Case Study: Coaching a Sedentary Client

Ex Rx: To help inactive clients make meaningful lifestyle changes, think outside the gym.

When Indiana University (IU) lecturer Carol Kennedy-Armbruster, MS, asked her personal training client Martin Siegel to speak during her “Methods of Personal Fitness Instruction” course, she thought it would be a great way to inform her students about special populations. At 60, Siegel was overweight, had prediabetes and suffered from hypertension and high cholesterol.

But when Siegel entered the classroom, he had an unexpected message for the group. “I’m not the special population—you are,” he said.

He went on to reiterate the same information the students had been hearing all semester—the great majority of Americans are overweight and get little exercise; heart disease and diabetes are widespread and on the rise—but he made the point in a way no textbook ever had. “Fit people are the freaks,” he said.

That day, Kennedy-Armbruster and her students took home a lesson often overlooked in the fitness setting: fitness and exercise seem completely unnatural to many people. Individuals who stand to benefit the most from physical activity can’t picture themselves setting foot in a fitness facility, let alone using fitness equipment. Exercise recommendations are actually discouraging to them, because they feel defeated hearing they must do something they are sure will be impossible for them.

Siegel, who has a PhD and is an associate dean in IU’s school of informatics, said his normally confident attitude evaporated when he entered a fitness facility. “I feel like Superman landing on Krypton,” he said.

As fitness professionals, how can you help clients like Siegel? Discover how you can boost their confidence and get them moving.

A Different Approach to Programming

For inactive clients like Siegel, one solution is to focus on lifestyle activity. The most recent guidelines from the American College of Sports Medicine and the American Heart Association state explicitly that accumulated 10-minute bouts of exercise are as beneficial as 30 continuous minutes of activity (Haskell 2007). Some evidence suggests that several short bouts may even have greater health benefits than one long activity session (Park, Rink & Wallace 2006).

Kennedy-Armbruster embraced this piecemeal approach when she first began working with Siegel 2 years ago. Their partnership began when Siegel sent her an e-mail describing himself as “a complete physical disaster” and stating, “I was thinking I could turn my body over to someone who could help me figure out what to do.”

When they met, instead of explaining exercise guidelines and drawing up a plan, she gave him a pedometer and instructed him to record his daily steps for 1 week. After establishing his baseline—2,500 steps—they worked on gradually increasing his activity by building more short walks into his day.

For Siegel, who read a lot about fitness but felt unable to implement his knowledge, the pedometer approach was a breakthrough. “It made so much sense to start this way rather than shocking my body by pushing weights in a gym,” he said. “Taking more steps was an accessible idea; it felt like something I could do. And because the pedometer recorded my activity, there was no way I could fool myself into thinking I was being active on a day I never got up from my chair.”

Movement = Life

Siegel was also moved by a question Kennedy-Armbruster posed to him during an early session. Referring to the tendency of many Americans to stay seated most of the day, she asked him to describe the most extreme state of nonmovement he could picture.

“And then I got it—the ultimate in nonmovement is death,” he said.

With his background in logic and computer programming, this equation became a powerful motivator.

“I started seeing all the sitting I was doing as bringing me closer and closer to death,” he said.

Conversely, movement became synonymous with vitality and health.

Finding Ways to Move More

A study led by Mayo Clinic researcher James Levine revealed that among a group of nonexercisers, obese individuals sat an average of 2 hours more per day than nonobese individuals (Levine 2005). The extra energy expended by those who spent more time on their feet amounted to 350 calories per day, enough to result in approximately 15 kilograms, or about 33 pounds, of weight loss a year. The finding suggests that simply by sitting less, the nonobese subjects were able to maintain a healthy weight.

In order to help Siegel sit less, Kennedy-Armbruster looked for activities in his schedule that could just as easily be done standing up as sitting down. As an academic dean, Siegel spent a lot of time in meetings with students and faculty members.

“Why not have a walking meeting?” she asked him. She led the way by walking with him during their weekly appointments, demonstrating that analysis and decision making could be compatible with activity.

She also helped Siegel assemble the resources to become more active by taking him to local trails, encouraging him to buy a new bicycle and introducing him to active individuals who shared some of his interests.

Slow and Steady Wins the Race

Siegel occasionally became discouraged by what he felt was slow progress. Although his cholesterol and blood pressure did improve, he wasn’t losing weight. A month into working with Kennedy-Armbruster, his daily step count started to dip by almost 50 percent.

Kennedy-Armbruster urged him to keep at it, reminding him of how good he felt after a walk outside and what a difference he was making in his overall health.

She was aided in her argument by a runner they observed on one of their walking meetings. The man was sprinting around the track, arms pumping and legs flying at top speed. Siegel lamented that he wished he could be like that runner, so graceful it hardly looked like an effort.

When they rounded the corner, the man was vomiting into a garbage can.

“Not so graceful now,” Kennedy-Armbruster observed. “Is that really what you want, Marty?”

Challenges for a Fitness Pro

As a full-time IU faculty member in the Fitness Specialist program, Kennedy-Armbruster was also challenged by her work with Siegel. She discovered she needed to rethink her assumptions about the training process and the support she had to provide her client.

For example, one week she assigned Siegel to buy a new pair of walking shoes. When they met the following week, he brought his new shoes—still in their box.

“Anyone who exercises would have known to start wearing the shoes to walk in,” she said. “But he was thinking literally and did exactly as I asked.”

She learned that more detailed and specific instructions helped Siegel feel capable and in control.

“Here is a very smart man whose whole life is his brain,” she said. “He needs to be able to think it all through step by step.”

Marty Siegel Today—Two Years On

These days, Siegel champions walking meetings throughout his department. Many of his students have adopted the practice, and he has yet to have a colleague turn down his offer to walk and talk. He has even been featured in the calendar of the university’s Division of Campus Recreational Sports, which the division distributes to faculty and staff to encourage them to become more active.

He aims for 6,000 steps a day, keeping an eye on his pedometer to track his progress. “If it gets toward the end of the day and I haven’t approached my goal, I start asking anyone who comes in the door to take a walk with me,” he said.

Siegel is pleased with the health benefits of his lifestyle changes, and he sees his activity as an investment in his longevity. He also draws a connection to his work, having observed that he thinks more clearly on days when he is most active.

“I used to think of my body as just a container for my brain,” he said. “Now I understand that it’s all one system, and my movement affects my thoughts and my attitude.”

He still wishes for weight loss—something he has yet to achieve—but he realizes that physical activity has benefits beyond and outside the scale. He also recognizes the need for improvements to his diet, which he hopes to accomplish in the same gradual, mindful manner as his lifestyle changes.

Thinking Outside the Gym

The next frontier for fitness professionals is reaching the millions like Siegel for whom formal exercise is an insurmountable obstacle. This growing population of inactive individuals desperately needs solutions to curtail the health problems that have become nationwide pandemics.

By working with clients to identify habits and practices they can alter to accommodate more movement, fitness professionals can serve as lifestyle coaches. Tools of accountability like pedometers and journals can help clients become more mindful of opportunities for health-promoting, life-affirming movement.

Lifestyle coaching may offer a solution that is both accessible and affordable. Research at Wake Forest University compared a lifestyle-based intervention with a structured exercise program and found that the former produced similar results to the latter at a considerably lower cost (Sevick 2000).

Fitness professionals need to learn to “walk in the shoes” of those who do not enjoy exercise, Kennedy-Armbruster said. “My experience working with Marty has changed how I teach my students to work with people who do not naturally enjoy exercise. The coach’s key to success is to build on the foundation of the client’s existing lifestyle. We need to understand how our clients think, not just how we think.”

SIDEBAR: Boosting Calorie Expenditure

Let clients know that all movement doesn’t need to be done in the gym. They can also burn calories through the following activities:

Caloric Expenditure During Activities of Daily Living (per Hour)
based on a 150-pound person

cleaning, light (dusting, straightening)

240
cleaning, heavy (scrubbing, scraping)

432
dancing 370
gardening 324
moving (carrying boxes)

504
mowing lawn (nonriding mower)

324
strolling206
walking briskly297
vacuuming or mopping 150

 



 

 

 

 

 



 

 

 

SIDEBAR: 10 Tips to Help Clients Move More

Offer your clients these ideas for increasing their activity levels. Be sure to help and encourage clients to implement the suggestions as necessary.

  • Use a pedometer to track daily step counts.
  • Create a list of destinations that are walking distance from home or the office.
  • Record how you spend your time over the course of a week, to identify opportunities for short bouts of activity.
  • Draw up a plan for the week that includes several short walks per day; for example, a walk around the block in the morning, a trip to the post office at lunch and a visit to a colleague in a nearby building in the afternoon.
  • Become familiar with parks and other recreation areas in town.
  • Make the cell phone a fitness tool: stand and stroll when talking on the phone.
  • If you work at a computer, download software (e.g., from www.stretchware.com) that will remind you to stand up and stretch at regular intervals.
  • De-automate: put away remote controls, take the stairs instead of the elevator, use a push lawnmower and walk or bike whenever possible.
  • Find walking groups or other active social networks.
  • Park smart: always park at the back of the parking lot to sneak in extra steps.

Elisabeth Andrews, MPH, is a freelance writer and a yoga and Pilates instructor in Bloom­ington, Indiana. A personal trainer since 2001 she writes for a variety of publications, and has helped to create an award-winning online health and fitness magazine for Indiana University.

References
Haskell, W.L., et al. 2007. Physical activity and public health: Updated recommendations for adults from the American College of Sports Medicine and the American Heart Association. Medicine & Science in Sports & Exercise, 39 (8), 1423–34.
Levine, J.A., et al. 2005. Interindividual variation in posture allocation: Possible role in human obesity. Science, 307 (5709), 584–86.
Park, S., Rink, L.D., & Wallace, J. P. 2006. Accumulation of physical activity leads to a greater blood pressure reduction than a single continuous session, in prehypertension. Journal of Hypertension, 24 (9), 1761–70.
Sevick, M.A., et al. 2000. Cost-effectiveness of lifestyle and structured exercise interventions in sedentary adults. American Journal of Preventive Medicine, 19 (1), 1–8.

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Elisabeth Andrews, MPH

IDEA Author/Presenter
Elisabeth Andrews, MPH, is a freelance writer and a yoga and Pilates instructor in Bloomington, I... more less
January 2008

© 2008 by IDEA Health & Fitness Inc. All rights reserved. Reproduction without permission is strictly prohibited.

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