EXERCISE
ADHERENCE
Damon Burton
University of Idaho
WHAT IS EXERCISE
ADHERENCE?
Exercise Adherence (EA) – is the ability
to maintain an exercise program for an
extended time period.
Exercise adherence is one of the biggest
health problems for American adults.
EA is also a problem for children and
adolescents, probably due in part to
extensive reductions in required
physical education classes.
How big a problem is
exercise adherence
among American
adults?
EXERCISE STATISTICS
30% of adults are sedentary (i.e., totally
inactive).
Physical activity levels begin to decline at
age 6 and continue throughout the life
cycle.
10-25% of adults get health benefits from
physical activity.
64% of Americans were considered
overweight or obese in 2004.
56% of American adults were considered
overweight in 2000 compared to 45% in
1991.
EXERCISE STATISTICS
Among youth ages 12 to 21, 50% do not
participate regularly in physical activity.
Among adults, only 10-15% exercise 3
times per week for at least 20 minutes.
Among boys and girls, physical activity
declines steadily thru adolescence from
70% at age 12 to 40% at age 21.
Women are more active than men, blacks
and Hispanics more than whites, older
adults compared to younger ones, and less
affluent compared to more affluent.
EXERCISE STATISTICS
10% of sedentary adults begin
exercise programs each year,
50% of new exercisers will drop
out within six months.
What are the major
reasons why adults
exercise?
REASONS ADULTS
EXERCISE
weight control for appearance and
health,
health benefits--particularly for
cardiovascular problems (i.e.,
hypertension),
stress and depression management
Enjoyment,
building self-esteem, and
social and affiliation benefits.
Do the reasons adults
start an exercise
program differ from
the reasons that they
continue to exercise?
REASONS FOR INITIATING
EXERCISE PROGRAMS
health benefits,
weight control,
Appearance,
increased energy,
mobility issues (e.g., joint
problems), and
meet people.
REASONS FOR MAINTAINING
EXERCISE PROGRAMS
stress and depression
management,
Enjoyment,
building self-esteem,
maintaining social
relationships,
weight maintenance, and
health maintenance.
What are the
common excuses
for not exercising?
EXERCISE BARRIERS
lack of time,
lack of energy, and
lack of motivation.
OTHER EXERCISE
BARRIERS
OTHER EXERCISE
BARRIERS
• social support barriers,
• health and fitness barriers,
• other commitments,
• resource barriers, and
• programming barriers.
EXERCISE BEHAVIOR
THEORIES & MODELS
• Health Belief Model,
• Theory of Planned Behavior,
• Social Cognitive Theory,
• Self-Determination Theory,
• Transtheoretical Model,
• Ecological Model, and
• Personal Investment Theory.
HEALTH BELIEFS MODEL
Becker & Maiman (1975) suggest that
the likelihood of an individual’s
engaging in preventive health
behaviors such as exercise depends
 on the person’s perception of the severity
of potential illness and
 their appraisal of the costs versus
benefits of taking action.
 For example, a person who believes
the potential illness is serious, he/she
is at risk and the pros of taking action
outweigh the cons of working out is
likely to exercise regularly.
THEORY OF PLANNED
BEHAVIOR
Ajzen & Madden (1986) extended Theory
of Reasoned Action that identified
intentions as the best predictors of
actual behavior.
Intentions are the product of an
individual’s attitude toward a particular
behavior and subjective norms regarding
that behavior.
Subjective norms are a product of beliefs
about others’ opinions and motivation to
comply with others’ opinions.
THEORY OF PLANNED
BEHAVIOR
For example, the Theory of Reasoned
Action (TRA) suggests that if you are a
nonexerciser and believe that other
significant people in your life (e.g., wife,
children, & friends) think you should
exercise, you may wish to do what other
want you to do.
Theory of Planned Behavior (TPB)
extends TRA by arguing that intentions
cannot be the sole predictors of
behavior, particularly when individuals
lack control over behaviors.
THEORY OF PLANNED
BEHAVIOR
In addition to subjective norms and
attitudes, TPB states that perceived
behavioral control (i.e., people’s
perception of their ability to perform the
behavior) also affect behavioral
outcomes.
TPB has been the most frequent theory
to be used to predict exercise behavior,
although it typically accounts for only
20-35% of the variance in exercise
behavior.
SOCIAL COGNITIVE THEORY
Social-cognitive theory (SCT) is based on
Bandura’s (1977) work that postulates
that we learn and modify behaviors
through interaction between personal,
behavioral and environmental influences.
SCT focuses on self-regulation whereby
we regulate our behavior based on goals,
behaviors and feelings.
We reflect on our actions based on 2
factors: (a) the consequences of our
behaviors (i.e., outcome expectancies)
and (b) our ability to perform those
behaviors (i.e., efficacy expectations).
SOCIAL COGNITIVE THEORY
Outcome expectancies = “Will exercise
help me lose weight?”
Efficacy expectancies = “Can I exercise
more often, at greater intensity or for
longer duration?”
Efficacy expectations are more critical to
actual behavior.
Sources of efficacy information include:
 performance accomplishment,
 vicarious experiences (e.g., modeling &
imagery),
 verbal persuasion, and
 positive mood enhancement.
TRANSTHEORETICAL MODEL
Marcus’ TTM proposes that behavior
change involves movement through
stages of change.
The term “transtheoretical” describes a
broad framework that includes both (a)
when (stages) and (b) how behavior
changes.
TTM includes (a) processes (i.e.,
strategies) and (b) mediators of change
(e.g., decision balance sheet or selfefficacy).
TRANSTHEORETICAL MODEL
Cognitive change processes (e.g.,
knowledge of sedentary risk) peak in the
action state whereas behavior processes
(e.g., social support) are most critical in
the maintenance stage.
Matching strategies to current stage of
change seems to be a effective
intervention strategy.
EA relapse typically increases in
probability when a major “life change”
occurs.
Self-monitoring and tweaking of EA
programs is necessary to prevent relapse.
TRANSTHEORETICAL
MODEL
Stage 1 = Precontemplation:
Person isn’t performing selfchange behavior and doesn’t
intend to start. Initial notice of a
problem.
Stage 2 = Contemplation: Person
isn’t performing the self-change
behavior but are thinking about
starting. Action seriously
considered.
TRANSTHEORETICAL
MODEL
Stage 3 = Preparation: Person
recently started preparing to
initiate self-change behavior such
as buying clothing and shoes,
purchasing a fitness membership
or lining up an exercise partner.
Stage 4 = Action: Person has
initiated the self-change behavior
consistently for a short period of
time. Trying to become more
systematic.
TRANSTHEORETICAL
MODEL
Stage 5 = Maintenance: Person has
maintained the self-change behavior
consistently for 6 months or more
and plans to continue doing so.
Reached habitual stage.
Stage 6 = Relapse Prevention:
Person encounters serious lifestyle
change after reaching maintenance
stage and has to adjust self change
program to prevent relapse. Making
needed adjustments to maintain
lifestyle change.
ECOLOGICAL MODEL
Premise – Ecological framework
highlights multiple EA influences.
Behavior can be a product of social,
psychological, environmental and
sociopolitical influences.
Motivated people may struggle to
be active if environmental
constraints are extensive.
Interventions must create supportive
environments and provide
exercisers with psychological tools
to change and regulate their
behavior.
PERSONAL INVESTMENT MODEL
Incentives/Goals – 12 common exercise
goals as measured by the Exercise and
Sport Goal Inventory [33% of variance].
Sense-of-Self Variables [not measured
but typically < 25% of variance]
 Competence (i.e., ability to attain goals)
 Self-reliance (i.e., autonomously reach goals)
 Goal-directedness (i.e., goals drive motivation)
Perceived Options
 Program compatibility (i.e., allows you to meet
important goals; 21% of variance)
 Barriers (i.e., goals not stifled by barriers;
38% of variance)
FACTORS IMPACTING
EXERCISE ADHERENCE
• personal factors and
• environmental factors
PERSONAL FACTORS
IMPACTING ADHERENCE
PERSONAL FACTORS
IMPACTING ADHERENCE
EXERCISE ADHERENCE
STRATEGIES
behavior modification approaches,
reinforcement approaches,
cognitive-behavioral approaches,
decision-making approaches
social support approaches, and
intrinsic approaches.
BEHAVIOR MODIFICATION
APPROACHES
prompts,
contracts, and
perceived choice.
REINFORCEMENT
APPROACHES
charting attendance
and participation,
rewarding attendance
and participation, and
feedback and testing.
COGNITIVE-BEHAVIORAL
APPROACHES
goals,
self talk, and
thought focus strategies
•association
•dissociation
DECISION-MAKING
APPROACHES
SOCIAL SUPPORT
APPROACHES
social support from partner,
group or class,
know where to go for what
you need, and
must trust and respect
person to go to them for
support.
INTRINSIC APPROACHES
focus on the experience,
focus on the process and
engage in meaningful
physical activity.
BEST EXERCISE
ADHERENCE STRATEGIES
1. Make exercise fun and enjoyable.
2. Tailor exercise frequency, duration
and intensity to the exerciser.
3. Promote group exercise.
4. Keep daily exercise logs.
5. Reinforce success.
6. Find a convenient place to exercise.
The
End