Tumgik
#maybe think for yourself instead of reading headlines and believing them exclusively
goore-ghoul · 21 days
Text
so....i'm noticing people who are saying "Don't vote for Harris or Trump" aren't American and don't have to live day to day under the administration
like
yes, the US does impact the rest of the world but also i don't want to live in fascism more than i have to
i would like trans people to be alive
i would like homeless people to have a chance
i would like medical care to be accessible to everyone
and even more things
there's a LOT at stake here
i will probably not exist if Trump wins and has his way? so i'm going to vote for Harris......and if you want to guilt me or anyone else for that
go fuck yourself bc we don't have a whole lot to work with
7 notes · View notes
Text
The Please Use Your Brain Master list
You cannot argue both that public schools are teaching us to be good little factory workers because of capitalism and also complain that they’re not preparing us for real jobs that don’t require college. Also: vocational schools exist.
Relatedly, do you think school exists just to prepare you for the working world or if it’s supposed to teach you to think? Because if the latter, stop blaming your lack of practical skills on the fact that you had to learn about mitochondria or trigonometry. Math and science teach you critical thinking and the humanities teach you context and empathy and maybe if you stopped whining for 30 seconds you’d be able to put these together and be a halfway decent excuse for a person. And maybe if you had paid attention in a standard public school Algebra 2 class you wouldn’t ask for mutually exclusive possibilities, Karen.
Speaking of, do you want schools to teach you how to do your taxes or what? Please keep in mind that the tax code is a mutable law, and taxes differ state-to-state. Also free tax prep programs are pretty good unless you have a complicated income or assets, and are available online. Free basic assistance is available at many libraries. If you do have a lot going on, you can pay someone money to help you do your taxes.
Yes you need to pay someone to help you do your taxes. It is their job. Do you believe in a living wage or not.
“Artists should get paid enough to live.” - good point
“Manhattan real estate prices are ridiculous, especially in midtown!” - true
“Broadway shows are too expensive.” - ...do you listen to yourself even
“I wish it were socially acceptable to” - I have yet to see one of these that describes something socially inacceptable. I have personally: taken a martial arts intro class for adults, gone to the movies alone, gone to a restaurant platonically with one friend, worn a costume not on Halloween in public. The vast majority of people will not give a fuck. Most of the rest won’t say or do anything. You can’t control if people judge you. If they actively harass you that’s a problem but if you just worry about silent judgement, guess what, they’d judge you if you didn’t do these things too. I’m judging you right now for having never left the fucking house apparently.
Pretending all women/PoC/LGBTQ+ people/etc have been irrevocably erased from history- typically this is complicated but ultimately not true and not helpful (and even harmful). It is undeniable that most mainstream public education in the U.S. is deeply flawed (hey look! Valid criticism of the educational system). However, there are books with this information! That are at libraries! For free! Also the internet exists! You know what is erasure? Denying the hard work many LGBTQ+ and/or ethnic minority researchers put in to writing tons of books about their histories!
Similarly, before saying “YOU KNOW WHY” or “Why is no one talking about this” you need to check the following.
Is the source valid? Because sometimes no one’s talking about it because it’s an outright scam.
Are people really not talking about it or are they just not talking about it on Tumblr because the last time I saw this I immediately found a NYMag profile and an NPR interview, both from within the past 5 years, by searching the person’s name.
On that note let’s talk journalism! It’s important, it’s dangerous (especially in this climate) and it is a job that people should get paid for. Unlike, say, healthcare, you really, really, really don’t want journalism to be state-sponsored. Share a subscription with a couple friends if you have to. Go to the library.
Oh and journalism typically has standards both of veracity (which means that you won’t hear about something that is pure hearsay no matter how nicely it fits your worldview) and style (which means that they don’t give names in headlines unless the person is well-known) The name is in the article, which you would know if you read the article.
I keep seeing that post saying that if libraries were proposed under capitalism they’d never come to be and honestly whether it’s true or not I doubt half of you would notice because you’ve only ever set foot in them to reread Harry Potter.
In conclusion: learn to use a search engine. Learn to do basic research (which my public school did in fact teach). Remember that a necessary part of paying people for their work means you don’t get the things they create for free. Read a book. A nonfiction one. Go outside. Read the article. Apologize to your mother. Consider whether your statements are constantly in direct conflict thus destroying all of your points. Make an effort to actually learn things instead of expecting Tumblr to shovel it into your brain.
235 notes · View notes
matildainmotion · 4 years
Text
What if Self-Love is Not About the Self? By Natasha Fowler and Matilda Leyser
This blog is a collage.
A collaboration
A conversation between my words -Matilda’s- and….
….Mine, Natasha’s
It’s a blog about looking after yourself, ourselves, and how I, you, we go about doing that.
It is in two parts. You can also listen to the blog if you go HERE:
PART ONE:
First, to introduce ourselves:
Matilda: I am a mother, writer, theatre-maker, co-director of Mothers Who Make, wife, daughter, insomniac.
Natasha: I am a friend, a lover, a guardian, a wounded human. I am a White woman, descendant from my ancestors. I make art, share what I know and raise children.
We met at an international MWM meeting.
I’m trying to finish a draft of my novel by Christmas, so I am not writing any blogs. Instead, I send an email to Natasha, in Amsterdam….
Hi Natasha, Please let me know if you wish to write a MWM blog for the month of November. The only requirement is that it ends with a question, relevant to the theme of mothering and making, that can become the focus for the month’s meetings should people wish to take it up. Let me know….. Matilda
Thank you, Matilda, yes. I started work on the self-care article yesterday. I’m going to edit today and share with a few friends. I can commit to having it to you by Wednesday. I hope you have a good steady day of eating, working, caring and resting. I have stretched, washed and consciously dressed but my teeth are not cleaned yet (3/4 of my morning routine). Time to get off emails! Natasha
Late Wednesday, I receive Natasha’s first draft. I see it come into my inbox at nine pm, as I am about to read bedtime stories to my daughter – I think, ‘I won’t read that now, or I won’t sleep.’ I close down my laptop.
I don’t sleep anyway. One of the worst things about insomnia is the radical loneliness – an irrational sense that no one else in the world is still awake.
The next day, tired, wired, I read Natasha’s blog. I know I am a word control freak -I have been known to edit, and re-edit, a text message - but I feel uncertain about publishing Natasha’s draft in the MWM blog spot. I want more mothering and making in it. This also seems a very dubious response- to invite new, diverse people to write a blog and, when they don’t sound like me, to want to edit them to make them sound more so…..and yet, at the same time, I think there is something valid in wanting to look after the particular space that MWM holds, in meetings, online, in writings. After dithering for a few days, I email Natasha –
Hi Natasha, first a disclaimer: I am not in a great place right now. My chronic insomnia has become acute and I am not functioning well, so my critical faculties are pretty ropey! …But would you be willing, to include a little more about your mothering and making in the writing….?
Hi Matilda, It makes sense to me that my approaches and the boundaries of the blog are having a conversation. I am curious about why I don’t talk about mothering and making in a way that meets the criteria. I have an imaginative block for what that’d look like - which tells me I’m categorising the requirement differently to you. It’s a familiar thought cul-de-sac that comes with this Neurodiverse mind I operate in.
Neurodiverse. It’s a term that is relatively new to me and suddenly tremendously potent: at the end of September my son at last received an autism diagnosis. “I get it,” he said when my husband and I told him, “My brain does this” – he drew a detailed picture in the air of different, curved and diagonal connections between invisible points of meaning– “And other peoples’ do this,” he said, drawing a series of straight, right-angled lines.
Hi Natasha, as part of my learning in this area I would be very interested to hear a little more about how you name and describe your neurodiversity. Please send me a few lines articulating your sense of it - why does our exchange feel like ‘a familiar cul-de-sac’ to you? Tell me more about the cul-de-sac and the other streets and highways of your mind :-) Thank you again for your openness, integrity, and all your work on this. Matilda xxx
The cul-de-sac I talk about is a place I get stuck when I've been given a task and I have no imaginable concept of what that would look like. With a long conversation and lots of back and forth clarification, I would probably discover that I do know what you're talking about but I learned a long time ago not to try and clarify everything so precisely, it was not practical/ possible and probably led to people being annoyed by my questions.
Part of my response to the task is to think "but I made the writing - that's the making" and "I am a mother, so if I speak, I'm speaking from the experience of mothering".
In the end I understand the labels autism/ADHD/dyslexia/neurodiversity to be bureaucratic necessities in a world obsessed with 'normal'. The necessary diversity of human experience is medicalised, categorised in order for us to get the money from the system that is needed to exist in the system. I am disabled by what I live in and my race/class/gender identity have protected me from that disabling being far more consequential.
I can’t and don’t want to argue with any of this. I feel dismayed at the idea that my requirements for the MWM blog might actually in themselves be exclusive. I don’t feel good about wading in and making Natasha’s voice more acceptable within my idea of what the text should sound like. So, I think instead I will be transparent – I will leave her words as they are and add some of mine – put in the mothering and the making that I feel the need to include. As it happens, Natasha’s chosen theme, of the need for self-care to be a process that takes place as a collective, community act, could not be more relevant to my experience of mothering and making this month.
Here we go then….
PART TWO:
Natasha: I ran out of self-love this summer, overwhelmed by stories of all my faults, what I’d lost and not done. I spent too much time subject to a cruel inner tyranny. I held onto the idea that I could take care of the situation alone. That I could create the self-love I needed. I could not. I needed to depend on something beyond my self. Although I had vowed to love myself first only two years ago, I was now raising questions about this individualised ideal of self-love.
Matilda: Take care, people say. I still struggle to do this. I sit on the stairs at 3am. My husband is asleep. My son and daughter are asleep. They are 8 and 4. I am 46. I ought to be able to rest too - how can I possibly take care of them, if I cannot take care of myself in this fundamental way? Self-soothing is a skill that babies, some say, are meant to have learnt after only a few months. I tell myself this when I get to the sobbing stage at 4am. I fantasize about a mother figure– not my real mother who is 79 now, also in my care, also asleep – but some great giant of a mother coming walking through the woods outside. She is coming to take me up in her arms, hold me against her, above the trees, hold me, grown as I am, until I fall asleep. Because tomorrow I have other people to take care of– the children, my mother. And I have another chapter of my novel to write. I know I cannot write when I haven’t slept.
Natasha: I finally gave up the idea that self-love is my sole responsibility. I began to accept the dependence that exists, the vulnerability of my well being. My self-love became communal. Just like the child raising that I do along with my partner, our friends and family; just like the neighbourhood garden my wee boy and I joined in preparing for winter last week.
But how did I end up believing self-love is something I have to do by myself? Born in 1978, independence and individuality were highly prized values when I was growing up. To be able to do things yourself without help was a given. To be free of the demands of a group was important. The myth of singular heroes was all over the culture, from lonesome superheroes to introvert inventors and brave explorers. The heroes saved the vulnerable, and the vulnerable were symbolised as young, straight, thin, white women. The stories of everyone around the inventor and all that they did were edited out. The people who were there before the explorer even set his foot down were erased. The values of independence of individuality, invulnerability are seeped into my bones.
Matilda: Did you sleep? My husband asks me in the morning. I shake my head. He is worried. I am worried. I don’t know what to do. I have tried so many things. I tell him I might put a post about it on the Mothers Who Make Facebook group– “You should,” he says. “That’s what it’s for.” True. I started it, but I find it hard to reach out for support. I have a kind of pride, almost a snobbery, that has often stopped me sharing. ‘What’s on your mind?’ FB asks me – so many things, but I don’t want to place them in that white public space. It feels immodest to do so, to turn my life into a headline. But the truth is, I am afraid.
I recognise this. It is also why I find it hard to share my work. I hold onto it. I have been working on this novel for ten years, and hardly anyone has read it. It is the same reason I edit, re-edit text messages. I do not let people see the mess. The missed comas. The words out of place. I feel safest when sealed off, private, when only carefully crafted images of vulnerability are revealed. And yet, when I am sobbing at 4am, all I want is company. A giant mother. Someone, anyone, to see me, to see the mess of me.
Natasha: I am communally made. My ideas of who I am, what I do, what is the value in me are made during my relationships. Maybe I always knew that like the self-hate I was carrying, my self-love was a communal responsibility. I suspect there is something about the experience of being a mother in my culture that helped me forget. It seems to be an experience that isolates and calcifies our individual sense of responsibility. The International mothers who make calls were part of my communal self-love recovery. Getting to turn up to a new group and hear me tell my story and listen to so much good company. I hope we might all give and receive the love that we need to maintain a sense of our self being loved. I hope we are all learning what we need to learn to be able to do that.
Matilda: So I did it – I put the post on Facebook. I need some help, I wrote, I don’t sleep and I can no longer blame my children for this. My children are sleeping – I am not. Many of you reading this, may have seen it and responded. It was extraordinary for me to see such a huge number of compassionate, wise, responses so fast. Humbling. Profoundly helpful – not just the resources, but the act itself of reaching out and finding so many hands writing back. After only an hour, I went online to look and I could see the wavy line that appears when someone, somewhere is in the process of typing something. A real person out there, taking care. Not just one. Over a hundred. A giant number of mothers.
I wrote back to Natasha:
P.s. The amazing response I received to my insomnia post rather wonderfully proves your point - we don’t have to do this self-care thing on our own. Xxxxx
Don’t have to – can’t even – whoever you are, how ever your mind works, however brilliant you are, however vulnerable, however divergent, however alone you feel.
It sounds so simple. So obvious. We are interconnected. All the streets link up, even the cul-de-sacs have passages leading onto one another. There is no such thing as social distancing. Physical distancing, yes, but social – two metres apart between your thoughts and mine, your experience and mine, your words and mine – is just not possible.
Here then is Natasha’s, my, your, our question for the month:
How do you understand self-love, is it clearly something you must do for yourself? Or something you share? or maybe you practise other ideals of compassion? Maybe you carry some communally made self-hate too? How do you sustain yourself when overwhelmed?
0 notes
yuurisolympicgold · 7 years
Text
Yuuri Week 2017, Day 4: On Ice Title: Blades of a Ballet Dancer Characters: Katsuki Yuuri, Victor Nikiforov, Minami Kenjirou. Pairing: Yuuri/Victor. Genres/Tags: Romance, Friendship, Fluff, Canon Compliant, Post-Canon. Ratings/Warnings: G/None. Summary: When word gets out that Yuuri helped create his record breaking routine Yuri On Ice, the world wants to know if he thinks he could do solo work. Yuuri says no, everyone else disagrees. Obviously, everyone else is a traitor. *Side note: the reference to the “Woody costume” is of course inspired by a baby Yuzuru Hanyu.
Yuuri couldn’t believe it when he read the headline Phichit forwarded, followed by an obnoxious string of dancing emojis. Or maybe that was just his mood after reading the joke in print on his phone screen. Him? Choreograph? He’d never even choreographed one of his own routines fully and they thought he could do it professionally?!
Yuuri decided it must be a slow news day in the skating world.
“I don’t see why you’re so hesitant,” Phichit said later on video chat. “Remember the improvised pair skates we sometimes did in Detroit before Ciao-Ciao yelled at us to stop goofing off? Those were pretty good! They wouldn’t break a world record, but maybe with some polishing they could have.”
Yuuri wasn’t upset per say, but it brought up a lot of things.
If Yuuri was honest with himself, before Victor he’d always wanted more creative input. It wasn’t that he’d disliked Celestino’s choices, but it felt like he lacked a personal connection with some of his past programs. He would increase the difficulty of his step sequences and change up some of the spirals when he felt he could do more, but that had been the most he could bring himself to ask of his former coach. He blamed it on his own inability to ask for things back then. Victor had other ideas.
“Sounds like you trained in a very creatively stifling environment,” Victor later stated plainly when Yuuri brought up his past experience and why he was so reticent about considering choreography.
“It wasn’t like that,” Yuuri insisted. Celestino was an amazing coach. One look at Phichit’s success was proof of that. He had always been kind, but Yuuri knew he lacked a connection with him. His anxiety for one was something Celestino never did understand during the years they worked together, but he’d understood Yuuri’s need for solitude. “I think we just lacked a degree of...compatibility.”
Seeing that headline now brought those old feelings to the surface. Victor being his coach and choreographer was so much different. Save for a few pitfalls in the beginning, it was almost surreal how well they worked together. He’d never had that much creative control and was constantly surprised whenever Victor asked him what he wanted; from the music to the technical aspects. Victor never made a decision without his input. Victor had asked for his opinion on every part of the composition of his free skate.
That was part of the reason why Yuri On Ice meant the world to him. It was his love letter to skating, his own career and to everyone who supported him. It was him learning to appreciate himself more. It was something he’d created together with Victor. Yuri On Ice had been the first time he’d felt comfortable expressing his complete self on the ice.
He had always wanted a hand in choreographing his own routines. Now he had someone who listened, even when he couldn’t always speak his mind. But the idea of doing it on his own? Anything he’d ever come up with while warming up or burning off stress outside of compulsive figures looked more like a dance he’d practice in Minako’s studio. That was his background, his true forte...
“Personally,” Victor cut into his train of thought. “I think there’s a lot of skaters out there who’d like a Yuuri Katsuki caliber step sequence for themselves. In fact,” Here he scrutinizes Yuuri with a finger pressed to his lips and actually looked excited at the prospect. “I wouldn’t mind one myself!”
Yuuri sputters but can’t deny how breathtakingly touched Victor’s praise made him feel.
Even though Yuuri had made the conscious effort not to discuss either the article or whether it was something he wished to pursue with anyone besides Victor and Phichit, who both already knew, news apparently traveled fast.
“YUURI-KUN.” Yuuri still winced. He’d almost forgotten that Minami was also performing at this ice show.
Since they’d competed together at World Team Trophy and won, narrowly edging out Yurio, Georgi Popovich and the rest of Team Russia, he’d come to appreciate Minami’s presence. He had mellowed a bit. Just enough that Yuuri didn't feel like slipping out the nearest fire exit whenever the honey blond ball of energy was nearby. His enthusiasm was not as overbearing as it had been and instead was just the right amount of grounding during the competition.
The teenager in question dropped his duffel bag and raced over to where Yuuri was leaning against the boards and hopped up next to him.
“I heard you’re choreographing now!” He exclaimed, swinging his legs excitedly.
“‘Now’?” Yuuri questioned. “Wait. How did you know about that?” He asked instead. The skating website it came from was fairly marginal. Certainly it wasn’t part of mainstream sports news.
“Everyone knows about that,” Minami answered cryptically. “Your entire fan club knows and they want answers!”
Yuuri chose not to acknowledge the idea that such a ‘fan club’ even existed.
“It’s nothing I’ve decided on,” Yuuri answered honestly and then shrugged. “Even after I moved up to Seniors I always at least had help with my exhibitions. My former coach had fairly exclusive creative control over my other programs.”
“But it’s something you’re considering?” Minami asked, a twinkle in his eye. “Because that would be really cool! I bet a lot of people would love to have a program choreographed by the Katsuki Yuuri!” He said dreamily.
“I sincerely doubt that,” Yuuri said dubiously. “My resume on that front is nil, remember?”
“That’s even more reason for you to try it out for yourself, and then—” He went sparkly-eyed as he was hit with an epiphany. “Then next season you can choreograph my short program!”
“W-wait. What? How did you get on that? I haven’t even made a decision about my own programs yet!”
Minami wasn’t listening. He stared at him beseechingly and starry-eyed, his body vibrating so much in excitement he was shaking the boards Yuuri was leaned against.
Yuuri just sighed.
Choreographing was an entirely different scope. It needed a comprehensive understanding of scale and tempo, pacing and required elements. Performing it was one thing, but actually creating something on his own...
“Need I remind you that you picked the Woody costume and theme after you saw Toy Story the first time? You were 8,” Yuuko teased and then winked at him. “I think you’d be good at it. You are known for your musicality, Yuu-kun!”
Yuuri should’ve known confiding in his friends would only lead to more conflicting thoughts. He couldn’t believe he was actually considering this.
“You know the program requirements. Anything you don’t already know you can learn,” Minako insisted. “Everyone has to learn something at some point. No one is born with a built-in encyclopedia of the ISO judging system. Not even Victor Nikiforov quad flip’d out of the womb with a stack of already made choreographies, you know.”
“Minako-sensei...” Yuuri groaned.
One thing was clear, everyone wanted to see him suffer.
The more Yuuri thought about it the more he realized he already knew the answer. Only one thing still held him back from fully embracing the idea. To him, it wasn’t simply the idea of choreographing that filled him with trepidation, it was the same reason why Yuri On Ice meant so much to him.
The next time he went with Victor to practice, he was ready to share why.
“Do you really think I can do it?” Yuuri asked.
“Have I ever been dishonest with you? Of course I do,” Victor didn’t need clarification and replied without hesitation. He then stayed quiet, sensing Yuuri had more to say.
Yuuri worried his bottom lip, unsure how to word what he was feeling. He felt more relaxed as Victor started rubbing between his shoulder blades. He exhaled.
“The thing is, Victor,” Yuuri began. “It’s not that I think I can’t do it. What you and everyone else said, I know you’re right. But... what makes my routines so special is the fact that I get to make them with you. One of my favorite memories from last summer is the time we spent pouring over them together. I love your input and your creative flare. There’s no one better than you. I'm just worried that if I did it myself it wouldn’t mean as much to me...”
Victor hadn’t yet said anything and Yuuri tilted his head back to look at him. He startled at the tears building in his fiance’s eyes.
“W-Wait! Don’t cry! Oh my god, here—” 
“I’m not. I’m just...you say the most wonderful things when I’m not at all prepared,” Victor sighed, brushing off his concern. “Yuuri, this isn’t an all or nothing arrangement. We can trade off, or work together. So please don’t worry about that.”
Yuuri stopped fretting as sudden pressure wrapped around his back and pulled him forward.
“Yuuri,” Victor said fondly, propping his chin on Yuuri’s shoulder. “I know you can do it. And anything you’re unsure of I can help you with. No one wants you to do anything you’re uncomfortable with. If you try it and don’t like it that’s perfectly acceptable, okay?” Yuuri nodded hesitantly. “But if it’s because you think you can’t then I’ll have to disagree. I didn’t choreograph Yuri on Ice by myself. That was your story. It required your input. I only helped flesh it out.”
“There’s always more stories to tell, aren’t there?” Yuuri asked quietly. He still couldn’t believe he was considering this. What Victor said was true though. Choreography couldn’t exist without a story, the emotional element and personal touch were necessities. That’s what he’d been missing while he’d worked with Celestino.
Victor hummed in his ear and placed a kiss on his neck. “I want to hear them too. You’ve been quiet long enough, so how about this? After you warm up try coming up with some sequences on your own. I always worked on multiple routines at the same time, even if I never used them.”
Yuuri nodded again and pulled away. He slipped off his hard guards and stepped onto the ice as he mulled over Victor’s advice. He could always count on Victor to give him something to think about. This time he grabbed his MP3 player as accompaniment; something he typically did while burning off anxious energy at Minako’s studio. He flipped over to a playlist he had of potential music he was considering skating to and set it to shuffle to a random song.
The familiar scrape of steel against ice helped clear his head as he let his thoughts drift away along with the music playing in his ears. When he practiced ballet he rarely had a specific routine he danced to. Unless Minako was overseeing his training session he tended to just let his body do whatever felt right.
Usually he’d be envisioning various pivots, transitions, where to fit a grand jeté, whatever most fit the musical score and his interpretation. Applying it to the ice didn’t feel much different. He turned and shifted his weight to the outside edge, the steps always came easiest to him. As the tempo slowed he imagined what would be a good place to add a biellmann spiral. Perhaps a hydroblade. He’d always wanted to incorporate one of those. Then maybe a triple axel—no, a combination would simply fit better...
The sound of sprayed ice filled the air as he stopped short. He ran a palm down his face in dismay. Damn it...that actually wasn’t too bad.
Yuuri knew he’d reached at least a partial decision and from the knowing and proud look on Victor’s face, he did too.
“Don’t stop now, Yuuri,” Victor practically purred to him, eyes never leaving his form. “That was just starting to feel really good.”
Lord help me, Yuuri thought with a blush.
The next time he saw Minami he tentatively agreed to his request, but not until next season. Then had to plug his ears at the ensuing screech and whoop of joy. Yuuri flailed then froze in place as the teen also latched himself around his torso and arms in a bear hug. Some things never changed.
18 notes · View notes
ebenpink · 6 years
Photo
Tumblr media
Evidence-based coaching: Why some health and fitness pros are doing it all wrong. https://ift.tt/2NS8g3O
Ask any health and fitness professional if they’re “evidence based,” and chances are good you’ll get a resounding, “Yes!” Perhaps even an indignant one. After all, everyone uses evidence… of some sort. But if you think evidence-based practice is only about what “research says,” you’re doing it wrong. In this article, we’ll show you the right way to use evidence to inform and enhance your coaching—and drive better client results. 
++++
Here at Precision Nutrition, we love science.
In fact, no one loves science more than us!
But is it possible to rely too heavily on scientific literature? Can you actually science too much?
Maybe.
Ever see someone:
Dismiss a coach’s successful method solely because some element of it isn’t “research proven?”
Refuse to modify a nutrition plan—even though a client hates it—“because science?”
Call a respected health professional a “quack” because they cite years of clinical experience instead of a definitive clinical trial?
(If you haven’t, you probably don’t spend much time in Facebook comments.)
In each case, the person’s inflated reverence for research could be limiting their ability to learn, and evolve as a coach. They might also influence others to follow their narrow line of thinking, causing them to miss out, too. And this is often done in the name of “evidenced based practice.”
Now, evidence-based practice, or EBP, is all the rage in certain health and fitness circles, which is a great thing. We heart science, remember? Except there’s just one problem…
A lot of coaches, though well-meaning, are getting EBP wrong. Specifically, they’re over-emphasizing “what the research says” to the exclusion of other relevant information, like their professional experience and the personal preferences and values of the people they work with.
And that’s not good for clients, business, or the health and fitness industry.
To make sure you get EBP right, use this guide to understand what the method really is, why it matters, and how to implement it effectively in your own coaching practice.
Because when used correctly, EBP is a powerful tool that’ll make you a better coach—so you can help even more people achieve lasting change and deep health.
And that we love even more than science.
+++
What is “evidence”?
There’s “everyday life” evidence.
In our Precision Nutrition Coaching program and Certifications, we tell our clients and coaches to use outcome-based decision making (OBDM).
Very simply, that means you decide what to do next based on the data you got from what you just did.
Did your waist measurement go up after two weeks of vacation buffets? That’s data that says, “Welcome home, maybe dial it back a little.”
Did your blood pressure go down after four months of sticking to your exercise program? That’s data that says, “Keep up the good work!”
We tell our coaches and clients to use as many data points as they can, and look for progress everywhere, including:
body measurements
blood work and other medical tests
athletic performance, such as getting stronger or faster
photos
how clothes fit
recovery
sleep
mood and wellbeing
confidence
consistency
And so on. (Here are some more ideas.)
All of these data points, collectively, give us evidence that we can use to make informed choices.
Then there’s scientific evidence.
This includes clinical or case studies, experimental research, basic research (for instance, studying cells in culture), and more.
This evidence can vary widely in quality, who is studied, and how applicable the results are to you and your clients.
However, in general, scientific evidence is one of the best ways we have to know about the nature of reality.
And though it might be obvious, we’re compelled to say it anyway: You’re looking to glean these insights directly from reputable, peer-reviewed scientific papers—not random websites, articles in magazines, or pictures of sunsets with words on them.
Finally, there’s stuff you learn on the job.
We call this “expertise.” It’s the old coach’s intuition, the senior clinician’s knack for diagnosis, the way a master carpenter can tell you if something is a quarter inch off square just by looking.
After you’ve worked with over 100,000 clients, as we have, you start to build a database of collected wisdom. And often, there’s stuff that’s hard to explain or defend—you’ve just seen it enough times that you know it’s a thing.
When we bring together experience, research, and expertise, we have a pretty good set of working hypotheses about what is likely to be effective.
And that’s evidenced-based practice. So it’s not just about clinical research.
EBP is a systematic way of thinking and application that integrates scientific data with clinical experience and the individual needs and preferences of each client or patient.
Yes, that’s the official, eye-glazing definition, but you might find the Instagram-able version even more enlightening. (See the illustration below.)
All three parts are equally important.
That’s because:
1. You aren’t coaching research averages. You’re coaching people.
Most studies report the average results of an intervention. (This is especially true of their headlines.)
Yet, if we look at the actual data of most studies, we see that individual results tend to fall on a bell curve of some sort.
Take this example, noted by James Krieger and Bret Contreras.
A study on resistance training and muscle gain concluded the following:
“Previously untrained people who engaged in resistance training three times a week for 9 weeks increased their muscle mass by 6%.”
Based on that, you might expect a client to achieve similar results on your three-day-a-week program.
But if you look at the individual data within the study, muscle growth ranged from -2.5 to 20 percent. That’s right: minus 2.5 percent. As Krieger and Contreras point out, five of the 53 participants actually lost muscle!
That’s not to suggest the research results are misleading. In fact, most of the study participants experienced muscle mass gains between 5 and 10 percent, and some even more. However, it does show the overall findings may not to apply to every individual. So don’t expect them to.
Another example is broccoli. There’s a significant body of evidence supporting the health benefits of eating this nutrient-dense vegetable.
But if broccoli makes someone gaggy or gassy, it’s not the healthiest food for them, no matter what the research says about it lowering disease risk.
These kinds of patterns happen over and over: Some people get great results from applying the research, some get very little (or negative) results, and most get results somewhere in between.
This is reality.
Research can be incredibly useful for giving us a starting point for most people. But humans differ—often wildly—from one another.
They differ in terms of their habits, mindset, physiology, environment, and personal preferences. They also differ in their ability to follow a program in the first place. And even if they stick to a plan perfectly, they can differ in the results they get.
Coach for the unique human in front of you, not for an average.
Not only will this improve your client results (because you’ll be working with their particular, practical reality), it’ll also improve your client retention (because you’ll be actually listening to them and trying to understand them as individual people, not as data sets).
When a client is suffering, they probably don’t need you to search PubMed for more evidence.
They often need you to provide a solid, trusting coaching relationship and, of course, your coaching skills. This combination can help you ease client resistance, be creative and flexible when typical solutions don’t work, and be compassionate and supportive when a client struggles with dark stuff.
2. Your professional experience really matters.
If you’re a mindful, growth-oriented coach or practitioner, it’s impossible not to develop a certain degree of experience and expertise over time.
A lot of things go into your “expertise bucket”: courses and programs you’ve taken; books you’ve read; lectures you’ve attended; mentoring relationships you’ve had; and all the practical experience you’ve acquired from observing and coaching clients or patients.
The accumulation of knowledge and experience gives you a kind of “intuition” that can help you coach more effectively.
This “intuition” shows up when you see a client perform a wonky squat, quickly identify exactly what’s wrong, and make corrections to improve form.
It shows up when you perform a client intake, and based on their answers (Just had a baby! Prone to perfectionism!), you can anticipate what aspects of a program they might struggle with, and how you might help them.
Or it shows up when you do a postural assessment, and immediately know which exercises to avoid and which could be helpful.
Much of the time, this is knowledge you could have never learned simply from reading studies. It requires time working with people, and exposing yourself to new ideas and methods, including those that have yet to be studied.
But there’s a challenge here, too. The knowledge we gather from our experiences is very prone to human error: Our memories are unreliable, we see patterns that may not actually exist, and we discount information that doesn’t conform to what we already believe.
How can we reduce human error?
First, be aware that bias and error exist… yes, even for you.
Take notes during or after client sessions, and use a variety of validated measurement tools—such as weight, body measurements, pictures, mood scales, and sleep quality scales—to track the effectiveness of your advice.
Get mentorship and feedback on your practice. Coaches need coaches. Or, find a like-minded group of professionals with whom to collaborate. (That’s why we developed the Precision Nutrition Level 2 Certification.)
If you’re aware of the errors you’re likely to make, and take steps to moderate them, you might start to see some reliable, overarching patterns.
Like that very rigid meal plans don’t work for people in the long term. Or that people can only train so long and so hard before they burn out.
Or a thousand other possibilities experienced coaches notice, but perhaps haven’t been fully validated by published research.
If you’re just starting out and don’t have the experience gained from coaching many people over many years, you can “borrow” insight from mentors or other coaches with more reps under their belt.
Drawing on the wisdom of your (or a colleague’s) accumulated experience is an essential part of being a good practitioner.
3. Science will never have it all figured out.
The evidence is always evolving. Nutrition research in particular is a relatively new area, and there’s still a lot to be learned.
Plus, some things are really hard (or downright unethical) to test in a research setting, and so we may never have scientific evidence on it.
Even if it is possible to test, quality research takes a long time to gather. Usually, one study isn’t enough to “prove” something true or false. But waiting for multiple studies on a specific topic, or better yet, a meta-analyses (which is kind of like a poll of the research) may require a lot of patience. Maybe decades.
And yet, we still have to help our clients and patients make informed decisions. Like, now.
That’s where evidence-based practice comes in.
The RIGHT way to use EBP.
You can formally apply the EBP process to coaching decisions that feel especially important or uncertain.
EBP offers one of the best tools to help you reach a decision that’s most likely to be safe and effective, and that’ll also make sense in the context of your client’s life.
Follow these 6 steps to see EBP in action.
1. Assess the client.
Identify their unique abilities and needs.
What are their strengths?
Where might they need help from you?
What are their precise goals?
What are their identities, values, and beliefs?
Gather this information by asking questions, using intake forms, and taking measurements. This’ll help you create an initial plan of action and also provide a baseline against which to gauge progress.
Plus, as you collect data on many clients, you’ll be accruing practical evidence that can aid with decision making in the future.
Let’s use a hypothetical client to apply these steps.
Her name is Nora. Her goal is to lose fat, and she’s also interested in intermittent fasting. Through your initial assessment you learn that she’s begun to show signs of perimenopause, and her sleep isn’t great these days.
2. Find your research question.
Before you jump to a solution, get clear on the problem you’re trying to help your client with. 
Then, turn the problem into a question that’ll help you isolate the evidence you need for your recommendations. This question should incorporate the problem, as well as relevant factors about your client or patient.
Nora’s main goal is to lose fat, and she’s curious about intermittent fasting. Important factors to consider: Nora is a woman and she’s perimenopausal.
But you’re not sure if intermittent fasting is safe (or effective) for losing fat. And you’re definitely not sure if it’s safe (or effective) for a perimenopausal woman.
So your research question might be: “Is intermittent fasting safe and effective for fat loss in perimenopausal women?”
3. Gather the evidence.
Search for info using an online database like PubMed or Google Scholar. (If you don’t know how to use online research databases, here’s a PubMed tutorial.)
Using a research database will curate your hits so you’re only getting original, peer-reviewed research, rather than someone else’s (potentially biased) interpretation of it.
To find relevant research for Nora, a good keyword combination to type in a search box could be “intermittent fasting + fat loss + menopause”. These keywords contain the intervention you’re interested in learning more about, plus information about Nora’s unique goals and life stage.
To identify the best available scientific evidence on the research subject, use the “Hierarchy of Evidence” pyramid below. The higher up on the pyramid, the more trustworthy the information. So start your search from the top down.
In the case of Nora, prioritize finding a position stand, a meta-analysis, or a systematic review on using intermittent fasting for fat loss in menopausal women. This will give you a comprehensive overview of the current evidence. Basically, scientists and/or academics have already done the hard work—of reviewing, comparing, and analyzing the available scientific evidence—for you.
If that doesn’t exist, look for randomized control trials that compare appropriately chosen groups of people with a control group (such as a group that received no intervention, or a different intervention).
No luck there? You can expand your search to just “women” rather than “menopausal women.” Depending on what’s available, you may have to continue broadening your search and moving down the hierarchy of evidence.
Now, if you’re not well-versed in reading studies or interpreting research, that’s okay. Chances are, if you don’t find a meta-analysis or review, or—best of all—a position stand, the research further down the pyramid will be of limited use to you anyway.
If that’s the case—or you can’t find any scientific research on the topic—you might have to use opinions from other trusted experts, or develop an educated hypothesis based on your own knowledge of how physiology and nutrition work. This still counts as evidence, it’s just not as reliable, so temper your confidence in it accordingly.
All hail the position stand.
If you don’t feel equipped to navigate and interpret scientific literature, consider looking for best practice guidelines or position stands written by an authority in your field.
Position stands are official statements made by a governing body on topics related to a particular field, like nutrition, exercise physiology, dietetics, or medicine.
Here’s an example: The 2017 International Society of Sports Nutrition Position Stand on protein and exercise.
If you have a client who’s older and you’re wondering how to safely increase their training capacity (but don’t want to immerse yourself in a dark hole of research), simply look for the position stand on exercise and older adults.
To find the position stands in your field, consult the website of whatever governing body you belong to.
For example, if you’re a personal trainer certified through ACSM, NASM, ACE, or NSCA, consult the respective website for each organization. They should feature position stands on a variety of topics.
4. Appraise the evidence.
Through your search, you’ll probably find at least some evidence. This might be just a few small studies or some articles from trusted experts in the field.
Now, using the hierarchy of evidence, determine how valid and reliable those pieces of evidence are.
The more you have to broaden your question or move down the quality hierarchy, the less confident you might be about your recommendations.
With Nora, if all you find are some articles by an internet guru who’s never actually seen any real clients, you may want to present your findings as a mere idea, rather than as reliable advice.
On the other hand, if you find a handful of systematic reviews about intermittent fasting in menopausal women, you can go to Nora with more confidence about your recommendations. (Quick fact check, FYI: We couldn’t find any reputable systematic reviews on intermittent fasting in menopausal women.)
5. Create your recommendation.
Unless they ask for it, most clients don’t want to know all the complicated science stuff; they just want to know what to do.
This is where the science of coaching morphs into the art of coaching.
It’s time to see if you can actually apply the evidence you’ve found—along with your own professional experience—to the complex, real, live human standing in front of you.
Notice that the evidence by itself doesn’t make the decision. Nor does your experience, nor do the client’s preferences.
The three simply offer a more holistic perspective on a problem, to ensure you find the best possible solution for your client.
Rather than plunking down a stack of research in front of your client, combine the research with your expertise and your client’s unique circumstances to translate it into practical advice.
It could work like this: Through your research, you find that intermittent fasting is effective for fat loss. However, through your own professional experience, you’ve also noticed that most clients struggle to stick with intermittent fasting long-term. (Aligning nicely with your coaching experience, the research also shows a relatively high drop-out rate with intermittent fasting.)
You’ve also noticed that in some of your female clients, intermittent fasting seems to deregulate menstrual cycles and exacerbate menopausal symptoms.
Thinking about Nora’s unique values and preferences, you know that she wants to lose weight, but you also know that she’s had some trouble sleeping lately. In your experience with other clients, people who are sleep-deprived have an extra-hard time regulating appetite and losing weight.
So… intermittent fasting seems to be effective, but combined with your concerns about Nora’s hormonal health and sleep quality, plus the fact that intermittent fasting can be hard to maintain, you may decide not to recommend it to Nora.
After explaining to her your reasoning, explore with her what she’s comfortable trying. In the end, you may suggest some simple nutrition habits along with some short fasting experiments, plus some sleep tips.
These recommendations include what you’ve found from the best available research, your own coaching experience, and Nora’s unique preferences, goals, and challenges.
Nora’s just gotten some pretty wise, tailored-to-her advice, where you worked as collaborators to come up with her action plan.
That’s the art and science of coaching.
6. Monitor the results.
Once you’ve given your client a little time to practice what you came up with together, you can assess if those actions are working.
Consult those measurements you took in your initial assessments. Compare them to current measurements.
Are things moving in the right direction?
And talk to your client about how the plan is working.
Nora tells you although she’s applying and benefitting from the sleep tips, she’s struggling with fasting, even the shorter experiments. Turns out, it’s hard to fast when you’re having trouble falling asleep because of a grumbling tummy.
As you monitor progress, use what you find to re-evaluate goals and pinpoint where your client or patient needs more support.
Now Nora’s asking you about trying the Paleo diet instead. Looks like you have more research to do.
But keep in mind, over time, you’ll develop a solid grasp of the body of evidence on a number of topics. That’s the good part about science moving slowly: It’s not that hard to keep up.
What to do next.
Be empathetic, supportive, and flexible.
No matter what you believe is “right” or “true,” your first job is to work with your client, wherever they’re at.
Many practitioners intuitively know this, but the bond between coach and client (or patient) is extremely important and influential.
This bond is called the “therapeutic alliance,” and it refers to the level of trust and rapport between a practitioner and the person they’re helping.
Change is hard, and often scary. A strong therapeutic alliance can help a person feel supported and understood while surfing the tides of change.
In fact, some studies show the results a client or patient achieves in your care are up to 85 percent dependent on the therapeutic alliance. So, the stronger that relationship, the better the results.
If you’re constantly butting heads with your client, telling them, “But the research says!” or, “I know best!”, you can wave goodbye to a strong therapeutic alliance.
Many of the obstacles your clients will face are behavioral and emotional, rather than rational and theory-based. So more than facts, your clients often need compassion, support, and creativity to get them through the tough stuff.
Focus on the big rocks.
Given how complicated bodies and behavioral change are, it’s not surprising that science is still “trying to figure things out.”
Rather than using “cutting-edge” protocols like intermittent fasting or precise macronutrient ratios (which should really only be for more advanced clients anyway), focus on “big rocks” that offer the most bang for buck, like:
eating enough protein and vegetables
moving regularly
getting adequate sleep
managing stress
reducing smoking and/or excessive alcohol consumption
If that sounds boring or too obvious, we ask you this: How many people do you know who are consistently doing all five well? (In case you’re curious, it’s only about three to five percent of the population.)
Just managing those five things will keep most people plenty busy.
Be humble, throw out the rules, and keep learning.
The smartest people are often the ones who are most comfortable asking questions, saying “I don’t know,” and resting in uncertainty.
It’s a cliche but true: The more you know about something, the more you realize what you don’t know.
Be wary when others claim absolute certainty. It may be they don’t fully understand the complexity of the matter.
True expertise is about being comfortable with limited knowledge—while continuing to seek more and better information—and also accepting we may never have complete certainty.
Experiment wisely, and learn from both successes and failures.
Want to see how a theory works in practice? Test it out on yourself, and measure your experience as objectively as possible.
With clients, so long as there is no risk of harm, try out well-informed experiments (with their permission) that are either based on research or expert theory. Then, as always, track and measure their experiences and results to inform your next steps.
Know what you don’t know and work with other experts as needed.
Especially if you’re a beginner in your practice, it’s okay not to know stuff.
Focus on what you know best, whether that’s good lifting form, coming up with healthy meal ideas, or giving support during sticky coaching situations. But also know that some things will be out of your scope of practice.
So build a strong professional network—which could include family doctors, dietitians, massage therapists, naturopaths, chiropractors, and psychotherapists—and refer out whenever you encounter something you feel uncomfortable or especially inexperienced with.
Establishing a deep roster of experts will help clients get the support they need. And we’re pretty sure the evidence will show that’s good for everyone.
If you’re a coach, or you want to be…
Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes—in way that’s evidenced based and personalized for each individual’s lifestyle and preferences—is both an art and a science.
If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certification. The next group kicks off shortly.
What’s it all about?
The Precision Nutrition Level 1 Certification is the world’s most respected nutrition education program. It gives you the knowledge, systems, and tools you need to really understand how food influences a person’s health and fitness. Plus the ability to turn that knowledge into a thriving coaching practice.
Developed over 15 years, and proven with over 100,000 clients and patients, the Level 1 curriculum stands alone as the authority on the science of nutrition and the art of coaching.
Whether you’re already mid-career, or just starting out, the Level 1 Certification is your springboard to a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results.
[Of course, if you’re already a student or graduate of the Level 1 Certification, check out our Level 2 Certification Master Class. It’s an exclusive, year-long mentorship designed for elite professionals looking to master the art of coaching and be part of the top 1% of health and fitness coaches in the world.]
Interested? Add your name to the presale list. You’ll save up to 33% and secure your spot 24 hours before everyone else.
We’ll be opening up spots in our next Precision Nutrition Level 1 Certification on Wednesday, April 3rd, 2019.
If you want to find out more, we’ve set up the following presale list, which gives you two advantages.
Pay less than everyone else. We like to reward people who are eager to boost their credentials and are ready to commit to getting the education they need. So we’re offering a discount of up to 33% off the general price when you sign up for the presale list.
Sign up 24 hours before the general public and increase your chances of getting a spot. We only open the certification program twice per year. Due to high demand, spots in the program are limited and have historically sold out in a matter of hours. But when you sign up for the presale list, we’ll give you the opportunity to register a full 24 hours before anyone else.
If you’re ready for a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results… this is your chance to see what the world’s top professional nutrition coaching system can do for you.
//
References
Click here to view the information sources referenced in this article.
Balachandran, A. & Schoenfeld, B. (2017, March 2) Evidence-based practice in Exercise and Nutrition: Common Misconceptions and Criticisms. Retrieved from https://www.lookgreatnaked.com/blog/evidence-based-practice-in-exercise-and-nutrition-common-misconceptions-and-criticisms/
Baldwin, S.A., Wampold, B.E., & Imel, Z E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842–852.
Cabaniss, D. L. (2012, May 31) The Therapeutic Alliance: The Essential Ingredient for Psychotherapy. Retrieved from https://www.huffpost.com/entry/therapeutic-alliance_b_1554007?fbclid=IwAR1NDl7sNR60OSvNFWmpTUA-GqAV65fMtxsOrOFAQ9fLM5Z5eQlcRR4APbU
Duke University. (2018). Introduction to Evidence-Based Practice. Retrieved from https://guides.mclibrary.duke.edu/ebmtutorial/home
Erskine, R.M., Jones, D.A., Williams, A.G., Stewart, C.E. & Degens, H. (2010) Inter-individual variability in the adaptation of human muscle specific tension to progressive resistance training. European Journal of Applied Physiology, 110(6), 1117-25.
Evidence-Based Medicine Working Group. (1992) Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. Journal of the American Medical Association, 268(17), 2420-5.
Frances, A.J. (2013, June 24) What Should Doctors Do When They Don’t Know What to Do? Retrieved from https://www.psychologytoday.com/us/blog/saving-normal/201306/what-should-doctors-do-when-they-dont-know-what-do?fbclid=IwAR3ce99uT-RDXcp_yvnJ0r2aTfBPWPpngqNUvkIc5a6PBZkyr5d-Z8sgy2Y
Joyce, A.S. & Piper, W.E. (1998) Expectancy, the Therapeutic Alliance, and Treatment Outcome in Short-Term Individual Psychotherapy. The Journal of Psychotherapy Practice and Research, 7(3), 236–248.
Löfgren, K. [Kent Löfgren]. (2013, February 25). What is epistemology? Introduction to the word and the concept [Video File]. Retrieved from https://www.youtube.com/watch?v=lI9-YgSzsEQ
Ludwig, J. (2018, April 16) Here’s what is going wrong with ‘evidence-based’ policies and practices in schools in Australia. Retrieved from https://www.aare.edu.au/blog/?p=2822
Schoenfeld, B.J., Contreras, B, Krieger, J., Grgic, J., Delcastillo, K., Belliard, R. & Alto, A. (2019) Resistance Training Volume Enhances Muscle Hypertrophy but Not Strength in Trained Men. Medicine & Science in Sports & Exercise, 51(1), 94-103.
Wampold, B. E. (2001). The great psychotherapy debate:Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum. NJ: Lawrence Erlbaum.
Evidence-Based Medicine Toolbox. (2017) Retrieved from https://ebm-tools.knowledgetranslation.net/
Evidence-based practice. (2018, November 19) Retrieved from https://en.wikipedia.org/wiki/Evidence-based_practice?fbclid=IwAR3ARk06zmx_lJYPIrTGA_chfBa9v_-NsW7HQbC7-rTHaq-Y7AYcSdLAk80
The well-built clinical question: a key to evidence-based decisions. (1995). Retrieved from https://mclibrary.duke.edu/sites/mclibrary.duke.edu/files/public/guides/richardson.pdf
The post Evidence-based coaching: Why some health and fitness pros are doing it all wrong. appeared first on Precision Nutrition.
from Blog – Precision Nutrition https://ift.tt/2IUp3nQ via IFTTT https://ift.tt/2Cbz4Hx
0 notes
oovitus · 6 years
Text
Evidence-based coaching: Why some health and fitness pros are doing it all wrong.
Ask any health and fitness professional if they’re “evidence based,” and chances are good you’ll get a resounding, “Yes!” Perhaps even an indignant one. After all, everyone uses evidence… of some sort. But if you think evidence-based practice is only what “research says,” you’re doing it wrong. In this article, we’ll show you the right way to use evidence to inform and enhance your coaching—for more effective advice and better client results. 
++++
Here at Precision Nutrition, we love science.
In fact, no one loves science more than us!
But is it possible to rely too heavily on scientific literature? Can you actually science too much?
Maybe.
Ever see someone:
Dismiss a coach’s successful method solely because some element of it isn’t “research proven?”
Refuse to modify a nutrition plan—even though a client hates it—“because science?”
Call a respected health professional a “quack” because they cite years of clinical experience instead of a definitive clinical trial?
(If you haven’t, you probably don’t spend much time in Facebook comments.)
In each case, the person’s inflated reverence for research could be limiting their ability to learn, and evolve as a coach. They might also influence others to follow their narrow line of thinking, causing them to miss out, too. And this is often done in the name of “evidenced based practice.”
Now, evidence-based practice, or EBP, is all the rage in certain health and fitness circles, which is a great thing. We heart science, remember? Except there’s just one problem…
A lot of coaches, though well-meaning, are getting EBP wrong. Specifically, they’re over-emphasizing “what the research says” to the exclusion of other relevant information, like their professional experience and the personal preferences and values of the people they work with.
And that’s not good for clients, business, or the health and fitness industry.
To make sure you get EBP right, use this guide to understand what the method really is, why it matters, and how to implement it effectively in your own coaching practice.
Because when used correctly, EBP is a powerful tool that’ll make you a better coach—so you can help even more people achieve lasting change and deep health.
And that we love even more than science.
+++
What is “evidence”?
There’s “everyday life” evidence.
In our Precision Nutrition Coaching program and Certifications, we tell our clients and coaches to use outcome-based decision making (OBDM).
Very simply, that means you decide what to do next based on the data you got from what you just did.
Did your waist measurement go up after two weeks of vacation buffets? That’s data that says, “Welcome home, maybe dial it back a little.”
Did your blood pressure go down after four months of sticking to your exercise program? That’s data that says, “Keep up the good work!”
We tell our coaches and clients to use as many data points as they can, and look for progress everywhere, including:
body measurements
blood work and other medical tests
athletic performance, such as getting stronger or faster
photos
how clothes fit
recovery
sleep
mood and wellbeing
confidence
consistency
And so on. (Here are some more ideas.)
All of these data points, collectively, give us evidence that we can use to make informed choices.
Then there’s scientific evidence.
This includes clinical or case studies, experimental research, basic research (for instance, studying cells in culture), and more.
This evidence can vary widely in quality, who is studied, and how applicable the results are to you and your clients.
However, in general, scientific evidence is one of the best ways we have to know about the nature of reality.
And though it might be obvious, we’re compelled to say it anyway: You’re looking to glean these insights directly from reputable, peer-reviewed scientific papers—not random websites, articles in magazines, or pictures of sunsets with words on them.
Finally, there’s stuff you learn on the job.
We call this “expertise.” It’s the old coach’s intuition, the senior clinician’s knack for diagnosis, the way a master carpenter can tell you if something is a quarter inch off square just by looking.
After you’ve worked with over 100,000 clients, as we have, you start to build a database of collected wisdom. And often, there’s stuff that’s hard to explain or defend—you’ve just seen it enough times that you know it’s a thing.
When we bring together experience, research, and expertise, we have a pretty good set of working hypotheses about what is likely to be effective.
And that’s evidenced-based practice. So it’s not just about clinical research.
EBP is a systematic way of thinking and application that integrates scientific data with clinical experience and the individual needs and preferences of each client or patient.
Yes, that’s the official, eye-glazing definition, but you might find the Instagram-able version even more enlightening. (See the illustration below.)
All three parts are equally important.
That’s because:
1. You aren’t coaching research averages. You’re coaching people.
Most studies report the average results of an intervention. (This is especially true of their headlines.)
Yet, if we look at the actual data of most studies, we see that individual results tend to fall on a bell curve of some sort.
Take this example, noted by James Krieger and Bret Contreras.
A study on resistance training and muscle gain concluded the following:
“Previously untrained people who engaged in resistance training three times a week for 9 weeks increased their muscle mass by 6%.”
Based on that, you might expect a client to achieve similar results on your three-day-a-week program.
But if you look at the individual data within the study, muscle growth ranged from -2.5 to 20 percent. That’s right: minus 2.5 percent. As Krieger and Contreras point out, five of the 53 participants actually lost muscle!
That’s not to suggest the research results are misleading. In fact, most of the study participants experienced muscle mass gains between 5 and 10 percent, and some even more. However, it does show the overall findings may not to apply to every individual. So don’t expect them to.
Another example is broccoli. There’s a significant body of evidence supporting the health benefits of eating this nutrient-dense vegetable.
But if broccoli makes someone gaggy or gassy, it’s not the healthiest food for them, no matter what the research says about it lowering disease risk.
These kinds of patterns happen over and over: Some people get great results from applying the research, some get very little (or negative) results, and most get results somewhere in between.
This is reality.
Research can be incredibly useful for giving us a starting point for most people. But humans differ—often wildly—from one another.
They differ in terms of their habits, mindset, physiology, environment, and personal preferences. They also differ in their ability to follow a program in the first place. And even if they stick to a plan perfectly, they can differ in the results they get.
Coach for the unique human in front of you, not for an average.
Not only will this improve your client results (because you’ll be working with their particular, practical reality), it’ll also improve your client retention (because you’ll be actually listening to them and trying to understand them as individual people, not as data sets).
When a client is suffering, they probably don’t need you to search PubMed for more evidence.
They often need you to provide a solid, trusting coaching relationship and, of course, your coaching skills. This combination can help you ease client resistance, be creative and flexible when typical solutions don’t work, and be compassionate and supportive when a client struggles with dark stuff.
2. Your professional experience really matters.
If you’re a mindful, growth-oriented coach or practitioner, it’s impossible not to develop a certain degree of experience and expertise over time.
A lot of things go into your “expertise bucket”: courses and programs you’ve taken; books you’ve read; lectures you’ve attended; mentoring relationships you’ve had; and all the practical experience you’ve acquired from observing and coaching clients or patients.
The accumulation of knowledge and experience gives you a kind of “intuition” that can help you coach more effectively.
This “intuition” shows up when you see a client perform a wonky squat, quickly identify exactly what’s wrong, and make corrections to improve form.
It shows up when you perform a client intake, and based on their answers (Just had a baby! Prone to perfectionism!), you can anticipate what aspects of a program they might struggle with, and how you might help them.
Or it shows up when you do a postural assessment, and immediately know which exercises to avoid and which could be helpful.
Much of the time, this is knowledge you could have never learned simply from reading studies. It requires time working with people, and exposing yourself to new ideas and methods, including those that have yet to be studied.
But there’s a challenge here, too. The knowledge we gather from our experiences is very prone to human error: Our memories are unreliable, we see patterns that may not actually exist, and we discount information that doesn’t conform to what we already believe.
How can we reduce human error?
First, be aware that bias and error exist… yes, even for you.
Take notes during or after client sessions, and use a variety of validated measurement tools—such as weight, body measurements, pictures, mood scales, and sleep quality scales—to track the effectiveness of your advice.
Get mentorship and feedback on your practice. Coaches need coaches. Or, find a like-minded group of professionals with whom to collaborate. (That’s why we developed the Precision Nutrition Level 2 Certification.)
If you’re aware of the errors you’re likely to make, and take steps to moderate them, you might start to see some reliable, overarching patterns.
Like that very rigid meal plans don’t work for people in the long term. Or that people can only train so long and so hard before they burn out.
Or a thousand other possibilities experienced coaches notice, but perhaps haven’t been fully validated by published research.
If you’re just starting out and don’t have the experience gained from coaching many people over many years, you can “borrow” insight from mentors or other coaches with more reps under their belt.
Drawing on the wisdom of your (or a colleague’s) accumulated experience is an essential part of being a good practitioner.
3. Science will never have it all figured out.
The evidence is always evolving. Nutrition research in particular is a relatively new area, and there’s still a lot to be learned.
Plus, some things are really hard (or downright unethical) to test in a research setting, and so we may never have scientific evidence on it.
Even if it is possible to test, quality research takes a long time to gather. Usually, one study isn’t enough to “prove” something true or false. But waiting for multiple studies on a specific topic, or better yet, a meta-analyses (which is kind of like a poll of the research) may require a lot of patience. Maybe decades.
And yet, we still have to help our clients and patients make informed decisions. Like, now.
That’s where evidence-based practice comes in.
The RIGHT way to use EBP.
You can formally apply the EBP process to coaching decisions that feel especially important or uncertain.
EBP offers one of the best tools to help you reach a decision that’s most likely to be safe and effective, and that’ll also make sense in the context of your client’s life.
Follow these 6 steps to see EBP in action.
1. Assess the client.
Identify their unique abilities and needs.
What are their strengths?
Where might they need help from you?
What are their precise goals?
What are their identities, values, and beliefs?
Gather this information by asking questions, using intake forms, and taking measurements. This’ll help you create an initial plan of action and also provide a baseline against which to gauge progress.
Plus, as you collect data on many clients, you’ll be accruing practical evidence that can aid with decision making in the future.
Let’s use a hypothetical client to apply these steps.
Her name is Nora. Her goal is to lose fat, and she’s also interested in intermittent fasting. Through your initial assessment you learn that she’s begun to show signs of perimenopause, and her sleep isn’t great these days.
2. Find your research question.
Before you jump to a solution, get clear on the problem you’re trying to help your client with. 
Then, turn the problem into a question that’ll help you isolate the evidence you need for your recommendations. This question should incorporate the problem, as well as relevant factors about your client or patient.
Nora’s main goal is to lose fat, and she’s curious about intermittent fasting. Important factors to consider: Nora is a woman and she’s perimenopausal.
But you’re not sure if intermittent fasting is safe (or effective) for losing fat. And you’re definitely not sure if it’s safe (or effective) for a perimenopausal woman.
So your research question might be: “Is intermittent fasting safe and effective for fat loss in perimenopausal women?”
3. Gather the evidence.
Search for info using an online database like PubMed or Google Scholar. (If you don’t know how to use online research databases, here’s a PubMed tutorial.)
Using a research database will curate your hits so you’re only getting original, peer-reviewed research, rather than someone else’s (potentially biased) interpretation of it.
To find relevant research for Nora, a good keyword combination to type in a search box could be “intermittent fasting + fat loss + menopause”. These keywords contain the intervention you’re interested in learning more about, plus information about Nora’s unique goals and life stage.
To identify the best available scientific evidence on the research subject, use the “Hierarchy of Evidence” pyramid below. The higher up on the pyramid, the more trustworthy the information. So start your search from the top down.
In the case of Nora, prioritize finding a position stand, a meta-analysis, or a systematic review on using intermittent fasting for fat loss in menopausal women. This will give you a comprehensive overview of the current evidence. Basically, scientists and/or academics have already done the hard work—of reviewing, comparing, and analyzing the available scientific evidence—for you.
If that doesn’t exist, look for randomized control trials that compare appropriately chosen groups of people with a control group (such as a group that received no intervention, or a different intervention).
No luck there? You can expand your search to just “women” rather than “menopausal women.” Depending on what’s available, you may have to continue broadening your search and moving down the hierarchy of evidence.
Now, if you’re not well-versed in reading studies or interpreting research, that’s okay. Chances are, if you don’t find a meta-analysis or review, or—best of all—a position stand, the research further down the pyramid will be of limited use to you anyway.
If that’s the case—or you can’t find any scientific research on the topic—you might have to use opinions from other trusted experts, or develop an educated hypothesis based on your own knowledge of how physiology and nutrition work. This still counts as evidence, it’s just not as reliable, so temper your confidence in it accordingly.
All hail the position stand.
If you don’t feel equipped to navigate and interpret scientific literature, consider looking for best practice guidelines or position stands written by an authority in your field.
Position stands are official statements made by a governing body on topics related to a particular field, like nutrition, exercise physiology, dietetics, or medicine.
Here’s an example: The 2017 International Society of Sports Nutrition Position Stand on protein and exercise.
If you have a client who’s older and you’re wondering how to safely increase their training capacity (but don’t want to immerse yourself in a dark hole of research), simply look for the position stand on exercise and older adults.
To find the position stands in your field, consult the website of whatever governing body you belong to.
For example, if you’re a personal trainer certified through ACSM, NASM, ACE, or NSCA, consult the respective website for each organization. They should feature position stands on a variety of topics.
4. Appraise the evidence.
Through your search, you’ll probably find at least some evidence. This might be just a few small studies or some articles from trusted experts in the field.
Now, using the hierarchy of evidence, determine how valid and reliable those pieces of evidence are.
The more you have to broaden your question or move down the quality hierarchy, the less confident you might be about your recommendations.
With Nora, if all you find are some articles by an internet guru who’s never actually seen any real clients, you may want to present your findings as a mere idea, rather than as reliable advice.
On the other hand, if you find a handful of systematic reviews about intermittent fasting in menopausal women, you can go to Nora with more confidence about your recommendations. (Quick fact check, FYI: We couldn’t find any reputable systematic reviews on intermittent fasting in menopausal women.)
5. Create your recommendation.
Unless they ask for it, most clients don’t want to know all the complicated science stuff; they just want to know what to do.
This is where the science of coaching morphs into the art of coaching.
It’s time to see if you can actually apply the evidence you’ve found—along with your own professional experience—to the complex, real, live human standing in front of you.
Notice that the evidence by itself doesn’t make the decision. Nor does your experience, nor do the client’s preferences.
The three simply offer a more holistic perspective on a problem, to ensure you find the best possible solution for your client.
Rather than plunking down a stack of research in front of your client, combine the research with your expertise and your client’s unique circumstances to translate it into practical advice.
It could work like this: Through your research, you find that intermittent fasting is effective for fat loss. However, through your own professional experience, you’ve also noticed that most clients struggle to stick with intermittent fasting long-term. (Aligning nicely with your coaching experience, the research also shows a relatively high drop-out rate with intermittent fasting.)
You’ve also noticed that in some of your female clients, intermittent fasting seems to deregulate menstrual cycles and exacerbate menopausal symptoms.
Thinking about Nora’s unique values and preferences, you know that she wants to lose weight, but you also know that she’s had some trouble sleeping lately. In your experience with other clients, people who are sleep-deprived have an extra-hard time regulating appetite and losing weight.
So… intermittent fasting seems to be effective, but combined with your concerns about Nora’s hormonal health and sleep quality, plus the fact that intermittent fasting can be hard to maintain, you may decide not to recommend it to Nora.
After explaining to her your reasoning, explore with her what she’s comfortable trying. In the end, you may suggest some simple nutrition habits along with some short fasting experiments, plus some sleep tips.
These recommendations include what you’ve found from the best available research, your own coaching experience, and Nora’s unique preferences, goals, and challenges.
Nora’s just gotten some pretty wise, tailored-to-her advice, where you worked as collaborators to come up with her action plan.
That’s the art and science of coaching.
6. Monitor the results.
Once you’ve given your client a little time to practice what you came up with together, you can assess if those actions are working.
Consult those measurements you took in your initial assessments. Compare them to current measurements.
Are things moving in the right direction?
And talk to your client about how the plan is working.
Nora tells you although she’s applying and benefitting from the sleep tips, she’s struggling with fasting, even the shorter experiments. Turns out, it’s hard to fast when you’re having trouble falling asleep because of a grumbling tummy.
As you monitor progress, use what you find to re-evaluate goals and pinpoint where your client or patient needs more support.
Now Nora’s asking you about trying the Paleo diet instead. Looks like you have more research to do.
But keep in mind, over time, you’ll develop a solid grasp of the body of evidence on a number of topics. That’s the good part about science moving slowly: It’s not that hard to keep up.
What to do next.
Be empathetic, supportive, and flexible.
No matter what you believe is “right” or “true,” your first job is to work with your client, wherever they’re at.
Many practitioners intuitively know this, but the bond between coach and client (or patient) is extremely important and influential.
This bond is called the “therapeutic alliance,” and it refers to the level of trust and rapport between a practitioner and the person they’re helping.
Change is hard, and often scary. A strong therapeutic alliance can help a person feel supported and understood while surfing the tides of change.
In fact, some studies show the results a client or patient achieves in your care are up to 85 percent dependent on the therapeutic alliance. So, the stronger that relationship, the better the results.
If you’re constantly butting heads with your client, telling them, “But the research says!” or, “I know best!”, you can wave goodbye to a strong therapeutic alliance.
Many of the obstacles your clients will face are behavioral and emotional, rather than rational and theory-based. So more than facts, your clients often need compassion, support, and creativity to get them through the tough stuff.
Focus on the big rocks.
Given how complicated bodies and behavioral change are, it’s not surprising that science is still “trying to figure things out.”
Rather than using “cutting-edge” protocols like intermittent fasting or precise macronutrient ratios (which should really only be for more advanced clients anyway), focus on “big rocks” that offer the most bang for buck, like:
eating enough protein and vegetables
moving regularly
getting adequate sleep
managing stress
reducing smoking and/or excessive alcohol consumption
If that sounds boring or too obvious, we ask you this: How many people do you know who are consistently doing all five well? (In case you’re curious, it’s only about three to five percent of the population.)
Just managing those five things will keep most people plenty busy.
Be humble, throw out the rules, and keep learning.
The smartest people are often the ones who are most comfortable asking questions, saying “I don’t know,” and resting in uncertainty.
It’s a cliche but true: The more you know about something, the more you realize what you don’t know.
Be wary when others claim absolute certainty. It may be they don’t fully understand the complexity of the matter.
True expertise is about being comfortable with limited knowledge—while continuing to seek more and better information—and also accepting we may never have complete certainty.
Experiment wisely, and learn from both successes and failures.
Want to see how a theory works in practice? Test it out on yourself, and measure your experience as objectively as possible.
With clients, so long as there is no risk of harm, try out well-informed experiments (with their permission) that are either based on research or expert theory. Then, as always, track and measure their experiences and results to inform your next steps.
Know what you don’t know and work with other experts as needed.
Especially if you’re a beginner in your practice, it’s okay not to know stuff.
Focus on what you know best, whether that’s good lifting form, coming up with healthy meal ideas, or giving support during sticky coaching situations. But also know that some things will be out of your scope of practice.
So build a strong professional network—which could include family doctors, dietitians, massage therapists, naturopaths, chiropractors, and psychotherapists—and refer out whenever you encounter something you feel uncomfortable or especially inexperienced with.
Establishing a deep roster of experts will help clients get the support they need. And we’re pretty sure the evidence will show that’s good for everyone.
If you’re a coach, or you want to be…
Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes—in way that’s evidenced based and personalized for each individual’s lifestyle and preferences—is both an art and a science.
If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certification. The next group kicks off shortly.
What’s it all about?
The Precision Nutrition Level 1 Certification is the world’s most respected nutrition education program. It gives you the knowledge, systems, and tools you need to really understand how food influences a person’s health and fitness. Plus the ability to turn that knowledge into a thriving coaching practice.
Developed over 15 years, and proven with over 100,000 clients and patients, the Level 1 curriculum stands alone as the authority on the science of nutrition and the art of coaching.
Whether you’re already mid-career, or just starting out, the Level 1 Certification is your springboard to a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results.
[Of course, if you’re already a student or graduate of the Level 1 Certification, check out our Level 2 Certification Master Class. It’s an exclusive, year-long mentorship designed for elite professionals looking to master the art of coaching and be part of the top 1% of health and fitness coaches in the world.]
Interested? Add your name to the presale list. You’ll save up to 33% and secure your spot 24 hours before everyone else.
We’ll be opening up spots in our next Precision Nutrition Level 1 Certification on Wednesday, April 3rd, 2019.
If you want to find out more, we’ve set up the following presale list, which gives you two advantages.
Pay less than everyone else. We like to reward people who are eager to boost their credentials and are ready to commit to getting the education they need. So we’re offering a discount of up to 33% off the general price when you sign up for the presale list.
Sign up 24 hours before the general public and increase your chances of getting a spot. We only open the certification program twice per year. Due to high demand, spots in the program are limited and have historically sold out in a matter of hours. But when you sign up for the presale list, we’ll give you the opportunity to register a full 24 hours before anyone else.
If you’re ready for a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results… this is your chance to see what the world’s top professional nutrition coaching system can do for you.
jQuery(document).ready(function(){ jQuery("#references_link").click(function(){ jQuery("#references_holder").show(); jQuery("#references_link").parent().hide(); }); });
References
Click here to view the information sources referenced in this article.
Balachandran, A. & Schoenfeld, B. (2017, March 2) Evidence-based practice in Exercise and Nutrition: Common Misconceptions and Criticisms. Retrieved from https://www.lookgreatnaked.com/blog/evidence-based-practice-in-exercise-and-nutrition-common-misconceptions-and-criticisms/
Baldwin, S.A., Wampold, B.E., & Imel, Z E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842–852.
Cabaniss, D. L. (2012, May 31) The Therapeutic Alliance: The Essential Ingredient for Psychotherapy. Retrieved from https://www.huffpost.com/entry/therapeutic-alliance_b_1554007?fbclid=IwAR1NDl7sNR60OSvNFWmpTUA-GqAV65fMtxsOrOFAQ9fLM5Z5eQlcRR4APbU
Duke University. (2018). Introduction to Evidence-Based Practice. Retrieved from https://guides.mclibrary.duke.edu/ebmtutorial/home
Erskine, R.M., Jones, D.A., Williams, A.G., Stewart, C.E. & Degens, H. (2010) Inter-individual variability in the adaptation of human muscle specific tension to progressive resistance training. European Journal of Applied Physiology, 110(6), 1117-25.
Evidence-Based Medicine Working Group. (1992) Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. Journal of the American Medical Association, 268(17), 2420-5.
Frances, A.J. (2013, June 24) What Should Doctors Do When They Don’t Know What to Do? Retrieved from https://www.psychologytoday.com/us/blog/saving-normal/201306/what-should-doctors-do-when-they-dont-know-what-do?fbclid=IwAR3ce99uT-RDXcp_yvnJ0r2aTfBPWPpngqNUvkIc5a6PBZkyr5d-Z8sgy2Y
Joyce, A.S. & Piper, W.E. (1998) Expectancy, the Therapeutic Alliance, and Treatment Outcome in Short-Term Individual Psychotherapy. The Journal of Psychotherapy Practice and Research, 7(3), 236–248.
Löfgren, K. [Kent Löfgren]. (2013, February 25). What is epistemology? Introduction to the word and the concept [Video File]. Retrieved from https://www.youtube.com/watch?v=lI9-YgSzsEQ
Ludwig, J. (2018, April 16) Here’s what is going wrong with ‘evidence-based’ policies and practices in schools in Australia. Retrieved from https://www.aare.edu.au/blog/?p=2822
Schoenfeld, B.J., Contreras, B, Krieger, J., Grgic, J., Delcastillo, K., Belliard, R. & Alto, A. (2019) Resistance Training Volume Enhances Muscle Hypertrophy but Not Strength in Trained Men. Medicine & Science in Sports & Exercise, 51(1), 94-103.
Wampold, B. E. (2001). The great psychotherapy debate:Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum. NJ: Lawrence Erlbaum.
Evidence-Based Medicine Toolbox. (2017) Retrieved from https://ebm-tools.knowledgetranslation.net/
Evidence-based practice. (2018, November 19) Retrieved from https://en.wikipedia.org/wiki/Evidence-based_practice?fbclid=IwAR3ARk06zmx_lJYPIrTGA_chfBa9v_-NsW7HQbC7-rTHaq-Y7AYcSdLAk80
The well-built clinical question: a key to evidence-based decisions. (1995). Retrieved from https://mclibrary.duke.edu/sites/mclibrary.duke.edu/files/public/guides/richardson.pdf
The post Evidence-based coaching: Why some health and fitness pros are doing it all wrong. appeared first on Precision Nutrition.
Evidence-based coaching: Why some health and fitness pros are doing it all wrong. published first on https://storeseapharmacy.tumblr.com
0 notes
idolizerp · 6 years
Photo
Tumblr media
LOADING INFORMATION ON POIZN’S MAIN RAP, LEAD VOCAL KANG HANBYUL...
IDOL DETAILS
STAGENAME: Sirius CURRENT AGE:  24 DEBUT AGE: 17 TRAINEE SINCE AGE: 13 COMPANY: 99 SECONDARY SKILL: Lyric writing
IDOL PROFILE
NICKNAME(S): 별 – byul ; which means star. a childhood nickname his parents called him and sometimes still do. INSPIRATION: his parents served as his biggest inspiration, introducing him to music at an early age. without them, he wouldn’t be where he is today. SPECIAL TALENTS:
oddly flexible waist and back that he is nearly unbeatable at the limbo.
quite clever at acrostic poems.
NOTABLE FACTS:
owns a large vinyl collection of vintage songs dating back to the ‘60s.
a big harry potter fan.
has two older siblings.
pacific wide shoulders. 
IDOL GOALS
SHORT-TERM GOALS:
hanbyul has been low-key since his scandal made headlines early 2018. his opportunity to debut solo was stripped, indefinitely postponed, but he hopes to finally release some kind of music possibly in 2019. the gravity of his scandal makes an official solo debut vague. so, he has hopes he can start small with features in songs, unpromoted and maybe, when more time passes, a feature in chain station as well. he had thought, considering love scenario’s popularity, he could have jumped on solo endeavours but the scandal set him too far back, that his main goal as of now is to get back on the good side of the company and public once again. for now, he does want to write and produce for poizn if another chance comes his way.
LONG-TERM GOALS:
this is overreaching, but hanbyul is aiming to hit it big like soloists before him: tiger jk, outsider. except he isn’t a soloist yet; he’s from a boy group and that is stigma and a setback within itself. regardless, he remains positive to at least reach a margin of their success if he can’t have it all. he wants to branch away from the rules of being just an idol; he wants to break that stigma idols aren’t artists. and he hopes to do so with his music.
if chances emerge, producing songs for other artists outside of POIZN (not just exclusive to those in 99 entertainment) are avenues hanbyul very much wants to traverse through. he has a flare for dabbling in different genres, so he never wants to be confined to one type of venture. he wants to branch out musically and lyrically to a wide variety of different idol groups if possible.
IDOL IMAGE
crooked smirks, intense glares—they tell hanbyul that’s what suits him best. to be tough, to act tough. to be that stereotypical bad boy, who is hard around the edges but with a heart of gold. cliche, really, but works on the fans. they eat it up, screaming his name—no, screaming sirius because that’s him. the star that burns (only to burn out).
on stage, sirius is charismatic, powering through performances, burning through the grid iron, shredding through lyrics. he performs like his life is on the line, that every stage is a competition and he must win against himself; he performs in the circus of the entertainment industry at the risk of plummeting without a net to catch him, at the risk of burning… out. hard work and diligence as well as fiery passion exude in the harsh growls between notes, in the vein protruding and jaw clenching as he never fails to put on a show.
it’s where he shines best. what he does best.
99 likes that about him. likes the switch between sirius and hanbyul. sirius, who is a firecracker in the night sky. and hanbyul, who is a soft blaze in the day. a ray of sun behind a wisp of cloud.
that is the heart of gold part of him thought to be true. the heart of gold that snares with silly, prepared jokes and timely good reactions that has cameras panning to him. he is the one who looks directly in the eyes, smile soft and gaze softer—tender, like he’s looking through you (but you can’t see through him) as he recites acrostic poems. this is the hanbyul he brings to the table during intimate moments of fansigns and interviews. this is the hanbyul that surprises and catches others off guard. this is the hanbyul that plays the part of what others want from him.
hanbyul knows what to do to make it work. knows what everyone likes because he’s been pleasing people since he was young. he will pretend to be whatever works to fit himself into hearts and garner attention. because it works to be well-received, well-liked, to be an illusion of a star people gaze at, awed, when deep down he doesn’t have that heart of gold.
it’s tainted; he’s tainted.
for years his parents mold him into someone they preferred until hanbyul can’t recognize who he truly is. then it comes to him when he’s once again taken over a recording studio, he’s an ambitious people-pleasing chameleon; someone who twists his face and personality to better slot into the situation for his own personal gain.
nobody will like this version of him, he thinks, so hanbyul tucks it behind a friendly smile, convincing others he is all nice with no ulterior motives. bad boy sirius with a heart of gold is better than kang hanbyul, an ambitious soul acting like someone sweet so people can like him—so he can get what he wants, anyway, right.
IDOL HISTORY
the kangs’ guide to creating the perfect idol.
step one: have a child. kang jinyoung and kim sora have two children, but they had hanbyul with the hopes he can fulfill their lifelong dream. each, a failed product in the chase of fame (jinyoung didn’t pass the comedian test, and sora, a singer, never found herself signed to an agency). together, they want nothing more than to vicariously live through hanbyul, to have him famous, to have him adored by a sea of thousands—millions. their time was up, but for hanbyul, it was just beginning.
step two: training. as soon as he can walk, they teach him dance, simple choreography he can grasp and maybe master until he’s old enough to attend proper classes. and as soon as he can talk, they teach him to sing, and eomma has that covered. no need to spend expenses there, expenses they don’t have but continue to use to craft hanbyul into the perfect product. they forget about their other children, and they forget hanbyul is just a child, who is only eager to please them.
step three: auditions. any opportunity in busan is snatched. hanbyul is brought to auditions for commercials, pictorials. nothing big, nothing that can launch him into overnight success, but baby-steps. instead of making friends at school, who tease and ostracize him for not knowing how to mingle well, always busy living for his parents, hanbyul is pampered by lights too bright, he has to squint to see the cameras.
this is something he never gets used to but pretends to.
step four: seoul. the capital has more chances for hanbyul, his parents decide. so, they uproot the entire family and move to seoul with nothing but some money hanbyul earned. his hyung and noona hate it, despise the move and blame hanbyul for being so easy to fool. he doesn’t get it, though, doesn’t understand he’s being used and exploited. and he won’t understand for years to come. the lights blind him for that long.
step five: more auditions. but they are no longer for lesser tier commercials that do nothing for his fame. instead, they are for companies. thirteen, hanbyul comes prepared with a song he rehearsed over and over again until perfection—or something close to it. his eomma recommended it. a jackson 5 song because she likes michael jackson and wanted similar recognition for hanbyul once. this is a hint of his parents’ delusions, the ones his siblings warned him about, but hanbyul ignores it. for good reason because he impressed the panel enough to make it.
step six: 99 entertainment. they take him in and raise him like his parents: training, training and more training. but unlike his parents’ strong beliefs, there is nothing outstanding about hanbyul. he realizes this in vocal class when others sing better than him, clearer, higher—in dance class when he can’t seem to time his steps, can’t seem to catch up and stay in sync with everyone else. his parents warn to steer clear, that potential friends are competitors and they’re vying for limited spots. quitting isn’t an option, though. when his voice fails to reach notes, when his feet struggle to keep up, hanbyul tries regardless. tries and tries and works himself dogged tired just to keep up. his addiction to perseverance and hard work begins here.
step seven: more training. his parents aren’t remotely proud of hanbyul when months then years pass and there is no word of his debut. they assume he’s slacking off, not doing his best and accuse him of wasting their efforts to get him to where he is today. finally, he is getting a glimpse of what his siblings talk about: that his parents are only in it for themselves. he just refuses to believe it at first. yet puberty wrecks his esteem more, his voice easily cracking. someone suggests taking up rapping, that it better suits his image, anyway. so, again, hanbyul is tasked to try, and he sucks at it. but his addiction kicks in—the one aimed to please with blood, sweat and tears.
step eight: expand yourself. he finds escape in rapping, thinks it’s something similar to telling a story: his story. hanbyul listens to more of it, to the lyrics that speak of injustice, of how unfair the world is, how unfair life can be, of trying to only end up with nothing. the hardships, the pain, he relates to. pen to paper, he writes down what he stored from years having barely anyone to truly talk to, what hurts him, what pains him, the blisters on his heels, the ache in his back, the bruises on his limbs. hanbyul reads for inspiration, listens for muse, writes and writes until he can twist his tongue around his own words, his own tales and makes something out of nothing, make his stories into songs.
step nine: jump at chances. and the company likes it, likes him for pushing himself to the limit, for not giving up, for finding avenues to go on until he is considered a valuable asset. a rap competition, broadcasted, provides an opportunity to show him off, to display on a pedestal what they have hidden in their roster. young and full of potential, plus his parents are thrilled he is getting his name out there, hanbyul greedily hops at the chance to boast, to gloat, to rip through stages he exhausted himself over day after day, night after night. the reviews are mixed. while his talent is not denied, it’s judged and put under a microscope. no one thinks hanbyul deserved such a high placement, but he’s happy. his parents aren’t.
step ten: avoid scandal. hanbyul returns to training, disheartened. his parents berate him for losing, express their disappointment in him with cold shoulders and icy glares. he finds no sympathy from his siblings, who are happy the ‘golden child’ has failed, and he barely has friends after being forced view everyone as competition. again, the addiction revs its engines and the thirst of recognition he’s barely tasted erupts, and hanbyul is back punishing himself to get better, to be better, to debut so his parents will love him again. finally, finally—poizn is announced, and he’s in the final line-up. his parents are only more than happy to sign his rights away. it should be the greatest time of his life, but it isn’t.
poizn is problematic. scandal after scandal, they are continuously benched from promotions. they spend more time back in training rooms than they do on stage. this is not what he had in mind, not what he wants. where is the spotlight. hanbyul writes more than he raps, learns to produce more than he has a chance to perform his own songs. it’s what he does to keep himself sane, to tells his parents he is doing something in his spare time, but the accusations are tossed, anyway: they blame him, they blame his members, they start believing the articles and rumours of apparent bad attitudes as if they don’t know their own son. they also threaten him to stay clean, spotless because being in poizn itself muddles his name.
for years, hanbyul manages to stay pristine. then the pictures happen. all because he fell for a girl, trusted a girl but became too busy for that girl (training, writing, producing, being a workaholic) and had to break up with that girl. in return, she released his pictures right after a monster hit. after management finally chose one of his songs for a title track. after his parents showered him with compliments and affection and he was satisfied. hanbyul loses everything because of a single post.
step eleven: this is no step eleven. not for hanbyul because he is far from the perfect idol his parents raised him to be. yet he’s still trying. he won’t give up to achieve their goals because they are his, too–they ingrained it into him even if it burns him out.
0 notes
Photo
Tumblr media
Samsung Galaxy Note 9: All the rumors in one place (Updated July 10) In this post, which will be updated regularly, we take a closer look at the latest rumors surrounding Samsung’s upcoming Galaxy Note 9 smartphone. Update (07/10): A new leaked image reportedly of the front of a Galaxy Note 9 is posted below, as well as some updated information on how the Bluetooth-enabled S Pen will charge. Trending: Samsung Galaxy S10 rumors – price, release date, specs, design Previous coverage: The Galaxy Note 8 was a smash hit. Despite being the most expensive Samsung smartphone to date and having a weirdly positioned fingerprint scanner, the flagship outsold previous Note devices. Its large 18.5:9 display, dual-camera setup, and stunning design were apparently good enough reasons for consumers to forget all about the Note 7 fiasco. Whether Samsung can manage a repeat with the Galaxy Note 9 depends on how much of an upgrade the handset will be over its predecessor…and its price tag. Although the specs and price haven’t been officially revealed yet, various rumors on these topics give us an idea of what to expect — check them out below. Samsung Galaxy Note 9: Release date The nitty-gritty Samsung will hold a Samsung Unpacked Event to launch the Galaxy Note 9 on Aug. 9, 2018. As per the rumors, this is two weeks earlier in the year than the Galaxy Note 8. There is still no confirmed release date, but the Samsung Galaxy Note 8 was released three weeks after it was first unveiled. Samsung has confirmed that it will unveil the Galaxy Note 9 at a Samsung Unpacked event on Aug. 9. While there is still no confirmed Galaxy Note 9 release date, the Galaxy Note 8 was released just over three weeks after Samsung unveiled it in 2018. We’ll let you know when we learn more. Samsung Galaxy Note 9: Specs The nitty-gritty The Samsung Galaxy Note 9 could sport a dual-camera setup with variable aperture. The smartphone should be powered by the Snapdragon 845 or Exynos 9810 chipset. It will come with the S Pen stylus, which could have a few new tricks up its sleeve. According to The Investor, the Galaxy Note 9’s display will be larger than that of the Note 8 — but the difference will be so small that you’ll hardly notice it. The smartphone is said to come with a 6.38-inch display, up from the Note 8’s 6.32 inches. The screen should be curved on both sides and sport an 18.5:9 aspect ratio like last year. No word on the resolution for now, but we expect it to be the same as the one on its predecessor at 2,960 x 1,440 pixels. Some rumors suggest a 4K display is also an option. The Note 9 will probably be powered by the latest Snapdragon 845 — or Samsung’s own Exynos 9810 chipset, depending on the region — just like the Galaxy S9 series. Like the Note 8, the Note 9 will likely pack 6GB of RAM under the hood, which means it will be able to handle anything you throw at it. However, there’s also a chance Samsung will announce a beefed-up version of the device. Chinese leaker Ice universe claims it will come with 8GB of RAM and a whopping 512GB of storage, but only “if you are lucky.” What exactly that means is anyone’s guess right now. It could be that Samsung hasn’t made a final decision yet, or that this variant will be exclusive to certain markets, like China. If you are lucky, you will see 8GB RAM and 512GB ROM Galaxy Note9 — Ice universe (@UniverseIce) May 26, 2018 We expect to see a few improvements in the camera department. Like its predecessor, the Note 9 will probably come with a dual-camera setup on the back, offering digital zoom and a bokeh effect. There’s a good chance the camera setup will sport a variable aperture like the S9 series, which is especially handy for low-light photography. Unfortunately, we haven’t come across any reliable leaks about the camera’s specs like the megapixel count, aperture size, and what have you. Read next: What is variable aperture? The ability to capture super slow-mo videos at 960fps could make its way from the S9 to the Note 9. AR Emoji feature, which lets you turn yourself into animated emoji with the help of the camera, could also cross over. It’s not perfect, but it is a lot of fun. Check out a few AR emojis of our very own Jimmy Westenberg and Joshua Vergara below. According to leaker Ice universe, the Note 9 will have a larger battery than its predecessor — possibly as large as 4,000mAh, up from 3,300mAh. 100% sure, Galaxy Note9 battery 4000mAh — Ice universe (@UniverseIce) June 13, 2018 Samsung has been playing it safe when it comes to battery sizes since the Note 7 fiasco. Maybe it will finally close that chapter and take a step forward. Speaking of the battery, Samsung might also launch a faster wireless charger alongside the Note 9. The folks at Galaxy Club spotted an FCC listing for a new wireless charger with model number EP-N6100 that supports an input rating of 12 volts and 2.1 amperes. That’s up from the 9 volt/1.67 amperes wireless charger (model number EP-N5100) Samsung launched this year with the Galaxy S9. Other specs and features expected include 64GB of base storage in the U.S., which you’ll be able to upgrade for an extra 400GB via a microSD card. Then there’s facial recognition, an iris scanner, and the Intelligent Scan feature already seen on the Galaxy S9, which merges the two biometric options. The Note 9 will likely sport a headphone jack and may come with a free pair of AKG headphones. Let’s not forget about the IP68 rating for protection against dust and water. The Note 9 will also likely come with a headphone jack and may ship with a free pair of AKG headphones in the box like its predecessor. Samsung is expected to make big changes to the S Pen. A filing with the FCC confirms that it will have Bluetooth, which ETNews suggests will allow the S Pen to take pictures remotely and control music, as well as act as a pointer during presentations. It also suggests that the S Pen will have the ability to create digital signatures for authentication. Per the FCC filing, the S Pen’s battery will charge via the smartphone itself when housed in its stylus port. The Galaxy Note 9 is expected to run Android 8.1 Oreo with Samsung’s Experience skin on top. The smartphone will likely also launch with the much anticipated Bixby 2.0 on board, which is an upgraded version of the company’s digital assistant. Based on the rumored specs and features of the Samsung Galaxy Note 9, the smartphone sounds like a slightly larger Galaxy S9 Plus with the added S Pen. That’s why it’s possible Samsung will add a few extra bells and whistles to the device to differentiate it from the S9 series. Samsung Galaxy Note 9 rumored specifications Display 6.38-inch Super AMOLED panel 2,960 x 1,440 resolution 18.5:9 aspect ratio Processor Snapdragon 845 or Exynos 9810 RAM 6/8GB Storage up to 512GB MicroSD Yes, up to 400GB Camera Dual-camera setup with variable aperture and super slow-mo video at 960fps Battery 3,850mAh Water resistant IP68 Headphone jack Yes Software Android 8.1 Oreo with Samsung Experience Other features S Pen stylus, facial recognition, iris scanner, and AR Emoji Samsung Galaxy Note 9: Design Samsung Galaxy Note 8 and Galaxy S9 Plus The nitty-gritty Renders and a 360-degree video allegedly showing the Galaxy Note 9 have leaked. The upcoming flagship could look similar to its predecessor, with a few minor changes. The fingerprint scanner may sit below the dual-camera setup instead of next to it. OnLeaks has teamed up with 91mobiles and released a 360-degree video as well as a few renders allegedly showing the Galaxy Note 9. They reveal that the upcoming smartphone may look similar to its predecessor, with a few small changes here and there. The biggest one is at the back, where you’ll find horizontally-positioned dual cameras along with a fingerprint scanner that now sits below the setup instead of next to it. This is something that was expected, as Samsung has also moved the scanner below the cameras on the Galaxy S9 series. It looks way better and is also a lot more practical, as it makes it easier to reach the scanner with a finger. The video and renders also squash rumors that we’ll see an in-display fingerprint scanner on the Galaxy Note 9. Although these aren’t official renders of the device, OnLeaks has a great track record and is rarely wrong with his predictions. This means the rumor claiming that the first Samsung device with a fingerprint scanner could be the Galaxy S10 just may be true. Android Headlines posted a leaked image reportedly of the Note 9, which you can see below. The first thing that you’ll notice is that the front of the device looks pretty much exactly like the Note 8, which lines up with previous rumors. If this leaked image is, in fact, the Galaxy Note 9, it will be hard to differentiate between a Note 9 and a Note 8. Android Headlines Buyers of the Galaxy Note 9 may have a selection of five colors to choose from. Galaxy Club claims the phone will be available in black, gray, violet or purple, blue, and brown. The report also says the S Pen will match the color of the phone. Samsung Galaxy Note 9: Price The nitty-gritty The Galaxy Note 9 could cost the same as its predecessor or more. It might set you back at least $950 unlocked. The unlocked version of the Galaxy Note 8 launched with a $930 price tag in the U.S., making it the most expensive Samsung smartphone to date. What’s more, its price has since increased — now $950. Editor's Pick Android smartphones with the best battery life (March 2018) Some people might think that the most important feature in a smartphone is its display size. Others believe it comes down to a phone's processor performance, or the amount of RAM, or how much storage … The Galaxy Note 9’s price remains a mystery for now, but we do know this: it won’t lower. Samsung doesn’t decrease the prices of its flagships, and we don’t expect that to change this year. In fact, the Note 9 could be more expensive than its predecessor. Samsung increased the price of the Galaxy S9 Plus to $840 unlocked — $15 more than the Galaxy S8. The Note 8 outsold its predecessor, despite being more expensive, which might give Samsung the confidence to bump up the price again this year. Pushing the price up too high might have a negative effect on sales, especially if the handset will only be a minor upgrade over last year’s model, but a small increase could be in the cards. These are all the rumors we’ve come across so far about the Samsung Galaxy Note 9. We’ll update this page as soon as we hear more. In the meantime, share your thoughts on Samsung’s upcoming smartphone with us. Will it outsell the Galaxy Note 8? Let us know in the comments! , via Android Authority http://bit.ly/2HcqvzV
0 notes
coolkoreamag · 7 years
Text
INTERVIEW WILL I GET A TICKET?
A Conversation About Life After Vogue With Lucinda Chambers
by Anja Aronowsky Cronberg
WE MEET AT A cosy private club in West London, the sort of hangout popular with fashion professionals who believe in the semblance of bohemia. For thirty-six years she’s been working at British Vogue, twenty-five of those as the magazine’s fashion director, but not long before we meet the fashion press has been full of headlines announcing her departure. We order lattes, and I’m struck by how candid she is.
A month and a half ago I was fired from Vogue. It took them three minutes to do it. No one in the building knew it was going to happen. The management and the editor I’ve worked with for twenty-five years had no idea. Nor did HR. Even the chairman told me he didn’t know it was going to happen. No one knew, except the man who did it – the new editor. Afterwards I walked out and ran into the publisher. ‘Oh Lucinda! How are you?’ I told him I’d just been fired. He said, ‘Outrageous! Ridiculous! Crazy!’ I phoned my lawyer; she asked me what I wanted to do about it. I told her I wanted to write a letter to my colleagues to tell them that Edward [Enninful] decided to let me go. And to say how proud I am to have worked at Vogue for as long as I did, to thank them for being such brilliant colleagues. My lawyer said sure, but don’t tell HR. They wouldn’t have wanted me to send it.
Later I was having lunch with an old friend who had just been fired from Sotheby’s. She said to me, ‘Lucinda, will you please stop telling people that you’ve been fired.’ I asked her why – it’s nothing I’m ashamed of. She told me, ‘If you keep talking about it, then thatbecomes the story. The story should be that you’ve had the most incredible career for over thirty years. The story shouldn’t be that you’ve been fired. Don’t muck up the story.’ But I don’t want to be that person. I don’t want to be the person who puts on a brave face and tells everyone, ‘Oh, I decided to leave the company,’ when everyone knows you were really fired. There’s too much smoke and mirrors in the industry as it is. And anyway, I didn’t leave. I was fired.
Fashion can chew you up and spit you out. I worked with a brilliant designer when I was at Marni – Paulo Melim Andersson. I adored him. He was challenging, but highly intelligent. Fragile, like a lot of creative people. We had our ups and downs, but he stayed with us for seven years. Then Chloé came along. The CEO at the time asked my advice about Paulo and I told him, ‘Paulo is great, but you have to know that he won’t turn the brand around for you in a season or even two. You’ve got to give him time, and surround him by the right people.’ ‘Absolutely, absolutely,’ he said. ‘I’ll do that.’ Three seasons later Paulo was out. They didn’t give him time, and he never got his people. I felt so sad for Paulo. If you want good results, you have to support people. You don’t get the best out of anyone by making them feel insecure or nervous. Ultimately, that way of treating people is only about control. If you make someone feel nervous, you’ve got them. But in my view, you’ve got them in the wrong way. You’ve got them in a state of anxiety. I’m thinking of one fashion editor in particular: it’s his modus operandi. He will wrong-foot you and wrong-foot you, and have everyone going, ‘Shit, shit, shit, shit, shit.’
You’re not allowed to fail in fashion – especially in this age of social media, when everything is about leading a successful, amazing life. Nobody today is allowed to fail, instead the prospect causes anxiety and terror. But why can’t we celebrate failure? After all, it helps us grow and develop. I’m not ashamed of what happened to me. If my shoots were really crappy… Oh I know they weren’t all good – some were crappy. The June cover with Alexa Chung in a stupid Michael Kors T-shirt iscrap. He’s a big advertiser so I knew why I had to do it. I knew it was cheesy when I was doing it, and I did it anyway. Ok, whatever. But there were others… There were others that were great.
In fashion people take you on your own estimation of yourself – that’s just a given. You can walk into a room feeling pumped up and confident, and if you radiate that the industry will believe in what you project. If, on the other hand, you appear vulnerable you won’t be seen as a winner. I remember a long time ago, when I was on maternity leave, Vogue employed a new fashion editor. When I met with my editor after having had my baby, she told me about her. She said, ‘Oh Lucinda, I’ve employed someone and she looked fantastic. She was wearing a red velvet dress and a pair of Wellington boots to the interview.’ This was twenty years ago. She went on, ‘She’s never done a shoot before. But she’s absolutely beautiful and so confident. I just fell in love with the way she looked.’ And I went, ‘Ok, ok. Let’s give her a go.’ She was a terrible stylist. Just terrible. But in fashion you can go far if you look fantastic and confident – no one wants to be the one to say ‘… but they’re crap.’ Honestly Anja, you can go quite far just with that. Fashion is full of anxious people. No one wants to be the one missing out.
Fashion moves like a shoal of fish; it’s cyclical and reactionary. Nobody can stay relevant for a lifetime – you always have peaks and troughs. The problem is that people are greedy. They think, ‘It worked then, we’ve got to make it work now.’ But fashion is an alchemy: it’s the right person at the right company at the right time. Creativity is a really hard thing to quantify and harness. The rise of the high street has put new expectations on big companies like LVMH. Businessmen are trying to get their creatives to behave in a businesslike way; everyone wants more and more, faster and faster. Big companies demand so much more from their designers – we’ve seen the casualties. It’s really hard. Those designers are going to have drink problems, they’re going to have drug problems. They’re going to have nervous breakdowns. It’s too much to ask a designer to do eight, or in some cases sixteen, collections a year. The designers do it, but they do it badly – and then they’re out. They fail in a very public way. How do you then get the confidence to say I will go back in and do it again?
The most authentic company I ever worked for is Marni. We didn’t advertise, and what we showed on the catwalk we always produced. We never wanted to be ‘in fashion.’ If you bought a skirt twenty years ago, you can still wear it today. We never changed the goalposts. Our shows were about empowering women. We always treated our models beautifully and had incredible diversity in the company: my team was half boys, half girls, all different nationalities. It was very transparent, but when the company was sold everything changed. The Castiglionis were naïve. They sold sixty percent of the company, thinking that the new owner would respect what they had built. I never understood why they sold it to Renzo Rosso of all people. He is the antithesis of everything Marni stood for. The antithesis. When Consuelo left, I remember thinking why not give the design task to someone from the team? It would have been a reflection of how fashion is created today, and it worked for Gucci – Alessandro Michele had been at the brand forever before becoming the creative director. I talked to Renzo and he agreed, but then at the last minute he changed his mind. He brought Francesco Risso onboard, who had nothing to do with the company. Before Marni, he did celebrity dressing at Prada. He’d never done a show, he’d never run a team. But he knows Anna Wintour. And who is Renzo Rosso enthralled by? Anna Wintour. The last womenswear collection at Marni was a disaster; it had terrible reviews. The show was appalling. I heard the cost to produce it was two-and-a-half times what we used to spend, and it sold fifty percent less. A lot of American buyers didn’t even bother to turn up. Marni is no more. It saddens me, but then I remind myself that from the ashes something new can emerge.
When Vetements came on the scene, what they were doing felt very new. At that particular time, it wasn’t what anyone else was doing. And when I saw the last Balenciaga show… Okay, you could say it’s a bit Margiela or a bit this or that, but honestly I was really really really excited. You know what was smart about it? It was the scale – you saw this tiny model emerge and it took forever for her to get close to the audience. It built up expectation. Everything was thought through: the casting, the music, the space. Everything. And I loved how we were all seated: so far from each other, it all felt anonymous. Normally at a fashion show, everyone looks at each other – who wears what, who sits where. ‘Oh, she’s got the new Céline shoes.’ But here you felt as if you were on your own. It was a new feeling.
Fashion shows are all about expectation and anxiety. We’re all on display. It’s theatre. I’m fifty-seven and I know that when the shows come around in September I will feel vulnerable. Will I still get a ticket? Where will I sit? I haven’t had to think about those things for twenty-five years. Most people who leave Vogue end up feeling that they’re lesser than, and the fact is that you’re never bigger than the company you work for. But I have a new idea now, and if it comes off maybe I won’t be feeling so vulnerable after all. We’ll have to wait and see.
There are very few fashion magazines that make you feel empowered. Most leave you totally anxiety-ridden, for not having the right kind of dinner party, setting the table in the right kind of way or meeting the right kind of people. Truth be told, I haven’t read Vogue in years. Maybe I was too close to it after working there for so long, but I never felt I led a Vogue-y kind of life. The clothes are just irrelevant for most people – so ridiculously expensive. What magazines want today is the latest, the exclusive. It’s a shame that magazines have lost the authority they once had. They’ve stopped being useful. In fashion we are always trying to make people buy something they don’t need. We don’t need any more bags, shirts or shoes. So we cajole, bully or encourage people into continue buying. I know glossy magazines are meant to be aspirational, but why not be both useful and aspirational? That’s the kind of fashion magazine I’d like to see.
Lucinda Chambers served as fashion director of British Vogue for 25 years.
Anja Aronowsky Cronberg is Vestoj’s Editor-in-Chief and Founder.
0 notes
oovitus · 6 years
Text
Evidence-based coaching: Why some health and fitness pros are doing it all wrong.
Ask any health and fitness professional if they’re “evidence based,” and chances are good you’ll get a resounding, “Yes!” Perhaps even an indignant one. After all, everyone uses evidence… of some sort. But if you think evidence-based practice is only what “research says,” you’re doing it wrong. In this article, we’ll show you the right way to use evidence to inform and enhance your coaching—for more effective advice and better client results. 
++++
Here at Precision Nutrition, we love science.
In fact, no one loves science more than us!
But is it possible to rely too heavily on scientific literature? Can you actually science too much?
Maybe.
Ever see someone:
Dismiss a coach’s successful method solely because some element of it isn’t “research proven?”
Refuse to modify a nutrition plan—even though a client hates it—“because science?”
Call a respected health professional a “quack” because they cite years of clinical experience instead of a definitive clinical trial?
(If you haven’t, you probably don’t spend much time in Facebook comments.)
In each case, the person’s inflated reverence for research could be limiting their ability to learn, and evolve as a coach. They might also influence others to follow their narrow line of thinking, causing them to miss out, too. And this is often done in the name of “evidenced based practice.”
Now, evidence-based practice, or EBP, is all the rage in certain health and fitness circles, which is a great thing. We heart science, remember? Except there’s just one problem…
A lot of coaches, though well-meaning, are getting EBP wrong. Specifically, they’re over-emphasizing “what the research says” to the exclusion of other relevant information, like their professional experience and the personal preferences and values of the people they work with.
And that’s not good for clients, business, or the health and fitness industry.
To make sure you get EBP right, use this guide to understand what the method really is, why it matters, and how to implement it effectively in your own coaching practice.
Because when used correctly, EBP is a powerful tool that’ll make you a better coach—so you can help even more people achieve lasting change and deep health.
And that we love even more than science.
+++
What is “evidence”?
There’s “everyday life” evidence.
In our Precision Nutrition Coaching program and Certifications, we tell our clients and coaches to use outcome-based decision making (OBDM).
Very simply, that means you decide what to do next based on the data you got from what you just did.
Did your waist measurement go up after two weeks of vacation buffets? That’s data that says, “Welcome home, maybe dial it back a little.”
Did your blood pressure go down after four months of sticking to your exercise program? That’s data that says, “Keep up the good work!”
We tell our coaches and clients to use as many data points as they can, and look for progress everywhere, including:
body measurements
blood work and other medical tests
athletic performance, such as getting stronger or faster
photos
how clothes fit
recovery
sleep
mood and wellbeing
confidence
consistency
And so on. (Here are some more ideas.)
All of these data points, collectively, give us evidence that we can use to make informed choices.
Then there’s scientific evidence.
This includes clinical or case studies, experimental research, basic research (for instance, studying cells in culture), and more.
This evidence can vary widely in quality, who is studied, and how applicable the results are to you and your clients.
However, in general, scientific evidence is one of the best ways we have to know about the nature of reality.
And though it might be obvious, we’re compelled to say it anyway: You’re looking to glean these insights directly from reputable, peer-reviewed scientific papers—not random websites, articles in magazines, or pictures of sunsets with words on them.
Finally, there’s stuff you learn on the job.
We call this “expertise.” It’s the old coach’s intuition, the senior clinician’s knack for diagnosis, the way a master carpenter can tell you if something is a quarter inch off square just by looking.
After you’ve worked with over 100,000 clients, as we have, you start to build a database of collected wisdom. And often, there’s stuff that’s hard to explain or defend—you’ve just seen it enough times that you know it’s a thing.
When we bring together experience, research, and expertise, we have a pretty good set of working hypotheses about what is likely to be effective.
And that’s evidenced-based practice. So it’s not just about clinical research.
EBP is a systematic way of thinking and application that integrates scientific data with clinical experience and the individual needs and preferences of each client or patient.
Yes, that’s the official, eye-glazing definition, but you might find the Instagram-able version even more enlightening. (See the illustration below.)
All three parts are equally important.
That’s because:
1. You aren’t coaching research averages. You’re coaching people.
Most studies report the average results of an intervention. (This is especially true of their headlines.)
Yet, if we look at the actual data of most studies, we see that individual results tend to fall on a bell curve of some sort.
Take this example, noted by James Krieger and Bret Contreras.
A study on resistance training and muscle gain concluded the following:
“Previously untrained people who engaged in resistance training three times a week for 9 weeks increased their muscle mass by 6%.”
Based on that, you might expect a client to achieve similar results on your three-day-a-week program.
But if you look at the individual data within the study, muscle growth ranged from -2.5 to 20 percent. That’s right: minus 2.5 percent. As Krieger and Contreras point out, five of the 53 participants actually lost muscle!
That’s not to suggest the research results are misleading. In fact, most of the study participants experienced muscle mass gains between 5 and 10 percent, and some even more. However, it does show the overall findings may not to apply to every individual. So don’t expect them to.
Another example is broccoli. There’s a significant body of evidence supporting the health benefits of eating this nutrient-dense vegetable.
But if broccoli makes someone gaggy or gassy, it’s not the healthiest food for them, no matter what the research says about it lowering disease risk.
These kinds of patterns happen over and over: Some people get great results from applying the research, some get very little (or negative) results, and most get results somewhere in between.
This is reality.
Research can be incredibly useful for giving us a starting point for most people. But humans differ—often wildly—from one another.
They differ in terms of their habits, mindset, physiology, environment, and personal preferences. They also differ in their ability to follow a program in the first place. And even if they stick to a plan perfectly, they can differ in the results they get.
Coach for the unique human in front of you, not for an average.
Not only will this improve your client results (because you’ll be working with their particular, practical reality), it’ll also improve your client retention (because you’ll be actually listening to them and trying to understand them as individual people, not as data sets).
When a client is suffering, they probably don’t need you to search PubMed for more evidence.
They often need you to provide a solid, trusting coaching relationship and, of course, your coaching skills. This combination can help you ease client resistance, be creative and flexible when typical solutions don’t work, and be compassionate and supportive when a client struggles with dark stuff.
2. Your professional experience really matters.
If you’re a mindful, growth-oriented coach or practitioner, it’s impossible not to develop a certain degree of experience and expertise over time.
A lot of things go into your “expertise bucket”: courses and programs you’ve taken; books you’ve read; lectures you’ve attended; mentoring relationships you’ve had; and all the practical experience you’ve acquired from observing and coaching clients or patients.
The accumulation of knowledge and experience gives you a kind of “intuition” that can help you coach more effectively.
This “intuition” shows up when you see a client perform a wonky squat, quickly identify exactly what’s wrong, and make corrections to improve form.
It shows up when you perform a client intake, and based on their answers (Just had a baby! Prone to perfectionism!), you can anticipate what aspects of a program they might struggle with, and how you might help them.
Or it shows up when you do a postural assessment, and immediately know which exercises to avoid and which could be helpful.
Much of the time, this is knowledge you could have never learned simply from reading studies. It requires time working with people, and exposing yourself to new ideas and methods, including those that have yet to be studied.
But there’s a challenge here, too. The knowledge we gather from our experiences is very prone to human error: Our memories are unreliable, we see patterns that may not actually exist, and we discount information that doesn’t conform to what we already believe.
How can we reduce human error?
First, be aware that bias and error exist… yes, even for you.
Take notes during or after client sessions, and use a variety of validated measurement tools—such as weight, body measurements, pictures, mood scales, and sleep quality scales—to track the effectiveness of your advice.
Get mentorship and feedback on your practice. Coaches need coaches. Or, find a like-minded group of professionals with whom to collaborate. (That’s why we developed the Precision Nutrition Level 2 Certification.)
If you’re aware of the errors you’re likely to make, and take steps to moderate them, you might start to see some reliable, overarching patterns.
Like that very rigid meal plans don’t work for people in the long term. Or that people can only train so long and so hard before they burn out.
Or a thousand other possibilities experienced coaches notice, but perhaps haven’t been fully validated by published research.
If you’re just starting out and don’t have the experience gained from coaching many people over many years, you can “borrow” insight from mentors or other coaches with more reps under their belt.
Drawing on the wisdom of your (or a colleague’s) accumulated experience is an essential part of being a good practitioner.
3. Science will never have it all figured out.
The evidence is always evolving. Nutrition research in particular is a relatively new area, and there’s still a lot to be learned.
Plus, some things are really hard (or downright unethical) to test in a research setting, and so we may never have scientific evidence on it.
Even if it is possible to test, quality research takes a long time to gather. Usually, one study isn’t enough to “prove” something true or false. But waiting for multiple studies on a specific topic, or better yet, a meta-analyses (which is kind of like a poll of the research) may require a lot of patience. Maybe decades.
And yet, we still have to help our clients and patients make informed decisions. Like, now.
That’s where evidence-based practice comes in.
The RIGHT way to use EBP.
You can formally apply the EBP process to coaching decisions that feel especially important or uncertain.
EBP offers one of the best tools to help you reach a decision that’s most likely to be safe and effective, and that’ll also make sense in the context of your client’s life.
Follow these 6 steps to see EBP in action.
1. Assess the client.
Identify their unique abilities and needs.
What are their strengths?
Where might they need help from you?
What are their precise goals?
What are their identities, values, and beliefs?
Gather this information by asking questions, using intake forms, and taking measurements. This’ll help you create an initial plan of action and also provide a baseline against which to gauge progress.
Plus, as you collect data on many clients, you’ll be accruing practical evidence that can aid with decision making in the future.
Let’s use a hypothetical client to apply these steps.
Her name is Nora. Her goal is to lose fat, and she’s also interested in intermittent fasting. Through your initial assessment you learn that she’s begun to show signs of perimenopause, and her sleep isn’t great these days.
2. Find your research question.
Before you jump to a solution, get clear on the problem you’re trying to help your client with. 
Then, turn the problem into a question that’ll help you isolate the evidence you need for your recommendations. This question should incorporate the problem, as well as relevant factors about your client or patient.
Nora’s main goal is to lose fat, and she’s curious about intermittent fasting. Important factors to consider: Nora is a woman and she’s perimenopausal.
But you’re not sure if intermittent fasting is safe (or effective) for losing fat. And you’re definitely not sure if it’s safe (or effective) for a perimenopausal woman.
So your research question might be: “Is intermittent fasting safe and effective for fat loss in perimenopausal women?”
3. Gather the evidence.
Search for info using an online database like PubMed or Google Scholar. (If you don’t know how to use online research databases, here’s a PubMed tutorial.)
Using a research database will curate your hits so you’re only getting original, peer-reviewed research, rather than someone else’s (potentially biased) interpretation of it.
To find relevant research for Nora, a good keyword combination to type in a search box could be “intermittent fasting + fat loss + menopause”. These keywords contain the intervention you’re interested in learning more about, plus information about Nora’s unique goals and life stage.
To identify the best available scientific evidence on the research subject, use the “Hierarchy of Evidence” pyramid below. The higher up on the pyramid, the more trustworthy the information. So start your search from the top down.
In the case of Nora, prioritize finding a position stand, a meta-analysis, or a systematic review on using intermittent fasting for fat loss in menopausal women. This will give you a comprehensive overview of the current evidence. Basically, scientists and/or academics have already done the hard work—of reviewing, comparing, and analyzing the available scientific evidence—for you.
If that doesn’t exist, look for randomized control trials that compare appropriately chosen groups of people with a control group (such as a group that received no intervention, or a different intervention).
No luck there? You can expand your search to just “women” rather than “menopausal women.” Depending on what’s available, you may have to continue broadening your search and moving down the hierarchy of evidence.
Now, if you’re not well-versed in reading studies or interpreting research, that’s okay. Chances are, if you don’t find a meta-analysis or review, or—best of all—a position stand, the research further down the pyramid will be of limited use to you anyway.
If that’s the case—or you can’t find any scientific research on the topic—you might have to use opinions from other trusted experts, or develop an educated hypothesis based on your own knowledge of how physiology and nutrition work. This still counts as evidence, it’s just not as reliable, so temper your confidence in it accordingly.
All hail the position stand.
If you don’t feel equipped to navigate and interpret scientific literature, consider looking for best practice guidelines or position stands written by an authority in your field.
Position stands are official statements made by a governing body on topics related to a particular field, like nutrition, exercise physiology, dietetics, or medicine.
Here’s an example: The 2017 International Society of Sports Nutrition Position Stand on protein and exercise.
If you have a client who’s older and you’re wondering how to safely increase their training capacity (but don’t want to immerse yourself in a dark hole of research), simply look for the position stand on exercise and older adults.
To find the position stands in your field, consult the website of whatever governing body you belong to.
For example, if you’re a personal trainer certified through ACSM, NASM, ACE, or NSCA, consult the respective website for each organization. They should feature position stands on a variety of topics.
4. Appraise the evidence.
Through your search, you’ll probably find at least some evidence. This might be just a few small studies or some articles from trusted experts in the field.
Now, using the hierarchy of evidence, determine how valid and reliable those pieces of evidence are.
The more you have to broaden your question or move down the quality hierarchy, the less confident you might be about your recommendations.
With Nora, if all you find are some articles by an internet guru who’s never actually seen any real clients, you may want to present your findings as a mere idea, rather than as reliable advice.
On the other hand, if you find a handful of systematic reviews about intermittent fasting in menopausal women, you can go to Nora with more confidence about your recommendations. (Quick fact check, FYI: We couldn’t find any reputable systematic reviews on intermittent fasting in menopausal women.)
5. Create your recommendation.
Unless they ask for it, most clients don’t want to know all the complicated science stuff; they just want to know what to do.
This is where the science of coaching morphs into the art of coaching.
It’s time to see if you can actually apply the evidence you’ve found—along with your own professional experience—to the complex, real, live human standing in front of you.
Notice that the evidence by itself doesn’t make the decision. Nor does your experience, nor do the client’s preferences.
The three simply offer a more holistic perspective on a problem, to ensure you find the best possible solution for your client.
Rather than plunking down a stack of research in front of your client, combine the research with your expertise and your client’s unique circumstances to translate it into practical advice.
It could work like this: Through your research, you find that intermittent fasting is effective for fat loss. However, through your own professional experience, you’ve also noticed that most clients struggle to stick with intermittent fasting long-term. (Aligning nicely with your coaching experience, the research also shows a relatively high drop-out rate with intermittent fasting.)
You’ve also noticed that in some of your female clients, intermittent fasting seems to deregulate menstrual cycles and exacerbate menopausal symptoms.
Thinking about Nora’s unique values and preferences, you know that she wants to lose weight, but you also know that she’s had some trouble sleeping lately. In your experience with other clients, people who are sleep-deprived have an extra-hard time regulating appetite and losing weight.
So… intermittent fasting seems to be effective, but combined with your concerns about Nora’s hormonal health and sleep quality, plus the fact that intermittent fasting can be hard to maintain, you may decide not to recommend it to Nora.
After explaining to her your reasoning, explore with her what she’s comfortable trying. In the end, you may suggest some simple nutrition habits along with some short fasting experiments, plus some sleep tips.
These recommendations include what you’ve found from the best available research, your own coaching experience, and Nora’s unique preferences, goals, and challenges.
Nora’s just gotten some pretty wise, tailored-to-her advice, where you worked as collaborators to come up with her action plan.
That’s the art and science of coaching.
6. Monitor the results.
Once you’ve given your client a little time to practice what you came up with together, you can assess if those actions are working.
Consult those measurements you took in your initial assessments. Compare them to current measurements.
Are things moving in the right direction?
And talk to your client about how the plan is working.
Nora tells you although she’s applying and benefitting from the sleep tips, she’s struggling with fasting, even the shorter experiments. Turns out, it’s hard to fast when you’re having trouble falling asleep because of a grumbling tummy.
As you monitor progress, use what you find to re-evaluate goals and pinpoint where your client or patient needs more support.
Now Nora’s asking you about trying the Paleo diet instead. Looks like you have more research to do.
But keep in mind, over time, you’ll develop a solid grasp of the body of evidence on a number of topics. That’s the good part about science moving slowly: It’s not that hard to keep up.
What to do next.
Be empathetic, supportive, and flexible.
No matter what you believe is “right” or “true,” your first job is to work with your client, wherever they’re at.
Many practitioners intuitively know this, but the bond between coach and client (or patient) is extremely important and influential.
This bond is called the “therapeutic alliance,” and it refers to the level of trust and rapport between a practitioner and the person they’re helping.
Change is hard, and often scary. A strong therapeutic alliance can help a person feel supported and understood while surfing the tides of change.
In fact, some studies show the results a client or patient achieves in your care are up to 85 percent dependent on the therapeutic alliance. So, the stronger that relationship, the better the results.
If you’re constantly butting heads with your client, telling them, “But the research says!” or, “I know best!”, you can wave goodbye to a strong therapeutic alliance.
Many of the obstacles your clients will face are behavioral and emotional, rather than rational and theory-based. So more than facts, your clients often need compassion, support, and creativity to get them through the tough stuff.
Focus on the big rocks.
Given how complicated bodies and behavioral change are, it’s not surprising that science is still “trying to figure things out.”
Rather than using “cutting-edge” protocols like intermittent fasting or precise macronutrient ratios (which should really only be for more advanced clients anyway), focus on “big rocks” that offer the most bang for buck, like:
eating enough protein and vegetables
moving regularly
getting adequate sleep
managing stress
reducing smoking and/or excessive alcohol consumption
If that sounds boring or too obvious, we ask you this: How many people do you know who are consistently doing all five well? (In case you’re curious, it’s only about three to five percent of the population.)
Just managing those five things will keep most people plenty busy.
Be humble, throw out the rules, and keep learning.
The smartest people are often the ones who are most comfortable asking questions, saying “I don’t know,” and resting in uncertainty.
It’s a cliche but true: The more you know about something, the more you realize what you don’t know.
Be wary when others claim absolute certainty. It may be they don’t fully understand the complexity of the matter.
True expertise is about being comfortable with limited knowledge—while continuing to seek more and better information—and also accepting we may never have complete certainty.
Experiment wisely, and learn from both successes and failures.
Want to see how a theory works in practice? Test it out on yourself, and measure your experience as objectively as possible.
With clients, so long as there is no risk of harm, try out well-informed experiments (with their permission) that are either based on research or expert theory. Then, as always, track and measure their experiences and results to inform your next steps.
Know what you don’t know and work with other experts as needed.
Especially if you’re a beginner in your practice, it’s okay not to know stuff.
Focus on what you know best, whether that’s good lifting form, coming up with healthy meal ideas, or giving support during sticky coaching situations. But also know that some things will be out of your scope of practice.
So build a strong professional network—which could include family doctors, dietitians, massage therapists, naturopaths, chiropractors, and psychotherapists—and refer out whenever you encounter something you feel uncomfortable or especially inexperienced with.
Establishing a deep roster of experts will help clients get the support they need. And we’re pretty sure the evidence will show that’s good for everyone.
If you’re a coach, or you want to be…
Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes—in way that’s evidenced based and personalized for each individual’s lifestyle and preferences—is both an art and a science.
If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certification. The next group kicks off shortly.
What’s it all about?
The Precision Nutrition Level 1 Certification is the world’s most respected nutrition education program. It gives you the knowledge, systems, and tools you need to really understand how food influences a person’s health and fitness. Plus the ability to turn that knowledge into a thriving coaching practice.
Developed over 15 years, and proven with over 100,000 clients and patients, the Level 1 curriculum stands alone as the authority on the science of nutrition and the art of coaching.
Whether you’re already mid-career, or just starting out, the Level 1 Certification is your springboard to a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results.
[Of course, if you’re already a student or graduate of the Level 1 Certification, check out our Level 2 Certification Master Class. It’s an exclusive, year-long mentorship designed for elite professionals looking to master the art of coaching and be part of the top 1% of health and fitness coaches in the world.]
Interested? Add your name to the presale list. You’ll save up to 33% and secure your spot 24 hours before everyone else.
We’ll be opening up spots in our next Precision Nutrition Level 1 Certification on Wednesday, April 3rd, 2019.
If you want to find out more, we’ve set up the following presale list, which gives you two advantages.
Pay less than everyone else. We like to reward people who are eager to boost their credentials and are ready to commit to getting the education they need. So we’re offering a discount of up to 33% off the general price when you sign up for the presale list.
Sign up 24 hours before the general public and increase your chances of getting a spot. We only open the certification program twice per year. Due to high demand, spots in the program are limited and have historically sold out in a matter of hours. But when you sign up for the presale list, we’ll give you the opportunity to register a full 24 hours before anyone else.
If you’re ready for a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results… this is your chance to see what the world’s top professional nutrition coaching system can do for you.
jQuery(document).ready(function(){ jQuery("#references_link").click(function(){ jQuery("#references_holder").show(); jQuery("#references_link").parent().hide(); }); });
References
Click here to view the information sources referenced in this article.
Balachandran, A. & Schoenfeld, B. (2017, March 2) Evidence-based practice in Exercise and Nutrition: Common Misconceptions and Criticisms. Retrieved from https://www.lookgreatnaked.com/blog/evidence-based-practice-in-exercise-and-nutrition-common-misconceptions-and-criticisms/
Baldwin, S.A., Wampold, B.E., & Imel, Z E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842–852.
Cabaniss, D. L. (2012, May 31) The Therapeutic Alliance: The Essential Ingredient for Psychotherapy. Retrieved from https://www.huffpost.com/entry/therapeutic-alliance_b_1554007?fbclid=IwAR1NDl7sNR60OSvNFWmpTUA-GqAV65fMtxsOrOFAQ9fLM5Z5eQlcRR4APbU
Duke University. (2018). Introduction to Evidence-Based Practice. Retrieved from https://guides.mclibrary.duke.edu/ebmtutorial/home
Erskine, R.M., Jones, D.A., Williams, A.G., Stewart, C.E. & Degens, H. (2010) Inter-individual variability in the adaptation of human muscle specific tension to progressive resistance training. European Journal of Applied Physiology, 110(6), 1117-25.
Evidence-Based Medicine Working Group. (1992) Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. Journal of the American Medical Association, 268(17), 2420-5.
Frances, A.J. (2013, June 24) What Should Doctors Do When They Don’t Know What to Do? Retrieved from https://www.psychologytoday.com/us/blog/saving-normal/201306/what-should-doctors-do-when-they-dont-know-what-do?fbclid=IwAR3ce99uT-RDXcp_yvnJ0r2aTfBPWPpngqNUvkIc5a6PBZkyr5d-Z8sgy2Y
Joyce, A.S. & Piper, W.E. (1998) Expectancy, the Therapeutic Alliance, and Treatment Outcome in Short-Term Individual Psychotherapy. The Journal of Psychotherapy Practice and Research, 7(3), 236–248.
Löfgren, K. [Kent Löfgren]. (2013, February 25). What is epistemology? Introduction to the word and the concept [Video File]. Retrieved from https://www.youtube.com/watch?v=lI9-YgSzsEQ
Ludwig, J. (2018, April 16) Here’s what is going wrong with ‘evidence-based’ policies and practices in schools in Australia. Retrieved from https://www.aare.edu.au/blog/?p=2822
Schoenfeld, B.J., Contreras, B, Krieger, J., Grgic, J., Delcastillo, K., Belliard, R. & Alto, A. (2019) Resistance Training Volume Enhances Muscle Hypertrophy but Not Strength in Trained Men. Medicine & Science in Sports & Exercise, 51(1), 94-103.
Wampold, B. E. (2001). The great psychotherapy debate:Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum. NJ: Lawrence Erlbaum.
Evidence-Based Medicine Toolbox. (2017) Retrieved from https://ebm-tools.knowledgetranslation.net/
Evidence-based practice. (2018, November 19) Retrieved from https://en.wikipedia.org/wiki/Evidence-based_practice?fbclid=IwAR3ARk06zmx_lJYPIrTGA_chfBa9v_-NsW7HQbC7-rTHaq-Y7AYcSdLAk80
The well-built clinical question: a key to evidence-based decisions. (1995). Retrieved from https://mclibrary.duke.edu/sites/mclibrary.duke.edu/files/public/guides/richardson.pdf
The post Evidence-based coaching: Why some health and fitness pros are doing it all wrong. appeared first on Precision Nutrition.
Evidence-based coaching: Why some health and fitness pros are doing it all wrong. published first on
0 notes
oovitus · 6 years
Text
Evidence-based coaching: Why some health and fitness pros are doing it all wrong.
Ask any health and fitness professional if they’re “evidence based,” and chances are good you’ll get a resounding, “Yes!” Perhaps even an indignant one. After all, everyone uses evidence… of some sort. But if you think evidence-based practice is only what “research says,” you’re doing it wrong. In this article, we’ll show you the right way to use evidence to inform and enhance your coaching—for more effective advice and better client results. 
++++
Here at Precision Nutrition, we love science.
In fact, no one loves science more than us!
But is it possible to rely too heavily on scientific literature? Can you actually science too much?
Maybe.
Ever see someone:
Dismiss a coach’s successful method solely because some element of it isn’t “research proven?”
Refuse to modify a nutrition plan—even though a client hates it—“because science?”
Call a respected health professional a “quack” because they cite years of clinical experience instead of a definitive clinical trial?
(If you haven’t, you probably don’t spend much time in Facebook comments.)
In each case, the person’s inflated reverence for research could be limiting their ability to learn, and evolve as a coach. They might also influence others to follow their narrow line of thinking, causing them to miss out, too. And this is often done in the name of “evidenced based practice.”
Now, evidence-based practice, or EBP, is all the rage in certain health and fitness circles, which is a great thing. We heart science, remember? Except there’s just one problem…
A lot of coaches, though well-meaning, are getting EBP wrong. Specifically, they’re over-emphasizing “what the research says” to the exclusion of other relevant information, like their professional experience and the personal preferences and values of the people they work with.
And that’s not good for clients, business, or the health and fitness industry.
To make sure you get EBP right, use this guide to understand what the method really is, why it matters, and how to implement it effectively in your own coaching practice.
Because when used correctly, EBP is a powerful tool that’ll make you a better coach—so you can help even more people achieve lasting change and deep health.
And that we love even more than science.
+++
What is “evidence”?
There’s “everyday life” evidence.
In our Precision Nutrition Coaching program and Certifications, we tell our clients and coaches to use outcome-based decision making (OBDM).
Very simply, that means you decide what to do next based on the data you got from what you just did.
Did your waist measurement go up after two weeks of vacation buffets? That’s data that says, “Welcome home, maybe dial it back a little.”
Did your blood pressure go down after four months of sticking to your exercise program? That’s data that says, “Keep up the good work!”
We tell our coaches and clients to use as many data points as they can, and look for progress everywhere, including:
body measurements
blood work and other medical tests
athletic performance, such as getting stronger or faster
photos
how clothes fit
recovery
sleep
mood and wellbeing
confidence
consistency
And so on. (Here are some more ideas.)
All of these data points, collectively, give us evidence that we can use to make informed choices.
Then there’s scientific evidence.
This includes clinical or case studies, experimental research, basic research (for instance, studying cells in culture), and more.
This evidence can vary widely in quality, who is studied, and how applicable the results are to you and your clients.
However, in general, scientific evidence is one of the best ways we have to know about the nature of reality.
And though it might be obvious, we’re compelled to say it anyway: You’re looking to glean these insights directly from reputable, peer-reviewed scientific papers—not random websites, articles in magazines, or pictures of sunsets with words on them.
Finally, there’s stuff you learn on the job.
We call this “expertise.” It’s the old coach’s intuition, the senior clinician’s knack for diagnosis, the way a master carpenter can tell you if something is a quarter inch off square just by looking.
After you’ve worked with over 100,000 clients, as we have, you start to build a database of collected wisdom. And often, there’s stuff that’s hard to explain or defend—you’ve just seen it enough times that you know it’s a thing.
When we bring together experience, research, and expertise, we have a pretty good set of working hypotheses about what is likely to be effective.
And that’s evidenced-based practice. So it’s not just about clinical research.
EBP is a systematic way of thinking and application that integrates scientific data with clinical experience and the individual needs and preferences of each client or patient.
Yes, that’s the official, eye-glazing definition, but you might find the Instagram-able version even more enlightening. (See the illustration below.)
All three parts are equally important.
That’s because:
1. You aren’t coaching research averages. You’re coaching people.
Most studies report the average results of an intervention. (This is especially true of their headlines.)
Yet, if we look at the actual data of most studies, we see that individual results tend to fall on a bell curve of some sort.
Take this example, noted by James Krieger and Bret Contreras.
A study on resistance training and muscle gain concluded the following:
“Previously untrained people who engaged in resistance training three times a week for 9 weeks increased their muscle mass by 6%.”
Based on that, you might expect a client to achieve similar results on your three-day-a-week program.
But if you look at the individual data within the study, muscle growth ranged from -2.5 to 20 percent. That’s right: minus 2.5 percent. As Krieger and Contreras point out, five of the 53 participants actually lost muscle!
That’s not to suggest the research results are misleading. In fact, most of the study participants experienced muscle mass gains between 5 and 10 percent, and some even more. However, it does show the overall findings may not to apply to every individual. So don’t expect them to.
Another example is broccoli. There’s a significant body of evidence supporting the health benefits of eating this nutrient-dense vegetable.
But if broccoli makes someone gaggy or gassy, it’s not the healthiest food for them, no matter what the research says about it lowering disease risk.
These kinds of patterns happen over and over: Some people get great results from applying the research, some get very little (or negative) results, and most get results somewhere in between.
This is reality.
Research can be incredibly useful for giving us a starting point for most people. But humans differ—often wildly—from one another.
They differ in terms of their habits, mindset, physiology, environment, and personal preferences. They also differ in their ability to follow a program in the first place. And even if they stick to a plan perfectly, they can differ in the results they get.
Coach for the unique human in front of you, not for an average.
Not only will this improve your client results (because you’ll be working with their particular, practical reality), it’ll also improve your client retention (because you’ll be actually listening to them and trying to understand them as individual people, not as data sets).
When a client is suffering, they probably don’t need you to search PubMed for more evidence.
They often need you to provide a solid, trusting coaching relationship and, of course, your coaching skills. This combination can help you ease client resistance, be creative and flexible when typical solutions don’t work, and be compassionate and supportive when a client struggles with dark stuff.
2. Your professional experience really matters.
If you’re a mindful, growth-oriented coach or practitioner, it’s impossible not to develop a certain degree of experience and expertise over time.
A lot of things go into your “expertise bucket”: courses and programs you’ve taken; books you’ve read; lectures you’ve attended; mentoring relationships you’ve had; and all the practical experience you’ve acquired from observing and coaching clients or patients.
The accumulation of knowledge and experience gives you a kind of “intuition” that can help you coach more effectively.
This “intuition” shows up when you see a client perform a wonky squat, quickly identify exactly what’s wrong, and make corrections to improve form.
It shows up when you perform a client intake, and based on their answers (Just had a baby! Prone to perfectionism!), you can anticipate what aspects of a program they might struggle with, and how you might help them.
Or it shows up when you do a postural assessment, and immediately know which exercises to avoid and which could be helpful.
Much of the time, this is knowledge you could have never learned simply from reading studies. It requires time working with people, and exposing yourself to new ideas and methods, including those that have yet to be studied.
But there’s a challenge here, too. The knowledge we gather from our experiences is very prone to human error: Our memories are unreliable, we see patterns that may not actually exist, and we discount information that doesn’t conform to what we already believe.
How can we reduce human error?
First, be aware that bias and error exist… yes, even for you.
Take notes during or after client sessions, and use a variety of validated measurement tools—such as weight, body measurements, pictures, mood scales, and sleep quality scales—to track the effectiveness of your advice.
Get mentorship and feedback on your practice. Coaches need coaches. Or, find a like-minded group of professionals with whom to collaborate. (That’s why we developed the Precision Nutrition Level 2 Certification.)
If you’re aware of the errors you’re likely to make, and take steps to moderate them, you might start to see some reliable, overarching patterns.
Like that very rigid meal plans don’t work for people in the long term. Or that people can only train so long and so hard before they burn out.
Or a thousand other possibilities experienced coaches notice, but perhaps haven’t been fully validated by published research.
If you’re just starting out and don’t have the experience gained from coaching many people over many years, you can “borrow” insight from mentors or other coaches with more reps under their belt.
Drawing on the wisdom of your (or a colleague’s) accumulated experience is an essential part of being a good practitioner.
3. Science will never have it all figured out.
The evidence is always evolving. Nutrition research in particular is a relatively new area, and there’s still a lot to be learned.
Plus, some things are really hard (or downright unethical) to test in a research setting, and so we may never have scientific evidence on it.
Even if it is possible to test, quality research takes a long time to gather. Usually, one study isn’t enough to “prove” something true or false. But waiting for multiple studies on a specific topic, or better yet, a meta-analyses (which is kind of like a poll of the research) may require a lot of patience. Maybe decades.
And yet, we still have to help our clients and patients make informed decisions. Like, now.
That’s where evidence-based practice comes in.
The RIGHT way to use EBP.
You can formally apply the EBP process to coaching decisions that feel especially important or uncertain.
EBP offers one of the best tools to help you reach a decision that’s most likely to be safe and effective, and that’ll also make sense in the context of your client’s life.
Follow these 6 steps to see EBP in action.
1. Assess the client.
Identify their unique abilities and needs.
What are their strengths?
Where might they need help from you?
What are their precise goals?
What are their identities, values, and beliefs?
Gather this information by asking questions, using intake forms, and taking measurements. This’ll help you create an initial plan of action and also provide a baseline against which to gauge progress.
Plus, as you collect data on many clients, you’ll be accruing practical evidence that can aid with decision making in the future.
Let’s use a hypothetical client to apply these steps.
Her name is Nora. Her goal is to lose fat, and she’s also interested in intermittent fasting. Through your initial assessment you learn that she’s begun to show signs of perimenopause, and her sleep isn’t great these days.
2. Find your research question.
Before you jump to a solution, get clear on the problem you’re trying to help your client with. 
Then, turn the problem into a question that’ll help you isolate the evidence you need for your recommendations. This question should incorporate the problem, as well as relevant factors about your client or patient.
Nora’s main goal is to lose fat, and she’s curious about intermittent fasting. Important factors to consider: Nora is a woman and she’s perimenopausal.
But you’re not sure if intermittent fasting is safe (or effective) for losing fat. And you’re definitely not sure if it’s safe (or effective) for a perimenopausal woman.
So your research question might be: “Is intermittent fasting safe and effective for fat loss in perimenopausal women?”
3. Gather the evidence.
Search for info using an online database like PubMed or Google Scholar. (If you don’t know how to use online research databases, here’s a PubMed tutorial.)
Using a research database will curate your hits so you’re only getting original, peer-reviewed research, rather than someone else’s (potentially biased) interpretation of it.
To find relevant research for Nora, a good keyword combination to type in a search box could be “intermittent fasting + fat loss + menopause”. These keywords contain the intervention you’re interested in learning more about, plus information about Nora’s unique goals and life stage.
To identify the best available scientific evidence on the research subject, use the “Hierarchy of Evidence” pyramid below. The higher up on the pyramid, the more trustworthy the information. So start your search from the top down.
In the case of Nora, prioritize finding a position stand, a meta-analysis, or a systematic review on using intermittent fasting for fat loss in menopausal women. This will give you a comprehensive overview of the current evidence. Basically, scientists and/or academics have already done the hard work—of reviewing, comparing, and analyzing the available scientific evidence—for you.
If that doesn’t exist, look for randomized control trials that compare appropriately chosen groups of people with a control group (such as a group that received no intervention, or a different intervention).
No luck there? You can expand your search to just “women” rather than “menopausal women.” Depending on what’s available, you may have to continue broadening your search and moving down the hierarchy of evidence.
Now, if you’re not well-versed in reading studies or interpreting research, that’s okay. Chances are, if you don’t find a meta-analysis or review, or—best of all—a position stand, the research further down the pyramid will be of limited use to you anyway.
If that’s the case—or you can’t find any scientific research on the topic—you might have to use opinions from other trusted experts, or develop an educated hypothesis based on your own knowledge of how physiology and nutrition work. This still counts as evidence, it’s just not as reliable, so temper your confidence in it accordingly.
All hail the position stand.
If you don’t feel equipped to navigate and interpret scientific literature, consider looking for best practice guidelines or position stands written by an authority in your field.
Position stands are official statements made by a governing body on topics related to a particular field, like nutrition, exercise physiology, dietetics, or medicine.
Here’s an example: The 2017 International Society of Sports Nutrition Position Stand on protein and exercise.
If you have a client who’s older and you’re wondering how to safely increase their training capacity (but don’t want to immerse yourself in a dark hole of research), simply look for the position stand on exercise and older adults.
To find the position stands in your field, consult the website of whatever governing body you belong to.
For example, if you’re a personal trainer certified through ACSM, NASM, ACE, or NSCA, consult the respective website for each organization. They should feature position stands on a variety of topics.
4. Appraise the evidence.
Through your search, you’ll probably find at least some evidence. This might be just a few small studies or some articles from trusted experts in the field.
Now, using the hierarchy of evidence, determine how valid and reliable those pieces of evidence are.
The more you have to broaden your question or move down the quality hierarchy, the less confident you might be about your recommendations.
With Nora, if all you find are some articles by an internet guru who’s never actually seen any real clients, you may want to present your findings as a mere idea, rather than as reliable advice.
On the other hand, if you find a handful of systematic reviews about intermittent fasting in menopausal women, you can go to Nora with more confidence about your recommendations. (Quick fact check, FYI: We couldn’t find any reputable systematic reviews on intermittent fasting in menopausal women.)
5. Create your recommendation.
Unless they ask for it, most clients don’t want to know all the complicated science stuff; they just want to know what to do.
This is where the science of coaching morphs into the art of coaching.
It’s time to see if you can actually apply the evidence you’ve found—along with your own professional experience—to the complex, real, live human standing in front of you.
Notice that the evidence by itself doesn’t make the decision. Nor does your experience, nor do the client’s preferences.
The three simply offer a more holistic perspective on a problem, to ensure you find the best possible solution for your client.
Rather than plunking down a stack of research in front of your client, combine the research with your expertise and your client’s unique circumstances to translate it into practical advice.
It could work like this: Through your research, you find that intermittent fasting is effective for fat loss. However, through your own professional experience, you’ve also noticed that most clients struggle to stick with intermittent fasting long-term. (Aligning nicely with your coaching experience, the research also shows a relatively high drop-out rate with intermittent fasting.)
You’ve also noticed that in some of your female clients, intermittent fasting seems to deregulate menstrual cycles and exacerbate menopausal symptoms.
Thinking about Nora’s unique values and preferences, you know that she wants to lose weight, but you also know that she’s had some trouble sleeping lately. In your experience with other clients, people who are sleep-deprived have an extra-hard time regulating appetite and losing weight.
So… intermittent fasting seems to be effective, but combined with your concerns about Nora’s hormonal health and sleep quality, plus the fact that intermittent fasting can be hard to maintain, you may decide not to recommend it to Nora.
After explaining to her your reasoning, explore with her what she’s comfortable trying. In the end, you may suggest some simple nutrition habits along with some short fasting experiments, plus some sleep tips.
These recommendations include what you’ve found from the best available research, your own coaching experience, and Nora’s unique preferences, goals, and challenges.
Nora’s just gotten some pretty wise, tailored-to-her advice, where you worked as collaborators to come up with her action plan.
That’s the art and science of coaching.
6. Monitor the results.
Once you’ve given your client a little time to practice what you came up with together, you can assess if those actions are working.
Consult those measurements you took in your initial assessments. Compare them to current measurements.
Are things moving in the right direction?
And talk to your client about how the plan is working.
Nora tells you although she’s applying and benefitting from the sleep tips, she’s struggling with fasting, even the shorter experiments. Turns out, it’s hard to fast when you’re having trouble falling asleep because of a grumbling tummy.
As you monitor progress, use what you find to re-evaluate goals and pinpoint where your client or patient needs more support.
Now Nora’s asking you about trying the Paleo diet instead. Looks like you have more research to do.
But keep in mind, over time, you’ll develop a solid grasp of the body of evidence on a number of topics. That’s the good part about science moving slowly: It’s not that hard to keep up.
What to do next.
Be empathetic, supportive, and flexible.
No matter what you believe is “right” or “true,” your first job is to work with your client, wherever they’re at.
Many practitioners intuitively know this, but the bond between coach and client (or patient) is extremely important and influential.
This bond is called the “therapeutic alliance,” and it refers to the level of trust and rapport between a practitioner and the person they’re helping.
Change is hard, and often scary. A strong therapeutic alliance can help a person feel supported and understood while surfing the tides of change.
In fact, some studies show the results a client or patient achieves in your care are up to 85 percent dependent on the therapeutic alliance. So, the stronger that relationship, the better the results.
If you’re constantly butting heads with your client, telling them, “But the research says!” or, “I know best!”, you can wave goodbye to a strong therapeutic alliance.
Many of the obstacles your clients will face are behavioral and emotional, rather than rational and theory-based. So more than facts, your clients often need compassion, support, and creativity to get them through the tough stuff.
Focus on the big rocks.
Given how complicated bodies and behavioral change are, it’s not surprising that science is still “trying to figure things out.”
Rather than using “cutting-edge” protocols like intermittent fasting or precise macronutrient ratios (which should really only be for more advanced clients anyway), focus on “big rocks” that offer the most bang for buck, like:
eating enough protein and vegetables
moving regularly
getting adequate sleep
managing stress
reducing smoking and/or excessive alcohol consumption
If that sounds boring or too obvious, we ask you this: How many people do you know who are consistently doing all five well? (In case you’re curious, it’s only about three to five percent of the population.)
Just managing those five things will keep most people plenty busy.
Be humble, throw out the rules, and keep learning.
The smartest people are often the ones who are most comfortable asking questions, saying “I don’t know,” and resting in uncertainty.
It’s a cliche but true: The more you know about something, the more you realize what you don’t know.
Be wary when others claim absolute certainty. It may be they don’t fully understand the complexity of the matter.
True expertise is about being comfortable with limited knowledge—while continuing to seek more and better information—and also accepting we may never have complete certainty.
Experiment wisely, and learn from both successes and failures.
Want to see how a theory works in practice? Test it out on yourself, and measure your experience as objectively as possible.
With clients, so long as there is no risk of harm, try out well-informed experiments (with their permission) that are either based on research or expert theory. Then, as always, track and measure their experiences and results to inform your next steps.
Know what you don’t know and work with other experts as needed.
Especially if you’re a beginner in your practice, it’s okay not to know stuff.
Focus on what you know best, whether that’s good lifting form, coming up with healthy meal ideas, or giving support during sticky coaching situations. But also know that some things will be out of your scope of practice.
So build a strong professional network—which could include family doctors, dietitians, massage therapists, naturopaths, chiropractors, and psychotherapists—and refer out whenever you encounter something you feel uncomfortable or especially inexperienced with.
Establishing a deep roster of experts will help clients get the support they need. And we’re pretty sure the evidence will show that’s good for everyone.
If you’re a coach, or you want to be…
Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes—in way that’s evidenced based and personalized for each individual’s lifestyle and preferences—is both an art and a science.
If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certification. The next group kicks off shortly.
What’s it all about?
The Precision Nutrition Level 1 Certification is the world’s most respected nutrition education program. It gives you the knowledge, systems, and tools you need to really understand how food influences a person’s health and fitness. Plus the ability to turn that knowledge into a thriving coaching practice.
Developed over 15 years, and proven with over 100,000 clients and patients, the Level 1 curriculum stands alone as the authority on the science of nutrition and the art of coaching.
Whether you’re already mid-career, or just starting out, the Level 1 Certification is your springboard to a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results.
[Of course, if you’re already a student or graduate of the Level 1 Certification, check out our Level 2 Certification Master Class. It’s an exclusive, year-long mentorship designed for elite professionals looking to master the art of coaching and be part of the top 1% of health and fitness coaches in the world.]
Interested? Add your name to the presale list. You’ll save up to 33% and secure your spot 24 hours before everyone else.
We’ll be opening up spots in our next Precision Nutrition Level 1 Certification on Wednesday, April 3rd, 2019.
If you want to find out more, we’ve set up the following presale list, which gives you two advantages.
Pay less than everyone else. We like to reward people who are eager to boost their credentials and are ready to commit to getting the education they need. So we’re offering a discount of up to 33% off the general price when you sign up for the presale list.
Sign up 24 hours before the general public and increase your chances of getting a spot. We only open the certification program twice per year. Due to high demand, spots in the program are limited and have historically sold out in a matter of hours. But when you sign up for the presale list, we’ll give you the opportunity to register a full 24 hours before anyone else.
If you’re ready for a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results… this is your chance to see what the world’s top professional nutrition coaching system can do for you.
jQuery(document).ready(function(){ jQuery("#references_link").click(function(){ jQuery("#references_holder").show(); jQuery("#references_link").parent().hide(); }); });
References
Click here to view the information sources referenced in this article.
Balachandran, A. & Schoenfeld, B. (2017, March 2) Evidence-based practice in Exercise and Nutrition: Common Misconceptions and Criticisms. Retrieved from https://www.lookgreatnaked.com/blog/evidence-based-practice-in-exercise-and-nutrition-common-misconceptions-and-criticisms/
Baldwin, S.A., Wampold, B.E., & Imel, Z E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842–852.
Cabaniss, D. L. (2012, May 31) The Therapeutic Alliance: The Essential Ingredient for Psychotherapy. Retrieved from https://www.huffpost.com/entry/therapeutic-alliance_b_1554007?fbclid=IwAR1NDl7sNR60OSvNFWmpTUA-GqAV65fMtxsOrOFAQ9fLM5Z5eQlcRR4APbU
Duke University. (2018). Introduction to Evidence-Based Practice. Retrieved from https://guides.mclibrary.duke.edu/ebmtutorial/home
Erskine, R.M., Jones, D.A., Williams, A.G., Stewart, C.E. & Degens, H. (2010) Inter-individual variability in the adaptation of human muscle specific tension to progressive resistance training. European Journal of Applied Physiology, 110(6), 1117-25.
Evidence-Based Medicine Working Group. (1992) Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. Journal of the American Medical Association, 268(17), 2420-5.
Frances, A.J. (2013, June 24) What Should Doctors Do When They Don’t Know What to Do? Retrieved from https://www.psychologytoday.com/us/blog/saving-normal/201306/what-should-doctors-do-when-they-dont-know-what-do?fbclid=IwAR3ce99uT-RDXcp_yvnJ0r2aTfBPWPpngqNUvkIc5a6PBZkyr5d-Z8sgy2Y
Joyce, A.S. & Piper, W.E. (1998) Expectancy, the Therapeutic Alliance, and Treatment Outcome in Short-Term Individual Psychotherapy. The Journal of Psychotherapy Practice and Research, 7(3), 236–248.
Löfgren, K. [Kent Löfgren]. (2013, February 25). What is epistemology? Introduction to the word and the concept [Video File]. Retrieved from https://www.youtube.com/watch?v=lI9-YgSzsEQ
Ludwig, J. (2018, April 16) Here’s what is going wrong with ‘evidence-based’ policies and practices in schools in Australia. Retrieved from https://www.aare.edu.au/blog/?p=2822
Schoenfeld, B.J., Contreras, B, Krieger, J., Grgic, J., Delcastillo, K., Belliard, R. & Alto, A. (2019) Resistance Training Volume Enhances Muscle Hypertrophy but Not Strength in Trained Men. Medicine & Science in Sports & Exercise, 51(1), 94-103.
Wampold, B. E. (2001). The great psychotherapy debate:Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum. NJ: Lawrence Erlbaum.
Evidence-Based Medicine Toolbox. (2017) Retrieved from https://ebm-tools.knowledgetranslation.net/
Evidence-based practice. (2018, November 19) Retrieved from https://en.wikipedia.org/wiki/Evidence-based_practice?fbclid=IwAR3ARk06zmx_lJYPIrTGA_chfBa9v_-NsW7HQbC7-rTHaq-Y7AYcSdLAk80
The well-built clinical question: a key to evidence-based decisions. (1995). Retrieved from https://mclibrary.duke.edu/sites/mclibrary.duke.edu/files/public/guides/richardson.pdf
The post Evidence-based coaching: Why some health and fitness pros are doing it all wrong. appeared first on Precision Nutrition.
Evidence-based coaching: Why some health and fitness pros are doing it all wrong. published first on https://storeseapharmacy.tumblr.com
0 notes
oovitus · 6 years
Text
Evidence-based coaching: Why some health and fitness pros are doing it all wrong.
Ask any health and fitness professional if they’re “evidence based,” and chances are good you’ll get a resounding, “Yes!” Perhaps even an indignant one. After all, everyone uses evidence… of some sort. But if you think evidence-based practice is only what “research says,” you’re doing it wrong. In this article, we’ll show you the right way to use evidence to inform and enhance your coaching—for more effective advice and better client results. 
++++
Here at Precision Nutrition, we love science.
In fact, no one loves science more than us!
But is it possible to rely too heavily on scientific literature? Can you actually science too much?
Maybe.
Ever see someone:
Dismiss a coach’s successful method solely because some element of it isn’t “research proven?”
Refuse to modify a nutrition plan—even though a client hates it—“because science?”
Call a respected health professional a “quack” because they cite years of clinical experience instead of a definitive clinical trial?
(If you haven’t, you probably don’t spend much time in Facebook comments.)
In each case, the person’s inflated reverence for research could be limiting their ability to learn, and evolve as a coach. They might also influence others to follow their narrow line of thinking, causing them to miss out, too. And this is often done in the name of “evidenced based practice.”
Now, evidence-based practice, or EBP, is all the rage in certain health and fitness circles, which is a great thing. We heart science, remember? Except there’s just one problem…
A lot of coaches, though well-meaning, are getting EBP wrong. Specifically, they’re over-emphasizing “what the research says” to the exclusion of other relevant information, like their professional experience and the personal preferences and values of the people they work with.
And that’s not good for clients, business, or the health and fitness industry.
To make sure you get EBP right, use this guide to understand what the method really is, why it matters, and how to implement it effectively in your own coaching practice.
Because when used correctly, EBP is a powerful tool that’ll make you a better coach—so you can help even more people achieve lasting change and deep health.
And that we love even more than science.
+++
What is “evidence”?
There’s “everyday life” evidence.
In our Precision Nutrition Coaching program and Certifications, we tell our clients and coaches to use outcome-based decision making (OBDM).
Very simply, that means you decide what to do next based on the data you got from what you just did.
Did your waist measurement go up after two weeks of vacation buffets? That’s data that says, “Welcome home, maybe dial it back a little.”
Did your blood pressure go down after four months of sticking to your exercise program? That’s data that says, “Keep up the good work!”
We tell our coaches and clients to use as many data points as they can, and look for progress everywhere, including:
body measurements
blood work and other medical tests
athletic performance, such as getting stronger or faster
photos
how clothes fit
recovery
sleep
mood and wellbeing
confidence
consistency
And so on. (Here are some more ideas.)
All of these data points, collectively, give us evidence that we can use to make informed choices.
Then there’s scientific evidence.
This includes clinical or case studies, experimental research, basic research (for instance, studying cells in culture), and more.
This evidence can vary widely in quality, who is studied, and how applicable the results are to you and your clients.
However, in general, scientific evidence is one of the best ways we have to know about the nature of reality.
And though it might be obvious, we’re compelled to say it anyway: You’re looking to glean these insights directly from reputable, peer-reviewed scientific papers—not random websites, articles in magazines, or pictures of sunsets with words on them.
Finally, there’s stuff you learn on the job.
We call this “expertise.” It’s the old coach’s intuition, the senior clinician’s knack for diagnosis, the way a master carpenter can tell you if something is a quarter inch off square just by looking.
After you’ve worked with over 100,000 clients, as we have, you start to build a database of collected wisdom. And often, there’s stuff that’s hard to explain or defend—you’ve just seen it enough times that you know it’s a thing.
When we bring together experience, research, and expertise, we have a pretty good set of working hypotheses about what is likely to be effective.
And that’s evidenced-based practice. So it’s not just about clinical research.
EBP is a systematic way of thinking and application that integrates scientific data with clinical experience and the individual needs and preferences of each client or patient.
Yes, that’s the official, eye-glazing definition, but you might find the Instagram-able version even more enlightening. (See the illustration below.)
All three parts are equally important.
That’s because:
1. You aren’t coaching research averages. You’re coaching people.
Most studies report the average results of an intervention. (This is especially true of their headlines.)
Yet, if we look at the actual data of most studies, we see that individual results tend to fall on a bell curve of some sort.
Take this example, noted by James Krieger and Bret Contreras.
A study on resistance training and muscle gain concluded the following:
“Previously untrained people who engaged in resistance training three times a week for 9 weeks increased their muscle mass by 6%.”
Based on that, you might expect a client to achieve similar results on your three-day-a-week program.
But if you look at the individual data within the study, muscle growth ranged from -2.5 to 20 percent. That’s right: minus 2.5 percent. As Krieger and Contreras point out, five of the 53 participants actually lost muscle!
That’s not to suggest the research results are misleading. In fact, most of the study participants experienced muscle mass gains between 5 and 10 percent, and some even more. However, it does show the overall findings may not to apply to every individual. So don’t expect them to.
Another example is broccoli. There’s a significant body of evidence supporting the health benefits of eating this nutrient-dense vegetable.
But if broccoli makes someone gaggy or gassy, it’s not the healthiest food for them, no matter what the research says about it lowering disease risk.
These kinds of patterns happen over and over: Some people get great results from applying the research, some get very little (or negative) results, and most get results somewhere in between.
This is reality.
Research can be incredibly useful for giving us a starting point for most people. But humans differ—often wildly—from one another.
They differ in terms of their habits, mindset, physiology, environment, and personal preferences. They also differ in their ability to follow a program in the first place. And even if they stick to a plan perfectly, they can differ in the results they get.
Coach for the unique human in front of you, not for an average.
Not only will this improve your client results (because you’ll be working with their particular, practical reality), it’ll also improve your client retention (because you’ll be actually listening to them and trying to understand them as individual people, not as data sets).
When a client is suffering, they probably don’t need you to search PubMed for more evidence.
They often need you to provide a solid, trusting coaching relationship and, of course, your coaching skills. This combination can help you ease client resistance, be creative and flexible when typical solutions don’t work, and be compassionate and supportive when a client struggles with dark stuff.
2. Your professional experience really matters.
If you’re a mindful, growth-oriented coach or practitioner, it’s impossible not to develop a certain degree of experience and expertise over time.
A lot of things go into your “expertise bucket”: courses and programs you’ve taken; books you’ve read; lectures you’ve attended; mentoring relationships you’ve had; and all the practical experience you’ve acquired from observing and coaching clients or patients.
The accumulation of knowledge and experience gives you a kind of “intuition” that can help you coach more effectively.
This “intuition” shows up when you see a client perform a wonky squat, quickly identify exactly what’s wrong, and make corrections to improve form.
It shows up when you perform a client intake, and based on their answers (Just had a baby! Prone to perfectionism!), you can anticipate what aspects of a program they might struggle with, and how you might help them.
Or it shows up when you do a postural assessment, and immediately know which exercises to avoid and which could be helpful.
Much of the time, this is knowledge you could have never learned simply from reading studies. It requires time working with people, and exposing yourself to new ideas and methods, including those that have yet to be studied.
But there’s a challenge here, too. The knowledge we gather from our experiences is very prone to human error: Our memories are unreliable, we see patterns that may not actually exist, and we discount information that doesn’t conform to what we already believe.
How can we reduce human error?
First, be aware that bias and error exist… yes, even for you.
Take notes during or after client sessions, and use a variety of validated measurement tools—such as weight, body measurements, pictures, mood scales, and sleep quality scales—to track the effectiveness of your advice.
Get mentorship and feedback on your practice. Coaches need coaches. Or, find a like-minded group of professionals with whom to collaborate. (That’s why we developed the Precision Nutrition Level 2 Certification.)
If you’re aware of the errors you’re likely to make, and take steps to moderate them, you might start to see some reliable, overarching patterns.
Like that very rigid meal plans don’t work for people in the long term. Or that people can only train so long and so hard before they burn out.
Or a thousand other possibilities experienced coaches notice, but perhaps haven’t been fully validated by published research.
If you’re just starting out and don’t have the experience gained from coaching many people over many years, you can “borrow” insight from mentors or other coaches with more reps under their belt.
Drawing on the wisdom of your (or a colleague’s) accumulated experience is an essential part of being a good practitioner.
3. Science will never have it all figured out.
The evidence is always evolving. Nutrition research in particular is a relatively new area, and there’s still a lot to be learned.
Plus, some things are really hard (or downright unethical) to test in a research setting, and so we may never have scientific evidence on it.
Even if it is possible to test, quality research takes a long time to gather. Usually, one study isn’t enough to “prove” something true or false. But waiting for multiple studies on a specific topic, or better yet, a meta-analyses (which is kind of like a poll of the research) may require a lot of patience. Maybe decades.
And yet, we still have to help our clients and patients make informed decisions. Like, now.
That’s where evidence-based practice comes in.
The RIGHT way to use EBP.
You can formally apply the EBP process to coaching decisions that feel especially important or uncertain.
EBP offers one of the best tools to help you reach a decision that’s most likely to be safe and effective, and that’ll also make sense in the context of your client’s life.
Follow these 6 steps to see EBP in action.
1. Assess the client.
Identify their unique abilities and needs.
What are their strengths?
Where might they need help from you?
What are their precise goals?
What are their identities, values, and beliefs?
Gather this information by asking questions, using intake forms, and taking measurements. This’ll help you create an initial plan of action and also provide a baseline against which to gauge progress.
Plus, as you collect data on many clients, you’ll be accruing practical evidence that can aid with decision making in the future.
Let’s use a hypothetical client to apply these steps.
Her name is Nora. Her goal is to lose fat, and she’s also interested in intermittent fasting. Through your initial assessment you learn that she’s begun to show signs of perimenopause, and her sleep isn’t great these days.
2. Find your research question.
Before you jump to a solution, get clear on the problem you’re trying to help your client with. 
Then, turn the problem into a question that’ll help you isolate the evidence you need for your recommendations. This question should incorporate the problem, as well as relevant factors about your client or patient.
Nora’s main goal is to lose fat, and she’s curious about intermittent fasting. Important factors to consider: Nora is a woman and she’s perimenopausal.
But you’re not sure if intermittent fasting is safe (or effective) for losing fat. And you’re definitely not sure if it’s safe (or effective) for a perimenopausal woman.
So your research question might be: “Is intermittent fasting safe and effective for fat loss in perimenopausal women?”
3. Gather the evidence.
Search for info using an online database like PubMed or Google Scholar. (If you don’t know how to use online research databases, here’s a PubMed tutorial.)
Using a research database will curate your hits so you’re only getting original, peer-reviewed research, rather than someone else’s (potentially biased) interpretation of it.
To find relevant research for Nora, a good keyword combination to type in a search box could be “intermittent fasting + fat loss + menopause”. These keywords contain the intervention you’re interested in learning more about, plus information about Nora’s unique goals and life stage.
To identify the best available scientific evidence on the research subject, use the “Hierarchy of Evidence” pyramid below. The higher up on the pyramid, the more trustworthy the information. So start your search from the top down.
In the case of Nora, prioritize finding a position stand, a meta-analysis, or a systematic review on using intermittent fasting for fat loss in menopausal women. This will give you a comprehensive overview of the current evidence. Basically, scientists and/or academics have already done the hard work—of reviewing, comparing, and analyzing the available scientific evidence—for you.
If that doesn’t exist, look for randomized control trials that compare appropriately chosen groups of people with a control group (such as a group that received no intervention, or a different intervention).
No luck there? You can expand your search to just “women” rather than “menopausal women.” Depending on what’s available, you may have to continue broadening your search and moving down the hierarchy of evidence.
Now, if you’re not well-versed in reading studies or interpreting research, that’s okay. Chances are, if you don’t find a meta-analysis or review, or—best of all—a position stand, the research further down the pyramid will be of limited use to you anyway.
If that’s the case—or you can’t find any scientific research on the topic—you might have to use opinions from other trusted experts, or develop an educated hypothesis based on your own knowledge of how physiology and nutrition work. This still counts as evidence, it’s just not as reliable, so temper your confidence in it accordingly.
All hail the position stand.
If you don’t feel equipped to navigate and interpret scientific literature, consider looking for best practice guidelines or position stands written by an authority in your field.
Position stands are official statements made by a governing body on topics related to a particular field, like nutrition, exercise physiology, dietetics, or medicine.
Here’s an example: The 2017 International Society of Sports Nutrition Position Stand on protein and exercise.
If you have a client who’s older and you’re wondering how to safely increase their training capacity (but don’t want to immerse yourself in a dark hole of research), simply look for the position stand on exercise and older adults.
To find the position stands in your field, consult the website of whatever governing body you belong to.
For example, if you’re a personal trainer certified through ACSM, NASM, ACE, or NSCA, consult the respective website for each organization. They should feature position stands on a variety of topics.
4. Appraise the evidence.
Through your search, you’ll probably find at least some evidence. This might be just a few small studies or some articles from trusted experts in the field.
Now, using the hierarchy of evidence, determine how valid and reliable those pieces of evidence are.
The more you have to broaden your question or move down the quality hierarchy, the less confident you might be about your recommendations.
With Nora, if all you find are some articles by an internet guru who’s never actually seen any real clients, you may want to present your findings as a mere idea, rather than as reliable advice.
On the other hand, if you find a handful of systematic reviews about intermittent fasting in menopausal women, you can go to Nora with more confidence about your recommendations. (Quick fact check, FYI: We couldn’t find any reputable systematic reviews on intermittent fasting in menopausal women.)
5. Create your recommendation.
Unless they ask for it, most clients don’t want to know all the complicated science stuff; they just want to know what to do.
This is where the science of coaching morphs into the art of coaching.
It’s time to see if you can actually apply the evidence you’ve found—along with your own professional experience—to the complex, real, live human standing in front of you.
Notice that the evidence by itself doesn’t make the decision. Nor does your experience, nor do the client’s preferences.
The three simply offer a more holistic perspective on a problem, to ensure you find the best possible solution for your client.
Rather than plunking down a stack of research in front of your client, combine the research with your expertise and your client’s unique circumstances to translate it into practical advice.
It could work like this: Through your research, you find that intermittent fasting is effective for fat loss. However, through your own professional experience, you’ve also noticed that most clients struggle to stick with intermittent fasting long-term. (Aligning nicely with your coaching experience, the research also shows a relatively high drop-out rate with intermittent fasting.)
You’ve also noticed that in some of your female clients, intermittent fasting seems to deregulate menstrual cycles and exacerbate menopausal symptoms.
Thinking about Nora’s unique values and preferences, you know that she wants to lose weight, but you also know that she’s had some trouble sleeping lately. In your experience with other clients, people who are sleep-deprived have an extra-hard time regulating appetite and losing weight.
So… intermittent fasting seems to be effective, but combined with your concerns about Nora’s hormonal health and sleep quality, plus the fact that intermittent fasting can be hard to maintain, you may decide not to recommend it to Nora.
After explaining to her your reasoning, explore with her what she’s comfortable trying. In the end, you may suggest some simple nutrition habits along with some short fasting experiments, plus some sleep tips.
These recommendations include what you’ve found from the best available research, your own coaching experience, and Nora’s unique preferences, goals, and challenges.
Nora’s just gotten some pretty wise, tailored-to-her advice, where you worked as collaborators to come up with her action plan.
That’s the art and science of coaching.
6. Monitor the results.
Once you’ve given your client a little time to practice what you came up with together, you can assess if those actions are working.
Consult those measurements you took in your initial assessments. Compare them to current measurements.
Are things moving in the right direction?
And talk to your client about how the plan is working.
Nora tells you although she’s applying and benefitting from the sleep tips, she’s struggling with fasting, even the shorter experiments. Turns out, it’s hard to fast when you’re having trouble falling asleep because of a grumbling tummy.
As you monitor progress, use what you find to re-evaluate goals and pinpoint where your client or patient needs more support.
Now Nora’s asking you about trying the Paleo diet instead. Looks like you have more research to do.
But keep in mind, over time, you’ll develop a solid grasp of the body of evidence on a number of topics. That’s the good part about science moving slowly: It’s not that hard to keep up.
What to do next.
Be empathetic, supportive, and flexible.
No matter what you believe is “right” or “true,” your first job is to work with your client, wherever they’re at.
Many practitioners intuitively know this, but the bond between coach and client (or patient) is extremely important and influential.
This bond is called the “therapeutic alliance,” and it refers to the level of trust and rapport between a practitioner and the person they’re helping.
Change is hard, and often scary. A strong therapeutic alliance can help a person feel supported and understood while surfing the tides of change.
In fact, some studies show the results a client or patient achieves in your care are up to 85 percent dependent on the therapeutic alliance. So, the stronger that relationship, the better the results.
If you’re constantly butting heads with your client, telling them, “But the research says!” or, “I know best!”, you can wave goodbye to a strong therapeutic alliance.
Many of the obstacles your clients will face are behavioral and emotional, rather than rational and theory-based. So more than facts, your clients often need compassion, support, and creativity to get them through the tough stuff.
Focus on the big rocks.
Given how complicated bodies and behavioral change are, it’s not surprising that science is still “trying to figure things out.”
Rather than using “cutting-edge” protocols like intermittent fasting or precise macronutrient ratios (which should really only be for more advanced clients anyway), focus on “big rocks” that offer the most bang for buck, like:
eating enough protein and vegetables
moving regularly
getting adequate sleep
managing stress
reducing smoking and/or excessive alcohol consumption
If that sounds boring or too obvious, we ask you this: How many people do you know who are consistently doing all five well? (In case you’re curious, it’s only about three to five percent of the population.)
Just managing those five things will keep most people plenty busy.
Be humble, throw out the rules, and keep learning.
The smartest people are often the ones who are most comfortable asking questions, saying “I don’t know,” and resting in uncertainty.
It’s a cliche but true: The more you know about something, the more you realize what you don’t know.
Be wary when others claim absolute certainty. It may be they don’t fully understand the complexity of the matter.
True expertise is about being comfortable with limited knowledge—while continuing to seek more and better information—and also accepting we may never have complete certainty.
Experiment wisely, and learn from both successes and failures.
Want to see how a theory works in practice? Test it out on yourself, and measure your experience as objectively as possible.
With clients, so long as there is no risk of harm, try out well-informed experiments (with their permission) that are either based on research or expert theory. Then, as always, track and measure their experiences and results to inform your next steps.
Know what you don’t know and work with other experts as needed.
Especially if you’re a beginner in your practice, it’s okay not to know stuff.
Focus on what you know best, whether that’s good lifting form, coming up with healthy meal ideas, or giving support during sticky coaching situations. But also know that some things will be out of your scope of practice.
So build a strong professional network—which could include family doctors, dietitians, massage therapists, naturopaths, chiropractors, and psychotherapists—and refer out whenever you encounter something you feel uncomfortable or especially inexperienced with.
Establishing a deep roster of experts will help clients get the support they need. And we’re pretty sure the evidence will show that’s good for everyone.
If you’re a coach, or you want to be…
Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes—in way that’s evidenced based and personalized for each individual’s lifestyle and preferences—is both an art and a science.
If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certification. The next group kicks off shortly.
What’s it all about?
The Precision Nutrition Level 1 Certification is the world’s most respected nutrition education program. It gives you the knowledge, systems, and tools you need to really understand how food influences a person’s health and fitness. Plus the ability to turn that knowledge into a thriving coaching practice.
Developed over 15 years, and proven with over 100,000 clients and patients, the Level 1 curriculum stands alone as the authority on the science of nutrition and the art of coaching.
Whether you’re already mid-career, or just starting out, the Level 1 Certification is your springboard to a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results.
[Of course, if you’re already a student or graduate of the Level 1 Certification, check out our Level 2 Certification Master Class. It’s an exclusive, year-long mentorship designed for elite professionals looking to master the art of coaching and be part of the top 1% of health and fitness coaches in the world.]
Interested? Add your name to the presale list. You’ll save up to 33% and secure your spot 24 hours before everyone else.
We’ll be opening up spots in our next Precision Nutrition Level 1 Certification on Wednesday, April 3rd, 2019.
If you want to find out more, we’ve set up the following presale list, which gives you two advantages.
Pay less than everyone else. We like to reward people who are eager to boost their credentials and are ready to commit to getting the education they need. So we’re offering a discount of up to 33% off the general price when you sign up for the presale list.
Sign up 24 hours before the general public and increase your chances of getting a spot. We only open the certification program twice per year. Due to high demand, spots in the program are limited and have historically sold out in a matter of hours. But when you sign up for the presale list, we’ll give you the opportunity to register a full 24 hours before anyone else.
If you’re ready for a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results… this is your chance to see what the world’s top professional nutrition coaching system can do for you.
jQuery(document).ready(function(){ jQuery("#references_link").click(function(){ jQuery("#references_holder").show(); jQuery("#references_link").parent().hide(); }); });
References
Click here to view the information sources referenced in this article.
Balachandran, A. & Schoenfeld, B. (2017, March 2) Evidence-based practice in Exercise and Nutrition: Common Misconceptions and Criticisms. Retrieved from https://www.lookgreatnaked.com/blog/evidence-based-practice-in-exercise-and-nutrition-common-misconceptions-and-criticisms/
Baldwin, S.A., Wampold, B.E., & Imel, Z E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842–852.
Cabaniss, D. L. (2012, May 31) The Therapeutic Alliance: The Essential Ingredient for Psychotherapy. Retrieved from https://www.huffpost.com/entry/therapeutic-alliance_b_1554007?fbclid=IwAR1NDl7sNR60OSvNFWmpTUA-GqAV65fMtxsOrOFAQ9fLM5Z5eQlcRR4APbU
Duke University. (2018). Introduction to Evidence-Based Practice. Retrieved from https://guides.mclibrary.duke.edu/ebmtutorial/home
Erskine, R.M., Jones, D.A., Williams, A.G., Stewart, C.E. & Degens, H. (2010) Inter-individual variability in the adaptation of human muscle specific tension to progressive resistance training. European Journal of Applied Physiology, 110(6), 1117-25.
Evidence-Based Medicine Working Group. (1992) Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. Journal of the American Medical Association, 268(17), 2420-5.
Frances, A.J. (2013, June 24) What Should Doctors Do When They Don’t Know What to Do? Retrieved from https://www.psychologytoday.com/us/blog/saving-normal/201306/what-should-doctors-do-when-they-dont-know-what-do?fbclid=IwAR3ce99uT-RDXcp_yvnJ0r2aTfBPWPpngqNUvkIc5a6PBZkyr5d-Z8sgy2Y
Joyce, A.S. & Piper, W.E. (1998) Expectancy, the Therapeutic Alliance, and Treatment Outcome in Short-Term Individual Psychotherapy. The Journal of Psychotherapy Practice and Research, 7(3), 236–248.
Löfgren, K. [Kent Löfgren]. (2013, February 25). What is epistemology? Introduction to the word and the concept [Video File]. Retrieved from https://www.youtube.com/watch?v=lI9-YgSzsEQ
Ludwig, J. (2018, April 16) Here’s what is going wrong with ‘evidence-based’ policies and practices in schools in Australia. Retrieved from https://www.aare.edu.au/blog/?p=2822
Schoenfeld, B.J., Contreras, B, Krieger, J., Grgic, J., Delcastillo, K., Belliard, R. & Alto, A. (2019) Resistance Training Volume Enhances Muscle Hypertrophy but Not Strength in Trained Men. Medicine & Science in Sports & Exercise, 51(1), 94-103.
Wampold, B. E. (2001). The great psychotherapy debate:Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum. NJ: Lawrence Erlbaum.
Evidence-Based Medicine Toolbox. (2017) Retrieved from https://ebm-tools.knowledgetranslation.net/
Evidence-based practice. (2018, November 19) Retrieved from https://en.wikipedia.org/wiki/Evidence-based_practice?fbclid=IwAR3ARk06zmx_lJYPIrTGA_chfBa9v_-NsW7HQbC7-rTHaq-Y7AYcSdLAk80
The well-built clinical question: a key to evidence-based decisions. (1995). Retrieved from https://mclibrary.duke.edu/sites/mclibrary.duke.edu/files/public/guides/richardson.pdf
The post Evidence-based coaching: Why some health and fitness pros are doing it all wrong. appeared first on Precision Nutrition.
Evidence-based coaching: Why some health and fitness pros are doing it all wrong. published first on
0 notes
oovitus · 6 years
Text
Evidence-based coaching: Why some health and fitness pros are doing it all wrong.
Ask any health and fitness professional if they’re “evidence based,” and chances are good you’ll get a resounding, “Yes!” Perhaps even an indignant one. After all, everyone uses evidence… of some sort. But if you think evidence-based practice is only what “research says,” you’re doing it wrong. In this article, we’ll show you the right way to use evidence to inform and enhance your coaching—for more effective advice and better client results. 
++++
Here at Precision Nutrition, we love science.
In fact, no one loves science more than us!
But is it possible to rely too heavily on scientific literature? Can you actually science too much?
Maybe.
Ever see someone:
Dismiss a coach’s successful method solely because some element of it isn’t “research proven?”
Refuse to modify a nutrition plan—even though a client hates it—“because science?”
Call a respected health professional a “quack” because they cite years of clinical experience instead of a definitive clinical trial?
(If you haven’t, you probably don’t spend much time in Facebook comments.)
In each case, the person’s inflated reverence for research could be limiting their ability to learn, and evolve as a coach. They might also influence others to follow their narrow line of thinking, causing them to miss out, too. And this is often done in the name of “evidenced based practice.”
Now, evidence-based practice, or EBP, is all the rage in certain health and fitness circles, which is a great thing. We heart science, remember? Except there’s just one problem…
A lot of coaches, though well-meaning, are getting EBP wrong. Specifically, they’re over-emphasizing “what the research says” to the exclusion of other relevant information, like their professional experience and the personal preferences and values of the people they work with.
And that’s not good for clients, business, or the health and fitness industry.
To make sure you get EBP right, use this guide to understand what the method really is, why it matters, and how to implement it effectively in your own coaching practice.
Because when used correctly, EBP is a powerful tool that’ll make you a better coach—so you can help even more people achieve lasting change and deep health.
And that we love even more than science.
+++
What is “evidence”?
There’s “everyday life” evidence.
In our Precision Nutrition Coaching program and Certifications, we tell our clients and coaches to use outcome-based decision making (OBDM).
Very simply, that means you decide what to do next based on the data you got from what you just did.
Did your waist measurement go up after two weeks of vacation buffets? That’s data that says, “Welcome home, maybe dial it back a little.”
Did your blood pressure go down after four months of sticking to your exercise program? That’s data that says, “Keep up the good work!”
We tell our coaches and clients to use as many data points as they can, and look for progress everywhere, including:
body measurements
blood work and other medical tests
athletic performance, such as getting stronger or faster
photos
how clothes fit
recovery
sleep
mood and wellbeing
confidence
consistency
And so on. (Here are some more ideas.)
All of these data points, collectively, give us evidence that we can use to make informed choices.
Then there’s scientific evidence.
This includes clinical or case studies, experimental research, basic research (for instance, studying cells in culture), and more.
This evidence can vary widely in quality, who is studied, and how applicable the results are to you and your clients.
However, in general, scientific evidence is one of the best ways we have to know about the nature of reality.
And though it might be obvious, we’re compelled to say it anyway: You’re looking to glean these insights directly from reputable, peer-reviewed scientific papers—not random websites, articles in magazines, or pictures of sunsets with words on them.
Finally, there’s stuff you learn on the job.
We call this “expertise.” It’s the old coach’s intuition, the senior clinician’s knack for diagnosis, the way a master carpenter can tell you if something is a quarter inch off square just by looking.
After you’ve worked with over 100,000 clients, as we have, you start to build a database of collected wisdom. And often, there’s stuff that’s hard to explain or defend—you’ve just seen it enough times that you know it’s a thing.
When we bring together experience, research, and expertise, we have a pretty good set of working hypotheses about what is likely to be effective.
And that’s evidenced-based practice. So it’s not just about clinical research.
EBP is a systematic way of thinking and application that integrates scientific data with clinical experience and the individual needs and preferences of each client or patient.
Yes, that’s the official, eye-glazing definition, but you might find the Instagram-able version even more enlightening. (See the illustration below.)
All three parts are equally important.
That’s because:
1. You aren’t coaching research averages. You’re coaching people.
Most studies report the average results of an intervention. (This is especially true of their headlines.)
Yet, if we look at the actual data of most studies, we see that individual results tend to fall on a bell curve of some sort.
Take this example, noted by James Krieger and Bret Contreras.
A study on resistance training and muscle gain concluded the following:
“Previously untrained people who engaged in resistance training three times a week for 9 weeks increased their muscle mass by 6%.”
Based on that, you might expect a client to achieve similar results on your three-day-a-week program.
But if you look at the individual data within the study, muscle growth ranged from -2.5 to 20 percent. That’s right: minus 2.5 percent. As Krieger and Contreras point out, five of the 53 participants actually lost muscle!
That’s not to suggest the research results are misleading. In fact, most of the study participants experienced muscle mass gains between 5 and 10 percent, and some even more. However, it does show the overall findings may not to apply to every individual. So don’t expect them to.
Another example is broccoli. There’s a significant body of evidence supporting the health benefits of eating this nutrient-dense vegetable.
But if broccoli makes someone gaggy or gassy, it’s not the healthiest food for them, no matter what the research says about it lowering disease risk.
These kinds of patterns happen over and over: Some people get great results from applying the research, some get very little (or negative) results, and most get results somewhere in between.
This is reality.
Research can be incredibly useful for giving us a starting point for most people. But humans differ—often wildly—from one another.
They differ in terms of their habits, mindset, physiology, environment, and personal preferences. They also differ in their ability to follow a program in the first place. And even if they stick to a plan perfectly, they can differ in the results they get.
Coach for the unique human in front of you, not for an average.
Not only will this improve your client results (because you’ll be working with their particular, practical reality), it’ll also improve your client retention (because you’ll be actually listening to them and trying to understand them as individual people, not as data sets).
When a client is suffering, they probably don’t need you to search PubMed for more evidence.
They often need you to provide a solid, trusting coaching relationship and, of course, your coaching skills. This combination can help you ease client resistance, be creative and flexible when typical solutions don’t work, and be compassionate and supportive when a client struggles with dark stuff.
2. Your professional experience really matters.
If you’re a mindful, growth-oriented coach or practitioner, it’s impossible not to develop a certain degree of experience and expertise over time.
A lot of things go into your “expertise bucket”: courses and programs you’ve taken; books you’ve read; lectures you’ve attended; mentoring relationships you’ve had; and all the practical experience you’ve acquired from observing and coaching clients or patients.
The accumulation of knowledge and experience gives you a kind of “intuition” that can help you coach more effectively.
This “intuition” shows up when you see a client perform a wonky squat, quickly identify exactly what’s wrong, and make corrections to improve form.
It shows up when you perform a client intake, and based on their answers (Just had a baby! Prone to perfectionism!), you can anticipate what aspects of a program they might struggle with, and how you might help them.
Or it shows up when you do a postural assessment, and immediately know which exercises to avoid and which could be helpful.
Much of the time, this is knowledge you could have never learned simply from reading studies. It requires time working with people, and exposing yourself to new ideas and methods, including those that have yet to be studied.
But there’s a challenge here, too. The knowledge we gather from our experiences is very prone to human error: Our memories are unreliable, we see patterns that may not actually exist, and we discount information that doesn’t conform to what we already believe.
How can we reduce human error?
First, be aware that bias and error exist… yes, even for you.
Take notes during or after client sessions, and use a variety of validated measurement tools—such as weight, body measurements, pictures, mood scales, and sleep quality scales—to track the effectiveness of your advice.
Get mentorship and feedback on your practice. Coaches need coaches. Or, find a like-minded group of professionals with whom to collaborate. (That’s why we developed the Precision Nutrition Level 2 Certification.)
If you’re aware of the errors you’re likely to make, and take steps to moderate them, you might start to see some reliable, overarching patterns.
Like that very rigid meal plans don’t work for people in the long term. Or that people can only train so long and so hard before they burn out.
Or a thousand other possibilities experienced coaches notice, but perhaps haven’t been fully validated by published research.
If you’re just starting out and don’t have the experience gained from coaching many people over many years, you can “borrow” insight from mentors or other coaches with more reps under their belt.
Drawing on the wisdom of your (or a colleague’s) accumulated experience is an essential part of being a good practitioner.
3. Science will never have it all figured out.
The evidence is always evolving. Nutrition research in particular is a relatively new area, and there’s still a lot to be learned.
Plus, some things are really hard (or downright unethical) to test in a research setting, and so we may never have scientific evidence on it.
Even if it is possible to test, quality research takes a long time to gather. Usually, one study isn’t enough to “prove” something true or false. But waiting for multiple studies on a specific topic, or better yet, a meta-analyses (which is kind of like a poll of the research) may require a lot of patience. Maybe decades.
And yet, we still have to help our clients and patients make informed decisions. Like, now.
That’s where evidence-based practice comes in.
The RIGHT way to use EBP.
You can formally apply the EBP process to coaching decisions that feel especially important or uncertain.
EBP offers one of the best tools to help you reach a decision that’s most likely to be safe and effective, and that’ll also make sense in the context of your client’s life.
Follow these 6 steps to see EBP in action.
1. Assess the client.
Identify their unique abilities and needs.
What are their strengths?
Where might they need help from you?
What are their precise goals?
What are their identities, values, and beliefs?
Gather this information by asking questions, using intake forms, and taking measurements. This’ll help you create an initial plan of action and also provide a baseline against which to gauge progress.
Plus, as you collect data on many clients, you’ll be accruing practical evidence that can aid with decision making in the future.
Let’s use a hypothetical client to apply these steps.
Her name is Nora. Her goal is to lose fat, and she’s also interested in intermittent fasting. Through your initial assessment you learn that she’s begun to show signs of perimenopause, and her sleep isn’t great these days.
2. Find your research question.
Before you jump to a solution, get clear on the problem you’re trying to help your client with. 
Then, turn the problem into a question that’ll help you isolate the evidence you need for your recommendations. This question should incorporate the problem, as well as relevant factors about your client or patient.
Nora’s main goal is to lose fat, and she’s curious about intermittent fasting. Important factors to consider: Nora is a woman and she’s perimenopausal.
But you’re not sure if intermittent fasting is safe (or effective) for losing fat. And you’re definitely not sure if it’s safe (or effective) for a perimenopausal woman.
So your research question might be: “Is intermittent fasting safe and effective for fat loss in perimenopausal women?”
3. Gather the evidence.
Search for info using an online database like PubMed or Google Scholar. (If you don’t know how to use online research databases, here’s a PubMed tutorial.)
Using a research database will curate your hits so you’re only getting original, peer-reviewed research, rather than someone else’s (potentially biased) interpretation of it.
To find relevant research for Nora, a good keyword combination to type in a search box could be “intermittent fasting + fat loss + menopause”. These keywords contain the intervention you’re interested in learning more about, plus information about Nora’s unique goals and life stage.
To identify the best available scientific evidence on the research subject, use the “Hierarchy of Evidence” pyramid below. The higher up on the pyramid, the more trustworthy the information. So start your search from the top down.
In the case of Nora, prioritize finding a position stand, a meta-analysis, or a systematic review on using intermittent fasting for fat loss in menopausal women. This will give you a comprehensive overview of the current evidence. Basically, scientists and/or academics have already done the hard work—of reviewing, comparing, and analyzing the available scientific evidence—for you.
If that doesn’t exist, look for randomized control trials that compare appropriately chosen groups of people with a control group (such as a group that received no intervention, or a different intervention).
No luck there? You can expand your search to just “women” rather than “menopausal women.” Depending on what’s available, you may have to continue broadening your search and moving down the hierarchy of evidence.
Now, if you’re not well-versed in reading studies or interpreting research, that’s okay. Chances are, if you don’t find a meta-analysis or review, or—best of all—a position stand, the research further down the pyramid will be of limited use to you anyway.
If that’s the case—or you can’t find any scientific research on the topic—you might have to use opinions from other trusted experts, or develop an educated hypothesis based on your own knowledge of how physiology and nutrition work. This still counts as evidence, it’s just not as reliable, so temper your confidence in it accordingly.
All hail the position stand.
If you don’t feel equipped to navigate and interpret scientific literature, consider looking for best practice guidelines or position stands written by an authority in your field.
Position stands are official statements made by a governing body on topics related to a particular field, like nutrition, exercise physiology, dietetics, or medicine.
Here’s an example: The 2017 International Society of Sports Nutrition Position Stand on protein and exercise.
If you have a client who’s older and you’re wondering how to safely increase their training capacity (but don’t want to immerse yourself in a dark hole of research), simply look for the position stand on exercise and older adults.
To find the position stands in your field, consult the website of whatever governing body you belong to.
For example, if you’re a personal trainer certified through ACSM, NASM, ACE, or NSCA, consult the respective website for each organization. They should feature position stands on a variety of topics.
4. Appraise the evidence.
Through your search, you’ll probably find at least some evidence. This might be just a few small studies or some articles from trusted experts in the field.
Now, using the hierarchy of evidence, determine how valid and reliable those pieces of evidence are.
The more you have to broaden your question or move down the quality hierarchy, the less confident you might be about your recommendations.
With Nora, if all you find are some articles by an internet guru who’s never actually seen any real clients, you may want to present your findings as a mere idea, rather than as reliable advice.
On the other hand, if you find a handful of systematic reviews about intermittent fasting in menopausal women, you can go to Nora with more confidence about your recommendations. (Quick fact check, FYI: We couldn’t find any reputable systematic reviews on intermittent fasting in menopausal women.)
5. Create your recommendation.
Unless they ask for it, most clients don’t want to know all the complicated science stuff; they just want to know what to do.
This is where the science of coaching morphs into the art of coaching.
It’s time to see if you can actually apply the evidence you’ve found—along with your own professional experience—to the complex, real, live human standing in front of you.
Notice that the evidence by itself doesn’t make the decision. Nor does your experience, nor do the client’s preferences.
The three simply offer a more holistic perspective on a problem, to ensure you find the best possible solution for your client.
Rather than plunking down a stack of research in front of your client, combine the research with your expertise and your client’s unique circumstances to translate it into practical advice.
It could work like this: Through your research, you find that intermittent fasting is effective for fat loss. However, through your own professional experience, you’ve also noticed that most clients struggle to stick with intermittent fasting long-term. (Aligning nicely with your coaching experience, the research also shows a relatively high drop-out rate with intermittent fasting.)
You’ve also noticed that in some of your female clients, intermittent fasting seems to deregulate menstrual cycles and exacerbate menopausal symptoms.
Thinking about Nora’s unique values and preferences, you know that she wants to lose weight, but you also know that she’s had some trouble sleeping lately. In your experience with other clients, people who are sleep-deprived have an extra-hard time regulating appetite and losing weight.
So… intermittent fasting seems to be effective, but combined with your concerns about Nora’s hormonal health and sleep quality, plus the fact that intermittent fasting can be hard to maintain, you may decide not to recommend it to Nora.
After explaining to her your reasoning, explore with her what she’s comfortable trying. In the end, you may suggest some simple nutrition habits along with some short fasting experiments, plus some sleep tips.
These recommendations include what you’ve found from the best available research, your own coaching experience, and Nora’s unique preferences, goals, and challenges.
Nora’s just gotten some pretty wise, tailored-to-her advice, where you worked as collaborators to come up with her action plan.
That’s the art and science of coaching.
6. Monitor the results.
Once you’ve given your client a little time to practice what you came up with together, you can assess if those actions are working.
Consult those measurements you took in your initial assessments. Compare them to current measurements.
Are things moving in the right direction?
And talk to your client about how the plan is working.
Nora tells you although she’s applying and benefitting from the sleep tips, she’s struggling with fasting, even the shorter experiments. Turns out, it’s hard to fast when you’re having trouble falling asleep because of a grumbling tummy.
As you monitor progress, use what you find to re-evaluate goals and pinpoint where your client or patient needs more support.
Now Nora’s asking you about trying the Paleo diet instead. Looks like you have more research to do.
But keep in mind, over time, you’ll develop a solid grasp of the body of evidence on a number of topics. That’s the good part about science moving slowly: It’s not that hard to keep up.
What to do next.
Be empathetic, supportive, and flexible.
No matter what you believe is “right” or “true,” your first job is to work with your client, wherever they’re at.
Many practitioners intuitively know this, but the bond between coach and client (or patient) is extremely important and influential.
This bond is called the “therapeutic alliance,” and it refers to the level of trust and rapport between a practitioner and the person they’re helping.
Change is hard, and often scary. A strong therapeutic alliance can help a person feel supported and understood while surfing the tides of change.
In fact, some studies show the results a client or patient achieves in your care are up to 85 percent dependent on the therapeutic alliance. So, the stronger that relationship, the better the results.
If you’re constantly butting heads with your client, telling them, “But the research says!” or, “I know best!”, you can wave goodbye to a strong therapeutic alliance.
Many of the obstacles your clients will face are behavioral and emotional, rather than rational and theory-based. So more than facts, your clients often need compassion, support, and creativity to get them through the tough stuff.
Focus on the big rocks.
Given how complicated bodies and behavioral change are, it’s not surprising that science is still “trying to figure things out.”
Rather than using “cutting-edge” protocols like intermittent fasting or precise macronutrient ratios (which should really only be for more advanced clients anyway), focus on “big rocks” that offer the most bang for buck, like:
eating enough protein and vegetables
moving regularly
getting adequate sleep
managing stress
reducing smoking and/or excessive alcohol consumption
If that sounds boring or too obvious, we ask you this: How many people do you know who are consistently doing all five well? (In case you’re curious, it’s only about three to five percent of the population.)
Just managing those five things will keep most people plenty busy.
Be humble, throw out the rules, and keep learning.
The smartest people are often the ones who are most comfortable asking questions, saying “I don’t know,” and resting in uncertainty.
It’s a cliche but true: The more you know about something, the more you realize what you don’t know.
Be wary when others claim absolute certainty. It may be they don’t fully understand the complexity of the matter.
True expertise is about being comfortable with limited knowledge—while continuing to seek more and better information—and also accepting we may never have complete certainty.
Experiment wisely, and learn from both successes and failures.
Want to see how a theory works in practice? Test it out on yourself, and measure your experience as objectively as possible.
With clients, so long as there is no risk of harm, try out well-informed experiments (with their permission) that are either based on research or expert theory. Then, as always, track and measure their experiences and results to inform your next steps.
Know what you don’t know and work with other experts as needed.
Especially if you’re a beginner in your practice, it’s okay not to know stuff.
Focus on what you know best, whether that’s good lifting form, coming up with healthy meal ideas, or giving support during sticky coaching situations. But also know that some things will be out of your scope of practice.
So build a strong professional network—which could include family doctors, dietitians, massage therapists, naturopaths, chiropractors, and psychotherapists—and refer out whenever you encounter something you feel uncomfortable or especially inexperienced with.
Establishing a deep roster of experts will help clients get the support they need. And we’re pretty sure the evidence will show that’s good for everyone.
If you’re a coach, or you want to be…
Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes—in way that’s evidenced based and personalized for each individual’s lifestyle and preferences—is both an art and a science.
If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certification. The next group kicks off shortly.
What’s it all about?
The Precision Nutrition Level 1 Certification is the world’s most respected nutrition education program. It gives you the knowledge, systems, and tools you need to really understand how food influences a person’s health and fitness. Plus the ability to turn that knowledge into a thriving coaching practice.
Developed over 15 years, and proven with over 100,000 clients and patients, the Level 1 curriculum stands alone as the authority on the science of nutrition and the art of coaching.
Whether you’re already mid-career, or just starting out, the Level 1 Certification is your springboard to a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results.
[Of course, if you’re already a student or graduate of the Level 1 Certification, check out our Level 2 Certification Master Class. It’s an exclusive, year-long mentorship designed for elite professionals looking to master the art of coaching and be part of the top 1% of health and fitness coaches in the world.]
Interested? Add your name to the presale list. You’ll save up to 33% and secure your spot 24 hours before everyone else.
We’ll be opening up spots in our next Precision Nutrition Level 1 Certification on Wednesday, April 3rd, 2019.
If you want to find out more, we’ve set up the following presale list, which gives you two advantages.
Pay less than everyone else. We like to reward people who are eager to boost their credentials and are ready to commit to getting the education they need. So we’re offering a discount of up to 33% off the general price when you sign up for the presale list.
Sign up 24 hours before the general public and increase your chances of getting a spot. We only open the certification program twice per year. Due to high demand, spots in the program are limited and have historically sold out in a matter of hours. But when you sign up for the presale list, we’ll give you the opportunity to register a full 24 hours before anyone else.
If you’re ready for a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results… this is your chance to see what the world’s top professional nutrition coaching system can do for you.
jQuery(document).ready(function(){ jQuery("#references_link").click(function(){ jQuery("#references_holder").show(); jQuery("#references_link").parent().hide(); }); });
References
Click here to view the information sources referenced in this article.
Balachandran, A. & Schoenfeld, B. (2017, March 2) Evidence-based practice in Exercise and Nutrition: Common Misconceptions and Criticisms. Retrieved from https://www.lookgreatnaked.com/blog/evidence-based-practice-in-exercise-and-nutrition-common-misconceptions-and-criticisms/
Baldwin, S.A., Wampold, B.E., & Imel, Z E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842–852.
Cabaniss, D. L. (2012, May 31) The Therapeutic Alliance: The Essential Ingredient for Psychotherapy. Retrieved from https://www.huffpost.com/entry/therapeutic-alliance_b_1554007?fbclid=IwAR1NDl7sNR60OSvNFWmpTUA-GqAV65fMtxsOrOFAQ9fLM5Z5eQlcRR4APbU
Duke University. (2018). Introduction to Evidence-Based Practice. Retrieved from https://guides.mclibrary.duke.edu/ebmtutorial/home
Erskine, R.M., Jones, D.A., Williams, A.G., Stewart, C.E. & Degens, H. (2010) Inter-individual variability in the adaptation of human muscle specific tension to progressive resistance training. European Journal of Applied Physiology, 110(6), 1117-25.
Evidence-Based Medicine Working Group. (1992) Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. Journal of the American Medical Association, 268(17), 2420-5.
Frances, A.J. (2013, June 24) What Should Doctors Do When They Don’t Know What to Do? Retrieved from https://www.psychologytoday.com/us/blog/saving-normal/201306/what-should-doctors-do-when-they-dont-know-what-do?fbclid=IwAR3ce99uT-RDXcp_yvnJ0r2aTfBPWPpngqNUvkIc5a6PBZkyr5d-Z8sgy2Y
Joyce, A.S. & Piper, W.E. (1998) Expectancy, the Therapeutic Alliance, and Treatment Outcome in Short-Term Individual Psychotherapy. The Journal of Psychotherapy Practice and Research, 7(3), 236–248.
Löfgren, K. [Kent Löfgren]. (2013, February 25). What is epistemology? Introduction to the word and the concept [Video File]. Retrieved from https://www.youtube.com/watch?v=lI9-YgSzsEQ
Ludwig, J. (2018, April 16) Here’s what is going wrong with ‘evidence-based’ policies and practices in schools in Australia. Retrieved from https://www.aare.edu.au/blog/?p=2822
Schoenfeld, B.J., Contreras, B, Krieger, J., Grgic, J., Delcastillo, K., Belliard, R. & Alto, A. (2019) Resistance Training Volume Enhances Muscle Hypertrophy but Not Strength in Trained Men. Medicine & Science in Sports & Exercise, 51(1), 94-103.
Wampold, B. E. (2001). The great psychotherapy debate:Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum. NJ: Lawrence Erlbaum.
Evidence-Based Medicine Toolbox. (2017) Retrieved from https://ebm-tools.knowledgetranslation.net/
Evidence-based practice. (2018, November 19) Retrieved from https://en.wikipedia.org/wiki/Evidence-based_practice?fbclid=IwAR3ARk06zmx_lJYPIrTGA_chfBa9v_-NsW7HQbC7-rTHaq-Y7AYcSdLAk80
The well-built clinical question: a key to evidence-based decisions. (1995). Retrieved from https://mclibrary.duke.edu/sites/mclibrary.duke.edu/files/public/guides/richardson.pdf
The post Evidence-based coaching: Why some health and fitness pros are doing it all wrong. appeared first on Precision Nutrition.
Evidence-based coaching: Why some health and fitness pros are doing it all wrong. published first on
0 notes
oovitus · 6 years
Text
Evidence-based coaching: Why some health and fitness pros are doing it all wrong.
Ask any health and fitness professional if they’re “evidence based,” and chances are good you’ll get a resounding, “Yes!” Perhaps even an indignant one. After all, everyone uses evidence… of some sort. But if you think evidence-based practice is only what “research says,” you’re doing it wrong. In this article, we’ll show you the right way to use evidence to inform and enhance your coaching—for more effective advice and better client results. 
++++
Here at Precision Nutrition, we love science.
In fact, no one loves science more than us!
But is it possible to rely too heavily on scientific literature? Can you actually science too much?
Maybe.
Ever see someone:
Dismiss a coach’s successful method solely because some element of it isn’t “research proven?”
Refuse to modify a nutrition plan—even though a client hates it—“because science?”
Call a respected health professional a “quack” because they cite years of clinical experience instead of a definitive clinical trial?
(If you haven’t, you probably don’t spend much time in Facebook comments.)
In each case, the person’s inflated reverence for research could be limiting their ability to learn, and evolve as a coach. They might also influence others to follow their narrow line of thinking, causing them to miss out, too. And this is often done in the name of “evidenced based practice.”
Now, evidence-based practice, or EBP, is all the rage in certain health and fitness circles, which is a great thing. We heart science, remember? Except there’s just one problem…
A lot of coaches, though well-meaning, are getting EBP wrong. Specifically, they’re over-emphasizing “what the research says” to the exclusion of other relevant information, like their professional experience and the personal preferences and values of the people they work with.
And that’s not good for clients, business, or the health and fitness industry.
To make sure you get EBP right, use this guide to understand what the method really is, why it matters, and how to implement it effectively in your own coaching practice.
Because when used correctly, EBP is a powerful tool that’ll make you a better coach—so you can help even more people achieve lasting change and deep health.
And that we love even more than science.
+++
What is “evidence”?
There’s “everyday life” evidence.
In our Precision Nutrition Coaching program and Certifications, we tell our clients and coaches to use outcome-based decision making (OBDM).
Very simply, that means you decide what to do next based on the data you got from what you just did.
Did your waist measurement go up after two weeks of vacation buffets? That’s data that says, “Welcome home, maybe dial it back a little.”
Did your blood pressure go down after four months of sticking to your exercise program? That’s data that says, “Keep up the good work!”
We tell our coaches and clients to use as many data points as they can, and look for progress everywhere, including:
body measurements
blood work and other medical tests
athletic performance, such as getting stronger or faster
photos
how clothes fit
recovery
sleep
mood and wellbeing
confidence
consistency
And so on. (Here are some more ideas.)
All of these data points, collectively, give us evidence that we can use to make informed choices.
Then there’s scientific evidence.
This includes clinical or case studies, experimental research, basic research (for instance, studying cells in culture), and more.
This evidence can vary widely in quality, who is studied, and how applicable the results are to you and your clients.
However, in general, scientific evidence is one of the best ways we have to know about the nature of reality.
And though it might be obvious, we’re compelled to say it anyway: You’re looking to glean these insights directly from reputable, peer-reviewed scientific papers—not random websites, articles in magazines, or pictures of sunsets with words on them.
Finally, there’s stuff you learn on the job.
We call this “expertise.” It’s the old coach’s intuition, the senior clinician’s knack for diagnosis, the way a master carpenter can tell you if something is a quarter inch off square just by looking.
After you’ve worked with over 100,000 clients, as we have, you start to build a database of collected wisdom. And often, there’s stuff that’s hard to explain or defend—you’ve just seen it enough times that you know it’s a thing.
When we bring together experience, research, and expertise, we have a pretty good set of working hypotheses about what is likely to be effective.
And that’s evidenced-based practice. So it’s not just about clinical research.
EBP is a systematic way of thinking and application that integrates scientific data with clinical experience and the individual needs and preferences of each client or patient.
Yes, that’s the official, eye-glazing definition, but you might find the Instagram-able version even more enlightening. (See the illustration below.)
All three parts are equally important.
That’s because:
1. You aren’t coaching research averages. You’re coaching people.
Most studies report the average results of an intervention. (This is especially true of their headlines.)
Yet, if we look at the actual data of most studies, we see that individual results tend to fall on a bell curve of some sort.
Take this example, noted by James Krieger and Bret Contreras.
A study on resistance training and muscle gain concluded the following:
“Previously untrained people who engaged in resistance training three times a week for 9 weeks increased their muscle mass by 6%.”
Based on that, you might expect a client to achieve similar results on your three-day-a-week program.
But if you look at the individual data within the study, muscle growth ranged from -2.5 to 20 percent. That’s right: minus 2.5 percent. As Krieger and Contreras point out, five of the 53 participants actually lost muscle!
That’s not to suggest the research results are misleading. In fact, most of the study participants experienced muscle mass gains between 5 and 10 percent, and some even more. However, it does show the overall findings may not to apply to every individual. So don’t expect them to.
Another example is broccoli. There’s a significant body of evidence supporting the health benefits of eating this nutrient-dense vegetable.
But if broccoli makes someone gaggy or gassy, it’s not the healthiest food for them, no matter what the research says about it lowering disease risk.
These kinds of patterns happen over and over: Some people get great results from applying the research, some get very little (or negative) results, and most get results somewhere in between.
This is reality.
Research can be incredibly useful for giving us a starting point for most people. But humans differ—often wildly—from one another.
They differ in terms of their habits, mindset, physiology, environment, and personal preferences. They also differ in their ability to follow a program in the first place. And even if they stick to a plan perfectly, they can differ in the results they get.
Coach for the unique human in front of you, not for an average.
Not only will this improve your client results (because you’ll be working with their particular, practical reality), it’ll also improve your client retention (because you’ll be actually listening to them and trying to understand them as individual people, not as data sets).
When a client is suffering, they probably don’t need you to search PubMed for more evidence.
They often need you to provide a solid, trusting coaching relationship and, of course, your coaching skills. This combination can help you ease client resistance, be creative and flexible when typical solutions don’t work, and be compassionate and supportive when a client struggles with dark stuff.
2. Your professional experience really matters.
If you’re a mindful, growth-oriented coach or practitioner, it’s impossible not to develop a certain degree of experience and expertise over time.
A lot of things go into your “expertise bucket”: courses and programs you’ve taken; books you’ve read; lectures you’ve attended; mentoring relationships you’ve had; and all the practical experience you’ve acquired from observing and coaching clients or patients.
The accumulation of knowledge and experience gives you a kind of “intuition” that can help you coach more effectively.
This “intuition” shows up when you see a client perform a wonky squat, quickly identify exactly what’s wrong, and make corrections to improve form.
It shows up when you perform a client intake, and based on their answers (Just had a baby! Prone to perfectionism!), you can anticipate what aspects of a program they might struggle with, and how you might help them.
Or it shows up when you do a postural assessment, and immediately know which exercises to avoid and which could be helpful.
Much of the time, this is knowledge you could have never learned simply from reading studies. It requires time working with people, and exposing yourself to new ideas and methods, including those that have yet to be studied.
But there’s a challenge here, too. The knowledge we gather from our experiences is very prone to human error: Our memories are unreliable, we see patterns that may not actually exist, and we discount information that doesn’t conform to what we already believe.
How can we reduce human error?
First, be aware that bias and error exist… yes, even for you.
Take notes during or after client sessions, and use a variety of validated measurement tools—such as weight, body measurements, pictures, mood scales, and sleep quality scales—to track the effectiveness of your advice.
Get mentorship and feedback on your practice. Coaches need coaches. Or, find a like-minded group of professionals with whom to collaborate. (That’s why we developed the Precision Nutrition Level 2 Certification.)
If you’re aware of the errors you’re likely to make, and take steps to moderate them, you might start to see some reliable, overarching patterns.
Like that very rigid meal plans don’t work for people in the long term. Or that people can only train so long and so hard before they burn out.
Or a thousand other possibilities experienced coaches notice, but perhaps haven’t been fully validated by published research.
If you’re just starting out and don’t have the experience gained from coaching many people over many years, you can “borrow” insight from mentors or other coaches with more reps under their belt.
Drawing on the wisdom of your (or a colleague’s) accumulated experience is an essential part of being a good practitioner.
3. Science will never have it all figured out.
The evidence is always evolving. Nutrition research in particular is a relatively new area, and there’s still a lot to be learned.
Plus, some things are really hard (or downright unethical) to test in a research setting, and so we may never have scientific evidence on it.
Even if it is possible to test, quality research takes a long time to gather. Usually, one study isn’t enough to “prove” something true or false. But waiting for multiple studies on a specific topic, or better yet, a meta-analyses (which is kind of like a poll of the research) may require a lot of patience. Maybe decades.
And yet, we still have to help our clients and patients make informed decisions. Like, now.
That’s where evidence-based practice comes in.
The RIGHT way to use EBP.
You can formally apply the EBP process to coaching decisions that feel especially important or uncertain.
EBP offers one of the best tools to help you reach a decision that’s most likely to be safe and effective, and that’ll also make sense in the context of your client’s life.
Follow these 6 steps to see EBP in action.
1. Assess the client.
Identify their unique abilities and needs.
What are their strengths?
Where might they need help from you?
What are their precise goals?
What are their identities, values, and beliefs?
Gather this information by asking questions, using intake forms, and taking measurements. This’ll help you create an initial plan of action and also provide a baseline against which to gauge progress.
Plus, as you collect data on many clients, you’ll be accruing practical evidence that can aid with decision making in the future.
Let’s use a hypothetical client to apply these steps.
Her name is Nora. Her goal is to lose fat, and she’s also interested in intermittent fasting. Through your initial assessment you learn that she’s begun to show signs of perimenopause, and her sleep isn’t great these days.
2. Find your research question.
Before you jump to a solution, get clear on the problem you’re trying to help your client with. 
Then, turn the problem into a question that’ll help you isolate the evidence you need for your recommendations. This question should incorporate the problem, as well as relevant factors about your client or patient.
Nora’s main goal is to lose fat, and she’s curious about intermittent fasting. Important factors to consider: Nora is a woman and she’s perimenopausal.
But you’re not sure if intermittent fasting is safe (or effective) for losing fat. And you’re definitely not sure if it’s safe (or effective) for a perimenopausal woman.
So your research question might be: “Is intermittent fasting safe and effective for fat loss in perimenopausal women?”
3. Gather the evidence.
Search for info using an online database like PubMed or Google Scholar. (If you don’t know how to use online research databases, here’s a PubMed tutorial.)
Using a research database will curate your hits so you’re only getting original, peer-reviewed research, rather than someone else’s (potentially biased) interpretation of it.
To find relevant research for Nora, a good keyword combination to type in a search box could be “intermittent fasting + fat loss + menopause”. These keywords contain the intervention you’re interested in learning more about, plus information about Nora’s unique goals and life stage.
To identify the best available scientific evidence on the research subject, use the “Hierarchy of Evidence” pyramid below. The higher up on the pyramid, the more trustworthy the information. So start your search from the top down.
In the case of Nora, prioritize finding a position stand, a meta-analysis, or a systematic review on using intermittent fasting for fat loss in menopausal women. This will give you a comprehensive overview of the current evidence. Basically, scientists and/or academics have already done the hard work—of reviewing, comparing, and analyzing the available scientific evidence—for you.
If that doesn’t exist, look for randomized control trials that compare appropriately chosen groups of people with a control group (such as a group that received no intervention, or a different intervention).
No luck there? You can expand your search to just “women” rather than “menopausal women.” Depending on what’s available, you may have to continue broadening your search and moving down the hierarchy of evidence.
Now, if you’re not well-versed in reading studies or interpreting research, that’s okay. Chances are, if you don’t find a meta-analysis or review, or—best of all—a position stand, the research further down the pyramid will be of limited use to you anyway.
If that’s the case—or you can’t find any scientific research on the topic—you might have to use opinions from other trusted experts, or develop an educated hypothesis based on your own knowledge of how physiology and nutrition work. This still counts as evidence, it’s just not as reliable, so temper your confidence in it accordingly.
All hail the position stand.
If you don’t feel equipped to navigate and interpret scientific literature, consider looking for best practice guidelines or position stands written by an authority in your field.
Position stands are official statements made by a governing body on topics related to a particular field, like nutrition, exercise physiology, dietetics, or medicine.
Here’s an example: The 2017 International Society of Sports Nutrition Position Stand on protein and exercise.
If you have a client who’s older and you’re wondering how to safely increase their training capacity (but don’t want to immerse yourself in a dark hole of research), simply look for the position stand on exercise and older adults.
To find the position stands in your field, consult the website of whatever governing body you belong to.
For example, if you’re a personal trainer certified through ACSM, NASM, ACE, or NSCA, consult the respective website for each organization. They should feature position stands on a variety of topics.
4. Appraise the evidence.
Through your search, you’ll probably find at least some evidence. This might be just a few small studies or some articles from trusted experts in the field.
Now, using the hierarchy of evidence, determine how valid and reliable those pieces of evidence are.
The more you have to broaden your question or move down the quality hierarchy, the less confident you might be about your recommendations.
With Nora, if all you find are some articles by an internet guru who’s never actually seen any real clients, you may want to present your findings as a mere idea, rather than as reliable advice.
On the other hand, if you find a handful of systematic reviews about intermittent fasting in menopausal women, you can go to Nora with more confidence about your recommendations. (Quick fact check, FYI: We couldn’t find any reputable systematic reviews on intermittent fasting in menopausal women.)
5. Create your recommendation.
Unless they ask for it, most clients don’t want to know all the complicated science stuff; they just want to know what to do.
This is where the science of coaching morphs into the art of coaching.
It’s time to see if you can actually apply the evidence you’ve found—along with your own professional experience—to the complex, real, live human standing in front of you.
Notice that the evidence by itself doesn’t make the decision. Nor does your experience, nor do the client’s preferences.
The three simply offer a more holistic perspective on a problem, to ensure you find the best possible solution for your client.
Rather than plunking down a stack of research in front of your client, combine the research with your expertise and your client’s unique circumstances to translate it into practical advice.
It could work like this: Through your research, you find that intermittent fasting is effective for fat loss. However, through your own professional experience, you’ve also noticed that most clients struggle to stick with intermittent fasting long-term. (Aligning nicely with your coaching experience, the research also shows a relatively high drop-out rate with intermittent fasting.)
You’ve also noticed that in some of your female clients, intermittent fasting seems to deregulate menstrual cycles and exacerbate menopausal symptoms.
Thinking about Nora’s unique values and preferences, you know that she wants to lose weight, but you also know that she’s had some trouble sleeping lately. In your experience with other clients, people who are sleep-deprived have an extra-hard time regulating appetite and losing weight.
So… intermittent fasting seems to be effective, but combined with your concerns about Nora’s hormonal health and sleep quality, plus the fact that intermittent fasting can be hard to maintain, you may decide not to recommend it to Nora.
After explaining to her your reasoning, explore with her what she’s comfortable trying. In the end, you may suggest some simple nutrition habits along with some short fasting experiments, plus some sleep tips.
These recommendations include what you’ve found from the best available research, your own coaching experience, and Nora’s unique preferences, goals, and challenges.
Nora’s just gotten some pretty wise, tailored-to-her advice, where you worked as collaborators to come up with her action plan.
That’s the art and science of coaching.
6. Monitor the results.
Once you’ve given your client a little time to practice what you came up with together, you can assess if those actions are working.
Consult those measurements you took in your initial assessments. Compare them to current measurements.
Are things moving in the right direction?
And talk to your client about how the plan is working.
Nora tells you although she’s applying and benefitting from the sleep tips, she’s struggling with fasting, even the shorter experiments. Turns out, it’s hard to fast when you’re having trouble falling asleep because of a grumbling tummy.
As you monitor progress, use what you find to re-evaluate goals and pinpoint where your client or patient needs more support.
Now Nora’s asking you about trying the Paleo diet instead. Looks like you have more research to do.
But keep in mind, over time, you’ll develop a solid grasp of the body of evidence on a number of topics. That’s the good part about science moving slowly: It’s not that hard to keep up.
What to do next.
Be empathetic, supportive, and flexible.
No matter what you believe is “right” or “true,” your first job is to work with your client, wherever they’re at.
Many practitioners intuitively know this, but the bond between coach and client (or patient) is extremely important and influential.
This bond is called the “therapeutic alliance,” and it refers to the level of trust and rapport between a practitioner and the person they’re helping.
Change is hard, and often scary. A strong therapeutic alliance can help a person feel supported and understood while surfing the tides of change.
In fact, some studies show the results a client or patient achieves in your care are up to 85 percent dependent on the therapeutic alliance. So, the stronger that relationship, the better the results.
If you’re constantly butting heads with your client, telling them, “But the research says!” or, “I know best!”, you can wave goodbye to a strong therapeutic alliance.
Many of the obstacles your clients will face are behavioral and emotional, rather than rational and theory-based. So more than facts, your clients often need compassion, support, and creativity to get them through the tough stuff.
Focus on the big rocks.
Given how complicated bodies and behavioral change are, it’s not surprising that science is still “trying to figure things out.”
Rather than using “cutting-edge” protocols like intermittent fasting or precise macronutrient ratios (which should really only be for more advanced clients anyway), focus on “big rocks” that offer the most bang for buck, like:
eating enough protein and vegetables
moving regularly
getting adequate sleep
managing stress
reducing smoking and/or excessive alcohol consumption
If that sounds boring or too obvious, we ask you this: How many people do you know who are consistently doing all five well? (In case you’re curious, it’s only about three to five percent of the population.)
Just managing those five things will keep most people plenty busy.
Be humble, throw out the rules, and keep learning.
The smartest people are often the ones who are most comfortable asking questions, saying “I don’t know,” and resting in uncertainty.
It’s a cliche but true: The more you know about something, the more you realize what you don’t know.
Be wary when others claim absolute certainty. It may be they don’t fully understand the complexity of the matter.
True expertise is about being comfortable with limited knowledge—while continuing to seek more and better information—and also accepting we may never have complete certainty.
Experiment wisely, and learn from both successes and failures.
Want to see how a theory works in practice? Test it out on yourself, and measure your experience as objectively as possible.
With clients, so long as there is no risk of harm, try out well-informed experiments (with their permission) that are either based on research or expert theory. Then, as always, track and measure their experiences and results to inform your next steps.
Know what you don’t know and work with other experts as needed.
Especially if you’re a beginner in your practice, it’s okay not to know stuff.
Focus on what you know best, whether that’s good lifting form, coming up with healthy meal ideas, or giving support during sticky coaching situations. But also know that some things will be out of your scope of practice.
So build a strong professional network—which could include family doctors, dietitians, massage therapists, naturopaths, chiropractors, and psychotherapists—and refer out whenever you encounter something you feel uncomfortable or especially inexperienced with.
Establishing a deep roster of experts will help clients get the support they need. And we’re pretty sure the evidence will show that’s good for everyone.
If you’re a coach, or you want to be…
Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes—in way that’s evidenced based and personalized for each individual’s lifestyle and preferences—is both an art and a science.
If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certification. The next group kicks off shortly.
What’s it all about?
The Precision Nutrition Level 1 Certification is the world’s most respected nutrition education program. It gives you the knowledge, systems, and tools you need to really understand how food influences a person’s health and fitness. Plus the ability to turn that knowledge into a thriving coaching practice.
Developed over 15 years, and proven with over 100,000 clients and patients, the Level 1 curriculum stands alone as the authority on the science of nutrition and the art of coaching.
Whether you’re already mid-career, or just starting out, the Level 1 Certification is your springboard to a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results.
[Of course, if you’re already a student or graduate of the Level 1 Certification, check out our Level 2 Certification Master Class. It’s an exclusive, year-long mentorship designed for elite professionals looking to master the art of coaching and be part of the top 1% of health and fitness coaches in the world.]
Interested? Add your name to the presale list. You’ll save up to 33% and secure your spot 24 hours before everyone else.
We’ll be opening up spots in our next Precision Nutrition Level 1 Certification on Wednesday, April 3rd, 2019.
If you want to find out more, we’ve set up the following presale list, which gives you two advantages.
Pay less than everyone else. We like to reward people who are eager to boost their credentials and are ready to commit to getting the education they need. So we’re offering a discount of up to 33% off the general price when you sign up for the presale list.
Sign up 24 hours before the general public and increase your chances of getting a spot. We only open the certification program twice per year. Due to high demand, spots in the program are limited and have historically sold out in a matter of hours. But when you sign up for the presale list, we’ll give you the opportunity to register a full 24 hours before anyone else.
If you’re ready for a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results… this is your chance to see what the world’s top professional nutrition coaching system can do for you.
jQuery(document).ready(function(){ jQuery("#references_link").click(function(){ jQuery("#references_holder").show(); jQuery("#references_link").parent().hide(); }); });
References
Click here to view the information sources referenced in this article.
Balachandran, A. & Schoenfeld, B. (2017, March 2) Evidence-based practice in Exercise and Nutrition: Common Misconceptions and Criticisms. Retrieved from https://www.lookgreatnaked.com/blog/evidence-based-practice-in-exercise-and-nutrition-common-misconceptions-and-criticisms/
Baldwin, S.A., Wampold, B.E., & Imel, Z E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842–852.
Cabaniss, D. L. (2012, May 31) The Therapeutic Alliance: The Essential Ingredient for Psychotherapy. Retrieved from https://www.huffpost.com/entry/therapeutic-alliance_b_1554007?fbclid=IwAR1NDl7sNR60OSvNFWmpTUA-GqAV65fMtxsOrOFAQ9fLM5Z5eQlcRR4APbU
Duke University. (2018). Introduction to Evidence-Based Practice. Retrieved from https://guides.mclibrary.duke.edu/ebmtutorial/home
Erskine, R.M., Jones, D.A., Williams, A.G., Stewart, C.E. & Degens, H. (2010) Inter-individual variability in the adaptation of human muscle specific tension to progressive resistance training. European Journal of Applied Physiology, 110(6), 1117-25.
Evidence-Based Medicine Working Group. (1992) Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. Journal of the American Medical Association, 268(17), 2420-5.
Frances, A.J. (2013, June 24) What Should Doctors Do When They Don’t Know What to Do? Retrieved from https://www.psychologytoday.com/us/blog/saving-normal/201306/what-should-doctors-do-when-they-dont-know-what-do?fbclid=IwAR3ce99uT-RDXcp_yvnJ0r2aTfBPWPpngqNUvkIc5a6PBZkyr5d-Z8sgy2Y
Joyce, A.S. & Piper, W.E. (1998) Expectancy, the Therapeutic Alliance, and Treatment Outcome in Short-Term Individual Psychotherapy. The Journal of Psychotherapy Practice and Research, 7(3), 236–248.
Löfgren, K. [Kent Löfgren]. (2013, February 25). What is epistemology? Introduction to the word and the concept [Video File]. Retrieved from https://www.youtube.com/watch?v=lI9-YgSzsEQ
Ludwig, J. (2018, April 16) Here’s what is going wrong with ‘evidence-based’ policies and practices in schools in Australia. Retrieved from https://www.aare.edu.au/blog/?p=2822
Schoenfeld, B.J., Contreras, B, Krieger, J., Grgic, J., Delcastillo, K., Belliard, R. & Alto, A. (2019) Resistance Training Volume Enhances Muscle Hypertrophy but Not Strength in Trained Men. Medicine & Science in Sports & Exercise, 51(1), 94-103.
Wampold, B. E. (2001). The great psychotherapy debate:Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum. NJ: Lawrence Erlbaum.
Evidence-Based Medicine Toolbox. (2017) Retrieved from https://ebm-tools.knowledgetranslation.net/
Evidence-based practice. (2018, November 19) Retrieved from https://en.wikipedia.org/wiki/Evidence-based_practice?fbclid=IwAR3ARk06zmx_lJYPIrTGA_chfBa9v_-NsW7HQbC7-rTHaq-Y7AYcSdLAk80
The well-built clinical question: a key to evidence-based decisions. (1995). Retrieved from https://mclibrary.duke.edu/sites/mclibrary.duke.edu/files/public/guides/richardson.pdf
The post Evidence-based coaching: Why some health and fitness pros are doing it all wrong. appeared first on Precision Nutrition.
Evidence-based coaching: Why some health and fitness pros are doing it all wrong. published first on https://storeseapharmacy.tumblr.com
0 notes
oovitus · 6 years
Text
Evidence-based coaching: Why some health and fitness pros are doing it all wrong.
Ask any health and fitness professional if they’re “evidence based,” and chances are good you’ll get a resounding, “Yes!” Perhaps even an indignant one. After all, everyone uses evidence… of some sort. But if you think evidence-based practice is only about what “research says,” you’re doing it wrong. In this article, we’ll show you the right way to use evidence to inform and enhance your coaching—and drive better client results. 
++++
Here at Precision Nutrition, we love science.
In fact, no one loves science more than us!
But is it possible to rely too heavily on scientific literature? Can you actually science too much?
Maybe.
Ever see someone:
Dismiss a coach’s successful method solely because some element of it isn’t “research proven?”
Refuse to modify a nutrition plan—even though a client hates it—“because science?”
Call a respected health professional a “quack” because they cite years of clinical experience instead of a definitive clinical trial?
(If you haven’t, you probably don’t spend much time in Facebook comments.)
In each case, the person’s inflated reverence for research could be limiting their ability to learn, and evolve as a coach. They might also influence others to follow their narrow line of thinking, causing them to miss out, too. And this is often done in the name of “evidenced based practice.”
Now, evidence-based practice, or EBP, is all the rage in certain health and fitness circles, which is a great thing. We heart science, remember? Except there’s just one problem…
A lot of coaches, though well-meaning, are getting EBP wrong. Specifically, they’re over-emphasizing “what the research says” to the exclusion of other relevant information, like their professional experience and the personal preferences and values of the people they work with.
And that’s not good for clients, business, or the health and fitness industry.
To make sure you get EBP right, use this guide to understand what the method really is, why it matters, and how to implement it effectively in your own coaching practice.
Because when used correctly, EBP is a powerful tool that’ll make you a better coach—so you can help even more people achieve lasting change and deep health.
And that we love even more than science.
+++
What is “evidence”?
There’s “everyday life” evidence.
In our Precision Nutrition Coaching program and Certifications, we tell our clients and coaches to use outcome-based decision making (OBDM).
Very simply, that means you decide what to do next based on the data you got from what you just did.
Did your waist measurement go up after two weeks of vacation buffets? That’s data that says, “Welcome home, maybe dial it back a little.”
Did your blood pressure go down after four months of sticking to your exercise program? That’s data that says, “Keep up the good work!”
We tell our coaches and clients to use as many data points as they can, and look for progress everywhere, including:
body measurements
blood work and other medical tests
athletic performance, such as getting stronger or faster
photos
how clothes fit
recovery
sleep
mood and wellbeing
confidence
consistency
And so on. (Here are some more ideas.)
All of these data points, collectively, give us evidence that we can use to make informed choices.
Then there’s scientific evidence.
This includes clinical or case studies, experimental research, basic research (for instance, studying cells in culture), and more.
This evidence can vary widely in quality, who is studied, and how applicable the results are to you and your clients.
However, in general, scientific evidence is one of the best ways we have to know about the nature of reality.
And though it might be obvious, we’re compelled to say it anyway: You’re looking to glean these insights directly from reputable, peer-reviewed scientific papers—not random websites, articles in magazines, or pictures of sunsets with words on them.
Finally, there’s stuff you learn on the job.
We call this “expertise.” It’s the old coach’s intuition, the senior clinician’s knack for diagnosis, the way a master carpenter can tell you if something is a quarter inch off square just by looking.
After you’ve worked with over 100,000 clients, as we have, you start to build a database of collected wisdom. And often, there’s stuff that’s hard to explain or defend—you’ve just seen it enough times that you know it’s a thing.
When we bring together experience, research, and expertise, we have a pretty good set of working hypotheses about what is likely to be effective.
And that’s evidenced-based practice. So it’s not just about clinical research.
EBP is a systematic way of thinking and application that integrates scientific data with clinical experience and the individual needs and preferences of each client or patient.
Yes, that’s the official, eye-glazing definition, but you might find the Instagram-able version even more enlightening. (See the illustration below.)
All three parts are equally important.
That’s because:
1. You aren’t coaching research averages. You’re coaching people.
Most studies report the average results of an intervention. (This is especially true of their headlines.)
Yet, if we look at the actual data of most studies, we see that individual results tend to fall on a bell curve of some sort.
Take this example, noted by James Krieger and Bret Contreras.
A study on resistance training and muscle gain concluded the following:
“Previously untrained people who engaged in resistance training three times a week for 9 weeks increased their muscle mass by 6%.”
Based on that, you might expect a client to achieve similar results on your three-day-a-week program.
But if you look at the individual data within the study, muscle growth ranged from -2.5 to 20 percent. That’s right: minus 2.5 percent. As Krieger and Contreras point out, five of the 53 participants actually lost muscle!
That’s not to suggest the research results are misleading. In fact, most of the study participants experienced muscle mass gains between 5 and 10 percent, and some even more. However, it does show the overall findings may not to apply to every individual. So don’t expect them to.
Another example is broccoli. There’s a significant body of evidence supporting the health benefits of eating this nutrient-dense vegetable.
But if broccoli makes someone gaggy or gassy, it’s not the healthiest food for them, no matter what the research says about it lowering disease risk.
These kinds of patterns happen over and over: Some people get great results from applying the research, some get very little (or negative) results, and most get results somewhere in between.
This is reality.
Research can be incredibly useful for giving us a starting point for most people. But humans differ—often wildly—from one another.
They differ in terms of their habits, mindset, physiology, environment, and personal preferences. They also differ in their ability to follow a program in the first place. And even if they stick to a plan perfectly, they can differ in the results they get.
Coach for the unique human in front of you, not for an average.
Not only will this improve your client results (because you’ll be working with their particular, practical reality), it’ll also improve your client retention (because you’ll be actually listening to them and trying to understand them as individual people, not as data sets).
When a client is suffering, they probably don’t need you to search PubMed for more evidence.
They often need you to provide a solid, trusting coaching relationship and, of course, your coaching skills. This combination can help you ease client resistance, be creative and flexible when typical solutions don’t work, and be compassionate and supportive when a client struggles with dark stuff.
2. Your professional experience really matters.
If you’re a mindful, growth-oriented coach or practitioner, it’s impossible not to develop a certain degree of experience and expertise over time.
A lot of things go into your “expertise bucket”: courses and programs you’ve taken; books you’ve read; lectures you’ve attended; mentoring relationships you’ve had; and all the practical experience you’ve acquired from observing and coaching clients or patients.
The accumulation of knowledge and experience gives you a kind of “intuition” that can help you coach more effectively.
This “intuition” shows up when you see a client perform a wonky squat, quickly identify exactly what’s wrong, and make corrections to improve form.
It shows up when you perform a client intake, and based on their answers (Just had a baby! Prone to perfectionism!), you can anticipate what aspects of a program they might struggle with, and how you might help them.
Or it shows up when you do a postural assessment, and immediately know which exercises to avoid and which could be helpful.
Much of the time, this is knowledge you could have never learned simply from reading studies. It requires time working with people, and exposing yourself to new ideas and methods, including those that have yet to be studied.
But there’s a challenge here, too. The knowledge we gather from our experiences is very prone to human error: Our memories are unreliable, we see patterns that may not actually exist, and we discount information that doesn’t conform to what we already believe.
How can we reduce human error?
First, be aware that bias and error exist… yes, even for you.
Take notes during or after client sessions, and use a variety of validated measurement tools—such as weight, body measurements, pictures, mood scales, and sleep quality scales—to track the effectiveness of your advice.
Get mentorship and feedback on your practice. Coaches need coaches. Or, find a like-minded group of professionals with whom to collaborate. (That’s why we developed the Precision Nutrition Level 2 Certification.)
If you’re aware of the errors you’re likely to make, and take steps to moderate them, you might start to see some reliable, overarching patterns.
Like that very rigid meal plans don’t work for people in the long term. Or that people can only train so long and so hard before they burn out.
Or a thousand other possibilities experienced coaches notice, but perhaps haven’t been fully validated by published research.
If you’re just starting out and don’t have the experience gained from coaching many people over many years, you can “borrow” insight from mentors or other coaches with more reps under their belt.
Drawing on the wisdom of your (or a colleague’s) accumulated experience is an essential part of being a good practitioner.
3. Science will never have it all figured out.
The evidence is always evolving. Nutrition research in particular is a relatively new area, and there’s still a lot to be learned.
Plus, some things are really hard (or downright unethical) to test in a research setting, and so we may never have scientific evidence on it.
Even if it is possible to test, quality research takes a long time to gather. Usually, one study isn’t enough to “prove” something true or false. But waiting for multiple studies on a specific topic, or better yet, a meta-analyses (which is kind of like a poll of the research) may require a lot of patience. Maybe decades.
And yet, we still have to help our clients and patients make informed decisions. Like, now.
That’s where evidence-based practice comes in.
The RIGHT way to use EBP.
You can formally apply the EBP process to coaching decisions that feel especially important or uncertain.
EBP offers one of the best tools to help you reach a decision that’s most likely to be safe and effective, and that’ll also make sense in the context of your client’s life.
Follow these 6 steps to see EBP in action.
1. Assess the client.
Identify their unique abilities and needs.
What are their strengths?
Where might they need help from you?
What are their precise goals?
What are their identities, values, and beliefs?
Gather this information by asking questions, using intake forms, and taking measurements. This’ll help you create an initial plan of action and also provide a baseline against which to gauge progress.
Plus, as you collect data on many clients, you’ll be accruing practical evidence that can aid with decision making in the future.
Let’s use a hypothetical client to apply these steps.
Her name is Nora. Her goal is to lose fat, and she’s also interested in intermittent fasting. Through your initial assessment you learn that she’s begun to show signs of perimenopause, and her sleep isn’t great these days.
2. Find your research question.
Before you jump to a solution, get clear on the problem you’re trying to help your client with. 
Then, turn the problem into a question that’ll help you isolate the evidence you need for your recommendations. This question should incorporate the problem, as well as relevant factors about your client or patient.
Nora’s main goal is to lose fat, and she’s curious about intermittent fasting. Important factors to consider: Nora is a woman and she’s perimenopausal.
But you’re not sure if intermittent fasting is safe (or effective) for losing fat. And you’re definitely not sure if it’s safe (or effective) for a perimenopausal woman.
So your research question might be: “Is intermittent fasting safe and effective for fat loss in perimenopausal women?”
3. Gather the evidence.
Search for info using an online database like PubMed or Google Scholar. (If you don’t know how to use online research databases, here’s a PubMed tutorial.)
Using a research database will curate your hits so you’re only getting original, peer-reviewed research, rather than someone else’s (potentially biased) interpretation of it.
To find relevant research for Nora, a good keyword combination to type in a search box could be “intermittent fasting + fat loss + menopause”. These keywords contain the intervention you’re interested in learning more about, plus information about Nora’s unique goals and life stage.
To identify the best available scientific evidence on the research subject, use the “Hierarchy of Evidence” pyramid below. The higher up on the pyramid, the more trustworthy the information. So start your search from the top down.
In the case of Nora, prioritize finding a position stand, a meta-analysis, or a systematic review on using intermittent fasting for fat loss in menopausal women. This will give you a comprehensive overview of the current evidence. Basically, scientists and/or academics have already done the hard work—of reviewing, comparing, and analyzing the available scientific evidence—for you.
If that doesn’t exist, look for randomized control trials that compare appropriately chosen groups of people with a control group (such as a group that received no intervention, or a different intervention).
No luck there? You can expand your search to just “women” rather than “menopausal women.” Depending on what’s available, you may have to continue broadening your search and moving down the hierarchy of evidence.
Now, if you’re not well-versed in reading studies or interpreting research, that’s okay. Chances are, if you don’t find a meta-analysis or review, or—best of all—a position stand, the research further down the pyramid will be of limited use to you anyway.
If that’s the case—or you can’t find any scientific research on the topic—you might have to use opinions from other trusted experts, or develop an educated hypothesis based on your own knowledge of how physiology and nutrition work. This still counts as evidence, it’s just not as reliable, so temper your confidence in it accordingly.
All hail the position stand.
If you don’t feel equipped to navigate and interpret scientific literature, consider looking for best practice guidelines or position stands written by an authority in your field.
Position stands are official statements made by a governing body on topics related to a particular field, like nutrition, exercise physiology, dietetics, or medicine.
Here’s an example: The 2017 International Society of Sports Nutrition Position Stand on protein and exercise.
If you have a client who’s older and you’re wondering how to safely increase their training capacity (but don’t want to immerse yourself in a dark hole of research), simply look for the position stand on exercise and older adults.
To find the position stands in your field, consult the website of whatever governing body you belong to.
For example, if you’re a personal trainer certified through ACSM, NASM, ACE, or NSCA, consult the respective website for each organization. They should feature position stands on a variety of topics.
4. Appraise the evidence.
Through your search, you’ll probably find at least some evidence. This might be just a few small studies or some articles from trusted experts in the field.
Now, using the hierarchy of evidence, determine how valid and reliable those pieces of evidence are.
The more you have to broaden your question or move down the quality hierarchy, the less confident you might be about your recommendations.
With Nora, if all you find are some articles by an internet guru who’s never actually seen any real clients, you may want to present your findings as a mere idea, rather than as reliable advice.
On the other hand, if you find a handful of systematic reviews about intermittent fasting in menopausal women, you can go to Nora with more confidence about your recommendations. (Quick fact check, FYI: We couldn’t find any reputable systematic reviews on intermittent fasting in menopausal women.)
5. Create your recommendation.
Unless they ask for it, most clients don’t want to know all the complicated science stuff; they just want to know what to do.
This is where the science of coaching morphs into the art of coaching.
It’s time to see if you can actually apply the evidence you’ve found—along with your own professional experience—to the complex, real, live human standing in front of you.
Notice that the evidence by itself doesn’t make the decision. Nor does your experience, nor do the client’s preferences.
The three simply offer a more holistic perspective on a problem, to ensure you find the best possible solution for your client.
Rather than plunking down a stack of research in front of your client, combine the research with your expertise and your client’s unique circumstances to translate it into practical advice.
It could work like this: Through your research, you find that intermittent fasting is effective for fat loss. However, through your own professional experience, you’ve also noticed that most clients struggle to stick with intermittent fasting long-term. (Aligning nicely with your coaching experience, the research also shows a relatively high drop-out rate with intermittent fasting.)
You’ve also noticed that in some of your female clients, intermittent fasting seems to deregulate menstrual cycles and exacerbate menopausal symptoms.
Thinking about Nora’s unique values and preferences, you know that she wants to lose weight, but you also know that she’s had some trouble sleeping lately. In your experience with other clients, people who are sleep-deprived have an extra-hard time regulating appetite and losing weight.
So… intermittent fasting seems to be effective, but combined with your concerns about Nora’s hormonal health and sleep quality, plus the fact that intermittent fasting can be hard to maintain, you may decide not to recommend it to Nora.
After explaining to her your reasoning, explore with her what she’s comfortable trying. In the end, you may suggest some simple nutrition habits along with some short fasting experiments, plus some sleep tips.
These recommendations include what you’ve found from the best available research, your own coaching experience, and Nora’s unique preferences, goals, and challenges.
Nora’s just gotten some pretty wise, tailored-to-her advice, where you worked as collaborators to come up with her action plan.
That’s the art and science of coaching.
6. Monitor the results.
Once you’ve given your client a little time to practice what you came up with together, you can assess if those actions are working.
Consult those measurements you took in your initial assessments. Compare them to current measurements.
Are things moving in the right direction?
And talk to your client about how the plan is working.
Nora tells you although she’s applying and benefitting from the sleep tips, she’s struggling with fasting, even the shorter experiments. Turns out, it’s hard to fast when you’re having trouble falling asleep because of a grumbling tummy.
As you monitor progress, use what you find to re-evaluate goals and pinpoint where your client or patient needs more support.
Now Nora’s asking you about trying the Paleo diet instead. Looks like you have more research to do.
But keep in mind, over time, you’ll develop a solid grasp of the body of evidence on a number of topics. That’s the good part about science moving slowly: It’s not that hard to keep up.
What to do next.
Be empathetic, supportive, and flexible.
No matter what you believe is “right” or “true,” your first job is to work with your client, wherever they’re at.
Many practitioners intuitively know this, but the bond between coach and client (or patient) is extremely important and influential.
This bond is called the “therapeutic alliance,” and it refers to the level of trust and rapport between a practitioner and the person they’re helping.
Change is hard, and often scary. A strong therapeutic alliance can help a person feel supported and understood while surfing the tides of change.
In fact, some studies show the results a client or patient achieves in your care are up to 85 percent dependent on the therapeutic alliance. So, the stronger that relationship, the better the results.
If you’re constantly butting heads with your client, telling them, “But the research says!” or, “I know best!”, you can wave goodbye to a strong therapeutic alliance.
Many of the obstacles your clients will face are behavioral and emotional, rather than rational and theory-based. So more than facts, your clients often need compassion, support, and creativity to get them through the tough stuff.
Focus on the big rocks.
Given how complicated bodies and behavioral change are, it’s not surprising that science is still “trying to figure things out.”
Rather than using “cutting-edge” protocols like intermittent fasting or precise macronutrient ratios (which should really only be for more advanced clients anyway), focus on “big rocks” that offer the most bang for buck, like:
eating enough protein and vegetables
moving regularly
getting adequate sleep
managing stress
reducing smoking and/or excessive alcohol consumption
If that sounds boring or too obvious, we ask you this: How many people do you know who are consistently doing all five well? (In case you’re curious, it’s only about three to five percent of the population.)
Just managing those five things will keep most people plenty busy.
Be humble, throw out the rules, and keep learning.
The smartest people are often the ones who are most comfortable asking questions, saying “I don’t know,” and resting in uncertainty.
It’s a cliche but true: The more you know about something, the more you realize what you don’t know.
Be wary when others claim absolute certainty. It may be they don’t fully understand the complexity of the matter.
True expertise is about being comfortable with limited knowledge—while continuing to seek more and better information—and also accepting we may never have complete certainty.
Experiment wisely, and learn from both successes and failures.
Want to see how a theory works in practice? Test it out on yourself, and measure your experience as objectively as possible.
With clients, so long as there is no risk of harm, try out well-informed experiments (with their permission) that are either based on research or expert theory. Then, as always, track and measure their experiences and results to inform your next steps.
Know what you don’t know and work with other experts as needed.
Especially if you’re a beginner in your practice, it’s okay not to know stuff.
Focus on what you know best, whether that’s good lifting form, coming up with healthy meal ideas, or giving support during sticky coaching situations. But also know that some things will be out of your scope of practice.
So build a strong professional network—which could include family doctors, dietitians, massage therapists, naturopaths, chiropractors, and psychotherapists—and refer out whenever you encounter something you feel uncomfortable or especially inexperienced with.
Establishing a deep roster of experts will help clients get the support they need. And we’re pretty sure the evidence will show that’s good for everyone.
If you’re a coach, or you want to be…
Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes — including helping them with meal transformation — is both an art and a science.
If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certification. The next group kicks off shortly.
What’s it all about?
The Precision Nutrition Level 1 Certification is the world’s most respected nutrition education program. It gives you the knowledge, systems, and tools you need to really understand how food influences a person’s health and fitness. Plus the ability to turn that knowledge into a thriving coaching practice.
Developed over 15 years, and proven with over 100,000 clients and patients, the Level 1 curriculum stands alone as the authority on the science of nutrition and the art of coaching.
Whether you’re already mid-career, or just starting out, the Level 1 Certification is your springboard to a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results.
[Of course, if you’re already a student or graduate of the Level 1 Certification, check out our Level 2 Certification Master Class. It’s an exclusive, year-long mentorship designed for elite professionals looking to master the art of coaching and be part of the top 1% of health and fitness coaches in the world.]
Interested? Add your name to the presale list. You’ll save up to 33% and secure your spot 24 hours before everyone else.
We’ll be opening up spots in our next Precision Nutrition Level 1 Certification on Wednesday, April 3rd, 2019.
If you want to find out more, we’ve set up the following presale list, which gives you two advantages.
Pay less than everyone else. We like to reward people who are eager to boost their credentials and are ready to commit to getting the education they need. So we’re offering a discount of up to 33% off the general price when you sign up for the presale list.
Sign up 24 hours before the general public and increase your chances of getting a spot. We only open the certification program twice per year. Due to high demand, spots in the program are limited and have historically sold out in a matter of hours. But when you sign up for the presale list, we’ll give you the opportunity to register a full 24 hours before anyone else.
If you’re ready for a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results… this is your chance to see what the world’s top professional nutrition coaching system can do for you.
jQuery(document).ready(function(){ jQuery("#references_link").click(function(){ jQuery("#references_holder").show(); jQuery("#references_link").parent().hide(); }); });
References
Click here to view the information sources referenced in this article.
Balachandran, A. & Schoenfeld, B. (2017, March 2) Evidence-based practice in Exercise and Nutrition: Common Misconceptions and Criticisms. Retrieved from https://www.lookgreatnaked.com/blog/evidence-based-practice-in-exercise-and-nutrition-common-misconceptions-and-criticisms/
Baldwin, S.A., Wampold, B.E., & Imel, Z E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6), 842–852.
Cabaniss, D. L. (2012, May 31) The Therapeutic Alliance: The Essential Ingredient for Psychotherapy. Retrieved from https://www.huffpost.com/entry/therapeutic-alliance_b_1554007?fbclid=IwAR1NDl7sNR60OSvNFWmpTUA-GqAV65fMtxsOrOFAQ9fLM5Z5eQlcRR4APbU
Duke University. (2018). Introduction to Evidence-Based Practice. Retrieved from https://guides.mclibrary.duke.edu/ebmtutorial/home
Erskine, R.M., Jones, D.A., Williams, A.G., Stewart, C.E. & Degens, H. (2010) Inter-individual variability in the adaptation of human muscle specific tension to progressive resistance training. European Journal of Applied Physiology, 110(6), 1117-25.
Evidence-Based Medicine Working Group. (1992) Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine. Journal of the American Medical Association, 268(17), 2420-5.
Frances, A.J. (2013, June 24) What Should Doctors Do When They Don’t Know What to Do? Retrieved from https://www.psychologytoday.com/us/blog/saving-normal/201306/what-should-doctors-do-when-they-dont-know-what-do?fbclid=IwAR3ce99uT-RDXcp_yvnJ0r2aTfBPWPpngqNUvkIc5a6PBZkyr5d-Z8sgy2Y
Joyce, A.S. & Piper, W.E. (1998) Expectancy, the Therapeutic Alliance, and Treatment Outcome in Short-Term Individual Psychotherapy. The Journal of Psychotherapy Practice and Research, 7(3), 236–248.
Löfgren, K. [Kent Löfgren]. (2013, February 25). What is epistemology? Introduction to the word and the concept [Video File]. Retrieved from https://www.youtube.com/watch?v=lI9-YgSzsEQ
Ludwig, J. (2018, April 16) Here’s what is going wrong with ‘evidence-based’ policies and practices in schools in Australia. Retrieved from https://www.aare.edu.au/blog/?p=2822
Schoenfeld, B.J., Contreras, B, Krieger, J., Grgic, J., Delcastillo, K., Belliard, R. & Alto, A. (2019) Resistance Training Volume Enhances Muscle Hypertrophy but Not Strength in Trained Men. Medicine & Science in Sports & Exercise, 51(1), 94-103.
Wampold, B. E. (2001). The great psychotherapy debate:Models, methods, and findings. Mahwah, NJ: Lawrence Erlbaum. NJ: Lawrence Erlbaum.
Evidence-Based Medicine Toolbox. (2017) Retrieved from https://ebm-tools.knowledgetranslation.net/
Evidence-based practice. (2018, November 19) Retrieved from https://en.wikipedia.org/wiki/Evidence-based_practice?fbclid=IwAR3ARk06zmx_lJYPIrTGA_chfBa9v_-NsW7HQbC7-rTHaq-Y7AYcSdLAk80
The well-built clinical question: a key to evidence-based decisions. (1995). Retrieved from https://mclibrary.duke.edu/sites/mclibrary.duke.edu/files/public/guides/richardson.pdf
The post Evidence-based coaching: Why some health and fitness pros are doing it all wrong. appeared first on Precision Nutrition.
Evidence-based coaching: Why some health and fitness pros are doing it all wrong. published first on
0 notes