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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
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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
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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
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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
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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
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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
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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
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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 .
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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
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• 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
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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
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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
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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
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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.
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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.