Motivation and Choice

My apologies for being away. I have been off enjoying the finer things in life- but not to worry I am back!

Today I would like to share with you a new program idea.

I met with a friend and colleague last week. We both had the same supervisor at school and both survived doing research in exercise physiology. Fun times!

My friend now works in a primary care network (PCN), working directly with patients who are referred to him by physicians.

As with all of our visits, the first hour is shop talk. He shared with me some new exciting things the PCN is doing, especially with the programs they are planning to offer. The program they want to implement, is to offer their patients a choice. Yes a choice! Let me explain.

They are planning for this program to be targeting patients who have weight management issues and/or type 2 diabetes. The patients who enter this program will go through introductory sessions on chronic disease management, with a focus on tools to help them with behaviour change (goal-setting, self-monitoring, etc). Once the patient completes these sessions they are given the option to have further assistance in either nutrition or physical activity. Of course, the patients can also get assistance in the other area they may not have initially chosen.

I think this is a great idea, which could be quite successful.

Motivation is a key aspect of changing behaviour. Providing patients a sense of autonomy (ie, a choice, sense that they have control) can be very helpful to maintain motivation.

I am very eager to hear about their program as it develops. I will also be curious to learn if the adherence to this program is better and of course the long term outcomes of their patients.

So, what do you think? Is offering choice useful? Have you seen programs do something similar? How can we give them a sense of autonomy and a sense of control to the people we work with?

Physical Activity Forum: Bringing worlds together

I am pumped for May 10th and 12th (bear with me, I am about to do a little bit of promotion).

Every year my organization holds a Physical Activity Forum in Edmonton and Calgary. This year the topic is on motivating physical activity.

I am very excited for this event. We have a great speaker coming (Dr. Phil Wilson), who is lively and engaging... and more importantly, very knowledgeable about human motivation and behaviour change. His main goal is to help us understand between fact and fiction when it comes to motivation and physical activity.

I am also excited about the panel discussion we will have after Dr. Wilson’s presentation. The panel consists of local practitioners. They will have the opportunity to respond to Dr. Wilson’s presentations with their own experiences and insights.

The idea is to have them share with us: What works? What doesn’t work? And how might they apply what Dr. Wilson presents.

The really exciting part of this event is bringing the world of research and the world of the practitioner together for half a day.

I encourage you to check out our website for information about the event. And… if interested, to register.

Understanding how health can influence physical activity

Health is a bigger motivator for me to be active. My family history is chock full of heart disease and cardiovascular issues, which I would like to fight off as long as I can.

When your health motivates you, it may be easy to assume it motivates others. This is not always the case.

Research has shown that a person’s health can be both a positive or negative influence on participation in physical activity.

We must remember that physical health, mental health, and perceptions of health all play an important role in an individual’s ability or willingness to participate in physical activity.

It is easy to forget that being active is not always easy, especially if they already have health issues.

As practitioners, we must be aware of how people’s health will affect their physical activity participation.

Things to consider:
- Whether or not their bodies can handle the activity. Such as: going for a walk but not having a park bench to rest on; being asked to sit on the floor to do exercises, but not given supports to help stand back up.

- Many medications can cause weight gain or other health-related side effects that may affect physical activity participation. For example, some blood pressure medication makes it more difficult for a person to regulate their core body temperature when they are active.

- Symptoms of a physical health condition that might make it difficult to participate in physical activity . For example, adults with Type 1 diabetes might not participate in physical activity because of the possibility of experiencing a low blood sugar level.

- Symptoms of a mental health condition that might make it difficult to participate in physical activity. For example, a person with an anxiety disorder may find it impossible to attend a group program.

Finally we also need to be aware of people’s perception of physical activity and their health. Concerns or fears about their health condition (whether they are based on fact or not) may actual deter people from participating.

* Fear that their existing health conditions might be made worse by becoming physically active or by doing too much.
* Fear of getting injured or re-injured.
* Fear of experiencing pain.
* Fear of participating in activities that aren’t appropriate for their age or, in some cases, for their health condition.

As practitioners, we need to be careful to listen and not belittle these fears.

That being said, promoting and educating the health benefits of physical activity is till important. We can help to motivate folks to move more, as long as we recognize their health situation and status. I believe, the key thing is taking the time to listen and understand the people we work with. How does their health currently influence them? How can you adapt your class, education, work, environment to better suit them?

For some other strategies on this topic check out this section of our website called Physical Activity for All:

Once again, I am open to hearing your ideas and experiences on this topic….

I wish good health to all of you!

Picking on weight loss challenges

In our field we often hear about physical activity challenges/competitions as a tool to get people's attention and to help provide some initial (external) motivation.

For example, I hear of workplaces hosting their own Biggest Loser, or running a pedometer step challenge. Here in Edmonton there is the Edmonton Journal and YMCA At Home Health Club Challenge. Nationally there is the CBC Live Right Now.

Often communities, workplaces, recreation facilities may offer similar challenges. The goal, is often to offer a competitive environment in hopes of inspiring people to take action, whether it is to eat healthier, be more active… or lose weight. We must remember that these challenges offer external motivation (read my earlier blog on motivation).

Challenges have their place for sure. However, many use the focus of weight loss as the main goal. This has many concerns for me, which I thought might be good to discuss.

Physical activity promoted as the major tool for weight loss. In some challenges physical activity is promoted as the main method for successful weight loss.

We must remember nutrition, eating habits and overall lifestyle changes (such sedentary behaviours) play a VERY large role.

As professionals in the field, we must remember losing weight is a complex issue and involves many different behaviour and lifestyle changes.

• So why are picking something so difficult for our participants?
• Will participants see long term success once the challenge is over?
• Are we supporting the typical yo-yo dieting and weight loss cycling that we know is so unhealthy?

How Physical Activity is Portrayed. Often in these challenges (especially the ones on TV) we see physical activity being portrayed as gruelling and the awful component of the weight loss story. I am not convinced that this is the correct or an effective message we want to send.

I have a few questions about how this messaging may affect people.

• If people are so focused on the weight loss do they miss seeing the other benefits they get from being active?
• Are we installing the fear that physical activity has to be hard and brutal in order to benefit from it?
• Are we encouraging the notion that it is only worthwhile to be active if you are on the ground sweating and moaning afterwords?

Some people may find this type of activity fun. But I suspect most don’t. Most people will likely not work that hard when on their own. So, once the challenge is over, what happens to the physical activity participation? It will likely decline.

Bottom line, physical activity should be fun, appropriate and sustainable for the person even after they complete the challenge.

Focus too much on the numbers. Often the success of weight loss challenges is based on the numbers on the scale or the inches lost with the tape measure.

I wonder if we are not setting people up for failure or disappointment. Yes, there will be the people who see success with changes on the scale. What about those who do not see changes in their numbers, or those who only see change at the beginning? Does that mean their hard work and effort to change their lifestyle should go unrewarded?

Those who promote physical activity know (or at least we should) that the behaviour change needs to happen before we can see significant physiological changes (especially weight loss).

So why not start using the behaviour as a marker for success? Such as:

• Did you increase how often you were active this week? Yes! Success!
• Did you reach Canada’s Physical Activity guidelines this week? Yes! Success!
• Were you able to be consistent doing the same amount of physical activity each week for the last month? Yes! Success!

This can allow people to focus on the doing, rather than the outcome.

Using numbers of course is a form of external motivation, and can help get people started… but should the focus be only on weight loss?

Why not focus on some of the other benefits of being active:

• Are you sleeping better (more hours, better quality)?
• How is your energy during the day?
• Can you walk longer? Faster?
• Are you getting stronger?
• Is your blood pressure lower?

So what about you? What are your thoughts on these kinds of challenges? Have you seen some great challenges? How about some ‘not-so great’ challenges?

I would love to hear your stories.