Amy McNeil

The Evolution of Health Literacy and Communication: Introducing Health Harmonics

In the last fifteen years, research on the link between health literacy (HL) and poor health outcomes has resulted in mixed results. Since 2004, concerted effort has been made to improve not only practitioner training, but also the HL of the United States population. And yet, to this day, only 12% of adults are considered health literate. Along with increased awareness of HL, creation of strategies and initiatives, such as shared decision, plain language, and decision aides, have improved patient-centered approaches to facilitating a persons ability to obtain and understand health information to the extent that they are able to affect a level of health autonomy; efforts have clearly fallen short given that during the same amount of time, the unhealthy living phenotype and chronic disease burden persists globally. In an effort to expand and leverage the work of shared decision making and communication models that include all forms of literacy (e.g., food, physical, emotional, financial, etc.) that make up the broad term of HL, we introduce the concept of harmonics as a framework to explore the bi-directional transaction between a patient and a practitioner with the goal of constructing meaning to assist in maintaining or improving ones health.

Public park spaces as a platform to promote healthy living: introducing a HealthPark concept

The concept of Healthy Living (HL) as a primary medical intervention continues to gain traction, and rightfully so. Being physically active, consuming a nutritious diet, not smoking and maintaining an appropriate body weight constitute the HL polypill, the foundation of HL medicine (HLM). Daily use of the HL polypill, working toward optimal dosages, portends profound health benefits, substantially reducing the risk of chronic disease [i.e., cardiovascular disease (CVD), pulmonary disease, metabolic syndromes, certain cancers, etc.] and associated adverse health consequences. To be effective and proactive, our healthcare system must rethink where its primary intervention, HLM, is delivered. Waiting for individuals to come to the traditional outpatient setting is an ineffective approach as poor lifestyle habits are typically well established by the time care is initiated. Ideally, HLM should be delivered where individuals live, work and go to school, promoting immersion in a culture of health and wellness. To this end, there is a growing interest in the use of public parks as a platform to promote the adoption of HL behaviors. The current perspectives paper provides a brief literature review on the use of public parks for HL interventions and introduces a new HealthPark model being developed in Chicago.

Physical function and exercise training in older patients with heart failure

Heart failure (HF) is a common end point for numerous cardiovascular conditions, including coronary artery disease, valvular disease, and hypertension. HF predominantly affects older individuals (aged ≥70 years), particularly those living in developed countries. The pathophysiological sequelae of HF progression have a substantial negative effect on physical function. Diminished physical function in older patients with HF, which is the result of combined disease-related and age-related effects, has important implications on health. A large body of research spanning several decades has demonstrated the safety and efficacy of regular physical activity in improving outcomes among the HF population, regardless of age, sex, or ethnicity. However, patients with HF, especially those who are older, are less likely to engage in regular exercise training compared with the general population. To improve initiation of regular exercise training and subsequent long-term compliance, there is a need to rethink the dialogue between clinicians and patients. This Review discusses the need to improve physical function and exercise habits in patients with HF, focusing on the older population.

Novel approaches for the promotion of physical activity and exercise for prevention and management of type 2 diabetes

Despite increased evidence for the importance of lifestyle modification, physical activity and diet in diabetes prevention and management, habitual physical activity levels have declined in recent decades in China and India. Further, other risk factors for type 2 diabetes, including overweight, obesity and physical inactivity, have also worsened. Here we present evidence for the importance of physical activity and exercise in the amelioration of type 2 diabetes and propose a novel approach to address the challenge of improving lifestyle behaviors in China and India—Movement is Medicine and a P4 (predictive, preventive, personalized and participatory) approach.

Training Health Professionals to Deliver Healthy Living Medicine

The growing incidence and prevalence of unhealthy living behaviors leading to compromised health, along with unhealthy supportive environments, are the primary reasons for the current chronic disease crisis in almost all countries. Over the course of health professions training across disciplines, a large amount about information regarding various aspects of chronic disease is introduced, from pathophysiology to a broad array of approaches to examinations (focused on diagnosis and prognosis) and interventions. Currently, a late primary or secondary prevention focus is the primary educational approach in the health professions. In either scenario, the health professional is often trained to approach their discipline from a catch up approach, with little focus on how an individuals health condition, at the time of presentation, came to be. It is unfortunate that so little educational time and effort are devoted to train future health professionals on how to practice Healthy Living Medicine (HLM) and, deliver healthy living (HL) interventions. The primary goal should be to keep individuals healthy where they live, work and go to school and minimize initiating care in the hospital and outpatient clinical setting. The current review describes current trends in training health professionals in HLM and the delivery of HL interventions.

The Current Global State of Key Lifestyle Characteristics: Health and Economic Implications

The chronic disease crisis we currently face must be addressed in rapid fashion. Cardiovascular (CV) and pulmonary diseases, diabetes as well as several forms of cancer are leading causes of morbidity and mortality globally. Collectively, these conditions have a significant impact on the quality of life of individuals, families and communities, placing an unsustainable burden on health systems. There is hope for the chronic disease crisis in that these conditions are largely preventable or can be delayed to much later in life through a timeless medicine, healthy living. Specifically, physical activity (PA), healthy nutrition, not smoking and maintaining a healthy body weight, the latter of which being predominantly influenced by PA and nutrition, are the key healthy living medicine (HLM) ingredients. Unfortunately, there is much work to be done, the unhealthy living phenotype is running rampant across the globe. Without improvements in PA, nutrition, tobacco use and body habitus patterns, there is little hope for curtailing the chronic disease epidemic that has been brought about by the dramatic increase in unhealthy living behaviors. This review highlights current trends in lifestyle behaviors, benefits associated with reversing those behaviors and potential paths to promote the increased utilization of HLM.

Let's Talk about Moving: The Impact of Cardiorespiratory Fitness, Exercise, Steps and Sitting on Cardiovascular Risk

preventing its occurrence (i.e., primary prevention). Moving further upstream, preventing the occurrence of well-established CVD risk factors from ever manifesting is optimal (i.e., primordial prevention). In the unfortunate and currently common situation where CVD does manifest, either clinical or subclinical, reversal of risk factors becomes imperative (i.e., secondary prevention). Regardless of the CVD prevention entry point (i.e., primordial to secondary), increasing physical activity and cardiorespiratory fitness (CRF) is a primary objective. While unique entities, there is a degree of overlap between physical activity and CRF that warrants recognition. Physical activity is quantified by some type of activity tracker or more commonly by self-report. CRF is quantified by exercise testing techniques, where peak/maximal aerobic capacity is either estimated [i.e., metabolic equivalents (METs)] or directly measured [i.e., peak oxygen consumption (VO 2 )]. The link between both higher levels of physical activity and CRF and a decreased risk of being diagnosed with CVD, or suffering a subsequent adverse event if already diagnosed with CVD, is beyond dispute. Comparatively, the drop in CVD risk with increasing CRF is sharper than that observed with increasing levels of physical activity, an observation likely associated with the fact that the former is a more objective measure that the latter. There are well established recommendations for weekly exercise patterns: 1) 150 minutes or more moderate-intensity aerobic activity per week; or 2) 75 minutes or more of vigorous aerobic activity per week. Participating in exercise at these volumes portends clear health benefits. Even so, it has become increasingly recognized that exercise volumes falling significantly below these recommendations also provides substantial health benefits. For example, Lavie et al. recently reviewed the risk of cardiovascular and all-cause mortality according to running EDITORIAL

Healthy Living Medicine in the Workplace: More Work to Do

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

Assessing the Value of Moving More-The Integral Role of Qualified Health Professionals

Being physically active or, in a broader sense, simply moving more throughout each day is one of the most important components of an individuals health plan. In conjunction with regular exercise training, taking more steps in a day and sitting less are also important components of ones movement portfolio. Given this priority, health care professionals must develop enhanced skills for prescribing and guiding individualized movement programs for all their patients. An important component of a health care professionals ability to prescribe movement as medicine is competency in assessing an individuals risk for untoward events if physical exertion was increased. The ability to appropriately assess ones risk before advising an individual to move more is integral to clinical decision-making related to subsequent testing if needed, exercise prescription, and level of supervision with exercise training. At present, there is a lack of clarity pertaining to how a health care professional should go about assessing an individuals readiness to move more on a daily basis in a safe manner. Therefore, this perspectives article clarifies key issues related to prescribing movement as medicine and presents a new process for clinical assessment before prescribing an individualized movement program.

Creating a pro-active health care system to combat chronic diseases in Sri Lanka: the central role of preventive medicine and healthy lifestyle behaviors

ABSTRACT Introduction: The current burden and future escalating threat of chronic diseases, constitutes the major global public health challenge. In Sri Lanka, cardiovascular diseases account for the majority of annual deaths. Data from Sri Lanka also indicate a high incidence and prevalence of pre-diabetes and diabetes; 1 in 5 adults have elevated blood sugar in Sri Lanka. It is well established that chronic diseases share four primary behavioral risk factors: 1) tobacco use; 2) unhealthy diet; 3) physical inactivity; and 4) harmful use of alcohol. Areas covered: Evidence has convincingly shown that replacing these behavioral risk factors with the converse, healthy lifestyle characteristics, decrease the risk of poor outcomes associated with chronic disease by 60 to 80%. In essence, prevention or reversal of these behavioral risk factors with effective healthy lifestyle programing and interventions is the solution to the current chronic disease crisis. Expert commentary: Healthy lifestyle is medicine with global applicability, including Sri Lanka and the rest of the South Asia region. This policy statement will discuss the chronic disease crisis in Sri Lanka, its current policies and action implemented to promote healthy lifestyles, and further recommendations on preventive medicine and healthy lifestyle initiatives that are needed to move forward.