copyright © 2014 american college of sports medicine chapter 4 building motivation: how ready are...

Copyright © 2014 American College of Sports Medicine

Chapter 4

Building Motivation: How Ready Are You?

Chapter 4

Building Motivation: How Ready Are You?


Chapter OverviewChapter Overview

• Transtheoretical Model of Behavior Change (TTM)

• Decisional balance

• Self-efficacy

• Stage paradigm

• Avoiding boredom

• Relapse prevention


The Transtheoretical Model of Behavior Change (TTM)The Transtheoretical Model of Behavior Change (TTM)

• Stages of Change model

• Assess client readiness

• Deliver tailored messages

• Success of TTM-based interventions

• Change as process over time


The Transtheoretical Model of Behavior Change (TTM) – cont’dThe Transtheoretical Model of Behavior Change (TTM) – cont’d



TTM: Precontemplation StageTTM: Precontemplation Stage

• Not intending to conduct physical activity in next 6 months

• Three D’s

• Perceived barriers

• Low self-efficacy

• Lack of information


TTM: Contemplation StageTTM: Contemplation Stage

• Intending to conduct physical activity in next 6 months

• Aware of pros

• Unaware of cons

• Ambivalent

• Chronic contemplation

• Lack confidence and commitment


TTM: Preparation StageTTM: Preparation Stage

• Ready to conduct physical activity in 30 days

• Have taken steps toward this goal

• Great candidates for traditional messaging programs

• More committed and confident


TTM: Action StageTTM: Action Stage

• Adopted exercise within past 6 months

• Actively create new habit

• Likely to experience a setback if experience a challenge


TTM: Maintenance StageTTM: Maintenance Stage

• Have been exercising regularly for over 6 months

• More confident

• Low confidence/self-efficacy lead to discontinuation


Moving Forward in TTMMoving Forward in TTM

• Individual’s stage has implication on intervention design

• Forward stage movement predicts success

• Encourage behavior change strategies specific to stage

• Decisional balance, self-efficacy, and ten processes of change


Decisional BalanceDecisional Balance

• Individual’s relative weighting of pros and cons

• Relationship of pros and cons across the stages

• Raising pros is twice as important as lowering cons

• Crucial to raise pros at early stages

• Contemplation is time to address barriers


Self-efficacySelf-efficacy

• Individual’s confidence to make and sustain changes

• Low in Precontemplation; increases across stages

• Important to raise early with small goals

• Build confidence for increasingly difficult challenges


The Processes of ChangeThe Processes of Change

• Behavior change strategies to progress through TTM

• Experiential processes are emphasized in earlier stages

• Behavioral processes are emphasized in later stages

• Process use differs throughout stages


Stage ParadigmStage Paradigm

• Majority of individuals are not ready to change

• Employ most effective strategies at right time

• Encourage using specific processes


Stage Paradigm: Step 1Stage Paradigm: Step 1

• Assess readiness to change

• Match intervention program to client needs

• How ready is client to meet public health recommendations?

• Determine physical limitations


Stage Paradigm: Step 2Stage Paradigm: Step 2

• Target intervention to readiness


Stage Paradigm: PrecontemplationStage Paradigm: Precontemplation

Goal: Encourage clients to view success as progress to Contemplation

•Increase pros

•Raise consciousness

•Social liberation

•Environmental reevaluation


Stage Paradigm: ContemplationStage Paradigm: Contemplation

Goal: Encourage clients to view success as progress to Preparation

•Make pros outweigh cons

•Raise consciousness

•Self-reevaluation

•Dramatic relief

•Encourage small steps


Stage Paradigm: PreparationStage Paradigm: Preparation

Goal: Encourage clients to view success adoption of regular physical activity

•Counterconditioning

•Stimulus control

•Helping relationships

•Reinforcement management

•Self liberation

•Self-efficacy


Stage Paradigm: ActionStage Paradigm: Action

Goal: Help clients continue to conduct physical activity regularly

•Self liberation

•Helping relationships

•Self-reevaluation


•Self-efficacy


Stage Paradigm: MaintenanceStage Paradigm: Maintenance

Goal: Help clients make regular physical activity a life-long habit

•Stimulus control


•Reinforcement management

•Get support

•Recycling


Stage ParadigmStage Paradigm



Avoiding BoredomAvoiding Boredom

• Boredom may cause relapse to sedentary behavior

• Incorporate variety in routines

• Vary route

• Change music

• Invite different friends


Strategies to Avoid BoredomStrategies to Avoid Boredom

• Reconceptualize boredom as an opportunity

• Identify what your client gets out of exercise and what types of activities could provide that outcome

• Look for other helpful information

• Explore other types of exercise


Strategies to Avoid Boredom (cont.)Strategies to Avoid Boredom (cont.)

• Internalize motivation

• Ask for help (friends, family, or coworkers)

• Realistically evaluate goals and expectations

• Track progress daily


Strategies to Avoid RelapseStrategies to Avoid Relapse

• Foresee setbacks

• Recognize times tempted to skip workout

• Develop strategies to avoid temptation

• Recognize previous accomplishments, successes, and new knowledge

• Reward self for accomplishments


Strategies to Avoid Relapse (cont.)Strategies to Avoid Relapse (cont.)

• Identify other people or groups that may help

• Identify cues that trigger sedentary behavior

• Substitute negatives with positives

• Stay updated with exercise strategies, opportunities, and benefits

• Monitor exercise routines, progress, goals, and setbacks


Behavior Change Resources: WebsitesBehavior Change Resources: Websites

• Centers of Disease Control: http://www.cdc.gov/physicalactivity/index.html

• National Institutes of Health: http://health.nih.gov/topic/ExercisePhysicalFitness http://health.nih.gov/topic/ExerciseForSeniors


Behavior Change Resources:Computer-Tailored InterventionBehavior Change Resources:Computer-Tailored Intervention

• LifeStyle Management Suite: www.prochange.com/myhealth


Take-Home MessagesTake-Home Messages

• Use stage-appropriate strategies with entire population of clients

• Assess client’s readiness

• Tailor interventions to stage of change

• Recognize unique needs of individuals

• Prepare prior to taking action to decrease relapse rates

copyright © 2014 american college of sports medicine chapter 4 building motivation: how ready are...

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