The Pillars and Practice of Performance Medicine

In prior blog we discussed the philosophy of performance medicine. Now let’s take a peek under the hood and delve into the actual components of the day-to-day practice itself.

As depicted below, performance medicine is a blend of three distinct, but interrelated disciplines applied to an individual’s unique physiology, psychology, and position (i.e. life circumstances).

Proactive Preventive Medicine

Proactive preventive medicine is all about diving deep to obtain a full picture of an individual’s risk of morbidity and mortality in the future.  This involves detailed intake interviews, advanced biomarker testing, and remote data monitoring, Currently, at VIM Medicine, we are focused on three key facets of health that are traditionally ignored until disease occurs.

Cardiovascular Health

Cardiovascular disease (CVD)—which includes heart attacks due to coronary artery disease, stroke, hypertension, and heart failure—continues to be the leading cause of death among men and women in the United States and worldwide, accounting for an estimated 655,000 deaths annually in the United States. The most recent statistics from the American Heart Association indicate that in 2017, an estimated 17.8 million deaths were attributed to CVD globally, a surge of 21.1% from 2007. The risk starts early, and often silently; 18.2 million adults 20 years and older have some degree of coronary artery disease.  Many of the classic risk factors for CVD, such as cigarette smoking, obesity, poor nutrition, and a sedentary lifestyle, are thought to fuel the formation of plaques in the arteries, known as atherogenesis.

In preventive cardiology, the name of the game is “risk reduction”—using all of our available tools to decrease the likelihood that you will suffer from a cardiovascular event at some point in the future. Current guidelines use predictive models to risk stratify patients to determine who would benefit from pharmacotherapy like statins. Unfortunately, many of the standard tests and biomarkers used today only scratch the surface of understanding a patient’s risk.  Performance medicine prioritizes using more in-depth testing to better understand an individual’s lipid profiles, markers of inflammation, and levels of oxidative stress.

Metabolic Health

Metabolism refers to the way in which our bodies process the food we eat into energy that can be used to power our cells, and thereby ourselves. Without diving into the weeds here, our metabolism involves a careful interplay of hormones that tightly control our digestion, blood sugar levels, and appetite signals. If these signals are thrown out of whack, this so-called “metabolic dysfunction” can cause obesity, Type 2 diabetes, cancer, and even Alzheimer’s disease.  Metabolic dysfunction most commonly manifests as insulin resistance which afflicts at least half of all Americans. And this is likely an underestimate.

Traditional health care often diagnoses insulin resistance long after the horse has left the barn—once insulin resistance manifests as prediabetes or even frank Type 2 diabetes based on standard blood tests. The insulin resistance likely began years (or even decades) prior. It can and should be detected earlier with more advanced testing and tools like continuous glucose monitors.

Musculoskeletal Health

While it may not be a killer like heart disease or cancer, musculoskeletal impairments are a major cause for disability and dysfunction. Low back pain, the most prevalent musculoskeletal disorder worldwide, tops the list of primary care complaints and contributes to enormous direct and indirect (i.e., work absenteeism or productivity loss) health care costs. This, as well as osteoarthritis, postural aches, sprains and strains are highly associated with mental health decline and often restrict the key behaviors (exercise!) that boost vitality.

Unfortunately, traditional primary care is woefully inadequate at treating, much less preventing musculoskeletal impairments. The standard prescription is an anti-inflammatory, rest, some ice and a referral to physical therapy. With proper biomechanical analysis and mobility screening, the risk of musculoskeletal injury can be significantly mitigated.  A prescription of corrective exercises (so called “prehab”), mobility routines, and strength training can prevent strains and aches before they appear. This happens in the gym, not in the doctor’s office.

Lifestyle Behavior Change

The major drivers of cardiovascular, metabolic, and musculoskeletal health are lifestyle-related, including levels of physical activity, dietary pattern, stress management, sleep, social connectedness and engagement. While these concepts sound simple in theory, executing them regularly is anything but in our calorie-dense, movement-sparing, stress-inducing modern environment.

This is why all lifestyle focused prescriptions must be built upon the science of human psychology and behavior change. Setting goals and connecting our desired outcomes to the daily process steps and incremental actions that drive results over time is hard work. Our actions must align with our values and vision of self. Acting in ways that delay immediate gratification in service of our future self requires discipline, habit formation, and motivational hacks. Fortunately, there is a real science to this work. Unfortunately, you won’t get it through traditional medicine.

Performance medicine focuses physical training at the core of a holistic lifestyle prescription. Not only is physical activity the most potent therapy to guard against cardiovascular, metabolic, and musculoskeletal disease, but it is gateway behavior for a healthier lifestyle. Engaging in physical training provides the tangible, immediate reward of increased energy, focus, and feel-good endorphins. A training plan tracks incremental progress over time and teaches the reward of incremental gains through commitment to the process (versus outcome)—essential learning for success in any domain of life.

Energy Management

Energy management, the third pillar of performance medicine, optimizes lifestyle and health behaviors to increase one’s capacity to perform successfully at work, at home, etc. Energy management involves learning how to mitigate, manage, and use stress productively—when to press the accelerator, when to cruise, and when to pump the brakes. Proper coaching teaches the strategic pairing of strain and recovery to increase endurance, focus, and resilience. Through applied practice, clients understand how time and energy invested in health promoting practices pay dividends in the other arenas of life.

Optimal health combined with proper lifestyle behaviors and energy management puts us in a prime position to achieve, learn, and grow. These three pillars of performance medicine interrelate and enhance each other. Integrating them together in a comprehensive package and prescription tailored to the individual is what real health care must deliver. This is what VIM Medicine strives to deliver.