Sometimes, it takes a long time for academics to catch up with popular knowledge as their need for evidence delays their willingness to promote what many of us already know is good advice on healthy living. Such is the case with the academic discipline of lifestyle medicine, still a fledgling subject in undergraduate medical schools, yet it touts information that many nutritional therapists, life coaches and other healthy living advocates have been telling us for years.
Assistant clinical professor at Harvard Medical School and wellness coach, Dr Beth Frates was in Dublin recently to explain this new academic subject of lifestyle medicine. In a public lecture and seminars to students at the Royal College of Surgeons of Ireland (RCSI), she shared her knowledge and experience of healthy living.
“The six pillars of lifestyle medicine are exercise, sleep, food, stress management, smoking cessation and alcohol moderation,” she explains. She says that there is a five-step cycle for health professionals to empower people to make healthy lifestyle changes. “Step one is to express empathy and understand the person. Step two is to find out what motivates them. Step three is to find practical ways to introduce changes (starting with what they want to address first). Step four is to report on their progress and step five is to give them empathic support,” explains Dr Frates.
She says that she is driven by a love of people and curiousity about human nature. In her public lectures and podcasts, Dr Frates offers tips for healthy living, many Irish people will already be familiar with. These include getting 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity every week; Eating more plant foods (and therefore less processed foods) including fruit and vegetables, nuts, seeds and beans [the Harvard Medical School healthy eating plate is filled with one quarter proteins, one quarter wholegrains and one half vegetables]; taking regular five minute walking breaks if you work at a desk and sleeping for seven to eight hours every night in a cool bedroom with electronic devices switched off. She also advises people to spend time with those who energise them rather than those who drain their energy. “Lifestyle medicine is not a quick fix. It’s a journey that lasts a lifetime,” she says.
I teach my boys the growth mindset where every misstep is an opportunity to learn
Now 51 and married with two teenage boys, Dr Frates is the picture of good health herself. She says she is an avid runner who eats a wholefood diet and practises yoga and deep breathing exercises. She did a mindfulness based stress management course when she was 43 which she describes as having been “transformative” in terms of managing her own stress. “I’ve learned that life itself is a journey and I teach my boys the growth mindset where every misstep is an opportunity to learn and grow,” she says.
In the public lecture at the RCSI, she shows photographs of alternatives to the office chair and desk such as a treadmill under a desk, a desk with pedals underneath, a physiotherapy ball instead of chair (which she uses herself) and a conference table in the form of stationary bicycles grouped together. All because “sitting is the new smoking and exercise is medicine”.
Dr Frates didn’t mention the simple challenge of using the stairs instead of lifts but she did say that in her private wellness clinic, she sometimes walks with her clients instead of sitting with them. And, she emphasised the importance of social connections, flow [how you concentrate better when stimulated by your work] and laughter for both physical and mental health. “It’s all about having a peaceful mind, a joyful heart and healthy body,” she says.
Her personal motivation for this work comes from her experience as an 18-year-old when her father had a heart attack and stroke at aged 52. Then studying business and planning to join the family business, Dr Frates – then Elizabeth Peg – turned to study psychology and biology instead and trained as a specialist in physical medicine and rehabilitation (physiatry). She proudly explains how her father, with the support of her mother, turned his life around and moved away from a workaholic lifestyle fuelled by fast food to a more balanced life fuelled by healthy fresh foods and daily exercise.
"His experience informed my career, my life work and purpose," she says. Dr Frates runs wellness groups for people who have had strokes at the Spaulding Rehabilitation Hospital in Charlestown, Boston, Massachusetts. In 2006, she co-authored Life After Stroke: The guide to recovering your health and preventing another stroke (John Hopkins University). And, she is the co-author of the recently published academic textbook, Lifestyle Medicine Handbook: an introduction to the power of healthy habits from the American College of Lifestyle Medicine.
She suggests that medical doctors may need to work with dieticians, exercise and behaviour management specialists to help people with chronic conditions to make beneficial lifestyle adjustments. “Not all doctors are empathetic and they need to be trained to ask open-ended questions or give powerful reflections back to their patients. Coaching patients is [still]not taught in medical school,” she says.
Thanking her for her public lecture, Professor Cathal Kelly, chief executive of the RCSI says, "we want to extend the scope of practice of our doctors with a focus on wellbeing and life skills. Doctors who do aerobic exercises themselves will recommend exercise. And doctors need to demonstrate a model of wellness to best serve their patients."
Doctors need to demonstrate a model of wellness to best serve their patients
So it’s clear then that it’s only when the health professionals have studies that validate the importance of nutritious food, a healthy mindset, adequate sleep and regular physical exercise, will they share this knowledge with their patients.
And, perhaps it’s only when they embrace this healthy lifestyle themselves, will they passionately prescribe things like walking in nature, eating more wholefoods and developing good sleep habits to people with chronic disease whose health would benefit greatly from these lifestyle adjustments.