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Columns: Enhancing Your Behavioral Toolkit

Self-Monitoring for Supporting Change

Buckworth, Janet Ph.D., FACSM

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ACSM's Health & Fitness Journal: July/August 2016 - Volume 20 - Issue 4 - p 31-32
doi: 10.1249/FIT.0000000000000213
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Self-monitoring is a valuable behavior change strategy to have in your toolkit. You can use self-monitoring with clients not only as part of assessment and problem identification but also as a tool for ongoing monitoring and change management. As part of assessment, your clients monitor specific behaviors that together you have identified based on other assessments. For example, tracking moderate-intensity physical activities or steps could be targets for someone whose aerobic capacity is low. An overweight client could monitor portion size and snacking. It is not unusual for a client seeking to become healthier to feel unsettled and overwhelmed if he or she does not know how to begin. Identifying behaviors that contribute to fitness attributes and are not at healthy or desirable levels gives you and your client options for what and how much to change and where to start.

Students in my class on weight management coaching record their exercise and diet for one week to identify what they want to target in a subsequent goal-setting assignment. Along with the initial logistical challenges of this assignment, they often are surprised to find inconsistencies between what they thought they were doing (“I drink plenty of water”) and the realities of their typical everyday choices (“I only drink two glasses of water a day”). Self-identification of the gaps between assumptions and actual behavior is valuable in determining where to start in a behavior change program. Directing your clients to begin a behavior change program by self-monitoring enables them to become aware of what they are doing or not doing in respect to their health and sets the foundation for personal accountability.

Self-monitoring should not be a difficult task for your client, but it will take some effort. There are a variety of tools available for tracking physical activity (2), diet, and smoking cessation (3). Clients can use smartphone apps, Web sites, and paper journals. Although there is some preliminary evidence for the effectiveness of smartphone applications over Web site and paper diary (1), the method selected should be practicable and convenient for your client. If your client attempted to track behavior before working with you, discuss the method(s) used to discover the characteristics of a better approach to take. Someone who often forgot to record snacks in a notebook might find it easier to use one of the many apps available for mobile devices.

The success of self-monitoring is influenced by the regularity of self-monitoring and the temporal proximity to the behaviors being monitored. In other words, the intensity, duration, cues, and consequences of swimming at the gym will be more accurate if recorded before leaving the building rather than the next day. Recording less salient behaviors, such as time sitting while working, are even more important to record close in time to their occurrence. The motivation to change the target behavior also influences the success and accuracy of self-monitoring, highlighting how important it is for you to work with your client on identifying behaviors to monitor and the links between those behaviors and your client’s goals. For example, pointing out how staying hydrated can help endurance performance can motivate a client training for his or her first 10K road race to track when and how much water he or she drinks.

One of the things that makes self-monitoring a versatile strategy for your toolkit also may complicate its use as a method to gather accurate baseline information about a client’s behavior. A good assessment tool is not reactive, that is, it does not change the behavior being assessed, but self-monitoring’s value as a strategy to foster change can confound its ability to be an assessment tool. Being aware of this possibility can guide you to potential inaccuracies. For example, your clients might not want to report being mostly sedentary during the week, so they walk more than usual, reacting to the measurement. Another possibility to keep in mind is that clients may continue with their usual behavior but record only acceptable behaviors and not what they actually did such as eating a second helping of dessert but not entering this in their food log. They may be embarrassed for you to know how far off they are from what they think they should be doing, so they change their behaviors (react to the measurement) or they do not record what they actually did. It is very important to reassure them that honest records will be the most useful in setting up a realistic plan. Be straightforward and nonjudgmental about the importance of gathering baseline information about unhealthy habits and identifying what prompts and reinforces these behaviors. It also will be helpful to set a clear time limit such as one full week of monitoring. For clients who are ready to change and are impatient to get on with it, knowing this information-gathering stage is time-limited can increase compliance.

Once you have identified target behaviors for change, self-monitoring can be used to support change management. Your client has become more aware of where and how he or she spends his or her time, especially time that is not as structured as work or school. Your role in the effectiveness of self-monitoring as a behavior change strategy hinges in part on helping your clients interpret what they continue to record after baseline assessment. You can assist your client in identifying barriers, supports, and other factors that influence sticking with a behavior change goal. Reviewing what your client has recorded also allows you to discover together any patterns that can be altered to allow healthy new habits to be introduced. Someone who wishes to lose weight can record when, what, and how much he or she eats throughout the day. Together, you can identify opportunities to eat healthier and track the success — or failure — of his or her plan. Pointing out that eating lunch with friends every Monday is associated with skipping supper and snacking at night can lead to a discussion about the effects of social eating and the introduction of strategies to eat more mindfully. One of my students reported that self-monitoring was like having a coach on his shoulder keeping him on track. The sense of being accountable to you and to themselves can be fostered by setting clear and specific behavioral goals and using self-monitoring to track goal-supporting behaviors.

Recording behavior brings self-awareness that disrupts mindless habits of overeating or spending most leisure time in sedentary activities. Through time, self-monitoring can become less about identifying barriers and supports and creating a plan and more about tangible evidence of progress, which fosters a sense of accomplishment for your client. Setting and achieving timely and specific behavioral goals goes hand in hand with self-monitoring, and is another strategy for your toolkit — and another column!

Self-monitoring creates intentional self-awareness that allows you and the client to identify behaviors that are important for improving health. Information about lifestyle patterns and behavioral choices, as well as cues, rewards, and punishments for fitness related behaviors are available for you to review and discuss with your client as you set up an individualized program.

Research has shown that self-monitoring is the single best predictor of success with weight loss, and people who self-monitor eating and exercise behaviors usually have the best adherence.

Self-monitoring and Change Management

  • Provides direct feedback of progress and accomplishments
  • Highlights information for short-term goal setting
  • Fosters automaticity and healthy habit development
  • Provides an opportunity to track energy level, alertness
  • Identifies barriers and supports for target behaviors
1. Carter MC, Burley VJ, Nykjaer C, Cade JE. Adherence to a smartphone application for weight loss compared to website and paper diary: pilot randomized controlled trial. J Med Internet Res. 2013;15(4): e32.
2. Lee J-M, Kim Y-W, Welk GJ. TRACK IT: validity and utility of consumer-based physical activity monitors. ACSMs Health Fit J. 2014;18(4):16–21.
3. Patel R, Sulzberger L, Li G, et al Smartphone apps for weight loss and smoking cessation: quality ranking of 120 apps. NZ Med J. 2015;128(1421):73–6.
© 2016 American College of Sports Medicine.