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Ken Fox PhD FFPH Emeritus Professor, Centre for Exercise, Nutrition and Health Sciences

AASP 2012 Exercise psychology keynote address Taking exercise psychology into public health research and practice. Ken Fox PhD FFPH Emeritus Professor, Centre for Exercise, Nutrition and Health Sciences University of Bristol.

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Ken Fox PhD FFPH Emeritus Professor, Centre for Exercise, Nutrition and Health Sciences

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  1. AASP 2012Exercise psychology keynote address Taking exercise psychology into public health research and practice Ken Fox PhD FFPH Emeritus Professor, Centre for Exercise, Nutrition and Health Sciences University of Bristol

  2. Post Graduate Centre for Exercise, Nutrition and Health Sciences, University of Bristol 1999-present MSc in Nutrition, Physical Activity and Public Health Research into biomedical, psycho-social,and socio-environmental aspects of activity and nutrition

  3. The mediating role of the self Self Well-being Exercise The development and preliminary validation of the Physical Self-Perception Profile, Journal of Sport and Exercise Psychology, 1989 The Physical Self: From Motivation to Well-Being. Human Kinetics, Champaign,IL , 1997

  4. Presentation outline Public health and its development Exercise psychology in public health Working in the world of public health Working in the commercial sector Opportunities for exercise psychology

  5. Public health and its development

  6. Earliest public health epidemiology Problem: Cholera spreading in London (1853-4) Thought to spread through ‘bad’ air or miasma But Dr John Snow suspected something different

  7. Death Rates From Cholera 1853-54

  8. Simple and cheap solution?: Remove the handle from the Broad Street pump. This ended the epidemic Original Broad Street with pump

  9. Not much to do with psychology?

  10. UK Public Health Association: Definition of public health • an approach that focuses on the health and well being of a society and the most effective means of protecting and improving it • encompasses the science, art and politics of preventing illness and disease and promoting health and well being • addresses the root causes of illness and disease, including the interacting social, environmental, biological and psychological dimensions, as well as the provision of effective health services

  11. Kmietowicz, Z. BMJ 2003;327:68

  12. Reducing health inequalities:Implications for studies and policy Must focus on the health needy sector of the population Convenience sampling is out of the question Have to show that you have recruited the difficult to reach sector to your intervention If not you are at risk of increasing inequalities!

  13. Foresight report into obesity (2008) Modern diseases have multiple causes that need multiple solutions

  14. Societal influences Individual psychology Individual activity Food Consumption Activity environment Food Production Biology

  15. Societal influences Individual psychology Individual activity Food Consumption Activity environment Food Production Biology

  16. FOOD Strong signals to eat Weak signals to stop Increased availability Eating is rewarding No viable alternatives Eating well is high status ACTIVITY Weak activity signal Strong signals to stop Reduced availability Inactivity is rewarding Inactivity is a viable alternative Inactivity is high status Biological and cultural mismatches to the westernised environment

  17. Hippocrates (400 BC) “Eating alone will not keep a man well: he must also exercise. For food and exercise while possessing opposite qualities, yet work together to produce health. It is necessary….. to proportion exercise to the bulk of food, to the constitution of the patient and the age of the individual”

  18. First clinical episodes* of CHD in male central London bus drivers and conductors aged 35-64, 1949-1950 *Angina, MI, CHD mortality Professor Jerry Morris et al., Lancet 1953 59 years ago!

  19. A Tribute to Professor Jeremy Morris (1912-2010): The Man Who Invented the Field of Physical Activity Epidemiology Steven N. Blair, George Davey Smith, I-Min Lee, Kenneth Fox, Melvyn Hillsdon, Robert McKeown, William L. Haskell American Journal of Epidemiology (2011) "We in the West are the first generation in human history in which the mass of the population has to deliberately exercise to be healthy. How can society's collective adaptations match?" (Jerry Morris, 2009)

  20. Health behavior is simply a case of • Being informed ? • Making intelligent choices ? • Having positive attitudes ? • Making health a priority ? • A nudge in the right direction? (Thaler and Sunstein, 2008)

  21. Legislation Brockman, R., Fox, K.R. (2011). Activity promotion by stealth not health ? The potential health benefits of a workplace transport plan. Public Health.. 125, 210-216

  22. A Taxonomy of Behaviour Change Techniques use in InterventionsAbrahams & Michie, Health Psychology, 2008 The behaviour change wheel: A new method for characterising and designing behaviour change interventions Michie, van Stralen, West . Implementation Science, 6, 2011.

  23. The need for a stronger focus on behavior change strategies is finally being recognised • National Prevention Research Initiative (4 phases) • Lifelong Health and Well-Being Initiative • NIHR Public Health section Show us you that you can produce long term change in health behavior in a way that might be replicated in the community

  24. Exercise psychology and physical activity for health

  25. Popular theoretical frameworks featured in exercise psychology Attribution theory Theory of planned behavior Self-efficacy theory Self-perception models Achievement goals theory Goal setting theories Health belief model Transtheoretical model Health action process approach (Biddle 1994, 2007. 2011)

  26. Systematic reviews of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventionsGreaves, Sheppard, Abraham, Hardeman, Roden, Evans, Schwartz, IMAGE Study Group, BMC Public Health (2011) Evidence to support the following strategies: • Providing instruction • Establishing self-monitoring • Relapse prevention techniques • Goal setting • Individual tailoring (for PA) • Time management techniques • Encouraging self talk • Use of pedometers • Motivational interviewing

  27. Challenges in the application of theory to activity interventions • For public health application we need to be theory users • We need strategies that change constructs that clearly emerge from theories • Testing theory means seeking evidence of which constructs mediate change in behavior • Often need a menu of ‘best bet’ strategies that derive from several theories • Measurement opportunities are very limited in public health settings.

  28. Importance of measurement of processes and product Motivational theory Self-perception theory Target construct Physical self-perceptions Intervention strategy Confidence building through incremental success Effect on behavior Adherence to exercise program

  29. Deep-seated drivers of human behavior • Unconditional love and regard • Competence • Autonomy and control • Significance and importance • Affiliation, relatedness and belonging (Rogers, 1951; Epstein, 1973; Campbell, 1984; Baumeister, 1993; Cloninger, 1994; Deci & Ryan, 1995;)

  30. Self-determination theory (SDT)Deci & Ryan, 2001 The self as the agency of change Perceived autonomy drives long term behaviors The self drives attempts to satisfy needs • Need to feel autonomous and in control • Need to feel competence and confidence • Need to feel relatedness and belonging

  31. Key SDT strategies • Language changes from instruction and prescription to facilitation • Increase participant competence and confidence through incremental mastery goals • Engage participants in choice decisions and encourage ownership “you made it happen” • Build behaviors into a new identity • Maximise the social benefits including belonging, support, and contribution • SDT fits well with motivational interviewing, some aspects of CBT, self theories, achievement goals theory (task v ego)

  32. Motives evidence • Mental benefits • Improved mood • Improved subjective well-being • Reduced anxiety and tension • Improved physical self-perceptions • Social affiliation and interaction Physical activity and psychological well-being Biddle, Fox, Boutcher (2000) Routledge

  33. Intrinsic-extrinsic continuum Intrinsic (emersion?) (persuasion?) Extrinsic (coersion?) Pleasure Competence Weight loss Payment Mastery Fitness Competition Autonomy Body image Status Mood Prize Friendship

  34. Other theories worth considering or revisiting? “Should I go or should I stay” The Clash theory Personal investment theory (Rusbult and Farrell, 1983) Commitment theory (Scanlan 1993)Moreira, H, Fox, K.R., & Sparkes, A.C. (2002). Job motivation profiles of physical educators. British Educational Research Journal, 28, 845-861 Habit theory (Verplanken, 1993, 2008) Social learning theory (Bandura) confidence building modelling as a means of inspiring others

  35. Exercise psychology Key questions:- • How do we increase exercise and sport participation among the population? • How does exercise and sport influence mental health and well-being? Participation and performance Mental health and well-being

  36. Mental health PHYSICAL DISEASE RISK Prevention Treatment/therapy MENTAL ILLNESS COGNITIVE FUNCTION MENTAL WELL-BEING

  37. Public health relevance • Prevalence of suffering • % of population • Burden of suffering • Mortality and morbidity • Human costs – QoL and well-being of sufferers and carers • Economic costs – health and social care, productivity • Potential for reduction of suffering • Feasibility • Cost-effectiveness

  38. Physical activity and risk of dementia Physical activity is associated with lower risk of premature cognitive decline, dementia and Alzheimer’s disease: Systematic review and meta-regression analysis. Kenneth R Fox, Neha Khandpur, Rod Taylor , Mark Davis

  39. Exercise training increases size of hippocampus and improves memoryErikson et al. (2011) Proc Nat Acad Sci, USA • 120 older adults without dementia assigned to intervention and control • Moderate intensity aerobic exercise 3 days per week for 12 months • Size of hippocampus (anterior) increased 2% in exercise group and decreased 1.4% in stretching control • Change was related to change in aerobic fitness

  40. Exploring the effects of exercise and brain stimulation on brain plasticity (Funded by Wellcome Trust and NIHR)NIHR Biomedical Research UnitUniversity of OxfordHeidi Johansen-Berg, Claire Mackay,Helen Dawes, Ken Fox et al. (2012-17)Objectives1. Improve sensitivity of fMRI measures2. Identify key changes in brain structure and function3. Assess effects of frequency, intensity, duration, setting, and concomitant conditions of exercise?

  41. Breaking the decline spiral in older age Today’s best buy in public health? Sedentary and low activity habits Decline in physical and cognitive function Cost and suffering Increasing isolation and loss of independence Accelerated biological ageing / subclinical disease Chronic disease development and huge care costs Premature death

  42. Working in the world of public health research and practice: A few lessons learned 1. Developing partnerships and networks to create sequences of research Research councils require: Multidisciplinarity Service providers, agencies and user involvement That your work has IMPACT

  43. Older people and active living Research partners: Geographers Planners Economists Sociologists Local authorities Primary care trusts Older adults Socio-ecological models

  44. Research with older adults…….. • 2003-5 Better Ageing - EU funded intervention • 2006-9 Project OPAL – NPRI funded descriptive study using objective measures • 2009-10 AVONet – LLHW funded collaborative network • 2010-11 OPAL-PLUS – 3 yrs on – Dunhill Medical Trust • 2012-14 Project ACE • 2012- Projects ENABLE, HABIT and PALS?

  45. Avon Network for the Promotion of Active Ageing in the Community (AVONet) 2009-10Lifelong Health and Well-Being Collaborative Network3 universities, local councils, service providers, older people themselvesAim:Identify ‘best bet’ solutions to physical activity promotion for older adults

  46. Network activities over 12 months Reviews of formal and grey literature Three day-long workshops Structured exercise/physical activity interventions for older people living in the community Lifestyle and environmental interventions targeting older people living in the community Best bet strategies for physical activity promotion in older adults in the Avon region Guidance report for commissioners of services and activity coordinators Two grant proposals for interventions

  47. Lesson learned Managing networks Helping all parties feel valued Getting buy-in Servicing the needs of all parties Communicating objectives Regular updates Celebrating outcomes

  48. Lessons learned Logical sequences of research increase credibility Establishing strong and stable core teams is effective Successful partnerships: Increase credibility for further grants Improve intervention design Provide strategies for recruiting health needy populations Provide networks for recruitment of participants Ground interventions in the reality of local challenges and the needs of the population

  49. Working in the world of public health research and practice: 2. Recognising different priorities and questions in public health

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