Priorities, priorities, priorities! Mark Twain said that to change your life, you need to change your priorities. As an executive coach whose job it is to focus on change, personal, team-focused, and organization-wide priorities come up in every coaching conversation. Priorities are how we match our ambitions with our capacity. Priorities shape organizational effectiveness, departmental focus, and individual contributions. And priorities aren’t limited to industrial focus, they are also essential to spiritual life. In spiritual practices we refer to this as discernment, the ability to judge well and select among options. Discernment is at the heart of spiritual discipline, moral living, and raising consciousness; it’s about making choices. And priorities are just that, clear choices grounded in awareness. Priorities signal to everyone what to pay attention to, where to deploy their Units of Attention. Here’s what I mean by that. Every day we wake up with an inventory of Units of Attention, and wherever we deploy a Unit of Attention is where we spend our energy and our time. If I give Units of Attention to making breakfast, my energy and time go to menu, cooking, eating, and clean up. If I spend Units of Attention on morning news, my energy and time go to thinking about weather and stock market and war. You get the picture. When you deploy a Unit of Attention, you spend energy and time on that Unit – whether a person, idea, process, or object. And that spent Unit of Attention is non-refundable and non-transferable. This is really, really important. You cannot reclaim or reverse the time and energy you spend by deploying those Units of Attention. This is key. Priorities tell us where to place our precious Units of Attention. In the words of Stephen Covey, “The key is not to prioritize what’s on your schedule, but to schedule your priorities.” And to schedule your priorities requires both wisdom and power. Wisdom to discern what’s aligned with your values and enriching to your life. And power to set boundaries and advocate for yourself. Wisdom and power establish your priorities. Priorities harness attention. This also works at group level. Team and organizational priorities direct how everyone applies their time and energy. And when we collectively attend to the same priorities, our collective efforts turn to amplification – power drawn from, “the whole that is greater than the sum of the parts.” Well-articulated priorities have the power to heal one of the most crippling organizational maladies – silos. When departments don’t focus on organization wide priorities, they spend their Units of Attention – time and energy – on their own ideas, and miss the power of amplification. Establishing priorities gets people and functions to collaborate, and effective collaboration is the key to amplifying power. Here, for your consideration, are six elements for your priority process. 1. Align on a clear picture Get alignment on what the key business challenges are and how to solve them, this begins alignment on priorities or what defines success. Get everyone on the same page and define your guiding light, your “north star.” (For coaches, it’s helping clients create a wellness vision that serves as their north star. You and the client are aligned in the direction to move) * 2. Signal collective propulsion Because department heads tend to prioritize their departments, they can be a little myopic of the bigger picture. Help functional leaders understand the big-picture goal and how they are going to help achieve it, so they can be connected to what’s most important. (As a coach, set aside your ideas about the next best step. Listen to your client. Defer to their genius. They know the way.) * 3. Set the pace and sequence Priorities combine pace and sequence, and near-term and long-term balance. Step onto the balcony and review priorities with the lenses of: running the business better today, building capability for tomorrow’s business, and growth bets for the future. (Your client likely has big dreams and goals, but it all takes time. Know your client's direction, then help them break that down into the now. Help orient them to how the goals they have for today, this week, feed toward the vision.) * 4. Communicate to resonate If people can’t relate their jobs to what you’re saying the company needs, and what they can do to help, they will automatically disconnect. So make priorities accessible and understandable in the context of daily work activities. (Clients need to have resonance for what they are working toward.; those goals and activities need to relate to their values and their lives.) * 5. Set in-process milestones We don’t just track priorities at the end, but along the way, too. Set “in-process” milestones for people to see if they are “on track” or “off track” that’s how they can make corrective action. (Weekly or bi-monthly coaching sessions help clients keep their focus while attending to the other day-to-day demands of life.) * 6. Celebrate wins, then rapidly move on It is essential to create momentum, and even a movement, by celebrating early successes and leveraging this success to other areas. And then challenge the status quo by running rapid experiments and capturing the learnings of successes or failure. Oh, and celebrate these, too. (No success is too small for acknowledgment. Take the win, however small or big!) * Dan Millman, author of Way of the Peaceful Warrior, once said, “I learned that we can do anything, but we can’t do everything… at least not at the same time. So, think of your priorities not just in terms of what activities you do, but when you do them. Timing is everything.” Do this not just for your sake, but because as a leader you are a steward of your people. Without priorities, people pull in different directions, give their Units of Attention (their precious energy and time) to different tasks, and weaken the overall effectiveness of the collective. By making your priorities explicit you are guiding attention, effort, and direction; you enable your people to pull together and generate positive power toward achieving meaningful results. Reprinted with permission *Information in parentheses are Wellcoaches additions.

Geoff Montgomery, NBC-HWC Health Coach WellSpark Choosing Wellcoaches is the best decision I made when I decided to pursue a new career as a Health and Wellbeing Coach. The methodology they teach is easily recognized in the Health Coaching profession and brings instant credibility when looking for a job in the industry. Wellcoaches experienced staff are extremely professional and offer continued support throughout the curriculum, helping ensure success and a feeling of community. Additionally, I have been able to take advantage of the continuing education and monthly offerings to stay up-to-date and continue my education. The Wellcoaches program helped me prepare for the National Board exam, and was instrumental in my getting hired by Well Spark as a Health Coach. I would highly recommend the Wellcoaches program to anyone looking to pursue a career in Health Coaching.

In an interview on Java with Jimmy, Coach Meg and Dr. Claude Alabre at Massachusetts General Hospital meet with host Jimmy Hills to discuss New Year’s resolutions. Here’s what we talked about. Juice last year to the last drop Left to our own devices with New Year’s resolutions, they can work out but they often don’t. But not for the reasons we imagine. We tend to blame a lack of motivation, laziness or being too busy as the reasons we miss the mark. There’s more to unpack. Coach Meg explained that because the new year switches over so quickly, we don’t take the time to really process the year before. We start running hard toward new goals as soon as the new year begins. Changing yourself is not easy, in the best of times. In order to move toward new change and growth, we need to cultivate a foundation of strengths. People can’t get better if they don’t have sufficient “psychological capital,” the resources needed to support the self-improvement process. We need to take time to ground ourselves in our resources and strengths. From that place, we are better prepared to move forward and step into the ups and downs of self-change. How to do that? Harvest the good that emerged last year. “Juice” the good experiences to the last drop: what did I do well, what are the biggest wins, how did I get better, what did I learn, how did I grow? Only then, is it a good time to start to consider – what are my next opportunities to get better? Create a lane in your life for the inside game Improving ourselves starts with an inside game. Lasting change requires a lot of reflection and internal discoveries about ourselves. When our energies are focused on meeting the demands of the external world, including expectations about New Year’s resolutions, we lose connection to the inner game. It’s important to create space in our lives to pause, reflect and allow ourselves to harvest in order to grow. If we are running in the lane of getting stuff done and performing well ALL of the time, there is no space to pull back and reflect and gather - gather lessons, gather gratitude, and breathe in what’s good in our lives and work. Give ourselves grace and gratitude as Jimmy says. Working with a partner or coach can help us to reflect and gather all of our psychological capital. Once we open up the lane of reflection on our strengths and we invest in our psychological bank accounts, we can turn to reflecting on what powers us through improving ourselves – the combination of deep, heartfelt motivation AND a solid amount of confidence in being successful. Go deeper than you would typically do to find out what goal is really important, what change really matters to you, and why it’s important, why it’s a top priority to get better. Then dig some more to cultivate confidence in your ability to change by considering your challenges and getting creative in finding ways to get around them. Ignore social pressures in order to pause Forget about the social pressures in the ritual of New Year’s resolutions. As humans, pausing and reflecting first is vital. Of course, we also need to strive - productive striving is really important. However, striving isn’t just for the start of a new year. If we make time for pausing and harvesting the wins from last year, striving can begin later. Whether you give yourself an extra push to strive in January, June, or September it doesn’t really matter. You don’t always have to be striving, even if it’s the start of a new year. What also works against our efforts to pause and harvest is the incessant thinking that takes over our minds. In the book Coach Meg co-authored with Paul Hammerness, “Organize Your Mind, Organize Your Life,” (now Train Your Brain) we explore the topic of frenzy. It’s one word with a lot behind it. The culture we live in creates frenzy by telling us: if we are not achieving something, we have no value. It’s important to keep in perspective that this force surrounds us. It’s like being in an intense weather system. It can take real effort to move against it and understand that we don’t need to be achieving or producing every moment of every day, including at the start of a new year. For starters, let’s give ourselves some group compassion for how we are all living in this pressure cooker of achievement, and appreciate that the extreme pressure runs counter to pausing - stopping to reflect and gather, or simply doing nothing, catching our breath and resting. See stress as a direction for growth The second thing in the big umbrella term of frenzy - is stress. By its simplest definition, stress is the sign that the demands of the moment are greater than our perceived abilities. Stress puts us into the state of being afraid we can’t keep up. In pandemic times, we all have a lot of stress and negative emotions circulating inside and outside. And the suffering is our path to new growth and more strength. We can be with, and work with, our stress and other difficult emotions and feel compassion for them, bringing warmth and curiosity. Then we can ask ourselves “what is the meaning of this experience?” After that, we can move toward learning and growth. A bigger way to think about this is the scientific model of post-traumatic growth. Trauma is a situation where the general future and our individual futures are disrupted. COVID has been and still is a trauma. We are all traumatized because our future continues to be disrupted. We need to let go of the idea of bouncing back, returning to old norms, and instead learn to suffer well, lean in, and turn the trauma into growth. If we have survived, the pandemic is ultimately a force for good in our lives, if we use the experiences well. Nature has growth in its basic design. We lose track of our basic nature – the urge to grow, become wiser, stronger, and more competent. A mindset to consider then is to view the whole process of living through a pandemic as a way to grow and expand ourselves. The goal to strive for isn’t reducing stress, it’s to expand ourselves; becoming bigger, stronger, and better people. Get in touch with how you are growing and who you are becoming. The deeper the sense of who you are and who you want to be and why that matters, the more likely you'll be successful in your efforts. What goals really matter Java with Jimmy is focused on helping people get healthier. Despite all of the urging, most people don’t view good health in itself as a high priority goal - the bigger goal is living a good life. What matters then is connecting your health to what you really want in life. Go a few layers deeper on what you would lose if you didn’t have your health. That’s what you need to think of every time you make a choice: apple or cookie, exercise or stay in bed, e-cigarette or yoga stretches. In those moments where we choose either our dearest life goals or, feeling better for a quick moment - pause to ask: who do I want to become? How do I want to get better? And how does this choice serve that? If we are not clear on our highest yearnings, we go for what feels better in the moment, rather than investing in the future we want, the future that’s precious to us. New Year New What? "Juice" the good from the last year Invest in your psychological bank account by pausing and reflecting on the good Feel compassion for the disruption of the pandemic on yourself and everyone else Welcome your stress and suffering as a signpost to grow Focus on the goals that really matter to you Strive well – know why self-improvement is precious to you. Then recall what is most precious when you make choices, remembering your goal for getting better. Onward to getting better, better days, and a better future. Coach Meg

While we could write a book about the 14-year journey from 2009-2022, I want to share the quick highlights to remember the countless hours and years invested by Wellcoaches that led us to the eve of applying for full approval of CPT codes for health and well-being coaching services, planned in early 2023. The original founders in 2009 were from Wellcoaches (me, Coach Meg), University of Minnesota (Karen Lawson), Duke, then Vanderbilt (Ruth Wolever), ACSM (Dick Cotton), Wisdom of the Whole (Linda Bark), CIIS (Meg Jordan), Real Global Wellness (Michael Arloski), Duke Integrative Health (Linda Smith), and Vanderbilt (Roy Elam). Our biggest accomplishment was the journey of the founding team from being competitors to making deep friendships and a collaborative agenda. We all transcended, moving past self-interest and our own organizations and even personal and financial interest to say, “This is for the betterment of the coaching industry and the world.” That energy, that collaboration of serving a larger cause, is the life force behind NBHWC. Here's a quick gallop through our journey together: 1. Co-chaired by me and Karen Lawson, we gathered 70 stakeholders for a fall 2010 summit in Wellesley, MA, titled: Summit on Standards & Credentialing of Professional Coaches in Healthcare & Wellness. We used an appreciative inquiry process to align on a shared agenda to make a big impact on healthcare – developing the new profession of Coaching in healthcare and wellness. One of our many accomplishments? New lyrics for the song – I’d Like to Teach the World to Sing: The Change that’s Sure to Last We used to teach the world to do, Exactly what we said. It didn’t bring them health or joy, And gave us jobs we dread. But now we’ve learned just how to coach, Results are coming fast. This brings them health and gives us joy. The change that’s sure to last. View the Executive Summary of the Summit here. 2. By 2013, the expanded team agreed on one job definition: Health and Wellness Coaches are professionals from diverse backgrounds and education who work with individuals and groups in a client-centered process to facilitate and empower the client to achieve self-determined goals related to health and wellness. Successful coaching takes place when coaches apply clearly defined knowledge and skills so that clients mobilize internal strengths and external resources for sustainable change. Our collaborative and hard-won breakthrough meeting weekly over our first two years was to build one set of standards – for one coach - the health and wellness coach (not different standards for different coaches, e.g. health coach, integrative health coach, or wellness coach). We formed a nonprofit legal entity and board of directors, and we raised $100k in donations. 3. 2014 was a big year. With Dick Cotton’s leadership, ACSM donated the services of a psychometrician to lead a job task analysis process, gathering 15 coaches with varied backgrounds for three days of discussion in Indianapolis to define the job tasks (tasks, knowledge, and skills), further validated by 1,000 practicing coaches. Armed with the job task analysis, and following the best practices DACUM process, we gathered 19 coaching leaders to collaborate in Minneapolis for three summer days on moving toward a consensus on the minimum training and education standards for the health and wellness coach. We invited advisors from ICF and other organizations to assist. The consensus and detailed minimum program standards evolved over the next six months to 60 hours of coaching skills training, 15 hours of healthy lifestyle knowledge, 3 mentor coaching sessions, and a pass/fail practical skills assessment, to be eligible for the national certification examination. We also agreed on a transition phase, ultimately from 2016-2021, with a lower standard - at least 30 hours of coaching skills training and a pass/fail practical skills assessment. We published the standards for public comment by May 2015. 4. In early 2015, Wellcoaches coach Leigh-Ann Webster joined the team as the first paid staff member, serving as the NBHWC operations manager. Now Leigh-Ann is the NBHWC Executive Director – a spectacular rise of a brilliant leader who has built an incredible team of rising leaders. We set out to find a partner to build a certification examination and reached out to several organizations. With great foresight, David Eisenberg introduced Don Melnick, then president of NBME, to me in spring 2015, which evolved into a 2016 MOU, and then a complex, multi-year negotiation, multi-million dollar investment, and formation of NBHWC as a non-profit NBME affiliate, starting up in January 2019. In parallel, we created a certification competency blueprint (team of 6, with Ruth Wolever and me doing much of the heavy-lifting), and creation of the first 600 certification examination items (team of 20+ coaching leaders). 5. Fast forward to 2022, NBHWC is now a financially healthy and growing organization, in its sixth year in delivering the national board certification examination for health and wellness coaches. NBHWC has approved 100+ programs to train health and wellness coaches eligible for the examination and certified 7,000 coaches, including nearly 1,000 Wellcoaches coaches who have accomplished a 93.1% pass rate. 6. Since 2019, my focus has been building the Healthcare Commission that is forging the path to billing and reimbursement of coaching services in healthcare, generating the economic foundation for the role of the coach. In 2019, with the VA’s leadership, we earned approval of Category III codes for health and well-being coaching services. In 2021, we established a taxonomy code for the health and wellness coach to work in healthcare, as well as guidance for coach use of various CPT codes. Erika Jackson, Chief Coaching Officer @ Wellcoaches is a member of the Program Approval Commission, assisting in the ongoing evolution of national standards. Through my 14 years of volunteer leadership and contributions, frequently two or more days of my workweek, I have helped lay down the foundation for our beloved profession – the vigorous teamwork and multiple intense retreats that led over five years to the standards and job task analysis, the rigorous weeks and months invested to meet the NBME certification standards and build a high-quality examination, a demanding three years of negotiations with the NBME legal team, starting up a five-year collaboration with the CDC on group coaching, the creation and execution of a robust business plan and high-functioning NBHWC board, and now the many hours and days preparing for the AMA CPT Panel meetings. My deepest gratitude goes out to the many friendships and rich collaborations with the top leaders across our field that continue to grow as we now have an NBHWC team that is more than 70 – 7 staff, 13 board members, and 30 volunteer leaders on four commissions, as well as a large team of 20+ that continues to evolve the certification examination. We really can move mountains together! Onward & upward! Margaret Moore, aka Coach Meg Founder/CEO, Wellcoaches Corporation Co-Founder, Board member, NBHWC

The Sept/Oct issue of the American College of Sport Medicine’s Health and Fitness Journal was a special themed issue with articles focusing on wellness throughout the lifespan – or, as we are asked to do, refocus on “healthspan” instead of lifespan. This issue contains our article (David Diggin was my co-author) entitled “Enhancing Wellness During Young Adulthood.” In this paper we provided a roadmap for improving wellness to fitness professionals working with young adults (roughly 18-45 years). A big part of the article placed emphasis on understanding barriers to wellness, such as lack of time, resources, and/or support. The interconnectedness of these barriers was discussed so that the fitness professional might understand the complexity of obstacles faced. As an example, imagine time is short at work and friends ask you to catch a “fast food” lunch during your designated walk/exercise break. Ouch – conflict - social pressures and times pressures now challenge good intentions for exercise and a healthy diet. These are struggles young adults face quite frequently -some manage the challenge, but many do not - complicated stuff! Several strategies to motivate young adults (e.g., gamification, persuasive technologies) toward wellness goals were offered in the article as help with overcoming barriers. Gamification is what it sounds like, making a game (e.g., accumulating points) out of achieving wellness goals. A good example of persuasive technologies is using a fitness app/cell phone to aid in exercise efforts. The suggestion to understand and encourage the formation of habits was also made in the paper – with a habit being a healthy behavior done while requiring a minimal effort or little cognitive resource. A common example is brushing our teeth before going to bed at night. Trying 5-10 minutes of meditation before going into a challenging meeting or preparing nutritious lunches for the week on Sunday afternoon, are other healthy habits one might consider adopting. Goal setting with clients was also discussed. Before concluding the paper, there was a recommendation for fitness professionals to remember the experts. When a client can’t seem to overcome obstacles - is just stuck and ready to throw in the towel; this is not the time to give up …. it is the time for fitness professionals to refer to a health and wellness coach (HWC). The article advocates for the effectiveness of the coaching process and suggests clients can be moved from wellness contemplators to action with professional help. To optimize clients’ chances for success, a fitness professional must recognize when it is time to call for a HWC's help. Fitness professionals should have contact info for one or two good wellness coaches. As coaches we should remember this advice cuts both ways! HWCs are advised to include fitness professionals in their professional network – they are important collaborators clients moving clients toward their wellness goals. The article concludes by emphasizing how important young adulthood is for developing healthy habits (e.g., an active lifestyle) that will influence well-being later in life. The fitness professional is urged to work with the young adult in overcoming wellness obstacles while being reminded a HWC coach is there if they need help with a tough client. If you want to access the original article here is the link – sorry but the publisher is only making the abstract available for free. CITATION Sforzo, Gary A. Ph.D., Diggin, David Ph.D. ENHANCING WELLNESS DURING YOUNG ADULTHOOD, ACSM's Health & Fitness Journal: 9/10 2020 - Volume 24 - Issue 5 - p 32-37 doi: 10.1249/FIT.0000000000000605

I imagine I'm not alone in my fantasy of being a drummer... ...living in the flow of sensing rhythm, creating rhythm, tapping into rhythm, or simply being the rhythm. Alas, like many of us, I don't have a natural aptitude for drumsticks. I look for rhythm, finding my groove, mostly in my work. What's a groove? Merriam-Webster describes a groove as a situation suited to one's abilities and interests, an enjoyable experience or rhythm, a sense of harmony with one's world. Most people who find their groove, find it through work. Gallup authors reported in the book Five Elements of Well-being that career well-being (liking what you do at work) matters the most. In positive psychology, Martin Seligman's PERMA model could be described in terms of grooving - we engage and expand our strengths in activities that bring higher meaning and enable achievement, thereby generating the positive emotions we get from grooving. Self-determination theory is another model of grooving - we have autonomy-supporting relationships, the social nutriments that enable our adventurous pursuit of interesting activities that make us feel ever-more competent through mastering new challenges. Let's give thanks to grooving job crafting scientists, translating positive psychology and self-determination theory into everyday work. They have shown through 100+ studies that we groove when we get to shape our work so that: it's meaningful uses our strengths grows our competence generates nourishing relationships brings interesting opportunities, and supports our non-work well-being - mind, body, and life. Labor Day 2022 If there was ever a moment to find our groove, to reinvent the experience of work, it's now. Those at Gallup who groove in gathering and analyzing data have been telling us for a long while about the crisis of low work engagement (no rhythm, no groove - emotionally detached). The 2022 Gallup global workplace data shows that only 33% of workers in the US and Canada are engaged (the highest scores globally), dropping to 14% in Europe (the lowest scores). The Washington Post noted: More than two years of a pandemic have jolted the meaning of work and the way employees think about it. The consequences are just unfolding... Millennials and Gen Zers are shifting ambitions from wanting to reach the top to having a meaningful effect on their communities, nation and the world. Our jobs are not loving us back, notes a cited Elle article on women's new take on ambition. This summer, McKinsey published an article on COVID 19 as a catalyst to cancel burnout cultures - workplaces that ask from workers more than they get back, throwing them out of their grooves. “People aren’t just quitting their jobs, they’re rejecting the idea that burnout is the price they have to pay for success,” said Arianna Huffington... Whatever accelerating work trend resonates most: the engagement crisis, the great resignation, quiet quitting, or the burnout epidemic, it all boils down to work ill-being, which drives our well-being downhill. More than that, work ill-being is a colossal, if not tragic, waste of human potential. How might we groove at work on a large scale? Zooming out, we can see a shift coming in capitalism - a shift in the longstanding, implicit deal between capital and workers. Recent Harvard Business School Dean Nitin Nohria wrote about it in HBR magazine this summer: Today workers up and down the socioeconomic ladder are reexamining their commitment to employers and the fairness of the existing bargain between capital and labor. Our deep questioning of capitalism is no surprise. If our work lives are a main driver of overall well-being, and work is failing to deliver what humans want dearly, than it is time for a new deal. How about we ask "capitalism" (leaders, bosses, investors) for a new deal: growing wealth and growing well-being together. Instead of consuming well-being for work, we all make well-being a product of work. We need to ask for more than corporate wellness - including physical well-being (eating, exercise, sleep, etc), and mental/emotional well-being (mindfulness, self-compassion, resilience, balance, recharge, etc), along with fair financial compensation. We need to properly integrate our groove - crafting personally meaningful work, that uses our strengths, grows our competence, generates nourishing relationships, and brings interesting opportunities. The future of work is good - more wealth and well-being, grooving together. Coach Meg. www.coachmeg.com Find a coach. Find your groove: www.wellcoachesnetwork.com

The August 2022 Online first edition of the American Journal of Lifestyle Medicine (AJLM) published our new paper about health and well-being coaching research. This issue contains our article (Sebastian Harenberg and Joel Edman are my co-authors) entitled “A Rubric to Assess the Design and Intervention Quality of Randomized Controlled Trials in Health and Wellness Coaching.” While the title is a mouthful, read on. We developed a rubric (a checklist of questions) to examine the quality of a research study from two perspectives: how well the study was designed and how well the coaching intervention was planned and implemented. In all, the rubric we created contains 28 items. Of these, 15 address study design criteria and 13 examine coaching intervention criteria. The questions related to study design assess items such as participant recruitment, participant allocation to group, exclusion criteria, sample size, control group management, outcome measures, and statistical analyses. The rubric questions are scored 0-1 or 0-2, and the greater the total score the better the assessment of study design quality. For studies of health and well-being coaching, it is also essential to examine the structure and implementation of the coaching intervention. The rubric questions addressing the quality of coaching intervention ask about items such as coach training, certification, and experience. Questions on the coaching intervention include coaching session frequency, duration, and program length (in months). Finally, the rubric also calls for a description of the coaching process, coach quality checks during the research project, and client adherence. Using the rubric, a given research paper might potentially score high on study design and low on coaching intervention, or vice versa. The best research papers score high on both dimensions. Check out the full-length article, which is cited below and is available open access from AJLM Sage publishing website. https://journals.sagepub.com/doi/full/10.1177/15598276221117089 Once the rubric items were selected, they were reviewed by research design and coaching experts. The items were also crossed-scored on 29 articles by the study authors to establish reliability. In other words, all three authors read 29 health and well-being coaching research papers and scored those articles using the rubric. An intraclass correlation of .85 (ICC = .85; CI95% - .68-.93) indicated very good levels of agreement between the three of us (study authors: Harenberg, Sforzo, Edman). These processes of gathering expert opinion and checking reliability provide a measure of validity for the new rubric. We have encouraged other authors to use the rubric in their work and further validate it as a useful tool for assessing health and well-being coaching research. In this paper, we applied the rubric to randomized controlled trials (RCTs) studying patients with Type 2 diabetes (T2D; n = 11 articles) or RCTs studying patients with obesity (n = 18 articles). The total rubric score for the T2D studies turned out to be slightly greater than found for the obesity studies – mainly because the scores for coaching intervention design were higher in the T2D research examined. This serves as a caution for readers of those obesity studies and as a reminder to future researchers of health and well-being coaching when applied in an obese patient population. It is important to carefully design and implement the coaching intervention. Only with a well-designed, described, and implemented coaching protocol can we optimize and best understand the effects of coaching. Those papers with carefully designed and presented coaching methodologies contain the research propelling the field forward and informing us how to apply the best coaching strategies in practice. We believe the most valuable contribution of the new rubric and this publication lies in application for future research. Rather than thinking of the rubric as an evaluation tool, it is best thought of as a roadmap for designing future health and well-being coaching research. When planning a project, researchers can look at the rubric and check off criteria to maximize rubric score and design the best possible study. We know from our Compendium work (2,3) the quantity of health and well-being coaching research is rapidly expanding. It is important to the development of health and well-being coaching profession that the quality of coaching research is continuously improved going forward. This article and the related explanation may seem like way too much information for the average health and well-being coach – why would they need to know how to assess research? Maybe they don’t! However, the typical coach benefits from understanding the status of the existing research and having an appreciation that this base of knowledge is being examined for quality. With such knowledge, a practicing coach can confidently apply state of the art methods and techniques with their clients. We expect application of the rubric will improve the future of health and well-being coaching research and thereby improve the standards of coaching. CITATIONS Harenberg S, Sforzo GA, Edman J. A Rubric to Assess the Design and Intervention Quality of Randomized Controlled Trials in Health and Wellness Coaching. American Journal of Lifestyle Medicine. August 2022. doi:10.1177/15598276221117089 Sforzo GA, Kaye MP, Todorova I, et al. Compendium of the Health and Wellness Coaching Literature. American Journal of Lifestyle Medicine. 2018;12(6):436-447. doi:10.1177/1559827617708562 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

Editor’s Note: This article was originally written as a research dose for the Institute of Coaching. Become a member of the Institute of Coaching to access thousands of resources on coaching science. To get a 40% discount, select Wellcoaches when asked. Positive emotions generate precious resources - they improve thinking, behavior, mood, and physiology, in turn improving self-efficacy, optimism, work engagement, creativity, stress coping and resilience, health, teamwork, relationships, customer satisfaction, and leadership. Positive emotions can be directly improved in organizations using practical techniques, leading to enduring resources and upgrading work enjoyment and performance for all. Introduction In April 2021, we lost a giant in the science of well-being – Ed Diener. This article features one of Ed Diener’s last publications (in collaboration with Stuti Thapa and Louis Tay) – a mega review on positive emotions at work (2020) addressing some important questions for coaching: How are positive emotions defined at work? How can we regulate our positive emotions? How do positive emotions exert their effects? What resources do positive emotions expand in the workplace? What are other interesting findings on positive emotions? 1. How are positive emotions defined at work? The first perspective – discrete positive emotions Scientists have explored and defined “discrete” positive emotions or constructs including gratitude, awe, pride, interest, optimism, and humor. The authors note that this perspective leads to studies of the effects of discrete emotions, for example: “different positive emotions have differential effects on job attitudes where pride is linked to psychological empowerment, interest is linked to work satisfaction, and gratitude is linked to satisfaction with supervisors and colleagues.” One study showed that work-related gratitude positively predicts job satisfaction and negatively predicts emotional exhaustion and depersonalization. Another study showed that awe led to the perception that time is more plentiful, reduced impatience, increased willingness to volunteer time, and much-improved goal progress. The second perspective – positive valence or feeling good The common thread of discrete positive emotions is their underlying dimension of feeling good – they have a positive valence or mood, which brings us to the second perspective. Positive valence (a general sense of feeling good rather than a specific type of good feeling like inspired, enthusiastic or proud) has been shown to be associated with positive individual and organizational outcomes, including better performance and job attitudes. The third perspective – positive adaptive function The authors describe a third perspective - positive adaptive function: “Emotions are regarded as positive insofar as they lead to positive personal and organizational outcomes; positivity is… the outcomes it produces… No emotion is universally “good” or “bad” but its value is context-dependent. For example, anger may be considered to be negative, but it can have prosocial functions if elicited by perceptions of injustice and unfairness and then induces remedial behavior to address the wrongdoing… A recent meta-analysis showed that shame can be positive, as it leads to prosociality and self-improvement when reparative actions can be taken. Although inducing gratitude can lead to prosocial behavior, it can have burdening and negative effects on the helpers.” 2. How can we regulate our positive emotions? First, regulatory approaches that highlight, harness, and sustain positive emotions include cognitive practices such as savoring, positive rumination, journaling, and sharing one’s blessings or gratitude with others. A second approach is behavioral strategies that can improve the quality and quantity of positive emotions including: being present and paying attention to the positive in current moments expressing positive emotions in communications celebrating positive events to amplify positive emotions summoning a specific positive emotion, such as optimism, gratitude, or a positive reinterpretation A third type of emotion regulation promotes emotional integrity—where the inner experience and outer expression of emotions are authentic and aligned. Emotional authenticity is both valued and less draining. An example is the concept of deep acting, as opposed to surface acting, where deep acting is the practice of modifying the inner emotion required of a job, whereas surface acting is merely modifying external emotional expressions. Deep acting is preferable, having shown more positive outcomes than surface acting. A fourth approach in emotion regulation is the multi-faceted construct of emotional intelligence, the ability to understand and distinguish one’s own and others’ emotions and use that knowledge to guide thoughts and behavior. Interestingly, there is a bi-directional street between positive emotions and regulation strategies for positive emotions – more of one generates more of the other, creating an upward spiral. Emotion regulation strategies have been shown effective for both undoing negative emotions and up-regulating positive emotions. A study of six emotion regulation strategies (reflection, reappraisal, rumination, distraction, expressive suppression, and social sharing) found that rumination and expressive suppression decreased positive emotions, whereas reflection increased positive emotions. Positive humor has been shown to down-regulate negative emotion and up-regulate positive emotion. 3. How do positive emotions exert their effects? The authors synthesize the literature into four channels that generate positive outcomes: cognition, affect, behaviors, and physiology. Emotion to cognition to outcome Maintaining (or savoring) and enhancing positive emotions through cognitive processes can promote positive outcomes such as more open-mindedness and more strategic thinking and creativity, which is the basis of positivity spirals (i.e., positive emotions beget more positive emotions— both degree and types of positive emotions) and undoing effects (i.e., positive emotions reduce the effects of negative emotions). In the work context, a study showed that high positivity reduced the impact of negative emotions in reducing job satisfaction. Emotion to behavior to outcome The authors explain: “positive emotions lead individuals to engage in novel and larger behavioral repertoires that lead to new opportunities and building of new skills. Positive emotions are related to positive promotion-focused individual behaviors that are important for worker health and productivity such as healthier eating, exercise, better sleep and stress management, and social behaviors like collaboration and cooperation.” Emotion to emotion to outcome “In addition to the direct experience of positive emotions, emotion expressions act as social information and can spread to others, creating positive emotion contagion. For example, genuine smiles (or Duchenne smiles) promote perceptions of employee friendliness and customer satisfaction; positive emotion expressions are associated with more positive social outcomes such as greater potential for business relationships and cooperation.” Emotion to physiology to outcome Substantial research supports the role of positive emotions in generating positive health outcomes such as greater longevity, lower intensity of illness, higher immune resistance, reduced inflammation, and better physiological recovery. Three physiological systems—cardiovascular functioning (lower heart rate and blood pressure), endocrine functioning, and immune functioning—are improved by positive emotions. 4. What resources do positive emotions expand in the workplace? Positive emotions expand resources, building physical, intellectual, social, and psychological resources that support positive outcomes or buffer against the damage of stressful situations. These resources include longer-term, habitual patterns of cognitions, behaviors, emotional responses, and physiology. The authors explain: “the broaden-and-build theory proffers the view that positive resources are an outcome of cumulative effect of positive emotions over time and are explicitly described as enduring.” These ten enduring resources are listed below and summarized in the Appendix: Positive belief in self, including self-efficacy Creativity Work engagement Stress coping and resilience Health Teamwork Relationships Customer satisfaction Leadership Performance 5. What are other interesting findings on positive emotions? Fluctuations in positive emotion, regardless of the mean levels or intensity of positivity, is maladaptive. A high level of reactivity to negative events (quick drops in positivity) may be maladaptive to well-being. There are daily cycles for positive emotions but not negative emotions, and weekly cycles for both, where people have higher positive affect during the weekend and then “blue Mondays” where people have steep downward slopes in positive emotions. Seasons can influence emotion states – some experience less positive mood in winter than summer. Positive outcomes don’t always emerge from positive emotions, as they can sometimes lead to shallow, cognitive processing. Negative moods can be sadder-but-wiser, leading to deeper cognitive processing. Maximal happiness is not ideal. While those who experience the highest levels of happiness have better close relationships and engage in more volunteer work, those who experience slightly lower levels of happiness have greater success in terms of income, higher rates of employment, and greater political participation. There are cultural differences - happiness is associated with personal achievement in Western societies in contrast to interpersonal connectedness in Eastern societies. In Eastern societies, positive low arousal emotions (e.g., calm) rather than positive high arousal emotions (e.g., excited) appear to be more related to positive outcomes. For example, European Americans preferred excited (versus calm) applicants, whereas the converse was true for Hong Kong Chinese. Individuals’ emotional experiences have a much more profound influence on the judgment of life satisfaction in individualist cultures than in collectivist cultures. It's important to note, that a focus on improving positive emotions in organizations is optimally combined with a focus on navigating negative emotions, including mindfulness, self-compassion, emotional agility, and post-traumatic growth. In February 2022, Wellcoaches shifted its credential title to reflect the value of well-being. While the terms wellness and well-being were used interchangeably, this has now changed. In recent years, the burst of scientific exploration of the domain of well-being has been profound. Well-being has now overtaken wellness as a larger, broader, and deeper construct of human flourishing and thriving. This change is energizing and expansive for the Wellcoaches community as we integrate the fullness of the well-being domain (physical, psychological, life, work) into health and well-being coaching. Takeaways for coaches Organizations can benefit by developing a workplace that cultivates positive emotions. Organizations can consciously manage and shape a positive emotional culture (e.g., a culture of joy/fun/love versus a culture of fear/anger) that can enhance organizational performance downstream. In coaching, you can: Intentionally cultivate authentic positive emotions as resources for change and well-being for your clients during coaching sessions, using appreciative inquiry techniques for example. Consider using the positivity ratio to help your clients get a quick read on their levels of positive emotions and negative emotions. Help your clients understand the various approaches to regulating positive emotions and negative emotions. Help your clients understand the organizational impact of elevating positive emotions – self-belief, engagement, creativity, teamwork, relationships, health, customer satisfaction, leadership, and performance. Citation: Diener, E., Thapa, S., & Tay, L. (2020). Positive emotions at work. Annual Review of Organizational Psychology and Organizational Behavior, 7, 451-477. Appendix Resources improved by positive emotions in organizations Positive belief in self The authors summarize: “positive emotion enhances positive belief in self that arm individuals against negative consequences of negative experiences. Self-efficacy is one such positive belief that has clear connections to work motivation and performance. There is substantial evidence that positive emotions promote self-efficacy. There is also evidence that people in a good mood set more ambitious goals and have higher expectations. Therefore, people who feel good see the world in a more optimistic light and have more positive beliefs about succeeding, which in turn promotes higher performance downstream. Studies also suggest that positive emotions are related to increases in ego-resilience over time.” Creativity Say the authors: “In the creativity literature, positive emotion (conceptualized often as mood) is one of the most reliable predictors of the creativity process. Multiple meta-analyses of the influence of positive mood on creativity have found positive moods to be a predictor of the creativity process (e.g., flexibility and fluency, the number of unique ideas produced) when compared to control conditions. For example, one study showed that physicians in a positive mood were more flexible and made more accurate diagnoses when solving a case of a patient with liver disease.” Work engagement Work engagement is a positive work-related state of mind, characterized by vigor (high energy and motivation to invest effort at work), dedication (strong involvement in work and experiencing pride and enthusiasm about work), and absorption in work (flow at work). Positive emotions have been shown to be a driver of work engagement, and their lack leading to disengagement. Coping Positive emotions and emotion regulation approaches can help people be resilient and cope with the inherent stress of work, supporting solving problems, planning, and positive reinterpretation rather than some of the less effective emotion-focused strategies such as avoidance, denial, disengagement, and turning to alcohol and drugs. One study showed that those with high levels of emotional intelligence use emotion-focused coping such as venting, denial, and disengagement, for both letting go of negative emotions and prolonging positive emotions (e.g., joy). Health “Multiple meta-analyses have found positive moods to be associated with better health and greater longevity… Research suggests that positive affect was associated with lower blood fat and blood pressure and a healthier body mass index…People with low levels of positive feelings were at a higher risk for heart disease….Experimental studies have found that inducing positive feelings led to faster cardiovascular recovery.” Teamwork “Positive emotions can contribute to collaborative behavior as well as choices and trust. Negotiation studies have found that positive emotions boost cooperative and collaborative behavior instead of withdrawal or competitive behavior. Individuals induced with positive moods are more willing to make concessions. Moreover, displaying positive emotions during negotiations can lead to increased interest in future business relationships and the likelihood of closing a deal as well as greater concession from the other party. In group managerial settings, induced positive affect promoted positive emotion contagion; in turn, it improved cooperation, decreased group conflict, and increased perceived task performance.” Relationships “There is firm evidence for the relation between positive emotions and good relationships; additionally, some studies also show that positive emotions may causally lead to better relationships...Experimental studies find that positive mood induction leads to interpersonal communication and self-disclosure, improved social skill assessments, and lasting social relationships.” Customer satisfaction “There is also a body of work showing a causal relation between positive emotions of employees to positive customer experience. Studies have identified emotion contagion as one of the explanations for how positive mood of workers can lead to better customer satisfaction….One study found that positive behaviors of shoe salespeople, such as greeting, smiling, and eye contact, correlated with customers’ in-store positive mood and subsequently the time they spent in the store and their willingness to shop there again. In general, there is evidence that positive emotions can promote greater sales performance through higher customer satisfaction.” Leadership “Positive emotions are recognized as a crucial aspect of charismatic, transformational, and authentic leadership…Theoretical and empirical work on authentic leadership posits positive emotion as a distinguishing feature between authentic and nonauthentic leadership…Authentic leaders affect employee creativity through the mediating role of employees’ positive affect and hope.” Performance “Research has shown that individuals disposed to positive affectivity perform better in ratings on decisional and interpersonal tasks. Furthermore, positive interpersonal affect has been shown to be associated with better performance ratings…One study found that collective positive emotions led to team resilience, which in turn leads to increased team performance as measured using supervisor ratings.”

In 2006 I began a journey to discover the purpose God had created me for. While watching what I thought to be an action movie in early 2007, I was introduced to the issue of human trafficking and was wrecked to the core. Not only did I know I had to do something, I also knew I had found “my thing” and truly felt in my spirit that one day I would be working for an anti-trafficking organization. Over the years, I took several mission trips overseas to serve at safe houses and during those trips discovered my passion for working with survivors as they endeavor to recover, restore and heal from the physical and emotional trauma they endured. Yet, I never felt called to study mental health. In 2019, my employer enrolled me in the Wellcoaches Coach Training as part of my Wellness Coordinator role. During the 4-day onsite initial training we went through the process of crafting our Wellness Vision. I was slightly surprised to see working in human trafficking show up in that vision. While I was still passionate about the issue, I had encountered many roadblocks in my efforts to serve in the space domestically. But there was no denying its need to be a part of my wellness vision. In early 2020, while attending an event, I heard a speaker who from a local anti-trafficking organization, Harbour Hope International, whose main mission is to provide mentoring relationships to survivors of human trafficking on their journey towards self-sustainability. I again felt the strong conviction that this was the place I was to pour out my passion. I went through their volunteer training and began serving as a mentor for a survivor. As my mentor partner and I helped our mentee establish goals for her life, I realized I had finally found the place for all of my Wellcoaches training to be applied in a way I was extremely passionate about. As the issue of trafficking continues to grow, so does our need for mentors to come alongside those survivors who are lucky enough to leave “the life”. In July of 2021 I was offered a position with Harbour Hope as their Mentor Program Coordinator, leading our mentor teams that are serving survivors on a daily basis. The skills I acquired during my Wellcoaches training perfectly prepared me for this position, equipping me to help guide others to discover how to be the best version of themselves, unlocking the great potential that already lies within but simply needs to be uncovered. When survivors of trafficking make the brave step to leave the life for good, they come with a lot of baggage but little self-efficacy in their ability to do anything but the life they came from. Witnessing the transformation of the heart, mindset and behaviors of these individuals, facilitated by the Wellcoaches approach to coaching, is truly life-changing – for me as a coach and the survivors we serve. It moves these courageous individuals from a life of literally just surviving to an expectant future of thriving. As my mentor team grows to accommodate the need, the evidence-based and practical protocols learned in my Wellcoaches certification allow me to help my mentors discover what sets their soul on fire and how they can step confidently & fully into that vision. While I appreciate every aspect of the comprehensive Wellcoaches training, creating my wellness vision and then watching it become my reality, has been the most motivating byproduct of the experience. Knowing we get to do the same for others is a blessing I feel honored to be a part of.

Today, more than 14,000 coaches in 50 countries have been trained in the Wellcoaches protocol, which was first designed and tested in 2000-2002 for the launch of the first Wellcoaches coach training program in September 2002. The protocol continued to expand, deepen, and evolve through the teamwork of ten Wellcoaches faculty, leading to its publication in the Wellcoaches Coaching Psychology Manual by Wolters Kluwer in 2009 (2nd edition in 2016). Research Since 2009, research teams in the US and Europe have designed, implemented, and published 22 outcomes-oriented studies of the Wellcoaches protocol, delivered by Wellcoaches trained and certified coaches, in peer-reviewed scientific journals. The evidence base consisting of 22 data-based studies of the Wellcoaches protocol, from 2009 to 2020, involved 623 coaches serving 34,0646 clients and delivering 129,225 coaching sessions. All 22 studies produced beneficial results with statistically significant outcomes. These 22 studies (summarized in the Table) are diverse in patient/client application, settings, demographics, and locations: Applications - patients or clients with obesity, pre-diabetes and diabetes, cancer, fibromyalgia, cardiovascular risk factors, smoking cessation, in need of lifestyle medicine or enhanced wellness behaviors. Settings - implemented in primary care practices, hospitals, community clinics, medical fitness programs, and employee wellness centers. Demographics – young, middle-age, and older adults, military, health-care workers, minority and low income, rural and urban settings Locations – throughout the US (15 states) and abroad. Weight Management There are five published studies of the Wellcoaches protocol addressing weight management. Weight loss was achieved in all four studies where it was a goal. The fifth study focused on disordered eating syndromes and showed diminished incidence of binge-eating in the 225 patients studied. Diabetes There are four research papers describing the impact of Wellcoaches protocol in patients with diabetes and/or pre-diabetes. Three of these studies tested A1C and all found a beneficial reduction in this primary diabetes outcome measure. The fourth study did not evaluate A1C; it found improved autonomy and self-efficacy, implying better diabetic self-care, after experiencing the coaching intervention. Risk Factors & Wellness There are nine research papers studying the Wellcoaches protocol for improvements in wellness, lifestyle medicine, and cardiovascular disease risk factors. These studies are unanimous in finding health benefits such as reduced blood pressure, lower BMI, improved fitness, lower anxiety, smoking cessation, and improved physical functioning. There are also reports of enhanced exercise habits and improved nutritional behaviors. Fibromyalgia and Cancer The beneficial results in studies of cancer and fibromyalgia include reduced anxiety and pain, reduced use of health care services, and improved quality of life. Physician Burnout Wellcoaches coaches adapted the Wellcoaches protocol to mitigate the effects of burnout for primary care physicans. After six coaching sessions, reduced burnout, improved job satisfaction and psychological capital were reported. Conclusions 1. The Wellcoaches protocol is the most thoroughly tested coaching protocol. 2. The evidence base for the Wellcoaches protocol includes 22 studies published in scientific journals between 2009 and 2020. 3. All 22 studies showed beneficial and statistically significant outcomes. 4. These studies involved 623 Wellcoaches-trained coaches serving 34,064 clients and delivering 139,225 coaching sessions. 5. The 22 studies addressed diverse: a. challenges including obesity, diabetes, cardiovascular risk factors, smoking cessation, lifestyle medicine/wellness behaviors, cancer, fibromyalgia, and physician burnout. b. demographics: age, low income, minority, military, healthcare workers, rural and urban populations, US and Europe. c. settings including primary care, community clinics, medical fitness facilities, hospitals, and employee wellness. Overview of published Wellcoaches Protocol studies Citations 1. Ahn S, Lee J, Bartlett-Prescott J, Carson L, Post L, Ward KD. Evaluation of a Behavioral Intervention with Multiple Components Among Low-Income and Uninsured Adults With Obesity and Diabetes. Am J Health Promotion 2018;32(2):409-422. doi:10.1177/0890117117696250 2. Berman MA, Guthrie NL, Edwards KL, Appelbaum KJ, Njike VY, Eisenberg DM, Katz DL. Change in Glycemic Control With Use of a Digital Therapeutic in Adults With Type 2 Diabetes: Cohort Study. JMIR Diabetes 2018; 3(1):e4. doi: 10.2196/diabetes.9591. PMID: 30291074; PMCID: PMC6238888 3. Djuric Z, Segar M, Orizondo C, Mann J, Faison M, Peddireddy N, Paletta M, Locke A. Delivery of Health Coaching by Medical Assistants in Primary Care. J Am Board Fam Med. 2017 May-Jun;30(3):362-370. doi: 10.3122/jabfm.2017.03.160321. PMID: 28484068; PMCID: PMC5634140 4. Edman JS, Galantino ML, Hutchinson J, Greeson JM. Health coaching for healthcare employees with chronic disease: A pilot study. Work 2019;63(1):49-56. doi: 10.3233/WOR-192907. PMID: 31127744. 5. Eisenberg DM, Righter AC, Matthews B, Zhang W, Willett WC, Massa J. Feasibility Pilot Study of a Teaching Kitchen and Self-Care Curriculum in a Workplace Setting. Am J Lifestyle Med. 2017;13(3):319-330. doi: 10.1177/1559827617709757. 6. Galantino ML, Schmid P, Milos A, Leonard S, Botis S, Dagan C, Albert W, Teixeira J, Mao J. Longitudinal Benefits of Wellness Coaching Interventions for Cancer Survivors. The International Journal of Interdisciplinary Social Sciences: Annual Review 2009: 4 (10): 41-58. doi:10.18848/1833-1882/CGP/v04i10/53020 7. Guthrie NL, Berman MA, Edwards KL, Appelbaum KJ, Dey S, Carpenter J, Eisenberg DM, Katz DL. Achieving Rapid Blood Pressure Control With Digital Therapeutics: Retrospective Cohort and Machine Learning Study. JMIR Cardio. 2019; 12;3(1):e13030. doi: 10.2196/13030. PMID: 31758792; PMCID: PMC6834235. 8. Hackshaw KV, Plans-Pujolras M, Rodriguez-Saona LE, Moore MA, Jackson EK, Sforzo GA, Buffington CA. A pilot study of health and wellness coaching for fibromyalgia. BMC Musculoskelet Disord. 2016 Nov 8;17(1):457. doi: 10.1186/s12891-016-1316-0. PMID: 27821160; PMCID: PMC5100173. 9. Hildebrandt T, Michaeledes A, Mayhew M, Greif R, Sysko R, Toro-Ramos T, DeBar L. Randomized Controlled Trial Comparing Health Coach-Delivered Smartphone-Guided Self-Help With Standard Care for Adults With Binge Eating. Am J Psychiatry 2020 Feb 1;177(2):134-142. doi:10.1176/appi.ajp.2019.19020184. 10. Long DA, Reed RW, Duncan I. Outcomes Across the Value Chain for a Comprehensive Employee Health and Wellness Intervention: A Cohort Study by Degrees of Health Engagement. J Occup Environ Med. 2016 Jul;58(7):696-706. doi: 10.1097/JOM.0000000000000765. PMID: 27294443. 11. McGloin H. Exploring the potential of telephone health and wellness coaching intervention for supporting behaviour change in adults with diabetes. Journal of Diabetes Nursing 2015:19:394-400. 12. McGonagle AK, Schwab L, Yahanda N, Duskey H, Gertz N, Prior L, Roy M, Kriegel G.. Coaching for primary care physician well-being: A randomized trial and follow-up analysis. Journal of Occupational Health Psychology 2020: 25(5), 297–314. https://doi.org/10.1037/ocp0000180 13. Mielenz TJ, Tracy M, Jia H, et al. Creation of the Person-Centered Wellness Home in Older Adults. Innov Aging. 2020;4(1): 1-13. igaa005. doi:10.1093/geroni/igaa005 14. Mettler EA, Preston HR, Jenkins SM, Lackore KA, Werneburg BL, Larson BG, Bradley KL, Warren BA, Olsen KD, Hagen PT, Vickers KS, Clark MM. Motivational improvements for health behavior change from wellness coaching. Am J Health Behav. 2014 Jan;38(1):83-91. doi: 10.5993/AJHB.38.1.9. PMID: 24034683. 15. Rivera LO, Ford JD, Hartzell MM, Hoover TA. An Evaluation of Army Wellness Center Clients' Health-Related Outcomes. Am J Health Promot. 2018 Sep;32(7):1526-1536. doi: 10.1177/0890117117753184. Epub 2018 Feb 5. PMID: 29402124. 16. Roy BA, Roberts PA, Lisowski C, Kaye MP, Sforzo GA. Integrating Health Coaching With a Medical Fitness Program to Treat Chronic Health Conditions. Am J Lifestyle Med. 2017;14(3):326-334 doi:10.1177/1559827617728025 17. Schwartz J. Wellness Coaching for Obesity: A Case Report . Global Adv Health Med. 2013;2(4)68-70. DOI: 10.7453/gahmj.2013.029 18. Sforzo GA, Kaye MP, Simunovich S, Micale FG. The effects of health coaching when added to a wellness program. Journal of Workplace Behavioral Health, 31:4, 242-257, doi: 10.1080/15555240.2016.1228463 19. Sforzo GA, Kaye M, Ayers GD, Talbert B, Hill M. Effective Tobacco Cessation via Health Coaching: An Institutional Case Report. Glob Adv Health Med. 2014 Sep;3(5):37-44. doi: 10.7453/gahmj.2014.029. PMID: 25568823; PMCID: PMC4268607. 20. Sherman RP, Petersen R, Guarino AJ, Crocker JB. Primary Care–Based Health Coaching Intervention for Weight Loss in Overweight/Obese Adults: A 2-Year Experience. Am J Lifestyle Med. 2019;13(4):405-413. doi.org/10.1177/1559827617715218 21. Sherman RP, Ganguli I. Primary Care-Based Health Coaching for the Management of Prediabetes. Am J Lifestyle Med. 2017; Apr 11;12(2):175-178. doi: 10.1177/1559827617702074. PMID: 30202390; PMCID: PMC6124994. 22. Tucker LA, Cook AJ, Nokes NR, Adams TB. Telephone-based diet and exercise coaching and a weight-loss supplement result in weight and fat loss in 120 men and women. Am J Health Promot. 2008;23(2):121-9. doi: 10.4278/ajhp.07051646.

In February 2022, the American Journal of Lifestyle Medicine published our article entitled “Dosing of Health and Wellness Coaching for Obesity and Type 2 Diabetes: Research Synthesis to Derive Recommendations.” The primary purpose of our study was to determine an effective initial amount (or dose) of health and wellness coaching to recommend to patients with obesity and/or type 2 diabetes (T2D). To make this determination, we closely examined the health and wellness (HWC) coaching literature using the previously published Compendium papers. After identifying 88 peer-reviewed articles (51 obesity; 37 T2D), we synthesized the amount of HWC effectively applied in this literature. We defined and quantified HWC programming using five variables: 1. session duration 2. session number 3. session frequency 4. program length 5. total HWC dose The general dosing recommendations we derived for HWC are shown here: This programming information can serve as a guideline for coaches when a patent asks, “How long will this take?” Now, the coach can provide an evidence-based answer to that important question. Another important function of these HWC dose recommendations is to provide physicians a starting place when referring patients to coaching treatment or intervention. All treatments have initial dosing recommendations (e.g., 8 sessions of physical therapy, 16 weeks of cardiac rehabilitation, or 10 mg of a statin). Such prescriptions allow for patient planning while also enabling appropriate billing practices to be understood and arranged. Underlying all initial prescriptions, is the fact that every prescription is adaptable to accommodate patient needs. Everything from a medication to an exercise prescription, can be adjusted to fit an individual patient. Flexibility is most certainly true for these HWC dosing recommendations. HWC is a patient-centric process, and these guidelines are in no way meant to change or violate this critical concept. All programming variables (from single session duration to program length and total HWC load) are ultimately determined by a patient and coach working together to determine how to best serve a patient. The recommendations provided in this study provide a reasonable and initial coaching dose that would be effective in most circumstances. If you are practicing coach, use these guidelines to best suit your needs and the needs of your patients. These recommendations were derived from studies involving obese and diabetic patients. It is reasonable to extend these findings to other patient groups, awaiting more data. HWC is a fast-evolving profession with need for science-based guidelines that support best practice guidelines. The recommendations in this article are appropriate for initial HWC programming guidelines. Dosing guidelines are sign of a maturing health profession. Check out the full paper to learn more about our investigation. References 1. Sforzo GA, Kaye MP, Faber A, Moore M. Dosing of Health and Wellness Coaching for Obesity and Type 2 Diabetes: Research Synthesis to Derive Recommendations. American Journal of Lifestyle Medicine. 2022. On-line First. doi:10.1177/15598276211073078 2. Sforzo GA, Kaye MP, Todorova I, et al. Compendium of the Health and Wellness Coaching Literature. American Journal of Lifestyle Medicine. 2018;12(6):436-447. doi:10.1177/1559827617708562 3. 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

Today we explore how to work with a client who is an avid runner and competes in many road races and marathons on the weekends. She has sustained a stress fracture and cannot run for 8 to 12 weeks. She is very concerned about maintaining her fitness, being ready for an upcoming marathon, and managing her weight and her stress levels. She has not done any other type of training in a long time and seems very reluctant or fearful of doing anything else. Anyone who depends upon regular exercise to stay sane in today’s crazy world could be terrified about losing the incredible benefits of exercise when stopped in their tracks due to an injury or surgery that requires a long recovery period. What are some tools and techniques that allow our clients and ourselves to recover well and return stronger than ever? Be a curious explorer: A great antidote to feeling frustrated and disappointed during a long recovery is to cultivate a curious and open mind that is looking for new adventures. Questions to consider: How can I look at my situation in new ways? What can I do differently? What do my mind and body need right now? How can I recover quickly and well? What is there to learn? This is a time for new questions, and a time when there are more questions than answers. Soften the need to be in control: The sense of freedom and being in control is heightened by mastery of an intensive exercise routine. It’s incredibly hard to watch others running when you are grounded for a long while. Perhaps the recovery experience is a way to learn to better accept what we can’t control, reminding ourselves of the serenity prayer, which I phrase as: accept the things I cannot change, be courageous about the things I can change, and get wise about knowing the difference. Make the experience meaningful: A valuable tool to rising to the challenge is to have faith that there will be silver linings,  although not immediately apparent. Humans learn and grow stronger through setbacks. Whatever led to an injury such as a stress fracture is the body’s way of telling us that something isn’t quite right. While the full value of a setback may not appear until long after recovery, an open and curious mind that is looking for new meanings will be a great asset along the way. For example,   a good physical rest may lead to healing of all sorts of physical stresses and strains from head to toe that a nonstop exercise routine prevents. Or it will be just the catalyst needed to experiment with changes in a stable exercise routine. Even better, the time freed can be used to create and enjoy new experiences. Learn new approaches to regulating emotions: If you use running or exercising to tame emotional frenzy, stress levels may  get more challenging during recovery. The time saved during recovery can be invested in developing new mental skills for handling negative emotions. Mindfulness techniques allow us to unhook from a burst of negative thoughts that come with a post-injury phase (Yikes! My cardio fitness is dropping like a stone. My muscles are going soft. My marathon time will be shot. I will gain weight…). This is also a good time to invest the time saved in not running to harness and harvest positive emotions: What professional and personal tasks make you feel good and how can you do more of them? What blessings can you count? Seek compassion and love: The biological method for soothing the scared emotions of a newborn is the tender soothing by the parents, which releases a neurochemical called oxytocin (also known as the hormone of love). This same soothing phenomenon works just as well in adults, except we can soothe ourselves with big-hearted self-kindness. A recovery period is an excellent time to exercise your self-compassion. And, connect with other people who have done well in recovering from long injuries and benefit from their empathy and compassion during this tough phase. Enhance body intelligence: It’s time to improve the depth of listening to what your body needs each moment and over the next days and weeks. What adjustments to eating habits are needed  to handle lower calorie needs? What exercises feel good and safe right now? Perhaps this is an opportunity to slow down your eating pace, savoring fully by chewing every bite at least 30 times. Or maybe there is an opportunity to trim some emptyish calories to keep weight stable. Get creative: One of the best interventions for mental and physical suffering is to engage in creative tasks. You could experiment with cooking new recipes, write poems or blogs, play the piano, or submit funny lines to The New Yorker for its weekly cartoons. Recalibrate self-esteem: If your self-worth is closely connected to the state if your physique and fitness level, maybe this is a  time to have your inner judge go on vacation, detaching your self-respect from your physical fitness. You could then set a good standard for simply dealing well with the physical setback, focusing on healing, increasing equanimity, and learning new life lessons. Build confidence: One of the main variables that predicts life satisfaction is resilience, the ability to bounce back from adversity. Take stock of all your personal strengths that have made you resilient in the past and look for creative ways to use you strengths in new ways during the recovery phase. This is a great opportunity to build resilience muscles. Reset goals: An injury is an opportunity to hit the reset button and to rethink fitness and life goals, at least in the short term. A great goal is to simply aim to recover beautifully, to not rush the biological processes, and to allow the body’s talents for healing to run well, so that you can run well when this phase is behind you. Originally published in ACSM Certified News Coaching Column