Complete Lifestyle Medicine Intervention Program-Ontario: Implementation Protocol for a Rural Study.

High proportions of post-9/11 veterans have musculoskeletal disorders (MSDs), but engaging them in care early in their course of illness has been challenging. The service connection application is an ideal point of contact for referring veterans to early interventions for their conditions. Among MSD claimants who reported risky substance use, we pilot-tested a counseling intervention targeting pain and risky substance use called Screening Brief Intervention and Referral to Treatment-Pain Module (SBIRT-PM). Veterans were randomly assigned in a 2:1:1 ratio to SBIRT-PM, Pain Module counseling only, or treatment as usual (TAU). Participants assigned to either counseling arm were offered a single meeting with a study therapist with two follow-up telephone calls as needed. Participants completed outcome assessments at four and 12 weeks after randomization. Of 257 veterans evaluated, 101 reported risky substance use and were randomized. Counseling was attended by 75% of veterans offered it and was well received. VA pain-related services were used by 51% of participants in either of the pain-focused conditions but only by 27% in TAU (P < 0.04). Starting with average pain severity ratings of 5.1/10 at baseline, only minimal changes in mean pain severity were noted regardless of condition. Self-reported risky substance use was significantly lower over time in the SBIRT-PM condition relative to the two other conditions (P < 0.02). At week 12, proportions of veterans reporting risky substance use were 0.39, 0.69, and 0.71 for the SBIRT-PM, Pain Module counseling, and TAU conditions, respectively. SBIRT-PM shows promise as a way to engage veterans in pain treatment and reduce substance use.

BACKGROUND: The Service member Transitional Advanced Rehabilitation Program (STAR) is a novel model designed to promote interdisciplinary collaboration while delivering comprehensive physical, psychosocial and vocational rehabilitation services. The STAR program was established as a pilot program in 2011 and is now approved for permanent continuation. It is housed in the Polytrauma Transitional Rehabilitation Center at Hunter Holmes McGuire VA Medical Center in Richmond, Virginia. OBJECTIVE: The present study introduces the development, implementation, participant characteristics and five-year program outcomes of the STAR program. METHODS: A paired sample t-test was employed to compare pre and posttest functioning in the following areas: physical, mental and emotional, vocational, and community integration. Mixed analysis of variance was further employed to determine the impact of demographic variables such as age, gender, race/ethnicity and marriage status on recovery. RESULTS: Statistically significant improvements in physical, mental and emotional, and vocational functioning was found in participants after completion of the STAR program. Regarding demographic variables, only marital status appeared to impact PTSD recovery. CONCLUSIONS: The STAR program’s vocational rehabilitation and community reintegration services, as well as efforts to improve physical and psychological functioning, have demonstrated positive outcomes. Overall, the development and implementation of the program has been highly successful.

e24053 Background: Lifestyle medicine emphasizes the role of 6 pillars in preventing chronic disease and improving health: nutrition, physical activity, sleep, stress management, social connection, and avoiding risky substance use. While most oncologists are aware of the role of these factors in reducing risk of recurrence and improving outcomes, there are numerous barriers to addressing these lifestyle factors during clinic visits. The PAVING the Path to Wellness for Breast Cancer Survivors program (PAVING) is a 12-week lifestyle medicine group intervention designed to deliver lifestyle medicine guidelines and practices to cancer survivors in a supportive setting. This study assessed short-term impacts of PAVING on behavioral and psychological outcomes. Methods: 101 women who completed PAVING since 2019 were invited to complete a survey. Inclusion criteria were primary oncology treatment at Massachusetts General Hospital, age &gt; 22, diagnosis of invasive breast cancer (Stages I-III) within past 5 years, ECOG score 0-1, and English fluency. 16 enrolled in the study, 13 of whom fully completed the survey. The REDCap survey included the REAP-S and EHQ nutrition scales, IPAQ-SQ physical activity measure, COPE Inventory for coping skills, Psychological Wellbeing Scale, PROMIS-QOL scale, and ratings of the impact of the program on well-being. Statistical analysis was completed in SPSS. Results: The participants, N = 16, were women above the age of 22 with a primary diagnosis of breast cancer. Analysis found while ASCO recommends a minimum of 150 min/week of moderate-vigorous exercise, PAVING participants achieved a median of 255 min/week (120 to 420). A Spearman’s rank correlation found a significant positive relationship between fruit intake and self-rated dietary improvement due to PAVING, r(13) = .764, p = .002. A significant positive relationship also existed between PAVING-attributed emotional well-being improvements and general mental health, r(13) = .615, p = .025. Participants strongly agreed PAVING improved their confidence in their ability to cope (M = 1.9, SD = .76) and set goals (M = 1.92, SD = .862). Participants agreed their quality of life (QOL) improved since completing PAVING (M = 2, SD = .816); QOL ratings (M = 1.69, SD = .751) reflect very good-to-excellent QOL in the average PAVING participant. Conclusions: PAVING Participants report positive lifestyle practices, many attributed to the program, supporting further investigation of this program for patients with cancer. Mental well-being, QOL, and fruit intake were all positively correlated with self-rated growth resulting from PAVING. Participants exceeded guidelines for physical activity, which has been shown to reduce risk of breast cancer recurrence. PAVING is an effective lifestyle-medicine intervention for breast cancer survivors, and expansion will enable a broader population to improve outcomes following diagnosis and treatment.

&lt;p style="text-align: justify;"&gt;The article analyzes the actual practice of developing psychological and pedagogical programs for the All-Russian Competition of the Best Psychological and Pedagogical Programs and Technologies in the Educational Environment &amp;mdash; 2023. A comprehensive assessment is carried out of the completeness of the competitive programs&amp;rsquo; fulfillment of the requirements for them in accordance with the regulations on the competition. Typical deficiencies and shortcomings that appear during the preparation and implementation of programs have been identified, and factors that have influenced the programs&amp;rsquo; incomplete compliance with the specified requirements have been identified. Analytical materials of existing discrepancies are presented and proposals for the scientific and methodological development of new developments of psychological and pedagogical programs are presented. The implementation of this complex task was undertaken by the Federation of Psychologists of Education of Russia, which unites psychological groups from all regions of the Russian Federation. The accumulated experience of such work allows us to formulate requirements for the development and implementation of psychological and pedagogical programs and technologies in the educational environment.&lt;/p&gt;

Background: As key components of the AHA Life’s Simple 7 campaign, lifestyle modifications play an integral role in the prevention of vascular disease. Little is known about the prevalence of lifestyle modification counseling in patients with acute ischemic stroke (AIS). We sought to investigate disparities in the delivery of lifestyle interventions to AIS patients in the large NINDS-funded FL-PR CReSD Registry of Get With The Guidelines-Stroke (GWTG-S) data. Methods: GWTG-S collects data on the provision of several lifestyle interventions including counseling on exercise/weight loss, Therapeutic Lifestyle Changes (TLC) diet, diabetes (DM) education and antihypertensive (low sodium) diet. 80,598 AIS cases were prospectively included from 82 sites (69 FL; 13 PR) from 2010-2016. Multilevel logistic regression models adjusted for age, race, and aphasia were used to evaluate differences in the provision of lifestyle interventions as indicated for patients prior to hospital discharge. Results: Among AIS cases, 51% were men, 62% non-Hispanic White (NHW), 18% NH-Black (NHB), 13% FL-Hispanic (FLH), and 6% PR-Hispanic (PRH). Mean age was 71±14 years. The highest mean BMI was in PRH (29±7 kg/m 2 ), with the lowest in NHW (27±6 kg/m 2 ) and FLH (28±6 kg/m 2 ). Despite this, PRH were less likely to receive exercise/weight loss counseling compared to NHW (OR 0.43, 95% CI 0.20-0.90) and FLH (OR 0.46, 95% CI 0.22-0.97). PRH also had lower odds of receiving TLC diet counseling compared to NHW and FLH (OR 0.32, 95% CI 0.15-0.68). Though NHB presented with higher rates of DM compared to NHW (38% vs. 25%), they were less likely to receive DM education (OR 0.95, 95% CI 0.91-0.99). Women were less likely to receive TLC diet counseling (OR 0.94, 95% CI 0.90-0.98) and DM education (OR 0.94, CI 0.92-0.97) compared to men. Despite higher HTN frequency in women and NHB (67% and 69%), both were less likely to receive low sodium diet recommendations as compared to men (OR 0.94, 95% CI 0.92-0.97) and NHW (OR 0.95, 95% CI 0.91-0.99). Conclusion: Overall, disparities were identified in the provision of several lifestyle interventions in AIS patients. These interventions can benefit all and providers should continue counseling patients regarding modifiable risk factors to prevent future stroke.

While the Western diet has evolved to become increasingly high in saturated fat, cholesterol, protein, sugar, and salt intake, nutrition education and training of health care professionals to counsel their patients on the hazards of such a diet has trailed behind. Primary care physicians have an opportunity to bridge the gap by providing nutrition and dietary counseling as key components in the delivery of preventive services. Increasing research points to the value of a whole-foods plant-based diet in combating chronic disease, yet the knowledge of health professionals about the topic is comparable to that of the general public. This education crisis is apparent in medical training with restricted time for dedicated lectures on nutrition, physical activity, restorative sleep, emotional well-being, and avoidance of risky substance use. Together, educators and learners are valuable catalysts for culture change in medical education, training, and clinical practice. Barriers to physician ability to counsel about lifestyle are many, but one that stands out is lack of training and comfort with counseling. This has implications for the training of health care professionals. American College of Lifestyle Medicine has a committee, Professionals in Training, composed of interprofessional and multidisciplinary students, residents, and fellows nationally and worldwide who are committed to expanding exposure to lifestyle medicine and implementation of lifestyle medicine in parallel curriculum and personal care.

Purpose The present study described associations between profile membership, based on lifetime experiences of intimate partner violence (IPV) and three conceptually relevant groups of variables hypothesized to facilitate vulnerability to IPV among emerging adults: Risky substance use, lifetime experiences of adversity, and dysfunctional relationship characteristics. Methods An ethnically and racially diverse sample of U.S. transgender adults ( N = 248, age M = 22.61 years) were surveyed using the CloudResearch participant recruitment platform. Latent profile analysis (LPA) was used to model the optimum number of underlying groups of participants, based on their self-reported lifetime experiences of psychological control, physical violence, and sexual violence by romantic or sexual partners. Results Four profiles were identified: High All IPV Scales, Low All IPV Scales, High Psychological/Physical IPV, and High Sexual IPV. Significant between-profile differences in dependent variables varied by variable domain. However, members of the small High All IPV Scales profile reported the highest mean scores for all indicators of risky substance use and lifetime adversity and very high mean scores for relational aggression and relational victimization. Conclusions There was substantial heterogeneity in transgender emerging adults’ experiences of IPV. More complex patterns of lifetime IPV were significantly associated with more severe patterns of risky substance use, lifetime adversity and forms of conflict in intimate relationships. The information generated in this descriptive study may be used to inform tailored counseling interventions for transgender emerging adults by integrating into IPV risk reduction initiatives detailed information regarding factors that facilitate client vulnerability to IPV.

Our friend and colleague Wayne Fenton asked to write this article for the Journal because of his desire to educate other psychiatrists about the treatment of schizophrenia, including what he recognized to be a growing problem with the metabolic syndrome. This lifelong passion, which he pursued from his psychiatry residency at Yale, through his directorship of Chestnut Lodge, to his position at NIMH as Director of the Division of Adult Translational Research and Associate Director for Clinical Affairs, ended tragically with his killing during an evaluation of a psychotic young man. Wayne had worked tirelessly to secure support for new drug discovery in the NIMH programs that he directed. The Journal will be initiating in 2007 a series of articles on the discovery of new mental illness treatments. We will dedicate this series to Wayne's memory and include with it a memorial of his life and contributions to the treatment of mental illness.

Background: There is a lack of evidence concerning the effective implementation of strategies for stroke prevention and management, particularly in resource-limited settings. A primary-care-based integrated mobile health intervention (SINEMA intervention) has been implemented and evaluated via a 1-year-long cluster-randomized controlled trial. This study reports the findings from the trial implementation and process evaluation that investigate the implementation of the intervention and inform factors that may influence the wider implementation of the intervention in the future.Methods: We developed an evaluation framework by employing both the RE-AIM framework and the MRC process evaluation framework to describe the implementation indicators, related enablers and barriers, and illustrate some potential impact pathways that may influence the effectiveness of the intervention in the trial. Quantitative data were collected from surveys and extracted from digital health monitoring systems. In addition, we conducted quarterly in-depth interviews with stakeholders in order to understand barriers and enablers of program implementation and effectiveness. Quantitative data analysis and thematic qualitative data analysis were applied, and the findings were synthesized based on the evaluation framework.Results: The SINEMA intervention was successfully implemented in 25 rural villages, reached 637 patients with stroke in rural Northern China during the 12 months of the trial. Almost 90% of the participants received all follow-up visits per protocol, and about half of the participants received daily voice messages. The majority of the intervention components were adopted by village doctors with some adaptation made. The interaction between human-delivered and technology-enabled components reinforced the program implementation and effectiveness. However, characteristics of the participants, doctor-patient relationships, and the healthcare system context attributed to the variation of program implementation and effectiveness.Conclusion: A comprehensive evaluation of program implementation demonstrates that the SINEMA program was well implemented in rural China. Findings from this research provide additional information for program adaptation, which shed light on the future program scale-up. The study also demonstrates the feasibility of combining RE-AIM and MRC process evaluation frameworks in process and implementation evaluation in trials.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03185858.

The objective of this expert consensus process was to define performance measures that can be used to document remission or long-term progress following lifestyle medicine (LM) treatment. Expert panel members with experience in intensive, therapeutic lifestyle change (ITLC) developed a list of performance measures for key disease states, using an established process for developing consensus statements adapted for the topic. Proposed performance measures were assessed for consensus using a modified Delphi process. After a series of meetings and an iterative Delphi process of voting and revision, a final set of 32 performance measures achieved consensus. These were grouped in 10 domains of diseases, conditions, or risk factors, including (1) Cardiac function, (2) Cardiac risk factors, (3) Cardiac medications and procedures, (4) Patient-centered cardiac health, (5) Hypertension, (6) Type 2 diabetes and prediabetes, (7) Metabolic syndrome, (8) Inflammatory conditions, (9) Inflammatory condition patient-centered measures, and (10) Chronic kidney disease. These measures compose a set of performance standards that can be used to evaluate the effectiveness of LM treatment for these conditions.

The digital revolution-including smartphones, wearable devices, mobile applications, and online platforms- has fundamentally transformed modern human lifestyle and health behaviors. This narrative review synthesizes evidence on the positive and negative impacts of social media and smart technologies on the six pillars of lifestyle medicine: nutrition, physical activity, stress management, substance use, restorative sleep, and social connection. We conducted a narrative review of English-language, peer-reviewed literature from 2010 to 2025. Searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and PsycINFO, supplemented by Google Scholar and reference-list screening. Across pillars, (SMAT) can enable self-monitoring, goal-setting, personalized feedback, and remote coaching. Evidence is strongest for physical activity and dietary self-management, particularly when interventions include behaviour change techniques (e.g., prompts, gamification, and social support) and clinician input. Digital mindfulness and cognitive-behavioral programs show modest reductions in perceived stress and improvements in sleep outcomes in selected populations. However, excessive screen time and evening device use are consistently associated with poorer sleep, digital fatigue, and reduced wellbeing. Social platforms can enhance peer support and accountability, but can also amplify misinformation, unhealthy comparison, and exposure to marketing or norms that promote risky substance use. Healthcare professionals, educators, and policymakers should promote evidence-based and balanced SMAT use by assessing digital health literacy, guiding purposeful engagement, monitoring for harms such as sleep disruption and anxiety, and addressing inequities in access. Hybrid models that combine digital tools with counseling, education, and family- or community-based support appear most promising for sustained behavior change. Regulatory oversight, app validation, data privacy protections, and long-term research in diverse populations are essential to ensure safe, effective, and equitable implementation.

BackgroundSeveral lifestyle factors have been independently associated with headache disorders; however, less is known on the aggregated impact of lifestyle factors on headache disability. We aimed to explore the relationship between a healthy lifestyle score based on the six pillars of lifestyle medicine and prevalence of headache disability in Brazil.MethodsData were derived from the 2019 Brazilian National Health Survey, a nationwide, cross-sectional study. Prevalence estimates for disease-related disability were based on days missed from work, school, domestic chores, or recreation due to disease or health condition in the past 2 weeks. A healthy lifestyle score (0–14 points) incorporated self-reported data on physical activity, diet, sleep, mental health, risky substance use, and social connections. Weighted binary logistic regression models assessed the relationship between the healthy lifestyle scores and occurrence of headache-associated activity loss. Models were adjusted for age, sex, and socioeconomic and geographic disparities. The results are presented as odds ratio (OR) and 95% confidence intervals (95% CI).ResultsAmong 88,531 adults included in the analysis (mean age 47.1 years; 52.9% female), 8,693 participants [weighted point prevalence = 8.8% (8.2%-9.2%)] reported disease-related disability. Headache-associated activity loss showed a weighted frequency of 5.3% (4.6%-6.0%), the fifth most prevalent disease-related disability among Brazilian adults. The headache-associated activity loss group had a lower healthy lifestyle score than the no disability group [mean (SD): 7.8 (2.4) vs. 8.8 (2.4), p < 0.001]. Compared to participants who reported no disability over the past 2 weeks, the adjusted models revealed a significant inverse linear association between healthy lifestyle scores and the occurrence of headache-associated activity loss [OR = 0.86 (95% CI: 0.82, 0.91), p for linear trend: < 0.001].ConclusionsThe adherence to the six pillars of lifestyle medicine is associated with lower occurrence of headache-associated activity loss in Brazil, warranting further investigation on the benefits of the adoption of a healthy lifestyle as a strategy to reduce headache burden.Graphical abstract

Many wellness programs for older adults focus on physical health or specific conditions, such as heart disease prevention or diabetes management. To supplement these efforts, there is a need for holistic wellness programming to enhance well-being in later life. We developed and piloted a novel wellness coaching program for residents of senior living communities to address this need. The theoretical framework of the program is based on a holistic, multidimensional wellness model and self-determination theory. Staff members from eight residential communities were trained on wellness coaching techniques, such as motivational interviewing, active listening, and group facilitation skills, before they led the 9-week resident wellness coaching program. A total of 79 residents, ages 71 to 97 (M = 84.3, SD = 6.5), completed the pilot program. The resident wellness coaching program included a mixture of individual and group coaching sessions. The coaching sessions provided wellness education, social support, and space to share progress on wellness goals. Participants completed surveys at three time points: pre-program, post-program, and 1-month follow-up. Residents reported high satisfaction with the overall program and its components. Repeated measures ANOVAs were conducted to examine changes in wellness over time. Comparison of pre- and post-test scores revealed significant improvements in health satisfaction, physical and psychological quality of life, purpose, loneliness, relatedness, and competence. Some of these changes, such as increases in psychological quality of life and decreases in loneliness, persisted at the one-month follow-up. These findings have implications for the development and implementation of wellness coaching programs with older adults.

Chronic disease places an enormous economic burden on both individuals and the healthcare system, and existing fee-for-service models of healthcare prioritize symptom management, medications, and procedures over treating the root causes of disease through changing health behaviors. Value-based care is gaining traction, and there is a need for value-based care models that achieve the quadruple aim of (1) improved population health, (2) enhanced patient experience, (3) reduced healthcare costs, and (4) improved work life and decreased burnout of healthcare providers. Lifestyle medicine (LM) has the potential to achieve these four aims, including promoting health and wellness and reducing healthcare costs; however, the economic outcomes of LM approaches need to be better quantified in research. This paper demonstrates proof of concept by detailing four cases that utilized an intensive, therapeutic lifestyle intervention change (ITLC) to dramatically reverse disease and reduce healthcare costs. In addition, priorities for lifestyle medicine economic research related to the components of quadruple aim are proposed, including conducting rigorously designed research studies to adequately measure the effects of ITLC interventions, modeling the potential economic cost savings enabled by health improvements following lifestyle interventions as compared to usual disease progression and management, and examining the effects of lifestyle medicine implementation upon different payment models.

Therapeutic lifestyle changes (TLC) are important for the prevention and management of, as well as adjuncts to, pharmacotherapy of hypertension. This article reviews relevant TLC and their effects on blood pressure (BP) levels, with emphasis on exercise and dietary habits. Regular, moderate-intensity (40%-70% of heart rate reserve) aerobic exercise training for 30 to 60 minutes, 3 to 5 times per week, can lower systolic and diastolic BP levels, with a greater reduction observed in patients with hypertension compared with those with normal BP levels. A diet rich in fruits, vegetables, and whole grains, with a moderate intake of fat-free or low-fat dairy products, and low in saturated and total fat, sodium, and alcohol, such as the Dietary Approaches to Stop Hypertension eating pattern, also significantly reduces BP levels. A TLC program including regular exercise and dietary modifications along with weight management appears to result in a greater BP reduction than either intervention alone. TLC can also significantly reduce other risk factors for cardiovascular disease commonly accompanying hypertension. Multiple mechanisms appear to contribute to BP reduction by dietary intervention (reduced weight, sodium, and alcohol and increased calcium, potassium, and magnesium). For exercise, these include improvements in arterial endothelial function and compliance, left ventricular structure and function, and perhaps vascular blood supply with increased cardiorespiratory endurance. The available evidence is robust in support of TLC for management of elevated BP and for the primary prevention of hypertension, supporting the recommendations by the Joint National Committee Seventh Report on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.