Lessons Learned from the Wellness Coaching Profession with Margaret Moore

As always , I'm your host , michael Stack , an exercise physiologist by training and a health educator and health entrepreneur by trade , and I'm fascinated by a phenomena I call the wellness paradox . This paradox , as I view it , is the trust , interaction and communication gap that exists between exercise professionals and our medical community .

This podcast is all about closing off that gap by disseminating the latest , most evidence-based and most engaging information in the health sciences . And to do that , in episode number eight of our 12-part series , we're joined by Margaret Moore .

Margaret was one of the co-authors of an article in the themed issue that was about lessons learned from the wellness coaching profession and their path to healthcare recognition , and I think this is an absolutely fascinating conversation , because wellness coaching has gone down a similar path to what the exercise profession is going down and it's evolved .

In fact , as you're gonna hear Margaret talk about at the end of the podcast , it's even evolved from health and wellness coaching to now wellbeing-being coaching .

So even the name has evolved and Margaret has been on the tip of the spear of the professionalization effort for coaching for nearly the past three decades almost , and she has really led the charge to get recognition inside of healthcare for coaching , but also with governmental agencies that are responsible for paying for these types of services .

And the way I like to say this is the health and wellbeing coaching profession , as Margaret calls it , is just a little further down the path than we are .

We're looking at them in the distance and I think we can look at the path they followed and we can learn many , many lessons from the great work that's been done and the great work they're doing right now . Any information we'd like to share with you from today's episode can be found on the show notes page . That's by going to wellnessparadoxpodcom .

Forward slash , episode ACSM8 . That's forward slash , episode ACSM8 . Please enjoy this conversation with Margaret Moore . We're delighted to welcome back Margaret Moore to the Wellness Paradox . Margaret , welcome back .

And when I moved from Canada to the US to marry my husband in 2000 , I started Well Coaches and that was the beginning of now I'm in my 25th year the first coaching school for health professionals , and then nine , 10 years later , the Institute of Coaching . So I've co-founded three organizations plus my own coaching practice , and I'm a coaching geek .

So I basically do , you know , I do whatever is needed to move the field forward . I'm a coach , I'm a trainer , I'm a CEO , I'm a policy contributor and fundamentally , I think I blend , you know , being a leader and being a coach .

And I'm extremely grateful for this journey of transformation , you know , because it's transformed me and I think it's still not transformed healthcare . But we're close . We're closer than we've ever been .

I know I have staff that are currently going through it as we speak , but you've had the lived experience of something that our profession exercise is going through right now , and when we were thinking about the themed issue , when we're thinking about all the topics we wanted to cover , we said , wow , wellness coaching has gone down this path and they're a little

further along the journey than we are right now . So it would be great to look at the lessons that we learned from the wellness coaching profession . So you co-wrote an article with some other great thought leaders in the space .

The title of the article was Lessons Learned from the Wellness Coaching Profession the Path to Healthcare Recognition , and Katie Smith is that column editor .

Cedric Bryant contributed to the article , jennifer Lundman contributed to the article and it really talked about , as I said , your lived experience for this 24 years of leading the charge to professionalization for wellness coaching . What are the important lessons that the exercise profession needs to learn from the journey you've gone on ?

They're like other professions . You know , acsm is really and ace has supported standards for exercise physiologists , but there's not a national credential that everybody agreed on school . And then nine , ten years later there were 12 of us in different .

You know Karen Lawson and I in particular , but also Duke and Vanderbilt and California Institute of Integrative Studies . So there was a Michael Oloski , linda Bark . You know there was a big gang of us .

I mean , we knew each other for a long time we came together , we rose above our competitive worlds because we were in the marketplace competitors and we sat down . I mean , it took us seven years to agree on standards and then bring in the National Board of Medical Examiners . So I think that the first thing that we did was all align around .

You know , we need one standard and I think that the exercise physiology field is moving in that direction . Personal training is harder , because personal training really built exams rather than curriculum , and so then there wasn't an agreement .

So because if you build curriculum , then you could agree on one central exam , but when you had like 50 different exams it was really hard to pull together . So we had that advantage of being new players together . So we had that advantage of being new players .

The second thing which we benefited from the research community , because most of that group did not drive the big studies . You know coaches helped along . We've got 22 publications , two randomized control studies of that group , but we didn't have millions of dollars to , you know , fund huge studies .

But there were groups that were , and so there's a literature now of more than 200 randomized control studies on something called coaching . It's not all , and most of it is actually not the standard that we've set . But at least the scientists really aligned around creating standardized interventions , large NIH-funded studies .

So those studies we piggybacked on and then brought them into the policy process .

The thing that the exercise field needs to do and it's the same for the lifestyle medicine field , and we've been talking about this for years you have to have services that get billed and those services have to be in the literature as very stand , you know , just like a medication , a standardized protocol .

So , for example , exercise physiology would be a series of sessions with a protocol that would take people from here to here . You'd measure the outcomes , then you'd study that and then you'd show that the service is , is improves health . Health outcomes , um , maybe return on investment , but mostly health for a reasonable investment .

And then you get that service codified and then you get the private , the payers , to pay . So that's the process . So , um , and that's harder to do with exercise , cardiac rehab is established , you know , and I know cancer rehab is also established . So you have to find , and so the field now is doing that .

I think that's what ACSM and others are coming together .

So we were , you know in hindsight I mean , we were , we did the right things , but we were a bit lucky actually in that the research world kind of identified with the coaching intervention a long time ago as a sort of something we could standardize not easy to standardize right at all and still not standardized .

And you know right now the , the journey , um , and maybe you know you can even you still have to get um today . You still really need to get codified services .

But now to really open the gate , we now have to do studies as part of routine clinical operations , using the existing codes and then showing that we can deliver consistent outcomes , because Medicare and the payers are concerned that there won't be significant outcomes , there'll be modest outcomes , not enough to be worthy of spending $1,000 a year on a patient .

So we're not done yet at all . But now we understand the path and I think the , the exercise data is there and now it just needs to bit more unification , codification and and you know the reason that Wellcoach is partnered with ACSM from 2002 , I mean I met Walt Thompson , jim Whitehead in 2000 . We talked about the coaching profession at that point .

It was just , you know , pieces of paper and definitions .

We didn't have services yet and back then , you know , acsm saw the opportunity for the exercise physiologist to also be a coach , and so that door is open now and I know there's , you know , roughly 5,000 of all of you , and I hope we can put all of you know , that whole popular , that whole sort of workforce to work as coaches as well as , and then maybe

that will actually speak things up because you can come in exercise , physio , exercise folks make great coaches , they're upbeat , you know , because exercise is energizing , right , you know , it's a , it's a , it's , it's , it's a lot more fun than talking about diabetes and heart and stroke and stuff like that .

So so I think that you know we're , we're , you know we saw acsm as , and I think exercise , I love exercise physiologists as coaches . So I think that you get the benefit of both the services the exercise services , and there's room for exercise support , education and support within coaching too . So , yeah , so that's the story in a nutshell .

It's what we're learning is first we need unification and then we actually need standards and a process that produces outcomes , and we've talked about that in the other podcasts in the series . You see it highlighted in this issue of the journal .

I'm curious , as someone who literally has been at the tip of the spear for this entire professionalization process for wellness coaching , what has surprised you the most along the way as you've gone on this journey the past 24 years , to the point you're at right now where you've made massive strides in professionalizing a field which essentially didn't really exist in

the way it exists right now when you started . What surprised you the most ?

I was telling you that I'm working on a book on the science of leadership , and so there's a lot of literature around transformational leadership , visionary leadership and inspirational leadership , and I would say my experience confirms what , as an MBA , was uncomfortable , which is you have a vision and a compass setting , but you don't have a roadmap , you don't .

You really don't know what's next and how things are going to come . You don't . I could never predicted how this would have unfolded . I would have predicted that I would not have been the one at the tip of the spear , because the what's required to go in front of the American Medical Association is CMS .

I would have expected that would be doctors or PhDs and things , but I um , you know it's more of an entrepreneurial thing , it's not . You don't really know what's next and you can't sort of be limited by what you've done in the past . You just have to get to learn about . I mean , I knew nothing . I'm a canadian . I knew nothing about the healthcare system .

I mean nothing , yeah , and so I never would have expected that I would . But you just , you just keep going and you keep learning and you keep you know , and , and I think the so I think it's confirmation that you don't need a roadmap . You , you just keep doing the right things . And then the other thing is um .

I think it was helpful that I was a business leader , like I understood a lot of different things as opposed to being a clinician which how to mobilize teams , how to , you know , produce good work , how to , how to um , inspire . And I think when you're confident and you know what you're doing and you know that you know I'm big coaching is deep in my DNA .

I mean , I was part of creating those early protocols and the standards and I think it , you know , by leaning in in that way , I think it's helped the field in terms of credibility that a few of us really knew what we were doing . You know we were and we were coaches who knew what we were doing .

You know we , we were and we were coaches who knew what we were doing , and I think that the fact that it's the coaches that have done it and figured it out has impressed . We're not done yet , but I think they're listening , I think that we've done it well .

I mean , you know the the people at the AMACPT panel told us that , um , a couple times that no one had ever done more work for a submission , that it was very well done , it was very thorough , and we just kept impressing people that we were on top of things .

And so the lesson is , you know , it's a very kind of Buddhist thing you are present in the moment to what's needed and you do it to your absolute best , and then you take the next step and you don't know what steps going to . We didn't know CMS would let the codes into telehealth . That was a surprise . So you just , you just keep going .

You put great people together . You , you know it's a big team , it's a big thing , and you get there . So you just know , if you just keep doing it well and turning up and doing the best you can do so that people realize and you know the exercise physiology world is full of highly credible scientists and practitioners you know you've got everything you need .

It's just you have to lean in and really work at it . You know that's . There's no shortcuts . There is no shortcuts in this world , especially in healthcare .

You said something about you're not done yet in your profession , which I think I realize , that I think maybe a lot of our audience doesn't pay as much attention to this as what somebody like I would what is on the horizon in the wellness coaching profession and the reason I ask this is because we can see you down the path further from us , you know in the

distance , and what you're doing right now is what we're going to be doing in the future , so give us a little bit of insight into what's next .

When he moved , he came from South Africa to the Cooper clinic and did a lot of research there .

So we become close friends and collaborators and um , so what was disappointing , um , is that I said we have a strong evidence base for coaching in health care and we've worked really hard to assemble it and to pull out the best studies and to explain them and to show the isolated effect of coaching .

But , like in exercise , there's a lot of heterogeneity across the studies and , similar to behavioral health , you know , any helping service which is personalized , and so the payers are nervous that the results won't be there because , like just take diabetes prevention , there's a stack of randomized control studies .

Cdc did a fabulous job overseeing all of that and now there's an intervention and there are billing codes for it and medicare is promoting it , um , and it's there's .

There's lots of conversation around the structure of it that you know it could be improved , but but um , it's not easy to replicate the results in the real world , um , and so there's nervousness on the part of payers , so it hasn't made it to , you know , category one and full reimbursement , because the payers want to see that in the normal course of clinical

operations the results are there . So we really , you know , we had hoped we would get through the gate with the and we made the most and are still doing that . I mean , mbhwc is advocating with CMS right now . They wrote their submission in September to push the current data set .

What CMS told us a year ago is they wanted to see published evidence using the codes in routine operations . And I come around to um respecting that and um , and I think that what that means is that in the fullness of time , we'll generate the data . You know , while coaches intervene , other groups will do it too , um , and we'll show that we can .

Coaching works , it's successful and it's making and you know , you know you're working with people who are ready to change , working with people that are engaged , so we're not likely to waste coaching resource because people aren't . Coaching is , you know , you have to work . You know , nobody's handing you a pill . You have to commit to improving yourself .

So I think we will focus the resource on the people who are ready to change , which will mean not everybody , because not everybody's ready at any point in time . We'll get good data and then people will say , yes , coaching is working on the ground . So you've been able to show that .

What happened in the randomized control studies , which is clinically significant 5% weight loss sustained about two years , or A1C down one point on average across population , or whatever blood pressure down by X points , all those things .

If we can do that and I know we can , I know we can then people will say this works and it's important to pay for it because we're helping people do the right thing . And the exercise folks , you guys can do the same thing .

And the fact , honestly , the faster you move into clinical practice and design the protocols and cobble together the billing codes through chronic whatever you you know , whatever you can do , that's out there . Get some payers to you know I can . You know . Whatever you can do , that's out there . Get some payers to you , know I can .

You know we can show you how we're positioning it . That so it does mean that there's still probably two , three , four years where we're gathering that data , but then , once we've done that , we'll be in and the standard will be there the coaches , the software platform .

So what we're doing is making sure that we have the data collection and reporting and publishing as part of routine clinical operations . That's a higher bar than any other service , right , there's no other . Like , physicians do not have to report their outcomes , nurses don't , you know you really are free to , you know , to deliver the services .

So I think we're held to a higher bar and I think it's a good thing . I think , in the long run , we're committed to high quality services that move the needle . I mean , surely that's the right thing . So I think we're . You know we're doing the right things and it's taking longer , um , but , but we'll get there .

And I think the exercise you're all committed to outcomes too . I mean , nobody wants to waste anybody's time or money . We want to help people , and fitness is a path to improving diabetes . You know like everything improves , right ? So , um , so I think we're on the way , we understand what's needed and I think the payers are not going to say no to good data .

Yeah , I don't think . I think they're , they're um , they recognize that people . I mean it's just getting worse , not better . The lack of engagement I mean people want to be healthy but weight's gone up . Eating habits are getting worse . Exercise actually has gotten better across the population .

That's the exercise world has made more progress than other lifestyle medicines . I would call them .

in health systems , the exercise physiologists that are in health systems or medical fitness centers . They're thinking just at the clinical level , but in order for this to be a reality , the policy environment is really the linchpin to getting this across the finish line . Linchpin to getting this across the finish line , and we talk about policy in the themed issue .

Mike Kaczynski , who's the head of government affairs for the Health Fitness Association , he talks about it . Lori Witzel , from the American Heart Association Physical Activity Alliance she talks about it . That policy piece is so critical because without that , the environmental conditions aren't set to actually compensate for these kinds of services .

You know , I advocated for a budget and a project to start down this road and that was the first thing we did was go to CMS to ask whether the coach could be considered clinical staff and deliver other services like chronic care management , et cetera , and so we engaged healthcare lawyers who have the CMS relationships and know how to hold your hand in those

interactions . You know there's a protocol for getting meetings , for what you present , what you do when you get there . You know it's not something you just you present what you do when you get there . You know it's a , it's a , it's a , it's not something you just . You know you just don't do it without expertise .

And the lawyers insisted that we not mention lifestyle , lifestyle medicine . We use the term health behavior . That was acceptable . So we were not allowed to talk about exercise , nutrition and health behavior . That was acceptable . Um , so we were not allowed to talk about exercise , nutrition and health behavior includes , you know , compliance with taking your medications .

You know , getting your colorectal cancer screening and you know , getting um depression screen , all kinds of health behaviors that you know we wouldn't normally think is .

I mean , yes , they're preventive and they're part of the preventive guidelines , but we couldn't do that Now , since the American College of Lifestyle Medicine has gained ground now they're in regular dialogue with CMS , they just got into the AMA House , the American Medical Association House of Delegates , so they're now Lifestyle medicine .

So , and that's that has really grown in the last five years . And so now it's not bad to talk about lifestyle medicine , but we couldn't even talk about it five years ago . And just think about that , yeah , it wasn't .

And and when , um , we were in front of the panel in Chicago last February last year , um , dr Ready from the VA said something about joy and wellbeing , and they , we were at the end of the table with 20 physicians and they went . You know that's not healthcare .

Like values , meaning joy , you know , and woof , like no , like that's just not part of , even though that's what patients want . That's where they get their motivation to improve is because it's meaningful to be healthy . But you know , they , you know we could say this , we could say that , we couldn't say this .

We could just sort of slip in something about internal motivation , but not too much , you know , don't go too psychological , or the psychological psychologists or the , you know the psychiatrists are not going to be happy . I mean , it's really you're like we're shoehorning in this idea of and and also that prevention .

Don't talk about prevention , don't talk about that's a , this set of codes , that's not what we do , we treat . So now the conversation is about treating chronic disease , because that's where the need is anyway . Certainly , I mean , sure , we want to prevent , but we need to help the .

You know 68 of folks over 65 who have more than two chronic conditions , and there's still time to make a big difference . So , yeah , so you have to , you have to play the game , the language game that they will um , respond to and and so that's , and that'll keep getting better in our the next decade .

Lifestyle medicine will be part of healthcare , as it should be , and so we're part . We're , you know we're benefiting from , you know , we're all together on this that lifestyle medicine . The exercise is medicine , the coaching is medicine . We're all , you know , we're all together advancing this cause .

And I'm involved in some of that in the exercise profession and it's just , it's fascinating the thing that , as you know , as frontline professionals that we take for granted that in those policy discussions are just their no-go zones and so I definitely appreciate that peek under the hood there .

If you could sum up the one big takeaway from the professionalization process that you've gone on for wellness coaching and apply it to the exercise profession .

You know mechanism of action , understanding what you're doing that leads to the change and then the outcomes data that gets published in good journals . By far the most important thing is the quality of science , the quality of science that informs the design of the techniques and the quality of the studies of the outcomes of those techniques .

And the thing that I brought . And internationally , you know there were only a handful of us in 2000 that were carrying the torch for science and coaching . It's still not mainstream in executive and life coaching , I mean we made sure in health care it was , and so that was probably the most important thing was .

You know , in the early days of Well Coaches we met all the lead scientists . You know Miller , bill Miller from Motivational Interviewing . You know Jim Prochaska , who sadly died . Rich Ryan at DC . You know I went to all the early positive psychology conferences . So you know , got to meet Marty Seligman and Chris Peterson and how to bring that into healthcare .

So I was in the thick of it , using the science to inform the and then committing to studying the whole of it as a protocol to show that you could deliver significant , clinically significant , not even statistically significant outcomes . You must do that . Even there's always holes . I mean , you know in in in clinical care .

You know if you have a particular disease in a particular demographic , there might only be one randomized control study relevant to your particulars with 150 people . So it's not like , you know , a lot of evidence-based medicine is , you know , a small number of studies .

You know the GOP ones are another story because it's a huge breakthrough and opportunity , for a lot of reasons , of money in pharma , and we don't have that kind of money in pharma and in exercise and coaching . So we really , you know , thankfully they're , you know you , acsm has got some very senior researchers who can get significant grants .

So those are that , it's the scientific game and and and exercise . You know you've got it down . I mean I , you know you know what happens metabolically , genetically , um , you know , I mean there's a lot , a lot of interesting discussion right now about bone density and exercise . You know that's an interesting one right now .

I talked to a number of people at the acsm conference in june . Uh , may , yeah , may and june , yeah , getting the science down and telling the scientific story in a way you have to . Then you're presenting to physicians and scientists who are not going to read all the literature .

So then you've got to distill it down in a way that they can relate to and then they will listen . So that's , you know , acs seminars have to do this , to tell a scientific story and you have to be objective about the weaknesses in your case , because I know research and exercise is not that easy to do . It's hard to supervise it .

Then it's hard to translate it into the real world . So you really need to have a small cadre of people who knew how to talk about science to others who are scientifically oriented but don't know this science , and to be able to do that really well .

You know that's a distill it down on paper , in PowerPoints , in presentations , so they know that you've done the right things in the right way and they can follow the trail , the scientific trail .

Um , well , coaches is a um , a huge um resource , for , I mean , we've we're almost at 16 000 coaches trained . We have a lot of , a lot of um articles and and and courses and classes and our memberships open to all coaches . The National Board for Health and Wellness Coaching you know we started it in well , originally 2010 .

You know the standards came out 2017 . We're now over 10,000 National Board Certified Coaches , so it's a movement and there's lots of resources there . And then I also co-founded the Institute of Coaching at McLean Hospital . That is an academic .

We do give out coaching research grants and we translate science into coaching practices for the whole field , and that's a wonderful gathering . We have a conference , a Harvard Medical School conference , every two years . Those are numerous places . I just did a LinkedIn Live podcast on a paper I published in the American Cultural Lifestyle Medicine .

There's a keynote that I did at that conference two years ago . So , yeah , there's lots . There's plenty out there today to share .

Margaret , before we get you out of here in this conversation , I'm going to ask a question somewhat similar to what I asked earlier , except I'm going to direct this question at you , for the individual frontline exercise professional that's listening . You told us broadly that from your professionalization effort it's focus on the evidence , be able to tell the story .

But the frontline exercise professional is at a different position . They're out there in the trenches every day , just like the health and wellness coaches , and they're causing people to make positive changes in their life . If you could give that frontline exercise professional one piece of advice to advance and elevate the profession , what would it be for that person ?

Relationships are about really their empathy and motion . I'm listening , I'm understanding . I'm listening , I'm understanding your thought process , your thinking , your emotional states , your aspirations , your values . It's a lot to listen to .

So make the effort to be a human in relationship , because that's what keeps people coming back , and then you get more information and then your , your um , the , the interventions you bring forward are more likely to work . So that's the first thing . The second thing , um , we have uh , shifted from the word wellness to well-being .

Well-being is a mouthful when you say well-being coaching , I know it's still . You still catch on that , um . In the .

In the 25 years , though , since I've been in this space and we started off with wellness coaching and well coaches , um , the field of positive psychology has come to the fore and um and well-being is a broader topic , including positive psychology , because there are well-being bodies of the well-being work that are that don't consider themselves positive psychology .

So it's a there's a lot of it . Psychological well-being , um , which is the psychological resources you know , like motive , the quality of your motivation . Now we understand good quality versus not so good quality motivation . You know high quality , low quality , um efficacy . You know hope , optimism , meaning values .

Those things are , um , now really well studied and wellness has got kind of frozen in time wellness wheels with a bunch of things that impact wellness , but the scientific world is calling it well-being , not wellness . They're just not using the term wellness , and so that would be .

The second thing is to understand the drivers of human well-being and how exercise makes those better , because the interaction of exercise and psychological well-being is profound at the genetic and cellular level . I mean your , your mood improves , you know you're . I remember someone's saying you know you're always only one workout away from a good mood .

Indeed , what else can you take ? The body needs to move . And then there's exercise for the , for the mind , which is flow , which is deep focus work , creative work . You know which is the non-exercise ? You know you exercise so you can do great mental work , basically , and creative work . So I would say , um , broaden out , you can learn it through coaching .

Coaching , because coaching is the channel for well-being and for relationships . So coaching is basically just relationship and well-being put together into a protocol and then whatever you talk about , it almost doesn't matter , because we're drawing out the resources that help everything .

You talk about it almost doesn't matter , because we're drawing out the resources that help everything . So so those are the two big contributions of coaching to exercise physiology is to really understand the human relationship side , the empathy , the compassion , the mindfulness , the emotional piece , the resonance , the .

You know , the um , the um , the attunement to humans , attuning and then then using that to promote psychological well-being . That's what I would say . And so don't think about coaching as some like thing . It's really bigger than the word . It's about relationships that help people improve their well-being , and so it's . I think it's fundamental .

And so I think in the long run , exercise physiology , nutrition , um , mindfulness , they'll all that you won't be just an exercise physiologist , you'll have all of it , and that all of it together will improve the outcomes with exercise too .

So that's how , that , that's where I would leave , and I don't want to oversell coaching , I'm just saying it's just , it's a stealth , it's the Trojan horse . What's inside there is really fundamental . It's not just this label that you call yourself a coach . No , it's about using relationships to improve wellbeing .

Those shares make a real difference for us . Any information we'd like to share with you from today's episode can be found in the show notes page . That's by going to wellnessparadoxpodcom . Forward slash episode ACSM8 . That's forward slash ACSM8 .

Please be on the lookout for our next episode in this series when it drops next Monday , and don't forget to subscribe through your favorite podcast platform Until we chat again next week , please be well .