1 Word count: 3287 Wellness Richard Schroeder Exercise Physiology Laboratory DeAnza College Cupertino, CA, USA In the last four decades, health care costs have dramatically risen from $12 billion in the 1950's to a projected $500 billion by the year 2000. This single expenditure will account for over 10% of the country's Gross National Product. Over one half of the costs will be born by business and industry which means that each and every one of us will be paying for increased health care costs through higher prices on all of the products we buy. As the government searches for ways to pay this escalating bill, and advances in medical care are keeping more people alive at a greater cost, we need to take some time to rethink what it means to be healthy. Traditionally, health meant taking care of yourself since professional medical care was called upon only as a last resort. Somewhere in the 1950's, the emphasis switched from self-care to professional medical care. The life expectancy in the United States rose from 47 years at the turn of the 2 century to over 70 years in the 1990's. A closer look at the statistics would show that most of the increase in longevity is due to lower infant mortality. Removing infant mortality from the statistics results in almost no gain in life expectancy for adults since the turn of the century (3). What medical science has done for us is to change the cause of death from bacterial diseases (pneumonia, influenza, etc.) to diseases of lifestyle (cardiovascular disease and cancer) which occur much later in life and in many cases may be preventable. What society needs is to reverse the trend of sole reliance on the physician for health maintenance, to keeping ourselves healthy through positive lifestyle changes and letting the medical community take care of the diseases that aren't affected by lifestyle. Definition Of Wellness If an individual exhibits no outward signs of disease, they are considered healthy, but as far back as the 1940's the World Health Organization stated that health is a state of physical, mental, and social well being and not merely the absence of disease. This definition of health still falls short since it is a definition of a static condition. Health is really more dynamic with many fluctuations of the physical, mental, social, emotional, and spiritual dimensions. Each dimension coexists in a symbiotic relationship with the others, so if there is an movement toward optimal health in 3 one dimension, it may affect others as well. As an example, we know that some cancer patients can survive many years past a physician's prognosis of death by having an optimistic and committed approach to life. To them, health problems are viewed as challenges that can be overcome. These patients are practicing and benefiting from a wellness lifestyle. Wellness is defined as, positive changes in attitudes and behaviors to enhance life and increase personal potential. This is done by attempting to gain optimum levels in each of the five dimensions of health: spiritual, emotional, intellectual, social, and physical. In the above example, a positive change in the mental component may have a positive effect on the physical component, leading to wellness. Dimensions of Health There are five dimensions of health leading to wellness: spiritual, emotional, intellectual, social, and physical . In order for an individual to personally take responsibility for wellness, each dimension must be understood. Once the concept of each dimension is grasped, it is up to the individual to institute positive lifestyle changes to work toward optimum health. The spiritual dimension is the belief that a person's values (morals and ethics) are in tune with, and affects, their behavior. It may also include religion, science, an awe of the majesty of nature or some inner peace based on one or more beliefs. It is what determines the focus or purpose of 4 life. Optimal health would be the ability to identify your personal life purpose, and direct your everyday activities toward that goal. The emotional dimension is a person's ability to handle stress and express themselves appropriately. Emotions can easily influence physical health. Those with low levels of stress, often have lower levels of stress related diseases such as: headaches, high blood pressure, and ulcers. Under heavy stress over a period of time, the immune system can shut down, increasing the risk for many diseases, including the ones mentioned above. Optimal health would be the ability to recognize, accept, and express the feelings of yourself and others, cope with everyday stress, and pursue activities with enjoyment. It also includes the ability to accept setbacks as well as advances. The intellectual dimension is a person's ability to learn and use information to the furtherance of personal goals. It is concerned with sound decision making based on information that has been gathered and evaluated before an action is taken. While intellectual capacity is not the same in all individuals, most people can make sound decisions if given the proper information. Not all information is correct, even if published in a professional journal. Many times the research results are misinterpreted by lay persons and false claims are published in the popular press that the original author never intended. Other times views change as more information is collected. In the movie Sleeper, Woodie Allen awakes after 5 being frozen for several hundred years to a world where desserts were found to be health food and cigarettes improved health. Decisions must be made using the best information presently at hand and adjusted as warranted by future information . The optimal goal is to strive for continued growth and learn to deal with situations as they arise. The social dimension is the ability to interact with people as individuals. It includes not only family but also interaction with strangers. It is the development of respect for those that don't share your views and beliefs. The social dimension is complex since we all play multiple roles depending on what our relationship is with other individuals we contact. There are different responsibilities and risks involved for a father vs. a son, a friend vs. a stranger, or a boss vs. a worker. We may be forced to play multiple roles at the same time, but all require a give-and-take attitude to progress to optimal health. The physical dimension is probably the best known of the wellness components. It includes cardiovascular and muscular fitness, diet and nutrition, body composition, and avoidance of drugs (including tobacco and alcohol). It also includes the body's response to injury and disease. Optimal physical health means being in tune with your body to recognize the signals that you need rest, nutrition, sleep, exercise, etc. and to act accordingly. It is easy to see that each of these dimensions is not an isolated entity. There is interaction between each dimension 6 and a change in one may affect others. For example, you have decided to exercise every day and eat a low fat diet (physical dimension) but your cousin's wedding (social dimension) is scheduled at the same time as one of your weekend bike rides that you normally take with several friends (social dimension). All week long you are fretting about how you will miss your exercise (emotional dimension) because you have to attend this wedding. You finally regain control by reminding yourself that you are only going to miss one bike ride, and if you want to, you can ride a little longer the next day to make up for it, and that you don't have to eat everything served at the reception (intellectual dimension). That one little thing (your cousin's wedding) started a chain reaction affecting several dimensions, but was brought back into perspective by another. This is why wellness is a continuum. There are daily (perhaps even hourly) forward and backward movements toward optimum health or premature death and only a balance between all of the components ultimately leads forward. The Health Continuum Health is a continuum from optimal health to premature death. Most people would place themselves in the middle of the continuum and be happy that they have no discernible illness. What is forgotten is that the average person will die prematurely from one of the three major lifestyle 7 diseases, cardiovascular, cerebrovascular, or cancer. This would indicate a need rethink what average health means. People want to be healthy. One only needs to look at the number of exercise and diet books, tapes, infomercials, and supplements that bombard every aspect of our daily lives to realize this. During 1988, we spent more than $6 billion on athletic shoes, $74 billion on low-calorie diet foods, $5 billion on health-club memberships, $738 million on exercise equipment, $1.5 billion on bottled water, and $2.1 billion on vitamin and mineral supplements (3). The problem is that most adults don't know how to take control of their own lives to modify the lifestyle behaviors that are making them unhealthy in spite of the absence of disease. A U.S. Public Health survey in 1986 found that one half of all Americans participated in some form of physical activity, but only 10- 20% of them exerted enough effort to actually increase cardiovascular efficiency (one of the parameters that affects a person's likelihood of developing cardiovascular disease) (2). A 1989 marketing research study found that 49% of all running shoes bought never are used for running, 50% of tennis shoes never see a tennis court, and 43% of exercise leotards never get sweaty from exercise (3). A physician can only treat a disease once it has manifested itself (through drugs or surgery), but each individual can be instrumental in slowing or preventing the progression of the disease from ever being life threatening by making lifestyle changes such as: eating properly, exercising 8 regularly, reducing stress, and not smoking. Until the 1980's it was difficult to show how fitness and wellness programs affected health care costs since no studies were undertaken. Several companies have now demonstrated that workers participating in fitness programs cost less in terms of medical expenses and sick leave. The Mesa Petroleum company saved nearly $200,000 in medical expenses in 1982. Tenneco Incorporated in Houston in 1982 and 1983 showed a 53% reduction for male and 41% reduction for female employees who regularly used the company fitness center. They also demonstrated that those with the highest productivity rating also used the fitness center the most. The New York Telephone Company spent nearly $3,000,000 on wellness and prevention programs. Their savings were over $5,540,000 or $69.25 per employee. So there is a lot of statistical evidence supporting wellness. In fact, many corporations are using fitness centers and wellness programs as hiring incentives for new employees (2). Wellness Lifestyle Changes Personal environment may affect how much each of the above components may be controlled. Personal environment includes everything that a person senses, learns, or uses to control from their immediate environment . 9 In order to direct positive energy into lifestyle changes, a person must feel safe, at ease, and in control of his or her personal environment. If this is not the case, much of the energy needed to develop a wellness lifestyle will be wasted merely coping with daily life. While it is important to have control and feel comfortable within your personal environment, there are some factors in each of the health dimensions that are outside of an individual's control and thus affect the quality of life. Of the factors that affect each person's quality of life, one fifth can be attributed to genetics and thus are out of the individual's control (keep in mind that a family disposition to cardiovascular disease means that healthy lifestyle changes may decrease or even remove the risk from other family members). Another one quarter is affected by health care and environment and may be partially controlled by an individual. But, most importantly, over one half of the factors influencing the quality of life, can be modified by lifestyle behavior changes. This gives a tremendous amount of personal control in one's wellness. There are eight lifestyle changes that have been associated with individuals who live longer and healthier lives. •. Sleeping 7 to 8 hours a night • Eating breakfast daily • Not eating between meals • Maintaining a healthy fat percentage 10 • Not smoking • Moderate (or no) alcohol use • Exercising regularly • Eating a low fat, high complex carbohydrate diet The modification of several of these lifestyle changes (reduction in smoking, decreased fat intake, increased exercise, and lowering of body weight) has reduced deaths from heart attack in males by nearly 30% in the last 15 years. How To Live The Wellness Lifestyle In order to live the wellness lifestyle, each individual must accept responsibility for change. While fear may be a good motivator to make lifestyle changes (someone who has suffered a heart attack quits smoking and loses weight), it is much more effective to motivate yourself to a healthy lifestyle before a physical need arises. In short, a person must believe that these lifestyle changes will benefit them in a positive way, even if the physical changes aren't apparent. For example, a dieter who switches from a high fat diet to a diet with a high percentage of complex carbohydrates, may not transform into the slender model seen in advertising, but in the long run, will prove to be healthier and may prevent some other diseases such as: breast cancer or heart disease from occurring. By accepting this diet, there has been a change in attitude and belief that this lifelong change will have some 11 effect on health. The dieter has taken information and, based on personal attitude and beliefs, decided first, that there may be some health risk if no changes are made (cardiovascular disease, cancer, etc.) and secondly if a change is made, some benefits or positive lifestyle changes will occur (increased wellness). In order to be successful, any lifestyle change must be undertaken because the individual has the desire to make the change, not because someone else wishes that individual to make changes. Exercising or dieting because a friend wants to most likely will not become a lifestyle change since it is done more out of duty to the friend than for personal gain. If the friend leaves, so does the motivation. Personal motivation is stronger and in conjunction with a person's self-esteem will help the lifestyle change persevere. Permanent changes in a person's lifestyle are based on an individual's ability to overcome barriers to change. Many excuses for not making healthy lifestyle changes such as: cost, embarrassment, fatigue, weather, etc., are really barriers that can be overcome if a person is willing to change their locus of control. Locus of control refers to personal perception of one's ability to change their personal environment. An external locus of control is beyond the individual's ability to control. There is always someone or something that prevents them from accomplishing a goal. They can't quit smoking because of certain social situations that constantly put them in contact with other smokers. Or they 12 can't exercise because there is no time during the day. An internal locus of control means that a person is master of their own destiny. They can exercise during a busy day, because they have chosen to set aside a certain time each day for that purpose, or they can quit smoking because they have the desire to do so. The belief in one's own ability to switch from an external to an internal locus of control is self-efficacy. It may be difficult, but with practice and patience, it can be done. A Plan For a Wellness Lifestyle In order to develop a more healthy lifestyle, you must first take an inventory of your present lifestyle. List all of the things that you now do that promote good health and then all of the things that inhibit health. Many wellness texts have Wellness Lifestyle Inventories that will help you find areas that need change (1,2,3). Pick one or two things that you feel may present you with the greatest risk to wellness. For example, lose 10 pounds, start an exercise program, or reduce stress levels. How you chose may be dictated by personal motivation, genetics, health and other factors that may be related to external locus of control. Next there must be some attitude adjustment. You need to believe that the changes you make will improve your wellness, but you must also avoid choosing goals that are too unrealistic. Unrealistic goals may set you up for failure which is the biggest cause of regression to old lifestyle 13 habits. For many individuals, failing to attain a particular goal means never trying again. It may be better to start with one or two easily attainable goals and move to more difficult ones after the initial feeling of accomplishment. The change in attitude and choice of goals must be viewed as lifestyle changes. This means that if your goal is to lose ten pounds (a short term goal), your lifestyle change is to keep that ten pounds from coming back. It is also better to cut back on bad habits rather than eliminating them altogether. If you have three drinks before dinner (about 450 calories), reduce your consumption to two (a reduction of 150 calories or the equivalent in excess calories of a pound of body fat in less than a month), and finally to one. The same method can be used with many other changes you wish to make. Finally develop a four step plan of action to implement your program. The first step is to set specific and realistic goals. To be specific, your goals must be easily measured. For example, your goal should be to walk for an hour each evening after dinner, rather than a goal of starting a regular exercise program. A regular exercise program is too vague since it doesn't have measurable parameters. How often will you exercise, how much, etc. Step two is to formulate a plan for achieving these goals. This can include a behavioral contract, positive or negative reinforcement, or joining support groups. The third step is to evaluate your progress. Since your goals are measurable, take time at appropriate intervals to 14 see if you are making progress. The time interval should be long enough to see changes but not too short as to become obsessed with the program to change your behavior. This may range from monthly assessment for body composition, to weekly assessment of stress reduction. It is also important to remember that success is relative. If after evaluating your success you find that you have not completely met your goals for that particular time interval, think back to why you didn't achieve your goal. Perhaps your goal was not realistic and you should make new short term goals. Too many people will figure they have failed completely if one goal doesn't follow the prescribed timeline. Finally, at set intervals, you may also wish to reassess your behavior and from the results and set a plan for achieving these new goals. By striving for positive lifestyle changes using specific short term goals, anyone can achieve wellness. 15 References 1. Anspaugh, D.J., M.H. Hamrick, and F.D. Rosato. Wellness. St. Louis, MO: Mosby-Year Book, Inc., 1991. 2. Fahey, T.D., P. Insel, and R. Roth. Fit and Well. Mt. View, CA: Mayfield Publishing Co., 1994. 3. Hoeger, W. K. Lifetime Physical Fitness and Wellness. Englewood, CO: Morton Publishing, 1989. 4. Hurley, J.S. and R.G. Schlaadt. Wellness - The Wellness Lifestyle. Guilford, CT: The Duskin Publishing Group, 1992. 5. Levy, M.R., M. Dignan, and J.H. Shirreffs. Targeting Wellness - The Core. New York, NY, 1992.