Lifestyle Modification Strategies Research Articles

The Association of Resting Heart Rate and Incident Hypertension: The Henry Ford Hospital Exercise Testing (FIT) Project

Given that sympathetic tone is associated with hypertension, we sought to determine whether resting heart rate (RHR), as a surrogate for cardiac autonomic function, was associated with incident hypertension. We analyzed 21,873 individuals without a history of hypertension who underwent a clinically indicated exercise stress test. Baseline RHR was assessed prior to testing and was categorized as <70, 70-85, and >85 beats-per-minute (bpm). Incident hypertension was defined by subsequent diagnosis codes for new-onset hypertension from three or more encounters. We tested for effect modification by age (<60 vs. ≥60 years), sex, race, and history of coronary heart disease (CHD). Mean (±SD) age was 49 (±12) years, 55% were men and 21% were Black. Compared to the lowest RHR (<70 bpm) category, patients in the highest category (>85 bpm) were younger, more likely to be female, heavier, diabetic, and achieve lower metabolic equivalents (METS). Over a median of 4 years follow-up, there were 8,179 cases of incident hypertension. Compared to RHR <70 bpm, persons with RHR >85 bpm had increased risk of hypertension after adjustment for CHD risk factors, baseline blood pressure (BP), and METS (hazard ratio = 1.15 (95% confidence interval 1.08-1.23)). Age was an effect modifier (interaction P = 0.02), whereas sex, race, and CHD were not. In age-stratified analyses the relationship remained significant only in those younger than 60 years. Elevated RHR is an independent risk factor for incident hypertension, particularly in younger persons. Whether lifestyle modification or other strategies to reduce RHR can prevent incident hypertension in high-risk individuals warrants further study.

Linking community resources in diabetes care: a role for technology?

Designing and implementing effective lifestyle modification strategies remains one of the great challenges in diabetes care. Historically, programs have focused on individual behavior change with little or no attempt to integrate change within the broader social framework or community context. However, these contextual factors have been shown to be associated with poor diabetes outcomes, particularly in low-income minority populations. Recent evidence suggests that one way to address these disparities is to match patient needs to existing community resources. Not only does this position patients to more quickly adapt behavior in a practical way, but this also refers patients back to their local communities where a support mechanism is in place to sustain healthy behavior. Technology offers a new and promising platform for connecting patients to meaningful resources (also referred to as "assets"). This paper summarizes several noteworthy innovations that use technology as a practical bridge between healthcare and community-based resources that promote diabetes self-care.

The Effect of an Acute Bout of Aerobic Versus Resistance Exercise on Ghrelin Levels in Obese Men

INTRODUCTION: Obesity is a major public health problem worldwide. Over 33.3% of adults are obese, and increased hunger has been shown to be a cause of overeating and weight gain. In normal weight individuals, the hormone ghrelin is attenuated after food consumption, as well as after moderate exercise, and this is thought to promote satiety. However, ghrelin has been found to remain elevated in obese individuals after food consumption. Exercise is an effective lifestyle modification strategy used to decrease adiposity. PURPOSE: The purpose of this study was to examine the effects of aerobic and resistance exercise on ghrelin concentrations and hunger in obese men. METHODS: Eleven obese men (M±SD: Age: 30±9.6yr; BMI: 38.7±11.3kg.m2) performed aerobic and resistance exercise on nonconsecutive days. The subject criterion required males, 18yrs and older, non-diabetic, not currently exercising more than 3 days a week, and not currently taking beta-blockers, verapamil, or digitalis. The resistance exercise session involved 6 circuit exercises targeting the major muscle groups for 4 sets and 10 repetitions per set. The aerobic exercise session involved treadmill walking performed between 60-80% heart rate maximum (HRmax) for a time interval that mirrored the resistance exercise session. HRmax was calculated as 220-age. Blood samples were taken via venipuncture pre, immediately post and 45 minutes post-exercise for each session. Perceived hunger was quantified at the same time points with a 16-point scale (0-16). Serum was assayed to determine ghrelin concentrations with an ELIZA kit manufactured by RayBiotech, Inc. Two 2X3 repeated measures ANOVAs were performed to analyze the interactions between ghrelin and perceived hunger over three time points. RESULTS: Perceived hunger was found to have a significant difference over time (p<0.05). Perceived hunger was significantly higher 45min post exercise compared to baseline for both exercise types (M±SD: pre: 4.27±0.47; post: 4.73±0.51; 45min post: 6.14±0.67). No significant interaction or differences were found for ghrelin (ng/ml) between exercise protocols or across time (p >0.05)(M±SD: pre: 110.53±21.12; post: 120.32±27.32; 45min post: 113.02±20.16) CONCLUSION: Overall, there was no difference in ghrelin concentrations over time or between exercise protocols in obese men. A significant change in perceived hunger was found over time with an increase in hunger after exercise.

Premature Mortality Costs Associated with Lifestyle Factors among US Citizens

Purpose: The leading causes of mortality in the US include chronic diseases such as heart disease, stroke, and cancer. These diseases may also be classified as major “lifestyle” diseases that trace partially to imprudent living and risky behavior. Design: To examine the monetary costs of lifestyle choices. Setting: USA Subjects: USA citizens Measures: We utilized the most recent data from the National Center for Health Statistics and mortality costs from the USA Census Bureau in order to estimate the costs of lifestyle decisions leading to premature death. Analysis: This study examines the monetary costs associated with six personal lifestyle decisions- smoking, diet, excessive alcohol consumption, illicit drug use, accidents, sexually transmitted infections-and consequent premature mortalities. Results: Our study showed that 40.0% of the 2.47 million deaths annually in the USA may be attributed to lifestyle decisions. The majority of premature deaths that occurred were associated with three lifestyle decisions-smoking, obesity or excessive alcohol consumption. Smoking, obesity, sexually transmitted infections and accidents decreased vis-a-vis the previous decade; whereas, illicit drugs and alcohol-related premature deaths increased from the previous decade. Conclusion: The value of lifetime earnings lost among individuals as a consequence of lifestyle choices is $241 billion annually. The prospect for future declines in these premature deaths will most likely depend on a decrease in risk factors, continued lifestyle modification and population-based intervention strategies.

A review of the use of the 5 A's model for weight loss counselling: differences between physician practice and patient demand.

The 5 A's (Assess, Advise, Agree, Assist and Arrange) is a model that can be used by primary care physicians and practitioners to promote patient behaviour change. The 5 A's model is a viable intervention for encouraging weight management in response to the epidemic of obesity among patients. To identify and summarize quantitative research related to the 5 A's patients want to receive from their physicians during weight loss discussions and how frequently physicians use each practice. We conducted a systematic literature review of the MEDLINE/PubMed database using relevant keywords. Of 230 articles originally identified, 15 articles included quantitative research data from cross-sectional studies related to the aim of this review. Based on the available evidence, the majority of patients want to discuss weight loss with their physicians, with the Assist and Arrange aspects of the 5 A's being most desired. However, physicians most frequently Advise and Assess, and rarely Agree, Assist or Arrange. There are some significant limitations to the available evidence, including a limited number of studies addressing patient preference, inconsistent assessment of all aspects of the 5 A's, a lack of longitudinal designs and failure to take contextual factors such as patient and physician characteristics into account when interpreting study results. Future studies should address these limitations, document the outcomes that result from better physician training in lifestyle modification strategies and determine how to best routinely implement all aspects of the 5 A's for weight management in family practice settings.

Parental perceptions regarding lifestyle interventions for obese children and adolescents with nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) affects 30% of obese children globally. The main treatment for NAFLD is to promote gradual weight loss through lifestyle modification. Very little is known regarding parental perspectives about the barriers and facilitators that influence the ability to promote healthy lifestyle behaviours in children with NAFLD. To explore and describe parental perspectives regarding barriers to and facilitators of implementing lifestyle modification in children with NAFLD. A mixed-methods approach, including qualitative methodology (focus groups) and validated questionnaires (Lifestyle Behaviour Checklist), was used to assess parental perceptions regarding barriers to and facilitators of lifestyle change in parents of children with healthy body weights (control parents) and in parents of children with NAFLD (NAFLD parents). NAFLD parents identified more problem behaviours related to food portion size and time spent in nonsedentary physical activity, and lower parental self-efficacy than parents of controls (P<0.05). Major barriers to lifestyle change cited by NAFLD parents were lack of time, self-motivation and role modelling of healthy lifestyle behaviours. In contrast, control parents used a variety of strategies to elicit healthy lifestyle behaviours in their children including positive role modelling, and inclusion of the child in food preparation and meal purchasing decisions, and perceived few barriers to promoting healthy lifestyles. Internet sources were the main form of nutrition information used by parents. Lifestyle modification strategies focused on promoting increased parental self-efficacy and parental motivation to promote healthy lifestyle behaviour are important components in the treatment of obese children with NAFLD.

Parental perceptions regarding lifestyle interventions for obese children and adolescents with nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) affects 30% of obese children globally. The main treatment for NAFLD is to promote gradual weight loss through lifestyle modification. Very little is known regarding parental perspectives about the barriers and facilitators that influence the ability to promote healthy lifestyle behaviours in children with NAFLD. To explore and describe parental perspectives regarding barriers to and facilitators of implementing lifestyle modification in children with NAFLD. A mixed-methods approach, including qualitative methodology (focus groups) and validated questionnaires (Lifestyle Behaviour Checklist), was used to assess parental perceptions regarding barriers to and facilitators of lifestyle change in parents of children with healthy body weights (control parents) and in parents of children with NAFLD (NAFLD parents). NAFLD parents identified more problem behaviours related to food portion size and time spent in nonsedentary physical activity, and lower parental self-efficacy than parents of controls (P<0.05). Major barriers to lifestyle change cited by NAFLD parents were lack of time, self-motivation and role modelling of healthy lifestyle behaviours. In contrast, control parents used a variety of strategies to elicit healthy lifestyle behaviours in their children including positive role modelling, and inclusion of the child in food preparation and meal purchasing decisions, and perceived few barriers to promoting healthy lifestyles. Internet sources were the main form of nutrition information used by parents. Lifestyle modification strategies focused on promoting increased parental self-efficacy and parental motivation to promote healthy lifestyle behaviour are important components in the treatment of obese children with NAFLD.

Evaluation of a systematic cardiovascular disease risk reduction strategy in primary healthcare: an exploratory study from Zhejiang, China

In China, cardiovascular disease (CVD) risk reduction strategies are not systematically implemented in primary healthcare (PHC). We conducted an exploratory study to evaluate the preliminary effectiveness of our systematic CVD risk reduction package in one township hospital of Zhejiang. Using the Asian Equation, we selected subjects aged 40-74 years with a calculated 10-year CVD risk of 20% or higher from the existing resident health records and research checkup. The subjects were provided, as appropriate, with the low-dose combination of CVD-preventive drugs (antihypertensive drugs, aspirin, statin), lifestyle modification and adherence strategies monthly. The intervention was piloted for three months in 2012, preceding the conduct of a cluster-based randomized controlled trial (RCT). A total of 153 (40%) subjects were recruited, with an average total 10-year risk of CVD of 28.5 ± 7.9%. After intervention, the appointment rate was up to 90%. An upward trend was observed for the use of CVD-preventive drugs. The smoking rates significantly reduced from 38 to 35%, with almost no change for salt reduction. The systolic blood pressure (BP) and diastolic BP decreased slightly. A holistic CVD risk reduction approach shows preliminary effects in a rural PHC setting of Zhejiang, China. However, further understanding is needed regarding its long-term effectiveness and feasibility in PHC practices. Our cluster-based RCT will provide the highest level of evidence for the policy development of preventing CVD in a rural PHC of China.

Demographic, laboratory, and therapeutic contributing factors of non-dipper blood pressure patterning in diabetes: the Hygia Project

1. Many organizations are exploring innovative employee wellness programs to improve workforce health. Prehypertension is a risk factor for the development of hypertension and an independent risk factor for cardiovascular (CV) disease. Hypertension is highly prevalent and leads to increased healthcare costs, but literature on the prevalence of prehypertension in the workplace is lacking. The purpose of our study was to evaluate prevalence of prehypertension and assess CV risk factors among the University’s staff. 2. Participants were recruited via campus-wide email sent to all employees. A health history questionnaire and physical activity questionnaire (PAR-Q) was used to exclude participants with any self-reported chronic illnesses, including any form of CV disease, diabetes, lung, liver or renal disease. Forty one (11Males/30Females, 50 6yrs) apparently healthy nonsmoking but sedentary participants were included. Office blood pressure (BP) was measured in the right arm, in duplicates with 5min intervals, using an aneroid sphygmomanometer, and the average was calculated, after the participants rested for 5min in a seated position. Fasting blood glucose and lipid profile were analyzed using Cholestech LDX analyzer. Height and weight were measured to calculate body mass index (BMI). 3. The prevalence of normotension, prehypertension, and hypertension were 21/41 (w51%), 17/41 (w41%) and 3/41 (w8%), respectively. Normotension vs. prehypertension (Mean SD) for systolic BP (109.4 6.6 vs. 126.8 7.4mmHg; p<0.001), diastolic BP (71.8 4.2 vs. 82.3 3.1mmHg; p<0.001), weight (74.9 13.1 vs. 86.9 18.5kg; p1⁄40.026), BMI (26.8 2.8 vs. 30.0 6.6 kg/m2; p1⁄40.040) and fasting blood glucose (94.8 6.1 vs. 102.8 10.1 mg/dL; p1⁄40.004). There were no statistically significant differences in lipid profiles between the groups. 4. Our preliminary findings indicate that prehypertension has high prevalence (41%) in the University workforce. Compared to normotensive participants, prehypertensives were more likely to be obese and have impaired fasting glucose. This suggests that prehypertension is associated with other CV risk factors and heightens CV risk of the University employees. Therefore, early and effective lifestyle modification strategies may help to decrease long-term CV risk.

Determinants factors of dipper phenomenoms and morning blood pressure

1. Many organizations are exploring innovative employee wellness programs to improve workforce health. Prehypertension is a risk factor for the development of hypertension and an independent risk factor for cardiovascular (CV) disease. Hypertension is highly prevalent and leads to increased healthcare costs, but literature on the prevalence of prehypertension in the workplace is lacking. The purpose of our study was to evaluate prevalence of prehypertension and assess CV risk factors among the University’s staff. 2. Participants were recruited via campus-wide email sent to all employees. A health history questionnaire and physical activity questionnaire (PAR-Q) was used to exclude participants with any self-reported chronic illnesses, including any form of CV disease, diabetes, lung, liver or renal disease. Forty one (11Males/30Females, 50 6yrs) apparently healthy nonsmoking but sedentary participants were included. Office blood pressure (BP) was measured in the right arm, in duplicates with 5min intervals, using an aneroid sphygmomanometer, and the average was calculated, after the participants rested for 5min in a seated position. Fasting blood glucose and lipid profile were analyzed using Cholestech LDX analyzer. Height and weight were measured to calculate body mass index (BMI). 3. The prevalence of normotension, prehypertension, and hypertension were 21/41 (w51%), 17/41 (w41%) and 3/41 (w8%), respectively. Normotension vs. prehypertension (Mean SD) for systolic BP (109.4 6.6 vs. 126.8 7.4mmHg; p<0.001), diastolic BP (71.8 4.2 vs. 82.3 3.1mmHg; p<0.001), weight (74.9 13.1 vs. 86.9 18.5kg; p1⁄40.026), BMI (26.8 2.8 vs. 30.0 6.6 kg/m2; p1⁄40.040) and fasting blood glucose (94.8 6.1 vs. 102.8 10.1 mg/dL; p1⁄40.004). There were no statistically significant differences in lipid profiles between the groups. 4. Our preliminary findings indicate that prehypertension has high prevalence (41%) in the University workforce. Compared to normotensive participants, prehypertensives were more likely to be obese and have impaired fasting glucose. This suggests that prehypertension is associated with other CV risk factors and heightens CV risk of the University employees. Therefore, early and effective lifestyle modification strategies may help to decrease long-term CV risk.

Comparison of cardiovascular risk factors between prehypertension and normotension in a university workplace setting

1. Many organizations are exploring innovative employee wellness programs to improve workforce health. Prehypertension is a risk factor for the development of hypertension and an independent risk factor for cardiovascular (CV) disease. Hypertension is highly prevalent and leads to increased healthcare costs, but literature on the prevalence of prehypertension in the workplace is lacking. The purpose of our study was to evaluate prevalence of prehypertension and assess CV risk factors among the University’s staff. 2. Participants were recruited via campus-wide email sent to all employees. A health history questionnaire and physical activity questionnaire (PAR-Q) was used to exclude participants with any self-reported chronic illnesses, including any form of CV disease, diabetes, lung, liver or renal disease. Forty one (11Males/30Females, 50 6yrs) apparently healthy nonsmoking but sedentary participants were included. Office blood pressure (BP) was measured in the right arm, in duplicates with 5min intervals, using an aneroid sphygmomanometer, and the average was calculated, after the participants rested for 5min in a seated position. Fasting blood glucose and lipid profile were analyzed using Cholestech LDX analyzer. Height and weight were measured to calculate body mass index (BMI). 3. The prevalence of normotension, prehypertension, and hypertension were 21/41 (w51%), 17/41 (w41%) and 3/41 (w8%), respectively. Normotension vs. prehypertension (Mean SD) for systolic BP (109.4 6.6 vs. 126.8 7.4mmHg; p<0.001), diastolic BP (71.8 4.2 vs. 82.3 3.1mmHg; p<0.001), weight (74.9 13.1 vs. 86.9 18.5kg; p1⁄40.026), BMI (26.8 2.8 vs. 30.0 6.6 kg/m2; p1⁄40.040) and fasting blood glucose (94.8 6.1 vs. 102.8 10.1 mg/dL; p1⁄40.004). There were no statistically significant differences in lipid profiles between the groups. 4. Our preliminary findings indicate that prehypertension has high prevalence (41%) in the University workforce. Compared to normotensive participants, prehypertensives were more likely to be obese and have impaired fasting glucose. This suggests that prehypertension is associated with other CV risk factors and heightens CV risk of the University employees. Therefore, early and effective lifestyle modification strategies may help to decrease long-term CV risk.

Lifestyle factors in hypertension drug research: systematic analysis of articles in a leading cochrane report.

Established standards for first-line hypertension management include lifestyle modification and behavior change. The degree to which and how lifestyle modification is systematically integrated into studies of first-line drug management for hypertension is of methodological and clinical relevance. This study systematically reviewed the methodology of articles from a recent Cochrane review that had been designed to inform first-line medical treatment of hypertension and was representative of high quality established clinical trials in the field. Source articles (n = 34) were systematically reviewed for lifestyle interventions including smoking cessation, diet, weight loss, physical activity and exercise, stress reduction, and moderate alcohol consumption. 54% of articles did not mention lifestyle modification; 46% contained nonspecific descriptions of interventions. We contend that hypertension management research trials (including drug studies) need to elucidate the benefits and risks of drug-lifestyle interaction, to support the priority of lifestyle modification, and that lifestyle modification, rather than drugs, is seen by patients and the public as a priority for health professionals. The inclusion of lifestyle modification strategies in research designs for hypertension drug trials could enhance current research, from trial efficacy to clinical outcome effectiveness, and align hypertension best practices of a range of health professionals with evidence-based knowledge translation.

Challenges For The Future Of Complementary And Integrative Care.

It is estimated that over 40% of American people integrate one or more of these unconventional health practices, while many individuals worldwide also explore multidimensional approaches as treatment for chronic conditions beyond pharmacological therapies. For example, chronic conditions such as arthritis are among the top 6 conditions for complementary and alternative medicine use [1]. In fact, overwhelming evidence suggests that specific elements of complementary, alternative and integrative medicine, including mind-body approaches and improved lifestyle-modification strategies, may prevent disease, relieve pain, and enhance both physical and psychological health [28]. Individualized treatment that embraces an integrative approach may positively affect the progression of disease while simultaneously decreasing morbidity.

Translation and Validation of the Dietary Approaches to Stop Hypertension for Koreans Intervention

Lifestyle modification strategies such as adoption of the Dietary Approaches to Stop Hypertension (DASH) diet are now recognized as an integral part of high blood pressure (HBP) management. Although the high prevalence of HBP among Korean Americans (KAs) is well documented, few dietary interventions have been implemented in this population, in part because of a lack of culturally relevant nutrition education guidelines. Translating and testing the efficacy of culturally relevant dietary recommendations using a well-established dietary guideline such as DASH are imperative for promoting better cardiovascular health for this high-risk cultural group. The aims of this study were to systematically translate and validate a culturally modified DASH for Koreans (K-DASH) and obtain preliminary evidence of efficacy. A 2-step approach of intervention translation and efficacy testing, together with close adherence to principles of community-based participatory research, was used to maximize community input. A 1-group pre-post design with 24-hour urine and 24-hour ambulatory blood pressure monitoring comparisons was used to test the initial feasibility and efficacy of the K-DASH intervention. A total of 28 KAs with HBP participated in a 10-week dietary intervention consisting of group education sessions and individual counseling. Both systolic blood pressure and diastolic blood pressure, as measured by ambulatory blood pressure monitoring, were significantly decreased at postintervention evaluation (systolic blood pressure, -4.5 mm Hg; diastolic blood pressure, -2.6 mm Hg; P < .05). Serum low-density lipoprotein cholesterol was significantly decreased (-7.3 mg/dL; P < .05). Serum potassium and ascorbic acid levels were also improved in the reference range. Urine potassium level was significantly increased, supporting increased fruit and vegetable consumption. This pilot study has (a) demonstrated that a cultural adaptation of DASH using community-based participatory research methodology produced a culturally relevant and efficacious dietary intervention for the KAs with HBP and (b) provided strong preliminary evidence for the efficacy of the K-DASH intervention in reducing HBP in hypertensive KAs.

Anthropometric differences among natives of Abuja living in urban and rural communities: correlations with other cardiovascular risk factors

BackgroundThere is an increase of obesity and other cardiovascular risk factors worldwide, but especially in developing countries where multifaceted transitions are occurring. There is need for more evidence for the cardio-metabolic effect of changing lifestyles and urbanization in Nigeria. This study aimed at defining rural–urban differences in anthropometric parameters in two Nigerian communities of the same ancestral origin and to determine the cardiovascular risk correlates of these anthropometric measurements. This was a cross-sectional epidemiological study using stratified cluster sampling method. We studied 335 and 332 urban and rural dwellers respectively. A complete cardiovascular profile as well as anthropometric measurements was compared between the two populations.ResultsAll anthropometric indices considered in this study (weight, BMI, waist circumference, waist circumference/height ratio, abdominal height; biceps, triceps, sub-scapular, abdominal, superior iliac skinfold thicknesses) were significantly higher in urban than in the rural population (p = <0.001). Overweight, obesity and hypertension were significantly prevalent among the urban population (p = <0.001) while there was no significant difference in the prevalence of dyslipidaemia (p = 0.096) and diabetes (p = 0.083) between the two cohorts. Females tend to have a higher chance of obesity than males although there was no gender difference in waist circumference and central skin fold thickness in the rural population. Age was the significant predictor of systolic blood pressure among the rural (R2 = 0.157, β = 0.258, p = 0.016) and urban female population (R2 = 0.201, β = 0.351, p = <0.001) while Abdominal height (R2 = 0.16, β = 0.281, p = 0.001) and waist circumference (R2 = 0.064 β = 0.064, p = .003) were predictors of systolic blood pressure in urban and rural men respectively.ConclusionAnthropometric indices were significantly higher among the urban than the rural populations. Cardiovascular risks were equally more prevalent among the urban population. Appropriate health education and lifestyle modification strategies may reduce the increased burden of cardiovascular risk factors associated with rural–urban migration.

The integration of diet and nutrition lifestyle management strategies into the dental office visit for diabetes risk reduction and management

The incidence of diabetes and prediabetes in the United States continues to increase. Oral health care professionals (OHCPs) play a role in diabetes screening and education. The author presents and explores diet and lifestyle management strategies OHCPs can provide to patients who have prediabetes and type 2 diabetes mellitus (T2DM). Modest weight loss (7 percent of body weight) and regular physical activity (150 minutes per week) are important in the prevention and treatment of prediabetes and T2DM. Following a carbohydrate-controlled diet that is limited in fat and cholesterol will help patients with T2DM achieve normoglycemia and reduce their risk of developing diabetes complications. The importance of using these strategies can be reinforced by OHCPs during office visits. OHCPs can collaborate with registered dietitians to improve the outcome of oral health through diabetes prevention, education and management. Being familiar with risk factors for T2DM and recommendations for lifestyle modification strategies to prevent T2DM may help OHCPs educate patients and refer them for appropriate treatment and therapy.

Excess maternal weight gain during pregnancy is associated with overweight/obesity in offspring at age 16 years, but maternal pre-pregnancy obesity has a greater effect

Implications for practice and research: Children of mothers who are obese prior to pregnancy, and/or gain excessive weight in early pregnancy, carry increased risk for obesity in adolescence. Obese women...

191 SIX-MONTHS OF LIFESTYLE INTERVENTION IMPROVES FLOW MEDIATED DILATION IN SEDENTARY AFRICAN AMERICAN SUBJECTS

Background: African-Americans have increased morbidity and mortality rates from cardiovascular disease (CVD). Diminished flow mediated dilation (FMD) is associated with CVD. Our study aimed to assess the efficacy of 6-months of diet and exercise intervention on FMD in African-American subjects. Methods: African-American subjects (N = 20, 17F/3 M, 53 ± 6yrs) who were sedentary, non-diabetic, non-smoking, free of CVD and not on medication completed 6-months of supervised aerobic exercise training (3 days/week, 65% of VO2max, 40 min/session). 6-weeks prior to initiation of exercise training, subjects underwent dietary stabilization under the supervision of a registered dietician and were required to strictly follow an AHA low-fat, low-salt diet for the duration of the study which was regularly monitored through a 3 days/week diet log. %FMD was defined as percentage change in brachial artery diameter at 1 min after reactive hyperemia, and was evaluated by a 7.5 MHz transducer of HP SONOS 5500. Results: FMD data were checked for normality of distribution with the Wilks’ Shapiro test. On repeated measures ANCOVA, the mean %FMD were statistically significantly different (F (1, 16) = 5.582, P = 0.031) between before vs. after training (Mean ± SEM; 6.4 ± 2.6% vs. 9.4 ± 2.1%), after adjusting for changed variables (BMI, total-cholesterol and C-reactive protein) as covariates. Conclusion: Our study showed that 6-months of diet and exercise intervention enhanced FMD by ∼32% in sedentary African-Americans. Improvement in endothelial-dependent FMD may contribute to the cardiovascular health benefits of lifestyle modification strategies in preventing CVD.

Abstract 128: Six Months of Lifestyle Intervention Reduces Carotid Intima-media Thickness in African Merican Adults

Background: African Americans tend to have greater carotid intima-media thickness (IMT), and are 60% more likely to have a stroke than Caucasians. Data on the effects of lifestyle intervention on carotid IMT in African Americans does not exist. The aim of our study was to assess the efficacy of 6 months of diet and exercise intervention on carotid IMT in sedentary African American adults. Methods: Nineteen African American subjects (15F/4M, 52 ± 6yrs) who were sedentary, non smoking, non diabetic, free of cardiovascular disease, not on antihypertensive or cholesterol medications underwent 6 weeks of dietary counseling under the supervision of a registered dietician and were required to follow an AHA low fat, low salt diet for the duration of the study. Compliance was assessed by a diet log (3 days/week). Subjects completed 6 months of supervised aerobic exercise training (3 days/week, 40 minutes/session at 65% of their estimated VO 2max ). Common carotid artery IMT was assessed using high resolution ultrasonography. Results: At baseline, IMT significantly correlated with age (r = 0.58, P = 0.003) and total cholesterol (r = 0.41, P = 0.04). At 6 months, there were significant changes in basal metabolic index (ΔBMI, -0.83 kg/m 2 , P = 0.01); Δtriglycerides (-13.7 mg/dL, P = 0.03) and Δfasting glucose (-7.2 mg/dL, P = 0.01). On repeated measures ANCOVA, the mean IMT were statistically significantly different (F (1, 15) = 7.999, P = 0.013) between before vs. after training (Mean ± SD; 0.617 ± 0.092mm vs. 0.572 ± 0.068mm), after adjusting for changed variables (ΔBMI, Δtotal cholesterol and Δmean arterial pressure) as covariates. Conclusion: Our preliminary study showed that 6 months of diet and exercise intervention reduced carotid IMT by ∼7.3% and improved the cardio-metabolic profile in sedentary African Americans. Reduction in IMT from early and effective lifestyle modification strategies may help to improve cerebrovascular health and prevent stroke in this at-risk stroke population.

Abstract 2205: Effects of a Stroke Awareness Promotion Intervention for Community Living Adults with Prehypertension in Korea.

Introduction : People with prehypertension that is systolic blood pressure (BP) over 120 mmHg or diastolic BP over 80 mmHg are known to be at increased risk for stroke compared to normotensive people. For primary prevention of stroke, community-level interventions that equip prehypertensive individuals with relevant knowledge and self-care strategies are of paramount importance, and may lead to substantial reduction in morbidity and economic burden due to stroke. This study assessed effectiveness of an educational intervention utilizing individualized risk assessment and highlighting importance of self-initiated lifestyle modifications on stroke awareness and compliance with self-BP monitoring and healthy lifestyle for stroke prevention. Methods : This was a single blinded, randomized, pretest, posttest study with 47 participants (23 in the intervention group and 24 in the control group) recruited by a convenience sampling in community culture centers and churches in two urban areas. The intervention consisted of 3- weekly, 2-hour face to face educational sessions accompanied by an individualized counseling session on individual stroke risk assessment using Framingham stroke risk profile; and 2 booster sessions by telephone calls. The intervention aimed to improve participants' awareness about stroke and their own risk of stroke; and active involvement in self-care management of their own health as primary prevention of stroke. All participants completed pretest, 4 weeks and 12 weeks measurements after intervention including stroke awareness, self-BP monitoring and lifestyle modification of regular physical activity and low-fat diet. Data were analyzed using descriptive statistics, χ 2 test, two sample and paired t-test, and repeated measures ANOVA with PASW statistics 18.0. Results : Mean age of experimental group participants was 46.5 (standard deviation (SD) 10) and of control group, participants, 48.3 (SD 18). Mean BPs in experimental and control groups were 123.8 (SD 12.1) and 125.7 (SD 13.1) mmHg, respectively. After the intervention, significant improvements were found in the experimental group for stroke awareness (p=.001), self-BP monitoring and record keeping (P &lt; .001), and lifestyle modification of regular physical activity and low-fat diet (p =.017). Effects of stroke awareness and self- BP monitoring were sustained over time. Conclusions : Results indicate effectiveness of a stroke prevention intervention to promote awareness of the key risk factors and their control for people with prehypertension on taking responsibility for their own self-care behavior on a daily basis. Further studies are warranted to refine and validate intervention strategies for sustained lifestyle modification.