By Anna Horner | News & Views

Health and wellness coaching (HWC), as defined by the National Board for Health & Wellness Coaching (NBHWC), represents a standardized, evidence-based, and nationally credentialed profession. Board-certified coaches (NBC-HWCs) adhere to rigorous ethical and competency standards, ensuring safe and effective practice. HWC can be a valuable complement to cardiopulmonary rehabilitation to engage patients and help them sustain behavioral changes over the long term, says Moain Abu Dabrh, MBBCh, MS, NBC-HWC, associate consultant and associate professor in the Division of Nephrology and Hypertension at Mayo Clinic Florida.

HWC in the Health Care Setting

Dr. Abu Dabrh describes HWC as a non-directive, person-driven partnership between a coach and an individual where they work together to identify what matters to the patient in becoming their best self in terms of health and wellness. Coaches leverage evidence-based strategies and approaches to help individuals become what he calls “independent, self-motivated problem-solvers and brainstormers” through self-discovery and active learning.

 “HWC has evolved over the past two decades, with rapid growth in the past decade following the establishment of national standards and board certification by the NBHWC in 2017. Over 400 peer-reviewed studies — including more than 120 randomized controlled trials — now demonstrate HWC’s impact on self-efficacy, adherence, quality of life, and both surrogate and clinical outcomes across diverse health care settings and populations,” says Dr. Abu Dabrh.

Although HWC in the health care setting is still person-centered, he explains that working with a patient means it’s slightly different, with the goal of improving their clinical care by helping them identify their health goals and understand, adhere to, and integrate them in their daily life. “It’s also about recognizing that the patient is a whole person — someone whose life extends beyond their diagnosis. The coach partners with the individual to help identify, envision, and enact well-being goals and way of living that matter to them, in the best way possible,” he adds.

How HWC Differs From Traditional Patient Education

Because the approach is non-directive, Dr. Abu Dabrh says coaches help empower patients to identify their goals themselves, whereas in a clinical care setting, physicians, nurse practitioners, and other clinicians or allied health care professionals will mostly direct what the patient needs to do based on their expertise. “With coaching, you are asking the person, ‘What is important to you and why? How would you like to enact it in your life? What are the challenges and the opportunities?’” he explains. “You're helping the person take the initiative and become empowered and confident within themselves to envision, identify, enact, and sustain their best possible selves — in health, well-being, and daily life — over the longer term.”

Despite the proven benefits of health, education, and counseling, Dr. Abu Dabrh says patients may not continue with what they’ve learned, and that’s where coaching comes in. “The coach helps them move toward sustainability, accountability, and motivation over the short and long term as they fit within the context of their lives, values, preferences, and care needs,” he notes.

HWC in Cardiopulmonary Rehab

The benefits of HWC can be seen in cardiopulmonary rehab, but Dr. Abu Dabrh says the wealth of information patients receive about their health, lifestyle, and clinical care during rehab can be overwhelming, making it difficult for them to build on what they learn in the program. He says coaches provide value by partnering with patients, either early on or toward the end of the rehab program, meeting with them in person or virtually to help them understand their rehab goals and care.

“They help the patient consider what they have learned about their health care goals in terms of exercise, nutrition, eating habits, sleep, stress management, etc., and then ask: ‘How do you plan to continue with these goals? What is important to you? How do you want to structure or build these goals and set them moving forward?’ There is a true partnership in ensuring that patients continue to implement what they have learned,” Dr. Abu Dabrh says. “Coaches can also serve as an early line of support, identifying when someone is struggling, falling back, or not fully understanding or applying what they learned during the rehab program. In those cases, the coach can reconnect the patient with their clinical team to prevent them from falling behind or getting lost in the system. In addition, coaches can leverage digital health and remote monitoring tools to stay connected with patients between visits; support patients in tracking their own adherence and progress on activity, nutrition, or stress goals; and deliver timely engagement and support — further extending the reach and impact of cardiopulmonary rehabilitation.”

Because health care professionals often lack the time or training to establish goals for behavioral change, Dr. Abu Dabrh stresses that coaches can ease their burden and complement the clinical team by helping patients identify, implement, and sustain healthy lifestyle behaviors that reinforce the care plan. “Ethical practice is foundational to coaching — board-certified health and wellness coaches adhere to defined standards of conduct, maintaining confidentiality, professional boundaries, and respect for the coached person’s autonomy while working collaboratively within their scope of practice,” he says. “There is growing momentum through advocacy, evidence, and policy. The American Medical Association has approved Category III CPT codes for HWC, and the Centers for Medicare & Medicaid Services is currently evaluating them for potential reimbursement. This positions HWC as a scalable service under active evaluation for future reimbursement that strengthens whole-person, value-based cardiopulmonary care.”

Takeaways for Cardiopulmonary Rehab Practitioners

Practitioners should understand HWC as a profession and the evidence that supports it, how it aligns with the goals of cardiopulmonary rehab, and the coach’s role, he says. It’s also important to understand the different HWC frameworks, particularly whether the rehab program has embedded coaches or partnerships with coaches in the community. Dr. Abu Dabrh concludes, “The value of HWC as an acceptable, effective, and scalable service is strong, and the evidence from research and practice supports it.”