Last month the American Journal of Lifestyle Medicine published an article entitled “Health and Wellness Coaching and Sustained Gains: A Systematic Review" (Ahmann et al., 2023). Three of the six authors of this paper were Wellcoaches trained!
The study’s purpose was to determine what is known about long-lasting effects for coaching clients after completing a health and wellness coaching program. To make this determination, the authors reviewed 231 HWC data-based research studies housed in the Compendium of Health and Wellness Coaching (Sforzo et al., 2020). They ultimately selected 28 articles of sufficient quality to examine the sustainability of a coaching effect post-intervention. Physiological, psychological, behavioral, and health risk outcomes were measured in these studies. It was essential that clients received NO additional coaching before the follow-up measurements, which usually occurred 3-12 months after the initial coaching period. The authors rated the results of each of the 28 retained studies as
gains not sustained,
gains partially sustained,
gains fully sustained, or
gains improved at follow-up compared to post-intervention.
The average length of coaching intervention for the 28 studies was 6.4 months with about 8 coaching sessions over this time. The time for follow-up measures averaged nearly seven months after the completion of the coaching intervention. So, in essence, the question being addressed in this paper was, are beneficial coaching changes still evident more than six months after the cessation of a six-month coaching program.
The authors found that coaching effects were sustained in 25 of the 28 studies examined (nearly 90%). This finding is supported by a large JAMA-published cluster RCT that found blood pressure changes after coaching were sustainable for up to four years (Nguyen-Huynh et al., 2020)!
Sustainability of treatment benefits is a robust achievement for health and wellness coaching. Consider that, short of surgery, the effects of most other health interventions are not maintained long after halting treatment. For example, medications must be taken regularly, or the effect quickly fades away – cholesterol will go up if the patient stops taking daily doses of a statin. Take rehab programs (e.g., cardiac rehab or PT for orthopedic reasons) that typically last 2-4 months. After these programs, patients will show a loss of gains made after 2-4 weeks of detraining, with all benefits likely lost within 3-6 months if treatment is fully halted. And we are all acutely aware of what happens when a client falls off a successful diet plan and returns to old eating habits – they will certainly regain most, if not all, of whatever weight was lost.
Long-lasting Effects of Coaching – I’ll have mine in BRICK, please!
The present study demonstrated that a coaching program, supporting and encouraging behavior change, can have long-lasting benefits. In fact, in nine studies examined outcomes of interest (e.g., physiological and psychological) actually improved months after ceasing the coaching process. This likely indicates that healthy behaviors habits, newly formed during the coaching process, yielded enhanced benefits months after the last coaching session. Health and well-being coaching appears to be a unique form of health intervention that keeps on giving well after the process stops.
In the 3 studies where outcomes were not sustained, it was likely to be physiological outcomes (e.g., BMI, A1C, or BP) that reverted to baseline. Improved psychological (e.g., stress or anxiety) or behavioral outcomes (e.g., exercise or eating habits) were more stable than physiological outcomes, typically being maintained for months of follow-up after coaching ended. These physiological parameters matter greatly in healthcare, and we do not want our clients to revert to baseline on these outcomes.
Practically applied, this finding might lead coaches to discuss with their client how to best follow-up after completing the initial coaching intervention. As with all coaching, this would be a client-centered discussion and would consider that maintaining beneficial physiological changes might take careful attention and may require a maintenance strategy. That strategy might include using new resources or on occasional coaching booster at a lesser frequency than initially prescribed. As part of their coaching competencies, the National Board of Health and Wellness Coaches clearly and formally encourages coaches to assist clients in finding a sustainable pathway forward.
The authors of this rapid systematic review strongly conclude that they provide “…evidence for the efficacy of sustaining gains beyond the active coaching period.” They continue, “…the unique value and important contribution HWC can make for varied health conditions….”
It is hard not to agree with their conclusions! A well-delivered program of health and wellness coaching not only helps a client during the process but also for a substantial period after the intervention is stopped. With careful attention to follow-up management, our patients and clients can expect gains made during a coaching program to stick with them for an indefinite length of time. Not too many health or medical interventions can make that claim. Viva health and well-being coaching …. and the clients who benefit!
References
Ahmann E, Saviet M, Conboy L, Smith K, Iachini B, DeMartin R. Health and Wellness Coaching and Sustained Gains: A Rapid Systematic Review. American Journal of Lifestyle Medicine. 2023;0(0).
Sforzo GA, Kaye MP, Harenberg S, et al. Compendium of Health and Wellness Coaching: 2019 Addendum. American Journal of Lifestyle Medicine. 2020;14(2):155-168. doi:10.1177/1559827619850489
Nguyen-Huynh MN, Young JD, Ovbiagele B, Alexander JG, Alexeeff S, Lee C, Blick N, Caan BJ, Go AS, Sidney S. Effect of Lifestyle Coaching or Enhanced Pharmacotherapy on Blood Pressure Control Among Black Adults With Persistent Uncontrolled Hypertension: A Cluster Randomized Clinical Trial. JAMA Netw Open. 2022 May 2;5(5):e2212397. doi: 10.1001/jamanetworkopen.2022.12397