Advanced Fitness Assessment and Exercise Prescription by Vivian H. Heyward outlines the components of exercise prescriptions and provides guidance on how to effectively implement such prescription programs.

Chapter 3: Principles of Assessment, Prescription, and Exercise Program Adherence

Basic Elements of the Exercise Prescription

Mode
Intensity |
Duration | Recommended everyday frequency. Increase duration, rather than intensity early in programs
Frequency | Daily activity, at a moderate level, is recommended — important to vary the mode of activity to avoid overuse injuries
Progression of Exercise | Increase the frequency, intensity, and duration gradually (see stages below)

Stages of Progression in the Exercise Program

Initial Conditioning Stage
Typically lasts 1-6 weeks
Progress slowly by increasing exercise duration first, followed by small increases in exercise intensity.

Improvement Stage
4-8 months
Rate of progression is more rapid
Frequency, intensity, and duration are systematically and slowly advanced, one element at a time until the fitness goal is reached

Maintenance Stage
Should continue on a regular, long-term basis
The amount of exercise required to maintain the physical fitness is less than that is needed to improve specific fitness components
The frequency of the Improvement Stage activities can be replaced by other, more diverse/enjoyable activities

Exercise Program Adherence

Behavior Modification Model

Clients become actively involved in the change process by setting realistic short- and long-term goals, developing a plan to achieve these goals, and signing a contract that describes each goal and how it ma be achieved.
– provide feedback
– revise plan as needed
You can help your client adopt by physical activity into their lifestyle by implementing behavior counseling strategies such as having clients keep a diary of their physical activity and developing a social support system for a client.

Sometimes it can be effective to give rewards (t-shirts, certificates, etc) to recognize attainment of specific goals.

Help client set short- and long-term goals (ensure they are realistic)

Periodically reevaluate client’s fitness levels to assess improvement

Social Cognititve Model

Developed by Bandura (1982) | self-efficacy and outcome expectation

The likelihood that people will engage in a specific behavior, like exercising regularly, depends on their self-efficacy or perception of their ability to perform the task, as well as their confidence in making the behavioral change (Grembowski et al. 1993).

To assess self-efficacy, have your clients rate, on a scale of 0% – 100% their confidence in making the specific behavior change

To increase self-efficacy, you should educate your clients so that they fully understand their beliefs and should help them identify specific barriers to engaging in physical activity (Stuhr 1998).

Techniques to improve self-efficacy include:
– performance mastery
– modeling
– positive reinforcement
– emotional arousal

Stages of Motivational Readiness for Change Model

Prochaska and DiClemente 1982 – individuals move through a series of stages they adopt and maintain a new habit

Model used to facilitate long-term changes in health behaviors such as smoking, weight managemetn, dietary modification, and stress management (Riebe and Niggs 1998) as well as in physical activity behaviors (Dunn, Marcus, Kampert, Garcia, Kohl, and Blair. 1999; Marcus, Bock, Pinto, Forsyth, Roberts, and Traficante 1998).

1. PrecontemplationL Client does not exercise and does not intent to start exercising.
2. Contemplation: Client is not exercising but intends to start
3. Preparation: Client is exercising but is not meeting the recommended amount of physical activity.
4. Action: Client has been performing the recommended amount of exercise regularly for less than six months
5. Maintenance: Client has been exercising regularly at the recommended amount for six months or longer.

Individuals are at different stages — you need to match intervention strategies to the client’s stage and tailor your approach to match individual needs, interests and concerns. (Marcus and Forsynth 2003; Marcus and Lewis 2003)

Strategies to Increase Exercise Program Adherence

• Reruiting physician support of the exercise program
• Prescribing moderate-intensity exercise to minimize injury and complications
• Advocating exercising with others
• Offering a variety of exercise and fitness activities that are enjoyable
• Providing positive reinforcement through periodic testing
• Recruiting support of the program from client’s families and friends
• Adding optional recreational games to the conditioning program
• Using progress charts to record exercise achievements
• Providing qualified, exercise professionals who are well trained, innovative, and enthusiastic