First performance standards published to measure the effectiveness of lifestyle medicine treatments

An expert panel has published the first performance measures to identify remission and evaluate the effectiveness of lifestyle medicine treatments, which will allow more objective comparisons between lifestyle behavior interventions and other non-lifestyle treatments.

The performance measures are significant because, as interest in the field of lifestyle medicine has grown, it became clear that the lack of standards to document remission or long-term progress following lifestyle medicine treatment was a barrier to the widespread integration of the practice into health care, said American College of Lifestyle Medicine Founding President John Kelly, MD, MPH, DipABLM, FACLM, lead author of the paper published in the American Journal of Lifestyle Medicine.

Lifestyle medicine is a medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions including, but not limited to, cardiovascular diseases, type 2 diabetes, and obesity. Lifestyle medicine-certified clinicians are trained to apply evidence-based, whole-person, prescriptive lifestyle change to treat and, when used intensively, often reverse such conditions.

Applying the six pillars of lifestyle medicine—a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, positive social connections, and avoidance of risky substances—also provides effective prevention for these conditions.

"Many clinical practice guidelines call it 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," Dr. Kelly said.

"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."

The expert panel focused on 10 diseases, conditions or risk factors and proposes using outcomes collected after three months of treatment with lifestyle medicine. The conditions 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. Patient-centered measures are metrics relevant to quality of life, such as quality of life or pain assessments.

For each disease, specific measurements were chosen to demonstrate if lifestyle medicine should be considered effective. For example, to measure the effectiveness of lifestyle medicine treatment for hypertension, the panel identified systolic and diastolic blood pressure three months after starting lifestyle interventions to address a poor diet and lack of exercise. The panel also considered important the use of medication or procedures with known effects on hypertension. Ultimately, 32 performance measures reached consensus.

The process for developing the performance measures made clear the need for a set of standards showing the effectiveness of lifestyle medicine, said Micaela Karlsen, Ph.D., MSPH, senior director of research for the American College of Lifestyle Medicine and last author of the paper.

"You would not expect surgery, a procedure, or medication to be prescribed if no evidence existed that it worked," Dr. Karlsen said. "Our hope is health practitioners will widely adopt these standards."

As the field of lifestyle medicine continues to grow, measurements will play an important role. Future work should use these measurements in data collection in the electronic medical record (EMR) system to standardize the evaluation of lifestyle medicine treatment effectiveness and performance, the panel recommended.