From expert to coach: health coaching to support behavior change within physical therapist practice.

BACKGROUND: Negative health behaviors are a significant risk factor for non-communicable diseases (NCDs) and are responsible for 40-50% of the burden of disease in the US population. Physical therapists (PTs) have the capacity to effect behavior change in their patients to reduce their risk of disease and promote health. Competence in health behavior change is recommended for physical therapists. One way to achieve this competence is by learning and adopting a health coaching approach. OBJECTIVES: To provide a theoretical and practical approach to applying a health coaching approach in physical therapist clinical practice. METHODS: 1) Describe a health coaching approach to facilitating behavior change; 2) present behavior change theories, communication strategies, and models underpinning health coaching; and 3) provide suggestions for ways PTs can integrate health coaching in clinical practice. RESULTS: Health coaching is a dynamic and collaborative approach to health behavior change that harnesses the patient's or client's values and strengths to realize their goals for health. CONCLUSION: Adopting a health coaching approach may enhance adherence to physical therapists' recommendations as well as improve health outcomes.

Health and wellness coaching positively impacts individuals with chronic pain and pain-related interference.

OBJECTIVES: Health and wellness coaching (HWC) interventions have been reported to improve health outcomes for individuals with chronic diseases such as diabetes, cardiovascular disease, or cancer. However, HWC also holds potential as an effective intervention within a biopsychosocial chronic pain management framework. The aim of the present study was to evaluate the effects of HWC on individuals with chronic pain. METHODS: Participants were referred by their primary care provider or insurance company to a comprehensive telephonic 12-month pain management HWC program. Relationships between pain outcomes and physical and psychological factors were retrospectively analyzed. Mixed linear-effects modeling explored whether physical and psychological variables were associated with pain outcomes over time. RESULTS: Four hundred nineteen participants (female, 58.9%; mean age, 54.8) enrolled in the program and 181 completed the intervention. After 12 months in the program, statistically and clinically significant reductions were observed for pain intensity (Hedges' g = 1.00) and pain-related interference (Hedges' g = 1.13). Linear mixed-effects modeling indicated that improvements in physical functioning and psychological factors were associated with improvements in pain intensity. DISCUSSION: Our results provide a novel analysis on the effects of HWC on chronic pain and pain-related interference. HWC appears to be a promising intervention to improve pain-related outcomes in a population with chronic pain. Further investigation of HWC as an intervention for chronic pain is warranted.

What Is the Effect of Health Coaching Delivered by Physical Therapists? A Systematic Review of Randomized Controlled Trials.

BACKGROUND: Health coaching has emerged as an intervention for improving health behaviors. Given the recent increased integration of health coaching into physical therapist practice, there has been a subsequent rise in research examining the effects of health coaching provided by physical therapists. However, there is a lack of literature summarizing the effectiveness of health coaching delivered by physical therapists in changing patient health behaviors. PURPOSE: The purpose of this study was to systematically review the effects of health coaching delivered by physical therapists on promoting participant health behaviors. DATA SOURCES: Cochrane, CINAHL, MEDLINE, PEDro, PsycINFO, and Web of Science databases were searched from inception to May 26, 2018, to identify randomized controlled trials examining the effects of health coaching delivered by physical therapists. STUDY SELECTION: Two reviewers independently screened titles, abstracts, and full texts according to inclusion and exclusion criteria to determine study eligibility. DATA EXTRACTION: Methodological quality was assessed using Physiotherapy Evidence Database (PEDro) scores. Risk of bias was assessed using the Cochrane Collaboration risk-of-bias assessment tool. Data were extracted using a standardized data extraction form describing study methods, design, and outcomes. DATA SYNTHESIS: Eleven trials met the inclusion criteria for this study. Health coaching produced positive effects on physical activity (6 studies) as well as physiological and psychological secondary outcomes. LIMITATIONS: The inclusion of only 11 randomized controlled trials in this review could limit the generalizability of the findings. The heterogeneity of the findings precluded the performance of a meta-analysis. CONCLUSIONS: Research on the effectiveness of health coaching delivered by physical therapists on health behavior outcomes is mixed. Data indicate statistically significant changes in some health behavior, physiological, and psychological outcomes.

Validity of a customized submaximal treadmill protocol for determining VO2max.

INTRODUCTION: A customized submaximal exercise test for cycle ergometry was reported as a superior estimate of maximum oxygen uptake (VO2max) in comparison to the traditional YMCA ergometry test. PURPOSE: Following similar methodology, we sought to validate a customized submaximal treadmill test (CustomTM) compared with the widely used Bruce submaximal protocol. METHODS: Participants (29 women and 21 men; age = 31.37 ± 11.44 year, BMI = 24.02 ± 3.03) performed a graded exercise test (GXT) with a subsequent exhaustive, square-wave bout for the verification of "true" VO2max. In counterbalanced order, subjects then completed submaximal protocols. The CustomTM protocol consisted of two 3-min stages estimated at 35 and 70% of VO2max, where VO2max was estimated with a linear regression equation utilizing sex, BMI, age, and self-reported physical activity. RESULTS: VO2 values from the GXT and verification bout were 47.2 ± 7.7 and 47.0 ± 7.7 ml kg-1 min-1, respectively (ICC = 0.99, CV = 2.0%, TE = 0.83 ml kg-1 min-1), with the highest value used as "true" VO2max (47.7 ± 7.7 ml kg-1 min-1). Neither the Bruce (45.95 ± 6.97 ml kg-1 min-1) nor the CustomTM (47.3 ± 9.4 ml kg-1 min-1) protocol differed from "true" VO2max. The CustomTM had a "very large" measurement agreement with "true" VO2max (ICC = 0.78, CV of 9.1%, TE = 4.07 ml kg-1 min-1). Bruce had a "large" measurement agreement with "true" VO2max (ICC = 0.62, CV of 10.0%, TE = 4.51 ml kg-1 min-1). CONCLUSION: The CustomTM was superior to the Bruce protocol, because it included a stage below and above gas exchange threshold, yielded a better measurement agreement for "true" VO2max, and was more time efficient.

Psychophysiological Tracking of a Female Physique Competitor through Competition Preparation.

Natural physique competitions are based on subjective judgments of how a competitor appears on show day. Prior to competition, there is a prolonged dieting phase referred to as contest preparation. The primary goal is to reduce body fat levels while maintaining skeletal muscle mass. The study tracked the physiological and psychological changes for a 24 year old female preparing for a physique competition. PURPOSE: The study was conducted to describe the physiological and psychological changes of a female physique competitor who engages in long-term contest preparation. METHODS: Diet, body composition, blood work, energy expenditure, mood, and performance were evaluated through contest preparation. RESULTS: The participant lost 10.1kg throughout contest preparation in a strong weekly linear pattern (R2=0.97). Body fat was reduced from 30.45% to 15.85% while fat free mass was maintained. Mood for the participant remained stable until month five, when an observed variation occurred, with performance maintaining. CONCLUSIONS: Contest preparation was successful in reducing the body fat in the participant while having a minimum effect on both performance and fat free mass. For athletes looking to lose large amounts of body fat with minimal performance decrements a prolonged diet period with moderate exercise and food restriction can be an effective solution.

Comparison of the YMCA and a Custom Submaximal Exercise Test for Determining VO2max.

UNLABELLED: The maximal oxygen uptake (VO2max) is deemed the highest predictor for all-cause mortality, and therefore, an ability to assess VO2max is important. The YMCA submaximal test is one of the most widely used tests to estimate VO2max; however, it has questionable validity. PURPOSE: We validated a customized submaximal test that accounts for the nonlinear rise in VO2 relative to power output and compared its accuracy against the YMCA protocol. METHODS: Fifty-six men and women performed a graded exercise test with a subsequent exhaustive, square wave bout for the verification of "true" VO2max. In counterbalanced order, subjects then completed the YMCA test and our new Mankato submaximal exercise test (MSET). The MSET consisted of a 3-min stage estimated at 35% VO2max and a second 3-min stage estimated at either 65% or 70% VO2max, where VO2max was estimated with a regression equation using sex, body mass index, age, and self-reported PA-R. RESULTS: VO2 values from the graded exercise test and square wave verification bout did not differ with the highest value used to identify "true" VO2max (45.1 ± 8.89 mL · kg(-1) · min(-1)). The MSET (43.6 ± 8.6 mL · kg(-1) · min(-1)) did not differ from "true" VO2max, whereas the YMCA test (41.1 ± 9.6 mL · kg(-1) · min(-1)) yielded an underestimation (P = 0.002). The MSET was moderately correlated with "true" VO2max (ICC = 0.73, CV of 11.3%). The YMCA test was poorly correlated with "true" VO2max (ICC = 0.29, CV of 15.1%). CONCLUSIONS: To our knowledge, this is the first study to examine submaximal exercise protocols versus a verified VO2max protocol. The MSET yielded better estimates of VO2max because of the protocol including a stage exceeding gas exchange threshold.

Acute moderate exercise does not attenuate cardiometabolic function associated with a bout of prolonged sitting.

Epidemiological studies suggest that prolonged sitting increases all-cause mortality; yet, physiological causes underpinning prolonged sitting remain elusive. We evaluated cardiometabolic function during prolonged sitting (5 h) in 10 adults with and without 30 min of moderate exercise leading up to the sitting. Mean arterial blood pressure (MAP), heart rate (HR) and posterior tibial artery blood velocity were measured at baseline and every hour subsequently. Blood glucose was measured at baseline, 3 and 5 h, with consumption of a caloric beverage at 1 h. Seated MAP and HR values were ~17 mmHg (P < 0.001) and ~4 bpm (P < 0.05) higher for the moderate exercise versus sitting conditions. A ~ 4 cm·s(-1) (16%) (P < 0.05) decline in posterior tibial artery blood velocity from prolonged sitting was observed, with no benefit conferred from moderate exercise. Postprandial glucose metabolism was not different between conditions (P > 0.05). We conclude prolonged sitting may be related to decreased posterior tibial artery blood velocity. Moreover, an acute bout of moderate exercise does not seem to attenuate cardiometabolic function during prolonged sitting in healthy, young adults.