Literature Review on the Effects of using Motivational Interviewing for Physical Activity: How is Physical Activity Attendance and Psychological wellbeing improved?
Client - Trainer Relationship
It is well known that exercise has a positive impact on an individual’s mental health. Exercising an appropriate amount, can help an individual feel more confident in their abilities, help them feel committed to and feel good carrying out a goal, and builds overall tangible strength. Exercise has even been examined for its antidepressant effects on individuals struggling with depression and anxiety. (Kandola, A., Ashdown-Franks, G., Hendrikse, J., Sabiston, C. M., & Stubbs, B. 2019).
While we know how beneficial exercise is to an individual’s mental health, what poses as an untapped resource in furthering to help one’s mental health during exercise, is the support of the personal trainer or coach. Coaches and trainers are in an extremely privileged and unique position when working with individuals. Trainers may see their clients one to four times a week, often times more than some of the client’s close friends or families. Trainers learn about their lives, habits, hobbies, families, understand their personalities and build a personal bond. Trainers are in a unique position to provide support that is different from a clinician.
Trainers have the ability to influence others to feel confidence and strength in themselves, when the trainer demonstrates strength and confidence in that individual. Another factor in influencing a client’s confidence in themselves is their relationship to their trainer; if the client-trainer relationship is strongly felt by the client, it is much more likely the client will feel confident in their abilities in and out of the gym. (Christopher R. Hill, Alan L. Smith, Nicholas D. Myers & Deborah L. Feltz 2021). In a survey given to 100 individuals struggling with mental health, 71 stated that they would prefer an instructor guided movement practice; 69 stated they prefer the practice to be with someone they know; and 68 stated that they prefer their to be a social aspect to the movement practice. (Chapman, Justin J ; Fraser, Sarah J ; Brown, Wendy J ; Burton, Nicola W 2016-09-02) This is to say that there is a huge potential for individuals with mental health struggles to better their psychological health by being paired with a trainer that they trust, feel comfortable with and who can provide social support. This in turn can create a reciprocating effect; by feeling more engaged and confident in one’s self during a session, an individual builds their self-efficacy. When an individual has a stronger self-efficacy, they are more likely to be consistent in the gym. This pattern can feed on itself to build more self-efficacy and further improve their mental health. (Jackson, Doug MEd, 2010).
Motivational Interviewing
There are many ways of strengthening the client-trainer relationship and to coach with compassion and empathy. One method that is used is Motivational Interviewing. Motivational Interviewing, otherwise known as MI, was created in 1980 as a counseling technique. The technique looks at habit change as a collaborative experience and helps individuals look at their readiness for change. (Brad W. Lundahl, Chelsea Kunz, Cynthia Brownell, Derrik Tollefson, and Brian L. Burke 2010). The “spirit of MI” is about empathy, developing a trusting rapport, building self-efficacy, and allowing the individual to come to their own problem solving solutions and conclusion with the MI instructor’s guidance. (Stonerock, Gregory L., Blumenthal, James A. 2017). It was first developed to work in a more clinical setting to aid with individuals suffering from alcoholism but has long reaching applications and has expanded since its onset. (Lundahl, Brad W. et al. 2010). In a metanalysis of 119 studies, across a variety of group types and behavior change goals, there was a statistical significant effect size change across 132 groups. Not only is MI effective in various formats for varying behavior change goals, but it is also designed to speed up the process by developing rapport early on. (Lundahl, Brad W. et al. 2010) MI can help an individual become more mindful of their actions and decisions, help create intrinsic motivation, and provide a social support, all of which can help an individual develop and maintain a physical fitness routine. (Lundahl, Brad W. et al. 2010)
MI has been shown to be effective across a variety of groups in helping create and sustain a movement routine. In a study of 12, low income women, MI sessions had a significant, positive effect on physical activity attendance over the eight week period in which the study took place. (Falahee, M. L., Benkert, R., George, N. M., Brogan Hartlieb, K., & Cederna, J. 2016). Another study looked at 47 individuals who had experience an Acute Coronary Syndrome (ACS). They received MI sessions to help promote physical activity, and found that a positive psychology MI intervention helped individuals achieve higher amounts of walking, as well as more intense activity 24 weeks after the onset of the intervention. (Huffman MD, Jeff C. 2019). In a 16 week MI program to promote physical activity among 70, type 2 diabetes individuals, a medium effect size in increasing these individual’s activity level was found. (Huffman MD, Jeff C. 2021). Another study placed 38 individuals over the age of 75 in a 12 week physical activity program and 32 individuals also over the age of 75 in a physical activity program along with an MI intervention. While statistically insignificant, there was an average increase of 909 steps per day in the group who received the MI intervention. (Larsen, R.T., Korfitsen. 2021). In a study of 30 individuals who had recently experienced a hip fracture, the group who receive an MI intervention took significantly more steps per day with an average of 1,237 more steps per day over the control group. (O’Halloran PD, Shields N, Blackstock F, Wintle E, Taylor NF. 2016). Diseases, health conditions, medical issues, stigma, poverty, can all increase mental health issues. By helping with adherence to a physical activity program, this can help with mental health as well.
Many of these groups also experienced an increase in their mental wellbeing. In the study with 12 women, those who completed three MI sessions instead of two or one session, had a significant increase in exercise self-confidence according to their own self reporting. (Falahee, M. L., et al. 2016). In the study conducted with 47 post ACS individuals, positive affect was shown to improve at 12 week and 24 weeks after the onset of the MI intervention. (Huffman MD, Jeff C. 2019). In a meta-analysis of 11 publication, MI was determined to have a modest effect of the rate of physical activity in those with chronic illnesses. (O’Halloran, Paul D. 2014). In the study focused on elder adults over the age of 75, the group receiving an MI intervention along with the physical activity program rated themselves 2.3 UCLA Loneliness Scale Sum Score less than the group who only received the physical activity program. (Larsen, R.T., Korfitsen. 2021). In the study focused on individuals who experience a hip fracture, MI helped these individuals gain self-efficacy in their ability to walk. (O’Halloran PD, et al. 2016). In an 8 week MI and physical activity program conducted for 56 older individuals with chronic pain, the group who received MI experienced a significant decrease in pain self-efficacy, significant decreases in state anxiety and experienced significantly less depression than the group who did not receive MI according to self-reported scales. (Tse, M.M., Vong, S.K. and Tang, S.K. 2013).
Motivational Interviewing has also been used in studies that specifically focus in on an individual’s mental health. One study took 55 individuals with an anxiety disorder and applied an MI intervention to some while others received no MI before going in to cognitive behavioral therapy (CBT). The study found that there was significant positive effect on the group who received MI before CBT on their out outlook on treatment for their anxiety disorder. (Westra, H.A., Dozois, D.J.A. 2006). By looking at the trends in the data, we can see that MI does help individuals create and maintain a more consistent movement routine. It also appears to help build self- efficacy and an individual’s confidence in one’s self. It also appears to serve as a helpful tool in kickstarting someone’s mental health treatment. By combining MI with a physical activity program, there appears to be a possibility to help individuals experiencing anxiety and depression.
One fascinating study took a group of 57 fathers who had children between the ages of 0 to 4 and placed them in a 6 week program that consisted of a one hour psycho-education and 30 minute workout. The trial surveyed the fathers before and after the study and found that there was a statistically significant decrease in their reported depression, and stress levels. The father reported that they learned a great deal about handling stress as a new father, helped them feel more confident as a parent, and appreciated the peer support from other dads. (Giallo, R., Evens, K., and Williams, L. A. 2018). While this study may not specifically use Motivational Interviewing, it is a view into the idea of how a physical activity program and a mental health program can be combined to work together and create multiple benefits from one program.
Another study involved 12 individuals between the ages of 18-24 experiencing major depressive disorder (MDD) were placed in an MI intervention before a 12 week physical training program. The study found a significant increase in the individuals physical activity self-efficacy. (Y. Nasstasia. 2014). While this study does have a low number of participants, it shows further potential for how individuals experiencing anxiety and depression can benefit from a combined physical activity program along with MI. This study also presents the idea of personal trainers themselves delivering MI techniques. (Y. Nasstasia. 2014). This has the potential to broaden the use of MI, making it more accessible for people to receive MI rather than having to go to a clinician or specific specialist.
Future Research
Currently, much of the research around MI and Physical Activity involves looking at consistency of routine with a potential to look at self-efficacy relating to an individual’s exercise abilities. There is little to no studies that involve personal trainers as the individuals delivering the MI or using “the spirit of MI” during their sessions. This has great potential to serve a larger group of individuals so clients do not need to go to more than one individual and/or don’t need to pay for multiple service. Personal trainers also may already have or are skilled at creating rapport with their clients that may be helpful in further benefiting their mental health. In the article, “Self-Efficacy, Self-Determination, and Self-Regulation: The Role of the Fitness Professional in Social Change Agency”, Joshua M. Garrin discusses how personal trainers can serve more than one role, taking on the part of a role model, a coach, a teacher, and how they can be helpful in teaching their clients about building confidence, self-awareness, body autonomy, and communication skills. Garrin goes on to discuss how personal trainers can serve as a facilitator of social change and can have a large effect on their clients and their community. (Garrin, Joseph M., 2014). One systematic review of 79 studies examined how motivation played a role in physical activity for individuals with severe mental illness and found that there is a lack of specific information that determines how motivate plays a role in physical activity for individuals with SMI. (Farholm, Anders. 2016).
In future research, it would be extremely helpful to look at how a tactic such as motivational interviewing, delivered specifically by a personal trainer, could serve as a moderating factor in strengthening how exercise and physical activity plays a role in improving mental health. One proposed study aims to look at how 68 participants with MDD between the ages of 15 and 25 will respond to a 12 week physical activity program along with an MI intervention. While not concluded, this study has the potential to reveal more information on how an tactic such as MI can be combined with physical fitness to benefit individuals dealing with mental health struggles. (Nasstasia, Yasmina. 2018). Even if a coaching technique like the “spirit of MI” can have a small positive influence in someone’s mental well-being, it could play a critical role in serving as a catalyst in improving someone’s mental health and challenges with anxiety and depression.
