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An article in The Permanente Journal indicates that "More than 80% of chronic conditions could be avoided through the adoption of healthy lifestyle recommendations."[1]An original investigation in JAMA Internal Medicine (2020) indicates that "Various healthy lifestyle profiles appear to be associated with extended gains in life lived without type 2 diabetes, cardiovascular and respiratory diseases, and cancer." The authors go onto say that "Of the 16 different lifestyle profiles studied, all 4 that were associated with the longest disease-free life span included a BMI [Body Mass Index] less than 25 and at least 2 of the following health behaviours: never smoking, physical activity, and moderate alcohol consumption."[2]
What is Lifestyle Medicine?
Berries
The first edition of the Lifestyle Medicine book, edited by James Rippe, MD, coined the term "lifestyle medicine" in 1999. The book defined lifestyle medicine as
"The integration of lifestyle practices into the modern practice of medicine both to lower the risk factors for chronic disease and/or, if disease is already present, serve as an adjunct in its therapy. Lifestyle medicine brings together sound, scientific evidence in diverse health-related fields to assist the clinician in the process of not only treating disease but also promoting good health."[3]
Regular Exercise"The use of evidence-based lifestyle therapeutic approaches, such as a predominantly whole food, plant-based diet, regular physical activity, adequate sleep, stress management, avoidance of risky substance use, and other non-drug modalities to treat, oftentimes, reverse and prevent the lifestyle-related, chronic disease that's all too prevalent."[4]
"The application of environmental, behavioural, medical and motivational principles to the management of lifestyle-related health problems in a clinical setting" and further added in the third edition that lifestyle medicine also includes "self-care and self-management."[5]
Figure 1 shows the basic components of lifestyle medicine. It can be seen that the main focus is on nutrition, physical activity or exercise, sleep, stress, avoidance of risky substances, and social relationships.
Figure 1. Components of Lifestyle Medicine
Lifestyle medicine is linked with the concept of health assets[6]. Health assets are potentials in the individuals’ possession. The core attributes of health assets include relational, motivational, protective, and volitional strengths, which are internal; and support, expectations of others, and physical and environmental elements, which are external. Health assets mobilize an individual to engage in deliberation, decision making, and change. The consequences of health assets are positive health behaviors that can lead to mastery, self-actualization, and improved health outcomes. Therefore, health assets are internal and external strengths and resources that individuals possess, which can be mobilized to promote positive health behaviors and improve health outcomes.
Lifestyle Medicine for Health and Disease Management
Research has shown that various lifestyle medicine components may help treat and manage conditions such as:
Figure 2 outlines modifiable risk factors affecting various diseases such as obesity, heart disease, diabetes, and cancer. All of these are areas physiotherapists can educate their patients and clients to improve their lifestyle in order to help manage and prevent disease.
Figure 2 Modifiable Risk Factors
Assessment Tools
The following are selected lifestyle medicine tools for assessing patients. For additional resources, see the American Academy of Family Physicians website.
Alcohol Use Disorder Identification Test- Consumption (AUDIT-C) Frank D, DeBenedetti AF, Volk RJ, Williams EC, Kivlahan DR, Bradley KA. Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic groups. J Gen Intern Med. 2008;23(6):781-787.
International Physical Activity Questionnaire (IPAQ) Craig CL, Marshall AL, Sjostrom M, et al. International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sport Exerc. 2003;35(8):1381-1395.
Meaning in Life Questionnaire Steger MF, Frazier P, Oishi S, Kaler M. The Meaning in Life Questionnaire: assessing the presence of and search for meaning in life. J Couns Psychol. 2006;53(1):80-93.
Mediterranean Diet Adherence Screener (MEDAS) García-Conesa MT, Philippou E, Pafilas C, et al. Exploring the validity of the 14-item Mediterranean Diet Adherence Screener (Medas): a cross-national study in seven European countries around the Mediterranean region. Nutrients. 2020;12(10):1-18.
Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. Kroenke K, Spitzer RL, Williams JBW. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284-1292.
Readiness Ruler Indiana University. Readiness Ruler. Accessed July 31, 2021.
Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) Butler SF, Fernandez K, Benoit C, Budman SH, Jamison RN. Validation of the revised screener and opioid assessment for patients with pain (SOAPP-R). J Pain. 2008;9(4):360-372.
Social Needs Screening Tool American Academy of Family Physicians. Social Needs Screening Tool. Accessed July 31, 2021. www.aafp.org/dam/AAFP/documents/patient_care/everyone_project/hops19-physician-form-sdoh.pdf
↑Frates B, Bonnet JP, Joseph R. & Peterson JA. Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. Monterey, CA: Healthy Learning; 2019.
↑Egger G, Binns A, Rossner S, Sagner M, eds. Lifestyle Medicine: Lifestyle, the Environment and Preventive Medicine in Health and Disease, 3rd ed. London, UK: 2017.
↑Rotegård AK, Moore SM, Fagermoen MS, Ruland CM. Health assets: a concept analysis. International Journal of Nursing Studies. 2010 Apr;47(4):513-25. Available from: https://pubmed.ncbi.nlm.nih.gov/19819452/.
