In this issue:
CHAD MORRIS, Ph.D., Director
Greetings DIMENSIONS Readers,
You may have noticed that our newsletter has a new format. After several years of exploring the 8 dimensions of wellness through the lives of our team members, it is time for our newsletter to evolve. We love sharing our personal wellness stories with you all, but we also want to share news about our team, our current endeavors, and our accomplishments. We want to offer you what’s on our minds concerning recent developments in the areas of healthcare policy, research, and wellness news in the column, A Study in Wellness. But, of course, we’ll still share our team’s personal wellness journeys through columns in Wellness in Practice. We hope you enjoy the new format of the Dimensions Newsletter as much as we enjoy creating it.
What is happening currently at BHWP? Well, we’ve reached the halfway point for our first Build A Clinic Learning Community. With funds from Pfizer’s Independent Grants for Learning and Change program, we are currently training 9 primary care clinics on the skills and knowledge necessary to create, integrate, and operate an efficient tobacco cessation workflow within normal clinic operations. The pace of the timeline for the construction of this learning community has been fast, with a call for proposals in early January, content creation for six distinct webinars in March, and an interactive video teleconference every month. So far, the feedback has been exceptional, and we can’t wait to evaluate how far the clinics have come.
In July, we will be calling for applications for new Build A Clinic Learning Community members. If you’re interested, email us at [email protected] to join the mailing list.
In the last few months, we’ve also been very busy creating a Motivational Interviewing (MI) education program for UNITY Consortium. Through our partnership, we created two instructional videos and an onsite training for physicians focused on how to use MI techniques in discussions about vaccination recommendations with parents and young patients. This project has been an excellent opportunity to expand our MI educational programs and video production portfolio.
And finally, we want to give our thanks to those organizations that contracted with us through our DIMENSIONS Programs. It has been our pleasure and privilege to conduct onsite trainings for the following organizations:
The Federal Judicial Center – Denver, CO – Leadership and Resiliency
St Mary’s and Glens Falls Hospitals – Cooperstown, NY – Organizational Change in the the Behavioral Health Setting
Assurance Health and Wellness – Tucson, AZ – DIMENSIONS: Tobacco Free Program
Solvista Health – Cañon City, CO – DIMENSIONS: Well Body & Tobacco Free Programs
Centerstone of Illinois – Carterville, IL – DIMENSIONS: Tobacco Free Program
Monterey County Health Department – CA – DIMENSIONS: Tobacco Free Program
A Study in Wellness
Is There Such a Thing as “Too Much Exercise”?
JIM PAVLIK, M.A., Program & Policy Analyst
In 2008, the US Department of Health and Human Services released guidelines concerning minimum threshold amounts of physical activity needed to remain in good health. The guide focused on minimums, because at the time, there were no known caps. Simply put, the more you exercised, the more your health improved (barring injury). Or so it was thought.
I ran my first marathon in 2011. In that year, there were a record-breaking 518,000 marathon finishes, and my wife and I were two of them. Compare that to 1976 when there were only 25,000 finishes. Over the years, the median finish time has crept up (from 3:32:17 for men in 1980 to 4:19:27 today) as has the median age (~33 in 1980, 38 today). In 2014, 3,326 men and women over 60 years old completed the Honolulu Marathon. Numbers for triathlons are similar.
The result of this astounding growth in the popularity of endurance sports has provided researchers remarkable new opportunities to test their hypotheses about whether there is such a thing as “too much exercise.” And of course, increased the importance of finding an answer as well.
And what they’ve found is that at extremely high levels of physical activity some of the longevity benefits of physical activity start to reverse.
The minimum recommended level of physical activity is 150 minutes per week of moderate activity or 75 minutes per week of vigorous activity. According to a recent study (Arem et al., 2015), longevity benefits from physical activity seems to plateau around 5 times the minimum recommended levels (about 12.5 hours of moderate exercise a week). At 10 times the minimum level of physical activity (or 25 hours per week), there is a trend toward longevity benefits beginning to decrease.
Some may argue that living a long life isn’t the most important reason to add leisure time exercise. While others might posit that if we aren’t prolonging years of quality living, what’s the point? I’ll leave that debate for another time. However, it’s worth pointing out that while these researchers found a decrease in the longevity benefit of high levels of physical activity, they did not find a significant elevation in mortality risk.
Advances in our understanding of physical activity and its effect on health and well-being, including emotional wellness, stress reduction, healing from injury, mitigating chronic disease, and weight loss, among others, probably mean that it may be a prime time for a thorough review of the physical activity guidelines.
For BHWP, findings like this provide impetus for our continual process of updating and refining our training materials and resources. Right now, we are in the process of a major revision to our DIMENSIONS: Well Body Program—so stay tuned for the upcoming unveiling of this revitalized, scientifically up to date resource.
Arem, H., Moore, S. C., Patel, A., Hartge, P., Berrington de Gonzalez, A. Visvanathan, K., … Matthews, C. E. (2015). Leisure time physical activity and mortality: A detailed pooled analysis of the dose-response relationship. JAMA Internal Medicine, 175(6), 959-967.
Wellness in Practice
CINDY WANG MORRIS, Psy.D., Clinical Director
In recent years, I have been particularly attuned to language, both verbal and written. While I value precision in language, what’s more important to me is what language says about someone’s internal experience. So I listen for key words.
One word that stands out is the “F” word. No, not that “F” word. The other one, “Fine.” Like me, you probably hear it all the time, coming out of your mouth or that of others. “Fine” is always a red flag for me. Think about your reaction to, “It’s fine.” In my mind, it’s saying, “I don’t like it—whatever it is—but I’ll tolerate it.” So whether you use the word, “Fine,” to describe how you are feeling or in response to a request from someone, take a moment to consider the true meaning of this word for you.
What does this have to do with spiritual wellness you ask? Often, when we talk about spiritual wellness, we’re referring to a spiritual practice, like meditation, yoga, and prayer. Or living by a certain spiritual belief system and values. I believe that as spiritual beings, we ought to treat ourselves with respect. And if someone feels like they regularly compromise what they want and need, they are not treating themselves with the respect they deserve.
There are many potential long-term consequences to being, “Fine.” One of the most important of these is losing sight of who you are and what you want. Or feelings of anger, resentment, depression, and regret for not truly expressing yourself. Or the belief that you don’t deserve any better and will, therefore, accept others’ decisions that directly affect your well-being. I know from experience that when I do not honor my feelings and desires, what appears to be small compromises can quickly transform into something with big implications. So part of my spiritual practice is to never be just, “Fine.” And that feels just spectacular.
Working It Out
JAMIE PFAHL, B.A., Community Liaison
“The clearest way into the Universe is through a forest wilderness.” – John Muir
I need a vacation, but not the kind of beach-lounging, daiquiri-drinking, hammock-relaxing vacation you may be imagining. I’ve never been great at that kind of relaxing. That’s not to say I can’t spend a day on the couch binge watching an entire season of a TV show every now and then, but I never feel good about it.
I see vacation as a time to reconnect with myself and my place in the universe and that kind of clarity has never come to me while sitting in a hammock. Lately, I have been wondering about what my life would be like if I were to wake up one day and find that I was the only person left on the planet. If there were no public scrutiny on my body, would I exercise as much as I do? Would I still try to read and learn just for the sake of knowledge if there was no one around to philosophize with or impress? Would I strive for excellence and challenge myself every day, or just try to survive as comfortably as possible?
To be happy and fulfilled, I need to live in accordance with my values. Values are at the heart of motivation, and motivation is what makes the difference between work and play. I’ve been struggling with connecting honestly with my own motivations and values. What is important to me? What gives meaning and purpose in my life? What is worth suffering for?
While some people might find the answers to those questions on a cruise ship or at the bottom of a fruit-infused stiff drink, I need something more than just a change of pace. Maybe I need the crushing sense of isolation and insignificance I can only truly experience when I am completely alone in a rugged and unforgiving wilderness. There is something both terrifying and magical about being alone and reliant on oneself, carrying only what I need to survive that allows space to discover what is really important. As John Muir once said, “Keep close to Nature’s heart…and break clear away, once in a while, and climb a mountain or spend a week in the woods. Wash your spirit clean.” That is what I need.
In the Flow
KATHIE GARRETT, M.A., Clinical Program Associate
As a Motivational Interviewing (MI) trainer, I spend considerable time coaching others on the spirit and practice of MI. To personalize each workshop, I’m ever searching for the right metaphor, symbol, or story in which to anchor my instruction, one that resonates with the unique culture and spirit of the group being trained.
As it happens, I’ve just spent three weeks on the road crisscrossing the country to lead workshops for an array of healthcare professionals, including a unique group of Native Alaskan Community Health Aides. These are exquisitely trained rural lay healthcare providers who deliver basic medical services and triage to people living in the most remote villages in Alaska. I was actually on the plane en route to Anchorage and still had not found a spiritual symbol consonant with motivational interviewing and my understanding of the life and work of Alaskan community health aides.
Then, just before the plane moved over the border of Canada and I lost my Internet connection, I noticed on my Facebook newsfeed one of those “because your memories matter” automatic reposts. It contained a poem that I had written and posted on FB for my son in 2010 after showing him my childhood home and telling him the story of the Spruce tree in the front yard. The poem was a long one, but it is these words that caught my eye: “Through the limbs of a tall pine my dad planted long ago, I share a family story about the sowing of seeds and the humble birth of this tall beauty. A kernel takes root in my son; sap comingles with blood. This is exactly how the shape and substance of the landscape enters the human spirit and evolves into us.”
It was like a light went off in my head, one of those fleeting and delicious “aha” moments. Earlier, I had been reading about the Sitka Spruce, one of Alaska’s few native trees. I had learned that not only does it grow to astonishing heights but also it can live for up to 700 years despite nutrient poor soil and extreme weather conditions. I thought “yes!” This is the spirit of the tree and this is the spirit of people who live in the most isolated regions of Alaska.
So I invoked the spirit of the strong and tenacious Sitka when I presented the MI heart set: partnership, acceptance, compassion, and evocation. And rather than define the elements of the MI spirit, I expressed it in a series of promises that I might make to a patient if promising to stay true to the MI spirit—promises as solid as the Sitka Tree is steady; promises as expansive as the Sitka tree is tall. The spiritual connection that existed between me, the community of trainees, and the natural landscape was immediate and powerful. In that moment I felt connected and awake. It was a sacred moment.
The mission of the Behavioral Health and Wellness Program is to improve quality of life by facilitating evidence-based health behavior change for communities, organizations, and individuals.