Sage Journals: Discover world-class research

Abstract

Occupational therapists (OT) are trained in interventions related to health and well-being, facilitating individuals in achieving occupational balance. This scoping review explored the current methods of disseminating Lifestyle Medicine (LM) knowledge in post-secondary health education and assessed the potential integration of LM principles into OT education. The review covered publications related to LM implementation in post-secondary health professions curricula. Six databases were searched. The authors conducted initial blind reviews of titles and abstracts, followed by a similar screening of full-text articles. Included full-text articles were obtained from university databases with the assistance of systematic review software. Among the 304 abstracts reviewed, 60 full-text articles were assessed, with 16 included in this scoping review. However, none of the programs in the literature were OT programs. The results show that the six pillars of lifestyle medicine were not equally emphasized in the reviewed programs, with social connection being the least addressed. However, OT education places importance on social connections, and the other pillars align well with the 2018 standards set by Accreditation Council of OT Education (ACOTE) and the parameters outlined in OT Practice Framework 4th Edition (OTFP-4). This alignment can be valuable for OT programs in meeting their accreditation requirements.

Keywords

academia social connection accreditation practice framework pillars

“The models currently taught in occupational therapy education encourage students to consider social connection within a client’s context.”

Introduction

Every day, there is an opportunity to make a decision that will positively impact one’s health and quality of life. What if every healthcare provider had the education, the resources, and the evidence to practice preventive medicine and support positive lifestyle decisions? With the American College of Lifestyle Medicine, health providers, such as occupational therapists can access the evidence, training, and resources that support people, communities, and populations in making decisions that positively impact their health for years to come. Occupational therapy professionals use meaningful engagement in roles, routines, and every day occupations to support their clients in health maintenance and health promotion, aligning with the goal of positive lifestyle decisions and action within the American College of Lifestyle Medicine.¹

Occupational therapy practitioners are educated on, trained in, and utilize interventions that address health and wellness, and support individuals in their journey towards a meaningful participation in their environments including the physical, cultural, institutional, social, and socioeconomic. Occupational therapists use engagement in valued occupations such as self-care, rest, work, and education as a means or intervention to manage health and view the occupation of health management as an ends or outcome when considering overall health and well-being. Imbalance among occupations or lack of access to an occupation can disrupt wellness.² In occupational therapy education, theoretical frameworks^3–6 are used to help students and clinicians explore comprehensive approaches to wellness that support people, communities, and populations. Some models support the goal of health and well-being through the whole person in their appropriate context.⁴

Occupational therapists could have a pivotal role in advancing preventive health and overall well-being. They possess a keen understanding of the intricate relationship between the environment, culture, and an individual’s life experiences. They provide tangible, hands-on interventions to empower individuals, communities, and entire populations in their pursuit of positive lifestyle changes.^2,6 While there is work to do to expand the role occupational therapists have in the promotion of health and well-being, the profession is committed to health promotion, as demonstrated by the American Occupational Therapy Association (AOTA) statement on “Occupational Therapy in the Promotion of Health and Well-Being.” In this statement AOTA defines critical roles for occupational therapists in health promotion and prevention, such as promoting healthy occupations and lifestyles for everyone and incorporating occupation in health promotion strategies. Some examples of prevention interventions approaches utilized by occupational therapists include education and training on eating habits and physical activity.²

Due to the high and increasing prevalence of many lifestyle-related chronic diseases, such as type 2 diabetes mellitus and heart disease, majority of the adults treated by occupational therapists will be dealing with at least one chronic disease.⁷ While the chronic disease might not be the reason for the referral, it is important that occupational therapists approach their patients from a holistic perspective and support the management of the chronic disease within their scope of practice. With 30 to 45 minutes to assess a client, their habits, roles, and routine and a range of 30-90 minutes to complete interventions across occupational therapy settings, therapists have substantial time to discuss resources and strategies for preventing and managing chronic disease.⁸ Integration of lifestyle medicine into occupational therapy education can equip occupational therapy professionals with the necessary skills and evidence-based insights to facilitate the health and well-being of individuals, communities, and populations. The intervention approach in this context extends beyond treatment to encompass health maintenance and promotion. In alignment with this holistic approach, the six pillars of lifestyle medicine—nutrition, physical activity, stress management, restorative sleep, social connection, and avoidance of risky substances—stand as key components. The incorporation of these pillars into occupational therapy programs serves to enrich the educational experience standardized by the Accreditation Council of Occupational Therapy Education (ACOTE).⁹ The standards that most clearly align with lifestyle medicine are outlined in Table 1 with their alignment illustrated in Table 2. Alignments with the Occupational Therapy Practice Framework 4th Edition¹⁰ (OTPF-4) is detailed in Table 3.

Table 1.

ACOTE Standard definitions.

ACOTE Standard	Description
B.1.1. Human body, development, and behavior	Demonstrate knowledge of: The structure and function of the human body to include the biological and physical sciences, neurosciences, kinesiology, and biomechanics.
B.1.2. Sociocultural, socioeconomic, diversity factors, and lifestyle choices	Apply, analyze, and evaluate the role of sociocultural, socioeconomic, and diversity factors, as well as lifestyle choices in contemporary society to meet the needs of persons, groups, and populations.
B.3.2. Interaction of occupation and activity	Apply, analyze, and evaluate the interaction of occupation and activity, including areas of occupation, performance skills, performance patterns, context(s) and environments, and client factors.
B.3.3. Distinct nature of occupation	Explain to consumers, potential employers, colleagues, third-party payers, regulatory boards, policymakers, and the general public the distinct nature of occupation and the evidence that occupation supports performance, participation, health, and well-being.
B.3.4. Balancing areas of occupation, role in promotion of health, and prevention	Apply, analyze, and evaluate scientific evidence to explain the importance of balancing areas of occupation; the role of occupation in the promotion of health; and the prevention of disease, illness, and dysfunction for persons, groups, and populations.
B.4.21. Teaching–Learning process and health literacy	Demonstrate, evaluate, and utilize the principles of the teaching–learning process using educational methods and health literacy education approaches: To design activities and clinical training for persons, groups, and populations. To instruct and train the client, caregiver, family, significant others, and communities at the level of the audience

Table 2.

Pillars of Lifestyle Medicine Alignment With ACOTE Standards.

ACOTE Standards	Nutrition	Physical Activity	Stress Management	Restorative Sleep	Social Connections	Avoidance of Risky Substances
B.1.1.		X
B.1.2.	X		X	X	X
B.3.2.	X	X			X
B.3.3.	X	X			X
B.3.4.	X	X	X	X		X
B.4.21.	X	X				X

Table 3.

Pillars of Lifestyle Medicine Alignment With OTPF-4.

Domain	Nutrition	Physical Activity	Stress Management	Restorative Sleep	Social Connections	Avoidance of Risky Substances
Occupations	X	X				X
Contexts	X	X	X		X
Performance patterns		X	X	X	X	X
Performance skills	X	X
Client factors	X	X

Despite these alignments, there exists a notable gap in the existing evidence regarding the integration of lifestyle medicine into occupational therapy curricula. In contrast, several other health science professions, such as physician, physician assistant, and pharmacy programs, have successfully integrated lifestyle medicine principles into their programs, showcasing the feasibility of incorporating these insights into occupational therapy education. This integration would equip OT students with a versatile toolkit to effectively address various aspects of client well-being, bridging the gap between profession-specific knowledge and emerging evidence from the field of lifestyle medicine.

The purpose of this scoping review was to investigate current approaches to disseminating lifestyle medicine knowledge within post-secondary health education and describing the potential of integrating LM principles into occupational therapy education.

Methods

The protocol for this scoping review was published through the Open Science Framework (OSF) on 3 July 2023 to support the systematic literature review. The content of this scoping review is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Reviews (PRISMA-ScR) guidelines.¹¹ Due to the nature of a scoping review, no risk of bias evaluation was performed.

Search Strategy and Review Criteria

On 19 July 2023, six databases were searched: PubMed, Embase, CINAHL, ProQuest, EBSCO Academic Search Elite, and EBSCO Health Source Nursing Academic. Initially the search included a cited reference search in the Web of Science database, this step was later removed due to duplicates being found in this process. Based on consultation with a librarian, keyword searches were performed as “Lifestyle Medicine” is not a recognized MeSH term in PubMed (Table 4). The databases were searched for articles describing how Lifestyle Medicine is delivered in health professions education, published in English in 2004 or after. The inclusion criteria in this review were: published in English, in or after 2004, describes Lifestyle Medicine implementation, information on the curriculum, post-secondary health professions education. The exclusion criteria in this review were: gray literature, Editorials, letters to the editor, conference abstracts, systematic reviews, scoping reviews, meta-analysis, case studies, case series, protocols, dissertations, Lifestyle Medicine in a course outside of health professions curriculum, papers that did not include the term “Lifestyle Medicine,” and papers that did not provide information on pillars or method of delivery. The articles that were included in this review describe Lifestyle Medicine implementation in post-secondary health professions education, and information on the curriculum.

Table 4.

Database and Search Strategy.

Database	Search Strategy 19 July 2023
PubMed keyword search	(“Lifestyle medicine”) AND (curriculum) Filters: English, from 2004/1/1, 2024/12/12

Study Selection

Two authors (ALP & AMR) discussed the inclusion and exclusion criteria prior to screening. Following this, all titles and abstracts were blindly screened for eligibility by these authors. Full-text articles were recovered, and each full text was blindly screened by both authors. Title and abstract and full-text article disputes were resolved via discussion between the two authors. Included full-text articles were retrieved through the university online database (i.e., MEDLINE, Ovid, etc.) and PubMed Central. Title and abstract screening and full-text screening were performed using the Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia).

Data Extraction

When creating the review protocol, ALP and AMR identified the data that needed to be extracted from the articles. After this, an existing data extraction template was edited on Covidence systematic review software. Two authors extracted data for each study using this pre-designed template. After both authors extracted data from all papers, the data was compared, and disagreements were resolved through discussion. Data extraction included the author, title, year, country, type of health profession and/or the department the profession is within, name of the institution, how many courses implement Lifestyle Medicine education, in what stage of post-secondary education Lifestyle Medicine is taught, the pillars of Lifestyle Medicine addressed, whether the course is a core part of curriculum or elective, credit hours of the course(s), whether the education is didactic or experiential(application/residency/patient care etc.), if there is a partial pathway for Lifestyle Medicine certification, and if available: competencies, assignments, and assessment related to Lifestyle Medicine.

Results

From the 304 study abstracts screened, 60 full-text articles were reviewed, and 16 were included in this scoping review. This process is illustrated in Figure 1 with a modified PRISMA diagram.¹¹ To analyze the data extracted from these papers, frequency counts and percentages were used to present the data. Out of the 16 papers, 20 program were mentioned; 3 papers did not provide the department; 4 programs did not provide a total number of courses; and 1 paper did not specify whether their lifestyle medicine courses were core or elective courses. The study characteristics are presented in Table 5, with Physician being the health profession that used lifestyle medicine curriculums the most. No occupational therapy program curriculums were found.

Figure 1.

A modified PRISMA diagram.

Table 5.

Study Characteristics.

Author(s)	Country	Institution	Department	Health Profession	Courses	Stage of Education	LM Pillars	Core vs Elective	Hours	Experiential or Didactic
Drost et al. 2021¹²	USA	Mayo Clinic Alix School of Medicine	School of medicine	Physician	1	1st year of medical school (graduate)	Nutrition, exercise, stress management, and sleep	Core	11	Both
Kaye et al. 2019¹³	USA	Wake Forest School of Medicine	School of medicine	Physician	1	1st year of medical school (graduate)	Nutrition, physical activity, sleep	Core & elective		Both
Keyes & Gardner 2020¹⁴	USA			Physician assistant	1	1st year of PA school (graduate)	Nutrition, physical activity, stress management, avoidance of risky substances	Core		Both
Lisevick et al. 2023¹⁵	USA			Physician	1	Pre-clinical (graduate school)	Nutrition, sleep, stress management, avoidance of risky substances, social connection			Both
Malatskey et al. 2017¹⁶	Israel	Bar Ilan University	Faculty of medicine	Physician	2	1st year (not reported if graduate or undergraduate)	Nutrition, physical activity, stress management, sleep, avoidance of risky substances	Core	8	Both
Malatskey et al. 2022¹⁷	Israel	Bar Ilan University	Faculty of medicine	Physician	Unclear	Years 1 and 2 (not clear if undergrad or grad)	Nutrition, physical activity	Elective		Both
Mattison & Nemec 2014¹⁸	USA	Western New England University	College of pharmacy	Pharmacists	1	Graduate, 3rd year of pharmacy program	Nutrition, avoidance of risky substance, stress management, sleep, social connection, physical activity	Elective	3	Both
McGrady et al. 2019¹⁹	USA	University of Toledo	Medical school	Physician	1	1st and 2nd year of graduate school	Nutrition, physical activity, stress management	Elective		Both
Pasarica & Kay 2020²⁰	USA	University of Central Florida	College of medicine	Physician	1	3rd year (graduate school)	Nutrition, physical activity, avoidance of risky substances	Core		Both
Phillips et al. 2021²¹	USA	VA Boston Healthcare System		Physician assistant	1	2^nd year G	Nutrition physical activity stress management		12	Both
Polak et al. 2017²²	Israel	Hadassah Hebrew University	Medical school	Physician	4	Year 1, 3, and 4, with elective available year 5 & 6 (not clear undergrad vs graduate)	Nutrition physical activity avoidance of risky substances	Core & elective	58	Both
Poulton & Antono 2022²³	USA	University of North Carolina	School of medicine	Physician	1	3th and 4th year (graduate school)	Nutrition	Elective		Both
Rea et al. 2021²⁴	USA	Harvard/University of Oklahoma/A T Still University/University of South Carolina/Loma Linda University	Medical school/College of medicine/School of osteopathic medicine/School of medicine/School of medicine	Physician	1/3/NR/NR/NR	Graduate school	Physical activity, nutrition, sleep, stress management, social connection, avoidance of risky substances	Elective/Core/Core/Elective/Elective & core		Both
Rockfield et al. 2020²⁵	USA	Quinnipiac University	School of medicine	Physician	1	3rd year (graduate school)	Stress management, nutrition, physical activity	Core		Both
Trilk et al. 2019²⁶	USA	University of South Caroline	School of medicine	Physician	22	Years 1 to 4 (Graduate school)	Nutrition, physical activity, sleep, avoiding risky substance, social connection, stress management	Core	86.5	Both
Wetherill et al. 2019²⁷	USA	University of Oklahoma - Tulsa	School of community medicine	Physician assistant	1	2nd year (graduate school)	Nutrition, physical activity, avoidance of risky substances	Core	2	Experiential

The pillars (Figure 2) covered in lifestyle medicine curriculum include Nutrition, Physical Activity, Stress Management, Avoidance of Risky Substances, Restorative Sleep, and Social Connection, with Social Connection being the least utilized in Lifestyle Medicine curriculum. The information extracted from each article, including: the number of courses covering lifestyle medicine, whether they are core or elective, the hours of content, and whether the content was experiential or didactic is presented in Table 5. Over half, 60% of programs that include lifestyle medicine in their curriculum have lifestyle medicine as a core component and of all of the programs, 95% include both experiential and didactic education on lifestyle medicine.

Figure 2.

A visual depiction of how many programs cover each LM pillar.

There were a variety of competencies and assignments described throughout the programs implementing lifestyle medicine curriculums, with 3 programs outlining competencies and all 16 articles describing assignments within their individual program curriculums, as seen in Table 6. Competencies included items such as: demonstrate knowledge of the evidence that specific lifestyle changes can have a positive effect on patient’s health outcomes; use nationally recognized practice guidelines to assist patients in self-managing their health behaviors; and the ability to list specific interventions and their effectiveness as the relate to stress management or tobacco cessation. In addition to competencies, programs also listed assignments such as keeping a food diary, engaging in physical activity, and working with clients on health goals.

Table 6.

Lifestyle Medicine Competencies and Assignment Examples.

Author(s)	Competencies	Assignments
Drost et al. 2021¹²		Video; article; survey; label reading; diet prescription; movie with discussion; physical fitness tests for cardiovascular fitness; strengthening; balancing; flexibility; exercise prescription; stress assessment
Kaye et al. 2019¹³		Grocery shopping on a budget; cooking; sleep diaries; sleep disorder measures; volunteering in community courses; Yoga
Keyes & Gardner 2020¹⁴	1. Understand the role of nutrition in preventing and treating chronic diseases, such as cardiovascular disease	“Prevention and lifestyle assessment write-up (PLWU), critical thinking session, lifestyle prescription”
	2. Understand the limitations of nutritional studies
	3. Discuss the proposed dietary guidelines for Americans, 2015
	4. List the shortfall nutrients of public health concern
	5. Outline the common characteristics of dietary patterns associated with beneficial health outcomes
	6. Demonstrate the ability to perform a basic nutrition assessment
	7. Demonstrate the ability to write a basic nutrition prescription
	8. Summarize nutrition prescriptions for the most common chronic diseases, including hyperlipidemia, diabetes, hypertension and cancer
	9. Describe the relationship between physical activity and health
	10. Define physical activity and exercise
	11. Develop an exercise prescription
	12. Identify the minimum and maximum levels of exercise
	13. Describe the US physical activity Guidelines for Americans (PAGA)
	14. List evidence-based recommendations for adults and healthy older adults
	15. Describe how to collaborate with your patients to promote physical activity change and address common barriers
	16. List the components of an exercise prescription
	17. Stress management: Understand the relationship between emotional distress and poor health
	18. Understand depression as a comorbidity to cardiovascular disease and diabetes
	19. Use screening tools for stress, depression and anxiety
	20. Describe a provider’s role in promoting and facilitating patient emotional wellness
	21. Describe components of emotional wellness self-management
	22. Summarize the evidence-based literature on tobacco cessation interventions
	23. Demonstrate the ability to assist patients to develop and implement plans for tobacco cessation
	24. Describe the health effects of tobacco use
	25. List at least five recommendations on tobacco cessation by the US public health service
Lisevick et al. 2023¹⁵		Case studies; workshops; guest faculty and student role models; movies; simulations; book clubs; reflection; one-on-one coaching by students who are course alumni; formulating one’s mission statement; conducting a whole health assessment; identifying actionable areas and developing SMART goals; student survey
Malatskey et al. 2017¹⁶		Aerobic and anaerobic physical activity; Yoga
Malatskey et al. 2022¹⁷		Guiding patients towards a healthier lifestyle tailored to their medical condition
Mattison & Nemec 2014¹⁸		Training for a 5K; goal setting for self; reflections; composite lifestyle Index (CLI); sleep log
McGrady et al. 2019¹⁹		SMART goal setting; stress management activities; meeting with a dietician; mental health screenings
Pasarica & Kay 2020²⁰	1. Demonstrate knowledge of the evidence that specific lifestyle changes can have a positive effect on patient’s health outcomes.	Case studies
	2. Use nationally recognized practice guidelines to assist patients in self-managing their health behaviors and lifestyles.
	3. Collaborate with patients and their families to develop evidence-based, achievable, specific, written action plans.
Phillips et al. 2021²¹		Exercise prescription; food preparation; presentation; clinical vignettes; motivational interviewing; reflection on behavior change
Polak et al. 2017²²		Patient coaching; reflection
Poulton & Antono 2022²³		Health goal setting, peer coaching, plant-based cooking
Rea et al. 2021²⁴		Self-care practices; community outreach; goal setting
Rockfield et al. 2020²⁵		Drawing a dinner plate; identifying sources of stress; identifying barriers of health behavior change; deep breathing activity; walking
Trilk et al. 2019²⁶	1. Explain why lifestyle medicine can be an effective strategy for population health	Exercise prescription; dietary counseling; behavioral change counseling; case studies; cooking demonstration
Trilk et al. 2019²⁶	2. Analyze the effects of lifestyle behaviors on growth and development and prevention and management of disease
Wetherill et al. 2019²⁷		Group patient case studies; weekly written reflections; group project; cooking demonstrations

Discussion

While no articles were found that explore lifestyle medicine in occupational therapy education, this discussion will use the findings from the included papers to consider how lifestyle medicine education may be applicable in occupational therapy education. The pillars of lifestyle medicine can enhance the content of occupational therapy programs, while conversely, occupational therapy education can provide support for lifestyle medicine education. The six pillars of lifestyle medicine can be aligned with the 2018 standards set forth by the ACOTE,⁹ alongside the parameters delineated in the OTFP-4.¹⁰ While the OTPF-4 serves as a structure for practice, occupational therapy modules that are commonly taught in occupational therapy education support approaches to wellness that are preventative and focused on individuals, communities, and entire populations. This confluence of resources and foundational knowledge can serve as valuable tools for occupational therapy programs to meet accreditation requirements while simultaneously elevating the less-emphasized aspects of lifestyle medicine. This section delves into the underrepresented pillars among programs incorporating lifestyle medicine in their curricula, explains connections between lifestyle medicine competencies and established occupational therapy curricula, and explores the instrumental role of the occupational therapy perspective in supporting lifestyle medicine education.

Least Utilized Pillars

The findings from this scoping review highlight that the Social Connection Pillar received the least attention, with the Restorative Sleep pillar following closely behind. The Social Connections pillar emphasizes the importance of fostering positive relationships with others. In occupational therapy education, students are instructed to use the OTPF-4 framework to assist clients in enhancing their social connections, thereby enhancing their physical, mental, and emotional well-being. The models currently taught in occupational therapy education encourage students to consider social connection within a client’s context. The Ecology of Human Performance facilitates consideration of a client’s skills or abilities to engage in social connection. Whereas the Person-Environment-Occupation-Performance model guides students to examine the characteristics of a person, features of the environment, and characteristics of activity associated with social connection. Furthermore, this approach aids occupational therapy programs in fulfilling ACOTE standards concerning sociocultural factors, areas of occupation, and the distinct nature of occupation. Occupational therapy students can utilize resources from the Social Connections pillar combined with guidance from the OTPF-4 and occupation therapy models to improve social connections of clients. At the same time, occupational therapy programs can highlight the effectiveness of this combined approach by generating evidence that can inform lifestyle medicine practices. This can facilitate collaborative efforts that are beneficial to both lifestyle medicine and occupational therapy.

Within the OTPF-4 framework, sleep quality is considered an integral aspect of daily life and habits, thus falling under the category of performance patterns. Occupational therapy students are taught the significance of establishing a consistent sleep routine, recognizing that adequate sleep is essential for everyone. The Restorative Sleep pillar within lifestyle medicine primarily focuses on enhancing attention span, mood, and mitigating issues such as insulin resistance and hunger through the attainment of high-quality sleep. The focus of this pillar is similar to Model of Human Occupations where clients make changes to their occupations based on interactions with the environment. The prevention piece from this pillar could serve as the catalyst that has an impact on the occupation of sleeping. Integrating resources from this pillar into an occupational therapy curriculum would be instrumental in aligning with ACOTE standards related to lifestyle choices and preventive measures for addressing health concerns. This could serve as the basis for further collaboration with professions that specialize in sleep issues.

The Avoidance of Risky Substances pillar, utilized by slightly more than half of the programs in the scoping review, advises against excessive tobacco and alcohol consumption to decrease the risk of chronic diseases and death. Occupational therapy students are instructed in this principle to equip them with the knowledge needed to guide their future clients in maintaining a balanced and health-conscious lifestyle, aligning with the standards set by the ACOTE. The preparation of OT students in this regard also adheres to the performance patterns of habits and routines, as well as the occupations of leisure and health management as outlined in OTPF-4. Lifestyle medicine could be utilized to help OT students learn how to address and prevent the habits and routines that lead to use of risky substances.

Most Utilized Pillars

All 20 programs included in the scoping review integrated the nutrition pillar into their curriculum. Following closely, the second most emphasized pillar was physical activity, with stress management ranking as the third most emphasized pillar. These three pillars can also be paired closely with the OTPF-4 and the education requirements of the ACOTE standards.

The nutrition pillar in lifestyle medicine emphasizes the importance of a plant-based diet for health prevention and management. OT students need to understand the significance of nutrition to guide their future clients in making healthy dietary choices and appreciating the impact of diet on health. They should also consider the need for adjusting daily habits and routines influenced by values and beliefs when helping clients adopt dietary guidelines. This aligns with the standards set by ACOTE and addresses activities of daily living and Health Management domains outlined in OTPF-4.

The physical activity pillar in lifestyle medicine emphasizes the importance of regular physical activity for overall well-being. OT students are required to incorporate physical activity considerations into their client assessments, treatments, and education, which aligns with specific ACOTE standards. These standards encompass understanding human body structure and function, the relationship between occupation and activity, the unique nature of occupation, balancing various areas of occupation, and the role of occupation in health promotion and prevention. These principles closely correlate with the physical activity pillar, which can be applied to various occupations through the OTPF-4, including activities of daily living, health management, play, leisure, and social participation. This also involves comprehending client factors such as values, beliefs, body functions, and body structures.

The stress management pillar in lifestyle medicine emphasizes the importance of effectively addressing negative stress to enhance overall well-being by reducing anxiety, depression, and immune-related issues. This pillar aligns with several ACOTE standards, encompassing sociocultural, socioeconomic, diversity factors, and lifestyle choices, as well as the balance of different areas of occupation and the role of occupational therapy in health promotion and prevention. As occupational therapy students learn to assist clients in managing stress, they must possess the tools and strategies to address potential stressors arising from various sources, individually or in combination. They should also understand the challenges clients face in balancing different aspects of daily life. Moreover, students must appreciate their role in promoting health and preventing issues, necessitating a deep understanding of clients' personal and environmental factors, habits, routines, roles, and beliefs, as outlined in the OTPF-4. Recognizing clients' values and beliefs is vital for crafting effective stress management plans, and the stress management pillar in lifestyle medicine provides valuable additional resources to aid students in this process.

Competencies

Some of the reviewed articles, Pasarica,²⁰ Keyes,¹⁴ Trilk,²⁶ and Wetherill,²⁷ include competencies used for assessing student comprehension of the components of LM. Many of these competencies pertain to domains within the occupational therapy scope of practice. Utilizing these competencies has the potential to fulfill the standards and guidelines set forth by ACOTE and the OTPF-4.

Pasarica²⁰ defined three lifestyle medicine competencies, the first being that students need to be able to “demonstrate knowledge of evidence that specific lifestyle changes can have a positive effect on patient health outcomes.” The second competency is that students need to be able to “use nationally recognized practice guidelines to assist patients in self-managing their health behaviors and lifestyle.” While the third competency indicated that students need to “collaborate with patients and their families to develop evidence-based, achievable, specific, written action plans.” The competencies outlined by Pasarica are in alignment with both ACOTE standards and OTPF-4. The first competency parallels the emphasis on evidence-based practice articulated in the standards and practice framework. The second competency corresponds with ACOTE standards B.3.4. and B.4.21, emphasizing health promotion, prevention, and health literacy, while also addressing the performance patterns of habits and routines as established by OTPF-4.^9,10 The third competency shares similarities with the client-centered nature of occupational therapy.

Similarly, Keyes¹⁴ and Trilk²⁶ encompass competencies appropriate for assessing occupational therapy students on ACOTE standards B.3.4., B.4.21., and the performance patterns domain in the OTPF-4. The competencies delineated by Keyes and Trilk have potential to address ACOTE standards concerning sociocultural and socioeconomic factors. Specifically, one of the competencies requires students to list the shortfall of nutrient intake as a public health concern and demonstrate knowledge of the role of nutrition in the prevention of chronic diseases.

Pasarica,²⁰ Keyes,¹⁴ and Trilk²⁶ employed specific competencies in their assessments. In contrast, Wetherill²⁷ utilized quizzes and a final examination to assess student proficiency in LM. OT education uses a combination of competency-based assessment along with quizzes and final exams to determine student competency of ACOTE standards and OTFP-4 guidelines.

The alignment between the ACOTE standards and OTPF-4 is further substantiated by consistency with the recently revised lifestyle medicine competencies in the article by Lianov.²⁸ Among the 88 identified competencies, those within the domains of The Role of the Practitioner’s Personal Health and Community Advocacy; Physical Activity Science, Assessment, and Prescription; Sleep Health Science and Interventions; Fundamentals of Health Behavior Change; and Emotional and Mental Health Assessment and Intervention exhibit the closest alignment with OT education. Specifically, these competencies resonate with ACOTE standards B.1.2., B.3.2., B.3.3., B.3.4., and B.4.21., as well as with the Context, Performance Patterns, and Client Factors domains within the OTPF-4.

A Summary of The Occupational Therapy Perspective

Occupational therapists approach preventive health from a client-centered standpoint. While the pillars of lifestyle medicine can contribute to occupational therapy education, the occupational therapy perspective can reciprocally influence lifestyle medicine education. Most notably, the Social Connection pillar was the least emphasized among the programs in the reviewed articles. However, the social component is a focal point in occupational therapy education, evident in the emphasis placed on it in ACOTE standards B.1.2., B.3.2., and B.3.3., as well as within the domains of Context and Performance Patterns in the OTPF-4. The same could be about the Restorative Sleep and Avoidance of Risky Substance pillars, as these are related to performance patterns addressed by occupational therapy.

Conclusions

While this review was able to explore the breadth of lifestyle medicine education and discuss possibilities in occupational therapy education, it would be of future interest to explore the depth to which occupational therapy education could implement this piece. A connection forged between lifestyle medicine education and occupational therapy could facilitate exploration of how occupational perspectives of humans and health, grounded in occupational science, support positive lifestyle behavior. The pillars of lifestyle medicine education possess the potential to increase educational resources available to occupational therapy programs, while establishing a reciprocal dynamic where the occupational therapy perspective lends support to lifestyle medicine. This alignment adheres to the ACOTE standards and OTPF-4. The combination of these resources forms an invaluable toolkit, equipping occupational therapy students, along with students in other health professions, to comprehensively address diverse facets of client care and overall well-being.

Footnotes

Acknowledgments

The authors thank Rudy Barreras of the Harriet K. and Philip Pumerantz Library for guidance on search terms and journals and Tina Lekas, an OT colleague, for support in initial idea refinement.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Alyssa L. Phillips

Anu M. Räisänen

Trevor T. St. Clair

References

Rippe

. Lifestyle medicine: the health promoting power of daily habits and practices. Am J Lifestyle Med. 2018;12(6):499-512. doi:10.1177/1559827618785554. Published 2018 Jul 20

Reitz

Scaffa

Dorsey

. Occupational therapy in the promotion of health and well-being. Am J Occup Ther. 2020;74(3):7403420010p1-7403420010p14. doi:10.5014/ajot.2020.743003

Dunn

Brown

McGuigan

. The ecology of human performance: a framework for considering the effect of context. Am J Occup Ther. 1994;48(7):595-607. doi:10.5014/ajot.48.7.595

Christiansen

Bass

Baum

. Occupational Therapy: Performance, Participation, and Well-Being. 4th ed. Slack Incorporated; 2014.

Kielhofner

Forsyth

. The model of human occupation: an overview of current concepts. Br J Occup Ther. 1997;60(3):103-110. doi:10.1177/030802269706000302

Iwama

Thomson

Macdonald

. The Kawa model: the power of culturally responsive occupational therapy. Disabil Rehabil. 2009;31(14):1125-1135. doi:10.1080/09638280902773711

Mokdad

Ballestros

Echko

et al. The state of US health, 1990-2016: burden of diseases, injuries, and risk factors among US States. JAMA. 2018;319(14):1444-1472. doi:10.1001/jama.2018.0158. PMID: 29634829; PMCID: PMC5933332

Akselrud

. Quintessential Occupational Therapy. SLACK Inc.; 2023.

2018 Accreditation Council for Occupational Therapy Education (ACOTE^®) . Standards and interpretive guide (effective july 31, 2020). Am J Occup Ther. 2018;72(Supplement_2):7212410005p1-7212410005p83. doi:10.5014/ajot.2018.72S217

10.

Occupational Therapy Practice Framework . Domain and process-fourth edition. Am J Occup Ther. 2020;74(Supplement_2):7412410010p1-7412410010p87. doi:10.5014/ajot.2020.74S2001

11.

Tricco

Lillie

Zarin

, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:10.7326/M18-0850

12.

Drost

Lucas

Patchett

Hatley

Johnson

Scales

. Introducing lifestyle medicine within the Mayo clinic Alix school of medicine in Arizona. Am J Lifestyle Med. 2021;15(6):612-618. doi:10.1177/15598276211007824. Published 2021 Apr 21

13.

Kaye

Pathman

Skelton

. Development and implementation of a student-led lifestyle medicine curriculum. Am J Lifestyle Med. 2018;13(3):253-261. doi:10.1177/1559827618821322. Published 2018 Dec 29

14.

Keyes

Gardner

. Educating physician-assistant students as agents of lifestyle medicine. Clin Teach. 2020;17(6):638-643. doi:10.1111/tct.13152

15.

Lisevick

Dreiling

Chauvin

, et al. Leadership for medical students: lessons learned from a relationship-centered leadership curriculum. Am J Lifestyle Med. 2022;17(1):56-63. doi:10.1177/15598276221106940. Published 2022 Jul 11

16.

Malatskey

Essa-Hadad

Willis

Rudolf

MCJ

. Leading healthy lives: lifestyle medicine for medical students. Am J Lifestyle Med. 2017;13(2):213-219. doi:10.1177/1559827616689041. Published 2017 Feb 5

17.

Malatskey

Essa-Hadad

Eldar

Filipov

Eilat-Tsanani

Rudolf

MCJ

. Medical student lifestyle counselling for non-communicable disease: impact on students’ competence and patients' health behaviors. Isr J Health Pol Res. 2022;11(1):23. doi:10.1186/s13584-022-00532-x. Published 2022 May 24

18.

Mattison

Nemec

. The impact of an immersive elective on learners' understanding of lifestyle medicine and its role in patients' lives. Am J Pharmaceut Educ. 2014;78(8):154. doi:10.5688/ajpe788154

19.

McGrady

Badenhop

Lynch

. Effects of a lifestyle medicine elective on self-care behaviors in preclinical medical students. Appl Psychophysiol Biofeedback. 2019;44(2):143-149. doi:10.1007/s10484-019-09431-5

20.

Pasarica

Kay

. Teaching lifestyle medicine competencies in undergraduate medical education: active collaborative intervention for students at multiple locations. Adv Physiol Educ. 2020;44(3):488-495. doi:10.1152/advan.00148.2019

21.

Phillips

McGlynn

Topor

Stauffer

. Training physician assistant students to provide evidence-based, holistic, patient-driven care: a novel curriculum. Med Sci Educ. 2021;31(2):319-323. doi:10.1007/s40670-020-01150-5. Published 2021 Jan 9

22.

Polak

Finkelstein

Axelrod

, et al. Medical students as health coaches: implementation of a student-initiated Lifestyle Medicine curriculum. Isr J Health Pol Res. 2017;6(1):42. doi:10.1186/s13584-017-0167-y. Published 2017 Nov 10

23.

Poulton

Antono

. A taste of virtual culinary medicine and lifestyle medicine-an online course for medical students. Am J Lifestyle Med. 2021;16(1):57-60. doi:10.1177/15598276211046558. Published 2021 Sep 25

24.

Rea

Worthman

Shetty

Alexander

Trilk

. Medical education transformation: lifestyle medicine in undergraduate and graduate medical education, fellowship, and continuing medical education. Am J Lifestyle Med. 2021;15(5):514-525. doi:10.1177/15598276211006629. Published 2021 Apr 29

25.

Rockfeld

Koppel

Buell

Zucconi

. An interactive lifestyle medicine curriculum for third-year medical students to promote student and patient wellness. MedEdPORTAL. 2020;16:10972. doi:10.15766/mep_2374-8265.10972. Published 2020 Sep 18

26.

Trilk

Elkhider

Asif

, et al. Design and implementation of a lifestyle medicine curriculum in undergraduate medical education. Am J Lifestyle Med. 2019;13(6):574-585. doi:10.1177/1559827619836676. Published 2019 Apr 3

27.

Wetherill

Davis

Kezbers

, et al. Development and evaluation of a nutrition-centered lifestyle medicine curriculum for physician assistant students. Med Sci Educ. 2018;29(1):163-172. doi:10.1007/s40670-018-00655-4. Published 2018 Dec 6

28.

Lianov

Adamson

Kelly

Matthews

Palma

Rea

. Lifestyle medicine core competencies: 2022 update. Am J Lifestyle Med. 2022;16(6):734-739. doi:10.1177/15598276221121580. Published 2022 Aug 31

Lifestyle Medicine as a Curricular Thread in Occupational Therapy Education: A Scoping Review and Discussion of Feasibility