Lesson Plan—Coaching Session #7

Staying Healthy Through Education and Prevention (STEP)

Barriers to Physical Activity and the Art of Problem Solving

Introduction

This session introduces barriers and lapses and calls attention to the ways in which they can affect one's ability to exercise regularly. The session provides definitions and examples of barriers and lapses and asks participants to discuss examples from their own experiences. The Take-Home Challenge encourages participants to (1) think about barriers they encounter and the countermeasures they can employ to overcome barriers and (2) look carefully at certain aspects of their exercise patterns in the coming week.

Preparation

  • Staff must be familiar with:
    • Content of Session 6, including
      • Positive and negative self-talk.
      • The STEP physical activity program.
      • How and why to record activity in the physical activity log.
      • Session 6 Take-Home Challenge.
    • The definitions of barrier and lapse.
    • How barriers and lapses can affect participants' exercise behaviors.
  • Print/copy in-class handouts and the Session 7 Take-Home Challenge.

Session Objectives

Participants will be asked to:

  • Review content of Session 6.
  • Reiterate goals of the STEP program.
  • Define and discuss barriers and lapses.
  • Increase awareness of personal barriers and review problem-solving skills to prevent lapses in the STEP program.

Session Outline

  1. Greeting/Review
  2. Barriers and Lapses
  3. Personal Experiences and Problem-Solving Strategies
  4. Take-Home Challenge and Wrap-Up

Session Content and Sample Scripts

I. Greeting/Review

  • Greet participants.
  • Review Content of Session 6.
  • Review of Session 6 Take-Home Challenge.
  • Positive and negative self-talk.
  • Relationship of positive self-talk to engagement in regular physical activity.
  • Importance of recording physical activity in the log.
  • Reiteration of STEP program goals and distinction between walking time and strength training time.

SCRIPT:

Last week we challenged ourselves to practice catching negative thoughts and changing them into positive thoughts. Let's jump right in. [Encourage discussion.]

What negative thoughts did you have regarding exercise in the past week?
How did you modify your thoughts to be more positive? Or how could you modify them?
What did you write down for your four positive thoughts?
Did you post the positive thoughts somewhere in your house to remind you of them?
How did recognizing negative thoughts and bolstering your positive thoughts help you with your physical activity?

I'm hearing that there is a very strong relationship between your thoughts and your exercise behaviors. The more positive your thoughts are, the more motivated you are to exercise, and the more negative your thoughts are, the more difficult it is to follow through on your exercise goals. This really is such an important skill, I'd like to spend a few more minutes talking through your experiences and making sure you've all mastered this skill.

Who found this Take-Home Challenge difficult and what was the hardest part? [Encourage discussion.] If talking back to your negative thoughts was hard, this could be a good time to get one of your exercise buddies involved. Since they've been in class, they understand the concept of positive and negative self-talk. Give them a call if you're feeling unmotivated; ask them to remind you about talking back to negative thoughts, or check in about completing your worksheets. We're all in this together, so let's remember to support each other in and outside of class.

Along the same lines, I want to encourage you to keep using your exercise logs. If you've been staying on top of it—great job! If you've fallen off the wagon, that's okay. It's a good time to pick it up again. At this point in the program, we're asking you to monitor your feelings, your walking, your strength training minutes, your RPE� How in the world could anyone keep track of all that information without writing it down? Create that record, that hard copy so you can look back whenever you need to and track your progress.

[Note: If the group has been working toward a shared goal or destination party, take a few minutes to update everyone on progress. Remind them of their individual goals as well: 150 minutes of exercise per week with a combination of strength exercises and regular walking. Strength RPE should be "hard" (15-16) and walking RPE should be "fairly light" to "somewhat hard" (11-13).

II. Barriers and Lapses

  • Transition from a discussion of thoughts and feelings into a discussion of barriers and lapses.

SCRIPT:

During the last few sessions, we've talked a lot about positive and negative thoughts and feelings. Now I want us to get more specific. When you have a negative thought, is it just a passing thought? Or is it a thought you encounter frequently when trying to increase or maintain your exercise? What happens next? Can you fight through it and turn it into a positive thought or does it cause you to fall short on meeting your goals? It's possible that what you're encountering is a BARRIER, which puts you in danger of having a LAPSE. Today, we're going to discuss common barriers to physical activity and how these barriers can lead to lapses in physical activity. Remember that although it is important to identify your personal barriers to physical activity, it is even more important to have a plan to counteract those barriers and prevent an extended lapse.

  • Define barrier.

A Barrier is something that keeps you from participating in regular physical activity or following through on an exercise plan. Barriers may include things such as the environment (such as hallways without safety grab bars), feelings and thoughts, or daily interruptions such as the telephone, a TV show, an unexpected guest, or even a change in our health. But barriers are not always negative occurrences or things we need to eliminate from our daily lives. For instance, some people have caregiving responsibilities that challenge their ability to engage in regular physical activity. Barriers may often trigger a lapse in physical activity, making it difficult to be successful.

  • Define lapse.

A Lapse is usually the result of encountering a barrier that you don't know how to overcome, which causes you to miss a scheduled event or fail to meet a goal once or twice. If this starts to happen consistently, it may lead to an extended lapse, where you completely stop attending scheduled events or working toward your goals. In this case, that means not doing your regular walking and strength classes for more than a week or two. If the lapse continues much longer, then it is likely you will revert to your old habits and lose the new ones you've worked so hard to develop. And as we all know, when you reduce your activity, your mobility decreases and can be hard to regain as more time passes. We've learned that this can affect your mood, which in turn can act as a barrier.

Some of you may have joined the STEP program due to a lapse in your exercise or activity participation and others because you wanted to be even more active. Whatever your reasons, you've made an important commitment to yourselves and to your health that deserves recognition. Now that you've come this far, don't let yourselves off the hook when it comes to physical activity and don't let a small lapse derail your long-term health goals.

That said, we have all had lapses at some point. You will probably have more of them. But they won't derail you if you ask the right questions and know how to get yourselves back on track. Remind yourselves that the sooner you bounce back from a lapse, the easier it will be to resume your physical activity at the same level. Don't worry about having a lapse. Instead, focus on ending it and getting back into your exercise routine as soon as possible.

  • Provide additional examples of barriers and facilitate discussion in which participants come up with examples.

Now that we have defined Barriers and Lapses, let's talk about some examples. There are two different types of barriers: external barriers and internal barriers. External barriers result from things in your environment or from your relationships with other people. Some examples are things such as a busy schedule or other activities, caregiving obligations or visiting relatives, or bad weather. Internal barriers emerge from inside you. Feelings of failure, feelings of resistance, dislike of exercise, and lack of motivation are common internal barriers people confront.

What are some other examples of barriers to physical activity? [Encourage discussion about barriers in general and participants' personal barriers.]

Okay, great examples. Now I want you to take a few minutes to do some self-reflection. [Ask them to take out their training logs and handout and refer them to the in-class worksheet, "Examining Your Week of Physical Activity."] Think about your participation in physical activity this week and the emotions you had. Then think about the barriers you encountered. Even if you met all your exercise goals, it may not always have been easy—what was going on and how did you overcome those barriers?

III. Personal Experiences and Problem-Solving Strategies

  • Allow participants to complete the worksheet and then facilitate a discussion about it. Focus on how they overcame barriers to avoid a lapse in physical activity.

SCRIPT:

[After discussion.] Thanks for sharing. Those are all good examples of overcoming barriers using self-reflection and self-monitoring. In fact, you can use all of the problem-solving skills we've learned to overcome barriers and prevent lapses. Let's take a minute to review the skills we've learned so far. [Prompt them to remember the strategies covered in previous sessions (examples are listed below).]

Skills and strategies to use when you encounter a barrier:
Practice self-awareness to help you identify the cause of that barrier. (Session 4)
Monitor your emotions and when/where/why you have them. (Session 5)
Talk back to negative thoughts. (Session 6)
Replace negative thoughts with positive thoughts. If necessary, set a new, reachable goal. (Session 6)
Bolster your positive thoughts by posting your positive thoughts worksheet on the refrigerator. (Session 6)
Think about your reasons for joining STEP and the benefits you will reap. (Sessions 2 and 3)
Look back at your tracking sheets and look at the progress you've made. (Session 4)
Call a friend or exercise buddy for support and motivation.

Many of these examples have to do with internal barriers, so let's spend a few minutes on external barriers. Think about your daily routines. Are barriers built into your schedule? Things that make it harder for you to be active even when you want to be? Those should be the first things you try to change. Make sure you have at least one block of time devoted to walking each week. It's nice to be flexible in general, but when it comes to exercise consistency is the only path to success. If you need help identifying barriers in your schedule and making those changes, I would be happy to help you come up with solutions. Or if there are things we could do at this facility to help you, come and talk to me about it so I'm on the alert.

We're going to reflect on barriers in the Take-Home Challenge and we'll review it next session so you have plenty of opportunities to continue this important conversation.

IV. Take-Home Challenge and Wrap-Up

  • Hand out Session 7 Take-Home Challenge.
  • Encourage participants to continue walking and to record their walking minutes and other physical activity time in the log.
  • Remind participants of the overall goal of the STEP program: Building up to 150 minutes of moderate exercise each week.
  • Answer any questions and end session on an upbeat, enthusiastic note.
  • Remind them that the next session will cover the value of social support and how to create a support network and will meet:
    Date and Time: ___________________________________________
Page last reviewed February 2011
Internet Citation: Lesson Plan—Coaching Session #7: Staying Healthy Through Education and Prevention (STEP). February 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/stepmanual/stepcoach7.html