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Title: Chapter%2013:%20CONCLUSIONS%20AND%20FUTURE%20DEVELOPMENTS


1
Chapter 13CONCLUSIONS AND FUTURE DEVELOPMENTS
  • Bringing it all together

2
Determinants of physical activity Descriptive
approaches 1
  • Concerning largely descriptive approaches to the
    study of determinants, we conclude
  • a minority of people in industrialised countries
    are sufficiently physically active to have a
    beneficial effect on their health
  • a greater understanding of the determinants
    (correlates) of involvement in exercise and
    physical activity is therefore needed
  • descriptive research on participation motives has
    tended to reflect motives for children's
    involvement in sport and adult's involvement in
    exercise and recreational physical activity

3
Determinants of physical activity Descriptive
approaches 2
  • for children and youth common motives are fun,
    skill development, affiliation, fitness, success
    and challenge
  • for adults, motives change across stages of the
    lifecycle
  • younger adults are motivated by challenge, skill
    development and fitness
  • older adults are interested in participation for
    reasons of health, relaxation and enjoyment

4
Determinants of physical activity Descriptive
approaches 3
  • key barriers are lack of time and, for young
    people, issues of safety and feelings of
    incompetence
  • correlates of sedentary behaviour in the form of
    TV viewing can be identified, but they are
    largely non-modifiable

5
Determinants of physical activity Comments on
descriptive approaches
  • Descriptive studies of determinants (correlates)
    are valuable but must lead to better informed
    interventions or policy
  • Widening the approach to include different
    research methods and behaviours (e.g., sedentary
    behaviours) is required.

6
Determinants of physical activity Theoretical
approaches 1
  • the Theory of Reasoned Action (TRA) has
    consistently predicted exercise intentions and
    behaviour across diverse settings and samples
  • attitude accounts for about 30-40 of the
    variance in intentions
  • social norm is only weakly associated with
    intentions
  • the Theory of Planned Behaviour (TPB) appears to
    add to the predictive utility of the TRA in
    physical activity
  • perceived behavioural control has been shown to
    account for 36 of the variance in intentions

7
Determinants of physical activity Theoretical
approaches 2
  • both TRA and TPB models are limited by their
    focus on conscious decision-making through
    cognitive processes
  • they are essentially static and uni-dimensional
    approaches
  • the prediction of physical activity from
    intentions may depend on the proximity of
    measurement of these two variables
  • the TRA and TPB have, however, been the most
    successful approaches in exercise psychology
    linking attitudes and related variables to
    intentions and participation
  • intentions share about 30 of the variance in
    physical activity assessment

8
Determinants of physical activity Theoretical
approaches 3
  • The Health Belief Model (HBM) has been shown to
    be a reasonably effective integrating social
    psychological framework for understanding health
    decision-making
  • But the HBM in physical activity settings has not
    been supported
  • The Health Action Process Approach allows for a
    distinction between a motivation phase and a
    volition/post-decision phase of health behaviour
    change
  • It is a hybrid model combining aspects of
    intention-behaviour links (continuous) and
    stage-based models

9
Determinants of physical activity Theoretical
approaches 4
  • Translating intentions into behaviour is a key
    challenge
  • Implementation intentions are self regulatory
    strategies that involve the formation of specific
    plans that specify when, how, and where
    performance of behaviour will take place
  • They are likely to be effective in promoting
    physical activity behaviour

10
Determinants of physical activity Theoretical
approaches 5
  • Self-Determination Theory is an important
    perspective for the study of motivation in
    physical activity and is likely to increase our
    understanding of motivation in the future, in
    particular the different types of extrinsic
    motivation that might exist in physical activity
  • Current research findings are not supportive of
    locus of control being a strong determinant of
    physical activity and exercise

11
Determinants of physical activity Theoretical
approaches 6
  • Participation in physical activity is clearly
    associated with perceptions of competence
  • More specific perceptions of competence/efficacy
    are likely to be better predictors of specific
    behaviours than generalised beliefs in competence
  • Goal perspectives theory proposes that people can
    define competence and success in different ways,
    the main ones being ego and task orientations
  • Research is consistent in showing the
    motivational benefits of a task orientation,
    either singly or in combination with an ego
    orientation

12
Determinants of physical activity Theoretical
approaches 7
  • research using self-efficacy with patient groups
    demonstrates that exercise self-efficacy can be
    developed
  • self-efficacy judgements can generalise but will
    be strongest for activities similar to the
    activity experienced
  • self-efficacy in 'dissimilar' activities can be
    enhanced through counselling
  • self-efficacy better predicts changes in exercise
    behaviour than generalised expectancies

13
Determinants of physical activity Theoretical
approaches 8
  • research with non-patient groups has shown that
  • exercise self-efficacy can be increased through
    intervention
  • will predict participation, particularly in the
    early stages of an exercise programme
  • will decline after a period of inactivity
  • is associated with positive exercise emotion

14
Determinants of physical activity Theoretical
approaches 9
  • The Transtheoretical Model (TTM) of behaviour
    change provides an important advance on static
    linear models of exercise and physical activity
    determinants
  • It hypothesises both the how and when of
    behaviour change
  • Meta-analytic evidence broadly supports the
    model, although the classification of processes
    of change into two higher-order categories is
    questioned
  • the hybrid HAPA model allows for the distinction
    between non-intentional, intentional, and action
    stages of behaviour

15
Determinants of physical activity Comments on
theoretical approaches
  • Psychological theories and models are too
    numerous to provide definitive guidelines for
    behaviour change
  • Approaches that articulate the important role of
    intentions, perceptions of competence, and
    beliefs concerning autonomy and control provide
    important messages for individual and population
    change
  • Stage-based and hybrid models provide
    parsimonious frameworks to apply theoretical
    principles

16
Determinants of physical activity Social
environmental approaches 1
  • sibling physical activity, parental support, and
    fathers physical activity are associated with
    physical activity in adolescents
  • social support from spouse and family are
    associated with physical activity in adults

17
Determinants of physical activity Social
environmental approaches 2
  • the development of a mastery motivational climate
    in exercise classes and groups appears to be
    desirable for motivation
  • research on group cohesion has shown that
    exercise group dropouts have lower perceptions of
    cohesion than those who stay
  • there is a positive relationship between exercise
    behaviour and some social influence variables,
    such as family support

18
Determinants of physical activity Social
environmental approaches 3
  • significant associations with physical activity
    have been found for ease of access to facilities,
    having places near by to be active, and perceived
    positive aesthetics of the local area
  • urban design and land-use policies can be
    associated with greater levels of physical
    activity
  • four key environmental features that should be
    taken into account in physical activity research
    include functional, safety, aesthetic and
    destination considerations

19
Determinants of physical activity Comments on
social environmental approaches
  • Identifying social and environmental determinants
    is complex
  • Why?
  • Because social and environmental influences are
    complex!
  • It is early days in identifying such factors, but
    evidence does exist that can provide useful
    guidance for behaviour change

20
Psychological outcomes of physical activity
Promoting good mental health 1
  • physical activity participation is consistently
    associated with positive mood and affect
  • quantified trends show that aerobic exercise has
    small-to-moderate positive effects on vigour, and
    small-to-moderate negative effects for fatigue
    and confusion
  • experimental trials support the effect of
    moderate exercise on psychological well-being

21
Psychological outcomes of physical activity
Promoting good mental health 2
  • exercise is related to positive changes in
    self-esteem and related physical self-perceptions
  • exercise can have a positive effect on sleep and
    positive benefits for womens experiences of
    menstruation, pregnancy and menopause
  • meta-analytic findings suggest that exercise is
    associated with a significant small-to-moderate
    reduction in non-clinical anxiety
  • experimental studies support an anxiety-reducing
    effect for non-clinical anxiety
  • physiological reactivity to stress is reduced for
    those high in aerobic fitness

22
Psychological outcomes of physical activity
Promoting good mental health 3
  • meta-analytic findings suggest that exercise is
    associated with a significant moderate reduction
    in non-clinical depression
  • large-scale epidemiological surveys support the
    claim that a physically active lifestyle is
    associated with lower levels of non-clinical
    depression
  • meta-analytic findings show a large effect size
    from studies that have used exercise as a
    treatment for clinically defined depression

23
Psychological outcomes of physical activity
Promoting good mental health 4
  • evidence suggests that there is a causal
    connection between physical activity and lower
    depression
  • There is no clear consensus about the mechanisms
    that could explain the psychological benefits
    experienced from physical activity

24
Psychological outcomes of physical activity
Clinical populations 1
  • patients in almost all categories of disease and
    disability could benefit from exercise
  • good short-term adherence (4-12 weeks) can be
    achieved from supervised programmes of exercise
  • for some populations, such as those in drug
    rehabilitation or those with HIV status, even
    short-term adherence may need special support
    systems
  • long term adherence (12 months - 4 years) is poor
    and not well documented

25
Psychological outcomes of physical activity
Clinical populations 2
  • very little is known about the level of exercise
    in clinical populations
  • barriers to exercise are similar to non-clinical
    populations but also include issues to do with
    the particular disease state (e.g., fear of
    another MI)
  • cognitive behavioural strategies can be effective
    and the use of a counselling approach should be
    encouraged in all clinical settings

26
Psychological outcomes of physical activity
Clinical populations 3
  • psychological outcomes are often mentioned
    anecdotally but are rarely measured in exercise
    programmes or interventions for clinical
    populations
  • there is a need for raising awareness in some
    medical teams concerning the role of exercise,
    the potential psychological benefits and the need
    to assist patients with adherence to exercise
  • Exercise dependence is a potentially harmful
    outcome from exercise but prevalence rates are
    not known
  • Exercise dependence secondary to eating disorders
    or muscle dysmorphia may be more common than
    primary exercise dependence

27
Psychological outcomes of physical activity
Comments on clinical populations
  • The topic of psychological well-being and
    physical activity is not new
  • We are still struggling to convince some health
    professionals and researchers of the benefits
  • The may be the result of weak designs and
    measurement
  • If all of the evidence is assembled, it is clear
    that physical activity has a major role to play
    in psychological well-being and general mental
    health
  • More innovative and creative research questions
    and designs are still required, as is the need to
    study diverse groups, populations and conditions

28
Interventions to enable physical activity
behaviour change 1
  • it is possible to increase the physical activity
    levels of sedentary individuals
  • short-term (3 12 weeks) increases are
    relatively easy to achieve
  • long-term change (6 24 months) is hard to
    achieve
  • more specific relapse prevention strategies for
    exercise and physical activity must be explored
  • there is a need to explore new media for
    delivering the messages

29
Interventions to enable physical activity
behaviour change 2
  • The effect of physical activity counselling needs
    to be tested over the long term
  • More work is required in primary care settings to
    establish how the primary care team can influence
    physical activity
  • Research must focus on the hard to reach

30
Interventions to enable physical activity
behaviour change 3
  • schools are well placed to promote healthy
    lifestyles, including physical activity
  • physical education has the potential to reach
    large numbers of children
  • interventions to increase physical activity in
    schools have met with mixed success or have not
    been properly evaluated

31
Interventions to enable physical activity
behaviour change 4
  • physical activity interventions are effective in
    the workplace for absenteeism, productivity and
    reduced health care costs
  • effectiveness in increasing physical activity has
    not been demonstrated
  • the greatest potential public health impact of
    physical activity promotion is likely to come
    through community interventions

32
Interventions to enable physical activity
behaviour change 5
  • approaches to attitude change and persuasion hold
    considerable promise for community interventions
  • principles of social marketing require further
    application to physical activity
  • note should be taken of the importance of market
    segmentation and targeted groups

33
Interventions to enable physical activity
behaviour change 6
  • governments of developed countries have only
    recently been involved in legislative initiatives
    in physical activity
  • this interest has helped to legitimise physical
    activity as an important health behaviour
  • effective physical activity promotion requires
    co-ordination across all levels of interventions
    as described by the ecological model and endorsed
    by the WHO global strategy

34
Interventions to enable physical activity
behaviour change Comments
  • Interventions to change physical activity are
    still in their infancy
  • Successful interventions have been hard to
    identify, probably due to the wider social,
    physical and political environment that often
    reinforces or encourages sedentary living

35
Developing the field of exercise psychology
36
Developing the field of exercise psychology
  • Moving from the theory of the problem to the
    theory of action
  • Moving from behaviour change theories to a wider
    socio-ecological approach
  • Filling the gaps in current knowledge
  • Training and supervision
  • Is exercise the correct title?

37
Moving from the theory of the problem to the
theory of action
  • Bartholomew et al. (2001) posed the question of
    whether efforts should be focussed on creating
    theories of the problem or theories of action
  • Theories of the problem are concerned with the
    formulation of appropriate determinants
  • Theories of action point to methods of behaviour
    change that fit with the determinants

38
Moving from behaviour change theories to a wider
socio-ecological approach
  • We have focussed mostly on individual behaviour
    change theories
  • The field of exercise psychology is only now
    beginning to focus on the wider socio-ecological
    approach
  • May be better to seek greater understanding of
    the interaction between individuals and the
    environments they live and work in

39
Filling the gaps in current knowledge
  • There is a lack of evidence for promoting
    physical activity to black and ethnic minority
    groups
  • We may have been guilty of researching the easy
    to reach
  • Need to focus on the hard to reach
  • Need to learn about the different needs of
    different segments of the population, such as
    children, older adults, black and ethnic
    minorities and clinical populations
  • Evidence of long term behaviour change is missing

40
Training and supervision
  • Training and supervision of sport psychologists
    has been discussed and supported
  • Are we providing the same level of training in
    exercise psychology as we do in sport psychology?
  • Almost all accreditation processes that exist
    around the world focus on assuring quality in the
    delivery of support for sport performers
  • Developing the training and supervisory needs for
    exercise psychology is another challenge

41
Is exercise the correct title?
  • The field is still generally known as exercise
    psychology
  • Would physical activity psychology show the wider
    concern for all types of activity?
  • Would this change align us more with health
    psychology than sport psychology and would this
    be a good or bad thing?
  • The title of the field is another challenge for
    the future of exercise psychology

42
Hill, A. B. (1965). The environment and disease
Association or causation? Proceedings of the
Royal Society of Medicine, 58, 295-300.
All scientific work is incomplete-whether it be
observational or experimental. All scientific
work is liable to be upset or modified by
advancing knowledge. That does not confer upon us
a freedom to ignore the knowledge we already
have, or postpone the action that it appears to
demand at a given time. (page 12).
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