INTRODUCTION

Conserving a healthy lifestyle and maintaining well-being has become a challenge after the appearance of COVID-19 disease and the subsequent worldwide pandemic. Local authorities of different countries in Latin America have implemented a variety of mitigating measures that include isolation, social distancing, quarantine in phases, hygiene measures, etc.¹which has represented a challenge for the people of this region to conserve their health. ^2,3) COVID-19 pandemic has been installed within another pre-existing pandemic: the pandemic of non-transmissible chronic disease, such as cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease, arterial hypertension, and cancer^1-5. In the Region of the Americas, there are 5.5 million deaths due to this cause per year.⁶ These conditions together with advanced age constitute a greater risk for those who develop COVID-19. Therefore, maintaining and improving integral health and wellbeing through lifestyle medicine (LM), defined as the practice of prescribing healthy habits based on scientific evidence ^7,8, is constituted as singular importance in health promotion, since it focuses on the origin and root of non-transmissible chronic disease risk factors ^8,10. Successful documented experiences exist regarding LM intervention programs, such as the Ornish Program¹¹and CHIP Program¹²but they are based on cultural standards particularly from population samples corresponding to North American culture. When facing the problem described, we recognize this void in the field of Lifestyle Medicine, given the lack of therapeutic intervention research in this field with respect to cultural context and particularly from Latin America. For all the before mentioned, it is necessary to develop research from a Lifestyle Medicine approach that considers the population characteristics of this region. Consequently, the objective of this study is to evaluate the subjective assessment from the LM program called Cardiofood Lifestyle in virtual mode in Latin American participants.

METHODS

RESULTS

Regarding the characteristics of the participants in this study, 44 (86%) were women between 30 and 65 years and 7 (14%) of the remainder of the total sample were men of 45 years as average age, all from different countries in Latin America, among them Chile, Argentina, Peru, Uruguay, Paraguay, Colombia, Venezuela, Mexico, and immigrants living in the United States.

The subjective assessment on confidence in the management of body weight resulted in 46 (90%) of the sample feeling more confident. When analyzing the subjective assessment on weight loss, 40 (78,43%) of the sample expressed having lost weight. The quantitative evaluation of weight loss according to individual measures of participants in their homes after having participated during 8 weeks of the program, gave the following results: 29.41%¹⁵of the sample lost 3 kg, 21.56%¹¹2 kg, 9.80%⁵lost 2.5 kg. (Table 2)

Analyzing the level of energy, 35 (68,62%) of the sample felt more energy compared to when they began the program. The subjective assessment of mental lucidity gave a result of 36 (70,58%) of the sample. (Table 3)

Regarding the subjective assessment of selection capacity of healthy food options, 46 (90%) of the sample expressed feeling much more confident, while 5 (10%) manifested feeling more or less confident with respect to it. (Table 4) When referring to the subjective assessment of health after completing the program, 41 (80.40%) manifested feeling much healthier and 10 (19.60%) expressed feeling somewhat healthier. (Table 4)

On the other hand, the wellness mean of the Cardiofood Lifestyle program is above 3, with an average evaluation of 4.71. In (Table 5), the scores of each participant can be seen.

DISCUSSION

Following the North American College of Lifestyle Medicine and the Latin American Society of Lifestyle Medicine, Lifestyle Medicine (LM) can be defined as an evidence-based approach the seeks to prevent, treat, and even reverse diseases by replacing harmful behaviors for other beneficial ones, such as how to eat healthier, being physically active, stress relief, avoiding abuse of toxic substances, adequate sleep, and having a solid emotional support system, through 6 fundamental pillars, we are able to organize, set health objectives fo the patients, and convert them into active and responsible agents when thinking about their well-being.^14,15

The intervention programs in lifestyle medicine, such as the Ornish Program¹¹and CHIP Program¹²are based on cultural standards particular to population samples corresponding to North American culture. The Cardiofood Lifestyle Program proposed to unite the knowledge acquired about LM and health coaching in the stages that preceded the COVID-19 pandemic. As a result of the knowledge in effectiveness of LM programs dosed in at least an 8-week period, we decided to experiment implementing these recommendations adapted to the Latin American population with their cultural characteristics and needs in the moment of the COVID-19 pandemic. Using education in healthy eating, a plant-based integral nutrition, as a main focus^1,16, during the sessions the participants gained knowledge to prevent, control and improve non-transmissible chronic diseases, such as cardiovascular disease, obesity, diabetes, cancer, and risk factors of COVID-19 ^1,4,5. Additionally, they feel healthier, more lucid, with more energy, and part of a group, guided and contents. ^1,17-20

Maintaining an adequate weight during the COVID-19 pandemic was a challenge with the subsequent increase in risk factors of getting this disease¹. During the Cardiofood Lifestyle Program, we urged participants to follow a low caloric density food pattern that generates great satiety, which offers a solution to weight loss and management.¹. This eating pattern was associated to a decrease of cardiovascular diseases and cancer^1,21, reduction in inflammation and oxidative stress^1,22, diversity in intestinal microbiota due to the presence of fibers and polyphenols and regulation of the immune system.^1,22,23The selection of healthy foods and confidence in this aspect constituted a central factor in well-being, resulting in 90% of positive assessment.

Regarding energy and lucidity of people during COVID-19, the preliminary reports have shown that people presented with a reduction in the average step count which fluctuates between 7% and 38% in all the countries.^1,24. Insufficient physical activity is one of the main risk factors of death in the world, as well as a key risk factor for at least 35 ailments²⁵, including cardiovascular disease, cancer and diabetes.^1,26,27During the Program, physical activity was supported through the incorporation of courtesy yoga classes and a recommendation of counting their steps daily, with the aim of reaching 10.000 by the end of the program. These recommendations resulted in an assessment of 68,62% of greater energy and 70,58% of greater lucidity of the sample.

These results reveal a very promising prognosis for the development and implementation of therapeutic intervention group programs in virtual mode of Latin Americans that have the need to eat healthier, feel more energized, lucidity and wellness. Fundamentally, we evidence that therapeutic education of the participants¹during the program was able to improve their subjective assessment on health.

Regarding healthy relationships, scientific evidence holds that authentic social interactions, including brief one, have positive effects on longevity and general health.^1,28According to a study by Grant & Glueck, healthy social connections are considered the most important predictor of happiness and longevity. Connectivity could activate the parasympathetic nervous system, reducing stress, and its dangerous consequences^1,17,29,. During COVID-19, social distancing was a very important recommendation to control infections and help save lives. In the Cardiofood Lifestyle Program, through weekly meetings of 1 hour and 15 minutes, the opening of an exclusive Facebook group created emotional support, through social interactions, Health Coaching sessions^19,20and virtual contact, such as is evidenced in the Wellness score results.

Therefore, we recommend moving forward with Lifestyle Medicine interventions and education for the Latin American population, with the goal of promoting specific actions geared towards improving healthy food choices, energy, and well-being withing the COVID-19 pandemic and non-transmissible chronic diseases.

Our study limitations have been, in the first place, that the online questionnaire may have generated response bias, however, we used an easy to use self-administered standardized instrument. We must mention that the total participation was of 120 people in the Cardiofood Lifestyle Program and only 51 completed the questionnaire. For future interventions, specific strategies will be evaluated to make this action more effective, for example carry it out in session 8 before finishing the program. Likewise, due to the virtual mode adopted during the COVID-19 pandemic, it was not possible to gather laboratory data and clinical parameters that could be effectively evaluated from a distance. Despite these limitations, we consider that he research provides important information.

CONCLUSION

We found a good subjective wellness evaluation from the LM program called Cardiofood Lifestyle in virtual mode in Latin American participants. In face of this, it is important to develop therapeutic intervention programs in lifestyle medicine for this population sample with the goal to improve wellbeing of people within the context of the COVID-19 world pandemic marked within the pandemic of non-transmissible chronic diseases.