Presence: Compliance Programming

As our industry evolves, we are learning that knowledge in the sophisticated arena of the body-mind connection is critical if we want to engage more people in physical activity and bring about long-term compliance. As wellness 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, over scheduling and information overload further encourages excessive delegation of responsibility–not only for personal well-being but for everyday life as well.

Before people 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 and participants 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’ body-mind intelligence and negatively affecting their abilities to comply with their programs. Our clients may have learned trainer-efficacy, not self-efficacy.

Compliance Programming (CP) Principles
What can our industry do to strengthen the body-mind 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. The model involves teaching participants to apply self-monitoring, self-evaluation and self-reinforcement through goal setting, positive self-talk and problem solving. In the fitness and wellness field, the aim is to enhance clients’ abilities to integrate physical activity into their daily lives.
In an effort to consolidate 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 wellness 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 (Amnesia 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’ body-mind 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 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, & Winter 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 a support group to keep you on track. 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 and wellness 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 a paradigm shift. As wellness 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 average 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 and participants strengthen their body-mind 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.

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 Review, 30 (2), 64-68.
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 Internal 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