The Six Factors of Health
When someone comes to physiotherapy with pain or an injury, it’s very easy to focus entirely on the painful body part.
Your knee hurts, so we look at the knee. Your back hurts, so we assess your back. Your shoulder hurts, so naturally we want to understand what’s happening at the shoulder.
And we absolutely should.
BUT you’re also a whole person, and what is happening outside that joint or muscle can influence how you feel, how you recover and how easily you’re able to make changes.
At By Design, we bring this back to what we call our 6 Factors of Health:
Sleep
Training
Nutrition + Hydration
Stress
Mindset
Connections
These aren’t six boxes we expect everyone to have fully organised. They’re a framework for looking at the bigger picture and identifying where there might be opportunities to support your health, recovery and long-term wellbeing.
For ease of understanding, I’ve simplified each one and included three healthy standards to consider.
Sleep
Sleep is your body’s main opportunity for rest and recovery. Consistent, good-quality sleep supports physical recovery, energy, concentration and many of the processes involved in maintaining our health. Improving sleep doesn’t mean creating an ideal nighttime routine. Sometimes it starts with recognising that consistently getting five hours is making everything else harder.
☐ 7–9 hours asleep, not just time spent in bed
☐ Consistent sleep and wake times
☐ Dark, cool and quiet sleeping environment
Training
Training and movement are about what your body is regularly exposed to. This includes everyday movement, strength training and cardiovascular fitness. More isn’t automatically better. Your training needs to provide enough challenge to create adaptation while still allowing you to recover and do it consistently.
☐ Aim for 8,000–10,000 steps per day
☐ Strength train at least 2 times per week
☐ Aim for 150+ minutes of moderate (or 75+ minutes of vigorous) cardiovascular activity per week
Nutrition + Hydration
Nutrition provides the energy and nutrients your body needs for everyday function, training and recovery. Rather than chasing the ideal diet, focus on eating enough to support what you’re asking your body to do, choosing predominantly nutrient-dense foods and drinking enough fluid throughout the day.
☐ Base most meals around whole or minimally processed foods: meat, fish, eggs, fruit, vegetables, wholegrains, legumes, nuts, seeds and dairy or alternatives
☐ If you train regularly, a general guide for most healthy adults is approximately 1.6–2 g of protein per kilogram of body weight per day
☐ Aim for at least 2 litres of fluid per day as a simple baseline, adjusting for training, sweating and hotter conditions
Nutrition is a huge field in itself. When someone needs individual nutrition advice outside our scope as physiotherapists, we encourage them to work with an appropriately qualified health professional.
Stress
Stress isn’t automatically bad. Training, work, relationships and learning new things can all create stress. The problem is when that load keeps accumulating without enough opportunity to recover. Rather than trying to eliminate stress, the goal is to understand your major stressors, recognise your own early warning signs and know what helps you recover.
☐ Know your stressors: recognise where your total load is coming from and have strategies for when it increases
☐ Schedule genuine downtime: this could be walking, reading, deep breathing, yoga, meditation, switching off your phone, sauna or cold therapy if you enjoy them
☐ Learn your warning signs: maybe you become irritable, struggle to think clearly, feel exhausted, notice headaches or find an old pain starting to creep back in
For me, those warning signs can include a cold sore, difficulty making decisions or my neck starting to get twingey. Yours will probably be different. Learning them gives you an opportunity to respond earlier.
As physios, we can discuss stress when it may be interacting with pain, recovery and behaviour. When there are factors beyond the physical that need more support, we recommend speaking with an appropriately qualified mental health professional who can explore these areas in more detail.
Mindset
Mindset is the lens through which we respond to challenge, setbacks and change. At By Design, we think about it as a continuum: Victim → Pessimist → Optimist → Realist → Competitor (or Warrior). These aren’t labels for people, but mindsets we can all move between. The aim is to move from focusing predominantly on what happened to us or what we can’t control, towards recognising what we can influence, learn and do next. It doesn’t mean pretending everything is positive. You can be frustrated, disappointed or have a bad day while still deciding what you do next. Own it. Change it. Learn from it.
☐ Own what you can control: focus on what you can influence next and how you choose to think about it
☐ Be present: notice when your attention is stuck on things outside your control and bring it back to your own actions
☐ Reflect often: ask yourself, What did this teach me? What needs to change? What can I do next?
Connections
Connections are the people and environments around you. Relationships can provide support, accountability, perspective and belonging, while the people and environments we spend time around can influence our behaviours. Not everyone already has the community they want, and sometimes building connection means deliberately putting yourself somewhere new where connection can happen.
That could be a gym, run club, bushwalking group, book club, cooking class, gardening group, ocean dip or something completely unrelated to exercise. Think about what you actually enjoy, find other people who enjoy it too and start there. The hardest part is often showing up for the first time.
☐ Schedule meaningful connection: make regular time for people you care about and who make you feel good
☐ Ask for support when you need it: you’re not a burden, and healthy relationships allow support to go both ways
☐ Choose your environment: spend time around people and communities that make the behaviours and person you want to become easier
You Don’t Need to WORK ON All Six AT ONCE
The important thing is that these six factors don’t operate independently. Poor sleep might affect your energy to train. High stress might change how well you recover. Your social environment might make a new habit easier or harder to maintain. An injury might temporarily reduce your movement, which then affects your mood and routine.
That’s why we don’t expect you to nail all six at once. In fact, trying to overhaul your sleep, training, nutrition, stress, mindset and social life simultaneously would probably just create another source of stress.
And just when you think you’ve mastered one, another one might need your attention.
I see these six factors as a learning process that continues throughout life. I’m still learning, adding information and simplifying them as I develop more awareness of what works for me too.
So instead of trying to change everything, rate yourself from 1–5 on each factor.
5 = this area is going really well and you’re consistently ticking most of the boxes.
1 = this area needs attention, isn’t working particularly well right now or has been a low priority.
Look at your scores and choose one factor to work on.
Make one or two realistic changes, put a reminder in your calendar for 30 days and then rate yourself again.
You might be surprised how far you can move the needle in a month when you focus your attention on one thing instead of trying to change everything. Health isn’t one behaviour, one exercise or one ideal routine. It’s the collection of things you do repeatedly over time. Sometimes the most useful place to start is simply understanding which part of that bigger picture needs your attention right now.
Want support understanding how your movement, training and recovery fit together?
Our physiotherapists can help you assess your current capacity and build a plan around your individual goals.
This is general information only. If you’re managing pain or an injury, speak with your physio about what’s right for you.
