ACE Health Coach
What is the "assessment trap" that coaches should avoid?
- Spend too much time reviewing data - Asking one-directional questions
With regard to activity trackers, usage consist of three behaviors:
1. Wearing the tracker 2. Looking at it daily 3. Adjusting one's behavior based on information given by the tracker
What are the health related components of physical fitness?
1. cardiorespiratory fitness 2. muscular strength and endurance 3. flexibility and body composition★
"Honoring clients' absolute worth and recognizing their autonomy " BEST describes which element of motivational interviewing (MI)?
Acceptance
For what % of global death is chronic disease responsible? A. 80 B. 70 C. 50 D. 60
B
Which technique can be used as a way to transition to change talk? A) Affirmation B) Summarizing C) Paraphrasing D) Reflecting
B
What is an example of behavior change theory or therapy that a health coach can use for a client with a substance abuse or misuse problem?
CBT Cognitive Behavioral Theory
Substance dependence is accompanied by changes in the ______, especially in areas comprising _________ _________
CNS Reward pathways
Which coaching approach and sale of communication may be most effective when working with a client and the maintenance stage of change?
Consultant
Whole grains
Contain the entire grain kernel Provide the nutrients fiber, iron, zinc, manganese, folate, magnesium, copper, thiamin, niacin, B6, phosphorus, selenium, riboflavin, and vit A
During an HPA (Hypothalamic Pituitary-Adrenal System) stress response, the pituitary gland releases which stress hormone?
Cortisol
As a health coach, what should you tell an older client who is experiencing sleep problems?
Encourage the client to work with his or her healthcare provider
Function of Copper (Cu)
Formation of RBC Bone growth Skin health
Personal Values Card Sort
Free activity to identify values www.guilford.com/add/miller2/values.pdf
Types of Self-Efficacy
General Domain-specific
Principles of AI: Anticipatory
Image inspires action
Principles of AI: Simultaneity
Inquiry creates change
Double-sided reflections
Integrate client's sustain talk with previously stated change talk
Is marijuana harmful?
It may be helpful, especially for pain relief. Some people may be negatively affected as it can cause issues with memory, learning, and problem solving. While marijuana is not physically addictive, some may become psychologically addicted.
Gellish formula
MHR = 206.9 - (0.67 x Age)
Evoking empowers the client to...
Make arguments for change by strategically responding to sustain talk and highlighting change talk. This helps work through ambivalence.
Behavior hack by BJ Fogg, PhD..
Make it very simple and celebrate
Practical approaches to evoke change talk: querying extremes
Makes client think about the best-case scenario if they to make a change, and about the worst-case scenario if they don't make a change
What occurs just before the stress response?
Neurological Triggering Mechanisms
Eight Dimensions of Wellness
Occupational Physical Social Intellectual Spiritual Emotional Financial Environmental
Reactance
Occurs when someone feels judged or criticized for substance or behavioral issues and resorts to the behaviors that are object of the criticism
Amplified reflections
Overstated reflections that challenge the client to think about what they said.
Allostasis
Process of adaptation to acute stress. Different from homeostasis by being the efficient regulation by anticipating needs and preparing to meet them before they arise
The Values in Action Classification of Strengths (p. 51)
Questionnaire that assesses six clusters of 24 strengths
Practical approaches to evoke change talk: Importance Ruler
Scale (typically 0-10) which clients are asked to rate the importance of making a particular change
Borg RPE scale
Scale 6 to 20 Correlates well with physiological factors associated with exercise, such as HR, breathing, oxygen uptake, overall fatigue Very accurate when used correctly
Stressor
Stimulus that challenges the body's homeostasis
Principles of AI: Narrative
Stories are transformative
Body language: Biting lip
Tension or trepidation
kilocalorie (kcal)
The amount of heat required to raise the temperature of 1 kg of water 1C. 1kcal=1,000 cal
Known as the "father of stress", Hans Selye defined stress as
The non-specific response of the body to any demand
Define stress
The nonspecific response of the body to any demand for change
People are more likely to be persuaded by what they hear...
Themselves say
Alternative Medicine
Therapies that replace conventional medicine
Whole grains are defined as...
Those that have the whole grain kernel
True or false: It is within the scope of practice of all health coaches to share evidence based dietary guidelines and resources, such as those endorsed or developed by the federal government, especially the DGA or MyPlate recommendations
True
Out of the protein subgroups, seeds have the most...
Vitamin E
The focus of the coaching relationship centers on...
What is going right in the client's life
In affirmations, it is better to use the word "———" instead of "—"
You I
Skill-related components of physical fitness
agility, balance, coordination, power, speed, reaction time
5 Health-Related Components of Physical Fitness
cardiorespiratory endurance, muscular strength, muscular endurance, flexibility, body composition
There is a ___________ relationship between physical activity and health
dose-response Or curvilinear
Health coaches should consider having clients fill out a _____________ before the first visit. This is one of the lengthiest forms and needs the most time and forethought.
lifestyle and health history (p.104-108)
Like motivation, self-control is a ________ resource
limited
What is a good source of potassium?
milk products
Clients are ultimately accountable to ____________ — not the coach
themselves
For general muscular fitness, a program like this would be beneficial:
🔵 Mix strength and endurance through lifting a moderate weight for 8-15 repetitions 🔵Work major muscle groups on non-consecutive days, 2-3 times weekly, 48 hours between sessions
Cardiovascular Endurance
🔵Ability to do large muscle, moderate to high intensity exercise for long periods of time 🔵Multisystem 🔵Lungs site for oxygen exchange 🔵Heart and vessels supply muscles with oxygen and nutrients 🔵Reduced risk of death from all causes, especially CVD 🔵20-60 minutes; 3-5 days weekly
Muscular Strength
🔵Ability to exert force 🔵Heavier weight for fewer reps
Muscular Endurance
🔵Muscle's ability to keep a contraction 🔵Submaximal load during more reps 🔵Isometric holds
Temperature Danger Zone (TDZ)
40-140 degrees F 4-60 degrees Celsius
How many positive thoughts does it take to cancel that one negative thought?
5
What is the recommendation regarding the percentage of fruit juice that should be consumed as part of the total recommended fruit intake?
50% or less
How might the health coach begin building rapport with a client during the initial interview? A) Begin asking questions about the client B) Begin with a few short success stories from previous clients C) Open the conversation up for the client to ask the questions D) Provide the client with a verbal outline of academic achievements
A
The DRI refers to... A. The four types of reference values for specific nutrient for individuals across age and gender B. A recommended nutrients and take level that appears to be sufficient for good health C. The level of intake of a nutrients that is adequate to meet the needs of 97 to 98% of the population D. The adequate intake of 50% of an age- and gender- specific group
A
What is a good source of vitamin K? A. Broccoli B. Egg yolks C. Almonds D. Sweet potatoes
A
What is an example of a physiological or psychological outcome of chronic stress? A. Anxiety and depression B. Type 1 diabetes C. Migraines D. Osteoporosis
A
What is important for a health coach to determine by the end of an initial interview? A) The client's readiness to change for each goal B) The validity of identified barriers C) The client's overall readiness to change D) Successful coping strategies for each barrier
A
Which of the following is equivalent to a "standard drink" of alcohol? A) 1.5 fl oz of spirits B) 8 fl oz of wine C) 12 fl oz of malt liquor D) 16 fl oz of regular beer
A
Mnemonic to identify unproductive thinking (p.83)
A - Activating event B - Beliefs C - Consequences D - Dispute negative thinking E - Effect
When using motivational interviewing skills with a client in the contemplation stage of change, the coach makes the following statement to keep the conversation focus on the positive: "Wow, that was great that you placed your gym bag by the front door. You took a big step forward." This type of statement represents which OARS skill?
Affirmation
How can people decrease their mercury exposure if they want to consume more seafood?
Aim to consume a mix of the different types of seafood
What is an anchor moment when it comes to creating tiny behaviors?
An existing routine that you do before the new behavior
Self-efficacy definition
An individual's belief that he or she is capable of performing a task or behavior
Body language: Crossed arms
Anger, defiance, or disinterested (unless the client is cold)
Function of vitamin E
Antioxidant
Function of vitamin C
Antioxidant, enzyme cofactor, promotes resistance to infection
Definition of Physical Activity
Any bodily movement contributing to calorie burning
How many adults meet the physical guidelines for Americans?
Approximately 1 in 5
Practical approaches to evoke change talk: Exploring values
Asking clients to highlight the things that they hold most dearly in life to provide anchors for change
Function of Thiamin (B1)
Assists in carbohydrate metabolism and amino acid metabolism and neural metabolism
Self-determination theory states that the 3 most important factors that influence motivation are...
Autonomy Competence Relatedness
Principles of AI: Free Choice
Autonomy liberates power
The 4 broad principles of ethics that the client-coach relationship is based upon and that serve as essential pillars in any health-related profession are:
Autonomy, Non-maleficence, beneficence, justice
What fish should pregnant women avoid?
Avoid those high in mercury such as tilefish, shark, swordfish, king mackerel
Awareness-Choice-Execution (ACE) cycle of change
Awareness: Self-exploration of current vs desired behavior Choice: Create self-directed goals and use personal strengths to plan towards them Execution: Create action plan and form self-efficacy
Which nonverbal cue may indicate the client is embarrassed about the topic being discussed? A) Continuously looking at the clock while speaking B) Keeping a quiet voice in a private setting C) Fidgeting with a pen and his or her hand D) Sitting with hunched posture
B
The Healthy Mediterranean-Style Eating Pattern contains... A. More lean meats and poultry B. More low-fat dairy products C. More fruits and seafood D. More healthy oils such as olive oil
C
Which is an example of client cognitive processes? A) Rewarding oneself with a new outfit when a weight-loss goal is reached B) Setting out workout gear the night before a workout C) Understanding that buying junk food at the grocery store provides one's children with unhealthy food as well D) Talking to coworkers about taking walks during breaks instead of sitting in the break room
C
Which is the BEST example of complex reflection after the following statement: "I feel better when I pack healthy snacks to bring to work, but I just don't have time in the morning"? A) "Have you thought about packing snacks the night before to save time?" B) Nodding and smiling while listening C) "You feel rushed in the morning, so it is not a good time to pack snacks for the day" D) "You seem upset about that"
C
Which is the MOST appropriate affirmation given to a client? A) "I'm very proud of your decision to choose veggies instead of fries" B) "Excellent choices this week!" C) "Your addition of veggies to your dinners Wednesday and Thursday was a great choice" D) "Your dinner selections are improving"
C
Which of the following are considered natural sugars? A) Glucose and maltose B) Brown sugar and molasses C) Fructose and lactose D) Fruit nectar and honey
C
Which of the following interpretations of the illness-wellness continuum is most accurate? A) Once illness occurs, wellness is unrealistic B) Wellness is achieved at the neutral point C) Wellness is dynamic and ever-changing D) Illness requires only medical treatment
C
Which of the following is an example of an internal stressor? A. Physical pain B. Cold temperatures C. Lack of perceived control D. Loss of a job
C
Simple Reflections
Concisely repeating and Rephrasing repeat what is said
Appreciative Inquiry is rooted in
Curious wonder and openness to change
Finding a client's "why" requires and understanding of her________ A. Barriers B. Problems C. Goals D. Values
D
Which statement would be the best to elicit change talk from a client who reported being at a 6 on a confidence ruler? A) What would it take to get to a 10? B) Why would you say a 6 instead of an 8 or 9? C) Do you think you could easily move up to a 7? D) Why would you say 6 instead of a 3 or a 4?
D
Why is it important for a health coach to take an ecological perspective to a clients health behaviors? A) Community laws are the primary driver of behavior choices B) Genetics drive an individual's disease susceptibility C) This perspective focuses on the influence of community policies and regulations D) Individuals should be understood in the context of their environment
D
Acronym to categorize types of change talk
DARN CATs
Affirmations can help reframe a "——————" mentality
Deficit
Belief an expectation ___________ the experience
Define
Function of iron
Delivery of oxygen to cells Improves blood quality Increases resistance to stress and disease Many adolescents females and adult women in particular suffer from Fe deficiency
Nutrient Content Claims on Food Labels
Describe level of nutrient in a product with words such as "high", "low", "reduced", etc.
Growth-Mindset
Desire to learn, grow, and embrace challenges, persisting in the face of setbacks
Readiness to change questionnaire can help the coach do what?
Determine the client's stage of change and adapt communication style accordingly
DASH diet
Dietary Approaches to Stop Hypertension - Low in saturated fat, total fat, cholesterol - Rich in fruits, vegetables, low-fat dairy - Whole grains, poultry, fish, nuts are encouraged - Limit amounts of fats, red meats, sweets, sugared beverages - <2 drinks for men, <1 drinks for women per day
Function of Zinc (Zn)
Digestion and metabolism Important in development of reproductive systems Aids in healing
Reflections that are helpful for sustain talk
Double-sides reflections using "and" or "but"
What is the first phase of motivational interviewing?
Engaging
Amplified Reflections
Exaggerated statement of what the client just said
Excess body fat, especially in which area, is associated with which conditions?
Excess body fat located around the abdomen is associated with conditions such as hypertension, metabolic syndrome, type 2 diabetes, stroke, heart disease, and dyslipidemia
What are some of the risk factors for obstructive sleep apnea?
Excess weight, narrowed airway, being male, being older, family history, use of alcohol or sedatives, smoking, and nasal congestion
Appropriate controllable stress =
Excitement and motivation Optimal performance
When entering the facility for the first time, nonverbal communication, including posture, eye contact, and tone of voice, can indicate the type of _______ the client has had in the past
Exercise experience
True or false: Heath coaches cannot share nonmedical nutrition information
False. Health coaches not only CAN but SHOULD share general nonmedical nutrition information.
True or false: It is out of the scope of practice of a health coach to share information created by an RDN or medical doctor
False. Health coaches can share this information. It is within their scope of practice.
True or False: Amount of fat is more important than the type of fat
False. Type of fat it more important, which is also why food labels no longer include "calories from fat"
Socio-Ecologic Model to Support Healthy Eating for All
Framework that suggests that interventions should extend well beyond providing traditional education about healthy choices, and should help build skills, reshape the environment, and reestablish social norms to facilitate individuas' healthy choices
If people have a job that makes them sit for long periods of time, a good way to address it is through...
Frequent low-intensity breaks (hourly)
Karvoven formula
HRR = MHR - RHR THR = (HRR x % intensity) + RHR
Interoceptive Awareness
Having a connection with internal body signals
Health Belief Model
Health Threat - Perceived susceptibility - Perceived seriousness Health Behavior - Benefits - Barriers
When beginning to design a plan of behavior change
Health coaches encourage clients to consider all potential possibilities and to approach the process as an experiment. Encourage the client to refrain from immediately evaluating ideas or approaches. Identify all potential options first
Some things that have a positive effect on resilience
Health coaching Cognitive restructuring Social support Stress-management strategies (e.g. meditation) Health behaviors (e.g. exercise)
And what should a club or facility invest to create a long - lasting behavior change and then prove exercise adherence?
Health coaching professionals
The achievement of the PfA outcome requires an ongoing focus on:
Health equity
Out of the protein subgroups, meat, poultry, and seafood have the most...
Heme iron
Which iron is better absorbed heme or non-heme?
Heme iron
Goal Setting Theory: Self-Efficacy
Higher self-efficacy, higher persistence
Motivational Interviewing: Acceptance
Honors client's absolute worth and recognizes autonomy
Ghrelin
Hunger hormone
Stress Response: Slow-Acting Pathway (HPA Axis)
Hypothalamus-Pituitary-Adrenal (HPA) Hypothalamus releases corticotropin-releasing hormone (CRH) CRH sígnala the pituitary to release adrenocorticotropic hormone (ACTH) into bloodstream ACTH travels to adrenal cortex, causing the release of glucocorticoids cortisol and aldosterone
Cytokines
Immune system signaling molecules
Practical Approaches to Evoke Change Talk
Importance Ruler Querying Extremes Looking Back Looking Forward Exploring Values
Insomnia
Inability to get an adequate amount of good-quality sleep
Leisure-time physical activity
Includes subcategories such as sports, exercise conditioning, household tasks, and other activities that may or may not contribute significantly to a person's energy expenditure during the day
What is a reason a client might smoke?
Increase self confidence
What is one reason why sleep deprivation can lead to obesity?
Increased appetite due to hormone impairment
High intake of saturated fat is associated with...
Increased total and low-density lipoprotein cholesterol — both of which increase the risk of CVD
Higher levels of reported stress, as well as the perception that stress affects health, are....
Independently associated with an increased likelihood of poor physical and mental health as well as an increased risk of premature death
Healy and colleagues (2011) found that prolonged periods of sedentary time (sitting), even in people who also regularly exercises at moderate- to vigorous- intensity, were associated with...
Indicators of declining cardiometabolic function and increased systemic inflammation
General self-efficacy (GSE)
Individual's belief that they can accomplish or cope with a wide range of demands
Domain-specific self-efficacy
Individual's confidence in their ability to carry out a specific action
Self-monitoring
Individual's evaluation of their thoughts and feelings and how that info is then used to shape goals and behaviors
Decisional balance definition
Individual's relative weighing of the benefits of changing versus the costs (Pros vs cons)
Lifestyle change is analogous to the law of...
Inertia
Goal of MyPlate
Influence Americans to eat a more balanced diet by encouraging people to make half of their plate vegetables and fruit
TTM - Contemplation
Intention to make change in the next month They are experiencing ambivalence Consider: Ask questions that encourage them to evaluate the behavior Encourage evaluation of pros and cons Identify and promote positive expectations and self-confidence Explore available options for making change
Types of Motivation (p66)
Intrinsic motivation Integrated regulation Identified regulation Introjected regulation External regulation Amotivation
What should happen when terminating coaching agreement?
Invite client to reflect on their learning and growth experienced through the relationship Reflect on new perspectives, knowledge, and skills gained Explore sources of support so that the client can continue to improve Express genuine gratitude for the opportunity to be a part of the journey
Mindful Eating
Involves slowing down the eating experience and practicing awareness of all sensations (taste, textures, feelings, sounds, and surroundings)
Cognitive Distortions
Irrational and likely harmful thoughts patterns that interfere with wellbeing Cognitive Distortions that reinforce negative thoughts/feelings csn alter the way people see reality, leading to a chronically negative and unproductive view of self and life
Cognitive distortions
Irrational and usually harmful thought patterns that interfere with well-being. Can reinforce and lead to chronic negative self-views.
Physical Activity Guidelines for Americans
Is accessible to, and appropriate reading for, the general public
Where did the concept of Self-Efficacy come from?
It came from Social Cognitive Theory (SCT)
How can stress impact self-regulatory abilities?
It can reduce them
How soon does a nicotine addiction develop?
It develops very quickly
How does sleep impact ghrelin?
It increases it
Social support has been shown to be a strong predictor of:
Life satisfaction
Function of potassium
Lowers blood pressure Decreases risk of kidney stones Prevents bone loss
Tanaka, Monahan and Seals maximal heart rate
MHR = 208 - (0.7 x Age)
The ability to be fully present with what is happening around and within oneself is a critical component of
Managing stress Igniting and supporting lasting and meaningful behavior change
The coach should ______ the client's voice volume, speed of talking, and body language
Match/Mirror
If a client wants to exercise for performance-related athletic endeavors
Moderate amount of moderate- to high- intensity structured activity, such as running, can increase fitness
Goal Setting Theory: Mobilized Effort
More challenging goals elicit more effort
Motivational Interviewing: Evocation
Most answers can be found within client, not from coach.
Is it okay for for a medical professional to withhold narcotics from suffering patients because patients could develop a chemical dependency from its use?
No, even though there is a risk of dependency, withholding narcotics from a suffering patient would be unethical
Mindfulness definition by Jon Kabat-Zinn
"Paying attention in a particular way: on purpose, in the present moment, and non-judgmentally"
Through mindfulness, in seeing themselves as they truly are, clients can start letting go of the...
"stories" to which they may be tightly clinging
Be careful with the word _______. It may be interpreted as accusatory, blaming, or shaming
"why"
Direct and indirect costs of obesity-related conditions costs the U.S, how much money annually?
$147 billion
Reward pathways include...
- Dopamine - Serotonin - Acetylcholine - Endorphins
Claims that can be used in food and supplement labels include:
- Health claims - Nutrient content claims - Structure function claims
What is the "premature focus trap" that coaches should avoid?
- Narrowing focus of discussion too soon
Drawbacks of using METs
- They are only approximations of energy expenditure - The system does not account for individual variations in age, sex, muscle mass, disease states, and environmental factors - The system is more accurate when doing such standardized activities as running, instead of non-standardized activities like tennis. This is because efficiency differences in activities such as running are generally small from one person to another
Examples of occasions when self-disclosure may be helpful:
- To build trust in client-coach relationship - To model openness and encourage reciprocity of disclosure from the client - To answer a client's direct question - To affirm the client's experience
OARS
Open-ended questions Affirmations Reflective listening Summaries MI is not defined by OARS, but they are still a tool that created a communication style that lets the client find their autonomous motivation
Motivational Interviewing (MI) is very helpful, but it is especially helpful for clients who...
...are experiencing ambivalence
4 Processes of Motivational Interviewing
1. Engaging 2. Focusing 3. Evoking 4. Planning
Five Factor Model
1. Opennesss to experience 2. Conscientiousness 3. Extroversion 4. Agreeableness 5. Neuroticism
4 Processes of MI: Planning
Parallels with Preparation Stage of TTM. "Whether" and "why" turn into "when" and "how". Important: this process is led by the client.
What needs to be unearthed before exploring a future with behavior change?
Personal values
PAR-Q+
Physical Activity Readiness Questionnaire for Everyone
What are the pillars of lifestyle medicine?
Physical activity Nutrition Stress management Avoid drug use Sleep Relationships
Why may older adults sleep less?
Physical and psychiatric illness may interfere with the ability to sleep well, as in the medications used to treat these illnesses.
What is a lifestyle factor that can affect someone's ability to get enough sleep?
Poor nutrition
Element of MI: Compassion
Practice in the best interest and for the ultimate welfare of the client, not for some secondary gain or benefit to the coach.
One of the most common features of effective programs is...
Proper goal setting
Function of Selenium (Se)
Protect body tissues against oxidative damage from radiation, pollution, and normal metabolic processing
Objective of an accountability system for the client...
Provides the client with an opportunity to give an account of what they committed to, reporting their action and learning. The accountability system does not consist on going over what was or wasn't accomplished. It helps explore obstacles to completing goals. Continued evaluation and experimentation.
Goal of PAR-Q+
Reduce unnecessary barriers to exercise
What screening tool should be used for clients with known CVD in clinical settings, such as a rehabilitation or medical fitness facility?
Risk-Stratification Criteria from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACPVR)
Appreciative Inquiry (AI)
Rooted in curious wonder and openness to change Comfort in not knowing Explore with an open mind
Which stress response system is responsible for the "fight or flight" response?
SAM (Sympathomedullary Pathway System)
Ambivalence definition
Simultaneous opposing thoughts about positive or negative behavior
Negative Health Behaviors
Some people may use them to/as: - Reduce negative emotions - Cope with stress - Fuel creativity - Form social connections - Find meaning in life - May become a part of one's identity
Withdrawal symptoms: specific or general?
Somewhat specific to the substance addiction
What should a health coach do if their substance-addicted client is a minor?
Speak with their parents on a separate occasion
Which approach is used to improve self-efficacy and self-management?
Strengths-based approach
If the food says "partially hydrogenated" on the label, but it says 0 grams of trans fat, what does this mean?
That the food does have trans fat, but it is <0.5 grams, so the food manufacturer is legally allowed to list is as 0 grams
Allostatic Load
The body's ability to respond to challenges is exceeded or inefficient as a result of an intense, repeated, or prolonged stress response, leading to accumulated "wear and tear" on the body
Goal of brief interaction before first session
The client should understand: Who the coach is What will happen next What responsibilities they have before the first session
What is the most important aspect in behavior change and wearable devices?
The easier a device is to use and understand, the greater the amount of control a person experiences, and the more his or her feelings of knowledge and skill increase
Cognitive Behavioral Coaching (CBC) and Cognitive Behavioral Therapy (CBT) are both based on...
The idea that negative thoughts can lead to negative emotions which can later lead to negative behavior
Relationship between the amount of time that a person has been smoking and difficulty quitting
The longer and more often that the person has been smoking, the more difficult it'll be to quit
Goal Setting Theory: Task Complexity
The more complex the goal, the more strategies are needed to achieve it
Why may health coaches need to be particularly careful to suspend judgement with someone who is dealing with some form of addiction?
The person might feel particularly shameful, as there is generally a social stigma associated with addictions
General rule for reflections and questions asked (Reflective/Active Listening)
There should be 2-3 reflections for every question asked.
How can a health coach work in residential programs for negative behaviors?
They can work with clients and cultivating healthy lifestyles and support them in new practices that will promote physical and psychological well-being
Common Barriers to Change
Time Other people Travel
Sleep and cytokines in immune system
Too little sleep increases presence of cytokines, leading to chronic inflammation
Taxonomy of Stressors: Distant Stressors (p.147)
Traumatic experiences that happened in a distant past yet continue to have long lasting psychological and emotional impact
Which oils are not recommended in the DGA and why?
Tropical plant oils such as coconut and palm oils because of their high content of saturated fat
Righting Reflex
Trying to "fix" what seems to be wrong with the client
Irrational belief
Unreasonable concept. Something that person assumes to be true, but does not mesh with what is truly possible. Often contain words "should" "ought" or "must".
Reversibility Principle
Use it or lose it
Best way to tackle long-term goals...
Use small, ongoing SMART goals
Open ended questions normally start with the words...
What and How
How quickly should you refrigerate perishable food?
Within 2 hours
The coach and client should continuously _____________, _______, _______ways of getting closer to goals, instead of sticking to something just because the client thinks that's what they "_________" do
explore, adapt, evolve; should
What is the initial goal of physical activity?
function
The level of risk of cardiovascular complications during low-to-moderate intensity resistance training is...
low
Exercise is now being viewed as a form of __________________, for both the prevention and management of chronic disease
medicine
Health-related components are ______________ than skill-related components
more important to health
The benefit of consuming high levels of omega-3 fatty acids _______ the risks of increased mercury intake
outweighs
Physical activity is an effective method in the __________ and __________ prevention of chronic health conditions
primary; secondary
Mindset can shape the stress _________ and stress-___________ __________
response; related outcomes
Sarcopenia
the loss of muscle mass, strength, and function that comes with aging and reduction of physical activity
What is one reason women are more susceptible to the effects of alcohol?
the rate of alcohol breakdown is slower in women
According to BJ Fogg, you pair the new ______ ______ with an _________
tiny behavior; anchor
Having set _______ can help clients overcome ___________
values; challenges
4 Signs of Discord in Client/Coach Relationship
- Defending - Squaring off - Interrupting - Disengagement
Factors that influence self-efficacy (Bandura 1997) p. 59
- Mastery experiences - Motivational models - Persuasive messages - Stress arousal
6 Traps that Occur in Engaging Process
1. Assessment Trap: Too many one-directional questions 2. Expert Trap: Seeing themselves at the expert with the answers 3. Premature Focus Trap: Focusing on one behavior change too soon 4. Labeling Trap: Naming the problem. May cause a feeling of alienation and stigma 5. Blaming Trap: Client feels that the coach will blame him for their problems 6. Chat Trap: Too much small talk
Designing a Plan for Behavior Change
1. Brainstorm and spontaneously come up with a list ideas, refraining from any judgement 2. Assess the options you co-created to identify which works best for the client 3. Break down goals into small ongoing SMART goals 4. Use the confidence scale to make sure goal is both motivating and feasible 5. Check in with clients to determine appropriate action
After an open ended question, a client's answer might go in 3 directions
1. Clear Direction: Client makes a statement with a focus, coach must confirm that focus 2. Choices in Direction: Client states a variety of focuses. Here, coach can help decide which one to narrow in on first 3. Unclear Direction: Client doesn't feel sure where to start. Coach helps find areas to make changes in.
Elicit-Provide-Elicit
1. Client says something 2. Coach responds with open-ended question 3. Client responds 4. Coach reflects or summarizes 5. Coach asks for permission to share info 6. Coach asks client their thoughts on given info
4 Forms/Agreements that a Health Coaching client should fill out
1. Coaching Agreement 2. Lifestyle and Health History Questionnaire 3. Readiness to Change Questionnaire 4. HIPAA Release Form (not required)
In terms of activity trackers, Reasoned Action Approach is divided into two constructs...
1. Instrumental Attitude: The person believes it is smart to use an activity tracker and be physically active 2. Experiential Attitude: The person believes the activity tracker is fun and pleasurable to use, and the advantages outweigh any disadvantages
1. Client's goals represent... 2. Client's values represent...
1. what they want to achieve 2. why they want to achieve those goals
When did the modern lifestyle medicine movement begin?
1999
Due to the increasing evidence supporting the health benefits of seafood the dietary guidelines recommend adults should consume which amount of seafood per week?
8 oz or more
Chronic stress can cause health challenges, including... A. Reproductive problems B. Asthma C. Heart palpitations D. Increased blood pressure
A
What are the phases of the ACE cycle of change? A) Awareness, choice, execution B) Acceptance, confidence, explanation C) Awareness, confidence, execution D) Acceptance, choice, explanation
A
An effective ACE Certified Health Coach exhibits which of the following abilities? A. Limit the role of medical providers B. Unlock a patient's potential C. Provide judgement only when necessary D. Focus on one specific issue at a time
B
Based on the International Coaching Federation's (ICF) core competencies, which example is MOST relevant to setting the foundation of a health coaching relationship? A) Requiring the release of the client's medical records B) Agreement on the coaching process and relationship C) Providing the client with the structured outline of the program D) A verbal agreement from the client to avoid unhealthy behaviors
B
Health coach served in the role as a "guide on the ______" A. Front B. Side C. Behind
B
Which is the MOST appropriate application of using motivational models to increase self-efficacy? A) Interject humor into sessions and phone calls with the client B) Introduce the client to a colleague who experienced a similar lifestyle change C) Set challenging goals early on that require a high amount perseverance D) Email daily encouraging messages to the client at work
B
Standard alcoholic drinks serving sizes
Beer: 12 fl oz of regular beer with about 5% ABV Malt liquor: 8-9 fl oz with about 7% ABV Wine: 5 fl oz with about 12% ABV Spirits (gin, rum, tequila, vodka, whiskey, etc.): 1.5 fl oz with about 40% ABV
How can health coaches help clients enhance self-regulatory capacity?
By helping them foster self-awareness and coping skills
A client's ambivalence about weighing the pros and cons is a key element in which stage of change? A) Action B) Preparation C) Contemplation D) Precontemplation
C
Applying the core principle that adults are more likely to retain and act upon new information when they are in a stage of readiness to learn, which learning activity is most appropriate? A) Have the client complete a worksheet of goals to identify learning gaps B) Role-play several possible experiences as a client pursues change and troubleshoot areas where increased learning is needed C) Gauge a clients interest in exploring a topic by asking powerful open-ended questions before asking permission to provide information
C
How can I help coach best help prepare a client for dealing with potential setbacks? A) Revisit the client's strengths and past experiences B) Revisit the client's values and motivation for change C) Support the client in identifying possible coping strategies D) supply the client with a list of alternative behavior choices to implement
C
What is the most appropriate response time to potential clients email inquiry? A) 3 days B) 1 week C) 1 day D) Within the week
C
What is the most effective approach to dealing with a setback? A) Ask the client to spend time reflecting on how the setback could have been prevented B) Redirect the conversation to focus on the successes the client has had in the process C) Ask the client what they learned from the experience that will help them in the future D) Explain to the client that setbacks are necessary in the early stages of behavior change
C
What is the next step for a client who indicates actively dealing with severe depression on his lifestyle and health history questionnaire? A) Ensure them that taking this step will also address their feelings of depression B) Explain that even though you feel you could assist them, legally you must refer them to a medical provider C) Inform them it is outside of the scope of practice of a health coach and refer them to a mental health professional D) Encourage them to participate in a minimum of two sessions per week
C
When a client asks for advice, what is the MOST appropriate response from the coach? A) Ask the client to confirm if he or she is ready to follow advice B) Use factual statements to share the most up to date info C) Use open ended questions to find out what the client already knows D) Paraphrase the question asked to be more clear on what the client is asking
C
When a client determines a change is needed, what skill can a health coach use to cultivate a positive mindset? A) Invite the client to reflect on his or her true motivation to change B) Provide the Client a list of meditation exercises C) Ask probing questions to identify the client's strengths D) Paraphrase with the client perceives as the barriers to change
C
When hosting a virtual session, what is the top priority? A) The background is serene B) The session is well organized C) It is conducted in a private setting D) Minimize background noise
C
Which of the following is essential in order for a health coach to help a client progress through the stages of behavior change? A) Mastery of teaching the necessary skills to cope with change B) A precise timeline of time spent in each stage C) An accurate understanding of the client's readiness to change D) The expertise to prevent a client from regressing
C
Which of the following is included in the scope of practice of an ACE Health Coach? A. Provide guidance on choosing supplements B. Develop complete meal plans C. Ask open-ended questions D. Prescribe effective exercise regimens
C
Which party or parties carries the responsibility of upholding a behavior change plan? A) Client and support system B) Client is solely responsible C) Client and coach D) Coach and support system
C
Dairy products are high in
Calcium Phosphorus Vitamin A Vitamin D (normally through fortification) Riboflavin Vitamin B12 Protein Potassium Zinc Choline Magnesium Selenium
While milk products are not necessary to meet nutrient needs, they do contain many nutrients, including...
Calcium, vitamin D, and potassium— all nutrients consumed in inadequate amounts by much of the population
Inpatient and Residential Treatment for people who are addicted to something
Can provide constant supervision for patients, along with a change of environment that can help remove people from the daily triggers at sustain the negative behavior
How could you find qualified exercise professionals for your clients?
Check the U.S. Registry of Exercise Professionals www.USREPS.org
Out of the protein subgroups, eggs have the most...
Choline
Prescription for Activity (PfA) systems change map:
Culture transformation: Across diverse populations within the U.S., being physically active is prioritized, feasible and enjoyable As measured by: 50% or more Americans in every community, demographic, and age group achieve recommended levels of physical activity Target year: 2035
A client has identified the following goal: "I would like to quit smoking to decrease my risk of developing cancer". Which element of SMART goal is missing? A) Attainable B) Specific C) Measurable D) Time-bound
D
Which of the following is the best assessment tool used by a health coach? A) Readiness to change questionnaire B) Lifestyle and health history questionnaire C) PAR-Q+ D) Listening
D
5 Subgroups of Vegetables
Dark green Red and orange Legumes (beans & peas) Starchy Other
Righting reflex
Directing individuals to "fix" what is wrong with them to set them on a better path.
Mindset...
Guides attention, motivation, influences how a person feels and ultimately acts.
What is the desired effect of OARS?
Guiding the client into change talk
TTM - Preparation
Intention to make change within the next month and has made plans to start taking action Consider: Encourage development of self-directed goals Design small action steps to help increase self-efficacy Identify social support
Taxonomy of Stressors: Brief Naturalistic Stressors (p.147)
More serious real-world challenges that are over relatively quickly
For what programming recommendations there is no known volume recommendation?
Neuromotor exercise
Out of the protein subgroups, poultry has the most...
Niacin
Summarizing
Recap key points of the conversation as well as keep the session on track if it has gone off topic
Instead of attempting to "fix" problems, health-coaches can use a __________-based approach
Strengths
What is the most common trigger causing people to abandon their behavior change goals?
Stress
4 Processes of MI: Focusing/Agenda Setting
Understanding more about the target areas that the clients wish to change. Ambivalence, complexities, and conflicts may be revealed. Additional reasons for behavior change may come up.
4 key elements of "Spirit of MI"
Collaboration Acceptance Compassion Evocation
Neuromotor Exercise
Combination of balance, coordination, gait, and agility training that is formally recommended for older adults to reduce the risk of falls
Body language: Cracking knuckles
Comforting habit
Self-talk and automatic thoughts
Commentary in one's mind that goes on throughout the day.
Self-talk; automatic thoughts aka
Commentary in our minds Mind chatter
What are the components of mobilizing change talk?
Commitment, activation, taking steps
What is "guiding style of communication"?
Communication in which the coach encourages, supports, and assists the client in the process of change. Help clients find their own way and awaken solutions within themselves.
According to the Reasoned Action Approach (RAA)...
Comprised of Autonomy (how much control the person has) and Capacity (how much knowledge and skill the person has)
Summarizing as MI
Emphasize and pull together useful parts of the convo and recap key points. After summarizing, let the client comment on summary to confirm that it is accurate and to correct any misunderstandings.
What if a client asks for information?
Emphasize autonomy ➡️Elicit-Provide-Elicit➡️Build off of knowledge ➡️Tailor to individual➡️Remind them that it's their choice➡️Finish with open ended question Respond to their request for info while emphasizing their autonomy. Use elicit-provide-elicit. Build off of client's existing knowledge. Tailor info to match client's strengths, needs, and individual learning style. Remind them that it is their choice whether or not they want to accept the information. Finish with an open ended question.
What should the coach do when the client uses change talk and sustain talk at the same time?
Emphasize client autonomy
What should a coach do when a client is feeling down about a setback?
Encourage them to reframe their perspective. "What is another way of looking at this situation?"
Other ways health coaches can respond...
Encouraging (short words, smiling and nodding) Paraphrasing (understand by restating) Reflecting emotional content ( "that must have been upsetting", "you seem discouraged", "that sounds like fun")
Practical approaches to evoke change talk: Looking forward
Envision life if the change is made. This increases motivation to change
Function of Manganese (Mn)
Enzyme activation Carbohydrate and fat production Sex hormone production Skeletal development
Which type of stress is associated with type A personalities?
Episodic Acute Stress
DGA recognizes oils as an important part of a healthy diet because they contain..
Essential fatty acids and vitamin E
Element of MI: Evocation
Evoke the client's inner wisdom to recognize what they need to change.
Heart of motivational interviewing
Evoking
HR Telemetry
Exerciser wears a HR monitor strapped to the chest during the workout, which transmits HR to a wristwatch ⌚️
Values Interview
Explore values and guiding life principles using open-ended questions
What if discord is not easily remedied and becomes ongoing?
Explore with the client if there is another professional that may help them. Make recommendations and try to facilitate the transition.
Double-sided Reflection
Exploring ambivalence by highlighting reins the client has given for and against change
Double-Sided Reflection
Exploring client's ambivalence by highlighting reasons given both for and against change
Locus of Control
Extent to which people think things happen for internal vs external reasons i.e. what can you control vs what can't you control?
__________ stressors are outside events __________ stressors are self-induced
External Internal
True or false: An event causes stress
False
Hiring the appropriate _________ is the first key and locking the door to beginning to build rapport with a new member
Front desk staff
ACE IFT Model
Function (Phase 1) Health (Phase 2) Fitness (Phase 3) Performance (Phase 4) Functional Movement & Resistance Training - Phase 1: Stability and mobility Training - Phase 2: Movement Training - Phase 3: Load Training - Phase 4: Performance Training Cardiorespiratory Training - Phase 1: Aerobic Base Training - Phase 2: Aerobic Efficiency Training - Phase 3: Anaerobic Endurance Training - Phase 4: Anaerobic Power Training
How can the health coach help clients decrease Na intake?
Give them the following advice: - Read nutrition labels and pay attention to Na content - Consume more fresh foods and fewer processed foods - Eat more home-prepared meals and add little table salt or Na-containing seasonings - When eating out, ask that salt not be added - Reduce calorie intake, since most foods also contain sodium
What is the health coach's role in working with clients with substance addictions and dependencies?
Health coaches should work as part of a healthcare team
Exercise health-screening for those who do not exercise regularly
If a client has CVD, metabolic or renal disease, or signs or symptoms of them, medical clearance is needed
Exercise health-screening for those who do exercise regularly
If a client has signs or symptoms suggestive of CVD, metabolic or renal disease, they should stop exercise and look for medical clearance. If a client has a history of known CVD, metabolic or renal disease and wants to progress to vigorous-intensity aerobic exercise, medical clearance is recommended
What adjustments should clients make if they have a schedule that requires them to sleep throughout the day?
- Set up a meal schedule - Manage light and dark exposure - Control caffeine intake
Examples of activities in the office to break up sedentary time:
- Stand up to take phone calls - Walk to see a colleague rather than phoning or emailing - Have standing meetings or regular breaks during meetings where people are allowed to stand - Go to a restroom on a different level, using the stairs to get there - Walk to a distant trash or recycling bins and printers rather than using these items close to the desk - Take the stairs instead of the elevator whenever possible
Hallucinogens
- Such as LSD, mescaline, and ayahuasca - May have medical applications under professional oversight - Main problem: impaired decision marking, which can become dangerous - Rare risk: persistent psychosis - Some people experience hallucinogen-persisting perception disorder
How can a health coach empower their clients to more effectively use an activity tracker?
- Support and Clients with set up, syncing, and battery charging instruction - Helping clients understand how to link their devices with a smart phone app or computer if applicable - Providing information about adjusting one's behavior based on the activity tracker's feedback - Providing troubleshooting guidance and other supporting resources - Exploring with clients the various uses of the device (e.g. social features) - Assisting with goalsetting and reminders - Providing periodic feedback and chickens based on the clients desired method of accountability — for example every week for the first 6 to 8 weeks, and every month or so thereafter
Methods to establish accountability
- Task Completion: "homework" for the patient. They try a behavior and they tell the coach what worked, what did not work, and together they discuss what can be changed. - Surveys: Client asks other people about information related to their behavior change to get opinions about it. Coach supports client to conduct these surveys. - Research: Clients go and research about the change that they want to make. Coach holds them accountable.
Examples of open-ended questions
- Tell me how you are feeling - Tell me how your health has been - How can I help you? - Give me an example of how you get relief from your pain at home - Walk me through a typical day for you - What things trigger you to smoke at those specific times? - What do you think would be a good first step? - How do you want me to hold you accountable?
A health coach might wish to discuss alcohol and drug use with a client for reasons such as the following:
- The client expresses concern about alcohol or drug use 🔸Don't try to diagnose them. Help them by finding out what behavior they want to change and in developing strategies. With their permission, contact the appropriate health professional. - The client's food records show a high intake of alcohol 🔸Can be used as a prompt for further discussion. - The health coach is uneasy about the client's discussion of drug use 🔸 The health coach can express concern and sincere interest and as open ended questions to understand their use. Remember to suspend judgement. - The client tells the coach they are struggling with a difficult addiction, such as opioids 🔸 Refer to s substance use disorder professional. - A client arrives to an appointment under the influence of something, or shows different and erratic behavior 🔸 If possible, call the client's emergency contact to drive the client home. Wait until the client is sober to have a discussion.
What if a health coach is employed by a place that requires them to sell nutritional supplements?
- The health coach must obtain complete scientific understanding of the supplements - The health coach must stay up to date with legal and/or regulatory issues regarding the supplement and its ingredients - The health coach must obtain adequate insurance coverage should a problem arise
Symptoms of insomnia
- Trouble falling asleep - Waking frequently during the night - Difficulty getting back to sleep after waking up - Waking up too early - Daytime fatigue
Health Effects of Sleep Deficits and Disorders
- Weight gain - Cognitive disorders and dementia - Depression and anxiety - Poor recovery from training - CVD and cardiometabolic disorders - Immune system effects
Examples of questions to consider when helping a client set a goal
- What will the client do this week/month? - Does there need to be a set plan or more flexibility? - What might get in the way? - What will make the plan stronger?
GROW Model
-establish a GOAL -examine the current REALITY -explore the OPTIONS -establish the WILL
Function of choline
Important in metabolism and neurotransmitter synthesis
When is it important to address health beliefs?
In the early stages of behaviors change
Classification of Weekly Total Amounts of Aerobic Physical Activity: 4 Types
Inactive Insufficiently Active Active Highly Active
Function of chromium
Increases effects of insulin, restores glucose tolerance
Function of fiber
Increases feelings of fullness, promotes normal bowel function, may help decrease risk of CVD, obesity, and T2 diabetes
Ecological Perspective for Behavior Change
Individual Interpersonal Community Built Environment Institutional/Organizational Social & Cultural Norms & Expectations Helps health professionals understand supportive influences as well as barriers to behavior change
Reflective/Active Listening
Listening to a person closely, and responding with a declarative statement that represents your interpretation of that the client means. This shows that you're interested and trying to understand them
Relationship between duration of exercise and sleep
Longer duration of exercise is associated with more positive sleep benefits *Note that intensity does not matter as much as duration
Recommended amount of sodium
<2,300 mg daily for low risk people <1,500 mg daily for high risk people
MET Classifications
<3 METs ➡️ Light 3-5.9 METs ➡️ Moderate > 6 METs ➡️ Vigorous
A health coach who is able to correctly identify emotions in clients demonstrates which component of emotional intelligence? A) Self-awareness B) Self-management C) Relationship-management D) Social awareness
A
According to the health belief model, which of the following MUST be present in the order to make ac decision to change? A) The perception of an increased susceptibility to an illness B) A serious illness has been diagnosed by a medical provider C) The belief that the threat of the illness outweighs the benefit of the healthy behavior D) The ability to eliminate all barriers before starting the healthy behavior
A
Body Composition
Amount of fat and lean body mass that make up total body weight Fat mass is made of subcutaneous fat and visceral fat Lean mass is all body tissues besides fat
Besides noting any chronic conditions, what is another important detail to note related to this?
Amount of time that they've had the chronic condition
Healthy U.S.-Style Eating Pattern
Based on the type and proportions of food Americans normally eat, done in the nutrient-dense and appropriate amounts
Principles of AI: Awareness
Be conscious of underlying assumptions
What is a habit a client can be encouraged to adopt to get better sleep?
Be exposed to sunlight first thing in the morning
Packages that were between one and two servings are now required to...
Be labeled as one serving since people commonly consumer the whole thing in one sitting
As a health coach, what is one of your biggest roles and helping clients deal with their stressors? A. Educating them on external and internal stressors B. Empathizing with them about their potential stress triggers C. Helping them identify their stressors and stress triggers D. Sharing with them your stressors and ways you have coped
C
How can a health coach BEST support a client who has decided to adopt a new sleep routine? A) Educate the client on the pros and cons of establishing a sleep routine B) Provide the client with educational articles about beneficial sleep habits C) Collaborate with the client on realistic goals to start D) Develop long-term goals and the addition of exercise habits
C
TTM - Maintenance
Client has done behavior for 6 months or more Consider: Examine strategies being used, discussing success or need for modifications Reevaluate current goals and revising as needed Transition from external to internal motivation Explore various program options to keep maintaining behavior
TTM - Action
Client has made behavior change that they have done consistently for less than 6 months Consider: Behavior modification strategies to help with long-term success Assist client in defining and verbalizing meaningful rewards Increase awareness of inevitable lapses and bolster self-efficacy in coping with lapses Continual feedback to build towards sustainable change
Practical approaches to evoke change talk: Looking back
Client remembers a time before wanting to change current behavior. This highlights the contrast between then and now
Value represent
Client's higher purpose and deeper meaning and motivation for change
Element of MI: Collaboration
Client-centered partnership between coach and client. "Dancing instead of wrestling".
What is important to note when change talk is coupled with sustain talk?
Clients are not being resistant or difficult. It is just the ambivalence that shows up in the process.
Why should coach be careful when asking questions that start with "why"?
Clients may sense this as accusatory, blaming or shaming in nature.
Goal Setting Theory: Persistence
Clients persist longer in their target behaviors when there are goals
Warm handoff
Clinician directly introduces the client to the coach
4 Processes of MI: Engaging
Coach strives to convey a feeling of professional, unconditional positive regard for the client to build rapport and trust
While a client dealing with substance addiction usually needs help beyond the scope of practice of the coach, how can the health coach contribute to their recovery?
Coaches can support clients as they strive to create healthier lifestyles, working closely with other members of the care team. The coach will motivate and support positive behavior change. The coach can use models such as TTM and techniques such as motivational interviewing.
Illegal stimulants and health
Cocaine and methamphetamine May cause serious health problems such as heart arrhythmias and heart attacks. May also cause neurological problems such as seizures and strokes
All-or-nothing belief is an example of
Cognitive Distortions
It is helpful for the client to leave the session with a plan in _________ or ___________ form
written; electronic
The MyPlate Food Plan Checklists to start working with clients to see daily calorie and nutrient needs
www.ChooseMyPlate.gov/MyPlatePlan
DRIs for specific nutrients are available at...
www.nationalacademies.org
To learn more about the PfA Task Force:
www.prescriptionforactivity.org
The new health-screening process is based on three factors that have been identified as important risk modulators of exercise-related cardiovascular events:
🔸Person's current level of physical activity 🔸Diagnosed CVD, metabolic, or renal disease and/or the presence of sins or symptoms of CVD, renal or metabolic disease 🔸 Desired exercise intensity
Complementary Medicine
Medicine used in conjunction to conventional medicine
Classification of Weekly Total Amounts of Aerobic Physical Activity: Active
Moderate-Intensity Mins per Week➡️150-300 mins/week (meets recommendations) Summary of Overall Health Benefits ➡️Substantial Lifestyle Application➡️Activity at the high end of this range has additional and more extensive health benefits than the activity at low end
Premature Focus Trap
Narrowing the focus of the discussion too soon
What is the main reason that someone might go back to smoking after trying to quit?
Negative feelings
Too much or too little stress =
Negatively impact performance and resilience
TTM - Precontemplation
No recognition of need or interest in change, even if they have been advised to make changes Client is uninformed or under-informed of consequences of behavior Consider: Identify if your client has incorrect information ("can you tell me what you know about ....?") Increase client awareness Encourage reevaluation of current behavior Discuss barriers and encourage self-exploration
Does coaching have a script to follow?
No. There's structure, but the process must remain flexible
Do older adults need less sleep?
No. They still need plenty of good quality sleep
Should you encourage a client to act before they are ready?
No. This means that the plan will probably fail
ACSM 9 Risk Factors for Atherosclerotic CVD
Nonmodifiable 1. Age 2. Family history Modifiable 3. Cigarette smoking 4. Physical inactivity 5. Obesity 6. Hypertension 7. Dyslipidemia 8. Diabetes 9. Low HDL-cholesterol
If a client has known CVD , metabolic or renal disease AND is asymptomatic, do they need medical clearance?
Not for moderate-intensity exercise. If they want to increase the intensity, then medical clearance might be needed
MI relies on four key skills:
Open-ended questions Affirmations Reflective listening Summarizing OARS
Coaching
Partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential
Motivational Interviewing: Collaboration
Partnership between you and your client, grounded in the point of view and experience of the client
Self-Determination Theory (SDT)
People are naturally motivated to pursue activities and goals that they are interested in or from which they believe they'll get some benefit
What does Social Cognitive Theory (SCT) state?
People's behaviors are influenced by: 1) Cognitive & personal factors (knowledge, outcome expectations, attitudes) 2) Behavioral factor (skills, practice, self-evaluation, self-efficacy) 3) Environmental factors (social norms, community influences, behavior reinforcement, observational learning) How people think about things exert a strong influence on their behaviors
Body language: Use of barrier (purse, backpack, briefcase, etc.)
Personal space is being invaded
Taxonomy of Stressors: Chronic Stressors (p.147)
Pervasive situations caused by life-changing circumstances that do not have a clear end-point in sight
Physical Activity vs Exercise vs Physical Fitness
Physical Activity 🔵Any body movement that contributes to daily energy expenditure 🔵Positively Associated with physical fitness Exercise 🔵Planned, structured, and repetitive body movement that contributes to daily energy expenditure 🔵Very positively associated with physical fitness 🔵Subcategory of physical activity 🔵Any type of physical activity that disrupts homeostasis Physical Fitness 🔵Set of attributes that a person has or achieves 🔵Health-related components: 🔸Cardiorespiratory endurance 🔸Muscular endurance 🔸Muscular strength 🔸Flexibility 🔸Body composition 🔵Skill-related components: 🔸Agility 🔸Balance 🔸Coordination 🔸Speed 🔸Power 🔸Reaction time
How are substance use disorders different that behavioral addictions?
Physical withdrawal symptoms for behavioral addictions tend to be less severe than those for substance use disorders
Principles of AI: Positive
Positive questions lead to positive change
Eustress
Positive stress. The right amount of moderate stimulation and discomfort
Which stage of behavioral changes a client most likely to benefit from a nurturing parent style of communication?
Precontemplation
Transtheoretical Model
Precontemplation stage Contemplation stage Preparation stage Action stage Maintenance stage
Amplified Reflection
Providing a direct and more exaggerated form of what the client said
A planned exercise program to improve body composition consists of...
Regular aerobic exercise to promote fat loss Consistent muscle-conditioning exercise to enhance and maintain muscle tissue
When it comes to the bodies stress response, cortisol plays a critical role of
Regulating glucose metabolism so blood glucose levels remain high
Simple Reflection
Repeating or rephrasing in a concise way
Cognitive reconstructing
Replace unproductive thinking with more helpful thoughts
What should a coach do when discord happens?
Respond to it immediately through reflective listening, apologizing, affirming client's autonomy and resourcefulness, shift focus away from sensitive topics.
Reflective/Active Listening consists of...
Responding to the client with a declarative statement and taking a "best guess" at the meaning of what the client has shared.
Stress Response: Fast-Acting Pathway (SAM Pathway)
Response to stress mediated by sympathetic-adrenal-medullary (SAM) pathway signals adrenal medulla Adrenal medulla secretes catecholamines epinephrine and norepinephrine Epinephrine and norepinephrine prepare the body to act against a threat Vasodilation occurs in places where blood will be needed to fight or flee (i.e. muscles of arms and legs) and vasoconstriction occurs in places where blood will not be needed to fight or flee (i.e. digestive system)
11 Core Competencies of Health Coaching (p. 29)
SETTING THE FOUNDATION - Meeting ethical guidelines & professional standards - Establishing the coaching agreement CO-CREATING THE RELATIONSHIP - Establishing trust & intimacy with the client - Coaching presence COMMUNICATING EFFECTIVELY - Active listening - Powerful questioning - Direct communication FACILITATING LEARNING & RESULTS - Creating awareness - Designing actions - Planning & goal setting - Managing progress & accountability
Types of Reflective/Active Listening
SIMPLE REFLECTIONS Restating/repeating what the person said COMPLEX REFLECTIONS Trying to interpret what the client really means with their statement STRAIGHT REFLECTIONS A complex reflection to a client's sustain talk AMPLIFIED REFLECTIONS Overstated/exaggerated statements that challenge the client to think more about what they just said DOUBLE-SIDED REFLECTIONS Blend both the sustain talk and change talk that the client has done
Identifying signs an symptoms of disease is within the ______ ___ ________ of the health coach. Interpretation of those same signs and symptoms are outside the _____ __ ________ of the health coach and should only be made by _____________________
Scope of practice Scope of practice; qualified licensed professional
General Adaptation Syndrome (GAS)
Selye's concept of the body's adaptive response to stress in three phases—alarm, resistance, exhaustion. Alarm: Exposure to stressor Resistance: Stressor persists and body continues to use resources to go back to homeostasis Exhaustion: Ongoing stressor and body depletes resources. Potential long-term damage may happen
In terms of serving sizes on food labels, law requires that...
Serving sizes be based on amounts that people commonly eat, not what they should consume
4 Core Competencies of Health Coaching (p.29)
Setting the Foundation Co-Creating the Relationship Communicating Effectively Facilitating Learning & Results
What if the client doesn't turn in the assessment forms or doesn't have time to complete them before the 1st health coaching session ?
The coach can still review pertinent info such as: - Health conditions - Daily routines - Interests - Personal values
Curious Question
The coach explores the metaphoric gap between the client's current health behavior and their vision for the future. "What needs to change in order to turn your vision of wellness into a reality?"
Who benefits the most from acute exercise when it comes to improving total sleep time and quality?
Those who participate in regular exercise
What is the goal of cognitive behavioral coaching?
To help a client identify and replace unrealistic or irrational thoughts with more accurate thoughts that ultimately will help to change behavior
For larger package sizes, manufacturers must include...
Two columns labels to include the amounts per serving and the amounts per package
Element of MI: Acceptance
Unconditional positive regard, respect, trust, empathy. The coach understands client's unique perspective.
Hours of sleep for adolescents
8-9 hours (an hour more than adults)
What % of chronic diseases are caused by lifestyle?
80%
Stimulus Control
Altering the environment to encourage healthy behaviors
What disease are amyloid proteins associated with?
Alzheimer's Disease
Underpinning of most mindfulness practices:
Elicitation of relaxation response
Possible reflective response for following statement: "The doctor told me that I need to lose weight to get my cholesterol down, but I just don't know if I can do it. I have tried in the past and I always quit"
"It appears you don't feel confident that you can lose weight "
Possible summary statement if the client says something like this: "I think I am ready to quit smoking. I have a bad cough, my chest hurts, and my grandkids won't hug me anymore because they say my clothes smell. I have tried in the past but I think I am really ready this time"
"It sounds like even though you were not ready to quit in the past, you have some important reasons to quit this time. Is that accurate?"
Substance-use Disorder: Definitipn and Diagnostic Criteria
"Maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by 2 or more of the following, occurring in a 12-month period": - Repeated substance use that results in a failure to fulfill major obligations - Repeated hazardous use of the substance, such as DUI - Continued use of the substance despite the fact that is it causing social or interpersonal problems and even though the user acknowledges that these problems are the result of use - Development of tolerance - Withdrawal symptoms - Substance is taken in larger amounts or for longer periods than intended - Efforts to reduce or eliminate use are unsuccessful - A lot of time is spent procuring or using the substance or recovering from the use - Involvement in important activities is given up or greatly reduced - Craving the use of the substance
Your body on stress
(Picture in phone)
Calorie-wise, what is low, moderate, and high?
- <40 is considered low - 100 is moderate - >400 is high
Daily Value (DV) %. What is low and what is high?
- <5% is low - >20% is high - This is based on a 2,000 calorie intake. These % must be adapted for those who need more or fewer calories
Healthy Mediterranean-Style Eating Pattern
- Adapted from Healthy U.S.-Style Eating Pattern - Except that is has more fruit and sea food - And it has less dairy, meat, and poultry - Nutritionally similar to Healthy U.S.-Style, but it has less Ca and vit D
Healthy Vegetarian Eating Pattern
- Adapted from Healthy U.S.-Style Pattern - Increased soy products, legumes, nuts, seeds, and whole grains - Dairy and eggs are included - Nutritionally similar to Healthy U.S.-Style, but higher in Ca and fiber, and lower in vit D
Prescription sedatives and tranquilizers
- Addictive - Often overused - May cause daytime drowsiness, increasing likelihood of accidents and injuries - When mixed with alcohol, heart rate and breathing rate may become dangerously low
Recommended Dietary Allowance (RDA)
- Adequate intake of a nutrient to cover needs of all healthy persons - Covers 97-98% of the population
Estimated Average Requirement (EAR)
- An adequate intake in 50% of age- and gender-specific group - If level is between EAR and RDA, the person likely consumed enough of the nutrient
Topics to bring up if you want to talk to a client about sleep
- Ask them about levels of fatigue - Ask about caffeine and alcohol intake - Encourage them to notice whether they sleep better on days that they exercise - Explore simple relaxation exercises to use at home, such as breathing and meditation - Encourage clients to address sources of stress that lead to wakefulness
Self-Determination Theory (SDT) 3 Factors
- Autonomy (Autonomous Motivation means doing things on own free will; Controlled Motivation means doing things because they are pressured by external forces) - Competence (People feel good and more motivated when they feel more competent in a skill or area of their life. Health coaches can help them in this by setting up and noting early successes) - Relatedness (Feeling of belonging in a group of people that supports and understands the person)
Habits conducive to sleep hygiene
- Avoid working in the sleep area - Keep it quiet, dark, and cool (60-68F or 15.6-20C) - Follow a consistent sleep/wake schedule - Limit bright lights, as these can interfere with melatonin - Exercise daily - Avoid caffeine and alcohol - Avoid eating too much too close to bedtime
Awareness-Choice-Execution (ACE) Cycle
- Awareness: Support clients in self-exploration to understand gap between current behavior and desired behavior. - Choice: Coach supports client in creating self-directed goals and setting a positive mindset to fuel long term change. Also, identify strengths and plan for challenges and successes along the way. - Execution: Co-create a plan to set visions into action. Take small steps towards goal and establish accountability. Client forms self-efficacy. Continuously evaluate and adapt plan.
Example questions to help the client establish accountability to themselves
- How would you like to be accountable for that? - How will you track your progress? - How can I help you to be accountable to yourself?
Melatonin
- Hormone that makes us sleepy - Made by pineal gland, which regulates circadian rhythm
Health Risks of Tobacco Use
- CVD: Tobacco products increase BP, HR, and blood-clotting rate. They also produce oxidative damage especially in lungs and bloodstream. - Cancer - Chronic respiratory disease - Sexual dysfunction: Reduced blood flow to sexual organs - Reproductive problems in women: Increased risk of ectopic pregnancy. - Systematic inflammation and impaired immune response - Poor management of diabetes: Tobacco users with diabetes experience more kidney disease, blindness, and circulatory problems leading to amputation - Slow healing - Eye disease: smoking contribute to the development of age related macular degeneration, A retinal disease that is leading cause of blindness - Accelerated aging of the skin: Appears to be caused by reduced blood flow, and affect of the vasoconstriction caused by nicotine
Some signs that warrant client referral to another professional:
- Changes in eating or sleeping habits - Notable decline in professional or academic performance - Worsening physical symptoms - Overwhelming inability to cope with the daily demands of life - Engagement in dangerous or destructive behaviors
Clients can use the following tips to reduce risk of foodborne illness
- Check produce for bruises, and feel and smell for ripeness - Look for "sell-by" date for breads and baked goods, a "use-by" date on some packaged foods, an "expiration date" on yeast and baking powder, and "packaged date" on canned and some packaged foods - Make sure packaged foods are not torn and cans are not dented, cracked, or bulging - Separate fish and poultry from other purchases by wrapping them separately in plastic bags - Pick up refrigerated and frozen foods last. Try to make sure all perishable items are refrigerated within one hour of purchase
Coaching agreement should include: (Sample in p.102)
- Clearly state client-coach relationship - Format of coaching - Primary goal established by the client - Schedule, frequency, time commitment of coaching - Cost, fees, payments - No-show, reschedule, cancel policies - Termination process - Client confidentiality
What some examples of the types of clients may be out of the scope of practice of a health coach?
- Clients with multiple chronic conditions - Clients with poorly controlled chronic conditions - Uncontrolled mental illness
The Academy of Nutrition and Dietetics notes that the most effective strategies for facilitating health- and nutrition-related behavior change include...
- Cognitive behavior therapy - Motivational interviewing - Self-monitoring - Financial rewards - Goal setting - Problem solving - Social support
4 Key Elements of Motivational Interviewing (MI)
- Collaboration: there is a natural partnership between coach and client. They are "dancing rather than wrestling" - Acceptance: unconditional positive regard. Unwavering acceptance. No judgement - Compassion: MI needs to be practiced in the best interest of the client. The goal is to benefit the client, not the coach - Evocation: instead of telling the client what to do, evoke from within them their wants, whys, strengths and motivations
Examples of venues through which health coaches can share nutrition information:
- Cooking demonstrations - Recipe exchanges - Handouts - Informational packets - Individual or group classes/seminars - One-on-one encounters
Symptoms of tobacco withdrawal
- Craving for tobacco - Depression - Anger - Irritability - Tension - Anxiety - Difficulty concentrating - Restlessness - Difficulty sleeping - Increased hunger - Weight gain
Health Claims on Food Labels
- Describe relationship between a food or its components and the prevention of treatment of disease - Must be approved by the FDA - Can be based on emerging evidence, but it must include a statement that the science is not conclusive
What should be discussed during the first session?
- Description of health coaching - Coach's approach/philosophy - What is usually involved in a session - What is usually involved in follow-ups - Length, content covered, frequency - Handling of late/missed appointments, fees, cancellations - Confidentiality - What the client wants to get out of the coaching - How the client wants to be coached
What can a health coach do when unsure about how to deal with clients with psychological or substance problems ?
- Discuss with supervisors and colleagues, while maintaining confidentiality protocols - The employer might already have policies and guidelines in place for such situations - Refer to professionals. Clients may need to find referral through their PCP so that they are covered through insurance. - If the client doesn't have insurance, try to find low cost alternatives to refer them to (community support groups, 12 step programs, etc.)
Other elements a health coach can include during reflective listening
- Encouraging: "that's interesting", "I see", nod and smile - Paraphrasing: Shows understanding and extending what the client means. If you understood it wrong, they will correct you - Reflecting Emotional Content: "that must have been upsetting", "you seem discouraged"
What does the NIH Body Weight Planner say in terms of weight loss?
- For every 10-calorie decrease, an average overweight adult will lose about 1 lbs - Half of the weight will be lost by 1 year - 95% of the weight change will happen by 3 years
FOOD Prescription (written by doctors)
- Frequency: Of the food, beverage, or meal to be eaten - Objective: The goal or reason to eat the food - Options: How much and how to prepare, growC shop and/or serve it - Duration: How many times per day, week, or month
GROW Model
- Goal (establish) - Reality (explore current situation and how it may affect the goal) - Options (brainstorm ways to achieve the goal, identify possible obstacles) - Will (clients determine their next steps)
DASH Diet Nutrition
- High in potassium, magnesium, calcium, protein, and fiber - Low in saturated and total fat and cholesterol
Effective interventions consider behavior change in domains such as...
- Home: such as development of cooking skills and reducing screen time - School: providing healthy snacks with nutrition labels, support physical activities, reach out to parents to also encourage change - Worksite: offer wellness programs and flexible schedules to allow for physical activities - Community: support places such as shelters and food banks - Food retail: reach out to consumers to make healthy changes. Make healthier options affordable
Opioids
- Increase use possibly because of aggressive marketing of opioid medications - People may start using them under medical care, but then become addicted - Once they don't have legitimate medical use for them and can't easily access the drug, they might turn to cheaper black market options such as heroin
Possibilities to explain why exercise may improve sleep
- Increasing the body's need to restorative sleep - Improving mood and reducing feelings of stress due to things such as changes in neurotransmitter levels and increases parasympathetic tone - Exercise may help people follow a more consistent schedule, which may also help with sleep - Outdoor exercise may help improve circadian rhythm, therefore benefitting the sleep cycle and sleep quality
What could non-residential behavior change programs potentially include?
- Individual counseling and psychotherapy - Group therapy - Integrative health treatments such as acupuncture, hypnosis, therapeutic yoga - Healthy eating behaviors are emphasized - Coping skills training - Stress management practices
What should a coach's "welcome packet" include?
- Info about coaching process - What to expect in terms of length and frequency - Any forms that need to be completed before the first session
Types of Motivation According to SDT
- Intrinsic motivation: most effective type for behavior change. Person does a behavior because they like it - Integrated regulation: they do a behavior because it has become a part of their self-concept - Identified regulation: doing a behavior because, even if they don't find it really enjoyable, they know it'll help them reach their goals - Introjected regulation: doing a behavior because they feel like they should, even if they don't want to. They'll feel guilty if they don't do it - External regulation: doing a behavior only because of external pressure. To avoid a punishment or get a reward - Amotivation: no motivation. Person does not do the behavior
What to do during cognitive restructuring?
- Keep a record of negative thoughts - Identify which thoughts might reflect real problems the client may want to talk about - Suspend judgement - Examine misconceptions that may underlie the thoughts - Empower clients to rephrase negative self-talk - Help clients anticipate and cope with common unhelpful thoughts
What should the coach consider prior to the first session?
- Keeping track of appointments (digitally or paper planner) - Schedule enough time between appointments to get done what needs to get done - Appointment reminders (how far in advance, what format, etc.) - Consider a first 15 complimentary session
Examples of Client Assessment Forms
- Lifestyle & Health History Questionnaire - Readiness to Change - PAR-Q+ (can be done before OR after 1st session)
Health pros and cons of alcohol
- Light-moderate drinking (1/daily women; 2/daily men) may reduce risk of coronary artery disease, improving blood lipid levels. - Heavier drinking can produce significant cardiovascular damage. - Toxic metabolites from alcohol breakdown may cause fatty liver in people who have 4+ drinks daily. This is reversible in early stages. Another risk is cirrhosis. - Even at low levels, alcohol intake is associated with higher risk of cancer. - Heavy alcohol intake is the primary cause of pancreatitis. - Acute and chronic alcohol misuse interferes with immune response. - Heavy alcohol use is associated with brain damage and poor brain function. - Alcohol is a teratogen, causing irreversible damage to the fetus in a physical, behavioral, and cognitive aspect. - Alcohol misuse if overall linked to harmful behaviors.
Tolerable Upper Intake Level (UL)
- Maximal intake that is unlikely to pose a health risk - Helps determine whether there is risk of toxicity
Possible items that could be in an end-of-session form (p.114)
- Measurements taken (if any) - Established goals (if appropriate) - Homework between sessions - Any responsibilities for the coach - Accountability system - Date/time next session
Adequate Intake (AI)
- Nutrient intake that appears to be sufficient in good health - Used when an EAR, therefore not an RDA either, can be established - If intake is below AI, it is possible, but not certain, that the client is deficient in the nutrient
Strategies to Quit Smoking
- OTC or prescription nicotine-replacement products - Identify triggers for smoking, and find ways to work through these triggers without relapsing - Improve lifestyle through better eating, exercise, and sleep. Monitor caloric intake since weight gain is a common side effect of smoking cessation - Online resources www.smokefree.gov
Reliable places to check out the validity, safety, and risks of supplements:
- Office of Dietary Supplements - National Center for Complementary and Alternative Medicine - Food and Drug Administration
Examples of specific strategies to support clients in shifting eating patterns:
- Partner with them to increase the awareness of their food and beverage patterns at home, and help identify where they could make small changes - Enhance self-efficacy with skills such as cooking, label reading, gardening, etc. - Explore ways that individuals can model healthy behaviors for friends and family - Co-create plans to help clients limit screen time and time spent being sedentary and increase physical activity
Ways the coach can help client in their journeys:
- Refer them to other professionals when appropriate - Help them identify support systems - Help them identify credible, evidence based resources
Structure/Function Claims on Food Labels
- Regulated by Dietary Supplement Health and Education Act (DSHEA) - Doesn't need FDA approval, but must state that the claims have not been evaluated by the FDA to treat or prevent disease - Relate a nutrient or ingredient to normal human function such as "calcium builds strong bones"
How are client assessment forms also good for the client?
- Self-awareness & self-reflection - Find gaps between current behaviors and where they want to be
Physiology of Stress
- Sensory info is processed by the amygdala - If stressor is identified as threat, a distress signal is sent to the hypothalamus - Hypothalamus communicates with ANS - Hypothalamus triggers "fight or fight" , activating SNS of ANS, suppressing PNS
Benson and Kippler identified that all relaxing practices have two common aspects:
1. Repetition 2. Passive disregard as thoughts arise
Transtheoretical Model (TTM)
1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance
1. For clients, a crucial aspect of adopting and ultimately sustaining healthful behaviors involves... 2. Health coaches provide a safe space where clients can cultivate awareness. This needs...
1. A willingness to continually and non-judgmentally observe what is happening in the present moment 2. Empathy, willingness and ability to understand, and generosity on the part of the health coach. They must also stay non-striving towards what they think is best for the client, and practice patience instead.
Types of Stressors
1. Acute time-limited 2. Brief naturalistic 3. Stressful event 4. Chronic 5. Distant
Anatomy of Tiny Habit
1. Anchor Moment 2. New Tiny Behavior 3. Instant Celebration
Processes of Change (TTM) p. 58
1. Consciousness rising 2. Dramatic relief 3. Self-reevaluation 4. Environmental reevaluation 5. Self-liberation 6. Helping relationships 7. Counter-conditioning 8. Reinforcement management 9. Stimulus control 10. Social liberation
4 Signs of Discord in Client-Coach Relationship
1. Defending: Client deflects blame, minimizes situation and justifies their decisions. Normally happens if they feel threatened. 2. Squaring off: Client senses an adversarial relationship. Statements like "you don't understand ", "you don't know what it's like to be me" or "you're wrong". 3. Interrupting: Client feels like the coach talks too much, doesn't understand, or is not listening. 4. Disengagement: Poor eye contact, distracted, or not participating in conversation.
Build on clients' strengths with these 4 approaches:
1. Ensure a positive tone in all coaching sessions 2. Ask clients to identify their character strengths 3. Uncover clients' values 4. Note progress towards goals
Key Nutritional Guidelines
1. Follow a healthy eating pattern across the lifespan 2. Focus on variety, nutrient density, and amount 3. Limit calories from added sugars and saturated fats and reduce sodium intake 4. Shift to healthier food and beverage choices 5. Support healthy eating patterns for all
The 3 types of healthy eating patterns discussed the most in the DGA are...
1. Healthy U.S.-Style Eating Pattern 2. Healthy Mediterranean-Style Eating Pattern 3. Healthy Vegetarian Eating Pattern
What happens to the brain during sleep?
1. It shrinks 2. Increases the space between neurons by 60% 3. Allowing cerebrospinal fluid and interstitial fluid to mix and sweep through the brain 4. Washing away harmful substances such as amyloid proteins
Common Cognitive Distortions (p.82)
1. Jumping to Conclusions 2. Magnification (Catastrophizing and Minimization) 3. Labeling 4. Overgeneralizing 5. Personalization and Blame 6. All-or-Nothing Thinking
Some evidence based mindfulness programs:
1. Mindfulness-Based Stress Reduction (MBSR) 2. Mindfulness-Based Cognitive Therapy (MBCT) 3. Mindfulness Self-Compassion (MSC)
6 Stress Management Interventions (chapter 7 video)
1. Mindfulness-based Stress Reduction 2. Mindfulness -based Cognitive Coaching 3. Breathing Exercises 4. Guided Imagery 5. Progressive Muscle Relaxation 6. Meditation
9 Pillars of mindfulness practice
1. Non-judging 2. Patience 3. Beginner's mind 4. Trust 5. Non-striving 6. Acceptance 7. Letting go 8. Generosity 9. Gratitude
7 Attitudinal Major Pilars of Mindfulness
1. Non-judging ➡️ Impartial witness to one's experience 2. Patience ➡️ Allow things to unfold and emerge in their own time 3. Beginner's mind ➡️ Releasing what one believes to know 4. Trust ➡️ Trusting one's feelings, experience, wisdom and intuition as guidance 5. Non-striving ➡️ Strive less toward a particular outcome 6. Acceptance ➡️ Embrace things as they truly are, instead as how one wants them to be 7. Letting go ➡️ Detach from particular aspects of an experience TWO EXTRAS 8. Generosity 9. Gratitude
Health Belief Model (HBM) - 4 Factors
1. Perceived Susceptibility (Health Threat) 2. Perceived Seriousness (Health Threat) 3. Benefits (Health Behavior) 4. Barriers (Health Behavior)
Stepwise approach to help clients read a food label:
1. Start at the top with serving sizes and servings per container (all of nutrient amounts listed are per 1 serving) 2. Look at total calories 3. Look at nutrient content. Aim to minimize saturated and trans fats, and to get enough fiber, vitamins and minerals (especially vitamin D, potassium, calcium, and iron). Pay attention to total sugars and added sugars
Agenda Mapping
1. Structuring: Step back from conversation to check out other options for focus (with client's permission) 2. Considering Options: Together explore possibilities for focus 3. Zoom In: Together choose an area of focus
What frameworks can a new health coach use to guide themselves during interviews with patients?
1. TTM 2. Self-Determination Theory 3. Motivational Interviewing 4. OARS 5. ACE Cycle
How much more likely is it for people with insomnia to develop depression compared to those who sleep well?
10 times greater
Grams of whole grains in a 1-ounce equivalent
16 grams
The DGA recommend that adults eat __________ of seafood per week
8 or more ounces
How to maximize a workout for the average person?
1st cardiorespiratory activity 2nd resistance activity 3rd and 4th flexibility and neuromotor, in whatever order *This also depends on the goals of the person
When should the last meal be eaten?
2-3 hrs before bedtime
Reflection to Question Ratio
2-3 reflections for every 1 question asked
What % of deaths are related to smoking?
20%
If your nap during the day how long shift and that be?
30 mins or less
Regardless of the physical activity goal, it will always include...
5 health-related components
Dietary Guidelines are updates every...
5 years
As little as ________ weight loss in individuals with obesity can result in many health benefits
5%
Hours of sleep for adults
7-8 hours
Recommended hours of sleep for adults
7-8 hours
Foods that are partly whole grain should contain at least _________ of whole grain per 1-ounce equivalent
8 grams
What is one way health coaches can use the socio-ecological model to help clients change their food and activity behaviors? A. Understand her client's access to affordable and healthy foods such as a farmer's market B. Demonstrate to the client on how to shop for affordable and healthy food C. Distribute a list of the kinds of stores that offer affordable and healthy foods D. Educate the client on ways to access affordable and healthy foods
A
What is the first step in implementing the peak experience strategy? A) Ask the client to identify two or three times he has been at his best B) Ask the client to talk about a specific event in great detail C) Invite the client to list her top four strengths D) Invite the client to envision a situation in which he will be at his best
A
What is the first step in the stepwise method for reading food labels? A. Serving size and total servings B. The nutrient content of the food C. Calories per serving D. The list of ingredients
A
What is the first step in using the elicit-provide-elicit model when responding to a request for information? A) Respectfully and curiously ask the client were they already know about the topic B) Clarify that supplying the information is not equivalent to professional advice C) Gently ask the client if they are ready to hear the information requested D) Politely agree and supply the amount of information necessary at the moment
A
What is the main goal of reframing irrational thoughts? A) Choosing a different way to view the situation to find a more positive alternative thought B) Acknowledging the client's weaknesses and building a plan around her strengths C) Restructuring the negative thought to form a positive thought D) Removing oneself from the situation to make the original thoughts irrelevant
A
What occurs during the discover part of the 4-D cycle used by appreciative inquiry practitioners? A) Clients focus on past experiences when they felt most fulfilled B) Clients realize their dreams and achievements C) Clients talk about what gives them joy and meaning to their lives D) Clients develop specific and attainable goals
A
What question could you ask a client showing cognitive distortion in order to examine the evidence? A) "What are the facts of the situation?" B) " How long have you felt this way?" C) "Is that what you really believe?" D) "Are you sure that is the cause of the problem ?"
A
What should the PRIMARY goal for the client at the end of a client-coach relationship? A) Enhanced self-reliance B) Limited need for external motivation C) Recognizing the need to make additional behavior changes D) Established trust with the health coach
A
When does building rapport with a client begin? A) At the first meeting B) After at least two sessions C) Upon achievement of the first goal D) In the first month
A
When it comes to health coaches providing nutrition education, it is within the scope of practice to provide... A. The recommended % daily calories for carbohydrates, fat, and proteins B. A calcium supplement based on the RDIs C. Recommendations for following the Paleo diet for weight loss D. Meal plans for your client
A
Which must a client established before deciding on an accountability method? A) SMART Goal B) Support network C) Reward D) Access to a tracking app
A
Which of the following BEST describes a client-centered ACE Certified Health Coach? A. Views the client as whole and resourceful B. Creates goals for the client to pursue C. Works to fix the client's issues D. Acts as the authority in the decision making process
A
Which of the following accountability statements is MOST accurate? A) Clients are accountable to themselves B) Clients are accountable to the coach C) Coaches should determine the level of accountability needed for a client D) clients should not be held accountable in first few initial sessions
A
Which of the following best describes the role of the NCCA? A) Provide proper exam administration B) Write relevant exam questions C) Create eligibility requirements D) Determine exam content
A
Which of the following describes an individual's confidence in his ability to initiate and sustain behavior change? A) Self-efficacy B) Self-awareness C) Resilience D) Strength
A
Which of the following is MOST accurate when working with a new client? A. Clients are experts in their own life B. Health coaches should identify clients' strengths for them C. Health coaches should provide solutions for clients D. Clients use health coaches to fix problems
A
Which of the following is an example of a reflective statement? A) You are determined to make this work B) You did a great job with that set of push-ups! C) You are right D) How did that make you feel?
A
Which of the following is an example of an acute time-limited stressor? A. Being asked to provide an update at a committee meeting B. Taking a certification test as a personal trainer C. Enduring physical abuse as a child D. Experiencing the death of a loved one
A
Which of the following is an example of identified regulation? A) Bringing a lunch from home to avoid overeating even though an individual prefers to go out to lunch B) Attending a health screen offered by an employer only so he or she won't incur a higher premium payment C) Biking for 20 mins every evening even though a client doesn't enjoy exercising, but needs to do it D) Beginning a new water aerobics class because they like water and swimming
A
Which of the following is an example of preparatory change talk? A) I need to quit smoking B) I swear I will quit smoking this time C) I started a smoking-cessation program D) I am willing to only smoke after lunch
A
Which of the following statements about non-communicable diseases is most accurate? A) They are greatly impacted by lifestyle choices B) Sedentary behavior is the leading cause C) Genetics do not play a role and development D) Onset is quick and often unprevetable
A
Which principle of appreciative inquiry is defined by people choosing what they work on and develop in their lives? A) Poetic principle B) Constructionist principle C) Narrative principle D) Positive principle
A
Why is it MOST appropriate to describe the client-coach relationship as "dancing rather than wrestling "? A) The client is the expert in his own life B) Goals are not focused on accomplishment, but on enjoyment C) The health coach leads the client through a set program D) The process of behavior is easy rather than intense
A
Why might a health coach need to talk to a client about alcohol use?
A client arrives with smell of alcohol on their breath
What is OARS?
A communication approach consisting of open ended questions, reflections, affirmations, and summarizing
Taxonomy of Stressors: Stressful event sequences (p.147)
A focal event that produces a series of difficult, long term consequences that will subside at some point in the future
Complex reflections
A guess at the underlying meaning of what the client said.
According to the Social Cognitive Theory...
A person must have a perceived self-efficacy to engage in a specific behavior
If a client wants to exercise for general health
A physical activity that minimizes risk of developing chronic diseases may be appropriate A modest amount of low-intensity exercise, such as walking, has been shown to improve health
Flexibility
Ability to move a joint through its complete and intended ROM Influencing factors are skin, connective tissues, body fat, bony structures Working on flexibility can help prevent injury Should be done to the point of discomfort, not pain, on most days
Key Coaching Elements - Building Blocks of Rapport
Acceptance / Unconditional Positive Regard Autonomy Empathy Affirmation
Function of Magnesium (Mg)
Acid/base balance Carbohydrate and mineral metabolism
What is important when using double-sided reflections when tackling sustain and change talks?
Acknowledge sustain talk first, then highlight change talk
When using double-sided reflections, what strategy is ideal to use?
Acknowledge the sustain talk first, then highlight the change talk
Principles of AI: Enactment
Acting "as if" is self-fulfilling
Motivational Interviewing: Compassion
Acting fully for the benefit of the other person
What does "A" stand for in the ABCDE mnemonic used to identify unproductive thinking?
Activating event
What is the most common type of stress?
Acute stress
Taxonomy of Stressors (p.147) are split into 5 categories
Acute time-limited stressors Brief naturalistic stressors Stressful event sequences Chronic stressors Distant stressors
How can you turn a closed-ended question into an open-ended question?
After the client has answered with "yes" or "no", follow up with another question or request like "tell me more about that"
The MyPlate recommendations:
Aim to translate the dietary guidelines into an image to guide nutrition choices
Binge Drinking
Alcohol consumption that raises BAC to 0.08 g/dL (generally after 4 drinks in women, and 5 in men) in the course of about 2 hours
Long term changes that may develop as a result of too much stress...(p.153)
Altered emotions Reproductive problems Increased risk of osteoporosis Increased insulin resistance Chronic inflammation Gastrointestinal issues Weight gain Memory impairment Cardiovascular dysfunction Chronic pain Headaches
Function of Cobalamin (B12)
Assists in amino acid metabolism Important for GI tract, bone marrow, and nervous system
Function of Folate (B9)
Assists in amino acid metabolism Important for red and white blood cell formation and in the prevention of neutral tube defects in fetuses
Function of Niacin (B3)
Assists in carbohydrate, amino acid and fat metabolism
Function of Pantothenic Acid (Vitamin B5)
Assists in carbohydrate, amino acid and fat metabolism
Function of Riboflavin (B2)
Assists in carbohydrate, amino acid and fat metabolism
Function of biotin (B7)
Assists in carbohydrate, amino acid and fat metabolism
Function of Pyridoxine (B6)
Assists in carbohydrate, amino acid and fat metabolism Helps make neurotransmitters May contribute to decreased CVD risk by helping regulate homocysteine
MET
Assumes that at rest, the body uses approximately 3.5mL of oxygen per kg of body weight per min 3.5mL/kg/min
A client communicates the desire to begin eating healthier. He has many ideas about how to begin adopting this behavior. What is the BEST course of action of an ACE health coach? A) Choose the best one for the client to implement B) Explore all suggestions with the client C) Offer proven successful options D) Ask the client to choose two strategies
B
According to the 5 factor model, which personality trait involves being humble , patient, and sensitive ? A) Conscientiousness B) Agreeableness C) Openness to experience D) Extroversion
B
How can a health coach BEST support a client's pursuit of a health goal? A) Determine the strategies best suited for the client to achieve the goal B) Provide feedback on progress at defined intervals C) Set more long-term goals to allow time for success D) Encourage the complexity of the goal requiring increased persistence
B
How should a client who has experienced the setback be addressed? A) Ask the client if his goal was unrealistic B) Guide the client through acknowledging and understanding why it occurred C) Allow the client to express their feelings and affirm it is only a mild roadblock D) Provide the client with strategies to overcome similar situations
B
Motivational Interviewing (MI) employs which style of communication A) Directing style B) Guiding style
B
Setting up a role play scenario of be a break room potluck for no a coworker's birthday aligns BEST with which coaching objective? A) Link learning to a successful pursuit of a client's vision, goals, and/ or action plans B) Applying all info and insight shared to relevant problem-centered scenarios C) Helping a client identify the gap between current reality and the info needed to achieve a goal D) Elicit a client's prior experiences and knowledge before providing "education"
B
The autonomic nervous system... A. Regulates the sympathetic adrenal medullary pathway B. Regulates the functioning of body processes without conscious effort C. Regulates the parasympathetic nervous system D. Regulates the sympathetic nervous system
B
The general adaptation syndrome describes... A. The process of adaptation to acute stress to restore homeostasis B. The body's response and adaptation to stressors C. The body's response to mobilize cortisol to reestablish homeostasis D. The effective response to terminate the allosteric responses
B
The negative feedback loops involved in the stress response are responsible for... A. Restricting bloodflow in other areas of the body where it is not needed B. Suppressing cortisol secretion and preventing extended elevations in hormones C. Mobilizing body's resources to address the stressor D. Regulating glucose metabolism to ensure blood glucose levels remain high to respond to stress
B
What is the ACE Cycle of Change? A) A model for coaching a client through change via awareness, change, and enforcement B) A framework to describe how people perceive through making behavioral changes through awareness, choice, and execution C) A form of coaching best described as awareness, coaching, and evaluation D) A method of coaching that relies on affect, choice, and enthusiasm
B
When clients begin identifying barriers to behavior change, which is the best tactic to promote resilience? A) Determine the client may not be ready for the desired behavior change and provide an alternative B) Leverage their identified strengths that have proven successful in other parts of their life C) Encourage them to use failed past attempts as motivation to overcome present barriers D) Direct them to smaller goals that will guarantee success
B
When would be MOST appropriate time to offer information to a client? A) At the beginning of the session, allowing time for discussion B) When identifying the client's lack of understanding C) After a setback to decrease the likelihood of reoccurrence D) At any time, as it is typically welcomed by clients
B
Which BEST defines the role of a health coach? A) Identifying the client's true motivation for change B) Guiding a client along their path of change C) Drawing out the client's emotional barriers D) Discovering the root of the client's problem inhibiting change
B
Which OARS skill is appropriate to use to reframe a client's "deficit mentality"? A) Reflective listening B) Affirmation C) Open-ended questions D) Summarizing
B
Which body language indicator is most likely displayed by a client who feels her personal space is being invaded? A) Standing with crossed arms B) Pulling her purse to the front of her chest C) Begin biting her lip D) Sitting angled towards the door
B
Which is a key component of autonomous motivation? A) The health coach stress small, achievable goals for the client B) The client is the expert on himself C) The client acts under the direction of the health coach D) The health coach is the expert on behavior change
B
Which of the following BEST describes an effective health coach? A) Directs the client's actions B) Collaborates with the client C) Supplies nutritional plans to the client D) Determines specific goals for the client
B
Which of the following BEST describes the field of coaching? A. Comes from a place of healing B. Functions somewhere within the present and desired future C. Concerned with the past D. Often leads to a diagnosis and treatment of dysfunction
B
Which of the following best describes the role of a health coach during an initial interview? A) Gather as much information as possible B) Let the client lead C) Define the client's goals D) Leave the client in a positive direction
B
Which of the following goals is the BEST application of the Tiny Habits method? A) I will perform 10 squats before bed B) After I get the mail, I will perform 3 squats C) I will perform 3 squats every time the phone rings at work D) I will perform 10 squats a day
B
Which of the following is a key aspect of MI? A) Includes advising the client on the best course of action B) Supports clients in self-directed learning C) Only used when clients are highly ambivalent D) Attempts to direct the client towards the pros of behavior change
B
Which of the following is an example of an acute effect of stress? A. Increased gastrointestinal issues B. Increased blood glucose levels C. Increased risk of osteoporosis D. Increased insulin resistance
B
Which of the following is defined as "meeting the client with unwavering acceptance"? A. Positive reinforcement B. Unconditional positive regard C. Rapport building blocks D. Empathetic response
B
Which of the following is most accurate regarding individuals in the action stage of change? A) Individuals are confident in their ability to overcome barriers B) Some individuals may struggle to stick to their plans C) They are considering adopting other behavior changes D) They are still weighing the pros and cons of behavior change
B
Which of the following is the most relevant characteristic of wellness? A) Wellness is the state of being disease-free B) Wellness is dynamic and ever-evolving C) Wellness can be stabilized with discipline D) Wellness is one-dimensional
B
Which of the following questions would explore a client's values? A) Why don't you run anymore? B) Will you tell me more about when you ran half marathons? C) Do you still enjoy running? D) Is it OK if I ask you about your racing days?
B
Which of the following statements is most accurate regarding a client initiating preparatory change talk? A) It means they are ready to move into the action phase B) It may be coupled with sustain talk C) It decreases ambivalence D) It initiates goal planning
B
During a regularly scheduled coaching session with a client with whom you have been working for the last month, the client states, "I did not stick with my health-related nutrition goals on Monday, so I decided to go the rest of the week without trying."which positive distortion does this statement best represent? A) Disqualifying the positive B) All-or-nothing thinking C) Emotional reasoning D) Jumping to conclusions
B) All-or-nothing thinking
Decisional Balance
Balance and shifting of the negative and positive thoughts associated with a behavior change (pros and cons)
Why should you limit sharing your own experience (either with your life or with your other clients) on a topic being discussed with a client?
Because your client is not the same as you or your other clients. They are unique. Share your experience sparingly to promote trust, model and encourage openness, answer a client's direct question, affirm the client's experience
Self-Perception Theory
Behaviors shape attitudes (the opposite of the general idea of the other behavioral models
Biopsychosocial Model of Behavior
Best blueprint for understanding health behavior Biological Social Psychological
Heavy Alcohol Use
Binge drinking on 5+ days during the past month
TTM also outlines ______ of change. Divided into: 1. 2.
Blank: processes 1. Cognitive processes: new way of thinking that reinforce motivation to change 2. Behavioral processes: support behavior change processes
Function of vitamin K
Blood clotting
Function of phosphorus
Bone development Carbohydrate, protein, and fat utilization
Function of fluoride
Bone formation Prevention of cavities
Function of calcium
Bone health Nerve function Blood vessel constriction and dilation Muscle contraction Children, adolescent girls, adult women, and adults over 51 yo are at increased risk of negative effects of insufficient calcium intake
Body language: Feet pointed towards the door; repeatedly looking at the watch
Bored or anxious to leave
What is a good visual aid for agenda mapping?
Bubble sheet
Affirmations
Build self-efficacy and autonomous motivation Should not be empty praises Should be specific Use "you" more than "I"
How can coaches help clients take the lead designing goals and plans that are rooted in their own unique values and vision?
By encouraging them to leverage their own strengths, habits, attitudes, and past successes
How can a health coach build confidence with a medical professional when initially contacting him or her regarding a client? A) Drop in to the provider's office during the lunch hour B) Send a copy of the notes from your sessions C) Provide a resume with letters of reference D) Contact the professional, then inform the client
C
Resilience is BEST defined as... A. The ability to monitor and manage emotions, thoughts, and behaviors based on the situation B. The ability to use appropriate amount of stress as motivation for optimal performance C. The ability to successfully adapt in the face of significant sources of stress D. The desire to learn, grow, and embrace challenges in the face of setbacks
C
The DGA suggest that adults consume _____ of total calories from saturated fat... A. <30% B. <20% C. <10% D. <5%
C
The Dietary Guidelines... A. Are updated every 2 years B. Reflect the best evidence on healthy eating for 98% of the American population C. Apply to Americans aged to an older D. I reviewed and updated by dietitians and nutritionists
C
The phrase "first, do no harm" is described by which pillar of ethics? A) Autonomy B) Justice C) Non-maleficence D) Beneficence
C
What is NOT a good reason to integrate coaching into your existing work? A) To attract new clients B) To improve health outcomes C) To increase success at getting clients to do what you say D) To increase client retention
C
What is one way a health coach could hinder the development of the client coach relationship? A) Beginning with open ended questions B) Engaging in the Active Listening throughout the session C) Asking too many assessment questions D) Asking closed ended questions
C
What is the PRIMARY benefit of establishing an accountability system? A) Provides an easy way to monitor progress toward defined goals B) Serves as a checks-and-balances system for behavior change C) Empowers the client to take action and explore barriers D) Allows the client to take inventory of successes
C
What is the first step in agenda mapping? A) Considering options B) Commitment C) Structuring D) Zooming in
C
What is the goal of incorporating positive psychology into coaching? A) To focus exclusively on the clients strengths rather than deficits B) To help a client focus only on positive attributes and the future C) To help clients build positive changes through identification and use of strengths D) To change the conversation from what is wrong to waters right
C
When working with a client as he or she evaluates self-talk, what is the role of the coach? A) Express genuine concern and desire to help B) Identify the negative statements that need to be restructured C) Refrain from judgement and show empathy D) Provide ways clients could deal with the conflicts
C
Which MOST accurately defines the concept of self-liberation in the process of change? A) Realizing behavior change is an important part of one's identity B) Finding and learning new facts, issues, and tips that support healthy behavior change C) Deciding to change and experiencing a new belief in the ability to change D) Substituting healthier behavior and cognitions for the unhealthy behavior
C
Which action should be avoided when interacting with a client? A) Keeping eye contact throughout the conversation B) Displaying a can and confident demeanor C) Walking around the room while the client is sitting D) Sitting with a slight lean forward towards the client
C
Which component is essential to fostering social wellness? A. Having a regular and healthy sleep schedule B. An expanded sense of purpose in life C. A well-developed support system D. Coping with life's challenges in a self-supporting way
C
Which of the following is an element of strength based coaching? A) It focuses on past experiences B) It focuses on successful experiences C) It focuses on the future D) It focuses on the present
C
Which of the following is an example of an open-ended question? A. Is this an attainable goal for you? B. Do you eat fruits or vegetables? C. What activities do you enjoy? D. Are you ready to begin this transformation?
C
Which of the following is most accurate regarding a coaching agreement? A) It should be a separate document from the payment policy B) It outlines only the health coach's responsibility C) It should be jointly developed by the clients and health coach D) The client should be able to review it prior to an initial meeting
C
Which of the following questions is best suited for aiding clients in examining their current situation and context? A) How often will you review your progress? B) How will you know that you achieved this goal? C) How does this goal conflict with your other goals D) What have you done in the past that has worked?
C
Which professional in a referral network would be MOST appropriate to aid in designing a fitness program for a client with osteoporosis? A. Psychologist B. Physician assistant C. Medical exercise specialist D. Group fitness instructor
C
Which term MOST accurately reflects the approach to medicine that takes i to account all evidence-informed therapies that support physical, emotional, psychological and spiritual aspects of individuals? A. Complimentary medicine B. Alternative medicine C. Integrative medicine D. Western medicine
C
Which type of coach is BEST suited for developing a client's capacity to deal with change in their organization or career? A. Wellness B. Health C. Executive D. Life
C
While working through ambivalence with a new client to increase commitment to change the importance ruler is used to a volk change talk. The client is asked to rate the level of importance the change on the scale from 1 to 10, with one being not important at all and 10 being extremely important. The client responds with the number 6. Which of the following is the most appropriate follow up question? A) What led you to choose a 6 and not an 8? B) What led you to choose a 6? C) what led you to choose a 6 and not a 4? D) Why did you not choose a 10?
C) What led you to choose a 6 and not a 4?)
CAT in DARN CAT
COMMITMENT - I will make exercise a regular part of my routine - I intend to make sleep a priority - I swear I will quit smoking this time ACTIVATION - I am willing to walk during my lunch break - I am ready to change my eating habits - I am prepared to cut back on the number of cigarettes I smoke TAKING STEPS - I have started to meditate in the morning to help manage my stress - I attended two group fitness classes this week - I bought a new cookbook so I can prepare some healthier dinners
Dependence is not the same for all substances, for example...
Caffeine dependence is much safer than a cocaine dependence
Legal stimulants and health
Caffeine, Yerba mate, and other herbal ingredients in various preparations. These can cause anxiety and insomnia.
Micronutrients currently required on a food labeñ
Calcium Vitamin D Iron Potassium
Sources of oils...
Canola, corn, olive, peanut, safflower, soybean, and sunflower oils Olives, nuts, avocados, and seafood
Alcohol Use Disorder
Chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences
A client says "Last month I started taking short meditation breaks during work as a stress management technique. It really helped! Lately, I can't get away from my desk even for one break." Which of the following is the BEST example of a double-sided reflection? A) Work must be very stressful right now B) You are choosing to do nothing about the stress you are feeling at work C) You feel stressed at work D) You are feeling stressed at work va and you know the meditation breaks help
D
A health coach should be prepared to discuss with a client... A. The amount and types of carbohydrates a client with pre-diabetes needs B. Recommendation and calcium and vitamin D supplements for bone health C. We are planning based on the Paleo or ketogenic diet D. The essential role of calcium and vitamin D on the health
D
According to the trans theoretical model of behavior change a person who has no intention of adopting a new behavior is in which stage of change? A) Maintenance B) Preparation C) Contemplation D) Precontemplation
D
After a physician visit, a client is warned of making lifestyle changes to avoid type 2 diabetes. The client is motivated to begin making changes and enjoys social learning environments. What is the BEST option for this client? A) Recommend the client to read through the American Dietetic Association (ADA) website B) Offer too videochat twice a week to review lifestyle choices and progress C) Encourage use of a phone app that tracks food intake and gives feedback D) Suggest participation in a local Diabetes Prevention Program (DPP) class
D
Doing activities that stimulate and challenge mental faculties to enhance one's mental fitness BEST describes which SAMHSA dimension of health? A. Spiritual B. Environmental C. Occupational D. Intellectual
D
If the body perceives a threat, which part of the brain receives the distress signal? A. Adrenal cortex B. Amygdala C. Adrenal medulla D. Hypothalamus
D
Incorporating creative and thought-provoking activities into one's daily life addresses which dimension of wellness? A. Financial B. Occupational C. Social D. Intellectual
D
It may be BEST to ask the client to complete which form before the initial session? A) Readiness to change questionnaire B) Food intake questionnaire C) PAR-Q+ D) Lifestyle and health-history questionnaire
D
The definition of allostatic load is.... A. An effective response to stressors, which appropriate anticipation and engagement leads to efficient termination of allostatic responses B. When the body deplete its resources resulting in compromise to function of various organs and symptoms C. The process of adaptation to acute stress to restore homeostasis in the midst of physical, environmental, or psychosocial challenges D. The body's wear and tear that accumulates after intense, repeated, and prolonged stress response
D
The statement "I ate way too much on vacation, so I might as well give up on my weight loss goal", is an example of which cognitive distortion? A) Overgeneralizing B) Jumping to conclusions C) Magnification D) All-or-none thinking
D
Vegetables are divided into five sub groups, one of which is... A. Fresh, frozen, or canned vegetables B. White and yellow vegetables C. Fibrous vegetables D. Starchy vegetables
D
What is an appropriate stimulus control for a client who wants to get 8 hours of quality sleep? A) Eliminate watching tv during the week B) Replace watching tv with reading a book C) Set a goal of going to bed at the same time every night D) Set a tv timer for the same time every night
D
What is one of the functions of copper? A. Prevents cavities B. Improves blood quality C. Aids in nerve function D. Formation of RBC
D
What is the MOST appropriate response to a client who indicated high blood pressure controlled with medicine on the lifestyle and health history questionnaire, but does not address it as a concern with the coach? A) Refer the client to a medical provider for clearance B) Ask the client if they would like to address it C) Ask probing questions to see if they client will discuss it D) Make note of it for when the client is ready to discuss it
D
What is the best intervention for a client who is in the Precontemplation stage of change? A) Motivational interviewing B) An accountability plan C) SMART goal setting D) Provision of information, with permission
D
What is the goal of working with a client in the preparation stage? A) Encourage them to stick to the plan B) Increase the awareness of the risks of keeping status quo and benefits of changing C) Have the client start thinking about change D) Guide the client to develop a clear and concise plan that sets him up for success
D
What is the primary purpose of values interview? A) Identify character strengths B) Determine readiness to change C) To see if the clients and coach have the same beliefs D) Create awareness of what is most important to the client
D
What technique would a health coach use with a client who communicates the desire to make a change, but is unclear about how to begin? A) Reflective listening B) SMART goals C) Agenda mapping D) OARS skills
D
Which BEST describes the biopsychosocial model of health? A) Health is mostly biological and psychological, with a smaller influence from social factors B) Health is mostly psychological, with smaller influences from biological and social factors C) Health is mostly biological, with smaller influences from social and psychological factors D) Health is a mix of biological, social, and psychological factors
D
Which BEST describes the goal of cognitive behavior coaching? A) Provide clients with specific positive thought to replace negative thoughts B) Implement proven methods to retrain the client's way of thinking to eliminate negative thoughts C) Engage clients who are clinically depressed in positive behaviors and self-talk D) Work with clients to replace negative thoughts with positive thoughts that would support behavior change
D
Which bear reflects the WHO's belief on person-centered care? A. Creating a plan based on past successful clients B. Focusing on what is wrong with the client C. Creating achievable goals for the client D. Focusing on what matters to the client
D
Which best describes "assessment trap? " A) Using too many assessment forms during the initial session B) Asking open ended questions about the results recorded on the assessment forms C) Failing to review the assessment forms before the next scheduled session D) Spending too much time reviewing assessment forms and asking one directional questions
D
Which best describes the role of a health coach? A) Provides clients the "necessary" motivation to be successful B) Formalizes the clients "why" for them C) Guides the clients towards "necessary" health goals D) Assist clients in finding the "how" to make changes
D
Which client would require a referral to another health profesional? A. A client who want to incorporate better eating strategies B. A client who wants to adopt a more active lifestyle C. A client who was obese as a child D. A client who wants a nutrition plan for his triathlon training
D
Which element must be present in a successful client-coach relationship? A) The coach must instruct the client on appropriate strategies B) The client must have had past behavior-change success C) The client must have a problem that needs to be fixed D) The coach must believe that client is capable of change
D
Which element of rapport supports clients in creating a positive perception of their ability to succeed? A) Autonomy B) Acceptance C) Empathy D) Affirmation
D
Which element of the "spirit motivational interviewing" refers to keeping the Kent's needs and desires as the priority? A) Collaboration B) Evocation C) Acceptance D) Compassion
D
Which is the BEST example of learned helplessness? A) A client whose last exercise program didn't work because of work commitments B) A client who doesn't think she will be able to complete a stress-reduction program C) A client who always has an excuse for not turning in a food journal at the end of each week D) A client who does not believe he will lose weight because he has tried unsuccessfully for years
D
Which of the following best describes person-centered care? A) Using authoritative healthcare providers B) Focusing on physician-led medical treatments C) Limiting healthcare integration and components D) Educating the patients and their families
D
Which of the following best describes the role of a health coach? A) Give individuals advice B) Recommend specific strategies to individuals C) Direct individuals on what to do D) Assist individuals and their desired actions
D
Which of the following is NOT a primary part of the stress-response system? A) Molecules B) Cells C) Neuroendocrine Response D) Muscular System
D
Which of the following is an example of a SMART goal? A) I will work out each week for six weeks B) I will take yoga class on Mondays and Wednesdays C) I will attend a yoga class three times a weeks D) I will take yoga during lunch two days a week this month
D
Which of the following is the MOST accurately represents the philosophy of the Tiny Habits method? A) New habits require a large amount of willpower B) New habits need continuous motivation C) New habits can be simple of complex D) The new habit should take place after an anchor moment
D
Which personality type place is value on relationships and helping others? A) Inspiring B) Cautious C) Dominant D) Supportive
D
Which process of MI is also known as agenda planning? A) Planning B) Evoking C) Engaging D) Focusing
D
Mnemonic to categorize change talk
DARN CAT Desire (I want / I would/ I wish) Ability (I could/ I might/ I can) Reasons (It would help/It is important to me/ It might better) Need (I need/ I must/ I've got to
Mnemonic to categorize change talk
DARN CAT Preparatory Change Talk: Desire (I want / I would/ I wish) Ability (I could/ I might/ I can) Reasons (It would help/It is important to me/ It might better) Need (I need/ I must/ I've got to Mobilizing Change Talk: Commitment (I will/ I intend to/ I swear) Activation (I am willing/ I am ready/ I am prepared) Taking Steps (I have started/ I attended/ I bought a new book;membership;equipment, etc.)
"DARN" in DARN CAT (p.125)
DESIRE - I want to exercise more regularly - I would like to better manage my stress - I wish I could improve my blood pressure ABILITY - I wish I could make healthier food choices at the grocery store - I might be able to cut back on how much wine I drink in the evening - I can make more of an effort to go to bed at a reasonable hour REASONS - It would help me to have more energy during the day - I might better manage my blood sugar - It is important to me to be able to play with my grandchildren NEED - I need to quit smoking - I must get more sleep - I've got to lose weight
What is one of the health risks associated with an adequate sleep?
Depression
What does the mnemonic DARN represent?
Desire, ability, reasons, need
Fixed-Mindset
Deterministic view, causing individuals to avoid challenges and give up easily
Excessive alcohol use is linked to an increased risk of
Digestive problems
Appreciative Inquiry (AI) 4-D Cycle
Discover Dream Design Deliver
4 Processes of MI: Evoking
Discover client's motivation for change. Respond to sustain talk and change talk strategically with OARS.
Reactance
Doing the thing a person has been told not to do. It comes from an "impulse to restore behavioral freedoms that are perceived to have been threatened or lost"
Vicious cycle of amyloid proteins
During sleep amyloid proteins or washed away, reducing the risk of cognitive decline If the person doesn't sleep well if you were amyloid proteins are washed away Buildup of amyloid proteins interfere with a persons ability to spend time in adequate deep sleep Making a bad situation even worse
When should an accountability system be established?
Early in the client-coach relationship
Factors that Influence Goal Behavior
Goal Commitment Goal Importance Self-Efficacy Feedback Task Complexity
Goal Setting Theory: Strategy
Goal setting stimulates clients to look for and use strategies
Goal Setting Theory
Goals affect people's performance and behavior
Goal Setting Theory: Directed Attention
Goals help direct thoughts and behaviors
Models vs Theories
Goals help understand and predict the way things work Theories give explanations
Function of Iodine
Growth and metabolism
Cognitive Behavioral Coaching (CBC)
Guided method to help identify, examine, challenge, and change unproductive thoughts and feelings.
A _______ style of communication encourages a client to make a change based on their own __________
Guiding Values
Acute effects of stress
Heart rate and blood pressure increase. This could cause heart palpitations, mild chest pain and dizziness Respiratory rate increases, maybe causing the feeling of shortness of breath. In more extreme situations hyperventilation may happen, potentially triggering asthma attacks or panic attacks Increased muscular tension Increased BG levels Digestive issues Skin and extremities become cool and clammy Mouth and throat become dry Heightened senses and increased alertness Increased emotional state Immune system releases pro inflammatory cytokines
What is the coach's goal when working with a client who is in the contemplation stage of change?
Help the client work through ambivalence about change
What is the first step and helping a client with stress management?
Helping identify stress triggers
Function of vitamin D
Helps reduce the risk of bone fractures and potentially provides many other health benefits, though that is currently under investigation and debate
Open-Ended Questions
Invite the person to share more info
What is sleep apnea?
It is a sleep disorder in which breathing repeatedly stops and starts, interrupting deep sleep and posing a risk as blood oxygen levels can drop to unhealthy levels
Classification of Weekly Total Amounts of Aerobic Physical Activity: Highly Active
Moderate-Intensity Mins per Week➡️>300 mins/week (surpasses recommendations) Summary of Overall Health Benefits ➡️Additional Lifestyle Application➡️There is no identifiable upper limit of activity above which there are no additional health benefits
Classification of Weekly Total Amounts of Aerobic Physical Activity: Insufficiently Active
Moderate-Intensity Mins per Week➡️Activity beyond baseline but less than the recommendations Summary of Overall Health Benefits ➡️Some Lifestyle Application➡️Low levels of activity are clearly preferable to an inactive lifestyle
Classification of Weekly Total Amounts of Aerobic Physical Activity: Inactive
Moderate-Intensity Mins per Week➡️No activity beyond baseline (ADL) Summary of Overall Health Benefits ➡️None Lifestyle Application➡️Being inactive is unhealthy
Values can be identified by using a "values worksheet "and they're effective at identifying client_________
Motivation
Focus of Positive Psychology (Seligman & colleagues)
Moving away from trying to fix a person, and move towards consciously nurturing and using one's character strengths to develop a meaningful and rewarding life
Fatigue can alter perception, making small problems seem...
Much larger
People with underlying CVD who perform a level of physical activity to which they are not used to are at risk for...
Myocardial infarction
Because thinking, planning, emotions, and moods include biochemical changes in the brain, with neurons communicating between each other throughout neurotransmitter release, it is impossible to separate _______ and _______ _________
Psychological and physical dependence NOTE: This explains gambling addictions, which create physical effects even though it's not a substance
Learned Helplessness
Psychological state in which people believe that they are helpless or have no power or control over situations They tend to see failure as inevitable and have learned to attribute their failures to internal, uncontrollable and stable causes
What type of intensity monitoring system would be best for clients who participates in a kickboxing class, where arms and legs are moving in many different directions against gravity?
RPE or Talk Test
What is a strategy a health coach can use to discuss sleep hygiene with a client?
Raise awareness of the link between regular exercise and better sleep
________ : foundation of the ACE Integrated Fitness Training Model and is helpful and creating a positive relationship during the initial stages of the client meeting
Rapport
Goal Setting Theory: Feedback
Receiving feedback on progress will make the client more willing to keep pursuing their goal
What is one of the most effective ways a health coach can facilitate health and nutrition related changes in the clients behavior?
Recommend finding social support
If a client wants to experiment with supplements, what should a health coach do?
Recommend that the client discuss this with a doctor, pharmacist, or highly qualified registered dietitian. Supplements may interact with current medications.
Function of Omega-3 FA
Reduces blood clotting, dilates blood vessels, reduces inflammation, reduces cholesterol and TG levels; may help preserve brain function and reduce risk of mental illness and ADHD
If a client has a request for meal planning, what should a health coach do?
Refer to registered dietitian
If a client has an eating disorder, what should a health coach do?
Refer to registered dietitian
If a client has multiple chronic disease states, what should a health coach do?
Refer to registered dietitian
If emotional factors are more than a barrier to change, such as indicating potential underlying emotional health concerns, ________________
Referral to a mental health professional is warranted
Detoxification
Refers to the initial stage of abstinence from an addictive substance, during which the person may experience and number of physical and psychological withdrawal effects
Distress
Severe and negative stress. Perceived as being beyond coping abilities. Marked by frustration, feeling overwhelmed, and demotivation.
Types of reflections
Simple Complex Straight Amplified Double-sided
Straight reflections
Simple or complex response to a client's sustain talk, followed by a change talk
Simple reflection
Simple restatement of what the client said.
SMART goals
Specific Measurable Attainable Relevant Time-bound
Principles of Training
Specificity Progressive Overload Reversibility
Affirmations definition
Statements that build self-efficacy and confidence in the client. They must be specific and personalized to the client.
Substance use vs substance misuse/abuse
Substance use -> can be positive, such as moderately using caffeine Substance misuse -> the person continues to use the substance even though they are experiencing negative health effects NOTE: The words misuse and abuse are generally used interchangeably, but a health coach might want to stick to "misuse", since it's a milder term for a sensitive subject
Taxonomy of Stressors: Acute Time-Limited Stressors (p.147)
Sudden anxiety provoking situations that tend to be short in duration
Fruit juice that is <100% is considered to be a...
Sugary drink and it should be avoided
What should a health coach do with a client who suspects that they have sleep apnea?
Suggest that they talk to their healthcare provider or refer them to a sleep specialist
Guided Discovery
Support clients to explore, dissect, neutralize, and counter the negative thought cycle, ultimately clearing a path for progress and behavior change
Goal Setting Theory: Importance
The person will be more motivated to achieve their goal if they see it as important to them and if it aligns with their values
Addiction is not simply a function of the substance or activity in question, does it also depends on...
The reasons for the use
Goal Setting Theory: Commitment
The stronger the commitment to the goal, the more effective the goal for behavior change
What is the "righting reflex"?
The tendency to provide the client with solutions
Negative health effects of anabolic steroids
These can range from acne and changes in secondary sex characteristics to heart attacks and liver damage. Since it affects at the hormonal level, multiple body systems are impacted.
How can health coaches help clients with stress?
They can help them identify resources and implement behavior change plans to achieve self-directed goals around stress management and improved health.
What if open ended questions are not helping the coach figure out if the client is ready to make behavior changes?
They can simply ask the client how they feel about changing They can use scaling. Example: "on a scale from 0-10, how confident are you that you'll be able to cut back on candy after lunch?"
For clients with substance use of some sort, what might they be open to do if they are in the contemplation stage?
They may be open to discuss the pros and cons of their behavior. Use motivational interviewing to find the discrepancy between their goals and substance use.
What are tobacco users possibly worried about if they have used smoking to quit other dangerous addictions, such as alcohol or drugs?
They might be worried about relapsing into their previous addictions
Why would users trying to tobacco products?
They might turn to it for a stress relief relaxation or simply because it is a habit that goes with daily activities such as talking on the phone or social time
What should a coach do before offering to provide input or information?
They must first ask for permission from the client
When should the coach try to establish rapport?
They should establish rapport from the first point of contact
If the HPA axis is excessively activated...
This increases the risk for a variety of mental and physical health problems
Intuitive Eating
This is an adaptive form of eating based on hunger and satiety cues to regulate food intake
True or false: Drinking water is a keystone habit
True
How can health coaches "meet people where they are"?
Understand individual choices and motivators by paying particular attention to: - Food access: consider safety, proximity, financial resources, etc. - Household food insecurity - Acculturation: Moving away from one's home country type of eating to a less healthy American eating habit. The recommended eating pattern is flexible and can be adapted to different food cultures.
BMI (body mass index)
Underweight - Less than 18.5 Normal - 18.5 - 24.9 Overweight - 25 - 29.9 Obese - 30 - 39.9
ePARmed-X+
Used for glue te who have had a positive response to the PAR-Q+ or have been referred to use this more comprehensive form by a healthcare professional
Talk Test
Useful for those who are new to exercise If the person can string together words in a sentence without stopping or gasping for air, they are probably exercising at an appropriate intensity
Cognitive Behavioral Coachinh
Uses the basic principles of cognitive behavioral therapy. Coaches can use this on emotionally healthy, non-clinical clients
What type of intensity monitoring system would be best for a client who exercises on the treadmill or participates in an indoor cycling class?
Using a HR monitor would be effective
Positive Psychology (Seligman & colleagues)
Valued subjective experiences: well-being, contentment, and satisfaction (in the past) Hope and optimism (for the future) Flow and happiness (in the present)
What is a powerful way to explore client's values and guiding life principles?
Values interview using open-ended questions
"Stress-is-debilitating" mindset
View stress as having negative outcomes
"Stress-is-enhancing" mindset
Views stress as a challenge that offers enhancing outcomes Improved response to stress, including more adaptive physiological responses and approach-oriented behavioral responses
Function of vitamin A
Vision, growth, immune function, reproduction, skin health
Out of the protein subgroups, seafood has the most...
Vitamin B12, vitamin D, and O-3 fatty acids
Example key follow-up questions when the importance ruler
What led you to choose a 7 and not a 5? (Should lead to change talk) What led you to choose a 7 and not a 9? (Should lead to sustain talk)
Principles of AI: Poetic
What you focus on influences the directions you take
Top 8 Allergens
Wheat Soy Milk Fish Shellfish Egg Peanuts Treenuts
Who is more affected by alcohol, men or women?
Women. Because of their higher body fat %, slower rate of breakdown because of less alcohol dehydrogenase in their bodies.
Principles of AI: Constructionist
Words create worlds
According to the American psychological association, what is one of the top stressors?
Work
Greater allostatic load is associated with
Worse health outcomes and an increased risk of disease and premature mortality
What if clients cannot articulate values verbally?
Write a personal mission statement or do a personal values card sort
Are food manufacturers required to list potential allergens?
Yes
Can coaches dedicate the first few minutes of a session to heightening awareness and evoking relaxation response through a brief mindful practice?
Yes
Can health coaches provide grocery store tours?
Yes
Can a coach record a session to evaluate themselves?
Yes, but only with the client's written consent.
Is it okay to write out the accountability system in the coaching contract?
Yes, this is okay
Is it okay for the coach to provide feedback to the client?
Yes. Feedback should be focused on behaviors and convey a genuine sense of non-judgement
Is it okay for the coach to ask for feedback from the client?
Yes. Specifically about the client's learning opportunities and how the coaching sessions should be structured to further promote the client's growth. "What was the most valuable part of today's session?" "What can I do differently to best support you?"
Could household activities fall into the category of exercise?
Yes. Tasks and household activities may be considered exercise if they are performed and structured to expend more energy to increase health benefits
How can you get a sense of a client's stage of change?
You can ask open ended questions, and this way you get an idea of where they're at in the TTM
Survival Rule of 3
You can only survive: 3 minutes w/o oxygen 3 hrs in extreme condition w/o shelter 3 days w/o water 3 weeks w/o food
Out of the protein subgroups, meat has the most...
Zinc
HIPAA (Health Insurance Portability and Accountability Act)
a federal law that sets standards for protecting the privacy of patients' health information
As long as they are within their values, goals can stretch the client outside of their comfort zone. However, these goals must also be perceived as...
achievable
When choosing whole grain products, whole grains should appear _____________ on the ingredients list
first or second
Health coaches may access an interactive DRI calculator at
http://fnic.nal.usda.gov/fnic/interactiveDRI/
NIH Body Weight Planner
https://www.niddk.nih.gov/health-information/weight-management/body-weight-planner
In terms of metabolism changing as weight loss progresses, the NIH Body Weight Planner...
more accurately accounts for these metabolic changes, rather than just sticking to the 3,500 calories per pound equation
The best means of establishing accountability is ____________________
one that the client chooses
4 Domains of Emotional Intelligence
self-awareness, self-management, social awareness, relationship management
Sleep deprivation typically leads to less ___________, and the resulting fatigue is leading cause of____________
self-regulatory control non-adherence to behavior change programs
The ultimate goal of the health coach is to enhance the client's ____________, which the dependence of one's own _______, _________ and ________
self-reliance; powers, capabilities, resources
The framework for the continued practice and cultivation of mindfulness can
serve as a guide for the client-coach relationship
Exercise is as effective for sleep as ________
sleep medications
The new health-screening process before someone starts to exercise is used to identify individuals who..
🔸Should get medical clearance before starting or intensifying an exercise program 🔸Have clinically significant diseases and could benefit from a medically supervised program 🔸Have a condition that may require exclusion from exercise until they are better controlled
Aerobic Exercise Recommendations
🔹Frequency - 5 days/week or more (moderate) - 3 days/week or more (vigorous) - Combination of moderate and vigorous 3-5 days/week or more 🔹Intensity - Moderate and/or vigorous for most adults - Light-moderate may be good for deconditioned people 🔹Time - 30-60min/day moderate - 20-60min/day vigorous - Combination of both for most adults 🔹Type - Regular, purposeful exercise involving major muscle groups and it continuous and rhythmic in nature 🔹Volume - 500-1,000 MET-minutes/week or more recommended - Increasing step count by 2,000 steps/day or more to reach a step count of over 7,000 steps/day - Exercising below these volumes is also beneficial for those who are unwilling or unable 🔹Pattern - May be done in one session, or multiple sessions of at least 10 mins - Exercise bouts of under 10 mins may yield benefits to deconditioned people 🔹Progression - Gradual progression of volume by adjusting duration, frequency, intensity is reasonable until the exercise goal is attained - This approach of "start slow and go slow" may improve adherence, reduce risks of injury and reduce risk of adverse cardiac events
Neuromotor Exercise Recommendations
🔹Frequency - 2 to 3 days per week or more is recommended 🔹Intensity - An effective intensity has not been determined 🔹Time - 20-30 mins/day may be needed 🔹Type - Exercises involving motor skills, proprioceptive exercise training, and multi faceted activities recommended for older adults to approve and maintain physical function and reduce falls in those at risk of falling 🔹Volume - The optimal volume is not known 🔹Pattern - Not known 🔹Progression - Not known
Flexibility Exercise Recommendations
🔹Frequency - 2-3 days or more weekly. Most effective if daily 🔹Intensity - Stretch to the point of feeling tightness or slight disc 🔹Time - Holding a static stretch for 10-30 seconds may be more beneficial - In older individuals, holding a stretch for 30-60 second may be better - For proprioceptive muscular facilitation (PNF) stretching, a 3-6 second light-to-moderate contraction (e.g. 20-75% maximum voluntary contraction) followed by a 10-30 second assisted stretch is desirable 🔹Type - A series of flexibility exercises for each major muscle-tendon units - Static flexibility, dynamic flexibility, ballistic flexibility, and PNF are each effective 🔹Volume - A reasonable target is to perform 60 seconds of total stretching time for each flexibility exercise 🔹Pattern - Repetition of each flexibility exercise 2 to 4 times is recommended - Flexibility exercise is most effective when the muscle is warmed through light-to-moderate aerobic activity or passively through external methods such as moist heat packs or hot baths 🔹Progression - Methods for optimal progression are not known
Resistance Exercise Recommendations
🔹Frequency - Each major muscle group 2-3 days/week 🔹Intensity - 60-70% 1-RM (moderate-to-vigorous intensity) for novice to intermediate exercisers to improve strength - Experienced people can gradually increase to over 80% 1-RM (vigorous-to- very vigorous) to improve strength - 40-50% 1-RM (very light-to-light intensity) for older individuals - 40-50% 1-RM (very light-to-light intensity) may be good for sedentary people who are just getting started - <50% 1-RM (light-to-moderate) to improve muscular endurance - 20-50% 1-RM in older adults to improve power 🔹Time - No specific duration has been established 🔹Type - Resistance exercises involving each major muscle group - Multijoint movements affecting more than one muscle group and targeting agonist and antagonist muscles - Single-joint exercises targeting major muscle groups may also be included after performing a multijoint exercise - A variety of exercise equipment or body weight can be used 🔹Repetitions - 8-12 for strength and power - 10-15 for improving strength in middle-aged and older adults - 15-25 for muscular endurance 🔹Sets - 2-4 sets for strength and power - Single set can be effective especially for older and novice exercisers - 2 sets or less for muscular endurance 🔹Pattern - Rest intervals of 2-3 mins between each set - Rest 48 hours or more between sessions of any single muscle group 🔹Progression - A gradual progression of greater resistance and/or more repetitions per set, and/or increasing frequency
Applying Behavior Change Theories and methods. What methods can be used to help a client change negative health behaviors?
🔹OARS Allows for collaborative conversations about difficult topics. The health coach can help the client achieve a better understanding of their substance use motivations and habits, and hopefully reach a decision to work on changing harmful behaviors. 🔹 Tailor the approach to the stage of change If the client is in the precontemplation or contemplation stage the health coach can help them evaluate the pros and cons for a change. The health coach can affirm the clients statements and efforts that move them toward positive change, and help them strengthen the reasons for changing, and address barriers to change If the client is in preparation and action stages, the best approach would be to implement self directed behavior change strategies 🔹 Applying the principles of self-determination theory When applying this theory a health coach needs to remember that people need to feel autonomous, connected to others, and competent. Remind the clients that they have their own choices. 🔹 Building self efficacy for change Clients who have failed repeatedly may develop a learned helplessness pattern. The health coach should help the client said small achievable goals. Additionally they can expose the client to helpful role models and encourage them to strengthen social support networks 🔹 Behavioral Change Therapies These may happen outside of the client-coach relationship - Coping skills training teachers cognitive and behavioral skills - CBT - Family therapy - Brief behavioral intervention - Self-help programs
