Lloyd-Jones, D.M., et al., on behalf of the American Heart Association Strategic Planning Task Force and Statistics Committee. 2010. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s Strategic Impact Goal through 2020 and beyond. Circulation, 121, 586–613.
The American Heart Association (AHA) recently issued its proactive agenda for the next decade by releasing a strategic plan for measuring, monitoring and improving the cardiovascular health of Americans.
In February 2009, the AHA board of directors approved the recommendation of scientists representing the AHA Strategic Planning Task Force, Statistics Committee and other ad hoc members. This group recommended that the AHA 2020 Impact Goal should be as follows: “By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases (CVD) and stroke by 20%.” While the AHA recognizes that defining and setting goals is a major first step, it is exercise professionals and health/fitness advocates who will direct the charge and implement exercise and intervention campaigns to inspire citizens to realize these goals.
Personal trainers have a unique opportunity and responsibility to lead the nation in reversing the rising tide of CVD events by promoting the meaningful and positive lifestyle changes presented by the AHA with regard to diet, physical activity and smoking. While the AHA report was written for U.S. providers, its recommendations can be helpful to fitness professionals worldwide.
Cardiovascular Disease and Stroke: Startling Statistics
Highlighted findings from the 2009 Heart Disease and Stroke Statistics report (Lloyd-Jones et al. 2009) reveal these disquieting facts:
- Approximately 2,400 Americans die of CVD each day. This means that on average there is one death every 37 seconds from CVD.
- More than 150,000 Americans killed by CVD in 2005 were under 65 years of age, which is far below the average life expectancy of 77.9 years.
- One in every 5 deaths in the United States in 2005 was from coronary heart disease (CHD, also referred to as atherosclerotic heart disease), which is the final result of the accumulation of atherosclerotic plaque within the walls of the coronary arteries.
- On average, someone in the United States has a stroke every 40 seconds (see the sidebar “Warning Signs of Stroke”). That represents about 1 in every 18 U.S. deaths.
- Despite health recommendations that all adult Americans complete 30 minutes of somewhat hard physical activity on most days of the week, 62% of adults over 18 years of age lead completely sedentary lifestyles.
- More than 12% of preschool children 2–5 years of age were overweight in 2005 (as measured by body mass index [BMI]—weight in kilograms divided by height in meters squared), placing them at or above the 95th percentile in body weight among children their age.
- An estimated 80 million American adults (approximately 1 in 3) have one or more types of CVD. These diseases include high blood pressure, coronary heart disease, myocardial infarction (heart attack), angina pectoris (chest pain), heart failure (inability of the heart to pump enough blood to sustain normal bodily functions), stroke and congenital (present at birth but not necessarily hereditary) cardiovascular defects.
- In 2005, the leading causes of death in women ≥ 65 years of age were (1) diseases of the heart, (2) cancer, (3) stroke and (4) chronic lower respiratory disease (CLRD, such as emphysema and chronic bronchitis). In older men, they were (1) heart disease, (2) cancer, (3) CLRD and (4) stroke (see Figure 1 for comparison of CVD and cancer by age in the U.S.).
Lloyd-Jones et al. (2010) note that data clearly show the prevalence of hypertension and type 2 diabetes in pediatric populations, which will no doubt lead to CVD at much younger ages for men and women in the future. Additionally, Lloyd-Jones et al. (2009) state that the underlying causes of the majority of CVD events are present and go undetected for decades before the occurrence of a “clinical event,” such as a nonfatal myocardial infarction or a disabling stroke.
AHA Introduces “Ideal” Cardiovascular Health
In its strategic plan for cardiovascular health promotion, the AHA has introduced a new concept called “ideal” cardiovascular health, defined as (a) the “simultaneous” presence of four favorable health behaviors (i.e., ideal BMI, physical activity, abstinence from smoking within the last year and dietary patterns that promote cardiovascular health), and/or (b) the “simultaneous” presence of four favorable health factors (untreated total cholesterol (< 200 milligrams per deciliter), untreated blood pressure (< 120/< 80 millimeters of mercury), abstinence from smoking within the last year, and absence of diabetes mellitus, and/or (c) the absence of clinical CVD (including stroke, heart failure, CHD, etc.). Because of its importance to ideal cardiovascular health, abstinence from smoking appears in the health behaviors and health factor lists (see the sidebar “Cardiovascular Health Effects of Smoking”). To further detail the new ideal cardiovascular health definition, a close inspection of each metric is given in Figure 2.
Charge to Action
The AHA is committed to attaining the 2020 cardiovascular health goals. The key to success is to translate the research-driven objectives into permanent public health efforts. However, it may very likely be the grass-roots efforts of personal trainers and group fitness instructors—who execute all of the AHA goals in their fitness interventions—that lead to these achievable outcomes being realized. Go for the Goal!
A stroke is a medical emergency that all exercise professionals must be able to recognize. Don’t ignore the signs of stroke, even if only a few are present or if they seem to go away temporarily. If someone has one or more of these stroke symptoms that last more than a few minutes, take immediate action:
- sudden numbness or weakness of the face, arm or leg, especially on one side of the body
- sudden confusion, trouble speaking or understanding
- sudden trouble seeing in one or both eyes
- sudden trouble walking, dizziness, loss of balance or coordination
- sudden, severe headache with no known cause
Action: If someone has one or more stroke symptoms that last more than a few minutes, immediately call 9-1-1 or your emergency medical service.
Key: kg/m2 = weight in kilograms divided by height in meters squared; mg/dl = milligrams per deciliter; mm Hg = millimeters of mercury.
With diet, a low trans fat intake is considered decidedly health promoting. Although the AHA acknowledges that no caloric guidelines from large sample studies are currently available to quantify precise caloric intake values, the new AHA recommendation encourages a diet that provides an appropriate energy balance for the individual and is consistent with a DASH (dietary approaches to stop hypertension) eating plan. This would include the following suggestions for a daily dietary intake of 2,000 kilocalories (kcal) (which should be scaled accordingly for other levels of caloric intake).
- sodium: < 1,500 mg per day
- fruits and vegetables: ≥ 4.5 cups per day
- fish: ≥ two 3.5-oz servings per week (preferably oily fish)
- fiber-rich whole grains (≥ 1.1 g of fiber per 10 g of carbohydrate); ≥ three 1-oz servings per day
- nuts, legumes and seeds: ≥ 4 servings per week
- processed meats: none or ≤ 2 servings per week
- saturated fat: < 7% of total energy intake
- sugar-sweetened beverages: ≤ 36 oz per week (≤ 450 kcal per week)
Key: mg = milligrams; g = grams; oz = ounce(s).
Source: Llyod-Jones et al. 2010.
Although cigarette smoking is highly associated with lung cancer, many individuals are unaware that smoking is also strongly related to heart disease. The nicotine in smoke reduces circulation by narrowing the arterial blood flow in the body. This places smokers at higher risk for peripheral vascular disease (an obstruction of the large arteries in the arms and legs that can cause a range of health problems, including pain, cramping, fatigue and circulatory problems).
Smoking has also been shown to lead to abdominal aortic aneurysms (i.e., swelling or weakening of the main artery of the body—the aorta—where it runs through the abdomen). In addition, smoking damages the airways of the lungs, leading to emphysema, chronic bronchitis and chronic airway obstructions, all of which may contribute to cardiovascular disease. According to the Centers for Disease Control and Prevention (CDD), smokers die on average 13–14 years earlier than nonsmokers.
Lloyd-Jones, D.M., et al. 2009. Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 119, e21-81. http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.108.191261v1
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