ACSM CPT Chapter 7: Theories of Behavior Change
ACSM CPT Chapter 7: Theories of Behavior Change

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Chapter Objectives: 

  • Find the reasons we should use theories to guide behavior change.
  • Talk about how theories are used to make programs that address many lifestyle changes.
  • Discuss the role of self-efficacy, self-monitoring, feedback, and goal setting in changing behavior.
  • Talk about the tailored interventions we have for clients with relevant theory elements.

The Challenge of Behavior Change

Changing someone’s behavior is hard because there are so many different factors that play an important role. These are readiness for change, motivation, ability, perceived self-efficacy, and situational factors like peer influences and scheduling.

Why is Theory Important?

Theories are frameworks that describe why and how behavior changes in populations in certain settings. Theories allow for replicable, sustainable, and generalized interventions. Theories allow us to understand better what is known and what is to be learned. Systematically testing theories allows us to identify new behavior change constructs and replace elements of the intervention that are not effective anymore.

The Transtheoretical Model

This integrative model is made with other constructs from the theories like social learning and social cognition.

This model states that someone’s behaviors are entirely based on the stage of change or readiness level that they are currently in. These are the five stages of change: 

  • Precontemplation: This is when the client does not intend to act in the direction of change and will not consider the benefits of making a change.
  • Contemplation: This is when the client starts to consider the negative consequences of their behaviors and will consider making a change within the next 6 months or so.
  • Preparation: This is when the client has started a plan of action for what they will do to get to their behavior change and is doing that change in the next 30 days.
  • Action: This is when the client is in the process of making behavior changes and has been regularly active for less than 6 months of time.
  • Maintenance: This is the final stage of change and it is when the client has maintained the changes they made in the previous action stage and made their new behaviors for 6 months or more now. The client works so that they can now prevent relapse.

The goal is to find what stage the client is in and then try to advance them into the next stage, with the goal being the end maintenance stage for everyone.

As clients go through the stages, they will develop new perspectives on behavior, and their self-efficacy will grow as they change their skills and experiences.

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A lot of the early stages use a pro and con table mentality where they will not move on in the stages or at least get past the first one until they see that the pros are going to outweigh the cons.

The Health Belief Model

This model is used for increasing health screening behaviors and suggests that a primary predictor of changing behavior is the level of seriousness perceived about a possible health problem, a person’s susceptibility to a possible health consequence, and a perceived belief or benefit that a change will reduce risks of consequences.

Clients need to believe that perceived barriers outweigh the benefits and need confidence in their own ability to do the action. The client sees the cost of behavior change as worth the reduction in risk offered by it.

It is a rather effective strategy for interventions.

A lot of times, the problem that is run into with this theory, is that feeling intention and motivation for change is not often enough for the client to actually change anything. 

Theory of Planned Behavior

This was made originally from the theory of reasoned action. It is used extensively in advertising, public relations, and health behavior change efforts. The overall suggestion of this theory is that intention to engage in some behavior will eventually result in that behavior happening, and the client’s intent level is determined by their attitude toward that behavior, subjective norms, and perceived behavior control.

It is a very effective theory when used in cases of smoking, alcohol abuse, and eating, but unproven when looking at physical activity alone.

Social Cognitive Theory

Today, this is considered the most used theory. It is based on the health belief model. It doesn’t emphasize perceived susceptibility like the health belief model but does state outcome expectations and self-efficacy are the most important things in changing behaviors. They are next divided into the environment, personal and individual, and behavior.

This theory is different because it puts a larger emphasis on the thoughts and feelings of the client. Thus, it will emphasize behavior on an interpersonal level. People using this will shape their own lives by reflecting, thinking, feeling, and observing themselves. 

This theory has many studies showing improvements in physical activities for clients.

Goal Setting Theory

Four mechanisms play a role in behavior change with goals:

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  • Goals put your attention and energy toward behavior that is desired.
  • Goals will lead to more effort.
  • Goals will extend the time and energy that is put into some behavior that is desired.
  • Goals will increase goal relevant skill usage.

This success is determined by commitment levels, goal importance, self-efficacy, feedback on goals, and skill attainment levels.

It is shown by research that it is more effective to set a goal for a client than it is to tell them to do their best.

Goals should not be broad but measurable. We will discuss this later on.

The Small Changes Model

This takes things from other theories and is relatively new. It is rather successful in nutrition and physical activity studies.

It says that behavior change is received through realistic, maintainable goals that are small, relate to the baseline activity, and are cumulative. Goal setting, feedback, and self-monitoring are combined here to increase the achievement of starting goals and self-efficacy for further changes.

Goals are SMALL

  • S: Self selected
  • M: Measurable
  • A: Action-oriented
  • L: Linked to your own life
  • L: Long term

Socioecological Model

Clients should be viewed as people in a larger social framework and infrastructure. This model says that our interpersonal interactions, our environment, the community, policies, and the law determine behaviors.

A strength of this is that it recognizes the effects of the larger environment on the client.

A weakness is that it is tough to change the environment we are in, and that change happens slowly if at all.

Building Theory Into Intervention

Self-monitoring

This is the practice of tracking your behavior to increase awareness and monitor progress.

This is important when looking at physical activity interventions, as it’s been surveyed to be the most influential predictor for behavior change.

The use of physical activity trackers and mobile apps

It can also be a subjective thing. This is where the apps come into play. They help by removing the subjectiveness and getting your information that a machine can measure and track, thus removing error and guesswork. 

Goal Setting

Client selected goals are the most effective ones.

SMART Goals

  • S: Specific
  • M: Measurable
  • A: Achievable
  • R: Realistic
  • T: Time-oriented

Feedback

This is two way communication between two or more people.

Not only is it necessary to set effective goals, but it is also important for any physical activity behavior to change. 

The client and trainer should interact, and feedback should be received often.

Customizing to a Population

Trainers should understand the unique needs of clients based on age, physical ability, gender, culture, or another factor.

Rapport

Build rapport with these:

  • Communicate and display your credentials.
  • Show professionalism in how you act and dress.
  • Highlight the likes, dislikes, and experiences you have in common with someone.
  • Affirm the strengths the client has.
  • Empathize with the clients.
  • Disclose some personal things that relate to training.
  • Use nonverbal cues.
  • Do not judge, and have an open mind.
  • Be an active listener.
  • Give explanations.
  • Always ask how the client feels regarding the info given in the session.
ACSM CPT Chapter 7: Theories of Behavior Change 1
ACSM CPT Chapter 7: Theories of Behavior Change 2
ACSM CPT Chapter 7: Theories of Behavior Change 3

Tyler Read

Tyler Read, BSc, CPT. Tyler holds a B.S. in Kinesiology from Sonoma State University and is a certified personal trainer (CPT) with NASM (National Academy of sports medicine), and has over 15 years of experience working as a personal trainer. He is a published author of running start, and a frequent contributing author on Healthline and Eat this, not that.

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