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Finding new ways to promote a heart-healthy lifestyle
Following a proper diet, exercising, reducing stress, adhering to medicines and not smoking are common-sense prescriptions for anyone who has suffered a heart attack, says Toronto Rehab Scientist Dr. David Alter. But as a cardiologist, Dr. Alter sees that such heart-healthy behaviours—as well as rehabilitation programs that encourage them—are often overlooked.
As Research Director of Toronto Rehab’s Cardiac Rehabilitation and Secondary Prevention Program, Dr. Alter is studying how to improve access to, and compliance with, cardiac rehabilitation programs, which emphasize exercise, resistance training and education.
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A landmark 2009 study that Dr. Alter conducted with Toronto Rehab Scientist Dr. Paul Oh found that patients hospitalized for major cardiac events who underwent cardiac rehabilitation cut their risk of dying of another heart attack in half.
Yet less than a third of heart patients actually participate in such programs, Dr. Alter says, with barriers ranging from a shortage of cardiac rehabilitation services to the fact that doctors often don’t refer patients to them and patients resist or find it difficult to participate.
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Much of Dr. Alter’s work at Toronto Rehab looks at how to promote healthy lifestyles in the population, and evaluate their effects. To expand the reach of cardiac rehabilitation, he favours tailoring lifestyle programs to individuals in the community as well as the home, while also trying to motivate the wider community. “We’re in the business of changing behaviours.”
As well as studying the benefits of cardiac rehab, he also looks at the costs. For example, one key project focuses on medical expenditures for cardiac rehabilitation patients, and whether they make fewer visits to hospitals and physicians, and use less medication. |
“We already know that cardiac rehabilitation saves lives,” he says. “The question is whether it saves money.”
Other areas of his research include evaluating the costs associated with obesity, which Dr. Alter calls “a public health crisis,” and the value of therapeutic lifestyle programs in workplace settings. He is also looking at how physicians are influenced by the life-expectancy of heart patients. Those perceived to have the highest risk often receive the lowest intensity therapies, a phenomenon known as the “treatment-risk paradox.”
As a physician as well as a researcher, Dr. Alter brings passion to his work stoked by his bed-side observations. “Caring for patients keeps it real, it keeps the questions relevant,” he says. “Success as a researcher is only as good as the questions you ask.”
A singer-songwriter, Dr. Alter has started a new not-for-profit organization called the “Vigour Projects”, which aims to improve the health of populations through music. Dr. Alter believes that music not only positively impacts the emotional state of individuals, but may also be helpful as “an enabler” for improved health promotion, health prevention, and public health within communities. He also wants to establish a new cardiac rehabilitation specialty, a so-called “lifestyle cardiologist” who has a unique, credible and complementary role on care teams.
Improving access to lifestyle programs and setting behavioural benchmarks for cardiac rehabilitation could have a significant impact on cardiovascular outcomes. It’s also very ambitious, Dr. Alter believes, “but I never want to base my career on safe questions.”
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