Manual of Lifestyle Medicine

James M. Rippe

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9781000381405
• Edition: 1
• Topic: Medicine
• Subtopic: Clinical Medicine

The fundamental premise of lifestyle medicine is that daily habits profoundly impact health and quality of life both in the short-term and long-term. Written by lifestyle medicine pioneer and cardiologist, Dr. James Rippe, this book provides a clinically oriented, evidence-based look into key lifestyle factors and how to prescribe them to individuals of all ages.

Written for professionals working at all levels of medical and healthcare practice, this manual summarizes the major components of lifestyle medicine, from physical activity and nutrition to weight management and the avoidance of tobacco products. It includes clinical guidelines and practices for using lifestyle medicine principles to lower the risk of numerous chronic conditions. The manual also provides information on behavior change, approaches to lowering the risk of dementia, treatment of addictions and injury prevention.

Features:

• Explains how lifestyle medicine can reduce the risk of heart disease, diabetes, cancer, osteoarthritis, dementia and many other chronic conditions.
• Chapters begin with bulleted key points and conclude with a list of clinical applications.
• Provides strategies for prescribing physical activity and helping patients improve their nutrition, lose weight if necessary and reduce stress.
• Includes clinically relevant sections on "Treating Addiction, Preventing Injury and Improving Brain Health".

This book provides updated and clinically targeted summaries used in conjunction with Dr. Rippe's major academic textbook Lifestyle Medicine, now in its third edition, published by CRC Press/Taylor & Francis Group, LLC.

1 Lifestyle Challenges and Opportunities

Key Points

• The study of how daily habits and actions impact on long- and short-term health and quality of life is the core concept in lifestyle medicine.
• There is no longer any serious doubt that positive habits and actions significantly impact on reduction of risk of disease as well as its treatment.
• Such modalities as increased physical activity, proper nutrition, weight management, avoidance of tobacco products, and sleep and stress reduction, all significantly impact both quality of life and likelihood of developing disease.

1.1 Introduction

An overwhelming body of scientific and medical literature supports the concept that daily habits and actions exert an enormous impact on short- and long-term health and quality of life (1). Thousands of studies supply evidence that engaging in regular physical activity, following sound nutritional practices, maintaining a healthy body weight, not smoking cigarettes or using other tobacco products, and other health promoting practices, all powerfully influence health and quality of life. These habits and practices have formed the basis of the emerging medical subspecialty of lifestyle medicine.

The strength of the scientific literature supporting the positive health impact of these daily habits and actions is underscored by their incorporation into virtually every evidence-based clinical guideline from organizations involved in the prevention and treatment of metabolically related diseases (2). Some of these guidelines and consensus statements from these prestigious medical organizations are found in Table 1.1.

TABLE 1.1
Consensus Statements from Various Organizations which feature Lifestyle Modalities

JNC VIII Guidelines for Hypertension, Prevention and Treatment ACC/AHA Guidelines for the Prevention, Detection, Evaluation and Treatment of High Blood Pressure NCEP (ATP IV) Guidelines for Blood Cholesterol Institute of Medicine Guidelines for Obesity Treatment ACC/AHA Scientific Consensus Statement on the Treatment for Blood Cholesterol Guidelines from the American Diabetes Association for the Management of Diabetes Dietary Guidelines for Americans 2015–2020 and 2020-2015 American Heart Association Nutrition Implementation Guidelines Guidelines from the American Academy of Pediatrics for the Prevention and Treatment of Childhood Obesity Guidelines from the American Academy of Pediatrics for the Treatment of Pediatric Blood Pressure Guidelines from the American Academy of Pediatrics for the Treatment of Lipids Guidelines from the American Heart Association and the American Academy of Pediatrics for the Prevention and Treatment of the Metabolic Syndrome American Heart Association Strategic Plan for 2020 Joint Statement from the American Heart Association and American Cancer Society for the Prevention of Heart Disease and Cancer Presidential Advisory from the AHA and American Stroke Association AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults ACS/ADA/AHA Scientific Statement on Preventing Cancer, Cardiovascular Disease and Diabetes Physical Activity Guidelines Advisory Committee Report of 2018.

Rippe JM. Lifestyle Medicine (3rd edition). CRC Press (Boca Raton), 2019.

All of these statements emphasize positive lifestyle habits and practices as key components of prevention and treatment of disease, sometimes in conjunction with surgical and medical therapies.

Despite the widespread recognition in the scientific and medical communities of the important role of lifestyle measures and practices as key components of the treatment of various metabolic diseases, it has been frustratingly difficult to achieve improvements in the habits and actions of the American public. Numerous studies have shown that a distinct minority of adults in the United States follow some or all of the recommended positive lifestyle habits and practices.

For example, the Strategic Plan for 2020, which was released by American Heart Association (AHA), stated that only 5% of the adult population in the United States practice the positive lifestyle measures or have the health parameters which are clearly shown to significantly reduce the risk of developing cardiovascular disease (CVD) (3).

Numerous studies, including randomized control trials and a variety of cohort studies, have uniformly demonstrated the enormous power of positive lifestyle habits and practices. For example, the Nurses’ Health Study, which is a study of over 100,000 female nurses followed for more than 20 years, showed that over 80% of all heart disease and over 91% of all diabetes in women could be eliminated if these individuals would adopt a cluster of positive lifestyle practices, including regular physical activity (30 minutes or more of moderate intensity physical activity on most or all days), maintenance of healthy body mass index (BMI of 19–25 kg/m²), not smoking cigarettes, and following a few simple nutritional practices such as consuming more fruits and vegetables and increasing whole grains (4). The U.S. Professional Health Study, which is a long-term study of male health professionals, showed similar dramatic reductions in risk of chronic diseases in men who followed the same behaviors (5). In fact, in both studies, individuals who adopted only one of these positive behaviors were able to reduce their risk of developing coronary heart disease (CHD) in half.

While the medical community is generally aware of the wealth of information in this area, a distinct minority of physicians has incorporated it in their medical practices. Physicians agree that we should practice “evidence-based medicine,” and yet in the area of lifestyle practices and habits we in the medical community have been relatively slow to apply this standard to preserving good health (6). Virtually every physician would agree with the premise that weight management, sound nutrition, regular physical activity, and not smoking cigarettes all result in health benefits. Less than 40% of physicians regularly counsel patients in these areas.

The purpose of the Manual of Lifestyle Medicine is to bring key summaries of lifestyle medicine habits and practices into a user-friendly format to the medical community. This book is an outgrowth of the major academic textbook, Lifestyle Medicine 3rd Edition, CRC Press, which I have the honor of editing. This larger text was published in 2019.

The Manual of Lifestyle Medicine distills some of the similar information, adds studies which have been published since the 3rd edition of Lifestyle Medicine, and puts it in a shorter, perhaps more user-friendly, format for practicing physicians and other health care professionals.

Optimally, individuals will utilize the Manual of Lifestyle Medicine in conjunction with my major academic textbook to not only refer to the practical guidelines but also have in-depth summaries of the evidence supporting the power of daily lifestyle habits and actions.

1.2 What Is Lifestyle Medicine?

I had the privilege of editing the first multiauthored academic textbook in lifestyle medicine. In fact, this textbook, which was published in 1999, introduced the term “Lifestyle Medicine” into the academic literature (7). We defined lifestyle medicine as “the discipline of studying how daily habits and practices impact both on the prevention and treatment of disease often in conjunction with pharmaceutical or surgical therapy to provide an important adjunct to overall health.” This initial textbook has continued to expand as the field of lifestyle medicine has continued to grow and mature. The 3rd edition of Lifestyle Medicine was published in 2019 and represents the combined wisdom of over 200 scientists and physicians in a 1,500-page double-column textbook (1).

Of course, many investigators have been involved in the diverse areas which are included under the umbrella of lifestyle medicine such as nutrition, physical activity, weight management, and smoking cessation. It is clear, however, that the study of these individual modalities when combined will coalesce around the term of lifestyle medicine.

For example, the AHA changed the name of one of its councils from the “Council on Nutrition, Physical Activity and Metabolism” to “Council on Lifestyle and Cardiometabolic Health” in 2013 (8). In addition, both the American College of Preventive Medicine and the American Academy of Family Practice have established working groups and educational tracks in the area of lifestyle medicine.

Representatives from a variety of organizations, including the American Academy of Pediatrics, American College of Sports Medicine, the Academy of Nutrition and Dietetics, the American Academy of Family Practice, and the American College of Preventive Medicine all sent representatives to a working group which established the first academic summar...