New AHA Scientific Statement: Advancing Physical Activity with a Clear Call for Coaching Skills
On April 4, 2018 the American Heart Association (AHA) released a new scientific statement entitled “Routine Assessment and Promotion of Physical Activity in Healthcare Settings” published in Circulation 1. This paper is available to all as an open-access publication and can be found at:
This AHA scientific statement provides concrete evidence on the risks of a sedentary lifestyle while presenting an argument for assessing a patient’s physical activity status at every office visit. The logic is that we routinely gauge other risk factors (e.g., obesity, smoking, blood pressure, glucose, cholesterol) but we do not typically make a standardized measure and record of sedentary lifestyle or physical activity (PA) level; the message from the AHA is we need to have a “PA vital sign.” There is substantial discussion of PA questionnaires, and leveraging the popularity of wearable activity monitors, as tools for measuring PA levels. After making a strong case for regularly assessing PA, the authors (Felipe Lobelo, Deborah Rohm Young, Robert Sallis et al.) emphasis shifts to how healthcare professionals can help patients improve PA. They note effectiveness, albeit limited, of various strategies and concluded a multilevel approach is necessary to improve our collective PA need. The AHA authors added, brief physician counseling combined with a referral system promoted improvements in patients’ PA and were also cost effective, i.e., results support a favorable return-on-investment (ROI).
The article then begins to recognize potential barriers to widespread integration of PA assessment in clinical settings. Poor training, scarce resources, and omni-present financial matters are identified and thoroughly addressed. It is at this point when the paper first considers the patient’s perspective, suggesting the primary-care provider should briefly counsel (1-2 min) on PA while, if possible, employing shared-decision making, motivational interviewing, and other proven behavioral strategies. This notion is immediately countered by a possible lack of time, and/or knowledge, for using these interventions. The recommendation then turns to physician referral………but to whom? There is mention of a patient navigator or exercise professional taking over as the lead in PA promotion, but also a clear recognition of the need for special skills to deliver behavior-change counseling. The AHA statement recognizes some individuals are not ready to immediately begin exercising – some are “in precontemplation” exploring the possibilities of increases PA while some others are in “contemplation.” This reference by the AHA to coaching skills, and the Transtheoretical Model’s stages of change, provides a clear opening for Health and Wellness Coaches to step through! Nurses, physical therapists, and exercise professionals are mentioned in the AHA statement, but most of these professionals are not fully prepared with coaching strategies to help patients aiming for behavior change ……….but a health coach is exactly what the doctor can (and should) order!
It is evident from this AHA scientific statement there is a perceived void in the medical system. There is a need for physicians to be able to refer their patients to someone who can professionally and effectively help with behavior change. Ample evidence for health and wellness coaches as effective behavior change agents for all types of patient populations exists in the evidence-based literature (see the Compendium of Health and Wellness Coaching Literature2). It should (and must) be made clear that Health and Wellness Coaches are most prepared and able to fill this perceived void while promoting positive behavior change and advancing patient care. There really is not a void – it just needs to be more apparent that we (health and wellness coaches) are here and ready to do the job. This AHA scientific statement on physical activity represents a major force in the health-care industry making a bold and potentially monumental set of recommendations. If you can, take the time to read the AHA Scientific Statement, and, pay particular attention to opportunities for professional health and wellness coaches to play a big part in being as a solution to major obstacles identified in the proposed plan.
References
1. Lobelo F, Rohm Young D, Sallis R, et al. Routine Assessment and Promotion of Physical Activity in Healthcare Settings. doi.org/10.1161/CIR.0000000000000559
2. Sforzo GA, Kaye MP, Torodova, I, et al. (2017). Compendium of health and wellness coaching. Am J Lifestyle Med. Published On-line First. doi: 10.1177/1559827617708562.