Lifestyle modification
Suboptimal health behaviours (eg diet, physical activity, and smoking) are implicated in the onset and deterioration of many common chronic diseases including hypertension. Behavioural change to improve lifestyle is therefore a major challenge for today's health practitioners.
Even where drug therapy is indicated for a condition, changing lifestyle risk factors are to be encouraged because of the risk benefits for multiple other conditions dependent on that lifestyle factor. It may also reduce the intensity of drug treatment required.
Smoking, suboptimal diet, excess alcohol intake and inadequate physical activity are the lifestyle risk factors associated with the greatest burden of disease in Australia, their effects mediated through conditions as diverse as obesity, hypertension, various cancers, respiratory diseases and mental disorders.
This training offers only a basic introduction to the principles of addressing these very complex topics. More detailed, evidence-based counselling points can be accessed through websites such as the National Heart Foundation of Australia, QUIT Australia and the Better Health Channel.
How can lifestyle modification be facilitated?
Not surprisingly, the 5As and motivational interviewing are critical for encouraging behavioural change. The same principles apply across the board for the range of health professionals and the need to motivate patients to change.
Motivating the patient to change requires achievement of the following (Schwarzer, 2008):
- The patient believes they have the ability to change their lifestyle, and that barriers to lifestyle goals - perceived or real - can be overcome.
- The patient believes changing health behavioural or treatment will be beneficial.
- The patient believes they need this change.
Education and the ability to provide objective information about patient risk and the benefits of changes is a key element of facilitating change. Listening to the patient and asking why they are not currently motivated to change will allow you to provide more focussed messages. Motivational interviewing, which explores issues from the patient perspective, encourages the patient to examine the validity of their own beliefs and argue for change themselves.
Small and achievable goals are essential to encourage patient self-efficacy. Here are some examples of easy steps for improving lifestyle - these tips and more are available on the websites listed above.
Diet and salt
Tips to reduce energy and saturated fat intake include:
- Trim meat before cooking and remove skin from chicken.
- Drink water when thirsty instead of high energy soft drinks, alcohol or fruit juices.
- Limit intake of takeaway foods at home by stocking up on healthy frozen meals.
- Choose vegetable-based instead of cream-based sauces, and use oil-based salad dressings.
Salt intake (important for blood pressure maintenance and reduction) can be reduced as follows:
- Consider not adding salt to food you are cooking.
- Substitute salt with flavours such as lemon, herbs or spices.
- Choose frozen or fresh vegetables instead of tinned.
- Avoid high-salt sauces such as fish oil, soy sauce etc, where possible.
AlcoholAlcohol intake can be limited through the following strategies:
- Drink water alongside alcoholic drinks.
- Establish alcohol-free days every week.
- Avoid binge drinking by deciding your limits before you commence drinking.
- Avoid salty snacks while consuming alcohol - they only make you thirsty.
- Consider low-alcohol alternatives.
Physical activity
Physical activity can be undertaken as several short bursts throughout the day. Activity levels might be increased through the following strategies:
- Set small but realistic goals initially (e.g. start with 15 mins walking).
- Consider parking, or getting off the bus or tram a short walking distance from work as a means of incorporating exercise into your usual daily routine.
- Take ten minutes at lunch to walk around the block.
- Stand up or walk around during work meetings or at lunch when possible, and use the stairs instead of an elevator.
Remember - physical activity is not just exercise; it is any activity that helps to burn energy during the day.