ACE 6th Edition Chapter 3: Basics of Behavior Change

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Chapter Goals:

• Find the common behavioral theory models. 
• Explain the self-determination theory and the strategies used to support its framework when using it with your clients. 
• Be able to describe the transtheoretical model and the stages that make it up. 
• Use the strategies of the normal behavior theory models to help your clients adapt and to maintain physical activity behaviors. 
• Find the behavior change principle and its effects on clients who are beginning these new stages of physical activity and healthy active lifestyles. 
• Use the basic strategies to lower the chances of your client dropping out of the programs and consider the adherence factors we see. 

Introduction

Only 23.5% of adults in the US actually meet the aerobic activity and the muscle strengthening guidelines we have set. So, with this, it is clear that people need some help initiating and sticking through with their exercise programs.

It is not as simple as just educating people on what they need to do and the benefits they will receive from exercising and staying physically active. We would see most of the population meeting these recommendations if it were. 

A big piece of getting people to adhere is going to be through the rapport built up, the mutual trust, and the understanding the trainer should have for the client’s level of readiness to change.

A successful trainer will do more for their client than design an effective program and then teach them the movements for them to do. 

A good trainer must be skilled in the coaching and motivation they must provide for their clients. 

Behavior Theory Models

There is no formula for us to predict why some people will adopt healthy behaviors and others will not. In general, however, we do break down the behavior change into factors such as environmental, it being an ongoing process, and the behavioral intention and action not equal the same thing. These are the three broad categories we see. 

Personal trainers are required to initiate a behavior change in a client and then attempt to maintain that over time when combined with the many unique challenges, characteristics, and considerations that come with each person. 

The personal trainer’s objective should be beyond just designing a great workout. Instead, the goal should empower their clients to adopt a lifelong habit of regular physical activity.

Health Belief Model

This model is on that states that people’s ideas and underlying emotions about illnesses, preventions, and treatments may influence health behaviors and decisions about change. 

The outcome variable of interest here will be the decision to change, so the model is most applicable to people who are in the early stages of change and, specifically, when they begin to weigh the pros and cons. 

The decision to change breaks down into the perception of a health threat and the perception of positive health behavior. 

The belief that something promotes health is broken down into the perceived susceptibility to an illness and the perceived level of seriousness for that illness. 

The second variables that come in are from the health behaviors and consist of the benefits and barriers that exist for someone when deciding on new health behavior.

Self-Determination

This essentially means that people pursue activities and goals in which they are naturally interested or from which they believe they will benefit. 

Motivation comes into play for this theory; specifically, the type of motivation is what matters. So, we have intrinsic and extrinsic. 

We have intrinsic, called autonomous motivation, which means that people feel as if they behave of their own free will. So, the motivation comes from them choosing to do something because they want to. 

Then we have the other form of motivation, which is extrinsic, or in the case of this theory, we call it controlled motivation. This has the desire to compete and win as the driving factor. 

In the context of exercise, an intrinsically motivated person would be someone that is engaged in exercise activities for the actual pleasure and experience that comes from the activity and just doing it. And then the extrinsically motivated person would desire to win and be better, not just play for fun.

Most people will be some combination of these two forms of motivation. 

In the self-determination theory’s words, people’s three needs will be competence, autonomy, and relatedness. 

Competence is the relation to self-perception that someone can successfully perform some task, which will be enhanced when the person receives forms of performance feedback in addition. Negative feedback will diminish the person’s perception and thwart the overall intrinsic motivation. 

Autonomy is important because someone must feel that their behaviors are being self-determined, instead of being coerced and controlled by someone else.

The relatedness aspects of the environments we work in will mean that the person must feel some sense of belonging and be connected with the other people so that their intrinsic motivation will flourish. 

Personal trainers have the goal of meeting the basic psychological needs of their clients by:

Creating opportunities for mastery experiences through offering appropriate challenges and consistent forms of positive feedback. 

Including the client in their goal setting and design of the program so that we work to maintain autonomy for the theory. 

Encouraging a sense of camaraderie among the clients and the other people within the fitness environment. 

Motivation research has shown lately that when someone is externally motivated, they are less likely to stick with something long-term. So, it is better to try to instill an intrinsic form of motivation or some combination of the two for the best forms of progress over the long term. 

Personal trainers should work to create an environment for their clients that will be caring and task involving for the provision of psychological benefits to clients through increases in enjoyment, social interaction, and feelings of competence. 

Personal trainers should utilize the task involving climate by emphasizing various forms of goals like that of the process goals over the use of the outcome goals. It should be things like making it to the gym four days a week rather than losing some exact amount of weight. Goals regarding the process invite more motivation and adherence when they are achieved rather than pure outcome goals. 

You should be careful not to compare your clients to other clients or other groups of people, as this can make the competition aspect come into play, increasing the negative aspects of health. 

Personal trainers should celebrate the accomplishments of their clients every time they meet and promote this positive and caring environment for them and their milestones. 

To promote the clients’ feelings of relatedness and belonging, we should consider introducing them to other gym members before or after their sessions. This will create that togetherness and community aspect that increases the client’s desire to continue and adhere. 

These are some social support strategies to be utilized on an ongoing basis:

• Find an exercise partner that is enjoyable and relatable for you. 
• Ask friends and family members to encourage and be positive regarding the exercise program. 
• Ask for reminders from family and friends regarding the physical activity goals and appointments.
• Set up contests with friends that base rewards on meeting various proven goals. 
• Add social elements to the exercise program. 
• Find an enjoyable activity based on being active with some group or club, like a sport or hiking club. 

Transtheoretical Model of Behavior Change

This theory revolves around the client and their readiness to change. So, the stages of changes model is another common name, but it is a component of it. 

The TTM is separated into four different components: Stages of change, processes of change, self-efficacy, and decisional balance. 

The Stages of Change:

• The Pre-contemplation stage is when people are not physically active and do not intend to seek a program to participate in. Physical activity is not seen as relevant to their lives, and little importance is put on it. 
• The Contemplation stage is when someone is still inactive but is thinking about starting to become active in some way with a program. This is usually seen as being within the next 6 months. 
• The Preparation Stage is marked by some engagement in physical activity, as individuals are mentally and physically preparing to adopt a program of activity. They may have some form of physical activity starting in this stage, but it is not consistent enough. 
• The Action stage is when the person is actually working out and has been consistent for less than 6 moths. 
• The Maintenance stage is when the participation in physical activity is longer than 6 months and the person is still consistent with their working out. 

Processes of Change

This is the second part of the TTM is possibly the most important part to know, and this is due to the processes of change being about how you help the client to move through the stages of change. 

The different processes of change are things like:

• Consciousness raising
• Dramatic relief
• Self-reevaluation
• Environmental reevaluation
• Self-liberation
• Helping relationships
• Counter-conditioning
• Reinforcement management
• Stimulus control
• Social liberation

Self-efficacy 

This is the third component of the TTM.

Self-efficacy is the individual believing they can successfully perform a given behavior. 

This was originally called the social cognitive theory, and it says that people are influenced by 3 things:

• Cognitive and personal factors
• Behavioral factors
• Environmental factors

The importance of having positive outcome expectations, goal setting, self-monitoring behavior, prompting intention formation, and planning are all important for personal trainers to embrace. 

Self-efficacy in exercise is the belief someone has in their ability to successfully complete a program of exercise. It is seen as the strongest and most consistent of the psychological correlations of physical activity behavior. 

We have a circular relationship between behavior change and self-efficacy, such that someone’s self-efficacy is related to whether they will participate in an activity, and someone’s participation in an activity influences their level of self-efficacy. 

Self-efficacy is very critical in the stages of pre-contemplation and contemplation in the stages of readiness.

The sources of self-efficacy that exist for people are going to be the things such as:

• Past performance experiences – an influential source of self-efficacy info. Trainers should ask about their previous experiences with exercise, facilities, and personal trainers in general. 
• Vicarious experiences – this is important for clients new to exercise who have little previous experience with supervised programs. 
• Verbal persuasion – it happens in the form of feedback and encouragement from the teaching professional. Statements will improve this self-efficacy if they come from a credible, respected, and knowledgeable source. 
• Physiological state appraisals – when these are related to exercise participation, they are quite valuable as they look at the state the client is in regarding emotional arousal, pain, and fatigue levels. These appraisals may lead to judgments regarding their ability to complete their exercise well. 
• Emotional state and mood appraisals – negative mood states and beliefs in emotions associated with exercises, like fear, anxiety, anger, and other things, are related to reduced self-efficacy and lower participation levels. 
• Imaginal experiences – these refer to the experiences in the mind that are either positive or negative and relate to participation in exercise. 

The personal trainer should be able to design and deliver a program that sets up the client for success with these things in mind regarding self-efficacy. 

Decisional Balance

This is the fourth and final part of the transtheoretical model and refers to balancing the pros and cons that all people go through when they are weighing the decision they wish to make. 

This specifically relates this part to the physical activity programs someone is in. this balance happens a lot in the precontemplation and the contemplation stages. Here we should try to instill the pros for the person to sway the decision to a positive side. 

Lapse and Relapse

Moving along the stages will not be a linear process for people, and clients may shift back and forth between stages as they progress. 

Relapse is the return to an original behavior, like when someone was physically inactive, which happens after many lapses. 

A simple lapse is just a slip that happens for a brief time, compared to a relapse, which is a long lapse and a shift back to a previous stage. 

One important strategy for dealing with lapses is going to be addressing them before they occur for the clients. The trainer should prepare them for the common things they see or know regarding lapses and their potential.

Principle of Behavior Change

Since many professionals are active on their own, they often can have trouble relating to the challenges people face when they have been inactive and are trying to change.

Operant Conditioning

This is the process through which behaviors are influenced by their consequences. In a more specific way, it looks at the relationship that exists between antecedents, behaviors, and consequences. It looks into the behavior chains that lead to the engagement of certain behaviors and the avoidance of others, and they take into account the consequences of each behavior. 

For exercise programs, the goal is to increase healthy behaviors in someone’s life. Behaviors are strengthened when they are reinforced in some way. 

Antecedents 

Part of the learning experience realizes the consequences of certain behaviors under particular conditions. The antecedents help in this part of the process since they are the stimuli that precede behaviors and often even signal the likeliness of consequences of behaviors. 

Stimulus control is an effective option for helping clients with behavior change. This refers to adjusting the environment to increase the likelihood of healthy behaviors. This could be as simple as choosing a gym that is on a direct route between home and work or keeping gym clothes in the car that are needed for a workout. 

Cognitions and Behaviors

A person’s behavior is influenced by how he or she thinks about the exercise or success in programs for exercise. 

Replacing irrational thoughts, setting goals, and self-monitoring are some of the cognitions and behaviors we should implement for success. 

We will discuss the goal setting portion throughout the next chapter. 

Physical Activity and Adherence

The possible determinant for physical activity is divided into the categories of personal attributes, environmental factors, and physical activity factors. 

Personal Attributes

This consists of the Health Status, Physical Activity History, Demographic variables, Psychological Traits, and things like knowledge, attitudes, and beliefs. 

Environmental Factors

These will be with things such as Access to facilities, time, and social support. 

Physical Activity Factors

Intensity, injury, and program design are what make up these factors.