6 Lessons in Healthy Eating from Those Who Live to 100

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A long, healthy life is about much more than good genes; it’s highly dependent on building healthy habits. Habits—both good and bad—are an integral part of your everyday life. Part of forming healthy habits is to become intentional with them until they become ingrained into your daily routine. It will take effort on your part, but if the payoff could be a long, healthy life, then it’s worth it, right?

So what’s the formula for success? Well, what better way to find and adopt healthy habits than from those already practicing them? Let’s take a look at the healthy habits practiced by people living happily into their hundreds, in parts of the world known as “Blue Zones.”

The Study

In 2004, author and explorer Dan Buettner rounded up a bunch of anthropologists, demographers, epidemiologists, and other researchers to travel around the world to study communities with surprisingly high percentages of centenarians. Funded in part by the U.S. National Institute on Aging, the study’s findings, highlighted in National Geographic by Buettner, discussed five hot spots—called “Blue Zones”—where there is a high rate of centenarians who enjoy a healthier lifestyle. These places were:

  • Loma Linda, U.S.
  • Nicoya, Costa Rica
  • Sardinia, Italy
  • Ikaria, Greece
  • Okinawa, Japan

Buettner and the researchers found that seniors in these widely separated regions share a number of key habits, despite many differences in backgrounds and beliefs. These universal healthy habits can be broken down into the following:

This first article in the series will focus on the first factor, having a healthy diet.

A Healthy Diet

It’s widely known that what you eat is important to your health and well-being, but with all the new diet trends and research, it can be difficult to figure out just exactly what eating healthy means. Another complication is that each of us is unique—we each have individual tastes, dietary restrictions and allergies, and cultural influences.

With that said, the Blue Zone study found that the majority of centenarians practice similar healthy eating habits. Here are some centenarian dietary best practices to try.

1. Eat More Plants

There is a clear theme across the Blue Zone communities to eat fresh, organic food, high in proteins and healthy fats. In general, the centenarians eat a large amount of vegetables and fruits, and small amounts of red meat. The fruit and vegetables tend to be high in antioxidants and fiber, such as tomatoes, onions, squash, roots/tubers, and beans. Whole grains are also often included in the Blue Zone diets in the form of breads or cereals.

2. Eat Locally/Home-Grown Food

The majority of centenarians eat fruits and vegetables that are home-grown or locally grown organic products. Picking up food at local farmers markets not only fosters a sense of community (another factor in longevity), but also allows you to eat seasonally, which means the fruits and vegetables will be more nutritionally dense. The same principles apply for growing your own food—a little more work, but you will be able to control what goes into your food—and what does not (i.e., pesticides).

3. Practice Portion Control

Consuming excess calories leads to weight gain and potential health risks. Learning to control your portions like many centenarians (and those following an Ayurvedic diet) can be a healthy eating habit.

For example, Okinawans practice “Hara hachi bu,” a Confucian mantra said before a meal that reminds them to stop eating when their stomachs are 80-percent full. The 20 percent gap between not being hungry and feeling full could help with losing weight. “Rituals like this and other forms of saying grace also provide a pause in everyday living, forcing people to slow down and pay attention to their foods,” says Buettner. “Ikarians, Saridinians, Costa Ricans, and Adventists all begin meals by saying a prayer.”

The Okinawans also eat off small plates to limit the amount of food consumption. Take a look at what size dishes are in your cupboard—you may want to invest in smaller plates to help with portion control.

4. Have a Meal Routine

When you eat is also important because it can help with digestion and ensure your body gets the energy it needs to perform. People in the Blue Zones tend to eat three meals a day and don’t make a habit of snacking. Their smallest meal is usually dinner and then they don’t eat any more the rest of the day, but adopting this habit will depend on your life schedule (dinner may be your first meal of the day, depending on your work hours).

5. Practice Moderate Alcohol Consumption

American alcohol consumption is on the rise—including increases in its abuse. Drinking alcohol in excess can cause liver damage, cardiovascular disease, cancer, and other health risks. It can also increase the chance of violence, motor vehicle accidents, and injuries due to falls.

That’s not to say alcohol consumption is off the table—just that the health risks of alcohol consumption tend to outweigh the benefits. If you drink, do so in moderation. Many centenarians in Okinawa, Sardinia, and Icaria enjoy a moderate amount of alcohol (wine and sake), while others such as the Seventh Day Adventists in Loma Linda refrain from drinking all together.

6. Eat with Family and Friends

Eating is best as a social experience where you can slow down, be present, and connect with others. “I’ve eaten countless meals with people in the Blue Zones, and they were often three-hour affairs with a succession of many small plates punctuated by toasts, stories, jokes, and conversation,” says Buettner. “Mealtimes are celebrations, a time to give thanks, talk out problems, and bond as a family. As a rule, people in the Blue Zones never eat alone, never eat standing up, and never eat with one hand on the steering wheel.”

By forming healthy eating habits you can optimize your lifestyle and may gain an extra decade of good life you’d otherwise miss. Adopting these six healthy eating habits practiced by centenarians may help to improve your life expectancy at any age.

*Editor’s Note: The information in this article is intended for your educational use only; does not necessarily reflect the opinions of the Chopra Center’s Mind-Body Medical Group; and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.


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Strength training: Get stronger, leaner, healthier

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Strength training: Get stronger, leaner, healthier

Strength training is an important part of an overall fitness program. Here’s what strength training can do for you — and how to get started.

By Mayo Clinic Staff

Want to reduce body fat, increase lean muscle mass and burn calories more efficiently? Strength training to the rescue! Strength training is a key component of overall health and fitness for everyone.

Use it or lose it

Lean muscle mass naturally diminishes with age.

Your body fat percentage will increase over time if you don’t do anything to replace the lean muscle you lose over time. Strength training can help you preserve and enhance your muscle mass at any age.

Strength training may also help you:

  • Develop strong bones. By stressing your bones, strength training can increase bone density and reduce the risk of osteoporosis.
  • Manage your weight. Strength training can help you manage or lose weight, and it can increase your metabolism to help you burn more calories.
  • Enhance your quality of life. Strength training may enhance your quality of life and improve your ability to do everyday activities. Strength training can also protect your joints from injury. Building muscle also can contribute to better balance and may reduce your risk of falls. This can help you maintain independence as you age.
  • Manage chronic conditions. Strength training can reduce the signs and symptoms of many chronic conditions, such as arthritis, back pain, obesity, heart disease, depression and diabetes.
  • Sharpen your thinking skills. Some research suggests that regular strength training and aerobic exercise may help improve thinking and learning skills for older adults.

Consider the options

Strength training can be done at home or in the gym. Common choices may include:

  • Body weight. You can do many exercises with little or no equipment. Try pushups, pullups, planks, lunges and squats.
  • Resistance tubing. Resistance tubing is inexpensive, lightweight tubing that provides resistance when stretched. You can choose from many types of resistance tubes in nearly any sporting goods store or online.
  • Free weights. Barbells and dumbbells are classic strength training tools. If you don’t have weights at home, you can use soup cans. Other options can include using medicine balls or kettle bells.
  • Weight machines. Most fitness centers offer various resistance machines. You can invest in weight machines for use at home, too.
  • Cable suspension training. Cable suspension training is another option to try. In cable suspension training, you suspend part of your body — such as your legs — while doing body weight training such as pushups or planks.

Getting started

If you have a chronic condition, or if you’re older than age 40 and you haven’t been active recently, check with your doctor before beginning a strength training or aerobic fitness program.

Before beginning strength training, consider warming up with brisk walking or another aerobic activity for five or 10 minutes. Cold muscles are more prone to injury than are warm muscles.

Choose a weight or resistance level heavy enough to tire your muscles after about 12 to 15 repetitions. When you can easily do more repetitions of a certain exercise, gradually increase the weight or resistance.

Research shows that a single set of 12 to 15 repetitions with the proper weight can build muscle efficiently in most people and can be as effective as three sets of the same exercise. As long as you take the muscle you are working to fatigue — meaning you can’t lift another repetition — you are doing the work necessary to make the muscle stronger. And fatiguing at a higher number of repetitions means you likely are using a lighter weight, which will make it easier for you to control and maintain correct form.

To give your muscles time to recover, rest one full day between exercising each specific muscle group.

Also be careful to listen to your body. If a strength training exercise causes pain, stop the exercise. Consider trying a lower weight or trying it again in a few days.

It’s important to use proper technique in strength training to avoid injuries. If you’re new to strength training, work with a trainer or other fitness specialist to learn correct form and technique. Remember to breathe as you strength train.

When to expect results

You don’t need to spend hours a day lifting weights to benefit from strength training. You can see significant improvement in your strength with just two or three 20- or 30-minute strength training sessions a week.

For most healthy adults, the Department of Health and Human Services recommends these exercise guidelines:

  • Aerobic activity. Get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. The guidelines suggest that you spread out this exercise during the course of a week. Greater amounts of exercise will provide even greater health benefits. But even small amounts of physical activity are helpful. Being active for short periods of time throughout the day can add up to provide health benefits.
  • Strength training. Do strength training exercises for all major muscle groups at least two times a week. Aim to do a single set of each exercise, using a weight or resistance level heavy enough to tire your muscles after about 12 to 15 repetitions.

As you incorporate strength training exercises into your fitness routine, you may notice improvement in your strength over time. As your muscle mass increases, you’ll likely be able to lift weight more easily and for longer periods of time. If you keep it up, you can continue to increase your strength, even if you’re not in shape when you begin.

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A Healthy Daily Routine to Keep Your Mental and Physical Health in Shape

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Nine out of 10 people I talk to don’t know what they want from life. They just let it happen without questioning it too much, often taking the path of least resistance. I was one of them. I didn’t know where I was going in life; I had vague goals, a poor work ethic and no clear vision. But then, I completely transformed my life by engineering a simple yet profound morning routine. Do you know what you want from your life?

The daily routine I will share in this article can be easily replicated and adjusted to take your life to the next level. Read on!


1.

The importance of “me” time

I always wanted to read more, spend time learning things that mattered to me and simply have time where no one can tell me what to do and I can just focus on getting lost improving myself. It’s important to set a specific time for yourself. Whether you want to do yoga, stretch, read, paint, write, anything. You must block time where you have little to no distractions and can spend time on yourself guilt free. My decision was clear when I started writing my first book. My day would become so busy that I wouldn’t have the time nor the energy to sit down and write. I decided to wake up one hour earlier and write. Nothing more, nothing less. Some days I would write two sentences, other days I would easily get to 1,000 words. For the last two years I have dedicated three hours, from 5am to 8am to “me” time and I have grown enormously.


2.

Prepare the night before


3.

Consistency beats ability

Showing up daily and performing consistently might not be sexy and won’t bring overnight results but it will definitely make you better. Here’s an article by James Clear on marginal gains that proves that improving just 1% every day will have a significant impact on your life in 365 days. Whether it’s fitness, finances, creativity or relationships, show up daily and improve just 1% to grow.

Action: Decide on what you want to improve this year and write it down. Every morning spend time practicing.


4.

Develop your grand life vision

As I mentioned at the very beginning of this article, most people don’t know what they want from life. Vague goals like building a house, buying a car, marrying and having a good job are not really goals. It’s the way people live, these are more like needs. I was focused on needs as well until I started thinking what is really important to me.

To help you develop your grand life vision, ask yourself the following questions.

  • What do I want to be remembered for?
  • What gives me enormous satisfaction?
  • How can I leave this world a better place?

For some people it’s music, for others it’s art. For me, it’s about mastering myself, learning new things and experimenting in life.

Action: Come up with a grand vision for your life. Remind yourself every morning why you woke up and why it matters. Visualize yourself getting closer to your goal.


6.

Read/listen/watch something uplifting

What works for me is to keep my schedule consistent and read every day for at least 30 minutes. It allows me to focus and forget myself while learning and gaining inspiration. Other times, when I travel early in the morning, I like to listen to podcasts about the things that matter to me. Whether it’s health, productivity, lifestyle design or business, I get inspired and pumped up hearing experts talk about these topics. Lastly, watching uplifting videos can fill you with positive energy in no time.

Back in 2015, I took an intense five-week training program for a half-marathon and had hard mornings when my legs and feet were sore, it was raining outside and I wouldn’t get excited about running 18 kilometers. Then, I would watch a motivational video on YouTube and become motivated in no time. My favorites are videos about great athletes like Lionel Messi, Novak Djokovic and Arnold Schwarzenegger.

Action: Make a motivational playlist on YouTube and watch it every morning for inspiration.


7.

Meditate/journal/stretch


8.

Step out of your exercise comfort zone

Finally, every morning I challenge myself through exercise. While traveling I don’t always have the luxury of hitting the gym and do a short HIIT session or use a fitness app. Exercise is extremely important as it contributes to my discipline, confidence and performance. If I show up daily and push myself to become a better person, I can demand from my body to perform at a higher level and make me more productive, focused and healthier. I know not everyone is lucky enough to be able to hit the gym every day but there are tons of other possibilities. Go for a run, do bodyweight exercises, challenge yourself with the HIIT session. Don’t just pity yourself and give in to an excuse that there is nothing you can do to make your body stronger. Getting into mental and physical shape requires a consistent healthy daily routine.

I noticed that exercise has become one of my keystone habits that push me out of my comfort zone every single day, building up stronger will and self-discipline.

Action: Decide how you will push yourself out of your comfort zone. Make it easy to start. Find a suitable training program, prepare your clothes the night before and find an accountability partner.

Do you have a morning routine that fires you up and makes you a better person day after day? Share your plans or tips in the comments below.

Lifestyle | The Sims Wiki

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Icon Name Description Effect Adrenaline Seeker.png Adrenaline Seeker Adrenaline Seeker is a Lifestyle for Sims who seek out danger, adventure, and sometimes even drama to ride the wave of an adrenaline rush! To acquire or maintain this Lifestyle, explore dangerous locales, get into fights, woohoo outside, work in a dangerous career, and seek out excitement in all its forms! Just be sure to avoid the mundane.
  • Various benefits when thrill-seeking
  • Avoids boring conversations
  • Does not panic during fire and finds it exciting
  • Increased work performance in dangerous careers
  • Can “Talk about New Adventure” and “Enthuse about Thrill-Seeking” with other Sims
  • Can “Fight for the Rush!” after having gone too long without a thrill
  • Bored when performing mundane interactions and socials
  • Tense when going too long without excitement
Close-Knit.png Close-Knit Sims living a Close-Knit Lifestyle prefer to form deep connections with a small circle of friends. To acquire or maintain this Lifestyle, a Sim should keep their friend count between one and three Sims while seeking to deepen the relationships they do have.
  • Keeps Good Friends longer but has a harder time staying friends with Sims at lower relationship levels
  • More likely to gain Long Term Sentiments with friends
  • Can “Ask to Be Confidant” and gains unique flavor socials with Confidant
  • Tense when without friends or when friend group grows to four or more

Conflicts with “People Person”.

Coffee fanatic.png Coffee Fanatic Sims who live a Coffee Fanatic Lifestyle want nothing more than another cup of java in order to reap its benefits. To acquire or maintain this Lifestyle, drink a lot of coffee.
  • Various benefits after drinking coffee
  • Will make and drink more coffee than other Sims
  • Brewed Coffee is always Outstanding Quality
  • Increased Skill gain in all Skills after drinking coffee
  • Can “Talk about Benefits of Coffee” or “Lament the Detriments of Coffee” depending on caffeinated status
  • Can “Work Caffeinated Shift” while at work
  • Increased work performance after drinking coffee
  • Uncomfortable after going too long without drinking coffee
Energetic.png Energetic Sims who live an Energetic Lifestyle love to stay active and keep moving! To acquire or maintain this Lifestyle, seek out athletic and sporty activities or join a high-energy career.
  • Various benefits when performing high-energy activities
  • Prefers to perform high-energy activities
  • Increased work performance in high-energy careers
  • Decreased work performance in low-energy careers
  • Dislikes low-energy activities and becomes tense when going without activity for too long

Conflicts with “Sedentary”

Frequent traveller.png Frequent Traveller Frequent Travelers make a habit of visiting new and exciting places and want to experience everything these locales have to offer! To acquire or maintain this Lifestyle, travel for vacations, visit exotic hidden destinations, and seek out new experiences while traveling.
  • Various benefits when traveling to another world or when taking a vacation
  • Increased Skill gain in all Skills while on vacation specifically
  • Increased work performance and other benefits after returning from a vacation
  • Can “Ask about Home Region” on locals to gather destination suggestions while traveling
  • Can “Share Travel Stories” after a vacation
  • Bored after having gone too long without travel
Health food nut.png Health Food Nut Sims who live a Health Food Nut Lifestyle are devoted to eating nutrient-filled foods! To acquire or maintain this Lifestyle, eat healthy foods and harvestables while avoiding Quick Meals, desserts, or anything that may seem unhealthy!
  • Various benefits when eating healthy food
  • Prefers to cook and eat healthy food
  • Can “Cook Healthy Meal” to make alternative healthy recipe options
  • Increased Weight Loss and Fitness Gain while working out after eating a meal made by “Cook Healthy Meal”
  • Can “Evangelize Benefits of Health Food” to other Sims
  • Displeased by eating junk food and tense when going too long without eating healthy food

Conflicts with “Junk Food Fiend”

Hungry for love.png Hungry for Love Sims living a Hungry for Love Lifestyle have a strong desire to be in a relationship and struggle to deal with life without one. To acquire or maintain this Lifestyle, engage with romantic media or attempt to romance other Sims.
  • Various benefits when in a romantic relationship
  • Prefers romantic behavior and is more likely to succeed when being romantic
  • Acquires romantic Sentiments more easily
  • Enjoys romantic media
  • Increased Work Performance when in a romantic relationship
  • Tense when not in a romantic relationship

Conflcits with “Single and Lovin’ It”

Indoorsy.png Indoorsy Sims living an Indoorsy Lifestyle prefer to be within the confines of an indoor space. To acquire or maintain this Lifestyle, prioritize doing activities indoors rather than outdoors.
  • Various benefits when doing indoor activities
  • Prefers to be indoors
  • Decreased work performance in outdoor careers
  • Tense when spending too much time outside rather than inside

Conflicts with “Outdoorsy”

Junk food fiend.png Junk Food Fiend Sims who live a Junk Food Fiend Lifestyle crave snacks and sweets and are enthusiasts of spicing food up with sugar and bacon! To acquire or maintain this Lifestyle, eat Quick Meals, desserts, or anything that may seem unhealthy as a rule. Just be sure to avoid eating healthy!
  • Various benefits when eating junk food
  • Prefers to eat junk food
  • Can “Add Sugar” or “Add Bacon” to food, turning it into junk food
  • Can “Evangelize Benefits of Junk Food” to other Sims
  • Displeased by eating healthy and tense when going too long without eating junk food

Conflicts with “Health Food Nut”

People person.png People Person Sims living a People Person Lifestyle have an easier time building and maintaining a large friend group, sometimes at the cost of connecting with those friends. To acquire or maintain this Lifestyle, a Sim should have four or more friends.
  • Keeps lower relationship level Friends easier but struggles to keep Good Friends or higher
  • Various benefits when interacting with three or more friends at a time or when making a new friend
  • Less likely to gain Long Term Sentiments with friends
  • Greater need to be social
  • Tense when friend group contains fewer than four Sims

Conflicts with “Close-Knit”

Single and lovin it.png Single and Lovin’ It Sims living a Single and Lovin’ It Lifestyle happily enjoy the ‘single life’ and savor their independence. To acquire or maintain this Lifestyle, avoid being in a committed romantic relationship and romantic media.
  • Various benefits when single
  • Increased Skill gain in all Skills when single
  • Less likely to acquire romantic Sentiments
  • Finds romantic media somewhat unrealistic
  • Increased Work Performance when single
  • Tense when in a new committed romantic relationship

Conflicts with “Hungry for Love”

Outdoorsy.png Outdoorsy Sims living an Outdoorsy Lifestyle prefer to be outside, taking in the fresh air. To acquire or maintain this Lifestyle, prioritize doing activities outdoors rather than indoors.
  • Various benefits when doing outdoor activities
  • Prefers to be outdoors
  • Increased work performance in outdoor careers
  • Tense when spending too much time inside rather than outside

Conflicts with “Indoorsy”

Sedentary.png Sedentary Sims who live a Sedentary Lifestyle favor relaxing and lounging in all its forms, and prefer to avoid exerting themselves. To acquire or maintain this Lifestyle, pursue low-energy activities that allow a Sim to relax, sit, and lounge around or join a low-energy career.
  • Various benefits when performing low-energy activities
  • Prefers to perform low-energy activities
  • Increased work performance in low-energy careers
  • Decreased work performance in high-energy careers
  • Tense when performing high-energy activities or when going too long without doing relaxing activities

Conflicts with “Energetic”

Techie.png Techie Live a life immersed in technology! To acquire or maintain this Lifestyle, interact regularly with electronics and technology or join a tech-related career.
  • Various benefits when interacting with technologyPrefers to use technology over non-electronic objects
  • Increased Skill gain in Programming and Rocket Science
  • Can apply the Overclocked Upgrade to computers and then “Enthuse about Processing Power” with other Sims
  • Improved success when repairing and upgrading electronics
  • Increased work performance in tech-related careers
  • Tense when on a lot without Power or when going without technology for too long

Conflicts with “Technophobe”

Technophobe.png Technophobe A Lifestyle dedicated to the avoidance of technology! To acquire or maintain this Lifestyle, a Sim should pursue a livelihood without Power or technology, even going so far as to sabotage or break electronics from time to time.
  • Various benefits relating to broken electronics, when on a lot without Power, or when on a lot using the Off-the-Grid Lot Trait
  • Prefers to avoid using technology
  • Can intentionally “Sabotage” electronics
  • Decreased work performance in tech-related careers
  • Tense when using technology

Conflicts with “Techie”

Workaholic.png Workaholic Sims living a Workaholic Lifestyle tend to fixate on their careers by working extra hard and rarely taking breaks. To acquire or maintain this Lifestyle, pursue promotions, Work Hard while at work, complete Daily Tasks, and abstain from taking days off.
  • Needs decay slower while at work
  • Increased work performance gain
  • Difficulty in keeping long term relationships
  • Can “Go to Work on Off Hours” and “Demand Promotion from Boss”
  • Receives extra work-related benefits when in the Corporate Worker career
  • Tense when neglecting work duties or without a job

Digital Health–Supported Lifestyle Change Programs to Prevent Type 2 Diabetes

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Posted in Healthy lifestyle

Abstract

IN BRIEF Type 2 diabetes can be prevented or delayed in people with prediabetes through participation in an intensive lifestyle change program (LCP), particularly one based on the Diabetes Prevention Program research study. Digital health offers opportunities to extend the reach of such LCPs and possibly improve on these programs, which traditionally have been delivered in person. In this review, we describe the current state of evidence regarding digital health–supported LCPs and discuss gaps in research and opportunities for future efforts.

The United States is confronting a type 2 diabetes epidemic; over 30 million Americans have diabetes, about 95% of whom have type 2 diabetes (1). The prevalence of type 2 diabetes will likely continue to grow because 84 million American adults have prediabetes (1). Prediabetes can be diagnosed through laboratory testing in “individuals whose glucose levels do not meet the criteria for diabetes, but are too high to be considered normal,” according to the American Diabetes Association (2). In addition to being associated with elevated risks for negative cardiovascular outcomes (3), prediabetes is associated with a high risk of progression to type 2 diabetes. Progression rates vary across populations; one estimate reports an incidence rate of type 2 diabetes of 35.6/1,000 person-years among people with prediabetes, whereas another observed that 29% of people with prediabetes progressed to type 2 diabetes within 3 years (4–6). An estimated 74% of people with pre-diabetes develop type 2 diabetes in their lifetime (7).

Thankfully, many people with prediabetes can prevent or delay type 2 diabetes by participating in an intensive lifestyle change program (LCP) modeled after the Diabetes Prevention Program (DPP) research study (8). Briefly, the DPP randomized, controlled trial (RCT) included 3,234 people with impaired fasting glucose or impaired glucose tolerance. Participants were randomized to receive one of three interventions: an in-person LCP that fostered the development of skills to achieve a healthy lifestyle, metformin therapy, or a placebo/standard of care control. The LCP and metformin reduced the incidence of type 2 diabetes after 3 years by 58 and 31%, respectively relative to placebo. Longer-term outcomes were reported in the Diabetes Prevention Program Outcomes Study (DPPOS) (9), which demonstrated that those who participated in the LCP experienced a 27% reduced incidence of type 2 diabetes relative to placebo 15 years later.

The original DPP LCP has been translated for more practical use and tested in a variety of settings using both health care professionals and lay individuals to deliver the program to individual participants and groups (10–13).

The Centers for Disease Control and Prevention (CDC) oversees the National Diabetes Prevention Program (National DPP), which harnesses the success of the DPP and DPPOS studies, as well as related translational evidence. The goals of the National DPP are to expand access to LCPs, increase program uptake and retention, and provide quality assurance for these programs via the Diabetes Prevention Recognition Program (DPRP) (14).

The CDC DPRP grants recognition to LCPs that deliver an approved curriculum and achieve other program standards, including an average 5% weight loss among participants. As of March 2018, the CDC recognized 1,779 organizations delivering in-person LCPs and at least 120 organizations delivering LCPs via other modes, including online delivery or distance learning (15). More than 160,000 people have participated in the National DPP as of 9 March 2018 (K.K., P. Schumacher, K. Henriksen, personal communication), which is a remarkable achievement. Yet, millions more Americans with prediabetes could still benefit from the program.

As the CDC and its partner organizations, including the American Medical Association (AMA), work to scale the National DPP, digital health modes of LCP delivery offer opportunities to extend the reach of the program and possibly improve LCPs. The AMA classifies digital health solutions into seven categories: remote monitoring for efficiency, remote monitoring and management for improved care, clinical decision support, patient engagement, tele-visits, point-of-care, and tools providing consumer access to clinical data (16). Digital health solutions that incorporate remote monitoring, patient engagement, and tele-visits are particularly relevant to LCPs. Here, we describe the evidence regarding digital health–supported delivery of LCPs intended to prevent type 2 diabetes and discuss gaps in research and future opportunities.

Evidence Review

The key components of LCPs include coaching; self-monitoring of diet, physical activity, and weight; skills development; and group support (Table 1). Digital health can supplement or replace standard delivery modes of these LCP components. CDC-recognized LCPs can offer course sessions through a desktop computer, laptop, tablet, or mobile phone with coaching interactions conducted through phone, email, texting, or online messaging; the CDC refers to these programs as “online” programs. Alternatively, LCPs can also provide access to a lifestyle coach conducting in-person sessions in another location via remote classrooms or telehealth; the CDC refers to these as “distance-learning” programs.

TABLE 1.

LCP Components Delivered in Person or via Digital Health

For this evidence review, we conducted a literature search in PubMed inclusive of articles published from 2000 to February 2018 that evaluated the effectiveness of digital health–supported LCPs based on the DPP research study. These programs may or may not have met the CDC Recognition Program standards and operating procedures (17). The following search terms were used: “Diabetes Prevention Programs and digital,” “DPP and virtual,” “DPP and telehealth,” and “DPP and distance learning.” Reference lists were reviewed to identify additional articles for inclusion.

In considering the effectiveness of digital health–supported LCPs, we primarily focus on the outcome of weight loss because it is an excellent proxy for the risk of developing type 2 diabetes in the future (18). As previously noted, a 5% loss of body weight is one of the CDC’s program standards and is widely considered a clinically meaningful amount of weight loss (8,14).

Comprehensive Digital Programs

Some CDC-recognized providers offer comprehensive digital LCPs: Omada Health, Inc., and Noom are two examples. Participants complete the curriculum on their own time (asynchronously) and use digital self-monitoring tools such as smart scales to monitor weight or wearables to track physical activity. Personalized health coaching and group support occur via messaging.

Three-year data from a single-arm trial of the Omada program demonstrated an average weight loss of 4.7% at 1 year (P <0.0001) and 3.0% at 3 years (P = 0.0009) (19). Another nonrandomized trial of the Omada program among people with prediabetes found that 31% lost 5% of their body weight compared to 20% of people in a matched control group (P = 0.001) (20). Finally, a single-arm retrospective analysis of 500 Medicare-age adults with prediabetes or metabolic syndrome demonstrated a mean 7.5% weight loss among the 86% of participants who completed 1 year of the program (21). Noom had similar results regarding program effectiveness in a pilot study of 43 employees of a large insurance company (mean age 51 years); 83% completed the program, losing a mean 7.5% of body weight at 6 months (22). Other small trials or pilot studies have tested similar interventions and report significant weight loss that varies in magnitude. However, many studies lack a comparison group (23–25).

Programs Using Less Comprehensive Digital Solutions

One feasibility RCT tested the combination of in-person course sessions of an LCP supplemented with mobile phone tracking, reminders, and messaging to enhance and reinforce the content from the in-person component. The control group received a pedometer and an educational brochure. Results showed that the intervention group lost an average 6.8% of body weight at 5 months compared to a 0.3% weight gain in the control group (P = 0.001) (26).

Another pilot took the opposite approach, completely automating the coaching component of the LCP (27). Participants received 1 year of regular contact through individually tailored goal-setting, automated emails, and automated motivational coaching phone calls. Despite the lack of a human coach, 70.6% of individuals remained engaged in the sixth and final month of the LCP, and mean body weight loss was 3.60% at 6 months compared to 1.32% in the control group (P <0.001).

Digital Programs Using Video or Telephone Delivery

LCPs delivered via tele-visit approaches demonstrate mixed results. A randomized comparative effectiveness trial tested a text message–based LCP in which participants received six text messages each week for 1 year. Text message content was based on the DPP LCP curriculum and focused on nutrition, physical activity, and motivation, and participants were asked once weekly for their current weight. Participants also had the option to receive weekly telephone motivational interviewing sessions, and both the intervention and control groups were offered several weight loss resources delivered by a local health care system (including an in-person DPP-based LCP); 29.2 and 35.6% of the respective groups reported using another weight loss program during the study period. The results showed no difference between groups in the proportion achieving a 5% weight loss, with <20% of all participants achieving this outcome. However, there was a significant between-group difference in the proportion achieving a 3% weight loss (28).

In another pilot study conducted in a remote frontier community, a DPP-based LCP was delivered simultaneously to an in-person group and an off-site group via video conferencing. The two groups achieved similar weight loss after the 16-week core curriculum program; >40% lost 7% of their body weight (29).

Another randomized comparative effectiveness trial (30) compared an LCP delivered via telephone to individual participants versus to groups. The DPP curriculum was adapted to be delivered by a primary care provider educator through group conference calls or individual phone calls during the first year of the study; the second year used a modified 12-session curriculum based on DPP materials. Completion rates and mean percentage of weight loss were similar for the individual and group interventions at 12 months (4.2 and 4.5%, respectively), but the group participants experienced greater weight loss at 2 years (1.8 vs. 5.6%, P = 0.016).

Research in Specific Populations

Limited available research suggests that digital LCPs intended to prevent type 2 diabetes can be tailored to specific populations. A randomized pilot of a video-conferencing LCP targeted to obese men led to an average weight loss of 3.5% of body weight at the end of the intervention period (31). Omada conducted a feasibility study of a Spanish-language LCP in a low-income Spanish-speaking population and found high engagement after 4 weeks of engaging with the program, but some participants had difficulty with the technology (32).

Participant Satisfaction and Engagement

Participants in digital LCPs report high satisfaction and positive perceptions of these programs. Surveys and focus groups suggest that people are willing to engage with LCPs using a variety of digital health solutions and see potential for this to provide real-time professional and peer support, as well as an opportunity to model and practice weight loss skills and healthy behaviors (33,34). One study of a 6-month LCP reported >75% participant satisfaction rates with the program’s entire “virtual package,” as well as high ratings of individual components such as virtual small group dynamics and the technology used (35). Another study of women veterans enrolled in the Omada LCP found that participants perceived that the program was a good fit for their health needs and integrated easily into their daily life (36).

Digital LCPs also offer an opportunity to collect granular data regarding participant engagement, providing insights into which components of an LCP drive effectiveness. A Noom study (37) found that both food tracking and group participation positively predicted weight loss. An Omada study (19) also found that group participation predicted weight loss, but tracking and completion of lessons was not associated with weight loss.

Cost Outcomes Associated With Digital LCPs

Omada has published two studies using economic simulations to predict the potential cost savings associated with its digital LCP. The first study examined a general participant population with prediabetes (38), and the second focused on a Medicare-age population with prediabetes (39). For the general prediabetes population, the model predicted that the digital LCP would result in cumulative per-person medical savings of $1,533, $3,317, and $10,043 at 3, 5, and 10 years, respectively, among participants who completed at least four lessons. Predicted savings was greater among participants who completed at least nine lessons. In the Medicare population, the model predicted that the digital LCP would result in a cumulative per-person medical savings of $1,720, $3,840, and $11,550 at the same time points. This was a relatively conservative estimate in which it was assumed that participants would regain at least some weight over time. In the general population, the medical savings exceeded the intervention costs around the 3-year time point. The break-even point occurred earlier in the Medicare population, at around 1–2 years.

Discussion

Digital health–supported LCPs can be delivered through a variety of modes, including telephone or video conferencing, text messaging, mobile apps, and online platforms. Although the quality of the published research on digital LCPs varies substantially, there is fair- to good-quality evidence that these programs are effective in achieving clinically significant weight loss and often have high engagement rates.

It should be noted that many studies recruited participants directly and thus may have incurred a selection bias for those patients who would prefer a digital delivery method. Although selection bias may be a threat to the validity of these studies, it may not actually represent a substantial limitation because it reflects the real-world implementation of LCPs, in which individuals self-select whether they will participate.

Very few studies of digital LCPs included participants who reflect the demographics of the general U.S. population. Most studies included populations that are largely Caucasian, female, college-educated, and located close to an urban area. A broad review of technology-based interventions to reduce cardiovascular risk among priority populations such as racial and ethnic minorities and individuals of lower socioeconomic status found that technology offers the opportunity of tailoring interventions to specific populations. However, available research is sparse and mostly limited to pilot studies involving Latino and non-Hispanic black participants (40).

Outside of the United States, a trial conducted in a South Asian Indian population with prediabetes found good evidence supporting a monthly telephone-delivered LCP, which resulted in a reduction in relative risk of type 2 diabetes of 28.5% at 3 years (41). However, this LCP was a significant departure from that of the original DPP research study, and it is not clear whether it would translate well to South Asian populations in the United States.

Noom and Omada offer their programs in a variety of languages in addition to English, although no studies have evaluated the cultural competence of digital health–supported LCPs. Although it could be hypothesized that digital translations would not differ significantly from in-person programs in this context, research would be helpful to confirm this hypothesis.

Many experts are optimistic that digital health–supported LCPs offer opportunities to reach and tailor content to underserved populations, including racial and ethnic minorities, men, and rural residents. However, without a sound evidence base, clinicians cannot confidently recommend digital health–supported LCPs to some of these priority populations, and further research is urgently needed.

We identified no direct comparisons of a digital health–supported LCP to an in-person LCP for the purposes of preventing type 2 diabetes, nor did we find a comparison of a comprehensive digital LCP to a program that supplemented in-person sessions with digital tools. These comparisons could be beneficial in designing future programs to expand the reach of LCPs.

However, the question of whether an in-person LCP or a digital LCP is more effective across a broad population is likely not a particularly important question. Rather, as the number of LCP options continues to grow, clinicians need evidence to guide individual patients in selecting the LCP in which they personally will be most likely to succeed. In other words, what are the key LCP and patient criteria that determine the best LCP-patient match, if any? Also, do patient outcomes improve if patients are offered a choice of LCP delivery methods and can select a program that best meets their needs? The option for patients to customize their delivery modes and digital tools may pave the way to personalized LCPs and possibly even increased participation in LCPs.

Limited research demonstrates positive patient experiences and perceptions of digital LCPs, and several studies show high participant engagement with these programs. Participant-level data from the CDC’s DPRP demonstrate a dose-response relationship between the number of LCP sessions that participants attend and the weight loss they achieve (42). When considering in-person LCPs, the most straightforward measurement of participant engagement is the number of sessions attended. However, comprehensive digital LCPs collect large quantities of granular data regarding participant engagement with several components of their programs. This creates an opportunity to develop a more nuanced understanding of different forms of participant engagement and of how quantity and type of engagement interact to affect weight loss outcomes.

Omada and Noom have begun to collect and publish data on the effects of specific components of their programs that can influence weight loss but are just beginning to scratch the surface of this new terrain. Research that more deeply evaluates participant engagement could shape the next generation of not only digital LCPs, but also all LCPs in the National DPP.

The original DPP trial provided one-on-one coaching to participants and was highly effective. However, delivering an LCP on an individual basis was quite labor-intensive and expensive, so translation of the DPP curriculum to a group setting was a key step to begin scaling the National DPP to a larger audience. Digital health–supported LCPs can mimic one-on-one coaching interactions through their individualized platforms and are able to automate certain components of the program, such as feedback on dietary and physical activity tracking data or reminders to participants, thereby reducing the human resources required to deliver an LCP.

If we seek to reach the 84 million Americans with prediabetes, there is no question that digital health–supported LCPs are an essential and growing piece of the National DPP initiative. Additionally, digital LCPs can deliver personalized coaching and simultaneously provide opportunities for the group interactions and support that are a valuable component of LCPs. In other words, digital LCPs do not require a choice between individual or group-based interactions because both are possible without significantly changing the structure or cost of the program.

Digital LCPs that involve mobile components also quite literally extend the program into the community. Participants interact with the program to implement healthy lifestyle changes at the actual places and times they need help with behavior modifications. This model aligns directly to a key tenet of the National DPP, which is to be grounded in the community and to meet participants when and where they need assistance. In this way, digital health–supported LCPs offer an exciting and scalable means to form stronger linkages for our patients between the clinical world and the day-to-day community setting.

Despite the gaps in literature described above, digital health solutions to prevent type 2 diabetes have a more robust evidence base than the vast majority of digital health solutions targeted toward consumers (43). However, in addition to the need to broaden the evidence base, a number of other practical challenges impede the adoption of digital LCPs. An AMA survey (16) determined that clinicians have four key questions about digital health: “Does it work?” “Does it work in my practice?” “Will I get paid?” and “Will I get sued?” The first question has been discussed here extensively, and the other questions speak to issues that need to be addressed before digital health– supported LCPs can be adopted widely. There are several factors that influence uptake, including lack of clinician awareness, implementation challenges (such as referral processes), and varying levels of insurance coverage and costs. Superimposed on these factors, the general digital health environment in the country is evolving, and issues around the Health Insurance Portability and Accountability Act (HIPAA), data security, and digital health regulations are in constant flux. Figure 1 depicts the relationship of these factors to the adoption of digital LCPs in the clinical setting. As health care delivery organizations successfully address these barriers to implementing digital health solutions, it is imperative that they publish their experiences so that best practices for the adoption of digital LCPs are documented and spread.

Factors influencing the adoption of digital health–supported LCPs.

” data-icon-position=”” data-hide-link-title=”0″>FIGURE 1.

FIGURE 1.

Factors influencing the adoption of digital health–supported LCPs.

It is worth noting that digital LCPs have the potential to generate cost savings for the health care system (37,38,42). Whether this will translate to more consistent insurance coverage for digital LCPs remains to be seen. Digital health–supported LCPs are currently excluded from the Medicare coverage for type 2 diabetes prevention LCPs that began in 2018 because they were not included in the model test that led to payment for in-person diabetes prevention LCPs (44).

Conclusion

Digital LCPs can expand access for patients who struggle to attend an in-person LCP or prefer a digital health solution. Gaps in evidence and implementation include a dearth of research regarding program effectiveness and implementation best practices in priority populations and guidance for clinicians seeking to determine the best patient-LCP match. Deeper exploration is also needed to characterize how participant engagement with different components of digital LCPs affects outcomes. Future work should address these gaps using pragmatic study designs that examine the clinical and organizational context for the adoption of digital health LCPs for the prevention of type 2 diabetes. As the United States strives to reduce the burden of type 2 diabetes, digital health–supported LCPs can innovatively bridge the clinical and community settings and are an important addition to our national type 2 diabetes prevention strategy.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the American Medical Association.

Acknowledgments

We are indebted to Annalynn Skipper for her assistance with the literature review and thoughtful editing and to Benjamin O’Brien for his creative figure development and formatting. We are also deeply grateful to Meg Barron, Chelsea Katz, Kim Brunisholz, and Karen Kmetik for invaluable feedback.

Duality of Interest

No potential conflicts of interest relevant to this article were reported.

Author Contributions

K.K. and N.S. researched data and wrote and edited the manuscript. K.K. is the guarantor of this work and, as such, had full access to all the data contributing to the literature review and takes full responsibility for the accuracy of the content summarized here.

More Than A Diet: Is The Blue Zone Solution The Lifestyle For Longevity?

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You may have heard some buzz about the “Blue Zone Solution,” National Geographic Fellow Dan Buettner’s bestselling book investigating regions of the world that produce the most centenarians (that’s people over 100 years old). Although many of these people follow a Mediterranean-style eating pattern, the Blue Zone Solution isn’t a diet.

“The Blue Zone Solution is really a lifestyle curated from regions where people live long, healthy lives,” explains Maria Conley, RDN, a registered dietitian and functional medicine nutritionist at Henry Ford Health System. “While these people live in different parts of the world and have access to different types of foods, 95% of their diet is rooted in plant-based foods.”

What Is A “Blue Zone” Diet?

The Blue Zone Solution is a combination of lifestyle choices that Buettner identified during a decade-long research project on centenarians. The key regions where living to 100 is common:

  • Icaria, Greece: People who live on this Greek island follow a Mediterranean diet, and they live roughly seven years longer than the average American. Plus, most people over 80 in this community are still mobile.
  • Ogliastra, Sardinia (Italy): Most residents of this island off the coast of Italy are shepherds who eat a plant-based diet with just a bit of pork and red wine.
  • Okinawa, Japan: This region of the world is so well known for its elderly population that there’s even a diet dubbed The Okinawa Diet. The key to their longevity? Plant-based eating and strong social networks.
  • Nicoya, Costa Rica: This central peninsula town in Costa Rica has the lowest rate of middle-aged death in the world. People here are three times more likely to live to age 90 than Americans. They eat a plant-based diet and continue with physical labor into their golden years. They also have a strong sense of purpose.
  • Loma Linda, California: It’s a bit surprising to see America make the list, but this region of the country is largely made up of Seventh-Day Adventists, a religious community that shuns sugar, meat, alcohol, tobacco and caffeinated beverages, among other things.

Blue Zone Tenets

Although genetics plays a role in how long you’ll live, it’s only one small part of the equation. “Diet, exercise, lifestyle and other factors account for up to 70% of your lifespan,” Conley says.

People in the Blue Zones eat fruits, vegetables, whole grains and beans every single day. They don’t snack on energy bars and processed foods, choosing instead to munch on nuts and seeds when they’re hungry. But they also adopt other healthful lifestyle habits, including what Buettner identified as the “Power 9”:

  1. Move naturally. The people who live the longest don’t hit the gym or log 40 minutes during their morning run. “Movement is simply part of the way they live,” Conley says. Maybe they’re gardening, fishing or transporting water from a well. This type of manual labor requires both cardiovascular and strength training activities — and it keeps you fit and trim.
  2. Find purpose. There’s no doubt that having a sense of purpose in your life helps people get out of bed in the morning. In Okinawa, locals call it “Ikigai,” in Nicoya, Costa Ricans call it “plan de vida.” Loosely translated, these phrases mean, “why I wake up in the morning.” Once you have that, it’s easier to get moving!
  3. Practice stress management. Stress is inevitable, but we all have a choice in how we manage it. In the Blue Zone regions people tend to de-stress throughout the day with specific routines. They might take 15 minutes to pray or meditate or “siesta” following the afternoon meal. No matter which stress-busting tools they choose, they make a point not to let the stress build up and fester.
  4. Eat less. People in these regions tend to stop eating before they’re bellies are overstuffed. In Okinawa, for example, people have a mantra they use to stop eating when they feel about 80% full. They often eat their smallest and last meal of the day in the late afternoon or early evening, a dietary pattern that’s mimicked by intermittent fasting.
  5. Swap meat for plants. Beans, vegetables, nuts, seeds and unprocessed ancient grains are staples in the Blue Zones. Meat, on the other hand, barely makes an appearance. “It’s usually 2 ounces or less of meat, just five times per month,” Conley says. Blue Zone regions also avoid processed foods and snacks, which are linked to diseases ranging from diabetes to cancer.
  6. Hit happy hour…in moderation. In every Blue Zone except Loma Linda, alcohol regularly shows up on the menu. Moderate drinkers outlive nondrinkers, but if you tip the scales past “moderate” (one drink for women, two for men), you’ll shorten your life rather than lengthen it.
  7. Keep the faith. The vast majority of centenarians have one thing in common: They belong to a faith-based community. Denomination doesn’t make a difference but attending some sort of service regularly could tack a few years on to your life.
  8. Put family first. Family is the cornerstone of healthy living for many people who reach their 100th birthday. They care for aging parents and grandparents. And they tend to marry and have children.
  9. Find community. Studies consistently show that strong social connections protect against premature death. “The reality is that people who have strong support systems tend to fare better when life gets difficult. Positive support systems also help to reinforce healthy behaviors.” Conley says.

Achieving A Blue Zone Benefit

If you’re interested in adding years to your life, you don’t have to move to a Blue Zone or adopt a vegetarian diet. The idea is to incorporate as many of the Power 9 tenets as possible into your busy life.

“People in Blue Zones eat more plant-based foods, fewer processed foods, they spend less time on devices, they move as part of their daily repertoire, and they value family, faith, and community,” says Conley. “They also find time to unwind.”

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To find a doctor at Henry Ford, visit henryford.com or call 1-800-HENRYFORD (436-7936).

Maria Conley, RDN, works with functional medicine patients as part of the Center for Integrative Medicine at Henry Ford Medical Center – Novi.

Teens and social media use: What’s the impact?

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Social media is a big part of many teens’ lives. A 2018 Pew Research Center survey of nearly 750 13- to 17-year-olds found that 45% are online almost constantly and 97% use a social media platform, such as YouTube, Facebook, Instagram or Snapchat.

But what impact does social media use have on teens?

Social media benefits

Social media allows teens to create online identities, communicate with others and build social networks. These networks can provide teens with valuable support, especially helping those who experience exclusion or have disabilities or chronic illnesses.

Teens also use social media for entertainment and self-expression. And the platforms can expose teens to current events, allow them to interact across geographic barriers and teach them about a variety of subjects, including healthy behaviors. Social media that’s humorous or distracting or provides a meaningful connection to peers and a wide social network might even help teens avoid depression.

Social media harms

However, social media use can also negatively affect teens, distracting them, disrupting their sleep, and exposing them to bullying, rumor spreading, unrealistic views of other people’s lives and peer pressure.

The risks might be related to how much social media teens use. A 2019 study of more than 6,500 12- to 15-year-olds in the U.S. found that those who spent more than three hours a day using social media might be at heightened risk for mental health problems. Another 2019 study of more than 12,000 13- to 16-year-olds in England found that using social media more than three times a day predicted poor mental health and well-being in teens.

Other studies also have observed links between high levels of social media use and depression or anxiety symptoms. A 2016 study of more than 450 teens found that greater social media use, nighttime social media use and emotional investment in social media — such as feeling upset when prevented from logging on — were each linked with worse sleep quality and higher levels of anxiety and depression.

How teens use social media also might determine its impact. A 2015 study found that social comparison and feedback seeking by teens using social media and cellphones was linked with depressive symptoms. In addition, a small 2013 study found that older adolescents who used social media passively, such as by just viewing others’ photos, reported declines in life satisfaction. Those who used social media to interact with others or post their own content didn’t experience these declines.

And an older study on the impact of social media on undergraduate college students showed that the longer they used Facebook, the stronger was their belief that others were happier than they were. But the more time the students spent going out with their friends, the less they felt this way.

Because of teens’ impulsive natures, experts suggest that teens who post content on social media are at risk of sharing intimate photos or highly personal stories. This can result in teens being bullied, harassed or even blackmailed. Teens often create posts without considering these consequences or privacy concerns.

Protecting your teen

There are steps you can take to encourage responsible use of social media and limit some of its negative effects. Consider these tips:

  • Set reasonable limits. Talk to your teen about how to avoid letting social media interfere with his or her activities, sleep, meals or homework. Encourage a bedtime routine that avoids electronic media use, and keep cellphones and tablets out of teens’ bedrooms. Set an example by following these rules yourself.
  • Monitor your teen’s accounts. Let your teen know that you’ll be regularly checking his or her social media accounts. You might aim to do so once a week or more. Make sure you follow through.
  • Explain what’s not OK. Discourage your teen from gossiping, spreading rumors, bullying or damaging someone’s reputation — online or otherwise. Talk to your teen about what is appropriate and safe to share on social media.
  • Encourage face-to-face contact with friends. This is particularly important for teens vulnerable to social anxiety disorder.
  • Talk about social media. Talk about your own social media habits. Ask your teen how he or she is using social media and how it makes him or her feel. Remind your teen that social media is full of unrealistic images.

If you think your teen is experiencing signs or symptoms of anxiety or depression related to social media use, talk to your child’s doctor.

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Do And Don’ts For Asthma Patients

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Do and don’ts for asthma patients  – Asthma is one of the most common health problems among people and even youngsters and kids. You have to be taking extra precautions to not worsen the condition. If you are here to know do and don’ts for asthmatic patients then you are at the right place. Asthma is nothing but a medical condition that affects the bronchioles of the lungs. Therefore, here we will discuss the top things to do and not do for asthma patients.

Do and donts for asthma patients

Asthma is basically caused by the inflammation of airways. The inflammation causes the airways to constrict which causes them to irritate and makes it difficult for the air to get in and leave the air passages and this causes wheezing and breathlessness. Asthma patients usually suffer from sudden and frequent attacks of short breath and breathlessness. Following certain effective tips can help you overcome this health issue with an utmost ease.

What are the causes and symptoms of Asthma?

Cold air, pollution, exercise, emotions, allergies to dust, pollen and animals, smoking and passive smoking are the some of the major reasons that are responsible for causing asthma. Other reason might include unhealthy eating habits, lifestyle etc. Now, that you know the causes, it is important for you to know the symptoms as well. Therefore, scroll down to know the symptoms of Asthma.

  • Wheezing
  • Troubled breathing
  • Shortness of breath
  • Panting
  • A cough with or without mucus

The list of do’s and don’ts for people suffering from Asthma

There are plenty of things that a person with Asthma should be careful about. Asthma is a serious health problem that definitely has to be taken care of. Therefore, you do not have to look any further if you want the simplest but the most effective things to do and not do when suffering from asthma. Below is the list of the most effective do’s and don’ts that you should strictly follow.

Do’s

Below mentioned are some of the things that you should strictly do if you are suffering from asthma. Following them in your daily routine can bring out the best and positive results in fewer days than expected.

  1. Asthma patients should strictly stay away from all the things that trigger the asthmatic attacks or breathing problems.
  2. Try to maintain a healthy sleep routine. Also, make sure to include exercises in your daily routine to lead a healthy life.
  3. Avoid smoking and even passive or second-hand smoking as all of them are equally bad for the overall health.
  4. Apart from taking care of yourself, make sure the place you live in is also dust or dirt free to avoid any breathing problem.
  5. Regularly consult your doctors and stay in more pollution- free environment.
  6. Keep inhalers and other important medications handy. Also, take medicines on a proper interval as per your doctor has suggested.

Don’ts

Here, we have compiled a set of the things that you should not do if you are an Asthma patient. Most people end up following wrong routines that make their condition worse. Therefore, go through the list below and try to follow them.

  1. Do not disrupt your regular and healthy routine as this will cause a major effect on your whole body and not just lungs.
  2. Do not smoke and drink, if you do you should quit it right away for the obvious reasons.
  3. Overwater indoor plants if you are allergic to mold. Wet soil encourages mold growth.
  4. Take more medications than required in order to lessen your symptoms.
  5. Hang sheets or clothing out to dry. Pollens and molds may collect on these items.

Conclusion

Therefore, if you have been looking out for the top do’s and don’ts for the asthma patients then we hope this might have been of some use to you. Aforementioned are the top and useful tips that you can bring out in your daily routine to get the satisfactory results. So, go ahead and now fight asthma with the most effective tips.

Healthy Eating During the COVID-19 Pandemic

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Support your physical and mental wellbeing with healthy eating

We are living during difficult times because of the coronavirus pandemic. Those challenges can affect us both physically and emotionally. It’s hard to keep the same routine when you have to physically distance from others, especially if you’re at higher risk of getting really sick from the virus. That makes preparing meals a special challenge. Here are some tips that can support you and your household both physically and mentally:

  • Do your best to eat nourishing meals, like those rich in fruits and vegetables, lean protein, and whole grains. Those foods can help keep your body and mind healthy during stressful times.
  • Cut down on foods that can ramp up anxiety, such as sugar, caffeine, and alcohol.
  • It’s important to enjoy small treats, but avoid going overboard. Try to limit excessive consumption of sugar, caffeine, and alcohol. Overindulging can lead to increased anxiety or sluggishness.
  • Feeling the urge to “stress snack”? Acknowledge your cravings, then take two or three deep breaths and ask yourself if you’re really hungry or just passing the time.
  • Having daily schedules and routines can ease anxieties and help you stay grounded. This applies to meals, too! Try to eat at regular meal times and avoid snacking in between. For more tips about managing stress, read Managing Stress and the Threat of COVID-19 (PDF).
  • If you’re staying at home with other people, try to eat at least one meal together each day. It can help dampen feelings of isolation, and help you practice mindful eating. Cooking together can also help you connect with others and ease the stress.
  • If you’re struggling to afford groceries, there are Minnesota-based resources available to you. Learn more about resources to help you afford food.

Safe grocery shopping

Woman in a face mask while shopping in a supermarket during coronavirus quarantineYou can help slow the spread of the coronavirus, even while you’re grocery shopping. By following a few basic guidelines, you can shop safely and efficiently, protecting yourself and others. The key is to plan ahead, limit your exposure to the virus, and buy only what you need—there’s more than enough food available if shoppers don’t hoard.

Just follow these basic tips:

  • Think ahead to limit your time in the store. Make a plan for meals and snacks for one or more weeks. Be flexible in case an item is temporarily out of stock – there might be a substitute.
  • Include healthy foods on your shopping list that have longer shelf-life. Those items can include carrots, turnips, potatoes, yams, beets, onions, squash, cabbage, apples, melons, oranges, grapefruit, lemons, and limes, as well as frozen fruits and vegetables.
  • Limit exposure by sending only one member of the household to shop. Do not bring along additional members, if possible.
  • Wear a cloth face covering when shopping. Also, many stores have cleaning stations to sanitize your shopping carts and hands. Use them if they are available. Don’t forget to wash your hands after leaving the store and after putting away the groceries.
  • Maintain at least 6 feet from other shoppers and grocery store staff as much as possible while shopping.
  • Touch only what you plan to purchase.
  • Do not use soap, detergent, or sanitizers to clean produce. They can get into the food and make it unsafe to eat.
  • Need help planning nutritious meals? The University of Minnesota Extension Service has an easy-to-follow Two Week Menu Kit that includes a grocery checklist.

Resources to help you afford food

Many people living in Minnesota face challenges to get safe, affordable, healthy food. That challenge is tougher because of the coronavirus pandemic. If you’re having a hard time affording food, or even if you might, there’s assistance now, before you run out of food.
The following resources are available to help you:

Healthy eating for the whole family

Social distancing guidelines and virtual learning have meant big shifts in family routines, and that may include how you feed your family. Good food is fuel, not only for the body but also for the brain. That’s especially true for younger and school-aged children. Preparing a healthy breakfast, lunch, and dinner every day may seem overwhelming, but taking it one step at a time, and focusing on progress–not perfection–can help.

Follow these tips to help your family set a healthy eating routine:

  • If possible, set up times for household “to-do’s,” including meals and snacks, time for physical activity, school, free time, and regular bed-times.
  • Try to plan out your meals and snacks before you go to the grocery store. That helps you limit your trips while making sure you have the right foods for you and your family to eat a balanced diet.
  • Ensure healthy, appealing snacks are available and visible, such as a bowl of fruit or carrots. Stock up on nutrient-rich snacks like dried fruits and nuts, cheese, boiled eggs, yogurt, chopped veggies, and hummus.
  • Involve kids in meal planning and cooking. Involving children in simple tasks like reading recipes, measuring, and learning about fruits and vegetables. That can be a part of their “distance learning” in reading, math, and science!
  • There are lots of online healthy lunch recipes for kids. Involve them in choosing and creating those lunches. Try this website from the University of Minnesota Extension for recipe ideas and cooking tips: https://reallifegoodfood.umn.edu/
  • Serve milk or water, and avoid sugary drinks. If you give your kids juice, limit it to one small glass of 100% fruit juice a day.
  • Aim for at least 60 minutes of active play during the “school” day, and if possible, spend time outside each day, while practicing social distancing guidelines.
  • Try to do your best to be a role model for healthy eating.
  • If you’re struggling to afford groceries, there are Minnesota-based resources available to you. Learn more about resources to help you afford food.

Breastfeeding and COVID-19 guidance

Breastfeeding is one of the most important things you can do for the long-term health of your baby. That’s because it’s the best source of nutrition for most infants. However, it’s also important to use caution when breastfeeding children during the coronavirus pandemic. Taking a few cautionary steps, similar to the steps recommended for reducing personal exposure to the coronavirus, can help to keep your baby healthy while breastfeeding.

Learn more about breastfeeding during the COVID-19 pandemic.

Staying safe while shopping at farmers markets

Minnesota’s farmers markets are a good source of locally grown fruits and vegetables. Shopping at a farmers market is similar to safely shopping at a grocery store. Think about the following tips:

  • Stay home if you are feeling sick.
  • Follow social distancing guidelines, keeping 6 feet between you and others.
  • Wear a face mask to help protect those around you.
  • If possible, have only one family member go into the market to help reduce your family’s exposure.
  • Wash your hands and sanitize them frequently. Many farmers markets have cleaning stations—it’s a good idea to take advantage of them.
  • Do not touch the produce or goods until they are handed to you by the vendor.
  • Bring smaller bills to reduce the money changing hands.
  • Be patient. The purchasing time may take a little longer.
  • Check market requirements on reusable bags. If they’re allowed, machine wash them between each shopping trip.
  • Some markets are offering pre-ordering and curbside pickup. Check out your market’s website to learn what options they offer.
  • Follow any instructions and signage posted at your market.

Keeping gardening fun and safe

Gardening can be a fun, relaxing activity that can help reduce stress while producing healthy food. For safe ways to garden during the outbreak, consider the following tips:

  • In the same way you buy groceries, plan your trip to the garden store in advance, to help limit your time at the store.
  • If possible, have only one family member go to the garden store to help reduce exposure.
  • Follow social distancing guidelines while shopping at the garden store, keeping 6 feet between you and others.
  • Wear a face mask to help protect those around you.
  • If you do not want to enter a garden store, contact them to see if it is possible to place your order online or over the telephone. You could also consider buying plants or seeds online.

If you garden in a community space, follow these practices to stay healthy:

  • Never enter community gardens if you are feeling sick.
  • Maintain a minimum distance of 6 feet from other people within the garden.
  • Do not hold community work days, celebrations, or other events that encourage gatherings at the community garden.
  • If you use shared tools, make sure they’re sanitized regularly.
  • Wash your hands often—at least before and after visiting the garden, and at the garden if a sanitation station is available.
  • Bring along your face mask just in case it’s hard to maintain effective social distancing.

If you are a community garden organizer, learn more about Guidance for Minnesota Community Gardens (PDF).

Exercise as it relates to Disease/The effect of different modes of training on glycaemic control?

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Posted in Healthy lifestyle

This article is a critical analysis of the paper:
“Effects of a short-term circuit weight training program on
glycaemic control in NIDDM” [1]

What is the background to this research?[edit | edit source]

Exercise has long been identified as an effective therapy for treating diabetes mellitus. Previous studies have utilised aerobic exercise as a means of improving/preventing Non-Insulin Dependent Diabetes Mellitus (NIDDM, type 2 diabetes-T2D). This study looks to identify the effect weight/strength training (specifically Circuit Weight Training – CWT) has on patients with NIDDM.[1] Evidence suggests weight training improves insulin sensitivity and glucose tolerance similarly to aerobic exercise.[2][3]

The table below presents background data from different exercise modality interventions examining similar diabetic indicators as those examined in this study.[4]

Diabetic indicators Aerobic Resistance Combined
Fasting glucose (mmol/L) -0.20 +- 0.15 (small) -0.10 +- 0.31 (unclear) 0.53 +- 0.31 (small)
Postprandial glucose (%) -0.44 +- 0.20 (small) -0.10 +- 0.53 (unclear) 0.28 +- 0.46 (small)
Insulin Sensitivity (%) 0.74 +- 0.47 (moderate) 0.34 +- 0.52 (small) 2.20 +- 1.85 (large)
Fasting insulin (%) 0.47 +- 0.63 (moderate) 0.78 +- 0.97 (moderate) 0.15 +- 1.89 (unclear)
  • Data: <0.20=trivial; 0.20–0.60=small; 0.60–1.20=moderate; >1.20=large. Small, moderate and large indicate magnitude of the benefit, ‘unclear’=evidence of a benefit is inconclusive.[4]

A more complex understanding of the characteristics of metabolic and physiological changes that occur from resistance/weight training, allows the most effective exercise treatment to be prescribed to type 2 diabetics.

Where is the research from?[edit | edit source]

The article was published in the Diabetes Research and Clinical Practice international journal. By authors that hold esteemed reputations, having published over 1500 documents between them investigating insulin sensitivity, diabetic and cardiometabolic markers response to exercise.[5][6][7] Such a wealth of knowledge is considered advantageous to a clinical health study.

Authors:

  • K.G Stanton – Diabetes and Endocrinology department.
  • D.W Dunstan – International Diabetes Institute.
  • L.J. Beilin, V.Burke and I.B Puddey – Heart Research Institute.
  • A.R Morton – Human Movement Department.

Support from the National Health and Medical Research Council is acknowledged, and no obvious biases exist regarding the configuration of this original article.

What kind of research was this?[edit | edit source]

The study was a prospective Randomised Control Trial (RCT). One group (n 11) were randomly assigned to the CWT intervention, whilst 10 control subjects were assigned for later comparison. RCT’s are the most effective way of determining a cause and effect relation between the intervention (treatment) and the outcome (effect).[8]

What did the research involve?[edit | edit source]

  • 21 diagnosed NIDDM subjects assigned to the CWT or control group.
  • Medical screenings and physical examinations conducted.
  • 8-week full body CWT intervention, 3 days/week.
  • Intensity – 50-55% 1 RM, 10-15 reps, 2 sets. Additional set added after 2 weeks.
  • Program midpoint (4weeks) strength (1RM) reassessed, training load adjusted.
  • Fasting serum glucose and insulin measured following 12h fast (OGGT -75g) before and after 8 weeks.[1]

Critique of the methodology used[edit | edit source]

Firstly, of the 21 subjects involved in the study 15 were using oral hypoglycemic medication (sulfonylureas use reported). Sulfonylureas stimulates increased insulin secretion at all glucose concentration levels.[9] Therefore, despite the exclusion of participants taking insulin, pre- and post-intervention measures of glucose and insulin may be jeopardised. Population demographic applicability is also narrowed in this study. Firstly, 51 was the reported mean age, restricting younger and older population applicability. Furthermore, participants were only chosen for the study if they reported less than 60 mins/wk. of vigorous intensity exercise in the last 6 months. Despite diabetes being common in sedentary populations, the response to increased exercise stimulus may differ significantly in T2D patients.[10]

Perhaps most significant are the predictive claims made based on participants self-reported lowered blood glucose. Results were assumed to be caused by CWT and its effect on glycaemic control and insulin responsiveness, despite the collection and reporting methods being exposed to potential bias. A glucose clamp technique, for example, would have provided more accurate evidence and data.[11] Predictive claims based on self-reported evidence should be avoided, especially given the exact effects/mechanisms CWT has on glycaemic control and insulin responsiveness remains relatively unknown. Finally, the program’s length means the findings are acute and despite CWT potentially inducing chronic beneficial T2D adaptations, further research is needed to support this claim, especially given participant adherence may decline.

Despite the possible limitations of the study there are strengths. The exercises employed in this study are like previous resistance exercise intervention studies that have improved glucose tolerance.[12] Furthermore the OGGT (75gm) has been used previously to investigate the link between exercise and glucose tolerance/metabolism before and after exercise interventions.[12]

What were the basic results?[edit | edit source]

Most notable change from baseline to post intervention:

  • CWT reduced plasma insulin response to glucose ingestion.
What Were The Important Findings.[1]
Baseline Glucose (mmol/L-1) Post-Glucose (mmol/L-1) Baseline Insulin (pmol/L-1) Post Insulin
CWT 9.6 (+-0.9) 9.4 (+-0.8) 64.3 (+-12.7) 63.1 (+-12.6)
Control 9.9 (+-1.2) 9.8 (+-1.3) 82.6 (+-10.5) 93.8 (+-12.6)
  • Randomly allocated groups therefore, baseline measures differed between control and CWT group.

The implications drawn from study results is that a short-term CWT program improves glycaemic control in patients with NIDDM. However, despite potentially improving insulin sensitivity, plasma glucose response following glucose ingestion remained relatively unchanged. Authors comment on the potential mechanisms yet acknowledge the study doesn’t support those previously cited (decrease body fat, increase lean muscle mass).[13] The study measured skinfolds and BMI (relatively unchanged) however, measurements of lean muscle mass and body fat may have been more advantageous to investigate the potential mechanisms of adaptation.

What conclusions can we take from this research?[edit | edit source]

Short-term CWT improved insulin response to a glucose load, however, insignificant improvements in glucose tolerance suggest potential weaknesses in data collection. The study acknowledges findings are acute adaptations and longer-term exercise interventions are required to examine the underpinning mechanisms and chronic effects of CWT on NIDDM.

The implications of this research (1998) and more recent evidence suggest small physiological benefits to the lifestyle management of NIDDM despite the exercise mode (resistance, aerobic, combination).[4] Furthermore, recent evidence suggests exercise intensity has little influence on diabetic management, despite most physiological adaptations being intensity sensitive.[4] Therefore, exercise adherence, despite the modality and intensity is perhaps the most important factor responsible for inducing chronic beneficial adaptations in T2D patients.[4] Exercise programming should be individualised, as individuals who may benefit the most from aerobic exercise often have the greatest difficulty performing it.[14] Resistance training may be more achievable and therefore beneficial for individuals with severe obesity, arthritis and/or diabetic complications.[14]

Recommendations for exercise interventions:

  • Conduct risk assessments and pre-exercise screenings.(https://www.essa.org.au/Public/ABOUT_ESSA/Adult_Pre-Screening_Tool.aspx).
  • Conduct relevant physiological tests.
  • Progress intensities following at least 2 weeks of training (discretion).
  • Monitor technique, physiological/health responses (test, re-test).
  • Group training and encouragement (create/maintain active lifestyle).
  • Combining the effects of exercise, diet and drug therapy will help better manage type 2 diabetes.

Further information/resources[edit | edit source]

If this article is of interest to you as a health practitioner see further resources below:

If this article is of interest to you as a patient see further resources below:

  1. a b c d DW, Puddey IB, Beilin LJ, Burke V, Morton AR, Stanton K. Effects of a short-term circuit weight training program on glycaemic control in NIDDM. Diabetes research and clinical practice. 1998;40(1):53-61.
  2. Krotkiewski M, Lönnroth P, Mandroukas K, Wroblewski Z, Rebuffe-Scrive M, Holm G, et al. The effects of physical training on insulin secretion and effectiveness and on glucose metabolism in obesity and type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1985;28(12):881-90.
  3. Miller JP, Pratley RE, Goldberg AP, Gordon P, Rubin M, Treuth M, et al. Strength training increases insulin action in healthy 50-to 65-yr-old men. Journal of Applied Physiology. 1994;77(3):1122-7.
  4. a b c d e NJ, Hopkins WG. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis. Diabetes care. 2006;29(11):2518-27.
  5. Dunstan D, Zimmet P, Welborn T. The Australian diabetes obesity lifestyle study rising prevalence diabetes and impaired glucose tolerance. Diabetes Care. 2002;25:829-34.
  6. Healy GN, Matthews CE, Dunstan DW, Winkler EA, Owen N. Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003–06. European heart journal. 2011;32(5):590-7.
  7. Kargotich S, Keast D, Goodman C, Bhagat C, Joske D, Dawson B, et al. Monitoring 6 weeks of progressive endurance training with plasma glutamine. International Journal of Sports Medicine. 2007;28(03):211-6.
  8. Kendall J. Designing a research project: randomised controlled trials and their principles. Emergency medicine journal: EMJ. 2003;20(2):164.
  9. Groop LC. Sulfonylureas in NIDDM. Diabetes care. 1992;15(6):737-54.
  10. Bassuk SS, Manson JE. Epidemiological evidence for the role of physical activity in reducing risk of type 2 diabetes and cardiovascular disease. Journal of applied physiology. 2005.
  11. Tessier D, Ménard J, Fülöp T, Ardilouze J-L, Roy M-A, Dubuc N, et al. Effects of aerobic physical exercise in the elderly with type 2 diabetes mellitus. Archives of gerontology and geriatrics. 2000;31(2):121-32.
  12. a b W, Sherman W, Ivy J. Effect of strength training on glucose tolerance and post-glucose insulin response. Medicine and science in sports and exercise. 1984;16(6):539.
  13. National Institutes of Health, Consensus developmentconference on diet and exercise in non-insulin-dependentdiabetes mellitus, Diabetes Care 10 (1987) 639 – 644
  14. a b ND, Plotnikoff RC. Resistance training and type 2 diabetes: considerations for implementation at the population level. Diabetes care. 2006;29(8):1933-41.