A toolkit for life
27th Sep 2011 Professor Garry Egger all articles by this author
What can GPs do to encourage lifestyle changes for patients?
IT IS now widely accepted that lifestyle and environmental issues are the causes of much chronic disease.
Simply advising patients to eat better, do more exercise and improve their sleep and stress levels can be as effective as telling the cat to get off the bed.
Of more benefit would be a ‘toolkit’ of available initiatives to encourage change.
The inside of a potential ‘lifestyle medicine toolkit’ might look something like that shown in the table below.
Some of these tools are self-explanatory, others may need some interpretation.
The Readiness to Participate questionnaire* was developed in New Zealand and has been modified for Australia.
It can be filled out before a consultation and gives you an idea of the areas on which to focus.
BIA (bio-impedance) scales measure not just weight, but the percentage of body fat, giving a better idea whether fat (not necessarily weight) loss is important for health improvement.
Blood measures such as CRP and Interleukin-6 can give an indication of potential lifestyle-related causes of disease.
Highly sensitive CRP that is slightly higher than normal is often ignored as not being important.
However, chronically elevated markers like these could indicate a form of low-level chronic inflammation indicative of poor lifestyle variables such as inactivity, inadequate sleep or poor nutrition.
The Flow Whiz sleep monitor was developed by Professor Ron Grunstein from the Woolcock Institute in Sydney.
This is a small portable device available for overnight hire that detects sleep problems and avoids the need for an overnight stay at a sleep clinic.
Importance and Confidence scales* are simple 10-point scales on which patients rate how important it is to them to change a behaviour and how confident they are that they can succeed at such a change. This then helps hone in on the focus for behaviour change.
DAB-Q (Diet, Activity and Behaviour Questionnaire) assesses those aspects of diet and exercise that require attention with a scaling score based on the practicalities of whether a change is possible or not. The test is available free at www.professortrim.com/DAB-Q.
It can be completed at leisure and a printout brought to a consultation when dealing with dietary and exercise prescriptions.
Act, Belong, Commit (ABC) – advice for improved mental health – was developed at Curtin University in Western Australia. This package of material, including a website (www.actbelongcommit.org.au) offers advice and instructions for low level mental health problems, particularly depression (see Medical Observer, Lifestyle Matters, 5 August).
The 5 S’s Prescription covers stamina, size, strength, suppleness and stability, and how to measure each to get a total score (maximum 100) from which recommendations can be made to improve those areas that are most deficient (and everybody is usually deficient in at least one).
Of course, the fulfilment of any lifestyle prescription depends on the patient’s motivation to change and self-manage, but is this very different to expecting compliance to a pharmaceutical prescription?
Professor Garry Egger
Director, Centre for Health Promotion and Research, Sydney; Professor of lifestyle medicine and applied health promotion, Southern Cross University, Lismore, NSW.
