Major life events such as having a baby, starting a new job, or retiring can all lead to poor heart health, says a new study published today by the American Heart Association working group.

Major life events such as starting school or a new job, having a baby, or entering retirement all have the potential to influence one’s physical activity level, which can have a negative impact on one’s cardiovascular health.

American Heart Association Scientific Statement issued today in the association’s flagship publication Circulation urges individuals and healthcare professionals to take action to combat this problem. They can do that by being proactive rather than reactive.

It’s critical, say the members of the statement drafting group, to consider how changes in physical activity can affect health during key life events and transitions since sedentary behavior is an emerging risk factor for cardiovascular disease.

Additionally, the statement gives guidelines to health care practitioners on how to identify, address, and promote regular physical activity in individuals who are undergoing substantial life changes. Additionally, options for community-level interventions to increase physical activity are discussed.

“Certain life events and transitions may mark the beginning and end of different phases of a person’s life, and these life changes may lead to periods of less physical activity and more sedentary lifestyle behaviors. Physical activity is an important heart-healthy behavior and too much sitting and inactivity is not good for you,” explained the writing group Chair Abbi D. Lane-Cordova.

“This is a particularly important topic right now because, in addition to life’s other major events, the COVID-19 pandemic is another disruption of everyone’s daily routines and activity levels.”

According to the American Heart Association, most adults should engage in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of moderate aerobic activity per week, or a combination of the two, preferably spaced throughout the week. Every day, children and adolescents aged 6-17 should engage in at least 60 minutes of moderate-to-vigorous physical activity.

According to the US Centers for Disease Control and Prevention’s Office of Disease Prevention and Health Promotion’s “Healthy People 2020” initiative, only about one-fifth of teens (20%) and about one-fourth of adults (24%) in the United States have routinely met recommended levels of physical activity in recent years. While these rates are generally low, data indicate that they can fluctuate dramatically during a significant life event or transition. The writing group analyzed data from seventeen distinct life events or transitions and discovered evidence of decreased activity levels during nine of them:

• Beginning a new school (elementary, middle, high school or college) – each distinct life events;
• a first job or career change;
• a marriage or civil union;
• pregnancy;
• parenting;
• retirement; or
• moving into a long-term care facility.

Additionally, the writing group evaluated the consequences of significant life changes on various subgroups within the United States population in order to identify individuals most in need of help throughout life transitions. The following individuals are particularly at risk of experiencing major decreases in physical activity as a result of life changes:

• individuals with lower levels of education;
• those who lived alone during the initial COVID-19 venue closings;
• those who lacked safe access to outdoor space for exercise and physical activity; and
• women during pregnancy and parenthood.

The “socioecological model,” which considers human, societal, environmental, and policy factors, was used to analyze a variety of factors affecting physical activity levels.

General factors determining physical activity levels among youth (18 years of age) at the individual level, according to the study, include:

• gender;
• age;
• motor coordination;
• time outside;
• physical activity preferences
• body image;
• perceived barriers;
• involvement in school sports; and
• physical education.

Youth were influenced by their weight and physical activity levels, as well as their parents’ educational degree, on an interpersonal level. Neighborhood crime rates, perceptions of safety, walkability, proximity, and access to school programs and recreational amenities were all environmental influencers for youth. COVID-19-related restrictions and stay-at-home orders have also been linked to changes in youth physical activity, and Lane-Cordova believes that additional research is needed in this area.

The analysis of physical activity levels for adults (18+ year old) revealed individual influencers included:

• the perceived health benefits of exercise;
• history of and intention to exercise;
• self-efficacy/confidence to achieve goals;
• enjoyment; and
• lower stress levels.

Adults were influenced both positively and adversely by social and cultural norms, whereas environmental factors included closeness to and availability to recreation facilities and greenspaces, transportation, neighborhood walkability, and convenience.

Due to the paucity of research on factors affecting physical activity throughout life transitions, the statement advises further work to discover socioecological elements that may contribute to the support of routine exercise. These elements include the creation of safer roadways for walkers and bicycles, rail-to-trail conversion initiatives, and park renovations. The writing group offers public health measures that would help ensure that physical exercise is supported at significant life events.

Additionally, the statement makes practical recommendations for health care practitioners on how to maintain routine physical activity levels during significant life events and transitions.

Physical activity can be assessed by health care professionals by asking a few questions as part of the vital sign collection process during a routine health visit. A quick screening instrument consisting of questions for individual patient responses may be a low-cost solution for assessing physical activity levels and needed support in a healthcare environment. The writing group recommends that patients use basic, commercially accessible wearable technologies such as pedometers or accelerometers to track their physical activity levels and changes on a regular basis. Simple actions such as increasing daily physical activity by 1,000 steps may result in better health benefits.

“It’s important to maintain or improve physical activity when major life events happen, which is often a time when exercise is most needed,” Lane-Cordova added.

“There are so many ways people can do this. They could plan family activities that involve exercise, use free videos or websites to exercise at home or take standing breaks while at work. The most important things are to be aware of the positive health and cardiovascular impact of physical activity and make the effort to get moving.”

The statement implies that health care professionals have a significant role to play in initiating conversations with their patients regarding their physical activity levels. The writing group proposes that health care workers place a premium on compassion and comprehension. Given that primary care physicians may lack the time and resources necessary to provide follow-up treatment, clinicians may consider expanding the roles of other members of the clinical care team, such as nurses, medical assistants, and health or lifestyle coaches.

Additionally, the statement includes behavioral counseling as a method of promoting physical exercise through significant life transitions or events. There are various benefits to beginning and maintaining regular physical activity throughout significant life events and transitions. Promoting regular physical activity, as well as showing compassion and understanding, helps to maintain physical and mental health during times of stress.

The organization that drafted the declaration acknowledges that health care workers may be a valuable source of encouragement. By referencing previous accomplishments, a patient’s confidence in their capacity to incorporate regular physical activity into their daily routine may be increased. Motivational interviewing may be more well-received during times of life transitions and events than a more standard educational approach. Additionally, physical activity coaching can be provided by a range of health care professionals, including physician assistants and health or lifestyle coaches.

The writing group concluded that it is crucial “to look beyond the health care setting and engage organizations, communities, workplaces, faith-based communities and assisted living facilities to promote physical activity.”

Source: 10.1161/CIR.0000000000001035

Image Credit: iStock

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