High-risk situations and rigid rules for healthy behaviors increase the risk of relapse.
Jesse had been attending the evening body sculpting class for 5 years and loved how great she felt. She knew everyone in the class, and even though she was the only person who had been in the class from the beginning, she welcomed each new member. But new members had been few and far between for the past year. Jesse liked this, though, because she almost felt as if she were getting personal training as the class got smaller. When the fitness director told her that they were discontinuing this evening class in 2 weeks, Jesse was shocked and discombobulated. She felt like the rug had been pulled out from under her. She glanced at the sheet with the new schedule of group exercise classes and left it in the locker room. “Now what am I going to do!?” she moaned.
Jesse needed a plan B for her exercise routine. Setting up a regular routine and making fitness activities habits can foster long-term adherence, but dependency on a particular routine puts a client at risk of not doing anything if the routine is disrupted. Without access to her accustomed class, Jesse was at risk of not exercising at all and relapsing into a more sedentary lifestyle.
The challenges of adherence to a healthy lifestyle are addressed in the relapse prevention model, which focuses on identifying situations that increase the chance someone will return to an old, undesired behavior pattern and on implementing strategies to cope effectively with these “high-risk” situations (1). Although the model addresses the maintenance of voluntary self-control and the cyclical nature of long-term behavior change, Marlatt and Gordon (1) aimed to explain how to enhance the abstinence from a high-frequency, undesired behavior in the context of the person’s ability to cope with relapses cognitively and behaviorally. The strategies associated with relapse prevention have been applied to maintaining positive health behaviors, such as sticking with a strength training program and eating at least five servings of vegetables each day. There will be a separate column on relapse prevention in general, but here the focus is on how having a plan B for workouts in the short and longer term is an important skill for your clients to decrease the risk of dropping out when their routine is disrupted.
We want clients to make exercise and healthy eating habits because once a habit is established, the behavior is activated based on situational cues and becomes more automatic and less dependent on reasoned consideration (2). Automatic behavior can thus reduce the cognitive demands of participating in healthy behaviors. We just don’t have to think much about how and when we’ll get in our workout or how to prepare a healthy meal. In Jesse’s case, she didn’t have to decide what to do after work on Tuesdays and Thursdays or what to do once she arrived at the fitness center to get the workout she wanted. She had a familiar, consistent, predictable routine — until she learned that her class would be canceled.
Everyone has to manage predictable disruptions in their lives. Events such as vacations and family holidays are typical situations that put regular exercisers at risk of skipping their usual activities and dietary choices. Many events that cause disruptions in a routine can be anticipated and thus provide opportunities to plan ahead and make healthy adjustments, such as skipping a morning jog before a family barbeque but taking a long walk with family members after the meal. The fitness professional can be aware of shared and personal situations that will make it harder for clients to stick with a fitness plan and work with them to make adjustments. Sharing a map of safe walking routes in the community and healthy holiday recipes before winter break, offering a class on body resistance routines that can be done on vacation, and organizing a walking club for parents waiting for their children during soccer practice are examples of ways to help clients plan ahead and have options for maintaining healthy habits.
Accommodating minor transient variations in an exercise routine pose little problem for most people. Swimming on Tuesday instead of Wednesday, skipping the leg press to pick up a child from the sitter on time, and walking an extra block to check out the new shop in the neighborhood are examples of minor adjustments individuals make without feeling that their personal exercise program is off track. But having a fitness program that is place, time, or mode dependent puts clients at risk of lapsing or relapsing from regular exercise even if the disruption is temporary. Their automatic pilot is not useful, and they have to make multiple decisions about what, when, where, and how they are going to respond. For someone like Jesse, exercise options had not been considered for a while because she assumed that her workout place and mode were stable and her plan for meeting her exercise goals was fixed.
Having limitations or more rigid rules for meeting a target behavior (e.g., I only exercise after work) will increase the chances that deviations from that routine will lead to relapse.
Although Jesse had a strong exercise habit, it was limited to a specific place, time, and mode. Fostering skills to cope with disruptions that are minor (jogger has 45 minutes to exercise and all the treadmills are in use; menu has no vegetarian entrées) or major (favorite long-term Pilates instructor is moving out of state; freezer full of frozen meals spoiled when electricity went out) can help your clients increase their self-efficacy for overcoming barriers and maintain their healthy choices. Remind them that flexibility and options in a plan are important for long-term maintenance. Plan B for volume of activity can be included in flexible goals, such as working out 3 to 5 days a week or walking at least 10,000 steps a day. The lower range of these goals can be used when time is more limited or other barriers arise. Having place options, such as running on the treadmill in the gym instead of outside during inclement weather or participating in online guided yoga routines when at home with a sick child, can be manageable options when clients can’t exercise where they want to. Helping clients with mode options is important for several reasons. Although swimmers might be frustrated when the pool is closed for maintenance, having a variety of aerobic, strength, and flexibility options that are part of their fitness plan B will keep them active when they can’t participate in their preferred mode. Flexibility in exercise mode also comes in handy in coping with an injury. A fractured wrist, for example, would not mean that a client stops strength training until the cast is off if he or she has back-up plans in place and guidance in safe alternative fitness activities. In addition, different exercise modes are part of a balanced fitness program that meets ACSM Guidelines.
Major permanent disruptions in fitness programs are going to happen, but fitness professionals can make sure their clients have appealing alternatives and not experience Jesse’s distress and risk of dropping out when her class was canceled. Promoting different programs and new equipment to new and established clients, such as “Try me!” classes and refresher instruction on using gym equipment, will increase client awareness of options and make it easier to shift to appealing substitutions when necessary. Disruptions can be predictable or unexpected, but they don’t have to derail healthy behaviors if your clients have engaging plan Bs in their toolkits.
1. Marlatt GA, Gordon JR. Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors
. New York (NY): Guilford Press; 1985.
2. Rhodes R, de Bruijn GJ, Matheson DH. Habit in the physical activity domain: integration with intention temporal stability and action control. J Sport Exerc Psychol
. 2010;32(1):84–98. Epub 2010/02/20. PubMed PMID: 20167953.