The following is a guest post by Patrick Beriault. Patrick digs deep into the issue of why clients aren’t adhering to physical activity and tells us 2 of his own personal strategies. If you’re interested in submitting a guest post please check out the contribution page.
The WHO (World Health Organisation) defines physical activity as “any bodily movement produced by skeletal muscles that require energy expenditure”. Physical inactivity is the fourth leading risk factor for global mortality causing an estimated 3.2 million deaths globally.
It’s known that physical activity has significant benefits for health. It can reduce the risk of cardiovascular diseases, diabetes, colon and breast cancer, and depression. Moreover, adequate levels of physical activity will decrease the risk of a hip or vertebral fracture and help control weight.
So why aren’t individuals taking this miracle cure?
(Click here for Canadian physical inactivity stats indicating that 85% of Canadians are considered inactive) And importantly, why is our health care system not making this a priority? It would clearly alleviate some of the financial burden our system is facing, during a global recession no less. I invite you to read this report by Micheal S. Border to have a peak into the American Childhood Obesity crisis. I especially like the final paragraph:
“We know the answers,” says Crawford. “We know the ways in which we can modify children’s behaviors in the direction for health. But we need the societal will, and the time, and the leaders in the effort to do it”.
We, as personal trainers, are the leaders who need to bring constructive damage to the status quo. Society will embrace this if we’re organized and backed up by science. Politicians won’t have a choice but to endorse the necessary changes since their political career depends on it.
If we don’t do anything, we’re postponing the problem and deferring it to future generations. Not exactly the legacy I want to leave for my children.
How can we get our 52% inactivity rate to 20%?
What can we do to make this change happen? How can we get the 70% of our overweight/obese Canadian population (see PHAC report here) to a healthier state? As a coach/mentor/trainer etc., you can have a positive impact on your client’s lives through the promotion of physical activity.
The power of exercise prescriptions (ExRx) is slowly gaining momentum and the use of physical activity/movement experts such as Kinesiologists, strength and conditioning coaches and personal trainers is making head way. (Click here for a resent Toronto Star Article in this topic). But is a simple ExRx on a piece of paper enough to get the unmovable moving?
Research certainly seems to support this (Petrella, R, 2002), but that alone doesn’t seem to work in my practice.
Let’s say I have one consultation a year. If I tell a client exactly what they need to do, and promise that “IF” she does exactly what I recommend, she would have control of their diabetes, hypertension or dyslipidemia, I would estimate that less than 15% of my clients would have followed through with my recommendations after 12 months.
And I consider myself a physical activity counseling expert seeing between 30-40 individual clients and leading over 30 group sessions per month, exclusively dealing with physical activity issues. Simply writing out an ExRx is simply not enough. It’s a good start, but not enough.
We have to acknowledge the barriers clients face with physical activity. Society is not making it easy to participate. Big pharmaceutical companies are not endorsing this because it’s bad for business. There’s no (or very little) private or public insurance coverage for physical activity services and there are more expectations and stereotypes associated with health and fitness industry then I care to even bring up.
You cannot work harder than your clients for their own health.
The responsibility ultimately lies within the client to bring behavioral change. You might need to be the catalyst for that change and part of the support system for sustaining the motivation.
One of the biggest client barriers fitness experts come across is the proper life coaching skills: “how can you motivate a client to embrace physical activity?” Answer that question, and you will have a successful returning client.
I’m happy to share some words of wisdom that I give to students I supervise from the University of Ottawa School of Human Kinetics program. I’ve developed the following analogies based on my own experience, and some science backs this up, but this aspect of the job is more art than science.
I tell students to imagine they’re on a first date (i.e. their client). The scenario is that my student has one chance to impress this person (i.e. initial consultation/annual physical), and they need to figure out a way to make this guy/girl ask them on a second date.
They need to ask the clients the right questions to figure out what makes them tick (i.e. what are their interests?), what turns them on (i.e. what do they love to do?), what drives them internally (i.e. what motivates them?), what will make them trust you and what will make them come back for that 2nd date (i.e. a chance for an actual lifestyle/behavior modification). (I have about 25 minutes in my clinic to do this)
Having a strict series of questions for varied demographics would be ideal, but this doesn’t work for me and my clients. If you have a relatively homogenous clientele, then I encourage you to develop an efficient series of canned questions. The important thing here is to understand the “Dating” analogy principle and apply it to your practice. Your clients will fall head over heels for you if you are able to tap into some of the answers they provide and make use of them during your consultations.
No matter how good you are at what you do, you won’t be able to convince everyone that physical activity is the solution for chronic disease (Diabetes, Hypertension, Arthritis, etc). We need to acknowledge this and respect the client’s wishes above all else. This is where interdisciplinary work allows for optimal decision-making with the client.
What happens when you have a client resisting change, or is in the early stage of change identified by the Prochaska Model (i.e. pre-contemplation or contemplation)?
Enter the movie Inception™. (Watch it if you haven’t)
During the first “Date” with their client, trainers need to figure out a way to plant a seed, or an idea in the clients reasoning that physical activity has value. If you’re successful, the client who’s sitting in the pre-contemplation or contemplation stages of change will eventually contact you and ask the questions that signal life style/behavior modifications (i.e. client in the preparation or action stages of the Prochaska Model).
At this point you simply become a facilitator for healthy behavior and not the conductor. This is only possible because of questions, notions, facts, reasoning or motivators you were able to identify during your “first date”, and brought them to the forefront of your client’s thinking/consciousness.
That’s “Inception”: triggering something in your clients’ mind that makes a specific issue important. It can be as simple as validating something they have accomplished that is relatively big for them ( “Wow Mr. Smith, you walked 2000 steps more today then you did last week”). Or finding out a deep internal motivator ( “If you could do anything right now anywhere where in the world what would it be and where?”).
You’d be surprised by how many clients wish they could travel, and have a chance to connect and play with family. These activities are that much easier and enjoyable when you’re active and have pain free movement.
Finally, I would like to remind you of the 4 important points:
1. If you’re working harder then your clients, you’re working too hard and will likely burn out.
2. Treat your initial consults/assessments as a “first date” and gather the necessary information to make your “second date” a success.
3. If you have a client who’s not ready to make the necessary changes in their life, still give them the best of what you have to offer while attempting a “Inception” style strategies with the knowledge you acquired during your initial consultation.
4. Finally, foster an interdisciplinary team to not only get to know your clients, but also to offer them the best you possibly can. Clients need to feel a level of emotional connection with their support system to make behavioral changes stick. Sometimes, that means helping them connect with friends and family. Other times that means you have to connect with them if.
Again, training clients is 50% science and 50% art and places like the PTDC provide such rich free information that it’s unacceptable to stay stagnate in learning.
Every trainer has encountered clients who have a hard time understanding the value of exercise. How do you do it?
Don’t forget to “like” thePTDC’s Facebook page and join our movement.
Patrick is the North American representative for ComplexCore™ and works at the Somerset West Community Health Centre where he leads the community health promotion program for physical activity. You can find out more at www.complexcore.at