Lifestyle and Life Expectancy: Five Factors to Minimize Health Risks An international team of scientists just released an original research article, “Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population” published April 30, 2018 in Circulation 1. The abstract for this important paper is available at: HTTP://CIRC.AHAJOURNALS.ORG/CONTENT/EARLY/2018/04/25/ CIRCULATIONAHA.117.032047 This international team from the US, UK, Netherlands, and China identified five low-risk, lifestyle related factors: never smoking, BMI < 25, mod-vigorous activity > 30 min/day, moderate alcohol intake, and high-quality diet. To examine these factors, along with rates of mortality, they used data from over 120,000 participants who originally took part in the NHANES and Health Professionals Follow-up studies. In these studies, they documented over 42,000 deaths in 34 years following participants. Examining non-adherence to the five low-risk factors they noticed significant relationships with cancer, cardiovascular, and all-cause mortality. They calculated that at age 50, participants who adopted all of the low-risk behaviors tended to live about 18 years longer (93.1 years for women; 87.6 years for men) than those who adopted zero low-risk lifestyle related factors. For reference, these lifespans are comparable to the average American life expectancy of 78.8 years (in 2014). The authors added, combinations of any low-risk factors (but less than all) also yielded prolonged life expectancy regardless of which lifestyle behaviors were examined. They did not differentiate between the strength of individual factors but instead considered each of the five low-risk behaviors essentially equal in their discussion. They determined that more than half of cancer-related, and three-quarters of cardiovascular-related, premature deaths are attributed to poor adherence to a low-risk lifestyle. Despite several limitations, this is very high-powered study with a clear and not-so-surprising conclusion: Life expectancy can be extended, particularly in the USA, by adopting improved health-related lifestyle behaviors. While providing a very strong case for promoting a low-risk lifestyle (high-quality diet, exercise, avoid smoking, moderate alcohol consumption, and maintain healthy BMI), this impactful article does not address interventions to encourage patients to adopt, or improve, their practice of healthy lifestyle behaviors. Not addressing such an important issue almost leaves the impression behavior change is as simple as the standard physician advice: “just stop smoking, eat right, and exercise more.” Decades of such advice, however, has proven essentially fruitless and we recognize healthy behavior change is difficult but possible. In fact, organizations exist primarily to emphasize the importance of a healthy lifestyle (e.g., AMERICAN COLLEGE OF LIFESTYLE MEDICINE-ACLM) and making related behavior changes (e.g., WELLCOACHES). Health and Wellness Coaches in particular, know healthy, sustainable behavior change can decrease burdens associated with protracted chronic lifestyle-related diseases but it is hard work. In this context, it is especially relevant to mention the ACLM and Wellcoaches recently launched (May, 2018) a partnership offering a Lifestyle Medicine Coaching credential to certified health and wellness coaches. The online course is open to all, however, only previously certified coaches can earn the advanced professional credential. When a major medical journal (Circulation 1) and two world-class organizations (ACLM, Wellcoaches) recognize the same important issue at nearly the same moment in time (the same month!) then the topic must be a highly relevant and timely matter. Adopting healthy lifestyle behaviors is the key to drastically reducing the individual and societal suffering associated with chronic lifestyle-related diseases. Health and wellness coaches have much to offer in this regard and now have lots of scientific and professional training support on their side. References Li Y, Pan A, Wang DD, Liu X, Dhana K, Franco OH, Kaptoge S, Di Angelantonio E, Stampfer M, Willett WC, Hu FB. Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population. HTTPS://DOI.ORG/10.1161/CIRCULATIONAHA.117.032047.

This month at the INSTITUTE OF COACHING we featured a LITERATURE META-ANALYSIS and a SCIENTIFIC WEBINAR by Siegfried Greif on the theory and application of “implementation intentions.” Before we discuss the theory and the meta-analysis, let’s consider the nature of “intention.” The wisdom of the inadequacy of intentions goes back a long way – the proverb – THE ROAD TO HELL IS PAVED WITH GOOD INTENTIONS– dates back to France in 1150. Philosophers have turned the study of intention into a broad conversation of a complex construct. Stanford Encyclopedia of Philosophy’s entry on INTENTION, updated in 2018, explains that intention comes in three guises: Intention for future – I intend to write this article to add to my writing contributions on coaching and change Intention with which I act (the why) – My intention for this article is to help myself and others be more discerning and impactful when discussing “intention” Intentional action – I am intentionally writing this article (in a conscious manner) to get readers thinking Now let’s move to November 2018, when a META-ANALYSIS OF RANDOMIZED CLINICAL STUDIES OF “IMPLEMENTATION INTENTIONS” arrived using physical activity as the target behavior. Here’s a quick tour of the paper. Good intentions abound in physical activity Even though regular exercise is a BREAKTHROUGH LIFESTYLE MEDICINE, improving control of diabetes, brain function, emotional well-being and self-efficacy, while reducing risk of heart disease and cancer, in the Americas 43% of the population is not active. (The WORLD HEALTH ORGANIZATION describes being physically active as engaging in 150 minutes per week of moderate physical activity or 75 minutes per week of intense physical activity). As a result, theoretical approaches to increase physical activity are of great interest to health practitioners and researchers. Intention is not enough Icek Ajzen’s THEORY OF PLANNED BEHAVIOR proposed that intention, or motivation, is a main predictor of behavior. However, even strong intentions aren’t reliable: one study of people with FIBROMYALGIA AND STRONG INTENTIONS to exercise showed that only 32% moved from intention to action. As we know from our own lives, even with strong intentions, the desired behavior may not reliably happen. This is the “intention-behavior gap.” Implementation intentions This gap led researchers to separate the elaboration of intention to engage in a behavior from executing or implementing of the intention. A new theory was created: theory of implementation intentions. Implementation focuses on the when, how, and where of a behavior, aka action planning. To reinforce the action planning, the theory expanded to include coping planning, where one imagines potential obstacles and ways to overcome them. Thereby, implementation intentions are the intentions to implement an action plan and a coping plan for a behavior that you intend to do in the future. The study conclusions The featured study is a systematic review of studies which tested the effectiveness of interventions that supported implementation intentions. The authors found 507 relevant studies and identified 11 for a meta-analysis. The authors concluded that interventions asking participants to develop implementation intentions were significantly more successful in increasing physical activity, compared to a control group. Most effective were interventions that helped participants develop action plans, strategies for coping with obstacles, along with reinforcing their implementation intentions (e.g. by phone or text) and adjusting the plans during the interventions. Translation for coaches Implementation intention activities are supported in coaching. Coaching techniques designed to help others change behavior include action plans, coping plans, and ongoing reinforcement and adjusting of both – coaches are applying the science of implementation intentions. We can go even further, now addressing four meanings of intention: 1.     I intend in the future to write an article on intention 2.     My intention for this article is to help myself and others be more conscious in using intentions 3.     I intentionally write this article to make a multifaceted construct easier to understand 4.     I intend to complete this article today, a rainy Sunday morning, while turning off email and avoiding distraction Here’s to the many facets of good intentions! Let’s pave our paths forward with all of them.

POSITIVE PSYCHOLOGY AND COACHING PSYCHOLOGY ARE GROWING UP TOGETHER. Let’s flash back 20 years to the birth of Wellcoaches and the launch of the health and wellness coaching industry. That was also the time when a new science of happiness, virtue, and optimal functioning —named positive psychology — was called for by Martin Seligman and colleagues. Since then an evidence base for both fields, positive psychology and coaching psychology, has grown quickly and matured. Now supported by the evidence: – coaches use techniques grounded in positive psychology concepts – coaches integrate positive psychology interventions into coaching programs – a coaching specialty called positive psychology coaching is growing Let’s have a look at a broad study of the peer-reviewed literature linked to the positive psychology movement (Donaldsen et al, 2015). A systematic review selected 750 articles published in English between 1999-2013 (no review yet for 2014-2019) that were empirical tests of positive psychology theories, principles, and interventions.This review did not include a review of the scientific quality of the articles. That said, this growing body of evidence indicates positive psychology is based on a foundation of respected scientific methods and positive outcomes. What are the interesting takeaways? While well-being is defined and measured in various ways, the authors note that this literature suggests that it includes hedonic and eudaimonic components. The hedonic component is the affective experience of positive emotions and absence of negative emotions, along with the cognitive aspect of evaluating life satisfaction. The eudaimonic component is the search and attainment of meaning, self-actualization and personal growth. The authors present five main conclusions: 1. Well-being is the dominant topic - The most researched topic in positive psychology to date is well-being, accounting for almost 40% more publications than all the other key topics combined. 2. Predictors of well-being - The research shows that gratitude, mindfulness, hope, and spirituality, and more generally, identification and use of character strengths predict well-being. 3. Well-being & performance - In the organizational context, several studies suggest that psychological capital is positively related to employee performance. 4. Predictors of post-traumatic growth - Post-traumatic growth is predicted by emotional expression and positive coping strategies, including positive attitude, hope, optimism, and spirituality. 5. Positive psychology interventions work - There is a growing evidence base for the effectiveness of positive psychology interventions. More than 160 intervention studies were identified; the major categories included coaching, mindfulness, strengths development, positive affect enhancement, and gratitude practice. Empirical evidence was found to link these interventions to increases in well-being, resilience, hardiness, engagement, hope, and goal attainment, among other outcomes. Let’s zoom into the impact of coaching as a positive psychology intervention. Thirteen coaching studies (in the positive psychology field) were selected. They were informed by the “solution-based cognitive model” that includes self-monitoring, cognitive restructuring, and behavior modification to enhance goal achievement. The authors conclude that coaching interventions report significant improvements in goal attainment, depression, anxiety, stress, and quality of life. Wellcoaches integrated coaching techniques based on positive psychology concepts, as well as positive psychology interventions, into our curriculum nearly 15 years ago and found the impact to be transformational for clients. As a bonus, our students have reported an increase their  own well-being, especially eudaimonic, in the learning process. Here’s to growing up together! Resources: DONALDSON ET AL (2015). HAPPINESS, EXCELLENCE, AND OPTIMAL HUMAN FUNCTIONING REVISITED: EXAMINING THE PEER REVIEWED LITERATURE LINKED TO POSITIVE PSYCHOLOGY, JOURNAL OF POSITIVE PSYCHOLOGY 10:3, 185-195

When I was ten years old, I was given a 3 inch reflecting telescope. That’s the kind in which a concave mirror focuses light, bounces it into a series of mirrors and ultimately into the eye piece. I could see the moon as if I was holding it in my hand. Now a telescope is being constructed on Mauna Kea in Hawaii which will have a 30 meter mirror! Why spend huge amounts of money, intelligence and passion to build a bigger mirror? Just this: to see beyond what our everyday eyes can see. Isn’t that a big part of what we do as coaches? We help our clients see what they have not seen about their environments, their goals, their lives, their possibilities. A challenge in building giant telescopes is that earth’s gravitational pull distorts the huge mirrors enough to create inaccurate images. Care must be taken to continually adjust the mirrors and to avoid the slightest dirt – even as small as a skin cell – which will damage the reflection. Reflective practice helps avoid distortions in coaching. 1. A coach became frustrated with his client’s progress toward agreed upon objectives. The coach’s intense values about completing objectives had prevented him from recognizing that his client’s world had changed dramatically during the engagement. Distortion: substituting his values for his client’s. 2. Another coach felt she and the client were swirling around, yet the client was very happy with the monthly conversations. Nothing changed. Distortion: the coach and client had similar difficulty prioritizing. 3. Another coach was working with a young executive. The executive received difficult feedback from her CEO and the coaching relationship deteriorated. Through supervision, the coach realized he was unconsciously caring for the executive as if he was her father. Distortion: loss of clear boundaries between parts of his life. 4. A health and wellness coach was frustrated with a client’s weight loss progress. In reflection, the coach discovered that her own life-long relationship with food was masking her compassion for the client, whose story about food was profoundly different. Distortion: assuming our histories and values flowing form them are the same. Reflective Practice in supervision is a discipline of opening ourselves to fresh information about what we see, feel, think, want and do. It calls us to see ourselves and our clients as accurately as possible before, during and after the coaching conversation. In short, reflective practice is a process of polishing and correcting our mirrors. Why is this important beyond initial coach training? In coach training, we learn important theories and competencies; we learn how to coach. According to Schon (1987) and McGonagill (2000) this process provides us with “espoused theories” as distinct from “theories in action”. The latter are the theories, and by extension behaviors, which we attempt to apply in moments of coaching. Schon and others observed that professional workers (in various fields) described their work one way and actually did it another way. Reflective practice helps bring espoused and in-action knowledge closer together over time, and it is never complete because our mirrors, like those on Mauna Kea, are constantly shifting. How can we develop a reflective practice? One approach is to work with a person trained in guiding reflective practice. In the world of coaching, this person is being referred to as a Coaching Supervisor who has substantial understanding of both coaching competencies and additional experience with coaching psychology, dynamics of relationships, human systems dynamics and various tools for deep reflection.  A result of this work is development of an internal supervisor – a part of us that observes our coaching in real time and helps keep the mirrors clean and aligned. We can also begin reflective practice by attending regularly to a process. Find a mirror, physical or in your mind. Take a moment and gaze into your reflection. 1. What do you feel good about in your coaching? 2. What is unsettling in your coaching right now? A client session that didn’t go as planned? A client relationship that is suddenly not as comfortable as it was? Clients you find you actually don’t like? 3. What distortions might be creeping into your mirrors? Fatigue? Fast pace? Surety rather than curiosity? 4. What boundaries are in need of attention? Might you be performing roles that are not yours to perform? Are you moving away from your client when there’s conflict in the air? Are you trying to make your client happy? 5. What other questions are you sitting with and where could you go for answers? References: 1. Donald Schon, (1987) Educating the Reflective Practitioner. Jossey-Bass 2. Grady McGonagill (2000) The Coach as Reflective Practitioner, Notes from a Journey without End. In Executive Coaching: Practices and Perspectives. eds Catherine Fitzgerald and Jennifer Garvey. Davies Black Publishing.

by SIMON MATTHEWS, DipIBLM FASLM M Hlth Sc Newcastle MAPS, Cert IV Fitness Reflections on the Journey from one discipline to another… So before you read any further, I think it’s only fair to tell you that this process of moving from Therapist to Coach is in train for me – I don’t want you to read all the way through looking for a happy ending and finding yourself frustrated at the absence of one, though it is a happy story so far… I’d been practicing as a Psychologist in Australia for over 20 years when the opportunity arose for me to undertake Coach training. I’d initially trained in Systemic Family Therapy, then Solution Focussed Brief Therapy (SFBT), Motivational Interviewing (MI) and along the way I’d dipped my toe in other approaches that held some interest for me such as Acceptance and Commitment Therapy and even the clinical use of metaphor in therapy. Over the years, as I’d become more ensconced in the ‘bread and butter” of psychological treatment – depression and anxiety, I began reading more about the benefits of activity and exercise for mood and mental health. Long story short, I became a Fitness Trainer and began incorporating this into my psychological treatment. Roll forward a little further and I became convinced about the importance of nutrition also, studied that formally and also incorporated nutritional guidance into my psychological treatment. Then one day I woke up and realized I’d toppled into Lifestyle Medicine. Over time I incorporated work with pre-and post-surgery bariatric patients, adding this to my portfolio of clients with depression, anxiety, life crises and marital breakdowns, all the while using my secret blend of SFBT, MI, Fitness and Nutrition. But to be honest, I’d started to become a little jaded…I didn’t look forward to client sessions like I used to, I’d started to entertain ideas that an increasing number of my clients were unmotivated for change, and I’d started to see myself as less efficacious as a treatment provider than previously had. If I’m really honest, I’d say that some of the humanity that I used to bring had started to fade and I was approaching my work more instrumentally and less humanly than I was comfortable with. The opportunity to undertake coach training arose and, encouraged by some peers I respected, I decided to enroll with Wellcoaches. I travelled halfway around the world (yes, literally) to complete my training and here’s my takeaway: It was the most transformative personal and professional experience I’ve had in 25 years. Let me explain a little more… I expected to come away with an increased range of professional skills and, based on the pre-reading I’d done, some nuanced capacity to apply skills I’d been using for two decades. What I didn’t expect was to come away with a clarity of vision for my own professional life, a re-vitalised well of energy for supporting others during processes of change and transition, a re-connection with my own joy, passion and purpose and a strongly enhanced sense of my own self-efficacy and self-esteem. Of course my Coach Trainer played a significant role in this, as did many of my fellow coaching students. Since completing my initial training I’ve had limited time to practice skills due to more travel and conferences but when I returned to Australia I made a decision to apply the health and wellness coaching protocol in all my sessions with bariatric clients both to consolidate the skills for me and also to give me a discrete set of clients for whom I could assess the impact. Here’s what I can say so far: – Every one of my clients had tears in their eyes when they stated aloud their health and wellness vision – not a word of a lie – every one! I haven’t seen passion and feeling in my clients in this way for years. There is something bold, brave, expansive and almost magical about the capacity to articulate such a vision – Every one of my clients has walked out of those sessions saying something along the lines of “Wow – that wasn’t what I expected” or “Wow – I got so much more out of that than I thought I would” – I get to the end of a session feeling energized and enthused, not drained and desperate for a Double Espresso – I feel like I am doing the right amount of work in relation to my client – rather than feeling like I’m working so hard to help them make a tiny bit of progress. – Most important of all for me – I feel like I am present again – able to simply “be with” another human being and not feel compelled to “do for” them. In 30 years of human services work and 20 years as a Psychologist, nothing has challenged me as much; nothing has energized me as much and nothing has reconnected me with my own enthusiasm and passion for work like coaching training has. Your mileage may vary…but if you’re a Psychologist or Therapist who’s considering the transition then follow the advice of Johann Wolfgang von Goethe: “Whatever you can do, or dream you can, begin it.” And I would add “Now”.

Watch HOW COACHING WORKS: A SHORT MOVIE A decade ago, we released a movie titled “How Coaching Works” as a way to explain coaching using an animated cartoon. This blog series aims to share the psychological underpinnings of the cartoon. This second blog in the series  is a simplified script for the coach and client dialogue. Scene One: MEET Coach:  Hello. Thanks for meeting today. Let’s begin by having you tell me more about what you hope for most for your life. Who would you be if you were at your best? Client: I would engage in activities that energize me, strive for optimal health, and live life with gratitude and a sense of purpose every day. I’ve been thinking about this for while, but when I start it doesn’t last, it doesn’t get done. And, when I think about all of the things that get in my way, I’m overwhelmed. Coach: WOW, that’s an appealing vision. I hear your deep yearning to get there. Let’s talk about how we can work together. I’ll help you construct a roadmap to your future. You’ll bring a wealth of insight about what works for you and what doesn’t. With the help of my toolbox, you’ll get it done.  Let’s explore more about your life today….cont’d. Scene Two: VISION Coach: Tell me more about that vision. What is important to you about it? Client: Taking control of my life. I’ve let my priorities get out of order. Coach: What’s important about now? Client: Life is going quickly and I realize that I don’t want it to pass me by.  I used to have big dreams…and then work and family responsibilities got in the way. Coach: What will be possible when you achieve it? Client: I’ll feel proud of myself and have more confidence. I think that’s what I miss most about my younger self – feeling like I can do anything. Coach: When you are at your best, you are confident and optimistic that you can achieve anything you set your mind to. Let’s expand your vision to address what strengths you’ll apply to get there, your major challenges, and some of the strategies you might use to rise above your challenges….cont’d. Scene Three:  THE PLAN Coach: Let’s start working on how you will get to the vision you yearn for. What is the first thing you’d like to be doing in three months that would get you closer? Client: That’s a good question.  The first thing I’d like to be doing in three months is spending time with my spouse most evenings. Coach: What do you mean by spending time? Client: We used to play games together; that was always fun. Or, taking walks – I see couples doing that and always think “How lovely.” Coach: What would be the benefits of spending more fun time with your spouse? Client: I always feel less stressed when I take time to relax. And, my spouse is my best friend; I always feel better about myself when we have time to be together. We talk about new things to pursue together. Coach: So, if you were to set a goal around this for the next three months, how would you write it? Let’s make it very specific and detailed. How much time would be enough to energize, relax, and inspire you? Client: By the end of three months, I would like to spend two evenings and one half-day on the weekend together. Coach: Would you be willing to change the language to say “I will spend two evenings and one half-day weekend day with my spouse”? Client: Yes, that sounds great! Coach: Let’s work on the rest of your plan. What’s the second goal you’d like to pursue in the next three months…cont’d. Scene Four: THE JOURNEY Coach: Now let’s work on the first step you will take toward your three month goals and your vision. What is a small step that you can take next week? Client: I’m not really sure. I’m so busy with work in the evenings and weekends and it’s been hard to take time out for myself, let alone to spend time with my spouse. Coach: You’re feeling overwhelmed right now because on one hand, it’s important to you to spend time with your spouse and, on the other hand, you are committed to doing a good job at work. Client: Yes, exactly. But, I know in the end, my spouse and my health are precious and I feel badly that they are not higher on my priority list. Coach: Tell me about a time when you are your spouse were taking time for each other. What was happening when you felt really connected? Client: Let me think about that…when we first got together, we used to take walks in the park near our home every night. After dinner, we would go for a 15 or 20 minute walk, just to digest our food and talk about our days. Coach: What did you enjoy about that? Client: Talking, being best friends…It also felt great to get outside at least once a day. Coach: You loved being connected to your spouse and you benefited from the exercise and fresh air. Client: Yes, we never made any plans those evenings until 7pm so we could be sure to walk. Coach: What could you learn from that and use today? Client: It seems that what was most important was that it was kind of an unspoken non-negotiable agreement that we’d walk every day. Coach: So, which part of that worked – the agreement or the walking every day? Client: It was the agreement we had together. And, just taking a short time; 15 minutes seems possible. Coach: What do you want to commit to this week? Client: I will take a 30-minute walk on Friday, after work, with my spouse. (Fast forward – The client attempts the goal but has a set back and “falls off of the ladder”) One week later… Coach: Tell me what went well with your goal of taking a 30-minute walk on Friday, after work, with your spouse. Client: It didn’t go as well as I’d hoped. Coach: Which part did go as well as you hoped? Client:  Although we didn’t actually take a walk, we did have some time, during a car ride, to start talking about what we’d like to do together. Coach: Sounds like just talking about the idea was a great way to connect. Client: Yes, it was. Coach: What did happen on Friday? Client: We ended up being invited to go to a friend’s house; it was a last minute invite from some friends we hadn’t seen in a while. The downside was that, even though we were both there, we were off talking to other people at opposite ends of the house. Coach: What did you learn from trying out this goal? Client: That Friday nights probably aren’t the best night to plan for our alone time together.  It does tend to be the night we are most likely to do something with other people. Coach: Okay, so it’s time to step back and rethink the goal; take a smaller step perhaps. Client: I think it would be more likely to happen if we planned for a weeknight instead of a weekend night. Coach: What night would be best next week? Client: Tuesday is the least busy. Coach: If you have chosen the best day, what else will it take to be successful with this? Client: I need to turn off my cell phone during dinner so I don’t get caught up in a phone call – my family tends to call during the evenings – instead of going on the walk. Coach: What is your goal this week? Client: I will take a walk with my spouse on Tuesday evening, after dinner, and will turn off my cell phone so we don’t get interrupted. Coach: How important is it to you that this happens? Client: Very. My spouse and I really are looking forward to it. Coach: On a scale of 1-10, how confident are you that this will happen? Client: A 10! Coach: Great work thinking this one through! I’m really looking forward to hearing about your success. Scene Four: Success Coach: Welcome back! I’ve been really excited to hear about your week. What was the best part of it? Client: Working on one goal got me thinking about the other areas of my life that I could make some improvements. Coach: Tell me more. Client: On Sunday, after having a big dinner, I was getting ready to cut out a big slice of my favorite kind of cheesecake when I remembered our conversation. Remember, when I said that my goal is do more activities that give me energy? Well, I was already full from dinner and it dawned on me that adding cheesecake on top of it was going to put me into a food coma. Coach: You were really paying attention to the signals your body was sending. What did you decide? Client: I didn’t eat the cake!  I told myself that “I had really enjoyed a great-tasting dinner and that I would appreciate it more if I stopped eating now.” Coach: How do you feel about that choice? Client: Surprised! I haven’t had that kind of willpower for years. Coach: It’s pretty exciting when you take control.  How did you use that willpower when you worked on your goal of walking on Tuesday, after dinner, without the cell phone? Client: We had such an incredible walk. The weather was perfect that evening, just the right temperature for a walk. We got to talk about our day and even do some planning for the next day. Coach: What did you most enjoy about working on this goal? Client: Giving myself 15 minutes to relax, away from the TV, and with my spouse. We laughed a lot. Coach: Sounds like you felt more energized and entertained than you usually are when you watch TV instead. Client: Yes, I usually use the TV to wind down, but it never really helps me relax. Coach: What did you learn about yourself this week? Client: That I really am ready to make some changes in my life. I can do it! Coach: I’m certain that you can – and you already are. What’s next?

Does coaching improve health? This is an important question for 160+ million people in the US, and multiples of that number globally, who have a health risk or chronic condition that can be improved by health-giving habits of mind and body. It’s also an important question for doctors and healthcare providers, leaders, employers, healthcare systems, health plans, governments, and of course coaches, who are dedicated to improving individual and population health. It’s an even more important question today because health is declining in the US and globally, mostly caused by unhealthy habits. More than 95% of adults don’t engage IN ALL OF THE TOP SEVEN HEALTH HABITS, 60% OF ADULTS HAVE AT LEAST ONE CHRONIC DISEASE, ONE THIRD OF ADULTS AND 19% OF CHILDREN ARE OBESE, and 50% OF ADULTS HAVE DIABETES OR PRE-DIABETES, which can be described as a food-borne disease. From the Aspen Health Strategy Group earlier this year: THE COST OF UNHEALTHY LIFESTYLES IN THE US WILL ADD UP TO $42 TRILLION BETWEEN 2016 AND 2030 IN HEALTHCARE COSTS AND LOST PRODUCTIVITY TO EMPLOYERS. Wellcoaches research advisor Gary Sforzo is leading a team that just published an UPDATE TO THE 2017 COMPENDIUM ON THE HEALTH & WELLNESS COACHING LITERATURE in May 2019. Two new meta-analyses of coaching outcomes were published in 2018 and the number of randomized clinical trials increased from 72 to 108 in two years since the 2017 compendium. The author team ambitiously delivered a complete review of HWC research, first from 2000-2016, and now an update from 2016-2018.  Selected papers met criteria that define coaching which emerged from a 2013 SYSTEMATIC REVIEW: 1. coaches trained in behavior change, motivational techniques 2. patient-centered (guided by patient values) 3. patient determined goals 4. self-discovery 5. accountability 6. ongoing relationship Key Characteristics You can see in Exhibit A that obesity, diabetes, and wellness are the main areas of research focus.  In Exhibit B, we learn that approximately half of selected studies are randomized controlled studies, 108 in total (well exceeding the 15 RANDOMIZED CONTROLLED STUDIES IN THE EXECUTIVE COACHING LITERATURE as of 2016). There is also one welcomed meta-analysis on the positive HWC effects on A1C IN DIABETES PUBLISHED IN 2018, and another meta-analysis on SEVERAL APPROACHES TO HYPERTENSION INCLUDING COACHING. Limitations of HWC outcomes research The main limitation is that many studies combine HWC with other education or wellness interventions (in fact, mirroring real world practice), thereby obscuring the pure effect of a coaching intervention on a particular outcome. In recent years, there are more studies isolating the effects of coaching. Yes, coaching improves health While not unanimous, the bulk of the research reports a favorable impact of HWC on obesity, diabetes, hypertension, cholesterol, heart disease, and general wellness.  The study of cancer patients, more limited, shows positive findings. The consistent and beneficial impacts of HWC on weight loss, A1C, blood pressure, cholesterol, stress, anxiety, self-efficacy, exercise participation, and nutritional habits nicely support the use of HWC to prevent or treat chronic conditions. More to come The HWC literature is on pace to double every four years or so. This will include better-designed studies and studies using coaches who meet newly established standards, passing the NATIONAL BOARD CERTIFICATION FOR HEALTH AND WELLNESS COACHES backed by the NATIONAL BOARD OF MEDICAL EXAMINERS. Studies will likely explore the optimal coaching dose, how to improve sustainability and cost effectiveness as well as emerging coaching trends, such as combining coaching with digital tools and group coaching models. Takeaways for Coaches 1. If you are a coach and your health needs an upgrade, walk the walk and engage a health and wellness coach. 2. Recommend to your doctor that s/he refers patients to NBC-HWC – national board certified health and wellness coaches. 3. If you coach leaders and their employees’ health needs an upgrade, suggest they hire health and wellness coaches to help them improve employee health, engagement and productivity. Let’s toast our most precious asset, health, and the hundreds of researchers showing that coaching improves health! Sforzo, Kaye, Harenberg, Costello, Cobus-Kuo, Rauff, Edman, Frates, Moore.  (2019). COMPENDIUM OF HEALTH AND WELLNESS COACHING: 2019 ADDENDUM.  American Journal of Lifestyle Medicine.

I recently presented at the annual conference of The Australasian Society of Lifestyle Medicine – held in Auckland (Tāmaki-makau-rau) New Zealand (Aotearoa). It was a brilliant time not just of learning but of connection and friendship with our brother and sister health and wellness professionals. On the morning of the final day of the conference, it was a delight to hear from Dr N Margarete Ezinwa, the Director of the Lifestyle Medicine Global Alliance. She spoke of the power of story to change and told a moving story of her own showing the power of Lifestyle Medicine to change lives. No spoilers, but the story was of someone very dear to her who had his own journey from Olympic champion to declining health and then incredible recovery. At the conference dinner the evening before, we were treated to an amazing story of redemption from a Māori man who set his own vision for better health at the point that he weighed over 600 pounds (275kg). He is now a champion of health behavior change in his own community. I want to tell you another story. I’m not going to name the individuals, not because I think they’d mind, but because I want to make sure the message of the story is paramount. On the Friday late afternoon of the conference I chanced upon a delegate. We got talking and it turned out he is a final year med student, born in Canada and studying in Australia. He was attending the conference through a collegiate connection but with perhaps some degree of skepticism or at least reserved judgment about the evidence behind lifestyle medicine. We spent the next hour or so chatting and connected over our own stories (including both sharing the same former occupation!) and he told me that this was the first ever medical conference he had attended. We connected briefly a couple more times during the conference and he indicated that he was enjoying his time. Fast forward to the last day of the conference – I was chatting with a Physician who has his own incredible story of recovery from near death and who had appreciated some input I had had at the conference. By way of gratitude, he gifted me a book he has written, inscribed with a personal message. I mentioned to him during our conversation my new colleague and that this was his first medical conference –  a Lifestyle Medicine conference! The response: “I want to give him one of my books too”. About 20 minutes later, I was handing over a copy of this book inscribed personally and with the message “Welcome to the Club”. As the conference concluded on Sunday afternoon, I farewelled my new medical student colleague and we agreed to stay in touch. As we parted, he said “Thank you for making me feel so welcome…” and then added “I think this conference has changed the course of my life”. I’ll admit to having a small tear rolling down my cheek as I write this, knowing that the power of story to change lives – personal and professional – is extraordinary. It appears that the worldwide movement of Lifestyle Medicine has a new member. And I’m confident that in time, he will have his own stories to tell to encourage the healing and enrichment of other lives. The stories our clients have about themselves and the stories they want to be able to tell about themselves are extraordinary. Our job as health coaches is to listen, to hear them and help to amplify the elements that lead to re-visioning and redemption, harnessing the genius, power and magic that lies in story. Simon Matthews is the CEO of Wellcoaches® Australia. He’s a Fellow of the Australasian Society of Lifestyle Medicine, IBLM Diplomate and Member of the Australian Psychological Society .

Watch HOW COACHING WORKS: A SHORT MOVIE Ten years ago, we released a movie titled “How Coaching Works” as a way to explain coaching, using an animated cartoon. Now viewed over 1.5 million times, this blog series aims to share the psychological underpinnings of the cartoon. Tell me about your day yesterday. Really – take a moment and write down what happened yesterday.  I’ll be here when you are finished… Keep writing…. Now, tell me about the best part of your day yesterday. Write about your best memory of yesterday. Keep writing… Next, take a look at both of your responses. What do you notice? What are the differences between the two? If you are like most of us, your first answer was a list focused on the craziness of the day – a hurried, breathtakingly-busy list which included highlights of the annoying or frustrating elements. The first answer usually includes information, but not details, about the day. Did the best part of your day even make it onto that list? It’s not likely. The second question was called an “appreciative inquiry”; a question that may have inspired you to think differently about your experience with the world. Rather than following our natural tendency to focus on all that is wrong with our day, a simple shift in words can change our focus. You may have even noticed a difference in how you felt when you considered the best part of your day. Many experience a greater sense of calm or joy, for example, that isn’t felt when only recalling what happened during the day.Because what we focus on grows, coaches encourage clients to look first to the things that are right with their world. The second question may have supported you in savoring that “best experience.”  Savoring experiences, positive psychologist have learned, is one key to happiness. This reminds me of the quote a colleague has on her wall, “We do not remember days, we remember moments.” Our days get lost and forgotten in the blur of activities, unless we pause to savor the moments. When we look at our lives appreciatively, we are better able to find the beauty in them, even amidst the inevitable chaos; we leverage our strengths to face our challenges; and, we focus on what we wish for, rather than what we don’t want. You can use appreciative inquiries in your interactions with others, and as reflection tools for yourself.  A few of the key elements of appreciative inquiries are that they: – Evoke values and ultimate concerns by asking about high point stories or most valued qualities. – Use positive questions that build on positive assumptions. – Enhance the possibility of storytelling by using open-ended questions that focus on personal experiences. Here are a few appreciative inquiries for you to consider as you move through your day: – Recall a time in your life when you felt great joy, a great delight inspired by something exceptionally good or satisfying. What was happening during that time? What led to the emotion? What were you able to do as a result? – What was the best choice you made about your health today? What strengths supported you in making that choice? What values did you honor? – If you could have any three wishes granted that would support you in being your best self, what would they be?

Today we want to explore a 2019 scientific paper on the connection between life purpose and health, titled: PURPOSE IN LIFE AND CONFLICT-RELATED NEURAL RESPONSES DURING HEALTH DECISION-MAKING. First, the authors summarize the literature indicating that a strong sense of purpose in life, or a set of goals based on one’s core values, is associated with reduced risk of stroke, cardiovascular events, cognitive impairment, enhanced glucose metabolism and reduced mortality risk. Interestingly, a sense of purpose reduces the wear and tear on the body caused by stress, what’s called allostatic load. Research also shows that people with value-based goals and purpose engage more in healthy behaviors, including more exercise, and taking their medications as prescribed. Their health matters because it serves their pursuit of valued goals. Why does a strong life purpose improve health? The processes underlying the link between health and purpose is unclear. The authors designed a study that sought to understand: Why are sedentary and overweight people with a stronger sense of purpose more receptive to health messages that explain the health benefits of physical activity? Impact of decisional conflicts Often people who are living an unhealthy lifestyle, and are at high risk for adverse health events, are defensive or resistant to change because they deal with conflicting motivations – the desire for self-improvement and the desire to maintain self-worth by denying the value of the healthy behavior. They may seem indifferent to the healthy behavior in order to sustain a positive self-review, and don’t reveal their inner conflict. These inner conflicts can arise when people are unclear about their core values and goals, which bring clearer direction to one’s choices, reducing decisional conflict. Brain activity in decisional conflicts In this study of 220 sedentary and overweight adults, the researchers tested whether those with a stronger life purpose were more likely to endorse positive health messages on physical activity. The participants listened to 30 messages (focused on risks, reasons, and strategies) and rated the degree that they agreed with the messages and were confident that they could do what the message recommended. While participants listened to the messages, the researchers used brain scans of multiple regions involved in neural processing of internal conflicts to learn whether the strong life purpose correlated with a lower level of activity in the brain regions involved in decisional conflict, a better test than self-reports of decisional conflict. Study results The study showed that people with greater purpose showed less activity in the brain regions involved in conflict processing during health decision-making, which in turn predicted greater endorsement of self-relevant health advice. The effect of purpose in life was stronger when participants were exposed to “how” messages than “why” messages. The broader “why” provided by life purpose may provide motivation and openness to “how” messages. Greater purpose may reduce internal conflicts or negative self-protective responses to health messages. What’s in it for coaches? The good news is that coaches apply science-based processes which helps clients connect with their values and develop visions and goals which are meaningful and purposeful, as taught in the Wellcoaches model. Now we know more about why the Wellcoaches tools helps people who are ambivalent about change. The field of neuroscience has delivered an underpinning to Nietzsche’s assertion: S/he who has a why to live can bear almost any how.” How cool is that! Coach Meg Reference: PURPOSE IN LIFE AND CONFLICT-RELATED NEURAL RESPONSES DURING HEALTH DECISION-MAKING. KANG, STRECHER, KIM, FALK. (2019) HEALTH PSYCHOLOGY.

Starting January 2020 in the US, physicians will be able to deliver health and well-being coaching services to their patients, putting to use what are called CATEGORY III CPT CODES AWARDED BY THE AMERICAN MEDICAL ASSOCIATION (AMA). The CPT coding system is the basis for healthcare reimbursement in the US. The AMA defines coaches as “non-physician healthcare professionals certified by the National Board for Health and Wellness Coaching (NBHWC) or the National Commission for Health Education Credentialing (NCHEC),” organizations responsible for unified national standards and certifications for health and wellness coaches and health educators respectively. The US Department of Veteran’s Affairs led the application to the AMA so that the VA can immediately start delivering and tracking coaching services nationwide. The VA, NBHWC, and NCHEC are now collaborating on the path to reimbursement by the US government and health plans. You will recall Gary Sforzo, Wellcoaches research advisor, is the lead author of TWO PUBLISHED COMPENDIA OF HEALTH AND WELLNESS COACHING (HWC) RESEARCH, which now includes 100+ randomized controlled studies as of mid-2018. The compendia includes a primary care practice-based study of coaching for weight loss described in this article. BEN CROCKER, Wellcoaches-trained physician at Massachusetts General Hospital, refers patients to the health and wellness coach on his team when they want support for weight loss, stress management, and managing chronic diseases. In their study titled – PRIMARY CARE-BASED HEALTH COACHING INTERVENTION FOR WEIGHT LOSS IN OVERWEIGHT/OBESE ADULTS – Wellcoaches coach Ryan Sherman delivered an average of 11 coaching sessions for the participants in the coaching group in the first year. The first 60-minute session was in-person and the ongoing phone sessions lasted an average of 31 minutes. Bottom line? The coaching intervention led to an average weight loss at 12 months of 7.24 percent of body weight—a mean of 15.4 pounds. At two years, average weight loss was well sustained at 6.8% of body weight. Leveraging the Strengths of Coaching The study included 271 overweight or obese adults already receiving care at the practice. Study groups were defined as such: – Coaching group (98): eligible patients who received weight loss coaching for at least three months; – Comparison group (121): eligible patients who did not receive coaching for weight loss; – Drop-out group (21): coaching group members who didn’t complete three months of coaching for weight loss; and – Non-weight coached group (29): eligible patients who received coaching for a reason other than weight loss, providing comparison for general motivation to change. Those in the coaching group completed a self-assessment of their health behaviors, met with the coach in person initially, and continued with coaching sessions by phone. The coaching protocol included techniques based upon transtheoretical model, appreciative inquiry, self-determination theory, positive psychology, motivational interviewing, and relational flow. From the study’s authors: “We believe that the intervention’s success is attributed to the specific use of a fully integrated coach. Health coaching techniques focus on patient empowerment, as opposed to standardized behavioral prescription and patient education. Eliciting from and supporting patients to leverage their unique strengths empowers them to choose their goals and create their own plan. Monitoring for obstacles to these goals and recognizing and celebrating achievements with patients develops self-awareness and builds self-efficacy. As a result of this behavioral change, health coaching may have a sustained effect on weight loss beyond the limited intensively active relationship with the patient.” Spreading the Word Monique Tello, MD, MPH, who also practices medicine at Massachusetts General Hospital, wrote about the study in LEAN FORWARD, Harvard Medical School’s CME blog. She noted that the results were “impressive” and “incredibly important.” She linked the findings to the CDC’s National Diabetes Prevention Program (DPP); participants in the DPP program—which includes group coaching and comprehensive support of lifestyle change including nutrition and exercise—lowered their chances of developing Type 2 diabetes by 58 percent compared with those participating in a non-coaching intervention. “Why aren’t we offering this sort of supported behavior change in every primary care doctor’s office across the country?” Tello asked. “The first argument is that it’s too expensive. After all, as the study authors point out, health coaching is not yet reimbursed by insurance companies. The study authors did a cost analysis and figured out that assuming a $60,000 annual salary of the coach, the cost per coached patient is about $289 per year (for all patients). For those who used the services more (and achieved minimum weight loss of 5 percent total body weight) the cost was $480 per patient per year.” The cost is, she continued, “peanuts” compared to the expense of weight loss surgery or most commercial weight loss programs—and without the inherent risks or unreliable results. Takeaways for Coaches Combining this real-world practice-based study with the larger HWC literature base leads to takeaways for coaches: 1. Supporting sustainable behavior change and weight loss is an ideal role for coaches. More than 70 percent of Americans age 20 and older are overweight or obese, according to the CDC. “Because of the medical and financial impacts of obesity,” the authors wrote, “the U.S. health care system is in need of effective and cost-efficient weight loss interventions.” 2. The CDC DIABETES PREVENTION PROGRAM, a group lifestyle coaching model for pre-diabetes with a target of 5% body weight loss at 12 months, is now reimbursed by Medicare and many health plans, and provides a benchmark for reimbursement for coaching services in primary care. 85 million US adults have pre-diabetes, bringing an epidemic of diabetes to primary care physicians in the next decade or so. 3. Health and wellness coaches are encouraged to complete an NBHWC-approved program and the NBHWC CERTIFICATION so that they meet the standards for the new CPT codes and are ready to collaborate with physicians, under their supervision and billing. Adapted from Research Dose published  by the Institute of Coaching. Featured Article Sherman, R. P., Petersen, R., Guarino, A. J., & Crocker, J. B. (2017). Primary Care-Based Health Coaching Intervention for Weight Loss in Overweight/Obese Adults: A 2-Year Experience. American journal of lifestyle medicine, 13(4), 405–413. doi:10.1177/1559827617715218. HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC6600613/

In the middle of 2019, I experienced a medical event which could have changed my life considerably. Ultimately it didn’t. I suffered a torn and detached retina in my left eye. By the time I was having surgery, my vision was severely affected. The skill and experience of my surgeon (who has conducted this repair procedure over 5000 times!) along with his dedication and passion for his work meant that the surgery was successful and my vision was restored. If you don’t know much about retinal detachment, I won’t bore you except to say this: the condition itself is painless, the surgical treatment is painless and the after effects are mild soreness for a day or so and the development of a cataract around 12 months later. If you experience any sudden change in your vision, get to a hospital, physician or optometrist straight away! Time matters here. Fast forward from July 2019 to late February 2020. I woke up one morning, thought something looked odd in my right eye vision and went straight to an optometrist. After insisting he dilate my pupil and gaze into my eye, he exclaimed “Oh wow – there’s a big horseshoe shaped tear there!” I arranged to go straight to my surgeon who confirmed the diagnosis and I was having surgery within hours. While it’s not the point of the story, the surgery was successful and my vision was restored again. Thankfully, we only have two eyes! A friend of over 30 years collected me from the hospital (my wife was working out of town and had arranged to return earlier than planned but not before I was discharged). He then drove me to my surgical post-op appointment the following day. After the Surgeon confirmed that everything was looking good in my eye, I had coffee with my friend. We got to talking about education and skill and technology and incredible advances in health care and friendship. And in an instant I felt overwhelmed with gratitude – that my sight had been saved not once but twice; that I live in a country with excellent health and medical care; that I live close to the centres of excellence for that care; that I have friends who I can call on and who change their own plans to accommodate me; that my Surgeon has the education, technical skill, experience and passion to do what he does. The restoration of my vision enabled me to capture and hold another vision – a life imbued with gratitude. Gratitude, of course, sits front and centre both in coaching and in health and wellness. Practices of gratitude appear linked to optimism, improved mental health, stress management, sleep quality, self-efficacy and even heart health! Supporting others to experience gratitude is a great gift! If you’re not familiar with the recent literature on gratitude, here’s a great WHITE PAPER published by the Greater Good Science Center at UC Berkeley. So…all of this has left me pondering a question that I invite you to consider:  Is it possible for a person to be sufficiently grateful?