Introduction of Lifestyle Medicine Flashcards
The following definition of LM comes from whom:
Lifestyle Medicine is the application of medical, behavioural, motivational and environmental principles to the mx of lifestyle related problems in clinical setting - self-care and self-mx are important elements
Lifestyle Medicine Textbook by Gary Egger
LM uses evidence based lifestyle therapeutic approaches to prevent, treat and oftentimes reverse lifestyle-related chronic disease - whose definition of LM is this?
American College of LM
ACLM state that LM involves what areas of focus in its approach to LM as whole? (6)
1) Predominantly whole food, plant based diet
2) Physical Exercise
3) Adequate Sleep
4) Stress Management
5) Emotional Wellbeing
6) Risky behaviour/substance avoidance
ITLC stands for what?
Intensive Therapeutic Lifestyle Change
What do Intensive Therapeutic Lifestyle Change programs entail?
Encourage drastic changes to daily routines including habits related to eating, exercising, stress management and sleep.
Usually 60min in-person sessions
-1-3x/wk for 18 weeks traditionally
(residential 7-21 days; immersion 3-10days)
Pritikin, Ornish and Diehl’s CHIP are all examples of what?
Evidence based ITLC programmes - used to treat severe disease (essential induction phase for these people)
What is the difference between ‘complementary’ and ‘alternative’ medicine?
> Complementary is non-conventional medical care (traditionally poorly researched) but often involves evidence-based modalities which may be utilised.
Alternative medicine - non-evidence based tx (should be avoided)
How may ‘integrative medicine’ be defined?
Medical practice which combines: experience-based complementary and alternative medicine with conventional methods
Medical methods that focus on physiological and biological functions of the body by assessment of hormones and metabolites describes what form of medicine?
(cellular metabolism, digestive function, detoxification and control of oxidative stress)
Functional medicine - somewhat controversial as virtually no accepted evidence-based medicine
Is mind-body medicine evidence-based or not?
relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, spirituality, tai chi
Some modalities very much so, others still unproven
What does ‘Preventative Medicine’ entail?
All aspects of morbidity and mortality prevention for the general public - overseeing field of PUBLIC HEALTH.
Emphasises POPULATION BASED HEALTH e.g. immunisations, screening and protection from bioterrorism
What is one key disadvantage of conventional medical care of patients in terms of control, leadership of their care? (provider vs patient)
Patients are recipients of their care while providers are considered responsible for their care. Patients play ‘passive’ role in their mx without being required to make significant changes
What was the leading cause of death in US in 2015?
Heart disease
(2. cancer, 3. Chronic Res Disease, 4. Accidents, 5. Stroke, 6. Alzheimer’s, 7. Diabetes, 8. Influenza and pneumonia, 9. Nephritis, nephrotic synd, nephrosis, 10. SH)
What was the leading cause of death in UK 2019?
Cancer
Heart disease, stroke, lung disease, liver disease
What % of conditions seen in primary care are lifestyle related according to Holman?
78%
To what 3 factors are 80% of all US premature deaths attributable?
Tobacco use
Poor diet
Inadequate physical activity
What % of people have healthy behaviours in ALL of the following areas:
- non-smoker
- BMI <25
- 5 portions fruit and veg / day
- regular physical activity (Rafferty 2000)
3%
1 in __ still smoked in US in 2019
1 in 7
_ in 4 people have diets low in fruit and veg
3 in 4
_ in 5 people don’t regularly exercise
4 in 5
What % of people following diagnosis of diabetes follow the accepted guidelines regarding low saturated fat diets?
11%
What % of people following heart disease diagnosis continue to smoke?
8%
To what extent does DNA sequencing explain variance in health status compared with epigenetics (gene switching)? (%)
- DNA sequence accounts for 10% variance
- Epigenetics account for 70-90% of health variance
(2005 - environmental factors = main determinant of epigenetic variance)
According to both Winkleby and Chen what is the best predictor of good health?
Having higher education
(lower socioeconomic status, racial minorities (poorer access), lower levels of literacy assoc with lower health literacy)
What is the Healthy People initiative?
Gov programme setting out 10-yr national objectives for improving health (science-based)
What were the 10 leading health indictors of Healthy People 2020?
(NB weight rather than diet and 5 BEHAVIOURS feature among them)
Heathy People 2020
PA, Excess weight, Tobacco, Substance abuse, Responsible sexual behaviour, MH, Injury/violence, Environmental quality, Imms, Access to healthcare
The National Prevention Strategy, first compiled in 2011 by Dr Regina Benjamin was the key component of which care act?
Affordable Care Act
focussed on health care moving from sick care model to wellness and disease prevention
With the intention of wellness promotion and disease prevention what are the 4 areas of focus for the National Prevention Strategy?
1) PA assessment and counselling
2) Overweight/obesity assessment and nutrition counselling
3) Alcohol excessive use screening and counselling
4) Tobacco use and cessation support
National Strategy for Quality Improvement in Health Care report in 2011 recommended 3 lifestyle related foci what were they?
National Strategy for Quality Improvement in Health Care report
1) promotion of most effective preventions and tx practices for leading causes of mortality starting with cardiovascular disease
2) Engage individuals and families as partners in their care
3) work with communities to promote wide use of best practices to enable healthy living
Lifestyle Medicine is effective in prevention and tx of chronic diseases such as T2DM. If allows pts to have more control over their health. It can reduce or even replace the need for _____ which has the added benefit of _____ side effects.
Medications
fewer / no
The Diabetes Prevention Program demonstrated that lifestyle measures resulted in __% better event-free survival
26%
Jenkins Portfolio Diet discovered that lifestyle measures offered safer control of biologic markers than what commonly used cardiovascular medication?
low-dose statin
Effective use of LM can reduce health care costs and make health care systems more ____
Demonstrated by what 2 major lifestyle programs
“sustainable”
Diabetes Prevention Program
CHIP
A healthy lifestyle can: beneficially effect gene ___ (AKA ___), reduce insulin ___ , reduce chronic ____ inflammation and provide ___oxidants
A healthy lifestyle can: beneficially effect gene expression (AKA epigenetics), reduce insulin resistance, reduce chronic systemic inflammation and provide antioxidants
The Cochrane Collaboration, AHA and US Preventative Services Task Force agreed there’s strong evidence that what 3 lifestyle areas decrease morbidity and mortality from Cardiovascular disease, cerebrovascular disease and cancer?
tobacco cessation
increased PA
dietary changes
Numerous sources agree that ___ counselling helps change dietary habits and reduces ___ costs
nutrition
medication
The World Cancer Research Fund and American Institute for Cancer Research agree that what proportion of the most common cancers may be prevented wth lifestyle changes? What are the 4 main contributory factors?
1/3
1) alcohol and tobacco
2) PA
3) diet
4) obesity
Roughly how many preventable cancers are there in the US every year? (2019)
340,000
Even if not overweight poor diet is associated with major causes of morbidity and mortality including? (4 categories)
CHD, stroke, HTN
T2DM
Osteoporisis
Some cancers
Merrill et al found during 18-m invention program that healthy lifestyle habits improved most ___ weeks into the program but that in over 50% of cases improvements above baseline were sustained in the following areas at 18m?
What interventions did it study / implement? (5 - 4 diet related)
6 weeks
PA lower calorie intake more fruit and veg portions fewer sat fats and sweets more fibre intake
The Interheart Study found that 9 key risk factors accounted for 90% and 94% respective of the attributable risk percent of acute MI in men and women what were they?
- Smoking - HTN
- PA - Lipids
- Alcohol - Obesity
- Diet - Psychosocial factors
- Diabetes
What 5 factors were attributable to 80% of attributable risk in acute MI according to Interheart Study?
Lipids, HTN, obesity, Diabetes, smoking
What risk factors in the Interheart Study were found to be equally attributable to risk of AMI as HTN or abdominal obesity?
Psychological factors inc stress, mental illness, isolation and addiction
The InterStroke study (c-c) including 32 countries what 10 risk factors worldwide were identified as associated with 90% of all strokes?
- HTN -Alcohol consumption
- current smoking -Psychological stress
- abdo obesity -Depression
- unhealthy diet -Cardiac causes
- inadequate PA -Abnormal lipids
50% decrease in total cholesterol decreases risk of heart disease by __%?
50%
6mmHg decrease in diastolic pressure decreases risk of heart disease by __% and stroke by__%?
16%
42%
Stopping smoking decreases risk of sudden MI by __%
50`%
maintaining ideal body weight & waist size and 150mins mod exercise a week (independently of one another) decreases risk of heart disease by __-__%
35-55%
=/>5 portions fruit and veg a day reduce risk if heart disease by __-__%
20-25
What did the Framingham Heart Study look at?
Lifetime risk for atherosclerotic cardiovascular disease in people free from CVD aged 50
Men with optimal risk status for lifetime atherosclerotic CVD risk had a _% lifetime risk versus __% in those with 2 or more risk factors (framingham heart study)
5% vs 69% lifetime risk atherosclerotic CVD risk
Women 8% vs 50%
median life expectancy in those with optimal risk status for atherosclerotic CVD was how many years longer than those with 2+ risk factors>
10yrs (men 11yr, women 8yr)
What did the Nurses’ Heath Study look at in 84,129 women?
Relative risk for CHD over 14yr period
The Nurses’ Health Study found 5 factors associated with lower risk CHD - what were they?
1) non-smoking
2) BMI <25
3) PA >30mins / day
4) Moderate alcohol consumption (5-30g (<4 units) / day)
5) Healthy diet score (fibre, Omega-3, folate)
When all 5 present vs none 82% risk reduction of CHD!
3 MAJOR studies: Nurses’ Health Study, Nurses’ Health Study 2 and Health Professionals Follow-up Study studied healthful vs unhealthful WHAT on on risk of CHD?
Plant-based diets
Studies inc >4,000,000 person yrs
The Adentist Health Study found that WHAT diet reduced risk of mortality from: all-causes, IHD, CVD, Cancer and other causes
total vegetarian diet
Adventist Health Study ALL cause mortality
Importantly the Adventist Health Study found that total vegetarian diet lowered what 4 health parameters?
BMI, odds of diabetes, HTN, metabolic syndrome
What did the Lyon Heart Study look at?
Secondary prevention of CHD with Mediterranean diet vs American Heart Association Step 1 diet
(benefits were maintained for 4 yrs following first MI)
What clinical role has been shown to have positive influence over patients’ lifestyle behaviours?
the physician (considered credible and reliable)
Patients who have been counselled to lose weight are more likely to understand what 2 things and be at a higher stage of what?
Understand:
-risks of obesity
-benefits of weight loss
Higher stage of readiness to change
Sedentary patients increased weekly walking by _ times if counselled and received follow up booster call vs standard care
5 times
5 key responsibilities of LM physician?
1) Screen for lifestyle risk factors & diseases
2) Treat chronic disease by prescribing and f/u lifestyle changes
3) Engage with MDT and refer to community resources
4) Ensure pts understand importance of lifestyle changes on their medical conditions
5) Coach pts on behaviour change based on readiness level
What type of lifestyle advice has been shown to be more effective?
SPECIFIC change rather than general advice
e.g. eat 5+ fruit and veg portions every day rather than each more fruit and veg / eat more healthily
What are the 5 overarching competencies for physicians prescribing lifestyle medicine?
a) Leadership
b) Knowledge
c) Assessment skills
d) Management skills
e) Use of office and community support
Competency 1: Leadership
Leaders should:
___ heath behaviours in disease ___ and health promotion
Seek to practice ___ personal behaviours
Create ____ that support healthy behaviours at school, work and home.
Competency 1: Leadership
Leaders should:
PROMOTE heath behaviours in disease PREVENTION and health promotion
Seek to practice HEALTHY personal behaviours
Create ENVIRONMENTS that support healthy behaviours at school, work and home.
Competency 2: Knowledge
Know the evidence that specific lifestyle changes can have on patients including:
1) ___ ___ on lung conditions, lung ca and other health
2) effect ___ has on occurrence and recurrence of breast ca
3) effect of ___ on MI and stoke survival
4) __-__ __ effect on reducing BP, lipids and prostate ca regression
Competency 2: Knowledge
Know the evidence that specific lifestyle changes can have on patients including:
1) SMOKING CESSATION on lung conditions, lung ca and other health
2) effect EXERCISE has on occurrence and recurrence of breast ca
3) effect of FITNESS on MI and stoke survival
4) PLANT-BASED DIET effect on reducing BP, lipids and prostate ca regression
Competency 3: Assessment Skills
Assess ___, ___ and ___ predispositions of patients’ behaviours and resulting health outcomes
Assess pt and family ___, willingness and ability to make health behaviour change
Perform hx and physical exam specific to pts lifestyle related health status inc lifestyle __ __: tobacco use, alcohol consumption, diet, PA, BMI, stress level, sleep & emotional wellbeing
Order and interpret tests to screen, __ and monitor lifestyle-related ___.
Competency 3: Assessment Skills
Assess PSYCHOLOGICAL, SOCIAL and BIOLOGICAL predispositions of patients’ behaviours and resulting health outcomes
Assess pt and family READINESS, willingness and ability to make health behaviour change
Perform hx and physical exam specific to pts lifestyle related health status inc lifestyle VITAL SIGNS: tobacco use, alcohol consumption, diet, PA, BMI, stress level, sleep & emotional wellbeing
Order and interpret tests to screen, DIAGNOSE and monitor lifestyle-related DISEASE.
Competency 4: Management Skills
Use nationally recognised ___ to assist pts in self-mx health behaviour and lifestyle
Establish effective ___ with pts and families to sustain behavioural change using __-__ counselling methods / f/u
Collaborate to develop __-__, achievable and __ action plans
Help pts __ and __healthy lifestyle practices. Refer to other HC profs inc intervention programmes
Competency 4: Management Skills
Use nationally recognised GUIDELINES to assist pts in self-mx health behaviour and lifestyle
Establish effective RELATIONSHIPS with pts and families to sustain behavioural change using EVIDENCE-BASED counselling methods / f/u
Collaborate to develop EVIDENCE-BASED, achievable and SPECIFIC action plans
Help pts MANAGE and SUSTAIN healthy lifestyle practices. Refer to other HC profs inc intervention programmes
Competency 5: Use office ad community support
Practice in a _______ team
Develop office systems in incorporate risk ___ tools and that bring to attention __ ___ behaviours and patients.
Measure processes and outcomes to ___ quality of lifestyle interventions
Use approbate referral resources to support ___ of healthy lifestyles including “induction phase” ___ programmes
Competency 5: Use office ad community support
Practice in a MULTIDISCIPLINARY team
Develop office systems in incorporate risk AX tools and that bring to attention AT RISK BEHAVIOURS and patients.
Measure processes and outcomes to IMPROVE quality of lifestyle interventions
Use appropriate referral resources to support IMPLEMENTATION of healthy lifestyles including “induction phase” INTERVENTION programmes
Disease reversal is defined as: all ___ markers or ___ tests within normal range without use of current ___ and without __ or ___ of disease.
Disease reversal is defined as: all LAB markers or DIAGNOSTIC tests within normal range without use of current MEDICATIONS and without SIGNS or SYMPTOMS of disease.
