Good morning everyone. Thank you so much for joining us. We are going to be doing Lifestyle Medicine 101. What is it and how you can get involved. We wanted to do brief introductions of ourselves. My name is Stacey. I'm from Houston, Texas. Born and raised. I did my medical school at University of Rochester and I did my I'm currently a PGY3 at Baylor College of Medicine in Houston, Texas. Hello everyone. Good morning. I am her twin. I'm Tracy. We're the Cedars twins and I also did my residency at Baylor College of Medicine and then Sports Medicine Fellowship at Cornell and now I just started as faculty last week at Columbia. And good morning everyone. My name is Emily Pinto. I did medical school at Campbell University down in North Carolina and now I'm at VCU and I'm a PGY4 serving as co-chief resident at our PM&R program and excited to be here. We also wanted to have a shout out to Dr. Raj who helped us with our project as well. So thank you all so much for joining us this morning and also thank you to our panelists as well who you'll get a chance to speak to and hear from at the end of our presentation. And the way that we have this set up is we'll do a brief overview of what lifestyle medicine is and then a lot of it will be focused on Q&A with our panelists who are here today and then we were also able to have them join in virtually through the videos. No disclosures. And as an introduction, lifestyle medicine, it uses evidence-based therapeutic lifestyle interventions and it incorporates more of a holistic approach and the main things is that it prevents, treats, and possibly reverses chronic diseases. The reason why I like this so much is that at Rochester we're very much focused on the biopsychosocial model of treating patients so this very much fits well with that. So there are six pillars of lifestyle medicine as you can see on the slides here. One of them including restorative sleep. So I hope that after last night we all had some really good sleep and thank you all for being here so early in the morning. So we appreciate that. Hope you got your caffeine and your coffee or tea. Another one of the six pillars of lifestyle medicine is stress management and you know us being physicians we do encounter a lot of stress in our life both personally and professionally in our careers so it's important for us to be able to identify what causes our stress, what those risk factors are, and how to mitigate those stress factors. And then of course positive social connections as well as avoidance of risky substances including alcohol. Everything in moderation. So one of the big organizations that we're going to be talking about today is ACLM and this is how you join. As a physician, MDDO, you can join for $249 a year for the membership. If you're a healthcare executive member they can join for also $249 a year and student trainees can join for $55 a year. The main thing that we also want to focus on is the education. So how do we get lifestyle medicine in residencies and this is one of them. It will mainly consist of 40 hours of didactics which is more of the educational portion and then the secondary portion would be more of the practical skills and that'll be doing clinicals and getting involved in the community. And so for the practical skills they have a minimum of 400 patient cases that you are suggested to complete and that way once the residents finish that, which can be done over a course of one year to three years, then they become eligible to sit for the boards. So here are the types of programs implementing the lifestyle medicine residency curriculum back in 2021, so just last year. And as you can see that's highlighted in the red box below or red box on the right side of the screen. For PM&R there were only two residency programs in the nation that did have the residency curriculum. So it really exploded in 2022. We have so many more programs with this lifestyle medicine curriculum seen here. So we have really expanded and we really think that this lifestyle medicine curriculum will infiltrate into a lot of different programs in the coming years. And it makes sense too because a lot of what we do as PM&R physicians is we do incorporate a lot about quality of life and function. And as we were suggesting earlier with the six pillars, nutrition, sleep, and then diet and exercise, all of those things help factor into how we take care of our patients. So it very much flows into what we already are doing in our practice. And in terms of how do we incorporate the lifestyle medicine curriculum in the residency programs, there is a fee that they ask for to sign on. It would be $5,000 from the department. And then to keep on doing it every single year it's $1,500. And that's more of the investment that they do with the ACLM. So in terms of the lifestyle medicine residency curriculum, these are ten of the different modules that are available or as part of the curriculum. And I'm not going to read everything to you, but just to give some snippets. One of them, of course, is the role of the physician health and the physician's personal health. So just like we are talking about physician wellness and promoting physician wellness and tackling physician burnout, it's important for us as physicians to also do self-care so that we can take care of ourselves, so that we can take care of our patients and of others. So that's one of the modules in the residency curriculum. Another one is, of course, physical activities, physical activity science and prescription, again, sleep health, managing tobacco cessation and other exposures such as alcohol, emotional and mental well-being, and a lot of connectedness and positive psychology. So again, a lot of these modules, as Stacey was mentioning, are a lot of things that we already do as physiatrists or physiatrists, and so it seems very seamless in order for us as PM&R to incorporate the lifestyle medicine curriculum into our residency programs. So for the education component, there is a clinical aspect for clinical patient encounters to get with this curriculum. So it's 400 patient encounters that can be inpatient, outpatient, but you're addressing these six pillars of lifestyle medicine with these patients. You can be doing food, sleep diaries, those types of things, really focusing on lifestyle habits and how we can modify their behaviors in this regard and help them through this. It can be this lifestyle medicine approach in inpatient or outpatient clinical care settings as well. Assessment interventions, we're talking again, nutrition, physical activity, exercise, prescriptions, emotional and mental well-being, substance use, helping them success from alcohol, tobacco, and preventing and treating and sometimes reversing some of these chronic diseases that we're seeing plague our society. And then a huge part of it, the one part that I really, really like about lifestyle medicine, is that it brings the physician on side as a coach. And so the physician and patient interaction is so important. We all know this as physicians, but really having that extra training on how do I coach someone, how do I make a difference in their lives, is all included in this curriculum, which is a really awesome thing. In addition, these also are offered by ACLM as complimentary webinars to help us get our feet and just wet into what is lifestyle medicine and how you can get more involved. So some of these, including as physicians, yes, we love to take care of our patients, but how do we get reimbursed for it? How can we do diagnostic billing and coding for that? And so that's one of the webinars that they have here. In addition, for those who are in the academic practice or institutions, how do we incorporate these into academia? And then also in the workplace as well. So again, these are highlighting different aspects of what lifestyle medicine is, how can we incorporate it into our workforce, and then also into our practice. And in terms of certification, there is the Board of Lifestyle Medicine. In order for anyone to sit for the boards in November and December, they have to have registered by September 30th. And these are the dates for next year, not for this year. The eligibility for those who are already in practice, they must be practicing for at least two years or already have been and have already been certified in Pumanr. And then for residents, they must have already completed the residency curriculum and then they can immediately take the board exam after they graduate. So for those who already, you know, as we mentioned in one of our previous slides, there are seven residency programs that already have the lifestyle medicine curriculum incorporated into their programs. So for those residents who are interested, they can immediately take it after upon graduation. They do not have to be boarded in part one or part two. But for those of us physicians who are already in practice, we do have to at least have been in practice for two years. But the actual certification will be issued after they've already gotten their certification from Pumanr. So in terms of fees, because of course things cost money, but to sit for the boards, you do have to pay $299 for the actual registration fee. And then as a member for the certification fee, you have that added on for a total of about $1650. And then in terms of what is the exam like, it is a four-hour exam, 150 questions each. We've all taken step one and step two. That's like eight hours or nine hours. So this should be okay. And then in terms of after you pass it, it lasts for ten years. Or there is an option to do ongoing certification, which is annually. You can take some CMEs and then there's ways to still get involved that ways. So in terms of lifestyle medicine interest groups, here's the map of the U.S. And all these blue dots are the different locations where they do have these interest groups. So you can identify where your state is and then see where's the nearest interest group located to you. And if there isn't one, then you can reach out and be the first to start. And this is one of the places where you can start here to learn about lifestyle medicine. And then also you've got our resources from our panelists. So we hope that you do consider starting a lifestyle medicine curriculum or an interest group. So how do you even do that? Like how do you get an interest group? So the first thing is find an advisor. Someone that can really help guide you. And in the time of internet, we have so many resources that can connect with you online and through like a Zoom that we all are familiar with, right? So you can identify an advisor either locally or further away. And there is a toolkit online that you can look at and really just get a bunch of your peers together. And peers come together, talk about lifestyle medicine, and you guys can all serve in a leadership role in that right just by learning together and creating a community. There's an orientation you can apply July, October, March. And this is an opportunity to connect with the region. Regional groups exist for lifestyle medicine groups. And again, all about building that community, that social connection, part of the pillars, and learning about hosting, leadership process, all of that. They do three sessions over one month during those months. And if you're interested in the interest group, there is a email address at the bottom of this slide that you can contact from former info. So this is an example of the lifestyle medicine interest group toolkit that they have. They do provide you with a lot of the resources available to help kick-start that. And they want to make it as easy as possible to go ahead and start these interest groups. So this is just a snippet of the welcome packet that they have. In addition, we all have social media, or maybe we do. And so here are some different places where you can go on social media, Facebook, Twitter, Instagram. You can do your hashtags, you can do your at your everything. So if you do have any questions, then you can always find more information via these hashtags as well. And this is a really cool opportunity. There is a grant out there, and all you have to do is apply. But basically, you get $500 to serve plant-based food at a lifestyle medicine event. And it could be, excuse me, $250 to $250, but you can get that four times a year up to $1,000. So pretty cool. One grant per event, you just have to apply 30 days before. So that's a really awesome thing. All you have to do is describe how your event is going to incorporate plant-based food, nutrition, lifestyle medicine. And if you have the lifestyle medicine interest group, they can apply for the $500 grant. It's a nice way to really incorporate and try to get people more interested in lifestyle medicine. So this is one of the ways they're helping to facilitate that. And for any of the residents or medical students who are interested in this as well, they do have a trainee executive board. And so these are going to be, their main mission is, again, we're trying to advance lifestyle medicine. And we're doing that through the interest groups. And in addition to doing any kinds of networking events, a lot of education, really trying to incorporate it as early as we can into the medical education system. That way, as we advance in our training, we can sort of help others as well. And then we talked about the social media. So this is the social media link and then the contact information for those who are interested in pursuing that. And this is an example of the 2022 executive board for the residents and for the fellows. And so as you can see, they have positions such as VP of Education, of Research, Development, and Liaisons, and also with Partnerships. So these are some of the leadership positions that, as trainees, you do have the opportunity to be involved in on the national scale. And one of the great things, too, is that this is a very interdisciplinary. So it's not just PNR. You have other people from different specialties. Internal medicine, emergency medicine, family medicine. Like it's a lot of people who are engaged and who really, really believe in lifestyle medicine. You get them to come together and then we form all these wonderful things. Yeah. And this is their Instagram account for the ACLM trainees. So you can follow them, get some more information, and follow them on social media. And this is an example of what they have currently on their social media posts. This is taken from Instagram and on the side where it has posts. It all shows all the different things that they have done in the past. And then as they do more events, then they update those on social media. So you can see, again, we talked about nutrition. On here, they have plant-based diets and weight management. Again, ties back to one of the grants that they have available for those to incorporate plant-based diet and nutrition within the systems. So another aspect of how to get involved is with research. And so there is a conference. This year it is in November in Orlando. And the abstracts were already due. But then once this conference is completed, then they'll have the updated version or the updated deadlines and dates for next year as well. So if anyone is interested in advancing the field of research for lifestyle medicine, they do have multiple opportunities in order to do so. And just kind of diving into what can you really do with your research topics. We just wanted to highlight that people are doing nutrition research, physical activity research, behavioral health, clinical, looking at specific diseases and how lifestyle changes can make a difference, and looking at the social connection, the connectedness and health. Pretty much any of the pillars, if you have research that ties to one of those or you can tie it to one of those, then it would be appropriate for this type of conference. And these are more research topics that you can do it. So as you submit your abstract, they'll ask you to select which research topic are you going to be putting it under. And then afterwards, which we'll talk about later in our presentation, they'll ask you to choose which track. And so the way I was trying to figure out, oh what's the difference between a topic versus a track? In PM&R, if you think about like track is sports medicine, pain, cancer rehab. So sort of the main big umbrellas. And then as you go deeper, like for example within sports, is it ultrasound? So to get an idea of how this sort of relates to how we do our research and conferences in PM&R. So these are examples of more research topics that can, that you can apply for whenever you do your research, so an abstract submission. And then as Stacey was mentioning, these are the different tracks. There are four of them for the allied health professionals. You have one for the science of lifestyle medicine and how-to, or the how of lifestyle medicine. So there's a lot of different tracks or umbrellas, where if you are interested, you do have the ability to decide where your research falls into. And this is our references, lifestylemedicine.org. There's a ton of stuff on there. I hope that this presentation kind of give you some resources that you can look back at. And now we're gonna start the fun part. We're gonna have Q&A with our panelists. So they're gonna answer most of these questions. The introduction, how do they find out about lifestyle medicine, how do they incorporate it, and any tips for any of us who are interested in it. But before we go ahead and start with our panelists, we do have three videos. We have three of our faculty members who would have loved to join us this morning, but are gonna join us virtually. So they had pre-recorded videos, and we're just gonna play those through. And then after that, we'll have our panelists who are here right now, and then we'll go ahead and go from there, and we'll open it up to the floor. Welcome. I'm Dr. Beth Brady's assistant professor at Harvard Medical School, part-time. I'm also the president-elect of the American College of Lifestyle Medicine. My hometown is Scarsdale, New York. I then went off to Boston for college at Harvard. Across the country, the Stanford for Medical School came back to Boston for my internship or transitional year at Mass General Hospital and Internal Medicine, and finished up my residency in Physical Medicine Rehabilitation at Spaulding Rehab Hospital, which is the Harvard Medical School Department of PM&R. I was chief resident and really enjoyed my residency as part of AAPM&R and the RPC and the AAP and developed a community of physiatrists across the country. It was after graduating that I focused in on stroke. My father actually had a heart attack and stroke when I was 18, which is the reason why I went into medicine in the first place. And I was very interested in how to prevent heart attacks and strokes since the age of 18. My thesis was on mental stress and its impact on the heart, looking at the EKG and thallium scans. Then when I was at Stanford for medical school, I looked at the impact of diet on endothelial cells. And it was during my residency that I studied a survey study, actually prepared a survey study at Spaulding with my colleagues and attending Joel Stein and fellow residents. And we asked family physicians if they exercised, we asked them if they did strength training, if they did aerobic exercise. And then we asked them if they counseled on exercise, if they counseled on strength training, if they counseled on aerobic exercise. And we saw that physicians that strength trained counsel on it, but physicians that don't strength train don't counsel on it. Same for aerobic activity. Found that fascinating, that was published in 2000. After that, with my stroke research, I looked at knowledge, expectations of patients and family members post-stroke and found there was a significant education or understanding gap. They were in the hospital for almost four weeks, but didn't have a great grasp of their recovery process or even what they would be doing to prevent another stroke. So this was an opportunity to write a book. And I did coauthor a book with Joel Stein and Julie Silver, fellow physiatrists at Spaulding. And we looked at stroke prevention. So my job was to look at exercise, nutrition, stress resiliency, what I was passionate about. And I spent a significant amount of time researching this on my own. After the completion of the book, I spoke at multiple different venues, almost anywhere they would have me, I would sign up to give the talk, to share the knowledge. I remember going to one of our PM&R meetings at Spaulding and Eddie Phillips, who you've heard from today, I know, and we just co-presented yesterday, was there. And he talked to me about my book. And he said, you know what you're doing, Beth? You're doing lifestyle medicine. I said, what's that? And he described it to me. And from that moment onward, I've been devoted to lifestyle medicine. I have been taking coach trainings. I've now done four or five actually, and have a motivational interviewing certificate. It's become my passion, how to counsel and motivate people to change. And I have been working with stroke survivors in groups with their family members to empower them to adopt and sustain healthy living, focusing on the six pillars of lifestyle medicine, exercise, nutrition, sleep, stress resiliency, social connection, and avoidance of risky substances. And I have been teaching. I started teaching when I was a resident here at Harvard, and I continue to teach in the core curriculum and outside of the core curriculum. And for me, devoting my career to lifestyle medicine, I started the Lifestyle Medicine Interest Group at Harvard. And this was a wonderful way for me to share information in a parallel curriculum with the medical students. And then I shared my process with American College of Lifestyle Medicine and created some documentation with the trainees at ACLM, so that others could easily adopt a Lifestyle Medicine Interest Group. If you don't already have one in your medical school, definitely contact me, because I'd love to help you get one started. We're trying to hit all 200 medical schools in the country. And I have been teaching in CME courses at Harvard and throughout the country, as well as internationally in Korea, in the Philippines, in Malaysia, in Brazil, in Peru, in Italy. With Zoom, it's easy to be in all these places in the same week. At any rate, just for me, sharing the information with colleagues and helping them fill their gap in nutrition, exercise, stress resiliency, and sleep education is very important for me to do. And I also enjoy trying to get these concepts into Harvard Medical School and other medical schools in collaboration with colleagues and teach college students at the Harvard Extension School, master's students, PhD students, some physicians even take the course, a full course, a full college course, master's level course on Lifestyle Medicine. I enjoy writing. I enjoy writing handbooks. I have three Lifestyle Medicine handbooks, the Teen Lifestyle Medicine handbook, the Lifestyle Medicine handbook, and Paving the Path to Wellness for Lay People. It's a workbook for them to utilize during group visits or also on their own if they can't attend a group visit. I enjoy research. I have been doing some research on my methodologies with the Paving the Path to Wellness for Stroke Survivors, as well as on some of my educational efforts to see if there are any outcomes there. Ultimately, the goal is that Lifestyle Medicine becomes mainstream, so we get it even into middle schools. All public middle schools in the United States would be using the Teen Lifestyle Medicine handbook and children would be learning the importance of sleep, stress resiliency, deep breathing, exercise, strength training, and why it's so great for you and delicious, too, to consume fruits and vegetables and whole grains and what fiber does to the microbiome by creating short-chain fatty acids and why are those important. Get people excited about their own physiology and how they can have an impact on their longevity. As president-elect of the American College of Lifestyle Medicine, I hope to advance the field in all areas in terms of research, have larger clinical studies, have them occur for long term, 10 years, 20 years, try to get those up and running. Clinically, get reimbursement for our work in Lifestyle Medicine. Education, get Lifestyle Medicine into every medical school and into residency curriculums as much as we can. Continue with the CME courses. And then I like to think about the community as well. How can we help educate our communities, our underserved communities? There is an LM101 curriculum that can help you to learn the basics of Lifestyle Medicine. You can download this at the American College of Lifestyle Medicine. You just search LM101 curriculum. You can also use these slide decks. There's 100 slides for 12 slide decks and pull out the slides you want to teach your own community or your fellow students. If you're going to get into the middle school, there is a teen Lifestyle Medicine curriculum at the American College of Lifestyle Medicine that you can also download and use those slides when you're teaching the teens. And you can accompany these with the handbook. Makes it an easy way to teach. I hope that this is helpful. I hope that you can join me in this wonderful journey of spreading the good news of Lifestyle Medicine. Thank you. Eddie Phillips Hi, this is Eddie Phillips greeting you. I'm sorry that I couldn't stick around at the conference to be there live. But I wanted to share a little bit of my background and interest for many years now in Lifestyle Medicine. I went to medical school at SUNY Buffalo, where we had a very strong PM&R department. So I was thankfully exposed to the field of physiatry. And I was particularly drawn to the idea that we could be exercise or muscle doctors. And with that went off to Columbia Presbyterian, where I was well trained. Spent the next three years after that at Beth Israel in New York, doing general rehab inpatient outpatient with Erwin Gonzalez, and then moved up to Boston, where we got the Harvard department started. I got there in 95. By 96, 97, we had launched the Department of Physical Medicine and Rehab. So my interest in even going to medical school was briefly that I really wanted to learn about health. I wanted to learn about exercise and about what to eat. And I'm not sure I even was aware that stress was such a big thing. I guess I had read Harvard Benson's book about the stress response. I learned a little bit about smoking, but not really a lot about exercise. We would joke that in medical school, stress was an experiential course that, of course, many of us have gone through. So with all of that, once I moved up to Boston, got interested in some fundamental questions about motivation and started off writing as early as, I think, 2002, analyzing how one might motivate individuals who find themselves on a rehab unit. They were just riding their motorcycle one day, necessarily motivated to go to the gym or to follow a lot of health habits recommended. And next day, they're on a rehab unit. We were asking them all sorts of things. From there, it broadened a little bit to an interest in motivation for exercise. Is there a science to it? And in those days, it was still evolving. I then connected with Margaret Moore, who in 2004, we met at American College of Sports Medicine meeting and quickly realized that we were both interested in the same thing. She was developing the field of health and wellness coaching, which has since become a profession with a national board. And they really provide a lot of the support when we try to get our patients motivated or going in the right direction. And we wrote through Harvard Medical School lifestyle medicine for weight management. So these are early days in 2005 as an online training program picked up by people from over 115 countries. And one of them was India. And that led to an invitation to run a Harvard Medical School course in India in March of 2006. Went to four cities across the country. I came back and after about a year and a half, founded now 15 years ago this month, the Institute of Lifestyle Medicine within Spaulding Rehab Hospital, which is an affiliate of Harvard Medical School. And the premise of the Institute of Lifestyle Medicine was that maybe we could retrofit the doctors, those that would come to a CME program with all of the knowledge, skills, tools, and self-care that would be needed for people to fully understand lifestyle medicine, all of the different behaviors, but also to try them. And some of the skills, some of the main ones are knowing how to best talk to our patients. So we set out to do that. Started with the CME world and have since run, was in track, I think 26 in-person and now virtual conferences every year. I'll give a brief shout out for folks to consider joining us at the Harvard Medical School Lifestyle Medicine Conference. It'll be live, but online. So in real time, but virtual June 9th and 10th, 2023. So just look up HMS CME Lifestyle Medicine, and you'd be able to find us. And I love having fellow physiatrists at the conference. So we've been doing that, moved on to do a great deal of work with an attention towards US medical schools through the Lifestyle Medicine Education Collaborative. We call that LMED. That's since been, the efforts have been moved over to the American College of Lifestyle Medicine, which I invite you to check out. And we went from US medical schools to not just medical schools and not just the US. That brings me to my current job, which is working at the VA where we have a nationwide program called Whole Health, which is basically lifestyle medicine with a lot of integrative health put in there. And I would argue that it's the largest, most comprehensive lifestyle medicine program, pretty much anywhere. We're trying to reach upwards of 8 to 9 million veterans through 150 institutions. And we talk about what behaviors they might wish to change once they determine what matters most to them. Not the question I learned in medical school is what's the matter with you, but what matters most to you. And let's align. And this is a very physiatric, I think, approach to things. We want to know what you want to do, and then we're going to help you reach it by giving you the exercises or the bracing or changing the environment, et cetera. But I think this is very motivating to patients and is completely aligned with our concept of function and not being so disease-oriented, but more focused on what it is that in a patient-driven world, what our patients want to do. So within the VA, I'm the Whole Health Medical Director in Boston. So I get to sort of be the evangelist for this across the institution. And then nationally, I'm able to work at spreading Whole Health into the training programs of over 120,000 health profession trainees. That's fancy talk for over 40 different health professions. Most of them are medical students, residents, and fellows that train at the VA. So we're trying to get some Whole Health into their program. A lot of what we're doing, there's one more lesson to be learned here, is also directed at the employees. We have upwards of 380,000 or 400,000 employees. And early data shows that first of the vets that are exposed to Whole Health do better, take less opiates, are more engaged in their care. And employees that are exposed to it similarly have less burnout, are happier with their jobs, less intention to quit, and lots of other benefits that are being shown. So sorry that I can't be at this meeting. Please reach out to me. The easiest email address is edward.phillips, P-H-I-L-L-I-P-S, at va.gov, edward.phillips at va.gov. I'd be happy to chat with folks about their interest in lifestyle medicine. Please consider joining us in June at our conference. And with that, I'll sign off. Thank you so much for this opportunity. Hi, my name is Rani Polak. I'm the program director of the chef coaching program at the Institute of Lifestyle Medicine at Spalding Rehabilitation Hospital. And I'm also an assistant professor part-time at Harvard Medical School. And I would like to talk with you today about lifestyle medicine. The definition of lifestyle medicine is evidence-based practice of helping individuals and families to adopt and sustain healthy behaviors. And to me, the promise of lifestyle medicine is the understanding that eating healthier, moving more is actually a behavior. It's not only knowledge that patients need to gain. It's literally the need to change behavior. And of course, the words sustain is very important because it is difficult to eat healthier for a month. It is more difficult to eat healthier for a lifetime. The way I got involved in lifestyle medicine was back in my residency. I had a few thoughts about the importance of home cooking. I had thoughts about how to help people do more nutrition with home cooking. And I started to follow my passion. I got training. I started my research. And then I found that there are more people like me who are interested in healthy behaviors. And it wasn't called back then lifestyle medicine. But after a few years, I found that there is an American College of Lifestyle Medicine. And then I got involved in a more national and international level of activities. If you would like to get to this field and to implement a lifestyle medicine practice in your clinic, I would recommend first to get training. There is today an American and international board in lifestyle medicine. There are various specific courses in specific components of lifestyle medicine, such as culinary medicine. This is the field that I am working in. And then once you feel that you are comfortable and confident to have your own program. So one of the most important tools to build for lifestyle medicine services is shared medical appointment. You bring a group of people to your practice and build each one of them for the education. So enjoy. People that work in lifestyle medicine usually have a quiet and enjoyable career. And I hope to see you in the future. Thank you. Good morning, everybody. Can you hear me? Perfect. So thank you so much for your attention today. I'm going to do my best to try to follow that illustrious group of people. My name is Alex Fogarty. I'm the current sports medicine fellow at Washington University in St. Louis. I am here today to try to represent the efforts of Washington University, and specifically Dr. Prather, and Dr. Hunt, and Dr. Cheng et al, who couldn't be here today to describe the program a little bit for you. At WashU, essentially we have a lifestyle medicine program that's been established for several years. It's actually a brick and mortar center where we specifically see patients who have musculoskeletal impairments that are limiting, essentially, their participation with sports, physical activity, or limiting their ability to obtain the surgical procedures that they otherwise would be required to have, such as a joint arthroplasty or a back surgery. So the center has been established now for several years, and one of the goals is that we're trying to collect data, specifically looking at the efficacy of lifestyle medicine for that patient population. And we use sort of this interdisciplinary physiatric approach with regular team conferences, in addition to kind of multidisciplinary support from nutrition, psychology, and all of the other things that are really relevant for the pillars of lifestyle medicine. So as a resident at Washington University, I was fortunate enough to be exposed to this approach, and then now continuing on my fellowship there, it's sort of a regular part of our experience. So I think that's been a fantastic opportunity, really, to see how it helps, not just our general PM&R population, but also specifically those with musculoskeletal issues, which are so prevalent in the community. So I look forward to incorporating at least the pillars of lifestyle medicine into my future practice, based upon the experience that I've had at our institution. If somebody has an interest in looking at the data, certainly stay tuned, there's a lot that's hopefully gonna be coming out of our center in the next few years, and I think that's really critical for not only incorporating this as part of our standard of care, but also for making sure that we can obtain reimbursement in a wider sense from insurance. So we did put out a pilot study, I recommend for you to look it up if you do have interest. Back in 2021, in the Purple Journal, the PM&R Journal, the first author was Dr. Prather, and the senior author was Dr. Hunt, and that sort of describes a little bit about this lifestyle medicine program for MSK pathology, and in greater detail, if that's an interest of yours. So I'll pass it on to the next person. Good morning, my name's Kelsey Sandifer. I'm from rural Maine, and then went to A.T. Still University in Kirksville, Missouri. I'm now a PGY-4 PM&R resident at Metro Health in Cleveland, Ohio, and I have grand plans to do a lifestyle medicine fellowship at Loma Linda in California. So I think we all have stories about how we learned about lifestyle medicine that we could talk about forever, but I'll try and keep it short. Basically, I was working at Kessler, working with stroke patients, and giving talks, educating younger students about how 80% of these strokes that we see are preventable, and I think after saying that about a dozen times, I realized what I was saying, and I looked into it, of like, okay, well, how do we prevent these potentially devastating events, and I learned about lifestyle medicine. So at that point, I figured to learn more, I should be a doctor, so I went to medical school, and kept waiting to learn more about it, but alas, here we are. I did get involved with ACLM pretty early in first year of medical school, so that gave me the support, the education throughout my career, and in PM&R, it's just kind of been finding the mentors here and there, in med school and residency, doing the electives, finding those connections, doing a little bit of research here and there. So, happy to talk more about the earlier training options, and biggest tips for those interested in lifestyle medicine would be to get involved with ACLM, take advantage of your flexible time, your elective rotations, make connections, and just start getting involved. And then think about the places that have the education already, and think about the fellowship options. Can you hear me all right? So my name is Pam Hansen, and I kind of joined this panel late. I just jumped in today, so I don't have any slides or anything prepared. But my path has been a little bit different. So I'm originally from a rural town in Minnesota. I spent most of my time at college taking any classes, many classes as I could, on nutrition and exercise physiology. I was an athlete in college, and I have a strong family history of cancer, and my life had been very impacted by that, and so I was very interested in nutrition and diet. I went to medical school at Northwestern, and was lucky enough to find physical medicine and rehabilitation, because it was a required rotation there, which was kind of a field that really resonated with me. I ended up doing my residency training at the University of Washington, and went on to do a sports medicine fellowship at the University of Utah, where I'm still practicing. I'm the residency program director at the University of Utah, and have been very interested in lifestyle medicine throughout my career, but am kind of late to the game in coming to find all of these resources, which is so exciting that they're there now for current trainees, and such a great way to get involved early. I ended up, after my fellowship year, which was 2003 to 2004, I had several cancer patients who were coming through my musculoskeletal clinic, who had musculoskeletal issues related to their cancer treatments, and so I ended up spending some time at our cancer hospital with the oncologist, and learning what patients, what kind of information, and what kind of guidance they were getting there in terms of taking care of themselves as they were going through cancer treatment, and ended up starting a wellness center at our cancer hospital, really initially focusing on individually guided exercise prescriptions for cancer patients, to help mitigate the side effects of treatment as they were going through. We added some dieticians, we've added acupuncture, massage, we have a physician who practices OMT, we have a gal who records people's stories, we have a lot of group and outdoor activities now, so it's really grown over the years. That's been how I've incorporated lifestyle medicine into my practice. I had a resident come to me not too long ago, very interested in the lifestyle medicine curriculum for residents, and so we decided we would join that, and kind of jump in, and we have six residents and four faculty who are currently going through the program together. So I'm super excited to find all the resources that are out there now, and really, yeah, kind of have a new passion for this area. Awesome, well, we'll go ahead and open it up to the floor. If anybody has any questions, please drop them in the chat. Mike troubles, sorry. Okay, so my name is Heidi. Thank you all for sharing your story. I was just wondering, of the six pillars, which one, I know everyone's not the same, but which pillar do you typically find that patients have the most difficulty buying into? Sorry, I know it's a really hard one for a first one. So I think out of the six pillars, food is the most sensitive subject. It's like talking about politics or religion, and I think people can be turned off very quickly depending on how you go about it. So it's such an important part of this training is learning how to talk with patients and going from that classic doctor expert approach, you know, this is what's best, this is what you should do, and going to the coach approach, where you're figuring out, you're doing motivational interviewing, you're figuring out where they're at, and you're figuring out what, you know, if they've thought about this before, and asking if they're open to hearing something, or if they want education, or if they have ideas of their own. So I definitely, you know, even sometimes just coming into patients rooms, and I'm like, lifestyle, and they're like, no, I'm not eating vegetables. It's like, okay, like, no problem, no problem, we don't, you know, I'm not gonna make you eat vegetables. That's what I'd say. All right, thank you. I would agree with that, and I think the point of learning where the patient is starting from, and what they're willing to do, is the most important, and learning how to take that history, and kind of find ways to connect with them before jumping in with, this is what you need to do. I have patients who come in and say they hate exercise. So how am I supposed, you know, what am I supposed to do? I hate exercise. I don't want to do it, and you know, one of them told me, I will exercise eight minutes a day, and no more, and I thought, that's a great place to start. Let's exercise eight minutes a day, and actually this patient has never, we usually graduate patients, like it's a gradual progression towards independence. This guy still shows up seven years later, and he is addicted to exercise, and he's fit, and he loves it, and he's in our group classes all the time. So I think starting small, and just working with where the patient is starting from, can ultimately achieve big gains. Just to add one small thing, absolutely 100% agree that nutrition is such a touchy subject. One thing that I think we've found is that there's just so much mythology around nutrition as well, whether it's on the internet, whether it's on social media, and so, you know, understanding where the patient's starting from, and trying to unpack a little bit, maybe some of the things that they've heard, or that they've read about, that maybe isn't evidence-based, or is just like a myth that's been passed down for generations. So yeah, I definitely agree with kind of the stepwise approach, and understanding exactly where they are, but realizing that there's so many other influences that are probably under the surface, and guiding the choices that people make is also pretty critical, I think. Great, thank you. Actually, I have another question, is that okay? So from the presentation, that was really great, and really informative, but for, say, the residents in a program that does not have that infrastructure already there, what can they do? Because I remember when I was in residency, I did look into this. I was like, oh, NYP's not on there. I guess that's it. I'll just wait until I'm in attending, and so what can people do in residency without those programs there, and don't have electives? Sorry, I know, I stole your answer there. One thing I thought of going to residency was how many elective rotations people had, and that is maybe like one of the only reasons I didn't go to Utah. Another thing I would say is that this is something that you can bring into any rotation, and should be bringing into any rotation, and I think it's applicable to nearly all of our encounters, so I don't know that it has to be, even if there aren't a lot of faculty or interest groups, it's great when there are, so much better to be able to surround yourself and support yourself with these resources, but even when there's not, I think you can still do it. There weren't these resources when I was going through training, but you can still, the information is now available. You can go through these curriculums, which is so fantastic, and learn so much through them, and you can really apply it, and I don't know if there are opportunities to join. It sounds like there's opportunities to join interest groups, even if you're not located in the same place, so it does sound like there's opportunities. The last thing that I would add to is the opportunity to maybe even start a lifestyle medicine interest group at the institution. Probably just by virtue of doing that, I would imagine that people would be surprised at how many people are actually engaging with these types of topics on the regular basis, and maybe are not coining it as lifestyle medicine, but are engaging with all of the pillars, and maybe in a different way. At Washington University, we started a lifestyle medicine interest group several years ago, and out of the woodwork, all sorts of different physicians, and medical students, and people actually in the community found this, and it was really interesting to see just the diversity in the interest, and how people were already doing a lot of this stuff, but just didn't have it labeled as lifestyle medicine. I wouldn't hesitate, if you're interested in it, just to take that initial step and try to found your own institution's chapter of an interest group. Now, the easy part of it is that the ACLM has put together all of these resources to make it really straightforward for each individual place to actually come up and develop that for themselves. Thank you. Hi. Good morning. Thanks, Heidi. That was, of course, great questions. I'm Dr. Lisa Merritt, a member-at-large on the board and director of the Multicultural Health Institute, and this was a great presentation, long in coming. I'm glad to see all of you and totally resonate with your ideas. It's fascinating how the names of things change over time. For what used to just be providing comprehensive care, when doctors had enough time to do all of these things. A comment and a question. So, the one comment is, in what dimension of this work do you also include the influences of social determinants of health, the worlds in which people live? There's a bit of presumption that people could safely exercise outside of their home, or people could actually garden or find vegetables to eat where they live, and people living in food deserts, etc. So, we're having a wellness workshop, and also we think it's important to empower and engage the populations that are at greatest risks, so that they become the messengers, that they're understood and heard in a way that patients can better resonate with. For example, we took some of our community health workers and took them through traditional diabetes education training, but we turned it with a different lens, in which the way they hold it, and the way they talk with one another, and the language and the words that they use, because they've all, some of them have diabetes, some of them have lost people with complications of diabetes, and it ends up with a better outcome, in a sense, because people can relate to that, and it's not so much of a power, like you were saying, you can't be coming in, you need to do this, you have to do that. And it's still not always successful, because there's a lot of other factors that influence why people are really self-destructing, and not feeling part of any kind of sense of empowerment themselves. So, my other comment is that I think we should be looking at cultural training and cultural dimensions. We talk about food, food is truly religion in some cultures, and maybe making it personal as well. For example, if I come in and I tell people that my Afro-Cuban father, who ate, you know, a lot of rice, and a lot of the wrong things, and was diabetic, etc., and when he had his first heart attack, before the subsequent three, we were able to achieve changes, and, you know, stop smoking three packs of cigarettes a day, and he had, you know, the way that his life changed and improved, even though he was an exerciser, and that he was eating salad, etc. That can resonate with another Afro-Latinx male who's determined he's not going to change, but, you know, because I made it personal, and about how important my emotional relationship was with my father. And the Association of Black Cardiologists has a line that says, you deserve to live, to know, and enjoy your grandchildren. So, appealing to who they are important to is also, sometimes people won't do it for themselves, but very often people will do it for the ones that care about them, or you engage them in the process. Like, I don't do, like, individual visits. I do family visits, and it's the family that will then be the part, especially if you're talking about certain cultures. If you don't involve the ones who are preparing the food, you can talk all day, because if they don't change, nothing's going to change, right? So, I just wanted to say, you know, to what degree to include, you know, the cultural aspects, and might we look more at the social determinants of health that's important in this line of work. I mean, I can speak to that just a little bit, and I wish I would have heard you say those words back in 2003, when I was trying to figure things out, because I think I've learned a lot of that along the way. It goes back to, you have to meet the patient where they're at, and know what's important to them, and what they have access to, and what's realistic. And so, that's part of the understanding who they are at the first visit. I spend an hour with my patients at their first visit, figuring out what have they done throughout their life, what are their goals, what is their transportation situation, what do they have access to, what is their social support, and all of that. And I will say many of them don't have resources to come and exercise with us at the university twice a week. That's not feasible. So, we do a lot through telehealth. We provide bands for patients for all their resistance exercises, and they walk. And we have a lot of online group classes, where if they don't have access, if they are not in a safe place to walk, we'll guide them through aerobic activity to meet the 150 minute per week guideline. There's a lot of group activities for the social support. So, we try to find ways, even if resources are minimal, to allow them to find ways to meet the guidelines for health regardless. Our nutrition consults are, hey bring your family, bring whoever cooks in your household, this is a family thing, this isn't a personal thing, which definitely seems to work a lot, a lot better. I know that there's so much more that we could be doing, and there's probably a lot that I haven't figured out yet, but we're trying to implement those kinds of things. I think it's super important. It's the only thing that makes it doable for patients, is to be thinking in those ways. Excellent. Yeah, I want to also point out the REACH Collaborative, which I was a part of in the early 90s, affiliated with Emory. We had a group of women, we took through a whole program through a year. It was a support group as much as education, so we didn't talk about it as education, we talked about it as painting each other's nails, talking about bringing favorite recipes. We made it, it was a very light version, and then we would insert instruction about heart problems, and kidney problems, and things like that, and you know, how did you exercise, what were your goals. And at the end of the program, they were able to show that everyone lost weight, everybody's blood pressure was better, and but most importantly, they felt more confident and stronger about themselves and their image, but it was that group of the support. So I think that's a great model you're describing, what you guys are doing. Thank you so much for that comment. I think it's incredibly important to mention the limitations, as well, of the healthcare system in which we work in delivering, you know, these multidisciplinary, comprehensive interventions to patients. And in all likelihood, right, it's the people who have less access, who really need these services the most, but the challenge is, like, how do we deliver that in our current model of care? I can only speak to the very, you know, limited experience that I've had at one institution, but two quick points. I think, number one, I think it's really important that now we have a word for what it is that we're doing. It's not necessarily a novel idea. People have been practicing this way. As you mentioned, this is comprehensive medical care. They've been practicing this way for years, but now the fact that there's a word for it, that it can be more maybe rigorously studied because it has a label, potentially, you know, does have the outcome that we could potentially convince, through our research, you know, the powers that be, that these are services that need to be reimbursed, you know, at the insurer level. So it's great to see so many people who are interested in lifestyle medicine, and hopefully a lot of you will be interested in, you know, engaging on the research side, as well, because if we can prove the efficacy of these multidisciplinary treatments, especially for the most vulnerable populations, and that's how I think we can, you know, maybe down the line, years and years from now, kind of affect more systemic change. So that was one of the goals of, you know, the center that Dr. Prather established at WashU, was to try to, you know, build it around data acquisition and serving a really wide variety of patients, who traditionally maybe would not have had access to these services, because, you know, nutrition counseling, psychology, all these things, physical therapy can be out of pocket, depending on where you are, and that's a huge limitation. So trying to address that with the data, you know, maybe is we're talking, you know, the output being several years from now, decades from now, but I think it's an important starting point. And then number two, you know, on a kind of anecdotal level, certainly if you do engage with the ACLM, and you do have a lifestyle medicine interest group, one benefit is that you can apply for these small grants, and these grants kind of allow you to not only bring in, like, food and things like that for your events, but also potentially to, you know, create more community type of engagement. So one example that was just very contemporary in my mind, because this was, we did this three weeks ago, we paired with a local organization in St. Louis, who does a lot of work to deliver, you know, basically nutrition education to underserved populations, who may, you know, have all sorts of, not only difficulty with access, but also have limited access to education around these topics. So we kind of created this, this programming with them to go into the community sort of longitudinally, to be able to do blood pressure checks, you know, check your blood sugar, and do some, like, lifestyle medicine counseling, in addition to bringing a discussion surrounding, like, healthy food and nutrition, and brought in food from a caterer as well, thanks to the ACLM grant. So that was kind of a, and I think, long story short, it would be nice to continue to be able to do these things more longitudinally, as opposed to just one and done, which is one of the goals that we have. Excellent. Thank you all. And one last little insert was starting community gardens is another strategy, and earth boxes, which is a self-contained growing unit to help people learn to grow their own vegetables, if they don't have that, and to get young people involved in that. Sorry, you were going to answer. No, excellent comments and questions overall, and just, you know, my two cents on it. ACLM definitely does have focus groups on this, and the power of, you know, being connected with a large group of people, is that people are working on so many different things. So there is a great resource called Eating on a Budget, which was focused on the WIC program. So with, you know, for a patient on the WIC program, how are we going to eat healthy? Culturally, they have created many different resources for different, you know, as we know, food is culture, culture is food. So maybe not everyone wants that classic handout on, you know, you know, certain kinds of, I don't know, you know, certain different, maybe they want to see different kinds of foods, they eat different kinds of foods. So there's different, you know, a handout for more Hispanic style foods in a healthy style, an African-American style. And then otherwise, yeah, I think it's really just meeting people where they're at, but also letting people know for kind of making the shift from exercise to physical activity, because a lot of times we think we have to exercise, we have to go to the gym, we have to be outside, we need weights, we need this, we need that. But for physical activity, all you need is your body, and you can be anywhere that you are comfortable, and you just have to learn how to move your body and get comfortable with that. So, you know, in the office, just having ideas about, okay, well, when you're in bed, how do we move our bodies in a way that might provide benefit? But yeah, great, great comments and questions. Thank you. Thank you. I'm about a hundred miles down the road from the Sports Medicine Fellow. I'm in Cape Girardeau. We are seeing the increasing influences of insurance restrictions, competition between hospitals, hospital systems, and such. What recommendations are there for marketing or community education slash outreach? Some of which you answered in the previous question. Any other suggestions you have to promote such a program in a hospital system? I suppose it also depends on what is your practice setting. Are you in a private practice setting or academia? I'm with Southeast Missouri Hospital in Cape Girardeau. I do inpatient, outpatient, and EMG. Right, yeah. Certainly, I think it's probably dependent as well on the setting. Certainly, my biased opinion is, you know, starting from, I guess, the faculty who started from the beginning in establishing this at Washington University did so using a lot of the, you know, the good faith that they had within the university system to really push forward this idea and sort of convincing people that they had been practicing this way for a while. But really, at this point, needed to develop a little bit more of a structure to really be able to make, you know, those lasting changes. So that's not really answering your question necessarily, but it did start out with this idea that, hey, we've been incorporating this for a while, but we need to solidify this and define the boundaries so that that way we can study it with an evidence-based lens for the purposes of then showing longitudinally that this works. And, of course, being in the United States, the reality is also, like, what is the cost-benefit ratio to this? And I think, you know, being really fortunate to work in a center where I think people are really motivated by patient outcomes is really helpful because certainly, you know, the surgeons don't necessarily want to be taking people to do operative interventions whereby, you know, these people are not optimized for surgery because of their weight, because of their smoking, because of all of their lifestyle impediments to their chronic musculoskeletal issues. That, I think, was a big selling point is how can we, because we're within the Department of Orthopedics, how can we optimize these people to do better for your, you know, surgical procedure and optimize outcomes that way? So using a bit of good faith, I think, was helpful, but also kind of framing it within the lens of where we were practicing, which is within the context of orthopedics with the end goal of getting people where they needed to be to be appropriate surgical candidates was one of the strategies. I don't know if that answers your question. Basically, you worked from within then, is what you did, within the hospital system to, and then actually served your fellow specialties by getting their patients ready for whatever came next for them. Yes. I understand. Thank you. I agree. That's been a huge, I'm sorry. I just, I have run into that challenge so much over the years, and my day that I spend at the cancer hospital is largely my charity day because I see one patient an hour and I don't make my, I don't, I don't bring in what I need to to make myself whole, and so I'm very interested in the the group visits, and I think there's so much that could be done there, and I see an added benefit of the social connection between similar patients, so that's something I will definitely be exploring. I think that's something to look into. And, yeah, so let's see, so remind me, it was kind of more about how do you get yourself out there, and then how do we make it financially? Yes, in this case, not looking just from within the system, but looking towards the people on the outside, the community, who are then interested in getting into this kind of a program. Yeah, I think, and from, you know, as a resident standpoint, not with my own practice, I think the biggest thing that I've seen successful, because I've rotated with a lot of different people, is knowing your referral base, and kind of, you know, working from the inside and doing some internal presentation so people know what you're doing, and so they know how you can help them, like when they reach the end of the rope with a patient, or when they kind of, they don't address that, letting them know that you will, and you can. More from the outside in with ACLM, there's a, now they use a online, you know, connection website called ACLM Connect, and so just putting your ideas out there can also connect you with some people, and getting ideas about what other people have done with their, there's so many different threads on, I've got this kind of practice, this is what I've done, what have you done, and everyone's bringing their ideas together.

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