Pa wisewoman health Coaching plus protocol pa wisewoman health Coaching + Fitness, Health Coaching + Nutrition, Health Coaching + Wellness, & Health Coaching + Community Linkages Approval
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- Rationale: Evidence of past effectiveness with specific population and/or brief explanation of why this approach can be expected to be appealing and effective with the target population.
- Minimum Partnership Requirements
- Minimum of four-month gym membership providing access to exercise equipment. Pre and post fitness assessments conducted to record health improvements
- Group fitness classes offered to WISEWOMAN client if available
- Monthly individualized support sessions to address questions/concerns and offer on-going support to WW client.
- Selected community establishment provides attendance records of WW clients monthly.
- Creation of a weekly diet plan
- Nutrition education classes delivered by a trained staff that meet with clients at least four times
- Study 1: Supervised Six-Month Exercise Program Yields Significant Health Improvements
- Study 2: Supervised vs. Non-supervised Exercise Program Effects on CVD Risk Factors
- Study 3: Participation in Personal Training Increases Willingness to Exercise
- Flow diagram or algorithm
- Key components/characteristics of the coaching
- Method of Documentation of Coaching Delivered
- Anticipated number of sessions/dosage/mode and in what timeframe
| PA WISEWOMAN Health Coaching PLUS Protocol
PA WISEWOMAN Health Coaching + Fitness, Health Coaching + Nutrition, Health Coaching + Wellness, & Health Coaching + Community Linkages Approval ______________ WISEWOMAN Programs are required to submit a proposed protocol for approval to use WISEWOMAN funding for Health Coaching.
The approach to incorporate Health Coaching into YMCA facilities by providing participants with a four-month membership was previously approved. This proposal aims to connect WISEWOMAN clients with alternative community-based resources in order to increase their accessibility to facilities which can promote healthy lifestyle behaviors. This initiative is useful for WW clients because not every client has a YMCA within convenient distance. For those women who are nearby a YMCA, their local branch may not yet have a certified wellness program available or the infrastructure required to fully maximize her willingness to increase physical activity. For women who do not have a convenient YMCA location, nearby community establishments may be equipped with the necessary resources enabling them to provide health coaching programs to WW clients. Several such facilities have been identified as being in close proximity to established WW provider locations. This convenient distance eliminates the barrier of transportation and lack of time for WW clients and increases the likelihood that a client will maintain on-going, active participation in the health coaching arrangement. The community establishments which have been recognized as potential partners may also offer reduced-fee, sliding scale memberships for low-income adults which is imperative as WW clients will be provided with an affordable membership upon completion of the wellness program funded by WW. This proposal aims to expand upon the previous YMCA health coaching proposal by allowing WISEWOMAN to supplement established programs with options for personal training, nutrition education, gym membership, and/or group exercise classes. Because each community establishment staffs a variety of wellness professionals and is able to provide different health services, this proposal has established a four-pronged framework referred to as the Health Coaching PLUS initiative. The following four programs will be established; Health Coaching + Fitness (focused on physical activity), Health Coaching + Nutrition (focused on healthy dieting) and Health Coaching + Wellness (combined fitness and nutrition program) and Health Coaching + Community Linkages (community organization refers clients to fitness classes at various sites within their locality) . Depending on both the infrastructure of each health coaching location and the WW clients’ personal needs, the client is eligible to participate in HC + Fitness, HC + Nutrition, the combination program HC + Wellness, or HC + Community Linkages.
The following are the minimum requirements the Health Coaching PLUS programs must be able to offer in order to be considered for this PA WISEWOMAN initiative. Health Coaching + Fitness
Health Coaching + Nutrition
Health Coaching + Wellness Offered as a comprehensive wellness programing combining Health Coaching + Fitness and Health Coaching + Nutrition. All requirements from each program must be met in order to be considered a Health Coaching + Wellness program. Ideally, Health Coaching + Wellness will be the program of choice for those WW clients who are able to access community establishments that have the appropriate infrastructure to offer both physical activity and nutrition education.
The Health Coaching + Community Linkages framework meets the requirements of approved HC programs by connecting women to a community organization that refers members to a variety of health education and physical activity classes at various locations throughout the locality. Participants in this program will be given four-month gym membership if a nearby participating community establishment is accessible. If not, the client will have the opportunity to participate in multiple health events which occur in the convenience of their own township. Examples may include fitness classes held at the local library, nutritional sessions sponsored by the local grocer, or yoga classes offered at an outdoor community park. Due to the unique program structure, Health Coaching + Community Linkages programs require an additional application process in order to be considered as an approved program. A summary of the linkage framework must be submitted including the following:
Health Coaching + Community Linkage program proposals will be evaluated. Approved programs will be implemented as soon as possible. Justification Multiple studies have proven that participating in a supervised program that incorporates physical training, nutrition education, and other wellness resources for lifestyle change has led to significant improvements in health outcomes1 2 3. The following are research studies which support this statement and demonstrate that implementing the specified program guidelines into a wellness program delivered by community establishments will be an effective treatment resource for WISEWOMAN clients. Study 1: Supervised Six-Month Exercise Program Yields Significant Health Improvements Alam et al. (2004). The Effect of a Six-Month Program on Very Low-Density Lipoprotein Apolipoprotein B Secretion in Type 2 Diabetes. The Journal of Clinical Endocrinology & Metabolism. 89(2):688-694. N=18 moderately obese type 2 diabetic patients randomized into either a supervised or unsupervised six-month exercise program. Following an initial training session, each participant was provided with an individualized exercise program asking them to exercise four times per week at 70% of their maximal oxygen uptake for 20-40 minutes for six months. Subjects in the supervised group received education on the relationship between diabetes and exercise and barriers to changing activity habits were addressed. The supervised group also had access to a personal exercise trainer once a week. The trainer led subjects through a workout and developed an activity plan for the following week. The unsupervised group received no contact with the personal trainer. Both the supervised and unsupervised group had access to a nutritionist. Results: Subjects in the supervised group experienced significant improvements in the following areas.
Subjects in the unsupervised group experienced no significant health improvements. Conclusion: Participation in a supervised exercise program incorporating interaction with a personal trainer yields greater health improvements than those who exercise independently without supervision from trained professional. Study 2: Supervised vs. Non-supervised Exercise Program Effects on CVD Risk Factors Stefanov et al. (2013). Effects of Supervised vs. Non-supervised Combined Aerobic and Resistance Exercise Programme on Cardiometabolic Risk Factors. Central European Journal of Public Health.21 (1): 8-16. N=85 sedentary, middle-aged, overweight/obese, non-diabetic subjects (27 men and 58 women) randomized into either a supervised, non-supervised, or control group to participate in six-month exercise program. All subjects received initial healthy lifestyle counseling on the health benefits of regular physical activity and nutrition as well as individual 1-hour meetings with a dietician which provided a standardized low-calorie diet plan. Subjects in the supervised and non-supervised groups participated in a six-month physical exercise program that included endurance, resistance, and flexibility training over an encouraged 66 exercise sessions. Subjects in the unsupervised group were allowed to meet with a physical trainer once every three weeks to evaluate progress. Subjects in the supervised group participated in group workouts led by the trained physical therapist who also provided on-going physical activity motivation and support throughout the duration of the study. Results: Subjects in both the supervised and non-supervised groups experienced health improvements, however, the supervised group obtained much more significant benefits from the exercise program (assumed to be due to greater participation adherence). Subjects in the supervised group experienced the following outcomes.
Conclusion: Participation in a six-month exercise program resulted in significant cardiometabolic health improvements for both supervised and non-supervised groups, however, improvements were more pronounced for those under professional supervision. This could be contributed to the fact that the supervised group had an additional accountability factor by training with the physical therapist, and therefore, attended more sessions throughout the duration of the study than the non-supervised group. Study 3: Participation in Personal Training Increases Willingness to Exercise McClaran, Steven, R. (2003). The Effectiveness of Personal Training on Changing Attitudes Towards Physical Activity. Journal of Sports Science and Medicine 2, 10-14. N=129 subjects (ages 20-65) assigned to a university Health Promotion student personal trainer for participation in a 10-week exercise program. Prior to participation, subjects were given a form to assess their stage of motivational readiness for exercise adoption as outlined by the Stages of Transtheoretical Model. Subjects classified themselves according to the following stages; precontemplation (not intending to make changes), contemplation (considering a change), preparation (getting ready to make a change), action (actively engaged in making a change but only for a short time) and maintenance (sustaining the change over time). 27 of the 129 subjects identified as being in the maintenance stage prior to engaging in the program and therefore were unable to move up further in the Stages of Transtheoretical Model. The ten-week exercise program consisted of one, 1-hour weekly session with the personal trainer. Discussed in this session were the benefits of physical activity, common barriers/obstacles that may be encountered, and the importance of goal setting, support systems, and relapse prevention. The personal trainer also developed training regimens for the subjects to complete on the days they did not meet. Results: After the 10 weeks, subjects filled out a second form identical to the first where they were asked to assess their stage of motivational readiness after working with the personal trainer. There was significant (p < 0.01) upward movement in the program.
Conclusions: One-on-one personal training is an effective strategy for increasing an individual’s willingness and motivation to exercise, and therefore is successful in increasing physical activity. In addition, this study suggests that using problem solving techniques is valuable for initial behavior change and long-term maintenance.
Participation Potential WISEWOMAN clients will be identified through the HealthyWoman BCCTP screening process delivered at health clinics. Those women who display risk factors for cardiovascular disease and meet the WISEWOMAN eligibility criteria will be invited to participate in the program. Those who agree to participate in a Health Coaching PLUS program will receive orientation on the program available at their local community establishment and the additional supports that may be available. WW clients will then be referred to the local community establishment where they will be provided with an adult membership lasting a minimum of 4 months (with a possible exception being for the HC + Community Linkages program) and begin participation in the Health Coaching PLUS program most suitable to her. This proposal includes the continuation of Health Coaching support calls for WISEWOMAN clients because it has proven to be effective and preferable for low-income populations due to its flexibility. In this framework, health coaching may be delivered in person or over the phone and may be conducted by either a staff member at the screening clinic or a staff member at the community establishment. This set-up reduces barriers which are common among the low-income population such as lack of transportation and time; it requires only follow-up sessions in which the client will be provided with on-going support and educational materials to motivate and sustain adoption of healthy behaviors. The initial health coaching session will focus on evaluating participation in the Health Coaching PLUS program, addressing any questions/concerns of the clients, and offering support and advice to promote willingness to adhere to program. Health coaching sessions will be conducted every four weeks thereafter and will serve the purpose of providing the clients with additional educational materials that serve as incentives for continuing participation in the program. The final health coaching session will focus on determining outcomes of the complete community establishment partnership (gym membership - if applicable - and participation in the Health Coaching PLUS programs). The client will be asked to return to the screening clinic to get a post assessment visit. Also, the program will work to determine the client’s desire to continue. If the client demonstrates willingness to sustain participation, the health coach will assist the client in applying for scholarship or reduced-fee memberships so she is financially able to continuing utilizing the exercise equipment in her local community establishment.
Health Coaching will be delivered by trained community establishment staff members. The credentials of coaches may vary at the different locations; all coaches will be certified through the training required at their place of employment. Support calls during a client’s engagement in the Health Coaching Plus programs will be done by staff at the screening clinic (Nurse Practitioners, Registered Nurses, Medical Assistants, trained community health workers, dieticians, and nutritionists.) or the program Health Coach. Certified personal trainers and certified health coaches from the community establishments will lead both the personal training sessions and the nutrition education sessions.
The Health Coaching Plus programs will take place at local community establishments. The WISEWOMAN client will also attend this facility to utilize her gym membership (if applicable). Health coaching is to be done over the phone or in person depending on client preference due to transportation, work, or other considerations.
WISEWOMAN clients are currently experiencing health improvements through referral to the YMCA for individual, unsupervised physical activity. However, research clearly demonstrates that those who participate in a supervised exercise program led by a personal trainer exhibit greater health improvements. Enrolling the WW client in a Health Coaching PLUS Program at a local, more convenient community establishment that educates her on physical activity, nutrition, and healthy lifestyle behaviors provides her access to all the necessary resources to help improve her cardiovascular health. This proposal creates an opportunity to link clients to a local community establishment that they may have otherwise never attended. In order to determine effectiveness of offering the client opportunities to participate in Health Coaching PLUS programs, the program must be piloted and evaluated. This proposal aims at establishing criteria guidelines for Health Coaching programs while allowing enough flexibility for each facility to provide the HC program most suitable to their infrastructure.
Ideally, the community establishment will be responsible for documenting client attendance in the manner deemed most appropriate. Records have previously been documented in an attendance database that corresponds to a member ID card which documents time and date every time it is swiped. Additional documentation methods may include an attendance sign-in sheet or a record of attendance taken by class instructor/personal trainer/health coach. If for any reason the community establishment is unable to provide documentation of attendance for WW clients, the client will be responsible for self-reporting her attendance for each program session attended.
Each WISEWOMAN client will receive an adult membership to the local establishment for a minimum of 4-months (Health Coaching + Community Linkages programs are a possible exception). Each WISEWOMAN client will be offered a minimum of 4, 30-45-minute one-on-one sessions with a certified personal trainer. Each WISEWOMAN client will be enrolled in a Health Coaching PLUS program offered at the local community establishment. Program structure and cost may vary from location to location, however, it must work with WISEWOMAN program staff to adhere to the minimum guidelines as detailed by this proposal (see page 2). Each WISEWOMAN client must receive a minimum of three health coaching sessions throughout the program duration. Health coaching sessions are to be spaced evenly throughout the program with one being delivered around the time the program has begun and one being delivered upon completion of program. During a client’s participation in the program, health coaching will be conducted once every four weeks. Frequent health coaching follow-up will increase client participation and motivation.
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