The good news: Most people are at least aware of changes they need to make to improve their heart health, a study in the Journal of the American Heart Association concluded. The bad: Nearly one in five people with the greatest risk for heart disease don’t feel the need to do anything.
Canadian researchers wanted to see how these risk factors for ischemic heart disease -- such as smoking, obesity, lack of physical activity, diabetes and high blood pressure – affected people’s perceptions about the need to improve their health. No matter how many risk factors someone has, the authors noted, he or she won’t make healthy changes unless they feel a need to do so. Ischemic heart disease, also called coronary artery disease, where plaque buildup in the arteries restricts blood flow to the heart, is largely preventable, they wrote, so understanding what might motivate people to change unhealthy behavior is crucial.
But it’s just a step toward solving a complex problem.
“It’s very difficult to get people to change their behavior,” says Dr. Elisabeth von der Lohe, MD, a cardiologist at Indiana University Health. “If they don’t have any pain or shortness of breath, the idea that they could die from heart disease is so abstract. They think it will happen to someone else but not to them.”
Examination of more than 45,000 health surveys about nine heart health risk factors revealed that 74 percent of the adults surveyed said they need to improve their health, and 81 percent of that group said they intended to do so in the upcoming year. Among people with five or more risk factors for heart disease, however, only 17.7 percent felt the need to change any unhealthy behaviors. More than half of survey respondents cited barriers that prevent them from making healthy changes, with lack of self-discipline topping the list, followed by work and family responsibilities.
People with high blood pressure and diabetes weren’t more likely than respondents without those conditions to feel the need to improve their health, which concerns Dr. von der Lohe.
“We talk a lot about losing weight, eating healthy and exercising, but we don’t talk so much about high blood pressure and diabetes,” von der Lohe says. “Yet diabetes is such strong risk factor for heart disease. People underestimate its impact on heart health.”
Regular exercise is important for people with diabetes, she says, because it improves hormonal function of the arteries. So it’s good that most survey respondents cited getting more exercise as their chief health improvement goal. But people need to address all their heart disease risk factors – such as quitting smoking and losing weight, which were lower priorities to respondents – not just focus on one or two. A particularly dangerous health cocktail is diabetes and smoking, especially for women, Dr. von der Lohe says. Someone with those two risk factors needs to do more than get to the gym once or twice a week to significantly lessen her risk.
Awareness of risk factors might motivate some people to change, the researchers wrote, but not others. Dr. von der Lohe says that generally, her patients seem more motivated by positive reinforcement than by scary discussions about behaviors that can kill them. People need some sort of reward to really change their behavior, she says.
“We have data to show that if you frighten people, it doesn’t change behavior,” she explains, noting that everyone knows that smoking often leads to death but people still do it.
“Maybe we need more personal trainers, nutritionists and health coaches to work with people,” she says. Joining a group dedicated to healthy diets and exercise might be helpful as well.
“People find it hard to do on their own, so it could be helpful if they have someone they’re accountable to and who can guide them,” she says.
-- By Virginia Pelley