Case study 2
Aayuska 
Chapter19PP.pptx
Exercise Behavior and Adherence
Chapter 19
Why Exercise Behavior and Adherence Are Important
More than half of adults do not meet the minimum requirement of 150 minutes of moderate exercise per week.
The prevalence of obesity by race is as follows: Non-Hispanic Asian (11.7%), non-Hispanic white (34.5%), Hispanic (42.5%), and non-Hispanic-black (48.1%).
Approximately 1 in 5 (21%) adults meet the 2008 Physical Activity Guidelines.
Fewer than 3 in 10 high school students get at least 60 minutes of physical activity every day.
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Why Exercise Behavior and Adherence Are Important (continued)
Of people 18 and older in the United States, 36% are classified as obese, with women (38.3%) higher than men (34.3%).
People who earn less than $15,000 a year are most likely to be obese (36%).
The prevalence of obesity among youth is 17%.
Men (54%) are more likely than women (46%) to meet 2008 Physical Activity Guidelines for aerobic activity.
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Why Exercise Behavior and Adherence Are Important (continued)
Obesity rates increased from 2000 to 2014 in adults (30.5% to 37.7%) and youth (13.9% to 17.2%).
Approximately 38% of U.S. adults 20 years and older are obese, and 17% of children ages 6 to 11 are obese.
Approximately 603 million adults and 107 million children worldwide are obese.
The prevalence of obesity doubled in 73 countries from 1980 to 2015 and continuously increased in most countries.
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Why Exercise Behavior and Adherence Are Important (continued)
Excess body weight accounted for about four million deaths in 2015.
China and India had the highest number of obese children, whereas the United States had the highest number of obese adults.
Obesity rates have increased in both rich and poor countries, indicating the problem is not simply about wealth or income. Changes in the food environment and food systems are probably major drivers.
Reasons to Exercise
Weight control (counter obesity epidemic)
Reduced risk of cardiovascular disease
Reduction in stress and depression
Enjoyment
Building self-esteem
Socializing
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Reasons to Exercise (continued)
Keys
Exercise combined with proper eating habits can help people lose weight.
Weight loss should be slow and steady.
Both the physiological and psychological benefits of exercise can be cited to persuade sedentary people to initiate exercise.
Maintenance and initiation of physical activity are critical.
Reasons for Not Exercising
Perceived lack of time
Lack of energy
Lack of motivation
Sedentary behavior
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Barriers to Physical Activity
Health issues: Physical limitations, injury, poor health, pain and soreness, psychological problems
Inconvenience: Lack of access to facilities, crowded facilities, lack of transportation, other commitments
Lack of motivation and energy: Feeling lazy or unmotivated, too much effort
Lack of social support: No exercise partner, lacking support from spouse
Lack of time and money
See the table on p. 439 of text.
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Figure 19.3 Change in rate of exercise program participation over time.
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Why People Have a Problem With Exercise Adherence
The prescriptions are often based solely on fitness data, ignoring people’s psychological readiness to exercise.
Most exercise prescriptions are overly restrictive and are not optimal for enhancing motivation for regular exercise.
Rigid exercise prescriptions based on principles of intensity, duration, and frequency are too challenging for many people, especially beginners.
Traditional exercise prescription does not promote self-responsibility or empower people to make long-term behavior change.
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Theories and Models of Exercise Behavior
Health belief model
Theory of planned behavior
Social cognitive theory
Self-determination theory
Transtheoretical model
Ecological model
Health 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.
Overall, there is inconsistent support for predictions of exercise behavior with the health belief model (Becker & Maiman, 1975).
Becker, M.H., & Maiman, L.A. (1975). Sociobehavioral determinants of compliance with health care and medical care recommendations. Medical Care, 13, 10–24.
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Theory of Planned Behavior
Exercise behavior is made up of intentions, subjective norms and attitudes, and perceptions of ability to control behavior (Ajzen & Madden, 1986).
Intentions are the product of an individual’s attitude toward a particular behavior and what is normative regarding the behavior (subjective norm).
Quality and strength of intentions are important as well as people’s perceptions of their ability to perform better in influencing behavior.
Ajzen, I., & Madden, T.J. (1986). Prediction of goal-directed behavior: Attitudes intentions, and perceived behavioral control. Journal of Experimental Social Psychology, 22, 453–474.
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Social Cognitive Theory
Exercise behavior is influenced by personal, behavioral, and environmental factors, particularly self-efficacy.
Self-efficacy is strongly related to exercise participation, especially in middle-aged and older adults.
Social cognitive theory has produced some of the most consistent results in predicting exercise behavior (Bandura, 1986, 1997).
Bandura, A. (1986). Social foundations of thought and actions: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: Freeman.
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Self-Determination Theory
People are inherently motivated to feel connected to others within a social milieu (relatedness), to function effectively in that milieu (effectance), and to feel a sense of personal initiative in doing so (autonomy).
Self-determination theory (SDT) was able to predict adherence in overweight and obese participants (Edmunds, Ntoumanis, & Duda, 2007).
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Edmunds, J., Ntoumanis, N., & Duda, J. (2007). Adherence and well-being in overweight and obese patients referred to an exercise on prescription scheme: A self-determination theory perspective. Psychology of Sport and Exercise, 8, 722–740.
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Self-Determination Theory (continued)
Participants who display autonomy in their exercise behavior and have strong social support systems exhibit stronger motivation and enhanced exercise adherence (Standage, Sebire, & Loney, 2008).
SDT has made an important contribution in terms of viewing intrinsic and extrinsic motivation on a continuum rather than a dichotomy.
Standage, M., Sebire, S., & Loney, T. (2008). Does exercise motivation predict engagement in objectively assessed bouts of moderate-intensity exercise? A self-determination theory perspective. Journal of Sport and Exercise Psychology, 30, 337–352.
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Transtheoretical Model
A person progresses through six stages of change:
Precontemplation: Does not exercise
Contemplation: Has fleeting thoughts of exercising
Preparation: Exercises, but not regularly enough
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Transtheoretical Model (continued)
Action: Has been exercising regularly, but for less than six months
Maintenance: Has been exercising regularly for more than six months
Termination: Exercisers have exercised for five years
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Ecological Model
Examine frameworks versus specific variables (Dishman et al., 2004).
Explain how the environment and behaviors affect each other.
Take into consideration intrapersonal (e.g., biological), interpersonal (e.g., family), institutional (e.g., schools), and policy (e.g., laws at all levels) influences.
Dishman, R.K., Washburn, R.A., & Heath, G.W. (2004). Physical activity epidemiology. Champaign, IL: Human Kinetics.
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Integration of Models
In reality, a combination of models might provide the best prediction for exercise behavior.
For example, integrating the ecological model with self-determination theory could help to enhance physical activity levels.
Determinants of Exercise Adherence
In addition to theories, a number of determinants of exercise behavior have been identified.
Table 19.2 lists a number of factors that influence physical activity involvement.
Most of these specific determinants fall within two broad categories:
Personal factors
Environmental factors
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Personal Factors
Demographic variables
Cognitive and personality variables
Behaviors
Demographic variable example: Blue-collar workers typically have lower exercise adherence rates than white-collar workers. However, increased choices can increase their adherence rates.
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Personal Factors (continued)
Cognitive and personality examples
Self-efficacy and self-motivation have been consistently related to physical activity adherence.
Beliefs about and expectations of benefits from exercise are associated with increased physical activity levels and adherence to structured physical activity programs among adults.
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Personal Factors (continued)
Behaviors example: Early involvement in sport and physical activity should be encouraged because a positive relationship exists between childhood exercise and adult physical activity patterns.
Environmental Factors
Social environment
Spousal support is critical to enhancing adherence rates for people in exercise programs.
Spouses should be involved in orientation sessions or in parallel exercise programs.
Physical environment
Access to facilities, local crime, distance from home to school
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Environmental Factors (continued)
Physical activity characteristics
Exercise intensity, frequency, and duration
Exercise intensities should be kept at moderate levels to enhance the probability of long-term adherence to exercise programs.
Comparing group with individual programs
Although exercising with a group generally produces higher levels of adherence than does exercising alone, certain people prefer to exercise alone for convenience. Tailor programs to fit individuals and the constraints they feel can help them adhere to the program.
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Environmental Factors (continued)
Physical activity characteristics
Leader qualities
Program leadership is important in determining the success of an exercise program.
Exercise leaders influence the success of an exercise program, so they should be knowledgeable, give lots of feedback and praise, help participants set flexible goals, and show concern for safety and psychological comfort.
However, an exercise leader may not be effective in all situations, so leaders should be tailored to the participant needs and likes.
Strategies for Enhancing Adherence to Exercise
Six categories of techniques:
Behavior modification approaches
Reinforcement approaches
Cognitive–behavioral approaches
Decision-making approaches
Social-support approaches
Intrinsic approaches
Category 1: Behavior Modification Approaches
Behavior modification is the planned, systematic application of learning principles to the modification of behavior.
Prompts: Verbal, physical, or symbolic cues initiate behaviors (e.g., posters encouraging people to take the stairs, placing running shoes by bed).
Contracting: Participants enter into a contract with their exercise practitioners.
Category 2: Reinforcement Approaches
Chart attendance and participation.
Rewards improve attendance but must be provided throughout the length of the program.
Providing feedback to participants on their progress has positive motivational effects.
Participants keep written records of their physical activity (self-monitoring).
Category 3: Cognitive–Behavioral Approaches
Goal setting should be used to motivate individuals.
Exercise-related goals should be
self-set rather than instructor-set,
flexible rather than fixed, and
time-based rather than distance-based.
Cognitive techniques: Dissociative strategies emphasize external distractions and the environment and produce significantly higher levels of exercise adherence than associative strategies focusing on internal body feedback.
Category 4: Decision-Making Approaches
Involve exercisers in decisions regarding program structure.
Develop balance sheets: Completing a decision balance sheet to increase awareness of the costs and benefits of participating in an exercise program can enhance exercise adherence.
Category 5: Social Support Approaches
A person (e.g., spouse, family member, friend) has a favorable attitude toward another person’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.
Category 6: Intrinsic Approaches
Focus on the experience itself.
Take a process orientation.
Engage in purposeful and meaningful physical activity.
Guidelines for Improving Exercise Adherence
Match the intervention to the participant’s stage of change.
Provide cues for exercises (signs, posters, cartoons).
Make the exercise enjoyable.
Tailor the intensity, duration, and frequency of the exercises.
Promote exercising with a group or friend.
Have participants sign a contract or statement of intent to comply with the exercise program.
Offer a choice of activities. (continued)
Guidelines for Improving Exercise Adherence (continued)
Provide rewards for attendance and participation.
Give individualized feedback.
Find a convenient place for exercising.
Have participants reward themselves for achieving certain goals.
Encourage goals to be self-set, flexible, and time-based (rather than distance-based).
Remind participants to focus on environmental cues (not bodily cues) when exercising.
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Guidelines for Improving Exercise Adherence (continued)
Use small-group discussions.
Have participants complete a decision balance sheet before starting the exercise program.
Obtain social support from the participant’s spouse, family members, and peers.
Suggest keeping daily exercise logs.
Practice time management skills.
Help participants choose purposeful physical activity.
