Lifestyle Medicine

This module acts as a foundation for the rest of the course, providing an introduction to the principles of lifestyle medicine (LM) and an understanding of LM as an evidence-based practice. You will learn the definition of LM and how LM plays a unique role in the prevention and treatment of non-communicable diseases. By understanding both the health advantages and disadvantages of lifestyle behaviors, you will comprehend primary healthcare's important role in screening, diagnosing, and monitoring lifestyle-related conditions. By the end of this module, you will appreciate that a physician's healthy lifestyle influences a patient's health behavior outcome. You are invited to examine your personal lifestyle and identify a health habit you would like to improve upon (and subsequently maintain) while taking this course.

This module requires you identify a mentor with whom you would like to work.  Your mentor should be someone who has worked as a primary-care physician for five years or more, with a particular interest in LM. Your mentor will serve as your main consultant and educator on new material and will help you understand application of these lessons in clinical practice.

Upon completion of this module, students should be able to perform the following:

• Define lifestyle medicine (LM) and describe the unique role of LM
• Describe the LM core competencies as identified by a national consensus panel
• Cite the scientific evidence that demonstrates the association of risk conditions (from unhealthy behaviors) as key to health outcomes
• Understand the importance of LM in treating the world's lifestyle disease burden
• Cite scientific data supporting that physicians who practice healthy lifestyles are more likely to offer counseling and improve patient outcomes
• Understand environmental lifestyle-related factors and their impact on non-communicable diseases

Required Learning Resources and Activities

Define lifestyle medicine (LM) and describe the unique role of LM

Describe the LM core competencies as identified by a national consensus panel

Cite the scientific evidence that demonstrates the association of risk conditions (from unhealthy behaviors) as key to health outcomes

Additional Learning Options

Required Learning Resources and Activities

Understand the importance of LM in treating the nation's lifestyle disease burden

Additional Learning Options

Required Learning Resources and Activities

Cite scientific data supporting that physicians who practice healthy lifestyles are more likely to offer counseling and improve patient outcomes

Additional Learning Options

Required Learning Resources and Activities

Understand environmental lifestyle-related factors and their impact on non-communicable diseases

Adoption of a healthy lifestyle is reached through changes in perception and habits. This module provides you with knowledge of the change process, equipping you with tools to support individuals willing to change their health behavior.

This module requires that you identify a patient with lifestyle health-related issues who you will accompany in his/her lifestyle health behavior change. Throughout the course, you will be asked to meet with your patient and practice the use of key materials and behavioral methods. By the end of this module, you should feel comfortable using practical tools that support your patients with their health behavior changes.

Upon completion of this module, students should be able to perform the following:

• Understand the role of behavioral determinants on positive and negative health outcomes
• Demonstrate key elements of conducting patient readiness assessment and stage matched responses
• Understand the gap between clinical guidelines and patient behavior; know how to apply the transtheoretical model of health behavior change
• Apply motivational interviewing, cognitive behavioral, and positive psychology techniques
• Describe the process of building effective relationships with patients
• Describe strategies for helping patients maintain healthy behaviors

Required Learning Resources and Activities

Understand the role of behavioral determinants on positive and negative health outcomes

Required Learning Resources and Activities

Demonstrate key elements of conducting patient readiness assessment and stage matched responses

Understand the gap between clinical guidelines and patient behavior; know how to apply the transtheoretical model of health behavior change

Required Learning Resources and Activities

Apply motivational interviewing, cognitive behavioral, and positive psychology techniques

Additional Learning Options

Required Learning Resources and Activities

Describe the process of building effective relationships with patients

Required Learning Resources and Activities

Describe strategies for helping patients maintain healthy behaviors

Additional Learning Options

“Physical inactivity is a fast-growing public health problem and contributes to a variety of chronic diseases and health complications, including obesity, diabetes and cancer. In addition to improving a patient’s overall health, increasing physical activity has proven effective in the treatment and prevention of chronic diseases. Even with all the benefits of physical activity…levels of inactivity are alarming. We are facing what is now referred to as an 'inactivity epidemic,' with tremendous costs" (Exercise is Medicine®, American College of Sports Medicine, 2015).

This module provides you with an understanding of the positive effects of physical activity, both on health and with respect to the development of non-communicable diseases worldwide. In addition, you will learn about fundamental concepts in sports medicine and become familiar with general recommendations for physical activity, including the essential components of an exercise prescription.

It is important to correctly perform a physical activity health screening.  This module gives you the chance to practice this screening with your patient and, by the end of this module, you will confidently evaluate and write an exercise prescription for your patient. Furthermore, you will be able to motivate your patients to exercise.

Furthermore, through self-examination of your own personal exercise, you will be better equipped to motivate your patients to exercise. As the above-referenced fact sheet (ACSM, 2015) notes, “40% of U.S. primary care doctors and 36% of U.S. medical students do not meet 2008 federal physical activity guidelines. Physically inactive doctors are less likely to provide exercise counseling to patients and provide less credible role models for the adoption of healthy behaviors.”

Upon completion of this module, students should be able to perform the following:

• Describe the relationship between physical activity and health
• Describe the global physical activity guidelines recommended by the WHO
• Describe the major evidence for the physical activity components (aerobic, strength, flexibility, and balance)
• Develop an exercise prescription
• Evaluate a patient prior to the initiation of physical activity
• Motivate patients to increase their physical activity

Required Learning Resources and Activities

Describe the relationship between physical activity and health

Additional Learning Options

Required Learning Resources and Activities

Describe the global physical activity guidelines recommended by the WHO

Additional Learning Options

Required Learning Resources and Activities

Describe the major evidence for the physical activity components (aerobic, strength, flexibility, and balance)

Additional Learning Options

Required Learning Resources and Activities

Evaluate a patient prior to the initiation of physical activity

Required Learning Resources and Activities

Develop an exercise prescription

Additional Learning Options

Required Learning Resources and Activities

Motivate patients to increase their physical activity

Additional Learning Options

Effective dietary counseling is difficult within the constraints of a primary healthcare clinic—and yet, poor nutrition and obesity play significant roles in every day health issues.

This module provides you with the basic concepts of nutrition, the connection between nutrition and illness, and an understanding of the risk factors of obesity, along with its complications and treatment principles. You will learn about popular diets and their evidenced-based health benefits and risks, as well as how to shop for and cook healthy food.  Moreover, you will gain the expertise to write a nutrition prescription and assist your patients in adopting healthy eating behaviors.

Upon completion of this module, students should be able to perform the following:

• Describe the basics of nutrition, as well as the metabolic effects of different foods
• Summarize the major nutrition studies and evidence base for nutrition prescriptions
• Describe different types of diets and their effects on health
• Understand the role of nutrition in preventing and treating chronic diseases such as cardiovascular disease
• Describe the role of nutrition in preventing, treating, and reversing diabetes
• Summarize nutrition prescriptions for the most common chronic diseases including hyperlipidemia, diabetes, hypertension, and cancer
• Know how to prescribe nutrition for basic disease processes including inflammation: food patterns / macronutrients, food types / micronutrients, food preparation / oxidation
• Demonstrate the ability to perform a basic nutrition assessment and to apply practical strategies to assist patients in achieving dietary changes
• Describe the basic principles of healthy cooking
• Properly interpret nutrition labels
• Define obesity and understand its epidemiology, as well as assist patients in the prevention and treatment of obesity

Required Learning Resources and Activities

Describe the basics of nutrition, as well as the metabolic effects of different foods

Summarize the major nutrition studies and evidence base for nutrition prescriptions

Additional Learning Options

Required Learning Resources and Activities

Describe different types of diets and their effects on health

Understand the role of nutrition in preventing and treating chronic diseases, such as cardiovascular disease

Describe the role of nutrition in preventing, treating, and reversing diabetes

Summarize nutrition prescriptions for the most common chronic diseases including hyperlipidemia, diabetes, hypertension, and cancer

Know how to prescribe nutrition for basic disease processes including inflammation: food patterns / macronutrients, food types / micronutrients, food preparation / oxidation

Additional Learning Options

Required Learning Resources and Activities

Demonstrate ability to perform a basic nutrition assessment and to apply practical strategies to assist patients in achieving dietary changes

Describe the basic principles of healthy cooking

Summarize the major nutrition studies and evidence base for nutrition prescriptions

Properly interpret nutrition labels

Additional Learning Options

Required Learning Resources and Activities

Define obesity and understand its epidemiology as well as assist patients in the prevention and treatment of obesity

Additional Learning Options

Insufficient sleep has been linked to the development of a number of chronic diseases and conditions, including diabetes, cardiovascular disease, obesity, and depression.

In this module, you will be provided with information about the basic structural organization of sleep as well as the types of sleep disturbances and how to manage common sleep disorders. By the end of this module, you will be able to evaluate patients who cannot sleep and suggest lifestyle-based changes as well as coping behaviors that can improve their sleep.

Upon completion of this module, students should be able to:

• Understand sleep’s role in health and chronic disease
• Understand the basic physiology and the structural organization of sleep
• Know the common types of sleep disorders and the tools to evaluate and manage sleep
• Identify lifestyle-based activity, dietary, environmental and coping behaviors that can improve sleep health
• Identify at least two lifestyle adjustments related to light exposure and meal composition and timing that support improved sleep

Required Learning Resources and Activities

Understand sleep’s role in health and chronic disease

Understand the basic physiology and the structural organization of sleep

Additional Learning Options

Required Learning Resources and Activities

Know the common types of sleep disorders and the tools to evaluate and manage sleep

Identify lifestyle-based activity, dietary, environmental, and coping behaviors that can improve sleep health

Identify at least two lifestyle adjustments related to light exposure and meal composition and timing that support improved sleep

Additional Learning Options

Stimulation of nicotinic cholinergic receptors releases a variety of neurotransmitters in the brain. One of them, dopamine, signals a pleasurable experience. Cigarette addiction involves physiological, psychological, and behavioral factors. As a physician, you generally have only five to ten minutes in your office to spend with a patient to help him/her stop smoking. Before you continue with this module, we recommend you watch this video titled "30 Seconds to save a life".

In this module you will learn about the epidemiology of smoking-related diseases and their prevention. By the end of this module, you will know how to interview and counsel patients who smoke, as well as how to offer appropriate treatment in the setting of a primary healthcare clinic or practice.

Upon completion of this module, students should be able to:

• Understand the role of tobacco cessation in preventing and treating chronic disease
• Summarize the evidence-based literature on tobacco cessation interventions
• Be able to state the aspects of tobacco addiction (physiological, psychological, and behavioral)
• Demonstrate the ability to assist patients to develop and implement plans for smoking cessation
• Be familiar with the medications and treatments commonly used for tobacco cessation
• Develop a written action plan based on the treatment prescription, adjusted for the appropriate stage of change

Required Learning Resources and Activities

Understand the role of tobacco cessation in preventing and treating chronic disease

Summarize the evidence-based literature on tobacco cessation interventions

Additional Learning Options

Required Learning Resources and Activities

Be able to state the aspects of tobacco addiction (physiological, psychological, behavioral)

Required Learning Resources and Activities

Demonstrate ability to assist patients to develop and implement plans for smoking cessation

Be familiar with the medications and treatments commonly used for tobacco cessation

Develop a written action plan based on the treatment prescription, adjusted for the appropriate stage of change

Additional Learning Options

According to the WHO , “the harmful use of alcohol ranks among the top five risk factors for disease, disability and death throughout the world”. Alcoholism often goes undiagnosed; the rate of screening for alcohol consumption in healthcare settings remains low. Some patients also may withhold information because of shame or fear of stigmatization.

In this module, you will learn about the epidemiology and the harm of alcohol use, useful screening tools, and the implementation of treatment plans to reduce alcohol-related health risks. Your ability to implement an intervention is of great importance; its effectiveness requires a close relationship with your patients.

Upon completion of this module, students should be able to:

• Understand the role of moderating alcohol use in preventing and treating chronic diseases
• Describe screening processes for harmful alcohol use
• Demonstrate the ability to assist patients to develop and implement plans for avoiding risky alcohol use
• Know the components of relapse prevention planning
• Develop a written action plan based on the treatment prescription, adjusted for the appropriate stage of change

Required Learning Resources and Activities

Understand the role of moderating alcohol use in preventing and treating chronic diseases

Additional Learning Options

Required Learning Resources and Activities

Describe screening processes for harmful alcohol use

Required Learning Resources and Activities

Demonstrate the ability to assist patients to develop and implement plans for avoiding risky alcohol use

Know the components of relapse prevention planning

Develop a written action plan based on the treatment prescription, adjusted for the appropriate stage of change

Required Learning Resources and Activities

Understand the basic elements of stress response and the relationship between emotional distress and poor health

Describe the components of emotional wellness self-management

Additional Learning Options

Required Learning Resources and Activities

Use screening tools for stress, depression, and anxiety

Required Learning Resources and Activities

Understand how skills of mindfulness-based stress reduction (MBSR) and other approaches can help patients intervene in stress reactions and better care for themselves

Additional Learning Options

Required Learning Resources and Activities

Demonstrate the ability to manage depression and anxiety in patients with comorbidities

Required Learning Resources and Activities

Be familiar with the unique stressors associated with being a physician, along with the possible ways of coping with stress, and describe the role of the provider in facilitating the emotional well-being of patients

Additional Learning Options

• Sexuality and health

Patients may have difficulty talking to their physician about sexuality and sexual health for many reasons. Sexual problems can greatly impact a person’s life, influencing both physical and psychological well-being. The causes for sexual dysfunction are numerous; they include various medical conditions and treatments, and can happen at any stage of life. Your responsibility as a physician is to create a trustworthy and secure environment where delicate subjects can be discussed during the medical visit.

In this module, you will learn about sexuality-related health issues and how to talk to your patients about these issues.

Upon completion of this module, students should be able to:

• Understand what is meant by the term ‘healthy sexuality’, and the relationship between sexuality and health
• Understand the role and the limitations of the physician in counseling and treating in the field of sexuality

Required Learning Resources and Activities

Understand what is meant by the term ‘healthy sexuality’, and the relationship between sexuality and health

Additional Learning Options

Required Learning Resources and Activities

Understand the role and the limitations of the physician in counseling and treating in the field of sexuality

Additional Learning Option

You have reached the final module in this training. Now is the time to summarize and integrate the course components into a comprehensive practical plan that will serve both you and your patients. As was mentioned throughout this course, change is a gradual process that requires patience; new skills are incorporated incrementally into your life through small, manageable steps.

In this module you will be provided with the tools necessary to implement health promotion into your practice.

Upon completion of this module, students should be able to:

1. Describe strategies for incorporating wellness into clinic, medical office, or other healthcare settings (wellness programs for health providers)
2. Describe the key strategies for leveraging the interdisciplinary team to enhance health behavior change interventions
3. Describe how planned and group visits can optimize office visits to support lifestyle modification
4. Describe screening and diagnostic tests relevant to lifestyle-related diseases
5. List components of the patient history and physical, with emphasis on lifestyle risk factors
6. Describe how to interpret the tests using evidence-based national guidelines
7. Demonstrate how to screen, diagnose, and monitor a lifestyle-related condition (case examples)
8. Describe appropriate situations for referring and collaborating with other health professionals, such as dieticians, health educators, fitness trainers, and psychologists
9. Cite strategies for effective office systems and office tools for tracking screening frequency and test results, and proactively prompting follow-up
10. Develop an action plan for implementing lifestyle medicine in clinical and personal settings by using tools and strategies for effective office systems
11. Describe strategies for a clinical practice to obtain information about local community resources

Required Learning Resources and Activities

Describe strategies for incorporating wellness into clinic, medical office, or other healthcare settings (wellness programs for health providers)

Describe the key strategies for leveraging the interdisciplinary team to enhance health behavior change interventions

Describe how planned and group visits can optimize office visits to support lifestyle modification

Additional Learning Options

Required Learning Resources and Activities

Describe screening and diagnostic tests relevant to lifestyle-related diseases

List components of the patient history and physical, with emphasis on lifestyle risk factors

Describe how to interpret the tests using evidence-based national guidelines

Demonstrate how to screen, diagnose, and monitor a lifestyle-related condition (case example)

Describe appropriate situations for referring and collaborating with other health professionals, such as dieticians, health educators, fitness trainers, and psychologists

Additional Learning Options

Required Learning Resources and Activities

Cite strategies for effective office systems and office tools for tracking screening frequency and test results, and proactively prompting follow-up

Develop an action plan for implementing lifestyle medicine in clinical and personal settings by using tools and strategies for effective office systems

Additional Learning Options

Required Learning Resources and Activities

Describe strategies for a clinical practice to obtain information about local community resources

Additional Learning Options

We hope that you have enhanced your personal health with the personal health behavior change project and that you will continue to become healthier and happier in the future!

Final thoughts

You are invited to read the story titled The 100th Monkey, a story about social change (found within the learning activity labelled "Enrichment Activity (optional):  Commitment to Lifestyle Medicine", Module 10, Lesson 3). Try to reflect on its deeper meaning for a few moments and imagine how you can contribute to the good health of our planet - and why not start doing so right away?

Thank you for taking this course. We wish you good luck on your final exam and all the best for a good, happy, and healthy life!