Chapter 4
Prevention and the Promotion of
Health, Wellness, and Fitness
The function of protecting and
developing health must rank even
above that of restoring it when it is
impaired — Hippocrates
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The Context for Primary Prevention
Physical therapists are expected to participate
actively in health and wellness practices.
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Prevention, Health Promotion, and
Health Education
Primary Prevention:
Includes health promotion, protection and
preventative health services.
Takes place in the “prepathogenesis” period—
before onset of disease.
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Secondary Prevention
Includes screening for the purpose of early diagnosis and
treatment of disease, as well as disability limitation.
 Secondary prevention services take place after the onset
of illness or injury, in the presence of pathology.
 e.g., breast and prostate screening, osteoporosis
screening, medical pre-placement evaluations.
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Tertiary Care
Encompasses traditional physical therapy
services.
 Health status of patient will determine if information falls
under primary, secondary, or tertiary care.
 e.g., A diabetic patient receiving rehabilitation for an
amputation would be receiving tertiary care.
Overall health status will determine which category the
patient requires.
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Differentiation of Primary, Secondary, and
Tertiary Prevention
Prepathogenesis Period
Health
Promotion
Health
Protection
Period of Pathogenesis
Preventative Early
Health
Diagnosis
Services
and
Prompt
Treatment
Primary Prevention
Disability
Limitation
Secondary
Prevention
Rehabilitation
Tertiary
Prevention
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Health Promotion
A combination of educational and environmental
programs or actions that are conducive
to health.
Factors/interventions are considered beyond the
exercise program (e.g., nutrition).
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Combination Component
Variety of learning experiences (interventions)
are necessary to influence change.
Interventions from other healthcare providers
may be enlisted.
e.g., Nutrition, hormone therapy, and therapeutic
exercise are combined as part of the
osteoporosis intervention program.
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Education Component:
Health Education
Any combination of learning experiences designed
to facilitate voluntary actions conducive to help.
 Health education activities are planned out and are
voluntary.
Examples:
 Counseling patients on the risks of smoking.
 An osteoporosis program.
 Teaching children how to carry and load their backpacks
safely.
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Environmental Component
Encompasses social forces that influence health:
social, political, economic, organizational, policy,
and regulatory issues.
Individual and social/regulatory activities are
included.
Individual’s vocational policies must be
considered to assist with positive responses
(e.g., nonsmoking policy at work).
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Health Promotion = Health Education?
 Not significantly different.
Health Promotion & Health Education:
Broad and varied set of strategies to:
Influence individuals and their environment
Improve health behavior
Enhance health and quality of life
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Health Protection/Preventative Health
Services
Health Protection
Strategies dealing with
engineering the
physical environment.
Preventative Health
Services
Traditional medical
system efforts to
prevent injury and
illness.
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Wellness and Lifestyle
Concepts that embrace positive health behaviors
and promote a state of physical and mental
balance and fitness.
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Wellness
1. Multidimensional concept.
2. Has salutogenic focus (what causes
health).
3. Uses a systems perspective.
4. Size of each dimension within systems
theory represents the amount of
wellness an individual possesses.
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Dimensions of Wellness
Physical
Psychological
Social
Emotional
Spiritual
Intellectual
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The Wellness Model
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Measurement of Wellness
Reflects the multidimensionality and systems
orientation of the concept and has a healthcausing (salutogenic) focus.
Includes perceptual tools when measuring
wellness for all levels of prevention (primary,
secondary, tertiary).
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Perceptions that may be Assessed
General health
Status
Social support
systems
Role and social
functioning
Functional status in
self-care and homemanagement
activities
Work
Community
Leisure activities
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Perceptual Measurement Tools
Instrument
 SF-36
 Satisfaction w/life scale
 Perceived wellness
survey
 NCHS general well-being
schedule
 Philadelphia Geriatric
Center morale scale
 Memorial University of
Newfoundland scale of
happiness
Perceptual Construct
 General health perceptions
 Life satisfaction
 Perceived wellness
 General well-being
 Morale
 Happiness
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Health Promotion and Wellness-Based
Practices
Offering services beyond traditional patient–
provider practices.
Change the focus:
Illness
Wellness
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From Illness to Wellness
Requires altering the approach to consider
patients as “clients” who can be MORE well.
Patients convert to “members” after
discharge and continue to use facility to
continue their exercise program.
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Establishing a Wellness-Based Practice
Facility is open and staffed at convenient hours.
Staff has expertise in exercise prescription and
wellness.
Educational classes (nutrition, exercise, etc.) tap
the intellectual aspect.
Provider often assumes the role of a facilitator.
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Use of Screening as an Examination
Tool within a Wellness-Based Practice
Used to identify whether client has risks that
require investigation before intervention
program.
Examples:
Satisfaction with life scale
Perceived wellness survey
NHCS general well-being schedule
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Starting a Wellness-Based Practice
1. Verify that “wellness” or “health promotion” is
included in the definition and description of PT in
the state practice act.
2. Check liability policy to ensure coverage.
3. Become educated on identifying/understanding
the potential risks of a wellness-based practice.
4. Incorporate marketing and advertising programs
and success evaluations.
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Summary
Classification of prevention – primary, secondary, tertiary.
Health promotion and wellness – primary prevention.
Most rehabilitation – secondary or tertiary.
The terms health promotion and health education are
often used interchangeably.
 Wellness is multidimensional salutogenic and requires a
systems perspective.
 Perceptual measures (screening) – good predictors of
general well-being.
 Wellness – Looking beyond physical domains and
biomedical model.
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