The lifesaving work of Clemson University researchers and practitioners happens in our science labs, our nursing classrooms and even within health care data sets dating back decades. But the University is also home to passionate people pursuing improved medical outcomes for patients in less conventional ways. Their work to promote more active lifestyles, instill healthier habits and build more connected communities takes health care out of doctors’ offices and into everyday living.
Habits are foundational to health. At least, that’s one perspective of whole person health, an emerging field of health research and practices that promotes behaviors like nutritious eating, physical activity and stress management as avenues to improved health outcomes. And while most people know that healthy diet and exercise patterns are essential health practices, whole person health asserts that behavioral changes require education about and access to healthy lifestyles — plus community and social support.
“Making the choice that we know we should make is in many ways harder than we think,” says Alumni Distinguished Professor of Psychology June Pilcher, a biopsychologist who researches the relationships between sleep, exercise and health. Part of the reason it’s difficult to make the “right” choice, according to whole person health perspective, is social contexts. While whole person health sees biology and behaviors as contributors to chronic disease and health conditions, it also recognizes that many social contexts promote poor diets, sedentary lifestyles and chronic stress.
“Individuals don’t exist in a bubble,” explains Brandi Crowe, associate professor of recreational therapy. “We all exist within a community or within a social context.”
As a lifestyle doctor, John Emerson, Prisma Health family physician and clinical associate professor in the Clemson University School of Health Research, connects patients with health programs shown to reverse conditions including cardiovascular disease, diabetes and obesity through lifestyle changes. Similarly, Clemson Rural Health, a fleet of health clinics in rural South Carolina communities, uses whole person health, connecting patients with resources that help them access and learn about healthy lifestyles.
This subset of medical care doesn’t simply leave it up to individuals to make behavioral changes. Rather, whole person health facilitates access to educational programs, resources and environments that guide people toward better health. Further, the approach addresses health through a holistic perspective, considering physical, mental and social factors that can promote or hinder health. Whole person health also meets people where they are, helping them to feel their best within the conditions they face.
At Clemson, many health researchers, educators, practitioners and reformers are carving paths to environments and lifestyles that improve the health and well-being of their communities. Together, they’re part of a burgeoning field that complements conventional approaches to health care.
Here are four ways Clemson faculty are researching and facilitating access to improved health and well-being.
Healthy Eating
Mainstream food culture and systems, according to Professor of Public Health Sciences Sarah Griffin, make it convenient to eat high-calorie, low-nutritional food. In grocery stores and along major roadways, fast and convenient food is readily available at lower costs. But that easy accessibility comes at a high cost.
According to the Centers for Disease Control and Prevention, inadequate nutrition is a significant risk factor for obesity and chronic disease, including Type 2 diabetes, heart disease, stroke, certain cancers and depression. Alternatively, healthy eating patterns are associated with the prevention and reversal of chronic disease.
One way Griffin and her interdisciplinary team promote healthy eating is through the High Obesity Program (HOP), which works in South Carolina counties where 40 percent or more adults have been diagnosed with obesity. Funded by the CDC, HOP utilizes public health researchers and Clemson Extension agents to transform food service organizations in rural counties. The partnership among the College of Agriculture, Forestry and Life Sciences’ Cooperative Extension Service; the College of Behavioral, Social and Health Sciences; the Department of Public Health Sciences; and Clemson Rural Health fuels HOP’s aim to reverse obesity rates, which account for $173 billion annually in health care costs.
In 2018, the CDC funded Clemson researchers and Extension agents to enact HOP in three South Carolina counties — Hampton, Lee and Marion — for five years. In 2023, the team received a second round of five-year funding to expand from three to 10 counties across the state, including Marlboro, Dillon, Marion, Florence, Darlington, Lee, Orangeburg, Bamberg, Allendale and Hampton.
“It’s about helping folks that are at the highest risk have increased access to healthy foods,” Griffin explains.
In each county, Clemson Extension agents work with food service organizations to prioritize healthy over unhealthy options. Known in South Carolina communities as the Healthy Options Program, HOP works with food pantries to increase their capacity to distribute fresh and healthy foods. They help farmers markets become eligible to receive Supplemental Nutrition Assistance Program vouchers. They ask community and faith organizations for statements committing to practices like making water a priority drink or having fresh produce available when serving meals, increasing exposure to healthy options.
Another way HOP is working to increase access to healthy food is by bringing produce prescription programs to the counties they serve. Produce prescription programs, such as Veggie Rx, prescribe boxes of fresh fruits and vegetables to patients diagnosed with diabetes. Currently, Clemson Rural Health deploys produce prescription programs through nurse practitioners, community health workers and registered dietitians in rural areas. By bringing these programs to the counties, HOP further increases access to healthy lifestyles.
Quality Sleeping
Quality sleep is crucial to feeling good, and it’s one of the six pillars of lifestyle medicine encouraged by lifestyle doctors. Pilcher, the biopsychologist, has been at the forefront of sleep research since the inception of lifestyle medicine nearly 20 years ago, and her research demonstrates links between quality sleep
and health outcomes.
“Sleeping regularly at night contributes to many physiological systems that keep us healthy and help us learn,” Pilcher says.
More specifically, she explains, research has shown that sleep improves memory formation, resets biological and emotional systems, regulates insulin, and allows protein synthesis to help muscles and organs recover and repair from the wear and tear of each day. Quality sleep has also been shown to improve immune functioning.
Pilcher cites a study where two groups of college students were exposed to cold rhinovirus. The results? Sleep-deprived students were more likely to catch a cold than those who had quality sleep. Research has also shown links between sleep deprivation and chronic diseases like diabetes.
“Sleep allows the brain to recuperate,” Pilcher says. “The brain is resetting or regenerating at night, creating alertness and readiness the next day.” When we’re alert and rested, she explains, we’re less likely to make unhealthy choices.
When considering quality sleep, it’s important to understand what it is and how to get it. Each night, Pilcher says, humans go through three sleep stages in about 90-minute cycles for seven to eight hours. Quality sleep is when you go through the 90-minute sleep cycles without disruption.
“You really do need seven to eight hours of sleep every night consistently to be at your best state,” says Emerson, the family physician, who educates his patients about what his field calls restorative sleep. Daytime naps or a couple of glasses of wine at night, he explains, can affect the ability to achieve restorative sleep. Alternatively, behavioral changes like limiting naps, avoiding harmful substances, managing stress and developing a sleep routine can contribute to quality sleep.
The more trouble you have sleeping, the more important it is to establish and maintain precise sleep patterns, like going to sleep and waking up at the same time each night and morning.
“The brain is a habit-making machine,” Pilcher asserts. The more one enacts behavioral changes, the more likely they are to become a habit.
Staying Active
Another way HOP aims to reverse morbidity rates in at-risk counties is by developing sidewalks and bike lanes to encourage walking and biking. HOP also brings evidence-based programs to community organizations like the YMCA, empowering people to reverse or manage disease through healthy lifestyles. These programs and infrastructural changes encourage physical activity as one of the important habits of good health.
One such evidence-based health program, Health Coaches for Hypertension Control, was developed by professors of public health science affiliated with the Clemson Institute for Engaged Aging. Adopted by the CDC in 2018, the eight-week program includes a unit about physical activity or aerobic exercise, which can include activities such as walking or gardening as habits of good health.
Crowe, the recreational therapy professor, belongs to a field that has researched the relationship between what is called “leisure-time physical activity” (LTPA) and improved health outcomes. For those who don’t necessarily enjoy “exercise or physical activity,” Crowe explains, LTPA can offer a route to health through activities that people enjoy, including horseback riding, scuba diving, biking, hiking, tennis, backpacking and walking.
“They’re still reaping the benefits of that aerobic or anaerobic benefit that exercise or physical activity promotes, but they’re engaging in it through something that they identify as leisure,” Crowe says. “They’re intrinsically motivated to do it. It’s a self-determined, autonomous decision. It’s freedom from — and freedom to.”
Crowe, along with her colleagues, has conducted research finding links between therapeutic yoga and health benefits for individuals with conditions including stroke, stress, menopause, traumatic brain injury, Parkinson’s disease, and intellectual and developmental disabilities. And while yoga works for some people, it isn’t a match for others, so recreational therapists work with patients to determine the right LTPA match.
In addition to encouraging physical activity, LTPA encourages stress management and social connection, which are important components of whole person health. Crowe cites foundational research by leisure stress-coping experts that suggests leisure can help people in three ways: It’s palliative, allowing respite from everyday stressors. It helps with mood enhancement by providing a sense of optimism. And it promotes social companionship through engagement in activities with others.
“We experience that social interaction, which we know can be so important to us in our health, but also when it is individuals who we share commonalities with, there’s a sense of support,” Crowe says. “It’s this sense of community, sense of belonging that allows people to know (they’re) not alone. And that sense of support is so important.”
Going Outside
The health benefits of spending time outside are not only abundant but also surprising. Matthew Browning, associate professor in the Department of Parks, Recreation and Tourism Management, details the many health benefits associated with spending time in nature.
“Living in greener settings, spending more time in nature, engaging in green-based exercise has been associated with over 100 different health outcomes,” Browning says. These outcomes include reduced risk of cardiovascular disease, increased longevity, improved mental health and treatments for eating disorders. The research has also examined the effects of nature on mortality rates, biomarkers of inflammation and ADHD diagnoses.
While biodiverse areas with abundant pollinators and wildlife have shown to be the most beneficial, simply being outdoors has proven health benefits — even if it’s walking 20 minutes to work or across campus. Optimal nature experiences, however, are found in biodiverse environments like gardens, forests, parks or beaches. “And those spaces are perceived by many, not necessarily everyone,” Browning explains, “as having beauty, buffering everyday stressors and providing a positive connection to nature.”
Being outside also encourages physical activity, while indoor environments are typically associated with being less active. And for those unable to go outside because of health conditions or fear, experiencing nature through virtual reality (VR) also has proven health benefits. The VR experience is not intended to replicate or replace nature experiences but to offer it to people who cannot comfortably or safely spend time outside, says Olivia McAnirlin, who co-directs Clemson’s Virtual Reality and Nature Lab with Browning.
As part of their research and outreach through the lab, McAnirlin and Browning have brought VR nature experiences to patients living with chronic diseases, including people in palliative care and hospice. In one research study, McAnirlin and Browning led a research team working with patients diagnosed with chronic obstructive pulmonary disease (COPD). Together, the team collaborated with the patients to co-create virtual landscapes familiar to and loved by the patients. The research team found that co-creating and experiencing familiar landscapes through VR helped to support the psychological well-being of people with COPD.
Whole person health isn’t simply about preventing, treating and reversing disease. Rather, it’s about helping people with chronic conditions and disabilities feel their best by creating nurturing environments that are reimagining and extending treatment beyond the conventional. And as Clemson faculty continue to research and advance whole person approaches to health, they strive to address the physical, social and mental well-being of individuals and communities who need it most.
Charlotte Lucke Ph.D. ’22 is the managing editor of Clemson World magazine.
