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Dr Hazel Hawker.
Declaration of Interest.
*Certified Lifestyle Medicine Physician *GP Appraiser
Lifestyle Medicine
“A branch of evidence based medicine in which comprehensive
lifestyle changes including nutrition, physical activity, stress
management, social support and environmental exposures are used to
prevent, treat and reverse the progression of chronic diseases by
addressing their underlying causes.”
Global Lifestyle Medicine Alliance 2014
Non-communicable diseases have overtaken infectious diseases
as the biggest killers worldwide.
M Chan WHO Director 2016
July 2019 Green Paper.
healthy physiology
LIFESTYLE the cause and cure of most disease – nourishment,
movement,
resilience, connectedness
HIGH RISK foreign, invasive
Hierarchy of drivers (determinants) in modern disease
Distal (Upstream) Medial (Midstream)
Environment Stress Anxiety Dep (mal)Nutrition Obesity CHD
(micro+macro) Insomnia Inactivity Hypertension Diabetes
Physical Depression Technopathology Lipids Stroke
Socio-cultural Iatrogenesis Sun exposure F Blood Glucose
Cancers
Political Alcohol Smoking
Social Inequality, Loneliness, Alienation HbA1c COPD
Adverse childhood experiences Infertility
‘cause of the cause’ ‘cause’
Rob Lawson: Adapted from G Egger, Lifestyle Medicine 3rd
edition
Components of Lifestyle Medicine
Tools (Aids) What tests/devices/equipment can be used to assist
changes towards a healthy lifestyle and/or environment. mHealth -
sms, telemetry, ambulatory monitoring, implantable devices, apps,
BIA, string
Procedures (Actions) What sequence of steps needs to be taken to
establish a course of action to improve unhealthy
lifestyles/environments Self-management training, SMAs (Group
Consultations)
Clinical Environmental
Procedures - actions
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The Stress Response
immune system
Mitochondrial oxidative stress in obesity: role of the
mineralocorti- coid receptor
Journal of Endocrinology Authors: Clara Lefranc 1 , et alVolume
238: Issue 3 Sep 2018
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Nutrition
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Role of the gut microbiota in nutrition and health BMJ 2018; 3 61
doi: https: //doi.org/10. 1136/bmj.k2 179 (Publishe d 13 June
2018)
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Time-restricted feeding (TRF) confines food access to 9–12 hrs
during the active phase
TRF is a therapeutic intervention against obesity without calorie
restriction
TRF protects against metabolic diseases even when briefly
interrupted on weekends
TRF is effective against high-fat, high- fructose, and high sucrose
diets
Time restricted eating
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Breaking sitting with standing and light intensity walking
effectively improved 24 hr glucose levels and improved insulin
sensitivity in individuals with type 2 diabetes to a greater extent
than structured exercise. Thus our results suggest that breaking
sitting and standing and light-intensity walking may be an
alternative to structured exercise to promote glycaemic control in
patients type 2 diabetes.
Exercise Snacks
'Exercise snacks' before meals: a novel strategy to improve
glycaemic control in individuals with insulin resistance.
Francois ME1, Baldi JC, Manning PJ, Lucas SJ, Hawley
JA, Williams MJ, Cotter JD.
Author information
Abstract
AIMS/HYPOTHESIS:
The aim of this study was to investigate whether small doses of
intense exercise
before each main meal ('exercise snacks') would result in better
blood glucose
control than a single bout of prolonged, continuous,
moderate-intensity exercise in
individuals with insulin resistance.
Nine individuals completed three exercise interventions in
randomised order.
Measures were recorded across 3 days with exercise performed on the
middle day,
as either: (1) traditional continuous exercise (CONT), comprising
30 min moderate-
intensity (60% of maximal heart rate [HRmax]) incline walking
before dinner; (2)
exercise snacking (ES), consisting of 6 × 1 min intense (90% HRmax)
incline
walking intervals 30 min before each meal; or (3) composite
exercise snacking
(CES), encompassing 6 × 1 min intervals alternating between walking
and
resistance-based exercise, 30 min before meals. Meal timing and
composition were
controlled within participants for exercise interventions.
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Walk more and sit less Focus on muscle mass Exercise ‘snacks’ High
intensity interval training
Importance of sleep
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Exposure to nature reduce incidents of;
Stroke High blood pressure Raised cholesterol Asthma Heart
disease
The health benefits of the great outdoors: A systematic review and
meta- analysis of greenspace exposure and health outcomes. Environ
Res. 2018 Oct;166:628-637 Twohig-Bennett C, Jones A.
How can we explain these effects?
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Reduce stress Improvement of healthy bacteria “microbiota” Exposure
to “fractals” Optimised sun exposure (vitamin D synthesis) Absence
of pollutants Reduced noise Opportunity to connect with others
Increased chance to move more freely , exercise Temperature
regulation
Fractal patterns
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Never ending pattern that repeats itself at different scales
Infinitely complex
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EEG Functional MRI scanning Eye tracking
Early research indicates that;
“people are ‘hard-wired’ to respond to a specific form of fractal
found in nature, one that reduces stress levels by up to 60%”
https://blogs.uoregon.edu/richardtaylor/2016/
02/03/human-physiological-responses-to-
fractals-in-nature-and-art/
The complete obvious, it seems, takes longer .
Edward R Murrow 1908-1965
Finally, it is accepted as being self-evident Schopenhauer
Now is the time for Lifestyle Medicine.
Let’s put health back into healthcare.
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