Chapter 13:CONCLUSIONS AND FUTURE

DEVELOPMENTSBringing it all together

Determinants of physical activity: Descriptive approaches 1

• Concerning largely descriptive approaches to the study of determinants, we conclude:

• a minority of people in industrialised countries are sufficiently physically active to have a beneficial effect on their health

• a greater understanding of the determinants (correlates) of involvement in exercise and physical activity is therefore needed

• descriptive research on participation motives has tended to reflect motives for children's involvement in sport and adult's involvement in exercise and recreational physical activity

Determinants of physical activity: Descriptive approaches 2

• for children and youth common motives are fun, skill development, affiliation, fitness, success and challenge

• for adults, motives change across stages of the lifecycle

• younger adults are motivated by challenge, skill development and fitness

• older adults are interested in participation for reasons of health, relaxation and enjoyment

Determinants of physical activity: Descriptive approaches 3

• key barriers are lack of time and, for young people, issues of safety and feelings of incompetence

• correlates of sedentary behaviour in the form of TV viewing can be identified, but they are largely non-modifiable

Determinants of physical activity:

Comments on descriptive approaches

• Descriptive studies of determinants (correlates) are valuable but must lead to better informed interventions or policy

• Widening the approach to include different research methods and behaviours (e.g., sedentary behaviours) is required.

Determinants of physical activity: Theoretical approaches 1

• the Theory of Reasoned Action (TRA) has consistently predicted exercise intentions and behaviour across diverse settings and samples

• attitude accounts for about 30-40% of the variance in intentions

• social norm is only weakly associated with intentions• the Theory of Planned Behaviour (TPB) appears to

add to the predictive utility of the TRA in physical activity

• perceived behavioural control has been shown to account for 36% of the variance in intentions

Determinants of physical activity: Theoretical approaches 2

• both TRA and TPB models are limited by their focus on conscious decision-making through cognitive processes

• they are essentially static and uni-dimensional approaches

• the prediction of physical activity from intentions may depend on the proximity of measurement of these two variables

• the TRA and TPB have, however, been the most successful approaches in exercise psychology linking attitudes and related variables to intentions and participation

• intentions share about 30% of the variance in physical activity assessment

Determinants of physical activity: Theoretical approaches 3

• The Health Belief Model (HBM) has been shown to be a reasonably effective integrating social psychological framework for understanding health decision-making

• But the HBM in physical activity settings has not been supported

• The Health Action Process Approach allows for a distinction between a motivation phase and a volition/post-decision phase of health behaviour change

• It is a ‘hybrid’ model combining aspects of intention-behaviour links (continuous) and stage-based models

Determinants of physical activity: Theoretical approaches 4

• Translating intentions into behaviour is a key challenge

• Implementation intentions are self regulatory strategies that involve the formation of specific plans that specify when, how, and where performance of behaviour will take place

• They are likely to be effective in promoting physical activity behaviour

Determinants of physical activity: Theoretical approaches 5

• Self-Determination Theory is an important perspective for the study of motivation in physical activity and is likely to increase our understanding of motivation in the future, in particular the different types of extrinsic motivation that might exist in physical activity

• Current research findings are not supportive of locus of control being a strong determinant of physical activity and exercise

Determinants of physical activity: Theoretical approaches 6

• Participation in physical activity is clearly associated with perceptions of competence

• More specific perceptions of competence/efficacy are likely to be better predictors of specific behaviours than generalised beliefs in competence

• Goal perspectives theory proposes that people can define competence and success in different ways, the main ones being ego and task orientations

• Research is consistent in showing the motivational benefits of a task orientation, either singly or in combination with an ego orientation

Determinants of physical activity: Theoretical approaches 7

• research using self-efficacy with patient groups demonstrates that exercise self-efficacy can be developed

• self-efficacy judgements can generalise but will be strongest for activities similar to the activity experienced

• self-efficacy in 'dissimilar' activities can be enhanced through counselling

• self-efficacy better predicts changes in exercise behaviour than generalised expectancies

Determinants of physical activity: Theoretical approaches 8

• research with non-patient groups has shown that…

exercise self-efficacy can be increased through intervention

will predict participation, particularly in the early stages of an exercise programme

will decline after a period of inactivity is associated with positive exercise emotion

Determinants of physical activity: Theoretical approaches 9

• The Transtheoretical Model (TTM) of behaviour change provides an important advance on static linear models of exercise and physical activity determinants

• It hypothesises both the ‘how’ and ‘when’ of behaviour change

• Meta-analytic evidence broadly supports the model, although the classification of processes of change into two higher-order categories is questioned

• the hybrid HAPA model allows for the distinction between non-intentional, intentional, and action stages of behaviour

Determinants of physical activity: Comments on theoretical approaches

• Psychological theories and models are too numerous to provide definitive guidelines for behaviour change

• Approaches that articulate the important role of intentions, perceptions of competence, and beliefs concerning autonomy and control provide important messages for individual and population change

• Stage-based and hybrid models provide parsimonious frameworks to apply theoretical principles

Determinants of physical activity: Social & environmental approaches 1

• sibling physical activity, parental support, and father’s physical activity are associated with physical activity in adolescents

• social support from spouse and family are associated with physical activity in adults

Determinants of physical activity: Social & environmental approaches 2

• the development of a mastery motivational climate in exercise classes and groups appears to be desirable for motivation

• research on group cohesion has shown that exercise group dropouts have lower perceptions of cohesion than those who stay

• there is a positive relationship between exercise behaviour and some social influence variables, such as family support

Determinants of physical activity: Social & environmental approaches 3

• significant associations with physical activity have been found for ease of access to facilities, having places near by to be active, and perceived positive aesthetics of the local area

• urban design and land-use policies can be associated with greater levels of physical activity

• four key environmental features that should be taken into account in physical activity research include functional, safety, aesthetic and destination considerations

Determinants of physical activity: Comments on social & environmental

approaches• Identifying social and environmental

determinants is complex

• Why?

• Because social and environmental influences are complex!

• It is early days in identifying such factors, but evidence does exist that can provide useful guidance for behaviour change

Psychological outcomes of physical

activity: Promoting good mental health 1 • physical activity participation is consistently

associated with positive mood and affect• quantified trends show that aerobic exercise has

small-to-moderate positive effects on vigour, and small-to-moderate negative effects for fatigue and confusion

• experimental trials support the effect of moderate exercise on psychological well-being

Psychological outcomes of physical

activity: Promoting good mental health 2 • exercise is related to positive changes in self-esteem

and related physical self-perceptions• exercise can have a positive effect on sleep and positive

benefits for women’s experiences of menstruation, pregnancy and menopause

• meta-analytic findings suggest that exercise is associated with a significant small-to-moderate reduction in non-clinical anxiety

• experimental studies support an anxiety-reducing effect for non-clinical anxiety

• physiological reactivity to stress is reduced for those high in aerobic fitness

Psychological outcomes of physical

activity: Promoting good mental health 3 • meta-analytic findings suggest that exercise is

associated with a significant moderate reduction in non-clinical depression

• large-scale epidemiological surveys support the claim that a physically active lifestyle is associated with lower levels of non-clinical depression

• meta-analytic findings show a large effect size from studies that have used exercise as a treatment for clinically defined depression

Psychological outcomes of physical

activity: Promoting good mental health 4

• evidence suggests that there is a causal connection between physical activity and lower depression

• There is no clear consensus about the mechanisms that could explain the psychological benefits experienced from physical activity

Psychological outcomes of physical activity: Clinical populations 1

• patients in almost all categories of disease and disability could benefit from exercise

• good short-term adherence (4-12 weeks) can be achieved from supervised programmes of exercise

• for some populations, such as those in drug rehabilitation or those with HIV + status, even short-term adherence may need special support systems

• long term adherence (12 months - 4 years) is poor and not well documented

Psychological outcomes of physical activity: Clinical populations 2

• very little is known about the level of exercise in clinical populations

• barriers to exercise are similar to non-clinical populations but also include issues to do with the particular disease state (e.g., fear of another MI)

• cognitive behavioural strategies can be effective and the use of a counselling approach should be encouraged in all clinical settings

Psychological outcomes of physical activity: Clinical populations 3

• psychological outcomes are often mentioned anecdotally but are rarely measured in exercise programmes or interventions for clinical populations

• there is a need for raising awareness in some medical teams concerning the role of exercise, the potential psychological benefits and the need to assist patients with adherence to exercise

• Exercise dependence is a potentially harmful outcome from exercise but prevalence rates are not known

• Exercise dependence secondary to eating disorders or muscle dysmorphia may be more common than primary exercise dependence

Psychological outcomes of physical activity: Comments on clinical populations

• The topic of psychological well-being and physical activity is not new

• We are still struggling to convince some health professionals and researchers of the benefits

• The may be the result of weak designs and measurement

• If all of the evidence is assembled, it is clear that physical activity has a major role to play in psychological well-being and general mental health

• More innovative and creative research questions and designs are still required, as is the need to study diverse groups, populations and conditions

Interventions to enable physical activity behaviour change 1

• it is possible to increase the physical activity levels of sedentary individuals

• short-term (3 – 12 weeks) increases are relatively easy to achieve

• long-term change (6 – 24 months) is hard to achieve

• more specific relapse prevention strategies for exercise and physical activity must be explored

• there is a need to explore new media for delivering the messages

Interventions to enable physical activity behaviour change 2

• The effect of physical activity counselling needs to be tested over the long term

• More work is required in primary care settings to establish how the primary care team can influence physical activity

• Research must focus on the ‘hard to reach’

Interventions to enable physical activity behaviour change 3

• schools are well placed to promote healthy lifestyles, including physical activity

• physical education has the potential to reach large numbers of children

• interventions to increase physical activity in schools have met with mixed success or have not been properly evaluated

Interventions to enable physical activity behaviour change 4

• physical activity interventions are effective in the workplace for absenteeism, productivity and reduced health care costs

• effectiveness in increasing physical activity has not been demonstrated

• the greatest potential public health impact of physical activity promotion is likely to come through community interventions

Interventions to enable physical activity behaviour change 5

• approaches to attitude change and persuasion hold considerable promise for community interventions

• principles of social marketing require further application to physical activity

• note should be taken of the importance of market segmentation and targeted groups

Interventions to enable physical activity behaviour change 6

• governments of developed countries have only recently been involved in legislative initiatives in physical activity

• this interest has helped to legitimise physical activity as an important health behaviour

• effective physical activity promotion requires co-ordination across all levels of interventions as described by the ecological model and endorsed by the WHO global strategy

Interventions to enable physical activity behaviour change: Comments

• Interventions to change physical activity are still in their infancy

• Successful interventions have been hard to identify, probably due to the wider social, physical and political environment that often reinforces or encourages sedentary living

Developing the field of exercise psychology

Developing the field of exercise psychology

• Moving from the theory of the problem to the theory of action

• Moving from behaviour change theories to a wider socio-ecological approach

• Filling the gaps in current knowledge

• Training and supervision

• Is ‘exercise’ the correct title?

Moving from the theory of the problem to the theory of action

• Bartholomew et al. (2001) posed the question of whether efforts should be focussed on creating ‘theories of the problem’ or ‘theories of action’

• Theories of the problem are concerned with the formulation of appropriate determinants

• Theories of action point to methods of behaviour change that fit with the determinants

Moving from behaviour change theories to a wider socio-ecological approach

• We have focussed mostly on individual behaviour change theories

• The field of exercise psychology is only now beginning to focus on the wider socio-ecological approach

• May be better to seek greater understanding of the interaction between individuals and the environments they live and work in

Filling the gaps in current knowledge

• There is a lack of evidence for promoting physical activity to black and ethnic minority groups

• We may have been guilty of researching the ‘easy to reach’

• Need to focus on the ‘hard to reach’• Need to learn about the different needs of different

segments of the population, such as children, older adults, black and ethnic minorities and clinical populations

• Evidence of long term behaviour change is missing

Training and supervision

• Training and supervision of sport psychologists has been discussed and supported

• Are we providing the same level of training in exercise psychology as we do in sport psychology?

• Almost all accreditation processes that exist around the world focus on assuring quality in the delivery of support for sport performers

• Developing the training and supervisory needs for exercise psychology is another challenge

Is ‘exercise’ the correct title?

• The field is still generally known as exercise psychology

• Would physical activity psychology show the wider concern for all types of activity?

• Would this change align us more with health psychology than sport psychology and would this be a good or bad thing?

• The title of the field is another challenge for the future of “exercise psychology”

“All scientific work is incomplete-whether it be observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have, or postpone the action that it appears to demand at a given time.” (page 12).

Hill, A. B. (1965). The environment and disease: Association or causation? Proceedings of the Royal

Society of Medicine, 58, 295-300.