By Denise Williams | News & Views

When it comes to health coaching cardiopulmonary rehab participants to change behavior — increase physical activity, stop smoking, or eat healthier, for example — are you a drill sergeant, or a dancer?

If your technique is to simply “prescribe” patients to make modifications, or else, you likely won’t see the desired outcomes, warns Roberto P. Benzo, MD, of Mayo Clinic. “Behavior change does not happen when you tell people what to do,” he reasons. “Change happens when people want to do something that is meaningful for them. What the health coach does is create conversations” to facilitate the self-discovery that will allow them to truly pursue — and realize — those goals.

During a pre-meeting workshop ahead of the AACVPR 39^th Annual Meeting in Anaheim, California, Dr. Benzo and co-presenters will demonstrate how this interaction between coach and patient should be less like boot camp and more like a delicate pas de deux between dance partners. “It’s not confrontational,” he explains. “It’s being respectful and understanding where people are. It’s getting closer to your partner — the “participant or coachee” — and following their lead. The coach moves based on the signals the coachee sends out, and so the dance begins.

Step Up

In practical terms, what that means is providing gentle encouragement and support to patients through four critical processes of Motivational Interviewing :

1. Engagement. Coaches must practice deep listening and put themselves in the patient’s shoes, Dr. Benzo explains, to understand their thoughts and emotions and grasp what is important to them. This requires effort, practice of silence, and deep listening.
2. Focus. Once establishing where the patient is now, he emphasizes, the key is to concentrate on just ONE meaningful change to tackle at a time.
3. Evocation. Dr. Benzo says the third process of coaching revolves around figuring out the true motivation of the patient to change. Patients’ preference usually involves  “increasing function” and  “decreasing disability,” which represent the World Health Organization’s definition of rehabilitation, he continues. This may simply mean being able to dress themselves, to walk more, or to be able to comfortably attend a grandchild’s baseball game. “When we adhere to patients’ true preference is when the lights start to come on,” he believes — when patients are able to begin envisioning the possibility of a different reality for themselves.
4. Plan. The last step, according to Dr. Benzo, is to work with the patient to craft a strategy — small, humble, trackable, and attainable — to achieve the patient’s goal.

To learn skills of coaching, the pre-meeting workshop will adopt a highly interactive approach. Participants will divide into groups and rotate between three hands-on stations, where they will be introduced to different aspects of coaching and behavior change. They’ll practice skills such as silence exercises, the art of reflection, and more. Importantly, Dr. Benzo says, the workshop will provide a safe space to ask questions and to learn without the fear of “getting it wrong” and facing subsequent backlash.

But just as a week of lessons won’t prime you to compete on “Dancing with the Stars,” Dr. Benzo acknowledges that “you won’t be a master coach with only four hours of training,” either. The AACVPR pre-meeting workshop can be a springboard, he contends — the ignition of a personal search for a better connection with patients, and specifically for cardiopulmonary rehab professionals who want to do more to help their patients live a better life. In addition to the role-playing and other interactive activities the forum will offer, it will provide specific sources where cardiopulmonary rehab professionals can seek additional training.

“In health coaching we want to improve connection, engagement, not only with the patients but with ourselves (the mindfulness of it)” Dr. Benzo summarizes. “Doctors, nurses, physical therapists, respiratory therapists, exercise physiologists … everybody has intentions of changing people’s behavior for the good. The intention is there: bringing behavior change to a common rehab practice to improve the “magic” of rehabilitation that is already happening. Cardiac and pulmonary rehab is a great and impactful reality, but maybe we can be even more impactful by incorporating simple behavior change skills to guide people to a fuller lifestyle.”