Damon Burton University of Idaho EXERCISE ADHERENCE Damon Burton University of Idaho

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

How big a problem is exercise adherence among American adults?

EXERCISE STATISTICS 30% of adults are sedentary (i.e., totally inactive). 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. 64% of Americans were considered overweight or obese in 2004. 56% of American adults were considered overweight in 2000 compared to 45% in 1991.

EXERCISE STATISTICS Among youth ages 12 to 21, 50% do not participate regularly in physical activity. Among adults, only 10-15% exercise 3 times per week for at least 20 minutes. Among boys and girls, physical activity declines steadily thru adolescence from 70% at age 12 to 40% at age 21. Women are more active than men, blacks and Hispanics more than whites, older adults compared to younger ones, and less affluent compared to more affluent. 5

EXERCISE STATISTICS 10% of sedentary adults begin exercise programs each year, 50% of new exercisers will drop out within six months. 6

What are the major reasons why adults exercise?

REASONS ADULTS EXERCISE weight control for appearance and health, health benefits--particularly for cardiovascular problems (i.e., hypertension), stress and depression management Enjoyment, building self-esteem, and social and affiliation benefits.

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

REASONS FOR INITIATING EXERCISE PROGRAMS health benefits, weight control, Appearance, increased energy, mobility issues (e.g., joint problems), and meet people.

REASONS FOR MAINTAINING EXERCISE PROGRAMS stress and depression management, Enjoyment, building self-esteem, maintaining social relationships, weight maintenance, and health maintenance.

What are the common excuses for not exercising?

EXERCISE BARRIERS lack of time, lack of energy, and lack of motivation.

OTHER EXERCISE BARRIERS

OTHER EXERCISE BARRIERS social support barriers, health and fitness barriers, other commitments, resource barriers, and programming barriers.

EXERCISE BEHAVIOR THEORIES & MODELS Health Belief Model, Theory of Planned Behavior, Social Cognitive Theory, Self-Determination Theory, Transtheoretical Model, Ecological Model, and Personal Investment Theory. 16

HEALTH BELIEFS MODEL Becker & Maiman (1975) suggest that the likelihood of an individual’s engaging in preventive health behaviors such as exercise depends on the person’s perception of the severity of potential illness and their appraisal of the costs versus benefits of taking action. For example, a person who believes the potential illness is serious, he/she is at risk and the pros of taking action outweigh the cons of working out is likely to exercise regularly.

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

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

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

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

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

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

TRANSTHEORETICAL MODEL Cognitive change processes (e.g., knowledge of sedentary risk) peak in the action state whereas behavior processes (e.g., social support) are most critical in the maintenance stage. Matching strategies to current stage of change seems to be a effective intervention strategy. EA relapse typically increases in probability when a major “life change” occurs. Self-monitoring and tweaking of EA programs is necessary to prevent relapse. arcus’ TTM proposes that behavior change involves movement through stages of change. The term “transtheoretical” describes a broad framework that includes both (a) when (stages) and (b) how behavior changes. TTM includes (a) processes (i.e., strategies) and (b) mediators of change (e.g., decision balance sheet or self-efficacy).

TRANSTHEORETICAL MODEL Stage 1 = Precontemplation: Person isn’t performing self-change behavior and doesn’t intend to start. Initial notice of a problem. Stage 2 = Contemplation: Person isn’t performing the self-change behavior but are thinking about starting. Action seriously considered.

TRANSTHEORETICAL MODEL Stage 3 = Preparation: Person recently started preparing to initiate self-change behavior such as buying clothing and shoes, purchasing a fitness membership or lining up an exercise partner. Stage 4 = Action: Person has initiated the self-change behavior consistently for a short period of time. Trying to become more systematic.

TRANSTHEORETICAL MODEL Stage 5 = Maintenance: Person has maintained the self-change behavior consistently for 6 months or more and plans to continue doing so. Reached habitual stage. Stage 6 = Relapse Prevention: Person encounters serious lifestyle change after reaching maintenance stage and has to adjust self change program to prevent relapse. Making needed adjustments to maintain lifestyle change.

ECOLOGICAL MODEL Premise – Ecological framework highlights multiple EA influences. Behavior can be a product of social, psychological, environmental and sociopolitical influences. Motivated people may struggle to be active if environmental constraints are extensive. Interventions must create supportive environments and provide exercisers with psychological tools to change and regulate their behavior.

PERSONAL INVESTMENT MODEL Incentives/Goals – 12 common exercise goals as measured by the Exercise and Sport Goal Inventory [33% of variance]. Sense-of-Self Variables [not measured but typically < 25% of variance] Competence (i.e., ability to attain goals) Self-reliance (i.e., autonomously reach goals) Goal-directedness (i.e., goals drive motivation) Perceived Options Program compatibility (i.e., allows you to meet important goals; 21% of variance) Barriers (i.e., goals not stifled by barriers; 38% of variance)

FACTORS IMPACTING EXERCISE ADHERENCE personal factors and environmental factors

PERSONAL FACTORS IMPACTING ADHERENCE

PERSONAL FACTORS IMPACTING ADHERENCE

EXERCISE ADHERENCE STRATEGIES behavior modification approaches, reinforcement approaches, cognitive-behavioral approaches, decision-making approaches social support approaches, and intrinsic approaches.

BEHAVIOR MODIFICATION APPROACHES prompts, contracts, and perceived choice.

REINFORCEMENT APPROACHES charting attendance and participation, rewarding attendance and participation, and feedback and testing.

COGNITIVE-BEHAVIORAL APPROACHES goals, self talk, and thought focus strategies association dissociation

DECISION-MAKING APPROACHES

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

INTRINSIC APPROACHES focus on the experience, focus on the process and engage in meaningful physical activity. 39

BEST EXERCISE ADHERENCE STRATEGIES Make exercise fun and enjoyable. Tailor exercise frequency, duration and intensity to the exerciser. Promote group exercise. Keep daily exercise logs. Reinforce success. Find a convenient place to exercise.

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