ACE Personal Trainer Manual Chapter 4 Basics Of Behavioral Change In Health Psychology

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I am taking the ACE personal trainer certification exam in December. I told my Fit Tribe online accountability group that I would share what I was learning. Here are my ACE Personal Trainer Manual Chapter 4 notes.

Health psychology examines the causes of illnesses and ways to promote and maintain health. Furthermore, the goal of health psychology is to prevent and treat illness and improve the healthcare system.

Behavioral Theory Models

First of all, the health belief model states that people will engage in a health behavior (exercise) based on their perceived threat regarding a health problem and the pros and cons of adopting the behavior. In addition, a perceived threat is defined as the degree to which a personal feels worried or threat by a particular health problem. Thus, it is influenced by several factors.

First, the perceived seriousness, which is the severity of the perceived potential consequences. Secondly, the perceived susceptibility which is the subjective appraisal of the likelihood of developing the problem. Lastly, cues to action which are events, either bodily or environmental, motivating people to make a change (key concept).* In conclusion, someone will likely take action if the perceived benefits outweigh the barriers and the perceived threat of illness is high.

Clients become more prepared when personal trainers educate them on the seriousness of the condition and helping them to understand their susceptibility of developing it. Many perceived barriers will be felt by a client who is sedentary, overweight and with low energy. Therefore, we need to develop a program that is easy to start and give these clients something to build on. Lastly, we can create programs with small, achievable steps that don’t require a huge time commitment or reorganization of schedules.

Self Efficacy

Self efficacy is subjective and interpreted through interpersonal communication and building rapport. We can gain a better understanding of a client’s self efficacy by learning about their previous experience with exercise, feelings and emotions associated with stating a program, expectations and apprehensions, and potential barriers. Beliefs about self efficacy influence thought patterns, emotional responses and behaviors. Higher levels of self efficacy means more motivated clients.

6 Sources of Self Efficacy Information

Past performance experience is the most important influencer of self efficacy. Vicarious experience is important for clients who have little previous experience with exercise. Observation or knowledge of someone else who is successfully participating in a similar program will increase their levels of self efficacy. Verbal persuasion occurs with feedback from teaching or encouragement. Additionally, when the influencer is credible, respected and knowledgable it is more influential. Psychological state appraisals may lead to someone judging their ability to participate in a program. Emotional state and mood appraisals may lead to a positive or negative mood about the program. When a client feels a negative mood, such as fear, anxiety, anger or frustration their self efficacy is decreased. When someone is in a positive mood state like mastery, their self efficacy is increased. Lastly, someone’s imagined experience whether positive or negative will influence self efficacy (key concept).*

When someone has high self efficacy, they will choose challenging tasks, set goals, display commitment to master the tasks, will work to overcome obstacles and challenges and will recover from setbacks. These clients will be more likely to adhere to a program long-term. On the other hand, clients with low self efficacy will choose non-challenging tasks that are non-threatening and easy to accomplish and display minimal effort in the face of challenges. They will likely give up if they are faced with too many setbacks.

Transtheoretical Model Of Behavioral Change

The transtheoretical model of behavioral change (TTM) is a theory examining health behaviors. It is separated into 4 components: stages of change, processes of change, self-efficacy and decisional balance.

Stages Of Change

There are 5 stages of change: precontemplation, contemplation, preparation, action, and maintenance. Someone is in the precontemplation stage when they are sedentary and not even considering exercise. A client is the contemplation stage when they are still sedentary but starting to consider activity as important and begun to identify implications of not being active. They are still not ready to commit. Someone is in the preparation stage when they are engaged in some physical activity and they are mentally and physically preparing to adopt an active lifestyle. They may be inconsistently and sporadically walking or going to the gym. When someone has been engaging in regular physical activity for less than 6 months they are in the action stage. Lastly, when someone has been engaging in regular physical activity for more than 6 months, they are in the maintenance stage (key concept).*

Processes Of Change

This stage is most important for personal trainers to understand because it entails the processes of change people use to get from one stage to the next. Our first step is to identify what stage our new client is in. Decisions, mental state, readiness and motivation all effect the processes of change. Stage specific interventions are the most effective strategies for helping clients move from one stage to the next. Helping a client advance to the next stage is our goal. Review table 4-1 on page 72 because it is a key concept.

Self Efficacy

Program adoption and maintenance are strongly correlated to self efficacy. There is a circular relationship between self efficacy and behavioral change. Increases in self efficacy lead to increased in participation and increases in participation lead to increases in self efficacy. We need to get them quick wins because past performance is the most influential factor.

Decisional Balance

Decisional balance is the number of pros versus cons a person perceives about adopting and/or maintaining and activity program. Precontemplators and contemplators perceive more cons. People in the action or maintenance stage perceive more pros. Thus, we help them by influencing their perceptions about being active. We can accomplish this by emphasizing a wide variety of benefits of activity and avoiding arguing about the cons. Cons are often a result of misinformation and lack of experience. Lastly, we can focus on both short and long term benefits. Relapse can occur at any stage.

Principles Of Behavioral Change

A personal trainer’s job is to provide guidance and support to help change our client’s behaviors. We can accomplish this by influencing their attitudes, motives, emotions and performance. The key is always focusing on gradual progression of a program.

Operant Conditioning

An approach to understanding human behavior based on consequences. When a program has positive consequences it increases the likelihood the client will stick with it long term. Antecedents are stimuli that precede a behavior and signal the likely consequences of the behavior. Stimulus control is a form of antecedent and is a valuable tool in behavioral modification. An example of this would be setting an alarm when it is time to leave work to go workout. Other examples would include: choosing a gym on your way home from work, keeping your gym bag in your car, having workout clothes laid out for the morning, writing down workout times as part of your schedule, and surrounding yourself with others who have similar health and fitness goals.


The most important component of operant conditioning is what happens after the behavior is executed. First of all, positive reinforcement increases the likelihood the behavior will be repeated. Secondly, negative reinforcement is the removal or avoidance of aversive stimuli following the undesirable behavior. For example, if someone is late to their session, don’t give them the extra time on the end of the session. This is an aversive consequence to tardiness and will decrease the likelihood that it will reoccur. Next, extinction is when we remove a positive stimulus that once followed the behavior. Finally, we can use punishment. This consists of an aversive stimuli following undesirable behavior. Use sparingly. Only for lack of effort and not based on performance.  It can lead to fear and lack of enjoyment. The behavior will be less likely to reoccur (key concept).*

Force Of Habit

Research has shown that people who successfully maintained a greater than 30 pound weight loss for greater than a year had a few things in common. They engaged in regular physical activity, followed a low calorie, low fat diet, ate breakfast, self-monitored their weight regularly, and maintained a consistent eating pattern.


Shaping is the process of using reinforcement to gradually achieve a target behavior. A client does better overall when you begin with performance of basic skills that they are currently capable of and progress from there. Skills should require increasing demands with positive reinforcement given. These steps are critical for a client to develop self efficacy. We need to learn what the correct starting point is in order to succeed.

Observational Learning

Personal trainers should never underestimate the role the client’s environment plays in their ability to make changes. It is important that we learn the exercise behaviors of the people closest to our clients. Furthermore, encouraging interactions with people who are active is important. We are competing with the sofa, family time, TV, work and other activities not other trainers. For a client to achieve long term adherence they need to value the exercise program over other demands in their lives. Asking questions as we design the program will ensure we are developing a one of value. How does the program make them feel? Is it fun? Are they enjoying the experience? Do they want to be part of it?

Behavior Change Patterns

We need to teach behavior change strategies. First of all, teach clients to be automatically active during the day. Secondly, help them identify time wasting behaviors and replace them with healthy activity. New behaviors can be triggered by wanting to change their appearance but long-term adherence is more about well being and enjoyment. Make being physically active as convenient as possible by using stimulus control. Will power means using the rational side of our brain to dictate what the emotional side wants. Emotions are much more powerful decision makers than reason, making this an unfair fight. Implementing strategies to preserve willpower can be helpful, such as planning in advance for moments of weakness. Journaling how to handle barriers when our willpower is the strongest is also helpful.

Written Agreements And Behavioral Contracts

Written agreements should outline the expectations of both parties, clarify roles, and clearly outline behaviors, attitudes and commitments. Then, behavioral contracts should create a rewards system got maintaining and adhering to the program. Cognitive behavioral techniques are effective tools influencing behavioral change by targeting how people think and feel. First, we identify the problematic belief and then change the destructive thoughts around it. Additional techniques include goal setting, feedback, decision making and self-monitoring.

Health At Every Size

Research has shown that two-thirds of Adult Americans are overweight or obese. People spend 60 billion dollars annually on weight loss solutions. The Health At Every Size (HAES) approach attempts to shift from weight loss to weight-neutral outcomes. Studies are more successful when we focus on improved physiological measures (BP or lipid levels), health behaviors (habits), and psychological outcomes (self-esteem and body image). Examples include: eating more lean protein, fruits and veggies or being active on most days. Long-term goals should focus on health, not weight. Interventions should have a holistic approach including physical, emotional, social, occupational, intellectual, spiritual, and ecological aspects of health. Programs should focus on promoting self-esteem and self efficacy, body satisfaction and body diversity. Interventions should focus on modifiable behaviors that improve health and not weight. Weight is not a behavior.

Feedback, Decision Making and Self Monitoring

New clients will need more extrinsic feedback. As they progress in their programs they will need to learn intrinsic feedback to achieve long-term adherence. This means reinforcing their own behaviors by providing internal encouragement, error correction and negative consequences. In addition, giving clients control over their program will increase their decision making abilities and help them adhere longer. Self-monitoring is also important for long-term adherence. They can do this by journaling their thoughts, experiences and emotions during sessions. Teach them to be honest and self reflective.

In conclusion, it is important to gather information during each session and make adjustments and modifications to the program as needed. When meeting with clients, focus on obtaining past activity experience, finding out about their social support system, identify attitudes, opinions, beliefs and educated and develop trust, teach goals setting techniques and self monitoring and most importantly empower them.

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