EXERCISE ADHERENCE

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EXERCISE ADHERENCE

• Damon Burton
• University of Idaho

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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.

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• How big a problem is exercise adherence among
  American adults?

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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.

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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.

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EXERCISE STATISTICS

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

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• What are the major reasons why adults exercise?

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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.

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

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REASONS FOR INITIATING EXERCISE PROGRAMS

• health benefits,
• weight control,
• Appearance,
• increased energy,
• mobility issues (e.g., joint problems), and
• meet people.

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REASONS FOR MAINTAINING EXERCISE PROGRAMS

• stress and depression management,
• Enjoyment,
• building self-esteem,
• maintaining social relationships,
• weight maintenance, and
• health maintenance.

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• What are the common excuses for not exercising?

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EXERCISE BARRIERS

• lack of time,
• lack of energy, and
• lack of motivation.

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OTHER EXERCISE BARRIERS
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OTHER EXERCISE BARRIERS

• social support barriers,
• health and fitness barriers,
• other commitments,
• resource barriers, and
• programming barriers.

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EXERCISE BEHAVIORTHEORIES MODELS

• Health Belief Model,
• Theory of Planned Behavior,
• Social Cognitive Theory,
• Self-Determination Theory,
• Transtheoretical Model,
• Ecological Model, and
• Personal Investment Theory.

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HEALTH BELIEFS MODEL

• Becker Maiman (1975) suggest that the
  likelihood of an individuals engaging in
  preventive health behaviors such as exercise
  depends
• on the persons 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.

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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 individuals
  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.

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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.

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THEORY OF PLANNED BEHAVIOR

• In addition to subjective norms and attitudes,
  TPB states that perceived behavioral control
  (i.e., peoples 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.

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SOCIAL COGNITIVE THEORY

• Social-cognitive theory (SCT) is based on
  Banduras (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).

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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.

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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).

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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).

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TRANSTHEORETICAL MODEL

• Stage 1 Precontemplation Person isnt
  performing self-change behavior and doesnt
  intend to start. Initial notice of a problem.
• Stage 2 Contemplation Person isnt performing
  the self-change behavior but are thinking about
  starting. Action seriously considered.

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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.
  

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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.

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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.

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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 lt 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)

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FACTORS IMPACTING EXERCISE ADHERENCE

• personal factors and
• environmental factors

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PERSONAL FACTORS IMPACTING ADHERENCE
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PERSONAL FACTORS IMPACTING ADHERENCE
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EXERCISE ADHERENCE STRATEGIES

• behavior modification approaches,
• reinforcement approaches,
• cognitive-behavioral approaches,
• decision-making approaches
• social support approaches, and
• intrinsic approaches.

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BEHAVIOR MODIFICATION APPROACHES

• prompts,
• contracts, and
• perceived choice.

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REINFORCEMENT APPROACHES

• charting attendance and participation,
• rewarding attendance and participation, and
• feedback and testing.

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COGNITIVE-BEHAVIORAL APPROACHES

• goals,
• self talk, and
• thought focus strategies
• association
• dissociation

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DECISION-MAKING APPROACHES
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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.

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INTRINSIC APPROACHES

• focus on the experience,
• focus on the process and
• engage in meaningful physical activity.

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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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• The
• End