Healthy longevity approach for health and wellness coaches

Highlights:

• Wellness coaching focuses on physical, mental, emotional, and spiritual well-being
• The priority of health coaches is to ensure and sustain the change of habits that would lead to a healthy lifestyle
• Health and wellness coaches have a positive impact on chronic disease prevention and longevity

Introduction

The state of wellness is the target of many health-promoting activities. Aging adults have a high prevalence of chronic diseases and often suffer from more than one chronic condition at a time. Wellness programs that focus on the implementation of a healthy lifestyle and disease management can prevent or delay the occurrence and consequences of these multiple chronic conditions. Health care professionals apply health and wellness coaching as a preventive method and treatment for age-related chronic diseases such as diabetes, hypertension, and a method of fixing unhealthy lifestyle habits. There are many varieties, such as health, wellness, personal, and life coaching. However, health and wellness coaching received common attention and are associated the most with a positive impact on health behavior change.

Health + Wellness = Longevity

The definition of wellness is a state of being in good health. It can also be defined as a general level of life satisfaction and subjective happiness. Therefore, wellness coaching focuses on physical, mental, emotional, and spiritual well-being. In the case of health coaching, the priority of health coaches is ensuring and sustaining the change of habits that would lead to a healthy lifestyle. Health and wellness coaching developed significantly in the past decade. The Compendium of the Health and Wellness Coaching Literature contains more than 150 studies that describe the positive impact of coaching on lifestyle changes and overall amelioration of health (1). The influence of health coaching in reducing the burden of age-related disease is gaining acceptance between primary care providers. According to The National Board of Health and Wellness Coaching:

"Health and Wellness Coaches partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance well-being. In the course of their work, health and wellness coaches display unconditional positive regard for their clients and a belief in their capacity for change, and honoring that each client is an expert on his or her life while ensuring that all interactions are respectful and non-judgmental."

In the U.S, there are now over 5000 national board-certified health and wellness coaches, and the profession is becoming more and more popular in other countries as well. Many health coaches are non-clinical professionals from various backgrounds such as nutrition consulting, health education, physical fitness, and wellness programming. A growing group of coaches is the licensed health care professionals, most notably nurse coaches (2). Health coaching utilizes research-based conversation, clinical strategies, and interventions to involve clients actively and safely in the self-management of their health by means of behavioral change. Health and wellness coaching focuses on minimizing health risks and preventing acute or chronic health conditions, which results in improved health, lowered health risks, decreased health care costs, and in the long run, improved healthspan and longevity (1, 3).

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Coaches needed

Worldwide, chronic diseases cause more than 71 % of deaths and 78 % of deaths in low- and middle-income countries. In the U.S, chronic diseases take 75 % of the annual health care budget and cause 70 % of deaths. Also, less than 50 % of Americans access the covered clinical preventative service. The United Nations announced in 2011 that the prevention and control of chronic conditions were fundamental for the health improvement of the member nations. Here wellness and health programs could be essential (4).

The recommended physical activity guidelines are often not met by adults, and the participation rates are lower for women and the elders. Worldwide, around 25 % of adults age 60–69, one-third of adults age 70–79, and 50 %  of the adults age 80 and older do not participate in the recommended amount of aerobic activity. The rates of physical activity are worse for citizens of high-income countries. Less than 42 % of U.S citizens aged 65–74 and 31 % of Americans aged 75 years and older get the recommended 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity activity weekly. The adherence is even worse for recommendations for twice weekly strength-building activities.

Globally, people are eating twice the daily recommended amount of sodium. The nutritional guidelines suggest eating 1.5–2 cups of fruits and 2–3 cups of vegetableggar per day for women and men respectively. The US dietary guidelines for 2020-2025 recommend eating less than 10 % of calories in saturated fat. 70–75 % of adult Americans exceed this limit which brings a serious risk for heart disease.

Another problem is sleep. The Centers for Disease Control and Prevention reports that over 35 % of Americans get less than 7 hours of sleep per night which is below the recommended amount of sleep for health and well-being.

Wellness coaching as a process in which a coach and client address the client's wellness goals can increase motivation and develop skills to improve the wellness and lifestyle balance of older adults. Which in return will lead to improving the statistics mentioned above.

Tailoring coaching to participants

The engagement of aging adults in wellness programs is still low. The reason for that might be a lack of programs designed particularly for older populations and managing more than one chronic disease. Therefore, identifying wellness program activities and delivery characteristics appealing to aging adults, especially those with multiple chronic conditions, may help design more engaging programs. A cross-sectional survey was done in 2019 and assessed wellness program preferences amongst adults. Based on the results, the participants were most interested in wellness activities aligned with their current health behaviors. People who exercised more were more likely to be interested in wellness programs that included physical training. According to that finding wellness programs should provide alternative exercise based on the current level and type of physical activity done by participants. Simultaneously, wellness activities should be designed to appeal to people who are not yet engaged in healthy habits and provide strategies for incorporating these behaviors in daily life (4, 5).

Generally, aging adults are most interested in wellness programs about healthy eating, purposeful living, exercise, stress management, and connecting with social groups and activities. Women more than men are interested in activities that occur in groups with people of the same age and gender. Compared to adults aged 55–64 years, participants aged 65 years and older were less interested in health coaching and internet-based programs. BMI, health-related quality of life, and general health did not influence preferences for wellness programs. Obese older adults are more likely to prefer supervised, team-based exercise programs, which occurred at a fixed time, with participants of the same age and gender. These findings can be used by health professionals preparing wellness programs for aging adults (4, 5).

The Center for Technology in Support of Self-Management and Health (NUCare) did a pilot study to determine the feasibility, usefulness, and relevance of personalized wellness coaching models for promoting physical activity among urban-based older adults. The study has shown major improvement in physical activity, health status, and quality of life for the group enrolled in a wellness coaching program for one year. The increase in physical activity level was a crucial outcome that was supported by improvements in quality of life and self-reported health (6, 7).

Programs supporting elders with chronic illnesses to self-manage their symptoms and treatments based on lifestyle changes are crucial for healthy living. The goal of such self-management programs is to improve problem-solving skills, exercise maintenance, medication use, and communication. Self-management programs can enhance the physical and psychological health status of patients with chronic illnesses. The chronic disease self-management program by Stanford University has shown numerous beneficial effects such as decreased blood pressure in patients with hypertension, reduced hemoglobin A1c in patients with diabetes, and enhancing the overall quality of life (8). In 2017 a study was conducted to evaluate the effects of the 8 weeks long health coaching self-management program for nursing home residents with mild-to-moderate cognitive impairment. The intervention group showed better self-efficacy, lower health distress, depression, and improved quality of life. These effects were successfully maintained over the five months of the trial (9).

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Longevity coaching strategies

Health coaches make a difference by working one-on-one with a client-oriented agenda to create goals based on the health risk profiles and history, current health status, preferences as well as needs and interests of a client. They collaborate with their clients to create wellness plans that suggest actionable steps for specific, measurable, achievable, relevant, and timebound health goals that can be directed by clients. Some examples of strategies of longevity coaching are:

• Supporting new habit formation regarding exercise, sleep hygiene, food preparation, social connections
• Suggesting benefits of exercise, regular health checks, hydration, and healthy diet
• Suggesting the involvement of family and friends for social engagement
• Educating about age-related chronic diseases and their prevention
• Supporting client's discussion with health care providers regarding their biometrics
• Assisting with behavior change for dietary modifications such as salt intake and glucose levels monitoring
• Supporting growth in emotional well-being and enhancement of social connections
• Supporting the exploration of daily practices of holistic self-care practices
• Helping in building connections to community resources and social networks 
• Tracking the progress of the client and regularly reviewing the results (2).

Conclusions

It was proven that participation in wellness and health coaching improves motivation, life satisfaction, energy levels and helps make positive health behavior changes such as healthy weight, physical activity, nutrition, health management, and mental fitness (10, 11). Aging societies worldwide should fully embrace the opportunities of aging and address the aging society challenges. Healthy longevity requires the focus on physical and mental fitness, preventing diseases, and improving well-being rather than simply treating particular conditions. A worldwide effort to guide the application of evidence-based strategies to advance healthy longevity among all people is urgently needed, especially now, during the global pandemic (2, 12).

References

1.            Sforzo GA, Kaye MP, Todorova I, Harenberg S, Costello K, Cobus-Kuo L, et al. Compendium of the health and wellness coaching literature. American journal of lifestyle medicine. 2018;12(6):436-47.

2.            Jordan MA. The Role of the Health Coach in a Global Pandemic. Glob Adv Health Med. 2021;10:21649561211039456.

3.            Huffman MH. Advancing the practice of health coaching: differentiation from wellness coaching. Workplace health & safety. 2016;64(9):400-3.

4.            Talley KM, Cheung C, Mathiason MA, Schorr E, McMahon S, Wyman JF. Aging Adults’ Preferences for Wellness Program Activities and Delivery Characteristics: A Cross-Sectional Survey. Topics in geriatric rehabilitation. 2019;35(4):289.

5.            Fullen M, Smith J, Sayer J, Clarke P, Tomlin C. Wellness Coaching: Practices and Preferences Among Life Plan Community Residents and Staff. Innovation in Aging. 2020;4(Suppl 1):377.

6.            Lees KE, Guthrie BJ, Henderson EL, Jimison HB, Sceppa C, Pavel M, et al. NUCare: Advancing research on technological integration for self-management in the aging population. Nursing outlook. 2018;66(2):121-9.

7.            Guthrie B, Sceppa C, Jimison H. USING TECHNOLOGY TO SUPPORT HEALTHY AGING AND ADDRESS CHRONIC ILLNESS: THE NUCARE CENTER. Innovation in Aging. 2018;2(Suppl 1):358.

8.            Smith ML, Cho J, Salazar CI, Ory MG. Changes in quality of life indicators among Chronic Disease Self-Management Program participants: an examination by race and ethnicity. Ethnicity & disease. 2013;23(2):182-8.

9.            Park Y-H, Moon S-H, Ha J-Y, Lee M-H. The long-term effects of the health coaching self-management program for nursing-home residents. Clinical interventions in aging. 2017;12:1079-88.

10.          Clark MM, Bradley KL, Jenkins SM, Mettler EA, Larson BG, Preston HR, et al. Improvements in health behaviors, eating self-efficacy, and goal-setting skills following participation in wellness coaching. American Journal of Health Promotion. 2016;30(6):458-64.

11.          Mettler EA, Preston HR, Jenkins SM, Lackore KA, Werneburg BL, Larson BG, et al. Motivational improvements for health behavior change from wellness coaching. American journal of health behavior. 2014;38(1):83-91.

12.          Dzau VJ, Jenkins JAC. Creating a global roadmap for healthy longevity. Oxford University Press US; 2019. p. S4-S6.

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