A study led by Ruth Wolever, PhD, professor of Physical Medicine and Rehabilitation and director of Vanderbilt Health Coaching at the Osher Center for Integrative Medicine, found that 10 sessions of health coaching for people at risk for coronary heart disease (CHD), type 2 diabetes (T2D) or both led to increased physical activity which was sustained six months after the intervention ended.
The study, in Health Psychology, is one of the few that addresses the sustainability of health coaching beyond the coaching period. With 200 participants, the trial was one of the largest to assess the impact of health coaching on health behaviors.
In addition, this was among the first trials testing whether incorporating genetic risk testing into risk counseling might enhance the impact of health coaching.
“Chronic health conditions — particularly heart disease and diabetes — are largely driven by behavior and lifestyle patterns,” Wolever said. “It can be very hard to create and sustain a healthy lifestyle, so any interventions that will help people make and sustain these healthy changes are vital.”
Health coaching is defined by the National Board for Health and Wellness Coaching as a partnership between a coach and a client that aims to enhance well-being through self-directed lasting changes aligned with the client’s values. Wolever and colleagues stuck closely to this definition when developing their study.
“There can be some confusion around what health coaching is. In our study, the coaching took a facilitative approach, focusing on asking the right questions and carefully listening to participants to better understand their goals,” Wolever said. “Coaching is not about diagnosing or directing behavior. It is about facilitating change from one’s intrinsic motivation.”
The participants, who were all active-duty United States Airforce (USAF), beneficiaries or USAF retirees, were enrolled in primary care at David Grant USAF Medical Center, Travis Air Force Base, California. Each had an elevated risk for developing CHD, T2D or both. Participants self-reported their dietary intake and exercise at baseline, three months, six months and one year.
The group that received health coaching was 3.6 times more likely to report moderate, hard or very hard intensity activity versus reporting inactivity or light activity at six months and 2.9 times more likely to report such at one year.
Depression scores at six months were also significantly lower among participants receiving health coaching. Interestingly, the study did not result in dietary improvements for participants, an outcome that has been observed by researchers in at least three other studies.
Increased exercise, which was reported by many participants who received health coaching, has myriad benefits — it can delay disease progression or prevent disease, boost metabolism and mood, and improve energy.
The study also explored potential interactions between coaching and genetic risk testing. Half of the coaching participants and half of the control group received the results of their genetic risk testing at baseline to see if this information would enhance outcomes in the coaching group. In the subset of participants who had elevated risk for T2D, those who received coaching as well as genetic risk testing lost slightly more weight (2.2 kg) at 12 months.
Wolever said the receipt of genetic risk information could have leveraged the coaching intervention, but this will require further study.
“We want clinicians to know that coaching is a really viable option for patients who need to change aspects of their lifestyle, such as physical activity,” Wolever said. “Six months after our participants were coached, the increase in exercise was still maintained. Coaching is effective, and we showed that this effectiveness can be sustained.”
