1. ACE Personal Trainer Manual 5th Edition
Chapter 4: Basics of Behavioral Change and Health Psychology
Lesson 4.1

2. BEHAVIOR THEORY MODELS
Health belief model
The health belief model predicts that people will engage in a health behavior (e.g., exercise) based on the perceived threat they feel regarding a health problem and the pros and cons of adopting the behavior.
This perceived threat is defined as the degree to which a person feels threatened or worried about the prospect of a particular health problem and is influenced by several factors:
Perceived seriousness
Perceived susceptibility
Cues to action
Ultimately, the client will assess the benefits along with the barriers of making a lifestyle modification.
Perceived seriousness:
Refers to the feelings one has about the seriousness of contracting an illness or leaving an illness untreated
The more serious the consequences are perceived to be, the more likely people are to engage in a health behavior.
Perceived susceptibility:
Is based on a person’s subjective appraisal of the likelihood of developing the problem
People have a higher perceived threat and an increased likelihood to engage in a health behavior when they believe they are vulnerable to a particular health problem.
Cues to action:
Refers to events that motivate people to make a change
The more people are reminded about a potential health problem, the more likely they are to take action and engage in a health behavior.

3. BEHAVIOR THEORY MODELS
Health belief model
The pros and cons of engaging in a health behavior are examined in terms of perceived benefits and perceived barriers:
A client will compare the benefits with the barriers of making a change.
If more barriers are perceived than benefits, change is unlikely.
If the perceived benefits outweigh the barriers and the perceived threat of illness is high, preventative action is likely.
If a client perceives very little threat, change is unlikely.
Personal trainers should understand client perceptions regarding illness and health, including the perceived benefits and barriers to program participation and success:
Make the seriousness of the illness more apparent.
Implement cues to action by introducing health information and education.

4. SELF-EFFICACY
Self-efficacy can be defined as the belief in one’s own capabilities to successfully be physically active.
Self-efficacy is important because it is believed to influence thought patterns, emotional responses, and behavior.
Self-efficacy is an ongoing part of the client–trainer relationship and will continually change, so a personal trainer should:
Ask about previous exercise experience
Ask about feelings and emotions associated with starting exercise
Ask about expectations and apprehensions related to exercise
Ask about potential barriers for program adherence
Take advantage of increases in self-efficacy and make program modifications when self-efficacy levels drop
Personal trainers can best gain an understanding of a client’s self-efficacy level through consistent communication and rapport-building strategies.

5. Six sources of self-efficacy information
Past performance experience
Vicarious experience
Verbal persuasion
Physiological state appraisals
Emotional state and mood appraisals
Imaginal experiences
Past performance experience:
Previous exercise experience will strongly influence current self-efficacy levels.
Past performance experience is the most influential source of self-efficacy information.
Vicarious experience:
The observation or knowledge of someone else who is successfully participating in a similar program—or has done so in the past—can increase one’s self-efficacy.
Verbal persuasion:
Typically occurs in the form of feedback
Statements from others are influential if they come from a credible, respected, and knowledgeable source.
Physiological state appraisals:
A client may perceive arousal, pain, or fatigue.
May lead to judgments about their ability to participate successfully
Emotional state and mood appraisals:
Negative mood states and emotional beliefs associated with exercise (e.g., fear, anxiety, anger, and frustration) are related to lower levels of participation and self-efficacy.
Positive mood states and emotional beliefs, including mastery, are related to higher levels of self-efficacy.
Imaginal experiences:
Refer to the imagined experiences (positive or negative) of exercise participation
A client’s preconceived notion of what exercise will be like will influence actual self-efficacy levels.

6. SELF-EFFICACY
Self-efficacy levels will influence the types of tasks an individual wants to engage in, how hard they will try, and if they will persist:
People with high self-efficacy will:
Choose challenging tasks, set goals, and display a commitment to master those tasks
Display maximum effort to reach their goals and even increase their effort when challenges arise
Work to overcome obstacles and challenges and will recover from setbacks
People with low self-efficacy will:
Be more likely to choose non-challenging tasks that are non-threatening and easy to accomplish
Display minimal effort to protect themselves in the face of a challenge
Likely lose faith, give up, and drop out of the program if faced with too many setbacks
Personal trainers should always take the time to gain an understanding of the self-efficacy levels of their clients:
Most effective when done through conversation and by understanding what an individual believes about his or her ability to succeed
Increases the ability to design a program that sets the client up for success

7. TRANSTHEORETICAL MODEL OF BEHAVIOR CHANGE
Precontemplation stage
People are sedentary and are not even considering an activity program.
They do not see activity as relevant in their lives.
They may even discount the importance of being physically active.
Contemplation stage
People are still sedentary.
They are starting to consider activity as important.
They have begun to identify the implications of being inactive.
They are still not ready to commit to making a change.
Preparation stage
Marked by some physical activity
People are mentally and physically preparing to adopt an activity program.
Activity is sporadic, periodic, and inconsistent.
They are ready to adopt and live an active lifestyle.
Action stage
People engage in regular physical activity.
They have been participating for less than six months.
Maintenance stage
People are engaged in regular physical activity.
They have been participating for longer than six months.

8. Succeeding at making a behavioral change is not a simple task.
PROCESSES OF CHANGE
Not everyone is ready to start a regular exercise program, and personal trainers must stop using the “one-size-fits-all” approach to exercise program design and implementation.
Succeeding at making a behavioral change is not a simple task.

9. PROCESSES OF CHANGE
The general goal of any intervention should be to advance the individual to the next stage of change.
A personal trainer first should try to identify the current stage of the client:
If someone is actively seeking information about fitness programs, he or she may be in the contemplation stage.
If someone is inconsistently working out, he or she may be in the preparation stage.
Listening to the types of questions an individual is asking, and to any hesitations, may help identify the current stage of change.

10. TTM AND SELF-EFFICACY
There is a circular relationship between self-efficacy and behavioral change:
Self-efficacy is related to whether a person will participate in an activity.
Participation in activity influences a person’s self-efficacy level.
Therefore, self-efficacy determines behavior and is also an outcome of behavioral change.
Additionally, there is a relationship between self-efficacy and stage of behavioral change:
Precontemplators and contemplators have lower levels of self-efficacy.
They are not exercising (or are inconsistent), and perhaps believe they do not have the ability or knowledge required to be active.
People in the action and maintenance stages have higher levels of self-efficacy.
They are engaged in regular activity, thus demonstrating a belief in the ability to be active.
Self-efficacy is strongly related to program adoption and maintenance.

11. TTM AND SELF-EFFICACY
The most important and powerful predictor of self-efficacy is past-performance experience:
A client with past success will have higher self-efficacy regarding his or her ability to be active in the future.
A client with no exercise experience will have lower self-efficacy regarding his or her ability to engage in an exercise program.
The trainer’s primary goal is to get non-exercisers positive exercise experience:
By influencing self-efficacy, a client may progress through the stages more efficiently.
By trying to increase self-efficacy, a personal trainer may be able to help a client progress to the action stage more quickly. .

12. TTM AND DECISIONAL BALANCE
Decisional balance refers to the number of pros and cons perceived about adopting and/or maintaining an activity program:
Perceived gains associated with adopting desired behaviors
Perceived losses associated with adoption desire behaviors
Strategies to maximize potential for achieving gains
Strategies to minimize potential for perceived losses
The perceived cons do not have to be logical or realistic and may be a result of misinformation and a lack of experience.
The decisional balance worksheet presented in Figure 4-1 can be used to help clients weigh the perceived benefits against the potential costs involved with making a change.
While this worksheet is a valuable tool to help trainers and clients work together to clarify potential barriers or psychological roadblocks, it is important that trainers do not become overly reliant on worksheets.
The most effective approach is for trainers to use worksheets in conjunction with continued communication and observation to build a complete understanding of client needs and to develop appropriate programming.
A natural change in decisional balance occurs as people progress through the stages of change:
The balance of pros and cons shifts – more pros are perceived
Focusing on both short- and long-term benefits is necessary:
Long-term weight-loss benefits can be overwhelming and may make those benefits seem unattainable.
Short-term benefits, such as increased energy and mastery of the exercise itself, will give the client something to look forward to immediately.

13. RELAPSE
Relapse is the act of returning to a previous condition, which can:
Occur at any stage of the TTM, including during the maintenance stage
Be triggered by many events and change into irregular or even no activity:
Moving
Change in job or work hours
Family changes
Injury
Change the behavior and commitment of long-term exercisers, which should not be taken for granted
Occur on any given day

14. STAGES OF CHANGE
Review the following examples of individuals in each of the stages of change. How would you respond in each scenario?
Precontemplation: You are having a discussion with your uncle, who is questioning how anyone can make a living by helping people exercise. Your uncle is sedentary and thinks that exercise is for women who take aerobics or for bodybuilder types who are looking to bulk up. He views exercise as completely irrelevant to his life. Your initial thought is to argue with your uncle and to tell him that he is completely misinformed, but this would be counterproductive. How would you educate your uncle without lecturing or arguing with him?

15. STAGES OF CHANGE
Contemplation: You receive a phone call at the gym from a woman who saw an advertisement for a free trial week. She says that she does not currently work out and that she has never exercised in a gym before. She seems very apprehensive and nervous on the phone and says that she is not sure if it is for her, but that she knows she needs to be more active. She asks if there is any programming for beginners and if someone will be available to help her if she comes in, since she does not know what she is doing. How would you respond, and what is the most appropriate course of action for working with this potential client?

16. STAGES OF CHANGE
Preparation: You are approached by a member at the gym who comes in a few times a month and goes through a basic workout. He tells you that he wants to be more consistent and lose weight, but that he is having a difficult time finding the motivation. He says that he is not really sure what he needs to be doing and that he needs help. How would you respond to this club member to best enhance his motivation for true lifestyle change?

17. STAGES OF CHANGE
Action: You have a female client who has been consistently training three days a week for a couple of months. She is seeing great results and loves her workouts. She is always happy to come in and never misses an appointment. The client has two children and, with the school year coming to an end, knows her schedule will change. She really wants to continue to train. You encourage the client by telling her how great she has done, reminding her how much she has accomplished. The two of you then talk about the challenges she will face trying to stick to her workouts when her children are out of school. How will you help your client adjust to her new schedule?

18. STAGES OF CHANGE
Maintenance: A long-time client has lost more than 60 pounds (27 kg) and feels great. He has reached his goals and loves being physically active. He has even started taking his family for hikes on the weekends. He rarely misses an appointment and is one of your easiest clients to deal with. You understand, however, that this state of consistency may not last forever, so you plan a sit-down session with the client to evaluate the program and set new goals. How would you manage this meeting and what topics would you discuss in order to help your client anticipate and overcome potential obstacles to continued success?

19. PRINCIPLES OF BEHAVIORAL CHANGE
The adoption of physical activity is a complicated process that requires replacing sedentary behaviors with healthy, active behaviors.
This process of behavioral change is a gradual progression that requires effort, dedication, and commitment.
A personal trainer must understand the factors that control behavior:
Operant conditioning
Shaping
Observational learning
Cognitions and behavior
It is the personal trainer’s job to provide guidance and support to help change client behaviors by influencing their attitudes, motives, emotions, and performance.

20. PRINCIPLES OF BEHAVIORAL CHANGE
Operant conditioning is the process by which behaviors are influenced by their consequences and examines the relationship between:
Antecedents
Behaviors
Consequences
Operant conditioning examines the behavior chains that lead to the engagement of certain behaviors and the avoidance of others, taking into account the consequences associated with each behavior:
Behaviors are strengthened when they are reinforced.
By using reinforcements, positive behaviors have consequences that increase the likelihood of the behavior happening again.
At the most basic level with a new client, a positive behavior is simply showing up to the gym. If the success of this behavior (which can be a real victory for a new exerciser) is ignored by the personal trainer, the likelihood of it happening again will decrease.
However, if the client is verbally rewarded for showing up and is further rewarded with a positive, pleasant, and supportive workout experience, then the behavior has been positively reinforced and the likelihood of it happening again has been increased.
As personal trainers, the opportunity to trigger lasting change is always present, and the basic principle of operant conditioning can serve as a good reminder of the influence personal trainers have with each client they encounter.

21. PRINCIPLES OF BEHAVIORAL CHANGE
The consequence following a behavior will influence the future occurrence of that behavior.
Positive reinforcement:
The presentation of a positive stimulus
Increases the likelihood that the behavior will reoccur
Negative reinforcement:
The removal or avoidance of aversive stimuli following the undesirable behavior
Also increases the likelihood that the behavior will reoccur
The most important component of operant conditioning is what happens after a behavior is executed.
For example, if a client is late to a training session and the trainer does not say anything about the tardiness and just extends the workout in accordance with the number of minutes that the client was late, this client will likely be late again because there was not accountability or an aversive consequence to his tardiness.
If a tardy client was told that his appointment was cancelled due to his tardiness and that he must be on time for his workout sessions, he will likely not be late again.

22. PRINCIPLES OF BEHAVIORAL CHANGE
Extinction:
Occurs when a positive stimulus that once followed a behavior is removed
Decreases the likelihood of the behavior reoccurring
Punishment:
Consists of an aversive stimulus following an undesirable behavior
Increases fear
Decreases enjoyment
Must be used sparingly and only when appropriate
It is important that trainers learn to provide appropriate feedback and consequences to clients’ behaviors.
Actions that are done well should be positively reinforced and actions that need improvement should not be ignored.

23. STRATEGIES FOR BEHAVIORAL CHANGE
Stimulus control refers to making adjustments to the environment to increase the likelihood of healthy behaviors, such as:
Choosing a gym that is in the direct route between home and work
Keeping a gym bag in the car that contains all the required items for a workout
Having workout clothes, socks, and shoes laid out for early morning workouts
Writing down workout times as part of a weekly schedule
Clients surrounding themselves with other people interested in being active
The overall goal of stimulus control is to make being physically active as convenient as possible.
Personal trainers should listen continuously for cues from their clients that are reflective of difficulty with adherence, and should be prepared to provide tips and strategies to help reduce the effort required to stick with the program.

24. STRATEGIES FOR BEHAVIORAL CHANGE
Written agreements and behavioral contracting are effective behavior-change tools that can be used together or on their own to help people stick with their exercise programs.
Written agreements:
Should be developed first before contracts
Can be between the personal trainer and client or just by the client
Should outline the expectations of the client and the trainer
Decrease ambiguity and clarify the roles of all people involved
Should be so specific that behaviors, attitudes, and commitments are clearly outlined
Will only be effective if the client has an active role in its development
Should be reviewed and adjusted at all program-modification points

25. STRATEGIES FOR BEHAVIORAL CHANGE
Once a written agreement has been established, an effective behavioral contract should be created.
Behavioral contracts:
Are created by both the personal trainer and client
Should outline a system of rewards for maintaining the program and maximizing adherence
Rewards must be outlined by the client.
Rewards must be meaningful or they will not be perceived by the client as worth the effort.
Must be revised and updated as goals are met and programs are modified

26. STRATEGIES FOR BEHAVIORAL CHANGE
Cognitive behavioral techniques are effective tools that influence behavioral change by targeting how people think and feel about being physically active.
When using cognitive techniques, one must:
Identify problematic beliefs that are barriers to change
Change the obstructive thoughts
Effective cognitive behavioral techniques include:
Goal setting
Feedback
Decision making
Self-monitoring
As with all behavior-change techniques, cognitive behavioral techniques are effective when used alone and when used together with other behavior-change strategies.

27. STRATEGIES FOR BEHAVIORAL CHANGE
Goal setting is one of the most widely used and straightforward cognitive behavioral techniques.
In order for goal setting to be most effective, goals must:
Be included as a regular part of the exercise program
Be written following the SMART goal guidelines (specific, measurable, attainable, relevant, and time-bound)
Clients should always be aware of what they are working toward and what it will take to get there.
Personal trainers should be able to clearly guide clients through the goal-setting process and help them understand how to set effective and appropriate goals.

28. STRATEGIES FOR BEHAVIORAL CHANGE
Extrinsic feedback is most common and includes the reinforcement and encouragement that personal trainers give to their clients.
As efficacy and ability build, trainers should:
Taper off the amount of external feedback they provide
Encourage clients to start providing feedback for themselves
Long-term program adherence is dependent on a client’s ability to provide internal feedback.
Clients must learn to reinforce their own behaviors by providing internal encouragement, error correction, and even negative consequences.
It is important for personal trainers to not give too much feedback.

29. STRATEGIES FOR BEHAVIORAL CHANGE
Decision making is reflective of a client’s ability to control a situation and choose appropriately among alternative courses of action.
Personal trainers can teach effective decision-making skills by giving clients control over their own program participation.
It is important that personal trainers:
Do not make every decision and micromanage their clients’ programs
Provide their clients the information needed to determine the outcome of their programs
Continuously educate their to give them the knowledge they need to be successful on their own .

30. STRATEGIES FOR BEHAVIORAL CHANGE
Self-monitoring helps a client keep track of program participation and progress, or lack thereof.
Self-monitoring is also:
An information-gathering process that will help clients and trainers identify potential barriers to success
Most effective in the form of keeping a journal that records thoughts, experiences, and emotions
Extremely helpful in developing an effective plan for long-term adherence
Only committed clients will be able to successfully self-monitor, as it requires honesty and self-reflection.

31. IMPLEMENTING STRATEGIES FOR BEHAVIORAL CHANGE
No assessment tool is available that personal trainers can give to their clients that will provide all the information they need about self-efficacy, health beliefs, and readiness to change.
Therefore, it is essential for the personal trainer to be able to:
Use effective and consistent communication to gain a better understanding about each client
Gather information through effective communication and observation for use in the program design and implementation
Continually gather information about the client’s attitudes, thoughts, and beliefs as part of each training session
Make minor adjustments and modifications to the program on an ongoing basis
Use feedback to be aware of the changes occurring with the client and make appropriate adjustments that maximize adherence
Effective and successful personal trainers will not only understand the theoretical constructs of behavioral change, but will also be able to apply that information when working with clients.
It is this application of knowledge that will generate adherence and long-term success for the trainer and the client.

32. PRINCIPLES OF BEHAVIORAL CHANGE
Think about your own daily routine and how you may already be using some of the principles of behavioral change in your own life.
Are there any techniques you can encourage your clients to use to improve their program adherence or adoption of sustained healthy lifestyle changes?