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Lifestyle Medicine Certification Prep > Sections 1-10 > Flashcards

Sections 1-10 Flashcards

1
Q

Assessments

A

Subjective:
-Sleep diary, Epworth sleepiness scale, Pittsburgh, STOP-BANG

Objective:
-Actigraphy
-Polysomnography (PSG) - gold standard for sleep staging

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2
Q

INTERHEART

A

Top 5 factors accounted for 80% MI risk: tobacco, lipids, HTN, DM, OB
WORLDWIDE
Examined psychosocial factors & established that they were comparable to the effect of HTN & abd OB

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3
Q

STOP_BANG

A

Snoring
Tiredness (daytime sleepiness)
Observed apnea
Pressure (HTN)
BMI > 30
Age > 50
Neck circ >16 (men), >14 (women)
Gender (male)

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4
Q

Depression & coronary disease

A

-Depression is an INDEPENDENT risk factor for coronary disease
-Abnormal platelet adherence, endothelial dysfunction
-Lower HR variability
-Dep precedes coronary disease by several years
-2x cardiac events

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5
Q

Highest sources of sodium in diet

A

~70% added outside the home
~14% inherent to food
~10% added in home food prep or at table

Ultra-processed
Commercially-prepared
Mixed dishes (burgers, sandwiches, tacos, rice/pasta/grain dishes; pizza; meat/poultry/seafood dishes; soup)

Types of food:
Sandwiches
Pizza
Soups
Chips/crackers/savory snacks

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6
Q

Heartrate variability

A

Time between each heartbeat
when sympathetic & parasympathetic are balanced, there is variability in time between beats

If sympathetic is high, then have low variability (more equal time between beats)

If parasympathetic is high, then have high variability

The greater the variability, the more resilient and greater cardiovasuclar fitness

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7
Q

Harvard Study of Adult Development

A

Single most important predictor of happiness and longevity was having social connections

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8
Q

Positive psychology

A

Strengths-focused approach (what is working well) vs. disordered-focused approach (what went wrong)

When positive emotions outweigh negative emotions, improved well-being occurs

Goal to increase well-being, flourishing through focus on PERMA

Use during all stages of change - examine strengths & motivations, explore & celebrate past sucesses, reconnect to purpsose/meaning, leverage challenges as learning opps

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9
Q

Health Belief Model

A

Perceived threat to health + perceived severity of this threat vs. perceived benefit of change + perceived barriers to change

Cues to action (internal symptoms, role models, environmental factors) that prompt change adoption

Self-efficacy

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10
Q

PERMA

A

Positive emotions - focus on these improves well-being; inspiration, hope, love, awe, gratitude, joy

Engagement - using strengths & talents to overcome challenges; have sense of control, clear goals, and fully able to concentrate; high challenge + high skills

Relationships - social connections are critical; strong relationships have greates impact on life satisfaction; focus on growth-focused, authentic relationships

Meaning/purpose - identifying values and pursuing activities aligned with them

Achievement/accomplishment - result of working toward and reaching goals with sucess; results in mastery, self-efficacy

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11
Q

Chronic Care Model

A

Promotes collaborative care, connection with community resources, increases access to care, increases patient engagement

Emphasizes self-management support & central role of patient in health care

Community resources + self-mgmt + health system intentionally organized (decision support, CIS)

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12
Q

Self-monitoring, self-management

A

Improved coping, expertise, overall sense of well-being
Emphasizes patient’s central role in their helaht care

Autonomy & self-efficacy are keys to sustainable self-management

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13
Q

Sources Vitamin A

A

Vision, growth, reproduction, skin

Requires conversion to retinol in plant foods (is preformed in animal foods)

Sweet potato
Mango
Carrots
Cantaloiupe
Butternut squash
Plant milks

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14
Q

5 As behavior change (and specific for smoking)

A

Assess health risks
Advise change (personalized)
Agree on counseling focus, willingness for change
Assist w/ setting goals, resources
Arrange follow-up & support

Tobacco-specific:
Ask about tobacco use on every patient
Advise quitting
Assess readiness to quit
Assist w/ counseling, Rx
Arrange follow-up (1 week prior, 3 days following quit date, first month ater)

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15
Q

Sourcres Vitamin D

A

Calcium absorption (bone health), muscle health, glucose metabolism

Salmon
Fortified milk
Sunlight
Supplement

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16
Q

PREDIMED

A

Pt w/ high CVD risk (had T2DM or mult risk factors)
Mediterranean (nuts vs. olive oil) vs. SAD showed 30% risk reduction of major CV event over 5 years

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17
Q

Chol norms

A

Total < 150
LDL < 100 (<70 in high risk)
HDL >40 (male), >50 (female)
Trig <150

If total chol is 90-140, plaque progression ceases and other risk factors (e.g., smoking, ob, inactivity) don’t produce plaques

ApoB is a stronger indicator of artherogenicity
Lp(a) independent risk factor for CVD - highly heritable

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18
Q

PPIs (Positive psychology interventions)

A

-Gratitude journal
-Volunteer work
-Reflecting on how want to be remembered
-practicing acts of kindness
-Counting blessings
-Connecting with others in person
-Thinking of happiest days

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19
Q

Intensive Therapeutic Lifestyle Change (ITLC): phases, key information

A

Induction: dramatic changes; typically indiv & group visits, multidisciplinary, not require motivation & self-efficacy
Maintenance:
Support:

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20
Q

Suprachiasmatic nucleus

A

Master circadian clock; located in the hypothalamus

Oscillators in all peripheral cells - mini clocks

Dysregulation comes when internal clock does not jive with social clock

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21
Q

Depression & mortality

A

-Depresesion is INDEPENDENT marker for all cause mortality
-As strong a marker as smoking
-Increased risk for CA and CVA

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22
Q

PHQ-2, GAD2, PHQ4

A

PHQ-2:
In the past 2 weeks, how often:
-Feeling down, depressed, hopeless
-Little interest or pleasure in normal things

GAD2
-Feeling nervous, anxious, on edge
-Can’t stop or control worrying

PHQ4 combines the two

For all 3, any score >/3 needs further evaluation

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23
Q

When to screen for TAPS

A

Smoking: Regularly

Alcohol:
-Ages 18+
-Annually + problem-focused visits when may be alcohol-related
-High risk groups more often

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24
Q

Lapse/relapse prevention & mangement

A

When might it occur, under what circumstances, with whom
How notice a lapse before becomes relapse?
Who to turn to during a lapse/relapse?

Lapse/relapse are normal parts of change process

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25
Q

Depression & diabetes

A

-T2DM & depression have BIDIRECTIONAL association
-Insulin indifrectly influences serotonin, norepi, dopamine synthesis
-Depression alters HPA axis & symp NS
-Perceived lack of ctrl over DM can increase dep & anx

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26
Q

Health Professionals Follow-Up Study

A

2 or more SSB/day (vs. <1/mo) incresased overall mortality by 21% and CVD death by 31%

Higher intake red meat = 11-15% increased risk CHD
Sub plant-protein for red meat decreased risk by 14-17%
Olive oil better than most animal fats & margarine at reducing CHD risk

Vitamin D binding protein decrease mob/mort CRCA

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27
Q

Sleep and health

A

Shortened sleep lead to:
-Higher nighttime cortisol, glucose, and reduced insulin sensitivity
-Lower daytime leptin -> highger intake carbs
-Reduced testosterone, growth hormone
-Increased AGEs
-Dyslipidemia
-Endothelial dysfunction
-Elevated BP
-Reduced peripheral perfusion
-Increased MI, CVD death risk
-Impaired learning, memory
-Emotional distress, impaired judgment
-Decresaesd alertness, cognitive processing
-Aberrant DNA methylation
-Immune supression
-Gene transcription dysfunction
-OB, T2DM, CV risk, depression, bipolar, seasonal affective, PMS, worsened PTSD, worsened TBI, cancer

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28
Q

Therapeutic alliance

A

Trust, empathy, inclusive
Working collaboratively towards goals

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29
Q

Depression Tx

A

-1st line is pharm alone, CBT alone (for mild), or combo; pharm is SOC for mod to severe
-CBT + pharm are more effective than meds alone for dep, panic d/o, OCD

-LM can be adjunct to pharm and CBT
—–Exercise is as effective as pharm for mild to moderate
—-Decreasing fast food, healthier diet
—–F/V have some evidence for increased eudamonia, fewer negative emotions, decreased symp of anx, dep; more + attitude

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30
Q

Transtheoretical Model

A

Precontemplation: not planning to change or > 6 months out; use MI; listneing, open-ended ?s; anticipate sustain talk; ask how would know ready to change; provide general info health risks

Contemplation: thinking about change in next 6 months; use MI; anticipate ambivalence b/c pros not yet outweighing cons; needs certainty & assurance; ask how would know ready to change; provide general info health risks

Preparation: Decided to make change in next month; CBT; assess confidence; co-create action plan - goals need to be specific & clear; excited & nervous; schedule follow-up

Action: Actively making changes for < 6 months; not yet met goals; CBT; challenge distorted thoughts; celebrate sucesses; very vulnerable to relapse; lapse prevention plan; estab social supportive resources; estab system of accountability & self-monitoring

Maintenance: Making changes for >6 months but still have some desire to return to old habits; CBT; reconnect w/ purpose for change (build autonomous motivation) & continue setting specific & clear goals

Termination: No longer tempted to return to old habits; has adequate self-efficacy & for skills

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31
Q

Diabetes Prevention Program

A

diet (low-fat, low-cal) + PA (150 MVPA) + lose/maintain 7% vs. metformin vs. placebo

Progression from preDM to T2DM:
lifestyle vs. placebo was ~60% lower incidence
metformin vs. placebo was ~30% lower incidence
lifestyle vs. metformin was ~39% lower incidence

Saw results even without full adherence (7% wt loss)

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32
Q

How to progress exercise (aerobic & resistance)

A

Aerobic:
-start at 15 min, moderate intensity, 3-4x week
-Increase by 20% until reach 30 minutes
-Increase duration first, then frequency, then intensity
-Slowly increase from mod to vig and from interval to continuous

Resistance:
-Start w/ single set of 8-12 reps (10-15 for older adults w/ lighter weight) of each major muscle group @ 40-50% 1RM, 2 days week
-Gradually increase resistance (weight), repetition (reps), frequency (#sets, days)
-Goal to get to 2-4 sets of each major muscle group

Goals:
-More reps, lighter load = muscle endurance
-Fewer reps, heavier load = muscle strength

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33
Q

INTERSTROKE

A

Examined top factors for stroke risk; top 10 lifestyle factors were associated a/ 90% of the stroke risk

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34
Q

NHANES

A

Ultraprocessed foods represented >50% caloric intake

Undiagnosed DM significant problem

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35
Q

Determinants of health

A

ACE, SDOH & disparities, genetics/epigenetics, SES, health literacy, environmental conditions

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36
Q

CBT

A

Cognitive behavioral therapy

Gold standard psychotherapy for many d/o

Best for stages of change Preparation/Action/Maintenance

Recognizes distorted (non-productive) thinking and reframing through self-talk

Distorted thoughts such as all-or-nothing, overgeneralizations, mind-reading, fortune telling, mental filters, magnificantion/minimization, personalization & blame, emotional reasoning, labeling/mislabeling, disqualifying the positive

Utilizes ABCDE method of behavioral change

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37
Q

Pre DM vs DM, other measures & when to screen

A

Pre DM
A1C 5.7-6.4
FBG 100-125
OGTT 150-199

DM >/= 6.5
FBG >125
OGT > 200
Random BG + symptoms

HOMA-IR - measure of insulin resistance

C-peptide is by product of insulin production - will be decreased in T1 and long term T2

Screen in all OW/OB adults w/ 1 other risk factor and all patients starting at age 45

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38
Q

DASH

A

Low fat, lots f/v, adequate mag, K+, ca2+, fewer snacks/sweets (vs. isocaloric SAD)

Pt w/ & w/o HTN, not on antihypertensives

Lower SBP & DBP after 2 weeks (-5/-3)

Those w/ HTN baseline had more pronounced improvements (-11/-5.5); age <50 did better

Results were comparable to reductions seen in monotherapy

Orig study kept Na+ stable at 3000 but everything else says low sodium (1500-2300)

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39
Q

Good sources of potassium

A

Bananas
Potato
Avocado
Beans
Beet greens
Apricots
Dates
Nuts
Green vegetables

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40
Q

Goals for max sodium, fat, added sugar

A

Max sodium 2300 (goal 1500 in HTN)

WHO goal <10% added sugar (<5% ideal); AHA 6-9 tsp (female/male)

AHA <5-6% total calories sat fat
top source in us diet is cheese

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41
Q

Ornish/Lifestyle Heart Trial

A

3% regression in coronary stenosis maintained over 5 years
Regression overall (lifestyle only, no meds) vs. progression on meds and tons of progression on no meds

Reduced LDL

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42
Q

CHIP

A

Diabetic cohort, workplace setting, Vanderbilt
ITLC

Less health care utilization, nearly 25% were able to cut one medication

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43
Q

Labels

A

Low source = </= 5% DV
Good source = 10-19% RDI or DV (regulated term)
High or excellent source = >20% (regulated term)
Gluten-free (regulated term)
Organic (regulated term)
Low sugar not allowed but lightly/slightly/less sweet is used
Natural is not regulated
Light sodium = 50% less
Reduced sodium = 25% less
No salt added = natural sodium still present

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44
Q

Social media impact on mental health

A

-Problematic social media use (high frequency) is strongly and independently associated w/ depression
-Assoc w/ poor sleep (esp nighttime use), low self-esteem, anx, dep

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45
Q

Triacylglycerol

A

Severe caloric restriction (~600kcal) resulted in normalization of beta cell function, reduced hepatic & pancreatic triacylglycerol within weeks

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46
Q

Resilience, self-care, burnout prevention - clinician

A

primordial: decrease risk factors before burnout onset; building social support networks, advocacy

primary: ID and reduce source of burnout; reduce burdens, normalize struggles, decrease isolation, provide support

secondary: reduce severity of burnout; stress management, mindfulness

tertiary: minimize adverse consequences of burnout; referrals to mental health, EAP

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47
Q

% GDP on health care spending

A

~20%

48
Q

Sources Vitamin E

A

Antioxidant, immune fx, endothelial health

Sunflower seeds
Almonds
Sun/safflower oils
Peanut, olive, corn oils
Peanut butter

49
Q

Serotonin, melatonin, adenosine

A

Serotonin highest in daytime

Melatonin (a derivative of serotonin) starts; melatonin starts several hours before bedtime and peaks 30 min before bedtime, then stabilizes until rapidly decreasing closre to subjective day. First light exposure (or bright light at any time) causes melatonin cessation

Adenosine accumilates in brain throughtout day - once sufficient, sleep onset is triggered

Caffeine counteracts adenosine accumulation

50
Q

GEMINAL

A

ITLC showed reduction in prostate cancer tumor

51
Q

Lifestyle Medicine core competencies

A

Leadership, knowledge, assessment skills, management skills, office/community support

52
Q

Self-motivation & Self-confidence (Self-efficacy) and how can it be increased/influenced

A

Self-motivation (autonomous or internal motivation); increased by connecting to meaning, purpose, values

Self-confidence: trust in their own capabilities; can be increased through eliciting positive emotions, change talk, leveraging strengths, robust support system, education to increase knowledge, skills

Self-efficacy: self-motivation + self-confidence = confidence they can successfully perform a behavior
Influenced by behavioral capability & environmental factors; CORE of successful health behavior change

53
Q

Types of fatty acids

A

Saturated - solid at room temp
-highest is coconut oil (90%)
-palm oil @ 50%
-lard ~40%
-olive oil ~15%

Trans - naturally found in red & processed meats, butter (so also in baked goods, refined grain products); now “unsafe for human consumption” due to high increase in CVD risk

Poly-unsaturated - omega 6 &3 are essential fatty acids
-Get plenty of omega 6 (corn oil, nuts, seeds)

Omega 3 (ALA, EPA, DHA - ALA can be converted into EPA & DHA; ALA source is algae; also in nuts, oils, fish

Mono-unsaturated
Canola, olive, vegetable oils

54
Q

NOVA

A

Unprocessed

Minimally processed (culinary ingredients)

Processed

Ultraprocessed

55
Q

MET definitions, examples

A

Metabolic equivalent of a tsk
1.0 = sitting comfortably; standard resting metabolic rate
0.9 = sleeping
<1.5 = sedentary
3 = walking 3mph
5 = walking 4mph
18 = running 10.9 mph (

1= 3.5mL O2/kg/min
amnt of O2/kg consumed in 1 min

Goal ~10-20 MET hr/week comes from figure re: mortality risk (HR 0.6 - 0.7); ~70% of benefit is reached by 8.25 MET hr/week (=150 MET min moderate)

MET hour = MET intensity * duration (hours)

Greatest gain (HR1.0 to 0.8) is with going from completely sedentary to minimally physically active

No evidence of increased risk to health at high end, but benefits plateau after ~20 MET hours/400 minutes MVPA

56
Q

Iron

A

Heme vs non-heme iron:
heme iron in animal foods is more easily absorbed; excess ion leads to inncreased risk of CVD, BRCA, stomach & esophageal CA
Non-heme iron in animal & plant foods; may be safer

Pair with Vitamin C increase absorption

Avoid Ca2+ supplements w/ meals, tea/coffee (tannins), or high-oxalate greens

57
Q

Coach vs. expert

A

Expert is assessing, diagnosing, creating treatment plan, educating

Coach is building self-confidence, self-efficacy, self-management; patients are leaders

58
Q

Portfolio

A

Impact of diet (low fat fiber, soy, plant sterols) on LDL
Showed equivalent to statin

59
Q

Low-dose CT

A

Age 50-80, 20-pack year h/o, current smoker or quit <15 years ago

60
Q

Adventist

A

Reduced all cause mortality in veg versus non-vegetarian diet

Vegan lower BMI, risk of DM, HTN, met synd

61
Q

EPIC Oxford

A

Vegetarian & vegan had 37% lower T2DM risk, 12% lower risk of cancer, 22% lower rate ischemic heart dz

62
Q

SMART & Action plans & LM prescriptions

A

Specific, measurable, achievable, relevant, time-bound

Action plans have more specific details

Personalized for patient’s skills, abilities, readiness, & confidence

63
Q

Body fat %

A

Normal
male <25%
female <30%

Obese
male >/=30%
female >/=35%

64
Q

Sleep restriction therapy

A

Goal to re-entrain circadian rhythms

-Take average sleep duration and shorten it, working backwards from needed waking time
-Slowly extend by 15-20 min/week until sleep need is met

65
Q

Light vs. Moderate vs. Vigorous

A

Talk test:
Sing - Light
Talk full sentences, not sing - Mod
Few words - Vig

MET
<3 = light
3-5.9 = mod
>/= 6 = vigorous

1 Rep Max (1RM)
Mod 50-69%
Vig 70+

66
Q

AUDIT-C

A

3 screening questions:
1) How many days past year consume alcohol?
2) How many drinks on average day when drinking?
3) How often do you consume >/= 6 drinks on a single occasion?

67
Q

BMI calculation, categories

A

weight (kg)/[height (meters)2]

18.5-24.9 normal
25-29 Ow
30-34 OB class 1
35-39 OB class 2
>/=40 OB class 3

68
Q

Guidelines for weight loss (%, calorie deficit, total calories)

A

Losing 5-10% body weight initially

Calorie deficit at least 500-750/day for slow, consistent

Need minimum 1200 calories

Women 1200-1500
Men 1500-1800

Lose 1 pound/week

Difficult to accomplish by exercise alone

OW/OB need to exercise closer to 250-300 min (vs. 150)

Offer/refer anyone BMI >/= 30 (OB class I) (or >/=25 w/ CV risk factors) for intensive, multi-modal bheavioral interventions

69
Q

Insomnia strategies; advancing/delaying sleep onset

A

-Typically has behavioral component
-Stimulus control: bed for sleep & sex only - this is single most important intervention
-In children, often lack of limit setting and attachment issues (can’t go to sleep w/out person/object)
-Cool, dark, quiet (but not silent)
-Warm bath (vasodilation, helps with cooling)
-Avoid strenuous exercise
-Avoid bright lights, devices
-Deep breathing, progressive muscle contraction
-Shifting wakeup time earlier: eating breakfast shortly after awakening
-Eating dinner too early may lead to falling asleep too early
-If falling asleep too late, shift carbs to earlier meals; avoid snacking and carb-rich dinners; eat an earlier dinner
-Eating more carbs at dinner (2-3 hours before ideal sleep time); good for jet lag travelling west
-Carbs earlier = asleep earlier; carbs later = delaying sleep onset

70
Q

Measuring fitness

A

Functional - 6 min walk test - no standard but anticpate 400-700 feet; distance is primary goal

Muscular endurance - situps, pushups, squats

Strength - dynamometer grip strength predicts early mortality, funcitonal status, proxy for overall strength

Flexibility - V-sit

CV - step test

71
Q

Specific effects of PA on diseases

A

Exercise = meds for secondary prevention of coronray heart disease and prediabetes

Exercise better than antiplatelets, anticoagulants in reducing mortality following stroke

Exercise not better than meds for CHF mortality reduction

Exercise can reduce SBP but not as much as medications

Exercise improved mobility, balance, gait speed, neuroplasticiy post stroke

Resistance exercise can reduce HgbA1c by 0.5% or more in T2DM - sim to meds

72
Q

Social Cognitive Theory

A

Recipricoal determinism: personal factors & human behavior & environment

Observational learning (modeling) - imitation of observed behaviors

Self-efficacy is influenced by behavioral capacity & environmental facilitators/inhibitors

Mastery experiences are key to self-efficacy

Bandura

73
Q

Definitions for problem drinking

A

At-risk: bingeing monthly; exceeds levels any day or week; increases risk of future problems even if no current symptoms

Binge drinking:
-4 drinks (female), 5 drinks (male) in 2 hours

Heavy use:
->/=5 drinks on >/=5 days/month

Alcohol use disorder: meet 2 of 11 criteria showing a pattern of impairment or distress
-Consequences, compulsion, craving, loss of control (as opposed to tolerance/withdrawal which indicate dependence)

74
Q

ABCDE approach

A

Method of behavioral change (CBT)

Action or event that occurred
Beliefs & thoughts about what happened
Consequences of action/event (emotional response)
Dispute unhealthy or distorted beliefs
Effect of reframing on how you feel; next steps

Based on premise that thoughts & beliefs about thoughts drive emotions which drive behavior

75
Q

Percutaneous angioplasty vs. exercise in stable CHD

A

Exercise (vs. PCI w/ stenting) showed higher EFS, less likely to experience angina, signif increased HDL, 1/2 cost, increased exercise tolerance

76
Q

Sources Vitamin C

A

Antioxidant, iron absorption, tissue growth/repair

Bok choy,
Parsley
Daikon radish
Cruciferous: Broccoli, Cauliflower, Cabbage, Brussels sprouts
Cantaloupe
Pineapple
Oranges
Mango
Kiwi
Spinach, other leafy greens
Pears
Peaches
Cherries

77
Q

Stress & Chronic Dz MOA

A

-Impaired immune function
-Inflammation
-Metabolic disease, increased appetite, weight gain, abdominal fat deposition
-Increased glucose, triglycerides
-Decreased bone density
-Increased clotting
-Decreased wound healing
-Pain, fatigue, low mood
-Telomere shortening

78
Q

Framingham

A

2 or more risk factors (vs 0) led to 69% (male) & 50% (female) lifetime arhteroslcerotic CVD risk and ~10 year less life expectancy

Systolic BP imp for CVA risk

Pre-HTN increases CVD risk

Changes in happiness level reached 3 degrees of separation

79
Q

Light types

A

-Blue wavelengths are the greatest suppressors of melatonin (monochromatic blue light such as blue appliance lights); shorter wavelengths
-Cool white light: halogen, fluorescent, LED back-lit screens (phone, TV, computer) is less suppressive
-Then warm white light (incandescent, candlelight); longer wavelengths
-Red light actually enhances mealtonin

80
Q

PAVS

A

Only validated PA vital sign (vs. assessment tool)

1) How many days a week do you engage in moderate to vigorous physical activity?
2) How many minutes per day?

Can add how many days did resistance training

81
Q

Leading US causes of death

A

CVD, cancer, accidents, stroke, COPD/pneumonia, Alzheimers, DM, chronic liver, renal dz

82
Q

60% US adults have a chronic disease: % of types disease

A

Approximately: 12% T2DM, 38% pre-diabetes; 40% OW/OB; 47% HTN; 12% hyperlipidemia; 7% CVD

83
Q

Waist circumfrence, waist:hip ratio

A

Considered “increased”
men >/=40”
women >/=35”

No standardized place to measure
horizontal plane level w/ iliac crests
WHO says between lowest rib & iliac crests

“Increased” waist:hip ratio
men >0.9
women >0.85

Increased waist and/or waist:hip ratios are associated w/ incresed risk of metabolic complications & other chronic disease

84
Q

Cortisol awakening response (CAR)

A

-Necessary for alertness at waking; transition from sleep to waking
-Enhanced by consuming a significant proportion of total daily carbs at breakfast and doing so within first hour of awakening

85
Q

4 principles of MI

A

Express empathy (show an understanding, listening, body language)

Support self-efficacy (you guide, they decide; highlight their confidence, change talk)

Roll with resistance (non-judmental, listen, ask open-ended)

Hold up discrepancy (highlight through reflections, non-judgmental, allow them to draw own conculsions)

86
Q

Theory of Planned Behavior

A

Based on motivation (intention) and ability (behavioral control)

Attitude
Behavioral intention: motivational factors are most important in predicting behavior
Subjective norms
Social norms
Perceived power
Perceived behavioral control

87
Q

LM vital signs

A

smoking status
BMI
sleep quality/duration
perceived stress
alcohol use
dietary pattern
exercise

88
Q

Patient Activation Measure (PAM)

A

Patient abilities that lead to improved health outcomes
to self-manage illness or problems
to engage in activities that maintain functionhng & freduce health declines
to be involved in treatment & diagnositic choices
to collaborate w/ providers
to select providers/orgs based on performance or quality
to navigate the healthcare system

89
Q

PSG, referral indications

A

PSG warranted:
-sleep apnea suspected
-narcolepsy
-REM sleep behavior disorder
-periodic limb movement d/o

No PSG:
-restless lets
-circadian rhythm d/o (advanced/delayed/shift work)
-insomnia
-non-REM parasomnias (sleep walking, talking, terrors)

Refer to sleep med specialist:
OSA (unless trained to treat, order cpap)
Narcolepsy
Periodic limb movement
non-iron deficient restless legs

Refer to sleep med behavioral specialist:
-CBTi
-Sleep restriction therapy
-Relaxation training

90
Q

2 key elements for improving health behaviors

A
  1. trusting therapeutic relationship
  2. patient support from multi-disciplinary team, friends/family/community
91
Q

Medical clearance

A

Risk of exercise is far greater than risk of continuing to be sedentary!

Greatest risk is going from nothing to high intensity

If walked into office without symptoms - cleared for light activity

Clearance needed if symptomatic CV, renal, metabolic dz

Pulmonary disease usually not need clearance but may need accommodations

PARQ+

Clearance may involve PE, labs, echo, EKG, stress test

92
Q

Potsdam study

A

4 healthy lifestyle facotrs: BMI <30, healthy diet, never smoker, PA >/= 3.5 hr/week

all 4 (vs. 0):
93% decreased risk DM, 81% MI, 50% stroke, 36% cancer, 78% chornic disease overall

BMI <30 exerted the largest reduction on risk of any chronic disease

Never smoking exerted largest risk reduction on MI & cancer

93
Q

Disease-specific exercise recommendations

A

Pregnancy

DM -
-Sustained cardiorespiratory fitness is one of the strongest independent risk predictors of mortality
-Focus especially on reducing sedentary time (multiple bouts activity aids glycemic ctrl)
-insulin, sulfonyureas; check blood glucose +/- ketones

OB - need >/=250 min mod for weight maintenance and even more for weight loss; may prefer non-weight-bearing or more resistance when starting out becuase of joint stress

Regardless of weight, meeting guidelines conferred same increased life expectancy

CV issues - consider cardiac rehab

Atrial fib - weight loss & improved aerobic fitness will decrease recurrence rates

94
Q

Common elements behavior change theories

A

Beliefs about risks/benefits

Internal/autonomous motivation

Self-efficacy

Enviornmental influence (social norms, community, supports)

Health behavior influenced by:
Intrapersonal
Interpersonal
Institutional
Community
Public policy
SDOH

95
Q

Good sources of magnesium

A

Nuts
Spinach
Edamame
Dark chocolate
Whole-grain bread
Brown rice
Tofiu
Potato
Black-eyed peas
Lima beans

96
Q

Stress & the brain

A

Mindfulness programs resulted in radiographic changes to the brain:
-Increased gray matter density in prefrontal cortex (processing, executive functioning, decision making, memory)
-Increased gray matter density in hippocampus (memory, emotion)
-Decreased gray matter density in amygdala (trauma response, emotion)
-Increased neuroplasticity (sulci show younger than stated age)

97
Q

Advocacy vs. activism

A

Activism is typically more extreme, vocal, rigid, upfront

Advocacy - coordinate efforts to defend, promote, or protect something or someone by influencing public policy debate and interacting with influencers. Individual, local, state, federal.

98
Q

Non-adherence

A

Medications for chronic illness ~50-80% nonadherence

Ask what led to behavior choices & explore other influences

99
Q

Good sources of soluble vs. insoluble fiber, goals, MOA

A

Goal 25g (female), 38 (male) - ideal more like 40/50
Only found in plants!!

Soluble: slowly absorbed, so slows down digestion & absorption of glucose; binds to and removes cholesterol; increases insulin sensitivity

Oats
Peas
Beans
Barley
Apples
Citrus
Carrots

Insoluble: not absorbed, so moves through gut more quickly, stool bulk - reduces CRCA risk, promotes laxation; food for bacteria -> SCFA
Whole wheat
Beans
Nuts
Potatoes
Some vegetables

100
Q

Nurses Health Study

A

Not smoking, healthy BMI, healthy diet, exercie, low alcohol resulted in 82% lower risk CHD

Refined carbs & trans fats increased CHD risk

Impact of alcohol on breast & colon cancer risk

Vitamin D on colon cancer/polyps

As little as 1-1.9 hr MVPA/week had risk reduction 82% all cause mortality

Combined w/ Health Professionals Follow-up study:
Health plant-based: 34% less risk T2DM; 25% less CHD
Unhealthy plant-based: 16% more risk T2DM; 32% more risk CHD
Increased risk T2Dm=M w/ meat, processed meat, >/= 5 eggs/week

101
Q

Lyon

A

H/o acute MI
Med diet (w/ high alpha lineoleic acid-omega3) prevented second MI and other cardiac risks (50-70% reduction in cardiac mobiditiy/mortality), significant cost reduction

Study stopped early after 4 years b/c of sig effects

102
Q

Lifestyle & Mental Health - Protection & Tx

A

Sleep, PA, healthy diet, and not smoking can be protective and/or tx for ADHD, depression, anxiety, bipolar, psychotic disorders

103
Q

Glycemic index vs. glycemic load

A

GI is a reflection of the potential to raise blood glucose

-more fiber, lower score; more processed, higher score

GL considers portion size + GI and reflects how quickly food enters bloodstream and how much gloucose per serviing it delivers

Short-term fluctuations in blood glucose are not as important as long-term trends

104
Q

Provider’s personal health practices - how impact patient

A

Physically active -> increased counseling

Healthy practices -> increased counseling (e.g., smoking, alcohol, exercise)

Those attempting to improve poor habits -> increased counseling (vs. those not making changes)

Non-smoking -> emphasize risks of smoking

weight patient > provider -> record OB dx & initiate convo

Ate less fat -> counsel on cholesterol

Ate f/v -> counsel on nutrition

Vegetarian diet -> counsel on weight loss

Normal BMI -> more confident counsel about PA

105
Q

Nutrients of concern, underconsumed, overconsumed

A

Underconsumed:
Vitamins A, C, D, E, K
Fiber
Potassium
Calcium
Magnesium
Choline

Of concern (public health implications):
Vitamin D
Fiber
Potassium
Calcium

Overconsumed:
Sodium
Saturated fat
[trans fats]
Sugar
[cholesterol]
Group 1 carcinogens (processed meats, alcohol)

106
Q

MBSR

A

-paying attention to the space around you, surroundings
-awareness of thoughts, feelings - but not judging them
-increased curiosity, connection, calm
-fully present in the moment
-increased tolerance, resilience, empathy, compassion

107
Q

Medications for quitting

A

Tobacco:
-Rx combos are more effective than monotherapy
-Rx + therapy results in highest quit rate
-CBT is first line in adolescents; best for pregnant
-5 types nicotine replacement (patch, lozenge, gum; inhaler & nasal spray require Rx); most effective patch + short-acting; stimulate dopamine release by binding to nicotinic receptors
-Virinocline (most effective monotherapy)
-Buproprion
2nd line:
-Clonidine
-Nortriptilyine

Alcohol:
-Naltrexone**
-Acamprosate (non-adherance due to tid dosing)
-Disulfuram (aversion agent; high non-adherenace)
Off-label: gabapentin, topiramate (for w/d, cravings)

Opioids:
-Naltrexone (opioid antagonist)
-Methadone (full opioid agonist)
-Bupronorphine (parital opioid agonist)

Clonidine can help w/ w/d symp

108
Q

GAD Tx

A

Ist line is CBT, SSRI, or physical activity
Adjunct - LM, especially diet

109
Q

~40% premature deaths can be attributed to the following factors

A

50% of deaths were related to top 9 facotrs

40% were attrib to tobacco, excess alcohol, poor diet, physical inactivity

really 80% b/c was 40% of the list which was 50%

110
Q

Impact of MBSR/mediration on stress, mental health

A

Sys review of 47 studies
-MBSR/meditation showed decreased symptoms of depression and anxiety (moderate evidence)
-Low evidence for stress reduction
-Improved pain (moderate evidence; potential for improved social connection since share pain center)
-No or insuff evidnece for being superior to meds or behavioral therapy, so use as adjunct

111
Q

Sources Vitamin K

A

Blood clotting, heart health, bone health

Green leafy vegetables
Broccoli
Cabbage
Asparagus,
Kiwi

112
Q

Nutrient dense (ranked by most underconsumed w/ least overconsumed)

A

Vegetables + mushrooms
Herbs & spices
Fruits
Legumes
Whole grains
Nuts
Seeds

113
Q

Aerobics Center Longitudinal Study

A

Examined global all cause mortality

Low cardiorespiratory fitness was #1 cause of preventable death

Cardiorespiratory fitness: best reflection of whole-body health & function; inversely associated w/ all cause CVD, CA; often assoc w/ increased visceral adiposity, OB, HTN, hyperlipid, & other chronic dz

114
Q

Hedonia vs. eudaimonia

A

Hedonia is pleasure for pleasures sake, maximizing happieness; satisfying desires (e.g. spa, watching TV)

Eudaimonia is doing positive things even though they may be challenging; using strengths; fulfilling personal goals; living up to your potential

Eudaimonia is associated with down-regulation of pro-inflammatory genes, lower inflammatory markers, slower rate cognitive decline

115
Q

Smoking impact on mortality; benefits of quitting

A

Smoking is #1 cause of preventable death & disease

-Shortens life expectancy by 10 years
-50% of deaths in smokers will be related to smoking
-1/3 cancer deaths related to smoking
-High co-morbidity with cancer, HTN, T2DM (30-40% higher risk), hyperlipidemia, stroke

Quitting:
-Slow COPD progression
-Immediate benefits in 1st 24 hours
-Immediate decrease risk of MI death by 50%
-At 1 year: decrease CVD risk by 50%
-At 2-5 year: decrease stroke risk to that of non-smoker
-At 10 years: decrease lung cancer risk by 50%
-Quit at 30 -> add 10 years to life

116
Q

Good sources of calcium

A

Broccoli
Soybeans
Chia seeds
Collard greens
Kale (low-oxalate)
Almonds
Black beans

High oxalate: spinach, beet greens, swiss chard inhibit ca2+ absorption

Lifestyle Medicine Certification Prep (2 decks)

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