Motivation, Behavior Change and Program Adherence
ACE Study Coaches are often asked about the importance or relevance of the chapters that pertain to motivation and program adherence because many people wonder what these have to do with training programs. While it might seem a little off topic, understanding this information can be the determining factor between having a client succeed in lifestyle changes—being more physically active or making healthier food choices, for example—or being one of the many who lose their motivation. (Health Coaches: This is of particular importance for you.) Understanding someone’s ambivalence to change and the appropriate steps to take with that person based on their current mindset is essential for setting them up for long-term adherence.
It all starts with motivation—the psychological drive to engage in a behavior. There are basically two parts that make up our motivation: intrinsic and extrinsic motivation. Intrinsic motivation comes from internal states (i.e., enjoyment or personal satisfaction), so even if you could wave a magic wand that would make you healthy or thin or strong, you would still exercise purely for the joy that the activity brings you. Extrinsic motivation is any external factor that drives you, whether it’s to decrease your blood pressure, fit in those “skinny jeans” or to reach your college bench-press max. No one is entirely intrinsically or extrinsically motivated, but intrinsic motivation is more likely to lead to program adherence. Basically, we want our clients to get to the point where they receive all the positive benefits of exercise (increased energy, better sleep, etc.) so they notice and develop that feeling of “Wow, it felt so good to get out and (insert favorite activity here) today!”
The other factor to consider is a client’s self-efficacy, which is basically their self-confidence in their ability to make a change. Whether a client has low- or high self-efficacy will guide you in your work with them. If someone has really high self-efficacy you’re simply going to be there as a guide to show them proper technique and fun new exercises or recipes to help keep them motivated and excited about their program. You won’t need to “hold their hand” through their program the way you might with someone who has low self-efficacy. For clients with low self-efficacy, your initial program is going to temporarily disregard ACSM’s recommendations for frequency, intensity, time and type, and instead focus on goals that increase your client’s confidence in his or her ability to adhere to a program and create enjoyable experiences. For the first week, for example, a client may only walk for 10 minutes a day and eat one fruit or vegetable, but this could be a HUGE accomplishment for that particular individual. So it is important to consider how you can help this client enjoy being physically active and eating healthier. Only then can you can start to gradually increase the number of changes you help them make.
As trainers, we want our conversations with clients to get them excited about their journey to change. A technique called motivational interviewing can be used to explore the roots of their motivation and help create awareness of how their current lifestyle needs to be modified. During motivational interviewing, you want to listen effectively, provide educational information, ask probing questions, build self-confidence, be friendly and encourage clients to generate ideas. This will help you to create goals that are going to lead them to success—and the nature of the goals will depend on their self-efficacy and their readiness to change, which can be identified according to the Transtheoretical Model (TTM) of Behavior Change. By identifying their ambivalence to change we can know the appropriate steps to take with a person to progress them to the next stage. Here are the five stages:
The first stage is precontemplation, during which people are sedentary and are not even considering an activity program. These people do not see activity as relevant in their lives, and may even discount the importance or practicality of being physically active.
The next stage is contemplation. People in the contemplation stage are still sedentary. However, they are starting to consider the importance of activity and have begun to identify the implications of being inactive. Nevertheless, they are still not ready to commit to making a change.
The preparation stage is marked by some physical activity, as individuals are mentally and physically preparing to adopt an activity program. Activity during the preparation stage may be a sporadic walk, or even a periodic visit to the gym, but it is inconsistent. People in the preparation stage are ready to adopt and live an active lifestyle.
Next is the action stage. During this stage, people engage in regular physical activity, but have been doing so for less than six months.
The final stage is maintenance, which is marked by regular physical activity participation.
These can be a little tricky because you would think that everyone you meet with would at least be in the preparation phase because they’ve taken some action to meet with you. But consider the following scenario: You meet with a potential new client who was told by his doctor that he has prehypertension, borderline high cholesterol and had gained some weight in the last year. The physician highly recommended he start adopting a more physically lifestyle to help manage and hopefully prevent going on medications for these conditions. He explains that he doesn’t enjoy exercise and has a job that involves a lot of travel, so he is often eating on the go where healthy food options aren’t always available. In fact, the only reason why he agreed to meet with you today is because he promised his spouse he would.
What stage of change do you think this person is in? If you chose precontemplation, you’re correct. Someone who is in precontemplation does not see the value in exercise, and perceives more cons than pros in adopting a healthier lifestyle. As fitness professionals, when you encounter someone in the precontemplation stage, you don’t want to jump into exercise recommendations because his or her mind is closed to it. Instead, you would want to use that time to make inactivity relevant by educating him or her on all of the risks associated with inactivity and how exercise can have a positive impact so hopefully he or she will start to consider being physically active.
You not only want to identify what stage a client is currently in, you also want to establish appropriate goals and identify relevant intervention strategies that can help the client progress to the action and maintenance stages. The following chart can help you identify what intervention strategies are the most appropriate for a given client. Also, here is a previous blog about How to Use the TTM to Help Clients Make Healthy Behavioral Changes. Keep in mind that maintaining a healthy lifestyle is a skill, just like basketball, chess, etc. It takes time and it takes practice to master these skills, so help your clients understand the concept of lapses and relapses. We want to make them aware that straying from their diet and exercise plans is not a failure or a reason to give up! Be there to help them get back on track.
If you have any questions or concerns regarding this or any other topic, please contact our Resource Center at firstname.lastname@example.org or by calling 800-825-3636, Ext. 195, where our Study Coaches attend the line Monday-Friday 7 a.m.–6 p.m. PST. Please allow 24 hours for response time.