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by: Earnest Greenholt


Earnest Greenholt
GPA 3.94

M. Kosma

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M. Kosma
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This 35 page Class Notes was uploaded by Earnest Greenholt on Tuesday October 13, 2015. The Class Notes belongs to KIN 4520 at Louisiana State University taught by M. Kosma in Fall. Since its upload, it has received 16 views. For similar materials see /class/222595/kin-4520-louisiana-state-university in Kinesiology at Louisiana State University.

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Date Created: 10/13/15
Wilson et 31 2005 0 Purpose Exam 2 I To examine the effects of a 4week student centered intervention program that focuses on increasing physical activity levels and theoretically related psychosocial factors exclusive to PA motivation selfconcept and self efficacy 0 Participants I 48 6th grade students ages 1012 years I StudentCentered Intervention Program 0 28 Students 0 61 Female 0 85 African American I Comparison Program 0 20 Students 0 85 Female 0 80 African American 0 Intervention I Control group 20 students 0 Treatment 0 4 weeks of general health education with no emphasis on PA during regular school hours I Intervention group 28 students 0 Goals 0 0 To increase physical activity levels to and theoretically related psychosocial factors specific to PA in students by allowing them a choice of PA activities and providing them with coping strategies for making effective lifestyle changes in PA Increase MVPA to 60 minutes per day based on guidelines for PA standards in adolescents 0 Treatment 0 0 Students selected own physical activities according to interest and generated selfcoping strategies for making effective PA behavior changes Three components of program to increase intrinsic motivation and behavioral skills I Homeworksnack 30 minutes O I Selected moderate to vigorous intensity activity 60 minutes I Educated on behavioral skills and motivational strategies to increase PA levels 30 minutes 0 SelfPresentation Videotape Interview I Task to advise other students how to handle problem solving situations by portraying their own coping strategies focusing on positive things they did to reach PA goals and on how they managed overcoming challenges Procedure A students videotaped during interview session B viewed tapes at next session C allowed to revise tapes until they approved of quality Major Variables Psychosocial Variables I Motivation for PA level of motivationdesire related to engaging in physical activityexercise amotivation intrinsic extrinsic I SelfConcept for PA individual s perception of self in relation to physical activity idea of where they stand I PA SelfEf cacy con dence in ability to make consistent changes in physical activity for at least 6 months I Enjoyment for PA level of enjoyment attained while participating in or related to physical exercise I Major Outcome Variable increase decrease in overall physical activity level Major results I Group Differences in PA levels 0 Post Intervention data collected via accelerometer o Intervention group showed greater increase in time spent in MPA MVPA and VPA than those in control group I Adjusted means and standard errors 0 MFA 9936i 588 vs 7263 i 588 o MVPA 11394 i 627 vs7878 i 627 o VPA 1133 i 107 vs 531 i 107 I Group Differences in Psychosocial levels 0 Students in intervention group showed greater increases in measures of PA motivation and Positive SelfConcept Motivation adjusted means and standard errors 457 i 016 vs 382 i 017 Positive SelfConcept adjusted means and standards errors 445 i 014 vs 404 i 015 o Enjoyment for PA of intervention group ranged from 642 i 106 to 689 i 020 over 4 week program 0 O 0 Study implication I This study provided evidence for the feasibility of increasing PA through a student program focusing on increasing intrinsic motivation and behavioral skills in underserved adolescents The results prove that the intervention program had a positive correlation with increased PA levels which could be used nationwide to help ght the current obesity epidemic and lower risks for developing other related health consequences Self Determination Theory 0 Psychological mediatorsneeds I Autonomy selfinitiation choice of behavior I Competence effective interaction with the environment perceived ability I Relatedness feel connected with others 0 Sources of motivationmotivation continuum I Amotivation I Extrinsice motivation external regulation avoid punishment or receive a reward o introjected regulation should or must be active incomplete internalization of behavior 0 identified regulation want to achieve a personal goal I Intrinsic motivation learn 0 accomplish tasks 0 experience sensations pleasant bodily and physical sensations 0 Outcomes I PA adherence I effect 0 Implications of SD Theory I Intrinsic motives towards exercise would increase exercise adherence I Extrinsic motives towards exercise would decrease exercise adherence Levy amp Cardinal AJHP 2004 0 Study purpose I Examine the effectiveness of a printbased exercise motivational program based on the selfdetermination theory among communitydwelling adults I Program effectiveness Was examined over a 2monthperiod by changes in exercise behavior and the mediator autonomy relatedness an competence 0 Major variables I Autonomy perceived selfinitiation of activity I Competence perceived ability to be active I Relatedness feelings of social connections I Exercise behavior regulation motivation continuum from amotivation to extrinsic I Exercise behavior frequency of leisuretime exercise at strenuous moderate and low exercise intensity I Process evaluation receipt of intervention packet and delity for eatment groups read the packet or postcard and completed intervention packet Worksheets o Intervention Baseline assessment ALL pa icipants I Intervention only group packet of intervention materials I Interventionplusbooster group intervention packet plus booster postcard a er the end of 2m1 assessment 1month I Control group AHAphysical activity and health fats packet I Intervention strategies decision making autonomy goal setting competence social support relatedness I Booster postcard 5 short messages to pinpoint intervention strategies I l and 2 month assessments ALL pa1ticipants 0 Major results Major Results Major Results Exercise Effectiveness Process Evaluation Variable Mam Maul lnleracImn gnaw E ear emup Tlme Group Receveu Read Completed Exam ND Vii N0 Maenais Mmenals Womsnaels Evilr523 mtenennm size 24 5 Zmunlhs Plusmusty Amunum ND VESlur NO I mm mtewenuun 971 32 5 35 Relzledness ND ND ND Canlml lDE lo m NA Cnmnetence ND ND ND Mutwatlun ND ND ND Cuntmuum 0 Study implications I It is important for PA promoters to develop low cost print based and theorybased SD physical activity motivational programs for adults reinforcing such motivational strategies as autonomy in choosing activities setting goals and social support It is important for PA promoters to include a process evaluation component in mailmediated motivational materials to test program delity Depression and Exercise 0 O O O 0 Major Depressive Episode I De ned by sustained feelings of sadness or elation feelings of guilt or worthlessness disturbance in appetite gain or lose without following diet 5 change per month disturbance in sleep patterns lack of energy difficulty concentrating loss of interest in all or most activities thoughts of suicide hallucinations Metaanalysis I Synthesis of a body of literature empirical databased studies I The body of lit has certain characteristics quantitative results I Raw data is converted to a standard score effect size I magnitude of the difference between control and experimental groups following the intervention I lt 03 is low I Between 0407 is medium I gt 08 is high moderators I a third variable construct that may affect the relationship between the independent and the dependent variables I ex men have more depression than women gender is a moderator Exercise and nonclinical depression I Metaanalysis of North et al 1990 I Exercise decreased depression ES 53 I Exercise was as effective as more traditional therapies relaxation psychotherapy medication the best effect was when exercise was combined with psychotherapy I Moderating factors 0 Mode of exercise no differences in the degree of depression reduction among various exercise modes not a moderator because there are no changes in this relation Length of exercise no differences Exercise intensity no consistent examination may or may not be a moderator Duration or frequency no differences Acute vs chronic no differences Age exercise decreased depression for all ages Gender no differences Initial level all participants decreased depression following exercise 0 Exercise and clinical depression I Metaanalysis of Craft and Landers 1998 I Exercise reduced clinical levels of depression ES 072 close to high effect size I Moderator variables 0 Exercise mode no differences 0 Age or gender no differences 0 Duration of exercise session or frequency no differences 0 Program length the reduction in depression was doubled for programs lasting 812 weeks vs lt 8 weeks MODERATOR because the longer the exercise program was more effective in its impact on clinical depression I Exercise intensity as a moderator variable 0 Light intensity ES 58 0 Moderate intensity ES 82 0 Moderate to heavy intensity ES 1 ll 0 Comfortable level ES 76 I More research is needed on the effects of exercise intensity on depression reduction 0 Mechanisms of change I PhysiologicalExplanations o Anthropological hypothesis human beings are genetically designed to be active 1920s manual labor was dominant Technology entered our lives and we became less active We have violated our genetic warranty Systematic increases in depression levels were observed the 0000 same time technology evolved o Endorphin hypothesis the endogenous body s morphine is released during exercise thus making us feel better o This hypothesis has not been completely accepted because we cannot test this in the brain due to the blood brain barrier o Monoamine hypothesis exercise increases the release and uptake of serotonin norepinephrine and dopamine mood regulators I PsychologicalExplanations o Mastery hypothesis sense of accomplishment or mastery leads to selfworth through exercise we are increasing our selfefficacy 0 Social interaction hypothesis social interactions through exercise reduces depression Body Image and Exercise Multidimensional construct o Perceptual dimension how we perceive we look level of accurate body judgment 0 Do we think we look thin fat muscular etc o How accurate are we in regards to out body shape and size 0 Accuracy of physique can be assessed in many ways I Ex ratio of perceived to actual width of particular body parts I If the ratio is close to one then they have an overall positive perceptual perception This could be an indicator of willingness to Ifthey have accurate perceptions then they have a more healthy body image Poorer perceptions could lead to eating disorders The higher the discrepancy between the perceived and actual physique the higher the body dissatisfaction Cognitivedimension satisfaction with body shape size and functions 0 Many people are accurate in perceiving how they look 0 Not many are satisfied with this perception o Surveys can be used to assess body satisfaction Affectiveoremotionaldimension feelings about one s body 0 How people feel about their bodies 0 Social physique anxiety 7 degree of anxiety people experience when other people evaluate their bodies 0 During exercise our bodies are exposed o How anxious you are about this evaluation process is a way to assess this dimension Behavioraldimension actions that re ect perceptions thoughts and feelings e g avoidance and lifestyle behaviors o Avoidance behaviors 7 avoiding social situations where the body is exposed trying to divert attention away from their body 0 Lifestyle behaviors 7 actions people take to alter the way they look ie excessive exercise or dieting to lose weight O 0000 Body Image o Healthybodyimage positive selfevaluations along the body image dimensions 0 How do people evaluate their bodies 0 How do they feel about their bodies 0 Can they accurately judge body shape and size 0 Are the satis ed 0 Are they anxious 0 Do they exhibit avoidance behaviors o Bodyimagedisturbance negative selfevaluations along one or all of the body image dimensions 0 1997 Psychology Today 7 56 women and 43 men reported dissatisfaction with their bodies Body Image Formation 0 Body reality actual physical characteristics 0 Bodyideal perceptions of how our body should look and function 0 The higher the discrepancy between body reality and ideal the higher the body dissatisfaction o The closer they are the higher the body satisfaction 0 Mediain uence personal body ideals and mediadriven body ideals 0 Personal ideals are aresult of media and cultural in uences 0 Eating disorders depression anxiety and disappointment can result when the individual realizes that these goals are unrealistic and unattainable o Vshape for men is idealized in magazines 0 Tall and thin is idealized for women in magazines 0 Culturalin uences body image between AA and Caucasian women 0 Caucasian women tend to have lower body image 0 African American women have healthier body images 0 African American women who have been exposed to westemized media have lower body images 0 Activityparticipation and body image 0 The type of activity can affect the way we think about our bodies 0 Swimmers v weight lifting v song distance runners 0 Age and body image 0 As age increases so does body dissatisfaction o 67 year old kids display the onset of body dissatisfaction o Battling obesity Body image has the highest affect on our self esteem Gender Differences in Body Image Dissatisfaction Cultural ideal weight ideal weight recommended by commercial diet centers media in the USA Medical ideal weight Metropolitan Life Insurance Company 1983 height and weight charts 0 Actual and desiredweight 0 Men significant overlap among cultural medical actual and desired weight 0 All those different weights are very similar 0 Women cultural and desired weight were much much less than medical and actual weight 0 Weight promoted by commercial tness centers was far less than the medical recommendation 0 Women are much more dissatis ed with their bodies than men Body Image and Psychological Well Being o Bodyimage satisfaction is positively related to selfesteem 0 Body image is the most important aspect of selfesteem 0 Poor body image is associated with increased anxiety and depression 0 Poor body image is an antecedent of anxiety and depression 0 Body dissatisfaction may be an indicative of body dysmorphic disorder e g muscle dysmorphia 0 Muscle dysmorphia 7 opposite of anorexia nervosa people think they are not muscular enough so they exercise compulsively to increase muscle mass they use steroids diuretics etc leading to physical and psychological risks Anorexia nervosa 7 people think they are too fat so they do not eat or exercise excessively Bulimia nervosa 7 people feel guilty after eating so they selfinduce vomiting or use laxatives O 0 Body Image and Physical Well Being 0 Body image eating disorders and unhealthy weight control strategies 0 Anorexia and bulimia laxative use excessive exercise 0 Body image and smoking 0 Many people mistakenly think smoking controls weight or decreases weight 0 People adopt smoking because they think it is an easy way to monitor weight 0 Body image concerns and healthpromoting behaviors 0 Not always a negative effect when the person is actually overweight Mechanisms of Body Image Change through Exercise Mediators 0 Improved tness 0 Comprises only 1012 ofbody image increases 0 Weight training has higher impact on body image than cardio 0 Weight training gives faster physical results 0 Cardio is not a visible change 0 Increased awareness of physical capabilities 0 Women who exercise to increase function have better increases in body image than women who exercise for appearance 0 Increase self ef cacy perceived competence 0 Social physique anxiety decreases 0 Healthy body image increases Improved fitness small effect N10712 Increase awareness of physical capabilities Increased se Ifrefficacy In uence of Body Image on Exercise Behavior Enhanced Body Image 0 Exercise motivation e g lose weight and increase muscle tone or being worried about looking overweight or uncoordinated o I exercise because I want to improve my body image 0 I am not going to exercise because I might look uncoordinated 0 Exercise setting and attire preference in relation to social physique anxiety 0 Studies have shown that women with high social physique anxiety will wear baggier clothes hide in the back of classes etc Implications o Promotional materials show a wise range of body shapes ages ethnicities sizes and physical abilities o This is how we sell BEHAVIOR 0 Exercise programs should focus on improving physical function strength and endurance 0 Weight training programs offer faster results 0 Promote exercises conducive to body image changes especially weight training and aerobic activities 0 Enjoyable exercises HRQOL and Exercise 0 QOL Subjective and objective evaluations of the goodness of one s life overall and the goodness of the various life dimensions 0 Subjective and objective measures used to evaluate QOL o Subjective 7 re ect the individual s perceived QOL 0 Objective 7 conducted by expertshealth providers researchers etc o HRQOL a subcomponent of QOL that re ects the goodness of those life dimensions that can be affected by health and by health interventions QOL Dimensions WHO 1993 Physical Health Psychological Health Spirituality General heal h Pain and disconfort Posl Iveaffect S Irnual rell Ion and Sensory functions Energl and Tang pgrsonalnybe 39efg Thinking memory SI iiwyt concentrating eep an res Selfesteem Body inage and appearance Negative affect Quality of Life In dependence EnVIron ment MObility i nysical safety and security ActquotMes of daily living Social Relationships 6 z vsf39g39c gfnm epen nceon medicinal l mancial resources and nonme 39cinal htinacyloy39ng eakh and social care SUbStamEes FSIEthShiPS all information and skills Comnunlcatlon capacity Socialsupport ecreation and leisure Wor capacity Acty ies as actiities HRQOL Dimensions in Most Populations 0 Physical Health 0 Physical functioning physical tness independent functioning physical selfconcept 0 Health status physical health symptoms and states e g disease energy fatigue pain sleep 0 Emotional Health 0 Emotional functioning and well being depression anxiety angerhostility feelings of happiness hope 0 Social functioning ful ll different social roles 0 Cognitive functioning memory attention concentration problem solving decision making Objective Measures of HRQOL 0 Assess individual HRQOL components e g physical function and health status 0 3minute steptest 0 V0 max 0 1 RM 0 12minute run 0 Assess overall HRQOL quality adjusted life years Quality Adjusted Life Years QALY quality of one s remaining years life expectancy level of health Subjective Measures of HRQOL 0 Assessment of individuals perceptions of their level of functioning in one or more HRQOL dimensions or their satisfaction with their functioning in one or more HRQOL dimensions 0 Short Form 36 Item Health Survey SF36 o Eg how much pain one has experienced in the past 4 weeks 0 Perceived m of functioning o Perceived Quality of Life Scale perceived satisfaction with functioning Objective vs Subjective Measures of HRQOL 0 Do HRQOL assessments from healthcare providers and researchers match with the person s perceptions of their HRQOL 0 Not very much 0 Subjective QOL measures better predict certain health outcomes like injury illness fitness than objective measures 0 Just remember that it is good practice to use both HRQOL Changes and Objective Changes in Disease and Physical Fitness 0 Are the positive effects of exercise on HRQOL related to exerciserelated improvements in objective indices of disease status or physical fitness HRQOL Changes and Perceived Changes in Important Aspects of One s Life 0 Are changes in CD4 Tcell counts the only aspect of health a person with HIV cares about 0 Lox et al looked at exercise effects of 12week exercise program on subjective aspects of HRQOL and tcell counts of HIV positive men 0 Perceived emotional and physical functioning was higher even though their cell counts did not change after 0 Subjective improvement in HRQOL but objectively there was no change 0 How meaningful are changes in maximal workload or maximal oxygen consumption to the average older adult with COPD Older adults care about being able to function independently in daily living Older adults do not care about max workload Perceptions matter The best predictors of health are subjective There has been a shift to focus on perceptions that complement the medical model O 0000 Motivation Direction of eff01t seeking out certain situations ie deciding to take tennis or dance 0 lessons 0 Intensity of effort effort one puts forth ie really trying hard in tennis class or dance lessons 0 Relationship between direction and intensity of effort Approaches to Motivation 0 Trait Centered View a function of individual characteristics 0 Motivation is affected by the individual 0 Some people are naturally goaloriented individuals 0 This view has not been endorsed by exercise psychologists o Situation Centered View motivation is determined primarily by situation 0 The environment affects our motivation in exercise 0 Physical and social environment 0 Accessibility social support weather exercise leader competitive vs recreation o This view is not solely endorsed either 0 Interactional View participantbysituation interaction 0 Accepted view is an interaction of the two Interactional View of Motivation Personal FaCIOTS Situational Factors Participantby ers mallty Situation Leadercoach ster Inttesressts Interaction Facility attractiveness Goals Team Winloss record Participant motivation 0 Would the best 4 swimmers necessarily make the best team No it depends on how they view the relay competition 9 fun vs threatening Five Guidelines for Building Motivation Implications of Interactional View of Motivation 0 Guideline 1 Both situations and traits motivate people 0 Guideline 2 People have multiple motives for involvement Points to remember 0 People participate for more than one reason 0 People have competing motives for involvement 0 People have both shared and unique motives individualize program based on unique motives 0 Cultural emphasis affects motives Asian exercisers are more interdependent Americans like independent exercise 0 Guideline 3 Change the environment to enhance motivation 0 Provide both competition and recreation 0 Provide multiple opportunities 0 Adjust to individuals within groups 0 Guideline 4 Leaders in uence motivation o Guideline 5 Use behavior modi cation punishment reprimand and positive and negative reinforcement to change undesirable participant motives 7 showing off dating causing injuries etc Achievement Motivation 0 Achievement Motivation a person s orientation to strive for task success persist in the face of failures and experience pride in accomplishments Gill 2000 0 Self comparison improvement is not competitiveness Attribution Theory affect motivation emotion and future behavior Basic Attribution Categories Locus ofCausality Stability Locus ofControI 4 Stable Unstable Intern a External n one s Out of one s control control Attribution Theory attributes re ect emotional states 0 Attributions of Success e g win a swimming race 0 Talent or good ability 7 internal and stable Good luck 7 unstable Tremendous effort in the last 50 meters 7 internal in control Easy field of competitors 7 external outside control Race plan 7 external outside control 0 Opponent s lack of physical conditioning 7 external outside control 0 Attributions 0f Failureeg drop out from an exercise program 0 Lack of talent 7 stable and intemal o Terrible instructor 0 Bad back 7 internal 0 O O O 0 Exercise facilities being too far from home 0 Lack of effort 0 Cost of the program Attributions and Achievement Motivation Attributions Psychological Result Stabil ity factors Stable Unstable Expectancy of future success Increased expectation of success Decreased expectation of success Causality factors Internal cause External cause Emotional influences Increased pride or shame Decreased pride or shame Control factors In one control Out of one control Emotional influences Increased motivation Decreased motiation Achievement Goal Theory Achievement Goals Perceived Ability High perceived ability or competenc Low perceived ability Taskoriented goals or competence IquotI Achievement Behavior Outcom eori ented goals Performance Effort Persistence Task choice Realistic tasksopponents Unrealistic tasksopponents Outcome and Task Orientations 0 Outcome orientations focus on winning and social comparisons o Taskorientations focus on mastering a goal learning and improving performance Task Orientation 0 High effort 0 Moderately difficult and realistic tasks o Persistence in the face of failure 0 High perceived competence 0 High performance and motivation Outcome Orientation 0 Low perceived competence 0 Reduced effort 0 Unrealistic tasks choices 7 winning all the time or losing all the time choose easy competitors to win or tough competitors to lose 0 Low performance and motivation P A m A andc m 139 a r o Autonomous competence stage the focus is on selfreferenced standards 0 Develops before the age of 4 0 You are focusing on learning improving 0 You are competing against yourself 0 Social comparison stage the focus is on social comparisons 0 We focus on winning comparing ourselves with others 0 This stage develops around age 5 0 Interest in who is bigger stronger smarter 0 Integrated stage integrates components of the previous two stages 0 Individuals know when to be competitive and when to have selfreferenced standards Implications Applications to Increase Achievement Motivation Recognize interactional factors in achievement motivation Emphasize taskoriented goals 7 focus on selfimprovement use videotapes reward systems for effort allow choices for them so you can discuss what they enjoy allow time for improvement Monitor and alter attribution feedbacki you want to attribute success to internal aspects Determine when competitive goals are appropriate Enhance feelings of competence and control Group Cohesion I Key Principle for Group Interventions 0 Coming Together Is a Beginning Staying Together Is Progress and Working Together Is Success Henry Ford The Dyersville Experience CommunityBased Weight Control Program 0 The Beginning 0 Coming together advertisement 4503800 people responded o The Progress 0 Staying together teams 0 They allowed the groups to choose their own names and attire o The Success 0 Working together collective weight loss 7500 pounds I Have to work together to lose weight need to care about the whole team Conceptual Model as a Basis for Group Interventions anuts Throughputs Outputs o Ultimately we want group cohesion because they need a cohesive environment Conceptual Model 0 Inputs 0 Group Environment class distinctiveness selfselected group names slogans apparel 0 Group Structure I Groupnorms common goals appropriate behavior group expectations etc should be set from the beginning I Group positions e g group locations in the gym this individualizes the program a bit 0 Throughputs 0 Group Processes group dynamics I Interactions andcommunications ask them to introduce themselves separate the large group into subgroups etc I Sacri ces eg assist new members with task 0 Outputs 0 Group Cohesion individual attractions to the group task ATG Task I Individual group members are attracted to the group because of the common tasldgoal I High cohesion means exercise adhesion The Transtheoretical Model TTM and PA Transtheoretical Model TTM Has been applied to PA and exercise Developed in psychotherapy One size does not fit all If we want to change behavior from inactivity to activity this takes time and different strategies apply to different people If has been applied to several behaviors like smoking drinking sun exposure diet and exercise Incorporates several theories Based on 300 theories Transtheoretical Model Processes Of Change Balance Stages of Change Termination Maintenanoe Action Preparation Contemplation Preoontemplation The stages are integrations of both traits and states Traits are stable states are more dynamic in nature A person can remain in one stage for a long period of time traits They can progress or regress at any given time states PA behavior and intention are incorporated in each stage The stages are reversible so they are NOT qualitative Use stages to determine what types of programs to prescribe You can implement different strategies to motivate people depending on what stage they are in Stages of Change 0 Precontemplation I won t or I can t o Inactive and do not intend to be active in next 6 months 0 In denial of the problem inactivity o Believers v nonbelievers 0 They may value exercise but they are overwhelmed with barriers they may be uninformed they may be lazy o The nonbelievers are the more difficult in which to stimulate change 0 Action oriented programs such as exercise prescriptions target people who are already motivated to be active or are already active 0 Contemplation I might o Inactive but they intend to be active in the next 6 months 0 The recognize the problem 0 They think about the bene ts and costs of exercise 0 They want to learn more 0 These individuals need commitment 0 Preparation I will 0 Irregularly active but they intend to be active within the next month 0 This is the most unstable state 0 It is easier for these people to move to action 0 Our goal is to progress from a lower to higher stage 0 If we can progress one stage then we are successful 0 Action I am 0 Regularly active for 6 months of less 0 Just started being regularly active 0 They need to be careful to set reasonable goals stay on top of things and not overtraining 0 Maintenance I have 0 Regularly active for more than 6 months 0 These individuals will likely not relapse 0 Termination stage or transformed stage 0 You completely quit inactivity and you are regularly active for a lifetime 5 years or more 0 There are definitely individuals that are active for a lifetime very few though 0 This stage is not applicable to exercise 0 This stage has been replaced by the Transformed Stage Uses of the Model 0 ID strategies that match individual needs 0 We need to develop stagematched programs 0 This is the highest strength of the model Stages of Change Questionnaire 0 Instruction Have you been regularly participating in physical activities of moderate or higher intensity such as brisk walking jogging swimming aerobic dancing biking rowing etc Activities that are primarily sedentary such as bowling and playing golf with a cart would not be considered physical activity 0 Yes I have been for more than 6 months 0 Yes I have been but for less than 6 months 0 Not regularly but I engage in such activities occasionally and plan to start on a regular basis within the next month No but I m thinking of starting in the next 6 months No and I am not thinking of starting in the next 6 months 00 Decisional Balance 0 Perceived pros bene ts and cons costs of PA 0 Exercise makes me stronger v exercise takes time away from my family 0 Perceived pros and cons across the stages of change SOC o Precontemplators and contemplators perceive more cons 0 People in preparation perceive the same number of pros and cons 0 People in action and maintenance perceive more pros Self Ef cacy 0 Level of perceived con dence to overcome PA barriers and be active 0 Relationship between selfefficacy and the SOC o The higher the SOC the higher the efficacy Processes of Change Cogitive Processes Behavioral Processes Gathering information Making substitutions Being moved emotionally Getting social support Being a role model Being rewarded Developing a Making a commitment healthy selfimage Taking advantage of Using cues social mores Learning Activity 1 o A 40year old male with heart failure has been referred to a cardiac rehabilitation program He has been thinking of initiating PA but is uncertain he wants to begin at this time 0 Stage contemplation 0 Goals move the individual to the next stage convince him that the bene ts outweigh the costs 0 Strategies giving him more information about exercise programs ask him about activities he enjoys ask about social support put him in a support group to discuss the pros and cons of exercise try to get him to commit to irregular exercise to get a feel for it have someone who has been through cardiac rehab to speak with him provide information about lifestyle activities and how these can lead to wellbeing Learning Activity 2 0 Susan has spinal cord injury and uses a wheelchair She has joined a PA club and has tried the facility equipment couple of times However Susan is becoming frustrated due to inaccessible equipment and space and she wants to give up exercising 0 Stage preparation 0 Goals to move the individual to the action stage convince her not to give up and find an accessible facility 0 Strategies research accessible gyms in her area local independent living centers social support workout pattern find people in similar situations for empowerment self reward goalsetting to commit to behavior TTM Advantages o Stagematched intervention programs 0 Educationbased programs are not successful because not everyone is in the same situation 0 Educationbased programs target active individuals we need to target inactive ones 0 Stage classification facilitates active recruitment o Proactively we can seek out people in the early stages 0 By knowing current stages we can predict future behavior 0 Prediction of future behavior TTM Limitations Nature of SOC quantitativereversible 0 People can progress and relapse Ambiguous relationship between the SOC and POC The TTM is descriptive in nature 7 we know HOW change takes place but not WHY The in uences of moderators eg gender age ethnicity are not included in the model 0 3rd variable that will change the relationship between independent and outcome variables Individual Level PA Intervention Programs Intervention Effectiveness by Type of Intervention DishmanampBuckworth 1996 Intervention Type Effect Size Behavior modification 92 Cognitive behavior 10 Health educationrisk 10 appraisal Exercise prescription 21 PE curriculum 21 Combination 11 0 Behavior modi cation was the most effective technique to motivate people 092 0 Exercise prescription was only 021 ES which is low Type of Intervention Behavior Modi cation Operant Conditioning Cues from the environment affect behaviors stimulus control which in turn have consequences 0 If the response is positive the behavior will likely occur again 0 If the response is negative the behavior will no likely occur again 0 Cues are motivational strategies we use to change behavior All other models are based on this one Cue Stimulus Control Response from enVIronment behaVlOFal Consequences response Type of Intervention 0 Cognitive behavior modi cation selfmonitoring selfreinforcement 0 Health educationrisk appraisal test results showing health risk factors 0 Exercise prescription moderateintensity 0 Physical education curriculum schoolbased programs 0 Combinations two or more distinct interventions Intervention Effectiveness by Intervention Delivery and Setting DishmanampBuckw0rth 1996 Mediated interventions are more effective than facetoface interventions 0 Info is provided through a medium printbased via mail or intemet or phone rather than a healthcare provider 0 Community is more effective than others Intervention Effectiveness by Social Context and Supervision Level DishmanampBuckw0rth 1996 Social Context Effect Size Group 75 Individual 16 Family 05 Level of Supervision Supervised 23 Notsupervised 78 0 People need to feel like they have control and choices Working in a group is more effective People do not like being watched so not supervised is more effective DoseResponse Issue DishmanampBuckw0rth 1996 Benefits of interventions are unrelated to the duration and frequency of their delivery Interventions targeting leisuretime PA vs those focusing on strength activities and aerobic exercises o The things we do at leisure in our daily routine are more motivating o Interventions focusing on lowintensity exercise vs those focusing on vigorous exercise 0 People would rather do low intensity than high intensity Interventions Based on Theoretical Models 0 Theorybased interventions produce modest effects but they are more effective than non theoretical interventions o Theorybased interventions are modeled on the theories we have discussed in class already such as TTM Theory of Planned Behavior Selfdetermination Theory SE Theory etc These programs 0 About 30 of the variance in exercise behavior change is explained by those models 0 The effect size is modest 0 However these are more effective than interventions like exercise prescription NOT based in any theory 0 There is no consistency in PA increases for the less motivated or unmotivated people 0 Interventions are more effective among people who are motivated to be in the program 0 How can we target unmotivated people 0 Make sure the advertisement captures the population of interest unmotivated people 0 We can reward them for attending 0 Interventions Based on Theoretical Models cont 0 Why don t theorybased interventions exhibit a high positive impact 0 These interventions are based on behavior modification models 0 Why then 0 Reasons 0 The mediating variables e g SelfEfficacy Subjective norms Perceived Behavioral Control do not change 0 The mediating variables do not contribute substantially to PA behavior change I Mediating variables are the constructs of the model you are going to use I TTM 7 process of change self efficacy decisional balance etc Interventions Based on Theoretical Models cont Need to examine the effects of the interventions on both the mediating variables and PA Intervention 9 Mediator 9 PA 0 We must rst change the moderators before PA can change Effective Intervention an effective program is one that changes both the mediator and PA change Ineffective Intervention two types o If the ineffective intervention changes the mediator but not PA then question the theory the theoretical framework 0 Ifthe ineffective intervention does not change the mediator then question the interventionprogramdesign Physical Activity Interventions Intervention Strategies 0 Informational Approach educate through media or community 0 Screen savers 0 Posters in hallways o Popup messages with reminders and cues about exercise Behavioral Approach sign a contract 0 Devise schemes to overcome barriers 0 Being active during lunch hours after work etc 0 Give rewards for being active Social Approach nd coworkers with same likes and dislikes and get them active together 0 Have them work together and support each other Environmental amp Policy Approach set up route from work place to nearest park 0 The worksite director should give them an extra 15 minutes to exercise at lunch INFORMATIONAL APPROACHES Intervention Physical Activity Informational Approaches IA ApproaChes Determmants Knowledge about PA 0 Information about the PA bene ts bene is 0 Awareness of PA opportunities quotm mwa d PA 0 Overcome PA barriers ehavioralmanage Behavioral menl skllls eg self 0 Overcome negatlve att1tudes approaches monitoring and go Physical Ac iviiy upponive PA social Behawor Social 0 Two types massmedia and Environmemaland APhysicaIenvironmems communitywide Policy approaches l supp PA Policies to support PA IA 7 Mass Media Campaigns o Broadcast media printbased materials audiovisual materials and the World Wide Web different from facetoface consultation and contact 0 Effectiveness 0 Mass media interventions alone are not effective for increasing PA 0 Why Change in behavior is very challenging education is not enough it does not capture people s needs people can read for days but application is not as easy to understand 0 Drawbacks o Considerably expensive and issues with reaching their target audience IA 7 CommunityWide Campaigns note we need to get involved with community leaders who have access to physicians teachers healthcare providers directors of retirement centers etc o Health risk appraisals e g communitybased screening for diseases 0 The idea is that if people nd out they are at risk for a disease then they will get motivated to be active 0 This is external motivation Fitness appraisals e g personalized information about tness levels Physiciancounseling 0 Community health and wellness fairs at worksites shopping centers universities and local sporting events CommunityWide Campaigns Effectiveness and Drawbacks 0 Effective for increasing the of people who are active expend energy and amount of time people spend being active 0 Drawbacks o Careful planning and coordination are needed welltrained staff and sufficient resources are needed to be effective this becomes expensive 0 In uential community members need to buy into the intervention and support it Developing Effective Informational Interventions 0 Messages should emphasize specific positive consequences of exercise that are meaningful to the members of the target population 0 You cannot target everyone you must have an audience in mind 0 Instead of giving general messages target the group s needs at that particular point in time 0 Messages should describe how to minimize the negative personal consequences of exercise 0 Example target group new mothers I Day cares at health clubs I Give examples of others who have done what they have done I Go for walks or jogs with your baby in a stroller I Take advantage of a babysitter even if just for 20 minutes I Give them techniques to overcome the time issue 0 Messages should create social pressure to exercise 0 Messages should enhance perceived behavioral control PBC 0 Moderate exercise is ne 0 Let them chose the activity and intensity BEHAVIORAL APPROACHES 0 Based on operant conditioning theory behavior modi cation 0 People need to learn skills ie how to manage relapses how to set goals nd ways to overcome barriers Behavioral skills to initiate and maintain an active lifestyle recognize cues and opportunities to be active manage situations that can sabotage activity plans develop strategies to prevent relapse to a sedentary lifestyle Most effective intervention strategy Exercise contract commitment to a certain amount of exercise and promise of a positive reinforcer o It is not bad to have a contract with yourself or others about exercise 0 Include reinforcers 7 if I meet my goals I can go on a trip buy myself a gift etc o This is an excellent motivator 0 Goal setting speci c measurable realistic and challenging goals Use a plan of action e g goalsetting worksheet 0 Goals must be set early in stages of exercise adoption 0 Have a goal sheet that is speci c and measurable Goal set date 1207 Target date 6107 Goal de ned To improve my CVE V02 max by 10 and lose weight 10 lbs Strategies to achieve goals a walk 1 ml through my neighborhood after dinner and b ride the stationary bike three times per week 30 minutes 70 heart rate Daily progress notes l407 7 walked after dinner no bike today weighed myself at 700 am 7 no change from two days ago 1607 7 walked after dinner yesterday and today biked during lunch hour but only made it 20 minutes heart rate around 80 max lost a pound Setupdate goal Use data to evaluate prog39ess toward goal andto update goal as needed Goal Setting Deelop strategies plan of action for achieving goals Process Accumulate data related to goal 39om daily progress rides tes ing o Self monitoring monitor PA intensity and daily PA behavior eg activity log 0 We can monitor PA intensity by tracking heart rate 0 We can track PA behavior by keeping a 7day activity log Date Mode Distance Time HR 39 1620 156 1547 o Relapseprevention 0 We are not talking about what you do after you relapse we want to keep it from happening 0 This is in line with preventative medicine Relapse 0 Failure to resume regular exercise following a lapse in activity 0 Relapses are inevitable 0 During a month you may set goals for yourself Relapse prevention Model 0 High risk situations that may lead to a lapse or relapse o Overtime at work 0 Vacations o Injury sickness etc o How do we respond to these t risk situations 0 Coping response is the key 0 Ifwe respond in a negative way we may end up increasing the probability for relapse I Negative coping responses could lead to o Decreased selfefficacy 0 Positive thinking about not exercising I Thus you have an initial lapse I Abstinence violation effect 7 you have violated your intention to be regularly active you feel helpless you feel like you could no return you have a negative emotions response you blame yourself you increase the probability for relapse I You viewed the lapse as a catastrophe o If you cope in a positive way you increase self ef cacy for exercising thus decreasing relapse probability High Risk Situation l Negative copin g response Decreased self ef cacy for exercising Posi ive outcome expectancies for effects of not exercising Positive coping Increased self ef cacy for exercising ni ia exercise lapse Abstinenceviolation effect Negative emotional response and self atlribution Decreased probability for relapse ncreased probability r relapse Strategies to Prevent Relapse 0 Identify highrisk thoughts feelings and situations that might prompt a relapse and devise strategies to prevent relapse e g vacationers can plan to stay in hotels that have a pool or fitness center 0 We do not however want exercise dependence 0 Plan for lapses before they emerge cope with lapses e g have an exercise buddy system 0 When there is a lapse you need support someone else to be there for you 0 Minimize the abstinence violation effect by using cognitive restructuring deal with lapses 0 Cognitive restructuring 7 do not view a lapse as a catastrophe do not obsess over it deal with it Behavioral Approaches Effectiveness and Drawbacks 0 Effectiveness 0 Most effective way to increase PA nearly 5 times more effective than any other intervention 0 35 increase in the amount of time spent on PA 0 65 increase in energy expenditure 0 Drawbacks o Welltrained counselors are needed 0 Limited of activity counselors compared to the huge numbers of inactive people SOCIAL APPROACHES 0 Establish exercise groups and buddy systems 0 Teach people to ask for support 0 Women are more likely to seek help than men Develop telephone support systems e g exercise interventioni 0 Can people to monitor progress 0 It is the frequency of phone calls that increases motivation o If you find out that a few people start lapsing do not ignore the behavior 0 Use group support systems discuss fears barriers and strengths 0 People take turns to discuss what is going on Social Approaches Effectiveness and Drawbacks 0 Effectiveness 0 Multiple intervention approach 7 conclusions cannot be made about the effectiveness of social interventions I We cannot determine of social approaches are effective alone because they are always used in conjunction with other approaches 0 Social support interventions in community groups e g members of a church and worksites are more effective than familybased interventions I We take family support for granted because we feel like they support us regardless External groups are the ones we care about more We value external opinions more then family opinions because we feel they are more objective 0 Drawbacks 0 Their success is contingent on the cooperation of group members 0 If the group does not get along then there will be problems ENVIRONMENTAL APPROACHES 0 Change the physical and organizational structure of the environment 0 Intervention Examples 0 Create transportation policies and change the infrastructure to promote non motorized transit walking trails bike lanes etc Focus on urban planning to create neighborhoods that induce exercise it would be great if we could bike to the store or to work Modify policies and curricula for schoolbased physical education PE Create and enhance access to facilities for PA 0 00 Environmental and Policy Approaches o Modifying policy and curriculum for schoolbased physical education PE 0 Increase the weekly of PE classes and lengthen the duration of existing classes Starting new PE classes that appeal to students who are currently opting not to take PE I PE is usually in a gym where kids play organized sports or play games or do nothing I Provide more fitness activities I Provide more recreational activities Change the activities performed during PE classes to increase the amount of moderate or vigorous activities Educate PE teachers on how to design classes that decrease instruction time and student standing around time I Instead of dividing the group into two huge teams for one soccer game play multiple soccer games by dividing the group into smaller teams 0 O O RE AIM Framework 0 Purpose I Acronym for reach efficacy adoption implementation maintenance I Goal evaluate public health impact of intervention programs ReAim Framework Glasgow et al 1999 0 Determine the public health impact of health promotion interventions e g translation of research into practice 0 Can we take a clinicalbased program and apply it to a reallife o This is what the REAIM framework wants to accomplish REAIM Framework Dimensions Dimension Level of Analysis Description Reach Individual Proportion of target population who Efficacy Individual Is the program effective Adoption Organizational Do we see community settings adopting the program Implementation Organizational Was the program administered as it was intended Maintenance IndividualOrganizational Did the people and organizations maintain the pro gram Reach 0 Percentage of individuals from a targeted population who actually participate in an intervention program 0 The ratio between the number of those who participated compared to the number of individuals in the communityc o Ifthe community has 10000 older adults and we get 100 people the reach is 1 0 Use census information to determine reach Delivery systems and reach levels eg mediated interventions vs oneon one counseling 0 Mediated interventions 7 printbased interventions phonebased interventions webbased interventions I Reach more people I Good for high reach 0 Oneonone counseling I Low reach Ef cacy o Determined by the effect size magnitude of behavior change associated with a given intervention 0 Does exercise increase after the program is implemented 0 Does participation between baseline and posttest increase after program implementation 0 What is more important efficacy or reach 0 Efficacy o If the program is not effective it does not matter how many people you reach 0 Efficacious programs behavioral approaches and theorybased programs 0 These models can be applicable to ID exercise promotion strategies Adoption 0 Proportion of settings that begin to use the intervention 0 The assessment of Reach at the organizational level 0 Ifis very difficult to assess adoption 0 If your intervention can be applicable to community setting like fitness centers how many have incorporated your intervention in their system I 1 month free membership Adoption 0 Mechanisms to Increase Adoption 0 Consult and inform individuals from all major community groups and institutions 0 Integrate intervention activities with existing community activities I You cannot incorporate skiing in LA I Must be closely related to culture of community 0 Involve new people and organizations in the project 0 Summarize and disseminate the intervention results to participants community leaders and organizations I Give a project report of the findings I You need to give back to the community I Give them feedback and ways to increase PA I Have the community centers implement your program I Translation of research to practice Implementation 0 The re ection of the fidelity of practitioners or researchers to the intended intervention protocol 0 Was the intervention delivered as intended 0 Did the staff apply the program as it was supposed to be 0 Did they follow the protocol or did they change it 0 Research staff implements interventions more successfully than hospital or community staff 0 There are more people in a hospital setting 0 Hospital staff do not get extra compensation for their efforts 0 Research staff are more trained for those programs In our careers we will be both because we know about research and we know how to devise programs but we will also be practitioners working in the community We have the opportunity to translate our research in to practice 0 0 Implementation as a Moderator between Intervention Program and its Efficacy 0 Moderator Variable a variable that alters the strengthor direction of the relation between a predictor eg intervention and an outcome variable program efficacy ie PA behavior change Program implementation moderates the relationship between the program and its effectiveness 0 Program efficacy 7 did the behavior change 0 The program that was implemented as intended will be more effective than a program administered incorrectly Effectiveness of a program depends on the way the program was implemented and the program itself 0 Maintenance 0 The longterm participation in behavior change eg PA 0 Do people follow the program for long periods of time o Followup assessment at the individual and organizational level 0 Do not stop in implementation 0 What happens after they leave our controlled setting Efficacy vs Translation Studies using the REAIM Framework RE AIM Ef cacy Study Translation Study Dimensions Issue Randomized Control Trial Practical Clinical Trial Reach Low homogeneous highly High broad heterogeneous motivated sample representativedefined sample Ef cacy or High Intensive very standardized Low Feasible brief adaptable interventions randomized or quasi effectiveness randomized designs experimental designs Adoption Low One setting to reduce High Workstested in a variety of variability settings Implementation High by highly trained research Lower different staff using adapted staff protocol Maintenance amp Cost Low High relapse rates 50 and costs focus on individual level High Focus on both individual and setting maintenance o Efficac o O 0 000 y Study Highly controlled setting Efficacy studies focus on efficacy internal validity 7 if PA behavior increases based on the program and implementation We need to first make sure it works in a highly controlled setting efficacy study before we can see if it works in real life translational study 0 Translation Study Translational studies focus on m adoption and maintenance Not as highly controlled less efficacy Lower implementation 7 diverse population so it has to be adjusted to different needs


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