STAGE-BASED AND OTHER MODELS OF PHYSICAL

ACTIVITYMoving from thinking to doing

Theories of Exercise Behaviour

Belief-AttitudeTheories

Competence-BasedTheories

Control-BasedTheories

Stage-BasedTheories

Example:Theory of

Planned Behaviour

Example:Self-Efficacy

Theory

Example:Self-Determination

Theory

Example:Transtheoretical

Model

HybridModels

Example:HAPA

Aims

• To outline the popular ‘Transtheoretical Model’ approach to physical activity decision-making

• Cover the ‘natural history’ model of exercise proposed by Sallis and Hovell (1990)

• Outline the relapse prevention model • Describe the lifespan interaction model

The Transtheoretical Model of Health Behaviour Change

• Core constructs:

• Stages of change

• Processes of change

• Decisional balance (pros and cons)

• Self-efficacy

The Transtheoretical Model

Self-EfficacyDecisional Balance

Processes of change

Precontemplation

Contemplation

Preparation

Action

Maintenance

HOWWHEN

PrecontemplatiPrecontemplationon

• Physically active? NO • Intention to be active?

NO

ContemplationContemplation

• Physically active? NO • Intention to be active?

YES

PreparationPreparation

• Physically active? Yes, but not at criterion level

• Intention to be active? YES

ActionAction

• Physically active? YES (less than 6 months)

• Intention to be active? YES

MaintenanceMaintenance

• Physically active? YES (more than 6 months)

• Intention to be active? YES

Prevalence estimates for stages by different levels of physical activity

0%10%20%30%40%50%60%70%80%90%

100%

3x15m 3x15MVPA 4-7x30MVPA

None

MainActionPrepContPre

(Marshall & Biddle, 2001)

Prevalence estimates for stages across four countries

0%10%20%30%40%50%60%70%80%90%

100%

Australia Canada UK USA Total

MainActionPrepContPre

(Marshall & Biddle, 2001)

Precontemplation

Contemplation

Preparation

Maintenance

Action

Stages are thought to be cyclical

Processes of change

• "the cognitive, affective, and behavioral strategies and techniques people use as they progress through the different stages of change over time" (Marcus et al., 1992)

Processes of changeProcess Description

COGNITIVE / THINKING PROCESSES

Increasing knowledge

Increasing information about oneself and physical activity.

Being aware of risks

Understanding the risks of inactivity and sedentary living.

Caring about consequences to others

Recognising how inactivity might affect others, such as family and co-workers.

Increasing healthy alternatives

Increasing awareness of alternatives for being physically active.

Understanding the benefits

Increasing awareness of the benefits of physical activity.

Processes of change

BEHAVIOURAL / DOING STRATEGIES

Substituting alternatives

Seeking ways of being physically active when encountering barriers of time etc.

Enlisting social support

Seek support from others for your physical activity efforts.

Rewarding yourself Praise and reward yourself, in a healthy way, for making successful efforts in physical activity.

Committing yourself Make plans and commitments for physical activity.

Reminding yourself Establish reminders and prompts for physical activity, such as diary time slots and making equipment easily available.

DECISIONAL BALANCEDECISIONAL BALANCE

Pros & cons of exercisingPros & cons of exercising

• I would be healthier if I exercised (pro)

• Other people would respect me more if I exercised (pro)

• It is expensive to join a health club (con)

• I would probably be sore and uncomfortable if I exercised (con)

Differences in pros and cons across stages (Marshall & Biddle, 2001)

1

0

0.5

Effect Size

Precontemplation Preparation Maintenance

Contemplation Action

ProsCons

2

1.5

Self EfficacySelf Efficacy

The confidence that you can be active in The confidence that you can be active in challenging situationschallenging situations

Example: I am confident I can be active when I feel I do not have much time

Differences in self-efficacy across stages (Marshall & Biddle, 2001)

Precontemplation Preparation Maintenance

Contemplation Action

1

2

0

1.5

0.5

Effect Size

2.5

TTM: Critique

• the majority of study designs are cross-sectional• there is a need to standardize and improve the

reliability of measurement of stages and related constructs

• the role of processes of change for physical activity behaviour remains unclear. The presence of higher-order constructs is not apparent in physical activity

• stage-by-process interactions are not evident

(Marshall & Biddle, 2001)

A NATURAL HISTIORY MODEL OF EXERCISE

SEDENTARY RESUMPTION

DROP-OUT

MAINTENANCE

ADOPTION

Determinants may differ across phases/stage of the model

• Key phases/stages applied to exercise:

• Starting exercise

• Maintaining exercise

• Ceasing exercise

• Resuming exercise

RELAPSE PREVENTION MODEL

High riskof ceasingexercise

Low self-efficacy

Negativeattributions

Highprobabilityof quitting

Adequateor increasedself-efficacy

Low probabilityof quitting

Lifespan Interaction Model

(to be inserted by publisher?)

Chapter 6: Conclusions 1

• the TTM provides an important advance on static linear models of exercise and physical activity determinants by hypothesising both the ‘how’ and ‘when’ of behaviour change

• Measures of stages and processes of change are now available and require validation across more diverse samples

• TTM research needs to advance beyond description of predictable cross-sectional differences between stages

• meta-analytic evidence broadly supports the model, although the classification of processes of change into two higher-order categories is questioned

Chapter 6: Conclusions 2

• a natural history model of exercise is a useful framework for identifying key stages in exercise behaviour

• more needs to be known about which determinants are important at each of the phases of the model

• relapse prevention may depend more on coping strategies than high-risk situations per se

• the hybrid HAPA model allows for the distinction between non-intentional, intentional, and action stages of behaviour