exercise adherence

EXERCISE EXERCISE ADHERENCEADHERENCE

Damon BurtonDamon BurtonUniversity of IdahoUniversity of Idaho

WHAT IS EXERCISE WHAT IS EXERCISE ADHERENCE?ADHERENCE?

Exercise Adherence (EA) Exercise Adherence (EA) – – is the ability is the ability to maintain an exercise program for an to maintain an exercise program for an extended time period.extended time period. Exercise adherence is one of the Exercise adherence is one of the biggest health problems for American biggest health problems for American adults. adults. EA is also a problem for children and EA is also a problem for children and adolescents, probably due in part to adolescents, probably due in part to extensive reductions in required extensive reductions in required physical education classes. physical education classes.

How big a problem is How big a problem is exercise adherence exercise adherence among American among American adults?adults?

EXERCISE STATISTICSEXERCISE STATISTICS30% of adults are sedentary (i.e., totally inactive). 30% of adults are sedentary (i.e., totally inactive). Physical activity levels begin to decline at age 6 and continue throughout the life cycle.Physical activity levels begin to decline at age 6 and continue throughout the life cycle.10-25% of adults get health benefits from physical activity. 10-25% of adults get health benefits from physical activity. 64% of Americans were considered overweight or obese in 2004.64% of Americans were considered overweight or obese in 2004.56% of American adults were considered overweight in 2000 compared to 45% in 1991.56% of American adults were considered overweight in 2000 compared to 45% in 1991.

EXERCISE EXERCISE STATISTICSSTATISTICS

Among youth ages 12 to 21, 50% do not participate regularly Among youth ages 12 to 21, 50% do not participate regularly in physical activity. in physical activity. Among adults, only 10-15% exercise 3 times per week for at Among adults, only 10-15% exercise 3 times per week for at least 20 minutes. least 20 minutes. Among boys and girls, physical activity declines steadily thru Among boys and girls, physical activity declines steadily thru adolescence from 70% at age 12 to 40% at age 21.adolescence from 70% at age 12 to 40% at age 21.Women are more active than men, blacks and Hispanics more Women are more active than men, blacks and Hispanics more than whites, older adults compared to younger ones, and than whites, older adults compared to younger ones, and less affluent compared to more affluent.less affluent compared to more affluent.

EXERCISE EXERCISE STATISTICSSTATISTICS

10% of sedentary adults begin exercise programs each 10% of sedentary adults begin exercise programs each year,year,50% of new exercisers will drop out within six months.50% of new exercisers will drop out within six months.

What are the major What are the major reasons why adults reasons why adults exercise?exercise?

REASONS ADULTS REASONS ADULTS EXERCISEEXERCISE

weight control for appearance and weight control for appearance and health,health,health benefits--particularly for health benefits--particularly for cardiovascular problems (i.e., cardiovascular problems (i.e., hypertension),hypertension),stress and depression managementstress and depression managementEnjoyment,Enjoyment,building self-esteem, andbuilding self-esteem, andsocial and affiliation benefits.social and affiliation benefits.

Do the reasons adults Do the reasons adults start an exercise start an exercise program differ from program differ from the reasons that they the reasons that they continue to exercise?continue to exercise?

REASONS FOR INITIATING REASONS FOR INITIATING EXERCISE PROGRAMSEXERCISE PROGRAMS

health benefits,health benefits,weight control,weight control,Appearance,Appearance,increased energy,increased energy,mobility issues (e.g., joint mobility issues (e.g., joint problems), andproblems), andmeet people.meet people.

REASONS FOR REASONS FOR MAINTAINING MAINTAINING

EXERCISE PROGRAMSEXERCISE PROGRAMSstress and depression stress and depression management,management,Enjoyment,Enjoyment,building self-esteem,building self-esteem,maintaining social maintaining social relationships, relationships, weight maintenance, andweight maintenance, andhealth maintenance.health maintenance.

What are the What are the common excuses common excuses for not exercising?for not exercising?

EXERCISE BARRIERSEXERCISE BARRIERS

lack of time,lack of time, lack of energy, andlack of energy, and lack of motivation.lack of motivation.

OTHER EXERCISE OTHER EXERCISE BARRIERSBARRIERS

OTHER EXERCISE OTHER EXERCISE BARRIERSBARRIERS

• social support barriers,social support barriers,• health and fitness barriers,health and fitness barriers,• other commitments,other commitments,• resource barriers, andresource barriers, and• programming barriers.programming barriers.

EXERCISE BEHAVIOREXERCISE BEHAVIORTHEORIES & MODELSTHEORIES & MODELS

• Health Belief Model,Health Belief Model,• Theory of Planned Behavior,Theory of Planned Behavior,• Social Cognitive Theory,Social Cognitive Theory,• Self-Determination Theory,Self-Determination Theory,• Transtheoretical Model, Transtheoretical Model, • Ecological Model, andEcological Model, and• Personal Investment Theory. Personal Investment Theory.

HEALTH BELIEFS HEALTH BELIEFS MODELMODEL

Becker & Maiman (1975) suggest that the Becker & Maiman (1975) suggest that the likelihood of an individual’s engaging in likelihood of an individual’s engaging in preventive health behaviors such as preventive health behaviors such as exercise dependsexercise depends on the person’s perception of the severity of on the person’s perception of the severity of

potential illness andpotential illness and their appraisal of the costs versus benefits of their appraisal of the costs versus benefits of

taking action.taking action. For example, a person who believes the For example, a person who believes the

potential illness is serious, he/she is at risk potential illness is serious, he/she is at risk and the pros of taking action outweigh the and the pros of taking action outweigh the cons of working out is likely to exercise cons of working out is likely to exercise regularly.regularly.

THEORY OF PLANNED THEORY OF PLANNED BEHAVIORBEHAVIOR

Ajzen & Madden (1986) extended Theory Ajzen & Madden (1986) extended Theory of Reasoned Action that identified of Reasoned Action that identified intentions as the best predictors of intentions as the best predictors of actual behavior.actual behavior.Intentions are the product of an Intentions are the product of an individual’s attitude toward a particular individual’s attitude toward a particular behavior and subjective norms regarding behavior and subjective norms regarding that behavior.that behavior.Subjective norms are a product of beliefs Subjective norms are a product of beliefs about others’ opinions and motivation to about others’ opinions and motivation to comply with others’ opinions.comply with others’ opinions.


For example, the Theory of Reasoned For example, the Theory of Reasoned Action (TRA) suggests that if you are a Action (TRA) suggests that if you are a nonexerciser and believe that other nonexerciser and believe that other significant people in your life (e.g., wife, significant people in your life (e.g., wife, children, & friends) think you should children, & friends) think you should exercise, you may wish to do what other exercise, you may wish to do what other want you to do.want you to do.Theory of Planned Behavior (TPB) extends Theory of Planned Behavior (TPB) extends TRA by arguing that intentions cannot be TRA by arguing that intentions cannot be the sole predictors of behavior, the sole predictors of behavior, particularly when individuals lack control particularly when individuals lack control over behaviors.over behaviors.


In addition to subjective norms and In addition to subjective norms and attitudes, TPB states that perceived attitudes, TPB states that perceived behavioral control (i.e., people’s behavioral control (i.e., people’s perception of their ability to perform the perception of their ability to perform the behavior) also affect behavioral behavior) also affect behavioral outcomes.outcomes.TPB has been the most frequent theory TPB has been the most frequent theory to be used to predict exercise behavior, to be used to predict exercise behavior, although it typically accounts for only although it typically accounts for only 20-35% of the variance in exercise 20-35% of the variance in exercise behavior.behavior.

SOCIAL COGNITIVE THEORYSOCIAL COGNITIVE THEORYSocial-cognitive theory (SCT) is based on Social-cognitive theory (SCT) is based on Bandura’s (1977) work that postulates Bandura’s (1977) work that postulates that we learn and modify behaviors that we learn and modify behaviors through interaction between personal, through interaction between personal, behavioral and environmental influences. behavioral and environmental influences. SCT focuses on self-regulation whereby SCT focuses on self-regulation whereby we regulate our behavior based on goals, we regulate our behavior based on goals, behaviors and feelings.behaviors and feelings.We reflect on our actions based on 2 We reflect on our actions based on 2 factors: (a) the consequences of our factors: (a) the consequences of our behaviors (i.e., outcome expectancies) behaviors (i.e., outcome expectancies) and (b) our ability to perform those and (b) our ability to perform those behaviors (i.e., efficacy expectations). behaviors (i.e., efficacy expectations).

SOCIAL COGNITIVE THEORYSOCIAL COGNITIVE THEORYOutcome expectancies = “Will exercise Outcome expectancies = “Will exercise help me lose weight?” help me lose weight?” Efficacy expectancies = “Can I exercise Efficacy expectancies = “Can I exercise more often, at greater intensity or for more often, at greater intensity or for longer duration?” longer duration?” Efficacy expectations are more critical to Efficacy expectations are more critical to actual behavior.actual behavior.Sources of efficacy information include: Sources of efficacy information include: performance accomplishment,performance accomplishment, vicarious experiences (e.g., modeling & vicarious experiences (e.g., modeling &

imagery),imagery), verbal persuasion, and verbal persuasion, and positive mood enhancement. positive mood enhancement.

TRANSTHEORETICAL MODELTRANSTHEORETICAL MODELMarcus’ TTM proposes that behavior Marcus’ TTM proposes that behavior change involves movement through change involves movement through stages of change. stages of change. The term “transtheoretical” describes a The term “transtheoretical” describes a broad framework that includes both (a) broad framework that includes both (a) when (stages) and (b) how behavior when (stages) and (b) how behavior changes. changes. TTM includes (a) processes (i.e., TTM includes (a) processes (i.e., strategies) and (b) mediators of change strategies) and (b) mediators of change (e.g., decision balance sheet or self-(e.g., decision balance sheet or self-efficacy). efficacy).

TRANSTHEORETICAL MODELTRANSTHEORETICAL MODELCognitive change processes (e.g., knowledge of sedentary risk) Cognitive change processes (e.g., knowledge of sedentary risk) peak in the action state whereas behavior processes (e.g., peak in the action state whereas behavior processes (e.g., social support) are most critical in the maintenance stage.social support) are most critical in the maintenance stage.Matching strategies to current stage of change seems to be a Matching strategies to current stage of change seems to be a effective intervention strategy.effective intervention strategy.EA relapse typically increases in probability when a major “life EA relapse typically increases in probability when a major “life change” occurs.change” occurs.Self-monitoring and tweaking of EA programs is necessary to Self-monitoring and tweaking of EA programs is necessary to prevent relapse.prevent relapse.

arcus’ TTM proposes that behavior change involves movement arcus’ TTM proposes that behavior change involves movement through stages of change. through stages of change. The term “transtheoretical” describes a broad framework that The term “transtheoretical” describes a broad framework that includes both (a) when (stages) and (b) how behavior changes. includes both (a) when (stages) and (b) how behavior changes. TTM includes (a) processes (i.e., strategies) and (b) mediators TTM includes (a) processes (i.e., strategies) and (b) mediators of change (e.g., decision balance sheet or self-efficacy). of change (e.g., decision balance sheet or self-efficacy).

TRANSTHEORETICAL TRANSTHEORETICAL MODELMODEL

Stage 1 = PrecontemplationStage 1 = Precontemplation: : Person isn’t performing self-change Person isn’t performing self-change behavior and doesn’t intend to behavior and doesn’t intend to start. Initial notice of a problem.start. Initial notice of a problem.Stage 2 = ContemplationStage 2 = Contemplation:: Person Person

isn’t performing the self-change isn’t performing the self-change behavior but are thinking about behavior but are thinking about starting. Action seriously starting. Action seriously considered.considered.


Stage 3 = PreparationStage 3 = Preparation:: Person Person recently started preparing to initiate recently started preparing to initiate self-change behavior such as buying self-change behavior such as buying clothing and shoes, purchasing a clothing and shoes, purchasing a fitness membership or lining up an fitness membership or lining up an exercise partner. exercise partner. Stage 4 = ActionStage 4 = Action:: Person has Person has

initiated the self-change behavior initiated the self-change behavior consistently for a short period of time. consistently for a short period of time. Trying to become more systematic. Trying to become more systematic.


Stage 5 = MaintenanceStage 5 = Maintenance:: Person has Person has maintained the self-change behavior maintained the self-change behavior consistently for 6 months or more and consistently for 6 months or more and plans to continue doing so. Reached plans to continue doing so. Reached habitual stage.habitual stage.Stage 6 = Relapse PreventionStage 6 = Relapse Prevention:: Person Person

encounters serious lifestyle change encounters serious lifestyle change after reaching maintenance stage and after reaching maintenance stage and has to adjust self change program to has to adjust self change program to prevent relapse. Making needed prevent relapse. Making needed adjustments to maintain lifestyle adjustments to maintain lifestyle change. change.

ECOLOGICAL MODELECOLOGICAL MODELPremise –Premise – Ecological framework Ecological framework

highlights multiple EA influences. highlights multiple EA influences. BehaviorBehavior can be a product of social, can be a product of social,

psychological, environmental psychological, environmental and and sociopolitical influences.sociopolitical influences.Motivated people Motivated people may struggle to may struggle to

be active if environmental be active if environmental constraints are extensive. constraints are extensive. Interventions Interventions must create supportive must create supportive

environments and provide environments and provide exercisers with psychological tools exercisers with psychological tools to change and regulate their to change and regulate their behavior. behavior.

PERSONAL INVESTMENT PERSONAL INVESTMENT MODELMODEL

Incentives/Goals – Incentives/Goals – 12 common exercise 12 common exercise goals as measured by the Exercise and goals as measured by the Exercise and Sport Goal Inventory Sport Goal Inventory [33% of variance].[33% of variance].Sense-of-Self Variables Sense-of-Self Variables [not measured but [not measured but typically < 25% of variance]typically < 25% of variance] CompetenceCompetence (i.e., ability to attain goals)(i.e., ability to attain goals) Self-relianceSelf-reliance (i.e., autonomously reach goals)(i.e., autonomously reach goals) Goal-directednessGoal-directedness (i.e., goals drive motivation)(i.e., goals drive motivation)Perceived OptionsPerceived Options Program compatibility Program compatibility (i.e., allows you to meet (i.e., allows you to meet

important goals; important goals; 21% of variance21% of variance)) BarriersBarriers (i.e., goals not stifled by barriers; (i.e., goals not stifled by barriers; 38% 38%

of varianceof variance))

FACTORS IMPACTING FACTORS IMPACTING EXERCISE ADHERENCEEXERCISE ADHERENCE

• personal factors andpersonal factors and• environmental factorsenvironmental factors

PERSONAL FACTORS PERSONAL FACTORS IMPACTING ADHERENCEIMPACTING ADHERENCE

EXERCISE ADHERENCE EXERCISE ADHERENCE STRATEGIESSTRATEGIES

behavior modification approaches,reinforcement approaches, cognitive-behavioral approaches,decision-making approachessocial support approaches, andintrinsic approaches.

BEHAVIOR MODIFICATION BEHAVIOR MODIFICATION APPROACHESAPPROACHES

prompts,prompts, contracts, andcontracts, and perceived choice.perceived choice.

REINFORCEMENT REINFORCEMENT APPROACHESAPPROACHES

charting attendance charting attendance and participation, and participation, rewarding attendance rewarding attendance and participation, andand participation, andfeedback and testing.feedback and testing.

COGNITIVE-COGNITIVE-BEHAVIORAL BEHAVIORAL APPROACHESAPPROACHES

goals,goals,self talk, andself talk, andthought focus strategiesthought focus strategies•associationassociation•dissociationdissociation

DECISION-MAKING DECISION-MAKING APPROACHESAPPROACHES

SOCIAL SUPPORT SOCIAL SUPPORT APPROACHESAPPROACHES

social support from partner, social support from partner, group or class,group or class,know where to go for what know where to go for what you need, andyou need, andmust trust and respect person must trust and respect person to go to them for support.to go to them for support.

INTRINSIC APPROACHESINTRINSIC APPROACHES

focus on the experience,focus on the experience,focus on the process andfocus on the process andengage in meaningful engage in meaningful physical activity.physical activity.

BEST EXERCISE BEST EXERCISE ADHERENCE STRATEGIESADHERENCE STRATEGIES

1.1.Make exercise fun and enjoyable.Make exercise fun and enjoyable.2.2.Tailor exercise frequency, duration Tailor exercise frequency, duration

and intensity to the exerciser.and intensity to the exerciser.3.3.Promote group exercise.Promote group exercise.4.4.Keep daily exercise logs.Keep daily exercise logs.5.5.Reinforce success.Reinforce success.6.6.Find a convenient place to exercise.Find a convenient place to exercise.

TheTheEndEnd

exercise adherence

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