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

2. After completing this session, you will be able to:
LEARNING OBJECTIVES
After completing this session, you will be able to:
Define the behavioral theory models and the implications for fitness professionals, including the health belief model and self-efficacy
List and discuss the four components of the transtheoretical model of behavioral change
List and discuss the five stages of change in the transtheoretical model of behavioral change
Utilize the decisional balance worksheet with clients

3. 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.

4. 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.

5. 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.

6. 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.

7. 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

8. 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.

9. 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.

10. 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.

11. 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.

12. 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. .

13. 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.

14. 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

15. 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?

16. 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?

17. 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?

18. 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?

19. 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?

20. SUMMARY
An understanding of the different behavioral change models will provide personal trainers with the knowledge required to help their clients make lasting behavioral change.
Personal trainers can best gain an understanding of a client’s self-efficacy level through consistent communication and rapport-building strategies.
It is critical that personal trainers are respectful of how difficult it is to adopt and maintain an exercise program, as the success of both the client and trainer is based on how well the processes of change are implemented and used on a regular basis.