Sport: A Holistic Approach to Lifestyle Medicine

Abstract

Sport represents a holistic health tool that unifies multiple pillars of lifestyle medicine. Sport can mitigate both the ongoing health disparities in communities that were present before COVID-19 and those exacerbated after COVID-19. The significance of this recommendation is highlighted by the impact sport participation has on creating healthy relationships, managing stress, and delivering physical activity among diverse populations. Importantly, sport can offer meaning and value to its participants, particularly when COVID-19 has limited people’s ability for purposeful activity and social interaction. Clinicians are urged to consider the broad utility of sport for the prevention and treatment of unhealthy behaviors.

“The possibility of bundling lifestyle medicine goals into one activity, sport, holds great promise for improving the efficiency of delivery and impact on health outcomes.”

The COVID-19 pandemic has underscored the importance of lifestyle medicine and the need to address chronic disease risk factors. ¹ The foundational six (6) pillars of lifestyle medicine—(1) healthy eating, (2) physical activity, (3) restorative sleep, (4) managing stress, (5) avoiding risky substances, and (6) promoting positive social connections—have been more difficult to achieve or sustain in this pandemic. ² For instance, rates of physical activity have declined more precipitously, ³ stress has been amplified,^4,5 and significant relationships have suffered strain or deterioration.^6,7 The pandemic has caused alterations in global and regional health policies that have limited or eliminated the availability and accessibility options to improve or maintain physical health. For example, many facilities have closed, sports activities have been paused or canceled, and social gatherings in recreational spaces now occur infrequently. ⁸ Perhaps most perniciously, these changes have elicited more disproportionate harm to historically marginalized groups (e.g., race/ethnicity, SES status, and age).^8-10

The combination of the COVID-19 pandemic and disproportional health disparities among historically marginalized groups is a multipronged issue that represents co-emergencies that we can no longer afford to ignore. A holistic or multi-dimensional solution is needed. Therefore, a clarion call for health interventions to combat pandemics and other threats to healthy lifestyles not only needs follow-up action but also innovative approaches that address diverse populations. Typically, we tend to focus on, or clinically treat, each health factor independently and universally. For example, in order to address physical activity, we would discuss with our patients ways in which they can increase walking or other forms of active daily living. To improve mental wellness, we may encourage activities that offer cognitive challenges or higher social interaction. Yet, the pandemic of COVID-19 and social health disparities have unveiled both the prevalence and exacerbation of deficiencies in healthy lifestyle behaviors that are multi-tiered, multifaceted, intricate, and co-varying with one another. As such, innovative interventions that address a multitude of these factors simultaneously using an interdisciplinary approach ⁹ would likely improve efficiency as well as address the interdependent nature of the foundational six pillars of lifestyle medicine to a larger population group.

An Innovative Tool: Sport as Lifestyle Medicine

Sport has been conspicuously absent and ignored from public health policy discourse.^11-13 Guided by the emergent research in the discipline of sport management ¹¹ and sport for development, ¹⁴ sport participation has been analyzed and often advocated for practical use to address multiple health determinants simultaneously (e.g., physical activity, social relationships, hedonic rewards, and cognitive and emotional health) and is theorized to predict overall wellbeing.^15,16 Sport has been legitimized to leverage its potential for beneficial outcomes, including overall health, salubrious socialization, and community development. ¹¹ Additionally, sport can serve as an optimal vehicle for packaging physical activity, due to its advantages of leveraging physical and social infrastructures that support sport programming. ¹¹ Work in this area continues to showcase the multi-level integration of sport, recreation, and physical activity as keys to synergizing various health outcomes. ¹⁷ Further, sport participation as a function of leisure has been characterized as a buffer for the prevention or management of emotional stress through social support and psycho-social health. ¹⁸ Moreover, sport can offer the key elements of hedonic rewards and social interaction, which may increase adherence to sport participation for healthy benefits. ¹² Lastly, sport has been shown to help promote intrinsic motives (e.g., meaningful, enjoyment, and accomplishment) and extrinsic motives (e.g., personal recognition and award) for physical activity participation. ¹³

Intrinsic motives are salient in promoting adherence to physical activity behaviors and retaining participation long enough to absorb the many health benefits of physical activity. Specifically, sport has shown to provide meaning and purpose to those who are involved, extending participation and retention. For example, older adults have used sport deliberately to navigate the aging process and invalidate the negative stereotypes of old age. ¹⁹ The physical, sociocultural, and psychological benefits of sport have induced “enhanced functional capacity, health promotion, relationship development, increased optimism, and inclusion in meaningful life activities and roles,” prompting sport’s inclusion in numerous therapeutic and rehabilitation programs. ²⁰ These programs established positive, meaningful outcomes that increased resiliency, promoted lifelong health, built self-esteem, connected others, taught coping mechanisms, and reduced depression. ²⁰ Sport is a valuable mechanism to promote meaning and purpose that catalyzes strong incentives for continued engagement.

The benefit of finding meaning and purpose in sport extends beyond the individual. It can enhance a sense of community and increase social capital among diverse groups of people.^20-22 Sport participation plays a valuable role in connecting individuals of various ages, backgrounds, and abilities through shared life experiences, particularly those with social issues. ²³ Participation in sport can help young people find a social network that disrupts social isolation and develops social capital. ²³ With intentional design, structure, and management, sport participation can facilitate social capital through expanding networks and community building. ²¹ Importantly, sport has been shown to increase social connectedness and relationships among communities that are ethnically and socio-economically diverse. ²⁴ These social benefits of sport highlight that health can be facilitated by developing multiple avenues of capital (e.g., physical, psychological, cultural, social, and economic) that traditionally allude marginalized groups. ²³

Theoretical and Practical Recommendations

Despite the benefits of sport and clear role it may play in lifestyle medicine, many view sport as competitively dysfunctional and/or regard it only as a spectator or entertainment activity. ²⁵ However, emergent research provides evidence-based theoretical models that can assist sport’s design as a viable implementation tool for health that should be taken more seriously by public health officials. For example, the sport as medicine conceptual model suggests ways sport can influence physical, social, and mental health outcomes that can transfer to all ages and backgrounds, dependent on how sport programs are designed and managed. ²⁵ This model offers three key design elements to manifest health outcomes: (1) creating a team structure (i.e., peer-led team sports), (2) providing a place to be accountable (i.e., social space for responsibility and recognizing individual’s desire to improve), and (3) ensuring no one is left out (i.e., inclusion-first environment). Combined, these elements are theorized to provide leadership and teamwork opportunities, promote diversity and inclusion, and create social spaces for social interaction, all of which are instrumental in promoting health in multifaceted ways.

Additionally, our research group^16,26 is advancing the concept of the sport as a resource model that explains how sport may help with human development across the life course. Our work specifically addresses how sport’s role can assist people in the adaptation process during life’s difficult transitional events, like those prompted by the pandemic of COVID-19 and/or social health disparities. Further, we have demonstrated that recent retirees from the workforce who were more behaviorally and socially involved with sport may receive a boost in the perception of gaining or accessing physical, psychological, and social resources known to improve wellbeing and successful aging. ²⁶ Hence, sport provided a meaningful activity for engagement that could substitute the meaning generated throughout the years in the workforce.

Finally, one key advantage to sport as lifestyle medicine tool may be its appeal to all people. The “sport for all” ethos argues that sport is not just for competitive or elite athletes; rather, sport can be played at all ages for enhancing a healthy lifestyle.^27,28 For instance, pickleball is the fastest growing sport in the U.S. and is highly popular among older adults. ²⁹ Playing pickleball has helped improve older adults sense of wellbeing, ³⁰ which may be attributed to sport’s capacity to induce hedonic rewards, ¹² encourage social connections and a sense of community, ²² provide meaning, ²⁰ and engage the participant with a cognitively challenging activity. ³¹ In another example, participation in intramural team sports for freshman college students helped build social benefits, like social interaction and a sense of community. ³² Lastly, the positive youth development literature^33-37 espouses the practice of using sport to teach life skills, positive relationships with adults, community engagement, and desirable personal traits to youth and adolescents that promote maturity, growth, and character building necessary for healthy development.

Conclusion

Sport participation is an important lifestyle medicine tool. Sport offers advantages that can package and support many health aims concurrently, promotes intrinsic motivators that facilitate adherence, and can be an inclusive activity for all ages and demographics to participate. Research on sport participation shows evidence of sport’s capability of addressing at least three out of the six lifestyle medicine pillars in one prescription: physical activity, managing stress, and promoting positive social connections. Sport also provides value in the opportunity for interdisciplinary work and the potential to address the many sociocultural health disparities that have been exacerbated in recent years by the COVID-19 pandemic. ¹⁷ Thus, the possibility of bundling lifestyle medicine goals into one activity, sport, holds great promise for improving the efficiency of delivery and the efficacy of impacting health outcomes.