Integrating Whole Health in Veterans Affairs Healthcare – The Role and Application of the TSAC-F

The Department of Veterans Affairs (VA) is the largest integrated healthcare delivery system in the United States (10). The U.S. Veterans Health Administration (VHA) is adapting a healthcare model known as Whole Health (WH), with the goal to shift from a primarily medical/disease-oriented system to a model that focuses on health promotion and disease prevention through complementary and integrative healthcare offerings (12). Under the WH Division at the Veterans Affairs Pittsburgh Healthcare System (VAPHS), the team is spearheading veteran-centric WH efforts by offering several exercise-related services and other interdisciplinary programs aimed at improving the lifestyles of veterans.

VETFIT

At the heart of all WH initiatives at the VAPHS is a steadfast commitment to lifestyle optimization through exercise and nutrition. Certified exercise professionals, holding National Strength and Conditioning Association (NSCA) credentials, are pioneering innovative strategies to expand access to exercise­driven preventive healthcare. These advancements are fueled by the unique needs of tactical operators and the veteran community that are expertly addressed by Tactical Strength and Conditioning Facilitators® (TSAC-F®).

The VetFit Program was established in 2023 by the Pittsburgh Veterans Affairs WH program in response to the Department of Veterans Affairs Fiscal Years 2022 - 2028 Strategic Plan (5). VetFit is a supervised, facility-based exercise and health promotion program for veterans under 65 years old (4). This program is intended to complement the already existing and nationally­recognized Gerofit program, which is for veterans aged 65 and older. Both programs meet the needs of veterans by tailoring the delivery of benefits and customizing whole healthcare and services for the veteran at each phase of their life. VetFit is a WH care coordination strategy established to prevent gaps in care to achieve desired health outcomes through preventive services that emphasize physical activity and exercise (9).

The Department of Veterans Affairs is modernizing the landscape of healthcare for veterans by increasingly adopting a holistic approach to well-being, termed "Whole Health." One of the defining features of WH is that the veteran is placed at the center of their care. This veteran-centric model emphasizes the treatment of ailments in addition to the overall wellness of individuals by addressing physical, mental, and social health. In this framework, the role of the TSAC-F is particularly crucial in the realms of diet and exercise.

DIET AND EXERCISE: CORNERSTONES OF WHOLE HEALTH

The Department of Veterans Affairs' WH program encourages veterans to take charge of their health through lifestyle choices that prioritize self-care and personal responsibility. Two fundamental components of this self-care approach are diet and exercise. Evidence demonstrates that nutrition and physical activity can significantly enhance physical health, improve mental well-being, and reduce the risk of chronic diseases (1,2,3,6,7,8,11). By focusing on physical fitness as a pathway to improved health and well-being, VetFit encourages younger veterans to actively engage in this healthcare program, ultimately leading to better health outcomes and a stronger commitment to their ongoing wellness journey.

1. NUTRITION AS FUEL AND MEDICINE

A TSAC-F plays a pivotal role in educating veterans about the importance of a balanced diet. This involves teaching the basics of nutrition and addressing specific dietary needs of tactical athletes and veterans. By emphasizing that food is both fuel and medicine, TSAC-Fs empowers veterans to make informed choices that enhance their overall well-being and longevity (1.13). When dietary advice falls into the area of registered dieticians, the facility should have resources available to both consult and utilize these licensed providers.

2. EXERCISE AS A PATHWAY TO RESILIENCE

Physical activity is more than fitness in the traditional sense, it is a pathway to resilience and recovery. TSAC-Fs are trained to develop customized exercise programs that cater to the varying abilities of veterans. In a WH program, these tailored exercise regimens are designed to improve physical strength, endurance, and coordination, ultimately leading to better physical health and reduced stress levels.

BUILDING COMMUNITY AND SUPPORT

Beyond just diet and exercise, a TSAC-F plays a pivotal role in building a strong sense of community among veterans, which is a critical factor given the isolation many face when transitioning to civilian life. Through structured group exercise programs and interactive fitness workshops, TSAC-Fs cultivate an environment of camaraderie that fosters meaningful social connections, which are essential for mental and emotional well-being (8).

In these group settings, TSAC-Fs employ motivational interviewing techniques to guide veterans in setting realistic and attainable goals, creating a supportive atmosphere that encourages personal growth. This approach not only strengthens their commitment to healthier lifestyles but also reinforces their sense of belonging. By integrating physical health with social connection, TSAC-Fs empower veterans to navigate life's challenges with confidence, resilience, and a strong support network (5).

VetFit presents a unique opportunity to engage younger veterans in Department of Veterans Affairs healthcare by addressing their specific needs and interests. By tapping into the values of camaraderie, physical fitness, and holistic well-being, VetFit effectively attracts a diverse range of participants including active reservists, National Guard members, and veterans who serve in law enforcement roles. These individuals often seek communities that understand their unique challenges and experiences. VetFit promotes a sense of belonging and purpose through a structured exercise environment which fosters social connections and support networks among veterans. Exercise offerings include group exercise, fitness competitions, exercise prescription, and corrective exercise. Additionally, for recently separated veterans, VetFit serves as a bridge to familiarize them with Department of Veterans Affairs resources and healthcare services which often feel daunting or inaccessible (14).

TAKEAWAY – THE RELEVANCE OF VETFIT IN VA CARE

In conclusion, the role of TSAC-Fs within the Department of Veterans Affairs' WH framework extends beyond traditional fitness training, encompassing a holistic approach to wellness. By integrating informed dietary guidance, customized exercise programs, and fostering a sense of community among veterans, the TSAC-F contributes to comprehensive health promotion. Embedding TSAC-F certified professionals within each WH program of the Department of Veterans Affairs ensures that both tactical operators and veterans have access to a specialized resource akin to those in military and paramilitary units.

This article originally appeared in TSAC Report, the NSCA’s quarterly, online-only publication geared toward the training of tactical athletes, operators, and facilitators. It provides research-based articles, performance drills, and conditioning techniques for operational, tactical athletes. The TSAC Report is only available for NSCA Members. Read more articles from TSAC Report