suspicious - super-super. · pdf filesuspicious minds: what actually motivates clients, and...

Suspicious Minds:h ll i li dWhat actually motivates clients, and

what holds them back

Lou Schuler

l h llouschuler.comthenewrulesoflifting.com

Can you feel the motivation?Can you feel the motivation?

Three stumbling blocksThree stumbling blocks

• They lack social supportThey lack social support


• They lack social supportThey lack social support• They lack self‐management skills


• They lack social supportThey lack social support• They lack self‐management skills

h i l ’ d l i h h di f f• They simply can’t deal with the discomfort of exercise

Our goals todayOur goals today

• The state of playThe state of play– How many people exerciseHow many start programs and then drop out– How many start programs and then drop out


• The state of playThe state of play• Some impediments to adherence



h ll i l• What actually motivates people



h ll i l• What actually motivates people• How to improve adherence



h ll i l• What actually motivates people• How to improve adherence

– People who’re really screwed– People who’re just kinda screwed– People who rolled Yahtzee



h ll i l• What actually motivates people• How to improve adherence• Lame attempt to sum everything up on one slide

Part 1: The state of playPart 1: The state of play

Why exercise?Why exercise?

• Weight‐loss programs based on calorieWeight loss programs based on calorie restriction typically fail (80‐90%)Rosenbaum and Leibel, “Adaptive thermogenesis in humans.” International Journal of Obesity, p g f y2010; 34: S47‐S55



• Calorie restriction often results in weight gain“ ’ f ff ”Mann et al, “Medicare’s search for effective obesity treatments: diets are not the answer.”

American Psychologist 2007; 62: 220‐233



• Calorie restriction often results in weight gain“ ’ f ff ”Mann et al, “Medicare’s search for effective obesity treatments: diets are not the answer.”

American Psychologist 2007; 62: 220‐233

• Exercise is strongest predictor of maintained g pweight lossAnnesi and Marti, “Path analysis of exercise treatment‐induced change in psychological factors leading to weight loss ” Psychology and Health 2011; 1‐18 iFirstfactors leading to weight loss. Psychology and Health 2011; 1 18 iFirst

How many Americans exercise?How many Americans exercise?

• 217 million Americans considered “active”217 million Americans considered active• About 60% participate in “fitness activities”

b % d hi “ l l ” “f l ”• About 44% do this “regularly” or “frequently”

Sporting Goods Manufacturers Association, “2012 Sports, Fitness and Leisure Activities Topline Participation Report”

What nonexercisers wish they were doingWhat nonexercisers wish they were doing

Among inactive peopleAmong inactive people 13‐44 years old, “working out with weights” is the most aspirational activity

Source: SGMA

Government‐approved!Government approved!

• 43.5% “aerobically active” (150 minutes/week of43.5% aerobically active (150 minutes/week of moderate‐intensity activity)

• 28.4% “highly active” (300 minutes/week of g y ( /moderate‐intensity activity)

• 21.2% meet strength‐training guidelines (2x week)g g g• 18.2% meet both guidelines

Carlson et al, “Trend and prevalence estimates based on the 2008 Physical Activity Guidelines for Americans.” American Journal of Preventive Medicine 2010; 39 (4): 305‐313.

The dropout rateThe dropout rate

50‐65% of those h b iwho begin an

exercise program will quit within 3‐6 months

Part 2: Impediments to exercisePart 2: Impediments to exercise

“Stereotype threat”Stereotype threat

Uncomfortable socialUncomfortable social situations make people feel “conditional stupidity”

Annie Murphy Paul, “It’s not me, it’s you.” New York Times, Oct. 7, 2012

Wrong friendsWrong friends

“People’s assessment of the health benefits theyPeople s assessment of the health benefits they receive from exercise are influenced by … comparisons of other people’s exercisecomparisons … of other people s exercise

amounts.”

Maltby et al, “Contextual effects on the perceived health benefits of exercise: the exercise rank hypothesis.” Journal of Sport & Exercise Physiology 2012;

34: 828‐841

Wrong friends, cont’dWrong friends, cont d

“Friendship isFriendship is generated, in part, by cognitive systems that function to assemble a support group for

t ti l fli t ”potential conflicts.”

DeScioli and Kurzban, “The ,Alliance Hypothesis for Human Friendship.” PLoS One 2009; 4 (6): e5802

Too many changes at onceToo many changes at once

• Willpower is a limited resourceWillpower is a limited resource• Willpower requires a steady supply of glucose to the brain which exercise and a calorieto the brain, which exercise and a calorie‐restricted diet both depleteTh h k fi d i i d• Those who make one firm decision, and commit to it, are more likely to succeed

John Tierney, “Be It Resolved.” New York Times, Jan. 5, 2012

They don’t enjoy the exercise they’ve chosenThey don t enjoy the exercise they ve chosen

• Best results occur atBest results occur at higher intensities

• Adherence is highest at glower intensities

• Pleasure mediates participation

Ekkekakis et al, “The pleasure and displeasure people feel when they exercise at different intensities.” Sports Medicine 2011; 41 (8): 641‐671; ( )

Part 3: What actually motivates people

General MotivatorsGeneral Motivators

• AutonomyAutonomy– Perception of choice predicts effort in any task

Daisy Yuhas, “Three Critical Elements Sustain Motivation.” Scientific American, Nov. 21, 2012



• Value• Value– The more value you assign to a task, the greater your sense of autonomy (and effort)your sense of autonomy (and effort)

Daisy Yuhas, “Three Critical Elements Sustain Motivation.” Scientific American, Nov. 21, 2012



• Value• Value– The more value you assign to a task, the greater your sense of autonomy (and effort)your sense of autonomy (and effort)

• Competence– Practice makes you feel you’re getting better, and getting better motivates you to continue

Daisy Yuhas “Three Critical Elements Sustain Motivation ” Scientific American Nov 21 2012Daisy Yuhas, Three Critical Elements Sustain Motivation. Scientific American, Nov. 21, 2012

Part 4: How to improve motivation and adherence

Heart‐failure patientsHeart failure patients

• 95% say exercise is95% say exercise is important

• 60‐70% don’t exercise• 50% of adherence interventions fail

Duncan et al, “A self‐directed adherence‐management program for patients withmanagement program for patients with heart failure completing combined aerobic and resistance exercise training.” Applied Nursing Research 2011; 24 (4): 207‐214

Adherence strategies over 24 weeksAdherence strategies over 24 weeks

• Exercise logsExercise logs• Heart‐rate monitor watchG i• Group support sessions

• Graphic feedback based on goals• Website (info, forums, access to experts)

D t l 2011Duncan et al 2011

Clear winners and losersClear winners and losers

1 Group support sessions1. Group support sessions2. Heart‐rate monitor watch3 G hi f db k b d l3. Graphic feedback based on goals4. Exercise logs5. Website (info, forums, access to experts)

D t l 2011Duncan et al 2011

Fine printFine print

• Small study (20 participants)Small study (20 participants)• Short duration (6 months)• Unhealthy sedentary populationUnhealthy, sedentary populationBut!• They exercised 5x week (3 AT 2 RT)• They exercised 5x week (3 AT, 2 RT)• They completed 75% of all workouts• They reached 105% of goals for AT duration and• They reached 105% of goals for AT duration and intensity

Duncan et al 2011

Healthy but sedentary adultsHealthy but sedentary adults

• Yelling at them doesn’t gwork!

• Extrinsic motivation (abs! ki j !) l kskinny jeans!) rarely works for long

• Intrinsic motivation (pleasure from task or challenge) is key to long‐term adherenceterm adherence

Teixeira et al, “Exercise, physical activity, and self‐determination theory: a systematic review.” International Journal of Behavioral Nutrition and Physical Activity 2012; 9: 78Physical Activity 2012; 9: 78

“Coach approach”Coach approach

• Middle‐aged, obese, sedentary men and women with long‐g , , y gterm weight‐loss goal

• Long‐term goal broken down into short‐term process goals• 6‐month program; 1 counseling session per month• Focus on self‐regulatory skills• Progress tracked graphically• Progress tracked graphically• Participants chose own form of endurance exercise• 6 1‐hour nutrition‐education sessions in first 3 months6 1 hour nutrition education sessions in first 3 months

Annesi and Marti, “Path analysis of exercise treatment‐induced change in psychological factors leading to weight loss.” Psychology and Health 2011; 1‐18 iFirst


• Weight loss modest (~ 15 lbs in 6 months)• Weight loss modest ( 15 lbs. in 6 months)• Strong correlations between:

S lf l ti f i d lf l ti f• Self‐regulation for exercise and self‐regulation for diet

• Self regulation for exercise and weight loss• Self‐regulation for exercise and weight loss

A i d M ti 2011Annesi and Marti 2011


“Self‐regulation applied to exercise enhanced, rather than detracted from, self‐regulation for , g

appropriate eating.”

Annesi and Marti 2011

Elite collegiate athletesElite collegiate athletes

Task orientation:Task orientation:• Success relates to their ability to train competently• High intrinsic motivation• High intrinsic motivationEgo orientation:• Goal is to compete with others and win• Goal is to compete with others, and win• Linked to boredom and willingness to cheat

Gilson et al, “Using goal orientations to understand motivation in strength training.” Journal of Strength and Conditioning Research 2008; 22 (4): 1169‐1175

Elite collegiate athletesElite collegiate athletes

Task‐oriented:• Predominantly upperclassmen• Expressed fear of letting teammates down• Linked individual effort to team successEgo‐oriented:• Strong link between self‐enhancing and social‐approval

orientations (they thrive on praise from coaches and respected teammates)p )

Gilson et al 2008

Part 5: Pretending I can tie all gthis together into a coherent set

of g idelinesof guidelines

Lesson #1: Exercise firstLesson #1: Exercise first

“One of the paradoxes about self‐control is thatOne of the paradoxes about self control is that it seems to take some to get some. Physical exercise for instance improves self‐control ”exercise, for instance, improves self control.

Daniel Akst, We Have Met the Enemy: , ySelf‐Control in an Age of Excess

(Penguin, 2011)(Penguin, 2011)

Lesson #2: Gooooooall!Lesson #2: Gooooooall!

• Have client spell out his or her goals• Have client spell out his or her goals• Make sure you understand those goals

E t i i P ibl h t t b t till l• Extrinsic: Possibly short‐term, but still real• Intrinsic: What will make this client happy?

• Make sure client understands you’re working toward those goals

Lesson #3: Be graphicLesson #3: Be graphic

• Charts and graphsCharts and graphs showing progress toward goal can be tremendously motivating

Lesson #4: Make it socialLesson #4: Make it social

• For most disabled clients social support fromFor most disabled clients, social support from peers can mean more than instruction from prospros

• Working out in groups can inspire better performanceperformance

Irwin et al, “Aerobic exercise is promoted when individual performance affects the group: a test of the Kohler motivation gain effect ” Annals of Behavioral Medicine 2012; 44: 151 159of the Kohler motivation gain effect. Annals of Behavioral Medicine 2012; 44: 151‐159

Lesson #5: Praise effortLesson #5: Praise effort

• People work harderPeople work harder when they think hard work has been, and will be, rewarded

Thank you!Thank you!

suspicious - super-super. · pdf filesuspicious minds: what actually motivates clients, and...

Documents