Lifestyle medicine (Hoboken, N.J.)最新文献

On 3 April 2018, Eye published a review titled ‘Physical activity, visual impairment, and eye disease’. The review concluded there was evidence that physical activity may protect against vision loss, and that vision loss causes a decline in physical activity.¹ There is also undisputed evidence that physical activity is generally good for us.² Regular physical activity reduces the risk of several leading chronic conditions, and the risk of premature mortality by 20%–30%.³

However, both the ‘Standards of practice for optometrists and dispensing opticians’⁴ and ‘The College of Optometrists clinical guidance’⁵ do not explicitly state that eyecare professionals should discuss physical activity with patients. Similarly, whilst the Royal College of Ophthalmologists guidance document titled ‘low vision: the essential guide for ophthalmologists’ references physical activity, by stating ‘four modifiable behaviours – smoking, physical inactivity, poor diet and drinking alcohol have been shown to be associated with reduced vision’, the preceding article focuses on smoking cessation with no further mention of physical activity.⁶ This is the research–policy gap. There is research to support that physical activity is good for patients; however, there are limited policies designed to promote physical activity to patients within eyecare.

As of 12 June 2022, if you search PubMed for ‘healthcare policy change’, you will get 69,885 results; if you run the same search replacing ‘healthcare’ with the term ‘eyecare’, you will get eight results. Of course, there are more rigorous methods of searching the literature, but the point is that compared to research exploring how to implement policy change within general healthcare, there is surprisingly scarce literature that focuses on implementing policy change within eyecare. Perhaps it is not surprising then that there is a research–policy gap in the promotion of physical activity within eyecare. However, eyecare can learn from research conducted in other healthcare settings. The following article proposes how to get from stage 1: evidence that physical activity is good for patients, to stage 2: eyecare professionals promoting physical activity to patients.

However, persuading eyecare professionals to promote physical activity should not stop in the elevator. People are diverse, and messages reach and resonate with different people dependent on their delivery. For example, sharing patient's stories of how physical activity benefited them, visual infographics depicting the benefits of physical activity, physical activity champions (peers who support their fellow colleagues to promote physical activity to patients), and social media can be used to encourage professionals to promote physical activity.⁹

Eyecare professionals nee

Lifestyle Medicine would like to thank the following people for their invaluable contribution to the peer-review process during 2021.

Allan, R. United Kingdom

Amusa, Ganiyu Adeniyi Nigeria

Anderson, Hermione United Kingdom

Barata, Bernardo Portugal

Barua, Lingkan Bangladesh

Chowdhury, M. A. B. United States

Ehrlich, Anna United Kingdom

El-Hamd, Mohammed Abu Egypt

Fair, Cynthia D. United States

Falloon, Karen New Zealand

Fayet-Moore, Flávia Australia

Findlater, Hannah United Kingdom

Haq, Shah Md Atiqul Bangladesh

Heath, Rory United Kingdom

Jóhannsson, Guðmundur Iceland

Junghans Minton, Connie United Kingdom

Lawson, Rob United Kingdom

Manger, Sam Australia

Maniatopoulos, Greg United Kingdom

Maselli, Luigi Italy

Massahikhaleghi, Parissa Iran (the Islamic Republic of)

Massey, Heather United Kingdom

Mercore, Emanuela Romania

Mineviciene, Egle Lithuania

Mishu, Masuma United Kingdom

Monye, Ifeoma Nigeria

Nadolsky, Spencer United States

Ribeiro, Sandra Brazil

Scanlon, Jack United Kingdom

Schmitt-Egenolf, Marcus Sweden

Sholl, Jonathan France

Sizear, Monaemul Islam Netherlands

Sumego, Marianne United States

Symington, Emily United Kingdom

Thomson, Richard United Kingdom

Tokell, Marisa United Kingdom

Ulasoglu, Celal Turkey

Ullah, Rahamat Bangladesh

Wardle, Jon Australia

Warmbrunn, Moritz V. Netherlands

Wilmore, Ellis

Yadav, Amit India

Zaman, Mostafa Bangladesh

Some light at the end of the COVID-19 tunnel may be nearing. Yet, that same light is revealing a larger and longer term burden on our communities. Our educational institutions and health services have not been spared. The pandemic has catalysed the longer standing impact of anxiety, stress and burnout for many frontline health workers and younger people in particular. It has magnified socioeconomic and wider inequalities that are so detrimental to health and well-being.

While fiscal responses to the pandemic continue to be debated, there remains a fundamental barrier for the triad of Public Health, Social Care and Health Care resourcing: workforce. The historical absence of strategic workforce planning in the United Kingdom's National Health Services means that without extending (ethically challenging) international recruitment efforts, even substantial injections of finance into health and care economies are stymied by how such monies can be spent.

Lifestyle Medicine stands ready to yield a double dividend. First: to leverage self-care and health improvement amid the plethora of contact points that our communities have with public and third sector services. And second: to protect the health of our current and future workforce. While Lifestyle Medicine is no substitute for traditional population-level public health interventions, Lifestyle Medicine is an important and scalable element of the population health armamentarium, not least as systems seek increasingly integrated and preventive approaches to health and well-being. Behaviour change in the form of physical activity has been recently highlighted as a first-line therapy by U.K. health regulators in the management of depression (National Institute for Health and Care Excellent)² and many other chronic physical health conditions. The relevance of health behaviours to mitigate communicable disease threats such as the COVID-19 pandemic will be clear in the minds of many. The need for skills in promoting lifestyle changes is endorsed as a core component of U.K. medical training.³

The specialty of Lifestyle Medicine, often described as emerging, can increasingly be described as maturing. As the American College of Lifestyle Medicine (ACLM) approaches 18 years of age, and the British Society of Lifestyle Medicine (BSLM) enters its seventh year, the global governance of the movement is transitioning too, with a new World Lifestyle Medicine Council. At the same time, consensus is being achieved on the specialty's scope: six pillars of lifestyle and increasingly concrete clinical application such as coaching, behaviour change and group consultations.

The evolution of interdisciplinary areas of practice is dependent on consensus - followed by convergence of both scope and practice. And while initially that involves interdisciplinary working, the extent to which Lifestyle Medicine is a logical expansion of scope for general prac

It has been repeatedly shown that randomized controlled trials (RCTs) do not represent real-world patient populations; a recent systematic review showed that more than 70% of trials are not broadly representative, limiting external validity.¹ Consequently, RCT-based conclusions can be true (high internal validity) but many are irrelevant for the real-world setting due to low external validity and generalizability. Evidence-based medicine has given pre-eminence to RCTs, and meta-analyses of RCTs graded as the highest evidence in medicine. Although RCTs are superior in certain situations, mainly for pharmacological intervention aiming to treat a single disease in an otherwise healthy patient population, their inherent reductionist setting can miss much of what is valuable in health—things that can only be captured in a more patient-centred approach.² This over-reliance on a familiar tool, known as the law of the instrument or ‘Maslow's hammer’, has already been described in 1966: ‘I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail’.³ RCTs should consequently be used appropriately, as necessary evidence before acquiring real-world evidence in pharmacological interventions.⁴

As we realize that societal determinants and individual lifestyle choices—which are not easily evaluated in RCTs—will be the major determinants of health and well-being in the future, over-reliance on the RCT instrument holds the danger of limiting medical progress through ‘by design’ prioritization of pharmacological interventions. Virtual group consultations, able to utilise limited resources (health professionals) maximally and deliver efficient care⁵, are an example of an innovative intervention that cannot be evaluated in a classic RCT. But observational designs have well-recognised limitations, so modern intervention and trial types now available to us should be more widely used and further developed. These include stepped wedge designs, just-in-time adaptive interventions (JITAIs, sometimes referred to as ‘jedis’), (sequential) multi-randomisation trials, and ‘small data’ approaches.^5-7 As innovative interventions spread at scale, we believe embedded evaluation should be prioritized through novel health technology assessment (HTA) or health service funding schemes, as they and other complex interventions are best studied in real-world conditions, despite a paucity of RCT data.⁹ New—and preferably collaborative to address global inequality—funding streams are needed like the recent initiative from the United Kingdom's National Institute for Health Research (NIHR) for varied research approaches in diverse populations.¹⁰ Only then can true variety be delivered to facilitate the robust healthcare system changes the syndemic h