How to Boost Participation in Your Fitness Program

Dr. Rob Winningham, Ph.D. was our recent guest presenter for an educational webinar focused on how to maximize resident engagement and motivation for exercise in senior living communities.

Dr. Winningham received his Ph.D. in Neuroscience from Baylor University and has 25 years of experience researching human memory and has largely focused on older adults and ways to enhance their mental functioning and quality of life. He creates brain stimulation activities that have been used in thousands of retirement communities and rehabilitation facilities including Dr. Rob’s Cognitive Connections with Masterpiece Living. He has trained thousands of professionals to offer high quality cognitive rehabilitation and therapy programs.

The following information was derived from this very important presentation.

Maximizing Participation and Engagement in Wellness Programs

You can be well trained in your field and working with state-of-the-art facilities and equipment, but it won’t do you any good if the seniors in your community aren’t motivated to engage in a fitness program.

As a general rule, about a third of people at any age are self-motivated to exercise no matter what. Unfortunately, another third of people will likely never exercise. But, the remaining group is who we want to focus on. They are the people who might not be engaged in regular physical exercise right now, but with the right information and encouragement, they will.

The motivation towards any behavior, including regular physical exercise, is dependent on two primary factors:

1. Whether or not they believe that they can do it
2. Whether or not they believe that there’s something positive in it for them.

Let’s break down both.

Self-efficacy – the first half of the motivation equation.

If someone believes they’re too old or unable to exercise for reasons beyond their control, it’s difficult to convince them otherwise. This can be frustrating, because if you’re a fitness director, physical therapist, or life enrichment director, you know that exercise can make a tremendous difference and maximize the quality of life for seniors of every age.

And that’s why understanding the nature of self-efficacy is so important. One of Dr. Rob’s students published a paper connecting self-efficacy to medical outcomes. They went into a large geriatric physical therapy clinic and asked new clients to rate how true the following statements are for them:

• I can always manage to solve difficult problems if I try hard enough.
• If someone opposes me, I can find the ways and means to get what I want.
• It is easy for me to stick to my aims and accomplish my goals.
• I am confident that I could deal effectively with unexpected events.
• Thanks to my resourcefulness, I know how to handle unforeseen situations.
• I can solve most problems if I invest the necessary effort.
• I can remain calm when facing difficulties because I can rely on my coping abilities.
• When I am confronted with a problem, I can usually find several solutions.
• If I am in trouble, I can usually think of a solution.
• I can usually handle whatever comes my way.

Their reactions to these 10 statements allowed the researchers to assign each participant a general self-efficacy score which was then compared to how much they improved after 9 physical therapy sessions. The results were staggering. A whopping 49% of how much the clients improved in physical therapy was predicted by their score on the self-efficacy scale.

So, even working with highly trained and qualified therapists, the outcome for physical therapy patients depends largely on their level of self-efficacy. The reason for this seems clear, when you think about it. If people think they can do it, they will be more fully engaged. If they don’t, they probably won’t.

How to improve self-efficacy

While it can be daunting to realize how much of a person’s health is dependent on their mindset, the good news is that care professionals can do a lot to increase the self-efficacy of their clients by providing opportunities for them to succeed.

Success begets success. So, when you provide people with the sense of achievement that comes from succeeding at something, it gives you a lot to build on.

One way to do this is to show them objective measures of their success. For many therapists and trainers, the administrative task of documenting their clients’ improvements are a part of their job. Simply sharing those numbers with their clients can make a huge difference in improving their sense of self-efficacy.

Real-time feedback is powerful. So, if you can show clients how what they are doing right now is making a difference in their physical health, that feeling of meaningful accomplishment can provide the fuel to keep going.

Three ways to provide real-time feedback for clients: 

• Use video to document improvement.
• Start and end each session with an exercise that they are successfully completing at a higher level from the last session.
• Use technology based real-time reporting, such as HUR SmartTouch outcome reports to demonstrate improvement.

In a recent HUR Hero's interview, Jan Olson, the Fitness and Living Well Manager at Paradise Valley Estates, shared how motivating real-time reporting is for her residents.

“The data is very motivating for our residents. Even when they don’t feel like they’re making progress, they can look at the screen and see that they are. The data is so powerful our trainers incorporated it into progress reports as a way to keep our residents motivated.”

Jan recommends setting reachable goals and building on each small success. She explained that for her residents, experiences in mastering new skills and overcoming obstacles have a huge impact on increasing self-efficacy. She also likes to incorporate success stories and mentors as much as possible.

When her residents can identify with someone who has succeeded at something they are trying to do, it offers tangible proof that the task can be done. Jan and her staff use their HUR SmartTouch data to incorporate motivating stories of other people who have made similar improvements in their health. It’s the kind of persuasive encouragement that helps residents realize that if someone else can do it, they might be able to as well.

The second half of the motivation equation – “What’s in it for me?”

1. Finding their big WHY

It’s likely that most people know that physical exercise is good for them. But, motivation comes from connecting the general sense of what’s “good for them” to specific activities that are important to them right now.

For example, exercise can help seniors:

• Maintain their ability to drive
• Travel
• Take care of pets
• Care for their spouse or other loved ones
• Fully engage in the hobbies they most enjoy
• Improve their mood
• Live independently
• Maintain mobility
• Reduce pain

To maximize motivation, it’s important to understand how someone wants to live their life and then connect the things they want to do to physical exercise. You can further increase motivation by incorporating social accountability.

In another HUR Hero interview, Dawn Mans, the Wellness Connection Coordinator at Three Pillars Senior Living in Wisconsin, shared a great example of how this is working well in her community. Through helping seniors find their big ‘WHY’, Three Pillars has achieved a 79% utilization rate of members in their wellness program.

Dawn tells us that she works to uncover each person’s big why in the very first meeting. That reason for being there is incorporated into the heart of their training program so that the person will not forget what they are working toward.

“Their reason for not working out isn’t because they didn’t know exercise is good for them. It’s that they haven’t connected exercise to their ability to live their life as they want to live it.” – Dawn Mans

2. The Impact of Positive Peer Pressure

Debbie Lennox, the Fitness Coordinator, Canterbury Woods in New York shared a story with us that’s bound to feel familiar to senior living fitness directors everywhere. “After the Grand Opening of the Fitness Center that included 7 pieces of HUR SmartTouch equipment, more people were working out than ever before! However, six months later there was a plateau and slight decline. We needed to happen to get residents re-engaged.”

Debbie and her team decided to set up a competition with “super-users” as team captains to help motivate and encourage their team. Participants earned points for their team by using HUR and cardio equipment. HUR SmartTouch technology was used to help track of resident frequency, time spent, and exercise completion. The results of this “positive peer pressure” was astounding.

“Team members were encouraging each other and cheering one another on. In fact, the residents got so into the competition we had to set limits to how much they could use the machines.”

3. Provide relevant information.

One simple way to motivate clients by helping them understand what’s in it for them is to be more explicit about why you are asking clients to perform certain exercises. It’s common for therapists to forget that their clients don’t know how a particular exercise might benefit them. But, knowing what the outcomes are can be very motivating for many people.

For example:

• These core exercises can reduce your lower back pain and chances of future injuries
• Taking this yoga class might improve your mood and reduce anxiety
• Performing these exercises three times a week can reduce your chance of falling again

4. Help them understand the connection between exercise and Executive Functioning

Executive functioning predicts a person’s chance of falling, how fast they can walk, and their ability to live independently. It’s also correlated with many mental health problems.

Executive functioning includes:

• Attention
• Cognitive inhibition - controlling distractibility and emotional stability
• Behavioral (or response) inhibition – our ability to not engage in destructive, negative behavior
• Problem solving
• Reasoning
• Planning
• Working (or short-term) memory

We know that we can improve executive functioning with regular physical exercise. The National Institute of Health put together a panel of experts to try and determine what interventions we are confident will delay or reduce your chances of developing dementia. The panel unanimously agreed that consistent physical exercise was the greatest thing people can do to maximize memory capacity and executive functioning.

It’s likely that most people reading this already understand how important physical exercise is to executive functioning. But, many of your residents might not. We all want to live life to its fullest potential and exercise is a huge part of that. Helping seniors understand this is often pivotal to their level of motivation.

How to respond to things you’re likely to hear from unmotivated residents.

Optimism and pessimism are important personality characteristics that are predictive of physical and behavioral outcomes. Optimists are people who generally have a favorable outlook on life and expect that good things will go their way. Pessimists generally do not have a favorable outlook on life and expect that things won’t go their way.

Research on coronary artery bypass surgery patients showed that optimists reached their goals quicker. For example, optimistic patients took less time before they began walking around their room. Using a similar population, researchers also found that low optimism patients were more likely to be re-hospitalized.

Since having an optimistic outlook can have such a big impact, what can we do to change pessimistic attributes?

One way is to challenge the pessimist’s thinking about things they believe to be intrinsic failures. For example, if you have a client who’s recovering from a fall, pay attention if they say things like, “I just have poor balance and have always been clumsy. It’s just who I am. I can’t change it.”

You can affect that mindset by deliberately building successes into therapy that contradict their belief about poor balance and clumsiness being an intrinsic part of who they are. With successes, pessimists tend to attribute the reasons for success to something temporary and outside their control. So, it’s also important to encourage them to see their role in their own success.

A high quality business = a high quality of life for residents

We know that high-quality exercise programs can improve the quality of life for residents in a big way. But, it can also strengthen the financial stability of the community and be the catalyst for growth and long-term sustainability.

Investing in high-quality cognitive, social, and physical exercise programs is imperative to organizational success because living long, full lives is what residents and prospective residents want. Investing in wellness is one of the best things senior living communities can do to improve ROI.