Knowing about the many benefits of a physically active life and nutritious dietary choices provides a foundation for action. However, knowing does not always translate into making healthy choices; the difficulty comes in actually acting on your knowledge of healthy behaviors. This chapter focuses on helping you advance from just knowing to doing. Whether you desire to start being more physically active, expand your current exercise program, make some nutritious substitutions, or improve your overall diet, you need to reflect on how you can make changes that work for you. Each person is unique with regard to health status, fitness level, work and family responsibilities, ethnic and social environments, and many other facets of life. Given the complexity of each individual, the chapter provides various methods and suggestions to allow you to find what works for you.
Motivation to Change
Developing and maintaining a physically active lifestyle involves attention to the issue of motivation. Motivation is the determination, drive, or desire with which you approach or avoid a behavior. Although this may seem to be a simple concept, many different forces make up your motivation to embrace or withdraw from a given behavior. In addition, behaviors tend to be ingrained over time and therefore are often difficult to modify. This may be a positive characteristic for healthy behaviors already in place, but may be an obstacle for change in those areas in need of improvement. However, change is possible, especially with the use of basic principles of behavior modification.
Self-Determination and Motivation
The idea of self-determination suggests that you develop your motivation for an activity based on both your psychological energy and the goal to which that energy or focus is directed. Rather than being an on-and-off switch, motivation slides across a continuum ranging from no or low extrinsic motivation to intrinsic motivation (1). Figure 4.1 provides an overview of the various levels of motivation: amotivation, extrinsic motivation (including external regulation, introjected regulation, identified regulation, and integrated regulation), and intrinsic motivation (1).
Figure 4.1 Motivation continuum.
Adapted by permission from American College of Sports Medicine, 2014, p. 284.
Amotivation
Amotivation represents the absence of motivation (1). For example, if you are at this level, you don’t expect exercise to meet your needs and thus you have absolutely no interest in or intention to exercise. Amotivation often includes a “Why bother?” or “What difference can exercise make?” mindset. This level of motivation may be the result of negative experiences in the past that affect your beliefs about the purpose and benefits of exercise. The same is true in relation to nutrition. If you don’t believe dietary changes can benefit your health, you will have little desire to alter your eating habits. To move beyond this level of motivation, consider the overwhelming evidence provided throughout this book on the positive potential impact of exercise and diet.
Extrinsic Motivation
Extrinsic motivation results in engaging in a behavior for a particular outcome or is based on outside factors (1). Levels of extrinsic motivation vary as to the degree to which they are internalized. The least internalized form is external regulation (1). Exercising in order to earn a T-shirt has an external focus. Selecting a side dish of fruit rather than french fries to avoid negative comments from health-focused coworkers is another example of external regulation. Motivation is based on seeking to gain rewards or avoid negative consequences. Pressure to make healthy choices can also come internally due to shame or guilt; this is referred to as introjected regulation (1). An example is feeling guilty about not exercising after investing in a home treadmill. Although these types of external motivation have the potential to stimulate exercise initially or promote healthy dietary choices, because the behavior is not freely chosen, the changes are often short-lived and the chances of dropping out are higher.
Shifting toward finding personal importance in a given behavior provides a greater likelihood for sticking with the behavior for the long term. Acting on motivations to exercise that are free of pressure and evaluation by others gives you the best chance of sticking with your exercise plan. Identified regulation refers to believing in the value or importance of a given behavior (1). An example is making nutritious dietary choices because of your belief that eating well promotes health. The most internalized form of extrinsic motivation is integrated regulation and involves engaging in behaviors that are consistent with other goals and values (1). An example is exercising regularly as a habit consistent with goals of losing weight and improving fitness.
Intrinsic Motivation
Intrinsic motivation exists when the reason for exercise is the fun and satisfaction received from the exercise itself and when the reason for healthy food selections is the enjoyment of the meal itself. Intrinsic motivation has the highest degree of self-determination. This type of motivation is difficult to achieve because, in many ways, it is less of an achievement and more of an experience.
Understanding the levels of motivation can help you develop healthy habits that you will continue in the future. Moving from amotivation toward intrinsic motivation is possible through education, positive encouragement, and successful experiences. Although you may not always attain an intrinsic motivation, by adopting a positive approach to exercise and nutrition you can advance to motives known to increase participation and adherence. The following sections highlight some of the effective strategies for increasing healthy behaviors (1, 2).
Enhancing Self-Efficacy
Self-efficacy is the confidence you have in your ability and is a key factor in making changes in behavior. For example, do you believe you have the ability to be physically active? What and how you think about exercise affects the likelihood that you will begin or continue being physically active. Some ways to increase self-efficacy are included in this section (1, 2).
Q&A
Are there different types of self-efficacy?
With regard to exercise behavior, two types of self-efficacy have been identified: task self-efficacy and barriers self-efficacy (2). Task self-efficacy reflects your belief that you can do a particular activity. Barriers self-efficacy represents your belief that you can do that activity when faced with a barrier (e.g., limited time). Having belief in your ability both to do an activity and to continue with an exercise program when challenges arise is important when you are seeking to change a behavior.
Mastery Experiences
Mastery experiences involve selecting activities that you are able to successfully complete. This supports the premise “start low and go slow” when beginning with an exercise program or a new activity (2). By starting with activities that you are able to carry out, you can build your confidence to continue to exercise. Realize that the body takes time to adapt when you are beginning to be physically active or advancing in your current exercise program. Progression needs to start from where you are now rather than where you want to be. This could also apply to changes in diet. Rather than attempting a complete, abrupt overhaul of what you eat, consider some substitutions that increase the healthfulness of your diet. You can build on this success over time.
Vicarious Experiences
Vicarious experiences involve observing peers who are having positive experiences. For example, observing someone your age completing a 10K run may be inspiring to you—suggesting that you can train and do the same in the future. Reading of someone’s successful weight loss using sound nutritional practices and regular physical activity could promote confidence in your ability to lose weight, if needed, with healthy choices. Seeing others like yourself realize success can promote your own confidence in doing the same.
Verbal Persuasion
Verbal persuasion involves receiving encouragement from others. Receiving encouraging feedback promotes confidence. Seek those who can provide that type of support and consider how you can provide support to someone else as well. A buddy system benefits both yourself and your health buddy! Feedback and support can even come from social media through connections maintained with online support groups or forums such as Facebook or Twitter (1).
Physiological Feedback
Physiological feedback includes many aspects such as enjoyment and positive mood. Reflect on the improvements in your fitness that are realized with a regular physical activity program and how these affect your ability to function in routine day-to-day activities. With regard to nutrition, you can enjoy healthy food choices, realizing the nutrients consumed provide energy for your daily activities.
Creating a Decisional Balance Sheet
Increasing your level of exercise and making better nutritional choices are major decisions. As with any big decision, creating a list of the pros and cons can be very productive. Consider the factors that support your decision to change while also acknowledging the factors that may inhibit that change. This is called a decisional balance sheet (1). See figure 4.2 for an example of a balance sheet related to exercise.
Figure 4.2 Sample decisional balance sheet.
As you examine your own list of factors impeding your commitment to regular exercise, consider how you might modify them to move them to the pro side of the list, or at least how you might address them. For example, the extra time that a regular exercise program takes cannot be denied. However, you can modify your perspective on the time spent. You can think of your exercise time as a time to clear your mind and unwind from the stresses of school, work, or home responsibilities. You may select aerobic activities such as treadmill walking or stationary biking that allow you to read or watch television—activities you find rewarding but typically don’t take time to enjoy.
If you have a jam-packed schedule, consider breaking your exercise routine into multiple shorter bouts. You may be able to take advantage of your lunch break to add extra activity to your day. Another option many people use is an early morning exercise routine. Although you may need to adjust your bedtime, morning workouts ensure that you exercise before the hectic schedule of the day takes over. The key is to reflect on your schedule and find an option that fits the best into your daily routine.
Another common concern is the fear of injury or even death with increased physical activity. As discussed in chapter 2, certain health-related situations may require you to meet with your health care provider to increase the safety of your exercise program. This is the reason for completing the preparticipation screening process outlined in chapter 2. For most apparently healthy people, starting with light to moderate intensity and progressing slowly minimizes the likelihood of injury as well as heart attack or death (2). The health benefits of a regular physical activity program are greater than the risk of adverse events for almost everyone (9).
Finally, if you find your current exercise routine boring—find other options! Your exercise program should include activities you enjoy. Consider adding more variety or joining a group exercise class. Listening to music or downloading an audio book can provide mental variety even if you keep your activity the same. Remember, when using a headset, be sure to be indoors or in a controlled environment so you do not become distracted and fail to observe traffic or others around you.
Setting Goals
Goal setting is one of the most important aspects of successful behavior change (1, 2). Without goals, you cannot develop a plan because you don’t know where you want to go. That would be like going on a trip but never identifying the geographic location of your final destination. To succeed, you need to develop both long-term and short-term goals. Long-term goals are like your final destination; short-term goals are the individual routes that will get you there.
Short-term goals are those that can be realistically accomplished within a brief period of time such as this week or this month. For example, if you have been totally inactive, a short-term goal might be to walk around your neighborhood for 10 minutes each night after work for the upcoming week. This short-term goal has some valuable characteristics that you can remember with the acronym SMARTS, as follows (2):
· Specific: The activity has been clearly defined in terms of both length and location. The goal is unambiguous with respect to what is desired.
· Measurable: At the end of the week, you can reflect back on whether you walked each day after work. This is better than having a goal such as “I want to get in better shape,” which would be hard to measure.
· Action-oriented: The goal includes an activity rather than generalities or an outcome, such as improving fitness or losing weight. It is focused on what you will actually be doing.
· Realistic: The location for the activity is convenient, and the length of the walk is not excessive. Too often, goals are so far out of reach that they become a source of discouragement rather than encouragement. Your goals should be relevant to you and firmly based in the reality of what you can accomplish.
· Timely: This goal is linked with a specific time frame. Rather than being too open-ended, the goal specifies the upcoming week. Without a time-centered approach, you might be tempted to procrastinate starting or moving forward with an exercise program.
· Self-determined: Rather than having someone else set your course of action, you need to be the one to define your goals (and this will promote your self-efficacy as well).
SMARTS short-term goals can provide wonderful encouragement and focus. In addition, they can instill a sense of self-confidence that you can perform the activity. By creating a series of short-term goals, you can build toward your long-term goals.
Long-term goals are those that you can achieve in the future—three months to a year from now. With careful planning, meeting your short-term goals should lead to accomplishing your long-term goals. For example, a long-term goal for a person who is currently jogging only a mile at a time might be to complete a 5K (3.1 miles) race three months from now without having to walk. To prepare for this race, the time spent jogging needs to increase in order to progress from being able to run only about one-third of the target distance to being able to run continuously for the entire 5K distance. Short-term goals could be set weekly with increased distance (e.g., adding an extra lap or two when running on the track). By mapping out short-term goals, an effective plan can be established, leading to successfully meeting the long-term goal (1).
Continuing to set new goals or revising prior goals keeps you moving forward in your journey toward improved fitness and health. Setting both short-term and long-term goals in each of the fitness areas allows you to individualize your exercise program. You may already be walking on a regular basis but see that you have neglected your muscular fitness or flexibility. By including goals in all areas, you can create a balanced exercise program. The same can be done with the various dietary components. For example, are you consuming adequate amounts of fruits and vegetables? Are you consistently replacing refined grains with whole grains? Is your sodium intake in the recommended range? As you identify your own strengths and weaknesses, you can focus additional attention on the areas in which you struggle, and you can seek to maintain your status in the areas in which you already have a solid foundation.
Q&A
How can I turn my goal from a dream into a reality?
Writing down your goals is helpful. Whether you put pen on paper or use technology to document your goals, this process of clearly identifying your goals can give you an opportunity to reflect on what you really want to accomplish with your exercise program and with your nutritional plan, providing you with a clear reference point. Keep your short-term goals prominently visible. Some people write their goals in their schedule books or post them on a note board, mirror, or even the refrigerator. Smartphone apps are also available for documenting and tracking goals. Find a method that works for you, one that allows you to see your goals as a reminder of the actions you want to take. You can check off completed short-term goals and add new ones as you progress toward your long-term goals.
Reinforcing Behavior
Using rewards is another way to promote positive behavior change (2). External rewards may be tangible (for example, purchasing a new pair of running shoes) or even social (for example, praise and encouragement from a family member or friend). Internal rewards come from within you. An example is the feeling of accomplishment when you try a new activity or when you complete a workout that was challenging. Although all rewards are beneficial, doing activities for internal rewards, or intrinsic reasons, tends to be related to one’s ability to stick with a program for the long term.
Finding Social Support
Social support is a very strong motivator (2). Consider the encouragement provided by a friend who supervises a young child so that a parent can head outside for a run or attend a group exercise session at a local health club. In addition, parents who model an active lifestyle are providing a wonderful example for their children. It is even better to be active together as a family. A family outing to a local park can be a great stress reliever as well as an opportunity for everyone to be active. Physical activity is important throughout the lifespan. Developing active habits early in life will have lifelong benefits.
Social support skills allow you to reach out to others. Establishing a network of people you trust can help facilitate healthy lifestyle changes. Beyond the family unit, consider coworkers and neighbors, as well as fitness and health care professionals, as sources of support. Others in your personal network can provide encouragement, assistance, and guidance as needed (2).
Participating in group activities—with family members, friends, or local groups—can also be a strong motivator to stay active. Most communities have clubs or associations of people with similar interests (e.g., cycling, running, mall walking, ballroom dancing). These are wonderful opportunities to meet new people and find real enjoyment in your exercise program.
If your family members or close friends do not support your desire to be active or to improve your diet, seek out other support systems. Some people, when facing their own health problems, may feel threatened by your resolution to move forward to better health. Don’t let others sabotage your plans. Find people who have goals for activity and nutrition similar to yours. By encouraging each other, you can generate the motivation to continue. Hopefully, over time, your example will persuade your family members and friends to also join you in making healthy lifestyle choices.
Exercising as a family is a great way to build fitness together.
Sticking With Your Plan
With your goals for both physical activity and nutrition written down, you now need to plan for success. To reap health and fitness benefits, your plan needs to become a regular part of your life—for your life. This section outlines a number of skills and strategies that experts have identified as helpful for promoting lasting behavior change.
Promoting Change
Resolving to change is the first step, but actually changing the behavior is key to realizing health and fitness benefits. Various tactics can be included to promote behavior change (6).
Counterconditioning
Counterconditioning involves using a behavior that circumvents the problem (5). For example, if you want to cut down on time spent sitting and watching TV, you instead make an appointment to meet a friend for a walk at a nearby park. On the nutritional front, you may want to avoid the draw of the vending machine, so you plan ahead by bringing an appealing and nutritious snack.
Fading
Rather than attempting abrupt changes, fading reflects a more gradual reduction in an undesired behavior as you increase the desired behavior (5). Extreme changes in diet or in exercise can be overwhelming. Instead, make a series of smaller changes. Reducing time spent sitting while gradually increasing the time spent exercising would be manageable. Dietary changes also can be promoted with fading. As you shift your food and beverage choices to healthier options, you will promote new habits that can be continued.
Stimulus Control
Surround yourself with reminders to make healthy choices (5). Having a bowl of fresh fruit on the kitchen counter and hanging a picture of a favorite hiking trail on your wall are ways to keep a focus on healthy behaviors. Stimulus control provides a positive and uplifting framework that can promote development of healthy habits.
Overcoming Barriers
Breaking down barriers often requires creativity, assistance from others, and careful planning (2). What factors are getting in your way when it comes to exercise or good nutritional choices? Table 4.1 explores some physical activity barriers and includes helpful suggestions on how to overcome those barriers (8). Frequent barriers to making good nutritional choices and tips on overcoming the barriers are included in table 4.2 (4, 7).
Preventing Relapse
Relapse prevention skills help you maintain your behavioral change efforts even when faced with situations that may increase the likelihood of a lapse or a poor health choice (2). Learning to avoid situations can help you avoid a complete relapse. For example, consider the time you plan to exercise. If you know that mornings are typically a rushed time for you, don’t schedule a workout class at that time, as you may be more likely to skip the class. On the nutritional front, buffets, by their “all-you-can-eat” nature, encourage overconsumption. If possible, select other options when dining out or simply order an entrée from the menu, thus encouraging portion control in advance. By anticipating circumstances that could derail your exercise and nutrition goals, you can plan ahead to avoid those situations and help yourself stay on track.
Another way to prevent relapse is to develop a plan for high-risk situations (2). Life situations arise that may disrupt your progress toward health and fitness goals. Don’t let this be discouraging. Instead, plan for it. Your exercise program is not an all-or-none endeavor. For example, when traveling for business, you may become stuck in the airport with a delayed flight. Rather than sit and fret about the delay (over which you have no control), take a brisk walk around the terminal. When traveling, consider staying in hotels that have fitness rooms. Although they are not ideal, typically you can find activities that will complement your program. If there is no fitness room, walk the halls or consider doing some calisthenics and stretching in your room. Ask the hotel staff about safe places to walk or jog in the neighborhood.
As with your exercise plan, your diet involves many small decisions made throughout the day, and planning ahead can help avoid lapses. A healthy diet includes focusing on a higher intake of some items (for example, vegetables, fruits, whole grains, low- or nonfat dairy, seafood, legumes, and nuts) while keeping to a lower intake of other items (for example, sugar-sweetened items, refined grains, saturated fats, and high-sodium items) (10). Rather than being discouraged by an overly stringent plan in which foods are placed into “good” versus “bad” categories, consider strategies for promoting a healthy pattern of eating. For example, for a tasty pasta dish, consider using whole-grain pasta rather than refined options along with a tomato-based sauce rather than a high-fat creamy sauce. Preplanning meals can be helpful at home as well as at work or school. Bringing a wholesome lunch or packing some nutritious snacks can help avoid reliance on fast food or vending machines during the day.
Unfortunately, plans and intentions to maintain a regular exercise program and make nutritious dietary choices can fail. Even then, use the situation to your advantage by taking the opportunity to explore what worked previously and what aspects led to a lapse (11). Researchers have actually found that lapses have the potential to strengthen one’s resolve (6). Be willing to honestly consider what factors brought about the lapse, and use those insights to renew your focus on your health and fitness goals.
Dealing With Setbacks
Will you experience setbacks in your path to better health and fitness? Very likely. When sickness, travel, family responsibilities, work obligations, and other unavoidable situations arise, realize they are just short-term holdups, not permanent derailments. Have a return plan of action in place (2). When faced with a setback in your exercise program, you might have to reverse your timeline a bit. For example, after an illness, you should start back slowly rather than jumping right back to where you left off. Although you may feel frustrated at losing fitness, be encouraged that you are able to start again and build back up. Similarly, when you find that your dietary plan is off track, start once again with making healthy substitutions, and before you know it, you will be off and running toward a wholesome approach to your diet. Keep a positive mindset by realizing that a single missed workout or overconsumption at a holiday party is not the end of the world. With this approach to the inevitable setbacks that come along, you can keep moving toward your goals.
Self-Monitoring
Self-monitoring involves observing and recording your behaviors as well as your thoughts and feelings (1). Keeping tabs on your exercise and nutrition helps keep you on track. Just as regular car maintenance gives you worry-free driving, taking a few moments to check your body’s progress ensures that you are still on course to meet your goals. One way to do this is to write down what you have accomplished each week along with your reflections on those activities.
Although logging your exercise accomplishments or your dietary choices can be done using paper and pencil (see figure 4.3 for a simple example of an exercise log), other options are available. Technology provides many interesting possibilities on monitoring behavior. For physical activity, consider a heart rate monitor, pedometer, or other commercial activity tracker. In addition to tracking physical activity, many smartphones have options to help monitor dietary intake. Whether recording on paper or using technology, monitoring your behaviors can help you check progress toward your goals. By tracking behavior as well as how you felt about the experience, you can reflect on your progress, including observation of barriers to achieving your goals.
No matter the method used, the key is to take time to reflect. Look for trends and patterns. Do you find that your approach to the weekend promotes or reduces your activity? As seasons change, do you struggle to maintain a regular exercise routine? Does eating out affect your dietary choices or are you able to maintain a healthy approach to your food and beverage selections? What dietary substitutions have you made, and how have they influenced your overall diet? A reflective and mindful approach can help you to make any needed adjustments in order to continue moving toward your goals.
Writing a Contract
How strong is your intention to be active and make healthy dietary choices? What are you doing to bridge the gap between your intentions and taking action? Many of the techniques discussed throughout this chapter promote this link. You may also find developing a contract to be effective. Contract components may include a clearly stated goal (remember the SMARTS characteristics), benefits of reaching the goal, what steps will be taken to meet the goal, what activities promote meeting the goal, what barriers inhibit reaching the goal and how you will overcome those barriers, and short-term goal(s). See figure 4.4 for an example of an exercise contract (3).
Taking a Long-Term Approach
One final consideration regarding behavior change and motivation relates to the development of a long-term, or lifetime, approach. In spite of advertisements that promise fitness or extreme weight loss in a week, the reality is that changes take time and require an ongoing commitment. Modern society has conditioned everyone to value things that are instant and disposable. This “now” perspective conflicts with the long-term commitment needed for building a healthy life. This mismatch in values likely contributes to the high dropout rate observed among new exercisers and the difficulty people have sustaining new behaviors.
Immediate pleasure is not always the outcome of exercise participation. Rather, physical discomfort such as muscle aches may occur, especially in the early weeks after starting a new program or advancing your exercise level in a given area. Changes in diet can be a challenge, and benefits to health or changes in body weight are not immediately apparent. Acknowledge the challenges you may face in the short term and experience each moment for what it is. Balance the challenges and effort in the short term with the greater feeling of well-being that will result in the long term.
Deciding to take charge of your health and to improve your fitness is a powerful resolution. Understanding the basic components of fitness and what constitutes a healthy diet gives you the tools you need. With tools in hand, you must reflect on what is important to you. Putting your goals down on paper and examining your reasons for exercising and making nutritious dietary choices will give you a perspective that allows you to create an individualized approach. Effective planning considers goals, available resources, and social support. Finding ways to overcome barriers and recover from setbacks or temporary lapses is key to developing a lifelong approach to health. This is not a static process but an evolution that continues to be refined as you develop new and more challenging goals.