Facilitating Fellowship

Americans are more socially isolated than ever before. In 2004 the typical American had just two people to talk to about important matters—and 24.6% of Americans reported that they didn’t have a single confidant (McPherson, Smith-Lovin & Brashears 2006). Why should this be particularly troubling news to wellness professionals? Research has shown time and time again that social disconnection is detrimental to body and mind.

Social connection has been recognized as an important predictor of physical health for more than 25 years, since the publication of a landmark study that found that socially isolated individuals were 2.5 times more likely to die over a 9-year period than more socially connected people (Berkman & Syme 1979). Research has continued to confirm these early findings. Low levels of social support are associated with a two- to three-fold increase in risk of cardiovascular disease and mortality (Mookadam & Arthur 2004)—a risk that is on a par with that
associated with physical inactivity (Berlin & Colditz 1990). Low levels of social support are also linked with increased risk of death from cancer and infectious disease (Uchino 2006).

Social support can prevent age-related declines in cardiovascular health (Uchino, Kiecolt-Glaser & Cacioppo 1992); having other people to talk to about problems has been particularly associated with better cardiovascular health in women (Uchino et al. 1995). In contrast, a recent study found that having two or fewer close friends—the same number that is now the American average—carries health risks equivalent to those associated with being overweight (Gallicchio, Hoffman & Helzlsouer 2007).

In another study, López-García and colleagues (2005) found that having little contact with friends is associated with worse physical function, greater physical pain and worse general health and mental health. The study also concluded that each of these effects was comparable to, or greater than, the effects of chronic pain. Individuals with small social networks are also at greater risk for depression and anxiety (Achat et al. 1998; Cacioppo et al. 2006).

These studies highlight the powerful relationship between
social connection and psychological and physical well-being. Members of any profession dedicated to wellness—including the fitness industry—need to consider what they can do to reduce, rather than reinforce, the trend of social isolation.

Meaningful Motivation

Many trends in the fitness industry foster the idea that exercise is something you do by yourself. Newcomers to exercise may buy a DVD set from an infomercial and exercise alone at home. Being isolated is becoming increasingly easy even at the gym, where each machine has its own personal entertainment system and earphones. In addition, body-mind practices, such as yoga, are commonly marketed as a way to “take time for yourself.”

Although these may be excellent strategies for motivating new exercisers, from a wellness perspective they offer a less-than-ideal approach over the long term. As a fitness professional, you can create programs that motivate people to be active and also meet their need for meaningful social connection.

Social connection comes in two forms: social integration and social support (Cohen 2004). Social integration is defined by the number of people you interact with on a regular basis, the number of social roles you play (i.e., sister, friend, mentor), and the number of groups to which you belong. High levels of social integration lead to a feeling of belonging and purpose. Socially integrated people know that they have a place in the world and that what they do matters. Individuals with a diverse social network show a particular type of health resiliency. For example, in one study, participants were directly infected with a cold virus and were then observed for symptoms. The subjects with larger and more diverse social networks were less likely to become sick; the less socially integrated participants were, the worse their symptoms were (Cohen et al. 1997).

Social support, on the other hand, is defined as the resources provided by other people to help a person cope with stress. These resources can range from listening or giving emotional reassurance to providing financial assistance—anything that can make it easier to deal with the challenges of life. For this reason, social support, more than social integration, is associated with a reduced risk of stress-related health problems (Cohen 2004; Uchino 2006).

Since both types of social connection contribute to well-
being, you may want to consider how your programs can provide both positive social interaction and focused support.

Creating Social Connection Through Fitness

Group programs offer the most obvious opportunity to create social connection through fitness. Christensen and colleagues (2006) found that supportive group fitness programs are characterized by three qualities: solidarity, mutual trust and the feeling of being accepted by others in the group. These qualities develop over time out of several important group processes. Participants need an opportunity to encourage and support one another. Simply showing up in the same place at the same time, even over a long period, does not create mutual trust. Members of a group also need the opportunity to identify common goals and motivations that will help them stick together.

Estabrooks and Carron (1999) point out that the typical group fitness class may lack all of the above processes if no procedures are in place to facilitate them. Strategies that facilitate these processes include group goal setting and decision making (for example, choosing the exercise activity), verbal encouragement from the instructor during the workout, an instructor-guided group discussion during the cool-down, and time reserved for informal social conversation after the workout (Courneya & McAuley 1995).

Fitness programs can also strengthen existing support networks by encouraging members to work out with family or friends. Individuals who start a program with other people are more likely to stick with it, particularly when the program provides the structure for supportive interaction. For example, one weight loss program invited friends and family to sign up together, and then gave participants “support homework,” such as calling each other or sharing a meal during the week (Wing & Jeffery 1999). Participants showed an impressive 95% adherence to this 4-month program, and 66% of them had maintained their weight loss at a 10-month follow-up. This compares to a 75%–83% adherence rate and 24% long-term success rate among members of a control group who did not join with friends and family and did not receive specific instructions for social support. Fitness professionals can stand in for friends and family when a natural social support network does not exist. One study found that individuals who reported not having a friend or family member with whom to discuss exercise benefited greatly from a monthly 10-minute phone call that encouraged them to continue exercising (King et al. 2006).

There are many types of social support. You may feel most natural providing informational support (advice, instruction, health news) and instrumental support (feedback, goal-focused assistance). However, balancing these types of encouragement with unconditional acceptance is important. One study, which investigated the types of social support older adults valued in an exercise program, found that, in addition to valuing information, individual guidance and encouragement from the instructor, participants valued being told that it was okay to rest if necessary (Resnick, Vogel & Luisi 2006). This study highlights the importance of what is called “belonging” or “acceptance support,” which distinguishes fully supportive interaction from good coaching.

Putting Theory Into Action

One of the most compelling findings in the research on social connection is the observation that any type of positive social connection has health benefits. The connection doesn’t need to come in the form of a deep and intimate bond. People benefit from feeling heard by others who don’t judge what they say. People benefit from knowing that if they don’t show up somewhere, their absence will be noticed. And they benefit from feeling that they have contributed to a collaborative effort. Keep these facts in mind as you think about how you can create social connection with and among your students and clients. The following profiles demonstrate some of the diverse approaches other fitness professionals are using to create social connection in their work.

Moms In Motion^®

Moms In Motion is an international program that organizes local fitness teams for women. Each team trains for 10–12 weeks to prepare for an event, such as a triathlon, that supports a charity. According to Jamie Allison, MA, founder and chief executive officer of Moms In Motion, the essence of the program is “the camaraderie and support of a team working together toward a common fitness goal and philanthropic cause.”

According to participant feedback, the social aspect is the most important part of the program. Allison says, “It is the glue of our program. It is what keeps members returning. Many members have said how much they dread running, but they keep signing up for the running team because they look forward to seeing their friends each week.” Allison shared the following information about how the program creates social integration and social support:

• The program is marketed to mothers, but women of all ages are invited to join, creating a multigenerational social network for each team. Allison says, “Members may join for a variety of reasons, be at completely polar stages of life and come from varying socioeconomic backgrounds; but as a team, everyone is leveled on the same playing field, and all the differences disappear as [team members] focus on a common goal.”

• At the first team meeting, the team leader sets a no-gossip/
  no-negativity policy. This is a particularly important strategy, since negative social interactions can carry a heavy toll on physical and emotional well-being (Abbey, Abramis & Caplan 1985; Cohen 2004).

• Moms In Motion creates a community website for each fitness team. Members can post team pictures, set up additional training times during the week, keep track of fundraising and discuss a wide range of both fitness-related and non-fitness-related topics.

• Each training session includes an opportunity for members to talk and share with the whole group, as well as a closing
  activity designed to build group cohesion.

• Most team leaders offer opportunities for participants to
  socialize over coffee or breakfast after training sessions, and many host “girls’ nights out” or potlucks. According to Allison, “The teams that do this are finding that their members are developing friendships earlier in the season, resulting in consistent attendance and a higher return rate for the next program offered.”

• The philanthropy component helps connect women socially by uniting them in a meaningful goal. In addition, providing support to others is an important part of social integration, and research suggests that it carries health benefits above and beyond those provided by receiving support (Brown et al. 2003).

• At the end of the training season, the team leader organizes a banquet where each member is recognized for her achievements and commitment to her personal goal.

Having family members who encourage exercise is an important predictor of exercise self-efficacy and behavior, particularly for women (Anderson et al. 2006; Wallace et al. 2000). One fitness professional taking full advantage of this fact is Lynda Ransdell, PhD, FACSM, a professor in the department of kinesiology at Boise State University, in Idaho. Ransdell has developed a program called GET FIT (Generations Exercising Together to Improve Fitness), which teaches daughters, mothers and grandmothers how to make time for physical activity. Studies of GET FIT have found that this intergenerational approach is an effective way to increase physical activity and fitness levels (Ransdell et al. 2004).

A key finding of Ransdell’s research is that, when participants have family support, home-based programs can be as successful as programs at a fitness facility. In one study, 20 pairs of sedentary mothers and daughters were randomly assigned to one of two conditions: (1) a formal program, in which they were encouraged to attend two fitness classes a week at a university gym and engage in recreational physical activity (hiking, sports, etc.) once a week, or (2) a home-based program, in which they were given educational and instructional materials and encouraged to be active together three times a week (Ransdell et al. 2005). Participants in both groups significantly increased physical activity and completed a high percentage of the recommended
activity sessions (77% in the university-based program, and 70% in the home-based program).

The program has not only increased the women’s physical
activity but also strengthened the bond between family members. As Ransdell puts it, “A side benefit of improving relations between mothers and their daughters is that they can achieve fitness together. In every research project we conducted, we found—anecdotally, qualitatively and statistically—that mothers improved their relationships with their daughters.”

Ransdell points to several components of the program that facilitate bonding: “Mothers and daughters set fitness goals and learn new activities and skills together. Participants also [take part in] a ropes course where mother-daughter pairs work together to accomplish challenges.” Another benefit is simply the time spent together, seeing each other in a new light. “You can learn something about a family member that you didn’t know before, and develop new appreciation for each other,” Ransdell says.

IDEA member Elissa Cobb, MA, is the director of programs at Phoenix Rising Yoga Therapy, an ACSM-certified personal trainer and a group fitness instructor. When she leads group programs—for example, fitness groups in which members share the goal of weight loss—she focuses on helping participants establish social connections that foster a sense of belonging and self-acceptance. In individual sessions, her goal is to establish that connection directly with the client. In both contexts, the ultimate goal is to create a kind of social support that leads to self-efficacy. Cobb explains, “There is a way to empower people, through social connection, to stand in their own power.”

To meet this goal, Cobb says, a fitness professional needs to make a shift from being just a coach to being a facilitator. Although you are an expert on fitness and health education, you must be able to switch roles, drop the authority mindset and learn to be a good listener and witness. Of course, Cobb acknowledges, teaching technique is important when leading exercise, but, she says, “different facilitation skills are needed to have people in a group talk about their experiences, goals and intentions.”

Cobb describes three key facilitation skills you need to create a supportive group or one-on-one experience:

1. being able to listen without trying to figure out how to fix the other person’s problem
2. responding to clients in a nonjudgmental way and with a sense of unconditional positive regard
3. knowing your own biases, beliefs and emotional triggers so you can recognize when you are being pulled out of the facilitator mindset

As an example, Cobb describes the differences between a coach’s and a facilitator’s approach to leading a group discussion. “In a regular coaching system,” Cobb says, “someone speaks; someone else identifies with that person’s experience; and someone—usually the group leader—offers advice. It’s human nature for a coach to jump in and give a story that’s similar, or give suggestions about what to do next time.”

A facilitation model, on the other hand, does not allow other members of the group or the facilitator to cross-talk or give advice. The facilitator will say something that seems, on its face, to be less helpful than advice: “That sounds really hard for you,” or “I really appreciate that you felt you could speak about that here.” However, according to Cobb, such a comment gives group members the sense of being understood and accepted, without any pressure to feel differently or change because someone else wants them to. This approach is supported by research: A survey of individuals with chronic low-back pain found that the most unhelpful type of social support was emotional support that left the individual feeling misunderstood or pressured to feel or act differently in some way (Masters, Stillman & Spielmans 2007).

Cobb often brings this kind of facilitation to the cool-down or flexibility component of a group session. Participants might sit in a circle, which supports both listening and speaking. Cobb might ask, “What did you notice today? What did you learn? What are you going home with?” She sometimes invites participants to share with a partner before asking for volunteers to share with the group. In pairs, one person speaks and the other person just listens—giving no commentary and no advice.

Cobb isn’t sure that individuals are coming to her consciously seeking social connection. “I imagine some of them are and some of them aren’t. Many of them are seeking self-connection. One can become the model for the other. If someone is seeking self-connection, [getting] closer to experiencing that . . . makes it easier to make social connections.” In other words, people who are experiencing success at knowing themselves better can go out to their social connections in a whole different way. “They know who they are,” Cobb explains.

Physical therapist Matthew Taylor, PhD, owned a community-oriented health club in Galena, Illinois, for 13 years before establishing Dynamic Systems Rehabilitation clinics in Phoenix and Scottsdale, Arizona. Both the club and clinics were founded on a business model that puts authentic connection at the center of service. Taylor sees this mission as an obligation of the wellness profession. “So many people are living in isolation,” he says. “Children have moved away. Fifty-five percent of the population is now single. Our species has gone from a social network to a much more isolated lifestyle. It’s this relatively rapid lack of connectedness that creates adverse health effects.”

Taylor’s business model in Galena emphasized social integration as a core benefit of club membership. He trained employees to create social connections with members, and also among members. Every employee, Taylor says, not only knew every member’s name but also knew to do two things: (1) engage all members in personal conversation every time they were in the club—perhaps by following up on past visits and discussions; and (2) make sure each member had an opportunity to engage with someone else in the club. Taylor adds, “This needs to be done in a warm,
authentic way, not in a contrived and manipulative way.”

Taylor taught employees observational skills related to
social connection that go beyond the physical observation skills most fitness trainers know about. Employees used what they
noticed about someone to start a conversation or introduce one member to another. “That’s the catalyst for organic development of community,” Taylor says. “Two women start talking in the gym and end up going for coffee. That new social fabric then spreads beyond the building.”

Taylor also created ways for members to contribute to the community. The club invited members to write about their success stories in the newsletter and bring in information for the educational bulletin board. “This created a learning community, where everyone could contribute to the shared goals,” Taylor says.

An unusual part of Taylor’s business model was a group called the “charter members,” 36 people who joined in the first 4 months the club was open. “We treated them like a board of directors and ambassadors, created a sense of ownership for them, and they became a feedback loop for us,” Taylor says. “They had pride in the organization. They didn’t have a financial business stake in it. It was the community they wanted to see sustained.”

Taylor’s new clinics in Arizona offer primarily one-on-one rehabilitation and yoga therapy, but many of the social skills that made his gym a success have transferred well. The ability to be totally present with another person is particularly important for one-on-one work. “When I’m [distracted] and just want the last 15 minutes to pass, there’s a flatness and lack of connection,” says Taylor.

Taylor designed the clinic’s physical space to support the experience of being fully present and focused on linking with the client. Taylor describes the clinic as “an uncluttered building. The walls are clear. The lighting is indirect. The space is quiet—no piped-in music. The building is designed to support relationship. You have two people sitting in a room looking at each other. There’s nowhere to go. It both forces and fosters connection. The only item of interest is the other person.”

Taylor encourages others in the fitness industry to take on the challenge of creating social connection. “As the pace of our lives accelerates and isolates us from others, there is a great need for wellness services to mend the fabric of human connection.”

One of the most compelling findings in the research on social connection is the observation that any type of positive social connection has health benefits.

Having family
members who
encourage exercise
is an important
predictor of exercise self-efficacy and
behavior, particularly for women.