Implications of lifestyle medicine in medical practice

ABSTRACT

Globally, we are seeing a rise in non-communicable diseases such as obesity, hypertension, diabetes, metabolic syndrome, chronic respiratory diseases, cancer, etc., due to stressful lifestyle in this competitive world. Most of the non-communicable diseases are associated with lifestyle behavior. Presently, the role of lifestyle medicine is very critical and important in the management of chronic lifestyle-associated disorders. Considering the above facts, we decided to review the literature to gain a deeper insight into the implications of lifestyle medicine in medical practice. A literature search was conducted on PubMed, Scopus and Google Scholar databases. We observed that lifestyle medicine intervention is a growing and newer discipline and is being employed along with conventional management of non-communicable diseases by medical practitioners today, as they are strongly associated with lifestyle behaviors and practices. Motivation for change in lifestyle is challenging because it depends on the patient’s determination and eagerness to adapt and accommodate to the newer lifestyle pattern. The medical practitioners should spend time in coaching patients on lifestyle-related health education. Guidance and coaching by medical practitioners will help patients adapt to practices of maintaining regular physical activity, a balanced diet, good sleep hygiene, and avoid addictions of tobacco and alcohol as part of life. Introducing real and progressive evidence-based behavioral changes to reduce the risks of lifestyle-related acute and chronic diseases in medical practice will reduce the burden of non-communicable disease.

Introduction

Lifestyle medicine is evidence-based medicine that promotes comprehensive lifestyle changes (especially pertaining to nutrition and dietary planning, physical activity and exercise intervention, stress management for behavioral changes, social interaction support, and altered environmental exposures) to prevent, effectively manage and reverse the progression of underlying chronic diseases by addressing the cause.[1] The definition of lifestyle medicine as describe by the American College of Lifestyle Medicine (ACLM) states that the lifestyle medicine is “the use of lifestyle interventions in the treatment and management of disease.” Moreover, ACLM emphasizes the intervention of exercise, a balance diet, stress management, smoking cessation, and a variety of other non-drug modalities as part of management of lifestyle-associated diseases.[2] The keywords for search were centered around “Life Style Medicine”, “Non Communicable diseases”, “Physical Activity”, “Sleep”, “Addiction”, “Exercise”, “Sexual Health”, “Behavioral Changes”, “Stress Relaxation”, and “Social Life”. India, which has progressively been developing as a major industrial nation and information technology hub, is also seeing a transition in its health demography where disease burden is shifting from infectious diseases to non-communicable diseases (NCDs). There were 61.8% deaths in 2017 in India due to non-communicable diseases. NCDs, in a broader aspect, encompass diseases such as hypertension, diabetes, cancer, cardiovascular diseases, mental illness, and chronic respiratory diseases.[3] The pathophysiology of NCDs are indicative of associated risk factors such as stress, lack of physical activity, alcohol and tobacco addiction, unhealthy eating habits, obesity, and environmental pollution.[2,3]

Lifestyle medicine intervention has emerged as a newer discipline to enhance conventional medical management therapy while addressing lifestyle-associated disorders so as to bring behavioral changes toward leading a healthy life comprising of regular physical activity, balanced nutritional diet, and living a stress-free life. Thereby lifestyle medicine targets introducing real and progressive evidence-based behavioral changes to reduce the risks of lifestyle-related acute and chronic diseases.[4,5] Considering these facts, more research is warranted that targets implications of lifestyle medicine in prevention of NCDs. Lifestyle medicine practitioners should address sleep disorders, addiction issues, and mental illness as they recommend other lifestyle changes.[6] Prescribing a lifestyle medicine regimen should be a part of medical management; moreover, customized feedback and briefing of the patient shall help in faster recovery of patients from their illnesses.[7,8]

The present review is written to explore the implications of lifestyle medicine in clinical practice.

Discussion

Lifestyle medicine in clinical practice

Lifestyle medicine helps in modifying and adapting to lifestyle behavioral changes for effectively combating the adverse health complications of lifestyle-associated NCDs. The patients are coached with evidence-based behavioral remedies such as physical activity, dietary habits, sleep hygiene, de-addiction of nicotine and alcohol, importance of maintaining connections in society, and stress management techniques for their physical, mental, and social wellbeing. Lifestyle medicine, along with physical medicine and rehabilitation, is a unique and synergistic mode of treating patients in a social context.[9–11]

Motivation as part of lifestyle medicine

Motivating patients to adapt to lifestyle-associated changes is the biggest challenge in medical practice. The health condition of the patient, their literacy, cultural, educational, and social backgrounds and particularly their mental makeup are all crucial factors when lifestyle changes are to be adopted by the patient. If the medical practitioner is able to convince and motivate the patient into incorporating lifestyle changes, the medical management is half done. One of the research studies in which a health educator as well as a physician counseled the patients regarding regular physical activity and had the patients’ regular feedback were found to follow physical activity of weekly walking exercises punctually.[12] Another study on patients with diabetes mellitus revealed that patients who were supervised and counseled for dietary changes followed the suggested diet more meticulously than the other group of patients who were just routinely instructed regarding their dietary pattern.[13] The medical practitioners should also concentrate on motivating patients to adapt to lifestyle changes to enhance health management benefits.

Practices in lifestyle medicine[10,11]

The commonly employed practices in lifestyle medicine include the following:

1. Regular physical activity and incorporation of exercise and meditation as a way of life; exercising for 150 minutes per week (30 minutes per day for five days a week) is a healthy recommended practice.

2. Practicing good sleep hygiene and having a restful sleep of about 9–10 hours per day in adults

3. Avoiding smoking and nicotine addiction and reducing alcohol intake

4. Consuming a balance diet and incorporating nutritional modifications to manage lifestyle diseases

5. Adapting to techniques for stress management and stress relaxation; visiting nature and forest bath at weekends;

6. Socializing with family, relatives, and friends to maintain social connections and personal wellbeing

Physical activity

Regular physical activity in terms of aerobic exercise is immensely helpful for optimum health. In our study conducted on 51 obese adults with sedentary lifestyle, we found out that high intermittent intensity exercise was more beneficial than moderate intensity exercise in reducing the individual’s weight. Moreover, our exercise protocol helped in decreasing the lipid profile to physiological levels.[14] Performing regular exercise decreases abdominal adiposity and aids in weight loss, controls lipid profile (e.g., decreases levels of triglycerides, enhances high-density lipoprotein and lowers low-density lipoprotein), decreases blood pressure, lowers blood glucose level, improves cardiac function, and facilitates better endothelial function. Suggesting regular physical activity will enhance psychological well-being as well as cognitive function in patients.[15] Even strenuous exercises have also been proven to enhance life expectancy in humans.[16] Research studies have suggested exercise prescription as part of medical management in 26 different diseases which include psychological disorders such as anxiety nervosa, depressive psychosis, and schizophrenia; neurological disorders such as dementia, paralysis agitans, and multiple sclerosis; metabolic disorders such as metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, obesity, and lipidemia; cardiovascular disorders such as hypertension and coronary heart disease; lung diseases such as chronic obstructive pulmonary disease and asthma; and various musculoskeletal disorders.[17] A meta-analysis conducted in the year 2015 found that exercise intervention programs improved physical fitness and reduced cardiovascular disease risk. Moreover, 90 minutes per week of moderate-to-vigorous exercise was found to reduce psychiatric symptoms.[18] A Cochrane Review of 3476 overweight or obese people of the total 41 randomized control trials revealed that physical activity helped in attaining significant loss of weight; moreover, physical activity in conjunction with dietary restriction and counseling was more effective in controlling weight.[19] In one of our study, we found that moderate intensity exercise helped in better control of weight, waist-to-hip ratio, skin-fold thickness, and lean body mass in subjects, whereas in high intensity exercise performers these benefits were present to a lower extent.[20]

These evidences suggest that prescribing exercise as part of medical management will help have a preventive and curative effect in individuals suffering from lifestyle-associated disorders.

Diet and nutrition prescription as part of lifestyle medicine practice

People having unhealthy eating habits and those who binge on junk food have a higher risk of developing obesity and metabolic disorders. Having a balance nutritional diet with proportionate intake of carbohydrates, fats, proteins, vitamins, and minerals is necessary for optimum health. The range of average intake of carbohydrates is 45%–65%, of fat is 25%–35%, and protein is 10%–30% of the total individual’s caloric requirement.[21] One study revealed that in the short-term, a high-protein and low-carbohydrate diet in combination with intermittent fasting promotes higher weight loss in obese individuals.[22] The rising number of centennials having longer life are found to be consuming Mediterranean diet which is rich in fruits, vegetables, grain, beans, nuts, legume, olive oil, herbs, spices, and sea food. These Mediterranean style of diets have been very effective in controlling hypertension as this diet is low in carbohydrate and fat and it ameliorates insulin resistance and metabolic syndrome. Thus, this approach decreases risk of diabetes mellitus and cardiovascular disease.[23] Studies reveal that consuming foods having low glycemic index (GI) and lower carbohydrate content is immensely helpful in the management of type 2 diabetes. Similarity consumption of unsaturated fatty acids, bioactive compounds, vitamins, and minerals is very good and helpful in the management of chronic diseases.[24] Another research study pointed out that a very low carbohydrate diet coupled with regular medications provides better blood glucose control in type 2 diabetes and subsequently reduces the dosage of diabetes medications in the patient.[25]

Lifestyle medicine recommends intake of a balance diet that matches the caloric requirement of individuals. It cautions against having a high carbohydrate and high fat diet. Avoiding fried food, high intake of soft drinks and beverages, quitting smoking, and leading a physically active life are the precious guidelines for optimum health for humans as recommended by lifestyle medicine practitioners.[1,2]

Stress relaxation

Stress is the most significant risk factor of metabolic diseases. Chronic stress may not only lead to psychological disorders such as anxiety but also affect the quality of life. Many relaxation techniques are being employed as a therapeutic remedy to help people combat anxiety and tension. Relaxation methods and techniques such as meditation, watching visual imagery of nature, and forest therapy help enhance calm and poise in individuals and enhances parasympathetic activities in the body.[26,27]

Visiting nature such as gardens, forests, mountains, and the sea coast have been found to produce physiological and psychological relaxation in humans, as well as improve cognition.[28] Nature visiting experiences decrease rumination and subgenual prefrontal cortex activation and thereby promotes parasympathetic activities.[29] Performing physical activities in nature enhances and promotes good physical and mental health.[30] A meta-analysis also revealed a positive correlation between nature connectedness and happiness. Lifestyle medicine strongly recommends adopting stress relaxation techniques along with regular physical activity for attaining optimum health.[31]

Addiction

High consumption of tobacco products and alcohol has led to rampant rise in NCDs.[32] The adolescent and young adults of today have a variety of options to consume sweetened and flavored tobacco products in the market. A stressful and competitive life faced by youngsters today may compel them to consume alcohol and other beverages and visit bars and clubs to relieve mental tension. Many adults stay away from family and become addicted to tobacco and alcohol.[32,33] These situational factors are increasing the prevalence of addiction and therefore lifestyle-associated medical disorders such as obesity, hypertension, and diabetes. As medical practitioners, one should coach their patients to avoid these addictions and adopt a healthy lifestyle for longevity of life. However, motivating and managing addicted patients are difficult. It requires health education, counseling, and regular follow-up of such patients.

Sexual health

A highly competitive and stressful life has been found to impact sexual health. Moreover obesity, diabetes, and metabolic syndrome have been found to be associated with erectile dysfunction.[34] There has been a rising trend of estranged marriages due to poor quality of sexual life and practices. As sexual health is a sensitive issue, many a time the medical practitioners are reluctant or in fact avoid discussing sexual health during consultations. Studies have revealed that addiction to tobacco and alcohol may lead to sexual dysfunction in the medium—to-long-term and this may hamper peaceful marital life.[35] Hence it is necessary that medical practitioners who promote lifestyle intervention should discuss sexual health with their patients and if any history is suggestive of erectile dysfunction, vaginismus, sexually transmitted disease, etc., it should be appropriately managed. Coaching patients with sexual problems on avoiding tobacco and alcohol consumption will be immensely helpful in restoring sexual health in their patients.[36] Sexual health is one of the most important aspects of lifestyle medicine intervention.

Sleep hygiene

Good sleep hygiene is an important aspect in lifestyle management of health diseases. An adult requires an average of 8–10 hours per day of sleep. Any deprivation of sleep may lead to anxiety, stress-associated disorders, cardiometabolic risk, hypertension, diabetes mellitus, and cardiovascular disorders.[37] A study conducted on patients with hypertension revealed that 52.1% of patients had sleep disorders, short sleep, and poor quality sleep.[38] As sleeping habits are an indicator of health status and quality of life, medical practitioners should take a detailed account of the sleep history of individuals while managing their medical issues.[39] Practicing good sleep hygiene matters immensely in lifestyle medicine intervention.

Socializing

Good social relations go a long way in building sound self-esteem in an individual, and it impacts mental health positively. A study carried out on Chinese nonagenarians revealed that social relations influenced cognitive functions positively.[40,41] Promoting a healthy social life to patients will have positive influence on their health outcomes, specifically while implementing lifestyle changes.[42]

Conclusion

The implications of lifestyle medicine in medical practice serve as a rejuvenating cocktail in attaining optimum health. It is important for any medical practitioner to foresee and evaluate if there is any association of lifestyle behavior towards underlying disease. Extra time devoted by the medical practitioner toward motivating, counseling, and coaching the patient for adapting to a healthy lifestyle will go a long way in preventing chronic diseases. This may also contribute toward reducing the burden of non-communicable disease. Lifestyle medicine management should be a part of today’s medical practice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.