American Journal of Lifestyle Medicine

Unintentional injuries are a persistent public health problem in the United States. A new health care landscape has the potential to create a clinical environment that fosters greater involvement by health care providers in injury prevention. The aim of this article is to provide evidence supporting the need for engagement by primary care providers in unintentional home injury prevention along with examples of how this could be accomplished. We know a great deal about what population groups are at risk for certain types of injuries. We also know that many injuries can be prevented through policies, programs, and resources that ensure safe environments and promote safe behaviors. For example, the Centers for Disease Control and Prevention’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative comprises clinical decision support tools and educational materials for health care providers. Two effective interventions that have demonstrated a reduction in falls among children are the redesign of baby walkers (engineering) and the mandated use of window guards (enforcement). Primary care clinicians can play a key role in promoting their patient’s safety. Taken collectively, a focused attention on preventing unintentional home injuries by primary care providers can contribute to the reduction of injuries and result in optimal health for all.

The aging US population is increasing, and it is estimated that adults older than 65 years will make up 20% of the population by 2029 and the proportion of individuals in the United States older than 65 years will outnumber individuals younger than 18 years. In older adults, accidental falls are the leading cause of fatal and nonfatal injuries. Prevalence of chronic conditions such as sarcopenia and frailty contribute to the increased risk for fall observed in this population. Nutritional status in elderly individuals is a key predictor of both frailty and sarcopenia, thus ensuring adequacy in these populations has the potential for preventing falls. Poor nutritional status is associated with the onset of frailty. Nutrition screening, assessment and interventions can be targeted at this age group to overcome treat and prevent malnutrition to minimize fall risk.

Education is ubiquitous with clinical care. However, not all education supports behavioral change. Education is a broad term that encompasses the process of obtaining general knowledge, personal awareness, and skills training. Although not sufficient, education is a necessary component for behavior change. This article outlines the role of education in behavior change and offers practical suggestions for how clinicians can provide education to their patients to help them change behavior.

Pediatric poisoning remains a common, preventable childhood injury and incidence is on the rise. Child-resistant packaging has been shown to prevent pharmaceutical poisoning, but must be applied and used appropriately to be effective. Prescription drug use among adults is also increasing and may be contributing to the problem through a greater number of medications in the child’s environment. Drug take back programs are designed to reduce the number of unused medications in the home. These programs are expanding and health care providers should be aware of and encourage safe drug disposal practices.

Sleep disturbances are common in postmenopausal women and contribute to increased morbidity and mortality. Sleep apnea may be underdiagnosed in women, and other conditions such as insomnia and restless legs may coexist with sleep apnea. This case illustrates the complex interplay of anatomical, hormonal, metabolic and psychological factors that can interfere with restorative sleep, and the importance of both diagnostic testing and clinical history in identifying which combination of therapies will be most beneficial in improving sleep quality and quantity.

Lifestyle medicine (LM) has been shown to be effective at preventing and reversing disease, while simultaneously reducing overall medical expenses. However, the current health care system is not designed to reimburse LM clinicians for the value that they provide. The micropractice model is an innovative approach to deliver LM in a financially viable manner. Costs are minimized by automating much of the practice through a website, limiting physical clinic space, and employing only essential staff. Described in this article is a unique micropractice family medicine/lifestyle medicine hybrid office that has partnered with a local health system and a culinary center to offer additional services.

Informed consent assumes full disclosure has been discussed in its entirety. However, is full disclosure ever really achieved? This column discusses how lifestyle medicine, both philosophically and ethically, must be a standard component of informed consent. Yet despite unequivocal evidence regarding the efficacy of lifestyle medicine, few physicians even consider lifestyle medicine as a viable option in the informed consent process. Reasons for the lack of lifestyle medicine considerations are postulated and a potential solution through education of trainees is suggested. How one medical school is addressing the need for lifestyle medicine education through several initiatives is discussed. Last, we expect that trainees educated in lifestyle medicine will push the momentum forward toward the “tipping point” where lifestyle medicine will be a viable option in the informed consent process—only then will full disclosure truly be achieved.

Health care professionals engaged in the management of coronary artery disease (CAD) patients, both in primary and secondary prevention settings, should possess the knowledge to develop and modify both aerobic exercise as well as musculoskeletal resistance exercise training programs. The traditional exercise prescription (ExRx) for aerobic-type exercise describes the intensity, frequency, duration, and mode of exercise, as well as the rate of progression. The more contemporary ExRx focuses on the energy expenditure associated with all physical activity not just structured exercise bouts. The total “volume or dose” of physical activity is associated with important health outcomes, including the potential to prevent and potentially reverse CAD lesions. Also, emerging evidence supporting the use of high-intensity interval training in CAD patients will also be provided. Furthermore, this review will also address the issue of generating an appropriate ExRx in the absence of maximal exercise “stress” test data, a common occurrence in the primary care setting and in this era of health care cost containment. Prescribing resistance exercise for CAD patients requires careful consideration and will be discussed in this review. Finally, this review will conclude with a section that describes the special considerations and/or modifications for some common comorbidities seen in CAD patients

Of nearly 800 000 strokes that occur annually, 23% are recurrent events. Risk for disability and mortality is higher following a recurrent stroke than following a first-time stroke, which makes secondary stroke prevention a priority. Many risk factors for stroke are modifiable and amenable to improvement through lifestyle modification. Lifestyle modification can be difficult for people with stroke, however, in part because of stroke-related physical and cognitive deficits. Despite these challenges, risk factor management through lifestyle modification is important. This article reviews the multiple cardiovascular and metabolic benefits associated with the modification of several lifestyle behaviors: diet, physical activity, smoking cessation, and alcohol consumption. Health behavior theories and existing lifestyle intervention programs are also reviewed to identify important behavioral and cognitive skills that can be used to facilitate modification of health behaviors, and practical skills and suggestions for health care providers are provided.

Many children with typical development are highly sedentary, overweight/obese, and are deemed not ready for school at kindergarten entry. All of these concerns can be related to a lack of movement skill proficiency in this population. The purpose of this narrative review was to synthesize the literature examining the impact of movement skills on 5 areas of overall health: physical activity, physical fitness, body composition, self-beliefs, and executive functioning. To gain an understanding of these relationships, only studies employing an experimental or observational longitudinal design were reviewed. Although the results were limited in the number of studies available, there is evidence that movement skill may have a positive influence on these broad domains of health both naturally over the course of development and through intervention. We recommend that a universal approach to movement skill development is warranted, given the range of benefits that stem from developing proficiency in these skills.

Thousands of dollars are spent today with policies encouraging physical activity and healthy eating, but nutritional consultation per se has continuously failed to yield consistent and lasting results. The aim of this case report is to detail and evaluate nutritional coaching (employing health coaching techniques) in promoting lifestyle changes, enabling improvement of nutritional and body composition associated parameters. The patient in this study had previously engaged in a series of different diet regimens, all of which failed in achieving the proposed aim. After 12 nutritional coaching sessions (one per week) with the strategy presented herein, reductions in body fat mass and in total body weight were attained. Nutritional habits also improved, as the patient showed decreased total energy intake, decreased fat intake, and increased fiber ingestion. Daily physical activity and energy expenditure were enhanced. The coaching program was able to induce immediate health benefits using a strategy with the patient at the core of promoting his own lifestyle changes. In conclusion, the nutritional coaching strategy detailed was effective at helping our patient develop new eating patterns and improve related health parameters.

Objective: The objective of this study was to test the effect of an online education intervention on providers’ attitudes, beliefs, knowledge, and practices pertaining to antenatal physical activity. Study design: A sample of 181 providers (ie, obstetricians, family medicine physicians, and certified nurse-midwives) was directed to view an online training on antenatal physical activity guidelines, counseling methods, and resources. Providers completed surveys before and 12 weeks after viewing the educational website material. Repeated-measures analyses were conducted to examine the effects of the online education. Results: A total of 164 providers (87.2%) completed baseline and follow-up surveys. After viewing the online training, participants more strongly agreed that it was their responsibility to encourage engagement in antenatal physical activity (P = .02) and believed that women would follow their advice about beginning antenatal physical activity (P = .01). Viewing the website material facilitated an increased confidence in ability to effectively talk with overweight and obese women about physical activity (P = .04) and more frequent advising to begin a moderate-intensity physical activity program for sedentary women (P = .02). Knowledge on antenatal physical activity guidelines also improved. Conclusion: Findings suggest that online educational interventions may be an effective tool in altering providers’ knowledge and practices pertaining to antenatal physical activity.

Introduction. Prediabetes is a prevalent disease that has been associated with its own health risks and is a known precursor of type 2 diabetes. Lifestyle interventions are known to effectively treat prediabetes but are often not offered to patients within a primary care setting. Study Design. Exploratory and descriptive study. Objective. To assess if the use of a health coaching intervention among primary care patients, with prediabetes, warrants further examination. Methods. A retrospective chart review was conducted for all patients who had prediabetes and received health coaching at the Ambulatory Practice of the Future between 2012 and 2014. Discussion. A health coaching intervention used among primary care patients, with prediabetes, deserves further examination, as participants had a significant reduction in hemoglobin A1c and weight over 2 years.