Psychological Components of Successful Exercise Compliance

By Carlos Alberto Rivas, M.S., C.S.C.S.

The benefits of physical activity have been well documented. The body responds to physical activity in ways that have important positive effects on the musculoskeletal, cardiovascular, respiratory and endocrine systems. These changes are consistent with a number of health benefits, including a reduced risk of heart disease, high blood pressure, obesity, colon cancer and diabetes. Regular exercise also appears to reduce depression and anxiety, improve mood and enhance the ability to perform daily tasks both at home and at work. Despite common knowledge that exercise is healthful, more than 60 percent of the population is not regularly active, and 25 percent of the population is not active at all.

Improving exercise compliance has been the mission of the U.S. Department of Health and Human Services, Center for Disease Control, the American Heart Association and other national organizations. To date, every organization tackling this issue has failed miserably. Studies have shown that over 50 percent of those starting an exercise program drop out within the first three months. Fitness and rehabilitation professionals face the challenge of working with clients or patients, as well as the community, to develop methods of improving compliance to exercise. To help people achieve positive changes in health-related behaviors, a professional must possess a clear understanding of the psychological influences on learning which either help increase or decrease compliance.

COMPONENTS OF SUCCESSFUL BEHAVIOR CHANGE

Exercise compliance is based upon the understanding of certain psychological theories. Behavior modification and the stages of motivational readiness are fundamental to guiding our clients.

Behavior modification factors:

1. Setting short- and long-term realistic and measurable goals.
2. Determining their confidence on goal achievement.
3. Signing a contract with clear description of desirable goal.
4. Receiving feedback on success.
5. Developing social support systems to provide encouragement.

The readiness to change theory has received wide acceptance and has been used by trainers with great success. This theory addresses the individual's ability to make permanent change based upon their emotional and intellectual readiness to change. Clients are evaluated on the stage of readiness they express before beginning an exercise program. Clients are counseled to deal with lapses or relapses and to recognize that these behaviors are not related to failure.

Stages of Readiness to Change Model

1. Precontemplation: Clients express lack of interest in making change. Moving clients through this stage involves utilization of multiple resources to stress the importance of the desired change. This can be achieved through written materials, educational classes, physician and family persuasion.
2. Contemplation: Clients are thinking about making a desired change. Helping clients define the risks and benefits of making or not making the desired change can influence this stage.
3. Preparation: Clients are doing some physical activity but not meeting the recommended criteria.
4. Action: Clients are meeting the recommended criteria (i.e. one hour of physical activity five days per week) on a consistent basis but they have not maintained the behavior for six months.
5. Maintenance: Clients have been in action for six months or more.

PRACTICAL SRATEGIES TO IMPROVE EXERCISE COMPLIANCE

In addition to educating clients about exercise, it is necessary to motivate them to act and maintain a regular fitness program. Research suggests that the following motivational strategies will enhance client interest, enthusiasm and long-term compliance.

• Physician support of the exercise program
• Minimizing injuries and/or complications with a moderate exercise prescription
• Advocate exercising with a trainer
• Emphasize variety and enjoyment in the exercise program
• Provide positive reinforcement through periodic testing
• Recruit support of the program among family and friends
• Use progress charts to record exercise achievements

THE BOTTOME LINE

Personal trainers are often asked questions about additional ways to implement exercise into their lifestyles. Although personal trainers are not expected to be experts in all areas, it is appropriate that they serve as a resource person to direct the participant to accurate information and additional services. It is also expected that the personal trainer assess lifestyle habits and risk factors, such as dietary patterns, smoking status, body composition, lipids and lipoproteins and psychological well being. The challenge for improving exercise compliance is well stated: We need to overcome many of the current limitations of home or group programs while maximizing the client's benefits.

Carlos Alberto Rivas, M.S., C.S.C.S., is the fitness/personal training director at the Baptist East/Milestone Wellness Center. Carlos has a master's degree in exercise physiology and has over 10,000 hours of personal training experience. He is also a member of Kentuckiana HealthFitness magazine's editorial advisory board. Carlos can be reached at 502-896-3900, ext.142.