Physical activity

Physical activity has a linear relationship with health benefits. It decreases cholesterol, triglycerides, blood pressure, insulin resistance, platelet aggregation, abdominal obesity and weight.

Recommendations are as below:
1. All adults should avoid inactivity.
2. Adults should do at least 150 minutes a week of moderate-intensity, or 75 minutes a week of vigorous-intensity aerobic physical activity.
3. Adults should also do muscle-strengthening activities involving all major muscle groups on 2 or more days a week.

Dietary changes

Diets using non hydrogenated unsaturated fats, whole grains as the main form of carbohydrates, an abundance of fruits and vegetables, and adequate omega-3 fatty acids can offer significant protection against heart diseases. Some dietary patterns are -

1. MED pattern (Mediterranean Diet)

   A typical Mediterranean (MED) diet is moderate in total fats, low in saturated fats, has high fibre content and high omega 3. Its constituents are fruits, vegetables, whole grains, fatty fish, low amounts of red meat, lower fat or fat-free dairy products, nuts, olive or canola oil and moderate amounts of red wine.

2. Indo-mediterranean Diet

   Including a lot of fruits, vegetables, whole grains like unpolished rice, whole wheat & millets; fatty fish for nonvegetarians and fenugreek seeds, mustard seeds, flax seeds, soyabean oil, mustard oil in vegetarians (as sources of omega 3 fatty acids) and nuts in an Indian diet can be a step towards an Indomediterranean pattern for a cardioprotective diet.

   It has been proposed that a diet pattern that is consistent with Mediterranean diet, when combined with physical activity and no smoking, can avoid significant number of heart attacks, strokes and diabetes.

3. DASH pattern (dietary approach to stop hypertension)

   A dietary pattern that emphasizes intake of fruits, vegetables, whole grains, low fat dairy products, legumes, poultry, fish, nuts, non tropical oils; limits intake of sweets, sugar sweetened beverages and red meats. Sodium intake is limited in DASH pattern to no more than 2,400 mg of sodium/day. It is advised to adults who would benefit from BP lowering to adopt a DASH dietary pattern.

Recommendations:
Dietary patterns are more significant rather than individual dietary components and adopting a dietary pattern that emphasizes intake of vegetables, fruits, & whole grains, low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils, nuts and limit intake of sweets, sugar-sweetened beverages, and red meat is recommended.

Smoking

Smoking and tobacco chewing have equal and comparable adverse effects on lipid profile and therefore raise the cardiovascular risk in same proportion. Complete abstinence from tobacco products is recommended.

Alcohol

Alcohol intake, even in moderation should preferably be avoided by Indians. Patients with heart diseases who do not consume alcohol should not be encouraged to start regular drinking.

Stress management

Stressful life events are more common within the prior year in patients with heart attacks than among controls. Psychological distress is a predictor of fatal stroke. Most of the association can be largely explained by behavioural changes like smoking, diet, lack of physical activity, etc. Counselling sessions and yoga can be considered for stressed individuals.