● What are the first impressions? ● What image do you think the environ- ment portrays? ● What kind of impact do the first staff convey to the person? ● What can be done to help the person feel less anxious? ● Can they see/meet other people who have had a good experience and are having fun?
2. First contact Once an inactive person has arrived at the door of the health and exercise profession- al the hard work begins. Each scheme will have a variety of ways of gathering per- sonal and health details, screening for risk and taking physical and fitness measures. These methods may include the use of com- puter software to collect physical and psy- chological data in order to generate feed- back, set goals and individualise exercise programmes. This data collection process itself may seem daunting and impact on a person’s self-confidence. Explain what the questions are for and how they will be used and that the information collected will remain confidential.
New research is showing that the use of a combination of behavioural (goal setting, relapse prevention) and cognitive tech- niques (imagining change, different think- ing strategies) can be useful in encourag- ing the inactive to become more active (4).
A recent review of the research into the effectiveness of strategies in promoting physical activity points to a number of key elements that improve compliance with an activity programme (4). Briefly these elements are: ● Reinforcement - rewarding people for successful completion ● Self-monitoring - keeping personal records or diaries of physical activity ● Relapse prevention training - spending time discussing and planning ahead for sit- uations that may cause the person to miss or stop their activity sessions ● Feeling the difference - in the long term the expected physical and mental benefits of the new activity need to be experienced by the person. Hence reinforcing their con- fidence and motives to continue their activity programme
According to the review, compliance may also be improved by keeping good contact with the newly started active person for
example by following up participants with phone calls. Finally home based activities and those involving walking appear to be more successful in continuing a long-term programme.
3. The health and exercise professional The professional will have many options for which particular strategies they use with each client, but to use these strategies effectively he/she needs a number of key skills. These strategies and skills could be described as part of the modern health and exercise professional’s toolbox!
Key Skills ● Listening ● Using open questions ● Reflective statements and summarising ● Exchanging information
Key strategies ● Assessing behaviour ● Exploring readiness to change and confi- dence ● Imagining change ● Exploring concerns ● Negotiating options ● Goal setting ● Relapse prevention ● Monitoring and follow up
The skills and strategies required would depend upon the reasons why the client has attended the first appointment and this information is important. For example, are they being recommended or referred to
a physical activity programme as a way of improving a chronic disease or condition or have they decided to start at a health and fitness club off their own initiative?
One-to-one behaviour change framework In the health setting a framework for one- to-one behaviour change has been devel- oped to help the professional best manage an activity change process with a client. This framework covers five stages and is taken from the Health Education Authority’s workbook `Managing Weight’ (5).
5. Maintaining change 4. Goal setting
3. Decision-making 2. Assessment
1. Screening Figure 2: A Framework for one-to-one working
1. Screening of one-to-one behaviour This stage is relevant to a health and exer- cise professional who is working oppor- tunistically or using systematic recruitment to identify which clients would benefit from support in their behaviour change process. eg. based on risk of CHD and stroke, BMI and current eating or physical activity behaviour.