Abstract
‘. . . lifestyle medicine, in turn, should be the foundation for modern health care . . .‘
This issue marks the 7th year that the American Journal of Lifestyle Medicine (AJLM) has devoted an entire issue focusing on presentations made from the previous national conference of the American College of Lifestyle Medicine (ACLM).
As always, esteemed members of ACLM served as Guest Editors for this annual issue. This year this task was admirably performed by Drs Michelle Tollefson and Cynthia Heiss.
The articles selected for this issue of AJLM demonstrate the continuing strengthening of the evidence-based, practical applications supporting the field of lifestyle medicine. As these articles amply demonstrate, the field continues to expand in diversity and power.
There is no longer any serious question that what each of us does in our daily lives has a profound impact on both our short-term and long-term health and quality of life. This is, of course, the foundation of lifestyle medicine, and lifestyle medicine, in turn, should be the foundation for modern health care, which was the theme of the 2019 ACLM national convention.
The articles in this issue provide ample evidence of why the field of lifestyle medicine is so vital to the health of individuals as well as public health in multiple countries. These articles also underscore how lifestyle medicine issues continue to interact with and are supported by other evidence-based guidelines and publications. They also show that components of lifestyle medicine such as regular physical activity, weight management, proper nutrition, and interaction with community-based programs chart a bright future for lifestyle medicine. The articles in this issue of AJLM also underscore that issues related to lifestyle medicine are highly relevant throughout the entire lifespan from birth to old age.
The article by Thompson, Sallis, Joy, Jaworski, and Stuhr on the “Exercise Is Medicine” (EIM) initiative provides a compendium of evidence-based information and practical applications for why all clinicians should be advocating regular physical activity to every patient. The EIM initiative, which was started in 2007 by the American College of Sports Medicine, has grown to an international, powerful movement.
When EIM was started, there was already abundant evidence of beneficial outcomes for this regular physical activity. The evidence for these benefits has continued to grow and deepen. This evidence was further underscored with the publication in 2018 of the Physical Activity Guidelines for Americans 2018 Scientific Report, which documented enormous benefits of physical activity across a wide spectrum of conditions and throughout the lifespan. These benefits include reduction of the risk of coronary artery disease, diabetes, cancer, and multiple other chronic conditions throughout the lifespan from birth through old age.
One important aspect of the EIM movement is that it not only underscores these benefits but also provides user-friendly ways for lifestyle medicine practitioners to incorporate counseling on the benefits of physical activity, not only for all of their patients but also for health care systems that they work in. There is no reason for lifestyle medicine practitioners, and all physicians for that matter, to not counsel every patient that they see about the multiple and profound benefits of regular physical activity. Despite the abundant knowledge available in this area, sadly less than 40% of physicians regularly counsel their patients on the benefits of physical activity.
As a lifelong exerciser and researcher in the area of physical activity and health, I have personally and professionally benefited from regular physical activity. In fact, I can still count on one hand the number of days each year where I do not engage in at least 30 minutes of physical activity and often considerably more than that. My research team, at Rippe Lifestyle Institute, over the last 25 years has also published numerous articles and books in this area. One particular area of interest for our research team has been the health benefits of walking. Research that we published in this area became part of the framework for the first Physical Activity Guidelines issued jointly by the American College of Sports Medicine and the American Medical Association. The lesson for all lifestyle medicine practitioners from the enormous body of research in this area is that exercise truly is medicine—something that we should be emphasizing every day to every patient in our practices!
The article by McHugh and Dalal points to the multiple benefits of lifestyle medicine components all the way from preconception to early childhood. This article focuses on the multiple benefits of plant-based nutrition, regular physical activity, sleep, stress reduction, and social relationships, all of which are key components of lifestyle medicine. Importantly, the authors emphasize that many of these modalities should begin before pregnancy even occurs. This substantially expands the purview of lifestyle medicine practitioners and will undoubtedly lead to healthier pregnancies and healthier babies!
The article by Puska and Jaini on the North Karelia Project summarizes one of the most important public health efforts ever undertaken. The original North Karelia Project ran from 1972 to 1977 and achieved such spectacular health-related results that it was renewed every 5 years for the next 20 years until it ended in 1997. Prior to its launch in North Karelia, the citizens of this eastern province in Finland suffered from the highest prevalence of heart attacks in the Western world. By dramatically lowering fat in the diet, as well as reducing cigarette smoking, and increasing the amount of physical activity, spectacular results were achieved including an 84% reduction in the risk of heart disease—not only in North Karelia but ultimately throughout Finland. This nationwide effort serves as a model for what can be accomplished by helping people change their daily habits through key components of lifestyle medicine.
To extend the reach of lifestyle medicine, it will be important for practitioners to link up with credible community organizations. There is probably no more reliable and credible source of community expertise in the areas of physical activity and health than the YMCA of the USA. The article by Rosen on sustainable clinical community partnerships outlines in considerable detail practical issues related to how health care practitioners and organizations can interact with community-based organizations. The key to successful partnerships is having a clear set of expectations on both sides. If this can be accomplished, enormous benefits can be achieved. For example, the YMCA of the USA is the largest provider of community-based diabetes prevention program modalities of any organization in the United States. Lifestyle medicine practitioners can learn a great deal from the lessons contained in this important article.
Overweight and obesity continue to be highly prevalent in the United States. It has been estimated that almost 70% of the adult population in the United States is either overweight or obese. Obesity is associated with multiple chronic diseases, most prominently coronary heart disease, diabetes, and the metabolic syndrome. We need to continue to explore ways to help people overcome weight gain and obesity. Dr Michael Greger has provided an interesting and instructive summary of how a whole food, plant-based diet can be highly effective in the area of healthy weight management. Not only are whole food, plant-based diets helpful in terms of their effect on weight loss but also the consumption of more fruits and vegetables and whole grains can contribute to multiple other health benefits such as reduction of risk of heart disease and diabetes. Dr Greger provides an enormous amount of evidence for the value of whole food, plant-based diets not only for weight loss but also for maintaining a healthy weight.
Many physicians are surprised to learn about the multiple ways that lifestyle habits and practices can have an impact on not only preventing cancers but also in the treatment of cancer in every stage from secondary to tertiary prevention. The article by Orman, Johnson, Comander, and Brockton provides an excellent, evidence-based summary of what the major research organizations in the field of cancer prevention and treatment have determined to be key issues related to lifestyle and cancer prevention and treatment.
While multiple cancers can be benefitted from lifestyle medicine habits and practices, perhaps the area that is most well studied is the area of breast cancer. These authors have put together a sound, evidence-based approach focusing on the most recent research concerning why we should be counselling all of our patients in important lifestyle measures and practices such as plant-based nutrition, regular physical activity, and weight management when it comes to the prevention and treatment of cancer. The recommendations from these authors, which mirror those of the American Cancer Society, the American Institute for Cancer Research/World Cancer Research Fund (AICR/WCRF), make a compelling case for why all patients should be counseled about lifestyle measures related to the prevention and treatment of cancer. Not only are these modalities important for prevention and treatment but they also help ameliorate symptoms of cancer treatments for those who are being treated for various forms of cancer, most prominently, breast cancer.
As the lifestyle medicine movement continues to grow in the United States, it also has spread rapidly throughout the world. The article by Dr Ezinwa provides an excellent summary of how lifestyle medicine organizations are springing up all over the world and joining the Lifestyle Medicine Global Alliance. We at AJLM feel that this trend is so important that we have inaugurated a series of columns titled “Lifestyle Medicine around the World” under the capable editorial direction of Dr Garry Egger.
It is clear from the article by Dr Ezinwa that some of the diseases that are so prevalent in the United States have now also spread to other countries around the world. This is particularly a problem in underdeveloped countries where adoption of some of the excesses of calorie consumption that are so prevalent in the United States and other adverse health issues such as cigarette smoking remain enormous challenges. It is very gratifying to see that the messages of lifestyle medicine are beginning to take hold in numerous countries around the world.
As the field of lifestyle medicine continues to grow, it will be important to reach out to educate individuals at all levels of training. This will assure the continued expansion of the benefits of lifestyle medicine. The article by members of the Lifestyle Medicine Pre-Professional Education group documents that there is tremendous interest and ferment among college students to learn about components of lifestyle medicine. I suspect that this will continue to grow and serve as a foundation for a very bright future of lifestyle medicine.
The President’s column from Dexter Shurney continues his ongoing series of excellent articles as part of his “From the ACLM President’s Desk” series. Dr Shurney’s current column is devoted to a conference wrap-up from the 2019 ACLM conference and continues to document the phenomenal growth and impact of lifestyle medicine. A number of new awards were presented at the conference as outlined in Dr Dexter’s column.
The editorial by Drs Michelle Tollefson and Cynthia Heiss reminds us of the power of storytelling. Both of these authors bravely share their own stories of how lifestyle medicine affected their own lives. This touching article reminded me of a story that a friend once told me where a man at a computer show speaks to a computer and says, “Will computers ever think?” The computer answers, “That reminds me of a story!” Everyone who practices lifestyle medicine has not only stories to tell of the patients who have benefited from these habits and practices, but many of us also have important and motivating stories from our own lives that can provide wonderful learning and powerful motivation to our colleagues and our patients. This is the underlying concept behind the editorial by Drs Tollefson and Heiss and also the collaboration between ACLM and Story Gorge. I hope that we will continue to see more stories from our contributors since this is an important component of not only lifestyle medicine but also the very basis of our shared humanity.
I would also be remiss if I did not extend heartfelt congratulations to Drs Tollefson and Heiss for the outstanding effort that they did putting together this entire issue of AJLM. Editing a journal is an arduous task and both of these Guest Editors did a phenomenal job of not only selecting excellent articles, but then putting them together in a user-friendly, motivational way. In this effort they were ably assisted by Shannon Worthman who coordinated production and delivery.
Finally, I would like to update a few issues related to AJLM. This has been another year of phenomenal growth for AJLM. Our subscriber base is now over 13 000 individuals and institutions around the world. This past year we experienced over 100 000 full-text downloads of articles. Our acceptance into PubMed has assured wide distribution of our articles throughout the medical and scientific communities.
Clearly, the message is getting out in the health care community. There is no longer any question that what we are doing in lifestyle medicine is influencing the world in very significant ways. While there are enormous challenges in front of us, we can all feel good about how rapidly and powerfully the messages of lifestyle medicine continue to grow! Lifestyle medicine is clearly building a strong foundation for modern health care! AJLM is proud to play a role in getting these important messages out to multiple audiences.