Wellness and Health

Promotion in
Physical Therapy
Learning Outcomes:
Upon completion of this discussion, students should be able
to:
1. To be able to gain insights about the Healthy People initiative,
particularly Healthy People 2020.
2. To be able to understand and compare the definitions of health and
wellness and other key terms.
3. To be able to differentiate between the six models of wellness
4. To be able to discuss the stages of wellness and apply them to
yourself and others.
5. To be able to differentiate between a lapse and relapse as well as
maintenance and permanent maintenance then apply these
definitions to yourself and others.
6. To be able to identify and provide a rationale for the stage of
wellness in an evaluation of a patient/client depending on a given
scenario
The Basics of Wellness
“A society in which all people live long,
healthy lives.”
Mission of Healthy People 2020:
• Identify nationwide health improvement priorities
• Increase public awareness and understanding of the
determinants of health, disease and disability and the
opportunities for progress
• Provide measurable objectives and goals that are applicable
at the national, state and local levels
• Engage multiple sectors to take actions to strengthen policies
and improve practices that are driven by the best available
evidence and knowledge
• Identify critical research, evaluation and data collection
needs
Goals of Healthy People 2020:
• Attain high quality , longer lives free of preventable disease,
disability, injury and premature death
• Achieve health equity, eliminate disparities and improve health
of all groups
• Create social and physical environments that promote health for
all
• Promote quality of life, healthy development and healthy
behaviors across all life stages
10 Leading Health Indicators:
1. Physical activity
2. Overweight and obesity
3. Tobacco use
4. Substance abuse
5. Responsible sexual behavior
6. Mental health
7. Injury and violence
8. Environmental quality
9. Immunization
10. Access to health care
Key Terms in Health
Promotion
• Health
• A state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity (World
Health Organization 1947, 2009).

• Wellness
• The sense that one is living in a manner that permits the
experience of consistent, balanced growth in the physical,
spiritual, emotional, intellectual, social, and psychological
dimensions of human existence.
• Disease
• Considered the opposite of health
• Defined as a pathological condition affecting the body

• Illness
• Opposite of wellness; multidimensional
• Defined as a social construct where individuals are not
achieving balance in their lives and are unable to create a
higher quality of life
Health Protection/Disease Prevention
Model

• 3 Types:
 Primary Prevention
- “Prevention of disease in a susceptible population
or potentially susceptible population through
specific measures such as general health
promotion efforts”
Secondary Prevention
- “Efforts to decrease duration of illness, severity of
disease, and sequelae through early diagnosis and
prompt intervention”

Tertiary Prevention
- “Efforts to decrease the degree of disability and
promote rehabilitation and restoration of function in
patients with chronic and irreversible diseases”
Health Protection/Disease Prevention
Model

Pre-pathology Pathology Present

Goals: Goal: Goal:
Protect health Early diagnosis Rehabilitation
Prevent disease and intervention following
Promote health to limit significant
impairment impairment or
and disability disability

Primary Prevention Secondary Prevention Tertiary Prevention

Population Health Management Model

• Used to describe health promotion and prevention

interventions for a population across a continuum of health
risk.
• Categorizes individuals based on risk for developing a
disease, and then provides the appropriate intervention for
the identified risk factor.
• Individuals at low or very minimal risk for disease receive
interventions to keep them from moving across the
continuum to a high-risk category or to actual development
of disease or pathology.
Wellness Models
• Illness-Wellness Continuum (John Travis, MD)
• Movement toward high-level wellness includes awareness,
education, and growth; while movement toward premature
death includes signs, symptoms, and disability
 Ardell’s Model of Wellness (Don Ardell, PhD)

• Ardell defines wellness as “a

choice to assume responsibility for
the quality of your life.”
Physical Domain • The areas most closely associated
Meaning
Mentaland
exercise Domain
fitness
and Purpose Domain with wellness, says Ardell, are
emotional intelligence,
nutrition,
meaning and purpose, “self-responsibility; exercise and
effective decisions,
appearance, fitness; nutrition; stress
Relationships,
stress management,
adaptations/ management; critical thinking;
humor,
factual knowledge,
challenges, meaning and purpose, or
play
mental health
lifestyle habits spirituality; emotional intelligence;
humor; play; and effective
relationships.”
Six-Dimensional Model of Wellness
• Developed by William Hettler, PhD in 1979
- Co-founder of the National Wellness Institute
(NWI)
• This holistic model explains:
- How a person contributes to their environment
and community ,and how to build better living
spaces and social networks
- The enrichment of life through work, and its
interconnectedness to living and playing
- The development of belief systems, values, and
creating a world-view
- The benefits of regular physical activity, healthy
eating habits, strength and vitality as well as
personal responsibility, self-care and when to
seek medical attention
- Self-esteem, self-control, and determination as a
sense of direction
- Creative and stimulating mental activities, and
sharing your gifts with others
Holistic Model for Wellness and Prevention Over
the Life Span
• Developed by J. Melvin Witmer and
Thomas J. Sweeney (1992)
• Presented for the purpose of theory
building, research, clinical
application, education, advocacy, and
consciousness raising.
• The model includes 11 characteristics
desirable for optimal health and
functioning.
- These characteristics are
expressed through the five life
tasks of spirituality, self‐
regulation, work, friendship, and
love.
- Life forces external to the person
are noted including family,
religion, education, community,
and media.
Perceived Wellness Model

• Developed by T. Adams,
J. Bezner, Mary Steinhardt
(1997)
• Contains six dimensions of
wellness: physical, social,
psychological, emotional, spiritual
and intellectual.
• Perceived wellness is defined as
the sense that one is living in a
manner that permits the experience
of consistent, balanced growth in
the emotional, intellectual,
physical, psychological, social and
spiritual dimensions of human
existence.
Humanistic Model of Wellness
• Developed by Sharon Elayne Fair, PT,MS,PhD
• It recognizes the importance of the cognitive knowledge of, the affective
commitment to, and the psychomotor behaviors associated with the
physical, mental, and social dimensions of wellness.
• The assessment tool for the HMW is the Self-Wellness Survey (SWS)
- designed to be utilized by a physical therapist as part of the tests and
measures section of a physical therapy examination
- contains 250 items: 100 are related to nutritional wellness, 72 relate to fitness
wellness, 27 are about body composition wellness and 51 are about mental
and social wellness
7 Stages of Wellness

• Primordial
• Pre-contemplation
• Contemplation
• Preparation
• Action
• Maintenance
• Permanent maintenance
Primordial Stage

• A patient/client is not aware that she or he has a

health-related problem and/or that she or he is
unknowingly engaging in a behavior that is
unhealthy.
Pre-contemplation Stage

• A patient/client has not yet embraced the notion that

there is a health-related problem and/or she or he is
engaging in unhealthy behaviors, but has begun to
recognize that she or he may have a health-related
problem and/or poor health habits.
Contemplation Stage

• A patient/client recognizes that she or he is engaging

in a behavior that is linked to a health problem and
may begin to investigate that behavior, including its
pros and cons, but remains ambivalent about what to
do about the situation, if anything.
Preparation Stage

• A patient/client has made the choice to change the

unhealthy behavior.
• Her or his unhealthy behavior is either self-assessed
or assessed by a professional and a plan of care is
developed.
Action Stage

• A patient/client initiates a change in her or his

behaviors.
Maintenance Stage

• The patient/client is regularly practicing the new

behavior
• During the maintenance stage, a lapse or a relapse
may occur.
• Lapse - a cessation of a healthy behavior, but the
cessation is temporary and does not produce
significant adverse effects.
• Relapse - a cessation of a healthy behavior that it
is longer than temporary and produces significant
adverse affects.
Permanent Maintenance Stage

• When an individual has reached the permanent

maintenance stage of a behavior, the behavior itself
is reinforcing and the person is intrinsically
motivated to continue the healthy behavior.
Case Scenarios:
1. One week ago, Rachel established a goal to consume about
1500 calories per day and since that time, she has met her
daily goal. Today, however, she consumes about 2800
calories. Rachel’s diet today constitutes what type of
lapse?

2. Two weeks ago, John established a goal to exercise three

times per week for 30 minutes per session, but he
exercised only once in the first week and did not exercise
at all during his second week. John’s transgression is
significant and should be considered a?
End. Thank you for listening!
Reference/s:
• Wellness and Physical Therapy - Sharon Elayne Fair,
PT,MS,PhD
• Physical Rehabilitation 6th edition – Susan B. O’Sullivan,
Thomas J. Schmitz, George D. Fulk ; Chapter 29: Promoting
Health and Wellness
• https://www.healthypeople.gov/
• https://nationalwellness.org/resources/six-dimensions-of-w
ellness/
• https://onlinelibrary.wiley.com/doi/abs/10.1002/j.1556-667
6.1992.tb02189.x
• https://pdfs.semanticscholar.org/f345/ee44e2f14c74f43fdd
ac1f771376706270cf.pdf
• https://perceivedwellness.com/perceived-wellness/