The stages of change - where are you?

For a person to successfully adopt a healthier behavior -- whether it's to exercise, lose weight, or stop smoking -- it may not be as simple as just deciding to do it. Behavior change expert James Prochaska and his colleagues developed a theory, which has been supported by numerous studies, showing that people cycle through a variety of stages before a new behavior is successfully adopted over the long term.

It may help you to understand how this works. As you read the description of each stage -- specifically as it relates to exercise -- you may find yourself nodding and saying to yourself, "Yes, that's me!"

Stage 1: Pre-Contemplation

People at this stage have no plans or desire to exercise. They aren't even considering exercising. People at this stage are generally unaware of the specific benefits that exercise can bring -- exercise may seem more like a hassle than something worth doing. Or, they may simply have "failed" in the past and have given up.

There's no point in talking about how to start an exercise program if you are at this stage. Instead, it is important to think about why exercise might be good for you personally -- by helping you to lose weight, feel better, have more confidence, live longer, sleep better, or have less stress. The benefits must be identified before a person will consider exercise.

If you are at this stage, a good activity is to ask four friends or family members why they exercise. That may unveil real-life benefits and inspire enough interest to compel you to take the next step.

Stage 2: Contemplation

A person at this stage is thinking, "I think I should probably exercise, but I need help getting started." People at this stage know that exercise is good for them, but it seems like a daunting task or they don't think they can pull it off. Some may have tried and "failed" in the past, but they are still receptive to another go-round.

It's important for people at this stage to consider some of the truths and falsehoods of exercise. For example, it is helpful to know that there are many forms of physical activity to select from, and that you can do your exercising in small chunks. It is not true that exercise has to be painful, or that you either succeed or fail. There is no such thing as "failure" -- people become more or less active at different stages of their lives, and it is never too late to get moving again. And people at this stage should find assurance that an exercise plan can be very simple.

If you are at this stage, a good activity is to write down (brainstorm) all your potential roadblocks -- the things that you believe make exercise difficult -- and to learn strategies for overcoming or side-stepping those hurdles. Many ideas are available on the Internet.

People at this stage might benefit from making a pledge, contract, or other commitment that they are going to get more active in the near future.

Prochaska and his colleagues write that people in this stage are "aware of the pros of changing but are also acutely aware of the cons. This balance between the costs and benefits of changing can produce profound ambivalence that can keep people stuck in this stage for long periods of time. We often characterize this phenomenon as chronic contemplation or behavioral procrastination."

Thus, the goal is to get un-stuck by identifying the roadblocks, ways to overcome these hurdles, and making a commitment.

Stage 3: Preparation

These folks are primed and motivated. They are ready to give exercise a try. The goal of this stage is to create a specific action plan that takes all factors into account, so that the "launch" is successful.

People at this stage need to know how much they should be exercising, their target heart rate, and the types of exercises. They should explore the different kinds of exercises and decide on which ones to try. At this stage, they'll evaluate exercise machines and health plans, pick the proper clothing or accessories, and consult a physician if necessary. And they need to think about how they are going to fit their exercise plans into their daily and weekly schedule.

If you are at this stage, you should also consider some backup plans -- what to do if it rains, or if you don't feel like exercising. That way you are prepared to overcome that hurdle when it happens. And you should be aware of what to realistically anticipate at the beginning (for example, you should understand that weight loss takes time, but the health benefits of exercise begin immediately).

Stage 4: Action!

People at this stage have just started exercising. This stage is where the most behavior change occurs -- these folks have started to exercise but it is not yet a long-term, ingrained habit. Prochaska notes that this stage requires significant commitment and energy.

If you are at this stage, keep talking to friends and family for inspiration. Review your backup plans. Reward yourself for small achievements. And give yourself notes and reminders to exercise. If you can find a friend to exercise with, that can be a huge support as you get through this stage. You want to build and maintain momentum, because it gets easier once it is a habit!

Stage 5: Maintenance

The folks at this stage have been exercising at least 6 months. At this point, exercising has started to become a habit. The goal here is to prevent relapse.

If you are at this stage, identify ways that you can fine-tune your program. Continue to identify roadblocks and improve your backup plans. Think about what you have found most enjoyable about exercising. What benefits have you gained? Keep reminding yourself of these perks.

If challenging yourself was part of your initial motivation, set new goals and give yourself new challenges. If you risk getting bored with your routine, find ways to vary it. Or maybe you have found a comfortable routine that you enjoy -- if it's working, great! Then no need to change it.

You might want to read or learn more about your method of exercising and develop a deeper level of understanding about it. Soon you'll be a pro!

Let's do it again

One point about the theory is that people do not proceed from one stage to another in a simple, step-by-step fashion. They actually cycle or spiral back and forth, so that they may move from stage 1 to 2 to 3, and then back to 2 again. They may stay in maintenance mode for years and then fall back to stage 2.

Remember that this is normal -- if you tried exercising in the past and didn't stick with it, don't consider yourself a failure. Just know that it's time to try again!

Revision

Last reviewed 6/28/2011 by Jeffrey Heit, MD, Internist with special emphasis on preventive health, fitness and nutrition, Philadelphia VA Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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