Why Can’t We ALL Learn to be Totally Fit?

moocPatients often lament, “I wish I would’ve learned these resilience skills earlier.”  Indeed, what if we ALL learned them earlier?

If we’re ever going to bend the healthcare cost curve, we ALL need to learn how to prevent unhealthy habits (e.g., diet, exercise, smoking) or stop them once they start. That requires having the skills and support to manage thoughts, feelings and behavior – right when we’re stressed! Truth is, we’re not taught these skills anywhere and community support is, at best, patchy.

That’s changing, at least in the military. Recently, the Army began its Comprehensive Soldier Fitness (CSF) program. They use a train-the-trainer format to teach & spread resilience skills to ALL the troops. Now thousands of young adults, within their cohesive units, are learning to help each other get Totally Fit.

I’ve taught these skills for decades, using simulations with medical & clinical psychology grad students (at USUHS) and service learning with nursing undergrads (at Georgetown University). As a school psychologist (in Fairfax County Schools), I’ve worked in Pre-K to secondary schools. As a learner myself, by far, the best skills course I’ve taken was Dr. Seligman’s distance learning course – along with over 300 others worldwide.

I’m convinced that, with access to these and other teaching tools, educators could structure the environment to enable their students to teach & spread resilience skills to all as well. If we’d only give them the option, students (from Pre-K to lifelong learners) could form their own ‘cohesive groups’ to train themselves to get Totally Fit too.

Promising Pilots

Health communication campaigns have found that in order to adopt widespread behavior change, it must be perceived as ‘easy, fun, & cool’ to do. Our challenge then would be to make it easy, fun, & cool for ANY educator to essentially add the CSF train-the-trainer fitness program onto their course. Easy, right?

Well not that hard either, if teachers offered the 4th credit option, a proven service-learning tool. For students who opt in, they’d add 1 service learning credit to their 3-credit course. That way, students could apply their course competencies as they volunteer to serve others. In this case, students from ANY course could earn a credit to join a ‘fitness team’ to share their strengths (course knowledge) to help others be more fit.

Recently, George Mason University colleagues and I piloted some of these ideas in their graduate and undergrad Communication courses. We wanted to see how difficult it would be for students and faculty to share a collaborative project (i.e., build a fitness competition) using service learning – across 4 courses and 2 semesters.

In fact, students did see it as ‘easy, fun & cool’ to volunteer. Most struggled with weight gain from freshmen year and hoped to prevent it for others. Some volunteered to survey freshman and found that that they’d be most apt to volunteer if they could earn course credit for joining a team or if they could win prizes, like a Starbucks gift card, for being the most fit. Using those findings, others volunteered to design the competition. Still others opted to try out the actual fitness path – between the campus Starbucks and one in Old Towne Fairfax. They tested a mobile tool that could record steps and transmit the data to their personal health records. Ultimately, these pilots were presented at the 2010 mHealth Summit.

Participating faculty were enthused. Even staff members of Wellness by Mason said they’d join the competition. And in the broader educational culture, we see favorable trends that bode well for everyone to get in the game.

Favorable Trends

Service learning & distance learning have emerged as gold standard training tools among professional schools (e.g., medical, nursing). Many require their students to learn quality improvement skills in multidisciplinary teams – at Dr. Berwick’s Open School. Students from all over (even Harvard) take distance courses to become ‘certified’ change agents. In serviceat their local hospitals, they apply those QI skills to reduce medical errors. That’s how the Open School is known to have measurably saved millions of lives!

Also brand new at professional schools is Clinical Prevention and Population Health skills training. No longer just focusing on illness, every discipline must be better ‘prepared and proactive’ to help whole communities to be more ‘informed and activated’ in their self-care. Included are mass media skills – even to the point of using social media to increase consumer demand for proven resources.

Another trend in higher education is to make courses accessible to virtually ANY student, via a Massive Open Online Course (MOOC). Leveraging open courseware, some professors are teaching thousands of far-flung students at once. Soon, it appears, MOOC’s will be offered for credit.

And, historically, peer-led training in self-care skills has been enormously successful. Those with chronic illnesses have long been volunteer trained peer-leaders even online. Stanford’s Self-Management Programs have been adopted by: the National Health Service of England, the Diabetes Society of British Columbia in Canada, Kaiser Permanente, and Group Health Cooperative of Puget Sound. They’ve been translated into Arabic, French, Chinese, Vietnamese, Norwegian, Somali, Bengali, Dutch, German, Hindi, Korean, Welsh, and Italian.

Finally, the Penn Resiliency Program began teaching skills in elementary and middle schools. It progressed to college students. And, those successes led to the Army’s version – the Comprehensive Soldier Fitness program.

In fact, while keynoting at the George Mason Resilience Conference in 2011, Dr. Seligman suggested that if his lab could train Army Drill Sergeants to train troops to be more resilient, he couldn’t see why college students couldn’t do so too. At least, he thought it was a good empirical question.

Next Steps

It’s time to test hypotheses. Can educators – anywhere, anytime – by adding a service learning credit to their courses, offer any student the opportunity to teach & spread how to be Totally Fit?  Could educators LEAD?

  • Leverage technologies to …
  • Engage students in shared service learning to compete to …
  • Accelerate resilience skill training on their campus & to
  • Disseminate what’s proven to work for Total Fitness.

Could Total Fitness Teams, comprised of multidisciplinary service-learners, compete for sponsored prizes while they help each other … learn to

  1. Know ‘what works’ for Total Fitness & well-being (e.g., resilience skills);
  2. Find proven resources (e.g. in their curated Total Fitness Directory); and
  3. Measure their improvement on the 8 domains of Total Fitness.

Imagine an Implementation Strategy

ANY college student, as a service-learner, would join a Total Fitness Team. Each semester, teams compete to be the most Totally Fit. Teams use the Jigsaw approach, a proven cooperative learning tool. To earn their service-learning credit, each team member must measurably use or teach others their knowledge (from their course of origin).

A new 3-credit course – Resilience Skills – is simul-taught. That means, using open courseware technology, virtually ANY student from any school could simultaneously join the face-to-face class to learn to be a peer trainer of resilience skills (using the Army train-the-trainer model). Those who opt into the ‘4th’ service learning credit, volunteer to join a Total Fitness Team to train their peers in resilience skills.

Any student could find a local Team, by searching the Total Fitness Directory (see the prototype). For service credit, this Directory is co-created and curated by students. And, Total Fitness Teams post information about resources (including themselves), from their Team website that is networked into the Directory.

Example:   Jan is taking a Leadership course and opted for the 4th credit to lead a Total Fitness Team to be the most physically & psychologically fit this semester. She begins by recruiting team members via her Team site (in the Directory). She’s excited that 8 on campus will also earn credit to share their strengths:

  • Leadership:  Jan leads the team to ‘win’ this semester.
  • Recreation:  Maria organizes a physical fitness event.
  • Psychology:  Joe trains resilience skills.
  • Statistics:  Trish evaluates fitness improvement.
  • IT:  Chuck trains how to track personal progress via a personal health record.
  • PR:  Russ posts a video on their site to attract new recruits (for next semester).
  • Performing Arts: John performs his new Team Gangnam song for Russ’ video.
  • Communication:  Julie studies site analytics to see the impact of the video.
  • Social Entrepreneurship: Linda develops a sponsor for the team.

Who Else Would Get in the Game?

An intercollegiate fitness challenge is conceivable to both – members of academia and private enterprise. Over 40 University Directors of Clinical Psychology programs indicated in a 2011 survey they’d incorporate it into their curricula. Some volunteered to help test and validate the concept first. As well, Entrepreneur of the Year and founder of PrincetonLivingWell, Rick Weiss says Bring it!  He’s eager for another community to challenge his to be the most totally fit and he has the NIH funding to back up his offer. 

Conclusion:  Total Fitness for ALL

From the top down, the Joint Chiefs’ strategy to win the war on soaring rates of suicide, substance abuse, and even overweight, is to train ALL to help each other to be Totally Fit.  And, from the bottom up, it’s clear to us in the Participatory Movement, from patients to providers to policymakers. We ALL need to learn how to participate in our own best care.

Isn’t it worth it to civilians to learn what the military has figured out?  Why not try to transfer their ‘technology’ to the rest of us? After all, we’ve paid hundreds of millions of dollars for it.

Promising trends and pilots suggest it’s feasible. The next step would be to test some of these ideas.

Together, semester-by-semester, educators anywhere could LEAD students toward Total Fitness for All.  We could …

  • Leverage technologies (e.g., open courseware) to
  • Engage students in shared service to others – an intercollegiate competition to be the most fit  (dubbed March Madness for Total Fitness)
  • Accelerate resilience skill training in all communities.
  • Disseminate – even create consumer demand for – what works for Total Fitness (e.g., a curated Total Fitness Directory).

Lastly, we could test out whether a University-based social enterprise could build and sustain this effort. Several business plans might work.

So, we could test these ideas …  but will we?  My hope in posting this (to the Total Fitness Directory) is to find the faculty group to go the next step.  Anybody want to play?

 

More details are in my chapter in Mary Banks Gregerson’s edited, Technology Innovations for Behavioral Education.

 

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