Paving the way to a healthier you through a community program

Kristen Siminski, PT is working in her dream job. Her passion for health and wellness and educating others about how to live a healthier lifestyle, have melded together in her role as public health physical therapist with the Visiting Nurse Association of Cape Cod (VNA) Public Health.

She is most excited about a class she is leading in the community, called PAVING the Path to Wellness, an evidence-based group coaching program that uses the latest research in lifestyle medicine to help participants make small changes that have a big impact on their long-term health.

That’s exactly the result Brenda Mazzeo of Barnstable said she found when she took part in a PAVING class at the Brewster Council on Aging this winter.

“It’s all about re-evaluating what we thought before,” she said recently on the last day of the class. “There were lots of opportunities to reflect on yourself and set achievable goals.”

Mazzeo’s classmate Lauren Polzer said the program “more than met my expectations.”

Participant Maureen Fettig particularly liked the recipes included in the workbook. “I knew I should be eating more whole grains, and now, because the recipes were handed to me, I do it,” she said.

Top left: Gina Paglucia Morrison, Ann Spears, Brenda Mazzeo, Kristen Siminski Bottom left: Heidi Low, Maureen Fettig, Lauren Polzer

What it Is

PAVING the Path to Wellness is divided into 12 different topics (PAVING STEPSS)

• P for physical activity
• A for attitude
• V for variety
• I for investigations
• N for nutrition
• G for goals
• S for stress
• T for time-outs
• E for energy
• P for purpose
• S for sleep
• S for social connections

The course’s weekly 90-minute sessions run from eight to 12 weeks long and are offered free to up to 12 participants at a time. With the guidance of a large 400-page workbook that each participant receives free of charge, they go through intensive training on what are known as the six pillars of health. The pillars are:

• Physical activity
• Nutrition
• Stress management
• Sleep health
• Social connections
• Avoidance of risky substances.

Developed by Physicians

The program was developed by Beth Frates, MD, an associate professor part time at Harvard Medical School in the department of Physical Medicine and Rehabilitation at Spaulding Rehabilitation Hospital and co-director of the non-profit PAVING the Path to Wellness, part time. She developed it, together with two other physicians, Amy Comander, MD and Michelle Tollefson, MD. Dr. Frates became interested in lifestyle medicine after working with patients who have had a stroke. Dr. Comander started using the techniques with patients who have had breast cancer, and Dr. Tollefson found it helpful for women going through perimenopause and menopause.

Siminski, who became board certified in Lifestyle Medicine through the American Board of Lifestyle Medicine in December, met Dr. Frates in 2020 and was asked to help promote the program a couple years ago.

“I was definitely honored, and wanted to see what this was all about,” Siminski said. When she researched it and saw how valuable it would be for people on Cape Cod, she brought it to the VNA and the program started on Cape Cod in 2025.

The 14 towns with a contract with VNA Public Health pay for the class, which includes the workbook. The course is offered free of charge to participants of any age, who learn ways to eat better, stay more physically active, sleep better, and the importance of staying socially connected, among other things.

A page in the beginning of the workbook lets participants assess on the “Paving Wheel” where they are with their overall health. This gives them insight into where they may need the most work.

Mazzeo said she initially filled in the wheel and then “redid it with honesty” and saw the true areas she wanted to work on. “It helps me be self-accountable,” she said.

Along with Siminski, Gina Paglucia Morrison volunteered her time by attending every Brewster class and, after each one, pulled together any information, like website links, podcasts mentioned, or books the group may have talked about. She often did additional research into areas participants may have asked about during a class and sends the information in a follow-up email.

What is Lifestyle Medicine?

Lifestyle medicine is a practice where health providers enlist the six pillars of health to help treat, prevent and manage chronic disease, said Siminski. For the past five years, she has been attending a conference put on by the American College of Lifestyle Medicine. The information she has gathered has been “invaluable,” she said.

Lifestyle medicine is “great for the patients, it’s great for the community and it’s great for us as providers,” she said.

Siminski was a physical therapist at Cape Cod Hospital for 20 years before moving to the VNA to become the public health physical therapist for its Public Health and Wellness division, which has contracts with every Cape Cod town except Barnstable. The department provides community-based prevention programs and initiatives. In addition to her involvement with the PAVING program, Siminski visits people’s homes to talk about safety concerns and lifestyle medicine issues.

Siminski said she has seen a shift during her 20 years in practice where patients are wanting to know more about how to prevent, treat and manage disease in a better way.

“What people want is to talk about health and wellness,” she said. “They want to be seen; they want to be heard. They want to know more about things that matter to them, like movement, nutrition, and talking about purpose.”

The PAVING program answers some of that need, she said, and they have had overwhelmingly positive feedback from participants. In addition to Brewster, the course has been offered in Falmouth (twice), Orleans and Provincetown. It is ongoing during March and April at the Dennis Center for Active Living and will be offered at the Sandwich Center for Active Living in the fall.

“It’s so invigorating to be part of this, and it is such a gift to me,” Siminski said. “Yes, I’m there facilitating, but participants talk to each other and learn from each other, too. It’s a privilege to be able to get a glimpse into their stories”

The classes are comprised mostly of women, but men are encouraged to take part as well, she said.

“What I love about lifestyle medicine is meeting people where they’re at and just being able to figure out what small steps they can make. Sometimes the most difficult part is getting out of the chair and turning the doorknob to get things going.”