“This new approach needs to bridge the gap between public health, with its preventive and population-based aims, and the treatment and patient-centred focus of clinical practice. The advent of a modified clinical discipline — “lifestyle medicine” — offers a way to bridge this gap.” Dr Garry Egger
“The root cause of chronic disease is lifestyle” The Cleveland Clinic.
The components of a Lifestyle Medicine Program include:
- Eat a whole food diet high in healthy fats, vegetables and fruit
- Restrict processed foods
- Reduce inactivity and promote daily physical activity
- Prioritize sleep
- Reduce stress
- Limited alcohol intake
- Smoking cessation and avoid risky substance abuse
“Given the significant associated mortality and morbidity, we propose that perhaps physical inactivity should also be considered for recognition as a disease in its own right. Physical inactivity is considered a primary cause of many chronic diseases.” Dr Richard Weiler and Dr Emmanuel Stamatakis.
In the UK, the annual cost of physical inactivity has been estimated at £8.2 billion, compared the annual cost of smoking estimated at £1.5 billion, alcohol at £3.0 billion and obesity at £4.2 billion.
“GPs (and all other healthcare professionals) should receive comprehensive training on exercise medicine and behaviour change during undergraduate and postgraduate training. Already qualified healthcare professionals should be offered opportunities and incentives for professional training on lifestyle medicine and particularly physical activity, which is the single most important modality for prevention and management of most chronic disease. “ Dr Richard Weiler and Dr Emmanuel Stamatakis.
There is little doubt of the importance of being physically active through the lifespan and while prescribing physical activity has been widespread its penetration rates and retention rates are still very poor. It seems that while people understand the importance of physical activity the majority are still reluctant to initially start an exercise program (< 18%), and from those over 50% will drop out after 12 months, 75% after 18 months. IHRSA reports indicate that there are three tiers of penetration rates globally. The first tier comprising the top 10 fitness nations included: Sweden 21.4%, Norway 20.9%, USA 20.3%, Denmark 18.3%, Netherlands 17.0%, Finland 16.8%, Canada 15.5%, Australia 15.3%, UK 14.8%, New Zealand 13.6%. The second-tier nations include; Singapore 5.8%, Hong Kong 5.85%, Japan 3.3% and Taiwan 3.0%. The third tier includes; Malaysia 1.04%, Philippines .53%, Vietnam .5%, Indonesia,1 8% and India .15%. Those countries with the highest penetration rates also have the lowest sedentary rates and lowest obesity rates.
More recently the role of sedentary behaviour as a legitimate contributor to increased mortality rates and morbidity rates has been reported. The message now is that being physically active as stand alone is not enough while still spending too much time in sedentary activities. Being sedentary is its own risk factor for heart disease, stroke, diabetes and some cancers.
The American College of Sports Medicine guidelines recommend moderate to vigorous exercise while also prescribing a reduction in prolonged sitting and being active every day.
The estimated increase in life expectancy from birth is 2 years for reducing sedentary time to less than 3 hours per day and a gain of 1.38 years from reducing television viewing to less than 2 hours per day.
To increase the number of people starting an exercise program, initially reducing their sedentary time in the home, transport, work and leisure time can translate into improved penetration rates, retention rates and participation rates.
The NEAT Fit coaching program promotes lifestyle changes inclusive of physical activity by using a behavioural modification approach, utilising simple movement techniques in all aspects of a person’s lifestyle. The NEAT Fit program was initially designed to attract sedentary clients by reactivating their lifestyles and then converting them to the more formal fitness program.
Evidence suggests that there is a significant “spill over” effect from initially reducing sedentary time to starting and maintaining a formal fitness program as well as an increased awareness of better eating practices, reduced alcohol consumption, sleep better, improved stress management and smoking cessation.
The most effective way of reducing sedentary time is to target it specifically rather than simply relying on prescribing a moderate to vigorous exercise program.