Key Points

• We have a young industry, making it hard for people to know what is best due to the prevalence of misinformation.
• Autonomy in health and wellness is the ability to govern one’s path through lifestyle changes. To be successful, an individual must learn autonomy.
• We accomplish autonomy by learning essential exercise and health and wellness principles and thoroughly understanding our biases, perceptions, and goals.
• While most people have a common baseline, an individual’s wants and needs determine the standards of optimal (healthy) and capable (well).
• If we teach individuals to be vulnerable and address weaknesses and compensations, they will become optimal and capable.

Most people want health and wellness, but how do we get there? Understanding health and wellness is imperative to know how to get there best. Fitness alone does not represent health nor biomarkers (Troponin, B-type Natriuretic Peptide (BNP), HbA1c levels, LDL-C levels, blood pressure, resting heart rate, etc.). A healthy individual is optimal and capable of living their life, equipped to meet its demands and challenges. There are many ways to achieve health and wellness and, equally, as many ways to spin your wheels and wind up sick.

Current State and Future Potential: Navigating and Evolving

Main idea: We have a young industry, and that makes things hard for people to know what is best due to the ease of misinformation.

The words health and wellness are often used interchangeably, apart from the occasional reference to an Eastern medicine method such as homeopathy. The Global Wellness Institute wrote an article on the history of wellness and provided a helpful timeline following major developments in this industry. This gives a good history from the lens of wellness.

Healthcare has also faced its fair share of evolution, undergoing significant transformations due to rising costs, care quality variability, and increasing treatment and technology complexity. Despite healthcare professionals’ hard work and expertise, the system often results in fragmented care, high costs relative to outcomes, and lacking a cohesive approach to creating value for the patient. This healthcare system is largely built around emergency medicine and symptom management rather than long-term prevention and root cause resolution. The prevailing approach frequently relies on pain management and surgical interventions as primary solutions, offering temporary relief but often failing to address underlying issues or prevent recurrence. Recent discussions promote internal and external changes to be made (2).

Internally, there is a need for a shift toward an evidence-based, value-driven system that improves quality, reduces waste, and enhances patient outcomes by leveraging new data sources like electronic health records and clinical registries to develop better evidence and personal care practices. This involves integrating more precise, patient-centered approaches and fostering a culture that continuously learns and adapts to new evidence, aiming to move beyond traditional models (3).

Externally, there’s a growing emphasis on integrating exercise, lifestyle, and mindset interventions, aiming to improve healthspan, bridge gaps in preventative care, and offer more sustainable, long-term solutions while acknowledging the strengths of healthcare professionals and the need for systemic improvement.

So where does exercise fall into the health and wellness industry? Although we’ve known about exercise for some time, the rising popularity of gyms used as health and wellness tools is quite young. For example most fields of study, such as chemistry, are hundreds of years old, while gym popularity within the general population is within the last 50 years. We can also see these popularity changes within the scope of sport.

Running 

The professionalization of running as a sport dates back to ancient Egyptians and Greeks. Still, it gained popularity in 16th century England and experienced a revival with the modern Olympic Games, leading to widespread participation today (4).

Swimming

Dating back to 2500 BCE, swimming evolved into a competitive activity in 19th-century England and was popularized by notable figures such as Matthew Webb, Duke Kahanamoku, and Michael Phelps (5).

Cycling

Cycling as a sport began in 1868 and became an international phenomenon with the Tour de France in 1903, with key figures like Charles M. Murphy and Greg LeMond (6).

Resistance Training

Tracing back to ancient Greek and Chinese civilizations, resistance training has evolved from using natural objects to developing modern specialized equipment (i.e. the barbell, dumbbell, machines, etc.), marked by significant milestones of barbell training and machine training in the 16th century (7).

In terms of recreation, before Dr. Ken Cooper’s release of The New Aerobics in 1979, very few, if any, people utilized running, cycling, or swimming at a high fitness level. Even modern health and fitness clubs did not debut until the 90s. Sure, in the 70s, you could find a Golds or YMCA, but this was far from popular.

This is not a comprehensive history of all modern training methods but rather a brief overview to illustrate that, while these methodologies have existed for quite some time, the field of health and wellness is young comparatively. The “exercise is medicine” movement had hints of growth in the late sixties.

“…there is growing evidence on the preventive value of exercise, and it is possible that, in the not too distant future, physical education will become a part of medicine.” – Peter Karpovich, 1968 (9)

Exercise physiology was not an established science until more recently. Exercise physiology is a multidisciplinary field that investigates how the body responds to various types of exercise. It aims to comprehend the effects of short-term and long-term physical activity, as well as inactivity, on the body’s physiological functions and the mechanisms involved. Studying exercise physiology enables students to gain insights that can be used to apply scientific discoveries to improve health, rehabilitation, and athletic performance for different populations. 

Kent et al. conducted a comprehensive exploration of exercise physiology studies published over the 40 years from 1980 to 2020.

This graph shows the significant increase in exercise physiology research as the idea of “movement as medicine” became more popular. And since then, we have made astounding strides in the health and wellness space and created a vast potential with human health and optimization. We can see a more robust timeline from NC State (10). This rapid growth becomes more impressive when you consider evidence of the first ideas of movement as medicine date back to 350 B.C.

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” – Hippocrates

Where are we now?

Main idea: Autonomy in health and wellness is the ability to govern one’s path through lifestyle changes. To be successful, an individual must learn autonomy. Learning essential exercise and health and wellness principles and gaining a deeper understanding of oneself will set people on a path to independence. 

Health – noun, the general condition of the body (physical or physiological) or mind (mental or psychological) concerning soundness and vigor; the absence of disease or ailment (11).

Wellness – noun, the approach to lifestyle choices, typically by deliberate effort, that leads to a healthy life or higher state of being; focus on an enhanced way of living as a means to preventing illness or sluggish states, as opposed to emphasizing the treatment of disease (11).

In summary, we can say that health is the absence of disease, while wellness encompasses the lifestyle choices that prevent disease. With mountains of information at our fingertips, it’s crucial to ground ourselves in fundamental principles to avoid being overwhelmed by various “improvement” strategies for health and wellness. Some individuals adopt hectic schedules filled with diet or exercise trends that are ultimately unsustainable and, in some cases, even dangerous. On the other hand, those who avoid extremes believe that health and wellness can be achieved and maintained merely through regular activity and abstaining from all unhealthy foods. However, I think this traditional view of health and wellness is outdated, given the development of exercise science and the evolution of the fitness industry. 

Getting clear about what we can change and not change, is about using our time wisely and improving the individual’s compliance and results. As a former CrossFit coach, I’d see all too often the middle-aged man spend his afternoons in the cold plunge. Six days a week, this man would come in with his gym back, get in a lift for an hour, and spend 10-20 minutes cycling in and out of the gym’s cold plunge. In conversations and training this man was convinced that these sessions were making him a better husband, father, and worker. More than likely, there are about 20 other things that could help this gentleman reduce stress in much less time than 60-120 minutes a week. The other day driving past the same CrossFit gym (it’s on a street corner) I saw a gentleman waiting for the crosswalk to change for him to continue on his way. While this 60+-year-old man waited, he practiced balancing on the curb. The reality from a physiological standpoint is that this “Curb Man” balancing for just a few minutes is getting more of a benefit than the “Cold Plunger.” But for more than just one reason. My favorite reason is probably the playful mindset of the “Curb Man” vs. the ridged mind of the “Cold Plunger.” 

Physiology Context – Think of reps on a continuum, one rep up to 10,000 reps. Assuming these reps are done with challenging load, repetitions close to 1 are considered mechanical, while the ones past 25 could be considered cyclical. Mechanical tension will increase tendon stiffness, while cyclical movement will decrease tendon stiffness. As we decrease tendon stiffness, we will increase existing weaknesses and strains in size (12). However, only mechanical loading results in too stiff tendons, increasing the risk of injury (13). Cyclical vs. mechanical loading may be a law, but these laws exist in nuance. 

Consider the isolation that results from filling your schedule with constant wellness practices. I believe many people are wasting time in the gym, and others are not utilizing the gym enough. While some argue that “something is better than nothing” and that “strength training is good for everyone,” the reality is that people may be wasting their time if they get hurt while exercising, lack the time or access to exercise, or fail to support their exercise other lifestyle factors. This usually stems from not understanding why they are doing it. Additionally, those who don’t enjoy being in the gym may find it challenging to adhere to an exercise routine. But consider the lack of long-term orthopedic health with simple “regular activity” (i.e. cyclical loading). This is a complicated issue, far more than is given credit. In today’s world, the equation for a healthy lifestyle involves balancing home life, work life, exercise, aches and pains, and nutrition. It’s not as simple as just “move more” for everyone. With only 28% of Americans meeting physical activity guidelines, more significant change is necessary (14). To be successful, an individual must learn autonomy. It allows them to shape their lives, fostering personal growth and self-governance. Relational accounts of autonomy emphasize that social relationships and broader environments significantly influence this capability, impacting self-identity, confidence, and the ability to achieve personal goals (15). Autonomy is also, by definition, the byproduct of behavior change (requiring motivation and confidence), all of which are critical for anyone hoping to achieve lasting change (16, 17). Working with a professional, learning basic exercise and health and wellness principles, and gaining a deeper understanding of oneself can help address these challenges and set people on a path to autonomy.

Modern Health and Wellness

Main idea: While most people have a common baseline, an individual’s wants and needs determine the standards of optimal (healthy) and capable (well). If we teach individuals to be vulnerable to address weaknesses and compensations they will become optimal and capable.

I propose that health and wellness are acquired by helping the individual achieve autonomy. We do this by being educated and coached to be optimal and capable.

Optimal – the appropriate level of fitness for an individual.

Capable – the minimal ability of the individual to live an independent life.

Health is the appropriate level of fitness for an individual. This means that back squatting 500lbs may not be suitable for you. That doesn’t mean it’s not possible, but it means that you have to ask yourself why you want that goal. As we strive for higher fitness levels, we often sacrifice other aspects of our lives, potentially diminishing our abilities in different areas. Professional athletes, for instance, are familiar with the sacrifices required at the elite level, and it is often not physical limitations but rather the toll on their overall wellness and capabilities that becomes challenging.

For example, if you can back squat 500lbs but cannot handle the stress at home, you are not “well/capable” even though you could say you are “healthy/optimal”.

If you are well enough to live without pain but not healthy/optimal (high enough bone density) sufficient to survive a short fall, you are not healthy. On top of that, if you do fall, you will no longer be “well” either.

So is health and wellness subjective? Or objective? It’s both.

Being optimal (healthy) depends on the lifestyle someone wants or needs. Being capable (well) also depends on the individual. In reality, we often rely on being great at one thing while being terrible at another – compensation.

Compensation feels safer than addressing weaknesses.

For this reason, I prefer teaching individuals to be vulnerable by reflecting and working on their weaknesses. Investigate why you are not currently in the position you desire and use these guides or a coach to determine the necessary actions to take to help you reach your goals.

Let’s build autonomous, optimal, and capable people.

Practical Applications

Reflect

Q: “Can I do everything I need to do during the day without help?” 

Example Answer: Yes, I don’t have much of an issue doing this. 

Coaches Response: That’s great. How much space or function is between you and someone who can’t? Basically, how close are you to being UNABLE to?

Q: “Can I do everything I want during the day without help?” 

Example Answer: Sort of, I can’t run like I used to, but that’s pretty normal, right? 

Coaches Response: Common, maybe, but I would push back on being “normal”. Most people struggle to navigate pain or function and aren’t sure how to progress back into it. 

Q: “Is the gym helping or hurting those things?”

Example Answer: I like benching and back squatting a lot, I think it makes me stronger in daily life. Although sometimes it hurts my shoulder and back. 

Coaches Response: Having movements that you enjoy is great, but there are other things we can do along side those movements that you enjoy, that will better support your goals outside of the gym. 

Learn

Preparation – the act of creating favorable adaptations to maintain or build the ability of the desired expression. 

Expression – the act of performing a task or event that fills your cup or is otherwise a necessary task to live.

Take Action

Find Your Expression – Write down five things that fill your cup daily, weekly, monthly, quarterly, annual, and non-time-bound. 

Define the Characteristics of This Expression – What skills or health markers are required for you to do this? How much of this do you lack vs. how much of this do you need to earn? 

Explore Your Beliefs Around This Expression – Do you think this is only something that young people can do? Or do you have an idea in your head about what “type” of person is actually capable of doing this? 

Starting – What is one thing that you could start today that would get you closer to where you want to be?

References

1. Global Wellness Institute [Internet]. [cited 2024 Sep 30]. History of Wellness. Available from: http://globalwellnessinstitute.org/what-is-wellness/history-of-wellness/
2. Medicine (US) I of. The Changing Nature of Health Care. In: Evidence-Based Medicine and the Changing Nature of Healthcare: 2007 IOM Annual Meeting Summary [Internet]. National Academies Press (US); 2008 [cited 2024 Sep 30]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK52825/
3. Kessler SE, Aunger R. The evolution of the human healthcare system and implications for understanding our responses to COVID-19. Evol Med Public Health. 2022 Jan 5;10(1):87–107.
4. Red Bull [Internet]. 2024 [cited 2024 Sep 30]. The history of running – from the Stone Age to the present day. Available from: https://www.redbull.com/au-en/the-history-of-running
5. Holmes T. The History of Swimming [Internet]. 2023 [cited 2024 Sep 30]. Available from: https://blog.myswimpro.com/2023/11/06/the-history-of-swimming/, https://blog.myswimpro.com/2023/11/06/the-history-of-swimming/
6. Cycling | History, Events, & Facts | Britannica [Internet]. [cited 2024 Sep 30]. Available from: https://www.britannica.com/sports/cycling
7. https://eleiko.com [Internet]. [cited 2024 Sep 30]. History of Olympic Weightlifting | Eleiko. Available from: https://eleiko.com/en-it/stories/history-of-olympic-weightlifting
8. Dr. Kenneth Cooper Q&A: The father of aerobics | CNN [Internet]. [cited 2024 Sep 30]. Available from: https://www.cnn.com/2023/12/15/health/kenneth-cooper-father-of-aerobics-wellness/index.html
9. Karpovich PV. Exercise in medicine: a review. Arch Phys Med Rehabil. 1968 Feb;49(2):66–76.
10. Health and Exercise Studies [Internet]. [cited 2024 Sep 30]. Historical Timeline. Available from: https://hes.dasa.ncsu.edu/historical-timeline/
11. Tatriele L. Global Wellness Institute. 2024 [cited 2024 Sep 30]. Wellness Architecture Terminology & Definitions. Available from: https://globalwellnessinstitute.org/global-wellness-institute-blog/2024/06/20/wellness-architecture-terminology-definitions/
12. Firminger CR, Edwards WB. Effects of cyclic loading on the mechanical properties and failure of human patellar tendon. J Biomech. 2021 May;120:110345.
13. Lorimer AV, Hume PA. Stiffness as a Risk Factor for Achilles Tendon Injury in Running Athletes. Sports Med. 2016 Dec;46(12):1921–38.
14. Elgaddal N, Kramarow EA, Reuben C. Physical Activity Among Adults Aged 18 and Over: United States, 2020 [Internet]. National Center for Health Statistics (U.S.); 2022 Aug [cited 2024 Sep 30]. Available from: https://stacks.cdc.gov/view/cdc/120213
15. Entwistle VA, Carter SM, Cribb A, McCaffery K. Supporting Patient Autonomy: The Importance of Clinician-patient Relationships. J Gen Intern Med. 2010 Jul;25(7):741–5.
16. Detailed Overview – Cancer Prevention Research Center [Internet]. [cited 2024 Sep 30]. Available from: https://web.uri.edu/cprc/transtheoretical-model/detailed-overview/
17. Moore M. Ground Zero in Lifestyle Medicine: Changing Mindsets to Change Behavior. Am J Lifestyle Med. 2023 Sep;17(5):632–8.