I was going to write a blog about maintenance of my exercise plan, but I got distracted by something I thought was more important at the time…..

No, seriously, I have been riding my bike 1800km across France and Spain and have been totally exhausted the past few days. I have reached my goal. Now the real challenge is to maintain this level of exercise. Cycling a 20km per day, every day, is my new realistic target.

For me now maintenance is going to be a personal challenge. I have set goals like this before (never this big) and then collapsed back into bad habits.

When I turned 40 I set myself a goal of cycling up the largest hill closet to my home: Lapstone Hill. I laugh as I write this today, as Lapstone Hill – so challenging so many years ago – is now only a gentle incline compared to the mountains I have crossed these past 6 weeks.

BUT after I achieved this goal – cycling up Lapstone Hill in the Blue Mountains of NSW- I simply stopped cycling.

“Individuals in the Maintenance stage have managed to stay in Action mode for at least six months.

That means they’ve successfully avoided or overcome the obstacles that could have caused them to slip back into old behaviors. Through practice, they’ve attained a greater level of confidence and capacity. Their new behaviors have started to become a more integrated part of their lifestyle and identity, and their risk of relapse is much lower than when they began.

Yet several things can trigger people in Maintenance to relapse: stress, crisis, apathy, boredom, a loss of environmental or emotional support, or a frustrating plateau in progress. Major life events — like a job change, romantic breakup, location change, birth or death in the family — can also trigger a relapse.

What constitutes a lapse in maintenance depends on the behavior change in question. For those who have embarked on a fitness routine, it may mean missing a few workouts in a row.

Whenever you fall out of Action for long enough that there’s a question about whether or not you’ll be back on track tomorrow, you’re probably stepping out of Maintenance and back into Action, Preparation, or even Contemplation. The thing to keep in mind, says Prochaska, is that “the only real mistake you can make in changing is to give up on your ability to change.”

You’re in the Maintenance stage if: For at least the past six months, you’ve been diligent and consistent in performing the actions you committed to as part of your desired behavior to change. They now seem fairly routine.

Moving from Maintenance to Termination: Treat obstacles and unanticipated challenges as opportunities to develop new strengths. Ward off boredom by taking on new challenges and expanding your skills. Stay on the maintenance path for two years or more, rallying even through stresses and setbacks, and you’ll reach a point where you can’t really imagine ever going back to the way things were before. from HERE

Maintenance

The maintenance phase of the Stages of Change Model involves successfully avoiding former behaviors and keeping up new behaviors.

Suggested Strategies:

• Write yourself a goal
• Share this goal with your friends and family
• Find one trusted person who can be your mentor – have a plan with them to ‘check in’ with you once a week to see how you are progressing towards your goal
• Leave your exercise clothing in a place that is ‘in your face’ at the time when you need it. e.g if you exercise immediately after coming in from work, leave your exercise gear on your bed / in the bathroom / inside the front door so you have to almost fall over it to find it and use it
• If your previous behavioir was to shop on your way home from work, then change this to shopping on your way to work

Confidence

During this stage, people become more assured that they will be able to continue their change.

Suggested Strategies:

• Make a list of the things that make it easy for you to continue on with your exercise goal
• Share this list with your friends and family

If you are trying to maintain a new behavior, look for ways to avoid temptation.

Try replacing old habits with more positive actions.

Rewards

Reward yourself when you are able to successfully avoid a relapse.

Suggested Strategies:

• Make yourself a score card. When you score sufficient points, rewards yourself with something healthy e.g. I have scored one point for each day I have walked. When I score 15 points I shall reward myself with …… (something healthy remember)

Flop

If you do lapse, don’t be too hard on yourself or give up. Instead, remind yourself that it was just a minor setback.

Suggested Strategies:

• Write yourself a statement of success e.g. “On the way to achievement I shall make mistakes. It’s not about the individual day, it’s about the whole journey over the coming months and years”.

Relaspe

As you will learn in the next stage, relapses are common and are a part of the process of making a lifelong change.

“Success is not final, failure is not fatal: it is the courage to continue that counts.” Winston Churchill

Kind Regards,

David – Diabetes Educator @ Diabetes Counselling Online

Please Share!

The Stages of Change model postulates behavioural change as a process of 5 identifiable stages through which patients pass: pre contemplation, contemplation, preparation, action and maintenance.

The model illustrates that for most persons a change in behaviour occurs gradually, with the patient moving from being uninterested, unaware or unwilling to make a change (pre contemplation), to considering a change (contemplation), or deciding and preparing to make a change (preparation); genuine, determined action is then taken and, over time, attempts to maintain the new behaviour occur.

This ‘stage’ concept allows for applying a temporal dimension to the Stages of Change . Within the model, relapses are almost inevitable and become part of the process of working toward life-long change . from http://www.jnrbm.com/content/10/1/13

Action Stage: THE Place to Be

The stage in which individuals modify their behaviour, experiences, or environment in order to overcome their problems. Action involves the most overt behavioural changes and requires considerable commitment of time and energy.

So, you are having your dose of exercise, great.

The questions to ask your self:

1. Is it safe?
2. Is it providing the desired effect?
3. Am I adjusting my meal plan correctly?
4. Do I have a wet weather / hot day plan?
5. Am I having fun!?!
6. What needs to happen to maintain this plan?
7. What is my blood pressure / cholesterol / HbA1c – and as I continue with my exercise plan, are they improving?
8. Has my podiatrist assessed my feet and given any special advice for the type of exercise that I have started?
9. Shall I include an exercise physiologist in next years health care plan (again) with my GP?
10. What are the things that will take me out of this action phase and back to the planning phase. And who can I talk to for support within the family?

Some Evidence : Research About Exercise

From: http://www.medscape.com/viewarticle/440097

Results: Patients in preparation and actions stages achieved a significantly larger reduction in hemoglobin A1c levels in a shorter time than patients in the combined precontemplation-contemplation stage.

Average change in hemoglobin A1c levels at 12 months was -1.06 ± 1.80 (P = .17) for the precontemplation-contemplation stage, -1.82 ± 1.84 (P = .006) for the preparation stage, and -2.56 ± 2.12 (P = .0006) for the action stage.

Patients had significantly more hemoglobin A1c measurements in the preparation stage (4.63 ± 2.42, P = .036) and the action stage (4.94 ± 2.38, P = .013) than patients in the precontemplation-contemplation stage (3.00 ± 1.22) during the 24-month study.

Conclusions: In this small population, stage of change as determined by a simple clinical tool was significantly associated with clinical improvement in hemoglobin A1c levels at 3 months after an educational intervention.

Significant differences in clinical improvement between groups persisted for at least 12 months. This tool could be used to tailor the most effective clinical diabetes interventions for patients and to address the needs of patients in a more targeted manner.

From: http://strathprints.strath.ac.uk/25760/

Objective: Investigate the relationship between physical activity and components of the Transtheoretical model (TTM), in an older clinical population. Method: 85 people with Type 2 diabetes and/or cardiovascular disease (age 64.8 8.2 yrs) completed TTM questionnaires. Physical activity was assessed using the 7-day recall questionnaire. Results: Differences across stage of change were found for physical activity, self-efficacy, the pros of more physical active and 5 processes of change. Physical activity, self-efficacy and the pros of more activity were greater in the maintenance than contemplation stage. Stage differences in processes were: consciousness raising (increased contemplation to action), self-liberation (increased contemplation to maintenance), helping relationships (increased preparation to maintenance), counter conditioning (increased contemplation to preparation, action and maintenance) and reinforcement management (increased contemplation and preparation to maintenance). Experiential processes were used more than behavioural processes in the preparation stage. Conclusions: Findings support the theoretical predictions of the TTM and the use of this model in older clinical populations.

Safety

Have fun with your exercise, and don’t be afraid to ask questions of your team. Safety first – after all the purpose of exercise is to increase your health and future quality of life.

Im surrounded by people of all shapes and sizes at present. They are doing at least 2 weeks of a long distance walk. Its amazing the things they are doing NOT to be safe. In fact so many people are having injuries because they are on a deadline – e.g. have a plane to catch.

You have no deadline. So take your time.

Exercise at a level of comfort….

NOT the old and outdated adage of “NO PAIN NO GAIN”

It’s likely if it is painful then you are causing damage to your body.

Kind Regards,

David

Diabetes Educator @ Diabetes Counselling Online

Please Share!