Background
Lifestyle behaviours, such as poor diet and inadequate physical activity, have been estimated to be a factor in at least 80% of chronic disease, making them a prime target for employee wellness programmes (EWPs) and requiring innovative approaches to create sustainable behaviour change. Health coaching, a patient-centred approach involving patient goal setting, active learning and self-monitoring of behaviours, has been shown to be an effective strategy for changing health behaviours, but one-on-one coaching, the typical delivery medium, can be expensive and inefficient. Group health coaching formats have shown promise in impacting more people without compromising positive outcomes; however, little research exists documenting the effects of group coaching.
Purpose
The purpose of this study was to determine if group health coaching delivered by a physical therapist could improve physical fitness and psychological constructs in an understudied population of university employees.
Methods
A quasi-experimental longitudinal study design was employed. A subset of university employees newly enrolled in an EWP (n = 100) were randomly selected from a pool of volunteers who were overweight or obese and at risk for cardiovascular disease. The EWP was free for employees and included health risk appraisal feedback, periodic wellness checks (body mass index and blood pressure), weekly newsletters with health information and tips about how to change behaviour, educational classes on health topics, group fitness classes, and access to a swimming pool and racquetball courts. The subset of 100 employees in the study was incentivized with free membership to the student recreation centre and group health coaching. Subjects participated in three, face-to-face, monthly, one-hour group coaching sessions tailored to stage of change for physical activity, facilitated by a physical therapist with training and experience in behaviour change. Grounded in health behaviour change theories, including the transtheoretical model and self-determination theory, these sessions focussed on improving physical activity behaviour, both in adopting new physical activity habits and managing lifestyle changes long term. Topics covered in the coaching sessions included intrinsic versus extrinsic motivation and rewards, connecting values to health behaviours, pros and cons of adopting physical activity, the current U.S. physical activity guidelines, developing habits, mental imagery, addressing self-talk, problem-solving to resolve barriers/challenges, the components of physical fitness, and EWP offerings. Subjects were assigned homework each month including setting weekly goals to increase physical activity, identifying an accountability partner, scheduling physical activity on their calendars, writing down the benefits of physical activity on a card they could refer to regularly as a reminder, mental imagery practice, mindfulness, and evaluation of their physical activity programmes to identify opportunities to address all of the components of physical fitness. Physical fitness testing was performed with each subject, including the measurement of blood pressure, resting heart rate, abdominal circumference, weight, body mass index, percent body fat, submaximal VO2, hand grip strength, push-ups, curl ups, and sit and reach distance. Psychological constructs from the transtheoretical model (TTM) and self-determination theory (SDT) were measured before and after the coaching sessions using published and validated questionnaires. Specific constructs measured included stage of change, processes of change, decisional balance, and self-efficacy from the TTM, and treatment self-regulation, perceived competence, and perceived support from the coach from the SDT. Data were analysed using paired t-tests and a multivariate regression analysis with post-coaching self-efficacy as the dependent variable.
Results
Eighty-four employees completed the intervention. Participants' stage of change improved from pre-test to post-test (2.77 ± 1.26 to 3.91 ± 1.22) from between the contemplation and preparation stages to between the preparation and action stages, as did self-efficacy (2.76 ± 0.44 to 2.97 ± 0.72), perceived competence (5.32 ± 1.88 to 5.62 ± 1.73), and perceived support (3.86 ± 2.11 to 4.80 ± 3.04). Attendance across all university EWP events, fitness classes, and coaching sessions was significantly predictive of post-test self-efficacy (p< .01). All of the measures of physical fitness improved statistically following coaching except for body mass index, as participants lost fat mass, gained fat-free mass, improved cardiorespiratory endurance, core strength, and low back and leg flexibility. Limitations of the study include that no direct measure of physical activity was included and there was not a control group. Given that physical fitness and physical activity are related, the fact that nearly all of the physical fitness parameters improved indicates that the subjects likely were engaging in greater amounts of physical activity after participating in group coaching.
Conclusions
In this study the positive effect of a group health coaching intervention on measures of physical fitness and psychological variables related to physical activity of university employees at risk for cardiovascular disease was demonstrated. Several groups of authors suggest that researchers studying health coaching define health coaching in terms of the intervention applied, specify the theoretical foundation of the intervention and relate the theories to the intervention delivered, and measure process variables (such as self-efficacy). In the current study, these recommendations were addressed and improvements in cognitive or process and health outcomes (measures of physical fitness) occurred in the study population. The intervention was delivered in a group coaching format, thereby increasing the availability, access, and cost effectiveness of health coaching. The primary factors contributing to the success of the group coaching were thought to be the theoretical basis of the curriculum and the sense of community established in each coaching session. Research is needed to determine which aspects of the coaching curriculum and what behaviour change theory or theories influenced change in the variables measured.
Implications
Physical therapists treat patients daily who can benefit from the adoption of healthy lifestyle behaviours, including physical activity. Group health coaching has been shown to promote behaviour change, can be delivered effectively by physical therapists, and was shown in the current study to improve psychological and physical parameters associated with improved health outcomes. Physical therapists should learn how to provide health-coaching services and deliver health coaching within the context of physical therapist practice as a viable option to stem the growth of chronic disease.
Disclosure statement
No potential conflict of interest was reported by the authors.