Dosing of Health and Wellness Coaching for Obesity and Type 2 Diabetes: Research Synthesis to Derive Recommendations.

Health and wellness coaching (HWC) is an effective intervention for lifestyle disease such as obesity and type 2 diabetes. The evolving HWC profession needs recommendations to guide clinical practice, particularly the appropriate dose of coaching. The purpose of this paper was to systematically review and synthesize HWC literature to derive HWC programming recommendations. Of 102 papers retrieved, 88 were retained with data extracted determining HWC session number, frequency, duration, program length, and total coaching load. Differential analysis yielded no statistical difference in programming variables for randomized control trials and other designs, nor for studies with significant findings v. those not finding statistical significance, allowing these data to be pooled. The HWC intervention for obesity was slightly more intense (15 sessions over 7-8 mo) than the diabetes programming (12 sessions over 9-10 mo). On average, HWC programming applied in the peer-reviewed literature was 12-15 sessions of 35-40 min duration over 7-9 months. These recommendations for HWC programming variables are put forth as initial practice guidelines and should be examined with comparative effectiveness study for optimization. HWC best practice guidelines for other patient groups (e.g., heart disease, cancer, and chronic pain) should also be studied once an adequate literature data base is available.

Effect of Varying Self-myofascial Release Duration on Subsequent Athletic Performance.

ABSTRACT: Phillips, J, Diggin, D, King, DL, and Sforzo, GA. Effect of varying self-myofascial release duration on subsequent athletic performance. J Strength Cond Res 35(3): 746-753, 2021-Self-myofascial release (SMR) treatments can enhance joint range-of-motion and restore movement function. The effects of different SMR durations on athletic performance have yet to be examined. Twenty-four volunteers had ankle and knee joint range-of-motion assessed using modified weight-bearing and kneeling lunge (KL) tests. Vertical jump and pro-agility sprint performance were also examined. All tests were conducted before and immediately after 1 (SMR_1) and 5 minutes (SMR_5) of foam rolling, and immediately after a control (CONTR) condition. Results showed KL scores increased after SMR_5 (16.4%; effect size [ES] = 0.85) when compared with SMR_1 (12.5%; ES = 0.58). Weight-bearing lunge scores showed little change after either SMR treatment. The CONTR condition exhibited little effect on joint range-of-motion. Vertical jump performance decreased after SMR_5 (5.1%; ES = 0.26) but changed little after SMR_1 (0.7%; ES = 0.03) and CONTR (1.9%; ES = 0.10) conditions. Pro-agility performance improved slightly after SMR_1 (1.1%) but deteriorated after CONTR (1.2%) and SMR_5 (0.5%). Effect size calculations for changes in pro-agility sprint times were trivial across all conditions (0.06-0.15). Data suggest that extended periods of SMR may be recommended, should improvements in joint range-of-motion be required. If power output is a critical requirement of subsequent exercise/performance tasks, prolonged SMR treatment (i.e., 5 minutes) should be avoided. Practitioners should be cautious when implementing SMR treatments within warm-ups.

Integrating Health Coaching With a Medical Fitness Program to Treat Chronic Health Conditions.

Medical fitness and health/wellness coaching (HWC) are emerging health care trends but potential synergistic effects are yet to be studied. PURPOSE: To determine the impact of integrating HWC within a community-based medical fitness program for patients with chronic health conditions. METHODS: A before and after clinical trial, examining 3 frequency levels of coaching sessions, with Journey-to-Wellness (J2W) participants (N = 1306) who were predominately female (76%), aged 12 to 87 years (mean ± SD = 53.54 ± 14.34 years), and referred by their health care provider. Over 3 months, J2W emphasized HWC, exercise, nutrition counseling, and group/interactive events. HWC averaged 4.4 ± 2.5 sessions and was analyzed at 3 levels (0-3; 4-6; 6+ sessions). Pre-post measures were Patient Health Questionnaire (PHQ-9), Positivity, General Anxiety Disorder (GAD-7), Dartmouth Quality of Life (QoL), Lifestyle Nutrition Behavior (LNB), Pain, exercise minutes, weight, waist circumference, and systolic/diastolic blood pressures. RESULTS: J2W intervention significantly (P < .01) improved all outcomes. Between 20% and 43% improvements were observed for PHQ-9, GAD-7, QoL while LNB improved 7.5%, and biometrics between 1% and 2.2%. Greater frequency of HWC enhanced J2W effect for PHQ-9 and QoL with weight and GAD approaching significance. CONCLUSION: J2W programming produced measurable improvement in health metrics, with greater HWC frequency adding to these beneficial effects, providing a powerful community-based health intervention.

Compendium of Health and Wellness Coaching: 2019 Addendum.

The 2019 Addendum, in conjunction with the original health and wellness coaching (HWC) Compendium, organizes HWC literature with the aim of assisting researchers while providing a resource for practitioners. The 2019 Addendum to the HWC Compendium extends the initial work by adding HWC-related literature published in the past 2 years. The 2019 Addendum divides articles retrieved into 8 categories, including a new miscellaneous section complementing categories examining HWC effects on cancer, cholesterol, diabetes, heart disease, hypertension, obesity, and wellness. The 2019 Addendum again provides in-depth information about the nature, quality, and results from each article in a detailed spreadsheet provided as an electronic appendix. The 2019 Addendum contributes another 104 peer-reviewed coaching-related articles to the HWC Compendium. This most recent research again describes HWC as a favorable intervention with treatment potential in all categories, though only 3 new cancer articles were included in the 2019 Addendum. Trends in HWC (ie, e-coaching and group coaching) are identified, and there is also discussion of future research needs. In conclusion, the field of HWC continues to grow, as does the research describing this clinical practice; the 2019 Addendum to the Compendium of HWC organizes and assists understanding of this literature.

Compendium of the Health and Wellness Coaching Literature.

Health and wellness coaching (HWC) for lifestyle behavior change is emerging as a practice, role, and profession, in diverse health care, employee wellness, and community settings. Health care professionals apply HWC as a behavior change methodology for the prevention and treatment of diabetes, hypertension, hyperlipidemia, heart disease, cancer, and other chronic disorders. The purpose of this systematic review was to provide a comprehensive and organized compendium of HWC literature. To date, extant HWC literature remains scattered with no meaningful summary accessible. Lack of comprehensive summary stems from lack of consensus on HWC definition and standards. We applied a recently proposed, standardized definition of HWC to determine compendium inclusion criteria for peer-reviewed, data-based literature from relevant search engines (ie, PubMed, PsychInfo, and CINAHL). A systematic review process was executed and ultimately yielded 219 articles meeting HWC inclusion criteria. Of these, 150 were data-based and the remainder were expert opinion or review-style articles. A summary of results generally reveals HWC as a promising intervention for chronic diseases though further research is needed in most categories. The resulting HWC compendium organizes and describes the quantity and quality of available literature for the use and benefit of HWC practitioners and researchers.

Improving Nutritional Habits With No Diet Prescription: Details of a Nutritional Coaching Process.

Thousands of dollars are spent today with policies encouraging physical activity and healthy eating, but nutritional consultation per se has continuously failed to yield consistent and lasting results. The aim of this case report is to detail and evaluate nutritional coaching (employing health coaching techniques) in promoting lifestyle changes, enabling improvement of nutritional and body composition associated parameters. The patient in this study had previously engaged in a series of different diet regimens, all of which failed in achieving the proposed aim. After 12 nutritional coaching sessions (one per week) with the strategy presented herein, reductions in body fat mass and in total body weight were attained. Nutritional habits also improved, as the patient showed decreased total energy intake, decreased fat intake, and increased fiber ingestion. Daily physical activity and energy expenditure were enhanced. The coaching program was able to induce immediate health benefits using a strategy with the patient at the core of promoting his own lifestyle changes. In conclusion, the nutritional coaching strategy detailed was effective at helping our patient develop new eating patterns and improve related health parameters.

Sustainability and repeatability of postactivation potentiation.

BACKGROUND: This study investigated the duration and repeatability of postactivation potentiation (PAP) benefits within a single exercise session. Specifically examined were the recurring effects, over multiple sets, of heavy back squats on repeated sprint times. METHODS: A partially randomized, counterbalanced, repeated measures design was implemented using 29 college-aged male NCAA varsity field sport athletes participating in PAP and control conditions. Subjects performed four repetitions of back squats (PAP=90% 1RM; control =20% 1RM), rested 8 minutes, performed a set of four 40-m sprints (55 s inter-repetition active recovery) and rested for 8 minutes after the last sprint. This was performed two more times, for a total of three sets (of back squats and sprints) performed 20 minutes apart. Sprint performance was measured using electronic timing gates and a timing pad to capture of reaction time (RT) at the start of each sprint. 2x3 (condition x sets) and 2x4 (condition X repetition) repeated measures ANOVAs were used to analyze both sprint and RT outcomes. RESULTS: Subjects ran significantly faster (P<0.05) after PAP than control. Specifically, sprint times were faster for the first two-three sprints, but not the fourth, across all three sets of sprints over the 51-min exercise session. RT was not affected (P>0.05) by PAP activity. CONCLUSIONS: The PAP effect was sustainable up to 11 minutes after heavy back squats and was repeated successfully three times. These findings can assist coaches and athletes interested in applying PAP to improve performance.

A pilot study of health and wellness coaching for fibromyalgia.

BACKGROUND: The purpose of this study was to test the hypothesis that a health and wellness coaching (HWC)-based intervention for fibromyalgia (FM) would result in sustained improvements in health and quality of life, and reductions in health care utilization. METHODS: Nine female subjects meeting American College of Rheumatology criteria for a diagnosis of primary FM were studied. The HWC protocol had two components, which were delivered telephonically over a twelve-month period. First, each patient met individually with a coach during the 12 month study at the patient's preference of schedule and frequency (Range:22-32 × 45-min sessions). Coaches were health professionals trained in health and wellness coaching tasks, knowledge, and skills. Second, each patient participated in bimonthly (first six months) and monthly (second six months) group classes on self-coaching strategies during the 12 month study. Prior to the intervention, and after 6 months and 12 months of coaching, the Revised Fibromyalgia Impact Questionnaire (FIQR) was used to measure health and quality of life, and the Brief Pain Inventory-Short Form (BPI) was used to measure pain intensity and interference with function. Total and rheumatology-related health encounters were documented using electronic medical records. Data were analyzed using repeated measures ANOVA. RESULTS: All nine patients finished the HWC protocol. FIQR scores improved by 35 % (P = 0.001). BPI scores decreased by 32 % overall (P = 0.006), 31 % for severity (P = 0.02), and 44 % for interference (P = 0.006). Health care utilization declined by 86 % (P = 0.006) for total and 78 % (P < 0.0001) for rheumatology-related encounters. CONCLUSION: The HWC program added to standard FM therapy produced clinically significant improvements in quality of life measures (FIQR), pain (BPI), and marked reductions in health care utilization. Such improvements do not typically occur spontaneously in FM patients, suggesting that HWC deserves further consideration as an intervention for FM.

Credentialed Chefs as Certified Wellness Coaches: Call for Action.

Beneficial relationships exist between food preparation skills and improved dietary quality, and between times spent preparing food and mortality. Food shopping, meal planning, preparation and cooking skills are valuable in supporting good health. Thus experts are proposing nutritional counseling be expanded to include these beneficial behavioral skills. Educational programs delivered by chefs have recently emerged as a way to improve engagement with nutritional guidelines. It is reasonable to assume that a chef with behavior change knowledge and skills, such as coaching, may be more effective in facilitating behavior change. We encourage chefs who wish to be involved in promoting health-related behavior change to consider continuing education in coaching knowledge and skills. We also recommend culinary schools to consider offering these courses, to aspiring chefs. Such programming will not only benefit future clients but also offers a career- enriching professional opportunity to chefs. Credentialed chefs can make a positive health impact and should be included as professionals who are eligible for the impending national certification of health and wellness coaches.

Auditory driving of the autonomic nervous system: Listening to theta-frequency binaural beats post-exercise increases parasympathetic activation and sympathetic withdrawal.

Binaural beats are an auditory illusion perceived when two or more pure tones of similar frequencies are presented dichotically through stereo headphones. Although this phenomenon is thought to facilitate state changes (e.g., relaxation), few empirical studies have reported on whether binaural beats produce changes in autonomic arousal. Therefore, the present study investigated the effects of binaural beating on autonomic dynamics [heart rate variability (HRV)] during post-exercise relaxation. Subjects (n = 21; 18-29 years old) participated in a double-blind, placebo-controlled study during which binaural beats and placebo were administered over two randomized and counterbalanced sessions (within-subjects repeated-measures design). At the onset of each visit, subjects exercised for 20-min; post-exercise, subjects listened to either binaural beats ('wide-band' theta-frequency binaural beats) or placebo (carrier tones) for 20-min while relaxing alone in a quiet, low-light environment. Dependent variables consisted of high-frequency (HF, reflecting parasympathetic activity), low-frequency (LF, reflecting sympathetic and parasympathetic activity), and LF/HF normalized powers, as well as self-reported relaxation. As compared to the placebo visit, the binaural-beat visit resulted in greater self-reported relaxation, increased parasympathetic activation and increased sympathetic withdrawal. By the end of the 20-min relaxation period there were no observable differences in HRV between binaural-beat and placebo visits, although binaural-beat associated HRV significantly predicted subsequent reported relaxation. Findings suggest that listening to binaural beats may exert an acute influence on both LF and HF components of HRV and may increase subjective feelings of relaxation.

Effective Tobacco Cessation via Health Coaching: An Institutional Case Report.

BACKGROUND: Tobacco abuse is a well-recognized scourge on health and healthcare costs. Attempts to facilitate tobacco cessation are rarely better than marginally effective. PRIMARY OBJECTIVE: To describe an observational trial of an existing and highly successful tobacco cessation program featuring health coaching as the primary intervention. Core components of program design and data are presented and may serve as a model for other public health settings. METHODS: Health coaching and three complementary program components (auriculotherapy, alpha-electrical stimulation, and relaxation techniques) are presented. Quit rates at 6 months for 161 patients over 3 years are provided featuring 30-day point prevalence smoke free and intent-to-treat values. Comparisons for telephonic vs in-clinic health coaching, free choice vs mandated participation, and program costs are provided. RESULTS: Point prevalence quit rate was 88.7% while the more conservative intent-to-treat quit rate was 51.6%. Telephonic and in-clinic health coaching were not significantly different at any time point. Smoke-free rates at 6 and 12 months were 76.9% and 63.2%, respectively. CONCLUSIONS: Two cost-effective smoking cessation models featuring health coaching are presented. Point prevalence (30-day) above 80% and an enduring effect was seen. Personal and societal burdens (health and financial) of tobacco use might be greatly impacted if such programs were successfully implemented on a larger scale.

The study of health coaching: the ithaca coaching project, research design, and future directions.

Health coaching (HC) is a process holding tremendous potential as a complementary medical intervention to shape healthy behavior change and affect rates of chronic lifestyle diseases. Empirical knowledge of effectiveness for the HC process, however, is lacking. The purposes of this paper are to present the study protocol for the Ithaca Coaching Project while also addressing research design, methodological issues, and directions for HC research. This is one of the first large-scale, randomized control trials of HC for primary prevention examining impact on physical and emotional health status in an employee population. An additional intent for the project is to investigate self-determination theory as a theoretical framework for the coaching process. Participants (n=300) are recruited as part of a campus-wide wellness initiative and randomly assigned to one of three levels of client-centered HC or a control with standard wellness program care. Repeated measures analyses of covariance will be used to examine coaching effectiveness while path analyses will be used to examine relationships between coaching processes, self-determination variables, and health outcomes. There is a great need for well-designed HC studies that define coaching best practices, examine intervention effectiveness, provide cost:benefit analysis, and address scope of practice. This information will allow a clearer definition of HC to emerge and determination of if, and how, HC fits in modern-day healthcare. This is an exciting but critical time for HC research and for the practice of HC.

La formación sanitaria (FS) es un proceso que posee un enorme potencial como intervención médica complementaria para lograr un cambio conductual saludable y reducir los índices de enfermedades crónicas. Sin embargo, se carece de conocimientos empíricos acerca de la eficacia del proceso de la FS. La finalidad de este artículo consiste en presentar el protocolo de estudio del proyecto de formación sanitaria Ithaca, al mismo tiempo que se abordan el diseño de la investigación, los aspectos metodológicos y el rumbo de la investigación de la FS. Se trata de uno de los primeros ensayos controlados y aleatorizados a gran escala para examinar la FS dirigida a la prevención primaria y su impacto sobre el estado de salud físico y emocional de una población de empleados. Una intención adicional del proyecto es la de investigar la teoría de la autodeterminación como marco teórico para el proceso de formación. Se está reclutando a los participantes (n 1 300) dentro de una iniciativa de bien-estar a lo largo del campus y se les está asignando, de forma aleatoria, a uno de tres niveles de FS centrada en el cliente o a un grupo de control que recibe atención a través de un programa de bienestar estándar. Se utilizarán análisis de covarianza con medidas repetidas para examinar la eficacia de la formación y se emplearán análisis de trayectorias para estudiar las relaciones entre procesos de formación, variables de autodeterminación y resultados sanitarios. Existe una gran necesidad de estudios de FS bien diseñados que establezcan buenas prácticas de formación, investiguen la eficacia de las intervenciones, elaboren un análisis de la relación entre costes y beneficios, y aborden el campo de aplicación. Estos datos permitirán definir con mayor claridad la FS para que emerja y contribuirán a averiguar si la FS encaja en la atención sanitaria moderna y de qué manera lo hace. Nos hallamos en un momento interesante pero crítico de la investigación y el ejercicio de la FS.

A Systematic Review of the Literature on Health and Wellness Coaching: Defining a Key Behavioral intervention in Healthcare.

PRIMARY OBJECTIVE: Review the operational definitions of health and wellness coaching as published in the peer-reviewed medical literature. BACKGROUND: As global rates of preventable chronic diseases have reached epidemic proportions, there has been an increased focus on strategies to improve health behaviors and associated outcomes. One such strategy, health and wellness coaching, has been inconsistently defined and shown mixed results. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review of the medical literature on health and wellness coaching allowed for compilation of data on specific features of the coaching interventions and background and training of coaches. RESULTS: Eight hundred abstracts were initially identified through PubMed, with 284 full-text articles ultimately included. The majority (76%) were empirical articles. The literature operationalized health and wellness coaching as a process that is fully or partially patient-centered (86% of articles), included patient-determined goals (71%), incorporated self-discovery and active learning processes (63%) (vs more passive receipt of advice), encouraged accountability for behaviors (86%), and provided some type of education to patients along with using coaching processes (91%). Additionally, 78% of articles indicated that the coaching occurs in the context of a consistent, ongoing relationship with a human coach who is trained in specific behavior change, communication, and motivational skills. CONCLUSIONS: Despite disparities in how health and wellness coaching have been operationalized previously, this systematic review observes an emerging consensus in what is referred to as health and wellness coaching; namely, a patient-centered process that is based upon behavior change theory and is delivered by health professionals with diverse backgrounds. The actual coaching process entails goal-setting determined by the patient, encourages self-discovery in addition to content education, and incorporates mechanisms for developing accountability in health behaviors. With a clear definition for health and wellness coaching, robust research can more accurately assess the effectiveness of the approach in bringing about changes in health behaviors, health outcomes and associated costs that are targeted to reduce the global burden of chronic disease.

Free choice access to multipoint wellness education and related services positively impacts employee wellness: a randomized and controlled trial.

OBJECTIVE: Examine effects of voluntary participation in employer-sponsored, multipoint wellness education programming on employee wellness. METHODS: A randomized and controlled design was used to organize 96 participants into an education + access group; an access-only group, and control group. Outcome measures were made at start and end of a 12-week intervention period. RESULTS: Education + access improved wellness knowledge, which, in turn, enhanced life satisfaction, employee morale, and energy, and nearly improved stress level. Those who received facility access without educational programming did not reap health benefits. Employees voluntarily used the fitness facility and healthy meal cards only 1.3 and 1.5 times per week, respectively. CONCLUSIONS: Participants made limited and likely inadequate use of wellness opportunities. As a result, physical health benefits (eg, blood pressure, fitness parameters) were not seen in the present study. However, multipoint wellness education resulted in psychosocial health benefits in 12 weeks.

Optimizing power output by varying repetition tempo.

The effects of varying interrepetition rest and eccentric velocity on power output (PO) and the number of repetitions performed during a bench press set were examined in 24 college-aged resistance trained men. On 6 separate occasions, subjects performed a set of bench press at 80% 1 repetition maximum until volitional fatigue. For each of the 6 repetition tempo trials, the bench press set was paced by metronome to a unique repetition tempo involving a combination of the following: interrepetition rest of 0 or 4 seconds; eccentric velocity of 1 or 4 seconds and bottom rest of 0 or 3 seconds. The velocity of concentric contraction was maximal during all 6 tempo trials. During each trial, video data were captured to determine PO variables and number of successful repetitions completed at each tempo. One-way repeated measures analysis of variance showed tempos with a fast eccentric phase (1 second), and no bottom rest produced significantly greater (p ≤ 0.05) PO and repetitions than tempos involving slower eccentric velocity (4 seconds) or greater bottom rest (4 seconds). This combination of greater repetitions and PO resulted in a greater volume of work. Varying interrepetition rest (1 or 4 seconds) did not significantly affect PO or repetitions. The results of this study support the use of fast eccentric speed and no bottom rest during acute performance testing to maximize PO and number of repetitions during a set of bench press.

The effects of combining elastic and free weight resistance on strength and power in athletes.

This study was undertaken to determine whether combined elastic and free weight resistance (CR) provides different strength and power adaptations than free weight resistance (FWR) training alone. Forty-four young (age 20 +/- 1 years), resistance-trained (4 +/- 2 years' experience) subjects were recruited from men's basketball and wrestling teams and women's basketball and hockey teams at Cornell University. Subjects were stratified according to team, then randomly assigned to the control (C; n = 21) or experimental group (E; n = 23). Before and after 7 weeks of resistance training, subjects were tested for lean body mass, 1 repetition maximum back squat and bench press, and peak and average power. Both C and E groups performed identical workouts except that E used CR (i.e., elastic resistance) for the back squat and bench press, whereas the C group used FWR alone. CR was performed using an elastic bungee cord attached to a standard barbell loaded with plates. Elastic tension was accounted for in an attempt to equalize the total work done by each group. Statistical analyses revealed significant (P < 0.05) between-group differences after training. Compared with C, improvement for E was nearly three times greater for back squat (16.47 +/- 5.67 vs. 6.84 +/- 4.42 kg increase), two times greater for bench press (6.68 +/- 3.41 vs. 3.34 +/- 2.67 kg increase), and nearly three times greater for average power (68.55 +/- 84.35 vs. 23.66 +/- 40.56 watt increase). Training with CR may be better than FWR alone for developing lower and upper body strength, and lower body power in resistance-trained individuals. Long-term effects are unclear, but CR training makes a meaningful contribution in the short term to performance adaptations of experienced athletes.

Knowledge and imagery of contractile mechanisms do not improve muscle strength.

Improving performance in strength tasks requires modifications charateristic of motor skill learning, such as more efficacious motor-unit firing behavior. Because domain-specific knowledge is integral to learning and performing motor kills, the present purpose was to examine selected factors of strength-specific knowledge and effects they might have on acquiring strength. Following baseline testing for maximal strength on a knee-extension task, participants were matched by sex and strength and placed into control (n=8) and treatment (n=8) groups. Quadriceps muscle electromyographic data were also collected. The treatment group underwent two educational sessions detailing muscle physiology, neural control of muscle force, and imagery training using this knowledge. The control group underwent two educational sessions about health and fitness. Following the educational sessions the participants were retested for strength. Analysis indicated that the education and imagery treatment had no effect on strength, nor did electromyographic measures indicate that the treatment group benefitted from intervention. It was concluded that the knowledge was simply not relevant to knee extension-force production or that use of the knowledge involved a disadvantageous internal focus of attention away from relevant task demands.