Rachel A. Millstein

Initiating and facilitating health-promoting behaviors is just the start of the change process. Transitioning initial changes to a sustainable, healthy lifestyle requires a focus on building the infrastructure to support and promote healthy living for a lifetime. Maintaining long-term health behaviors requires continuous motivation; adjusting for life changes, stages, and setbacks; and finding solutions for socio-environmental barriers. This chapter reviews how to use behavior change models and strategies such as the capability–opportunity–motivation–behavior model, self-determination theory, social cognitive theory, positive psychology, and growth mindset to sustain long-lasting motivation and change. The chapter also explores forces that may help or hinder long-term adherence to healthy habits, such as family, community, social, economic, and environmental factors. Furthermore, the chapter discusses creating positive relationships between health care providers and patients. It covers utilizing community resources, support groups, and other social programs to provide continuous support and accountability.

Background: Lifestyle medicine (LM) is increasingly recognized in cancer survivorship guidelines. The 6 LM pillars are physical activity, a predominantly plant diet, restorative sleep, stress management, avoiding risky substance use, and social connections. Through a multidisciplinary LM clinic in oncology, we describe 2 illustrative cases and the implications for broader implementation and dissemination of this clinic model. Methods: In the multidisciplinary LM clinic in oncology, patients meet with an American College of Lifestyle Medicine (ACLM) board-certified physician or nurse practitioner, a registered dietitian, and, as needed, a clinical psychologist, a psychiatrist, an obesity medicine physician, a physical therapist, and/or a rehabilitation medicine physician. Results: Patient 1 met with the physician, the registered dietitian, the psychologist, and an affiliated cancer center psychiatrist. Patient 2 met with the nurse practitioner and the registered dietitian. The 2 cases presented illustrate the diversity of LM pillars and strategies to increase health and well-being post cancer treatment. Conclusion: This paper details the model of implementation of a novel oncology-focused multidisciplinary LM clinic and the clinical focuses of 2 diverse patients. The LM needs of cancer survivors seeking lifestyle consultation are growing, and awareness of the benefits of LM for this population can enhance the quality of life for patients who are survivors of cancer. Keywords: lifestyle medicine, cancer, survivorship, clinical program, case studies

Veterans are at risk for mental and physical health problems but may not seek traditional health care services. Wellness-based interventions, including exercise and nutrition, have been associated with improvements in physical and mental health among this population. This study explores the acceptability, feasibility, and efficacy of a 3-month health and fitness program for veterans. Participants in 2 time-based cohorts from 2019 to 2023 (cohort 1: n = 261; cohort 2: n = 256) were cleared by a physician to participate. Participants then completed a fitness test and self-reported surveys (e.g., quality of life, sleep, and pain) before and after the 3-month program. Participants were recruited to participate at one of three sites: Boston, MA Fort Myers, FL, or Tampa, FL. The 3-month program consisted of weekly, supervised group fitness and one-on-one sessions, nutritional consultations, yoga, and other wellness activities. Primary program outcomes were measured by fitness assessments, self-report surveys, program completion, and program satisfaction. Fitness assessments included measures of weight, body mass index, grip strength, waist to hip ratio, body fat, lean mass, fat mass, heart rate, and blood pressure (BP). Self-report measures included quality of life, depression, loneliness, sleep quality, pain intensity, and pain interference. In cohort 1, significant improvements were found for measures of weight (P = .01), left-handed grip strength (P < .01), body fat percent (P < .01), and quality of life (P < .01). In cohort 2, significant improvements were found for measures of waist:hip ratio (P = .02), right and left-handed grip strength (P < .01), body mass index (P = .02), body fat percent (P < .01), and quality of life (P = .02). For both cohorts, pain intensity (cohort 1: P = .01, cohort 2: P < .001) and pain interference (cohort 1: P = .02, cohort 2: P < .001) increased significantly. These data suggest that a 3-month health and fitness program for veterans is acceptable and feasible and may improve physical and mental health outcomes. Considerations for program retention and assessment completion are discussed.

Background: Cancer survivorship guidelines emphasize Lifestyle Medicine (LM) pillars, including physical activity, healthy eating, restorative sleep, stress management, and avoiding risky substance use. We describe the development and patient population of a multidisciplinary LM clinic in oncology. Methods: The clinic launched virtually in 2020. Patients had same-day consultations with an oncologist/nurse practitioner, nutritionist, and psychologist. Patients completed a one-time online survey assessing demographics, quality of life, LM pillars, and mental health. Descriptive statistics were used to characterize the population. Results: Seventy-six patients took the survey (July 2020-January 2023). Most were female, non-Hispanic White, with early-stage cancers. The mean BMI was 30 kg/m ² . A minority of patients met aerobic physical activity (27.6%) and dietary (28.6%) recommendations. Two-thirds (67%) reported sleep difficulties, and 30%–36% reported elevated anxiety/depression. Over half (53.3%) gained weight due to cancer treatment and 78.7% were trying to lose weight. Conclusion: This paper details the baseline LM needs of cancer survivors seeking lifestyle consultation and describes the development of the clinic to address these concerns. Patients were open to evaluation and treatment in an oncology-focused LM clinic. This clinic model has potential to improve quality of life for survivors.

Defining optimism. Optimism is a characteristic that broadly describes positive expectations of the future. It is relevant to health and human functioning because it has bearing on physical health,...

Background: Physical activity is critical for preventing and treating Type 2 diabetes (T2D). It is important to identify different profiles of physical activity change among those participating in behavioral interventions to optimize intervention-person fit. Methods: This study analyzes longitudinal trajectories of change in moderate-to-vigorous physical activity (MVPA) in a positive psychology (PP) and motivational interviewing (MI) intervention for T2D, using latent growth curve modeling (LGCM). Objective measures of MVPA were collected using accelerometers at three time points: pre-intervention, immediately post-intervention, and eight weeks post-intervention. LGCM analyses identified subpopulations of participants who responded similarly to the intervention and examined if sociodemographic, medical and psychosocial characteristics were associated with MVPA trajectories. Results: Analyses included 47 participants with complete follow-ups: 49% male, 81% non-Hispanic white, average age 66.1 (SD = 10.1). Overall, 36% of the participants increased MVPA while 57% did not. LGCM identified three profiles with distinct MVPA trajectories. Profile 1 (‘Started Low, No Change’; 65.8% of participants) with a starting mean of 4.54 min of MVPA/day and decreased by −3.36 min. Profile 2 (‘Moderate-High Start, Minimal Change,’ 27.4% of participants) and had a starting mean of 22.86 min/day of MVPA with an average increase of 1.03 min. Profile 3 (‘Moderate Start, Ended High’; 6.8% of participants), had a starting mean of 7.33 min MVPA/day, and increased by 28.4 min. Being male, younger, having fewer medical and psychiatric comorbidities were associated with increases in MVPA. Conclusions: This secondary analysis detected three distinct physical activity profiles during and after a PP-MI intervention. Future interventions can target individuals with characteristics that showed the greatest benefit and add additional supports to people in groups that did not increase physical activity as much. These findings show a need for targeted and sustained behavior change strategies during and after physical activity interventions. Trial registration: ClinicalTrials.gov; identifier: NCT03001999.

Mind-body programs can improve mental health and well-being in military populations. This pilot study of a virtual synchronous resilience intervention was conducted from 2018 to 2020 among 26 military personnel. Participants completed self-report psychosocial questionnaires before and after the 6-week program, including measures of posttraumatic stress disorder, depression, stress, resilience, and mindfulness. The intervention included eliciting the relaxation response, adaptive coping strategies, and healthy behaviors. Pre-post changes were calculated using paired t tests and effect sizes (d). Significant improvements were found for depression (Patient Health Questionnaire-8), stress reactivity (Measure of Current Status-Abbreviated Scale), and mindfulness (Cognitive Affective Mindfulness Scale-Revised). A 6-week resilience intervention can help military personnel improve mental health, coping, and stress management. [Psychiatr Ann. 2022;52(5):186–190.]

Positive Psychological (PP) constructs (e.g., optimism and gratitude) may impact the adherence to healthy behaviors, including diet, though prior studies have shown mixed findings. This qualitative study explored the relationships between PP constructs and dietary behaviors among 21 adults with metabolic syndrome through semi-structured interviews. Directed content analysis led to five themes: eating healthfully leads to PP constructs, PP constructs lead to eating healthfully, eating healthfully prevents negative emotions, healthy behaviors associated with diet, and an upward healthy spiral. Given the close relationship between PP constructs and diet, these may be targeted to improve diet in risk populations through interventions that promote well-being.

Depression in patients with cardiovascular disease is independently associated with progression of heart disease, major adverse cardiac events, and mortality. A wide variety of depression treatment strategies have been studied in randomized controlled trials as the field works to identify optimal depression treatments in this population. A contemporary scoping review of the literature can help to consolidate and synthesize the growing and disparate literature on depression treatment trials in people with cardiovascular disease. We conducted a scoping review utilizing a systematic search of the literature via 4 databases (PubMed, PsycINFO, EMBASE, and Google Scholar) from database inception to March 2020. We identified 42 relevant randomized controlled trials of depression treatment interventions in patients with cardiac disease (n=9181 patients with coronary artery disease, n=1981 patients with heart failure). Selective serotonin reuptake inhibitors appear to be safe in patients with cardiac disease and to have beneficial effects on depression (and some suggestion of cardiac benefit) in patients with coronary artery disease, with less evidence of their efficacy in heart failure. In contrast, psychotherapy appears to be effective for depression in coronary artery disease and heart failure, but with less evidence of cardiac benefit. Newer multimodal depression care management approaches that utilize flexible approaches to patients' care have been less studied but appear promising across cardiac patient groups. Selective serotonin reuptake inhibitors may be preferred in the treatment of patients with coronary artery disease, psychotherapy may be preferred in heart failure, and more flexible depression care management approaches have shown promise by potentially using both approaches based on patient needs.