American Journal of Lifestyle Medicine current issue

Lifestyle Medicine and Health Care Reform

Rippe, J. M., Angelopoulos, T. J., Rippe, W. F. — Thu, 12 Nov 2009 10:56:46 PST

Lifestyle Modifications for Its Prevention and Management

Bronas, U. G., Leon, A. S. — Thu, 12 Nov 2009 10:56:46 PST

Therapeutic lifestyle changes (TLC) are important for the prevention and management of, as well as adjuncts to, pharmacotherapy of hypertension. This article reviews relevant TLC and their effects on blood pressure (BP) levels, with emphasis on exercise and dietary habits. Regular, moderate-intensity (40%-70% of heart rate reserve) aerobic exercise training for 30 to 60 minutes, 3 to 5 times per week, can lower systolic and diastolic BP levels, with a greater reduction observed in patients with hypertension compared with those with normal BP levels. A diet rich in fruits, vegetables, and whole grains, with a moderate intake of fat-free or low-fat dairy products, and low in saturated and total fat, sodium, and alcohol, such as the Dietary Approaches to Stop Hypertension eating pattern, also significantly reduces BP levels. A TLC program including regular exercise and dietary modifications along with weight management appears to result in a greater BP reduction than either intervention alone. TLC can also significantly reduce other risk factors for cardiovascular disease commonly accompanying hypertension. Multiple mechanisms appear to contribute to BP reduction by dietary intervention (reduced weight, sodium, and alcohol and increased calcium, potassium, and magnesium). For exercise, these include improvements in arterial endothelial function and compliance, left ventricular structure and function, and perhaps vascular blood supply with increased cardiorespiratory endurance. The available evidence is robust in support of TLC for management of elevated BP and for the primary prevention of hypertension, supporting the recommendations by the Joint National Committee Seventh Report on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

When It Comes to Managing Blood Pressure, Don't Overlook the Importance of Salt

Gerweck, C., Curran Celentano, J. — Thu, 12 Nov 2009 10:56:46 PST

Controlling blood pressure is complex and influenced by a variety of physiologic, dietary, and environmental factors. Dietary salt, or more specifically sodium chloride (NaCl), is an important effector of blood pressure regulation. In our current food environment, we are ingesting an amount of salt that is far above recommendations. A major issue in salt consumption is that much of it is involuntary and attributed to the increase in the consumption of packaged, processed, and restaurant foods. Although there is still debate regarding the role of sodium in the development of hypertension for all individuals, reducing the use of salt is warranted to decrease the risk for cardiovascular disease and stroke. It is important for individuals to take personal action, but it is equally essential that the food industry reduce the salt content of food so that consumers can have more control over their health.

Exercise Prescription for the Prevention and Management of Hypertension

Goodwin, K. A., Headley, S. A. E., Pescatello, L. S. — Thu, 12 Nov 2009 10:56:46 PST

Regular physical activity is known to reduce blood pressure in 75% of individuals with hypertension and is a key component of lifestyle therapy for the prevention and management of hypertension. However, the frequency, intensity, duration, and mode of activity play a role in the magnitude and duration of blood pressure reduction. Aerobic activity is the preferred type of activity to lower blood pressure. Acute, moderate-intensity aerobic activity (40%-60% VO_2max ) can decrease blood pressure by 5 to 7 mm Hg for up to 22 hours postexercise, so participation in aerobic activity is recommended on most, if not all, days of the week. The recommended duration for aerobic activity is 30 to 60 minutes of continuous or intermittent activity. Resistance activity results in a 3-mm Hg decrease in blood pressure and should supplement the aerobic activity. Low- to moderate-intensity resistance training (30%-40% of a 1—repetition maximum [1RM] for upper body exercises and 50%-60% 1RM for lower body exercises) is recommended 2 to 3 d/wk. The volume of resistance training for blood pressure reduction is 1 to 3 sets of 10 to 15 repetitions for 8 to 10 exercises that target large muscle groups (thighs, hips, back, chest, arms, and abdominals). When prescribing physical activity for the prevention or management of hypertension, it is important to know that certain populations respond differently to activity and that certain medications can inhibit physical performance.

Advancing the Prevention and Control of Hypertension

Terre, L. — Thu, 12 Nov 2009 10:56:46 PST

Hypertension is on a worrisome public health trajectory. This review discusses some key contributing dynamics as well as considerations for progress toward the prevention and control of hypertension and its comorbidities.

Pharmacodynamic Interactions with Exercise and Beta-Blocker Medications

Lenz, T. L. — Thu, 12 Nov 2009 10:56:46 PST

It is recommended that all individuals who have high blood pressure should also participate in a regular exercise program to help control their blood pressure and decrease their risk for cardiovascular disease. Most of these individuals will also be on medications, and many will be on a medication from the class of antihypertensives called beta-blockers. Research has shown that a pharmacodynamic drug-exercise interaction exists when beta-blockers and exercise are taken together. Hemodynamic changes occur with this interaction, causing a decrease in exercising heart rate and cardiac output. Clinically, this results in patients feeling fatigued and that their ability to exercise is more difficult, which can result in poor exercise adherence. Health care professionals should routinely talk with their patients who are taking beta-blocker therapy about what to expect when the 2 treatments are taken together. This article provides background information about this drug-exercise interaction and several points of information that health care professionals can discuss with their patients, including how to monitor their exercise intensity without using the exercise heart rate response method.

Management of Chronic Obstructive Pulmonary Disease

Mann, R., Nichols, J. — Thu, 12 Nov 2009 10:56:46 PST

Chronic obstructive pulmonary disease (COPD) is a complex disease currently affecting a large number of individuals across the world. Historically thought of as an older male disease, the prevalence in women is rising. Patients with COPD primarily suffer from dyspnea, decreased exercise capacity, and chronic cough, which are due to progressive airflow limitation. Although typically considered a respiratory disorder, COPD differs from asthma both in pathophysiology and treatment. The airway obstruction commonly encountered in COPD results from multiple pathophysiologic processes, some of which may be preventable and modifiable. The mainstays of treatment are bronchodilators, and as lung function declines, the importance of including lifestyle modifications becomes even more essential. National and international guidelines direct treatment and diagnosis and attempt to increase awareness and education on the proper care of patients with COPD.

Community-Based Strength Training Improves Physical Function in Older Women With Arthritis

Thu, 12 Nov 2009 10:56:46 PST

Exercise is recognized as a mainstay treatment of arthritis, yet more than 40% of adults with arthritis report no leisure time physical activity participation. The Centers for Disease Control and Prevention is working to identify and promote evidence-based physical activity programs to improve physical function among adults with arthritis. The authors conducted a multisite, pilot randomized controlled trial to examine the effects of community-based strength training versus usual activity in women (n = 33) 55 years of age and older with arthritis. The moderate-intensity, progressive strength training intervention included balance and flexibility exercises. Classes met 2 times per week for 12 weeks. Outcome measures included muscle strength, performance-based physical function (mobility, flexibility, and balance), and arthritis symptoms. Lower body strength improved from baseline to 12 weeks in the strength training versus control group (32.2%-7.3%, respectively; P = .004). Physical function improved in the strength training group over 12 weeks (range, 7%-50%; P < .05), with no change in control group. Adherence to the intervention was 82% ± 16%. There were no adverse effects on arthritis symptoms. These results demonstrate the efficacy of this program and its potential to be disseminated as an evidence-based strength training intervention to improve physical function and strength among older women with arthritis and other major comorbidities.

Physical Activity at Child Care Settings: Review and Research Recommendations

Ward, D. S., Vaughn, A., McWilliams, C., Hales, D. — Thu, 12 Nov 2009 10:56:46 PST

Child care settings, such as nursery schools and preschools, provide important opportunities to increase physical activity in children aged 2 to 5 years. Because of the large numbers of children enrolled, physical activity interventions at child care facilities have the potential to reach many children at an age when behaviors are influenced more easily. To learn more about this possibility, the authors conducted a systematic review of the published literature for intervention studies conducted at organized child care settings that focused on increasing children’s physical activity levels. Although 8 databases were searched from their inception, only 9 studies were found that met inclusion criteria, all of which were published since 2003. Of these, 7 studies implemented some type of organized educational program or specific curricula, whereas 2 studies implemented environmental changes. Intervention length across studies varied from 2 days to 12 months. Five studies demonstrated a positive change in physical activity; however, the limited number of studies included and the range of research quality made it difficult to draw clear conclusions. A number of potential targets for increasing physical activity at child care settings were identified, including active opportunities, sedentary opportunities, physical environment, staff training and behavior, center policies, and outreach. All these areas seem to merit further investigation, and specific research questions for each are discussed.

Impact of Aerobic and Resistance Exercise on the Health of HIV-Infected Persons

Hand, G. A., Lyerly, G. W., Jaggers, J. R., Dudgeon, W. D. — Thu, 12 Nov 2009 10:56:46 PST

Individuals infected with HIV experience numerous comorbidities caused by the disease progression and medications, lack of (or inability to perform) physical activity, malnutrition, or a combination of these causes. Common symptoms include loss of muscle mass, fatigue, lypodystrophy, lypoatrophy, and decreases in strength, functional capacity, and overall quality of life. Studies have shown that exercise is a potential treatment of many of these symptoms. Research suggests that exercise may produce beneficial physiological changes in the HIV-infected population such as improved body composition and increases in both strength and endurance. In addition, psychological conditions such as depression and anxiety have been shown to be positively affected by exercise. The purpose of this review is to examine the literature regarding effects of aerobic, resistance, and combined aerobic and resistance exercise training on HIV-infected individuals.

Ready-to-Eat Cereal Breakfasts Are Associated with Improved Nutrient Intake and Dietary Adequacy but Not Body Mass Index in Black Adolescents

Williams, B. M., O'Neil, C. E., Keast, D. R., Cho, S., Nicklas, T. A. — Thu, 12 Nov 2009 10:56:46 PST

The goal of this study was to determine whether nutrient intake, dietary adequacy, and weight status were associated with type of breakfast consumption: skipping breakfast, consuming ready-to-eat cereal (RTEC) at breakfast, or consuming other types of foods at breakfast. Data from black adolescents 13 to 18 years of age (n = 988) participating in the 1999-2002 National Health and Nutrition Examination Survey were used in a secondary data analysis. Thirty-seven percent of black adolescents skipped breakfast, 19% consumed RTEC at breakfast, and 44% consumed other breakfasts. RTEC breakfast and other breakfast consumers had higher mean energy intakes than breakfast skippers (P ≤ .05). After adjusting for gender and energy intake, RTEC breakfast consumers had higher intakes of thiamin, riboflavin, niacin, folate, calcium, phosphorus, magnesium, iron, zinc, potassium, and vitamins A, B6, and B12 than breakfast skippers and other breakfast consumers (P ≤ .05). RTEC breakfast consumers had the highest mean adequacy ratio, followed by other breakfast consumers, then breakfast skippers (P ≤ .05). Those consuming RTEC at breakfast had lower mean body mass index (P ≤ .05) and waist circumference (P ≤ .05) than breakfast skippers; however, there was no difference between those consuming RTEC and other breakfasts. If confirmed in prospective studies, consuming a breakfast meal with RTEC may be a useful strategy to encourage in black adolescents as a way to improve nutrient intake and dietary adequacy without increasing weight.

Letter to the Editor

Goldstein, M. R., Mascitelli, L., Pezzetta, F. — Thu, 12 Nov 2009 10:56:46 PST

Sport Psychology edited by Britton W. Brewer * Hoboken, NJ: Wiley-Blackwell * 2009 * $54.95 * ISBN: 978-1-4051-7363-6

Tobar, D. A. — Thu, 12 Nov 2009 10:56:46 PST

2009-2010 Conferences

Thu, 12 Nov 2009 10:56:46 PST