A family affair: coping with heart disease and other chronic illnesses.

• Author: Finn, Kristen Lidke

IT COMMONLY is known that regular aerobic exercise and a diet low in saturated fat and cholesterol greatly can reduce the chances of developing heart disease. However, an equally important factor in the wellness equation long has been overlooked by the medical community. Only recently have physicians begun to recognize the role of the family in promoting healthy behavior and helping--or hindering--recovery from heart disease and other chronic illnesses.

According to Thomas L. Schwenk, department chair and associate professor of family practice, University of Michigan Medical Center, "The family is the origin of genetic risk factors for disease, but it's also the context within which healthy lifestyles can be established. It can be the source of stress contributing to the development of disease, but it's also the most important source of support when people become ill.... And they have enormous influence on medical care and on the patient's health, and the medical profession must do better at taking this into account."

For example, studies show that up to 60% of American youngsters may develop at least one risk factor for heart disease, such as obesity, a sedentary lifestyle, borderline high blood pressure, or high cholesterol levels. "But these are not pediatric risk factors; these are family risk factors, because children do not eat, exercise, or live in isolation," Schwenk maintains.

Just as kids take on many of the same dietary and activity patterns of their parents and siblings, spouses exert significant influence on each other's health. "Spouses tend to share the same eating and dietary patterns, smoking habits, and alcohol consumption. That's why when we see a person with heart disease, there are probably multiple opportunities for intervention within that person's household." For this reason, Schwenk advocates treating both members of the couple as a unit, even if only one partner is sick. "For example, intervention with the husband is one thing. But getting both the husband and the wife to start exercising can be far more effective in the long run."

Another red flag for intervention is the presence of recurrent minor illness. "A third or more of all strep and upper respiratory infections seem to be related to family disruption and family instability. It is wellknown among primary physicians that if a child keeps coming in with multiple infections, colds, coughs, diarrhea, and viral gastroenteritis, the family may be undergoing some disruption, change, or upset." Sometimes, the disruption--and symptoms--are only...