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Evidence-based Wellness: Physical

Spin ClassIn 1948 the World Health Organization defined ‘health’ as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ Sixty years later, that definition sounds a lot like what we mean when we say ‘wellness.’ Physical wellness prevents many chronic illnesses, helps control chronic illnesses if they do occur, and in both the long and short term improves emotional health. Physical wellness—proper nutrition, regular physical activity, and avoidance of toxins—should be the cornerstone of everyone’s wellness strategy.

Medical students are generally in their twenties, a stage of life where people establish habits that are likely to stay with them for decades. Habits of nutrition and physical activity will either lay the basis for future diabetes and cardiovascular disease, or for future robust good health. It is easy to put off until tomorrow the health habits that will benefit us tomorrow, but enhancing physical wellness brings short-term benefits as well.

Doctors in training, whether working on their M.D. or doing residency, experience overwork, insufficient sleep, and professional and personal stress. A recent systematic review of clinical depression during residency (Mata et al, JAMA: 2015:314(22):2373-2383) showed a dramatic increase during the internship year. Will push ups prevent this? Perhaps. The Alameda County Studied followed hundreds of young adults for over a decade, and found that baseline high levels of physical activity predicted a substantial reduction in likelihood of developing depression. (Camacho et al, Am J Epidem 1991;134:220-31). If depression does occur, RCTs show a large treatment effect in favor of physical activity versus no physical activity—an effect in mild and moderate depression that was as large as that of antidepressant medications.

Anecdotally, many young adults will report that a good workout helps them relax and deal with the stresses of training. There is a strong physiologic basis to this. Faced with a psychosocial stressor, those who are inactive and unfit demonstrate a dramatic rise in serum cortisol compared to those who are active and fit. (Hackney, Expert Rev Endocrinol Metab.2006 Nov 1; 1(6): 783-792.)

Finally, some young physicians add unwanted body weight during training. Emotional stress, access to ‘comfort food,’ and insufficient time for exercise conspire to move some from desirable weight to overweight or overweight to obese. (Leventer-Roberts et al. JGME. Sept 2013.)

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Physical wellness, when combined with deliberate cognitive practices such as mindfulness, meditation, and with formation of strong social networks, is the basis of ‘Lifestyle Medicine.’ Some doctors are aggressively incorporating this into their conventional primary care practice, and others are focusing almost exclusively on lifestyle as both prevention and treatment. UConn Health offers a Lifestyle Modification Clinic, within the Division of Cardiology, that offers intensive health coaching to those with established heart disease or diabetes, or multiple risk factors for these conditions. Elsewhere, lifestyle practices offer everything from treatment to secondary prevention to primary prevention to primordial prevention, often through group visits, cooking lessons, and physical activity events in the community.

The American College of Lifestyle Medicine offers peer support, education and training, and relevant literature review. The College supports Lifestyle Medicine interest groups at many medical schools as well as a closely affiliated group LMEd – the Lifestyle Medicine Education Collaborative. The ACLM has published a 70 page review of lifestyle and its benefits; although a great deal has been learned since that review was published in 2009, it still merits review by anyone not yet convinced of the power of lifestyle. For less comprehensive but more timely evidence, visit LMed