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: 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. Practicing good sleep hygiene and having a restful sleep of about 9–10 hours per day in adults Avoiding smoking and nicotine addiction and reducing alcohol intake Consuming a balance diet and incorporating nutritional modifications to manage lifestyle diseases Adapting to techniques for stress management and stress relaxation; visiting nature and forest bath at weekends; 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