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Multidimensional wellness promotion in the health and fitness industry

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James D Beauchemin at Boise State University
James D Beauchemin
Nicole Gabana
Nicole Gabana
Kirk Ketelsen at Boise State University
Kirk Ketelsen
Chris McGrath
Chris McGrath
Chris McGrath
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Current trends in the United States indicate an increase in sedentary behaviors, obesity, stress and poor diet, contributing to heightened rates of chronic illness and mortality. These trends illustrate a need for prioritizing prevention and wellness promotion, and conceptualizing health as a multidimensional construct. The exercise and fitness industry is uniquely positioned to support individuals in establishing healthy lifestyle trends that address multiple domains of wellness. This research study utilized health and fitness professional survey data to assess relationships between the frequency of addressing each of the five primary domains of wellness (physical, social, emotional, intellectual and spiritual), and a number of demographic variables. Relationships between the frequency of addressing domains of wellness and all demographic variables (e.g. physical wellness by industry role) were examined using Pearson Chi Square Tests of Independence. Results indicate differences in the frequency that unique dimensions of wellness were addressed with clients, as well as differences based on industry role and gender. Implications are discussed, including challenges associated with a consensus organizational definition of wellness, and variability in training and education requirements of fitness professionals, that may impact the promotion of wellness domains beyond the traditional physical focus.
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International Journal of Health Promotion and Education
ISSN: 1463-5240 (Print) 2164-9545 (Online) Journal homepage: http://www.tandfonline.com/loi/rhpe20
Multidimensional wellness promotion in the
health and fitness industry
James D Beauchemin, Nicole Gabana, Kirk Ketelsen & Chris McGrath
To cite this article: James D Beauchemin, Nicole Gabana, Kirk Ketelsen & Chris McGrath (2019):
Multidimensional wellness promotion in the health and fitness industry, International Journal of
Health Promotion and Education, DOI: 10.1080/14635240.2018.1559752
To link to this article: https://doi.org/10.1080/14635240.2018.1559752
Published online: 09 Jan 2019.
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Multidimensional wellness promotion in the health and
fitness industry
James D Beauchemin
a
, Nicole Gabana
b
, Kirk Ketelsen
c
and Chris McGrath
d
a
Social Work, Boise State University, Boise, USA;
b
College of Education, Florida State University,
Tallahassee, USA;
c
Community and Environmental Health, Boise State University, Boise, USA;
d
Health &
Exercise Science, Long Island University, Brooklyn, USA
ABSTRACT
Current trends in the United States indicate an increase in sedentary
behaviors, obesity, stress and poor diet, contributing to heightened
rates of chronic illness and mortality. These trends illustrate a need
for prioritizing prevention and wellness promotion, and conceptua-
lizing health as a multidimensional construct. The exercise and
fitness industry is uniquely positioned to support individuals in
establishing healthy lifestyle trends that address multiple domains
of wellness. This research study utilized health and fitness profes-
sional survey data to assess relationships between the frequency of
addressing each of the five primary domains of wellness (physical,
social, emotional, intellectual and spiritual), and a number of demo-
graphic variables. Relationships between the frequency of addres-
sing domains of wellness and all demographic variables (e.g.
physical wellness by industry role) were examined using Pearson
Chi Square Tests of Independence. Results indicate differences in
the frequency that unique dimensions of wellness were addressed
with clients, as well as differences based on industry role and
gender. Implications are discussed, including challenges associated
with a consensus organizational definition of wellness, and varia-
bility in training and education requirements of fitness profes-
sionals, that may impact the promotion of wellness domains
beyond the traditional physical focus.
ARTICLE HISTORY
Received 26 March 2018
Accepted 13 December 2018
KEYWORDS
Wellness; multidimensional;
fitness; lifestyle
Introduction
Background
Chronic diseases are the main causes of poor health, disability and death. Chronic
illness is largely driven by lifestyle behaviors, linking factors such as inactivity, diet,
smoking and sustained stress with an increased risk for major illness and death (Smith
et al. 2013). Many adults spend 70% or more of their waking hours sitting (Dietz et al.
2015), which has been associated with negative health outcomes (Biswas et al. 2015).
Conversely, replacing as little as 30 min of sedentary time with light activity has been
found to reduce risk of mortality by as much as 14% (Schmid et al. 2016). The
increasing prevalence of poor diet and unhealthy lifestyle indicates that more than
CONTACT James D Beauchemin jamesbeauchemin@boisestate.edu Social Work, Boise State University, 1910
University Drive, Boise, ID, 83725, USA
INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION
https://doi.org/10.1080/14635240.2018.1559752
© 2019 Institute of Health Promotion and Education
one in three adults, and one in six children are considered to have obesity (U.S.
Department of Health and Human Services 2014), while dietary factors represent
a significant proportion of deaths from heart disease, stroke and Type 2 diabetes
(Micha et al. 2017). In addition, life stress is strongly associated with poor mental
and physical health (Slavich et al. 2010), and accounts for substantial mortality
(Pedersen, Bovbjerg, and Zachariae 2011).
Wellness
Understanding the impact of various lifestyle behaviors on health outcomes is essential
in shaping how chronic illness is addressed. Acceptance of a multidimensional con-
ceptualization of health and wellness has been gradual within the traditional Western
medical model. Historically, the biomedical model of illness has focused exclusively on
biology while ignoring psychological, social and environmental influences on health
and well-being. A change toward a comprehensive understanding of health is supported
by the World Health Organization (WHO), which defines health as a state of complete
physical, mental and social well-being and not merely the absence of disease or
infirmity (WHO 1992). Building on this understanding, focus should be shifted toward
establishing healthy lifestyle trends to improve multiple domains of wellness that result
in wellness promotion, and ultimately decreased chronic illness and death.
Health and fitness industry stakeholders have historically been promoters, innovators
and leaders in assisting individuals in making lifestyle changes leading to improved
health outcomes. The changing paradigm in health and wellness toward inclusion of
domains beyond the traditional physical fitness focus requires a new approach to
wellness promotion among industry leaders to best meet the changing needs of clien-
tele. The research supporting that domains of wellness such as social, spiritual and
emotional can have a profound impact on one’s wellness (e.g. Fry 2000; Raza et al.
2011) necessitates alternative approaches, education, training and promotional efforts
within the industry. For example, spiritual well-being is gaining increased attention in
the health and rehabilitation literature, as researchers have found that spiritual beliefs
can significantly impact quality of life, mental health and physical health, such as injury
rehabilitation and coping with chronic illness (Wilson et al. 2017).
The subjective nature of terminology such as fitness, health and wellness creates
challenges in developing consensus definitions, and consequently, approaches and
interventions that are applicable across models. Within the industry, fitness is generally
accepted as the ability to function well in daily activities without injury, enjoy leisure
time, be healthy, and includes: cardiorespiratory, flexibility, body composition, muscu-
lar strength and endurance components (Mantell 2013). However, the emergence of the
wellness paradigm, generally conceptualized as a multidimensional construct, has
resulted in many different wellness definitions and models. Among the evidence-
based models of wellness are Dunn’s High Level Wellness (Dunn 1977), which inte-
grates body, mind and spirit; Ardell’s Components of Wellness model (1977), which
incorporates three parallel domains that include physical, mental and meaning and
purpose; and Hettler’s Hexagonal Model of Wellness (1980), incorporating social,
spiritual, physical, emotional, occupational and intellectual domains of wellness.
Additionally, the Wheel of Wellness (Witmer and Sweeney 1991), which evolved into
2J. D. BEAUCHEMIN ET AL.
the Indivisible Self Wellness Model (Myers and Sweeney 2004), has a substantial
research base and is measured using the Five Factor Wellness Evaluation of Lifestyle
(5F-WEL). Although there are numerous conceptualizations of wellness evident in the
literature, consistent among them is a multidimensional understanding of the construct.
The most commonly included components of wellness are physical, social, emotional,
intellectual and spiritual (Roscoe 2009), although domain titles may vary depending
upon the model.
Education and training
In order to support individuals in improving multidimensional wellness, counseling
and lifestyle change techniques are needed to inform, engage and empower clients so
they can effectively communicate their needs, and ensure that they are active in change-
related decision-making (Caldwell, Gray, and Wolever 2013). Thus, the integration of
behavior change theory into education and training of health professionals is critical to
the synthesis of physical health with other domains of wellness. There are numerous
models related to lifestyle behavior change including the Theory of Planned Behavior
(Ajzen 1991), Health Belief Model (Rosenstock 1974) and the Transtheoretical Model of
Change (Prochaska and Velicer 1997), which may be beneficial as foundational theories
upon which to base lifestyle change interventions and approaches. In addition to
knowledge related to theoretical underpinnings, advanced understanding of specific
evidence-based strategies to support individuals in moving toward healthy lifestyle
change are essential to adopting a comprehensive approach to wellness within the
industry.
There is evidence that the health and fitness industry is making progress in re-
conceptualizing health and wellness, and developing strategies to facilitate lasting well-
ness-focused lifestyle change. For example, the growing prevalence of health ‘coaching’
models is indicative of efforts to develop brief approaches that focus on lifestyle change.
Coaching can be defined as a means of helping others attain a desired goal (O’Connell,
Palmer, and Williams 2013), and can include models such as Life Coaching, Wellness
Coaching and Executive Coaching, depending on client needs. There are numerous
programs and certifications that focus on health and/or wellness coaching including the
National Society of Health Coaches, Wellcoaches, American Council on Exercise and
the Duke Integrative Health Coach Program. Despite the diversity among the numerous
models, training requirements and definitions of wellness (Smith et al. 2013),
approaches prove consistent in the understanding that wellness is not
a unidimensional construct, and that lifestyle change is a critical factor in attaining
multidimensional health and wellness.
Given the evidence supporting wellness as a multidimensional construct, and the
understanding that domains may have complex, reciprocal relationships with one
another (e.g. poor psychological wellness may impact physical wellness), it is essential
that health and fitness professionals develop expertise in the ways that varied compo-
nents (e.g. emotional wellness) may affect clients’health goals and outcomes, as well as
training in behavior change theory and intervention. To truly support clients in pursuit
of wellness, it should be addressed at both general and domain-specific levels using
behavior-based theory and coaching techniques.
INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 3
Purpose
The purpose of this study was to examine the frequency of promotion of lifestyle
change via various domains of wellness among health and fitness professionals.
Additionally, based on a multidimensional model of wellness, the study aimed to
examine relationships between the frequency of addressing each of the five primary
domains of wellness (physical, social, emotional, intellectual and spiritual) and
a number of demographic variables. A survey was utilized to answer the primary
research questions:
Which domains of wellness do health and fitness professionals most often address with
clients?
Is there a relationship between multidimensional wellness promotion and specific demo-
graphic variables (e.g. education, age, industry role, gender, certification type)?
Materials and methods
Procedure
This cross-sectional exploratory study utilized survey data to assess frequency of
promoting multidimensional wellness among health and fitness professionals. Surveys
were administered to voluntary participants at several national health and fitness
conferences between 2015 and 2017. Since anonymous data were gathered for program-
ming and training rather than research purposes, the secondary analysis was deemed
exempt by the affiliated Institutional Review Board (IRB). The survey was developed
and administered by representatives from an industry stakeholder to inform needs
related to future training, education and marketing. The representatives provided
permission for analysis for research purposes.
The study sample consisted of 185 individuals who identified as health and fitness
professionals. A convenience sampling approach was utilized, as all participants were
attendees at national conferences focused on health and fitness. Surveys were adminis-
tered at the beginning of a number of ‘break-out sessions’of varied content throughout
the conferences. An explanation of the survey and purpose was provided by the
stakeholder representative, who emphasized the voluntary and anonymous nature of
the surveys.
Surveys were created to gather sample demographic information, as well as informa-
tion related to the frequency of discussing domains of wellness with clients (Appendix).
Among the demographic variables assessed were: age, education, certifying organiza-
tion, gender and industry role. Although there are numerous models of wellness, this
survey utilized a common factors approach (Roscoe 2009) which includes emotional,
intellectual, physical, spiritual and social wellness domains. Questions about each of the
above-mentioned domains of wellness (e.g. ‘How frequently do you discuss social
wellness with clients?’) were posed using a 5-point Likert scale format (1 = Never;
5 = Very often). An additional item inquired about the frequency of discussing lifestyle
change with clients. Frequencies were calculated for all demographic variables,
4J. D. BEAUCHEMIN ET AL.
providing descriptive statistics for the study sample (Table 1). Response frequencies
based on wellness domains were also calculated to provide insight into fitness profes-
sionals’priorities (Table 2). Finally, to identify relationships between groups based on
category (e.g. physical wellness by industry role), a Pearson Chi Square Test of
Independence was performed (See Tables 3 and 4for Chi Square results). All statistical
analyses were conducted using SPSS 23 software (IBM).
Table 1. Sample characteristics (N= 185).
Frequency (Percent)
Gender
Male 48 (25.9)
Female 136 (73.5)
Other 1 (.5)
Age
20–29 46 (24.9)
30–39 44 (23.8)
40–49 49 (26.5)
50–59 38 (20.5)
60+ 8 (4.3)
Education
High School Diploma 39 (21.1)
Associate’s Degree 3 (1.6)
Bachelor’s Degree 103 (55.7)
Master’s Degree 35 (18.9)
Doctoral Degree 5 (2.7)
Certification
ACE
a
45 (24.3)
ACSM
b
21 (11.4)
NASM
c
46 (24.9)
NSCA
d
5 (2.7)
ISSA
e
6 (3.2)
Other 23 (12.4)
Multiple 39 (21.1)
Role
Personal Trainer 43 (23.2)
Group Instructor 5 (2.7)
Strength Conditioning Coach 1 (.5)
Educator 2 (1.1)
Club owner/manager 2 (1.1)
Researcher 1 (.5)
Two roles 46 (24.9)
Three roles 50 (27.0)
More than Three roles 35 (18.9)
a
American Council on Exercise.
b
American College of Sports
Medicine.
c
National Academy of Sports Medicine.
d
National
Strength and Conditioning Association.
e
International Sports
Sciences Association
Table 2. Wellness domains response frequency (%).
Never Almost never Sometimes Often Very often
Physical 6.5 33.5 60.0
Social 2.2 16.8 38.9 26.5 15.7
Spiritual 10.3 27.6 34.1 14.6 13.5
Emotional 1.1 10.3 28.1 34.1 26.5
Intellectual 6.5 21.6 40.0 20.0 11.9
Lifestyle change 11.4 30.3 58.4
INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 5
Results
Descriptive statistics were calculated for all study participants (N= 185). Results
illustrated that nearly three times as many participants were female (n= 136) than
male (n= 48). Ages of participants were widely dispersed, with each age range (e.g.
30–39) representing more than 20% of the total sample. The majority of participants
had achieved a bachelor’s degree (n= 103), followed by high school diploma (n= 39)
and master’s degree (n= 35). American Council on Exercise (ACE; n= 45) and
National Academy of Sports Medicine (NASM; n= 46) were the most common
certifications reported by fitness professionals, followed by American College of
Sports Medicine (ACSM; n= 21). Twenty-three participants reported ‘other’as certi-
fication, while a significant percentage reported having ‘multiple’certifications (n= 39).
Of the specific roles identified by participants, personal trainer was most common
(n= 43); however, the majority of fitness professionals indicated that they assumed two
roles (n= 46), three roles (n= 50) or more than three roles (n= 35). Complete
descriptive statistics are provided in Table 1.
In order to examine potential relationships between the categorical variables, Pearson
Chi Square Tests of Independence were conducted using α= .05 for significance. Results
indicated a number of significant associations between industry role and the frequency of
promoting various domains of wellness. For example, the relationship between industry
role and physical wellness promotion was significant, X
2
(8, N= 185) = 24.34, p< .01, with
a small to medium effect size (d= .27). Of the participants who identified as personal
trainers, 84% indicated ‘often’or ‘very often’in response to frequency of discussion of
physical wellness with clients. Similarly, among those who identified as having multiple
industry roles (three or more), 98% responded ‘often’or ‘very often’.
Chi Square tests also revealed significant relationships between industry role and the
frequency of discussing both emotional wellness, X
2
(16, N= 185) = 30.19, p< .05,
d= .26, and lifestyle change, X
2
(8, 185) = 23.07, p< .01, d= .25). Results indicated that
40% participants who identified as having one industry role reported that they dis-
cussed emotional wellness ‘often’or ‘very often’, in contrast to 72% of those who had
multiple roles. Following a similar trend to the previously discussed domains of
Table 3. Wellness domains by industry role.
df Chi Sq p ES (d)
Social 16 20.53 .197
Physical 8 23.34 .002 .27
Emotional 16 30.19 .017 .26
Intellectual 16 25.76 .057
Spiritual 16 22.43 .130
Lifestyle change 8 23.07 .003 .25
Table 4. Wellness domains by gender.
df Chi Sq p ES (d)
Social 4 3.86 .425
Physical 2 4.01 .135
Emotional 4 12.10 .017 .179
Intellectual 4 2.41 .661
Spiritual 4 3.43 .489
Lifestyle change 2 5.75 .056
6J. D. BEAUCHEMIN ET AL.
wellness, those who identified as having multiple industry roles reported a high fre-
quency of addressing lifestyle change with clients ‘often’or ‘very often’(98%).
In addition, a Chi Square analysis of the frequency of addressing wellness domains
based on gender was conducted. Although no significant results were found for
physical, intellectual, spiritual or social wellness based on gender, a significant relation-
ship was found for gender and emotional wellness, X
2
(4, N= 185) = 12.01, p< .05,
d= .18. Results indicate that female fitness professionals were significantly more likely
to address emotional wellness (‘often’or ‘very often’= 67%) than male fitness profes-
sionals (42%). No significant differences were found for any of the wellness domains
based on type of certification, age or education level.
Discussion
Given the shifting paradigm toward a more comprehensive conceptualization of health
and wellness, there is a clear need for fitness industry professionals to promote health
and lifestyle change from a multidimensional perspective. Findings from the current
study demonstrated differences in addressing wellness concepts with clients across all
health and fitness professionals surveyed. Differences in the frequency of addressing
multiple domains of wellness when working with clients illustrate the current paradigm
focused primarily on physical health, and represent a need for re-conceptualizing health
and wellness as multidimensional constructs within this industry. Although the exercise
science industry has traditionally focused exclusively on physical health, the existing
literature illustrating connections between domains of wellness and the influence on
one’s physical state highlights the importance of using a multidimensional approach to
health and wellness. This study provides evidence that despite the acceptance of
a multidimensional view of wellness, industry professionals continue to promote
a narrow conceptualization of health with their clientele.
Several potential barriers may be impacting multidimensional wellness promotion in
the health and fitness industry. Although multidimensional wellness is emerging as
a paradigm, the traditional western medical model continues to be the dominant approach
to treating illness, and by extension, addressing fitness concerns and challenges. Thus,
conceptualizing health and wellness as a combination of interrelated domains as opposed
to exclusively physically focused has been slow. As a result, training and education
opportunities related to multidimensional wellness promotion may be limited for health
professionals. Training issues are compounded by the number of certifying organizations,
which, while perhaps consistent in their intention to provide training and credentialing for
industry professionals, may have vastly different priorities and utilize differing models of
wellness. The lack of consensus definition of wellness and relevant promotion strategies,
compounded by potential differences in philosophies and training among certifying
organizations, point to barriers to promoting wellness in consistent and inclusive ways.
Industry roles
Wellness promotion within the industry is further compounded by the variability in
fitness professional roles and associated education and training, as evidenced by the
significant differences between roles for wellness domains within this study sample.
INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 7
Those with multiple roles (n= 85) consistently scored higher across all domains of
wellness, as opposed to those who reported a single industry role (e.g. personal trainer
or group instructor). It is possible that those with multiple roles had been afforded
opportunities for advanced training, increasing the likelihood of specialized certifica-
tions (e.g. health coach) that integrate more holistic approaches. Single certifications
may not provide a comprehensive foundation of wellness and lifestyle change, whereas
fitness professionals who have multiple roles may gather more integrative training
through multiple outlets.
Results also highlight potential differences between academic education and indus-
try-specific training. Based on the current sample, the hypothesis that advanced educa-
tion results in a more integrated approach to wellness promotion was not supported, as
no significant relationships were found across wellness domains based on education
level. Thus, certification-specific training in integrative approaches may be more influ-
ential than formal academic study. Since there is no minimum formal education
expectation for the majority of fitness professional roles, the responsibility for prepara-
tion in wellness promotion among professionals falls on certifying organizations and
industry leaders.
It is clear from the results related to promoting domains of wellness beyond the
physical, that the training related to multidimensional wellness is inadequate, particu-
larly among individual certification holders. Re-conceptualizing health as a construct
that promotes understanding of the integrated relationships between wellness domains,
as well as the influence of social, spiritual, intellectual and emotional well-being on
physical health, may lead to improved training opportunities for industry professionals.
Thus, more wellness-focused training should be integrated across certifications to
increase accessibility and consistency. For example, those pursuing a personal trainer
certification should have access to information and training on multidimensional well-
ness promotion without having to assume multiple roles and/or certifications.
Additionally, increased continuing education courses and workshops focused on multi-
dimensional wellness promotion, as well as ‘specialization’certificates, could provide
opportunities for professional growth in this area.
Gender
Additional inquiry should be directed toward gender differences in conceptualizations
and promotion of wellness. Although no significant differences were found in education
or role based on gender in this sample, results indicate that female health and fitness
professionals tend to address wellness across domains (beyond physical) more fre-
quently than male professionals. In particular, female professionals were likely to
address emotional wellness significantly more than their male counterparts. This is
consistent with previous research which has found that ‘emotion work’, which involves
promoting the emotional well-being of others, is typically exhibited more often by
women than men (Eichler and Albanese 2007). Furthermore, there seems to be a social
understanding that women are more innately skilled at perceiving and attending to
emotions compared to men (Thomeer, Umberson, and Pudrovska 2013). Notably,
Thomeer, Reczek, and Umberson (2015) recently emphasized the importance of study-
ing gender differences regarding emotion work, especially in relation to physical health.
8J. D. BEAUCHEMIN ET AL.
Future research may examine potential differences in training across gender, as well as
role and approach to working with clients. For example, it is possible that female health
professionals take a more holistic approach, incorporate more emotion work into their
practice or have a higher prevalence of roles that currently incorporate emotional and
lifestyle change wellness concepts (e.g. health coach, yoga instructor). Additional
information regarding training and approach related to multidimensional wellness
among female fitness professionals may inform existing discrepancies and future train-
ing that ensures inclusivity and competency across gender.
Limitations
Several study limitations should be addressed. As this study utilized secondary data
from a sample of health and fitness professionals in attendance at conferences specific
to this industry, there is the possibility that results cannot be generalized beyond
participants. Conference attendance may be representative of increased investment
and training, and may not be representative of fitness professionals who do not seek
professional development opportunities. The study was also limited by the cross-
sectional design and convenience sample, since wellness-related constructs were
assessed at one point in time with a population of volunteer participants.
Additionally, although it is possible to operationalize training, knowledge and applica-
tion by industry role and certifying organization, the quality and extent of training
related to multidimensional wellness was not assessed. Thus, a causal relationship
between training and wellness promotion cannot be definitively assumed. Finally,
although findings indicated that industry professionals who identified as having multi-
ple roles were addressing multiple domains of wellness with more frequency than those
with one role, the inability to discern which roles they employ most frequently is
a major limitation. Future study should include modified data collection methods to
facilitate an analysis of primary industry roles.
Conclusion
Fitness professionals are in a unique position to support clients in not only improving
their physical health, but in developing strategies to improve multiple facets of their
lives. This study demonstrates a continued emphasis on physical wellness among fitness
professionals, and the lack of attention given to other wellness domains within the
health and fitness industry such as spiritual and intellectual wellness. Furthermore, the
results of the current study highlight discrepancies in wellness promotion based on
gender and industry role. The finding that professionals with multiple industry roles
address multidimensional wellness domains with greater frequency than those with
a single role may indicate that with increased roles or certifications, comes more
wellness-related training opportunities. In addition, the lack of relationship between
education level and wellness promotion seems to indicate that training and experience
based on multiple industry roles is more impactful than formal education (i.e. degree
level) in promoting domains of wellness. Training opportunities that emphasize well-
ness promotion for health and fitness professionals regardless of industry role are
INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 9
essential to supporting the shifting paradigm, and ultimately supporting clients in
moving toward optimal wellness across multiple interrelated domains.
The other finding of interest, that women were more likely to address emotional
wellness than men, indicates a need for examining the training experiences in this arena
with consideration of gender-related factors. Given the impact emotional states can
have on physical well-being, this gender discrepancy may require intentional efforts to
ensure inclusivity and address competency issues across training opportunities.
Ultimately, this study provides evidence of a continued lack of emphasis on the multi-
dimensional nature of wellness by industry professionals across roles, education, gen-
der, certification type and age. Despite the increased understanding and acceptance of
the multidimensional wellness model and the potential impact of wellness domains
such as emotional and spiritual on physical health, there appears to be a need for
increased training specific to these domains within the health and fitness industry. In
order to truly promote wellness as a multidimensional construct and foster healthy
lifestyle trends, more empirical and practical attention is needed in this regard.
Disclosure statement
No potential conflict of interest was reported by the authors.
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INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 11
Appendix
(1) Demographic information:
(2) How would you describe your role in the health and fitness industry? (may check more
than one)
□Personal Trainer
□Group Instructor
□Health Coach
□Strength & Conditioning Coach
□Educator
□Club Manager / Owner
□Sports Coach
□Researcher
□Other
(3) What is your current certification(s) affiliation?
□American Council on Exercise (ACE)
□American College of Sports Medicine (ACSM)
□National Academy of Sports Medicine (NASM)
□National Strength and Conditioning Association (NSCA)
□International Sports Sciences Association (ISSA)
□International Health, Racquet & Sportsclub Association (IHRSA)
□Other
(4) How frequently do you discuss physical wellness with clients?
(5) How frequently do you discuss social wellness with clients?
(6) How frequently do you discuss spiritual wellness with clients?
(7) How frequently do you discuss emotional wellness with clients?
Gender
□M
□F
Age
□20–29
□30–39
□40–49
□50–59
□60+
Education
□H.S.
□Bachelor Degree
□Master Degree
□Doctoral Degree
12 345
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Never Almost Never Sometimes Often Very Often
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12 J. D. BEAUCHEMIN ET AL.
(8) How frequently do you discuss intellectual wellness with clients?
(9) How frequently do you discuss lifestyle change with clients?
12 345
Never Almost Never Sometimes Often Very Often
12 345
Never Almost Never Sometimes Often Very Often
INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 13
... The first prism refracts cognition into embodied, embedded, enactive, and extended [83]. The second prism refracts well-being into social, physical, emotional, cognitive, lifestyle, and spiritual [84]. The final prism refracts intrinsic motivation into competence, usefulness, tension reversed, relatedness, importance, choice, and enjoyment [41,85]. ...
... Lifestyle wellness is defined as "establishing healthy behaviors to improve multiple domains of wellness that result in wellness promotion and ultimately decreased chronic illness and death" [84] risk of heart disease [101]. Lower levels of interleukin-6 were associated with awe more than other positive emotions, including amusement, contentment, and joy. ...
Prisms of Neuroscience: Frameworks for Thinking About Educational Gamification
Article
Full-text available
  • Mar 2023
The mind, brain, body, and environment are inextricably interconnected. In the field of education, this neuropsychologically-backed claim suggests that to optimize learners’ (1) educational experiences, (2) retention of knowledge, and (3) creative use and application of knowledge beyond the classroom walls, teaching practices in all content areas must align with all parts of what makes us human. Unlike hardwired computers, our neuroplastic brains change with environmental interactions via our bodies. This article examines technology as an extension of cognition, where gamification emerges as a fundamental rather than supplemental tool for educators to co-construct knowledge with students. Gamification supports student learning and holistic well-being when considering affective, social, and motoric entanglements with cognitive processes. This article creatively employs five neuroscientific “prisms” to support and explain this humanistic claim. When synthesized, these refracted dimensions provide a framework for thinking about how, why, and when gamification functions as a valuable 21st-century educational tool.
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... In recent years, the link between this sector and the sport industry has been reinforced (Ratten 2018). Indeed, the very idea of physical fitness is currently experiencing a pivotal moment in the sportification of the most developed societies (Beauchemin et al. 2019;García-Fernández et al. 2018;Nash 2018). As the wellness promotion and interest in physical activity and fitness have grown, the entire fitness industry has also grown tremendously (Andreasson and Johansson 2014;Weiner 2017). ...
... However, this outlook has changed in recent times and, currently, it may be said that the contemporary West have vigorously re-embraced the equation of fitness with religion/spirituality (Deardorff II and White 2008;Worthington and Deuster 2018;Yi and Silver 2015). One of the main drivers of this shift has been the changing paradigm in both health and wellness, which has added other domains to physical exercise that is opening new avenues for incorporating religious and spiritual elements in the fitness sector (Beauchemin et al. 2019;Miragaia and Constantino 2019). Slow fitness is a good example of fitness activities related somewhat to religious faith or mystic experiences (Greenwood and Delgado 2013;Kercher 2018;Powers and Greenwell 2017). ...
Looking for God, meaning, physical fitness and beyond: the religious and spiritual space in sport entrepreneurship
Article
Full-text available
  • Sep 2020
  • Int Enterpren Manag J
Over the past several years, both academic literature and the popular press have heralded a renewed interest in religion and spirituality in both entrepreneurship and sport disciplines. The search for God, meaning, and other expressions of religiosity and spirituality tends to appear embedded in a wider variety of cultural forms in the Western world, including enterprise and sport cultures. Notwithstanding the increasing awareness of the mutual impacts of religion and spirituality in the entrepreneurship and sports academic fields, attention to these topics is lacking within the sport entrepreneurship literature. In this conceptual paper, sport entrepreneurship is re-thought from its religious and spiritual dimensions, paying special attention to the fitness sector, specifically to activities related to so-called “slow fitness”. Utilizing existential philosophy from Paul Ricoeur as our theoretical framework, we reflect on this part of the fitness industry to understand the religious and spiritual space in sport entrepreneurship. In this sense, the paper provides other elements to introduce into discussions of what defines this emergent academic area.
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... Changes in lifestyle due to trends regaarding a more beautiful appearance, then connecting some extreme sports from the recreational domain with a better social and economic position, as well as the pursuit of a healthier life, are circumstances that affect the growth of the popularity of the sports market. (Batrakoulis, 2019;Beauchemin et al., 2019;Kuipers, 2022;Mutz, Müller, 2021) In addition, the sports market has been expanding towards women in recent decades, both through the aforementioned trends and through their greater participation in professional sports. (Lough, Irwin, 2001;Lacković, Gašparić, 2022) In addition to the women's market segment, there is also a noticeable increase in the presence of children in the sports industry. ...
CORPORATE GOALS OF SPONSORSHIP IN SPORTS
Article
Full-text available
  • Oct 2023
The two-sided focus of sponsorship goals in sports is present due to the existence of two parties in the sponsorship relationship. The buyer of sponsorship and the seller of sponsorship have different goals, but they also have common goals related to the interest to realize the sponsorship according to the plan, as well as to achieve the maximization of the effects of the expectations of both parties. That common interest is of primary nature and leads to partnership. The separate goals of the participating parties are defined in such a way that mutual interest gets fulfilled. The goals of corporate sponsors are determined by motives, and in most cases they are external and opportunistic, that is, commercial. However, the goals can be also internal and altruistic, and as such focused on highlighting other benefits, such as building good relationships with employees and other participants in the value delivery chain that the sponsor promotes, including the public. The analysis that follows is based on literature research and already existing conclusions regarding the nature of goals and motives in sponsorship. The aim of this paper is to verify the existing conclusions of the focus of sponsorship objectives in sports. The content analysis method led to the conclusion that the goals of sponsorship in sports can be defined through the categories of market, society, relationships and clan. This confirms the conclusions of previous research.
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... (697). Within these countries, the publications about healthy lifestyles related to wellbeing with different populations have been potentiated by the governments and institutions to decrease chronic illness and improve patients' health [53,58,59]. In the case of the US, the increase of publications about healthy lifestyles and wellbeing might be linked to the growth in environmental, social, and corporate governance performance arising since 2004 regarding food consumption and production [46]. ...
The importance of healthy lifestyles in helping achieving wellbeing
Chapter
  • Jan 2022
Individual habits, behaviors or conducts have been linked to health and illness since ancient times. A clear example would be the humans’ ability to integrate previously unknown products into our body that were later incorporated as eating habits, such as grains. In the case of grains, they have become the main energy source, unchanged in the last millennium, helping human beings to keep a healthy metabolic balance. However, because of the change in food production and mobility, the healthy metabolic balance has been modified, resulting in diverse diseases, such as cardiometabolic syndromes. In the case of grains, they have become the main energy source, unchanged in the last millennium, helping human beings to keep a healthy metabolic balance. However, because of the change in food production and mobility, the healthy metabolic balance has been modified, resulting in diverse diseases, such as cardiometabolic syndromes. In this chapter, the relationship between a healthy lifestyle and adequate balance has been analyzed, as well as the negative effects on health and wellbeing (for instance, obesity). Based on that, with the progress of time and scientific proof of the risk of unhealthy lifestyles, researchers and governments have promoted healthy lifestyles, basing on lowing the risk of having a chronic disease. This healthy lifestyle should include a familiar and social structure for the promotion and maintenance of positive behavior. In this sense, the main pillar is maternal health since maternal habits have repercussions on the health of the children. An important tool to understand what the latest publications have focused on and the tendency of researchers is the bibliometric study. Moreover, this type of analysis is a complementary tool that allows measuring the quality of the last scientific knowledge and the impact on the health of the population. Bibliometric studies provide a wider perspective of the scientific data since both national and international researchers are studied. From the previous data, it could be concluded that healthy lifestyles may be linked to the decrease of multiple diseases and prevention of risky behaviors from mental health to determine fertility. This topic of the study showed the link between healthy lifestyles related to age, pregnancy, public health, social behavior, and organization and management. In this sense, out of the 15,306 documents found, 1,550 were related to pregnancy, and 867 focused on fertility, reflecting the relationship of the pregnancy with public health, organization, and management or age of the population. Other results also showed a connection between lifestyles and mental health, especially including the quality of life of aged adults and the role of exercise. Finally, another result proved that child welfare is connected to the relation of family and the consumption of substances or unhealthy diets. In general, therefore, it seems that the relationship between healthy lifestyles and wellbeing, especially focused on women and pregnancy, continues growing to understand, determine factors connected to chronic disease, and trying to decrease these. All being said, these findings have significant implications for the understanding of how the future of healthcare may lead to the role of lifestyle in the wellbeing of education and communication with patients.
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... Fitness lowers the risk of heart disease, stroke and depression (Achen, 2020). Therefore, fitness is considered as a promoter to help individuals improve health and rebuild themselves (Beauchemin et al., 2019). It has become a new trend in contemporary society and the focus of scholars. ...
From appearance comparison to fitness intention: mediating roles of appearance-based exercise motivation and perceived behavioral control
Article
  • Oct 2021
  • Asia Pac J Market Logist
Purpose This study aims to explore the influence of appearance comparison on fitness intention. Specifically, it analyzes the mediating effect of appearance-based exercise motivation and perceived behavioral control between appearance comparison and fitness intention. Design/methodology/approach 434 samples were obtained by the network survey in China. Hierarchical regression analysis and the Hayes' SPSS PROCESS macro were used to verify the hypotheses. Findings Appearance comparison has a positive influence on fitness intention. Appearance-based exercise motivation mediates appearance comparison and fitness intention. Appearance comparison can produce a positive effect on fitness intention via appearance-based exercise motivation and perceived behavioral control in sequence. Practical implications The findings have some practical implications for both individuals and fitness center managers. First, people can view appearance comparison rationally, understand the process of its transformation into fitness intention and enhance fitness intention. Second, fitness center managers can make some reasonable marketing plans according to this study. Originality/value This study explores the positive effects of appearance comparison combining social comparison theory, social cognitive theory and the theory of planned behavior. It contributes to extant literatures about appearance comparison and fitness intention by promoting the understanding of the influence mechanism of fitness intention.
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... Wellness tourists are considered active health seekers who are determined to play a role in maintaining their health (Smith & Kelly, 2006). Wellness is multidimensional consisting of physical wellness, emotional wellness, social wellness, intellectual wellness, and spiritual wellness (Beauchemin et al., 2018). ...
Impact of COVID-19 on wellness and spa industry
Article
  • Oct 2021
The world is facing a global pandemic of COVID-19, a humanitarian crisis that has brought the whole socio-economic structure to a dead end. It has challenged the entire health system. The pandemic has affected almost all industries, few industries have fallen whereas numerous remain unscathed and registered promising growth. The tourism industry is the worst affected among the others as it is an important source of employment and income for both developed and developing countries [UNWTO, 2020b UNWTO. (2020b, March 24). Impact assessment of COVID-19 outbreak on international tourism. https://webunwto.s3.eu-west-1.amazonaws.com/s3fs-public/2020-03/24-03Coronavirus.pdf [Google Scholar]] . The COVID-19 has raised awareness among people about the importance of health and wellness but at the same time pandemic caused shutdown of spas and wellness centres leading to unemployment. The whole population is living in fear of death and illness , losing jobs, falling economy, and livelihood. In the phase of such challenging times, wellness and health become the most important than ever before. In this study, we aim to assess and discuss the impact of the COVID-19 on wellnessand spa industry. . The secondary research was adopted in which data was drawn from various databases using relevant keywords. There is sufficient evidence to confirm that the COVID-19 pandemic has deleterious as well as beneficial effects on the wellness and spa industry.
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... Fitness entrepreneurs appear associated to a sense of self where their work seems disengaged from the restrictions and limitations normally enforced in the ordinary economic life. Besides, their creative approach is also notable for how it establishes freedom and playfulness as inextricable intertwined (e.g., Beauchemin, Gabana, Ketelsen, & McGrath, 2019;Wang et al., 2018;Worthington & Deuster, 2018). Fitness entrepreneurs begin with the ludiclooking for funny, odditiespersonalizing situations that they encounter and infusing them with positive affect. ...
More than a New Business: A Theology of Play for Sport Entrepreneurship
Chapter
  • Aug 2020
Within entrepreneurship literature, the conventional approaches inspired by Schumpeter’s “creative destruction” have largely emphasized the role of human cognitive processes to come up with new business ideas. In contemporary studies, however, there is a recent research stream wherein creativity is aestheticized. As a research line of the aesthetic approach, there is an increasing interest for playfulness and other signals of enjoyment that can also stimulate the entrepreneur’s creative acts. This chapter is a reflexion about the liberating and creative role of play in the context of sport entrepreneurship, particularly, in the fitness industry. It aspires to give to the recent development of the sport entrepreneurship field a novel twist by relating it to a theology of play. Drawing on the work of one of the most influential twentieth-century theologians who has approached play theology, Hugo Rahner, we present how its theological approach may be used to widen our understanding of sport entrepreneurship. This theological perspective allows us to develop alternative thoughts based on concepts that transcend the typical rationalist business approach and its instrumental language. https://www-emerald-com.libproxy.viko.lt/insight/content/doi/10.1108/978-1-83982-836-220201006/full/html
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... A multidimensional approach to wellness has called for increased attention to spiritual well-being, given its association with improved quality of life, coping, and factors related to mental and physical health such as depression and injury rehabilitation (Beauchemin, Gabana, Ketelsen, & McGrath, 2019;Wilson, Forchheimer, Heinemann, Warren, & McCullumsmith, 2017). Similarly, sport psychology literature has emphasized the importance of taking a holistic approach to the athlete performer, advocating for an integration of the physical, psychological, social, emotional, and cultural aspects of the individual. ...
Examining the Relationships Between Gratitude and Spiritual and Religious Identification Among Collegiate Athletes
Article
Full-text available
  • Sep 2019
Salient aspects of an athlete’s identity hold implications for how sport psychology practitioners conceptualize and intervene on both the mental health and performance realms of the athlete person. Given that spirituality, religiosity, and gratitude have been associated in previous literature, the current study examined whether athletes differed in dispositional gratitude based on their spiritual and religious identification. Results indicated that among 331 NCAA Division I-III athletes, those who identified as both spiritual and religious scored significantly higher in dispositional gratitude than self-identified spiritual/non-religious and non-spiritual/non-religious athletes. Non-spiritual/non-religious and spiritual/non-religious athletes did not significantly differ in levels of gratitude. Findings and limitations of the current study warrant further investigation on this topic, and recommendations for future research and practice are provided.
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It Really Works! Qualitative Content Analysis of Multilevel Marketing Organizations’ Online Promotional Messaging and Recruitment Strategies
Article
  • Jun 2022
Though controversial due to their similarities to illegal pyramid schemes, multilevel marketing (MLM) companies annually generate billions of dollars and recruit millions of people, particularly women. The purpose of the present study is to assess how three major MLMs—It Works!, Young Living, and Younique—situate themselves online. We engage in a qualitative content analysis of these companies’ Web sites (including the language, visuals, and site navigation) to identify notable themes that emerge from online recruitment efforts. The analysis draws upon theoretical frameworks related to feminism, faith, and commodity activism as they intersect with neoliberal capitalism. The application of critiques of neoliberal feminism and commodity activism to an ignored but significant corner of modern capitalism shapes the development of a coding schema that unlocks a deeper understanding of how women are targeted by MLM promotional messaging.
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Assessment of the relationship of spiritual well-being to depression and quality of life for persons with spinal cord injury
Article
Full-text available
Objective: This study sought to describe the association between spiritual well-being, demographic characteristics, quality of life (QOL) and depressive symptoms following spinal cord injury (SCI). We hypothesized QOL and depressed mood would both be explained by extent of spiritual well-being, and meaning-focused (M&P) spirituality would have a stronger impact than faith-focused spirituality. Methods: 210 individuals with SCI were screened as part of a randomized control trial of venlafaxine XR for major depressive disorder (MDD). 204 completed all measures: Patient Health Questionniare-9 (PHQ-9) assessed depression, the FACIT-Sp assessed spiritual well-being, the Neuro-QOL PAWB scale assessed QOL, and the PANAS assessed affect. Results: Approximately 26% had major depression. Bivariate correlations of scores on PAWB and PANAS and FACIT-Sp showed that all four scales had strong associations with those on PAWB (p < 0.0005). As hypothesized, both the M&P and Faith scales of the FACIT-Sp were significant predictors of QOL (β = 0.544; p < 0.0005 and β = 0.151; p = 0.004), though only the M&P scale was an independently significant predictor of likely MDD. Conclusion: The findings support that spirituality, as measured by the FACIT-Sp, is strongly associated with QOL and likelihood of MDD. Assessment of spirituality should be included along with more traditional psychological measurements to better inform treatment. Implications for Rehabilitation Spiritual beliefs can contribute to quality of life and may help moderate depressive symptoms that accompany chronic illness and disability, suggesting that rehabilitation professionals should address spirituality in working with their patients with spinal cord injury (SCI). While spiritual issues are often deferred to pastoral counselors during hospitalization, it is clear that addressing these is not the domain of one discipline and does not end upon inpatient discharge. In addressing spirituality, clinicians should tap the spiritual strengths present in their clients, whether meaning/peace-focused or religious, understanding that spirituality involves more than religiosity and also that having a sense of meaning and peace appears to be of great importance.
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Human and Social Capital Development for Self Efficacy of University Graduates: Bases for Development of Society
Article
Full-text available
  • Aug 2011
The study investigated perceptions of students and employers about the development of human and social capital in terms of intellectual development skills, personal development skills, professional development skills, and social development skills for self efficacy of university graduates. How students and employers were viewing the development of human and social capital for self efficacy of university graduates; which areas of development skills were relatively stronger; and which sectors of industry or discipline of study were more satisfied or worried about were the questions answered in the study. Students of 4 public and 4 private universities and managers of 65 companies from 12 sectors of industry listed with Lahore Stock Exchange constituted the sample. Data were collected through an adopted, 30-item survey scale which was found reliable at 0.930 Cronbach's alpha. Mean scores and correlations were calculated for the four sub-scales. One-Sample t-test, Independent samples t-test, and one-way ANOA were employed for significance and variance analysis. The study concluded that students and employers were not fully satisfied with the development of human and social capital for self efficacy of university graduates. Intellectual development skills got the highest position whereas personal development skills were found at the lowest position. Professional and social development skills were found in the middle. This situation reflects performance of universities below standards and speaks of under utilization of their potential for contributing to the development of society. Serious initiative for the development of human and social capital for self efficacy of university graduates was the major recommendation.
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The Theory of Planned Behavior
Article
Full-text available
  • Dec 1991
Research dealing with various aspects of* the theory of planned behavior (Ajzen, 1985, 1987) is reviewed, and some unresolved issues are discussed. In broad terms, the theory is found to be well supported by empirical evidence. Intentions to perform behaviors of different kinds can be predicted with high accuracy from attitudes toward the behavior, subjective norms, and perceived behavioral control; and these intentions, together with perceptions of behavioral control, account for considerable variance in actual behavior. Attitudes, subjective norms, and perceived behavioral control are shown to be related to appropriate sets of salient behavioral, normative, and control beliefs about the behavior, but the exact nature of these relations is still uncertain. Expectancy— value formulations are found to be only partly successful in dealing with these relations. Optimal rescaling of expectancy and value measures is offered as a means of dealing with measurement limitations. Finally, inclusion of past behavior in the prediction equation is shown to provide a means of testing the theory*s sufficiency, another issue that remains unresolved. The limited available evidence concerning this question shows that the theory is predicting behavior quite well in comparison to the ceiling imposed by behavioral reliability.
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Solution Focused Coaching in Practice
Book
Full-text available
  • May 2012
Solution Focused Coaching in Practice is a practical ‘how-to’ guide that provides an invaluable overview of Solution Focused Coaching skills and techniques. Reflecting upon published research on the solution focused approach, Bill O’Connell, Stephen Palmer and Helen Williams bring their own experiences of Solution Focused Coaching together with others in the field to cover topics such as: the coach-coachee relationship the role of technology in coaching inclusive coaching group and team coaching practical issues and skills. Incorporating coachee case studies, worksheets, practice tips and discussion points, the skills, strategies and techniques in this book are straightforward to apply and can be used in most coaching settings. This practical book is essential reading for experienced personal or executive coaches, managers considering introducing a new and better coaching culture for their staff, and for those just starting out on their coaching journey. Details: https://www.routledge.com/Solution-Focused-Coaching-in-Practice/OConnell-Palmer-Williams/p/book/9780415447072
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The Indivisible Self: An Evidence-Based Model of Wellness
Article
Full-text available
  • Jan 2004
  • J Indiv Psychol
The Indivisible Self, an evidence-based model of wellness, emerged from factor analytic studies based on an earlier wellness model, the Wheel of Wellness. Both models use Individual Psychology as an organizing theory; however, the current model exemplifies holism as the foundation of human wellness. In this article, the Indivisible Self model is described, and implications for counseling and needed research are provided. Article: Wellness has been defined as a new paradigm in health care (Larson, 1999), as a strengths-based approach to mental health care (Smith, 2001), and as the paradigm for counseling and development (Myers, 1992). Over the past two decades, a variety of models of wellness have been proposed, the earliest ones being based in the physical health professions (e.g., Ardell, 1977; Hettler, 1984) and the most recent reflecting correlates of psychological well-being identified through the positive psychology movement (Seligman, 2002; Snyder & Lopez, 2001). Only one current model is based in counseling theory, that being the Wheel of Wellness, first introduced in the early 1990s (Sweeney & Witmer, 1991; Witmer & Sweeney, 1992) and later modified to incorporate new findings relative to issues of diversity . and self-direction (Myers, Sweeney, & Witmer, 2000). As was true of earlier models, the Wheel model evolved from an examination of the existing knowledge base relative to components of wellness. It is unique in that Individual Psychology (Adler, 1927/1954) provides the unifying theme for organizing and explaining the components of well being. Each of the models mentioned above has served as a foundation for assessment; however, assessment information has seldom been the basis for examining and changing the theories and models. For example, factor analyses of the Lifestyle Assessment Questionnaire (LAQ; National Wellness Institute, 1980), based on Hettler's hexagon model of wellness, failed to support the six subscales of the instrument. Instead, a two-factor structure defined as "behavioral wellness and cognitive wellness" was identified (Cooper, 1990, p. 86). To date, Cooper's findings have not been integrated to create changes in the original model or revisions in the LAQ. In contrast, Sexton (2001) cogently argued the need for evidence-based models to inform clinical practice. From this perspective, theoretical models require empirical testing and validation. When findings fail to support the models, new models must be created and further examined.
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Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States
Article
  • Mar 2017
Importance In the United States, national associations of individual dietary factors with specific cardiometabolic diseases are not well established. Objective To estimate associations of intake of 10 specific dietary factors with mortality due to heart disease, stroke, and type 2 diabetes (cardiometabolic mortality) among US adults. Design, Setting, and Participants A comparative risk assessment model incorporated data and corresponding uncertainty on population demographics and dietary habits from National Health and Nutrition Examination Surveys (1999-2002: n = 8104; 2009-2012: n = 8516); estimated associations of diet and disease from meta-analyses of prospective studies and clinical trials with validity analyses to assess potential bias; and estimated disease-specific national mortality from the National Center for Health Statistics. Exposures Consumption of 10 foods/nutrients associated with cardiometabolic diseases: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), polyunsaturated fats, seafood omega-3 fats, and sodium. Main Outcomes and Measures Estimated absolute and percentage mortality due to heart disease, stroke, and type 2 diabetes in 2012. Disease-specific and demographic-specific (age, sex, race, and education) mortality and trends between 2002 and 2012 were also evaluated. Results In 2012, 702 308 cardiometabolic deaths occurred in US adults, including 506 100 from heart disease (371 266 coronary heart disease, 35 019 hypertensive heart disease, and 99 815 other cardiovascular disease), 128 294 from stroke (16 125 ischemic, 32 591 hemorrhagic, and 79 578 other), and 67 914 from type 2 diabetes. Of these, an estimated 318 656 (95% uncertainty interval [UI], 306 064-329 755; 45.4%) cardiometabolic deaths per year were associated with suboptimal intakes—48.6% (95% UI, 46.2%-50.9%) of cardiometabolic deaths in men and 41.8% (95% UI, 39.3%-44.2%) in women; 64.2% (95% UI, 60.6%-67.9%) at younger ages (25-34 years) and 35.7% (95% UI, 33.1%-38.1%) at older ages (≥75 years); 53.1% (95% UI, 51.6%-54.8%) among blacks, 50.0% (95% UI, 48.2%-51.8%) among Hispanics, and 42.8% (95% UI, 40.9%-44.5%) among whites; and 46.8% (95% UI, 44.9%-48.7%) among lower-, 45.7% (95% UI, 44.2%-47.4%) among medium-, and 39.1% (95% UI, 37.2%-41.2%) among higher-educated individuals. The largest numbers of estimated diet-related cardiometabolic deaths were related to high sodium (66 508 deaths in 2012; 9.5% of all cardiometabolic deaths), low nuts/seeds (59 374; 8.5%), high processed meats (57 766; 8.2%), low seafood omega-3 fats (54 626; 7.8%), low vegetables (53 410; 7.6%), low fruits (52 547; 7.5%), and high SSBs (51 694; 7.4%). Between 2002 and 2012, population-adjusted US cardiometabolic deaths per year decreased by 26.5%. The greatest decline was associated with insufficient polyunsaturated fats (−20.8% relative change [95% UI, −18.5% to −22.8%]), nuts/seeds (−18.0% [95% UI, −14.6% to −21.0%]), and excess SSBs (−14.5% [95% UI, −12.0% to −16.9%]). The greatest increase was associated with unprocessed red meats (+14.4% [95% UI, 9.1%-19.5%]). Conclusions and Relevance Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.
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Replacing Sedentary Time with Physical Activity in Relation to Mortality
Article
  • Feb 2016
  • MED SCI SPORT EXER
Introduction: Data evaluating mortality benefit from replacing sedentary time with physical activity are sparse. We explored reallocating time spent in sedentary behavior to physical activity of different intensities in relation to mortality risk. Methods: Women and men aged 50-85 years from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2005-2006 cycles with follow-up through December 31, 2011 were included. Sedentary time and physical activity were assessed using an ActiGraph accelerometer. Isotemporal substitution models were used to estimate the effect of replacing one activity behavior with another activity behavior for the same amount of time while holding total accelerometer wear time constant. Results: During a mean follow-up of 6.35 years, 697 deaths from any cause occurred. Replacing 30 minutes of sedentary time with an equal amount of light activity was associated with 14% reduced risk of mortality (multivariable-adjusted hazard ratio (HR)=0.86, 95% confidence interval (CI)=0.83-0.90). Replacement of sedentary time with moderate to vigorous activity was related to 50% mortality risk reduction (HR=0.50, 95% CI=0.31-0.80). We also noted a 42% reduced risk of mortality when light physical activity was replaced by moderate to vigorous activity (HR=0.58, 95% CI=0.36-0.93). Conclusion: Replacing sedentary time with an equal amount of physical activity may protect against preterm mortality. Replacement of light physical activity with moderate to vigorous activity is also associated with protection from premature mortality.
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Management of obesity: Improvement of health-care training and systems for prevention and care
Article
  • Feb 2015
Although the caloric deficits achieved by increased awareness, policy, and environmental approaches have begun to achieve reductions in the prevalence of obesity in some countries, these approaches are insufficient to achieve weight loss in patients with severe obesity. Because the prevalence of obesity poses an enormous clinical burden, innovative treatment and care-delivery strategies are needed. Nonetheless, health professionals are poorly prepared to address obesity. In addition to biases and unfounded assumptions about patients with obesity, absence of training in behaviour-change strategies and scarce experience working within interprofessional teams impairs care of patients with obesity. Modalities available for the treatment of adult obesity include clinical counselling focused on diet, physical activity, and behaviour change, pharmacotherapy, and bariatric surgery. Few options, few published reports of treatment, and no large randomised trials are available for paediatric patients. Improved care for patients with obesity will need alignment of the intensity of therapy with the severity of disease and integration of therapy with environmental changes that reinforce clinical strategies. New treatment strategies, such as the use of technology and innovative means of health-care delivery that rely on health professionals other than physicians, represent promising options, particularly for patients with overweight and patients with mild to moderate obesity. The co-occurrence of undernutrition and obesity in low-income and middle-income countries poses unique challenges that might not be amenable to the same strategies as those that can be used in high-income countries. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Marital Processes around Depression: A Gendered and Relational Perspective
Article
  • Oct 2013
Despite extensive evidence of the importance of marriage and marital processes for mental health, little is known about the interpersonal processes around depression within marriage and the extent to which these processes are gendered. We use a mixed methods approach to explore the importance of gender in shaping processes around depression within marriage; we approach this in two ways. First, using quantitative longitudinal analysis of 2,601 couples from the Health and Retirement Study (HRS), we address whether depressive symptoms in one spouse shape the other spouse's depressive symptoms and whether men or women are more influential in this process. We find that a wife's depressive symptoms influence her husband's future depressive symptoms but a husband's depressive symptoms do not influence his wife's future symptoms. Second, we conduct a qualitative analysis of in-depth interviews with 29 couples wherein one or both spouses experienced depression to provide additional insight into how gender impacts depression and reactions to depression within marriage. Our study points to the importance of cultural scripts of masculinity and femininity in shaping depression and emotional processes within marriage and highlights the importance of applying a gendered couple-level approach to better understand the mental health effects of marital processes.
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Gendered emotion work around physical health problems in mid- and later-life marriages
Article
  • Jan 2015
  • J AGING STUD
The provision and receipt of emotion work—defined as intentional activities done to promote another's emotional well-being—are central dimensions of marriage. However, emotion work in response to physical health problems is a largely unexplored, yet likely important, aspect of the marital experience. We analyze dyadic in-depth interviews with husbands and wives in 21 mid- to later-life couples to examine the ways that health-impaired people and their spouses provide, interpret, and explain emotion work. Because physical health problems, emotion work, and marital dynamics are gendered, we consider how these processes differ for women and men. We find that wives provide emotion work regardless of their own health status. Husbands provide emotion work less consistently, typically only when the husbands see themselves as their wife's primary source of stability or when the husbands view their marriage as balanced. Notions of traditional masculinity preclude some husbands from providing emotion work even when their wife is health-impaired. This study articulates emotion work around physical health problems as one factor that sustains and exacerbates gender inequalities in marriage with implications for emotional and physical well-being.
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