Dr. Robert Nolan, second from left, and his team
Dr. Robert Nolan, second from left, and his team at the Peter Munk Cardiac Centre work to find ways for patients to deal with hypertension by creating important and long-lasting lifestyle changes. (Photo: The Globe and Mail)

Everyone knows that a healthy diet and regular exercise can lead to a longer life, but for most people, it's nearly impossible to break bad lifestyle habits.

In 2010, Dr. Robert Nolan, Director of the Cardiac eHealth and Behavioural Cardiology Research Unit at Peter Munk Cardiac Centre (PMCC), set out to change that by helping patients connect heart-healthy lifestyle change to their personal goals for living well.

Over the past seven years, Dr. Nolan has been devising ways to help patients with hypertension create meaningful and long-lasting lifestyle changes.

In the past, people would have consultations with a specialist and then be left to fend for themselves. Some might change their behaviours for a short period, but most would revert to old habits.

"They'd get educational sessions that would last a few weeks, but giving people information was not sufficient to help them feel ready and confident to sustain lifestyle change," says Dr. Nolan. "Without support to develop skills for putting a change plan into action, it was hard to shift old habits beyond a few weeks."

For patients with hypertension, short-term changes aren't good enough. If high blood pressure is not treated with a better diet, more physical activity, smoke-free living and taking medications as prescribed, then it could lead to a stroke or a heart attack.

The best way to beat the problem is through meaningful change, he says.

While many hospitals and private centres have tried to help people kick bad habits through internet-based programs, most of these haven't been designed to provide the type of support patients receive in face-to-face counselling, says Dr. Nolan. Many Web-focused counselling programs are either interactive or automated – not both.

With the interactive programs, someone might instant message with a counsellor and discuss their issues, but when the conversation ends, the patient is left without support about what to do next.

With the automated education, someone might input personal information on a website and get articles and data tailored to them, but when the reading ends, there's no clear idea on how to apply the information to their personal situation.

"Our programs often fail to provide guidance as someone interacts with a program within a single log-on session, or as we log on time after time," says Dr. Nolan. "We had to create a balance of the two."

Dr. Nolan developed REACH (Reducing risk with E-based support for Adherence to lifestyle Change in Hypertension), a comprehensive e-counselling program to help people make permanent changes to their lifestyle or "self-care behaviours."

PMCC Magazine 

The third annual Peter Munk Cardiac Centre (PMCC) magazine published by The Globe and Mail focuses on why Canada's premier cardiac centre is known for being "the heartbeat of innovation." The magazine explores the PMCC model that supports the creation, development and evolution of innovative ideas into action – making "today's idea, tomorrow's practice." It also examines the impact that a culture of innovation has on the way cardiovascular care is delivered now and into the future.

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