Exercise Behavior and Adherence
Session Outline
 Why Study Exercise Behavior?
 Why Exercise Behavior and Adherence Are
Important
 Reasons to Exercise
 Reasons for Not Exercising
 The Problem of Exercise Adherence
(continued)
Session Outline
 Theories/Models of Exercise Behavior
 Determinants of Exercise Adherence
 Strategies for Enhancing Adherence to Exercise
 Settings for Exercise Interventions
 Guidelines for Improving Exercise Adherence
Why Study Exercise Behavior?
Despite the current societal emphasis on fitness,
a small percentage of children and adults
participate in regular physical activity.
Why Exercise Behavior
and Adherence Are Important
 50% of adults are completely sedentary.
 50% of youth (ages 12-21) do not participate in
regular physical activity.
 25% of children and adults report doing no
physical activity.
 Only 15% of adults participate in vigorous and
frequent activity.
 Only 10% of sedentary adults are likely to begin
a program of regular exercise within a year.
(continued)
Why Exercise Behavior
and Adherence Are Important
 Among boys and girls, physical activity declines
steadily through adolescence.
 Physical inactivity is more prevalent among
women, African-Americans, and Hispanics, as
well as among older and less affluent adults.
 50% of people starting an exercise program will
drop out within six months.
 Daily attendance in physical education classes
dropped from 42% to 25% between 1990 and
1995.
Reasons to Exercise
 Weight control
 Reduced risk of cardiovascular disease
 Reduction in stress and depression
 Enjoyment
 Building self-esteem
 Socializing
Reasons to Exercise
KEY—
Exercise combined with proper eating habits can
help people lose weight; but weight loss should
be slow and steady, occurring as changes in
exercise and eating patterns take place.
Reasons to Exercise
KEY—
Both the physiological and psychological
benefits of exercise can be cited to help
persuade sedentary people to initiate exercise.
“Maintenance” as well as initiation of physical
activity is critical.
Reasons for Not Exercising
 Lack of time
 Lack of energy
 Lack of motivation
Reasons for Not Exercising
KEY—
Exercise professionals should highlight the
benefits of exercise and provide a supportive
environment to involve sedentary people in
physical activity.
Reasons for Not Exercising
KEY—
People often cite time constraints for not
exercising, but such constraints are more
perceived than real and often reveal a person’s
priorities.
Individual Barriers to Physical Activity
 Lack of time, energy, or motivation
 Excessive cost
 Illness or injury
 Feeling uncomfortable
 Lack of skill
 Fear of injury
(See table 18.1 on p. 403 of text.)
The Problem of Exercise Adherence
The Problem of Exercise Adherence
 Help those who start exercising to overcome
barriers to continuing the exercise program.
 Help exercisers develop contingency plans to
overcome factors leading to relapses (not
exercising).
Theories/Models of Exercise Behavior
Health Belief Model
(Becker and Maiman, 1975)
The likelihood of exercising depends on the person’s
perception of the severity of health risks and appraisal
of the costs and benefits of taking action.
Theories/Models of Exercise Behavior
Health Belief Model
KEY—
Overall “inconsistent” support for Health Belief
Model predictions of exercise behavior
(Becker and Maiman, 1975)
Theories/Models of Exercise Behavior
Theory of Planned Behavior
Exercise behavior is made up of
 intentions,
 subjective norms and attitudes, and
 perceptions of ability to perform behavior.
(Ajzen and Madden, 1986)
Normative beliefs and subjective
norms
Normative
belief:
an
individual's
perception about the particular behavior,
which is influenced by the judgment of
significant others (e.g., parents, spouse,
friends, teachers.
Subjective
norm:
an
individual's
perception
of
social
normative
pressures, or relevant others' beliefs that
he or she should or should not perform
such behavior.
Theories/Models of Exercise Behavior
Theory of Planned Behavior
KEY—
The theory of planned behavior is a useful theory
for predicting exercise behavior.
(Ajzen and Madden, 1986)
Theories/Models of Exercise Behavior
Social Cognitive Theory
(Bandura, 1986, 1997)
Exercise behavior is influenced by both personal and
environmental factors, particularly self-efficacy.
What Is Cognition?
Cognition is a term referring to the mental
processes involved in gaining knowledge
and comprehension, including thinking,
knowing, remembering, judging and
problem-solving. These are higher-level
functions of the brain and encompass
language, imagination, perception and
planning.
Theories/Models of Exercise Behavior
Social Cognitive Theory
KEY—
Social cognitive theory has produced some of
the most consistent results in predicting
exercise behavior.
(Bandura, 1986, 1997)
Core Assumptions and Statements
The social cognitive theory explains how
people acquire and maintain certain behavioral
patterns, while also providing the basis for
intervention
strategies
(Bandura,
1997).
Evaluating behavioral change depends on the
factors environment, people and behavior. SCT
provides
a
framework
for
designing,
implementing and evaluating programs.
Environment refers to the factors that can affect a person’s
behavior. There are social and physical environments. Social
environment include family members, friends and colleagues.
Physical environment is the size of a room, the ambient
temperature or the availability of certain foods. Environment
and situation provide the framework for understanding
behavior (Parraga, 1990). The situation refers to the cognitive
or mental representations of the environment that may affect a
person’s behavior. The situation is a person’s perception of the
lace, time, physical features and activity (Glanz et al, 2002).
The three factors environment, people and behavior
are constantly influencing each other.
Behavior is not simply the result of the environment
and the person, just as the environment is not simply
the result of the person and behavior (Glanz et al,
2002).
The environment provides models for behavior.
Observational learning occurs when a person watches
the actions of another person and the reinforcements
that the person receives (Bandura, 1997). The concept
of behavior can be viewed in many ways. Behavioral
capability means that if a person is to perform a
behavior he must know what the behavior is and have
the skills to perform it.
Major Constructs in SCT and Implications for
Intervention:
• Environment: Factors physically external to the
person; Provides opportunities and social support
• Situation: Perception of the environment; Correct
misperceptions and promote healthful forms
• Behavioral capability: Knowledge and skill to
perform a given behavior; Promote mastery
learning through skills training
• Expectations: Anticipatory outcomes of a
behavior; Model positive outcomes of healthful
behavior
• Expectancies: The values that the person
places on a given outcome, incentives;
Present outcomes of change that have
functional meaning
• Self-control: Personal regulation of goaldirected behavior or performance; Provide
opportunities for self-monitoring, goal
setting, problem solving, and self-reward
Major Constructs and Implications
(continued)
• Observational learning: Behavioral acquisition
that occurs by watching the actions and outcomes
of others’ behavior; Include credible role models
of the targeted behavior
• Reinforcements: Responses to a person’s behavior
that increase or decrease the likelihood of
reoccurrence; Promote self-initiated rewards and
incentives
• Self-efficacy: The person’s confidence in
performing a particular behavior; Approach
behavioral change in small steps to ensure success
• Emotional coping responses: Strategies or
tactics that are used by a person to deal with
emotional stimuli; Provide training in
problem solving and stress management
• Reciprocal determinism: The dynamic
interaction of the person, the behavior, and
the environment in which the behavior is
performed; Consider multiple avenues to
behavioral change, including
environmental, skill, and personal change.
Theories/Models of Exercise Behavior
Transtheoretical Model
An individual progresses through five
stages of change:
1. Precontemplation stage (does not exercise)
2. Contemplation stage (has fleeting thoughts of
exercising)
3. Preparation stage (exercises, but not regularly
enough)
(Prochaska, DiClemente, and Norcross, 1992)
(continued)
Theories/Models of Exercise Behavior
Transtheoretical Model
An individual progresses through five
stages of change:
4. Action stage (has been exercising regularly,
but for less than six months)
5. Maintenance stage (has been exercising
regularly for more than six months)
(Prochaska, DiClemente, and Norcross, 1992)
STAGE DETAILS
Stage 1: Precontemplation (Not Ready)
People at this stage do not intend to start the
healthy behavior in the near future (within 6
months), and may be unaware of the need to
change. People here learn more about healthy
behavior: they are encouraged to think about the
pros of changing their behavior and to feel
emotions about the effects of their negative
behavior on others.
Precontemplators typically underestimate the
pros of changing, overestimate the cons, and
often are not aware of making such mistakes.
These individuals are encouraged to become
more mindful of their decision making and
more conscious of the multiple benefits of
changing an unhealthy behavior.
Stage 2: Contemplation (Getting Ready)
At this stage, participants are intending to start the
healthy behavior within the next 6 months.
While they are usually now more aware of the
pros of changing, their cons are about equal to
their Pros. This ambivalence about changing can
cause them to keep putting off taking action.
People here learn about the kind of person they
could be if they changed their behavior and learn
more from people who behave in healthy ways.
They're encouraged to work at reducing the cons
of changing their behavior.
Stage 3: Preparation (Ready)
People at this stage are ready to start taking action within the
next 30 days. They take small steps that they believe can
help them make the healthy behavior a part of their lives.
For example, they tell their friends and family that they
want to change their behavior.
People in this stage are encouraged to seek support from
friends they trust, tell people about their plan to change the
way they act, and think about how they would feel if they
behaved in a healthier way. Their number one concern is:
when they act, will they fail? They learn that the better
prepared they are, the more likely they are to keep
progressing.
STAGE 4: ACTION
People at this stage have changed their behavior within
the last 6 months and need to work hard to keep
moving ahead. These participants need to learn how
to strengthen their commitments to change and to
fight urges to slip back.
People in this stage are taught techniques for keeping
up their commitments such as substituting activities
related to the unhealthy behavior with positive ones,
rewarding themselves for taking steps toward
changing, and avoiding people and situations that
tempt them to behave in unhealthy ways.
STAGE 5: MAINTENANCE
People at this stage changed their behavior more
than 6 months ago. It is important for people in
this stage to be aware of situations that may
tempt them to slip back into doing the unhealthy
behavior—particularly stressful situations.
It is recommended that people in this stage seek
support from and talk with people whom they
trust, spend time with people who behave in
healthy ways, and remember to engage in
healthy activities to cope with stress instead of
relying on unhealthy behavior.
Theories/Models of Exercise Behavior
Transtheoretical Model
KEY—
Different exercise behavior induction strategies
are used during the different transtheoretical
stages.
(Prochaska, DiClemente, and Norcross, 1992)
KEY—
Matching the intervention to the stage of change
is effective in producing high levels of regular
exercise.
Factors Associated With Participation
in Supervised Exercise Programs
Many factors, from demographics to physical and
social environment, affect exercise participation.
(See table 18.03 on p. 409 of text.)
Determinants of Exercise Adherence:
Highlights
 Demographic variables (e.g., education, income,
gender, socioeconomic status) have a strong
association with physical activity.
 Early involvement in sport and physical activity
should be encouraged, because there is a
positive relation between childhood exercise
and adult physical activity patterns.
 Barriers to exercise are similar for white and
nonwhite populations.
(continued)
Determinants of Exercise Adherence:
Highlights
 Self-efficacy and self-motivation consistently
predict physical activity.
 Spousal support is critical to enhance adherence rates for people in exercise programs.
Spouses should be involved in orientation
sessions or in parallel exercise programs.
 Exercise intensities should be kept at moderate
levels to enhance the probability of long-term
adherence to exercise programs.
(continued)
Determinants of Exercise Adherence:
Highlights
 Group exercising generally produces higher
levels of adherence than exercising alone, but
tailoring programs to fit individuals and the
constraints they feel can help them adhere to
the program.
 Post-exercise participation predicts exercise
behavior.
(continued)
Determinants of Exercise Adherence:
Highlights
 Exercise leaders influence the success of an
exercise program. They should be knowledgeable, give lots of feedback and praise, help
participants set flexible goals, and show
concern for safety and psychological comfort.
 A convenient location is an important predictor
of exercise behavior.
Strategies for Enhancing
Adherence to Exercise
Six categories of techniques
Behavior modification approaches
Reinforcement approaches
Cognitive/behavioral approaches
Decision-making approaches
Social-support approaches
Intrinsic approaches
Category 1
Behavior Modification Approaches
Prompts
Verbal, physical, or symbolic cues that initiate
behaviors (e.g., posters, running shoes by bed).
Contracting
Participants enter into a contract with their exercise
leader.
Category 2
Reinforcement Approaches
Charting attendance and participation
Rewards for Attendance and Participation
Rewards improve attendance but must be provided
throughout the length of the program.
(continued)
Category 2
Reinforcement Approaches
Feedback
Providing feedback to participants on their progress
has positive motivational effects.
Self-Monitoring
Participants keep written records of their physical
activity.
Category 3
Cognitive/Behavioral Approaches
Goal setting should be used to motivate individuals.
Exercise-related goals should be
 self-set rather than instructor-set,
 flexible rather than fixed, and
 time based rather than distance based.
Category 3
Cognitive/Behavioral Approaches
Cognitive Techniques
Dissociative strategies emphasize external distractions
and produce significantly higher levels of exercise
adherence than associative strategies focusing on
internal body feedback.
Category 4
Decision-Making Approaches
Involve exercisers in decisions regarding program
structure.
Develop Balance Sheets
Completing a decision balance sheet to increase
awareness of the costs and benefits of participating in
an exercise program can enhance exercise adherence.
Category 4
A Decision Balance Sheet
GAINS TO SELF
LOSSES TO SELF
Better physical
condition
Less time with
hobbies
More energy
Weight loss
(continued)
Category 4
A Decision Balance Sheet
GAINS TO
IMPORTANT OTHERS
LOSSES TO
IMPORTANT OTHERS
Get healthier so I can
play baseball
Less time with my
family
Become more attractive to my spouse
Less time to devote
to work
(continued)
Category 4
A Decision Balance Sheet
APPROVAL OF OTHERS
DISAPPROVAL OF OTHERS
My children would
like to see me be
more active
My boss thinks it
takes time away
from work
My spouse would like
me to lead healthier
lifestyle
(continued)
Category 4
A Decision Balance Sheet
SELF-APPROVAL
SELF-DISAPPROVAL
Feel more confident
I look foolish exercising because I’m
Improved self-concept
out of shape
(continued)
Category 5
Social-Support Approaches
Social Support
 An individual’s (e.g., spouse’s, family member’s,
friend’s) favorable attitude toward another
individual’s involvement in an exercise program.
 Social support can be enhanced by participation in a
small group, the use of personalized feedback and
the use of a buddy system.
Category 6
Intrinsic Approaches
 Focus on the experience itself.
 Take a process orientation.
 Engage in purposeful and meaningful physical
activity.
Settings for Exercise Interventions
 Schools
 Work sites
 Home
 Community
 Health care facilities
Settings for Exercise Interventions
KEY—
Community-based approaches appear to offer
the best way of reaching large numbers of
people.
Guidelines for Improving
Exercise Adherence
 Match the intervention to the participant’s stage
of change.
 Provide cues for exercises (signs, posters,
cartoons).
 Make the exercises enjoyable.
 Tailor the intensity, duration, and frequency of
the exercises.
(continued)
Guidelines for Improving
Exercise Adherence
 Promote exercising with a group or friend.
 Have participants sign a contract or statement
of intent to comply with the exercise program.
 Offer a choice of activities.
 Provide rewards for attendance and
participation.
 Give individualized feedback.
(continued)
Guidelines for Improving
Exercise Adherence
 Find a convenient place for exercising.
 Have participants reward themselves for
achieving certain goals.
 Encourage goals to be a self-set, flexible, and
time based (rather than distance based).
 Remind participants to focus on environmental
cues (not bodily cues) when exercising.
(continued)
Guidelines for Improving
Exercise Adherence
 Use small-group discussions.
 Have participants complete a decision balance
sheet before starting the exercise program.
 Obtain social support from the participant’s
spouse, family members, and peers.
 Suggest keeping daily exercise logs.
 Help participants choose purposeful physical
activity.