"How do you best help a client if he or she is having a difficult time making healthy changes?"

During a new client's initial interview and evaluation, we discuss long-term goals and the means to acheive them.

We thoroughly discuss different exersise, nutrition and stress management factors. Following this meeting, I put together short- and long-term plans of action athat I hope will fit the rhythm of the client’s lifestyle. Together we review the plans and decide which of the short-term goals can realistically be achieved and what time frame and exercise frequency will be needed.

It is a mutual agreement. I never impose goals that may not be achievable, nor training techniques or methodologies that do not fit the client’s profile. However, I do educate the client on how various modalities will allow her to attain her long-term objectives. This agreement is used as the base of any discussions we have at a later date.

If I witness the client having a difficult time making healthy changes, we go back and review our agreement. We also look at what hindered the client from making the changes and decide on alternate strategies for success and a new time frame if needed. If the client is able to make only one small change at a time, then so be it. The whole process may be too difficult to handle if she attempts too many changes at once.

If I see that the client is still not making progress or if she complains that she is not making the progress she expected, we go back to the initial goal-setting to establish a fresh approach.

In terms of exercising outside of our sessions, I ask that the client honestly track whatever time she spends in physical activity. I attempt to have her commit to at least one exercise session on her own, regardless of the activity or its duration. (Ten minutes is better than 0 minutes, right?) We review this plan on an ongoing basis.

To help the client make healthy food choices, we review her eating habits together. Based on initial goals, I suggest a general food plan. If necessary, I ask her to record what she eats for a 2- to 3-day period. We then discuss the pros and cons of her choices and what food substitutes might be preferable. If she requires a more specific plan, I refer her to a nutrition specialist.

For stress management I ask that, systematically, she take some time for herself, even if it is a limited amount . . . time that is solely for her. I highly encourage this time, whether she spends it taking a walk outside or just relaxing to music in her bedroom with the door closed.

Helping clients make healthy changes and adhere to them can be quite challenging. There is no single answer, and each case must be looked at individually. My hope is that by establishing reachable goals, educating clients about the choices we’ve agreed on and encouraging them to take responsibility for their actions, I can ensure that they stay successfully on track.

Fred Hoffman, MEd

International Fitness Consultant

Fitness and Lifestyle Director,

Buddha Spa

Fitness Marketing Consultant,

Reebok France

Paris, France

When clients are having difficulty adhering to healthy lifestyle changes, I sit down and chat with them. I find out what obstacles are in their way and develop a systematic approach to help clear those obstacles. I think it’s useful to make clients accountable for their actions by having them write everything down.

Asking clients to keep a food journal and show it to me every session usually helps them to stay on track with healthy food choices. I also ask them to write down what they do every time they exercise. I tell them that I want to see them do, at a minimum, three exercise sessions a week, including our sessions together.

For stress management, I tell clients how important it is to make time for eating properly and exercising regularly, as those are two key ingredients for decreasing stress. I find out what causes clients the most stress and suggest how they can deal with it. If needed, I refer them to an allied health professional who can help them. I prefer not to go beyond my scope of practice by delving into their private lives.

If clients still don’t change, I refer them to another trainer and/or a dietitian. I find that clients like this can be a huge energy drain, and I don’t want them to affect my other clients who are serious about healthy lifestyle changes.

Tracy Masson

BCRPA-Certified Personal Trainer,

Fitness World

Coquitlam, British Columbia

Negotiate How Many Weekly Workouts Are Realistic. I always err on the side of caution. If the client says three or four times, I might say, “Why don’t we go with three, and if you get in the fourth, it’ll be a fantastic bonus!” I get her to pin down the days and times she’ll do the workouts and to put them in her daytimer the same way she would any other important appointment.

Keep in Touch by Phone. Because I know when a client is exercising on her own, I tell her I’ll be calling her on those days to hear about the workouts. Clients regularly tell me that this is the service they appreciate the most. Some clients say that knowing I’ll be calling gives them extra incentive to exercise, because they don’t want to disappoint me! Sometimes, when a client returns my calls late at night, I know she probably missed the scheduled morning workout and squeezed it in that evening just to be able to reply with good news. Even people who have no trouble sticking to their programs tell me they appreciate the follow-up attention.

Create a Program Card That’s Easy to Understand. I don’t want people to feel frustrated or incompetent when I’m not there, so I use clip art (Physigraphe is excellent) to help them easily recall each exercise. If the name of the exercise does not do it, a quick glance at the clip art image is a great trigger. I also include key points about the execution of the exercise. A program card includes the same key phrases I use during the workout (e.g., “as if your leg is moving through wet cement” or “as if there is a magnetic attraction between the top of your head and the ceiling,” etc.).

Make Success Visible. If the plan is for a client to do 12 workouts in a month, I create a program card for that month that has 12 columns for 12 workouts. That way, we can both clearly see as we go along whether the client is on track to complete all the workouts. I strongly encourage the client to fill out the entire card; workouts that are missed early on can be made up later in the month, if necessary.

With some clients, we also set short-term goals for the month. To make sure these are not forgotten, I type them onto the clients’ program cards. Often the goals are very simple (e.g., Make a doctor’s appointment to discuss headaches; Take lunch to work eight times; Buy new running shoes). I find that committing goals to paper is what makes them happen, and over time it’s amazing what clients can accomplish.

Recognize That Some People Just Won’t Succeed. I’ve discovered over the years that, despite my best efforts, some people are not going to be successful. I can usually recognize these clients at the first meeting by their language and lack of excitement. When I hear that a client’s husband bought the sessions because he wants her to lose weight, that a client bought the sessions because his friend just got a trainer or that the person wants to lose 20 pounds in 5 weeks for a special event, a huge red flag goes up. My instincts are never wrong, and I find that these clients are rarely committed or focused.

Regarding who does and doesn’t reach their fitness goals, I have discovered an interesting correlation between income and success. My clients tend to be high earners, and I charge a premium fee. However, occasionally I am hired by people who really have to budget carefully to pay for my services. I find that these clients are often the most determined to reach their goals, because they want to make their substantial investment really count.

Barb Gormley

Owner, CustomFit Personal Training

Toronto, Ontario

The newest approach we are working on follows more of a case management model, where multiple co-workers of various disciplines (basically nutritionists and trainers) focus on improving one individual’s health. We have used this approach with one client thus far, and it seems to have had an impact. We receive weekly e-mail food records from this client with exercise updates each week, and each member of the case management team provides feedback.

Lastly, we have incorporated the Body Gem, a device that analyzes resting metabolic rate, into our service menu. We believe that knowledge is power. If we can let a client accurately know his resting metabolic rate, we can use this information to more specifically tailor his diet to his individual needs. We are going to introduce this device, as a new learning tool, to clients who have been with us for a while. We hope it could be the catalyst to help them change their nutrition habits.

Dale Huff, RD, CSCS

Co-Owner, NutriFormance LLC

St. Louis, Missouri

In terms of changing unhealthy eating habits or incorporating exercise into a client’s life, I like to refer to the May 2004 IDEA Health & Fitness Source article “Watch Old Habits Disappear” by Paul Bedford, MS. I like the Stages of Change model in the article because I believe you have to know where you are before you can successfully determine where you want to go. Often, clients arbitrarily pick a weight goal without looking at whether it is realistically achievable.

When a client wants to lose weight, as many of my clients do, I tell him to read this article and think about what stage he is at. In the meantime, I ask him to keep a food log for 3–5 days. I explain that he is to write down everything: every snack, every handful of M&Ms, what was on his sandwich, how the food was prepared, an estimate of portion sizes, the time of day, and the emotion he experienced when he ate. In this way the client learns where he is at in terms of behavioral change and what his food preferences and habits are.

After reading this information, I sit down with the client and we determine realistic goals. If he is in the contemplation stage, perhaps we focus on education—for example, food choices and portion sizes—instead of on losing 25 pounds in 6 months. We also incorporate exercise that is suitable to his lifestyle and current physical capabilities. I’m not going to recommend that a sedentary client attend an indoor cycling class three times per week. Rather, I will recommend walking.

My clients learn a lot about themselves when I implement this strategy. They are not setting themselves up for failure with unrealistic goals. Instead, they are educating themselves about health, nutrition and exercise, and they are learning a lot about what they eat and don’t eat and why. Many clients finish a 3- to 5-day food log and realize that they don’t eat as many fruits and veggies as they thought they did. Or they learn that they have been underestimating portion sizes. Many clients have even learned that the daily requirements for fruits and veggies aren’t as overwhelmingly large as once thought and that it is easy to incorporate them into their daily diets.

I also discuss with clients the importance of credible, reliable information and stress that they cannot successfully change a behavior if they do not know it needs to be changed. If a person does not realize that a behavior is an impediment to his health, he cannot change it. But when he gets an “ah-ha,” he becomes empowered to make an informed choice. That is motivating. From there the client moves more quickly through the Stages of Change—from Contemplation to Preparation and then to Action.

This method works well for most of my clients who want to lose 50 pounds or less. With the morbidly obese, I find that most have emotional issues with food that require clinical work beyond my scope of practice. In these cases I refer them out for counseling.

Jill Teller

ACE-Certified Personal Trainer,

Edward Health & Fitness Centers

Naperville, Illinois

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March 2006

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

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