Non-pharmaceutical intervention

A non-pharmaceutical intervention or non-pharmacological intervention (NPI) is any type of health intervention which is not primarily based on medication. Some examples include exercise,[1] sleep improvement,[2] or dietary habits.[3]

This article is about the general concept. For use in epidemics, such as the COVID-19 pandemic, see Non-pharmaceutical intervention (epidemiology).

Non-pharmacological interventions may be intended to prevent or treat disease or other health-related conditions, or to improve public health. They can be educational, and they may involve a variety of lifestyle or environmental changes.[4] Complex or multicomponent interventions use multiple strategies,[5] and they often involve the participation of several care providers.[6]

Non-pharmacological treatments can call on various fields of expertise, such as surgery, medical devices, rehabilitation, psychotherapy, and behavioral interventions.[6]

Examples

Hypertension

The first line of treatment for hypertension is lifestyle changes, including dietary changes, physical exercise, and weight loss. Though these have all been recommended in scientific advisories,[7] a Cochrane systematic review of available relevant studies found that weigh loss diets did reduce body weight and blood pressure, but the impact of these changes could not be demonstrated due to the small number of participants and studies, therefore, the impact of weigh loss on mortality and morbidity is unknown.[8] Their potential effectiveness is similar to and at times exceeds a single medication.[9] If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication. Dietary changes shown to reduce blood pressure include diets with low sodium,[10][11] the DASH diet (Dietary Approaches to Stop Hypertension),[12] vegetarian diets,[13] and green tea consumption.[14][15][16][17] Physical exercise regimens which are shown to reduce blood pressure include isometric resistance exercise, aerobic exercise, resistance exercise, and device-guided breathing.[18]

See also

References
  1. Hilfiker, Roger; Meichtry, Andre; Eicher, Manuela; Nilsson Balfe, Lina; Knols, Ruud H.; Verra, Martin L.; Taeymans, Jan (2018). "Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis". British Journal of Sports Medicine. 52 (10): 651–658. doi:10.1136/bjsports-2016-096422. ISSN 1473-0480. PMC 5931245. PMID 28501804.
  2. Zoremba, N.; Coburn, M.; Schälte, G. (2018). "[Delirium in intensive care patients: A multiprofessional challenge]". Der Anaesthesist. 67 (11): 811–820. doi:10.1007/s00101-018-0497-3. ISSN 1432-055X. PMID 30298270.
  3. McKennon, Skye A. (2000), Feingold, Kenneth R.; Anawalt, Bradley; Boyce, Alison; Chrousos, George (eds.), "Non-Pharmaceutical Intervention Options For Type 2 Diabetes: Diets And Dietary Supplements (Botanicals, Antioxidants, and Minerals)", Endotext, South Dartmouth (MA): MDText.com, Inc., PMID 25905290, retrieved 2020-11-24
  4. Abraha I, Rimland JM, Trotta FM, et al. (2017). "Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series". BMJ Open. 7 (3): e012759. doi:10.1136/bmjopen-2016-012759. PMC 5372076. PMID 28302633.
  5. Boutron I, Ravaud P (2012). "Introduction". In Boutron I, Ravaud P, Moher D (eds.). Randomized clinical trials of nonpharmacological treatments. Boca Raton: CRC Press. pp. xi–xii. ISBN 9781420088021.
  6. Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P (2017). "CONSORT Statement for Randomized Trials of Nonpharmacologic Treatments: A 2017 Update and a CONSORT Extension for Nonpharmacologic Trial Abstracts". Annals of Internal Medicine. 167 (1): 40–47. doi:10.7326/M17-0046. PMID 28630973.
  7. Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, Sanchez E (April 2014). "An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention". Hypertension. 63 (4): 878–85. doi:10.1161/HYP.0000000000000003. PMC 10280688. PMID 24243703.
  8. Semlitsch, Thomas; Krenn, Cornelia; Jeitler, Klaus; Berghold, Andrea; Horvath, Karl; Siebenhofer, Andrea (2021-02-08). "Long-term effects of weight-reducing diets in people with hypertension". The Cochrane Database of Systematic Reviews. 2021 (2): CD008274. doi:10.1002/14651858.CD008274.pub4. ISSN 1469-493X. PMC 8093137. PMID 33555049.
  9. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. (July 2013). "2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". European Heart Journal. 34 (28): 2159–219. doi:10.1093/eurheartj/eht151. PMID 23771844.
  10. He FJ, Li J, Macgregor GA (April 2013). "Effect of longer-term modest salt reduction on blood pressure". The Cochrane Database of Systematic Reviews (Systematic Review & Meta-Analysis). 30 (4): CD004937. doi:10.1002/14651858.CD004937.pub2. PMID 23633321. S2CID 23522004.
  11. Huang, Liping; Trieu, Kathy; Yoshimura, Sohei; Neal, Bruce; Woodward, Mark; Campbell, Norm R C; Li, Qiang; Lackland, Daniel T; Leung, Alexander A; Anderson, Cheryl A M; MacGr 2020; He, Feng J (2020). "Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials". BMJ. 368: m315. doi:10.1136/bmj.m315. PMC 7190039. PMID 32094151.
  12. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin PH (January 2001). "Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group". The New England Journal of Medicine. 344 (1): 3–10. doi:10.1056/NEJM200101043440101. PMID 11136953.
  13. Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, Okamura T, Miyamoto Y (April 2014). "Vegetarian diets and blood pressure: a meta-analysis". JAMA Internal Medicine. 174 (4): 577–87. doi:10.1001/jamainternmed.2013.14547. PMID 24566947.
  14. Hartley L, Flowers N, Holmes J, Clarke A, Stranges S, Hooper L, Rees K (June 2013). "Green and black tea for the primary prevention of cardiovascular disease" (PDF). The Cochrane Database of Systematic Reviews (Systematic Review and Meta-Analysis). 2013 (6): CD009934. doi:10.1002/14651858.CD009934.pub2. PMC 7433290. PMID 23780706. Archived (PDF) from the original on 3 July 2018. Retrieved 3 July 2018.
  15. Liu G, Mi XN, Zheng XX, Xu YL, Lu J, Huang XH (October 2014). "Effects of tea intake on blood pressure: a meta-analysis of randomised controlled trials". The British Journal of Nutrition (Meta-Analysis). 112 (7): 1043–54. doi:10.1017/S0007114514001731. PMID 25137341.
  16. Khalesi S, Sun J, Buys N, Jamshidi A, Nikbakht-Nasrabadi E, Khosravi-Boroujeni H (September 2014). "Green tea catechins and blood pressure: a systematic review and meta-analysis of randomised controlled trials". European Journal of Nutrition (Systematic Review and Meta-Analysis). 53 (6): 1299–311. doi:10.1007/s00394-014-0720-1. hdl:10018/1239907. PMID 24861099. S2CID 206969226.
  17. Peng X, Zhou R, Wang B, Yu X, Yang X, Liu K, Mi M (September 2014). "Effect of green tea consumption on blood pressure: a meta-analysis of 13 randomized controlled trials". Scientific Reports (Meta-Analysis). 4: 6251. Bibcode:2014NatSR...4E6251P. doi:10.1038/srep06251. PMC 4150247. PMID 25176280.
  18. Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, Fuchs FD, Hughes JW, Lackland DT, Staffileno BA, Townsend RR, Rajagopalan S (June 2013). "Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the american heart association". Hypertension. 61 (6): 1360–83. doi:10.1161/HYP.0b013e318293645f. PMID 23608661.

Further reading
  • Boutron I, Ravaud P, Moher D, eds. (2012). Randomized clinical trials of nonpharmacological treatments. Boca Raton: CRC Press. ISBN 9781420088021.
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