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

Daubenmier, Jennifer; Weidner, Gerdi; Sumner, Michael D.; Mendell, Nancy R.; Merritt-Worden, Terri; Studley, Joli; Ornish, Dean

doi:10.1207/s15324796abm3301_7

Cited by 137 publications

(112 citation statements)

References 54 publications

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“…These interventions follow the paradigm that because unhealthy lifestyle behaviours cluster together [50][51], interventions to reduce overall risk are more relevant and beneficial than individual approaches [51][52][53]. For example, research shows that 99% of smokers have additional unhealthy lifestyle behaviour such as unhealthy diet, alcohol consumption, or insufficient physical activity [50][51].…”

Section: Discussionmentioning

confidence: 99%

“…For example, research shows that 99% of smokers have additional unhealthy lifestyle behaviour such as unhealthy diet, alcohol consumption, or insufficient physical activity [50][51]. Moreover, evidence in the heart disease literature speaks to the benefits of multi-modal interventions focusing on diet, exercise, and stress management at improving coronary risk and psychosocial factors [52]. At the individual risk factor level, our results show that self-management interventions have a significant effect at improving medication adherence.…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review and Meta-Analysis on Self-Management for Improving Risk Factor Control in Stroke Patients

2016

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Purpose-The aim of this review was to describe the self-management interventions used to improve risk factor control in stroke patients, and quantitatively assess their effects on: 1) overall risk factor control from lifestyle behaviour (i.e. physical activity, diet and nutrition, stress management, smoking, alcohol, and medication adherence), and medical risk factors (i.e. blood pressure, cholesterol, blood glucose); and 2) individual risk factors (e.g. physical activity, blood pressure, cholesterol).Methods-We systematically searched the PubMed, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews databases to September 2015 to identify relevant randomized controlled trials investigating self-management to improve stroke risk factors. The selfmanagement interventions were qualitatively described, and the data included in meta-analyses.Results-Fourteen studies were included for review. The model estimating an effect averaged across all stroke risk factors was not significant, but became significant when four low quality studies were removed (SMD = 0.10 [95% CI = 0.02 to 0.17], I 2 = 0%, p=0.01). Subgroup analyses revealed a significant effect of self-management interventions on lifestyle behaviour risk factors (SMD = 0.15 [95% CI = 0.04 to 0.25], I 2 = 0%, p=0.007) but not medical risk factors. Medication adherence was the only individual risk factor that self-management interventions significantly improved (SMD = 0.31 [95% CI = 0.07 to 0.56], I 2 = 0%, p=0.01).Conclusions-Self-management interventions appear to be effective at improving overall risk factor control, however, more high quality research is needed to corroborate this observation. SelfCorresponding author: Janice J. Eng, PhD, BSc(PT/OT), Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Tel: 604-714-4108; Fax: 604-714-4168; janice.eng@ubc.ca. Compliance with Ethical StandardsConflict of Interest: BMS declares that he has no conflict of interest. AJK declares that she has no conflict of interest. JJE declares that she has no conflict of interest. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: Informed consent was obtained from all individual participants included in the study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis on Self-Management for Improving Risk Factor Control in Stroke Patients

2016

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“…Stress exposure also increases unhealthy coping behaviors such as comfort eating, smoking, excessive alcohol intake, pharmaceutical abuse and increased sedentary activity. These behaviors exacerbate psychological and physiological stress-related symptoms and increase risk for disease (9)(10)(11)(12)(13)(14)(15). There is reason to believe health disparities also contribute to stress resulting in differences in trust and engagement in the health care system (16).…”

Section: Introductionmentioning

confidence: 99%

Formative evaluation on cultural tailoring breathing awareness meditation smartphone apps to reduce stress and blood pressure

Sieverdes

Adams

Nemeth

et al. 2017

mHealth

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Background: Chronic stress is an independent risk factor for essential hypertension (EH), cardiovascular disease (CVD), and is sometimes confronted by mal-adaptive coping behaviors (e.g., stress eating, excessive alcohol consumption, etc.). Pre-essential hypertension (preEH) is the leading predictor of future EH status.Breathing awareness meditation (BAM) can result in clinically beneficial blood pressure (BP) reductions, though face-to-face sessions presents barriers to reach those in need. The purpose of this study was to identify if a culturally tailored approach is needed in the design and preferences between groups of preEH African American and White adults toward using a smartphone BAM app, the Tension Tamer (TT) app.Methods: TT includes audio delivered BAM instructions, real-time heart rate, feedback graphs and motivational reinforcement text messaging. Questionnaires and two focus groups each of African American and White adults, [n=34, mean age =43.1 years, (SD 13.8 years), 44.1% African American] were conducted to understand stress, EH knowledge, app usage along with feedback from a hands-on demonstration of TT.Grounded theory using NVivo 10 was used to develop themes and combined with the questionnaires in the analysis.Results: No racial differences were found in the analysis including app use scenarios, preferences, knowledge, technology use or the attitudes and acceptance toward mobile health (mHealth) programs.Reported stress was high for African Americans [PSS-4: mean 6.87 (SD 3.3) versus mean 4.56 (SD 2.6); P=0.03]. Four main themes were found: (I) stress was pervasive; (II) coping strategies were both positive and negative; (III) BAM training was easy to incorporated; and (IV) tracking stress responses was useful.Responses suggest that additional personalization of app interfaces may drive ownership and adherence to protocols. Measures and reports of heart rate monitoring while in session were favorably viewed with low issues with confidentiality or trust issues on collected session data. Conclusions:Results suggest that a culturally tailored approach may be unnecessary in the design of BAM apps.Further investigation is warranted for other racial groups, age ranges, and disease conditions.

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“…Evidence has shown that overweight, eating behaviors and physical activity affect most cardiometabolic variables associated with cardiovascular risk factors, such as serum lipids, blood pressure, waist circumference and insulin resistance (2).…”

Section: Introductionmentioning

confidence: 99%

The association between water intake, body composition and cardiometabolic factors among children - The Cuenca study

et al. 2016

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Introduction: Beverage consumption and its possible association with current obesity epidemic and metabolic syndrome is under investigation in recent years, however water intake is probably the most underestimated of all beverages and could play an important role. Objective: The aim of this study was to examine the association between water intake, body composition and cardiometabolic factors in a sample of Spanish children. Methods: A cross-sectional study was conducted in 366 schoolchildren (53.5% girls) aged 9-11 years from the province of Cuenca in Spain. Data of anthropometrics, body composition, cardiometabolic risk factors and cardiorespiratory fi tness variables were collected. Beverage consumption was assessed using two non-consecutive 24 h dietary recalls. Results: We found an inverse association between the consumption of water (ml)/kg per weight with BMI, body fat, fat-free mass, waist circumference, insulin levels, HOMA-IR (p < 0.001), and with arterial pressure parameters, systolic (p < 0.010) and diastolic blood pressure (p < 0.028), and mean arterial pressure (p < 0.012), as well as direct associations with HDL cholesterol (p < 0.001). In ANCOVA analyses, children who drank less water (ml)/kg per weight, had higher levels of LDL cholesterol (p < 0.050) and lower levels of HDL cholesterol (p < 0.042), and overweight-obesity subjects drank less water (ml)/kg per weight than normal peers (p < 0.011). Besides, children with lower levels of HDL cholesterol and higher levels of triglycerides and blood pressure had less water intake as a beverage. Finally, children who drank less water from beverages had high levels of LDL cholesterol. Conclusions: Higher consumption of water (ml)/kg per weight was negatively associated with BMI, body fat, fat-free mass, waist circumference, insulin levels, HOMA-IR, and positively with HDL cholesterol in children independently of age, sex and cardiorespiratory fi tness. In addition, overweight-obese children drank less water (ml)/kg per weight than normoweight ones. Therefore, water consumption is associated with numerous health benefi ts and its adequate intake could contribute to prevent obesity and metabolic syndrome in childhood.

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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

Abstract: 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.

Cited by 137 publications

References 54 publications

A Systematic Review and Meta-Analysis on Self-Management for Improving Risk Factor Control in Stroke Patients

A Systematic Review and Meta-Analysis on Self-Management for Improving Risk Factor Control in Stroke Patients

Formative evaluation on cultural tailoring breathing awareness meditation smartphone apps to reduce stress and blood pressure

The association between water intake, body composition and cardiometabolic factors among children - The Cuenca study

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