Physiological Health for Safer Performance

If you’ve been following this series, you know that it was founded on a simple but powerful idea: personal accountability.

In Part 1, we discussed agency, or the degree to which you believe you are responsible for your own safety. Part 2 examined mental preparation, the “firmware” that governs how you think, react and perform under pressure. And in Part 3, we explored spiritual health; that’s the internal code that guides your behavior when the right choice is inconvenient or uncomfortable.

This article addresses physiological health, which is the bedrock of the previous three factors. While many of us think of risk as external – voltage, heights, equipment – you must also consider your physical condition. No matter how well-trained or well-intentioned you are, your ability to think clearly, make good decisions and execute safely depends on your body’s well-being.

When Performance Breaks Down
Most incidents don’t originate at the jobsite. They begin to coalesce hours earlier due to poor sleep, missed meals, unmanaged stress and/or physical fatigue. By the time workers must make a critical field decision, the conditions shaping it are already in place. This means you must manage your biological risk in addition to any job risks.

Consider this scenario that plays out every day across our industry: A crew heads out early. One worker hardly slept, another skipped breakfast, and the third has elevated blood pressure that they haven’t checked or treated in years. By midmorning, the job becomes more complex than expected, and the crew members must quickly make a consequential choice. Yet their attention has waned, their reaction times have slowed, and their judgment isn’t as accurate as it could be. Often, slight differences like these are all that’s needed to prompt an incident.

We tend to attribute incidents to systems, procedures and hazards. These factors matter; however, there is another factor that is just as real yet far less discussed: the condition of the human being doing the work.

This is why OSHA and the National Institute for Occupational Safety and Health introduced the Total Worker Health framework (www.cdc.gov/niosh/twh/), which recognizes that safety cannot be separated from overall health and well-being. The framework expands our conversation from “How do we prevent accidents?” to “What is the condition of our employees when they face risk?”

Physiology Matters
At some point, every safety system relies on someone to recognize a hazard, interpret what they see and make a decision – capabilities that depend on cognitive performance: memory, concentration, information processing and motor function. According to a document published by Stanford Lifestyle Medicine (see https://drive.google.com/file/d/1BvbUpKErJLgeVuGHfy0RGSG6I_6XVkBe/view?pli=1), these capabilities are directly influenced by movement, nutrition, sleep and other lifestyle factors. One great resource I recommend is the book “Eat Move Sleep” by Tom Rath. You can check out a summary at https://app.philosophersnotes.com/note/eat-move-sleep-tom-rath.

The takeaway here is that good physiological health is a prerequisite for safe performance. While we have spent decades refining our organizational systems, the persistence of serious injuries and fatalities indicates that our systems are necessary but not sufficient (see https://incident-prevention.com/blog/when-the-system-isnt-enough-how-to-create-personal-motivation-that-saves-lives/).

Stanford’s Lifestyle Pillars
Stanford has identified seven pillars of lifestyle medicine that shape how we think, decide and perform: movement; nutrition; sleep; stress management; social engagement; cognitive health; and purpose. Not all of these are purely physiological. You’ll note that we addressed cognitive health and mental performance in Part 2 of this series (https://incident-prevention.com/blog/mental-preparation-for-safer-work/); Part 3 covered gratitude, purpose and meaning (https://incident-prevention.com/blog/spiritual-preparation-for-safer-work/). Social engagement supports stress regulation and behavioral consistency, reinforcing those earlier themes.

For the purposes of this article, let’s focus on the Stanford pillars that most directly influence your physical readiness and safe performance in the field.

Movement and Exercise: Physical Capacity Under Load
Strength, balance and endurance determine how stable you are on structures, how well you handle equipment and how effectively you respond when something unexpectedly shifts. Many of us assume we are physically active enough, but research suggests that only a small percentage of individuals meet the recommended level.

I recently did two things to obtain an accurate assessment of my own physical status. First, I began tracking the frequency and length of my workouts using a fitness app on my watch. Then I asked a physical therapist to measure my movement capacity relative to my age. While not alarming, the results were not where I wanted them to be, which led to some personal changes: I bought some new fitness equipment, began to seriously schedule my workouts and set measurable goals. Simply put, once I could see where I stood, the responsibility to improve became mine.

Healthful Nutrition: Sustaining Focus and Energy
Nutrition is often discussed in the context of long-term health, but it has an equally important impact on daily performance. Poor dietary habits lead to fluctuations in energy, reduced concentration and slower cognitive processing, all of which affect job performance.

According to the Stanford Lifestyle Medicine document, more than 70% of Americans are overweight or obese, increasing the risk of conditions that degrade both health and performance. Stanford emphasizes a diet of nutrient-dense, minimally processed foods in appropriate portions.

To gain an accurate picture of my personal nutritional status, I took four steps. First, I completed a dual-energy X-ray absorptiometry (DEXA) scan (see www.dexafit.com/blog2/dexafit-dexa-scan-netflix-documentary), which provided the most accurate possible measurements of my weight, lean muscle mass, body fat percentage and bone mineral content. Next, I completed a comprehensive blood panel through Function Health (www.functionhealth.com). The third thing I did was dig out earlier results from MyFitnessPal (www.myfitnesspal.com), an app that helps you track your macronutrient intake (i.e., protein, fat and carbohydrates). Lastly, I shared my results with Natalie Barriball, NMD, an Arizona-based naturopathic physician (www.drnataliebarriball.com).

Dr. Barriball took the time to carefully comb through all my test results and put them into perspective, an essential step that yielded clarity far beyond what I expected. My results were clear, though some were not what I expected, providing an objective picture of where I stood. That clarity directly influenced my decision to adjust my dietary habits, including essential supplements.

Restorative Sleep: Protecting Judgment and Reaction Time
Sleep is one of the most influential yet underestimated human performance factors. An inadequate amount impairs cognitive function, emotional regulation and resilience, which are critical to safety in high-risk environments. This can show up in subtle ways. For instance, a well-rested worker is more likely to pause and reassess a situation when something doesn’t feel right, while a fatigued worker is more likely to push forward, even as conditions change.

I have struggled with sleep for years. Consistent with my new focus on accurate measurement, I recently began using the sleep tracker on my watch (https://support.apple.com/guide/watch/track-your-sleep-apd830528336/watchos), making small adjustments such as limiting screen time close to bedtime, avoiding late meals and reading only paper-based materials to fall asleep. Each tweak has improved my results, though it remains an ongoing effort.

Stress Management: Maintaining Control Under Pressure
Stress has direct physiological effects that influence your attention, decision-making and emotional control. When stress is unmanaged, thinking narrows and reactions become less deliberate. That loss of control can be consequential in our line of work. Managing stress does not mean eliminating it; rather, proper management helps you regulate your response so that you remain composed when conditions deteriorate.

Closing the Gap
These pillars are not mandates, nor are they about perfection. They are areas in which honest assessment can reveal gaps between where you are and where you must be to perform at your best. Once those gaps are clear, the next step – as always – is yours to decide.

Data that directly links reduced incident rates to improvements across these pillars is still emerging. What we know for sure is that human performance plays a role in most serious injuries and fatalities. Further, physical factors directly influence how we think, react and make choices under pressure. This is one of the gaps our industry has been working to close: how to better account for the human factors that influence performance in the field.

What I’ve described in this article is not a departure from traditional safety but an expansion of it. As noted earlier, the Total Worker Health framework was developed with the understanding that (1) safety cannot be separated from the condition of the worker and (2) performance is shaped by more than rules, procedures and equipment.

Approaches like motivational interviewing reinforce a principle introduced at the beginning of this series: Lasting progress is not a product of being told what to do. It derives from clearly understanding your current condition and deciding for yourself what needs to change. The process is straightforward but not easy. You must self-assess honestly, realize where you stand and determine what you want to do differently, if anything. No one can make the choice for you.

Full Circle
That brings us back to where we started. Assuming total responsibility for your safety means more than following procedures and wearing the proper protective equipment. It also includes taking ownership of the condition you bring to work each day. How you sleep, eat, move and manage stress influence safety. They are not separate from it.

Professionals in other high-risk fields understand this well. Surgeons, pilots, professional athletes and special operations personnel do not leave their performance to chance, preparing deliberately and consistently because they know what is at stake. Given the daily risks in our line of work, every aspect of our preparation matters for our continued safety, health and wellness.

About the Author: Tom Cohenno, Ed.D., CSP, CUSP, NBC-HWC, is a recognized safety expert and principal of Applied Learning Science (https://appliedlearningscience.com). With deep academic and operational experience as a U.S. Navy veteran, substation chief and former utility executive, he blends real-world insight with evidence-based research to deliver practical, impactful safety solutions.