🎯 Core Philosophy

1. Nutrition Assessment

• Dietary Pattern: Mediterranean, DASH, Western, Plant-based, Keto, etc.
• Meal Timing: Eating window, breakfast habits, late-night eating
• Macronutrient Balance: Protein, carbs, fat distribution
• Micronutrient Status: Key vitamins/minerals vs. RDA
• Hydration: Daily water intake
• Special Factors: Food allergies, intolerances, preferences

2. Exercise Assessment

• Activity Level: Sedentary, Light, Moderate, Active, Very Active
• Exercise Types: Cardio, Strength, Flexibility, Balance
• Weekly Volume: Duration, frequency, intensity
• Recovery: Rest days, sleep quality, soreness management
• Functional Movement: Mobility, posture, injury history
• Motivation & Barriers: Goals, obstacles, support system

3. Sleep Assessment

• Duration: Average hours/night
• Quality: Sleep efficiency, awakenings, restfulness
• Timing: Bedtime consistency, sleep latency
• Environment: Light, noise, temperature, comfort
• Pre-Sleep Routine: Screen time, relaxation practices
• Disorders: Snoring, apnea symptoms, restless leg, insomnia

4. Stress & Recovery

• Perceived Stress: Daily stress level (1-10)
• Stress Sources: Work, relationships, financial, health
• Coping Strategies: Exercise, meditation, social support
• Recovery Practices: Rest days, vacations, hobbies
• Burnout Signs: Exhaustion, cynicism, reduced efficacy

🔗 Cross-Dimensional Correlations

Nutrition ↔ Sleep

Nutrition ↔ Exercise

Exercise ↔ Sleep

Stress ↔ All Domains

🎯 Goal-Specific Programs

Weight Loss Program

Calorie Deficit Strategy:

• Target: 500-750 cal/day deficit → 0.5-0.75 kg/week loss
• Never go below 1200 cal/day (women) or 1500 cal/day (men)

Macronutrient Distribution:

• Protein: 1.6-2.2 g/kg (preserves muscle, increases satiety)
• Carbs: 40-45% (focus on complex carbs, fiber)
• Fat: 30-35% (emphasize unsaturated fats)

Exercise Prescription:

• Cardio: 200-300 min/week moderate (increases calorie expenditure)
• Resistance: 3-4 sessions/week (preserves muscle mass)
• NEAT: 10,000+ steps/day (non-exercise activity thermogenesis)

Sleep Optimization:

• Target: 7-9 hours/night
• Sleep deprivation increases ghrelin (hunger hormone) by 15%
• Sleep deprivation decreases leptin (satiety hormone) by 15%

Behavioral Strategies:

• Food diary (increases awareness, 20-30% more weight loss)
• Weekly weigh-ins (objective feedback)
• Meal planning/prep (reduces impulsive eating)
• Mindful eating (slower pace, better satiety recognition)

Timeline:

• Weeks 1-2: Establish baseline, create deficit, build habits
• Weeks 3-8: Consistent loss (0.5-0.75 kg/week)
• Weeks 9-12: Adjust if plateau, maintain muscle mass
• Month 4+: Transition to maintenance

Muscle Building Program

Calorie Surplus Strategy:

• Target: 200-300 cal/day surplus → 0.25-0.5 kg/week gain
• Minimize fat gain with modest surplus

Macronutrient Distribution:

• Protein: 1.6-2.2 g/kg (muscle protein synthesis)
• Carbs: 45-55% (glycogen for training, insulin for anabolism)
• Fat: 25-30% (hormone production)

Training Principles:

• Progressive Overload: Gradually increase weight, reps, or volume
• Volume: 10-20 sets/muscle group/week
• Frequency: 2-3 sessions/muscle group/week
• Intensity: 65-85% 1RM for hypertrophy

Nutrition Timing:

• Pre-workout: 30-60g carbs + 20g protein (1-2 hours before)
• Post-workout: 30-40g protein + 60-80g carbs (within 2 hours)
• Before bed: 30-40g casein protein (slow-digesting)

Recovery:

• Sleep: 8-9 hours/night (growth hormone release)
• Rest days: 2-3 days/week (muscle repair)
• Deload: Every 6-8 weeks (prevent overtraining)

Supplements (Evidence-Based):

• Creatine monohydrate: 5g/day (increases strength, muscle mass)
• Whey protein: As needed to meet protein targets
• Caffeine: 3-6 mg/kg pre-workout (performance enhancement)

Sleep Optimization Program

Sleep Hygiene Foundation:

• Consistency: Same bedtime/wake time (±30 min) even on weekends
• Environment: Dark (blackout curtains), cool (18-20°C), quiet
• Bed Association: Bed is for sleep and intimacy only
• Pre-Sleep Routine: 60-min wind-down (no screens, relaxing activities)

Light Exposure:

• Morning: 10-30 min outdoor light within 1 hour of waking
• Evening: Dim lights 2 hours before bed, blue light filters
• Night: Avoid screens 1 hour before bed (or use blue light blocking glasses)

Caffeine Management:

• Half-life: 5-6 hours (can affect sleep 8-10 hours later)
• Cut-off: No caffeine after 2 PM (or 8 hours before bedtime)
• Sensitivity: Some individuals are fast/slow metabolizers (genetic)

Alcohol & Sleep:

• Alcohol helps sleep onset but fragments sleep architecture
• Reduces REM sleep (important for memory, mood)
• Recommendation: No alcohol within 3 hours of bedtime

Exercise Timing:

• Morning/afternoon: Improves sleep quality
• Evening (vigorous): Finish 3 hours before bed (elevated core temperature)
• Evening (gentle): Yoga, stretching can promote relaxation

Cognitive Strategies:

• Worry Time: Schedule 15 min afternoon "worry time" to process concerns
• Journaling: Write tomorrow's to-do list before bed (offloads mental burden)
• Paradoxical Intention: Try to stay awake (reduces performance anxiety about sleep)
• Mindfulness: Body scan, breathing exercises (activates parasympathetic)

CBT-I Techniques (Cognitive Behavioral Therapy for Insomnia):

• Stimulus Control: Bed only for sleep (no TV, work, phone)
• Sleep Restriction: Limit time in bed to actual sleep time (increases sleep drive)
• Cognitive Restructuring: Challenge unhelpful beliefs about sleep
• Relaxation Training: Progressive muscle relaxation, guided imagery

Athletic Performance Program

Periodization:

• Macrocycle: Annual plan (competition phases)
• Mesocycle: 4-6 week blocks (specific adaptations)
• Microcycle: Weekly plan (training/recovery balance)

Nutrition Periodization:

• Training Days: Higher carbs (fuel training)
• Rest Days: Lower carbs, higher fat (metabolic flexibility)
• Competition: Carb loading if endurance event (>90 min)

Hydration Strategy:

• Pre-exercise: 500ml 2 hours before, 250ml 15 min before
• During: 150-350ml every 15-20 min (depending on sweat rate)
• Post: 150% of fluid loss (weigh before/after to estimate)

Recovery Optimization:

• Sleep: 8-10 hours/night (elite athletes)
• Naps: 20-30 min (performance enhancement)
• Active Recovery: Light movement on rest days
• Modalities: Massage, foam rolling, contrast baths

Injury Prevention:

• Warm-up: Dynamic stretching, activation exercises
• Cool-down: Static stretching, mobility work
• Strength: Address muscle imbalances
• Load Management: Gradual progression (10% rule)

📋 Assessment Tools

Nutrition Assessment

24-Hour Dietary Recall:

Breakfast (time): [foods, amounts]
Snack (time): [foods, amounts]
Lunch (time): [foods, amounts]
Snack (time): [foods, amounts]
Dinner (time): [foods, amounts]
Evening Snack (time): [foods, amounts]

Fluids: [types, amounts]
Supplements: [types, doses]

Diet Quality Score (0-100):

• Vegetables/Fruits (25 points): ≥5 servings/day
• Whole Grains (15 points): ≥3 servings/day
• Lean Protein (15 points): Adequate intake
• Healthy Fats (15 points): Omega-3, unsaturated
• Limited Processed (15 points): Minimal ultra-processed
• Hydration (15 points): ≥2L water/day

Exercise Assessment

PAR-Q+ (Physical Activity Readiness Questionnaire):

• Screens for contraindications to exercise
• Identifies need for medical clearance

Exercise History:

• Current routine (type, frequency, duration, intensity)
• Past exercise experience (positive/negative)
• Barriers (time, motivation, physical limitations)
• Preferences (individual/group, indoor/outdoor, competitive/recreational)

Fitness Testing (Baseline):

• Cardiovascular: Resting HR, 3-min step test or 1-mile walk
• Strength: Push-up test, chair stand test
• Flexibility: Sit-and-reach test
• Body Composition: BMI, waist circumference, body fat %

Sleep Assessment

Pittsburgh Sleep Quality Index (PSQI):

• 7 components (0-3 each, total 0-21)
• Score >5 indicates poor sleep quality

Sleep Diary (2-week minimum):

Date: _______
Bedtime: _______
Sleep latency (min): _______
Awakenings (number): _______
Wake time: _______
Total sleep time (hours): _______
Sleep quality (1-5): _______
Factors affecting sleep: _______________

Epworth Sleepiness Scale:

• Daytime sleepiness (0-24)
• Score >10 indicates excessive daytime sleepiness

🔄 Behavior Change Framework

Stages of Change (Transtheoretical Model)

SMART Goals Framework

Habit Formation Strategies

Implementation Intentions:

• Format: "If [situation], then [behavior]"
• Example: "If it's 7 AM on weekday, then I will walk for 30 minutes"

Habit Stacking:

• Anchor new habit to existing habit
• Example: "After I brush my teeth (existing), I will meditate for 5 minutes (new)"

Environment Design:

• Make desired behaviors easy, undesired behaviors hard
• Example: Place workout clothes by bed (easy), keep junk food out of house (hard)

Reward Substitution:

• Immediate rewards for long-term behaviors
• Example: Listen to favorite podcast only while exercising

📊 Progress Tracking

Weekly Check-Ins

Metrics to Track:

• Weight (same time, same conditions)
• Waist circumference (weekly)
• Sleep quality (daily, averaged weekly)
• Exercise completion (sessions completed/planned)
• Nutrition adherence (days within targets)
• Energy level (1-10 scale)
• Mood (1-10 scale)

Adjustment Triggers:

• Weight loss >1 kg/week → Increase calories slightly
• Weight loss <0.25 kg/week for 2 weeks → Decrease calories or increase activity
• Sleep quality <6/10 for 1 week → Review sleep hygiene
• Exercise completion <70% → Reassess program feasibility

Monthly Assessments

Comprehensive Review:

• Goal progress (% toward target)
• What's working well (continue)
• What's challenging (problem-solve)
• Program adjustments needed
• New goals or focus areas

Body Composition:

• Weight trend (monthly average)
• Waist-to-hip ratio
• Body fat % (if available)
• Progress photos (front, side, back)

Fitness Testing:

• Repeat baseline tests
• Compare to previous month
• Celebrate improvements

⚠️ Safety Considerations

Exercise Contraindications

Absolute Contraindications:

• Unstable angina
• Recent MI (<2 days)
• Uncontrolled arrhythmias
• Severe aortic stenosis
• Acute heart failure

Relative Contraindications (require medical clearance):

• Controlled hypertension
• Known cardiovascular disease
• Type 1 diabetes
• Pregnancy (high-risk)
• Severe obesity (BMI >40)

Nutrition Red Flags

Disordered Eating Screening:

• Preoccupation with weight/food
• Restrictive eating patterns
• Binge eating episodes
• Compensatory behaviors (excessive exercise, purging)
• Body image distortion

Action: Refer to registered dietitian or mental health professional

Sleep Disorder Screening

Sleep Apnea Risk (STOP-BANG):

• Snoring (loud)
• Tired (daytime)
• Observed (stopped breathing)
• Pressure (high blood pressure)
• BMI >35
• Age >50
• Neck circumference >40cm
• Gender (male)

Score ≥3: Refer for sleep study

📚 Evidence-Based References

Nutrition

• Dietary Guidelines for Americans 2025-2030
• ADA Standards of Care in Diabetes
• AHA Dietary Guidelines
• WHO Healthy Diet Factsheet

Exercise

• ACSM Guidelines for Exercise Testing and Prescription (11th ed.)
• WHO Guidelines on Physical Activity and Sedentary Behaviour
• AHA Physical Activity Recommendations

Sleep

• AASM Clinical Practice Guidelines
• CDC Sleep and Sleep Disorders
• NICE Guidelines on Insomnia

Behavior Change

• Michie S, et al. The Behavior Change Wheel
• Prochaska JO, DiClemente CC. Transtheoretical Model
• Clear J. Atomic Habits

Version: v1.0 Created: March 2026 Maintainer: Family Doctor Team