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Cardiovascular disease remains the leading cause of death worldwide compared with any other clinical condition, and improving medication adherence contributes to better outcomes. There is no single predictor of good or poor adherence. Patient beliefs about their illness can affect willingness to adhere to medicines. A health coaching approach can support medication adherence by raising the patient's awareness of their issue or problem and increasing their responsibility for managing their condition. This ultimately supports patients to be their own problem solvers. Cognitive behavioural therapy (CBT) can be used to support adherence where the patient works collaboratively with a therapist to identify and re-evaluate the content and effects of their thoughts, beliefs and emotional states that affect adherence. Both health coaching and cognitive behavioural change techniques have been used successfully in routine medicinesrelated consultations including use of the Four Es (explore, educate, empower, enable) framework to support adherence. Use of cognitive behavioural change techniques, including health coaching and CBT, can support patients to better engage with their medicines-related activity to improve health outcomes. [ABSTRACT FROM AUTHOR]

BackgroundPhysical distancing measures taken to contain COVID-19 transmission may substantially reduce physical activity levels and cause individuals to adopt a more sedentary lifestyle. ObjectiveThe objective of this study is to determine if there was any change in daily steps, an important component of daily physical activity, and examine risk factors for frequent low daily steps during the COVID-19 epidemic. MethodsWe used data collected from the Step Study, a population-based longitudinal study of walking activity among residents aged ≥40 years in Changsha, China. Daily steps were collected via a smartphone linked to WeChat, a social networking platform. We plotted mean daily steps and the prevalence of low daily steps (≤1500 steps/day) 30 days before (reference period) and 30 days after (epidemic period) January 21, 2020 (date of the first COVID-19 case diagnosed in Changsha), and compared it with the same corresponding period from 2019. We examined the association of risk factors with the prevalence of frequent low daily steps (≤1500 steps/day for ≥14 days) using logistic regression. ResultsAmong 3544 participants (mean age 51.6 years; n=1226 females, 34.6%), mean daily steps dropped from 8097 to 5440 and the prevalence of low daily steps increased from 3% (2287/76,136 person-day) to 18.5% (12,951/70,183 person-day) during the reference and epidemic periods, respectively. No such phenomenon was observed during the corresponding period in 2019. Older age (P for interaction=.001) and female sex (P for interaction