In addition to physical activity, diet is another relatively easy target for increasing health and wellbeing of people living with chronic conditions. Referring back to the link between depression and chronic illness noted above, using diet as a clinical target has proven effective in improving depression symptomology \citep{Opie2015,Parletta2019}
An important dietary contributor to risk of future chronic illness is alcohol consumption, which has been causally related to 60 medical conditions, including certain cancers (breast, mouth and liver), epilepsy and haemorrhagic stroke \citep*{Room2005}. Shockingly, ~20% of nursing home residents have been reported to be malnourished internationally, although depending on the definition of malnutrition prevalence ranges from 1.5% to 66.5% \citep*{Bell2015}. Suggested interventions for reducing malnutrition included dietary supplements, encouraging active participation in food choice and staff training programmes. These findings are especially concerning when considering the increasingly understood role of poor diet as a contributing factor to mental health conditions [REF], which subsequently increases risk of further ill-health [REF]. In recent years, research has demonstrated that the Mediterranean diet may protect against chronic disease including common mental disorders \citep{Lassale2019,Dinu2018}. Dietary and physical activity modifications have also proven effective in reducing the progression of type 2 diabetes and cardiovascular disease in particular \citep{Greaves2011,Sofi2010}\citet{Sofi2010} concluded from a systematic review and meta-analysis that a greater adherence to a Mediterranean diet leads to a significant reduction in cardiovascular incidence, cancer incidence or mortality and neurodegenerative diseases. Importantly, randomised controlled trials now demonstrate that adopting a Mediterranean diet independently reduces cognitive decline in chronic conditions \citep{Martínez-Lapiscina2013,Valls-Pedret2015}. Intestinal microbiome also plays a key role in modulating the risk of disease development, including inflammatory bowel disease, obesity, type 2 diabetes, cardiovascular disease, and cancer. Dietary changes have shown to be effective in triggering changes in the microbiome within 24 hours, highlighting the importance of diet as a pathway through which health can be improved \citep{Singh_2017}. It is argued that targeting diet would be an effective opportunity to relieve the growing burden of mental and neurological disease \citep*{Owen_2017}.    
It is noted however, that simply providing information on modifications to health behaviours such as level of physical activity and diet quality is not sufficient to elicit behaviour change; the use of behaviour change theory or behaviour change techniques is needed to initiate behaviour changes \citep*{Michie2009}. Simply put, information is not transformation, and targeting the mechanisms through which behaviour change can be achieved is vital. Interventions that include self-monitoring and at least one other technique, such as goal setting, goal review and feedback, are more successful than interventions that do not adopt these strategies \citep{Michie2009}. Based on the upward spiral theory of lifestyle change, increasing positive affect will encourage adherence to a new behaviour change \citep*{Van2018}, mediated by increasing HRV and social connectedness \citep*{Kok2010}. There is a need to build positive psychological experiences in parallel with the ongoing medical treatment to both increase treatment adherence and improve health and wellbeing through other routes.
Another important factor influencing health and wellbeing of people living with chronic conditions is sleep. Many chronic conditions are associated with sleep-related problems, including sleep-related breathing disorders, insomnia, sleep-related movement disorders and sleep-related epilepsy \citep{Basnet2016,Dyken2012}. Critically, sleep quality is vitally important for people living with chronic conditions as it can worsen their already existing symptoms, for example, sleep quality has been shown to impact on metabolic function of type 2 diabetes \citep{Lee2012}. More generally, comorbid insomnia with a chronic condition is more severe and persistent than in cases where insomnia is the only disorder \citep*{Ancoli-Israel2006}. Among an elderly population with comorbid medical and mental illness, sleep is a useful predictor for general physical and mental health-related quality of life status \citep{Reid2006}. Sleep – in both the general population and among people with chronic conditions – can be improved through physical activity \citep{Hartescu2015,Kredlow2015}. Alternative forms of exercise such as Tai Chi are now being adopted and researched to encourage greater physical activity \citep{Raman2013}. Other methods through which sleep can be improved include music therapy, with research highlighting benefits for both acute and chronic sleep disorders \citep*{Wang2014}. Massage, acupuncture, natural sounds and music videos have also been reported to be effective in health care settings \citep*{Hellström2011}. Environmental modifications may also be another option for improving sleep, especially for those living in care homes, and this opportunity is discussed further within the section on the environment below.
In addition to positive health behaviours, the promotion of individual strengths such as acceptance, optimism and resilience are likely to promote health and wellbeing in people living with chronic conditions. These strengths are developed through cognitive-behaviour therapy, acceptance and commitment therapy and positive psychotherapy \citep{Hughes2017,Joyce2018} (Neenan, 2011). Understandably, people living with chronic conditions have a much lower level of resilience compared to healthy individuals although notably, increased resilience among those living with a chronic condition is associated with reduced psychological distress, and reduced symptoms of anxiety and depression \citep{Keil2017,Winger2016}. Strikingly, a strong sense of coherence (or SOC) is associated with a 30% reduction in mortality rate from cardiovascular disease, cancer and all cause-related death \citep{Surtees2003}. SOC reflects feelings of confidence that stimuli in the (internal and external) environment are comprehensible, manageable and meaningful. Common resilience-related protective factors that are employed by this population include self-efficacy and adaptive coping \citep{Ghanei2016}. A recent study involved administering a 6-week programme that incorporated mindfulness and CBT techniques to build resilience in individuals living with chronic physical conditions including heart disease and diabetes \citep*{Robinson2019}. Findings emphasised positive experiences around well-being, condition management, and social engagement. In another study, a mind-body intervention involving dance and movement has also been shown to be effective in improving resilience in people suffering from chronic pain \citep{Shim_2017}.
In summary, there is tremendous opportunity for improving the health and wellbeing of people living with chronic conditions by focusing on the individual. Traditional routes for improving physical health, such as physical activity, diet and sleep may now be considered as opportunities to support mental wellbeing, when combined with strategies for behaviour change. Treatments that build strengths, resilience, optimism and positive psychological attributes will provide useful strategies to promote health and wellbeing, as has been discussed previously [REF].