Most health and fitness professionals come to their client relationships with an agenda of what they would like to accomplish. In fact, quality metrics sometimes require it. Whether it is the number of pounds lost, amount of muscle gained, lab values improved, or any of a number of other success criteria—health and fitness professionals are graded and judged based on the outcomes of their clients. So it just makes sense that you come to a client relationship with a specific goal and aim of what you want and need the client to do to achieve those outcomes. If they would follow what you say to do…then they would realize their goals and finally achieve the success that they’ve been looking for.

But anyone who has tried to help people make a behavioral change knows that it doesn’t work like that. Behavior change is difficult, and not everyone is ready to make the changes we think they need to make to improve their health. Unless an individual truly owns and desires making a given change, any externally-motivated changes will be short-lived and unsustainable.

As a behavior change expert, much of your expertise is demonstrated through not being the expert at all, but rather leaving your own agenda and wealth of knowledge behind, and serving as a guide while your client takes the leading role in the behavior-change journey.

The ACE Cycle of Change, which includes three distinct phases—awareness, choice and execution—is a relatively straightforward way to think about this journey. In this model, the coach recognizes that behavior change occurs in phases and tailors any behavior change intervention to the client’s readiness to change.  

In the awareness phase, a client comes to first realize that a behavior change is needed. This does not mean that the client is actually ready to change.

In the choice phase, the client comes to terms with wanting to make a change and commits to taking some steps toward that change.

In the execution phase, the client begins to act on the plan for change. Oftentimes, health professionals want to leap clients to this phase. However, pushing clients too much and skipping the first two phases is rarely successful.

So, how does this play out in real life? Using a few case scenarios, here are five strategies to help guide clients toward behavior change using the ACE Cycle of Change as a framework.

Scenario 1: A client with prediabetes who has been referred for coaching

A new client has just been told by her physician that she is at increased risk for diabetes. Her physician referred her to a certified health coach to help her make nutrition and exercise changes to decrease her risk for diabetes. Reluctantly, the client shows up for her first visit.

What phase in the cycle of change does this represent?

Awareness

What might be an effective intervention?

In the expert-centered model, a health professional might start by telling the client how important it is to be healthier and jump right into developing nutrition and exercise goals for the client.

In the client-centered model, the health coach may step back and ask the client a series of open-ended questions. This would be followed with reflections to better understand her point of view related to this diagnosis, the factors that may have contributed to it developing, what she believes are the most important next steps, and how she believes the coach might be able to help.

For example, the coach might start with:

• “Tell me a little bit more about why you are here.”
• “How do you feel about this diagnosis?”
• “What might be a best-case scenario that comes from us working together on this? “

Key strategy:  Use of open-ended questions and reflections

Scenario 2: A personal training client who is frustrated that, despite her regular exercise program, she has been unable to lose any weight

What phase in the cycle of change does this represent?

While this client may be in the execution phase of her exercise program, she sounds like she may be in the awareness phase with respect to other factors that contribute to weight loss, such as nutrition changes.

What might be an effective intervention?

An effective intervention for this client may start by her keeping a three-day nutrition log (two weekdays and one weekend day) to get a better understanding of her current nutrition habits. She may be reminded to not worry about making any changes to her current patterns. This activity is simply to understand her current habits. When clients have a good awareness of their current habits, they will be much more likely to develop effective goals in the choice phase of change.

Key strategy: Gathering baseline information through nutrition and exercise logs

Scenario 3: A client who has decided that she would like to complete a half marathon this year and is requesting assistance developing a training plan

What phase in the cycle of change does this represent?

Late choice/early execution: This client already has established a goal. Now she needs help putting together the action plan to have a successful experience.

What might be an effective intervention?

Establish an action-plan and short- and medium-term SMART (specific, measurable, attainable, relevant, time-bound) goals to help support her longer-term goal of completing the half marathon.

Key strategy: Developing an action plan made up of short- and medium-term behavioral-based SMART goals to support a longer-term goal.

Scenario 4: A client who has successfully lost 7 percent of her body weight and would like help maintaining the weight loss

What phase in the cycle of change does this represent?

Execution

What might be an effective intervention?

Identify those factors that have worked well for the client in achieving this weight loss and then provide assistance in helping to maintain them, so they become ingrained lifestyle behaviors. This assistance often comes in the form of regular check-ins, whether those be training sessions, coaching sessions, virtual meetings, emails  or some other form of correspondence. Working with the client to develop a plan for self-accountability will also help the behavior stick despite the many ups and downs that come with everyday life and trying to maintain changes.  The ups and downs, of course, may include relapses, which are a normal part of making any behavioral change. Helping a client to anticipate, prepare for and overcome relapses can help to ensure that they are temporary.

Key strategy: Accountability, regular monitoring and developing action plans to help transition new behaviors into habits

By truly focusing on what our clients want (versus what we want), our clients will increase their ownership and motivation to achieve their goals. Ultimately, this is what will move us closer to effectively helping our clients improve their overall health and well-being in a sustainable manner.