Using the stage model for successful physical activity interventions

1. Using the stage model for successful physical activity interventions Chapter 5

2. Physical Activity Programs • All used the change model (TTM model). • The programs are: • Imagine Action (Community based program) • Jump Start to Health (Workplace based study) • Jump Start (Community based study) • Project Active (Community based study) • Project Stride (Community based study) • Step into Motion (Community based study)

3. Imagine Action • Participants: Adults enrolled through their workplace or response to advertisement (mass media) • Interventions: • Letter describing the program. • Respondents indicated their level of activity using stage of change inventory • Reward for enrolling was “T-shirt.” • Staged match Self help & resource manual • Weekly fun walks and activity nights • Program length was 6 weeks

4. Self-help Manual • Stage 2 of manual was called: What’s in It for You. • Stimulus prompts (e.g., take the stairs) • Benefits of exercise • Common barriers • Rewarding oneself (self-determination) • Stage 3 of manual was called: Read for Action • Goal was 30 minutes of moderate intense activity or 20 minutes of vigorous activity 3-5 days per week (Goal setting). • Address barriers to and benefits of PA • Goal setting • Rewarding oneself • Time management (e.g. how to fit your exercise into a busy day) • Detailed walking program

5. Self-help & Resource Manual • Stage 4 of the manual was called, “Keep it Going.” • Preventing lapse and relapse (e.g., trouble shooting situations0 • Rewarding oneself • Goal setting • Cross training to prevent boredom (variety) • Avoid injury • Social support (e.g., find other people who are active) • Resource Manual • Variety of fee and low cost light to vigorous PA options • Organized by mode (e.g., walking, volleyball, aerobics)

6. Results • 30% in stage 2 and 61% in stage 3 at the beginning progressed to stage 4. • Additional 30% in stage 2 progressed to Stage 3. • Very few lapse or relapse occurred in the adult participants. Program demonstrated that low cost, low intensity program can produce important changes in physical activity

7. Jump to Health Study • Participants: Sedentary employees • Study: • Recruited through signage at the workplace • Participants were randomly assigned to a stage matched self-help program or a non-staged match self-help program. • Interventions • Printed materials delivered at the beginning and 1 month later • Questionnaires about PA habits • Employees were given time off to complete the questionnaires • Free popcorn and beverages were available for completing the questions. • $1 dollar Rhode Island State lottery ticket (Reward)

8. Study • Two groups were formed: • Stage matched people were given manuals matched to their current stage. • Stage 1: Do I need this? (Focus on benefits) • Stage 2: Try it you’ll like it? (Focus on decision balance) • Stage 3: I’m on my way. (Focus on goals & barriers) • Stage 4: Keep it going (Focus enhance confidence) • Stage 5: I won’t stop now (Focus on rewards, variety) • Non-staged matched people received American Heart Association manuals.

9. Results • Subject in the staged matched groups became more active than non matched group (37% to 27%) • The greats changes where people in stages 1,2, & 3.

10. Jump Start • Participants: Anyone • Interventions • Printed materials that provide individual feedback each time they fill out a questionnaire • Questionnaires • Contained motivation • Cognitive and behavioral strategies • Barrier to and benefits of exercise • Self-efficacy • Exercise prescription

11. Results • People who received the individual stage matched program were more like to achieve the ACSM guideline of 30 minutes of PA every day. • People were more likely to maintain there exercise program.

12. Project Active Study • Participant: Any group • Interventions • Walking • Free membership at a gym • Hour long behavior meeting • Goal setting • Support person • Self- rewards • Compared traditional, structured exercise program to that of lifestyle stage matched approach program.

13. Results • Each group was given a 6 month membership to a fitness center. • Both groups program gradually increased the participants to exercising for at least 30 minutes for 5 day a week. • The study continued over a 2-year period. • Both groups showed improvement when compared to the beginning of the program • Lifestyle approached worked the best for people in stages 1 and 2.

14. Step into Motion Study • Participants: Anyone with access to the internet • Interventions: • Internet • No chat rooms, no blogs only restricted to stage matching material on the web • Tested a Web-based version in Project STRIDE • Study predominately involved women and Caucasians. • 44.4% of the participants who received Web based materials achieved public health recommended levels of physical activity and 39.5% achieved the recommended levels in 12 months.

15. Summary! • What are the commonalities of these programs and studies? • Staged matched approach promoted PA and exercise level in participants • One- treatment-fits-all approach is less effective than matching interventions to the level of the client • Stage matched approach delivered in non traditional means is just as effective at traditional, structured exercise programs.