154SECT|oN‖· WHAT TO DO W| TH THE|NF○RMAT|ON history of a number of disease processes and possibly even obviate the need for therapeutic interventions. As mentioned earlier, the presence of these diseases may well bccomc a motivational factor in convincing a nonexerciscr to get started. Regular exercise in high-risk patients is beyond the scope of this chapter. However, it is important to stress that in initiating exercise such patients must follow a slow, gradual, and careful regimen with close medical supervision COUNSELING Getting Started GOAL SETTING In most cases, the first subject to discuss with patients is goal setting: why is the patient thinking about regular exercise? It may be because the clinician suggested it, but virtually no one becomes and remains a regular exerciser simply because they are told to do so. To succeed, the patient must mobilize internal motivation. What goals does the patient want to achieve, and why? Specifically, does the patient want to become fit, lose weight, look better and feel better, reduce future risk of various diseases and conditions, or join a friend or family member in a race? In both starting and staying with a regular exercise program, it is very helpful if patients have a good grasp of just why they are doing it in the first place. The same list can be used in the process of motivational interviewing with patients who are not yet prepared to make health-promoting lifestyle changes. Chapter 5 provides additional information about motivational interviewing and also discusses the"stages of change""delineated in Prochaska's Transtheoretical Model: precontemplation, contemplation, Preparation, action, and maintenance(see pages 132-133). For patients currently in the precontemplation or contemplation stages of change, addressing the questions mentioned earlier may be helpful to patients in advancing to the next stage REALISM The clinician should counsel patients to set realistic goals and define success for themselves. a good formulation of this concept is to explore your limits and recognize your limitations. " Consider the example of endurance versus speed After some reasonable period of training, say 3-4 months, most people can improve endurance, but they may not be able to improve their speed. Speed is the product of speed-specific training plus natural ability. Many people will be able to train fairly easily for endurance, because for most people endurance is not simply the product of natural ability. On the other hand, because natural ability is such an important element in speed, many exercisers will not be able to improve their speed no matter how hard they try. Clinicians should stress