“Results” is a word we use a lot as personal trainers. But in the face of growing global concerns about society's long term health and behaviour, does that word mean the same thing as it did 20, 10 or even five years ago?
When we talk to our clients about results, what exactly are we offering them, a short term effect or a long term benefit?
I think we would all like to know that the work we do with clients will truly help them in the long term. But the fact is this will require a radical re-thinking of how we work with our clients, how we listen to them and, most importantly, what sort of relationship we build with them.
This is the first part of an article series that will address the future role of the personal trainer and how to go about building this role. In this article, I will introduce the specific professional profile that we as personal trainers need to develop. Why is this new personal trainer profile necessary? Because our clients need to obtain results that are not based solely on physical objectives but that also allow them to establish a personal development process that integrates new lifestyle habits. Physical activity is one of these habits.
This aspect of our job is still in its infancy. Personal trainers today are passionate about the physical training side but rather less so about the psychological level. I am convinced, however, that there is a challenge to be met here for our profession. Are we ready to address this challenge?
The Global Challenge: Unhealthy Habits
Statistics by the World Health Organization (WHO) indicate 30 percent of deaths globally were attributable to cardiovascular disease in 2005. In total, that represented 17.5 million people. What’s more, the WHO estimates that, if measures are not taken, the number of deaths due to CV disease could rise to 20 million people per year by 2015!
According to the WHO, the principle causes of this trend come down to lack of physical activity, consumption of tobacco and unhealthy eating habits.
Let us take our investigation further, into the realm of overweight and obesity. Overweight can be defined for adults (over 15 years old) as having a BMI greater than 25, while obesity in this same group is having a BMI greater than 30. The latest WHO projections for 2005 give a figure of approximately 1.6 billion overweight adults and 400 million obese adults. The organization’s report mentions the following major causes:
- An increase in the consumption of foods that are calorie dense (high in fat and sugar) but poor in vitamins, minerals and other micronutrients.
- A trend towards decreased physical activity due to the increasingly sedentary nature of work, changes in transportation methods and increased urbanization.
Let us also take a look at the growth in musculoskeletal troubles (MST) and back pain, which is a major cause of work absenteeism, resulting in a high cost to society in general. In my country of Belgium, an estimated 60 percent of the population suffers from back pain and only one to 10 percent of these problems are caused by complex pathologies! (In the USA, this number is greater, with approximately 80% of the population suffering from lower back pain.) The others are common pains (i.e., lumbagos), and their number continues to grow. This situation is also clearly linked to sedentarianism and thus lack of movement.
So, the common denominator in everything I have just cited is sedentarianism.
Let us take this reasoning further:
- In the three cases cited (CV disease, overweight/obesity and MST/back pain), physical activity must be practiced over the person’s lifetime. Whichever problem is being addressed, the solution is not to undertake physical activity over a limited period in order obtain “relief of the symptoms.” Rather, it is to achieve results that last.
- In the three cases cited, we must regretfully note that the number of victims is high, and the WHO projections point towards further growth!
The PT Challenge: Taking Our Role Further
When we consider the two points above, we can draw the following conclusions regarding our role as personal trainers:
- We must go further than just allowing a person to reach the objectives he has stated in coming to us. We must also always make the link between that objective and the individual’s health. On the other hand, if we wish to see extended results, it is fundamental that we accompany the person in such a way that he develops the habit of practicing physical activity as part of his lifestyle, a habit that must continue for the rest of his life.
- It is important, if we want to have a role in society, to reach a great number of people.
For me, this is what “giving clients results” means today.
In effect, vis-à-vis obesity, cardiovascular disease, diabetes, musculoskeletal problems, etc., the true “result” for the client is to continue to be physically active in the long term and to continue to eat in a different manner, etc. This means that the role that falls to us has not only a physical aspect but also a behavioural one. Practicing a physical activity requires time and lifestyle management. While it may seem simple to us, for many people it is not.
To achieve all this, we must acquire techniques and intervention strategies at both the cognitive and behavioural levels. And this challenge includes a societal aspect (the second point in my above conclusions). In effect, all of these illnesses cost the community a lot of money (i.e., work absenteeism, social security, etc.). Therefore, every person educated in physical activity is a gain for the whole community. This isn’t even taking into account the positive influence a parent who undertakes regular physical activity has on his children in terms of practicing physical activity.
It’s a sizable challenge, on the level of both the objectives and the attitude of the personal trainer. What does the challenge entail? Giving the client an educational experience at both the physical and behavioural levels. And what is this “educational experience”?
The Latin root of "educate," is ducere, which means to lead, guide or drive. Thus, “educating” in our profession consists of allowing a professional, through an interactive relational process, to lead the client towards a reorganization of his lifestyle in order to integrate physical activity (and even another approach to eating).
This interactive relational process does not stop at giving good advice and guiding the client in his/her choices. Moreover, this type of intervention can’t just be improvised. It must be a well organized and well planned process.
Brown and Piper consider that psychology plays an important role in planning health education actions. The impact, they conclude in their study, is only positive when the programs are oriented towards sustaining a personal development process and when the individual is supported in his choices (and psychosocial status). On the other hand, when the programs are persuasive and focus on reinforcing social controls on activities such as reducing cigarette or alcohol consumption or increasing exercise, they do not achieve their objectives.
The Importance of Personal Autonomy in Building Change
“Sustaining a personal development process” is aligned with autonomy. A person can be considered autonomous when he listens to what is good for him in relation to his own reflections and environment.
This means accompanying the person. It is not enough to give advice and/or to convince the person of the benefits of exercise. The person must understand what he is in the process of putting into place in order to integrate the new “law” into his lifestyle. This is a law that is approved, that is felt and that is progressively inscribed in the individual’s norms and values.
Accompanying the person in an autonomy process does not mean constantly staying at his side. Accumulating training sessions becomes paradoxical in this case. This is the point at which, during my seminars, the professionals often react:
- Isn’t it necessary to stay with the client as long as he has not yet achieved the results?
- Assisting clients to become autonomous will not allow me to build up a loyal customer base!
- What if the client wants to pay me to work with him all of the time?
To which I respond:
- For the client to learn to be autonomous, he must have the possibility of testing himself. This means the opportunity to work alone, and we must find ways to systematically take this into account. Why? Because these experiences expose the difficulties, which are often resistances to adopting a new behaviour. It is here that the personal trainer must accompany the client, so that the client comes up with options to resolve the problems, developing the ability to manage his own behaviour over the long term.
- “...as long as he has not yet achieved the results..." Isn’t it possible to give a client results while allowing him to train alone with the exercises the personal trainer has provided? The trainer is not 100 percent responsible for achieving the results; the client also has his part to play. This is why I like the approach of Gary Gray. He said, “The client’s body heals itself,” explaining how to create an environment of movements that will nourish the proprioceptors and thus aide the body in finding its own power. I am firmly convinced that we must stop believing that we possess the power over the body. We possess the knowledge that should allow us to create an environment in which the body can experiment with “healing” and in which the client’s mind can experiment with autonomy. Isn’t that achieving a result?
- “If the client wants to pay me to work with him all of the time,” that is the client’s choice. What is my choice? What is my work ethic? How am I prepared to place myself in this situation? Looking at other healthcare professionals, we see that they respect an ethic that determines how they take responsibility regarding the patient. I deeply believe that if the personal trainer wants to be recognized as a “professional working in the framework of health” he must define for himself a work ethic that will determine the attitude vis-à-vis the client. This attitude must disassociate the personal trainer from a consumerism too often in force in our sector.
The Professional PT Attitude
In order to accompany the client in the autonomy process, we must develop a professional attitude. This attitude is the determining factor in this accompaniment. The classic schema in fitness often resembles the following:
- The client comes with his desire: to engage in sports, to lose weight, to get in shape, etc. The professional responds in general by providing advice relating to physical activity, taking into account the VO2 Max parameters and the fat percentage and comparing them to the absolute health entities. These are used to define the goals to attain, and the means that will be set up and designed to achieve them. At that moment, the client is reassured and happy to be in the care of a professional who is so knowledgeable. The client will, in some way, apply what the professional has said and will move towards the goal that the professional has defined. In such a relational schema, there is little place to allow the client to take part in a cognitive process where he can develop:
- His responsibility vis-à-vis the action undertaken
- His awareness of the importance of physical activity in the lifestyle
- His understanding of the connection between the physical activity and his health versus his own thoughts and feelings relating to his health
What’s more, such an assumption of responsibility leaves no room for expressing the degree of confidence that the client can have in terms of his capacity to regularly engage in physical activity.
Prescribing exercise is common practice among physical conditioning and fitness professionals, but this exposes an (often unconscious) demonstration of a form of power: the power of knowledge and expertise in the service of a “truth,” which the client is invited to conform to.
Rather than prescribing, it would be better to develop an interface between the professional and the client, in which the latter can find a space for personal research into his relationship with the physical activity relative to his health. This will lead to the client taking the responsibility in the process of putting into place the activity, with the professional and not by the professional.
We will see, in the interviews below, that the personal trainer can adopt an attitude that makes it possible to open a personal development space for the client. After the introductions, the trainer explores the relationship between the client and the physical activity.
Importance and Confidence as Change Motivators
According to Rollnick, there are two factors that affect the motivation to change behaviour: importance (of practicing a physical activity) and confidence (in practicing the activity). Everything that increase the client’s level of importance or confidence in relation to engaging in physical activity will therefore have a positive influence on the change. Here, we will explore the attitude of the personal trainer regarding importance and will come back to the theme of confidence in the second article.
A new client, a woman in her 40s, walked into my office. She explained she was wanted help getting back into shape and we had the following conversation:
Me: Are you currently practicing any physical activity, or have you done so in the past?
Client: Before I married, I used to go to the local swimming pool pretty often, but after I married, I stopped going. Then I had children, and the time just flew by. Somehow I never went back.
Me: And what motivated you to go to the pool back then?
Client: Well, I knew several other people who went, and I wanted to move around a bit to do something. It was fun, and I always felt good after a few laps in the pool. And I was in much better shape than I am now (she laughed).
Me: So you felt good and in better shape?
Client: Yes. I also had more energy, and swimming relaxed and de-stressed me. I always had a lot of work, and the financial sector is rarely calm. Of course now, with children, things aren’t any calmer!
Me: I agree with you that practicing a physical activity gives us more energy and reduces the stresses that can build up in our daily lives. Can you tell me any other benefits that physical activity can have?
Client: You can lose weight - which I need to do! - and of course it’s really good for your heart.
Me: Absolutely. Physical activity helps to lose - and to control! - weight and to maintain your heart. Any more advantages?
Client: Hmmm, I can’t really think of any more off the top of my head.
Me: Would it be all right with you if I share some of the other benefits I feel are important?
Me: To start with, regular physical activity helps prevent hypertension, insulin resistance and Type II diabetes. In women, exercise can also reduce the risk of breast cancer, balance hormones better and prevent osteoporosis. Physical activity also has a psychological effect, increasing stress tolerance and stimulating a positive self image and a good mood. Does any of what I’ve just said strike a chord with you?
Client: When you said breast cancer, I thought of my mother, who was diagnosed with it last year. I’ve been really worried about it. Plus, I’ll be going back to work soon, and I can tell you that having more self confidence would be a real boost, especially since I stopped working for 10 years to take care of my children.
Me: So, if I understand what you’re saying, you see several of the benefits of re-starting physical activity as being particularly advantageous for you: weight loss, breast cancer prevention and building your self confidence to return to your profession.
Client: Yes, that’s right. If it could help me like that, I would be very happy.
Me: Let’s talk about how important physical activity is to you. On a scale of one to 10, where one means not at all important and 10 means very important, how important to you is regular physical exercise?
Client: I would say about an eight.
Me: So, I’m hearing from you that physical activity is rather important to you?
Client: Yes, I want to feel good and get back in shape.
As you can see, this interview structurally created a true process that the client could advance along. My role as the personal trainer was to accompany her and to stay centered on her.
Sometimes, however, we meet a client who does not like physical activity and who perhaps had past experiences that left a bad memory. Here’s an example of a client, a man in his early 50s, who responded quite differently:
Me: The fact that you are here today in the gym shows that you have a certain interest in exercising. Tell me what made you decide that you should start exercising.
Client: I thought that if I didn’t do something now, I would get in worse shape.
Me: What concerns you the most about becoming less fit?
Client: I run out of breath really quickly when I walk up stairs, and I can’t really enjoy activities like Sunday bike rides with my family or skiing.
Me: And you want to change that?
Me: Let’s imagine for a moment that you’ve been doing physical activity for a few months and your physical condition is better. How do you see things changing for you?
Client: I could do more with my children and even organize holidays like kayaking in the south of France. We have a holiday home there, and it’s fantastic.
Me: And how do you see things changing for your wife and children?
Client: I’m sure they would be really happy not to have to put up with the frustration of limiting their activities because of me. My family is quite active!
Me: So you would finally be able to fully participate in your family’s activities, and that would make you really happy?
Client: Yes, exactly.
Me: Let me summarize what we’ve just talked about. You’re concerned that if you don’t do something, you will stay in the poor shape you are in now. You want to exercise in order to get in better shape so you can participate more in weekends and holiday family activities. This change will let your wife and kids feel freer to do the activities they want, and you want to surprise them with some “adventure” activities during your next holiday in the south of France. Does that cover it?
Client: Yes, that’s it. That’s just what I want.
Again, in this situation, in my role as personal trainer I allowed the client to express the importance of physical activity to himself in terms of his desire to make changes in his life. It’s all about the client!
This is where the difference lies: staying centered on the client to allow him to stick to practicing the physical activity thanks to the cognitive process that has been established, rather than "selling" him a results contract for a given objective.
In the industry of fitness, too often the accent is placed on the materials, the facilities and the results the client can hope for thanks to technical knowledge that is transferred within a program, whether more or less sophisticated. This may work with people who are already active or who have already managed to change their behaviour, so they can stick with the program. But for “new exercisers” or anyone who is restarting chronic activity, the problem is totally different. This isn’t just important for personal trainers. It also impacts clubs in terms of how they welcome new members, from the sales process to the moment when the instructor takes charge of the client.
So, what can we take away from this new approach? We must always keep in mind that, if we want clients to experience profound and long-lasting results, we must focus on the behavioural change inherent in regularly engaging in physical activity. Only in this way can we help them to stick with the training program and feel the effects long after we have stepped out of the picture.
- "(WHOSIS) statistics system." Web site of WHO: http://www.who.int
- Brehm, Barbara A. Successful Fitness Motivation Stratefies. USA: Human Kinetics, 2004.
- Brown P. and Piper S. "Empowerment or social control? Differing interpretations of psychology in health education." Health Education Journal. 1995: 54: 115-123.
- Gray, Gary and Tiberio David. Chain Reaction Function. DVD. Wynn Marketing, Inc., 2001,2006.
- Malherbe, Jean-François. Autonomie et Prévention. Québec: Artel-Fides, 1994.
- Manidi, Marie-José et.al. Activité Physique et Santé. Paris: Masson, 2000.
- Miller, William R. and Rollnick S. Motivational Interviewing. New York: The Guilford Press, 2002.
- Rollnick, Stephen et.al. Health Behaviour Change. UK: Churchill Livingstone, 2002.