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What Are the Most Important Elements of Wellness?

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The most important elements of well-being are reason, exuberance, sportiness and freedom. The acronym for these four dimensions is REAL. REAL Wellness avoids the confusion that often arises when wellness is sent out into the world for protection without a bit of specificity. The term wellness has been circulated so recklessly over the past four decades that a modifier that signals clear emphasis is essential to clearly communicating the concept. These four areas are that in my opinion the most important elements of wellness. Because of this, I believe a new medical specialty is needed. Physicians who care about healthy lifestyles should be trained in four REAL wellness specialties.

Following is an outline for a new medical specialty for Fitness and Nutrition, both of which are part of the Athletics element.

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medical specialties

In 2012, the AMA Physician Masterfile of specialty practices included 200 categories with an additional 140 officially recognized subspecialties. (Source: Association of American Medical Colleges 2012 Physician Specialty Data Book.)

The range of disciplines is impressive and demonstrates the dedication of our medical system to disease and dysfunction. The spectrum of disciplines ranges from A (allergy and immunology) to V (vascular surgery). Unfortunately, there is no specialty for dealing with what is perhaps the most common disease, a disease that affects hundreds of millions of sufferers in western countries. I am of course referring to sedentary dysfunctionitis.

Sedentary Dysfunctionitis or SD is a horrible condition that manifests itself in a variety of disorders, all caused by mental deficiencies, genetic abnormalities, adverse environmental factors and rarely a lack of proper information/education. All of these factors contribute to the common inability of citizens in the developed world to adequately manipulate and engage their organs, muscle groups, and accessory body systems in movements of sufficient frequency, duration, and intensity. This failure leads to a number of adverse health conditions and diseases including obesity, high blood pressure, heart disease, diabetes and more. Unfortunate millions confront the reality of cantdoit and become vessels for medical billing codes in a disease system still badly in need of repair.

Therefore, it is inexcusable, outrageous, scandalous and shocking that there is no medical specialty that offers treatment, not for the symptoms of SD (at least half of all specialists treat the myriad of SD-related illnesses and diseases) but for the condition from SD itself. As long as people suffer from SD, specialists in at least 100 specialty categories will have ample opportunity to engage and successfully treat those suffering from symptoms of SD disorder while the disorder itself remains undetected, or at least untreated.

The Role of the Physician Fitness Specialist

The physician who specializes in the treatment of SD is required to have advanced training in exercise physiology, motivational psychology, the nature of TRUE well-being, and a range of related skills, in addition to mastery of the standard medical school curriculum and other requirements for admission to the profession Skills that enable assessment and consultation, experimentation, research and more. He must understand related fields such as nutrition and positive psychology.

However, one area that will take up significant amounts of her or his time with patients will be diagnosing and assisting patients in reforming lifestyle-related metabolic, musculoskeletal, and psychological dysfunctions. After all, these are the basic elements for the onset and persistence of SD. Rather than prescribing drugs or performing invasive procedures, the fitness specialist MD prescribes and oversees exercise and fitness programs, often assisted by a team of exercise professionals. These patient-centric plans will target aerobic fitness, strength and flexibility. A default goal will be to restore and maintain healthy metabolic, musculoskeletal, and psychological stability and strength.

An example of the fitness specialist’s detailed focus might be to help SD patients regain the level of strength and flexibility they need. The doctor will want the pelvis and bones to align over it, otherwise joint and muscle pain will persist. Weak musculature does not allow a person to perform typical everyday tasks without collapsing, as muscles throw bones off balance. The fitness specialist knows that pain points are rarely the causative areas of pain experienced. He will know where to look for the problem and will prohibit routines and lifestyles that tackle the source, not the symptoms.


As Australian physical education educator John Miller has long argued, It’s a big challenge to expect someone to stay healthy without keeping fit themselves. It is an even greater request to expect that you will get better if someone is going to harm you. Sooner or later you have to do something to yourself.

Health without exercise and fitness cannot be maintained – at least not for long. Medical spending would be a fraction of what it is today (nearly 18% of US GDP — 6% in 1965) if we had half as many doctors treating SD as we treat allergies doing vascular surgeries and the others practice specialties in between. Too many doctors devote their talents to relatively rare and end-stage diseases. It is high time to put our national health system in order. It is time to create specialists for the all too common diseases of SD caused by dysfunctions that have led to my underuse of important body systems, particularly the cardiovascular, digestive and musculoskeletal systems.

Take a look at the Miller Model Continuum shown below, one of countless variations on the classic model developed in the early ’70’s ​​by John Travis, MD and first promoted at the world’s first wellness center in the heart of downtown Mill Valley, CA , was developed. Every disease and malaise known to man and woman exists on this continuum from the turning point in the center far left of the continuum – the terrible nadir or scab of despair point of physical deterioration. This is the playing field for all 200 medical specialties. Now look to the right of the turning point on the graphic. This would be the domain of the fitness doctor.

Be healthy, exercise daily, get fit and stay that way. There’s no point waiting for medical leaders to create a new specialty of doctors to take care of you if you get SD.

Thanks to Donald Ardell

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