1. Presentation Package for Concepts of Fitness and Wellness 6e
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Presentation Package for Concepts of Fitness and Wellness 6e
Section I: Concept 02:
Using Self-Management Skills to Adhere to Healthy Lifestyle Behaviors
This presentation covers the implications of lifestyle behaviors on health and provides some preliminary information on theories of behavior and strategies used to modify lifestyles.
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2. Concepts of Fitness and Wellness 6e
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Major Causes of Death
1. Heart disease 6. Diabetes
2. Cancer Pneumonia
3. Stroke Alzheimers
4. Lung disease 9. Kidney disease
5. Accidents 10. Septicemia
Slide lists the top 10 causes of death in our society. (Data from the Centers for Disease Control, 1994). This is the first survey in which AIDS has made it into the top ten. Point out that Heart Disease and Cancer account for about 60% of all deaths so the lecture will focus on how to reduce risks for those two diseases.
The majority of deaths in the U.S. can be attributed in some way to unhealthy lifestyles.
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3. Actual Causes of Death (Based on Mokdad et al., 2004)
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Actual Causes of Death (Based on Mokdad et al., 2004)
This slide reveals the actual causes of death as estimated by a leading public health official. The numbers cannot be interpreted as exact calculations but the point is clear that most causes of death are related to unhealthy behaviors.
There was considerable media attention given to this study because the CDC later indicated that the projections for diet and inactivity may have been miscalculated. Smoking remains the leading cause of preventable mortality but that doesn’t discount the major public health implications associated with a sedentary lifestlye.
Smoking
Physical inactivity and overweight conditions
Drinking (primarily refering to drinking and driving)
1990
2000
The data from 2000 show diet/inactivity “catching up” to tobacco but these figures have been disputed. Unhealthy lifestyles are clearly the leading cause of preventable mortality.
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4. Concepts of Fitness and Wellness 6e
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What is a “Lifestyle”?
A "lifestyle" is more than the way we spend our time!
“Lifestyles” are the behaviors that we adopt based on the context of our life circumstances.
Your lifestyle is more than the way you spend your time. It reflects your values and beliefs and philosophy about life.
Click on the icon to view a series of slides that reveal the impact of lifestyle behaviors on health.
Lifestyle behaviors have a major impact on our health
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5. Factors that Influence Our Lifestyles
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Factors that Influence Our Lifestyles
Biological
Psychological
Personal
Societal
Environmental
These are some of the factors that influence lifestyle. Separate slides will be used to go over each of the different dimensions.
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6. Biological Influences
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Biological Influences
Self-actualization
Satisfaction of basic needs is a pre-requisite for personal growth Maslow’s Hierarchy of Needs
Growth
Esteem
Affection
Biological factors influences our sense of "need"
ex) hunger may influence choice of food
Security
Physical
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7. Psychological Influences
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Psychological Influences
Values / beliefs
Attitudes
Psychological
Lifestyle
Psychological
The Iceburg Model:
Only the top 10% of an
iceburg’s mass is above the water. The causes of lifestyle behaviors are similarly obscured.
Psychological factors determine your motivations/desires toward different health behaviors.
The Iceburg model postulates that our behaviors are the visible part of our lifestyle but they are influeced by our psychological perspectives, our cultural attitudes and our spiritual beliefs.
It is important to recognize for students to understand how our psychological perspectives regarding health and our conceptions of our abilities to change are influenced. This model provides a useful teaching aid to illustrate the concept.
Cultural Attitudes
Spiritual Values / Beliefs
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8. Concepts of Fitness and Wellness 6e
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Personal Influences
School and work responsibilities
Family responsibilities
Personal factors include our school, work and family responsibilities.
Life presents many challenges and quite often health and healthy behaviors don’t get the attention they deserve because other more immediate concerns dominate our time.
It is important to remember that without health, the rest of our life would not be worth living so it is not something to compromise on.
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9. Concepts of Fitness and Wellness 6e
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Societal Influences
Power of media
Power of group identity
Relative acceptance of negative behaviors
Societal forces provides a "model" of normal behaviors. Note that normal is not necessarily healthy
ex) Media: suggests that parties are what life is about so that is what people come to value
ex) Power of Group Identity: - We all have a desire to be accepted by others so peer pressure can influence people to do things they otherwise would not do.
ex) Relative acceptance of negative behaviors: drinking, smoking and overeating in our society.
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10. Environmental Influences
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Environmental Influences
Access to many unhealthy options (e.g. fast food)
Lack of lifestyle activity due to modern conveniences
Environmental factors provides setting for different behaviors. It is sometimes hard to adopt positive health behaviors if you always find yourself in settings where that is more difficult. (Settings could be places or time)
Ex) it is hard to not drink if always at a bar
Ex) it is hard to not smoke if you always smoke after dinner.
Our society currently presents us with many unhealthy options and fewer ways to be healthy. These environmental influences make it challenging to lead healthy lives.
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11. Concepts of Fitness and Wellness 6e
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Stages of Change
See “On the Web” 02-1
Research shows that people advance through a series of stages as they attempt to change behaviors
What stage are you at?
The stages of change is a model developed by Dr. James Prochaska to explain the processes people go through in changing their behaviors. It was originally developed to explain the stages people use to change negative behaviors such as smoking but has recently been extended to help explain stages of exercise behavior.
People in precontemplation are not really interested in beginning an exercise program. Efforts at motivating them will probably fall on deaf ears since they are not even interested in the idea of starting an exercise program. Individuals in contemplation are beginning to think about starting but don’t know where to start. Individuals in preparation have taken some initial steps at beginning a regular exercise program. Those in action are doing regular exercise and those in maintenance have been doing it regularly for more than 6 months. Ask students what category they fall into.
Prochaska, J.O., DiClemente, C.C., and Norcross, J.C. (1992). In search of how people change: applications to addictive behaviors. American Psychologist 47(9):
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12. Pros and Cons of Physical Activity Across Stages
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Pros and Cons of Physical Activity Across Stages
In terms of decision balance, the stages of change model suggests that benefits and costs will be different depending on what stage a person is at.
People in precontemplation will have much higher scores on the Cons of Exercise compared with the Pros while people in maintenance will be the opposite. In the Preparation stage the levels of both aspects are about equal indicating that they are trying to change but still find significant barriers to participation.
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13. Factors in Behavior Change
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Factors in Behavior Change
BEHAVIOR
PREDISPOSING FACTORS
ENABLING FACTORS
REINFORCING FACTORS
This model by Green and Kreuter (1991) covers the factors that lead to changes in health behavior. It can be used effectively to explain exercise adherence. The factors will each be reviewed in separate slides.
Green, L.W., & Kreuter, M.W. (1991). Health Promotion Planning: an educational and environmental approach. Mayfield Publishing, Toronto
(pp. 151).
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14. Concepts of Fitness and Wellness 6e
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Predisposing Factors
Is it Worth it?
Self-motivation
Enjoyment
Balance of attitudes
Beliefs
Knowledge
Am I able?
Self-confidence
Self-efficacy
Safe environment
Access
Review the predisposing factors
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15. Concepts of Fitness and Wellness 6e
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Enabling Factors
Goal setting skills
Self-assessment
Self-monitoring
Self-planning
Performance skills
Coping skills
Consumer skills
Time management
Review the enabling factors
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16. Concepts of Fitness and Wellness 6e
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Reinforcing Factors
Success
Family Support
Peer Support
Support of Health professionals
Review the reinforcing factors
Do societal norms “reinforce” healthy behavior? Yes or No
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17. Factors that Influence Behavior Change
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Lab 2a info
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Factors that Influence Behavior Change
Maintenance
Reinforcing Factors
Action
Enabling Factors
Preparation
This slide reviews the model again. The important point to comment on is that while all three factors exert a direct influence they also can work indirectly. Reinforcing factors and Enabling factors can both influence our predispositions to adopt healthy behaviors.
Use the slide to describe the assessments used in Lab 1 to evaluate predisposing, enabling and reinforcing factors for physical activity.
Predisposing Factors
Contemplation
Personal Factors:
Pre-contemplation
(age, gender, heredity, current level of health and fitness)
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18. Self-Management Skills
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Lab 2b info
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Self-Management Skills
A major goal of the class is to help you develop self management skills so that you can maintain an active and healthy lifestyle
Different self management skills are needed for predisposing, enabling and reinforcing factors.
The slide introduces the importance of self-management skills to establish positive lifestyles.
Use the slide to review the different self-management skills and to cover the behavioral lab on self-management skills. The following slide provides specific skills needed for predisposing, enabling and reinforcing factors.
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19. Self Management Skills
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Self Management Skills
Changing Predisposing Factors
Overcoming barriers
Building self confidence
Balancing Attitudes
Building knowledge and changing beliefs
Changing Predisposing Factors
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20. Self Management Skills
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Self Management Skills
Changing Enabling Factors
Goal setting skills
Self-assessment skills
Self-monitoring skills
Self-planning skills
Performance skills
Adopting coping skills
Learning consumer skills
Managing time
Changing Enabling Factors
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21. Self Management Skills
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Self Management Skills
Changing Reinforcing Factors
Finding social support
Preventing relapse
Changing Reinforcing Factors
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22. Models of Behavior Change
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Models of Behavior Change
See Concept 2 ‘On the Web’ (click 03) for details on these theories
Transtheoretical Model
Health Belief Model
Social Cognitive Theory
Theory of Reasoned Action
Theory of Planned Behavior
Self-Determination Theory
Many theories of behavior have been created. The health belief model and the theory of planned behavior are two of the more common models. Discuss these models or discuss why it is often hard to change behaviors.
Additional information on these models is available on the Web review pages on the Internet.
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23. Strategies for Changing Health Behaviors
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Strategies for Changing Health Behaviors
Monitor baseline information
Make goals
Develop plans
Monitor progress
There are some important guidelines to follow when trying to change your behaviors. Remember that lifestyle habits develop over a long time and are influenced by many factors. It is not easy to change lifestyle behaviors even relatively small ones. The best approach is to be very structured and stay focused.
Step 1: monitor behavior and note when it occurs
Step 2: make goals (small, but objective changes at first)
Step 3: develop plans to turn goal into reality
(don't just hope that change will occur - plan for it)
Step 4: monitor progress (keep a log or journal of efforts)
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24. Hints for Successful Behavior Change
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Hints for Successful Behavior Change
Make small changes
Reward your progress
Don't give up
Slide covers additional suggestions for behavioral change
Aim for small changes:
Don't try to completely change diet just make a few simple corrections (ex. eating a piece of fruit, eating fast food only once a week)
Reward progress:
Be content with yourself and your efforts. Measure success by the process (your efforts) not the product.
Don't give up:
Behavior change is hard but that is all it is! If you keep trying you will learn from past mistakes and improve.
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25. Concepts of Fitness and Wellness 6e
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Web Resources
“On the Web” pages for Concept
Online Learning Center
This page provides active hyperlinks if the computer is connected to the Internet.
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26. Supplementary Graphics
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Supplementary Graphics
Lab Information
Additional Detail about the Primary Risk Factors Involved in Coronary Heart Disease
Maps Showing Prevalence of Selected CHD Risk Factors Across the country
Supplementary graphics
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27. Lab 2a Information Physical Activity Adherence Questionnaire
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Lab 2a Information Physical Activity Adherence Questionnaire
Return to presentation
Complete the Physical Activity Adherence Questionnaire by rating whether items are very true, somewhat true or not true for you.
Compute scores for Predisposing, Enabling and Reinforcing Factors.
Record your ratings in the chart and discuss whether they are indicative of your current activity level.
Lab Information
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28. Lab 2b Information Self-Management Skills
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Lab 2b Information Self-Management Skills
Return to presentation
Complete the Self-Management survey.
Sum scores to get composite indicator of self-management skills
Discuss what skills you could learn that would help you become a better “self-manager”
Discuss what self-management is needed for other behaviors
Lab information
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CVD Risk Factors
Non-modifiable
sex
age
heredity
Modifiable
smoking
hypertension
cholesterol
physical inactivity
The four major risk factors for CHD are all related to lifestyle behaviors.
These are the risk factors for Coronary Heart Disease. Some are non-modifiable which means you can't do anything about it. Risks for CHD increase with age and are greater for males. The modifiable risks can be altered with a healthy diet and regular exercise
Physical inactivity was recently added to the list of established risk factors. It is now clear that activity exerts an independent effect on CHD risk. This means that even if a person is a smoker, their overall risk will be less if they perform regular physical activity.
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30. Primary Behaviors Involved in Reducing Risks of CHD
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Primary Behaviors Involved in Reducing Risks of CHD
Don't smoke
Perform regular physical activity
Eat a low fat diet
These are the key preventable behaviors for reducing risk of CHD
Click through next slides to see the impact of these behaviors on overall rates of CHD in the United States.
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31. Rates of Cardiovascular Disease in the U.S. by State
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Rates of Cardiovascular Disease in the U.S. by State
Quartiles of Age-Adjusted Death Rates Due to CVD
Slide shows the rates of cardiovascular disease by state
Have students try to explain the regional variation in disease rates by state. Some common explanations might be
1. The tendency for high fat foods in the south
2. The tendency for people in the west to be more physically active
Have students get a mental picture of the color patterns because subsequent slides will show the regional variations in the established risk factors. By comparing the patterns for the risk behaviors with those for CVD they will be able to directly see the impact of lifestyle behaviors on health.
Source: American Heart Association
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32. Smoking Levels in the U.S. by State (BRFSS data)
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Smoking Levels in the U.S. by State (BRFSS data)
Quartiles of Smoking Status
This slide shows rates of smoking.
Note the higher rates of smoking in the south where tobacco is grown.
Note the high rate of smoking in Nevada
Lower rates of smoking are clearly evident in most of the western part of the country.
source: MMWR 1996; 45(No ss-6)
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33. Cholesterol Levels in the U.S. by State (BRFSS data)
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Cholesterol Levels in the U.S. by State (BRFSS data)
Quartiles of Cholesterol Levels
This slide shows regional variability in cholesterol values. There is not a consistent pattern that is evident. Cholesterol is determined both by genetics and high fat foods.
The cholesterol rates are high in Wisconsin and Minnesota where dairy products are very prominent.
High rates in Florida may be attributed to a larger elderly population since cholesterol levels will typically increase with age.
source: MMWR 1996; 45(No ss-6)
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34. Hypertension Levels in the U.S. by State (BRFSS data)
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Hypertension Levels in the U.S. by State (BRFSS data)
Quartiles of Hypertension Levels
Slide shows regional variability in hypertension.
Note the high prevalence of hypertension in the south. This area of the country is known as the stroke belt because of high rates of stroke. Much of this risk is caused by hypertension.
Rates of hypertension are higher among blacks who reside in greater populations within these states.
source: MMWR 1996; 45(No ss-6)
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35. Inactivity Levels in the U.S. by State (BRFSS data)
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Inactivity Levels in the U.S. by State (BRFSS data)
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Quartiles of Inactivity Status
This slide shows the variability in inactivity across the country.
Note the high rates of inactivity in the south and the low rates in the west. This graph bears the closest similarity to the overall patterns of CVD (personal opinion of authors) and support the importance of physical activity as one of the most important lifestyle behaviors.
source: MMWR 1996; 45(No ss-6)
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36. Diabetes Levels in the U.S. by State (BRFSS data)
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Diabetes Levels in the U.S. by State (BRFSS data)
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Quartiles of Diabetes Levels
Slide shows variability in diabetes levels across the country.
Diabetes rates will parallel overweight conditions so have students compare the graph to the next slide.
source: MMWR 1996; 45(No ss-6)
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37. Overweight Levels in the U.S. by State (BRFSS data)
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Overweight Levels in the U.S. by State (BRFSS data)
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Quartiles of Overweight Levels
Slide shows regional variability in overweight conditions.
Highest rates of obesity are in the midwest and south.
Lowest rates are in the west.
This graph also bears a strong similarity to the overall rates of CVD
source: MMWR 1996; 45(No ss-6)
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