1
Q
define Lifestyle Medicine
A
ACLM: LM uses evidence-based lifestyle therapeutic approaches to prevent, treat and oftentimes reverse lifestyle-related chronic disease. The LS approach includes: a predominantly whole-food, plant based diet, regular physical activity, adequate sleep, stress management, avoidance of risky substance use, use of other non-drug modalities that promote health and prevent disease
2018 LM Core Competencies: LM offers a unique approach that leaverages a whole food, plant based diet, phys act, sleep, emot wellbeing, avoiding risky substances to not only prevent but also treat and reverse ls-related diseases
LM G Egger: LM is application of medical, behavoural, motivational and environmental principles to the management of LS related health problems in a clinical setting. Teaching self care and self-management are important elements of LS medicine.
2
Q
what is ITLC and name some notable published ones
A
Intensive Therapeutic Lifestyle change programs:
- drastic changes in LS domains
- usu delivered in gps
- usu 60 min visits, one to 3/ week, 3 to 18 weeks; shorter progs exist
- always involves multidisciplinary team
- evidence based methods
- accepted research methods
- Pritkin, Ornish, Diehl CHIP prog’s
- induction–> maintenance
3
Q
Briefly outline the role of: Hippocrietes, Edison
A
- Hippocrites “let you food be your medicine and your medicine be your food”
- Thomas Edison: “ the docotr of the future will give no medicine but will interest his patients in the care of human frame, in diet and in the cause and prevention of disease”
4
Q
BRiefly describe the role of Nnathan PRitkin in LMM
A
1970’s: residential healthcare centre that used nutrition , exercise and education to treat ad reverse heart dis
5
Q
BRiefly describe the role of John Mc Dougal in LM
A
1970: residential; unlimited plant based diet, stress reduction, exercise to treat and reverse HD
6
Q
BRiefly describe the role of Dean Ornish in LM
A
Dean Ornish Preventive MEdicine Research Center (1980’s)
The Lifestyle Heart Trial - regression of coronary stenosis @ 1 year and cont impr @5 y: low fat vegetarian diet, stress management, smoking cessation in small gp setting; positive psychology and connectedness
7
Q
BRiefly describe the role of HAns Diehl in LM
A
founder of CHIP: Coronary HEalth Improvement Program, now Complete HEalth improvement program (1990’s)
- OP, ITLC; whole food, plant based, exercise
8
Q
BRiefly describe the role of Caldwell B Esselstyn Jr in LM
A
Cleveland Clinic (1990’s): began a >20 y longit. study about areesting and reversing heart dis in critically ill patients (A way to reverse CAD? J Fam Prac, 2014), “In cholesterol lowering, moderation kills. Cleve Clin J Med, 2000)
9
Q
Which WHO document highlight the importance of diet in chronic disease and when was it first published?
A
WHO “Diet, nutrition, and the prevention of chronic disease” ; included nutrient guidance on the optimal intake of fats, carbohydrates and salt (1990’s)
10
Q
BRiefly describe the role of JAme Rippe
A
First comprehensive LM text: Lifestyle MEdicine (1990)
11
Q
when and where was ACLM founded
A
2004, JOhn Kelly, incollab w. Loma Linda Unov
12
Q
NAme and briefly describe the landmark article describing competencies in LM
A
“physician Competencies for Prescribing Lifestyle Medicine”, JAMA 2010: written by a pannel of experts from multiple disciplines and organisations
13
Q
What makes LM unique?
A
- focuses on treating causes of chronic disease
- uses evidence based LS interventions based on evidence as FIRST line
- can use evidence based medicasions as supplement (NOT first line)
- requires patient engagement and resposibility
- focuses on long term outcomes
- provider = expert and coach
- is cost saving
14
Q
Name the evidence based modalities of LM (6)
A
- whole food, plant based diet
- physical activity
- stress management and emotional wellness
- sleep
- smoking cessation and avoidance of riskyt substance use
- positive psychology and connectedness
15
Q
what is the definition of disease reversal for the purposes of LM foundations manual
A
laboratory makers and other diagnostic tests within normal limits without current use of medications, no present signs or symptoms of the disease
16
Q
what is the definition of disease cotnrol for the purposes of LM foundations manual
A
improvement in lab markers and diagnostic tests to accepted standards but without complete normalisation (with or without current medications or mnedical interventions)
17
Q
what is the defnition of complementary and alternative medicine?
A
- not currently considered part of conventional medicine
- uses complimentary (together w/ conventional med) or alternative (instead of conventionl med)
- historically not been researched
- EVIDENCE BASED COMPLIMENTARY MODALITIES = APPROPRIATE, not ev-based should not be used
18
Q
what is the defnition of INTEGRATIVE MEDICINE
A
- addresses pat whole person needs (physical, social, emotional, mental, environmental, spiritual), through a combination of conventional, complimentary and alternative medicine
- “integrates” evidence based conventional methods w/ not evidence based methods (strength/ handicap?)
19
Q
what is the defnition of FUNCTIONAL MEDICINE
A
- focuses on the physiologic and biochemical functions of the body (from cells to organ systems); investigating the processes of cellular metabolism, digestive function, detoxification and control of oxidative stress
- tends to emphasise testing of various hormones and metabolites that are not well-proven or generally accepted w/in evidence baswed medicine, and this is still somewhat controversial
20
Q
what is the defnition of MIND BODY MEDICINE
A
investigates interactions betw body and mind behaviourally, emotionally, mentally, socially and spiritually
- uses modalities like relaxation, hypnosis, visual imaginery,, meditation, yoga, biofeedback, spirituality, thai chi etc.
- some very solid evidence, others not
21
Q
what is the defnition of PREVENTITIVE MEDICINE
A
- all aspects of morbidity and mortality prevention for gen public, ie oversses the field of public health
- emphasises population based interentions that inc. immunisation, screening, protection from bioterrorism
22
Q
what is the defnition of CONVENTIONAL MEDICINE
A
- uses medications, surgical techniquesm etc.; often at highest level of care and “end” treatmetn
- dis thought to occur from exposure to a pathogen or environmental factor, or genetic predisposition
- treatments acute/ long term
- disease focused
- pat = recipient of care, complies w/ treatment, not required to make signif changes
- provider considered responsible for care and outcomes, patient passive recepient
23
Q
Name the shaping forces of medicine in the US and challenges of LM
A
- consts increasing, quickly becoming unstable and unsustainable, complicated by health care repeals and replacements
- employers and goverment = main payers, destroying self-balancing market place
- direct-to-consumer marketing= legal => incr demand for pharmaceuticals and interventions
- America = ill-prepared to embrace LM , almost all reimbursements = misaligned
- prevalent belief: pharmaceuticals, supplements, biochem treatments are the key to longevity
- internet = source of information; medical system not fully utilising technology
24
Q
what is the role of behavioural determinants for positive health outcomes?
A
Lifestyle practices and health habits = most important deterinants of positive health outcomes
- improving health beh = foundational to effective medical care, dis prevention and health promotion
25
what are the key elements for improving health behaviours and outcomes
1. trusting relationship betw physiician and patient
| 2. patient support; MDT, loved ones, greater community
26
what are the 10 leading causes of death in the US (2010)
1. heart disease (633,842; 31.5%)
2. Cancer (595.930; 29.6%)
3. chronic lower respiratory disease (155,041; 7.7%)
4. accidents (unintentional injuries) ( 146,571; 7.3%)
5. stroke (CVD) ( 140,323; 7%)
6. Alzheimer's dis (110,561; 5.5%)\
7. Diabetes (79.565; 4.0%)
8. Influenza and pneumonia (57,062; 2.8%)
9. nephritis, neprotic syndr, nephrosis (49,959; 2.5%)
10. Intentional self-harm (suicide) (44,193; 2.2%)
27
What proportion of presentations to family physicians are due to chronic disease, in the US? And what are the top 8?
78% (Holman 2004)
1. obesity
2. metabolic syndrome
3. hypertension
4. cardiovascular disease
5. dyslipidaemia
6. arthritis
7. diabetes
8. osteoporosis
28
what proportion of premature deaths are attributable to lifestyle factors and name these lifestyle factors.
80%
1. tobacco use
2. poor diet
3. lack of physical activity
29
waht proportion of patients have sufficient amount of all four healthy behaviours and name these behaviours>
3%
1. non-smoking 76%
2. healthy we3ight (BMI <25) 40%
3. 5 fruits and veg/day 23%
4. regular physical activity 22%
30
what proportion of people in the US smoke?
1 / 7
31
what proportion of people in the US eat diet low in fruit and vegetables?
3/ 4
32
what proportion of people in the US do not get enough physical activity?
4/5
33
what proportion of people in the US follow dietary guidelines for saturated fat after diagnosed with medical problems attributable to lifestyle>?
11%
34
what proportion of people in the US continues smoking after a diagnosis w/ heart disease
8%
35
name the determinants of health
1. Adverse childhood events
2. genetic and epigenetic predisposition
3. health literacy
4. local environmental conditions
36
what is the relationship between the ACEs (Adverse Childhood Events) and health
the more ACEs the higher the risk of adverse health outcome: eg self-rated health, functional limitations, mental illness, slef harm, drug and alcohol abuse, diabetes, cancer,m respiratory disease, heart attacks
37
what is the relationship between genetic predisposition and health?
- dna sequence (genes) explains appx 10% variance in health status
38
what is the relationship between the epigenetic predisposition and health
"gene switches" appx 70-90% of variance in health
- 2005 study "epigenetic differences arise during lifetime of monozygotic twins" => environmental, not genetic factors are the MAIN DETERMINANTS of health variance;
- methylation
- more variance between monozygotic twins if livedin different environments
39
explain the relationship between health literacy and health outcomes
- higher education = higher health literacy
- low health literacy = higher rates of hosp adm. and physician visits; less knowledge and poorer management of serious health conditions *e.g. HIV, asthma, DM)
40
What are the main determinants of health outcomes in terms of LOCAL ENVIRONMENTAL CONDITIONS
1. air pollution
2. second hand smoking
3. water supply
4. foo deserts
5. war, famine, earthquakes, etc.
41
explain the relationship between SOCIOECONIMIC STATUS and health outcomes
1. lower SES correlatees w/ poorer health recardless of country studied
2. racial minorities receive lower-quality care and have less access to interventions
3. among socioeconomic factors, having higher education is the best predictor of good health
42
Name the factors responsible for disparities in health outcomes and health care result from different underlying rates of illness
1. genetic predisposition
2. local environmental factors
3. poorer care
poor lifestyle choices
5. different care-seeking behaviours
6. linguistic barriers
7. lack of trust in health care providers
43
what is the THE HEALTHY PEOPLE INITIATIVE
government program that provides science-based, 10 y national objectives for improving the health of all Americans
44
what are the leading health indicators of HEALTHY PEOPLE INITIATIVE?
1. physical activity
2. overweight and obesity
3. tobacco use
4. substance use
5. responsible sexual behavior
6. mental health
7. injury and violence
8. environmental quality
9. immunization
10. access to health care
45
what is "America's plan for better health and wellness" and when was it compiled
- first and current (as at 2019) NAtional Prevention Strategy
- key component of Affordable Care Act, overseen by Surgeon general Dr Regina Benjamin
- 2011
- idea was to create a strategy to change America's health care system from a predominantly sick care model to one that is focused on wellness and disease prevention
46
What legisalation is the America's plan for better health and wellness part of and what is its purpose?
- key component of Affordable Care Act, overseen by Surgeon general Dr Regina Benjamin
- idea was to create a strategy to change America's health care system from a predominantly sick care model to one that is focused on wellness and disease prevention
47
What strategies does the America's plan for better health and wellness include?
health care providers providing lifestyle modification services such as:
1. physical activity assessment and counselling
2. obesity screening and nutrition counselling
3. screening and counselling for excessive alcohol use
4. tobacco cessation services
48
What were the recommendations of "The NAtional Strategy for Quality Improvement in HEalth Care" report, submitted to Congress in 20112 by the US dept of Health and Human Services
1. promote the most effective prevention and rtreatment practics for the elading causes of mortality, starting with cardiovascular disease
2. engage each person and family asw partners in their health care
3. work with communities to promote wide use of best practices to enable healthy living
49
Which lifestyle interventions have been most strongly y shown by research to correlate w/ health outcomes?
1. tobacco cessation, incr phys act., dietary changes can decrease morbidity and mortality from Cardiovas., cerebrovasc and cancer in adults: Cochrane Collaboration, the AHA and the US Prevent Task Force (USPSTF)
50
What grade of recommendation has USPSTF assigned to referring adults w/ CVD risk factors for beh. counselling interventions to promote healthy diet and physical activity
grade B
- Benefits of counseling interventions to promote a healthy diet and physical activity: adequate evidence that counseling interventions reduce overall CVD events (e.g., myocardial infarction and stroke).
There is convincing evidence that counseling interventions improve blood pressure, lipid and fasting blood glucose levels, and body weight/adiposity. There is adequate evidence that counseling interventions improve healthy eating habits.
- Harms of counseling interventions to promote a healthy diet and physical activity There is inadequate direct evidence to determine the harms of counseling interventions, although they can be bound as no greater than small in magnitude based on the nature of the interventions
The USPSTF concludes with moderate certainty that intensive counseling interventions to promote a healthy diet and physical activity in adults with CVD risk factors has a MODERATE NET BENEFIT
51
Name the behavior counselling interventions to promote healthy diet recommended by USPSTF for adults with CVD RF's to prevent CVD
Behavior change goals:
Reduce consumption of saturated fat, sodium, sweets, and added sugar.
Increase consumption of vegetables, fruits, whole grains, healthy fats (e.g., omega-3 fats), and fish.
Promote specific diets such as the DASH and Mediterranean diets.
Physical activity counseling typically advised 90 to 180 minutes per week of moderate to vigorous activity.
Materials for practice
U.S. DHHS/USDA dietary guidelines and resources (https://health.gov/dietaryguidelines/2015/)
DASH Eating plan (https://www.nhlbi.nih.gov/health-topics/dash-eating-plan)19
Mediterranean diet
52
Name the behavior counselling interventions to promote physical activity, recommended by USPSTF for adults with CVD RF's to prevent CVD,
(https://www.nejm.org/doi/10.1056/NEJMoa1800389)20
U.S. DHHS physical activity guidelines and resources (https://health.gov/our-work/physical-activity/move-your-way-campaign)3
53
what Behavior change interventions have been assessed and recommended by USPSTF for people w/ cvd risk factors
Behavior change techniques included goal setting, active use of self-monitoring, and addressing barriers related to diet, physical activity, or weight change. Motivational interviewing was commonly employed. A small number of trials included family members as well as the individual with CVD risk factors.
Intervention modality
Face-to-face sessions with or without additional telephone or web-based or other technology-enhanced components. Group sessions typically included an additional individual meeting for each person.
54
waht was the Intervention intensity of interventions assessed by USPSTF for adults w/ CVD RFs?
The median number of contacts was 12 (range, 5 to 27 contacts), with an estimated 6 hours (range, 2.1 to 16.5 hours) of contact over 12 months (range, 6 to 18 months).10
55
what were the characteristics of recipients of beh interventions assessed by USPSTF for adults w/ CVD RFs?
Intervention recipient Adults with hypertension, prehypertension, dyslipidemia, or any of multiple CVD risk factors; most participants were overweight or obese (mean BMI, 29.8 kg/m2). The mean age of study participants was 56 years.
56
What were the intervention settings and who delivered them, (USPTSF for adults w/ CVD RFs)
Intervention settings Most interventions took place in primary care settings.
Person delivering intervention
Most were nonphysicians, including registered dieticians, health educators, nurses, lifestyle coaches, psychologists or psychology graduate students, and exercise physiologists.
Brief (60 to 90 minutes) training was typically provided to primary care providers and their staff when they were involved in the delivery of the intervention.
57
What were the demonstrated benefits of the interventions assessed and recommended by USPTSF for adults w/ CVD RFs at 1- 16 years followup?
Demonstrated benefit
Overall, persons receiving behavioral interventions had FEWER cardiovascular events (e.g., myocardial infarction, stroke, or incidence of peripheral artery disease) at 1 to 16 years of followup (pooled RR, 0.81 [95% CI, 0.74 to 0.88]).
58
What were the demonstrated benefits of the interventions assessed and recommended by USPTSF for adults w/ CVD RFs at 12-24 months followup?
At 12 to 24 months, the intervention groups showed: GREATER REDUCTION IN BP (systolic blood pressure, -1.8 mm Hg [95% CI, -2.5 to -1.2], diastolic blood pressure, -1.2 mm Hg [95% CI, -1.6 to -0.7]),
TOTAL CHOLESTEROL (-3.7 mg/dL [95% CI, -5.9 to -1.5]), LDL (-2.3 mg/dL [95% CI, -4.3 to -0.2]),
BMI (-0.4 kg/m2 [95% CI, -0.7 to -0.2]),
WEIGHT-1.5 kg [95% CI, -2.1 to -1.1]),
WAIST CIRCUMFERENCE (-1.6 cm [95% CI, -2.3 to -0.9]).10
59
Was there a demonstrable difference between interventions in terms of duration, who delivered them, or mode of delivery in the interventions assessed by USPTSF?
No difference in effectiveness based on intensity of the intervention, duration of the intervention, whether there was in-person support, whether individual in-person or telephone sessions were offered, whether medication management was offered, or whether blood pressure monitors or pedometers were provided. Larger weight loss effects were evident in weight loss trials.10
60
What do the World Cancer Research Fund and the American Institute for Cancer Research data suggest with regards to the role of lifestyle behaviors and most common cancers?
1/3 of the most common cancers in the US could be prevented with improvement of:
1. tobacco and alcohol use
2. lack of physical activity
3. dietary factors
4. obesity
- there are 340000 preventable cancers a year in the US
61
What does the evidence suggest w/ reg to healthy diet and its effect on health outcomes?
- assoc w/ lower risk of chronic dis morbidity and mortality
- poor diet (even if wt normal): incr causes of MM for CVD, CVA, HTN, T2DM, Osteoporosis, some Ca
-
62
What did the Merrill's et all study find w/ reg to healthy behaviours?
- health beh most improved at 6 week
- sustained benefits at 18 months; above prior baselines, in >50% partic.
- physical activity, lower caloric intake, more servings of fruits and vege, less intake sat fats and sweets, more intake dietary fiber
63
with regards to INTERHEART STUDY: briefly describe its design
standardised, case control
1st presentation of MI (admitted to cardiac care)
multicentre: 52 countries
aim: identify modifiable risk factors for MI
64
What were the most important findings of INTERHEART STUDY:
```
9 signif worldwide RFs for MI:
similar across gender, race/ ethnicity, physical location
1. smoking
2. lipids
3. hypertension
4. diabetes
5. obesity
6. diet
7. physical activity
8. alcohol consumption
9. psychosocial factors (stress, mental illness, isolation, addictions, etc.): first time identified that PSYCHOLOGICAL FACTORS comparable to the effect of HTN and abdominal obesity (poppulation attributable risk PAR 33%)
- factors 1-5 accounted for 80% of MIs
- 9 factors PAR 90% men, 94% women
```
65
With regards to INTERSTERSTROKE study briefly describe its design and findings
```
prospective case control study
multicentre (32 countries)
to identify RFs for stroke
- 10 rf's: htn, current smoking, abdominal obesity, unhealthy diet, physical inactivity, diabetes, alcohol intake, psychological stress, depression, cardiac causes, abn lipids
- these 10 rf's assoc w/* 90% of strokes
```
66
briefly describe results of the CHICAGO HEART ASSOCIATION DETECTION PROJECT in INDUSTRY
- risk of heart dis determined by the number of RFs
- ASSOCIATION between LOWER RISK (i.e. less RF's) @ MIDDLE AGE & better QOL, & LOWER MEdicare COST: men; <2/3 wom <1/2 total cost (cf control ppn)
67
according to the findings of CHICAGO HEART ASSOCIATION DETECTION PROJECT in INDUSTRY, how much can 50% decrease in total cholesterol decrease the risk of heard disease?
50%
68
according to the findings of CHICAGO HEART ASSOCIATION DETECTION PROJECT in INDUSTRY, how much can 6mmHg decrease in diastolic pressure reduce the risk of heart disease?
16%, (42% reduction stroke risk)
69
according to the findings of CHICAGO HEART ASSOCIATION DETECTION PROJECT in INDUSTRY, how much can SMOKING CESSATION re4duce the risk of heart disease?
50% risk of sudden heart attack
70
according to the findings of CHICAGO HEART ASSOCIATION DETECTION PROJECT in INDUSTRY, how much can maintaining of IDEAL BODY WEIGHT AND WAIST SIZE reduce the risk of heart disease?
35-55%
71
according to the findings of CHICAGO HEART ASSOCIATION DETECTION PROJECT in INDUSTRY, how much can >150min/ week of moderate exercise reducethe risk of heart disease?
35-55%
72
according to the findings of CHICAGO HEART ASSOCIATION DETECTION PROJECT in INDUSTRY, what proportion of Americans eat > 5 SERVINGS FRUITS AND VEG/ day
20-25%
73
What did FRAMIGHAM HEART STUDY examine and in what kind of population?
lifetime risk for atherosclerotic cardiovascualr disease in people w/out cvd aged 50
74
briefly describe the design of NURSES HEALTH STUDY
PROSPECTIVE
RELATIVE RISK OF CVD over 14y
in 84129 women
75
what were the principal findings of the MRFIT study: (MULTIPLE RISK FACTOR INTERVENTION TRIAL) for people w/ low RF status?
1. 73-85% lower risk of cardiovasc disease MORTALITY
76
what were the principal findings of the MRFIT study: (MULTIPLE RISK FACTOR INTERVENTION TRIAL)?
for people w/ low RF status:
1. 73-85% lower risk of CVD MORTALITY
2. 40-60% lower TOTAL MORTALITY
3. 6-10 years greater LIFE EXPECTANCY
77
what were the principal findings of the NURSES HEALTH STUDY?
5 health factors assoc w/ lower risk of coronary heart dis:
1. NO SMOKING
2. BMI <25 kg/m2
3. PA 30min/day or more
4. MODERATED ALCOHOL consumption (5-3gr or 1/5 -1 oz/ day)
5. HEALTHY DIET SCORE in the top two quintiles (top 40%)
78
briefly describe how were HEALTHY DIET SCORES in NURSES HEALTH STUDY obtained?
3 key items: 1. cereal FIBRE, 2. marine OMEGA-3's, 3. FOLATE: categorised into quintiles from most to least; higher score= healthier diet
79
Briefly describe key findings of NURSES HEALTH STUDY
1. ALL 5 protective factors present vs none = 82% lower risk of CHD
2. 3 protective factors (diet, non-smokingg, PA 30min/day) = 12.7% of women, RR 0.46, PAR 51%
3. 4 protective factors (diet, nonsmoking, PA 30min/day, BMI<25) = 7.2% women, RR 0.25, PAR 74%
5. 5 protective factors = 3.1 women, RR 0.25, PAR 74%
PAR= population attributable risk= incidence of a disease in the population that would be eliminated if exposure were eliminated.
80
name the studies that analysed the effects of healthful vs unhealthful plant-based diets and risk of CHD
1. NURSES HEALTH STUDY
2. NURSES HEALTH STUDY 2
3. HEALTH PROFESSIONALS FOLLOW UP STUDY
81
briefly describe the design and main findings of the HEALTH PROFESSIONALS FOLLOW-UP STUDY
- analysed the effects of healthful vs unhealthful plant-based diets and risk of CHD
- almost 5 million person-years of follow up
- documented 8631 cases of CHD
- pooled multivariant analysis
- HIGHER ADHERENCE TO A HEALTHY PLANT-BASED DIET = INDEPENDENTLY INVERSELY ASSOCIATED W/ CHD (HR of extreme deciles = 0.92
- the LESS PROCESSED FOOD and MORE WHOLEFOOD = the STRONGER THE INVERSE ASSOC : HR 0.75
- UNHEALTHY plant-based diet = POSIT ASSOC W/ CHD: HR 1.32
82
briefly outline the design of ADVENTIST HEALTH STUDY 2
>70 000 partic.
| assessed "degree of animal products avoidance" - 5 "graded gp.s
83
briefly outline the findings of ADVENTIST HEALTH STUDY 2
MORTALITY RISK vegetarian vs non-vegetarian:
1. ALL CAUSES HR 0.85
2. Isch Heart dis., Cancer, other cardiovasc dise: HR appx 0.9
3. Other causes 0.74
LINEAR relationship btw vegetarian diet vs non-vegetarian diet : total veget. lower BMI (dif appx 5kg/m2), lower risk of DM (OR 0.51), HTN (OR 0.37), metab. syndr. (OR 0.44)
84
briefly describe the design of LYON DIET HEART STUDY
- RCT, free-living subjects, after 1st MI
- MEDITERANIAN vs AHA step 1 vs diet comparable to Standard American (western) diet
- experimental group = 1-hour counseling session.
- Controls = no specific dietary advice apart from that generally provided by hospital dietitians or attending physicians.
85
what are the prescribed proportions of fat for step 1 AHA diet?
AHA step 1 (30% of calories from fat, 8% to 10% from saturated fat, 300 mg/d cholesterol)
86
Outline the MEditeranean diet, as described in the Lyon Heart Study protocol
- more bread, more root vegetables and green
vegetables, more fish, fruit at least once daily,
- less red meat (replaced with poultry), and margarine w/ fatty acid composition comparable to olive oil
- Exclusive use of rapeseed oil and olive oil in salads and food preparation
- Wine in moderation allowed with meals.
87
briefly outline the results of LYON DIET HEART STUDY (
- signif. reduceced cardiovasc mortality and non-fatal recurrence
- first to correlate omega 3's w/ cardioprotection and dietary RF's beyond lipids and lipoproteins
- proposed independent cardioprotective role of a-linolenic acid
- mediteranian diet patterns maintained for 4 years
88
outline the ways in which a health provider can influence lifestyle-related behaviour of patients
1. public perception of physicians as credible and reliable sources of information re health
2. beh. counselling, (MIm education and evidence) by physicians and nurses = effective and supported by evidence
3. patients who made a beh change often state tat their physician's advice influenced them (most evidence on wt loss)
89
what is the estimated proportion of patients w/ chronic conditions seen by their primary care provider at least once a year, and 2-3 times/ year
3 out of 4 at least once a year
| most 2-3 times a year
90
what is the best setting for delivering LSM
primary care setting = natural fit for LSM; it's imperative that LSM becomes integrated into primary care
91
what are the responsibilities of LSM physicians
1. SCREEN for LS factors and diseases
2. TREAT chron dis by prescribing and following up on LS changes
3. ENGAGE w/ a MULTIDISCIPLINARY team and REFER pat to COMMUNITY resources
4. ENSURE UNDERSTANDINGof the iptce of LS changes on pat. chronic condition
5. COACH pat on beh change based on their readiness to change
92
what does the evidence suggest re PATIENT-PHYSICIAN RELATIONSHIP
MIXED EVIDENCE
- but apparent SMALL POSITIVE EFFECT IN INCREASEING HEALTHY BEH.
- difficult to assess evidence as wide array of methodolgies, interventions,e tc.
- evidence that prescribing SPECIFIC change = MORE EFFECTIVE
- SMOKING CESSATION INTERVENTIONS = SOLIDLY PROVEN effective
93
what are the CORE PHYSICIAN COMPETENCIES FOR PRESCRIBING LSM
- data not avail yet, anecdotal evidence that adopting the core competencies will improve health
1. LEADERSHIP
- PROMOTEhealthy beh. as foundational to medical care, dis prevention and helath promotion
- PRACTICE healthy pers beh.
- CREATE environments that support healthy beh. at school, work, home
2. KNOWLEDGE
- know the EVIDENCE for specific changes on health outcomes; e.g. smoking cessation on lung cond., exercise on occurence and reccurence of breast ca, fitness on heart attacks and stroke survival, plant based diet on reduced bp, lipids, prostate ca regression
3. ASSESSMENT skills: soc., psycholog. and biol. PREDISCPOSITIONS of pat beh's and the resulting health outcomes; patient's and family's r, perform REDINESS FOR CHANGE, problem-specific HISTORY and physical EXAMINATION, incl. lifestyle vital signs; order and interpret TESTS to screen, dignose and monitor LS-related diseases
4. MANAGEMENT skills: use nationally recognised practice GUIDELINES to assist pat self-managing their health beh and ls; establish EFFECTIVE RELATIONSHIP w/ pat and fa's to affect and sustain beh change; COLLABORATE w/ pat and fa to develop goals, plans and prescriptions, help pat SUSTAIN healthy ls practices (refer, follow up, etc)
5. USE SUPPORT (colleagues and community); INTERDISCIPLINARY TEAM approach, develp and apply SUSTEMS that support LS medical care, MEASURE processes and outcomes to IMPROVE QUALITY of interventions, use approp commuynity referral resources to support implementation of healthy lsm; this should include INTENSE INDUCTION PHASE intervention programs when indicated
94
what is ITLC
INTENSIVE THERAPEUTIC LIFESTYLE CHANGE program
ASLMBCE
flashcards
Decks in class (13)
# Cards
-
Sect 3: Clinical processes in lifestyle medicine (8%)72
-
ASLMBCE Sect 5: nutrition (24%)197
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Section 2: Fundamentals of behavior change (10%)75
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Section 1: Introduction (4%)94
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Section 6: Physical Activity 14%76
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Section 4: The Role of Physician in LSM 4%12
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Section 8: Sleep 8%64
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Connectedness and Positive PSychology 8%17
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MCQ's Random13
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Sections 7 and 10: Emotional and Mental Wellbeing, Connectedness, Positive Psychology 10% + 8%26
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MCQs Key PApers28
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Section 9: Smoking and alcohol 8%49
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Appendix: Overweight and Obesity- fundamentals of beh change0
