Lifestyle Medicine

Topic outline

• Course Home Page
  

  Course Home Page

  

  

  This introductory course in Lifestyle Medicine is intended for primary-care physicians and other mid- to senior-level healthcare professionals, both in training and in practice. The course provides a foundation of theoretical and practical knowledge and skills, as well as an opportunity to plan strategies and practice techniques for assisting patients with positive health behavior changes (while partnering with locally and globally available peers and mentors). All components of this training—like all NextGenU.org trainings—are free, including registration, learning, testing, and a certificate of completion.

  The course’s 10 modules provide an introduction to the principles of lifestyle medicine; an understanding of the effects of physical activity, nutrition, sleep, stress, and sexuality on health; overviews of smoking cessation and alcohol use disorders; and skills to develop and implement action plans for lifestyle medicine in both clinical and personal settings.

  At the end of each lesson, there is a practice quiz. At the end of the course, you will take a final exam; a chance to assess the training will also be provided. In order to receive a certificate of completion, you will need to identify a patient to accompany and support in lifestyle health behavior change. Throughout the modules, you will meet with this patient and practice the use of key materials and behavioral methods. By the end of the course, you will submit an assignment to your mentor that summarizes your practical clinical project.

  The results of your assessments will be provided to you, and we can report your testing information and share your work with anyone you request (school, employer, etc.). The assessment you provide at the course’s conclusion will help us improve the training for future students. We hope you find this Lifestyle Medicine course a wonderful learning experience!

  Please start by taking the Pre-Test.

  Select the "Next" button to begin Module 1:  Introduction to Lifestyle Medicine

  The Lifestyle Medicine course was developed in partnership with Bar-Ilan University, the Brookfield Centre for Lifestyle Medicine, the European Lifestyle Medicine Organization ELMO, the Institute of Lifestyle Medicine at Harvard, the Israeli Society of Family Medicine, Lifestyle Medicine section, the Lifestyle Medical Education Collaborative, and the USC School of Medicine Greenville.  Like all NextGenU courses, the course is competency-based; this course utilizes competencies from the  Lifestyle Medicine Program Curriculum Outline of the American College of Lifestyle Medicine and the Israeli Society of Lifestyle Medicine. In addition, the Lifestyle Medicine course uses resources from accredited world-class organizations that include the American College of Lifestyle Medicine, the  American College of Preventive Medicine, the American College of Sports Medicine, the U.S. Centers for Disease Control and Prevention, the U.S. National Institutes of Health, and the World Health Organization. The course developer is Lilach Malatskey, MD, MHA, Chairman of the Israeli Society of Lifestyle Medicine of the Family Physicians Association, who received substantial input from the Executive Members of the Israeli Society of Lifestyle Medicine. Significant feedback was also received from our Advisory Group members, Ioannis Arkadianos, MD; Erica Frank, MD, MPH; Ioan Hanes, MD; Jenny Lee, MD, PhD, MPH; Dr. Ifeoma Monye, MBBS, DCH, DFFP, DRCOG, FRCGP;  Edward M. Phillips, MD; Verena Rossa-Roccor, MD; Mary Rudolf, MB, BS, BSc, FRCPCH, FAAP; Jennifer Trilk, PhD; and Stefania Ubaldi, MD, PhD.

  • News forum
  • LM Course Files Folder
• Pre-Test: Lifestyle Medicine
  

  Pre-Test: Lifestyle Medicine

  

  • Pre-Test Quiz
• Pre-Test Part 2: Confidential Learner Health Assessment for Lifestyle Medicine Certification Course
  

  Pre-Test Part 2: Confidential Learner Health Assessment for Lifestyle Medicine Certification Course

  
• Module 1: Introduction to Lifestyle Medicine
  

  Module 1: Introduction to Lifestyle Medicine

  First, do no harm. — Hippocratic oath 

  Competencies covered in this module:

  • Introduction to lifestyle medicine
  • The role of physician health
  • Environmental lifestyle factors and their impact on non-communicable diseases

  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

  Please take the Pre-Test before starting Module 1.
• Lesson 1: Definition, Role, and Evidence Base for Lifestyle Medicine
  

  Lesson 1: Definition, Role, and Evidence Base for Lifestyle Medicine

  Learning Objectives 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

  • Required Learning Resources and Activities

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

  • Lifestyle Medicine: Treating the Causes of Disease URL

    Watch the video.  If necessary, download a transcript of the video by clicking on the link titled ʺView Transcriptʺ.

  • Official Standards of the American College of Lifestyle Medicine URL

    Click on "Standards document" to download the "Lifestyle Medicine Standards" document.  Read the section titled "Definition of Lifestyle Medicine" and the content of Table 1 (page 2).

  • Lifestyle Medicine - Evidence Review URL

    Read pages 2-5 and from the section ʺIII. Current Status of Lifestyle Medicineʺ (page 8) to the sub-section ʺPhysician Responsibilityʺ (page 9).  Then, read from ʺA. Prevalence of Lifestyle-related Conditionsʺ (page 10) down to ʺD. Behavioral Science Methods to Change Risk Factorsʺ (page 13), as well as ʺEvidence Chartʺ (appendix, page 70).  For additional information, read pages 14-42 (optional reading).

  • 10 Facts on Noncommunicable Diseases URL

    View the slideshow.

  • Noncommunicable diseases URL

    Read the fact sheet.

  • Noncommunicable diseases and mental health URL

    Scroll down and click on the first link, "Full-fledged text", found within the box titled "NCD targets and indicators".  Read the text.

  • Noncommunicable diseases country profiles 2014 URL

    Scroll down through the list and click on links to access the fact sheets for United States of America, Australia, Sweden, United Kingdom, and Germany.  Read those fact sheets and the fact sheets of any other high-income country of your choice.  Learn about the prevalence of non-communicable diseases in high-income countries.

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

  • Lifestyle Medicine Competencies for Primary Care Physicians URL

    Read the entire article.

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

  • Lifestyle choices and mental health: a representative population survey URL

    Read the entire article.

  • Individual Activity: Identifying a Mentor Assignment
  • Peer Activity: Advocacy on Behalf of LM Workshop

    Set up a time to speak with your mentor.

    In this meeting, you should initiate a general conversation about LM. Explain to your mentor how you are going to conduct effective advocacy on behalf of LM directly with your patients and their families, with health providers at your clinic as well as with policy and decision makers within the community (based on your knowledge from this lesson).

    Have your mentor reflect and guide you on how to apply your ideas.

    After the meeting, write a 250-500 word summary of the interview, with the audience being your NextGenU peers. Describe your ideas and summarize what you learned during the meeting.

    Your submission will be sent to three automatically chosen NextGenU peers who will determine whether or not you have met the criteria listed below.
  • Quiz: Module 1: Lesson 1
  • Additional Learning Options

  • TEDxMindStreamAcademy - Dr. David Katz - The Road to Health URL

    Watch the video.

  • Core Competencies of Lifestyle Medicine URL

    Read the web page.

• Lesson 2: The Importance of Lifestyle Medicine in Treating the World's Lifestyle Disease Burden
  

  Lesson 2: The Importance of Lifestyle Medicine in Treating the World's Lifestyle Disease Burden

  Learning Objective Understand the importance of LM in treating the world's lifestyle disease burden

  • Required Learning Resources and Activities

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

  • Lifestyle medicine potential for reversing a world of chronic disease epidemics: from cell to community URL

    Read the entire article.

  • The Advent of Lifestyle Medicine URL

    Read down to the beginning of the section titled "Lifestyle and Pima Indians".

  • Lifestyle Medicine URL

    Read the entire web page.

  • Quiz: Module 1: Lesson 2
  • Additional Learning Options

  • Lifestyle medicine: The importance of considering all the causes of disease URL

    Read the entire article.

• Lesson 3: The Role of Physician Health and Physician Advocacy
  

  Lesson 3: The Role of Physician Health and Physician Advocacy

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

  • 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

  • Lifestyle Medicine - Evidence Review URL

    Read from the section titled "Physician Responsibility" (page 9) to the section titled "A. Prevalence of Lifestyle-related Conditions" (page 10).

  • Physicians' health practices strongly influence patient health practices URL

    Read the entire article.

  • Introduction Activity: Identifying a Peer for the Health Behavior Change Project Assignment
  • Individual Activity: Personal Health Behavior Change Project Workshop
  • Quiz: Module 1: Lesson 3
  • Additional Learning Options

  • How to Exercise at Your Desk URL

    Practice the recommended exercises at your desk, as outlined in the images at the bottom of the web page.

  • Enrichment Activity (optional): The Blue Zones Project Assignment
• Lesson 4: Environmental Lifestyle Factors and Their Impact on Non-communicable Diseases
  

  Lesson 4: Environmental Lifestyle Factors and Their Impact on Non-communicable Diseases

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

  • Required Learning Resources and Activities

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

  • Global Health Risk - Mortality and burden of disease attributable to selected major risks URL

    Read "Summary" (page v), along with "2.6 Environmental risks" and "2.7 Occupational and other risks" (pages 23-27).

  • Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes URL

    Read the entire article.

  • Quiz: Module 1: Lesson 4
• Module 2: Fundamentals of Health Behavior Change
  

  Module 2: Fundamentals of Health Behavior Change

  Knowing is not enough—we must apply. Willing is not enough—we must do. — Johann Wolfgang von Goethe

  Competency covered in this module:

  • Fundamentals of health behavior change

  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

   
• Lesson 1: Introduction to Behavior Change
  

  Lesson 1: Introduction to Behavior Change

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

  • Required Learning Resources and Activities

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

  • Why behavior change is hard - and why you should keep trying URL

    Read the entire article.

  • Quiz: Module 2: Lesson 1
• Lesson 2: Tools for Health Behavior Change
  

  Lesson 2: Tools for Health Behavior Change

  Learning Objectives 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

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

  • AFMC Primer on Population Health: A virtual textbook on Public Health concepts for clinicians - 8.7 Changing Behaviour URL

    Read section 8.7, "Changing Behaviour".

  • The Stages of Change Model, and Treatment Planning URL

    Read slides 8-29.

  • Does health coaching work? A rapid review of empirical evidence URL

    Read pages 1-6.

  • Health Coaching for Patients With Chronic Illness URL

    Read down to the section "Two models of health coaching".

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

  • Influencing Patient Adherence to Treatment Guidelines URL

    Read the entire article.

  • Enhancing Motivation for Change in Substance Abuse Treatment: Treatment Improvement Protocol (TIP) Series, No. 35 URL

    Scroll down and read the section "A Transtheoretical Model Of the Stages of Change" (pages 15-19). For more information, read Chapter 8, "Measuring Components of Client Motivation" (pages 135-145) (optional reading).

  • Peer Project Part I: Health Behavior Change Assignment
  • Mentored Activity: Work with the patient towards health behavior change Assignment
  • Quiz: Module 2: Lesson 2
• Lesson 3: Techniques for Health Behavior Change
  

  Lesson 3: Techniques for Health Behavior Change

  Learning Objective Apply motivational interviewing, cognitive behavioral, and positive psychology techniques

  • Required Learning Resources and Activities

  • Apply motivational interviewing, cognitive behavioral, and positive psychology techniques

  • 5 Communication Strategies to Promote Self-Management of Chronic Illness URL

    Read the entire article.

  • Health Goals URL

    Read the entire document that outlines how to set S.M.A.R.T. health goals.

  • Encouraging Patients to Change Unhealthy Behaviors with Motivational Interviewing URL

    Read the entire article.

  • CCNC Motivational Interviewing (MI) Resource Guide URL

    Read pages 5-6, 21, 28-30, and 66.

  • Positive psychology in practice URL

    Read down to the section "Resources".

  • Use of Appreciative Inquiry To Engage Parents as Codesigners of a Weight Management Intervention for Adolescents URL

    Read from "Appreciative Inquiry" to the end of "Procedures" found in the "Materials and Methods" section. Ensure you examine Tables 1 and 2.

  • Wellness Wheel URL

    Read the entire text.

  • The 10 Building Blocks of Primary Care - My Action Plan URL

    Read the entire text.

  • 5 A’s Behavior Change Model Adapted for Self-Management Support Improvement URL

    Read the entire document.

  • Cognitive Behavioral Therapy for Treatment of Adult Obesity (in International Journal of Medical Reviews) URL

    Click on Volume 3, Issue 1; download the PDF version and read the entire article.

  • Quiz: Module 2: Lesson 3
  • Additional Learning Options

  • Motivational interviewing techniques: Facilitating behaviour change in the general practice setting URL

    Read the entire article.

• Lesson 4: Building Effective Relationships with Patients
  

  Lesson 4: Building Effective Relationships with Patients

  Learning Objective Describe the process of building effective relationships with patients

  • Required Learning Resources and Activities

  • Describe the process of building effective relationships with patients

  • The Effective Physician: Motivational Interviewing Demonstration URL

    Watch the entire video.

  • The Ineffective Physician: Non-Motivational Approach URL

    Watch the entire video.

  • Quiz: Module 2: Lesson 4
• Lesson 5: Maintain Healthy Behaviors
  

  Lesson 5: Maintain Healthy Behaviors

  Learning Objective Describe strategies for helping patients maintain healthy behaviors

  • Required Learning Resources and Activities

  • Describe strategies for helping patients maintain healthy behaviors

  • Making lifestyle changes that last URL

    Read the web page.

  • Creating Health & Nutrition Fact Sheets - Tips for Making Healthy Behavior Changes Last URL

    Read the entire document.

  • Quiz: Module 2: Lesson 5
  • Additional Learning Options

  • Supporting Self-management in Patients with Chronic Illness URL

    Read down to the section "Motivational Interviewing".

• Module 3: Physical Activity
  

  Module 3: Physical Activity

  Those who think they have no time for bodily exercise will sooner or later have to find time for illness. — Edward Stanley, Earl of Derby (1873)

  

  Competency covered in this module:

  • Physical activity science and prescription

  “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
• Lesson 1: Introduction to Physical Activity
  

  Lesson 1: Introduction to Physical Activity

  Learning Objective Describe the relationship between physical activity and health

  • Required Learning Resources and Activities

  • Describe the relationship between physical activity and health

  • Global Recommendations on Physical Activity for Health URL

    Read section 2.1, "Public Health Significance of Physical Activity" (page 10).

  • Your Prescription for Health - Exercise Is Medicine - Fact Sheet URL

    Read the entire fact sheet.

  • Quiz: Module 3: Lesson 1
  • Additional Learning Options

  • Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy URL

    Read the Summary. 

  • 23 and 1/2 hours: What is the single best thing we can do for our health? URL

    Watch the entire video.

• Lesson 2: Recommendations on Physical Activity
  

  Lesson 2: Recommendations on Physical Activity

  Learning Objective Describe the global physical activity guidelines recommended by the WHO

  • Required Learning Resources and Activities

  • Describe the global physical activity guidelines recommended by the WHO

  • Global Recommendations on Physical Activity for Health URL

    Read the Executive Summary (pages 7-8).

  • Quiz: Module 3: Lesson 2
  • Additional Learning Options

  • How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over URL

    Read the Abstract.  For additional information, read the entire article (optional).  Note:  This article is based on scientific research.

• Lesson 3: Components of Physical Activity
  

  Lesson 3: Components of Physical Activity

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

  • Required Learning Resources and Activities

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

  • Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise URL

    Read the entire article.

  • Quiz: Module 3: Lesson 3
  • Additional Learning Options

  • Activity Bursts Everywhere for Fitness - Physical Activity Engineered to fit YOUR life! URL

    Choose one exercise video to perform either at home, in the office, or in the waiting area.  Enjoy.

• Lesson 4: Exercise Prescription
  

  Lesson 4: Exercise Prescription

  Learning Objective Develop an exercise prescription

  • Required Learning Resources and Activities

  • Develop an exercise prescription

  • Physical Education/Health Education; Grade 11 Active Healthy Lifestyles: Manitoba Physical Education/Health Education Curriculum Framework of Outcomes and A Foundation for Implementation URL

    Scroll down and click on the link "List of Modules, Lessons and Resource Masters".  Then, click on the pdf link to "Module B Lesson 6: Planning for Physical Fitness".  Read from the section "The FITT Principle" (page 168) to the end of page 172.

  • Perceived Exertion (Borg Rating of Perceived Exertion Scale) URL

    Read the web page.

  • Your Prescription for Health - Exercise is Medicine URL

    Read the text.

  • Your Rx for Health Series URL

    Under the heading "Your Rx for Health Series", click on the links "Asthma" and "Type 2 Diabetes" and read the content, along with any other topics in the Health Series.

  • Physical Activity in Children and Adolescents URL

    Read the text.

  • Committee Opinion: Physical Activity and Exercise During Pregnancy and the Postpartum Period URL

    Read the entire document.

  • Quiz: Module 3: Lesson 4
• Lesson 5: Patient Evaluation
  

  Lesson 5: Patient Evaluation

  Learning Objective Evaluate a patient prior to the initiation of physical activity

  • Required Learning Resources and Activities

  • Evaluate a patient prior to the initiation of physical activity

  • Exercise Prescription Doctor's Handbook URL

    Click on the link "Pre-Participation Health Screening" to download Chapter 3, then read pages 16-21.

  • Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening URL

    Study Figure 2 (essential).  Then, read from the section ʺThe New Exercise Preparticipation Health Screening Process Algorithm" to the end of the article (essential).  The text preceding this section is optional reading.

  • PAR-Q Forms URL

    Scroll through the questionnaire "PAR-Q & YOU". Be familiar with other questionnaires on this site.

  • Mentored Activity: Pre-participation Health Screening and Exercise Prescription Assignment
  • Quiz: Module 3: Lesson 5
• Lesson 6: Improving Exercise Adoption and Maintenance
  

  Lesson 6: Improving Exercise Adoption and Maintenance

  Learning Objective Motivate patients to increase their physical activity

  • Required Learning Resources and Activities

  • Motivate patients to increase their physical activity

  • Exercise Prescription Doctor's Handbook URL

    Click on the link "General Principles of Exercise Prescription" to download Chapter 4, then read the section "Improving Exercise Adoption and Maintenance" (pages 33-37).

  • Healthcare Providers' Action Guide URL

    Read pages 2-3, 8-11, and 17-19.

  • Peer Project Part II: Personal Exercise Habits Assignment
  • Quiz: Module 3: Lesson 6
  • Additional Learning Options

  • Exercise Prescription Doctor's Handbook URL

    Scroll through the site and read chapters and sections of interest to you.  Note: Some parts of this resource should already have been read.

  • Enrichment Activity (optional): Physical Activity and Local Guidelines Assignment
• Module 4: Nutrition
  

  Module 4: Nutrition

  Let food be thy medicine and medicine be thy food. — Hippocrates

  

  Competency covered in this module:

  • Nutrition science, assessment, and prescription

  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
• Lesson 1: Introduction to Nutrition
  

  Lesson 1: Introduction to Nutrition

  Learning Objectives 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

  • Required Learning Resources and Activities

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

  • Overview of Nutrition URL

    Read down to the section "Micronutrients".

  • EFSA sets European dietary reference values for nutrient intakes URL

    Read the web page.

  • Energy intake and expenditure URL

    Read slides 1-6.

  • Micronutrients for Health URL

    Read the document.

  • Vitamin Supplements: Hype or Help for Healthy Eating URL

    Read the web page.

  • Summarize the major nutrition studies and evidence base for nutrition prescriptions

  • Disease Control Priorities in Developing Countries, 2nd edition URL

    Scroll down and click on "Chapter 44. Prevention of Chronic Disease by Means of Diet and Lifestyle Changes".  Then, under the heading "Chronic Disease Prevention", read the subsection "Eat a Healthy Diet" and the section "Potential of Dietary and Lifestyle Factors to Prevent Chronic Diseases".

  • Quiz: Module 4: Lesson 1
  • Additional Learning Options

  • Vitamins and Minerals URL

    Scroll through the site.

• Lesson 2: The Role of Nutrition in Preventing and Treating Chronic Diseases
  

  Lesson 2: The Role of Nutrition in Preventing and Treating Chronic Diseases

  Learning Objectives 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

  • Required Learning Resources and Activities

  • Describe different types of diets and their effects on health

  • Healthy diet  URL

    Read the fact sheet.

  • Dietary Guidelines for Americans 2010 URL

    Read the section titled "The Heavy Toll of Diet-Related Chronic Diseases" (page 3).

  • The Association Between Dietary Patterns at Midlife and Health in Aging:  An Observational Study URL

    Read from the section titled "Background" down to the end of the section titled "Conclusion".

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

  • Nutritional Recommendations for Cardiovascular Disease Prevention URL

    Read the entire article.

  • Diets for Cardiovascular Disease Prevention: What Is the Evidence? URL

    Read the entire article.

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

  • The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern URL

    Read the entire article.

  • Diet reverses Type 2 Diabetes URL

    Read the web page.

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

  • Effects of Different Dietary Interventions on Blood Pressure URL

    Read the entire article.

  • Diabetes Management Guidelines - American Diabetes Association (ADA) Nutrition Guidelines for Adults With Diabetes URL

    Read the web page.

  • 11 foods that lower cholesterol URL

    Read the entire web page.

  • Heal Well: A Cancer Nutrition Guide URL

    Read chapters 1 and 2 (pages 3-14) as well as chapters 5 and 6 (pages 21-24).

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

  • Diet components can suppress inflammation and reduce cancer risk URL

    Read the entire article.

  • Overview of Inflammation URL

    Read the entire article.

  • Foods that fight inflammation URL

    Read the web page.

  • Quiz: Module 4: Lesson 2:
  • Additional Learning Options

  • The Mediterranean diet URL

    Watch the entire video.

  • Nutrition Pilot Curriculum (Archived) URL

    Watch the entire video.

  • Nutrition and Cardiovascular Disease: Finding the Perfect Recipe for Cardiovascular Health URL

    Read the entire article.

  • Mediterranean Diet and Diabetes: Prevention and Treatment URL

    Read the entire article.

  • Nutrition Prescription to Achieve Positive Outcomes in Chronic Kidney Disease: A Systematic Review URL

    Read the entire article.

  • Macronutrient intake induces oxidative and inflammatory stress: potential relevance to atherosclerosis and insulin resistance URL

    Read the entire article.

  • Diet and Inflammation URL

    Read the section titled "Abstract".

• Lesson 3: Dietary Guidelines and Nutrition Prescriptions
  

  Lesson 3: Dietary Guidelines and Nutrition Prescriptions

  Learning Objectives 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

  • 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

  • Dietary Guidelines for Americans 2015-2020 (Eighth Edition) - For Professionals:  Recommendations At-A-Glance URL

    Read the entire guideline.

  • Describe the basic principles of healthy cooking

  • MyPlate URL

    Scroll through the site.

  • Dietary Guidelines for Americans 2015-2020 (Eighth Edition) - For Professionals:  Talk to Your Patients & Clients About Healthy Eating Patterns URL

    Read the entire guideline.

  • Healthy cooking tips URL

    Read the entire web page.

  • Summarize the major nutrition studies and evidence base for nutrition prescriptions

  • Nutrition prescriptions URL

    Read the entire web page.

  • Properly interpret nutrition labels

  • What's On The Nutrition Facts Label URL

    Read the entire Fact Sheet.

  • Mentored Activity: Healthy Nutrition Assignment
  • Quiz: Module 4: Lesson 3:
  • Additional Learning Options

  • Culinary Medicine – Resources for Patients and Clinicians URL

    Watch two recipes videos as well as the "Cooking at Home Instructional Videos" found at the bottom of the web page.

  • Dietary Guidelines for Americans 2015-2020 (Eighth Edition) - An In-Depth Look at the 2015-2020 Dietary Guidelines URL

    Read through the slide presentation.

  • Stanford Introduction to Food and Health URL

    Go to "Enroll Now", register, and do the course.

  • Enrichment Activity (optional): Nutrition Facts Label Assignment
• Lesson 4: Obesity
  

  Lesson 4: Obesity

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

  • Required Learning Resources and Activities

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

  • Obesity as a Disease URL

    Read the entire web page.

  • Obesity and overweight URL

    Read the Fact Sheet.

  • Adult Obesity Causes & Consequences URL

    Read the web page and then click on the link titled "Obesity and Genomics".  Then, read the content of the web page titled "Behavior, environment, and genetic factors all have a role in causing people to be overweight and obese".

  • Measuring Obesity URL

    Read down to the beginning of the section titled "Bioelectric Impedance (BIA)".

  • U.S. Preventive Services Task Force - Screening for and Management of Obesity in Adults: Recommendation Statement URL

    Read down to the section titled ʺClinical Considerationsʺ.  Be sure to read Table 1.

  • Office-Based Strategies for the Management of Obesity URL

    Read the entire article.

  • Treatment for Overweight & Obesity URL

    Read the entire web page. Then, under the heading "Healthy eating plan and regular physical activity", click on the link titled "healthy eating plan" and read the web page titled "Eating & Physical Activity to Lose or Maintain Weight".

  • Peer Activity: Healthy nutrition Assignment
  • Quiz: Module 4: Lesson 4:
  • Additional Learning Options

  • Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation URL

    Read the entire article.

  • Obesity prevalence worldwide - Adults URL

    Explore the interactive map and read the country statistics listed below the map.

  • Overweight & Obesity URL

    Scroll through the site.

  • Treatment of Adult Obesity with Bariatric Surgery URL

    Read the entire article.

  • What's the Best Diet? Healthy Eating 101 URL

    Watch the entire video.

  • Healthy Weight Checklist URL

    Read the entire web page.

• Module 5: Sleep Health
  

  Module 5: Sleep Health

  Competency covered in this module:

  • Sleep health science and interventions

  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
• Lesson 1: The Role of Sleep in Health
  

  Lesson 1: The Role of Sleep in Health

  Learning Objectives Understand sleep’s role in health and chronic disease Understand the basic physiology and the structural organization of sleep

  • Required Learning Resources and Activities

  • Understand sleep’s role in health and chronic disease

  • Sleep and Chronic Disease URL

    Read the entire web page.

  • Understand the basic physiology and the structural organization of sleep

  • Sleep and Disease Risk URL

    Read the information on the web page (essential).  Listen to the two videos (optional).

  • Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem URL

    Read from the beginning of chapter 2 titled "Sleep Physiology" down to the section titled "Sleep-Wake Regulation" (essential).  The rest of the chapter is optional reading.

  • Recommended Amount of Sleep for a Healthy Adult:  A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society URL

    Read the entire article.

  • Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine URL

    Read the entire article.

  • Quiz: Module 5: Lesson 1:
  • Additional Learning Options

  • Session 4: Understanding Sleep's Role in Health Promotion & Chronic Disease  (Archived Webinar) URL

    Watch and listen to the webinar.

  • Association of Sleep Duration with Chronic Diseases in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study URL

    Read the entire article.

  • Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem URL

    Read whichever section(s) that is of interest to you (for those interested in depth).

• Lesson 2: Sleep Disorder Evaluation and Management
  

  Lesson 2: Sleep Disorder Evaluation and Management

  Learning Objectives 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

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

  • Management of Common Sleep Disorders URL

    Read the entire article.

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

  • STOP Questionnaire:  A Tool to Screen Patients for Obstructive Sleep Apnea URL

    Read down to the section titled "Materials and Methods".  Then, scroll down and read "Appendix 1:  STOP Questionnaire".

  • Tips for Getting a Good Night's Sleep URL

    Download the "Sample Sleep Diary" by clicking on the image found on the right side of the web page.  Then, read the text.

  • Strategies for Getting Enough Sleep URL

    Read the web page.

  • Twelve Simple Tips to Improve Your Sleep URL

    Read the web page.

  • Sleep problems - Insomnia Management Kit URL

    Explore the site and read in detail the content of the link titled "Sleep: Facts and Hygiene".

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

  • Fiber and Saturated Fat Are Associated with Sleep Arousals and Slow Wave Sleep URL

    Read the entire article.

  • Blue light has a dark side URL

    Read the entire health letter.

  • Relationship between Food Intake and Sleep Pattern in Healthy Individuals URL

    Read the entire article.

  • Peer Activity: A Case Study - Insomnia Workshop

    A 42-year-old woman presents to your clinic complaining that she does not sleep well, which in turn affects her daytime activities. She has a full-time job and two active young boys that take all of her energy. She is a single parent with many responsibilities and monetary problems. She feels depleted and stressed all the time. She has started to drink four to five strong cups of coffee per day in order to stay awake and tries to take a nap whenever possible.

    Describe in 250-500 words which factors in her life and which of her behaviors might contribute to her sleeping problems. How would you diagnose her? What lifestyle-based changes and coping behaviors could improve her sleep?

    Your submission will be sent to three automatically chosen NextGenU peers who will determine whether or not you have met the criteria listed below.

  • Quiz: Module 5: Lesson 2:
  • Additional Learning Options

  • Your Guide to Healthy Sleep URL

    Look through the booklet.

  • Impact of lifestyle and technology developments on sleep URL

    Read the entire article.

• Module 6: Tobacco Use
  

  Module 6: Tobacco Use

  Tobacco kills up to half of its users. - World Health Organization (2016)

  

   

  Competency covered in this module:

  • Fundamentals of Tobacco Cessation

  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
• Lesson 1: Epidemiology of Tobacco-Related Diseases
  

  Lesson 1: Epidemiology of Tobacco-Related Diseases

  Learning Objectives Understand the role of tobacco cessation in preventing and treating chronic disease Summarize the evidence-based literature on tobacco cessation interventions

  • Required Learning Resources and Activities

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

  • The Health Consequences of Smoking—50 Years of Progress:  A Report of the Surgeon General - Executive Summary URL

    Read the section titled "Overview" including Figures 1A and 1B (pages 1-3).  Then, read "Section 2:  The Health Consequences of Active and Passive Smoking:  The Evidence in 2014" (page 5) down to the section titled "Chapter 5: Nicotine" (page 7).

  • Tobacco URL

    Read down to the section titled "Picture warnings work".

  • 21st-Century Hazards of Smoking and Benefits of Cessation in the United States URL

    Read the section titled "Abstract".

  • Summarize the evidence-based literature on tobacco cessation interventions

  • Final Recommendation Statement: Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions URL

    Read the recommendation statement.

  • Final Recommendation Statement: Tobacco Use in Children and Adolescents: Primary Care Interventions URL

    Read the recommendation statement.

  • Quiz: Module 6: Lesson 1:
  • Additional Learning Options

  • Smoking Cessation Interventions for Youth: A Review of the Literature URL

    Read the report.

• Lesson 2: The Physiological, Psychological, and Behavioral Components of Tobacco Use
  

  Lesson 2: The Physiological, Psychological, and Behavioral Components of Tobacco Use

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

  • Required Learning Resources and Activities

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

  • Nicotine Addiction URL

    Read down to the section titled "Vulnerability to Addiction".

  • DrugFacts: Cigarettes and Other Tobacco Products URL

    Scroll down and read the section titled "How Does Tobacco Affect the Brain?".

  • Pharmacology of Nicotine: Addiction, Smoking-Induced Disease, and Therapeutics URL

    Read the section titled "Mechanisms of Action". 

  • The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. URL

    Scroll down and read the section titled ʺPathophysiology of Nicotine Addictionʺ.

  • Quiz: Module 6: Lesson 2:
• Lesson 3: Treatment of Tobacco Use
  

  Lesson 3: Treatment of Tobacco Use

  Learning Objectives 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

  • Required Learning Resources and Activities

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

  • Physician advice for smoking cessation URL

    Read the section titled "Abstract".

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

  • Toolkit for delivering the 5A’s and 5R’s brief tobacco interventions in primary care URL

    Read the section titled "II. The unique role of the healthcare provider in tobacco control" (page 6).  Then, read from the sub-section titled "iii. Three Challenges of Quitting" (page 10) down to the end of the section titled "V.  The 5R's model to increase motivation to quit" (page 14).

  • Instrument:  Fagerstrom Test For Nicotine Dependence (FTND) URL

    Read the web page.  Then, open the attachment titled "Fagerstrom Test_2014March24.pdf" and read the questionnaire.

  • The New Zealand Guidelines for Helping People to Stop Smoking URL

    Read from the section titled "Part 1 - Managers of health care services" down to the end of the document.

  • The Brief Tobacco Intervention URL

    Read the section titled "The 2As & R" (page 1).

  • Promoting Smoking Cessation URL

    Read the entire article.

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

  • The transtheoretical model use for smoking cessation URL

    Read the entire article.

  • Mentored Activity: Brief Tobacco Interventions Assignment
  • Peer Activity: Reflection on Brief Tobacco Interventions Workshop

    In 250 to 500 words, describe the intervention with one of the patients you chose for the mentor activity. Explain which tools you used and how the patient reacted to them. Was there talk about change? A progress toward change? Challenges you encountered?

    Your submission will be sent to three automatically chosen NextGenU peers who will determine whether or not you have met the criteria listed below.

  • Quiz: Module 6: Lesson 3:
  • Additional Learning Options

  • Quitting is a Journey URL

    Scroll through the site.

  • Very Brief Advice on Smoking - 30 Seconds to save a life URL

    Watch the video titled "30 Seconds to save a life".

  • For Smokers Who Want to Quit - One Step at a Time URL

    Read the entire booklet.

  • Resource library URL

    Scroll through the site.

  • Enrichment Activity (optional): Local Sources for Smoking Cessation Assignment
• Module 7: Alcohol Use
  

  Module 7: Alcohol Use

  "What are you doing here?" he asked the drunkard... "Drinking," replied the drunkard, with a gloomy expression. "Why are you drinking?" the little prince asked. "To forget," replied the drunkard. "To forget what?" inquired the little prince, who was already feeling sorry for him. "To forget that I'm ashamed," confessed the drunkard, hanging his head. "What are you ashamed of?" inquired the little prince, who wanted to help. "Of drinking!" concluded the drunkard... - Antoine de Saint-Exupéry, "The Little Prince"

  

  Competency covered in this module:

  • Fundamentals of managing risky alcohol use

  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
• Lesson 1: Epidemiology of Alcohol-Related Diseases
  

  Lesson 1: Epidemiology of Alcohol-Related Diseases

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

  • Required Learning Resources and Activities

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

  • Global status report on alcohol and health 2014 URL

    Read the section titled "Executive summary" (pages xiii-xiv).  Then, read from the section titled "1.6.1 Health Consequences for Drinkers" (pages 11-13).  Ensure you examine boxes 3 and 4.

  • Quiz: Module 7: Lesson 1:
  • Additional Learning Options

  • Problem Drinking and Alcoholism: Diagnosis and Treatment URL

    Read the entire article.

• Lesson 2: Screening for Harmful Alcohol Use
  

  Lesson 2: Screening for Harmful Alcohol Use

  Learning Objective Describe screening processes for harmful alcohol use

  • Required Learning Resources and Activities

  • Describe screening processes for harmful alcohol use

  • Alcohol Screening and Counseling URL

    Read the web page (essential).  If you require additional information, click on the link titled "Screening and Brief Intervention for Excessive Drinking in Clinical Settings" and read the content (optional).

  • CAGE URL

    Read the entire document.

  • Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care URL

    Read the content of the box titled "Recommendation Summary".  Then, scroll through the box titled "Related Information for Health Professionals" and click on the links to the "AUDIT" and "CAGE" questionnaires.  Read the content of those links.

  • Quiz: Module 7: Lesson 2:
• Lesson 3: Intervention and Prevention
  

  Lesson 3: Intervention and Prevention

  Learning Objectives 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

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

  • Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use URL

    Read the section titled "II. Adapting Alcohol SBI to Your Practice" (pages 11-17).  The rest of the guide is optional reading.

  • Know the components of relapse prevention planning

  • Relapse Prevention Video: Early Warning Signs and Important Coping Skills URL

    Watch the video and read the text found below it.

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

  • Enhancing Motivation for Change in Substance Abuse Treatment: Treatment Improvement Protocol (TIP) Series, No. 35 URL

    Read the section titled "Motivational Intervention And the Stages of Change" (pages 29-30) and examine Figure 2.2 (pages 31-32).  Read chapters 4-7 to learn more about modifying treatments in relation to the patient's stage of change (optional reading).

  • Peer Activity: Relapse Prevention Workshop

    Read again the resource from addictionsandrecovery.org:

    Think about different aspects of unhealthy behavior such as morbid obesity, heavy smoking, etc.  Is there a difference between the addiction behavior to alcohol as compared to the addiction to food or cigarettes? Write a 250-500 word summary on this topic.

    Your submission will be sent to three automatically chosen NextGenU peers who will determine whether or not you have met the criteria listed below.
  • Quiz: Module 7: Lesson 3:
• Module 8: Emotional and Mental Well-being
  

  Module 8: Emotional and Mental Well-being

  "God, grant me the serenity to accept the things I cannot change, Courage to change the things I can, And wisdom to know the difference." - Reinhold Niebuhr, The Serenity Prayer

  Competency covered in this module:

  • Emotional and Mental Well-being Assessment and Interventions

  People accept stress as an inevitable part of their lives, but exposure to chronic high levels leads to various forms of significant stress-induced morbidity.  

  In this module, you will learn how to identify a stressed patient and how to help him/her manage emotional and mental well-being.

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

  • Understand the basic elements of stress response and the relationship between emotional distress and poor health
  • Describe the components of emotional wellness self-management
  • Use screening tools for stress, depression, and anxiety
  • Understand how skills of mindfulness-based stress reduction (MBSR) and other approaches can help patients intervene in stress reactions and better care for themselves
  • Demonstrate the ability to manage depression and anxiety in patients with comorbidities
  • 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
• Lesson 1: Relationship Between Stress and Health
  

  Lesson 1: Relationship Between Stress and Health

  Learning Objectives Understand the basic elements of stress response and the relationship between emotional distress and poor health Describe the components of emotional wellness self-management

  • Required Learning Resources and Activities

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

  • Stress URL

    Read down to the sub-section titled "Childhood Factors".  Then, read from the section titled "Complications" down to the section titled "Conditions with Similar Symptoms".

  • Describe the components of emotional wellness self-management

  • 6 ways to improve your emotional wellness URL

    Read the entire web page.

  • Quiz: Module 8: Lesson 1:
  • Additional Learning Options

  • The Nature of Stress URL

    Read the entire article.

  • Positive Emotions and Your Health: Developing a Brighter Outlook URL

    Read the entire article.

  • Enrichment Activity (optional): Guided Meditation Assignment
• Lesson 2: Screening and Screening Tools
  

  Lesson 2: Screening and Screening Tools

  Learning Objective Use screening tools for stress, depression, and anxiety

  • Required Learning Resources and Activities

  • Use screening tools for stress, depression, and anxiety

  • Stress URL

    Scroll down and read from the section titled "Treatment" down to the end of the document.

  • Depression Anxiety Stress Scales (DASS) URL

    Click on the link titled "Overview of DASS" and read the content.  Then, return to the home page and click on the link titled "Download DASS".  Choose which version you want to download and then download the "DASS response form".  Read the questionnaire.

  • Lifestyle Medicine Standards URL

    Read from the section titled "Stress Management/Guidelines" (page 9) down to the section titled "Tobacco Use Cessation Guidelines" (page 10).

  • Quiz: Module 8: Lesson 2:
  • Additional Learning Option

  • Mentored Activity: Patients’ Emotional Wellness Assignment
• Lesson 3: Lifestyle-related Intervention Strategies
  

  Lesson 3: Lifestyle-related Intervention Strategies

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

  • 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

  • Learn to manage stress URL

    Read the entire web page.

  • Exercise, Yoga, and Meditation for Depressive and Anxiety Disorders URL

    Read the entire article.

  • A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial) URL

    Read the entire article.

  • Relaxation techniques for stress URL

    Read the entire web page.

  • 3 Tips to Manage Stress URL

    Read the web page.

  • Standardised Mindfulness-Based Interventions in Healthcare: An Overview of Systematic Reviews and Meta-Analyses of RCTs URL

    Read the sections titled "Introduction", "Discussion", and "Conclusions".

  • Quiz: Module 8: Lesson 3:
• Lesson 4: Depression and Anxiety in Patients with Comorbidities
  

  Lesson 4: Depression and Anxiety in Patients with Comorbidities

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

  • Required Learning Resources and Activities

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

  • Addressing comorbidity between mental disorders and major noncommunicable diseases URL

    Read down to the beginning of the section titled ʺ1.2 Political commitment to addressing the burden of mental disorders and major noncommunicable diseasesʺ.  Then, read the sections titled ʺKey factsʺ (bullet points) and ʺConclusionsʺ for each noncommunicable disease found in sections 2.1 to 2.4.  Then, read the chapter titled ʺ4. Conclusionsʺ (page 25-26).

  • Quiz: Module 8: Lesson 4:
• Lesson 5: Stress and Burnout Among Physicians
  

  Lesson 5: Stress and Burnout Among Physicians

  Learning Objective 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

  • 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

  • The BASICS - Strategies for coping with stress and building personal resilience for physicians URL

    Read the chapter titled "B is for Body" (pages 4-11).

  • Burnout among physicians URL

    Read the entire article.

  • Peer Project Part III: The BASICS Assignment
  • Quiz: Module 8: Lesson 5:
• Module 9: Sexuality and Health
  

  Module 9: Sexuality and Health

  Sexual health working definition: “... a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”  The World Health Organization (2006)

  Competency covered in this module:

  • 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

   
• Lesson 1: Relationship Between Sexuality and Health
  

  Lesson 1: Relationship Between Sexuality and Health

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

  • Required Learning Resources and Activities

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

  • Defining sexual health URL

    Read the web page.

  • Public Education Pamphlets: What is a Healthy Sex Life? URL

    Read the web page.

  • What You Should Know about Men’s Sexual Health URL

    Read the entire article.

  • Sexual Dysfunction URL

    Read the content under the tabs titled "Erectile Dysfunction" and "Low Testosterone", including the content of the links titled "Causes of Erectile Dysfunction" and "Treatments for Erectile Dysfunction at UC San Diego Health".

  • Sexual Health Fundamentals - The Top 10 Things You Need to Know About Female Sexuality URL

    Read the entire fact sheet.

  • How Chronic Illness Can Affect Sexual Function URL

    Read the entire web page.

  • Drug-induced sexual dysfunction in men and women URL

    Read the entire web page.

  • Quiz: Module 9: Lesson 1:
  • Additional Learning Options

  • Sexuality in Later Life URL

    Read the web page.

  • Lesbian, Gay, Bisexual, and Transgender Health URL

    Explore the web site.

• Lesson 2: Counseling Patients with Sexuality Issues
  

  Lesson 2: Counseling Patients with Sexuality Issues

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

  • Required Learning Resources and Activities

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

  • Talking With Patients About Sexuality and Sexual Health URL

    Read the web page.

  • Sex Therapy for Non-Sex Therapists URL

    Read down to the begining of the section titled "Sex Therapy Interventions".

  • Health and lifestyle factors associated with sexual difficulties in men – results from a study of Australian men aged 18 to 55 years URL

    Read the section titled "Abstract".

  • Association of Lifestyle and Relationship Factors with Sexual Functioning of Women During Midlife URL

    Read the section titled "Abstract".

  • Female Sexual Health Consensus Clinical Guidelines URL

    Read the section titled "SOGC Clinical Practice Guideline" (pages S1-S4).  The rest of the document is optional reading.

  • Quiz: Module 9: Lesson 2:
  • Additional Learning Option

  • Mentored Activity: How to Consult About Sexuality Assignment
• Module 10: Implementing Lifestyle Medicine
  

  Module 10: Implementing Lifestyle Medicine

  “People are generally better persuaded by the reasons which they have themselves discovered than by those which have come into the minds of others.” - Blaise Pascal

  Competencies covered in this module:

  • Tools to promote health change
  • Key clinical processes in lifestyle medicine

  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:

  • 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
  • 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 examples)
  • Describe appropriate situations for referring and collaborating with other health professionals, such as dieticians, health educators, fitness trainers, and psychologists
  • 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
  • Describe strategies for a clinical practice to obtain information about local community resources
• Lesson 1: Health Promotion in Clinics and Practices
  

  Lesson 1: Health Promotion in Clinics and Practices

  Learning Objectives 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

  • Required Learning Resources and Activities

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

  • 4 Strategies for Promoting Healthy Lifestyles in Your Practice URL

    Read the entire document.

  • Physician wellness: preventing resident and fellow burnout URL

    Read the entire module.

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

  • Ten principles of good interdisciplinary team work URL

    Read the entire article.

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

  • Leveraging Time With Lifestyle-Based Group Visits URL

    Read the entire abstract.

  • Quiz: Module 10: Lesson 1:
  • Additional Learning Options

  • Employer Resources for Success URL

    Browse the web page and click on any links of interest to you.

  • Healthy Team Healthy U: A Prospective Validation of an Evidence-Based Worksite Health Promotion and Wellness Platform URL

    Read the entire article.

  • Ten Lessons in Collaboration URL

    Read the entire article.

  • Effects of a Multi-Disciplinary Lifestyle Intervention on Cardiometabolic Risk Factors in Young Women with Abdominal Obesity: A Randomised Controlled Trial URL

    Read the entire article.

  • Patient Experiences of a Theory-Based Lifestyle-Focused Group Treatment in the Prevention of Cardiovascular Diseases and Type 2 Diabetes URL

    Read the entire article.

  • Effectiveness of Prediabetes Nutrition Shared Medical Appointments: Prevention of Diabetes URL

    Read the entire article.

• Lesson 2: Key Clinical Processes in Lifestyle Medicine
  

  Lesson 2: Key Clinical Processes in Lifestyle Medicine

  Learning Objectives 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

  • Required Learning Resources and Activities

  • Describe screening and diagnostic tests relevant to lifestyle-related diseases

  • The role of primary health care in preventing the onset of chronic disease, with a particular focus on the lifestyle risk factors for obesity, tobacco and alcohol URL

    Read pages 1-8, excluding the section titled "Role of practice nurse".

  • USPSTF A and B Recommendations URL

    Read the content of the table that is relevant to lifestyle medicine.

  • Screening for High Blood Pressure in Adults: Recommendation Statement URL

    Read the entire article.

  • Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Recommendation Statement URL

    Read the entire article.

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

  • Adult Health Questionnaire URL

    Examine the questionnaire.

  • Physical Examination for High Blood Pressure URL

    Read the web page.

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

  • 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC8) URL

    Download the pdf version of the article by clicking on the link found at the top left side of the web page.  Then, read all 9 recommendations listed in the box found on page 511 and examine the algorithm to manage hypertension outlined in Figure 1 (page 516).  The rest of the guideline is optional reading.

  • Screening for and Diagnosing Diabetes URL

    Read the web page and explore the interactive screening tool. For more information, click on the link titled “Full Guidelines” found under the heading titled ʺGuidelinesʺ located on the top left side of the web page. Then, click on the link to chapter 3 titled ʺDefinition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndromeʺ found under the heading titled ʺ2013 Guidelinesʺ, and read the text (optional reading).

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

  • Diabetes Mellitus Type 2 URL

    Read the content of all links found under the heading titled "Table of Contents".

  • Lifestyle Management of Adult Obesity URL

    Read the content of all links found under the heading titled "Table of Contents".

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

  • 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary] URL

    Scroll down to the section titled "Using the guidelines: an illustrative case scenario".  Be sure to examine Figure 1, which outlines the approach a healthcare team should use to assess and manage an overweight or an obese patient.

  • 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children URL

    Scroll down and read the chapter titled "9. Role of the health care team in the evaluation and management of obesity" (pages 51-54 in the Adobe toolbar).

  • Adding Health Education Specialists to Your Practice URL

    Read the entire article.

  • Quiz: Module 10: Lesson 2:
  • Additional Learning Options

  • Lifestyle Issues in Cardiac Health URL

    Read the introduction to the case study.  Then, click on the links titled ʺPatient Presentsʺ, ʺPatient Historyʺ, and ʺPhysical Examʺ found on the left side of the web page.  Read the content of each link.  The rest of the case study deals with the diagnosis and management of the condition.

  • Nutrition Guideline Referral to Registered Dietitian URL

    Read the entire guideline.

• Lesson 3: Strategies for Effective Office Systems to Plan Screenings, Follow Up on Test Results and Clinical Follow-Ups
  

  Lesson 3: Strategies for Effective Office Systems to Plan Screenings, Follow Up on Test Results and Clinical Follow-Ups

  Learning Objectives 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

  • 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

  • Committee Opinion: Tracking and Reminder Systems URL

    Read the entire article.

  • Automated Clinician Prompts and Referrals Facilitate Access to Counseling Services, Leading to Positive Behavior Changes Among Patients URL

    Read the entire article.

  • Physician-Linked Correspondence: A proven way to get more of your patients screened for cancer URL

    Read the section titled "Physician-Linked Correspondence".  Then, under the section titled "Physician-Linked Correspondence (PLC):  Questions and Answers", read the responses to questions 1, 2, and 10.

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

  • Mentored Activity: Action Plan for Implementing LM in Your Clinic Assignment
  • Peer Activity: Summary of the Course Project: In vivo Practice with a Patient on Healthy Lifestyle Behavior Change Workshop

    We hope that by the end of this course you feel healthier and happier, thanks to the personal health behavior change peer project!

    It is now time for you to summarize your project.

    Set up a meeting with your peer for a final discussion. Ask your peer about his/her reflections on the journey you took together and about his/her successes and challenges. Inquire whether there are any tips he/she could give you to further improve future interventions.

    Think of other activities to support his/her achievements and further promote health; a maintenance program is a very important step in the process of change.

    Summarize your project in writing. Your submission will be sent to three automatically chosen NextGenU peers who will determine whether or not you have met the criteria listed below.

  • Quiz: Module 10: Lesson 3:
  • Additional Learning Options

  • Comparative Effectiveness of Mailed Reminder Letters on Mammography Screening Compliance URL

    Read the entire article.

  • Enrichment Activity (optional): Commitment to Lifestyle Medicine Assignment
  • MCQ-writing activity Workshop
• Lesson 4: Strategies to Obtain Information about Local Community Resources
  

  Lesson 4: Strategies to Obtain Information about Local Community Resources

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

  • Required Learning Resources and Activities

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

  • Community Tool Box: Table of Contents URL

    Scroll down and click on the link titled "Chapter 3. Assessing Community Needs and Resources".  Then, click on the link titled "Section 8. Identifying Community Assets and Resources" and read the entire web page.

  • Quiz: Module 10: Lesson 4:
  • Additional Learning Options

  • Primary Health Care - Resource Centre URL

    Explore the web page.

  • Health together: how community resources can enhance clinical practice URL

    Read the entire article.

  • 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!

• Final Exam:
  

  Final Exam:

  The final exam consists of 50 multiple choice questions. You will need to complete all other activities before you can take the final exam. Write to support@nextgenu.org to obtain the password after you have completed all the peer and required activities. 
  

  • Final Exam Quiz
• Course Evaluation
  

  Course Evaluation

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