Understanding the 5 Stages of Change to Improve Healthy Behaviors

Examining the Stages of Change

Understanding some basic concepts about the process of change can be helpful to keep in mind as we move our patients/clients forward on their path to discovering better health.

Learning to recognize where our clients are in this process can not only help to move them forward from one stage to the next, but also help both you and the client learn how to handle any “backslides” that are bound to occur along the way.

There is more than one theory on how health behavior change occurs.  The Transtheoretical Model of Behavior Change developed by James Prochaska and colleagues which began in 1977 is a popular model currently used in many health and wellness practices. Prochaska’s book, Changing for Good along with research using this framework have made it a dominant model used for health behavior change.

What are the 5 Stages of Change?

1. 1. PRECOMTEMPLATION –the patient or client has no interest in change– they may state I’m not even thinking about it, “I Won’t” or “I Can’t”
2. 2. CONTEMPLATION – Statements such as “I May” or “I’ve thought about – getting more active, improving my eating habits or changing other health behaviors but haven’t done so yet, indicate they are in the contemplation stage.   They are ambivalent about changing.   During this stage, patients assess barriers (e.g., time, expense, hassle, fear, “I know I need to but …”).   They are sizing up, or contemplating the barriers versus the benefits.  People can stay in the contemplation stage for months to even years!
3. PREPARATION STAGE – If the patient has been increasing their activity level, exercise, or eating better but it has been inconsistent, they are in the “I Will” or Preparation Stage.  During the preparation stage, patients are starting to make a specific change. They may experiment with small actions or changes as their determination to change that specific behavior increases.
4. ACTION STAGE – If the patient has been exercising, eating better, or engaging in other activities to improve your overall health status consistently, but for less than 6 month.  They are in the “I AM” or Action Stage.  This stage can last up to 6 months while they are establishing your new habit
5. MAINTAINANCE STAGE – If the patient/client has been engaging in their new healthy activity for more than 6 months, they are in the Maintenance Stage, or “I Still Am!”. It is in this stage that the new behavior change has become a habit.  They are more confident in their ability to maintain the new behavior

Early in my career as a physical therapist, I struggled trying to figure out why some patients progressed more easily than others.  We all know those patients or clients that we love to work with – they listen to you, are more compliant with their treatment or rehabilitation program, and seem to get better with less difficulty.

Then there are the ones that I asked “what on earth can I do to help you, why aren’t you doing what you need to get better?  Learning to incorporate the Stages of Change into practice was instrumental in determining how to approach that particular individual, what information might be best for them at that particular time, and what might be the best intervention strategy for them to help move them forward along the spectrum of change.

Now that you know the basics of the stages of behavior change, in the next post, we’ll discuss how to incorporate them into your practice to help your clients achieve a healthier lifestyle.

This is the second in our series on Leading your Clients to Good Health.  If you missed the first one, go here:  http://www.healthpathtoday.com/?p=504

This Weeks Health Bytes

• Today’s Heatlh Tip: 5 tips to losing 5 pounds by summer http://today.msnbc.msn.com/id/43101327/ns/today-today_health/

• Anti-inflammatory pain killers are known to increase heart risks, and new findings from more than 83,000 people suggest that even a couple of days of treatment can be dangerous in people with a history of heart problems.  Read more:   http://www.msnbc.msn.com/id/43083991/ns/health-heart_health/

• McDonald’s Stockholders reject obesity proposal OAK BROOK, Illinois (Reuters) – McDonald’s Corp spurned calls to assess the impact of its food on childhood obesity, and said its trademark clown Ronald McDonald would be hawking Happy Meals to kids for years to come……….Read more: http://www.reuters.com/news/health

• Foods with benefiits, or so they say Labels proclaiming health benefits of foods almost shout out in the aisles of supermarkets. But shoppers, and regulators, have their hands full trying to sort it all out……Read more http://www.nytimes.com/pages/health/nutrition/index.html

• CDC Links Obesity, Arthritis, and Lack of Exercise Obese adults with arthritis are 44% more likely to be physically inactive than obese people who do not suffer from the painful disease that causes inflammation and stiffness of the joints, the CDC says in a new report…….Read more  http://arthritis.webmd.com/news/20110519/cdc-links-obesity-arthritis-and-lack-of-exercise

What’s your guess?

No…..it’s not a supplement, new fad diet, work out ’til you drop exercise program or some crazy device “proven” to shed pounds while lying on the couch………..

The answer:  WATER.   Although some people are probably aware of this already, water is still very under-rated in many health, diet, and exercise programs.  Folklore and personal experience have suggested that water can aid in weight loss but there has been little scientific evidence to show it until now.

A recent study by Brenda Davy, PhD, associate professor in nutrition from Virginia Tech  showed that drinking 2, 8 ounce glasses of water before a meal can help people lose more weight than those who did not.

Her study included 48 adults between age 55 and 75; all participants also ate a low-calorie diet throughout the study.

After 12 weeks, water drinkers lost about 15.5 pounds, compared to non-water-drinking dieters, who lost only 11 pounds.  Better yet, was that those water drinkers who continued for a 12 month period, not only maintained the weight loss, but also lost additional weight.  The reason is simple – drinking water makes you feel more full, therefore tending to eat less and it has no calories.

Davy recommends that women drink up to 9 cups of fluids per day while men should consume up to 13 cups.  People should not substitute with diet drinks or other liquids that contain calories.

So, it’s a “no brainer”……….encourage your friends, family, or clients to drink more water – for all of it’s health benefits!

DRINK UP!

This article on protein intake seemed like a perfect follow up to my last post so I thought I would share it with you.

My partners over at Prograde love helping you make your life easier. And this new article they just released is further proof of that.

If you’re looking for easy advice on how to lose weight faster, than take a look at this:

http://healthpath.getprograde.com/top-4-reasons-you-need-protein.html

Yours in health,

Christine

PS – You don’t have to lose weight faster, but when it’s this easy…

http://healthpath.getprograde.com/top-4-reasons-you-need-protein.html

The question? Researchers and dieters alike have debated which diet is better for weight loss – low fat or low carb? Dieters on each side would swear by the one that they chose.  Now researchers have some answers:

The Annals of Internal Medicine reported the outcomes in a recent 2 year study.  Weight at the end of 2 years was the primary outcome. Secondary measures included weight at 3, 6, and 12 months and cholesterol (serum lipid concentrations), blood pressure, urinary ketones, symptoms, bone mineral density, and body composition. Both diets improved systolic blood pressure, triglyceride levels and low density lipid cholesterol level.  However, the low carb diet showed greater reductions in many of these measures at 6 months.  The low-carbohydrate diet group also had greater increases in high-density lipoprotein (good) cholesterol levels at all time points, approximating a 23% increase at 2 years.

The results? It seems that weight loss was equally effective at the 2 year mark.  Participants lost an average of 24 pounds after 1 year and at 2 years, they were able to keep off 15 of those pounds.

The Conclusion: You can achieve successful weight loss with either a low-fat or low-carbohydrate diet when coupled with behavioral treatment. However, if you are wanting to improve your overall heart health, the low carb diet was associated with more favorable changes in cardiovascular disease risk factors at 2 years.

One difference in this study compared to others that looked at diet differences was the addition of a comprehensive lifestyle modification program. More on this to come………………….

Citrus Basil Salmon

2 Tbsp. basil olive oil
4 Tbsp each fresh lemon and lime juice
1½ tsp. lemon zest
1 tsp salt
½ tsp. Freshly ground black pepper
4–7 skinless salmon fillets

Directions:

• In a large shallow dish, whisk together 1 Tbsp of the basil oil, 3 Tbsp of the lemon juice, 3 Tbsp of the lime Juice, ½ tsp lemon zest, ½ tsp of the lime zest, ½ tsp salt, and ¼ tsp of the pepper.
• Add Salmon to dish, turning to coat fillets. Spray a large nonstick skillet with olive oil cooking spray.  Heat over medium-high heat. Add salmon, rounded side down, and cook 4 minutes. Turn fillets and cook 3 to 4 minutes for medium-rare or longer for desired doneness.
• Remove from heat. Spoon the remaining 1 Tbsp basil oil and the remaining 1 Tbsp each lemon juice and lime juice over fillets, dividing evenly.
• Sprinkle fillets with remaining 1 tsp each lemon and lime zest, ½ tsp salt, and ¼ tsp pepper.

Voilà! You have a great easy, heart healthy recipe rich in omega 3 that is delicious too.  This recipe came from my partners at Prograde.  You can get this and many yummy  recipes free – just sign up for them in the box to the right!