Motivational Interviewing in the Fitness World
Motivational interviewing to increase physical activity in people with chronic health conditions: a systematic review and meta-analysis written by O’Halloran, Blackstock, Shields, Holland, Iles, et al. first appeared in Clinical Rehabilitation in 2014. The article examines 11 varying publications looking over 10 different trials which researched the effects of motivational interviewing in creating a fitness routine. The article reviewed scholarly work that focused on populations with chronic health conditions that includes fibromyalgia, hypertension, obesity, cardiovascular conditions, and multiple sclerosis. The authors then categorized findings into three categories consisting of physical activity, cardiorespiratory fitness, and functional exercise capacity. Through meta-analysis, the article concluded that motivational interviewing has modest effects on improving physical fitness adherence.
This systematic review used multiple data bases to search for previously completed research on motivational interviewing in combination with physical fitness change in individuals with chronic health conditions. In order to be eligible to be part of the meta-analysis, the population had to be over the age of 18, and had to be diagnosed with a chronic health condition “defined as a long-term condition with pathophysiological changes or a mental health condition you would expect to be managed by medical practitioner or allied health professional.” (pg.1161). The studies needed to include motivational interviewing which had a focus on behavior change, empathetic listening, and emphasis on evoking motivation. The outcomes of these studies involved in this meta-analysis must have measured results in physical activity, cardiorespiratory fitness, or functional exercise capacity. Motivational interviewing was mainly delivered through face to face or telephone communication. The number of sessions ranged from 1-11 during the various trials. There was variation in who delivered the motivational interviewing in each of the trials. In terms of bias, nine trials were moderate and one was rated high in quality. The outcome findings showed that “there was moderate level evidence that motivational interviewing increased physical activity levels for people with health conditions with a small but significant effect observed immediately following the intervention”. (1167) In terms of cardiorespiratory fitness, “very low evidence indicated no effect of intervention”. (1163) And in terms of functional exercise capacity, “no significant difference between the groups were observed with the meta-analysis”(1167) however, there was a significant positive effect of motivational interviewing when participants show physical activity as their goal behavior change prior to the randomization of the trial. The conclusion of this systematic review determined that there is evidence for a small positive effect on motivational interviewing on self-reported physical activity in people with chronic health conditions. There is also evidence to support that the outcome to have a higher effect change when there was a higher participation in motivational interviewing. Evidence did not show a difference between face to face or in person delivery of motivational interviewing.
One issue that this meta-analysis addresses is that the trials do not go into detail about the fidelity of treatment for conditions being treated. This could have a potential effect on the outcome of the results. Another limitation stated is that many of the trials used in this analysis used self-reporting measures which can often be overestimated. This could falsely inflate the effectiveness of motivational interviewing on physical fitness adherence. Another limitation exists due to the fact that these trials include varying conditions and diseases which affect individuals differently.
There are many other limiting issues not addresses in this meta-analysis as well. The analysis of these trails seems to do an overall good job of creating set standards, decreasing bias and pooling together the best available data. This issue seems to be in the original creation of the data. One issue is that there seems to be a varying amounts of motivational interviewing sessions given, 1-11 person, that is used within a time range of anywhere between 3-18 months. It would be really great to see more trials and experiments conducted with a longer term timeline, somewhere between 6-24 months. When creating a habit change such as a physical fitness routine, it is quite important to have a long term mentality rather than a short term mentality. Short term experiments may be able to create adherence within a small amount of time, but may fail in the longer term in creating a habit change that sticks beyond the trial. A longer term habit change plan is likely to have times where adherence moves up and down, but in the end, is able to be more consistent. More consistency and exposures of Motivational interviewing would also be helpful in creating more adherence. It would be beneficial to see how many sessions were conducted within a certain period of time. For example, is someone having a session once or twice a week? A month? Or just once overall? It could be very interesting to see a trial created with varying amounts of motivational interviewing sessions and how that translates to optimal adherence. It is possible the trial would find there could be a point where there is too much motivational interviewing and a point where there isn’t enough.
One question the trials do not focus in on is who the motivational interviewing sessions are being conducted by. This could be crucial in creating adherence. Are these session being conducted by a specialist, a medical professional, a trainer, or coach? While motivational interviewing could be used by all of these individuals, it could have an effect on how the person adheres to a fitness program. It would be very interesting to see coaches and personal trainers use motivational interviewing and how that would help adherence in physical activity.
An important question that is not addressed in these trials, nor the meta-analysis of someone interest in physical activity before the start of the trial. Nor does it speak about if the participants have choices in what kinds of fitness they participate in. This could have a great deal of effect on the results. If someone does not have a big interest in running, yet the trial is trying to use motivational interviewing to have an individual adhere to a running program, it is very unlikely the trial will yield great long term results. However, if someone hates running, but loves lifting weights, or has an interest in learning to lift weights, that could have a dramatic effect on the adherence of a physical fitness program. It would be very interesting to measure participants enjoyment of different activities when they begin the trail and see if that enjoyment changes throughout the process and what their enjoyment is at the end. It would further be beneficial to see how their enjoyment of an activity affected what activity they chose to participate in, or how being able to choose an activity or range of activities versus being assigned an activity would affect adherence.
Another topic to discuss is how the term adherence is defined. Often times in a trial, adherence for a physical fitness program might be set as participating for a set amount of minutes a set amount of times per week. For example, the participant completes 60 minutes of vigorous activity 2-3 times per week. Using the spirit of MI, it could be very interesting to create a trial that bases adherence on a more personal level than the same amount of time across the board for everyone. Through motivational interviewing, participants could create their own goals on consistency for a physical fitness program, and adherence could be based upon the person’s goals that each individual sets upon for themselves. For example, one person may decide they want to complete a fitness program that allows them to lift weights 3 times a week for 30 minutes and jog 2 times a week for 20 minutes while another individual decides to lift weights for 90 minutes 3 times per week and another person decides to dance 2 times per week for 60 minutes and lift light weights 2 times per week for 45 minutes. While there would be a difference in what the adherence is from person to person, it could potentially show more reflection on how motivational interviewing can work. The goal of motivational interviewing is to find the goal that best fits the individual instead of finding a way to fit the individual to the goal. The results could be based upon a percentage of completion in consistency. By figuring out a goal through motivational interviewing and then testing the adherence you would be getting a better idea of the all-around effectiveness of motivational interviewing on creating and sustaining fitness goals as opposed to simply trying to get participants to accomplish a narrow view of a goal.
Lastly, the meta-analysis speaks somewhat about the differences in conditions used in each of these trials as well as the lack of information known on the fidelity of the participants’ treatment plans. It would also be beneficial to elaborate and discuss more on how varying diseases and conditions effect physical fitness abilities and adherence. Someone experiencing fibromyalgia is going to have a very different experience than someone with mild hypertension. A discussion around how these conditions play into someone’s pain level and mental health and how it affects adherence could also elaborate more on someone’s full extent as to why some participants may be more adherent than others. The category of obesity, should not even be considered a medical condition on its own as there are plenty of individuals in larger bodies without any medical conditions.
Overall, this meta-analysis of 11 articles covering 10 studies does a sufficient job of gathering and analyzing the data provided. Since Motivational Interviewing being used for physical fitness adherence is still a relatively new practice, there is still a lot of research to be done with more trials covering a wider array of needs.
