The Psychological Side of Adherence
Standby for an absolute knowledge bomb which will rock your world forever! Ok, perhaps that’s going a tad overboard 😉
In this article we’re going to delve into the psychology of adherence. Why are some people so motivated to consistently go to the gym, yet others find themselves having to battle against using every excuse under the sun to avoid pumping that iron?
To really understand this, we need to dive into a hugely misunderstood (and often bastardised) concept known as change theory.
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Imagine this scenario… 90 year old Doris is riddled with OA, with a history of stroke, multiple M.I’s, severe de-conditioning following 25 years of physical inactivity and most recently, 18 months of bed rest post hip fracture following a fall at home. Doris’s family have suddenly had a bill through for the increased care that their beloved matriarch now requires due to their severely immobility.
What do they do? They immediately get on the blower to the GP, who without much thought, says those words that send utter dread through even the most hardy of physio’s: ‘okey dokey, don’t worry.. we’ll just get some physio in to fix her and get her back on her feet’.
Cue the start of the nightmare that is dealing with unrealistic expectations that have been implanted by the lazy, lacklustre, slopey shouldered use of the English language in an attempt to quickly mag to grid (get rid) of the family and move onto the next.
Whoa, ok… maybe that’s a bit harsh. Let me get back on track 🙂
Now Doris hasn’t got the slightest interest in engaging with physio. After all, she feels like she’s 90 years old, with a long history of a variety of severe co-morbidities that have severely impacted her life. Doris is happy enough doing her crosswords, knitting, watching repeats of Homes Under the Hammer, chatting with friends and occassionally getting outside in her wheelchair to enjoy the sights, sounds and smells of mother nature. Herein lies the problem…
Doris isn’t the one who’s had the initial thought of ‘oh, I have a problem – maybe I need to change something here’. This tends to be the target indicator of whether or not a person is likely to engage, thus be prepared to make changes to their current lifestyle in order to achieve a self set goal.
You can find a myriad of change theories on Google, lots of which do indeed hold merit (especially when it comes to organisational change). The theory that I like to use with my patient’s however is quite an old one that was initially proposed in 1977, then built upon in 1983 by Prochaska and DiClemente, called The Transtheoretical Model (aka. the Stages of Change Model). This focuses more on peoples health behaviour changes, with it being just as relevant today as it was 40 years ago.
See this great illustration by Social Work Tech which neatly describes the individual changes.
Using our example, 90 year old Doris is most likely in the pre-contemplation stage of change and is unlikely to be receptive to any education or advice informing them that they need to start engaging in a progressive exercise regime (be that in whatever form) if they want to see significant changes in their mobility.
Now Doris didn’t even know she was referred to the physio in the first place. She either says “on yer bike matey, don’t you know I’m 90 years old!” – or “oh, you seem like a lovely handsome young man, that sounds like a lovely idea”, when what she really means is ‘oh, wouldn’t it be nice to have a young chap to talk to every week whilst he does exercises for me’.
There is potentially a third outcome, in which Doris is actually extremely motivated to consistently engage and commit to some form of exercise regime. However in this author’s experience, that’d be like having Sandra Bullock, Jennifer Connolly and Shania Twain all asking for your hand in marriage at once. I mean, IT IS possible… but it’s highly unlikely!
Screw Doris! How does all this relate to whether I’m going to stick it at the gym?
Great question!
Now that we understand that there are certain stages to ones health behaviours, if you’re reading this then you’re likely in either the ‘maintenance or relapse’ stage of Prochaska and DiClemente’s model. You should probably accept that slipping into the relapse stage is inevitable at some point, and this really isn’t the end of the world if you realise and learn from why you relapsed. The key is to keep learning from the triggers that cause you to relapse, and try to eliminate or change said triggers. Common triggers can be things like:
- Stress at work = chronic fatigue, poor diet and lack of quality sleep (aka. an unhealthy work-life balance).
- Relationship breakdowns.
- Sudden loss of income.
- Minor or major injuries.
You may even develop some entirely new barriers to exercise such as:
- Insufficient time to exercise.
- Inconvenience of exercise.
- Boredom with exercise.
- Lack of confidence in their ability to be physically active (low self-efficacy).
- Lack of encouragement, support, or companionship from family and friends.
Building resilience, working on improving your emotional intelligence and recognising your barriers can be the key to figuring out why you might be more inclined to ditch the weights, pick up the fork and put your feet up when times get tough.
If you fancy some practical tips on how to stick to your new found life of fitness, check out our original article here.
Whilst not writing for FGUK, Tim works as a Physiotherapist, Personal Trainer and is a Retired Ammunition Technician with the British Army. In his spare time Tim enjoys engaging in a whole variety of sports, spending considerable time with his little rascal of a dog, relaxing with his friends and family, but most of all.. geeking out on all things fitness!
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