Holistic interventions in managing suboptimal health status

Manage suboptimal health status (SHS) from the get-go to enrich health. This article zeroes in on six focus areas to alleviate SHS.

Suboptimal health status (SHS), a subclinical state between health and disease characterised by fatigue and a constellation of other physical symptoms but with no diagnosable disease condition, is a growing public health concern.1-5 As evidence indicates that unhealthy lifestyles may be key in the development of SHS, health-promoting lifestyle interventions may be effective in its management and prevention.5-7

In this context, health-promoting lifestyle has been defined as “a multidimensional pattern of actions and perceptions that serve to maintain or enhance the level of wellness, self-actualization and fulfilment of the individual.”8 It comprises six dimensions, namely nutrition, physical activity, stress management, health responsibility, interpersonal relations, and spiritual growth. A number of studies have shown that this holistic approach is associated with significant improvements in SHS scores.5,7,9

Six dimensions of health-promoting lifestyle interventions


This dimension involves the selection and consumption of foods essential for sustenance, health and well-being. In terms of macronutrient selection and consumption, adherence to the guidelines provided by the Food Guide Pyramid can be recommended.8 There are also a wide variety of nutritional interventions that may be necessary to maintain a healthy weight, supplement nutritional deficiencies, prevent disease and optimise health.10

Physical activity.

The performance of light, moderate and/or vigorous physical activity is associated with several benefits, including reduced mortality and morbidity, and improved wellbeing.10-12 The recommendations for physical activity should ideally include aerobic exercise, anaerobic exercises such as resistance training and flexibility exercises.10 This complementary programme improves not only cardiovascular fitness but also muscle strength, resistance to stress, coordination, balance and psychological wellbeing. Physical activity may be in the form of a planned and monitored programme or as part of daily life or leisure activities.8

Stress management.

The management of stress involves the identification and mobilization of psychological and physical resources to effectively control or reduce tension, including sufficient sleep, time management, cognitive behavioural therapy, diaphragmatic breathing, progressive muscle relaxation, biofeedback (technique of making involuntary bodily processes perceptible to the senses in order to learn to manipulate them consciously), guided imagery and meditation.13 The specific intervention would depend on the types of stressors and individual preferences and resources; furthermore, multiple interventions may be combined.

Health Responsibility.

This dimension requires that individuals are accountable for their own health and wellbeing. It includes paying attention to one’s own health, educating oneself about health and making informed decisions on when to seek professional care.8 In practice, this might include health advice and discussions on improving health knowledge and awareness, and increasing self-care.

Interpersonal relations.

Meaningful relationships with others help to relieve stress and mental well-being. The development of interpersonal relations involves communication with others through sharing of thoughts and feelings using verbal and nonverbal messages.8 Attention to one’s social history, improved doctor–patient communication and compassionate care may serve to foster improved personal relations in clinical practice.

Spiritual growth.

Spiritual growth involves the development of inner resources through transcendence (being in touch with our balanced selves) and development (maximizing human potential for wellness by searching for meaning, finding a sense of purpose and working toward goals in life).8 Achievement of spiritual growth may include multiple interventions, some of which are within the role of other professionals such as psychologists, therapists and professional coaches. Establishing a robust professional network for referral may help facilitate the integration of spiritual growth with health-promoting lifestyle interventions.

In closing, clinicians should bear in mind that given the variations in attitudes, resources and health status of individuals in the general population, planning and implementation of health-promoting lifestyle interventions should be individualised for optimal adherence and effectiveness.


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