Wellness Program Blog

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

Smoking cessation programs ought to be multi-component with a focus on skills to build positive voluntary behavior modification practices. Useful techniques include starting reasons for quitting, understanding the smoking habit, various techniques for stopping and remaining a non-smoker, overcoming the problems of quitting, short-term objective setting, weight management, stress management, effect of exercise, relationship of alcohol consumption to urges to use tobacco. Use no aversive or scare tactics.

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

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

Evaluation of success is sometimes very dubious in smoking cessation programs. Measurement of success ought to 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 physical activity programs ought to include education on benefits of regular exercise and risks of a sedentary lifestyle, its impact 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 ought to include the following:

• Informed consent prior to implementing 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 care assessment is essential for exercise such as the Physical Activity Readiness Questionnaire (PAR-Q, see forms).
• Measurements of Blood Pressure (BP) and resting heart rate are useful evaluation 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 fitness program ought to include:

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

Exercise instructors ought to 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 medical 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 central heath risk.
• Referral for participants who are morbidly obese who would require medical 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 colleague 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% of body weight, 1-2 pounds per week.
• Explanation of unsafe weight loss methods.
• Daily calorie level is adjusted to meet each colleague’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 find foods which meet 100% 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 food selection.

The protein, fat, carbohydrate, and fluid content of the food 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% calories as fat.
Carbohydrate    At least 100 grams per day.
Fluid    At least one liter of water daily.

• Exercise component ought to be a valuable portion of the program and be both didactic and experiential.
• Participant is appropriately screened for exercise using a evaluation 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 provided for continued support.
• Weight control programs ought to be conducted by a registered dietitian or by degreed health professionals with training in nutrition with consultation by a registered dietitian.
• Trained lay leaders may support  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 offer appropriate interpretation of blood lipid evaluation 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 medical care as follows:

Total Cholesterol
< 200 mg/dl     Recheck blood lipid 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 care or risk reduction service within two months; if no stated history of CVD or less than two other risk factors, reassess blood lipid status within 1-2 years.
> 240mg/dl     Refer to medical care 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.

Provide the following:
• The relationship of blood lipids, elevated Blood Pressure (BP), and other risk factors.
o Risk factors include: elevated Blood Pressure (BP) 140/90 or higher or on hypertension medication; current tobacco use; 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., effect of controlling fat intake less than 30% of total calories from fat, less 10% 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 (BP), referral protocols, and delivering educational messages to colleague conducting Blood Pressure (BP) programs. These programs are required to follow national standard procedures.

• National standard procedures for Blood Pressure (BP) protocols:
o Calibration of Blood Pressure (BP) calculating equipment
be done at least each year.
o Two or more measurements of colleague’s Blood Pressure (BP) ought to be taken.
o Referral of participants with elevated 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 colleague that Blood Pressure (BP) is under great control today and ought to continue seeing and following treatment program.
o High Normal:   130-139 systolic and/or 85-89 diastolic
Action: Recommend that colleague have Blood Pressure (BP) rechecked within 1 year unless under treatment. Advise colleague that the readings are in a high normal range that needs rechecking. In the interim, suggest that one of the most effective means to decrease Blood Pressure (BP) 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 colleague 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 colleague 65 years of age or older.
Action: Advise colleague 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 medical care 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 standard procedures, and an explanation of Blood Pressure (BP) levels given to each colleague with individualized counseling, including advice about the interval of time recommended when the colleague ought to 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 (BP), March 1994.
o Written and audiovisual materials that are informative, easy to be aware of, and useful while containing scientifically accurate information.
o Relationship of elevated Blood Pressure (BP) 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 (BP).
o Importance of following prescribed treatment.

Health risk evaluation programs ought to be carried out on a one-on-one basis by trained medical care professionals. Health risk measures ought to include the following:

• Blood Pressure (BP) measurements – at least two Blood Pressure (BP) measurements taken during the evaluation episode, using a mercury sphygmomanometers or regularly calibrated aneroids.
• Blood Pressure (BP) treatment status – evaluate whether the colleague is under a doctor’s care, on any medication, on a prescribed diet, or any other sort of treatment for hypertension.
• Blood cholesterol measurement – total cholesterol and HDL-cholesterol taken either using a properly tested and maintained table top blood analyzer offering immediate feedback to the client, or sending blood to a laboratory offering feedback using a method that is as effective as immediate feedback.
• Cholesterol treatment status – evaluate 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. By way of example assess participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index.
o Identify people 20% or more above their ideal weight.
• Smoking status – assess whether the colleague currently smokes cigarettes, whether the client has quit or never smoked, and the number of cigarettes smoked/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 – evaluate if the client has had a heart attack or other sort of coronary heart disease.
• Stress – colleague’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 colleague authorizes the program to draw blood for testing to send information to the colleague’s medical care provider if medical care risks are identified, and to get information from the provider about diagnosis and prescribed treatment.
• Participant interest survey – if an assessment of interest has not been collected previously, the evaluation exercise must assess levels of interest in programs such as: weight management, smoking cessation, fitness or exercise, stress management, nutrition, self-care, blood lipid control.
• Health education messages – the screener must review with the colleague his/her identified health risks and what they mean to the colleague’s central health, and give the colleague 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 evaluation, workplace, client’s name, address, social security number, home and work phone number, sex, race, date of birth, relevant work information (e.g., hourly or salaried), department number, and work shift.

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

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

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

Incentives can be used to increase participation rates, help with completion or attendance at programs, and to help people shift or adhere to healthy lifestyles. The purpose of the incentive is to encourage workers to adopt positive behaviors or maintain an existing positive behavior. Everyone who achieves a objective or maintains a behavior ought to receive something. Many employers also offer incentives/rewards merely for participating in activities.

Stay away from being the “best” or doing the “most.” Encouraging workers 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 incentives/rewards.

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

A primary concern in wellness programming is attracting workers to take part and maximizing participation. When introducing a program, a letter briefly explaining the program signed by the president or CEO is a great endorsement.

Utilizing posters, newsletter articles, and handouts are great means of promoting the program. Other promotional methods to consider are e-mail and announcements at employee gatherings. Ask Company Wellness Committee members to recruit participants.

Once the program is kicked off you may want to offer an incentive for any employee who recruits another employee to any of the program offerings.

When selecting a program from a vendor you ought to ask the following questions:

• How many worksites have done the program?
• What types of employee population was the program provided?
• What educational materials are used?
• Will the program meet the needs of workers?
• What are the techniques used to help modify behaviors?
• Does the program help workers move through stages of readiness to make health behavior changes?
• How do you market the program to workers?
• What follow-up do you offer?
• How do you make referrals for medical care or other supportive services workers may need?
• How do you know the program works?
• How do you measure colleague satisfaction?