The long view of lifestyle change: Part I
Those with chronic health conditions are frequently told by health care providers (and others) that they will see significant improvement in their health if they change their lifestyle. But which health conditions might these changes help? And what exactly does “lifestyle change” mean, what is involved, how easy is it, and how long does it take?
Contributors to health and disease
Before addressing these questions, there’s something important that needs to be understood: health is complicated.
Many diseases are caused by a highly complex interplay of genes, lifestyle, environmental and other factors. This means that, with some exceptions, we are not “doomed” to get certain diseases because of our genetic inheritance. Therefore, while knowing our individual genetic sequence might be helpful, this alone cannot typically predict our health later in life. Even when genes do play a significant role in the development of diseases, turns out most diseases are contributed to by multiple genes[i].
Further complicating matters is the role of epigenetics in the development of disease. While your genes may be fixed at the time of conception, epigenetics relates to something called “gene expression”, or whether certain genes are turned off or on, a process that begins in the womb and continues throughout the life cycle. Genes that are turned off or on can initiate pathways to certain diseases, so epigenetics plays a significant role[ii].
Environmental, social and economic factors also play a significant role in health and disease, probably through their influence on gene expression. This is a huge subject that I am especially interested in, commonly referred to as “the social determinants of health”[iii]. They include things like air and water quality; access to health care facilities; access to healthy food and physical activity; workplace health, and whether we live close to toxic waste. As significant as all of these are, since we tend to have little or no control over them as individuals, I will set them aside for now.
This leaves lifestyle factors. While not yet well understood, along with environmental, social and economic factors, it is thought that lifestyle as well plays a significant role in gene expression, or whether a predisposition to develop a certain disease actually results in that disease later.
Lifestyle and health
Which conditions tend to be most affected by lifestyle? The most common chronic diseases like obesity, type 2 diabetes, high blood pressure, cardiovascular disease and several types of cancer. There is also growing evidence that lifestyle factors contribute to the growing incidence of autoimmune and other inflammatory diseases such as multiple sclerosis, type 1 diabetes, bowel conditions such as Crohn’s disease, systemic lupus erythematosus (“lupus”), myasthenia gravis, Hashimoto’s thyroiditis, and rheumatic diseases like rheumatoid arthritis[iv].
The list of conditions is long, and this is why lifestyle change can have such a big impact on health.
What exactly is lifestyle? It is usually thought to include nutrition, exercise and stress management. While knowledge about the social determinants of health tells us we cannot always control these, we can generally exercise choice, with major beneficial effects for our health.
In this article, I will briefly address stress management and exercise, Part 2 will focus on nutrition.
Managing stress
Stress is known to contribute to many diseases. But like everything to do with health, it’s complicated.
While we don’t yet fully understand the complexities, it seems that not all forms of stress are alike. For example, studies have shown that short-term stress can boost the immune system, but chronic stress interferes with immune system functioning. This suggests it’s mainly measures taken to reduce chronic stress can have the biggest positive impact on health[v].
Reducing chronic stress typically involves one or both of two things: reducing or eliminating “stressors” (stimuli that trigger a stress response) and modifying the stress response itself.
Stressors include things like taking on too many commitments (can’t we all identify with that?) which can be acted on. Others, like caring for children, not so easily. The trick, then, is to try to make changes in the number and nature of stressors you actually have control over.
Then there’s stress response, which is hugely different from one person to another: some people process stress much more easily than others.
Here are some things you can do that might help to modify your stress response:
· Deep breathing exercises
· Meditation
· Relaxation techniques such as progressive muscle relaxation, mental imagery and the use of music
· If possible, work on improving sleep
· Biofeedback (this usually requires the assistance of a trained practitioner)
· Counseling
Like other lifestyle changes, reducing stress in your life can be challenging. This is because it requires constant vigilance. If you have always had difficulties “saying no”, then limiting commitments in your life will not be a one-time effort. And adding stress-busting habits into your daily routine requires, well, daily effort. It can take a while to shift years of unconscious habits, so you need to be patient and forgiving of yourself. It might take time.
Physical exercise
It has been known for many years that regular physical exercise contributes substantially to mental and physical health and the prevention of disease[vi].
There is plenty of controversy about what kind of physical exercise, how intense it should be and how often to do it. There is not sufficient space to fully explore this here (nor do I have the expertise to do so!).
One thing is clear, however. For those who engage in no regular physical activity, any increase, no matter how minimal, can bestow substantial health benefits[vii]. Something else is becoming increasingly clear: the more we move, the healthier we are. In other words, movement is not just about planned exercise, it’s also about, well, moving: using the stairs instead of the elevator, intentionally parking far from the door, taking regular movement breaks during your 8-hour day at the office, even fidgeting[viii].
The simplest, least expensive, most accessible type of exercise with a very low risk of injury is walking. You can control the intensity (from casual to brisk) and the duration (e.g. 20 minutes or 2 hours)[ix]. And if you can walk in a green space (such as a city park or country trail) there are additional benefits for your health of exposure to nature.
Like stress management, changing your physical activity routine can be challenging. For those with full lives, it can seem impossible to incorporate extra time for physical exercise. This is why it’s important to remember that even small changes that take only a few minutes a day can have a big impact on your health. You can start slowly and build it gradually.
And, once again, be patient and forgiving of yourself. It might take time.
Stay tuned for Part 2, on nutrition…
[i] Jackson, M, L Marks G May J Wilson (2018) “The genetic basis of disease” Essays in Biochemistry 62(5): 643–723 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279436/
[ii] Moosavi, A, Ardekani, A (2016) “Role of Epigenetics in Biology and Human Diseases” Iranian Biomedical Journal 20(5): 246–258 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075137/
[iii] Braveman, P, L Gottlieb (2014) “The social determinants of health: it’s time to consider the causes of the causes” Public Health 129(Suppl 2): 19–31 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3863696/
[iv] J Rippe (2018) “Lifestyle medicine: the health promoting power of daily habits and practices” American Journal of Lifestyle Medicine 12(6): 499–512 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367881/
[v] https://www.apa.org/topics/stress/body
[vi] Posadzki, P, D Pieper R Bajpai H Makaruk N Konsgen A Neuhaus M Awmwal (2020) “Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews” BMC Public Health 1724 https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09855-3
[vii] Ejsvogels, T, P Thompson (2015) “Exercise is medicine at any dose?” Journal of the American Medical Association (18):1915-1916
[viii] For more on the importance of movement, check out the following:
https://www.mayoclinichealthsystem.org/hometown-health/featured-topic/the-importance-of-movement https://www.nutritiousmovement.com/build-your-movement-rich-life/
https://www.precisionnutrition.com/healthy-movement
[ix] https://www.nbcnews.com/better/health/why-walking-most-underrated-form-exercise-ncna797271