Lifestyle Medicine: How a Healthy Lifestyle Can Prevent Chronic Disease

“Lifestyle Medicine (LM) is the use of a whole food, plant predominant eating pattern, regular physical activity, restorative sleep, stress management, positive social connections and avoidance of risky substances as a primary therapeutic approach for the prevention, treatment and, often, reversal of chronic disease,” said Dr Ng.

Its essence can be narrowed to six essential pillars. “Just remember the 2 E’s and 4 S’s,” Dr Ng added.

The 2 E’s & 4 S’s of Lifestyle Medicine

1. Eat healthily
2. Exercise adequately
3. Sleep sufficiently
4. Manage Stress
5. Avoid addictive Substances
6. Maintain positive Social connections

1. Eat healthily: The power of fibre and plant-based proteins

The typical Singaporean diet is filled with highly processed carbohydrates, fats, salt, and sugar, making it a recipe for health problems.

Instead, Dr Ng advocates remembering these 2 words when it comes to nutrition:

• Fibre
• Plant-based proteins

Consume more high-fibre foods such as minimally processed whole grains, vegetables, fruits, legumes, nuts and seeds.

“Eat the rainbow to ensure good variety of fruits and vegetables,” said Dr Ng.

When it comes to protein, seniors often think that consuming 1 egg per day (which contains about 6g of protein) is enough protein. The fact is older adults require more protein than younger adults. Seniors should aim for 20g to 25g or even 30g of protein per meal. 

“A common misconception is that meat protein is superior to plant-based, this is not true. Plant-based proteins are neither inferior nor incomplete, and can help to reduce chronic disease risk,” she added.

For more ways to include protein in your meals, see this article.

Above: Examples of local plant-based meals.

Another easy way to remember of what to put on your plate is to follow HPB’s "My Healthy Plate" (below), which emphasises a balanced diet with an appropriate mix of food groups.

2. Exercise adequately: To optimise muscle and bone health

Physical inactivity is a major contributor to the rise of obesity and diabetes in Singapore. Among older adults, there is also the common misconception that frailty is a normal part of ageing and that exercising risks adding injury to an already frail body.

“This is NOT true. In fact, frailty can be prevented, delayed or in some cases even reversed by just doing two things: lead an active lifestyle and healthy nutrition,” Dr Ng said.

It’s also never too late to start exercising. According to HPB and Sport Singapore, the following are the recommended levels of physical activities for adults:

For adults aged 18-64

• At least 150-300 minutes of moderate intensity aerobic exercises a week
• Do at least moderate-intensity activities that strengthen muscles, bones and joints at least twice a week
• For those over 50, include moderate-intensity activities that emphasise strength and functional balance at least three days a week

For older adults aged 65 and above

• At least 150-300 minutes of moderate intensity aerobic exercises a week
• Engage in muscle strengthening activities two or more days a week
• Include moderate-intensity activities that emphasis strength and functional balance at least three days a week

For adults with chronic conditions, the same recommendations are still applicable. If you are unsure how to begin, do consult a healthcare professional prior to exercising.

Apart from keeping frailty at bay, regular exercise has also been proven to:

• Keep blood pressure under control
• Lower cholesterol
• Reverse prediabetes
• Increase muscle
• Reverse osteopenia (bone density loss)
• Improve osteoporosis
• Prevent dementia – When you gain muscle in strength training, you also gain brain function!
• Prevent depression

For more on preventing frailty, see this article.

4 key areas of exercise to focus on

a) Boost endurance

As a first step, start by building up your fitness and stamina, especially if you have never or rarely exercise. 

Aim to hit between 150mins to 300mins of moderate-intensity aerobic activity per week. A good way to know if your activity is of the right intensity is that you should still be able to talk while doing the activity, but unable to sing.

The easiest form of moderate-intensity aerobic activity is brisk walking. Do it for between 30 to 60mins daily, five days a week.

b) Build strength

Next, build up the strength of your bones and muscles by doing resistance exercises at least 2 times per week.

Strength-based resistance exercises require the use of free weights (such as dumbbells and kettlebells) and resistant bands, so start at low frequency and intensity then gradually increase progressively.

c) Improve balance

Improving your balance through exercise can help to prevent falls and injuries. You can follow the balance exercises (as well as the other exercises) on HPB’s “7 Easy Exercises”, which lets you exercise in the comfort of home.

Practise balance exercises two to three times weekly. When new to balance exercises, always do it while holding on to a sturdy piece of furniture such as a chair or table, when needed. Alternatively, you can join your neighbourhood tai chi class.

d) Maintain flexibility

Doing stretching exercises regularly can go a long way to minimising age-related inflexibility.

It is important to maintain flexibility as it helps with everyday tasks we take for granted when younger such as wearing clothes and getting out of a vehicle. Remember, motion is lotion! 

How often should I exercise?

“In terms of exercise frequency, it can’t just be a once-a-week or occasional event, you need to move as much as you can daily, as well as do a variety of exercises several times a week,” advised Dr Ng.

The physical activity pyramid serves as a good reference.

3. Sleep sufficiently: To restore your body

Singapore consistently ranks among the most sleep-deprived countries in the world. In fact, Singapore is the third most sleep-deprived among 43 cities profiled in a recent published report. 

Adults above 18 years of age should strive to get between 7 to 9 hours of sleep daily.

Why is good sleep important?

• Sleep deprivation or sleeping less than 6 to 8 hours a night raises risk of high blood pressure, heart disease, obesity and diabetes – increasing the possibility of early death by approximately 12 per cent.
• Sleep provides protection from oxidative stress and is involved in the “glymphatic system” (a waste clearance pathway in the brain that is more active during sleep) which clears waste and breakdown products
• Obstructive sleep apnoea and other sleep disorders have been associated with increased risk of cardiovascular disease, cognitive decline such as Alzheimer’s and mood disorders like depression
• Impaired sleep affects your life in multiple ways: affecting how you think, feel and function

Tips for better sleep

• Keep to a fixed sleep and waketime (regardless of weekdays or weekends)
• Find your right amount of sleep
  • Adults require between 7 to 9 hours of sleep daily.
  • Teens require between 9 to 11 hours of sleep daily
  • Children require between 11 to 15 hours of sleep daily
• Have a fixed bedtime routine and sleep environment. Power down your phone 30 minutes before bedtime, then follow a routine of 4 to 5 activities to prepare for bed such as dimming the lights and cooling the room.
• If you can’t fall asleep after 20mins, get out of bed and do a low-key (non-electronic) activity then return to bed when feeling sleepy.
• In the day, take foods that promote sleep such as those rich in calcium, magnesium and potassium. Avoid caffeine, alcohol, high-fat and sugary foods.
  Also, ensure some exposure to sunlight. It is preferable to exercise during the day if possible, as exercising too close to bedtime may make it harder for you to wind down and fall asleep.

For more tips for better sleep, see this article.

4. Manage stress: So that it doesn’t manage you

“When a person fails to take control of stress. The stress will likely end up taking control of the person,” advised Dr Ng.

Being unable to manage stress properly can lead to:

• Inability to sleep (insomnia)
• Overeating to relieve stress (stress eating)
• Reducing or even completely stop exercising due to a “lack of time”
• Avoiding social gatherings
• Finding it hard to appreciate humourous situations
• Focusing on the negative " leading to depression
• Seeking relief from harmful substances such as alcohol, cigarettes or drugs

Instead, train your body to cope with stress by harnessing the relaxation response. These can be done by practising:

• Meditation
• Mindfulness
  • You can try the mindfulness techniques shown here and here.
• Relaxation techniques such as abdominal breathing
  • You can try the breathing exercises shown here and here.

For more stress-busting tips, see this article.

5. Avoid addictive substances: Because they can kill!

In line with the inability to manage stress properly, addiction and the misuse of substances such as alcohol, nicotine and drugs not only doubles the risk of chronic conditions but can also kill.

“It’s a well-known fact that cigarettes and drugs can kill but for alcohol, it is still widely believed that there are “safe” levels to drinking. However, based on research, there is strong scientific evidence to show that alcohol drinking can cause cancer.

Also, as Asians are more susceptible to alcohol-related conditions such as oesophageal cancer (see Asian Flush Syndrome article), the wise move is: If you drink, cut down your drinking as much as possible. If you don’t drink, don’t start,” Dr Ng said.

A newer form of addiction, which we may think is harmless and only affects the young, is excessive use of mobile phones and social media.

“This is not true. With increasing dependance on electronic devices and use of social media, we are seeing people of all ages being affected by it in one way or another, from the impact on mental health in the form of lower self-esteem, increased anxiety and depression, to nocturnal usage resulting in sleep deprivation and increased chronic disease risk,” Dr Ng explained.

For mental health tips on social media use, see this article.

6. Maintain positive social connections: Because social support reduces stress and prevents loneliness/isolation

Studies have shown that people with a wide range of social relationships usually:

• Live longer happier
• Have less cognitive decline with ageing
• Have greater resistance to infectious disease
• Have better prognoses when facing chronic life-threatening illnesses
• Offer greater peace of mind to their loved ones and caregivers

“Make it a point to continue to stay connected with friends and family. It doesn’t have to be for long durations or specially arranged events, even brief moments of connection daily can create positive emotions and boost wellbeing,” advised Dr Ng.

The beauty about lifestyle medicine is that it’s easy to incorporate in your life, based on health fundamentals you already know, like eating healthily and sensibly, exercising regularly, getting sufficient good-quality sleep, keeping stress in check and staying connected with loved ones. 

“It is important to recognise that lifestyle choices are affected by emotional states and vice versa. If you live well (by taking care of your health), you will feel well, and when you feel well, you’ll continue to live well.

So start to live better by introducing one simple change in your life today – Perhaps it can be to up your daily intake of fibre-rich plant foods, while cutting down on meat, processed foods and sugar? Or you can sit less and move more in a day? Or make it a point to cut off screen time 1 hour before bedtime and get eight hours of sleep daily?

The more improvements you can make to your life and stick to it, the better your life will be,” Dr Ng said.

Ref: F26