CONSISTENCY AND ADHERENCE

Consistency and Adherence are arguably two of the biggest factors affecting and limiting individuals that are trying and potentially failing to improve measures of health. These measures include body fat to muscle mass ratio, strength, cardiovascular endurance, mental health and many more, in other words these factors affect your ability to look great, feel better about / within yourself and get stronger. Despite various levels of digital applications, health and fitness coaches and online personal trainers are still struggling to create increased levels of compliance within their clientele, whilst clients are still struggling to complete fitness programs and take potentially life-saving medication. So how do we approach this sizeable challenge, read on and you we will discuss the factors affecting consistency and adherence and talk through strategies to help you improve.

So how do we define adherence and consistency?

We can define consistency quite simply as “the ability to execute positive daily habits” or alternatively “active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behaviour to produce a therapeutic result.” Meichenbaum D, Turk DC: (1987). These habits from the perspective of health and fitness could mean things like eating 3 meals per day, sleeping 8 hours per night or getting 30-40 min of resistance training and low intensity cardio in, yes, I said it, “LOW INTENSITY CARDIO”.

 We can define adherence as stated by the Cambridge English dictionary as “The act of doing some something according to a particular rule of law, standard or agreement”. Additionally, Meichenbaum and Turk (1991) define adherence as an ‘active, voluntary, collaborative involvement of the patient in a mutually acceptable course of behaviour to produce a desired preventative or therapeutic result’.

Now personally I much prefer the second definition, this definition is based upon the mutual agreement between the client and practitioner to work towards a shared goal. This definition allows for a higher order relationship to be delveloped, and when it comes to succeeding this is one of the most vital components

These two factors alone are a major predictor of how successful a client will be in achieving their goals. This sounds ominous I know. It is often presumed that society is generally adherent to taking lifesaving medications and completing health / self-improvement strategies autonomously. Yet with more than 50% of the population not adhering to lifesaving medicative care, it doesn’t bode well for the rest of us trying to get a little healthier and lose a little body fat. So, to understand the problem we need some context.

Background

 With no real model defined in the clinical literature to improve compliance and adherence with specific reference towards taking medication for chronic and life-threatening illness. Non-adherence / compliance remains to be one of the biggest challenges to health care professionals around the world. As a health and fitness professional and online personal trainer, we can learn a lot from the medical world in how to tackle this problem, more so the world and work of behavioural psychologists.

What are the factors that can affect adherence?

Well there are several these range from (but do remember this blog isn’t going into great detail but giving you the broad picture)

The next points are taking from Delamater, A.M., (2006) a study into improving patient adherence rates in diabetic patients.

– Demographics: This can include socio-economic status, and level of education and age.

– Psychological: differing beliefs around health, and how to achieve it along general mental health status

– Social: The support system you have around you and the relationships you have will have a large if not the largest effect on the general population when referring to the topic of discussion

– Health care providers: whether your adherence issue is related to medication or lifestyle change the quality of the provider of that care will have a significant impact. Having the support of a qualified professional has been shown to improve adherence rates in diabetes patients.

– Disease and treatment related factors: Research have generally shown that lower adherence rate can be expected when a health condition is chronic, when the required change is complex and often when the symptoms are not directly experienced, such as that of a poor lifestyle.

– Other factors can include a client’s initial motivation to change, relationship with the trainer, and environment (e.g. How many barriers they have such as kids, busy work life etc)

Why is consistency and adherence important?

Without consistently implementing behaviours that lead to success, you may struggle to reach the goals defined at the start of your journey. But there is light at the end of the tunnel, you don’t need to be 100% consistent all of the time, there is a margin. Now this margin will depend on the individual, but it is what you do most of the time that leads to success.

An independent analysis of data by Precision Nutrition of nearly a million data points over a thousand clients found that with a consistency rate of between 10-49%, there clients were still able to lose weight. You see if you have currently a lifestyle that leads a lot to be desired and you have decided to make a change, just ensuring that you make a few sustainable small changes over a long period of time (about 6 weeks) will lead to you moving towards your goal.

What are then, the factors that affect the regular girl or guy trying to look good, feel better and get a little bit stronger? There are several consistent themes that pop up when the online personal trainers here at Base Training consult their clientele during the initial and subsequent monthly meetings. These often include limiting factors like, work, travel, energy levels, time availability, stress, lack of knowledge, miss alignment between goals and priorities, miss understanding of the true intent of exercising for health, lack of balance within their life and daily rhythm. These factors are along the lines of what we would term “Basic Lifestyle Guidelines”.

Research suggests that you are most likely to stick to something if you enjoy it. This factor includes the overall perceived level of happiness that the client is experiencing. This we have found plays a huge role within the level of success a client will attain. In a brief report on how happiness is best kept stable: Positive emotion variability is associated with poorer psychological health, Gruber et al (2012), 244 adult participants were asked to rate their positive feelings for 14 consecutive days prior to going to bed, (ironically of that 244 only 2.9% failed to complete less than 50% of the entries required, from this we could infer that accountability and relationships with an authority figure may aid consistency and adherence). Participants were asked to indicate how happy and excited they felt over the past 24-hour period ranging on a scale of 1 – very/slightly/not at all to 5 – extremely. These same participants also completed a concurrently running study of psychological health that in measures of functioning life satisfaction, depression and symptoms of anxiety.

For study one, participants who experienced greater positive emotion variability throughout the 14-day period reported worse psychological health outcomes. These outcomes held up when controlling for life stressors, suggesting that they were not driven merely by external life events. For study two those who reported a greater positive emotion variability throughout the previous day experienced worse psychological health outcomes, including decreased daily life satisfaction, decreased life satisfaction, and decreased subjective happiness. 

This paper is arguing that being in overall higher frequency of lower level positive experiences is more conducive to consistency and adherence to a program than intense bursts of positive emotion. 

Now we all know that when it comes to exercise, the prevalence of HIIT training is currently dominating the fitness industry’s narrative, with the extreme high that comes after a workout vs the low often reported during the workout, could this play into the high levels of variance in happiness? The answer, in our experience yes, this is though anecdotal and based upon several years within the HIIT model.

Management of the intensity at which we experience good things isn’t predictive of our overall wellbeing, intensity of emotion though, is linked to intensity of negative emotion. This changes your reference point.

Our argument is, that, consistent adherence to a program that provide lower levels of happiness during and post exercise may be more beneficial to overall happiness levels. Understanding that intense positive feelings equals to intense negative feelings could be a major deciding factor in whether or not you are able to stick to your program long term.

What can we do to aid consistency and adherence to an online personal training program?

Managing expectations

Oettingen & Wadden (1991) found that while positive expectations were associated with success, positive fantasies predicted failure. It becomes extremely important that at the start of your journey we close the gap on what you may expect to see happen and what you may actually see for the hard work you put in. Understanding that a longer timeframe than initially thought to reach your goals may be needed.  Now, we are beginning to touch on goal setting and the most appropriate way to set them and to actually stick to them but that is a whole other blog post, lucky enough we have already written one and you can find it here. The overall theme of managing your expectations is that we have to be realistic about the timeframes and levels of improvement you may experience during your program. Remember in some cases these problems have been persisting for years, and unfortunately at present there is no magic pill that is going to make it all better.As the Chinese rice paddy workers would say “No man that fails to rise before the sun will fail to make his family rich”. This quote eludes to the level of time and dedication that is put into farming. This type of farming requires hours of painstaking work, high levels of patience, attention to detail, mastery of the basics and a comprehensive understanding of the goal you are working towards, and that the goal you are working towards is a meaningful one, and that there is value in meaningful work. Trust the process. If you are able to grasp this, truly, then you will be at ease with the time it takes, and the work it takes to reach your goals. Before you start your new fitness journey or the new diet plan or even continue with the one you’re on, remember to have a conversation and ask yourself whether the perceived gap between your actual and desired goals match up, if they do not then aim to close that gap and you will have a greater level of success and sense of fulfilment.

One way you could work on this is by making the steps to get there more concrete so that even small progress is more easily recognisable one way to ensure this happens is to utilise the practice of implementation intentions.

Goal Setting and implementation

Ensure that you are setting goals. Focus on utilising the theory of process goals. Process goals are often intrinsically motivated whilst outcome goals are exactly that, they are the outcome and are often motivated by extrinsic factors. Now neither is right or wrong, each to their own, however through years of online personal training and working with clients in person I have experienced a higher level of success with clients when they take a process driven approach. Instead of focusing on the long-term goal focus on what you can do right here, right now and in this moment to progress your position. Do this again and again, over and over and eventually they add up to reaching and most often surpassing your originally stated goal. However, goal setting is a waste of time if you do not have a plan to execute them, in the blog post I wrote previously I have provided a template to allow you to turn your goals into actions.  Head over and check it out, once you have set your goals and turned them into actions reach out in a couple of months to let us know how you got on.

Find a professional

Finding a professional online personal trainer can be tough, we get it, all of the coaches here at BASE utilise online personal trainers and they are hard to find. Do your research ask questions and ensure that your coach is dedicated to helping you reach your goals. If you are in doubt fill out a contact form and get in touch for your free discovery call, here we will discuss your goals, lifestyle, nutrition, and training, but more importantly get to know the human driving the car.