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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Lifestyle intervention and smoking cessation

Cardiology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull

Synopsis

Deliver measurable UK cardiovascular lifestyle intervention and evidence-based treatment of tobacco dependence.

  • Ask and record current tobacco and nicotine use at every relevant encounter; offer treatment rather than advice alone.
  • Combine behavioural support with an effective stop-smoking medicine when acceptable and suitable.
  • Adults should aim for at least 150 minutes of moderate or 75 minutes of vigorous activity weekly plus strength work on at least 2 days.
  • Use a cardioprotective eating pattern rich in vegetables, fruit, wholegrains, pulses, nuts and fish, replacing saturated with unsaturated fat.
  • Adults should consume no more than 6 g salt daily.
  • If alcohol is consumed, advise no more than 14 units weekly, spread over 3 or more days, with drink-free days.
  • Set a specific goal, anticipate barriers and arrange follow-up; a generic instruction to live more healthily is not an intervention.

Key red flags

Exercise red flags

Exertional syncope, chest pain, disproportionate breathlessness or sustained palpitations requires cardiovascular assessment before vigorous exercise.

Investigation priorities

01
Smoking and nicotine historyFirst step

Define products, daily use, dependence, previous attempts and triggers.

Management branches

FirstBrief cardiovascular lifestyle intervention

Routine prevention, chronic disease review or a teachable clinical moment.

  1. Ask permission and assess smoking, diet, activity, alcohol, sleep, weight context and cardiovascular symptoms.
  2. Agree one personally meaningful SMART goal and specify how it will be measured.
  3. Offer the relevant NHS service or structured programme and remove practical barriers where possible.
  4. Record the plan and arrange review of progress and clinical risk factors.

Key medicines

VareniclineDays 1 to 3: 0.5 mg orally once daily; days 4 to 7: 0.5 mg twice daily; from day 8: 1 mg twice daily, usually for 12 weeks.Reduce dose in severe renal impairment; nausea and vivid dreams are common. Review new or worsening neuropsychiatric symptoms. Not recommended in pregnancy or breastfeeding.
Combination nicotine replacement therapyTypical high-dependence regimen: 25 mg/16-hour nicotine patch once daily plus 2 mg gum or lozenge when cravings occur, within the selected product's maximum dose.Match starting strength to dependence and product instructions; nausea, palpitations or dizziness may indicate excess nicotine. NRT is safer than continued smoking, including when considered in pregnancy with specialist support.
Open full textbook →Answer 2 questionsCardiology check
Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE NG209: Tobacco dependenceCurrent stop-smoking support and medicine options.
  • Varenicline SmPCAdult titration, course and cautions.
  • NHS physical activity guidelines for adultsNational weekly aerobic and strength targets.
  • NHS healthy eating adviceBalanced diet and 6 g salt limit.
  • NHS alcohol unitsFourteen-unit weekly low-risk ceiling.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom