Implementing Lifestyle Medicine Competencies in Didactic and Clinical Settings for Allied Health Professionals: A Call to Action

Abstract

In this article, we discuss and reflect on the essential components of our concurrent session presentation at the American College of Lifestyle Medicine (ACLM) annual conference LM2023, “Implementing Lifestyle Medicine Competencies in Didactic and Clinical Settings for Allied Health Professionals.” We illustrate the necessity of interdisciplinary lifestyle medicine approaches through a conscious fusion of analysis and storytelling. This review concludes with a call to action empowering the medical community to embrace interdisciplinary lifestyle medicine approaches in effort to increase access to equitable healthcare.

“Lifestyle medicine is implemented across the 3-year curriculum in both didactic and integrated clinical education settings.”

Introduction

The lifestyle medicine field was largely pioneered by physicians with the notable contributions of a nutritionist and a public health leader, all fondly referred to as the forefathers of lifestyle medicine. ¹ Although lifestyle medicine as an evidence-based therapeutic approach is considered by some to be a newer emerging therapeutic approach, history reflects the use of healthy lifestyle changes to treat disease being implemented over 2000 years ago. ²

Nonetheless, the health of many American adults continues to be impacted by lifestyle-related factors, resulting in 60% having at least 1 chronic disease and more than 40% have been diagnosed with 2 or more. ³ The Centers for Disease Control and Prevention estimate that 1 in 3 adults have pre-diabetes; more than 80% of these individuals are not even aware of this sobering truth. ⁴ Additionally, half of all American adults live with cardiovascular disease, while 1 in 3 deaths in America continue to be linked to cardiovascular disease. ⁵ At least 7 out of 10 of the leading causes of death are inextricably linked to lifestyle-related factors. ⁶ This public health crisis is further magnified for historically minoritized populations who have an even shorter lifespan and disproportionately worse health outcomes.^7-10

As result, healthcare costs continue to rise, from $3.8 trillion of annual expenditures in 2019 to $4.5 trillion in 2022. ¹¹ Notably, 90% of these expenses continue to be associated with chronic mental and physical health conditions. ¹² This data illustrates a chronic disease epidemic in the United States of America that has been unwavering for decades: plainly stated during our conference presentation, “AMERICA HAS A PROBLEM.”

Presenters and audience members alike agreed in unison with the mounting evidence illustrating lifestyle medicine as a powerful solution. Maximizing the benefits of lifestyle medicine interventions requires an interdisciplinary approach or in other words as Dr Brown passionately expressed during the session, “ALL [HEALTHCARE] HANDS ON DECK.” Effective interdisciplinary care begins in academia, ensuring that all health professionals are adequately trained from their scope of practice on the value of implementing lifestyle medicine therapeutic approaches. Dr Brown, an occupational therapy faculty, initiated collaboration with the Department of Physical Therapy Education-Oregon at Western University of Health Sciences to implement lifestyle medicine competencies across their existing curriculum.

Here, we discuss the essential components of our presentation at the American College of Lifestyle Medicine (ACLM) annual conference LM 2023, “Implementing Lifestyle Medicine Competencies in Didactic and Clinical Settings for Allied Health Professionals.” Through an intentional weaving of analysis and storytelling, we illustrate the necessity of interdisciplinary lifestyle medicine intervention approaches beginning with integration in academia, as a means to ameliorate access to equitable healthcare for all people, populations, and communities.

The Benefits of Interdisciplinary Lifestyle Medicine Approaches

Our presentation began with a poll to identify what health professions our audience members represented. It was our initial assumption that the audience would consist of various allied health professionals, considering our presentation was a part of the “Allied Health Professionals Track.” However, it was gratifying to identify that in addition to allied healthcare professionals, there were also many physicians in attendance. With this knowledge, we facilitated an inclusive conversation, providing strategies for allied healthcare professionals to implement lifestyle medicine interventions (from their scope of practice) as well as ways in which physicians can maximize intended patient outcomes through interdisciplinary collaboration and referrals.

The foundational principles of lifestyle medicine are naturally optimized through an interdisciplinary approach to care. Considering the science of behavior change along with the recognized link between healthy lifestyle and optimal health outcomes, physicians can ideally diagnose chronic conditions with lifestyle-related factors, prescribe therapeutic lifestyle changes, and refer to appropriate rehabilitation specialists for a succinct continuum of care. For example, occupational therapy practitioners are uniquely equipped to provide both preventive and restorative interventions across the lifespan for individuals and groups who may be facing physical, mental, or cognitive impairments.^13-17 Among the areas of training that align closely with lifestyle medicine, occupational therapy notably addresses the prevention and impact of chronic conditions through health promoting treatment approaches. These interventions specifically focus on health condition management, nutrition, physical activity, restorative sleep, and social connections. ¹³

Another viable interdisciplinary approach is group visits or lifestyle medicine shared medical appointments (LMSMAs). Dr Lacagnina and colleagues ¹⁸ propose that LMSMAs have the potential to increase health outcomes and reduce the impact of chronic disease. Patient benefits include more time with healthcare providers, increased access to equitable quality care, and opportunities for peer support from others experiencing similar health issues. LMSMAs also support decreased risk of physician burnout allowing providers the opportunity to efficiently provide patient education.

We continued to emphasize the necessity for “ALL HEALTHCARE HANDS ON DECK” with the rationale that each health profession brings forth a unique perspective and skillset that when used in harmony can increase patient safety, maximize resources, and improve outcomes.^19,20

Implementing Lifestyle Medicine in Allied Health Professionals Education

In effort to materialize quality interdisciplinary lifestyle medicine approaches, it is critical that lifestyle medicine competencies are a core component of allied health professionals didactic and clinical education. We propose using discipline-specific accreditation standards as a guide to integrate lifestyle medicine throughout the curriculum, which presents a chance to cohesively train future healthcare practitioners. For example, lifestyle medicine competencies can be integrated into courses with learning objectives that address topics related to behavior change, chronic condition management, health promotion, and/or social determinants of health.

The ACLM offers a number of complimentary resources on their website to support the integration of lifestyle medicine into academia. These resources include lifestyle medicine curriculum, question banks, and access to funding for learning experiences. Further exemplifying their commitment to increasing allied health professional’s role in lifestyle medicine, ACLM developed the ACLM Partial Academic Pathway.

The ACLM Partial Academic Pathway is a complimentary opportunity for health professions master’s and doctoral programs. Students who complete an ACLM approved university course with a grade of B- or better receive a waiver for the 10 hour in-person continued medical education requirement that is one of the prerequisites for the American Board of Lifestyle Medicine certification exam. The conference waiver can be used within 3 years of graduation.

In order for a course to be approved as part of the ACLM Partial Academic Pathway, the course must cover at least 22 of the 88 lifestyle medicine core competencies. ²¹ Out of the ten competency domains, 2 are mandatory: at least 1 competency from the Nutrition Science, Assessment and Prescription domain and 1 from the Physical Activity Science, Assessment, and Prescription domain must be covered.

To culminate the ways in which lifestyle medicine can be implemented in allied health professional programs, we presented how we have begun integrating lifestyle medicine competencies into the Doctor of Physical Therapy program at the Western University of Health Sciences.

Implementation Case Example: Physical Therapy Curriculum

The Western University of Health Sciences is an independent nonprofit health professions university with campuses in Pomona, CA and Lebanon, OR. The university confers master’s and doctoral degrees in dental medicine, health sciences, medical sciences, nursing, optometry, osteopathic medicine, pharmacy, physical therapy, physician assistant studies, podiatric medicine, and veterinary medicine. The Western University of Health Sciences Department of Physical Therapy Education-Oregon was the first doctor of physical therapy program to join the ACLM Partial Academic pathway in the fall of 2022.

At the Department of Physical Therapy Education-Oregon, Dr Brown spearheaded the implementation of lifestyle medicine in the Doctor of Physical Therapy program. Currently, lifestyle medicine is implemented across the 3-year curriculum in both didactic and integrated clinical education settings. Students first learn about the 6 pillars of lifestyle medicine during trimester I as they are introduced to the professional aspects of physical therapy. During trimester II, students learn about all the 10 core competency domains of lifestyle medicine as part of the compulsory 2-credit hour course that is the ACLM approved course that will provide the Academic Pathway waiver. After completing this course, students get to put their lifestyle medicine competencies to practice with volunteer patients as they begin the first of five practical applications lab courses. During their second year, students revisit lifestyle medicine competencies related to the social determinants of health as they learn about health equity and access to care in rural areas.

The 5 practical applications lab courses serve as the integrated clinical experience of the program. In the practical applications lab sessions, the students learn to provide clinical patient care in small groups with faculty supervision and guidance. The volunteer patients are members of the local rural community and are mostly underinsured or uninsured. Prior to their first visit, the volunteer patients fill out an intake form that includes the typical questions, such as questions related to symptoms, medical history, and medication. In addition, questions related to all the 6 pillars of lifestyle medicine are included. Dr Brown and colleagues created this intake form to help students identify what lifestyle factors might be related to the patient’s current condition and symptoms. Using the information from the intake form and their training in lifestyle medicine competencies, students are able to discuss lifestyle medicine-related topics with the patients during their visits. Implementing lifestyle medicine in the patient interactions in the integrated clinical experience is considered very valuable in the rural setting, where access to healthcare is often limited due to the lack of healthcare providers.

Dr Brown’s Reflection: A Call to Action

In preparation for this publication, I came across several powerful articles that used storytelling as a teaching tool within lifestyle medicine; this inspired me to share a personal story. After presenting our work at the LM2023 conference in a room full of esteemed peers, we had the opportunity to meet several of the attendees individually. Many shared how hearing our success with integrating lifestyle medicine into allied health education made them feel empowered to advocate for interdisciplinary solutions within their organizations. Personally, this feedback affirmed my intent to have an impact, to contribute to increasing access to equitable care.

Less than 2 hours after delivering what felt like a transformative presentation, I learned that my uncle, in his early 60s, had passed away. His cause of death, cardiovascular disease, could be traced back to lack of access and years of insufficiently addressed health issues. As my mom hesitantly delivered the news, I soberly thought to myself, “Why him, he was so young!” In reflection, I knew, after all I just presented on our nation’s public health crisis. My late uncle spent much of his adult life in a small, impoverished town in Alabama, in which he did his best to simply survive day to day. In an LM2023 keynote speech, Dr Kofi Essel eloquently expressed the reality of how expensive poverty truly is along with the detrimental impact of toxic stress on one’s cognitive bandwidth. Systemically, my uncle did not have the resources nor cognitive bandwidth to access healthy lifestyle choices in adulthood. Sadly, he was not an anomaly; throughout my life I have witnessed far too many loved ones grapple with similar health disparities. This is why I am passionate about increasing access to equitable healthcare.

I believe lifestyle medicine is a viable solution to increasing access, one that requires ALL HEALTHCARE HANDS ON DECK. To materialize this, it is vital that future healthcare providers are cohesively trained to deliver quality care. As practitioners, we must understand that quality healthcare does not truly exist without equitable access.

Conclusion

Ultimately, our intention was to emphasize that lifestyle medicine and optimal patient outcomes require an interdisciplinary approach. Essentially, allied healthcare professionals are experts in restoration and rehabilitation which directly impacts physician's plan of care. Due to the role of allied health professionals in addressing lifestyle-related conditions, it is critical to integrate lifestyle medicine competencies into health professions education.