Pediatricians ensure the health and well-being of infants, children, adolescents, and young adults, focusing on preventing, diagnosing, and treating a wide range of illnesses, promoting healthy development, and providing guidance to parents on childcare practices. They play an essential role in educating families and addressing physical and mental health concems to help young people thrive. As acknowledged in multiple clinical practice guidelines, the implementation of lifestyle medicine is crucial to achieving this goal.
Lifestyle factors, including physical activity, dietary patterns, sleep, stress response, social connections, and use of risky substances, are increasingly recognized as predictors of cardiovascular disease (CVD) and cardiovascular health, with significant overlap between the American Heart Association's Life's Essential 8 guidelines and the 6 pillars of Lifestyle Medicine (LM). Assessing and addressing lifestyle factors have a foundational role in the prevention and management of cardiovascular disease and improving cardiovascular health. Sex and/or gender related factors can influence access, engagement, and adherence to guidelines around lifestyle and may lead to differential effects on cardiovascular risk and outcomes that are not well understood. This review summarizes the research on sex and gender factors that impact lifestyle medicine for women, including motivations and barriers to adopt LM recommendations, impact on cardiac risk factors and physiology, and interactions among LM pillars that influence women's cardiovascular risk and outcomes. Recognition of the reproductive age and perimenopausal predictors of higher cardiovascular and cardiometabolic risks can provide windows of opportunity to discuss lifestyle and primary prevention across the lifespan. While more research is needed, a deeper understanding of these sex and gender differences related to lifestyle and heart health for women has the potential to support earlier discussions and referrals when indicated to preventive cardiologists and LM certified clinicians, including physicians, dieticians, exercise physiologists, sleep specialists, social workers, behavioral therapists, and coaches. Alignment of LM education with women's symptoms, preferences, and goals may increase adherence to guidelines around physical activity, whole food plant predominant nutrition, sleep quality and quantity, stress management, social connections and avoidance of risky substances, leading to reduced cardiovascular risk and improved cardiovascular health and outcomes.
The practice of Lifestyle medicine (LM) focuses on helping patients make healthy choices to prevent and treat disease. While such interventions are considered first-line treatment for many diseases, many medical schools have not yet been able to include lifestyle medicine classes in the core curriculum but most are able to offer a parallel curriculum that does not interfere with the schedule of core classes. Lifestyle Medicine Interest Groups (LMIGs) are being created around the country and around the globe. Many students and faculty members are interested in starting and sustaining a LMIG at their schools, but some do not have enough funding or they lack the framework that provides structure to their efforts. To address this situation, the American College of Lifestyle Medicine (ACLM) has encouraged the development of LMIGs, which are student-run organizations that provide a parallel curriculum in LM. To support and strengthen this effort, the ACLM initiated the Donald A. Pegg award to fund four allied health students in founding and augmenting their institution’s LMIGs. The 2016 inaugural winners were James Gardner, P. Elainee Poling, Alyssa Abreu, and Jessie M. Hipple. Their LMIG activities have included events such as nutrition and cooking classes, exercise prescription seminars, group fitness sessions, and patient lifestyle counseling in various clinical settings. Pearls of wisdom for building successful LMIGs include cultivating strong faculty mentorship, marketing the personal benefits to students who attend activities, and collaborating with other student groups.
Chronic diseases, previously thought to require decades of risk factors, have become increasingly prevalent in America’s youth. National Health Education Standards have been published since 1995, and yet nearly a fifth of schools fail to follow any state or national health education guidelines. Utilizing the phrase “lifestyle medicine” in childhood would elevate the importance and standardization of the core health guidelines. Several independent pilot programs taught by undergraduate and medical student volunteers have successfully demonstrated lifestyle medicine education models at intermediate and secondary schools. Preliminary feedback demonstrates that student interest in and consideration of behavioral change is possible within this age group. As with any life stage, significant behavior change in youth requires strategic planning of authentic learning practices and culturally competent lessons. We argue for the interdisciplinary development and implementation of community-engaged lifestyle medicine education for intermediate and secondary schools as a promising intervention to address and reverse the chronic disease trend in our youth.
Objective: Regular physical activity can reduce the incidence and prevalence of many chronic diseases. A vast majority of Americans cite their physician as their primary source of information regarding healthy lifestyle decisions. This study was designed to obtain information about the personal exercise behavior and counseling practices of primary care physicians, to evaluate the relationship between their personal and professional exercise practices, and to determine whether physician specialty is associated with these practices. Design: A cross-sectional survey was mailed to a randomly selected sample of primary care physicians in the United States. A questionnaire was used to obtain detailed information on the personal exercise habits, counseling practices, and barriers to counseling of these physicians, regarding both aerobic exercise and strength training. Participants: 298 primary care physicians, comprising 84 family practitioners, 79 pediatricians, 58 geriatricians, and 77 internists. Main outcome measures: Frequency of physician exercise, exercise counseling, and relationship between these practices. Results: Physicians who perform aerobic exercise regularly are more likely to counsel their patients on the benefits of these exercises, as are physicians who perform strength training. Pediatricians and geriatricians counsel fewer patients about aerobic exercise than family practitioners and internists. Counseling regarding strength training is less common in all physician groups surveyed, and lowest among pediatricians, of whom 50% did not advise these exercises for any of their patients. Inadequate time was noted by 61% and inadequate knowledge and/or experience by 16% of respondents as the major barriers to counseling regarding aerobic exercise. Conclusion: Physicians who exercise are more likely to counsel their patients to exercise. Inadequate time and knowledge/experience regarding exercise are the most common barriers to counseling identified. These findings suggest strategies that might increase physician exercise counseling behavior.