VP1- LM and ITLC Flashcards
Which of the following statements about Lifestyle Medicine is most accurate?
A. The main focus of lifestyle medicine is to prevent disease with emphasis on immunizations and screening
B. Providers tell patients to enhance their diet with whole foods, incorporate physical activity, and emotional well-being practices, and avoid risky substances
C. Holistic approaches to balance core functional processes, control oxidative stresses at a cellular level, and promote detoxification is the main focus in lifestyle medicine
D. Lifestyle medicine is a collaborative, evidence-based method of incorporating lifestyle modification for the treatment, reversal and prevention of chronic diseases related to lifestyle and behaviors
D.
Lifestyle medicine is a collaborative, evidence-based method of incorporating lifestyle modification for the treatment, reversal and prevention of chronic diseases related to lifestyle and behaviors.
-Preventive Medicine focuses on prevention of disease with an emphasis on immunizations and screening (Answer A)
-Lifestyle Medicine requires persistent treatment with medical, behavioral, motivational, and environmental principles to help individuals adopt and sustain healthy behavior changes (Answer B).
-Functional medicine is defined as a holistic approach that is used to balance core functional processes in the body, such as cellular metabolism, control of oxidative stress, detoxification and digestive function (Answer C).
Which statement best describes the core competencies for prescribing Lifestyle Medicine?
A. The core competencies were created to help medical specialties prescribe interventions that promote healthy lifestyle practices.
B. The use of an interdisciplinary team like a coach, dietitian and physician is nice but not essential to creating the office and community support needed for sustained behavior change.
C. Leadership is one of the key areas of the competencies and includes leading teams to better diagnose chronic conditions and provide the usual standard of care treatment.
D. Quality improvement projects, such as measuring interventions, tracking outcomes, and implementing process improvements, are standard practice for Lifestyle Medicine physicians.
D.
Quality improvement projects, such as measuring interventions, tracking outcomes, and implementing process improvements, are standard practice for Lifestyle Medicine physicians.
Tracking performance measures is one of the competencies for Lifestyle Medicine physicians.
- The core competencies for prescribing Lifestyle Medicine were created to guide primary care providers. However, those competencies can be applied to any specialty (Answer A).
- An interdisciplinary team is an essential component of Lifestyle Medicine (Answer B).
- Certainly, physicians should implement processes to diagnose and treat chronic conditions with excellence according to the standard of care, but leadership in Lifestyle Medicine involves much more, including an emphasis on disease prevention, community advocacy and the creation of personal and professional environments of health (Answer C).
This ability is required by providers for the practice of lifestyle medicine:
A. Incorporate relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, spirituality, tai chi, etc
B. Recognize the interactions between the mind, body and behavior, and prescribe appropriate biofeedback techniques
C. Focus on the physiologic and biochemical functions of the body, investigating the balance and processes of cellular metabolism, digestive function, detoxification and control of oxidative stress
D. Expand vital signs to include tobacco use, sleep, stress and emotional well-being and make referrals to community resources and other health professionals when appropriate
D.
Expanding vital signs to include tobacco use, sleep, stress and emotional well-being and make referrals to community resources and other health professionals when appropriate is required in the practice of lifestyle medicine.
- Incorporating relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, spirituality, tai chi, etc is a skill needed in the field of mind-body medicine (Answer A)
- The ability to prescribe biofeedback for recognized inter-actions between the mind, body and consequential behaviors is a skill needed in the field of mind-body medicine (Answer B).
- Focus on the physiologic and biochemical functions of the body, investigating the balance and processes of cellular metabolism, digestive function, detoxification and control of oxidative stress is a main component of functional medicine. (Answer C)
Lifestyle medicine and conventional medicine differ in their approach to patient care. Which statement is an accurate comparison between lifestyle medicine and conventional medicine?
A. In conventional medicine, responsibility for health falls mostly with the patient, whereas in Lifestyle Medicine the responsibility falls mainly with the provider.
B. Patients are required to make big changes in health behaviors in conventional medicine. However, in Lifestyle Medicine patients are asked to only make small lifestyle changes.
C. Conventional medicine is often long-term, whereas Lifestyle Medicine treatments are always short term.
D. In conventional medicine, the patient is a passive recipient. Whereas, in Lifestyle Medicine, the patient is an active partner in care.
E. Causes of disease are treated in conventional medicine, whereas the risk factors of disease are treated with Lifestyle Medicine.
D.
In the conventional medicine approach, the responsibility for health care falls mainly on the provider, and the patient is a passive recipient.
- The change required by patients revolves mainly around being compliant with medications and medical interventions, which are generally viewed as the higher level of care. However, in Lifestyle Medicine, the responsibility for health remains with the patients. They must be active participants in their health care in order to make the substantial changes necessary to treat the unhealthy lifestyle behaviors that are the cause of most chronic diseases.
Which of the following statements about the Ornish Lifestyle Heart Trial is true?
A. It used a pre versus post design with each subject serving as their own control.
B. It compared a low-fat diet to a low-carb diet in the secondary prevention of coronary artery disease.
C. The treatment group had a relative difference in progression of stenoses of -35.6% at five years compared to all controls, and a difference of -54.6% compared to controls not taking lipid-lowering medications.
D. There was no association between adherence and change in stenoses or risk factors.
E. There was a minimal increase in stenoses in controls not taking lipid-lowering medications
C.
The treatment group had a relative difference in progression of stenoses of -35.6% at five years compared to all controls, and a difference of -54.6% compared to controls not taking lipid-lowering medications.
The treatment group had a 7.9% reduction in stenoses at five years, while average progression was 27.7% for all controls, for a net difference of -35.6%.
- The controls not taking lipid-lowering medications had a progression of 46.7%, for a net difference of -54.6%.
- The study used a randomized parallel design, not pre versus post.
- It compared a low-fat diet to optimized usual care which recommends the American Heart Association (AHA) Step 2 diet (not a low-carb diet) for patients with known CAD.
- There was a strong dose-response relationship between self-reported adherence and angiographic changes.
*Intensive lifestyle changes for reversal of coronary heart disease. Ornish et al. JAMA. 1998:280(23):2001-7.
Which of the following statements about the Ornish Lifestyle Heart Trial is true?
A. It compared minimal lifestyle changes to no lifestyle changes
B. It used a randomized, double-blind, parallel cohort design
C. In spite of its small sample size, the trial found both statistically significant and clinically significant differences between optimized usual care and intensive lifestyle treatment
D. The experimental treatment included only low-fat diet and smoking cessation
C.
In spite of its small sample size, the trial found both statistically significant and clinically significant differences between optimized usual care and intensive lifestyle treatment.
The study had a small number of subjects, but the differences were highly significant, both clinically and statistically, as there were far fewer cardiac events among the experimental group, and most differences had p-values <0.05.
- The study used a randomized parallel design, but was not double-blind.
- It compared a multifactorial lifestyle intervention (low-fat vegetarian diet, aerobic exercise, stress management, smoking cessation and group psychosocial support) to optimized usual care, not merely a low-fat diet and smoking cessation.
- The study compared intensive (not minimal) lifestyle changes to non-intensive lifestyle changes, because the control group was instructed to follow their doctor’s lifestyle recommendations and received written information about the AHA Step 2 diet.
*Intensive lifestyle changes for reversal of coronary heart disease. Ornish et al. JAMA. 1998:280(23):2001-7.
Which of the following statements about the NDPP study is true?
A. It was an observational cohort study comparing the effect of intensive lifestyle modification or metformin to a control group receiving a placebo
B. The primary outcome measure of this trial was reduced incidence of diabetes (prevention)
C. Incidence of diabetes was reduced by 31% in the lifestyle intervention group and 58% in the metformin group
D. Since the trial was not a multi-center trial, the generalizability of the findings is limited
B.
The primary aim of the study was a reduction in the incidence of diabetes
- The trial was a randomized clinical trial comparing the effect of intensive lifestyle modification or metformin to a control group receiving a placebo
- The incidence of diabetes was reduced by 31% in the metformin group and 58% in the lifestyle intervention group
- It was a multicenter trial, so the results can be generalized to a wide population of similar subjects.
*Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Knowler et al. N Engl J Med. 2002 Feb 7;346(6):393-403.
Which of the following best describes the findings of the NDPP?
A. The intensive lifestyle modification reversed type 2 diabetes.
B. As compared to the control group, subjects in the intensive lifestyle modification group demonstrated decreased risk of diabetes but had no change in their weight.
C. As compared to the control group, subjects in the intensive lifestyle modification group demonstrated no change in their risk of diabetes but they did decrease their weight.
D. As compared to the control group, subjects in the intensive lifestyle modification group demonstrated no change in their risk of diabetes or weight.
E. As compared to the control group, subjects in the intensive lifestyle modification group demonstrated a reduction in both their risk of diabetes and in their weight.
E.
As compared to the control group, subjects in the intensive lifestyle modification group demonstrated a reduction in both their risk of diabetes and in their weight.
- The lifestyle modification group did not reverse type 2 diabetes because the subjects did not have type 2 diabetes—they had impaired glucose tolerance, or pre-diabetes. (This was a prevention trial, not a disease reversal trial.)
*Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Knowler et al. N Engl J Med. 2002 Feb 7;346(6):393-403.
Based on the Hambrecht study results, which is the most correct statement?
A. As compared to the PCI group, maximal heart rate was significantly lower in the exercise training group at the end of the study.
B. As compared to the PCI group, resting heart rate was significantly higher in the exercise training group at the end of the study.
C. As compared to the PCI group, VO2 max was significantly lower in the exercise training group at the end of the study.
D. As compared to the PCI group, physical work capacity was significantly higher in the exercise training group at the end of the study.
E. As compared to the PCI group, the exercise training group had ~25% greater risk of cardiac events (70% versus 88%).
D.
In the exercise training group, physical work capacity increased from 133 at baseline to 159 at the end of the study. This change was significant as compared to almost no change observed in the PCI group.
- The resting heart rate was lower in the exercise training group, and the maximal heart rate and VO2-max were higher in the exercise training group at the end of the study as compared to the PCI group.
- The exercise group was 88% event free after 12 months, compared to only 70% of the PCI group, resulting in a 26% lower risk in the exercise group than the PCI group.
*Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Hambrecht et al. Circulation. 2004 Mar 23;109(11):1371-8.
Which of the following statements about the Hambrecht study is true?
A. Exercise training was more cost effective as compared to PCI with respect to changing the Canadian Cardiovascular Risk Class and improving exercise capacity.
B. Exercise training was less cost effective as compared to PCI with respect to changing the Canadian Cardiovascular Risk Class and improving exercise capacity.
C. Exercise training showed no change in cost effectiveness as compared to PCI with respect to changing the Canadian Cardiovascular Risk Class.
D. Exercise training was more cost effective as compared to PCI with respect to changing the Canadian Cardiovascular Risk Class, but decreased exercise capacity.
A.
Exercise training was more cost effective as compared to PCI with respect to changing the Canadian Cardiovascular Risk Class and improving exercise capacity.
Exercise training cost $3,429 to change by one class of the Canadian Cardiovascular Society as compared to PCI which cost $6,956.
- Exercise training was superior to PCI in improved exercise capacity at lower costs largely due to lower repeat hospitalizations and revascularizations.
- Therefore, exercise training was more cost effective as compared to PCI for both Canadian Risk Class and exercise capacity.
*Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Hambrecht et al. Circulation. 2004 Mar 23;109(11):1371-8.
The aim of the Jenkins Portfolio diet study was to show:
A. The effectiveness of reducing serum cholesterol levels using a diet very low in saturated fats as compared to statins
B. A low-fat diet was equally efficacious as statins in lowering serum lipid levels
C. The comparison of a low-fat diet to a low-carbohydrate diet and to usual care for lowering serum cholesterol
D. The effectiveness of serum cholesterol reduction with a diet containing four dietary cholesterol-lowering items compared to statins
E. A low-fat diet was better than statins for treating hypercholesterolemia
D.
The effectiveness of serum cholesterol reduction with a diet containing four dietary cholesterol-lowering items compared to statins.
The purpose of the study was “to determine whether a diet containing the recommended food components (low saturated fat, with plant sterols and viscous fibers, and soy protein and nuts) leads to cholesterol reduction comparable with that of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins).”
*Effects of a dietary portfolio of cholesterol-lowering foods versus lovastatin on serum lipids and C-reactive protein. Jenkins et al. JAMA. 2003 Jul 23;290(4):502-10.
In the Jenkins Portfolio diet study, reduction in which of the following has been considered as an ‘adverse event?’
A. Total cholesterol
B. LDL
C. HDL
D. Total cholesterol: HDL-C ratio
E. LDL-C: HDL-C ratio
C. HDL
Improvement in metabolic profile is typically associated with increased HDL and a reduction in other cholesterol subtypes and ratios. Although a transient reduction in HDL may be seen with dietary change, sustained reduction in HDL has been considered an ‘adverse event.’
- More recent research is revealing that not all HDL is protective and a reduction in the harmful HDL is not an ‘adverse event.’
*Effects of a dietary portfolio of cholesterol-lowering foods versus lovastatin on serum lipids and C-reactive protein. Jenkins et al. JAMA. 2003 Jul 23;290(4):502-10.
