By Dr. Mike Mann
I believe most Primary Care visits lack a thorough and adequate evaluation of Fitness, Nutrition and Stress Management. This may be due to a patient’s limited time with their physician. Perhaps physicians do not feel comfortable and knowledgeable enough about these areas to make recommendations for meaningful lifestyle changes. Also, physicians may feel apprehensive to make recommendations where there may be significant patient noncompliance.
This lack of thorough Fitness, Nutrition and Stress Management strategies, though, may leave patients with limited options as they age or are diagnosed with a chronic disease. Many patients may not realize that physical inactivity can put them at increased risk of Cardiovascular Disease and Stroke over their lifetime.1
Health and Human Services recommends patients have at least 150 minutes per week of moderate to vigorous exercise, including aerobic and weight based exercises.2 This recommendation sounds simple, but every patient is different and may require a personalized approach that accounts for age, initial fitness level, motivating interests, chronic or acute disease, and injuries among other factors that make fitness plans sustainable. And the key to compliance with any Medical and Health recommendations is a collaborative Patient-Physician relationship with clear communication.3, 4
Stress and Sleep management are also important factors in disease prevention and treatment. Over time, patients who experience persistent levels of stress, referred to as Allostatic Load, can have more sensitive and heightened physical responses to stress which can have a significant effect on their overall health.5, 6 Stress reduction and sleep hygiene strategies can help mitigate the physical effects of stress over time.
Direct Primary Care (DPC) is a unique and innovative healthcare model that prioritizes an optimal Patient-Physician relationship with clear communication. The extra time physicians are able to spend with patients allows them to address Fitness, Nutrition and Stress Management in a more personalized meaningful way. I believe a comprehensive approach to personalized care places equal importance on Fitness, Nutrition and Stress Management as it does on medications and specialist referrals.
References
Powell KE, Thompson PD, Caspersen CJ, Kendrick JS. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health. 1987;8:253.
The U.S. Department of Health and Human Services Second Edition of Physical Activity Guidelines for Americans released in 2018.
Daley, J. Overcoming the barrier of words. In: Through the Patient's Eyes: Understanding and Promoting Patient-Centered Care, Gerteis, M, Edgman-Levitan, S, Daley, J, Delbanco, TL (Eds), Jossey-Bass Publishers, San Francisco 1993.
Cuffey YL, Hargraves JL, Rosal M, Breisacher BA, Schoenthaler A, Person S, Hullet S, Allison J. Reported racial discrimination, trust in physicians, and medication adherence among inner-city African Americans with hypertension. Am J Public Health. 2013;103:e55-e62. doi:10.2105/AJPH.2013.301554.
McEwen BS, Stellar E (September 1993). “Stress and the individual. Mechanisms leading to disease”. Archives of Internal Medicine. 153(18): 2093-101.
Lee, Do & Kim, Eosu & Choi, Man-Ho. (2014). Technical and clinical aspects of cortisol as a biochemical marker of chronic stress. BMB reports. 48.
*This article was also posted on DPC HTX