Clinical Effectiveness of Lifestyle Health Coaching: Case Study of an Evidence-Based Program

Abstract

We have developed, tested, and successfully implemented an affordable, evidence-based, technology-enabled, data-driven, outcomes-oriented, comprehensive lifestyle health coaching (LHC) program. The LHC program has been used primarily to provide services to employees of larger employers (ie, with at least 3000 employees) but has also been implemented in a variety of other settings, including hospitals, cardiac rehabilitation centers, physician practices, and as part of multicenter clinical trials. The program is delivered mainly using the telephone and Internet. Health coaches are guided by a Web-based participant management and tracking system. Lifestyle management interventions are based on several behavior change models and strategies, especially adult learning theory, social learning theory, the stages of change model, single concept learning theory, and motivational interviewing. The program is administered by nonphysician health professionals whose services are integrated with the care provided by participants' physicians. Outcomes data from published studies, including randomized clinical trials and independent third-party conducted research, have documented the clinical effectiveness of this evidence-based approach in terms of modification of multiple risk factors in healthy persons as well as those with certain common chronic diseases.

Keywords: exercise; nutrition; prevention; wellness.

Figure 1.

Comparative effectiveness of 3 models for comprehensive cardiovascular disease risk reduction: changes in clinical outcome measures after 12 weeks of intervention in individuals with abnormal baseline values (n = 142). Changes from baseline were statistically significant (P ≤ .05) except for HDL cholesterol (all 3 programs) and triglycerides (MD supervised, RN case-managed program). Differences among programs were statistically significant as follows: change in VO_2max was greater with the phase 2 cardiac rehabilitation program and lifestyle health coaching program versus MD supervised, RN case-managed program (P ≤ .05). See Table 1 and Gordon et al. Abbreviations: BP, blood pressure; HDL, high-density lipoprotein; LDL, low-density lipoprotein; MD, physician; RN, nurse; VO_2max, maximal oxygen uptake.

Figure 2.

Effect of 12 weeks of lifestyle health coaching on control of systolic and diastolic BP in participants not taking antihypertensive medications, fasting glucose in those not taking antidiabetic medications, and LDL cholesterol in those not taking antilipidemic medications: percentage of participants with abnormal baseline values who achieved the goal level. See Table 1 and Gordon et al. Abbreviations: BP, blood pressure; LDL, low-density lipoprotein.

Figure 3.

Clinical effectiveness of a lifestyle health coaching program versus a lower-intensity comparison intervention: percentage change (relative risk reduction) in Framingham 10-year coronary heart disease risk score. *P = .017 for lifestyle health coaching program versus lower-intensity comparison intervention. See Table 1 and Maron et al.