%, and it is expected to further decline to 46% by 2030,18, while sports activity in China decreased by 45% from 1991 to 2009.
In the Arab world, between 33% and 70% of the population in eight countries lack physical exercise.
Over the past 50 years, significant declines in energy spending in household management and civil occupations have been sufficient to account for the increasing prevalence of obesity.
22 on a global scale, physical inactivity and smoking cause more deaths than any other changeable risk factor.
Clinical Scientists are continuing to find more features that amplify the problem.
For example, sitting time is associated with an increase in the metabolic risk of the heart, not with the level of physical activity.
Low aerobic fitness is a risk factor for all
Mortality, cancer, and cardiovascular disease unrelated to physical obesity.
26, 27 while the problem of lack of physical activity, poor diet and unhealthy lifestyle behavior is obvious, the real problem is that we have failed to mitigate the steady rise in non-communicable diseases.
Indeed, in the course of our accumulation of research data and the publication of statement of position and recommendation, the incidence and mortality rates of non-communicable diseases have declined.
28 the existence of only national sports activity policies or action plans does not ensure the functioning or implementation of these policies or plans.
The guide to sports activities is not implemented, and the implementation is not guaranteed to change.
29 we can no longer think of governments, schools, employers, facilities managers, urban planners, the Ministry of Education, global organizations, healthcare professionals, universities, the entertainment and health sectors, community organizations, sports federations, what the health care system and the transportation sector \"should\" do.
The SEM community can do something because its expertise is closest to the intersection of physical activity, diet and health.
Despite global advocacy for a sound \"whole government system\" approach, the direct and indirect costs of non-communicable diseases remain staggering and unsustainable due to the financial, political and structural complexities involved.
The health care industry promotes government agencies to formulate policies that lead to change, and the government promotes prevention programs in the health care industry.
Attempts to limit the size of sugar grains failed-
New York Mayor Bloomberg\'s sweet drink is an example of a power constraint, even if there is a good one
Expected policy intervention.
31 by contrast, the director of the Swedish National Health and Welfare Bureau has announced that there is sufficient evidence in the health care system to act \"immediately;
An example of the government\'s expectation that real change requires action by the health care system.
Prevention remains in the middle as policy makers demand change in health care and vice versa.
Have extensive and sick
Clear goals lack consistency and strategic focus, prevention remains in the theoretical field of passivity and suggestion, and a large amount of scientific evidence, while true, is of no use in achieving change.
34 it is not surprising that there is no clear response plan.
We can easily acknowledge the conflict between the complexity of chronic diseases and the simplified methods used to solve chronic diseases, as well as the potential blind spots caused by the determinist thinking.
35. 36 complex Africa
The linearity of healthy behavior does not allow simplification by focusing solely on a single intervention.
On the one hand, we must resist the lack of concrete and clear statements and suggestions of lofty positions that transfer responsibility to intangible entities, and on the other hand, we must resist
The downward approach envisioned by medical and scientific experts reproduces knowledge and guidelines that will not translate into action.
We must find ways to overcome the obstacles that prevent us from making progress in prevention.
Including :(1)
The reduction theory and decisive thinking method in medical science have become the default method of medical care ,(2)
Financial model of diseaseBased on and events
Basic Medicine ,(3)
Single intervention mode ,(4)
Lack of disease-
Burden matching and prevention
Training courses for health care professionals ,(5)
Lack of specialized distribution channels to provide knowledge and (6)
Change the uncertainty of human behavior
37 most of the problems in human history are that people need physical activity in order to survive.
Today, for example, only 20% of Norwegian people are 15 years old and 8 years old.
2% of USA16 and 5% of UK17 adults are in line with the sports guide. Over a four-
During the ten-year period, sports activities in the United States fell by 32%, and it is expected to further decline to 46% by 2030,18, while sports activity in China decreased by 45% from 1991 to 2009.
In the Arab world, between 33% and 70% of the population in eight countries lack physical exercise.
Over the past 50 years, significant declines in energy spending in household management and civil occupations have been sufficient to account for the increasing prevalence of obesity.
22 on a global scale, physical inactivity and smoking cause more deaths than any other changeable risk factor.
Clinical Scientists are continuing to find more features that amplify the problem.
For example, sitting time is associated with an increase in the metabolic risk of the heart, not with the level of physical activity.
Low aerobic fitness is a risk factor for all
Mortality, cancer, and cardiovascular disease unrelated to physical obesity.
26, 27 while the problem of lack of physical activity, poor diet and unhealthy lifestyle behavior is obvious, the real problem is that we have failed to mitigate the steady rise in non-communicable diseases.
Indeed, in the course of our accumulation of research data and the publication of statement of position and recommendation, the incidence and mortality rates of non-communicable diseases have declined.
28 the existence of only national sports activity policies or action plans does not ensure the functioning or implementation of these policies or plans.
The guide to sports activities is not implemented, and the implementation is not guaranteed to change.
29 we can no longer think of governments, schools, employers, facilities managers, urban planners, the Ministry of Education, global organizations, healthcare professionals, universities, the entertainment and health sectors, community organizations, sports federations, what the health care system and the transportation sector \"should\" do.
The SEM community can do something because its expertise is closest to the intersection of physical activity, diet and health.
Despite global advocacy for a sound \"whole government system\" approach, the direct and indirect costs of non-communicable diseases remain staggering and unsustainable due to the financial, political and structural complexities involved.
The health care industry promotes government agencies to formulate policies that lead to change, and the government promotes prevention programs in the health care industry.
Attempts to limit the size of sugar grains failed-
New York Mayor Bloomberg\'s sweet drink is an example of a power constraint, even if there is a good one
Expected policy intervention.
31 by contrast, the director of the Swedish National Health and Welfare Bureau has announced that there is sufficient evidence in the health care system to act \"immediately;
An example of the government\'s expectation that real change requires action by the health care system.
Prevention remains in the middle as policy makers demand change in health care and vice versa.
Have extensive and sick
Clear goals lack consistency and strategic focus, prevention remains in the theoretical field of passivity and suggestion, and a large amount of scientific evidence, while true, is of no use in achieving change.
34 it is not surprising that there is no clear response plan.
We can easily acknowledge the conflict between the complexity of chronic diseases and the simplified methods used to solve chronic diseases, as well as the potential blind spots caused by the determinist thinking.
35. 36 complex Africa
The linearity of healthy behavior does not allow simplification by focusing solely on a single intervention.
On the one hand, we must resist the lack of concrete and clear statements and suggestions of lofty positions that transfer responsibility to intangible entities, and on the other hand, we must resist
The downward approach envisioned by medical and scientific experts reproduces knowledge and guidelines that will not translate into action.
We must find ways to overcome the obstacles that prevent us from making progress in prevention.
Including :(1)
The reduction theory and decisive thinking method in medical science have become the default method of medical care ,(2)
Financial model of diseaseBased on and events
Basic Medicine ,(3)
Single intervention mode ,(4)
Lack of disease-
Burden matching and prevention
Training courses for health care professionals ,(5)
Lack of specialized distribution channels to provide knowledge and (6)
Change the uncertainty of human behavior
Methods in order to develop a consensus action plan for the prevention and management of chronic diseases, the International Olympic Committee convened an expert group in Lausanne on April 12, 2013, representing the reliability and repeatability of sports and sports medicine, public health, clinical epidemiology, design thinking, industry leading, advocacy, practical science, biomedical evidence, social marketing, education, technology and lifestyle behavior intervention.
Prior to that, five participants held a one-day meeting in New York on December 2012 to plan the design mindset of the meeting. The 2.
The 5-day meeting begins with an introduction and presentation of the question, followed by a 15-minute lecture and discussion by each participant on the following three questions :(1)
Why did you accept the invitation for this meeting?
Why are you here)? (2)
What do you think is the most important thing that needs to happen (
Actual occurrence)
Reduce the incidence and mortality of chronic diseases? (3)
What steps will you take in the coming year to achieve this \"thing \"?
Experts are urged to use the existing systematic evidence collection and to identify new areas of opportunity.
These presentations and discussions prompted the panel to raise the following questions for consideration :(1)the problem, (2)
Opportunities for change in behavior ,(3)
The importance of HCD ,(4)
The value of the SEM model for function and performance ,(5)
Requirements of the actual center for the development of prevention programmes and (6)
The importance of the IOC leadership.
Half of the meeting time is to use design thinking methods to combine scientific evidence with human reality in order to reach a consensus on an action plan. The last half-
It took a day to work out the draft of the manuscript and 18-
Monthly Action Agenda
In view of the impact of unhealthy lifestyles on the prevalence of chronic diseases and behavioral changes, governments in 5, 16, and 29 countries began decades ago, emphasis was placed on changing the way of life and behaviour, extending the scope of the national health policy beyond traditional medical and surgical interventions.
38-40 therefore, behavioural change is critical as a core component of all clinical protocols for the prevention and management of chronic diseases.
Given the broad and overlapping relevance of individuals, it is very complex to understand and guide human behavior (
Belief and attitude)
Interpersonal (
Cultural and social norms)
Environment (
Social, architectural and natural environment)and policy (
Regional, national and global)factors.
In a Swedish study, 76% of patients recognized the responsibility to change their behavior, but still hoped that the health care system would help them change.
This complexity reflects a potential discussion about the individual or society\'s responsibility for physical inactivity and other lifestyle \"choices.
The focus of the intervention can be on the recent (individual)
Or more remote (
Social-culture and/or environment-politics)
Factors associated with physical inactivity and other lifestyles
Related behavior
There is good reason to believe that the proper emphasis is to change the environment without personal awareness by turning physical activity into our daily life.
Insights such as the so-called \"push\" encourage and support people to change their behavior by changing the structure of choice, while fully maintaining their autonomy and respecting cultural norms.
In short, a nudge can be used to change the default option to a healthier option, such as 42,43, by placing healthier products in a more prominent and convenient place in the cafeteria.
However, by advocating concurrency, system-
A broad strategy to build a supportive environment requires tremendous efforts to coordinate multiple stakeholders, including policy makers.
Government organization (NGO)
Schools and companies bring about ideal changes.
Various social cognitive theories that only emphasize self-intention
Regulation and self
Control is a key determinant of behavior, for example, given the importance of the process of habit formation and the contextual nature of the behavior, rational action theory and planned behavior theory are not enough.
47 traditional interventions assume that people make rational lifestyle decisions, and in reality, many of these decisions are actually unreasonable (habits)
Not logic.
48 therefore, most interventions designed only from a content perspective are more likely to fail if the user is not recognized as an expert in his or her own experience.
Interventions and solutions need to be \"consistent with how people behave \".
\"49. The Power of Habit formation in behavioral counseling is still relatively untapped for the prevention of non-communicable diseases.
Habit is an automatic response to contextual cues, obtained by repeated behavior in the presence of these cues.
50 in order to change these habits, one needs to take into account that if the motivation and ability to perform the task is sufficient to generate a physical or psychological reward, a specific clue will trigger the action.
For example, even if an unhealthy person has a high motivation for tomorrow\'s marathon, it is likely that he or she will not succeed because of his or her physical abilities (
Cardiovascular capacity and muscle endurance)
Need to develop over time.
Therefore, it is necessary to reduce the difficulty of the task and thus improve the ability to perform the task.
The formation of habits begins with simple, very specific tasks of daily physical activity, which can gradually increase as people build confidence and control (
Take the stairs instead of taking the elevator while working).
With more success and adoption of more ambitious behaviors, the goal is to make it easier to understand and change specific behaviors, rather than complex tasks like \"running a marathon.
When a particular health habit is successfully formed in isolation, it may have a spillover effect on many other aspects of personal life.
52, 53 in addition, for a person with a behavioral change plan, it may affect his or her social network by triggering a major behavioral change of the person\'s friend, thus forming a social norm.
52 thus, the cumulative impact of preventive intervention is the sum of direct health outcomes for individuals, plus incidental health outcomes for those with social connections (
Attached health effects).
This emphasizes the connection between the social determinants of personal and surrounding health.
54 of course, the side effects can be either positive or negative, so both possibilities should be considered.
A great opportunity arises when it comes to converting data into information that will help guide clinicians and patients in making correct decisions.
Tools like patient activation measures help to layered and personalize patient care by customizing guidance, education, prevention and care programs for different patients with different levels of preparation.
55 technological advances are readily available, such as pedometers or tracking devices, and may include sensors in smartphones to provide important information about patterns of personal physical activity.
56 Persuasive technology uses interactive smartphone applications as decision support tools to trigger certain user behaviors with instant feedback and support.
51 through integration from real-
Time patient data analysis may provide insights into the selection architecture for more targeted behavioral counseling.
The explosion of big data generated by the digital society has triggered a management revolution in other industries in decision-making --
Production and customer participation.
57, 58 companies around the world have invested heavily in complex analytical capabilities designed to gain meaningful customer insights.
56 for example, traditional retailers analyze the buying habits of customers and run algorithms to better predict the needs of customers and customize their product suggestions based on their unique preferences.
59 in public health, Google is able to predict the spread of the flu pandemic more accurately and weeks in advance than the traditional surveillance system of the U. S. Centers for Disease Control (CDC).
For a long time, in sports such as baseball and football, 60 comprehensive data analyses have been used to determine success factors and adjust tactics accordingly.
61 medical and electronic medical records (EMR)
Generating massive data sets presents a challenge for how to transform unstructured data
Healthcare products provide useful assets for patient insight.
62 these technological advances will leverage insight, promote behavioral change, and ultimately lead to the formation of habits by influencing individual, interpersonal or environmental factors, which are necessary for a successful prevention plan. Human-
Preventive health-centered design we often skip critical steps such as observation, Discovery, interpretation, conception, prototyping, iteration, and monitoring, from understanding the situation to \"learning solutions\"figure 2A).
This applies to many of our daily tasks (
Open Beta-
High-blood pressure)
But as the lifestyle changes, it reaches its limits.
For example, we don\'t always know how to translate accurate, good
Incorporate established guidelines and suggestions into the daily life of individuals.
63 we also do not have good knowledge and skills to educate health care providers
Establishment and evidence
Intervention based on our patients.
64 from a scientific, analytical point of view, we know the dose-response relationship of regular exercise in terms of frequency, duration, and intensity.
65 in fact, every health care professional and layman is more or less aware of the importance of physical activity to health
The existence and quality of life.
Nevertheless, the compliance rate of the evidence
From the provider and patient point of view, guidelines-based guidelines are poor and inconsistent. 63, 66 interventions are designed from a content point of view and only treat users as end products or services to guide people by using the top
Do not consider barriers to implementation and compliance at the individual and organizational levels.
67 patients often receive solutions that focus only on disease treatment, rather than solutions that also include accessibility aspects (figure 1).
For example, prescribing is a treatment option for many diseases, but if there is no behavioral plan to form a habit, compliance may hinder the success of such a treatment option.
Determining the context of behavior change when designing prevention programs requires asking the right questions, which is often \"what is most important to you\" rather than \"what is the problem \".
The lack of active human involvement in understanding the patient\'s potential problems and developing viable solutions may explain why, after decades of tool development, we have not achieved results in prevention.
Download the new tabDownload figureOpen powerpointFigure1 person
Center design 72 (HCD)
It\'s an innovative approach that requires people to understand their preferences.
With innovation, there are three overlapping constraints.
Feasibility is functionally or technically possible in the foreseeable future.
Innovation is likely to be part of a sustainable business model.
Accessibility refers to something that makes sense to people and people (
Important human factors).
These constraints stimulate innovation, and the HCD approach will balance innovation in harmony.
The foundation of the HCD is the willingness and even enthusiasm to accept competition restrictions.
The design thinking process includes :(1)Understanding—
Challenge the status quo (
We often jump from ideas to solutions without understanding the underlying incentives and drivers), (2)observation—
Get insights through on
On-site observation ,(3)synthesis—
Build and group insights with visual technology to identify problems and opportunities
It is crucial to find the right problem, because the way the problem is formed usually determines the method of innovation ,(4)ideate—
Various methods for innovation and (5)prototype—
Rapid prototyping allows fast feedback iterations (
Modified from Tim Brown72).
However, \"providing care, needs and values that respect and respond to the individual preferences of patients, and ensuring patient values guide all clinical decisions\" 68 has long been considered a key quality improvement parameter for patientscentred care.
69-71 in fact, there is an entire industry called HCD that relies on understanding people\'s needs and motivations in order to design ideal, viable, high-quality solutions that meet those needs.
From a behavioral point of view, prevention is different from treatment because future health problems are \"invisible \"(
Asymptomatic sub-clinical
75 comes from deep-rooted habits.
\"Success\" is defined as no result through prevention (
Avoid Heart Attack).
Therefore, empathy solutions are critical in prevention.
The challenge for health care is to accept responsibility and understand the factors that directly change behavior in this case.
HCD contains limitations on innovative solutions from a human perspective (figure 1)
And combine empathy, creativity, and rationality to analyze and fit solutions for background and personal preferences.
HCD uses techniques and methods to understand the complex context of internal motivation and external barriers to behavior change and habit formation.
Direct observation and interaction with people is used to understand what they want and need in their lives and how they like or dislike the production and delivery of a particular product or service (figure 1).
72 through investigation-
For-
Human factors have the potential to gain unexpected insights from an individual\'s point of view on how to build problems in ways that help to develop sustainable solutions.
The design attitude towards problem solving allows us to ask some basic but basic questions such as \"What is the real problem we face and how can we overcome it? ”.
76 The original solution was created taking into account the human desire and later focused on the technical feasibility and feasibility of the possible solution.
77 for example, increased focus on age suitability, fun, incentives and motivation, social support, feedback on interventions for children and the teaching/guiding style experience and feeling of interventions may be substantial.
78 HCD is a method that can be incorporated into other methods such as intervention Mapping79, 80, and can make up for the lack of the need to \"implement the study.
With these categories, design a simple and easy-to-understand solution (more user-centric)
Avoid confusion that often occurs at the end of program development when a low level of compliance with the intervention is found.
This is a huge opportunity as healthcare professionals show growing interest in paying attention to users --
Designers can have a profound impact on social innovation.
83 critical balance between creative thinking and intuitive thinking (Design thinking)
Expertise in technology and content (
Analytical thinking)
Very successful in different environments and organizations.
72, 74 HCD has a tendency to act and can pilot, expand and formally test rapid prototyping and multiple iterations to demonstrate its ability to develop effective prevention programmes for chronic diseases.
The unique properties of SEM for disease prevention SEM modern medical disciplines are deeply rooted in scientific research on human function and beneficial adaptation to physical activity and exercise generated in multiple organ systems.
The human body has a profound ability to improve performance in response to training.
Muscle mass, stroke volume and ejection fraction, RBC mass, capillary density, increased mitochondrial volume density, and changes in fuel storage and utilization, results in muscle strength, endurance, aerobic and aerobic capacity, as well as agility, balance, and flexibility.
These adaptations are profound.
The term performance is often used to describe these adaptations of a competitive athlete, while functional abilities are most commonly used in non-athletes.
For older people or people with chronic and multiple diseases, functional abilities can still be trained like athletes.
84 training leading to these physiological adaptations is the same as training that is beneficial to health.
Although SEM is a clinical discipline with a history of less than 40 years, its potential for health and functional benefits other than competitive athletes has not yet been realized.
Therefore, it is necessary to extend the knowledge and skills of structural equations to the general population to establish new programs for the prevention and management of chronic diseases focusing on physical activity, diet and other lifestyles.
Almost everyone suffers from chronic diseases, and most people suffer from multiple chronic diseases.
Therefore, it is unrealistic to establish a culture of health and disease.
A more realistic approach is to recognize the reality of chronic diseases and to work towards the prevention and management of chronic diseases throughout the life cycle.
Symptoms of chronic diseases are only events that last for many years, during which preventive practice may affect the onset and severity of symptoms.
Traditional medicine believes that no symptoms are healthy, and the emergence of disease symptoms is an acute event that needs treatment (
(Such as medicine or surgery).
Prevention attempts to identify risk factors early and address them, thereby delaying the onset of symptoms of chronic diseases.
In addition, prevention can improve the impact of existing chronic diseases on functional capacity and the development of related chronic diseases (comorbidities).
How to successfully incorporate the prevention and management of chronic diseases into the daily clinical practice of SEM and primary health care medicine is an urgent challenge.
37 The challenge is one of them-
Develop new capabilities, clinical programmes and expertise in chronic disease prevention and management to provide new preventive services to the public in an effective and cost-effective mannereffective way.
85. the focus of most SEM practitioners and clinics remains on the care of competitive athletes.
A unique feature of the SEM range is that, unlike other medical specialties, it is not organ system or disease specific.
So far, knowledge and clinical skills in the field of chronic disease prevention and management are not the focus of SEM\'s continued professional development, although this will be a relatively simple and potentially influential step.
Formal clinical training in chronic disease prevention and management must be developed and provided for SEM and primary care practitioners, including role recognition, communication and integration between healthcare providers and the fitness and health industry.
At present, there are practical programs and centers for disease prevention, and there is no preventive \"home\" in health care \".
No community-
Prevention Centers that anyone who tries to maintain or improve their health can go directly.
Although some rehabilitation facilities and lifestyle units are available in primary health care, there is no population programme --
Focus on a wide range of behavioral changes in physical activity, exercise, or other lifestyle choices.
This vacuum is being filled by the weight loss center, fitness and health studio;
This is a multi-billion-dollar industry based on a different principle than the healthcare industry.
This leads to low levels of interaction and coordination as health care systems tend to believe that these industries lack the \"credibility\" and \"authenticity\" of preventive partners \".
Establish practical centers to design, implement, study and improve prevention programs for chronic diseases, the value provided by evidence
Basic medicine needs to be combined with the value that fitness, health and weight provide
Action in the loss industry
Extensive distribution network.
Building a sustainable foundation for prevention requires a physical center (figure 2).
Initially, these centers can be pilot centers that meet strong standards for evidence-to-HCD integration, technology use, and mobility tendencies and rapid prototyping.
Several of these centres have had meaningful cooperation with health care, academia, industry and the technical sector as a place for development.
Although there are some excellent, good
Behavior changes are studied using a reasonable conceptual model, and current clinical methods are often intuitive and experimental. and-
The error process relies primarily on the experience and skills of individual practitioners and health coaches.
The first center will foster a seedling bed for behavioral design by understanding, observing, synthesizing, conceiving, prototyping, and iterating, thus providing the structure for the ideal prevention program.
The factors that determine success are first and foremost the ability to meet human needs that are currently considered more important (
Quantitative measurement of disease status, figure 1).
Starting with compassion and human desire, the empirical elements of these projects are centered around \"work-to-be-
For the individuals behind the disease.
Therefore, initial screening needs to include cognitive and behavioral assessments as well as traditional functional assessments.
Download the new tabDownload powerpointFigure2 (A)
Center for Community prevention (CPCs)
Is a practical facility for scientific evidence.
Basic medicine and humanCenter design (HCD)
Development and implementation of prevention programmes.
While the interaction between many disciplines remains to be precisely defined, the road map presented combines the HCD approach with the traditional programming approach.
Initially, medical conditions (MS)
Evaluate the cognitive function of each customer (CF)
Physical capacity (PC)
And behavior quotient (BQ).
This input helps healthcare professionals to observe and understand the context of an individual\'s current situation and to generate insights into the possibility of behavior change.
Interpreting and combining these insights and backgrounds enables the development of prototype character characters to classify customer services based on key features associated with the likelihood of success of certain interventions.
Based on the experience and history of certain role profiles, healthcare professionals can engage clients in a conceptual process that targets healthier behavior.
A single, achievable task leading to behavior change is used as an iterative prototype to build confidence and control.
The evolution cycle of habit formation is dynamic, notlinear.
Through electronic monitoring
In addition to re-evaluation, health tools include measurements of results. (B)
CPCs integrates, communicates and coordinates the customer experience in an ecosystem that includes healthcare providers, fitness and health providers, workplace health promotion partners, and information technology partners.
This communication, coordination and integration is critical to connecting CPCs with existing structures in order to provide integrated services to customers.
Close medical tracking
Communication and communication are particularly important for patients with chronic diseases.
The ideal environment for the initial development and testing of these projects is in a dedicated research center that meets strong standards for collaboration and feasibility.
The details of these projects will change over time with the help of data analysis, so that the initial intuitive process will become a more standardized and accurate way of behavior change design.
By achieving this, the program will become more affordable and potentially scale by issuing licensing agreements to other health care providers or fitness facilities.
Traditional groupings of primary, secondary and tertiary prevention are valuable to health care providers, medical scientists, and programme development strategists related to Demographic Stratification, safety, programming, logistics and outcomes.
However, such classification has little to do with individuals entering the prevention program, as they are remnants of reductionist thinking related to the presence or absence of disease or risk factors.
Organizing projects around these categories, among other things, has not recognized human factors beyond the medical field
Biological origins of these prevention categories: namely, personal interests, personality traits, temperament, skills and abilities.
By thinking about the disease category, any prevention program boils down its process and function to the stage and progress of a certain disease.
Similarly, if not overwhelming, it can be confusing to determine what is the prevention and management of chronic diseases.
It is clear that prevention applies to people who do not have a disease or risk factor, and management applies to people who have a chronic disease.
However, this distinction is arbitrary and, as a general term, prevents behavioral changes that apply to disease or risk factors.
The most important thing for people is that the scheme is desirable.
This is a starting point.
In meeting people\'s real needs, it is essential to identify certain character features and features of a particular population.
This helps to shift from simply labeling people based on the performance of the disease to focusing on their needs and goals, which is at the heart of prevention.
80% of the health care expenditure is for patients with severe illness, and the health care expenditure can be traced back to patients with basically predictable health care needs and expenditures: patients with chronic diseases.
This bloated figure is a mirror of our medical structure, which is heavily biased towards \"fixed\" diseases.
Level 3 prevention (management)
Possible immediate gain from the build
From a benefit point of view, we must avoid the rigid division of prevention into Level 1, Level 2 and Level 3, as this again focuses the scope of service on simplified models of disease types and stages.
Clinical, integrated lifestyle interventions have a lot of similarities to the basic principles of behavioral design, regardless of how a person is \"tagged\" or what category they are assigned.
If any clinical protocol focuses only on one Prevention category and does not recognize this, it is impossible to create a real population --wide impact.
For this reason, we need to move from the abstract concept of prevention to the specific related programs, which are reflected in different character roles and grouped according to their functional, behavioral and cognitive conditions.
This approach, which takes advantage of the human desire for aggregation and stratification, is a key distinguishing factor in the success of prevention programmes.
It is absolutely necessary to be consistent at this point.
The basic components of the prevention programme include assessment (
Medical, cognitive, physical, behavioral)
Programme design and implementation and monitoring and re-evaluation (figure 2A).
The various components of the programme must be based on evidence and current guidelines and provided by trained health care professionals with experience and expertise.
Much of this work remains to be developed.
Functional capabilities include all factors related to the physical ability to perform a given task.
Behavioral quotient is a set of attributes that indicate motivation, such as the degree of readiness to change.
88 cognitive function refers to information processing and learning.
These four groups of factors determine the structure of prevention programmes.
In aggregation, these variables and attributes help with a different set of role profiles.
After considering different preferences from different angles of personal development, it is possible to better design solutions suitable for personal needs.
Therefore, factors that take advantage of the human desire for aggregation and stratification are a key distinguishing factor in the success of prevention programmes (figure 2A).
Based on these evaluation results and role profiles, a project can be designed and customized to achieve individual goals.
Multiple options for health
Relevant data exists (
E-medical records, sports activity tracking devices, purchase history, social media profiles, for example)
This helps to be layered at the population level and at the individual level to support rational decision-making. 48 The ever-
In the prevention pilot program, an increase in patient throughput will result in a large database
Experience in helping to identify and discover patterns of population levels allows to predict in which case it is effective for whom from a probability perspective.
This will formalise the intuitive, informal process currently being provided by healthcare professionals for behavioral change advice, and shift prevention to a precise and personalized approach to mass customization.
Therefore, standardized but personalized programmes of high quality and low cost can be scaled up at the population level.
The core of developing prevention programmes and centers is creating value for patients and care --
Through HCD (
Figure 1).
Similarly, in order to expand the size of the programme and create a population, a sound business model must be established --wide impact (
Figure 1).
The global SEM has established strong partnerships with primary health care communities, sports federations and national Olympic committees (NOCs)
Resources could be mobilized to expand and distribute prevention programmes using the network (
Feasibility, figure 1).
Work under these three constraints;
Feasibility, feasibility and feasibility provide the greatest opportunity for preventive innovation.
Progress in prevention and management of chronic diseases will require very strong leadership, a willingness to interrupt, and a focus on rapid innovation.
To be successful, a well-thought, systematic approach is required to map the strategy clearly and continuously to the mission and vision, and to develop resources to create capacity.
Sports and Exercise play an important role in preventing and managing NCD85, 90 sports, and the IOC is a natural leader in this field.
91 The International Federation and the National Olympic Committee can all play an indispensable role in promoting sports activities through cooperation with the International Olympic Committee, who, the international sports activity Network, the SEM Association and the non-International Olympic Committee
Government organization (NGOs).
92 many countries now focus on improving the heritage of population health by increasing physical activity as part of hosting major sporting events such as the Olympic and Paralympic Games.
93,94 the International Olympic Committee has demonstrated its leadership in the establishment of national sports, 95 Olympic Day celebrations, 96 projects, 97 the initiative of the International Olympic Committee medical committee, such as the provision of health and fitness services for young people through sports activities and sports 98 and education programmes, the 99-101 Youth Olympic Games, and through work with the World Health Organization
Both the Olympic Games and the Olympic brand are based on positive universal values. Beyond the emotional and unique identity of the movement, there is a strong resonance with people of different ages and cultures from all over the world.
103 Olympic athletes inspire people to do their best in their daily lives.
The enterprise partnership is based on this inspiration
Relevant marketing activities to help companies build a socially responsible image and brand affinity within their customer base and translate into higher brand memories, preferences, and purchases.
These partners maintain a mutually beneficial and collaborative relationship with the IOC, which operates as a non-governmental organization.
Through the alliance with well-there is a good opportunity to promote prevention programmes recognized by the IOC
To penetrate and convince a large customer base, well-known and respected corporate partners, medical associations and academic groups.
104 facilities and distribution channels already exist through SEM and primary health care networks.
Success and cost in Development-
These programmes have an adjusted but stable financial model that can be rolled out on an international scale to lead to widespread changes in prevention.
The IOC, as a governing body, will continue its common commitment and partnership with the SEM community by initiating and continuing efforts to prevent chronic diseases, using the type change framework described by Kotter (box 2).
105 some activities of the IOC will include new and innovative approaches such as design thinking, which will require the autonomy and appropriate opportunities for creative work, other activities will promote collaboration, diversity and integration and maintain respect for tradition. 2 kotter\'s 8-box
Build a sense of the urgencyCreate guidance alliance to develop a vision for change that conveys the vision of purchaseInEmpower wide
Short generation based on action
Terms of never giving up
Building on change and integrating change into culture, the IOC, in view of its political influence, still has to advocate multi-faceted approach1-3, 8, 11, and work with policy makers, NGOs, schools and companies, 106107 the IOC must currently focus on one goal to prevent overwhelming paralysis in trying to balance all public health issues at the same time.
What is true for individuals also applies to organizations: \"You can eat elephants but only one bite at a time \".
The IOC will work with the SEM community to design clinical lifestyle intervention tools for healthcare professionals to fully guide and help patients change their behavior.
Given the vested interests of talent, knowledge and resources within the IOC and the SEM community, the impact of this individual-focused partnership has great potential.
The establishment of the Prevention Center enables the leadership to adopt a clear strategy, a simple, direct and acceptable approach that impacts from health care and will have a broad impact on the population.
The centers will incorporate evidence while systematically combining design thinking with current health promotion principles.
In order to get support and bring the current abstract ideas into life (
Change of behavior, etc)
Grassroots pilot projects with a tendency for rapid prototyping are needed.
This will raise people\'s aspirations and inspire skeptics to act.
Therefore, it is essential to identify the core groups of a group of early-stage supporters and strategic key stakeholders with personal passion, enthusiasm and commitment, who are prepared to postpone traditional judgment and express their willingness to stimulate breakthrough ideas
Initial prototyping and experiments may be performed in a clinical setting.
However, the success of the programme of work depends on its distribution and size.
It is therefore important to successfully transfer these programmes to primary care, the workplace, the health initiative, 108 and the fitness industry.
This can be achieved through the transfer of content, skills and expertise to interested healthcare professionals through a licensing agreement in order to create a network of brand prevention centers (figure 2B).
Training and education are critical to the development of future professionals working in the field of disease prevention and management.
At present, no group of health care professionals have the full knowledge and skills needed for clinical work in disease prevention.
64. 109 the various components between doctors, fitness experts, physiotherapy, nursing, and sports pathologists are scattered (kinesiologists)
And other professions
2 it is essential to coordinate the development of courses, training and certification between and within these specialties. The IOC-
SEM partnership has the ability to certify practitioners in prevention and management.
Given the new approach to openness
Learning99-101, 110, and 111 of resources can be provided globally, providing immediate and extensive distribution and expansion.
For example, the IOC has developed a 2-
The annual diploma course in nutrition and sports medicine, 99-101, but may take a step towards incorporating preventive scholars into the network of prevention centers operating under certification standards.
The idea is to go beyond education, training and skills development to provide the basic framework for a healthy business model that allows for the implementation of prevention in the health care system.
This will further promote renewed commitment to prevention even within traditional health care stakeholders. The under-
When sound and reasonable alternatives such as prevention programmes recognized by the IOC are ready, representation of integrated lifestyle interventions, including physical activity in medical and other health professionals courses, will be more effective
In view of the impact of unhealthy lifestyles on the prevalence of chronic diseases and behavioral changes, governments in 5, 16, and 29 countries began decades ago, emphasis was placed on changing the way of life and behaviour, extending the scope of the national health policy beyond traditional medical and surgical interventions.
38-40 therefore, behavioural change is critical as a core component of all clinical protocols for the prevention and management of chronic diseases.
Given the broad and overlapping relevance of individuals, it is very complex to understand and guide human behavior (
Belief and attitude)
Interpersonal (
Cultural and social norms)
Environment (
Social, architectural and natural environment)and policy (
Regional, national and global)factors.
In a Swedish study, 76% of patients recognized the responsibility to change their behavior, but still hoped that the health care system would help them change.
This complexity reflects a potential discussion about the individual or society\'s responsibility for physical inactivity and other lifestyle \"choices.
The focus of the intervention can be on the recent (individual)
Or more remote (
Social-culture and/or environment-politics)
Factors associated with physical inactivity and other lifestyles
Related behavior
There is good reason to believe that the proper emphasis is to change the environment without personal awareness by turning physical activity into our daily life.
Insights such as the so-called \"push\" encourage and support people to change their behavior by changing the structure of choice, while fully maintaining their autonomy and respecting cultural norms.
In short, a nudge can be used to change the default option to a healthier option, such as 42,43, by placing healthier products in a more prominent and convenient place in the cafeteria.
However, by advocating concurrency, system-
A broad strategy to build a supportive environment requires tremendous efforts to coordinate multiple stakeholders, including policy makers.
Government organization (NGO)
Schools and companies bring about ideal changes.
Various social cognitive theories that only emphasize self-intention
Regulation and self
Control is a key determinant of behavior, for example, given the importance of the process of habit formation and the contextual nature of the behavior, rational action theory and planned behavior theory are not enough.
47 traditional interventions assume that people make rational lifestyle decisions, and in reality, many of these decisions are actually unreasonable (habits)
Not logic.
48 therefore, most interventions designed only from a content perspective are more likely to fail if the user is not recognized as an expert in his or her own experience.
Interventions and solutions need to be \"consistent with how people behave \".
\"49. The Power of Habit formation in behavioral counseling is still relatively untapped for the prevention of non-communicable diseases.
Habit is an automatic response to contextual cues, obtained by repeated behavior in the presence of these cues.
50 in order to change these habits, one needs to take into account that if the motivation and ability to perform the task is sufficient to generate a physical or psychological reward, a specific clue will trigger the action.
For example, even if an unhealthy person has a high motivation for tomorrow\'s marathon, it is likely that he or she will not succeed because of his or her physical abilities (
Cardiovascular capacity and muscle endurance)
Need to develop over time.
Therefore, it is necessary to reduce the difficulty of the task and thus improve the ability to perform the task.
The formation of habits begins with simple, very specific tasks of daily physical activity, which can gradually increase as people build confidence and control (
Take the stairs instead of taking the elevator while working).
With more success and adoption of more ambitious behaviors, the goal is to make it easier to understand and change specific behaviors, rather than complex tasks like \"running a marathon.
When a particular health habit is successfully formed in isolation, it may have a spillover effect on many other aspects of personal life.
52, 53 in addition, for a person with a behavioral change plan, it may affect his or her social network by triggering a major behavioral change of the person\'s friend, thus forming a social norm.
52 thus, the cumulative impact of preventive intervention is the sum of direct health outcomes for individuals, plus incidental health outcomes for those with social connections (
Attached health effects).
This emphasizes the connection between the social determinants of personal and surrounding health.
54 of course, the side effects can be either positive or negative, so both possibilities should be considered.
A great opportunity arises when it comes to converting data into information that will help guide clinicians and patients in making correct decisions.
Tools like patient activation measures help to layered and personalize patient care by customizing guidance, education, prevention and care programs for different patients with different levels of preparation.
55 technological advances are readily available, such as pedometers or tracking devices, and may include sensors in smartphones to provide important information about patterns of personal physical activity.
56 Persuasive technology uses interactive smartphone applications as decision support tools to trigger certain user behaviors with instant feedback and support.
51 through integration from real-
Time patient data analysis may provide insights into the selection architecture for more targeted behavioral counseling.
The explosion of big data generated by the digital society has triggered a management revolution in other industries in decision-making --
Production and customer participation.
57, 58 companies around the world have invested heavily in complex analytical capabilities designed to gain meaningful customer insights.
56 for example, traditional retailers analyze the buying habits of customers and run algorithms to better predict the needs of customers and customize their product suggestions based on their unique preferences.
59 in public health, Google is able to predict the spread of the flu pandemic more accurately and weeks in advance than the traditional surveillance system of the U. S. Centers for Disease Control (CDC).
For a long time, in sports such as baseball and football, 60 comprehensive data analyses have been used to determine success factors and adjust tactics accordingly.
61 medical and electronic medical records (EMR)
Generating massive data sets presents a challenge for how to transform unstructured data
Healthcare products provide useful assets for patient insight.
62 these technological advances will leverage insight, promote behavioral change, and ultimately lead to the formation of habits by influencing individual, interpersonal or environmental factors, which are necessary for a successful prevention plan. Human-
Preventive health-centered design we often skip critical steps such as observation, Discovery, interpretation, conception, prototyping, iteration, and monitoring, from understanding the situation to \"learning solutions\"figure 2A).
This applies to many of our daily tasks (
Open Beta-
High-blood pressure)
But as the lifestyle changes, it reaches its limits.
For example, we don\'t always know how to translate accurate, good
Incorporate established guidelines and suggestions into the daily life of individuals.
63 we also do not have good knowledge and skills to educate health care providers
Establishment and evidence
Intervention based on our patients.
64 from a scientific, analytical point of view, we know the dose-response relationship of regular exercise in terms of frequency, duration, and intensity.
65 in fact, every health care professional and layman is more or less aware of the importance of physical activity to health
The existence and quality of life.
Nevertheless, the compliance rate of the evidence
From the provider and patient point of view, guidelines-based guidelines are poor and inconsistent. 63, 66 interventions are designed from a content point of view and only treat users as end products or services to guide people by using the top
Do not consider barriers to implementation and compliance at the individual and organizational levels.
67 patients often receive solutions that focus only on disease treatment, rather than solutions that also include accessibility aspects (figure 1).
For example, prescribing is a treatment option for many diseases, but if there is no behavioral plan to form a habit, compliance may hinder the success of such a treatment option.
Determining the context of behavior change when designing prevention programs requires asking the right questions, which is often \"what is most important to you\" rather than \"what is the problem \".
The lack of active human involvement in understanding the patient\'s potential problems and developing viable solutions may explain why, after decades of tool development, we have not achieved results in prevention.
Download the new tabDownload figureOpen powerpointFigure1 person
Center design 72 (HCD)
It\'s an innovative approach that requires people to understand their preferences.
With innovation, there are three overlapping constraints.
Feasibility is functionally or technically possible in the foreseeable future.
Innovation is likely to be part of a sustainable business model.
Accessibility refers to something that makes sense to people and people (
Important human factors).
These constraints stimulate innovation, a