American Journal of Lifestyle Medicine RSS feed -- OnlineFirst Articles

Preventing Weight Regain After Bariatric Surgery: An Overview of Lifestyle and Psychosocial Modulators

Wed, 11 Nov 2009 12:48:40 PST

Bariatric surgery is being increasingly used as a treatment for obesity. With this weight loss intervention, obesity-specific disease remission and mortality reduction benefits are undeniable. After surgical weight loss is complete, one of the greatest challenges becomes long-term weight loss maintenance, which is largely behaviorally based. The fundamental behavioral components to maintaining surgical weight loss include dietary control, commitment to regular physical activity, and behavior modification. Changing these longstanding lifestyle habits, however, is a serious challenge and, unfortunately, many formerly obese individuals ultimately experience weight regain due to noncompliance. Further research is needed to identify optimal treatment strategies for postoperative bariatric surgery patients to minimize weight regain.

Health Promotion in Latinos

Pekmezi, D., Marquez, B., Marcus-Blank, J. — Fri, 06 Nov 2009 07:50:22 PST

This article provides a review of health promotion research conducted among Latinos. The authors examined 31 intervention studies promoting physical activity and/or healthy diet in Latino samples. Overall, findings suggested that Latinos are responsive to interventions promoting physical activity and healthy diet, despite facing numerous barriers to health promotion. In fact, 12 of the 21 studies that measured physical activity and 19 of the 26 studies that measured dietary behavior reported that the intervention produced significant improvements in those health behaviors. Design strengths of these studies included the high rates of retention and large number of randomized controlled trials. However, there were concerns regarding the lack of diversity in the samples (mostly Mexican American women), limiting the generalizability of the findings and the underutilization of objective measures of physical activity and diet behavior in intervention studies.

Relationships of Physical Activity to Brain Health and the Academic Performance of Schoolchildren

Trudeau, F., Shephard, R. J. — Fri, 06 Nov 2009 07:50:23 PST

This review examines possible relationships between academic performance and participation in sports, physical education, and other forms of physical activity. Recent fundamental research has reignited interest in the effects of physical activity on cognitive processes. Experimental studies of potential mediating variables point to physiological influences such as greater arousal and an increased secretion of neurotrophins and psychosocial influences such as increased self-esteem and connectedness to schools. In the specific case of sports, experimental studies are limited to demonstrations of greater attention and acute gains of mental performance immediately following such activity. Several quasi-experimental studies of other types of physical activity have been completed, mainly in primary school students; these have found no decrease in academic performance despite a curtailing of the time allocated to the teaching of academic subjects. Indeed, in some cases, experimental students undertaking more physical activity have outperformed control students. Many investigators have looked at cross-sectional associations between participation in sport or other forms of physical activity and academic performance. Despite difficulties in allowing for confounding variables, particularly socioeconomic status, the overall conclusion has been of a weak positive association. From the practical point of view, it can be concluded that the physical activity needed for healthy child development can be incorporated into the school curriculum without detriment to academic achievement.

Preventing Unintentional Injury: A Review of Behavior Change Theories for Primary Care

Sleet, D. A., Gielen, A. C., Diekman, S., Ikeda, R. — Fri, 06 Nov 2009 07:50:22 PST

Many injuries are preventable, and most have a behavioral component on their causal pathway. However, far more effective use of theory-based approaches to behavioral risk management is needed, which remains a challenge for practitioners. This review discusses theories and applications of behavioral change principles for use in primary care and community health settings. Injury-related behaviors cannot be separated from the environments in which they take place. Preventing unintentional injuries requires an understanding of patient knowledge, attitudes, and behaviors, as well as community norms, that lead to injuries. In addition to the role clinicians have in counseling for lifestyle change to prevent injuries, reducing exposure of patients to hazardous products and environments, and fostering social and organizational change to improve public policy, legislation, and enforcement to prevent injuries are equally important. Challenges lie ahead in testing the applicability of these theories in primary care settings and in predicting and understanding injury-related behaviors of patients. Training more medical practitioners in the epidemiology of injury and the science of injury control is an urgent priority. Success will partly depend on how behavioral theories can be integrated into practice and adapted through clinical experience to benefit patients.

The Influence of Exercise on Metabolic Syndrome in Youth: A Review

McMurray, R. G., Andersen, L. B. — Mon, 02 Nov 2009 14:07:29 PST

The metabolic syndrome (MetS) is a clustering of dyslipidemia, hypertension, glucose intolerance, and central obesity or waist circumference that places individuals at high risk for developing cardiovascular or heart disease. Although first characterized in adults, it has been found in children, but the definition of MetS in children is still controversial. Although MetS is most closely associated with obesity in children, 2 factors believed to affect MetS are physical activity (PA) and aerobic power or fitness. Studies using accelerometry to estimate PA of children have shown that low levels are associated with increased risk of developing MetS. Conversely, high levels of PA at moderate to vigorous intensities reduce the risk. Similarly, low levels of aerobic fitness increase the likelihood of developing MetS. These effects appear to be independent of obesity. Studies have also shown that interventions that increase PA levels and improve aerobic fitness cause a reduction in MetS risk; however, an exact prescription for exercise cannot be presently provided. This review provides an in-depth analysis of what is presently known about the relationship between MetS and PA and aerobic fitness in children. In addition, information is presented regarding potential mechanisms for exercise to affect the major markers of MetS.

Diabetes Health Coaching Improves Medication Adherence: A Pilot Study

Melko, C. N., Terry, P. E., Camp, K., Xi, M., Healey, M. L. — Thu, 22 Oct 2009 09:49:56 PDT

Adherence to medications is central to successfully managing diabetes. Health coaching, which relies on frequent contact and ongoing intervention, has emerged in recent years as part of disease management initiatives and has been promoted as an effective method for improving health outcomes and patient compliance with medication. This study evaluated a 6-month worksite health coaching model to promote medication adherence. It assessed the effectiveness of tailoring health coaching for compliance with medication regimens among people with diabetes. The program was delivered through 3 face-to-face and 3 telephone consultations. Participants set goals promoting diabetes management at the end of each monthly consultation. The authors collected questionnaires from enrolled employees at baseline (n = 27) and from those who stayed in the program at completion of the intervention (n = 23). Using the ASK-20^SM for evaluation, the authors were able to significantly reduce the average number of barriers to medication adherence from pre (3.7) to post (2.2; P < .001) in those who completed the program. The results of this study suggest that health coaching combined with tools to help identify barriers increased medication adherence.

The Influence of Education and Exercise on Neck Pain

Hanney, W. J., Kolber, M. J., Schack-Dugre', J., Negrete, R., Pabian, P. — Thu, 22 Oct 2009 09:49:56 PDT

Neck pain is a significant contributor to worldwide disability and poses a considerable financial burden to its stakeholders. The prognosis for chronic neck pain is generally poor, and the associated disability seems to be more persistent than low back pain. It has been suggested that the goals of a rehabilitation program are to maximize return to function, limit progression of degenerative changes, and prevent further injury. The variety of treatment options can make it difficult for clinicians to agree on the most effective treatment intervention. This article reviews noninvasive treatment considerations for patients with neck pain. Exercise-based interventions, including aerobic conditioning, stretching, and strengthening, are addressed. Moreover, concepts related to education are covered, including the effects of posture and ergonomic counseling.

Human Factors in Injury Control

Porter, B. E., Bliss, J. P., Sleet, D. A. — Tue, 13 Oct 2009 09:13:59 PDT

A person’s interaction with the environment represents a system for research and focus. Human factors is a discipline dedicated to studying this system. The authors provide a summary of how the field human factors informs and enhances injury control programs. They introduce perception, cognition, and environmental design components that should be considered; review automation and workload issues; and discuss best practice recommendations for increasing safe product use as well. Finally, the authors offer lessons learned from human factors approaches to safety at large and suggest future areas of study. Specifically, they note that investigating behavioral adaptation is important to extend intervention effects. They also note that human factors approaches have been used extensively in occupational and transportation areas but can be applied to other areas of injury control that are worth exploring.

Empowering Parents to Prevent Unintentional Childhood Injuries

Huitric, M. A., Borse, N. N., Sleet, D. A. — Tue, 13 Oct 2009 09:13:58 PDT

On average, 33 children die each day in the United States—about 12 000 children a year—because of unintentional childhood injuries. Another 9 million children are treated in emergency departments for unintentional injuries each year. To address this issue, the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control has launched a new initiative focused on parents: Protect the Ones You Love: Child Injuries Are Preventable. As trusted sources of health information, physicians and health care providers can use the initiative and the related ancillary materials to inform parents and caregivers about lifestyle changes that reduce the risk and potential harmful outcomes of an injury to a child or other family member.

Preventing Traffic Injuries: Strategies That Work

Dellinger, A. M., Sleet, D. A. — Wed, 07 Oct 2009 11:37:12 PDT

Motor vehicle crashes result in more than 40 000 deaths and 4.3 million nonfatal injuries annually. Many known effective strategies to address these preventable deaths and injuries are closely related to lifestyle factors. Clinicians can play a large part in supporting effective interventions in their practice, for example, by counseling patients about seat belt use. Clinicians can also have an impact in their community by supporting positive public policy change.

Child Injury: The Role of Supervision in Prevention

Morrongiello, B. A., Schell, S. L. — Wed, 07 Oct 2009 11:37:12 PDT

As the leading cause of death and major contributor to hospitalization for children, unintentional injury is a significant health problem in the United States. How supervision influences children’s risk of injury has been of interest for some time, and much progress has been made recently to address definitional and measurement issues pertaining to supervision. Increasing evidence supports the notion of a general relationship between increased supervision and decreased injury risk, but also reveals that child behavioral attributes and environmental characteristics can interact with level of supervision to affect injury risk, making it challenging to develop guidelines regarding what constitutes "adequate" supervision. Further research is needed to explore if and how children’s risk of injury varies with different supervisors (eg, mothers vs fathers vs older siblings) and how these relations change as a function of children’s developmental level. Recent research has identified messaging approaches that are effective to invoke a commitment to more closely supervising young children at home. Examining how these messages affect actual supervisory practices is an essential next step in this research and can support the development of evidence-based programs to improve supervision and reduce children’s risk of injuries.

Opioid Drug Overdoses: A Prescription for Harm and Potential for Prevention

Dasgupta, N., Sanford, C., Albert, S., Brason, F. W. — Wed, 07 Oct 2009 11:37:12 PDT

This article reviews the burden of accidental poisonings from opioid overdoses in the United States, describes several current federal- and state-level prevention strategies, and illustrates several approaches taken to prevent deaths from opioid overdoses and reduce emergency department visits for chronic pain. One approach, Project Lazarus in North Carolina, is a community-based, secondary prevention program that trains medical care providers to coprescribe naloxone with opioids and provide education to patients who are at risk of opioid overdoses and to their families and peers.

Home Injuries: Potential for Prevention

Mack, K. A., Liller, K. D. — Wed, 07 Oct 2009 11:37:11 PDT

There are approximately 18 000 injury-related deaths at home each year. Some of the leading causes of home injury deaths are falls, fire/burns, poisonings, choking/suffocations, and drownings. Many more home injuries are treated at emergency departments, in doctors’ offices, or with self-care at home. Children and older adults are especially at risk for home injuries, and environmental factors can contribute to population disparities in home injuries. The causes and circumstances of home injuries are complex and multifaceted. This article provides an overview of the epidemiology and burden of home injuries and reviews the evidence for prevention by life stage. Reducing the risk of injuries at home is challenging, but fortunately there many ways that practitioners can help promote safer behaviors and help change home environments for patients and their families.

Injury Prevention in Sports

Schiff, M. A., Caine, D. J., O'Halloran, R. — Wed, 07 Oct 2009 11:37:11 PDT

Sports injuries can occur and may cause significant discomfort and disability. They may also be associated with considerable medical expenses. The objective of this article was to evaluate the current evidence-based effectiveness of sports injury prevention strategies. The authors assessed both intrinsic and extrinsic injury prevention strategies. However, determination of the relative contribution of each component was not determined in the multifaceted intervention studies. Among the interventions that used multiple components, including various combinations of warm-up, strengthening, stretching, and plyometric and balance exercises, the authors could not identify which of the components was effective. Among the extrinsic strategies, including mouthguards, face shields, helmets, bracing, insoles and orthotics, breakaway bases, and sport-specific rules, the authors found that ankle bracing, helmets, face shields, and mouthguards were effective. Studies of breakaway bases and sport-specific rules had methodological flaws that made interpretation difficult. Much future research is needed to identify modifiable risk factors that will lead to the development of new interventions. In addition, studies of new interventions should adhere to rigorous methodology to assess their effectiveness.

Injuries: An Underrecognized Lifestyle Problem

Sleet, D. A., Ballesteros, M. F., Baldwin, G. T. — Wed, 07 Oct 2009 11:37:12 PDT

This article introduces the field of injury prevention and control and its relationship to lifestyle medicine. A review of injury epidemiology, definitions, intervention approaches, and the importance of injury as a public health problem are discussed. Injuries are a large, predictable, and preventable national and international problem affecting individuals, families, and communities. Behavioral, environmental, and technological solutions are necessary to reduce or eliminate injuries. Reductions in injuries and their costs to patients and their families are possible but will need support, collaboration, and partnering from policy makers, clinicians, and health care practitioners. Lifestyle medicine and primary care family practitioners are important allies in encouraging lifestyle choices that reduce injuries and in advocating for medical and public health policies related to injury prevention. Injuries should be added to the broad range of conditions resulting from lifestyle choices, and primary caregivers and other gatekeepers in health care can help reduce injuries from all causes.

Older Adult Fall Prevention: Perceptions, Beliefs, and Behaviors

Stevens, J. A., Noonan, R. K., Rubenstein, L. Z. — Wed, 07 Oct 2009 11:37:11 PDT

Falls in adults aged 65 years and older are an important health issue associated with excess mortality, functional limitations, loss of independence, and reduced quality of life. Physicians can reduce the likelihood of falls in their older patients by incorporating prevention strategies into their clinical practice. Research has identified effective interventions, notably clinical assessment and risk factor reduction and exercise programs with balance training, that require older adults to adopt new behaviors. However, some older adults believe falls are an inevitable consequence of aging, while others do not see themselves as personally vulnerable. Factors that facilitate adopting fall interventions include social support, low-intensity exercise, and the perception that the programs are relevant. Barriers include fatalism, denial of risk, poor self-efficacy, and no previous history of exercise. To encourage their patients’ participation, physicians need to present fall interventions as lifestyle enhancing and as a way to remain independent. Messages should focus on positive health and social benefits such as improving balance and maintaining independence, rather than emphasizing negative information about falls and fall injuries. Along with the support of family and friends, a personal invitation from a health care provider will encourage older adults to take part in fall prevention programs.

Vitamin D and Injury Prevention

Johnson, M. A., Kimlin, M. G., Porter, K. N. — Wed, 30 Sep 2009 09:10:40 PDT

Vitamin D, along with calcium, may help decrease the risk of falls and fractures in older adults. Sunlight and other sources of ultraviolet radiation are not recommended because they increase the risk of skin cancers and sun-induced eye disorders. Rather, vitamin D and calcium needs should be met through foods and dietary supplements. As a preventive measure to reduce the risk of falls and fractures, it is recommended that older adults meet the 2005 Dietary Guidelines and consume 1000 IU of vitamin D, preferably as vitamin D₃.

Patient Counseling for Unintentional Injury Prevention

Ballesteros, M. F., Gielen, A. C. — Wed, 30 Sep 2009 09:10:39 PDT

Injury prevention counseling (IPC) by health care providers is one strategy to reduce injury risk by encouraging people to modify their environment or their personal behaviors to protect themselves or their loved ones. National surveys indicate that few patients are receiving IPC. The evidence of IPC being effective at increasing safety practices is inconsistent. This may be explained partially because counseling recommendations for some injury issues may involve more effort, cost, or inconvenience by the patient. IPC that is based on behavior change theories is more likely to be effective. Physicians and other health care providers can play a critical role in efforts to prevent injuries, but barriers for delivering IPC need to be overcome.

Gender Differences in Cardiorespiratory Fitness With Advancing Age: Is the Age-Associated Decline in VO2max More Rapid in Men and Do Older Men and Women Respond Differently to Exercise?

Zoeller, R. F. — Tue, 09 Sep 2008 07:43:21 PDT

Both cross-sectional and longitudinal data suggest that the age-associated decline in VO_2max is greater in men when expressed in absolute terms such as L or mL⋅min^–1. When expressed in relative terms (ie, percentage decline per decade), the apparent gender difference disappears. Cross-sectional studies report a slower rate of decline than longitudinal studies, probably due to selection bias. The impact of physical activity on the rate of decline in aerobic power with age is not entirely clear. Meta-analyses of cross-sectional studies did not find increased levels of physical activity to be associated with lower rates of decline in VO_2max. Longitudinal studies suggest that regular vigorous exercise can slow the rate of decline in VO_2max by as much as 50%, but the reduction or cessation of training with advancing age may result in a misleading acceleration in that decline. The most consistent finding in cross-sectional and longitudinal studies is a strong association between the age-associated declines in maximal heart rate and VO_2max, but physical activity has little, if any, impact on maximal heart rate. Aerobic exercise training of sufficient intensity can increase aerobic power in both men and women, but the mechanisms may be different, with men demonstrating a greater improvement in factors related to stroke volume and cardiac output, whereas the adaptations in women appear to be more dependent on increased oxygen extraction by skeletal muscle.

A Review of Men's Health and Masculinity

Garfield, C. F., Isacco, A., Rogers, T. E. — Wed, 27 Aug 2008 15:14:00 PDT

Men's health is a new and evolving area of specialty that goes beyond men's cancers and sexual activities. Men's health in the 21st century incorporates a broader conceptualization of health, health behaviors, and lifestyle choices. This new focus results from the fact that men continue to lag behind women in life expectancy and in health care use, a situation that is worse for minority men. Understanding how gender socialization and masculine ideology affects men's health is an important step toward providing effective care for men. In this article, the authors review these areas and then discuss each of the top actual causes of death for men: tobacco use, poor diet, alcohol use, and physical inactivity. They then discuss the important issue of steroid use among men. Throughout the review, the authors highlight racial and ethnic differences in health behaviors. Furthermore, they provide empirically supported clinical implications to assist clinicians who see men with health concerns in their practices. Finally, they offer suggestions for creating ways to include men in the health care system in hopes of improving their use.

Exercise in the Prevention and Treatment of Adolescent Depression: A Promising but Little Researched Intervention

Dunn, A. L., Weintraub, P. — Fri, 22 Aug 2008 11:49:06 PDT

Despite a dramatic increase in the number of treatment studies for adolescent major depressive disorder in the past 15 years, the majority being clinical trials of medications and cognitive behavioral therapy, response rates have been modest and remission rates low. Moreover, most positive responders posttreatment have many residual symptoms, significant functional impairment, and high rates of relapse. There is a need for the development of new, more effective interventions to treat this severe, chronic condition that usually persists into adulthood with poor long-term outcomes. Findings from preliminary treatment studies suggest that exercise may have the potential to be efficacious as a monotherapy or as part of a combined treatment for adolescent major depressive disorder. This review summarizes the findings and analyzes the design flaws of randomized trials of exercise to treat adolescent depression, offering recommendations on how to design more methodologically sound studies with an emphasis on subject selection criteria; issues related to control conditions, types of diagnostic interviews, and measures needed to establish the diagnosis of depression; types of exercise treatments; and appropriate outcome measures. Future studies of exercise to treat and prevent adolescent major depressive disorder need to be comparable to state-of-the-art treatment studies of pharmacotherapy and cognitive behavioral therapy in this population to more accurately determine its efficacy and potential public health benefits.

Beyond Gender Profiling in Lifestyle Medicine

Terre, L. — Tue, 12 Aug 2008 09:03:44 PDT

This review discusses evidence-based perspectives on lifestyle risk reduction for men. Implications for clinical best practices and social policy are considered. Directions for future research also are highlighted.