Lifestyle Medicine Essentials: “Walk More, Eat Less, Sleep More”—White's Early Inspiration

One of the American Heart Association (AHA) founders, Paul Dudley White (June 6, 1886–October 31, 1973), a renowned cardiologist in the 20th century, emphasized the importance of a balanced lifestyle to maintain heart health. In keeping with his beliefs, he was a vigorous walker and bicycle rider. He was appointed as President Dwight D. Eisenhower's cardiologist following his heart attack in 1955 and played an important role in his recovery and his subsequent running for a second presidential term of office [1]. Dr. White's key recommendations were to “walk more, eat less, and sleep more”; coincidently, he is the father of prevention cardiology. White advocated for exercise, diet, and weight control in preventing heart disease, prescribing cycling for the president. Furthermore, Dr. White played a key role in establishing the National Institutes of Health and the Framingham Heart Study, which identified major risk factors for heart disease [1, 2]. Over the last 100 years, advancements in technology, research, and development have led to numerous groundbreaking discoveries in cardiology, revolutionizing the diagnosis and treatment of cardiac diseases. These include electrocardiography (ECG), cardiac catheterization and coronary angiography, open-heart surgery, cardiopulmonary resuscitation, percutaneous coronary intervention, the use of defibrillators, thrombolytic therapy, genetic insights into heart disease, high-resolution imaging (such as echocardiography, cardiac CT, and MRI), and an enhanced understanding of leukocyte biology [3, 4]. Today, the application of artificial intelligence is accelerating ECG and imaging analysis, enabling personalized risk assessments, diagnostics, and long-term treatment plans. Despite these revolutionary and timely advances, the “Life's Essential 8” with primary diet, sleep, and exercise—remain foundational elements of lifestyle medicine. These three lifestyle components regulate body weight, blood pressure, lipids, and glucose, playing a decisive role in the prevention and management of cardiovascular diseases.

Acute inflammation directed by 1% leukocytes (innate immune cells) is necessary for host defense that coincides with the safe clearance of inflammation termed resolution; however, the chronic or unresolved infiltration of leukocytes leads to chronic inflammation which is the prime basis of multiple cardiovascular and cardiometabolic disorders [4, 10]. At the immunological, cellular, and molecular levels, an imbalance in diet, sleep, and exercise can trigger weight gain, obesity, low-grade chronic inflammation (residual inflammation), and cardiometabolic syndrome [11-13]. Heart failure is broadly classified into two types: heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction with multiple signs of chronic inflammation in obesity. Outcomes from UK biobank participants indicate that adherence to a healthy lifestyle was associated with a lower risk of obesity and related morbidities, regardless of genetic predisposition [14]. Future integration of the OM factor (mind and body) with multi-omics studies that includes genomics, transcriptomics, proteomics, metabolomics, exposomics, microbiomics, lipidomics, interactomics, epigenomics, cannabinomics, metagenomics, phenomics, cellomics, immunomics, pharmacogenomics, nutrigenomics (nutrikinetics/dietokinetics, nutridynamics/dietodynamics) [15], and adductomics (modification of nucleic acids such as DNA, RNA, and the modified DNA and RNA pools) allows for a comprehensive understanding of how integrative lifestyle factors interact with biological systems to influence inflammation. Thus, holistic views can lead to personalized health strategies aimed at reducing inflammation and improving overall health outcomes. The complexity of the OM factor (mind and body), and extensive “omics” interactions underscores the importance of coordinated integrative approaches in advancing our understanding of inflammation-resolution signaling and its modulation through lifestyle changes [16]. Imbalance in diet, sleep, and exercise leads to chronic metabolic diseases, whereas balance maintains allostasis, functional health, and homeostasis. According to Dr. White and yogic philosophy (Figure 1) a balanced diet, sleep, and exercise are foundational to yoga and the OM factor (Aum; mind and body), while imbalance (bhoga; over pleasure) leads to chronic diseases (roga; Bhagavad Gita Chapter 6 Verse 17). Thus, Dr. White's tested philosophy planted the seed of lifestyle medicine, emphasizing the balance of diet, exercise, and sleep in preventing lifestyle-related cardiometabolic and noncommunicable diseases.

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