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DELIVERING CHANGE THAT LASTS

Health and Wellness Coaching Competencies for Exercise Professionals

Sforzo, Gary A. Ph.D., FACSM; Moore, Margaret M.B.A.; Scholtz, Michael M.A.

doi: 10.1249/FIT.0000000000000109
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LEARNING OBJECTIVES 
  • • Exercise professionals will begin to understand health and wellness coaching concepts, including mindfulness, compassion, positive emotions, autonomous motivation, appreciative inquiry, motivational interviewing, reflections, self-efficacy, visioning, and goal setting.
  • • Exercise professionals will consider if, how, and when to apply these coaching concepts when working with fitness clients.

Gary A. Sforzo, Ph.D., FACSM, is a professor and coordinator of the Clinical Exercise Science program in the Department of Exercise and Sport Sciences at Ithaca College. He has published extensively in fitness and wellness research. He is ACSM Clinical Exercise SpecialistSM certified and an active member of ACSM for more than 25 years.

Margaret Moore, M.B.A., is founder and CEO of Wellcoaches Corporation, a strategic partner of ACSM; a faculty member at Harvard University Extension School and codirects the Institute of Coaching at McLean Hospital, an affiliate of Harvard Medical School. She is a featured contributor to ACSM Certified News and has authored numerous articles and books on health and wellness coaching.

Michael Scholtz, M.A., is co-owner of NOVO Wellness, a company focused on helping people achieve sustainable and healthy weight loss. He is a faculty member of Wellcoaches Corporation, a fitness expert and consultant for several health and wellness Web sites, and the coauthor of Coach Yourself Thin (Rodale, 2012). Michael is a Certified Wellcoach, an ACE-Certified Personal Trainer, and an NSCA Strength and Conditioning Specialist.

Disclosure: The authors declare no conflict of interest and do not have any financial disclosures.

Clients typically come to an exercise professional (e.g., health fitness specialist [HFS] or personal trainer [CPT]) for help in reaching health and fitness goals. The exercise professional helps them learn to exercise safely and stretch physical limits. However, clients often deal with barriers to reaching new heights of fitness such as recovering from an injury, time pressures, inconvenience, and sustained motivation to exercise. These are common challenges limiting successful pursuits of becoming habitually active.

Exercise adherence is a recognized long-standing problem, with a systematic review from the United Kingdom indicating a program dropout rate of approximately 80% (7). In other words, the efforts of exercise professionals to change sedentary lifestyles are rarely yielding sustainable results for their clients. In a recent philosophical statement, Anthony Abbott most eloquently opined that the fitness industry’s inability to sustain participation is because most fitness instructors are unqualified to instruct and motivate (1). He added, they must become experts with specific skills (e.g., communication, motivation, relational) suited to their truly important responsibility; he mentioned wellness coaching as a potential remedy.

The desire for greater client impact and success motivates exercise professionals to seek new approaches to influence lasting behavior change. Health and wellness coaching (HWC) offers a potential toolbox of skills for the HFS to deliver sustainable impact. Wolever et al. (20) recently defined HWC as a client-centered process, based on behavior change theory, applied in an interpersonal relationship with a coach. HWC services are delivered by health professionals trained in applying strategies that develop motivation, confidence, and capacities important to making sustainable health behavior changes. At their best, HWC help clients become more responsible, mindful, resilient, self-compassionate, self-motivated, confident, and more fully engaged in leading a healthy lifestyle. Various applications of HWC are reported to improve wellness program satisfaction (13), physical health, healthy behaviors (14), weight management (2), mood, and exercise participation (19).

This article presents coaching (HWC) skills for exercise professionals to consider adding to their toolbox, potentially improving their success with clients. HWC skills are condensed into a 4C scheme, shown in the Figure, elaborating how connection, curiosity, confidence, and change (i.e., 4C scheme) encompass key coaching attributes. As you read about coaching skills below, notice examples of exercise professionals applying these skills with clients in their practice. Integrating HWC skills can be rewarding but challenging for the exercise professional; this process of skill integration is discussed later in the article.

Figure

Figure

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CONNECTION: MINDFUL COMPASSION AND POSITIVITY

Increased self-awareness, new insights, and learning are essential to creating lasting behavior change. Many adults, however, are dealing with a surplus of negative emotions, which narrow focus and attention, decrease open-mindedness, and impair creativity, problem-solving, and strategic thinking. In short, negativity restricts the brain’s resources for learning and change. Calming negativity contributes to the ideal conditions for learning, developing new habits, and accomplishing new goals (14).

Mindfulness is a state of mind that can reduce the impact of negative emotions. Being mindful is a temporary state of present-centered attention and awareness when one is open-minded, nonjudgmental, and nonreactive and can observe emotional clouds passing by rather than be hijacked by them (16). A mindful HWC helps clients tame negative emotions to support discovery and reflection. The HWC also helps a client to feel self-compassion toward negative emotions that come up when reflecting on the past or when anxious about the future. Self-compassion has a growing research base demonstrating its value in handling negative emotions.

A prominent researcher in self-compassion, Dr. Kristen Neff, has identified three main components: self-kindness versus self-judgment, connection (I am not alone; many people share similar flaws and struggles) versus isolation, and mindfulness versus overidentification (not ignoring but also not obsessing over disliked aspects of oneself). Self-compassion works better as a motivator than fear based on self-criticism (11). An exercise professional can use mindful listening and reflections to deliver genuine compassion. Applying coaching skills this way, the exercise professional helps a client to be more self-compassionate, hence reducing the impact of negative emotions. A nonjudgmental and empathetic exercise professional can help a client loosen the grip of self-criticism to promote greater hope for positive behavior changes. Generating positivity early can improve the mood, and potentially the effectiveness, of the entire session. Asking clients to shift focus from the negative to describe their best day, activity, or experience since the last meeting provides a great start for any exercise session (see Coaching Insight Box A).

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Coaching Insight Box A: Connecting With Positivity

Coach Bell says, “During the warm up, I’ll do some coaching. I start off with the positive because most people come into the session with frustration or guilt about what they didn’t do since we last met. I focus on strengths and what went well. The clients have a better workout because they are feeling better about themselves and their mind is more open to possibilities.”

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CURIOSITY: INQUIRY, REFLECTIONS, AND AUTONOMOUS MOTIVATION

A HWC encourages client curiosity to improve self-awareness of unhealthy patterns of emotions, thoughts, and habits. New insights emerge, triggering more curiosity, which then spills over to imagining new possibilities for change. Coaching inquiry is the art of asking provocative questions, enabling clients to consider new possibilities. Open questions require more than a “yes” or “no” response”; begin with “how” or “what” and generate narrative answers. “What would it take to steer around your roadblock?” is a better question than “Can you try this idea to get around your roadblock?” An exercise professional who asks “What would you like to accomplish during your session today?” will learn a lot more about a client than by asking “Are you ready for your workout today?” When a client provides a heartfelt answer to an open question, the HWC then replies with an appropriate reflection.

Reflections are an important motivational interviewing technique (10), mirroring and reframing what clients say, along with the emotions they are expressing. Reflections demonstrate effective listening and allow clients the opportunity to hear what they are saying, perhaps bringing new insights. Reflecting emotional states (“you sound uncertain”) helps clients consider messages offered by their emotions, for example, a fear of failure. Alternating open questions with several reflections, at least two reflections for every question, enables clients to dig deeper to reveal their motivators, personal values and priorities, challenges, and possibilities.

In addition to describing autonomy as a primary need, psychologists Deci and Ryan (6) determined that autonomous motivation delivers better performance and greater success than external motivators such as others’ wishes (my spouse wants me to do this) or inner criticism (I’ll be a failure if I don’t do this). People are wired to dislike being told what to do and perform best when making independent choices (6). People also become personally responsible for their health when supported to act autonomously (18). Our current health care system is dominated by expert-led provider-client relationships. For example, an exercise professional may often take the lead in determining an agenda rather than asking the client to generate a plan energized by an autonomous heartfelt source of motivation. Considering when to remove the expert hat while applying HWC skills may prove a very effective strategy for exercise professionals (see Coaching Insight Box B) to increase client responsibility and self-direction (the Table details the Expert vs. Coach Approach). A deeper exploration into what motivates clients also activates their sense of autonomy. They discover what they treasure most (e.g., living life fully) and then appreciate how health is an essential resource to get what they most want. Clients are then energized by autonomous motivators and intentions, which can be called on many times a day to make a healthy choice. Highly competent exercise professionals understand that their role is not to merely teach and tell but to assist clients in finding autonomous motivators and realizing that fitness and wellness are the fuel source for the lives they want to live.

Table

Table

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Coaching Insight Box B: Promoting Autonomy

Coach Goldman says of her goal-setting approach, “We strategize, looking at life as it changes, adjusting their lifestyle to their new circumstances. Clients own their goals. Goals are more meaningful. Clients need to give you more than an outcome goal, like reaching a weight target. They need to become connected to what is meaningful to them and embrace the behaviors that will get them to that outcome. This way, they can reach their full potential because there is a bigger well to draw from. Getting clients to express what goals mean to them, how it would feel to reach those goals, is more powerful than just focusing on the outcome.”

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CONFIDENCE: BUILDING SELF-EFFICACY VIA COLLABORATION

Self-efficacy, defined by Albert Bandura, is the belief in one’s ability to perform behaviors required to produce a specific outcome (3). Similar to Deci and Ryan’s (6) second primary human need of competence (the ability to do something successfully), self-efficacy is a codependent companion of motivation: both are essential for successful change (10). Motivation fades quickly if belief in the ability to reach desired goals (i.e., self-efficacy) falls short.

Fortunately, there are many means to building self-efficacy. One can be inspired vicariously by others’ successes (i.e., role models). Another road is to strengthen the internal “locus of control,” basically the belief in one’s power to influence their overall health. Success in one area can improve confidence in another area, as clients gain a greater sense of control over their health and lives. For example, successfully adding two servings of vegetables daily may improve confidence for starting mindfulness practice or increasing exercise.

Appreciative inquiry (AI), originally studied at Cleveland Clinic by David Cooperrider, is a process that helps clients discover past successes in an area they wish to change (5). Applying the model of AI, as well as research on character strengths (12), an HWC can help a client access past experiences to identify underused strengths and enhance self-efficacy. Often people are renowned for certain skills such as persistence or reliability in their jobs and have not considered transferring these skills to their personal fitness and well-being (see Coaching Insight Box C).

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Coaching Insight Box C: Confidence Building

Sarah Enders has 16 years of experience as a personal trainer and is a certified professional wellness coach. When asked what drew her to coaching, she says, “One of the things I love about coaching is focusing on strengths. People tend to focus on a problem, ‘This is what I need to change. This is what I’m not doing well.’ Instead, I focus on helping clients identify their strengths and how they used them to make progress in the past.”

Another opportunity to build confidence is harvesting the potential of positive emotions to improve resilience. Barbara Fredrickson’s research team (4) demonstrated that the main mediator of resilience (ability to withstand challenges and bounce back from setbacks) is the level of positive emotions summoned in a time of stress or adversity. Opposite to the impact of negative emotions, positive emotions improve access to working memory, broaden thinking, improve curiosity, creativity and problem solving abilities, and open people to new possibilities.

The HWC (or exercise professional applying these skills) enhances the clients’ level of positivity by exploring positive topics (what was the best thing that happened last week, what did you learn, what did you enjoy most), allowing them to get creative and identify new ideas for navigating obstacles that impair confidence. Harnessing positive emotions helps keep clients on track when facing difficulties. Helping clients amplify sources of positive emotions in their lives not only builds confidence, it also makes collaborating with them fun.

As clients work toward goals, HWC often use brainstorming to help them deal with setbacks. Creative brainstorming, without judgment, generates new insights. Such insights enhance confidence by increasing hope and optimism while leading to novel possibilities for navigating challenges. Hope theory focuses on two factors that determine one’s hope of being successful, having self-determined goals and identifying multiple pathways to meet the goals. Ideally then, brainstorming identifies three to four possible ways to circumvent obstacles, which improve hope and confidence.

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CHANGE: VISIONS, GOALS, AND ACCOUNTABILITY

As an architect draws blueprints for a new house, clients benefit from having a detailed vision of their ideal future. AI can be used to explore dreams for the future (5), and an exercise professional applying HWC skills can help clients envision physical changes. From this vision emerges strategic planning and goal setting. Engaging in the envisioning process also may strengthen the connection between a client and the exercise professional.

Helping clients to design appropriate goals to move them toward their visions is a thoughtful process. Although research tells us that ambitious goals are more engaging and lead to higher performance than modest goals (9), a moderating factor is impact on confidence. Too-challenging goals can lead to stress and anxiety, thereby damaging confidence. Therefore, it is a balancing act to find engaging goals that stretch and inspire clients to the edge of their abilities while not making them anxious about failing. An exercise professional working with an enthusiastic, but novice, runner dreaming of completing a marathon might best collaborate with her to discover that a 5- or 10-km race is an achievable intermediate goal. Achieving small goals lifts confidence and keeps motivation charged especially when benefits are noticeable like more energy or better sleep.

Several categories of goals together support sustainable change and offer a menu from which clients can choose. Types of goals include performance, behaviors, and skill building. Performance goals are quantifiable outcomes — a target weight, waist girth, blood pressure level, or finishing a 5-km race. Behavioral goals focus on engaging in new habits consistently, such as “I will do three 30-minute yoga sessions every week.” Skill goals include physical skills (e.g., how to lift weights safely or cook healthy meals) and mental skills (e.g., how to meditate or tame negative emotions). Mental fitness goals also may include improving psychological resources such as mindfulness, self-awareness, self-compassion, positivity, creativity, or resilience.

To facilitate goal achievement, HWC thinks about coaching the environment not just the client. Wansink’s (17) experiments with food portions emphasized the importance of environmental effects (e.g., showing we eat more when eating socially). Accordingly, it is vital to help clients design environments to support their goals. For example, organizing positive social support, stocking kitchen shelves with healthy food options, or having a treadmill at home for rainy mornings may each provide an environment supporting clients’ goals.

Having clients choose a preferred approach to accountability is another important step in the goal-setting and achievement process. Accountability to others is a valuable source of social support, and a simple approach to accountability is a regular progress report, perhaps weekly, monthly, or quarterly. Leveraging mobile technologies (e.g., activity trackers) and/or social networking “apps” (e.g., http://www.myfitnesspal.com/apps) are tools exercise professional might propose to enhance client accountability. In addition, setting quarterly milestones for review (and celebration) provides accountability and validation of progress. Collaborating with clients to design a thoughtful approach to periodic accountability is a valuable part of the visioning/goal-setting processes and integral to good coaching practice.

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INTEGRATING COACHING AND PERSONAL TRAINING

Using HWC skills as an exercise professional might sound beneficial in theory; however, it may be a bit tricky in real-world application. Clients generally expect their exercise professionals to be leaders and experts, whereas a credo of HWC is setting aside the expert hat while letting the client take the lead as we discussed previously in the Curiosity Section as well as in the Table. The exercise professional can explain that clients generating their own plan have excellent potential for lasting change (6). Clients, with guidance from an exercise professional, choosing those goals that most excite them have the best chance at success. When applying HWC strategies, the exercise professional strives to understand and accept a client’s reasons not to change certain behaviors or pursue specific goals. As an example, imagine a client who could benefit from resistance exercise (RE) deciding not to begin an RE program. An exercise professional, although fully accepting that decision, can still help the client explore the pros and cons for RE. The client who understands RE health and fitness benefits may ultimately decide that a RE program is something they will reconsider in the future.

To apply HWC strategies during a session, the exercise professional can find opportunities to adroitly switch between providing the expert advice the client expects and exploring client needs, values, and motivators with curious inquiry and reflections. These transitions may not come easy at first but with practice can become a natural part of client interactions. A client who asks for a new exercise to work “lats” expects the exercise professional to supply such information (expert role) but a client announcing missing the next 2 weeks of sessions to catch up on work is an opportunity for a conversation that explores values and motivators (coach role). The adept exercise professional, using HWC skills, recognizes the difference between these situations and acts accordingly (see Coaching Insight Box D). Although balancing these dual roles of expert and coach sounds tricky, a recent article concluded that coaching techniques can be successfully used by exercise professionals in a clinical setting (15).

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Coaching Insight Box D: Asking vs. Telling

Andrew Barton started his personal training business in 2001 and has been a certified wellness coach since 2007: “I’ve made a huge shift in my ratio of asking vs. telling. I stop myself from telling someone what to do and no longer say, ‘you should.’ Instead, I ask people what they think and what they want to do. That’s not to say I never tell them what to do in a workout……but I’ve gone from an expert-based approach to a client-centered approach.”

Note: Coach Insight Boxes derived from Personal Communications with each Coach responding to the question — How have coaching skills impacted your personal training?

Box A: K. Bell (1/31/2013); Box B: E. Goldman (12/18/2012);

Box C: S. Enders (1/30/2013); Box D: A. Barton (1/30/2013)

Another approach for the exercise professional is augmenting exercise sessions with separate HWC sessions. Putting a time and space break between these services may optimize impact, guiding a client toward greater fitness and wellness. An exercise professional can thoughtfully explore the HWC skills discussed in this article and explore opportunities for implementing these. However, fully integrating HWC skills into exercise sessions, conducting full HWC sessions, and/or creating a HWC side business will likely require a much greater commitment to understanding HWC than reading this article. As with any other specialty, developing a high level of HWC competence takes effort. Trained HWCs spend hours each day crafting and refining their coaching skills while employed full time in HWC positions.

After augmenting their educational background, exercise professionals can achieve HWC effectiveness. HWC publications are available, and sport psychology graduate courses (or degree programs) emphasizing coaching/counseling skills also exist. HWC certification is another option that may be worth exploring. In addition, the U.S. National Consortium for Credentialing Health & Wellness Coaches is working to develop new standards and credentialing paths for the field. The reader should recognize that pursuing a coaching degree, or credential, is a valuable but much larger commitment than applying a few HWC strategies during an exercise session.

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SUSTAINABLE CHANGE

Lasting change depends on a mindset change (“I love being fit and don’t want to go back to my old sedentary ways”) together with behavior change (“I consistently do four 30-minute workouts weekly”). Making a sustainable behavior change takes weeks and months of creative brainstorming, experimenting with goals, practicing skills, gaining insights, bouncing back from setbacks, and recharging motivation and confidence. There is evidence that HWC can improve wellness program satisfaction (13), increase exercise participation (19), and improve health outcomes (2,14). The HWC skills discussed in this article may assist exercise professionals to enable their clients to make sustainable healthy behavior changes despite the opposing chaos of everyday life.

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CONCLUSIONS AND IMPLICATIONS

The coaching skills explored in this article emphasize a client-centered way to facilitate change rather than to simply prescribe, teach, and train. When an exercise professional uses HWC skills, collaboration reigns and responsibility for decisions about everything from assessment to goal setting to program design shifts to the client. With this collaborative approach, clients become empowered to make sustainable behavior changes. Coaching techniques focus on creatively overcoming obstacles, engaging fully and adhering to exercise programming, and ultimately achieving a wellness vision. If the goal of an exercise professional is to achieve long-term results, consider how HWC strategies might be integrated into practice. Coaching skills may provide an invaluable resource for helping clients make lasting behavior changes.

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BRIDGING THE GAP

Health and wellness coaching is a set of skills and processes that effectively can assist clients in their efforts to adopt new health habits. Coaches use proven communication and psychological tools (e.g., mindfulness, positivity, self-efficacy, goal setting) to assist clients in making sustainable healthy behavior changes. It is feasible for exercise professionals (e.g., health fitness specialist or personal trainer) to adopt coaching strategies to improve clients’ chances of becoming habitually active. Exercise professionals can consider if, how, and when to incorporate a health and wellness coaching approach into their professional practice.

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SUMMARY

Health and wellness coaching processes provide a toolbox of skills proven effective at assisting people make healthy behavior changes. Which coaching tools can an exercise professional (e.g., health fitness specialist) use to improve the probability of success with his or her clientele? Eliciting client mindfulness, positivity, and autonomous motivation and developing self-efficacy are among the coaching skills that can serve the exercise professional well while moving outside the fitness expert–only box.

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Acknowledgements

Coach Insight Boxes derived from Personal Communications with each Coach responding to the question — How have coaching skills impacted your personal training?

Box A: K. Bell (1/31/2013); Box B: E. Goldman (12/18/2012);

Box C: S. Enders (1/30/2013); Box D: A. Barton (1/30/2013)

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    Keywords:

    Personal Trainer; Exercise Adherence; Motivation; Positive Emotions; Mindfulness

    © 2015 American College of Sports Medicine.