Wellness coach is a relatively new formal profession in the disciplines of psychology, health care, fitness, and wellness (9,12,34). Wellness coaching does not refer to athletic coaching, performance coaching, or executive/life coaching or simply encouraging participants to perform better. Rather, the National Consortium for Credentialing of Health and Wellness Coaches (NCCHWC) defined wellness coaches as “professionals from diverse backgrounds and education who work with individuals and groups in a client-centered process to facilitate and empower the client to achieve self-determined goals related to health and wellness (20).”
Wellness coaching has emerged as a service offered by clinics, health insurance companies, wellness companies, and fitness centers. The expansion has created new opportunities for certified personal trainers and those with degrees in exercise science or related degree programs. Driving forces for careers in wellness coaching may be from client demand; formation of wellness coaching organizations; health care reform; and a result of television, personalities, and celebrity personal trainers (24). Nevertheless, it is reasonable to assume that wellness coaching and personal training are complimentary and offer personal trainers another avenue to expand their scope of services, partner with health care providers, and increase their client’s success.
Given the complexities of ameliorating sedentary lifestyles, now more than ever, personal trainers need to draw on the psychology of behavior change and coaching psychology theory. Unfortunately, the information from these disciplines is limited in exercise science baccalaureate degree programs, although it is increasing (7,8,25). This article will summarize what a wellness coach is, how wellness coaching is different from personal training, and how personal trainers can develop their wellness coaching skills to develop a potential career path in health care.
WHAT WELLNESS COACHING IS
Coaching is “the art of creating an environment, through conversation and a way of being, that facilitates the process by which a person can move toward desired goals in a fulfilling manner (11).” In other words, coaches act as hiking guides: they conavigate the journey up the mountain with the client but cannot hike up the mountain for them. With a focus on building self-efficacy, the goal of coaching is to encourage personal responsibility and deep thinking to help clients reach their goals (19). Clients are provided a nonjudgmental supportive but challenging environment to explore self-discovery while working toward their self-defined goals (19).
Wellness coaches help cofacilitate the behavior change process. For example, a client may seek a wellness coach to help them reduce their stress and resolve their ambivalence about improving their overall health. A wellness coach may meet with their client face-to-face, telephonically, or using other technologies over the course of weeks or months depending on a variety of factors. Early sessions may involve setting a wellness vision or specific wellness-related goals (19). Subsequent wellness coaching sessions may involve using techniques such as motivational interviewing to elicit “change talk” (one’s own reasons and arguments for change) (17).
Wellness coaching is grounded in coaching psychology theory and integrates over 15 evidence-based theories from a variety of academic fields (18). Examples of theories a wellness coach might use include appreciative inquiry (4), motivational interviewing (16,17), and transtheoretical model of change (27). Although coaching psychology draws on many psychological theories, it is important to understand the difference between coaches and psychologists.
WHAT COACHING IS NOT
Psychologists, therapists, and psychiatrists treat diagnosable disorders based on the Diagnostic and Statistical Manual of Mental Disorders (1). Wellness coaches are not trained to diagnose, treat, or coach individuals that suffer from mental health disorders. Rather, they should be trained to recognize the signs and symptoms of mental health disorders and how to refer to appropriate resources. Simply put, “coaching works with people who are already doing some things well in their lives and who wish to do better or to develop in other dimensions (18).”
PHILOSOPHICAL DIFFERENCES OF PERSONAL TRAINING AND WELLNESS COACHING
Individuals seek personal trainers for advice on exercise techniques and developing comprehensive physical training programs. Successful personal trainers may draw on their academic preparation and experiences to help clients improve fitness parameters (e.g., strength, endurance) by providing specific instruction and education to their clients. Telling someone exactly what they need to do to improve their health can be successful when clients are highly motivated. Conversely, if a client has significant barriers or is ambivalent, they will struggle often to improve their health in a meaningful way.
Wellness coaching is not didactic in nature and coaches are trained to collaborate with their client rather than telling them exactly what to do (3). Wellness coaches seldom analyze problems and set the goals for the client. Wellness coaches believe that clients have the answers that will work best for them and the power to change within themselves (3,19). A wellness coach’s job is to increase a client’s self-efficacy and help a client resolve any ambivalence to change (19).
Some core philosophical differences shown in the Table may impose challenges for the personal trainer–client relationship. If the personal trainer is serving as the client’s wellness coach and personal trainer, the skill-set may be different depending on their focus for that day (e.g., teaching an exercise versus discussing behavior change strategies). While a challenge, being a successful wellness coach and a personal trainer is attainable; however, additional training beyond a certification and/or baccalaureate degree in exercise science or related discipline is needed (e.g., behavior change theory, motivational interviewing, and practical wellness coaching skills) (7).
PERSONAL TRAINING PREPARATION AND ACADEMIC COURSEWORK
The requirements to challenge the NSCA Certified Personal Trainer certification examination (22) include the following: (a) being at least 18 years of age, (b) having a high school diploma or equivalent, and (c) CPR and AED certified. If one does not have an exercise science–related degree, the NSCA recommends reviewing the NSCA-CPT Exam Content Description booklet (2) and the NSCA’s Essentials of Personal Training textbook (6). To challenge the NSCA Certified Special Population Specialists (CSPS) certification exam (23), one must meet all the following criteria: (a) CPR and AED certified, (b) baccalaureate degree in exercise science or related field, and (c) 250 hours of related practical experience.
Wellness coaching a sedentary individual to adopt a physically active lifestyle requires a different set of competencies. Moreover, most exercise science curricula lack comprehensive coverage of behavior change theories and coaching psychology theory (7). For example, the NSCA’s Essentials of Personal Training textbook (6) does not cover information related to behavior change theory or coaching psychology theory. Skills related to psychology are focused on athletic performance. As such, personal trainers must seek additional training that is evidence based to offer the additional service of wellness coaching. Organizations such as the NSCA may consider additional emphasis on wellness coaching competencies as the role of the personal trainer evolves. The CSPS certification appears to be headed in that specific direction with the emphasis on partnering with health care providers and patients with chronic diseases. That is, the CSPS certification does cover some content on “applying motivational/coaching techniques” (23).
WELLNESS COACHING COMPETENCIES
The International Coaching Federation identifies 11 core coaching competencies and accredits “health and wellness” coaching programs (14). Unfortunately, none of these coaching programs appear to be specific to exercise-related behavior changes. Recently, the NCCHWC, a group of 75 organizations and individuals, formed to create a vision to “transform the health care system in America by the integration of professional health and wellness coaches; addressing health issues with a whole-person orientation, focusing on prevention and wellness, and facilitating personal engagement and empowerment for all ages, levels of socioeconomic status, and cultures” (21). The primary goal of NCCHWC is to develop competencies for the profession and integrate health and wellness coaches into health care. Academic institutions offer certifications, minors, and graduate degrees grounded in coaching psychology theory including the University of Minnesota (30), Duke University (5), University of Louisville (29), University of Delaware (28), and University of Sydney, Australia (31).
AFFORDABLE CARE ACT AND THE FUTURE OF HEALTH CARE
On March 23, 2010, the United State’s Patient Protection and Affordable Care Act (PPACA) became law (26). The law includes language about prevention and the importance of enhancing prevention services and included a 15 million dollar Prevention and Public Health Fund. Specifically, on September 23, 2010, preventive care became free and includes counseling on such topics as losing weight, eating healthfully, and depression (26). In addition, new language was added that includes an Annual Wellness Visit and Personalized Prevention Plan for all Medicare participants. It is unclear who would provide the preventive counseling services, but it may include a fitness professional as part of the health care team or a referral to a fitness professional.
On January 1, 2015, physicians in the United States will receive reimbursement for their services based on value not volume (26). In other words, physicians will receive more reimbursement, based on a patient's increased level of health. This change in the United State’s health care system strengthens the case for fitness professionals and wellness coaches to be reimbursed for their primary prevention services as part of the allied health care team. The PPACA will greatly enhance the opportunities for NSCA CSPS professionals, especially if they attain wellness coaching competencies, to improve primary and secondary prevention efforts.
WELLNESS COACHING CERTIFICATIONS AND HEALTH CARE
As certified personal trainers begin to expand their services in wellness coaching, there will be an increasing demand for coaching psychology and behavior change competencies embedded in academic programs and certification curricula. In addition, industry may demand the skills of wellness coaching to meet the health care challenges related to chronic disease. Wellness coaching skills in combination with the expertise of personal trainers will best position the profession to meet the needs of their clients. Ensuring evidence-based wellness coach training for personal trainers is the essential next step.
The wellness coaching industry continues to evolve and the NCCHWC continues to make progress. In the meantime, personal trainers have some certification options available to them. Three examples of wellness or health coaching certifications include Wellcoaches, the Health Science Institute, and Mayo Clinic.
In partnership with the American College of Sports Medicine, Wellcoaches (32) offers a 18-week evidence-based certification program grounded in coaching psychology and behavior change theory. The certification exam consists of a practical skills assessment, written exam, submission of practice client data, submission of your client’s personal wellness vision, and 3-month goals and a certification fee. Prerequisites include a baccalaureate degree in a health-related field or a nonhealth–related baccalaureate degree plus a health-related certification such as the NSCA-CPT or CSCS certifications (33). Some exercise science programs are partnering with Wellcoaches (e.g., University of Louisville (29)) to introduce wellness coaching competencies into their curriculum.
The Health Science Institute (13) offers a Chronic Care Professional certification that includes a 40-hour curriculum focused on chronic disease, health care, prevention, and health coaching. The certification exam consists of 100 multiple choice questions. Prerequisites include anyone working currently in health care or a health-related field. Unfortunately, the examination does not include a practical portion; therefore, those challenging the examination are not required to demonstrate competencies in wellness coaching.
Mayo Clinic offers a wellness coach certification program through the Mayo School of Health Sciences (15). On completion of the course, the participant is eligible for 3 credits of graduate coursework. It is an 11-week online program with a 2.5-day workshop onsite at Mayo Clinic in Rochester, Minnesota. Prerequisites include baccalaureate degree or an associate degree in a health care–related field with current license to practice. The 2.5-day workshop includes an assessment of practical coaching skills.
It is not clear to what extent the personal training industry, academia, and health care will embrace wellness coaching as a discipline; however, these 3 industries, through the power of collaboration, have the potential to impact chronic disease by helping those with diabetes, obesity, and other health-related conditions. In addition, these new professionals have an opportunity to engage the health care community in primary prevention. Certifications and curricula within the discipline of kinesiology should include training and application of evidence-based behavior change and coaching psychology to meet the needs of clients and the challenges individuals face in their effort to reduce sedentary lifestyles. Moreover, it is likely that health care providers will seek to refer their patients to professionals that have certifications that emphasize competencies related to behavior change. Likewise, certified wellness coaches may consider attaining a baccalaureate degree in exercise science. The synergy between these 2 disciplines has the potential to better meet the needs of clients and may increase career opportunities in health care as the Affordable Care Act continues to unfold.
Personal trainers may consider adding wellness coaching as a service to better meet their client’s needs and enhance health-related outcomes. There are philosophical differences between the didactic model of personal training and the cofacilitation model of wellness coaching. Thus, certified personal trainers or new CSPS professionals may consider attaining additional education or certifications in wellness coaching. By becoming competent in wellness coaching, personal trainers may have additional opportunities to provide preventive counseling services as part of an allied health care team to help patients become healthier as written in the PPACA. Fitness professional organizations, academic programs, and health care will play an important role in enhancing personal training education and competencies because they relate to behavior change and coaching psychology theory to impact chronic disease and primary prevention efforts.
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