The 3 Pillars of Health

Three pillars of health behaviors will support your physical therapy: physical activity, sleep, and nutrition. These three areas of focus are key for continuing health and wellness improvements after completing your plan of care. Work with your PT to personalize each, identifying barriers and their matched solutions that are meaningful to you.

How much physical activity do you need?

Exercise is the foundation of physical therapy. It is needed to improve your strength and cardiovascular capacity. Exercise helps prevent and treat chronic diseases, such as diabetes. Exercise helps overcome movement fears, build physical activity confidence, and reduce pain. The more physically fit you are, the better you can recover from future injuries and stressors.

We have provided you with a tailored exercise program specific to your pain. When you finish your treatment, it is important to sustain regular exercise habits. There are many options at your disposal. To get started, aim to meet the physical activity guidelines.

In the United States, the Centers for Disease Control and Prevention (CDC) provides guidelines for physical activity. Here are the general recommendations for adults:

• Aerobic Activity:
  • At least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week.
  • Alternatively, a combination of moderate and vigorous activity throughout the week.
• Muscle-Strengthening Activities:
  • Include muscle-strengthening activities on 2 or more days a week.
  • Focus on major muscle groups, including legs, hips, back, abdomen, chest, shoulders, and arms.
• Additional Benefits:
  • More extensive health benefits can be achieved with 300 minutes of moderate-intensity aerobic activity, 150 minutes of vigorous-intensity aerobic activity, or an equivalent combination each week.
  • Adults should also engage in activities that enhance balance and flexibility, especially for older adults.

Aerobic activity comes in many forms, such as cycling, rowing, running, brisk walking, hiking, or swimming. Resistance training can be completed with machines, free weights, bands, or body weight (i.e., calisthenics). Choose the option you are most comfortable with and most likely to stick with for the long haul.

Pay attention to sleep quality and duration

Sleep is more than just rest; it’s a vital process when your body repairs and rejuvenates, and your brain organizes what you’ve learned. Especially for athletes, numerous studies highlight the critical role sleep plays in physical performance. Before we delve into strategies for better sleep and enhanced performance, let’s understand some sleep basics.

Stages of Sleep:

• NREM Sleep (Non-REM):
  • Stage 1: Transitional and only lasts a few minutes.
  • Stage 2: Further relaxation with occasional bursts of rapid brain waves.
  • Stage 3: Deep sleep when physical and mental restoration occur.
• REM Sleep (Rapid Eye Movement):
  • Dreaming occurs, brain activity increases, and your eyes move rapidly.
  • Essential for cognitive restoration and memory consolidation.

Sleep occurs in cycles. It is normal to briefly wake during the night when you are in stage one (light) sleep. If you quickly fall back asleep, your sleep quality won’t be affected.

When Sleep Loss is a Problem:

• Sleep Restriction (SR): Partial disturbance, occasional sleep loss. This could be a single late night out or staying up to study for a test.
• Sleep Deprivation (SD): Extreme loss affecting both quality and quantity. Parents of young children are very familiar with this state.

Both impact cognitive function, reaction time, motor skills, motivation, and recovery, posing a threat to athletic performance.

Benefits of Sleep for Physical Performance:

Adequate sleep prevents cognitive impairment, and fatigue, and enhances mental acuity, reaction time, and overall performance. Elite athletes with over 8 hours of quality sleep showed improved mood, energy, and reduced injury risk.

Recovery and Performance:

Each sleep stage triggers different physiological events crucial for skill retention and information processing. Skipping sleep may impair submaximal strength, anaerobic power, and sport-specific skill execution. Sleep deprivation significantly impacts athletic performance by increasing metabolic demand and impairing muscle glycogen restoration.

How Much Sleep Do We Need?

Consistency is key; you can’t “bank” sleep. Adults generally need 7-9 hours per night. It varies based on age, lifestyle, and individual factors. Trial and error helps establish a target duration based on quality.

Strategies to Improve Sleep:

• Consistent Sleep Schedule: Regular bedtime and wake-up time.
• Relaxing Sleep Environment: Quiet, cool, dark bedroom with comfortable bedding.
• Limit Daytime Naps: Keep them short, and avoid late naps.
• Avoid Stimulants Before Bed: No caffeine, nicotine, or alcohol.
• Relaxing Bedtime Routine: Activities like a warm bath or reading (not in bed).
• Regular Exercise: But not too close to bedtime; match exercise to your daily rhythm.
• Manage Stress: Use relaxation techniques like deep breathing or meditation.

Every individual is unique, so find the combination that works best for you. Experiment with these strategies to boost sleep quality and achieve the necessary amount for optimal athletic performance.

Understanding nutrition fundamentals

For a personalized nutrition plan, work with a registered dietitian. There are many aspects of nutrition to consider. Here, we will focus on some fundamentals for health and wellness.

First, make sure your diet consists of a lot of plants. You don’t need to eat a vegetarian or vegan diet, you just need to make sure plants are a staple in your diet. Research shows that all-cause mortality is lowest for people who consume high levels of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish, and lean meat or poultry. The healthy eating patterns were relatively low in red and processed meat, high-fat dairy, and refined carbohydrates or sweets. Translation? Eat more plants and limit ultra-processed foods and meats high in saturated fat.

Why are plants so important? First, they are very nutrient-dense, providing you with many essential vitamins and minerals at a low-calorie count. Second, plants provide you with fiber, which is integral for gut health. Soluble fiber forms a gel-like substance in the stomach which slow digestion, helping control blood sugar and cholesterol, like a metabolic sponge. Insoluble fiber adds bulk to stool and improves regularity. It also helps regulate insulin and your blood sugar levels. We start to see substantial health benefits — lower body fat, improved glycemic response, and reduced blood pressure, triglycerides, and low-density lipoprotein cholesterol (LDL-C) — once crossing the 25–30 gram per day threshold.

The next very important consideration for your diet is protein intake. Protein is the building block of muscle tissue, and it is necessary for muscle repair and growth of most parts of our body. While you will find more protein in meat and animal products, you will find plenty of protein in plant-based sources as well, such as beans, legumes, and whole grains. For maximizing muscle growth, studies suggest consuming 1.2–2.2 grams per kilogram of body weight per day (g/kg/d) For example, if you weigh 150 pounds (or roughly 68 kilograms), your protein intake would fall between 82–150 grams per day. For a personalized plan of macronutrient distribution (fat, protein, carbohydrate), talk to a registered dietician.

The last thing we will touch on is what to limit. We mentioned limiting saturated fat and ultra-processed foods. The former is linked to cardiovascular disease. The latter contributes to weight gain and chronic diseases, such as diabetes. Utra-processed, like chips, candy, and soda, are hyper-palatable and low in fiber and protein, leading to overconsumption. They are not filling and they provide little nutritional value. That doesn’t mean you should never consume them, but they should be limited.

Alcohol falls in this category as well. While you may hear about anti-oxidants from wine, know alcohol is still unhealthy. It is directly linked to cancer and fatty liver disease. Like sweets and ultra-processed foods, you can safely consume alcohol, but the amount should be limited. It will impair short-term physical performance and recovery and negatively impact long-term health if regularly consumed.

There are many ways to eat a healthy diet. Be wary of anyone claiming certain foods are poison or that you must eat in a specific dietary pattern. Focus on the big picture. If you eat a lot of plants, don’t overconsume, and meet the physical activity guidelines, you will have a lot of wiggle room in your diet.