Helping Your Clients Adhere to a Lifelong Exercise Habit
By Hervé Bensabat

(Part 1) (Part 2)

Part 3

4. The 1 to 12 Shift

So far we have concentrated primarily on ways of integrating physical activity into our approach as fitness trainers, but what about the structured exercise training program itself?

Are there program-related factors that can influence adherence and the establishment of a lifelong habit?

Research shows that almost 50 percent of those who participate in an exercise program will quit within one year with the highest percentage dropping out in the first three months (3, 8). According to a survey published by the American Sports Data company (1998), clients report an average of 18 sessions with a trainer.

These findings suggest two very important things...

First, inspiring one in every two clients to embrace the fitness lifestyle is going to be a challenging task. And secondly, we only have on 'average', roughly 18 sessions or the equivalent of 6 to 12 weeks to persuade them to do so.

Barring advancing age, illness, or injury, clients who are most prone to dropping out are typically sedentary or first time exercisers.

Generally, athletes or advanced exercisers with a training age of two or more years are already bonafide fitness enthusiasts. Without dismissing the likelihood of recidivism even at these advanced stages or negating all of the possible exceptions to the rule, it may prove insightful in this instance to amplify our diligence toward the novice exerciser who is arguably at greater risk.

When such a client first comes to us, we typically set about writing an exercise training program consisting of conventional fitness parameters including a frequency of 2 to 3 sessions weekly, a duration of 30 to 60 minutes per session, a half dozen to a dozen exercises performed at low to moderate intensities and low volumes. A classic exercise program will run an average of 3 to 6 weeks before significant modifications or a revised program is introduced for the next cycle...

In view of the significant dropout rate during this critical period, perhaps a shift in emphasis is warranted throughout the 1st to 12th week of client programming.

Rather than rapidly setting conventional fitness parameters which will ultimately be necessary to move our clients toward their fitness goals, fitness professionals might instead consider the primary objective as program adherence and the successful establishment of the exercise habit.

This means the initial program design should be easy to accomplish and focus on gradually shaping and maintaining the exercise behaviour. Seek to establish positive experiences. Clients have many reasons for quitting. The initial program should address these concerns with the goal of reducing the occasions for failure.

Of all the fitness parameters mentioned above, perhaps the most controversial as it pertains to our discussion here, is Intensity. This is because research shows a higher intensity level is undeniably the most significant factor responsible for eliciting favourable physiological adaptations. At the same time, higher intensities are also associated with greater health risks, injuries, and dropout rates (9, 10).

If the duration is too long or the exercise mode so boring that people would rather watch paint dry, the dropout rate will increase.

But I think the best way to create an aversion to exercise is through the initial intensity level.

Many people simply do not like to work too hard at anything except the things they naturally love to do. Those of us who love exercise are perhaps very fortunate. But remember however, that exercise is voluntary and given the choice, people will more readily abandon their program rather than endure something they perceive as painful or unpleasant. See to it initially at least, that the perceived 'costs' are worth the burden of exercise.

So the notion here is that although conventional fitness parameters may in actuality be appropriate for our novice exercisers, in order to shape what may be construed as a difficult behaviour for them, it may prove more effective in the first twelve weeks to shift the emphasis toward program adherence.

This may be achieved by designing an exercise program that is both pleasant to accomplish and well within the capabilities of our client so that they may first and foremost, ease into the exercise habit before resuming the subsequent goals set forth by the conventional parameters of the program.

5. Lapse - Relapse

Whether you have been exercising for years or whether you are just starting out, it is important to realize that anyone, anytime can suffer a relapse. The only proper thing to do about it is to plan for it.

A distinction may perhaps be made between the terms “lapse” and “relapse.” A lapse is a slight error or slip whereas a relapse is a return to former behaviour patterns.

One of the best things we can do for our clients is to forewarn them against perceiving adherence as an 'all or nothing' situation-- either the extremes of complete success or total failure.

Just because we may miss a day, a week, a month, or longer does not mean we have failed or that it is all over. Constantly remind your clients that physical activity and exercise is a lifelong endeavour. At worse, even a few years of absence is a relatively short time when measured over the span of a lifetime.

Encourage your client to view these experiences as simple lapses and not to fall into the trap of 'all or nothing'. Repeat the message often that it is never too late and it is never over.

What matters most over the long run is that we learn to start again, and again.

Teach your clients that contrary to popular belief, experiencing lapses or relapses is not indicative of personal weakness or lack of self-control. Rather than blame themselves or denigrate their own capacities, clients should therefore expect and anticipate the occurrence of lapses and view them simply as a natural part of life.

This may also be an opportune time to reiterate the many physical, social, and psychological benefits associated with exercise and sound nutrition.

The best strategy then, once we have instructed our clients right from the start to expect lapses and not to mindlessly beat themselves up over it, is to prepare and plan for it.

Our plan should comprise a list of potentially 'high-risk' situations. The purpose is to identify and anticipate situations which make us more prone to diverge from our activity goals. This can be anything ranging from bad weather to lack of time, lack of energy, loss of motivation, vacation time or a significant change in routine, etc. The next step is devising an appropriate set of actions to take when they eventually do occur.

Some solutions will be fairly simple. For example, devising alternative exercises to perform at home in case of bad weather, or including a set of resistance tubing in your luggage or locating a hiking trail near your living accommodations when on vacation. However, other solutions will require more complex problem solving approaches to some fairly difficult situations.

Recall that lack of time is one of the most often cited barriers to physical activity. Whenever clients list time constraints as a potential trigger, always suggest 'exercise snacks', i.e., shorter bouts of exercise dispersed throughout the day as a plausible strategy for preventing a relapse.

Ultimately, perhaps the most successful skill to learn and possess is simply the ability to pick up and start again. Always start again.

References

1. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs. 4th ed. Champaign, IL. Human Kinetics. 2003
2. 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.
3. 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.
4. 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.
5. Canadian Fitness and Lifestyle Research Institute (CFLRI). 1997 Physical Activity Monitor.
6. Ades PA, Waldmann ML, McCann WJ, et al. Predictors of cardiac rehabilitation participation in older coronary patients. Arch Intern Med 152 (1992):1033-1035.
7. 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.
8. Dishman R. Exercise Adherence: Its Impact on Public Health. Champaign, IL: Human Kinetics, 1988.
9. Vuori I. Perspectives on Health and Exercise. Edited by Mckenna J, Riddoch C. New York: Palgrave Macmillan, 1997.
10. 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.

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