LO3 of Unit 3 – Understand behaviour change and exercise adherence
Understand behaviour change and exercise adherence
Learning outcomes
By the end of this section, you will be able to:
3.1 Describe the stages of change/trans-theoretical models of behaviour change
3.2 Describe the role of intrinsic and extrinsic motivation in exercise adherence
3.3 Identify a range of techniques/approaches that can support adherence to exercise
3.1
The stages of change/trans-theoretical models of behaviour change
What is Behaviour Change?
Behaviour change refers to the transformation of a person’s conduct and activities. In the context of health and fitness the focus is on people’s behaviour change in relation to exercise or physical activity and healthy eating.
The fitness instructor has an important role to play by using techniques or interventions that have been specifically designed to change behaviour. There are many models of behavioural change that practitioners use to try and understand the process of current behaviour and how an individual changes from one behavioural state to another.
The most common model, however, is called the ‘Transtheoretical Model’ or ‘Stages of Change Model’. The Transtheoretical Model was first developed by James O. Prochaska of the University of Rhode Island, Carlo Di Clemente, and colleagues in 1977. It sub-divides individuals into five levels of motivational readiness along a continuum of behaviour change.
The table below describes each stage of change and the possible interventions within each stage in more detail.
| Transtheoretical model of behavioural change – processes of change | ||
| Stage of change | Goal | Interventions |
| Precontemplation – (Not yet acknowledging that there is a problem behaviour that needs to be changed) In the precontemplation stage, people are not thinking seriously about changing and are not interested in any kind of help. People in this stage tend to defend their current bad habit(s) and do not feel it is a problem. They may be defensive in the face of other people’s efforts to pressure them to quit. | To make inactivity a relevant issue and to start thinking about being active | ● Provide information about the risks of being inactive and the benefits of being active. ● Provide information from multiple sources i.e., news, leaflets, web sources. Use multimedia sources. ● Make inactivity a relevant issue. |
| Contemplation – (Acknowledging that there is a problem but not yet ready or sure of wanting to make a change) In the contemplation stage people are more aware of the personal consequences of their bad habit and they spend time thinking about their problem. Although they are able to consider the possibility of changing, they tend to be ambivalent about it. | To get involved in some type of activity | ● Provide opportunities to ask questions. ● Provide information about the benefits of exercise. ● Provide information about activity options, i.e., fitness facilities, programmes, PT, fitness classes. ● Provide cues for actions, such as passes to nearby facilities, invitations to try sessions |
| Preparation – (Getting ready to change) In the preparation/determination stage, people have made a commitment to make a change. Their motivation for changing is reflected by statements such as: “I’ve got to do something about this — this is serious. Something has to change. What can I do?” This is sort of a research phase: people are now taking small steps toward making changes. They are trying to gather information (sometimes by reading things like this) about what they will need to do to change their behaviour. | Regular physical activity participation | ● Provide an opportunity to be active. ● Provide a lot of support, feedback, and reinforcement. ● Provide clients with the opportunity to express their concerns. ● Introduce different types of exercise to help clients something they enjoy. ● Help create support groups of similar people who are also starting exercise programmes. |
| Action – (Changing behaviour) This is the stage where people believe they have the ability to change their behaviour and are actively involved in taking steps to change their bad behaviour by using a variety of different techniques. This is the shortest of all the stages. The amount of time people spend in action varies | Maintain regular physical activity | ● Provide continued support and feedback. ● Identify things and events that are potential barriers to adherence. ● Identify high-risk individuals and situations. ● Educate clients about the likelihood of relapse and factors that may trigger relapse. ● Teach physical and psychological skills to deal with potential barriers. ● Provide continuing opportunities to be active and a plan to maintain activity at different times of the year. |
| Maintenance – (Maintaining the behaviour change) Maintenance involves being able to successfully avoid any temptations to return to the bad habit. The goal of the maintenance stage is to maintain the new status quo, continuing with the change. People in this stage tend to remind themselves of how much progress they have made. People in maintenance constantly reformulate the rules of their lives and are acquiring new skills to deal with life and avoid relapse. They are able to anticipate the situations in which a relapse could occur and prepare coping strategies in advance. People in this stage do not apply change processes as frequently as do people in action. | Prevent relapse and maintain continued activity | ● Maintain social support from family and friends. ● Provide continued education about barrier identification. ● Keep exercise enjoyable, stimulating and varied. ● Create a reward system to encourage exercise adherence. ● Be mindful of signs of staleness and boredom. |
| Relapse – (Returning to older behaviours and abandoning the new changes) Regression occurs when individuals revert to an earlier stage of change. Relapse is one form of regression, involving regression from Action or Maintenance to an earlier stage. However, people can regress from any stage to an earlier stage. The bad news is that relapse tends to be the rule when action is taken for most health behaviour problems. The good news is that for smoking and exercise only about 15% of people regress all the way to the Precontemplation stage. The vast majority regress to Contemplating or Preparation. | To redefine goals and offer more support to prevent relapse | ● Identify triggers that lead to relapse. ● Recognise barriers to success ● Reaffirm the goal and commitment to change. ● Reaffirm the motivation, plan of action. Also, make plans for how you will deal with any future temptations. |
3.2
The role of intrinsic and extrinsic motivation in exercise adherence
Increasing client motivation and exercise adherence
A fitness instructor’s role can now be viewed as more than just teaching exercise, you play a significant part in motivating clients to exercise and in adhering to the training programme you prescribe.
Motivation can be described as ‘the psychological drive to engage in a behaviour’. There are basically two types of motivation:
Intrinsic Motivation – a state of internal motivation where you participate because you find it enjoyable and like the way it makes you feel. According to Ryan and Deci (2000) (pp. 56), Intrinsic motivation is defined as the doing of an activity for its inherent satisfaction rather than for some separable consequence., A person, when motivated intrinsically, is moved to act for the fun or challenge involved rather than because of external products, pressures, or rewards.
Extrinsic Motivation – is what drives a person to attain some form of an external reward, such as money, status, or recognition. The external driving force behind an individual’s motivation is usually based around something that can be obtained immediately, or in the near future. It refers to doing an activity simply for the enjoyment of the activity itself, rather than its instrumental value.
Motivation influenced by external factors to include the following:
- Physical – lose weight, fitness assessment results
- Medical assessment – health improvement, GP results
- Targets – goals, competitions
- Feedback from others – praise, encouragement
- Health benefits – reduced blood pressure, decreased stress, improved coping mechanisms
As cited in the National Obesity Observatory Report, a lack of motivation is a major reason why adults do not participate regularly in exercise or activity. Fortunately, there are several strategies and tools you can use to motivate and empower individuals to exercise and these are discussed in the next three sections.
Client responsibility and accountability for their own fitness and motivation
How often have you heard a colleague put the blame on or point a finger at someone else for poor results to avoid accountability? Likewise, as a fitness instructor or personal trainer people look to you to guarantee a result. Whose fault is it if the client does not see any appreciable change?
It is particularly important that clients understand that they are responsible and accountable for their goals. A lack of responsibility could be having an unrealistic goal in the first place or a fear of failure, low self-esteem, and confidence. Whatever the reason if clients fail to take responsibility they will not succeed. Typically, the signs are:
- Making excuses regularly
- Blaming and finger pointing at others
- Activity avoidance if it is challenging
Your role as a fitness instructor is to empower individuals by giving them the skills and creating the right environment for them to take responsibility for their decisions and actions.
You can do this by:
- Goal setting and identifying targets
- Developing exercise skill, i.e., learning how to perform exercise
- Encouraging them to try new fitness activities, e.g., choosing a different class on the timetable
- Sharing regular feedback
- Giving praise to build confidence
- Finding enjoyable activities for your client
- Making activities fun
- Activity logbook or diary
- Tracking progress
As mentioned in the previous section, a lack of self-motivation is cited as a major barrier to why people do not regularly participate in physical activity. Motivation can be defined as ‘the desire to engage in an activity’. People’s motivation is often driven by:
- Intensity of desire or need
- Incentive or reward value of the goal
- Expectations of the individual and of his or her peers
An example is a team player that spends extra time practicing because he or she wants to make the team.
Having self-motivation is an important quality for success and certainly needed to change exercise behaviour.
Reasons given for a lack of self-motivation include:
- A lack of willpower
- Previous bad experience
- No belief in ability to change
- Boring
- Do not see the goal as being important
- Poor knowledge and skills
- Fear of failure
- A feeling of a goal being overwhelming
3.3
A range of techniques/approaches that can support adherence to exercise
Adherence and Motivational strategies
1: Find their motivation – It is paramount you understand what the client’s end or outcome goal is, what they hope to achieve and their underpinning motivation. Knowing this allows you to choose the correct activity strategy. For example, someone may want to lose weight and their underpinning motivation is that they are getting married in six months, or perhaps a sportsman needs to increase the strength of their legs as part of their rehabilitation and recovery from injury to make the first team.
2: Set short-term goals – Setting goals increases exercise adherence because they focus an individual’s attention on important aspects concerning the goal’s outcome, i.e., losing weight requires energy expenditure. However, outcome goals take time and do not happen overnight. Set short-term or process goals to increase motivation by making the outcome achievable. Examples could include asking the client to perform an extra set or a few more reps. It could also be asking them to try a new food or exercise.
3: Track progress – Monitoring progress over time is another good strategy for increasing client motivation and exercise adherence. It could be something simple like stepping onto a pair of weighing scales and recording the result. Another example could be writing down the number of sets and reps and comparing them to the previous week’s entries. Results occur over time and it is very motivating if results are tangible or can be measured.
4: Add variety – With the best will in the world, all fitness programs at some stage will cease to be effective and the early results seen by the client will stop. In effect, the body has become accustomed to the exercise stimulus. To keep seeing results and to stop boredom, mix up the program with new ideas, try different exercises or change something about the program that the body is not accustomed to, for example, speed of execution, number of sets or reps.
5: Reassess over time – Re-evaluate the client’s goals at regular intervals as conditions may change and the client’s original reason for exercising may not be relevant anymore. New outcome and process goals need to be set. It may be necessary to go back over exercise likes and dislikes and expectations or fears.
6: Remind your client where they started – At some point results will slow down and the client may not feel that they are reaching their goal quickly enough. It takes hard effort and consistency; goals are not reached overnight. Always remind the client of their success so far – it is easy to forget. For example, if the client was expecting to lose one stone by a certain point but only lost 9lb, remind the client that it is still an exceptionally good achievement and it is difficult to lose weight consistently. Sometimes a photo may be taken at the start of programming as an incentive to remind them of all the hard work so far.
7: Set incentives – The incentive may be part of the overall goal such as losing weight for a friend’s wedding or to reduce blood pressure or levels of stress. On the other hand, it could be to do with rewarding yourself. It cannot be all hard work and no play. Discuss rewards when first determining goals, however, be careful to match the right type of reward. For example, if a client is trying to lose weight, try and avoid food rewards. It could be as simple as a trip to the health spa or buying new clothes.
Arteries
Our arteries function to transport blood away from the heart and are under high pressure. Arteries mainly carry oxygenated blood; however, there is an exception: the pulmonary artery transports deoxygenated blood from the heart’s right ventricle to the lungs.
Arteries have thick muscular walls (smooth muscle) which are elastic, allowing them to stretch when the heart contracts forcefully, pushing blood out from the left ventricle into the aorta. In this way, the pressure the blood exerts on the artery wall is not excessive. However, arterial pressure is critical because it maintains blood flow through the capillary beds.
[IMAGE 5]
Artery
Capillaries
Being only one cell thick, capillaries are the smallest type of blood vessel, so they’re incredibly thin. Blood pressure within the capillaries is very low (otherwise you would bleed to death), declining along their length from less than 35mmHg to about 18mmHg.
The thin walls allow oxygen, nutrients and carbon dioxide to exchange (via diffusion) between the capillaries and the body’s cells and from the body’s cells to the capillaries.
Veins
The role of veins is to carry mainly deoxygenated blood towards the heart. However, the pulmonary vein is the exception, carrying oxygenated blood from the lungs to the left atrium.
Venous pressure is low, only about 18mmHg from the venules to the right atrium. Due to the low pressure, veins have thin walls and a large lumen. The low pressure in veins means blood would struggle to return to the heart without a sufficient mechanism to aid return. Fortunately, several mechanisms assist venous return to the right atrium, which enable them to deal with low blood pressure flow. One striking feature is that veins below the heart level are lined with non-return valve structures. Once blood is pumped through the valve system, they shut, stopping any backflow of blood which would otherwise pool in the lower extremities.
‘A sign of wisdom and maturity is when you come to terms with the realisation that your decisions cause your rewards and consequences. You are responsible for your life, and your ultimate success depends on the choices you make.’
Denis Waitley, author and coach