American Journal of Lifestyle Medicine current issue

Interventions to Promote Physical Activity Among African Americans

Pekmezi, D., Jennings, E. — 2009-05-08

This article provides a summary of recent physical activity intervention research conducted among African Americans. As prior reviews have been published in this area, the authors updated the literature by focusing on the past 8 years. Overall, there has been an increase in the number and methodological rigor of the studies in this area. Thirty studies published in peer-reviewed journals were included in the current review. Results from 18 of these studies indicated that interventions produced significant increases in activity behavior among African American participants. Recent improvements in this research include larger sample sizes, more randomized controlled trials, and increased use of reliable and valid self-report measures, objective assessment tools, and theoretical backgrounds for interventions. However, attrition and long-term exercise adherence remain problematic in this area of research.

Increased Fruit and Vegetable Intake May Reduce the Nutrition-Related Health Disparities in African Americans

Celentano, J. C. — 2009-05-08

Racial and ethnic minorities in the United States have higher rates of nutrition-related health problems than whites. African Americans have a higher incidence of cardiovascular disease, diabetes, obesity, and some cancers. The cause for the disparity in these diseases and conditions is complex and multifaceted, and lifestyle factors are clearly implicated. African Americans have a lower intake of fruit and vegetables and poorer overall diet quality scores than other minority and majority populations, and it is possible that such differences contribute to health disparities. Modification in eating patterns is likely to improve the health outlook, but implementing changes requires attention to both personal behaviors and the food environment. Access to healthy foods is attenuated in many low-income and predominately African American neighborhoods, leaving residents overweight and undernourished. It is important to consider availability and access to healthy foods, including fruit and vegetables, as part of a culturally sensitive intervention strategy to reduce nutrition-related health disparities in African Americans.

Physical Activity and Fitness in African Americans: Implications for Cardiovascular Health

Zoeller, R. F. — 2009-05-08

The prevalence of cardiovascular disease (CVD), obesity, diabetes mellitus, hypertension, and physical inactivity is significantly higher in African Americans. The higher prevalence of these important risk factors is thought to be largely responsible for the higher CVD mortality rate in blacks. Limited evidence suggests that the aerobic power of African Americans may be inherently lower than that of whites. This apparent deficiency may be explained, in part, by differences in muscle oxidative capacity but is poorly understood. Studies have shown a lower prevalence of overweight/obesity, the metabolic syndrome, and insulin resistance with higher levels of physical activity/fitness. Training studies have shown that increasing physical activity and/or fitness positively affects metabolic risk factors, body composition, and insulin sensitivity. The few studies of African Americans suggest that they respond to exercise training in a manner similar to whites. Controlling blood pressure of hypertensive blacks at levels comparable with that of whites could result in more than 7000 fewer deaths from CVD. Physical fitness has been shown to be negatively associated with blood pressure in African Americans, but results from interventional studies have been equivocal. Some evidence suggests that increased physical activity and/or fitness may reduce the blood pressure response to submaximal exercise and other stressors in African Americans. Blacks have higher levels of high-density lipoprotein cholesterol (HDL-C) and lower levels of total cholesterol, triglycerides, and small dense low-density lipoprotein particles. Studies suggest that the blood lipid response to exercise training is similar between African Americans and whites. There may be an intensity threshold of 75% of age-predicted maximal heart rate to elicit significant changes in HDL-C. More research is needed to explore the association between physical activity/fitness and CVD risk factors in this population.

Promoting Physical Activity in Minority Populations

Terre, L. — 2009-05-08

This review discusses evidence-based perspectives on promoting physical activity in minority populations. Future directions for inquiry and empirically driven public policy initiatives also are addressed.

Minorities and Disease Prevention in Pharmacy Practice

Lenz, T. L. — 2009-05-08

Minority populations tend to have a disproportionately higher incidence of several chronic diseases such as hypertension, obesity, and diabetes mellitus. Knowing disease prevalence information about certain minority populations can help pharmacists and other health care professionals focus disease prevention strategies. In addition, knowing which factors influence participation and adherence to lifestyle intervention strategies can aid health care professionals when designing programs that can effectively work to prevent and control chronic diseases. Given the current timing and discussion on health care reform, pharmacists should take this opportunity to design inter-professional programs aimed at reducing the burdens of chronic disease with the use of lifestyle intervention strategies. This article presents these issues in greater detail.

Managing Erectile Dysfunction in Patients With Cardiovascular Diseases: The Efficacy and Safety of Phosphodiesterase-5 Inhibitors

Cheng, J. W. M., Berhane, S. R. — 2009-05-08

Patients with cardiovascular disease have a high prevalence of erectile dysfunction. Recent evidence demonstrated that erectile dysfunction is an early indication of coronary artery disease. Phosphodiesterase-5 (PDE-5) inhibitors are effective in managing erectile dysfunction due to cardiovascular disease. However, when used together with nitrates or other vasodilators such as alpha-antagonists, they may cause hypotension. Clinical studies demonstrated that in patients with stable coronary artery disease, heart failure, and hypertension controlled by medications who were not receiving nitrates, PDE-5 inhibitors were well tolerated. Therefore, it is important for clinicians to carefully evaluate each patient before initiating PDE-5 inhibitors. PDE-5 inhibitors are absolutely contraindicated with concurrent nitrate use. No PDE-5 inhibitors should be administered within 12 hours after the last nitrate dose. If a patient develops chest pain while taking PDE-5 inhibitors, nitrates should be administered only after the PDE-5 inhibitors have been washed out of the system, based on the half-life of individual agents (washed-out period for sildenafil 20hours; vardenafil 24 hours; tadalafil 88 hours [or 3-4 days]). If symptomatic hypotension occurs, patients should be put in a Trendelenburg position. Fluid resuscitation therapy and alpha-agonists should be used to support blood pressure, if necessary. PDE-5 inhibitors have not been studied in patients with severe and unstable cardiac conditions.

Lactose Maldigestion Revisited: Diagnosis, Prevalence in Ethnic Minorities, and Dietary Recommendations to Overcome It

Gaskin, D. J., Ilich, J. Z. — 2009-05-08

Currently, an estimated 25% of Americans and 75% of individuals worldwide seem to suffer from lactose maldigestion. The authors' objective was to evaluate current prevalence of lactose maldigestion/intolerance in populations of various ethnic groups, examine the severity of symptoms, and recommend ways in alleviating them. In the United States, 25% of people who are lactose maldigesters are ethnic minorities. Earlier estimates report that 50% of Hispanic, almost 100% of Asian, and 80% of African Americans suffer from lactose maldigestion. There is evidence linking lactose maldigestion as a factor contributing to low calcium intake, leading to subsequent osteoporotic fractures. Although bone mineral density is higher in African and Hispanic American men and women compared to white and Asian Americans, osteoporosis is still a concern in those populations. Recent studies suggest that current estimates of lactose maldigestion may be grossly overestimated. Clinical trials show that even those individuals who do maldigest lactose could overcome adverse symptoms by a few simple dietary strategies. In addition, new research points to possible manipulation of colonic microflora toward alleviating symptoms.

School Physical Education: The Pill Not Taken

McKenzie, T. L., Lounsbery, M. A. F. — 2009-05-08

Physical education programs in schools have the potential to promote healthy, active lifestyles by providing children with some of their recommended physical activity, increasing their physical fitness levels, and teaching them generalizable movement and behavioral skills. If "exercise is medicine," physical education is the pill not taken. Numerous barriers, including limited curriculum time allocations, low subject status, and inadequate resources hinder physical education from playing a major role in providing and promoting physical activity. This article profiles physical education as it relates to physical activity, describes its current status from both historical and contextual standpoints, and concludes with recommendations for improving it.

An Update on Fibromyalgia Syndrome: The Multimodal Therapeutic Approach

Rosenzweig, T. M., Thomas, T. M. — 2009-05-08

Fibromyalgia is a chronic, musculoskeletal, noninflammatory pain disorder. Patients frequently suffer from sleep disturbances, headaches, anxiety, morning stiffness, and a poor sense of well-being. It is estimated that approximately 6 million Americans live with this condition. Fibromyalgia is characterized by the presence of at least 11 tender points, as well as widespread bilateral pain for at least 3 months. If left untreated, it may lead to a significant impairment in patients' quality of life or even disability. Although the exact pathophysiology of fibromyalgia remains a source of speculation, several treatment modalities are available to patients with this condition. Among nonpharmacological options, cognitive-behavioral therapy, patient education, exercise, physical therapy, and diet have all been found effective in reducing the symptoms of fibromyalgia. Pregabalin, a second-generation anticonvulsant, and duloxetine (a selective serotonin and norepinephrine reuptake inhibitor) are the only pharmacological agents approved by the Food and Drug Administration for the treatment of fibromyalgia. However, other medications such as tricyclic antidepressants, selective serotonin reuptake inhibitors, anticonvulsants, and tramadol have been investigated in clinical trials and shown to be effective treatment options. Currently, the recommended management strategy for patients with fibromyalgia is a combination of pharmacological and nonpharmacological treatment modalities.

Pharmacotherapy and Lifestyle Interventions for Tension-Type Headaches

Woods, T. M., Dunican, K. C., Desilets, A. R. — 2009-05-08

The objective of this review was to evaluate the efficacy of pharmacotherapy and lifestyle interventions for tension-type headaches. Literature was obtained through a MEDLINE (1966 to April 2008) search and a bibliographic review of published articles. Key terms searched included tension-type headaches, chronic tension-type headaches, pharmacotherapy, and lifestyle therapy. The search was further limited to the English language. Tension-type headaches are the most common and least studied primary headache disorder. These headaches are characterized by mild to moderate bilateral pain that is described as dull, aching, and bandlike. Episodic tension-type headaches may be treated with mild analgesics such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen; although treatment should be individualized, data suggest that NSAIDs may be considered first line. Chronic and frequent episodic tension-type headaches often require prophylactic therapy. Although tricyclic antidepressants are considered the drugs of choice for chronic tension-type headaches, preliminary trials with venlafaxine, mirtazapine, tizanidine, and topiramate have shown promise. Lifestyle interventions such as physical therapy, behavioral therapy, and acupuncture are often employed, despite the lack of sound clinical evidence to support their use. Preliminary data support the combination of a tricyclic antidepressant and behavioral therapy for chronic tension-type headache.

Medical Myths That Can Kill You: And the 101 Truths That Will Save, Extend, and Improve Your Life by Nancy L. Snyderman, MD New York: Crown * 2008 * $24.95 * ISBN: 978-0307406132

Borrelli, B. — 2009-05-08

2009 Conferences

2009-05-08