Unit 4: The Practice of Longevity Coaching¶

Chapter 4.25: Case Studies — The "Overwhelmed" Mid-Lifer¶

[CHONK: Meeting David: The Assessment Reality]

Meet David Okonkwo.¶

David is 45. He's the CFO of a mid-size tech company. On paper, he's successful: MBA, corner office, respected by his team, compensation that puts him in the top few percent of earners.

In reality, he's running on fumes.

When David fills out his intake form, the numbers tell one story. When you sit down with him, you hear another.

The intake form says:
- "Moderate exercise" (he clicked "a few times per week")
- "Average stress" (he picked 6 out of 10)
- "7-8 hours sleep" (what he aims for)
- "Occasional alcohol" (2-3 drinks)

The conversation reveals:
- He hasn't exercised regularly in five years ("I used to play basketball in college")
- His stress is "honestly, maybe an 11 out of 10"
- He sleeps 5-6 hours, wakes frequently, often can't turn off work thoughts
- He has 3-4 drinks most evenings "to unwind"

This gap between what clients report and what's actually happening isn't unusual. David isn't lying. He's so disconnected from his own body and habits that he genuinely doesn't see how bad things have gotten.

What the data shows¶

David's recent bloodwork paints a concerning picture:

• Blood pressure: 135/88 (elevated; normal is below 120/80)
• HbA1c: 5.8% (prediabetic range; normal is below 5.7%)
• LDL cholesterol: Elevated
• BMI: 29 (overweight; 30+ is obesity)
• Visceral fat: Increasing based on waist circumference

These aren't dramatic numbers. There's no emergency. But they're warning signs, especially combined with his family history: David's father died of a heart attack at 58. That's 13 years from where David sits today.

David knows this. It's what brought him to coaching.

The sandwich generation context¶

David is part of what researchers call the "sandwich generation," adults who simultaneously support children and aging parents. Approximately 28 percent of U.S. caregivers (about 11 million adults) are in this situation.[^12]

Research on people like David tells a clear story:

• Providing time-intensive care to both children and parents nearly doubles the odds of severe psychological distress
• Work-family conflict is a core mechanism linking caregiving burden to anxiety, depression, and sleep problems
• Long work hours, low job flexibility, and weak partner support exacerbate strain
• Chronic caregiving stress is linked to elevated cardiometabolic risk, hypertension, and cardiovascular disease

David isn't just stressed because of work. He's managing competing demands that would challenge anyone. A demanding job, two kids, a wife with her own demanding career, and a father with progressive illness who needs increasing support.

When you understand this context, his patterns make more sense. The evening drinks aren't weakness, they're a coping strategy for an overwhelmed nervous system. The late-night work isn't workaholism, it's trying to keep all the plates spinning.

This doesn't excuse unhealthy patterns. But it reframes them. David isn't lazy or undisciplined. He's stretched beyond capacity and hasn't found sustainable ways to cope.

David's Deep Health snapshot¶

Looking at David through the Deep Health lens reveals gaps across multiple dimensions, not just physical health.

The physical markers are important, but they're not the whole story. David's stress, sleep, and relationship strain are all interconnected, and they're all affecting his longevity risk.

What David says he wants¶

"I don't want to die like my dad."

"I need more energy. I'm running on fumes."

"My wife says if I don't change something, she's done."

"Just tell me what to do. I don't have time for BS."

Notice what's embedded in that last statement: David wants efficiency. He's used to solving problems quickly. He expects you to hand him a protocol, and he'll execute it.

That's not how this works, and helping David understand why will be part of your coaching.

[CHONK: Time-Constrained Coaching: The Minimum Effective Dose]

Why "just make time" advice fails¶

If you tell David to "make time for your health," you'll lose him.

He's heard this before. His wife has said it. His doctor has said it. He's said it to himself. And every time, he's tried—joined a gym, bought home equipment, blocked time on his calendar—and within weeks, work swallowed it all.

The problem isn't willpower. The problem is that David's schedule genuinely has very little slack. He works 60-70 hours a week. He has a 45-minute commute each way. He's helping care for his father, who has early Parkinson's. His wife is an ER physician with her own demanding schedule. They have two kids—ages 12 and 9—whose games and events David keeps missing.

When coaches say "find time for health," they're often asking clients like David to carve out time that doesn't exist. And when he can't do it, he feels like a failure, which adds to his stress, which makes everything worse.

The solution isn't addition. It's integration.

The minimum effective dose¶

Research on time and health benefits gives us a clearer picture:

About 15 minutes per day of moderate physical activity, roughly 90 minutes per week, is associated with approximately 14 percent lower all-cause mortality and about three additional years of life expectancy.[^1] That's not the optimal dose. But it's a meaningful starting point.

Even smaller increases matter. Among previously inactive adults, adding just 10 minutes per day of moderate activity was linked to roughly 20 percent lower mortality.[^2] The dose-response curve is steepest at the low end, meaning the jump from nothing to something delivers the biggest relative benefit.

If those numbers feel surprisingly small, that's actually good news for overwhelmed clients; they don't need perfect routines to start changing their health trajectory.

This is the minimum effective dose philosophy: What's the smallest intervention that produces meaningful results?

For David, this reframes the question. Instead of "How can I find an hour for the gym?" it becomes "Where can I find 15 minutes that already exist in my day?"

Integration, not addition¶

David's schedule has hidden opportunities. Your job is to help him find them.

The commute: 45 minutes each way, five days a week. That's seven and a half hours. What if even a portion of that time served a health purpose?
- On days he drives, could he listen to guided breathing or mindfulness audio instead of work calls?
- Could he occasionally take public transit and walk part of the route?

Walking meetings: Research shows that replacing a sedentary meeting with a walking meeting can add meaningful moderate activity.[^3] For David, even one or two 30-minute walking meetings per week adds up.

Phone calls: David spends significant time on calls. Many of these don't require sitting at a desk. Walking while talking converts dead time into active time.

Lunch: David currently either skips lunch or has business lunches with clients. Both undermine his health. Eating something with adequate protein—instead of nothing or a heavy client dinner—supports metabolic health without requiring extra time.

Evening wind-down: David's current evening routine is: get home late, stress-eat, have several drinks, crash. What if even 10 minutes of that time shifted to something restorative?

15-minute interventions that matter¶

When David protests that he can't fit in hour-long gym sessions, you can share evidence on brief interventions:

• Exercise "snacks": Very brief vigorous bouts, even less than one minute, performed multiple times daily can improve cardiovascular fitness, blood pressure, and metabolic markers.[^4] Three one-minute stair climbs during David's workday is feasible.

• Short HIIT: Three 15-minute high-intensity sessions per week reduced systolic blood pressure by approximately 9 mmHg in one study, clinically meaningful without requiring gym access or long time blocks.[^5]

• Morning light: Ten minutes of bright light exposure in the morning helps anchor circadian rhythm and can improve sleep quality, critical for David.

The message to David: "I'm not asking you to become a gym person. I'm asking you to find 15 minutes that already exist and use them differently."

Coaching in Practice: Finding Time That Already Exists¶

[CHONK: Coaching in Practice - Finding Time That Already Exists]

Coach: You mentioned your schedule feels impossible. Walk me through a typical Tuesday.

David: I'm up at 5:30, checking email before the kids are even awake. Out the door by 7. In meetings until 6 or 7 PM. Home by 8. Kids are doing homework. I try to be present, but I'm fried. After they're in bed, I eat whatever's around, have a few drinks, maybe catch up on more work, crash around midnight.

Coach: That's a lot. I'm not going to suggest you add an hour-long workout to that. But I'm curious. During that day, are there pockets of time that don't feel like work but also aren't really rest?

David: [thinking] I guess... some of my calls could happen while walking. I used to do that. And lunch. I either skip it or it's a client thing. There's not really a lunch for me.

Coach: What if we started there? Not adding new blocks, but using time that already exists differently. What would it look like to take two calls walking tomorrow?

David: I could probably do that. It's weird, but yeah.

Coach: That's not weird. That's minimum effective dose. Let's see how it goes for a week.

[CHONK: Stress as the PRIMARY Intervention]

The stress-sleep-alcohol triangle¶

Many coaches want to start with exercise or nutrition. For clients like David, that's a mistake.

David's primary issue isn't that he doesn't know vegetables are healthy. It's that he's operating in a state of chronic stress that undermines everything else. Until that's addressed, other interventions will fail.

The triangle works like this:

Chronic stress → David's HPA axis (the body's stress response system) is chronically activated. This affects his sleep, his appetite, his cravings, his blood pressure, and his metabolic function. Research shows chronic stress is associated with 16-28 percent higher all-cause mortality, with even greater risk at older ages.[^6]

Poor sleep → David averages 5-6 hours, often disrupted by work anxiety. Short sleep (under 7 hours) is associated with approximately 14 percent higher all-cause mortality.[^7] For very short sleep (under 5 hours), that risk increases to about 40 percent.[^8] Beyond mortality, inadequate sleep impairs glucose regulation, increases appetite, and reduces cognitive function. All of these effects impact David.

Evening alcohol → David uses alcohol to "unwind." But alcohol disrupts sleep architecture, particularly REM sleep, even at relatively low doses.[^9] It creates the illusion of relaxation while actually worsening recovery. This leaves David more tired the next day, which increases stress, which perpetuates the cycle.

These three factors reinforce each other. Addressing one without the others rarely works.

If mapping out this triangle feels a bit overwhelming, that's normal. You don't have to fix every side at once; you'll help clients start where change feels most possible.

Sleep as the non-negotiable foundation¶

For David, sleep is intervention number one. Not exercise. Not nutrition. Sleep.

Why? Because:
- His current 5-6 hours puts him in a higher mortality risk category
- Poor sleep directly impairs glucose metabolism (relevant to his prediabetic HbA1c)
- Sleep deprivation increases cortisol and drives poor food choices
- He can't outwork sleep deprivation. It affects everything

The target: 7+ hours of actual sleep, with more consistent timing.

This won't be easy. David's pattern of late-night work and alcohol has been his routine for years. But it's foundational.

The alcohol conversation¶

This is a conversation many coaches avoid. It shouldn't be avoided. It should be approached skillfully.

David's drinking pattern—3-4 drinks most evenings—puts him above the low-risk thresholds defined by NIAAA (more than 4 drinks per day or 14 per week for men indicates at-risk drinking).[^10]

Your role isn't to lecture or diagnose. It's to explore what alcohol is doing for him, and whether there might be better ways to meet those needs.

Coaching in Practice: The Alcohol Conversation¶

[CHONK: Coaching in Practice - The Alcohol Conversation]

Coach: You mentioned having a few drinks in the evening to unwind. What's that like for you?

David: Honestly, it's the only way I can turn off. If I don't have a drink, I'm still thinking about work at midnight.

Coach: That makes sense. Alcohol can feel like it helps you relax. What do you notice about your sleep after drinking?

David: [pauses] Actually, I wake up a lot. Two, three AM. Then I can't get back to sleep.

Coach: That's really common. Alcohol has this paradox: it helps you fall asleep but then fragments your sleep later in the night. It suppresses REM sleep, which is when a lot of mental recovery happens. So you're trading a faster wind-down for worse overall rest.

David: I didn't know that.

Coach: Here's what I'm curious about: what would it take to feel like you could wind down without alcohol some nights? Not all nights. We're not talking about going cold turkey. But what if two or three nights a week, you tried something else?

David: Like what?

Coach: That's what we'd figure out together. Some people find a short walk after dinner helps. Others find a few minutes of breathing exercises works. Some just need a firm boundary: phone off at 9 PM, no exceptions. What sounds most realistic to try?

David: The phone thing would be hard. But maybe the walk. My wife has been wanting to walk together. I keep saying I'm too tired.

Coach: What if that evening walk served double duty: time with your wife and a wind-down that doesn't involve alcohol? Worth a week's experiment? |

Important: This is harm reduction coaching, not addiction treatment. You're helping David explore patterns and consider alternatives. You're not diagnosing or treating alcohol use disorder.

When to refer: If David showed signs of dependence—drinking in the morning, physical withdrawal symptoms, inability to stop once started, drinking interfering with major life responsibilities despite wanting to stop—you would refer to a medical professional or addiction specialist. David's pattern appears to be stress-driven situational overuse, which is within coaching scope to address through behavior change approaches. But stay alert to signs that suggest something more serious.

Setting boundaries at work¶

David's stress is partly about work volume, but it's also about work invasion: the way work bleeds into every corner of his life.

Addressing this is delicate. You're not David's therapist or career coach. You're not going to help him "find his purpose" or tell him his job is wrong for him.

But you can:
- Help him identify his values and notice where his current patterns conflict with them
- Explore what boundaries might be possible, even small ones
- Support experiments, like no email after 9 PM, without prescribing solutions

In scope: Helping David clarify what matters to him and testing small boundaries
Out of scope: Advising him to quit his job, providing therapy for workaholism, or addressing deep identity issues around work and self-worth

[CHONK: Building David's Reality-Based Roadmap]

The phased approach¶

David wants you to tell him what to do. His instinct is to attack the problem all at once. Change everything, show discipline, achieve results.

That approach will fail. Not because David lacks willpower, but because change doesn't work that way, especially for someone already stretched thin.

Instead, you'll build a phased roadmap that respects his constraints and builds sustainable change over time.

Month 1: Sleep only¶

In Month 1, you're focusing on one thing: sleep. Nothing else.

The targets:
- Consistent bedtime (within 30 minutes) most nights
- Target 7+ hours of sleep opportunity (time in bed)
- No work email after 9 PM
- Phone charges outside the bedroom

Why "less is more": David is already overwhelmed. Adding five new habits will guarantee failure. By focusing on one area, protecting that focus fiercely, you increase the odds of success.

The specific action to test: Phone charges outside the bedroom.

This is a small change with outsized impact. It removes the temptation to check email. It eliminates the blue light exposure right before sleep. And it creates a physical boundary between work and rest.

David might protest: "What if there's an emergency?"

You can explore this: In his 20+ years of working, how many genuine emergencies required immediate response at 11 PM? Usually, the answer is very few. The phone beside the bed isn't about emergencies, it's about anxiety.

Month 2: Add nutrition basics¶

Once sleep is stabilizing, not perfect, but improving, you add nutrition.

The targets:
- Eat something with protein at lunch (not skip or only client meals)
- Reduce evening alcohol from 3-4 drinks to 1-2 most nights
- Continue protecting sleep foundation

Note what's NOT included: calorie counting, meal prep, elimination diets, supplements. David doesn't need optimization. He needs basics, consistently.

The evening alcohol reduction: This isn't abstinence. It's harm reduction. Research shows that reducing drinking by even one WHO risk level (e.g., from high risk to medium risk) predicts improvements in sleep quality at six months.[^11] David can still have a drink, 1-2 instead of 3-4, and not every night.

Month 3: Expansion only if foundation solid¶

Only when sleep and basic nutrition are stable do you expand.

Potential additions:
- Walking (the morning commute walk, the evening walk with his wife, walking meetings)
- Brief stress management (2-minute breathing before high-stakes meetings)
- Some form of strength training (if and when he's ready)

The key criterion: Is the foundation solid? If David's sleep has collapsed, or he's back to 4 drinks nightly, you don't add more. You reinforce what's working or troubleshoot what's not.

What success looks like for David¶

Six months from now, what's realistic?

Realistic:
- Sleeping 6.5-7 hours most nights (up from 5-6)
- Blood pressure trending down
- Drinking 1-2 drinks, 3-4 nights per week (reduced)
- Walking 20-30 minutes most days (integrated into existing schedule)
- More energy; wife noticing he's more present
- Still working hard, but with boundaries

Not realistic:
- Transforming into a fitness enthusiast
- Perfect habits every day
- Resolving his marriage strain (that requires relationship work, not coaching)
- Fixing his career stress entirely
- Reversing all his metabolic markers in six months

Progress, not perfection. Consistency over intensity. This is a decades-long game, and David is at the beginning.

[CHONK: The Hard Conversations]

"I don't have time"¶

This is the most common objection you'll hear from clients like David. And it requires nuance to address well.

Don't dismiss it. David's time constraints are real. He's not exaggerating when he describes 70-hour weeks and dual caregiving responsibilities. If you wave this away with "everyone has the same 24 hours," you'll lose his trust.

Do explore it. Not all of David's time usage is non-negotiable. Some of it is habit, or assumption, or cultural expectation that hasn't been examined.

Coaching in Practice: Exploring "I Don't Have Time"¶

[CHONK: Coaching in Practice - Exploring "I Don't Have Time"]

Coach: When you say you don't have time, I believe you. Your schedule sounds genuinely packed. I'm not going to pretend that's easy. But I am curious, when you look at a typical day, is all of it truly non-negotiable? Or are there parts that feel essential but might be more flexible than they seem?

(Reflection: acknowledging his reality while inviting exploration)

David: I mean, I have to work. I have to be there for the kids when I can. I have to help with my dad.

Coach: Right. And those are real commitments. What about the stuff in between? Like, what happens between 9 PM and midnight?

(Open question: exploring a specific time window)

David: That's when I catch up on email. Or zone out in front of the TV. Or have a drink. It's not exactly productive, but I need to decompress.

Coach: So that time exists. It's just currently serving a decompression function that might not be working that well. What if decompression could look different?

(Reframe: his "no time" contains time that's not serving him well)

David: I guess. I never thought of it that way.

The technique here is the "calendar audit": helping David see where time actually goes versus where he thinks it goes. Often, there's more flexibility than clients initially believe.

"My job requires this"¶

David believes his work demands are fixed. Maybe they are. But often, beliefs about work are unexamined.

Coach questions to explore this:
- "What would happen if you left at 6 PM twice a week?"
- "Who in your organization works long hours and who doesn't? What patterns do you notice?"
- "If you got seriously sick and had to cut back, what would have to give? Could any of that give now?"

You're not telling David he's wrong. You're inviting him to examine assumptions. Some might be accurate. Others might be stories he's been telling himself.

What's in scope: Helping David clarify his values, notice conflicts, and test small experiments with boundaries.
What's out of scope: Career counseling, advising him to find a new job, or deep therapy around workaholism.

"I can't say no"¶

Many overwhelmed clients struggle with boundaries. David says yes to work requests, yes to business dinners, yes to being constantly available, even when it costs him.

The values question: What matters more?

When David says "My wife says if I don't change something, she's done," that's a window. His marriage matters to him. His kids matter to him. Living to see them grow up matters to him.

If those things matter more than another late meeting, then saying no to the meeting is saying yes to what matters. But David may need help seeing that framing.

The motivation: David's father died at 58 of a heart attack. David is 45. That gives him, potentially, 13 years on his father's trajectory.

This fear can be a powerful motivator, but use it carefully. You don't want to create anxiety that drives more stress. The goal is to connect his daily choices to his deeper values, not to terrorize him into compliance.

When to refer¶

Not every struggle belongs in coaching. Know when to refer:

Signs that suggest clinical depression (beyond normal stress):
- Persistent hopelessness or emptiness lasting weeks
- Loss of interest in nearly all activities
- Significant weight change without trying
- Thoughts of death or suicide

Signs that suggest burnout requiring clinical intervention:
- Complete emotional exhaustion that doesn't improve with rest
- Cynicism and detachment that extends beyond work
- Physical symptoms (chronic pain, immune dysfunction)

Marital issues: David's marriage is strained. You can acknowledge this and support him in being more present at home. But if the marriage needs repair, that's work for a couples therapist, not a longevity coach.

Alcohol use disorder: If David's drinking escalates, if he can't stop when he wants to, if he shows withdrawal symptoms, if drinking causes major problems that he continues despite. Refer to a medical professional or addiction specialist.

Your role is clear: You're helping David build sustainable health behaviors. You're not his therapist, career counselor, marriage counselor, or addiction specialist. Knowing your boundaries protects both you and your client.

If this list feels intimidating, that's understandable. You're not expected to diagnose or manage these conditions; your job is to notice red flags, stay within your scope, and bring in the right professionals when needed.

The Triangle of Care in action¶

Remember the Triangle of Care from earlier in this course: Client ↔ Coach ↔ Medical Team.

For David, this triangle is active:

David's physician has flagged his elevated markers and is monitoring them. You're not replacing that medical oversight. You're supporting behavior change that complements it.

If David's HbA1c moves from prediabetic into diabetic range, that's medical management, not coaching. Your role would be to support whatever lifestyle modifications the physician recommends.

If David develops chest pain or concerning symptoms, that's immediate medical attention, not a coaching conversation.

If David shows signs of clinical depression or alcohol dependence, that's referral to appropriate specialists: mental health professionals or addiction medicine.

The boundaries aren't limitations. They're what allows you to focus on what you do well: helping David make sustainable behavior changes within your scope of competence.

[CHONK: 6-Month Check-In: David's Progress]

What changed¶

Six months later, David isn't transformed, but he's different. That's exactly what realistic progress looks like.

Sleep: He now averages 6.5-7 hours most nights, up from 5-6. Not perfect, but meaningful. His phone charges in the kitchen. He's in bed by 10:30 most nights.

Alcohol: Down to 1-2 drinks, 3-4 nights per week. He still drinks, but it's no longer his primary wind-down strategy. Some nights he takes a short walk with his wife instead.

Movement: Walking at lunch most days, about 20 minutes. Two walking meetings per week. Total weekly activity is around 150 minutes, up from essentially nothing.

Blood pressure: Down to 128/82. Still elevated, but improved. His doctor is watching it.

Energy: Noticeably better. He reports feeling less depleted by evening. His wife has commented on it.

What's still work in progress¶

David is still working too much. He's more aware of it now, and he's made some boundaries, but the fundamental pattern hasn't shifted dramatically. He still misses some of his kids' events, though fewer than before.

His father's health is declining, adding stress. This is the reality of the sandwich generation: care needs increase even as David tries to take care of himself.

He hasn't addressed strength training yet. There's only so much bandwidth, and the priority has been sleep and stress management.

What changed his trajectory¶

Two things shifted David's perspective:

The "I don't want to die like my dad" conversation: When David really sat with this, not as abstract fear but as concrete math (13 years until he's the age his father was when he died), something clicked. His father never changed his patterns. David can choose differently.

His wife noticing: When David started going to bed earlier and drinking less, his wife noticed. She commented that he seemed more present on weekends. That feedback loop, seeing that change was visible to someone who mattered, reinforced his motivation.

Family impact¶

The marriage isn't fixed. That would require deeper work than coaching provides. But the temperature has lowered. His wife sees him trying. They walk together some evenings. She's mentioned that she feels like he's "coming back."

With the kids, David is more present on weekends. He's made it to more games. He's not the dad who's always on his phone anymore, or at least, not as often.

The ongoing relationship¶

David's coaching isn't "done." This is a long game. He's built some foundations: sleep, stress management, basic movement. The next phase might include:
- Adding strength training when there's bandwidth
- Addressing nutrition in more depth
- Navigating his father's declining health
- Continuing to strengthen boundaries at work

The goal was never perfection. The goal was sustainable progress toward a longer, healthier life. David is on that path.

[CHONK: Study guide questions]

Study Guide Questions¶

Here are some questions that can help you think through the material and prepare for the chapter exam. They're optional, but we recommend you try answering at least a few as part of your active learning process.

1. Why does the chapter recommend focusing on sleep as the first intervention for clients like David, rather than exercise or nutrition?

2. What is the "minimum effective dose" philosophy, and how does it apply to time-constrained clients?

3. Describe the stress-sleep-alcohol triangle. How do these three factors reinforce each other?

4. How would you approach the alcohol conversation with a client who is using drinking as a primary stress management strategy? What's within coaching scope, and what would require referral?

5. When a client says "I don't have time," what coaching approach does the chapter recommend? Why is dismissing this objection counterproductive?

6. What are the signs that a client like David should be referred rather than coached? List at least three specific indicators.

7. Why does the chapter emphasize "progress, not perfection" for clients like David? What does realistic success look like after six months of coaching?

8. How does the Deep Health framework apply to David's case? Which dimensions were most affected, and how did they interact?

Chapter exam¶

Test your understanding of the key concepts from this chapter. Select the best answer for each question.

1. David's intake form shows "moderate exercise" and "7-8 hours sleep," but the coaching conversation reveals he hasn't exercised in years and sleeps 5-6 hours. What does this gap illustrate?

a) David is intentionally lying to make himself look better
b) Clients are often disconnected from their actual habits and may not accurately report them
c) Intake forms are unreliable and shouldn't be used in coaching
d) David needs to be confronted about his dishonesty

2. For a time-constrained client like David, the "minimum effective dose" philosophy suggests:

a) Clients should aim for at least 60 minutes of exercise daily
b) Small amounts of activity (as little as 15 minutes daily) can provide meaningful health benefits
c) Exercise is less important than other interventions for busy professionals
d) Clients should prioritize intensity over consistency

3. Why does the chapter recommend addressing sleep BEFORE exercise or nutrition for clients like David?

a) Sleep is easier to change than other behaviors
b) Poor sleep undermines metabolic function, stress management, and decision-making, making other changes harder
c) Exercise and nutrition aren't important for longevity
d) Clients prefer to work on sleep first

4. The "stress-sleep-alcohol triangle" refers to:

a) A medical diagnosis requiring referral
b) The reinforcing cycle where chronic stress disrupts sleep, poor sleep is "treated" with alcohol, and alcohol further disrupts sleep
c) A framework for assessing client personality
d) The three most common reasons clients seek coaching

5. When coaching David about his alcohol use (3-4 drinks most evenings), the appropriate approach is:

a) Tell him he has an alcohol problem and must stop drinking immediately
b) Avoid mentioning alcohol because it's outside coaching scope
c) Explore what alcohol is doing for him and whether there might be better ways to meet those needs
d) Refer him to addiction treatment

6. Which of the following would indicate David should be REFERRED rather than coached?

a) He reports stress levels of 11/10
b) He expresses persistent hopelessness, loss of interest in all activities, and thoughts of death
c) His wife is frustrated with his work hours
d) He struggles to maintain new habits consistently

7. The phased approach for David's first three months focuses on:

a) Month 1: Exercise; Month 2: Nutrition; Month 3: Sleep
b) Month 1: Sleep only; Month 2: Add nutrition basics; Month 3: Expansion only if foundation solid
c) All three areas simultaneously from Month 1
d) Month 1: Supplements; Month 2: Advanced biohacks; Month 3: Optimization

8. When David says "I don't have time," the recommended coaching response is to:

a) Dismiss this as an excuse and insist he make time
b) Acknowledge his constraints are real, then explore whether all his time use is truly non-negotiable
c) Accept that he can't make changes until his schedule improves
d) Suggest he quit his job to free up time for health

9. Research on "exercise snacks" shows that:

a) Brief vigorous bouts (less than 1 minute) performed multiple times daily can improve cardiovascular fitness and blood pressure
b) Exercise must be at least 30 minutes continuous to provide any benefit
c) Only gym-based exercise produces health improvements
d) Brief exercise is counterproductive and should be avoided

10. At David's 6-month check-in, what represents realistic success?

a) Complete transformation to a fitness enthusiast with perfect habits
b) Sleeping 6.5-7 hours (up from 5-6), reduced alcohol, walking most days, blood pressure trending down, wife noticing he's more present
c) Resolution of all marriage problems and career stress
d) Reversal of all metabolic markers to optimal levels

11. The Deep Health framework shows that David's issues span:

a) Only the physical dimension
b) Multiple dimensions including physical, emotional, mental, social, environmental, and existential
c) Only stress-related dimensions
d) Dimensions that cannot be addressed through coaching

12. Which statement about harm reduction and alcohol is supported by the research cited in this chapter?

a) Only complete abstinence improves health outcomes
b) Reducing alcohol consumption by one WHO risk level (without abstinence) predicts improvements in sleep quality
c) Moderate alcohol use has no impact on sleep
d) Harm reduction approaches have been shown to be ineffective

[CHONK: Works Cited]

References¶

1. Wen CP, Wai JPM, Tsai MK, Yang YC, Cheng TYD, Lee M, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. The Lancet. 2011;378(9798):1244-1253. doi:10.1016/s0140-6736(11)60749-6

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