Prediction models indicate that, by the year 2030, 1 in 2 Americans will be obese or diagnosed with type 2 diabetes1,2 and 40.5% will have a diagnosis of heart disease.3 The medical model in our health care system trends toward "sick care" versus "health care." As health care professionals and experts in human movement science, physical therapists (PTs) and physical therapist assistants (PTAs) are called to action to enlist a culture of change focusing on primary prevention of chronic disease. The authors of this study, Billek-Sawhney et al,4 have proposed an excellent tool, the Wellness Aging Model Related to Inactivity, Illness, and Injury (WAMI-3), a patient education tool, which can be easily translated into clinical practice to educate the adult population (young and old) about the benefits of physical activity and the positive impact it has on illness prevention and aging successfully.

Only 22.9% of the nation's adult population is getting the adequate recommended amount of daily exercise and/or physical activity.5 This number is disturbing, and as Billek-Sawhney and colleagues stated it is a "steep challenge" to fully promote and implement a culture of change to increase physical activity levels. It is important that we as human movement specialists understand each of our client's individual factors that set them apart as unique human beings able to autonomously change their lifestyle habits. It is vital that we share the WAMI-3 resource not only with patients who are 65 years and older but also with the younger population. Instilling education and implementing healthy activity habits at a younger age could improve that rightward shift on the normal aging curve (as demonstrated by the WAMI-3 schematic) if patients continue to adhere to a healthy lifestyle as they age. This is where PTs and PTAs can begin to implement change and provide continued follow-up with these patients to allow for tracking and accountability. The WAMI-3 can be the tool to assist with tracking in this area. The authors touched on the need for positive motivational interviewing and behavioral change therapy. One can postulate that together these interviewing techniques are the backbone to ensure that our profession addresses healthy habits (physical activity, nutrition, sleep, stress reduction, and social/emotional connections) head on and begin to introduce primary prevention in health care. These interviewing techniques are beginning to gain ground in entry-level DPT programs as well as PT and PTA continuing education, but more work needs to be done to ensure that our profession is accountable for their use in the clinical setting so that tools like the WAMI-3 are addressed as a standardized practice guideline during the individual examination, evaluation, and interim progress assessments.

In the age of technology and advancing technological assessments, the WAMI-3 could also be used as a digital assessment, educational resource, and tracking tool. Considering the vast amount of smartphone applications, it is plausible that this tool could be easily converted to a digital application. For example, the Stroke RiskoMeter, endorsed by the World Heart Federation and the World Stroke Organization, is a new smartphone application to assess stroke risk in the next 5 to 10 years and promote lifestyle changes one can make to reduce that risk.6 This tool has been implemented clinically, and I have personally used it to begin that discussion of behavioral change for this patient population. Allowing the patient to see in real time their risk and giving them the autonomy to set goals to reset their stroke risk or recurrence has been helpful in the success of reaching and maintaining individual healthy habits. The WAMI-3 could be another example for those persons who may be seeing a PT for a variety of reasons (fall prevention, age-related changes, acute/chronic orthopedic injury, chronic neurological injury, cancer rehabilitation, etc.). Thus, using this tool, the PT could help the patient shift that WAMI-3 curve rightward, and implement a primary preventive technique for those persons to reduce their risk of developing a chronic disease as one ages.

Finally, it is important to note that the authors of this article state that moderate exercise is of importance to create a significant rightward shift on this educational tool's scale. This is a crucial point to address as several literary articles particularly those in the neurological field discuss high-intensity training to ensure neuroplasticity, especially when rehabilitating those persons with stroke, spinal cord injury, or Parkinson's disease.7,8 Intensity is of importance for neuroplastic change,9 but we must consider the individual and the populations we are treating. Looking at the effects of exercise, moderate-intensity exercise had the most benefit on sequestering oxidative stress.10 In fact, high-intensity exercise induced more oxidative stress in the body.10 Oxidative stress can be defined as an imbalance of free radicals and antioxidants in the body, which weakens our immune system and cardiovascular system, leaving more susceptibility for disease to enter the body.10 Therapists must understand and implement heart rate and perceived exertion monitoring to ensure maintenance of moderate activity parameters. The patient or client must also be taught these parameters and be able to self-track these parameters while performing physical exercise and activity in their home and community. This implementation must be done to ensure the positive effects of exercise as stated in the literature, and to see positive change reflected on the WAMI-3 resource tool.

To conclude, the WAMI-3 is a valuable tool that can immediately be used in clinical practice. This tool in its original form has the capability to prompt what could be perceived as difficult conversations related to lifestyle medicine and begin coaching techniques in the form of motivational interviewing and behavior change therapy by PTs and PTAs. The clinician must be knowledgeable about exercise parameters to induce positive results as well as educate the client on the importance of tracking these parameters in the home and community. Additionally, this tool has the capacity to evolve to a digital version, which can be more widely used for real-time monitoring and goal setting as well as goal attainment so that patients can visibly see these positive changes taking place, as physical activity and exercise targets are set and met on a daily, weekly, monthly, and yearly basis.

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