Exercise Behavior

and Adherence
Background

● Less than 5% of adults participate in 30 minutes of physical activity each day

● Only one in three adults receive the recommended amount of physical activity each week.
● 36.5% of American adults are obese
● 16.2% of american tee
Reasons to Exercise
● Weight Control: Exercise burns calories that is taken in from food and drink. It is
recommended that each person should do some sort of moderate exercise for at least 150
minutes a week. It is all about calories in vs calories out

● Reduce Risk of Cardiovascular Disease: When exercising it raises the heart rate which
strengthens the heart. The increased heart rate during exercise leads to a decreased
overall heart rate at rest and throughout the day. It also increases blood flow and
regulates blood pressure

● Reduction in Stress and Depression: Exercise induces the brain and endocrine system to
release hormones and endorphins that increase overall mood, It can be a way to get the
mind off of stressors in life or a way to use the anger in a positive manner.
 Reasons to Exercise (cont.)

● Enjoyment: Exercise leads to endorphins being released which create a positive feeling in the body. The feeling of
endorphins release is similar to the effect of morphine.

● Enhancement of Self-Esteem: When someone exercises the body transformation is visible and tends to be their self
confidence is greatly increased.

● Opportunities to Socialize: Exercise can come in many forms, some of which are in large groups, The large groups
allow people to meet new people
Reasons for Not Exercising

Injuries/health issues: Injuries such as a broken bone can cause issues that prevent a person
from exercising due to immobility. Some activities such as contact sports or health concerns can
also prevent a person from exercising.

Could cause eating disorders or body dysmorphia: Exercising can cause a person to become
very self aware of their body appearance and may cause them to have an unhealthy relationship
with food to look a certain way. It can also cause a person to think that they look a certain way
when in reality they don’t (body dysmorphia).
 Reasons for Not Exercising (cont.)

● Perceived Lack of Time: A person may have other activities that are more important than exercise . An example of
this would be taking care of a child instead going for a run

● Lack of Energy: Daily activities or lack of sleep can cause a person to be tired during the day. A person may rather
take a nap instead of going for a walk

● Lack of Motivation: Motivation comes from both intrinsic and extrinsic, If the person doesn’t have a reason to
workout they most likely will not. They may not be overweight or may be happy with their body appearance these
are intrinsic forms of motivation for some. They may be in a relationship so the motivation to look a certain way is
most likely not as important.

● Sedentary Behavior: In today’s age it is very easy to sit and use technology for hours of the day.
 Problem of Exercise Adherence

Definition: the extent to which a patient acts in accordance with the advised interval, exercise dose, and
exercise dosing regimen.

Ways to improve exercise adherence:

Find a friend or family member to keep you on track

Make goals and set rewards to goals’

Write down motives and place somewhere you see everyday

 Theories and Models of Exercise Behavior

● Health Belief Model: People will not change their health behaviors unless they believe that they are at risk

● Theory of Planned Behavior: a theory used to understand and predict behaviors, which posits that behaviors are
immediately determined by behavioral intentions and under certain circumstances, perceived behavioral control.

● Social Cognitive Theory the influence of individual experiences, the actions of others, and environmental factors
on individual health behaviors.

● Self-Determination Theory: people are motivated to grow and change by three innate and universal
psychological needs. This theory suggests that people are able to become self-determined when their needs for
competence, connection, and autonomy are fulfilled.
Theories and Models of Exercise Behavior (cont.)

● Transtheoretical Model: Progress does not move in a linear fashion, but rather in stages of
change that are cyclic. Interventions and information need to be tailored to match the
particular stage an individual is in at the time.
Transtheoretical model (decision balance)

● Decisional Balance: the cost-benefit analysis people go through when making a decision
about exercise

● Every stage forward in the model the pros increase while the cons decrease.

● Motives for exercise become more internal as the participant progresses through the
stages
○ Focusing on guilt or obligation rather than fostering self motivation may have a negative effect on
adherence
Theories and Models of Exercise Behavior (cont.)

● Physical Activity Maintenance Model: Goal is to help better understand the long-term
maintenance of physical activity.

Key aspects of the model predicting the maintenance of physical activity:

○ Goal Setting
○ Self Motivation
○ Self-Efficacy
○ Physical activity environment
○ Life stress

*few studies available that measure maintenance behavior.

Theories and Models of Exercise Behavior (cont.)

● Ecological Models: How do environments and behaviors affect each other. Considers
intrapersonal, interpersonal, institutional, and policy influences.

Zhang, Solomon, Gao, Kosma (2012)

● Integration of Models: A combination of models might provide the best prediction of

exercise behavior. Ecological model with SDT.
Determinants of Exercise Adherence

There are many factors that play a role in in

adherence to exercise programs. Generally
these factors fall into two categories.
Personal factors and environmental factors.

None of these factors isolated from the

others. They influence and are influenced by
one another.

Gender and age have to most consistent and

strongest effects on physical activity.
Determinants of Exercise Adherence

● Personal Factors
○ Demographic Variables
■ Education, Income, Socioeconomic status; Consistent and Positively related
■ Male Vs Female; More participation but no difference in intensity
■ Age; Decrease in physical activity usually occurs during adolescence
■ Overweight and Obesity; Negatively associated with physical activity.
■ Race/Ethnicity; Nonwhite groups are at a higher risk for low levels of physical activity
○ Cognitive personality variables
■ Self-Efficacy and Self-Motivation are the most consistent predictors of physical activity
■ Beliefs about and expectations of benefits from exercise are associated with higher levels
of physical activity
○ Behaviors
■ Past Participation in an exercise program is THE MOST RELIABLE PREDICTOR of current
participation.
■ Childhood exercise and adult physical activity patterns
Determinants of Exercise Adherence

● Environmental Factors
○ Social Environment - Friends, Family, SPOUSE,
○ Physical Environment - LOCATION, weather, “lack of time”
○ Physical Activity Characteristics
■ Exercise Intensity, Frequency, and Duration
● Best adherence at 50% or less of their aerobic capacity
● Pleasant feelings vs. unpleasant feelings (discomfort)
● Past Intensity
● Risk of/Past Injury
■ Comparing Group with Individual Programs
● Group exercising leads to better adherence
○ Social Support, personal commitment, opportunity to compare progress
■ Leader Qualities
● Knowledgeable, likeable, genuine concern for safety and psychological comfort.
● Style: Interactive, encouraging, energetic; Democratic Style
● Unique to the participate
Settings for Exercise Interventions

While interventions conducted in worksites, health care facilities, and homes are virtually
ineffective, school based interventions show modest results.

Interventions applied in a community setting have been the MOST successful.

Informational interventions

“Point-of-decision” prompts

Behavioral or social interventions

Social support in community settings; school-based physical education

Environmental and policy interventions

Focus on access to places for physical activity combined with info outreach activity
Strategies for Enhancing Adherence to Exercise

Recommendations for promoting physical activity in school and community Programs:

● Policy
● Environment
● Physical education
● Health education
● Extracurricular activities
● Parental Involvement
● Personnel training
● Health Services
● Community Programs
● Evaluation
Strategies for Enhancing Adherence to Exercise

● Motivational Interviewing (MI): “A collaborative, person-centered form of guiding to elicit

and strengthen motivation for change”
○ Goal is to increase the likelihood that a client will consider, initiate, and maintain specific strategies
for changing behavior.
○ Principles of MI include:
■ It is the client’s task, NOT the counselor’s to articulate and resolve the clients feelings
about exercise or not exercising
■ Motivation to change is elicited from the client rather than the counselor
■ The style of the counselor is more client centered, letting them figure out their feelings
regarding exercise.
■ Readiness to change is not a client trait but rather a fluctuating product of interpersonal
interaction.
■ The client-counselor relationship is more of a partnership, with the counselor respecting
the autonomy and decision making of the client.
Strategies for Enhancing Adherence to Exercise
(cont.)

Behavior Modification Approaches

● “The planned, systemic application of learning principles to the modification of behavior”(458, Weinberg)
○ Prompts are cues that when seen or heard activate a certain behavior. They can be:
■ Verbal: “You got this” or “You can do it”
■ Physical: Getting over a sticking point
■ Symbolic: Workout gear in a car
○ Prompts can increase exercise behavior like a sign saying “take the stairs over the elevator”
■ When prompts are taken away too soon, they can lead to a reverse effect
■ If taken away slowly it can still have effect, this is called Fading
○ Contracting is when the participant enters into a contract with the person helping them,
■ “The contract will specify expectations, responsibilities, and contingencies for behavioral
change”(459,Weinberg)
■ Focus is on helping motivate the participant and make the take action
Strategies for Enhancing Adherence to Exercise
(cont.)

● Reinforcement Approaches
○ Reinforcement can be positive and negative
○ Powerful determination of future action
○ Reinforcement can be an award or incentive for staying on task
● Charting Attendance and Participation
○ If public, people will strive to be better since everyone can see how they were rated on their last
class
● Rewarding Attendance and Participation
○ Rewarding is incentive base, those who work the hardest or attend the most get a free T-shirt
● Feedback
○ Feedback on performance is rewarding as well.
○ Being told “Your doing great” or “You did great today” makes people feel good about themselves.
○ Makes them want to keep going so they can do great again.
Strategies for Enhancing Adherence to Exercise
(cont.)

● Cognitive-Behavioral Approaches is the “thinking” portion of behavioral change

○ Goal Setting: Useful motivational technique to improve exercise behavior
■ Motivating goals: “I want to build muscle”
■ Action goals: “I will bring workout clothes with me to work everyday so I can go right to the gym”
■ 16% more likely to complete goals when the participant sets the goal instead of the instructor
■ Intrinsic goals (ex: Improve personal health) better than Extrinsic goals(ex: I want to be a model)
○ Association and Dissociation
■ Association is when the participant is focused on the internal body(ex: how the muscle feels)
■ Dissociation is when participant is focused elsewhere(ex: how pretty the sky looks out the window)
■ Dissociation is a distraction to the participant
● Decision Making Approaches
○ Psychologists created a Decision Balance Sheet to make people aware of the benefits and cost of an exercise
program
○ Sheet contains questions on what is anticipated by the participant(Gains, losses, approval and disapproval of self
and others
● Social Support Approaches
○ Having friends or family members join the participant can increase enjoyment and performance
○ May act as a model or cue to the participant
Strategies for Enhancing Adherence to Exercise
(cont.)

● Intrinsic Approaches
○ Focus on the Experience Itself:
■ While exercising, focus on the quality of what the participant is doing instead just doing the
motions to try and achieve their goal.
○ Focus on the Process
■ Focus on muscles being used
■ Intrinsic > Extrinsic orientation
■ If focused on extrinsic orientation, the participant will be more likely to drop out of the
program
○ Engage in Purposeful and Meaningful Physical Activity
■ If the activity is purposeful and meaningful to the participant then they are more likely to
do it.
Guidelines for Improving Exercise Adherence

Keys to enhancing adherence to exercise among participants:

● Match the intervention to the stage of ● Find a convenient place for exercising
change of the participant ● Have participants reward themselves for
● Provide cues for exercise achieving certain goals
● Make exercises enjoyable ● Encourage goals to be self-set, flexible, and
● Tailor the intensity, duration, and frequency time- based
● Remind participants to focus on
of the exercises
environmental cues when exercising
● Promote exercising with a group of friends
● Have participants complete a decision
● Have participants sign a contract or balance sheet before starting program
statement of intent to comply with the ● Obtain social support from the participants
exercise program spouse, family, and peer’s
● Offer a choice of activities ● Suggest keeping daily exercise logs
● Provide rewards for attendance and ● Practice time management skills
participation ● Help participants choose a purposeful
● Give individualized feedback physical activity

463/464, Weinberg
Reference

Robert S. Weinberg. “Foundations of Sport and Exercise Psychology.”