Compliance Programming

As our industry evolves, we are learning that knowledge in the sophisticated arena of the mind-body connection is critical if we want to engage more people in physical activity and bring about long-term compliance. As fitness professionals, we certainly have our work cut out for us. Today’s media and fast-paced culture support an ever-growing disconnect between our minds and our bodies. What’s more, the increasing trend toward fast-paced lifestyles, overscheduling and information overload further encourage excessive delegation of responsibility–not only for personal well-being but for everyday life as well.

Is our own industry responsible on some level? According to an IDEA survey on job satisfaction among personal fitness trainers, one of the most common complaints is clients’ lack of responsibility for training and their low levels of commitment (Gavin 1998). This is a frustrating problem, but could we unknowingly be facilitating this lack of commitment? Could our industry’s current paradigm for fitness instruction actually encourage the mind-body disconnect?

Before clients come to us, they have already been significantly affected by societal and cultural influences. But we can’t deny that we, too, may be culturally influenced to believe that if our clients are to succeed at exercise, we must be there to micromanage them, ensuring that they do it right, do it safely and do it at all.

What some trainers may not know is that our constant physical presence could be compromising clients’ mind-body intelligence and negatively affecting their abilities to comply with their exercise programs. Our clients may have learned trainer-efficacy, not self-efficacy.

Shifting From Trainer-Efficacy to Self-Efficacy

Trainer-efficacy vs. self-efficacy describes an efficacy continuum and is related to locus of control. An emphasis on self-efficacy encourages the development of an internal locus of control by facilitating and reinforcing self-management and personal responsibility. Perceived self-efficacy can influence whether a client attempts an exercise program, whether he perseveres when dealing with obstacles, and how well he succeeds (Godin 1994).

Trainer-efficacy emphasizes an external locus of control and fosters varying levels of client dependency on the trainer. Trainer-efficacy is manifested when the physical presence of an instructor is the primary and perpetual source of motivation to begin and end exercise; to know if exercise is executed safely and effectively; and to know which exercises to execute and in which order.

It makes sense that our clients have an initial increase in compliance with an emphasis on trainer-efficacy at the beginning of the client-trainer relationship. However, a continued emphasis on trainer-efficacy does little to support the mind-body intelligence. Rather, it reinforces the mind-body disconnect that our clients are preconditioned to accept. Most clients become so dependent on the trainer’s physical presence for motivation and feelings of competence that they eventually do not exercise at all–or do not exercise frequently enough–on the 4-5 nontrainer days each week. The decline is then exacerbated: Clients lose their commitment because of lack of results; cancellations, illnesses and personal crises mysteriously become increasingly familiar; and trainers get frustrated, bored and burned out.

Compliance Programming (CP) Principles

What can our industry do to strengthen the mind-body connection and foster long-term compliance? According to Castro and King (2002), “Research on telephone-assisted counseling for physical activity has established a convincing body of evidence supporting its effectiveness in promoting long-term physical activity change in adult populations.” What’s more, studies demonstrate the viability of this approach across modalities: cardiovascular, strength and flexibility exercise; and in healthy adults as well as special populations (Castro & King 2002).

Phone-based counseling interventions are based on the self-regulation model of change, which is derived from social cognitive theory. Self-regulation is extremely important because it provides the foundation for the gradual substitution of internal controls for external controls of behavior. The model involves teaching participants to apply self-monitoring, self-evaluation and self-reinforcement through goal setting, positive self-talk and problem solving. If fitness professionals incorporate telephone-assisted counseling based on self regulation early on, clients may be able to better integrate physical activity into their daily lives and maintain activity long term with less intensive physical contact.

In an effort to consolidate the research on telephone-assisted counseling and the key principles of self-regulation–and to facilitate their application–my own company, Fitness by Phone®, coined the term compliance programming, or CP. The CP approach highlights three research-based principles that fitness professionals can immediately begin using to shift their clients’ locus of control from trainer-efficacy (external) to self-efficacy (internal):

1. Self-Monitoring and Self-Documenting Systems. Studies have shown that self-monitoring tools increase exercise adherence (Annessi 1996; Castro & King 2002). They can be as basic as age-related heart rate charts and calories-per-activity charts or as sophisticated as heart rate monitors, accelerometers (calorie trackers), pedometers, and displays on electronic strength training and cardiovascular equipment. Self-documentation systems such as exercise diaries help clients keep track of their daily goals, their monitor readings and their personal achievements.

Using self-monitoring devices to get immediate, objective feedback during activity without the presence of a personal trainer re-educates clients’ mind-body intelligence by stimulating a cognitive reconnection between their minds and their physical efforts. For example, feedback from a heart rate monitor tells a client how much extra effort to exert to reach an exercise intensity five beats higher than he did last week.

2. Home-Based Exercise Programming and Lifestyle Activity. Versatile home-based exercise choices (e.g., video workouts, neighborhood jogs or home equipment workouts) and lifestyle activity options (e.g., gardening, walking the dog, taking the stairs instead of the elevator and parking at the end of the parking lot) quickly and comfortably assist clients overcome the scheduling conflicts and intimidation issues that can be associated with group and facility-based programming.

3. Phone-Based Accountability Systems. Research shows that holding clients accountable to their exercise programs by phone with frequent (weekly, biweekly or monthly), highly structured phone prompts for as little time as 3 minutes increases adherence by more than 1,500% (Lombard, Lombard, & Winett 1995). Other studies use approximately 10-15 minutes (Hooker et. al. 2005). Further, “if participants successfully adopt a more active lifestyle with early telephone-assisted counseling, it appears that they may be able to maintain activity long term through less-intensive mediated programs” (Castro & King 2002).

Potential Challenges in Applying CP Principles

When applying the CP approach, you may encounter one or more of the following challenges:

You Find It Hard to Stay Committed to the New Paradigm. If you find yourself reverting to an emphasis on trainer-efficacy, you might benefit from networking with other CP trainers for support. You might also choose to begin by applying only the CP principles and tools that are most familiar to you (e.g., client self-monitoring with heart rate monitors). As you gain confidence and see client compliance increase, you can gradually incorporate other CP elements.

Gaining Client Buy-In Proves Difficult. One way of gaining client acceptance of the CP approach is to seamlessly integrate CP elements into your existing instructional approach. Requiring clients to have monitors and use self-documentation will not significantly alter clients’ perceptions of a traditional training approach. Assigning home-based exercise and lifestyle activities on nontrainer days while requiring self-monitoring and self-reporting will only increase the value of your programming techniques in clients’ eyes.

You Fear That Your Livelihood May Be Compromised. Fitness professionals may fear that their livelihoods will be compromised if clients achieve high levels of self-efficacy. Such scarcity thinking in and of itself requires an industry paradigm shift. As fitness professionals, we must focus first and foremost on the mission of our industry. Rather than keeping people dependent on us so we don’t have to find new clients, let’s use CP tools to create an even more lucrative niche for ourselves by reaching the 78% who do not exercise at the level recommended by the American College of Sports Medicine and the 50% of participants in typical exercise programs who drop out within 6 months (U.S. Department of Health and Human Services, as cited in Lombard, Lombard & Winett 1995).

Maintaining a Good Connection

By introducing CP principles and tools into our programs, we can help our clients strengthen their mind-body connection and increase their exercise adherence. Ultimately, the CP approach facilitates personal responsibility and self-management and provides the versatility necessary for our culture’s ever-increasing, fast-paced lifestyle. Start using or increasing the utilization of these research-based principles and tools and see how much more motivated and compliant your clients become.*

Sidebar: Compliance Programming: A Case Study

Carol is 48 years old and a single, working mother of two. She is 20 pounds overweight and feels lethargic and unmotivated to exercise. Carol has joined a gym and tried personal trainers on occasion; however, her hectic life continually thwarts her efforts to get fit and healthy. Finally, Carol inadvertently finds a trainer experienced in compliance programming (CP). While Carol doesn’t ever hear the term, more and more CP principles are added to her training program over time.

Carol’s trainer, Bob, identifies up front whether she is serious about making changes. He also explains why she might have been struggling with exercise up until now. He educates Carol about the mind-body connection and explains that the usual personal trainer-client relationship creates an unbalanced dependency on the trainer. Bob tells Carol that the American College of Sports Medicine and the Centers for Disease Control and Prevention recommend being physically active most days of the week, yet the majority of clients do not exercise enough, or at all, on the 4-5 nontrainer days.

Bob requires Carol to purchase a heart rate monitor and a calorie tracker that measures calories whether she is exercising, sitting at the computer or gardening. In addition to two in-person training sessions each week, Bob sets up a weekly 15-minute phone session to give Carol focus and direction about what to do on nontrainer days. Carol reports her accomplishments by e-mail the night before each phone session.

Each week, Bob is amazed at how much activity Carol is accumulating on her own. She is now walking to the grocery with her kids twice a week, she’s taking the stairs instead of the elevator at work, and her house is cleaner than ever before. In total, she is accumulating an extra 200-300 calories a day in nonexercise, or lifestyle activity, calories. She is also engaging in two home-based workouts a week without him. Within 4 weeks, Carol is down to one workout a week with Bob and three on her own. She has gone from engaging in only 2,800 calories of activity a week to 5,400. Her heart rate training zone has gone from 117-128 beats per minute (bpm) to 125-149 bpm. And Carol has never felt so in charge of her life.

However, at week five, Carol says she’s behind with a deadline at work and her family vacation is only a week away. She says there is no way she can make it to her workouts with Bob over the next 3 weeks and she is worried about her commitment to her program. She says this is when she typically stops exercising, and it can take months before she gets back into the swing of things.

Bob immediately cuts out her Monday night in-person workouts for a month and gets her to recommit to meeting with him each week by phone, wearing her heart rate and calorie monitors, documenting her numbers, and e-mailing them to him before each phone session. He cuts both her workout and lifestyle activity goals in half.

Ironically, Carol loses 4 more pounds–and maintains her commitment to exercise. She gets back to her regular program the week she said she would. It takes her only 3 weeks after the quasi-hiatus to return to her original fitness level and resume her progress. Six months into her work with Bob, Carol has lost 15 pounds. She works out in the gym and at home and maintains a biweekly phone session with Bob to ensure she stays on track, especially during stressful times.

More on Compliance Programming

Susan Block Vézina will present a session called “Bridge the Gap From Fitness Instructor to Coach” (session #676) at the Inner IDEA® Convention on Tuesday, July 25, 2006. She will discuss how to use research-based compliance-programming principles to gradually juxtapose the client-fitness professional relationship with a coaching paradigm. To register or obtain more information about the Inner IDEA Conference, go to www.inneridea.com, or call (800) 535-8979, ext. 7.

Susan Block Vézina is president and founder of The Association of Fitness by Phone® Coaches and an exercise physiologist. She has been a fitness professional for 23 years. Contact her at www.fitnessbyphone.com.

Ms. Block Vézina would like to thank Cynthia Castro, PhD, and Abby King, PhD, from the Stanford Research Center, for their ongoing support over the last 4 years in educating her about the tremendous body of research on the topic of phone counseling for physical activity.

Copyright 2006 by IDEA Health & Fitness Inc. All rights reserved. Reproduction without permission is strictly prohibited.

References

Annessi, J. 1996. Enhancing Exercise Motivation: A Guide to Increasing Fitness Center Member Retention. Fitness Management Leisure Publications.

Castro, C.M., & King, A.C. 2002. Telephone-assisted counseling for physical activity. Exercise and Sport Sciences Reviews, 30 (2), 64-68.

Gavin, J. 1998. 1998 IDEA Personal Trainer Survey: A report on personal trainers’ job satisfaction. IDEA Personal Trainer, 9 (7), 38-43.

Godin, G. 1994. Social-cognitive models. In Rod K. Dishman, (Ed.), Advances in Exercise Adherence. Human Kinetics Publishers.

Hooker, S.P., et al. 2005. The California Active Aging Community Grant Program: Translating science into practice to promote physical activity in older adults. Annals of Behavorial Medicine, 29 (3), 155-65.

Lombard, D.N., Lombard, T.N., & Winett, R. A. 1995. Walking to meet health guidelines: The effect of prompting frequency and prompt structure. Health Psychology, 14 (2), 164-70.