Epidemiology

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The final version of this paper was published in: Anshel, M. H., & Sutarso, T. (2010). Effect of a Storyboarding technique on selected measures of fitness among university employees. Research Quarterly for Exercise and Sport, 81 (3), 252-263.

Effect of a Storyboarding Technique on Selected Measures of Fitness Among University Employees

Mark H. Anshel and Toto Sutarso

Abstract The purpose of this study was to determine the effectiveness of an intervention, called storyboarding (i.e., participants written narrative) on improving selected measures of fitness among unfit men and women over a 10-week wellness program. Groups consisted of storytelling during the program orientation, storytelling plus two coaching sessions, or the normal program only (control). Using difference (pretest from posttest) scores, a one-way multivariate analysis of variance indicated significant differences between groups (p < .01). For percent body fat, only the coached group was statistically superior to the control group (p < .03), while the two experimental groups were statistically similar. For submax VO2, both storyboarding groups were superior to the control group (p < .04). It was concluded that storyboarding may be an effective means for changing selected health behaviors. -----Key words: Exercise intervention, experimental research, fitness, narrative inquiry, storyboarding, wellness _________________________________________________________________________________

The ability to promote favorable changes health behavior has challenged researchers and practitioners for many years. Outcome studies on the effects of interventions in replacing negative, unhealthy habits with positive, healthier routines have been met with only limited success. Among the problems of existing intervention research has been the assumption by researchers and practitioners that a behavior change is desirable behavior, as opposed to behavior change that is self-generated and selfdetermined (Buckworth & Dishman, 2002). Buckworth and Dishman contend that one false assumption among health behavior researchers is that the persons desire for behavior change is sufficient to result in actual behavior change, particularly over the long term. Another partial explanation of these results, according to Klesges, Estabrooks, Dzewaltowski, Bull, and Glasgow (2005), is that efficacy studies are conducted under highly controlled and optimal conditions, including participants with similar characteristics. The participant, not surprisingly, experiences the benefits of making expected behavior changes relatively soon after new behaviors are enacted. Individualized personal instruction and feedback, and other forms of social support further

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enhance changes in desirable behavioral outcomes. Numerous studies in the exercise psychology and behavioral medicine literature have not included these intervention components, thereby reducing program effectiveness, particularly with respect to encouraging exercise adherence (Buckworth & Dishman, 2002). Not surprisingly, the decision to refrain from or maintain a program of regular exercise reflects what are often called exercise barriers. Barriers usually stem from past experiences related to sport and exercise (Lox, Martin, & Petruzzello, 2003). Examples include children who are excluded by their peers from sport participation due to poor sport skills, and physical education teachers and coaches who punish their students and athletes by requiring additional exercise (e.g., taking two laps due to being tardy to class or 20 push-ups for making an error). Other psychological exercise barriers include intimidation and self-consciousness to exercise in public settings, lack of social support, self-defeating (irrational) thoughts, and depression (Anshel, 2006). These issues are important factors that reflect the individuals personal history and experiences that reflect lifestyle choices, specifically in relation to unhealthy habits (Loehr, 2007; Lox et al., 2003). One approach to changing health behavior that has been neglected in the related research literature is the influence of storyboarding as a means to generate a persons selfmotivation to encourage a healthy lifestyle, including exercise. Storyboarding The purpose of storyboarding, often referred to in the literature as storytelling (Loehr, 2007; Pennebaker, 1997; Smith & Sparkes, in press), is to understand the ways in which society and culture have shaped a persons experiences, and to frame what activities and health behaviors a person applies that could lead to better intervention strategies (Smith & Sparkes, 2008). Each of these authors contends that stories reflect our unique interpretation of our world of experience. The stories we tell represent the single most powerful tool we have for managing energy and achieving any important mission in life. People live stories, and in the telling of these stories, reaffirm them, modify them, and create new ones (Pennebaker, 1997). As humans, we continually tell ourselves stories about our successes or failures, our needs and wants, and our hopes and dreams. Stories often concern our work, our families and relationships, our health, and about what we are capable of achieving. The context of their stories may endure for an hour, a day, or an entire lifetime. Yet, while our stories profoundly affect how others see us and how we see ourselves, we often fail to recognize that we can change our stories which, in turn, can transform our destiny and, for the purpose of this study, to improve our health (Smith & Sparkes, in press). The story we tell about ourselves becomes our reality. Pennebaker (1997) and Loehr (2007) posit that each of us has two voices, our public voice and our private (inner) voice. The primary objective of storyboarding is to recruit the inner (private) voice. The private voice often distracts us from the truth about our life, resulting in a dysfunctional outcome. Our goal for maintaining a high quality of life and good physical and mental health is to recruit the inner voice that creates maturity, the truth about who we are and how we want to live the true inner voice, and a lifestyle that is consistent with our values. At the same time, we want to avoid the old, dysfunctional inner voice that disengage us, block personal growth and make us victims of our circumstances. The right stories bring us to the truth, mobilize us to dig deeper and make tough values-based choices that lead to expanded growth. They also deepen our engagement in life, keep hope alive and, despite risks, inspire us to take courageous action. According to Loehr (2007), accurate stories deepen our engagement and inspire us to act courageously. Successful personal change invariably requires that we change our story. Stories that deepen engagement and facilitate difficult life changes allow researchers to examine the individuals history that has contributed to the current unhealthy lifestyle, help practitioners to understand the mechanisms for changing those behaviors that lead to new, healthier routines, and provide a focus for future efforts to change unwanted, undesirable behavioral patterns resulting in a more satisfying life. The most powerful method of storytelling is through written narrative, which is why storytelling is viewed as a component of the research method, narrative inquiry (Clandinin, & Connelly, 2000). In his

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meta-analysis of related literature, Frattaroli (2006) found that written expression of ones inner voice is a more beneficial to improving health, quality of life, and performance outcomes then to talk about it. The process of writing changes a persons thinking perspective (King, 2001; Ramirez-Esparza & Pennebaker, 2006). The authors contend that writing connects meaning to neurological pathways. It has been posited that storytelling increases emotional intensity, thus increasing biochemical changes in the brain, such as dopamine and serotonin. The process by which these changes occur, however, is through written expression of ones inner voice. Emotion drives the favorable effect of storytelling (Smith & Sparkes, 2006). Several studies have addressed the influence of written expression on health-related outcomes. For example, Burton and King (2008) asked participants to write about a personal trauma, a positive life experience, or a control topic for 2 minutes each day for 2 days. Emotion word usage in the essays was examined and physical health complaints were measured 46 weeks after the last writing session. They found that essays about trauma and positive experiences contained more emotional content than the control essays. In addition, both the trauma and the positive experience conditions reported fewer health complaints at follow-up than the control condition. Storyboarding has selected similarities to the research method called narrative inquiry. Narrative inquiry, the individuals interpretation of personal experience, has been used, albeit rarely, as a research method to understand personal feelings of patients in rehabilitation settings. A story is not a transparent window into ones personal world, however (Smith & Sparkes, in press). Instead, our stories are shaped, mediated, and regulated by ones narrative resources (Riessman, 2008). As Loehr (2007) and Smith and Sparkes (in press) assert, narratives are personal. They are intended to lend insight into the reasons and explanations of our needs, habits, aspirations, and behavior patterns, both good (healthy) and bad (unhealthy). Similar to narrative inquiry, storytelling is a form of therapy that promotes a persons healthy body image, which is especially important in exercise and wellness program settings (Leahy & Harrigan, 2006). In one study, Smith and Sparkes (2005) examined 14 English rugby athletes who suffered a spinal cord injury to determine the ways in which their debilitating injury and sense of identify as athletes influenced their future health and quality of life. The researchers asked each participant to tell their life story on three occasions over one year. Briefly, the researchers found that a common denominator among the athletes was concrete hope, that is, the sense that they were once healthy, than became disabled, and will one day become healthy, again. The use of narrative inquiry allowed the researchers to understand the underlying psychological and emotional factors that accompany rehabilitation for a life-changing injury. Testimony to this process is the researchers conclusion that, to these injured athletes, the present is filled with stories of concrete hope and life is narrated in the future tense as the individual waits for a cure that will return them to an able-bodied state of being (p. 1102). By allowing the athletes to tell their story, medical and mental health practitioners can tailor their respective treatments in assisting each patient to adjust to a new lifestyle, while avoiding possible psychopathology, such as depression, hopelessness, and thoughts of suicide. While other studies using the narrative inquiry research method have been used to improve our understanding of the factors that influence our thoughts, emotions, and actions, there is an apparent absence of research using this research methodology as an intervention to promote exercise behavior. It is thought that our willingness to tell the stories that have impeded our ability to live a life that is consistent with our core values, called our old story (Loehr, 2007). Revealing our old story helps us explain the sources of our unhealthy habits, such as lack of physical activity and poor nutrition. Self-disclosure of our personal history through the eyes of our old story allows us to generate a new story that, predictably, will change our reality (Loehr, 2007). The present study is a first test of Loehrs eight-step storyboarding program that promotes this process. The purpose of this study, then, was to examine the effect of a storyboarding technique, or the inclusion of narrative inquiry, following Loehrs (2007) eight-step program, on changes in selected measures of fitness and exercise adherence. It was hypothesized that the group that experienced the eight-

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step program and additional personal coaching during the intervention period following the introductory orientation would demonstrate significantly better fitness from pre-test to post-test, as compared to the group that received the eight-step program, but with no further coaching, and the (control) group that experienced the orientation, but did not receive the eight-step program. Method Participants The study, subsidized by a university grant, included faculty and staff employed at a university located in the southeastern U.S., who paid a $25.00 registration fee to participate in a campus wellness program. The program, financially supported by an internal grant, included fitness and nutrition coaching, and fitness testing prior to and immediately following the intervention. All participants were recruited at the programs orientation, which consisted of 100 registrants. The orientations purpose was to review the program and introduce staff. At the conclusion of the orientation, all attendees were invited to become involved in an additional component of the program that included experiencing an eight-step program, authored by Loehr (2007), which will be explained later. Specific program content, however, was not revealed at this time. Participants were informed that participation was optional and an additional component to their regular fitness and nutrition coaching in the wellness program, and that they could leave the study at any time without any negative repercussions. A total of 46 individuals, 10 males and 36 females, all Caucasians and full-time employees of the university, ranging in age from 28.4 to 58.6 yrs. (M = 43.7 yrs., SD = 3.21), volunteered to participate in the study. The participants acknowledged they have not engaged in regular exercise over the past 30 days and categorized themselves as unfit with respect to both strength and cardiovascular fitness. In addition, to help ensure that each individual was capable of carrying out their respective exercise prescription, no participant was considered obese based on their body mass index of less then 30, and the written approval by their personal care provider (PCP) to engage in the program. PCP approval was an integral part of obtaining campus IRB approval, and ensured that each participant was medically cleared to engage in an exercise program that was of sufficient intensity that would result in significantly improved fitness. This study was approved by the universitys Institutional Review Board. Group assignments were based on the individuals willingness to engage in a particular intervention (i.e., time for individualized coaching and completing writing tasks), resulting in uneven group sample sizes. The coaching group (n = 15) completed the program orientation and the storyboarding task, and then interacted with a performance coach on two occasions during the 10-week program. The orientation only group (n = 13) wrote out their story during the orientation, but did not subsequently interact with a coach. The third (control) group (n = 18) consisted of individuals who wanted to receive the wellness program, but were not interested in experiencing the storyboarding treatment. Despite the lack of random assignment, demographic data indicated that participants in each group were similar with respect to gender, age range, and fitness level. Equipment Four fitness tests were conducted within 72 hours of the programs formal beginning, consisting of a 3-hour seminar (described later), and again, at the conclusion of the intervention 10 weeks later.

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Fitness Tests The dependent variables in this study consisted of four measures that reflected the results of the 10-week fitness program, body composition (i.e., percent body fat), cardiovascular fitness (submax VO2), upper body strength, and lower body strength. Body composition. Body composition was measured using a Lange skinfold caliper. Trained technicians performed a seven-site assessment to assure accuracy and consistency (Pollock & Jackson, 1984). Body fat percentage was calculated from estimates of body density using the Siri equation (Siri, 1961). Cardiovascular fitness. Estimated VO2 max was assessed by the use of the Single-Stage Treadmill Test. Each test was performed on a Quinton Treadmill, Model number Q55 using standard protocol (Ebbeling, Ward, Puleo, Widrick, & Rippe, 1991). Participants were asked not to hold onto the handrails during the test unless absolutely necessary. Heart rate was manually palpated for 10 seconds during the final minute of the test for use in the prediction equation. Muscular strength (Estimated 1-RM Testing). Upper and lower body strength was estimated using a Universal weight machine. Each participant was briefly instructed as to proper form and breathing technique before performing each test. Bench press was used for upper body, and leg press was used for lower body testing. Participants were asked about their involvement in weight training in an effort to estimate the appropriate weight load for the test. Participants were then instructed to perform as many repetitions at the selected weight until fatigue up to 15 repetitions. Prediction conversions were used with weight lifted and repetitions performed to determine estimated one repetition maximum (1-RM). Procedures Outcome evaluation, also called process-outcome studies (DeAngelis, 2005), encompasses program assessment and outcomes (Schalock, 2001); in-session behaviors are linked to treatment outcome. Specific methods include performance planning and reporting and performance indicators that are commensurate with program goals. The current study was carried out in accordance with Schalocks recommendations: (a) establishing baseline data, (b) determining desired outcomes, and (c) aligning program services with desired outcomes. The orientation began with introducing all fitness coaches (i.e., university students who specialized in exercise science) and the programs nutrition coach, a registered dietician, with whom they would work during the 10-week intervention. Clients made appointments to receive pre-testing and initial consulting sessions with their respective fitness and nutrition coach. A 90-min. seminar was then completed which included a workbook, power point presentation, group member interaction, and lecture. Clients were given four fitness tests, upper strength, lower strength, submax VO2, and percent body fat, and then provided an exercise prescription based on test results. While clients were asked to exercise a minimum of three times per week, they met each client in person only once per week during the 10-week intervention. Purposes of the weekly meeting were: (a) to provide verbal and written instruction about proper exercise techniques, particularly related to use of weight machines and proper lifting techniques, (b) to receive instruction on cardiovascular training, in some cases, to exercise with the client, (c) to develop strategies to overcome perceived barriers to completing the program (e.g., not enough time, overcoming physical discomfort, feeling comfortable at the exercise venue (the Campus Fitness Center, lending social support), and (d) to provide positive feedback on desirable performance and improvement. Coaches obtained exercise adherence data either verbally or via e-mail from their respective clients at the end of each week. In addition, clients had one 30-minute private session with the registered dietician to discuss ways to improve eating habits, and attended weekly nutrition seminars. The control group engaged in the regular 10-week wellness program, including fitness and nutrition coaching, however, with no exposure to the storytelling and other aspects of the Loehr (2007) program. Intervention The intervention, experienced by two of the three groups, followed the concept of energy management training developed by Loehr (2007), Loehr and Schwartz (2003), and Groppel (2000)

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consisting primarily of helping individuals to recognize their unhealthy habits, and to develop cognitive and behavioral strategies that improve physical, mental, emotional, and spiritual functioning what the authors call expanding their capacity, to replace those bad habits with desirable, healthier routines. While members of all three groups in the study experienced this 90-minute program, participants in the two experimental groups engaged in an additional 90-minute program that incorporated Loehrs (2007) eight-step storyboarding program that has clinical content that requires the individual to divulge personal information about their hopes and dreams, and how helping the client plan the strategies to accomplish them. While following a particular diet was not integrated into the program, suggested guidelines for maintaining particular nutritional habits followed suggestions by Groppel (2000) and Whitnesy and RadyRolfes (2004). Sample guidelines include eat a low-fat breakfast daily, eat until satisfied not full, while keeping portions reasonably small, eat small meals, including low glycemic snacks, every 3 to 4 hours each day, and drink from 48-64 oz. of water daily. Eating high glycemic, high fat food before bedtime was also discouraged. Loehrs (2007) Eight-Step Program The eight-step program consists of the client performing the following tasks: (1) to determine the individuals ultimate mission, or purpose, that reflects his or her wants or needs, and to identify the clients preferred legacy; what areas of his or her life in which they want to be extraordinary to fulfill their destiny; (2) to face the truth by identifying ones old story, answering two questions: In which of the following area(s) of your life is your story not working? and In which areas do you need or want to be more engaged to fulfill your Ultimate Mission? Answers areas of ones life - to both questions consist of a checklist, including work/job/boss, family, health, happiness, friendship, religion, trust, spirituality, love, food/diet, exercise, children, and spouse/partner, (3) to select which of these old stories individuals want to address first; (4) to write the story individuals have been telling themselves that has allowed the misalignment to occur; this means including the faulty thinking and the strange logic that helped to form the story you now wish to edit (Loehr, 2007, p. 229); (5) to reflect on ones old story, and answer the following questions: How does it make you feel? Sick? Stupid? Dumb? Embarrassed? Does it stir powerful feelings of disgust? Can you see and feel (his italics) the storys dysfunctionality? (p. 231); (6) to write a new story that is fully aligned with (the individuals) ultimate purpose, reflects the truth, (and) inspires (the individual) to take hope-filled action; (7) to design explicit rituals that ensures the new story becomes reality (e.g., making time for the behaviors that are consistent with ones values); and (8) to establish a system by which the individual is held accountable each day for conducting these new rituals. It is important to note that Loehrs program provided written tasks for clients to complete, however, there are no quantitative data (i.e., dependent variables) that result from this program. Loehr (2007) defines as story as those tales we create and tell ourselves and others, and which form the only reality we will ever know in this life (p. 5). He contends that our future, or destiny, follows our stories, therefore, its imperative that we do everything in our power to get our stories right (p. 5). He further divides our stories into two categories, our old story, and our new story. A persons old story consists of what they have been telling themselves that has allowed them to justify their thoughts and actions, or to explain their pain or problems. Among the objectives of his program is to encourage individuals to edit their dysfunctional story by answering the following question: In which important areas of my life is it clear that I cannot achieve my goals with the story Ive got? (p. 5). To Loehr (2007), individuals reach their ultimate mission in performing consistently at the highest level when they the story they tell themselves reflect their fundamental purpose, which henceforth will drive everything (they) do (p. 44). The final stage of Loehrs program consists of My Mission (e.g., To be more energized and engaged in the afternoon at work and with my family at home (p. 236), and a Daily Training Log that includes a list of rituals for each day of the week. Sample rituals include daily mental preparation 5:45 a.m., eat breakfast, eat until satisfied (not full), break every 90 to 120 minutes, exercise, maintain proper

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exercise intensity, drink water carry water bottle, be fully engaged for 30 minutes at home, and evening engagement with family. Loehr (2007) makes the following important recommendations in completing the program by using a daily accountability system for the rituals that each individual has established. These include: (a) to make ones accountability system easy to complete and accessible; (b) to view this procedure as a way to foster time management and energy management (e.g., Did you do what you said you would at the time you committed to?); (c) to review ones accountability log with someone the person respects, and to ask that person to serve as a coach during the 90-day mission of this program; (d) to be obsessive about record-keeping and compliance during the 90 days; and (e) if enthusiasm wanes and boredom sets in, that participants should review the entire process again in a much shorter time frame. This entails rewriting ones story to reignite excitement and commitment to change (p. 238). Coach-Client Interaction During the individual coaching sessions, participants were asked to briefly describe observations about their lives and the barriers and negative habits that kept them from becoming their truest selves. Participants were already familiar with the concept of storytelling, so this portion of the interview was mainly geared around developing a relationship with the clients and allowing them to openly voice and claim responsibility for bad habits and self-destructive behaviors. The environment was positive and constructive and deliberately not focused on how the individuals should change, but rather on how they could alter their schedules to pursue higher goals. Secondly, the first coaching session asked the participants to develop what Loehr (2007) refers to as an "ultimate mission," whereby the clients envisioned a new story. This new story involves removing undesirable habits, emotions, thoughts, fears, and other negative mindsets. It is a picture of what can be with certain modifications. Essential to the attainment of a new story and ultimate mission is the process of developing smaller "training missions" unique to the participant. The client was coached to program specific rituals into his or her daily life based on the attainment of a specific goal (i.e. connecting abstract values with concrete activities). For example, if a participant stated that he or she wanted to aspire to be more involved with family, we would ask him/her to set aside certain times during the week to pursue this goal. The aim was to facilitate accountability and adherence to a new way of living. At the conclusion of the first session, participants were asked to solidify their "old story" and to replace it by crafting a "new story," that is, to create a different way of thinking. In addition, they were asked to provide feedback about specific rituals that they were implementing to transition between the new and old stories. Again, we did not want the individuals to be overwhelmed by negative circumstances in the present. Instead, we wanted them to leave with a vision or a new legacy for their lives. Each client was asked to follow three rules in moving from ones old to new story, as described by Loehr (2007). The first rule was for the participant to link his or her new story to a primary value such as family, integrity, faith, or kindness. The second rule asked the individual to represent the truth as much as humanly possible in his or her new story. The purpose of the third rule was to engender a deep sense of hope in the persons new story that successful change is possible. Three weeks after the first appointment, a second appointment was scheduled at a time convenient to the client and researcher to review the process of storytelling and to refine and craft new stories. Participants were asked about their progress and again encouraged to connect abstract values with concrete behaviors. At this point, it was possible to ensure that the client was getting the maximum benefit of the intervention. The aim was for clients to make strides toward their ultimate mission and new story. At the conclusion of this second session, clients were asked to submit their old and new stories and were given the assignment to attach additional rituals to their schedules. The second session marked the end of the treatment. Participants returned to the regular health and fitness routines of the regular wellness program. Appendix A provides sample old and new stories from two study participants. Data Analysis

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Before the intervention we measured the participants PBF, VO2, US, and LS (described in the Procedures section). The Storyboarding Technique was a primary source of motivation to help participants feel capable of achieving their fitness goals (e.g., decrease PBF, increase cardiovascular fitness and strength) during the intervention. After the intervention, these dependent variables were measured again. Since we were interested in improvement we used the difference between before and after program. A one-way multivariate analysis of variance (MANOVA), using difference scores (improvement) between before and after treatment, was computed to examine the effect of the interventions on selected physical fitness measures. If the overall multivariate statistic was significant, a post hoc test was conducted to examine which dependent measures and which values of a factor contributed to the significant overall test. Tukeys HSD to compare multiple group means would be used if significant improvements were found and the assumption of homogeneity of variance of the three groups was achieved. Because group sample size was unequal, Least Square Means (LSMs) were used to compare group means. Results Fitness Measures The overall multivariate statistic result indicated a significant difference between groups (Wilks Lambda = .64, F [8,80] = 2.52, p < .02). Post hoc analyses indicated that two measures, percent body fat (PBF; F [2,43] = 4.08, p < .02) and submax VO2 (F = [2,43] 4.91, p < .01), differed significantly between groups. Specifically, multiple comparisons using Tukeys HSD on the VO2 measure indicated that both storyboarding groups were superior to the control group from pre-test to posttest (p < .05 between the coached group and control; p <.02 between the orientation only group and control). For PBF, the coached group, but not the orientation only group, was statistically superior to the control group (p<.03). The two experimental groups were statistically similar on these measures, and group comparisons on the other fitness measures were also non-significant. Comparisons of group means for improved performance, and descriptive statistics for pre and post physical fitness measures, are located in Tables 1. The assumption of normality was satisfactory. Exercise Adherence Exercise adherence was defined in this study as the extent to which each participant engaged in his or her prescribed aerobic and strength exercise programs. Aerobic exercise was prescribed a minimum of three times per week, in accordance with the existing scientific literature for marked improvement on cardiovascular fitness, while strength training was prescribed a minimum of twice per week. Thus, full exercise adherence for aerobic exercise was operationally defined as exercising at least three times per week over 10 weeks, or 30 sessions. Full adherence for strength exercise included a minimum of two sessions per week over 10 weeks, or 20 sessions. Adherence data consisted of self-report, which was obtained the fitness coaches at the end of each week by e-mail or phone contact with their respective clients. Corroborative evidence of adherence rates was also collected from post-test fitness scores. Adherence rates for the coaching group averaged 23 out of 30 aerobic exercise sessions (77%), and 16 out of 20 sessions (80%) for strength training. The orientation only group recorded adherence rates of 21 out of 30 (70%) and 15 out of 20 sessions (75%) for aerobic and strength conditioning, respectively. Finally, the control group adherence rates were 15 out of 30 (50%) and 16 out of 20 sessions (80%), respectively. Thus, while adherence was far greater for the two treatment groups, as opposed to the control group, adherence rates were very similar for strength training. None of the 46 participants who volunteered for the study dropped out. Survey Responses

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Immediately after the 10-week wellness program, each participant in the two treatment groups was sent a survey online that provided additional meaning to the storytelling task, and the ways in which this procedure influenced their thoughts, emotions, and actions in the program. Here are the questions and selected responses obtained from a small sample of participants that reflect the effect of storyboarding on the factor(s) that lead to their change in health behavior. This survey also provided a manipulation check clearly indicating that participants had, in fact, applied Loehrs (2007) 8-step program. Question: Describe how your old story prevented you until now from reaching your mission of improved fitness, health, and energy? Answer: To see it written make it more tangible and gets your attention. My old story was full of excuses. I saw how much time I was wasting instead of taking better care of myself. Question: How has your new story provided you with the incentive to overcome bad (unhealthy) habits and to accomplish the goals in your new story? Answer: It has provided me with the incentive to want to erase (change) the written old story. My new story was full of action, not just reasons why I could not achieve my goals. Question: As part of your new story, in what areas of your life have you been and must you truly be extraordinary to fulfill your destiny? Answer: I must be focused on my goals and truly engaged in only those things that improve my situation. I must embrace the moment and plan fun activities. Question: What was your daily average energy level before the wellness program on a scale of 1 (very low) to 10 (extremely high)? How has your energy improved since the programs completion? Answer: The average pre-program energy level was 3.55 (SD = .83), and the post-program energy level was 7.75 (SD = .91). Question: On a scale from 1 (very low) to 10 (extremely high), how confident are you that you will maintain these new rituals that you learned in the wellness program? (M = 8.50, SD = 0.71). Answer: I realized that excuses are just that, and that nothing can be lost in trying. I realize how self-destructive my old story was and I wont let that happen to me again. It was very telling about why so many people do not achieve their new story out of sight, out of mind but with the support I have received in this program I am confident I will stick with my new program. Discussion The purpose of this study was to examine the effect of an intervention based on the concept of storytelling, also called storyboarding or narrative inquiry, on replacing negative, unhealthy habits with positive, healthy routines, the result of which was to improve fitness and maintain participation in the 10week program, or exercise adherence. Participants were assigned to one of two groups, a group that experienced the orientation and Loehrs (2007) eight-step storyboarding program, which included two additional coaching sessions during the 10-week wellness program, or a group that experienced the same orientation and eight-step program, but without additional coaching during the 10-week wellness program. The third (control) group consisted of individuals who engaged in the wellness program only and were not exposed to the orientation. The participants who received the storytelling treatment in this study were profoundly affected by their experience. As revealed in the post-program survey comments, the individuals felt a degree of vastly improved self-control in their lives and were on a new mission to invest in a new set of rituals that improved their health and energy. Not surprisingly, the storytelling procedure was the first time they expressed very personal issues in written form. Pennebaker (1997) offers two additional possible explanations for the marked improvement in fitness for the two treatment groups in this study, as compared to the control group: (1) the nature of storytelling, and (2) a persons motivation to change his or her health behavior. According to Pennebaker, one reason the writing process can result in behavior change is that it requires the individual to organize past traumas which may have lead to their dysfunctional (i.e., unhealthy) habits. Traumas, he contends, are the sources of our old story that prevents many individuals from living a life consistent with their

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values and achieving at the highest level. When individuals write about significant events in their life, they begin to organize and understand them. This allows them to reduce the experiences complexity and making it more understandable, thus, allowing them to move beyond the trauma. With respect to a persons motivation to change his or her health behavior, Pennebaker (1997) reflects a plethora of existing clinical literature that the self-motivation to change is the best predictor of replacing unhealthy, often self-destructive habits with improved, healthier routines. Writing, he contends, allows the individual to explore their motives for health behavior change. He suggests that writing allows the person to scrutinize their deepest thoughts and feelings about why they think change is necessary. The participants who engaged in the two treatment groups, particularly individuals who invested time and effort, and were unafraid to expose their inner thoughts and feelings that may help explain their selfdestructive nature, were highly self-motivated to improve their health and quality of life. This was clear in their writing; both their old and new stories and reflected by their post-study survey responses (described earlier). An important outcome of the study was the strong influence of storyboarding on the treatment groups experience in this wellness program. As indicated earlier, this study provided the first test of Loehrs (2007) eight-step storyboarding program. Storyboarding presents a potentially effective method for understanding the individuals resistance to health behavior change. For the individuals in this study, it created, what Clandinin and Connelly (2000) call, an experience of the experience. The authors assert that educators are interested in life as an educational tool, and that storytelling allows educators to examine how peoples lives are composed and lived out. In addition, however, storyboarding provides researchers and practitioners with the incentive to overcome their personal storms, and to improve their sense of selfcontrol in improving quality of life. As a form of manipulation check, each participant assured us that they followed the daily accountability system for their rituals, as suggested in Loehrs (2007) program. These included making their accountability system easy to complete and accessible (e.g., near their bed, on the kitchen table, on their office desk), to ask themselves, daily, if they carried out the rituals to which they committed, to review their accountability log with another person (i.e., someone they designated as their coach, to keep records and to comply with the rituals and (e) to review the entire process and rewrite their stories if enthusiasm wanes and boredom set in. All participants in the coaching group indicated full adherence to these tasks. It is, perhaps, this point acknowledging the factors responsible for ones lack of fulfillment in life by identifying ones old story, overcoming personal storms, and improving a sense of self-control through the narrative of a new story, then instituting daily rituals that help overcome past personal limitations and barriers, that make the storyboarding technique so powerful and effective (Loehr, 2007). The task of reflection and reviewing the foundations of your lack of fulfillment is grounded in identifying the inconsistency between your values what you consider very important in life and your unhealthy or ineffective behavioral patterns (Anshel & Kang, 2007). For example, one client (see Appendix) states, about changing his life and improving his future health: The truth is my new New Story is one of a New Life. It is no longer one of personal lies with imaginary plans, but actual action. In July 2007 I got married into a family with Jennifer and her daughter Meggan. All my decisions now have consequences beyond myself. My life is no longer day-to-day, but part of a lifelong journey. This person found new meaning in life from his family; his values changed and his journey was now focused on maintaining good health. He had more to live for then meeting personal needs. In the parlance of Loehr and Schwartz (2003), he connected to a deeply held set of values and to a purpose beyond our self-interest (p. 110). The result was a renewed sense of spiritual energy (that was) sustained by balancing a commitment to others with adequate self-care (p. 110). He now thought of the long-term consequences to his negative habits and a renewed sense of purpose in his journey to live a fulfilling life. The ability to tell ones story old and new reflects the effectiveness of storytelling and reflects the unique contributions of narrative inquiry in understanding the factors that influence human

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behavior. To Smith (2007), in explaining the value of narrative inquiry research methodology, People understand themselves as selves through the stories they tell and the stories they feel part of (p. 391). Smith (2007) also provides insights into another factor that helps explain the strong influence of narratives on self-understanding and behavior change that narrative is also a form of social action. To Smith, narratives are done (ital.) in social interactions (because) people do (ital.) things with narratives and they have important social functions. Thus, stories do (ital.) things in relation to others (p. 391). The present study included full social support of coaches in the areas of fitness, nutrition, storytelling, and additional social support from family members and work colleagues with whom many of the participants exercised. There is an apparent prominent social role in providing a person with the incentive to develop, carry out, and adhere to new rituals and influence the stories we tell. Additional research is needed to more closely examine the social influence of our stories that lead to developing new, permanent changes in health behaviors. One possible limitation to this study was that both participants and the researchers were members of the same university faculty. Although full confidentiality was promised (and acknowledged by the participants), it is possible that there was a degree of inhibition and holding back when disclosing their personal story. This issue is intrinsic to the narrative inquiry process (Clandinin & Connelly, 2000). It should also be noted, however, that the stories were very personal and intimate relating to ones professional career and personal relationships. In addition, the relationship established between the researchers and each participant was sincere and respectful. All meetings were held in a private office, and each person expressed full comfort in expressing their old and new stories, which they wrote on their own time and in the privacy of their home or office. At no time did the researchers feel that clients were providing story content they thought the researchers wanted to hear (i.e., social desirability effect), however, this issue could not be controlled. Another limitation in the study was that the assignment of participants to groups was not random. While all individuals in the study were registered to participate in a 10-week wellness program, group assignment was based on the selective criteria. For example, only persons who were willing to meet with their coach to engage in the intervention were assigned the coaching group, while others were assigned to the orientation only (no-coaching) group. The remaining individuals comprised the control (wellness program only) group. The self-selection of participants to conditions, as opposed to random assignment, may result in a behavioral artifact called volunteerism, or volunteer bias (Rosenthal & Rosnow, 1975), that reflects heightened motivation and other characteristics of individuals who volunteer to participate in a program or study. Nevertheless, participants in all three groups demonstrated similarly low fitness level and interest to participate in the wellness program. We also acknowledge the important potential of qualitative research in future examinations of the ways that storyboarding may influence health behavior change, particularly with respect to exercise. Stories lend themselves to structured interview questions about the antecedents and underlying factors that help explain the mechanisms for decisions to develop, carry out, and adhere to new rituals that improve health and lead to permanent lifestyle changes (Smith & Sparkes, 2008). In summary, the results indicated that the orientation-plus-coached group, but not the orientation group only, was significantly superior for reduced percent body fat and improved cardiovascular fitness, as opposed to the control group. The two treatment groups, however, were statistically similar for PBF. On the submax VO 2 measure, both treatment groups scored significantly better then the control group and, again, were statistically similar. Exercise adherence rates were superior for the two treatment groups when engaging in aerobic fitness, however, all three groups demonstrated similar adherence to the strength training part of the program. The results of this study strongly suggest that storyboarding may be effective in attempts to change health behavior, particularly with respect to encouraging exercise, by allowing the individual to discover mental and emotional factors that have fostered negative habits, while impeding behaviors that promote happiness and high quality of life. The effect of storyboarding on long-term changes in healthenhancing behavioral patterns, particularly exercise, awaits further research.

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References Anshel, M. H. (2006). Applied exercise psychology: A practitioners guide to improving client health and fitness. New York: Springer Publishing Company. Anshel, M. H., & Kang, M. (2007). Effect of an intervention on replacing negative habits with positive routines for improving full engagement at work: A test of the Disconnected Values Model. Consulting Psychology Journal: Practice and Research, 59, 110-125. Buckworth, J., & Dishman, R. K. (2002). Exercise psychology. Champaign, IL: Human Kinetics. Burton, C. M., & King, L. A. (2008). Effects of (very) brief writing on health: The two-minute miracle. British Journal of Health Psychology, 13, 914. Clandinin, D. J., & Connelly, F. M. (2000). Narrative inquiry: Experience and story in qualitative research. San Francisco, CA: Jossey-Bass. Ebbeling, C. B., Ward, A., Puleo, E. M., Widrick, J., & Rippe, J. M. (1991). Development of a singlestage treadmill walking test. Medicine and Science in Sports, 23, 966-973. Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132, 823865. Groppel, J. (2000). The corporate athlete: How to achieve maximal performance in business and life. New York: John Wiley & Sons. King, L. A. (2001). The health benefits of writing about life goals. Personality and Social Psychology Bulletin, 27, 798807. Klesges, L. M., Estabrooks, P. A., Dzewaltowski, D. A., Bull, S. S., & Glasgow, R. E. (2005). Beginning with the application in mind: Designing and planning health behavior change interventions to enhance dissemination. Annals of Behavioral Medicine, 29, 66-75. Leahy, T., & Harrigan, R. (2006). Using narrative therapy in sport psychology practice: Application to a psychoeducational body image program. The Sport Psychologist, 20, 480-494. Loehr, J. (2007). The power of story: Rewrite your destiny in business and in life. New York: Free Press. Loehr, J., & Schwartz, T. (2003). The power of full engagement: Managing energy, not time, is the key to high performance and personal renewal. New York: Free Press. Lox, C. L., Martin, K. A., & Petruzzello, S. J. (2003). The psychology of exercise : Integrating theory and practice. Pennebaker, J. S. (1997). Opening up: The healing power of expressing emotions. New York: Guilford Press. Pollock, M. L. & Jackson, A. S. (1984). Research progress in validation of clinical methods of assessing body composition. Medicine and Science in Sports and Exercise 16, 606-615. Ramirez-Esparza, N., & Pennebaker, J. (2006). Do good stories produce good health? Exploring words, language and culture. Narrative Inquiry, 16, 211-219. Riessman, C. (2008). Narrative methods for the human sciences. Thousand Oaks, CA: Sage. Rosenthal, R., & Rosnow, R. (1975). The volunteer subject. New York: John Wiley & Sons. Schalock, R. L. (2001). Outcome-based Evaluation (2nd ed.). Kluwer, New York. Siri, W. E. (1961). Body composition from fluid spaces and density: analysis of methods, Nutrition, 9: 480-491. Smith, B. (2007). The state of the art in narative inquiry. Narrative Inquiry, 17, 391-398. Smith, B., & Sparkes, A. C. (2005). Men, sport, spinal cord injry, and narratives of hope. Social Science & Medicine, 61, 1095-1105. Smith, B., & Sparkes, A. C. (2006). Narrative inquiry in psychology: exporing the tensions within. Qualitative Research in Psychology, 3, 169-192. Smith, B., & Sparkes, A. C. (2008). Narrative analysis and sport and exercise psychology: Understanding lives in diverse ways. Psychology of Sport & Exercise, 9, 1-10. Smith, B., & Sparkes, A. C. (in press). Narrative inquiry in sport and exercise psychology: What can it mean, and why might we do it? Psychology of Sport & Exercise. Whitnesy, E., & Rady-Rolfes, S. (2004). Understanding nutrition (10th ed.). New York:

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Table 1. Group Mean Improvement Comparisons on Physical Fitness Measures

Measures Percent body fat* Group Coaching Test Pre Post Orientation Only Pre Post Control Pre Post Submax VO2 Coaching Pre Post Orientation Only Pre Post Control Pre Post Upper Strength Coaching Pre Post Orientation Only Pre Post Control Pre Post Lower Strength Coaching Pre Post Orientation Only Pre Post Control Pre Post Mean 32.54 28.95 30.22 26.98 26.34 24.78 34.78 38.33 37.07 41.18 39.52 40.03 67.65 80.04 81.15 101.87 59.98 80.00 256.78 318.78 308.04 381.76 241.48 287.10 Standard Deviation 5.27 5.56 8.65 7.65 8.03 8.48 7.57 6.04 8.68 9.30 7.13 8.29 37.58 37.24 36.25 44.82 30.10 34.95 156.94 157.93 100.85 98.18 78.05 72.97 N 15 15 13 13 18 18 15 15 13 13 18 18 15 15 13 13 18 18 15 15 13 13 18 18 45.62 (40.28) 73.72 (41.93) 62.00 (40.27) 20.02 (24.30) 20.72 (16.36) 12.39 ( 9.68) 0.51 ( 3.48) 4.11 ( 2.85) 3.55 ( 4.02) Coaching > Control (p < .05) Orientation Only > Control (p < .02) - 1.56 ( 2.75) - 3.24 ( 1.49)

Mean Improvement & (Std. Deviation)

- 3.59 ( 1.90)

Significant Improvement and p-value Coaching < Control (p < .03)

Negative Mean Improvement in Percent body fat = Less Percent body fat

Epidemiology Appendix A

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Storyboarding Samples (unedited) Participant A Old Story I was a former high school and college athlete who enjoyed working out when I would actually get off my lazy-boy and get to the gym. My lifestyle for many years was one of living alone, irregular eating habits and bachelor tendencies. I drank too much and had no portion control. I usually ate anything and everything until uncomfortably stuffed. A regular weekend dinner might include a two liter of cola and a large pepperoni pizza. My finances consisted of multiple credit cards maxed out and living from paycheck to paycheck, while making minimal payments on my delinquent accounts. I never really planned much, more or less, lived day-to-day and week-to-week. The only person I usually ever had to worry about was myself. My life had little or no direction. I finished my MBA, but usually only did enough to just get by. I never saw myself as overweight or out of shape, and part of me wanted to be the college athlete againso I put on the act. Working out consisted of infrequent visits to the Campus Recreation Center where I would sweat and look like I was a man trying to get in better shape. In all actuality, it was wasted time and in some ways more harmful than it was good. New Story The truth is my new New Story is one of a New Life. It is no longer one of personal lies with imaginary plans, but actual action. In July 2007 I got married into a family with Jennifer and her daughter Meggan. All my decisions now have consequences beyond myself. My life is no longer day-to-day, but part of a lifelong journey. In January of this year, while on our honeymoon in Las Vegas, we made a decision to change our lives. We decided to start working-out regularly, eat better foods and work on controlling our portions and cravings. No longer does food control our lives. We eat 5-6 meals a day including snacks, and try to eat something every 2 hours or so. This has kept us from being hungry and giving our bodies only what it needs. Since beginning our lifestyle changes I have lost close to 30 lbs and attend the gym, including 45-60 minutes of cardiovascular activities and lifting weights 4-5 times a week. Working out has become part of my daily routine, and days without it seem empty. I have more energy and have become more focused in all aspects of my life. I have since paid off most of my debt, have worked my 5th year as an Instructor of Marketing and won Professor of the Year in the College of Business. My life now has focus, and its my wife and daughter. My habits have balance between work, home, and personal well being. I have prioritized my actions and live to be a father to my daughter, a loving husband to my wife, and to take back control of my life. Participant B Old Story I dislike my life. While I like parts of my job, I feel that there is too much work, particularly paperwork and administrative duties. I am constantly experiencing low-level ill health, and I dont find time to do the things I want. I always feel overwhelmed by everything I should be doing. I always imagine things I want to do some day or in the future, and often imagine better choices I could have made in the past but I never do those things now, and I dont prepare to do them in the future. I am in denial about how I spend my time every day, every semester, I just try to get through the day but that feeling never ends. I never feel like I have arrived where I want to be, or even that I have made progress. I would be embarrassed to admit to almost anyone how I spend my days on activities I feel have little importance.

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The truth is, I feel like a fraud, a failure. My procrastination gives me an escape from feeling overwhelmed but the irony is, it only adds to the feeling in time, and makes my feeling of failure come true. I cant imagine this changing which makes me panic I allow myself to entertain the thought, rather than pushing it away. New Story The truth is, even though I have wasted many opportunities, I have accomplished many things in my life, and had many good experiences. The truth is, I use my ill-health and my excess of work as excuses, and I indulge in behaviors that continue them, because this allows me a temporary denial of the larger problems and issues in my life but it makes them much worse in the long-term. The truth is, I have been lucky to have the opportunities and experiences I have had throughout my life. While I cannot change the past, I can make better choices now, and continue to make the most of the opportunities I am given. If I fail to correct my lifestyle and the way I spend my time, my life will continue to worsen, with possible unemployment, continued living in a place I dislike, the loss of friends and family, and continued general malaise. To quote Sojourner Truth, Im sick and tired of being sick and tired. I want to respect myself and others by living out my life in the best way possible. Although I do not currently adhere to a particular faith tradition, I having been pondering the notion that it is a sin not to make the most of the talents and gifts we have been given, to waste our lives. I choose not to do this anymore. I will build a better balance between the three parts of my life: body, mind, and spirit. I will use my time to its fullest, and plan time each day for each aspect of my life. I will celebrate my work, and celebrate my leisure. I know that if I stop simply planning what I should/want to do, and follow through, I will be energized, and a positive cycle will begin, which will make all of these goals easier. As I often say to my Womens Studies students, changing the world (and yourself!) is not about the one moment of heroism where you get to slay the dragon. Rather, the personal is the political, and your values are reflected in the unextraordinary things you do everyday, just as your life is the sum of these small pieces of time. I choose to enact this. My New Values Body physical health: yoga, dance, good food, enjoyment of the physical; Mind intellectual development, cultural experience, creative experiences; Spirit spiritual growth, family; Integrity being responsible, completing commitments, living out my values, being a good role model for students, my nieces, and others; Harmony between the parts of my life, generosity, social justice, helping others; Knowledge self-knowledge, creativity, cultural activities My Ultimate Mission To be an excellent teacher, good researcher, good friend & family member, good role model, spend my days even in the small things engaged in activities that reflect my values, Carpe diem, a sense of satisfaction at the end of the day of time well spent, a balance in my life, passion in my life one of my gifts, and a living situation with which I am pleased. Barriers Time management, sleep patterns, habits, inertia, procrastination, fear of failure, avoidance, denial, lack of follow-through, and disconnect between stated values and actions. My Essential Life Purpose To leave a legacy to the people who knew me that my life was an example of how to live an abundant life by loving, serving, learning, laughing and seeing beauty in all situations. Specific Life Mission Statements To have resilient, unquestionable and loving family relationships; To practice my profession as an educator with integrity and effectiveness; To live life to the fullest by using time and money wisely; and To inspire others, by my example, to love themselves, to respect other people and to seek beauty.