By Fabio Comana, MA, MS, NASM-CPT, CES & PES; ACE CPT & HC, CSCS, HFS, CISSN
Coaching has become the buzzword in the personal training industry. See how behavior coaching can enhance a client’s potential for success, while also enhancing the relevance and value of the services fitness professionals provide. We’ll even share tools you can start using today to get your clients started on the path to successful behavior change.
A healthy employee is a productive employee. Yet, considering America’s obesity epidemic where obese individuals spend approximately 42% more in direct healthcare costs than healthy weight people, and the escalating costs of health care that are predicted to almost quadruple between 2012 and 2030, it becomes clearly evident that we have a significant economic challenge ahead (1, 2). In fact, it is estimated that by 2030, the loss of economic productivity will range between 390 and 580 billion dollars annually (3, 4).
As obesity predictions continue to climb (estimated at 42 – 51% by 2030), where one in every six dollars will be spent on obesity-related issues, it will become one of our greatest economic and health challenges over the next 20 years (1, 5). Nevertheless, in spite of these growing statistics, fitness professionals continue to promote exercise and diet as the weight loss solution. While exercise offers a myriad of benefits including the potential for weight loss (if the total caloric expenditure reaches 2,000 kcal per week), the unfortunate reality is that for most, their weekly caloric expenditure through exercise is generally insufficient to attain their weight loss goals (6). Given how precious time is as a commodity in our lives, asking one to commit more time to their already hectic schedule to exercise is generally unrealistic. Likewise, striving to push an individual harder through an express 25-minute workout will also yield insufficient expended calories to reach 2,000 kcal weekly.
So how can trainers realistically expect to achieve great success when they only have a few hours each week to make an impact? Forget for the moment that this available time might also be shrinking as the demands of our personal and professional lives continue to increase. With less available time to positively influence a client’s life, our value and relevance begin to diminish which makes it even harder to justify the price we charge. So what then are we supposed to do? If we examine our profession carefully, ideas and trends are emerging that are shifting our roles, and our spheres of influence and opportunity. For example, for weight loss, the frontline in the battle of the bulge has moved away from the three to four hours a week a person can commit to exercise, to focus more upon the remaining 110 – 115 hours that we are awake; by changing the way we do things (i.e., increasing your non-exercise activity thermogenesis or NEAT calories) (7, 8).
Enter the world of coaching, an opportunity to shape the person or their environment, and attain greater success. Coaching can successfully build on our relevance and value, helping to justify the fees charged for training services. But what opportunities exist for coaches and how is coaching different from training?
First, let’s examine coaching. A health or wellness coach is a relatively nebulous and imprecise term, ranging from one who holds a degree as a counselor to one who is educated through a self-directed online health portal. It encompasses a wide variety of professionals ranging from dietitians and nurses to health educators and fitness trainers. The qualifications and training standards for health or wellness coaches, as well as their skills and competencies, are under debate although some initiatives are underway to develop national standards and certifications to legitimize this profession. Regardless, one fundamental trait shared by all good health and wellness coaches is the expertise in facilitating behavior change – not simply the study of behavioral change, but demonstrated practice and success. This knowledge extends far beyond a single chapter in a textbook.
NASM’s Behavioral Change Specialisation (BSC) provides a foundation in delivering a comprehensive knowledge base, plus assorted tools to help shape behavioral change (9).
As health care continues to migrate towards more self-care and self-empowerment, this demands more personal responsibility for wellness on the part of the consumer. This affords the health or wellness coaches with more opportunities to support this changing paradigm (i.e., a balanced lifestyle of total health and not just greater levels of fitness). Consider our aging population – as they age their desire for functional independence and quality of life is growing increasingly more important than just living longer. Within corporate wellness, coaching is finding a niche as it demonstrates employee and employer cost-savings; self-care improvements; reductions in medical visits, and an overall positive impact on personal well-being. These all translate to controlled business expenses and improved work productivity. It should come as no surprise to learn why employers are gravitating towards health coaches who can help curb escalating employee healthcare costs. Although the idea of health and wellness coaching is increasingly growing within the public sector, it’s only beginning to take root within the medical community.
Bottom line – the market is poised to expand dramatically as more people live longer and continue to recognize the importance of maintaining total health.
So how then does coaching differ from personal training? Before reading this segment of the article, I’d like to first ask you to complete a simple challenge by answering the following questions on a piece of paper – keep your information handy to compare and contrast your perceptions against some of the traits discussed.
- What does coaching mean to you?
- How do you think it differs from personal training?
- What essential knowledge, skills and abilities do you think are needed to be a good coach?
From an industry perspective, there are numerous differences between coaching and training. It may help to first understand our history and that the roots of personal training lie within medicine which has, by tradition, been prescriptive, self-focused and directive. What this essentially means is that trainers have generally adopted a practice of planning and directing the change process with minimal collaboration on the part of the individual, and we do this given our expertise and belief that we understand what is best for the person (self-focused). Part of the directive approach may arise out of our altruistic ‘righting reflex’ (to make right), as we witness with medicine, but also perhaps because of what we have come to accept and practice as the norm in our profession. This is sometimes described as being very tell-orientated (prescribe and treat) as opposed to what coaches do – more ask-orientated (enable and empower). Unfortunately, a directive approach often minimizes or even eliminates one’s sense of autonomy or right to choose. Autonomy, whether actual or perceived (i.e., belief you have ownership of the path) is a powerful driver of intrinsic motivation and sustainable change. While coaches guide they rarely direct, although there are times when some directive strategies might be appropriate (especially in the initial stages of a program) or when a client consents to allow their coach to do so. NASM’s BCS uses the ‘COACH’ acronym to define key traits of a good coach (9):
- C = Care: Demonstrate care and empathy to build rapport and trust.
- O = Open-ended: Ask more open-ended questions to understand their challenges and foster that appropriate the level of care.
- A = Affirm: Validate a client’s thinking and their needs, desires, attitudes and belief systems without being judgmental.
- C = Concentrate: Listen actively without distractions. Be responsive by finding ways to meet their needs and desires and be reflective by finding opportunities to paraphrase their messages to demonstrate how you value and what you understand from their message.
- H = Help: Adopting a helping or supportive role using more counseling styles of communication initially.
Table one provides additional traits possessed by coaches and how they differ from trainers. It also demonstrates how coaching is heavily reliant upon rapport, strong communication skills (listening and speaking), and empowering sustainable behavioral change.
Table One: Key differentiators between coaching and training
|Goal:||Self-improvement, self-empowerment||Change – mostly physical|
|Engagement:||Maps initial plan; fosters self-exploration and self-discovery||Mostly responsible for mapping plan|
|Format:||Collaborative – client-centric (ask).Explorative||Mostly directive (tell).Self-focused|
|Necessary Skills:||Rapport-building; effective communication skills; behavioral science.||Exercise scienceProgram design/implementation|
|Issues Discussed:||More personal||Less personal|
|Keys to Success:||Building trusting relationships; promoting self-efficacy||Program participation|
Simple Coaching Tools to Consider
To this point, this article has outlined some unique functions of a coach as well as potential future opportunities, but not including some coaching tools or practical applications would be a disservice to the reader. Coaching successful and sustainable change depends in part upon gaining a solid understanding of a person’s challenges, their perceptions and ambivalence towards change; and the utilization of tools that can effectively shape the change process. The importance and relevance of change and the belief in one’s own ability (self-efficacy) are foundational pillars critical to positive change. These can be identified and even quantified through the use of two simple tools; a core value assessment and the decisional balance worksheet. The latter is part of Prochaska and DiClement’s Transtheoretical Model of Change (TTM) presented in NASM’s BCS course (9).
First, strive to understand what is important and relevant to the client. To do this, help them identify their own core values (CV) – as this take time, don’t rush the process. CV represent personality traits (e.g., being selfless, affectionate), aspects within one’s life (e.g., career, family) or any individual factors viewed as important to overall quality of life (e.g., sleep, health, nutrition, physical fitness). They are values that people deem dear and sacred; ones to which they generally would not hesitate to commit the resources of time, energy and money to attain. For example, a person may claim to never have sufficient time to exercise, yet will camp out overnight at the mall to attain the first release of a new smart phone. Why? Because that phone and what it embodies represent something of importance that holds value to the individual.
Once these values have been identified, complete the following tasks:
- Have them score each value using a scale of 0 – 10 for level of importance (LI) in their life:
- Zero (0) representing little importance.
- Ten (10) representing great importance (ideally these should all be 9’s and 10’s).
- Next, score each value to current level of satisfaction (LS) over the past 6 months, using the same 0 to 10 scale.
- Compare and contrast LI v. LS scores – this allows opportunities for reflection on the commitment needed/available and helps develop a vision for change:
- Reflection – as each CV requires a specific investment of resources (e.g., time, energy), identifying discrepancies between LI and LS (i.e., unresolved matters) can provide insight into whether the needed resources are available to fully commit to tackling new behaviors – or perhaps the need to prioritize goals with CV.
- Vision – CV can also provide additional reasons or motivation needed to initiate change. The goal is to creatively connect each CV to the desired goal to build greater importance and relevance. For example, if Mary cites family and time together on vacations as a CV, yet has a goal to lose 60 lbs., the professional should connect the two together – losing 60lbs. may reduce sick days, improve work performance and recognition, which in turn may allow more vacation time (versus sick) and perhaps even a promotion to afford more vacation options.
The decisional balance (DB) worksheet provides the professional with a comprehensive snapshot of their client’s perception of the outcomes (benefits), sacrifices (losses) and the process that is needed to attain their desired outcome(s). This self-directed process (i.e., completed by the client from their own perspective) helps the professional gain an in-depth understanding of their mindset, attitudes and belief systems. It involves a sequential completion of the 4-quadrant worksheet illustrated in figure two from which a change plan can be effectively mapped. Instruct your client to complete the DB worksheet as follows:
- Complete the upper row (2 top quadrants – OUTCOMES) by asking the client to first identify any perceived benefits associated with attaining their goal (top left quadrant). For example, Mary identifies that losing 60 lbs. may improve her health and help her feel more confident about her physique in public. Similarly, have the client identify any perceived sacrifices (losses) associated with pursuing their goal (top right quadrant). For example, Mary believes she will need to commit a great deal of time to exercise and have to follow some kind of diet, which she is a little reluctant to do. The top rows help the professional gain valuable insight into their client’s current level of understanding of the outcome(s) they desire.
- Next, ask the client to rank how important each of these benefits and losses are using a level of importance scoring system between 0 and 10. Obviously, there must be more benefits than losses perceived as important if any chance of sustainable change is to occur. If any perceived sacrifice is scored too high, it offers insight into why ambivalence or resistance exists over embarking upon a desired change process (i.e., a high-scoring sacrifice presents a barrier that may be too important to give up). Until that change becomes more important to the client, change may never occur.
Figure Two: Decisions Balance Worksheet
|List perceived benefits or gains associated with making this change.||List perceived costs, sacrifices or losses associated with making this change.|
|List strategies to maximize perceived gains.||List strategies to minimize perceived losses.|
- Complete the lower two rows (PROCESSES) by asking the client to list the daily tasks (tactics) they believe they need to participate in to achieve their outcomes (bottom left quadrant). For example, Mary believes she may need to perform cardio each day, eliminate snacking from her diet and stop her Friday happy hour to lose weight. Next, challenge the client to identify any strategies they might have to minimize the impact of their sacrifices they believe they need to make (bottom right quadrant). For example, ask Mary is she has any ideas on how she might find more time to make it to the gym if she believes this is what is needed (i.e., reduce the impact of the sacrifices needed to be made). Unfortunately, this quadrant often comes up empty, otherwise they might never have scored the sacrifices as very important. The bottom rows help the professional identify, from their client’s perspective, what they believe is needed to be done to achieve their goal.
- Lastly, ask the client to rank how confident they are in participating in each of the tactics indefinitely using a level of ability (confidence) scoring system between 0 and 10. Any processes scoring low on ability present an obstacle that must be examined closely in order to find simpler alternatives.
The goal of the DB worksheet once complete, allows the professional to sway the decisional balance process in favor of change using specific strategies:
- Connect any identified CV to the benefits associated in the DB worksheet to build greater importance and relevance to the desired goal(s) (top left quadrant).
- Understand the client’s perceptions and self-efficacy limitations to the tactics believed to be needed (bottom left) – explore and offer simplified solutions that score higher on ability.
- While one may not be able to directly change an importance score associated with any listed sacrifice(s), exploring simpler solutions or perhaps even ideas to reduce the impact of the sacrifice(s) can lower that overall importance score.
- The strategies can effectively shift the overall decisional balance by providing a simplified, more approachable process for change.
Ultimately, the value of using such tools helps professionals map plans for successful and sustainable change. They provide greater clarity on understanding current attitudes, beliefs and even misconceptions, from which a change process can be shaped. It is the good coach who employs such tools to first understand their client’s mindset and emotions, then collaborates to empower a positive path.
In closing, given the existing changes within healthcare and within our population, the future of training needs to evolve beyond fitness. Coaching seeks to first understand, then empower individuals via self-exploration and self-discovery so that they can overcome their cognitive, emotional or physical barriers to healthier behaviors. From a professional perspective, coaching expands a practitioner’s opportunity for greater client interaction – moving beyond the traditional confines of the gym’s brick-and-mortar to support their personal and professional lives 24-7. Not only does this enhance a client’s potential for success, but enhances the relevance and value of the services a professional provides. This is coaching and it is the evolution of training.
- Robert Wood Johnson Foundation / Trust for America’s Health, (2012). F as in Fat: How obesity threatens America’s future 2012. www.healthyamericans.org. Retrieved 04/08/15.
- Finkelstein EA, Trogdon JG, Cohen JW, and Dietz W, (2009). Annual Medical Spending Attributable to Obesity: Payer-and Service-Specific Estimates. Health Affairs, 28(5):w822-831.
- Cawley J, Rizzo JA, and Haas K, (2007). Occupation specific absenteeism Costs Associated with Obesity and Morbid Obesity. Journal of Occupational and Environmental Medicine, 49(12):1317–1324.
- Wang YC, McPherson K, Marsh T, Gortmaker SL, and Brown M, (2011). Health and Economic Burden of the Projected Obesity Trends in the USA and the UK. The Lancet, 378.
- Flegal KM, Carroll MD, Kit BK, and Ogden CL, (2010). Prevalence of Obesity and Trends in the Distribution of Body Mass Index among US Adults, 1999-2010. Journal of the American Medical Association, 303(3):235 – 241.
- American College of Sports Medicine (2014). Guidelines for exercise testing and prescription (9th edition). Baltimore, MD, Lippincott, Williams and Wilkins.
- Levine JL, and Yeager S, (2009). Move a little, lose a lot. New York, NY, Three Rivers Press.
- Katzmarzyk PT, Church TS, Craig CL, and Bouchard C, (2009). Sitting time and mortality from all causes, cardiovascular disease and cancer. Medicine and Science in Sports and Exercise, 41(5): 998-1005.
- National Academy of Sports Medicine, (2014). Behavioral Change Specialist. Chandler, AZ., NASM.