Helping Your Clients Adhere to a Lifelong Exercise Habit

By Herve Bensabat, CFT, CSCS, NASM-CPT is a strength and conditioning specialist and personal trainer. He is also certified in post-rehabilitation fitness therapy and performance nutrition with the International Sports Sciences Association.

Visit Herve online at www.workout-from-home.com

Part 1 of 4

This article was featured in the June 2008 edition of ProTrainerOnline. To sign up for this bi-monthly newsletter, please visit: http://ipost.com/issa/prefs

Give your clients the gift of a lifetime. Teach them the true value of robust health. Impart the notion that physical activity is a lifelong endeavour, and inspire them to truly live the fitness lifestyle. It doesn't cost a dime. And it won't take you anymore time than you're already awarding them...

We instinctively know this. Exercise is beneficial for your health.

Laboratory and population-based studies have clearly demonstrated that regular exercise prevents occurrences of cardiac events, reduces the incidence of strokes, hypertension, diabetes and other chronic diseases, and substantially increases energy expenditure (1).

Other scientific studies have postulated that physical activity may also lessen anxiety and depression, enhance feelings of well-being, and improve sleep (2). Doctors, clinicians, health organizations, insurance companies, and health care providers all concur. No one disputes the importance of incorporating regular exercise and healthy nutrition into your lifestyle.

Most public health agencies across the nation agree that just one hour of physical activity out of the 24 hours in your day is all that is needed to reduce the risk of disease, improve your health, and start living the fitness lifestyle.

And the great news is all the agencies are in agreement that health benefits can accrue by simply adding up brief activity periods of at least 10 minutes each throughout the day. What could be simpler?

While the benefits of exercise have been well documented in the scientific literature, some have criticized the collective efforts of public and private agencies and mass media awareness campaigns to propagate the physical activity message, claiming that not enough is being done to reach the North American audience.

Even if this is so, you would have to concede that common sense dictates that we all inherently know deep down that exercise is good for us and that we should all be more active on a regular basis.

Indeed, some research is now pointing to the fact that more and more Americans are cognizant of the health benefits and the need for physical activity. Despite this increased interest, as much as half of the population does not exercise as per the U.S. Centers for Disease Control and Prevention (CDC) and the American College Of Sports Medicine (ACSM) physical activity recommendations. And one quarter or more do not exercise at all (3, 4).

In Canada, the findings are similar. Almost two thirds of the population fail to meet the guidelines set forth in the Canada Physical Activity guide (5).

Perhaps more intriguing is the disconcerting reality that of the small percentage of sedentary individuals who begin regular physical activity, almost half of them will quit within three to six months – and the drop out rates for previously active individuals are no better (3).

"Physical activity" as defined by the agencies consists of such accommodating activities as, for example, walking, gardening, biking, swimming, raking leaves, and dancing. Why then do we fail to meet even the most basic requirements knowing our health hangs in the balance?

The answer to this question is as diverse as the population itself.

The most often cited factors are lack of time, lack of energy, inconvenience, and proximity, access to, and affordability of the activity or exercise facility. Environmental constraints such as weather, traffic, crime, safety, and lighting are also important considerations. For sub-populations such as older adults or the overweight, it is not uncommon to learn that fear of injury or fear of embarrassment can also act as a hindrance.

While this short list represents just a fragment of the constellation of factors acting as barriers to adopting a fitness lifestyle, fitness professionals should appreciate that the most potent reasons people have are rarely verbalized. These have to do with deeply ingrained belief systems, past experiences, or negative perceptions related to exercise.

Clearly, the issue of adherence is not an insignificant one.

Although we commonly think of client goals in terms of toning up, losing weight, building muscle, or improving performance, it is important to remember that as fitness professionals, our primary chief obligation toward our clients is to help them establish a lifelong habit of active living and healthy eating long after they no longer train with us. This cannot be over-emphasized.

It's fairly safe to assume that individuals who seek out the services of certified fitness trainers have already made the decision to become active, or are about to. Others looking for trainers may already be active but are searching for professional guidance to advance their health, fitness, or athletic goals.

At the other end of the spectrum, those that are inactive or insufficiently active are either contemplating the decision but haven't as yet committed, or they are not even considering it. Part of the reason why a greater emphasis needs to be placed on adherence is because the issue is not always so clear cut. Unfortunately, it is not simply a matter of belonging to one group or the other. Thus, identifying those at risk is not a simple matter.

For many of us, the decision to become active or inactive is cyclical in nature. There are moments in our lives when we are engaged in fitness and moments when we are not. Even the most fervent fitness enthusiasts amongst us are not immune to disruptions despite our best intentions, either because of illness, injury, job change, geographic move, travel, holidays, competing priorities, growing family or work demands.

For first time exercisers especially, the stark reality is that many attempts at physical activity are needed before a durable habit can be formed. Recognizing that exercise is voluntary, time consuming and competes with many other daily responsibilities is the first step to appreciating the complexities involved.

While the relatively short time we share with our clients does not guarantee they will remain active over the course of a lifetime, we can substantially influence and increase the chances of success by educating them about the role physical activity plays in reducing the risk of disease and repeating this message often, by ensuring that their experiences with physical activity and exercise are positive ones, and through the use of a multitude of strategies to help shape and establish a durable habit.

Every training session should be viewed as an opportunity to promote adherence.

For fitness professionals wanting to make a difference in the lives of those around us, this is an area where we can truly be of service and have a lasting impact on the lives of others.

This series of articles will outline for you some of the steps you can take today to educate, encourage, and inspire your clients to get active and stay active throughout the seasons of their lives.

The psychology literature is filled with proven principles to effectuate behaviour change and encourage adherence. Every good personal trainer is already aware of the battery of tools and methods available to them. Let me outline in bullet form some of the more common approaches used to facilitate this task...

• Increasing knowledge (constantly educating your client)

• Rewards system (rewarding oneself after accomplishing a task)

• Commitment system (committing oneself by making promises known)

• Motivational reminders (posting notes, etc., in visible places)

• Goal setting

• Learning stress management (ways of coping with stress)

• Learning time management (scheduling and setting time aside)

• Feedback system (providing positive feedback)

• Written contracts / written agreements

• Enlisting social support (family, friends, groups, etc.)

• Use of role models

• Use of LISTS:

Exercise / physical activity log Nutrition log Mood diaries Listing advantages Listing barriers Cost-benefit / decisional balance sheet • Progress analysis (discussion of progress / new & regular assessments)

• Personal responsibility & accountability (encouraging self-reliance, self-efficacy, etc.)

• Substitutions system (substituting alternative tasks to reduce aversion)

• Contact support (periodic telephone calls, letters, postcards, e-mails, newsletters, etc.)

Adding to, and combining some of these methods together to the ones you are no doubt already employing can magnify the impact you are having.

In Part 2 of this series, I will share with you some of the principles I use to service my clients beyond the traditional exercise training program to foster the notion of exercise adherence over the span of a lifetime and to fully live the fitness lifestyle.

References

American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs. 4th ed. Champaign, IL. Human Kinetics. 2003 Ferketich AK, Schwartzbaum JA, Frid DJ, et al. Depression as an antecedent to heart disease among women and men in the NHANES I study. Arch Intern Med 160 (2000):1261-1268. U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. Washington, DC: U.S. Department of Health and Human Services, 2000. Canadian Fitness and Lifestyle Research Institute (CFLRI). 1997 Physical Activity Monitor. Ades PA, Waldmann ML, McCann WJ, et al. Predictors of cardiac rehabilitation participation in older coronary patients. Arch Intern Med 152 (1992):1033-1035. Petrella RJ, Koval JJ, Cunningham DA, et al. Can primary care doctors prescribe exercise to improve fitness? The Step Test Exercise Prescription (STEP) project. Am J Prev Med 24 (2003): 316-322. Dishman R. Exercise Adherence: Its Impact on Public Health. Champaign, IL: Human Kinetics, 1988. Vuori I. Perspectives on Health and Exercise. Edited by Mckenna J, Riddoch C. New York: Palgrave Macmillan, 1997. Powell KE, Heath GW, Kresnow MJ, et al. Injury rates from walking, gardening, weightlifting, outdoor bicycling and aerobics. Med Sci Sports Exerc 30 (1998): 1246-1249.