Why focus on lifestyle?
Therapeutic lifestyle changes involving diet, exercise and stress reduction have been shown to improve longevity and reduce risk for chronic disease.
In the Intervene phase of the AIM to Prevent program, the South Asian Heart Center provides expert counseling focused on personalized lifestyle changes. We know that lifestyle changes are easier said than done. That is the reason why, in the Manage phase of AIM to Prevent, the Center has trained heart health coaches to help participants make and sustain lifestyle habits. All aspects of the AIM to Prevent program, from advanced screening to lifestyle coaching are evidence-based.
| Study |
Alameda Seven
1
Health habits of U.S. adults, 1985: the "Alameda 7" revisited. Schoenborn CA. Public Health Rep. 1986 Nov-Dec;101(6):571-80. PMID: 3097736
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Swedish Study
2
Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men: A Population-Based Prospective Cohort Study. Akesson A, Larsson SC, Discacciati A, Wolk A. J Am Coll Cardiol. 2014 Sep 30;64(13):1299-306. doi: 10.1016/j.jacc.2014.06.1190. PMID: 25257629
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INTERHEART
3
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Lancet. 2004 Sep 11-17;364(9438):937-52. PMID: 15364185
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|---|---|---|---|
| Study Design |
Study of 7000 people in Alameda County, CA over 25 years found seven lifestyle habits that promote successful aging. Going from three to seven of these habits extends longevity by eleven years. |
Study of 20,721 healthy individuals over 11 years, showed that a combination of healthy diet and lifestyle practices has a significant impact on primary prevention of myocardial infarction (MI). |
Large case-control study of acute myocardial infarction (MI) in 52 countries with 15,152 cases and 14,820 controls showed that nine clinical and lifestyle factors accounted for 90% of heart attacks. |
| Key Findings |
7 healthy lifestyle habits promote longevity |
80% of heart attacks preventable with positive lifestyle habits alone |
6 of 9 factors that explain heart attacks pertain to poor lifestyle |
 Sleep |
Adequate 7-8 hours a night | ||
 Stress |
Psychological stress | ||
 Obesity |
Maintaining recommended weight |
Manage abdominal adiposity (waist circumference < 95 cm) |
Obesity |
 Diet |
Eating breakfast regularly Not snacking |
Healthy diet | Poor vegetable and fruit intake |
 Exercise |
Regular vigorous activity (>3kcal/kg/day) |
Being physically active walk/bike ≥40 m/day & exercise ≥ 1 h/wk |
Sedentary lifestyle |
 Smoking |
Not smoking | Not smoking | Smoking |
 Alcohol |
None/moderate alcohol | Moderate alcohol 10-30g a day | None/excessive alcohol consumption |
| Study |
Alameda Seven
1
Health habits of U.S. adults, 1985: the "Alameda 7" revisited. Schoenborn CA. Public Health Rep. 1986 Nov-Dec;101(6):571-80. PMID: 3097736
|
|---|---|
| Study Design |
Study of 7000 people in Alameda County, CA over 25 years found seven lifestyle habits that promote successful aging. Going from three to seven of these habits extends longevity by eleven years. |
| Key Findings |
7 healthy lifestyle habits promote longevity |
|
Sleep |
Adequate 7-8 hours a night |
|
Stress |
|
|
Obesity |
Maintaining recommended weight |
|
Diet |
Eating breakfast regularly Not snacking |
|
Exercise |
Regular vigorous activity (>3kcal/kg/day) |
|
Smoking |
Not smoking |
|
Alcohol |
None/moderate alcohol |
| Study |
Swedish Study
2
Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men: A Population-Based Prospective Cohort Study. Akesson A, Larsson SC, Discacciati A, Wolk A. J Am Coll Cardiol. 2014 Sep 30;64(13):1299-306. doi: 10.1016/j.jacc.2014.06.1190. PMID: 25257629
|
|---|---|
| Study Design | Study of 20,721 healthy individuals over 11 years, showed that a combination of healthy diet and lifestyle practices has a significant impact on primary prevention of myocardial infarction (MI). |
| Key Findings |
80% of heart attacks preventable with positive lifestyle habits alone |
|
Sleep |
|
|
Stress |
|
|
Obesity |
Manage abdominal adiposity (waist circumference < 95 cm) |
|
Diet |
Healthy diet |
|
Exercise |
Being physically active walk/bike ≥40 m/day & exercise ≥ 1 h/wk |
|
Smoking |
Not smoking |
|
Alcohol |
Moderate alcohol 10-30g a day |
| Study |
INTERHEART
3
Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Lancet. 2004 Sep 11-17;364(9438):937-52. PMID: 15364185
|
|---|---|
| Study Design |
Large case-control study of acute myocardial infarction (MI) in 52 countries with 15,152 cases and 14,820 controls showed that nine clinical and lifestyle factors accounted for 90% of heart attacks. |
| Key Findings |
6 of 9 factors that explain heart attacks pertain to poor lifestyle |
|
Sleep |
|
|
Stress |
Psychological stress |
|
Obesity |
Obesity |
|
Diet |
Poor vegetable and fruit intake |
|
Exercise |
Sedentary lifestyle |
|
Smoking |
Smoking |
|
Alcohol |
None/excessive alcohol consumption |
Stress is defined as feeling irritable, anxious, or as having sleep difficulties as a result of conditions at work or at home. Psychological stress results from the inability of an individual to creatively overcome challenges. Physiological stress results from the inability of the body to maintain balance or steady state.
Studies on stress have shown a strong correlation with increase in risk for heart attacks, dyslipidemia, inflammation and obesity.
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Chronic stress is linked to a 2.67 fold increase in risk for heart attacks4Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study.Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, Blackett KN, Sitthi-amorn C, Sato H, Yusuf S; INTERHEART investigators. Lancet.2004 Sep 11-17;364(9438):953-62. PMID: 15364186
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Work stress is associated with atherogenic lipids and elevated fibrinogen5Chronic work stress is associated with atherogenic lipids and elevated fibrinogen in middle-aged men. Siegrist J, Peter R, Cremer P, Seidel D. J Intern Med. 1997 Aug;242(2):149-56. PMID: 9279292
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Stress exaggerates diet-induced obesity through a mechanism in the abdominal adipose tissue6Neuropeptide Y acts directly in the periphery on fat tissue and mediates stress-induced obesity and metabolic syndrome. Kuo LE, Kitlinska JB, Tilan JU, Li L, Baker SB, Johnson MD, Lee EW, Burnett MS, Fricke ST, Kvetnansky R, Herzog H, Zukowska Z. Nat Med. 2007 Jul;13(7):803-11. Epub 2007 Jul 1. Erratum in: Nat Med. 2007 Sep;13(9):1120. PMID: 17603492
The key to prevention of heart attacks and diabetes is early and comprehensive assessment followed by personalized lifestyle intervention. The Alameda Seven, INTERHEART, and the Swedish prevention study, illustrate the benefits of good lifestyle behaviors and the disease consequences of poor lifestyle.
Alameda Seven, Swedish prevention study, and INTERHEART illustrate the benefits of good lifestyle behaviors and the disease consequences of poor lifestyle.
Derived from hallmark studies, these therapeutic components are most relevant for risk reduction in South Asians and are, therefore, the key offering in the AIM to Prevent program.
Other habits like smoking and excessive alcohol consumption, are also important to reduce risk. The South Asian Heart Center refers participants who seek help with these habits to the many dedicated resources available within the community.
A growing body of scientific research supports the health benefits of meditation. Meditation is a simple mind-body process which leads to deep relaxation and stress reduction. Meditation helps in managing chronic conditions such as heart disease, high blood pressure, cancer, and depression.
Goal: Meditate for 20 minutes, twice daily
Meditation is a sit-down, eyes-closed, conscious technique, practiced in one of the following ways: Concentration where you focus on an object, contemplation where you observe the object, and transcendental where you lose the object. The South Asian Heart Center suggests you develop the habit of meditation, and recommends Transcendental Meditation for stress reduction because of evidence showing its effectiveness in addressing cardiovascular mortality.
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Restful Sleep and Restful Alertness (South Asian Heart Center TLC Series)
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Stress Reduction. (South Asian Heart Center)
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The TM Experience: How TM works
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An in-depth introduction to the Transcendental Meditation® technique (by Bob Roth, President of the David Lynch Foundation)
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Single most important thing you can do to manage your stress. (DocMikeEvans)
Exercise is structured physical activity and falls into the following categories: aerobic, strength, and balance and flexibility. Unstructured physical activity such as climbing stairs, gardening, playing with children, also counts. It is important to include the different types of exercise into your daily practice.
Goal: 150 minutes of physical activity per week.
It is not necessary to have a gym membership to receive benefits of exercise. Home-based programs do in fact have greater adherence than gym-based programs.
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MYFITNESSPAL
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MAPMYWALK
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RUNKEEPER
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NIKE RUN
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Get Moving
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Exercise to lower your triglycerides. (Mayo Clinic)
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23 and ½ hours: What is the single best thing we can do for our health? (DocMikeEvans)
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Benefits of Physical Activity. (Centers for Disease Control and Prevention)
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Recommendations for Physical Activity. (National Heart Lung and Blood Institute)
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#chalechalo A way for South Asian Heart Center participants to promote physical activity in their lives
The NIDDK's Diabetes Prevention Program results indicate that millions of high-risk individuals can delay or avoid developing Type 2 diabetes by losing weight through regular physical activity. Weight loss and physical activity lower the risk of diabetes by improving the body's ability to use insulin and process glucose.
According to the National Heart, Lung and Blood Institute (NHLBI), adults need to do at least 150 minutes of moderate-intensity aerobic activity on a weekly basis to realize health benefits.
1 hour free orientation and beginner physical training class, plus a 12-week training program at a discounted rate with exercise physiologists
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Daly City, CA, Free orientation and discounted 12-week training program.
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Milpitas, CA, Free orientation and discounted 12-week training program.
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Sunnyvale, CA. Free orientation and discounted 12-week training program.
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from Mona Khan Company. Instructor-led, free orientation for a fun Bollywood style aerobic workout and discounted 8-session program.
Good nutrition is another key lifestyle ingredient in the prevention of heart disease and diabetes. Sensible selections and substitutions to the traditional diet may be necessary to make it heart healthy.
Goal: 2 fistfuls of vegetables/day, 1 fistful of fruit/day, 12 nuts/day, zero sugared drinks.
The South Asian Heart Center encourages high-fiber, plant based foods, limited consumption of refined carbohydrates, animal fats and processed foods, and discourages sweet beverages and fried snacks.
The Center recommends at least 3 sit down meals per day, inclusive of breakfast, and suggests consuming a fistful of fruit, 12 nuts, and a minimum of two fistfuls of vegetables per day.
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MYFITNESSPAL
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SEAFOODWATCH
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Heartier Choices Guidelines. (South Asian Heart Center)
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Carbohydrate Counting for Traditional Indian and Pakistani Foods. (SJSU)
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Cooking from the Heart. (South Asian Heart Center)
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Nutrition Guide to Optimal Health - 1. (AAPI USA)
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Nutrition Guide to Optimal Health - 2. (AAPI USA)
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Healthy Eating Handbook. (Whole Foods)
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10 Tips to a Great Plate. (choosemyplate.gov)
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Simple Steps to preventing Diabetes. (Harvard)
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Heart Healthy Diet Tips. (Helpguide.org)
The Center's recommendations on dietary changes are based on evidence behind the importance of increasing consumption of vegetables and fruits, limiting intake of fats and reducing simple carbohydrates to decrease risk of heart disease. Evidence
Sleep is a naturally recurring state characterized by reduced or absent consciousness, relatively suspended sensory activity, and inactivity of most voluntary muscles. At the same time, sleep is also a heightened anabolic state, accentuating the growth and rejuvenation of the immune, nervous, skeletal and muscular systems.
Goal: 7-8 hours per night.
The consequences of insufficient or fragmented sleep are neurobehavioral and performance deficits in addition to cardio-metabolic problems like, obesity, Type 2 DM, and hypertension, which in turn lead to increased morbidity/mortality and a decreased quality of life.
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Restful Sleep and Restful Alertness (South Asian Heart Center TLC Series)
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How much sleep do you need? (Helpguide.org)
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Natural Patterns of Sleep (Harvard)
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Brain Basics: Understanding Sleep (NINDS)
During sleep, the brain is still active, performing a variety of biological maintenance tasks that keeps the body performing in peak condition. Sleep occurs in a series of recurring sleep stages that are very different from one another. From deep sleep to dreaming sleep, they are all vital for your body and mind. Without enough hours of restful sleep, you will not feel restored and recharged, and are bound to feel stressed and ill-prepared to meet the challenges of the day.
Studies on sleep have shown the impact of sleep duration (both deprivation and excess) and disorders on diabetes, hypertension, obesity, coronary artery disease and mortality.
A unique aspect of South Asian Heart Center's AIM to Prevent program is the use of trained health coaches to engage actively with participants pursuing therapeutic lifestyle changes. Unlike traditional methods where health care providers merely recommend behavior modifications, the Center's coaches get better compliance because they gauge the readiness of participants, understand their reasons for ambivalence, and encourage behavioral change one step at a time.
Heart health coaching is optional to participants after completion of comprehensive screening, individualized risk assessment and behavioral recommendations. Coaches contact enrolled participants regularly for the first year (and annually thereafter) to provide encouragement with behavior change, troubleshoot challenges and assess adherence.
What is unique about the Center's personalized and culturally sensitive coaching and case management program is that the coaches are South Asian community volunteers who undergo specific training. Their effectiveness stems from their ability to relate well to the participants' needs based on their own personal experience, or that of friends and family, with the epidemics, and to understand the challenges of lifestyle changes within the cultural context. Using volunteers to coach participants keeps program costs under control and makes it possible for a dedicated program like the Center's, to scale and have greater impact.
