Elaine Walizer

Achievement of heart health characteristics through participation in an intensive lifestyle change program (Coronary Artery Disease Reversal Study).

PURPOSE Lifestyle habits and cardiovascular disease (CVD) risk factors are closely linked. Unfortunately, few individuals meet the goals for cardiovascular health that are recommended in public health initiatives. The purpose of this study was to determine the effect of an intensive lifestyle intervention program on the achievement of a group of recognized heart health characteristics as well as on the reduction of individual CVD risk factors. METHODS Of 200 military healthcare beneficiaries with coronary artery disease or CVD risk factors (mean age = 61 years) who entered a 1-year, prospective, cohort, multicomponent lifestyle intervention study (lacto-ovo vegetarian diet, exercise, stress management, group support), 186 subjects enrolled and 144 participated for 1 year. RESULTS At 3 months and 1 year compared with baseline, the proportion of subjects meeting 5 recognized heart health characteristics improved (P < .001): fiber intake >25 g/d (94% and 72% vs 35%); exercise ≥150 min/wk (79% and 58% vs 31%); low-density lipoprotein cholesterol <100 mg/dL (75% and 63% vs 46%); body mass index <25 kg/m2 (34% and 38% vs 23%); and blood pressure <140/90 mm Hg (84% and 83% vs 69%). At 1 year, more subjects (72% vs 32% at baseline), especially those with intervention adherence above (94%) versus below (58%) the study population median (P < .0005), achieved 3 or more of these characteristics. CONCLUSION An intensive lifestyle intervention promotes achievement of important heart health characteristics that, if maintained, may substantially reduce CVD events.

Early Empowerment Strategies Boost Self-Efficacy to Improve Cardiovascular Health Behaviors

Background: Self-efficacy, defined as confidence in the ability to carry out behavior to achieve a desired goal, is considered to be a prerequisite for behavior change. Self-efficacy correlates with cardiovascular health although optimal timing to incorporate self-efficacy strategies is not well established. We sought to study the effect of an empowerment approach implemented in the introductory phase of a multicomponent lifestyle intervention on cardiovascular health outcomes. Design: Prospective intervention cohort study. Methods: Patients in the Integrative Cardiac Health Project Registry, a prospective lifestyle change program for the prevention of cardiovascular disease were analyzed for behavioral changes by survey, at baseline and one year, in the domains of nutrition, exercise, stress management and sleep. Self-efficacy questionnaires were administered at baseline and after the empowerment intervention, at 8 weeks. Results: Of 119 consecutive registry completers, 60 comprised a high self-efficacy group (scoring at or above the median of 36 points) and 59 the low self-efficacy group (scoring below median). Self-efficacy scores increased irrespective of baseline self-efficacy but the largest gains in self-efficacy occurred in patients who ranked in the lower half for self-efficacy at baseline. This lower self-efficacy group demonstrated behavioral gains that erased differences between the high and low self-efficacy groups. Conclusions: A boost to self-efficacy early in a lifestyle intervention program produces significant improvements in behavioral outcomes. Employing empowerment in an early phase may be a critical strategy to improve self-efficacy and lower risk in individuals vulnerable to cardiovascular disease.