Regardless of the problem being discussed, medical professionals almost always start their list of recommendations with lifestyle changes. When it’s hypertension, lifestyle changes come first. Or if it’s diabetes, once again the recommendations start with lifestyle changes. That’s nice, but “lifestyle changes” is a broad category with a lot of variation depending on the context in which it is recommended. What it means is specific to the problem being treated. In most cases, lifestyle changes have four main “pillars” that form the foundation of the recommendations intended to help the problem at hand.
The Four Pillars of Lifestyle Change are:
Physical activity
Nutrition
Sleep
Stress
Of the four items, physical activity is the most important. Physical fitness is always helpful for the cardiovascular system by helping to keep the cholesterol, blood pressure, and blood sugar at controlled levels. Being overweight or obese is directly associated with an increase in the risk of all-cause mortality as well as cardiovascular mortality. Physical activity helps lower weight, but if you’re fit, however, it doesn’t matter what your BMI is. If you’re not fit, you have a 2-3 fold increase in mortality from cardiovascular disease and all-cause mortality. So the first and most important “lifestyle” recommendation is to STAY FIT.
Additionally, physical activity LOWERs cancer risk—the highest 20% of physically active adults were 26% less likely to have cancer because they are physically fit. Patients after surgery for colon cancer who were in a structured exercise program had a disease-free survival that was 28% longer than those not in an exercise program. Patients in an exercise program also had a 6.6% longer 5-year survival rate. 6.6% doesn’t sound like much, but it means these patients live 4 months longer, on average, than all others in the same situation.
The second most important “pillar” of lifestyle is Nutrition. Nutrition translates into healthier brain function. Those patients who ate well and exercised had better cognition and less decline in memory and “executive function.” Good nutrition focuses on the elimination of Ultra-processed foods—ready-to-eat foods, packaged snacks, carbonated soft drinks, instant noodles, ready made foods, industrial formulations, chemically altered foods, and additives for taste, texture, appearance, and durability. (details unavailable). The new food pyramid will be discussed in the future.
Ultraprocessed foods have been associated with a higher risk of all-cause mortality (a 20% increased risk), heart-disease related mortality (a 66% increased risk), and a higher risk of diabetes (40%). They have also been associated with depression, anxiety, poor sleep, respiratory problems, and common mental disorders. These foods have been around for many years, but have not been restricted other than by public condemnation and are commonly consumed.
The third pillar of lifestyle changes is Sleep. Getting less than 5 hours of sleep a night increases the risk of Type 2 Diabetes. Sleeping 7 hours or less worsens age-adjusted mortality by 6%-15%, and is a significant risk factor for HTN, stroke, and CAD, and increases obesity by 50%. Sleep disorders are strongly associated with atrial fibrillation, diabetes, high blood pressure, heart problems, stroke, depression, impaired cognitive function, and mood disorders like depression. Obstructive sleep apnea is the most common sleep disorder, and its major issue is hypoxia—lower than normal blood oxygen levels that have cardiovascular consequences. Healthy sleep is an extremely important lifestyle factor, and has more effect on general wellness than realized.
Stress is the last lifestyle change. Stress is a fact of life in the modern world and translates into a 49% increase in cardiovascular disease risk. Medium to high stress levels as determined by job stress and life assessments had an 20% increase in CV disease outcomes. So the stresses of life and work are significant.
One particularly important stress is “social isolation,” the millions of “Eleanor Rigby’s” of the world—“ah, look at all the lonely people!”—who have an increase in age-adjusted mortality of 33%. Their loneliness and isolation are tremendous stresses.
Lifestyle changes are the foundation of nearly every medical treatment regimen. And they are probably the most important factor in any treatment plan. They are basic to a healthy life and useful for anyone regardless of whether they are ill of not. Of course, lifestyle recommendations also include the obvious tobacco and alcohol use, but for this article they were excluded.
Reference: Skolnik N. Lifestyle Medicine’s Four Pillars: A Year-end Review. Medscape 2026 January 9.
