TMD Health
the intersection of medicine, physiology, and performance
Medicine historically treats disease after it appears. While we need to react to problems when they arise, management of chronic diseases and age-related decline in functional capacity is more effective when prevented in a proactive manner. The accumulation of chronic conditions that affect many people (think heart disease, hyperlipidemia, hypertension, diabetes, osteoporosis, sarcopenia, etc.) progress silently for years to decades before presenting with any symptoms. It is estimated that only 7% of the US adult population meets the definition of optimal cardio metabolic health and many people who consider themselves “healthy” have multiple conditions quietly progressing under the surface.
Many people think athletics when discussing performance. More generally, performance focuses on improving capacity. When it comes to health and aging, functional capacity is your ability to perform mental and physical tasks, activities, and daily routines. Capacity metrics, such as VO₂ max, strength, power, and muscle mass are among the strongest predictors of long-term survival and independence. Our functional capacity peaks in our 30s followed by decades of decline until we reach a state of frailty and disability resulting in loss of independence, reduced quality of life, and increased risk of dying. This decline is measurable, meaningful, and actionable.
It is pivotal to understand your physiology, where your functional capacity stands, and where your risks, strengths and weakness lay if you are to leverage your limited time and energy to make the biggest possible difference in your health trajectory.
The approach at TMD Health is to systematically and objectively assess the domains of health and performance to build lasting health and resilience.
Information vs Behavioral Engineering
There is strong evidence that a good lifestyle influences cardiometabolic disease, cancer risk, neurodegeneration, and mortality. Many people know that exercise, diet quality, sleep, and stress management are tied to better health outcomes yet have difficulty implementing and sustaining these in the distractions and stressors of daily life. Most people are not getting enough quality sleep, are overworked and stressed, don’t meet minimum exercise recommendations, and have a poor quality diet.
Traditional medicine treats clinical lifestyle counseling as information-based. The assumption is that knowledge drives behavior, meaning that the more you “inform” someone on a topic, the more likely they are to change their habits and behavior. However, studies of smoking, diet, and exercise repeatedly demonstrate that knowledge alone produces minimal long-term adherence (frequently falling below 30–40% by one year). In contrast, well-run performance systems often maintain 80–90% adherence by focusing on program structure, design, and behavioral science.
How behavioral science supports medical interventions
Excessive Cognitive Load
As previously stated, many people are already overwhelmed by the demands of life and don’t have a lot of residual mental bandwidth. When medical advice and interventions require a lot of thinking, tracking, and in-the-moment decisions, the brain is going to default to automatic, habitual behaviors. This is an evolutionary and positive way of freeing up attention and cognitive space for more pressing tasks. It becomes If the cognitive load of managing one’s healthTraditional medicine often increases a patient’s cognitive load. Example lifestyle advice might include: change diet, start exercising, track calories, improve sleep, reduce alcohol, and manage stress. Each piece of advice requires ongoing decision-making resulting in decision fatigue becoming a major barrier.
A clearly structured plan simplifies decision-making and reduces cognitive load, removing a major barrier to compliance.
Long Feedback Delays and Lack of Progress Narrative
Humans are poorly motivated by delayed rewards. Lipid profiles, Hemoglobin A1c, and cardiovascular risk reduction are often imperceivable to patients and can take months to achieve. Additionally, patients often perceive little progress because the metrics emphasized are limited. For example, if someone’s weight doesn’t change, the patient believes the program failed. However, if they are shown that they lost fat, gained muscle, improved their biomarkers, and are adopting lifelong habits, they sustain their motivatdion.
Humans are also more motivated by narrative. Narrative gives behavior emotional relevance and constantly reinforces the meaning of the process. By tracking progress in multiple domains and shortening the feedback loop, the narrative shifts to one of interval progressive improvement and allows short-term visible improvements to reinforce behavior.
Lack of Identity Shift
Patients are typically framed as trying to reduce disease risk which reinforces an illness identity (diabetic patient, hypertensive patient, overweight patient, …) rather than performance and capacity identities (I am someone who trains, I’m building my aerobic base, I am investing in my future self…).
Research in behavioral psychology shows identity-based habits are far more durable than outcome-based goals and identity-consistent behavior becomes self-reinforcing.
Absence of Accountability
In medicine, most patients have infrequent follow-up with no reinforcement between visits. Continuous engagement and frequent contact points promote durable engagement. Weekly messages and calls, monthly program adjustments, quarterly reassessments are all contact points that maintain engagement.
A study in the American Society of Training and Development reported the probability of completing a goal: idea or intention (~10%), commitment to someone else (~65%), scheduled accountability appointment (~95%).
Programs Not Designed for Real Life
In medicine, advice is often idealized rather than practical. What may be physiologically optimal may be unrealistic. Programs built around real-world constraints that prioritize sustainability and adapt with progress show more success.
With time scarcity, career demands, and family obligations, many people abandon programs because they appear too time intensive. The typical fitness industry model demands 7-10 hours per week. Research consistently shows adherence drops sharply when exercise exceeds ~5 hours/week in previously sedentary adults.
Lack of Progressive Challenge
Finally, lifestyle advice is often static. What starts at “Walk 30 minutes daily” eventually becomes too easy, progression stalls, and engagement drops. Training programs should evolve to maintain engagement and produce continued physiological adaptation. For example, what starts as walking progresses to jogging and interval training which then becomes threshold work and strength development.
The TMD Health Approach
A Superior Physician Led Performance Model
Behavioral coaching and adherence architecture
Assessment-Driven Personalization
TMD Health doesn’t prescribe generic programs. We build from diagnostics.
Accountability and Feedback
Daily data collection
Weekly check ins
Monthly program adjustments
Quarterly progress assessment with health progress narrative
Real World Protocols
Designed to work with time scarcity, career demands, and family obligations
Build systems that make the desired behavior easier, automatic, and identity-consistent.
Minimize complexity and cognitive load
Longitudinal tracking showing ROI on health
Physiologic testing
VO₂ max
Ventilatory thresholds
Metabolic testing
Power and strength
Balance and mobility
Body composition
Medical risk stratification and management
Cardiovascular risk
Metabolic disease
Hormone balance
Cancer risk
Genetics
Advanced lab interpretation
Imaging integration
Evidence-based pharmacology