Helping patients adopt a healthier lifestyle
Lifestyle medicine has long been a component of medical care, but recently it has become a defined sub-specialty that the doctors at Emerald Physicians are embracing. Nurse Practitioner Carol Penfield, NP-C has joined Emerald Physicians at their South Yarmouth office and will be working collaboratively with Medical Director Kumara Sidhartha, MD, to help patients get past obstacles that prevent a healthy lifestyle.
“Lifestyle medicine integrates medical care with exercise and nutritional therapy to improve health,” Penfield explained. “Interventions include motivational techniques and promotion of healthy behaviors for people with or at risk for chronic diseases.”
Penfield has been interested in lifestyle medicine ever since reading about cardiologist Dean Ornish’s 1990 Lifestyle Heart Trial study. In that groundbreaking study, Dr. Ornish took 48 patients with coronary heart disease and divided them into two groups. He put 28 of the patients on a low-fat plant-based diet. They also quit smoking, began exercising, attended stress management training and were given social support.
The other 20 patients were given the usual cardiac care with no lifestyle changes. At the end of a year, the patients who had adopted healthier lifestyles had slowed their heart disease, while the others had not.
From Awareness To New Behavior
The model of a once-a-year physical just isn’t enough to actually change patients’ behavior in most cases, Penfield said. Doctors often find themselves saying the same things about diet, exercise, and smoking to the same patients year after year. The patient will agree, but without follow-up support, many people don’t change their behavior.
“If patients are told by their primary care provider to lose weight, quit smoking, exercise more and follow a healthy diet, the patient is more likely to comply,” she explained. “However, the resources including time and support to guide individuals on how to do it are lacking. It takes more than simple advice to change behaviors. The challenge is to convert their awareness into behavior change. That’s where I enter.”
Penfield schedules an initial intake appointment with patients where they review about 15 categories of health, such as nutrition, exercise, sleep, stress management, pain, osteoporosis and arthritis. She will then help the patient decide which areas are the most important to work on and create an initial plan to make the changes. They will also discuss any barriers to making health conscious changes.
“The idea is to really focus on the patient and how they are living their day-to-day life and how that affects their health,” she said.
The patient then comes back two weeks later to discuss how well they are doing in meeting their goals. They go over the program again and come back for a third visit a few weeks later. At that point, they will be assessed to see if they would benefit from joining small groups called shared medical appointments. Shared medical appointments combine the power of group dynamics with personalized medicine and have proven to be very effective.
Dr. Sidhartha has already been working with patients with diabetes, obesity and heart disease in shared medical appointments and has seen some success stories with patients willing to change their diet and lifestyle. Penfield would like to also develop shared medical appointments for people with osteoporosis, arthritis and muscular skeletal issues because those are some of her interests.
In addition to being a nurse practitioner, Penfield is also a certified personal trainer who owned a private lifestyle medicine practice at Chatham Health and Swim Club for six years. During that time she ran a very successful weight loss program that helped 475 people lose more than a ton and a half of weight. An easy tip she recommends for weight loss is to start eating off of a nine-inch plate to ensure smaller portions.
For blood pressure control and stress relief, she teaches people yoga breathing, which consists of inhaling in on a count of four and exhaling slowly on a count of eight. She shows patients how effective the breathing can be by taking their blood pressure before they do the breathing and afterwards. Penfield has seen patients’ blood pressure drop 20 to 30 points just by doing yoga breathing. That type of illustration gives the patient an “aha moment” that is often the first step towards making positive changes.
Other stress relieving techniques include taking a nature walk, listening to guided meditation tapes or tensing and then relaxing each part of the body starting with the feet and traveling upwards.
One of the most important components in helping people make healthy lifestyle changes is to touch base with them in between appointments. Penfield plans to set up a system to contact patients through their preference of telephone or through the secure patient portal once a week to check in on them and offer encouragement.
“There are plenty of people out there who just need a gentle nudge in the right direction,” she said. “I think a lot of people are taking more responsibility for their health. They just need a resource. They need a place to go to get sound medical information and support. Support is key. You really need to touch people to get them to change.”
Note: As of 5/1/2019, Emerald Physicians joined Medical Affiliates of Cape Cod (MACC), a division of primary and specialty care physicians from Cape Cod Healthcare.