As health professionals, it’s not always easy to keep our clients motivated to exercise. Some individuals love exercise and are self- motivated. But more often our clients can struggle at times to maintain the programs that we provide. Regular exercise is a complex, multi-factorial behaviour that we need to better understand, in order to help clients stay active and healthy.

Research suggests that 50% of persons starting an exercise program will drop out within the first 6 months (Wilson and Brookfield, 2009).

An interesting article by Buchan J et al (2015) explored assessing exercise barriers for individuals with cancer-related lymphoedema.

Abstract 1: Exercise barriers self-efficacy: development and validation of a subscale for individuals with cancer-related lymphedema.

Exercise barriers self-efficacy: development and validation of a subcale for individuals with cancer-related lymphedema, Health and Quality of Life Outcomes (Published: 18 March 2015) by Jena Buchan, Monika Janda, Robyn Box, Laura Rogers and Sandi Hayes

Why are some people motivated and others not?

How people view themselves, from past experiences to current reality, will influence whether they participate in exercise (Whaley and Schrider 2005). You may provide sound medical reasons to your client why they should exercise but they may still not undertake what is recommended due to their own self perception. Clients self efficacy which in this case is the person’s confidence in her/his ability to do exercise contributes to exercise adherence. The more people think they can successfully do exercise signifies they will more likely adhere to the exercise program. Exercise adherence demonstrate an intrinsic (incentive to exercise based on the expected enjoyment) motivation to exercise (Huberty et al 2008)

Being overweight and/or obese consistently proves to be negatively associated with exercise adherence. Schrider highlights that a person’s future hopes may also motivate them to exercise. For instance, if a person wishes to be independent in older adulthood, he/she may begin an exercise program and stay physically active to reach that goal.

Below are some factors and tips that you may want to consider when you are trying to motivate your clients to exercise. It’s not an exhaustive list but rather some ideas to add to the tool box. Firstly you need to establish a sense of trust which is underpinned by effective listening and showing empathy.

1. Uncover your client’s needs

Perhaps the most critical skill in uncovering the needs of a client is the skill of inquiry. Central to effective dialogue, inquiry involves asking questions with a spirit of curiosity and with a goal of trying to understand how your client perceives exercise.

As practitioners we are keen for our clients to exercise. For our clients to start and the sustain exercising there is a direct relationship with their motivation, ability and willingness to take and sustain effective action. The more difficult or uncomfortable the action is, the more your client must obtain desire, resources and permission.

2. Desire

Clients need to have a desire or want to exercise. Practitioners can assist this by imparting appropriate knowledge. Research has consistently demonstrated that client’s “understanding of their condition and treatments is positively related to adherence” (Lipton-Dibner 2011) Adherence, satisfaction, recall and understanding are all related to the amount and type of information given.

Tips

• Limit instructions to 3 or 4 major points.
• Use simple, everyday language.
• After demonstrating or explaining exercise programs provide written material that is in a point form and clear to understand.
• Involve client’s family members and friends. For example if your client is commencing a walking program they may be more motivated if they do this with a family member, friend or walking group.

Don’t forget use a pedometer to provide feedback and motivate achieving more steps

• Choose something they will enjoy.
• Reinforce concepts at each visit.
• Simplify the exercise program. The more complex the program the greater the effect on adherence. Break down the exercise program into less complex stages. For example an exercise program for someone with lymphoedema usually includes exercises for the lymphatic system, range of movement, strengthening and cardiovascular. For clients that are new to exercise the practitioner may need to introduce each of these types of exercises separately and even break down each of these to smaller components.

3. Modifying beliefs and human behaviour

It is important to address the client’s belief, intention and self-efficacy (perceived ability to perform the action) as knowledge alone isn’t enough to enhance the desire for a client to exercise. Practitioners can assist by ensuring the client understands:

• The positive effects of the various exercise types.
• Reinforce that the client has the skills to perform the exercise program ( self- efficacy).

4. Client communication

Practitioners need to leave behind their bias. A client may have certain personality traits, education level or certain demographic factors but that doesn’t mean that they can be labelled with poor or good adherence. In fact a person’s adherence can fluctuate from time to time.

5. Evaluate adherence

Don’t forget to evaluate adherence eg a walking log book is a simple way to review a clients’ walking program.

6. Resources

Lack of sufficient resources such as  money, time, family support, transport and health can block a client’s ability to exercise.

7. Permission

The most complex and overlooked component of client’s ability to exercise is the degree to which action is blocked because the client isn’t willing to change. While there are many factors that inhibit permission the most common are fear, anger, lack of self-esteem and insufficient trust in the practitioners or in their opinion of what they are prescribing.

8. Promoting patient activities

The more difficult the action you want your clients to do, the greater must be their desire, resources and permission. Together they form the Action Plan.

Desire + Resources + Permission = Action