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Exercise Behavior and Adherence

Chapter 18 & 19

Lindsey Swanson

on 11 April 2013

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Transcript of Exercise Behavior and Adherence

Exercise Behavior and Adherence Statistics Reasons Barriers Among adults, 30% do not participate in any physical activity

66% of Americans were overweight or obese in 2005

The propensity to be overweight increases with age: 44% of people age 18 to 29 and 77% of people age 46 to 64 were overweight in 2005

Among youths from 12 to 21 years of age, 50% do not participate regularly in physical activity.

Among adults, only 10% to 15% participate in vigorous exercise regularly (three times a week for at least 20 minutes

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

Among both boys and girls, physical activity declines steadily through adolescence from about 70% at age 12 to 30-40% by age 21

Among women, physical inactivity is more prevalent than among men, as it is among blacks and Hispanics compared with whites, older adults compared with younger ones, and the less affluent compared with the more affluent

Of people who start an exercise program, 50% will drop out within 6 months Weight control (counter obesity epidemic)

Reduced risk of cardiovascular disease

Reduction in stress and depression


Building self-esteem

Socializing Health issues: Physical limitations, injury, poor health, pain and soreness, psychological problems

Inconvenience: Lack of access to facilities, crowded facilities, lacking 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 Why do people struggle adhering to a exercise plan? Programs are often based solely on fitness data, ignoring people’s psychological readiness to exercise

Most exercise programs 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 Preventing Relapses Expect and plan for lapses (e.g., scheduling alternative activities while on vacation)

Develop coping strategies to deal with high-risk situations (e.g., relaxation training, time management, imagery)

Replace “shoulds” with “wants” to provide more balance in your life (“Shoulds” put pressure and expectations on you)

Use positive self-talk and imagery to avoid self-dialogues focusing on relapse

Identify situations that put you at risk, and attempt to avoid or plan for these settings

Do not view a temporary relapse as catastrophic since this undermines confidence and willpower (e.g., if you didn’t exercise for a week, you are not a total failure; just start again next week) Strategies/Techniques Guidelines 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

Provide rewards for attendance and participation

Give individualized feedback

Find a convenient place for exercising Determinants/Highlights table 18.2 on pgs. 428–429 of text

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

Self-efficacy and self-motivation consistently predict 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

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

Support from families and friends has been consistently linked to physical activity participation and adherence

Finding the best time to exercise for each person is essential

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

A convenient location is an important predictor of exercise behavior Theories Perceived lack of time

Lack of energy

Lack of motivation For Exercising For NOT Exercising Health Belief Model Theory of Planned Behavior Social Cognitive Theory Self-Determination Theory Transtheoretical Model Physical Activity Maintenance Model Ecological 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 Exercise behavior is made up of intentions, subjective norms and attitudes, and perceptions of ability to control behavior (Ajzen & Maiman, 1986)

Useful for predicting exercise behavior (Mummery and Wankel, 1999) Exercise behavior is influenced by both personal and environmental factors (particularly self-efficacy)

Produced some of the most consistent results in predicting exercise behavior (Bandura, 1986, 1997) 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)

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) A person progresses through six stages of change:

1. Precontemplation: Does not exercise
2. Contemplation: Has fleeting thoughts of exercising
3. Preparation: Exercises, but not regularly enough (Prochaska, DiClemente, & Norcross, 1992)
4. Action: Has been exercising regularly, but for less than 6 months
5. Maintenance: Has been exercising regularly for more than 6 months
6. Termination: Once exercisers have exercised for 5 years

Matching the intervention to the stage of change is effective in producing high levels of regular exercise Key aspects to predicting the maintenance of physical activity:

Goal setting: Commitment attainment, satisfaction

Self-motivation: Persistence in the pursuit of behavioral goals independent of any situational constraints

Self-efficacy: Confidence to overcome barriers and avoid relapse

Physical activity environment: Access, attractiveness, enjoyable scenery, social support

Life stress: Recent life changes, everyday hassles Examine frameworks versus specific variables (Dishman, 2002)

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 (Sallis & Owen, 1999) Behavior Modification Approaches Reinforcement Approaches Cognitive–Behavioral Approaches Decision-Making Approaches Social-Support Approaches Intrinsic Approaches 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 Charting attendance and participation

Rewards for attendance and participation: Rewards improve attendance but must be provided throughout the length of the program

Feedback: Providing feedback to participants on their progress has positive motivational effects

Self-monitoring: Participants keep written records of their physical activity Goal setting should be used to motivate individuals

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 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 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 Focus on the experience itself

Take a process orientation

Engage in purposeful and meaningful physical activity Motivational Interviewing An intervention to increase the likelihood of a client’s considering, initiating, and maintaining specific strategies to reduce harmful behavior via an interview

Motivation to change is elicited from the client rather than the counselor

Client–counselor relationship is more of a partnership 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

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 Athletes and Injuries Reactions to Being Injured Identity loss
Lack of confidence
Performance decrements Signs of Poor Adjustment Feelings of anger and confusion
Obsession with the question of when one can return to play
Denial (e.g., “The injury is no big deal”)
Repeatedly coming back too soon and experiencing reinjury
Exaggerated bragging about accomplishments
Dwelling on minor physical complaints
Guilt about letting the team down
Withdrawal from significant others
Rapid mood swings
Statements indicating that no matter what is done, recovery will not occur How can we help? Educate and inform athletes about injury and rehabilitation
Foster positive interaction and customize training
Help them develop competence and confidence
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