Okay? Excellent. I'm Eddie Phillips, and this is a lifestyle medicine presentation, and we thought that we would live the experience. Everyone's invited to stand up, just a little warmup. They'll be on your own two feet as you're able, if you wish. You don't have to, and I'm gonna invite you guys just to put your arms all the way up in the air. Wanna challenge yourselves, maybe go up on your toes. We're not supposed to be too political, but I urge you all now to please lean to the left. There we go. Oh, does that feel good? Any conservatives in the room that realize how good that feels? Oh my God. All the way up this way, a little bipartisanship. Let's lean to the right. Anyone feel a little pull in their side there? I could say QL here, and you guys won't know what I'm talking about. I'm like a regular audience. Good. One more time. Usually at this point in an audience, I invite people to see a physiatrist if their back is hurting them. Once again, that's if you wanna do this. All right, all the way up. Now we're gonna take one of those big therapy balls, you know those ones that you have your patients on, and we're gonna roll it between your legs. You gotta catch it, and push it all the way up to the heavens, and give it a little puff. There's another one. Oh, and if you only had one body weight exercise to give your patients, what do you think it would be? I would say squatting, yeah, because if your patients can get off the toilet with less than one person assisting them, they're gonna remain independent until late life. Good, I already tricked you into number seven. Good, excellent. Let's pick up your left leg. No, nothing political here. Lean all the way forward. Lock the back hip in. Does anyone recognize what this, has anyone been in a yoga class in the last 30 years? All right, we're gonna call this warrior one. You should feel a little pull in your hip flexors in the back. If you're hurting in the back, see one of your colleagues, there we go. Push a little further forward. There's a competitive, oh, look at that. Down they go. Excellent. Other leg. I get my sides confused. Lean forward, lock in. Arms up, in through your nose, out through your mouth. These young competitive guys are gonna stay like this for the next 75 minutes. It's just they're already challenging each other, so just, you guys, the rest of you will sit down. Good. And I'm gonna now just invite you to, we'll kind of like walk this out now. You could bring your heels up, right? Elbows back. Oh, but they're better than this, aren't they, Kelsey? I see the knees coming up. I see people, you gotta start the timer there, Koi, otherwise we're gonna be at this for an hour. And we're gonna go as fast and as high as you wish. Nine, eight, seven, six, five, four, three, two, one. Big, deep breath. At your own peril, you're invited to sit down. Dr. Kelsey Sandefur. Okay. All right, so, welcome to our session, now that you're suitably warmed up. I'm a little sweaty. This is Physiatrists Expanding Leadership in Lifestyle Medicine. This is one of the advancing PM&R lectures that we have at our conference this year. My name's Kelsey Sandifer. I'm a proud DO. I'm a PGY-4 PM&R resident at Metro Health in the Grand Cleveland, Ohio. And today I'm gonna be presenting with Dr. Edward Phillips, who you have met, who I'll do a formal introduction to a little bit later in my presentation, and Dr. Elizabeth Pig-Fratys, who has joined us on Zoom this morning. Okay, so for a quick outline for today, I'm going to be starting with the introduction and I'm going to tell you what we're talking about, which is lifestyle medicine. We're going to try and figure out what is lifestyle medicine and what lifestyle medicine is not. In my first section, I'll dive a little bit about a survey that I did asking other residents what they thought about lifestyle medicine. I'll then pass the torch to Dr. Eddie Phillips. He's going to take a deeper dive into the rich history of PM&R and lifestyle medicine. And then Dr. Freides will end our session with some practical steps on how to become leaders in lifestyle medicine. So we have learning objectives because we had to have learning objectives, but essentially Okay, so from the basics, what is lifestyle medicine? So it is a medical specialty. It uses therapeutic lifestyle interventions. to that spectrum of obesity, diabetes, cardiovascular disease that we see in just about all of our patients. So, I now just used the word lifestyle in my definition of lifestyle medicine. So, diving into that a little bit more, as lifestyle medicine providers, we're evidence-based and we focus on six main pillars. Basically, our daily habits. What we're eating, which research has found time and time again, it should be a plant-predominant eating pattern. Physical activity, how we move. How we're managing stress. How we're sleeping. Our social connections. And avoidance of risky substances. So, in short. But formally, the field of lifestyle medicine has been. Then, with an exponential increase in growth, we now have a board certification for lifestyle medicine since 2017. So, both Dr. Phillips, Dr. Frady's, we'll dive a little bit. What is lifestyle medicine and is it this or is it that? So we'll just review through some other similar fields of medicine or approaches to medicine so first off we have allopathic medicine or what should also be up here predominantly focuses on medications and. Lifestyle medicine then is what we're Preventive medicine is more of that umbrella term that can be applied to so many different fields of medicine And it's basically any approach that tries to and we'll definitely have lots of time for questions at the end. Okay, so maybe you're here. So just for fun, starting way back with the inaugural volume of the PM&R Journal, there was two articles. There is an article by Dr. Lakowski, Action on Obesity. Table, Chronic MSK Pain and Nutrition, Where We Are and Where We're Heading, and then Lifestyle Medicine, published in the Physical Medicine and Rehab Clinics of North America Journal. Following the articles, there's the conferences. I have to say. but AAPMNR movement that we have, we have the. and memorize it, but I couldn't. So this is a short version, and I had to write it down. Dr. Freides, so she is a Harvard-trained physiatrist, board-certified in lifestyle medicine. She teaches lifestyle medicine at Harvard and has authored many lifestyle medicine resources, including multiple lifestyle medicine handbooks, a full lifestyle medicine syllabus, and curriculum. She is the director of wellness programming at the Stroke Institute at Spalding Rehab Hospital and the director of lifestyle medicine and wellness for the Department of Surgery at Mass General Hospital. In a couple weeks, she will step up into the role of president. Dr. Phillips, also physiatrist trained, as well as lifestyle medicine board certified, he's a professor at Harvard Medical School, and he's the founder of the Institute of Lifestyle Medicine at Spalding Rehab Hospital, where he's directed dozens of research projects. So, hopefully we're getting the idea that this relationship already exists, but another way to look at it is looking at our goals, our patients, and our approach. So for PMNR, our goal is function. In lifestyle medicine, our goal is function. The patients we're seeing in PM&R are often pretty. So, lastly, I'll give you a little bit of information on a survey I did earlier this year. You don't have to take it just from me, because I went and I asked what the other PM&R residents think about lifestyle medicine. So it was a classic resident survey. I pestered all of the PM&R coordinators to send more emails to their residents. And I was asking their residents, do they know about lifestyle? But for the interesting stuff, the vast majority thought that medical school and residencies should have lifestyle medicine education. And most exciting, 78% thought that physiatry should be allowed. So, to wrap up, I'll show you some of my very biased and favorite comments from the survey. Yes, this is an area that I have been thinking of pursuing without actually realizing it is a thing. There is significant crossover. practice or as their primary specialty. I've been trying to bring the American College of Lifestyle Medicine to my residency program, especially PM&R. Really appreciate your efforts of incorporating lifestyle medicine into rehab medicine training and practice. This is super important and should absolutely be part of our curriculum. Yay! I have great interest in this area and hope to learn how I can incorporate this officially into my future practice. And my favorite, I don't know much about this field but it seems to dovetail with the goals of rehab. So with that I will pass the torch to Dr. Eddie Phillips. Do you guys have any questions to start with so we could make this a conversation more than just a lecture? Questions for Kelsey? Okay. Let me put down my cards here when people want to be in contact after. So I'm going to have just this briefest moment of mindfulness and ask you guys to take your deepest breath of the day all together. if I ask you to do that later, it's got to be even deeper. So, you know, just plan, plan ahead. Just, you know, give you a little clue there. So, I think I'm going to sort of tell you like my, it's funny when you, when you think about a career, it was a winding path, but the way I'm going to describe it, it's just like this, you know, it was as straight as an arrow, right? You know, so I went to medical school. You heard SUNY Buffalo. Wonderful, wonderful rehab program up there back in the late 80s. My first inkling that I wanted to be in this field was sitting in the cafeteria at Buffalo General Hospital, and you would like hang out with different groups of residents, and the surgeons were complaining about, you know, being so tired, and the psychiatrists were just complaining, and the, you know, everyone was just like, you know, going on, and there were these, these physiatry residents that were talking about, this is like 1987, about swimming in the Niagara River upstream in order to train for a triathlon. So first question is, what was a triathlon? What's a triathlon? Because in 1987, it was like not like as big as it is now. Second, how fast does the Niagara River go? And the answer is, as it goes over the falls, about 12 miles an hour, but if you go upstream, and you're like on the side, it's like a flume. You know those endless pools? They're, you can find them in nature. You just swim upstream, and I thought, who are you guys, and what is this? And they go, oh, it's this field of, it's physiatry, and we actually like watch people walk for a living. Like, oh, I'm in. So it was just, you know, I had a long martial arts career, and I thought I was gonna be like a karate instructor. I felt like I could do that as a doctor, like watch people walk, and then actually get them stronger, and you, I was like, this is great. So with that, I applied, and thankfully got into Columbia Presbyterian, and, you know, trained as a physiatrist, and a lovely program, but what was missing was what I thought I was gonna learn in medical school. I thought that, I didn't read the brochure, that medical school, and even physiatry, was gonna be about health, that I would actually learn about exercise, that we would actually talk about what to eat. Like how many of you guys remember your first Christmas home as medical students and you're sitting around the table, Thanksgiving, I won't make it too religious, and people go like, okay, you're gonna be a doctor. What kind of vitamins should I take? Like, I'll call you when we cover that. You know, like what kind of exercise should I do? Like, as soon as we cover that, I'll get to you. So for me, medical school turned, exercise was an antidote to medical school. Actually took up squash because it was a court like right on the campus and like, I don't know, it was just a thing to do. Nutrition, you ready? Here's the, we learned four basic food groups. Crunchy, chewy, chocolate, and alcohol. And if you're careful, you can actually concoct a dessert that has all of them. And stress was an experiential course. Not everyone passed it. So that's like, that was my lifestyle medicine training in medical school. I'm sorry, tobacco, I learned was very bad for you, and actually did some research into tobacco ads, even though we weren't supposed to have ads on television by the late 80s. So then I go off into practice. I was at Beth Israel in New York. I worked with Erwin Gonzalez there. And I was there for like three years and then went up to Boston, and we had yet to found the Harvard Department of Physical Medicine and Rehab. I get 25 cents from my boss every time I mention this. So the Harvard Department didn't start till, it's 50 cents, up till 1997. And we had like, we had really young kids at that point. And I always tell people that it's not until your kids actually get enough FIM points where they're independent, which is like around age five, six, if they're a little slower on the draw. So we had kids, and I was just like, my professional goal was like not to knowingly kill someone. And it's hard to do that as a physiatrist to actually hurt someone that badly. And so I wasn't that creative yet, but then I started wrestling with this thing like, how do you actually motivate people to do the stuff that we know they should do? Did anyone learn this in school? Okay, like, is there a science? So the first thing that we wrote was actually 2001, Physiology of, Physiologic Basis of Rehab Medicine and we wrestled with the question of, okay, you just had this guy land in your fill in the blank, spinal cord unit, TBI unit, whatever. He was not living, you know, a healthy life, decided to, you know, whatever. You know, they not decided to, but you know, had an accident and now all of a sudden you're, he's supposed to like do exactly what you say, exercise for the rest of his life. Like, how do you, how do you even get started? So we sort of wrestled with that. And then that expanded to the idea of exercise. If exercise is so, this is my academic question for 20 years, if exercise is so damn good, why doesn't, why don't more people do it? And then I started looking at like, is there any science to it? At the same time, I was actually working at a psychiatric institution. Now, once again, you guys know the difference. I'm not a psychiatrist nor a podiatrist. I'm a physiatrist, but I worked at McLean, which is a psychiatric institution, lovely place. I took care of musculoskeletal issues, pain, walking difficulties. And I was there like only for like 18 years, you know, what they're doing, consultation. So I got really imbued with the idea of behavior and, you know, talking to psychologists. And then for full disclosure, if there was something I learned during the day that I didn't quite understand, I got to come home to my wife, who is a psychiatrist psychoanalyst and say like, they were talking about blah, blah, blah. What were they talking about? And then she would explain. So I was getting this kind of the behavior stuff. And then I was doing my rehab medicine. And then I got the opportunity to be a research physician at Tufts, working with older adults, late life mobility. So I was getting my dose of exercise physiology, which hello, I never learned in medical school. And I didn't really learn that much even in physiatry. So I learned a lot of exercise physiology sort of informally. So, all right, so now we got these like weaving things. We got the mind, we got the body, we got, you know, how do you actually get people to, you know, to do stuff? And I thought there's gotta be something out there. And I went to an American College of Sports Medicine meeting in 2004, and I met Margaret Moore. Margaret Moore runs a company called Well Coaches, which is, and she has worked now for going on 20 years to formalize and create a profession called health coaching. And she and I hit it off in about a nanosecond when we realized that not only were we neighbors like three miles apart, but that she said like, I will not be able to launch this field until we get doctors to refer to health coaches. And I said, and we're not gonna get anywhere in this unnamed field in 2004 until we learn how to motivate people. So she said, well, that's what we do. Like, ah, well, let's work together. So we set out and we got a small grant through Harvard Medical School, I'm up to 75 cents, and wrote the Lifestyle Medicine for Weight Management. It was an online program in 2005, for those of you, this is like the internet had just been invented for these young people here. And it went out and someone in India said, this is really cool, would you come to India? And I was like, who are you talking to? Like, what do you mean? So they were ready for this before we were. Okay, they don't have this enormous medical infrastructure, they don't have this delusion that drugs and surgery are gonna fix lifestyle illness. So with that, went off to India, I mean, this is like 500 hours of like preparation, and we ran a course there in four different medical schools. And then I went to my counterpart in India, and I said like, okay, that was fun, what do we do next? I have my own personal wise man from the East, okay? Just saying. And he looks at me, he goes, you should go back to Harvard, I'm up to a dollar, and establish an Institute of Lifestyle Medicine. And I was like, okay. So I used every bit of political capital I could, and we set up an Institute of Lifestyle Medicine. Beth Frady is sitting here, that's where she comes in, we met in like 1996, I'm talking to a screen, when Beth was a resident, and started politicking and politicking, and we set up Institute of Lifestyle Medicine, it's the anniversary in October that we set it up within Spaulding, which is part of Harvard, okay. So we do that, talked about whatever, met her, and blah, blah, blah, and there's more to my life. Okay, there we are, and then the American College of Lifestyle Medicine starts to rise. The first meeting I went to, in 2009, there were about 40 people, so like half the people in this room, within the American College of Preventive Medicine. It was just like, okay, it's this new thing. The meeting where Beth will become president, I think we're expecting 2,000 participants live, in person, and then more online. Just, not that this is a competition, but there's about 1,500 people physically at this meeting. And about another 1,000 online. So, became part of the advisory board there. The lane that I chose, we chose, Beth is very involved in this, is education. In other words, there's practice of lifestyle medicine, but the education, like how, can I change this? Can we collectively change this so that future medical students, so Kelsey Sandefurs of America are exposed to lifestyle medicine in their training. You don't have to become a physiatrist. Everyone should learn how to talk to their patients. So we, oh, we've only run 26 live courses. There's one coming up in June. It's virtual, Harvard Medical School. That's CME, you'll be able to find us. You can join from anywhere. And we've reached over 25,000 clinicians across the world. We then went from CME to undergraduate medical education. UME, and with the idea of could we inculcate this into US medical schools, and we set up the Lifestyle Medicine Education Collaborative. And we've had some marked success in getting this introduced. Along the way, we set up, I was a founding member of the board of directors of the American College of Lifestyle Medicine, and that has gone just absolutely gangbusters. We first met in 2016 to discuss the idea. It had been percolating for 10 years. Had the first test by 2017, and there's something like north of 5,000 clinicians worldwide that have certified. And any of you can do it, and there are some, but not an enormous number of physiatrists that are doing that. And then, my career, this is the round and whatever, I ended up at the VA, where there's a national program called Whole Health, so that's the VA brand of lifestyle medicine, so it's lifestyle medicine plus a healthy dose of integrative medicine, and it's in the nation's largest integrated healthcare system, and my job is actually to get in front of only 120,000 trainees. How many of you guys have set foot in a VA at some point in your training? It's actually hard to avoid it as a US physician. You'd have to go to the right medical, the wrong medical school, and then become like a pediatrician. Otherwise, you're gonna somehow find yourself at the VA, so we're trying to get Whole Health in front of these trainees for their care, but also for their self-care. So, questions on my path, or anyone learn anything that might help them? All right, so what does it mean when a patient walks in, how is my thinking any different than before we started to develop this field? So, I'm going to, by show of hands, have any of you guys seen this patient? I can't find him. He's 75 years old, white male, Vietnam veteran, retired construction worker. Okay, and you guys are from across the country, maybe around the world. Okay, all right, good. All right, what's up? I don't like numbers for presentations. What's up? My blood sugar, my blood pressure, my lipids, my weight. Have you still seen him? Okay, what's down? My physical activity, my sleep, my mood. Are we on the same page here? What's my chief complaint? Doc, my knees. For God's sakes, my knees, they're, okay. You don't really always need x-rays, okay? But we got them because I'm, which doctor am I seeing? Which doctor? I'm the which doctor. Which doctor, what number doctor am I seeing this guy for this complaint? Has the rheumatologist seen, are you up to number four? Yeah, third or fourth. Third or fourth? Do I hear five? Six? Do I hear 14? As physiatry has gotten more established, like I'm old enough that you would say physiatry, or when I was at the psych hospital, I would walk into people's rooms, and I would say, I'm a physiatrist, and they would like take off their shoes. And I thought it was like a biblical respect thing, but it was actually, I was supposed to wash their feet, and they say, I thought you were podiatrist. I'm like, no, no, I'm a physiatrist. And they go, you're a psychiatrist. And I go, no, I'm not a psychiatrist. Then they would lean in, they go, you're not? Oh, I can talk to you then. Okay, so I would actually like, you know, do, like hear stuff that the psychiatrist wanted to hear. Okay, so as we've become more established, okay, we're moving up the chain. It used to be like I was the eighth doctor, now like in the VA, they just sort of say, your knee hurts, go see the physiatrist. The orthopedists are not gonna talk to you. I can tell you, you know, so we're, all right, physical exam, functional weakness. I love wrestling with my veterans. You know, when I say that my arms are stronger than your legs, this is not a good, this is not good. And they're like really insulted, and they go, no, no, no. And I go, good, let's get, you know, let's get active when you're stronger, when you can overcome my arms, you're doing well. So functional weakness, they're carrying extra weight around here, they've, I've already walked them in, you know, and I love this thing, it's like half the exam is over, right? I said hello, I shook their hands, they stood up. Not from these chairs, there's no arms on the chairs. You know, they stood up, walked them down the hallway, like we're halfway there. So they're slow to gait, and there's palpable changes with their knees. Has anyone, you know, has anyone, is this new to anyone? Okay, good. Prior recommendations, am I the first doctor to say, you know, you should probably eat less. And if you exercise more, you'd probably be good, and you should take your NSAID, but not too much, okay? And you should do the physical therapy, how many times, rounds of physical therapy has he had? And the NSAIDs, I don't know, it's ended up there again, now we're gonna do a topical one. All right, I can tell that story. And I can do an injection, we have the topicals, and we can brace, and he's not like, hello? Like, I like to say original things. And he's looking at me like, okay, like, you know, you're very kind, you know, maybe a little funnier than the others, but same story, right? And so, you know, what are we gonna do differently? In the whole health lifestyle medicine approach, I'm gonna like just take an extra minute, and this should sound very physiatric. What do you want your health for? You know, what's, like, you know, why are you really ultimately here? Like, what, if you were able to do it, you would have canceled the appointment? And he goes, you know, to do stuff around the house and take care of my family, right? That's pretty fundamental, you know? Here's a retired guy, he's taking care of the world, you know, and now he just wants to do stuff. He still is getting a, you guys know what a honey-do list is? Okay, for those that don't, that are not nodding, that's when your spouse writes, honey, do this for me, you know, like, go change the light bulbs, go clean the gutters. And then I ask, so how is the knee pain affecting you? How is this getting in the way? Well, you know, were you listening? Like, it just, it hurts to walk, and it actually sometimes wakes me up, and then I don't sleep, and then I'm cranky, and then this is not a good solution. I'm like, all right, I'm starting to feel his pain a little bit. And then I'll ask, you know, when we get your knees feeling better? Because we know how to get there, right? Is anyone, like, you know, he's not gonna be, he's not gonna have new knees. Well, he could, but you know, we're not going there yet. And then he says, like, very poignantly, I'll be able to throw a ball with my 10-year-old grandson. Oh, is there no one else to throw a ball with him? He goes, there's my son-in-law, he's a great guy. He does right by my daughter, I love that phrase. He does right by, he doesn't know much about baseball. He's not teaching the boy right, like, I gotta do this. And I go, well, what's wrong? He says, well, you know, the ball goes over here, and I can't, like, all right. So we got a fish on the hook now. He's got a reason to get his knees better. And then I basically, like, shut up, pull back, and just sort of, like, look at him, and I go, so what do you wanna do? That was a therapeutic pause of approximately five seconds. It should actually be longer. And then he sort of nods, and he goes, well, Doc, I was thinking, just, maybe I'm crazy, but if I lost some of this weight, because I'm the 14th doctor to tell him that, it might take some stress off my knees. You can go into the physics of it, okay. Also, the exercises that that eighth physical therapist showed me, which was just like the other seven, might make it easier for me to bend my knees and get my knees back. And also, the exercises that that eighth physical therapist showed me, which was just like the other seven, might make it easier for me to bend down and pick up the ball. Can I try to give that a try? So he has just written himself a lifestyle medicine prescription, okay. And the less I talk, the better it is, okay. And then I go, all right, so how do you wanna go? He goes, you know, now we're into the details. You know, do you need some help to lose the weight? No. You know, I know that I should give up, but if he wants help, we have it. Do you want to go back to the physical therapist? He goes, let me give this a try. I still have the handouts and all that. So that is the, that is the approach. And I just say, that sounds like a great idea. You know, what else do you need? And I'm giving you sort of a, you know, a cleaned up version of this. Ta-da, on to Dr. Beth Frady's. She doesn't need this, right? Beth, I'm gonna give you the, are we playing? Oh, yeah, I'll give a, just a quick intro. All right. So for our last section, Dr. Frady's, she's gonna go through practical steps to become a leader in lifestyle medicine at any age, any stage in your career. So whether you're starting out, or whether you've been practicing for 30 years and you're getting burned out, you want to change your scenery, lifestyle medicine docs, or people trained in lifestyle medicine are some of the happiest, most fulfilled doctors I see, which is saying a lot in the field of physiatry, because in general, we're really happy. But sometimes you practice for 30 years and you need a little change up in life. So we'll get some practical steps now. can get involved. Let me share with you one that I'm passionate about in 2008, actually noted in 2009, but when I look back at my notes, I see that Timothy McGlaston, a Harvard medical student came up to me about some of the conditions that his. And guess what? We agreed. So we started the very first Lifestyle Medicine Interest Group. And it's very exciting because over the course of a year, There's also funding for this with the PEG award. And it is hard to believe, but yes, indeed. And this is the first place In fact, the student leader at Harvard Medical School, Alexa Smith, she is presenting at the American Medical Association on work that she did with WholeheartedMD, which is published. There are 44 medical schools. The others are nursing schools or schools of nutrition and physical therapy, and other schools that have adopted lifestyle medicine interest groups. For medical schools, we know that Brown, Emory, Howard, Mayo, Loma Linda, Michigan, HMS, Ohio State, Rutgers, UC San Diego, University of Hawaii, University of Colorado, UMass, University of Michigan, University of Vermont and Cornell as well as Yale. And you can contact me directly if you have any questions. college curriculum together for a semester long journey in exploring lifestyle medicine pillars. I then shared this syllabus nationally and internationally through the American College. and last year's stats showed 5,000 downloads in over 100 countries. So if you're interested in lifestyle medicine, get a hold of Sylvus and think about how you can learn from it and perhaps. branded Lifestyle Medicine 101 curriculum for the American College of Lifestyle Medicine. You can download this for free through the ACLM website noted right here and this has been downloaded by faculty. To accompany this, we have the Lifestyle Medicine Handbook, which was first published in 2018. I co-authored this with Jonathan Bond, who was a teaching assistant in the LM101 course at the Harvard Extension School, and then a resident that I was mentoring, Richard Joseph. Both, of course, are at this time full-fledged attendings and leaders in their own right. If you'd like to think about big brother, big sister programs near you. Going beyond medical school and going beyond college and middle school let's take a step over to the right here with to make that a reality. lifestyle medicine. And as of 2017, we have certification. The areas for the Lifestyle Medicine Residency curriculum mirror those actually that are in the handbook. in Connectedness and Positive Psychology. As we said, there are 40 hours of didactics and then there's 60 hours of application activities. For a total of 100 hours of your residency would be devoted to lifestyle medicine. You can try an intro pack if you don't already have. lifestyle medicine residency curriculum Premier, one, that is most popular, physical medicine rehab, there are two, family preventive medicine, one, internal medicine, occupational medicine, one, primary care, residency, preventive medicine, psychiatry. University of Rochester, Preventive Medicine, Case Western Reserve, Preventive Medicine, Mount Sinai Physical Medicine Rehab. Going further, after residency, we are starting up the Specialist Fellowship, and this is a non-ACGME, with hopes of eventually ADMS. Creating a Lifestyle Medicine Specialist Fellowship, a replicable. be part of the practice for prevention. and then 10 hours need to be live in person. Of course, COVID created an exception to that. And then a case study that you have to submit. The educational pathway with the LMRC, you've gone through that with me. change key clinical processes. There are people who are board-certified in life. As we just went over, you could take LM courses. Maybe you could even take my Extension School course in January term. It's a compact one month. Reading books, textbooks, Dr. James Rippey has an extensive life cycle. And other ideas to start or join a journal club. So we just started our first one at Harvard Medical School, and Walter Willett was the first person to be presenting on nutrition with our Lifestyle Medicine Interest Group President, Alexis Smith, and we'll be continuing that throughout the year and keeping that growing. And that involves not just Spaulding, Mass General, the Brigham, people in the quad at HMS itself. the Institute of Lifestyle Medicine conferences live. and co-author book chapters or books, maybe do a podcast, can start small with a social media. exercise habits and counseling habits of primary care physicians. This was published in the Clinical Journal of Sports Medicine in 2000, and we found that physicians who counsel on exercise, they're actually the ones that are doing the exercise. In fact, if you did strength training, you counseled on it. If you didn't do strength training, you didn't counsel on it. If you did aerobic training, you counseled on it. So this was eye-opening, and it really does show that we preach what we practice, and that's the importance of thinking about these six pillars of lifestyle medicine. This article, and then the following one, which is the Patient Member Knowledge and Expectations for Functional Recovery after Stroke, was published in 2003. The outcome of that, for me, was creating a book with colleagues Julie Silver and Joel Stein at Spalding in PM&R, Recovering from Stroke and Preventing a Second Stroke. We felt that that was a gap in the literature, so we co-authored a book on this topic, which led me to dive deeply into exercise, nutrition, and stress resiliency, which I was not taught in medical school at Stanford, or really the nutrition piece, for sure, not during my residency, and even the stress resiliency piece, not during my residency. Physical activity is something we talk a lot about in PM&R, doing more and more in nutrition as the year goes by. So then I became a health and wellness coach, and I want to share this, share this with my group, American Journal of Physical Medicine Rehabilitation. So after three years of practicing, I co-authored Coaching for Behavior Change in Physiatry to share what I had learned so that others could practice some of the same behavior change counseling strategies. Then after serving as the... medical student who was the president of the life to get this article published and to get the research completed, and it was published in Primary Care Companions, CNS Disorders. Dr. Stern is a psychiatrist at Harvard Medical School, and we looked at the effect of one behavior change course on the knowledge and confidence of the medical students and found that, of course, knowledge increased because you all, medical students and healthcare professional students, are very bright. They can take the information, and what was surprising is their confidence in counseling increased just after one lecture. So that made us think, let's keep doing what we're doing, keep these lifestyle medicine interest groups going. Lastly, we've seen this with Dr. Eddie Phillips and I partnering. It's been a delight and a joy to be part of Lifestyle Medicine here. and the health of livestock. While we're transitioning to take questions, I guess we want you to, it's being recorded, so if you have questions, you can come up to the microphone, please. And as we're transitioning, guess what? Let's take the deepest breath of the day, a little deeper than earlier, and let it go. Good morning. Thank you so much. I was so happy to see this talk and the others that are coming. My name is Brandi Waite and I I wanted to just put another practical something just announced that's an opportunity for free CME in this for everyone the American College of Lifestyle Medicine just participated in the White House conference on hunger nutrition and health and a CLM Move with the motivation that you have that brought you here today. Thank you Good morning. Thank you for the talk. It was really informational. My name is Logan Connor I'm a fourth year medical student at Central Michigan College of Medicine Definitely have an My question kind of comes in the form of nutritional education for those who are in medical school and for us future physiatrists. It's obviously a topic that's very lacking in medical schools with surveys demonstrating that only 27% of medical schools only have like a class on nutrition. So my question is given that we're very strong in the fitness and Functionality side of medicine. How can physiatrists get resources and educate their patients more on nutrition and in the forms of lifestyle medicine? Should we can we point to the screen over there for the first answer? You absolutely can. Okay So one resource while Beth's coming up is the Physicians Committee for Responsible Medicine PCRM has a whole effort in getting Nutrition education into medical schools and they publish a book and then Sarai Stancic is now hired. She's a Infectious disease doc, but she's hired to integrate into medical schools the material and Also just so you understand the materials that you're going to use for the medical schools are going to be very similar to That what you're going to use that in residencies or and so to that matter see me Beth Information earlier that that is a super resource for you And if you go to a CLM can download a lot of resources for patients as I heard you say Information on counseling patients and that's a big piece of it It's also our own information right our own knowledge. So I think that for ourselves Steve DeVries who is an adjunct professor at Harvard School of Public Health. He has a four-hour CME through the AMA Which is on nutrition basics. I've taken it He just advertised it a couple of weeks ago through the AMA And so if you go to the AMA site and you look up CME on nutrition and Steve DeVries D E V R I E S You you could take that one for $50. So it's it's short short money and it was really very good Then of course going to Lifestyle medicine CMEs you are going to get a great deal of nutrition Going to the American College of Lifestyle Medicine Courses you will get nutrition But if you're really just focused in and you only want to hear about nutrition, then I do recommend the Steve DeVries nutrition from AMA I will share with you that McGraw-Hill reached out to me to do a nutrition Handbook for medical students and we are pulling this together Through Harvard Medical School and this would be appropriate for any physician practicing. It should be out in 2023 And this will give you the core pieces of nutrition that every medical student should know and then the practicing physicians Will be able to fill in the gap through this McGraw-Hill textbook, which will be coming out shortly So does that help you to find a four-hour right away you could do it on your plane ride home perhaps CME and then other options. Is that what you were looking for? Yeah. Yeah, that certainly helps So as we move on to the next question, just another field to look at is the culinary medicine is closely aligned. That's exactly what I volunteered with was culinary medicine through Spectrum Health in Grand Rapids. Yeah, and so for those uninitiated, not yet initiated, our patients are really fundamentally interested in food, not nutrition. So teaching them how to prepare food, how to store food, how to plan ahead is something. And there's a lovely spread of medical students turning in their white lab coats for their chef's coats and learning about cooking. I appreciate it so much, thank you. Thanks. the conflict between RBUs and dual eligibles. Dual eligibles mean, what's the definition? Medicare, Medicaid, the most expensive patients, unhealthy, social determinants of health, the most difficult. So the short answer, so the VA and places like Kaiser and Intermountain, which are more closed than not, are going to benefit from what we'll call a wellness dividend. As the patients get better, there's money to be saved. If they're just floating around and you're collecting RBUs, the leap is that once you engage in lifestyle medicine, and you're not going to do it alone, you're going to have health coaches around, you're going to have people to refer to, there may be a whole team, your patients are going to get healthier. We're showing that at the VA. It's not the payment system that gets them healthier, it's the intervention. But is it going to take you more time? It need not take more time. Knowing what is most important to your patient and couching your recommendations so that they can throw the ball with their grandson is going to get better compliance. They're actually going to take their meds more steadily. And then Beth can comment on this. Most physicians in the country are in that position, and they're starting to do it at various levels. Another way, another whole area of practice is actually shared medical appointments. And lifestyle medicine is really aligned with that. You're going to say the same recommendations about what to eat, why not get 10 of them together in a room, and you charge for all of them. And that's a big way of practice. Beth, other practice? That's brilliant, Eddie. And I was thinking of Ed Noxinger when we had him at the Institute of Lifestyle Medicine sharing about shared medical appointments back only a decade ago. So shared medical appointments in these group visits could be a really nice way for you, if you're talking about for yourself, to practice lifestyle medicine with a big reach and to really have this be financially sound for you. The American College of Lifestyle Medicine has dug into this deeply and CPT codes for this. So there is a resource called SMA, Shared Medical Appointment Toolkit, that you can download from the American College of Lifestyle Medicine website. And you can get the CPT codes for this. And as Eddie said, you can see eight patients in one hour. And as long as you do the appropriate billing and you have the documentation for each patient, you do get a reimbursement. And I love this way of practicing. I actually do these group visits with stroke survivors at Spaulding. I've been doing them since 2012. And I love it because you get that social connection and you get each patient actually helping each other. They're listening to your words. You get some education in there and then you get some coaching and you get that power of the group and you get that social connection in there. So that's a plug for the group. So we have time for one more question. But just one other point is that in the world of ACLM that Beth is talking about, one of the fastest growing areas is a council of health systems. So there are upwards of 80 or more health systems that are actually answering the same question. In other words, how do we pay the doctors properly because we need to get the patients healthier? Because this sickness care system, it's your point that you want, yeah, for this session but also for your office visit. Last question. Welcome. Hi, my name is Kevin Panetta, PGY-4 resident at Kessler. I represent JMS. Thanks a lot for the presentation. Actually, my question was. Great question. So the LMRC is something that can be implemented at any residency. For that, you have to have a resident who wants to do it, a faculty who will support you to do it, as well as some financial support, and then resident interest. So at my residency program, I have yet to find a mentor who's interested in lifestyle medicine. So initially, I had grand plans to implement LMRC at MetroHealth. I'm a PGY-4, and it didn't happen. So I was able to link up with another program, Loma Linda, who has great support for lifestyle medicine, and I have joined their LMRC. So the question doesn't really apply for me in terms of timeline, because I don't know. I wasn't able to do it at my institute. So I don't know if, Beth, you have any insight on how long it would take for a resident to implement the LMRC? Yes. Great, great. Thank you for bringing this up. And so what I will tell you is that I was tapped by the faculty, Stephanos Kail, the professor at the School of Public Health, in April, that he wanted to start the LMRC and needed me to teach it. So this was April, and we applied, we got funding, got approval, and so we connected with the LMRC ACLM committee in July, and we are moving it forward. And I will say that's because I am faculty, and I am meeting with the residents, and I have identified two residents that are co-leaders with me. So what I'm learning from Kelsey, and just thinking in general, if you wanna do this, I think an important piece will be find a faculty that's, it has to be someone that's board-certified in lifestyle medicine, I believe, for the LMRC. So that might also be Kelsey part of the problem. You need to find someone that has the knowledge. One caveat, though, is if they're interested, the faculty, and they're not yet certified, they can go into this process with the residents and be board-eligible at the end. So they're committing to teaching the faculty, and then by going through it, they can be board-eligible. So it's great if you have a board-certified person, but you need someone who's interested with experience, and then they could get board-eligible for your LMRC. Mostly you need a faculty member to help you shepherd this through, it sounds like to me. You could connect with me. I'll stay here on Zoom later. If anyone has questions, I'll stay right here in this little spot. But you could also connect with the American College of Lifestyle Medicine, and then people at LMRC, and say, do you know faculty? And then get yourself connected to a faculty. And they have, usually I think you start in July and January. So if you're interested now, you might be able to get it going in January by their timeline and time clock that I'm aware of at LMRC-ACLM. Does this help? Yeah, absolutely. I'd love to hear more about it from you later on. Thanks a lot, Kelsey. All right, thank you so much for coming. We'll hang around for a little bit. As will Beth, okay. Thank you guys. Thank you.

lifestyle medicine

physicians

exercise

nutrition

stress management

social connections

leaders in lifestyle medicine

medical school

residency curricula

shared medical appointments

patient outcomes