Motivational Interviewing


  • Purpose: To understand the individual and promote behavior change.

Lecture Plan

  1. Exercise as a behavior

  2. Changing behavior

    • a) Social Cognitive Theory

    • b) Stages of behavior change

    • c) Motivational interviewing

Exercise as a Behavior

Definition of Exercise

  • Structured

  • Organized

  • Intentional

  • Planned

  • Competitive

  • Performance-oriented

Importance of Encouraging Exercise

  • To improve health outcomes for clients: YES

  • Other perspectives: NO, exercise is not the only way to improve health.

Understanding Physical Activity

Definition

  • Any bodily movement produced by skeletal muscle contraction that expends energy.

Encouragement for Physical Activity

  • It is not enough just to promote physical activity; we must also reduce sedentary time.

  • Goal: Increase physical activity AND decrease sedentary time.

Consequences of Sedentary Behavior

  • Associated with various health issues:

    • Cardiovascular disease

    • Diabetes

    • Hypertension

    • Multiple cancers (e.g., breast, colon)

    • Increased risk with age

  • Sedentary behavior presents an opportunity for improvement ("low hanging fruit").

Updated WHO Guidelines (2020)

  • Aims to improve physical activity and reduce sedentary behavior.

  • Emphasizes the need for a variety of exercises for optimal health:

    • Moderate-vigorous activity

    • Strength training

Compliance with Physical Activity Guidelines

  • Issues with compliance to minimum standards for moderate-vigorous activity.

  • The age group 20-29 is the only one meeting guidelines effectively, with many missing vigorous activity.

Physical Activity Requirements

  • A little bit of exercise is better than none.

  • Reducing sedentary time might be easier than increasing movement time.

Summary of Exercise Promotion

  • Shift the focus from only "exercise" to better physical activity and lower sedentary time.

Social Cognitive Theory

Overview

  • Examines how individuals acquire and maintain behaviors considering their social environment.

  • Key elements include:

    • Skills

    • Practice

    • Self-efficacy

    • Knowledge

    • Expectations

    • Attitudes

    • Social norms

    • Community access

Professional Role

  • Aim to increase client confidence.

  • Tailor behavioral examples to fit client backgrounds.

  • Facilitate early mastery by breaking goals into smaller steps.

  • Educate clients on benefits and set realistic expectations.

Behavior Change Example

Client Case

  • A 50-year-old businessman completing a 4km run.

  • Success fosters a sense of mastery, encouraging further achievement.

Positive and Negative Consequences

Positive

  • Enhanced performance at work

  • Improved health and fitness

  • Better sleep

Negative

  • Discomfort (hot, sweaty)

  • Risk of injuries

  • Doubts about improvement

Environmental Influences on Behavior

  • Impact of weather on physical activity decisions.

  • Importance of having alternatives that enhance self-efficacy.

Stages of Behavior Change

Overview

  1. Pre-contemplation

  2. Contemplation

  3. Preparation

  4. Action

  5. Maintenance

Definitions of Stages

  • Pre-contemplation: Not active

  • Contemplation: Thinking about activity

  • Preparation: Some activity, not at recommended levels

  • Action: Engaging in activity for less than 6 months

  • Maintenance: Active for over 6 months

Cognitive and Behavioral Strategies

Motivation Across Stages

  • Encourage knowledge and awareness of inactivity risks.

  • Help clients appreciate personal benefits of increased activity.

Practical Strategies for Each Stage

  • Pre-contemplation: Read blogs/pamphlets.

  • Contemplation: Analyze pros/cons of physical activity.

  • Preparation: Identify barriers.

  • Action: Self-monitoring plans.

  • Maintenance: Prepare for setbacks.

Motivational Interviewing (MI)

Definition

  • An evidence-based approach to facilitate change.

  • Used to address various areas including health, relationships, money, and employment.

Key Principles of MI

  1. Partnership (no power over client)

  2. Ownership (client-driven ideas)

  3. Acceptance (respecting client’s choices)

  4. Compassion (prioritizing client’s interests)

Engaging Clients in MI

  • Building a respectful relationship is crucial.

  • Aim for mutual goals and a welcoming environment.

Negative Approaches to Avoid

  • Avoid using closed questions and diagnosing.

  • Steer clear of labeling or asserting authority.

Focusing

Establishing Direction

  • Utilize OARS to stay directed.

  • Develop clear, mutual goals with the client.

Motivating Clients

Encouraging Change

  • Foster client’s motivation and recognize "change talk."

  • Use open questions that facilitate looking both forward and back in evaluating changes.

Tools for Engagement

  • Use scaling questions to measure significance and confidence regarding change.

Planning for Change

Developing a Plan

  • Create an actionable agreement with the client.

  • Ensure goals adhere to S.M.A.R.T criteria: Specific, Measurable, Attainable, Relevant, Timely.

Alternatives to Standard Goals

  • Consider learning goals for those new to complex tasks and open goals for improved outcomes.

Summary of Facilitation Approach

  • Focus on personal, behavioral, and environmental factors to support change.

  • Understanding client stages aids effective intervention.

  • Exercise professionals play a critical role in facilitating meaningful behavior changes for better health outcomes.