Author ORCID Identifier:
Date of Graduation
5-2026
Document Type
Thesis
Degree Name
Master of Science in Exercise Science (MS)
Degree Level
Graduate
Department
Health, Human Performance and Recreation
Advisor/Mentor
Hickey, Erin Howie
Committee Member
Gray, Michelle
Second Committee Member
Elbin, Robert
Keywords
Exercise Is Medicine; Exercise Is Medicine-On Campus; Health Coaching
Abstract
Higher levels of physical activity (PA) are known to be associated with lower rates of chronic disease and better quality of living. However, population-wide deficits in PA continue to demand strategies for supporting PA-related behavior change. Health coaching represents a promising intervention strategy for behavior change, but its effectiveness in generally healthy, non-clinical populations is not clear. The purpose of this project was to evaluate the feasibility, cost, and effectiveness of integrating student-delivered, motivational interviewing (MI)-based health coaching into an existing university-based exercise referral program (ERP). Additionally, this study aimed to use students as health coaches, and to document training procedures and implementation workflows for posterity. Two undergraduate students and three graduate students completed a structured health coach training program consisting of didactic instruction, video and audio materials, demonstration sessions, and roleplay practice. Training emphasized core MI skills and example conversations between ERP student health coaches (SHCs) and participants. ERP participants completed a fitness assessment (FA) and were then assigned to a SHC for three health coaching sessions. In the first session, SHCs reviewed assessment results and encouraged participants to set goals to improve some dimension of their health and/or fitness. Both follow-up sessions focused on addressing obstacles to participant goals and modifying goals in response to participants’ experiences. Implementation metrics were tracked, including total MI sessions completed, sessions delivered per student, and participant drop-out rates. Cost of implementation was similarly tracked. Participants that completed six-month follow-up (6MFU) sessions had their baseline fitness assessment outcomes compared to their 6MFU outcomes to evaluate program efficacy. A total of 169 coaching sessions were delivered to the 75 ERP participants included in this study. Training materials and session delivery protocols have been included, with demonstration sessions available upon request. SHCs were trained at an average cost of $93.50 per SHC. Each participant cost the ERP an average of $410 in direct costs. For the 18 participants that completed follow-up FAs, estimated VO₂max was significantly increased (p = .005) at the six-month follow-up (6MFU) time point (33.39 ± 8.32 to 37.60 ± 8.39), with a medium-to-large effect size (d = .77). Push-ups did not significantly increase (p = .050) from baseline to 6MFU (20.07 ± 14.30 to 27.30 ± 17.13) but did achieve a medium-to-large effect size (d = .77). All other outcome variables did not significantly change from baseline to 6MFU. This study represents a potential blueprint for offering a scalable, low-cost, effective program for implementing health coaching within an existing university ERP. Future research is warranted to further support the evidence for pragmatic, community-based ERPs like the one presented in this study.
Citation
Friedman, Z. J. (2026). Applying Motivational Interviewing-Based Health Coaching Within an Existing Exercise Referral Program: A Cost, Implementation, and Effectiveness Analysis. Graduate Theses and Dissertations Retrieved from https://scholarworks.uark.edu/etd/6245
