Key Points

Most people would say that they want to achieve health and wellness, but how do we get there? Understanding health and wellness is imperative if we want to know how to best get there. Fitness alone does not represent health and neither do biomarkers (Troponin, B-type Natriuretic Peptide (BNP), HbA1c levels, LDL-C levels, blood pressure, resting heart rate, etc.). A healthy individual is someone who 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 method of medicine. The Global Wellness Institute wrote and article on the history of wellness and provided a useful timeline following major developments in this industry. This gives a nice scope from the lens of medicine.

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 the hard work and expertise of healthcare professionals, 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 is system 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.

Internally, the 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 [11]. 

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 both 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, but it gained popularity in 16th century England and experienced a revival with the modern Olympic Games, leading to the widespread participation today [3].

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 [4].

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 [5].

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 [6].

In terms of recreation, prior to 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 make their 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 comparitively. The “exercise is medicine” movement had hints of growth back in the late sixties.

“…there is growing evidence on the preventive value of exercise, and it is possible that, in the not too distance future, physical education will become a part of medicine.” – Peter Karpovich, 1968 [14]

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-year period from 1980 to 2020.

This graph shows the large 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 timline from NC State [18]. 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 ones own path through lifestyle changes. In order to be successful, an individual must learn autonomy. Learning basic exercise and health and wellness principles and gaining a deeper understanding of oneself will set people on a path to autonomy. 

Health – noun, the general condition of the body (physical or physiological) or mind (mental or psychological) with reference to soundness and vigor; the absence of disease or ailment [9].

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 means to preventing illness or sluggish states, as opposed to emphasizing the treatment of disease [9].

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 not sustainable and, in some cases, even dangerous. On the other hand, those who avoid extremes might believe that health and wellness can be achieved and maintained merely through regular activity and abstaining from all unhealthy foods. However, I believe this traditional view of health and wellness is outdated, given the new discoveries in human physiology as well as considerations for modern day. Let’s discuss why. 

Think of reps on a continuum, 1 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 stiffness in the tendons, we will increase existing weaknesses and strains in size [12]. However, only mechanical loading results in tendons that are too stiff, resulting in an increased risk of injury [13]. Cyclical vs. mechanical loading may be a law, but these laws exist in nuance.

Therefore, consider the isolation that results from filling your schedule with constant wellness practices. Consider the lack of long-term orthopedic health with simple “regular activity” (i.e. cyclical loading). I believe that 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. 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, it’s evident greater change is necessary [10].

In order to be successful, an individual must learn autonomy. It allows them to shape their own life, 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 and they will become optimal and capable.

I propose that health and wellness is aquired 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 appropriate 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 levels of fitness, we often find ourselves making sacrifices in other aspects of our lives, potentially diminishing our abilities in other 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 are incapable of handling the stress thrown at you in the home, you are not “well/capable” even though you could say you are “healthy/optimal”.

If you are well enough to live your life without pain but not healthy/optimal (high enough bone density) enough 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. The reality is, 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

“Can I do all the things I need to do during the day without help? Can I do all the things that I want to do during the day without help? Is the gym helping or hurting those things?”

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

References

1. Institute of Medicine (US). Evidence-Based Medicine and the Changing Nature of Healthcare: 2007 IOM Annual Meeting Summary. Washington (DC): National Academies Press (US); 2008. 1, The Changing Nature of Health Care. Available at: https://www.ncbi.nlm.nih.gov/books/NBK52825/

2. Global Wellness Institute. “History of Wellness.” Global Wellness Institute, 2019. Available at: https://globalwellnessinstitute.org/what-is-wellness/history-of-wellness/

3. Thies, Henner. “The History of Running – from the Stone Age to the Present Day.” Redbull.com, 22 Apr. 2022. Available at: https://www.redbull.com/au-en/the-history-of-running

4. Holmes, Taylor. “The History of Swimming – MySwimPro.” MySwimPro, 6 Nov. 2023. Available at: https://blog.myswimpro.com/2023/11/06/the-history-of-swimming/

5. Abt, Samuel. “Cycling | Sport.” Encyclopædia Britannica, 24 May 2019. Available at: https://www.britannica.com/sports/cycling

6. Corn, Rodney. “History of Olympic Weightlifting | Eleiko.” Eleiko. Available at: https://eleiko.com/en-it/stories/history-of-olympic-weightlifting

7. McManus, Melanie Radzicki. “Love Group Cardio Classes? Thank Dr. Cooper, the Father of Aerobics.” CNN, 15 Dec. 2023. Available at: https://www.cnn.com/2023/12/15/health/kenneth-cooper-father-of-aerobics-wellness/index.html

8. Kent, JA, and Hayes, KL. “Exercise Physiology From 1980 to 2020: Application of the Natural Sciences.” Kinesiology Review (Champaign). 2021 Aug; 10(3): 238-247. doi: 10.1123/kr.2021-0024. Epub 2021 Jun 30. PMID: 35464337; PMCID: PMC9022627.

9. Tatriele, Lahra. “Wellness Architecture Terminology & Definitions.” Global Wellness Institute, 20 June 2024. Available at: https://globalwellnessinstitute.org/global-wellness-institute-blog/2024/06/20/wellness-architecture-terminology-definitions/. Accessed 2 Aug. 2024.

10. Elgaddal, N., Kramarow, E. A., & Reuben, C. Physical Activity Among Adults Aged 18 and Over: United States, 2020. National Center for Health Statistics, 2022. https://doi.org/10.15620/cdc:120213

11. Kessler, SE, and Aunger, R. “The Evolution of the Human Healthcare System and Implications for Understanding Our Responses to COVID-19.” Evolution, Medicine, and Public Health, 2022 Feb 12; 10(1): 87-107. doi: 10.1093/emph/eoac004. PMID: 35284079; PMCID: PMC8908543.

12. Firminger, CR, and Edwards, WB. “Effects of Cyclic Loading on the Mechanical Properties and Failure of Human Patellar Tendon.” Journal of Biomechanics, 2021 May 7; 120: 110345. doi: 10.1016/j.jbiomech.2021.110345. Epub 2021 Mar 1. PMID: 33735631.

13. Lorimer, AV, and Hume, PA. “Stiffness as a Risk Factor for Achilles Tendon Injury in Running Athletes.” Sports Medicine, 2016 Dec; 46(12): 1921-1938. doi: 10.1007/s40279-016-0526-9. PMID: 27194434.

14. Karpovich, PV. “Exercise in Medicine: A Review.” Archives of Physical Medicine and Rehabilitation, 1968 Feb; 49(2): 66-76. PMID: 4867442.

15. Entwistle, VA, Carter, SM, Cribb, A, and McCaffery, K. “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships.” Journal of General Internal Medicine, 2010 Jul; 25(7): 741-745. doi: 10.1007/s11606-010-1292-2. Epub 2010 Mar 6. PMID: 20213206; PMCID: PMC2881979.

16. Velicer, WF, Prochaska, JO, Fava, JL, Norman, GJ, and Redding, CA. “Smoking Cessation and Stress Management: Applications of the Transtheoretical Model of Behavior Change.” Homeostasis, 1998; 38: 216-233. Detailed overview by the University of Rhode Island. Available at: https://web.uri.edu/cprc/transtheoretical-model/detailed-overview/

17. Moore, M. “Ground Zero in Lifestyle Medicine: Changing Mindsets to Change Behavior.” American Journal of Lifestyle Medicine, 2023; 17(5): 632-638. doi: 10.1177/15598276231166320

18. NC State. “Historical Timeline of Exercise Physiology.” NC State. Available at: https://hes.dasa.ncsu.edu/historical-timeline/