Noncommunicable chronic diseases (NCDs) are the leading cause of premature death and disability worldwide. Lifestyle medicine group interventions are effective in promoting behavior change and improving health outcomes. This study evaluated the impact of the PAVING THE PATH TO WELLNESS program among Okinawan descendants in São Paulo, Brazil. A longitudinal mixed-methods pilot study was conducted with 16 adults (≥18 years) from the Okinawa Vila Carrão Association. The 8-week group program included weekly sessions addressing purpose, attitude, variety, investigation, movement, stress management, nutrition, sleep, time, relationships, and goal-setting. Pre- and post-intervention surveys assessed health behaviors and literacy. A focus group was conducted at program completion. Quantitative data were analyzed using paired tests, and qualitative data were thematically analyzed. A convergent parallel mixed-methods design integrated both strands to enhance depth and validity.Pre- and post-intervention surveys show that statistically significant changes occurred in stress management (P = 0.034), nutrition (P = 0.034), energy (P = 0.008), experiences (P = 0.035), and goal-setting (P = 0.005). The Net Promoter Score was 93.7, indicating high satisfaction. Qualitative findings reinforced these outcomes. Taken together, these findings suggest that the PAVING pilot program was well accepted and effective in promoting health education, lifestyle changes, and reinforcing Okinawan cultural salutogenic resources, supporting its relevance for culturally adapted interventions.
Adolescents living in post-conflict communities face social, economic, and psychological challenges that may influence their health behaviors and overall well-being. However, evidence regarding health-promoting lifestyle behaviors among adolescents in these settings remains limited. This study aimed to assess health-promoting lifestyle behaviors among adolescents living in post-conflict communities and identify associated factors. A descriptive cross-sectional study was conducted among 420 adolescents aged 13-19 years attending secondary schools in Nineveh Governorate, Iraq. Data were collected using the Health-Promoting Lifestyle Profile-II (HPLP-II), the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and the Multidimensional Scale of Perceived Social Support (MSPSS). Data were analyzed using descriptive statistics, Pearson correlation, and multiple linear regression. Participants demonstrated moderate levels of health-promoting lifestyle behaviors, with a mean HPLP-II score of 132.4 ± 21.6. Interpersonal relationships and spiritual growth had the highest scores, whereas physical activity had the lowest. Health-promoting lifestyle behaviors were positively correlated with resilience (r = .52, p < .001) and perceived social support (r = .61, p < .001). Multiple linear regression showed that perceived social support, resilience, family income, and female gender were significant predictors of health-promoting lifestyle behaviors, collectively explaining 48% of the variance. These findings highlight perceived social support and resilience as important factors associated with healthier lifestyle behaviors among adolescents living in post-conflict communities. Interventions aimed at strengthening social support and resilience while addressing socioeconomic barriers may contribute to improving health-promoting behaviors and overall well-being among adolescents in post-conflict settings.
Current physical activity (PA) guidelines for chronic disease management (e.g., diabetes) are based on population averages and may not reflect physiological differences across racial/ethnic groups. This study investigates whether the association between PA and glycemic control varies among Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Mexican American (MA) adults. We analyzed weighted NHANES 2005-2006 data in adults aged ≥20 (n = 2354 unweighted). PA was measured via accelerometer (≥10 hours/day, 4-7 days) and glycemic control was assessed using HbA1c, categorized as normal (<5.7%), prediabetes (5.7%-<6.5%), and diabetes (≥6.5%). Questionnaire-reported sleep time was integrated with accelerometer-derived sedentary behavior (SB), light-intensity physical activity (LIPA), and moderate/vigorous physical activity (MVPA) to represent a 24-hour time-use composition. Weighted multivariate isotemporal compositional regression models were then conducted to estimate HbA1c across activity categories adjusting for confounders and stratified by race/ethnicity. Mean HbA1c differed by racial/ethnic groups: NHW (5.41%), NHB (5.78%), and MA (5.61%) (P < .01). At 30 min/day of MVPA, HbA1c was lower in NHW (5.28%) compared to NHB (5.62%) and MA (5.56%) (P < .01). Similar trends were observed at 20 and 0 min/day (P < .01). MVPA is associated with improved glycemic control, but the benefits vary by race/ethnicity. Findings suggest that PA benefits differ by race/ethnicity, indicating a need for more tailored guidelines incorporating additional lifestyle and contextual factors.
Adolescents have been identified as a population that receives inadequate nutrition counseling. Medical education for physicians and global policy implementation have aimed to improve this gap. The purpose of this study is to evaluate the effectiveness of these interventions by surveying families with adolescents in rural West Virginia (WV) regarding the nutrition counseling they are receiving at annual physician visits. Surveys were developed based on the US Centers for Disease Control and Prevention (CDC) Guidelines for Americans 2020-2025 to assess how often adolescents' physicians discussed nutrition topics during their annual visits. Inclusion criteria included families who had an adolescent in their household aged fourteen to eighteen years. These were distributed at two free food pantries in Morgantown, WV. At least 37% of families reported "never" discussing the 10 survey topics with their physician at annual visits. Counseling on limiting saturated fats and sodium intake was most often reported as "never" having been discussed. Despite emerging global policy and medical school interventions to improve nutrition education for physicians, the adolescent population in the studied community is likely not receiving adequate counseling. This highlights the need for practical, scalable strategies to be implemented in the clinical setting.
Dietary supplements are commonly used to support health and athletic performance. This article provides practical guidance for evaluating supplement quality, labeling, formulations, and ingredients, with particular attention to plant-based products. Creatine, caffeine, and beta-alanine are highlighted to illustrate differences in available formulations, dosing considerations, safety, and potential non-vegan ingredients. Health care professionals can use this information to help individuals select supplements that align with their health needs, goals, preferences, and values.
Background: Polyendocrine metabolic ovarian syndrome (PMOS) is a prevalent endocrine disorder affecting 10-13% of reproductive-aged women. Characterized by hyperandrogenism, ovulatory dysfunction, and metabolic disturbances, its management is increasingly focused on the gut-brain-ovary axis and chronic low-grade inflammation. This review examines current evidence for lifestyle-based, nutritional, and pharmacologic interventions in PMOS management. Methods: A review of current literature and clinical guidelines was conducted, focusing on pathophysiology, including genetic, hormonal, and inflammatory drivers, and therapeutic strategies. Results: Lifestyle modification remains the primary therapy, improving insulin sensitivity, menstrual regularity, and psychological well-being. Pharmacologic adjuncts like metformin and oral contraceptives address specific metabolic and reproductive symptoms. Nutritional supplementation, particularly a 40:1 ratio of myo-inositol to D-chiro-inositol, shows significant efficacy in restoring ovarian function. Emerging research highlights the role of gut dysbiosis in driving systemic inflammation and hormonal dysregulation. Conclusion: Effective PMOS management requires an individualized, multimodal approach that integrates lifestyle medicine with targeted supplementation and pharmacotherapy to address the complex metabolic and reproductive features of the syndrome.
This article is a narrative review that aims to explore the relationship between religion/spirituality (R/S) and lifestyle medicine (LM) pillars to examine if and how R/S influences health behaviors and inform whole-person LM practice. R/S influences multiple lifestyle behaviors through direct and indirect behavioral, psychological, and social pathways. The strongest evidence supports associations with avoidance of risky substances, stress management, and social connectedness. R/S is also associated with dietary practices and healthier eating patterns, although findings vary across religious traditions and measures of religiosity. Evidence regarding physical activity and sleep is generally positive but remains more mixed and less consistent across populations and religious traditions. Overall, R/S appears to shape lifestyle behaviors through health-related beliefs, meaning-making, coping strategies, spiritual experiences, community involvement, and behavioral norms. Because R/S can influence multiple lifestyle behaviors, recognizing and exploring patients' R/S experiences, beliefs, values, and practices is consistent with a whole-person approach to lifestyle medicine. Understanding these influences may help clinicians individualize recommendations that are both evidence-based and personally meaningful, supporting person-centered care while potentially enhancing engagement with and adherence to lifestyle interventions.
Introduction: Subjective health predicts mortality in older adults. We examined associations of vegetarian diet, adherence duration, and a Healthy Lifestyle Index with quality of life (QoL) and self-rated health (SRH) in adults ≥75 years. Methods: We analyzed cross-sectional data from 421 Loma Linda Longevity Study participants using ordinal logistic regression. Three hierarchical models were estimated: M1 (diet + sociodemographic covariates), M2 (M1 + diet duration + Healthy Lifestyle Index), and M3 (final fully adjusted model: M2 + BMI + multimorbidity). Moderation by adherence duration (<10 vs ≥ 10 years) was tested via interaction and stratified analyses. Results: The Healthy Lifestyle Index showed strong dose-response (highest vs lowest quartile: QoL aOR = 7.24, 95% CI: 3.31-15.85; SRH aOR = 4.69, 95% CI: 2.26-9.72; both P for trend <0.001). Among long-term adherents (≥10 years), vegetarian diet was significantly associated with better SRH (aOR = 2.11, 95% CI: 1.11-4.00, P = 0.022). In the fully adjusted model, the vegetarian association attenuated to borderline significance, with multimorbidity (for both outcomes) and BMI (for SRH only) emerging as stronger independent predictors. Conclusions: An integrated healthy lifestyle shows a robust dose-response with subjective health. Long-term vegetarian adherence is independently associated with better self-rated health in adults ≥75 years.
Dietary interventions can improve cardiometabolic health, however, affordability, sustainability, and efficacy remain a challenge. Full Plate Living (FPL) is a free, virtual, research-based, experience-centered nutrition program that has been shown to improve health. Here, we describe self-reported outcomes using FPL and highlight four participant cases. A cross-sectional survey was emailed to all 59,410 FPL members. They were invited to share their experience with FPL and their health changes in a long form interview. Descriptive statistics were performed. The majority of the 459 respondents were engaged with FPL for at least one year, with 33% engaging for two years or more. Health improvements were reported by nearly 60% of participants, with 22% reporting weight loss/maintenance, 13% increased energy, 9% better sleep, and 6% improved lab results. Four participants completed interviews as case studies and demonstrated an average weight loss of 33 pounds, a 3.3% drop in hemoglobin A1C, and reductions in liver function tests. Total cholesterol, LDL-cholesterol, and triglycerides decreased on average by 55, 38, and 165 mg/dL, respectively. We conclude that FPL is an evidence-based nutrition education program that is sustainable, adaptable, and effective in helping members lose weight and improve overall cardiometabolic health.
The full potential of lifestyle medicine has yet to be realized within the healthcare system, and it is hindered by the lack of systematic data collection focused on modifiable lifestyle factors that influence chronic disease. It is the position of the American College of Lifestyle Medicine (ACLM) that (1) current data collection practices at point of care are typically inconsistent across practice settings, electronic health record (EHR) environments, and specialties, limiting usability of data collected; (2) optimal data collection across all settings will demonstrate the effectiveness of lifestyle medicine (LM) for patient health improvements, enhance patient care, identify preventive and treatment strategies, illustrate cost-effectiveness, and establish performance measure standards for consistent evaluation, and supplement our national surveillance systems; (3) standardized data collection in the field of lifestyle medicine can include but is not limited to patient visit information, lifestyle-specific biometrics, anthropometrics, self-reported lifestyle behavior assessments, lifestyle interventions, patient goals, and when possible, reimbursement/healthcare claims data and patient experience; (4) a critical need exists for terminological codes for data capture and interoperability to integrate LM terminologies into existing biomedical terminologies, with an ultimate goal of national health digital infrastructure to support LM practice.
Traumatic brain injury (TBI) is a prevalent, chronic disease with heterogenous recovery and dementia risk. Poor brain health is associated with increased dementia risk, but brain health remains unexplored in TBI. Brain Care Score (BCS), a tool measuring brain health with physical, lifestyle, and social factors, has not been used in TBI. Retrospective cohort study of TBI-clinic visits in the Neurology Traumatic Brain Injury and Concussion Clinic (9/2022-10/2025). Inclusion criteria: ≥18yo, self-reported TBI, BCS, functional outcomes. Disability defined as Glasgow Outcome Scale-Extended (GOSE) <7. Among 185 patients (median age 45yo, 55.1% men, 76.2% mild TBI), 64.9% were disabled (mean GOSE 5.11 [SD: 0.80]) whom had lower BCS vs non-disabled (14.9 vs 16.8, P < 0.001). In multivariable analysis adjusted for age, sex, insurance status, Injury Severity Score (ISS), higher ISS was associated with greater odds of disability (OR = 1.06, 95% CI: 1.02-1.10, P = 0.006). Higher BCS was associated with lower odds of disability (OR = 0.779, 95% CI: 0.677-0.883, P < 0.001). We demonstrate feasibility of measuring brain health with BCS in a TBI clinic. Higher BCS is associated with lower disability risk. Future studies will investigate brain health as potentially intervenable risk factors for long-term disability in TBI survivors.
Objective: This integrative review applies Self-Determination Theory to synthesize literature on Health and Wellness Coaching (HWC) interventions for Chronic Obstructive Pulmonary Disease (COPD), mapping intervention components to the core constructs of autonomy, competence, and relatedness. Methods: We searched five databases (PubMed, CINAHL Complete, SCOPUS, Healthcare Administration, and PsycINFO). Inclusion criteria: (1) adult COPD-only population, (2) reported a clearly defined quality of life (QOL) outcome measuring intervention effectiveness, and (3) met all four HWC intervention components established in prior compendia. SDT guided data extraction, with the Mixed Methods Appraisal Tool (MMAT) evaluating study quality. Results: Ten distinct HWC interventions were evaluated across 17 studies published between 2009 and 2022. Of the eight studies reporting positive QOL outcomes, all used Motivational Interviewing (MI) practices. Three of four studies showing no significant QOL improvements did not explicitly report use of MI. Interventions that did not purposely address psychological barriers (depression, anxiety, apathy, perceived futility, and fear of dyspnea) were less consistently associated with positive outcomes than those that did. Conclusion: Effective HWC interventions supported autonomy through MI-informed, flexible goal-setting; built competence by addressing psychological barriers (depression, anxiety, fear of dyspnea) alongside disease knowledge and skills training; and fostered relatedness through empathic coach-patient relationships.
Purpose: Reimbursable in-person Shared Medical Appointments, where multiple patients meet with a provider to receive general education and individualized care, are effective at reducing glycated hemoglobin A1c (HbA1c) for patients with prediabetes and type 2 diabetes mellitus. There is little research on improving HbA1c control using Lifestyle Medicine Shared Medical Appointment (LMSMA) series, especially with virtual sessions. Setting: We describe the glycemic outcomes of a virtual LMSMA series for patients with prediabetes and type 2 diabetes mellitus in an academic primary care setting. Intervention: The intervention group consisted of patients attending ≥1 virtual LMSMA session; the control group was propensity-matched patients who were referred but did not schedule. Outcomes: The intervention led to a non-significant 0.09% greater HbA1c reduction (95% CI: -0.32, 0.14) vs control. However, intervention patients were 9% (95% CI: 1.01-1.17, control 85.3% vs intervention 91.4%) more likely to achieve HbA1c <7.0% approximately 1.5 years after the intervention and, in the setting of similar antihyperglycemic medication doses as baseline, had 0.51 fewer active antihyperglycemic medications over follow-up vs control patients (95% CI: -0.96, -0.06). Lessons Learned: These findings support further exploration of virtual LMSMA series as a care delivery strategy for improving blood sugar control.
Lifestyle medicine (LM) takes an evidence-based approach to the prevention and management of many conditions affecting women; however, no dedicated competency framework currently guides its application across the life span. We aimed to develop a comprehensive set of core competencies for women's health-focused lifestyle medicine. Building on existing American and International Boards of Lifestyle Medicine (ABLM/IBLM) frameworks, we convened an international, interdisciplinary expert committee including physicians from obstetrics and gynecology and primary care, representing the United States, Asia, the Middle East, and South America. A modified Delphi process was used to evaluate consensus on proposed competencies, with agreement assessed on a Likert scale with defined terms for consensus. All 7 committee members completed the Delphi survey, and all 73 competency statements reached consensus. The final framework comprises 73 competencies organized into 11 categories: fundamental knowledge; the 6 lifestyle medicine pillars; clinical assessment and management processes; behavior change strategies; mental health; and contextual determinants, including social determinants of health and trauma-informed care. This consensus-derived framework provides the first structured foundation for integrating lifestyle medicine into women's health education, clinical training, certification, and practice. Its adoption has the potential to advance more equitable, preventive, and person-centered care for women globally.
Noncommunicable diseases (NCDs) remain the leading causes of morbidity and mortality in the United States, yet adherence to recommended physical activity and dietary behaviors remains suboptimal. Authors of this study examined associations between physical activity, diet, and selected NCDs among United States adults. Data were drawn from the 2024 Health Information National Trends Survey, a nationally representative cross-sectional sample of United States adults aged ≥18 years. Survey-weighted analyses examined self-reported diagnoses of diabetes, hypertension, heart disease, and lung disease in relation to aerobic activity, strength training, and fruit and vegetable intake. Bivariate analyses assessed sociodemographic differences, and multivariable logistic regression models estimated adjusted odds of not being diagnosed with each condition. Mean body mass index was 28.8 kg/m2, with 35.8% of respondents classified as obese. Few respondents met guidelines for moderate-intensity exercise (36.3%), strength training (38.4%), fruit intake (19.9%), or vegetable intake (28.0%). Meeting aerobic activity guidelines was associated with higher odds of not being diagnosed with diabetes (adjusted odds ratio [aOR] 1.33; 95% CI, 1.04-1.69) and hypertension (aOR 1.49; 95% CI, 1.15-1.93). Strength training was inversely associated with lung disease (aOR 0.66; 95% CI, 0.49-0.89). Fruit intake also was associated with lower odds of lung disease (aOR 1.97; 95% CI, 1.17-3.30). Younger age, healthy weight, and higher income were consistently associated with lower odds of NCD diagnoses. Aerobic physical activity demonstrated the most consistent protective associations with diabetes and hypertension, while diet and strength training showed condition-specific relationships. Improving adherence to lifestyle guidelines may reduce NCD burden and persistent disparities.
A growing number of women in the United States are cancer survivors. Behavioral and lifestyle factors are important components of health during and after cancer treatment and are modifiable with sustained behavior change. In this review, we summarize published evidence on the associations of the American College of Lifestyle Medicine’s 6 lifestyle pillars—nutrition, physical activity, stress management, avoidance of risky substances, restorative sleep, and social connection—with survival and cancer recurrence among female cancer survivors and on the effects of interventions to modify each pillar in this population. We found that most of the 6 pillars have been associated with mortality and recurrence in large observational studies. Physical activity interventions have been associated with the broadest range of health benefits among female cancer survivors, including improved quality of life, cardiorespiratory fitness, physical functioning, mental health, sleep, and survival. Cognitive behavioral therapy and mindfulness-based relaxation, including mind-body exercises such as yoga, have also consistently shown efficacy for improving sleep and mental health. More work is needed to identify effective interventions for diet, alcohol and tobacco use, and social support and for improving maintenance of lifestyle changes. Implications for integrating behavioral and lifestyle medicine into clinical oncology are discussed.
Lifestyle Medicine (LM) is increasingly recognized as a foundational approach to the prevention, treatment, and potential reversal of chronic non-communicable diseases through six core pillars. However, translating these pillars into a consistent, practical, and scalable framework for clinical practice, education, research, and community engagement remains a challenge. This paper introduces the DREAMS (Diet and Nutrition, Relationships and Social Connectedness, Exercise and Physical Activity, Avoidance of Harmful Substances, Mental Wellbeing and Stress Management, and Sleep Optimization) framework as an integrative, operational approach designed to unify and apply the six pillars of LM. Structured as a memorable acronym, the framework has the potential to enhance recall, support education, and facilitate delivery of crosspillar multimodal lifestyle interventions across diverse settings. The DREAMS framework offers a practical pathway for advancing the implementation and global impact of LM and provides a foundation for future research and evaluation.
Obesity in women of reproductive age is a major and growing contributor to adverse pregnancy outcomes and long-term cardiovascular disease (CVD). Pregnancy is increasingly recognized as a physiological stress test that can reveal underlying cardiometabolic vulnerability. In this context, obesity amplifies risk through inflammation, endothelial dysfunction, and metabolic dysregulation. A life-course approach to prevention identifies preconception health as a critical and actionable window for intervention. Lifestyle medicine, through its core pillars of nutrition, physical activity, sleep, stress management, avoidance of harmful substances, and social connection, offers effective strategies to optimize cardiovascular health before pregnancy. Integrating structured lifestyle interventions into preconception care has the potential to improve maternal outcomes, reduce long-term cardiovascular risk, and promote intergenerational health.
