1. Individual-Level Interventions EPHE 348

2. Interventions  Defn: promoting activities that change psychosocial, biological, or behavioural outcomes –Efficacy trials –Effectiveness trials

3. So….what works?  Average individual-level intervention effect is a small effect size (Dishman & Buckworth, 1996; Hillsdon et al., 2005; Kahn et al, 2002)  This lowers with clinical, obese, and disabled populations

4. Figure 17.2

5. Types of interventions  Behaviour modification (small effect)  Cognitive modification (trivial)  Health education (trivial)  Prescription (trivial)  Curriculum (small)

6. Implemetation  Marcus et al. 2007 show relatively little difference across medium (face to face, internet, booklet, group, etc.)  Face to face and internet have current appeal

7. What Generally Makes A Good Exercise Counselor?  Most important instrument during prescription is yourself as a person  Bring the human qualities and the exercise experiences that have influenced yourself to the session  Being merely a technical expert will result in a sterile experience for the client

8. General Exercise Counseling Roles  Provide a climate for change  Arrive at an prescription/intervention that is best for the client while meeting the requirements of the prescription  Help clients recognize their own strengths and weaknesses, and discover how to overcome their barriers

9. When Should You Counsel?  Counsel when the issues are linked to exercise or you have knowledge in the area of concern  Do not counsel when the area is out of your expertise (e.g., depression). Instead refer to a specialist

10. Decision-Making Paradigm

11. Counseling Strategies  Three components of Communication –Attending  awareness of nonverbal behavior  awareness of client’s nonverbal behavior –Listening  understanding feeling and content of verbal messages  identifying incongruities –Empathic Responding  showing Empathy  understanding core message

12. Attending:Nonverbal Behavior of the Counselor  Examples –squaring turning one’s body to fully focus attention. Failure to do so can reflect disinterest and lack of respect. –energy level –Absence of energy is frequently interpreted as a lack of interest or preoccupation. Presence of energy will directly affect the clients openness to you and also affects “approachability”.

13. Nonverbal Behavior of the Counselor Cont... –Posture – folded arms crossed legs, foot shaking. Can be signs of disinterest in the client or topic. –Eye contact – most common and powerful technique. In our society, steady eye contact reflects interest. –Others to watch are: facial expressions, gestures, voice volumes, mannerisms  Keep behavior congruent with the message!

14. Attending: Nonverbal Behavior of Clients  Often more significant than verbal communication  Conveys 65% of the meaning in a message (Gazda, 1984).Powerful because it is not as censored.  Look for incongruities (e.g., smiling with a nervous gesture)

15. Listening  Active listeners can accurately identify congruities and inconsistencies in verbal and nonverbal behavior  5WH strategy “who” “what”, “when”, “where”, “why”, and “how”

16. Empathic Responding  Empathy – ability to understand the experience of another person from that person’s frame of reference  May be the most important factor for bringing about change (Rogers, 1957)  May need to paraphrase or perception check to make this work

17. Key to Exercise Counseling  Be aware of these strategies  Develop your own style

18. Exercise  Get into groups of three  Assign roles:  1) client, 2) counselor, 3 observer  Client talks about what she/he has done over the past weekend and what she/he felt about it  Observer marks the use of counseling strategies by the counselor using the check list  Do for 5 minutes then switch roles….

19. Setting in Interventions  Home superior to Community-based (small effect size difference) – Rhodes et al., in press  School (small)  Worksite (small)  Health Care (small to trivial)  Multi-site may be most effective (McKay et al., in press)

20. Social Context  Group (ranges)  Individual (small)  Family (trivial)  Supervised (small)  Unsupervised (ranges)

21. Interventions by Theory Rhodes & Pfaeffli, in press Theory# of Studies % Symmetry % Positive Symmetry Formal Mediator Analysis TTM978%22%4 (mixed 2- 2) SCT3100%67%1 (mixed by constructs) TPB3100%33%None conducted PMT2100%50%None conducted SDT2100%50%None conducted

22. Results: Construct Evidence Construct# of Studies % Symmetry % Positive Symmetry Formal Mediator Analysis Self-Efficacy2273%23%5 (1 support; 4 null) Outcome Expectations 1669%19%4 (all null) Self- Regulatory Processes 1883%33%4 (mixed 2- 2) Social Constructs 978%22%2 (mixed 1 – 1)

23. Self-Regulatory Strategies: What Works?  1) Planning- moving from vague intentions to concrete plans..  When, where, how, and what  2) Problem solving – identifying obstacles and creating alternative solutions

24. Goal Setting (Locke & Latham, 1981)  Technique that effectively increases performance in many domains  Goal – “attaining a specific standard of proficiency on a task, usually within a specified time limit”  90% of studies have found this technique effective

25. How Does Goal Setting Work?  Directs attention to the task (allows for a map)  Prolongs effort over time (reviewing & revising goals)  Motivates the person to develop relevant strategies to attain the goals (breakdown of requirements)

26. The Findings in Goal Setting Research  Specific goals are more effective than general goals  Short term goals help attain long-term goals  Goal setting is most effective when feedback is provided  Goals need to be accepted by the client to be effective

27. How to Goal Set  1) Specify the task to be done  2) Determine how progress will be measured  3) Specify the standard to be reached  4) Specify the time period in which to reach the goal  5) Prioritize goals  6) Modify goals from time to time when necessary

28. SMART  Specific  Measurable/Meaningful  Attainable  Realistic  Time-Frame

29. Exercise Enjoyment and Strategies to Enhance Enjoyment Instruction: 1.In the COLUMN A, list the factors related to PROXIMITY of where you plan to exercise, 2.In the COLUMN B, list the AESTHETIC factors of the environment where you plan to exercise, 3.In the COLUMN C, list the ways to enhance your engagement in exercise, including factors that increase your INTEREST in exercise, opportunities for SOCIAL interaction, and other aspects that provide VARIETY to your exercise routine (i.e. listening to music) COLUMN A PROXIMITY COLUMN B AESTHETICS COLUMN C INTEREST Example: Where will I exercise? Is the location where I plan to exercise close to my home? Example: Is the location a pleasant environment for performing exercise? Example: How can I… -make exercise more interesting/stimulating? -involve friends and family or others in exercise? -incorporate variety, and other aspects such as music to enhance my engagement in exercise? Location #1:Factor #1:Interest: Location #2:Factor #2:Social: Location #3:Factor #3:Variety: Patient Signature:______________________ therapist Signature:__________________ Date:____________________________ _ Date:________________________

30. Tangible Incentives  E.G., awards, time off, money etc.  Most people respond to this if the tangible incentive is sought by the individual  Caution: extrinsic factors should not replace intrinsic interest itself  Best strategy is to initiate with these and slowly drop them out of the program  Also must watch the “satiation factor”. A strategy is to use variable incentives