Sleep, rest, and relaxation are often undervalued factors that contribute to the maintenance and improvement of wellness. Sleep cycles and their given durations have been clinically proven to influence essential aspects of human life: cardiovascular health, metabolic health, mental health, immunologic health, human performance, and mortality, to name a few [1]. Inadequate sleep has known associations with increased risks of mortality, cardiovascular disease, cerebrovascular disease, obesity, diabetes, cancer, and depression. Rest, in the context of this chapter, is not necessarily synonymous with sleep – for instance, sleep can still occur without rest and its improvements on overall functioning [2]. Relaxation often corresponds to feelings of peace, comfort, body laxity, mental laxity, and positive emotions. Relaxation as a wellness tool can take a variety of forms, such as abdominal breathing and progressive muscle relaxation techniques [3].

According to the World Health Organization, chronic illnesses are responsible for 68 percent of global deaths, including more than 40 percent of premature deaths before the age of 70 [1]. In addition to psychological, social, and physical suffering caused by these conditions, the estimated economic losses for middle- and low-income countries in 2011–2025 are projected to be $7 trillion, which vastly outnumbers the annual $11.2 billion spent on implementing interventions aimed at reducing the chronic disease burden [1]. Given the personal, societal, and economic implications of chronic conditions, substantial research effort has been put into developing the best methods of care for the chronically ill population. Wellness medicine offers a unique perspective in advocating for positive well-being in addition to symptom alleviation. This chapter, drawing from evidence-based research and our own clinical experience, discusses how wellness can be fostered in the chronically ill by considering the biopsychosocial and spiritual approach.

Imagine a society comprising individuals who realize their maximal potential in every facet of their lives. In this society, people work together to better their communities and the lives of others. Individually, the citizens are free of disease, physically fit, well-educated masters of their craft, and they engage in a life of recreation and interconnectedness with family, neighbors, and friends while living with purpose and passion. Is this utopia too good to be true? The voice of reason may say life is not perfect; there are too many ever-changing variables. We are familiar with the physical law of entropy stating that randomness, or disorder, increases with time. However, why not aim toward a society as described above? We can strive to be the best version of ourselves, both on the micro, individual level and on the macro, societal level.

In 2014, 2.6 million people died in the USA. Death is inevitable and can find someone in any number of ways, and most hope for a good death [1]. Terminal illness is an irreversible or incurable disease condition from which death is expected in the foreseeable future. Some often regulate this to a prognosis of the last 6–12 months of life; however, some live longer with a terminal illness in palliative or hospice care. Even with a terminal illness, many patients continue to receive treatment to reduce symptom burden, continue to keep fighting with experimental procedures (sometimes to give purpose), at times not to disappoint family members, and at other times it is part of their values [2]. The transition from a chronic illness to a terminal illness can be devastating for some patients, and navigating this change requires a significant amount of work from both the practitioner and the patient for a good quality of life [3].

The relationship between mind, body, and spirit has inspired philosophers, artists, physicians, and scientists for centuries. Daring to reach for our dreams yet fearing to lose that which we have fought so hard to attain, the tools developed to navigate the human condition have pushed the limits of technological advancement. Although the landscape and its demands will continue to evolve, a common thread throughout time is humanity’s desire to reach its potential, to function at peak capacity. This guiding light has led to the development of medicine, which has been utilized as a means by which to save the fragile yet resilient corporeal form, as well as an instrument to transcend its bounds. Medicine as an art involves the use of wide-ranging modalities, including pharmaceuticals. Experiencing health in all meanings of the word involves the absence of illness, as well as the optimization of health.

There are multiple movements within medicine, public health, and health policy that have expanded the measurement of well-being and wellness and made such practices imperative. Medicine continues to grow more highly specialized and focused on biomedical treatments. Physicians’ roles have become more siloed, and our knowledge of the effects of illness and medical treatments on patients’ lives is limited. Simultaneously, public health research has elucidated the importance of contexts, connectedness, and functioning to health. Biomedical treatments and the absence of illness do not define health. Well-being, social connectedness, and one’s ability to function in essential domains of life are essential components of health. In response, health policy has begun to prioritize patient-reported outcomes, including well-being and health-related quality of life (QOL).

In conceptualizing lifestyle approaches to promote health and well-being, most attention is paid toward physical rituals, including physical activity, dietary modification, and cessation of drugs and alcohol. Less discussed are the fundamental aspects of work, play, and love that have the potential to promote – or erode – overall health and wellness. These factors may, in certain cases, play an even more profound role in wellness than traditional physical practices. “Joie de vivre” is a term used to describe overall enjoyment of life, and in a sense, encompasses all three domains.

Wellness is often intimidating. Pursuing it requires significant commitment and carries emotional risk/vulnerability [1]. While fear can be a strong motivator, it can also be the reason one may not try or follow-through with a plan. In most cases, fear prevents us from being able to accomplish what we wish to. In the case of wellness, we found that due to the commitment many were challenged by the fear of not being able to achieve the results and goals they had set for themselves. For example, if one was never taught, or had modeled, how to live a life full of joy, love, and wellness, they will fear a life different than what they were taught, whether by observation or directly. Occasionally it can be more difficult and painful to break a pattern than to live in it [2]. The path to wellness will likely be unique for each and every one of us.

Cancer is the first or second leading cause of death before age 70 years in 91 of 172 countries, ranking third or fourth in an additional 22 countries [1]. It accounts for 1 in every 6 deaths worldwide – more than HIV/AIDS, tuberculosis, and malaria combined [1–3]. GLOBOCAN reported that an estimated 18.1 million cases of cancer were diagnosed around the world, with 9.6 million cancer deaths, in 2018. Approximately 70 percent of cancer deaths occur in low- and middle-income countries, where a majority of these countries lack the medical resources and health systems to support the disease burden. The current risk of developing the disease in a lifetime is 1 in 8 for men and 1 in 10 for women [1]. Additionally, the economic impact of cancer is significant and continues to increase; in 2010, the total annual cost was estimated at approximately $1.16 trillion [3].

Cardiovascular diseases include coronary artery disease, stroke, hypertensive heart disease, valvular heart disease, cardiac arrhythmias, heart failure, aortic aneurysm and dissection, peripheral arterial disease, and deep venous thrombosis [1]. Pulmonary diseases include asthma, bronchitis, chronic obstructive pulmonary disease (COPD), cystic fibrosis, idiopathic pulmonary fibrosis, lung cancer, pneumonia, pulmonary embolism, pulmonary hypertension, sarcoidosis, and tuberculosis [2]. Both cardiovascular and pulmonary disorders share symptoms of chest pain, shortness of breath, palpitations, fatigue, and leg swelling. The literature is rich in interventions that aim to prevent or treat cardiovascular and pulmonary disorders. This chapter not only reviews the evidence for wellness interventions that can be implemented beyond traditional methods that are utilized to address cardiovascular and pulmonary symptom severity, but also explores the evidence for interventions that primarily improve wellness in patients with cardiovascular and pulmonary pathology.

Wellness is a term encompassing many aspects of the human experience, including physical health. Much of the regulation and maintenance of the human body occurs via hormonal expression. The human endocrine organs include the pituitary, adrenals, thyroid, testes, and ovaries, and produce many of the hormones responsible for maintaining homeostasis and optimal cellular function [1]. Many factors can alter hormonal expression, including aging, environmental toxins, disease, nutrition, and even stress [1]. Hormonal imbalances often lead to poorer health outcomes and decreased wellness in the long run. This chapter will give an overview of the most common endocrine disorders, how they impact wellness, and what has been done to improve patient quality of life (QOL).

Clinicians are consistently presented with the arduous task of characterizing, identifying, classifying, and evaluating response-to-intervention when treating or examining a broad array of patient populations. The primary aim of this chapter is to outline and define wellness among patients living with chronic medical conditions (PLW-CMC). An operational definition of a chronic medical condition is one requiring ongoing management and treatment over extended periods of time, often comprised of a broad constellation of conditions including heart disease, stroke, cancer, chronic respiratory diseases, infectious diseases, metabolic/endocrine disorders, genetic disorders, and disorders resulting in disability/impairment [1]. The number of persons living with one or more chronic medical conditions continues to increase, both nationally and internationally. Thus, the need for literature pertaining to interventions that optimize a patient's quality of life (QOL) is pertinent, as health status is known to be associated with an individual's perception or appraisal of wellness, life satisfaction, happiness, and overall well-being.

Sex is on the mind of many people, whether they admit it or not. What makes “good sex” elusive is the relatively subjective nature of what that means and the varying opinions on how to attain it. Moreover, theories exist on the differences in the biological and psychological sexual response and expectations regarding sex between males and females. In this chapter, we define several key elements, suggest factors important to achieving sexual well-being, and suggest practical “real-world” techniques that may be helpful to the clinician advising patients on sex or intimacy, along with methods to optimize this area of life.