KIN 345 unit 2

Individual level

Focus of second section of KIN 345 - The built environment is a large factor

supportive environment

Necessary, but not sufficient for behavior change

Many individuals lack

the motivation and confidence to maintain a physically active lifestyle

>50%

Percent of individuals who start an exercise program and quit within 6 months

Common (BUT WRONG) assumptions

education is an effective strategy to promote PA We can scare people into being physically active You need a gym to be physically active

Behavior change process

to be successful, health professionals must understand this

Personal training, physical therapy, etc. will only be effective if individuals adhere to prescribed regimens

Many clients will be ambivalent and unmotivated - how can you help them reach their goals?

Motivation and self-efficacy

Expected outcomes of PA and enjoyment of PA

Individual factors that influence physical activity behavior

Self regulation

Goal setting, planning

Self-monitoring

Relapse prevention

Once you have identified key determinants, you can develop strategies to target them and change behavior

1. Precontemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenace

Stages of change in the Transtheoretical Model

Precontemplation

-Not currently physically active

-No intention to change behavior in the foreseeable future

-Do not see the value in exercising

Contemplation

-Not currently active, but thinking about becomming more active

-Aware of the benefits of exercise

-Intend to change behavior within the next 6 months

Preparation

Doing some PA or intending to start within the next month

-Preparing for exercise (Checking out gyms, buying gear)

-May be making small changes in PA levels already (taking stairs)

-Not meeting PA guidelines

---Does not receive health benefits yet

Action

-Individuals are exercising at recommended levels for health and fitness

-Requires considerable commitment of time and energy

-At high risk of dropping out of exercise program

-Behavior initiated within past 6 months

Maintenance

-Active lifesytle has been maintained for at least six months or more

-Individuals work ro prevent relapse

-Typically highly confident in ability to maintain regular exercise

Cyclical

Movement through stages is

Movement through stages of change

-Can move forward or backward

-May take multiple cycles before a HABIT IS ESTABLISHED

-Individuals in stage 5 are unlikely to return to stage 1

-Even those in stage 5 must work hard to continue their healthy habit

Motivation and readiness

Important to consider when developing programs to promote PA and match strategies to stage of change

if individuals aren't prepared to change, they won't benefit form traditional Action-Oriented interventions

Individuals in latter stages are unlikely to benefit from strictly Educational programs

1 vs. 2 - See value in exercising

4 vs. 5 - Improved confidence to maintain physical activity

Difference between:

Stage 1 vs. 2 -

Stage 4 vs. 5

Early stages of change (1 &2)

Cognitive processes of change that focus on educating individuals about the benefits of physical activity are most relevant to individuals in:

The benefits of exercising generally outweigh the costs

Decisional balance can help individuals see that:

Increased energy

Which of the following is an example of an immediate intrinsic benefit of engaging in physical activity?

To lose weight

According to the article by Segar and colleagues, participants were least active at 1-year follow-up if they reported exercising:

Daily well-being

Segar and colleagues propose we should "rebrand exercise" to emphasize benefits related to:

Stage 1

Emphasize benefits and minimize costs; address myths and unrealistic expectations

Stage 2

Address barriers; set small, reasonable short-term goals - ex. Walk for five min a day

Stage 3

Develop specific plans for incorporating PA

Stage 4

Encourage PA tracking/monitoring; enlist social support

Stage 5

Set long-term goals; integrate various activities to reduce boredom

Decisonal balance

list of immediate and delayed consequences, both negative and positive, that is meant to show that the pros of being physically active outweigh the cons

Hedonic Principle

a person will choose to maximize a positive outcome over a negative one

-Have a positive toward the behavior

-Be motivated to pursue the behavior

If the perceived advantages of engaging in a behavior outweigh the disadvantages, an individual is more likely to:

Motivation

-the "fuel" that drives our behavior

-It builds the foundation for our doing the behavior

-Long-term change is dependent upon a strong foundation

-A matter of quality, not just quantity

superordinate exercise goal

Why you care about exercising

behavior

An expectation that a specific outcome will follow a given

positive or negative

Expected outcomes can be

Generally, perceived benefits

will positively influence one's attitude toward the behavior and increase the likelihood that one will engage in the behavior

False Hope Syndrome

When positive outcome expectations have a negative effect on behavior

Unrealistic outcomes in an unrealistically short amount of time, people usually get discouraged and quit

Affective

involve feeling states derived directly from the exercise experience (e.g., enjoyment, stress relief, satisfaction)

-Tend to be more Immediate outcomes

Instrumental

do not involve feeling states (e.g., improved fitness and appearance, reduced risk of chronic disease)

-Tend to be more Long-term outcomes

Segar's study

Determined which are more closely related to sustained physical activity

Meet their goal - no incentive to keep exercising - relapse

Do not get expected results in small amount of time - loose interest - and give up

Why do you think the weight loss group was least successful in sustaining physical activity?

Abstract - health is defined very broadly and differently - and hard to measure

Could be too much of a long-term goal, to keep motivation up in the current

Why is health not an optimal motivator?

Autonomy

A fundamental human need to feel volitional in one's actions (as opposed to feeling pressured to behave a certain way)

Considered crucial for long-term maintenance

Provide a meaningful rationale for the behavior Tap into values that are important to the individual Emphasize choice and minimize control

How do we increase autonomy

Intrinsic Motivation

Behavior is performed for the inherent satisfaction and enjoyment it provides

Engage in the behavior in the absence of external incentives

Intrinsic Motivation is:

-Undermined by rewards, threats of punishment, etc

-Fostered by providing choice

-More likely to lead to lasting behavior change

Controlled Motivation

Feeling a pressure/demand to behave in a certain way

Extrinsic Motivation

Engaging in a behavior to achieve some separable outcome

-Tangible rewards/punishments

-Avoidance of guilt/shame

-Achieving health benefits

Controlled and extrinsic motivation

Research consistently shows that these types of motivation are ___NOT linked____ to sustained behavior over time

What messages about WHY we should exercise are people exposed to most often?

Tends to focus on weight/appearance (Media) and preventing health problems (Doctor)

Doctors prescribe exercise for its medical/health value (especially for weight loss)

Popular media emphasize body sculpting and weight loss benefits

Health and weight loss

Undermines Intrinsic motivation

Individuals have been socialized to value exercise for:

Turns exercise into a "___Should___" instead of a "____want____" (compliance vs. autonomy)

Undermines

What's wrong with promoting health?

Emphasizing health and weight loss makes exercise seem like another "necessary evil" in our lives - it's another chore we're supposed to add to our to-do lists

-Translate to behavior

Whats wrong with health:

What an individual says is important does not necessarily

No regular feedback

Health/weight loss outcomes take a long time to achieve

small, immediate

As humans we prefer _______ rewards over larger delayed rewards

Our short-term decisions are motivated more by

emotions than logic

rebranding exercise

Immediate benefits related to ____daily well-being____ are better motivators than distant goals

Exercise promotion should focus on benefits that are most compelling to individuals (i.e., "feeling better" - reduced stress, more energy, etc.)

Adds PURPOSE to the behavior

Establishes a strong foundation: People who want to exercise for these reasons are more likely to plan it into their lives!

Summary

Showing people how exercise can enhance their lives ____Right Now____ is likely to be the most effective strategy

The extent to which individuals ___view physical activity favorably___ is likely to influence their uptake of the behavior

Segar findings

Because immediate payoffs motivate behavior better than distant goals, a more effective "hook" for promoting sustainable participation might be to rebrand exercise as a primary way individuals can enhance the quality of their daily lives.

If an individual expects PA will lead to positive outcomes AND he/she Values those outcomes,

he/she is more likely to engage in the behavior

timing

of the outcomes is important

Affective (immediate feelings) vs. Instrumental (long-term extrinsic outcomes)

proximal

Focus on ____ outcomes

-alleviating major barriers
-highlighting positive affective experiences

What's wrong with promoting health/weight loss?

Distant, abstract outcomes

Elicit controlled motivation (should vs. want)

What should we be talking about instead?

Immediate benefits related to daily well-being

How do we make physical activity feel essential?

Busy individuals prioritize activities they deem essential to their daily lives

Research has consistently shown exercise produces "feel-good" effects:

-Reduced stress and anxiety

-Enhanced enhanced mood
-Increased energy and reduced fatigue
-Reduced tension and hostility
-Increased feelings of calm and relaxation

Factors that typically enhance feel good effects

-Type of activity (rhythmic and repetitive movements)

-Optimal duration, intensity, and frequency
-Lack of interpersonal competition
-ENJOYMENT

Often people initiate exercise to improve health and/or lose weight, but

continue exercise because it brings them enjoyment and satisfaction

Enjoyment is one of the most consistent determinants of long-term

adherence

intrinsic motivation

When we're busy, it's hard to prioritize activities we dislike

How do we enhance PA enjoyment?

Educate individuals about how exercise will make them "feel better"?

-Good reminder for those who have enjoyed exercise in the past

-What about those who view exercise as inherently boring

-If we know enjoyment is important, we need to find out what strategies are most effective for enhancing it

Results: Ekkekakis

When speed was _______self-selected_____, ______pleasure/displeasure_______ was not significantly affected by the exercise session

When speed was _____imposed_____ (10% higher), overweight women reported significant ____declines in pleasure____ as the exercise session progressed

Implications for practice: Ekkekakis

Choosing exercise mode and intensity for an individual takes the control away from him or her

-Undermines autonomy and potentially adherence

-In general, exercise intensity is inversely related with pleasure

-Forcing high intensity exercise may undermine intrinsic motivation and potentially adherence

-Must find a balance - don't want to sacrifice enjoyment and adherence for the sake of optimal intensity/duration

-Previous studies have found that intensity is negatively related to adherence

-Overweight individuals perceived higher rates of RPE than normal weight individuals for the same exercise

Results: Leininger

Participants reported significantly greater enjoyment after completing a session of DDR - dance dance revolution than they did after a session of treadmill walking

-Oxygen consumption and rating of perceived exertion (i.e., intensity) did not differ significantly between the two conditions

Implications for practice: Leininger

Many individuals find "traditional" of exercise boring or unpleasant

-Introduce individuals to a variety of novel modes of exercise to help them find something they enjoy

Active video games
Dance/zumba
Sport-based activities
Yoga
Etc.

-Individuals may endure higher intensities for longer duration if it's an activity they enjoy

Results: Focht

Both walking conditions elicited significant improvements in affective responses

Participants reported greater enjoyment and intention to exercise regularly in a similar setting in the future after the outdoor walking condition

Implications for practice: Focht

-The environment in which one exercises can have a significant impact on his/her experience

-Encourage clients to "think beyond the gym"

-Tips for modifying environment to enhance enjoyment:

Get outside
Use favorite music/TV show as a distraction
Be active with friends

Enjoyment Summary

-Enjoyment is a key determinant of physical activity maintenance

-For individuals who don't enjoy exercise, modifying the mode an/or environment may alter their perceptions

-Relax the "__gold standard__" if necessary - doing something is always better than doing nothing

Self-efficacy

One's confidence in his or her capability to carry out a course of action

Situation-specific self-confidence
Exercise vs. diet
Walking vs. running

The MOST CONSISTENT psychosocial determinant of physical activity behavior

direct control

People with a strong sense of efficacy believe they have ____________ over their health habits

Efficacy expectations influence

The ____activities____ individuals choose to pursue

The _____effort______ they expend in pursuit of their goals

The outcomes they expect for their efforts

The extent to which they ___persist___ when they encounter barriers

CHOICE, EFFORT, PERSISTANCE... related to exercise adherence?

Perfect PA cycle

Exercise --> Succeed --> Believe you can succeed again

Why focus on self-efficacy

Unless people believe they have control over their own behavior and they are Unlikely to be moved to act

Perceptions of control are especially good predictors of behavior in challenging situations

Distinguishes people with similar abilities and expectations

Associated with health behaviors so consistently that theories are considered incomplete without it

Self efficacy is included in virtually every theory

How is self-efficacy different from self-esteem?

Dispositional vs. situation-specific

Judgment of self-worth vs. specific capabilities

Self-efficacy is highly highly modifiable
-Fluctuates according to circumstances and a variety of internal and external influences

Measuring Self-Efficacy

Individuals rank confidence on a scale from 0% to 100% (or 1 to 10)

Items should start with a phrase such as "I believe I am capable of..."

Items should be structured hierarchically to reflect increasingly difficult tasks

2 types of exercise self-efficacy
-Barriers (coping)
-Task-specific

Barriers (Coping) Self-Efficacy

Confidence to _engage in regular exercise_ in the face of common barriers (_Adherence_ self-efficacy)

-Lack of ___time___
-Too ___tired___
-Bad weather
-Feeling stressed
-No one to exercise with
-Program is not enjoyable

Measures should include an array of barriers
Include population-specific barriers when possible

Task-specific Self-Efficacy

Confidence in ability to accomplish a specific _exercise-related task_

-Walking
-Cycling
-Tai chi

Measures specify incremental levels of difficulty (e.g., distance, duration, etc.)

Appropriate when interventions are designed to target a particular behavior

Assessing your own self-efficacy

For each measure, calculate the average of all items

Are your scores similar? Is this what you would expect?

If you exercise consistently no matter what obstacles you face -> high coping self-efficacy

If you can jog 3+ miles with ease -> high task-specific self-efficacy

four sources of self-efficacy

Target these sources to enhance self-efficacy

mastery experiences - experiences (past performance accomplishments)

Vicarious experience /modeling - (seeing similar others succeed)

Verbal persuasion - (_encouragement and feedback_ from others)

Interpretation of physiological and psychological responses - (e.g., muscle soreness, reduced stress)

Which is the most powerful source of self-efficacy?

Mastery experiences - thought to be best predictor of how confident they will be when asked to do a task in the future

HOW would you target self-efficacy sources to enhance TASK efficacy?

Mastery - Use a program such as couch to 5K that emphasizes gradual progression

Modeling - Train with others of similar ability

Persuasion - receive clear, positive feedback from a trainer or coach

Interpretation - aware of the natural responses and adaptations to exercise -that is a good thing; Keep an activity log and monitor distance, pace, etc. as training progresses

Efficacy-building interventions: Site-based

-Start with small, easy tasks that participants can complete successfully

-Build duration and intensity gradually

-Provide frequent verbal and written feedback to highlight improvements

-Conduct exercise sessions in groups
Train leaders to be supportive and encouraging

HOW would you target self-efficacy sources to enhance COPING efficacy?

-Mastery - set small, short term goals in order to be successful early and often

-Modeling - join a social network where similar others share their success stories

-Persuasion - tell family and friends about exercise accomplishments so they can provide encouragement

-Interpretation - keep an activity log and monitor enjoyment, stress, etc. before and after

Efficacy-building interventions: Home-based

Improve participants' motivation and resources

-Emphasize, meaningful, attainable outcomes
-Let participants choose activities they enjoy
-Teach self-regulatory skills (goal setting, planning, etc.)
-Teach physical activity skills
-Incorporate active role models

Make the behavior easier
-Broaden definition of "exercise" to include small, manageable bouts
-combine PA with things we already have to do
-Modify environment to reduce barriers and facilitate activity

The easier the task, the less individuals have to rely on motivation to be successful

Summary - Self-efficacy

Self-efficacy (or some derivation) is included in nearly every health behavior theory

Consistently emerges as an independent predictor of physical activity in various populations

Self-efficacy is highly modifiable, so practitioners must employ strategies to enhance (and not undermine) self-efficacy

Behavior change Process

Part 1: Motivation (the WHY)

Does the individual value the behavior and outcomes?
Positive attitude, intrinsic motivation, self-efficacy, etc.
Develop an Intention to change behavior

Part 2: Self-regulation (the HOW)
Do they have the skills to make the behavior a priority in their busy lives?
Maintainers are adept at using behavior change strategies to stay regularly active

Translate intentions to action

Self-regulation

Strategies that an individual uses to regulate his or her goal-directed behavior or performance

Goal setting, planning, self-monitoring

Use of these skills strongly predicts successful physical activity maintenance

Self-regulation in action: The CardiACTION trial

Insufficiently active patients in a healthcare clinic

Randomly assigned to 1 of 4 conditions:
-Increased environmental accessibility to PA resources (free gym membership for a year (ENV)
-Interactive action planning session based on 5 As model (SC)
-ENV + SC (COMBO)
-Matched contact control focused on healthy eating (CON)

Follow-up measure of PA behavior 1 month later

The 5 As model

-ASSESS patient's PA level and motives for increasing PA

-Provide ADVICE on recommended PA levels
-AGREE on a goal for the upcoming month
-ASSIST patient in identifying barriers and developing strategies to overcome them
-ARRANGE for follow-up one month later

Goes beyond ___education___ and gets patient actively involved in self-regulating his/her behavior

CardiACTION Results

-Groups that received the interactive action planning session (SC and COMBO) increased PA significantly

-Group that received free gym membership only did not improve significantly relative to the control condition

-Access to a supportive environment alone was insufficient to produce significant changes in behavior

-Teaching patients self-regulatory strategies WAS effective

Goal

future valued outcome

- something an individual wants to attain