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Ozasa N, Kaneda K, Washida K, Umeda Shiozaki Y, Imai S, Kitta K, Higuchi Y, Yoshiuchi S, Yoshida T, Nakatsuma K, Kimura T, Ono K. Online Intensive Cardiac Rehabilitation Program for Japanese Patients With Coronary Artery Disease - A Pilot Study Protocol. Circ Rep 2024; 6:401-405. [PMID: 39262643 PMCID: PMC11383542 DOI: 10.1253/circrep.cr-24-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 09/13/2024] Open
Abstract
Background A comprehensive cardiac rehabilitation (CR) program is recommended for coronary artery disease (CAD). However, many facilities do not have established programs for dietary guidance and patient education, resulting in an exercise-based CR program and limited efficacy for secondary prevention. Methods and Results A pilot study will be conducted to develop an online Japanese-style intensive cardiac rehabilitation (J-ICR) program for Japanese patients with CAD and will examine adherence, safety, and efficacy. Twenty-four patients diagnosed with stable CAD will be randomly assigned in a 1 : 1 ratio to either an early or late-phase group. The program will comprise the following four parts: exercise sessions; dietary education centered on "the Japan diet"; mindfulness; and group support, with a frequency of 3 h per session, once a week for 12 weeks (a total of 36 h). The primary endpoint will be program feasibility, determined by examining its adherence. Physical examination and function, stress-coping skills, risk of classic CAD (e.g., lipid profile, glucose tolerance, and blood pressure), and dietary changes will be assessed as secondary endpoints. Conclusions The online J-ICR program is designed as a comprehensive CR program for Japanese patients with CAD. If this program shows high adherence and an improvement in CAD risk factors, its secondary prevention effect should be verified with appropriately powered randomized trials at multiple centers.
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Affiliation(s)
- Neiko Ozasa
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
- Department of Cardiology, Kansai Heart Center, Takanohara Central Hospital Nara Japan
| | - Kazuhisa Kaneda
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
| | - Koichi Washida
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
| | | | - Saeko Imai
- Department of Food and Nutrition, Kyoto Women's University Kyoto Japan
| | - Kaoru Kitta
- Department of Food and Nutrition, Kyoto Women's University Kyoto Japan
| | - Yuki Higuchi
- Department of Food and Nutrition, Kyoto Women's University Kyoto Japan
| | - Sawako Yoshiuchi
- Health Science Center, Kansai Medical University Hospital Osaka Japan
| | - Toshiko Yoshida
- Graduate School of Nursing Science, St. Luke's International University Tokyo Japan
| | - Kenji Nakatsuma
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
| | - Takeshi Kimura
- Division of Cardiology, Hirakata Kohsai Hospital Osaka Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Kyoto Japan
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2
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Grega ML, Shalz JT, Rosenfeld RM, Bidwell JH, Bonnet JP, Bowman D, Brown ML, Dwivedi ME, Ezinwa NM, Kelly JH, Mechley AR, Miller LA, Misquitta RK, Parkinson MD, Patel D, Patel PM, Studer KR, Karlsen MC. American College of Lifestyle Medicine Expert Consensus Statement: Lifestyle Medicine for Optimal Outcomes in Primary Care. Am J Lifestyle Med 2024; 18:269-293. [PMID: 38559790 PMCID: PMC10979727 DOI: 10.1177/15598276231202970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Identify areas of consensus on integrating lifestyle medicine (LM) into primary care to achieve optimal outcomes. METHODS Experts in both LM and primary care followed an a priori protocol for developing consensus statements. Using an iterative, online process, panel members expressed levels of agreement with statements, resulting in classification as consensus, near consensus, or no consensus. RESULTS The panel identified 124 candidate statements addressing: (1) Integration into Primary Care, (2) Delivery Models, (3) Provider Education, (4) Evidence-base for LM, (5) Vital Signs, (6) Treatment, (7) Resource Referral and Reimbursement, (8) Patient, Family, and Community Involvement; Shared Decision-Making, (9) Social Determinants of Health and Health Equity, and (10) Barriers to LM. After three iterations of an online Delphi survey, statement revisions, and removal of duplicative statements, 65 statements met criteria for consensus, 24 for near consensus, and 35 for no consensus. Consensus was reached on key topics that included LM being recognized as an essential component of primary care in patients of all ages, including LM as a foundational element of health professional education. CONCLUSION The practice of LM in primary care can be strengthened by applying these statements to improve quality of care, inform policy, and identify areas for future research.
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Affiliation(s)
- Meagan L. Grega
- St. Luke's University Health Network, Easton, PA, USA; Kellyn Foundation, Tatamy, PA, USA (MLG)
| | - Jennifer T. Shalz
- Lifestyle Medicine Department, St. Luke’s Health System, Boise ID, USA (JTS)
| | - Richard M. Rosenfeld
- Department of Otolaryngology, SUNY Downstate Health Science University, Brooklyn, NY, USA (RMR)
| | - Josie H. Bidwell
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MI, USA (JHB)
| | - Jonathan P. Bonnet
- Palo Alto VA Health Care, Palo Alto, CA, USA; Department of Medicine and Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA (JPB)
| | - David Bowman
- Department of Pediatrics, Howard University College of Medicine, Washington, DC, USA; Lifestyle Med Revolution, LLC, Upper Marlboro, MD, USA (DB)
| | - Melanie L. Brown
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA (MLB)
| | - Mollie E. Dwivedi
- Department of Orthopaedic Surgery, Division of Physical Medicine and Rehabilitation, Washington University Living Well Center, St. Louis, MO, USA (MED)
| | | | - John H. Kelly
- Loma Linda University, Loma Linda, CA, USA; Lifestyle Health Education Inc., Rocky Mount, VA, USA (JHK)
| | - Amy R. Mechley
- University of Cincinnati College of Medicine, Cincinnati, OH, USA (ARM)
| | - Lawrence A. Miller
- Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA (LAM)
| | - Rajiv K. Misquitta
- Department of Lifestyle Medicine, The Permanente Medical Group, Sacramento, CA, USA (RKM)
| | | | - Dipak Patel
- Community Health Center, Inc., Meriden, CT, USA; Connecticut Lifestyle Medicine, CT, USA (DP)Community Health Center, Inc., Middletown, CT, USA (DP)
| | - Padmaja M. Patel
- Lifestyle Medicine Center, Midland Health, Midland, TX, USA (PMP)
| | - Karen R. Studer
- Preventive Medicine, Loma Linda University Health, Loma Linda, CA, USA (KRS)
| | - Micaela C. Karlsen
- Department of Research, American College of Lifestyle Medicine, Chesterfield, MO, USA; Departments of Applied Nutrition and Global Public Health, University of New England, Biddeford, ME, USA (MCK)
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3
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Fallows E, Maxwell A, Lawson R. Lifestyle medicine: a modern medical discipline full of optimism. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:268-269. [PMID: 36913327 DOI: 10.12968/bjon.2023.32.5.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Ellen Fallows
- GP and Vice-President, British Society of Lifestyle Medicine
| | - Alex Maxwell
- GP and President, British Society of Lifestyle Medicine
| | - Rob Lawson
- Chair, British Society of Lifestyle Medicine
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4
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Dean E, Lomi C. A health and lifestyle framework: An evidence-informed basis for contemporary physical therapist clinical practice guidelines with special reference to individuals with heart failure. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2022; 27:e1950. [PMID: 35467065 PMCID: PMC9539698 DOI: 10.1002/pri.1950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/26/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE This study proposes contemporary physical therapist clinical practice guidelines (CPGs) with special reference to heart failure (HF) be grounded in an evidence-informed integrative health and lifestyle framework to not only better reflect the totality and weighting of the literature, but also in the interest of superior patient, clinical, and economic outcomes. METHODS As an illustration, a health and lifestyle framework is described to underpin, thereby complement, recently published physical therapist CPGs for individuals with HF. RESULTS The case for the framework, an alternative to a single-disease biomedical perspective, is consistent with 21st century professional and epidemiologic indicators. Four themes that emerged from the HF CPGs and further support such a framework, emerged that is, limitations of conventionally constructed CPGs; physical therapists' scope of practice as "health" professionals; "best" practice in an era of NCDs including HF; and superior economic benefit. DISCUSSION A health and lifestyle framework underpinning contemporary physical therapist CPGs will enable clinicians to better appreciate the power of lifestyle change in maximizing the health of the heart, its healing and repair, and in mitigating and reversing signs and symptoms of cardiac dysfunction. Further, a focus on health and lifestyle will augment the benefits of the core, evidence-based, key action statements related to exercise in the HF CPGs.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical TherapyFaculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Constantina Lomi
- Women´s Health and Allied Health Professionals ThemeMedical Unit Occupational Therapy and PhysiotherapyKarolinska University HospitalStockholmSweden
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5
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Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia despite substantial efforts to understand the pathophysiology of the condition and develop improved treatments. Identifying the underlying causative mechanisms of AF in individual patients is difficult and the efficacy of current therapies is suboptimal. Consequently, the incidence of AF is steadily rising and there is a pressing need for novel therapies. Research has revealed that defects in specific molecular pathways underlie AF pathogenesis, resulting in electrical conduction disorders that drive AF. The severity of this so-called electropathology correlates with the stage of AF disease progression and determines the response to AF treatment. Therefore, unravelling the molecular mechanisms underlying electropathology is expected to fuel the development of innovative personalized diagnostic tools and mechanism-based therapies. Moreover, the co-creation of AF studies with patients to implement novel diagnostic tools and therapies is a prerequisite for successful personalized AF management. Currently, various treatment modalities targeting AF-related electropathology, including lifestyle changes, pharmaceutical and nutraceutical therapy, substrate-based ablative therapy, and neuromodulation, are available to maintain sinus rhythm and might offer a novel holistic strategy to treat AF.
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Affiliation(s)
- Bianca J J M Brundel
- Department of Physiology, Amsterdam University Medical Centers, VU Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands.
| | - Xun Ai
- Department of Physiology and Cell Biology, College of Medicine/Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | | | - Myrthe F Kuipers
- AFIPonline.org, Atrial Fibrillation Innovation Platform, Amsterdam, Netherlands
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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6
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Dean E, Söderlund A, Gosselink R, Jones AYM, Yu HPM, Skinner M. Immuno-modulation with lifestyle behaviour change to reduce SARS-CoV-2 susceptibility and COVID-19 severity: goals consistent with contemporary physiotherapy practice. Physiotherapy 2021; 114:63-67. [PMID: 34563382 PMCID: PMC8363425 DOI: 10.1016/j.physio.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/12/2021] [Accepted: 08/04/2021] [Indexed: 02/08/2023]
Abstract
Lifestyle-related non-communicable diseases (NCDs) and their risk factors are unequivocally associated with SARS-CoV-2 susceptibility and COVID-19 severity. NCD manifestations and their lifestyle risks are associated with chronic low-grade systemic inflammation (CLGSI). This review supports that immuno-modulation with positive lifestyle change aimed at reducing SARS-CoV-2 susceptibility and COVID-19 severity, is a goal consistent with contemporary physiotherapy practice. Physiotherapists have a long tradition of managing a , thus, managing CLGSI is a logical extension. Improving patients’ lifestyle practices also reduces their NCD risks and increases activity/exercise capacity, health and wellbeing – all principal goals of contemporary physiotherapy. The COVID-19 pandemic lends further support for prioritising health and lifestyle competencies including smoking cessation; whole food plant-based nutrition; healthy weight; healthy sleep practices; and stress management; in conjunction with reducing sedentariness and increasing physical activity/exercise, to augment immunity as well as function and overall health and wellbeing. To support patients’ lifestyle change efforts, physiotherapists may refer patients to other health professionals. The authors conclude that immuno-modulation with lifestyle behaviour change to reduce susceptibility to viruses including SARS-CoV-2, is consistent with contemporary physiotherapy practice. Immuno-modulation needs to be reflected in health competencies taught in physiotherapy professional education curricula and taught at standards comparable to other established interventions.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Anne Söderlund
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Rik Gosselink
- Department Rehabilitation Sciences, Faculty Movement and Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium
| | - Alice Y M Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Homer Peng-Ming Yu
- Rehabilitation Medical Center, West China Hospital, Sichuan University, and Faculty of Physical Therapy, Rehabilitation Medicine College, Sichuan University, Chengdu, China
| | - Margot Skinner
- School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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7
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Jonas WB, Rosenbaum E. The Case for Whole-Person Integrative Care. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:677. [PMID: 34209250 PMCID: PMC8307064 DOI: 10.3390/medicina57070677] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 12/02/2022]
Abstract
Rationale: There is a need for medicine to deliver more whole-person care. This is a narrative review of several models of whole-person care and studies that illustrate the business case for whole-person models in primary care. Objectives: To provide an overview of what whole-person care models exist and explore evidence to support these models. Study Selection: Representative whole-person care models widely used in the United States are summarized and evaluated. Selected studies focused on outpatient primary care with examples from programs that integrate the delivery of conventional medical care, complementary and alternative medicine, and self-care within the context of social and cultural environments. Methods: Pubmed search conducted December 2020-February 2021. Two iterative searches using terms for "Whole Health Veterans Administration," "integrative medicine," "integrative health," "complementary and alternative medicine," and, as they related to the outcomes, of "health outcomes," "cost-effectiveness," "cost reduction," "patient satisfaction," and "physician satisfaction." Additional studies were identified from an initial search and the authors' experience of over 50 years. We looked for studies of whole-person care used in general primary care, those not using a single modality and only from United States practices. Results: A total of 125 (out of 1746) studies were found and met our inclusion criteria. We found that whole-person models of primary care exist, are quite heterogeneous in their approaches, and routinely report substantial benefits for improving the patient experience, clinical outcomes and in reducing costs. Conclusions: Evidence for the benefit of whole-person care models exist but definitions are quite heterogenous and unfocused. There is a need for more standardization of whole-person models and more research using whole systems approaches rather than reductionistic attempts using isolated components.
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Affiliation(s)
| | - Elena Rosenbaum
- Department of Family and Community Medicine, Albany Medical College, Albany, NY 12208, USA;
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8
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Dean E, Skinner M, Yu HPM, Jones AYM, Gosselink R, Söderlund A. Why COVID-19 strengthens the case to scale up assault on non-communicable diseases: role of health professionals including physical therapists in mitigating pandemic waves. AIMS Public Health 2021; 8:369-375. [PMID: 34017898 PMCID: PMC8116194 DOI: 10.3934/publichealth.2021028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/14/2021] [Indexed: 02/05/2023] Open
Abstract
As SARS-CoV-2, the virus responsible for COVID-19, spread globally, the most severely affected sub-populations were the elderly and those with multi-morbidity largely related to non-communicable diseases (NCDs), e.g., heart disease, hypertension, type 2 diabetes, obesity. NCDs are largely preventable with healthy nutrition, regular activity, and not smoking. This perspective outlines the rationale for health professionals' including physical therapists' role in reducing COVID-19 susceptibility. Evidence is synthesized supporting the pro-inflammatory effects of the western diet, increasingly consumed globally, inactivity, and smoking; and the immune-boosting, anti-inflammatory effects of a whole food plant-based diet, regular physical activity, and not smoking. An increased background of chronic low-grade systemic inflammation associated with unhealthy lifestyle practices appears implicated in an individual's susceptibility to SARS-CoV-2. It is timely to re-double efforts across healthcare sectors to reduce the global prevalence of NCDs on two fronts: one, to reduce SARS-CoV-2 susceptibility; and two, to reduce the impact of subsequent waves given high blood pressure and blood sugar, common in people with multi-morbidity, can be improved within days/weeks with anti-inflammatory healthy lifestyle practices, and weight loss and atherosclerosis reduction/reversal, within months/years. With re-doubled efforts to control NCD risk factors, subsequent waves could be less severe. Health professionals including physical therapists have a primary role in actively leading this initiative.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Margot Skinner
- School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Homer Peng-Ming Yu
- Rehabilitation Medical Center, West China Hospital, Sichuan University, and Faculty of Physical Therapy, Rehabilitation Medicine College, Sichuan University, Chengdu, China
| | - Alice YM Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rik Gosselink
- Department Rehabilitation Sciences, Faculty Movement and Rehabilitation Sciences, Katholieke Universiteit, Leuven, Belgium
| | - Anne Söderlund
- Division of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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9
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Krauss J, Frates E, Parekh M, Chan J, Kiratli BJ, Myers J. Comprehensive Lifestyle Medicine Program Improves Fitness, Function, and Blood Pressure in Poststroke Veteran Cohort: A Pilot Study. Am J Lifestyle Med 2021; 16:765-771. [DOI: 10.1177/1559827620988659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Comprehensive lifestyle medicine programs have begun to show efficacy in patients with cerebrovascular disease. The Veterans Affairs (VA) health care system has a large poststroke population and VA rehabilitation departments have significant expertise and resources for promoting healthy lifestyles. A 12-week clinical lifestyle medicine program was therefore implemented for poststroke patients, along with an optional observational study evaluating cardiovascular fitness, function, body composition, vitals, and quality of life before and after the program. Seventeen of 18 clinical patients elected to participate in the study, and 3 later withdrew. The 14 participants improved VO2 max by 1.94 mL O2/min/kg ( P = .001, 95% CI 0.96-2.90). Significant improvements were seen in estimated metabolic equivalents, exercise duration, 6-minute walk test, 30-second sit to stand, grip strength, and balance. Among patients who were hypertensive at baseline, mean decrease in supine systolic blood pressure (SBP) was −9.70 mm Hg (n = 10, P = .005, 95% CI −15.7 to −3.7) and standing SBP was −11.09 mm Hg (n = 11, P = .009, 95% CI −18.7 to −3.48). There were no significant improvements in laboratory measures or body composition. Participant satisfaction was high. These findings corroborate recent literature suggesting that lifestyle programs improve stroke recovery and reduce recurrence risk.
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Affiliation(s)
- Jeffrey Krauss
- Department of Rehabilitation, VA Palo Alto Health Care System, Palo Alto, California
- Department of Orthopedics, Physical Medicine and Rehabilitation Division, Stanford School of Medicine, Stanford, California
| | - Elizabeth Frates
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, Massachusetts
| | - Mira Parekh
- Department of Rehabilitation, VA Palo Alto Health Care System, Palo Alto, California
| | - John Chan
- Department of Orthopedics, Physical Medicine and Rehabilitation Division, Stanford School of Medicine, Stanford, California
| | - B. Jenny Kiratli
- Department of Rehabilitation, VA Palo Alto Health Care System, Palo Alto, California
| | - Jonathan Myers
- Department of Rehabilitation, VA Palo Alto Health Care System, Palo Alto, California
- Department of Cardiovascular Medicine, Stanford School of Medicine, Stanford, California
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Rudchenko IV, Tyrenko VV, Kachnov VA. Nutrition as one of the important factors in prevention and treatment of atherosclerotic cardiovascular diseases. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The article discusses the issues of nutrition types and related effects on cardiovascular disease, the potential benefits of a particular diet for the cardiovascular system. The problems in studying the nutrition effect on cardiovascular diseases are characterized. Special attention is paid to the plant-based diet and its effect on atherosclerosis. An analysis of PURE (Prospective Urban and Rural Epidemiological) study, which contains a modern view of the diet and the development of cardiovascular diseases, is carried out.
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11
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Dean E, Jones A, Yu HPM, Gosselink R, Skinner M. Translating COVID-19 Evidence to Maximize Physical Therapists' Impact and Public Health Response. Phys Ther 2020; 100:1458-1464. [PMID: 32589718 PMCID: PMC7337734 DOI: 10.1093/ptj/pzaa115] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2020] [Indexed: 02/05/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has sounded alarm bells throughout global health systems. As of late May, 2020, over 100,000 COVID-19-related deaths were reported in the United States, which is the highest number of any country. This article describes COVID-19 as the next historical turning point in the physical therapy profession's growth and development. The profession has had over a 100-year tradition of responding to epidemics, including poliomyelitis; 2 world wars and geographical regions experiencing conflicts and natural disasters; and, the epidemic of noncommunicable diseases (NCDs). The evidence-based role of noninvasive interventions (nonpharmacological/nonsurgical) that hallmark physical therapist practice has emerged as being highly relevant today in addressing COVID-19 in 2 primary ways. First, despite some unique features, COVID-19 presents as acute respiratory distress syndrome in its severe acute stage. Acute respiratory distress syndrome is very familiar to physical therapists in intensive care units. Body positioning and mobilization, prescribed based on comprehensive assessments/examinations, counter the negative sequelae of recumbency and bedrest; augment gas exchange and reduce airway closure, deconditioning, and critical illness complications; and maximize long-term functional outcomes. Physical therapists have an indisputable role across the contiuum of COVID-19 care. Second, over 90% of individuals who die from COVID-19 have comorbidities, most notably cardiovascular disease, hypertension, chronic lung disease, type 2 diabetes mellitus, and obesity. Physical therapists need to redouble their efforts to address NCDs by assessing patients for risk factors and manifestations and institute evidence-based health education (smoking cessation, whole-food plant-based nutrition, weight control, physical activity/exercise), and/or support patients' efforts when these are managed by other professionals. Effective health education is a core competency for addressing risk of death by COVID-19 as well as NCDs. COVID-19 is a wake-up call to the profession, an opportunity to assert its role throughout the COVID-19 care continuum, and augment public health initiatives by reducing the impact of the current pandemic.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 Friedman Bldg, 2177 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada,Address all correspondence to Dr. Dean at:
| | - Alice Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Homer Peng-Ming Yu
- Rehabilitation Medical Center, West China Hospital, Sichuan University, Sichuan, China; and Faculty of Physical Therapy, Rehabilitation Medicine College, Sichuan University
| | - Rik Gosselink
- Department Rehabilitation Sciences, Faculty Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Margot Skinner
- School of Physiotherapy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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12
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Abstract
PURPOSE OF REVIEW Obesity continues to be a growing concern globally due to association with a number of comorbidities and contributing significantly to increase in health care expenditures. Despite availability of a number of treatment modalities, lifestyle modification with dietary modification and exercise continues to be the foundation. However, the standard model of lifestyle modification is not efficacious or sustainable for many patients leading them to seek alternative approaches. We conducted a comprehensive literature review to present the data regarding efficacy and sustainability of many common dietary approaches. RECENT FINDINGS Building upon previous work, recent randomized controlled trials have compared many popular diets head to head in varying patient populations. Along with the weight changes, studies have investigated the changes in metabolic parameters, inflammatory markers, and cardiac risk factor reduction. Though the studies do not show superiority of one diet compared to the other, the preventive benefits and other favorable metabolic changes of the diets make them worthy of consideration.
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13
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Jensen LL, Drozek DS, Grega ML, Gobble J. Lifestyle Medicine: Successful Reimbursement Methods and Practice Models. Am J Lifestyle Med 2019; 13:246-252. [PMID: 31105486 PMCID: PMC6506971 DOI: 10.1177/1559827618817294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Preventable and reversible chronic diseases affect millions of Americans, costing the United States billions of dollars annually for treatments that slow the trajectory but fail to address the root cause of illness. Lifestyle medicine is efficacious, and research has shown that this medical approach garners a significant return on investment in the treatment of many chronic diseases. To obtain an overview of successful reimbursement and practice models used by practitioners, American College of Lifestyle Medicine members were invited to participate in an online survey regarding their experience with lifestyle medicine services and reimbursement models. Three hundred and fifty-one respondents with diverse practice structures, geographical locations, and educational backgrounds completed the survey. The results demonstrate that practitioners are utilizing a variety of lifestyle medicine programs and reimbursement and practice models. Seventy-four percent of respondents are currently providing lifestyle medicine, though the majority do not receive reimbursement for their services. This study provides examples of successful lifestyle medicine reimbursement and practice models, as well as demonstrates the need for continued advocacy for sustainable reimbursement of lifestyle medicine services.
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Affiliation(s)
- Laura L. Jensen
- Independent Researcher, Athens, Ohio (LLJ)
- Ohio University Heritage College of Osteopathic
Medicine, Athens, Ohio (DSD)
- Kellyn Foundation, Tatamy, Pennsylvania (MLG)
- Lifestyle Medicine Group, Clackamas, Oregon
(JG)
| | - David S. Drozek
- David S. Drozek, DO, FACLM, Ohio University
Heritage College of Osteopathic Medicine, 106 Parks Hall, Athens, OH 45701;
e-mail:
| | - Meagan L. Grega
- Independent Researcher, Athens, Ohio (LLJ)
- Ohio University Heritage College of Osteopathic
Medicine, Athens, Ohio (DSD)
- Kellyn Foundation, Tatamy, Pennsylvania (MLG)
- Lifestyle Medicine Group, Clackamas, Oregon
(JG)
| | - John Gobble
- Independent Researcher, Athens, Ohio (LLJ)
- Ohio University Heritage College of Osteopathic
Medicine, Athens, Ohio (DSD)
- Kellyn Foundation, Tatamy, Pennsylvania (MLG)
- Lifestyle Medicine Group, Clackamas, Oregon
(JG)
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15
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Bodai BI, Nakata TE, Wong WT, Clark DR, Lawenda S, Tsou C, Liu R, Shiue L, Cooper N, Rehbein M, Ha BP, Mckeirnan A, Misquitta R, Vij P, Klonecke A, Mejia CS, Dionysian E, Hashmi S, Greger M, Stoll S, Campbell TM. Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival. Perm J 2018; 22:17-025. [PMID: 29035175 DOI: 10.7812/tpp/17-025] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
By ignoring the root causes of disease and neglecting to prioritize lifestyle measures for prevention, the medical community is placing people at harm. Advanced nations, influenced by a Western lifestyle, are in the midst of a health crisis, resulting largely from poor lifestyle choices. Epidemiologic, ecologic, and interventional studies have repeatedly indicated that most chronic illnesses, including cardiovascular disease, cancer, and type 2 diabetes, are the result of lifestyles fueled by poor nutrition and physical inactivity.In this article, we describe the practice of lifestyle medicine and its powerful effect on these modern instigators of premature disability and death. We address the economic benefits of prevention-based lifestyle medicine and its effect on our health care system: A system on the verge of bankruptcy. We recommend vital changes to a disastrous course. Many deaths and many causes of pain, suffering, and disability could be circumvented if the medical community could effectively implement and share the power of healthy lifestyle choices. We believe that lifestyle medicine should become the primary approach to the management of chronic conditions and, more importantly, their prevention. For future generations, for our own health, and for the Hippocratic Oath we swore to uphold ("First do no harm"), the medical community must take action. It is our hope that the information presented will inspire our colleagues to pursue lifestyle medicine research and incorporate such practices into their daily care of patients. The time to make this change is now.
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Affiliation(s)
- Balazs I Bodai
- Director of The Breast Cancer Survivorship Institute in Sacramento, CA.
| | - Therese E Nakata
- Program Manager of The Breast Cancer Survivorship Institute in Sacramento, CA.
| | | | - Dawn R Clark
- Chief Facilitator of the Physician Wellness Program and an Obstetrician/Gynecologist at the San Dimas-Baldwin Park Medical Center in San Dimas, CA.
| | - Steven Lawenda
- Internist at the Antelope Valley Medical Center in Lancaster, CA.
| | | | - Raymond Liu
- Chief of Hematology-Oncology at the San Francisco Medical Center in CA.
| | - Linda Shiue
- Internist and the Director of Culinary Medicine at the San Francisco Medical Center in CA.
| | - Neil Cooper
- Radiologist at the Glenlake Medical Center in Atlanta, GA.
| | - Michael Rehbein
- Pediatrician and Assistant Physician-in-Charge for Outpatient Service at the Stockton Medical Office in CA.
| | - Benjamin P Ha
- Associate Area Medical Director for Family Medicine at the Bakersfield Medical Center in CA.
| | - Anne Mckeirnan
- Obstetrician/Gynecologist at the San Diego Medical Center in CA.
| | - Rajiv Misquitta
- Primary Care Physician at the South Sacramento Medical Center in CA. He is also an Elected Representative on The Permanente Medical Group Board of Directors.
| | - Pankaj Vij
- Medical Director of the Kaiser Permanente Weight Management Program in Pleasanton, CA.
| | - Andrew Klonecke
- Nuclear Medicine Specialist at the Sacramento Medical Center and at the Roseville Medical Center in CA.
| | | | - Emil Dionysian
- Orthopedic Surgeon at the Lakeview Medical Offices and at the Orange County Medical Center in Anaheim, CA.
| | - Sean Hashmi
- Internist at the Woodland Hills Medical Center in CA.
| | - Michael Greger
- Physician and Founder of NutritionFacts.org in Kensington, MD.
| | - Scott Stoll
- Co-Founder and Chairman of the Plantrician Project in Rieglesville, PA.
| | - Thomas M Campbell
- Instructor of Clinical Family Medicine at the University of Rochester School of Medicine and Dentistry and the Co-Founder and Clinical Director of the University of Rochester Program for Nutrition in Medicine in NY.
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Amaravathi E, Ramarao NH, Raghuram N, Pradhan B. Yoga-Based Postoperative Cardiac Rehabilitation Program for Improving Quality of Life and Stress Levels: Fifth-Year Follow-up through a Randomized Controlled Trial. Int J Yoga 2018; 11:44-52. [PMID: 29343930 PMCID: PMC5769198 DOI: 10.4103/ijoy.ijoy_57_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives: This study was aimed to assess the efficacy of yoga-based lifestyle program (YLSP) in improving quality of life (QOL) and stress levels in patients after 5 years of coronary artery bypass graft (CABG). Methodology: Three hundred patients posted for elective CABG in Narayana Hrudayalaya Super Speciality Hospital, Bengaluru, were randomized into two groups: YLSP and conventional lifestyle program (CLSP), and follow-up was done for 5 years. Intervention: In YLSP group, all practices of integrative approach of yoga therapy such as yama, niyama, asana, pranayama, and meditation were used as an add-on to conventional cardiac rehabilitation. The control group (CLSP) continued conventional cardiac rehabilitation only. Outcome Measures: World Health Organization (WHO)-QOL BREF Questionnaire, Perceived Stress Scale, Positive and Negative Affect Scale (PANAS), and Hospital Anxiety and Depression Scale (HADS) were assessed before surgery and at the end of the 5th year after CABG. As data were not normally distributed, Mann–Whitney U-test was used for between-group comparisons and Wilcoxon's signed-rank test was used for within-group comparisons. Results: At the end of 5 years, mental health (P = 0.05), perceived stress (P = 0.01), and negative affect (NA) (P = 0.05) have shown significant improvements. WHO-QOL BREF score has shown improvements in physical health (P = 0.046), environmental health (P = 0.04), perceived stress (P = 0.001), and NA (P = 0.02) in YLSP than CLSP. Positive affect has significantly improved in CLSP than YLSP. Other domains of WHO-QOL-BREF, PANAS, and HADS did not reveal any significant between-group differences. Conclusion: Addition of long-term YLSP to conventional cardiac rehabilitation brings better improvements in QOL and reduction in stress levels at the end of 5 years after CABG.
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Affiliation(s)
- Eraballi Amaravathi
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, India
| | - Nagendra Hongasandra Ramarao
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, India
| | - Nagarathna Raghuram
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, India
| | - Balaram Pradhan
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, India
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Abstract
The science of nutrition has long been entrapped in reductionist interpretation of details, a source of great confusion. However, if nutrition is defined as the integration of countless nutrient factors, metabolic reactions and outcomes, biologically orchestrated as in symphony, its relevance for personal and public health would be less confusing and more productive. This more wholistic interpretation may be observed at the cellular and physiological levels and may be described, in part, by the concept of pleiotropy (multiple cell-based effects from one nutrient source), together with its more expansive cousin, epitropy (multiple cell-based effects from multiple nutrients). There are many consequences. First, wholistic interpretation helps to explain the profound but little-known health benefits of whole plant-based foods (not vegan or vegetarian) when compared with whole animal-based foods and/or with the nutritionally variable convenience foods (generally high in fat, salt, refined carbohydrates and low in complex carbohydrates). Second, wholistic interpretation explains why the U.S. Dietary Guidelines and related public policies, which are primarily conceived from reductionist reasoning, serve political agendas so effectively. If diet and health advisories were to acknowledge the biological complexity of nutrition, then make greater use of deductive (top down) instead of inductive (bottom up) reasoning, there would be less confusion. Third, wholistic nutrition, if acknowledged, could greatly help to resolve the highly-polarized, virtually intractable political debate on health care. And fourth, this definition tells why nutrition is rarely if ever offered in medical school training, is not one of the 130 or so medical specialties, and does not have a dedicated research institute at U.S. National Institutes of Health. Nutrition is a wholistic science whereas medical practice is reductionist, a serious mismatch that causes biased judgement of nutrition. But this dichotomy would not exist if the medical practice profession were to understand and adopt wholistic interpretation. Reductionist research, however, is crucially important because its findings provide the granular structure for wholistic interpretation-these two philosophies are inescapably interdependent. Evidence obtained in this manner lends strong support to the suggestion that nutrition is more efficacious and far more affordable in maintaining and restoring (treating) health than all the pills and procedures combined. Admittedly, this is a challenging paradigm for the domain of medical science itself.
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Affiliation(s)
- TC Campbell
- Division of Nutritional Sciences, Cornell University, NY 14851,
USA
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18
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Krachler B, Jerdén L, Lindén C. Written Examinations in Swedish Medical Schools: Minds Molded to Medicate? Am J Lifestyle Med 2017; 13:611-614. [PMID: 31662728 PMCID: PMC6796225 DOI: 10.1177/1559827617724338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 11/17/2022] Open
Abstract
Lifestyle medicine (LM) is part of official educational goals in Swedish medical
schools. We studied questions concerning 5 noncommunicable diseases: diabetes,
hypertension, coronary heart disease (CHD), chronic obstructive pulmonary
disease (COPD), and stroke from 124 written examinations conducted between 2012
and 2015. LM knowledge yielded between 2% and 10%, whereas pharmacology-related
knowledge yielded between 24% and 50%, of total points. The multiples at which
pharmacology-related knowledge was valued higher than LM knowledge were 2.4 for
COPD (P < .056), 4.3 for diabetes (P < .0001), 4.8 for hypertension (P
< .0001), 5.2 for CHD (P < .0001), and 31.5 for stroke (P < .0001). Our
results indicate that lifestyle-related knowledge, though covered by official
teaching goals, is currently underrated in Swedish medical education.
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Affiliation(s)
- Benno Krachler
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden (BK).,Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden (LJ).,Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden (CL)
| | - Lars Jerdén
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden (BK).,Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden (LJ).,Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden (CL)
| | - Christina Lindén
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden (BK).,Department of Public Health and Clinical Medicine, Epidemiology, Umeå University, Umeå, Sweden (LJ).,Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden (CL)
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19
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Freeman AM, Morris PB, Barnard N, Esselstyn CB, Ros E, Agatston A, Devries S, O'Keefe J, Miller M, Ornish D, Williams K, Kris-Etherton P. Trending Cardiovascular Nutrition Controversies. J Am Coll Cardiol 2017; 69:1172-1187. [PMID: 28254181 DOI: 10.1016/j.jacc.2016.10.086] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022]
Abstract
The potential cardiovascular benefits of several trending foods and dietary patterns are still incompletely understood, and nutritional science continues to evolve. However, in the meantime, a number of controversial dietary patterns, foods, and nutrients have received significant media exposure and are mired by hype. This review addresses some of the more popular foods and dietary patterns that are promoted for cardiovascular health to provide clinicians with accurate information for patient discussions in the clinical setting.
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Affiliation(s)
- Andrew M Freeman
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, Colorado.
| | - Pamela B Morris
- Medical University of South Carolina, Charleston, South Carolina
| | - Neal Barnard
- George Washington University School of Medicine; Physicians Committee for Responsible Medicine, Washington, DC
| | | | - Emilio Ros
- Lipid Clinic, Endocrinology and Nutrition Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona and Ciber Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Arthur Agatston
- Herbert Wertheim College of Medicine, Florida International University and Baptist Health of South Florida, Miami, Florida
| | - Stephen Devries
- Gaples Institute for Integrative Cardiology, Deerfield, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James O'Keefe
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Michael Miller
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Dean Ornish
- Preventive Medicine Research Institute, Sausalito, California and University of California-San Francisco, San Francisco, California
| | - Kim Williams
- Rush University Medical Center, Chicago, Illinois
| | - Penny Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
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20
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Eraballi A, Pradhan B. Quality of life improvement with rehabilitation according to constitution of the World Health Organization for coronary artery bypass graft surgery patients: A descriptive review. Ayu 2017; 38:102-107. [PMID: 30254387 PMCID: PMC6153913 DOI: 10.4103/ayu.ayu_152_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This is a descriptive review focusing on trends of treatments required for postoperative coronary artery bypass graft surgery (CABG) patients to improve the quality of life (QOL). METHODOLOGY The sources of literary research to understand the concepts of coronary artery disease according to Indian scriptures are Ayurveda texts, Bhagavad Gita, Patanjali Yoga Sutra. The data was typed in Sanskrit using Devanagari script and explanation in English was given. As per new research techniques, surgery, physiotherapy rehabilitation and Yoga are serving CABG patient's medical and psychological health better. The World Health Organization (WHO) defines health as physical, mental and social well-being later redefined with additional terms like environmental and spiritual health. This definition is similar to the Panchakosha concept in Yoga and Pancha Mahabhutas in Ayurveda. In cases of emergency or passive treatment, medication serves as a better option for physical health. In circumstances where the person is able to move in daily activities (just after discharge), rehabilitation serves as a better option for physical, mental and social health. Travel and reactions to climatic change serve environmental health. Last strategy, belief, cultural and traditional methods with scientific background serves as the spiritual health. These step-wise treatments are required for CABG patients to get the overall health or QOL. However, surgery and physiotherapy rehabilitation are advanced as per modern era which serves physical, mental, and social health also, but environmental health and spiritual health have yet to be addressed. As an ancient system of medicine, Yoga combines physical, mental, social, environmental and spiritual practices and it should be added as treatment along with surgery and physiotherapy rehabilitation. If all of these therapies were in the treatment protocol for CABG surgery patients, we would observe the changes of QOL and fulfill the requirements of constitution of the WHO. Integrating concepts of Yoga, Ayurveda, modern rehabilitation, surgery and patient cooperation with lifestyle change are the key to QOL improvements after CABG.
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Affiliation(s)
- Amaravathi Eraballi
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, India
| | - Balaram Pradhan
- Yoga and Life Science, Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru, Karnataka, India
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21
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Esselstyn CB. A plant-based diet and coronary artery disease: a mandate for effective therapy. J Geriatr Cardiol 2017; 14:317-320. [PMID: 28630609 PMCID: PMC5466936 DOI: 10.11909/j.issn.1671-5411.2017.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Caldwell B Esselstyn
- Cleveland Clinic Wellness Institute, 1950 Richmond Road, Lyndhurst, Ohio 44124, USA. E-mail:
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22
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A Comprehensive Lifestyle Intervention to Prevent Type 2 Diabetes and Cardiovascular Diseases: the German CHIP Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 17:386-97. [PMID: 26739253 DOI: 10.1007/s11121-015-0623-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The prevalence of type 2 diabetes is continuously increasing. This chronic metabolic disorder is difficult to treat and imposes a considerable economic burden on the healthcare system. In view of the fact that type 2 diabetes is primarily caused by behavioral factors, effective preventive strategies are urgently needed. We examined the effects of a holistic lifestyle intervention on clinical and laboratory parameters as well as on the long-term diabetes risk in patients at risk to develop diabetes. We conducted a randomized controlled trial in a primary care setting in Hannover, Germany, with 83 patients diagnosed as (pre)diabetic or at risk for diabetes. CHIP Germany is a 40-hour coaching lifestyle intervention program for the primary and secondary prevention of type 2 diabetes and cardiovascular diseases. The intervention included a comprehensive nutrition and health educational program based on the American CHIP approach. The primary outcome parameter was the body mass index (BMI). Secondary outcome parameters included body weight, blood pressure, fasting glucose, HbA1c, blood lipids, and the FINDRISK score, which assesses long-term diabetes risk. At the final measurement after 12 months, in the intervention group the BMI was reduced by 1.4 versus 0.2 kg/m(2) in controls (p = .119). The mean sustained weight loss after 12 months was -4.1 kg in the intervention group versus -0.8 kg in controls. Furthermore, we found a trend toward a stronger reduction in blood pressure, fasting glucose, and HbA1c as well as an improved FINDRISK score in the intervention group, compared to controls. Although failing to reach statistical significance at the final assessment, this comprehensive lifestyle intervention showed a noticeable reduction in several cardiometabolic risk factors which may facilitate the prevention of diabetes.
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23
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Terre L. Building a Footbridge From Research to Practice in Cardiovascular Risk Reduction. Am J Lifestyle Med 2016. [DOI: 10.1177/1559827606297036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As Rippe, Angelopoulos, and Zukley noted in their State-of-the-Art Review, empirically supported lifestyle modification strategies offer numerous advantages over other modalities for reducing cardiovascular risks. Yet, despite compelling evidence for their implementation, the translation of lifestyle interventions from research to practice has been challenging. Their review prompts discussion of several especially thorny barriers including the persistent tensions between (1) research and practice, (2) main effects and mediators, (3) single and multifactor approaches to risk management, and (4) primary care and communitybased systems of health delivery.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri–Kansas City, 4825 Troost Building, Suite 215, Kansas City, MO 64110-2499
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24
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Esselstyn CB. Defining an Overdue Requiem for Palliative Cardiovascular Medicine. Am J Lifestyle Med 2016; 10:313-317. [PMID: 30202287 PMCID: PMC6125067 DOI: 10.1177/1559827616638647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2024] Open
Abstract
During the past 40 years, we have witnessed significant advances in the pharmaceutical and interventional treatment of cardiovascular disease (CVD), which have helped achieve a decrease in morbidity and mortality for this illness. Nevertheless, CVD remains the number 1 killer of women and men in Western civilizations. This fact is in stark contrast to the scenario in multiple whole food, plant-based nutrition (WFPBN) cultures, where CVD is virtually nonexistent. The utility of plant-based nutrition to halt and prevent CVD has been demonstrated epidemiologically, during wartime deprivation, in large cohort and population transitioning studies, and through prospective randomized and nonrandomized investigations. A basic scientific study confirms that omnivores have intestinal bacteria capable of converting animal food to trimethylamine oxide (TMAO), which injures blood vessels, whereas those eating plants only do not have intestinal bacteria capable of producing TMAO. Despite this overwhelming evidence for the safety, simplicity, and efficacy of plant nutrition to halt and prevent coronary artery disease, the cardiovascular medicine community has failed to embrace this option of therapy and persists in palliative treatments associated with high morbidity, mortality, and expense. It is long overdue to question why.
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25
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Cullum-Dugan D, Pawlak R. REMOVED: Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet 2015; 115:801-810. [DOI: 10.1016/j.jand.2015.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Indexed: 01/30/2023]
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Sagner M, Katz D, Egger G, Lianov L, Schulz KH, Braman M, Behbod B, Phillips E, Dysinger W, Ornish D. Lifestyle medicine potential for reversing a world of chronic disease epidemics: from cell to community. Int J Clin Pract 2014; 68:1289-92. [PMID: 25348380 DOI: 10.1111/ijcp.12509] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/25/2014] [Indexed: 01/05/2023] Open
Affiliation(s)
- M Sagner
- European Society of Lifestyle Medicine, Paris, France
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Franklin BA, Durstine JL, Roberts CK, Barnard RJ. Impact of diet and exercise on lipid management in the modern era. Best Pract Res Clin Endocrinol Metab 2014; 28:405-21. [PMID: 24840267 DOI: 10.1016/j.beem.2014.01.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Unfortunately, many patients as well as the medical community, continue to rely on coronary revascularization procedures and cardioprotective medications as a first-line strategy to stabilize or favorably modify established risk factors and the course of coronary artery disease. However, these therapies do not address the root of the problem, that is, the most proximal risk factors for heart disease, including unhealthy dietary practices, physical inactivity, and cigarette smoking. We argue that more emphasis must be placed on novel approaches to embrace current primary and secondary prevention guidelines, which requires attacking conventional risk factors and their underlying environmental causes. The impact of lifestyle on the risk of cardiovascular disease has been well established in clinical trials, but these results are often overlooked and underemphasized. Considerable data also strongly support the role of lifestyle intervention to improve glucose and insulin homeostasis, as well as physical inactivity and/or low aerobic fitness. Accordingly, intensive diet and exercise interventions can be highly effective in facilitating coronary risk reduction, complementing and enhancing medications, and in some instances, even outperforming drug therapy.
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Affiliation(s)
- Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, MI, USA.
| | | | - Christian K Roberts
- Exercise and Metabolic Disease Research Laboratory, Translational Sciences Section, School of Nursing, University of California, Los Angeles, CA, USA
| | - R James Barnard
- Department of Physiological Science, University of California Los Angeles, Los Angeles, CA, USA
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28
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Ventegodt S, Merrick J. Dean Ornish should receive the Nobel prize in medicine. Int J Adolesc Med Health 2012; 24:97-98. [PMID: 22909930 DOI: 10.1515/ijamh.2012.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
No abstract available.
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29
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Fismer K, Lewith G. College of Medicine: A new vision of healthcare. Eur J Integr Med 2011. [DOI: 10.1016/j.eujim.2011.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Ricanati EH, Golubić M, Yang D, Saager L, Mascha EJ, Roizen MF. Mitigating preventable chronic disease: Progress report of the Cleveland Clinic's Lifestyle 180 program. Nutr Metab (Lond) 2011; 8:83. [PMID: 22112436 PMCID: PMC3264524 DOI: 10.1186/1743-7075-8-83] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 11/23/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Poor lifestyle choices are key in development and progression of preventable chronic diseases. The purpose of the study was to design and test a program to mitigate the physical and fiscal consequences of chronic diseases. METHODS Here we report the outcomes for 429 participants with one or more chronic conditions, including obesity, hypertension, hyperlipidemia and diabetes mellitus, many of whom had failed traditional disease management programs, who enrolled into a comprehensive lifestyle intervention. The Lifestyle 180 program integrates nutrition, physical activity and stress management interventions and was conducted at the Wellness Institute of the Cleveland Clinic, United States. An intensive 6 week immersion course, with 8 hours of group instruction per week, was followed by 3 follow-up, 4 hour-long sessions over the course of 6 months. RESULTS Changes in biometric (weight, height, waist circumference, resting heart rate and blood pressure) and laboratory variables (fasting lipid panel, blood glucose, insulin, hemoglobin A1c, ultra sensitive C-reactive protein) at 6 months were compared with baseline (pre-post analysis). At week 30, biometric and laboratory data were available for 244 (57%) and 299 (70%) participants, respectively. These had a mean ± SD reduction in weight (6.8 ± 6.9 kg, P < 0.001), waist circumference (6.1 ± 7.3 cm, P < 0.001), glucose (4.5 ± 29.6 mg/dL or 0.25 ± 1.64 mmol/L, P = 0.009), triglycerides (26.4 ± 58.5 mg/dL or 0.30 ± 0.66 mmol/L, P < 0.001), low-density lipoprotein cholesterol (LDL) (7.9 ± 25.1 mg/dL or 0.2 ± 0.65 mmol/L, P < 0.001), hemoglobin A1c (HgbA1c) (0.20 ± 0.64%, P = 0.001), insulin (3.8 ± 11 microU/ml or 26.6 ± 76.4 ρmol, P < 0.001) and ultra sensitive C-reactive protein (US - CRP) (0.9 ± 4.8 mg/dL or 7.3 ± 40.2 nmol/L, P = 0.012), an increase in mean high-density lipoprotein cholesterol (HDL) (3.7 ± 8.4 mg/dL or 0.1 ± 0.22, P < 0.001), and decreased use of medications. CONCLUSION Implementation of a comprehensive lifestyle modification program among adults with common chronic conditions results in significant and clinically meaningful improvements in biometric and laboratory outcomes after 6 months.
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Affiliation(s)
- Elizabeth Hw Ricanati
- Wellness Institute, Cleveland Clinic, 1950 Richmond Road, TR2-341, Lyndhurst, OH 44124, USA.
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31
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A challenging epigenetic message: telomerase activity is associated with complex changes in lifestyle. Cell Biol Int 2011; 35:1079-83. [DOI: 10.1042/cbi20110046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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32
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Gudkovs J. Intentional teams in rural health care: a preliminary report. Australas Psychiatry 2011; 19 Suppl 1:S98-101. [PMID: 21878032 DOI: 10.3109/10398562.2011.583063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This paper reports on how private practitioners were engaged in a rural community in an intentional team to provide a comprehensive lifestyle program for "hard to treat" patients with physical and mental health problems. METHODS A field trial of a 12-week program for patients with depression or anxiety plus other chronic disease was delivered by a team of allied health practitioners. RESULTS Significant improvements in mental health as measured by DASS and SF36 were achieved. CONCLUSIONS Utilizing community resources effectively can lessen the burden on other aspects of the health care system.
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Affiliation(s)
- Jan Gudkovs
- Total Health and Education Foundation, Warwick, QLD, Australia.
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Guarneri E, Horrigan BJ, Pechura CM. The efficacy and cost effectiveness of integrative medicine: a review of the medical and corporate literature. Explore (NY) 2011; 6:308-12. [PMID: 20832763 DOI: 10.1016/j.explore.2010.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Data supporting the efficacy and cost effectiveness of an integrative approach to healthcare comes from three sources: medical research conducted at universities, studies carried out by corporations developing employee wellness programs, and pilot projects run by insurance companies. The integrative approaches being studied place the patient at the center of the care and address the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person's health. Most importantly, they promote prevention by engaging the whole person in the attainment of a personalized lifestyle that supports health. A review of the medical, corporate, and payer literature reveals that, to start, immediate and significant health benefits and cost savings could be realized throughout our healthcare system by utilizing three integrative strategies: (1) integrative lifestyle change programs for those with chronic disease, (2) integrative interventions for people experiencing depression, and (3) integrative preventive strategies to support wellness in all populations.
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Affiliation(s)
- Erminia Guarneri
- Scripps Center for Integrative Medicine, Scripps Health, La Jolla, CA 92037, USA
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Speechly C, Bridges-Webb C, McKenzie S, Zurynski Y, Lucas A. Patient and general practitioner attitudes to healthy lifestyle behaviours and medication following coronary heart disease: an exploratory study. Aust J Prim Health 2011; 16:154-8. [PMID: 21128577 DOI: 10.1071/py09011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patients with coronary heart disease often engage in unhealthy lifestyle behaviours. We explored patients' and general practitioners' (GPs') perceptions about the effectiveness of healthy behaviours and medications for the prevention of further cardiovascular disease. This exploratory study used semi-structured interviews with eight Sydney GPs and 13 of their patients with coronary heart disease. Patients perceived medications to be more effective than healthy behaviours in improving specific aspects of cardiovascular health, such as angina symptoms, cholesterol and blood pressure, whilst GPs perceived that medications were more effective in patients they considered at highest cardiovascular risk, patients with uncontrolled risk factors, or where adherence to healthy behaviours was poor. Among patients we found a negative perception of the effort required to adhere to healthy behaviours and possible underestimation of their future cardiovascular risk. Patients valued support from peers and family. This study opens up avenues for investigation in further research, including whether patient adherence to healthy behaviours may be enhanced by the exploration oftheir perceptions about behaviour effectiveness, barriers and cardiovascular risk and by GP facilitation of practical supports.
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Affiliation(s)
- Catherine Speechly
- Projects, Research and Development Unit, RACGP NSW and ACT Faculty, 12 Mount Street, North Sydney, NSW 2060, Australia.
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Kones R. Is prevention a fantasy, or the future of medicine? A panoramic view of recent data, status, and direction in cardiovascular prevention. Ther Adv Cardiovasc Dis 2010; 5:61-81. [DOI: 10.1177/1753944710391350] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Americans are under assault by a fierce epidemic of obesity, diabetes, and cardiovascular disease, of their own doing. Lowered death rates from heart disease and reduced rates of smoking are seriously threatened by the inexorable rise in overweight and obesity. Latest data indicate that 32% of children are overweight or obese, and fewer than 17% exercise sufficiently. Over 68% of adults are overweight, 35% are obese, nearly 40% fulfill criteria for the metabolic syndrome, 8–13% have diabetes, 34% have hypertension, 36% have prehypertension, 29% have prediabetes, 15% of the population with either diabetes, hypertension, or dyslipidemia are undiagnosed, 59% engage in no vigorous activity, and fewer than 5% of the US population qualifies for the American Heart Association (AHA) definition of ideal cardiovascular health. Health, nutrition, and exercise illiteracy is prevalent, while misinformation and unrealistic expectations are the norm. Half of American adults have at least one cardiovascular risk factor. Up to 65% do not have their conventional risk biomarkers under control. Of those patients with multiple risk factors, fewer than 10% have all of them adequately controlled. Even when patients are treated according to evidence-based protocols, about 70% of cardiac events remain unaddressed. Undertreatment is also common. Poor patient adherence, probably well below 50%, adds further difficulty in reducing cardiovascular risk. Available data indicate that only a modest fraction of the total cardiovascular risk burden in the population is actually now being eliminated. A fresh view of these issues, a change in current philosophy, leading to new and different, multimechanistic methods of prevention may be needed. Adherence to published guidelines will improve substantially outcomes in both primary and secondary prevention. Primordial prevention, which does not allow risk values to appear in a population, affords more complete protection than subsequent partial reversal of elevated risk factors or biomarkers. Current evidence supports recent calls for massive educational programs supporting primordial prevention, individual responsibility and pride in achieving population-wide ideal cardiovascular health through lifestyle modification. Environmental and social changes will be necessary, along with major supportive adjustments in the food industry and the assistance of the media. Cooperation is critical to the success of such an initiative.
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Affiliation(s)
- Richard Kones
- Cardiometabolic Research Institute and the Institute for Spirituality and Health at the Texas Medical Center, 8181 Fannin Street, U314, Houston, TX 77054, USA
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Silberman A, Banthia R, Estay IS, Kemp C, Studley J, Hareras D, Ornish D. The Effectiveness and Efficacy of an Intensive Cardiac Rehabilitation Program in 24 Sites. Am J Health Promot 2010; 24:260-6. [DOI: 10.4278/ajhp.24.4.arb] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. The purpose of this study is to test the efficacy and effectiveness of an intensive cardiac rehabilitation program in improving health outcomes in multiple sites. Methods. This study employs a nonexperimental (prospective time series) design to investigate changes in cardiovascular disease in 2974 men and women from 24 socioeconomically diverse sites who participated in an intensive cardiac rehabilitation program at baseline, 12 weeks, and 1 year. Paired t-tests were used to assess differences by comparing baseline values to those after 12 weeks, baseline values to those after 1 year, and values after 12 weeks to those after 1 year. Results. Eighty-eight percent of patients remained enrolled in the program after 12 weeks, and 78.1% remained enrolled in the program after 1 year. Patients showed statistically significant improvements after 12 weeks in body mass index (BMI), triglycerides, low density lipoprotein cholesterol, total cholesterol, hemoglobin A1c, systolic blood pressure, diastolic blood pressure, depression, hostility, exercise, and functional capacity. These differences also remained significant after 1 year. There was additional significant improvement between 12 weeks and 1 year only in BMI, high density lipoprotein cholesterol, functional capacity, and hostility, and significant recidivism between 12 weeks and 1 year in all other measures (except triglycerides) and depression, yet improvements from baseline to 1 year remained significant in all measures (except HDL, which was unchanged) (p < .005). Conclusions. This intensive cardiac rehabilitation program was feasible and sustainable for most patients who enrolled and was associated with numerous subjective and objective improvements in health outcomes. It demonstrates that the intervention works when it is administered by staff at multiple clinical/community sites in four different states. These improvements were also seen in patients 65 years of age or older.
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Affiliation(s)
- Anna Silberman
- Anna Silberman, MPH; Joli Studley, MS; and Dennis Hareras, DC, are with Highmark, Inc, Pittsburgh, Pennsylvania. Rajni Banthia, PhD; Ivette S. Estay, PhD; Colleen Kemp, MSN; and Dean Ornish, MD, are with the Preventive Medicine Research Institute, Sausalito, California. Dean Ornish is Clinical Professor of Medicine, School of Medicine, University of California, San Francisco
| | - Rajni Banthia
- Anna Silberman, MPH; Joli Studley, MS; and Dennis Hareras, DC, are with Highmark, Inc, Pittsburgh, Pennsylvania. Rajni Banthia, PhD; Ivette S. Estay, PhD; Colleen Kemp, MSN; and Dean Ornish, MD, are with the Preventive Medicine Research Institute, Sausalito, California. Dean Ornish is Clinical Professor of Medicine, School of Medicine, University of California, San Francisco
| | - Ivette S. Estay
- Anna Silberman, MPH; Joli Studley, MS; and Dennis Hareras, DC, are with Highmark, Inc, Pittsburgh, Pennsylvania. Rajni Banthia, PhD; Ivette S. Estay, PhD; Colleen Kemp, MSN; and Dean Ornish, MD, are with the Preventive Medicine Research Institute, Sausalito, California. Dean Ornish is Clinical Professor of Medicine, School of Medicine, University of California, San Francisco
| | - Colleen Kemp
- Anna Silberman, MPH; Joli Studley, MS; and Dennis Hareras, DC, are with Highmark, Inc, Pittsburgh, Pennsylvania. Rajni Banthia, PhD; Ivette S. Estay, PhD; Colleen Kemp, MSN; and Dean Ornish, MD, are with the Preventive Medicine Research Institute, Sausalito, California. Dean Ornish is Clinical Professor of Medicine, School of Medicine, University of California, San Francisco
| | - Joli Studley
- Anna Silberman, MPH; Joli Studley, MS; and Dennis Hareras, DC, are with Highmark, Inc, Pittsburgh, Pennsylvania. Rajni Banthia, PhD; Ivette S. Estay, PhD; Colleen Kemp, MSN; and Dean Ornish, MD, are with the Preventive Medicine Research Institute, Sausalito, California. Dean Ornish is Clinical Professor of Medicine, School of Medicine, University of California, San Francisco
| | - Dennis Hareras
- Anna Silberman, MPH; Joli Studley, MS; and Dennis Hareras, DC, are with Highmark, Inc, Pittsburgh, Pennsylvania. Rajni Banthia, PhD; Ivette S. Estay, PhD; Colleen Kemp, MSN; and Dean Ornish, MD, are with the Preventive Medicine Research Institute, Sausalito, California. Dean Ornish is Clinical Professor of Medicine, School of Medicine, University of California, San Francisco
| | - Dean Ornish
- Anna Silberman, MPH; Joli Studley, MS; and Dennis Hareras, DC, are with Highmark, Inc, Pittsburgh, Pennsylvania. Rajni Banthia, PhD; Ivette S. Estay, PhD; Colleen Kemp, MSN; and Dean Ornish, MD, are with the Preventive Medicine Research Institute, Sausalito, California. Dean Ornish is Clinical Professor of Medicine, School of Medicine, University of California, San Francisco
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Pelletier KR, Herman PM, Metz RD, Nelson CF. Health and Medical Economics Applied to Integrative Medicine. Explore (NY) 2010; 6:86-99. [DOI: 10.1016/j.explore.2009.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Dean E. Physical therapy in the 21st century (Part I): toward practice informed by epidemiology and the crisis of lifestyle conditions. Physiother Theory Pract 2010; 25:330-53. [PMID: 19842862 DOI: 10.1080/09593980802668027] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Part I of this two-part introduction to this Special Issue on the practice of physical therapy in the 21st century outlines the epidemiological basis and rationale for evidence-informed physical therapy practice for addressing contemporary health priorities. This evidence emanates from the definition of health by the World Health Organization (WHO) and the International Classification of Functioning (ICF), and WHO and other international databases on the prevalence of lifestyle conditions. Lifestyle conditions include ischemic heart disease, smoking-related conditions, hypertension and stroke, obesity, diabetes, and cancer. Epidemiological data combined with evidence supporting the effectiveness of noninvasive interventions related to physical therapy to address these priorities (e.g., health education and exercise) are highly consistent with the promotion of health and wellness and the ICF. Given their commitment to exploiting effective noninvasive interventions, physical therapists are in a preeminent position to focus on prevention of these disabling and lethal conditions in every client or patient, their cure in some cases, as well as their management. Thus, a compelling argument can be made that clinical competencies in 21st century physical therapy need to include assessment of smoking and smoking cessation (or at least its initiation), basic nutritional assessment and counseling, recommendations for physical activity and exercise, stress assessment and basic stress reduction recommendations, and sleep assessment and basic sleep hygiene recommendations. The physical therapist can then make an informed clinical judgment regarding whether a client or patient needs to be referred to another professional related to one or more of these specialty areas. The prominence of physical therapy as an established health care profession and its unique pattern of practice (prolonged visits over prolonged periods of time) attest further to the fact that physical therapists are uniquely qualified to lead in the assault on lifestyle conditions. Evidence-based physical therapy practiced within the context of epidemiological indicators (i.e., evidence-informed practice) maximally empowers clinicians to promote lifelong health in every person and in turn, the health of communities. This vision of physical therapy's leading role in health promotion and health care in the 21st century holds the promise of reducing the need for invasive health interventions (drugs and surgery). Part II of this introduction describes evidence-based physical therapy practice within this context of evidence-informed practice.
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Affiliation(s)
- Elizabeth Dean
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Affiliation(s)
- Dean Ornish
- Preventive Medicine Research Institute, Sausalito, CA, USA and University of California, San Francisco, CA, USA.
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Schulz U, Pischke CR, Weidner G, Daubenmier J, Elliot-Eller M, Scherwitz L, Bullinger M, Ornish D. Social support group attendance is related to blood pressure, health behaviours, and quality of life in the Multicenter Lifestyle Demonstration Project. PSYCHOL HEALTH MED 2008; 13:423-37. [PMID: 18825581 DOI: 10.1080/13548500701660442] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Changes in coronary risk factors, health behaviours, and health-related quality of life (HRQOL) were examined by tertiles of social support group attendance in 440 patients (21% females) with coronary artery disease. All patients participated in the Multicenter Lifestyle Demonstration Project (MLDP; eight hospital sites in the USA), an insurance-covered multi-component cardiac prevention program including dietary changes, stress management, exercise and group support for 1 year. Significant improvements in coronary risk factors, health behaviours, and HRQOL were noted at 1 year. Several of these improvements (i.e. systolic blood pressure, health behaviours, HRQOL) were related to social support group attendance, favoring those who attended more sessions. The associations between support group attendance to systolic blood pressure and to four HRQOL subscales (bodily pain, social functioning, mental health, and the mental health summary score) remained significant when controlling for changes in health behaviours, but dropped to a non-significant level for the HRQOL subscales 'physical functioning', 'general health' and 'role-emotional'. These results suggest an independent relationship of social support group attendance to systolic blood pressure while improvements in quality of life may be in part due to improved health behaviours facilitated by increased social support group attendance.
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Affiliation(s)
- Ute Schulz
- Preventive Medicine Research Institute, Sausalito, USA
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Abstract
Ranolazine is a new and unique antianginal drug that has been approved for the treatment of chronic stable angina pectoris. The drug is administered as a sustained-release formulation. Although the drug's mechanism of action has not been fully elucidated, current thinking is that ranolazine, a selective inhibitor of late sodium influx, attenuates the abnormalities of ventricular repolarisation and contractility associated with ischaemia. Three randomised trials have shown efficacy for ranolazine in increasing exercise testing or reducing anginal episodes or use of glyceryl trinitrate. Side-effects include dizziness, constipation, nausea, and the potential for prolongation of the QT(c) interval. Ranolazine seems to be a safe addition to current traditional drugs for chronic stable angina, especially in aggressive multidrug regimens.
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Affiliation(s)
- David T Nash
- Syracuse Preventive Cardiology, Syracuse, NY 13202, USA.
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Frattaroli J, Weidner G, Merritt-Worden TA, Frenda S, Ornish D. Angina pectoris and atherosclerotic risk factors in the multisite cardiac lifestyle intervention program. Am J Cardiol 2008; 101:911-8. [PMID: 18359307 DOI: 10.1016/j.amjcard.2007.11.039] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 11/13/2007] [Accepted: 11/13/2007] [Indexed: 10/22/2022]
Abstract
Cardiovascular symptom relief is a major indicator for revascularization procedures. To examine the effects of intensive lifestyle modification on symptom relief, we investigated changes in angina pectoris, coronary risk factors, quality of life, and lifestyle behaviors in patients with stable coronary artery disease enrolled in the multisite cardiac lifestyle intervention program, an ongoing health insurance-covered lifestyle intervention conducted at 22 sites in the united states. Patients with coronary artery disease (nonsmokers; 757 men, 395 women; mean age 61 years) were asked to make changes in diet (10% calories from fat, plant based), engage in moderate exercise (3 hours/week), and practice stress management (1 hour/day). At baseline, 108 patients (43% women) reported mild angina and 174 patients (37% women) reported limiting angina. By 12 weeks, 74% of these patients were angina free, and an additional 9% moved from limiting to mild angina. This improvement in angina was significant for patients with mild and limiting angina at baseline regardless of gender (p <0.01). Significant improvements in cardiac risk factors, quality of life, and lifestyle behaviors were observed, and patients with angina who became angina free by 12 weeks showed the greatest improvements in exercise capacity, depression, and health-related quality of life (p <0.05). In conclusion, the observed improvements in angina in patients making intensive lifestyle changes could drastically reduce their need for revascularization procedures.
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Innes KE, Vincent HK. The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: a systematic review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2007; 4:469-86. [PMID: 18227915 PMCID: PMC2176136 DOI: 10.1093/ecam/nel103] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Accepted: 11/13/2006] [Indexed: 12/12/2022]
Abstract
There is growing evidence that yoga may offer a safe and cost-effective intervention for Type 2 Diabetes mellitus (DM 2). However, systematic reviews are lacking. This article critically reviews the published literature regarding the effects of yoga-based programs on physiologic and anthropometric risk profiles and related clinical outcomes in adults with DM 2. We performed a comprehensive literature search using four computerized English and Indian scientific databases. The search was restricted to original studies (1970-2006) that evaluated the metabolic and clinical effects of yoga in adults with DM 2. Studies targeting clinical populations with cardiovascular disorders that included adults with comorbid DM were also evaluated. Data were extracted regarding study design, setting, target population, intervention, comparison group or condition, outcome assessment, data analysis and presentation, follow-up, and key results, and the quality of each study was evaluated according to specific predetermined criteria. We identified 25 eligible studies, including 15 uncontrolled trials, 6 non-randomized controlled trials and 4 randomized controlled trials (RCTs). Overall, these studies suggest beneficial changes in several risk indices, including glucose tolerance and insulin sensitivity, lipid profiles, anthropometric characteristics, blood pressure, oxidative stress, coagulation profiles, sympathetic activation and pulmonary function, as well as improvement in specific clinical outcomes. Yoga may improve risk profiles in adults with DM 2, and may have promise for the prevention and management of cardiovascular complications in this population. However, the limitations characterizing most studies preclude drawing firm conclusions. Additional high-quality RCTs are needed to confirm and further elucidate the effects of standardized yoga programs in populations with DM 2.
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Affiliation(s)
- Kim E. Innes
- Center for the Study of Complementary and Alternative Therapies and Department of Physical Medicine and Rehabilitation, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Heather K. Vincent
- Center for the Study of Complementary and Alternative Therapies and Department of Physical Medicine and Rehabilitation, University of Virginia Health Systems, Charlottesville, VA, USA
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Burke LE, Warziski M, Styn MA, Music E, Hudson AG, Sereika SM. A randomized clinical trial of a standard versus vegetarian diet for weight loss: the impact of treatment preference. Int J Obes (Lond) 2007; 32:166-76. [PMID: 17700579 DOI: 10.1038/sj.ijo.0803706] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND With obesity rampant, methods to achieve sustained weight loss remain elusive. OBJECTIVE To compare the long-term weight-loss efficacy of 2 cal and fat-restricted diets, standard (omnivorous) versus lacto-ovo-vegetarian, and to determine the effect of a chosen diet versus an assigned diet. DESIGN, SUBJECTS A randomized clinical trial was conducted with 176 adults who were sedentary and overweight (mean body mass index, 34.0 kg/m(2)). Participants were first randomly assigned to either receive their preferred diet or be assigned to a diet group and second, were given their diet of preference or randomly assigned to a standard weight-loss diet or a lacto-ovo-vegetarian diet. Participants underwent a university-based weight-control program consisting of daily dietary and exercise goals plus 12 months of behavioral counseling followed by a 6-month maintenance phase. MEASUREMENTS Percentage change in body weight, body mass index, waist circumference, low- and high-density lipoprotein, glucose, insulin and macronutrient intake. RESULTS The program was completed by 132 (75%) of the participants. At 18 months, mean percentage weight loss was greater (P=0.01) in the two groups that were assigned a diet (standard, 8.0% (s.d., 7.8%); vegetarian, 7.9% (s.d., 8.1%)) than in those provided the diet of their choice (standard, 3.9% (s.d., 6.1%); vegetarian, 5.3% (s.d., 6.2%)). No difference was observed in weight loss between the two types of diet. Over the 18-month program, all groups showed significant weight loss. CONCLUSIONS Participants assigned to their dietary preference did not have enhanced treatment outcomes. However, all groups lost weight with losses ranging from 4 to 8% at 18 months.
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Affiliation(s)
- L E Burke
- Department of Health and Community Systems and the Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
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Pischke CR, Weidner G, Elliott-Eller M, Ornish D. Lifestyle changes and clinical profile in coronary heart disease patients with an ejection fraction of <or=40% or >40% in the Multicenter Lifestyle Demonstration Project. Eur J Heart Fail 2007; 9:928-34. [PMID: 17572148 DOI: 10.1016/j.ejheart.2007.05.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Revised: 02/23/2007] [Accepted: 05/14/2007] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lifestyle changes are recommended for coronary heart disease (CHD) patients at risk for heart failure (HF) [ACC/AHA stage B; left ventricular ejection fraction (LVEF)<or=40%]. However, it is not clear whether changes in lifestyle are feasible and beneficial in these patients. AIM To investigate the feasibility of intensive lifestyle changes for CHD patients at risk for HF. METHODS We compared 50 patients (18% female) with angiographically documented LVEF<or=40% (mean=33.4+/-7.3; range: 15-40%) to 186 patients (18% female) with LVEF>40% (mean=58.2+/-9.6; range: 42-87%), who were participants in the Multicenter Lifestyle Demonstration Project (MLDP). All were non-smoking CHD patients. The MLDP was a community-based, insurance-sponsored intervention (low-fat, plant-based diet; exercise; stress management) implemented at 8 sites in the US. Coronary risk factors, lifestyle and quality of life (SF-36) were assessed at baseline, 3 and 12 months. RESULTS Regardless of LVEF, patients showed significant improvements (all p<.05) in lifestyle behaviours, body weight, body fat, blood pressure, resting heart rate, total and LDL-cholesterol, exercise capacity, and quality of life by 3 months; most improvements were maintained over 12 months. CONCLUSION CHD patients at risk for heart failure with an LVEF<or=40%, can make changes in lifestyle to achieve similar medical and psychosocial benefit to patients with an LVEF>40%.
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Affiliation(s)
- Claudia R Pischke
- Preventive Medicine Research Institute (PMRI), Sausalito, CA, United States
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Englert HS, Diehl HA, Greenlaw RL, Willich SN, Aldana S. The effect of a community-based coronary risk reduction: the Rockford CHIP. Prev Med 2007; 44:513-9. [PMID: 17383717 DOI: 10.1016/j.ypmed.2007.01.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 01/05/2007] [Accepted: 01/26/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to assess the clinical effects of a community-based lifestyle intervention program in reducing coronary risk, especially in a high risk group. METHOD The 40-hour educational curriculum of the Coronary Health Improvement Project (CHIP) delivered over a 30-day period with clinical and nutritional assessments before and after was offered in the spring and fall of 2000 to 2002 through the Center for Complementary Medicine of the Swedish American Health System in Rockford, Illinois to its employees and the general public. The participants were instructed to optimize their diet, quit smoking and exercise daily (walking 30 min/day). RESULTS The data of the 5 CHIP programs were pooled and analyzed. 544 men and 973 women (almost all Caucasian; mean age 55 years) were eligible for analysis. At the end of the 30-day intervention period, stratified analyses of total cholesterol, LDL, triglycerides, blood glucose, blood pressure and weight showed highly significant reductions with the greatest improvements among those at highest risk. CONCLUSION Well-designed community-based intervention programs can improve lifestyle choices and health habits. They can also markedly and rather quickly reduce the level of coronary risk factors in a non-randomized population.
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Daubenmier JJ, Weidner G, Sumner MD, Mendell N, Merritt-Worden T, Studley J, Ornish D. The contribution of changes in diet, exercise, and stress management to changes in coronary risk in women and men in the Multisite Cardiac Lifestyle Intervention Program. Ann Behav Med 2007; 33:57-68. [PMID: 17291171 DOI: 10.1207/s15324796abm3301_7] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The relative contribution of health behaviors to coronary risk factors in multicomponent secondary coronary heart disease (CHD) prevention programs is largely unknown. PURPOSE Our purpose is to evaluate the additive and interactive effects of 3-month changes in health behaviors (dietary fat intake, exercise, and stress management) on 3-month changes in coronary risk and psychosocial factors among 869 nonsmoking CHD patients (34% female) enrolled in the health insurance-based Multisite Cardiac Lifestyle Intervention Program. METHODS Analyses of variance for repeated measures were used to analyze health behaviors, coronary risk factors, and psychosocial factors at baseline and 3 months. Multiple regression analyses evaluated changes in dietary fat intake and hours per week of exercise and stress management as predictors of changes in coronary risk and psychosocial factors. RESULTS Significant overall improvement in coronary risk was observed. Reductions in dietary fat intake predicted reductions in weight, total cholesterol, low-density lipoprotein cholesterol, and interacted with increased exercise to predict reductions in perceived stress. Increases in exercise predicted improvements in total cholesterol and exercise capacity (for women). Increased stress management was related to reductions in weight, total cholesterol/high-density lipoprotein cholesterol (for men), triglycerides, hemoglobin A1c (in patients with diabetes), and hostility. CONCLUSIONS Improvements in dietary fat intake, exercise, and stress management were individually, additively and interactively related to coronary risk and psychosocial factors, suggesting that multicomponent programs focusing on diet, exercise, and stress management may benefit patients with CHD.
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Oster rediscovered--mega-dose folate for symptomatic atherosclerosis. Med Hypotheses 2007; 69:325-32. [PMID: 17224245 DOI: 10.1016/j.mehy.2004.11.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Accepted: 11/13/2004] [Indexed: 10/23/2022]
Abstract
Thirty years ago, Kurt Oster promulgated the avant-garde theory that bovine xanthine oxidase, absorbed intact from homogenized milk, promoted atherogenesis by oxidatively damaging membrane plasmalogens. Under the mistaken impression that folic acid is a xanthine oxidase inhibitor, he administered high-dose folate (80 mg daily) to hundreds of patients afflicted with symptomatic atherosclerosis, and reported marked improvements in angina, intermittent claudication, and wound healing; he also suspected that this regimen was decreasing heart attack risk. The xanthine oxidase theory has since fallen by the wayside, but there is now evidence that folic acid can lessen endothelial oxidative stress by improving the function of "uncoupled" nitric oxide synthase deficient in tetrahydrobiopterin. In light of these new findings, a properly controlled assessment of Oster's mega-dose folate therapy is warranted.
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Burke LE, Styn MA, Steenkiste AR, Music E, Warziski M, Choo J. A randomized clinical trial testing treatment preference and two dietary options in behavioral weight management: preliminary results of the impact of diet at 6 months--PREFER study. Obesity (Silver Spring) 2006; 14:2007-17. [PMID: 17135618 DOI: 10.1038/oby.2006.235] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The PREFER study objectives were to examine potential differences in weight loss during a standard behavioral intervention between subjects assigned to one of two calorie- and fat-restricted diets [standard behavior treatment (SBT) and lacto-ovo-vegetarian ([SBT+LOV)], with or without regard to their preferred dietary treatment. This article reports the differences in outcomes between diet groups after the first 6 months of the intervention. RESEARCH METHODS AND PROCEDURES The study used a four-group design. Subjects (n = 182) were randomized to a treatment preference group and then to a dietary treatment group. For this report, preference groups were combined to permit comparisons by dietary treatment only (SBT, n = 98; SBT+LOV, n = 84). Additional analyses compared SBT+LOV subjects who were 100% adherent (did not consume any meat, fish, or poultry, n = 47) to those who were <100% adherent (n = 24). RESULTS Significant differences were seen in the baseline to 6-month change scores between the two groups for carbohydrate consumption (p = 0.013), protein consumption (p < 0.001), polyunsaturated-to-saturated fat ratio (p = 0.009), and low-density lipoprotein-cholesterol (LDL-C) level (p = 0.013). Among SBT+LOV subjects, those who were 100% adherent experienced greater reductions in weight (p < 0.001), total cholesterol (p = 0.026), LDL-C (p = 0.034), and glucose (p = 0.002) and consumed less fat (p = 0.030) compared with those who were <100% adherent. DISCUSSION Differences between dietary treatment groups at 6 months were minimal, most likely because one-third of the SBT+LOV group did not follow the vegetarian diet and because both groups had the same calorie and fat restrictions. SBT+LOV subjects who were 100% adherent were more successful at both weight loss and cholesterol reduction than those who were <100% adherent, suggesting that vegetarian diets are efficacious for weight and cholesterol control.
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Affiliation(s)
- Lora E Burke
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, 415 Victoria Building, Pittsburgh, PA 15261, USA.
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