Natalie Digate Muth by Natalie Digate Muth
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As we learn more about behavior change and what works and what doesn’t work in helping people to sustain health behavior changes like eating healthier and getting regular physical activity, it has become increasingly clear that we need to change our approach from telling people what to do, to helping guide people to making healthful choices. The final goal could end up being similar, or even the same, but when the client sets the agenda with the guidance of the health and fitness professional (the “expert”), rather than the health and fitness professional setting the agenda, the outcome is usually much better.

Here are four examples of how health and fitness professionals might gradually adjust their approach to develop a more client-centered approach to helping people improve their health and fitness.

1. “Expert”-centered program:

“Exercise science guidelines suggest that all adults should do cardio three to five days per week and full-body resistance training two to three days per week. The program that I have created for you will help you achieve those recommendations for optimal fitness.” 

Client-centered program: “Help me understand what kinds of physical activities seem most interesting and fun for you. Let’s use that as a starting point, and begin with a plan that can build from there. Here are some guidelines for optimal health and fitness, but let’s not worry about that right now. We will build to those over time, in a way that is fun and easier to stick with over time.”

Aim: Fun and enjoyment is a key predictor of whether or not someone will initiate and continue an exercise program. Starting with what the client enjoys doing as a starting point is much more likely to result in long-term success than starting from the outset in creating a “perfect” program that meets all of the established guidelines. The goal should be consistent, gradual progress—not perfection.

 

2. “Expert”-centered program:

“Lifting weights is very important to achieve peak fitness. Our time together will include a machine- and free weight-based program to help you build muscle mass.” 

Client-centered program: “How do you feel about a weight-lifting program? What, if any, questions or concerns do you have about working out in the weight room?” 

Aim: Demonstrate empathy by remembering what it might feel like to be new to a gym environment and address any potential fears or concerns a new client may have. Many new exercisers express a lot of discomfort and self-doubt in the weight room. A highly empathic trainer will help the client acknowledge and work through those concerns in a productive way. The first step is recognizing that the client may feel this way, which can be achieved through the use of open-ended questions.

 

3. “Expert”-centered program:

“If you can eat 250 fewer calories per day and burn off 250 more calories per day, you will lose about 1 pound per week. Within three months of working with me, you will be able to drop those extra 15 pounds. You just have to make sure that you stick to the program!” 

Client-centered program: “I understand that one of your major goals is to lose weight. I would like to help you achieve that goal. I think the best way to start may be by making some behavior-change goals. These are goals that you can easily track rather than a specific number on the scale. For example, eating a certain number of vegetables and fruits each day, or exercising for a certain number of minutes or times per week. We will still monitor weight, along with other measures such as sleep, energy level, mood, blood pressure and body composition, to see how our program is doing. How do you feel about that?” 

Aim: By helping a client consider more process-centered behavioral goals like changes to eating patterns and exercise, rather than focusing exclusively on a number on the scale, which can be influenced by many factors, the client is more likely to experience a sense of control over the program. This increased sense of control will lead to higher self-efficacy and greater likelihood the client will stick with a program, even if the number on the scale doesn’t decrease as rapidly or as much as he or she (or the health and fitness professional) would like.

 

4. “Expert”-centered program:

“I used to be overweight, too, and I lost a lot of weight by following the [X] diet. I think you’ll be successful with this program, too.”

Client-centered program: “I understand that you would like to lose weight and are looking at changing your eating habits by following a new eating plan. Which ones have you considered trying? How likely do you think it is that you will be able to stick with the plan for the long term?”

Aim: What may work for one individual may not necessarily be effective for another—it’s also not within the scope of practice of health and fitness professionals to advise clients to follow specific meal plans. While health and fitness professionals are often asked what they do to achieve and maintain their high levels of nutrition and fitness, rarely will those exact habits be sustainable or appropriate for someone else. When it comes to diets, research has repeatedly shown most all of them can work if they are sustained for the long term (i.e., become a lifestyle change). A health and fitness professional is most helpful in serving as a resource to someone who is considering a fitness or nutrition change by using open-ended questions and reflective listening to help that person work through what might be best for him or her, rather than what may have worked well for someone else. With that said, if a trainer is asked directly about his or her personal nutrition or fitness habits, it is O.K. to provide a direct answer. However, it is probably best to also help redirect the client to explore what might work best for him or her, acknowledging that there are many ways that work to help improve health and lose weight, and your goal is to help the client identify what will work best for him or her.

 

You can find more information on motivational interviewing tactics like these in this ACE ProSource article: Harness the Power of Effective Motivational Interviewing.

Ultimately, health and fitness professionals will be able to maximize client-behavior change by using coaching techniques such as open-ended questions and reflective listening to help a client explore his or her own motivations, strengths and benefits from making the change. When they do this, they shift their approach from “expert”-centered programs to client-centered programs, and set the stage for increased client success. 

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