Division of Cardiology, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America.
Prog Cardiovasc Dis. 2023 Mar-Apr;77:4-13. doi: 10.1016/j.pcad.2023.04.004. Epub 2023 Apr 12.
Poor lifestyle habits, such as physical inactivity and poor diets, are highly prevalent within society and even more so among patients with chronic disease. The need to stem poor lifestyle habits has led to the development of a new field of Lifestyle Medicine, whose mission is to prevent, treat, and even reverse chronic diseases through lifestyle interventions. Three fields within Cardiology relate to this mission: Cardiac Rehabilitation, Preventive Cardiology, and Behavioral Cardiology. Each of these three fields have contributed substantially to the reduction of cardiovascular disease (CVD) morbidity and mortality. The historic contributions of these three cardiac fields are reviewed as well as the challenges each of these fields has faced in optimizing the application of lifestyle medicine practices. A shared agenda between Cardiology and the American College of Lifestyle Medicine could further the utilization of behavioral interventions. This review suggests seven steps that could be shared by these organizations and other medical societies. First, there is a need to develop and promulgate the assessment of lifestyle factors as "vital signs" during patient visits. Second, developing a strong partnership between the fields of Cardiology and Physiatry could improve important aspects of cardiac care, including a potential redesign of cardiac stress testing. Third, behavioral evaluations should be optimized at patients' entrée points into medical care since these may be considered "windows of opportunity". Fourth, there is a need to broaden cardiac rehabilitation into inexpensive programs and make this program eligible for patients with risk factors but no known CVD. Fifth, lifestyle medicine education should be integrated into the core competencies for relevant specialties. Sixth, there is a need for inter-societal advocacy to promote lifestyle medicine practices. Seventh, the well-being effects of healthy lifestyle behaviors, such as their impact on one's sense of vitality, should be emphasized.
不良的生活方式习惯，如缺乏身体活动和不良饮食，在社会中非常普遍，在慢性病患者中更是如此。遏制不良生活方式习惯的需求催生了一个新的领域——生活方式医学，其使命是通过生活方式干预来预防、治疗甚至逆转慢性病。心脏病学中有三个领域与这一使命相关：心脏康复、预防心脏病学和行为心脏病学。这三个领域都为降低心血管疾病（CVD）发病率和死亡率做出了巨大贡献。本文回顾了这三个心脏领域的历史贡献，以及每个领域在优化生活方式医学实践应用方面所面临的挑战。心脏病学和美国生活方式医学学院之间的共同议程可以进一步促进行为干预的应用。这篇综述提出了这两个组织和其他医学协会可以共享的七个步骤。首先，需要将生活方式因素的评估作为患者就诊时的“生命体征”进行开发和推广。其次，心脏病学和物理治疗学领域之间建立强有力的伙伴关系可以改善心脏护理的重要方面，包括对心脏压力测试的潜在重新设计。第三，应在患者进入医疗保健的入口点优化行为评估，因为这些可能被视为“机会之窗”。第四，需要将心脏康复扩展到低成本的项目，并使该项目适用于有风险因素但没有已知 CVD 的患者。第五，应将生活方式医学教育纳入相关专业的核心能力中。第六，需要倡导跨协会来促进生活方式医学实践。第七，应强调健康生活方式行为的健康效益，例如它们对活力感的影响。
