Heart-Healthy Lifestyle Change Usually Requires Combinations of Cognitive Approaches

Reed Miller

This article is saying all the right things, save one. Our society does have a built in provention system, and if you’re a member of this site or a direct client of PVS FIT you are already experiencing it’s benefits. I do however agree that our healthcare system needs to provide people a means to easily take advantage of it. Until that time PVS FIT is committed to providing the highest level service and “health care” at the most affordable prices we can.

July 14, 2010 (Dallas, Texas) — A program of counseling with extended follow-up in conjunction with self-monitoring and goal-setting is the best approach to affecting sustainable lifestyle changes to reduce cardiovascular risk, according to a new scientific statement from the American Heart Association [1].

The new statement, published online July 12, 2010 in Circulation, was created by the AHA’s Prevention Committee of the Council on Cardiovascular Nursing. It is based on analyses of 74 studies of US adults between January 1997 and May 2007, measuring effects of behavioral change on blood pressure, cholesterol levels, physical activity and fitness, and diet, including intake of fat, calories, salt, fiber, and fruits and vegetables.

Council chair Dr Nancy Artinian (Wayne State University, Detroit, MI) told heartwire the key finding of the council’s review is that risk-factor mitigation plans that integrate more than one cognitive lifestyle change approach are more likely to be successful than those focused on just one. An example of a cognitive behavior change strategies includes patients setting specific and attainable goals such as a particular weight-loss target. Another is self-monitoring–patients are also more likely to succeed if they monitor their progress by, for example, weighing themselves regularly or keeping a log of what they eat.

Providers can help patients meet their goals by staying in contact and routinely providing feedback. For example, the doctor can encourage patients to stick with their plan by showing them how their weight loss has reduced their blood pressure and pointing out how their symptoms of hypertension have disappeared as a result, Artinian explained.

On the other hand, nonindividualized efforts to influence patient behavior do not usually work, Artinian said. "We’ve learned that just using brochures or paper information that is not personalized to the individual is probably not going to work . . . unless they can personalize it to their own life, and they’re probably going to need some help doing that."

The research summarized in the statement confirms that minorities and individuals of low socioeconomic background are often at more risk for heart disease. Fortunately, "we’ve also learned there are interventions that do work for all [people], but those interventions or lifestyle change adaptations may need to be culturally adapted for use with a minority group."

The statement doesn’t include any specific public-policy recommendations, but "we know we’re going to need some healthcare policy changes, within the healthcare system," Artinian said. "We need to make it easier for healthcare providers to focus on prevention and help people work through lifestyle changes, because at the moment, healthcare providers face a lot of barriers. We all live in toxic environments. It’s very difficult to stay healthy these days."

As examples of positive public-policy changes, in its release about the new scientific statement, AHA cites provisions in the latest federal healthcare reform legislation that will provide more reimbursement to support prevention services like lifestyle counseling [2]. The organization also commends proposals to improve product packaging and restaurant menus to help individuals make better choices.

"I’m looking forward to the future when we will have a healthcare system that gives more weight to the importance of prevention and changing lifestyle behaviors to help people stay healthy and reduce cardiovascular risk," Artinian said.

Artinian said the impetus to write the statement was the realization "that healthcare providers were very good about telling patients that they need to make lifestyle changes, and there was a great deal of evidence that high-risk factors are going to increase morbidity and mortality, but what we didn’t know a lot about, and what healthcare providers needed assistance with, is helping patients translate that behavior into their everyday life. It’s very difficult for people to change behavior and maintain it over a lifetime.

"When we started out doing this, we didn’t know a thing about anything, and everybody said the studies are so diverse that we’re never going to be able to home in and make sense of everything," she recalled. "So the fact that we did weed through all of the studies and work together and come up with recommendations was maybe a little bit surprising. . . . But now we have a consensus."

News Author: Lisa Nainggolan
CME Author: Désirée Lie, MD, MSEd

June 10, 2010 — A new analysis of the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) study, published online June 1, 2010 in Hypertension, shows that both physical fitness and physical activity are inversely associated with the development of hypertension over a period of 20 years [1]. But importantly, the researchers illustrate that activity was significantly associated with nonhypertensive blood-pressure readings only when fitness levels were the highest.

The study is one of the few to jointly measure fitness and activity, and distinguishing between the two is important, they explain, because physical activity is a behavior, whereas aerobic fitness is a physiologic measure.

"We know that activity is the principal behavioral determinant of fitness, and we know that being more physically active can improve one’s fitness. But the activity needs to be moderate to vigorous to adequately improve fitness to see the greater health benefits," lead author Dr Mercedes R Carnethon (Feinberg School of Medicine, Chicago, IL) told heartwire . While she concedes that this may not be rocket science, she says: "We are showing this, for the first time, with objective data, and it’s good that this is consistent with what we know."

People should adopt good habits early on.

Also, the measurements were taken in young adulthood "and showed that even at a time when most young people are not that worried about their heart-disease risk factors and hypertension, it’s important to adopt a physically active lifestyle," Carnethon says. Activity and fitness matter because activity behaviors tend to track over time, and this work shows that activity and fitness count in relation to the long-term development of heart disease. "So people should adopt good habits early on," she observes.

Hypertension Could Be Avoided if People Improved Their Fitness

Carnethon et al tested whether fitness and activity were independently associated with the 20-year incidence of hypertension in 4618 men and women aged 18 to 30 initially, who were participating in the CARDIA study.

At baseline, fitness was estimated based on the duration of a symptom-limited graded exercise treadmill test, and physical activity was self-reported.

The incidence rate of hypertension–systolic BP >140 mm Hg or diastolic BP >90 mm Hg–was 13.8 per 1000 person-years (n=1022). Both baseline fitness (hazard ratio 0.63) and physical activity (hazard ratio 0.86) were inversely associated with incident hypertension when included jointly in a model that also adjusted for age, sex, race, smoking status, systolic BP, alcohol intake, HDL cholesterol, dietary fiber, dietary sodium, fasting glucose, and body-mass index.

A previous analysis of the same study showed that the young adults who were the most physically active had a decreased risk of developing hypertension, the researchers note.

"We extend beyond the previous analysis to demonstrate a significant inverse association of fitness . . . with incident hypertension," they say, and the additional five years of follow-up in this new report, with 388 more hypertension events, enabled them to stratify their analysis by activity categories.

The magnitude of association between physical activity and hypertension was strongest among participants in the high-fitness category (hazard ratio 0.80), whereas the strength of association between fitness and hypertension was similar across tertiles of activity.

Fitness, says Carnethon, is a trait that reflects a combination of activity behaviors, genetic potential, and functional health of various organ systems. A third of hypertension cases (34%) could be prevented if participants moved to a higher fitness category; this figure varied by race and sex, however.

But this being an observational study, the researchers were unable to make a recommendation for the amount of activity needed to improve fitness levels to a higher category, Carnethon noted. Clinical trials will be needed to determine this, she added.

She said also that while the rates of hypertension were much higher among black participants in the study, the association of activity and fitness with hypertension was similar in both blacks and whites. "So it is very important to promote activity and fitness in all racial groups," she concluded.

The authors declare that they have no conflicts of interest.

References

1. Carnethon MR, Evans NS, Church TS, et al. Joint associations of physical activity and aerobic fitness on the development of incident hypertension. Coronary artery risk development in young adults. Hypertension 2010; DOI:10.1161/HYPERTENSIONAHA.109.147603. Available at: http://hyper.ahajournals.org.

Additional Resource
More information on prevention, detection, and evaluation of hypertension is available online from the National Heart, Lung, and Blood Institute.

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