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Passport to Whole Health: Chapter 5

Chapter 5. Moving the Body: Energy & Flexibility

An icon of two hands clapping together.
Lack of activity destroys the good condition of every human being while movement and methodical physical exercise saves and preserves it.
―Attributed to Plato

This chapter is the first of a series of chapters focusing on the “Areas of Proactive Self-Care.” These are the eight smaller circles that make up the Self-Care Circle, which is (not by accident) the largest circle within the Circle of Health. The eight self-care chapters of this reference guide, Chapters 5-12, summarize research findings related to how each area of self-care contributes to well-being. These chapters provide general tips as well as specific “Whole Health Tools” designed to support Veterans and their care teams as they incorporate these important areas into Personal Health Plans (PHPs).

In 2018, the VA Office of Patient Centered Care and Cultural Transformation (OPCC&CT) created skill-building courses for Veterans, one for each of the eight areas of self-care. The skill- building courses are designed to get Veterans thinking about options and to encourage them to zero in on specific options, or “ subtopics” to incorporate into their PHPs. Figure 5-1 lists the Moving the Body subtopics. Note that there is a “Make One Small Change” circle that leaves room for creativity and flexibility, if Veterans do not see an option that interests them. There is also a subtopic circle focused on getting professional support (i.e., “Work with an Expert”). The Resources section of Chapter 1 describes how to access the skill-building course materials.

Sixsubtopics surround the Self-Care header of Moving the Body. Those subtopics include: Make One Small Change, Create a Personlalized Activity Plan, Work with and Expert, Mindful Movement, Take a Class, and Track Your Progress.

Figure 5-1. Subtopics within the Moving the Body Circle of Self-Care

Two subtopics specific to Moving the Body, personal activity plans and mindful movement, are discussed later in this chapter as Whole Health tools. It is helpful for people to track their progress with apps or monitoring devices, which are now widely available. Several are mentioned in the resources list at the end of this chapter. Mindful movement approaches—namely, yoga and tai chi/qi gong —are now covered services by the VA (as discussed in Chapter 14), and live and online instruction is increasingly available. In addition, Veterans should be encouraged make good use of the experts at their sites, including physical, occupational, and recreational therapists.

Benefits of Movement and Activity

Physical activity levels continue to decline worldwide. Physical inactivity contributes to at least 6-10% of the chronic national disease burden and premature mortality. Moving the Body is one of the most common areas of self-care people choose to focus on in their PHPs, and for good reason: physical activity has a profound impact on health. The Exercise is Medicine website, developed by the American College of Sports Medicine, asks a simple question :

What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension, and obesity? Would you prescribe it for your patients? Certainly.

Physical activity is that prescription, and there are not many health conditions it cannot benefit. To cite some important examples, the vast body of research in this area has shown the following:

  • Physical activity lowers all-cause mortality and increases life span.
  • It improves quality of life.
  • It slows the negative effects of aging (even when initiated late in life).
  • It reduces fatigue and helps regulate sleep.
  • It promotes brain cell growth and enhances mental function, attention, memory, and processing speed. It improves executive function and academic performance.
  • It reduces dementia risk.
  • It improves mental health, including decreasing anxiety and depression. It also helps with ADHD and is likely to help with substance use disorder and bipolar disorder as well.
  • It reduces pain, including chronic pain, low back pain, osteoarthritis pain, and musculoskeletal pain. It also improves global well-being and quality of life in fibromyalgia.
  • Level of physical activity correlates with better postoperative outcomes.
  • It helps prevent or treat many other chronic health problems, including:
    • Cardiovascular disease and other circulatory disorders, like claudication. It counteracts the negative cardiac effects of stress.
    • Cancer (e.g., colon, breast, and renal)
    • Type 1 and type 2 diabetes
    • Hypertension
    • Obesity
    • Abnormal lipid (cholesterol) profiles
    • Osteoporosis
    • Stroke prevention and recovery
    • Multiple sclerosis
    • COPD and obstructive sleep apnea
    • Pulmonary hypertension
    • Heart failure
    • Renal failure (especially regarding blood pressure)
    • Psoriasis
    • Erectile dysfunction
  • It can help people with spinal cord injury, when tailored appropriately.
  • It favorably alters gene expression and helps maintain telomeres.
  • It changes the gut microbiome in a positive way.
  • It improves overall performance, range of motion, and muscular strength and endurance (as everyone knows).

Studies are discussed in more detail in the “Moving the Body” overview.

Some General Physical Activity-Related Tips

  • Focus on activity over “exercise.” Remember that Moving the Body involves more than just "exercise.” Exercise refers to structured and repeated activity with a specific intent. Some people prefer exercise, but many prefer to incorporate Moving the Body with less regimented activities, like walking in a park, gardening, or playing with a pet or child.
  • Go beyond activity at work. Some people argue they get their exercise through their work. Most recommendations suggest that what really matters is “leisure time” physical activity, i.e., the activity that happens outside of working hours. Of course, using the stairs at work or walking at lunch or any number of extra activities during the workday can be counted.
  • Consider sports. A 2016 analysis of data for over 80,000 people found that all-cause mortality decreased markedly for people who participated in various sports. Hazard ratios were 0.85 for cycling, 0.72 for swimming, 0.53 for racquet sports, and 0.73 for aerobics.
  • Counsel about the risks of being sedentary, too. Just as exercise is beneficial in many ways, the opposite is also true; being inactive is an independent risk for health problems. Many recent studies have shown that time spent being inactive is a health risk itself, even if a person exercises regularly. In fact, if a person exercises but otherwise sits most of the time, their likelihood of mortality is about 20% higher than if they are active about half the time during the day.
  • Remember that, while movement is important, there is more to it. It is good to think about other aspects of Moving the Body when you make recommendations. Many PHPs will incorporate not only aerobic activity, but also strength training and flexibility. Balance, dexterity, range of motion, and ability to perform daily tasks should also be considered.
  • Respect disabilities. For some Veterans, Moving the Body may mean more effectively using prosthetics or wheelchairs, management of contractures, or the care of a paralyzed limb.
  • Every bit counts. In most of the research, any activity is better than none. Even a few minutes a day can have benefits.
  • Use local talent. That is, make good use of physical and occupational therapists. In the VA, recreational therapists can also be valuable members of the Whole Health team.
  • Encourage self monitoring. Tracking progress using activity monitors, phone apps, wearables, and other devices is known to have health benefits, e.g., for cardiovascular disease. Refer to the Resource list at the end of this chapter for examples.
  • Emphasize safety. Activity tends to be quite safe if tailored to the individual, but there are some risks to certain patient populations. One study noted 1/100,000 marathoners are at risk for sudden cardiac deaths. It is also important to watch for the female athlete triad of disordered eating, amenorrhea, and osteoporosis. Note that 6-30% of military trainees have been noted to be injured monthly with training. In general, probably 1% of people who do moderate or intense exercise are injured each month. The key is to tailor the routine and to have people remain mindfully aware of what their body is telling them when they are active.
  • Focus on more than the health benefits. A 2019 review of 39 papers indicated that older adults are more likely to exercise if they are reminded to consider “the wider set of goals and aspirations which are of greater personal importance” to them.

Questions to Ask About Moving the Body

The first step when it comes to incorporating areas of self-care is to ask the most helpful questions you can. Consider some of the following:

  • What kind of relationship do you have with your body?
  • What activities do you enjoy?
  • How have your activities benefited you?
  • Does the word “exercise” make you cringe or feel guilty?
  • Is exercising something you enjoy?
  • How active have you been in the past 30 days?
  • Are you doing any strengthening activities?
  • What do you do to maintain or improve your flexibility?
  • Have you ever used a pedometer or other technology (phone applications, etc.) to support your physical activities?
  • How is your balance?

To determine where someone would like to go with Moving the Body, there are some mindful awareness practices that can help. Chapter 4 includes a “Body Scan” Whole Health tool that offers guidance to sequentially bring awareness to different parts of the body. You can also try a Mindful Movement exercise, as outlined on the next page.

Moving the Body Whole Health Tools

Moving the Body Resources

Websites
VA Whole Health and Related Sites
Whole Health Library Website
Other Websites
Books
  • Fitness and Health, 6th ed., Brian Sharkey (2006)
  • Full-Body Flexibility: The 3-Step Method for Flexibility, Mobility, and Strength, Jay Blahnik (2010)
  • Healing Moves: How to Cure, Relieve, and Prevent Common Ailments with Exercise, Carol Krucoff (2009)
  • Strong Women Stay Young, Miriam Nelson (2005)
  • The Complete Guide to Walking for Health, Weight Loss, and Fitness, Mark Fenton (2008)
  • Yoga
    • 2,100 Asanas: The Complete Yoga Poses, Daniel Lacerda (2015)
    • Yoga for Arthritis: The Complete Guide, Loren Fishman (2008)
    • Yoga for Back Pain, Loren Fishman (2012)
    • Yoga for Osteoporosis: The Complete Guide, Loren Fishman (2011)
  • Tai chi and qi gong
    • Harvard Medical School Guide to Tai Chi, Peter Wayne (2013)
    • Qi Gong for Beginners, Stanley Wilson (2007)
    • The Tai Chi Workbook, Paul Crompton (1987)
    • The Way of Qigong: The Art and Science of Chinese Energy Healing, Ken Cohen (1999)
Apps and Monitoring Software

The popular phone apps listed below are free, although most have in-app purchases or memberships available. Find them by searching online or in your device’s app store. Note there are many other fitness apps offered by large sporting goods companies that also tend to be highly rated.

  • 7 Minute Chi. Download an app that demonstrates various tai chi exercises.
  • C25K Pro. Trains with 30-minute cardio workouts, 3 times a week for 8 weeks.
  • Cyclemeter
  • Daily Workouts Fitness Trainer
  • Daily Yoga
  • Fitness Buddy
  • Fitness Builder. Strength training app.
  • FitOn. Helps create a personalized class schedule.
  • Jefit. Helps create workout plans based on where you work out and what equipment you do or do not have.
  • Lotus Yoga
  • MyFitnessPal
  • Simply Yoga
  • SparkPeople
  • Strava
  • Strong Workout Tracker
  • Sworkit. Free for kids only.
  • Workout: Gym Tracker
  • Yoga for Beginners
  • Zombies, Run! Adds a story and missions for users to complete with walking, jogging, or running
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