by by James J. Annesi and Jane K. Jennings
Over the past several months, we have contributed to ACE professionals through (a) four blogs (see links below), (b) an article on emotional eating in CERTIFIED™ and (c) two hour-long webinars on the association between manageable amounts of exercise and sustained weight loss. Most of that work emanated from our 25-year research program into behavioral weight loss and maintenance. Unfortunately, the essential premise that exercise indirectly supports well-managed eating and control over weight through its associated psychological changes (rather than through associated energy expenditures, which can be very difficult to sustain for adults with overweight and obesity) is sometimes mistakenly reduced to something like, “We already know that exercise plays an important part in weight management, so what’s new here?”
Thus, within this blog, we would like to conclude this current wave of communications facilitated by ACE by directly and succinctly answering this question. Special attention is paid to the implications for your practice. Although our program of research is steeped in behavioral theory, previous research findings and statistical analyses, we will largely dispense with those details here. The interested reader can go to ORCID (the Open Researcher and Contributor ID), and review any or all of the hundreds of studies and reports we published that led to the suggestions below. Health coaches and exercise professionals may wish to consider these five essential methods for increasing your productivity with clients with health risks associated with inactivity and/or overweight/obesity.
1. Build behavioral adherence through self-regulation skills, rather than through relying on education.
Although there is good evidence that sustaining (not initiating) health behaviors is not associated with how much a client knows about nutrition or exercise methods, some professionals still act as if education is a panacea. Clients seem receptive to the information and often pledge to maintain suggested health behaviors, but then reality and the barriers/challenges set in. Slow progress, exercise-associated discomforts, social pressures to eat, stress, etc., can overwhelm their best intentions.
The informed professional internalizes this reality and adjusts their actions accordingly. Helping clients counter the many lifestyle barriers affecting an array of self-regulatory skills is paramount. These techniques of self-management have been successfully incorporated into other health behaviors such as smoking cessation and alcohol/drug rehabilitation. However, only recently have their potential for transference from an exercise to a controlled eating context come to light. The results have been meaningful. Therefore, professionals should spend time transferring self-regulation methods such as: (a) enhancing control over unproductive self-talk, (b) diligently tracking small-scale progress, (c) distancing the attentional focus away from discomfort, (d) recruiting social supports and (e) minimizing barriers and prompting positive behaviors. Each can be practiced and applied in an exercise context and adapted—again through the guidance of the professional—to controlled eating.
2. Leverage exercise-induced mood change.
Although exercise is inherently rewarding to many exercise professionals, this is not the case for most adults. That is partially why physical exertion has largely been engineered out of our daily lives. Our research demonstrated that as few as three moderate-intensity sessions of exercise are associated with significant reductions in depression, anxiety and fatigue in adults with obesity. When measured and tracked, this is not only reinforcing to most people in terms of adherence, but it also helps reduce the problem of emotional eating.
Sustained improvements in mood are termed “chronic improvements” because they are stable (as long as dropout does not occur). However, exercise can also induce “acute mood improvements,” which occur immediately after exercise is completed. If exercise amounts are adjusted correctly, these changes in mood can positively impact exercise adherence. However, exercise’s association with discomfort promotes dropout. We suggest professionals briefly evaluate pre- to post-exercise changes in feelings to ensure that the programmed exercise volume is associated with reinforcing, rather than punishing, feelings.
3. Respect clients’ long-term goals but redirect their attention toward short-term goal progress.
While clients often have lofty goals associated with their fitness and weight, without adherence these will not be possible. To facilitate adherence, research indicates that professionals’ role in adjusting long-term goals into several short-term (1–2 month) goals is important. These “process goals” should be quite specific and allow for subsequent adjustments based on their attainment/non-attainment.
Diligent progress tracking is essential, and “do your best” goals should be avoided. An example of an exercise-related goal might be to increase cardio time from 30 minutes/week to 80 minutes/week within a month. An eating behavior goal could be to reduce fast-food consumption from five meals/week to two meals/week within a month. Regardless of attainment of a difficult long-term goal such as losing 75 pounds (34 kg), obtaining and resetting short-term goals builds a sense of accomplishment and mastery. When professionals facilitate such an increase in self-efficacy, the commitment and persistence required for long-term success is increased.
4. Keep behavioral targets as simple as possible.
There is a plethora of both diets and exercise regimens that can be overwhelming to clients. Most are quite specific in their requirements. Clients can feel overwhelmed and overburdened and perceive enough disappointment when a “violation” happens that complete dropout is often the result. Because much of our research focuses on the benefits of exercise for its psychological-change properties, we tested the association of exercise volume with weight loss in women with obesity. Although avoiding dropout was essential, there was no greater weight loss associated with more days of exercise per week when self-regulation skills were the program focus. Thus, we suggest professionals avoid overburdening clients’ weight-loss goals with difficult exercise regimens—the payoff is just not there. In terms of eating behaviors, we found increasing fruit and vegetable consumption was associated with the reduction of (a) overall energy intake, (b) consumption of other food groups and (c) sweets intake. Reduction in sweets was the most strongly associated with both long-term weight management and reductions in emotional eating. Thus, professionals’ suggestions to maximize fruit/vegetable intake is a worthwhile practice.
5. Prepare, in advance, for behavioral “slips.”
No matter how thoughtful programs are, there will be times when clients fall off track and experience a lapse. Those prone to “black and white” thinking might perceive failure, and vow to “start fresh” the first of next month or when things might get easier for them (e.g., when work gets less busy). It’s important to inform clients that there is no “gold standard” when it comes to completing exercise or improving eating behaviors. Some setbacks will occur. Minimizing barriers (where possible), while also preparing for behavioral slips may be a useful approach for sustained behavior change.
We suggest that professionals first list potential challenges and barriers to both exercise and controlled eating behaviors, then think about (and write down) how they can be avoided. In the next step of the process, professionals can prepare statements in advance of their need (i.e., when a slip occurs). The statements should be centered around the need to be persistent even when perfection is not possible. When a client misses a session of planned exercise or eats in an unhealthy manner, there is no need to try to make up for this during the next day or days. Rather, the client should simply acknowledge the misstep and recommit to their plan.
Conclusion
Without long-term adherence, health-risk reductions will not be attained. Even when a client appears to be highly receptive and committed, if they are able to sustain their initial health behavior changes beyond several months, they will be the exception rather than the rule. This is evidenced by a very well-informed U.S. populace where 74% currently have overweight or obesity, and less than 10% complete even the minimum amount of physical activity/exercise deemed needed for health.
The forward-thinking professional embraces their role as a health behavior–change agent, educates themself on state-of-the-science methods in that area and avoids blaming a client when they experience a lapse. Keep in mind the role that regular (and manageable amounts of) exercise plays in weight control that goes well beyond caloric expenditures, and you can become an expert in supporting exercise, positive eating behaviors and physical/mental health for even the most at-risk clients.
To learn from Dr. Annesi and read more about his extensive research on behavior change and the relationship between exercise and weight loss, check out these recent blogs:
Jane K. Jennings
Jane K. Jennings has been a health and fitness professional for over 30 years. She applies evidence-based physical activity, exercise and eating behavior-change methods that have helped thousands in search of a healthy lifestyle and controlled weight. Her approach is rooted in behavioral theory and focuses on adherence to exercise, incremental goal progress and self-regulatory skills development. Jennings has collaborated on research with Dr. James Annesi on the effects of group cohesion, self-efficacy and mood change on exercise and eating behaviors. She also contributed to the longitudinal study of The Women’s Health Initiative and applied her translational behavioral medicine approaches to numerous fitness, medical and health-promotion centers, including Englewood Health Medical Center and Spectrum for Living.
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