Fri, 6 Nov. 2009 - 12:02 p.m. MT
Talking About Training
The Ordinary Mortals® Pathway to Mobilizing Motivation
By Steven Jonas, MD, MPH
As I note in my “Message from the Editor” in this issue of our Journal, everyone knows that “exercise is good for you.” Why then doesn’t everyone do it? Why are so few Americans regular exercisers? After all, we are bombarded with information about why to do it in terms of health promotion of many kinds, endlessly. People regularly see, hear, and read about its numerous benefits, especially those related to their physical health, in newspapers and magazines, on TV, on videos, in e-mail services, and on the Internet. There is also a continuous flow of information from the same sources about what to do, both in terms of the activities and sports in which one can engage, and how much time/distance should be spent. Yet we have a population that is becoming increasingly sedentary. It is obvious, then, that the “why” and the “what” are just not enough.
Missing is the attention to how people get going and how to help them get going; in other words, the process of mobilizing their motivation to make the difficult change in their lifestyle to become a regular exerciser. That is why, as I point out in the selfsame editorial, Dr. Edward Phillips and I spend so much time on that subject in our textbook for ACSM’s Exercise is Medicine™ program. We offer two different pathways for mobilizing motivation—one designed by Phillips and the other by me—that you and your patients can follow to accomplish the feat.
I believe that an essential element in helping people to “get motivated” is to understand the primary reasons why most regular exercisers do it. For those of us who exercise regularly (which certainly includes most of the readers of this column), it is not about simply reducing the risk of future illness. In fact, for many of us that’s not it at all. At an annual meeting of the American Public Health Association in the 1980s, I attended a session given by Dr. Ken Cooper (known to the older readers of the Journal as the inventor of the modern usage of the Greek word “aerobic”). He presented about 20 minutes worth of slides showing the evidence for the positive relationship between regular exercise and health (and even back then, it was ample). When he finished with the slides, Ken turned to the packed room and asked, “How many of you are regular exercisers?” Most of us raised our hands. “How many do it because of the data I just put up there?” he then asked. A handful of hands went up. “Why do you do it, then?” “Because it makes us feel good,” the chorus came back. Regular exercise makes one feel better and feel better about oneself. This is an observation that I stress when talking with folks about becoming and staying as regular exercisers—exercise can greatly benefit you mentally. Looking better to oneself and to others is an important part of it, too.
When confronting the obstacles to becoming a regular exerciser, it is important to recognize an almost unique aspect of the activity as compared with almost every other health-promoting personal behavior. For most people, the hard part of regular exercise is making it “regular.” It’s not the exercise itself that is daunting. Regular exercise is time-consuming on an ongoing basis. I would venture to say that making sure you exercise regularly can require just as much commitment as being a recovering alcoholic and having to go to Alcoholics Anonymous on a regular basis.
What is motivation? A long definition is: “Motivation is not a thing. It is a process, a mental process that links an emotion, feeling, desire, idea, or intellectual understanding, or a recognized psychological, physiological, or health need, to the taking of one or more actions.” A short simple definition is: “Motivation is a mental process that links a thought or a feeling to an action.” People make changes in their behavior by following a mental pathway to doing so. One widely used approach to the understanding of the process is the “Stages of Change/Transtheoretical Model,” originally designed by Professors Prochaska and DiClemente (1). The Six Stages include: 1) Pre-contemplation (not even thinking about it), 2) Contemplation (thinking about it), 3) Planning (I’m gonna do it and this is how), 4) Action (I’m doing it), 5) Relapse (slipping back a bit), and 6) Permanent Maintenance.
The key element in this pathway for making personal behavior change is getting to step four from three. This is the step that many people have trouble with; it is where one has to mobilize one’s motivation to get over the divide from planning to action. To give that mobilization its necessary emphasis, I have developed a modification of the “Stages of Change” which I call “The Six Phases of Behavior Change.” It puts mobilizing motivation at the center of the process: 1) Not on the radar screen, 2) Thinking about it, 3) Going to get going, 4) On the Ordinary Mortals® Pathway to Mobilizing Motivation, 5) Getting going! 6) Making it part of one’s life.
The Ordinary Mortals® Pathway to Mobilizing Motivation (and yes, I have a registered trademark for “Ordinary Mortals®”) itself has five steps: 1) Self-Assessment, 2) Defining Success, 3) Setting Goals, 4) Establishing Priorities, and 5) Taking Control.
The Pathway takes the following elements into consideration: 1) Self‑Assessment is asking oneself such questions as “Where am I now?” “How did I get here?” “What do I like about myself?” “What do I not like?” “What would I like to change?” “What is going on in my life that would facilitate behavior change?” 2) Defining Success has to be done in the context of oneself as a person, what one’s measure of their innate skills and capabilities is. To work for a given individual, “success” as they define it has to be something that is reasonable, realistic and conceivably achievable, for them, given whom they are as a person and what else is going on their life. It has to be such that one is not setting oneself up for failure.
3) Goal‑Setting is the central element in the Ordinary Mortals® Pathway to Mobilizing Motivation. It is accomplished by answering questions like: “To where do I want to get?” “Why do I want to get there?” “For whom would I be making the change; others, or myself?” “What do I expect to get out of the change should I achieve it?” “What do I think I can reasonably and realistically expect to do?” Very importantly, is a consideration of what are the “give-ups,” and can I, do I want to, commit to making them? Answering the questions, “What do I really want to do and why do I want to do it?,” provides the focus and the concentration one must have in order to have the best chance of success in the chosen endeavor.
4) Establishing Priorities among specific goals and between new goals and the rest of one’s life is central to making the whole process work. If one has set more than one goal, what are their rankings? Which do they consider to be the most important to achieve? Which the least? In addition, what about priorities between new goal(s) and other important elements of one’s life, like family, friends, other leisure time activities, and employment? (See also Step 2.) If juggling needs to be done, it will be very helpful to do some thinking about that and to set priorities.
5) Taking Control means putting oneself in charge of the whole process, adopting an “I can do this” attitude and perspective, given that the first four steps have been followed. It means not depending upon anyone else but also not taking anyone else’s direction, of accepting responsibility for both success and failure. Finally, “Taking Control” itself has Seven Keys. For most people, making change for themselves and not anyone else is crucial to achieving a successful outcome; therefore, taking personal control of the whole process is essential.
The Seven Keys are: 1) understanding for sure that motivation is not a thing, but a process that links a thought or a feeling with an action; 2) following the first four steps of the Ordinary Mortals® Pathway to Mobilizing Your Motivation, from the beginning; 3) making sure to examine what you already do well: health-promoting behaviors that are part of your life; 4) recognizing that gradual change leads to permanent changes; 5) dealing with the fear both of failure and of success; 6) being ready to explore your limits while recognizing your limitations; and 7) appreciating the process of psychological immediate gratification.
Is this a complex process? Yes, if one tries to bite off the whole package at once. But it is the process through which most regular exercisers, and folks who have made any type of positive health-promoting behavior change, have done. And it is completed only one step at a time. As the old Chinese saying goes, “Each journey begins with but a single step.” We just want to help our patients begin with the right one.
1. Prochaska JO and Velicer WF. The transtheoretical model of behavior change. Am J Health Promot 1997; 12(1): 38-48.
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