The most important consideration in setting exercise goals is to include the client in the process. You may have a wealth of information about your clients, such as body composition data, fitness test scores, and lipid values, as well as knowledge about and experience with healthful and prudent goals, but if you simply inform them of their new goals during a consultation, they may not take them to heart. A better strategy is to lead your clients into discovering the goals they should set for themselves. Always maintain a positive and encouraging attitude that helps your clients understand what would be appropriate goals, and be sufficiently open-minded to see when clients are not interested in the goals you believe are appropriate.
Lay out the current situation to the client: "Your aerobic capacity is such-and-such, which for your age and sex is a little below average. More important, it places you at a higher risk for heart disease and means that you can’t enjoy many recreational activities." Suggest what would be appropriate and attainable goals: "Fortunately, you can make some real progress in this area with the right exercise program. If you put the effort into it, we could help you to reach the above-average category in just a few months. That would significantly reduce your risk of heart disease and give you the capacity to enjoy an afternoon of tennis without feeling exhausted afterward. On the other hand, a more modest program would at least allow you to reach the average category and help you maintain a reasonable level of fitness for the coming years." At this point you are in a position to ask the client to set the goal: "What would you like to accomplish? Where would you like to be a year from now?"
Following are other important factors to consider in goal setting:
1. Goals should be challenging but attainable.
2. Clients should set long-term and short-term goals.
3. Goals should be highly specific and practical.
4. Clients should enlist social support to help them reach their goals.
Goals should be challenging but attainable. Don’t fall into the pattern of expecting little progress from a client just because in your experience many clients don’t make dramatic improvements. Dramatic improvements are indeed possible, and you need to project confidence that the client can make great changes. Ask clients to think about how they would really like to be a year or two from now. Lose 100 lb (45 kg) and look fit and trim? Lower total cholesterol from 300 to well under 200 mg . dl-1? Improve aerobic capacity from couch potato status to marathon finisher? All of these are very achievable for most people. Give your clients the motivation to reach for their dreams. However, changes like these do not happen overnight. If a client announces, "I’ve never run before and I want to run a marathon next month," your response can be, "Great, but let’s aim for next year." Some clients may have unrealistic goals. To a client who says, "I want to be national champion in my sport someday," you can respond, "You’ve been competing in your sport for several years and are still at a regional level; we can help you improve, but your aerobic power [or muscle strength or whatever] isn’t likely to reach elite levels."
Lofty goals for the future are admirable, provided they are also realistic, but what will the client accomplish in the next week or month? Help clients break down long-term goals into short-term, manageable segments. This provides a framework for setting workout plans and evaluating progress. It also provides frequent reinforcement as clients attain intermediate goals. A desire to lose 100 lb (45 kg) in the next two years can be lost if the person sees no progress in the next two weeks.
Goals to improve fitness, lower cholesterol, or lose weight are appropriate as a starting point. But such general goals are not meaningful in a practical sense. Goals must be translated into a highly specific, personalized plan of action. Consider a goal to lower cholesterol by 50 points through a decrease in dietary fat intake. What specific new foods is the client committing to eating? Drinking skim milk instead of whole milk, eating fish instead of red meat, and using olive oil instead of saturated and hydrogenated fats? The client needs goals associated with adopting new behaviors, not just numbers from a blood test. Or consider a goal to improve aerobic capacity from the average to the above-average category. This goal needs to be expressed in terms of behavior change, in association with a detailed exercise prescription. For example, the client may commit to walking briskly for 20 to 30 minutes four times a week. When, exactly, will she do this walking? Ask her to verbalize the days of the week and the times of day she will walk. Write it down as part of the exercise prescription. Of course, some flexibility is needed in putting these changes into action, but obtaining a clear commitment from the client for specific behaviors, and not just outcomes, makes the goal more concrete and more likely to be accomplished.
Social support is a key element to successful behavior change. Humans are social animals, and much of human behavior is based on seeking the approval of others. If family members or coworkers scoff at clients’ new behaviors, it will be much harder for them to achieve their goals. Try to turn clients’ desire for approval to their advantage: Involve family members in the program; run team contests at work sites; enlist partners in a buddy system; and target highly visible and respected people for programming, such as company CEOs. Tapping into the power of social support is an important ingredient in helping clients to achieve their goals.
This is an excerpt from Exercise Prescription, Second Edition.