Health, fitness and wellbeing - back to balance

From the outset here today I would like to put forth a concept of integrated health that encompasses four areas: physical, mental, emotional and spiritual well-being. If you don’t like where this is going, tune out now and head on over to YouTube for some aimless video browsing. Because the discussion that follows is an in-depth one that you might want to be switched on for.

Below is my concept of how our physical, mental and emotional health cross over to determine our spiritual well-being. There is a brief and wonderful overview of eight different areas of wellness at the University of California Davis campus website (https://shcs.ucdavis.edu/wellness) which discusses the dimensions of occupational, emotional, intellectual, environmental, financial, spiritual, physical and social wellness, defining wellness as “an active process of becoming aware of and making choices towards a healthy and fulfilling life”. They go on to say “wellness is more than being free from illness, it is a dynamic process of change and growth… Each dimension of wellness is interrelated with another. Each dimension is equally vital in the pursuit of optimum health. One can reach an optimal level of wellness by understanding how to maintain and optimize each of the dimensions of wellness”. I have simplified these eight areas down to four, as you can see below, as I feel my abbreviated model summarises those things intrinsic to us as human beings that a health practitioner can have some kind of influence on. I cannot directly facilitate the environmental, occupational, financial or social changes my clients may need or desire, although these certainly have an influence on us and will in turn be affected by our physical, mental, emotional and spiritual wellbeing. My motivation is to help people understand how they can positively alter their internal environment in order to have a positive effect on their external environment.

My last blog post attracted a lot of (excuse the pun) healthy discussion regarding the use of the terms “health”, “fitness” and “wellness”. Many of your ideas aligned with my own and have helped me refine and shape a new theoretical model of health care with some corresponding terminology to move forwards with. I thank you all for your contributions! (Including Anita who conceptualised the venn diagram idea. :) )

So what do “health”, “fitness” and “wellness” mean to you? Of course for each of us, the meaning we read into something will depend on its context. In today’s world the term “gay” means something completely different to what it did 100 years ago. So based on where you are, who you are, what you have experienced, who you are with, how you perceive things and when, language is adaptable. And because language is vital in communicating messages between each other (particularly when body language and vocal tone can’t be used) we need to be adaptable also.

I would like to discuss each of these terms one at a time, considering their formal meanings as well as my own interpretations.

First – HEALTH, as defined by the Oxford Dictionary online, is: “the state of being free from illness or injury” or “a person’s mental or physical condition”. Wikipedia goes a little further to explain that health is “the level of functional or metabolic efficiency of a living organism” and that “in humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental or social challenges”.

If we subscribe to these definitions and ideas, then we are to believe that health is a disease-free state relating to physical and mental adaptability, with particular regard to function and one’s metabolism. This concept does not consider a person’s emotional or spiritual state, and there is a focus on the absence of (or ability to cope with) illness, injury and other various challenges. This reflects how focussed we are (at least in Australia) on reactive health care, responding to one’s state of health only when it becomes problematic.

I personally do not like this type of definition or approach, and prefer the World Health Organisation’s concept of health being “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. It is interesting to note here that again there is no mention of emotional or spiritual health, although one might argue that these could be referred to under the umbrella of “social well-being”. I feel that health care in Australia has not caught up yet with the idea of health being a state of complete well-being, hence why the two terms remain separate. This reflects how “health” is possibly seen as an institutionalised or medicalised term, not incorporating the bigger picture of a person’s existence.

Secondly – FITNESS. Health and fitness, hand-in-hand? Maybe not. Let’s first explore the term “fit”, which the Oxford dictionary defines in two ways: “Of a suitable quality, standard or type to meet the required purpose”, or “in good health, especially because of regular physical exercise”.

“Fitness” itself is described in three ways: “The condition of being physically fit and healthy”, or

“an organism’s ability to survive and reproduce in a particular environment”, or “the quality of being suitable to fulfil a particular role or task”.

On one hand, it appears that fitness relates to health at least as far as the physical component goes, while on the other hand it describes a utilitarian purpose, the ability to carry out a given task. The third concept of evolutionary fitness (one’s ability to survive and reproduce) may not be considered a huge amount outside of the science world, and the ability of a fitness fanatic to successfully survive and reproduce is sometimes questionable (possible increase in sexual desirability off-set by decrease in menstruation regularity for highly active women, for instance).

My own definition that I have used for fitness is “the ability to meet the physical demands of a particular activity”, which aligns pretty closely with the utilitarian definitions above. I certainly believe that even amongst the very fit there are multiple types of “fitness” – in fact as many types as there are activities. I can be a very fit swimmer, for instance, but a very unfit runner. Someone who manages to attain a high level of fitness in swimming, running AND cycling can be a very fit triathlete, but note that the triathlete does not train with only one particular exercise type leading up to competition – they need to be proficient at each of them, and therefore need to train all three modalities together.

Notice also that despite the common use of the word “fit”, for example “you look really fit”, it actually has nothing to do with appearance, body weight or size. If you consider the ability of a sumo wrestler to meet the physical demands of his activity, the smaller he is the less fit he may be for his sport. So while we are considering the delineation between health and fitness, let’s also realise that while one’s body fat percentage can have implications on their health, it is not a measure synonymous with fitness (or health either, for that matter). Furthermore, the focus on body weight for many people can lead to serious detriment for their overall health.

Consider the following excerpt from Health at Every Size: The Surprising Truth About Your Weight by Linda Bacon, PhD. “Let’s face facts. We’ve lost the war on obesity. Fighting fat hasn’t made the fat go away. And being thinner, even if we knew how to successfully accomplish it, will not necessarily make us healthier or happier. The war on obesity has taken its toll. Extensive “collateral damage” has resulted: Food and body preoccupation, self-hatred, eating disorders, discrimination, poor health… Few of us are at peace with our bodies, whether because we’re fat or because we fear becoming fat. Health at Every Size is the new peace movement. Very simply, it acknowledges that good health can best be realized independent from considerations of size. It supports people of all sizes in addressing health directly by adopting healthy behaviours.”

Thank you to Tabitha for pointing me in the direction of the HAES website at http://www.haescommunity.org/ . I think it’s a wonderful movement with a wholistic view of health that can help many people move past the Western obsession with physical size and look a little deeper.

Now finally, onto the concept of well-being, or wellness (terms which I use interchangeably, although I really like the sound of wellbeing ever since I grasped the concept of people being human beings rather than human doings – thank you Eckhart Tolle!) The Oxford definitions are separate ones:

WELLNESS – “the state or condition of being in good physical and mental health”.

WELL-BEING – “the state of being comfortable, healthy or happy”.

Wikipedia describes well-being as “a general term for the condition of an individual or group, for example their social, economic, psychological, spiritual or medical state; high well-being means that, in some sense, the individual or group’s experience is positive, while low well-being is associated with negative happenings”. If you search “wellness” in Wikipedia there is no longer a separate entry, but you are redirected to their “health” page, suggesting that both the Oxford dictionary and Wikipedia consider that wellness relates more directly to health, while well-being encompasses something broader. Note the use of the terms “social, economic, psychological, spiritual or medical” in relation to wellbeing. Now it seems like we are getting towards a term that describes the full gamut of human experience.

Or are we?

Unfortunately because of the broad and general nature of the term “well-being”, there are many concepts that have snuck in here that are less than legitimate. I’m talking about the health hoaxes and quick-fix alternative therapists that promote their products and services under the banner of well-being or wellness, because the medical / health industry wouldn’t have a bar of them. Please let me clarify that I do not categorise all alternative therapies as hoaxes; far from it. I am a huge advocate for the use of traditional Chinese medicine, acupuncture, Ayurvedic techniques, yoga, meditation and all sorts of other complementary therapies as ways of improving overall health where medical science may not have a solution, and am thrilled by all the new research showing their effectiveness. You’ll hear me talk about the concept of people’s energy flow almost every day, and you’ll see me get excited when I talk about how science is finally catching up to explain all the “weird hippie stuff” that has been practiced for thousands of years. At the foundation of my viewpoint though, is an education including a certificate in fitness, a science degree, a Master’s in physiotherapy, a very decent grade point average in these academic pursuits, and generally a whole lot of critical thinking. While I firmly embrace an evidence-based approach, I also embrace the idea that the evidence isn’t there – YET – for certain things, and so I float in limbo. Not quite medicalised enough to have my feet planted firmly in science, far too curious and critically-minded to subscribe only to a health viewpoint, more open-minded than the typical allied health professional… yet way too evidence-motivated to believe just anything, more technical than your average Jo and with more clinical and research expertise than most alternative therapists or yoga teachers.

So where does this leave me? Somewhere in the middle of being a health professional and a wellness consultant…. which in actual fact is quite exciting, because I’m hearing that a lot of people are disappointed with their experiences of both the medical and alternative worlds. I was quite inspired to hear of the Australasian Integrative Medicine Association, whose aim is to integrate complementary and mainstream medicine to provide whole-person medical care (see http://www.aima.net.au). I plan on joining the association at some stage, but again I’m in limbo, as their focus is on the medical doctor being at the centre of the approach and drawing on the expertise of others as needed. Short of getting another (medical) degree, this leaves me little choice but to define and launch a different type of health care – an approach based on multidisciplinary allied health care, encompassing evidence-based practice which is proactive, wholistic and client-centred.

I call it INTEGRATED HEALTH.

While people in the medical and fitness areas most often wait until there is an injury or illness to deal with before seeking help, an integrated health approach will encourage the proactive behaviours more commonly practiced in the wellness industry, but without any of the quackery. Instead of merely focusing on the physical and mental aspects of health, an integrated health system takes into account the emotional and spiritual factors of one’s well-being also. And instead of dismissing the existing medical, health, fitness and well-being industries, integrated health combines the best of them all to provide a client with an optimised approach for all facets of their personal development.

Are you as inspired by this concept as I am? Do you think the world needs it? Do you think Australia is ready for it? Any thoughts, opinions, and points of feedback are most welcome.

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