Welcome to Exercise adherence! Exercise adherence is the ability to stick to a regular exercise routine over time, and it is a crucial factor in achieving health and fitness goals. In this topic, we’ll recap on understanding human behaviour relating to changing client’s habits to achieve long-term health and wellness. You will also learn about common barriers and the skills to motivate your clients to adhere to exercise independently.
We’ll cover:
- Understanding human behaviour
- Factors effecting exercise adherence
- Strategies for exercise adherence
Remember, changing a client’s behaviour to form and maintain good habits is a gradual process that occurs in different stages and varies for each client.
It is crucial to identify which stage of change a client is in and support them accordingly, without pressuring them. This will help them progress towards successful changes at a suitable pace.
Let’s recap on the States of Change model you learnt in Behaviour Modification and how it needs to be considered with special population clients.
Stages of Change
The Stages of Change model, also known as the Transtheoretical Model, is a framework that describes the process of behaviour change. It consists of 6 stages:
| Stages | Description |
|---|---|
| Stage 1: Precontemplation |
When a client hasn’t considered changing their behaviour and may be unaware of the need for change. |
| Stage 2: Contemplation |
When a client recognise change is needed but may feel uncertain about taking action. |
| Stage 3: Preparation |
When a client is ready to take action and has a plan in place to make the necessary changes. |
| Stage 4: Action |
When a client begins to implement their plan and makes observable changes to their behaviour. |
| Stage 5: Maintenance |
When a client can sustain their change in behaviour over time and adhere to their newly formed habits. This should be a final stage, but a client may end up in Stage 6: Relapse which would require further action to get them back on track. |
| Stage 6: Relapse |
This stage is not ideal but is a common part of behaviour change. This is when a client was doing well, but then has regressed to undoing their newly formed habits. At this stage, it might require intervention and client action, where the cycles of stage 4 to stage 5 need to be repeated until it sticks. |
The Stages of Change model is useful for understanding the process of behaviour change and tailoring interventions to meet a client’s specific needs at each stage, but ultimately, making it your goal for your client to maintain exercise adherence independently.
Just like any general population groups, a special population client will also go through the same behaviour change when trying to adhere to exercise.
Exercise adherence is a crucial aspect of achieving the desired outcomes of any exercise programme. Whether it's weight loss, muscle gain, or improved overall health, clients who stick to their exercise routines are more likely to achieve their goals. There are general factors that affect exercise adherence. These general factors apply to all clients including special population clients.
Let's recap on some general factors and consider strategies that can help your client progress towards Stage 5 (Maintenance) in the States of Change model. Reflect on how you can assist your special population client in this process.
General factors
There are various factors that can influence exercise adherence, ranging from personal barriers to environmental factors. For many clients, a perceived lack of time, busy lifestyles, and work commitments can make it challenging to prioritise exercise.
Other common barriers include limited access to convenient exercise facilities, low self-efficacy, and low levels of motivation. Remember also that both intrinsic and extrinsic motivation can also play a significant role in determining an individual's exercise adherence.
Watch
Watch the following videos that mention a few common barriers that many of your clients may experience.
Let’s revisit some general factors, exploring strategies to overcome these barriers and promote exercise adherence for long-term health and wellness benefits.
Perceived lack of time
Clients may struggle to incorporate regular exercise into their daily schedules due to factors such as long working hours or family commitments. Additionally, the perceived importance of exercise can also impact a client’s ability to prioritise it within their daily routine.
For example, clients may prioritise the following aspects of their lives and use them as reasons for not having the time to exercise:
- Date night
- Family time
- Friends outing
- Work
- Social events
- Time with their pet(s)
- Watch TV
- Go shopping
Have you considered what you could do or say to help change your client’s perception regarding their “lack of time” to help your client make exercising a top priority?
Convenience
Convenience is a critical factor that can significantly affect exercise adherence. The location of a gym or fitness centre can either encourage or discourage a client from exercising regularly. If a gym is too far away, clients may find it difficult to make time to travel to the location and exercise. On the other hand, if a gym is conveniently located, individuals are more likely to stick to their exercise routines.
Also, the convenience in opening hours of a facility can affect exercise adherence as the client may not find their trading hours align with their free time that they would like to attend.
Additionally, the convenience of the workout itself can also impact exercise adherence. If a workout routine is too complicated or time-consuming, clients may find it challenging to incorporate it into their busy schedules.
Clients are more likely to adhere to their exercise routines if they are straightforward and easier to follow or if they are short in duration.
Overall, convenience is a crucial factor in achieving exercise adherence, and you should take convenience into account when designing workout routines and recommending workout facilities or locations to your clients.
- Can you think of ways others have considered convenience for clients?
- Can you think of convenient locations and trading hours of facilities?
- Can you think of any promoted exercises routines that are easy and/or short?
Self-efficacy
This may well be the largest predictor of exercise adherence. Self-efficacy refers to a client's belief in their ability to successfully perform a specific task or behaviour, such as exercising regularly. Self-efficacy in a client may determine whether they will be able to stick to their exercise routine over the long term.
Clients with high self-efficacy in exercise believe that they can overcome challenges, such as lack of motivation or difficult workouts, and stick to their exercise routine despite any setbacks they may encounter. Alternatively, clients with low self-efficacy in exercise may give up more easily when faced with these challenges, leading to lower exercise adherence.
You can help clients build self-efficacy in exercise by setting achievable goals, providing positive feedback, and helping them develop strategies for overcoming obstacles.
Self-motivation
Self-motivation typically refers to the pressure a client puts on themselves to perform at a high level.
Recall the following 2 types of motivation you learnt in Behaviour modification? See the following to jog your memory:
- Intrinsic - motivation which comes from within the individual e.g., performing an activity without a focus on the outcome, simply for the enjoyment of taking part, personal satisfaction or accomplishment.
- Extrinsic - motivation which comes from an external source e.g., pressured from others (family, partner, friends), material rewards such as money or the thrill of performing in front of a large crowd, sponsor or knowing talent scout is present.
After gaining information about your client and what barriers they may face, you will be able to apply strategies that act as building blocks that enable your client to reach exercise adherence.
Successful exercise professionals are problem solvers! It is essential to be prepared to work around the client’s barriers and develop a personalised, achievable and sustainable exercise routine.
Factors specific to special population clients
Adhering to exercise, simply put, means not to give up and to make it a part of your everyday life. It's important to remember that while these groups may have some things in common that make exercise challenging for them, not every person in the group will have the same issues. So, we can't assume or stereotype our clients. We need to get to know them individually through pre-screening and consultation and work closely with them to figure out how to help them meet their exercise goals.
Exercise adherence is important for both the general population and special population groups. However, special population groups may require additional considerations when it comes to exercise programming and adherence. For instance, clients with specific health conditions such as, arthritis or diabetes, may require modifications to their exercise programme to ensure safety and effectiveness. Additionally, factors such as pain, fatigue, and medication side effects may impact adherence. Therefore, when you are working with special population groups, you need to consider individualised programming, frequent communication, and ongoing support to promote adherence and achieve positive outcomes.
Now, let's take a closer look at some of the specific factors that might affect special population groups.
Obese
This is a very common special population group. When people that are obese have adhered to their exercise, they will notice dramatic changes to their body composition and overall health. When an obese client commences their States of Change cycle, they often go through a series of emotions and barriers before starting and during their exercise programme. People that are obese will need to change many lifestyle habits and behaviours to see results. Remember, changing all the habits and behaviours at once may not come easy, in fact, often there will be relapses where you need to help your client persevere. When you are coaching a person that is obese, you will need to consider the following barriers that can impact exercise adherence.
Participation: Obese clients are less likely to attend a high rate of exercise. Slowly introduce them to exercise that are achievable and comfortable before challenging them with difficult exercises.
Medical conditions: Obese clients are likely to suffer from medical conditions such as high blood pressure, diabetes, and physical conditions such as joint pain and lower back pain. Understanding their health status prior to prescribing exercise, collaborating with their health professionals and determining an appropriate exercise programme that supports them in achieving results without worsening any conditions is essential.
Self-esteem: Low self-esteem is a common barrier due to it hindering them from adhering to exercise. Negative self-talk may stop them from wanting to go to the gym. This is a behaviour that needs to change if they are to see results. They must move past body image or shaming themselves and keep reaching towards their goals and aims. Motivation and support on your part may be needed.
Enjoyment of exercise: A client that is obese will generally have a negative perception of exercise due to past experiences. They may feel inadequate or even limited due to their physical skills. Choosing an exercise that is both achievable and suitable within their fitness programme will help these clients gain confidence in their abilities. Remember, exercise releases endorphins that make you feel happy. This will also help clients enjoy exercising, simply because of how it makes them feel.
Weight loss diets
A weight loss diet can impact exercise adherence in a few ways. First, diets that involve severe calorie restriction can result in low energy levels, making it harder to find the motivation to exercise. Additionally, if a client is already restricting their food intake to lose weight, they may be less likely to add in exercise, as they feel they are already doing enough to achieve their weight loss goals.
Some diets can be unsustainable and difficult to maintain over the long term, leading to a cycle of weight loss and gain known as "yo-yo dieting." This can make exercise adherence more challenging, as clients may feel discouraged by the lack of progress or frustrated that they are not able to maintain their weight loss.
On the other hand, a balanced and sustainable weight loss diet that includes adequate nutrition and energy can actually improve exercise adherence. Eating a balanced diet can provide the necessary nutrients and energy to fuel physical activity and can also promote feelings of wellbeing and motivation to exercise. If your client is able to successfully lose weight and maintain a healthy weight, they may feel more confident and motivated to continue with an exercise routine to maintain their weight loss success.
Pregnant
Be careful not to assume that pregnant clients are unfit. Many pregnant clients are fitness enthusiasts and are just looking to exercise in a safe manner whilst pregnant and still achieve their results. Others on the other hand, may be completely new to exercise.
Whether your clients of this special population group are experts or novices to exercise, they may still have common barriers. These include:
Environment: Some pregnant clients may not feel comfortable in a male dominant environment. Be sure to discuss their preferences and comfort levels so that the prescribed exercise and its environment don’t lead to giving up on their exercise programme.
Physical condition: Specific exercises may be difficult to achieve due to their body’s centre of gravity moving forward. This can alter their balance and coordination making it hard to adhere to exercise. Be sure to modify specific exercises that are safe and suitable.
Medical condition: Pregnant clients are not classified as a medical condition, however, they may be difficulties in their pregnancy that can trigger medical conditions. For instance, they may develop gestational diabetes, sciatic nerve pains and lower back issues. All very common and must be treated by health professionals. These may be barriers to exercise adherence, however, liaising with their health professional can help you provide a safe and effective approach to ensure that the client has no fear to continue with their personalised exercise programme.
Stages of pregnancy: Depending on which trimester your client is in, may determine whether they can or cannot perform specific exercises. Stopping an exercise may trigger a relapse and it might get harder for the client to get back into a regular exercise routine. Ensuring you are speaking to their health professional will help develop a new exercise routine that suits their stage in pregnancy but does not stop the client from being active and achieving their results.
Elderly
Elderly clients are often less involved in regular exercise and their mobility may have declined with age. Once a regular exercise programme has been established, the elderly may be more likely to adhere.
It is without a doubt that a regular exercise routine will improve their quality of life and increase their endurance, strength and mobility. However, it is important to consider possible barriers that some elderly clients may endure. These include:
- Poor health
- Body aches and pains
- Lack of strength
- Fear of injury
Illnesses
No one is immune to illness. There are several illnesses that can directly impact the adherence to exercise for a client. Some illnesses can cause a temporary disruption whilst other illnesses may be ongoing, making it difficult for a client to stick with a regular exercise routine.
Though illnesses need to be considered when prescribing exercises, it doesn’t mean exercise needs to be avoided. Therefore, it is important we understand what types of barriers clients with illnesses may face so you are able to support your client with an indivdualised exercise programme that they can adhere to. These may include:
Physical limitations: Clients with certain illnesses may have physical limitations that make it difficult for them to engage in certain types of exercise. For example, someone with arthritis may have difficulty with high-impact exercises such as running or jumping. It is your job to prescribe and exercise that will not cause pain and that can be performed comfortably. Collaboration with the client’s health professional may be needed to be certain that the exercises prescribed are not only suitable, but easy for the client to sustain long-term.
Fatigue: Chronic illnesses like cancer, chronic fatigue syndrome, and fibromyalgia can result in extreme fatigue that makes it challenging for clients to find the energy to exercise. (Lindberg, 2019). As a result, clients may become discouraged and abandon exercise altogether. To avoid this, it is beneficial for you to work with their health professional to identify appropriate exercise options that minimise fatigue and do not interfere with their daily routines, but rather enhance them. By doing so, clients can maintain their physical health without becoming overwhelmed by the demands of exercise.
Pain: Chronic pain is a common symptom of many illnesses and can make it difficult for clients to engage in physical activity. However, at times, specific exercises can reduce the severity of pain symptoms. It is best to speak with their health professional to determine which exercises are best. Prescribing exercises that will illuminate or minimise pain can assist in clients adhering to regular exercise.
Fear of exacerbating symptoms: Some individuals may be hesitant to exercise for fear that it will exacerbate their symptoms or cause injury. Unknowingly, they may be avoiding exercise when it can at times be recommended for certain illnesses such as diabetes, heart conditions and obesity. With chronic illnesses of any case, you must always seek advice and/or approval from their health professional. Trust can be built with your client when you demonstrate that you are able to collaborate with their health professional to seek information and implement an exercise that is indivdualised for them, ensuring their symptoms will not be affected.
Many clients believe that exercise can exacerbate their symptoms, and are unaware of how exercise may be of benefit. See the following list describes how exercise can help clients with diabetes.
- Improves the management of diabetes by having insulin work better.
- Reduces insulin resistance and reduces blood glucose levels.
- Improves joint and muscle movement and strengthens bones.
- Maintains a healthy weight.
- Lowers blood pressure.
- Reduces the risk of heart disease.
- Reduces stress and anxiety.
- Improves sleep. (Diabetes Australia, n.d.)
It is important for clients with illnesses to work closely with their health professional to develop an exercise plan that takes into account their specific limitations and needs. By doing so, they can improve their overall health and wellbeing while minimising the risks of exacerbating their symptoms or causing injury.
As an exercise coach, you'll need to develop skills that significantly influence and support your clients. These skills relate to how you interact with your clients, introduce exercises, and set them up for long-term success. You want your client to sustain a positive relationship with exercise and nutrition.
By getting to know your client’s building a strong rapport with your clients, you will be able to determine your client’s needs, limitations, barriers, goals, and even their excuses for not exercising. This will allow you to provide personalised support by identifying which strategies will be most useful and guide them towards achieving exercise adherence.
Practical recommendations
There are many ways in which you can support your client to balance the obstacles which life can present. The following are some practical recommendations to guide you in effectively supporting your clients and achieving exercise adherence.
- Positive reinforcement of desirable behaviours.
- Provision and encouragement of social interaction. E.g. group exercises, group Personal training.
- Discussion of barriers and strategies to overcome them.
- Provision of specific individualised feedback.
- Prevention of disruptions to training.
- Improving enjoyment through tailoring activities to client preferences and adding variety.
- Positive feedback.
- Stay in touch with your client. E.g. via Phone calls, texts and emails.
- Discuss barriers and help find solutions.
- Revisit client’s initial goals and aims.
- Re-emphasise the importance of exercise and how it will benefit them.
- Adaptations to the programme to suit client needs.
- Discuss ways your client can gain family support or participate in exercises together. E.g., kids bike ride while your client jogs or power walks.
- Discuss and agree on an established routine that the client can achieve independently.
Don’t forget, avoiding injuries can also mean that there is less chance for relapse as they can maintain consistency with exercising. The following describes ways to prevent injuries to a variety of special population clients.
Preventing injuries
When it comes to preventing injuries for obese, ill, elderly, and pregnant clients, there are a few things to keep in mind.
Firstly, it's important to start with proper screening and assessment to determine the client's health status and any potential risk factors that could lead to injuries. Once you have this information, you can create a customised exercise plan that takes into consideration their individual needs and limitations.
For obese clients: It is recommended to include low-impact exercises that are easier on the joints, such as walking or swimming, may be more appropriate. Additionally, it's important to ensure that any equipment being used can accommodate their weight and size.
For ill or elderly clients: It's important to focus on exercises that improve strength, balance, and flexibility. These exercises can help prevent falls, which are a common cause of injury for these populations.
For pregnant clients: Include exercises that are low-impact and not too strenuous are usually recommended. It's important to avoid any exercises that could increase the risk of falls or put too much pressure on the abdomen.
In general, it's important to start slowly and gradually increase the intensity and duration of the workout over time. Encouraging proper form and technique is also crucial to prevent injuries. Remember, communication is key. Encourage clients to speak up if they experience any pain or discomfort during a workout, so that you can adjust the programme accordingly.
A few extra tips to avoid injuries on your clients during exercise include:
- a proper warm-up is performed
- appropriate exercise attire is worn
- the environment is suitable for the session
- the client is monitored at all times during the session
- adequate hydration and rest are achieved and look for “danger signs”, chest pain, dizziness etc.
Implementing strategies
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time.Thomas Edison
As an exercise professional, it's important to help your clients prepare for situations that could lead to them stopping their exercise routine, or "relapsing." Instead of seeing these moments as failures, they should be viewed as challenges that are bound to happen from time to time. For example, during the winter months, it can be tempting to stop exercising because it's too cold outside.
It's crucial to educate clients on how to deal with these moments of relapse so they can adhere to exercise.
Here are some strategies that can enhance the practical recommendations and further support your client with exercise adherence.
Identify barriers
Identify barriers that can trigger a relapse. For example, if you know that your client’s busy work schedule causes them to skip workouts, you can plan ahead and schedule your client’s exercise sessions at a different time or on a different day.
Explaining benefits of exercising
One approach to motivating our clients is by educating them. It may help your client to know how exercise exercise benefits them.
Here are some ways exercise can be beneficial to clients. See if you can determine which apply to specific special population clients.
| Immediate benefits (brain health) | “Benefits include improved thinking or cognition for children 6 to 13 years of age and reduced short-term feelings of anxiety for adults. Regular physical activity can help keep your thinking, learning, and judgment skills sharp as you age. It can also reduce your risk of depression and anxiety and help you sleep better.” (CDC, 2022) |
| Weight management | Exercise can assist in both maintaining and losing weight. |
| Reduce health risk | Being physically active lowers your risk for developing several common cancers along with reducing the risk of cardiovascular diseases and diabetes. |
| Strengthen bones and muscles | “This is important for older adults who experience reduced muscle mass and muscle strength with aging. Slowly increasing the amount of weight and number of repetitions you do as part of muscle strengthening activities will give you even more benefits, no matter your age.” (CDC, 2022) |
| Improve physical ability prevents falls | By implementing activities such as aerobic, muscle strengthening, and balance training, you can help prevent falls, in particularly for elderly clients. |
| Increase your chances of living longer | An increase in movement and steps for older age groups can enhance your years of life. |
| Manage chronic health conditions & disabilities | “Helps clients manage existing chronic conditions and disabilities. For example, regular physical activity can:
|
(CDC, 2022)
Watch
Check out the following Ted Talk by Wendy Suzuki.
She's a neuroscientist who explains how exercise can benefit you in a lot of different ways, including protecting your brain from diseases. This really inspiring talk highlights how even just one minute of movement everyday can make a difference. Take note of the immediate benefits that can be used to assist clients with motivation and adherence.
Set realistic goals
You want to set your client up for success. This means their goals need to be realistic. Setting unrealistic goals can be overwhelming and lead to frustration. Work with your client to set achievable and realistic goals that align with their fitness level, lifestyle and consider any existing conditions.
Motivate your clients
You may ask yourself… “How can I motivate my clients to maintain a personal fitness programme?”
To motivate your clients, there are a few things you can do. The first thing to know is that you'll need to help them stay motivated not just at the beginning of their programme, but also during and after it. That way, they'll be able to keep up with their exercise routine on their own.
To get started, there are a few strategies you can use to motivate your clients, and it's important to find what works best for each individual. Motivating your clients starts with finding the right approach for them and helping them stay on track throughout their fitness journey.
Develop a support system
Have your client set up their own support system. Sometimes having family and friends to hold your client accountable can be an excellent way for them to stay motivated. To implement exercise long turn, you can discuss with your client ways that different support systems may work for them. For instance, clients can:
- join a fitness group.
- find a workout buddy.
- scheduling regular check-ins with you.
- join mothers groups that work out together and/or with their children.
- jog while their children ride their bikes.
- use social media to connect with like-minded people.
- join a community of exercise groups.
- gain support of family, friends and co-workers (preferably sought from the beginning).
Programmes where people exercise alone compare poorly with those programmes incorporating group dynamics in terms of adherence rates.
The commitments made as part of a group tend to be stronger than those made independently. The social support provided by others may offer the incentive to continue even during periods of sagging interest.
Create a plan
Have you ever realised that a missed day at the gym can turn into weeks or months without returning? This is because you need to have a plan and stick to it!
Develop a plan for your client that outlines specific actions they can take when they experience a setback or a relapse. For example, if they miss a workout, plan to make up for it the next day or do a shorter workout at home. Help your clients to develop a growth mindset and view setbacks as opportunities for learning and improvement. Creating this mindset is the best way to set you client up with the independent skills to adhere to their exercise without reliance of others.
Find out what motivational strategy works for them and have them motivate and push themselves to continue with their exercise.
Celebrate successes
It is nice when you celebrate your client’s successes. But teach them to also celebrate their successes along the way, no matter how small they may be. This can help them stay motivated and reinforce positive behaviours.
Remember, preventing a relapse and adhering to exercise is not always easy, but with the right support and strategies, it is possible to maintain a consistent exercise routine and achieve your fitness goals.
