Assessing motivational readiness and decision making for exercise.

Motivational and cognitive processes of behavior change with respect to the area of exercise adoption were investigated. A total of 778 men and women, recruited from four worksites, answered a 40-item questionnaire consisting of statements based on constructs from the trans-theoretical model of behavior change. Principal-components analysis identified two factors--one a 6-item component representing avoidance of exercise (Cons), the other a 10-item component representing positive perceptions of exercise (Pros). Analysis of variance showed that the Pros, Cons, and a Decisional Balance measure (Pros minus Cons) were significantly associated with stage of exercise adoption. Results are consistent with applications of the model to smoking cessation and other areas of behavior change. Distinctions between exercise adoption and behaviors such as smoking cessation, weight loss, and alcoholism are discussed.     

Is the sequencing of change processes by stage consistent across health problems? A meta-analysis.

Clinicians and researchers applying the transtheoretical model (J.O. Prochaska, C.C. DiClemente, & J.C. Norcross, 1992) to health promotion often assume that relationships of processes and stages observed in smoking cessation can be generalized to other problems. A reanalysis of 47 cross-sectional studies determined that use of change processes varies by stage, but the sequencing of processes is not consistent across health problems. In smoking cessation, cognitive processes were used in earlier stages than were behavioral processes. In exercise adoption and diet change, use of behavioral and cognitive processes increased together. Results for substance abuse and psychotherapy were less consistent. Substituting new behaviors, making a commitment, considering consequences, seeking information, controlling cues, and using rewards varied most by stage. Future longitudinal studies should assess these processes as potential mediators of lifestyle change.     

Causal Models of Physical Exercise Participation: Testing the Predictive Power of the Construct "Pressure to Change"

This study examines 2 different causal models to predict physical exercise motivation and behavior under a longitudinal perspective. The first model includes 5 latent variables that were hypothesized to have an impact on exercise intention and behavior: behavior-specific social support, exercise self-efficacy, perceived health benefits, perceived barriers, and subjective vulnerability to cardiovascular disease. The second model was based on all variables of the first model, but additionally included the new variable "pressure to change." Pressure to change was defined as the extent to which a person feels the necessity that specific personal life circumstances (e.g., health status, social relations) may not remain as they are and ought to be changed. It was hypothesized that the inclusion of health-related pressure to change would result in a better prediction of exercise intention. The proposed causal models were tested separately at the stages of exercise adoption and maintenance. Covariance structure analyses (LISREL) confirmed that pressure to change may be an important factor in the motivational process that leads to the adoption of regular physical exercise. Adding this latent variable to the basic model improved the amount of explained variance in exercise intention by 6%. Furthermore, the results did not support the assumption that cognitive control is critical especially during the acquisition of exercise behaviors, but may be less influential once the behavioral routines have been established. Our data rather indicate that regular physical exercise, even if performed on a regular basis for years, always remains a behavior that requires a high level of cognitive guidance.     

Promoting exercise behavior among Chinese youth with hearing loss: a randomized controlled trial based on the transtheoretical model

The transtheoretical model proposes that behavior change is experienced as a series of stages. Interventions tailored to these stages are most likely to be effective in progressing people through the model's hypothesized behavior change continuum. In this study, a stage-tailored, 12-week, exercise behavior intervention based on the transtheoretical model was conducted among a sample of 150 Chinese youth with hearing loss. Participants were randomized into an intervention or control group with all the core transtheoretical model constructs assessed pre- and post-intervention. Participants in the intervention group showed greater advances in their stage of exercise behavior change, decisional balance, and processes of change use compared to those in the control group. The intervention, however, was insufficient for increasing participants' self-efficacy for exercise behavior. The findings partially support the utility of the theory-based intervention for improving the exercise behavior of Chinese youth with hearing loss, while simultaneously helping to identify areas in need of improvement for future applications.     

A longitudinal study of pubertal timing and extreme body change behaviors among adolescent boys and girls

Recent studies have examined the prevalence of disordered eating and other health risk behaviors among adolescent boys and girls. However, these studies generally have not examined predictors of these behaviors, and have not embedded the investigations within a theoretical framework. This study employed a longitudinal design to evaluate the validity of a biosocial model in explaining health risk behaviors related to extreme body change strategies (disordered eating, exercise dependence, use of food supplements, steroid use) among adolescents. The participants were 430 adolescent boys (mean age = 13.33 years) and 451 adolescent girls (mean age = 13.28 years) who completed measures of pubertal timing, perceived popularity with peers, body dissatisfaction, focus on sport, involvement in competitive sport, strategies to lose weight, strategies to increase muscle, disordered eating, use of food supplements and steroids, and exercise dependence. It was found that both early and late maturing girls were at greatest risk of engaging in health risk behaviors, whereas boys demonstrated more variability in the relationship between pubertal timing and extreme body change behaviors. The results of this study provide important insights into the role of pubertal development in the adoption of extreme body change behaviors among adolescents.     

A Contextual Model of Control Beliefs,Behavior, and Health: Latino and European Americans with Type 2 Diabetes

Sense of control is frequently found to be related to health. A model of control beliefs, disease-management behaviors, and health indicators was tested in a sample of 74 Latino Americans and 115 European Americans with Type 2 diabetes. Two measures of control beliefs, one diabetes-specific (diabetes self-efficacy) and one global (mastery), were examined for their effects on management behaviors (diet and exercise) and on health (Hb_A1C and general health). Results indicated that the relationship between control and management behaviors varied by measure of control and by group. For Latino participants, global mastery was related to management behaviors; whereas, self-efficacy was related to such behaviors among European Americans. The relationship between control and health did not appear to be mediated by management behaviors. This study provides support for a diversified approach to control, behavior, and health.     

Greek students' attitudes toward physical activity and health-related behavior

A three-wave study over one year with 882 adolescents, aged 10 to 16 years at the initial testing, examined psychosocial variables regarding four health-related behaviors: exercise, eating fruit, smoking, and drug use. Analysis showed that during the stages of the study, high school students' exercise behavior decreased and their smoking behavior increased as well as their willingness to use drugs. It seems that study of physical education and health education during adolescence must take into account the possible differences in psychosocial variables associated with health-related behaviors as well as the different stages of adolescence.     

How do I feel about the behavior? The interplay of affective associations with behaviors and cognitive beliefs as influences on physical activity behavior.

Individuals have affective associations with health behaviors. In other domains such associations have been shown to influence behavior, but affective associations with health behaviors are not included in current health decision-making models. The authors examined whether affective associations with exercise predicted individuals' activity behavior and, if so, how they interfaced with other decision-making constructs to influence behavior. Adult participants (N = 433) reported their current physical activity behavior and affective associations with physical activity. Health belief model and theory of planned behavior constructs were also assessed. More positive affective associations with activity significantly predicted greater activity behavior. Moreover, the influence of the health belief model and theory of planned behavior constructs on activity behavior was mediated through affective associations. Affective associations were shown to play a central role in individuals' activity behavior, both as a mediator of the effects of cognitively based decision-making factors and as an independent predictor of activity behavior. The results suggest the need to include affective influences on behavior in formal models of health decision making and, potentially, to explore affectively based intervention routes to change behaviors.     

The Biobehavioral Model of Persuasion: Generating Challenge Appraisals to Promote Health1

By borrowing from the biopsychosocial model of challenge and threat, we may understand when health communications adequately motivate behavior change or when they are overly distressing and inhibit behavior change. The present studies were guided by the biobehavioral model of persuasion, which predicts that different health appeals should evoke different appraisals, as well as psychological and physiological responses that motivate the adoption or rejection of health behaviors. Challenging messages should be associated with approach motivational tendencies, whereas threatening messages should be linked to avoidance. Findings from 2 experiments support the biobehavioral model of persuasion and offer mechanisms that confer message effectiveness. By understanding the psychological and physiological processes that drive message effectiveness, message designers can create more effective health appeals.     

Changes in health-promoting behavior following diagnosis with HIV: prevalence and correlates in a national probability sample.

Diet, exercise, smoking, and substance use patterns affect the course of illness and quality of life for people with HIV. In interviews with a national probability sample of 2,864 persons receiving HIV care, it was found that most had made health-promoting changes in one or more of these behaviors since diagnosis. Many reported increased physical activity (43%) and improved diet (59%). Forty-nine percent of cigarette smokers quit or cut down; 80% of substance users did so. Desire for involvement in one's HIV care and information seeking-positive coping were the most consistent correlates of change. Other correlates varied by health practice but included health status, emotional well-being, demographics, and attitudes toward other aspects of HIV care. Most people with HIV improve their health behavior following diagnosis, but more might be helped to do so by targeting these behaviors in future interventions.     

Decision Making Versus Decision Implementation: An Action Control Approach to Exercise Adoption and Adherence1

Two studies were conducted, one involving adoption of an exercise program and the other involving adherence to an aerobics exercise program. Consistent with action control theory, it was hypothesized that (a) subjective expected utility theory would predict exercise intentions but not exercise behavior in each study; (b) exercise adoption (Study 1) and attendance at an aerobics class (Study 2) would be predictable from the intentions regarding these behaviors expressed by action-oriented but not state-oriented subjects; and (c) subjects who had engaged in planning in regard to exercising would be more likely to adopt an exercise program (Study 1) and would exercise more frequently (Study 2). The findings provide some support for all three hypotheses. Implications of this research are discussed in regard to the distinction between decision making and decision implementation or action control; the relative usefulness of an action-control versus an expectancy-value approach for behavior involving complex decision implementation over a long period of time; the value of action orientation as a moderator of intention-behavior relationships; and the role of planning in exercise behavior.     

The Process by Which Relative Autonomous Motivation Affects Intentional Behavior: Comparing Effects Across Dieting and Exercise Behaviors

A motivational model integrating self-deter-mination theory and the theory of planned behavior was tested in two samples for exercise and dieting behavior respectively. Relative autonomous motivation from self-determination theory was hypothesized to predict intentions to exercise or diet via the mediation of attitudes and perceived behavioral control (PBC) from the theory of planned behavior. It was also expected that attitudes and PBC would predict actual levels of exercise and dieting behavior via the mediation of intentions. Relations in the proposed model were expected to be invariant across the behaviors. Two samples of participants (N = 511) completed measures of the autonomous motives, attitudes, subjective norms, PBC, and intentions with respect to exercise and dieting behavior. Four weeks later, participants self-reported their behavior. Structural equation models supported the replicability of the proposed model in both behaviors. Findings supported the majority of the hypothesized effects in the proposed model across the two health behaviors. However, four effects were significantly different across the two behaviors: the effect of autonomous motives on intentions, subjective norms and PBC on intentions, and intentions on behavior. Findings extend knowledge of the processes by which psychological antecedents from the theories affect health behaviors integral to the maintenance of energy balance.

Integrating stage and continuum models to explain processing of exercise messages and exercise initiation among sedentary college students.

Concepts from the transtheoretical model (J.O. Prochaska, C.C. DiClemente, & J.C. Norcross, 1992), theory of planned behavior (I. Ajzen, 1985), and the elaboration likelihood model (R.E. Petty & J.T. Cacioppo, 1986b) were used to examine how exercise readiness impacted processing of exercise messages and exercise initiation. Sedentary college students (n = 147) were assessed for exercise attitude, intent, behavior, and stage of change. Students also listed their thoughts after reading messages with either strong or weak arguments for exercise. Attitude predicted depth of message processing, but stage of change did not. Stage of change and intent at baseline predicted exercise adoption at 1- to 3-month follow-up (n = 134), with baseline activity moderating the effect of intent. Tailoring messages to recipients' depth of processing and interactive effects of intent and behavior on exercise adoption should be considered in future research.     

Conscientiousness, the transtheoretical model of change, and exercise: a neo-socioanalytic integration of trait and social-cognitive frameworks in the prediction of behavior

ABSTRACT Relationships between conscientiousness-related traits and transtheoretical model (TTM) of change constructs, exercise self-efficacy, and exercise behavior were examined in college and community samples ( N =566). Measures of the conscientiousness-related traits of conventionality and industriousness were expected to show positive relations with measures of exercise behavior stage location, processes of exercise behavior change, endorsing the benefits of exercise behavior (i.e., decisional balance), exercise self-efficacy, and self-reported exercise behavior. In addition, based on Neo-Socioanalytic Theory ( Roberts & Wood, 2006 ) an intervening role was predicted for TTM constructs and exercise self-efficacy in the relationship between conscientiousness-related traits and exercise behavior stage location. The results showed industriousness (being hardworking) to be the most robust conscientiousness-related predictor of stage location, processes of change, endorsing the benefits of exercise behavior, and exercise self-efficacy. Mediation analyses showed the relationship between industriousness and exercise behavior stage location to be fully accounted for by select processes of change and exercise self-efficacy scales. The results are discussed in terms of a useful integration of trait and social-cognitive approaches to exercise behavior, with an emphasis on the role of industriousness as an important individual difference factor therein.     

Planning and Self-Efficacy in the Adoption and Maintenance of Breast Self-Examination: A Longitudinal Study on Self-Regulatory Cognitions

Many women may be reluctant to perform breast self-examination (B.S.E.) regularly due to motivational or self-regulatory deficits. The Health Action Process Approach (Schwarzer, R. (1992). Self-efficacy in the adoption and maintenance of health behaviors: theoretical approaches and a new model. In: Schwarzer, R. (Ed.), Self-efficacy: Thought Control of Action , pp. 217-243. Hemisphere, Washington DC; Schwarzer, R. (2001). Social-cognitive factors in changing health-related behavior. Current Directions in Psychological Science , 10 , 47-51.), a health behavior change model that advocates the separation of motivation and action phases, such as goal setting and goal pursuit, was applied to data from 418 young women whose risk perceptions, outcome expectancies, self-efficacy, intention to perform B.S.E., planning, and reported examination behaviors were examined at two points in time. Risk perception was found to have a negligible influence in a path analysis, whereas self-efficacy emerged as the best predictor of intention and planning. Planning, in turn, appeared to be the best predictor of B.S.E. behaviors, followed by self-efficacy. The results point to the influential role that self-regulatory strategies (such as planning) play in translating goals into action. The study contributes to the current debate on stage theories of health behavior change and the orchestration of self-beliefs and strategies in the context of goal-directed behaviors.     

Social-Cognitive Factors in Changing Health-Related Behaviors

Changing health-related behaviors requires two separate processes that involve motivation and volition, respectively. First, an intention to change is developed, in part on the basis of self-beliefs. Second, the change must be planned, initiated, and maintained, and relapses must be managed; self-regulation plays a critical role in these processes. Social-cognition models of health behavior change address these two processes. One such model, the health action process approach, is explicitly based on the assumption that two distinct phases need to be studied longitudinally, one phase that leads to a behavioral intention and another that leads to the actual behavior. Particular social-cognitive variables may play different roles in the two stages; perceived self-efficacy is the only predictor that seems to be equally important in the two phases.     

Social cognitive models of health and exercise behavior: An introduction and review of conceptual issues

Abstract

This article reviews the major social cognitive models of adherence or compliance in health and exercise behavior and attempts to show that these models are more similar to each other than different from each other. Self-efficacy theory and the theory of reasoned action/planned behavior have guided most of the theory-based research on exercise behavior. Two other models, protection motivation theory and the health belief model, have guided much research on the role of social cognitive factors in other health behaviors. These models are comprised largely of the same basic set of social cognitive variables: self-efficacy expectancy, outcome expectancy, outcome value, and intention. Two other factors, situational cues and habits, although not common to all the models, round out the theoretical picture by explaining how the relationship between the major social cognitive variables and behavior may change with repeated performance of a behavior over time.An integration of these models is offered using the theory of planned behavior as a foundation. It is suggested that research on health and exercise behavior that pits one model against another to determine which one is the better predictor of behavior is likely to be unproductive due to the striking similarities of the models. It is suggested instead that theorists and researchers focus their efforts on integration of the major social cognitive models and on determining the relative predictive utility of the various social cognitive factors with various health behaviors and in various contexts.     

Predictors of Progression and Regression in Exercise Adoption in Young Women1

An integrative model of readiness to exercise (Marcus, Eaton, Rossi, & Harlow, 1994) was tested. Measures of stage of exercise adoption and of the 2 motivation variables from the model plus 3 others were obtained at baseline and 6 months later from 238 young adult females. Logistic regression analysis was used to assess the effects of both state (baseline) and change measures of the variables on progressive and regressive movement among the stages of change. Progression was predicted by change in self‐efficacy (p= .018), change in perceived behavioral control (p= .007), and a baseline measure of desire to exercise (.041). Regression was predicted by change in self‐efficacy (p= .04). These findings provide only partial support for the integrative model.     

Self-Efficacy,Decision-Making,and Stages of Change: An Integrative Model of Physical Exercise1

Exercise has important health benefits but a large proportion of the population is physically inactive. We examined the stages of readiness to exercise and their relationship to self-efficacy, the costs and benefits of exercising, and self-report of physical activity in a sample of Rhode Island worksites. Using a three-step model-building approach, exploratory principal components analyses were followed by an examination of the stages of change model with confirmatory structural equation modeling procedures. The model was then examined with longitudinal data. Confirmatory and longitudinal analyses showed an excellent tit between the model and the data. Results indicated that the costs and benefits of exercise and self-efficacy for exercise were related to physical activity only indirectly, through the mediation of stage of readiness to exercise. Structural modeling fit indices revealed that much of the variation and covariation in physical activity was explained by the model. There is the potential to enhance the impact of exercise interventions, by targeting them so as to address factors related to these different stages of readiness.     

Psychosocial, behavioral, and biometric characteristics of stages of exercise adoption

This study incorporates the Stages of Change model to examine the relationship between the stages of exercise adoption and indicators of health and fitness. Subjects were 198 United States Forest Service (USFS) workers recruited from 8 USFS ranger stations in the Pacific Northwest. Analysis indicated that those subjects in Action and Maintenance stages of exercise adoption differed significantly from those in Preparation and Precontemplation/Contemplation stages on a variety of indicators of both health and fitness. Also, interesting differences were noted among the physically inactive stages, e.g., Preparation stage subjects showed lower triglycerides, systolic blood pressure, and higher HDL cholesterol compared with subjects in the Precontemplation/Contemplation stage. Progressing to the Preparation stage, where the individual remains inactive but is aware of the problem and has begun to make small changes, is associated with a differing (more positive) health profile in this study compared to those in the Precontemplation/Contemplation stage. These results imply that simply advancing in stage can have a variety of health benefits.