Over recent decades, chronic and lifestyle diseases such as diabetes, heart disease, cancer and osteoarthritis have become the predominant causes of ill health, driven in part by changes in our daily lives.

We are now more sedentary, with a diet poor in whole foods, more screen time and more use of substances like alcohol, tobacco/vaping products and drugs.

According to the Australian Bureau of Statistics, one in two people live with at least one chronic condition; among people over 65, one in two have two or more chronic conditions (ABS 2022).

The most common chronic conditions in Australia are mental/behavioural conditions (26.1 per cent), back problems (15.7 per cent), arthritis (14.5 per cent) and asthma (10.8 per cent), with diabetes and cardiovascular diseases accounting for just over five per cent each.

Lifestyle medicine is an emerging clinical practice that looks at the root causes of chronic disease—the behavioural, environmental and social determinants—rather than just the risk factors and symptoms.

Defined by Australian researcher Professor Garry Egger, a pioneer in the field, as ‘the application of environmental, behavioural, medical and motivational principles to the management (including self-care and self-management) of lifestyle-related health problems in a clinical and/or public health setting’ (Egger et al 2017), lifestyle medicine is increasingly being practised by doctors and allied health clinicians, including physiotherapists.

Clinicians can gain postgraduate qualifications at universities including James Cook University in Queensland and Southern Cross University in New South Wales and Queensland.

‘It’s about approaching lifestyle as a form of medicine,’ says Dr Sam Manger, a GP who practises lifestyle medicine.

Sam is the current vice-president of the Australasian Society of Lifestyle Medicine and academic lead for postgraduate programs in lifestyle medicine at James Cook University.

‘Lifestyle medicine is the evidence-based practice of nutrition; movement; sleep; mind–body approaches like meditation, relaxation therapy and breathwork; substance reduction; social connection; social prescribing; and connection to our natural world, combined with behaviour change skills,’ Sam says.

‘Practising four simple lifestyle behaviours—not smoking; following diet guidelines; doing physical activity for 30 minutes, five days a week; and having a BMI less than 30, which is still overweight but not obese—can prevent about 90 percent of diabetes, about 80 percent of heart disease and about 35 percent of cancers.

‘It’s now looking like about 40 per cent of dementias are preventable too and the list goes on.’

There is growing evidence that in addition to preventing chronic diseases from taking hold, ‘lifestyle prescriptions’ can reverse the progress of a number of chronic diseases.

‘In people with established chronic diseases—whether it’s metabolic-type diseases like diabetes, fatty liver and cardiovascular disease; chronic pain conditions; mental illness; or even cognitive impairment (investigated in recent trials)—we’re seeing that lifestyle interventions can effectively treat some of these conditions and in some cases lead to remission and the research and translation of that into clinical practice keep growing,’ Sam says.

‘Even cancer—there’s good evidence now that in people with a diagnosis of cancer who are undergoing treatment, physical activity not only improves outcomes (aka cancer remission) but also reduces the chance of that cancer coming back.’

Physiotherapist Angela Gray APAM is operations manager at Solenne, a lifestyle medicine practice in Adelaide.

Angela’s interest in lifestyle medicine grew out of her experiences working in aged care and led her to pursue additional studies, initially in nutrition and more recently through a Master of Integrative Medicine.

‘Aged care was an eye-opener for me in terms of chronic conditions and their effect on how we age,’ she says.

‘The research points to metabolic function as the key driver of chronic conditions including diabetes.

‘In terms of musculoskeletal problems, this metabolic dysfunction can show up as chronic pain; it can impair the tissues and weaken the muscles.

‘So incorporating ways to support our metabolism into physio is what I’m finding is helping our clients to reach their goals and feel better.’

The importance of physical activity

One of the core pillars of lifestyle medicine is physical activity.

Being physically inactive— leading a sedentary lifestyle—is strongly associated with an increased risk of chronic diseases.

Research has demonstrated that including physical activity as part of the treatment for a chronic disease improves quality of life for the patient (Anderson & Durstine 2019) and can also reverse, prevent or delay progression of their condition.

Physical activity has positive effects on the human body at every level, from the physiological systems down to the cellular processes, including the inflammatory processes that are a primary cause of almost every chronic disease including diabetes, cardiovascular disease and neurodegenerative and musculoskeletal conditions (Gleeson et al 2011).

Dr Sam Manger is a GP in Queensland and the current vice-president of the Australasian Society of Lifestyle Medicine. .

‘Physical activity directly and indirectly improves essentially every physiological process in the body and it’s synergistic with every other lifestyle behaviour and form of therapy,’ Sam says.

‘When people do physical activity plus a nutrition intervention, they get far better results than if they do just one or the other.

‘And when people have a positive experience because of their movement, or a sense of achievement, or they build relationships because of the movement practices, then they’re much more likely to engage with and adhere to other lifestyle behaviours.’

Evidence on using physical activity as a treatment for patients with mental health conditions including depression and anxiety has shown that it can make a difference comparable to using psychotropic medications (Singh et al 2023).

In addition, patients who are more physically active will on average use 15 per cent less psychotropic medications (Wolf et al 2024).

‘That’s just increasing general physical activity guidelines, not anything particularly personalised,’ says Sam.

Furthermore, studies have shown that when a patient exercises can have an effect on how well therapy sessions work (Crombie et al 2023)—doing aerobic exercise right after a psychotherapy session reduced post-traumatic stress disorder symptoms far more than doing the psychotherapy session by itself or exercising before the session.

‘Physical activity works with medication; it works with therapy; it works with other lifestyle interventions.

‘It’s a glue and a domain in and of itself,’ Sam says.

How does physiotherapy fit into the picture?

Physiotherapists are well positioned to take a leading role in lifestyle medicine because they already look at the whole person, not just at the specific problem that brought the patient to them.

‘In a lot of ways, this is what we already do.

‘It isn’t a new thing; it just complements what we have been doing for years,’ says Angela.

‘Lifestyle medicine is about creating well-rounded, whole-of-person health professionals who can assess and address lifestyle and social determinants within their scope of practice,’ says Sam.

‘For example, a physio learning how mind–body approaches work and how to apply them will significantly enhance their physiotherapy prescriptions.

‘They can bring things like mindfulness and relaxation training into their practice or learn social prescription models to further connect their clients with their community.’

Physiotherapists are also well versed in behaviour change. They know how to help clients and patients make changes and are familiar with the challenges and barriers to success.

‘We coach people through how to maintain a good exercise plan after an injury or when something has previously prevented them from engaging.

‘We can work around that with them,’ Angela says.

‘But I would say that it doesn’t always happen in the first consult.

‘We’re very lucky as physiotherapists that we get lots of time with people.

‘Our consults are longer but also, while an acute injury is repairing or healing or when we are dealing with, say, a chronic lower back problem, we might be seeing a patient more frequently.

‘It’s a matter of building trust, building rapport and then slowly bringing in the evidence.’

Angela Grey is a physiotherapist and lifestyle medicine practitioner at Solenne, a multidisciplinary clinic in Adelaide.

One patient in particular showed Angela the value of taking a lifestyle approach to treatment.

‘I had a client who came to me with knee pain and during her assessment she also mentioned that she had arthritic hand pain and psoriasis.

‘So we did some tests including a gut health test and we found that she had chronic inflammation and was experiencing gut dysbiosis,’ she says.

The patient was given advice on changing her diet in addition to treatment for her pain and within weeks began to see improvement in various symptoms.

‘She’d been to see specialists and was having topical skin treatments but nothing had worked for her and she was about to go on a strong course of steroids.

‘No-one had looked at her diet or exercise or stress and those were the main contributors we found.

‘She was super dedicated and within a few weeks her psoriasis had cleared.

‘She was able to bend and flex her fingers, which she hadn’t done pain-free for years, and her knee pain was on the way to improving.

‘If she had just come to see me about her knee as a traditional physio, we probably wouldn’t have been able to address that whole body system.’

Working together, not side by side

Ultimately, lifestyle medicine relies on multidisciplinary care to be successful.

But as Sam points out, it doesn’t always happen in real-life situations.

‘Multidisciplinary care is one of the great pleasures in professional life when it works.

‘But if we’re honest, in the community and primary care setting it is much more an ideal than an actual practice.

‘Our system is still far too siloed,’ he says.

‘The field of lifestyle medicine aspires to implement real interdisciplinary models of care.

‘One of our great challenges in the next five years is to say, “Okay, we all agree that this is important but how do we actually do it?”’

Angela agrees that an integrated approach to providing care to patients is key.

‘That’s a big thing with chronic disease.

‘Because a single profession doesn’t have all the answers, we need to work together.

‘I have worked with multidisciplinary teams before but it has always felt more side by side rather than collaborative,’ she says.

Her practice has a multidisciplinary, interprofessional team offering physiotherapy, podiatry, exercise physiology and health coaching, nutrition, speech pathology and occupational therapy as well as a GP with an interest in lifestyle medicine.

Angela notes that the benefit of having all of the different health professions in one place is that patients can experience a cohesive and integrated approach to treatment.

She says that the team regularly meets to review cases from all angles.

In addition to shared decision-making, team members challenge each other’s ideas and suggest new directions.

‘We all have that lifestyle medicine focus so that brings our perspectives together.

‘I’ve had someone suggest something that I might not have thought of and it’s led to good outcomes,’ says Angela.

It comes down to culture change, both in the clinic and in the community.

‘If all health professionals work to address these lifestyle social determinants and all of us are aware of how to assess simple things like blood sugar levels, blood pressure, body weight and body fat, then patients will keep receiving the same message.

‘That is a form of interdisciplinary care in itself,’ Sam says.

‘Lifestyle medicine is really in its infancy.

‘We already have some impressive evidence for its efficacy in relation to different diseases but once we figure out personalised lifestyle medicine—once we work out how to reverse and treat autoimmune diseases and gut microbiome problems and the many other complex diseases we have these days—I think it’s going to be a completely new sort of revolution in healthcare.’

>>Lifestyle medicine in mental health care, an eTalk by Sam Manger, is available on cpd4physios.com.au

Quick links:

• References