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Welcome to - Motivate Me ?
Motivating older people to take part in physical activity
Bob Laventure
Anglesey – March 2010
Our core business
The Later Life Training continuum
• Exercise for the Prevention of Falls & Injuries in
Frailer Older People (PSI)
• Otago Exercise Leaders Award (OEP)
• Chair-based Exercise Leaders Award (CBE)
• Underpinned by Motivation Courses (“Someone
Like Me” and “Motivate Me”)
Supported with bespoke educational courses and
continuing professional development
www.laterlifetraining.co.uk
Discussion Board
Directory of Teachers
Resources and Links
Course Dates and Flyers
Student log in
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Course aims
To provide the instructor/student with • Underpinning knowledge of behaviour change
throughout the lifespan in order to assist with their understanding of why some older people are and others aren’t motivated to be active
• A range of evidence based (and/or recommended) adapted practical strategies and approaches to assist older participants to make a change
• The opportunity to practice, and receive expert guidance and peer feedback on, a range of adapted strategies and approaches
• An awareness of the National Occupational Standards that are covered in this training programme.
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Course learning outcomes
By the end of the course the instructor/student will be able to:
• Identify the theoretical concepts and stages underlying the process of behaviour change throughout the life span and in old age in particular
• Describe and discuss how to adapt a range of effective practical strategies and approaches with a wide range of older participants
• Demonstrate and reflect on how to use and adapt appropriate practical strategies and approaches to engage and motivate a diverse range of older participants
• Identify the National Occupational Standards that are covered in the training programme.
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Programme for the day• 9.30 – 9.50 Welcomes – Introduction, rationale for the course.
– Aims and Learning Outcomes, content and materials• 9.50 – 11.15 Motivation, behaviour change and older people
– Overview of evidence - the barriers and motivation of older people • 11.15 - 11.30 Refreshments• 11.30 – 12.45 Motivation – underpinning knowledge
– Behaviour change process• 12.45 – 1.30 Lunch• 1.30 – 2.15 Meeting individual needs and differences
– listening and talking, negotiating barriers • 2.30 Best practice and implementation
– best practice and support strategies• 4.10 Participant review and planning• 4.20 – 4.30 Course summary, participant guidance and support
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the decisional balance - benefits and cost – starting a
walking regime
Get out of the house and get some fresh air.
(Might) loose some weight
Meet some new people
Will help with my blood pressure
Difficult to get into the mood
Shopping will take longer
I’ve got a stiff knee
There are other things I want to do
(Janis and Mann 1977)
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Practical opportunities to intervene
• Referral and Assessment• Listening and talking• 1st experiences and
induction• Target/goal setting• Feelings Achievements
and Rewards• Educational opportunities • Support Strategies
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Session 1
Motivation, Behaviour Change and Older People
Pre-course task
Overview of evidence
Barriers to physical activity
The decisional balance
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Your experiences
• Identify a participant who has dropped out of a programme you were involved inand …….
• a participant you have met who was resistant/apprehensive towards physical activity/exercise recommendations, but was encouraged to make a start and become involved.– Identify
• What were the main factors influencing each of these case studies ?
• what did you to do to resolve the situation ?
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Barriers to physical activity
• Intrinsic barriers - are those that relate to the individual’s beliefs, motives and experiences concerning physical activity. These are most likely to be addressed by those who provide counselling, advice, motivation - for example, a peer mentor, health visitor or GP
• Extrinsic barriers - are those that relate to the broader physical activity environment, the attitudes of others and opportunities that are available. These are more likely to be influenced by other people and those responsible for policy and strategic developments.
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Intrinsic barriers
• Older people’s sources of beliefs • The media (radio, TV, magazines,
newspapers, Workplace, H.P leaflets • ‘Common sense’ and medical and health
professionals• Personal and previous experiences (and
experiences of others) e.g. school, armed forces
(Finch, 1997)
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Beliefs about activity – the underlying motivators
• To maintain suppleness and agility, and control weight
• ‘Feeling better’ • Manage existing health problems• Enjoyment• Prevent future illness and disability• To keep going, be independent (live longer rare)• Adventure/challenge, new learning
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Extrinsic barriers
• E.g. Skills and attitudes of others, e.g. exercise instructors, GPs, leisure/recreation managers, family and friend support
• Appropriate programming• Accessible opportunities (transport)• Safe activity environments (parks, well-lit
streets)• Positive images of older people
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Moderation “at our age”
• “You can overdo it.”
• Gentler activities are more suitable.
• It depends on the individual.
• Might make something worse
• Fears over breathlessness and increased heart rate.
(Finch, 1997)
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Beliefs – exceptions to the positive view
• The health ‘lottery’
• A fashion for exercise nowadays
• “You need to be fit to do physical activity.”
• Too late to start
• Dangers when you stop
• “It can become an obsession.” (Finch, 1997)
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Overcoming concerns about being active
• “I don’t think I should start at my age.”
• “I’m worried I might hurt something.”
• “I have to take it easy at my age.”
• “My aches and pains will get worse.”
• “Can I do exercise with my blood pressure ?”
advice of a GP is powerful.
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Overcoming barriers - Pain
• Fear of or real ?• Pain or sensation ?• During post exercise/activity• Cause - known e.g. arthritis or unknown ?• Foot care - the forgotten factor – key to
walking (toenails, bunions etc.)• Education – what’s (ab)normal ?• Route to care and solution
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‘Triggers’ and life events
• Wanting to play with grandchildren
• Physiological signs of ageing
• Retirement, children leaving home
• Onset of ailment or illness
• Moving home
• Bereavement
• Maintaining independence (Finch, 1997)
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Barriers to physical activity including programming
Intrinsic Programming Extrinsic
Poor self image, self efficacy
No history of positive
experience of exercise
Fear of over-exertion
Inconvenient time
Location and transport
Boredom
Exercising alone
Poor instruction
Too easy, too hard
Society norms
Lack of family/partner
support
Social support
Weather/season
Medical problems
(Jones & Rose 2005)
Group activity
Which barriers feature most frequently in your work with older people ?
Identify 3 that relate to intrinsic beliefs and values
Identify 3 that relate to extrinsic factors
Exclude transport !
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Understanding older people’s views of falls prevention advice: focus group and interview study
• to explore older people’s views of different types of falls prevention advice
• to identify features of communications about balance training and falling prevention that may result in negative experiences
• Yardley L & Todd, C, Donovan-Hall M & Francis KJ. - Help the Aged (2005)
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Perceptions of falls prevention messages presented
Discussion of falling prevention is beneficial
‘I think it would be helpful if someone knows what you should do and what you shouldn’t do’
‘I think it would give me more confidence of building up your balance if I read this [leaflet about improving balance] now. I think it would give me more confidence when I’m out.’
(Members of focus group of women aged 78 to 95 living in sheltered accommodation)
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Perceptions of falls prevention messages presented cont.
It’s good advice BUT- they wouldn’t necessarily act on (all of) it‘It’s all good. I mean its good advice, yes,
excellent, I agree. I doesn’t mean to say I do it all but I agree.’
- it may not fit with their circumstances, lifestyle, prioritised goals
‘ No, no, no, no, no, no ... Nobody would go around with padding.’
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Perceptions of falls prevention messages presented cont.
It’s good advice - for ‘them’- only seen as relevant to ‘elderly’‘Because we’re that much fitter -- we don’t really take too
much notice of it, only for other people, for other disabled or elderly people that we have to watch when we’re – we always watch older people anyway’.
(male participant aged 79 in sheltered accommodation)- rejected by fit, younger people, seen as humiliating‘I wouldn’t go for that [advice] because it didn’t apply to me
in any shape or form. Is there a bit of pride, is there a bit of “Well, you know, I’m not there yet”?’
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Perceptions of falls prevention messages presented cont.
Falls prevention advice unnecessary, upsetting‘It can make you feel – somebody producing the
leaflets here – that these people here are senile and they just don’t have any common sense and they need to be told everything.’
‘The last thing you want as you get older is to be told that you’ve got to be conscious every time you go out and might fall, you don’t want that, otherwise your life’s gone.’
(female participant, 78, who had recently fallen)
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Participants’ suggestions for future advice
• Incorporate falls prevention activities into lifestyle and general exercise programmes, and promote these activities as enjoyable, interesting, sociable
• Offer suggestions in constructive manner recognising individual’s knowledge and choice regarding their own lifestyle, and giving explanations for suggestions
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Evidence about falls • What are the key motivations for older
people to take up strength and balance training exercises?
• thinking you are the kind of person who should do these activities
• thinking other people think you should do these exercises
• believing that these activities would be enjoyable (mastery and control)
Selective Optimisation and Compensation Theory
• Falls prevention advice can induce anxiety and lead to Activity Restriction (AR)
• Exercise interventions design should take account of:• ‘Selectors’
– See AR as a sensible approach to cope with their balance problems – at risk of spiral of functional decline and poor adherence to exercise
• ‘Optimisers’– Better uptake and adherence to exercise as see increasing activity as
a good approach to reducing falls
• ‘Compensators’– Tend to just adjust the activities they do rather than increase activities
– more likely to accept home environmental advice and assistive walking aids
Laybourne, Biggs, Martin, 2008
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Other studies - 1
Adds to Yardley (2005) study and …….• I’m too young to fall (again)• Confusion - Physical activity and exercise
(physical exercise ?) used inter-changeably• Do not make connection with exercise and falls• Fatalism – it’s going to happen anyway ?• Differences between those who have (not) fallen
(Horne 2008)
Other studies - 2
• Educate older adults – clear base of exercise recommendation(s) (FIT)
• Access to quality community programmes (conducive atmosphere, well trained leaders to ensure safety and suitability)
• Use of health professionals and peer mentors to improve motivation and self-efficacy (to overcome individual barriers, facilitate progression through change)
(Hale et al 2009)
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Other studies – 2 (Older Women)
• Relationships strong motivator
• Previous history (esp. childhood) important
• The future is uncertain, so immediate benefits please !
• Caring for and supporting others
• “Vulnerable” starters/newcomers, lacking in confidence
Women’s Sports Foundation (2006)
Other Studies – 3 (Older Men)
• Less likely to talk about and act upon health
• Still looking for competitive experiences ?
• Looking for other roles ?
• Changes around retirement
• Do not associate with movement and music
(Age Concern and Men’s Health Forum 2006)
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Other studies - 4
Impact of the environment• Perceptions of safety, crime and
neighbourhood • No-one to go with• Single, female, poor health (increased
barriers)• Physical environment - Access to green
spaces, post office, absence of rubbish, road crossings (JAPA 2006)
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Other studies - 5
4th Age (80 + in nursing homes)Building/increasing confidence - • Perception that the environment is safe• Trust in the instructor • Decision to try and experience of
success/achievement• Transfer and apply to other activities of
daily livingStathi and Simey (JAPA 2007)
HOT OFF THE PRESS !
• Educate participants in what exercise needs to consist of (FIT and benefits)
• Increase access, availability and improve environments and skills of leaders
• Increase motivation and self-efficacy through professional and peer support to overcome barriers and move through Stages Of Change
(Hutton et al NZ Journal of Physiotherapy July 2009)
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Qualitative studiesLimitations• Most limited to community living, relatively
healthy (young) older people• Little information on older men or ethnic minority
elders• Can we summarise ? - reflect a wide range of
individual differences• Very few rules and givensNB See further reading and LLT student page
(Sept 2009 onwards)
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Session 2
Motivation – Underpinning Knowledge
Evidence and best practice model
Trans-theoretical model of change
The Life-time model of physical activity
Listening and talking about physical activity
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BHF NC Guidelines - interventions and programming - what works ?
Making sense of evidence• Effective interventions and
older people– Population wide– Programme design– 0ne to one – programming
(Owen. N 1994, Sallis J. 1998 NICE 2007)
• Components of best practice
www.bhfactive.org.uk
Population wide interventions
• Built and natural environment
• Promotional campaigns
• Transport and planning
• In what way do these affect the participation of people you work with ?
• Do you have a role to make changes ?
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Advising older people to become active
• Use of a health educator and an extended consultation time
• Assessment of problem areas• Recognition of readiness to change• Goals agreed by both the older person and the
professional• Identification and recognition of social and
environmental barriers • Tailored action plan (specifies activity)• A choice and range of accessible local activities
including lifestyle activities• Supplementary educational materials• Systematic follow-up and support over a period of time
www.bhfactive.org.uk (2007)
)
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Generic models of behaviour change
• Theory of Reasoned Action – intention determined by attitude towards behaviour and social influences (Fishbean & Azjen 1975)
• Theory of Planned Behaviour + perceived behavioural control (confidence and opportunity) (Azjen 1985)
• Social Cognitive Theory - Self Efficacy and knowledge of health risks (Bandura 1986)
• Trans-theoretical model of change (Prochaska & DiClimente and Marcus and Forsyth 2003) Stages of change
• Ecological theories (Sallis J 1999, NICE 2008) The environment
(Sport England 2005)
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Models of behaviour change
Summary - Change is more likely when
• Perceived benefits of physical activity outweigh the costs• Becoming more active will lead to social approval, not
disapproval• Being more active will lead to self-satisfaction and is
consistent with highly valued, broader life goals• Desirable outcomes are within one’s personal control,
achievable through one’s own actions• There are few obstacles/barriers to achieving desirable
outcomes• Opportunities and access to physical activity are high• An activity enhancing environment
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Trans-theoretical model of change (Marcus & Forsyth 2003)
Stage number Stage name Description
1 Pre-contemplation No intention of changing behaviour
2 Contemplation Thinking of changing behaviour
3 Preparation Preparing/planning to change behaviour
4 Action Adopted the intended behaviour, but for less than 6 months
5 Maintenance Adopted the intended behaviour for longer than 6 months
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Trans-theoretical/Stages of Change
1. Inactive and not thinking about becoming active
1. Inactive and thinking about becoming more active
2. Doing some physical activity3. Doing enough physical activity4. Making physical activity a habit
Marcus B (2003)-
• Increasing knowledge about physical activity and health
• Awareness of risks• Consequences to others e.g.
family• Understanding of benefits• Looking at previous experiences
of activity• Exploration of barriers (real or
excuses)• First steps to confidence (you
could)
Pre-contemplation
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Trans-theoretical/Stages of Change
1. Inactive and not thinking about becoming active
2. Inactive and thinking about becoming more active
3. Doing some physical activity
4. Doing enough physical activity
5. Making physical activity a habit
Marcus B (2003)
• Exploring past successes• Exploring self projection (what
would it look like ?)• Personalise benefits• What changes would you
expect ?• Explore lifestyle and time use• Explore types of activities that
might be manageable • Explore practical strategies
(setting a date/time - specific goals
• First steps to confidence and self efficacy (you could)
• Peer or buddy support
Contemplation
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Trans-theoretical/Stages of Change
1. Inactive and not thinking about becoming active
2. Inactive and thinking about becoming more active
3. Doing some physical activity
4. Doing enough physical activity5. Making physical activity a habit
Marcus B (2003)
• Exploring benefits from current activity patterns
• Exploring current problems e.g. what gets in the way ?
• Exploring preferences, choices• Setting incremental targets (5
minutes more ?)• Prompts to increasing
frequency (lifestyle activity)• Peer or buddy support
Preparation
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Trans-theoretical/Stages of Change
1. Inactive and not thinking about becoming active
2. Inactive and thinking about becoming more active
3. Doing some physical activity
4. Doing enough physical activity
5. Making physical activity a habit
Marcus B (2003)
• Maintenance and working towards (goal setting)
• How much is enough frequency, time, intensity, components e.g. strength and flexibility
• Mode, e.g. brisk walking or strolling with the dog
• Continuing to explore problems e.g. Anticipating relapse events loss of buddy, illness (ability to re-start)
• Exploring benefits (rewards) from current activity patterns (real or perceived, physical, psychological
Action
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Trans-theoretical/Stages of Change
1. Inactive and not thinking about becoming active
2. Inactive and thinking about becoming more active
3. Doing some physical activity4. Doing enough physical activity
5. Making physical activity a habit (six months)
Marcus B (2003)
• Maintenance and working towards (review of goal setting)
• Choices and variation (new horizons)
• Refresh and review e.g. support structures
• Anticipating relapse events loss of buddy, illness (ability to re-start)
• Re-enforcement through physical appraisal, e.g. weight loss, improved VO2 max
• How much is enough ?Maintenance
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Lapse or Relapse model• What are the situations that might result in drop
out ?• It poured with rain all day, I didn’t want to go• Injury/illness• Increased work/caring• Loss of buddy, partner• Moving house
What’s the difference ? • Lapse is missing a session or two• Relapse returning to sedentary behaviour
What’s your role ?Monitoring to anticipate – relapse is normal
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Practical opportunities to intervene
• Referral and Assessment• Listening and talking• 1st experiences and
induction• Target/goal setting• Feelings Achievements
and Rewards• Educational opportunities • Support Strategies
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Pre-exercise assessment
• Health
• Function
• Readiness to exercise(Later Life Training Manual)
How do we assess readiness to exercise among participants ?
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Key questions to ask (exploring thoughts)
• Importance question - I wonder how important being active is for you ?
• General questions - What kinds of physical activity do you do at the moment ?
• Benefits question - Imagine if you did more, what benefits would you expect to see ?
• Barriers question - What things prevent you from being more active ?
• Concerns question - What things worry you about being more active ?
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Listening and talking about physical activity
Using the traffic light system
1. How do we help to overcome some of the barriers ?
• How do we deal with uncertainty ?
• How do we build upon positive responses and convert good intentions into actions
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Who is the motivator ?
“ People are generally better persuaded by the reasons which they have themselves discovered, than by those which have come into the mind of others.”
Blaise Pascal 1670
French mathematician, physicist and philosopher.
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Listening and talking about physical activity
Using the traffic light system• How do we help to
overcome some of the barriers ?
• How do we deal with uncertainty ?
• How do we build upon positive responses and convert good intentions into actions
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“Imagine if – What if ?…”
• Explore possibility of change• Imagine for a moment you decided to be
more active, I wonder what sort of thing you’d see yourself doing ?
• How do you think you would feel ?• What sorts of improvements would you
expect ?• What sorts of benefits would you expect ?• If someone could imagine what, but not where?• Use local knowledge, one place people tell me they
use is …How does that sound ?
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A different “spin” on fitness• Strength to lift household
objects, open a jar and get in and out of the bath
• Flexibility to wash hair, tie shoes• Balance and agility to climb
stairs• Co-ordination and dexterity to
open a door with a key• Speed to cross the road whilst
the lights are green• Endurance to walk to the shops,
play with the grandchildren
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Listening and talking about physical activity
Using the traffic light system• How do we help to overcome
some of the barriers ?• How do we deal with
uncertainty ?
• How do we build upon positive responses and convert good intentions into actions ?
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Getting started - information
• Do I know
• What’s available and for who ?
• Is it any good ? (quality) and who says so ?
• What’s required and how to get there ?
• Point of contact ?
• Does it add up to access and choice ?
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Commit to start
Cognitive – behavioural strategies
• Understanding not enough
• Commit to action by
• Planning the When, What, How and With Who ?
• anticipate the behaviour, consequences
• Goal setting included
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Individual differences
• Earlier experiences• Cultural or religious reasons• Gender• Age/generation cohort• Self-image/self efficacy• Personal circumstances • Time barriers and perception of activity• Lifestage
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Able and willing to be
active
Able but unwilling to be active
Unable but willing to be
active
Unable and unwilling to be
active
Able
Willing
Unable
Unwilling
(Age Concern 2006)
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Individual triggers
• Turning 50 (SAGA Subscription) or 60• Retirement part-time working, volunteering• Decline in health or major health incident
e.g. MI or Fall• Declining function (stair use)• Social stages, empty nesting, grand-parenting,
caring for others, bereavement
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Making sense of the future
Heydayers, Fullfilled, LIFERRS, Inevitables, Countdowners,
GolfersBOOMERS, SWELLS and
SKIERS
Age Concern Research Services2008
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“Heydayers” 21%
• Positive about life and ageing
• No particular health or financial concerns paid off mortgages, enough to get by
• But concerned about wider issues crime, environment, education etc
• Largely retired, older Swells , widowed or still with partner, female bias, enjoy shopping
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“The fulfilled” 21%
• The most positive group overall
• Active, healthy, content with their lives and
• where they live
• Reasonably affluent, in control of finances
• Quite home-focused ( e.g. gardening) but help in community
• Male bias, aged below 70, still married
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“The LIFERRS” - 15%
• The most concerned about age and ageing not at all happy about life
• Main problem is money, not health, low income, income support etc
• Loneliness and isolation a real worry• Lack of trust in people and services• Heavy TV viewers, most likely to be• smokers
Lonely, Isolated, Financially Excluded and Resenting but Requiring Support
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“The Inevitables” - 14%
• The most pessimistic group but due to health as well as finances
• Not at all happy with life, want to change, but doing little about it
• resigned to circumstances and health status• The most dependent on others and the State
pensions etc• More likely to be living in social rented
accommodation
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“The Countdowners” - 11%
• The oldest and most passive group
• Not really participating in life, living day-to-day, low income and have health problems
• The least active and sociable withdrawn into themselves, almost given up on life
• Retired, widowed, living on own, particularly 80+ and males
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“The Golfers” 17%
• More typical of Baby Boomers largely working, but looking forward to retirement
• The most financial commitments (mortgage, family) spending not saving
• Lead full and active lives (exercise, holidays• and eating out)• IT literate, heavy press readers• Under 60, married, 3/4 person householdsGrowing Older, but Looking Forward
to Enjoying Retirement
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Additional informationSee also Sport England
www.sportengland.org.uk
Resources – Research - Market Segmentation
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Session 4
Best practice and implementation
Practical opportunities to intervene
Best practice in programming
Self review - where am I now ?
Evaluation
Key lessons
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Practical opportunities to intervene
• Referral and Assessment• Listening and talking• 1st experiences and
induction• Target/goal setting• Feelings Achievements
and Rewards• Educational opportunities • Support Strategies
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Getting started
Once they have made a decision to come/attend
The induction process
What are the most common questions and concerns that appear at this stage ?
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Common barriers
• Fear of falling or fear of the unknown
• Over-exertion
• How will I get on with the others ?
• Harming oneself or making a condition worse
• Will I be good enough ?
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Common barriers
• What time do we go home ?• Where are the toilets ?• Fear of falling or fear of the unknown• Over-exertion• How will I get on with the others ?• Harming oneself or making a condition
worse• Will I be good enough ?
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Goal setting – 6 steps
1. Expectations (during individual screening or initial assessment ?)
2. Set own goals SMART - long term and short term (Early goals must be achieved so behavioural goals not outcomes (self-efficacy)
3. Monitor and provide feedback4. Reward and incentives5. Problem solving to overcome obstacles6. Promote long term adherence
(Jones and Rose 2005)
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Goal setting• Behavioural (short
term)• To attend the next
three classes• To keep Tuesdays
clear
• Outcome goals (medium/long term)
• To increase strength• To improve balance• To improve
independence
What short term goals can we set that lead to early success and
achievement ?Establish patterns of behaviour and
success that will lead to longer term goals
Can we help to change matters?
Evidence of effectiveness – duration vs outcome
• Gait (8 weeks)• Balance (Static 8 weeks + Dynamic 8 weeks)• Muscle strength (8-12 weeks) • Muscle power (12 weeks)• Endurance (26 weeks)• Transfers (6 months)• Postural hypotension (24 weeks)• Bone strength (1 year for femur and lumbar spine)• Falls (1 year) (Dinan & Skelton 2006)
Goal setting activity
How do we distinguish between
Overall motives, long term aims
Short term goals
Medium term goals
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Feelings, Achievements and Rewards
We are all motivated by feeling good about ourselves and our bodies, the activity and
our successes …
As teachers and leaders … how can we provide opportunities to identify,
recognise and register those positive feelings ?
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Positive feelings about being active
What are the best words to describe positive feelings
about being active ?
What’s the vocabulary ?
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Feelings, Achievements and Rewards
Assist participants to identify e.g.
Easier movement
Increased no of reps
Reaching a goal or target
I can ……..
I find it easier to ………
I am able to ………
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Individual rating scale (IRS)
Number Overall feeling
1 Terrible
2 Lousy
3 Blah
4 So-so
5 Fair
6 Good
7 Very good
8 Great
9 Fantastic
10 The best ever
Educational opportunities
• Additional materials e.g. Help the Aged, BHF, Local Directories
• Specific falls programmes
• Whole health programmes (CHAMPS)
• Take home activities
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Support strategies
• All literature provides strong evidence that they are effective (NICE, HDA, CDC, Campbell, FAME)
• Communication strategies
• Technologies
• Social activities
• Educational programmes (Stewart et al 2001)
Fame - Support strategies employed
• Education on benefits to ADLs and everyday life– Purpose of exercises and regularity
• Follow up of non-attendance• Exercise diary completed weekly• Buddying within classes which developed to buddying
in use of transport and getting to the class• Naming the group “Fallen Angels Club”
– Met every two months in Starbucks, Oxford Street, London.• Towards end of intervention
– Newsletter / Social events, produced/organised by the participants
(Skelton 2005)
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Otago Exercise Programme - Schedule
Month 1 2 3 4 5 6 ……
12
Week 1 2 4 8
Home Exercise Visits
Telephone follow up
Champs - Programme components
• Personal attention and encouragement from staff
• Information meeting • Telephone calls from
staff • PA planning session • Monthly newsletters • Programme handouts
• Monthly workshops • Exercise booklets • Functional fitness
evaluations • Activity Logs • Feelings of belonging
to a group • Goals
setting/contracts (Gillis et al JAPA 2002)
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Support StrategiesStrategy Strength Weakness Score
Telephone and written contact
Exercise log books and diaries
IT email and text
Informal groups and meetings
Social events
Peer and buddy support
Group name/identity
Family partner support
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Support strategies
Evidence into practice
Strengths and weaknesses –
which are the 3
“best buys”
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Supporting activity
Walk With Me • Mobilising through
assisted walking• Strategies to increase
frequency and distance• Related to setting and
location• Can apply to individuals
and small groups • Goal setting and
purpose of critical importance
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Key learning -1
What are the key motivators ?• Thinking that you are the
sort of person who should do these exercises (self-efficacy)
• Thinking that other people think you should do these exercises (social approval)
• Believing that these exercises will be enjoyable (mastery and control)
LLT Motivation 100
Key learning - 2
What might the biggest barriers be ?
• Concern for personal safety
• Personal (out walking, fear of crime, traffic, the dark)
• Over-exertion, pain and harm
LLT Motivation 101
Key learning - 3
Powerful motivatorSocial aspects of
participation, friendship, reduction of isolation, getting out of
the housebut it’s only once a week,
do we prepare for home based
opportunities ?(from or at home)
LLT Motivation 103
Key learning 5
Older people are the best sources of
information about the barriers, but also how
to overcome them……..
let them find the solutions …..
Help them motivate themselves !
LLT Motivation 104
Next steps
• More information and understanding• Behavioural change and physical activity
(Marcus and Forsyth 2005, Mutrie, N)• Motivational Interviewing (Rollnick SJ)• BHF NC Guidelines www.bhfactive.org.uk.
What else would assist you ?(LLT student learning on website)