Step 5: ASSIST

Question 1

What is the goal of step 5 AGREE??

Answer 1

INCREASE MOTIVATION AND OVERCOME BARRIERS.
- Clients with low motivation and/or high ambivalence may need additional support making lifestyle changes including increasing physical activity levels. Qualified exercise professionals should use motivational interviewing skills to address reasons for ambivalence, discuss potential barriers, and explore strategies to increase motivation and adherence.

Question 2

To-do list for step 5 AGREE?

Answer 2

Explore low motivation, high ambivalence, and/or potential barriers using appropriate CSEP-PATH tools.

Question 3

What are the Tools/ documents used in step 5?

Answer 3

Barriers to Physical Activity
Decision Balance Worksheet
First Step Planning Worksheet
Alternatives for Action Worksheet

Question 4

what is the sign for pre-contemplation and how can we address this?

Answer 4

Sign; I won’t, I can’t.
Response:
Acknowledge: I’m hearing you are thinking about it now, but aren’t ready to take action at this point.

Confirm autonomy: The evidence shows 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.

Question 5

What are the signs for the contemplation stage and how can we address this?

Answer 5

Sign: I may.
Response:
Acknowledge: I can appreciate 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?

Question 6

What are the signs for the preparation stage and how can we address this?

Answer 6

Sign: I will.
Response:
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?

Question 7

What are the signs for the action stage and how can we address this?

Answer 7

Sign: I am.
Response:
Praise and reinforce: Congratulate and facilitate reward for achieving behavioral goals. You should be proud of yourself for getting out for those three planned exercise sessions.

Question 8

What are the signs for the maintenance stage and how can we address this?

Answer 8

Sign: I still am.
Track progress: Refine the prescription and goals 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.

Question 9

True or False? the more someone talks about change, the more likely they are to attempt it.

Answer 9

True.

Question 10

Change talk gives a lot of insight on the client, what verbal cues should we look out for?

Answer 10

I want to be more active. (Desire)
I think I can walk to work. (Ability)
I need to get moving to lose weight and improve my health. (Reasons)
I am going to start walking regularly. (Commitment)

Question 11

Why should we use content reflections?

Answer 11

• Mostly to confirm understanding and demonstrate you are listening.
• Paraphrasing what the client has told you. If I have this right, your main motivation in coming today is concern about your weight.

Question 12

Why should we use reflection on meaning/feelings?

Answer 12

• Mostly to demonstrate empathy.
• acknowledging how something makes the client feel is a powerful way to build rapport and encourage the client to disclose other feelings. I sense that you are feeling a bit embarrassed about your weight.

Question 13

Why should we use amplified negative reflections?

Answer 13

• Mostly to address resistance from clients stuck on the ‘yes, but’ stage.
• Exaggerating the client’s perspective can help exhaust negativity. So, you see no benefit in getting more physically active?

Question 14

why should we use double-sided reflections?

Answer 14

• Mostly to acknowledge you heard the client’s reasons for and against change.
• Another form of paraphrasing. 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.

Question 15

Why should we use action reflections?

Answer 15

• Once the client has made a commitment and moves into action planning.
• Proposing possible solutions to the client’s challenges. Often reflects a concrete step to which the client has already referred. 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.

Question 16

Why should we pay close attention to resistance talk?

Answer 16

Sustain talk (or resistance talk) is a signal that requires special attention. If a client shows resistance, it is important to 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 and encourage the client to explore alternative perspectives.

Question 17

What are the common barriers to change?

Answer 17

1. Time; I don’t have enough time for physical activity
2. Lack of interest; I think physical activity is boring.
3. self-consciousness; I’m self-conscious about how I look.
4. energy; I’m too tired after work.
5. passed failed attempt; I’ve tried in the past and failed.
6. fear of injury/ reinjury; I’m afraid I’ll hurt myself.
7. lack of support system; My family doesn’t support my efforts.
8. affordability; I can’t afford health club fees.

Question 18

How can we combat the time barrier?

Answer 18

Let them know that even 10-minute bouts can be beneficial.

Question 19

How can we combat the lack of interest barrier?

Answer 19

let them know that repetition can be boring but we can make it less boring for them by finding things they enjoy and rotating among several different kinds of activity.

Question 20

How can we combat the self-consciousness barrier?

Answer 20

let them know that they are not alone. Just keep reminding them that they are doing a great thing for their health. And remember that as they increase their physical activity, they are likely to feel less self-conscious. If they are uncomfortable being active around others, perhaps walking or doing home-based activity would be a good place to start.

Question 21

How can we combat the energy barrier?

Answer 21

Let them know that physical activity will make them feel more energized. that even taking small steps like walking when they are the most energized is beneficial.

Question 22

How can we combat the passed failed attempt barrier?

Answer 22

• encourage them to not give-up and evaluate what went wrong last time.
• ask them to pace themselves.
• help them set realistic goals.
• remind them why they started.

Question 23

How can we combat the injury barrier?

Answer 23

Let them know that physical activity is very safe for most people. We can take it slow and add new activities to your routine as your body adjusts. Low impact activities like cycling can reduce your risk of injury and may even strengthen your knee.

Question 24

How do we combat the lack of support system barrier?

Answer 24

• suggest family-oriented activities that can be done together.
• suggest that they teach their family about the benefits of exercise.

Question 25

How do we combat the affordability barrier?

Answer 25

• let them know that exercise can be done from home.
• cheap equipment can be bought at the store for a price of less than one month at the gym.
• give examples of activities they can do from home.

Question 26

What is the barriers to physical activity tool?

Answer 26

• The Barriers to Physical Activity Tool is designed for clients in the pre-contemplative and contemplative stage of change who may have difficulty identifying which obstacles or barriers prevent them from becoming more physically active. Ask the client to consider what things may prevent them from engaging in regular physical activity. Once the client has identified and ranked the barriers of greatest significance, discuss options for addressing them as part of the client’s action plan.

Question 27

What is the decision balance worksheet?

Answer 27

The Decision Balance Worksheet is designed for clients in the contemplative or preparation stage of change. It may help them weigh the possible benefits (gains) and drawbacks (losses) of increasing their level of physical activity. The goal is to have the client come up with their own list of reasons (gains) to make the change, as well as the costs (losses) of doing so. Once the client has identified and ranked the barriers of greatest significance, discuss options for addressing them as part of the client’s action plan.

Question 28

What is the first step planning worksheet?

Answer 28

The First Steps Planning Worksheet is designed for clients in the contemplation phase. Asking such clients to set small obtainable goals can deliver the first taste of success to build upon. Ask the client to complete this exercise to discover what their best option is for getting started on the road to greater physical activity. Have them rate the activity they chose after they have done it. Is it really something they like and are able to keep up, given their lifestyle? Have them add up their points. If their total is six or more, they have made a good choice.

Question 29

What is the alternatives for action worksheet?

Answer 29

The Alternatives for Action Tool is designed to help pre-contemplative and contemplative stage of change clients consider the potential benefits and downsides of increasing their level of physical activity and identify specific coping strategies. In collaboration with the client, generate a list of alternatives that will achieve their desired objective. Once the alternatives are listed, have the client generate a list of advantages and disadvantages for each. Based on the list, have the client choose the best alternative (or combination of alternatives) and develop coping strategies to address the disadvantages.

Question 30

What are the three main reasons which people engage in physical activity?

Answer 30

1. Health benefits.
2. enjoyment.
3. to express or improve self-image

Question 31

What health benefits would cause someone to want to become more physically active?

Answer 31

This can be a strong motivator for initiating a plan to increase physical activity. Health reasons may be evident in client comments like “I want to get into shape” and “I want to feel better.” Specific health reasons may also apply (e.g., increase stamina, improve strength, lose weight, manage stress, or reduced the risk of certain diseases).

Question 32

Why is enjoyment important in getting someone more physically active?

Answer 32

A person’s success in sticking with a more active lifestyle over time will depend on the degree to which the individual enjoys the activity and/or its results. Finding out what clients like to do can therefore effectively shape the types of activity recommended.

Question 33

Why would expressing or improving self-image make someone become more active?

Answer 33

Involvement in physical activity can serve as a means of self-expression (e.g., dancers, skaters). It can also spark a specific desire for change (e.g., the desire to lose body fat or have a more muscular body).