EXCI252-CSEP-PATH-Section-4-F2023.pptx

CSEP-PATH Section 4 Physical Activity Training for Health EXCI 252 1 6 Key Steps of the CSEP-PATH Sequence Step Step 1 – ASK Step 2 – ASSESS Objective Get to Know the Client Physical Activity, Fitness, & Lifestyle Step 3 – ADVISE Evaluation Report & Discussion Step 4 – AGREE Devise an Actio...

CSEP-PATH Section 4 Physical Activity Training for Health EXCI 252 1 6 Key Steps of the CSEP-PATH Sequence Step Step 1 – ASK Step 2 – ASSESS Objective Get to Know the Client Physical Activity, Fitness, & Lifestyle Step 3 – ADVISE Evaluation Report & Discussion Step 4 – AGREE Devise an Action Plan Step 5 – ASSIST Step 6 – ARRANGE Increase Motivation & Overcome Barriers Provide Continuing Support EXCI 252 2 Step 2 – ASSESS: Physical Activity, Fitness, & Lifestyle Purpose Select assessmen t options and administer protocols Detailed Objectives Detailed examination of the client’s types and levels of physical activity and sedentary behaviour. Discern the client’s fitness with the help of objective, evidence-based standardized tests. Useful Tools & Protocols  Client Information Sheet (Tool # 10)  Physical Activity & Sedentary Behaviour Questionnaire (PASB-Q; Adult = Tool # 15 & Youth = Tool # 16)  Healthy Sleep Assessment (Tool # 17)  Stages of Change Questionnaire (SOC-Q; Tool # 18)  Anthropometry: Height, Weight, BMI, Waist Circumference  Aerobic tests: mCAFT, Ebbeling Treadmill Walk Test, Rockport 1-Mile Walk Test, or YMCA Cycle Ergometer Test and associated Data Collection Sheets (Tool #s 19, 20, 21, & 22)  Musculoskeletal tests: Grip Strength, Push-ups, Sit & Reach, Vertical Jump, Back Extension, Forearm Plank, One-Leg Stance, and Y Balance Test.  Predicting EXCI 252 1-RM Data Collection Worksheet (Tool 3 # 23) Stages of Change Questionnaire (SOC-Q)  Purpose  To identify a client’s stage of motivational readiness for change.  To identify a client’s current stage of change in the Transtheoretical Model of Behaviour Change.  Allows the QEP to decide appropriate strategies for enhancing the client’s commitment to change.  Refer to Section 3, Behaviour Change, for more information about the Transtheoretical Model of Behaviour Change. EXCI 252 4 Step 3 – ADVISE: Evaluation Report & Discussion  Discuss the assessment results with clients.  Explain the results to the client in clear, non-technical terms.  Explain how regular physical activity, exercise, and reduced sedentary behaviour can improve health, fitness and/or performance for work or recreational sport.  Use the assessment results to help the client understand how physical activity and exercise can help the client address other lifestyle concerns, such as smoking, stress, and sleep. EXCI 252 5 Step 3 – ADVISE: Evaluation Report & Discussion Purpose Discuss assessme nt findings. Detailed Objectives Present & discuss the assessment findings. Tools & Protocols  CSEP-PATH Evaluation Summary Report for Adults (Tool # 27) or Youth (Tool # 28) EXCI 252 6 CSEP-PATH Evaluation Summary Report  Purpose  Used to provide clients with a summary of the results of their physical activity, fitness, and lifestyle assessment in terms of the Health Benefit Ratings (HBRs).  Components  Physical Activity & Sedentary Behaviour Questionnaire (PASB-Q)  Anthropometry Assessment  Aerobic Fitness Assessment  Musculoskeletal Fitness Assessment  Health Benefits Rating Summary EXCI 252 7 Step 4 – AGREE: Devise An Action Plan Purpose Set goals & make plans for action. Detailed Objectives Examine options for realizing the client’s commitment to change. Develop a tailored action plan with SMART goals & tactics. Tools & Protocols  Inventory of Lifestyle Needs & Physical Activity Preferences (Tool # 29)  Goal Setting Worksheet (Tool # 30)  CSEP-PATH Physical Activity and Exercise Prescription Card (Tool # 31)  Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years), Children and Youth (5-17 years), Adults (18-64), and Older Adults (65+) [Tools 38, 39, 40, & 41.]  Canada’s Food Guide (www.canada.ca/foodguide.) EXCI 252 8 Step 4 – AGREE: Devise An Action Plan  Based on the assessment results and discussion with the client, the QEP should have a clear understanding of the client’s  Strengths,  Areas for improvement,  Personal goals, and  Level of commitment to change. EXCI 252 9 Step 4 – AGREE: Devise An Action Plan  What must be present to proceed with the development of an action plan?  A client’s expressed commitment to making a change.  What should be done with clients who are not ready to commit to increasing physical activity at the time of the 1st appointment?  The QEP may consider jumping ahead to Step 5 (Assist) to explore ambivalence and potential barriers to changing physical activity levels.  Best Practices  Know the Client’s Goal  Encourage Realistic Change EXCI 252 10 Step 4 – AGREE: Devise An Action Plan  Encouraging Realistic Change  Emphasize the importance of setting small, achievable goals.  Progress slowly.  Help the client move from “I can’t” (precontemplation) to “I might” (contemplation) to “I will” (preparation) at which point they make a commitment to change & are ready to move into goal setting & action planning. EXCI 252 11 Step 4 – AGREE: Devise An Action Plan  SMART Goal Setting:  Specific, Measurable, Actionable, Relevant & Timed.  Physical Activity or Exercise Program incorporating the following as applicable:  Primary Prescription Principles  Progression, Overload, Specificity, Reversibility, & Individuality.  Aerobic, Resistance, and/or Flexibility Training Prescription  Frequency, Intensity, Time, & Type.  Balance and Stability Training EXCI 252 12 Step 4 – AGREE: Devise An Action Plan  Remember to be ‘Client-Centered.’  Begin small & build on success over time.  To bolster adherence, pay attention to barriers and work with the client to identify strategies for overcoming those barriers in practical ways.  Be wary of the ‘cookie-cutter’ approach to exercise program design. EXCI 252 13 Inventory of Lifestyle Needs & Activity Preferences  Purpose  To help clients identify lifestyle needs that are important to them, and choose activities that will help meet these needs. EXCI 252 14 Goal Setting Worksheet  Purpose  To identify practical, short-term & longer-term goals & specific actions for achieving them.  Stage of Change  Designed to help clients in the preparation stage of the Transtheoretical Model of Behaviour Change (TMBC).  Instructions  Ask clients to complete the form on their own & then discuss their answers with them.  Encourage them to refer to the document from time to time to reconfirm their commitment & to remind themselves of the obstacles & opportunities they felt would affect their efforts. EXCI 252 15 SMART Goal Setting Specific Well-defined clear actions. Measurable Objective & quantifiable so it is known when the goal is achieved. Actionable Based on things the client will do (i.e., not an outcome). Relevant Goals must be important & meaningful to the client. Timed Establish a set deadline that is reasonable given the goal one wishes to achieve. A set deadline indicates a sense of urgency. EXCI 252 16 CSEP-PATH Physical Activity and Exercise Prescription Card  Purpose  Used to summarize the recommendations you are making for each individual client.  Summarizes the physical activity/exercise program. EXCI 252 17 Step 5 – ASSIST: Increase Motivation & Overcome Barriers  What may be needed by clients with low motivation and/or high ambivalence?  Additional support making lifestyle changes including increasing physical activity levels.  What should QEPs do to help clients with low motivation and/or high ambivalence?  Use motivational interviewing skills to address reasons for ambivalence,  Discuss potential barriers, and  Explore strategies to increase motivation and adherence. EXCI 252 18 Step 5 – ASSIST: Increase Motivation & Overcome Barriers Purpose Provide support. Detailed Objectives Tools & Protocols Explore motivation, ambivalence, and/or barriers using the CSEP-PATH tools.  Barriers to Physical Activity (Tool # 32)  Decision Balance Worksheet (Tool # 33)  First Step Planning Worksheet (Tool # 34)  Alternatives for Action Worksheet (Tool # 35) EXCI 252 19 Step 5 – ASSIST: Increase Motivation & Overcome Barriers  Best Practices  Remain Client-Centered  Support Self-Efficacy  Use Reflection to Elicit ‘Change Talk’  Managing the Client’s ‘Sustain Talk’  Address Related Lifestyle Concerns EXCI 252 20 Motivational Cues & Response Strategies STAGE SIGN RESPONSE STRATEGIES Precontempl ation I Acknowledge: I’m hearing you are thinking won’t about it now, but aren’t ready to take action at I can’t this point. Confirm autonomy: I believe the benefits will be worth it. But it’s your call. Re-frame: Anyone who has ever done this started where you are right now. Like them, you have to figure out YOUR reasons to do this. Contemplatio I may n Acknowledge: I can understand why you feel that way. Encourage further consideration: Does your inactivity cause you any problems? Can you imagine it might cause problems in the future? What do you think might be some of the benefits of getting active? What about the challenges? EXCI 252 21 Motivational Cues & Response Strategies STAGE SIGN Preparati I will on RESPONSE STRATEGIES Praise: It’s great you want to try this. You are doing something important for your health. Support planning (goal setting, identifying obstacles and coping strategies): Let’s consider some ways you might add activity into your regular schedule. Are there family or friends who might be able to help you? How could they support you? Action I am Praise and reinforce: Congratulate & facilitate reward for achieving behavioural goals. You should be proud of yourself for getting out for those three planned exercise sessions. EXCI 252 22 Motivational Cues & Response Strategies STAGE SIGN RESPONSE STRATEGIES Maintenan I still Track progress: Refine the prescription & goals ce am as the client progresses. Set new goals to maintain interest in the plan. How would you like to train for a 10K running event? Have you thought about picking up a recreational sport? Discuss reassessment to measure results at some time in the future. EXCI 252 23 Step 5 – ASSIST: Increase Motivation & Overcome Barriers  Support Self-Efficacy  Adopt a positive, strengths-based approach to support the client’s autonomy and self-efficacy for change.  Important for clients in earlier stages of readiness for change and not yet convinced they can maintain a more active lifestyle.  Offer praise for having taken the first step and for having successfully completed the assessment.  Highlight the client’s key strengths, especially any that are evident in the assessment results.  Bolstering the client’s confidence in their own ability to succeed will go a long way in boosting their commitment to getting started. EXCI 252 24 Step 5 – ASSIST: Increase Motivation & Overcome Barriers  Use Reflection to Elicit ‘Change Talk’  A key principle of behaviour change is that the more someone talks about change, the more likely they are to attempt it.  Listen carefully to the client.  Use open-ended questions & reflection.  ‘Change talk’ provides signals of progress towards making commitment. EXCI 252 25 Step 5 – ASSIST: Increase Motivation & Overcome Barriers  Use Reflection to Elicit ‘Change Talk’  Verbal signals of client’s ‘change talk’:  I want to be more active  Desire  I think I can walk to work  Ability  I need to get moving to lose weight to improve my health  Reasons  I am going to start walking regularly  Commitment  Reinforce change talk by linking it to the client's goals. EXCI 252 26 Step 5 – ASSIST: Increase Motivation & Overcome Barriers  Managing the Client’s ‘Sustain Talk’  Sustain talk (or resistance talk) is reflective of a client showing resistance.  Avoid the temptation to ‘set the client straight’ (i.e., often called the ‘righting reflex’) by directly challenging the client.  Instead, use reflection tactics to ‘re-frame’ the point of resistance & encourage the client to explore alternative perspectives. EXCI 252 27 Using Reflection Tactics to Keep Things Moving Forward REFLECTION TYPE WHEN TO USE EXPLANATION & EXAMPLES Mostly to confirm understanding & demonstrate you are listening. Paraphrasing what the client has told you. Reflection on feeling/mea ning Mostly to demonstrate empathy. Powerful way to build rapport & encourage the client to disclose other feelings. Amplified negative reflections Mostly to address Exaggerating the client’s resistance from perspective can help exhaust clients stuck on the negativity. ‘yes, but.’ EXCI 252 28 So, you see no benefit in getting Content reflections If I have this right, your main motivation in coming today is concern about your weight. I sense that you are feeling a bit embarrassed about your weight. Using Reflection Tactics to Keep Things Moving Forward REFLECTION TYPE WHEN TO USE EXPLANATION & EXAMPLES Double-sided Reflections Mostly to acknowledge you heard the client’s reasons for & against change. Another form of paraphrasing. Action reflections Once the client has made a commitment & moves into action planning. Proposing possible solutions to the client’s challenges. Often reflects a concrete step to which the client has already referred. On the one hand you’d like to become more physically active, but you are not willing to give up time with your family to go to a gym. Sounds like you need to find ways to be more active WITH your family such as bicycling together on weekends or walking the dog after dinner on weeknights. EXCI 252 29 Step 5 – ASSIST: Increase Motivation & Overcome Barriers  Address Related Lifestyle Concerns  Some lifestyle concerns may become apparent through conversations with a client during the appraisal.  When appropriate, make a direct connection between physical activity & the particular area of concern.  Areas of concern:      Feeling disconnected from family and friends Poor nutrition choices Smoking Trouble sleeping Stress EXCI 252 30 Step 5 – ASSIST: Increase Motivation & Overcome Barriers  Addressing Commonly Cited Barriers to Physical Activity:  Time  Lack of interest*  Self-confidence*  Self-consciousness  Energy*  Past failed attempt  Fear of injury or re-Injury  Lack of support system  Affordability *Most commonly expressed barriers. EXCI 252 31 Barriers to Physical Activity  Purpose  To identify obstacles or barriers that may be preventing clients from becoming more physically active.  Stage of Change  Designed for clients in the precontemplation & contemplation stages of the TMBC that may have difficulty identifying which obstacles or barriers prevent them from becoming more physically active. EXCI 252 32 Barriers to Physical Activity  Instructions  Ask clients to indicate the level of importance a barrier may have on their situation on a scale of 1-10.  Once a client has identified & ranked the barriers of greatest significance, discuss options for addressing them as part of the client’s action plan. EXCI 252 33 Decision Balance Worksheet  Purpose  Helps clients weigh the possible benefits (gains) and drawbacks (losses) of increasing their level of physical activity.  Stage of Change  Designed for clients in the contemplation or preparation stages of the TMBC. EXCI 252 34 Decision Balance Worksheet  Instructions  Client comes up with their own list of reasons (gains) to make the change, as well as the ‘costs’ (losses) of doing so.  Review the client’s answers weighing the gains & losses to determine whether the gains outweigh the losses.  Then ask the client about what strategies might help to lessen the consequences (losses) identified. EXCI 252 35 First Step Planning Worksheet  Purpose  To discover what the client’s best option is for getting started on the road to greater physical activity, minimizing sedentary behaviour, or getting sufficient sleep.  Stage of Change  Designed for clients in the contemplation stage of the TMBC.  Instructions  Clients choose an activity, then they rate the activity after doing it by adding up their points.  If their total is six or more, they have made a good choice. EXCI 252 36 Alternatives for Action Worksheet  Purpose  To consider the potential benefits & downsides of increasing the level of physical activity and identify specific coping strategies.  Stage of Change  Designed for clients in the precontemplation & contemplation stages of the TMBC. EXCI 252 37 Alternatives for Action Worksheet  Instructions:  Generate a list of alternatives that will achieve a client’s desired objective.  Once the alternatives are listed, have the client generate a list of advantages & disadvantages for each one.  Based on the list, have the client choose the best alternative (or combination of alternatives) & develop coping strategies to address the disadvantages. EXCI 252 38 Step 6 – ARRANGE: Providing Continuing Support  Conclusion of the Initial Meeting  Agree to a follow-up plan.  Clients will likely require  ongoing motivational & technical support as they strive to implement their physical activity, fitness, and/or lifestyle action plan.  The QEP needs to encourage  clients to keep track of their efforts.  clients to return at a mutually agreed time to discuss their progress and identify adjustments to address issues or progress. EXCI 252 39 Step 6 – ARRANGE: Providing Continuing Support Purpose Meeting wrapup. Detailed Objectives Tools & Protocols Establish timing & format of follow-up & continuing support.  Weekly Physical Activity Planner & Log (Tool # 36)  Relapse Planning Worksheet (Tool # 37) EXCI 252 40 Step 6 – ARRANGE: Providing Continuing Support  Best Practices  Encourage Clients to Plan & Track Their Physical Activity  Encourage Clients to Share How They Feel About Their Efforts  Establish a Follow-Up Schedule  Schedule a Resistance Training Demonstration  Relapse Planning  Maintain Regular Contact with Clients EXCI 252 41 Step 6 – ARRANGE: Providing Continuing Support  Encourage Clients to Plan & Track Their Physical Activity  Evidence indicates that keeping track of physical activity is an effective way to promote adherence because it holds clients accountable to themselves for following through on the plans they have set.  Encourage clients to use the Weekly Physical Activity Planner & Log to plan when they will make time for the physical activity they have committed to, & then to track their results against those plans. EXCI 252 42 Step 6 – ARRANGE: Providing Continuing Support  Encourage Clients to Share How They Feel About Their Efforts  Regular physical activity can elicit an improved sense of physical awareness.  It is important to provide clients an opportunity to celebrate the good feelings associated with regular physical activity to create momentum for continued progress. EXCI 252 43 Step 6 – ARRANGE: Providing Continuing Support  Establish a Follow-Up Schedule  Facilitates adherence and helpful adjustment to the action plan & physical activity prescription.  May be especially important for clients who have been inactive and striving to make significant change in their behavioural patterns. EXCI 252 44 Step 6 – ARRANGE: Providing Continuing Support  Schedule a Resistance Training Demonstration  Clients may not have the requisite knowledge & experience to perform the movements in a safe & effective manner.  Having the client perform the exercises will provide the opportunity to correct improper technique & offer further guidance about proper posture, breathing, & the importance of controlled movements. EXCI 252 45 Step 6 – ARRANGE: Providing Continuing Support  Relapse Planning  Once clients have begun to implement their physical activity action plan, it will be important to anticipate & plan for relapse.  Evidence indicates that relapses are likely to occur.  Use the CSEP-PATH Relapse Planning Worksheet to facilitate a discussion of the factors that may derail a client’s efforts and strategies that may help keep the client on track. EXCI 252 46 Step 6 – ARRANGE: Providing Continuing Support  Maintain Regular Contact with Clients  Effective exercise professionals will look for ways to continue to engage clients not only to monitor their progress & provide words of encouragement, but also to educate clients on key areas of interest. EXCI 252 47 Weekly Physical Activity Planner & Log  Purpose  Intended to help clients plan & keep track of their physical activity, & to facilitate review with the trainer each week or as agreed upon between the trainer & client.  Keeping track of physical activity promotes adherence. EXCI 252 48 Relapse Planning Worksheet  Purpose  Used to facilitate a discussion of things that might derail the efforts of clients & what strategies might help them remain on track.  Handled appropriately, relapses can be an important part of the learning process leading to selfefficacy. EXCI 252 49