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Helping You Make It Happen

Regular physical activity can improve health and help prevent and manage chronic health conditions, such as cancer, diabetes and arthritis. Health care professionals play a significant role in promoting and facilitating physical activity behaviour change in their clients. This section provides health care professionals with examples of frameworks effective for changing physical activity behaviour. It also includes resources to support applying aspects of the frameworks and guiding clients toward more physically active lifestyles.

Frameworks and Associated Resources Applied to Physical Activity Behaviour

There is nothing so practical as a good theory” (Lewin, 1951)

This quote remains popular with many scientists who specialize in behaviour changes specific to health because it reminds us of why it is important to use evidence from science to guide how we help people change their behaviour.

The “ISLAGIATT” Approach

Health care professionals and scientists who specialize in health behaviour change are passionate about helping individuals improve their health. Unfortunately, this desire to help others has all too often led to what is now commonly referred to as the “ISLAGIATT” approach: It Seemed Like aGood Idea At The Time. This means that although well intended, many recommendations and/or programs which have been provided, are not based on the evidence of what works and what does not, and are therefore more likely to fail.

There is No One-Size-Fits-All Approach that Works

We now know that it is not sufficient to just tell a client why they need to do physical activity – instead, we need to also help them figure out how to be physically active in a way that is most meaningful, and possible, for them. In addition, although there are consistent and clear recommendations for people with different types of chronic health conditions to do regular physical activity it is less clear how they need to do so – for example, how should an individual with a lung condition exercise differently than an individual with a kidney condition?

Changing the way an individual lives their life is complex, and although there is no one-size-fits-all approach, there are ways to guide better conversations between health care professionals and clients. The list below provides some examples of frameworks that have been shown to be effective when used by health care professionals with limited time to advise on physical activity.

5As

The mnemonic “5As” refers to a reputable counselling framework that encourages brief, client-centred conversations to occur in a deliberative sequence that can be easily remembered. Specific to the behaviour of physical activity, the health care professional is encouraged to:

Assess

Assess involves asking the client about their physical activity level (type, frequency, duration and intensity), beliefs and knowledge, readiness for change, and self-efficacy for change and physical activity/exercise.

Advise

Advise involves giving the client individualized behaviour change guidance, including information about the health risks of not changing and benefits of implementing change, and relevant physical activity guidelines/recommendations.

Agree

Agree involves working with the client to develop an action plan based on their willingness and confidence to change and interests/goals.

Assist

Assist involves helping the client achieve their action plan by facilitating the needed skills (e.g., identifying potential barriers and solutions) and identifying relevant resources.

Arrange

Arrange involves working with the client to establish a plan for follow-up (e.g., visits or telephone calls) to provide ongoing support and modify the action plan as needed.

ABCDs

The mnemonic “ABCDs” is another counseling framework designed specifically for busy health care professionals wishing to help their clients make changes to their diet and/or physical activity. Like the 5As, the framework provides recommended discussion points to have with the client, and heavily encourages listening to the client rather than dictating what should be done (‘telling’ typically leads to resistance and avoidance from the client):

Assess

Assess involves asking the client about their physical activity level (type, frequency, duration and intensity), beliefs and knowledge, readiness for change, and self-efficacy for change and physical activity/exercise.

Barriers

Barriers involves asking the client to identify potential barriers to successfully changing their physical activity behaviour.

Commit

Commit involves working with the client to create strategies to address their perceived barriers and an action plan to change their physical activity behaviour.

Demonstrate

Demonstrate involves encouraging the client to monitor progress on their action plan facilitating demonstration of change and provision of ongoing support.

Motivational Interviewing

Motivational Interviewing, or MI, is a client-centred collaborative counselling style that strives to help clients bolster their personal motivation and commitment to change (Rollnick & Miler, 2013).

To help empower the client and resolve any ambivalence they may have about making changes to their physical activity behaviour, an MI-counselling approach focuses on the quality of the interaction between the client and the health care professional. It is important to note that improving the quality of this conversation does not mean increasing the quanitity of time spent with the client. The relationship between client and health care professional is built through the following four processes:

  1. Engaging with the client
  2. Creating specific goals by focusing the conversation
  3. Evoking a client's personal reasons and motivation for change
  4. Planning specific actions to take

Overarching communication skills that are evidenced to foster the relationship are: asking open-ended questions, affirming changes the client has taken, reflecting as a way to demonstrate listening, and providing summaries of what was collaboratively discussed. Relatedly, underlying all conversations using an MI-counselling approach means acting and listening with genuine care and empathy for the client, accepting and respecting that they have the right to change or not to change (with valid reasons behind their decision), and partnering with the client to work together in which the client is the expert. Ways in which a relationship between client and health care professional are often undermined are:

  1. Righting reflex (attempting to ‘fix’ a client's unhealthy behaviours)
  2. Expert trap (health care professional assumes they have the best and only answers to a client's problems)

The following resources may support application of the aforementioned frameworks, and are organized according to the aspect of the 5As, the ABCDs and/or MI they suit best.

Engaging

Culturally Connected (BC Children’s Hospital & Women’s Hospital, Canada)

Health Literacy Umbrella (Centre for Collaboration, Motivation & Innovation, Canada)

Introdution to Motivational Interviewing (Centre for Collaboration, Motivation & Innovation, Canada)

Supporting People to Change their Health Behaviour (Motivate 2 Move, United Kingdom)

Assessing

Start Where the Client Is: Assessment to Support Behavior Change (American College of Sports Medicine, USA)

Health Care Providers’ Action Guide (Exercise is Medicine, USA)

Evoking

Supporting Healthy Decision Making (American College of Sports Medicine, USA)

Building Motivation From Basic Needs: Choose, Accomplish, Connect (American College of Sports Medicine, USA)

Motivational Interviewing for Promoting Healthy Behaviors (UComm Rudd Center for Food Policy & Obesity, USA)

Motivational Interviewing: Example Scripts (UComm Rudd Center for Food Policy & Obesity, USA)

Advising

Ask-Tell-Ask (Centre for Collaboration, Motivation & Innovation, Canada)

Ask-Tell-Ask Skills Checklist (Centre for Collaboration, Motivation & Innovation, Canada)

Teach-Back (Centre for Collaboration, Motivation & Innovation, Canada)

Agreeing & Planning

Brief Action Planning Guide (Centre for Collaboration, Motivation & Innovation, Canada)

Brief Action Planning Flow Chart (Centre for Collaboration, Motivation & Innovation, Canada)

Brief Action Planning Skills Checklist (Centre for Collaboration, Motivation & Innovation, Canada)

Setting Strategic Goals (American College of Sports Medicine, USA)

Staying on Track: Creating a Practical Plan B (American College of Sports Medicine, USA)

Identifying and Managing Relapse Risk (American College of Sports Medicine, USA)

Assisting & Arranging

Promoting Self-Efficacy for Healthy Behaviors (American College of Sports Medicine, USA)

Evaluating and Enhancing Self-Efficay for Physical Activity (American College of Sports Medicine, USA)

Self-Monitoring for Supporting Change (American College of Sports Medicine, USA)

Further Reading

AuYoung, M, Linke, SE, et al. Integrating physical activity in primary care practice. American J of Med. 2016;129(10):1022-29. Available at: https://www.amjmed.com/article/S0002-9343(16)30195-4/fulltext.

Lehr AL, Driver SL, Stone NJ. The ABCDs of Lifestyle Counseling. JAMA Cardiol. 2016;1(5):505-6. Available at: https://jamanetwork.com/journals/jamacardiology/fullarticle/2527092?resultClick=1.

Motivational interviewing in brief consultations (United Kingdom)

Physical Activity in the Prevention and Treatment of Disease: Chapter 5 (Sweden)

Physical Activity in the Prevention and Treatment of Disease: Chapter 6 (Sweden)