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Strategies to increase exercise adherence in older adults

This is an excerpt from Physical Activity Instruction of Older Adults by C. Jessie Jones & Debra Rose.

The choice of whether or not to exercise is a daily decision. Although a person's risk of dropping out of an exercise program is lower when he or she has maintained participation for six months or longer, lapses (i.e., missing several exercise sessions) and relapses (i.e., returning to a sedentary state) are the rule rather than the exception. Once your client has incorporated an exercise program into his or her lifestyle, it is a good time to introduce relapse prevention strategies. According to relapse prevention models (Marlatt & Gorden, 1985), lapses and relapses are often triggered by high-risk situations coupled with the absence of coping responses. Helping clients to view lapses and relapses as a normal part of behavior change can be useful.

Encourage clients to identify situations when they are likely to experience lapses or relapses in their exercise program. The most common situations include travel, holidays, illness, stress, poor weather, and competing family obligations. When clients anticipate these high-risk situations and develop strategies (both cognitive and behavioral) to deal with them, they are better prepared in the actual situations and tend to have higher self-efficacy in coping with them. Illness and family obligations, particularly caregiving, are especially relevant for older adults. It can be difficult for anyone to restart an exercise program after recovering from a cold or flu, but it is particularly challenging for older adults, who tend to remain ill longer and may experience a greater loss of function during this period.

Many thoughts go through a person's mind when deciding whether or not to exercise. Thoughts such as "I'm too tired" and "I'm not in the mood" often precede (i.e., are antecedents to) the decision to not exercise. An important part of relapse prevention is helping people question their "all-or-nothing" thinking. After missing an exercise session or two, a person often feels as though he or she has completely failed. This person might decide to wait until the following week or the following month or even the following year to resume their program. In addition, it is common to feel discouraged when goals are not met and outcomes are not reached. These thoughts can lead to a brief lapse in an exercise program or to quitting the program altogether.

Clients can be taught to replace their negative thoughts with more realistic or positive ones. The first step is for the client to be aware of his or her thoughts and how thoughts lead to behaviors. Encourage clients to challenge their thoughts. A useful technique is to ask what the client would say to a friend with the same thought, and encourage the client to focus on similar thoughts. You can also model healthy thoughts by emphasizing that adherence is not an all-or-nothing phenomenon. For example, when a client says, "I had a stressful week and only exercised twice—I really blew it," you can respond, "I think it's great that you were still able to get in two sessions, despite your stressful week!" It is important that neither you nor the client forgets that engaging in some level of physical activity is better than engaging in no physical activity.

Although it is important to brainstorm ways to overcome barriers and high-risk situations, there will inevitably be times when it is nearly impossible for a person to exercise. One strategy that may initially seem counter to your natural instincts is to schedule a brief, planned lapse with your client. It is important that the time frame of the lapse be defined very specifically. Also, the client should have a very specific plan for resuming the exercise program after the lapse. Otherwise, it can be difficult to start up again after the scheduled time has passed. A planned lapse gives the client permission to stop exercising, and thus the client is less likely to feel guilty or to view himself or herself as a failure, which is a common trigger for a relapse.

Finally, an important aspect of relapse prevention is helping clients to differentiate between a lapse and a relapse. The all-or-nothing trap is powerful, and clients should be reminded to view exercise and adherence as a continuum. This more realistic view reduces negative thoughts and emotions associated with lapses and thus reduces the likelihood of a complete relapse.

More Excerpts From Physical Activity Instruction of Older Adults