American Journal of Lifestyle Medicine recent issues

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

Lifestyle Interventions in the Prevention and Treatment of Cancer

Fri, 11 Sep 2009 15:39:31 PDT

Despite evidence that cancer death rates in the United States are declining, the absolute number of new cancers and cancer deaths continues to increase, and there is clear evidence that certain human behaviors are influencing these increases. The 4 major factors of lifestyle that continue to be causally related to certain cancers—tobacco use, an unhealthy diet, inadequate exercise, and excessive exposure to ultraviolet radiation—are each independently important in their effects on the genetic and molecular processes that result in the malignant transformation of human cells. There is both irrefutable and otherwise strong evidence that 4 common cancers that occur in the United States—lung cancer, colon/rectal cancer, breast cancer, and prostate cancer—and a less common cancer, malignant melanoma, have etiologic factors that are lifestyle based and therefore controllable through alterations in human behavior. These cancers and the evidence that lifestyle is important in the causation and/or prevention of the disease are the subjects of this review.

Something New Under the Sun: Lutein's Role in Skin Health

Evans, J. A., Johnson, E. J. — Fri, 11 Sep 2009 15:39:31 PDT

Lutein has a well-established role in eye health. There is accumulating evidence that lutein may also play a role in skin health. Its presence in human skin along with its antioxidant and anti-inflammatory activity provide a rationale for a role in preventing ultraviolet-induced damage to skin. Epidemiological studies support a role for diets high in lutein and decreased risk of wrinkling and cancer. Recent intervention studies have shown lutein to prevent ultraviolet-induced carcinogenesis in animals and to improve skin physiology parameters in humans, including antioxidant protection from ultraviolet light irradiation. In this review, the authors explore the rationale and plausibility of a role for lutein in skin health.

Lifestyle in the Prevention and Management of Cancer: Physical Activity

Zoeller, R. F. — Fri, 11 Sep 2009 15:39:31 PDT

Cancer is the second leading cause of death in the United States, accounting for 1 in 4 deaths annually. It has been estimated that one third of all cancer deaths are related to overweight/ obesity, physical inactivity, and poor diet. Epidemiological studies have shown that regular physical activity reduces the risk for some types of cancer as well as postdiagnosis mortality. In studies examining the relation between regular physical activity and the risk of breast cancer, women who were the most physically active reduced their risk by at least 20%. Higher levels of recreational physical activity especially demonstrated greater risk reduction. Meta-analyses suggest that greater physical activity, especially leisure-time physical activity, may reduce the risk of colon cancer by 20% or more in men and women. Physical activity did not demonstrate an association with the risk for cancer of the rectum in either gender. Most studies report an inverse relation between physical activity level and risk for endometrial cancer. Although the estimates of risk reduction vary greatly across studies, the average reported risk reduction was about 30%. The benefit of regular physical activity in the prevention of prostate cancer is not as clear as with other types of cancer. There is some evidence, however, that physical activity may be protective of the more aggressive forms of the disease. Further research is needed to better quantify the specific components of physical activity required to reduce the risk for different cancers.

Communicating Cancer Risk Reduction

Terre, L. — Fri, 11 Sep 2009 15:39:31 PDT

This review discusses considerations in the development and dissemination of cancer risk reduction appeals and associated challenges to the amelioration of health-compromising behaviors. Strategic implications for empirically driven public policy initiatives and primary care also are addressed.

Vitamin D Supplementation and Cancer Prevention

Lenz, T. L. — Fri, 11 Sep 2009 15:39:31 PDT

It is estimated that approximately 1 billion people worldwide have blood concentrations of vitamin D that are considered suboptimal. Much research has been conducted over the past 30 years linking low vitamin D serum concentrations to both skeletal and nonskeletal conditions, including several types of cancers, cardiovascular disease, diabetes, upper respiratory tract infections, all-cause mortality, and many others. Several observational studies and a few prospectively randomized controlled trials have demonstrated that adequate levels of vitamin D can decrease the risk and improve survival rates for several types of cancers including breast, rectum, ovary, prostate, stomach, bladder, esophagus, kidney, lung, pancreas, uterus, non-Hodgkin lymphoma, and multiple myeloma. Individuals with serum vitamin D concentrations less than 20 ng/mL are considered most at risk, whereas those who achieve levels of 32 to 100 ng/mL are considered to have sufficient serum vitamin D concentrations. Vitamin D can be obtained from exposure to the sun, through dietary intake, and via supplementation. Obtaining a total of approximately 4000 IU/d of vitamin D₃ from all sources has been shown to achieve serum concentrations considered to be in the sufficient range. Most individuals will require a dietary supplement of 2000 IU/d of vitamin D₃ to achieve sufficient levels as up to 10 000 IU/d is considered safe. Vitamin D₃ is available as an over-the-counter product at most pharmacies and is relatively inexpensive, especially when compared with the demonstrated benefits.

Promoting Lifestyle Change Among Cancer Survivors: When Is the Teachable Moment?

Rabin, C. — Fri, 11 Sep 2009 15:39:31 PDT

There is mounting evidence that cancer survivors who adopt a healthy lifestyle—for example, by exercising, consuming a healthy diet, and not smoking—reap physical and emotional benefits. Depending on the behavior targeted, these benefits may include reduced fatigue, improved physical functioning, improved quality of life, and greater likelihood of disease-free survival. Given the advantages, cancer survivors should be urged to address any unhealthy behaviors. It remains unclear, however, when cancer survivors will be most receptive to advice from health care providers and others about their lifestyle behaviors. In other words, it is unclear if a "teachable moment" occurs shortly after the cancer diagnosis, during cancer treatment, or sometime after treatment has been completed. This review describes the reasons it has been difficult to identify the optimal time within the cancer trajectory to promote healthy lifestyle behaviors. Some strategies for clarifying the optimal timing are discussed. The review concludes by summarizing health behavior recommendations for cancer survivors outlined by an American Cancer Society expert panel.

Pathophysiology of Coronary Heart Disease and Biological Mechanisms for the Cardioprotective Effects of Regular Aerobic Exercise

Leon, A. S., Bronas, U. G. — Fri, 11 Sep 2009 15:39:31 PDT

Atherosclerosis, the underlying cause of coronary heart disease (CHD), is a chronic inflammatory condition involving the subendothelial layer of coronary as well as other large-and medium-sized arteries. This disease process is initiated early in life by multiple risk factors. Endothelial dysfunction and lipid infiltration are fundamental for the initiation and progression of the atherosclerotic process. After many asymptomatic decades, acute coronary syndromes are generally triggered by a coronary occlusion, caused by a thrombosis initiated by disruption of a vulnerable lipid-laden plaque with a thin, noncalcified fibrosis cap. Epidemiology studies over the past 50 years have consistently observed an inverse association between CHD and regular physical activity and/or cardiorespiratory fitness. Supporting evidence of causative relationships has been provided by exercise training studies demonstrating multiple, plausible, cardioprotective, biological mechanisms. These pleotropic effects may be classified as (1) direct antiatherosclerotic effects and indirect effects via reduction of other risk factors, (2) anti-ischemic effects by decreasing myocardial oxygen demands and increasing its vascular supply and by decreasing the severity of ischemic injuries by direct conditioning effects on cardiomyocytes, (3) antiarrhythmic effects by improving electrical stability of the heart, and (4) antithrombotic (and prothrombolytic) effects, reducing risk of a coronary thrombotic occlusion. It is concluded based on an impressive body of evidence that regular aerobic exercise attenuates the risk of CHD at all stages of the atherothrombotic process.

Vitamin D: Bone Health and Beyond

Lapp, J. L. — Fri, 11 Sep 2009 15:39:31 PDT

The "sunshine vitamin" or vitamin D has long been known to play an important role in the promotion and maintenance of strong, healthy bones. Vitamin D status has generally not been a focus of public health concern for many years; reasons include our endogenous manufacture of vitamin D in the skin, fortification of some foods, and the rarity of overt childhood vitamin D deficiency ("rickets") in the United States and Europe. However, recent evidence suggests that the vitamin D status of many Americans may, in fact, be reason for significant concern. And it is not just bone health that is affected. Research indicates that vitamin D has many nonskeletal functions. Epidemiologic associations have linked vitamin D with the risk of developing a host of health conditions, including multiple sclerosis, type 1 diabetes, rheumatoid arthritis, hypertension, cardiovascular disease, some cancers, and forms of depression. At the same time, questions remain about the risks and benefits of exposure to sunlight, supplement use, and food fortification. Worldwide vitamin D insufficiency has been termed a "pandemic" by some experts. Yet most experts agree that, to date, insufficient data exist to support reliable assessment and supplementation guidelines for most subpopulations. This article describes the state of knowledge about vitamin D, clinical implications, screening criteria, dietary and supplemental sources, and recommendations.

Consumer-Driven Health Care: The Changing Nature of Health Insurance

Herrick, D. M. — Fri, 11 Sep 2009 15:39:31 PDT

Consumer-driven health care (CDHC) plans are a new health insurance paradigm that lets consumers control some of their own health care dollars. It also provides financial incentives to manage medical spending wisely while affording consumers greater choice and control over the types of medical services received. The premise of CDHC is coupling a tax-preferred, personal health account, used to fund day-to-day medical expenses, with a high-deductible health plan to fund care of a catastrophic nature. When individuals enter the medical marketplace, they will spend first from their health savings accounts, health reimbursement arrangements, or flexible spending accounts. Once they reach their deductible, insurance pays all remaining costs. CDHC plans are relatively new to the market, and the market share is still quite small compared to traditional forms of health insurance. CDHC is not for everyone—and not everyone wants to take greater control of health care spending. However, early evidence is encouraging. Virtually all the studies have found that people treat their own money with more care than funds belonging to someone else. Many individuals will appreciate the flexibility in benefits and the added convenience that controlling health care dollars allows.

Vitamin D and Health: Can Too Much Be Harmful?

Davis, C. D. — Fri, 11 Sep 2009 15:39:31 PDT

Lifestyle Medicine by Garry Egger, Andrew Binns, and Stephen Rossner * North Ryde NSW: McGraw-Hill Australia Pty Ltd * 2008 * Australia $69/New Zealand $74 * ISBN-10: 0070138176 * ISBN-13: 978-0070138179

David, S. P. — Fri, 11 Sep 2009 15:39:31 PDT

Letter to the Editor

Mascitelli, L., Pezzetta, F., Goldstein, M. R — Fri, 11 Sep 2009 15:39:31 PDT

2009-2010 Conferences

Fri, 11 Sep 2009 15:39:31 PDT

From the Editor

Rippe, J. M. — Wed, 15 Jul 2009 12:00:12 PDT

Building Healthy Lifestyles Conference: Modifying Lifestyles to Enhance Physical Activity and Diet and Reduce Cardiovascular Disease

Pettee Gabriel, K. K., Ainsworth, B. E. — Wed, 15 Jul 2009 12:00:12 PDT

Effectiveness of Lifestyle Physical Activity Interventions to Reduce Cardiovascular Disease

Dunn, A. L. — Wed, 15 Jul 2009 12:00:12 PDT

Lifestyle interventions have evolved from proof-of-concept pilot studies to efficacy and effectiveness studies and have now moved toward translation and dissemination studies because of their demonstrated ability to improve cardiovascular disease (CVD) outcomes. When combined with diet, they also have demonstrated the ability to normalize blood glucose levels and help to regulate weight. This review highlights the converging lines of evidence that led to lifestyle physical activity interventions, beginning with early epidemiology studies, and provides evidence for the efficacy and effectiveness of lifestyle interventions. However, if lifestyle interventions are to play a role in preventing CVD and improving CVD outcomes, their use must be more widespread. This will require translational and dissemination research to understand how to move into real-world settings. Successful examples of translational studies will be highlighted, and issues related to theoretical and practical issues as well as capacity building will be discussed. Building bridges between research and practice must be done if lifestyle interventions are to deliver on their public health promise.

The Epidemiologic Transition: Changing Patterns of Mortality and Population Dynamics

McKeown, R. E. — Wed, 15 Jul 2009 12:00:12 PDT

The epidemiologic transition describes changing patterns of population age distributions, mortality, fertility, life expectancy, and causes of death. A number of critiques of the theory have revealed limitations, including an insufficient account of the role of poverty in determining disease risk and mortality, a failure to distinguish adequately the risk of dying from a given cause or set of causes from the relative contributions of various causes of death to overall mortality, and oversimplification of the transition patterns, which do not fit neatly into either historical periods or geographic locations. Recent developments in epidemiologic methods reveal other limitations. A life course perspective prompts examination of changes in causal pathways across the life span when considering shifts in the age distribution of a population, as described by the epidemiologic transition theory. The ecological model assumes multiple levels of determinants acting in complex and interrelated ways, with higher level determinants exhibiting emergent properties. Development, testing, and implementation of innovative approaches to reduce the risks associated with the sedentary lifestyle and hypernutrition in developed countries should not overshadow the continuing threat from infectious diseases, especially resistant strains or newly encountered agents. Interventions must fit populations and the threats to health they experience while anticipating changes that will emerge with success in some areas. This will require new ways of thinking that go beyond the epidemiologic transition theory.

Physical Activity Transitions and Chronic Disease

Heath, G. W. — Wed, 15 Jul 2009 12:00:12 PDT

The 20th century in the United States has experienced a dramatic increase in life expectancy among adult men and women, an increase unprecedented in the history of this country. As a result, the pattern of disease and conditions most responsible for death in the United States shifted during the past century from infectious diseases and unintentional injuries to the current array of the leading causes of mortality dominated by the chronic diseases. During this same period, daily lifestyle dramatically shifted from a life full of active living to one of inactivity. The argument has been made that in the case of human beings, there has been little or no change in our genotype within the past 50 years. However, there have been major changes documented in the living environment among economically developed societies during this same time period. Through the collection of epidemiologic, clinical, and experimental findings, evidence suggests that physical inactivity is associated with the onset of chronic diseases of our day. Trends in physical inactivity, evident through the monitoring of transport, recreation, sport, and purposeful activity, have demonstrated that the current lifestyle of the 21st century has contributed substantially to the chronic disease burden in the United States and elsewhere. By addressing the domains that influence physical activity behaviors including the environment (both physical and social/cultural), health systems access, and behavioral correlates of physical activity and inactivity, the current chronic disease crisis potentially can be addressed.

Biological Mechanisms for the Cardioprotective Effects of Aerobic Exercise

Leon, A. S. — Wed, 15 Jul 2009 12:00:12 PDT

Epidemiologic studies have consistently identified a strong inverse association between coronary heart disease (CHD) and regular, predominantly moderate-intensity physical activity and cardiorespiratory fitness. Supporting evidence of causative relationships has been provided by aerobic exercise training studies in both animals and humans. This research demonstrated multiple plausible cardioprotective biological mechanisms. These include direct antiatherosclerotic effects by improving artery endothelial function and reducing inflammation and indirectly via modification of other risk factor components of the metabolic syndrome, by reducing risk of a coronary thrombotic occlusion (antithrombotic effects), by decreasing myocardial oxygen demands and increasing its vascular supply (anti-ischemic effects), and by improving cardiomyocyte electrical stability and autonomic nervous system adaptations (antiarrhythmic effects). Although much additional research is needed to better define and establish optimal dose-response relationships, clearly these pleotropic effects strongly suggest that aerobic exercise can attenuate the risk of CHD at all stages of the underlying atherothrombotic process.

A Historical Perspective of the Understanding of the Link Between Diet and Coronary Heart Disease

Yngve, A. — Wed, 15 Jul 2009 12:00:12 PDT

The development of the understanding of the underlying causes of coronary heart disease has undergone several stages. Ecological studies, such as the Seven Countries' Study, showed a possible relationship between mortality in coronary heart disease and intake of saturated fats. The investigated area with the lowest rates of cardiovascular disease was the island of Crete, Greece. A discussion soon started to evolve around the Mediterranean diet, which at the time consisted mainly of foods of vegetable origin, olive oil, and cereals of unrefined nature. Several clinical trials have been undertaken since then, including the Lyon Heart Diet Study, in which it was clearly shown that both mortality and morbidity in coronary heart disease were substantially lowered by Mediterranean food compared with controls. Dean Ornish proved that an extreme regimen actually could reduce already existing sclerotic plaques, while the Women's Health Initiative study showed that a more modest diet change did not cause the intended reduction in heart disease in middle-aged women. Another prospective study of a similar age group of women showed that a diet with a low glycemic load provided a good reduction in coronary heart disease. Multiple studies of different components of food have shown no positive result, pointing at the whole diet rather than its components of nutrients as being of importance. Today, the experts agree on the optimal diet to prevent not only heart disease but also cancer forms and other chronic disease such as type 2 diabetes mellitus. This diet consists of a lot of fruit and vegetables, lots of fish, less salt and sugar, more unrefined cereals, beans, and nuts. Going from a general notion of Mediterranean food to testing that food in clinical settings and testing nutrients as preventative agents, it can be concluded that a generally healthy lifestyle, including a healthy diet, appropriate amounts of physical activity, good sleep, and less stress, is the way to a heart-healthy life.

Functional Foods as Modifiers of Cardiovascular Disease

Johnston, C. — Wed, 15 Jul 2009 12:00:12 PDT

There is growing consensus that systemic inflammation is at the heart of cardiovascular disease (CVD). Inflammation is a key feature of the immune system, functioning to defend tissue integrity and function. However, chronic stimulation of inflammatory mediators leads to lasting vascular reactivity, insulin resistance, hyperlipidemia, and, subsequently, chronic disease. Dietary practices to minimize inflammatory stimuli and CVD risk include regular intakes of fatty fish rich in the eicosapentaenoic and docosahexaenoic acids that compete with the more pervasive membrane fatty acid, arachidonic acid, disrupting the metabolic cascades that stimulate inflammation. Another effective dietary strategy is to consume less arachidonic acid by reducing beef, poultry, fish, and eggs from the diet (eg, adopting a vegetarian-like diet). Because oxidative stress plays a prominent role in immune system activation, regular ingestion of ample amounts of fruits and vegetables (8+ servings/d) rich in antioxidant compounds, the polyphenols, carotenoids, and vitamin C (eg, citrus, tomatoes, berries, carrots, and greens), lowers inflammatory mediators and risk for chronic disease. Whole grains, legumes, and nuts have also been demonstrated in clinical trials to effectively reduce inflammatory mediators and risk for CVD. As proclaimed in antiquity, "let food be thy medicine and medicine be thy food."

Physical Activity and Cardiovascular Disease: How Much Is Enough?

Carnethon, M. R. — Wed, 15 Jul 2009 12:00:12 PDT

Physical inactivity is an established risk factor for cardiovascular diseases. However, although physical activity is recommended as a component of healthy lifestyle, the amount (intensity, duration, and frequency) of physical activity required to protect against coronary heart disease (CHD) and cerebrovascular disease (ie, stroke) is unclear. In general, there is a graded inverse association of physical activity with CHD and total cardiovascular disease (the combination of CHD and stroke). The patterns of association between physical activity dose and stroke are less clear; individual studies suggest a threshold effect for benefits, whereas meta-analytic studies report a graded inverse association. Despite known differences in physical activity behaviors between men and women, the patterns of association between dose of activity and cardiovascular diseases are similar by gender. Observational studies of walking behaviors and one recent clinical trial suggest that lower "doses" of physical activity are associated with a lower risk of cardiovascular disease. Thus, with very few specific cautions, there is enough evidence to recommend to healthy adults that any activity is beneficial and that more activity is even better.

Promoting Lifestyle Physical Activity: Experiences With the First Step Program

Tudor-Locke, C. — Wed, 15 Jul 2009 12:00:12 PDT

The purpose of this article is to describe a pedometer-based physical activity intervention (and the research that has been conducted on this program) to provide insight into workable strategies focused on promoting lifestyle physical activity. The First Step Program (FSP) is a facilitated theory-based behavior modification program, originally developed for individuals with type 2 diabetes, that capitalizes on the unique properties of a pedometer to serve as a stimulus for walking and an instrument for individual goal setting, self-monitoring, and feedback. Formative evaluation revealed that participants were highly enthusiastic about the program, and pilot testing demonstrated an immediate and dramatic increase in walking behavior (by approximately 3700 steps/d or 34 minutes of walking per day). A randomized and controlled evaluation produced similar results, as have head-to-head comparisons of participant outcomes produced by professional versus peer delivery, and adaptations of the program to work site and community-based delivery. The effectiveness of the FSP can be explained by a thoughtful consideration of pedometer characteristics, program features, and the people who participate. Sustained delivery is contingent on funding sources and administrative structures that support formalized implementation.

Sleep Disturbances and Their Relationship to Cardiovascular Disease

Quan, S. F. — Wed, 15 Jul 2009 12:00:12 PDT

Sleep disturbances are a common problem, with chronic insomnia occurring in 10% of the general adult population and obstructive sleep apnea present in 4% and 2% of middle-aged men and women, respectively. In addition, Americans are sleeping fewer hours per night than they did 20 years ago. There is now increasing evidence that reductions and increases in sleep duration, as well as various sleep disorders, including obstructive sleep apnea and insomnia, may be causal factors in the development of cardiovascular disease. Some of the evidence linking disturbances of sleep with cardiovascular disease is described in this review.

Building Emotional Resilience to Promote Health

Davis, M. C. — Wed, 15 Jul 2009 12:00:12 PDT

In recent years, a growing body of evidence has linked positive emotional health with lower cardiovascular morbidity and mortality, independent of negative emotion. Several potential mechanisms have been posited to account for these associations, including improved health behavior, direct physiological benefits, and enhanced resistance to and recovery from stress among individuals with high versus low positive emotional resources. Links between positive emotion and health have implications for targeted interventions, but no empirical investigations to date have tested the impact of efforts to enhance positive emotion on cardiovascular risk. Nevertheless, some existing data point to the potential value of strategies to increase emotional resources for individuals' functional health and capacity to manage stress.

Culturally Tailored Foods and Cardiovascular Disease Prevention

Winham, D. M. — Wed, 15 Jul 2009 12:00:12 PDT

Culture plays an integral role in people's food choices and lifestyle decisions. Health care messages may conflict with cultural beliefs for many immigrant, minority, and low-income populations. The multiple ways that culture can positively and negatively affect disease risk must be used in the development of culturally tailored messages or interventions. Only through the creation of interventions that are meaningful and culturally relevant can successful behavior stability or change occur. The recognition of current health-promoting factors is important to develop rapport and credibility with individuals and population groups to reduce the risk of cardiovascular disease and other lifestyle-based chronic diseases for optimal health.

Multiple Approaches to Reducing the Burden of Cardiovascular Disease: Summary and Conclusion

Ainsworth, B. E., Pettee Gabriel, K. K. — Wed, 15 Jul 2009 12:00:12 PDT

Dyslipidemia and Risk of Coronary Heart Disease: Role of Lifestyle Approaches for Its Management

Leon, A. S., Bronas, U. G. — Wed, 15 Jul 2009 12:01:18 PDT

Multiple risk factors have a causative relationship to the etiology of coronary heart disease (CHD). However, it is clear that dyslipidemia plays a central role. The chain of evidence is strongest for elevated levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). An inverse association has also been demonstrated between levels of high-density lipoprotein cholesterol (HDL-C) and its principal apolipoprotein, A-1, and risk of CHD. Elevated levels of fasting triglyceride (TG) also are a predictor of CHD, but the independent contribution of TG is difficult to prove because of its usual association with reduced levels of HDL-C; elevated levels of small, dense, highly-atherogenic LDL particles; and the metabolic syndrome. Elevated fasting levels of non—HDL-C (TC — LDL-C) and apolipoprotein B also are strongly predictive of the risk of CHD. Therapeutic lifestyle changes are important adjuncts to pharmacologic management of dyslipidemia. The purpose of this article is to review these contributions with an emphasis on dietary habits (particularly lipid intake), weight management, and aerobic exercise.

Where Do Eggs Fit in a Heart-Healthy Diet?

Curran Celentano, J. — Wed, 15 Jul 2009 12:01:18 PDT

Eggs make up a relatively small contribution to the energy consumption of the average American, in part because of the perception that the cholesterol content makes them a forbidden food for a heart-healthy diet. The relationship between egg cholesterol, blood cholesterol, and cardiovascular disease risk is complex and not clearly understood. In addition, eggs provide many valuable and bioavailable nutrients. Thus, the place of eggs in meal planning should be reconsidered while keeping in mind the diet and lifestyle recommendations of the American Heart Association.

Physical Activity, Blood Lipids, and Lipoproteins

Mestek, M. L. — Wed, 15 Jul 2009 12:01:18 PDT

Dyslipidemia is a major modifiable cardiovascular disease (CVD) risk factor. While pharmacological treatment has been a focal point of dyslipidemia management for several years, increasing physical activity is a safe, cost-effective treatment option that should also be recommended by health care practitioners. Moderate aerobic exercise consistently increases high-density lipoprotein cholesterol (HDL-C) and reduces triglycerides (TG), independent of changes in body weight. However, reductions in total and low-density lipoprotein cholesterol are reported less often following aerobic exercise. Therefore, clinicians should understand that aerobic exercise is not likely to be an effective treatment option for their management. Recent empirical evidence also indicates that aerobic exercise may be of benefit for treating emerging lipid and lipoprotein risk factors such as lipoprotein particle size and number and triglyceride-rich lipoproteins. Further work is needed to clarify the impact of aerobic exercise on apolipoproteins. Based on current evidence, prescribing aerobic exercise as a means of increasing HDL-C and lowering TG is usually an efficacious strategy for treating these aspects of dyslipidemia. These effects are likely to be accompanied by changes in emerging lipid and lipoprotein risk factors.

Cognitive Risks of Dyslipidemia

Terre, L. — Wed, 15 Jul 2009 12:01:19 PDT

This review discusses evidence-based perspectives on the relationship between dyslipidemia and cognitive decline, including strategic implications for risk reduction in primary care and empirically driven public policy initiatives to prevent cognitive dysfunction.

Are Physically Active Individuals Taking Statins at Increased Risk for Myopathy?

Lenz, T. L. — Wed, 15 Jul 2009 12:01:19 PDT

Statin drugs are generally well tolerated in most patients. A limited number of studies have been published that look at the relationship of skeletal muscle injury in patients who take statin medications and exercise compared with taking statin medications without exercise. To date, the sample size of these studies is small, but there appears to be evidence to show that statin medications may exacerbate exercise-induced skeletal muscle injury. In addition, a study of professional athletes with familial hypercholesterolemia showed that 16 of 22 athletes could not tolerate statin medications. Patients with dyslipidemia who experience muscle pain and discomfort may be less likely to be compliant with their medication and/or physical activity regimens. Educating patients to recognize the signs and symptoms of medication-induced myopathy versus exercise-induced muscle soreness is an important counseling topic for health care providers.

Water Exercise in Patients With and Without Cardiovascular Disease: Benefits, Rationale, Safety, and Prescriptive Guidelines

Brinks, J., Franklin, B. A., Spring, T. — Wed, 15 Jul 2009 12:01:19 PDT

Research regarding the benefits of exercise-based cardiac rehabilitation is extensive and well documented. Water exercise, in the form of stretching, walking, jogging, aerobics, strength and balance training, and swimming, provides an attractive alternative from traditional land-based exercise for achieving improved health and fitness. Patients with orthopedic or musculoskeletal limitations, pulmonary disease, excess adiposity, and other medical conditions may significantly benefit from a water-based exercise program. Although water exercise is beneficial for varied patient populations, the safety and appropriateness of higher intensity activities such as swimming should be considered. Because coronary patients have a reduced ability to identify ischemic symptoms in water, water exercise should be prescribed with caution in high-risk patients, individuals with limited swimming skills, and those with significant left ventricular dysfunction. Furthermore, the acute physiological responses during water submersion and exercise may vary considerably from land-based activity and require attention when prescribing a water-based exercise program for patients with and without coronary artery disease.

Co-occurrence of Insomnia and Anxiety Disorders: A Review of the Literature

Marcks, B. A., Weisberg, R. B. — Wed, 15 Jul 2009 12:01:19 PDT

Insomnia and anxiety disorders are highly prevalent and are associated with significant impairment and disability. There is evidence that insomnia and anxiety disorders commonly co-occur, in addition to both being highly comorbid with major depressive disorder. Thus, it is important for health care providers to be familiar with the literature in this area. Therefore, the purpose of this review was to examine the empirical literature on the co-occurrence of insomnia and anxiety disorders, as well as discuss the clinical and research implications of the findings. Studies were identified through PubMed and PsycINFO searches (1975-2007) and a bibliographic review of published articles. The results from this literature review suggest that certain anxiety disorders, such as panic disorder and generalized anxiety disorder, are clearly associated with symptoms of insomnia (eg, delayed sleep onset, restless sleep). Although there are some discrepancies in the literature, the findings suggest that individuals with posttraumatic stress disorder also experience significant sleep problems (eg, middle-of-the-night insomnia, poor sleep quality, nightmares), and the presence of such problems during the early posttrauma period predicts later development of the disorder. Few empirical studies examine sleep in other anxiety disorders, and the majority of studies on insomnia and anxiety disorders in general have not examined the effects of comorbid major depressive disorder, indicating a need for additional research. Overall, the findings highlight the importance of screening for and treating anxiety symptoms when a patient presents with symptoms of insomnia and vice versa. Clearly, treatment development work on interventions that address co-occurring insomnia and anxiety disorders is greatly needed.

Osteoporosis and Strength Training

Going, S. B., Laudermilk, M. — Wed, 15 Jul 2009 12:01:19 PDT

Osteoporosis is a major public health problem. Mechanical strain, imparted by muscle action and ground reaction forces, regulates bone size, shape, mineral mass, and density and subsequently bone strength. Thus, physical activity is critical for bone development, bone health, and fracture risk reduction. Animal studies, in which strain can be manipulated and measured directly, consistently show bone responds to high-strain magnitudes and rates, and only a few repetitions are needed to elicit a response. Extrapolation to humans suggests resistance exercise may be effective for osteoporosis prevention. Indeed, strength-trained athletes have significantly higher bone mass and density than athletes and nonathletes who do not engage in similar training. Prospective studies also support the benefits of resistance exercise demonstrating slowed bone loss and often an increase of 1% to 3% in regional bone mineral density, especially in women. Although more work is needed to define the optimal dose and the effects of nonmechanical factors (eg, nutritional, endocrine, body composition) on the response, the effects of resistance exercise on muscle mass and strength, balance, and agility, in addition to direct skeletal benefits, underscore its importance for osteoporosis, falls, and fracture prevention.

Dehydration and Thermal Strain in Junior Tennis

Bergeron, M. F. — Wed, 15 Jul 2009 12:01:19 PDT

Playing tennis effectively and safely in the heat can be particularly challenging in junior tennis, especially during organized tournament competition when young players have to compete in demanding environmental conditions several times on the same day. With sweat rates ranging from 0.5 L to more than 2.0 L per hour, a young player can readily incur significant total body water and sodium deficits during a very long match or when participating in multiple matches on the same day over several days in a row. On-court thermal strain can be quite high, as tournament-level tennis can elicit appreciable metabolic heat production and storage, even during doubles; this can be exacerbated by poor hydration as well as carryover effects from previous same-day competition and heat exposure. Appropriate and effective safety and performance guidelines for young tennis players training and competing in the heat should focus on readily modifiable risk factors such as hydration management and scheduling of play versus any purported inherent thermoregulatory disadvantages in this specific age group.

Letter to the Editor

Mascitelli, L., Pezzetta, F., Goldstein, M. R. — Wed, 15 Jul 2009 12:01:19 PDT

Counseling Overweight Adults: The Lifestyle Patterns and Toolkit by Robert F. Kushner, MD, Nancy Kushner, MSN, RN, and Dawn Jackson Blatner, RD, LD * Chicago: American Dietetic Association * 2008 * $53.00 * ISBN: 0-8809142-2-X

Kushner, R. F., Kushner, N., Blatner, D. J., Gorin, A. — Wed, 15 Jul 2009 12:01:19 PDT

2009-2010 Conferences

Wed, 15 Jul 2009 12:01:19 PDT