1. Copyright © 2014 American College of Sports Medicine Chapter 4 Building Motivation: How Ready Are You?

2. Copyright © 2014 American College of Sports Medicine Chapter Overview Transtheoretical Model of Behavior Change (TTM) Decisional balance Self-efficacy Stage paradigm Avoiding boredom Relapse prevention

3. Copyright © 2014 American College of Sports Medicine 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

4. Copyright © 2014 American College of Sports Medicine The Transtheoretical Model of Behavior Change (TTM) – cont’d Copyright © 2014 American College of Sports Medicine

5. TTM: Precontemplation Stage Not intending to conduct physical activity in next 6 months Three D’s Perceived barriers Low self-efficacy Lack of information

6. Copyright © 2014 American College of Sports Medicine TTM: Contemplation Stage Intending to conduct physical activity in next 6 months Aware of pros Unaware of cons Ambivalent Chronic contemplation Lack confidence and commitment

7. Copyright © 2014 American College of Sports Medicine TTM: 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

8. Copyright © 2014 American College of Sports Medicine TTM: Action Stage Adopted exercise within past 6 months Actively create new habit Likely to experience a setback if experience a challenge

9. Copyright © 2014 American College of Sports Medicine TTM: Maintenance Stage Have been exercising regularly for over 6 months More confident Low confidence/self-efficacy lead to discontinuation

10. Copyright © 2014 American College of Sports Medicine Moving 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

11. Copyright © 2014 American College of Sports Medicine Decisional 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

12. Copyright © 2014 American College of Sports Medicine Self-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

13. Copyright © 2014 American College of Sports Medicine The 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

14. Copyright © 2014 American College of Sports Medicine Stage Paradigm Majority of individuals are not ready to change Employ most effective strategies at right time Encourage using specific processes

15. Copyright © 2014 American College of Sports Medicine Stage 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

16. Copyright © 2014 American College of Sports Medicine Stage Paradigm: Step 2 Target intervention to readiness

17. Copyright © 2014 American College of Sports Medicine Stage Paradigm: Precontemplation Goal: Encourage clients to view success as progress to Contemplation Increase pros Raise consciousness Social liberation Environmental reevaluation

18. Copyright © 2014 American College of Sports Medicine Stage 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

19. Copyright © 2014 American College of Sports Medicine Stage Paradigm: Preparation Goal: Encourage clients to view success adoption of regular physical activity Counterconditioning Stimulus control Helping relationships Reinforcement management Self liberation Self-efficacy

20. Copyright © 2014 American College of Sports Medicine Stage Paradigm: Action Goal: Help clients continue to conduct physical activity regularly Self liberation Helping relationships Self-reevaluation Counterconditioning Self-efficacy

21. Copyright © 2014 American College of Sports Medicine Stage Paradigm: Maintenance Goal: Help clients make regular physical activity a life-long habit Stimulus control Counterconditioning Reinforcement management Get support Recycling

22. Copyright © 2014 American College of Sports Medicine Stage Paradigm Copyright © 2014 American College of Sports Medicine

23. Avoiding Boredom Boredom may cause relapse to sedentary behavior Incorporate variety in routines Vary route Change music Invite different friends

24. Copyright © 2014 American College of Sports Medicine Strategies 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

25. Copyright © 2014 American College of Sports Medicine Strategies to Avoid Boredom (cont.) Internalize motivation Ask for help (friends, family, or coworkers) Realistically evaluate goals and expectations Track progress daily

26. Copyright © 2014 American College of Sports Medicine Strategies 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

27. Copyright © 2014 American College of Sports Medicine 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

28. Copyright © 2014 American College of Sports Medicine Behavior Change Resources: Websites Centers of Disease Control: http://www.cdc.gov/physicalactivity/index.html http://www.cdc.gov/physicalactivity/index.html National Institutes of Health: http://health.nih.gov/topic/ExercisePhysicalFitness http://health.nih.gov/topic/ExerciseForSeniors http://health.nih.gov/topic/ExercisePhysicalFitness http://health.nih.gov/topic/ExerciseForSeniors

29. Copyright © 2014 American College of Sports Medicine Behavior Change Resources: Computer-Tailored Intervention LifeStyle Management Suite: www.prochange.com/myhealth www.prochange.com/myhealth

30. Copyright © 2014 American College of Sports Medicine Take-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