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.

The effects of massage on delayed onset muscle soreness

OBJECTIVES

The purpose of this study was to investigate the physiological and psychological effects of massage on delayed onset muscle soreness (DOMS).

METHODS

Eighteen volunteers were randomly assigned to either a massage or control group. DOMS was induced with six sets of eight maximal eccentric contractions of the right hamstring, which were followed 2 h later by 20 min of massage or sham massage (control). Peak torque and mood were assessed at 2, 6, 24, and 48 h postexercise. Range of motion (ROM) and intensity and unpleasantness of soreness were assessed at 6, 24, and 48 h postexercise. Neutrophil count was assessed at 6 and 24 h postexercise.

RESULTS

A two factor ANOVA (treatment v time) with repeated measures on the second factor showed no significant treatment differences for peak torque, ROM, neutrophils, unpleasantness of soreness, and mood (p > 0.05). The intensity of soreness, however, was significantly lower in the massage group relative to the control group at 48 h postexercise (p < 0.05).

CONCLUSIONS

Massage administered 2 h after exercise induced muscle injury did not improve hamstring function but did reduce the intensity of soreness 48 h after muscle insult.

In vivo autoradiography: visualization of stress-induced changes in opiate receptor occupancy in the rat brain

A method of in vivo autoradiography was utilized which allows the visualization of local changes in opiate receptor occupation in the intact rat brain. The method is based on the exclusion of [3H]diprenorphine binding in areas in which the release of endogenous opiate peptides is increased by behavioral manipulation. The technique lends itself to the use of film autoradiography, allowing the mapping of relative levels of functional receptor occupancy throughout the whole brain. Prolonged intermittent footshock and forced swims in cold water (two stress-inducing manipulations which are known to release endogenous opiates) were found to cause highly significant decreases in specific high-affinity [3H]diprenorphine binding, as measured by liquid scintillation counting. These changes were unaccompanied by corresponding changes in non-specific binding and were not related to local changes in blood flow. A prolonged non-stressful swim in warm water caused no changes in [3H]diprenorphine binding. The use of tritium-sensitive film autoradiography allowed the resolution of these decreases to the level of individual nuclei. Differences in specific binding were found to be greatest in the periaqueductal gray, the reticular formation, and in midline-intralaminar thalamic nuclei, all of which have been implicated in the modulation of pain sensation.

Impact of rapid weight loss on cognitive function in collegiate wrestlers

PURPOSE

The purpose of this study was to examine the effects of rapid weight loss (RWL) on cognitive function in collegiate wrestlers.

METHODS

Wrestlers (N = 14) and controls (N = 15) were college-aged males who were tested at three different times: baseline, RWL, and rehydration. Wrestlers practiced RWL in preparation for competition while controls maintained normal body weight and dietary practices throughout the study. At each test session, blood glucose, hemoglobin (Hgb), hematocrit (Hct), plasma volume (PV), and body weight were measured. Subjects also completed mood and hypoglycemic profiles as well as five short cognitive tests.

RESULTS

Two-way ANOVA and post-hoc tests revealed poorer performance for wrestlers than controls in two recall tests as well as greater mood negativity for the wrestlers after RWL. With RWL, between group differences were also evident in hypoglycemic profile, blood glucose, PV, and body weight. All measures returned to near baseline values after rehydration, suggesting that all physiological and cognitive effects associated with RWL were reversible. It is possible that precompetition anxiety may partially explain the results.

CONCLUSIONS

RWL in collegiate wrestlers before a competition appears to cause physiological effects that are accompanied by transient mood reduction and impairment of short-term memory. The potential negative impact of this practice on the student-athlete should be considered.

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.

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.

Opioids and exercise. An update

A number of endogenously produced opioid peptides interact with centrally and peripherally located specific receptors to form a widespread neuroendocrine system with many implications for human function. It is becoming increasingly evident that moderately high and high intensity exercise stimulate the release of the opioid peptide beta-endorphin to the circulation and this event may be subject to considerable intra- and interindividual variation. Moreover, endorphin levels probably remain elevated for 15 to 60 minutes following exercise. The duration of exertion does not seem to be critical, and low or moderate (less than 75% VO2max) intensity efforts do not stimulate this response. It also appears (mostly from animal model research) that exercise might elicit central opioid effects, but there is conflicting evidence on this topic. Physical training may encourage adapted opioid system function (e.g. altered peptide response to exercise or receptor number), but these adaptations are not well elucidated by the few existing studies. The significance of peripherally released opioid peptides during exercise has frequently been questioned. Exercise-induced affective response (e.g. mood enhancement), analgesia, food intake suppression and reproductive dysfunction are often mentioned as potentially controlled by an opioid mediated mechanism. While most of these events are normally considered under central control, it is time we begin entertaining the notion of peripheral effects (e.g. altered catecholamine release) and afferent input affecting central function in some of these phenomena. Additionally, evidence exists to suggest peripherally released enkephalins may cross the blood-brain barrier, but this is probably not true for endorphins. A number of other reported exercise-related events could possibly involve an underlying opioid mechanism. Exercise-associated metabolic regulation, immunosuppression, and cardiovascular function are areas for future opioid research.

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.

Resilience to exercise detraining in healthy older adults

OBJECTIVE

To determine the effects of stopping and restarting two types of exercise programs in older adults.

DESIGN

A controlled, longitudinal study that utilized random assignment of volunteers. Treatments were exercise programs designed to improve cardiovascular or neuromuscular fitness.

MEASUREMENTS

Dependent variables measured before and after implementation of treatments were: maximum oxygen consumption, oxygen pulse, treadmill and cycle training workloads, quadriceps isokinetic peak torque, quadriceps isokinetic total work, and quadriceps training workload.

MAIN RESULTS

Exercise training was highly effective in improving cardiovascular endurance or muscular strength. Ten weeks of exercise detraining resulted in small losses in newly gained cardiovascular capacity but more noticeable losses in muscular strength. Exercise retraining was accomplished easily using cardiovascular or resistive exercises. The functional benefits of restarting a cardiovascular exercise program appeared additive despite a 10-week intervening period of exercise detraining. In this age group, cardiovascular exercise produced limited improvements in muscular strength, and resistive exercise training positively influenced cardiovascular exercise performance.

CONCLUSIONS

Older adults are fairly resilient to 10 weeks of cardiovascular detraining and retain newly gained muscular strength for at least 5 weeks, despite an interruption of formal exercise. An occasional missed exercise session or temporary cessation of habitual exercise should not be a cause for distress in exercising older adults. Instead, they should realize the case with which they may restart their exercise program and also appreciate the generalized fitness benefits that can be ascribed to becoming more active.

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.

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.

Serum beta-endorphin and affective responses to graded exercise in young and elderly men

Nine young (26.1 +/- 2.52 years) (M +/- SD) and seven elderly (66.0 +/- 5.85 years) untrained men performed a graded exercise to peak VO2 to compare whether serum beta-endorphin (B-EP) would respond similarly with age. B-EP levels were not different at rest (31.8 +/- 3.3 and 25.3 +/- 4.1 pg/ml in the old and young groups, respectively), and both groups displayed similar responses to exercise. Specifically, we noted no change in B-EP during the final stage of exercise followed by a significant rise for the recovery period (40.0 +/- 3.7 and 38.1 +/- 5.0 pg/ml in the aged and young groups, respectively). Post-exercise reports of anxiety and depression were unchanged in either group, and only minor changes in hostility were noted, as measured by the Multiple Affect Adjective Checklist. These results demonstrate a similar serum B-EP response in older men compared to young men following graded maximal exercise and support the contention that circulatory changes in B-EP may not be related to changes in specific affective states.

Efficacy of Instability Resistance Training

The use of the stability ball as a platform for upper-body resistance training has gained much attention in recent years. However, the efficacy of such training regimens remains largely unstudied. The purpose of this study was to evaluate the influence of platform (unstable vs. stable, stability ball vs. flat bench) on strength and work capacity during barbell chest-press exercise. We also sought to determine the effects of a barbell chest-press training program performed on a stability ball or flat bench on strength, work capacity, and abdominal power. Fourteen young women (20 - 23 yr) performed a 1 repetition maximum (1RM) barbell chest-press and the YMCA bench press test (YBT) on a stability ball and flat bench, as well as two field tests measuring abdominal power. The women were then assigned to perform 3 weeks of barbell chest-press training on a stability ball (SB group) or flat bench (FB group); assignment was balanced based on 1RM strength. Barbell chest-press training included 3 sets of 3 - 5 repetitions at loads greater or equal to 85 % of 1RM. The 1RM barbell chest-press, YBT, front abdominal power test (FAPT), and side abdominal power test (SAPT) were used to evaluate changes in strength, work capacity, and abdominal power, respectively. The chest-press tests were completed on both platforms following the training program. Platform (stability ball vs. flat bench) had no influence on strength, but work capacity was initially 12 % lower on the stability ball compared to the flat bench. In response to training, both groups significantly increased strength and work capacity, and there were no group differences. The increase in 1RM strength was 15 % and 16 % on the stability ball and flat bench for the SB group, and 16 % and 19 % for the FB group, respectively. The increase in work capacity was 32 % and 13 % on the stability ball and flat bench for the SB group, and 27 % and 26 % for the FB group, respectively. Both groups significantly improved on the FAPT, and there were no group differences. Performance on the FAPT improved by 5 % for the SB group, and 22 % for the FB group. Performance on the SAPT did not change. Barbell chest-press training performed on either the stability ball or flat bench increased strength and work capacity, and these changes were transferable across platforms. Thus, the stability ball is an effective platform for barbell chest-press training in untrained women over a short duration.

Effects of meal form and composition on plasma testosterone, cortisol, and insulin following resistance exercise

The purpose of this study was to examine the effects of postexercise feeding on plasma levels of insulin, testosterone, cortisol, and testosterone:cortisol (T:C). Ten experienced, resistance trained males (20.7 +/- 0.95 years) were given whole food (WF: protein 38 g; carbohydrate 70 g; fat 7 g), a supplemental drink (SD; isocaloric and isonitrogenous to WF), an isocaloric carbohydrate beverage (C), or a placebo beverage (P) immediately, 2 and 4 hours after a standardized weight training protocol on 4 days, each separated by 1 week, in a repeated measures design. Subjects also received a standardized meal at 7 and 12 hours postexercise. Insulin, testosterone, and cortisol were measured pre-exercise and during 24 hours of recovery (at 0.5, 2.5, 4.5, 8, and 24 hours) using venous blood samples. Significant (condition 3 time) interactions were found for insulin, testosterone, and T:C, but not for cortisol (p <. 05). The SD yielded a greater response for insulin than all other conditions. Conversely, P demonstrated the greatest values for testosterone and T:C at 2.5 and 4.5 hours postexercise. Cortisol did not vary between conditions and there were no condition effects for insulin, testosterone, cortisol, and T:C at 8 or 24 hours. In conclusion, the efficacy of postexercise feeding for optimizing T:C and muscle growth is unclear; however, consumption of SD appears to maximize circulating insulin for several hours following resistance exercise.

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.

Effect of breathing instruction on blood pressure responses during isometric exercise

Twenty-seven normotensive, college-aged, female subjects were studied to assess the effects of training in breathing techniques on blood pressure during isometric contractions. Subjects were randomly and equally assigned to one of three training groups: 1) a group that was taught to perform a Valsalva maneuver during isometric efforts (VAL Group), 2) a group that was instructed to avoid performing the Valsalva maneuver (NO-VAL Group), and 3) a control group that was given no instructions (CONT Group). Prior to and following three breathing technique training sessions, two blood pressure measurements were made by amplified auscultation during 10 isometric contractions of the quadriceps femoris muscle with the leg positioned at 65 degrees of knee flexion. Breathing patterns were recorded on an impedance pneumograph. Data were submitted to a 2 X 2 X 3 (time X trial X group) multivariate analysis of covariance using resting systolic and diastolic blood pressures as covariates. A significant (p less than .05) time-x-group interaction revealed posttraining blood pressure response to isometric exercise had significantly decreased in the NO-VAL Group (163/120 vs 148/112 mm Hg), and had not significantly changed in the CONT Group (157/117 vs 153/117 mm Hg). These data illustrate that training to avoid the Valsalva maneuver may help attenuate the pressor response observed during isometric contractions and provide a means for safer patient exercise.

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.

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.

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.

Exercise intensity and the thermic effect of food

This study investigated the effect of varying exercise intensity on the thermic effect of food (TEF). Sixteen lean male subjects were matched for VO2 max and randomly assigned to either a high or low intensity group for 30 min of treadmill exercise. Caloric expenditure was measured using indirect calorimetry at rest and at 30-min intervals over 3 hrs following each of three conditions: a 750-kcal liquid meal, high or low intensity exercise, and a 750-kcal liquid meal followed by high or low intensity exercise. Low intensity exercise enhanced the TEF during recovery at 60 and 90 min while high intensity enhanced it only at 180 min but depressed it at 30 min. Total metabolic expense for a 3-hr postmeal period was not differently affected by the two exercise intensities. Exercise following a meal had a synergistic effect on metabolism; however, this effect was delayed until 180 min postmeal when exercise intensity was high. The circulatory demands of high intensity exercise may have initially blunted the TEF, but ultimately the TEF measured over the 3-hr period was at least equal to that experienced following low intensity exercise.

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.

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.

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.