LM- Exam 1

lifestyle medicine

The use of evidence-based lifestyle therapeutic approaches, such as a predominantly whole food, plant-based diet, regular physical activity adequate sleep, stress management, avoidance of risky substance use, and other non-drug modalities to treat, and oftentimes, reverse and prevent the lifestyle-

related chronic diseases that are all too prevalent

Healthspan

part of a person’s life during which they are generally in good health

lifespan

length of time a person lives

quality of life

patient’s ability to enjoy normal life activities

evidence-based

in medicine, pertaining to the conscientious, explicit, and judicious use of current best evidence in making decisions about care of individual patients

what are the 3 big T’s

transportation, television, technology,

health advances that have helped expand lifespan

vaccines, surgical anesthesia and antisepsis, clean water/improved sanitation, antibiotics/antiviral meds, improved heart surgery and cardiac care, randomized control trials, radiological imaging, improved screening and recommendations for early screening, advances in childbirth and birth control, organ transplants

top causes of death

mostly preventable diseases (heart disease, some cancers, etc)

quality of evidence (highest to lowest)

1. critical appraisal (meta-analyses, systematic reviews, critically appraised literature evidence based practice guidelines) *supports causations

2. experimental studies (randomized controlled trails, non-randomized controlled trials) *can support causations

3. observational studies (cohort studies, case series or studies, individual case reports, background info, expert opinion, non-EBM guidelines) *association no causations

what is CRAAP

Currency

relevance

authority

accuracy

purpose

Interheart study

low risk diet and lifestyle

diabetes prevention program

traditional medicine vs lifestyle medicine

traditional: treat risk factors, patient expects a solution (advice, meds, or surgical), may have multiple specialists

lifestyle: looks at root causes, whole-patient focused, patients actively participate, team approach to treatment

levels of prevention

1. primary: healthy individual w/goal of staying healthy (lifestyle)

2. secondary: individual at risk and wants to avoid chronic disease (lifestyle)

3. tertiary: an individual who has already suffered from or been diagnosed with chronic disease, looking to prevent any consequences or even reverse it (lifestyle and traditional)

allopathic medicine

conventional/traditional medicine, symptoms management, may include diagnostic, pharmacological, procedures

preventive medicine

early detection, screening and public health

integrative medicine

blend of conventional and complementary therapies

functional medicine

novel blood work, nutraceuticals, supplements

what is a coach

1. helps patients help themselves

2. builds motivation, confidence, and engagement

3. relies on patient self-awareness and insights

4. strives to help patients find their own answers

5. focuses on what is working well

6. collaborates

what is an expert

treats patients

educations

relies on skills and knowledge of expert

strives to have all answers

focuses on problem

advises

how can I remember coach approach

Curiosity

Openness

Appreciation

Compassion

Honesty

how can I remember expert approach

Expert

X-ray

Plan

Explain

Repeat

Tell

skills for coach approach

sharing knowledge, listening, asking questions, approaching problems, responsibility

what does sharing knowledge look like for coach vs expert

coach: shares knowledge, but starts by being curious (ex:”what do you know about”)

expert: usually provides knowledge, informs patient, teach as much as possible, might do most of talking

what does listening skills look like for coach vs expert

coach: build rapport, pays attention to body language, tone of voice and feeling behind words of patient

expert: cognitive listening (paraphrasing, probing, summarizing), search for facts and physical signs

what does asking questions look like for coach vs expert

coach: often open-ended questions, take client agenda into account (ex: star questions with: what, how, tell me about, etc) *be careful with why (judemental)

expert: often close ended, expert’s agenda

what does approaching problems look like for coach vs expert

coach: client has solution to problem, focus on possibilities (what do you like to do, find what works, client is their own expert)

expert: focus on problem and finding best solution, expert shares knowledge

what does responsibility look like for coach vs expert

coach: client’s decision if, when, how they want to change, client is responsible and coach assist in finding solutions, client stays an active participant

*****Flexible, nonjudgmental, re-evaluate/adjust

expert: expert feels responsible, trained to find best possible solution

what are 5 A’s in coaching

1. Assess (screenings, diagnostic, observations, open-ended questions)

2. Advice (sharing knowledge “what do you know about…”, and educate)

3. Agree (client agrees and chooses what they want to do)

4. Assist (goals, plans, referral, education, make plan how to do change)

5. Arrange (arrange time for follow up

coronary heart disease (CHD)

most common type of heart disease in US, most cases due to atherosclerosis

CVD/CHD risk factors

modifiable: obesity, hypertension, elevated cholesterol levels, tobacco use, diabetes

non-modifiable: age, family history

CHD (myocardial infarction) signs and symptoms

chest pain (angina), shortness of breath, fatigue, neck/shoulder/jaw pain (MI)

*may start less severe and progress/become more frequent

*may be more prominent during exercise

how to prevent heart disease (American heart association)

be more active, quit tobacco, healthy sleep, manage weight, control cholesterol, manage blood sugar, manage blood pressure

how to calculate BMI

kg/ (m²)

BMI range for underweight

below 18.5

BMI range for healthy weight

18.5-24.9

BMI range for overweight

25-29.9

BMI range for obese

greater 30

what are the measures for central obesity in men and women using waist circumference

men: greater than 40in

women: grater than 35in

what are the measurements of central obesity using waist-to-hip ratio

men: greater/equal to 0.90

women: greater/equal to .85

what is healthy cholesterol level

<200

what is unhealthy cholesterol range

>240

what is healthy LDL range

<100

what is unhealthy LDL range

160-189

what is healthy HDL range

>/equal to 60

what is unhealthy HDL range

<40

what is healthy triglyceride levels

<150

what is unhealthy triglyceride levels

200-499

what is stroke

blockage of blood supply to brain or blood vessel in brain bursts

lead to long-term damage, disability, or death

what are stroke risk factors

hypertension, smoking, diabetes, diet, physical inactivity, obesity, high cholesterol, sleep apnea, AFib

how to spot a stroke

Balance

Eyes

Face

Arms

Speech

Time

normal bp

<120 and <80

elevated bp

120-130 and <80

hypertension stage 1

130-139 or 80-89

hypertension stage 2

140 (or higher) or 90 (or higher)

hypertensive crisis

higher than 180 and/or higher than 120

hypertension risk factors

obesity, diet, excessive alcohol intake, physical inactivity, short sleep duration, age, family history

hypertension signs & symptoms

usually no warning signs and symptoms (acute: headache, dizziness, anxiety, SOB)

regular monitoring necessary (esp. if pre-hypertensive)

if left untreated can cause heart disease or stroke

type 1 diabetes

autoimmune disease in which the pancreas no longer makes insulin

type 2 diabetes

insulin resistance and/or impaired insulin secretion

diabetes risk factors

family history, obesity/abdominal obesity, childhood weight, lifestyle (physical inactivity, diet, smoking, alcohol consumption, sleep duration)

diabetes signs and symptoms

frequent thirst and/or urination, unexplained weight loss or gain, increased appetite, fatigue, poor wound healing, blurred vision, numbness

diabetes biomarkers

fasting blood glucose: measures amount of glucose in blood after not eating or drink for at least 8hrs

hemoglobin A1C: measures avg blood glucose over last 3 months

normal fasting blood glucose

<100

prediabetes fasting glucose

100-125

type 2 diabetes fasting blood glucose

>125

normal HbA1C

<5.7%

prediabetes for HbA1C

5.7-6.4%

type 2 diabetes HbA1C

greater/equal to 6.5%

what is metabolic syndrome

if you have 3 or more present or have drugs for them:

central obesity (waist circumference), triglycerides (>150), HDL (<40), BP (>130/85), fasting glucose (>110)

what is transtheoretical model of change

precontemplation, contemplation, preparation, actions, and maintenance

what are transtheoretical model constructs

1. stage of readiness/change

2. processes of change

3. decisional balance

4. self-efficacy

pre-contemplation

patient/client is resistant to change, working with ppl in this stage needs empathy and reinforcing that you are available

what are processes of change during pre-contemplation

1. consciousness raising

2. environmental re-evaluation

3. dramatic relief

4. social liberation

consciousness raising

during pre-contemplation and contemplation

building knowledge and awareness, pros/cons of not/are doing something

environmental re-evaluation

pre-contemplation, contemplation

impact of behavior has on environment, or ppl around you

dramatic relief

pre-contemplation, contemplation

using techniques/strategies that appeal to persons emotions

social liberation

pre-contemplation, contemplation, preparation

policy/social influences be supportive of behavior

what is contemplation

patient/client is thinking about changing, working with ppl need to use vision and motivators(pros)

what are processes of change during contemplation

1. consciousness raising

2. environmental re-evaluation

3. dramatic relief

4. social liberation

5. self-reevaluation

self-reevaluation

contemplation, preparation

what if, how would your life look like if you did this

preparation

patient/client is planning to change

key: plan with smart goals (support important)

preparation stages of change

1. self-reevaluation

2. self-liberation

3. helping relationships

4. counterconditioning

self-liberation

preparation

commitment and own ability to change

helping relationships

preparation, action, maintenance

having social support

counterconditioning

preparation, action, maintenance

what can we substitute (ex: drinking water instead of soda)

action

patient/client has engaged in healthy behaviors for <6 months

key: motivate, reward, celebrate (support is important)

action processes of change

1. helping relationships

2. counterconditioning

3. reinforcement management

4. stimulus control

reinforcement management

rewarding and incentivizing behaviors (should be appropriate)

stimulus control

action, maintenance

how can we set up environment for successful behavior

maintenance

patients/clients have been in action for at least 6 months

key: continue to motivate, celebrate (review positive health changes, and possible barriers/how to overcome them)

maintenance processes of change

1. helping relationships

2. counterconditioning

3. reinforcement management

4. stimulus control

decisional balance

transtheoretical indicates balance of pros and cons shifts across stages of change and is the marker of behavior change

*to change, the cons of not changing must outweigh the benefits of not changing

self-efficacy

confidence and belief in one’s ability to complete a specific task or behavior

how do we increase self-efficacy

mastery experiences (previous successful experience), vicarious experiences (observe experiences or modeling by others), verbal persuasion (coaching and feedback), physiological and emotional states (experience of physical and emotional sensation)

what is self-determination theory and motivation

autonomy (need to have control in life/behaviors), competence (need to feel effective/master behavior), and relatedness (need to feel a sense of belonging/connectedness)

what is self-determination motivation continuum

1. amotiviated

2. external

3. introjected

4. identified

5. integrated

6. intrinsic

amotivation

non-intentional, non-valuing, incompetence, lack of control (no motivation)

external

compliance, external rewards and punishments (extrinsic motivation)