|Year : 2018 | Volume
| Issue : 2 | Page : 67-73
Health-promoting lifestyle practices among patients with chronic diseases and its related factors
Fatemeh Samiei Siboni1, Marzieh Khatooni1, Vajihe Atashi2
1 Nursing Department, Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
2 Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||29-Oct-2018|
Dr. Vajihe Atashi
Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Hezarjereeb Avenue, Isfahan
Source of Support: None, Conflict of Interest: None
Introduction: Engaging in health-promoting lifestyle practices is one of the factors influencing the reduction of the burden of disease among individuals with chronic diseases. This study aimed to evaluate the health-promoting behaviors in individuals with chronic diseases and their related factors.Methods: In this cross-sectional study, health-promoting lifestyle practices in 625 individuals with a common type of chronic diseases in Qazvin city were investigated. Convenient sampling was used from May to December 2016 at specialized chronic diseases clinics of three university hospitals. The data collection was performed using a demographic questionnaire and the Farsi version of the health promotion lifestyle profile (HPLP II) questionnaire. Data were analyzed using descriptive and inferential statistics (independent t-test and stepwise multiple linear regression) via the SPSS version 21 software. Results: In the present study, 326 women and 299 men participated. The score of HPLP was 2.49 ± 0.37 in men and 2.47 ± 0.41 in women, with the highest score in nutrition and lowest score in physical activity. The results of the regression model showed that in women, the education of women and the spouse and satisfaction from the economic situation, whereas in men, the duration of the disease, unemployment, having chronic diseases in the digestive system and multiple sclerosis, age and education of the spouse, and satisfaction with the economic situation predicted health-promoting lifestyle practices. Conclusion: Given the low rate of health-promoting lifestyle practices, training and empowering these patients to promote lifestyle improvement of health-promotion behaviors, especially in physical activity, should be planned as part of the process of treatment and follow-up.
Keywords: Chronic disease, health-promoting lifestyle practices, related factors
|How to cite this article:|
Siboni FS, Khatooni M, Atashi V. Health-promoting lifestyle practices among patients with chronic diseases and its related factors. Soc Health Behav 2018;1:67-73
|How to cite this URL:|
Siboni FS, Khatooni M, Atashi V. Health-promoting lifestyle practices among patients with chronic diseases and its related factors. Soc Health Behav [serial online] 2018 [cited 2020 Jun 3];1:67-73. Available from: http://www.shbonweb.com/text.asp?2018/1/2/67/244340
| Introduction|| |
Improvements in public health have dramatically increased life expectancy across the globe. A majority of aging populations report chronic illness, and annually, 38 million deaths are reported due to chronic illness. Chronic illnesses are permanent or recurrent, significantly influence well-being, require daily and consistent healthcare management, and endure more than 3 months. Chronic diseases such as heart diseases, stroke, cancer, and diabetes are the most common diseases and are costly and preventable health concerns. Unhealthy lifestyle is one of the contributing factors to many health problems and is a risk factor for various diseases such as cancer, diabetes, cardiovascular diseases, obesity, and metabolic syndrome.
According to the World Health Organization, 40%–50% of deaths and 70%–80% of deaths in developing and developed countries, respectively, are due to lifestyle-related diseases. In Iran, the highest percentage of deaths in 2012 was reported as 70% and was related to chronic diseases, including cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, and other chronic diseases. Furthermore, the most important cause of chronic diseases was reported to be the unhealthy lifestyle.
Chronic diseases are major health threats and source of healthcare costs. Therefore, researchers and healthcare providers focus on interventions to prevent or control their exacerbation. Health promotion helps with the reduction of occurrence of diseases and death rate and contributed to the improvement of health status. Health promotion is a multidimensional pattern of self-initiated actions and perceptions that maintain or enhance well-being and self-actualization. Therefore, a healthy lifestyle and health-promoting behaviors are major strategies for improving and maintaining individuals' health.
Lifestyle-related measures not only help prevent and protect against chronic diseases but can also reduce mortality from chronic diseases. Therefore, promoting health among patients with chronic diseases is a desirable strategy to control the cost of care and improve the quality of life. For example, in patients with type 2 diabetes, lifestyle changes can prevent diseases' complications. Therefore, consultation with healthcare professionals to determine health-related behaviors in the daily life of individuals with chronic illnesses is required to improve their health and patients' health. As the first step, patients' behaviors can provide evidence for designing and implementing health-promoting lifestyle programs. Therefore, this study aimed to evaluate health-promoting behaviors among patients suffering from chronic diseases and its related factors in Qazvin city, Iran.
| Methods|| |
Study design and participants
In this cross-sectional study, 625 individuals with chronic diseases from Qazvin city, Iran, were recruited. Data were collected between May and December 2016. Using a convenience sampling method, the researchers referred to specialized clinics of chronic diseases, including cardiovascular diseases, neurology, internal medicine, lung disease, gastrointestinal diseases, nephrology, and oncology in three university hospitals of Qazvin city, Iran. Individuals who attend these clinics for their routine follow-up visits were invited to take part in this study. Inclusion criteria were used to assess if they were eligible, and then, they were asked to fill out questionnaires.
They were included from any age range if they suffered from one of the common chronic diseases, including hypertension, asthma and chronic obstructive pulmonary disease (COPD), multiple sclerosis (MS), diabetes, cancer, peptic ulcer, or chronic renal failure. They were excluded if they were in the acute phase of the disease or were unwilling to take part in this study. The diagnosis of diseases was performed according to the patients' health records.
Data collection was conducted through interviewing the patients using the health promotion lifestyle profile (HPLP-II) questionnaire and demographic characteristic form. The demographic characteristics had questions related to patients' age, occupation, education level, satisfaction with the economic situation, and duration of the disease. Furthermore, their spouses' age, education level, and job were also asked.
The HPLP II was designed by Walker et al. to assess the patients' health-promoting lifestyle practices. The HPLP II was consisted of 52 items that measured health-promoting behaviors in six domains of nutrition, physical activity, health responsibilities, stress management, interpersonal relationships, and spiritual growth. It had a 4-point Likert scale from 1 to 4 (never, sometimes, often, and always). The mean score of individuals' responses was calculated in each dimension and in total, and a score of 2.5–4 represented a frequent or continuous engagement in health-promoting behaviors. The psychometric properties of the Iranian version of this questionnaire was assessed by Zeidi et al. that reported its appropriate validity and reliability.
Descriptive and inferential statistics were used for data analysis via the SPSS software version 21 (IBM, SPSS statistics for windows, New York, IBM Corp). The Kolmogorov–Smirnov test was used to examine normality of variables. Since the data were normally distributed, parametric tests were used. The HPLP subscale scores in the groups were compared using the independent t-test. The multivariate linear regressions were used to investigate the association between selected variables using the HPLP total score. The linear regression model was run using a stepwise method. To apply the linear regression, assumptions including the normal distribution of the HPLP were confirmed. In addition, data were assessed for outliers, which was rule out. In the regression analysis, nominal independent variables with more than two categories were defined as dummy variables. After running the regression model, collinearity was assessed and none of the variables had variance inflation factor of >2 and tolerance of <0.1. Furthermore, P < 0.05 was considered statistically significant for the interpretation of findings.
The findings presented here are one part of a research investigating the relationship between the HPLP and quality of life among patients with chronic diseases. The research proposal was approved by the Institutional Review Board; in addition, it was approved by the Institutional Ethics Committee Board (code: IR.QUMS.REC.1394.225). After obtaining necessary permissions, and describing the research objectives, privacy, and confidentiality data to the subjects, the sampling was started. Further, those patients who were willing to take part in the study filled informed consent form.
| Results|| |
In this study, 326 women and 299 men participated. The mean age and standard deviation of the male and female participants were 53.36 ± 13.85 and 55.7 ± 14.41 years, respectively. Most of the participants in the study were married (84.4% women and 88.3% men). The majority of the female participants (77.3%) were homemakers, and the majority of male participants (71.7%) were employed. The majority of the women (40%) were illiterate, and the majority of the men (48%) had diploma or less diploma degree. Most of them were dissatisfied with their economic situation. The mean duration of the disease in women was 5.39 ± 5.56 years and in men was 4.68 ± 4.74 years. The demographic characteristics of the subjects are presented in [Table 1].
Comparison of health-promoting behaviors in men and women in terms of a variety of diseases is presented in [Table 2]. Given the cutoff point of 2.5 for the continued health-promotion behaviors, the findings showed that the participants did not do health-promoting behaviors in most areas and in general. In both men and women, the highest score in the nutrition domain was reported (2.79 ± 0.51 vs. 2.77 ± 0.50), whereas the lowest score was in the physical activity domain (1.95 ± 63 vs. 1.84 ± 0.66). The comparison of male and female scores in the HPLP domains showed no statistically significant differences between them in applying health-promoting behaviors in all domains, and only the women had significantly lower scores in the domain of physical activity compared to men (1.84 ± 0.61 vs. 1.95 ± 0.63). The results of this study showed that the HPLP scores differed significantly between the men and women with chronic renal diseases, and the women in all domains achieved less scores than the men. In the diabetic group, however, the women had significantly less physical activity than the men (1.47 ± 0.56 vs. 1.77 ± 0.54).
|Table 2: Score of the health-promoting lifestyle subscales (mean±standard deviation) based on type of disease*|
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The findings of the final regression model showed that in women with less education than noneducated people and having spouses with university education, illiterate spouses were associated with an increase in HPLP scores, while the dissatisfaction with the economic situation had a significant negative effect on the behaviors to promote women's health [Table 3]. The results of the study showed that the variables entered in the multivariate regression model were able to explain 15% of the variance associated with HPLP in women with chronic diseases. The results of multivariate regression model in men showed that the duration of illness, type of disease, occupation, age and education of the spouse, and satisfaction with economic status were the variables that significantly affected male HPLP [Table 4]. The findings showed that increasing the duration of the disease, increasing the spikes' sin, becoming unemployed, and getting chronic diseases of the digestive tract and MS had a negative effect on the male health-promotion behaviors. Further, having spouses with university education and satisfaction with the economic situation was associated with improving health-promoting lifestyle practices in men. In total, the variables introduced in the regression model were able to explain 23% of the variances associated with health-promoting lifestyle practices in men.
|Table 3: Results of multivariate linear regression via stepwise model between health-promoting lifestyle and sociodemographic characteristics of female participants|
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|Table 4: Results of multivariate linear regression via stepwise model between health-promoting lifestyle and sociodemographic characteristics of male participants|
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The findings of the final regression model showed that in the women with lower than diploma education compared with illiterate individuals and having spouses with academic education compared with illiterate spouses, an increase in the HPLP scores was reported. However, dissatisfaction with the economic situation had a significant negative effect on the women's health-promoting behaviors [Table 3]. The results of the study showed that variables entered in the multivariate regression model explained 15% of the variance associated with the HPLP in the women with chronic diseases. The results of the multivariate regression model in men showed that the duration of illness, type of the disease, occupation, age and education of the spouse, and satisfaction with economic status were the variables that significantly affected the male's HPLP [Table 4]. The findings showed that increasing the duration of the disease, increasing husbands' age, becoming unemployed, and getting chronic diseases of the digestive system and MS had negative effects on the male's health-promotion behaviors. Further, having spouses with academic education and satisfaction with the economic situation was associated with improving the health-promoting lifestyle practices in the men. In total, the variables introduced in the regression model could explain 23% of the variances associated with health-promoting lifestyle practices in the men.
| Discussion|| |
Engagement in health-promotion and lifestyle behaviors should be considered as an important strategy for improving and maintaining individuals' health. Lifestyle-related measures are not only effective in preventing and protecting against chronic diseases but can also reduce the incidence and mortality of chronic diseases. The results of this study with the aim of evaluating the status of health-promoting lifestyle practices in patients with chronic diseases showed that the participants did not continuously improve their health behaviors. Regardless of the type of the disease, there was no significant difference between the women and men in terms of performing health-promotion behaviors. The only significant difference was in physical activity. While both groups of women and men had the lowest score in terms of physical activity, the women significantly had less score than the men. The results of this study was consistent with the results of previous studies, indicating that lack of physical activity has always been recognized as an independent risk factor for many noncommunicable diseases. The Nocon et al.'s meta-analysis of the relationship between physical activity and disease-related death showed the importance of physical activity. The findings of this meta-analysis showed that having physical activity reduced the risk of a variety of diseases to 35% and the deaths from all kinds of diseases to 33%. In the study by Janwijit, patients with COPD with an average score of 2.38 in health-promoting activities showed a lower status than expected, which was the lowest score in terms of physical activity (1.73) in this study. In the study of Rico et al., patients with COPD had the lowest score in terms of physical activity. Furthermore, in the Oliver-Mcneil and Artinian's study, women with a history of heart disease with an average score of 2.44 in total and the lowest score in terms of physical activity did not have a favorable status in health-promoting lifestyle practices. Similarly, the results of the ElMokadem's study showed that women at the high risk of cardiovascular diseases did not achieve health-promoting behaviors by gaining a score of 2.44. Similar to the present study, the lowest score (1.77) was obtained in physical activity. Patients with chronic kidney diseases had the lowest score in physical activity. In the present study, the women were significantly less physically active than men, but the findings were inconsistent with previous studies., Gutiérrez et al. also reported a difference in health-promoting lifestyle practices by gender based on structural determinants in 20–65-year-olds individuals referred in healthcare centers. Inconsistent findings in this regard can be due to cultural differences and the level of awareness of the benefits of health-promoting behaviors.
Significantly, differences between the women and men with chronic renal diseases in all domains were reported and the women achieved less score than men. The Houle et al.'s study of health-promoting behaviors in patients with chronic renal diseases showed consistent results with those of the current study, suggesting that individuals with chronic kidney diseases did not continuously improve their health behaviors in the later stages of the disease. However, the scores of different dimensions of the HPLP were not reported by gender compared to the present study. Another finding of the present study was that in the diabetic group, the women had significantly less physical activity than men. Such a difference was not observed in Sutherland et al.'s study when comparing the physical activity of healthy, at-risk, and high-risk individuals with diabetes. Furthermore, in the study of Shafiee and Ghoddosi in patients with diabetes, despite the lowest score in physical activity, there was no difference between the men and women in this dimension or other dimensions of the HPLP. The reason for this difference could be the cultural conditions of individuals and their knowledge about the importance of physical activity in controlling blood glucose levels and improving their health. Therefore, there is a need to design appropriate educational interventions and provide appropriate facilities for promoting health behaviors with an emphasis on physical activity for all patients with chronic diseases, especially patients with diabetes.
The results of the regression model showed that in women with less education than noneducated women and having spouses with academic education, illiterate spouses were associated with an increase in the HPLP scores, but the dissatisfaction with the economic situation had a significant negative effect on the behaviors of women. The results of regression analysis in the men showed that increasing the duration of the disease, being unemployed compared to those with occupation or being retired, and the incidence of chronic diseases of the digestive system and MS compared to other type of diseases had negative effects on health-promotion behaviors. In contrast, having spouses with academic education and satisfaction with the economic situation was accompanied by improvements in male's health-promotion behaviors. In line with the current research, the level of education and knowledge of individuals about the disease were the determinants of health-promoting lifestyle practices in older people with hypertension, women without the history of heart diseases and chest pain, and patients with coronary heart diseases. Given the fact that most of previous studies examined the health-promoting behaviors in only one group of patients, the results of the study were not comparable to previous studies in terms of the prevalence based on the disease's type.
One of the strengths of this study is the simultaneous study and comparison of health-promoting lifestyle practices among several groups of patients with chronic diseases. The selection of disease groups was based on the most common chronic diseases in Iran. A concurrent comparison of these patients can guide healthcare providers to design and implement health-promotion interventions based on the conditions of each group. On the other hand, the evidence related to the comparison of these groups can be helpful in identifying priority groups for related interventions. The main limitation of this study was the cross-sectional design of the study and the collection of information using a self-report method. Other limitations of this study were the lack of evaluation of the degree of patients' disability and lack of information from the healthy group without chronic diseases for better between-group comparisons.
| Conclusion|| |
Given that promoting healthy lifestyle behaviors can reduce the burden of chronic diseases, planning to improve health-promoting behaviors, especially in the field of physical activity, is important. More attention should be paid to barriers to and facilitators of health-promoting lifestyle practices by gender and disease. Since the findings of the present study showed that some diseases such as respiratory illness in the women or gastrointestinal diseases and MS in the men played the main role in performing health-promoting behaviors, and further investigation of these patients regarding lifestyle behaviors and effective factors are required. It is suggested that participation in these health-promoting behaviors is encouraged. Finally, given the low level of participation of patients with chronic disease in promoting health behaviors, training and empowering patients to promote their lifestyle are recommended as one part of the process of treatment and follow up.
Hereby, we would like to appreciate Research Deputy and Health Deputy of the university, authorities of the hospitals, and specialized clinics, as well as all the participants for their participation and cooperation in this project.
Financial support and sponsorship
This Research Project was financially supported by the Research Vice Chancellor of the Qazvin University of Medical Sciences, Qazvin, Iran.
Conflicts of interest
There are no conflicts of interest.
| References|| |
WHO. Noncommunicable Diseases Country Profiles. Geneva, Switzerland: WHO; 2014.
Ausili D, Masotto M, Dall'Ora C, Salvini L, Di Mauro S. A literature review on self-care of chronic illness: Definition, assessment and related outcomes. Prof Inferm 2014;67:180-9.
Schopp LH, Bike DH, Clark MJ, Minor MA. Act healthy: Promoting health behaviors and self-efficacy in the workplace. Health Educ Res 2015;30:542-53.
Emerging Risk Factors Collaboration, Di Angelantonio E, Kaptoge S, Wormser D, Willeit P, Butterworth AS, et al.
Association of cardiometabolic multimorbidity with mortality. JAMA 2015;314:52-60.
O'Dowd A. Lifestyle contributes most to distribution of cancer, report says. BMJ 2005;331:65.
Reis JP, Loria CM, Sorlie PD, Park Y, Hollenbeck A, Schatzkin A, et al.
Lifestyle factors and risk for new-onset diabetes: A population-based cohort study. Ann Intern Med 2011;155:292-9.
Folsom AR, Yatsuya H, Nettleton JA, Lutsey PL, Cushman M, Rosamond WD, et al.
Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence. J Am Coll Cardiol 2011;57:1690-6.
Sikorski C, Luppa M, Weyerer S, König HH, Maier W, Schön G, et al.
Obesity and associated lifestyle in a large sample of multi-morbid german primary care attendees. PLoS One 2014;9:e102587.
Healy GN, Wijndaele K, Dunstan DW, Shaw JE, Salmon J, Zimmet PZ, et al.
Objectively measured sedentary time, physical activity, and metabolic risk: The Australian Diabetes, Obesity and Lifestyle study (AusDiab). Diabetes Care 2008;31:369-71.
Pirincci E, Rahman S, Durmuş AB, Erdem R. Factors affecting health-promoting behaviours in academic staff. Public Health 2008;122:1261-3.
WHO. Preventing Chronic Disease a Vital Investment: WHO Global Report. Geneva, Switzerland: Department of Chronic Diseases and Health Promotion; World Health Organization; 2005.
Riegel B, Barbaranelli C, Sethares KA, Marguerite D, Moser DK, Miller JL, et al
. Development and initial testing of the self-care of chronic illness inventory. J Adv Nurs 2018. DOI:10.1111/jan.13775.
Ay S, Yanikkerem E, Çalim SI, Yazici M. Health-promoting lifestyle behaviour for cancer prevention: A survey of Turkish university students. Asian Pac J Cancer Prev 2012;13:2269-77.
Walker SN, Sechrist KR, Pender NJ. The health-promoting lifestyle profile: Development and psychometric characteristics. Nurs Res 1987;36:76-81.
Hong JF, Sermsri S and Keiwkarnka B. Health-promoting lifestyles of nursing students in Mahidol University. Journal of Public Health and Development 2007;5:27-40.
Yoon U, Kwok LL, Magkidis A. Efficacy of lifestyle interventions in reducing diabetes incidence in patients with impaired glucose tolerance: A systematic review of randomized controlled trials. Metabolism 2013;62:303-14.
Han K, Lee P, Lee S, Park E. Factors influencing quality of life in people with chronic illness in Korea. J Nurs Scholarsh 2003;35:139-44.
Salmela SM, Vähäsarja K, Villberg J, Vanhala M, Saaristo T, Lindström J, et al.
The reporting of previous lifestyle counseling by persons at high risk of Type 2 diabetes. Patient Educ Couns 2012;87:178-85.
Wallace K. Determinants Of Health Promoting Behaviors In Older Adults. Thesis for Master of Science in Nursing: Kirkhof School of Nursing. Grand Valley State University; 2000. Available from: http://scholarworks.gvsu.edu/theses/609
Zeidi IM, Hajiagha AP, Zeidi BP. Reliability and validity of Persian version of the health-promoting lifestyle profile. J Mazandaran Univ Med Sci 2012;21:102-13.
Reusch A, Ströbl V, Ellgring H, Faller H. Effectiveness of small-group interactive education vs. Lecture-based information-only programs on motivation to change and lifestyle behaviours. A prospective controlled trial of rehabilitation inpatients. Patient Educ Couns 2011;82:186-92.
Stengel B, Tarver-Carr ME, Powe NR, Eberhardt MS, Brancati FL. Lifestyle factors, obesity and the risk of chronic kidney disease. Epidemiology 2003;14:479-87.
Nocon M, Hiemann T, Müller-Riemenschneider F, Thalau F, Roll S, Willich SN, et al.
Association of physical activity with all-cause and cardiovascular mortality: A systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 2008;15:239-46.
Janwijit S. Health Promoting Lifestyle and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease. Virginia, USA: Dissertation for Ph.D. of Nursing. Adult Health Nursing department, Virginia Commonwealth University; 2006.
Rico CL, Trujillo OM, Gallego FA. Health promotion behaviors and physical dependence in people with clinical diagnosis of chronic obstructive pulmonary disease. Enfermería Glob 2017;16:68-79.
Oliver-Mcneil S, Artinian NT. Women's perceptions of personal cardiovascular risk and their risk-reducing behaviors. Am J Crit Care 2002;11:221-7.
ElMokadem NM. Health promoting lifestyle behaviors among women at high risk for cardiovascular diseases. Med J Cairo Univ 2013;81:83-8.
Houle N, Bohannon RW, Frigon L, Maljanian R, Nieszczezewski J. Health promoting behaviors, quality of life, and hospital resource utilization of patients receiving kidney transplants. Nephrol Nurs J 2002;29:35-40, 56.
Cao W, Hou G, Guo C, Guo Y, Zheng J. Health-promoting behaviors and quality of life in older adults with hypertension as compared to a community control group. J Hum Hypertens 2018; doi: 10.1038/s41371-018-0073-y.
Gutiérrez DV, García IC, Gutiérrez MZ, Gilchrist RM, Torres MC, Montecino AC. Social determinants of health and lifestyles in adult population Concepción, Chile. Ciencia y Enfermería 2014;20:61-74.
Sutherland LL, Weiler DM, Bond L, Simonson S, Reis J. Northwest Latinos' health promotion lifestyle profiles according to diabetes risk status. J Immigr Minor Health 2012;14:999-1005.
Shafiee A and Ghoddosi A. Evaluation of health promotion activities in diabetic patients type ?? Admitted to clinics in Najaf Abad 2013. Jundishapur J Chronic Dis Care 2014;3:32270.
Giena VP, Thongpat S, Nitirat P. Predictors of health-promoting behaviour among older adults with hypertension in Indonesia. Int J Nurs Sci 2018;5:201-5.
Thanavaro JL, Moore SM, Anthony M, Narsavage G, Delicath T. Predictors of health promotion behavior in women without prior history of coronary heart disease. Appl Nurs Res 2006;19:149-55.
Thanavaro JL, Thanavaro S, Delicath T. Health promotion behaviors in women with chest pain. Heart Lung 2010;39:394-403.
Kang Y, Yang IS, Kim N. Correlates of health behaviors in patients with coronary artery disease. Asian Nurs Res (Korean Soc Nurs Sci) 2010;4:45-55.
Xiao L, Wang P, Fang Q, Zhao Q. Health-promoting lifestyle in patients after percutaneous coronary intervention. Korean Circ J 2018;48:507-15.
[Table 1], [Table 2], [Table 3], [Table 4]