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Copyright © 2014 American College of Sports Medicine
Chapter 4
Building Motivation: How Ready Are You?
Chapter 4
Building Motivation: How Ready Are You?
Copyright © 2014 American College of Sports Medicine
Chapter OverviewChapter Overview
• Transtheoretical Model of Behavior Change (TTM)
• Decisional balance
• Self-efficacy
• Stage paradigm
• Avoiding boredom
• Relapse prevention
Copyright © 2014 American College of Sports Medicine
The Transtheoretical Model of Behavior Change (TTM)The Transtheoretical Model of Behavior Change (TTM)
• Stages of Change model
• Assess client readiness
• Deliver tailored messages
• Success of TTM-based interventions
• Change as process over time
Copyright © 2014 American College of Sports Medicine
The Transtheoretical Model of Behavior Change (TTM) – cont’dThe Transtheoretical Model of Behavior Change (TTM) – cont’d
Copyright © 2014 American College of Sports Medicine
Copyright © 2014 American College of Sports Medicine
TTM: Precontemplation StageTTM: Precontemplation Stage
• Not intending to conduct physical activity in next 6 months
• Three D’s
• Perceived barriers
• Low self-efficacy
• Lack of information
Copyright © 2014 American College of Sports Medicine
TTM: Contemplation StageTTM: Contemplation Stage
• Intending to conduct physical activity in next 6 months
• Aware of pros
• Unaware of cons
• Ambivalent
• Chronic contemplation
• Lack confidence and commitment
Copyright © 2014 American College of Sports Medicine
TTM: Preparation StageTTM: Preparation Stage
• Ready to conduct physical activity in 30 days
• Have taken steps toward this goal
• Great candidates for traditional messaging programs
• More committed and confident
Copyright © 2014 American College of Sports Medicine
TTM: Action StageTTM: Action Stage
• Adopted exercise within past 6 months
• Actively create new habit
• Likely to experience a setback if experience a challenge
Copyright © 2014 American College of Sports Medicine
TTM: Maintenance StageTTM: Maintenance Stage
• Have been exercising regularly for over 6 months
• More confident
• Low confidence/self-efficacy lead to discontinuation
Copyright © 2014 American College of Sports Medicine
Moving Forward in TTMMoving Forward in TTM
• Individual’s stage has implication on intervention design
• Forward stage movement predicts success
• Encourage behavior change strategies specific to stage
• Decisional balance, self-efficacy, and ten processes of change
Copyright © 2014 American College of Sports Medicine
Decisional BalanceDecisional Balance
• Individual’s relative weighting of pros and cons
• Relationship of pros and cons across the stages
• Raising pros is twice as important as lowering cons
• Crucial to raise pros at early stages
• Contemplation is time to address barriers
Copyright © 2014 American College of Sports Medicine
Self-efficacySelf-efficacy
• Individual’s confidence to make and sustain changes
• Low in Precontemplation; increases across stages
• Important to raise early with small goals
• Build confidence for increasingly difficult challenges
Copyright © 2014 American College of Sports Medicine
The Processes of ChangeThe Processes of Change
• Behavior change strategies to progress through TTM
• Experiential processes are emphasized in earlier stages
• Behavioral processes are emphasized in later stages
• Process use differs throughout stages
Copyright © 2014 American College of Sports Medicine
Stage ParadigmStage Paradigm
• Majority of individuals are not ready to change
• Employ most effective strategies at right time
• Encourage using specific processes
Copyright © 2014 American College of Sports Medicine
Stage Paradigm: Step 1Stage Paradigm: Step 1
• Assess readiness to change
• Match intervention program to client needs
• How ready is client to meet public health recommendations?
• Determine physical limitations
Copyright © 2014 American College of Sports Medicine
Stage Paradigm: Step 2Stage Paradigm: Step 2
• Target intervention to readiness
Copyright © 2014 American College of Sports Medicine
Stage Paradigm: PrecontemplationStage Paradigm: Precontemplation
Goal: Encourage clients to view success as progress to Contemplation
•Increase pros
•Raise consciousness
•Social liberation
•Environmental reevaluation
Copyright © 2014 American College of Sports Medicine
Stage Paradigm: ContemplationStage Paradigm: Contemplation
Goal: Encourage clients to view success as progress to Preparation
•Make pros outweigh cons
•Raise consciousness
•Self-reevaluation
•Dramatic relief
•Encourage small steps
Copyright © 2014 American College of Sports Medicine
Stage Paradigm: PreparationStage Paradigm: Preparation
Goal: Encourage clients to view success adoption of regular physical activity
•Counterconditioning
•Stimulus control
•Helping relationships
•Reinforcement management
•Self liberation
•Self-efficacy
Copyright © 2014 American College of Sports Medicine
Stage Paradigm: ActionStage Paradigm: Action
Goal: Help clients continue to conduct physical activity regularly
•Self liberation
•Helping relationships
•Self-reevaluation
•Counterconditioning
•Self-efficacy
Copyright © 2014 American College of Sports Medicine
Stage Paradigm: MaintenanceStage Paradigm: Maintenance
Goal: Help clients make regular physical activity a life-long habit
•Stimulus control
•Counterconditioning
•Reinforcement management
•Get support
•Recycling
Copyright © 2014 American College of Sports Medicine
Stage ParadigmStage Paradigm
Copyright © 2014 American College of Sports Medicine
Copyright © 2014 American College of Sports Medicine
Avoiding BoredomAvoiding Boredom
• Boredom may cause relapse to sedentary behavior
• Incorporate variety in routines
• Vary route
• Change music
• Invite different friends
Copyright © 2014 American College of Sports Medicine
Strategies to Avoid BoredomStrategies to Avoid Boredom
• Reconceptualize boredom as an opportunity
• Identify what your client gets out of exercise and what types of activities could provide that outcome
• Look for other helpful information
• Explore other types of exercise
Copyright © 2014 American College of Sports Medicine
Strategies to Avoid Boredom (cont.)Strategies to Avoid Boredom (cont.)
• Internalize motivation
• Ask for help (friends, family, or coworkers)
• Realistically evaluate goals and expectations
• Track progress daily
Copyright © 2014 American College of Sports Medicine
Strategies to Avoid RelapseStrategies to Avoid Relapse
• Foresee setbacks
• Recognize times tempted to skip workout
• Develop strategies to avoid temptation
• Recognize previous accomplishments, successes, and new knowledge
• Reward self for accomplishments
Copyright © 2014 American College of Sports Medicine
Strategies to Avoid Relapse (cont.)Strategies to Avoid Relapse (cont.)
• Identify other people or groups that may help
• Identify cues that trigger sedentary behavior
• Substitute negatives with positives
• Stay updated with exercise strategies, opportunities, and benefits
• Monitor exercise routines, progress, goals, and setbacks
Copyright © 2014 American College of Sports Medicine
Behavior Change Resources: WebsitesBehavior Change Resources: Websites
• Centers of Disease Control: http://www.cdc.gov/physicalactivity/index.html
• National Institutes of Health: http://health.nih.gov/topic/ExercisePhysicalFitness http://health.nih.gov/topic/ExerciseForSeniors
Copyright © 2014 American College of Sports Medicine
Behavior Change Resources:Computer-Tailored InterventionBehavior Change Resources:Computer-Tailored Intervention
• LifeStyle Management Suite: www.prochange.com/myhealth
Copyright © 2014 American College of Sports Medicine
Take-Home MessagesTake-Home Messages
• Use stage-appropriate strategies with entire population of clients
• Assess client’s readiness
• Tailor interventions to stage of change
• Recognize unique needs of individuals
• Prepare prior to taking action to decrease relapse rates