Lifestyle Prescriptions

Introduction

Lifestyle Prescriptions were developed by the Health Promotion Board to assist healthcare professionals, in particular, primary care physicians, in providing concise lifestyle advice to patients without restricting the physician's individual clinical judgement.

When healthcare professionals present patients with various options for managing their lifestyles, patients feel more confident in participating in the care process because they trust their doctors and the treatment they are receiving.

The recommendations are based on the best available evidence at the time of development, drawing references from the MOH's Clinical Practice Guidelines and Care Protocols for diabetes, hypertension and lipid disorders. They seek to highlight lifestyle recommendations specific to the medical condition, in addition to those for individuals with no chronic conditions.

Lifestyle prescriptions are presented under the lifestyle domains of: nutrition and healthy eating, physical activity, weight management, mental well-being and smoking. To facilitate recall, we have approached lifestyle prescriptions from the perspective of:

Quantity: How much should I eat or do?

Quality: What types of food and activity should I eat or do?

Timing: When should I eat or carry out the activity?

We have also included a model to guide how doctors might fit lifestyle prescriptions into their busy practice to better support their patients.

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List of Abbreviations used

Quick Glance

The following table provides a summary of lifestyle prescriptions (LPs). Use hyperlinks to navigate to the subsections for more details. The list of LPs for each category is presented such that the prior recommendations apply to that category too.

For example, the LPs for ‘Type 2 Diabetic at Risk of Hypoglycaemia’ patients include prior prescriptions for ‘No Chronic Conditions’, ‘Pre-Diabetic’ and ‘Diabetic’ patients.

Patient Category	Nutrition & Healthy Eating			Physical Activity			Weight Management	Mental Well-Being
	Quality	Quantity	Timing	Quality	Quantity	Timing
No Chronic Conditions	Use my Healthy Plate Substitute ≥20% of refined carbs with wholegrains Choose lean protein, fresh produce and healthier oils and fats	Reduce salt and sugar intake Increase soluble fibre intake	For older adults, include protein as part of every meal	Aim for 150-300 mins of mod-intensity aerobic exercise per week (able to speak in short sentences but not sing) Include strength training exercises at least 2 days per week Limit sedentary time			BMI ≥23: Reduce weight by 5% to 10% over 6 to 12 months Following BMI Control Care Protocol: Green segment Encourage self-directed activities Orange segment Well-controlled chronic diseases: Consider referral to structured community programmes Poorly-controlled chronic diseases: Refer to PCN for support on controlling chronic condition Red segment Consider referral to tertiary weight management programmes These BMI values are based on Asian cut-offs. Individuals who have either not reached their individualised treatment targets or have established complications of their chronic condition(s).	Manage stress Aim for 7 hours of sleep each day Practise mindfulness Consult healthcare team if they experience anxiety or depression (For Hypertension) Manage psychosocial triggers

Pre-Diabetes	Substitute ≥50% of refined carbs with wholegrains Pair wholegrains with proteins and vegs					Include post-meal activity

Type 2 Diabetes Mellitus		Reduce carb portion	Consider meal timing and spacing	Perform exercise pre-participation assessment Avoid certain exercises for certain complications

Type 2 Diabetes Mellitus at Risk of Hypoglycaemia	Exercise caution if drinking alcohol	Keep carb portion constant	Eat regular meals		Gradually increase PA levels Stop exercising if blood glucose is low and follow 15/15 rule	Check blood glucose levels before and after exercising

High-Normal Blood Pressure	Use lower sodium alternatives			Lifestyle prescriptions for healthy patients apply here

Hypertension	Include DASH diet components	Limit sodium intake to 2,000mg per day (about 1 tsp of salt)		Perform exercise pre-participation assessment Take caution when lifting heavy weights Gradually increase PA levels

Intermediate Risk of 10-Year Coronary Artery Disease	Choose healthier fats	Limit saturated fat and trans fat as well as cholesterol intake		Gradually increase PA levels

High–Very High Risk of 10-Year Coronary Artery Disease	Consult healthcare team for condition-specific dietary requirements			Perform exercise pre-participation assessment

For patients who smoke, advise them to quit smoking.

Patients with No Chronic Conditions

Access BMI Control Care Protocol for the weight management programmes.

Patients with Pre-Diabetes

Recommendations for 'No Chronic Conditions' apply.

Access BMI Control Care Protocol for the weight management programmes.

Patients with Type 2 Diabetes Mellitus

Recommendations for 'Pre-Diabetes' apply.

For more patient resources, refer to the National Diabetes Reference Materials.

Access BMI Control Care Protocol for the weight management programmes.

Patients with Type 2 Diabetes Mellitus at Risk of Hypoglycaemia

Recommendations for 'Type 2 Diabetes Mellitus' apply.

For more patient resources, refer to the National Diabetes Reference Materials.

Access BMI Control Care Protocol for the weight management programmes.

Patients with High-Normal Blood Pressure

Recommendations for 'No Chronic Conditions' apply.

Access BMI Control Care Protocol for the weight management programmes.

Patients with Hypertension

Recommendations for 'High-Normal BP' apply.

Access BMI Control Care Protocol for the weight management programmes.

Patients with Intermediate Risk of 10-Year Coronary Artery Disease

Recommendations for 'No Chronic Conditions' apply.

Access CVD risk calculator.

Access BMI Control Care Protocol for the weight management programmes.

Patients with High–Very High Risk of 10-Year Coronary Artery Disease

Recommendations for 'Intermediate Risk' apply.

Access CVD risk calculator.

Access BMI Control Care Protocol for the weight management programmes.

4As Model: Steps to Engaging Your Patients

Adapted from the 5As model by the US Department of Health and Human Services, the 4As Model offers a patient-centered approach to how healthcare professionals might engage patients. Healthcare professionals can adapt the model to suit the situation.

For example, if you are already familiar with your patient’s needs, you could skip ‘Ask’ and go straight to ‘Assess’ to understand their progress before proceeding with ‘Advise’ and ‘Assist’.

Healthcare professionals can use the Lifestyle Prescriptions Patient Education Resource to aid lifestyle prescribing.