|
Introduction to Lifestyle Medicine:
Implications to health, wellness promotion,
disease management, and prevention
PSYC E-1037 - January Term 2021
Instructor: Elizabeth Frates., MD. Assistant Clinical Professor of Physical Medicine and Rehabilitation, Spaulding Rehabilitation, Harvard Medical School Email: efrates1@partners.org
Course website:
Class: Online Live Web-conference: Monday, Tuesday, Wednesday, and Thursday 11:00 am - 2:00 pm EST
(Classes are held from January 4th – 21st 2021, No class on January 18th - Martin Luther King Jr. Day)
Room: Lectures Live on-line
Sections: Friday, Jan. 8, Friday, Jan.15, and Tuesday, Jan. 19 - On-line via Zoom meeting
Required Reading: The Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits
by Beth Frates MD, Jonathan P. Bonne MD, Richard Joseph MD, James A. Peterson PhD
Instructional Staff: Dr. Elizabeth P. Frates
Teaching Assistants: Irena Matanovic,
Example of the previous Introduction to Lifestyle Medicine Lectures: First Lecture 2015
____________________________________________________________________________
Course Description
Lifestyle Medicine is the science and application of healthy lifestyles as interventions for the prevention and treatment of lifestyle-related diseases such as heart disease, diabetes, stroke, obesity, some neurological conditions, and some cancers. It is the evidence-based specialty bridging the science of physical activity, nutrition, stress management, and resilience; sleep hygiene, and other healthy habits to individuals through clinical practice in healthcare. Lifestyle interventions include exercise prescriptions, nutrition prescriptions, stress management, and resilience, smoking cessation programs, sleep evaluations, identifying and encouraging social connections, harnessing individuals’ strengths, and using positive emotions such as gratitude and laughter as medicine to empower individuals to reach their optimal state of health and well being. Starting with Hippocrates and ending with modern medicine, we will explore how trends and guidelines in lifestyle choices by individuals and clinicians have shaped and altered the health of the population. This course brings evidence-based knowledge and practical strategies to those professionals aspiring to instill healthful lifestyle behaviors in themselves as well as in their patients, clients, family, and friends.
Course Aims and Learning Objectives
In this Introductory Lifestyle Medicine Course students will gain a basic understanding of the main components of lifestyle medicine as well as the importance of using the coach approach when counseling patients about behavior change. Upon completion of the course students will be able to:
- Define lifestyle medicine and describe its essential components.
- Recognize that lifestyle choices are the root cause of many chronic diseases: approximately half of the actual causes of death in the US and a significant amount of healthcare costs.
- Describe the difference between the coach approach and the expert approach when counseling for therapeutic lifestyle changes (TLC).
- Utilize evidence-based coach approach techniques for behavior change.
- List the current guidelines and recommendations for exercise and nutrition counseling.
- Identify how lifestyle behaviors including physical activity, nutrition, sleep, stress management, and resilience, relaxation techniques, expressing positive emotions, social connections and chemical dependencies affect the mind, body, behavior, and health
- Commit to improvement in their personal health choices to best serve as role models.
The overarching aim of this course is to demonstrate how Lifestyle Medicine principles and interventions apply to individual health behaviors, examining both short and long-term health outcomes. The Introduction to Lifestyle Medicine course will enable students to confidently co-create goals with individuals with whom they work while progressing toward the adoption of healthy habits. Utilizing the coach approach, students will be able to collaborate with individuals in order to identify social supports and methods of accountability that will enable lasting change. This course will provide the basic lifestyle medicine foundation for coaching individuals to reach their optimal state of health and wellness.
Grading
Assignments are outlined in the following table.
|
Undergraduate Students
|
Graduate Students
|
|
Class Participation 20%
Discussion Board Posting 10%
Case Studies 25%
Article Review 20%
Course Project/Lifestyle Project 25%
|
Class Participation 20%
Discussion Board Posting 10%
Case Studies 25%
Article Review 20%
Course Project/Lifestyle Project 25%
|
Grading expectations:
Although assignments will be similar for undergraduate and graduate students, graduate students will be expected to show more advanced thinking, analysis, and expression skills.
|
Grade
|
Minimum Expectations
|
|
90-100
A
|
· Complete all readings and watch all videos
· Attend and participate actively in 90%+ of the classes
· Complete 100% of the homework
· Achieve 90%+ average on all work and assessments
|
|
80-89%
B
|
· Complete 90% of the readings and watch videos
· Attend and participate actively in 80%+ of the classes
· Complete 90% of the homework
· Achieve 80%+ average on all work and assessments
|
|
70-79%
C
|
· Complete 80% of the readings and watch all videos
· Attend and participate actively in 70%+ of the classes
· Complete 80% of the homework
· Achieve 70%+ average on all work and assessments
|
|
60-69%
D
|
· Complete 60% of the readings and watch all videos
· Attend and participate actively in 60%+ of the classes
· Complete 60% of the homework
· Achieve 60%+ average on all work and assessments
|
|
Below 60% is an “F”
|
|
A and A–: Earned by work whose superior quality indicates a full mastery of the subject, and in the case of A, work of extraordinary distinction. There is no grade of A+
B+, B, and B–: Earned by work that indicates a strong comprehension of the course material, a good command of the skills needed to work with the course materials, and the student’s full engagement with the course requirements and activities.
C+, C, and C–: Earned by work that indicates an adequate and satisfactory comprehension of the course material and the skills needed to work with the course materials, and that indicates that the student has met the basic requirements for completing assigned work and participating in-class activities.
D+, D, and D–: Earned by work that is unsatisfactory but that indicates some minimal command of the course materials and some minimal participation in-class activities that are worthy of course credit.
E: Earned by work that is unsatisfactory and unworthy of course credit. This grade may also be assigned to students who do not submit required work in courses from which they have not officially withdrawn by the withdrawal deadline. Zero or E grades are assigned to students for missing work. These grades are included in the calculation of the final grade.
Expectations and Policies
Academic Integrity
You are responsible for understanding Harvard Extension School policies on academic integrity (https://www.extension.harvard.edu/resources-policies/student-conduct/academic-integrity) and how to use sources responsibly. Stated most broadly, academic integrity means that all course work submitted, whether a draft or a final version of a paper, project, take-home exam, online exam, computer program, oral presentation, or lab report, must be your own words and ideas, or the sources must be clearly acknowledged. The potential outcomes for violations of academic integrity are serious and ordinarily include all of the following: required withdrawal (RQ), which means a failing grade in the course (with no refund), the suspension of registration privileges, and a notation on your transcript.
Using sources responsibly (https://www.extension.harvard.edu/resources-policies/resources/avoiding-plagiarism) is an essential part of your Harvard education. We provide additional information about our expectations regarding academic integrity on our website. We invite you to review that information and to check your understanding of academic citation rules by completing two free online 15-minute tutorials that are also available on our site. The tutorials are anonymous open-learning tools.
Accommodations for students with disabilities
Harvard Extension School is committed to providing an inclusive, accessible academic community for students with disabilities and chronic health conditions. The Accessibility Services Office (ASO) (https://www.extension.harvard.edu/resources-policies/accessibility-services-office-aso) offers accommodations and supports to students with documented disabilities. If you have a need for accommodations or adjustments in your course, please contact the Accessibility Services Office by email at accessibility@extension.harvard.edu or by phone at 617-998-9640.
Attendance - Class & Sections Participation:
Attendance: Please read the text-book chapter related to that day lecture before viewing the class so you can participate in the meaningful class discussion. This is a January course and it fulfills the degree residency requirement. This makes attending class during the live meeting necessary to get your participation points for that day.
Sections: There will be three weekly sections this January term (Friday, January 8th , 11 am – 12:30 pm, Friday, January 15th, 11 am – 12:30 pm, and Tuesday, January 19th , 6 pm – 7 pm). Sections will be on-line via the Zoom meeting. If you want to discuss more topics covered during the week or ask about upcoming assignments, attending sections as they happen will enable you to do that. Sections will be taped and it is highly recommended that you viewed them, as material presented in sections will be very beneficial to complete your assignments properly.
Course Outline and Schedule
|
Day
|
Reading
|
Topic
|
|
January 4
|
LMH: Chapter 1 - Understanding Lifestyle Medicine
|
Lecture: Introduction and Overview of Lifestyle Medicine
This introductory lecture will provide students with a framework from which to build. It is the skeleton on which we will add the muscles, skin, and clothes as the course goes forward. Starting from Hippocrates and moving forward, the forefathers of lifestyle medicine will be highlighted. We will explore how the development of vaccines and antibiotics changed the landscape of medicine and how the Industrial Revolution played a part in the spread of lifestyle-related diseases. In addition, the economics of lifestyle medicine will be addressed looking at the cost and burden of chronic diseases such as diabetes, obesity, cardiac disease, and metabolic disorder.
|
|
January 5
|
LMH: Chapter 2 - Empowering People to Change
|
Lecture: How to Evoke Behavior Change for self and those you care for personally and professionally
Coaching is the verb in lifestyle medicine. It is the way we evoke behavior change. There are distinct differences between being a coach and being an expert, which we will explore in-depth, looking at both doing and being skills. A coach has many tools in his or her toolbox and we will introduce some of the most important tools that empower the doing of coaching. These include the Transtheoretical Model of Change, Motivational Interviewing basic principles, Appreciative Inquiry, Goal Setting Theory, and Social-Ecological Model. Equally important are the being attributes of a coach, known as the “spirit” in motivational interviewing. The five A’s of counseling (assess, ask, agree, assist, arrange) and its evolution will be reviewed. We will consider the two approaches in theory as well as from a patient perspective. In addition, we will take a look at the medical literature to see what research has been performed in this area.
|
|
January 6
|
LMH: Chapter 3 -Collaborating, Motivating, Goal-Setting, and Tracking
|
Lecture: Goal Setting, Accountability, and Tracking for Lifestyle Medicine
To practice lifestyle medicine, one must practice setting goals that are appropriate for the patient and that patient’s stage of change for that particular behavior. Patients can be in different stages of change for different behaviors, and thus, the goals they set for the behavior will be different. Building self-efficacy, confidence that a person can complete a task, is critical in lifestyle medicine. Co-creating SMART goals are essential. SMART goals are specific, measurable, action-oriented, realistic, and time-sensitive. It is important to practice setting SMART goals so that patients can enjoy small successes and feel motivated to carry on with their lifestyle changes. It is important to appreciate the fact that the best goal is the one that the patient feels is important, the one the patient has confidence he or she can complete it, and the one that is SMART. The caregiver might feel that the patient should complete a goal that the caregiver feels is very important, but if the patient does not view that particular goal as worthy, important, or interesting, then the patient is not going to work towards that goal. Setting the goal is one piece of the puzzle and keeping the patient accountable for the goal is another piece. If no one is checking on the patient, then the patient might forget or just ignore the goal. We will explore effective strategies for holding people accountable for their goals.
|
|
January 7
|
LMH: Chapter 4 - Improving Health through Exercise
|
Lecture: Physical Activity Guidelines and Prescription
Starting from suggestions provided by Hippocrates, we will examine physical activity recommendations over the years. The most recent government guidelines provided by the Department of Health and Human Services in 2008 will be examined. Understanding the definitions and differences between types of physical activity will be stressed with a special appreciation for lifestyle exercise. The four parts of the exercise prescription (FITT= frequency, intensity, time, and type) will be introduced as a framework for exercise counseling while using the coach approach for behavior change. Lastly, the risks of exercise will be discussed with a focus on the American College of Sports Medicine’s algorithm for risk stratification, putting patients in a high, moderate, or low risk.
|
|
January 11
|
LMH: Chapter 5 - The Nutrition-Health Connection
|
Lecture: Nutrition Guidelines and Prescription
Eating patterns and guidelines have changed over the years. With new research come new recommendations and guidelines. We will explore the history of these guidelines over the years and determine where we are now as well as how we got here. We will review the Harvard School of Public Health’s Healthy plate and explore ways to utilize it in nutrition counseling. We will discuss how to use the coach approach when counseling on dietary patterns and habits as well as consider the use of nutrition prescriptions
|
|
January 12
|
LMH: Chapter 6 -Sleep Matters
|
Lecture: Sleep and its Effect on Health and Well-being
Sleep is often ignored and taken for granted. While people boast about how they only need 3 hours of sleep a night, researchers are demonstrating that sleep is connected to satiety hormones, mood, productivity, learning, and weight. We will review the basics of sleep and sleep cycles. We will review how poor sleep affects the human body and how proper sleep enhances the functioning of the human body. We will identify the factors that promote healthy sleep and identifying those factors that steal sleep. After stressing the importance of sleep for a healthy body, we will explore possible sleep prescriptions and strategies.
|
|
January 13
|
LMH: Chapter 7 - Stress and Resilience
|
Lecture: Stress Resilience
We will discuss a variety of definitions for stress. The negative impact that stress has on the body will be identified, and the positive aspects of stress will be considered as well. Stress has been the topic of scientific experimentation for many years. We will review the literature around stress, looking at some specific clinical trials from 25 years ago as well as from 2014. People cope with stress in a myriad of ways, and we will examine both the unhealthy coping strategies as well as healthy ones. Finally, we will discuss the concept of stress resiliency and consider ways to counsel towards this goal.
|
|
January 14
|
LMH: Chapter 8 - Peace of Mind with Meditation, Mindfulness, and Relaxation
|
Lecture: Relaxation, Mindfulness, and Meditation
Relaxation, mindfulness, and meditation have all been used to enhance health and well-being. We will briefly examine the history of these three tools and then explore each one separately. Starting with Dr. Herb Benson’s relaxation response, which is the bedrock of his mind-body medicine program at MGH, we will identify how to elicit the relaxation response and what happens to the body during this process. Mindfulness will also be introduced and its opposite, mindlessness, will be compared. Mindfulness-Based Stress Reduction programs from UMass and Jon Kabat-Zin will be reviewed. The ancient practice of meditation and its effect on the body will be described and demonstrated.
|
|
January 19
|
LMH: Chapter 9 - The Power of Connection
|
Lecture: The Connection Prescription
There has been evidence of the power of human connection ever since the bond between mother and baby has been acknowledged. There is a deep-rooted need for humans to connect with each other. In addition, connection to pets, especially dogs, has been researched in the medical literature and is so clearly beneficial that dogs are used as therapeutic agents in the hospital, in medical schools, and in elderly care facilities. We will review the medical literature and identify the benefits of connection to the body and the mind. Connecting with nature and one’s faith are other ways to enrich lives and to improve one’s state of well-being. After examining a variety of connections, we will determine how to counsel patients in this important area of their lives.
|
|
January 20
|
LMH: Chapter 10 - Positively Positive
|
Lecture: Positive Emotions: Laughter, Optimism, and Gratitude
Positive emotions play a central role in wellbeing. The relatively new field of positive psychology has demonstrated this through research, writing, and teaching. We will focus on laughter, optimism, and gratitude as gateways into positivity. The laughter prescription will be explored with emphasis on research demonstrating the physiologic effects of laughter, whether it be in response to humor or forced as in laughter yoga. We will define optimism and demonstrate its power to help transform lives. In addition, we will consider gratitude as a healing agent and demonstrate how it affects the mind and body of the person giving as well as the person receiving the gratitude.
|
|
January 21
|
LMH: Chapter 11 - Substance Abuse
|
Lecture: Smoking, Alcohol, and Addiction
Although rates of smoking are decreasing, it still represents a major lifestyle risk factor causing significant morbidity and mortality. Despite the advances made by pharmaceutical companies to discover drugs that can ease the pain of withdrawal for some patients, smoking continues to plague both patients and practitioners. Smoking cessation programs have evolved over the years and counseling strategies taught in medical schools have also changed. We will discuss the use of motivational interviewing for smoking cessation. Alcohol in moderation has health benefits, but on the flip side, alcohol can also cause distress, disease, and death. We will explore the recommendations released by the American Heart Association and review effective counseling strategies around alcohol consumption. Addiction to smoking and alcohol are major problems for the healthcare system. We will determine what it means to be addicted, and what we can do about it. In addition, we will introduce the concept of food addiction.
|
Assignments:
Discussion board: Required postings to the class discussion board due each week by the end of day Wednesday. Each week's discussion question will be posted by Monday morning. Guidelines for discussions will be given in discussion postings.
Research Article Analysis: First and second week of classes you will be required to find, read, and write about one scientific journal article related to topics covered during that week. Undergraduate students can choose, find, and read one of the articles listed in a References section after each course-book chapter (choose any from the references in chapters covered during that week). Graduate students will be required to do a little bit of research and find one article that is not listed in reference sections of the text-book but is related by topic to the chapters covered during that week. Graduate students will also be expected to provide more thoughtful scientific paper quality analysis. Instructions and grading criteria will be given in each week's assignment posting. Research article analysis write-ups will be due end of day Friday
Case Studies: Several case studies will be presented the first and the second week of the semester. They will be related to the material covered during that week. The patient case studies will be presented along with guiding questions, instructions, and a rubric before the corresponding week lectures. For each week you will choose one of the cases presented and work on it. Students will be required to submit their completed case studies electronically by the end of the day following Monday (i.e. for week 1 case study is due Monday, January 11, and for week 2 Monday, January 18).
Health Behavior Change Project/Final Project: The project will require students to identify a healthy habit that they want to work on incorporating into their lifestyle. It will include a personal vision, goals, action steps, and a final reflective progress report. Self-evaluation pre-assignment is part of this project and the final project grade. Beginning of each week, that week’s sub-assignment for the Behavior Change project will be posted and it will be due Saturday of that week (sub-assignment for week 1 due Saturday, January 9, and week 2 due Saturday, January 16). The final reflective progress report will be due by the end of the last day of classes (January 21).
Assignments Calendar:
|
Assignments
|
Due Date (end of the day)
|
Assignment Group
|
|
Pre-assignment 1: Introduce yourself
|
January 4 (Monday)
|
Class Participation
|
|
Pre-assignment 2: Self-evaluation
|
January 4 (Monday)
|
Behavior Change Project
|
|
Discussion Week 1
|
January 6 (Wednesday)
|
Discussion
|
|
Research article analysis 1
|
January 8 (Friday)
|
Research Articles Analysis
|
|
Personal vision
|
January 9 (Saturday)
|
Behavior Change Project
|
|
Case Study 1
|
January 11 (Monday)
|
Case Studies
|
|
Discussion Week 2
|
January 13 (Wednesday)
|
Discussion
|
|
Research article analysis 2
|
January 15 (Friday)
|
Research Articles Analysis
|
|
SMART goals
|
January 16 (Saturday)
|
Behavior Change Project
|
|
Case Study 2
|
January 18 (Monday)
|
Case Studies
|
|
Discussion Week 3
|
January 20 (Wednesday)
|
Discussion
|
|
Reflective Progress Report – final assignment
|
January 21 (Thursday)
|
Behavior Change Project
|
|