The New Paradigm Shift in Exercise Guidance… and Why it Matters!

The Affordable Care Act has led to an emphasis on prevention in keeping people healthy.
The Affordable Care Act has resulted in an increased emphasis on disease prevention in keeping our nation healthy.

The following post was contributed by Melinda Huffman, BSN, MSN, CCNS, CHC, co-founder of The National Society of Health Coaches.

While there is a great deal of negativity surrounding the implementation of the Affordable Care Act, there is a positive side to its ramifications… that being Prevention.

In an informal review of a sample of full-time employees whose insurance companies’ coverage has changed, it’s clear that going forward, prevention will be the key to optimal self-management of health, of chronic conditions, and keeping costs down.

Preventative measures such as vaccinations and periodic diagnostic procedures are only a small part of the overall picture. Prevention will focus largely on health behavior change!


It’s not easy to change health behavior, especially those related to exercise and diet. As healthcare providers, we know that individuals (including ourselves!) have difficulty making these changes. But the good news is there is much we can do with the right skill set to guide our patients and clients through this journey!

How do we start? As providers, we must realize that our traditional approach of teaching individuals what to do or telling them what we think they should do (even when based on best practice interventions) hasn’t worked very well. One only has to consider the increasing incidence of obesity and diabetes to bring this notion to light.

Or in my own case as a cardiovascular clinical nurse specialist, having high cholesterol and the knowledge to manage it was not what motivated me to get it under control. The motivator for me to change my exercise level and dietary habits had more to do with the social aspects of my life instead of my knowledge about the condition and its downside. Such it is with health behavior change. Prevention will be more about what motivates individuals to increase their physical activity and change other behaviors than the knowledge they may or may not have about it.

Dr. Susan Butterworth of Oregon Health and Sciences University conducted a survey that revealed the most common reasons why people don’t change behavior. These were:

  • Their values don’t support it.
  • They don’t think it’s important.
  • They don’t think they can.
  • They haven’t worked through their ambivalence.
  • They aren’t ready for it.
  • They don’t have a good plan.
  • They don’t have adequate social support.

Notice that “lack of knowledge” isn’t listed… Consider my own case above…. Knowledge wasn’t my key motivator. It was other factors related to my personal life that made the difference.

Miller and Rollnick (2013) suggest that people have difficulty with changing behavior, not because they don’t understand the seriousness of their situation, but because they have conflicting feelings about it. Consider these examples, “I would exercise, but I work long hours, and I’m just too tired when I get home”. “I know that I should walk 150 minutes per week, but I just can’t find the time.” The important message for providers is that we must be willing to make the paradigm shift from our traditional approach to that of partnering and active engagement to achieve the outcome(s) together, rather than “telling the patient” what we think he must do and expecting him to comply.

Dr. William Miller (2008) originator of MI and co-author of Motivational Interviewing in Healthcare: Helping Patients Change Behavior, states, “What we say, and how we say it can make a difference in whether behavior change happens.” Over 300 studies in MI over 30 years attest to its effectiveness.

A Taste of Evidence-based Health Coaching (EBHC)® with Motivational Interviewing

Four Beginner Tips for the Patient/Provider Partnership:

1. Skilled Listening:

Providers should do less of the talking, and more listening. Are you a good listener? Access NSHC’s Listening Self-Assessment at this quick link to find out!  http://www.nshcoa.com/pdf/listen.pdf

2. Guiding the Agenda:

Ask the individual what is most concerning to them about the patient’s changing his/her exercise habits. Consider all concerns mentioned. Drill down to help him/her discover the greatest motivator for change.

3. Addressing Ambivalence (inner conflict that maintains the status quo):

Have the patient list the reasons he hasn’t increased or maintained his level of physical activity, and the reasons the behavior needs to change. Have the patient decide on those behaviors that are most meaningful to him.

Motivational Interviewing Adapted for Brief Encounters:

(Use Open-ended questions/statements and Empathy) *Note: Don’t interrogate; but explore.

Open-ended Questions (Examples)

  • Tell me about what hinders you from increasing your physical activity.
  • What will regular physical activity do for you personally?
  • How will it affect your work or life?

4. Giving Information:

Most often, we as providers give information we think the patient/client needs to hear. Finding out what is already known and providing information based on this is a way to show respect for what is known and empowers the client in the process. Motivational Interviewing calls this approach: Elicit-Provide-Elicit. (Rollnick, Mason & Bulter, 1999)

While the healthcare provider may be the expert in clinical interventions for chronic conditions or in recommendations to achieve optimal health and wellness, the patient/client is the expert about “himself”! When the two collaborate as partners in health, behavior change can happen, improving outcomes and decreasing overall costs in the process! Training in Evidence-based Health Coaching(EBHC)® with Motivational Interviewing helps providers achieve this end!

Go to this quick link to find out more about NSHC’s convenient self-study program: http://www.nshcoa.com/site/healthcoacheducationcertification.php