Gary A. Sforzo

Resilience to Exercise Detraining in Healthy Older Adults

OBJECTIVE: To determine the effects of stopping and restarting two types of exercise programs in older adults.

Auditory driving of the autonomic nervous system: Listening to theta-frequency binaural beats post-exercise increases parasympathetic activation and sympathetic withdrawal.

Binaural beats are an auditory illusion perceived when two or more pure tones of similar frequencies are presented dichotically through stereo headphones. Although this phenomenon is thought to facilitate state changes (e.g., relaxation), few empirical studies have reported on whether binaural beats produce changes in autonomic arousal. Therefore, the present study investigated the effects of binaural beating on autonomic dynamics [heart rate variability (HRV)] during post-exercise relaxation. Subjects (n = 21; 18–29 years old) participated in a double-blind, placebo-controlled study during which binaural beats and placebo were administered over two randomized and counterbalanced sessions (within-subjects repeated-measures design). At the onset of each visit, subjects exercised for 20-min; post-exercise, subjects listened to either binaural beats (‘wide-band’ theta-frequency binaural beats) or placebo (carrier tones) for 20-min while relaxing alone in a quiet, low-light environment. Dependent variables consisted of high-frequency (HF, reflecting parasympathetic activity), low-frequency (LF, reflecting sympathetic and parasympathetic activity), and LF/HF normalized powers, as well as self-reported relaxation. As compared to the placebo visit, the binaural-beat visit resulted in greater self-reported relaxation, increased parasympathetic activation and increased sympathetic withdrawal. By the end of the 20-min relaxation period there were no observable differences in HRV between binaural-beat and placebo visits, although binaural-beat associated HRV significantly predicted subsequent reported relaxation. Findings suggest that listening to binaural beats may exert an acute influence on both LF and HF components of HRV and may increase subjective feelings of relaxation.

KNOWLEDGE AND IMAGERY OF CONTRACTILE MECHANISMS DO NOT IMPROVE MUSCLE STRENGTH

Improving performance in strength tasks requires modifications characteristic of motor skill learning, such as more efficacious motor-unit firing behavior. Because domain-specific knowledge is integral to learning and performing motor skills, the present purpose was to examine selected factors of strength-specific knowledge and effects they might have on acquiring strength. Following baseline testing for maximal strength on a knee-extension task, participants were matched by sex and strength and placed into control (n = 8) and treatment (n = 8) groups. Quadriceps muscle electromyographic data were also collected. The treatment group underwent two educational sessions detailing muscle physiology, neural control of muscle force, and imagery training using this knowledge. The control group underwent two educational sessions about health and fitness. Following the educational sessions the participants were retested for strength. Analysis indicated that the education and imagery treatment had no effect on strength, nor did electromyographic measures indicate that the treatment group benefitted from intervention. It was concluded that the knowledge was simply not relevant to knee extension-force production or that use of the knowledge involved a disadvantageous internal focus of attention away from relevant task demands.

Free choice access to multipoint wellness education and related services positively impacts employee wellness: a randomized and controlled trial.

Objective: Examine effects of voluntary participation in employer-sponsored, multipoint wellness education programming on employee wellness. Methods: A randomized and controlled design was used to organize 96 participants into an education + access group; an access-only group, and control group. Outcome measures were made at start and end of a 12-week intervention period. Results: Education + access improved wellness knowledge, which, in turn, enhanced life satisfaction, employee morale, and energy, and nearly improved stress level. Those who received facility access without educational programming did not reap health benefits. Employees voluntarily used the fitness facility and healthy meal cards only 1.3 and 1.5 times per week, respectively. Conclusions: Participants made limited and likely inadequate use of wellness opportunities. As a result, physical health benefits (eg, blood pressure, fitness parameters) were not seen in the present study. However, multipoint wellness education resulted in psychosocial health benefits in 12 weeks.

Effective Tobacco Cessation via Health Coaching: An Institutional Case Report

Background: Tobacco abuse is a well-recognized scourge on health and healthcare costs. Attempts to facilitate tobacco cessation are rarely better than marginally effective. Primary Objective: To describe an observational trial of an existing and highly successful tobacco cessation program featuring health coaching as the primary intervention. Core components of program design and data are presented and may serve as a model for other public health settings. Methods: Health coaching and three complementary program components (auriculotherapy, alpha-electrical stimulation, and relaxation techniques) are presented. Quit rates at 6 months for 161 patients over 3 years are provided featuring 30-day point prevalence smoke free and intent-to-treat values. Comparisons for telephonic vs in-clinic health coaching, free choice vs mandated participation, and program costs are provided. Results: Point prevalence quit rate was 88.7% while the more conservative intent-to-treat quit rate was 51.6%. Telephonic and in-clinic health coaching were not significantly different at any time point. Smoke-free rates at 6 and 12 months were 76.9% and 63.2%, respectively. Conclusions: Two cost-effective smoking cessation models featuring health coaching are presented. Point prevalence (30–day) above 80% and an enduring effect was seen. Personal and societal burdens (health and financial) of tobacco use might be greatly impacted if such programs were successfully implemented on a larger scale.

Effect of calcium supplementation on bone mineral density in female athletes

Abstract Females engaged in athletic activities frequently select to follow severe dietary restrictions, depriving their bodies of essential nutrients such as calcium in an effort to achieve some idealized body shape. Calcium poor diets are associated with stress fractures in the athlete and a rising prevalence in osteoporosis. The purpose of this study was to determine if calcium supplementation would enhance bone mineral density (BMD) in young (18–22 year old) female athletes. In this double blind study, thirty athletes from Division I and Division III teams were randomized to calcium supplementation (N = 17) and placebo (N = 13) groups. Treatment subjects were given tablets containing 1000 mg. elemental calcium for one year. Six BMD sites (lumbar spine, total hip, femoral neck, trochanter, Wards Triangle and radius) were assessed at baseline and 6 and 12 months utilizing the Hologic QDR 1000W scanner. Treatment groups were compared with respect to BMD and changes in BMD at baseline and 6 and 12 month intervals utilizing two way ANOVAs. The relationship between primary and secondary efficacy variables were investigated using Pearson and Spearman Rank Correlations. The impact of calcium supplementation on BMD was investigated using ANCOVA with average calcium intake serving as the covariate. No significant differences in BMD or changes in BMD between treatment groups were observed at baseline, 6 and 12 months. Mean reported compliance was 64 ± 4.8% for the calcium supplementation (CS) group and 73 ± 6.3% for the placebo group. Compliance data suggest that the CS group failed to consume the prescribed 1000 mg. daily intake of calcium. Furthermore, subjects in the placebo group reported a higher intake of calcium when compared with the CS group. Lumbar spine BMD increased in the CS group and remained stable in the placebo group. While significant differences in BMD were not achieved with calcium supplementation in these young athletes, study results reflect some benefit to BMD from higher calcium intakes. The potential cost-benefit of decreasing the prevalence of low bone mass in American women supports the need for further calcium supplementation studies in young females.

Credentialed Chefs as Certified Wellness Coaches: Call for Action.

Beneficial relationships exist between food preparation skills and improved dietary quality, and between times spent preparing food and mortality. Food shopping, meal planning, preparation and cooking skills are valuable in supporting good health. Thus experts are proposing nutritional counseling be expanded to include these beneficial behavioral skills. Educational programs delivered by chefs have recently emerged as a way to improve engagement with nutritional guidelines. It is reasonable to assume that a chef with behavior change knowledge and skills, such as coaching, may be more effective in facilitating behavior change. We encourage chefs who wish to be involved in promoting health-related behavior change to consider continuing education in coaching knowledge and skills. We also recommend culinary schools to consider offering these courses, to aspiring chefs. Such programming will not only benefit future clients but also offers a career- enriching professional opportunity to chefs. Credentialed chefs can make a positive health impact and should be included as professionals who are eligible for the impending national certification of health and wellness coaches.

A New Clinical Perspective: Treating Obesity with Nutritional Coaching v. Energy-restricted Diets

Although current guidelines for obesity treatment endorse lifestyle modifications to achieve weight loss, energy-restricted diets are still the most commonly used method for the management of overweight. Diet restriction, however, not only is ineffective in promoting long-term weight loss but also may have more costs than benefits, predisposing the individual to fat regain. Several physiological and psychological mechanisms protect the body against starvation and explain how food restriction can promote paradoxically the opposite of what it is planned to achieve, triggering changes in energy metabolism, endocrine function and, thus, body composition. New approaches that focus on behavioral treatment without diet restriction, such as nutritional coaching, are showing strong growth that arises as an innovative way to create sustainable and effective lifestyle changes.

Improving Nutritional Habits With No Diet Prescription: Details of a Nutritional Coaching Process:

Thousands of dollars are spent today with policies encouraging physical activity and healthy eating, but nutritional consultation per se has continuously failed to yield consistent and lasting results. The aim of this case report is to detail and evaluate nutritional coaching (employing health coaching techniques) in promoting lifestyle changes, enabling improvement of nutritional and body composition associated parameters. The patient in this study had previously engaged in a series of different diet regimens, all of which failed in achieving the proposed aim. After 12 nutritional coaching sessions (one per week) with the strategy presented herein, reductions in body fat mass and in total body weight were attained. Nutritional habits also improved, as the patient showed decreased total energy intake, decreased fat intake, and increased fiber ingestion. Daily physical activity and energy expenditure were enhanced. The coaching program was able to induce immediate health benefits using a strategy with the patient at the core of promoting his own lifestyle changes. In conclusion, the nutritional coaching strategy detailed was effective at helping our patient develop new eating patterns and improve related health parameters.

The effects of health coaching when added to a wellness program

ABSTRACT To test whether health coaching would enhance the effectiveness of lifestyle medical advice, the authors examined health impacts of adding coaching to an employee wellness program. Random assignment of 302 volunteers to three coaching treatments or a control preceded 3 to 6 months of weekly 30 to 40 minute telephonic coaching sessions. All participants initiated a wellness program providing exercise programming options. Blood pressure, body weight, resting heart rate, fitness score, health risk appraisal, cholesterol, and glucose were measured at baseline, and after 3 and 6 months of coaching. Data inspection via latent growth curve analyses and ANOVA revealed blood pressure to be positively affected by health coaching. All other variables responded positively to wellness programming but health coaching did not add further benefits. In women, greater readiness to change behavior was related to better health profile (for example, resting heart rate at baseline: bfemale = −3.13, p < .001; bmale = .32, p = .77). Readiness to change behavior is a potentially valuable coaching tool that may have gender differences deserving of further study. Health coaching, with the present approach, results in important but limited additional benefits (lower blood pressures) when utilized in a generally healthy employee population and in conjunction with a comprehensive wellness program (education, support, access to exercise programming).