exercise behavior and adherence

Exercise Behavior and AdherenceExercise Behavior and Adherence

Session OutlineSession Outline

Why Study Exercise Behavior? Why Study Exercise Behavior?

Why Exercise Behavior and Adherence Are Important

Why Exercise Behavior and Adherence Are Important

Reasons to Exercise Reasons to Exercise

Reasons for Not Exercising Reasons for Not Exercising

(continued)(continued)

The Problem of Exercise Adherence The Problem of Exercise Adherence

Session OutlineSession Outline

Theories/Models of Exercise Behavior Theories/Models of Exercise Behavior

Determinants of Exercise Adherence Determinants of Exercise Adherence

Strategies for Enhancing Adherence to Exercise Strategies for Enhancing Adherence to Exercise

Settings for Exercise Interventions Settings for Exercise Interventions

Guidelines for Improving Exercise Adherence Guidelines for Improving Exercise Adherence

Despite the current societal emphasis on fitness, a small percentage of children and adults participate in regular physical activity.

Despite the current societal emphasis on fitness, a small percentage of children and adults participate in regular physical activity.

Why Study Exercise Behavior?Why Study Exercise Behavior?

50% of adults are completely sedentary. 50% of adults are completely sedentary.

50% of youth (ages 12-21) do not participate in regular physical activity.

50% of youth (ages 12-21) do not participate in regular physical activity.

25% of children and adults report doing no physical activity.

25% of children and adults report doing no physical activity.

Only 15% of adults participate in vigorous and frequent activity.

Only 15% of adults participate in vigorous and frequent activity.

Why Exercise Behaviorand Adherence Are Important


Only 10% of sedentary adults are likely to begin a program of regular exercise within a year.

Only 10% of sedentary adults are likely to begin a program of regular exercise within a year.


Among boys and girls, physical activity declines steadily through adolescence.

Among boys and girls, physical activity declines steadily through adolescence.

Physical inactivity is more prevalent among women, African-Americans, and Hispanics, as well as among older and less affluent adults.

Physical inactivity is more prevalent among women, African-Americans, and Hispanics, as well as among older and less affluent adults.

50% of people starting an exercise program will drop out within six months.

50% of people starting an exercise program will drop out within six months.

Daily attendance in physical education classes dropped from 42% to 25% between 1990 and 1995.

Daily attendance in physical education classes dropped from 42% to 25% between 1990 and 1995.



Reasons to ExerciseReasons to Exercise

Weight control Weight control

Reduced risk of cardiovascular disease Reduced risk of cardiovascular disease

Reduction in stress and depression Reduction in stress and depression

Enjoyment Enjoyment

Building self-esteem Building self-esteem

Socializing Socializing


Exercise combined with proper eating habits can help people lose weight; but weight loss should be slow and steady, occurring as changes in exercise and eating patterns take place.

Exercise combined with proper eating habits can help people lose weight; but weight loss should be slow and steady, occurring as changes in exercise and eating patterns take place.

KEY—KEY—


Both the physiological and psychological benefits of exercise can be cited to help persuade sedentary people to initiate exercise.

“Maintenance” as well as initiation of physical activity is critical.

Both the physiological and psychological benefits of exercise can be cited to help persuade sedentary people to initiate exercise.

“Maintenance” as well as initiation of physical activity is critical.

KEY—KEY—

Reasons for Not ExercisingReasons for Not Exercising

Lack of time Lack of time

Lack of energy Lack of energy

Lack of motivation Lack of motivation


Exercise professionals should highlight the benefits of exercise and provide a supportive environment to involve sedentary people in physical activity.

Exercise professionals should highlight the benefits of exercise and provide a supportive environment to involve sedentary people in physical activity.

KEY—KEY—

People often cite time constraints for not exercising, but such constraints are more perceived than real and often reveal a person’s priorities.

People often cite time constraints for not exercising, but such constraints are more perceived than real and often reveal a person’s priorities.

KEY—KEY—


Individual Barriers to Physical ActivityIndividual Barriers to Physical Activity

Lack of time, energy, or motivation Lack of time, energy, or motivation

Excessive cost Excessive cost

Illness or injury Illness or injury

Feeling uncomfortable Feeling uncomfortable

Lack of skill Lack of skill

Fear of injury Fear of injury

(See table 18.1 on p. 403 of text.)(See table 18.1 on p. 403 of text.)

The Problem of Exercise AdherenceThe Problem of Exercise Adherence

The Problem of Exercise AdherenceThe Problem of Exercise Adherence

Help those who start exercising to overcome barriers to continuing the exercise program.

Help those who start exercising to overcome barriers to continuing the exercise program.

Help exercisers develop contingency plans to overcome factors leading to relapses (not exercising).

Help exercisers develop contingency plans to overcome factors leading to relapses (not exercising).

Theories/Models of Exercise BehaviorTheories/Models of Exercise Behavior

Health Belief ModelHealth Belief Model

The likelihood of exercising depends on the person’s perception of the severity of health risks and appraisal of the costs and benefits of taking action.

The likelihood of exercising depends on the person’s perception of the severity of health risks and appraisal of the costs and benefits of taking action.

(Becker and Maiman, 1975)(Becker and Maiman, 1975)

Overall “inconsistent” support for Health Belief Model predictions of exercise behaviorOverall “inconsistent” support for Health Belief Model predictions of exercise behavior

KEY—KEY—

Theories/Models of Exercise BehaviorHealth Belief Model

Theories/Models of Exercise BehaviorHealth Belief Model

(Becker and Maiman, 1975)(Becker and Maiman, 1975)

intentions, intentions,

subjective norms and attitudes, and subjective norms and attitudes, and

Exercise behavior is made up ofExercise behavior is made up of

Theories/Models of Exercise BehaviorTheory of Planned Behavior


perceptions of ability to perform behavior. perceptions of ability to perform behavior.

(Ajzen and Madden, 1986)(Ajzen and Madden, 1986)

Normative beliefs and subjective norms

Normative belief: an individual's perception

about the particular behavior, which is

influenced by the judgment of significant

others (e.g., parents, spouse, friends, teachers.

Subjective norm: an individual's perception of

social normative pressures, or relevant others'

beliefs that he or she should or should not

perform such behavior.

The theory of planned behavior is a useful theory for predicting exercise behavior.The theory of planned behavior is a useful theory for predicting exercise behavior.

KEY—KEY—



(Ajzen and Madden, 1986)(Ajzen and Madden, 1986)

Theories/Models of Exercise BehaviorTheories/Models of Exercise Behavior

Social Cognitive TheorySocial Cognitive Theory

Exercise behavior is influenced by both personal and environmental factors, particularly self-efficacy.Exercise behavior is influenced by both personal and environmental factors, particularly self-efficacy.

(Bandura, 1986, 1997)(Bandura, 1986, 1997)

What Is Cognition?

Cognition is a term referring to the mental processes involved in gaining knowledge and comprehension, including thinking, knowing, remembering, judging and problem-solving. These are higher-level functions of the brain and encompass language, imagination, perception and planning.

Social cognitive theory has produced some of the most consistent results in predicting exercise behavior.

Social cognitive theory has produced some of the most consistent results in predicting exercise behavior.

KEY—KEY—

Theories/Models of Exercise BehaviorSocial Cognitive Theory

Theories/Models of Exercise BehaviorSocial Cognitive Theory

(Bandura, 1986, 1997)(Bandura, 1986, 1997)

Core Assumptions and Statements

The social cognitive theory explains how people acquire and maintain certain behavioral patterns, while also providing the basis for intervention strategies (Bandura, 1997). Evaluating behavioral change depends on the factors environment, people and behavior. SCT provides a framework for designing, implementing and evaluating programs.

Environment refers to the factors that can affect a person’s behavior. There are social and physical environments. Social environment include family members, friends and colleagues. Physical environment is the size of a room, the ambient temperature or the availability of certain foods. Environment and situation provide the framework for understanding behavior (Parraga, 1990). The situation refers to the cognitive or mental representations of the environment that may affect a person’s behavior. The situation is a person’s perception of the lace, time, physical features and activity (Glanz et al, 2002).

The three factors environment, people and behavior are constantly influencing each other.

Behavior is not simply the result of the environment and the person, just as the environment is not simply the result of the person and behavior (Glanz et al, 2002).

The environment provides models for behavior. Observational learning occurs when a person watches the actions of another person and the reinforcements that the person receives (Bandura, 1997). The concept of behavior can be viewed in many ways. Behavioral capability means that if a person is to perform a behavior he must know what the behavior is and have the skills to perform it.

Major Constructs in SCT and Implications for Intervention:

• Environment: Factors physically external to the person; Provides opportunities and social support

• Situation: Perception of the environment; Correct misperceptions and promote healthful forms

• Behavioral capability: Knowledge and skill to perform a given behavior; Promote mastery learning through skills training

• Expectations: Anticipatory outcomes of a behavior; Model positive outcomes of healthful behavior

• Expectancies: The values that the person places on a given outcome, incentives; Present outcomes of change that have functional meaning

• Self-control: Personal regulation of goal-directed behavior or performance; Provide opportunities for self-monitoring, goal setting, problem solving, and self-reward

Major Constructs and Implications (continued)

• Observational learning: Behavioral acquisition that occurs by watching the actions and outcomes of others’ behavior; Include credible role models of the targeted behavior

• Reinforcements: Responses to a person’s behavior that increase or decrease the likelihood of reoccurrence; Promote self-initiated rewards and incentives

• Self-efficacy: The person’s confidence in performing a particular behavior; Approach behavioral change in small steps to ensure success

• Emotional coping responses: Strategies or tactics that are used by a person to deal with emotional stimuli; Provide training in problem solving and stress management

• Reciprocal determinism: The dynamic interaction of the person, the behavior, and the environment in which the behavior is performed; Consider multiple avenues to behavioral change, including environmental, skill, and personal change.

Theories/Models of Exercise BehaviorTranstheoretical Model


1.Precontemplation stage (does not exercise)1.Precontemplation stage (does not exercise)

2.Contemplation stage (has fleeting thoughts of exercising)2.Contemplation stage (has fleeting thoughts of exercising)

An individual progresses through five stages of change:An individual progresses through five stages of change:

3.Preparation stage (exercises, but not regularly enough)3.Preparation stage (exercises, but not regularly enough)

(continued)(continued)(Prochaska, DiClemente, and Norcross, 1992)(Prochaska, DiClemente, and Norcross, 1992)



4.Action stage (has been exercising regularly, but for less than six months)4.Action stage (has been exercising regularly, but for less than six months)

5.Maintenance stage (has been exercising regularly for more than six months)5.Maintenance stage (has been exercising regularly for more than six months)

An individual progresses through five stages of change:An individual progresses through five stages of change:

(Prochaska, DiClemente, and Norcross, 1992)(Prochaska, DiClemente, and Norcross, 1992)

STAGE DETAILS

Stage 1: Precontemplation (Not Ready)

People at this stage do not intend to start the healthy behavior in the near future (within 6 months), and may be unaware of the need to change. People here learn more about healthy behavior: they are encouraged to think about the pros of changing their behavior and to feel emotions about the effects of their negative behavior on others.

Precontemplators typically underestimate the pros of changing, overestimate the cons, and often are not aware of making such mistakes. These individuals are encouraged to become more mindful of their decision making and more conscious of the multiple benefits of changing an unhealthy behavior.

Stage 2: Contemplation (Getting Ready)

At this stage, participants are intending to start the healthy behavior within the next 6 months. While they are usually now more aware of the pros of changing, their cons are about equal to their Pros. This ambivalence about changing can cause them to keep putting off taking action.

People here learn about the kind of person they could be if they changed their behavior and learn more from people who behave in healthy ways. They're encouraged to work at reducing the cons of changing their behavior.

Stage 3: Preparation (Ready)

People at this stage are ready to start taking action within the next 30 days. They take small steps that they believe can help them make the healthy behavior a part of their lives. For example, they tell their friends and family that they want to change their behavior.

People in this stage are encouraged to seek support from friends they trust, tell people about their plan to change the way they act, and think about how they would feel if they behaved in a healthier way. Their number one concern is: when they act, will they fail? They learn that the better prepared they are, the more likely they are to keep progressing.

STAGE 4: ACTION

People at this stage have changed their behavior within the last 6 months and need to work hard to keep moving ahead. These participants need to learn how to strengthen their commitments to change and to fight urges to slip back.

People in this stage are taught techniques for keeping up their commitments such as substituting activities related to the unhealthy behavior with positive ones, rewarding themselves for taking steps toward changing, and avoiding people and situations that tempt them to behave in unhealthy ways.

STAGE 5: MAINTENANCE

People at this stage changed their behavior more than 6 months ago. It is important for people in this stage to be aware of situations that may tempt them to slip back into doing the unhealthy behavior—particularly stressful situations.

It is recommended that people in this stage seek support from and talk with people whom they trust, spend time with people who behave in healthy ways, and remember to engage in healthy activities to cope with stress instead of relying on unhealthy behavior.

Different exercise behavior induction strategies are used during the different transtheoretical stages.

Different exercise behavior induction strategies are used during the different transtheoretical stages.

KEY—KEY—



(Prochaska, DiClemente, and Norcross, 1992)(Prochaska, DiClemente, and Norcross, 1992)

Matching the intervention to the stage of change is effective in producing high levels of regular exercise.

Matching the intervention to the stage of change is effective in producing high levels of regular exercise.

KEY—KEY—

Many factors, from demographics to physical and social environment, affect exercise participation.Many factors, from demographics to physical and social environment, affect exercise participation.

Factors Associated With Participationin Supervised Exercise Programs

Factors Associated With Participationin Supervised Exercise Programs

(See table 18.03 on p. 409 of text.)(See table 18.03 on p. 409 of text.)

Determinants of Exercise Adherence:Highlights


Demographic variables (e.g., education, income, gender, socioeconomic status) have a strong association with physical activity.

Demographic variables (e.g., education, income, gender, socioeconomic status) have a strong association with physical activity.

Early involvement in sport and physical activity should be encouraged, because there is a positive relation between childhood exercise and adult physical activity patterns.

Early involvement in sport and physical activity should be encouraged, because there is a positive relation between childhood exercise and adult physical activity patterns.

Barriers to exercise are similar for white and nonwhite populations.

Barriers to exercise are similar for white and nonwhite populations.


Self-efficacy and self-motivation consistently predict physical activity.

Self-efficacy and self-motivation consistently predict physical activity.

Spousal support is critical to enhance adher-ence rates for people in exercise programs. Spouses should be involved in orientation sessions or in parallel exercise programs.

Spousal support is critical to enhance adher-ence rates for people in exercise programs. Spouses should be involved in orientation sessions or in parallel exercise programs.

Exercise intensities should be kept at moderate levels to enhance the probability of long-term adherence to exercise programs.

Exercise intensities should be kept at moderate levels to enhance the probability of long-term adherence to exercise programs.




Group exercising generally produces higher levels of adherence than exercising alone, but tailoring programs to fit individuals and the constraints they feel can help them adhere to the program.

Group exercising generally produces higher levels of adherence than exercising alone, but tailoring programs to fit individuals and the constraints they feel can help them adhere to the program.

Post-exercise participation predicts exercise behavior.

Post-exercise participation predicts exercise behavior.




Exercise leaders influence the success of an exercise program. They should be knowledge-able, give lots of feedback and praise, help participants set flexible goals, and show concern for safety and psychological comfort.

Exercise leaders influence the success of an exercise program. They should be knowledge-able, give lots of feedback and praise, help participants set flexible goals, and show concern for safety and psychological comfort.

A convenient location is an important predictor of exercise behavior.

A convenient location is an important predictor of exercise behavior.



Strategies for EnhancingAdherence to Exercise

Strategies for EnhancingAdherence to Exercise

Behavior modification approachesBehavior modification approaches

Reinforcement approachesReinforcement approaches

Six categories of techniquesSix categories of techniques

Cognitive/behavioral approachesCognitive/behavioral approaches

Decision-making approachesDecision-making approaches

Social-support approachesSocial-support approaches

Intrinsic approachesIntrinsic approaches

Behavior Modification ApproachesBehavior Modification Approaches

PromptsPrompts

Verbal, physical, or symbolic cues that initiate behaviors (e.g., posters, running shoes by bed).Verbal, physical, or symbolic cues that initiate behaviors (e.g., posters, running shoes by bed).

Category 1Category 1

ContractingContracting

Participants enter into a contract with their exercise leader.Participants enter into a contract with their exercise leader.

Reinforcement ApproachesReinforcement Approaches

Rewards for Attendance and ParticipationRewards for Attendance and Participation

Rewards improve attendance but must be provided throughout the length of the program.Rewards improve attendance but must be provided throughout the length of the program.


Charting attendance and participationCharting attendance and participation


Reinforcement ApproachesReinforcement ApproachesCategory 2Category 2

FeedbackFeedback

Providing feedback to participants on their progress has positive motivational effects.Providing feedback to participants on their progress has positive motivational effects.

Self-MonitoringSelf-Monitoring

Participants keep written records of their physical activity.Participants keep written records of their physical activity.

Cognitive/Behavioral ApproachesCognitive/Behavioral ApproachesCategory 3Category 3

self-set rather than instructor-set, self-set rather than instructor-set,

flexible rather than fixed, and flexible rather than fixed, and

Exercise-related goals should beExercise-related goals should be

time based rather than distance based. time based rather than distance based.

Goal setting should be used to motivate individuals.Goal setting should be used to motivate individuals.

Cognitive/Behavioral ApproachesCognitive/Behavioral ApproachesCategory 3Category 3

Dissociative strategies emphasize external distractions and produce significantly higher levels of exercise adherence than associative strategies focusing on internal body feedback.

Dissociative strategies emphasize external distractions and produce significantly higher levels of exercise adherence than associative strategies focusing on internal body feedback.

Cognitive TechniquesCognitive Techniques

Decision-Making ApproachesDecision-Making ApproachesCategory 4Category 4

Completing a decision balance sheet to increase awareness of the costs and benefits of participating in an exercise program can enhance exercise adherence.

Completing a decision balance sheet to increase awareness of the costs and benefits of participating in an exercise program can enhance exercise adherence.

Develop Balance SheetsDevelop Balance Sheets

Involve exercisers in decisions regarding program structure.Involve exercisers in decisions regarding program structure.

A Decision Balance SheetA Decision Balance SheetCategory 4Category 4

Better physical Less time with condition hobbies

More energy

Weight loss

Better physical Less time with condition hobbies

More energy

Weight loss

GAINS TO SELF LOSSES TO SELFGAINS TO SELF LOSSES TO SELF



Get healthier so I can Less time with myplay baseball family

Become more attrac- Less time to devotetive to my spouse to work

Get healthier so I can Less time with myplay baseball family

Become more attrac- Less time to devotetive to my spouse to work

GAINS TO LOSSES TO IMPORTANT OTHERS IMPORTANT OTHERSGAINS TO LOSSES TO IMPORTANT OTHERS IMPORTANT OTHERS



My children would My boss thinks itlike to see me be takes time awaymore active from work

My spouse would like me to lead healthier lifestyle

My children would My boss thinks itlike to see me be takes time awaymore active from work

My spouse would like me to lead healthier lifestyle

APPROVAL OF OTHERS DISAPPROVAL OF OTHERSAPPROVAL OF OTHERS DISAPPROVAL OF OTHERS



SELF-APPROVAL SELF-DISAPPROVALSELF-APPROVAL SELF-DISAPPROVAL


Feel more confident I look foolish exer-cising

because I’m out of shape

Feel more confident I look foolish exer-cising

because I’m out of shape

Improved self-conceptImproved self-concept

Social-Support ApproachesSocial-Support ApproachesCategory 5Category 5

Social SupportSocial Support

An individual’s (e.g., spouse’s, family member’s, friend’s) favorable attitude toward another individual’s involvement in an exercise program.

An individual’s (e.g., spouse’s, family member’s, friend’s) favorable attitude toward another individual’s involvement in an exercise program.

Social support can be enhanced by participation in a small group, the use of personalized feedback and the use of a buddy system.

Social support can be enhanced by participation in a small group, the use of personalized feedback and the use of a buddy system.

Intrinsic ApproachesIntrinsic Approaches

Focus on the experience itself. Focus on the experience itself.

Take a process orientation. Take a process orientation.

Engage in purposeful and meaningful physical activity.

Engage in purposeful and meaningful physical activity.


Settings for Exercise InterventionsSettings for Exercise Interventions

Schools Schools

Work sites Work sites

Home Home

Community Community

Health care facilities Health care facilities

Community-based approaches appear to offer the best way of reaching large numbers of people.

Community-based approaches appear to offer the best way of reaching large numbers of people.

KEY—KEY—

Settings for Exercise InterventionsSettings for Exercise Interventions

Guidelines for ImprovingExercise Adherence


Match the intervention to the participant’s stage of change.

Match the intervention to the participant’s stage of change.

Provide cues for exercises (signs, posters, cartoons).

Provide cues for exercises (signs, posters, cartoons).

Make the exercises enjoyable. Make the exercises enjoyable.


Tailor the intensity, duration, and frequency of the exercises.

Tailor the intensity, duration, and frequency of the exercises.



Promote exercising with a group or friend. Promote exercising with a group or friend.

Have participants sign a contract or statement of intent to comply with the exercise program.

Have participants sign a contract or statement of intent to comply with the exercise program.

Offer a choice of activities. Offer a choice of activities.


Provide rewards for attendance and participation.

Provide rewards for attendance and participation.

Give individualized feedback. Give individualized feedback.



Find a convenient place for exercising. Find a convenient place for exercising.

Have participants reward themselves for achieving certain goals.

Have participants reward themselves for achieving certain goals.

Encourage goals to be a self-set, flexible, and time based (rather than distance based).

Encourage goals to be a self-set, flexible, and time based (rather than distance based).


Remind participants to focus on environmental cues (not bodily cues) when exercising.

Remind participants to focus on environmental cues (not bodily cues) when exercising.



Use small-group discussions. Use small-group discussions.

Have participants complete a decision balance sheet before starting the exercise program.

Have participants complete a decision balance sheet before starting the exercise program.

Obtain social support from the participant’s spouse, family members, and peers.

Obtain social support from the participant’s spouse, family members, and peers.

Suggest keeping daily exercise logs. Suggest keeping daily exercise logs.

Help participants choose purposeful physical activity.

Help participants choose purposeful physical activity.

exercise behavior and adherence

Documents

exercise program

exercise adherencedespite

program of regular exercise

regular physical activity

physical activity declines

physical inactivity

sedentary adults

physical activitylack