Behavioral Change

The other day I got a text message from a friend I have helped many times with fitness advice and workout ideas over the years. The question he posed to me described an all too familiar scenario: an overweight person not knowing how to start exercising. He wanted to help his aunt improve her health, and she wanted to as well, but they didn’t know where to begin. Well my response was pretty boring.

I went on to explain myself. Since he is a good friend I knew he could appreciate my advice without thinking I was being insincere or short with him. I told him the question he posed was one of behavior change. The first thing she needs to do to change her behavior is establish a routine. Secondly, she needs to begin her exercise with only a few basic movements to start. And third, she needs to learn the basics of exercise progression if she’s going to do this on her own. The goal of my advice was to make exercise easy for her, if that’s possible.

My friend was surprised when I gave him such a basic exercise program for his aunt. Only walking? Really? After all, the training programs I have sent him in the past usually look more like the one below:

Since it’s pretty easy to tell that the lifting program above would not be appropriate for his aunt, we are back to the question at hand of where to start.

The first step for his aunt is behavior change:

any transformation or modification of human behavior.

She needs an easy-to-maintain plan to make this change. Although behavior(al) change is a tenet of psychology, it plays an immeasurably large role across many disciplines including coaching, training, and therapy, all of my favorites. 🙂

[img cred]

Step 1: Establish a routine.

Yeah, I know. Another freakin self help blog post telling people to establish a routine. Real original stuff. Even if it’s just a walking program, this is incredibly important to the process. Step one in behavior change is following and establishing a sustainable routine. It may be boring, and it may be basic, but the fundamentals are crucial to long term success.

Research on success shows that self-regulation might enhance self-efficacy through feelings of ability to manage barriers (1). If you have a routine in place to exercise 5 times a week, but you usually only make it 3 or 4 times, that’s not going to cut it. Instead, create a realistic schedule of 3 times per week with an optional 4th day and be successful in following in your plan.
Minimizing barriers has shown to be an important aspect in behavior change (2). Part of establishing a routine is having plans in place for different life scenarios. Travel for work? Work late some nights? Only have 45 minutes? Sometimes following the plan means being adaptable. If time is your biggest obstacle, you may need to have abbreviated workouts for your busy days. Make your exercise program evolve around your life, and not vice versa.
Studies continually show that social support and encouragement is an important part of adopting new health related habits (2). An often overlooked and important part of establishing a routine is establishing a support circle. Find an exercise buddy or group setting that you enjoy. Make sure your significant other, close family and friends, etc. are on board with your routine. Because if they don’t believe in what you’re doing, you won’t either.

[img cred]

Step 2: Stick to a few basic movements.

Once the behavior change is underway, don’t overcomplicate exercise.

During the time of initial neurological adaptations to a movement, variation should be kept low in order to achieve maximal strength gains (3). I can’t emphasize this concept enough. While changing workouts is necessary for long term progress, it can be detrimental in the short term. When a new exercise is introduced to a training program, it is an additional stress that must be accounted for. This concept applies across all tenets of exercise from resistance training to rehabilitation.
For lifters, the ultimate goal of strength training is hypertrophy, the process of muscle growth. Hypertrophy can take a month or two to even begin as the initial improvements in resistance training are primarily neurological (3). For this reason, strength training movement variation should be low in order to see maximal strength training results once hypertrophy begins to be a contributing mechanism of adaptation. Simply put, get good at a few lifts before you branch out.
Even for low back pain patients, it has been shown that while beginning a non-specific exercise intervention, graded exercise exposure is superior to graded activity exposure for minimizing catastrophizing events (4). By slowly adding new exercises, the therapist can maximize a patient’s control over his or her pain, thus fostering confidence in the treatment plan. PT’s should focus on succinct, easy-to-follow home exercise programs. Don’t throw the kitchen sink at them.

Step 3. Learn the basics of exercise progression

[img cred]

The last step, is avoiding the dreaded plateau that so often derails a beginner’s motivation and progress.

The easiest way to teach beginners how to progress their exercise is linear progression. I like to describe exercise progression in an oversimplified way using linear principles. All you have to do is improve in any one factor and you’re making progress. Was the run easier? Did the exercise feel smoother? Did you do more reps? Did you go a further distance? Did you lift more weight? Were you less tired at the end of the workout? Were you less sore? Etc. Yes. I know this is wrong… This is my own version of linear progression, and I’m OK with it for this purpose. We’re not talking about training powerlifters or triathletes.
There are some very effective ways to make progress during this time period without changing exercise selection. Changing range of motion or loading patterns, using bands to resist different planes of movement, changing daily workout splits or exercise sequences, altering the points of emphasis in each workout by manipulating reps and sets are all progression techniques that can elicit new adaptations without introducing new movements. Exercise variety is overrated. Muscles don’t respond to confusion, they respond to the principles of overload and specificity.
While I will admit that linear progression is not the best long term plan for experienced lifters, that’s a topic for another day (5,6,7). The reality is that most people have no interest in learning complex training theory and periodization, all they want is an easy way to stay healthy. And I say, give the people what they want!

In closing,

In order to elicit behavior change and start an exercise program, a routine should be established first and foremost. The emphasis should be placed on basic exercises and familiar movements. For some people this may just be walking. As progress is made and adaptations start to slow, these movements should be progressed with a variety of loading patterns and set and rep schemes, while conservatively adding new exercises to the workout regimen.

-Teddy

References

Annesi JJ, Johnson PH, McEwen KL. Changes in Self-Efficacy for Exercise and Improved Nutrition Fostered by Increased Self-Regulation Among Adults With Obesity. J Prim Prev. 2015 Aug 9. [Epub ahead of print]
Van Harten WH, Buffart LM, Sonke GS. Why do patients choose (not) to participate in an exercise trial during adjuvant chemotherapy for breast cancer? Psychooncology. 2015 Aug 17. [Epub ahead of print]
Sampson JA, McAndrew D, Donohoe A. The effect of a familiarisation period on subsequent strength gain. J Sports Sci. 2013;31(2):204-11. doi: 10.1080/02640414.2012.725134. Epub 2012 Sep 21.
López-de-Uralde-Villanueva, Muñoz-García D, Gil-Martínez A. A Systematic Review and Meta-Analysis on the Effectiveness of Graded Activity and Graded Exposure for Chronic Nonspecific Low Back Pain. Pain Med. 2015 Aug 3. [Epub ahead of print]
Prestes J, Frollini AB, et al. Comparison between linear and daily undulating periodized resistance training to increase strength. J Strength Cond Res. 2009 Dec;23(9):2437-42.
Miranda F, Simão R, et al. Effects of linear vs. daily undulatory periodized resistance training on maximal and submaximal strength gains. J Strength Cond Res. 2011 Jul;25(7):1824-30.
Simão R, Spineti J, et al. Comparison between nonlinear and linear periodized resistance training: hypertrophic and strength effects. J Strength Cond Res. 2012 May;26(5):1389-95.

Here are some related posts on this topic:

http://www.theptdc.com/2012/01/personal-trainers-shouldnt-periodize/

http://bretcontreras.com/how-i-became-a-national-level-olympic-weightlifter-in-a-year/

http://bretcontreras.com/10-things-beginning-lifters-know/