Creating a group lifestyle medicine program for spine pain

By Deborah Bernal, MD, physiatrist and lifestyle medicine provider

Adjusting lifestyle factors — like diet, exercise and sleep — can play a major role in healing and managing back and neck pain. But access to specialized lifestyle medicine is limited.

Deborah Bernal, MD

Many programs have long waitlists, and visits are often just 30 minutes — too short to both address medical concerns and have an in-depth discussion about how to make major lifestyle changes.

That’s why, in January 2025, we launched a solution at WellSpan Health: virtual group visits for our lifestyle medicine program.

Group visits improve access by letting me see 8 to 12 patients at once, and they’re more effective than short one-on-one appointments. With 90 minutes, I can spend more time guiding patients through lifestyle changes, and they benefit from the support, motivation and accountability that comes from being part of a group.

Anchoring each visit to a lifestyle medicine pillar

Each session includes a focused discussion on one of lifestyle medicine’s six pillars:

1. Nutrition
2. Physical activity
3. Stress management
4. Restorative sleep
5. Avoiding risky substances like alcohol and highly processed foods
6. Social connections

Focusing on one pillar allows us to dive deeper — educating patients on the topic and providing practical tools and resources.

For example, during a nutrition visit, we watch a video on how a mostly plant-based, unprocessed diet can reduce inflammation and aid healing. I then introduce resources, such as an online course, a mobile app and a booklet, so patients can choose the option that’s best for them. 

A benefit of the group setting is that patients often share what’s worked for them — like maybe they’ve tried the app and it’s helped them eat healthier and reduce pain. This can be a powerful motivator for others to try it too.

Fostering a support group setting

Lifestyle change is hard, but it’s a lot easier with the support of a buddy or a group. That’s why each visit is designed to help patients feel comfortable opening up and encouraging one another.

We require participants to keep their camera on and raise their hand when they have something to share. We’ve found that they follow these simple rules and are very respectful.

Each visit also follows a consistent format, including: 

• Relaxation: I guide the group through a vagal breathing exercise, which helps them relax and be more likely to share.
• Medical appointment for each patient: All participants have had an individual evaluation, so I check their charts beforehand for needs like labs, medication adjustments or new exercises that we address during the group visit. Participants benefit from hearing each other’s updates and often chime in with support.
• Small group discussion: After the educational portion, patients break into small groups to talk through their motivation, challenges and strategies for applying what they’ve learned.
• Large group goal setting: We share insights together and set S.M.A.R.T. goals — goals that are Specific, Measurable, Attainable, Realistic and Time-bound. For example, a nutrition goal could be: “I’ve noticed my pain improves when I drink more water. I usually get three cups a day, but I’ll aim for five over the next two weeks.”

Connecting with others on a similar journey is comforting and inspiring, and research shows it also supports the physical healing process.

A few patients have found the support group so helpful that they’ve stayed in touch after completing the program to continue supporting each other.  

Helping patients stay on track 

At the end of the visit, we document each patient’s motivation, challenges and goals for follow-up, and we set them up on Care Companion — WellSpan Health’s AI-powered platform that helps them stay on track with reminders to watch course videos, exercise or log their sleep. 

A win-win for providers and patients

The group lifestyle medicine program is a win for patients because it has significantly improved access, reducing the Third Next Available Appointment from 45 days to just two days. And because each session is more in-depth, we’re seeing that patients are more satisfied and are more likely to integrate lifestyle changes. It’s also a win for me personally — it’s deeply fulfilling to spend more meaningful time with patients addressing the root causes of disease.

If you’re interested in our program or in creating one, I’m happy to answer any questions. There are also resources available through the American College of Lifestyle Medicine.