Category: Prevention

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Heart Health Hypertension Prevention

Isometric Exercise to Lower Blood Pressure

A prescription medication like benazepril can lower the systolic blood pressure of someone with hypertension by 5-10 points (mmHg) and the diastolic number by 3-5. But what about exercise to lower blood pressure? And which exercise is best?

Longterm Effects of High Blood Pressure

When a person takes a blood pressure lowering medication such as an antihypertensive, the goal is to lower the blood pressure to decrease the longterm effects of hypertension.

Longterm effects of hypertension include:

  • increased risk of stroke
  • kidney damage
  • heart disease
  • erectile dysfunction
  • dementia
  • peripheral vascular disease
  • atrial fibrillation

Fortunately, a lot of the damage can be reversed by lowering these elevated pressures. The sooner, the better, which is why it makes sense to screen individuals for hypertension.

Measuring the number in the doctor’s office, however, is the least effective method of screening for elevated blood pressure; it should ideally be done at home or using an ambulatory blood pressure reading.

Exercise to Lower Blood Pressure

We hear the mantra frequently that exercise lowers blood pressure, which is true. But which type of exercise is most effective?

Fortunately, a recent, well-designed research study answered this exact question. And, as we have predicted before, cardio is the least effective among the various exercise options.

Types of exercises tested in this study:

  • aerobic training (cardio)
  • dynamic resistance training
  • combined training
  • high-intensity interval training (HIIT)
  • isometric exercise training

The advantage of using exercise to lower blood pressure instead of just medications is that exercise has the added advantage of improving blood sugars, increasing bone density, decreasing the risk of injuries from falls, and improving mood and sleep.

At Heart Health Coach, we prioritize comprehensive approaches to improving heart health rather than singular methods.

Which Exercise to Choose

This study found that isometric exercises came far ahead in lower systolic and diastolic blood pressure numbers. So, which exercise should you do?

The best exercise to choose is the one you can stick with and enjoy. If you despise exercise then the best one to choose is the one that will have the most result with the least effort.

Don’t change what you’re doing because of this study. Instead, measure your blood pressure using proper techniques (not just a blood pressure cuff) and see if you are at goal.

If you’re at goal, exercise based on what you enjoy. If not at goal then add in some isometrics (handgrip, leg extension, wall squats).

Isometric Exercises for High Blood Pressure

We are fans of the exercises mentioned in the video above since they are a range of different isometric exercises anyone can perform at home.

The data points to holding the contraction for 30-180 seconds with 1-2 minutes of rest between the next set, for a total of 3-6 sets. Why so vague? Because chances are you’ll have great results just by doing these and doing a little more might lower that blood pressure a little more.

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Afib Heart Health Prevention

Proven Ways to Prevent Afib

It’s not on most people’s radar, but there are proven ways to prevent Afib – Atrial Fibrillation – a cardiovascular condition that increases the risk of strokes and heart failure.

Lifetime Risk of Afib

The lifetime risk of Afib is 1 in 4. A good 25% of us will have Afib when we get older. Over the age of 65, it can be as high as 1 in 3.

We work with our Heat Health Coaching clients to identify their risks and adopt a way of life to help decrease that overall risk.

Healthy aging is a major program for us here at Heart Health Coach, and we address all such risk factors.

Proven Ways to Prevent Afib

Here at HHC, we take evidence-based medicine seriously. We don’t just look at the latest and greatest research published without considering its biases. Instead, we focus on data that has been proven time and time again and work our way towards the factors less based on strong science.

1. Age

There are modifiable risk factors and nonmodifiable risk factors. We mention age because as Afib risk increases with age, it’s even more important to modify the factors that can help decrease our lifetime risk of developing this condition.

2. Family History

Also not a modifiable risk factor, but nevertheless among the strongest drivers of Afib, having other family members with Afib increases our risk of developing Afib at some point in our lives.

3. Hypertension

From causing left atrial enlargement to increased sympathetic activity, elevated blood pressure is a major driver of Atrial Fibrillation.

It’s a modifiable risk factor. Those who manage their blood pressure even with medications will see a 26% decrease in the lifetime risk of developing Afib.

4. Excessive Exercise

Younger athletes who train quite hard may be at increased risk of Afib. Fortunately, their cardiac arrhythmia may not necessarily increase their risk of stroke – the main side effect of having this condition.

Nevertheless, if family history is present and if any other abnormal rhythms are present, it’s worthwhile to investigate the potential for paroxysmal Afib further.

5. Sleep Apnea

Decreased blood oxygenation, elevated pressure on the heart, and increased risk of PACs may all contribute to developing Afib if Sleep Apnea remains poorly controlled.

A study over a 5-year period showed that controlling Sleep Apnea with a CPAP device may decrease the risk of developing Afib by 40%.

6. Endocrine Problems

Obesity, blood sugar dysregulation, and thyroid problems can contribute to Afib.

Don’t Fear Afib

Fortunately, we have medications to treat Afib, and this is important to mention because this article isn’t meant to be fear-inducing.

Some will even develop transient Afib brought on by stress, sleep, or dietary changes which might resolve on its own.

From medication to ablation to lifestyle changes, there are ways of treating Afib, which we’ll discuss in future articles. One of our clients cut out alcohol and with it, her Afib disappeared.

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Heart Health Prevention

Autoimmune Disease and Heart Health

Many individuals live with autoimmune conditions where the body’s immune system engages in an inflammatory response. Autoimmune disease and heart health are related due to this underlying inflammation and the medications prescribed for such conditions.

In this article, we’ll discuss how we address cardiovascular health in our clients who experience autoimmune conditions.

Autoimmune Diseases in Western Medicine

Thanks to advances in lab testing and the development of biologics, many autoimmune conditions that previously were tragic can be managed quite well.

Lupus, Rheumatoid Arthritis (RA), Crohn’s, and Ulcerative Colitis are some medical conditions. Among the most common are Hashimoto’s Thyroiditis and RA, and Type 1 Diabetes Mellitus (T1DM).

Due to the nature of our healthcare system, it’s common to have multiple specialists involved who cannot properly communicate with each other.

The Gastroenterologist is working with the individual on the proper infusion regimen, and the Primary Care doctor is helping coordinate care.

Autoimmune Diseases Affecting Heart Health

This study offers a thorough overview of the increased risk of heart disease in certain autoimmune diseases. The increased risk is listed as a hazard ratio, a statistical lingo where 1 would indicate no increased risk, 2 would indicate double the risk, and 0.5 would be half the risk, and so on.

Inflammation may be at the heart of this relationship, and the goal at Heart Health is to measure and help decrease any potential inflammation in the body.

Since inflammation accelerates atherosclerosis, it’s an important lever to lean on. Always gentle, always wholistically, and always with the individual in mind.

Autoimmune diseases are taxing enough on the person, add to it the fear of heart disease, and only add to inflammation. That is not the point of this article.

Though the risk of heart disease is higher in autoimmune conditions, it’s certainly not a guarantee that any negative consequence will occur.

Improving Cardiovascular Health

Current goal lipid levels are debated constantly by different groups, from the ADA to AHA to CDC. What should your ideal lipid panel look like?

Education and empowerment have been our mantra at Heart Health Coaching since the beginning. We are good at compiling relevant information and empowering our clients to make their own best health decisions.

An individual with Rheumatoid Arthritis who rarely has any flares and is well-managed with a single agent may do well with a low ApoB. In contrast, someone with a more aggressive disease and other autoimmune diseases would benefit from a stricter Heart Health regimen.

We recommend clients measure their inflammatory markers, have lower fasting insulin levels, decrease their visceral fat, adopt a slightly higher-protein diet, and decrease their excess oil/fat intake.

Factors the Client Can Modify

The following factors, directly and indirectly, affect inflammation in the body. Not only does the cardiovascular risk decrease by modifying these factors but so does the autoimmune condition itself.

Adopted from the wonderful book of Integrative Rheumatology.

  • Mind
    • Breathing techniques
    • Reduce reactivity
    • Prayer
    • Creative outlets
    • Laughter and lightheartedness
  • Body
    • High fiber diet
    • High-quality proteins
    • Low-glycemic carbohydrates
    • Healthy fats
    • Supplements
  • Activity
    • Zone 2 training
    • Zone 5 training
    • Resistance training
    • Stretching
    • Meditation
    • Nature exposure
  • Spirit
    • Employment
    • Relationships
    • Purpose, hope, and meaning
  • Treatments
    • Physical manipulations
      • Massage
      • Acupuncture
      • Herbals
      • Topicals
      • Prescription medications
    • Psychotherapy
    • Guided Imagery
    • Eye Movement Desensitization and Reprocessing
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Heart Health Prevention

The Heart Health Risk Score

I don’t know of any other health coach who creates a Heart Health risk score for their clients. I came up with this because most of us understand risk and know how to work with percentages.

Perhaps the most important point is that prevention is the most powerful tool against cardiovascular disease.

The objective is to push a heart attack, heart failure, peripheral vascular disease, valvular disease, or a stroke as far into the future as possible.

Heart Health Risk Score Criteria

In a previous article, I discussed the overview of risk stratification. In this article, I want to dive deeper into the anatomy of this score.

I have broken the risk score up into the following categories. It’s a constantly evolving tool that must be revisited often.

1. Age

You might think age isn’t much of a lever, but I disagree. If you are reading this article and taking action now, you have decided to prevent heart disease earlier than your future self.

In fact, age is the number one risk factor for cardiovascular disease. The older we get, the higher the risk.

2. Family History

A parent who suffered a heart attack at 49 is a powerful risk contributor to the heart risk score. While an uncle who suffered heart disease at 79 may not tell us much about this risk.

Your mother’s health and the environment in which she carried the pregnancy portend future risk.

3. Comorbidities

Comorbidities include conditions and diseases which accelerate atherosclerosis or elevate the coagulation response in case of an unstable plaque.

Sleep apnea, hypertension, diabetes mellitus, obesity, elevated lipid profile, systemic inflammation, and certain lifestyle factors.

Getting more granular, hypogonadism, and severe menopausal symptoms negatively impact the Heart Health Risk Score.

4. Exercise Capacity

While some variables increase the risk of heart disease, others are protective and lower the overall cardiovascular risk score.

A healthy VO2 Max and a higher than average HRV are indicators and may be protective. In fact, exercise improves these metrics and is independently protective against cardiovascular disease.

5. Mental Health

Living in an area with high pollution, loud noise, or being under constant stress negatively impacts heart health. More so in those who don’t have compensatory coping mechanisms.

Ongoing financial stress, poor sleep, childhood adversities, and relationship stress also elevate the risk score.

6. Imaging Studies

Another category worth considering is imaging studies such as the Coronary Artery Calcium score (CAC) and a CT Angiogram (CTA).

These are often done preemptively but when they are part of a comprehensive heart risk assessment plan, they can be quite powerful.

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Heart Health Metabolic Prevention

The Body Mass Index Limits

The Body Mass Index has had its fair share of troubles because it’s open to interpretation. Those who are muscular are comfortable being in the upper limits of it, and those who exercise a lot are comfortable in the lower ranges. Let’s discuss body mass index limits to avoid any confusion.

Body Mass Index Examples

I’m around 165 lbs and 6′. This brings my BMI to 22.4. My friends consider me too skinny when they look at me. In fact, I could lose more weight around the midsection and still would be healthy.

Unaccounted for here is that I could gain 18 lbs, and my BMI would still be normal at 24.8. So I would be okay?

Unfortunately, no. The extra 18 lbs would increase my metabolic disease risk, negatively impacting my heart health.

Using the BMI

There are limits to using the body mass index to monitor your health. But I use it as an assessment of my patient’s initial health.

My BMI of 22.4 is a good start. Knowing other factors, such as my cardiovascular risk factors, activity levels, and genetic factors, is essential.

The CDC states that a BMI between 18.5 to 24.9 is a “Healthy Weight range,” which isn’t true for everyone, as seen in the example above.

Other Weight Factors

I like to know how much weight my client has gained and over what period of time.

Equally important is the location of the majority of the weight. Central weight versus more spread out makes a difference.

Blood pressure, snoring scores, energy levels, basal heart rate, and heart rate variability can also be helpful when considering someone’s BMI.

Book a Heart Health consult with me today!

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Heart Attacks Heart Health Prevention Treatment

Heart Health in Traditional Medicine

Traditional medicine, also called western medicine, is exalted for its evidence-based, scientific approach. It has proven capable of treating some of the most life-threatening and severe conditions. However, heart health in traditional medicine remains less advanced.

First Signs of Heart Disease

Most adults don’t necessarily know they have heart disease. And unfortunately, death is the first presenting symptom in a little less than half of those presenting for the first time.

That means 50% will have a fatal heart attack and not just a high cholesterol level or atherosclerosis seen on imaging.

We haven’t figured out a way to decrease that number fast enough. This means that heart health in traditional medicine can only help 50% of adults.

Traditional Medicine and Heart Disease

In traditional medicine, assuming you have good insurance, you can get excellent care to lower your cholesterol levels and blood pressure by using medications.

This requires regular visits for blood testing to make sure your liver and kidney can handle the medications. Refills cost money and time spent in the pharmacy.

These treatments don’t work for everyone. However, traditional medicine views all high-lipid and hypertensive patients similarly and treats them the same. This is one of the downsides of this practice model.

But if you need a stent or need to be resuscitated, western medicine is as good as it gets. We have incredible talent that can perform heart transplants and perform bypass grafting.

Heart Health is About Prevention

I can treat the high cholesterol with statins and perform a stent in the coronary artery, followed by a coronary artery bypass graft later in life. This is treating the symptom and not the condition.

Heart Health Coaching, which is what I do, focuses on lifestyle factors. It’s more about prevention and diving deep into potential causes for not-so-great metabolic health.

Heart Health and Pills

A pill can lower your blood pressure and decrease the chance of atherosclerosis plaque progression.

But it cannot prevent a heart attack or prevent you from getting fatty liver or diabetes from the factors which lead to high cholesterol or high blood pressure, to begin with.

Perhaps somewhere around 2-3% of individuals have genetic factors causing high cholesterol and high blood pressure. All methods other than pills will likely fail these individuals. For the rest of us, pills may not be as effective.

Prevention + Treatment

In the perfect world, everyone would have a Heart Health Coach and work to overcome hurdles toward ideal heart health.

If that fails and heart disease develops, they have the excellent skills of capable cardiologists, surgeons, and intensivists who can help restore their cardiovascular health.

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Diet Heart Health Prevention

Salt Intake and Heart Disease

There is an ongoing discussion regarding salt but we also have good science to help us make good salt decisions. There is an important connection between salt intake and heart disease.

My heart health coach clients know that each person’s diet and lifestyle are individual. No single formula applies to everyone. However, salt has a particular effect on the body which most of us share in common.

Is Salt Bad for You?

Let’s start with this question first because I get it asked a lot. I don’t think salt is bad. But for my patients who have major vascular problems, I like them to limit their salt intake.

And for my average heart health client who is healthy and wants to prevent future cardiovascular events, I urge them to reset their salt taste.

Even those with heart failure and hypertension can do fine with normal daily salt intake. But none of us will do too well with the current amounts of salt found in food.

Salt in Prepared Foods

I have a hard time trusting the sodium values listed on boxed foods. Think, Trader Joe’s or Whole Foods and canned products. And even if they are accurate, the amount of salt is staggering.

I had a taboule salad today with that chickpea salad from Trader Joe’s which I haven’t had in a year. It was during a busy urgent care shift so that’s all I could grab.

For 4 hours I’ve been dry-eyed and fatigued because my body doesn’t know what to do with the salt. I can drink a lot more water in order to pee out the salt but the salt will change the elasticity of my vessels and will drive up my blood pressure.

Bread and pastry and soups are other classic culprits.

Salt and Vascular Stress

I won’t get into the details in this article but whether you are salt sensitive or not, having more than small amounts of salt in your arteries will cause them to behave differently.

Over a long enough lifespan, this effect is cumulative and decreases the ability of the arteries to function properly. It doesn’t matter whether it’s the arteries of the heart, the brain, or the kidneys.

How Much is too Much

I don’t have my heart health clients count their salt intake. Instead, we start with good food and the salt that’s needed for good food to go down.

Take a salt you made with some spinach, baby greens, nuts, olive oil, tomatoes, and arugula. By itself, it’s not that exciting.

Add in some olives in a brine solution and now it’s exciting. A little bit of vinegar and you’re in for a treat. Of course, you have to get your taste buds used to having less salt. This takes time.

So don’t panic just because you had a few too many salty dishes in your life or during the holidays. Cardiovascular health for most of us is a marathon; slowly retrain your palate to consume less salt.

Salty Taste is a Habit

I’m sure there are exceptions but most of my patients tell me that food and tastes and flavors are matters of habit. Cut out burgers and after a while, you won’t crave them. Or if you have them they’ll feel exceedingly rich.

Cut out sugar or salt and when someone takes you to PF Chang’s you’ll put down your fork. It’s simply too much when you’ve gotten accustomed to just enough salt for the flavors to come through.

Heart health shouldn’t be the only goal for a good life and healthspan. It should be something sustainable and enjoyable. Therefore, salt is fine. It’s when we use excess amounts of it that our body responds and reacts negatively.

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Diet Heart Health Hyperlipidemia Prevention Statins Treatment

How the Body Regulates Cholesterol

In this article, I wanted to provide a basic overview of cholesterol regulation in the body. I share such articles with my heart health coaching clients whenever necessary. How the body regulates cholesterol is relevant to choose the right method of controlling cholesterol levels.

Cholesterol Regulation

Cholesterol is quite essential. The following key players regulate cholesterol in the body:

  • cells lining the intestine
  • liver
  • pancreas
  • intestinal bacteria

The food we eat has some form of cholesterol which becomes absorbable after manipulation by intestinal bacteria and pancreatic enzymes.

Cholesterol can enter the bloodstream also through the bile system. Whether you still have a gallbladder or not, your liver will produce cholesterol pumped into the intestines.

Cholesterol Absorption Varies

Some individuals are hypoabsorbers of cholesterol. No matter how much high cholesterol foods they consume, their intestinal cells don’t take up much of it.

Others are hyperabsorbers of cholesterol; even the lightest meals can have every bit of its cholesterol extracted and pumped into the bloodstream.

Cholesterol Regulation and Treatment Options

For my hypoabsorber clients, I am less concerned about their dietary cholesterol intake. Their cholesterol production in the liver would be a more important factor.

The hyperabsorbers will benefit a lot from a particular dietary change. Sometimes it helps to cut back on saturated fats, but eating times and gut bacteria are also important criteria.

Dietary change? Statin therapy? Ezetimibe? Evolocumab?

To answer that, I need more information about the person. A generic cholesterol test won’t always tell us the whole story.

The Liver’s Cholesterol Production

How cholesterol is regulated in the body has a lot to do with the liver. This fleshy organ on the right upper quadrant of the abdomen produces LDL, HDL, and VLDL particles.

Statin drugs decrease the production of cholesterol molecules in the liver.

The liver also has LDL receptors and absorbs cholesterol.

From fatty liver to elevation of liver enzymes to problems with the gallbladder, it’s important to consider the health of this organ when assessing my clients.

The Role of Gut Flora and How Cholesterol is Regulated

Some bacteria in the gut convert free cholesterol molecules into a stanol chemical that intestinal cells cannot absorb.

We could call these beneficial bacteria. They can help slow down the absorption of cholesterol for certain individuals.

Ezetimibe is a medication that works similarly, blocking the absorption of free cholesterol molecules.

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Heart Health Prevention

Heart Healthy Aging

I believe in an individual approach when it comes to health. But some basic tenets are worth paying attention to regarding heart healthy aging.

A heart healthy approach to aging makes sense because it’s no longer war, famine, and infectious diseases responsible for most deaths.

For those of you reading this, you are likely more susceptible to cardiovascular risk factors and disease:

  • atherosclerosis
  • high blood pressure
  • nerve damage from ischemia
  • kidney damage from hypertension
  • dementia from poor cerebral blood flow
  • heart attacks
  • ischemic amputations

How to Design a Heart Healthy Aging Model

Perfection is the enemy of progress when it comes to health. Every step you take in the right direction will improve your health.

Much like investing, multiple such behavioral changes will have compounding effects. Let’s keep that in mind before reading the list below.

Thank you to Dr. Weil for the inspiration for this list.

1. Maintain a Healthy Activity Level

Staying active has, time and time again, proven protective. From how our muscles metabolize nutrients to healthy bones to how our heart responds to stress, being active is protective and healing in many ways.

Our lives are ever more sedentary, but that doesn’t mean we can’t get up from time to time. We can perform stretches and go for a walk.

The term exercise doesn’t capture things quite as well. People who are marathon runners aren’t necessarily “healthier” than those who remain active by going for walks or performing active house chores.

How active do you need to be?

It depends on your risk factors and what you’re capable of doing based on where you are on your heart health journey.

2. Minimize Your Body’s Inflammation

Inflammation is something our bodies are great at managing and repairing the damage from it. But there is a limit to how much our bodies can cope with.

Recognizing the signs of inflammation is perhaps the toughest challenge. This takes an astute clinician and practice on your part to recognize the signs.

And it’s often our diets that can help decrease the effects of inflammation on our cardiovascular and metabolic systems.

What’s a good diet?

Each person will need an individualized approach to their diet. But almost all sides agree that a minimally processed diet with high nutrient content and a low pesticide content will get you there 90% of the way.

3. Manage Your Stress

I don’t know how to avoid stress and wouldn’t advise my patients to search for the holy grail of a stress-free life.

Coping with stress or managing stress is more valuable when aiming to age in a heart healthy manner.

How much stress is too much?

There are some serum markers for inflammation, but it’s not advisable nor feasible to monitor inflammation in such a way.

If you are feeling stressed or suffering consequences from your lifestyle, it’s fair to say that uncompensated or unmanaged stress is present.

4. Allow Your Body & Mind to Recuperate

The human body and the mind need to recover from damage, infection, hard work, and other day-to-day microtraumas.

Restful nightly sleep is quite important. Trying to catch up after many sleepless nights is as inefficient as working out only on the weekends.

Sleep & rest are important aspects of allowing our bodies to recover and recuperate. That’s why this is #4 on the list for heart healthy aging.

5. Know Your Heart Health Risks

My father had a heart attack in his 70s and needed multiple stents. Family history is an important risk factor.

I also went through medical school and had a highly processed diet when I was younger. Our past medical history is also important when assessing our overall risk.

Screening tests such as cholesterol levels, blood pressure, coronary calcium scores, body mass index, heart rate variability, and your resting heart rate are important heart health risk factors as well.

What’s your risk?

Your heart health coach can sit down with you to calculate your heart health risk score and help you design a program to help you mitigate such risks.

6. Build a Social Network and Form Meaningful Connections

I have a good support system in my life. There are people whom I can reach out to and who care about me. I enjoy physical touch from loved ones and don’t feel alone.

For most of us a human network is necessary for this. For others they can get this same social connection from animals, trees, and life all around us.

To age with a healthy heart it’s important to feel supported and cater to some of the evolutionary chemicals in our body which are released from interacting with others.

7. Work With Your Body Instead of Resisting it

Aging, as many say, isn’t for the faint of heart. Certain human characteristics are honed by aging, and certain senses become dull.

I can’t do certain exercises nor expend the same energy as when I was 25. But I have the patience of someone in the mid-40s, which is a huge plus.

Aging is normal, and the weakening of certain organs is also normal. But disease is not normal. Learning to enjoy the dance of old age is better than resisting the aging process.

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Heart Health Prevention

Calculating Heart Disease Risk

Calculating heart disease risk is an important result I share with my Heart Health coaching clients. It’s not something I calculate on the first visit. Instead, it’s something we aggregate over time.

This intake process is perhaps one of the most tedious aspects of our visits. But it doesn’t go down bitterly; I make it entertaining enough. With a healthy dose of humor, we get through it and can decide which actions to focus on next.

The current heart risk scores don’t apply to all patients and certainly don’t account for all known heart disease factors.

A risk score should be something actionable and empowering. Not a data point that induces fear or paralyzes the individual.

Heart Risk Score

A sedentary, obese 17-year-old videogame player who eats a processed diet will have a low score, mostly because her age is highly protective. Her risk score is low, meaning her heart disease risk is low.

There hasn’t been enough time for inflammation or atherosclerosis to take effect.

The risk score has several factors I take into consideration but each risk factor carries a different weight.

A thin, active smoker who eats a healthy diet will have a very low heart risk score because the other factors are quite protective. More protective than the negative effects of the smoking habit.

Heart Disease Risk Factors

Most of my health coaching clients already know the most common risk factors:

  • age
  • high blood pressure
  • diabetes
  • high cholesterol
  • obesity
  • family history
  • nicotine
  • sedentary

But that doesn’t tell the whole story. To dive in deeper, I also want to factor in other heart risk score factors.

  • high-stress
  • low heart rate variability
  • central adiposity
  • insomnia
  • autoimmune disease
  • air pollution
  • diet
  • muscle mass
  • hydration level
  • medication use
  • noise pollution
  • substance use
  • alcohol use
  • coping strategies
  • sleep apnea

Using the Score

What’s the use of a score if it just makes you fearful? The purpose of the score is to create awareness and empowerment, and spark action.

If obesity is the biggest factor, then we might address that first. But if it’s the hardest factor for the client to change, we’ll focus on other high-risk factors instead.

There is no one-size-fits-all. Each one of us is unique. Everything we do matters, and our health is perpetually evolving.