Experts Establish First Performance Measures of Lifestyle Medicine Treatments

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Investigators identify 32 performance measures in the final set grouped into 10 categories of disease or health condition.

The first performance measures were used to identify remission and evaluate the effectiveness of lifestyle medicine treatments, according to results of an expert consensus published in American Journal of Lifestyle Medicine. The results could allow for more objective comparisons between lifestyle interventions and non-lifestyle treatments.1,2

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“Many clinical practice guidelines [say it's] important to address lifestyle behaviors in the treatment of chronic disease, but without measurable performance standards, it was not possible to effectively evaluate progress or long-term outcomes for patients following lifestyle medicine interventions,” John Kelly, MD, MPH, DipABLM, FACLM, founding president of the American College of Lifestyle Medicine, said in a press release. “These new performance measures defined by the expert panel will help clinicians adopt evidence-based lifestyle medicine by equipping them with the standards they need to measure the success of those treatments.”1

In the press release, lifestyle medicine was defined as a medical specialty that employs therapeutic lifestyle interventions as a primary modality to treat chronic conditions, such as cardiovascular disease, type 2 diabetes, and obesity. Further, there are 6 pillars included in lifestyle medicine: whole food, plant-predominate eating patterns, physical activity, restorative sleep, stress management, positive social connections, and avoidance of risky substances.1

According to the experts, there were 32 performance measures in the final set groups into 10 categories of disease or health condition, which included: cardiac function; cardiac risk factors; cardiac medications and procedures; patient-centered cardiac health; hypertension; type 2 diabetes and prediabetes; metabolic syndrome; inflammatory conditions; inflammatory condition patient-centered measures; and chronic kidney disease. The patient-centered measures were all relevant to quality of life, according to the press release.1,2

Investigators chose specific measures that demonstrated if lifestyle medicine would be considered effective, such systolic and diastolic blood pressure 3 months after starting lifestyle interventions to address poor diet and lack of exercise as a measure of hypertension.1 Another measure for hypertension included a reduction in the need for medications or procedures with known effects on hypertension.2

Measures of cardiac function included ejection fraction by echocardiogram, need for coronary artery bypass graft or percutaneous coronary intervention, and functional capacity assessment. Cardiac risk factors included measures of low-density lipoprotein cholesterol, triglycerides, waist-hip ratio, systolic and diastolic blood pressure, and cardiac-C-reactive protein. Cardiac medication and procedures included the dosing of medications and use of procedures, and measures for patient-centered cardiac health included quality of life assessments.2

Key Takeaways

  1. These new measures allow for objective comparisons between lifestyle interventions and non-lifestyle treatments for chronic conditions.
  2. The measures target various chronic diseases including heart disease, diabetes, and kidney disease.
  3. Experts hope these standards will be widely adopted by health care professionals.

For the measures of type diabetes and prediabetes, the authors included 3 measures: hbA1c, fasting serum glucose, and the net reduction or no increase in medications, procedures, or surgeries between measures. Measures for metabolic syndrome included waist circumference, triglycerides, high-density lipoprotein, blood pressure, fasting glucose, and no increase in medications or procedures, according to the experts.2

Measures of inflammatory conditions and patient-centered measures included cardiac CRP and the specific measures for specific inflammatory diseases, as well as SF12 and visual analog scale pain scale, respectively. Measures of chronic kidney disease included serum creatine, estimated glomerular filtration rate, and creatinine clearance.2

“You would not expect surgery, a procedure or medication to be prescribed if no evidence existed that it worked,” Karlsen said in the press release. “Our hope is these standards will be widely adopted by health practitioners.”1

References
  1. First performance standards published to measure the effectiveness of lifestyle medicine treatments. News release. EurekAlert. March 28, 2024. Accessed March 29, 2024. https://www.eurekalert.org/news-releases/1039451
  2. Kelly JH, Lianov L, Karlsen MC, et al. Lifestyle Medicine Performance Measures: An Expert Consensus Statement Defining Metrics to Identify Remission or Long-Term Progress Following Lifestyle Medicine Treatment. AJLM. 2024. doi:https://doi.org/10.1177/1559827624123023
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