When we ask our clients to adhere to a home exercise program, we’re asking them to make a health behavior change. Often times, clients are given their HEP’s and sent on their way while we hope they’ve absorbed enough of the information that we gave them in a treatment session to self-manage their dysfunction outside of the clinic. However, in order to maximize the potential for compliance, a general understanding of theories behind behavior change is needed to help guide a clinician in education tactics to best meet individual needs. A multitude of studies discuss various theoretical concepts that can be used to identify the most pragmatic strategies for working with clients. The Transtheoretical Model (TTM) and the Health Belief Model (HBM) are two major constructs that we can consider when working with clients. In this two-part series, we’ll start with the TTM.

Behavior change has been studied to illustrate a series of stages occurring often in a nonlinear fashion[1]. To recognize this, the TTM suggests that there are 6 core constructs to behavioral change: pre-contemplation, contemplation, preparation, action, maintenance, and termination. These stages are defined in the table below[1]:

In one example, a study that utilized the TTM in looking at the health behavior change of increasing physical activity to improve metabolic syndrome indicators in women supports the effectiveness of this construct [2]. At 3- and 6-months post-intervention, the researchers found that the group of women that received TTM-based support for behavior change had an increased level of physical activity compared to a control group. According to the results of this study and others similar to it, it appears that a TTM approach may be successful in facilitating health behavior changes.

Just like the individual differences in scar tissue development can impede a post-op recovery, the differences in psychosocial readiness for behavior change can largely impact a patient’s plan of care. What have been your experiences as a clinician working with patients in these various stages of change? What important factors do you consider when prescribing a unique HEP to different patients who might have the same condition? In the next post, we’ll look more closely at the Health Belief Model consider psychological factors behind changing health behaviors.


1.     Prochaska JO, Redding CA, Evers KE. The transtheoretical model and stages of change. 2008:97. http://www.josseybass.com/WileyCDA/WileyTitle/productCd-0470432489.html.
2.     Mostafavi F, Ghofranipour F, Feizi A, Pirzadeh A. Improving physical activity and metabolic syndrome indicators in women: A transtheoretical model???based intervention. Int J Prev Med. 2015;2015-April. doi:10.4103/2008-7802.154382.