Self-efficacy, decision making, and the stages of exercise behavior change
by Jennifer Carol Haas
A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in
Health and Human Development
Montana State University
© Copyright by Jennifer Carol Haas (1996)
Abstract:
Based on the Transtheoretical Model of Behavior Change, an understanding of the determinants of
exercise behavior is beginning to emerge. In this study exercise behavior was examined to determine
its association with self-efficacy and decisional making. One hundred seventy four freshman college
students answered three questionnaires to assess their stage of exercise behavior, self-efficacy and
decisional balance (i.e., pros and cons). Frequency counts were used to determine the distribution of
freshman students among the stages of adoption. Stage of exercise adoption was the independent
variable, and self-efficacy and decisional balance were the dependent variables in the analysis.
Analysis of variance showed that self-efficacy and decision making were able to significantly
differentiate one's stage of exercise change. Understanding the states of exercise behavior change may
yield important information for designing physical education curriculum that would enhance exercise
adoption and adherence. SELF-EFFICACY, DECISION MAKING, AND
THE STAGES OF EXERCISE BEHAVIOR CHANGE
by
Jennifer Carol Haas-
A thesis submitted in partial fulfillment
of the requirements for the degree
of
Master of Science
in
Health and Human Development
MONTANA STATE UNIVERSITY
Bozeman, Montana
June 1996
N31?
Hllx
ii
APPROVAL
of a thesis submitted by-
Jennifer Carol Haas
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Graduate Studies.
Approved for the Department of Health and Human Development
Ellen Krieghbaum,
PhD
(Signature)
Date
Approved for the College of Graduate Studies
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PhD
(Signature)
Datfe
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ill
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University-Bozeman,
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iv
TABLE OF CONTENTS
Page
1.
2.
3.
INTRODUCTION. . ...............................
The Problem................................. . .
Statement of the Problem. ............. .....
Significance............
Purpose............................... . .
Hypothesis..............................
Delimitations.........
Limitations.....................
Assumptions.............................
Definition of Terms. .........
Operational Definitions..............
REVIEW OF LITERATURE..........................
Health Benefits of Physical Activity, Exercise,
and Physical Fitness,.............. . ........
Physiological Benefits.................
Physical Activity...........'.....
Exercise...........................
Physical Fitness..............
Psychological Benefits................
Physical Activity and Exercise....
Physical Fitness..................
Determinants of Exercise Participation.
Exercise Adoption and Adherence........
Psychosocial Models Applied to
Exercise............................
Transtheoretical Model of
Behavioral Change......................
Stages of Behavior Change..........
Process of Behavior Change........
Transtheoretical Model and Exercise....
Decisional Balance......
Self Efficacy.................
Summary..................................
METHODS AND PROCEDURES.......................
Design................................ '• »
I
3
5
5.
8
9
10
10
10
10
11
13
13
15
15
18
23
25
25
27
28
32
36
44
45
47
48
55
59
64
66
67
V
TABLE OF CONTENTS- Continued
Assessment Instruments...................
Data Collection...........................
Data Analysis......................
67
70
4.
ANALYSIS AND DISCUSSION OF DATA...............
Results...................................
Stage of Exercise Adoption.........
Self Efficacy.......................
Decisional Balance. ..................
Discussion................................
Self Efficacy........................
Decisional Balance..................
Summary..............................
73
74
74
74
78
82
82
83
85
5.
SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS...
Summary...................................
Conclusions.............................
Recommendations for Future Research....
Recommendations for Practical
Application................
REFERENCES CITED.............
VO
86
86
90
91
92
93
APPENDICES.... . .........................
Appendix A ............
HS
Determinants of Exercise Behavior.... .
116
Appendix B ..........................
Stages of Exercise Adoption
Questionnaire...........................
118
Appendix C ....................................
119
Algorithm for Stages of Adoption
Questionnaire.....................
Appendix D .....................................
121
Self Efficacy Questionnaire.............
122
Appendix E .....................................
123
Decisional Balance Questionnaire........
124
114
HV
120
vi
LIST OF. TABLES
Table
Page
1.
Processes of Change............. ..............
2.
Means and Standard Deviations on
Self-Efficacy Measure. . .......................... 76
3.
Newman Keuls Post Hoc Comparisons for SelfEfficacy and Stages of Exercise Cha n g e.....
76
Newman Keuls Post Hoc Comparisons for
Active and Nonactive Students............
77
Means and Standard Deviations of the Pros,
Cons, and Decisional Balance Scales by Stage
of Exercise Change...........................
79
Newman Keuls Post Hoc Comparisons for Pro,
Con, and Decisional Balance Indices.........
80
Newman Keuls Post Hoc Comparisons for
the Active and Inactive Subjects............
80
4.
5.
6.
7.
49
vii
LIST OF FIGURES
Figure
1.
2.
Page
Frequency Distribution of Subjects in Stages
of Exercise Change..................
75
The Pros and Cons (In T Scores) by Stage
of Exercise Change..........
81
viii
ABSTRACT
Based on the Transtheoretical Model of Behavior Change,
an understanding of the determinants of exercise behavior is
beginning to emerge.
In this study exercise behavior was
examined to determine its association with self-efficacy and
decisional making.
One hundred seventy four freshman
college students answered three questionnaires to assess
their stage of exercise behavior, self-efficacy and
decisional balance (i.e., pros and cons).
Frequency counts
were used to determine the distribution of freshman students
among the stages of adoption. Stage of exercise adoption was
the independent variable, and self-efficacy and decisional
balance were the dependent variables in the analysis.
Analysis of variance showed that self-efficacy and decision
making were able to significantly differentiate one's stage
of exercise change. Understanding the states of exercise
behavior change may yield important information for
designing physical education curriculum that would enhance
exercise adoption and adherence.
I
Chapter I
INTRODUCTION
The most prominent causes of death in the United States
today are lifestyle related.
According to the U.S.
Department of Health and Human Services
(1993),
approximately seventy percent of all deaths in the United
States are caused by either cardiovascular disease or
cancer. Nearly eighty percent of these deaths could be
prevented through the adoption of healthy lifestyle
behaviors. Researchers have shown an inverse relationship
between exercise and premature cardiovascular mortality
rates
(Paffenbarger, Hyde, Wing & Steinmetz,
et a l . (1989)
1984) .
Blair
found that death rates from cardiovascular
'x
disease and from all causes of mortality, were lower in
individuals who were fit than in individuals who were unfit.
Additionally, physically inactive people were almost twice
as likely to develop coronary heart disease than people who
engaged in regular physical activity (Powell, Thompson,
Casperson,
& Kendrick,
Consequentially,
1987).
risk reduction is a major focus of the
national health promotion and disease prevention objectives
for the Year 2000.
The objectives were proposed to ensure
2
that health related dimensions o f physical activity become
part of regular behavior patterns
and Human Services,
(U.S . Department of Health
Public Health Service,
1996).
Three
important elements were addressed: personal responsibility,
health benefits for all people, and health promotion and
disease prevention..
predisposing,
It was recommended that the
enabling,
and reinforcing determinants leading
to a physically active lifestyle be known by the turn of the
century.
One goal presented in the Year 2000 objectives is
to increase the number of young adults who engage in
vigorous physical activity that promotes the development and
maintenance of cardiorespiratory fitness.
In 1995, less
than ten percent of adults were active in their leisure time
at the intensity,
frequency and duration recommended by the
American College of Sports Medicine
(ACSM, 1995).
Over the last decade, a sizable decline in the fitness
levels of American youth has been reported
Warren,
& Kann, 1994).
(Heath, Pratt,
Fifty percent of our children do not
receive appropriate physical activity,
i.e. activity most
likely to ensure cardiorespiratory fitness and to establish
life-long exercise patterns
Human Services,
1987).
(U.S. Department of Health and
Prevalence rates of known risk
factors for chronic disease,
including cardiovascular
disease and mortality in adults,
are alarmingly high in
3
childhood and adolescence.
Risk factors linked to behavior,
such as smoking, obesity, hypertension, diabetes and stress
have been detected in children as young as seven years of
age
(Berenson,
1980).
The prevalence of physical inactivity increases with
age, especially during adolescence and adulthood
Department of Health and Human Services,
198 6) . In a review
of physical activity patterns in North America,
(1980)
(U.S .
Stephens
suggested that the most remarkable decrease in
participation occurs in late adolescence as activity
patterns in the school environment change.
It was estimated
that only forty six percent of our young population,
18-35
years of age, continued an active lifestyle beyond the
school years
1990).
(US Department of Health and Human Resources,
This is not a new problem.
Miller
(1963)
acknowledged the poor fitness levels of college students and
emphasized that physical education programs at the college
level offer a student the "final opportunity" to develop
necessary attitudes toward exercise and to establish habits
of regular exercise participation.
The Problem
It seems as though our young adults are not being
properly prepared to accept responsibility for their own
4
well-being.
In their review of physical activity promotion
programs in the United States,
Christenson
Iverson, Fielding,
Crow,
&
(1985) concluded:
It appears that a major opportunity to influence
favorable physical activity in the United States
is being missed in schools. A large majority of
students are enrolled in physical education classes,
but the classes appear to have little effect on
the current physical.fitness levels of children,
and furthermore, have little impact on developing
lifelong physical activity skills. (p. 212)
Traditionally,
college physical education activity
classes offered a student a chance to learn and play a
particular sport or activity.
the "how" rather than on
Baylor,
1980).
Curriculum emphasis was on
"the why"
Skill, technique,
and once mastered,
semester "playing."
(Dishman,
Falls &
and rules were taught,
the students spent the rest of the
Sage
(1987)
described this as the
"roll out the ball" or recess approach.
Those who still
hold rigidly to the notion of exposing students only to
sports,
skill development and games,
insist that by this
means students will be prepared to play and exercise
throughout life
(Beam, 1973).
Unfortunately,
this method
provided the student with very little basis for making
intelligent future decisions in regard to his or her
personal exercise habits
(Beam, 1973).
Exercise program interventions in the school can be
effective in increasing fitness and leisure activity
5
adoption
(Dishman, 1988).: A number of factors make schools
a desirable vehicle for fitness/wellness education.
First,
classes provide an opportunity to ensure a minimal,
regular
amount of physical activity and help to establish physical
activity patterns that may extend into adulthood. Secondly,
if the class is required for graduation, virtually all of
the population can be reached, therefore ensuring that
proper health habits are taught and behavior modification
strategies are implemented.
Most people attend college to
learn how to make a living, but a fitness and wellness
course will teach people how to live.
Statement of the Problem
In this study it will be determined if exercise
behavior can be associated with self-efficacy and the
perceived benefits and costs of exercise for freshman
students at Montana State University.
Significance
Exercise adherence research has received a great deal
of attention in the past several years.
However,
investigators are still unable to successfully predict
adherence
(Dishman,
1982; Sonstroem,
1988).
We do know that
approximately 50% of individuals who start an exercise
program will stop within the first six months,
even though
6
it is well known that to obtain health benefits associated
with physical activity, participation must be maintained
(Carmody, Senner, Manilow,
1988).
& Matarazzo,
1980/ Dishman,
Programs involving the use of behavioral management
techniques appeared to increase short term adherence to
exercise, however long term follow-up of behavioral
intervention methods and their effects on exercise adherence
was generally lacking
(Robison & Rogers,
1994).
A number of
psycho-social models have been developed to describe
exercise adoption and maintenance.
Researchers use these
models to reveal the decision making process that underlies
and precedes an action.
Psycho-social models are employed
to examine how attitudes, beliefs,
efficacy,
social norms,
expectations,
self-
and behavioral skills affect the
barriers to activity and the reinforcement of participation.
The Transtheoretical Model of Behavioral Change
(Prochaska & DiClemente,
health behaviors.
1983) has recently been applied to
Prochaska and DiClemente
(1983) developed
the "stages-of-change" framework to describe the different
phases involved in the acquisition and maintenance of a
behavior.
Researchers suggested that individuals engaging
in a new behavior move in an orderly progression through the
stages of precontemplation
behavior), contemplation
preparation
(thinking about starting a
(deciding to begin a new behavior),
(preparing to start a new behavior), action
7
(actively incorporating a new behavior into one's
lifestyle), and maintenance
time)
(maintaining the behavior over
(Dishmanz 1982; Marcus & Simkinz 1993; Martin &
Dubbertz 1992; Sonstroemz 1988).
Two important constructs,
self-efficacy and decisional balance, have been integrated
into the stage dimension of the Transtheoretical M o d e l .
Self-efficacy is a personal belief as to how easy or
difficult adoption of a new behavior is likely to be
& Madden,
1986).
(Ajzen
Researchers found that self-efficacy was
an important predictor of exercise behavior in the
Transtheoretical Model
(Prochaska & DiClemente, 1983;
Marcus,
Selby, Niaura,
& Rossi,
change,
self-efficacy scores increase linearly from
1992).
precontemplation to maintenance.
Decisional balance
involves assessing the pros and cons
specific behaviors
(benefits and costs)
(O'Connell & Velicer,
focus on enhanced confidence,
Across the stages of
1988) .
of
The Pros
feeling good about oneself,
and having more energy for one's family and friends,
and the
Cons focus on the perception of being too tired, being
concerned about the weather,
(Velicer, DiClemente,
and feeling uncomfortable
Prochaska,
& Brandenburg,
1985).
The
Pros and Cons were clearly relevant for understanding and
predicating transitions between the stages of change
(DiClemente et a l ., 1991;
Marcus, Rakowski, Rossi,
and support the work of Dishman,
1992)
Sallis and Ornstein on the
8
determinants of exercise behavior
al.
(1985).
Prochaska, et
(1994) reported that the Cons of changing a behavior
always outweigh the Pros during the early stages
(precontemplation and contemplation,
and the opposite is
true in the later stages of action and maintenance.
By
assessing an individual's stage of change, one can predict
their self-efficacy and decisional balance measures.
Specific interventions, designed to increase self-efficacy
and decisional balance,
applied during each stage may
facilitate the change in behavior.
This would appear to
have promise for increasing our understanding of the process
of exercise initiation and maintenance.
Educators may choose to include behavioral strategies
designed to increase self-efficacy and increase the
knowledge about the benefits of exercise in the curriculum
design of physical education (Dishman, 1994).
Additionally,
educators may wish to use the Transtheoretical Model of
Behavior Change framework to begin testing the efficacy of
stage specific physical activity interventions used in
physical/wellness education courses.
Purpose
The researcher examined three theoretical models to
help understand exercise behavior in college freshman.
purposes of this study were I) To investigate the
The
9
applicability of the Transtheoretical Model to exercise
behavior; 2) To examine how self-efficacy applied to the
stages of exercise behavior; and, 3) To examine how
decisional balance applied to the stages of exercise
behavior.
Hypothesis
1.
There is a difference in self reported self-efficacy
among individuals as identified by the five stages of
behavior change: precontemplation,
preparation,
2.
contemplation,
action and maintenance.
There is a difference in self reported self-efficacy
between the active
(Preparers, Actors and
Maintainers) and inactive
(Precontemplators and
Contemplators) individuals.
3.
There will be an increase in self-efficacy along the
continuum from precontemplation to maintenance.
4.
There is a difference in self reported exercise beliefs
among individuals identified by the five stages of
behavior change:
5.
There is a difference in self reported exercise beliefs
between the active and inactive groups.
6.
The perceived benefits of exercise the
(Pros) will
increase along the continuum from precontemplation to
maintenance, while the perceived costs of exercise
10
(Cons) will decrease along the continuum from the
precontemplation to maintenance.
Delimitations of the Study
I.
All subjects were volunteers.
Limitations of the Study
I.
The assessment of exercise behavior relied exclusively
on the self-reporting of exercise.
Assumptions
1.
The questionnaires were- valid measures of assessing
exercise behavior.
2.
The subjects adhered to the researcher's instructions
and were honest in answering the questions.
3.
The subjects understood and answered the questions
according to the researcher's definitions.
Definition of Terms
Decisional Balance Model - a model used to assess the pros
and cons of decision making in regards to behavior change
(Janis & Mann,
1977).
Self-Efficacy - a personal belief as to how easy or
difficult adoption of exercise b e h a v i o r .is likely to be
(Ajzen & Madden,
1986).
11
Stages of Change - the temporal dimension of the
Transtheoretical Model indicating an individual's readiness
to change
(Prochaska &.DiClementez 1983).
Transtheoretical Model of Change - a theoretical construct
used to describe how individuals change their behavior
(Prochaska,
1979) .
Operational Definitions
Actors - include those who exercise regularly, but who have
done so for less than six months.
Appropriate regular physical activity- exercise which
involves large muscle groups in dynamic movement for periods
of 20 minutes or longer,
three or more days per week, and
which is performed at an intensity requiring 60% or greater
of an individual's cardiorespiratory capacity.
Contemplators - include those who do not exercise, but who
intend to start in the next six months.
Determinant- used to denote a reproducible association or
predictive relationship other than cause and eff e c t .
Exercise Adherence - maintaining a regular exercise program
for at least six m o nths.
Precontemplators - include individuals who do not exercise,
and who are not planning to start exercising in the next six
months.
Preparers - those who exercise some, but not regularly.
12
Maintainers -include those who exercise regularly and have
done so for six months or longer.
Regular Exercise - exercise executed at least 3 times per
week for 30 minutes of more.
13
Chapter 2
REVIEW OF LITERATURE
Health Benefits of Physical Fitness,
Physical Activity, and Exercise
Participation in a regular exercise program has been
confirmed to be beneficial in the prevention of most
lifestyle related diseases
(Dishman, 1994). Exercise is
conducive to physiological and psychological well-being.
The protective effect of physical activity was detected in
the decreased death rate from cardiovascular disease
Kohl, Barlow,
& Gibbons,
Thompson, Casperson,
Collins,
1991; LaPorte,
& Kendrick,
1987;
(Blair,
et al/ 1984; Powell,
Williams, Ekers,
& Lee, 1991) and a substantial amount of evidence
established exercise as a helpful treatment for
psychological problems
1989; Martinsen,
(King, Taylor, Haskell,
& DeBusk,
1990; Steptoe & Cox, 1988 ).
Regular exercise can help enhance the quality of life
for people of all ages
(Katz, et al.., 1983 ). However,
improving the quality of life is a matter of personal
choice.
Therefore,
the greatest challenge is no longer
documenting the benefits of regular exercise, but rather
teaching individuals how to take control of their health
14
habits to ensure a better, healthier, more productive life
(Marcus, Banspach et a l ., 1992).
Before revealing the physiological and psychological
benefits of exercise, it is important to clarify the terms
Physical
physical fitness, physical activity and exercise.
activity is defined as any bodily movement produced by
skeletal muscles that results in energy expenditure
(Casperson,
Powell,
& Christenson,
1985).
can be categorized as either occupational,
conditioning,
1985).
or household activities
Physical activity
sports,
(Casperson,
Individuals are classified as inactive,
et al.,
active or
highly active, depending on their daily or weekly energy
expenditure.
Exercise is a subset of physical activity and
is defined as a planned,
structured,
and repetitive movement
for the purpose of improving or maintaining one or more
components of physical fitness
(Casperson, et al.,
1985).
Physical fitness is defined as the general capacity to adapt
and- respond favorably to physical effort,
implying that
individuals are physically fit when they can meet the
ordinary as well as the unusual demands of daily life safely
and effectively without being overly fatigued,
and still
have energy left for leisure and recreational activities
(Koplan, Casperson,
& Powell,
1989).
Although it is widely
accepted that appropriate activity exerts a positive
15
influence on health and longevity, much less certainty
exists about the type and quantity of appropriate exercise.
Physiological Benefits
Physical Activity
Individuals who are sedentary and unfit make up nearly
30% of the United States population
(ACSMz 1993) .
Such a
high prevalence constitutes a major public health problem
(US Department of Health and Human Resources,
1996).
'
Inactivity is listed as one of the major risk factors of
coronary heart disease
Weather/
(CHD)(ACSM, 1995). Blair, Wells,
and Paffenbarger
(1994) reported that "there is
substantial evidence that regular physical activity reduces
the risk of chronic suffering and premature death from
cardiovascular diseases, diabetes,
and osteoporosis"
(p. 35).
some cancers, obesity,
In a review of 43
epidemiological studies, physical activity was said to have
a "protective effect" on coronary heart disease
(Powell, et
al., 1987) .
Paffenbarger and Hale
(1975) assessed the relationship
between work activity and coronary health disease mortality
of San Francisco longshoremen.
The researchers reported
that the risk for CHD mortality was higher for workers with
lower levels of work-related activity, less than 2,000
kcal/week,
compared with workers who were more vigorous at
16
work,
greater than or equal to 2,000 kcal/week.
Paffenbarger, Hyde, Wing,
& Hseih
Similarly,
(1986) conducted a study
among 16,936 Harvard Alumni, relating physical activity
habits and mortality rates.
The researchers reported that
as the amount of weekly physical activity increased/ the
risk of cardiovascular deaths decreased.
(1989)
Blair et a l .
substantiated the previous findings based on the data
from 13,344 people who were studied for an average of eight
years.
The researchers confirmed that the level of
cardiovascular fitness was related to mortality from all
causes and that regular physical activity indirectly
affected the risk of coronary heart disease by moderating
the risk factors. The relative risk of CHD was reduced among
persons who engaged in high levels of physical activity
compared with their sedentary counterparts both in the
presence and absence of risk factors such as hypertension,
obesity and smoking
(Paffenbarger, Wing, Hyde,
Siscovick, Weiss, Fletcher, Schoenbach,
& Jung,
& Wagner,
1983;
1984).
Paffenbarger et a l . (1993) indicated that the benefits of
starting a moderate to vigorous physical activity program,
by previously inactive adults, were as important as quitting
smoking, managing blood pressure,
cholesterol.
or controlling
The increase in physical activity led to the
same decrease as quitting smoking in the relative risk for
death from C H D .
17
Epidimiologists have identified a lower prevalence of
hypertension in individuals who were more physically active
(Paffenbarger et a l ., 1983; Sellierz 1995; Tipton,
Tipton
1991).
(1991) reported that people who exercise have
systolic blood pressures of 5-25 mmHg lower than non
exercisers and diastolic blood pressures of 3-15 mmHg lower.
In an 18-year follow-up study on exercising and non­
exercising subjects, researchers, found lower blood pressures
in the active group
Wallace,
1990).
(Kash, Boyer, VanCamp, Verity,
&
The exercise group had an average resting
blood pressure of 120/78 mmHg as compared to 150/90 mmHg for
the non exercise group.
Not only did regular physical
activity reduce the risk of developing hypertension, but it
also may reduce the mortality from stroke.
Hypertension
often leads to the incidence of stroke, therefore several
researchers have investigated stroke in relation to physical
activity
(KanneI & Sorlie,
1979; Fiebach, et al, 1989).
Fiebach,
et a l . (1989) found an inverse relationship between
self reported physical activity and the incidence of stroke.
It has been shown that increased activity level may
have a protective effect from certain forms of cancer in
both men and women
(Kohl, LaPorte,
LaPorte,
(1988) reported that an increase in
and Blair
& Blair,
1988) .
Kohl, ,
physical activity may reduce risk of colon cancer in men and
reproductive cancer in women.
Inactive women had a greater
18
risk for developing cervical and breast cancer
Blairz & Taylorz 1989).
(Albanesz
Physical activity may offer one
means for the primary prevention of breast cancer through
its influence on ovarian hormones
1995).
(Friedenreich & Rohan,
Friedenreich and Rohan reported that there was a
decreased risk of breast cancer among those women who were
more physically active.
Leez Paffenbarger and Hseih
(1991)
reinvestigated the data from the Harvard alumni study
(Paffenbargerz et al.z 1986) and reported that the highly
active males had half the risk of developing colon cancer
than the inactive male alumni.
Additionally,
former
athletes were found to have a lower rate of non-reproductive
system cancers when compared to non-athletes
Wyshakz Albright, Albright,
(Frisch,
& Schiff, 1989).
When summarizing the physiological effects of physical
activity,
Blair, et a l . (1994) stated that the "health
benefits of changing one's activity from doing nothing to
doing something often exceed those gained by increasing from
moderate to high levels of activity"
(p. 50) .
While high
levels of physical activity were associated with the lowest
risks of disease,
individuals also received benefits from
low levels of physical activity (Blair, et al, 19:94) .
Exercise
Exercise is the regular and planned performance of
19
physical activity with the final or intermediate objective
of improving or maintaining levels of physical fitness
(Casperson, et a l ., 1985).
Participation in a regular
exercise regimen has been confirmed to be beneficial in the
prevention of most lifestyle related diseases and was
reported to be conducive to physiological well-being
et al.,
1994; Brown,
1990)
(Blair,
The benefits of regular
exercise may be manifested in terms of primary prevention or
via the use of exercise as a treatment for an already
diagnosed disease
(Powell, 1988).
Regular exercise
indirectly affects the risk of coronary heart disease by
moderating the risk factors
(Ekelund, et al.,
1988).
Researchers who conducted longitudinal research found that
increased aerobic activity was effective in controlling
several cardiac risk factors such as obesity,
(Epstein &
Wing,
(Paffenbarger,
1980; Wood, et al., 1991), hypertension
et al.,
1983), and osteoporosis
(Gutin & Kasper,
1992).
Even when individuals possessed numerous risk factors, their
risk for CHD was higher if they did not exercise regularly
(Siscovick, LaPorte,
& Newman,
1985).
Investigators
revealed that by prescribing endurance training for patients
with diagnosed coronary artery disease
reduction in mortality and morbidity
Ornish,
et al., 1990).
(CAD), there was a
(Brown, et al.,
1989;
Hence, there appears to be a
relationship between exercise and cardiovascular disease
20
mortality,
as well as a relationship between regular
exercise and longevity.
Boger
(1970), and Choguette and Ferguson
(1973)
examined the effect of exercise training on the blood
pressure levels of normotensive and hypertensive men.
In
both studies the researchers found that exercise training
lowered systolic and diastolic blood pressures,
and that the
magnitude of the reductions in blood pressure was
significantly greater for individuals with hypertension when
compared to individuals with normal blood pressures. Hagberg
& Seals
(1986)
found'that individuals with hypertension
showed a significant decrease in blood pressure after only
4-5 weeks of initiating training.
They reported that this
reduction would remain as long as an active lifestyle was
continued.
Regular exercise was beneficial to patients with
mild hypertension with reported reductions of 5-8 mmHg
diastolic and 8-10 systolic blood pressures
a l ., 1985; ACSM,
Sherwood,
& Waugh
1993).
(Siscovick, .et
Blumenthal, Thyrum, Gullette,
(1995) confirmed that exercise along with
weight loss offered promise as a non-pharmacological
treatment for hypertension.
Obesity is a chronic disease possessed by an estimated
33% of the adult population (Kuczmarski, Flegal, Campbell,
Johnson,
1994).
It is characterized by the accumulation of
excessive levels of body fat and may contribute to heart
&
21
disease, hypertension, diabetes, and some cancers.
reported that in the prevention of obesity,
It was
regular exercise
was the most important factor influencing lifestyle change
(J'ak'Op,
1995).
Also, when controlled for other lifestyle
changes, exercise was important for the overall reduction of
body weight and subsequent maintenance of weight-loss
(Zelasko,
1995).
Exercise has been associated with improved
body composition, preservation of lean body mass
1995; Hawks,
1989), and an increase in the oxidative
capacity of muscle tissue
and McMinn
(ACSM,
(1990)
(Kahahn & McMinn, 1990) .
Kahahn
found lower insulin levels and increased
sensitivity to fat-mobilizing hormones in patients that
exercised.
Researchers reported a strong association between the
prevalence of obesity and cardiovascular risk factors
(Kuczmarski,
et a l ., 1994).
The prevalence of hypertension
was 2.9 times greater for individuals who were overweight
than those individuals who were not overweight,
and 2.1.
times greater for cholesterolemia than that of the non over
weight individuals.
Additionally,
the incidence for
diabetes was 2.9 times greater in the individuals who were
overweight.
Regular aerobic exercise was shown to alter the
lipoprotein profile in post menopausal women
(Whitehurst &
Menendez, 1991), and both men and women were reported to
have lowered their cholesterol by an average of 23% in only
22
three weeks after following a low fat, low calorie diet,
combined with regular aerobic exercise
Anspaugh, Humter and Dignan
(Barnard,
1991).
(1996) reported lower levels of
total cholesterol, LDL cholesterol,
and triglycerides levels
for exercisers than for non-exercisers.
They also reported
that blood levels of HDL cholesterol were significantly
higher in those who exercised.
According to Helmrich, Raglund, Leung, and Paffenbarger
(1991) aerobic exercise was helpful in preventing diabetes
in middle-aged men.
The protective effect was even greater
in those with risk factors such as obesity, high blood
pressure,
and family propensity.
The preventative effect
was attributed to less body fat and better sugar and fat i
metabolism resulting from the regular exercise.
Roos
(1989)
reported that exercise was useful in the treatment and
management of type II diabetes, but to be beneficial,
the
exercise must be regular and aerobic.
Exercise has been correlated with bone mineral density,
and in the prevention of osteoporosis
1991).
(Snow-Harter & Marcus,
Older people who had been active for many years were
found to have enhanced bone mineral densities
Kasper,
1992).
Lohman et al.
(1995)
(Gutin &
studied the effects of
an 18 month resistance training program on regional and
total bone mineral density in premenopausal women.
The
researchers, supported the use of strength training for
23
increasing lean mass and muscular strength and regional
increases in bone mineral density.
(1990)
Davee, Rosen,
and Alder
found that young women who supplemented aerobic
exercise with weight training of only one hour per week had
higher spine bone mineral densities than women who were
sedentary or participated only in aerobic exercise.
Additionally,
athletes -have been observed to have higher
bone densities than non athletes
Upton,
& Hagan,
1983; Pirnay, Bodeux, Crielaard,
Franchimont, 1987).
Talmage
(1984)
(Brewer, Meyer, Keele,
&
Jacobson, Beaver, Grubb, Taft and
suggested that increased activity may be
associated with a lower rate of age-related bone loss.
Physical Fitness
Physical fitness is a set of attributes that people
have or achieve that relates to the ability to perform
physical activity (Casperson, et a l ., 1985).
Without
physical activity, there cannot be physical fitness.
Paffenbarger
(1988) concluded that the higher levels of
physical fitness led to a delay in cardiovascular disease
and cancer mortality.
Blair, Goodyear, Gibbons,
& Cooper,
(1984) examined physical fitness levels and the incidence of
hypertension in healthy normotensive men and women.
found that physical fitness, as assessed by maximal
treadmill testing, was related to the incidence of
They
24
hypertension.
When compared to individuals with high
fitness levels, individuals with low fitness levels had a
52% greater risk for the development of hypertension and the
largest difference in death rates was evident between people
with the low and moderate fitness levels.
Cooper,
& Smith
(1983)
Gibbons, Blair,
found an inverse relationship between
physical fitness and systolic and diastolic blood pressures.
Ekelund,
et al.
(1988) reported that low physical fitness
was associated with an increased risk of cardiovascular
disease.
Finally, there is a lower prevalence of osteoporosis
among physically fit individuals.
Hajek,
Chow, Harrison, Brown,
&
(1986) compared bone mineral mass and physical
fitness in post menopausal women and found that physical
fitness correlated significantly with the bone mineral
density.
Subjects with average physical fitness had lower
bone mineral densities,
and bench press and leg press
strength than did subjects with above average fitness.
Also
ah increase in lumbar spine, femoral neck and total body
bone mineral density has been correlated with physical
activity
Yeates,
(Aloia, Vaswani, Yeh,
Sambrook,
activity,
& Eberl,
& Cohn, 1988; Pocock, Eismah,
1986).
In summary, physical
exercise and physical fitness all are key
determinants of physiological well-being.
25
Psychological Benefits
Physical Activity and Exercise
Exercise and physical activity are increasingly being
prescribed as a means to maintain and enhance good mental
health.
Therapeutic approaches emphasizing increased levels
of energy expenditure draw on the beneficial effects of
exercise in influencing mood and attitude
& Tran,
1990; Steptoe & Bolton,
Needle,
1985).
(North, McCullagh,
1988; Taylor, Sallis,
Thirway and Benton
&
(1992) found that
physical activity rather than physical fitness was the
factor associated with better mental health and mood, and
that higher levels of physical activity were associated with
better mood scores.
Researchers have indicated that
exercise produces both short and long term psychological
benefits such as increased vigor and clearer thinking
(Dishman,
1985; Morgan & Goldston,
1988), psychological hardiness
reduced anxiety
(Shephard & Shek,
(Allchiter & Motta,
Weyerer and Kupfer
1987; Ross & Hayes,
1994), and
1994).
(1994) , and Ross and Hayes
(1988)
reported that low or moderate intensity activity reduced
symptoms of depression, anxiety, and malaise in the general
population.
Also,
individuals who were mildly or moderately
anxious or depressed experienced positive mood changes with
exercise
(Ross & Hayes,
1988) .
King, et a l . (1989)
found
26
that acute vigorous activity resulted in reductions of
anxiety
(King, et a l ., 1989), whereas chronic activity led
to lower levels of depression
Kuper, & Robertson,
1985).
(Simons, McGowan, Epstein,
Martinsen
(1990) reported that
exercise had an antidepressive effect on patients with mild
to moderate forms of depressive disorders,
and patients who
continued to exercise had lower depression scores than those
who did n o t .
Weyerer and Kupfer
(1994) indicated that for
individuals who were just beginning exercise,
individuals
who had low fitness levels, individuals who were elderly,
and individuals suffering from psychiatric disorders, the
psychological benefits of exercise were comparable to gains
found with standard forms of psychotherapy and that aerobic
exercise plus counseling was more effective than counseling
alone.
In several studies investigators reported that regular
exercise was an effective non pharmacological treatment for
stress, depression and anxiety,
Martinsen,
1994; Shephard,
(Klingman & Pepin,
1991).
1992;
The value of exercise in
reducing stress is related to several factors such as
decreased muscular tension, release of endorphins and
monoamines,
O'Connor,
thermogenic response, and distraction
1988).
Vigorous aerobic exercise,
(Morgan &
that is
continuous in nature and lasts 30 minutes or longer,
is
associated with the release of endorphins from the pituitary
27
gland in the brain which may induce a calming effect
(Steinberg & Sykes,
1985; Steptoe & Bolton,
1988).
The
theory of distraction is based on the concept that exercise
gives a person a "time out" or distraction from the causes
of stress experienced in their daily routine
Morgan,
(Raglin &
1987).
Researchers suggested that chronic exercise is
associated with decreased depression
Shephard,
(Klingman & Pepin 1992;
1991; Simons, et a l ., 1985).
Based on results
from clinical studies, Weyerer and Kupfer
(1994)
supported
the use of chronic exercise to treat depression.
Consequentially,
for healthy individuals the benefits of
exercise may help in the prevention of psychological
disorders,
and for those individuals who suffer from mild to
moderate emotional illness, exercise may function as a means
of treatment.
Physical Fitness
Physically fit individuals have been found to respond
more favorably to the psychological stressors experienced in
daily life.
Individuals who were cardiovascularly fit have
been reported to have a reduced psychosocial stress
response.
This was particularly evident in prolonged
exercise participation
Loftin
(Crews & Landers,
1987) .
Brandon and
(1991) studied the relationship between physical
28
fitness and depression,
state and trait anxiety,
locus of control and self-control.
internal.
Significant positive
correlations were found between fitness and the depression
scores,
internal locus of control, and self-control.
They
theorized that there was a link between physical fitness and
improved emotional response
Tucker
(Brandon & Loftin,
1991).
(1990) examined the degree to which physical fitness
contributed to the reduced prevalence of distress
(perception of workload,
problems,
anxiety,. work pressures,
and depression)
family
in 4,032 adults. .The author found
that as physical fitness increased, the prevalence of
psychological distress decreased.
support for an associative
It appears that there is
(not causative)
relationship
between exercise and improved mental health
(Sime, 1990).
Determinants of Exercise Participation
Knowledge about the factors related to physical
activity is important in health planning and programming
(Godin,
1994).
Many studies have been conducted to uncover
the determinants of physical activity and exercise.
Dishman,
Sallis, and Ornstein (1985) suggested that a
variety of determinants predispose,
enable,
reinforce the exercise adoption process.
impede, and
Rehor
(1991a)
hypothesized associations between the personal,
environmental and activity determinants of exercise and the
29
five stages of behavior change in relation to exercise
(Appendix A) .
Exercise researchers have provided valuable
data delineating factors associated with exercise
participation.
Most researchers have identified only
correlates or potential determinants of exercise.
The
initial problem faced by those who studied exercise .
determinants was the difficulty in defining and measuring
exercise and physical activity (Dishman,
1994) .
Measurement
of physical activity is complicated by variations in type,
intensity,
frequency, duration and intermittency. The
determinants of exercise maintenance rather than the
determinants of exercise adoption were revealed in most
literature on exercise participation
However,
(Dishman,
1994).
the predictors of exercise adoption is a topic of
great importance,
and in need of serious investigation,
considering the low percentage of Americans that participate
in regular exercise
(Sallis & Hovell,
1990). The
determinants known today can be categorized into one of the
following groups:
Personal characteristics; knowledge,
attitudes and beliefs; environmental factors; or social
factors.
Personal characteristics were likely to play a major
role in determining exercise participation
1990).
(Sallis & Hovell,
Investigators have reported that age, race,
gender,
and education all played a role in exercise participation.
30
Physical activity has been noted to decrease with age after
late adolescence
50
(Stephens, 1980) and again after the age of
(Reaven, McPhillips, Barrett-Connor,
& Crack,
1990).
Many researchers have reported lower activity levels among
women than among men, particularly at younger ages
Patterson, Buono, Atkins,
& Nader,
(Sallis,
1988; Schoenborn,
1986).
Comparisons by race are said to be confounded by
socioeconomic status and level of education
1992). However,
(King, et a l .,
in two studies, researchers reported that
black women were found to be less active than white women
(Folsom, et al., 1991; Ford, et al., 1991) .
Occupation,
exercise habits.
education, and income may also determine
"Blue collar" workers were less likely to
engage in physical activity than white collar workers
Carl, Birkel,
& Haskell,
1988)
(King,
This may be due to the
physical nature of the job, although, in the clinical area,
blue collar occupation was also associated with poor
adherence
(Oldridge,
1982).
The level of education has been
positively associated with physical activity
Kelsey, Meilhan, Fuller,
White,
& Wing,
(Matthews,
1989; Stephens,
Jacobs,
&
1985), and a positive relationship was also reported
between income and physical activity (Schoenborn,
Stephens,
1986;
et al., 1985).
Knowledge,
attitudes, and beliefs positively correlate
with exercise participation.
(Dishman, 1982; Shephard,
31
1978).
Dishman et a l . (1985) stated that while active
individuals were knowledgeable about exercise,
it was
unclear whether such knowledge was an antecedent or a
consequence of involvement.
Additionally, people who
believed that exercise was of little value exercised less
than those who held exercise in high "regard"
1982).
(Dishman,
People who perceived their health as poor are
unlikely to adopt or adhere to an exercise program
1986).
(Sallis,
Also one's self-efficacy (i.e ., confidence in one's
abilities)
of being able to perform a specific activity or
behavior has been associated with physical activity
(Bandura,
1977; Dzewaltowski, Noble,
& ,Shaw, 1990) .
Dzewaltowski et a l . (1990) reported that the more confidence
one has in their physical activity abilities,
the more
likely they will initiate and regularly participate in an
exercise program.
The influence of environmental factors can affect
physical activity.
and equipment,
Lack of time, convenience of facilities
safety of the neighborhood,
and weather.are
just a few factors that may have an influence on exercise
participation.
Dishman (1982) and Oldridge
(1982)
found
that the most common reason of dropping out of an exercise
program was lack of time.
Environmental reinforcement and
stimulus control via advertising and media have been
successful in increasing adherence
(Brownell, Stunkanrd,
&
32
Albaum,
1980).
Additionally,
the social factors appeared to be an
important contributor in the adoption and maintenance of
physical activity (Rosenthal & Bandura,
1978).
Aspects of
the social environment include the attitudes of family,
peers,
and health professionals,
competing responsibilities.
or hinder participation.
spouse support,
and
These aspects can either help
For example, Dishman
(1984)
found
that social reinforcement from exercise staff or exercise
partners helped individual's adherence
(Wankel,
1985).
Numerous studies have been conducted for the purpose of
understanding, predicting and facilitating exercise
adherence
(Ajzen,
1988; Bandura,
1977; Dishman,
1982; Gatch
& Kendzierski,
1990; Oldridge & Streiner,
et a l ., 1994)
Though many techniques and constructs have
been investigated,
1990; Prochaska,
success has been limited and conclusive
guidelines have not emerged.
Several theorists believed
this failure to determine predictable results could be due
to the design and implementation of research without an
underlying theoretical basis to explain the change processes
involved in initiating and maintaining an exercise program
(Dishman,
1994).
Exercise Adoption and Adherence
Despite the many benefits of exercise, retaining people
33
in an exercise program can .be quite difficult.
Gettman
.Dishman and
(1980) affirmed that attrition rates may exceed 50%
within the first six months of initial involvement.
Helping
people to stay regularly involved in physical activity is a
challenge requiring the use of a sound theoretical approach
on the part of the health educator.
Finding ways to
encourage the extremely sedentary to adopt a more active
lifestyle represents an increasingly important public health
goal.
Dishman
willpower,
(1988) stated that "neither intention,
commitment, nor knowledge will be adequate by
themselves to change a sedentary lifestyle to an active
o n e ...."
(p. 209).
A wide range of determinants contributing to
participation in physical activity has been revealed in the
past ten years.
Investigators have examined factors that
influence the decision to exercise
Dubbert, 1982).
Dishman
(Dishman7 1982, Martin &
(1982) examined the interaction
between situational, biological,
and psychological factors
that lead an individual to make a decision about exercise
participation.
Dishman (1992) attributed decisions to be a
product of abstract beliefs
perception
(feelings)
(thoughts) and concrete sensory
that a person brings to or experiences
during exercise.
Situational factors were various components of a
person's lifestyle outside of exercise that either
34
facilitated or competed with exercise,
of the experience
such as the enjoyment
(Kravitz & Furst, 1991).
Dishman
(1982)
reported that the average person will have a better chance
of adhering to an exercise program that was conveniently
located and easily accessible.
Situational factors can be
lifestyle related, such as support from "significant
others," or can depend on the exercise setting,
such as
small group versus alone, and can be influenced by
behavioral change strategies like using reinforcement
techniques.
Biological factors were described as traits
which an individual possessed such as body composition,
aerobic fitness level, and health status
asymptomatic).
(symptomatic vs.
Biological factors can have a significant
impact on one's decision to exercise.
In addition,
these
factors may also interact with motivational factors or
beliefs about the outcomes of exercise and may influence the
choice of the mode, intensity and duration of the exercise
that a person chooses
Finally,
(Dishman, 1984).
some psychological factors have an impact on
one's willingness to exercise.
Dishman (1984) reported that
attitudes can predict a person's initial involvement and the
type of exercise a person selects.
Although,
the fact that
individuals viewed exercise as a rewarding experience did
not ensure' that they adhered to a program.
,The beliefs that
35
a person holds about the consequences of exercise and the
expected outcomes he or she hopes to gain from the
experience also influence the.decision to exercise.
A
person who believes that a relationship exits between
exercise and improved health is more likely to adopt fitness
into their lifestyle.
Additionally, personality traits
affects one's decision to exercise.
Dishman,
Dishman
(1984)
and
et a l . (1985) revealed that extroversion and self-
motivation are the two most common personality traits
believed to enhance adaptability to the behavioral demands
that exercise impose.
Dishman
(1984) noted that extroverts
are more likely to adhere to an exercise program and tend to
choose group exercise Classes over individual routines,
while introverts prefer exercising alone. Furthermore,
exercise adoption can be increased by matching an
individual's personality traits with a suitable exercise
program. Self motivation is another psychological trait
thought to influence adoption of exercise.
Dishman
(1984)
concluded that self-motivated individuals are better suited
to overcome environmental obstacles in an exercise setting,
such as an inconvenient time or an un-supportive spouse.
Dishman,
et a l . (1985) supported the principle that
individual differences
(psychological, biological and
situational traits) must be accommodated for in program
36
planning, but stressed that each situation is unique and
what succeeds for one individual may not succeed for
another.
Psychosocial Models Applied to Exercise
An increasing amount of studies have failed to provide
basic answers about who will exercise, why, or for how long
(Dishman,
Gionet,
1982; 1985; Dzewaltowski,
1991).
et a l ., 1990; Godin &
Researchers have studied several existing
psychosocial models used with exercise in hopes to gain a
better understanding of exercise adoption and adherence.
The following models are based on the social/cognitive
learning theories.
Researchers using the social/cognitive
theory identified the importance of people's ability to
regulate their own, behavior by goal setting, monitoring,
and
actively intervening,to make their social and physical
environment supportive of these goals.
The social learning
variables were identified as being important determinants in
adult's and children's physical activity participation
(Stucky & DiLorenzo,
1993).
Stucky and DiLorenzo
.
(1993)
suggested that the social cognitive framework provides
practitioners with a strong foundation on which to build
interventions as well as to compare other theories and
models.
Social cognitive theories may differ in the
interpretation of the causes of behavior, however,
the same
37
or similar variables are detected in each of the theories.
A thoroughly studied construct is the Health Belief
Model
(HBM)
(Becker & Maimanz 1975).
Proponents of this
model postulate that health-related behaviors can be
understood in relation to their potential to protect against
disease or improve health
(King, et a l ., 1992).
The
perception of a health threat is determined by the strength
of two underlying beliefs: personal susceptibility to a
given disease and the potential severity of its impact on
the individual’s life.
Therefore, an individual should
decide to exercise regularly if a sedentary lifestyle is
perceived as a threat to some aspect of health,
and regular
activity is seen as decreasing that risk.
When used to describe exercise participation,
was thought to be inappropriate
the HBM
(King, et al., 1992).
In
two studies, authors reported no significant association
between the HBM variables and exercise behavior
Hersey,
& Iverson,
McKinley,
1985).
(Mullen,
1987; O'Connell, Rice, Roberts,
Jurs, &
This may be explained by the uni­
dimensional framework.
The HBM is constructed on the
supposition that an individual's motivation for changing a
behavior stems from illness avoidance.
However,
the
motivation of exercise participation was thought to be
influenced by many factors
(Dishman/ et al.,
1985).
exception to this may include the motivation for
The
38
rehabilitative exercise for a population already affected by
disease
(Dishman, 1994) .
Physical activity was perceived as
requiring more time and effort than other health behaviors,
thus physical activity appeared to be unique among healthrelated actions
(Rehor, 1991b).
The HBM model was designed
for risk avoidance behaviors not health enhancement
behaviors,
therefore,
its effectiveness■may be less for
those who view physical activity as a health promoting
behavior than those who view exercise as an illness reducing
behavior.
The Protection Motivation Theory (PMT)
(Rogers, 1975)
is similar to the HBM with the addition of the component of
self-efficacy. Self-efficacy involves people’s degree of
confidence that they can abstain or engage in a behavior
(Bandura,
1977).
The model was designed to explain how
people cope with a threatened danger.
Maddux and Rogers
(1983) theorized that the intention to protect oneself
depends upon four factors:
1.
The perceived severity of a threatened event
2.
The perceived probability of the occurrence
3.
The efficacy of the recommended preventative
behavior
4.
The perceived self-efficacy
Wurtle and Maddux
(1987) applied the PMT to exercise
behavior and reported that perceived susceptibility to
39
cardiovascular disease and perceived self-efficacy enhanced
intentions to exercise among a group of female
undergraduates.
(1987)
Similarly, Desharnais, Godin,
and Jobin
found that all subjects who were exposed to
persuasive communication increased their intention to
exercise,
Godin
regardless of their perceived susceptibility.
(1994) concluded that messages that convey a
persuasive threat seemed effective in enhancing
participants'
intentions to change, but they are less
effective in inducing and sustaining changes of actual
behaviors.
Godin
(1987) found that subjects who had their
physical fitness evaluated reported a stronger intention to
exercise over the next three months than those who did not,
however,
the behavioral effect diminished after three
m o nths.
The authors of The Theory of Reasoned Action
(Fishbein & Ajzen,
1975) assumed that social factors
affected the decision to exercise.
and Ajzen
(TRA)
According to Fishbein
(1975) the proximate determinants of the intent to
adopt a given behavior are the individual’s attitude about
performing the behavior and the influence of social factors
upon performance of the behavior. The model assists
researchers in explaining the interaction of personal and
environmental characteristics. The attitudes about a
specific exercise prescription
(i.e ., time place,
and type
40
of exercise)
can predict behavior through its interaction
with social norms, and both can predict intention
Fishbein,
1977).
(Ajzen &
The model can be represented symbolically
as follows:
B-I= (Aact)wl + (SN)w2 .
Where
(B) behavior approximates
equal to
(I) the intention,
(Aact) the attitudinal component plus
normative component.
and is
(SN) the
The attitudinal component is the
person's attitude toward the behavior,
and the normative
component is a person's perception that the majority of
"significant others" think that he or she should adopt the
behavior.
Wl and W2 are the weighing coefficients which
show inter-situational and inter-individual differences.
For some behaviors the attitudinal component is the major
determinant of intention,
whereas for other behaviors the
normative component is the dominant component
"The personal attitude toward the behavior,
(Godin, 1994).
is a function of
the beliefs concerning the perceived consequences of
carrying out a- specific action, and a personal evaluation of
these consequences"
(Godin, in Dishman
(Ed.), 1994, p,- 118).
In a review of studies that used this theory, Godin
(1994) reported that approximately 30 % qf the variance in
intention to exercise was explained by the attitudinal
component,
and that the normative component did not appear
to be a variable for the interpretation of exercise
41
behavior.
The weakness of the TBA in predicting exercise
behavior from attitudes and social norms lies in its
postulation that intentions are the sole predictors of
behavior
(Ajzen & Madden,
1986; Dzewaltowski,
et a l ., 1990).
While intentions are necessary for adoption of habitual
exercise,
they are not sufficient to predict physical
activity. The TRA has proved helpful in clarifying the
discriminating process that underlies exercise behavior
(Dishman, et al., 1985).
The Theory of Planned Behavior
(TPB)
(Ajzen,
1985)
extended beyond the theory of reasoned action by including
the concept of perceived behavioral control
(Godin,
1994)„
B~I= (Aact) W1 + (SN)W2 + (PBC) W3
In this model,
intention,
(B) is the behavioral component,
(Aact) is the attitudinal component,
(I) is the
(SN) is the
normative component and (PBC) represents perceived
behavioral control.
W1, W2 and W3 are the weighing
coefficients affecting the strength of the attitudes, social
norms and perceived behavioral control as they influence
intentions.
Perceived behavioral control is determined by the
perceived presence or absence of required resources and '
opportunities and of anticipated obstacles; the control
belief and by the perceived power of a particular control
factor to facilitate or inhibit performance of the behavior
42
(Godinz 1994). Investigators of this model postulated that
most behaviors fall along a continuum that extends from
total control to complete lack of control.
The perception
of control affects the decision to perform a specific
behavior
1991)
(Ajzen, 1985; 1991; Godin,
1994).
Ajzen
(1985,
ascertained that individual's beliefs about how easy
or difficult adoption of the behavior will be, and how their
beliefs about the availability of resources and
opportunities may be viewed, underlies their perceived
behavioral control. The developers of the Theory of Planned
Behavior accounted for the influence of the perceived
barriers to action and self-efficacy as influencing
behavior.
One's perceived behavioral control,
attitude,
and
subjective norms, all influence intentions to perform a
behavior.
Furthermore, perceived behavioral control
reflects personal beliefs as to how easy or difficult
adopting a behavior is likely to be.
Application of this model to exercise has been useful
in describing exercise behavior as it helps researchers
understand the formation of intention to exercise
(Drewaltowski et a l ., 1990; Gatch & Kendzierski,
Gatch and Kendzierski
1990).
(1990) found that perceived behavioral
control contributed to the prediction of the intention to do
aerobics regularly. Similarly, Godin and Gionet
(1991)
determined that perceived behavioral control influenced the
43
intention to exercise among employees who suffered from
coronary heart disease.
Godin (1994) suggested that partial
support be given to the usefulness of this model with
exercise behavior, however, additional studies were needed
before a final conclusion could be m a d e .
Theory of Interpersonal Behavior
(TIB)
(Triandis,
1977) was developed to predict behavior from the interaction
between the intentions to perform the behavior,
and
conditions facilitating or discouraging performance of the
behavior.
Triandis
(1977) postulated that some behaviors
became automatic and were performed with little conscious
intervention.
performed,
Therefore, the number of times a behavior was
the more likely it would become a habit.
The
theorists of interpersonal behavior indicated that intention
is shaped by four components: a cognitive component; an
affective component; a social component; and
personal
normative beliefs.
B= (IxF) wi-f = (HxF) wh-f
(B) is the given behavior,
(I) is the individual's intention
to perform or not to perform the behavior,
(H) is the
evaluation of the habit of number of times the individual
has performed the behavior,
and (F) is the evaluation of
conditions facilitating or discouraging performance of the
behavior.
Wiif and Wh--f are the corresponding regression
coefficients
(Godin, 1994).
44
The cognitive component includes the analysis of the
advantages and disadvantages of adopting a behavior.
The
affective component is described as the individual's
emotional response to the thought of adopting a behavior.
This component may be shaped by previous experiences of the
behavior. The social component reflects the relationships
between the individual and other people and the
appropriateness of performing the behavior.
Finally,
personal normative beliefs are the measure of the
individual's perceived obligation to perform the desired
behavior.
Application of this model to exercise suggested that
the affective component of attitude was more influential
than the cognitive component
(Godin, 1987/ Wankel,
1985).
Criticism of this model originates from the absence of
recognizing variables such as self-efficacy,
barriers to exercise participation
Godin, Valois,
Jobin,
& Ross,
and perceived
(Godin & Gionet,
1991;
1991).
Transtheoretical Model of Behavioral Change
While traditional behavioral change theorists
conceptualized behavioral change as a linear sequence,
those ■
who prescribed to the Transtheoretical Model of Behavioral
Change
(TMBC) recognized that acquisition and maintenance of
a behavior was a dynamic process incorporating sequential
45
stages rather than a dichotomous event
(Prochaska &
DiClementez 1983; Prochaskaz Velicerz DiClementez & Favaz
1988).
These theorists have demonstrated the existence of
stages and processes of change for a number of behaviors
such as smoking cessation, dietary habits, weight reduction
and health screening.
Use of the TMBC has proven to be
applicable to the acquisition and maintenance of a behavior
and involves five stages: precontemplation,
preparation,
action and maintenance
1994; Sonstroem,
Behavior Change
behavior
(Prochaska,
et a l .,
1988). The Transtheoretical Model of
(TMBC) has been recently applied to health
(Marcus, Rossi, Selby, Niaura,
Marcus & Simkin,
contemplation,
1993).
& Abrams,
1992;
This model uses constructs from
other theories such as self efficacy and decisional balance
to examine the behavioral processes an individual goes
through when adopting a new behavior. Behavioral theorists
have examined the stages and processes that influence
exercise participation
DiClemente,
(Marcus & Simkin,
1983; Sonstroem,
1993; Prochaska &
1988). Factors such as self
efficacy and decision making were key components of this
model
(Godin, 1994).
Stages of Behavior Change
Dishman
(1982) attributed the lack of success in
exercise adherence research to a narrow focus of exercise
46
participation.
Most researchers have investigated the
predictive characteristics of exercise rather than the
process characteristics of exercise. Dishman
(1982)
recommended placing more importance on the interaction
between these two variables. Dishman
(1982) along with other
researchers have taken a theoretical approach to behavioral .
change
(Marcus & Simkin,
DiClemente,
1993; Prochaska,
1979; Prochaska'&
1984).
Researchers have suggested that individuals engaging in
a new behavior move through a series of stages of
Precontemplation
Contemplation
(not intending to make changes),
(considering change), Preparation
(making
small changes), Action
(actively engaging in the new
behavior ), Maintenance
(sustaining the change over time),
and Termination
Simkin,
(having no temptation to relapse)
1993; Prochaska & DiClemente,
1983).
(Marcus &
The model of
stages of change has been used to explain how an individual
progresses through the stages of changing a behavior.
Stages are characterized as being "dynamic in nature, and
behavior change is not an "all-or-none phenomenon;
individuals who perform a behavior may relapse and start
again"
(Dishman,
1994). In essence, each stage is open to
change.
A stages of exercise adoption questionnaire
(SEA) was
developed in order to describe a person as being in one of
47
the five stages of change
(Marcus, Rossi,
et a l ., 1992).
Six statements were designed to assess current stage of
exercise behavior.
1.
I do exercise now
2.
In the next 6 months I plan to exercise
3.
I exercise regularly now (regular exercise is defined
as 3 or more times a week for 30 mins, or longer)
4.
For the past 6 months I have exercised regularly
5.
In the past,
I have exercised regularly for a period of
at least 3 months
Using an algorithm (Appendix C) researchers are able to
evaluate the questionnaire in order to classify an '
individual as being in one of the five groups.'
"Processes of Behavior Change
Theorists proposed that individuals, while moving
sequentially between the stages, used ten,processes of
change
(Prochaska & DiClemente,
DiClemente,
& Fava, 1988).
experimental processes,
behavioral processes
1983; Prochaska, Velicer,
Five processes are classified as
and five are classified as .
(Table I ) .
Experimental processes were
used to explain the early behavior changes
(precontemplation
- preparation), while the behavioral processes were used to
predict the later transitions
(Marcus, Rossi, et al., 1992).
(preparation - maintenance)
48
Transtheoretical Model and Exercise
Unlike other health behaviors,
the habit of regular
exercise involves factors that .may be unique,
and therefore
required studying the processes that occur between exercise
adoption and adherence
(King & Martin,
1993).
Researchers
have indicated that factors influencing initial adoption and
early participation in exercise may differ from those
affecting subsequent maintenance
Marcus, Rakowski,
& Rossi,
(King & Martin,
1993;
1992).Sonstroem (1988) was the
first to apply the Transtheoretical Model to exercise.
He
believed that researchers should study processes of change
in exercise adoption to enhance the design and delivery of
exercise interventions.
Sonstroem classified two hundred and twenty males, as
being in one of the stages of exercise change, by their self
reported exercise history.
Subjects answered statements
concerning their beliefs about the outcome of regular
exercise participation.
Sonstroem (1988) found that beliefs
were related to the stage of exercise behavior
1988).
(Sonstroem,
Selby (1989) examined the applicability of the
Transtheoretical Model's processes to exercise behavior.
49
Table I.
Processes of Change
EXPERIMENTAL PROCESSES
CONSCIOUSNESS RAISING -
Increasing the information .
available to individuals;
ENVIRONMENTAL REEVALUATION - altering .an individual's
perception of his/her behavior's effects on the environment;
SELF-REEVALUATION - altering one's perceptions regarding the
effects of a particular behavior on oneself;
SOCIAL LIBERATION - society changing to provide more
alternatives for problem behaviors;
DRAMATIC RELIEF - releasing blocked emotions by extrinsic
emotional observations;
SELF LIBERATION - freeing oneself of old beliefs and
behaviors and becoming aware of new possibilities;
BEHAVIORAL PROCESSES
COUNTERCONDITIONING- altering the way we respond to a
stimulus that had been controlling our behavior;
STIMULUS CONTROL - altering the environment;
REINFORCEMENT MANAGEMENT - altering the contingencies which
reinforce and maintain a behavior;
HELPING RELATIONSHIPS- support from others during behavior
change.
50
She hypothesized that individuals use similar'change
processes in developing exercise habits as those
demonstrated in other problem behavior changes.
A
questionnaire was developed using the definitions of the ten
processes related to behavior change and was administered to
443 college students.
The author revealed that only seven
of the ten change processes were employed by individuals in
developing their exercise habits: Consciousness Raising,
Dramatic Relief, Environmental Reevaluation, Helping
Relationships,
Stimulus Control, Counterconditioning,
Self-Reevaluation. As she predicted,
and
individuals in the '
early stages used more of the experimental change processes/
and those in the later stages used more of the behavioral
processes. Also, Selby found that all processes were used
most frequently by subjects in the maintenance stage.
Barke and Nicholas
(1990) compared the stages between
active and inactive groups of older adults.
The researchers
revealed that the active group's responses categorized the
adults .into either the action or maintenance stage, whereas,
the inactive group's responses were categorized as belonging
to the precontemplation and contemplation stages.
It was
concluded that use of the stages of change model,
is a way
to differentiate adults by knowing the amount of their
activity participation.
Selby and DiLorenzo
(1991) administered a stages of
)
51
change and processes questionnaire to college students to
determine if there was a different application of the change
process by current stage of exercise.
The authors found
that the processes used by the students were different
depending on their stage classification.
It was reported
that the experiential processes were used in the earlier
stages
(precontemplation and contemplation), and the
behavioral processes were used more in the later stages
(preparation, action, and maintenance).
Marcus, Rossi, et al (1992) applied the stages and
processes of change to exercise adoption and adherence. ■
Participants in a work-site health promotion project were
asked to complete two questionnaires dealing with the stages
and processes of exercise.
The purposes of the
investigation were to develop a scale to measure stages of
change for exercise behavior, obtain prevalence information
regarding where individuals were distributed along the
exercise scale, and to test the ability of a self-efficacy
measure to differentiate individuals according to stage of
readiness to change.
Participants were classified as being
in one of the five stages of behavior change.
The Stages of
Change model developed for smoking (DiClemente & Prochaska,
1982) was modified to describe exercise behavior.
A five-
item self-efficacy measure designed to measure confidence in
one's ability to persist with exercise in various situations
52
was also developed.
Self-efficacy items represented the
following areas: negative affect, resisting relapse,
making time for exercise.
Based on the results,
and
the authors
reported that scores on the self-efficacy measure were
significantly related to stage in the change process, and
that self-efficacy was closely linked to stage of self­
change in physical activity. - They concluded that those in
pre-contemplation and contemplation had the lowest selfefficacy scores and those in maintenance had the highest
self-efficacy scores.
Also, individuals at various stages
had different degrees of exercise-specific self-efficacy.
This difference suggests that individuals at the different
stages might benefit from interventions that differ in their
focus on enhancing efficacy expectations.
They found that
subjects in the various stages of change used the processes
of change differently.
Those in precontemplation used all
10 processes significantly less than subject in other
stages. Subjects in the earlier stages used more
experimental processes, while those in the later stages used
more of the behavioral processes
(Marcus, Rossi,
et a l .,
1992) .
Marcus,
Selby, et al.
(1992) examined the application
of the stages of change model to the study of exercise
behavior as part of a work site health promotion project.
Two hundred and thirty five
(235) male and female employees
53
completed an exercise behavior questionnaire and a 7-day
physical activity recall
(self report)
questionnaire
Subjects were categorized into five stages of exercise
behavior and then classified into three categories
(Precontemplation/Contemplation, Preparation,
Action/Maintenance).
The researchers performed a one-way
analysis of variance to assess the correlation between the
stages of exercise behavior and reported time spent in
moderate and vigorous exercise.
The authors revealed that
there was a significant difference in participation in
physical activity among the three stages.
Subjects in the
Action/Maintenance group reported significantly more
vigorous and moderate physical activity compared to subjects
in the Precontemplation/ Contemplation group.
Subjects in
"Preparation" were also found to report more vigorous and
moderate physical activity than those in "Precontemplation/
Contemplation".
Subjects in Action/Maintenance differed
from those in Preparation in terms of vigorous activity.
Marcus and Simkin
(1993) concluded that one's stage of
exercise behavior appeared to be. differentiated by selfreported physical activity..
Rehor & McNeil
(1993) evaluated the use of the
Transtheoretical Model in relation to exercise behavior of
senior citizens.
The purpose of the study was to develop a
health intervention strategy that would encourage senior
54
citizens to adopt' and adhere to a regular exercise program.
The participants self assessed their exercise behavior using
the Exercise Questionnaire at baseline, three months and six
months into the program.
The investigators then classified
the participants into one of the five stages of the
Transtheoretical Model of Behavior Change.
Stage specific,
cognitive behavioral strategies were developed for each
stage and administered to the participants at the beginning
of the program and three months later in accordance with
their classification within the mod e l .
Rehor and McNeil
(1993) reported that the intervention was effective in
increasing exercise participation.
Examination of only
those stages of the model where positive change was possible
i.e. all stages except maintenance,
revealed that for every
two individuals who regressed within the stage model there
were five who advanced to a higher level.
In addition, over
50% of those individuals in stages where positive movement
was possible, made positive movement to higher level of
exercise adoption. They concluded that the interventions
developed were successful in encouraging the senior citizens
to adopt exercise
In summary,
(Rehor & McNeil,
1993).
the Transtheoretical Model has been helpful
in the understanding of exercise and health behaviors.
Assessing stages of change has been found to predict the
likelihood of future effort to change
(Prochaska, Velicer,
55
Guadognoli, Rossi,
Selby
& DiClentente, 1991) .
Roberson
(1989) and
(1989) have developed reliable, valid instruments to
assess the stages and processes involved in exercise
acquisition and maintenance.
Perhaps the most important
application of this model allows researchers to identify
strategies that will work best for individuals at different
stages and levels of exercise participation.
Decisional Balance
Decision making theories have been helpful in the
research of behavior change.
Janis and Mann
(1977)
recommended that positive and negative outcomes should be
recognized when investigating decision-making.
They
developed a decisional balance model that applied eight
decision making constructs: instrumental benefits to self,
instrumental benefits to others, instrumental costs to self,
instrumental costs to others, approval from self, approval
from others, disapproval from self, and disapproval from
others
(Janis & Mann,
1977). This decision-making process
has been found to' be highly related to current and future
likelihood of participating in health behavior change
(O'Connell & Velicer,
1988; Prochaska, et a l ., 1994).
Before change can take place, one must perceive the behavior
as having high benefits
Recently,
(Pros) and low costs
(Cons).
researchers have simplified this model to a
56
two factor construct based on the comparison of the
perceived positive aspects
(Cons) of a new behavior
Prochaskaz et a l . 1 9 9 4 ) .
(Pros) and negative aspects
(O'Connell & Velicerz 1988;
This decision-making process has
been found to be highly related to the current and future
likelihood of participating in health behavior change
(Marcus, Eaton, Rossi,
& Harlow,
1994).
This model has been
valuable to the understanding of the Transtheoretical Model
of Change.
The balance between the Pros and Cons varies depending
on the stage of change.
Prochaska et a l . (1994) reviewed
the stages of change of 12 problem behaviors and revealed
that predictable patterns were applicable across the stages
(Prochaska et al., 1994).
In the Contemplation stage, the
Cons of changing the behavior outweighed the Pros in all of
the 12 samples.
In the Action and Maintenance stages, the
Pros outweighed the Cons of the problem behaviors.
Researchers have applied the decisional balance model to
smoking cessation and depicted the difference between
pro/con across the stages of change
1991).
(DiClemente et al.
The pros and cons of a new behavior were most
pertinent of movement in the first three stages of
behavioral change
Preparation)
(Precontemplation, Contemplation and
and was characterized as being predictive of
behavior change
(DiClemente et al., 1991; Marcus,
Selby,
et
57
a l ., 1992).
Similar findings were reported in a study on
mammography screening and decisional balance
(Rakowski, et
al./ 1992) .
The decisional balance model has been recently applied
to health promoting behaviors such as exercise, adoption
(Marcus & Owen,
1992; Marcus, Rakowski,
Marcus et al., 1994)
1988).
and weight loss
Marcus, Rakowski,
& Rossi
& Rossi,
1992;
(O' Connell & Velicer,
(1992) tested a 40-item
questionnaire consisting of statements based on constructs
from the Transtheoretical Model of Behavior Change.
Using a
principal component analysis, they identified two factors; a
six item component that represented avoidance of exercise
(Cons)
and a ten item component that represented the
positive perceptions of exercise
(Pros).
Pros, Cons, and decisional balance measure
In addition, the
(Pros minus Cons)
were found to be significantly associated with stage of
exercise adoption.
Researchers have compared the sum of the
Pro, Con and Pro/Con scores across the stages of the change
process
(Marcus & Owen, 1992; Marcus, Rakowski,
1992).
& Rossi,
By using the decisional balance measure,
the
researchers were successful in differentiating between five
groups representing the stages of change in the adoption of
exercise.
The sum of the Pros were lowest for the
Precontemplators and the highest for those in Maintenance.
The opposite was true of the Con scores.
The significant
58
imbalance of pros over cons appeared in the action group.
Grimleyz Rileyz Beilis & Prochaska
(1993) also found the
imbalance of pros over cons to occur in the action stage for
the behaviors of contraceptive and condom u s e .
findings have also been reported for exercise
(Prochaska et al.,1994).
Similar
behavior
Prochaska et a l . (1994) theorized
that one's perceived exercise beliefs
(Decisional balance)
probably takes place during the preparation stage suggesting
that for most problem behaviors the decision to change the
behavior
(Pros outweighing the Cons) will occur before an
individual takes action.
The progress from Precontemplation
to Action involved both an increase in Pros
(Precontemplation to Contemplation)
(Contemplation to Action).
and a decrease in Cons
This transition facilitated the
decisional crossover from Precontemplation to Action and is
dependent on "how much and when the pros increase and how
much and when the cons decrease"
44).
Marcus, Rakowskiz & Rossi
(Prochaska et a l ., 1994 p.
(1992) appropriately
characterized the usefulness of the decisional balance
measure stating that "knowing participant's beliefs may
portend the degree of acceptance or reluctance encountered
by attempts to produce behavioral change toward regular
exercise behavior"
(p. 260).
59
Self-Efficacy
Self-efficacy is the perception of one's ability to
perform a task successfully (Bandura,
1977).
It is a
function of past learning and the judgement of the
complexity or difficulty of the behavior required.
Bandura
(1977) developed the self-efficacy theory using the concepts
of confidence and expectations.
Bandura's theory places
self-efficacy as a common cognitive mechanism for mediating
motivation and behavior.
Personal factors and personal
attributes were thought to influence behavior and efficacy
cognitions were theorized to be reciprocally determined by
that behavior
(Bandura, 1977).
One's self-efficacy
determines whether an individual attempts a given task, the
degree of persistence when the individual encounters
difficulties,
and their ultimate mastery of the task.
The
use of the self-efficacy construct has been successful in
predicating sport participation,
(Feltz, 1988; McAuley &
Gill,
(Bernier & Avard,
1983)
and health behaviors
1986).
Behavior can be interpreted by use of the self-efficacy
theory by examining outcome expectations or efficacy
expectations.
Outcome expectations are beliefs that a
certain action will result in a desired outcome.
expectations are
behavior
(Bandura,
Efficacy
beliefs that one can perform a desired
1977).
Researchers supported the
relevance of self-efficacy in influencing and predicting
60
health promoting behaviors such as, smoking cessation,
weight loss, and dietary changes
Contento & Murphy,
1990).
(Bandura & Simon,
Kelly, Zyzanski,
1977;
and Alemango
(1991) examined the constructs of self-efficacy, health
beliefs,
and social support and their relationship to
smoking,
stress, eating behavior,
and seat belt u s e .
The
authors evaluated how well the constructs were able to
predict motivation for change.
Self-efficacy and perceived
benefits were reported to have the strongest influence on
behavior change.
In a cross-sectional study, self-efficacy was regarded
as an important determinant of quitting smoking among
pregnant women
(DeVries & Backbier, 1994). ' The
investigators reported that individuals in the Action and
Maintenance stages possessed greater self-efficacy than
Precontemplators and Contemplators.
Self-efficacy is also a strong predictor of exercise
adoption and adherence. The attempt to increase exercise
behavior is influenced by self judgement of the expected
beliefs of regular exercise and the perceived ability to
exercise regularly (Dishman, 1994).
A low self-efficacy may
lead to early attrition, whereas a high self-efficacy should
strengthen future expectations
(McAuley & Jacobson,
1992).
Marcus et a l . (1991) examined the self-efficacy and
decisional balance in 431 employed women.
The authors
61
revealed that women in pre-contemplation scored the lowest
on the self-efficacy. Pro, and decisional balance indices.
Women in maintenance scored the highest on these measures.
They concluded that women may be better served by stagemethod interventions to increase physical activity.
McAuley
(1992) employed a social cognitive framework
to examine self-efficacy and exercise behavior in sedentary
middle-aged adults.
The author found self-efficacy was a
reliable predictor of exercise adoption.
Additionally,
the
influence of self-efficacy was strongest in the adoption
phase of exercise behavior,
a stage where how often one
exercises and the degree of perceived exertion expended are
related to one's beliefs concerning their physical abilities
and confidence to continue exercising despite a myriad of
barriers.
In this phase, exercise participation may be
"tiring , painful,
system"
(McAuley,
inconvenient,
1991).
and stressful to the
McAuley (1992) suggested that as
the desired behavior becomes more difficult,
self-efficacy
plays a more portentous role.
McAuley, Courneya and Lettunich
(1991) examined the
self-efficacy of sedentary males and females when they
participated in various types of exercise.
The authors
found that both males and females demonstrated a significant
increase in efficacy following acute and long term
exercise.
Likewise, McAuley, Lox and Duncan,
(1993)
62
reported that self-efficacy was the only variable that
significantly predicted adherence to a 5-month structured
program.
Similarly,
self-efficacy was found to be the
strongest predictor of physical activity in a population of
rural homemakers
(Horne, 1994).
Horne examined the
variables related to the intention and behavior.
social support,
Perceived
attitude and self-efficacy predicated future
intention in active homemakers.
Only self-efficacy and
attitude were cited as predictors in inactive homemakers.
Marcus,
Selby, et al.
(1992) administered the stage of
exercise adoption and self-efficacy of exercise to 1,492
employees.
The researchers found that the scores on
efficacy items significantly differentiated employees■at
most stages.
Further,
employees who had not yet begun to
exercise, were found to have little confidence in their
ability to exercise in comparison with regular exercisers.
Interventions based on self-efficacy have been reported
to enhance exercise adherence and modify behavior
(McAuley,
Courneya, Rudolph & box, 1994; Strecher, DeVellis, Becker &
Rosenstock,
1986).
McAuley et al.,
(1994), explored the
function of an efficacy-based information intervention on
exercise adoption in sedentary, middle-aged males and
females.
Subjects were assigned to either an adherence-
intervention group or an attention-control group.
The
efficacy-based intervention group had better adherence to
63
the exercise program than did the control group.
The
authors found that by knowing one's self-efficacy they were
able to predict exercise behavior.
However,
the
intervention did not have an direct effect on the
participants self-efficacy.
Marcus,
et a l . (1994) conducted a similar study with
the inclusion of a predication analysis.
three questionnaires,
Subjects answered
stage of exercise adoption,
efficacy and decisional balance at baseline,
months later.
individuals'
self-
and again six
The researchers indicated that an
level of physical activity could be predicted
by knowing their self-efficacy,
stage of readiness,
and
their perceptions of costs and benefits of exercise.
Researchers concluded that individuals who placed a high
importance on engaging in exercise, and have high selfefficacy can be expected to feel a greater readiness for
exercise than individuals with low self-efficacy.
Knowing the self-efficacy beliefs of individuals is
important in the understanding of how one perceives physical
activity will personally benefit them.
Self-efficacy
factors are associated with initial participation in
physical activity, however,
it does not appear to influence
how long an individual maintains an exercise regimen
(Prochaska & Marcus,
1994).
64
Summary
In summary, researchers have clearly established the
benefits of exercise, physical activity and physical fitness
to physiological and psychological health.
In spite of this
evidence, participation and adherence to exercise is still
quite low.
Therefore, researchers should no longer be
primarily concerned with documenting the benefits of
exercise, but concentrate on understanding exercise behavior
so that effective intervention programs can be designed.
Research into the determinants of physical activity
participation has typically attempted to predict which
individuals are or will be active or inactive at a given
point of time.
This approach has met some success, but has
hot provided a level of understanding that would allow for
the development of precise and effective interventions.
As a result there has been a proliferation of theoretical
models applied to exercise.
Although various theoretical
approaches have achieved some success in understanding
exercise behavior,
criticism.
these approaches have also met some
Exercise researchers have suggested that we need
to shift from predictive to process models to better
understand behavior change.
The Transtheoretical Model of Behavior Change appears
to be a model that has taken us one step ahead of the
65
traditional unidimensional model to a more dynamic model.
The TMBC posits that a person moves through a series of
stages when changing a behavior.
In these stages, certain
processes and variables appear to facilitate the movement to
a higher stage.
The TMBC .defines a set of outcomes or
intermediate variables that includes decisional balance,
the
pro and cons of behavior change, and self-efficacy both of
which have been helpful in the understanding of exercise
behavior.
66
Chapter 3
METHODS AND PROCEDURES
The purpose of this study was to examine self-efficacy
and decision making in relation to the stages of exercise
adoption.
The investigator hypothesized that there would be
a difference in self reported self-efficacy and decisional
balance among individuals in the stages of exercise change.
This study analyzes two empirical models to examine the
association between exercise behavior and two outcome
measures,
self-efficacy and decisional balance.
The two
models are described in the following mathematical notation:
y=x and z=x
Where x equals the stages of exercise adoption,
(precontemplation,,
maintenance)
contemplation, preparation,
y equals self-efficacy,
action,
and
and z equals decisional
balance.
The investigator also hypothesized that there would be
a significant difference in self-efficacy and decisional
balance between the inactive
contemplation)
maintenance)
and active
individuals.
(precontemplation and
(preparation,
action and
These models are described in the
following mathematical notation:
67
Y1=Xi and Z1=Xi
Where i equals active or inactive,
efficacy,
y equals self-
and z equals decisional balance.
Design
The investigator used a cross-sectional design to
examine if the self-efficacy and decisional balance measures
differentiated o n e ’s stage of exercise adoption.
Since this type of study is descriptive.in nature,
the
investigator cannot presume a cause-and-effeet relationship.
However,
the investigator will be able to conclude whether
an association exists between the independent and dependent
variables.
This type of design is also prone to the threat
of selection bias
which occurs from using volunteers, who
may not be representative of anyone but other volunteers
(Campbell & Stanley,
1963).
The volunteers may differ
considerably from non-volunteers in their motivation for
participating in the experimental task.
It was possible
that only those students that had an interest in exercise
were willing to participate in the study.
not exercise,
Students who did
and or had a poor perception of exercise may
not have been equally represented in this study.
Assessment Instruments
The following instruments were administered:
68
The Stages of Exercise Adoption Questionnaire
(Selby,
(SEA)
1989) was used to determine the present stage of
readiness of exercise behavior
(Appendix B ) .
The
questionnaire included five statements designed to
discriminate among the stages of change.
Subjects were
asked to answer either "yes" or "no" to each statement.
This
information was used to categorize subjects into one of the
five stages of behavior change .via an algorithm designed to
assess stage of exercise adoption in accordance with the
method of Prochaska & DiClemente
(1983)(Appendix C ) .
Reliability of the stages of exercise adoption measure has
been examined by Marcus, Selby,
et a l ., (1992) who reported
the kappa index of reliability over a 2-week period was
(N = 20).
.78
Concurrent validity for this measure has been
demonstrated by its association with the Seven Day Recall
Activity Questionnaire
(Marcus & Simkin,
1993) .
This
measure has also been shown to be significantly related to
instruments measuring self-efficacy and decision making
(Marcus & Owen,
Marcus,
1992; Marcus, Rakowski,
Selby, et al.,
& Rossi,
1992;
1992).
The Self-Efficacy Questionnaire was employed to. measure
confidence in one's ability to persist with exercising in
various situations. The questionnaire contained five items
that measured "resisting relapse" and seven items that
measured "making time for exercise."
Subjects were asked to
69
indicate., on a 5-point Likert scale;
(3) occasionally
(I) always
(2) often
(4) rarely (5) never, how frequently each
statement applied to them.
The lower the sum of the scores
on the Likert scale, the lower the self-efficacy.
Internal
consistency of this measure was reported to be 0.85 for the
"resisting relapse" component and 0.83 for the "making time
for exercise component"
Patterson,
&. Nader,
(Sallis, Pinski, Grossman,
1988)
(Appendix D) .
The Decisional Balance Questionnaire contained sixteen
questions designed to assess exercise beliefs
Rakowski, Rossi,
1992)
(Appendix E ) .
represented the positive beliefs
(Marcus,
Ten questions
(Pros) about exercise and
six questions represented the negative beliefs or obstacles
(Cons) of exercise.
A decisional balance measure was
created by subtracting the Cons from the Pros.
were asked to indicate,
strongly agree
(2) agree
Subjects
on a 5-point Likert s c a l e ; (I)
(3) unsure
(4) disagree and (5)
strongly disagree, how important each statement was with
respect to their decisions to exercise, or not.
Internal
consistency for this measure was reported to be satisfactory
(Cons = .70, Pros = .95)
(Marcus, Rakowski,
& Rossi,
1992).
The lower the sum of the Pro scores the lower the perceived
benefits,
and the lower the sum of the Con scores the lower
the perceived costs.
70
Data Collection
Three hundred students were randomly selected from
first time freshmen who were living on campus.
All selected
students were mailed a letter describing the purpose of the
study.
Students were invited to participate in one of
three sessions.
supplied.
As an incentive,
free pizza and soda were
After providing a brief description of the
purpose of the study and the procedures involved,
researcher administered three questionnaires:
Exercise Adoption
the
Stages of
(SEA) , Self-Efficacy Questionnaire,
and
Decisional Balance Questionnaire.
Initially,
fifty of the three hundred students
contacted responded to the questionnaire,
a 16% return rate.
The researcher attributed bad weather and an inconvenient
location to the low percentage of response.
The researcher
then contacted the remaining selected students by. phone and
offered an additional time to meet.
This time,
the
researcher chose a more convenient location. An additional
124 participants completed the questionnaires.
The final
response rate was 57%.
Data Analyses
Frequency counts were used to determine the
distribution of freshman students among the stages of
71
adoption. Stage of exercise adoption was the independent
variable,
and self-efficacy and decisional balance were the
dependent variables in the analysis.
Scale scores were
calculated for each subject on the self-efficacy measure.
The scores are the un-weighted sum of the twelve items.
A
coefficient alpha was calculated for the self-efficacy scale
to estimate internal consistency
(Allen & Yen,
A one-way analysis of variance
1979).
(ANOVA) was used to
examine if there was a significant difference in selfefficacy among the stages of change.
In addition, post hoc
comparisons using the Newman Keuls procedure to determine
which stages the self-efficacy measure was able to
differentiate was employed.
The researcher applied an ANOVA
to determine if there was a difference in the self-efficacy
scores of the active groups
Maintenance)
(Action, Preparation and
and inactive groups
(Precontemplation,
Contemplation).
A one way analysis of variance was used to examine if
there was a significant increase in the Pros scores and a
significant decrease in the Con scores between the stages of
exercise adoption.
In addition,
the Decisional Balance
measure was created by subtracting the Cons from the Pros.
Scale scores were calculated for each subject on both the
Pro and Con indices.
The scores' were the un-weighted sum of
the 10 items composing the Pro scale and the 6 items
72
composing the Con scale.
Internal consistency was
calculated for each scale to estimate reliability.
scores were converted to standardized T scores
The raw
(M = 5 0 ,
SD =
10) in order to provided a standard metric for use in
further analysis.
In addition, post hoc comparisons using
the Newman Keuls procedure were applied to determine which
stages the Pros, Cons and Decisional Balance indices were
significantly different.
This same procedure was applied to
determine if there was a difference in decisional balance
between the active and inactive groups.
Although,
the investigator assumed that there would be
equal variance between the five stages of change it should
be noted that unequal cell numbers are common in
nonexperimental studies where the investigator uses survey
data to make comparisons.
When using ANOVA it is assumed
that the five groups have equal variances.
assumption,
Based on this
two groups may be statistically similar
(not
significantly different) when using a more conservative
procedure.
Therefore, it may be necessary to apply an
unbiased estimate such as the Satterthwaite approximation
(1946) where an approximate
(i.e ., lower) number of degrees
of freedom are assigned so that an ordinary analysis of
variance table can be used.
was not used in this study.
The Satterthwaite approximation
73
Chapter 4
ANALYSIS AND DISCUSSION OF DATA
The purpose of this study was to examine self-efficacy
and decision making in relation to the stages of exercise
adoption.
Exercise behavior was assessed by the stage of
exercise adoption
(SEA)
(Prochaska & DiClemente, 1983).
Self-efficacy was assessed using a measure developed by
Sallis,
et al.
(1988), and decisional balance was assessed
using questionnaire designed by Marcus, Rakowski, & Rossi,
(1992).
An analysis of variance
the following hypotheses:
(ANOVA) was applied to test
(I) There is a difference in self
reported self-efficacy among individuals as identified by
the five stages of change.
(2) There is a difference in
self reported self-efficacy between the active and inactive
individuals.
(3) There will be an increase in self-efficacy
along the continuum from the precontemplation to maintenance
stage.
(4) There is a difference in self reported exercise
beliefs among individuals identified by the five stages of
behavior change.
(5) There is a difference in self reported
exercise beliefs between the active and inactive groups. (6)
The perceived benefits of exercise
(Pros) will increase
along the continuum from precontemplation to maintenance,
74
while the perceived costs of exericse will decrease.
An
alpha level of .05 was used for all statistical tests.
Results
Stage of Exercise Adoption
The stage' of exercise adoption was assessed using the
algorithm for determining stage of exercise behavior,
originally developed for the assessment of smoking behavior
(Prochaska & DiClemente,
1983).
Subjects were classified
into one of the five stages of exercise adoption:
Precontemplation
(n = I, 4%), Contemplation
Preparation
(n = 33, 18.9%), Action
Maintenance
(n = 76, 43.6%).
(n = 34, 19.5%),
(n = 24, 13.7%), and
Figure I displays the
frequency distributions of individuals in each of the five
stages
(precontemplation., contemplation, preparation,
and maintenance for the total sample
action
(n = 174).
Self-Efficacy
For the twelve item self-efficacy measure,
consistency was 0.89
(n = 174).
internal
Results revealed that total
scores on self efficacy items differentiated students at
different stages F (4, 169) = 33.42, p < .0001.
proportion of variance explained by the model was
The
.44,
greatly exceeding Cohen’s (1977) definition of a large
effect size.
Table 2 provides the means and standard
75
Pireconemplat ion
Cont empIation
Pr ep aration
Action
Maintenance
Figure I.
Frequency Distribution of Subjects in Stages of
Exercise Adoption
76
Table 2. Means and'.Standard Deviations on the
Self-Efficacy Measure
Stage
Self-Efficacy
Precontemplation
Contemplation
Preparation
Action
Maintenance
21.28
33.70
38.42
42.04
46.27
Note.
(9.0)
(7.3)
(8.4)
(7.4)
(6.2)
Standard deviations are given in parentheses
Table 3. Newman'Keuls Post Hoc Comparisons for SelfEfficacy and Stages of Exercise Change
Newman Keuls Results
Significant Differences
(p <.05) Between:
Precontemplation
Contemplation
Preparation
Contemplation
Preparation
Action
Maintenance
Preparation
Action
Maintenance
Maintenance
N o t e . R2 = .44; £(4,173) = 33.42
(p < .0001)
77
deviations for all five groups and Table 3 presents the
Newman Keuls post hoc comparisons of scores.
Precontemplators were significantly different from subjects
in all other stages.
A clear pattern emerged, with
PrecontemplatorS scoring the lowest and Maintainers scoring
the highest on the self-efficacy measure,
revealing that
those in Maintenance had greater self-efficacy than those in
the lower stages.
Further results based on the Newman Keuls analysis,
revealed that total scores on the self-efficacy items
differentiated inactive students
(precontemplators and
contemplators) from active students
maintainers)
(preparers,
actors and
F (I, 172) = 69.81, p < .0001, r2 = .29) (Table
4) .
Table 4. Newman Keuls Post Hoc Comparison Results for
Active and Nonactive Subjects
Newman Keuls Test Results
Significant Differences (p < .05)
Activity Status
Inactive
Active
TiT--U,.
O O
Note. T>2
R2=.29
Mean SelfEfficacy
31.58
43.56
Tn
/I
F
(I,
172) = 69.81, p < .0001
The scores on the self-efficacy measure were
significantly related to the stages of exercise behavior.
78
This finding supports the work of DiClemente et al., (1985)
who found that Precontemplators and Contemplators had lower
self-efficacy compared to those in Maintenance,
although no
clear differentiation between all stages was revealed.
Decisional Balance
A one way analysis of variance was used to examine the
association among stages of exercise adoption and the Pros
and Cons indices.
In order to provide a standard metric.
Pros and Cons indices were converted to T scores
= 10).
In addition,
(M = 50, SD
the decisional balance measure was
created by subtracting Cons from Pros.
Table 5 presents the
T-score means and standard deviations by stage of exercise
adoption.
Differences on the decisional balance measures by
stage of exercise adoption were significant for the Pros,
F
(4, 169) = 7.16, E < .0001, r2 = .14, Cons F (4, 169) =■
6.25, E < .0001, r2 = .12, and Decisional Balance F- (4 ,169)
= 10.4, E < .0001, r2 = .19.
Coefficient alpha reliability
(internal consistency) was .89 for the Pro scores and .78
for the Con scores.
Table 6 presents the results from the Newman Keuls
analysis.
Precontemplators were significantly different
from subjects in all other stages but contemplation on the
Pro measure, however, Precontemplators were only
significantly different from the action and maintenance
79
groups. A clear pattern emerged with Precontemplators
scoring the lowest and Maintainers scoring the highest on
the decisional balance measure.
Precontemplators had more
negative beliefs about exercise than members of all other
stages.
Figure 2 presents a pictorial view of the Pro and
Con scales by stage of exercise adoption.
the active groups with, the inactive groups,
on the Pros, Cons,
When comparing
the total scores
and Decisional Balance items
significantly differentiated the active and inactive
students, Pros,
F (I, 172) = 19.99, p < .0001, r2 = .10);
Cons, F (I, 172) = 16.20, p < .0001, r2 = .09); Dbal, F (I,°
172) = 27.03, p < .0001, r2 = .14)
Table 5.
(Table 7).
Means and Standard Deviations of the Pros, Cons,
and Decisional Balance Scales by Stage of Exercise Change
Stage of Adoption
STAGE
Precontempla-
Contemplation
Preparation
TPROS
41.07
(12.08)
56.70
(9.91)
-15.62
(9.30)
44.84
(11.92)
54.98
. (7.69)
-10.14
(15.66)
49.39
(9.51)
52.10
(10.95)
-2.71
(16.67)
TCONS
TDBAL
Note.
Action
49.12
(9.34)
49.05
(6.86)
0.07
(14.28)
Standard deviations are in parentheses.
Maint­
enance
53.65
(7.57)
46.55
(10.06)
-7.10
(14.99)
80
Table 6. Newman Keuls Results for Pro, Con, and Decisional
Balance Indices
Newman Keuls Results
Significant Differences
(£ < .05) Between:
Stage:
Precontemplation
Contemplation
PRO
Preparation
Action
Maintenance
Preparation
Maintenance
CON
Action
Maintenance
DEAL
Preparation
Action
Maintenance
Note.
PRO r 2 = .14; F (4, 169) = 7.16, p < .0001
CON r2 = .12, F (4, 169) = 6.25, p < .0001
DEAL r2 = .19; F (4, 169) = 10.4, p < .0001
Maintenance
Table 7. Newman Keuls Post Hoc Comparisons for the Active
and Nonactive Subjects
Newman Keuls Results
Significant Differences
(p < .05)
Activity Status
Mean Pro
Score
Mean Con
Score
Mean Dbal
Score
Inactive
Active
44.20
51.77
55.27
48.38
-11.07
3.39
Note.
Pro
Con
Dbal
r2 = .10 £(1,172) = 19.99, p < .0001
r2 = .08 £(1, 172) = 16.20, p < .0001
r2 = .13 F (I,172) = 27.03, p < .0001
81
Pros
Cons
Figure 2.
The PROS and CONS (in T scores) by stage of
exercise change (PC = precontemplation; C = contemplation;
P = preparation; A = action; M = maintenance)
82
Discussion
The study was conducted to explore the cognitive and
motivational aspects related to the progression through the
stages of change in exercise.
Self-efficacy and decisional
balance of exercise are two underlying cognitions that have
been identified as consistently discriminating individuals
at different stages of readiness
Marcus, Rakowski, & Rossi,
1992) .
(Marcus & Owen,
1992;
The- self-efficacy and
decisional balance measure reflected the hypothesized
differences, across the stages of exercise adoption.
Self-Efficacy
The primary interest in this study was to determine the
association between the individual’s sel-efficacy and their
exercise behavior.
The results derived from this study
revealed that the self-efficacy measure significantly
differentiated the stages of exercise behavior.
This
measure reliably differentiated seven out of the ten
possible pairings of stages.
This finding supports the work
of DiClemente et a l .,
(1985) in the area of smoking and
Marcus,
(1992) in the area of exercise, who
Selby, et al.
found Precontemplators and Contemplators had the lowest
scores on self-efficacy and those in Maintenance had the
highest scores on the self-efficacy measure.
The contrasts
between the stages of preparation and action,
and action and
83
maintenance were statistically insignificant in this study.
■However,
a perusal of the means from the preparation to
maintenance stage
(Table 2) shows that the trends for the
self-efficacy construct were in the expected direction.
It
appears that individuals at various stages have different
degrees of exercise-specific self-efficacy.
This suggests
that individuals at the different stages might benefit from
interventions techniques that differ in their focus on
enhancing self-efficacy expectations.
Decisional Balance
The Pro, Con, and Decisional balance scores were
compared across the groups representing five stages in the
change process:
Precontempiation, Contemplation,
Preparation, Action,
and Maintenance.
The present study did
not find that Precontemplators could be differentiated from
participants in all other stages as did previous studies
using the same measures
Rossi,
e t .a l ., 1992;
(Marcus & Owen,
Marcus,
1992;, Marcus,
Selby, et a l ., 1992).
Five of
the ten possible pairwise contrasts were significant for the
Pros and only two of the possible pairwise contrasts were
significant for the Cons.
Four of the ten possible pairwise
contrasts were significant for the decisional balance
me a s u r e .
A number of limitations of this study should be noted.
84
This research was based on a cross-sectional study that used
self-report data, therefore, no objective information on
actual exercise behavior was utilized.
However,
the present
results do provide some evidence that participants' reports
of current exercise behavior
(i .e ., stages of adoption)
correspond to beliefs about favorable and unfavorable
features
(i .e .,. pros, cons,, and decisional balance)
and.,
self-efficacy.
Secondly,
the self-efficacy and decisional balance
questionnaires used a Likert-scale format, where equal
response intervals were assumed.
In addition,
scale data is discrete rather than continuous.
the Likert
This study
utilized ANTOVA, which assumes data is continuous and
normally distributed.
Other statistical methods could have
been employed which would have recognized the discontinuous
and non-normally distributed data.
Finally, use of the ANOVA with the Transtheoretical
Model of Behavioral Change may have been inappropriate due
to the framework of the mod e l .
The TMBC describes cyclical
movement between the stages of change, therefore,
may have been in between a stage.
a person
An analysis of variance
assumes that there is a definite position and that movement
is linear.
In a longitudinal design, where movement is
studied,
the use of an ANOVA may not adequately describe
change.
Analyzing the TMBC in this way has been
85
scrutinized, however, presently a more appropriate method
has not been revealed.
Summary
It appears that students at various stages have
different degrees of self-efficacy and decisional balance.
This suggests that individuals at the different stages might
benefit from interventions that differ in their focus on
enhancing efficacy expectations and the awareness of the
benefits
(Decisional balance)
of the decisional balance,
of exercise.
The combination
self-efficacy and stages of
change models appears to offer a powerful tool for relating
three important elements
efficacy,
(stage of exercise adoption,
and decisional balance)
how change occurs naturally,
in an integrated theory of
and how it could be facilitated
through specialized interventions.
Specifying relationships
among constructs may facilitate a more integrated and
systematic understanding of a complex behavior such as
exercise.
self-
86
Chapter 5
SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS
Summary.
The purposes of this study were I) to examine the
association of the self-efficacy measure and the stages of
exercise behavior,
and 2) to examine the association of the
decisional .balance and the stages of exercise behavior.
The
investigator sought to determine if self-efficacy and
decisional balance measures could be used to differentiate
the stages of exercise change of the subjects.
Researchers have clearly established the importance of
regular exercise to physiological and psychological well­
being.
Researchers have also provided evidence
demonstrating that only a small percentage of young adults
participate in regular exercise that will significantly
benefit their health.
Unfortunately,
the behavioral
patterns seen in young adults may exert influences on both
health and.exercise behavior in their later life
(Dishman,
1988) .
Many colleges and universities have begun to offer a
physical/wellness education course as a graduation
87
requirement.
Rehor
(1991a) suggested that the curriculum of
a physical education should be focused on the development of
a habit of regular exercise rather than on the enhancement
of physical performance.
The acquisition of knowledge,
fitness gain, and behavioral skills should comprise the
foundation of the curriculum where behavioral change is the
outcome of a fitness program and exercise adoption and
adherence are the primary objectives.
■
Physical education
programs should prepare students for a lifetime of physical
activity (Rehor,
1991b).
Although extensive research has been directed toward
understanding and facilitating exercise adherence, most
research attempts have not provided a model capable of
predicting successful results.
The Transtheoretical Model
has been helpful in the understanding of many health
behaviors
(Marcus et al., 1994).
More recently,
several
exercise adherence researchers have used the
Transtheoretical Model of behavior change in predicting
exercise adoption and adherence.
Roberson
(1989) and Selby
(1989) hypothesized that individuals pass through a
hierarchy of stages in the acquisition of exercise behavior.
Further,
each stage has unique processes and characteristics
necessary for successful movement to the next stage,
such as
self-efficacy and decision making.
Reliable and valid instruments have been designed to
88
assess the stages and processes involved in exercise
acquisition and maintenance.
Researchers have even reported
that by knowing an individual’s self-efficacy or decisional
balance measure they can predict the likelihood of future
effort to change
(Prochaskaz Velicerz Guadagnoliz Rossi,
DiClementez 1991).
&
Perhaps the most important application
of this model is that it allows educators to use stage
specific strategies that will work best for individuals at
different levels of exercise participation.
In the current study, the investigator used a crosssectional design to examine if the self-efficacy and
decisional balance measures were different for individuals
in each of the five stages of exercise adoption.
The
subjects studied were freshman students from Montana State
University.
It was anticipated that the students would
present a normal distribution across the continuum of
exercise behavior.
After providing a description of the procedures,
investigator administered three questionnaires,
exercise adoption,
self-efficacy,
the
stages of
and decisional balance.
Frequency counts were used to classify the scores into one
of the five stages of change. Using the stages of exercise
change as the independent variable and the self-efficacy
measure as the dependent variable,
analysis of variance was
employed to ascertain differential use of the stages of
89
exercise, behavior change.
A Newman Keuls post hoc
comparison was conducted to determine which stages were
different.
The same method was used to determine the
association between the stages and the decisional balance
measures.
An analysis of variance was conducted to
ascertain the differential use of the Pros, Cons,
and
Decisional balance indices, which was followed by the Newman
Keuls post hoc comparison to determine which stages were
significantly different from all other stages.
Justification was given to the applicability of the
Transtheoretical Model to exercise behavior.
The self-
efficacy measure and decisional balance measures reflected
the hypothesized differences across stages of exercise
adoption indicating differential use of these constructs
across the five stages of change.
These findings are
consistent with the work of Marcus, Rakowski and Rossi
(1992)
and Marcus,
Selby et al.
(1992) . The results of this
study may have implications for exercise behavior in other
college populations.
If the present findings are replicated
in longitudinal investigations, physical educators may be
assisted in designing and testing specific interventions to
help students move more quickly from one stage of exercise
adoption to another.
interventions,
Development of more successful
in turn, will help us reach the goals of
increasing the level of physical activity of young adults in
90
the United States and attaining the fitness objectives that
have been established for the year 2000
Health and Human Services,
(U.S . Department of
1991).
Conclusions
Based upon the findings of this study,
the following
conclusions are justified:
1.
There exists a hierarchy of stages through which
individuals progress in the acquisition and maintenance
of exercise behavior.
This hierarchy of stages is
consistent with the work of other researchers, who have
applied the Transtheoretical Model to health behaviors.
2.
Self-efficacy increases as individuals move from
Precontemplation to Maintenance stage.
3.
Individuals engaged in the adoption and maintenance of
exercise behavior have significantly different beliefs(Pros and Cons)
4.
about exercise.
The Cons of exercise outweigh the Pros of exercise in
the early stages, whereas,
in. the later stages.
the Pros outweigh the Cons
This suggests that, as one moves'
through the stages of change, their beliefs about.
the drawbacks of exercise are overcome by their beliefs
about the benefits of exercise.
6.
The combination of the self-efficacy measure .and
decisional balance measure with the stages of change.
91
model appears to offer a powerful tool for relating
three important constructs in an integrated theory of
how change occurs.
Recommendations for Future Research
The following recommendations are offered for future
research of exercise behavior:
1.
Future researchers should continue to examine the
application of the Transtheoretical Model to
exercise behavior in a variety of settings and
populations;
2.
Investigators should use the same instruments in a
longitudinal design;
3.
Additional investigations should examine the
reliability and validity of the self-efficacy and
decisional balances measures;
4.
Additional determinants of exercise participation
should be examined,
facilities,
such as social support,
access to
and locus of control;
5. . Research designs and assessment tools need to be
standardized to allow researchers to examine
whether the results of behavioral patterns and
determinants can be generalized across different
settings and populations;
92
Recommendations for Practical Application
1.
As the applicability of the Transthedretical Model to
exercise, behavior becomes further understood,
researchers can begin to design and implement
intervention programs based on the model.
2.
Physical education programs should focus on teaching
behavioral skills that would increase ones selfefficacy and decision making, which in turn may
enhance the probability of forming a habit of regular
exercise that will last a lifetime.
3.
Colleges need to support the inclusion of a required
fitness/wellness course that will teach lifetime
health-promoting behaviors.
93
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APPENDICIES
115
APPENDIX A
ASSOCIATION BETWEEN SELECTED DETERMINANTS
AND STAGES OF EXERCISE ADOPTION
116
Association Between Selected Determinants and
Stages of Exercise Adoption
DETERMINANT
CHANGE STAGES
PC
C
Personal attributes
Past Program
Participation
++
++
Blue Collar
Occupation
0
Smoking
0
0
Overweight
0
0
++
++
Locus of Control
+
Education
+
Self-efficacy
++
0
Behavior Skills
0
0
Environmental Factors
+
+
Spouse Support
Perceived lack
of time
Facilities access
+
0
Social Support
0
0
++
Physical Influence ++
Contracts
0
0
++
Benefit & Cost
0
Relapse Prevention
Training
0
0
Phvsical Activitv Characteristics
Activity Intensity 0
0
+
0
Activity Type
++
Perceived Effort
0
-
—
—
—
P
A
M
++
++
++
0
0
++
+
++
+
+
+
+
+
+
+
++
0
+
+
++
++
++
++
++
+
+
+
+
++
+
+
+
+
++
-fr+
+
+
+
0
+
++
++
+
0
++
++
0
++
++
0
—
Strong increased probability
Increased probability
No relationship
Decreased probability
Strong decreased probability
(Adapted from Dishman, Sallis, & Ornstejn,
—
-
++
+
0
PC = precontemplation, C = contemplation,
action, M = maintenance
1985)
P = preparation, A =
APPENDIX B
STAGE OF EXERCISE ADOPTION QUESTIONNAIRE
118
Stage of.Exercise Adoption Questionnaire
1.
I do exercise now
2.
In the next 6 months I plan
3.
'I exercise regularly
4.
For the past 6 months I have
toexercise.
now.
exercised regularly.
5.
In the past,
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
I have exercise regularly
for a period of at least 3months.
119
APPENDIX C
ALGORITHM FOR STAGE OF EXERCISE ADOPTION
120
Algorithm for Stage of Exercise Adoption
Question Numher
Ql
Q2
Q3
Q4
Stage of Change
Q5
I.
NO
2.
NO
YES
NO
3.
YES
YES
YES
NO
Preparation
4.
YES
YES
YES
YES NO
Action
5.
YES
YES
YES
YES YES
Maintenance
Precontemplation
Contemplation
APPENDIX D
SELF-EFFICACY QUESTIONNAIRE
122
Self-Efficacy Questionnaire
1.
Stick to your exercise program when your friends
are demanding more time from you.
2.
Stick to your exercise program when you have
chores to attend to.
3.
Stick to your exercise program when social
obligations are time consumingi
4.
Read or study less in order to exercise more.
5.
Get up early, even on weekends to exercise.
6.
Exercise after a long day at school or work.
7.
Exercise even though you are feeling depressed.
8.
Exercise while it is cold, humid or hot.
9.
Exercise even though you are feeling tired.
10.
Set aside at least 30 minutes, three times a
week for exercising.
11.
Continue to exercise with others even though
they are too fast or too slow for you.
12.
Stick to your exercise program when undergoing
a stressful life change.
123
APPENDIX E
DECISIONAL BALANCE QUESTIONNAIRE
124
Decisional Balance Questionnaire
1.
I would have more energy for my family and friends
if I exercised regularly.
2.
Regular exercise would help me relieve tension.
3.
I would feel more confident if I exercised regularly.
4.
I would sleep more soundly if I exercised regularly.
5.
I would feel good about myself if I kept my commitment
to exercise regularly.
6.
I would like my body better if I exercised regularly.
7.
It would be easier for me to perform routine physical
tasks if I exercised regularly. -
8.
I would feel less stressed.if
I exercised regularly.
9.
I would feel more comfortable
with my body if I
exercised regularly.
10.
Regular exercise would help me have a more positive
outlook on life.
11.
I think I would be too tired to do my daily work after
exercising.
12.
I would find it difficult to find an exercise activity
that I enjoy that is not affected by bad weather.
13.
I feel uncomfortable when I exercise because I get
out of breath and my heart beats vqry fast.
14.
Regular exercise would take too much of my time.
15.
I would have less time for m y
if I exercised regularly.
family and friends,
125
16.
At the end of the day,
I am t o o .exhausted to exercise
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