Most of us can build a solid programme and write a nutrition plan that makes sense for the client sitting in front of us. The harder question, and the one that comes up more and more the longer you coach, is what do you do when that client knows exactly what they should be doing and still isn’t doing it? It’s the difference between technical coaching and behaviour-change coaching, and it’s exactly where motivational interviewing comes in.
Motivational interviewing (MI for short) is a structured, evidence-backed style of coaching conversation that helps clients find their own reasons to change, rather than being given ours. The recent research on MI has shifted the conversation more in eighteen months than in the previous decade. For PTs, MI is the single most research-backed communication framework you can add next. It’s the mark of a coach who doesn’t just prescribe exercise but genuinely makes a difference to client behaviour.
What Motivational Interviewing Actually Is
MI was developed by clinical psychologists William R. Miller and Stephen Rollnick back in the early 1980s, originally for work with clients struggling with addiction. It’s now used widely across healthcare, physical therapy and increasingly in personal training. At its core, MI is a collaborative, goal-oriented style of communication designed to draw out and strengthen a person’s own motivation for change.
If that sounds a bit abstract, here’s the quick version of what it isn’t. It isn’t advice-giving dressed up with a smile. It isn’t motivational speaking in the gym-floor sense. It isn’t a checklist of questions you fire off at a client consultation. MI is a skillset built around listening carefully, reflecting skilfully, guiding rather than telling and helping the client articulate their own change talk. Skilled MI practitioners often say less, not more, than the average coach.
Why the Recent Evidence Is a Step Change
The case for adding MI to your coaching has always been intuitive. What’s new is that the last two years have produced the strongest evidence base we’ve ever had.
The first noteworthy study is Zhu et al. (2024), a systematic review and meta-analysis published in the BMJ. The team pooled 129 randomised trials covering adults across a broad range of health conditions and compared MI-based behavioural interventions against usual care. The headline finding was that MI produced significant increases in physical activity outcomes, with the effect holding up across different delivery formats, population types and intervention lengths. The research was large enough and the effect size big enough that the authors recommended MI as a first-line communication framework for clinicians aiming to influence physical activity.
A more targeted piece of work came from Wintle et al. (2025) in the Brazilian Journal of Physical Therapy. This one looked specifically at practitioner-delivered MI, across nine randomised controlled trials involving over 900 participants. The findings were very clear: practitioner-delivered MI produced measurable increases in physical activity compared with minimal intervention. For coaches this is the most directly relevant evidence, because the “practitioner” in that review is a face-to-face allied health professional, the closest clinical analogue to how most of us actually work.
Takemura et al. (2024), published in Worldviews on Evidence-Based Nursing, took the same question into cancer survivorship. Across trials of adults living with or recovering from cancer, motivational strategies (with MI as the dominant framework) improved physical activity behaviour and associated outcomes such as fatigue and quality of life. The signal is useful because it shows MI works in populations where motivation is often fragile and clients carry a heavy psychological load.
Finally, the landmark clinical RCT of the year is Taylor et al. (2025) in the Lancet Healthy Longevity. A multisite, open-label randomised controlled trial across three Australian health networks delivered telephone-based MI to community-dwelling older adults after hip fracture and tracked physical activity at twelve months. This is a high-bar study: a real-world population, a serious clinical context and a long follow-up window. MI produced significant benefits in physical activity and self-reported mobility compared with usual care.
Stepping back, what these four studies tell us is that MI is no longer a “nice to have”. Across large adult populations, practitioner-delivered contexts, cancer survivorship and post-hip-fracture rehab, it has a consistent and measurable effect on behaviour change. For a coach building a career, that’s a powerful credential to sit alongside your programming skills.
The Four Core Processes
MI isn’t a single technique. It’s a flow of four overlapping processes that structure the coaching conversation. Miller and Rollnick call them Engaging, Focusing, Evoking and Planning.
Engaging is the work of building the relationship. Rapport first, agenda second. In a PT context this is where most coaches already do well: the intake conversation, the warmth, the genuine interest in the client’s life outside the gym.
Focusing is where MI starts to look different from how most of us were taught. Rather than you deciding the session’s goal or setting a target based on your programme template, you guide the client towards identifying what they want to work on, within the scope of what you can help with. This keeps the change agenda theirs, not yours.
Evoking is the heart of MI. It’s the work of drawing out the client’s own reasons for change. Counter-intuitively this often means resisting the urge to advise. You ask what they would gain from the change, what concerns they have about staying the same, what they’ve tried before and what they learned from it. You listen for what’s called change talk, the language a client uses when they’re starting to move towards change rather than away from it.
Planning is where you shift from drawing out to action. Once change talk is clear and the client is signalling readiness, you collaborate on the specific steps. Jump into planning too early and you get nodded compliance, not commitment.
The OARS Skills
Within those four processes sits a toolkit of four core communication skills, remembered by the acronym OARS: Open questions, Affirmations, Reflections and Summaries.
Open questions are questions that can’t be answered with a yes or a no. “How has your training week been?” rather than “Did you hit your workouts?”. Open questions invite elaboration and surface far more useful information.
Affirmations recognise a client’s strengths and efforts, specifically and genuinely. “You’ve juggled two night shifts and still got three sessions in, that’s a lot of self-discipline” lands far better than a generic “well done”.
Reflections are the workhorse of MI. A reflection is a statement that captures what the client has just said, often with a slight shift that invites them to deepen the thought. “So the weekends are where it tends to come apart” might be a simple reflection. “It sounds like you’re okay in the structure of the week but weekends feel harder to stay in control of” is a more complex reflection. Skilled MI practitioners reflect at least twice as often as they ask questions.
Summaries are longer reflections that tie together what’s been said over the course of a conversation. They’re especially useful at the end of a session or when a client is starting to tangle themselves up. A good summary highlights the change talk the client has offered, gently and without commentary.
Working With Ambivalence
One of MI’s most useful ideas is that ambivalence about change isn’t a sign of weakness or stubbornness, it’s a normal human state. Most clients who come to us for coaching are genuinely torn. They want the results and they want the life they already have. The job of the coach is to help them work through that ambivalence rather than push against it.
A short everyday example would be: A client tells you they keep meaning to meal prep on Sundays but they never quite get round to it. Most of us are tempted to offer a tip, a template or a nudge. An MI-trained coach might instead say “Sunday prep feels like the right idea but something keeps getting in the way. What’s that something?”. Now the client does the work of articulating what’s actually blocking them. Nine times out of ten they’ll uncover a much more useful insight than any tip would have given them.
MI in Practice: Two Coaching Scripts
Here’s what this can sound like in a real coaching context.
Script one: the ambivalent intake. New client, mid-forties, been inactive for years, has come in because their GP has said something about blood pressure.
Coach: “So you’ve come along today. What’s brought you in at this point?”
Client: “I know I need to do something, I’ve just never been great at sticking with it.”
Coach: “You’ve tried before and it hasn’t quite held. What did you learn from those earlier tries?”
Client: “That I start strong and then life gets in the way.”
Coach: “So what’s different this time that makes you think it’s worth another go?”
Notice what’s not happening. No speech about the health risks of inactivity. No “don’t worry, we’ll sort you out”. No prescribing. The coach is quietly helping the client surface their own reasons.
Script two: the stalled mid-programme client. Three months in, progress has flattened, sessions are still being attended but the energy has gone out of them.
Coach: “You’ve been coming in, you’re turning up, but the last few sessions have felt a bit flat. What’s going on?”
Client: “I don’t know. I think I’ve lost the why a bit.”
Coach: “You’ve lost the why. When you think back to when you started, what was the why?”
Client: “Honestly, I wanted to feel strong again. I used to, and I haven’t for years.”
Coach: “And right now, how close to that do you feel?”
Again, no pep talk, no new programme rolled out on the spot. The client is doing the reconnecting and the coach is guiding it.
How Quickly You Can Build This
The good news is that MI is a learnable skill with a fairly steep early learning curve. Most practitioners see noticeable improvements in their client conversations within the first twenty or so deliberately MI-guided sessions. The research on clinician training suggests that short structured training, ideally with feedback on recorded sessions, produces durable improvements in skill. You don’t need a psychology degree. You do need the willingness to talk less, listen more and tolerate short silences while clients think.
Where This Sits in a Coaching Career
If you are already a qualified fitness professional, adding MI is one of the cleanest upgrades you can make to your skillset. It slots naturally alongside your existing programming, nutrition and consultation skills and it’s the layer that enhances your existing skills. Clients who feel heard, who arrive at their own reasons for change and who co-author their plans stick with coaching longer, work harder and recommend you to more people.
For coaches already pursuing a Specialist or Master Diploma, MI is the kind of advanced coaching skill that genuinely differentiates a career-long professional from a competent beginner. It’s also directly transferable into adjacent markets like health coaching, behaviour-change consultancy and executive wellness, where communication skill is what sells.
And if you’re curious about the broader coaching skillset that sits around MI, a dedicated life coaching qualification is the natural next step. MI is a specialist communication framework within coaching, and knowing the wider map of coaching skills is what makes you confident at picking the right approach for each client.
Reference
- Takemura, N., Cheung, D.S.T., Fong, D.Y.T., Chau, P.H. and Lin, C.-C. (2024). Effectiveness of motivational strategies on physical activity behavior and associated outcomes in patients with cancer: a systematic review and meta-analysis. Worldviews on Evidence-Based Nursing, 21(4), pp. 428-439. Click here to review the full research article.
- Taylor, N.F., Harding, K.E., Dennett, A.M., Febrey, S., Warmoth, K., Hall, A.J., Prendergast, L.A. and Peiris, C.L. (2025). The effect of motivational interviewing on physical activity after hip fracture: a multisite, open-label, randomised controlled trial in Australia. The Lancet Healthy Longevity, 6(10), 100779. Click here to review the full research article.
- Wintle, E., Sennett, C., Ash, G.I., Taylor, N.F. and Peiris, C.L. (2025). Physical therapist-delivered motivational interviewing and health-related behaviour change: a systematic review and meta-analysis. Brazilian Journal of Physical Therapy, 29(1), 101165. Click here to review the full research article.
- Zhu, S., Hardeman, W., Boyd, K., Crouch, R., Ferguson, E., Mitchell, E., Thorn, J. and Kendrick, T. (2024). Effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes in adults: systematic review and meta-analysis. BMJ, 386, e078242. Click here to review the full research article.
Ready to Add MI to Your Coaching Toolkit?
If this article has got you thinking about how you’d bring MI into your own client conversations, the PT Practitioner, Specialist and Master Diplomas are the clearest route to building this into a career. MI sits at the intersection of fitness coaching and behaviour change, and the Practitioner Diploma gives you the exercise, nutrition and coaching foundations to put it to work from day one, whatever format suits your life (In-Person, Distance or Live-Virtual).
To take it further, the Specialist and Master Diplomas build on the Practitioner with advanced programming, client-psychology and assessment skills that let you work with more complex populations and more premium clients. And with any PT Diploma this week, you’ll also get our Life Coaching Course worth £399 completely free. That gives you a structured introduction to the broader coaching skillset that sits around MI, so you can choose the right approach for each client you see.
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