READINESS TO CHANGE

2. Assessment In this stage the professional’s task is to assess if, and how much, the person wants to consider changing their inactive behav- iour. A number of strategies will help to explore how the person feels and help to focus the discussion on what aspect of their current behaviour they wish to change and what their expectations are of a more active lifestyle. Building up the pic- ture of their physical activity “lifetime” model allows the professional to explore the client’s motivations and confidence levels, as well as their experience of being sedentary and their perceptions of a phys- ically active lifestyle. The professional can establish the current activity level of the client by using a diary or asking them to describe a typical week’s activity and exer- cise. Useful questions to ask at this stage about someone’s experiences, readiness and confidence could include: ● What types of exercise or physical activ- ities have you done in the past? ● What made you stop these activities? ● How ready are you to start taking more physical activity on a regular basis? ● What would you imagine would happen to you if you were more active? ● Imagine if you were doing more regular activity how confident are you that you could keep active on a regular basis?

The role of the health and exercise profes- sional is to explore the person’s beliefs about taking more regular exercise, the possible benefits of doing this activity and their confidence about keeping their activ- ity programme going.

3. Negotiation At this point the professional begins to explore and negotiate the lifestyle changes an individual needs/wishes to make. ● Identify and discuss any misconcep- tions of the amount of physical activity the client believes is required to achieve certain benefits eg. one session a week for weight loss ● Discuss the preferred type, frequency, intensity and duration of activities required to achieve the desired goals ● Plan for the lifestyle change by dis- cussing any perceived barriers to success ● Identify and manage unrealistic expec- tations

4. Goal setting Once you have discussed and agreed a plan of action, the specific goals should be

26 SportEX Table 1: Guidelines for goal setting Number of goals Specific Measurable Agreed Realistic Time-specific Support

as making changes can be difficult, encourage clients to set a small number of goals initially - say two or three - once these have been achieved, more goals can be negotiated

discuss specific changes - like walking at lunchtime twice each week as opposed to ‘exercising more’

such as walking for 15 minutes or walking from home to the shops - allows for monitoring of progress

change is more likely to be successful if the individual decides and agrees the goals rather than having them imposed by the professional

encourage the client to really think through how the proposed change will affect them. Goals are more likely to be achieved if they fit easily into the person’s life

building in a time by which goals will have been achieved, or attempted, helps to monitor progress - but ensure that this is also realistic

successful change requires support and encouragement - who will provide this support for the individual? Will it be you, a friend or family member - exploring the details of support at this point improve the chances of successful change

Planning ahead

there will be difficult times during change attempts - discussing future events which are likely to cause problems in maintaining change can help people plan and prepare for difficulties

Criteria for success establishing measures for success - how will the client know their plans are working? What might be different about them if they were walking more?

recorded. The points in table 1 should be considered.

5. Monitoring progress Regular follow up and support is an impor- tant factor in maintaining successful change. Success can be monitored against the agreed goals and established criteria for success and support can be given to enable the client to: ● continue to maintain achieved change ● make additional changes ● learn from relapse

Using data generated from physical mea- sures can demonstrate real indications of change. If someone wants to be fitter one option could be using their fitness scores from an earlier test and comparing these with their score now. It is important that these changes have a function and are meaningful to the client, different people may notice improvements in their fitness in different ways such as being less out of breath after climbing the stairs.

Highlighting these short-term benefits will also increase the confidence of the client.

Charlie Foster is a research officer for physical activity at the British Heart Foundation Health Promotion Research Group, University of Oxford. He has recently finished working in primary care testing different methods of engaging sedentary adults in physical activity.

References 1. Activity And Health Research. (1992) Allied Dunbar National Fitness Survey. Sports Council and Health Education Authority, London. 2. Bandura A. Self-efficacy: toward a unifying theory of behaviour change. Psychology Review 1986;84:191-215 3. A model of a physical activity “lifetime” in Promoting physical activity with young women. Health Education Authority, London 1997 4. Benefits and hazards of exercise. Chapters 2- 4. BMJ Press, London 1999 5. Managing Weight - A workbook for health and other professionals. Health Education Authority 1998.