ACSM-EP Behavior Change & Client Communication — Questions and Answers

Question 1: A client says, "I bought running shoes and I plan to start jogging with a coworker next week." According to the Transtheoretical Model, which stage best describes this client?

Contemplation
Action
Preparation (Correct answer)
Maintenance

Correct answer: Preparation

The client intends to act within the next 30 days and has taken small preparatory steps, which defines the Preparation stage.

In the Transtheoretical Model, Preparation means the person intends to take action in the near future (typically within 30 days) and has begun small steps such as buying equipment or recruiting a partner. Contemplation is only thinking about change within about 6 months without commitment. Action requires that the person has been doing regular exercise for less than 6 months, and Maintenance requires 6 months or more. Stage-matched coaching in Preparation focuses on finalizing a realistic plan, setting SMART goals, and building confidence.

Question 2: Which response by an exercise physiologist is an example of reflective listening?

"You want to be more active, but your work schedule keeps getting in the way." (Correct answer)
"Why don't you just get up earlier to work out?"
"Did you know exercise lowers your risk of heart disease?"
"Don't worry, you will find the time eventually."

Correct answer: "You want to be more active, but your work schedule keeps getting in the way."

A reflective statement restates the client's own meaning without adding advice or judgment, which is the core of OARS in motivational interviewing.

Reflective listening (the R in OARS: Open questions, Affirmations, Reflections, Summaries) restates what the client said or implied, which shows understanding and invites the client to elaborate. The suggestion to get up earlier is advice-giving (the righting reflex), the heart-disease statement is information given without permission, and the reassurance dismisses the client's concern. Reflections keep the client doing the talking and strengthen rapport and trust.

Question 3: Which of the following is a SMART goal for a previously sedentary client?

"I want to get fitter this year."
"I will try to walk more often."
"I will lose a lot of weight by summer."
"I will walk briskly for 30 minutes on Monday, Wednesday, and Friday after work for the next 8 weeks." (Correct answer)

Correct answer: "I will walk briskly for 30 minutes on Monday, Wednesday, and Friday after work for the next 8 weeks."

Only the last goal is Specific, Measurable, Achievable, Relevant, and Time-bound.

SMART goals are Specific, Measurable, Achievable, Relevant, and Time-bound. The correct option states the behavior (brisk walking), amount (30 minutes, 3 days per week), and time frame (8 weeks), and it is realistic for a sedentary person. The other options are vague or unmeasurable, such as get fitter, try to walk more, or lose a lot of weight. Behavioral goals that the client controls are generally better predictors of adherence than outcome goals.

Question 4: According to Bandura's social cognitive theory, which source of self-efficacy is generally the most powerful?

Verbal persuasion from the exercise professional
Mastery experiences, or successfully performing the behavior (Correct answer)
Vicarious experience from watching others exercise
Physiological and emotional states during exercise

Correct answer: Mastery experiences, or successfully performing the behavior

Mastery experiences, meaning successful personal performance of the behavior, are the strongest source of self-efficacy.

Bandura identified four sources of self-efficacy: mastery experiences, vicarious experiences, verbal persuasion, and physiological/emotional states. Mastery experiences are the strongest because the client has direct evidence of capability. In practice this means starting with achievable tasks (for example 10-minute walks) so the client succeeds early and then progressing gradually. Verbal encouragement and modeling help but are weaker than the client's own successes.

Question 5: A client in the Precontemplation stage does not believe inactivity affects their health. Which process of change is most appropriate to use first?

Reinforcement management
Stimulus control
Consciousness raising with personalized information about the consequences of inactivity (Correct answer)
Written behavioral contracting

Correct answer: Consciousness raising with personalized information about the consequences of inactivity

Early-stage clients benefit from cognitive processes such as consciousness raising, while behavioral processes fit later stages.

Experiential or cognitive processes such as consciousness raising and dramatic relief are most useful in Precontemplation and Contemplation. Behavioral processes, including reinforcement management, stimulus control, and behavioral contracting, are most useful in Preparation, Action, and Maintenance. Offering personalized, nonjudgmental information (for example risk screening results) raises awareness without triggering resistance. Pushing action strategies on a precontemplator usually increases defensiveness.

Question 6: Which client statement is an example of change talk?

"I really want to be able to play with my grandkids without getting winded." (Correct answer)
"I've never been an exercise person."
"I don't see how I could ever fit it into my week."
"My doctor keeps nagging me, but it won't make a difference."

Correct answer: "I really want to be able to play with my grandkids without getting winded."

Statements of desire, ability, reasons, or need to change (DARN) are change talk; the other statements are sustain talk.

In motivational interviewing, change talk includes desire, ability, reasons, and need (DARN), followed by commitment, activation, and taking steps. The grandchildren statement expresses a desire and a reason to change. The other statements express reasons not to change or low confidence, which is sustain talk. The professional elicits and reinforces change talk with open questions and reflections, because clients are more likely to follow through on arguments they voice themselves.

Question 7: According to self-determination theory, satisfying which three basic psychological needs fosters intrinsic motivation for exercise?

Safety, status, and structure
Knowledge, rewards, and accountability
Pleasure, pain avoidance, and social approval
Autonomy, competence, and relatedness (Correct answer)

Correct answer: Autonomy, competence, and relatedness

Self-determination theory identifies autonomy, competence, and relatedness as the needs that support intrinsic motivation.

Self-determination theory holds that motivation is more self-sustained when people feel autonomy (choice and control), competence (feeling capable), and relatedness (connection with others). Practical application includes offering the client choices of activities, setting achievable challenges, and building supportive social connections such as group classes or partners. External rewards alone tend to produce short-lived adherence. The other options are not the three needs described by the theory.

Question 8: A client says, "I would exercise, but the gym is 30 minutes away and the membership is too expensive." Which Health Belief Model construct does this statement represent?

Perceived susceptibility
Perceived barriers (Correct answer)
Cues to action
Perceived severity

Correct answer: Perceived barriers

Travel distance and cost are obstacles to action, which the Health Belief Model calls perceived barriers.

In the Health Belief Model, perceived barriers are the costs or obstacles the person associates with the behavior, including money, time, distance, and discomfort. Perceived susceptibility and severity concern how likely and how serious a health problem seems, and cues to action are triggers such as a reminder or a physician's advice. The coach can respond by problem-solving, for example suggesting a home or neighborhood walking program that costs nothing. Reducing perceived barriers is a key strategy in adherence.

Question 9: After 3 months of regular exercise, a client misses 2 weeks because of illness and says, "I blew it, I'm back to square one." Which response best applies relapse-prevention principles?

Advise taking another month off until motivation returns
Increase the intensity for the first week back to make up for lost time
Normalize the lapse, identify what triggered it, and agree on a plan to resume at a reduced workload (Correct answer)
Suggest the client drop the exercise goal since it did not work

Correct answer: Normalize the lapse, identify what triggered it, and agree on a plan to resume at a reduced workload

Relapse prevention treats a lapse as a temporary setback, analyzes the trigger, and plans a graded return.

Relapse prevention teaches clients to anticipate high-risk situations, view a lapse as a learning opportunity rather than a failure (countering the abstinence violation effect), and recover quickly. After about 2 weeks off, resuming at a reduced volume and intensity is safer than jumping back in at the previous level or making up lost time. Waiting for motivation or abandoning the goal turns a lapse into a full relapse. The coach also reviews the plan with the client so they know what to do next time.

ACSM-EP Behavior Change & Client Communication

A client says, "I bought running shoes and I plan to start jogging with a coworker next week." According to the Transtheoretical Model, which stage best describes this client?

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