WELLNESS - Jones & Bartlett Learningsamples.jbpub.com/9780763758219/58219_FMxx_FINAL.pdf · WELLNESS AND PHYSICAL THERAPY SHARON ELAYNE FAIR, PT, MS, PhD President of The Wellness

WELLNESSAND PHYSICAL THERAPY

SHARON ELAYNE FAIR, PT, MS, PhDPresident of The Wellness Society

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Library of Congress Cataloging-in-Publication DataFair, Sharon Elayne, 1960-Wellness and physical therapy / by Sharon Elayne Fair.

p. ; cm.Includes bibliographical references and index.ISBN-13: 978-0-7637-5821-9 (pbk.)ISBN-10: 0-7637-5821-3 (pbk.)1. Physical therapy. 2. Physical fitness. 3. Health. I. Title.[DNLM: 1. Physical Therapy Modalities. 2. Health Behavior. 3. Health Promotion. WB 460 F163w 2010]RM700.F35 2010615.8’2—dc22

20080553846048

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■ iii ■

Dedication

I dedicate this book to my daughter, Embury Elayne Fair-Russell, whom I love more thanthe universe is big and always will, and my brother, Michael James Fair, who sacrificedhis life for our country and whom I continue to love and miss every single day.

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■ v ■

Contents

Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi

Introduction by the Series Editor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii

Chapter 1 The Basics of Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Section 1: Health and Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Health Promotion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Wellness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Health Versus Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Summary: Health and Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Section 2: Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Primary Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Secondary Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Tertiary Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Prevention: Present and Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Summary: Prevention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

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Section 3: Healthy People. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Summary: Healthy People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Section 4: Wellness Models and Surveys . . . . . . . . . . . . . . . . . . . . . . . . . . 8Illness–Wellness Continuum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Ardell’s Models of Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9The Six-Dimensional Model of Wellness . . . . . . . . . . . . . . . . . . . . . 9Holistic Model for Wellness and Prevention

Over the Life Span. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Perceived Wellness Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Humanistic Model of Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Summary: Wellness Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Section 5: Stages of Wellness: Examination, Evaluation, Plan of Care, and Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Primordial Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Pre-Contemplation Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Contemplation Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Preparation Stage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Action Stage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Maintenance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Permanent Maintenance Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Summary: Stages of Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Section 6: Surveys to Assess Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Summary: Surveys to Assess Wellness . . . . . . . . . . . . . . . . . . . . . . 20

Chapter 2 The Application of Wellness to Physical Therapy . . . . . . . . . . . . . 21

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Section 1: Wellness Practitioners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Disciplines That Contribute To and Impact Wellness . . . . . . . . . . . 22Credentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Provider Expertise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Summary: Wellness Practitioners . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Section 2: Physical Therapy Services: Restorative, Maintenance, Prevention, and Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Restorative Physical Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Maintenance Physical Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Prevention Physical Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Wellness Physical Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Standards of Care and Malpractice . . . . . . . . . . . . . . . . . . . . . . . . 25Summary: Physical Therapy Services . . . . . . . . . . . . . . . . . . . . . . . 26

Section 3: Physical Therapy Education. . . . . . . . . . . . . . . . . . . . . . . . . . . 26Summary: Physical Therapy Education . . . . . . . . . . . . . . . . . . . . . 28

vi ■ CONTENTS

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Section 4: Why Should Physical Therapists Possess an Operational Knowledge of Wellness? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Patient Questions Related to Wellness . . . . . . . . . . . . . . . . . . . . . . 30Physical Therapists Are Wellness Role Models . . . . . . . . . . . . . . . . 30Summary: Why Should Physical Therapists Possess an

Operational Knowledge of Wellness?. . . . . . . . . . . . . . . . . . . . . 31

Chapter 3 Physical Therapy and Wellness: Past, Present, and Future . . . . . . 33

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Section 1: Roots of Physical Therapy and Wellness . . . . . . . . . . . . . . . . . 34

Summary: Roots of Physical Therapy and Wellness . . . . . . . . . . . . 35Section 2: Precursors of Wellness and Physical Therapy in the

United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Summary: Precursors of Wellness and Physical Therapy

in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Section 3: The First Half of the 20th Century: Birth of the Physical

Therapy Profession. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Summary: The First Half of the 20th Century: Birth of

the Physical Therapy Profession . . . . . . . . . . . . . . . . . . . . . . . . . 39Section 4: The Second Half of the 20th Century: Physical Therapy

and Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39The 1960s Through the 1980s . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39The 1990s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Summary: The Second Half of the 20th Century:

Physical Therapy and Wellness. . . . . . . . . . . . . . . . . . . . . . . . . . 43Section 5: Physical Therapy’s Expansion of Wellness in the

New Century . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43The Years 2000 Through 2004. . . . . . . . . . . . . . . . . . . . . . . . . . . . 43The Years 2005 Through 2008. . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Summary: Physical Therapy’s Expansion of Wellness in the

New Century . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Section 6: Future Relationship Between Physical Therapy and

(Fitness) Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Summary: Future Relationship Between Physical Therapy

and (Fitness) Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Chapter 4 Physical Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Section 1: Physical Wellness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Diseases and Medical Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Pharmaceuticals and Drugs and Drug Wellness . . . . . . . . . . . . . . . 53

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Nutrition and Nutritional Wellness . . . . . . . . . . . . . . . . . . . . . . . . 54Aerobic Capacity and Aerobic Capacity Wellness. . . . . . . . . . . . . . 54Muscular Fitness and Muscular Fitness Wellness . . . . . . . . . . . . . . 54Flexibility and Flexibility Wellness . . . . . . . . . . . . . . . . . . . . . . . . . 55Body Composition and Body Composition Wellness. . . . . . . . . . . . 55Summary: Physical Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

Section 2: Why Physical Therapists Should Possess an Operational Knowledge of Physical Wellness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Restorative Physical Therapy Patients Present with Impaired Physical Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Physical Therapy Patients/Clients Present with Impaired Drug Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Physical Therapy Patients Present with Impaired Nutritional, Fitness, and Body Composition Wellness . . . . . . . . . . . . . . . . . . 59

Physical Wellness Affects Physical Health . . . . . . . . . . . . . . . . . . . 59Physical Wellness Is Linked to Mental and Social Health . . . . . . . . 60Physical Wellness Can Affect the Ability to Engage and

Progress in Physical Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . 60Physical Therapy Practice Is Expanding into the Fitness

Wellness Arena . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Physical Therapists Are Viewed as Wellness Experts and

Role Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62Knowledge of Wellness and Physical Wellness Are Accreditation

Requirements in Entry-Level Physical Therapy Curriculum . . . . 63Summary: Why Physical Therapists Should Possess an

Operational Knowledge of Physical Wellness . . . . . . . . . . . . . . . 63

Chapter 5 Physical Wellness and Nutrition. . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65Section 1: Nutritional Wellness and Scope of Care of Physical

Therapy Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66Summary: Nutritional Wellness and Scope of Care . . . . . . . . . . . . 67

Section 2: Basic Terminology and Concepts . . . . . . . . . . . . . . . . . . . . . . . 67Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68Beverages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68Calorie and Caloric Intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68Carbohydrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Coffee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Dietary Reference Intake, Reference Daily Intake, and

Recommended Daily Intake . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

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Dietician (Versus Nutritionist) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70Fats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70Fiber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71Fruits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72Grains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72Milk and Dairy Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Minerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Oils and Fats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74Protein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74Protein-Rich Foods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75Soda Beverages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75Soups, Sauces, and Gravies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75Substrates and Substrate Intake . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Sugary Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Vegetables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Vegetarians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Vitamins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Summary: Basic Terminology and Concepts . . . . . . . . . . . . . . . . . . 78

Section 3: Nutritional Wellness Pyramids. . . . . . . . . . . . . . . . . . . . . . . . . 78Summary: Nutritional Wellness Pyramids . . . . . . . . . . . . . . . . . . . 82

Section 4: History of Nutritional Wellness . . . . . . . . . . . . . . . . . . . . . . . . 82History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Historical Nutrition Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Analysis of History of Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . 84Summary: History of Nutritional Wellness . . . . . . . . . . . . . . . . . . . 84

Section 5: Systems Review of Nutritional Wellness . . . . . . . . . . . . . . . . . 84Analysis of Nutritional Wellness Systems Review. . . . . . . . . . . . . . 86Summary: Systems Review of Nutritional Wellness . . . . . . . . . . . . 86

Section 6: Tests and Measures of Nutritional Wellness . . . . . . . . . . . . . . . 86Section 7: Nutritional Wellness Evaluation. . . . . . . . . . . . . . . . . . . . . . . . 95

Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95The Typical Patient/Client . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98Categories of Reference Patients/Clients . . . . . . . . . . . . . . . . . . . . 99Summary: Nutritional Wellness Evaluation . . . . . . . . . . . . . . . . . 100

Section 8: Nutritional Wellness Conditions and Diagnoses. . . . . . . . . . . 100Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Vegetarianism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Athleticism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Summary: Nutritional Wellness Conditions

and Diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Contents ■ ix

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Section 9: Prognosis, Plan of Care, and Goals . . . . . . . . . . . . . . . . . . . . 102Nutritional Wellness Prognosis. . . . . . . . . . . . . . . . . . . . . . . . . . . 102Nutritional Wellness Plan of Care . . . . . . . . . . . . . . . . . . . . . . . . 102Nutritional Wellness Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102Prognosis of Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Plan of Care and Goals Related to the Food Groups . . . . . . . . . . 103Plan of Care and Goals Related to Caloric Input . . . . . . . . . . . . . 104Plan of Care and Goals Related to the

Nutritional Substrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104Plan of Care and Goals Related to the Athlete . . . . . . . . . . . . . . . 106Summary: Prognosis, Plan of Care, and Goals . . . . . . . . . . . . . . . 108

Section 10: Nutritional Wellness Interventions and Global Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Global Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Summary: Nutritional Wellness Interventions

and Global Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

Chapter 6 Physical Wellness and Fitness. . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Section 1: Scope of Physical Therapy Practice . . . . . . . . . . . . . . . . . . . . 110

Summary: Scope of Physical Therapy Practice . . . . . . . . . . . . . . . 110Section 2: Basic Terms and Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . 111

Anabolic Steroids. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Caloric Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Dehydration and Hydration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112Examination of Fitness Wellness . . . . . . . . . . . . . . . . . . . . . . . . . 112Isometrics, Isotonics, and Isokinetics . . . . . . . . . . . . . . . . . . . . . . 112Substrate Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113Warm-Up and Cool-Down . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113Summary: Basic Terms and Concepts. . . . . . . . . . . . . . . . . . . . . . 114

Section 3: Examination: History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Analysis of the History of Fitness and Fitness

Wellness Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115Summary: History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Section 4: Examination: Systems Review . . . . . . . . . . . . . . . . . . . . . . . . 117Analysis of the Fitness Wellness Systems Review . . . . . . . . . . . . . 117Summary: Systems Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Section 5: Examination: Tests and Measures . . . . . . . . . . . . . . . . . . . . . 119Fitness Wellness Tests and Measures . . . . . . . . . . . . . . . . . . . . . . 119

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Fitness and Fitness Wellness Survey . . . . . . . . . . . . . . . . . . . . . . . 127Fitness Tests and Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127Summary: Tests and Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . 132

Section 6: Evaluation of Fitness and Fitness Wellness . . . . . . . . . . . . . . 135Evaluation of the Fitness Wellness Survey . . . . . . . . . . . . . . . . . . 135The Typical Patient’s/Client’s Fitness Wellness . . . . . . . . . . . . . . . 140Evaluation of Aerobic Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . 141Evaluation of Muscular Fitness . . . . . . . . . . . . . . . . . . . . . . . . . . 142Flexibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142Summary: Evaluation of Fitness and Fitness Wellness . . . . . . . . . 143

Section 7: Fitness Wellness Condition/Diagnosis . . . . . . . . . . . . . . . . . . 144Summary: Fitness Wellness Condition/Diagnosis . . . . . . . . . . . . . 144

Section 8: Fitness and Fitness Wellness Prognosis, Plan of Care, and Goals/Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144

Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144Plan of Care and Goals/Objectives. . . . . . . . . . . . . . . . . . . . . . . . 145Plan of Care Related to Exercise Adherence. . . . . . . . . . . . . . . . . 149Summary: Prognosis, Plan of Care, and Goals . . . . . . . . . . . . . . . 150

Section 9: Aerobic Capacity Wellness and Aerobic Capacity Plan of Care and Goals/Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

Variables of Aerobic Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . 151Aerobic Capacity Wellness Preferred Practice Pattern . . . . . . . . . 154Aerobic Capacity Wellness Goals/Objectives . . . . . . . . . . . . . . . . 154Aerobic Capacity Preferred Practice Patterns . . . . . . . . . . . . . . . . 155Aerobic Capacity Goals/Objectives . . . . . . . . . . . . . . . . . . . . . . . 156Summary: Aerobic Capacity and Aerobic Capacity Wellness . . . . 158

Section 10: Muscular Fitness and Muscular Fitness Wellness Plan of Care and Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Muscular Fitness Wellness Preferred Practice Pattern . . . . . . . . . 159Muscular Fitness Wellness Goals/Objectives . . . . . . . . . . . . . . . . 159Muscular Fitness Preferred Practice Pattern . . . . . . . . . . . . . . . . . 161Muscular Fitness Goals/Objectives . . . . . . . . . . . . . . . . . . . . . . . 162Summary: Muscular Fitness and Muscular Fitness Wellness. . . . . 163

Section 11: Flexibility and Flexibility Wellness Plan of Care and Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163Flexibility Wellness Preferred Practice Pattern . . . . . . . . . . . . . . . 164Flexibility Wellness Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164Flexibility Plan of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166Summary: Flexibility and Flexibility Wellness. . . . . . . . . . . . . . . . 168

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Section 12: Fitness and Fitness Wellness Interventions and Global Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168

Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168Global Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169Summary: Fitness Interventions and Global Outcomes . . . . . . . . 170

Chapter 7 Physical Wellness and Body Composition . . . . . . . . . . . . . . . . . . 171

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171Section 1: Scope of Physical Therapy Practice . . . . . . . . . . . . . . . . . . . . 172

Summary: Scope of Physical Therapy Practice . . . . . . . . . . . . . . . 172Section 2: Basic Terms and Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . 173

Basal and Resting Metabolic Rate . . . . . . . . . . . . . . . . . . . . . . . . 173Body Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173Body Mass Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173Body Classification: Ectomorph, Endomorph, Mesomorph . . . . . 173Body Type: Android and Gynoid . . . . . . . . . . . . . . . . . . . . . . . . . 174Caloric Input and Caloric Output. . . . . . . . . . . . . . . . . . . . . . . . . 174Dietary-Induced Thermogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . 174Examination of Body Composition Wellness . . . . . . . . . . . . . . . . 175Fat Mass. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Hyperplasia and Hypertrophy of Fat Cells . . . . . . . . . . . . . . . . . . 175Lean Body Mass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Obese. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Overfat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Overweight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Set Point Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176Summary: Basic Terms and Concepts. . . . . . . . . . . . . . . . . . . . . . 176

Section 3: Examination: History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176Analysis of History of Body Composition and Body

Composition Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177Summary: History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

Section 4: Examination: Systems Review . . . . . . . . . . . . . . . . . . . . . . . . 177Analysis of the Body Composition Screen and Body

Composition Wellness Screens . . . . . . . . . . . . . . . . . . . . . . . . . 180Summary: Systems Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180

Section 5: Examination: Tests and Measures . . . . . . . . . . . . . . . . . . . . . 180Body Composition Wellness Tests and Measures . . . . . . . . . . . . . 181Body Composition Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181Summary: Tests and Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

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Section 6: Evaluation of Body Composition and Body Composition Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187

Evaluation of the Surveys Related to Body Composition Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

The Typical Patient’s/Client’s Body Composition and Body Composition Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189

Summary: Evaluation of Body Composition . . . . . . . . . . . . . . . . . 190Section 7: Body Composition Wellness Condition and/or Diagnosis . . . 190

Diagnoses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191Summary: Condition and/or Diagnosis . . . . . . . . . . . . . . . . . . . . 191

Section 8: Body Composition Wellness Prognosis, Plan of Care, and Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191

Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191Plan of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192Plan of Care and Goals Related to Caloric Input . . . . . . . . . . . . . 193Plan of Care Related to Reducing Fat Mass . . . . . . . . . . . . . . . . . 194Plan of Care Related to Long-Term Weight-Loss Maintenance . . . 194Summary: Plan of Care and Goals . . . . . . . . . . . . . . . . . . . . . . . . 195

Section 9: Body Composition Wellness Interventions and Outcomes . . . 195Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195Global Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196Summary: Interventions and Outcomes . . . . . . . . . . . . . . . . . . . . 196

Chapter 8 Mental and Social Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197Section 1: Scope of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198

Summary: Scope of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199Section 2: Basic Terms and Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

Behavior and Personality Patterns . . . . . . . . . . . . . . . . . . . . . . . . 199Emotional Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200Environmental Wellness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201Family Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202Intellectual Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203Mental Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205Occupational Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207Purpose of Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

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Social Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208Social Responsibility of Physical Therapists . . . . . . . . . . . . . . . . . 209Stress, Anxiety, Burn Out, Relaxation, and

Antistress Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209Summary: Basic Terms and Concepts. . . . . . . . . . . . . . . . . . . . . . 211

Section 3: Examination: History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212Analysis of the History of the Mental and Social Wellness Survey . . 213Summary: History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

Section 4: Examination and Systems Review . . . . . . . . . . . . . . . . . . . . . 214Analysis of the Mental and Social Wellness Systems Review . . . . 215Summary: Systems Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

Section 5: Examination: Tests and Measures . . . . . . . . . . . . . . . . . . . . . 215Summary: Tests and Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . 220

Section 6: Evaluation of Mental and Social Wellness . . . . . . . . . . . . . . . 220Analysis of the Mental and Social Wellness Survey . . . . . . . . . . . 220Summary: Mental and Social Wellness Evaluation . . . . . . . . . . . . 223

Section 7: Mental Diagnoses and Mental and Social Wellness Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224

Mental Diagnoses and Mental and Social Conditions . . . . . . . . . . 224Diagnosis: Anxiety (300.02) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224Diagnosis: Adjustment Disorder (309.0–309.9). . . . . . . . . . . . . . 224Condition: Impaired Mental Wellness—Stress/Anxiety. . . . . . . . . 225Diagnosis: Major (296) and Minor Depression (311) . . . . . . . . . 225Condition: Impaired Mental Wellness—Depression . . . . . . . . . . . 225Condition: Impaired Emotional Wellness—Self-Esteem . . . . . . . . 226Diagnosis: Body Dysmorphic Disorder (300.7) . . . . . . . . . . . . . . 226Diagnosis: Anorexia Nervosa (307.1). . . . . . . . . . . . . . . . . . . . . . 226Diagnosis: Bulimia Nervosa (307.51). . . . . . . . . . . . . . . . . . . . . . 226Diagnosis: Binge Eating (783.6). . . . . . . . . . . . . . . . . . . . . . . . . . 227Condition: Night-Eating Syndrome . . . . . . . . . . . . . . . . . . . . . . . 227V-Code: Malingering (V65.2). . . . . . . . . . . . . . . . . . . . . . . . . . . . 227Diagnosis: Factitious Disorder (300.16; 300.19) . . . . . . . . . . . . . 227V-Code: Noncompliance with Treatment (V15.81) . . . . . . . . . . . 227Condition: Impaired Social Wellness . . . . . . . . . . . . . . . . . . . . . . 228Summary: Mental Diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228

Section 8: Mental and Social Wellness Goals and Prognosis. . . . . . . . . . 228Summary: Goals and Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . 229

Section 9: Mental and Social Wellness Plan of Care . . . . . . . . . . . . . . . . 229Mental Health Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229Plan of Care for Specific Conditions or Disorders . . . . . . . . . . . . 233Summary: Plan of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

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Section 10: Mental and Social Wellness Interventions and Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

Interventions to Enhance Impaired Mental Wellness–Stress/Anxiety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236

Interventions for Patients/Clients Who Are Noncompliant with Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

Interventions for Patients/Clients with the Condition of Impaired Social Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239

Mental and Social Wellness Outcomes . . . . . . . . . . . . . . . . . . . . . 241Summary: Interventions and Outcomes . . . . . . . . . . . . . . . . . . . . 241

Chapter 9 Wellness Preferred Practice Pattern . . . . . . . . . . . . . . . . . . . . . . 243

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243Section 1: Scope of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244

Summary: Scope of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244Section 2: The Wellness Examination. . . . . . . . . . . . . . . . . . . . . . . . . . . 245

Wellness History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245Wellness Patient/Client Report. . . . . . . . . . . . . . . . . . . . . . . . . . . 246Wellness Systems Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246Examination: Tests and Measures. . . . . . . . . . . . . . . . . . . . . . . . . 250Summary: Wellness Examination . . . . . . . . . . . . . . . . . . . . . . . . . 251

Section 3: Wellness Evaluation and Condition/Diagnosis. . . . . . . . . . . . 251Summary: Evaluation and Condition/Diagnosis . . . . . . . . . . . . . . 252

Section 4: Wellness Prognosis, Plan of Care, Goals, Intervention, and Outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252

Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252Plan of Care and Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253Wellness Intervention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253Wellness Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254Summary: Prognosis, Plan of Care, Intervention,

and Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254

Chapter 10 Wellness and Physical Therapy Case Scenario. . . . . . . . . . . . . . 255

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255Section 1: Case Scenario . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256

Patient/Client History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256Systems Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262Tests and Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290Diagnosis/Condition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296

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Prognosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296Plan of Care and Goals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299Outcomes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

Chapter 11 Community Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303Section 1: The Health Belief Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304

Summary: The Health Belief Model . . . . . . . . . . . . . . . . . . . . . . . 304Section 2: Wellness and Prevention Programs Suggested by

the American Physical Therapy Association . . . . . . . . . . . . . . . . . . . . 304Individual Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304Group-Level Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305Policy-Level Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305Summary: Examples from the American Physical

Therapy Association. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305Section 3: Community Wellness Projects . . . . . . . . . . . . . . . . . . . . . . . . 305

Phases of a Community Wellness Project . . . . . . . . . . . . . . . . . . . 305Abbreviated Scenario of a Community Wellness Project . . . . . . . 306Summary: One Community Wellness Project . . . . . . . . . . . . . . . . 309

Section 4: Corporate Fitness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310Summary: Corporate Fitness . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357

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■ xvii ■

Preface

Two roads diverged in a wood, and I—I took the one less traveled by,

And that has made all the difference.■ ■ ■ ■ ■ ■ ■

Robert Frost

PHYSICAL THERAPY EDUCATORSThis book was designed to meet or exceed the educational objectives related to wellnessoutlined in A Normative Model of Physical Therapist Professional Education: Version2004. Accordingly, this textbook can be utilized, and it is indeed suggested that it beadopted, as a (required) textbook in the wellness courses offered by the entry-level physi-cal therapy programs accredited by the Commission on Accreditation in Physical TherapyEducation (CAPTE).

Some entry-level physical therapy programs require two courses related to wellness:an introductory course and a more advanced course. For example: “Wellness I” and“Wellness II”; or “Health Promotion and Wellness for Physical Therapy Practice I” and“Health Promotion and Wellness for Physical Therapy Practice II.” This two-tier modelmirrors the multistep model deemed appropriate and employed for other core subjectmatters and specialties, such as musculoskeletal and neuromuscular curricula andresearch. (Note: I believe the two-tier system is the best model for wellness pedagogy.) Inthose cases in which this textbook is adopted for use in a two-tier model of wellness ped-agogy, the contents of the book may be readily divided as indicated by the number ofcredit hours per course and at the discretion of the professor.

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Many physical therapy programs offer a single course related to wellness. Thesecourses are known by a variety of names, such as “Health and Wellness,” “Prevention andWellness,” “Physical Therapy Constructs of Health and Wellness,” “Health Promotion andDisease Prevention,” or simply “Wellness.” In some cases, the course is offered early in thecurriculum (e.g., term two); in other cases, it is offered relatively late in the curriculum(e.g., term seven). Placement of the wellness course will be a factor in how to best utilizethis textbook to meet or exceed the objectives of A Normative Model of Physical TherapistProfessional Education: Version 2004. For example, if the wellness course is offered earlyin the curriculum, perhaps a mock, rather than an authentic, community wellness projectmight be appropriate. However, if the wellness course is offered later in the curriculum, agenuine community wellness project might be indicated and of substantial benefit.

Some physical therapy programs do not offer a “wellness” course, and instead inte-grate topics related to wellness into another course or courses. In these cases, the con-tents of this book may be integrated into the program’s classes/modules/labs related towellness. If the wellness content is divided into two or more courses, it may be a chal-lenge for the professors to integrate the information from the textbook into their respec-tive courses. However, these challenges can be overcome with communication andcoordination among the involved faculty. One suggestion is for involved faculty to agreeupon which chapter will be examined in which course.

Indeed, the task of serving as one of the required textbooks (if not the only textbook)in a wellness course(s) in a physical therapy program is daunting. The reasons include,but are not necessarily limited to (1) the relationship between physical therapy and well-ness has not been clearly delineated (Culver, 2007); (2) compared to subject matter thathas traditionally been offered in physical therapy curricula and is often considered to be“core coursework” (such as musculoskeletal and neuromuscular curricula), wellness is arelatively new concept; and (3) compared to traditional specialties (such as gerontologyand women’s health), wellness is an emerging forte. Few physical therapists or physicaltherapist faculty members possess an “expertise” in wellness. Accordingly, it can be spec-ulated that fewer physical therapy programs appreciate the uniqueness of wellness andrecognize the value of a multitier model of wellness pedagogy and the necessity of requir-ing a wellness-related textbook. The challenges that face a textbook relating physical ther-apy and wellness may be exemplified by comparing the number of physical therapytextbooks dedicated to traditional subject matters to the number of physical therapy text-books related to wellness. This textbook is a first step in a largely unchartered territory toelucidate the provision of wellness by physical therapists.

PHYSICAL THERAPY STUDENTSThis textbook is designed to serve as an educational tool for you to learn about wellnessand its relationship to the provision of physical therapy. This is the first textbook with thislong-overdue goal.

xviii ■ PREFACE

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As you should be aware, A Normative Model of Physical Therapist Professional Edu-cation: Version 2004 includes educational objectives related to wellness, just as it includeseducational objectives related to such areas as orthopedics and neurology. The contents ofthis book are designed to meet or exceed CAPTE’s educational objectives related to well-ness and are poised to meet the wellness-related educational objectives in the next editionof A Normative Model of Physical Therapist Professional Education.

Historically, the focus of physical therapy has been restorative care (Moffat, 1996).This means that physical therapists primarily provided rehabilitative care to patients whohad a disease (e.g., Parkinson’s disease) or had been injured (e.g., presented status postsprain or fracture). While current-day physical therapists still provide this type of care,more and more are learning about and providing wellness-related care.

The three dimensions of wellness are physical, mental, and social wellness, and eachof these is linked to the provision of physical therapy. Of the three dimensions of well-ness, physicals therapists are best educated and trained to provide certain types of physi-cal wellness, particularly body composition and fitness wellness. While physical therapistscan directly provide these aspects of physical wellness (e.g., by teaching a patient/clientabout aerobic capacity and facilitating an improvement in her/his exercise regimen), theycan and should also integrate wellness into their restorative care. For example, a physicaltherapist might utilize her or his knowledge related to mental wellness to motivate apatient/client to adhere to the home program the physical therapist has designed.

I am confident that your exploration of this textbook will provide a solid foundationto provide direct wellness services as well as to integrate wellness into your restorativepractice. I wish you the best!

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■ xxi ■

Acknowledgments

Although this book is dedicated to my daughter, Embury Fair-Russell, and my brother,Michael Fair, I also wish to acknowledge the unique contributions these two wondrousindividuals have made to my life, which, among other things, propelled me to fulfill mychildhood dream of becoming a writer.

I also acknowledge other family members who have contributed to the completion ofthis book in one form or another, including my dad, Donald Fair, and my late paternalgrandfather, Joseph Fair. In particular, I thank my mom, Perena Cianelli-Fair. When Iattempted to express myself through poetry, she gifted me Robert Frost’s The Book ofPoetry and closed her inscription with “To my creative writer.” And during the seeminglyeternal process of writing this book, she offered continuous encouragement.

Professionally, I acknowledge those colleagues who have supported my interest andexpertise in wellness, including, but not limited to, former University of St. Augustinefor Health Sciences faculty members Emily Fox, PT, MA; Patricia (Trish) King, PT, MA,MTC; and David Lehman, PT, PhD. I am especially grateful to Dr. Fox for her support ofmy pursuit of the triad of wellness. I also value the criticisms received from certain col-leagues in response to my attempts to catechize others, including them, that wellnessmirrors the World Health Organization’s (1947; 2009) unwavering definition of health,and that consequently wellness consists of three and only three dimensions of wellness

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(i.e., physical, mental, and social). In part, it was their insistence upon what might bedescribed as a “pre-Copernican” perception of wellness that has propelled me, and willcontinue to propel me, to educate myself and others about the enlightened concept ofthe triad of wellness.

If a flower is of a fair seed, its roots are embedded in hardy soil,and there is adequate sunshine,

Even a dreary rain from a murky cloud helps that flower to blossom.■ ■ ■ ■ ■ ■

Tamar Fair

Last but not least, I acknowledge my physical therapy wellness clients and my physi-cal therapy “restorative” patients. My wellness patients and clients have inspired me toshare with others, including current and future colleagues, my understanding of the rela-tionship between wellness and physical therapy. As I teach and help my patients andclients, they teach and help me. As they thank me, I thank them. As I bring well-beinginto their lives, they bring well-being into mine.

xxii ■ ACKNOWLEDGMENTS

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■ xxiii ■

Introduction by the Series Editor

Enhancing and restoring physical fitness and wellness by way of specific exercise instruc-tion and education with regard to exercise and healthy living habits has been a corner-stone of physical therapy from the inception of the profession. In fact, it was the concernabout declining levels of physical fitness in new military recruits that directly contributedto the emergence of physical education in the 18th century and the subsequent develop-ment of physical therapy in the early and mid-19th century in various Northern and West-ern European countries, including Sweden, Germany, and the Netherlands (Ottoson,2005; Terlouw, 2007).

Over time, however, and perhaps related to the limited number of physical therapistsavailable, limited societal resources were allotted to fund physical therapy services. At thetime, greater societal recognition was for those working and with the sick and disabled,and the emphasis shifted from therapists also providing wellness, preventative, and main-tenance services to the profession of physical therapy almost exclusively associated withrestorative services. Physical therapy came to be synonymous with treatment to addressimpairments and associated limitations in activities and restrictions in participationresulting from congenital, degenerative, trauma-related, post-surgical, disease-related,and other causes.

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In the first half of the 20th century, increasing standards of living, especially in thedeveloped world, led to a resurging recognition of the importance of wellness and fitnesswith regard to health and well-being. This demand for services related to enhancing andrestoring wellness and fitness was initially filled by alternative healthcare providers work-ing from unsubstantiated and often implausible underlying theoretical models (Whorton,1988). However, the recognition of the role of wellness and fitness again increasinglygained ground in mainstream medicine as reflected in the World Health Organizationview of health as a triad of physical, mental, and social well-being. Health was thusdefined as not merely the absence of disease but rather as a state of complete physical,mental, and social well-being (WHO, 1947).

Undoubtedly driven by more down-to-earth motives of seeking alternate avenues ofgenerating revenue in the face of diminishing reimbursement for restorative physical ther-apy services, and also by more lofty motives related to a recognition of the importance ofwellness in attaining optimal results when providing restorative services and in the grow-ing understanding of the crucial and natural leadership role physical therapy has in pro-moting health and well-being in individuals and society as a whole, therapists are onceagain increasingly engaging in providing wellness services outside and within the tradi-tional restorative service model. In fact, A Normative Model of Physical Therapist Profes-sional Education (CAPTE, 2004) has required entry-level physical therapy students to beeducated in wellness since 2004. The 2004 edition further elaborated on requirementswith regard to wellness in the physical therapy entry-level curriculum (CAPTE, 2004).The American Physical Therapy Association, in The Guide to Physical Therapist Practice,has also included a discussion of wellness, defining wellness as the “concepts thatembrace positive health behaviors that promote a state of physical and mental balanceand fitness” (APTA, 2001b).

When comparing the World Health Organization definition with the definition pro-posed in The Guide to Physical Therapist Practice above, it becomes evident that the lat-ter definition overtly excludes the social realm of the wellness triad. Dr. Sharon Fair iseminently qualified with degrees in physical therapy, exercise science, psychology, andeducation. She has professional experience as a personal trainer, physical therapist, andeducator, and has a body of publications including a doctoral dissertation on the topic ofwellness and physical therapy. In this book she proposes and constructs a comprehensiveapproach to wellness in physical therapy based on her more inclusive definition of well-ness as a lifestyle that promotes physical, mental, and social health in the cognitive, psy-chomotor, and affective domains, both internally and externally (Fair, 2002b).

Following the five-element approach to patient management discussed in The Guideto Physical Therapist Practice, Dr. Fair discusses examination, evaluation, diagnosis,prognosis and plan of care, and interventions in the context of nutritional wellness, fit-ness wellness, body composition wellness, and mental and social wellness. Examinationsections include sufficient detail for immediate clinical application discussion of screen-ing, history, and tests and measures. The author introduces both validated history and

xxiv ■ INTRODUCTION BY THE SERIES EDITOR

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physical examination items and tools developed as part of her original research and doc-toral work in the area of wellness. All information is supported by up-to-date and relevantreferences from the peer-reviewed literature. Didactic elements in each chapter includelearning objectives and definitions of basic terms and concepts. The author also makesthe link to ICD codes and Preferred Practice Patterns discussed in The Guide to PhysicalTherapist Practice. Data on the “typical client” and athlete allow for comparison of find-ings to normative data. An eight-step community wellness project and an in-depth well-ness case example will help the reader to apply the concepts introduced in the text.

In this book, Dr. Fair provides readers with the information on knowledge and skillsthat will allow physical therapists to truly align with the portion of the APTA VisionStatement for Physical Therapy 2020 that proposes physical therapists as the practition-ers of choice in the area of wellness. Her comprehensive and at times passionate discus-sion of the topic is certain to appeal to both entry-level physical therapy students andexperienced clinicians.

Peter A. Huijbregts, PT, MSc, MHSc, DPT, OCS, FAAOMPT, FCAMTSeries Editor, Contemporary Issues in

Physical Therapy and Rehabilitation MedicineVictoria, British Columbia, Canada

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WELLNESS - Jones & Bartlett Learningsamples.jbpub.com/9780763758219/58219_FMxx_FINAL.pdf · WELLNESS AND PHYSICAL THERAPY SHARON ELAYNE FAIR, PT, MS, PhD President of The Wellness

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