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

Social, physical, and organizational stressors should be explained and methods to ease or elevate stressors should be presented.

At the individual level how changes in attitudes and behaviors help one to cope with stressors; learning techniques to minimize stress response, such as meditation, relaxation response, and exercise.

Content of the program should provide the following –

• Identifying sources of stress

• Relationship of stress to health

• Just how the individual experiences stress, personal, family, work

• Solutions for coping and managing stress

• Techniques for reducing stress

• Value of stress, both negative and positive

• Practical steps of incorporating stress reduction into lifestyle

Personnel conducting stress management programs should have training in psychology, behavioral sciences, or related disciplines such as mental health experts, counselors, health educators, psychologists, and psychiatrists.

Training in a reputable program on how to teach the stress management course including group process skills is a must.

A nutrition education program ought to include a nutritional needs assessment, education counseling, and referral as necessary.

Educational sessions and materials ought to include the following information –

• The relationship of nutrition and chronic conditions

• Improving eating patterns

• Relationship of nutrition and proper weight maintenance

• Exercise

• Stress

• Blood pressure (BP)

• Cholesterol

• Diabetes and other chronic illnesss.

• Nutritionally exact information regarding the relationship of health to diet, including cholesterol, fats, fiber, alcohol, carbohydrates, salt, sugar, and vitamin/mineral supplementation.

Methods for identifying healthier foods and incorporating low-calorie, high nutrient foods into eating habits. Guidelines for improving eating habits ought to be based on or in line with national recommendations like the Food Guide Pyramid.

Instructor ought to be a registered dietitian, registered nurse, or have a baccalaureate degree or higher in health education with training in nutrition.

If an allied health specialist instructs the program, a consultation and review of the program design by a registered dietitian is recommended.

It is advised that tobacco use cessation programs subscribe to the Code of Practice for Use of tobacco Cessation Programs.

Tobacco use cessation programs should be multi-component with a focus on skills to build positive voluntary behavior modification practices.

Useful techniques include establishing reasons for quitting, understanding the smoking habit, various techniques for stopping and remaining a non-smoker, overcoming the problems of quitting, short-term goal setting, weight control, stress management, importance of exercise, relationship of alcohol consumption to urges to smoke. Use no aversive or frighten tactics.

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

The instructor should have formal training in use of tobacco cessation from a nationally recognized organization such as American Heart Association, American Cancer Society, American Lung Association, or a nationally recognized commercial program such as Smoke Enders.

Investigation of success is sometimes very dubious in use of tobacco cessation programs. Measurement of success ought to include participation rate, including the number starting the program, the number completing the program, and the average number per session.

Additionally included, number and percent who stopped tobacco use at the end of the program, and the number and percent who had not resumed tobacco use by the end of one year.

Participatory fitness plans should include education on benefits of regular exercise and risks of a sedentary lifestyle, its impact on cardiovascular health and diseases, its relationship with weight control and stress management, and aerobic activity options.

Discussion and practice of safe principles of exercise – warm up, cool down, frequency, intensity, duration, flexibility and strength components.  The wellness program follows guidelines by the American College of Sports Medicine.

Safety precautions should include the following –

• Informed consent before beginning exercise with clear and complete written and verbal instructions of possible risk, purpose of exercise, exercise format to be followed, opportunity for questions, and a signed informed consent with date.

• A screening/evaluation of participants to determine when medical evaluation is necessary for exercise such as the Physical Activity Readiness Questionnaire (PAR-Q, see forms).

• Measurements of blood pressure and resting heart rate are useful screening information to determine exercise readiness.

• Participants who fail screening are medically referred and should obtain a written clearance from their physician to exercise.    

• The basic content of an group fitness program ought to include –     

Warm up   5 – 10 minutes

Aerobic exercise   20 – 40 minutes

Cool down   5 – 10 minutes

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

Health Promotion Program offered is consisitent with scientific and medical recommendations for losing weight, reflects a multi-disciplinary approach which offers four components –  behavioral, exercise, nutrition, and maintenance, and is in accordance with the document Guidance for Treatment of Adult Obesity. It includes –    

• Screening to verify that the participant lacks medical or psychological conditions which would make losing weight inappropriate, and to identify the participant’s level of health risk, classifying participants not only on excess body weight, but also on the basis of associated medical conditions and overall heath risk.

• Referral for participants who are morbidly obese who’d require medical guidance for weight reduction.

• Informed consent, explanation of potential physical and psychological risk from losing weight and regain, likely long-term success of health promotion program, full cost of the health promotion program, credentials of the staff.

• Identification of factors to participant’s weight status, serving as the basis for an individualized weight loss plan which includes the weight goal and plans for nutrition, exercise, and behavioral components.

• Weight goal of participant is reasonable based on personal and family weight history not solely on height and weight charts; initial weight loss goal does not exceed loss of 10% of body weight, 1-2 pounds per week.

• Explanation of unsafe losing weight methods.

• Daily calorie level is altered to meet each participant’s recommended rate of weight reduction.

• Daily caloric intake isn’t less than 1,000 calories; if less, doctor monitoring is required.

• Food plan designed so participants can choose foods which meet 100 percent of all the Recommended Daily Allowance (RDA) except for calories. Nutritional supplementation may be used to achieve RDAs, however shouldn’t greatly exceed RDAs.    

• Nutrition education stimulating permanent healthful eating habits based on the Food Guide Pyramid.    

• Participant involved in meal planning and food selection.    

The protein, fat, carbohydrate, and fluid content of the food plan meet safety recommendations –     

Protein   Between 0.8 and 1.5 grams of protein per kilogram of goal body weight, but no more than 100 grams of protein a day.

Fat   10 – 30% calories as fat.

Carbohydrate   At least 100 grams per day.

Fluid   At least one liter of water daily.

• Exercise component ought to be a meaningful portion of the wellness program and be both didactic and experiential.

• Participant is appropriately screened for exercise using a screening questionnaire such as the Par-Q Readiness Assessment (see forms). Instruction on recognizing untoward responses to exercise.

• Participants work towards 30-60 minutes of exercise 5-7 days per week.

• No appetite suppressant drugs.

• Maintenance plan offered for continued support.

• Weight control programs should be conducted by a registered dietitian or by degreed health experts with training in nutrition with consultation by a registered dietitian.

• Trained lay leaders may assist if supervised by nutrition professional.

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

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

Follow national guidelines –

Total Cholesterol

Desirable cholesterol   < 200 mg/dl

Borderline cholesterol   200 – 239 mg/dl

High cholesterol   > 240 mg/dl

HDL   

Desirable HDL    > 35 mg/dl

Low HDL    < 35 mg/dl

Refer cholesterol screening participants to medical care as follows –    

Total Cholesterol   

< 200 mg/dl    Recheck cholesterol in five years, if history of coronary heart illness or if two or more CHD risk factors are detected refers to risk reduction program or health experts, as appropriate.

200 - 239 mg/dl    When history of CHD or if two or more other risk factors are detected, refer to medical care or risk reduction service within two months; if no reported history of CVD or less than two other risk factors, reassess cholesterol status within 1-2 years.

> 240mg/dl    Refer to medical care within two months.

HDL   

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

Give the following –    

• The relationship of blood cholesterol, high blood pressure, and other risk factors.    

   o Risk factors include –  high blood pressure 140/90 or higher or on hypertension medication; current cigarette use of tobacco; family history of premature CHD; diabetes mellitus; age – male > 45 years, female > 55 years or premature menopause without estrogen replacement therapy.

   o Negative risk factor –  high HDL 60 mg/dl or greater (subtract one risk factor).

   o Risk factors such as family history, tobacco use, high fat or other unhealthy diet, andphysical inactivity lead to the development of cardiovascular disease (CVD).

• Definitions and causes of high blood cholesterol and HDL, desirable levels, the meaning and limitations of a single measurement, the cause of variability, and the need for multiple measurements prior to diagnosis.    

• Wide range of treatment options, including diet (e.g., importance of controlling fat intake less than 30 percent of sum calories from fat, less 10 percent saturated fats), less than 300 mg. of cholesterol per day, well-balanced diet, weight maintenance or reduction, exercise, and medication.    

• Importance of following prescribed treatment and specialist advice.    

Appropriate medical or allied health specialist trained in measurement of blood pressure, referral protocols, and delivering educational messages to participant conducting blood pressure programs. These wellness programs are required to follow national guidelines.

National guidelines for blood pressure (BP) protocols –  

• Calibration of blood pressure measuring equipment must be done at least yearly.

• Two or more measurements of participant’s blood pressure should be taken.

• Referral of participants with high blood pressure readings to personal physician for further analysis.   

Systolic / Diastolic Follow-Up –     

• Normal –    <130 / <85   

   Action –  Recheck in 2 years

• High Normal –    130-139 / 85-90   

   Action –  Recheck in 1 year

Hypertension –     

• Stage 1 (Mild) –    140-159 / 90-99    

   Action –  Confirm within 2 Months.

• Stage 2 (Moderate) –    160-179 / 100-109    

   Action –  Refer to source of care within 1 month.

• Stage 3 (Severe) –    180-209 / 110-119    

   Action –  Refer to source of care within 1 week.

• Stage 4 (Very Severe) –    >210 / >120    

   Action –  Refer to source of care immediately.

Appropriate educational messages –     

• Normal –    <130 systolic and <85 diastolic   

   Action -  No referral. When on treatment, then inform participant that blood pressure (BP) is under good control today and should continue seeing and following treatment program.

• High Normal -    130-139 systolic and/or 85-89 diastolic   

   Action -  Recommend that participant have blood pressure rechecked within 1 year unless under treatment. Advise participant that the readings are in a high normal range that needs rechecking. In the interim, suggest that among the most effective means to lower blood pressure is to bring weight into normal range and to exercise.

• High -    >140 systolic and/or >90 diastolic   

   Action –  Refer to physician for further investigation within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. If already on treatment, advise participant of readings and need to get blood pressure to a goal of 140/90 or less.

• Isolated Systolic Hypertension –    140-159 systolic and < 90 diastolic in a participant 65 years of age or older.   

   Action -  Advise participant to inform doctor of readings at next visit and consider advice regarding weight reduction and exercise if appropriate.

• Urgent -    180-209 systolic and/or 110-119 diastolic   

   Action -  Recommend obtaining medical examination within 1 week.

• Emergency -    >210 systolic and/or >120 diastolic   

   Action –  Obtain immediate medical attention.

Provides the following –     

• Written results, referral instructions, and an explanation of blood pressure (BP) levels given to each participant with individualized counseling, including advice about the interval of time advised when the participant must be checked again.    

• Utilizes the recommendations in the Fifth Report of the Joint National Committee on Detection, Examination and Treatment of High Blood Pressure, March 1994.    

• Written and audiovisual materials that are informative, easy to understand, and useful while containing scientifically exact information.    

• Relationship of high blood pressure and other risk factors, like family history, tobacco use, high fat and unhealthful diet, lack of exercise, in the development of cardiovascular disease, including stroke, kidney disease, heart attack, and other diseases.

• Definition and causes of high blood pressure.

• Importance of following prescribed treatment.

Health risk screening programs should be carried out on a one-on-one basis by trained health care specialists. Health risk measures should include the following –

• Blood pressure measurements – at least two blood pressure measurements taken during the screening episode, using a mercury sphygmomanometers or regularly calibrated aneroids.    

• Blood pressure (BP) treatment status – ascertain whether the participant is under a doctor’s care, on any medication, on a prescribed diet, or any other kind of treatment for hypertension.    

• Blood cholesterol measurement – total cholesterol and HDL-cholesterol taken either using a properly tested and maintained table top blood analyzer providing immediate feedback to the patron, or sending blood to a laboratory providing feedback using a method that is as effective as immediate feedback.    

• Cholesterol treatment status – ascertain whether the customer is under a physician’s care, on any medication, on a prescribed diet, or any other kind of treatment for high cholesterol.    

• Obesity – utilize an accepted method for estimating obesity. for example assess participants height and weight and use the 1959 Metropolitan Life Height/Weight charts or use Body Mass Index.    

   o Identify individuals  20 percent or more above their ideal weight.

• Smoking status – assess whether the participant currently smokes cigarettes, whether the patron has quit or never smoked, and the number of cigarettes smoked/day.    

• Exercise habits – screening questions may  be limited to frequency and duration exercise. Do participants exercise in a moderately vigorous fashion at least three times per week for 30 minutes or more.    

• Diabetes – whether the client has diabetes, and whether or not it is currently under control. A blood glucose could  be also done via finger stick and desk top analyzer. Several manufactures make available cassettes which include cholesterol and glucose measurements.

• Cerebrovascular disease or occlusive PVD – ascertain when the patron has had a stroke or other type of blood vessel disease.

• Family history of cardiovascular illness – ascertain whether any of the participants’ parents or siblings had a heart attack or sudden death as a result of heart illness before age 55.

• Coronary heart illness – ascertain if the client has had a heart attack or other kind of coronary heart illness.

• Stress – participant’s assessment of stress in work and/or personal life. A series of well-tested and validated questions reviewing  levels of stress are available from the Staff Member Health Program.

• Participant release form (see forms) – A release form is required in which the participant allows the wellness program to draw blood for testing to send information to the participant’s medical care provider if medical risks are identified, and to obtain information from the provider about diagnosis and prescribed treatment.

• Participant interest survey – when an assessment of interest has not been gathered previously, the screening activity must assess levels of interest in wellness programs like –  weight control, smoking cessation, fitness or exercise, stress management, nutrition, self-care, cholesterol control.

• Health education messages – the screener must review with the participant his/her identified health risks and what they mean to the participant’s overall health, and give the participant a written record of the blood pressure, total cholesterol, and any other physiological measures taken.

• Referral of participants for treatment – participants with elevated risks must be referred to appropriate sources of diagnosis and possible treatment following nationally or locally recognized guidelines for such referral.

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

Wellness Program directors or providers should’ve a background in health promotion programming and a professional health-related degree or certification.    

They should’ve professionalise in content areas, planning, promotion, administration, examination, and ability to grow a wellness program and tailor the wellness program to the worksite.   

Health Promotion Program providers should have a quality assurance program for reviewing  the effectiveness of service personnel, to assess satisfaction of participants, and for personnel training and continuing education.   

An overall policy statement must be available from directors and health promotion program providers addressing the following issues –  

• Assurance of confidentiality of health data,
• referral to health and medical care for at-risk participants,
• follow-up with referred participants and those at-risk,
• wellness program evaluation on process and outcomes,
• organization of the worksite for promotion of wellness and changes in corporate culture.

A clear contract or letter of agreement for services ought to be provided.

Incentives may be used to increase participation rates, help with completion or attendance at wellness programs, and to help individuals change or adhere to healthy behaviors.

The purpose of the incentive is to encourage personnel to adopt positive behaviors or maintain an existing positive behavior.

Everybody who achieves a goal or maintains a behavior should receive something. Many organizations also provide incentives merely for participating in events.

Stay away from being the “best” or doing the “most.” Encouraging individuals  to be the best or doing the most promotes excessive behavior, discourages others, and creates elitism.    

The best designed incentive programs are ones which are based on achieving goals that are attainable by most individuals. Recognition, acknowledgment by top management, or special privileges are examples of great intangible incentives.   

Health Promotion Program Incentive Ideas –    

• Free or Low-Cost Incentives-     

   o Certificates

   o Movie passes

   o Recognition in staff member newsletter

   o Mugs

   o Water bottles

   o Commendation from upper-level management

   o T-shirts

   o Hats

• Moderate Cost Incentives –     

   o Entertainment tickets

   o Sweatshirts

   o Waist packs

   o Subscriptions to health magazines

   o Fitness and health books

   o Videos

• High Cost Incentives –     

   o Week-end getaways

   o Dinner for two

   o Clocks

   o Watches

• Other Incentives –     

   o Cash

   o Gift certificates