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  • ConceptSection 1L i f e s t y l e s f o r H e a l t h , F i t n e s s , a n d W e l l n e s s1Health,Wellness,Fitness, andHealthyLifestyles: AnIntroductionGood health,wellness,fitness, andhealthylifestyles areimportant forall people.

  • A Statement about National Health GoalsAt the beginning of each concept in this book is a sectioncontaining abbreviated statements of the new national healthgoals from the document Healthy People 2010: NationalHealth Promotion and Disease Prevention Objectives.These statements, established by expert groups representingmore than 300 national organizations, are intended as realis-tic national health goals to be achieved by the year 2010.These objectives for the first decade of the new millennium,are intended to improve the health of those in the UnitedStates, but they seem important for all people in NorthAmerica and in other industrialized cultures throughout theworld. The health objectives are designed to contribute tothe current World Health Organization strategy of Healthfor All. This book is written with the achievement of theseimportant health goals in mind. first national health goals were developed in1979 to be accomplished by the year 1990. Thefocus of those objectives was on reduction in the

    death rate among infants, children, adolescents, young adultsand adults. Except for reducing death rates among adoles-cents, those goals were met and the average life expectancywas increased by more than 2 years by the 1990s. Those firstnational health objectives gave way to the Healthy People2000 objectives designed to be accomplished by the turn ofthe century. The emphasis in these objectives shifted fromreduction in premature death to disease prevention andhealth promotion. While many of these objectives have beenachieved, others have yet to be accomplished.

    The goals of the Healthy People 2010 continue to focus ondisease prevention and health promotion, but have areas ofexpanded focus. First, the goals emphasize quality of life, well-being, and functional capacityall important wellness consid-erations. This emphasis is based on the World Health Organi-zation statement that It is counterproductive to evaluatedevelopment of programs without considering their impact onthe quality of life of the community. We can no longer main-tain strict, artificial divisions between physical and mentalwell-being (World Health Organization, 1995). Second, thenew national health goals take the bold step of trying toeliminate health disparities as opposed to reducing them asoutlined in Healthy People 2000. Consistent with nationalhealth goals for the new millennium, this book is designed toaid all people in adopting healthy lifestyles that will allowthem to achieve lifetime health, fitness and wellness.

    The Facts about Health and Wellness

    Good health is of primary importance toadults in our society.

    When polled about important social values, 99 percent ofadults in the United States identified being in good healthas one of their major concerns. Two other concernsexpressed most often were good family life and good self-image. The one percent who did not identify good health asan important concern had no opinion on any social issues.Among those polled, none felt that good health was unim-portant. Results of surveys in Canada and other Westernnations show similar commitments to good health.

    Health varies greatly with income, gender,age, and family origin.

    Reducing health disparities among adults over 18 is a majornational health goal. We have some distance to go in accom-plishing this goal because health varies widely depending onincome, gender, age, and family origin. Self-ratings of healthhave been shown to be good general indicators of health sta-tus. When asked to rate health as excellent, good, fair, or poor,more than a few adults indicated that their health was only fairor poor (see Figure 1). It is evident that many more people inpoor or near-poor income groups are considered to be fair orpoor in health as opposed to good or excellent. African Amer-icans and Hispanics are more often classified as fair or poor inhealth than white non-Hispanics. Minority women are alsolikely to be classified as fair or poor in health. Though notindicated in Figure 1, there is good evidence that older adultsare especially likely to report poor health and wellness. Animportant national health goal is to increase the number ofhealthy dayspeople have each month.

    Section 1 Lifestyles for Health, Fitness, and Wellness2

    Health Goals f o r t h e y e a r 2 0 1 0

    Increase quality and years of healthy life.

    Eliminate health disparities.

    Increase incidence of people reporting healthy days.

    Increase incidence of people reporting active days.

    Increase access to health information andservices for all people.


  • Increasing the span of healthy life is aprincipal health goal. principal public health goal of Westernnations is to increase the healthy life span of allindividuals. During this century, the life

    expectancy for the average person has increased by 60 per-cent. A child born in 1900 could expect to live only 47 years.By 1930, the life expectancy increased by more than 10years; currently, the average life expectancy is slightly morethan 76 years. As illustrated in Figure 2, women live longerthan men, with the difference between men and womenbecoming more dramatic with each passing decade. Unfortu-nately, the average person can expect only about 64 years ofhealthy life. Approximately 12 years are characterized asdysfunctional or lacking in quality of life (see Figure 3). Dis-ease and illness often associated with poor health limit lengthof life and contribute to the dysfunctional living.

    Health is more than freedom from illnessand disease.

    Over 50 years ago, the World Health Organization definedhealthas being more than freedom from illness, disease, anddebilitating conditions. In recent years, public health experts

    Concept 1 Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 3

    Health Health is optimal well-being that con-

    tributes to quality of life. It is more than freedom

    from disease and illness, though freedom from

    disease is important to good health. Optimal

    health includes high-level mental, social, emo-

    tional, spiritual, and physical wellness within the

    limits of ones heredity and personal abilities.

    Healthy days A self-rating of the number of

    days (per week or month) a person considers

    himself or herself to be in good or better than

    good health.


    Figure 1Fair or poor health among adults 18 and over byincome, gender, and family origin.NOTE: Percents are age adjusted.

    SOURCE: Centers for Disease Control and Prevention, National Center forHealth Statistics, National Health Interview Survey. Health United States,1998.





    Men WomenFamily income




    t (po

    or o

    r fa

    ir h







    Hispanic White,non-







    Very lowincome


    Figure 2Life expectancy.SOURCE: National Center for Health Statistics.


    50 Women










    30 40 50 60Year (decade)

    70 90 Now80


    Figure 3Years of healthy life as a proportion of lifeexpectancy (U.S. population).SOURCE: Data from National Vital Statistics Systemand National HealthInterview Survey.Centers for Disease Control and Prevention, Atlanta, GA.

    Healthy Life64 years

    Life Expectancy76.1 years

    Dysfunctional Life12.1 years

  • have identified wellnessas a sense of well-being andquality of life. Healthy People 2010 objectives use thenumber of activity days as one indicator of wellness.

    Many illnesses are manageable and haveonly limited effect on total health.

    Many illnessesare curable and may have only a temporaryeffect on health. Others, such as diabetes, are not curable butcan be managed with proper eating, physical activity, andsound medical supervision. It should be noted that thosepossessing manageable conditions may be more at risk forother health problems, so proper management is essential.For example, unmanaged diabetes is associated with highrisk for heart disease and other health problems.

    Wellness is the positive component ofoptimal health.

    Death, disease, illness, and debilitating conditions are nega-tive components that detract from optimal health. Death is theultimate opposite of optimal health. Disease, illness, anddebilitating conditions obviously detract from optimal health.Wellness has been recognized as the positive component ofoptimal health as evidenced by a sense of well-being reflectedin optimal functioning, a good quality of life, meaningfulwork, and a contribution to society (see Figure 4). Wellnessallows the expansion of ones potential to live and work effec-tively and to make a significant contribution to society.

    Health and wellness are multidimensional.

    The dimensions of health and wellness include the emo-tional (mental), intellectual, physical, social, and spiritual.

    Figure 5 illustrates the importance of each dimension tototal wellness. Throughout this book, references will bemade to these wellness dimensions (see Table 1) to helpreinforce their importance.

    Wellness reflects how one feels about life aswell as ones ability to function effectively.

    A positive total outlook on life is essential to wellness andeach of the wellness dimensions. A well person is satisfiedin his/her work, is spiritually fulfilled, enjoys leisure time, isphysically fit, is socially involved, and has a positive emo-tional-mental outlook. This person is happy and fulfilled.Many experts believe that a positive total outlook is a key towellness (see Table 2).

    The way one perceives each of the dimensions of well-ness affects total outlook. Researchers use the term self-perceptionsto describe these feelings. Many researchersbelieve that self-perceptions about wellness are moreimportant than actual ability. For example, a person whohas an important job may find less meaning and job satis-faction than another person with a much less important job.Apparently, one of the important factors for a person whohas achieved high-level wellness and a positive lifes out-look is the ability to reward himself/herself. Some people,however, seem unable to give themselves credit for theirlifes experiences. The development of a system that allowsa person to positively perceive the self is important. Ofcourse, the adoption of positive lifestyles that encourageimproved self-perceptions is also important. The question-naire in the Lab 1A will help you assess your self-perceptions of the various wellness dimensions. For opti-mal wellness, it would be important to find positive feelingsabout each dimension.

    Section 1 Lifestyles for Health, Fitness, and Wellness4

    Figure 4A model of optimal health including wellness.


    Quality ofLife




    eaningful Wor

    kContribution to Soc



    ness Wellness

    Freedom fr

    om Disease

    Freedomfrom Debilitating








    Figure 5The dimensions of health and wellness.




    Social Intellectual

  • Health and wellness are integrated states ofbeing.

    The segmented pictures of health and wellness shown inFigure 5 and Table 2 are used only to illustrate the multidi-mensional nature of health and wellness. In reality, health,

    Concept 1 Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 5

    Wellness Wellness is the integration of many

    different components (mental, social, emotional,

    spiritual, and physical) that expand ones poten-

    tial to live (quality of life) and work effectively

    and to make a significant contribution to soci-

    ety. Wellness reflects how one feels (a sense of

    well-being) about life as well as ones ability to

    function effectively. Wellness, as opposed to ill-

    ness (a negative), is sometimes described as

    the positive component of good health.

    Quality of Life A term used to describe well-

    ness. An individual with quality of life can enjoy-

    ably do the activities of life with little or no

    limitation and can function independently. Indi-

    vidual quality of life requires a pleasant and

    supportive community.

    Activity days A self-rating of the number of

    days (per week or month) a person feels that

    he/she can perform usual daily activities

    successfully and in good health.

    Illness Illness is the ill feeling and/or

    symptoms associated with a disease or circum-

    stances that upset homeostasis.

    Lifestyles Lifestyles are patterns of behavior

    or ways an individual typically lives.

    Table 1 Health and Wellness Definitions

    Emotional healthA person with emotional health is (1) free from emotional-mental illnesses or debilitatingconditions such as clinical depression and (2) possessesemotional wellness. The goals for the nations health refer tomental rather than emotional health and wellness. In thisbook, mental health and wellness are considered to be thesame as emotional health and wellness.

    Emotional wellnessEmotional wellness is a persons abil-ity to cope with daily circumstances and to deal withpersonal feelings in a positive, optimistic, and constructivemanner. A person with emotional wellness is generally char-acterized as happy, as opposed to depressed.

    Intellectual healthA person with intellectual health is freefrom illnesses that invade the brain and other systems thatallow learning. A person with intellectual health alsopossesses intellectual wellness.

    Intellectual wellnessIntellectual wellness is a personsability to learn and to use information to enhance the qualityof daily living and optimal functioning. A person with intellec-tual wellness is generally characterized as informed, asopposed to ignorant.

    Physical healthA person with physical health is free fromillnesses that affect the physiological systems of the bodysuch as the heart, the nervous system, etc. A person withphysical health possesses an adequate level of physical fit-ness and physical wellness.

    Physical wellnessPhysical wellness is a persons abilityto function effectively in meeting the demands of the dayswork and to use free time effectively. Physical wellnessincludes good physical fitness and the possession of usefulmotor skills. A person with physical wellness is generallycharacterized as fit versus unfit.

    Social healthA person with social health is free fromillnesses or conditions that severely limit functioning in soci-ety, including antisocial pathologies.

    Social wellnessSocial wellness is a persons ability tosuccessfully interact with others and to establish meaningfulrelationships that enhance the quality of life for all peopleinvolved in the interaction (including self). A person withsocial wellness is generally characterized as involved asopposed to lonely.

    Spiritual healthSpiritual health is the one component ofhealth that is totally comprised of the wellness dimension;for this reason, spiritual health is considered to be synony-mous with spiritual wellness.

    Spiritual wellnessA persons ability to establish a valuessystem and act on the system of beliefs, as well as to estab-lish and carry out meaningful and constructive lifetime goals.Spiritual wellness is often based on a belief in a force greaterthan the individual that helps one contribute to an improvedquality of life for all people. A person with spiritual wellnessis generally characterized as fulfilled as opposed tounfulfilled.

    Table 2 The Dimensions of Wellness

    Wellness Dimensions +

    Depressed Emotional-mental Happy

    Ignorant Intellectual Informed

    Unfit Physical Fit

    Lonely Social Involved

    Unfulfilled Spiritual Fulfilled

    Negative Total outlook Positive

  • Section 1 Lifestyles for Health, Fitness, and Wellness6

    Figure 6The integration of wellness dimensions.



    Sp S








    E ISp








    = Physical= Social


    = Intellectual= Emotional


    = SpiritualSp

    of people with disease, illness, and disability. The concepts ofwellness and optimal health must be considered in light ofones heredity and personal disabilities and disease states.

    Figure 7 illustrates the fact that the most desirable con-dition is buoyant health (a) including freedom from illnessand a high level of wellness. However, a person with a phys-ical illness but who possesses a good wellness (b) has a bet-ter overall health status than a person with no illness butpoor wellness (c).

    Wellness is a useful term that may be usedby quacks as well as experts.

    Unfortunately, some individuals and groups have tried toidentify wellness with products and services that promisebenefits that cannot be documented. Because well-beingis a subjective feeling that is hard to document, it is easy forquacks to make claims of improved wellness for their prod-uct or service without facts to back them up.

    Holistic healthis a term that is similarly abused. Opti-mal health includes many areas, thus the term holistic (total)is appropriate. In fact, the word healthoriginates from a rootword meaning wholeness. Unfortunately, many quacksinclude their questionable health practices under this guiseof holistic health. Care should be used when consideringservices and products that make claims of wellness and/orholistic health to be sure that they are legitimate.

    Facts about Physical Fitness

    Physical fitness is a multidimensional stateof being.

    Physical fitnessis the bodys ability to function efficiently andeffectively. It is a state of being that consists of at least fivehealth-related and six skill-related, physical fitness compo-nents, each of which contributes to total quality of life.Physical fitness is associated with a persons ability to workeffectively, enjoy leisure time, be healthy, resist hypokineticdiseases,and meet emergency situations. It is related to, but

    Figure 7Wellness need not be limited by illness.

    Illness present No illness presentNo illness




    (a) (b) (c)(a)

    and its positive component (wellness), is an integrated stateof being that is best depicted as many threads that can bewoven together to produce a larger, integrated fabric. Eachspecific dimension relates to each of the others and overlapsall others. The overlap is so frequent and so great that thespecific contribution of each thread is almost indistinguish-able when looking at the total (Figure 6). The total is clearlygreater than the sum of the parts.

    Health and wellness are individual in nature.

    Each individual is different from all others. Health and well-ness depend on each persons individual characteristics.Making comparisons to other people on specific individualcharacteristics may produce feelings of inadequacy thatdetract from ones profile of total health and wellness. Eachof us has personal limitations and personal strengths. Focus-ing on strengths and learning to accommodate weaknessesare essential keys to optimal health and wellness.

    It is possible to possess wellness while beingill or possessing a debilitating condition.

    All people can benefit from enhanced wellness. Wellnessand an improved quality of life are possible for everyone,regardless of disease states. Evidence is accumulating toindicate that people with a positive outlook are better able toresist the progress of disease and illness than those with anegative outlook. Thinking positive thoughts has been asso-ciated with enhanced results from various medical treat-ments and better results from surgical procedures.

    Because self-perceptions are important to wellness, posi-tive perceptions of self are especially important to the wellness

  • Concept 1 Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 7

    different from, health and wellness. Although the developmentof physical fitness is the result of many things, optimal physi-cal fitness is not possible without regular physical activity.

    The health-related components of physical fit-ness are directly associated with good health.

    The five components of health-related physical fitness arebody composition, cardiovascular fitness, flexibility, muscu-lar endurance, and strength (see Table 3). Each healthrelated fitness characteristic has a direct relationship to goodhealth and reduced risk of hypokinetic disease.

    Body compositionThe relative percent-age of muscle, fat,bone, and othertissues that com-prise the body. Afit person has arelatively low, butnot too low, percent-

    age of body fat (bodyfatness).

    Physical Fitness Physical fitness is the bodys

    ability to function efficiently and effectively. It con-

    sists of health-related physical fitness and skill-

    related physical fitness, which have at least 11

    different components, each of which contributes

    to total quality of life. Physical fitness also

    includes metabolic fitness (see page 9). Physical

    fitness is associated with a persons ability to

    work effectively, enjoy leisure time, be healthy,

    resist hypokinetic diseases, and meet emergency

    situations. It is related to, but different from health,

    wellness, and the psychological, sociological,

    emotional, and spiritual components of fitness.

    Although the development of physical fitness is

    the result of many things, optimal physical fitness

    is not possible without regular exercise.

    Hypokinetic Diseases or Conditions Hypo-

    means under or too little, and -kinetic means

    movement or activity. Thus, hypokinetic

    means too little activity. A hypokinetic disease

    or condition is one associated with lack of physi-

    cal activity or too little regular exercise. Examples

    of such conditions include heart disease, low

    back pain, adult-onset diabetes, and obesity.

    Table 3 Health-Related Physical Fitness Terms

    FlexibilityThe range ofmotion available in a joint.

    It is affected by musclelength, joint structure,and other factors. A fitperson can move thebody joints through afull range of motion inwork and in play.

    Muscular EnduranceThe ability of the musclesto repeatedly exert them-selves. A fit person canrepeat movements for a

    long period without unduefatigue.

    Cardiovascular fitnessThe abil-ity of the heart, blood vessels,

    blood, and respiratory systemto supply fuel and oxygen tothe muscles and the ability ofthe muscles to utilize fuel toallow sustained exercise. A fitperson can persist in physicalactivity for relatively long peri-

    ods without undue stress.

    StrengthThe abil-ity of the muscles

    to exert an exter-nal force or tolift a heavyweight. A fitperson can dowork or playthat involves

    exerting force,such as lifting or

    controlling onesown body weight.

  • Section 1 Lifestyles for Health, Fitness, and Wellness8

    Table 4 Skill-Related Physical Fitness Terms

    BalanceThe maintenance of equi-librium while stationary or whilemoving. Water skiing, performing onthe balance beam, or working as ariveter on a high-rise building areactivities that require exceptionalbalance.

    CoordinationThe ability to use thesenses with the body parts to performmotor tasks smoothly and accurately. Jug-gling, hitting a golf ball, batting a baseball,or kicking a ball are examples of activitiesrequiring good coordination.

    Reaction timeThe time elapsed betweenstimulation and the beginning of reaction to thatstimulation. Driving a racing car and starting asprint race require good reaction time.

    PowerThe ability to transfer energyinto force at a fast rate. Throwing thediscus and putting the shot are activi-ties that require considerable power.

    AgilityThe ability to rapidly and accu-rately change the direction of the move-ment of the entire body in space. Skiingand wrestling are examples of activitiesthat require exceptional agility.

    SpeedThe ability to perform a move-ment in a short period of time. A runneron a track team or a wide receiver on afootball team needs good foot and legspeed.

    Possessing a moderate amount of each component ofhealth-related fitness is essential to disease prevention andhealth promotion, but it is not essential to have exceptionallyhigh levels of fitness to achieve health benefits. High levels ofhealth-related fitness relate more to performance than healthbenefits. For example, moderate amounts of strength are nec-essary to prevent back and posture problems, whereas highlevels of strength contribute most to improved performance inactivities such as football and jobs involving heavy lifting.

    The skill-related components of physicalfitness are more associated withperformance than good health.

    The components of skill-related physical fitness areagility, balance, coordination, power, reaction time, andspeed (see Table 4). They are called skill-related becausepeople who possess them find it easy to achieve high

  • Concept 1 Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 9

    Metabolic Fitness Metabolic fitness is a

    positive state of the physiological systems com-

    monly associated with reduced risk of chronic

    diseases such as diabetes and heart disease.

    Metabolic fitness is evidenced by healthy blood

    fat (lipid) profiles, healthy blood pressure,

    healthy blood sugar and insulin levels, and other

    nonperformance measures. This type of fitness

    shows positive responses to moderate physical


    Bone Integrity Soundness of the bones

    associated with high density and absence of

    symptoms of deterioration.

    levels of performance in motor skills, such as thoserequired in sports and in specific types of jobs. Skill-relatedfitness is sometimes called sports fitness or motor fitness.

    There is little doubt that there are other abilities thatcould be classified as skill-related fitness components.Also, each part of skill-related fitness is multidimen-sional. For example, coordination could be hand-eyecoordination such as batting a ball, foot-eye coordinationsuch as kicking a ball, or any of many other possibilities.The six parts of skill-related fitness identified here arethose that are commonly associated with successfulsports and work performance. It should be noted that eachcould be measured in ways other than those presented inthis book. Measurements are provided to help the readerunderstand the nature of total physical fitness and to helpthe reader make important decisions about lifetime physi-cal activity.

    Metabolic fitness is a nonperformancecomponent of total fitness.

    Research studies show that health benefits often occur evenwithout dramatic improvements in traditional health-relatedphysical fitness measures. Metabolic fitness is a state ofbeing associated with lower risk of many chronic healthproblems, but not necessarily associated with high perfor-mance levels of health-related physical fitness. Examples ofnonperformance indicators of reduced risk are lowered bloodpressure, lowered fat levels in the blood, and better regula-tion of blood sugar. Moderate physical activity has beenshown to enhance metabolic fitness. Conventional wisdomclassifies body composition as a component of health-relatedphysical fitness, but some consider it to be a part of metabolicfitness because it is a nonperformance measure, and it ishighly related to nutrition as well as physical activity. Youwill learn how to assess your metabolic fitness in subsequentconcepts.

    Bone integrity is often considered to be anonperformance measure of fitness.

    Traditional definitions do not include bone integrity as apart of physical fitness, but some experts feel that itshould be. Like metabolic fitness, bone integrity cannotbe assessed with performance measures as can mosthealth-related fitness parts. Regardless of whether it isconsidered as a part of fitness or a component of health,there is little doubt that strong healthy bones are impor-tant to optimal health and are associated with regularphysical activity and sound diet.

    The many components of physical fitnessare specific in nature, but are alsointerrelated.

    Physical fitness is a combination of several aspects ratherthan a single characteristic. A fit person possesses at leastadequate levels of each of the health-related, skill-related,and metabolic fitness components. People who possess oneaspect of physical fitness do not necessarily possess theother aspects.

    Some relationships exist among different fitness char-acteristics, but each of the components of physical fitness isseparate and different from the others. For example, peoplewho possess exceptional strength do not necessarily havegood cardiovascular fitness, and those who have good coor-dination do not necessarily possess good flexibility. Lab 1Bis designed to help you distinguish among the differentparts of health-related and skill-related physical fitness. Aseparate questionnaire helps you estimate your current fit-ness levels.

    Good physical fitness is important too, butit is not the same as physical health andwellness.

    Good physical fitness contributes directly to the physicalcomponent of good health and wellness, and indirectly to theother four components. Good fitness has been shown to beassociated with reduced risk of chronic diseases such ascoronary heart disease and has been shown to reduce the

  • Section 1 Lifestyles for Health, Fitness, and Wellness10

    consequences of many debilitating conditions. In addition,good fitness contributes to wellness by helping us look ourbest, feel good, and enjoy life. Other physical factors can alsoinfluence health and wellness. For example, having goodphysical skills enhances quality of life by allowing us to par-ticipate in enjoyable activities such as tennis, golf, and bowl-ing. While fitness can assist in performing these activities,regular practice is also necessary. Another example is theability to fight off viral and bacterial infections. While fitnesscan promote a strong immune system, other physical factorscan influence our susceptibility to these and other conditions.

    For optimal health and wellness it is important to havegood physical fitness andphysical wellness. It is also impor-tant to strive for good emotional (mental), social, spiritual,and intellectual health and wellness.

    The Facts about HealthyLifestyles

    Lifestyle change, more than any otherfactor, is considered to be the best way ofpreventing illness and early death in oursociety.

    When people in Western society die before the age of 65, itis considered to be early or premature death. Many factorscontribute to early death in Western culture. By far the mostimportant is unhealthy lifestyles that contribute to more thanone-half of all early deaths. Eleven healthy lifestyles havebeen identified that are associated with reduced disease risk

    and increased wellness. As shown in Figure 8, theselifestyles affect health, wellness, and physical fitness. Thedouble-headed arrow between health and wellness andphysical fitness illustrate the interaction between these fac-tors. Physical fitness is important to health and wellnessdevelopment, and vice versa. Others factors, some not asmuch in your control as healthy lifestyles, also affect yourhealth, fitness, and wellness. These factors include environ-mental factors (e.g., pollution, contaminants in the work-place), human biology (inherited conditions), and inadequa-cies in the health-care system, to name but a few.

    Figure 8Factors influencing health, wellness, and physical fitness.


    Regular physical activityEating wellManaging stressAvoiding destructive habitsPracticing safe sexAdopting good safety habitsLearning first aidAdopting good personal health habitsSeeking and complying with medical adviceBeing an informed consumerProtecting the environment

    Healthy lifestyles

    HeredityEnvironmentPoor medicalcare

    Other factors




    Exercise provides an opportunity for socialinvolvement.

  • Concept 1 Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 11

    The major causes of early death haveshifted from infectious diseases to chroniclifestyle-related conditions. advances and improvements in medi-cine and health care have dramatically reducedthe incidence of infectious diseases over the past

    100 years (see Table 5). For example, new drugs have dra-matically reduced deaths from pneumonia and influenza.Small pox, a major cause of death less than a century ago,was globally eradicated in 1977 because of the advent ofimmunizations. Other examples are the virtual eliminationof diphtheria and polio in the United States and Canada.

    As infectious diseases have been eliminated, other ill-nesses have replaced them as the leading causes of earlydeath in Western culture. HIV/AIDS, formerly eighth on thelist, has dropped from the top ten, not because of fewer newcases, but because of new treatments that increase length oflife among those who are infected. Many among the top tenare referred to as chronic lifestyle related conditions becausealteration of lifestyles can result in reduced risk for theseconditions.

    Healthy lifestyles are critical to wellness.

    Just as unhealthy lifestyles are the principal causes ofmodern-day illnesses such as heart disease, cancer, anddiabetes, healthy lifestyles can result in an improved

    feeling of wellness that is critical to optimal health. In rec-ognizing the importance of years of healthy life, the Pub-lic Health Service also recognizes what it calls measures ofwell-being. This well-being or wellness is associated withsocial, mental, spiritual, and physical functioning. Beingphysically active and eating well are two examples ofhealthy lifestyles that can improve well-being and add yearsof quality living. Many of the healthy lifestyles associatedwith good physical fitness and optimal wellness will be dis-cussed in detail later in this book. The Healthy LifestyleQuestionnaire at the end if this concept gives you the oppor-tunity to assess your current lifestyles.

    Regular physical activity, sound nutrition,and stress management are considered to bepriority healthy lifestyles.

    Three of the healthy lifestyles listed in Figure 8 are consid-ered to be priority healthy lifestyles. These are regular phys-ical activity (exercise), eating well, and managing stress.There are several reasons for placing priority on theselifestyles. First, they are behaviors that affect the lives of allpeople. Second, they are lifestyles in which large numbersof people can make improvement. Finally, modest changesin these behaviors can make dramatic improvements in indi-vidual and public health.

    To be sure, the other healthy lifestyles listed in Figure 8are important. For example people who use tobacco, abusedrugs (including alcohol), or practice unsafe sex can haveimmediate and dramatic health benefits by changing thesebehaviors. On the other hand, large segments of the popula-tion do not have problems in these areas. Obviously, thesepeople cannot benefit from lifestyle changes in these areas.However, the majority of the population can benefit from

    Exercise Exercise is defined as physical

    activity done for the purpose of getting

    physically fit.

    Physical activity is generally considered to be

    a broad term used to describe all forms of large

    muscle movements including sports, dance,

    games, work, lifestyle activities, and exercise

    for fitness. In this book, exercise and physical

    activity will often be used interchangeably to

    make reading less repetitive and more interest-


    Table 5 Major Causes of Death

    1900 CurrentRank Cause Rank Cause

    1. Pneumonia 1. Heart disease

    2. Tuberculosis 2. Cancer

    3. Diarrhea/enteritis 3. Stroke

    4. Heart disease 4. Bronchitis/emphysema

    5. Stroke 5. Injuries

    6. Liver disease 6. Pneumonia/influenza

    7. Injuries 7. Diabetes

    8. Cancer 8. Suicide

    9. Senility 9. Chronic Liver Disease

    10. Diphtheria 14. HIV/AIDS*

    *Formerly 8thSOURCE: National Center for Health Statistics.


  • A personal philosophy that emphasizesHealth can lead to behaviors that promote it.

    The H in HELP stands for health. One theory that hasbeen extensively tested indicates that people who believein the benefits of healthy lifestyles are more likely toengage in healthy behaviors. The theory also suggests thatpeople who state intentions to put their beliefs in actionare likely to adopt behaviors that lead to health, wellness,and fitness.

    Everyone can benefit from healthylifestyles.

    The E in HELP stands for everyone. Accepting the factthat anyone can change a behavior or lifestyle means thatYOUare included. Nevertheless, many adults feel ineffec-tive in making lifestyle changes. Physical activity is not justfor athletesit is for all people. Eating well is not just forother peopleyou can do it too. All people can learn stress-management techniques. Healthy lifestyles can be practicedby everyone. As noted earlier in this concept, importanthealth goals include eliminating health disparities and pro-moting Health for All.

    Healthy behaviors are most effective whenpracticed for a L ifetime.

    The L in HELP stands for lifetime. Young people some-times feel immortal because the harmful effects of unhealthylifestyles are often not immediate. As we grow older, webegin to realize that we are not immortal and that unhealthylifestyles have cumulative negative effects. Starting early inlife to emphasize healthy behaviors results in long-term

    increasing their activity level, eating a better diet, and man-aging personal stress. For example, statistics suggest thatmodest changes in physical activity patterns and nutritioncan prevent more than 200,000 premature death annually.Similarly, learning to manage stresses that all of us face ona daily basis can result in significant reductions in morethan a few health problems. Stress has a major impact ondrug, alcohol, and smoking behavior so managing stresscan help individuals minimize or avoid these behaviors.Many healthy lifestyles will be discussed in this book, butthe focus is on the priority healthy lifestyles because virtu-ally all people can achieve positive wellness benefits if theyadopt them.

    The change in causes of illness and the newemphasis on fitness, wellness, and healthylifestyles have resulted in a shift towardprevention and promotion.

    Early medicine focused on treatment of disease. Physicianswere scarce and were consulted only when illness occurred.A shift toward prevention began with advancements inmedical science (e.g., immunizations, antibiotics) and thedevelopment of public health efforts (e.g., safe water sup-plies). Now more than at any other time in history, effortsare being made to promote healthy lifestyles that lead to fit-ness and wellness. In this text, the emphasis will be onstrategies for preventing chronic diseases and promotingfitness and wellness.

    The HELP Philosophy: The Facts

    The HELP philosophy can provide a basisfor making healthy lifestyle changepossible.

    The four-letter acronym illustrated in Table 6 provides abasis for a philosophy that has helped thousands of peopleadopt healthy lifestyles. Each letter in the word HELP char-acterizes an important part of the philosophy.

    Section 1 Lifestyles for Health, Fitness, and Wellness12

    Table 6 The HELP Philosophy

    H = Health

    E = Everyone

    L = Lifetime

    P = Personal

  • health, wellness, and fitness benefits. One recent study showsthat the longer healthy lifestyles are practiced, the greater thebeneficial effects. This study also demonstrated that long-term healthy lifestyles can even overcome hereditary predis-position to illness and disease.

    Healthy lifestyles should be based onPersonal needs.

    The P in HELPstands for personal. No two people are exactlyalike. Just as there is no single pill that will cure all illnesses,there is no single lifestyle prescription for good health, wellness,and fitness. It is important for each person to assess personalneeds and make lifestyle changes based on those needs.

    Strategies for Action: The Facts

    Self-assessments of lifestyles will help youdetermine areas in which you may needchanges to promote optimal health,wellness, and fitness.

    As you begin your study of health, wellness, fitness, andhealthy lifestyles, it is wise to make a self-assessment of

    your current behaviors. The Healthy Lifestyle Question-naire in the lab resource materials will allow you to assessyour current lifestyle behaviors to determine if they arecontributing positively to your health, wellness, and fitness.Because this questionnaire contains some very personalinformation, answering all questions honestly will help youget an accurate assessment. As you continue your study,you may want to refer back to this questionnaire to see ifyour lifestyles have changed.

    Initial self-assessments of wellness andfitness will provide information for self-comparison. Healthy Lifestyle Questionnaire allows youto assess your lifestyles or behaviors. It is alsoimportant to assess your wellness and fitness at

    an early stage. These early assessments will only be esti-mates. As you continue your study, you will have theopportunity to do more comprehensive self- assessmentsthat will allow you to see how accurate your early esti-mates were.

    In Lab 1A you will estimate your wellness using aWellness Self-Perceptions Questionnaire, which assessesfive wellness dimensions. Remember, wellness is a stateof being that is influenced by healthy lifestyles. Becauseother factors such as heredity, environment, and healthcare affect wellness, it is possible to have good wellnessscores even if you do not do well on the lifestyle ques-tionnaire. However, over a lifetime, unhealthy lifestyleswill catch up with you and have an influence on yourwellness and fitness.

    Lab 1B allows you to get a better understanding ofthe different components of health-related and skill-related physical fitness. You will perform some simplestunts to help you distinguish among the different fitnessparts. You can use these as a basis for estimating yourcurrent fitness levels. Later, you will use more accuratetests to get a good assessment of your fitness. Like well-ness, fitness is a state of being that is influenced byhealthy lifestyles, especially regular physical activity.Young people sometimes have relatively good fitnessespecially skill-related fitnesseven if they have notbeen doing regular activity. Over a lifetime, inactivitygreatly influences your fitness.

    Concept 1 Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 13

    Physical activity is for everyone.


  • Web ReviewWeb review materials for Concept 1 are available are

    AMA Health

    Mayo Health


    Wellness Interactive

    Healthy People

    Centers for Disease Prevention and Control (CDC)

    Section 1 Lifestyles for Health, Fitness, and Wellness14

    WEB Suggested ReadingsClement, M. and Hales, D. How Healthy Are We? Parade Magazine.Sep-

    tember 7, 1998, 4.Corbin, C. B. and Pangrazi, R. P. (Editors), Towards a Better Understand-

    ing of Physical Fitness and Activity.Scottsdale, AZ: Holcomb-Hath-away, 1998.

    National Center for Health Statistics. Health, United States, 1998: WithSocioeconomic Statistics and Health Chartbook.Hyattsville, MD:National Center for Health Statistics, 1998.

    Payne, W. A. & Hahn, D. B. Understanding Your Health.(5th ed.) St.Louis: WCB/McGraw-Hill, 1998.

    U.S. Department of Health and Human Services. Physical Activity andHealth: A Report of the Surgeon General.Atlanta, GA: U.S. Depart-ment of Health and Human Services, 1996.

    U.S. Department of Health and Human Services. Healthy People 2010Objectives: Draft for Comments.Washington, DC:U.S. Departmentof Health and Human Services, 1998.

  • Concept 1 Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 15

    Lab Resource Materials: The Healthy Lifestyle Questionnaire

    The purpose of this questionnaire is to help you analyze your lifestyle behaviors and to help you in making deci-sions concerning good health and wellness for the future. Information on this Healthy Lifestyle Questionnaire isof a very personal nature. For this reason, this questionnaire is not designed to be submitted to your instructor. Itis for your information only. Answer each question as honestly as possible and use the scoring information to helpyou assess your lifestyle.

    Directions: Place an X over the yes circle to answer yes. If you answer no, make no mark. Score the ques-tionnaire using the procedures that follow.

    1. I accumulate 30 minutes of moderate physicalactivity most days of the week (brisk walking,climbing the stairs, yard work, or home chores).

    2. I do vigorous activity that elevates my heartrate for 20 minutes at least three days a week.

    3. I do exercises for flexibility at least three days aweek.

    4. I do exercises for muscle fitness at least twodays a week.

    5. I eat three regular meals each day.

    6. I select appropriate servings from the food guidepyramid each day.

    7. I restrict the amount of fat in my diet.

    8. I consume only as many calories as I expendeach day.

    9. I am able to identify situations in daily life thatcause stress.

    10. I take time out during the day to relax andrecover from daily stress.

    11. I find time for family, friends and things I espe-cially enjoy doing.

    12. I regularly perform exercises designed to relievetension.

    13. I do not smoke or use other tobacco products.

    14. I do not abuse alcohol.

    15. I do not abuse drugs (prescription or illegal).

    16. I take over-the-counter drugs sparingly and usethem only according to directions.

    17. I abstain from sex or limit sexual activity to asafe partner.

    18. I practice safe procedures for avoiding STDs.

    19. I use seat belts and adhere to the speed limitwhen I drive.

    20. I have a smoke detector in my home and check itregularly to see that it is working.

    21. I have had training to perform CPR if called onin an emergency.

    22. I can perform the Heimlich maneuver effec-tively if called on in an emergency.

    23. I brush my teeth at least two times a day andfloss at least once a day.

    24. I get an adequate amount of sleep each night.

    25. I do regular self-exams, have regular medicalcheck-ups, and seek medical advice when symp-toms are present.

    26. When I receive advice and/or medication from aphysician, I follow the advice and take the med-ication as prescribed.

    27. I read product labels and investigate their effec-tiveness before I buy them.

    28. I avoid using products that have not been shownby research to be effective.

    29. I recycle paper, glass or aluminum.

    30. I practice environmental protection such as carpooling and conserving energy.

    Overall ScoreTotal Yes Answers































  • Section 1 Lifestyles for Health, Fitness, and Wellness16

    Scoring: Give yourself one point for each yes answer. Add your scores for each of the lifestyle behaviors. To calculate youroverall score, sum the totals for all lifestyles.

    Avoiding AdoptingPhysical Managing Destructive Practicing SafetyActivity Nutrition Stress Habits Safe Sex Habits

    1 5 9 13 17 19

    2 6 10 14 18 20

    3 7 11 15

    4 8 12 16

    Total + Total + Total + Total + Total + Total +

    Personal Using Being an Sum All Knowing Health Medical Informed Protecting the Totals forFirst Aid Habits Advice Consumer Environment Overall Score

    21 23 25 27 29

    22 24 26 28 30

    Total + Total + Total + Total + Total =

    Interpreting Scores:Scores of 3 or 4 on the four-itemscales are indicative of generally positive lifestyles. For thetwo-item scales, a score of 2 would indicate the presence ofpositive lifestyles. An overall score of 26 or more would bea good indicator of healthy lifestyle behaviors. It is impor-tant to consider the following special note when interpretingscores.

    Special Note:Your scores on the Healthy LifestyleQuestionnaire should be interpreted with caution. There areseveral reasons for this. First, all lifestyle behaviors do notpose the same risks. For example, using tobacco or abusingdrugs has immediate negative affects on health and

    wellness, while others, such as knowing first aid, may haveonly occasional use. Second, you may score well on oneitem in a scale, but not on another. If one item indicates anunhealthy lifestyle in an area that poses a serious health risk,your lifestyle may appear to be healthier than it really is. Forexample, you could get a score of 3 on the destructive habitsscale and be a regular smoker. For this reason, the overallscore can be particularly deceiving.

    Strategies for Change:In the space below, you may wantto make some notes concerning the healthy lifestyle areas inwhich you could make some changes. You can refer to thesenotes later to see if you have made progress.

  • Concept 1 Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 17


    b 1



    ess S





    Purpose: To assess self-perceptions of wellness.

    Procedures:1. Place an X over the appropriate circle for each question (4 = strongly agree, 3 = agree, 2 = disagree, 1 = 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 and Conclusions and Implications sections.

    Strongly StronglyQuestion Agree Agree Disagree Disagree Score

    1. I am happy most of the time. 4 3 2 1

    2. I have good self-esteem. 4 3 2 1

    3. I do not generally feel stressed. 4 3 2 1

    Emotional Wellness Total =

    4. I am well informed about current events. 4 3 2 1

    5. I am comfortable expressing my views and opinions. 4 3 2 1

    6. I am interested in my career development. 4 3 2 1

    Intellectual Wellness Total =

    7. I am physically fit. 4 3 2 1

    8. I am able to perform the physical tasks of my work. 4 3 2 1

    9. I am physically able to perform leisure activities. 4 3 2 1

    Physical Wellness Total =

    10. 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

    Social Wellness Total =

    13. I am fulfilled spiritually. 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 =

    Comprehensive Wellness(Sum of 5 wellness scores)

    Lab 1A: Wellness Self-Perception

    34 2 1

    34 2 1

    34 2 1

    34 2 1

    34 2 1

    34 2 1

    34 2 1

    34 2 1

    34 2 1

    34 2 1

    34 2 1

    34 2 1

    34 2 1

    34 2 1

    34 2 1

    Name Section Date

  • Section 1 Lifestyles for Health, Fitness, and Wellness18

    Conclusions and implications: In the space provided below, use several paragraphs to describe your current state ofwellness. Do you think the ratings are indicative of your true state of wellness? Are there areas in which there is room forimprovement?

    Results:Wellness Dimension Score Rating







    Wellness Rating Chart:Wellness Comprehensive

    Rating Dimension Scores Wellness Score

    High-level wellness 1012 5060Good wellness 89 4049Marginal wellness 67 3039Low wellness below 6 below 30

  • Concept 1 Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 19


    b 1


    itness S


    ts an

    d F

    itness E



    Purpose: To help you better understand each of the 11 components of health-related and skill-related physical fitness, and tohelp you estimate your current levels of physical fitness.

    Special Note: The stunts performed in the lab are not intended as valid tests of physical fitness. It is hoped that theperformance of the stunts will help you better understand each component of fitness so that you can estimate your current fit-ness levels. You should not rely primarily on the results of the stunts to make your estimates. Rather, you should rely on pre-vious fitness tests you have taken and your own best judgment of your current fitness. Later in this book you will learn howto perform accurate assessments of each fitness component and determine the accuracy of your estimates.

    Procedures:1. Perform each of the stunts described in chart 1 on the back of this lab sheet.2. Use past fitness test performances and your own judgment to estimate your current levels for each of the health- and

    skill-related physical fitness parts. Low Fitness = improvement definitely needed, Marginal = some improvement neces-sary, Good = adequate for healthy daily living.

    3. Place an X in the appropriate box for your fitness estimate in the results section below.

    Results:Low Marginal Good

    Fitness Component Fitness Fitness Fitness

    Body composition x x x

    Cardiovascular fitness


    Muscular endurance






    Reaction time


    Conclusions and Implications: In several sentences, discuss the information you used to make your estimates of physicalfitness. How confident are you that these estimates are accurate?

    Lab 1B: Fitness Stunts and Fitness Estimates

    Name Section Date

  • Section 1 Lifestyles for Health, Fitness, and Wellness20

    Chart 1 Physical Fitness StuntsBalance

    1. One-foot balance. Stand on onefoot; press up so that the weight ison the ball of the foot with the heeloff the floor. Hold the hands and theother leg straight out in front for 10seconds.


    2. Standing long jump. Stand with thetoes behind a line. Using no run orhop step, jump as far as possible.Men must jump their height plus 6inches. Women must jump theirheight only.


    3. Paper ball pickup. Place twowadded paper balls on the floor 5feet away. Run, pick up the firstball, and return both feet behind thestarting line. Repeat with thesecond ball. Finish in 5 seconds.

    Reaction Time

    4. Paper drop. Have a partner hold asheet of notebook paper so that theside edge is between your thumband index finger, about the width ofyour hand from the top of the page.When your partner drops the paper,catch it before it slips through thethumb and finger. Do not lower yourhand to catch the paper.


    5. Double heel click. With the feetapart, jump up and tap the heelstogether twice before you hit theground. You must land with yourfeet at least 3 inches apart.


    6. Paper ball bounce. Wad up a sheetof notebook paper into a ball.Bounce the ball back and forthbetween the right and left hands.Keep the hands open and palmsup. Bounce the ball three times witheach hand (six times total), alternat-ing hands for each bounce.

    Cardiovascular Fitness

    7. Run in place. Run in place forone-and-a-half minutes (120steps per minute). Rest for 1minute and count the heart ratefor 30 seconds. A heart rate of60 or lower passes. A step iscounted each time the rightfoot hits the floor.


    8. Backsaver toe touch. Sit on thefloor with one foot against awall. Bend the other knee.Bend forward at the hips. Afterthree warm-up trials, reach for-ward and touch your closedfists to the wall. Bend forwardslowly; do not bounce. Repeatwith the other leg straight. Passif fists touch the wall with eachleg straight.

    Note: This is a stunt, not anexercise.

    Body Composition

    9. The pinch. Have a partnerpinch a fold of fat on the backof your upper arm (bodyfatness), halfway between thetip of the elbow and the tip ofthe shoulder.

    Men: No greater than 3/4 of aninch.

    Women: No greater than 1 inch.


    10.Push-up. Lie face down on thefloor. Place the hands under theshoulders. Keeping the legsand body straight, press off thefloor until the arms are fullyextended. Women repeat once;men, three times.

    Muscular Endurance

    11.Side leg raise. Lie on the flooron your side. Lift your leg upand to the side of the body untilyour feet are 24 to 36 inchesapart. Keep the knee and pelvisfacing forward. Do not rotate sothat the knees face the ceiling.Perform 10 with each leg.

    Directions: Attempt each of the stunts in the chart below. Place an X in the circle next to each component of physical fitnessto indicate that you have attempted the stunt.