Healthy Lifestyle Interventions to Combat Noncommunicable Disease—A Novel Nonhierarchical Connectivity Model for Key Stakeholders: A Policy Statement From the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine

Research Opportunities and Challenges in the Era of Healthy Living Medicine: Unlocking the Potential

Non-communicable diseases, such as cardiovascular disease (CVD), obesity, cancer, pulmonary disease, and diabetes are a very high global health concern. The health costs of risk factors for CVD, such as hypertension (HTN), is mounting and are unrelenting. As an example, it is estimated that direct and indirect costs due to HTN amounted to $46.4 billion in 2011 and projections of six-fold increases by 2030; the importance of low-cost nonpharmacological interventions involving collaborative teams of health care professionals is at a critical junction. Certainly, the data supported by research including some clinical trials for healthy living interventions support deploying health education, nutrition, smoking cessation, and physical activity(PA) in preventing CVD risk, such as HTN. Exercise training (ET) for blood pressure (BP) control has been shown to be an effective and integral component of BP management. However, less is known about what optimization of PA/ET modalities with nutrition and lifestyle tracking with modern era technologies will bring to this equation. New research methods may need to consider how to collaborate to collect data in using teams of researchers while interacting with community centers, school systems, and in traditional health care practices. This review will discuss and present what is known about the research that support modern era healthy living medicine and how this data may be integrated in venues that support health lifestyle in the community (i.e. schools and the work place).

Healthy Living Medicine in the Workplace: More Work to Do

Non-communicable diseases (NCDs) are five of the top ten causes of death for Americans: cardiovascular disease (CVD), cancer, lower respiratory disease, stroke and diabetes mellitus. Risk factors for these NCDs and for CVD are tobacco use, poor diet quality, physical inactivity, increase body mass index, increased blood pressure, increased blood cholesterol, and glucose intolerance. Depression, depressive symptoms and anxiety also contribute to CVD risk. There is also evidence work stress itself contributes to CVD risk. By 2024 there is expected to be approximately 164 million workers in the US labor force and the share of older workers will likewise increase. Currently, about 25 million of those are over the age of 55, the age at which many diseases of lifestyle become clinically apparent. Furthermore, Americans spend as much as half of their waking hours at work. This makes the worksite an important target for the delivery of healthy living medicine.

Appetite for change: a multidisciplinary team approach to behavioral modification for weight management in a community health group setting

PURPOSE

Obesity is a growing issue in Australia with limited evidence for brief community based intervention. This preliminary study aimed to investigate the long term effects of a 4-week group based multidisciplinary behavior management program for weight loss in the community health setting.

METHOD

A quasi-experimental study design was employed recruiting patients referred to two Community Health Centers. Participants completed a 4-week Appetite for change program, comprising four 2-h group sessions co-facilitated by a multidisciplinary team. The mindfulness self efficacy scale (MSES), quality of life scale (QoL), and self-reported knowledge and stages of change were measured pre-treatment, immediately post-treatment and, 6 and 12 months post-treatment. Weight and waist circumference were additionally measured at baseline, 6 and 12 months post-treatment.

RESULTS

Eighty participants (mean age 63 ± 12.1 years) comprising 73 % women consented to participate. Statistically significant improvements (p ≤ 0.01) from pre-treatment were found at both 6 and 12 months, with a clinically significant mean percentage weight loss of approximately 4 %, and a mean improvement of 8.5 point on QoL at 12 months follow-up. Self-reported improvements in stages of change and knowledge were also maintained at 12 months.

CONCLUSION

Clinically and statistically significant long term improvements in all outcomes were found following a multidisciplinary brief intervention program for overweight/obese adults in the community health setting. The promising results following the Appetite for Change program warrant further controlled investigation.

Vascular Disease in Young Indians (20-40 years): Role of Ischemic Heart Disease

Coronary Artery Disease (CAD) occurs at a younger age in Indians with over 50% of Cardiovascular Disease (CVD) mortality occurring in individuals aged less than 50 years. Although several risk factors have been suggested; smoking, dyslipidemia and hypertension are major risk factors in the young. In this review, we have pooled the current evidence on Ischemic Heart Disease (IHD) in young (20-40 years) and provided an opinion for the effective management of IHD in young Indians.

All-cause mortality risk as a function of sedentary behavior, moderate-to-vigorous physical activity and cardiorespiratory fitness

OBJECTIVE

Emerging work demonstrates individual associations of sedentary behavior, moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness (CRF) on mortality risk. Limited research has evaluated all three of these parameters in a model when considering mortality risk, and their potential additive association on mortality risk has not been fully evaluated, which was the purpose of this study.

METHODS

Data from the 2003-2006 National Health and Nutrition Examination Survey were used (N = 2,295 adults 20-85 yrs), with follow-up through 2011. Sedentary behavior and MVPA were objectively assessed (accelerometry) with cardiorespiratory estimated from a prediction equation taking into consideration participant demographic, anthropometric and behavioral characteristics. Using the median values, a PACS (Physical Activity Cardiorespiratory Sedentary) score was created that ranged from 0-3, indicating the number of these three positive characteristics.

RESULTS

Those with below median sedentary behavior did not have a reduced all-cause mortality risk (HR = 0.59; 95% CI: 0.34-1.04; P = 0.07), but those with above median MVPA (HR = 0.35; 95% CI: 0.15-0.82; P = 0.02) and above median CRF did (HR = 0.20; 95% CI: 0.09-0.43; P < 0.001). Compared to those with a PACS score of 0, those with a PACS score of 1, 2, and 3, respectively, had a 67% (HR = 0.33; 95% CI: 0.17-0.63, P = 0.002), 82% (HR = 0.12; 95% CI: 0.05-0.30; P < 0.001) and 96% (HR = 0.04; 95% CI: 0.02-0.11; P < 0.001) reduced risk of all-cause mortality.

CONCLUSION

Cardiorespiratory fitness and MVPA, but not sedentary behavior, were independently associated with reduced mortality risk. Adults with all three characteristics (below median sedentary and above median MVPA and CRF), however, had the lowest mortality risk.

Nurse and Physician Involvement in Health Risk Appraisals: An Integrative Review

Unhealthy lifestyle behaviors continue to be a strong contributor to chronic illness and death in the United States. Despite the health care system's efforts to refocus on prevention, primary care visits remain acute care focused. Health risk appraisals are tools that can be used by primary care providers to enhance lifestyle behavior change and prevention efforts. The purpose of this integrative review is to examine nurse and physician use of health risk appraisals in primary care. A total of 26 national and international papers, selected through an electronic database and ancestry search, were reviewed. Identified nurse and physician interventions in addition to other programming included helping participants understand and interpret feedback, behavioral counseling, and development of plans to address unhealthy lifestyle behaviors. The most common intervention was provision of telephonic nurse advice lines. Overall outcomes were positive. The use of these tools could be key to enhancing primary care prevention.

Personalized Weight Management Interventions for Cardiovascular Risk Reduction: A Viable Option for African-American Women

Obesity is an independent contributor to cardiovascular disease (CVD) and a major driving force behind racial/ethnic and gender disparities in risk. Due to a multitude of interrelating factors (i.e., personal, social, cultural, economic and environmental), African-American (AA) women are disproportionately obese and twice as likely to succumb to CVD, yet they are significantly underrepresented in behavioral weight management interventions. In this selective review we highlight components of the limited interventions shown to enhance weight loss outcomes in this population and make a case for leveraging Web-based technology and artificial intelligence techniques to deliver personalized programs aimed at obesity treatment and CVD risk reduction. Although many of the approaches discussed are generally applicable across populations burdened by disparate rates of obesity and CVD, we specifically focus on AA women due to the disproportionate impact of these non-communicable diseases and the general paucity of interventions targeted to this high-risk group.

Prescribing a Healthy Lifestyle Polypill With High Therapeutic Efficacy in Many Shapes and Sizes

The paradigm allowing for a lifestyle immersed in unhealthy behaviors to perpetuate to a point where a non-communicable disease (NCD) is eminent or manifests, and then initiating health care interventions, is deeply flawed, results in poor outcomes, and is unsustainable. This paradigm describes the current predominant healthcare model in many countries around the world and has resulted in the continual increase in unhealthy lifestyle patterns that have led to the global NCD epidemic. It is now broadly recognized that rapid integration of a new healthcare model, one heavily focused on primordial and primary NCD prevention, is needed. Being physically active, eating healthy and nutritious foods, not smoking and minimizing second-hand exposure, and maintaining an appropriate body weight are central to this new prevention model. Combined, these four characteristics can be viewed as the key ingredients for the "healthy lifestyle polypill". Recently, the American Heart Association (AHA), European Society of Cardiology (ESC), European Association for Cardiovascular Prevention and Rehabilitation (EACPR), and American College of Preventive Medicine (ACPM) came together to publish, in both the Mayo Clinic Proceedings and European Heart Journal, a policy statement entitled "Healthy Lifestyle Interventions to Combat Non-Communicable Disease: A Novel Non-Hierarchical Connectivity Model for Key Stakeholders". We hope the AHA-ESC-EACPR-ACPM healthy lifestyle policy statement prompts a massive increase in production of the healthy lifestyle polypill. Regulatory approval is not needed to start manufacturing and distributing this medication. The polypill can take many forms and have differing ingredients and dosages while still maintaining high therapeutic efficacy.