Benefit to improving diet and exercise at the same time

https://www.health.harvard.edu/blog/benefit-to-improving-diet-and-exercise-at-the-same-time-201304266126
Daniel DeNoon, Executive Editor, Harvard Heart Letter

When you decide it’s time to live a healthier lifestyle, you’re likely to get better long-term results if you start improving your diet andincreasing physical activity at the same time.

It may seem better to improve just one thing at a time.  But while you don’t have to make drastic changes overnight, a new study suggests that it’s best to begin by bettering both your nutrition and your activity level.

“This gives me hope that making two changes at the same time can work,” says Kathy McManus, director of the nutrition department at Harvard-affiliated Brigham and Women’s Hospital.

Counseling Advice for Lifestyle Management: The CALM Study

The study, from Stanford University researcher Abby King and colleagues, enrolled 200 people over age 44 whose diets and physical-activity levels were well below healthy standards. They were hoping to improve their lifestyles, but were not specifically trying to lose weight.

Study participants were randomly assigned to one of four groups:

• The diet-first group began with four months of counseling about improving nutrition, then received both nutrition and exercise counseling for eight months.
• The exercise-first group began with four months of counseling about increasing their activity level, then received both nutrition and exercise counseling for eight months.
• The simultaneous group got 12 months of both nutrition and exercise counseling.
• The control group got 12 months of stress-reduction counseling.

For all groups, the exercise goal was to increase moderate-to-vigorous physical activity to 150 minutes (two and a half hours) each week. The diet goal was to get five to nine daily servings of fruits and vegetables and to reduce saturated fats to 10% of total calories consumed.

What happened? The control group met none of these goals. Those in the diet-first group met their dietary goals.  Those in the exercise-first group met their activity goal. But only those in the simultaneous group met both goals.

On the other hand, nobody lost significant weight.  “Many of us are trying to do that, also,” McManus says. “We don’t know how this would play out if the focus of lifestyle change were on weight loss.”

How To Change Your Lifestyle

Lifestyle change is very hard to do by oneself. Most people need counseling and encouragement. McManus praises the Stanford study for providing much-needed data on how healthcare providers can help people achieve lifestyle change.  However, she notes that every individual has his or her own lifestyle and needs an individualized approach to changing it.

“The patient is really the expert in his or her own self-change. We are experts in medicine, but patients are experts on their own behavior,” McManus says. “We elicit dialog around that, building on any successful changes they’ve made in the past. And we develop connections about what matters to them and why it matters, understanding and empathizing with what they will miss if they leave out, say, the high-sodium snacks they’ve been eating.”

It doesn’t work merely to tell people what they must do, what they need to do, or what they should do.

“We use phrases such as, ‘Other folks have found,’ ‘Some have benefitted from,’ and ‘You might consider,’” she says. “Once patients feel listened to they are more open to what you have to say.”

Over time, McManus says, people place more importance on healthy behaviors and become more confident in their ability to make changes.

“Without confidence, behavior change chances are slim,” she says. “We go from that, to where the individual is driving his or her own intervention and behavior change.”