Strategies for Enhancing Adherence to Exercise 1. Behaviour modification approaches 2. Reinforcement approaches 3. Cognitive-behavioural approaches 4. Decision-making approaches 5. Social support approaches 6. Intrinsic Approaches 1. Behaviour Modification Approaches Prompts – A cue that initiates a behaviour – Verbal, physical, or symbolic (work out gear in car) – Increased cues for desired behaviour (positive reinforcement) – Decrease cues for undesirable behaviours (negative reinforcement) – Fading: gradually eliminate cues to increase independence Contracting – Enter in a contract with realistic goals – Sign a statement of intent – Dishman and Buckworth (1996) showed that behaviour modification approaches to improving exercise adherence consistently produced extremely positive results. Behaviour modification approaches may have an impact on something in the physical environment that acts as a cue for habits of behaviour. If you want to promote exercise (until the exercise becomes more intrinsically motivating), one technique is to provide cues that will eventually become associated with exercise. – Prompts A prompt is a cue that initiates a behaviour. Prompts can be verbal (e.g., “You can hang in there”), physical (e.g., getting over a “sticking point” in weightlifting), or symbolic (e.g., workout gear in the car). The goal is to increase cues for the desired behaviour and decrease cues for competing behaviours. Examples of cues to increase exercise behaviour include posters, slogans, notes, placement of exercise equipment in visible locations, recruitment of social support, and performance of exercise at the same time and place every day. removing a prompt can have an adverse effect on adherence behaviour; signs, posters, and other materials should be kept in clear view of exercisers to encourage adherence. Eventually, prompts can be gradually eliminated through a process called fading. Using a prompt less and less over time allows an individual to gain increasing independence without the sudden withdrawal of support, which occurred in the stair-climbing study. Finally, prompts can also be combined with other techniques. – Contracting Another way to change exercise behavior is to have participants enter into a contract with the exercise practitioner. The contract typically specifies expectations, responsibilities, and contingencies for behavioral change. Contracts should include realistic goals, dates by which goals should be reached, and consequences for not meeting goals (Willis & Campbell, 1992). A different type of contract, in which participants sign a statement of intent to comply with the exercise regimen, has also been used effectively (Oldridge & Jones, 1983). Research has shown that people who sign such a statement have significantly better attendance than those who refuse to sign. Thus, people’s choosing not to sign a statement of intent to comply can be a signal that they need special measures to enhance their motivation. Finally, when contracting is used, the focus should be on helping the person take action, establishing criteria for meeting goals, and providing a means for clarifying consequences (Kanfer & Gaelick, 1986). 2. Reinforcement Approaches ■ Charting Attendance and Participation – Public reporting increases motivation – Visuals are more effective – Increases cognitive awareness ■ Rewarding Attendance and Participation ■ Feedback – Individual feedback is more effective than group praise ■ Reinforcement, either positive or negative, is a powerful determinant of future action. To increase exercise adherence, incentives or rewards can be given for staying with the program. ■ Charting attendance and participation Public reporting of attendance and performance is another way to increase the motivation of participants in exercise programs. Performance feedback can be made even more effective if the information is converted to a graph or chart (e.g., Franklin, 1984). The chart is helpful and motivational in that it can tell people at a glance what changes are taking place (even small changes) and whether they are on target for the behaviour involved. This may be important for maintaining interest, especially later in a program when people reach the point where improvements are often small and occur less frequently. In addition, recording and charting keep individuals constantly informed, and often the increased cognitive awareness is all that is necessary to bring about changes in the target behaviour. Furthermore, if people know that their workout record is available for everyone to see, they are much more likely to strive to keep up the positive behaviour (this information also tells exercise leaders, as well as other program participants, when is the right time to offer praise and encouragement). ■ Rewarding attendance and participation In general, the results have been encouraging for initial attendance or adherence but less so for long-term improvement. Additional incentives or reinforcement must be provided throughout the program to encourage adherence over longer time periods. ■ Feedback Providing feedback to participants on their progress can have motivational benefits. 3. Cognitive-Behavioural Approaches ■ Goal Setting – Intrinsic goal setting is more effective – Regular exercisers are better able to balance interfering goals ■ Association and Dissociation – Association: focus on internal body feedback – Dissociation: focus on external environment ■ Improves adherence ■ Reduces boredom and fatigue ■ Cognitive–behavioral types of approaches assume that internal events (i.e., thinking) have an important role in behavior change ■ Goal setting Goal setting can be a useful motivational technique and strategy to improve exercise behaviour and adherence. ■ The exercise goals that were most often reported included increasing cardiovascular fitness (28%), toning or strengthening muscles (18%), losing weight (13%), and exercising regularly (5%). Along with these goals were multiple action plans to reach the goals, such as bringing fitness clothes to school or work (25%), attending fitness classes regularly (16%), and organizing time or work around fitness (9%). Martin and his colleagues (1984) found that flexible goals that participants set themselves resulted in better attendance and maintenance of exercise behaviour (for a 3-month span) than did fixed, instructor-set goals. Specifically, attendance rates were 83% when participants set their own goals, compared with 67% when instructors set the goals. Furthermore, 47% of those who set their own goals were still exercising 3 months after the program ended (compared with 28% of the people for whom the instructor had set goals). ■ Exercisers setting intrinsic goals reported higher levels of self-esteem, psychological well-being, psychological need satisfaction, and exercise behavior and lower levels of anxiety than exercisers setting extrinsic goals. ■ Karoly and colleagues (2005) investigated the role of goal setting in regular and irregular exercisers. Results revealed that irregular exercisers tended to place greater motivational significance on their interfering goals (e.g., academic, relationships, family) than did regular exercisers, who were better able to balance their goals. In essence, regular exercisers have evidently acquired the capacity to elevate the self regulatory significance of their relatively infrequent bouts of exercise to the same level as their academic and interpersonal goals. The authors suggest that irregular exercisers should reorganize their goal systems so that exercise goals receive just as much attention as do other important goals in their lives. ■ Association and dissociation Thoughts or cognitions—what people focus their attention on—during exercising are also important to adherence to the exercise program. When the focus is on internal body feedback (e.g., how the muscles feel, or breathing), it is called association; when the focus is on the external environment (e.g., how pretty the scenery is), it is called dissociation (a distraction). Researchers have found that people who dissociate have significantly better attendance (77%) than those whose thinking is associative (58%). 4. Decision Making Approaches Example of a decision balance sheet Whether to start an exercise program can often be a difficult decision. To help people in this decision making process, psychologists developed a technique known as a decision balance sheet (Hoyt & Janis, 1975; Wankel, 1984). This technique can make people more aware of potential benefits and costs of an exercise program. In devising a decision balance sheet, individuals write down the anticipated consequences of exercise participation in terms of gains to self, losses to self, gains to important others, losses to important others, approval of others, disapproval of others, self-approval, and self-disapproval 5. Social Support Approaches ■ An individual’s favorable attitude toward someone else’s involvement in an exercise programmed. ■ Social support through: – Cues – Serving as a model – Practical assistance – Effective group leaders In our context, social support refers to an individual’s favorable attitude toward someone else’s involvement in an exercise program. Social and family interactions may influence physical activity in many ways. Spouses, family members, and friends can cue exercise through verbal reminders. Significant others who exercise may model and cue physical activity by their behavior and reinforce it by their companionship during exercise. Often people give practical assistance, providing transportation, measuring exercise routes, or lending exercise clothing or equipment. In any case, social support from family and friends has been consistently and positively related to adult physical activity and adherence to structured exercise programs (USDHHS, 1996). Stress-Athletic Injury Model Stress isn’t the only psychological factor to influence athletic injuries, however. As you also see in the figure, personality factors, a history of stressors, and coping resources all influence the stress process and, in turn, the probability of injury. Furthermore, after someone sustains an injury, these same factors influence how much stress the injury causes and the individual’s subsequent rehabilitation and recovery. Moreover, people who develop psychological skills (e.g., goal setting, imagery, and relaxation) deal better with stress, reducing both their chances of being injured and the stress of injury should it occur. It has also been suggested that the stress–athletic injury model can be extended to explain not only physical injuries but also physical illnesses that may result from the combination of intense physical training and psychosocial variables (Petrie & Perna, 2004). Thus, the model may also be useful in explaining why athletes develop infections, poor adaption to training and physical complaints when highly stressed. Dealing with Eating Disorders Practitioners are in an excellent position to spot individuals with eating disorders (Thompson, 1987). Thus, they must be able to recognize the physical and psychological signs and symptoms of these conditions. Often, unusual eating patterns are among the best indicators of problems. People with anorexia often pick at their food, push it around on their plate, lie about their eating, and frequently engage in compulsive or ritualistic eating patterns such as cutting food into tiny morsels or eating only a very limited number of bland, low calorie foods. People with bulimia often hide food and disappear after eating (so they can purge the food just eaten) or simply eat alone. Whenever possible, fitness educators should observe the eating patterns of students and athletes, looking for abnormalities. In addition, it is commonly assumed that the frequency and duration of exercise are related to eating disorders. However, research (Lipsey, Barton, Hulley, & Hill, 2006) has shown that eating disorders cannot be inferred from exercise behavior alone. Rather, commitment to exercise, as well as weight and mood regulation, predicted an eating disorder, not exercise per se. There are also standardized self-report inventories to diagnose eating disorders, but these should be administered and interpreted only by trained professionals (e.g., a licensed psychologist). As a practitioner, if you identify someone who demonstrates symptoms, you’ll need to solicit help from a specialist familiar with eating disorders. But this is a difficult judgment because some people exhibit some of these signs without having a disorder, whereas others do have a disorder and do need a referral. If you or a colleague suspects an eating disorder, the person who has the best rapport with the individual should schedule a private meeting to discuss his concerns (Garner & Rosen, 1991). The emphasis here should be on feelings, rather than directly on eating behaviors. Be supportive in such instances and keep all information confidential. Make a referral then to a specific clinic or person, rather than giving a vague recommendation such as “You should seek some help.” If an athlete is still hesitant, suggest that he see the clinic or the individual professional simply for an assessment to determine if there is a problem. ■ Staleness – Physiological state of overtraining characterized by a significant reduction in performance for an extended period of time – Cannot achieve previous performance results despite reductions in training – Mood disturbances ■ Burnout – Physical and emotional exhaustion – Low personal accomplishment, low-self esteem, failure, and depression – Depersonalization and devaluation Staleness Staleness is seen as the end result or outcome of overtraining when the athlete has difficulty maintaining standard training regimens and can no longer achieve previous performance results. The truly stale athlete has a significant reduction in performance (e.g., 5% or greater) for an extended period of time (e.g., 2 weeks or longer) that occurs during or following a period of overtraining and fails to improve in response to short-term reductions in training (O’Connor, 1997). The principal behavioral sign of staleness is impaired performance, whereas the principal psychological symptoms are mood disturbance and increases in perceptual effort during exercise. For example, it has been reported that about 80% of stale athletes are clinically depressed. Although more common in elite athletes, staleness is not confined to these athletes, as has been commonly assumed. Staleness is a problem for athletes in all sports and for athletes from various cultures. Apparently, once an athlete experiences staleness, subsequent bouts become more probable. Burnout There is no one universally accepted definition. After reviewing the literature, Gould and Whitley (2009) defined burnout as a physical, emotional, and social withdrawal from a formerly enjoyable sport activity. This withdrawal is characterized by emotional and physical exhaustion, reduced sense of accomplishments, and sport devaluation. Moreover, burnout occurs as a result of chronic stress (a perceived or actual imbalance between what is expected of an athlete physically, psychologically, and socially and his or her response capabilities) and motivational orientations and changes in the athlete. (p. 3) The following are characteristics of burnout: 1. Exhaustion, both physical and emotional. The exhaustion takes the form of lost energy, interest, and trust. 2. Feelings of low personal accomplishment, low self-esteem, failure, and depression. This is often visible in low job productivity or a decreased performance level. 3. Depersonalization and devaluation. Depersonalization is seen as the individual’s being impersonal and unfeeling. This negative response to others is in large part attributable to mental and physical exhaustion. Whereas depersonalization characterizes burnout in helping professionals like counselors, coaches, and teachers, Raedeke and Smith (2001) found that for athletes depersonalization takes the form of devaluation of the activity, where they stop caring about their sport and what is important to them within it. Unlike what happens in other phases of the training stress syndrome, once a person experiences burnout, withdrawal from the stress environment is often inevitable. In sport, burnout differs from simply dropping out because it involves such characteristics as psychological and emotional exhaustion, negative responses to others, low self-esteem, and depression. There are many reasons why athletes drop out of sport participation, and burnout is just one of them. In fact, it appears that few athletes and coaches completely drop out of sport solely because of burnout, although they often exhibit many of the characteristics of burnout. For example, despite feeling burned out, athletes often remain in their sport for such reasons as financial rewards (e.g., scholarships) and parental or coach pressures and expectations. Individuals typically discontinue sport involvement only when the costs outweigh benefits relative to alternative activities. Athletes and coaches who discontinue sport involvement as a consequence of the high cost of excessive longterm stress are typically viewed as being burned out. Role of Friends in Youth Sport ■ Affiliation motive- Major motive for children to participate in sport ■ Peer relationships and children’s psychological development – Peer relationships are linked to; ■ Sense of acceptance ■ Self-esteem ■ Motivation – Positive components of sport participation ■ Companionship ■ Pleasant play association ■ Enhancement of self-esteem ■ Help and guidance ■ Prosocial behavior ■ Intimacy ■ Loyalty ■ Things in common (shared interests) ■ Attractive personal qualities ■ Affiliation motive is a major motive that children have for sport participation. Thus, children enjoy sport because of the opportunities it provides to be with friends and make new friends. Although affiliation is certainly important in its own right, sport psychology researchers have discovered that friends and the peer group have other important effects on young athletes. ■ Peer relationships and children’s psychological development Leading developmental sport psychologist Maureen Weiss and her colleagues have studied friendship and peer relationships in sport. For example, they conducted in-depth interviews with 38 sport participants, 8 to 16 years of age, to learn how children view the component of friendship in sport (Weiss, Smith, & Theeboom, 1996). They identified both positive and negative dimensions in this facet of sport participation. These were some positive dimensions that the researchers heard about: ■ Companionship (spending time or “hanging out” together) ■ Pleasant play association (enjoying being around one’s friend) ■ Enhancement of self-esteem (friends saying things or taking actions that boost one’s selfesteem) ■ Help and guidance (friends providing assistance relative to learning sport skills as well as general assistance in other domains, such as school) ■ Prosocial behavior (saying and doing things that conform to social convention, such as not saying negative things, sharing) ■ Intimacy (mutual feelings of close, personal bonds) ■ Loyalty (a sense of commitment to one another) ■ Things in common (shared interests) ■ Attractive personal qualities (friends have positive characteristics such as personality or physical features) ■ Emotional support (expressions and feelings of concern for one another) ■ Absence of conflicts (some friends do not argue, fight, or disagree) ■ Conflict resolution (other friends are able to resolve conflicts) ■ Implications for practice – Time should be provided for socializing – Coaches and parents should encourage positive peer reinforcement ■ Positive statements to teammates – Children must be taught to respect others, refrain from aggression and how to resolve conflicts – Emphasise the importance of teamwork and encourage pursuit of group goals The research on peer relationships and friendship has a number of implications for practice (Weiss et al., 1996). First, time should be provided for children to be with their friends and for making new friends. The adage that all work and no play makes Jack (or Jill) a dull boy (or girl) seems to ring true. Second, in an effort to enhance self-esteem among youngsters participating in physical activity, coaches and parents should encourage positive peer reinforcement. Positive statements to teammates should be reinforced, whereas derogatory remarks, teasing, and negative comments should not be tolerated. Children must be taught to respect others, refrain from verbal aggression, and learn how to resolve conflicts with peers. Third, the importance of teamwork and the pursuit of group goals should be emphasized. Techniques to foster group cohesion and goal setting should be frequently used in the youth sport setting. Stages of Athletic Development ■ Entry or initial phase – Focus on fun, explore the sport, achieve success and parents emphasize hard work and doing things well ■ Investment phase – Talent is recognized and child begins to specialize in one sport – Focus on: Technical mastery, technique, and excellence in skill development – Parents: extensive logistical, time, emotional, and financial support ■ Elite performance excellence phase – Recognized as truly elite and undertake many hours of training a day under supervision of a master coach – Goal: Turn training and technical skills into personalized performance excellence – Parents: Important source of social support ■ Excellence maintenance phase 1. Entry or initial phase—The child tries various sports and develops a love of the sport that she ends up specializing in later. The focus of participation is on fun and development, and the child receives encouragement from significant others, is free to explore the activity, and achieves a good deal of success. Parents instill the value of hard work and doing things well but typically do not emphasize winning as the primary goal of participation. 2. Investment phase—Talent is recognized, and the child begins to specialize in one sport. An expert coach or teacher promotes long-term systematic talent development in the individual. The focus is on technical mastery, technique, and excellence in skill development. Parents provide extensive logistical, time, emotional, and financial support. 3. Elite performance excellence phase—The athlete is recognized as truly elite and practices many hours a day under the supervision of a master coach. The goal is to turn training and technical skills into personalized performance excellence. There is a realization by everyone involved that the activity is very significant in one’s life. Parents are less involved but are an important source of social support. 4. Excellence maintenance phase—The athlete is recognized as exceptional and focuses on maintaining the excellence he has achieved. Considerable demands are placed on the athlete. ■ Most interesting in this research is the finding that most champion athletes did not start out their sport careers with elite champion aspirations in mind (nor did the parents have these aspirations for the child). Instead, these individuals were exposed to active lifestyles and to numerous sports and were encouraged to participate for fun and development reasons. They participated in many sports and then found the right sport for their body type and mental makeup. Only later, after they fell in love with the activity and showed talent, did they develop elite sport aspirations. Moreover, once these athletes developed elite competitor dreams, parents and coaches provided them with the support they needed to turn dreams into reality. This research, then, emphasizes the importance of children’s not specializing in sports too early, of taking a fun and development focus early, and of having highly supportive but not overbearing parents.
