Noncommunicable diseases and lifestyle choices
Currently, when we talk about the main causes of morbidity and mortality in the world, we are referring to noncommunicable diseases. Among them, cardiovascular, respiratory, and metabolic diseases stand out, accounting for more than half of the deaths worldwide as reported by the World Health Organization (WHO, 2021). The prevention and treatment for these diseases, most often, involve behavioural and lifestyle changes, not only the pharmacological approach. Lifestyle refers to nutritional habits, sleep quality, physical activity, stress management, and substance use such as alcohol, tobacco, or drugs (WHO, 2021, Rea et al, 2021).
However, medical schools still have gaps in medical training, offering little educational support in lifestyle guidance and counselling for patients. Although students have a general notion of this topic, they often do not feel prepared to approach it as a preventive or therapeutic practice (Rea et al, 2021).
Researching gaps in medical training
Based on this perspective, our group conducted research to explore this topic, detailing our findings in a number of papers (Neves et al, 2019; Mendes et al, 2020; Schlickmann and Kock, 2021). In these papers, associations between the variables that make up lifestyle in medical students at a university in southern Brazil were tested. The intent of this research was both exploratory and descriptive, as well as provocative and reflective, pointing directions for adjustments in the curriculum and also indicating that the greater experience of these practices during medical training can influence professional conduct as a physician.
In one of these studies (Neves et al, 2021), we compared sociodemographic and lifestyle aspects with sleep quality and excessive daytime sleepiness. Among the motivations for this research, we inferred that the young profile and the lack of proximity to family members, combined with the demands of university life, can reinforce stress and generate problems in the student’s lifestyle, causing them to adopt behaviours that are harmful to their bodies, such as fast-food abuse, tobacco and alcohol use, decreased regular exercise and reduced sleep quality. So, as research instruments, sociodemographic data were collected and the questionnaires: Fantastic Lifestyle, Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). The sample consisted of 299 students, with the majority being female (56.9%), with a median age of 22 years. The PSQI score indicated that 14.7% had sleep disturbance and the ESS score showed 7.4% of students with severe sleepiness. Poor/regular lifestyle was found in 8.7% of the students. When comparing these items, a significant association was shown between a better lifestyle and higher scores on the sleep questionnaires (PSQI and ESS). It is pondered that studies such as this can provide a reflection on student life, with practical effects on professional life and counselling of future patients.
Stress, BMI and movement
In another study (Mendes et al, 2020), we investigated the relationship between physical activity, body mass index and stress. We infer that the heavy workload of studies, the competitive environment, and the excess of assessments in medical training can change the student’s lifestyle. Among these changes, we highlight mental health problems and obesity, strongly associated with increased food intake and reduced physical activity. Therefore, in this study, we evaluated 402 medical students and collected sociodemographic data, body mass index (BMI), level of physical activity by the International Physical Activity Questionnaire (IPAQ) and Perceived Stress Scale (PSS 14). As results, we observed a higher presence of women (62.2%) with a median age of 22 years. Regarding BMI, 74.1% fit within the range 18.5-24.9 Kg/m2, being classified as appropriate weight. Regarding the level of physical activity, 41.0% were in the low physical activity level range, which is considered when it does not exceed 600 MET-minutes/week of physical activity. Comparing the genders, we observed higher levels of physical activity (IPAQ) and BMI in men, and, in contrast, higher stress in women. These findings portray a young, female profile of medical students. Most were eutrophic, i.e., with adequate BMI. However, it indicated that almost half of the evaluated students practiced little physical activity, especially women, who also showed a higher level of stress (PSS-14). Thus, we can see that a profile of students would need more support to adjust these lifestyle issues. Perhaps, university programs that encourage the practice of healthy habits would be important for the formation, experience and training of these skills.
The more you know?
And, in our last study (Schlickmann and Kock, 2021), we investigated the level of knowledge about physical activity. Our hypothesis was that students who were physically active or practiced some sports would have greater knowledge about physical activity orientation and concepts. As variables of this study, we collected sociodemographic data, physical activity level using the International Physical Activity Questionnaire (IPAQ), and, to measure knowledge about physical activity, we used validated questions and others based on the World Health Organization (WHO). A total of 294 students participated in this study. The sociodemographic results were similar to our other studies, with a higher profile of women (67.3%) and young people (mean age 22 years). However, the data that drew attention was the low rate of correct answers about the weekly physical activity time recommended by the WHO. Only 21.8% and 19.0% of the students got this guideline right for adults and children, respectively. In addition, no significant difference was found between knowledge about physical activity and physically active students, showing that these aspects may not be related. Another important finding was that, 90.5% of the participants would like to receive information about physical activity. This indicates that most of the knowledge on this subject seems to be common sense and that in-depth information is not covered in the curriculum.
In conclusion, we perceived through these surveys that aspects of lifestyle may be associated with and perhaps influence the education of medical students. We consider that understanding and experiencing these habits during the university period are extremely important to influence the future physician’s conduct. Chronic diseases are part of the main causes of morbidity and mortality and present multidimensional factors for their development. For this reason, a real understanding of these factors can provide adequate counselling to patients, both in the preventive and curative sense. The physician is, many times, the professional of first contact; in this sense, his support in changing the lifestyle and referring the patient to a multi-professional team can facilitate this process. Understanding that the behavioural approach is as important as the pharmacological one is part of the paradigm of an integral view of the human being.
ReferencesWorld Health Organization. (2021) Noncommunicable diseases. [Online] www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases [Accessed 06/07/2022 ]
Schlickmann DW, Kock KS, (2021) Level of Physical Activity Knowledge of Medical Students in a Brazilian University. J Lifestyle Med;12(1):47-55. doi.org/10.15280/jlm.2022.12.1.47
Rea B, et al, (2021) Medical Education Transformation: Lifestyle Medicine in Undergraduate and Graduate Medical Education, Fellowship, and Continuing Medical Education. American Journal of Lifestyle Medicine;15(5):514-525. doi.org/10.1177/15598276211006629
Mendes RC, et al, (2020) Relationship between physical activity, body mass index and stress in academics of medicine of a university of the south of Santa Catarina. Rev bras ciênc mov.; 28(1): 92-101. doi.org/10.31501/rbcm.v28i1.10159
Neves MVT, Kock KS, (2019) Comparison of sociodemographic aspects and lifestyle with quality of sleep and excessive daytime sleepiness in academics of medicine in a university of south of Santa Catarina. R bras Qual Vida;11(1):1-17. doi.org/10.3895/rbqv.v11n1.9336