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

(Part 1)

Part 2

I would like to share with you here 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.

1. The Doctor Factor

There is some research showing that one of the most powerful influences to becoming active stems from a personal recommendation made by an individual's physician (6, 7).

Personally, I can attest to this truth and cite several examples from my own surroundings. I assure you that all of the resistance I might have met with vanished when the message was pronounced by the doctor himself.

I have to tell you though; an off-hand remark offered in passing will not suffice. The more the doctor delivers the message with ardour and conviction – the more compelling it will be.

Although changes are underway, for whatever reason, many doctors still do not readily recommend exercise to their patients. This will ultimately come to pass. In the mean time, fitness professionals should not hesitate to actively recruit physician support for the exercise program.

If your client requires medical clearance prior to engaging in physical activity, seize this opportunity to include a small note to this effect. Or better yet, if at all possible, speak directly to the doctor to explain how your client – his patient after all – can stand to benefit for the many years ahead from a simple, firm endorsement.

2. Physical Activity vs. Exercise Training

We all know about how we can get more active without necessarily disrupting our daily routines...

• Park the car further from the entrance
• Get off one or two bus stops sooner and walk the rest of the way
• Take the stairs instead of the elevator
• Golf without a ride cart
• Do the activities you are doing now more often, etc…

We have also heard about the most often recommended physical activities required for improving health and reducing risk of disease...

• Walking
• Volleyball
• Gardening
• Biking
• Raking leaves
• Swimming
• Dancing, etc…

Because we charge for our services, we would never dream of writing a training program around raking leaves. We typically favour structured exercises and reserve program design strictly to the time we spend with our clients.

I write programs around raking leaves.

Well, not exactly but allow me to explain. For almost all clients but especially for beginner or sedentary individuals, I write programs that incorporate physical activities outside the time we spend together – in addition to the structured exercise training program.

The clients understand the daily activities are part of the total program and that it is expected of them to accumulate a certain number of minutes of activity throughout the day in addition to our regular structured sessions. We choose the activities together based on their preferences, abilities, and time constraints.

I like to impose two conditions – it cannot be too hard and it must be enjoyable.

Having positive associations to physical activity helps to establish a healthy habit. If it’s fun, simple, and convenient the probability of adhering over the long-term increases substantially.

While it may be true that our clients will generally not be breaking any fitness records nor will they be expending a great deal of calories as compared to a structured exercise training program, it should not be viewed as inferior or worthless.

Remember, the purpose is to shape notions, habits, and to keep your client active everyday.

Perhaps just as importantly, realize that any amount of time spent on physical activity is time that cannot be spent on inactivity.

And moments of inactivity are precisely those perilous moments that tend to ambush our efforts despite our best intentions. Reducing those susceptible moments means they cannot be indulging in any of the bad habits that generally accompany inactivity if they're otherwise preoccupied with physical activity.

This can translate to one less cupcake, cookie, bag of chips, cigarette, beer, or soda pop.

Broadening program design to incorporate daily physical activities helps shape the lifelong notion for our client that the proper approach to health is to be active throughout the week, and not just the few times we meet together.

The concept here is that physical activity can serve as an effective complement to any structured exercise training program and that fitness professionals should consider broadening program design to include planning some of these activities outside of the regular sessions with clients.

3. Reverse Focus

One strategy I find especially useful for overweight children, although it applies equally well to anyone, is to reverse the focus. Sometimes, instead of focusing on what to do, it helps to focus on what not to do.

When we write programs for our clients, we are very precise about what they should be doing...

We know how many reps and sets they will accomplish. We know how much weight they will be lifting. We know the exact number of exercises they will perform and we have scrupulously selected each exercise for a specific purpose. We calculate every detail down to the exact heart beat they will train at.

Indeed, when it comes to our client’s activity, we program what they should be doing with tremendous precision. When it comes to their inactivity however, we tend to give generalized advice or we make vague recommendations such as 'watch a little less television' or 'try to get out more' or 'spend less time sitting at your computer.'

Reverse the focus.

Rather than centering on how much activity is needed, we might focus instead on the maximum amount of inactivity allotted per time period. For example, allowing no more than two hours of inactivity at any one time. Place an emphasis on decreasing sedentary time.

I find when I give my clients a precise plan on how they can reduce their inactivity time, and I apply as much vigour as I do for the design of their traditional training program, they become highly motivated and much more resolute in their actions throughout the course of the week. Plus, it teaches them how they might apply these lessons in the future.

The first step is simply an assessment of their inactivity patterns. I have my clients fill out what I loosely refer to as an 'inactivity log' – much the same way we would ask our clients to complete a nutrition log, for example.

Next, identify patterns of inactivity. Be mindful to distinguish between purposeful inactivity and unproductive inactivity. After all, everyone needs time for relaxation and inactivity.

Set maximum permissible time periods for inactivity. Initially target one mutually acceptable trouble spot and aim to reduce this inactivity time. Start slowly and do not take away too much inactive time at once. Think minutes not hours.

Set realistic goals, carefully select appropriate strategies, and provide a generous list of possible alternatives to choose from to successfully replace moments of inactivity.

Finally, be certain to enlist the participation of your client in this process when devising the goals, strategies, and especially the 'menu' of replacement activities. Simply convincing them to agree to your plan will not produce a successful behaviour change. Arriving at a sincere agreement on the part of the client as to what constitutes a workable, realistic, achievable plan is absolutely fundamental.

The notion here then, is why not design an additional stand-alone plan that specifically addresses our client's inactivity time? In lieu of vague statements, why not provide our clients with specific strategies to employ at precise moments with the goal of reducing minutes of inactivity dispersed throughout the day, and delivering this plan with the same care and conviction we routinely place in traditional exercise training programs?

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