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The psychology of heart-healthy behavior

Maureen Shelly By Maureen Shelly

Caring for your heart can sometimes feel like a trade-off between long-term health and short-term happiness. Who wants to live forever if you can’t eat, drink and binge-watch old sitcoms? But doctors say practicing heart-healthy habits doesn’t have to mean giving up the good life. “I tell my patients, have a piece of cake on your birthday, have a good-quality steak,” says Bradley Artel, MD, FACC, FASE , a cardiologist and Aetna medical director. “Don’t live like a monk. You’ll just be miserable longer.”

That’s welcome news. The catch is that overindulging is all too easy, especially when we’re under stress. “Heart health is more psychological in nature than other conditions,” Dr. Artel acknowledges. “Eating well is not about reading labels. It’s about keeping in mind where you’ll be 20 years from now.”

In fact, it’s not unusual for cardiologists to refer patients to a psychologist for help getting mind and body aligned. Keep reading to learn what scientific research has to say about motivation, decision-making and maintaining heart-healthy habits. This holistic approach to good heart health could help you stick to your diet and exercise plan with less effort and more satisfaction. And that should warm your heart.

The average risk of a heart attack: 30 percent

  • Risk with no exercise: 55 percent
  • Risk with excessive drinking: 45 percent
  • Risk with smoking: 65 percent
  • Risk with poor diet: 50 percent

Kicking these habits can reduce your risk by 80 percent.

Source: American College of Cardiology

1. When you’re tempted to blow your diet…

The usual suspects: Mint chocolate-chip ice cream. A supersized fast-food burger. The complimentary bread basket.
Expert advice: Resisting cravings gets easier over time.

“We are surprisingly poor judges of what will make us happy,” writes Daniel Gilbert in his best-selling book Stumbling on Happiness. Gilbert is a psychologist who studies “emotional forecasting,” or our ability to judge how certain decisions will affect us. His research reveals that we tend to overreact to perceived negative events ― like passing on dessert ― and underestimate our coping skills. In reality, we all have a “psychological immune system” that speeds our adjustment to new routines.

Making healthy choices, on the other hand, sets up a positive feedback loop: We soon realize that forgoing treats is not that tough, and actually feels better than indulging. Studies show that a healthy diet can lower your risk of heart attack by 50 percent: Try to cut back on sugary, salty and processed foods, and eat more vegetables, whole grains and fish. It’s that simple.

Where to find support: Some health insurance plans, like Aetna, offer weight-management programs that tailor advice to your lifestyle and goals.

Read more about how to head off bad eating habits before they undermine your health goals.

2. When you think just one cigarette won’t hurt…

The usual suspects: Social smoking. Vaping. Cigars and pipes.
Expert advice: Imagine yourself 10 or 20 years from now.

Dr. Artel recalls patients who claimed they’d rather die younger than give up cigarettes and other vices. “If you knew you could enjoy life till the very end and not be a burden on anyone, then you could do what you want. That’s an attractive option,” he says. “But that’s not how it works: Not every heart attack kills you. You can have a disabling attack or stroke and still live for 15 to 20 years.”

That image of Future You paying the consequences ― or worse, your loved ones ― is a powerful motivator. If cigarettes are your weakness, quitting is a must. Smoking is the number one controllable risk factor for heart attack.

“People make many choices that, if they reflected upon them, they would do differently. There’s no question about that,” says Daniel Kahneman, a Nobel Prize-winning economist and best-selling author who studies judgment, decision-making and life satisfaction. “We tend to frame problems very narrowly. When people take a broader view, they make better decisions.”

Where to get support: Tobacco cessation resources are available through and many health insurance plans. Aetna members, for instance, have access to the Simple Steps to a Healthier Life® online coaching program.

Read about proven quitting strategies from former smokers.

Lesser-known signs of a heart attack:

  • Dizziness or lightheadedness
  • Unusual fatigue
  • Upper body pain or tingling
  • Heartburn, stomach pain or vomiting

Talk to your doctor about the symptoms you should look out for.

3. When you’re losing too many hours to screen time...

The usual suspects: Game of Thrones. Social-media feeds. Cat videos.
Expert advice: Unplug to reduce stress.

“Hollywood makes perfection look possible. But it’s not about being perfect. It’s about being better than you were the day before,” says Dr. Artel. The media can fuel stress by reinforcing unrealistic expectations of what our homes, bodies and lives should look like. Turn off the TV, computer and phone, then devote the time you save to exercise, cooking, face-to-face socializing and sleeping. Your stress levels will nosedive.

If you’re a perfectionist, though, be careful not to go overboard with extreme diets and fitness routines. Social media often promotes weird health trends the average person can’t maintain. “People think if you don’t feel like you’re being tortured, it’s not exercise,” Dr. Artel observes. “I tell them, get a heart monitor. The heart-rate range for exercise is not that high or hard. It can be light to moderate if you sustain it ― it won’t seem so much like a chore. That’s better than a 100-yard dash that lasts 15 seconds.”

Where to get support: The Cardiograph app allows you to track your heart rate using your phone’s camera.

Meet an unlikely fitness guru named Larry.

4. If you prioritize work over your health...

The usual suspects: Putting work before personal obligations and self-care. Regularly skipping social events because you’re either working or exhausted.
Expert advice: Chronic overwork is not a virtue, and might be an escape.

Work, like screen time, can undermine healthy habits. Even more dangerous, working can make you feel like you’re doing the right thing. “We put so much pressure on ourselves to succeed, we are more likely to sacrifice our health because those effects are not seen immediately,” says Dr. Artel. “When I was a young intern, I declared martial law on my body and decided that whatever it took to get me through a weekend on-call, that’s what I’d do. You eat a little more, exercise a little less. I was not terribly unhealthy ― but not very healthy.”

“People are susceptible to what we call the focusing illusion,” Kahneman explains. Obsessing over something (getting a raise or promotion, office politics) inflates its importance in our minds. And that makes it virtually impossible to make rational decisions. Numerous studies have found little correlation between income and life satisfaction. That’s because we quickly adapt to positive changes like a bump in salary ― or even winning the lottery ― and then aim higher. So what does predict long-term well-being? According to Kahneman’s research, what makes us happy is achieving our goals.

Where to find support: Companies are becoming more sensitive to work-life balance and the dangers of burnout. If you’re an Aetna member, ask about available stress-reduction and mindfulness programs.

Learn quick de-stressing tricks you can practice at work.

High blood pressure facts

  • A blood pressure cuff is called a sphygmomanometer
  • Normal blood pressure is under 120 over 80
  • High blood pressure is above 130 over 80
  • 1 in 3 Americans is affected
  • High blood pressure is the second major risk factor for heart disease, after smoking
  • Lowering your blood pressure extends your life by 5 years

Many people take their heart for granted, until they have a health crisis. That’s because heart disease, the leading cause of death for Americans, often presents no symptoms. See your doctor to find out your risk. Then get help making lifestyle changes. By eating well, drinking sensibly, not smoking and getting regular exercise, you can cut your risk of heart attack by 80 percent.

About the author

Maureen Shelly is a health and science geek living in New York City.

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