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USP97M Health and lifestyle

Unit reference number: J/507/5642

Level: 3

Guided Learning (GL) hours: 60

Overview

This unit provides learners with the knowledge and understanding of health and lifestyle. Learners will develop their knowledge of the different components of health and the lifestyle behaviours and choices that affect health and wellbeing, which contribute to positive health or poor health. Learners will also develop the knowledge and skills to collect and assess lifestyle information and provide guidance and recommendations for lifestyle improvement for clients.

Learning outcomes

On completion of this unit, learners will: LO1 Know the components of health and wellbeing

LO2 Know how lifestyle behaviours affect health and wellbeing

LO3 Know how to collect and assess lifestyle information

LO4 Be able to collect and assess lifestyle information

LO5 Be able to offer recommendations and guidance for lifestyle improvement

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Assessment requirements

Learners must complete all assessment requirements related to this unit: 1. Service portfolio 2. Graded practical assessment 3. External examination 4. Graded synoptic assessment

1. Service portfolio

Learners must produce a service portfolio that includes evidence of lifestyle consultations and assessments carried out with proficiency. At a minimum the service portfolio for this unit must include consultation notes and lifestyle questionnaires covering all the following:

Used all methods to assess lifestyle - Interview

- Questioning

- Use of questionnaires

Complete lifestyle records and action plan to improve health and lifestyle - Physical activity

- Diet

- Sleep patterns

- Work-life balance

- Stress

- Alcohol use

- Smoking

Collected all client information - Personal details

- Lifestyle behaviours

- Medical history and information

- Attitude, motivation to making changes, barriers to change

- Stage of readiness Evidence from the graded practical assessment must also be presented in the service portfolio. The service portfolio must be completed prior to learners undertaking the practical skills test. Whilst service portfolios will not be graded, they may be sampled by the VTCT External Quality Assurer (EQA).

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2. Graded practical assessment

Learners must carry out a complete consultation and assessment of a client’s lifestyle and make appropriate recommendations to improve lifestyle and health. This will be observed, marked and graded by centre assessors. The grade achieved in the graded practical assessment will be the grade awarded for the unit. The graded practical assessment must take place in a real or realistic working environment on a real or realistic client. At a minimum the graded practical assessment for this unit must cover:

Methods to assess lifestyle - Interview

- Questioning

- Use of questionnaires

Lifestyle records and action plan to improve health and lifestyle - Physical activity

- Diet

- Sleep patterns

- Work-life balance

- Stress

- Alcohol use

- Smoking

Client information - Personal details

- Lifestyle behaviours

- Medical history and information

- Attitude, motivation to making changes, barriers to change

- Stage of readiness Recorded professional discussion can also be used as an assessment method attached to the graded practical assessment and is particularly useful for gathering evidence for criteria related to evaluation and reflection. Professional discussions should be planned and recorded.

3. External examination

Whilst the theory content of LO1, LO2, and LO3 may be naturally assessed in the graded practical assessment, they will be tested by an external examination at the end of the period of learning. External examinations will test knowledge and understanding from across the whole vocational area (mandatory units). Learners should use the unit content section of this unit to aid revision since exam questions will test the full breadth of this content. External examinations will be set and marked by VTCT and will contribute to the overall qualification grade.

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4. Graded synoptic assessment

In the last term or final third of their qualification, learners will be required to undertake a graded synoptic assessment. This will require learners to carry out a range of services from across the whole vocational area (mandatory units). Assessment coverage will vary year on year, although all services will be covered over time. VTCT will set a brief for centres which will detail the services to be covered in the graded synoptic assessment. Grading descriptors for the synoptic assessment will also be provided by VTCT. The graded synoptic assessment will be marked and graded by centre staff and externally verified by VTCT. The graded synoptic assessment will contribute to the overall qualification grade.

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Unit content

LO1 Know the components of health and wellbeing

Learners must know what is meant by the terms health, fitness and wellbeing:

Health – ‘A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (World Health Organisation. 1948)

Components of health and total fitness: - Physical – the body systems including the heart, lungs, muscles, bones and

joints Cardiovascular – efficiency of the heart, lungs and circulatory system

to take in, transport and utilise oxygen and remove waste products; activities that involve rhythmic use of large muscle groups, moderate or vigorous intensity, e.g. swimming, cycling, walking, running

Muscular fitness – strength – the ability of a muscle or group of muscles to generate maximal force or overcome a maximal resistance; endurance – the ability of a muscle or group of muscles to contract repeatedly for an extended duration without fatigue; exercises such as resistance machines, body weight exercises, free weights, e.g. gym-based training, studio resistance training, body conditioning classes, yoga, Pilates

Flexibility – the ability of a joint and associated muscles to move through the full potential range of motion; types of stretching – active, passive, static, dynamic, ballistic, proprioceptive neuromuscular facilitation

Skill-related or motor fitness – speed, reaction time, agility, balance, coordination, power

- Nutritional – diet and healthy eating, eating a healthy and balanced diet containing all main nutrients, maintaining a healthy body weight and body composition, having access to healthy food

- Medical – absence of any diagnosed chronic health condition, disease, illness or injury

- Mental and emotional – the mind and emotions, having a positive mind-set, balanced emotions, harmony between the mind and emotions, ability to cope and manage stress and stressful situations

- Social – maintaining positive relationships and connections with others at work, home, community and society, inclusion and equality, rather than isolation and exclusion

Wellbeing – no standard or agreed definition. Integrates mental and physical health (mind and body) to promote more holistic approaches to health promotion and chronic disease prevention

Five Ways to Wellbeing – evidence-based actions people can pursue in their daily life to promote wellbeing, published around 2008:

- Connect – time with friends and family, build social relationships

- Be active – sit down less and move more, increase physical activity (walking, gardening)

- Learn – building sense of achievement through learning, e.g. adult education courses or learn a new skill

- Give to others – charity work, volunteering or giving to charity, giving encouragement praise

- Take notice – mindfulness and being present in the here and now, being aware of what is happening – thoughts, feelings, body sensations, colour of the sky, sounds in the environment, e.g. birds, breeze

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Learners must know the different factors that can affect fitness, health and well-being:

Genetics and heredity – predisposition to certain diseases, inherited characteristics

Individual factors – gender, age, ethnicity, height, weight, body type

Lifestyle factors – sedentary behaviour, physical inactivity, physical activity, exercise, nutrition, smoking, alcohol, drugs, work, rest, stress, weather

Health inequalities – socio-economic status, low income, low education, ethnicity Learners must know what is meant by the terms physical activity, exercise, fitness, sport:

Definition of physical activity – any movement of the body that increases energy expenditure above resting levels. Not being physically inactive/sedentary for extended periods of time. Examples: everyday activities, e.g. gardening or vigorous housework, playing games, dancing

Definition of exercise – activities that are planned, structured and performed regularly with the specific intention of maintaining or improving one or more of the components of physical fitness. Examples: walking, swimming (cardiovascular fitness), weight training, body weight exercises (muscular fitness), stretching, yoga, Pilates (flexibility, core stability and balance), sports or sports training sessions

Definition of fitness – result or outcome from taking part in regular exercise - Health-related – cardiovascular, muscular fitness (strength and endurance),

flexibility - Skill-related – agility, balance, power, speed, reaction time, coordination

Definition of sport – activities that may be competitive or recreational, individual or team, played or competed in at an amateur, professional or Olympiad, Paralympic level, e.g. team games, athletics, field events, water based sports, distance running, individual sports, e.g. boxing

Learners must know the health benefits associated with regular physical activity, exercise and sport:

Physical: - Improved components of fitness (cardiovascular fitness, muscular strength

and endurance, flexibility, body composition)

- Stabilised blood sugar and energy levels

- Reduced early mortality, reduced morbidity from coronary heart disease, stroke, diabetes, certain cancers

- Improved weight management and body composition, reduced risk of obesity

- Improved posture, prevention of lower back pain, reduced risk of injury, improved joint stability

- Increased bone density, reduced risk of osteoporosis

- Improved quality of life, improved independence, reduced risk of falls (older adults)

- Improved ability to perform active daily living tasks, improved functional capacity

Psychological: - Improved mental health and psychological wellbeing

- Reduced risk of anxiety, stress and depression

- Increased confidence, increased self esteem

- Increased drive and motivation

- Improved concentration

- Assists management of depression

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- Relief of tension

- Improved sleep

- Improved mental resilience

Social: - Meeting new friends

- Widened social network

- Improved work performance

Learners must know the effect of physical activity on the causes of diseases and chronic health conditions:

Coronary heart disease – reduced blood pressure, improved blood cholesterol profile, improved elasticity of blood vessels, capillarisation, improved blood flow distribution

Some cancers – increased physical activity is associated with reduced risk of colon cancer, other healthier lifestyle choices and reduced stress that may be contributory factors for some other cancers

Type 2 diabetes – improved regulation of insulin, improved blood glucose regulation

Hypertension – reduced blood pressure post-exercise and long-term, improved blood flow distribution, improved elasticity of blood vessels, reduced muscular tension, reduced stress level

Obesity – improved fat metabolism, increased calorie expenditure

Osteoporosis – increased bone formation, improved density, improved posture, reduced risk of injury

Mental health – improved mood, increased dopamine, endorphins, increased feel good factor and sense of wellbeing

Learners must know current guidelines and recommendations (ACSM and Department of Health) for physical activity to maintain health for adults and older adults:

Adults: - 150 minutes of moderate-intensity aerobic activity every week, e.g. 5 days for

30 minutes (time can be accumulated in bouts of ten minutes or more)

- Or 75 minutes of vigorous-intensity activities (at least 20 minutes, 3 days a week)

- Or an equivalent combination of moderate- and vigorous-intensity activities

- Plus 2 days a week muscular fitness training

- Reduce sedentary time

Older adults: - As above with the addition of balance and co-ordination activities

- Activities appropriate to mobility and functional ability of the individual (ACSM, 2014. DH, 2011)

Learners must know current guidelines and recommendations for healthy eating:

Information sources – National Food Guide, Food Standards Agency (FSA), eatwell guide (balance of good health), Government Department of Health (DoH) ‘five a day’ fruit and vegetable recommendation

General nutritional principles and features: - Food types

- Balanced intake of macronutrients and micronutrients

- Food proportions

- Food choices

- Portion sizes

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Learners must know the health risks associated with poor nutrition and unhealthy eating:

Chronic diseases associated with poor nutrition, e.g. obesity, type 2 diabetes, heart disease, stroke, osteoporosis, cancer, atherosclerosis, hypertension, arthritis, mental health problems (depression, anxiety)

Acute conditions associated with nutritional deficiencies, e.g. anaemia, dehydration, hypoglycaemia

Learners must know general healthy eating advice:

Balanced intake of nutrients

Regular timing of food intake

High fibre

More complex carbohydrates

Low fat

Low salt

Less red meat

Less processed foods

Less cakes and pastries

Five portions of fruit and vegetables a day

Fish twice weekly, one portion of oily fish

Alcohol intake within recommended guidelines Learners must know the dietary role and sources of the key macronutrients and micronutrients:

Carbohydrates: - Role – energy, digestion (fibre), nervous system function

- Sources – simple carbohydrates – sugar, sweets, chocolate, fruit and complex carbohydrates - beans, bread, pasta, potatoes, rice, corn

Fats: - Role – provide essential fatty acids, insulation, protection of vital organs, energy,

transport fat-soluble vitamins

- Sources – saturated – animal/dairy products, meat, fish, eggs, dairy products., unsaturated fish oils, nuts, seeds, fruit (olives, avocado), plant oils, grains, beans and pulses, hydrogenated/trans-processed food products, e.g. confectionery, cakes, biscuits, bread, boxed cereals

Protein: - Role – muscle growth, muscle repair, oxygen transport, fight disease, energy.

- Sources – animal (all amino acids) - animal/dairy products, meat, fish, eggs, dairy products, plant (not all amino acids) - grains, beans and pulses, leafy vegetables

Vitamins – water soluble (C and B group), fat soluble (A, D, E and K) - Role – energy metabolism, protein synthesis, glycogen synthesis, blood

clotting, red blood cell formation, aid growth, maintenance of teeth and bones, aid vision

- Source – all natural food sources, e.g. vegetables, fruit, milk, fish, eggs

Minerals – macro and trace e.g. calcium, copper, iron, magnesium, phosphorus, potassium, sodium, selenium, zinc

- Role – bone growth, teeth growth, energy production, enzyme function, nerve and muscle function, water balance, blood clotting, oxygen transport in red blood cells

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- Sources – all natural food sources e.g. milk, nuts, seeds, vegetables, meats, grains

Hydration – intake of fluid/drinks, water (preferred source) - Intake quantity, timing of intake - depending on activity levels, temperature

- Importance–maintain body balance/homeostasis, maintain body processes and functions, physical and mental performance, thermoregulation, blood plasma volume, removal of waste products

Learners must know the role of the energy balance equation in relation to weight management:

The two components of the energy equation: - Energy intake – food and drink, the type and amount of food eaten, type and

amount of drinks consumed that contain energy, i.e. all macronutrients and alcohol

- Energy expenditure – relative expenditure of energy, basal/resting metabolic rate (BMR/RMR), movement (physical activity and exercise), thermic effect of food

Energy balance equation: - Energy in and out balanced = maintain weight

- Energy in exceeds energy out = weight gain

- Energy out exceeds energy in = weight loss

Other considerations - influence of individual differences on energy expenditure, e.g. genetics, hormone balance, energy needs for different activities, fitness levels, movement efficiency

Relevance – weight requirements for some aesthetic sports and associated risks, e.g. disordered eating

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LO2 Know how lifestyle behaviours affect health and wellbeing

Learners must know how different lifestyle behaviours affect health and well-being:

Physical activity/inactivity: - Physical activity – may be incidental or planned, has no lower intensity

threshold, improves efficiency of all body systems, improves general health and wellbeing, improves quality of life, assists with stress management, assists with weight management, and reduces risk of chronic health conditions, including depression and anxiety

- Exercise – has advantages for health over and above being physically active; can be used to elicit specific adaptations to increase components of fitness; is structured and planned activity, typically of a vigorous intensity

- Inactivity – prolonged time sitting or lying down increases risk of mortality independently of participation in physical activity or exercise, increases risk of chronic health conditions including – cardiovascular disease (CVD), obesity, diabetes, osteoporosis, depression and anxiety

Not smoking/smoking: - Not smoking – maintains cardiovascular and pulmonary health

- Smoking – is a primary risk factor for many chronic health conditions including – CVD, chronic obstructive pulmonary disease (COPD), osteoporosis and various cancers. Tobacco products contain a range of harmful substances, including carbon monoxide (reduces oxygen uptake), tar (blocks the airways), nicotine (addictive) and other harmful chemicals

Alcohol use/misuse: - Alcohol use – within the recommended safe guidelines, there are no

significant health risks

- Alcohol misuse – drinking in excess of the recommended guidelines on a regular basis may contribute to a number of chronic health conditions, including obesity, diabetes, stroke, liver diseases, some cancers and CVD; alcohol misuse can also lead to unsafe sex (pregnancy, sexually transmitted diseases), other risk taking or anti-social behaviours (assault, dangerous driving, domestic violence and other criminal offences). Alcohol misuse also increases the risk of addiction (psychological and physical)

Healthy eating/unhealthy eating: - Healthy eating – improves the efficiency of all body systems and contributes

to improved overall health and wellbeing and healthy weight management and mood management

- Unhealthy eating increases risk of obesity (energy balance equation, energy in higher than energy out), diabetes, malnutrition, osteoporosis, changes in mood (increased anxiety), eating disorders (bulimia nervosa, binge eating)

Sleeping well/poor sleep: - Sleeping – essential for survival and health, maintenance of brain function,

recovery and restoration of all body systems, supports mental and physical health

- Poor sleep – may relate to duration or quality of sleep, may be caused by medical conditions e.g. insomnia, mental health disorders, pain; may be caused by medication or drug use, e.g. prescription medication side effects, alcohol, caffeine, nicotine; increases risk for mental and physical health conditions

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Learners must know sources for gathering information on the recommended National guidelines for different lifestyle behaviours:

Information sources: (websites listed at back) - Department of Health (DoH)

- American College of Sports Medicine (ACSM)

- Change4life

- Alcohol concern/Drink aware

- Action on smoking and health (ASH)

- National Institute for health and care excellence (NICE)

- Food standards agency/eatwell guide

- NHS choices

- National Sleep Foundation

Safe guidelines: - Smoking – cessation or abstinence

- Healthy eating – eatwell guide

- Physical activity – minimum of 150 minutes moderate intensity physical activity per week

- Alcohol – maximum units for women (2-3 per day) and men (3-4 per day) with 2 days per week alcohol free

- Sleep – amount needed depends on age, adults typically require 7-9 hours, good sleep hygiene practices recommended

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LO3 Know how to collect and assess lifestyle information

Learners must know the types of information to collect from the client:

Personal details – name, age, gender, address, contact details, preferred method of contact, emergency contact

Medical history and current health status – current or previous medical conditions, injuries, medications

Lifestyle information

Diet history (food diary or 24 hour recall): - Food and fluid – timings, types, portion sizes/amounts, cooking methods, food

preferences

- Reasons for eating – hunger, emotion, boredom, hunger rating before eating and level of fullness/satisfaction after eating, nutritional knowledge

Physical activity history (IPAQ questionnaire): - Past and current levels of activity and exercise experience

- Type of activity/exercise programme undertaken

- Physical activity preferences – likes and dislikes

- Physical activity and exercise knowledge

- Time spent in sedentary behaviour (home and/or work/school)

- Participation in sport, type of sport, frequency, intensity, time of training, level of competition

Other relevant lifestyle factors: - Stress levels and coping strategies

- Work-life balance – work time, study time, social time

- Sleep and relaxation - duration, frequency, sleep patterns

- Smoking

- Alcohol intake

Motivation and attitudes towards making changes

Stage of readiness to make changes

Barriers to making changes: - Intrinsic – self-esteem, confidence, fear, lack of motivation

- Extrinsic – family, work, time, finances Learners must know how to collect information:

Methods - interview, consultation, questionnaires (PAR-Q, IPAQ, EQ-5D), diaries (food and activity)

Communication skills: - Initiate conversation – encourage client to speak openly (using open-ended

questions), use follow-up questions (probing) where appropriate

- Build rapport and reflect empathy – using active listening, affirming statements, reflective statements, appropriate non-verbal communications e.g. body position, posture, gestures, facial expressions, summaries to help progress the conversation

- Facilitate goal-setting – determine client readiness to set goals in relation to a specific lifestyle behaviour e.g. use of questionnaires and rating scales, assess balance of change and sustain talk, confidence scales; assist the client with SMART (specific, measurable, achievable, realistic, timely) goal-setting (process and outcome goals), short, medium and long term goals, help the client to identify any personal barriers to making lifestyle changes and their personal suggestions and strategies for managing these barriers

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Discuss the benefits of making changes and reviewing progress against agreed targets

Provide affirmations, encouragement to the client

Negotiate action plan and ensure the client is satisfied with the agreed action plan Learners must know how to develop effective working relationships with clients:

Respect for equality and diversity of clients: - Specific needs – apparently healthy adults, young people, antenatal and

postnatal clients, disabled clients

- Protected and other characteristics – age, gender, race, nationality, ethnic or national origin, religious or political beliefs, disability, marital status, social background, family circumstance, sexual orientation, gender reassignment, spent criminal convictions

Importance: - Build rapport, value individual and diversity, mutual respect, confidence and

trust, fair treatment, determine and meet client needs, present self and organisation positively, gain new clients (word of mouth), enable client to achieve goals and reach potential

Use effective communication skills

Factors that influence the effectiveness of a helping relationship: - Between helper and client – power, rank, prejudice, trust, respect, value,

equality, openness, genuineness

- Protected characteristics that present individual differences or similarities

- Communication style differences – assertive, passive, aggressive, manipulative (passive-aggressive)

- Roles/games - drama triangle (persecutor, victim, rescuer), ego-states (parent, adult, child), ‘yes, but’ (games people play)

- Skills of the helper

- Client feeling and emotions – fear, self-blaming, shame, guilt and embarrassment.

- Environment – consultation space and décor, noise, privacy, interruptions, environmental barriers, e.g. desks, chair positioning

- Helper feeling and motions – any pre-judgement, lack of confidence, personal fears or anxieties and ability to separate these (not project or transfer)

- Effects on relationship – rapport, quality of information gathered, client motivation and commitment, quality of relationship, client safety and trust

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Learners must know their professional role boundaries with regard to providing advice:

Role boundaries: - Provide advice and guidance in areas of specialism only (where qualified),

e.g. general healthy eating advice and general physical activity advice

- Use of evidence-based information that is available from recognised sources e.g. Food standards agency (FSA), Department of Health (DoH)

- Not providing information in relation to areas outside of specialism and qualification, e.g. smoking, alcohol, diets/nutrition – general recommendations can be made but these areas should be signposted to a specialist for appropriate support

Signposting to specialist professionals and services when appropriate: - Nutritionist/dietician

- Specialist health/exercise professional

- Exercise instructor/personal trainer

- Physician

- Clients social network

- Lifestyle support specialists – smoking cessation programme, psychologist/counsellor, physiologist

When to refer to GP or other healthcare professionals – client needs exceed role boundaries

Responsibilities: - Establish and discuss clear ground rules and boundaries

Facilitate communication to support the client – active listening, open questions, core conditions: empathy, congruence and unconditional positive regard.

- Legalities: Handle sensitive information appropriately

Maintain confidentiality, data protection

Professional conduct - appropriate dress/appearance, positive attitude, show respect, equal opportunities, inclusion, punctuality

Maintain professional boundaries – work within scope of practice, not friend or expert on specialist information, e.g. alcohol

Sources for information on boundaries - Code of Ethics, REPs Code of Conduct, British Dietetic Association

Learners must know different stages of change and motivational strategies:

Trans-theoretical model (TTM) (Prochaska and Diclemente) - Stages of change and characteristics of each stage - pre-contemplation,

contemplation, preparation, action, maintenance, termination, relapse

- Processes of change (cognitive and behavioural), consciousness raising, dramatic relief, environmental re-evaluation, social liberation, self-revaluation, self-liberation, helping relationships/social support, counter-conditioning, stimulus control, contingency/reinforcement management

- Decisional balance - the reasons for making change and not making change that are weighed throughout the change process

- Self-efficacy - an individual’s belief in their ability to make a desired change

Motivational interviewing (Rollnick and Miller) - Foundation in person-centred spirit – collaboration, compassion, acceptance,

evocation but with some direction from the helper

- Steps – engaging, focusing, evoking, planning

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- Skills – active listening

- Techniques - open ended questions, affirmations, reflective statements, summaries (OARS)

- Change and sustain talk and how to facilitate change talk Learners must know the reasons that contribute to individuals adopting specific lifestyle behaviours:

Role-modelling – peers or family

Rebellion – family, parents, society norms

Peer pressure

Socio-economic factors – uninformed, lack of knowledge, financial reasons,

Personal reasons – mental health issues (depression and anxiety), preferences, method of coping with underlying anxieties and emotions, e.g. stress

Learners must know the factors that influence lifestyle change:

No change – habit, fear of change, don’t see problem, denial, cognitive dissonance, low self-efficacy, lack of motivation, lack of opportunity, lack of capability

Change – personal decision, request of family or friends, health warning from GP, resolution of ambivalence or cognitive dissonance, combination of sufficient motivation, capability and opportunity to change

Factors affecting adherence to a lifestyle behaviour change: - Positive – motivation (intrinsic and extrinsic), enjoyment of something new,

positive effects experienced, social support from others, praise, autonomy, task mastery, sense of belonging

- Negative – addiction, cravings, withdrawal symptoms, increased anxiety, lack of social support, social isolation or exclusion, presence of sabotaging relationships, lack of perceived capability to maintain new behaviours

Learners must know how to provide guidance and advice on lifestyle management:

Ask client if they would like to explore other lifestyle areas

Respect client readiness

Use motivational strategies appropriate to client readiness e.g. information leaflet or handout for client not contemplating making changes to a specific area

Listen and encourage client to share what they know, e.g. benefits of making changes, before giving information/advice (client is expert on themselves and they know what stops them from making changes – respect and acknowledge this information)

Awareness of cognitive dissonance (Festinger 1975) – where client holds two sets of contradictory beliefs which create discomfort, requiring a change in one of the beliefs, e.g. a smoker who knows the risks may counter the dissonance by thinking they will not be affected

Provide information within scope of practice and from credible and nationally accepted sources

Learners must know how to maintain records:

Accurately record ethically gathered information using an appropriate format

Maintain client confidentiality and adhere to relevant legislation when maintaining and storing client records

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LO4 Be able to collect and assess lifestyle information

Prepare and check the area and resources needed to consult with the client and collect information:

Environment prepared

Consultation resources prepared Use appropriate communication skills to encourage the client to speak openly:

Use of open questions

Active listening and empathy

Consideration to verbal and non-verbal communication (own and client’s)

Explain own role boundaries with regard to providing guidance

Encourage the client to share any concerns (health and lifestyle behaviours)

Specialist needs to be signposted Collect and record the information needed to assess lifestyle:

Appropriate methods and resources – verbal discussion, interview, consultation, with use of questionnaires when appropriate, food diary, 24 hour recall, activity log, IPA-Q

Ensure privacy and confidentiality – private area

Information to collect – levels, types and intensity of physical activity, diet, alcohol intake, smoking, stress levels, sleep patterns

Record information: - Use approved formats – written, spreadsheet, apps

- Adhere to data protection legislation

- Confidentiality Identify areas of lifestyle where improvement could be made:

Identify strengths and areas where improvement could be made

Lifestyle areas - physical activity, healthy eating, alcohol

Discuss different guidance and support available

Use credible guidance sources

Show sensitivity to client readiness

Encourage client choice in decision making, regarding the information they want and need

See LO1 to LO3

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LO5 Be able to offer recommendations and guidance for lifestyle improvement

Provide lifestyle improvement advice appropriate to the client’s needs:

Check client readiness to explore lifestyle areas

Ensure client is involved maximally in discussion

Use motivational strategies appropriate to client readiness and stages of change, e.g. information leaflet or handout for client at pre-contemplation stage

Listen and facilitate conversation to encourage client to share what they know – benefits of making changes; show sensitivity when giving information (client is expert on themselves and they know what stops them from making changes – respect and acknowledge this information, avoid forcing information if it is not wanted)

Awareness of cognitive dissonance (Festinger 1975) – where client holds two sets of contradictory beliefs which create discomfort, requiring a change in one of the beliefs, e.g. a smoker who knows the risks may counter the dissonance by thinking they will not be affected

Provide information within scope of practice from credible and nationally accepted sources:

- Increasing physical activity – walking, swimming, stair climbing or cross- training to vary stresses of sporting activity, adequate rest days

- Improving diet – eating more or less of certain foods, monitor food intake, food preparation, avoid takeaways and processed food

- Reducing alcohol intake – signpost to counselling, alternative activities, self-help groups, avoiding temptation, alcohol-free days

- Stop smoking – signpost to NHS stop smoking services, NHS quit kit, nicotine replacement therapies, NHS smoking helpline

- Stress management techniques – goal setting, time management, physical activity, relaxation, breathing exercises, signpost to counselling

- Stop drug taking – signpost to drug related services or information sources - FRANK, seek healthy ways to cope with stress, signpost to therapy or counselling, maintain strong relationships, pursue alternative activities

Five Ways to Wellbeing – evidence-based actions people can pursue in their daily life to promote wellbeing, published around 2008:

- Connect – time with friends and family, build social relationships.

- Be active – sit down less and move more, increase physical activity (walking, gardening)

- Learn – building sense of achievement through learning, e.g. adult education courses or learn a new skill

- Give to others – charity work, volunteering or giving to charity, giving encouragement praise

- Take notice – mindfulness and being present in the here and now, being aware of what is happening – thoughts, feelings, body sensations, colour of the sky, sounds in the environment, e.g. birds, breeze

See LO1 to LO3

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Employability skills to be demonstrated throughout the graded practical assessment and synoptic assessment

Professionalism:

Adherence and respect to industry codes of ethical practice, e.g. Skills for health, health and safety and safeguarding legislation, equality, diversity and inclusion legislation and organisational policies and procedures

Communication:

Use of appropriate verbal and non-verbal communication to meet client’s needs

Adapt and tailor their communication approach for different clients, e.g. new and existing clients – special populations (older adults, ante- or post-natal women, disabled people), clients with other needs, e.g. speakers of other languages, deaf or partially hearing, blind or partially sighted

Communication – speaking manner and tone of voice, being supportive, empathetic, non-judgemental, respectful, sensitive to client, use open questioning and active listening to gather feedback, be aware of body language, eye contact, gestures, posture, space and proximity. Sensitivity to clients with different communication styles

Customer service:

Principles of customer service – quality, keeping promises, managing customer expectations, customer satisfaction, speed of service, follow organisation procedures for meeting and greeting and inducting the client to equipment. Industry code of conduct to inform all client working practices

Examples of good practice in customer service - effective working relationships with diverse range of clients, positive presentation of self and organisation to clients, meeting and exceeding customer needs and expectations, adding a personal touch, providing personal attention, knowing client names, using polite language, making extra efforts to demonstrate willingness to please the customer, treating the customer as an individual

Dealing quickly and effectively with a complaint. Acknowledge complaint immediately (HEAT – Hear, Empathise, Apologise, Take action), handle complaints (privately, positively, confidently, professionally, promptly, confidentially, empathetically, with trust and respect, to client’s satisfaction), follow agreed procedures to check complaint has been dealt with

The importance of customer service to a business - professional image, reputation of instructor, organisation and industry sector, exercise adherence, customer retention, customer satisfaction, customer relationships and repeat business, including word of mouth recommendations and referrals

Commercial awareness:

Opportunities to promote other services to meet client’s needs, e.g. personal training, group exercise, swimming, weight management groups

Other activities, e.g. social events, specialist talks

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Skin cancer awareness

Please note this information will not be assessed for the achievement of this unit. Public awareness of skin cancer has never been higher, and yet skin cancer remains the

fastest growing cancer in the UK, especially amongst young people. The chances of a

positive outcome can be dramatically increased with early identification and diagnosis.

Professionals in hair, beauty, sports massage and health and wellbeing industries work

closely with clients and in many cases have sight of areas of skin which may not be easily

visible to the client. An informed awareness of the signs, symptoms and changes of

appearance to be aware of when checking for early signs of cancer is a crucial tool for the

conscientious practitioner in order to provide the most thorough service and in some cases,

possibly lifesaving information signposting.

Signs to look for when checking moles include utilising the ABCDE guide:

A - Asymmetry – the two halves of the area/mole may differ in their shape and not match.

B - Border – the edges of the mole area may be irregular or blurred and sometimes show

notches or look ‘ragged’.

C - Colour – this may be uneven and patchy. Different shades of black, brown and pink may

be seen.

D - Diameter – most but not all melanomas are at least 6mm in diameter. If any mole gets

bigger or changes see your doctor.

E - Elevation/evolving – elevation means the mole is raised above the surface and has an

uneven surface. Looks different from the rest or changing in size, shape or colour. Anyone

can get a suspicious mole or patch of skin checked out for free by the NHS by visiting their

doctor, who may then refer to a dermatologist (an expert in diagnosing skin cancer).

If you require any additional NHS information please refer to https://www.nhs.uk/be-clear-on-

cancer/symptoms/skin-cancer

If your learners are interested in learning more about skin cancer awareness alongside this

qualification, VTCT runs the following qualification: VTCT Level 2 Award in Skin Cancer

Awareness for Non-Healthcare Professionals.

This qualification has been specifically designed for those working in the sports massage,

health and wellbeing, beauty, hairdressing and barbering sectors. It will enable learners to

identify any changes to their client’s skin and to highlight those changes to the client using

appropriate language and communication skills. It will enable the learner to raise awareness

of skin cancer and signpost their clients to public information about skin cancer.

This qualification will enable hair, beauty and wellbeing professionals to gain the appropriate

knowledge and communication skills required to provide non-diagnostic, professional advice

and information to clients in a discrete, empathetic and confidential manner.

For more information please refer to the Record of Assessment book:

https://qualifications.vtct.org.uk/finder/qualfinder/1Record%20of%20Assessment%20Book/A

G20529.pdf

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Assessment criteria

Assessment criteria will be applied to the graded practical assessment. In order to pass this unit, learners must at a minimum achieve all pass criteria. The pass criteria relate to the proficient demonstration of skills and knowledge. All criteria within a given grade must be achieved to be awarded that grade.

Learning outcome

The learner must:

Pass

The learner can:

Merit

To achieve a merit grade, in addition to achievement of the pass criteria, the learner can:

Distinction

To achieve a distinction grade, in addition to achievement of the pass and merit criteria, the learner can:

LO4 Be able to collect and assess lifestyle information

P1 Prepare and check the area and resources needed to consult with the client and collect information

M1 Adapt and tailor interpersonal communication to meet the client’s needs and elicit lifestyle information

M2 Use a systematic approach to carry out the consultation

M3 Predict how lifestyle improvement advice may affect the client’s health

D1 Reflect on the effectiveness of communication skills used and identify ways to improve personal practice

D2 Justify the choice of lifestyle improvement advice provided

P2 Use appropriate communication skills to encourage the client to speak openly

P3 Collect and record the information needed to assess lifestyle

P4 Identify areas of lifestyle where improvement could be made

LO5 Be able to offer recommendations and guidance for lifestyle improvement

P5 Provide lifestyle improvement advice appropriate to the client’s needs

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Assessment Guidance

Assessors must use the amplified assessment guidance in this section to judge whether assessment criteria have been achieved in the graded practical assessment.

P1 Prepare and check the area and resources needed to consult with the client and collect information

Learners must prepare and check the area ready for the consultation, so that it is welcoming and free from any distractions. Learners must ensure they have all the appropriate resources available and accessible to gather and provide information, e.g. client records, information leaflets and handouts, information gathering questionnaires or other tools (when appropriate) e.g. food diary or 24 hour recall, activity diary, lifestyle questionnaire.

Appropriate health and safety checks should also be made.

P2 Use appropriate communication skills to encourage the client to speak openly

Learners must use appropriate communication skills to encourage the client to speak openly and discuss their lifestyle, for example, the use of positive and open body language, relevant open questions, active and empathic listening and reflective statements.

P3 Collect and record the information needed to assess lifestyle

Learners must consult with a client to gather the information needed to provide appropriate lifestyle advice. Information collected must include personal information (age, gender), informed consent to gather information; as well as lifestyle information such as physical activity levels, eating behaviours, use of alcohol or cigarettes, sleep patterns, stress levels and work-life balance.

The information collected must be recorded using an appropriate format, e.g. client records, use of questionnaires. All records must be concise and clearly presented and must maintain client confidentiality.

P4 Identify areas of lifestyle where improvement could be made

Learners must discuss with the client how the information they have gathered can be analysed and used to identify lifestyle changes to improve the client’s health and wellbeing. For example, if a client expresses that they often feel tired at specific times of the day, the influence of various lifestyle factors can be discussed in relation to energy levels, e.g. food choices, timings and hydration, the influence of stress, alcohol use, poor sleep patterns and a work/life imbalance and inactivity may all contribute to low energy.

Learners must work with the client to identify the areas the client would like to improve and their readiness to make changes, e.g. the use of a 0-10 readiness scale can be used.

All information must be recorded using an appropriate format.

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P5 Provide lifestyle improvement advice appropriate to the client’s needs

Learners must provide lifestyle advice that is appropriate to the client’s needs and their level of readiness to make changes to a specific lifestyle area or areas to improve their health. This may include general guidance for increasing activity levels or making small changes to eating behaviours, it may also include signposting the client to other services, where relevant e.g. smoking cessation, personal training, change4life website; and the provision of information leaflets on specific lifestyle factors, e.g. smoking, alcohol use, sleep patterns, work-life balance. Information leaflets are relevant when the client is not ready to make changes (pre-contemplation).

The information provided must reflect national guidance from credible agencies, which include Department of Health, change4life, dietitian, G.P, Food Standards Agency, alcohol concern, FRANK

All information must be recorded using an appropriate format.

M1 Adapt and tailor interpersonal communication to meet the client’s needs and elicit lifestyle information

Learners must demonstrate that they can tailor their use of communication skills and adapt these to meet the needs of the client. Communication skills adapted and tailored to elicit lifestyle information should include: active listening, reflection of empathy through the use of affirming gestures or language and reflective statements, e.g. reflecting back what the client says and the words they use. Learners should also use appropriate and sensitive open questions to encourage the client to speak more openly and provide more information. Learners must also show awareness of their own and the client’s non-verbal communication (body language, posture, facial expressions and voice intonation).

Learners must demonstrate sensitivity when discussing lifestyle improvement recommendations with the client. The client must be involved maximally in the discussion, sharing their own views, e.g. rather than the therapist just giving information. Client permission and readiness should be sought before giving any information and all information provided must be factual and communicated in a respectful, empathetic and non-judgemental way, e.g. without blaming or shaming. Client dignity should be maintained and respected at all times.

M2 Use a systematic approach to carry out the consultation

Learners must demonstrate effective and efficient organisational and time management skills when conducting the consultation with the client. All resources must be available and ready and the client prepared to ensure the consultation runs smoothly and professionally. All information must be collected using a logical and systematic approach. The consultation must be completed in an appropriate time frame.

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M3 Predict how lifestyle improvement advice may affect the client’s health

Learners must predict how the lifestyle improvement advice has the potential to affect the client’s health, provided the client follows some of the guidance and makes the recommended changes. This will be determined by the specific needs of the client and the advice selected and provided to meet the client’s needs and their readiness to make changes.

For example an inactive client may be advised on the benefits on physical activity and ways of integrating this into their lifestyle. If they are ready and choose to make these changes it could be predicted that the longer term benefits may be: improved weight management, improved mood (less anxious or stressed), improved overall sense of wellbeing and enjoyment of life, more energy, as well as many other physical benefits and changes (noticeable improvements in strength and mobility).

Another example could be for a client who struggles to manage stress and who is advised of the benefits of relaxation, breathing and yoga exercises. If they are ready and choose to make these changes, the predicted long term benefits may be: improved ability to manage stressful situations, ability to relax more easily, reduced physical and mental tension, as well as other physical and mental benefits (variable, depending on the specific changes made)

D1 Reflect on the effectiveness of communication skills used and identify ways to improve personal practice

Learners must reflect on the full range of communication skills used to consult with the client and consider the detail and depth of the information gathered. Learners must reflect on the extent to which the communication skills used helped to elicit information from the client, or blocked rapport and relationship. Learners must identify a range of ways they can refine their skills to improve their practice.

D2 Justify the choice of lifestyle improvement advice provided

Learners must be able to justify the choice of lifestyle improvement advice offered to the client. Learners must provide a rationale which includes why these choices are most appropriate for the client at the specific point in time, e.g. with consideration to the client’s level of readiness to make changes; how these will benefit the client, and how realistically the recommendations can fit with the client’s current lifestyle.

Learners must also be able to justify any recommendations that were not offered to the client, but that would be beneficial, for example, lifestyle behaviours the client is not ready or wanting to change or changes that require signposting for specialist intervention, e.g. specific dietary needs, smoking cessation.

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Resources

The resources for this unit must support learners to develop their knowledge of lifestyle factors that affect health and wellbeing. Learners should be given the opportunity to work on real or realistic clients in real or realistic environments to develop the skills to assess lifestyle information and offer guidance. Best practice should be encouraged by giving learners the opportunity to access current research and guidelines that inform health, lifestyle and wellbeing (e.g. NICE, ACSM, BASES, BHFNC, Department of Health, Change4life). Recommended text books:

ACSM (2014). ACSM’s Guidelines for Exercise Testing and Prescription. 9th ed. American College of Sports Medicine. Wolters Kluwer/Lippincott Williams & Wilkins. Philadelphia. USA

Bean, A (2014) Food for Fitness. 4th edition. Bloomsbury Publishing. London. UK

Biddle, S and Mutrie, N (2008) Psychology of Physical Activity. Determinants, well-being and interventions. 2nd Edition. Routledge. London

Bolitho, S, Lawrence, D and McNish, E (20112. The Complete Guide to Behavioural Change for Sport and Fitness Professionals. Bloomsbury Publishing. London. UK

Michie, S., Atkins, L & West, R., (2014) The Behaviour Change Wheel A guide to designing interventions, Silverback publishing, UK

Michie, S., West, R., Campbell., Brown., Gainforth., (2014) ABC of behaviour change theories. Silverback publishing, UK

Paine, T (2000) The Complete Guide to Sports Massage. 2nd ed. Bloomsbury Publishing. London. UK

Prochaska, J. O., Velcier, W. F., (1997) The Transtheoretical Model of Health Behaviour Change, American Journal of Health Promotion, 12(1): 38-48

Rollnick, S, and Miller, W (1991) Motivational Interviewing. Preparing People to Change Addictive Behaviour. The Guilford Press. New York. USA

NB: This list is not exhaustive. There are many other valuable text books.

Government reports and white papers:

Department of Health (2004). At Least Five a Week. Evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. London. Department of Health. Department of Health (2011) Start Active, Stay Active: A report on physical activity for health from the four home countries’ Chief Medical Officers. London: Department of Health Physical Activity Team. Available from: http://www.bhfactive.org.uk/userfiles/Documents/startactivestayactive.pdf

Websites:

British Association of Counselling and Psychotherapy. Available from: www.bacp.co.uk

Motivational interviewing (MINT): www.motivationalinterviewing.org

Mindfulness for mental wellbeing: www.nhs.uk/conditions/stress-anxiety-depression

British Association of Sport and Exercise Science: www.bases.org.uk

National Institute for Health and Care Excellence (NICE): www.nice.org.uk

American College of Sport Medicine (ACSM): www.acsm.org

National Institute for Health and Care Excellence (NICE): www.nice.org.uk

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Department of health: www.gov.uk/government/organisations/department-of-health

Eatwell guide: https://www.gov.uk/government/publications/the-eatwell-guide

British Heart Foundation National Centre: www.bhfactive.org

NHS Choices: www.nhs.uk/Livewell/Goodfood?pages/water-drinks.aspx

Alcohol concern: www.alcoholconcern.org.uk

ASH (Action on smoking and health): www.ash.org.uk

Change4life - http://www.nhs.uk/Change4Life

Drug aware http://www.drug-aware.com/alcohol-abuse-facts-statistics.htm

Drink aware: http://www.drinkaware.co.uk

FRANK (Drug awareness) - www.talktofrank.com

Public Health England: http://healthengland.org/

Health and Social Care Information Centre (Information governance): http://systems.hscic.gov.uk/infogov

Public Health Scotland: http://www.healthscotland.com/

Public Health Wales: http://www.publichealthwales.wales.nhs.uk/

Public Health Agency Northern Ireland: http://www.publichealth.hscni.net/

Time to Change (mental health): http://www.time-to-change.org.uk/

Delivery guidance

Teachers are encouraged to use innovative, practical and engaging delivery methods to enhance the learning experience. Learners may benefit from the use of:

Interactive information and technology systems and software so they can actively learn about different concepts and theories relating to health, wellbeing and relevant lifestyle factors including smoking, alcohol, stress and healthy eating guidelines

Presentations and forums using guest speakers, e.g. dietitian, alcohol services, smoking cessation team, mental health services, public health representatives

Opportunities to practise their consultation skills, working with peers as clients

Group discussions to explore reasons for lifestyle behaviours and choices and barriers clients may face when making changes

Presentations on different motivational strategies to support lifestyle change

Opportunities to reflect on changes they have made and the approach they have taken to making these changes, including the barriers they faced and how they overcame these barriers

Opportunities to practise and develop active listening skills

Workshops where they can prepare resources such as posters or information leaflets to provide information on lifestyle change, e.g. activity, healthy eating

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Links with other units

In the VTCT Level 3 Diploma in Massage and Therapies for Sport, this unit is closely linked with the following units:

USP92M Anatomy and physiology for sports massage

Learners will be required to apply their knowledge of anatomy and physiology when learning about health and lifestyle and the effects of different lifestyle behaviours on physical health. The content of the anatomy and physiology unit should be delivered before delivery of the health and lifestyle unit.

USP93M Professional practice in sports massage

Learners will be required to apply their knowledge of professional practice when collecting health and lifestyle information. Learners will be expected to work professionally and ensure their conduct meets with industry codes of practice and ethical guidelines. The content of the professional practice unit should be delivered before delivery of the health and lifestyle unit.

USP94M Assessment for sports massage

Learners will be required to apply their knowledge of assessment for sports massage when consulting with the client to collect health and lifestyle information. Consultation and assessment are legal requirements of the role and failure to consult properly with the client prior to treatment or recommendations could invalidate therapy insurance. The content of the assessment for sports massage unit may be delivered before or integrated with the delivery of the health and lifestyle unit. USP95M Sports massage treatments

Learners will be required to apply their knowledge of sports massage treatments when collecting health and lifestyle information. This will ensure the complete service is holistic and fully meets all the client needs. The content of the sports massage treatments unit may be delivered before, or integrated with the delivery of the health and lifestyle unit.

USP96M Understand the principles of soft tissue dysfunction

Learners will be required to apply their knowledge of soft tissue dysfunction when consulting with the client to assess their needs and prepare a full treatment plan, including health and lifestyle advice. Learners must recognise the signs and symptoms of injury and dysfunction, to ensure they can devise the correct treatment and work within their scope of practice and professional boundaries. The content of the principles of soft tissue dysfunction unit should be delivered before delivery of the health and lifestyle unit.

Graded synoptic assessment

At the end of the qualification of which this unit forms part, there will be a graded synoptic assessment which will assess the learner’s ability to identify and use effectively in an integrated way an appropriate selection of skills, techniques, concepts, theories, and knowledge from a number of units from within the qualification. It is therefore necessary and important that units are delivered and assessed together and synoptically to prepare learners suitably for their final graded assessment.

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In the VTCT Level 2 Diploma in Exercise and fitness instruction for health and wellbeing, VTCT Level 2 Extended Diploma in Exercise and Fitness Instruction for Health and Wellbeing and in the VTCT Level 3 Diploma in Exercise Science and Personal Training, this unit is closely linked with the following units:

USP105M Anatomy and physiology for exercise and health

Learners will be required to apply their knowledge of anatomy and physiology when learning about health and lifestyle and the effects of different lifestyle behaviours on physical health. The content of the anatomy and physiology unit should be delivered before delivery of the health and lifestyle unit.

USP52M Health, safety and welfare in a fitness environment

Learners will be required to apply their knowledge health, safety and welfare when learning about health and lifestyle and the effects of different lifestyle behaviours on physical health. The content of the health, safety and welfare unit should be delivered before delivery of the health and lifestyle unit.

USP53M Principles of exercise, fitness and health

Learners will be required to apply their knowledge of the principles of exercise, fitness and health when learning about health and lifestyle and the effects of different lifestyle behaviours on physical health. The content of the principles of exercise, fitness and health unit can be delivered before or integrated with the delivery of the health and lifestyle unit.

USP54M Planning gym-based exercise

Learners will be required to apply their knowledge and skills of planning gym based exercise when learning about health and lifestyle and the effects of different lifestyle behaviours on physical health. The content of the planning gym-based exercise unit can be delivered before or integrated with the delivery of the health and lifestyle unit.

USP55M Instructing gym-based exercise

Learners will be required to apply their knowledge and skills of instructing gym-based exercise unit when learning about health and lifestyle and the effects of different lifestyle behaviours on physical health. The content of the instructing gym-based exercise unit can be delivered before or integrated with the delivery of the health and lifestyle unit.

Graded synoptic assessment

At the end of the qualification which this unit forms part of, there will be a graded synoptic assessment which will assess the learner’s ability to identify and use effectively in an integrated way an appropriate selection of skills, techniques, concepts, theories, and knowledge from a number of units from within the qualification. It is therefore necessary and important that units are delivered and assessed together and synoptically to prepare learners suitably for their final graded assessment.

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Version Details of amendments Date

v9 Skin cancer information page added

13/06/17