*UPDATE* Psychological Effects of Heart Rate Monitor Use Study

12/21/2010: Preliminary results were reported at Indoor Cycle Instructor in October 2010. Manuscript in preparation. Once published, results will be made available on this site and at ICI.

Sunday, September 6, 2009

"To Intervene or Not Intervene: That is the Question. See also: The Perils & Pleasures of Correcting Form

Could my title have been more obnoxiously complicated? Maybe. But it's fitting for the topic at hand: thoughts on when/how to correct form in Spinning classes.

In the interim since I've last written, I've been spending less time training for epic bike feats (my race did go well, exactly according to my training plan in my last post, despite wiping out 100' from the finish line and bloodily dragging my bike and its broken chain the rest of the way -- I was actually SO pleased with the way I landed) and more time training for that whole "being a doctor" thing. I did, however, resume teaching Spinning classes for the first time in 2 months (the longest I've ever been away in my coaching career -- and to be honest, I'm a little stale. Ick.)

The weekend before my Burlington classes started for the semester (I teach on a college campus, so group fitness classes go according to the academic calendar), I *drove* to NYC for 14 hours and taught my old Sunday AM class. (Yes, I drove into Manhattan proper. I was SO proud.) The aesthetics of NYC Spinning studios (lighting, sound, general ambiance) can be quite powerful, if maximized to their potential. I happen to be good at that, which hid my staleness until I psychologically/emotionally warmed up to the task at hand. But as a sub (I moved a year ago -- though some regulars flocked when I announced my return, most of my "old class" isn't really my class), I was mindful of how stuck I was about correcting form.

Though I cued general form tips, there were more extensive interventions that I would have liked to pursue. But didn't. Were they dire safety issues? No. But could they have improved someone's efficiency and/or comfort? Absolutely. Did I feel like, as a sub, I had enough "street cred" to effect change? No. Hence my silence.

On the morning of my first class back in Burlington, the New York Times ran a pseudo-interesting article about trainer and participant perceptions of feedback on form. It didn't say anything ground-breaking. It's common sense that there is a continuum of effective feedback, and a continuum of how people perceive feedback. But there were a couple of comments that reminded me of a theme I try to bring to my coaching all the time -- that is, gauging people's goals and expectations -- yet often forget to apply to the issue of form.

A few months ago, I wrote on my other blog about an experience I had (as a sub, no less) in intervening into what I deemed a safety issue in a Spinning class I was teaching. Though I felt intimidated and ineffective, I reminded myself of my commitment to this theme of identifying people's values and educating them about framing various choices in the context of those values. Choosing a medication, a surgery, a heart rate training zone, a handlebar height, an angle of an SPD cleat, a pelvic tilt, a knee alignment -- they're all the same. That's always what every choice is about.

I feel strongly enough sharing the above-linked post (which presents this story as part of a larger point about synergy between my "medical student" and "coach" worlds) that I'll excerpt part of it:

The other day, a woman in an NYC class I subbed was executing all kinds of safety-contraindicated stuff: mashing her legs, cranking the resistance too heavy to even turn the flywheel, letting go of the handlebars. As a life policy, my interventions begin with general guidance to the group. This is usually sufficient; "offenders" often hear what I say, appreciate the inconsistency between what they hear and what they are doing, and make the appropriate adjustments. If this fails, I describe my corrections in alternate ways. If this still fails AND I think this is a major safety risk, I mute my mic and approach this person individually. As a sub, my threshold for individual intervention is pretty high -- I'm more concerned with pissing people off and inspiring them to cause a scene. So after 6 or 7 "group" interventions and very unambiguous "this pertains to you" signaling, I gave up. I knew that speaking to her privately during class would likely alienate her, and wouldn't actually have an impact on her training practices once I walked out of the room and out of her world.

I couldn't make a difference, so why bother? I gave up on her.

Then I remembered that I wasn't wearing a particular "hat." I was just ME, the cycling coach who knows what the hell she's talking about, who also just so happens to be training as a physician. Time to start acting like one.

I'd given up on this rider who ignored my educational pleas for health and safety. Just like a doctor giving up on an obese, hypertensive patient with Type II diabetes who eats terrible, drinks too much alcohol, smokes, and doesn't take his or her meds. That's what I just did. I didn't find a way to connect, so I blamed this woman as "refractory to cues." No. I just didn't find the right cues. Yet.

At the clinic where I'm working this summer, I'm running a survey that examines patient attitudes towards medications, taking medications, their involvement in their treatment plans, etc. I included an open-ended question that probes patients' reasons for skipping doses of meds. It was my goal to demonstrate that mismatches between patients' goals/values and the regimens prescribed by their providers, or misunderstandings/miscommunications mattered. That calling this phenomenon "non-compliance" is a cop-out -- and that by asking people a really basic question about their obstacles to a desired outcome, we can learn from this and improve said outcome.

Could I apply what comes so naturally to me in medicine... here?

After class, I approached her.
"Hey, I notice you have really strong legs and a great pedal stroke," I said to the woman.
Her eyes perked up.
"But let me ask you something. I notice that you often let go of the handlebar. I'm always interested in the thought process of the people who take my classes -- when you do that, what goes through your mind?"
"Oh, well, I'm pregnant -- and I don't like reaching over. It's uncomfortable."

Really? That's all this was about? Turns out, "non-compliance" doesn't exist on a Spin bike either.

Now I understood her obstacles to heeding the information I presented; now I knew how to frame my message in a way that was consistent with her values. I showed her how to raise the handlebars so that she could hold on without hinging forward too far, and educated her about how riding without holding on places undue strain on her lower and middle back. We then had a lovely conversation about exercise intensity and pregnancy and... get this... heart rate monitoring. By the end of those 5 minutes, she really would not ONLY always hold onto the handlebar (my goal) -- but would be investing in a heart rate monitor, and thus investing in her health and that of her future child.

It was an important reminder on what can happen with a commitment to not giving up on people. It's tempting to detach, to focus one's energy on causes more likely to yield the greatest impact. But the likelihood of impact is also inextricably linked to one's belief in one's ability to have that impact. Like anything else, it's all in the way one talks to oneself.

Take-home points?
1) Believe that fine-tuning form is important.
I will refer to you two previous posts:
"Do Your Riders Know Why They're Riding?" --
details the merits of explaining each and every form cue, and includes a ride profile based on educating people about why various aspects of their form matter. I forgot this exists, and I'm going to use it in my class on Tuesday. Sweet: one less new ride to make.

"Practical Applications of Life on a Spin Bike"
-- where I described super-subtle changes I made to my form (pelvic tilt, wrist rotation, seat adjustment) that made LIFE-ALTERING changes in my ability to comfortably ride my first 70-mile and 107-mile rides outside. Just want to demonstrate that subtleties in form TOTALLY matter.

2) Believe that you are a useful and knowledgeable resource.
As a medical student, I struggle with this issue every day of my life. I spend so much time mindfully acknowledging that I know very little in the big scheme of things, and that I haven't actively earned many of the privileges bestowed upon me to learn them (i.e., the generosity of patients allowing me to practice rectal and vaginal exams) that it often distracts me from learning. But as a coach, 99% of the time I genuinely believe that what comes out of my mouth is informed, precise, and useful. When I am in that 1% mentality, that's when I don't speak up about form.

I refer you to a really long/verbose/annoying but probably one of the best posts I've ever written:
Trust Your Judgment: Evaluating Yourself... and Evaluating Others - describes my evolution from an unconfident "newbie" to a more confident, more effective (though, of course, always still evolving) coach, and suggests a few parameters for evaluating influences to which you are exposed.

3) Find multiple different ways of describing the same form cue
I took a FABULOUS, FABULOUS workshop at WSSC 2008 with Luciana Marcial-Vinson about identifying your most frequently (over)used cues and brainstorming alternatives to them. At that time, I hadn't realized how stale my cues were. Going through the process of physically writing down the things I said all the time was scary and occasionally horrifying. But by forcing myself to own my staleness, I could commit to improvement.

Common sense suggests that people respond to different things -- one way might "click" for someone and mean nothing to something else. So when we say the same thing all the time, there may be people falling through the cracks. If we deliver the same concept in multiple different ways, we have an increased likelihood of "reaching" more people. So where do you get your cues? The creative process can be accomplished in SO many different ways: Take continuing ed workshops. Take other instructors' classes. Read blogs and books and websites. Ride by yourself and think about the subtleties of what you're doing. Spend 10 minutes just being THOUGHTFUL, and you will come up with beyond-useful material.

4) Ask the questions.
I'm taught in medical school that 95% of diagnoses come from the patient's history. Not fancy lab or imaging tests -- just by asking subtle questions, and listening to what a patient tells you (and does not tell you). I think about that as a coach, too. The story I cited above in asking the "cue-refractory" woman who would NOT hold onto the handlebar about how she came to make that decision, I learned that she thought she was accomplishing x goal (i.e., avoiding discomfort in pregnancy). When I learned that, I could educate her about different means to accomplish x goal safely (i.e., raising her handlebars) AND how what she was doing wasn't actually having the desired effect she intended. Had I never asked the question, I would never have been prompted to educate her about those specific points. By asking the question, I made my feedback relevant.

Putting this all together:
Basic Cue: "Keep your feet nice and flat. Drop your heel as you pull back on the pedal, keeping your toes straight ahead."

Improvement #1: Tell Them Why
"By dropping your heel, you engage the muscles in the back of your leg for a more powerful pedal stroke."

Improvement #2: Make It Relevant
"Here's why we care about a powerful and efficient pedal stroke..." -- be sure to include relevancy for both outdoor and non-outdoor riders

Improvement #3: Alternate Description

"Think about a magnet on your heel. The floor is metal. Allow your heel to be drawn towards the floor, and pull up against that force to bring your heel towards your butt."

Improvement #4: "Intervention"
"I notice that [insert some sort of positive, empowering feedback]. That's awesome. I notice that you're pointing your toes a bit -- does it feel that way to you/are you aware that that's happening? If yes: What were you hoping to achieve by doing that, so that I can help you find a way to think about it. If no: Yeah, most people can't tell. I figured it was accidental. Here are some ways you can think about it instead, and here's why it matters..."

I need to stop writing massive blog novels when I'm supposed to be studying. I think *I* need an intervention.

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