Lifestyle Medicine Exam Questions And
Answers Graded A+!!!
Lifestyle Medicine Definition - ANS -the use of lifestyle interventions in the treatment and
management of dz
-aim: replace medication with lifestyle changes
-elements: whole food, plant-based, physical activity, adequate sleep, stress mgmt, avoidance
of risky substances
-collaborative model with patient
-evidenced based
-applies to every patient, every practice
Complementary and Alternative Medicine (CAM) - ANS -used in addition or instead of
standard trx
-practices are not currently considered part of conventional medicine (not evidenced-based)
-may use supplements, spiritual healing
-typically not strong in science
Integrative Medicine - ANS -COMBINES alternative medicine with conventional medicine
-patient centered
-addresses all aspects of health (very comprehensive)
-includes meds and supplements in addition to lifestyle medicine techniques
Functional Medicine - ANS -looking to balance core functional processes (metabolism,
hormones, etc)
-fixes physiological and biochemical functions
-may use supplements and meds
Mind-Body Medicine - ANS -focuses on interactions bw mind and body
-treats dz with methods targeted to the mind (relaxation, hypnosis, imagery, etc)
-major focus on emotional, spiritual, etc
-ex: hypnosis, visual imagery, yoga, etc
Preventive Medicine - ANS -traditional medical approach to prevent health conditions
-immunizations, mammography, etc
-focus in pubic health and population health
6 primary components of LM trx - ANS -healthful eating: whole, plant based diet
-increase physical activity
,-manage stress
-form and maintain relationships
-improve sleep
-tobacco cessation
-
Conventional Medicine - ANS -allopathic medicine
-dz=secondary to exposure to pathogens or environmental fxs or genetic predisposition
-trx: acute and target pathogens or long-term to target risk fx's
-dz-focused approach
-patients are passive recipients of care, not participants
-physician centric
-symptom-targeted treatment
-pt not required to make major changes
Lifestyle medicine approach - ANS -addresses lifestyle related causes of morbidity and
mortality
-trx=lifestyle changes; other adjuvants as needed
-requires effort and commitment from patients
-long term treatment
-patient is active partner in trx
-evidence-based; avoid fads
Dr. Ludwig Johns Hopkins 2005 NEJM study - ANS 2000=first generation to have
decreased life expectancy than prior generation
National Prevention Strategy - ANS -part of ACA passed in 2011
-strategy to change healthcare from sick care to wellness and dz prevention
-coverage for providers to do lifestyle modification: physical activity assessments/counseling;
obesity screening and nutrition; screening and counseling for alcohol use; tobacco cessation
ITLC: Intensive Therapeutic Lifestyle Change - ANS -most intense lifestyle changes (max
dose for induction phase)
-normally used in immersion programs or residential programs
-needed in reversal of advanced/severe conditions (prevention only requires TLC)
-strongest LM evidence come from ITLC studies; efficacy of TLC presumed from these studies
-multi-factorial (not just focused on one aspect of LM)
LM trx intensity - ANS 2 components:
1. intensity of contact hours
2. extent of lifestyle changes made
ITLC maximizes both of these
,Ornish Lifestyle Heart Trial - ANS -1990 with 5 yr results in 1998
-blinded RCT; n=48 adults with CAD
-control; usual care with info about healthy eating and exercise
-intervention: lifestyle program (low fat veg diet, aerobic exercise, smoking cessation, stress
mgmt, group support) with no lipid lowering meds
-f/u: 1 and 5 years
-outcome: CAD stenosis via angiography
-results: 7.9% reduction in stenosis (exp) vs 27.7% increase in stenosis (control); 47% increase
in stenosis in controls not taking lipid lowering meds; 25 cardiac events (exp) vs 45 (control)-RR:
2.47
-CAD regression lasted x 5 yrs in exp group but control had continued progression
-dose-response relationship for adherence and stenosis regression
-82% exp group had regression
National Diabetes Prevention Program (DPP)-Knowler NEJM 2002 - ANS -RCT
-n=>3000 pre-diabetics
-placebo vs metformin (500mg bid) vs lifestyle (>150 min PA/wk to get 5-7% weight loss w/ less
fat, decreased calories + my plate) x 12 mo
-outcome: incidence of T2DM
-table 1: 51 yo, 68% F, 45% minority, BMI 34
-f/u: 2.8 years (shortened bc ethics issue--do lifestyle or metformin)
-results: DM incidence: 11 placebo, 7.8 metformin, 4.8 lifestyle
DM incidence reduction: lifestyle-58%; metformin 31%
-NNT in 3 yrs w/ lifestyle intervention: 6.9
-NNT in 3 yrs w/ metformin: 13.9
-earliest RCT for lifestyle intervention vs meds in PREVENTING chronic dz
-reduced risk of T2DM x 58% and 71% in >=60yo (all ethnicities and genders)
-decreased CVD risk also with decreased BP and cholesterol
-further questions: sustainability of changes and any long-term vascular benefits/mortality
benefits (10 yrs after, participants 1/3 less likely to get T2DM)
Hambrecht Study-Circulation 2004 - ANS -RCT to compare PCI with stenting to exercise
for stable CAD
-f/u: 1 yr
-n=101 males
-outcomes: angina free exercise capacity, myocardial perfusion, cost-effectiveness (avg $ to
improve canadian CVD score x 1), freq of clinical end point (death, stroke, CABG, angioplasty,
worsening angina-->hopsitalization, AMI)
-intervention: 12 mo x exercise x 20 min/day at 70% symptom free HR or PCI w/ stent
-results: higher event free survival (88% to 70%); increased VO2 max (both statistically
significant)
-$7000 vs $3500
Portfolio Diet Study-Jenkens JAMA 2003 - ANS -RCT; n=55
, -intervention: portfolio diet with cholesterol lowing food (plant-sterols, soy protein, viscous fibers
(eggplant/okra), and almonds) or lovastatin 20mg qd + usual diet (below)
-control: usual trx diet (low fat, whole wheat cereal)
-f/u: 1 month
-outcome: LDL reductions
-results: controls 8%, statin 30%, portfolio diet 28%
-outcome: CRP reductions
control 10%, statin 33%, portfolio 28%
-results: no significant difference bw results of statin group and portfolio diet
-reduction in HDL was reported as an adverse event
-FDA now supports foods with high plant sterols as CHD reducing process
Atkins, Ornish, WW and Zone diets for weight loss and HD RR-Dansinger, JAMA - ANS
-RCT-single center
-n=160 overweight/obese 22-72 yo's w/ HTN, DLP, or pre-diabetes
-intervention: atkins (low carb), zone (macronutrient balance), WW (calorie restriction) or Ornish
(low fat)
-f/u 1 yr
-outcomes: weight loss and HD RR
-results: weight loss: atkins-4.6 lbs, zone-7.1 lbs, WW-6.6 lbs, Ornish-7.2 (weight loss amt ass'd
with diet adherence but not type)
-DLP: all reduced LDL/HDL ration x 10%
-HTN: no change
-pre-DM: no change
-adherence ~ 25%
-weight loss ass'd with decrease total/HDL ratio, CRP, insulin (no diff bw diets)
Prostate GEMINAL study-Ornish, 2008 - ANS -prospective cohort; n=30 men w/ low risk
prostate CA
-outcome: gene expression
-intervention: 3 mo comprehensive lifestyle program (<10% calories from fat, whole food plant
diet + 60 min/day stress mgmt+ 30 min/day x 60 days mod aerobic exercise+1hr group
support/wk+soy, fish oil, vita E, selenium, vita C supplements)
-results: improved weight, abd fat, BP, lipids (ss);
gene expression was altered in 500 changes: 450 down-regulated and 50 were turned on (not
all had known fx's)
-limitations: 30% biopsy samples had tumor tissue
Lifestyle changes on telomerase actviity in prostate CA-Ornish, Lancet 2013 - ANS
-descriptive study of long term results of RCT
-n=35 men w/ low grade prostate CA
-f/u: 5 yrs
-intervention: lifestyle changes (diet, activity, stress mgmt, social support)
-outcome: telomere length
