Sara Hodson told me that she read my book No Sweat after she heard me speak at the American College of Sports Medicine conference — a few years after launching her first Live Well Exercise Clinic in Vancouver, British Columbia. Live Well is a medical fitness clinic specializing in supervised exercise and healthy lifestyle coaching for people with chronic diseases such as diabetes, heart disease, and obesity, as well as for prevention.
Sara decided to implement a traditional strategy used in fitness gyms and clubs — reducing membership fees by 5% if members committed for 6 months, and 10% if they committed for 1 year, financial incentives that are notorious for getting members to sign up but don’t motivate long-term.
She understood those limitations, and wanted to genuinely boost retention and adherence in her patient-based clientele. We spoke after my presentation and Sara shared that she was intrigued by the idea that she might be able to help her patients sustain their motivation to exercise by making only a few simple strategic changes. Sara not only adopted some of the key science-based principles from No Sweat, but she astutely integrated them into her entire patient-centered system — starting from the moment the patient walks in the door.
Three concepts in particular from No Sweat guided her Live Well strategy:

• Clients are immediately taught to be aware of the instant gratification that moving brings, such as boosts in energy and mood.
• Her exercise professionals help patients understand and formulate their own Right WHY for exercise (to replace a “should” with a meaningful “want”).
• They help patients learn “sustainability training” strategies that enable them to navigate exercise challenges within their complex lives outside the clinic.

While I had been excited about her systematic approach to integrating these principles across the patient experience and education, what blew me away was the results she shared with about patient behavior and business growth over the past year that she attributed to integrating these principles from No Sweat into her exercise clinic.
In the year that Live Well had been testing out the No Sweat strategies, patient retention rates had improved exponentially:

• Three months after joining, patient retention rates increased from 64% to 97%.
• Six months after joining, patient retention rates increased from 51% to 84%.
• One year after joining, patient retention rates increased from 38% to 71%.

Starting with just one clinic in 2011, Sarah also told me about the accelerated growth her business is experiencing – “We now have five clinics in the Greater Vancouver Area and are opening an additional 15 all over Canada in the next six to nine months.”
Sarah’s findings align with what I have learned in the 25 years I’ve spent studying the science about and creating and evaluating methods for creating sustainable behavior change: If you want to start achieving sustainable behavior change in consumers, patients, and employees, you need to create a systematic integration of the most relevant and powerful science-based principles into training, programs and protocols, and algorithms for behavior design.
It’s not just about using one, two, or three strategies in isolation or haphazardly, as many do when trying to design behavior change. Instead – whether through an app, health-behavior counseling protocol, or employee well-being program – I advise my organizational clients to strategically integrate these principles into every point of contact. The point is to create a cohesive and consistent system of messaging and methods that continuously reinforces behavior change so it can be sustained.
This type of strategic behavioral architecting and implementation might take longer and be more costly up front, in terms of the need to develop systems across all points of the business (yes, including onboarding and sales in addition to the more traditional staff training). Yet this comprehensive and consistent approach is what will truly reap the best outcomes, including high-quality motivation, behavioral sustainability, well-being, and key health- and well-being-related outcomes. It reflects the often-touted (by myself and many others!) advice “Start with the end in mind.”
Getting people to change their behavior for a while is easy. It’s sustaining a behavior change that needs our attention. Cultivating the right set of scientifically supported principles in systematic ways will help you achieve this essential outcome.
If you have been applying these ideas in your organization or work, I’d love to learn more about what you are finding.