Wellness Library

The educational program ought to include approaches to stress awareness/reduction at the environmental level and at the individual level.

Social, physical, and employer stressors ought to be explained and methods to ease or elevate stressors ought to be presented. At the individual level how changes in attitudes and behaviors help one to cope with stressors; learning techniques to minimize stress response, such as meditation, relaxation response, and exercise.

Content of the program must offer the following:
• Identifying sources of stress
• Relationship of stress to health
• How the individual experiences stress, personal, family, work
• Solutions for coping and managing stress
• Techniques for decreasing stress
• Value of stress, both detrimental and positive
• Practical steps of incorporating stress reduction into lifestyle

Personnel delivering stress management programs must have training in psychology, behavioral sciences, or related disciplines such as mental health professionals, counselors, health educators, psychologists, and psychiatrists. Training in a reputable program on how to teach the stress management course including group process skills is a must.

A nutrition education program must include a nutritional needs assessment, education counseling, and referral as crucial.

Educational sessions and materials should include the following information:

• The relationship of diet and chronic diseases
• Improving eating patterns
• Relationship of diet and proper weight maintenance
• Exercise
• Stress
• Blood Pressure (BP)
• Cholesterol
• Diabetes and other chronic diseases.
• Nutritionally accurate information regarding the relationship of health to diet, including cholesterol, fats, fiber, alcohol, carbohydrates, salt, sugar, and vitamin/mineral supplementation.

Methods for identifying healthier foods and incorporating low-calorie, high nutrient foods into eating habits. Guidelines for bettering eating habits ought to be based on or consistent with national recommendations such as The Food Guide Pyramid.

Instructor must be a registered dietitian, registered nurse, or have a baccalaureate degree or higher in health education with training in nutrition. If an allied health professional instructs the program, a consultation and review of the program design by a registered dietitian is recommended.

It is recommended that tobacco cessation programs subscribe to the Code Of Practice for Smoking Cessation Programs.

Smoking cessation programs should be multi-component with a focus on skills to build beneficial voluntary behavior modification practices. Useful techniques include establishing reasons for quitting, understanding the smoking habit, various techniques for stopping and remaining a non-smoker, overcoming the concerns of quitting, short-term goal setting, weight control, stress management, significance of exercise, relationship of alcohol consumption to urges to smoke. Use no aversive or scare tactics.

In programs that use aids such as the “patch” or medications such as “Zyban” appropriate consultation should be available on the usage of these aids.

The instructor must have formal training in smoking cessation from a nationally recognized corporation such as American Heart Association, American Cancer Society, American Lung Association, or a nationally recognized commercial program such as Smoke Enders.

Assessment of success is at times very dubious in smoking cessation programs. Measurement of success must include participation rate, including the number implementing the program, the number completing the program, and the average number per session. Also included, number and percent who stopped smoking at the end of the program, and the number and percent who had not resumed smoking by the end of one year.

Participatory exercise programs ought to include education on benefits of regular exercise and risks of a sedentary lifestyle, its influence on cardiovascular health and diseases, its relationship with weight management and stress management, and aerobic exercise options. Discussion and practice of safe principles of exercise – warm up, cool down, frequency, intensity, duration, flexibility and strength components. The program follows standard procedures by the American College Of Sports Medicine.

Safety precautions should include the following:

• Informed consent prior to starting exercise with clear and complete written and verbal standard procedures of possible risk, purpose of exercise, exercise format to be followed, opportunity for questions, and a signed informed consent with date.
• A screening/assessment of participants to determine if medical assessment is significant for exercise such as the Physical Activity Readiness Questionnaire (PAR-Q, see forms).
• Measurements of Blood Pressure and resting heart rate are useful screening information to determine exercise readiness.
• Members who fail screening are medically referred and ought to get a written clearance from their physician to exercise.
• The basic content of an aerobic physical activity program should include:

Warm up   5 – 10 minutes
Aerobic exercise   20 – 40 minutes
Cool down   5 – 10 minutes

Exercise instructors should have education and training in exercise physiology, physical education, physical therapy or comparable discipline, or possess a current certification by a nationally recognized sports medicine or exercise association, and be CPR certified.

Program provided is consistent with scientific and health care recommendations for weight loss, reflects a multi-disciplinary approach which offers four components: behavioral, exercise, nutrition, and maintenance, and is in accordance with the document Guidance For Treatment Of Adult Obesity. It includes:

• Screening to verify that the colleague has no medical or psychological conditions which would make weight loss inappropriate, and to identify the colleague’s level of health risk, classifying participants not only on excess body weight, but also on the basis of associated medical conditions and overriding heath risk.
• Referral for participants who are morbidly obese who would require health care guidance for weight loss.
• Informed consent, explanation of potential physical and psychological risk from weight loss and regain, likely long-term success of program, full cost of the program, credentials of the employee.
• Identification of contributing factors to colleague’s weight status, serving as the basis for an individualized weight loss plan which includes the weight objective and plans for nutrition, exercise, and behavioral components.
• Weight objective of attendant is reasonable based on personal and family weight history not solely on height and weight charts; initial weight loss objective does not exceed loss of 10 percent of body weight, 1-2 pounds per week.
• Explanation of unsafe weight loss methods.
• Daily calorie level is adjusted to meet each attendant’s recommended rate of weight loss.
• Daily caloric intake is not less than 1,000 calories; if less, physician monitoring is required.
• Food plan designed so participants can choose foods which meet 100 percent of all the Recommended Daily Allowance (RDA) except for calories. Nutritional supplementation can be used to achieve RDAs, however ought to not greatly exceed RDAs.
• Nutrition education encouraging permanent healthful eating habits based on The Food Guide Pyramid.
• Participant involved in meal planning and meal selection.

The protein, fat, carbohydrate, and fluid content of the meal plan meet safety recommendations:

Protein   Between 0.8 and 1.5 grams of protein per kilogram of objective body weight, but no more than 100 grams of protein a day.
Fat   10 – 30 percent calories as fat.
Carbohydrate   At least 100 grams per day.
Fluid   At least one liter of water daily.

• Exercise component should be a valuable portion of the program and be both didactic and experiential.
• Participant is appropriately screened for exercise using a assessment questionnaire such as the Par-Q Readiness Assessment (see forms). Instruction on recognizing untoward responses to exercise.
• Members work towards 30-60 minutes of exercise 5-7 days per week.
• No appetite suppressant drugs.
• Maintenance plan available for continued backing.
• Weight control programs should be conducted by a registered dietitian or by degreed health professionals with training in diet with consultation by a registered dietitian.
• Trained lay leaders may assist  if supervised by nutrition professional.

Note: There’s an interactive version of Guidance for the Treatment of Adult Obesity at e-Guidance for the Treatment of Adult Obesity.

A program is required to support appropriate interpretation of cholesterol screening results, including a caution that a single measurement neither excludes nor establishes a diagnosis of their blood cholesterol.

Follow national standard procedures:

Total Cholesterol
Desirable cholesterol   < 200 mg/dl
Borderline cholesterol   200 – 239 mg/dl
High cholesterol   > 240 mg/dl

HDL
Desirable HDL    > 35 mg/dl
Low HDL    < 35 mg/dl

Refer blood lipid evaluation participants to healthcare as follows:

Total Cholesterol
< 200 mg/dl    Recheck cholesterol in five years, if history of coronary heart disease or if two or more CHD risk factors are detected refers to risk reduction program or health professionals, as appropriate.
200 - 239 mg/dl    If history of CHD or if two or more other risk factors are detected, refer to medical or risk reduction service within two months; if no reported history of CVD or less than two other risk factors, reassess blood lipid status within 1-2 years.
> 240mg/dl    Refer to healthcare within two months.

HDL
> 35 mg/dl   If fewer than 2 risk factors and borderline total cholesterol, refer to risk reduction service, as appropriate. Reassess HDL in 1-2 years.

Give the following:
• The relationship of blood lipids, elevated Blood Pressure, and other risk factors.
   o Risk factors include: high Blood Pressure 140/90 or higher or on hypertension medication; current cigarette smoking; family history of premature CHD; diabetes mellitus; age – male > 45 years, female > 55 years or premature menopause without estrogen replacement therapy.
   o Negative risk factor: high HDL 60 mg/dl or greater (subtract one risk factor).
   o Risk factors such as family history, smoking, high fat or other unhealthy diet, and lack of exercise lead to the development of cardiovascular disease (CVD).
• Definitions and causes of elevated blood lipids and HDL, desirable levels, the meaning and limitations of a single measurement, the cause of variability, and the need for multiple measurements prior to diagnosis.
• Wide range of treatment options, including diet (e.g., importance of controlling fat intake less than 30 percent of total calories from fat, less 10 percent saturated fats), less than 300 mg. of cholesterol per day, well-balanced diet, weight maintenance or reduction, exercise, and medication.
• Importance of following prescribed treatment and professional advice.

Appropriate medical care or allied health professional trained in measurement of Blood Pressure, referral protocols, and delivering educational messages to colleague conducting Blood Pressure programs. These programs are required to follow national guidelines.

• National standard procedures for Blood Pressure protocols:
   o Calibration of Blood Pressure (BP) quantifying equipment
   be done at least annually.
   o Two or more measurements of colleague’s Blood Pressure should be taken.
   o Referral of participants with high Blood Pressure (BP) readings to personal physician for further assessment.

• Systolic/Diastolic Follow-Up:
   o Normal:   <130 / <85
      Action: Recheck in 2 years
   o High Normal:   130-139 / 85-90
      Action: Recheck in 1 year

• Hypertension:
   o Stage 1 (Mild):   140-159 / 90-99
      Action: Confirm within 2 Months.
   o Stage 2 (Moderate):   160-179 / 100-109
      Action: Refer to source of care within 1 month.
   o Stage 3 (Severe):   180-209 / 110-119
      Action: Refer to source of care within 1 week.
   o Stage 4 (Very Severe):   >210 / >120
      Action: Refer to source of care immediately.

• Appropriate educational messages:
   o Normal:   <130 systolic and <85 diastolic
      Action: No referral. If on treatment, then inform participant that Blood Pressure (BP) is under great control today and should continue seeing and following treatment program.
   o High Normal:   130-139 systolic and/or 85-89 diastolic
      Action: Recommend that participant have Blood Pressure rechecked within 1 year unless under treatment. Advise participant that the readings are in a high normal range that needs rechecking. In the interim, suggest that one of the most effective means to reduce Blood Pressure is to bring weight into normal range and to exercise.
   o High:   >140 systolic and/or >90 diastolic
      Action: Refer to physician for further assessment within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. If already on treatment, advise participant of readings and need to get Blood Pressure (BP) to a objective of 140/90 or less.
   o Isolated Systolic Hypertension:   140-159 systolic and < 90 diastolic in a participant 65 years of age or older.
      Action: Advise participant to inform physician of readings at next visit and consider advice regarding weight loss and exercise if appropriate.
   o Urgent:   180-209 systolic and/or 110-119 diastolic
      Action: Recommend obtaining healthcare assessment within 1 week.
   o Emergency:   >210 systolic and/or >120 diastolic
      Action: Obtain immediate medical care attention.

• Provides the following:
   o Written results, referral guidelines, and an explanation of Blood Pressure (BP) levels given to each attendant with individualized counseling, including advice about the interval of time recommended when the attendant must be checked again.
   o Utilizes the recommendations in The Fifth Report Of The Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, March 1994.
   o Written and audiovisual materials that are informative, simple to be aware of, and useful while containing scientifically accurate information.
   o Relationship of elevated Blood Pressure and other risk factors, such as family history, smoking, high fat and unhealthy diet, lack of exercise, in the development of cardiovascular disease, including stroke, kidney disease, heart attack, and other diseases.
   o Definition and causes of elevated Blood Pressure.
   o Importance of following prescribed treatment.

Health risk assessment programs must be carried out on a one-on-one basis by trained medical professionals. Health risk measures must include the following:

• Blood Pressure (BP) measurements – at least two Blood Pressure (BP) measurements taken during the screening episode, using a mercury sphygmomanometers or regularly calibrated aneroids.
• Blood Pressure treatment status – determine whether the attendant is under a doctor’s care, on any medication, on a prescribed diet, or any other type of treatment for hypertension.
• Blood cholesterol measurement – total cholesterol and HDL-cholesterol taken either using a properly tested and maintained table top blood analyzer providing immediate feedback to the client, or sending blood to a laboratory providing feedback using a method that is as effective as immediate feedback.
• Cholesterol treatment status – determine whether the client is under a doctor’s care, on any medication, on a prescribed diet, or any other sort of treatment for elevated blood lipids.
• Obesity – utilize an accepted method for estimating obesity. For example evaluate participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index.
   o Identify people 20 percent or more above their ideal weight.
• Smoking status – evaluate whether the attendant currently smokes cigarettes, whether the client has quit or never used tobacco, and the number of cigarettes used tobacco/day.
• Exercise habits – evaluation questions may be limited to frequency and duration exercise. Do participants exercise in a moderately vigorous fashion at least three times per week for 30 minutes or more.
• Diabetes – whether the client has diabetes, and whether or not it is currently under control. A blood glucose may be also done via finger stick and desk top analyzer. Several manufactures make available cassettes which include blood lipid and glucose measurements.
• Cerebrovascular disease or occlusive PVD – evaluate if the client has had a stroke or other kind of blood vessel disease.
• Family history of cardiovascular disease – evaluate whether any of the participants’ parents or siblings had a heart attack or sudden death due to heart disease before age 55.
• Coronary heart disease – ascertain if the client has had a heart attack or other sort of coronary heart disease.
• Stress – attendant’s assessment of stress in work and/or personal life. A series of well-tested and validated questions assessing levels of stress are available from the Worker Health Program.
• Participant release form (see forms) – A release form is required in which the participant authorizes the program to draw blood for testing to send information to the participant’s medical provider if medical risks are identified, and to obtain information from the provider about diagnosis and prescribed treatment.
• Participant interest survey – if an assessment of interest has not been gathered previously, the evaluation exercise must evaluate levels of interest in programs such as: weight control, smoking cessation, fitness or exercise, stress management, diet, self-care, cholesterol control.
• Health education messages – the screener must review with the attendant his/her identified health risks and what they mean to the attendant’s overall health, and give the attendant a written record of the Blood Pressure (BP), total cholesterol, and any other physiological measures taken.
• Referral of participants for treatment – participants with elevated risks must be referred to appropriate sources of diagnosis and possible treatment following nationally or locally recognized standard procedures for such referral.

Demographic information ought to include location of the assessment, worksite, client’s name, address, social security number, work and home phone number, sex, race, date of birth, relevant job information (e.g., hourly or salaried), department number, and work shift.

Program directors or providers must have a background in wellness programming and a professional health-related degree or certification. They must have expertise in content areas, planning, promotion, administration, assessment, and ability to grow a program and tailor the program to the worksite.

Program providers ought to have a quality assurance program for evaluating the performance of service personnel, to assess satisfaction of participants, and for personnel training and continuing education.

An overriding policy statement ought to be available from directors and program vendors addressing the following issues: assurance of confidentiality of health data, referral to medical care for at-risk participants, follow-up with referred participants and those at-risk, program evaluation on process and outcomes, company of the worksite for promotion of wellness and changes in corporate culture. A clear contract or letter of agreement for services ought to be provided.

Stay away from being the “best” or doing the “most.” Encouraging employees to be the best or doing the most promotes excessive behavior, discourages others, and creates elitism. The best designed incentive programs are ones which are based on achieving objectives that are attainable by most people. Recognition, acknowledgment by top management, or special privileges are examples of excellent intangible rewards and incentives.

Incentive ideas:

• Free or Low-Cost:
   o Certificates
   o Movie passes
   o Recognition in employee newsletter
   o Mugs
   o Water bottles
   o Commendation from management
   o T-shirts
   o Hats

• Moderate Cost:
   o Entertainment tickets
   o Sweatshirts
   o Waist packs
   o Subscriptions to health magazines
   o Health and fitness books
   o Videos

• High Cost:
   o Week-end getaways
   o Dinner for two
   o Clocks
   o Watches

• Others:
   o Cash
   o Gift certificates