What are the management schemes for non-communicable diseases (NCDs)?

Management Schemes for Non-Communicable Diseases

Adults with non-communicable diseases should engage in at least 150 minutes per week of moderate-intensity aerobic physical activity (or 75 minutes of vigorous-intensity activity) plus muscle-strengthening activities twice weekly, combined with behavior change interventions delivered through exercise referral schemes and theory-based approaches in healthcare settings. 1

Core Physical Activity Recommendations

The management of NCDs centers on structured physical activity as an effective treatment option across multiple conditions including type 2 diabetes, COPD, arthritis, ischemic heart disease, stroke, depression, and chronic back pain. 1

Specific Activity Targets

• Aerobic exercise: 150 minutes/week of moderate-intensity OR 75 minutes/week of vigorous-intensity OR equivalent combination 1
• Session structure: Activities should occur in bouts of at least 10 minutes, distributed across days (e.g., 3×10 minutes/day for 5 days/week) 1
• Resistance training: Muscle-strengthening activities at least twice weekly 1
• Progressive approach: Any movement away from complete inactivity provides health benefits; every incremental increase matters 1

Safety Protocol for Initiating Physical Activity

Before starting or intensifying physical activity programs, adults with NCDs must follow these safety steps to minimize adverse events: 1

1. Medical clearance: Obtain sports medicine examination before commencing activity programs 1
2. Professional assessment: Determine with physician whether independent activity is safe or supervised care is needed initially 1
3. Individualized dosing: Work with physical activity professionals to tailor type, intensity, duration, and frequency to functional capacity 1
4. Ongoing monitoring: Seek professional guidance during disease progression, loss of disease control, or health deterioration to adjust or temporarily suspend activity 1

Physical Activity Promotion Interventions

Healthcare institutions should implement structured promotion strategies that demonstrate efficacy in increasing activity levels among NCD patients. 1

Evidence-Based Promotion Strategies

• Exercise referral schemes: Formal programs linking healthcare providers to community exercise facilities 1
• Theory-based interventions: Utilize behavioral change frameworks (transtheoretical model, social cognitive theory, health belief model) rather than atheoretical approaches 1
• Single behavior focus: Target physical activity change specifically rather than combining with multiple health behaviors simultaneously, as addressing PA first can catalyze other behavioral changes 1
• Target group tailoring: Customize interventions to specific NCD populations rather than generic approaches 1

Digital Health Integration for Self-Management

mHealth technologies provide complementary support for NCD self-management, particularly for younger adults, though implementation requires careful attention to technical readiness and system-level factors. 1

Key Implementation Considerations

• Technical readiness: Ensure apps are accessible, downloadable on current devices, and align with users' habitual routines 1
• Disease-specific capabilities: Provide accurate monitoring and task-specific functions for unique NCD requirements 1
• System-wide approach: Address barriers at micro (technical), meso (organizational, workforce, workflow), and macro (regulatory, governance) levels 1
• Core self-management support: Enable problem-solving, decision-making, resource utilization, and patient-provider relationships through digital platforms 1

Comprehensive Risk Factor Management

Beyond physical activity, effective NCD management requires addressing multiple modifiable risk factors through population-level and individual interventions. 2, 3

Primary Prevention Strategies

• Tobacco and alcohol control: Implement comprehensive regulation through taxation and sales/advertising restrictions 3
• Dietary modifications: Reduce salt, unhealthy fats, and sugars through regulation and public education; increase fruits, vegetables, and whole grains through pricing and availability improvements 3
• Metabolic risk factor control: Establish universal primary care systems that address cardiometabolic risk factors and NCD-precursor infections 3
• Life-course approach: Begin prevention in early childhood, as NCDs originate in early life despite manifesting in adulthood 4

Common Pitfalls and Caveats

Avoid combining multiple behavior changes simultaneously - while medically logical to address smoking, diet, alcohol, and activity together, this decreases probability of successful change; prioritize physical activity first as it catalyzes other behavioral modifications. 1

Do not apply uniform activity prescriptions - the 150-minute weekly target may be excessive for some NCD patients; emphasize that patients should remain "as active as their current situation permits" during illness exacerbations or reduced capacity phases. 1

Recognize implementation complexity - mHealth and digital interventions require more than pilot feasibility studies; they demand appropriately designed trials, long-term evaluation, and real-world population monitoring with attention to whole-system factors. 1

Address social determinants comprehensively - effective NCD prevention requires "Health in All Policies" approach starting in early childhood and considering socioeconomic factors, not just individual lifestyle modification. 5