Greg Dea: Wellness Monitoring
Wellness Targets – How to hit more bulls-eyes with daily wellness monitoring for your clients.
On any given day, your client’s state of wellbeing has more to do with how good a trainer or coach you are than you might think.
Paul McIlroy said it right when he said “you don’t build strength; it’s granted to you by your nervous system.” This also means if a client’s state of wellbeing is contrary to your planned session, you won’t win that day. In fact, the consequences of working against it can cost you more than time. You could very well lose a client, the revenue that goes with that client, your reputation and more importantly, the chance to refine your professional output.
That’s not my opinion. It’s a universal law of physiology and evolution.
I hear you thinking ‘That’s not me. I’m in tune with my clients.’
They aren’t piano strings to strike with a tuning fork to see if they’re out of tune. They aren’t digital radio stations to program an exact frequency.
Your proof is in your client’s wellness improving (or at least not getting worse), and for that, you need a measure. A measure that should be simple and responsive to your training as well as the stresses of the world. I’ve been working with one for many years. It keeps me on the same side of the white line as my client’s wellness. It’s not perfect, but it’s honest and it works for my clients and me.
It’s an honest mess instead of a tidy lie.
This article will tell you how you can simply find out the effects made by the many, varied elements of your clients lives . . . and how you should be adjusting your session for any one day. The practice is called daily wellness monitoring and it supplements the high-tech element of training load monitoring.
I give my athletes these questions when they walk in the door. I have a range of scores for each question.
I get to know what’s usual for them for the questions.
I know what some training will do to those scores.
I pay attention when the number changes from what is expected.
Sleep start and finish.
This is a variable that is personal for everyone’s circumstances. That said, there are preferred answers. More hours before midnight are desirable. I like to know what time they went to sleep and what time they woke up to understand whether they are getting the required recovery time.
How many hours did you sleep?
This is also different for everyone. Youth need more sleep, elderly adults tend to need less. Those in high levels of training definitely need more.
How well did you sleep?
A multiple-choice set of answers works well. For example:
- Very bad
- Very Good
I like to see numbers above 3 but will keep an eye on the in-training response of someone who scores a 3 on that day. I want to know if, despite getting plenty of sleep, did they sleep well and do they feel rested.
A person who uses a personal device like a phone, tablet, laptop or television in the two hours prior to sleep can have up to 20% reduction in the sleep promoting hormone melatonin—eight hours with 20% less melatonin won’t allow many nervous systems to recover.
How rested are you?
- Very tired
- Well rested
- Very well rested
An athlete who presents as tired or very tired is getting a different session than what was originally planned. A nervous system that is deflated enough for the person to recognize and say they are tired is a nervous system that needs caressing. Remember, every training session is a preparation for the next one.
[bctt tweet=”Every training session is a preparation for the next one. ~Greg Dea” via=”no”]
How willing are you to train today (WTT)?
- Dreading it
- Not looking forward to it
- Could take it or leave it
- Very keen
Did you even know that being unwilling to train is a thing to be measured and adjusted for? Discuss it, measure it, and adjust for it.
I need to know how they feel about their willingness to train that day. In China, where athletes don’t choose to be athletes, some of them don’t want to be training with you. I’ve had more than a few athletes who score a 3 on this question—they told me they “could take it or leave it.” I eventually learned that scoring a 3 on that question wasn’t personal. Nor did it mean there was a barrier to training that day. For a western athlete, who chooses to be in training, a 3 tells me that their head isn’t in the game and I need to be part of the solution or direct them to a solution. I definitely shouldn’t ignore a potential problem. I learned that for those clients who habitually scored themselves a 3, they would be fine that day once we had some social time, included them into the group and eased into the session by addressing their specific weak links.
It’s very important to know where your client sits on the WTT scale each time they turn up to training—particularly if you train performance athletes. If you have a plan to pursue a performance goal, missing more than 20% of your planned training sessions significantly lowers your chance of meeting that goal. So, to that end, the emotional motivation to train plays a big part in whether you keep a client on track.
This is particularly the case in youth/teenage sports where there’s a high dropout rate. We don’t want that dropout rate to be related to injury or inability to adapt to physical stress because of any sort of issue that affects them negatively. That would be our fault if we didn’t find those issues, protect against them (if it’s not our scope to correct them) or correct them (if it is.)
Movement health is but one part of a bigger picture that starts with health, moves through function and chases right on to performance. The health element is often assumed or evaluated initially, but rarely monitored each training session.
How sore are you?
- Very sore
- Pretty sore
- Minor soreness
- Hardly noticeable
- Not sore at all
I need to know whether my client is sore. This score tells me whether or not they have recovered from previous training. Often, the soreness effects of training are a desirable effect for growth, but it is necessary to understand the extent of it since pain changes how people move. Paying attention to a sore athlete is absolutely necessary to ensure they recognize you as someone to take them forward, not ignore them and punish them.
Exercise should never be used as punishment if you want your clients to stay in the game.
Are you ill/sick?
I scan their response every day. I need to know at the beginning of every session whether someone is sick or not. If they are sick, being at training is not where they need to be.
Integrating Daily Wellness Monitoring
For all athletes, if I see a score of 1 or 2 on the previous questions (excepting 2 for illness), we have a chat about their recovery from training or other factors in their life that will impact on the day’s session. For some athletes, a score of 3 is to be expected given their personal circumstances and recent training load.
For example, in China, a high percentage of my athletes were carrying injury. Many had no choice or desire to be an athlete, so a score of 3 on their willingness to train scale was par for the course. I did not take a score of 3 as being a reflection of anything other than normal. What I did value was the athlete who always scored a 3 who started to think about it being a 4—that meant I was leaving that athlete better off and they wanted more of it.
Performance coach Rett Larson and I often looked at ways of proving we were moving the needle. We knew that if we couldn’t manage something, monitoring it might be a waste of time. What we could do was manage the effects of other stressors on the training program. Getting a result with a client is about adapting to them—coaxing results from them. This means understanding better when you can blast their nervous system and when you should be caressing it.
Here’s a sample wellness monitoring template I’ve used. It includes an extra question on whether the individual had to monitor their training because of illness, soreness or other circumstances. I can track this to ensure they stay under 20% of sessions being modified, or re-evaluate realistic timeframes for achieving a goal.
It also includes a sample of regeneration/recovery ideas they can do, with points attributed. I like the client to have achieved 50 points each day and 100 points each weekend.
Towards the latter months of my time in China, my rehabilitation group grew in size. I had athletes in various stages of rehabilitation—some were advancing towards full training with their team, while others were early into their rehabilitation from surgery. All of them needed monitoring. All of them needed to be fit enough, eventually, to train at least six hours each day. Most of my athletes were in national teams, but had returned to Shanghai province to train with the Shanghai squad while they weren’t required for national duties. Their Shanghai coach recognized they were suffering injuries from their national duties and weren’t up to training like the locals were. I had a squad of seven athletes, six days per week, twice per day for five of those days. I monitored them each day, adjusted intensity and volume as their monitoring dictated, and trained them hard when they were scoring good numbers. A few things came out of this strategy:
- The athletes knew when scoring low was expected—heavy training can do that—and they were okay with the training when they knew it would be adjusted afterwards;
- The athletes knew I would respond in the responsible direction if they had an important team social event that kept them up too late;
- The athletes knew that their numbers were worse if they didn’t get a minimum of eight hours sleep;
- The athletes knew why training was lighter when their numbers were low, but they also understood that the numbers would rise and we would push harder when they did;
- The athletes would ask for extra conditioning when they were with high numbers—this represented an athlete balancing stress and recovery extremely well;
- Other athletes heard and saw how my athletes trained, moved, felt and appeared and would ask to join my program;
- The head coach was confident in my ability to turn these athletes around for the better and trusted I would deliver improvement, with the requisite gains in performance.
Of these questions, we could argue which is most important. Clearly sleep is. Then again, sleep before midnight is more valuable, right? Also, soreness is more important, since your nervous system grants you strength and a sore body means less permission to perform. Right?
There is evidence for all of these being very important, some more important than others on a given day. Knowing that makes you more valuable.
In the fitness industry, a client leaves you each day better off . . . or worse off.
They leave you closer to their goal . . . or further from it.
They are more likely to recommend you . . .or less likely.
What really moves them from one side to the other? We like to think that our training will always leave them better off, moving towards their goal and recommending us. Don’t we have testimonials that say that’s the case? Aren’t we paying our rent or mortgage to prove it? Aren’t our satisfaction surveys telling us this is the case?
Not always. Consider the clients who didn’t complete a survey. Consider the ones who stopped coming to see you, for whatever reason. It may be our fault that we lost these clients, but it’s more often because our influence is minor compared to the rest of their life. Keep a tab on it, adjust as required and leave your client better off for the session, the cycle, the phase, the season, the career and the life.
It’s your job.
Greg Dea is a Sports Physiotherapist who recently finished working for FIVB World Cup winner’s, China Women’s Volleyball team. Dea holds the Australian Physiotherapy Association title of Sports Physiotherapist. This is a protected title, with strict post graduate education requirements, including experience, expertise and examinations in Sports Physiotherapy. Prior to his current role, Greg served two years as head physiotherapist and sports medicine coordinator at the Northern Territory Football Club, a semi-professional Australian Football Club. During that that time, the Australian Football Club achieved record-breaking premiership cup success and were finalists the second year. Greg has also served in various positions in Australian and British Defence Force environments in Australia, England and Germany, and private practice clinics in Australia.
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