Week 1 Topic 2 Methods for Changing Exercise Behaviors

1. Week 1 Topic 2Methods for Changing Exercise Behaviors Prof. Warren Payne HM734 Prof. Warren Payne

2. Exercise Compliance • Dropout rates: 9-87% - generally highest in first 3 months (approx. 50% in 1 year) • Similar to other health related behavior change • Why the high dropout rate: exercise is voluntary, time consuming, results are not immediate, can be costly, can involve some discomfort. HM734 Prof. Warren Payne

3. Exercise Compliance • Two approaches: • Assistance with reinvolvement • Identification of dropout prone individuals: • Psycho-social problems (perception, convenience): leads to half of drop outs HM734 Prof. Warren Payne

4. Exercise Compliance • Dropout Prone Individuals: Personal Factors • Cigarette smoking • Blue collar employment • Inactive leisure • Inactive occupation • Type A personality • Increase physical strength • Extroverted HM734 Prof. Warren Payne

5. Exercise Compliance • Dropout Prone Individuals: Personal Factors • Poor credit rating • Overweight • Poor self-motivation • Depressed • Hypochondriacal • Anxious • Introverted • Low ego strength HM734 Prof. Warren Payne

6. Exercise Compliance • Program Factors • Inconvenient time or location • Excessive cost • High intensity exercise • Lack of exercise variety • Exercising alone • Lack of positive feedback • Inflexible exercise goals • Low enjoyment ratings • Poor exercise leadership HM734 Prof. Warren Payne

7. Exercise Compliance • Other factors • Lack of spouse support • Inclement weather • Excessive job travel • Injury • Job Change and/or move HM734 Prof. Warren Payne

8. Adult Learning Principles • Learning Influenced by: • Individual • Social • Environmental • Medical • Cultural factors HM734 Prof. Warren Payne

9. Principles of Adult Learning • Self direction • Participation in decision making • Base learning on past experience • Use problem solving • Learn only when ready (physically and emotionally stable) HM734 Prof. Warren Payne

10. Psychological Components of Behavior Change • Behavior Modification Theory • Social Cognitive Theory • Readiness for Change Theory HM734 Prof. Warren Payne

11. Behavior Modification Theory • Patient actively involved in the process • Setting realistic short term goals • Determining their confidence to achieve each goal • Receiving feedback on success and revise plan • Receiving lifestyle/physical activity counseling (prompts to increase adoption and maintenance) • Develop social support systems HM734 Prof. Warren Payne

12. Social Cognitive Theory • Interrelationship between: beliefs,understanding, environment and behavior • Behavior is driven by beliefs HM734 Prof. Warren Payne

13. Social Cognitive Theory • Perceived ability to successfully change • Self efficacy • Can assess by asking clients to rate their confidence to change (0 –100%) • If below 70% have low chance of success • Low self efficacy: need to increase education and overcome barriers. HM734 Prof. Warren Payne

14. Readiness for Change Theory • Precontemplation • Patients express lack of interest in making change. Moving patients through this stage involves utilization of multiple resources to stress the importance of the desired change. This can be achieved through written materials, education classes, doctor and family persuasion, and other means HM734 Prof. Warren Payne

15. Readiness for Change Theory • Contemplation: • Patients are ‘thinking’ about making a desired change. This stage can be influenced by helping patients define the risks and benefits of making or not making the desired change (eg. Starting and exercise program). HM734 Prof. Warren Payne

16. Readiness for Change Theory • Preparation: • Patients are doing some physical activity but not meeting the recommended criteria ie. 30 min of moderate intensity physical activity for 5 or more days, or 3-5 days/week of vigorous intensity activity for 20 minutes. HM734 Prof. Warren Payne

17. Readiness for Change Theory • Action: • Patients are meeting the above-referenced (preparation) criteria on a consistent basis but they have not maintained the behavior for 6 months. HM734 Prof. Warren Payne

18. Readiness for Change Theory • Maintenance: • Patients have been in action for 6 months or more. HM734 Prof. Warren Payne

19. Strategies to Improve Behavior Change Outcomes • Integrating strategies from various theories • Avoid considering our own behaviors as the gold standards • Not necessary to use all strategies HM734 Prof. Warren Payne

20. Practical Recommendations to Enhance Exercise • Testing and Prescription are often over emphasized in relation to behavioral components. • Specifics: • Recruit doctor to support exercise program • Minimize injuries with moderate exercise prescription • Advocate exercising with others • Emphasize variety • Positive reinforcement through periodic testing • Recruit support amongst family members HM734 Prof. Warren Payne

21. Practical Recommendations to Enhance Exercise • Specifics: • Include recreational games • Establish regularity of workouts • Use progress charts to record achievements • Recognition through a system of rewards • Qualified, enthusiastic professionals HM734 Prof. Warren Payne

22. Program Models • Group v’s Individual (Home) Based Programs: • Group Program Benefits: • Safety where complicated pathology is involved • Social reinforcement • Facilitate education • Group Program Negatives: • Travel • Shyness/Lack of Confidence HM734 Prof. Warren Payne

23. Practical Recommendations to Enhance Exercise • Group v’s Individual (Home) Based Programs: • Home Program Benefits: • Reduced cost • Convenience • Independence • Has been shown to effectively increase functional capacity and decrease CVD risk factors HM734 Prof. Warren Payne

24. Practical Recommendations to Enhance Exercise • Group v’s Individual (Home) Based Programs: • Home Program Negatives: • Reduced effectiveness of education • Reduced peer support • Problems can be overcome by telephone contact, videos and internet. HM734 Prof. Warren Payne