SAN FRANCISCO — A surprisingly high 85% of older adults with hypertension, hyperglycemia, or hyperlipidemia reported engaging in lifestyle modifications, such as diet change or exercise, in a longitudinal study of 666 people, Eleanor M. Simonsick, Ph.D., said at the annual meeting of the Gerontological Society of America.
Patients who reported voluntary lifestyle modification generally weighed less, had less obesity, and exercised more than patients who denied lifestyle modification. The two groups did not differ, however, in measures of disease such as blood pressure, hemoglobin A1c values, and cholesterol levels, with the possible exception of triglyceride levels, reported Dr. Simonsick, an epidemiologist at the National Institute on Aging, Baltimore, and her associates.
Data from previous intervention studies suggest that people with these chronic diseases improve disease parameters through lifestyle modifications, “but these interventions are often very comprehensive and quite rigorous,” she said. Little is known about what people do on their own or how effective the changes may be.
“In terms of their specific conditions, it would appear that additional guidance is required” for voluntary lifestyle modification to improve health, she added.
On the plus side, the results refute the common notion that patients aren't interested in lifestyle modification, a misconception that dissuades many physicians from bringing up the subject, some surveys suggest. “I think that we should have more confidence in the patient population, that they may actually be receptive to lifestyle modification,” Dr. Simonsick said. Sociodemographic factors did not affect participation rates in lifestyle modification.
The study analyzed data from the Baltimore Longitudinal Study of Aging (BLSA), which performs 3-day examinations and surveys of participants every 1–4 years, depending on their age. Participants make the trip to Baltimore for these visits, so the study is skewed toward healthier, more highly educated adults, she acknowledged. The study's results are not representative of the general population, and probably represent the most positive outcomes one might expect to see in terms of effects from lifestyle modification, she said.
Patients in this analysis of visits during 2004 to 2007 had a mean age of 68 years. Half were women, 29% were black, and a majority had more than a college education.
Overall, 47% of participants reported being diagnosed with hypertension, 19% said they had been told they had either diabetes or high glucose levels, 56% said they had been diagnosed with hyperglycemia, and 23% had none of the above.
Among those with hypertension, 83% reported voluntary lifestyle modification, “which is a much higher number than we had expected,” Dr. Simonsick said. Of those who made lifestyle modifications, 90% were taking antihypertensive medication, compared with 91% who did not change their lifestyle.
The obesity rate in hypertensive patients was 31% with lifestyle modification and 65% without, a significant difference. There were no major differences between these groups in systolic or diastolic blood pressures—126/67 mm Hg in the lifestyle modification group, compared with 127/69 mm Hg in the others.
Among participants with hyperglycemia, 85% reported lifestyle modification, and these patients were significantly more likely to be on medication (48% vs. 22% of non-lifestyle modifiers). Fasting glucose levels were slightly higher in the lifestyle modification group than in other patients, but hemoglobin A1c values were 6% in both groups.
The higher medication use and higher fasting glucose levels in the lifestyle modification group may be caused by a higher rate of diabetes rather than just hyperglycemia, compared with the non-lifestyle modification group, but the data couldn't show that explicitly, Dr. Simonsick said.
Among those with hyperlipidemia, 85% reported lifestyle modification, and 62% of these people were taking medication, compared with 54% of non-lifestyle modifiers (a nonsignificant difference).
Obesity rates were 26% in the lifestyle modifiers and 50% in non-lifestyle. Triglyceride levels also were significantly different between groups—though “not remarkably so,” she said—measuring 116 mg/dL in patients who pursued lifestyle modification, compared with 133 mg/dL in those who didn't.