Chapter 3: Communication & Teaching Techniques

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Generating & Discussing Alternatives

After clarifying goals, discuss with your client alternative ways to achieve these goals. Why? The ultimate goal is adherence to the exercise program. Problem: One of the most common causes of exercise dropout is the client perceives the exercise program is too time-consuming. Solution: Encourage the client to take the lead in what seems realistic (time commitment and scheduling).

4 Stages of Client-Trainer Relationship (RIPA) 2. Investigation Stage: Gather information

Ask client to complete health history and lifestyle questionnaire. Learn about: 1. Medical concerns 2. Fitness assessment results 3. Body weight 4. Exercise history: A. Client's likes and dislikes, preferences --exercise alone, with a friend, or in a group --exercise morning or evening --moderate or vigorous intensities B. Previous physical activities C. Factors that furthered or disrupted exercise adherence. --what has worked (or not worked)

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Using Motivational Interviewing Techniques • Ask Probing Questions

1. Ask probing questions Ask open-ended questions about daily activity, health concerns, physical activity history. Move toward questions that help client conclude that physical activity is essential for good health. Example: If client has a family history of heart disease, follow up by asking, "Did you know that regular physical activity helps prevent heart disease>"

4 Stages of Client-Trainer Relationship (RIPA) 4. Action Stage: Individualizing teaching techniques Preferred Learning Styles

4 Stages of Client-Trainer Relationship (RIPA) 4. Action Stage: Individualizing teaching techniques • Visual Client Action: Visual learners WATCH intently Prefer reading Client Statement: "Oh, I see" "Let me see that again" Strategy: Demonstrations • Auditory Client Action: Auditory learners LISTEN carefully Prefer hearing Client Statement: "Yeah, I hear you" "Say that again" Strategy: Question and answer • Kinesthetic Client Action: Kinesthetic learners TOUCH or HOLD Prefer to be spotted Client Statement: "I feel that" "This does not feel right" Strategy: Hands-on supervision

4 Stages of Client-Trainer Relationship (RIPA) 4. Action Stage: Individualizing teaching techniques KEY CONCEPT: Providing Feedback

4. Action Stage: Individualizing teaching techniques KEY CONCEPT: Providing Feedback Once the client has tried the skill, the personal trainer should give helpful feedback. Why? • Provide reinforcement for what was done well • Correct errors • Motivate client to continue practicing and improving Correcting errors: sandwich this between reinforcement and motivation. Example: "Your breathing and timing were just right on the first four lifts. Remember to keep breathing, even as the exercise starts to feel harder. You'll find the work easier now that you're learning how to breathe correctly." DO: "Remember to breathe" DON'T: "Don't hold your breath"

4 Stages of Client-Trainer Relationship (RIPA) 4. Action Stage: Individualizing teaching techniques

4. Action Stage: Individualizing teaching techniques Personal trainers teach: • motor skills (physical) -- such as correct lifting techniques for strength training • information (cognitive)-- such as explaining health problems and how physical activity affects physiological variables, and how to prevent injury

4 Stages of Client-Trainer Relationship (RIPA) 4. Action Stage: Set up self-monitoring system

4. Action Stage: Set up self-monitoring system • Give client written exercise plan • With the client's input, determine a system for recording exercise sessions (including any relevant data you and the client want to track). Self-monitoring is one of the most effective ways to support behavioral change--including exercise program adherence and improved eating behaviors. • Self-monitoring increases client self-awareness It acts as a mirror to give clients a more objective view of their behaviors. • Self-monitoring enhances client-trainer communication. Knowing that someone will be checking on their adherence may prod clients to action

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Using Motivational Interviewing Techniques • Keep the conversation friendly

4. Keep the conversation friendly You may challenge the client, but avoid negative feelings which may make the client defensive. • Switch to more neutral, information-gathering questions. • Express empathy and respect for the difficulties that client faces

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Using Motivational Interviewing Techniques • Build self-confidence

5. Build self-confidence Help client identify areas of success, no matter how small. Example: Client currently walks the dog daily for 10 minutes. Suggest the client consider increasing the walk time by a few minutes each week.

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Using Motivational Interviewing Techniques • Encourage clients to generate ideas

6. Encourage clients to generate ideas If client seems willing to make small changes, let him/her take the lead in making suggestions that might work for him/her.

4 Stages of Client-Trainer Relationship (RIPA) 1. Rapport Stage: 3. Interactions with the Personal Trainer

A. Clients have confidence in the trainer's qualifications, training, experience, and skills. B. Clients have enough time to express their concerns. C. The PT listens carefully and tries to understand the client's concerns. D. Clients believe that the PT is genuinely interested in what clients have to say. E. Clients perceive an unconditional positive regard from the PT. F. Clients believe that the PT respects them and their opinions. G. Clients trust that the PT will maintain their confidentiality and has their best interests at heart. H. Instructions are clearly explained ant clients' questions are answered.

4 Stages of Client-Trainer Relationship (RIPA) 1. Rapport Stage: 1. Environment

A. Facility is neat and clean. B. Offices & staff have a well-organized appearance.

4 Stages of Client-Trainer Relationship (RIPA) 1. Rapport Stage: 2. Appearance of the Personal Trainer

A. The PT wears professional attire. B. The PT's appearance is fit, neat, and clean. C. The PT is friendly and interested in the client. D. The PT shows a warm, positive attitude. E. The PT makes a positive first impression.

4 Stages of Client-Trainer Relationship (RIPA) 1. Rapport Stage: Positive first impressions

During the first meeting with clients, PT should be sure clients know about their education, training, certifications, qualifications, and work experience.

4 Stages of Client-Trainer Relationship (RIPA)

Rapport Investigation Planning Action

4 Stages of Client-Trainer Relationship (RIPA) 4. Action Stage: Individualizing teaching techniques KEY CONCEPT: Motor learning

Tell, Show, Do Motor learning is the process of acquiring and improving motor skills. Many adults are self-conscious in the motor-skill domain, especially if they have had little experience in sports or physical activity. • Remind beginners that it takes time and practice to improve motor skills. Motor skills are more strongly related to practice and experience, than natural ability alone • Introduce new skills slowly and clearly -- Begin with a short explanation of what you're demonstrating, and why. -- Safety information should be emphasized, along with guidelines for preventing injury -- Skills should be explained in terms of what it is accomplishing, or why it's important Focus on the goal of the movement • Allow clients the opportunity for focused practice People learn more quickly when they focus on performing the motor skill without being distracted by talking or listening.

4 Stages of Client-Trainer Relationship (RIPA) 4. Action Stage: Individualizing teaching techniques KEY CONCEPT: Tell, Show, Do

Tell, Show, Do Tell me and I'll forget Show me and I may remember Involve me and I'll understand --Chinese Proverb

4 Stages of Client-Trainer Relationship (RIPA) 4. Action Stage: Individualizing teaching techniques Teaching Pace

• Teaching pace should be modified for each client. Clients should feel successful in their mastery of new exercises. • Success improves self-efficacy Clients will continue to exercise the effort required to meet new challenges. Note: Some clients catch on to new skills quickly, while others require a great deal of patience and support.

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Goal-Generating Questions for Clients

• What are your short-term goals? 3-6 months • What are your long-term goals? beyond 6 months • What motivates you? • What things are most important to you? How will a healthy lifestyle support this? • What exercise programs have you tried in the past? • What did you like most -- and least -- about previous exercise programs? • How will you integrate exercise into your life? • How much time do you have to commit to exercise? • What kind of support (family and friends) do you have to help you change your lifestyle? • What is something you are good at now? Did you know you were good at it before you did it, or the first time you did it? • When was the last time you exercised regularly? (3x/week or more) How long did it last? Why did you stop?

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Using Motivational Interviewing Techniques • Provide educational information

3. Provide educational information Explain the dangers of a sedentary lifestyle and the health benefits of regular physical activity.

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Formulating a Plan

Write the plan down, give it to the client, include info needed to get started. TIP: A fitness facility can feel intimidating to a new comer. • Help the client feel prepared: Give advice on what to wear, tips on facility etiquette, etc. (as appropriate).

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Using Motivational Interviewing Techniques Notes

If you sense that the client has stopped listening? Stop talking! Instead, ask client what he/she is thinking about or if he/she has questions. Look for ways to help client find motivation within himself/herself that nudges her to consider behavioral change.

4 Stages of Client-Trainer Relationship (RIPA) 2. Investigation Stage: Effective Listening

Listen closely and carefully to both the words and the emotions behind the speaker's words. Listen empathetically, and with an open mind. Use appropriate eye contact, proper body language, and taking notes (as necessary) This helps the PT gather information that will enhance exercise program design, and the PT's working relationship with the client.

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Fitness Indicators for SMART Goal Setting

1. Emotional health indicators: Clients may have measurable improvements in mood, energy level, and sleep quality, and fewer feelings of stress following exercise. 2. Resting heart rate: 3. Heart rate during a given submaximal workout: 4. Muscular strength and endurance: Gains in muscular strength and endurance occur fairly quickly during the first few months of an exercise program. Client's gains (amount of resistance used or number of reps performed) are easily measured. 5. Walking test: Timed walking test usually yields positive results if clients have been walking as part of their exercise programs for several weeks. 6. Flexibility: 7. Balance: Balance measures show the most improvement for adults participating in some sort of balance training program, which are becoming increasingly popular --especially among older adults. 8. Skill level: 9. Medical indicators: Biometrics, such as resting blood pressure, blood lips levels, or blood sugar levels (if they are the focus of the client's exercise program, should be taken at regular intervals as established by their healthcare providers. 10. Body weight: Body weight is easily measured. Slow and consistent weight loss is more likely to yield long-term weight loss maintenance. 11. Body size: Body composition changes (fat loss with an increase in muscle mass) may lead to a change in body size. Because of its greater density, lean tissue, takes up less space than fat tissue. Clients should watch for changes in the way their clothes fit. 12. Body composition:

4 Stages of Client-Trainer Relationship (RIPA) 1. Rapport Stage: Characteristics of Positive Client-Trainer Experiences

1. Environment 2. Appearance of the Personal Trainer 3. Interactions with the Personal Trainer

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: How to Set Health & Fitness Goals that Motivate Clients for Long-term Adherence

1. Listen carefully to understand what clients hope to accomplish with an exercise program. 2. Help them define specific, measurable goals. 3. Suggest additional goals that clients may not have thought of, such as feeling more energetic and less stressed. 4. Break large goals (reachable in 6 months or more) into small goals (reachable in 8-10 weeks), and even weekly goals (such as completing a certain number of exercise sessions). 5. Include many process goals, such as the completion of exercise sessions. Just completing workouts accomplishes a goal. 6. Record goals and set up a record-keeping system to record workouts and track progress toward goals. 7. Be sure clients understand what types of exercise will help them reach their health and fitness goals. 8. Reevaluate and revise goals and exercise recommendations periodically to prevent discouragement if large goals are not being met.

4 Stages of Client-Trainer Relationship (RIPA) 1. Rapport Stage: Verbal Communication

1. Speak clearly and use language that is easily understood by clients (without talking down to them). 2. Use exercise science vocabulary and define terms that may be unfamiliar to clients. 3. Verbal content can be enhanced with visual information that illustrates concepts (pictures, diagrams, charts) and exercise demonstrations.

4 Stages of Client-Trainer Relationship (RIPA) 1. Rapport Stage: Non-verbal Communication

1. Voice quality 2. Eye contact 3. Facial expression 4. Hand gestures 5. Body position

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Using Motivational Interviewing Techniques • Listen effectively

2. Listen effectively Listen carefully to uncover valuable information and show client that he/she is respected.

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage

Client adherence is usually better when clients help take responsibility for exercise program design. This is a give-and-take opportunity. 1. Setting goals 2. Generating and discussing alternatives 3. Formulating a plan 4. Evaluating the exercise program

4 Stages of Client-Trainer Relationship (RIPA) 2. Investigation Stage: Effective Listening & Responding

Effective Listening responses include: 1. Encouraging: Using short phrases: "I see" "Yes" "I know what you mean" Smiling and nodding 2. Paraphrasing: Demonstrate understanding by restating in a clear and concise way the essence of what the client said. 3. Questioning: Open-ended questions encourage the client to share relevant information. Ask questions at appropriate times to clarify points you don't understand or to move the conversation in a more productive direction. e.g. "You said you quit exercising last year. What made you stop?" 4. Reflecting: Demonstrate understanding or seek clarification by restating the main points and feelings in the client's communication. This helps move the conversation in a productive direction. 5. Summarizing: Try to summarize key points that have a bearing on exercise program design. This provides an opportunity to direct a conversation that is wandering too far off topic or keep an appointment on track in terms of time.

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Evaluating the Exercise Program

Evaluate the exercise program regularly. Review client's exercise records together. Discuss what's working and what needs adjusting. Reassess client periodically to measure progress toward goal. Evaluate exercise challenge -- and adherence. Modify programs -- more realistic or more challenging If adherence is faltering, discuss what's causing problems and revise the exercise program design as needed.

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Setting Goals (SMART Goals)

Help clients define goals in more specific and measurable terms so that progress can be evaluated. SMART Goals: 1. Specific: Goals must be clear and unambiguous, stating specifically what must be accomplished. 2. Measurable: Goals must be measurable so that clients can see whether they are making progress. 3. Attainable: Goals should be realistically attainable by the client. 4. Relevant: Goals must be relevant to the particular interests, needs, and abilities of the client. 5. Time-bound: Goals must contain estimated timelines for completion. Clients should be evaluated regularly to monitor progress toward goals. NOTE: Err on the conservative side of setting goals (what might be realistically achieved by the client).

4 Stages of Client-Trainer Relationship (RIPA) 2. Investigation Stage: Effective Listening & Responding-- Responding to Difficult Disclosures

Often a short response is all that is required. Example: "I'm so sorry." "That must have been very hard." "I can't even imagine how difficult that must have been for you and your family." Follow the client's lead as to whether he or she wants to say anything more on the topic or not. If the situation affects exercise program design, turn the conversation back to practical details. --If clients reveal new medical information that causes concern, they should be referred back to their healthcare providers for medical clearance. --If a new medical condition places the client outside your scope of practice and expertise, refer the client to someone with the necessary training and experience. --If the information is worrisome or alarming (depression, eating disorder, or other serious health problem) encourage the client to seek professional help, document your concerns, and share concerns with supervisors to confirm referral plan. Be sure to maintain client confidentiality.

4 Stages of Client-Trainer Relationship (RIPA) 4. Action Stage

Once the exercise program design is complete, the client is ready to begin exercising. The program is usually a combination of exercise completed with personal trainer instructing and supervising, and exercise to be completed by client on her own.

4 Stages of Client-Trainer Relationship (RIPA) 2. Investigation Stage: Effective Listening & Responding-- Self-disclosure

PT can use a limited amount of self-disclosure to demonstrate understanding and forge bonds with clients. Limit this to 1-2 sentences, keeping the focus on the client. Example: "I know what you mean. When I moved to a new city, I didn't exercise for several weeks either. What do you think we could do to help you get back on track?"

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Setting Goals (Process Goals & Product Goals)

Process Goals: Something a client DOES, such as completing a certain amount of workouts per week. Product Goals: Something ACHIEVED, like weight loss or a resistance lifted on a strength-training machine. Note: Clients often reach process goals before noticeable changes occur in terms of weight loss or improved performance. Remind them of the importance of these successes.

4 Stages of Client-Trainer Relationship (RIPA) 3. Planning Stage: Using Motivational Interviewing Techniques What it is. The Goal. How to.

Unless a client has made a decision to change, his/her exercise attempts are likely to fail. •Discuss why a client feels unable to become more active. Motivational Interviewing is designed to show supportive concern while challenging a client's current behavior. Goal: Create awareness that a sedentary lifestyle will likely cause health problems. Using direct questions, you can help clients realize that good health is important, and a sedentary lifestyle is dangerous to their health and well-being.

4 Stages of Client-Trainer Relationship (RIPA) 1. Rapport stage (of client/trainer relationship)

Verbal & Nonverbal Communication