// Enhancing exercise adherence
by Wendy Sweet
Getting people to move more, start a regular exercise program and ultimately stick with it are emerging topics in the growing field of behavioural health.
With public health initiatives for physical activity and exercise adoption on the rise, as well as greater concern among facility owners and managers regarding attrition (member drop-off) rates, the subject of exercise adoption and maintenance has never been so topical.
First and foremost trainers and instructors need to understand current theory and thinking in exercise adherence research. Secondly, they need a number of strategies and ‘tools’ to apply in order to motivate clients and members to stick with their new exercise regimes. This knowledge is essential for trainers who are encouraging new exercisers to adopt life-long exercise habits.
Current research in exercise adoption and maintenanceHealthy People 2000, the US National Health Promotion and Disease Prevention Objectives (USHHS, 1991) identified the need for further research into better understanding of the attitudinal, behavioural and social skills needed for people to adopt and maintain regular.
exercise. With a 50 per cent chance of drop-out from formal exercise programs for individuals within the first three months of starting, (Buckworth and Dishman, 2002), it is imperative that trainers understand not only the barriers which people face when adopting an exercise program, but also the theories behind behavioural change processes.
Evidence for adherence strategies:
Strategies to adopt and adhere to an active lifestyle stem from a variety of social psychology models of the biological, social and psychological influences which link to determine individual behaviour, i.e. ‘determinants of behaviour’.
Behavioural theories attempt to explain why some people adopt a particular behaviour while other members of the same population do not. A popular theory from Prochaska et.al. (1992), suggests that people progress through five stages of change and decision-making while they think about, adopt, adapt to and learn new habits and behaviours. This Transtheoretical Model of Behaviour Change (‘Stages of Change’ Model) is favoured by health promoters and is suitable for use by fitness professionals. Successful trainers and instructors need to be able to identify the stage of change that their clients are in, and to also implement strategies which work to move a client from one stage to another. This is especially applicable with previously sedentary people as they are at a higher-risk of dropping out of exercise. Intervention strategies can then be employed to ‘coax’ clients to become self-motivated to exercise.
Identifying barriers to behaviour change
Prescribing exercise for a previously sedentary person requires an understanding of the motives behind the decision to adopt an exercise program and the perceived ‘barriers’ that have prevented them from starting in the past or may have caused them to relapse into sedentary behaviour.
The many barriers (both real and perceived) preventing people from becoming active on a regular basis include:
• Lack of time
• Lack of social support or spousal support
• Lack of energy
• Overly intense programs
• Lack of willpower
• Lack of self-efficacy (confidence in their ability to perform the exercise and to succeed)
• Lack of access to facilities or amenities such as parks, fitness facilities or bike-paths.
These barriers should be taken into consideration when deciding on the type, frequency, intensity and duration of exercise for a new exerciser.
Tools for your trainer tool-box
Many new members and clients are often ‘between’ these stages of readiness to maintain exercise. In these cases trainers and instructors should use proven strategies which have been successful in increasing exercise adherence. These include:
• Identifying your client’s level of commitment and motivation to exercise. From this, generate some specific goals, including behavioural change ones.
• Finding out their ‘perceived barriers’ to exercise and minimising relapse behaviour. What were the circumstances which made them relapse in the past or over the past few weeks? Trainers should work with the client and empower them to remove, or at least work around, those barriers. With perceived ‘lack of time’ being the main barrier to exercise adherence, trainers need to address this weekly with clients.• Rewarding often with praise and giving feedback on progress (no matter how small). Use progress charts or a training diary. Set rewards that are meaningful to clients.
• Building their self-efficacy regularly to progress them to the next stage of change. Identify base-line self-efficacy and make sure that you know why they commenced the exercise program and chose you as their trainer. Ensure that communication skills are motivating and assist clients with low confidence and belief in themselves to master new skills. Positively acknowledge new skill acquisition and try not to bring in more complex exercises too quickly.
• Finally, having FUN! One of the most enduring retention and adherence strategies is to ensure that the client is having a positive experience. Focus less on the ‘prescriptive side’ of exercise in the early days and more on participating in a variety of exercise experiences which suit the client.
Trainers these days are ‘change agents’ and should value their client’s thoughts as much as their actions. Clients can be at different levels of self-efficacy and stages of change for exercise, so selecting appropriate strategies to use in accordance with their stage of change or readiness to change is important.
In view of evidence showing the health benefits of exercise and physical activity, the need for interventions which use valid measures for assessing the experiences and outcomes of physical activity is apparent. Interventions to change an individual from sedentary to regularly active must take into consideration a host of issues around their motives for adopting physical activity, their stage of change or readiness to begin, and barriers that may cause relapse once they do begin. To increase exercise adherence and reduce attrition rates trainers and instructors must keep up with their knowledge of the ‘psychological’ as well as the ‘physiological’ needs of clients and members.
Wendy Sweet, Reg. Nurse, B.P.E, PG Dip. SPLS
With over twenty years experience in the New Zealand fitness industry, Wendy played a key role in establishing Les Mills Personal Training. She is a university lecturer and regular contributor to various fitness publications and has presented at FILEX and conventions throughout New Zealand. Wendy now applies her expertise in the prescription and psychology of exercise and behavioural change to assist PT’s to retain their clients. She is on the executive of the New Zealand Register of Exercise Professionals, a professional body she has been integral in establishing.
NETWORK MAGAZINE • SPRING 2006 • PP11-13