Concepts of Fitness And Wellness

Concepts of Fitness & Wellness A Comprehensive Lifestyle Approach ELEVENTH EDITION Charles B. Corbin Arizona State University Gregory J. Welk Iowa State University William R. Corbin Arizona State University Karen A. Welk Mary Greeley Medical Center, Ames, Iowa

CONCEPTS OF FITNESS AND WELLNESS: A COMPREHENSIVE LIFESTYLE APPROACH, ELEVENTH EDITION Published by McGraw-Hill, a business unit of The McGraw-Hill Companies, Inc., 1221 Avenue of the Americas, New York, NY, 10020. Copyright © 2016 by The McGraw-Hill Companies, Inc. All rights reserved. Printed in the United States of America. Previous editions © 2013, 2011, 2009. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written consent of The McGraw-Hill Companies, Inc., including, but not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning. Some ancillaries, including electronic and print components, may not be available to customers outside the United States. This book is printed on acid-free paper. 1 2 3 4 5 6 7 8 9 0 RMN/RMN 1 0 9 8 7 6 ISBN 978-007-352348-4 MHID 0-07-352348-8 Senior Vice President, Products & Markets: Kurt L. Strand Vice President, General Manager: Mike Ryan Vice President, Content, Design and Delivery: Kimberly Meriwether David Managing Director: Gina Boedeker Brand Manager: Courtney Austermehle Director, Product Development: Meghan Campbell Lead Product Developer: Rhona Robbin Senior Product Developer: Kirstan Price Editorial Coordinator: Diane Grayson Product Developer: Vicki Malinee, Van Brien & Associates Director of Digital Content Development: Andrea Pasquarelli Executive Marketing Manager: April Cole Marketing Manager: Phil Weaver Director, Content Design & Delivery: Terri Schiesl Program Manager: Marianne Musni Content Project Managers: Rick Hecker, Katie Klochan, Judi David Buyer: Sandy Ludovissy Designer: Debra Kubiak Cover/Interior Designer: Debra Kubiak Cover Image: OSTILL/Getty Images (both photos) Photo Researcher: David Tietz/Editorial Image, LLC Compositor: SPi Global Printer: R.R. Donnelley Menasha All credits appearing at the end of the book are considered to be an extension of the copyright page. Library of Congress Cataloging-in-Publication Data C oncepts of fitness & wellness : a comprehensive lifestyle approach/Charles B. Corbin, Arizona State University, Gregory J. Welk, Iowa State University, William R. Corbin, Arizona State University, Karen A. Welk, Mary Greeley Medical Center, Ames, Iowa. — Eleventh edition.    pages cm   Includes bibliographical references and index.   ISBN 978-0-07-352348-4 (acid-free paper)   1.  Physical fitness.  2.  Exercise.  3.  Health.  I.  Corbin, Charles B.  II.  Title: Concepts of fitness and wellness.   RA781.C644 2015  613.7—dc23 2015024375 The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website does not indicate an endorsement by the authors or McGraw-Hill, and McGraw-Hill does not guarantee the accuracy of the information presented at these sites. www.mhhe.com

Brief Contents Section I 15 Nutrition  307 16 Managing Diet and Activity for Healthy Body Lifestyles for Health, Wellness, and Fitness  1 Fatness  331 1 Health, Wellness, Fitness, and Healthy Lifestyles: Section VI An Introduction  1 Stress Management  345 2 Determinants of Lifelong Health, Wellness, and Fitness  15 17 Stress and Health  345 18 S tress Management, Relaxation, and Time 3 Self-Management and Self-Planning Skills for Health Behavior Change  27 Management  359 Section II Section VII An Introduction to Physical Activity  45 Avoiding Destructive Behaviors  379 4 Preparing for Physical Activity  45 19 The Use and Abuse of Tobacco  379 5 The Health Benefits of Physical Activity  65 2 0 The Use and Abuse of Alcohol  391 6 How Much Physical Activity Is Enough?  83 21 The Use and Abuse of Other Drugs  407 2 2 Preventing Sexually Transmitted Infections  421 Section III Section VIII The Physical Activity Pyramid  97 Making Informed Choices  435 7 Moving from Inactivity to Moderate-Intensity Active Lifestyles  97 2 3 C ancer, Diabetes, and Other Health Threats  435 8 Cardiorespiratory Endurance  113 9 Vigorous Aerobics, Sports, and Recreational 24 E valuating Fitness and Wellness Products: Becoming an Informed Consumer  455 Activities  135 10 M uscle Fitness and Resistance Exercise  153 25 Toward Optimal Health and Wellness: 11 Flexibility 193 Planning for Healthy Lifestyle Change  471 Section IV Appendixes Physical Activity: Special A Metric Conversion Charts  493 Considerations 217 B Calories of Protein, Carbohydrates, 12 Body Mechanics: Posture, Questionable and Fats in Foods  494 Exercises, and Care of the Back and Neck  217 C Canada's Food Guide to Healthy Eating  496 References  498 13 Performance Benefits of Physical Activity  253 Credits  503 Index  505 Section V iii Nutrition and Body Composition  275 14 Body Composition  275

Contents Preface  xiii 3 Self-Management and Healthy People 2020  xx Self-Planning Skills for Health Behavior Change 27 Section I Lifestyles for Health, Wellness, Making Lifestyle Changes  28 and Fitness  1 Factors That Promote Lifestyle Change  29 Self-Management Skills  34 1 Health, Wellness, Fitness, and Healthy Self-Planning for Healthy Lifestyles  34 Lifestyles: An Introduction  1 Suggested Resources and Readings  39 The HELP Philosophy  2 Lab 3A: Stages of Change National Health Goals  2 and Self-Management Skills  41 Health and Wellness  4 Physical Fitness  6 Section II Suggested Resources and Readings  11 An Introduction to Physical Lab 1A: Wellness Self-Perceptions  13 Activity 45 2 Determinants of Lifelong Health, 4 Preparing for Physical Activity  45 Wellness, and Fitness  15 Factors to Consider Prior Determinants of Health, Wellness, and Fitness  16 to Physical Activity  46 Determinants over Which You Have Little Components of a Typical Bout or Some Control  16 of Physical Activity  48 Determinants over Which You Have Physical Activity in the Greater Control  18 Heat and Cold  50 Suggested Resources and Readings  21 Physical Activity in Other Environments  54 Lab 2A: Healthy Lifestyle Questionnaire  23 Soreness and Injury  54 Attitudes about Physical Activity  56 iv Suggested Resources and Readings  58 Lab 4A: Readiness for Physical Activity  59 Lab 4B: The Warm-Up  61 Lab 4C: Physical Activity Attitude Questionnaire 63 5 The Health Benefits of Physical Activity 65 Physical Activity, Fitness, and Wellness  66 Physical Activity and Hypokinetic Diseases  68 Physical Activity and Cardiovascular Diseases  68 Physical Activity and the Healthy Heart  69 Physical Activity and Atherosclerosis  69

Contents v Physical Activity and Heart Attack  71 Lab 8A: Counting Target Heart Rate and Ratings Physical Activity and Other Cardiovascular of Perceived Exertion  131 Diseases 72 Physical Activity and Metabolic Syndrome  73 Lab 8B: Evaluating Cardiorespiratory Physical Activity and Other Hypokinetic Conditions  74 Endurance 133 Physical Activity as a Treatment  78 Suggested Resources and Readings  80 9 Vigorous Aerobics, Sports, and Recreational Activities  135 Lab 5A: Assessing Heart Disease Risk Factors  81 Physical Activity Pyramid: Steps 2 and 3  136 6 How Much Physical Activity Is Enough? 83 Vigorous Aerobic Activities  138 The Principles of Physical Activity  84 Vigorous Sports and Recreational Activities  142 The FITT Formula  85 The Physical Activity Pyramid  86 Patterns and Trends in Physical Activity Physical Activity Patterns  90 Participation 143 Physical Fitness Standards  91 Suggested Resources and Readings  92 Suggested Resources and Readings  146 Lab 6A: Self-Assessment of Physical Activity  93 Lab 9A: The Physical Activity Adherence Questionnaire 147 Lab 6B: Estimating Your Fitness  95 Lab 9B: Planning and Logging Participation in Section III Vigorous Physical Activity  149 The Physical Activity Pyramid  97 Lab 9C: Combining Moderate and Vigorous 7 Moving from Inactivity to Moderate- Physical Activity  151 Intensity Active Lifestyles  97 10 Muscle Fitness and Resistance Moving from Inactivity to Active Living  98 Exercise 153 The Health and Wellness Benefits of Moderate Physical Activity 100 Factors Influencing Muscle Fitness  154 How Much Moderate Physical Activity Is Enough?  101 Monitoring Physical Activity Behavior  102 Health Benefits of Muscle Fitness Exercise  156 Adopting and Sustaining an Active Identity  106 Suggested Resources and Readings  108 Types of Progressive Resistance Exercise  157 Lab 7A: Setting Goals for Moderate Physical Progressive Resistance Exercise: How Much Is Activity and Self-Monitoring (Logging) Program  109 Enough? 160 Lab 7B: Estimating Sedentary Behavior  111 Resistance Training Equipment  163 8 Cardiorespiratory Endurance  113 Principles of Muscle Fitness Training  165 Elements of Cardiorespiratory Endurance  114 Guidelines for Safe and Effective PRE  167 Cardiorespiratory Endurance and Health Benefits  117 The FIT Formula for Cardiorespiratory Endurance  118 Suggested Resources and Readings  170 Threshold and Target Zones for Intensity of Activity to Build Cardiorespiratory Endurance  120 Lab 10A: Evaluating Muscle Strength: 1RM and Guidelines for Heart Rate and Exercise Monitoring  123 Grip Strength  185 Suggested Resources and Readings  126 Lab 10B: Evaluating Muscular Endurance and Power 187 Lab 10C: Planning and Logging Muscle Fit- ness Exercises: Free Weights or Resistance Machines 189 Lab 10D: Planning and Logging Muscle Fit- ness Exercises: Calisthenics, Core Exercises, or Plyometrics 191 11 Flexibility  193 Factors Influencing Flexibility  194 Health Benefits of Flexibility and Stretching  196 Stretching Methods  197

vi Contents Suggested Resources and Readings  232 How Much Stretch Is Enough?  199 Lab 12A: The Back/Neck Questionnaire and Flexibility-Based Activities  202 Healthy Back Tests  247 Guidelines for Safe and Effective Stretching Exercise 203 Lab 12B: Evaluating Posture  249 Suggested Resources and Readings  205 Lab 12C: Planning and Logging Core and Back Lab 11A: Evaluating Flexibility  213 Exercises 251 Lab 11B: Planning and Logging Stretching Exercises 215 13 Performance Benefits of Physical Activity 253 Section IV Physical Activity: Special High-Level Performance and Training Considerations 217 Characteristics 254 Training for Endurance and Speed  255 12 Body Mechanics: Posture, Questionable Training for Strength and Muscular Endurance  258 Exercises, and Care of the Back and Training for Power  259 Neck 217 Training for Functional Fitness and Flexibility  261 Training for High-Level Performance: Skill-Related Anatomy and Function of the Spine  218 Fitness and Skill  262 Anatomy and Function of the Core Musculature  218 High-Level Performance Training  263 Causes and Consequences of Back and Neck Performance Trends and Ergogenic Aids  264 Pain 220 Suggested Resources and Readings  266 Prevention of and Rehabilitation from Back and Neck Problems 222 Lab 13A: Evaluating Skill-Related Physical Good Posture Is Important for Back and Neck Fitness 271 Health 224 Good Body Mechanics Is Important for Back and Neck Lab 13B: Identifying Symptoms of Health 228 Overtraining 273 Exercise Guidelines for Back and Neck Health  228 Section V Nutrition and Body Composition 275 14 Body Composition  275 Understanding and Interpreting Body Composition Measures 276

Contents vii Methods Used to Assess Body Composition  278 Section VI Health Risks Associated with Obesity  280 Stress Management  345 The Origin of Obesity  282 Treatment and Prevention of Overweight and 17 Stress and Health  345 Obesity 284 Health Risks Associated with Excessively Low Body Sources of Stress  346 Fatness 286 Stress in Contemporary Society  347 Suggested Resources and Readings  288 Reactions to Stress  348 Stress Effects on Health and Wellness  349 Lab 14A: Evaluating Body Composition: Skinfold Individual Differences in the Stress Response  351 Measures 297 Suggested Resources and Readings  354 Lab 17A: Evaluating Your Stress Level  355 Lab 14B: Evaluating Body Composition: Height, Lab 17B: Evaluating Your Hardiness Weight, and Circumference Measures  301 and Locus of Control  357 Lab 14C: Determining Your Daily Energy 18 Stress Management, Relaxation, Expenditure 303 and Time Management  359 15 Nutrition  307 Physical Activity and Stress Management  360 Stress, Sleep, and Recreation  360 Guidelines for Healthy Eating  308 Time Management  362 Dietary Recommendations for Carbohydrates  311 Stress Management  363 Dietary Recommendations for Fat  312 Effective Coping Strategies  365 Dietary Recommendations for Proteins  314 Social Support and Stress Management  370 Dietary Recommendations for Vitamins  316 Suggested Resources and Readings  372 Dietary Recommendations for Minerals  317 Dietary Recommendations for Water and Other Fluids 318 Making Well-Informed Food Choices  319 Sound Eating Practices  320 Nutrition and Physical Performance  321 Suggested Resources and Readings  323 Lab 15A: Nutrition Analysis  325 Lab 15B: Selecting Nutritious Foods  329 16 Managing Diet and Activity for Healthy Body Fatness  331 Factors Influencing Weight and Fat Control  332 Confronting an Obesogenic Environment  334 Guidelines for Losing Body Fat  335 Facts about Fad Diets and Clinical Approaches to Weight Loss  338 Suggested Resources and Readings  340 Lab 16A: Selecting Strategies for Managing Eating 341 Lab 16B: Evaluating Fast Food Options  343

viii Contents Lab 18A:  Time Management  373 Suggested Resources and Readings  432 Lab 18B: Relaxation Exercises  375 Lab 18C: Evaluating Levels of Social Support  377 Lab 22A: Sexually Transmitted Infection Risk Questionnaire 433 Section VII Avoiding Destructive Section VIII Behaviors 379 Making Informed Choices  435 19 The Use and Abuse of Tobacco  379 23 Cancer, Diabetes, and Other Health Threats 435 Tobacco and Nicotine  380 The Health and Economic Costs of Tobacco  380 Cancer 436 The Facts about Tobacco Usage  383 Cancer Prevention  443 Suggested Resources and Readings  388 Diabetes 445 Mental Health  447 Lab 19A: Use and Abuse of Tobacco  389 Injuries and Other Health Threats  447 Suggested Resources and Readings  449 2 0 The Use and Abuse of Alcohol  391 Lab 23A: Determining Your Cancer Risk  451 Alcohol and Alcoholic Beverages  392 Alcohol Consumption and Alcohol Abuse  392 Lab 23B: Breast and Testicular Self-Exams  453 Health and Behavioral Consequences of Alcohol Use 394 24 Evaluating Fitness and Wellness Products: Risk Factors for Alcohol-Related Problems  397 Becoming an Informed Consumer  455 Alcohol Use in Young Adults  398 Effective Approaches for Alcohol Prevention Quacks and Quackery  456 and Treatment  400 Physical Activity Quackery  457 Suggested Resources and Readings  401 Considerations with Exercise Equipment  459 Considerations with Health Clubs and Leaders  460 Lab 20A: Blood Alcohol Level  403 Considerations with Saunas and Tanning Salons  461 Lab 20B: Perceptions about Alcohol Use  405 Body Composition Quackery  462 Nutrition Quackery  462 21 The Use and Abuse of Other Drugs  407 Consumer Protections Against Fraud and Quackery 463 Classification of Illicit and Prescription Drugs  408 Health Literacy and the Internet  465 The Consequences of Drug Use  410 Suggested Resources and Readings  466 Causes of Illicit Drug Abuse  412 Prevalence and Consequences of Illicit Drug Abuse 413 Suggested Resources and Readings  417 Lab 21A: Use and Abuse of Other Drugs  419 22 Preventing Sexually Transmitted Infections 421 General Facts  422 HIV/AIDS 422 Common Sexually Transmitted Infections  426 Factors That Contribute to Sexual Risks  429 Prevention and Early Intervention of STIs  431

Contents ix Lab 24A: Practicing Consumer Skills: Evaluating Lab 25B: Planning for Improved Health, Wellness, Products 467 and Fitness  483 Lab 25C: Planning Your Personal Physical Activity Lab 24B: Evaluating a Health, Wellness, or Fitness Program 485 Club 469 Appendixes 2 5 Toward Optimal Health and Well- ness: Planning for Healthy Lifestyle A Metric Conversion Charts  493 Change 471 B Calories of Protein, Carbohydrates, and Fats Understand Inherited Risks and Strengths  472 in Foods  494 C Canada's Food Guide to Healthy Eating  496 Make Effective Use of Health Care  473 References 498 Consider Environmental Influences on Your Credits 503 Health 475 Index 505 Adopt and Maintain Healthy Lifestyles  476 Importance of Personal Actions and Interactions  477 Suggested Resources and Readings  480 Lab 25A: Assessing Factors That Influence Health, Wellness, and Fitness  481

Features A CLOSER LOOK TECHNOLOGY UPDATE 1: Changing Fitness Terminology  7 1: Health Websites  10 2: Poor Health Status in the United States  18 2: Podcasts 20 3: Blue Zones and Personal Responsibility  30 3: Health Apps  38 4: CPR Guidelines and AEDs  48 4: Sensing Your Personal Health  55 5: 23 and ½ Hours!  79 5: Heart360: Heart Health Monitoring  73 6: The Tabata Workout  90 6: Activity Monitors  89 7: Every Body Walk  106 7: Standing Desks and Treadmill Desks  106 8: Online Fitness Tools and Calculators  121 8: E-bikes 124 9: Fitness and Physical Activity Trends  141 9: Interactive Gaming in Exercise Equipment  140 10: CrossFit Controversy  164 10: Muscle Repair from Stem Cell Therapy  159 11: Potent Health Benefits from Tai Chi  204 11: Software Facilitates Stretching at Work  196 12: Functional Movement Tests  220 12: New Training Aids for Core Training  227 13: Impressions of Compression  265 13: Smart Ball Technology in Sports  254 14: Reporting Obesity Trends  276 14: Saxenda 281 15: Genetically Modified Foods  321 15: Reinventing Veggie Burgers  315 16: Mindless Eating  333 16: Apps for Calorie Tracking  338 17: Toxic Stress from Childhood Experiences  352 17: Effects of Smartphones on Stress and Sleep  350 18: Leisure Time  361 18: Managing Stress  368 19: E-Cigarettes: Smoking Cessation Aid or Gateway to 19: Text Messaging for Smoking Cessation  386 20: Alcohol-Sensing Lasers  397 Smoking? 384 21: Nasal Spray May Help Save Heroin Addicts  416 20: Impaired Driving and Traffic Fatalities  396 22: “Hook-Up” Apps May Contribute to STIs  430 21: Public Health Implications of Marijuana 23: Smart Contact Lenses  446 24: Paid Testimonials  465 Decriminalization 411 25: Genetic Testing  473 22: HIV Prevention Drugs: Benefits and Risks  424 23: Tanning Beds  442 24: Buyer Be Very Aware  464 25: Healthy Eating Index  476 In the News 13: Extreme Exercise  258 14: Treating Obesity  282 1: Healthiest Places to Live  4 15: Reading the Label  319 2: The Built Environment 16: Best Weight Loss Regimens  339 17: Mental Health of Returning Veterans  350 and Obesity  19 18: Social Networking for Social Support  370 3: Myths and Medical Conspiracy Theories  29 19: Smoking Cessation  386 4: Extreme Exercise and the Heart  55 20: Are the Health Benefits of Alcohol Exaggerated?  395 5: Diabetes Epidemic  75 21: New Federal Regulations Designed to Decrease 6: Employer Fitness Programming Through the Affordable Misuse of Prescription Narcotics  416 Care Act  85 22: “Yes Means Yes”  430 7: Smart Phone Apps for Self-Monitoring  105 23: Do Antibacterial Soaps Really Work?  438 8: Running for Your Health  124 24: Exaggerated Health Claims on Shoes  458 9: Cross Training  140 25: Health Insurance  474 10: Warnings about Muscle Building Supplements  169 11: Yoga as a Complementary Health Approach  197 12: “Sitting Is the New Smoking”  231 x

Lab Activities All end-of-concept Lab Activities are available in Connect and can be edited, assigned, completed, submitted, and graded online. Rev.Confirming Pages Lab 1A Wellness Self-Perceptions  13 Lab 1A Wellness Self-Perceptions Lab 2A Healthy Lifestyle Questionnaire  23 Lab 3A Stages of Change and Self-Management Skills  41 Name Section Date Lab 1A Lab 4A Readiness for Physical Activity  59 Lab 4B The Warm-Up  61 Purpose: To assess self-perceptions of wellness Rev.Confirming Pages Lab 4C Physical Activity Attitude Questionnaire  63 Lab 5A Assessing Heart Disease Risk Factors  81 Procedures Wellness Self-Perceptions Lab 6A Self-Assessment of Physical Activity  93 Lab 6B Estimating Your Fitness  95 1. Place an X over the appropriate circle for each question (4 5 strongly agree, 3 5 agree, 2 5 disagree, 1 5 strongly disagree). Lab 7A Setting Goals for Moderate Physical Activity 2. Write the number found in that circle in the box to the right. 3. Sum the three boxes for each wellness dimension to get your wellness dimension totals. and Self-Monitoring (Logging) Program  109 4. Sum all wellness dimension totals to get your comprehensive wellness total. 5. Use the rating chart to rate each wellness area. Lab 7B Estimating Sedentary Behavior  111 6. Complete the Results section and the Conclusions and Implications section. Lab 8A Counting Target Heart Rate and Ratings of Perceived Question Strongly Agree Disagree Strongly Score Results (Record your scores from the previous page; then determine your ratings Exertion 131 Agree 3 2 Disagree from the Chart). 3 2 Lab 8B Evaluating Cardiorespiratory Endurance  133 1. I am physically fit. 4 1 Lab 1A Wellness Dimension Score Rating Lab 9A The Physical Activity Adherence Questionnaire  147 Physical Lab 9B Planning and Logging Participation in 2. I am able to perform the physical tasks of my work. 4 1 Emotional/mental Intellectual Vigorous Physical Activity  149 3. I am physically able to perform leisure activities. 4 32 1 Social Spiritual Lab 9C Combining Moderate and Vigorous Physical Physical Wellness  Total 5 Comprehensive Activity 151 4. I am happy most of the time. 4 32 1 Wellness Self-Perceptions Lab 10A Evaluating Muscle Strength: 1RM and Grip 5. I have good self-esteem. 4 Strength 185 32 1 Lab 10B Evaluating Muscular Endurance and Power  187 6. I do not generally feel stressed. 4 32 1 Lab 10C Planning and Logging Muscle Fitness Exercises: Emotional/Mental Wellness  Total 5 Free Weights or Resistance Machines  189 Wellness Rating Chart Lab 10D Planning and Logging Muscle Fitness Exercises: 7. I am well informed about current events. 4 32 1 Calisthenics, Core Exercises, or Plyometrics  191 8. I am comfortable expressing my views and opinions. 4 32 1 Rating Wellness Dimension Comprehensive Lab 11A Evaluating Flexibility  213 9. I am interested in my career development. 4 32 1 High-level wellness Scores Wellness Scores Lab 11B Planning and Logging Stretching Exercises  215 Good wellness Lab 12A The Back/Neck Questionnaire and Healthy Back Intellectual Wellness  Total 5 Marginal wellness 10–12 50–60 Low-level wellness Tests 247 10. I have many friends and am involved socially. 4 32 1 8–9 40–49 11. I have close ties with my family. 4 Lab 12B Evaluating Posture  249 12. I am confident in social situations. 4 32 1 6–7 30–39 Lab 12C Planning and Logging Core and Back Exercises  251 Lab 13A Evaluating Skill-Related Physical Fitness  271 Below 6 Below 30 Lab 13B Identifying Symptoms of Overtraining  273 Lab 14A Evaluating Body Composition: Skinfold 32 1 Conclusions and Implications: Rank each dimension of wellness. Place a 1 by the dimension you need to work on most and a 2 by the dimension needing the next most work. Rank the others as 3, 4, and 5. Then in the box below, briefly Measures 297 Social Wellness  Total 5 4 32 1 discuss your wellness ratings. Comment on your current level of wellness and dimensions that could use improvement. Lab 14B Evaluating Body Composition: Height, Weight, 4 32 1 and Circumference Measures  301 13. I am fulfilled spiritually. 4 32 1 Physical Emotional/mental Intellectual Social Spiritual 14. I feel connected to the world around me. Lab 14C Determining Your Daily Energy Expenditure  303 15. I have a sense of purpose in my life. Lab 15A Nutrition Analysis  325 Spiritual Wellness Total 5 Comprehensive Wellness (Sum of five wellness scores) 13 cor23488_ch01_001-014.indd 13 07/15/15 11:40 AM 14 07/15/15 11:40 AM cor23488_ch01_001-014.indd 14 Lab 15B Selecting Nutritious Foods  329 Lab 16A Selecting Strategies for Managing Eating  341 Lab 16B Evaluating Fast Food Options  343 Lab 17A Evaluating Your Stress Level  355 Lab 17B Evaluating Your Hardiness and Locus of Control  357 Lab 18A Time Management  373 Lab 18B Relaxation Exercises  375 Lab 18C Evaluating Levels of Social Support  377 Lab 19A Use and Abuse of Tobacco  389 Lab 20A Blood Alcohol Level  403 Lab 20B Perceptions about Alcohol Use  405 Lab 21A Use and Abuse of Other Drugs  419 Lab 22A Sexually Transmitted Infection Risk Questionnaire 433 Lab 23A Determining Your Cancer Risk  451 Lab 23B Breast and Testicular Self-Exams  453 Lab 24A Practicing Consumer Skills: Evaluating Products  467 Lab 24B Evaluating a Health, Wellness, or Fitness Club  469 Lab 25A Assessing Factors That Influence Health, Wellness, and Fitness  481 Lab 25B Planning for Improved Health, Wellness, and Fitness 483 Lab 25C Planning Your Personal Physical Activity Program 485 xi

Thank You Two words, thank you, can never be said enough to the many In Tribute people who have helped the Concepts books to be success- ful, including the thousands of instructors and students who Dr. Ruth Lindsey have taught and learned from these books for more than 1926–2005 50 years. We are proud that the Concepts books were among the first ever published for use in college fitness and well- On May 29, 2005, we lost a great leader and an outstanding ness courses; that the Surgeon General’s Report on Physical advocate for healthy lifestyles, physical activity, and physi- Activity and Health adopted definitions from the book; and cal education. Our longtime coauthor and friend, Ruth Lind- that instructors have taught and learned from these books for sey, will long be remembered as one of the original authors nearly 50 years. of Concepts of Fitness and Wellness and for her contribu- tions to our profession. We listen to those who review our books and to our users, who provide comments by mail, phone, personal conversations, Dedication and email. Comments and critiques help us make our books better for both students and instructors. We want to thank the The authors dedicate this new edition to our families reviewers for the eleventh edition for their excellent input: (spouses, children, and grandchildren) for their support and sacrifices that enabled us to spend the time necessary to cre- Steven Ball, University of Missouri–Columbia ate this book. Mark Deaton, Morehead State University Patty Donaldson, Angelina College A Final Word Mary Ewert-Knodell, North Hennepin Community College Jackie Franz, Mercer County Community College To list everyone who has made an impact on the Concepts Joyce Gronman, Atlantic Cape Community College texts over the years would take several book pages. Never- Brooke Towner, Coastal Carolina University theless, we feel that it is important to acknowledge those Greg Wimer, Armstrong Atlantic State University who have helped us. A list of those who have contributed to previous editions is available at www.corbinconcepts.org, In addition to the hundreds of instructors who have as are additional resources we have provided that support provided reviews for earlier editions, many others are also the use of Concepts of Fitness and Wellness in your course. deserving of special thanks, including fitness pioneers who Charles B. Corbin were early adopters and graduate students and employees of Gregory J. Welk our universities who have helped in so many ways. William R. Corbin Karen A. Welk We would also like to thank Mark Ahn, of Mark Ahn Cre- www.corbinconcepts.org ative Services, for his video production; Vicki Malinee, content developmental editor; Rick Hecker, project manager; Debra Kubiak, senior designer; David Tietz, photo researcher; Kristan Price, digital content editor; Rhona Robbin, lead product devel- oper; and Courtney Austermehle, brand manager. xii

Preface xiii HELP: “Health is available to Everyone for a Lifetime, and it’s Personal” Rev.Confirming Pages Concept 2 c D A proven philosophy forLifestyles for Health, Wellness, and Fitness c Section I 17  achieving lifetime fitness HELPHealth, Wellness, Fitness, and Health is available to Everyone mo for a Lifetime, and it’s Personal A According to the National Institutes of Health, although fact and wellness.Healthy Lifestyles: An IntroductionRev.ConfirmingPages Table 9 can Concept 1 nes genes do not necessarily cause diseases, they do influ- exte ence our risk of developing diseases, such as cancer, Confirming Pages Dis heart disease, and addiction. Research on the interactions lim resu 30 Section 1 c Lifestyles for Health, Wellness, and Fitness between our genes and our health is promising but in F and LEARNING OBJECTIVES controversial. (See link in Suggested Resources and imp fun After completing the study of this Concept, you wiRllebineforacbinlge to: Success wel kin Staying in Factors Family support Readings.) Table 9 The Basic Eight for Calisthenics wit wit c Describe the HELP philosophy aMnadindteinsacnucess its implications in mPaekeirnsugpppoertrsonal rien Support of professionals c DdeecfiinsieonthseadbiSomMtauoegtvenihsnsgeoifotahCnlrthohsaun,goghwfeehlelnaeMltshosvia,nagnnddEFwanfcaeittbolnllrinensgessss. , Goal setting Performance skills 1. PuWsho-Uuplsd knowing you were genet3ic. aDliplys predisposed to a The influence health and wellneinstos.Action how they This experacisretdiecvuelolpasrthedmisusecleassofethecahrmas,nshgoueldetrsh, e liTfheissetxeyrcliese ddeeveclopiss tihoendesltoyid,ou makeV?IDEO 9 illn aSenlfd-asesexspsmlaeinnt iCnotpeinrgascktilltso 10 p Self-monitoring Consumer skills ties Self-planning Time management and chest. Lie on the floor, face down with hands under latissimus, rhomboid, and tricep. Start in a fully extended who gre c IDdiesntintifgyurieshlahteedalPntrhae-ptriKaoereanlyatsiaottelnohdeaPFaarnelctddthoisrspsgkoosilialn-lgrsealaaAntbmdeledI?shdoimweSSShneeaofllsffe--wecieoonnncvmfiaisrdcoeeynonemcfeteipnnthgypswiIecositrr?aittshlofnitnaSEBleneagsjllofa-sonym.mcaoeetlisnovtaf ctaiotatnitnudes shoulders. Keep body straight from the knees position with hands grasping the bar (palms facing in). is n c die to the top of the head. Push up until the Slowly drop down until the upper part of the arm is uals they arms are straight. Slowly lower chest to horizontal or parallel with the floor. go com contribute to reaching national goals. Access Beliefs/knowledge floor. Repeat. Variation: If this exer- ExstetanrAdtintChgepTaorsImiVtsiobnI aTacnkYdurpeptoeatht.e Act cise is too difficult, modify by hea Personal Age Education has Beginning Factors Gender Friends performing on bent Note: Many gyms have a dip/ of a Contemplation Heredity Setting Health/disability Norms knees. pull-up machine with accom- E help modating resistance that adv or d provides a variable amount see this called “Concepts”Precontemplation of assistance to help you tim (“I Don’t Want to Change”) see • Concise modules paaVteifhrroaneaemrsaniiaettigisctpxoi.otub •nehnsen ah:nodnEStuedtdaHttpaudltaro.ohut9iCrwnfcE0rmatieoiuldtnhrmLatteuhiroeegtnkmPhnrteeeins:nloeDtuchsisodapfe;rrieciolmPmPbTtuntireerniaiiavnciccjsccceoottvoohprerirraisiaaoillestiirsslfisle.eyah,stpeoaesannlbdtdchuioa-iflrufpdeerplraamelgytneuettdshscbeptleuehHndyeaEsefniLnicdtPtasslptoftfdLmDRThroaroheiaitcroolijctistseomdooislprnriimmbdosmeoepeuidsslpefstoleostethhp,seceiheittxne,yrccsbisaleou.mddye- they healthynot arch back. lifestyles, based on our hereditary tendencies. mo give instructors flexibility and students aFigure 2 c Different factors influence progress at various stages of change. is o var manageable framework for learning andto initiate behavior change—moving toward contemplation illustrated by the fact that women use health services more W or even preparation. Enabling factors help those in contem- by mastering course content. Learning objectivesplation or preparation take a step toward action. Reinforcing often than men. Women are more likely than men to have identified a primary care doctor and are more likely to par- ticipate in regular health screenings. As you will discover in more detail later, heredity plays a role in health behaviors. factors move people from action to maintenance and help introduce each Concept, guiding students onthose in maintenance stay there. For example, some people have a hereditary predisposition to T2aEh.irsvMeexeoernidcniisfeiehdmdeevPeorluoiprltls-eeUdpis.mFpoorrteaxnatmipsleth, astomT4ph.isreCeexreudernciiascsehrdpl(eCyvoeulsordlp-isUetthipaeo) utnphpsesr to diseases gain weight, and this may affect their eating behaviors. are a resultabdominal muscles. Lie key points and how to assess their progress.Personal factors affect health behaviors but are often out of your personal control. Age, gender, heredity, social Personal factors also capture other conditions that influ- status, and current health and fitness levels are all personal ence ability to make change. People with little education are factors that affect your health behaviors. more likely to have health problems and make less money. of untreatable hereditary conditions (e.g., congenital heartthe muscles of the arms and shoulders. Hang Age effects are exemplified by differences in health People with limited income often have less access to health on the floor with the knees bent and the arms extended behaviors across the lifespan. For example, young adults are care and healthy foods. Social interactions also affect your or crossed with hands on shoulders defects). Obviously, some inherited conditions are man-(palms forward and shoulder-width apart) more likely to smoke and drink excessively but to be more ability to change. People who have friends who practice or palms on ears. If desired, legs physically active than older adults. Gender differences are healthy habits have an easier time adopting healthy behaviors may rest on bench to increase Good health, wellness, fitness, and ageable (e.g., diabetes) with proper medical supervisionfrom a low bar (may be placed across two difficulty. For less resistance, place hands at side of body chairs), heels on floor, and appropriate lifestyles. Heredity is a determinant overwith the body straight from feet to head. Brac- which we have little control; therefore, it is illustrated ining the feet against a healthy lifestylAeCsLaOrSeERimLOpOoKrtant for Internal (do not put hands behind abdominal head or neck). For more Blue Zones and Personal Responasilblil itpyeople. oblique resistance, move hands higher. Curl up until the partner or fixed object dark blue in Figure 1. Each of us can limit the effects ofis helpful. Pull up, keeping the body straight; touch the chest heredity by being aware of our personal family history andto the bar; then lower to the starting position. Repeat. Note: by making efforts to best manage those factors over whichThis exercise becomes more difficult as the angle of the we do have  control. In the Concepts that follow, you willbody approaches horizontal Lifestyles have a big impact on both quality and quantity of life. important, each person ultimately has to make wise choices Trapezius External shoulder blades leave For his book Blue Zones, Dan Buettner researched commu- and manage his or her own lifestyle, regardless of the setting. Rhomboids abdominal floor; then roll down to the nities across the world that had higher life expectancies and (See link in Suggested Resources and Readings.) oblique starting position. Repeat. quality of life compared to other communities. The common Deltoid Rectus Note: Twisting the trunk characteristics in these healthy communities—including diet Does your community provide a supportive environment for Teres major abdominis on the curl-up develops and activity—were identified and described as being impor- your health behaviors? Does the environment dictate your Latissimus tant for healthy lifestyles. Although a healthy environment is ability to be healthy, or is it your personal responsibility? dorsi the oblique abdominals. ACTIVITY learn more aboutand easier as it approaches the heredity and how it affects health, well- vertical. Variations: Perform so ness, and fitness.that the feet do not touch the floor (full pull-up). Or, perform with palms turned up. When Health, wellness, and fitness are influenced by thepalms all the • A Closer Look focuses on recent and aerlbeotwur1nfleedxoarws.aWy iftrhopmatlmhes face, pull-ups tend to use facing the body, the biceps sometimes controversial topics. Additionalcor23488_ch03_027-044.indd 30 07/15/15 09:58 AM are emphasized more. features include Technology Update (advances aging of our population. In 2030, when all of the post18–1 World War II baby boomers will be over the age of 65, in technology)cor23488_ch01_001-014.indd 1 and In the News (late-breaking adu0• 7l/1 t5/s15D161e:450tAMaoirleodld, eurpwdialltemdaiklleuusptra2t0iopnesrcsehnot wof sthtuedpeonptuslation. The neuxmabcetlrycor23488_ch10_153-192.indd 181 ohfopweotoplpeeorvfoerrm85stwreinllgttrhiptlreaibnyin2g0a5n0d. In the07/03/15 11:09 AM fitness and wellness information). Follow-up UnitedfleSxtiabteilsitytheexreeracriesecsu,rraenndtlythme ocroerethmanu1sc0l0e,s00th0epyeople over tahreeaigmeporfo1v0in0g. .The definition of old is changing, with critical-thinking questions spur class discussion most people believing that a person is not old until age 71 or and personal reflection and are assignable within Connect. older. Nearly a quarter of the population believes that being old begins at 81. Whatever the standard for being old, age is a factor over which we have no control. The major health and wellness concerns of older adults include losing health, losing the ability to care for oneself, losing mental abilities, running out of money, being a burden to family, and being alone.

xiv Preface A proven approach for teaching behavior change for health, wellness, and fitness McGraw-Hill Connect® gives students access to a wealth of online interactive activities and assignments—including interactive labs, videos with assessment, short essay questions, and auto-graded quizzes. Connect provides a highly interactive learning environment designed to help students connect to the resources they need to achieve success in the course. Connect gives instructors the tools to choose and create assignments, monitor student progress, and manage their course more easily and efficiently. With Connect, the educational possibilities are limitless.

Preface xv Connect now includes SmartBook, the first—and only—adaptive reading and study experience. As a student engages with SmartBook, the reading experience continuously adapts by highlighting content based on what the student knows and doesn’t know. This ensures the focus is on the content he or she needs to learn, while simultaneously promoting long-term retention of material. Powered by the LearnSmart adaptive engine, SmartBook is unique because it focuses not only on addressing the learning moment, but also empowers students by helping them retain information over time so they come to class more prepared and engaged. New to Connect is Connect Insight™, the first and only visual analytics tool of its kind—now available for both instructors and students. Connect Insight provides at-a-glance information regarding student performance, which is immediately actionable. By presenting assignment, assessment, and topical performance results together with a time metric that is easily visible for aggregate or individual results, Connect Insight gives the user the ability to take a just-in- time approach to teaching and learning, which was never before available. Connect Insight presents data that empower students and help instructors improve class performance in a way that is efficient and effective.

xvi Preface Highlights of the Eleventh Edition guidelines also prompted changes in exercise recommenda- tions for several health-related fitness components. Addi- The eleventh edition of Concepts of Fitness and Wellness is tional examples of new and updated content follow: designed to deliver an integrated print and digital program that continues to be at the cutting edge of physical activity 1 Health, Wellness, Fitness, and Healthy Lifestyles: An and health promotion, empowering students to take positive Introduction steps toward developing a lifelong commitment to healthy and active living. With its hallmark modular approach called ∙ Updated information on the Healthy People 2020 goals “Concepts,” the new edition has been thoroughly updated ∙ New content on the concept of healthspan versus lifespan and offers several features designed to enhance student ∙ Updated descriptions and terminology related to health- learning. Revised content in Connect adds new and exciting related fitness, including that power is now considered a materials for easy use by students and instructors. A vari- health-related component of fitness ety of updated and expanded Connect video activities help explain complex issues and provide opportunities for ∙ New statistics about health, longevity, and wellness personal reflection and critical thinking. Connect icons throughout the text guide students to these and additional 2 Determinants of Lifelong Health, Wellness, online assignments that help students apply the material. and Fitness (New!) LearnSmart, a new adaptive learning resource, is designed to maximize pro- ∙ New Concept on the factors influencing health, wellness, ductivity and efficiency in learning by facilitating the learning process from ACTIVITY and fitness course prep to concept mastery. ∙ Updated statistics on the leading causes of death Based on feedback from course instructors, a new ∙ Behavioral emphasis on the differences in the degree of Concept 2 covers the determinants of health, wellness, and fitness and Concept 3 focuses on self-management and self- control over dimensions planning skills. Learning objectives at the beginning of each Concept guide student learning. Increased attention has been ∙ Explanation of the new focus on health-related quality of life placed on behavior change, including revisions in several lab activities. Each Concept also includes many features with 3 Self-Management and Self-Planning Skills for Health engaging contemporary content that are useful for class dis- Behavior Change cussions. A Closer Look provides information about new and sometimes controversial topics related to health, wellness, ∙ Updated content on the stages of change and fitness and encourages critical thinking. Technology ∙ New examples of self-management skills Update describes advances in health and fitness technol- ∙ Expanded content on SMART goals ogy and prompts exploration and personal evaluation. In the News highlights late-breaking health, wellness, and fitness 4 Preparing for Physical Activity information and provides opportunities for reflection. The HELP feature personalizes fitness and health issues to help ∙ Distinctions among stretch warm-up, dynamic warm-up, students internalize the information. New key Suggested Resources and Readings at the end of each Concept provide and traditional warm-up students with additional online resources for further explo- ration and the end-of-text References highlight the latest ∙ Updated stretching and warm-up guidelines for different research. A new Healthy People 2020 chart at the beginning of this edition helps students understand the health goals activities discussed throughout. Dynamic changes in the body of knowledge relating to ∙ Revised FIT formula information based on revised health, wellness, and fitness are captured in the extensive updates to this edition. New recommendations from the ACSM guidelines National Academy of Medicine about fitness terminology and assessments have been incorp­ orated. For example, the ∙ New content on behavioral strategies for change term cardiorespiratory endurance has replaced cardiovas- ∙ Updated recommendations about exercise at higher cular fitness and power is now classified as a health-related component of fitness. Changes in American College of altitude and with pollution Sports Medicine (ACSM) exercise testing and prescription 5 The Health Benefits of Physical Activity ∙ Revised information about hypokinetic diseases ∙ Updated information on the links between inactivity and metabolic syndrome ∙ Rationale for activity promotion in schools, at worksites, and in clinical settings 6 How Much Physical Activity Is Enough? ∙ Revised FITT-VP model to capture ACSM “Volume” and “Progression” terms ∙ New statistics on adults meeting the U.S. physical activity guidelines

Preface xvii ∙ Clarifications in the application of the physical activity 1 2 Body Mechanics: Posture, Questionable Exercises, and Care of the Back and Neck pyramid 7 Moving from Inactivity to Moderate-Intensity Active ∙ Expanded content on the risks for microtrauma ∙ New exercise illustrations and descriptions Lifestyles ∙ Revised behavioral lab on planning and logging core and ∙ Clarification about the concept of METs and tracking of back exercises 1 3 Performance Benefits of Physical Activity MET-minutes ∙ Expanded content on plyometrics and advanced power ∙ New information on sedentary behavior and independent training risks from inactivity ∙ Expanded content on functional fitness training ∙ New lab activity on the assessment of sedentary ∙ Revised information about the links among fitness, behavior skills, and performance 14 Body Composition ∙ Updated information and features on activity monitors ∙ Updated information on the prevalence of obesity and 8 Cardiorespiratory Endurance extreme obesity ∙ Updated terminology (i.e., cardiorespiratory endurance) ∙ New content on the National Academy of Medicine (for- ∙ New content on the health risks of obesity and the merly IOM) guidelines and cardiorespiratory endurance related benefits of activity ∙ Updates on the benefits of vigorous exercise and cardio- ∙ New information on the American Medical Associa- respiratory endurance tion’s designation of obesity as a disease ∙ Revisions and new descriptions of FIT principles for ∙ New content on revised obesity treatment guidelines cardiorespiratory endurance 1 5 Nutrition 9 Vigorous Aerobics, Sports, and Recreational ∙ Summaries of recommendations from the Dietary Activities Guidelines Advisory Committee ∙ Revised descriptions of different aerobic exercises ∙ Updated information on patterns and trends in sports ∙ Updated information on the descriptions and labeling of fiber ∙ Expanded content on the health benefits of fruits and and recreation vegetables ∙ New content on the popularity of vigorous recreation ∙ Revised recommendations related to dietary fat and and extreme sports 10 Muscle Fitness and Resistance Exercise cholesterol, including information on the new FDA prohibition on trans fats ∙ Expanded content and focus on health benefits of 16 Managing Diet and Activity for Healthy Body Fatness resistance exercise ∙ New content on public awareness of calorie needs ∙ Information about food policies and initiatives to pro- ∙ New information about power as a health-related fitness mote healthy eating. dimension ∙ Updated information on the benefits of light activity for ∙ Updated descriptions of absolute and relative strength weight control and endurance 17 Stress and Health ∙ Expanded content on plyometrics and functional fitness ∙ Updated statistics about stress and stressors ∙ New diagrams depicting the stress process training methods ∙ New content on the effects of stress on health and wellness ∙ Summaries of new research on the sources of stress and ∙ Revised behavioral labs on planning and logging resis- the implications for health tance exercises 1 8 Stress Management, Relaxation, and Time 11 Flexibility Management ∙ New content on the distinctions between static ∙ Updated information about the benefits of physical and dynamic flexibility activity for stress management ∙ Updated information on links between flexibility and functional fitness ∙ Revised stretching recommendations based on new ACSM guidelines ∙ Revised behavioral lab activity on tracking and logging stretching

xviii Preface ∙ New section on the prevention and early treatment of ∙ Updated information on time use and the implications of STIs stress ∙ Updates on the issues and trends related to HPV ∙ Clarifications and examples of types of coping strategies vaccinations ∙ New information on conscious relaxation and 23 Cancer, Diabetes, and Other Health Threats mindfulness ∙ Updated statistics on prevalence and death rates from 19 The Use and Abuse of Tobacco various cancers ∙ Updated statistics on smoking patterns and trends ∙ Revised facts about secondhand smoke and the implica- ∙ New screening guidelines for breast and prostate cancers ∙ New content on skin cancer and labeling of sunscreen tions for policy changes products ∙ New information on the marketing of tobacco and con- ∙ Revised content and descriptions of diabetes siderations with e-cigarettes 20 The Use and Abuse of Alcohol 24 Evaluating Fitness and Wellness Products: Becoming an Informed Consumer ∙ New guidelines for defining binge drinking ∙ New statistics and risks related to drinking and driving ∙ New examples of quackery in the health and fitness ∙ Updated information on campus strategies related to industry alcohol abuse ∙ New warnings about tanning with sunlamps ∙ Explanation of new terminology for alcohol use disorder ∙ Explanation of consumer advocacy links through 21 The Use and Abuse of Other Drugs MedWatch 2 5 Toward Optimal Health and Wellness: Planning for ∙ New information about synthetic cannabinoids and Healthy Lifestyle Change legalized marijuana ∙ Updated content on the factors that influence health and ∙ Implications of “generational forgetting” on drug use wellness patterns ∙ New tips on accessing health care effectively ∙ Updated statistics and graphics on the costs of drug ∙ New information about health insurance coverage ∙ Technology considerations with genetic testing abuse in society 22 Preventing Sexually Transmitted Infections ∙ Updated statistics on the prevalence of different sexually transmitted infections

Preface xix More Resources for McGraw-Hill Campus™ Teaching with Concepts of Fitness & Wellness McGraw-Hill Campus™ is a one-stop teaching and learning experience available to users of any learning management Create, Because Customization system. This institutional service allows faculty and students Matters to enjoy single sign-on (SSO) access to all McGraw-Hill Higher Education materials, including the award-winning Design your ideal course materials with McGraw-Hill’s McGraw-Hill Connect™ platform, from directly within the Create at www.mcgrawhillcreate.com! Rearrange or omit institution’s website. McGraw-Hill Campus™ provides fac- chapters, combine material from other sources, and/or ulty with instant access to all McGraw-Hill Higher Edu- upload your syllabus or any other content you have writ- cation teaching materials (e.g., eTextbooks, test banks, ten to make the perfect resource for your students. Search PowerPoint slides, animations, and learning objects), allow- thousands of leading McGraw-Hill textbooks to find the best ing them to browse, search, and use any instructor ancillary content for your students, then arrange it to fit your teach- content in our vast library at no additional cost to instructors ing style. You can even personalize your book’s appearance or students. Students enjoy SSO access to a variety of free by selecting the cover and adding your name, school, and products (e.g., quizzes, flash cards, narrated presentations) course information. When you order a Create book, you as well as subscription-based products (e.g., McGraw-Hill receive a complimentary review copy. Get a printed copy in Connect™). With this program enabled, faculty and students 3 to 5 business days or an electronic copy (eComp) via email never need to create another account to access McGraw-Hill in about an hour. products and services. Register today at www.mcgrawhillcreate.com and Instructor Resources craft your course resources to match the way you teach. Instructors can access the following resources through the Library tab in Connect: ∙ PowerPoint presentations ∙ Instructor’s manual ∙ Test bank ∙ Image bank

xx Healthy People 2020 • Reduce cancer incidence and death rates, increase cancer 2020Healthy People patient longevity, increase survivor’s quality of life, and increase cancer screening. Healthy People 2020 outlines national health targets to achieve by 2020. The specific goals listed below are reflected • Reduce diabetes incidence and death rates; increase throughout Concepts of Fitness and Wellness. As you meet your personal goals, you contribute to the achievement of diabetes screening, education, and care. these national health goals. • Reduce osteoporosis (related hip fractures), pain of arthritis, General Health Goals and limitations from chronic back pain. • Create a society in which all people live long, healthy lives. • Promote quality of life, healthy development, and healthy • Increase percentage of college students receiving risk factor behaviors (including being active, eating well, and avoiding information. destructive habits) across all stages of life. • Increase young adult awareness of CHD signs and • Attain high-quality, longer lives free of preventable disease, symptoms. injury, and premature death. • Reduce rate of sunburn among young people (tanning). • Achieve health equity, eliminate disparities, and improve the Body Composition/Weight Control Goals health of all groups. • Increase proportion of adults with healthy weight. • Create social and physical environments that promote good • Reduce childhood overweight and obesity. • Reduce disordered eating among adolescents. health for all. • Increase worksites that offer nutrition and weight • Increase public awareness and understanding of the deter- management classes and counseling. minants of health, disease, and disability. • Increase physician counseling on nutrition and weight • Increase health literacy of the population. management. • Increase participation in employee wellness programs. • Increase percentage of high-quality health-related websites. • Increase BMI measurement by primary doctors. • Increase percentage of people with health-care providers • Increase weight-control efforts and activity levels of adults who involve them in decisions about health care. with high LDL. • Increase recycling and environmental health efforts. Nutrition Goals • Increase policies that give retail food outlets incentives to Fitness and Physical Activity Goals • Reduce proportion of adults who do no leisure-time activity. carry foods that meet dietary guidelines. • Increase proportion of adults who meet guidelines for mod- • Increase the contribution of fruits in the diet. erate to vigorous aerobic activity. • Increase the variety and contribution of vegetables in the • Increase proportion of adults who meet guidelines for mus- diet. cle fitness activity. • Increase the contribution of whole grains in the diet. • Reduce consumption of saturated fat in the diet. • Increase proportion of people who regularly perform exer- • Reduce consumption of sodium. • Increase consumption of calcium. cises for flexibility. • Reduce iron deficiency. • Reduce consumption of calories from solid fats and added • Increase access to employee-based exercise facilities and sugars. programs. • Decrease the consumption of sugar-sweetened beverages. • Increase proportion of trips made by walking. • Increase food safety (variety of areas). • Increase proportion of youth who meet guidelines for TV Mental and Emotional Health Goals viewing and computer use and overuse (overuse is 2 hours • Reduce depression and increase screening for depression. a day or more). • Increase screening for and treatment of mental health • Increase schools with activity spaces that can be used in problems. non-school hours. • Reduce suicide and suicide attempts. • Increase availability of worksite stress-reduction programs. • Increase percentage of physicians who counsel or educate • Reduce rates of depression and disordered eating. • Increase levels of social support among adults. patients about exercise. • Increase the proportion of primary care facilities that provide • Decrease activity limitations, especially in older adults and mental health treatment. disabled. Hypokinetic Disease Goals • Increase overall cardiovascular health; reduce heart disease, stroke, high blood pressure, and high blood cholesterol; increase screening; increase awareness; and increase emer- gency treatment by professionals or bystanders.

Healthy People 2020 xxi 2020Healthy People Safety and Injury Prevention Goals • Increase the percentage of pregnancies that are intended. • Reduce sports and recreation injuries. • Increase percentage of adolescents who receive formal • Reduce injuries from overexertion. • Reduce emergency department visits for nonfatal injuries. instruction on reproduction before age 18. • Increase the proportion of public and private schools that Goals Related to Drug Use require students to wear appropriate protective gear when • Reduce substance abuse to protect the health, safety, and engaged in school-sponsored physical activities. quality of life for all, especially children. • Reduce injuries and accidental deaths (automobile, assault, • Reduce deaths and injuries caused by drug-related motor drowning, firearms-related, homicides, motorcycle, pedes- trian, poisonings). vehicle crashes. Goals Related to Tobacco Use • Increase availability of specialty treatment for substance • Increase the number of current smokers who try to quit. • Reduce smoking during pregnancy. abuse. • Increase the percentage of smoke-free homes. • Reduce initiation of tobacco use among youth. • Increase effectiveness of drug-abuse treatment • Increase state and federal taxes on tobacco products. • Reduce teen exposure to tobacco advertising. programs. • Increase tobacco screening in health-care settings. • Increase indoor smoking bans in public places. • Reduce proportion of youth offered drugs or sold drugs at • Reduce secondhand-smoke exposure. school. Goals Related to Sexually Transmitted Infections • Promote responsible sexual behaviors to prevent • Reduce nonmedical use of prescription drugs. • Reduce medical emergencies that occur from adverse sexually transmitted infections (STIs) and their complications. events associated with medicines. • Reduce incidence of chlamydia, gonorrhea, syphilis, genital • Increase the age of onset and proportion of young people herpes, human papillomavirus (HPV), pelvic inflammatory who remain drug free. disease (PID), and hepatitis B. • Increase the proportion of adolescents who disapprove of • Increase proportion tested for HIV. • Increase percentage of sexually active women who are substance abuse. tested for chlamydia. • Reduce steroid use by adolescents. • Reduce adverse events from medical products. • Increase the number of health insurance plans that cover • Reduce substance abuse to protect the health, safety, and contraceptives. quality of life for all, especially children. • Increase proportion of young people who abstain from sex- Goals Related to Alcohol Use • Reduce deaths and injuries caused by alcohol-related motor ual intercourse, use condoms during sexual activity, and avoid risky sexual behaviors. vehicle crashes. • Reduce alcohol-related injuries and ER visits. • Reduce the frequency of driving while intoxicated. • Increase the proportion of adolescents who remain alcohol free. • Reduce binge drinking and average alcohol consumption. • Increase the number of adolescents who disapprove of alco- hol consumption. Source: Adapted from Healthy People 2020.

Concepts of Fitness & Wellness A Comprehensive Lifestyle Approach

Lifestyles for Health, Wellness, and Fitness  c  Section I Concept 1 Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction LEARNING OBJECTIVES After completing the study of this Concept, you will be able to: c Describe the HELP philosophy and discuss its implications in making personal decisions about health, wellness, and fitness. c Define the dimensions of health and wellness, and explain how they interact to influence health and wellness. c Distinguish health-related and skill-related dimensions of physical fitness. c Identify related national health goals and show how meeting personal goals can contribute to reaching national goals. Good health, wellness, fitness, and healthy lifestyles are important for all people. 1

2 Section 1  c  Lifestyles for Health, Wellness, and Fitness Health and wellness are available to everyone for a lifetime. principles and guidelines that help you adopt positive life- styles. The labs provide experiences for learning behavioral Ninety-nine percent of American adults say that “being skills needed to maintain these lifestyles. in good health” is of primary importance. Good health—for them and those they care about—is more A personal philosophy that emphasizes health can important than money and other material things. Having lead to behaviors that promote it. The H in HELP stands good health, wellness, and fitness can make us feel good, for health. One theory that has been extensively tested indi- look good, and enjoy life fully. Concepts of Fitness and cates that people who believe in the benefits of healthy life- Wellness is designed to help you achieve good health by styles are more likely to engage in healthy behaviors. The providing information to help you make good decisions. theory also suggests that people who state intentions to put You will also learn essential self-management skills. With their beliefs into action are likely to adopt behaviors that practice, use of these skills promotes healthy lifestyles that lead to health, wellness, and fitness. lead to good health, wellness, and fitness throughout life. An overview of basic self-management skills is provided in Everyone can benefit from healthy lifestyles. The E in a later Concept. HELP stands for everyone. Anyone can change a behavior or lifestyle. Nevertheless, many adults feel ineffective in The HELP Philosophy making lifestyle changes. Physical activity is not just for athletes—it is for all people. Eating well is not just for other The HELP philosophy provides a basis for making people—you can do it, too. All people can learn stress- healthy lifestyle change possible. The acronym— management techniques and practice healthy lifestyles. HELP—characterizes an important part of the philosophy: Health is available to Everyone for a Lifetime—and it’s Healthy behaviors are most effective when practiced Personal. The HELP philosophy aids you as you apply the for a lifetime. The L in HELP stands for lifetime. Young people sometimes feel immortal because the harmful effects of unhealthy lifestyles are often not immediate. As we age, however, unhealthy lifestyles have cumulative neg- ative effects. Thus, adopting and sustaining healthy habits early in life is important for long-term health, wellness, and fitness. Healthy lifestyles should be based on personal needs. The P in HELP stands for personal. Each person has unique needs regarding health, wellness, and fitness. People also vary in attitudes, perceptions, and personal characteristics that influence healthy lifestyles. You will be provided with information about a variety of self-management skills, but it is up to each individual to take personal responsibility for learning and using these skills. You can adopt the HELP philosophy. As you progress through these Concepts, consider ways that you can imple- ment the HELP philosophy. In each Concept, HELP boxes are provided to stimulate your thinking about key health issues. National Health Goals Healthy People 2020 (HP2020) is a comprehensive set of health promotion and disease prevention objectives with the primary intent of improving the nation’s health. The objectives, developed by experts from hundreds of national health organizations and published in 2010, provide benchmarks to determine progress over the period from 2010 to 2020. The objectives also serve as goals to motivate and guide people in making sound health

Concept 1  c  Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction   3 decisions as well as to provide a focus for public health HELP Health is available to Everyone programs. for a Lifetime, and it’s Personal The Healthy People 2020 goals represent the U.S. goals In addition to helping change the health of society at for health and health promotion. The goals focus on pro- large, HP2020 goals have implications for personal health moting quality of life, healthy development, and healthy behavior change. Societal changes can occur only when behaviors across all stages of life and in all segments of individuals adjust personal behaviors and work together to the population. Although the goals are set at the national make changes that benefit other people. Not all objectives level, they have implications for determining state and will have personal implications for each individual, but local funding, programming, and policy development. increased societal awareness of the objectives may lead to Do you think these public health goals can work to future changes in the health of our country. The four primary ultimately influence individual behavior? Similarly, or overarching goals of HP2020 are described in the sections do you think your individual choices and behaviors that follow to provide context for these societal goals. ultimately influence (or have an impact on) progress toward societal goals? A primary goal of HP2020 is to help all people have high-quality, longer lives free of preventable ACTIVITY disease, injury, and premature death. This goal makes distinctions between the terms lifespan and healthspan. and Wellness has a similar goal: to help you maximize the Lifespan refers to the number of years you live. Over the portion of your lifespan that is lived in good health (that is, past century, the lifespan (life expectancy) of Americans healthspan). has increased by 60 percent. The expected lifespan for three North American countries is shown in Figure 1. According Achieving health equity, eliminating disparities, and to World Factbook, Canada ranks 13th, the United States improving the health of all groups is another primary 50th, and Mexico 72nd in expected lifespan. The term goal of HP2020. Health varies greatly with ethnicity, healthspan refers to the number of healthy years in your income, gender, and age. As defined in HP2020, a health life. It includes years free of illness and debilitating condi- disparity is “a particular type of health difference that is tions and years of wellness (years with a good quality of closely linked with social, economic, and/or environmental life). The green bars in Figure 1 depict the relative health- disadvantage.” To reduce health disparities, it is important span in each country and the orange shows years with poor to address underlying causes. health and low quality of life. Although unhealthy years occur more often toward the end of the lifespan they can Another primary goal of HP2020 is to create social happen at any time. Increasing both lifespan and healths- and physical environments that promote good health pan is an overarching goal of HP2020. Concepts of Fitness for all. The environment, both social and physical, has much to do with quality and length of life. Social environ- Country Healthspan Unhealthy 9 Total ment refers to norms and values that influence our behavior, years 8 life whereas physical environment refers to characteristics or USA expectancy features that may allow the healthier choice to be the easier Females 72 9 choice. These features are known as “social determinants of 69 81 health” and will be discussed in more detail later. Males 70 77 All 79 Self-Management Skills  Skills that you learn to help you adopt healthy lifestyles and adhere to them. Canada 76 8 84 Health  Optimal well-being that contributes to one’s quality of Females 72 8 80 life. It is more than freedom from disease and illness, though 82 freedom from disease is important to good health. Optimal Males 74 8 health includes high-level mental, social, emotional, spiritual, All and physical wellness within the limits of one’s heredity and 69 9 78 personal abilities. Mexico 64 72 Lifespan  The number of years you live (life expectancy). Females 8 75 Healthspan  The number of healthy years in your life. It includes 66 9 years free of illness and debilitating conditions and years of well- Males ness (years with a good quality of life). All 55 60 65 70 75 80 Years Figure 1  c  Healthspan and lifespan for many North Americans. Sources: World Health Organization and National Center for Health Statistics.

4 Section 1  c  Lifestyles for Health, Wellness, and Fitness In the News Healthiest Places to Live news agencies (e.g., Time and CNN) provide annual ratings and lists of the healthiest places to live based on a variety of criteria. Each year a number of organizations conduct surveys to determine which American cities Do healthier people simply seek out healthier environments rate highest in well-being and/or physical fitness. The Gallup- (and healthier cities) or are there unique attributes that help Healthways Well-Being Index®, for example, surveys samples make an area or city healthier? How does your city rate? of U.S. residents on a daily basis in order to capture changes in perceptions of health and well-being over time. Many other ACTIVITY HEALTH reedom from illness and dis F ons ease Fre Wellness Quality of life Sense of well-being Physical activity is for everyone regardless of ability of disability. edom from debilitating conditi The final primary goal of HP2020 is to promote quality Figure 2  c  A model of optimal health, including wellness. of life, healthy development, and healthy behaviors across all stages of life. Healthy days decrease as we age. Wellness is the positive component of optimal health. Young adults experience more healthy days each month than Disease, illness, and debilitating conditions are nega- older adults. Over the past two decades, there has been a tive components that detract from optimal health. Death steady decline in healthy days for the average person, no can be considered the ultimate opposite of optimal health. doubt because of the increase in the number of older adults Wellness, in contrast, is the positive component of optimal in our society. Increasing healthy days is still a goal for all. health. It is characterized by a sense of well-being reflected in optimal functioning, health-related quality of life, mean- Health and Wellness ingful work, and a contribution to society. HP2020 goals use the term health-related quality of life to describe a general Health is more than freedom from illness and disease. sense of happiness and satisfaction with life. Over 60 years ago, the World Health Organization defined health as more than freedom from illness, disease, and debilitating con- Health and wellness are personal. Every individual is ditions. Prior to that time, you were unique—and health and wellness are influenced by each considered to be “healthy” if you were VIDEO 1 person’s unique characteristics. Making comparisons to not sick. HP2020 refers to quality of other people on specific character- life in two of its four primary goals, highlighting the impor- istics may produce feelings of inad- tance of the wellness component of health. equacy that detract from one’s profile Figure 2 illustrates the modern concept of health. This of total health and wellness. Each of us VIDEO 2 general state of being is characterized by freedom from dis- has personal limitations and strengths. ease and debilitating conditions (outer circle), as well as Focusing on strengths and learning to accommodate weak- wellness (center circle). nesses are essential keys to optimal health and wellness.

Concept 1  c  Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction   5 Health and wellness are multidimensional. The dimen- people include environmental and vocational dimensions in sions of health and wellness include physical, emotional/ addition to the five shown in Figure 3. Health and wellness mental, intellectual, social, and spiritual. Table 1 describes are to be personal factors, so environmental and vocational the various dimensions, and Figure 3 illustrates the impor- wellness are not included in Tables 1 and 2. However, the tance of each one for optimal health and wellness. Some environment (including your work environment) is very important to overall personal wellness, and for this reason, Table 1  c  Definitions of Health and Wellness Dimensions environmental factors are prominent in the model of well- ness described later. Physical health—Freedom from illnesses that affect the physiological systems of the body, such as the heart and the Physical nervous system. A person with physical health possesses an adequate level of physical fitness and physical wellness. Spiritual Emotional/ Mental Physical wellness—The ability to function effectively in meeting the demands of the day’s work and to use free time effectively. Social Intellectual Physical wellness includes good physical fitness and the possession of useful motor skills. A person with physical wellness Figure 3  c  The dimensions of health and wellness. is generally characterized as fit instead of unfit. Table 2  c  The Dimensions of Wellness Emotional/mental health—Freedom from emotional/mental illnesses, such as clinical depression, and possession of emotional wellness. Wellness Dimension Negative - - - - - - - - - - - - - Positive The goals for the nation’s health refer to mental rather than emotional Physical Unfit - - - - - - - - - - - - - - - - - Fit health and wellness. However, mental health and wellness are Emotional/mental Depressed - - - - - - - - - - - - Happy conceptually the same as emotional health and wellness. Intellectual Ignorant - - - - - - - - - - - - - - Informed Social Lonely - - - - - - - - - - - - - - - Involved Emotional/mental wellness—The ability to cope with daily Spiritual Unfulfilled - - - - - - - - - - - - - Fulfilled circumstances and to deal with personal feelings in a positive, Total outlook Negative - - - - - - - - - - - - - Positive optimistic, and constructive manner. A person with emotional wellness is generally characterized as happy instead of depressed. Illness  The ill feeling and/or symptoms associated with a disease or circumstances that upset homeostasis. Intellectual health—Freedom from illnesses that invade the brain Wellness  The integration of many different components (physi- and other systems that allow learning. A person with intellectual cal, emotional/mental, intellectual, social, and spiritual) that health also possesses intellectual wellness. expand one’s potential to live (quality of life) and work effec- tively and to make a significant contribution to society. Wellness Intellectual wellness—The ability to learn and to use information reflects how one feels (a sense of well-being) about life, as well to enhance the quality of daily living and optimal functioning. A as one’s ability to function effectively. Wellness, as opposed to person with intellectual wellness is generally characterized as illness (a negative), is sometimes described as the positive com- informed instead of ignorant. ponent of good health. Quality of Life  A term used to describe wellness. An individual Social health—Freedom from illnesses or conditions that severely with quality of life can enjoyably do the activities of life with little limit functioning in society, including antisocial pathologies. or no limitation and can function independently. Individual qual- ity of life requires a pleasant and supportive community. Social wellness—The ability to interact with others successfully and to establish meaningful relationships that enhance the quality of life for all people involved in the interaction (including self). A person with social wellness is generally characterized as involved instead of lonely. Spiritual health—The one component of health that is totally composed of the wellness dimension; it is synonymous with spiritual wellness. Spiritual wellness—The ability to establish a values system and act on the system of beliefs, as well as to establish and carry out meaningful and constructive lifetime goals. Spiritual wellness is often based on a belief in a force greater than the individual that helps her or him contribute to an improved quality of life for all people. A person with spiritual wellness is generally characterized as fulfilled instead of unfulfilled.

6 Section 1  c  Lifestyles for Health, Wellness, and Fitness Wellness reflects how one feels about life, as well as on health. Others, such as Type I diabetes, are not curable one’s ability to function effectively. A positive total out- but can be managed with proper eating, physical activity, look on life is essential to each of the wellness dimensions. and sound medical treatment. Those with manageable con- As illustrated in Table 2, a “well” person is satisfied in work, ditions may, however, be at risk for other health problems. is spiritually fulfilled, enjoys leisure time, is physically fit, is For example, unmanaged diabetes is associated with a high socially involved, and has a positive emotional/mental out- risk for heart disease and other health problems. look. He or she is happy and fulfilled. The way one perceives each dimension of wellness Debilitating conditions, such as the loss of a limb or loss affects one’s total outlook. Researchers use the term self– of function in a body part, can contribute to a lower level of perceptions to describe these feelings. Many research- functioning or an increased risk for illness and thus to poor ers believe that self-perceptions about wellness are more health. On the other hand, such conditions need not limit important than actual circumstances or a person’s actual wellness. A person with a debilitating condition who has state of being. For example, a person who has an important a positive outlook on life may have better overall health (a job may find less meaning and job satisfaction than another long healthspan) than a person with a poor outlook on life person with a much less important job. Apparently, one of but no debilitating condition. the important factors for a person who has achieved high- level wellness and a positive outlook on life is the ability Just as wellness is possible among those with illness to reward himself or herself. Some and disability, evidence is accumulating that people with people, however, seem unable to give a positive outlook are better able to resist the progress themselves credit for their successes. of disease and illness than are those with a negative out- The development of a system that VIDEO 3 look. Thinking positive thoughts has been associated with enhanced results from various medical treatments and sur- allows a person to perceive the self gical procedures. positively is essential, along with the adoption of positive Wellness is a term used by the uninformed as well as lifestyles that encourage improved self-perceptions. The experts. Unfortunately, some individuals and groups have questionnaire in Lab 1A will help you assess your self- tried to identify wellness with products and services that perceptions of the various wellness dimensions. For opti- promise benefits that cannot be documented. Because well- mal wellness, it is important to find positive feelings about being is a subjective feeling, unscrupulous people can easily each dimension. make claims of improved wellness for their product or ser- vice without facts to back them up. Health and wellness are integrated states of being. The segmented pictures of health and wellness shown in Holistic health is a term that is similarly abused. Con- Figure 3 and Tables 1 and 2 are used only to illustrate the sider that optimal health includes many areas; thus, the multidimensional nature of health and wellness. In reality, term holistic (total) is appropriate. In fact, the word health health and wellness are integrated states of being that can originates from a root word meaning “wholeness.” Unfor- best be depicted as threads woven together to produce a tunately, questionable health practices are sometimes pro- larger, integrated fabric. Each dimension relates to each moted under the guise of holistic health. Care should be of the others and overlaps all the others. The overlap is used when considering services and products that make so frequent and so great that the specific contribution of claims of wellness and/or holistic health to be sure that they each thread is almost indistinguishable when looking at are legitimate. the total (Figure 4). The total is clearly greater than the sum of the parts. Physical Fitness It is possible to possess health and wellness while Physical fitness is a multidimensional state of being ill or possessing a debilitating condition. Many being. Physical fitness is the body’s ability to func- illnesses are curable and may have only a temporary effect tion efficiently and effectively. It consists of at least six health-related and five skill-related dimensions, each of which contributes to total quality of life. Physical fitness is associated with a person’s ability to work effectively, enjoy leisure time, be healthy, resist hypokinetic diseases or conditions, PhysiIcnEatmelSlopletiircointtuuaaal/SMll oecnitaall and meet emergency situations. It is Figure 4  c  The integration of wellness dimensions. related to, but different from, health VIDEO 4 and wellness. Although the develop- ment of physical fitness is the result of many things, opti- mal physical fitness is not possible without regular physical activity.

Concept 1  c  Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction   7 The health-related dimensions of physical fitness are skill-related because people who possess them find it directly associated with good health. The six dimen- easy to achieve high levels of performance in motor skills, sions of health-related physical fitness are body composi- such as those required in sports and in specific types of tion, cardiorespiratory endurance, flexibility, muscular jobs. Power, a dimension that requires both strength and endurance, power, and strength (see Figure 5 on next page). speed, was formerly considered a skill-related dimension Each health-related fitness dimensions has a direct rela- of fitness but new evidence has linked power with good tionship to good health and reduced risk for hypokinetic health. diseases. This is why they are emphasized in personal fit- ness programs. Skill-related fitness has been called “sports fitness” Possessing a moderate amount of each dimension of or “motor fitness,” but note that it is multidimensional health-related fitness is essential to disease prevention and and highly specific. For example, coordination could be health promotion, but it is not essential to have exceptionally hand-eye coordination, such as batting a ball; foot-eye high levels of fitness to achieve health benefits. High levels coordination, such as kicking a ball; or many other possibil- of health-related fitness relate more to ities. The five dimensions of skill-related fitness identified performance than to health benefits. here are those commonly associated with successful sports For example, moderate amounts of and work performance. Additional information and self- strength are necessary to prevent back VIDEO 5 assessments on skill-related fitness are included in later concepts to help you understand the nature of total physical and posture problems, whereas high fitness and make important decisions about lifetime physi- levels of strength contribute most to improved performance cal activity. in activities such as football and jobs involving heavy lifting. Metabolic fitness is a nonperformance dimension of total fitness. Physical activity can provide health ben- The skill-related dimensions of physical fitness are efits that are independent of changes in traditional health- associated more with performance than with good related fitness measures. Physical activity promotes good health. The dimensions of skill-related physical fitness metabolic fitness, a state associated with reduced risk for are agility, balance, coordination, reaction time, and many chronic diseases. People with a cluster of low meta- speed (see Figure 6 later in the chapter). They are called bolic fitness characteristics are said to have metabolic syn- drome (also known as Syndrome X). Metabolic syndrome is A CLOSER LOOK discussed in more detail in a later Concept. Changing Fitness Terminology Lifestyles  Patterns of behavior or ways an individual typically lives. Fitness is a multidimensional construct, but the terminol- Physical Fitness The body’s ability to function efficiently and ogy and dimensions evolve as new research is done. The effectively. It consists of health-related physical fitness and skill- Institute of Medicine (IOM) report recommended the use of related physical fitness, which have at least 11 components, each the term “cardiorespiratory endurance” instead of the pre- of which contributes to total quality of life. Physical fitness also viously used term “cardiovascular fitness.” This term better includes metabolic fitness and bone integrity. Physical fitness is captures the integration of the cardiovascular and respira- associated with a person’s ability to work effectively, enjoy leisure tory systems. Endurance is used because it refers to the time, be healthy, resist hypokinetic diseases, and meet emergency sit- ability to sustain performance for extended periods of time. uations. It is an important part of the physical aspects of both health The IOM report also recommended that “power” be classi- and wellness but it also impacts the other dimensions. Although the fied as a health-related dimension of fitness instead of as development of physical fitness is the result of many things, optimal a skill-related dimension, as it has been viewed previously. physical fitness is not possible without regular exercise. The rationale for the change is that it is now clear that power Hypokinetic Diseases or Conditions Hypo- means “under” relates to good bone health and other health factors, espe- or “too little,” and -kinetic means “movement” or “activity.” cially in youth and older adults. Thus, hypokinetic means “too little activity.” A hypokinetic dis- ease or condition is one associated with lack of physical activity It is important to perform both aerobic exercise (for or too little regular exercise. Examples include heart disease, low cardiorespiratory endurance) and resistance exercise back pain, Type II diabetes, and obesity. (for musculoskeletal fitness and power). Which do you Metabolic Fitness  A positive state of the physiological sys- find easier to perform? Why is it important to do both? tems commonly associated with reduced risk for chronic dis- eases such as diabetes and heart disease. Metabolic fitness is ACTIVITY evidenced by healthy blood fat (lipid) profiles, healthy blood pressure, healthy blood sugar and insulin levels.

8 Section 1  c  Lifestyles for Health, Wellness, and Fitness Muscular Endurance Body Composition The ability of the muscles to exert themselves repeatedly. A fit person can repeat movements for a long period without undue fatigue. Cardiorespiratory Endurance The relative percentage of muscle, Dimensions The ability of the heart, blood fat, bone, and other tissues that of Health- vessels, blood, and respiratory make up the body. A fit person has a system to supply nutrients and relatively low, but not too low, Related oxygen to the muscles and the percentage of body fat (body Physical ability of the muscles to utilize fuel fatness). Fitness to allow sustained exercise. A fit person can persist in physical Strength Power activity for relatively long periods without undue stress. Power Flexibility The ability of the muscles to exert an The ability to transfer energy into The range of motion available in a external force or to lift a heavy force at a fast rate. Kicking in martial joint. It is a ected by muscle length, weight. A fit person can do work or arts and throwing the discus are joint structure, and other factors. A play that involves exerting force, activities that require considerable fit person can move the body joints such as lifting or controlling one’s power. through a full range of motion in own body weight. work and in play. Figure 5  c  Dimensions of health-related physical fitness.

Concept 1  c  Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction   9 Agility Reaction Time The ability to rapidly and accurately Dimensions The time elapsed between stimula- change the direction of the move- of Skill-Related tion and the beginning of reaction to ment of the entire body in space. that stimulation. Reacting to a soccer Skiing and wrestling are examples of Physical ball and starting a sprint race require activities that require exceptional Fitness good reaction time. agility. Balance Coordination Speed The ability to use the senses with the The maintenance of equilibrium while body parts to perform motor tasks stationary or while moving. Performing smoothly and accurately. Juggling, tai chi movements and performing hitting a tennis ball, and kicking a ball stunts on the balance beam are are examples of activities requiring activities that require exceptional good coordination. balance. The ability to perform a movement in a short period of time. Sprinters and wide receivers in football need good foot and leg speed. Figure 6  c  Dimensions of skill-related physical fitness.

10 Section 1  c  Lifestyles for Health, Wellness, and Fitness TECHNOLOGY UPDATE Bone integrity is often considered to be a Health Websites nonperformance measure of fitness. Traditional defi- nitions do not include bone integrity as a part of physical The Internet provides a tremendous source of information fitness, but some experts feel they should. Like metabolic about health, wellness, and fitness. However, all online fitness, bone integrity cannot be assessed with performance sources are not equally credible or useful. The best way measures the way most health-related fitness parts can. to get accurate information is to use reliable sources. Regardless of whether bone integrity is considered a part of Focus on government agencies (.gov), prominent medical fitness or a component of health, strong, healthy bones are and public health associations, and established nonprofit important to optimal health and are associated with regular agencies (.org). The first sites that come up in searches physical activity and sound diet. may not be the best, so check the source. A brief list of The many components of physical fitness are specific some prominent and credible Internet sites is provided but are also interrelated. Physical fitness is a combina- below. Additional organizations and websites are refer- tion of several aspects, rather than a single characteristic. enced in other sections. A fit person possesses at least adequate levels of each of Academy of Nutrition and Dietetics (AND) the health-related, skill-related, and metabolic fitness com- American College of Sports Medicine (ACSM) ponents. Some relationships exist among various fitness American Heart Association (AHA) characteristics, but each component of physical fitness is American Medical Association (AMA) separate and different from the others. For example, people Center for Science in the Public Interest who possess exceptional strength may not have good cardio- Centers for Disease Control and Prevention (CDC) respiratory endurance and those who have good coordina- Federal Trade Commission (FTC) tion do not necessarily possess good flexibility. Food and Drug Administration (FDA) Functional fitness is important for people of all ages. Gallup-Healthways Functional fitness refers to the ability to perform activities Harvard Health Publications of daily life. For adults, this includes performing work and Health Canada household tasks as well as leisure activities without undue Healthy People 2020 fatigue. It also includes having adequate fitness to meet the Institute of Medicine (IOM) demands of emergency situations. For youth, functional fit- Mayo Clinic Health Letter ness includes the ability to function in school and leisure MedlinePlus activities without undue fatigue. The Institute of Medicine National Institutes of Health (NIH) notes the importance of functional fitness for young people Pew Research Center—Health and the American College of Sports Medicine emphasizes President’s Council on Fitness, Sports and Nutrition the importance of functional fitness training, especially for Quackwatch older adults. Robert Woods Johnson Foundation Good physical fitness is important, but it is not the Society of Health and Physical Educators (SHAPE America) same as physical health and wellness. Good fitness U.S. Consumer Information Center contributes to the physical dimension of health and wellness WebMD by reducing risk for chronic diseases and by reducing the World Health Organization (WHO) consequences of many debilitating conditions. Good fitness also contributes indirectly to other dimensions by helping Do you consider the quality of sources when you access us look our best, feel good, perform daily tasks, and enjoy health-related information on the Internet? What features life. However, other physical factors can also influence should you look for to ensure credibility? health and wellness. For example, having good physical skills enhances quality of life by allowing us to participate ACTIVITY in enjoyable activities, such as tennis, golf, and bowling. Although fitness can assist us in performing these activities, Functional Fitness  The ability to perform activities of daily life. regular practice is also necessary. Another example is the ability to fight off viral and bacterial infections. Although fitness can promote a strong immune system, other physical factors can influence our susceptibility to illness.

Concept 1  c  Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction   11 Strategies for Action An initial self-assessment of wellness and will help you as you determine areas of priority as you will provide information for future set goals and make plans for improving. Answering the same self-comparison. In Lab 1A, you will estimate your wellness questions at a later date can help you to see if you have made using a Wellness Self-Perceptions Questionnaire, which progress. As each person makes progress toward improving assesses the five wellness dimensions. Assessing each dimen- wellness, collectively we move closer to the HP2020 goal of sion will help you to see areas of strengths and weaknesses living long, high-quality lives. ACTIVITY Suggested Resources ∙∙ Healthy People 2020 Goals for the Nation. and Readings Institute of Medicine. (2012). Fitness Measures and Health Outcomes in Youth. Washington, DC: National Academies Press. The websites for the following sources can be accessed by searching online for the organization, program, or title listed. Specific scientific ∙ John Hopkins Medicine Library: Reliable Health Information on references are available at the end of this edition of Concepts of the Internet (pdf). Fitness and Wellness. ∙ National Institutes of Health: MedlinePlus Consumer Health Resources. ∙∙ American College of Sports Medicine: American Fitness Index. Central Intelligence Agency. (2014). The World Factbook. ∙ Trust for America’s Health: A Healthier America 2013: Strategies to Move from Sick Care to Health Care (pdf). Washington, DC: CIA. ∙∙ U.S. Department of Health and Human Services: HealthFinder.gov. ∙ Corbin, C. B., et al. (2014). Youth Physical Fitness: Ten Key U.S. Office of Disease Prevention and Health Promotion (Health. Concepts. JOPERD, 85(2): 24–31. gov): Health Literacy. ∙ Gallup Poll: Well-Being Index. ∙ World Health Organization (WHO): World Health Statistics 2014.



Lab 1A  Wellness Self-Perceptions Name Section Date Lab 1A Purpose: To assess self-perceptions of wellness. Wellness Self-Perceptions Procedures 1. Place an X over the appropriate circle for each question (4 5 strongly agree, 3 5 agree, 2 5 disagree, 1 5 strongly disagree). 2. Write the number found in that circle in the box to the right. 3. Sum the three boxes for each wellness dimension to get your wellness dimension totals. 4. Sum all wellness dimension totals to get your comprehensive wellness total. 5. Use the rating chart to rate each wellness area. 6. Complete the Results section and the Conclusions and Implications section. Strongly Strongly Question Agree Agree Disagree Disagree Score 1. I am physically fit. 4 3 2 1 2. I am able to perform the physical tasks of my work. 4 3 2 1 3. I am physically able to perform leisure activities. 4 3 2 1 4. I am happy most of the time. Physical Wellness  Total  5 5. I have good self-esteem. 4 3 2 1 4 3 2 1 6. I do not generally feel stressed. 4 3 2 1 Emotional/Mental Wellness  Total  5 7. I am well informed about current events. 4 3 2 1 8. I am comfortable expressing my views and opinions. 4 3 2 1 3 2 1 9. I am interested in my career development. 4 Intellectual Wellness  Total  5 1 0. I have many friends and am involved socially. 4 3 2 1 11. I have close ties with my family. 4 3 2 1 12. I am confident in social situations. 4 3 2 1 1 3. I am fulfilled spiritually. Social Wellness  Total  5 4 3 2 1 14. I feel connected to the world around me. 4 3 2 1 15. I have a sense of purpose in my life. 4 3 2 1 Spiritual Wellness Total  5 Comprehensive Wellness (Sum of five wellness scores) 13

Results (Record your scores from the previous page; then determine your ratings from the Chart). Lab 1A Wellness Dimension Score Rating Physical Wellness Self-Perceptions Emotional/mental Intellectual Social Spiritual Comprehensive Wellness Rating Chart Rating Wellness Dimension Comprehensive High-level wellness Scores Wellness Scores Good wellness Marginal wellness 10–12 50–60 Low-level wellness 8–9 40–49 6–7 30–39 Below 6 Below 30 Conclusions and Implications: Rank each dimension of wellness. Place a 1 by the dimension you need to work on most and a 2 by the dimension needing the next most work. Rank the others as 3, 4, and 5. Then in the box below, briefly discuss your wellness ratings. Comment on your current level of wellness and dimensions that could use improvement. Physical Emotional/mental Intellectual Social Spiritual 14

Determinants of Lifelong Concept 2 Health, Wellness, and Fitness LEARNING OBJECTIVES After completing the study of this Concept, you will be able to: c Identify the determinants of health, wellness, and fitness, and explain how they each contribute to health, wellness, and fitness. c Differentiate between factors over which you have lesser and greater control. c Use health behavior change strategies to carry out self-assessments of personal lifestyles and wellness perceptions. Many factors contribute to health, wellness, and fitness, and some are more in your control than others. 15

16 Section 1  c  Lifestyles for Health, Wellness, and Fitness states of being. Those shaded in dark blue are the factors over which you have the least control (heredity, age, and Your health, wellness, and fitness are influenced by many disability). Those shaded in light blue factors. These factors are referred to as determinants but (health care and environmental fac- you have more control over some than of others. One of the tors) are factors over which you have health goals for the year 2020, and of this Concept, is to some control but less than the factors VIDEO 1 identify the various determinants and to explain how each contributes to health, wellness, and fitness. shaded in red (personal actions/inter- actions, cognitions, and emotions). Those shaded in light Determinants of Health, red are the factors over which you have greatest control Wellness, and Fitness (healthy lifestyles). Many factors are important in developing lifetime Determinants over Which You health, wellness, and fitness, and some are more in Have Little or Some Control your control than others. Figure 1 provides a model for describing many of the factors that contribute to health, Heredity (human biology) is a determinant over wellness, and fitness. Central to the model are health, which we have little control. Experts estimate that wellness, and fitness because these are the states of being human biology, or heredity, accounts for 16 percent of all (shaded in green and gold) that each of us wants to achieve. health problems, including early death. Heredity influences Around the periphery are the factors that influence these More control Personal actions and interactions Cognitions and emotions Healthy lifestyles Health Environmental factors Engaging in regular physical Physical, social and Wellness activity* cultural, spiritual, Eating well* Physical worksite, other Managing stress* fitness Most control Avoiding destructive habits Some control *These lifestyles Practicing safe sex are viewed as Managing time (priority lifestyles). Being an informed consumer Adopting good health habits Adopting good safety habits Health-care system Learning first aid Access Compliance Heredity Age Disability Least control Figure 1  c  Determinants of health, fitness, and wellness.

Concept 2  c  Determinants of Lifelong Health, Wellness, and Fitness    17 HELP Health is available to Everyone 17 percent of those under 30. Older adults have 36 percent for a Lifetime, and it’s Personal more unhealthy days than young adults. According to the National Institutes of Health, although genes do not necessarily cause diseases, they do influ- Age is shaded in dark blue in Figure 1 because it is a ence our risk of developing diseases, such as cancer, factor that you cannot control. However, healthy lifestyles heart disease, and addiction. Research on the interactions can reduce the effects of aging on health, wellness, and fit- between our genes and our health is promising but ness. As discussed in more detail later, healthy lifestyles can controversial. (See link in Suggested Resources and extend life and have a positive effect on quality of life. Readings.) Would knowing you were genetically predisposed to a Disabilities can affect, but they do not necessarily particular disease change the lifestyle decisions you make? limit, health, wellness, and fitness. Disabilities typically result from factors beyond your control (shaded in dark blue ACTIVITY in Figure 1). Many types of disabilities affect health, fitness, and wellness. An objective disability (e.g., loss of a limb, each dimension of health-related physical fitness, includ- impaired intellectual functioning) can make it difficult to ing our tendencies to build muscle and to deposit body function in certain circumstances but need not limit health, fat. Each of us reaps different benefits from the same wellness, and fitness. All people have a limitation of one healthy lifestyles, based on our hereditary tendencies. kind or another. Societal efforts to help all people function Even more important is that predispositions to diseases within their limitations can help everyone, including people are inherited. For example, some early deaths are a result with disabilities, to have a positive outlook on life and expe- of untreatable hereditary conditions (e.g., congenital heart rience a high quality of life. defects). Obviously, some inherited conditions are man- ageable (e.g., diabetes) with proper medical supervision The health-care system affects our ability to overcome and appropriate lifestyles. Heredity is a determinant over illness and improve our quality of life. Approximately which we have little control; therefore, it is illustrated in 10 percent of unnecessary deaths occur as a result of dispari- dark blue in Figure 1. Each of us can limit the effects of ties in the health-care system. The quality of life for those heredity by being aware of our personal family history and who are sick and those who tend to be sick is influenced by making efforts to best manage those factors over which greatly by the type of medical care they receive. Health care we do have  control. In the Concepts that follow, you will is not equally available to all. Each year, thousands of people learn more about heredity and how it affects health, well- die because they lack health insurance. Uninsured individ- ness, and fitness. uals may not seek health care, and the quality of the care Health, wellness, and fitness are influenced by the they do receive may not be high. Chronic conditions that aging of our population. In 2030, when all of the post– go undetected can become untreatable or lead to additional World War II baby boomers will be over the age of 65, complications. The passage of the Affordable Health Care adults 65 or older will make up 20 percent of the population. Act addressed this issue by enabling all Americans to have The number of people over 85 will triple by 2050. In the health insurance. The percentage of uninsured Americans United States there are currently more than 100,000 people has fallen from 22 percent in 2013 to the current rate over the age of 100. The definition of old is changing, with of approximately 15 percent. most people believing that a person is not old until age 71 or Even with coverage, many people fail to seek medical older. Nearly a quarter of the population believes that being help even when warranted, and others fail to follow medical old begins at 81. advice. For example, they do not take prescribed medicine or do not follow up with treatments. Men are less likely to Whatever the standard for being old, age is a factor over seek medical advice than women. For which we have no control. The major health and wellness this reason, treatable conditions some- concerns of older adults include losing health, losing the times become untreatable. Once men ability to care for oneself, losing mental abilities, running seek medical care, evidence reveals, VIDEO 2 out of money, being a burden to family, and being alone. Chronic pain is also a major problem among older adults. they get better care than women. Also, Nearly 30 percent of adults over 65 experience chronic pain, more of the medical research has been done on men. This as opposed to 3 percent of those under 30. Nearly 60 percent is of concern because treatments for men and women often of older adults experience frequent pain, as opposed to vary for similar conditions. Wellness as evidenced by quality of life is also influenced by the health-care system. Traditional medicine, sometimes referred to as the medical model, has focused primarily on the treatment of illness with medicine, rather than ill- ness prevention and wellness promotion. Efforts to edu- cate health-care personnel about techniques for promoting

18 Section 1  c  Lifestyles for Health, Wellness, and Fitness A CLOSER LOOK Poor Health Status in the United States health care), health behaviors (e.g., poor diet and exercise habits), social and economic conditions (e.g., education system and high The United States is one of the wealthiest countries in the world poverty), and unhealthy environments (e.g., walkability and fast but far from the healthiest. Research from the National Academy food). (See link in Suggested Resources and Readings.) of Sciences indicates that Americans are less healthy than people in 16 other developed countries. We have higher rates of chronic What do you think is the most important determinant? Which diseases, are more likely to be murdered or to die in car acci- of the determinants do you personally have most control dents, and are more likely to be overweight than people in other over? Which one do you have least control over? countries. This has been attributed to a number of key deter- minants including health systems (e.g., differences in access to ACTIVITY wellness have been initiated in recent years. Still, it is often over heredity, age and disability (and limited control over up to the patient to find information about health promotion. health care and the environment), but there are things you can For example, a patient with risk factors for heart disease do to take control over your lifestyle. You can use your cogni- might be advised to eat better or to exercise more, but little tive abilities to learn about your family history and use that specific information may be offered. In Figure 1, the health- information to limit the negative influences of heredity. You care system is in light blue to illustrate the fact that it is a can learn how to adapt to disabilities and personal limitations, factor over which you may have limited control. as well as to the aging process. You can research the health- care system and seek out healthy opportunities and options The environment is a major determinant affecting our even in unhealthy environments. health, wellness, and fitness. Environmental determi- Your personal interactions also influence your health, nants account for nearly one-fourth of all early deaths and wellness, and fitness. You are not alone in this world. Your affect quality of life in many ways. We do have more control various environments, and how you interact with them, over environmental factors than heredity, but they are not influence you greatly. You have a choice about the envi- totally under our control. For this reason, the environmental ronments in which you place yourself and the people with factors box is depicted in Figure 1 with a lighter shade of whom you interact in these environments. blue than the heredity, age, and disability box. Humans have the ability to think (cognitions) and to use critical thinking to make choices and to determine You can exert personal control by selecting healthy envi- the actions they take and the interactions they engage in. ronments rather than by exposing yourself to unhealthy or Emotions also affect personal actions and interactions. unsafe environments. This includes your choice of living A major goal of Concepts of Fitness and Wellness is to and work location, as well as the social, spiritual, and intel- help you use your cognitive abilities to solve problems and lectual environments. On the other hand, circumstances may make good decisions about good health, wellness, and fit- make it impossible for you to make the choices you would ness, as well as to help you to be in control of your emo- prefer. Important environmental determinants will be dis- tions when taking action and making decisions that affect cussed many times, particularly in the Concept on moderate your health. physical activity and the final Concept. Some suggestions None of us makes perfect decisions all of the time. Some- for how you can work to alter the environment in a positive times we take actions and make choices based on inadequate way are specifically discussed in the last Concept. information, faulty thinking, pressure from others, or negative influences from our emotions. While Determinants over Which You the focus of Concepts that follow is on Have Greater Control healthy lifestyles, all of the factors that influence health, wellness, and fitness VIDEO 3 Personal actions, interactions, cognitions, and emotions all have an effect on health, wellness, and fitness. Some are important to consider. The goal is people think that good health, wellness, and fitness are totally to help you consider all factors and to make informed deci- out of personal control. Others think that they are totally in sions that will lead to healthful behaviors. Some strategies control. Neither statement is entirely true. You have no control for action for each of the factors are presented in the final Concept.

Concept 2  c  Determinants of Lifelong Health, Wellness, and Fitness    19 In the News The Built Environment and Obesity The environment we live and work in can to recreation facilities and proximity to grocery stores partially directly impact our health. Many studies have explain the lower body fat levels of more educated and wealthier documented that characteristics of the “built environment” are individuals. (See link in Suggested Resources and Readings.) associated with lifestyle behaviors. For example, access to healthy How does the environment influence your ability to be active foods and the availability of walking routes make it easier to make and to eat healthfully? What can you do to find healthier healthy choices. It has been challenging to demonstrate causality opportunities wherever you live? in this line of research, but a recent study confirmed that access ACTIVITY Lifestyle change, more than any other determinant, Table 1  c  Major Causes of Death in the United States is the best way to prevent illness and early death in our society. Statistics show that more than half of Current 1900 early deaths are the result of chronic diseases caused by Rank Cause Rank Cause unhealthy lifestyles. Many of these chronic diseases are tar- geted in the HP2020 report, and many of the new health  1 Heart disease  1 Pneumonia* objectives focus on them. As shown in Figure 1, these lifestyles affect health, wellness, and physical fitness. The  2 Cancer  2 Tuberculosis* double-headed arrow between health/wellness and physi- cal fitness illustrates the interaction between these factors.  3 Lower respiratory  3 Diarrhea/enteritis* Physical fitness is important to health and wellness devel- disease opment and vice versa.  4 Stroke  4 Heart disease The major causes of early death have shifted from infectious diseases to chronic lifestyle-related  5 Injuries/accidents  5 Stroke conditions. Scientific advances and improvements in medi- cine and health care have dramatically reduced the incidence  6 Alzheimer’s disease  6 Liver disease of infectious diseases over the past 100 years (see Table 1). Diphtheria and polio, both major causes of death in the 20th  7 Diabetes  7 Injuries century, have been virtually eliminated in Western culture. Smallpox was globally eradicated in 1977.  8 Influenza/pneumonia*  8 Cancer Infectious diseases have been replaced with chronic  9 Kidney disease  9 Senility lifestyle-related conditions as the major causes of death. Four of the top seven current causes of death (heart disease, 10 Suicide 10 Diphtheria* cancer, stroke, and diabetes) fall into this category. While heart disease remains the leading killer among all adults, *Infectious diseases: The only diseases among the top 10 that are primarily National Cancer Institute statistics indicate that cancer is the infectious in nature today are influenza/pneumonia. leading cause of death for adults under the age of 85. Death Data from the Centers for Disease Control and Prevention (CDC). rates have recently decreased for 8 of the top 10 causes of death. The incidence of kidney disease was unchanged, and Healthy lifestyles are critical to wellness. Just as suicide increased 1 percent. unhealthy lifestyles are the principal causes of modern- day illnesses, such as heart disease, cancer, and diabetes, HIV, formerly in the top 10, has now dropped out of the healthy lifestyles can result in the improved feeling of well- top 15 causes of death primarily because of the develop- ness that is critical to optimal health. The CDC uses the term ment of new treatments and prevention methods. It remains eighth among those aged 25–44. Many among the top 10 are Medical Model  The focus of the health-care system on treating referred to as chronic lifestyle-related conditions because illness with medicine, with little emphasis on prevention or well- healthy lifestyles can help reduce associated risks. ness promotion.

20 Section 1  c  Lifestyles for Health, Wellness, and Fitness health-related quality of life to describe the wellness benefits Table 2  c  Actual Causes of Death in the United States of healthy lifestyles. This well-being, or wellness, is associ- ated with social, emotional/mental, spiritual, and physical Rank Actual Cause Percentage of Deaths functioning. Being physically active and eating well are two healthy lifestyles that can improve well-being and add years  1 Inactivity/poor nutrition 18 of quality living. Many of the healthy lifestyles associated with good physical fitness and optimal wellness will be dis-  2 Tobacco use 15 cussed in detail later. The Healthy Lifestyle Questionnaire in Lab 2A at the end of this Concept gives you the opportunity  3 Alcohol misuse 3 to assess your current lifestyles.  4 Medical errors 3 Regular physical activity, sound nutrition, and stress  5 Toxic agents 2.5 management are priority healthy lifestyles. Three of  6 Microbial agents 2 the lifestyles listed in Figure 1 are considered to be prior- ity healthy lifestyles: engaging in regular physical activity  7 Firearms 1.5 or exercise, eating well, and manag-  8 Sexual behavior 1 ing stress. There are several reasons for placing priority on these lifestyles.  9 Motor vehicles 1 First, they affect the lives of all people. VIDEO 4 10 Illicit drug use ,1 Second, they are lifestyles in which large numbers of people can make improvement. Finally, Note: Other factors account for the remaining 52 percent of the causes. modest changes in these behaviors can make dramatic Sources: National Research Council and Institute of Medicine (2015). improvements in individual and public health. The other healthy lifestyles listed in Figure 1 are also important for good health. The reason that they are not TECHNOLOGY UPDATE emphasized as priority lifestyles is that they do not affect everyone as much as the first three do. Many healthy life- Podcasts styles will be discussed in the Concepts that follow, but the focus is on the priority healthy lifestyles because virtually Numerous health agencies post audio podcasts to pro- all people can achieve positive wellness benefits if they vide health information to professionals and consumers. adopt them. Podcasts can provide a great source of information about health, wellness, and fitness, but you have to know where The “actual causes” of most deaths are due to to look and what you are looking for. The most popular unhealthy lifestyles. As illustrated in Table 1, chronic dis- podcasts may not always be the most accurate or appro- eases (e.g., heart diseases, cancer) are the direct causes of priate. Thus, look for podcasts from reliable sources, such most deaths in our society. Public health experts have used as the American Council on Exercise (ACE), the Centers for epidemiological statistics to show that unhealthy lifestyles Disease Control and Prevention (CDC), the U.S. Food and such as tobacco use, inactivity, and poor eating actually cause Drug Administration (FDA), Johns Hopkins Medical Center, the chronic diseases and for this reason are referred to as the Journal of the American Medical Association, Mayo the “actual causes of death.” A recent report of the National Clinic, Medscape, National Public Radio (NPR), USA.gov, Research Council and the Institute of Medicine indicates and the U.S. Department of Agriculture (USDA). that inactivity and poor nutrition (combined) are the lead- Do you think you would use podcasts for health-related information? Why or why not? ing actual cause of death in the United States (see Table 2). Tobacco use, previously the leading cause of actual death, is now the second leading cause. Tobacco use has decreased over the past several decades, but poor dietary habits and ACTIVITY lack of adequate exercise have increased. Destructive hab- its (tobacco use, alcohol misuse, illicit drug use, and unsafe Physical Activity Generally considered to be a broad term sexual behavior) account for 20 percent, factors related to used to describe all forms of large muscle movements, including health care (medical errors and microbial agents) account for sports, dance, games, work, lifestyle activities, and exercise for 5 percent, and accidents (firearms, toxic agents, motor vehi- fitness. Although they have slightly different definitions, exer- cles) account for 5 percent of prema- cise and physical activity are sometimes interchangeably to make ture deaths in the United States. Most reading less repetitive and more interesting. of these are determinants over which Exercise  Physical activity done for the purpose of getting physi- you have considerable control. VIDEO 5 cally fit.

Concept 2  c  Determinants of Lifelong Health, Wellness, and Fitness    21 Strategies for Action Self-assessments of lifestyles will help you assess your current lifestyle behaviors to determine if they you determine areas in which you are contributing positively to your health, wellness, and fitness. may need changes to promote optimal health, wellness, and As you continue your study, refer back to this questionnaire to fitness. The Healthy Lifestyle Questionnaire in Lab 2A will help see if your lifestyles have changed. ACTIVITY Suggested Resources ∙∙∙∙ Healthy People 2020: Social Determinants of Health. and Readings Johns Hopkins Medicine: PodMed Health and Medicine Podcasts. National Library of Medicine: Genetic Ancestry Testing. The websites for the following sources can be accessed by searching National Research Council and Institute of Medicine. (2013). online for the organization, program, or title listed. Specific scientific references are available at the end of this edition of Concepts of U.S. Health in International Perspective: Shorter Lives, Poorer Fitness and Wellness. Health. Institute of Medicine. Washington, DC: National ∙ Centers for Disease Control and Prevention. (2011). Impact of the Academies Press. Built Environment on Health (pdf). ∙ National Research Council and Institute of Medicine. (2015). Measuring the Risks and Causes of Premature Death. Washington, ∙ Centers for Disease Control and Prevention. (2014). Health- DC: National Academies Press. Related Quality of Life. Atlanta: CDC.



Lab 2A  Healthy Lifestyle Questionnaire Name Section Date Lab 2A Purpose: To assess the current status of various lifestyle behaviors and to help you make decisions concerning good health and wellness for the future. Procedures Healthy Lifestyle Questionnaire 1. Complete the Healthy Lifestyle Questionnaire on the next page by answering “Almost Never,” “Sometimes,” or “Almost Always” to each of the questions. If your behavior is not consistent, or you feel you are between the extremes, then choose the middle option (“Sometimes”). 2. For each of the 10 habits, sum the scores in the adjacent Total box. 3. Sum the 10 composite scores to create a Total Lifestyle Rating. 4. Record your scores in the Results section below. 5. Use the Healthy Lifestyle Rating Chart to determine your ratings. Add the ratings to the Results section. 6. Answer the question in the Conclusions and Implications section. Results Healthy Lifestyle Rating Chart Lifestyle Behavior Score Rating Habit Rating Score Physical Activity Habits Good Lifestyle 5–6 Nutrition Habits Neutral Lifestyle 3–4 Stress-Management Habits Needs improvement 1–2 Destructive Habits Safety Habits Total Score Rating 45–60 First Aid Habits Good Lifestyle 30–45 Health Habits Neutral Lifestyle ,30 Medical Habits Needs improvement Consumer Habits Environmental Habits Total Score Note: Your scores on the Healthy Lifestyle Questionnaire should be interpreted carefully. The statements are intended to provide a simple self-evaluation and are not designed as a screening or diagnostic tool. The various lifestyle behaviors pose different types of risks. For example, using tobacco or abusing drugs has immediate and significant negative effects on health and wellness, whereas other health lifestyles and skills, such as knowing first aid, may have more subtle and less direct effects. Therefore, it is important not to compare scores on the different scales. The goal is to evaluate your overall profile and identify areas where you are doing well and areas that may need improvement. 23

Healthy Lifestyle Questionnaire Almost Never Sometimes Almost Always Total 1 2 3 Lab 2A Directions: Place a number in the box to the right of each question. Sum the two numbers to get a score for each habit. Sum the habit scores to get a total score. Physical Activity Habits 1. I perform physical activity most days of the week (or vigorous 3 days). 2. I perform some exercises for muscle fit- ness (at least 2 days a week). Healthy Lifestyle Questionnaire Nutrition Habits 1 3. I consume 4–5 servings of fruits and veg- etables per day. 4. I monitor the amount of fat in my diet. S tress-Management Habits 1 5. I am able to identify situations in daily life that cause stress. 6. I take time out during the day to relax and recover from daily stress. Destructive Habits 1 7. I do not smoke or use other tobacco products. 8. I do not binge drink or abuse alcohol. S afety Habits 1 9. I use seat belts and adhere to the speed limit when I drive. 10. I avoid risky environments and situations. F irst Aid Habits 1 11. I can perform CPR if called on in an emergency. 12. I can perform basic first aid if needed in an emergency. H ealth Habits 1 13. I brush my teeth at least twice a day and floss at least once a day. 14. I get an adequate amount of sleep each night. M edical Habits 1 15. I do regular self-exams and have regular medical checkups. 16. I seek and follow medical advice when needed and prescribed. Consumer Habits 1 17. I read product labels and make careful decisions before I buy. 18. I avoid using questionable products or programs. 24

Healthy Lifestyle Questionnaire Almost Never Sometimes Almost Always Total Environmental Habits 1 2 3 1 19. I recycle paper, glass, and aluminum. 5 Lab 2A 20. I look for ways to conserve energy and protect the environment. Total Lifestyle Rating Note: These 10 habits capture only a sample of important lifestyle behaviors. A number of other potentially harmful behaviors are intentionally excluded due Healthy Lifestyle Questionnaire to their personal nature (such as the use and abuse of drugs, sexual practices, drinking and driving). Use the framework from this lab to think critically about your lifestyle behaviors and how you can work to improve them. Conclusions and Implications: In the space below, summarize the overall status of your lifestyle behaviors and indicate your strengths (areas where you are adopting healthy lifestyles) and concerns (areas where you may need to improve). 25



Self-Management and Self-Planning Concept 3 Skills for Health Behavior Change LEARNING OBJECTIVES After completing the study of this Concept, you will be able to: c Identify and define the five stages of change and explain how the stages relate to making lifestyle changes. c Describe the four key factors that influence health behaviors, describe components in each category, and explain how the factors relate to stages of change. c Identify and describe the self-management skills that predispose and enable you to change and to reinforce changes once you have made them. c Identify and describe the six steps in self-planning and explain how they can be used to make personal plans for behavior change. c Conduct self-assessments of your current stages for health behaviors and your self-management skills for making health behavior change. Learning and regularly using self-management skills can help you adopt and maintain healthy lifestyles throughout life. 27