Indiana University of Pennsylvania
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Theses and Dissertations
8-2013
The Effects of a Lifestyle Intervention Program on
Exercise Adherence and Physical Activity Behavior
Danielle Marie Ostendorf
Indiana University of Pennsylvania
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THE EFFECTS OF A LIFESTYLE INTERVENTION PROGRAM ON EXERCISE
ADHERENCE AND PHYSICAL ACTIVITY BEHAVIOR
A Thesis
Submitted to the School of Graduate Studies and Research
in Partial Fulfillment of the
Requirements for the Degree
Master of Science
Danielle Marie Ostendorf
Indiana University of Pennsylvania
August 2013
© 2013 Danielle Marie Ostendorf
All Rights Reserved
ii
Indiana University of Pennsylvania
School of Graduate Studies and Research
Department of Health and Physical Education
We hereby approve the thesis of
Danielle Marie Ostendorf
Candidate for the degree of Master of Science
_______________________
________________________________________________
Elaine A. Blair, Ph.D.
Professor of Health and Physical Education, Advisor
_______________________
________________________________________________
Madeline Paternostro Bayles, Ph.D.
Professor of Health and Physical Education
_______________________
________________________________________________
Robert E. Alman II, D. Ed.
Assistant Professor of Health and Physical Education
_______________________
________________________________________________
John A. Mills, Ph.D.
Professor of Psychology
ACCEPTED
_______________________________________
Timothy P. Mack, Ph.D.
Dean
School of Graduate Studies and Research
iii
______________________________
Title: The Effects of a Lifestyle Intervention Program on Exercise Adherence and Physical
Activity Behavior
Author: Danielle Marie Ostendorf
Thesis Chair: Dr. Elaine A. Blair
Thesis Committee Members: Dr. Madeline Paternostro Bayles
Dr. Robert E. Alman II
Dr. John A. Mills
The purpose of this study was to examine the effects of lifestyle intervention program on
exercise adherence and physical activity behavior in members of a university-based fitness
center. In an experimental study design, 32 apparently healthy adults were randomized to either
a lifestyle intervention (LI) group or a personal training only (PT) group. Both groups received
eight weeks of personal training, but LI received additional behavioral and cognitive strategies.
Statistical analyses compared between and within group differences using independent and
paired samples t-tests. Results indicated that LI significantly improved exercise adherence (p =
0.029) and self-efficacy (p = 0.025) compared to PT. Future research is recommended to
examine the efficacy of using a lifestyle intervention program within an Exercise Science
curriculum. For future consideration, health/fitness professionals should be aware of additional
behavioral strategies to help clients improve exercise adherence and self-efficacy, two important
components to maintaining healthy lifestyle behaviors.
iv
ACKNOWLEDGMENTS
I would sincerely like to thank several individuals who made this endeavor possible and
offered guidance and support not only throughout the research process but also throughout the
completion of my Bachelor’s and Master’s degrees at Indiana University of Pennsylvania. First
and foremost, I would like to extend my deepest appreciation for my thesis advisor, Dr. Elaine
Blair. Her continuous hard work, encouragement, and guidance during this research process
cannot be appreciated enough. Secondly, I would like to thank Dr. Madeline Bayles for
graciously allowing me to use her class as a basis for this research study and for giving me extra
time to make this endeavor a success. I would also like to thank Dr. Robert Alman, who was not
only on my thesis committee, but also my academic advisor for four years. Over this time, he has
served as a mentor, professor, volleyball fan, a motivator, and has been an enormous inspiration
for my future. I would like to thank Dr. John Mills, for his mentorship, for fostering my
unceasing curiosity to learn, and for challenging me to reach my highest potential. I feel truly
blessed to have had the opportunity to know and learn from these amazing and highly esteemed
professors. I feel confident in my ability to succeed at the doctoral level, thanks to the
preparation and support from each of these professors.
To my parents, thank you for always supporting me in all that I do and instilling the
confidence in me to exceed my own expectations and pursue my wildest dreams. I am very
appreciative of my family and friends for their unconditional love, support, and encouragement
to be all that I can be.
v
TABLE OF CONTENTS
Chapter
I
Page
INTRODUCTION ............................................................................................. 1
Problem Statement ............................................................................................. 3
Hypotheses ......................................................................................................... 3
Definition of Terms............................................................................................ 3
Assumptions ....................................................................................................... 5
Limitations ......................................................................................................... 6
Significance........................................................................................................ 6
II
REVIEW OF LITERATURE............................................................................. 7
Interventions Designed to Increase Physical Activity ........................................ 7
Interventions Designed to Improve Exercise Adherence.................................... 10
Interventions Designed to Improve Physical Fitness Outcomes......................... 12
Lifestyle Intervention Programs ......................................................................... 13
The Diabetes Prevention Program .......................................................... 15
Conclusion .......................................................................................................... 18
III
METHODOLOGY ............................................................................................. 20
Participants .......................................................................................................... 20
General Procedures ............................................................................................. 23
Instrumentation ................................................................................................... 24
Institute for Healthy Living Medical History Questionnaire ................. 24
Demographic Data Survey ..................................................................... 25
Modifiable Activity Questionnaire (MAQ) ........................................... 25
Exercise Adherence ............................................................................... 25
Physical Activity Stages of Change Questionnaire (PASCQ) ............... 26
Decisional Balance Questionnaire ......................................................... 26
Self-Efficacy for Exercise Scale (SEE) ................................................. 27
Physical Fitness Measures ..................................................................... 27
Test Procedures .................................................................................................. 28
Physical Activity Behavior .................................................................... 28
Client Exercise Adherence ..................................................................... 28
Motivational Readiness for Change ....................................................... 29
Self-Efficacy .......................................................................................... 29
Perceived Barriers/Benefits ................................................................... 30
Physical Fitness Measures ..................................................................... 30
Train-the-Trainer Sessions ..................................................................... 31
Lifestyle Intervention Sessions .............................................................. 32
Personal Training Only Sessions ........................................................... 33
Data Collection ...................................................................................... 33
Statistical Design ............................................................................................... 34
vi
Chapter
Page
Confidentiality ................................................................................................... 35
IV
RESULTS .......................................................................................................... 37
Hypothesis 1....................................................................................................... 43
Hypothesis 2....................................................................................................... 49
Hypothesis 3....................................................................................................... 54
Hypothesis 4....................................................................................................... 65
Hypothesis 5....................................................................................................... 69
V
DISCUSSION, RECOMMENDATIONS, AND CONCLUSION .................... 78
Summary of Methods ......................................................................................... 79
Summary of Results ........................................................................................... 80
Hypothesis 1........................................................................................... 81
Hypothesis 2........................................................................................... 84
Hypothesis 3........................................................................................... 86
Hypothesis 4........................................................................................... 88
Hypothesis 5........................................................................................... 90
Applications and Recommendations................................................................. 92
Conclusions ........................................................................................................ 94
REFERENCES .................................................................................................. 95
APPENDICES ........................................................................................................................... 99
Appendix A – IRB Approval Letter................................................................... 100
Appendix B – Client Informed Consent ............................................................ 102
Appendix C – Student Informed Consent .......................................................... 106
Appendix D – Permission to Use the SEE ......................................................... 110
Appendix E – Permission to Use the Demographic Data Survey ...................... 112
Appendix F – Demographic Data Survey .......................................................... 115
Appendix G – Institute for Healthy Living Medical History Questionnaire ..... 122
Appendix H – Modifiable Activity Questionnaire (MAQ)................................ 126
Appendix I – Fitness Tests Data Collection Form ............................................. 129
Appendix J – Self-Efficacy for Exercise Scale (SEE) ....................................... 142
Appendix K – Decisional Balance Questionnaire ............................................. 144
Appendix L – Physical Activity Stages of Change Questionnaire (PASCQ) .... 146
Appendix M – Sample Exercise Log ................................................................. 148
vii
LIST OF TABLES
Table
Page
1
Selected Baseline Characteristics by Treatment Group .................................................... 38
2
Selected Baseline Characteristics by Exercise Predisposition .......................................... 39
3
Baseline Exercise Adherence and Physical Activity Behavior by
Treatment Group ............................................................................................................... 39
4
Baseline Exercise Adherence and Physical Activity Behavior by
Exercise Predisposition ..................................................................................................... 40
5
Baseline Fitness Test Scores by Treatment Group ........................................................... 40
6
Baseline Fitness Test Scores by Exercise Predisposition ................................................. 41
7
Baseline Behavioral Measures by Treatment Group ........................................................ 42
8
Baseline Behavioral Measures by Exercise Predisposition .............................................. 42
9
Results of Independent-samples t-test Comparing Change in Exercise Minutes
and Leisure Time Activity from Pre to Post by Treatment Group ................................... 43
10 Results of Independent-samples t-test Comparing Change in Exercise Minutes
and Leisure Time Activity from Pre to Post by Exercise Predisposition ......................... 45
11 Results of Paired-samples t-test Comparing Pre and Post Exercise Minutes
and Leisure Time Activity for the Lifestyle Intervention Group ...................................... 49
12 Results of Paired-samples t-test Comparing Pre and Post Exercise Minutes
and Leisure Time Activity for the Personal Training Only Group ................................... 50
13 Results of Paired-samples t-test Comparing Pre and Post Exercise Minutes
and Leisure Time Activity for the Exercisers in the Lifestyle Intervention Group .......... 51
14 Results of Paired-samples t-test Comparing Pre and Post Exercise Minutes and
Leisure Time Activity for the Non-Exercisers in the Lifestyle Intervention Group......... 52
15 Results of Paired-samples t-test Comparing Pre and Post Exercise Minutes and
Leisure Time Activity for the Exercisers in the Personal Training Only Group .............. 53
16 Results of Paired-samples t-test Comparing Pre and Post Exercise Minutes and
Leisure Time Activity for the Non-Exercisers in the Personal Training Only Group ...... 54
viii
Table
Page
17 Results of Paired-samples t-test Comparing Pre and Post Fitness Test Scores for
the Lifestyle Intervention Group ....................................................................................... 56
18 Results of Paired-samples t-test Comparing Pre and Post Fitness Test Scores for
the Personal Training Only Group .................................................................................... 58
19 Results of Independent-samples t-test Comparing Change in Fitness Test Scores from
Pre to Post by Treatment Group........................................................................................ 60
20 Results of Independent-samples t-test Comparing Change in Behavioral Survey
Scores from Pre to Post by Treatment Group ................................................................... 66
21 Results of Independent-samples t-test Comparing Change in Behavioral Survey
Scores from Pre to Post by Exercise Predisposition ......................................................... 67
22 Results of Paired-samples t-test Comparing Pre and Post Behavioral Survey
Scores for the Lifestyle Intervention Group ..................................................................... 70
23 Results of Paired-samples t-test Comparing Pre and Post Behavioral Survey
Scores for the Personal Training Only Group................................................................... 71
24 Results of the Wilcoxon Signed Rank Test Comparing Pre and Post Stages of
Change for the Lifestyle Intervention Group .................................................................... 71
25 Results of the Wilcoxon Signed Rank Test Comparing Pre and Post Stages of
Change for the Personal Training Only Group ................................................................. 72
26 Results of Paired-samples t-test Comparing Pre and Post Behavioral Survey
Scores for the Exercisers in the Lifestyle Intervention Group .......................................... 73
27 Results of Paired-samples t-test Comparing Pre and Post Behavioral Survey
Scores for the Non-Exercisers in the Lifestyle Intervention Group ................................. 73
28 Results of the Wilcoxon Signed Rank Test Comparing Pre and Post Stages of
Change for the Exercisers in the Lifestyle Intervention Group ........................................ 74
29 Results of the Wilcoxon Signed Rank Test Comparing Pre and Post Stages of
Change for the Non-Exercisers in the Lifestyle Intervention Group ................................ 74
30 Results of Paired-samples t-test Comparing Pre and Post Behavioral Survey
Scores for the Exercisers in the Personal Training Only Group ....................................... 75
31 Results of Paired-samples t-test Comparing Pre and Post Behavioral Survey
Scores for the Non-Exercisers in the Personal Training Only Group ............................... 75
ix
Table
Page
32 Results of the Wilcoxon Signed Rank Test Comparing Pre and Post Stages of
Change for the Exercisers in the Personal Training Only Group ..................................... 76
33 Results of the Wilcoxon Signed Rank Test Comparing Pre and Post Stages of
Change for the Non-Exercisers in the Personal Training Only Group ............................. 76
x
LIST OF FIGURES
Figure
Page
1
Schematic representation of study timeline and test procedure ........................................ 22
2
Comparison of the mean change in exercise adherence (min/week) from
pre to post between LI and PT .......................................................................................... 46
3
Comparison of the mean change in leisure time physical activity (min/week) from
pre to post between LI and PT .......................................................................................... 47
4
Graph of a comparison of mean total minutes of exercise/week over eight
weeks of personal training for LI and PT groups ............................................................. 48
5
Comparison of change in mean Sit-N-Reach scores between LI and PT ......................... 61
6
Comparison of change in mean V02 Max scores between LI and PT .............................. 61
7
Comparison of change in mean Number of Chair Stands between LI and PT ................. 62
8
Comparison of change in mean Back Scratch Test scores between LI and PT ................ 62
9
Comparison of change in mean Number of Arm Curls between LI and PT..................... 63
10 Comparison of change in mean Shoulder Flexibility scores (in.)
between LI and PT ............................................................................................................ 63
11 Comparison of mean change in Hand Grip Strength (kg.) between LI and PT ................ 64
12 Comparison of mean change in Dynamic Muscular Endurance Test Battery
scores between LI and PT ................................................................................................. 64
13 Comparison of change in mean self-efficacy between LI and PT .................................... 68
14 Comparison of mean change in decisional balance scores between LI and PT................ 68
15 Comparison of change in median stages of change between LI and PT .......................... 69
xi
CHAPTER I
INTRODUCTION
Physical activity is a significant component of health and well-being. It is well known
that physical activity can reduce risks for several chronic diseases, including cardiovascular
disease and type II diabetes, as well as some forms of cancer (Bize, Johnson, & Plotnikoff,
2007). Physical activity can also reduce osteoporotic fractures, falls, symptoms of depression, as
well as improve physical fitness, weight management, cognitive function, and quality of life
(Bize et al., 2007). Despite the known positive benefits of physical activity, American adults are
still not meeting the recommended levels of physical activity. Less than half of adults meet the
2008 Physical Activity Guidelines recommended by the Centers for Disease Control and
Prevention (2012; U.S. Department of Health & Human Services, 2000). Nationally,
approximately 24% do not participate in any physical activity (CDC, 2010). The Behavioral Risk
Factor Surveillance System (BRFSS) reported no significant change in the number of people
participating in regular physical activity (30+ minutes of any physical activity on 5 or more days
of the week) from 1996 to 2000 (CDC, 2010).
In order for physical activity to be beneficial to a person’s health and well-being, exercise
adherence must be maintained. Unfortunately, of the people that do start an exercise program,
approximately 50% dropout after only a short period of time (Buckworth & Dishman, 2002) and
long-term adherence to exercise has been shown to be very poor. In 2008, it was found that adult
adherence to the recommended physical activity levels (at least 150 minutes/week of moderate
intensity exercise) was less than five percent (Troiano, Berrigan, Dodd, Masse, Tilert, &
McDowell, 2008).
1
Many research studies have examined the effectiveness of interventions designed to
increase physical activity and exercise adherence. These interventions often include behavioral
modification components, such as decision-making, feedback, self-monitoring, goal setting,
problem solving, and relapse prevention, among other strategies. A literature review by Leith &
Taylor (1992) examined the potential of behavior modification techniques for promoting
exercise adherence. The majority of quasi-experimental studies examined (15 of 16 studies)
showed that behavioral interventions were effective in improving exercise adherence. In the
experimental research studies examined (n=15), behavioral interventions were moderately
effective in improving exercise adherence (10 of 15 studies). A meta-analysis of interventions
designed to increase physical activity in healthy adults showed that these interventions produced
statistically significant increases in physical activity behavior (Conn, Hafdahl, & Mehr, 2011).
There was an overall mean effect size of 0.19 for comparisons of the treatment groups versus the
control groups with a mean effect size of 0.00. Another meta-analysis examining interventions to
increase physical activity in older adults (Conn, Valentine, & Cooper, 2002), found modest
overall effect sizes (d=0.26 ± .05) when weighted by sample size.
A large body of evidence supports the positive effects of intervention programs to
increase physical activity, however, the majority of the research studies have not controlled for
the nonspecific effect (also known as the Hawthorne effect), or the idea that participants have
positive outcomes for exercise adherence and other health measures because they feel they are
receiving special attention. Therefore, this study was designed to examine the effect of a lifestyle
intervention program on exercise adherence and physical activity behavior while controlling for
the nonspecific effect. The study was conducted within the context of an Exercise Science class
2
designed to teach exercise prescription and personal training skills. In addition, no known studies
have been conducted in the context of an exercise science curriculum.
Problem Statement
The purpose of this study was to examine whether the addition of a lifestyle intervention
program to personal training sessions would improve exercise adherence and physical activity
behavior in adult members of a university-based fitness center.
Hypotheses
1. Participants in the lifestyle intervention group will have improved exercise adherence and
increased physical activity behavior compared to participants in the personal training only
group.
2. Adherence to exercise and physical activity behavior will be increased from pre to post within
both groups.
3. Fitness test scores will be improved from pre to post within groups, but between group
differences will not be significant.
4. Participants in the lifestyle intervention group will have improved posttest self-efficacy,
perceived barriers and benefits, and be placed in higher stages of motivational readiness for
change compared to participants in the personal training only group.
5. Self-efficacy, perceived barriers and benefits, and stages of motivational readiness for change
will improve from pre to post within both groups.
Definition of Terms
Behavioral Modification- The use of change interventions aimed at behavioral antecedents, the
behavior itself, or the behavioral consequences in an attempt to improve exercise adherence
(Leith et al., 1992).
Body Composition- Expressed as the relative percentage of body mass that is fat and fat-free
tissue (American College of Sports Medicine, 2014).
3
Cardiorespiratory Fitness- The ability to perform large muscle, dynamic, moderate-to-high
intensity exercise for prolonged periods (American College of Sports Medicine, 2014).
Decisional Balance- Activities in which advantages and disadvantages of a behavior are
deliberately considered (Conn et al., 2002).
Exercise- A subcategory of physical activity; it is physical activity that is planned, structured,
and repetitive (Marcus & Forsyth, 2009).
Exercise Adherence- The maintained frequency of exercise behavior, measured in minutes/week.
Feedback- Information provided to participants about their exercise behavior (Conn et al., 2002).
Flexibility- The ability to move a joint through its complete range of motion (ACSM guidelines).
Goal Setting- Involves establishing specific, measurable, achievable, realistic and time-targeted
goals to work towards an objective (Conn et al., 2002).
Health Belief Model- Theorizes that an individual’s beliefs about whether or not she or he is
susceptible to disease, and hers or his perceptions of the benefits of trying to avoid it, influence
her or his readiness to act (American College of Sports Medicine, 2014).
MET- Metabolic equivalent; a standardized way to describe the absolute intensity of a variety of
physical activities. Light physical is defined as <3 METs, moderate as 3-<6 METs, and vigorous
as >6 METs (American College of Sports Medicine, 2014).
Personal Training- Individualized exercise prescription that may result in improved body
composition, physical performance, heart condition and health outcomes (Kraemer, 2011).
Physical Activity- Any bodily movement that results in the burning of calories (Caspersen, 1989
as cited in Marcus & Forsyth, 2009).
Physical Fitness- A set of attributes that are either health-related or skill-related that relate to a
person’s ability to perform physical activity (Caspersen et al., 1985).
Relapse Prevention- A cognitive-behavioral approach with the goal of identifying and preventing
high-risk situations, such as a return to an inactive lifestyle (Witkiewitz & Marlatt, 2004).
Self-Determination Theory- Theorizes that individuals have three primary psychosocial needs
that they are trying to satisfy: a) self-determination or autonomy; b) demonstration of
competence or mastery; and c) relatedness or ability to experience meaningful social interactions
with others (American College of Sports Medicine, 2014).
Self-Efficacy- The confidence in one’s ability to successfully perform a particular behavior
(Marcus & Forsyth, 2009).
4
Self-monitoring- Participant self-recording of physical activity, exercise, and exercise behavior
as an intentional component of an intervention (Conn et al., 2002).
Social Ecological Model- Model that suggests that multiple levels of factors influence health
behaviors including intrapersonal factors, social environment factors, physical environments, and
policies (American College of Sports Medicine, 2014).
Stimulus Control- Modification of the environment to cue exercise behavior (Conn et al., 2002).
Strength- The external force that can be generated by a specific muscle or muscle group
(American College of Sports Medicine, 2014).
Social Cognitive Theory- A theory proposed by Albert Bandura that behavior change is affected
by interactions among the environment, personal factors, and attributes of the behavior itself
(Marcus & Forsyth, 2009).
Theory of Planned Behavior- Postulates intention to perform a behavior is the primary
determinant of behavior.
Thought Restructuring- Teaching altered ways of thinking about exercise-phenomenon (e.g.,
coping self-statements; new statements about failure) (Conn et al., 2002).
Transtheoretical Model- An integrative model of behavior change developed from many
different psychological theories including Social Cognitive Theory and the Learning Theory. The
Transtheoretical Model was first described by Dr. James Prochaska and Dr. Carlo DiClemente
(Pekmezi, Barbera, & Marcus, 2010).
Assumptions
1. Participants answered truthfully in all questionnaires and surveys.
2. All student personal trainers followed consistent and accurate procedures for fitness testing.
3. All student personal trainers followed the guidelines for implementing the lifestyle
intervention program.
4. The test instruments were appropriate for the target population and are valid and reliable
measures.
5
Limitations
1. The sample size of interest, members of an adult fitness program at a university fitness center
who volunteered to take part in the student personal training project, is small and may not be
representative of the general population.
2. The study’s length, an eight week intervention, may not be long enough to show a change in
outcome measures.
3. The study does not address long term adherence.
4. The main outcome measures are limited by participant self-report and recall.
Significance
Despite the known positive benefits of physical activity, such as reducing the incidence
rates for several chronic diseases including cardiovascular disease, type 2 diabetes, and some
forms of cancer (Bize, Johnson, & Plotnikoff, 2007), about half of adults in the United States do
not meet the recommendations for physical activity (CDC, 2012). Of the people that do start an
exercise program, a large percentage drop out only after a short period of time, and long-term
adherence to exercise programs are even worse (Dishman, 1988). In order for people to achieve
the many benefits of physical activity, adherence to exercise programs must be maintained.
Although many studies report the effectiveness of lifestyle interventions to increase physical
activity, a gap exists in the current literature in the exploration of interventions that control for
the nonspecific effect, as well as interventions conducted in the context of an Exercise Science
course at the university level. Therefore, the purpose of this study was to examine the effects of
the addition of a lifestyle intervention program to personal training sessions on exercise
adherence and physical activity behavior within the context of a student personal training project
in a senior level Exercise Science class.
6
CHAPTER II
REVIEW OF LITERATURE
Despite well documented evidence that regular exercise can improve quality of life and
reduce risk of chronic disease, most Americans do not meet the recommendations for activity set
by the Centers for Disease Control and Prevention (US Department of Health and Human
Services, 2012). Consequently, much research has been focused on strategies and interventions
to help people begin and maintain an exercise regime. Many of the studies have examined the
effectiveness of lifestyle intervention programs aimed at increasing physical activity. This review
of literature is limited to research studies that include: a) lifestyle intervention programs designed
to increase physical activity, b) lifestyle interventions designed to increase exercise adherence, c)
interventions designed to improve physical fitness outcomes, d) lifestyle intervention programs,
and e) interventions specifically using the Diabetes Prevention Program (DPP) to increase
physical activity and improve health outcomes.
Interventions Designed to Increase Physical Activity
Multiple studies have examined the effectiveness of lifestyle interventions used to
increase physical activity. In a meta-analysis of interventions designed to increase physical
activity among healthy adults, the efficacy of several moderators of physical activity and
exercise adherence were examined (Conn, Hafdahl, & Mehr, 2011). The meta-analysis included
358 research studies totaling 99,011 participants. The purpose of the research was to examine a)
the overall effects of interventions on physical activity behavior after the completion of the
intervention and b) the interventions’ effects on physical activity behavior based on type of
intervention, methodology, and sample characteristics. The interventions were found to be
modestly effective with an overall mean effect size of .19 for comparisons of the treatment
7
groups versus the control groups which had an overall mean effect size of .00 (Conn et al.,
2011). When examining changes from pre to post in the treatment and control groups, the
treatment groups had a mean effect size of .33 compared to a mean effect size of .00 found in the
control groups. These results indicate that the interventions increased overall physical activity
and the control participants showed no increases physical activity.
A meta-analysis examining interventions to increase physical activity in older adults
examined 43 primary research studies with overall physical activity as the outcome variable
(Conn, Valentine, & Cooper, 2002). The purpose of this meta-analysis was to synthesize and
integrate the research findings. This was the first meta-analysis to provide a quantitative review
focusing on older adults. Studies were included if they had at least five participants with a mean
age of 60 years or greater and reported data during the years of 1960-1999. The researchers
examined overall physical activity (total amount of body movement) or episodic exercise
behavior as the outcome variable. Results indicated modest overall effect sizes (d=0.26 ± .05)
when weighted by sample size (Conn et al., 2002). Approximately 60% of the participants in the
treatment groups had higher physical activity scores than the participants in the control groups.
A third meta-analysis also showed positive and moderate effects for interventions aimed
to promote physical activity. Hillsdon, Foster, Thorogood, Kaur, & Wedatilake (2012) analyzed
19 studies that examined the effect of interventions on self-reported physical activity and 11
studies that examined the effect of interventions on cardio-respiratory fitness. The pooled effect
sizes for interventions aimed to promote physical activity were moderate (SMD 0.28, 95% CI
0.15 to 0.41). Measures of physical activity included estimated energy expenditure (kcals/day or
kcals/week), total time of physical activity (mean min/week of moderate physical activity), mean
number of occasions of physical activity over the past four weeks, and a dichotomous measure of
8
physically labeled as active or inactive. The randomized clinical trials examined showed
increases in physical activity from baseline to post-intervention between the treatment and
control groups, as well as increases in physical activity from baseline to post-intervention within
the treatment groups.
Dunn, Marcus, Kampert, Garcia, Kohl, & Blair (1999) compared the effects of a lifestyle
intervention program to a structured exercise program on physical activity and cardiorespiratory
fitness. To assess physical activity, the 7-Day Physical Activity Recall (PAR) survey was used.
This survey estimates total energy expenditure in METs. Both groups in this study showed
significant improvements in physical activity, as well as in cardiorespiratory fitness. Marshall,
Bauman, Owen, Booth, Crawford, & Marcus (2004) also used a questionnaire to assess physical
activity. Their physical activity measure assessed the frequency and duration of walking,
moderate intensity activities, and vigorous intensity activities from the past seven days with the
responses summed into overall physical activity measured in minutes/week. Marshall et al.,
(2004) observed non-significant increases in physical activity from baseline to an 8-month
follow-up in both the intervention and control groups.
A study examining the use of behavioral strategies to improve weight loss outcomes
assessed physical activity with the Paffenbarger Physical Activity Questionnaire (Wing, Crane,
Thomas, Kumar, & Weinberg, 2010). The Paffenbarger Questionnaire estimates total energy
expenditure in kcals/week. In study one, participants in both the standard group and the
behavioral strategy group reported increases in their physical activity (an increase of 800
kcal/week). In study two, participants in the enhanced intervention group also reported increases
in physical activity (Wing et al., 2010).
9
Harland, White, Chinn, Farr, and Howel (1999) examined the effects of a randomized
controlled trial of methods to promote physical activity. Physical activity was measured with the
National Fitness Survey questionnaire. This survey gave each participant a physical activity
score based on the number of reported sessions of moderate/vigorous exercise lasting at least 20
minutes in the last four weeks (Harland et al., 1999). Physical activity scores at 12 weeks were
22% higher in the intervention group compared to the control group, which was not considered
statistically significant.
Similarly, Wolin, Fagin, James, & Early (2012) saw increases in physical activity among
participants who were at risk for colon cancer. Physical activity was measured with a sealed
pedometer (steps/day) and accelerometer (minutes of moderate/vigorous intensity activity) at
baseline and follow-up. Participants in the 30 minutes of walking-based activity group and the 60
minutes of walking-based physical activity group showed increases in their physical activity.
Results showed a mean increase of 1,791 steps/day and 105 minutes/week of moderate/vigorous
activity in both groups with significant differences between groups.
In conclusion, every study examined showed increases in physical activity. However, the
method of assessing physical activity varied by study. Review of this literature reveals the
problems with using physical activity as a measure since there is no agreed upon ‘gold standard’
measure of physical activity. The proposed study used the Modified Activity Questionnaire
(MAQ) to assess physical activity because it is highly validated and easy to administer.
Interventions Designed to Improve Exercise Adherence
The majority of studies reviewed showed increases in exercise adherence. A literature
review by Leith & Taylor (1992) examined the potential of behavior modification techniques to
promote exercise adherence. Of the quasi-experimental studies examined, behavioral
10
interventions were effective in improving exercise adherence in almost every study (15 of 16
studies). Of the experimental research studies examined, behavioral interventions were
moderately effective in improving exercise adherence (10 of 15 studies). Pearson, Burkahrt,
Pifalo, Palaggo-Toy, & Krohn (2005) measured exercise adherence using an interview between
the participant and the exercise physiologist. The exercise physiologist estimated the
participant’s time of aerobic and strength training exercises in minutes/week. Pearson et al.
(2005) used a one-group pre-posttest design with participants who were at risk for osteoporosis.
At baseline, participants averaged 92 minutes of aerobic activity per week and 25% of
participants were already participating in the recommended levels of exercise (150
minutes/week). At eight weeks and six months, participants showed significant improvements in
exercise adherence. At two years, participants maintained levels of exercise adherence that were
achieved at six months.
Socioeconomic status, as indicated by income and education, can significantly impact
exercise adherence and physical activity levels. When one considers Maslow’s hierarchy of
needs, if one’s physiological needs such as hunger, thirst, and bodily comforts are not met, then
one cannot move to the higher levels of needs, such as esteem needs, the need to achieve, to be
competent, and the need to gain approval and recognition (Huitt, 2007). People who struggle
paying for groceries and worry about having enough food are not concerned about how much
exercise they get throughout the week. Authors Dishman, Sallis, & Orenstein (1985) found that
regular adherence to unsupervised exercise is positively associated with educational level and
that having a blue-collar job is negatively associated with participation in supervised exercise.
Similarly, Chinn, White, Harland, Drinwkater, & Raybound (1999) found that specific barriers to
exercise, such as lack of time, lack of money, lack of motivation, etc. were related to income.
11
Barriers, such as lack of motivation and lack of time, were positively related to income, while
barriers such as illness, disability, lack of money, and lack of transport were negatively related to
income (Chinn et al., 1999). Chinn et al. (1999) concluded that this information should be
applied appropriately to interventions promoting physical activity in populations of similar
socioeconomic statuses.
Interventions Designed to Improve Physical Fitness Outcomes
A literature review of behavior modification and exercise adherence showed that only a
small number of the studies examined reported physical fitness scores (Leith et al., 1992). Of the
studies examined, only 7 out of 31 measured individual fitness pre- and posttest. Leith et al.
(1992) reported that these findings were particularly surprising, since the majority of studies
examined discussed one of the main goals of behavioral modification programs as having a
positive effect on physical fitness scores. However, more recently, studies have included a
physical fitness outcome. Hillsdon et al. (2012) reviewed interventions for promoting physical
activity. This review included 11 studies that examined the effect of their intervention on
cardiorespiratory fitness. The pooled effect scores were positive and moderate for
cardiorespiratory fitness (SMD 0.52 95% CI 0.14 to 0.90). Hillsdon et al. (2012) cited a study by
Juneau (1987) that reported increased fitness scores in participants who received consultations,
educational videos, heart rate monitors, and daily physical activity logs compared to the
participants in the control group. Another study cited by Hillsdon et al. (2012) found that women
who received behavioral counseling, support materials, and phone calls were more likely to
increase their fitness scores compared to a group that received advice only (Simons-Morton,
2001).
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Dunn et al. (1999) measured blood pressure, VO2 peak, weight, and percentage of body
fat. In this study, 235 healthy but sedentary participants were randomized into one of two groups:
a lifestyle physical activity program or a structured exercise program. Both groups showed
significant improvements in their physical fitness scores from baseline to 24 months; VO2 peak
scores for the lifestyle group increased by a mean of 0.77 ml/kg/min (p = .002) and for the
structured group, 1.34 ml/kg/min (p < .001). Systolic blood pressure was also reduced by 3.63
mm Hg (p < .001) in the lifestyle group and 3.26 mm Hg (p = .002) in the structured exercise
group. Diastolic blood pressure decreased by 5.38 mm Hg (p < .001) in the lifestyle group and
5.14 mm Hg (p < .001) in the structured group. Significant reductions in body fat percentage
were also observed. The lifestyle group reduced their body fat percentage by 2.39% (p < .001)
and the structured exercise group reduced their body fat percentage by 1.85% (p < .001).
However, neither group saw significant decreases in weight (Dunn et al., 1999). In conclusion,
these studies show that lifestyle interventions, as well as structured exercise programs, can
improve physical fitness.
Lifestyle Intervention Programs
The purpose of this section is to examine lifestyle intervention programs and synthesize
specific components used by those programs. Components of lifestyle intervention programs that
will be examined include: self-monitoring, daily recording of physical activity, feedback, goalsetting, thought restructuring, barriers to exercise, relapse prevention, if a theory was used
(Social Cognitive Theory and/or Transtheoretical Model), exercise prescription, group versus
individual sessions, stimulus control, reinforcement, and problem solving. The synthesis from
meta-analyses and review articles will be examined first, followed by studies implementing
experimental trials.
13
In a meta-analysis examining interventions to increase physical activity among healthy
adults, Conn et al. (2011) found larger effect sizes when the interventions: a) did not use the
social cognitive theory, b) were behavioral interventions instead of cognitive interventions, c)
were face-to-face interventions rather than mediated interventions, and d) targeted individuals
instead of communities. The results indicate moderate effect sizes when the interventions: a) did
not use the Transtheoretical model, b) were provided by the research staff versus a train-thetrainer approach, c) used other strategies to increase physical activity over mass-media
approaches, and d) targeted individuals over entire communities (Conn et al., 2011). Another
meta-analysis by Conn et al. (2002) found larger effect sizes when the interventions: a) targeted
only activity behavior, b) excluded general health education, c) incorporated self-monitoring, d)
used center-based exercise (versus home-based), e) recommended moderate intensity activity, f)
delivered the intervention in groups, g) used intense contact between the interventionist and the
participant, and h) targeted patient populations (Conn et al., 2002).
In a review of interventions for promoting physical activity by Hillsdon, et al. (2012),
some evidence indicates that a mixture of professional guidance, self-direction, and on-going
professional support may lead to improvements in physical activity behavior. Leith et al. (1992)
reviewed studies of behavioral modification and exercise adherence and found that out of the 16
quasi-experimental studies, 15 reported that the behavioral interventions used were effective in
improving exercise adherence. These behavioral interventions used several components
including: reinforcement (11 studies), stimulus control (5 studies), contracting (4 studies),
relapse prevention (2 studies), and an instructional self-management package (2 studies). Of the
experimental studies examined, 11 out of 15 reported that the behavioral interventions were
effective in improving exercise adherence. The types of components used in these interventions
14
included: reinforcement (6 studies), instructional self-management package (5 studies), decision
balance sheets (3 studies), self-monitoring (3 studies), and relapse prevention training (2 studies).
The Diabetes Prevention Program
Among the many lifestyle intervention programs, as described above, one that is relevant
to the current study is the Diabetes Prevention Program (DPP). The purpose of this section is to
examine the DPP randomized trial, to describe in detail the intervention used in the DPP, and to
examine additional studies that used the DPP modules as part of their lifestyle intervention.
The Diabetes Prevention Program randomized trial is an immensely important research
study contributing to the body of knowledge about lifestyle intervention and specifically
designed for diabetes prevention. This was a large randomized clinical trial designed to
investigate the effect of lifestyle intervention strategies compared to a medical approach on
metabolic syndrome. This study examined 3,234 participants with fasting plasma glucose levels
of 5.3-7.0 mmol/L, a 2-hour plasma glucose levels of 7.8-11.1 mmol/L, ages of at least 25 years,
and BMI of at least 24 kg/m² (Diabetes Prevention Program Research Group, 2002). At
baseline, approximately half of the participants had metabolic syndrome. Participants were
randomized into one of three groups: standard lifestyle recommendations plus metformin (850
mg twice per day), standard lifestyle recommendations plus placebo, or an intensive program of
lifestyle intervention. The participants in the intensive lifestyle intervention group received
information and guidance regarding a healthy low calorie diet and physical activity of moderate
intensity, as well as behavior change and cognitive strategies in the instructional DPP modules.
The goals for participants in the intensive lifestyle intervention were to achieve and maintain a
weight loss of seven percent of their initial body weight through diet and engaging in at least 150
minutes of moderate to vigorous physical activity per week. Measures of fasting glucose levels,
15
fasting lipid levels, and waist circumference were taken at six months and annually. Subjects
were followed for an average of 3.2 years. A unique aspect of this research study is that it
included a large sample size that is representative of the United States population, including
whites, Hispanics, African Americans, Native Americans, and Asian Americans. The study’s
results suggested that a lifestyle intervention program may be the best method to prevent and
reduce the incidence of metabolic syndrome. Participants in the lifestyle intervention group had a
reduced incidence of metabolic syndrome by 41% compared to a 17% decrease in incidence in
the metformin group, a very significant finding (Orchard, Temprosa, Goldberg, Haffner, Ratner,
Marcovina, & Fowler, 2005).
An article by the DPP Research group (2002) gives a detailed description of the lifestyle
intervention used in the previously mentioned DPP study (Diabetes Prevention Program
Research Group, 2002). The authors discuss eight key features of the DPP lifestyle intervention:
1) individual life coaches, 2) frequent contact with participants, 3) structured 16-session
curriculum that focused on behavioral strategies for improving weight loss and physical activity,
4) supervised physical activity sessions, 5) a flexible maintenance intervention using group and
individual sessions, motivational campaigns, and “restarts,” 6) individualization through a
“toolbox” of adherence strategies, 7) having materials that address ethnic diversity, and 8) a
substantial network of training, feedback, and clinical support (Diabetes Prevention Program
Research group, 2002). Each of these components is explained in detail in the article (The
Diabetes Prevention Program, 2002).
Due to the significant findings of this study, subsequent studies have attempted to
replicate these results using the DPP modules as part of lifestyle intervention to increase physical
activity through behavioral and cognitive strategies. A meta-analysis of 28 U.S. based studies
16
applying the findings of the DPP was conducted by Ali, Echouffo-Tchequgui, & Williamson
(2012). Results showed that of the studies examined, the average weight loss was approximately
4% of the participant’s baseline weight after 12 months of the intervention. The amount of
weight loss was positively correlated with the number of lifestyle sessions attended by the
participants. Change in weight did not vary when the intervention was delivered by clinically
trained professionals or lay educators. The researchers concluded that the costs of diabetes
prevention can be lowered without sacrificing the effectiveness of the intervention by using nonmedical personnel, as well as by motivating participants to have high program attendance rates
(Ali et al., 2012).
Another study using the DPP modules as part of a lifestyle intervention program was
conducted by Wing et al., (2010). These researchers examined how the addition of behavioral
weight loss strategies affected the outcomes of a community weight loss campaign. The research
involved two different studies: 1) An intervention using video lessons (based on the DPP
modules), and 2) The video lessons (based on the DPP modules) combined with self-monitoring
and automated feedback. All participants were part of the Shape UP RI program, a 12-week
online program for residents of Rhode Island who wanted to improve their health status. In the
first study, 179 participants were randomized into either the standard Shape Up RI program or to
the program plus video lessons on weight loss. These video lessons involved weekly 20 minute
instructions about physical activity, nutrition, and behavior change strategies (goal setting, selfmonitoring, problem solving, and stimulus control). In the second study, 128 participants were
randomized to either the standard group or the enhanced intervention group (Internet behavioral
weight loss lessons with regular self-monitoring and automated feedback). The enhanced
intervention group used regular self-monitoring of diet, activity, and body weight. They received
17
automated feedback that recommended strategies for overcoming barriers and providing positive
reinforcement for behavior change. The results of study one showed that participants in the
intervention group with videos experienced greater weight losses compared to participants in the
standard program, but differences were not significant. The results of study two indicated that
participants in the enhanced intervention group experienced significantly greater weight losses
(3.5 kg +/- 3.8kg) compared to the standard group (1.4 kg +/- 2.7 kg) over the 12 week program.
This enhanced group also reported greater increases in physical activity, daily self-weighing, and
other healthy weight control strategies. It may be concluded from these results that behavioral
strategies used in the DPP such as goal setting, self-monitoring and feedback may play a large
role in increasing physical activity and weight loss and promoting successful behavior change.
Conclusion
In conclusion, there is strong evidence in the literature to support the effectiveness of
lifestyle interventions in promoting physical activity behavior and exercise adherence. There is
also evidence showing that lifestyle intervention programs can improve physical fitness, and
even in some cases, reduce a participant’s risk for disease (Orchard et al., 2005). Specific
components of lifestyle intervention programs such as self-monitoring, feedback, and intense
contact between the interventionist and the participant have shown to be very effective
components of behavioral change strategies. Several studies have supported the efficacy of the
DPP modules, specifically in promoting behavior change and increasing physical activity.
However, most of the lifestyle intervention research has been conducted in a research or clinical
setting. Thus far, no known research on the use of lifestyle interventions in the context of an
Exercise Science curriculum has been published. Therefore, the purpose of this study was to
examine the effects of a lifestyle intervention program using revised DPP modules on exercise
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adherence, physical activity behavior, and fitness in apparently healthy adults in a universitybased fitness center within the context of an Exercise Science curriculum.
19
CHAPTER III
METHODOLOGY
This study examined the effects of adding a lifestyle intervention program to personal
training sessions on exercise adherence and physical activity behavior in adult members of a
university-based fitness center. The study utilized a randomized experimental design and
compared pre- to post-test data between and within groups. The study was conducted as part of
an Exercise Prescription student personal training project. Students majoring in exercise science,
usually in their fourth year of college, served as the student personal trainers who implemented
personal training and/or lifestyle intervention with their clients. Further, by ensuring that both
participant groups received the same amount of attention from their student personal trainers, the
study controlled for the non-specific effect, or the idea that the treatment group improved due to
feelings of receiving special attention.
Participants
Study participants were members of the Indiana University of Pennsylvania Adult Fitness
Program offered by the James G. Mill Fitness Center in Zink Hall. Participants were recruited for
the study after they volunteered to participate in a student personal training project for Exercise
Prescription, a required course for senior level Exercise Science majors. Participants included 4
men and 28 women (n = 32). The James G. Mill Fitness Center requires members to have a
medical clearance including a health history questionnaire and a sign off from the member’s
physician to clear them for exercise. Once the clients agreed to work with the students for the
personal training project, they were prescreened with a demographic survey to see which clients
met the ACSM guidelines for physical activity and were therefore categorized as ‘exercisers’ or
‘non-exercisers.’
20
Participant requirements included the following: 1) Participants had to be a member of
the James G. Mill Fitness Center, 2) Participants had to have volunteered for the student personal
training project, and 3) Participants had to signed an informed consent. Sample consent forms
can be found in Appendices B and C. Participant ages ranged from 21 to 70 years, with a mean
age of 55 years. The sample was fairly homogenous with 100% of the participants being white.
18 of the 32 (56%) of the participants held an occupation in the professional or technical career
during the past year (2012-2013). Approximately 84% of the participants are married. 78% of the
participants live in a household with a gross annual income of $50,000 or more. Over 50% of the
participants have a Master’s degree or higher. All participants attended at least ten sessions with
their student trainers throughout the eight-week program. Figure 1 shows a schematic
representation of the study timeline and general procedures.
21
IRB Approval
Participant Recruitment
Signing of Informed Consent
Randomization into Lifestyle Intervention (LI) vs. Personal
Training Only (PT)
Pre-Intervention Data Collection
LI
Exercisers
Non-exercisers
(n=15)
(n=17)
PT
LI
Intervention
(8 weeks in length, 1 session per week)
Post-Intervention Data Collection
Figure 1. Schematic representation of study timeline and test procedure.
22
PT
General Procedures
This study included a total of ten sessions. These sessions took place at the James G. Mill
Fitness Center. Participant volunteers were randomly assigned to one of two groups: a lifestyle
intervention group (LI) or a personal training only (PT) group. The randomization was stratified
based on the participant’s exercise predisposition. The participants that met the ACSM
guidelines (30 minutes/day, 5 days/week of moderate intensity for the last six months) were
labeled as ‘exercisers’ and the participants that did not meet the ACSM guidelines were labeled
as ‘non-exercisers.’ The LI group included eight exercisers and eight non-exercisers. The PT
group included seven exercisers and nine non-exercisers.
Once participants were randomly assigned to one of the groups, for scheduling purposes,
student personal trainers were informed about which group their client was placed, identified as
group one or group two. Throughout the eight-week program, student personal trainers were
required to attend educational sessions with the principle investigator once weekly for a total of
eight weeks. Students whose clients were in the LI group were given instruction about how to
conduct the lifestyle intervention sessions. Students whose clients were in the PT group were
given additional information about exercise prescription on topics such as stretching, interval
training, cardiorespiratory endurance, etc.
The first exercise session involved the collection of the pre-test data. Student personal
trainers met their clients at the James G. Mill Fitness Center to conduct fitness tests and surveys,
to inform clients about the current research study, and to give clients the informed consent to
sign. The next eight sessions were part of the intervention/personal training and were conducted
by student personal trainers once a week for 45-60 minutes on average. During their exercise
sessions, participants in the LI group received weekly sessions involving behavioral and
23
cognitive strategies on topics such as goal setting, how to increase physical activity levels,
relapse prevention, and self-monitoring. The sessions took place typically during the client’s
warm-up so as to minimize participant burden as well as to control for the non-specific effect.
The sessions were adapted from the Diabetes Prevention Program (DPP) modules. Participants in
the PT group met with their student personal trainers for their weekly exercise sessions without
receiving behavioral or cognitive strategies. Both groups were equal in terms of contact hours
with their trainers. The tenth and final session involved collection of the post-test data. This
study was conducted during the spring semester of 2013, excluding one week for spring break,
and required a ten week commitment. It should be noted that all measurements and testing were
part of a personal training project that participants previously agreed to participate in. Their
consent to participate in the study allowed the primary investigator to use the results of their
measures and testing for the purpose of this research study.
The primary investigator conducted each education session for the student personal
trainers in an advanced Exercise Prescription class. The primary investigator has a B.S. in
Exercise Science and is currently completing a Master’s degree in Sports Science.
Instrumentation
Institute for Healthy Living Medical History Questionnaire
This questionnaire asks clients about their height, weight, birthdate, emergency contact
information, any known disease or medical complications, alcohol consumption, cigarette
smoking, and their main goals for signing up for the program. This questionnaire has been
regularly used for the student personal training project and can be found in Appendix G.
24
Demographic Data Survey
This questionnaire asks clients about their age, gender, race/ethnicity, education, marital
status, employment status, and annual household income. Studies have shown that
socioeconomic status can significantly impact exercise adherence and physical activity behavior
(Dishman, Sallis, & Orenstein, 1985). A letter for permission to this survey can be found in
Appendix E. The Demographic Data Survey can be found in Appendix F.
Modifiable Activity Questionnaire (MAQ)
The Modifiable Activity Questionnaire (MAQ) is a survey that asks participants to
estimate the amount of time spent doing leisure time physical activity as well as occupational
physical activity over the past year. It includes a variety of physical activities such as yard work,
snow skiing, jogging, resistance training, water aerobics, yoga, etc. The survey requires the
participant to determine which months of the year they do each activity. Then, the participant is
asked to estimate the average number of times per month the activity was completed as well as
the average amount of time spent doing that activity in minutes. The average hours of leisure and
occupational activity per week are estimated with a given formula. The MAQ has been found to
be reliable and valid (Vuillemin, Oppert, Guillemin, Essermeant, Fontvieille, Galan, & ...
Hercberg, 2000). The MAQ can be found in Appendix H.
Exercise Adherence
Exercise adherence was assessed weekly throughout the ten week program. During each
exercise session, the student personal trainer recorded the client’s number of exercise sessions
and average minutes per exercise session for the previous week. Additional measures of exercise
adherence and program adherence included whether or not the participants in the LI group were
meeting their weekly behavioral goals, as well as a survey that was conducted at the end of the
25
program asking about session cancellations and the reasoning for those cancellations. However,
data from this survey will not be analyzed for the current study. Exercise adherence was recorded
using an Exercise Log which can be found in Appendix M.
Physical Activity Stages of Change Questionnaire (PASCQ)
The Physical Activity Stages of Change Questionnaire (PASCQ) was developed by
Marcus et al. (1992). It is a binary questionnaire that asks yes/no questions about the
participant’s physical activity. Participants are classified into one of five stages by a scoring
algorithm. The five stages of motivational readiness include pre-contemplation, contemplation,
preparation, action, and maintenance and are based on the Transtheoretical Model (TTM)
developed by Prochaska and DiClemente (1983) (Marcus & Forsyth, 2009). The stages describe
how a person progresses through behavior change. The first stage starts with no intention to
change behavior and the final stage involves changing the behavior and maintaining this change
over time. The PASCQ has been found to be a reliable measure of people’s intentions and actual
behavior in general, not just at the time they are filling out the questionnaire (Marcus, Selby, et
al., 1992). Marcus et al. (1992) found that people fell in the same stage over a 2-week period.
The PASCQ is valid and related to measures of actual physical activity and can be found in
Appendix L (Marcus & Simkin, 1993).
Decisional Balance Questionnaire
This questionnaire was developed from Janis and Mann’s (1977) decision-making theory.
Decisional balance scores tend to correspond to the various stages of motivation readiness (as
determined by the PASCQ). The questionnaire asks clients to rate how important each statement
is in their decision of whether or not to be physically active. It is composed of 16 questions and
each answer ranges from 1 (not at all important) to 5 (extremely important). It is scored by
26
computing the averages of the 10 pro-physical activity items and the 6 con-physical activity
items and then subtracting the con average from the pro average to equal the decisional balance
score. Scores greater than 0 indicate that the client sees more benefits than barriers to being
active. Scores less than 0 indicate that the client sees more barriers than benefits to being active.
Higher scores on the decisional balance measure have been shown to predict increases in
physical activity behavior (Dunn et al., 1997). The Decisional Balance Questionnaire can be
found in Appendix K.
Self-Efficacy for Exercise Scale (SEE)
The Self-Efficacy for Exercise (SEE) scale was adapted from McAuley’s (1990) original
13-time instrument that examined self-efficacy beliefs associated with one’s ability to exercise
despite barriers to exercise. Resnick & Spellbring (2000) revised McAuley’s instrument to
explore the self-efficacy of older adults in relation to a walking program. The SEE measures the
participant’s self-efficacy relating to their exercise behavior. Self-efficacy is the confidence that
once can accomplish a goal. This scale was found to be reliable and valid in older adults by
Resnick & Jenkins (2000). Several studies have shown that self-efficacy relates to physical
activity behavior (Marcus & Forsyth, 2009). According to the Social Cognitive Theory, selfefficacy is the most important mediator of behavior change (Marcus & Forsyth, 2009). No
specific interventions were used in this current study to improve self-efficacy and the measures
were only for pre- and post-test measures. A letter for permission to use this scale can be found
in Appendix D. The SEE can be found in Appendix J.
Physical Fitness Measures
A single stage treadmill test was used by the student trainers to estimate the participant’s
maximal VO2 score. Measures of strength included the following: a 30 Second Chair Stand to
27
assess lower-body strength, an Arm Curl Test to assess upper-body strength, the Hand Grip Test
to assess hand grip strength, and the Dynamic Muscular Endurance Test Battery to assess overall
muscular strength. Measures of flexibility included: the Back Scratch Test to assess upper body
flexibility, a Shoulder Flexibility Test to assess flexibility in shoulder rotation, and the YMCA
Sit and Reach Test to assess lower body flexibility. To measure body composition, waist
circumference and BMI were assessed. The waist circumference was assessed using a Gulick
spring-loaded handle. The Fitness Tests Data Collection form and instructions on how to conduct
each test can be found in Appendix I.
Test Procedures
Physical Activity Behavior
Physical activity behavior was measured with the Modifiable Activity Questionnaire
(MAQ). The students were given instructions on how to conduct the survey and how to calculate
the results in total leisure hours of physical activity per week for the previous three months. The
total leisure hours of physical activity were then computed to total leisure minutes of physical
activity for comparison purposes.
Client Exercise Adherence
Exercise adherence was measured by recording the amount of reported times the client
went to the gym per week and how much time (in minutes) the client spent exercising per week.
The participants in the lifestyle intervention group recorded the number of minutes/day and
days/week spent exercising in their daily log book. Participants were required to bring their daily
log book to each session. During the session, the student personal trainer was responsible for
recording the participant’s daily exercise minutes from the previous week on their data collection
form. The clients in the personal training only group were asked about the amount of reported
28
exercise sessions the client completed per week and how much time (in minutes) the client spent
exercising per session. This number was recorded by the client’s student personal trainer each
session on the data collection sheet (Appendix M). All data collection sheets were collected
weekly by the primary investigator.
Motivational Readiness for Change
To assess participants’ motivational readiness for change, student personal trainers
administered the Physical Activity Stages of Change Questionnaire (PASCQ). They explained to
their client what constitutes as physical activity, such as walking briskly, jogging, bicycling,
swimming, or any other activity that is of similar intensity to these mentioned. The students
asked their clients each question aloud to facilitate opportunity for open discussion regarding the
client response. Students assessed their client’s answers and then identified the client as being in
one of the five stages of change. This information was used solely as a measure to assess pretest
to posttest changes. Specific interventions based on the participant’s stage were not used
(interventions based on the Transtheoretical Model).
Self-Efficacy
To assess the participant’s self-efficacy for exercise, the student personal trainers used
the Self-Efficacy for Exercise (SEE) scale. They asked their client each question aloud, giving
the client time to respond and elaborate on their answer. Student personal trainers were
instructed to ask their clients additional questions based on the client’s response to learn more
information about the client and to establish rapport. This procedure was followed for both preand post-test data collection.
29
Perceived Barriers/Benefits
To obtain a measure of the participants’ perceived benefits and barriers to exercise, the
student personal trainers used the Decisional Balance Questionnaire. The student personal
trainers asked their clients each question individually so as to allow for open discussion about the
questions. This allowed for the student personal trainers to establish a relationship with their
client, as well as to learn more about their client’s exercise habits. This knowledge helped the
student personal trainers to guide their clients to helpful solutions based on the client’s individual
needs.
Physical Fitness Measures
The following tests were conducted by the student personal trainer during the pre- and
post-test sessions: Single Stage Treadmill Test, 30 Second Chair Stand, Arm Curl Test, Shoulder
Flexibility Test, Hand Grip Test, Dynamic Muscular Endurance Test Battery, Back Scratch Test,
and the YMCA Sit and Reach Test. The Single Stage Treadmill Test was used as a measure of
cardiorespiratory fitness. The 30 Second Chair Stand, Arm Curl Test, Hand Grip Test, and the
Dynamic Muscular Endurance Test Battery were used as measures of strength. The Shoulder
Flexibility Test, the Back Scratch Test, and the YMCA Sit and Reach Test were used to assess
flexibility. During pre-test data collection, the student personal trainers measured their client’s
waist circumference with a Gulick spring-loaded handle to assess body composition. Procedures
for baseline measurements complied with the ACSM Guidelines for Exercise Testing and
Prescription, eighth edition (2010). Additionally, the participants’ BMI was recorded for pre and
posttest measures by the student personal trainer. Additionally, the participants’ BMI were
recorded for pre- and post-test measures. The protocol for each fitness test is included in
Appendix I.
30
Train-the-Trainer Sessions
This study utilized the train-the-trainer approach. Two weeks before the eight-week
intervention, the primary investigator met with the students and reviewed the informed consent
form, educated the student personal trainers on the proper fitness testing protocol, gave the
student personal trainers an instructional packet, and reviewed data collection procedures. The
primary faculty instructor was not present during any of these meetings. The primary
investigator met once a week for approximately 15 minutes with each of the student personal
trainer groups (Group One and Group Two). Group education sessions were held for 15 minutes
before and after the Exercise Prescription class. The lifestyle intervention group (Group One)
met before class and the personal training only group (Group Two) met after class. The lifestyle
intervention group received the modified Diabetes Prevention Program (DPP) modules and
instructions on how to implement the lifestyle intervention program. The personal training only
group received articles about different topics in exercise prescription such as flexibility, interval
training, and how to build cardiorespiratory endurance. Students whose clients were in the
personal training only group did not receive any instructions on lifestyle or behavioral
modification strategies. These education sessions were used to review how the previous week’s
session went with the participants, to go over any new information, and to answer any student
questions and concerns. Any student that missed an education session was contacted and a new
meeting was established to review the missed material. During the education sessions, the
student personal trainers brought their data to hand in to the primary investigator. The primary
investigator copied the material and returned it to the students the same day. The primary
investigator entered the data into SPSS no later than three days after initially receiving it.
31
Lifestyle Intervention Sessions
Participants in the lifestyle intervention (LI) group received a total of eight sessions, one
session scheduled per week. These individual sessions took place during the participant’s
exercise session with their student personal trainer. Each exercise session lasted approximately
45-60 minutes. To control for the non-specific effect, the exercise sessions for the LI and PT
group lasted for approximately the same amount of time. For the LI group, the lifestyle
intervention sessions were administered during their warm-up to decrease participant burden.
The exercise sessions generally involved a warm-up, aerobic exercise, resistance training,
flexibility training, and a cool down. All student exercise prescriptions were pre-approved by the
course professor who has a Ph.D in Exercise Physiology and is a fellow of the American College
of Sports Medicine (FACSM).
The first LI session, based on the DPP, is titled “Welcome to the Lifestyle Intervention
Program,” and included: defining the client’s exercise goal, reviewing the expectations of the
client and the interventionist (student personal trainer), reviewing a contract to commit to those
expectations, a schedule for the next seven sessions, and a diary to self-monitor and record
activity and behavior throughout the eight-week intervention. The second session, titled “Move
Those Muscles,” focused on ways to increase planned and unstructured activity, the benefits of
an active lifestyle, how to exercise safely, what to do for injuries, how to stretch, and what type
of shoes to wear. The third session, titled “Take Charge of What’s Around You,” involved
reviewing ways to add positive activity cues, ways to decrease negative activity cues, and goal
setting involving activity cues. The fourth session, titled, “Make Social Cues Work for You,”
reviewed how to add positive social cues, get rid of negative social cues, and goal setting for
social cues. The fifth session, titled “Problem Solving,” discussed the five steps to problem
32
solving, how to brainstorm solutions, how to make an action plan, and goal setting. The sixth
session, titled The Slippery Slope of Lifestyle Change,” defined ‘slips,’ informed the participant
what to do after a ‘slip,’ informed the participant how to combat self-defeating thoughts, and
included goal setting for how to handle slips. The seventh session, titled “Talk Back to Negative
Thoughts,” described the cycle of self-defeat, ways to talk back with a positive thought, and goal
setting for talking back to negative thoughts. The eighth and final session, titled “Ways to Stay
Motivated,” discussed the benefits the participant received thus far from exercise, recognizing
successes, rewarding for successes, how to avoid stress, how to make new goals, and goal setting
for recognizing successes.
Personal Training Only Sessions
Participants in the personal training only (PT) group received a total of eight sessions,
with one session scheduled per week. The sessions were individual sessions and took place
during the participant’s exercise session with their student personal trainer. Each exercise session
lasted approximately 45-60 minutes, the same amount of time as the LI exercise sessions. The
PT group received only personal training sessions and were not given specific behavioral or
cognitive strategies. The personal training sessions generally involved a warm-up, aerobic
exercise, resistance training, flexibility training, and a cool down, similar to the LI group. All
student exercise prescriptions were pre-approved by the course professor.
Data Collection
Participants were pre-screened to assess whether they were eligible to participate in the
study through a demographic survey. This survey asked clients if they have been exercising at
moderate intensity for at least 150 minutes/week, 30 minutes/day, on at least 5 days/week for the
past six months. Each client was assigned a Client ID number to ensure that the client’s research
33
data remained confidential. Baseline or pre-test measures were taken the week before the
personal training and intervention sessions began. These measures included: Demographic Data
Survey, MAQ, Decisional Balance Questionnaire, PASCQ, SEE, Institute for Healthy Living
Medical History Form, waist circumference, Single Stage Treadmill Test, Sit-N-Reach, 30
Second Chair Stand, Back Scratch Test, Arm Curl Test, Shoulder Flexibility Test, Hand Grip
Test, and the Dynamic Muscular Endurance Test Battery. This information was received from
the students within one week from when it was originally collected. The students gave their
client information to the primary investigator at the beginning of their education sessions once a
week. The data were entered into SPSS under the appropriate client identification number no
later than three days after the primary investigator received the information. This procedure was
followed for data collection throughout the eight-week intervention.
During the intervention, all participants met with their student personal trainers at least
eight times and on average, once per week. Participants in the LI group received a lifestyle
intervention session once per exercise session. During these intervention sessions, the clients set
a behavioral goal for the following week. The student personal trainer recorded whether their
client met their behavior goal for the previous week on their data collection sheet.
After the eighth week of exercise sessions and either lifestyle intervention or personal
training sessions only, post-test measures were taken by the student personal trainer and included
the same measures from pre-test except for the Demographic Data Survey and the Institute for
Healthy Living Medical History Form.
Statistical Design
All data analyses were performed using SPSS software (SPSS Inc., Chicago, IL) with a p
value set at .05 for significance. T-tests were conducted to analyze differences between and
34
within groups. More specifically, independent-samples t-tests were calculated for between group
change scores for the following measures: Exercise adherence, physical activity behavior, fitness
test scores, the Decisional Balance Questionnaire, the Physical Activity Stages of Change
(PASQ), and the Self-efficacy for Exercise (SEE) Scale. To examine how participants within
each group changed from pre to post paired-samples t-tests were completed. These pairedsamples t-tests were calculated for the measures: exercise adherence, physical activity behavior,
fitness test scores, the Decisional Balance Questionnaire, and the SEE Scale. To examine how
the participants in each group changed from pre to post in the physical activity stages of change
(motivational readiness), Wilcoxon Signed Rank Tests were used because the statistical data is
ordinal. Descriptive statistics (measures of central tendency) were used to describe the
characteristics of the participants.
Confidentiality
Participation in the study was voluntary and the participants were free to withdraw at any
time without adversely affecting their membership at the James G. Mill Fitness center or their
participation in the student personal training project for Exercise Prescription. The decision to
withdraw would not have resulted in any loss of benefits that they were otherwise entitled to. If
participants chose to participate, they were able to withdraw at any time during the study by
notifying the principle investigator or their student personal trainer. If the student personal trainer
became aware that their client wished to withdraw from the study, the student personal trainer
was instructed to contact the principle investigator no later than one day after receiving the
information. If they chose to participate, all participant information was held in strict confidence
and had no bearing on the services they receive from the James G. Mill Fitness Center. Each
participant was given an identification number that was used when their data was entered into
35
SPSS, thus keeping their name and other information confidential. All records are stored in a
locked facility.
Following the study, individual results may be shared upon request. Results may be
shared with the Exercise Prescription course professor upon request. The information obtained in
the study may be published in scientific journals or presented at scientific meetings, but identity
of individual participants will remain strictly confidential.
36
CHAPTER IV
RESULTS
As described previously in Chapter III (p. 20), participants for this study included 32
volunteers from a university-based fitness center who were apparently healthy or with stable
chronic disease. Selected baseline characteristics for the 32 participants are shown in Tables 1-8.
Approximately half of the participants (n = 15) were considered “Exercisers” and reported
participating in regular physical activity (150 minutes/week, five times/week, 30 minutes/day for
the past six months). The other half of the participants (n = 17) were labeled as Non-Exercisers
because they did not meet the American College of Sports Medicine (ACSM) guidelines for
physical activity. There were no significant between group differences between the lifestyle
intervention (LI) group or the personal training only (PT) group in the baseline measures
reported in Tables 1, 3, 5, and 7 . Both groups included a similar amount of Exercisers and NonExercisers. The baseline characteristics for the Exercisers and the Non-Exercisers are reported in
Tables 2, 4, 6, and 8.
37
Table 1
Selected Baseline Characteristics by Treatment Group
Characteristics
Lifestyle Intervention
(n = 16)
Personal Training Only
(n = 16)
Age, years
53.4 (12.7)
57 (6.2)
Gender, %
87.5% F, 12.5% M
87.5% F, 12.5% M
Weight, lbs
183.9 (48.8)
172.41 (37.8)
BMI, kg/m2
29.99 (5.6)
29.22 (6.4)
Waist Girth, in
36.8 (7.0)
36.1 (6.1)
Resting Heart Rate, bpm
75.0 (9.6)
70.6 (10.4)
Resting Systolic Blood Pressure,
mmHg
126.1 (9.3)
126.4 (13.4)
Resting Diastolic Blood Pressure,
mmHg
78.9 (6.0)
75.6 (8.1)
*BMI indicates body mass index (defined as weight in kilograms divided by the square of height in meters); Waist Girth is the
circumference of the waist at the narrowest part of the torso; Values are mean (SD) unless otherwise noted.
There were no significant between group differences in baseline characteristics.
38
Table 2
Selected Baseline Characteristics by Exercise Predisposition
Characteristics
Exercisers
(n = 15)
Non-exercisers
(n = 17)
Age, years
54.0 (13.6)
56.1 (6.2)
Gender, %
87.5% F, 12.5% M
87.5% F, 12.5% M
Weight, lbs
173.6 (54.9)
182.3 (32.6)
BMI, kg/m2
28.2 (6.5)
30.8 (5.3)
Waist Girth, in
35.8 (6.2)
37.1 (6.9)
Resting Heart Rate, bpm
71.6 (10.8)
73.9 (9.6)
Resting Systolic Blood Pressure,
mmHg
124.7 (11.7)
127.7 (11.2)
Resting Diastolic Blood Pressure,
mmHg
76.7 (6.9)
77.8 (7.6)
*BMI indicates body mass index (defined as weight in kilograms divided by the square of height in meters); Waist Girth is the
circumference of the waist at the narrowest part of the torso; Values are mean (SD) unless otherwise noted.
There were no significant between group differences in the baseline characteristics.
Table 3
Baseline Exercise Adherence and Physical Activity Behavior by Treatment Group
Characteristics
Lifestyle Intervention
(n = 16)
Personal Training Only
(n = 16)
Exercise Time, min/week
164.06 (149.2)
180.31 (102.1)
Total Leisure Time, hours/week
for previous 3 months
7.5 (8.3)
4.48 (4.7)
*Exercise Time is the total minutes of exercise for the week before the intervention started. Values are mean (SD) unless
otherwise noted.
There was no difference between groups on exercise adherence or physical activity
behavior reported at baseline.
39
Table 4
Baseline Exercise Adherence and Physical Activity Behavior by Exercise Predisposition
Characteristics
Exercisers
(n = 15)
Non-exercisers
(n = 17)
Exercise Time, min/week
217.7 (139.7)
132.1 (100.2)
Total Leisure Time, hours/week
for previous 3 months
584.7 (496.9)
158.9 (125.0)
*Exercise Time is the total minutes of exercise for the week before the intervention started. Values are mean (SD) unless
otherwise noted.
There was a statistically significant difference in leisure time physical activity between
groups for the Exercisers (M=584.7, SD = 496.9) and the Non-Exercisers M = 158.9, SD =
125.0; t (30) = 3.42, p = .002 (one-tailed). There is a moderately non-significant difference in
exercise adherence between groups for the Exercisers (M=217.7, SD = 139.7) and the NonExercisers M = 131.1, SD = 100.2; t (30) = 2.01, p = .054 (one-tailed).
Table 5
Baseline Fitness Test Scores by Treatment Group
Characteristics
Lifestyle Intervention
(n = 16)
Personal Training Only
(n = 16)
Estimated V02 Max, ml/kg/min
32.7 (11.7)
31.4 (9.3)
YMCA Sit-N-Reach, in
14.8 (3.0)
14.4 (4.0)
Total Number of Arm Curls
19.6 (3.9)
20.9 (5.0)
Dynamic Muscular Endurance
Test Battery, total repetitions
74 (23.5)
75.19 (22.6)
Hand Grip Strength, kg
57.1 (16.1)
59.8 (12.3)
Shoulder Flexibility, in
28.4 (7.7)
23.6 (9.8)
Back Scratch Test, in
-2.3 (3.8)
-1 (4.4)
Total Number of Chair Stands
15.4 (3.8)
17.9 (6.5)
*Estimated V02max, maximal oxygen consumption; Values are mean (SD) unless otherwise noted.
40
There were no significant between group differences on any physical characteristics
measured at baseline.
Table 6
Baseline Fitness Test Scores by Exercise Predisposition
Characteristics
Exercisers
(n = 15)
Non-exercisers
(n = 17)
Estimated V02 Max, ml/kg/min
36.1 (10.7)
28.5 (9.2)
YMCA Sit-N-Reach, in
15.6 (3.8)
13.9 (3.1)
Total Number of Arm Curls
21.0 (4.8)
19.5 (4.3)
Dynamic Muscular Endurance
Test Battery, total repetitions
83.1 (20.7)
67.1 (22.3)
Hand Grip Strength, kg
59.7 (14.4)
57.3 (14.3)
Shoulder Flexibility, in
26.9 (10.7)
25.1 (7.6)
Back Scratch Test, in
-1.7 (4.7)
-1.6 (3.6)
Total Number of Chair Stands
15.9 (4.0)
17.1 (6.4)
*Estimated V02max, maximal oxygen consumption; Values are mean (SD) unless otherwise noted.
There was a statistically significant difference in V02 Max between groups for the
Exercisers (M=36.1, SD = 10.7) and the Non-Exercisers M = 28.5, SD = 9.2; t (28) =2.09, p =
.046 (one-tailed). There was a statistically significant difference in total amount of repetitions
performed on the Dynamic Muscular Endurance Test Battery between groups for the Exercisers
(M=83.1, SD = 20.7) and the Non-Exercisers M = 67.1, SD = 22.3; t (30) = 2.11, p = .044 (onetailed). All other fitness tests showed no significant between group differences.
41
Table 7
Baseline Behavioral Measures by Treatment Group
Characteristics
Lifestyle Intervention
(n = 16)
Personal Training Only
(n = 16)
Self-Efficacy
6.6 (2.4)
7.2 (1.8)
Decisional Balance
2.7 (1.3)
2.1 (1.1)
Stages of Change
3.8 (1.4)
4.5 (.9)
Values are mean (SD) unless otherwise noted.
There were no between group differences on any behavioral measures assessed at
baseline.
Table 8
Baseline Behavioral Measures by Exercise Predisposition
Characteristics
Exercisers
(n = 15)
Non-Exercisers
(n = 17)
Self-Efficacy
7.2 (2.5)
6.5 (1.7)
Decisional Balance
2.7 (1.4)
2.1 (0.9)
Stages of Change
4.8 (0.8)
3.6 (1.2)
Values are mean (SD) unless otherwise noted.
There was a statistically significant difference in motivational readiness between groups
for the Exercisers (M=4.8, SD = 0.8) and the Non-Exercisers M = 3.6, SD = 1.2; t (30) =3.28, p
= .003 (one-tailed). There were no significant between group differences for self-efficacy or
perceived barriers and benefits.
The study’s hypotheses are identified below and are accompanied by a description of the
statistical procedures applied. A brief summary of the results and their significance are also
presented. Significance levels were set at p < .05. Effect sizes are also presented to indicate the
magnitude of the differences found in the results. Values for eta squared range from a small
42
effect size, described as .01, to moderate effect size of .06, and a large effect size, described as
.14 (Pallant, 2007, p. 236).
Hypothesis 1
It was hypothesized that the participants in the lifestyle intervention (LI) group would
have improved exercise adherence and increased physical activity behavior compared to
participants in the personal training only (PT) group. To assess the between group differences on
measures of exercise adherence and physical activity behavior, exercise adherence was reported
in exercise minutes per week and physical activity behavior was calculated from the participant
responses on the Modifiable Activity Questionnaire (MAQ) in average hours per week of leisure
time physical activity which was then computed to minutes per week for comparison purposes.
An independent-samples t-test was conducted to evaluate the effect of the eight-week
intervention on participant’s change in exercise minutes per week, as well as leisure time
physical activity from pre to post. Results from the independent-samples t-test are presented in
Table 9 and represented in Figures 2-4.
Table 9
Results of Independent-samples t-test Comparing Change in Exercise Minutes and Leisure Time
Activity from Pre to Post by Treatment Group
Treatment
Mean
SD
t
df
Sig. (1Eta
tailed)
Squared
Exercise
(min/week)
Leisure physical
activity
(min/week)
LI
44.22
75.58
PT
-17.67
97.87
LI
-65.18
397
PT
70.43
311.1
43
1.98
29
.029
.119
-1.08
30
.291
.04
An independent-samples t-test evaluated the impact of the eight-week intervention on the
LI versus the PT group’s change from pre to post in exercise minutes per week and leisure time
physical activity measured in minutes per week. There was a statistically significant change in
the exercise minutes per week from pre to post between groups for the LI group (M=44.22, SD =
75.58) and PT group M = -17.67, SD = 97.87; t (29) =1.98, p = .029 (one-tailed). This result is
consistent with the hypothesis. The overall effect size was .119, indicating a moderate to large
effect, also supporting that the LI group reported improved exercise adherence. There was no
significant difference in leisure time physical activity in scores for the LI group (M = -65.18, SD
= 397) and the PT group M = 70.43, SD = 311.1; t (30) = -1.08, p = .291 (one-tailed). There was
a small effect size (eta = .04), indicating that there was little difference in physical activity
behavior between groups. This result is not consistent with the hypothesis.
An additional analysis was conducted to further investigate if exercise predisposition was
a factor in the change in exercise adherence and physical activity behavior. Results of this
additional analysis are presented in Table 10.
44
Table 10
Results of Independent-samples t-test Comparing Change in Exercise Minutes and Leisure Time
Activity from Pre to Post by Exercise Predisposition
Exercise
Mean
SD
t
df
Sig. (2Eta
Predisposition
tailed)
Squared
Exercise
(min/week)
Leisure physical
activity
(min/week)
Exercisers
5.36
88.26
NonExercisers
Exercisers
33.27
104.91
-69.24
505.93
Non-
66.04
120.76
-0.75
25
.460
.022
-1.01
30
.328
.033
Exercisers
An additional analysis was conducted to further investigate if exercise predisposition was
a factor in the change in exercise adherence and physical activity behavior. In this analysis, an
independent-samples t-test evaluated the impact of the eight-week intervention on the Exercisers
versus the Non-Exercisers’ change from pre to post in exercise minutes per week and leisure
time physical activity measured in minutes per week. There was no statistically significant
change in the exercise minutes per week from pre to post between groups for the Exercisers
(M=5.36, SD = 88.26) and Non-Exercisers M = 33.27, SD = 104.91; t (25) = -0.75, p = .460
(two-tailed). The overall effect size was .022, indicating a small effect. There was no significant
difference in leisure time physical activity in scores for the Exercisers (M = -69.24 SD = 505.93)
and the Non-Exercisers M = 66.04, SD = 120.76; t (30) = -1.01, p = .328 (two-tailed). There was
a small effect size (eta = .033), indicating that there was little difference in physical activity
behavior between groups.
45
Mean Exercise min/week vs. Treatment Group
Mean Exercise min/week
230.0
221.25
172.5
182.69
170.36
166.92
115.0
57.5
.0
LI
PT
Treatment Group
Pre Exercise (min/week)
Post Exercise (min/week)
Figure 2. Comparison of the mean change in exercise adherence (min/week) from pre to post
between LI and PT. Standard deviations are reported in Tables 11 and 12.
46
Mean Leisure Time (min/week)
Mean Lesiure Time (min/week) vs. Treatment Group
500
447
375
383
339
250
269
125
0
Lifestyle Intervention
Personal Training Only
Treatment Group
Pre Leisure Time (min/week)
Post Leisure Time (min/week)
Figure 3. Comparison of the mean change in leisure time physical activity (min/week) from pre
to post between LI and PT. Standard deviations are reported in Tables 11 and 12.
47
Mean Exercise Min/Week vs. Time
239
240
214
208
Mean Exercise Time (min/week)
194
180
180 164
174
162
157
154
120
60
0
Week 0 (Pre)
Week 2
Week 4
Week 6
Week 9 (Post)
Time
Lifestyle Intervention
Personal Training Only
Figure 4. Graph of a comparison of mean total minutes of exercise/week over eight weeks of
personal training for LI and PT groups.
This graph shows how the mean total minutes of exercise per week changed over time for
both the lifestyle intervention group and the personal training only group. Before the
intervention, the personal training only group reported a higher amount of exercise minutes/week
compared to the lifestyle intervention group. Over time, the lifestyle intervention group’s
exercise time minutes/week showed a general increase in minutes/week, whereas the personal
training only group’s exercise time showed a general non-significant decrease in minutes/week.
The lifestyle intervention group showed a significant increase in exercise minutes/week from pre
to post.
48
Hypothesis 2
The second research hypothesis examined the within group differences on measures of
exercise adherence and physical activity behavior. It was hypothesized that these measures
would increase from pre to post within each group. A paired-samples t-test was conducted to
examine within group differences. Results are presented in Tables 11 and 12 for each treatment
group.
Table 11
Results of Paired-samples t-test Comparing Pre and Post Exercise Minutes and Leisure Time
Activity for the Lifestyle Intervention Group
Mean
SD
t
df
Sig. (1Eta Squared
tailed)
Exercise (min/
week 0)
164.06
149.18
Exercise (min/
week 9)
208.28
132.63
Pre Leisure
min/week
447.98
496.84
Post Leisure
min/week
382.8
321.25
2.34
15
.017
.267
-0.657
15
.261
.028
A paired-samples t-test was used to analyze the impact of the eight-week intervention on
the LI group’s change from pre to post in weekly exercise and leisure time physical activity
measured in minutes per week. There was a significant difference in the minutes of exercise per
week from pre (M = 164.06, SD = 149.18) to post (M = 208.28, SD = 132.63), t (15) = 2.34, p =
.017 (one-tailed). The effect size was very large (eta squared = .267). This result is consistent
with the hypothesis. There was no significant difference in total leisure time physical activity
from pre (M = 447.98, SD = 496.84) to post (M = 382.8, SD = 321.25, t (15) = -0.657, p = .028
49
(one-tailed). The effect size was very small (eta squared = .028). This result is not consistent
with the hypothesis.
Table 12
Results of Paired-samples t-test Comparing Pre and Post Exercise Minutes and Leisure Time
Activity for the Personal Training Only Group
Mean
SD
t
df
Sig. (1Eta Squared
tailed)
Exercise (min/
week 0)
172.33
100.39
Exercise (min/
week 9)
154.67
73.64
Pre Leisure
min/week
269.06
282.03
Post Leisure
min/week
339.49
301.69
0.699
14
.248
.034
0.906
15
.19
.052
A paired-samples t-test was also used to evaluate the impact of the eight-week
intervention on the PT group’s change from pre to post in weekly exercise and leisure time
physical activity measured in minutes per week. There was no significant difference in the
minutes of exercise per week from pre (M = 172.33, SD = 100.39) to post (M = 154.67, SD =
73.64), t (14) = 0.699, p = .248 (one-tailed). The effect size was very small (eta squared = .034).
There was no significant difference in the total leisure time of physical activity from pre (M =
269.06, SD = 282.03) to post (M = 339.49, SD = 301.69) t (15) = 0.906, p = .19 (one-tailed). The
effect size was very small (eta squared = .052). These results are not consistent with the
hypothesis.
An additional analysis was conducted to further investigate if exercise predisposition was
a factor in 1) the change in exercise adherence and physical activity behavior within the
50
Exercisers in the LI group, 2) the change in these measures within the Non-Exercisers in the LI
group, 3) the change in these measures within the Exercisers in the PT group, and 4) the change
in these measures within the Non-Exercisers in the PT group. Results of these additional
analyses are presented in Tables 13, 14, 15, and 16.
Table 13
Results of Paired-samples t-test Comparing Pre and Post Exercise Minutes and Leisure Time
Activity for the Exercisers in the Lifestyle Intervention Group
Mean
SD
t
df
Sig. (1Eta Squared
tailed)
Exercise (min/
week 0)
241.25
171.73
Exercise (min/
week 9)
267.5
152.55
Pre Leisure
min/week
728.55
579.76
Post Leisure
min/week
567.23
354.46
-1.04
7
.1665
.134
0.82
7
.219
.088
First, a paired-samples t-test was used to analyze the impact of the eight-week
intervention on the Exercisers in the LI group’s change from pre to post in weekly exercise and
leisure time physical activity measured in minutes per week. There was no significant difference
in the minutes of exercise per week from pre (M = 241.25, SD = 171.73) to post (M = 267.50,
SD = 152.55), t (7) = -1.04, p = .1665 (one-tailed). The effect size was moderate to large (eta
squared = .134). There was no significant difference in total leisure time physical activity from
pre (M = 728.55, SD = 579.76) to post (M = 567.23, SD = 354.46, t (7) = 0.82, p = .219 (onetailed). The effect size was very small (eta squared = .088).
51
Table 14
Results of Paired-samples t-test Comparing Pre and Post Exercise Minutes and Leisure Time
Activity for the Non-Exercisers in the Lifestyle Intervention Group
Mean
SD
t
df
Sig. (1Eta Squared
tailed)
Exercise (min/
week 0)
86.88
67.66
Exercise (min/
week 9)
149.06
80.04
Pre Leisure
min/week
167.4
113.6
Post Leisure
min/week
198.38
133.28
-2.2
7
.032
.409
-0.94
7
.1905
.112
In a second analysis, a paired-samples t-tests was used to analyze the impact of the eightweek intervention on the Non-Exercisers in the LI group’s change from pre to post in weekly
exercise and leisure time physical activity measured in minutes per week. There was a
statistically significant increase in the minutes of exercise per week from pre (M = 86.88, SD =
67.66) to post (M = 149.06, SD = 80.04), t (7) = -2.20, p = .032 (one-tailed). The effect size was
large (eta squared = .409). There was as non-significant increase in total leisure time physical
activity from pre (M = 167.40, SD = 113.60) to post (M = 198.38, SD = 133.28, t (7) = -0.094, p
= .1905 (one-tailed). The effect size was moderate (eta squared = .112).
52
Table 15
Results of Paired-samples t-test Comparing Pre and Post Exercise Minutes and Leisure Time
Activity for the Exercisers in the Personal Training Only Group
Mean
SD
t
df
Sig. (2Eta Squared
tailed)
Exercise (min/
week 0)
190.71
97.66
Exercise (min/
week 9)
176.43
67.74
Pre Leisure
min/week
420.34
353.49
Post Leisure
min/week
456.34
420.91
0.39
6
.709
.025
-0.206
6
.844
.007
A paired-samples t-tests was used to analyze the impact of the eight-week intervention on
the Exercisers in the PT group’s change from pre to post in weekly exercise and leisure time
physical activity measured in minutes per week. There was no significant difference in the
minutes of exercise per week from pre (M = 190.71, SD = 97.66) to post (M = 176.43, SD =
67.74), t (6) = 0.39, p = .709 (two-tailed). The effect size was very small (eta squared = .025).
There was no significant difference in total leisure time physical activity from pre (M = 420.34,
SD = 353.49) to post (M = 456.34, SD = 420.91, t (6) = -0.206, p = .844 (two-tailed). The effect
size was very small (eta squared = .007).
53
Table 16
Results of Paired-samples t-test Comparing Pre and Post Exercise Minutes and Leisure Time
Activity for the Non-Exercisers in the Personal Training Only Group
Mean
SD
t
df
Sig. (2Eta Squared
tailed)
Exercise (min/
week 0)
156.25
106.53
Exercise (min/
week 9)
135.63
77.62
Pre Leisure
min/week
151.4
140.81
Post Leisure
min/week
248.6
128.62
0.553
7
.597
.042
-2.106
8
.068
.357
A paired-samples t-tests was used to analyze the impact of the eight-week intervention on
the Non-Exercisers in the PT group’s change from pre to post in weekly exercise and leisure time
physical activity measured in minutes per week. There was no significant difference in the
minutes of exercise per week from pre (M = 156.25, SD = 106.53) to post (M = 135.63, SD =
77.62), t (7) = 0.553, p = .597 (two-tailed). The effect size was very small (eta squared = .042).
There was a marginally non-significant increase in total leisure time physical activity from pre
(M = 151.4, SD = 140.81) to post (M = 248.6, SD = 128.62, t (8) = -2.106, p = .068 (two-tailed).
The effect size was very large (eta squared = .357).
Hypothesis 3
The third hypothesis examined between group differences on measures of physical
fitness, including the following tests: Single Stage Treadmill Test, YMCA Sit-N-Reach, 30
Second Chair Stand, Back Scratch Test, Arm Curl Test, Shoulder Flexibility Test, Hand Grip
Test, and the Dynamic Muscular Endurance Test Battery. It was hypothesized that physical
54
fitness would be improved from pre to post within groups, but that between group differences
would not be significant. The Single Stage Treadmill Test is a measure of cardiorespiratory
endurance based on the participant’s estimated V02Max in ml/kg/min. The YMCA Sit-N-Reach
is a measure of lower body flexibility and is reported in inches. The 30 Second Chair Stand is a
measure of lower body strength and is measured in total repetitions. The Back Scratch Test is a
measure of upper body flexibility and is measure in inches. Back scratch test scores are positive
if the participant’s hands are overlapping and negative if participant’s hands are not touching.
The Arm Curl Test is a measure of upper body strength and is measured in the total amount of
repetitions the participant can complete in 30 seconds. The Shoulder Flexibility Test is a measure
of upper body flexibility and is measured in inches. The lower score indicates better shoulder
flexibility. The Hand Grip Test is a measure of grip strength and is measured in total kilograms
for both the best right hand and left hand scores. The Dynamic Muscular Endurance Test Battery
is a series of resistance training exercises and measures total body muscular endurance in total
repetitions.
Results from paired-samples t-tests and the independent-samples t-test are presented in
Tables 17-19 and represented in Figures 5-12.
55
Table 17
Results of Paired-samples t-test Comparing Pre and Post Fitness Test Scores for the Lifestyle
Intervention Group
Mean
SD
T
df
Sig. (1Eta Squared
tailed)
Pre Sit-N-Reach (in.)
14.8
2.99
Post Sit-N-Reach (in.)
16.25
3.09
Pre V02Max (ml/kg/min)
32.66
11.69
Post V02Max (ml/kg/min)
33.15
10.01
Pre Number of Chair Stands
15.38
3.79
Post Number of Chair Stands
23.44
4.69
Pre Back Scratch Test (in.)
-2.34
3.8
Post Back Scratch Test (in.)
-0.97
3.69
Pre Number of Arm Curls
19.56
3.99
Post Number of Arm Curls
23.44
5.61
Pre Shoulder Flexibility (in.)
28.38
7.65
Post Shoulder Flexibility (in.)
25.26
7.54
Pre Hand Grip Strength (kg.)
57.06
16.06
Post Hand Grip Strength (kg.)
61.38
16.58
Pre Dynamic Muscular
Endurance Total Repetitions
74
23.52
Post Dynamic Muscular
Endurance Total Repetitions
81.81
23.46
56
-2.82
14
.007
.362
-0.428
15
.338
.012
-1.88
15
.04
.191
-1.39
15
.092
.114
-5.23
15
p < .001
.646
1.94
14
.0365
.212
-2.76
15
.0075
.337
-2.951
15
.005
.367
A paired-samples t-test evaluated the impact of the eight-week intervention on the
lifestyle intervention group’s change from pre to post in several fitness test scores. All fitness test
scores significantly improved from pre to post except for the estimated V02Max and the Back
Scratch Test as seen above in Table 8. All fitness test scores except for the estimated V02Max
showed a very large effect size. The estimated V02Max increased but it was not significant (p=
.338). These results are consistent with the hypothesis.
57
Table 18
Results of Paired-samples t-test Comparing Pre and Post Fitness Test Scores for the Personal
Training Only Group
Mean
SD
T
df
Sig. (1Eta Squared
tailed)
Pre Sit-N-Reach (in.)
14.43
4.02
Post Sit-N-Reach (in.)
17
3.25
Pre V02Max (ml/kg/min)
31.19
9.64
Post V02Max (ml/kg/min)
32.06
7.69
Pre Number of Chair Stands
17.87
6.53
Post Number of Chair Stands
20.73
5.82
Pre Back Scratch Test (in.)
-1
4.4
Post Back Scratch Test (in.)
-1.81
4.13
Pre Number of Arm Curls
20.88
5.05
Post Number of Arm Curls
25.38
6.7
Pre Shoulder Flexibility (in.)
23.63
9.85
Post Shoulder Flexibility (in.)
20.47
7.35
Pre Hand Grip Strength (kg.)
59.84
12.29
Post Hand Grip Strength (kg.)
64.56
13.1
Pre Dynamic Muscular
Endurance Total Repetitions
75.19
22.59
Post Dynamic Muscular
Endurance Total Repetitions
85.13
17.97
-4.14
14
.0005
.550
-0.622
12
.273
.027
-4.25
14
.0005
.563
1.81
15
.0455
.179
-4.72
15
< .001
.598
1.37
15
.095
.111
-3.15
15
.0035
.398
-3.92
15
.0005
.506
A paired-samples t-test evaluated the impact of the eight-week intervention on the PT
group’s change from pre to post in several fitness test scores. All fitness test scores significantly
improved from pre to post except for the estimated V02Max and the Back Scratch Test as seen in
58
Table 9. These results are consistent with the hypothesis. All fitness test scores except for the
estimated V02Max and the Back Scratch Test showed a very large effect size. The estimated
V02Max increased but was not significant (p= .273) and showed a very small effect size (eta
squared = .05). The Back Scratch Test scores did not show improvement and showed a very
large effect size.
59
Table 19
Results of Independent-samples t-test Comparing Change in Fitness Test Scores from Pre to Post
by Treatment Group
Treatment
Mean
SD
t
df Sig. (2Eta
tailed) Squared
Sit-N-Reach (in.)
V02Max
(ml/kg/min)
Number of Chair
Stands
Back Scratch Test
(in.)
Number of Arm
Curls
Shoulder
Flexibility (in.)
Hand Grip
Strength (kg.)
Dynamic
Muscular
Endurance Total
Repetitions
LI
1.45
1.99
PT
2.53
2.37
LI
0.491
4.59
PT
0.87
4.8
LI
2.19
4.67
PT
2.87
2.61
LI
1.38
3.95
PT
-0.81
1.8
LI
3.88
2.96
PT
4.5
3.81
LI
-3.13
6.25
PT
-3.16
9.2
LI
4.31
6.25
PT
4.72
5.99
LI
7.81
10.59
PT
9.94
10.15
-1.36
28
.186
.062
-0.221
28
.827
.002
-0.5
29
.624
.009
2.02
30
.053
.12
-0.52
30
.608
.009
0.01
29
.992
.000
-0.19
30
.852
.001
-0.58
30
.567
.011
An independent-samples t-test evaluated the impact of the eight-week intervention on the
LI group’s versus the PT group’s change from pre to post in fitness test scores. There were no
significant between group differences. There was a small effect size for the all of the tests except
60
for the YMCA Sit-N-Reach Test and the Back Scratch Test. The YMCA Sit-N-Reach Test (eta
squared = .062) and the Back Scratch Test (eta squared = .12) both showed moderate effect sizes.
These results are consistent with the hypothesis.
Sit-N-Reach Scores vs. Treatment Group
Sit-N-Reach (in.)
19.00
14.25
14.8
17.0
16.3
14.4
9.50
4.75
.00
Lifestyle Intervention
Personal Training Only
Treatment Group
Pre Sit-N-Reach (in.)
Post Sit-N-Reach (in.)
Figure 5. Comparison of change in mean Sit-N-Reach scores between LI and PT. Standard
deviations are reported in Tables 17 and 18.
V02 Max Scores vs. Treatment Group
V02 Max (ml/kg/min)
35.00
32.66
33.15
31.39
26.25
32.26
17.50
8.75
.00
Lifestyle Intervention
Personal Training Only
Treatment Group
Pre V02Max (ml/kg/min)
Post V02Max (ml/kg/min)
Figure 6. Comparison of change in mean V02 Max scores between LI and PT. Standard
deviations are reported in Tables 17 and 18.
61
Number of Chair Stands
Number of Chair Stands vs. Treatment Group
30.0
22.5
23.44
20.73
15.0
17.87
15.38
7.5
.0
Lifestyle Intervention
Personal Training Only
Treatment Group
Pre Number of Chair Stands
Post Number of Chair Stands
Figure 7. Comparison of change in mean Number of Chair Stands between LI and PT. Standard
deviations are reported in Tables 17 and 18.
Back Scratch Test Scores
(in.)
Back Scratch Scores vs. Treatment Group
.00
-1.25
-.97
-1.00
-2.34
-1.81
-2.50
-3.75
-5.00
Lifestyle Intervention
Personal Training Only
Treatment Group
Pre Back Scratch Test (in.)
Post Back Scratch Test (in.)
Figure 8. Comparison of change in mean Back Scratch Test scores between LI and PT. Standard
deviations are reported in Tables 17 and 18.
62
Mean Number of Arm Curls
Mean Number of Arm Curls vs. Treatment Group
27.00
25.38
23.44
20.25
20.88
19.56
13.50
6.75
.00
Lifestyle Intervention
Personal Training Only
Treatment Group
Pre Number of Arm Curls
Post Number of Arm Curls
Figure 9. Comparison of change in mean Number of Arm Curls between LI and PT. Standard
deviations are reported in Tables 17 and 18.
Mean Shoulder Flexibility
Score (in.)
Mean Shoulder Flexibility Score vs. Treatment Group
30.0
22.5
28.38
25.26
23.63
15.0
20.47
7.5
.0
Lifestyle Intervention
Personal Training Only
Treatment Group
Pre Shoulder Flexibility
Post Shoulder Flexibility
Figure 10. Comparison of change in mean Shoulder Flexibility scores (in.) between LI and PT.
Standard deviations are reported in Tables 17 and 18.
63
Mean Hand Grip Strength
(kg.)
Mean Hand Grip Strength vs. Treatment Group
70.0
52.5
57.06
61.38
59.84
64.56
35.0
17.5
.0
Lifestyle Intervention
Personal Training Only
Treatment Group
Pre Hand Grip Strength (kg.)
Post Hand Grip Strength (kg.)
Figure 11. Comparison of mean change in Hand Grip Strength (kg.) between LI and PT.
Standard deviations are reported in Tables 17 and 18.
Mean Dynamic Muscular Battery
Score
Mean Muscular Test Battery vs. Treatment Group
90.0
67.5
85
82
75
74
45.0
22.5
.0
Lifestyle Intervention
Personal Training Only
Treatment Group
Pre Dynamic Muscular Endurance Test Battery
Post Dynamic Muscular Endurance Test Battery
Figure 12. Comparison of mean change in Dynamic Muscular Endurance Test Battery scores
between LI and PT. Standard deviations are reported in Tables 17 and 18.
64
Hypothesis 4
The fourth hypothesis examined between group differences on measures of behavioral
surveys, including: Self-efficacy, perceived barriers and benefits, and motivational readiness for
change. The Self-efficacy for Exercise Scale measures the participant’s confidence in their
ability to exercise and scores can range from zero, indicating very low confidence, to ten,
indicating very high confidence. The Decisional Balance Questionnaire examines participant’s
perceived barriers and benefits towards exercise and scores can range from a -4.0, indicating that
a participant sees more barriers to exercise, and 4.0, indicating that a participant sees more
benefits to exercise. The Physical Activity Stages of Change Questionnaire measures
motivational readiness for change and places participants into five stages of change. The first
stage indicates that the participant is not even thinking about starting to exercise and stage five
indicates that the participant has been regularly exercising for at least six months. It was
hypothesized that participants in the lifestyle intervention group would have improved selfefficacy, perceived barriers and benefits, and be placed in higher stages of motivational readiness
compared to the participants in the personal training only group. An independent-samples t-test
analyzed the effect of the eight-week intervention on between group changes in behavioral
scores from pre to post. Results from the independent-samples t-test are presented in Table 20
and represented in Figures 13-15.
65
Table 20
Results of Independent-samples t-test Comparing Change in Behavioral Survey Scores from Pre
to Post by Treatment Group
Treatment
Mean
SD
t
df
Sig. (1Eta
tailed)
Squared
Self-Efficacy
Decisional
Balance
Stages of Change
LI
1.42
2.2
PT
0.00
1.65
LI
-0.1
1.17
PT
0.01
1.15
LI
0.75
1.06
PT
0.25
0.77
2.06
30
.025
.124
-0.27
30
.40
.002
1.52
27.41
.07
.071
An independent-samples t-test evaluated the impact of the eight-week intervention on the
LI group’s versus the PT group’s change from pre to post in behavioral survey scores. There was
a statistically significant difference in the mean change in self-efficacy from pre to post between
groups for the LI group (M=1.42, SD = 2.2) and PT group M = 0.00, SD = 1.65; t (30) =2.06, p =
.025 (one-tailed). There was a moderate to large effect size (eta squared = .124). The results are
consistent with the hypothesis. There was no significant difference in the mean change in
decisional balance from pre to post between groups for the LI group (M=-0.1, SD = 1.17) and PT
group M = 0.01, SD = 1.15; t (30) = -0.27, p = .40 (one-tailed). The effect size was very small
(eta squared = .002). There was no significant between group difference for the change in
motivational readiness from pre to post for the LI group (M= 0.75, SD = 1.06) and PT group M =
0.25, SD = 0.77; t (27.41) = 1.52, p = .07 (one-tailed). Motivational readiness was marginally
non-significant (p= .07) with a small effect size (eta squared = .071). These results are not
consistent with the hypothesis.
66
An additional analysis was conducted to further investigate if exercise predisposition was
a factor in the change in self-efficacy, decisional balance, and motivational readiness between
the LI and PT groups. Results of this additional analysis are presented in 21.
Table 21
Results of Independent-samples t-test Comparing Change in Behavioral Survey Scores from Pre
to Post by Exercise Predisposition
Exercise
Mean
SD
t
df
Sig. (2Eta
Predisposition
tailed)
Squared
Self-Efficacy
Decisional
Balance
Stages of
Change
Exercisers
0.7
2.59
Non-Exercisers
0.72
1.49
Exercisers
-0.28
1.21
Non-Exercisers
0.17
1.08
Exercisers
0.2
0.77
Non-Exercisers
0.76
1.03
-0.02
30
.986
.000
-1.1
30
.280
.039
-1.73
30
.094
.091
An independent-samples t-test evaluated the impact of the eight-week intervention on the
Exercisers versus the Non-Exercisers change from pre to post in behavioral survey scores. There
were no statistically significant differences in the mean change in self-efficacy, perceived
barriers and benefits, and motivational readiness for change. However, the Non-Exercisers did
show more improvement compared to the Exercisers on all behavioral measures. The change in
self-efficacy from pre to post between groups for the Exercisers (M=0.70, SD = 2.59) and NonExercisers M = 0.72, SD = 1.49; t (30) = -0.02, p = .986 (two-tailed) was not significant. The
change in perceived barriers and benefits from pre to post between groups for the Exercisers (M=
-0.28, SD = 1.21) and Non-Exercisers M = 0.17, SD = 1.08; t (30) = -1.10, p = .280 (two-tailed)
was not significant. The change in motivational readiness from pre to post between groups for
67
the Exercisers (M=0.20, SD = 0.77) and Non-Exercisers M = 0.76, SD = 1.03; t (30) = -1.73, p =
.094 (two-tailed) was not significant. The effect sizes for all three measures were small.
Mean Self-Efficacy Score vs. Treatment Group
Mean SelfEfficacy Score
9.00
8.02
6.75
4.50
7.17
6.61
7.18
2.25
.00
Lifestyle Intervention
Personal Training Only
Treatment Group
Pre Self-Efficacy
Post Self-Efficacy
Figure 13. Comparison of mean change in self-efficacy between LI and PT. Standard deviations
are reported in Tables 22 and 23.
Mean Decisional
Balance
Mean Decisional Balance vs. Treatment Group
3.00
2.25
1.50
.75
.00
2.69
2.60
2.13
Lifestyle Intervention
2.14
Personal Training Only
Treatment Group
Pre Decisional Balance
Post Decisional Balance
Figure 14. Comparison of mean change in decisional balance scores between LI and PT.
Standard deviations are reported in Tables 22 and 23.
68
Median Stages of Change
Median Stages of Change vs. Treatment Group
5.00
3.75
4.5
5.0
5.0
5.0
2.50
1.25
.00
Lifestyle Intervention
Personal Training Only
Treatment Group
Pre Stages of Change (median score)
Post Stages of Change (median score)
Figure 15. Comparison of change in median stages of change between LI and PT. Standard
deviations are reported in Tables 24 and 25.
Hypothesis 5
The fifth hypothesis examined within group differences in behavioral measures
including: Self-efficacy, perceived barriers and benefits (decisional balance), and motivational
readiness for change. It was hypothesized that these behavioral measures would improve from
pre to post within each group. Results from the paired-samples t-tests are presented in Tables 22
and 23 for each treatment group. Results from the Wilcoxon Signed Rank Tests are present in
Tables 24 and 25 for each treatment group. The Wilcoxon Signed Rank Test was used because
the stages of change data are ordinal. Effect sizes for the Wilcoxon Signed Rank Test are
reported with the r value. An r value of .1 indicates a small effect, an r value of .3 indicates a
medium effect, and an r value of .5 indicates a large effect.
69
Table 22
Results of Paired-samples t-test Comparing Pre and Post Behavioral Survey Scores for the
Lifestyle Intervention Group
Mean
SD
t
df
Sig. (1- Eta Squared
tailed)
Pre Self-Efficacy
6.61
2.45
-2.58
15
.0105
.307
Post Self-Efficacy
8.02
1.6
Pre Decisional Balance
2.69
1.31
0.33
15
.374
.007
Post Decisional Balance
2.6
1.2
A paired-samples t-test evaluated the impact of the eight-week intervention on the LI
group’s change from pre to post in self-efficacy and decisional balance. There was a significant
increase in self-efficacy from pre (M = 6.61, SD = 2.45) to post (M = 8.02, SD = 1.6), t (15) = 2.58, p = .0105 (one-tailed). The effect size was large (eta squared = .307). This result is
consistent with the hypothesis. There was no significant difference in decisional balance from
pre (M = 2.69, SD = 1.31) to post (M = 2.6, SD = 1.2), t (15) = 0.33, p = .374 (one-tailed). The
effect size was very small (eta squared = .007). This result is not consistent with the hypothesis.
70
Table 23
Results of Paired-samples t-test Comparing Pre and Post Behavioral Survey Scores for the
Personal Training Only Group
Mean
SD
t
df
Sig. (1- Eta Squared
tailed)
Pre Self-Efficacy
7.17
1.78
Post Self-Efficacy
7.18
1.13
Pre Decisional Balance
2.13
1.07
Post Decisional Balance
2.14
0.90
-0.011
15
.496
.000
0.33
15
.483
.007
A paired-samples t-test evaluated the impact of the eight-week intervention on the PT
group’s change from pre to post in self-efficacy and decisional balance. There was no significant
difference in self-efficacy from pre (M = 7.17, SD = 1.78) to post (M = 7.18, SD = 1.13), t (15) =
-0.011, p = .496 (one-tailed). The effect size was very small (eta squared = .000). There was no
significant difference in decisional balance from pre (M = 2.13, SD = 1.07) to post (M = 2.15,
SD = 0.90), t (15) = 0.33, p = .483 (one-tailed). The effect size was very small (eta squared =
.007). These results are not consistent with the hypothesis.
Table 24
Results of the Wilcoxon Signed Rank Test Comparing Pre and Post Stages of Change for the
Lifestyle Intervention Group
Median (50th Percentile)
Z
Sig. (1-tailed)
r
Pre Stages of Change
4.5
-2.26
.012
.565
Post Stages of Change
5.0
71
The Wilcoxon Signed Rank Test examined the impact of the eight-week intervention on
the LI change from pre to post in motivational readiness. There was a significant improvement in
the stages of change, z = -2.26, p = .012, with a large effect size (r = .565). The median score
significantly increased from pre (Md = 4.5) to post (Md = 5.0).
Table 25
Results of the Wilcoxon Signed Rank Test Comparing Pre and Post Stages of Change for the
Personal Training Only Group
Median (50th Percentile)
Z
Sig. (1-tailed)
r
Pre Stages of Change
5.0
Post Stages of Change
5.0
-1.3
.097
.325
The Wilcoxon Signed Rank Test examined the impact of the eight-week intervention on
the PT group’s change from pre to post in the physical activity stages of change. There was no
significant improvement in the stages of change, z = -1.3, p = .097, with a medium effect size (r
= .325). The median score did not change from pre (Md = 5.0) to post (Md = 5.0).
An additional analysis was conducted to further investigate if exercise predisposition was
a factor in 1) the change in self-efficacy, decisional balance, and motivational readiness within
the Exercisers in the LI group, 2) the change in these measures within the Non-Exercisers in the
LI group, 3) the change in these measures within the Exercisers in the PT group, and 4) the
change in these measures within the Non-Exercisers in the PT group. Results of these additional
analyses are presented in Tables 26-33.
72
Table 26
Results of Paired-samples t-test Comparing Pre and Post Behavioral Survey Scores for the
Exercisers in the Lifestyle Intervention Group
Mean
SD
t
df
Sig. (1- Eta Squared
tailed)
Pre Self-Efficacy
6.59
3.04
-1.94
7
.047
.350
Post Self-Efficacy
8.43
1.16
Pre Decisional Balance
2.89
1.71
0.96
7
.1765
.116
Post Decisional Balance
2.43
1.35
A paired-samples t-test evaluated the impact of the eight-week intervention on the
Exercisers in the LI group’s change from pre to post in self-efficacy and decisional balance.
There was a statistically significant increase in self-efficacy from pre (M = 6.59, SD = 3.04) to
post (M = 8.43, SD = 1.16), t (7) = -1.94, p = .047 (one-tailed). The effect size was large (eta
squared = .350). There was a non-significant decrease in decisional balance from pre (M = 2.89,
SD = 1.71 to post (M = 2.43, SD = 1.35), t (7) = 0.96, p = .1765 (one-tailed). The effect size was
large (eta squared = .116).
Table 27
Results of Paired-samples t-test Comparing Pre and Post Behavioral Survey Scores for the NonExercisers in the Lifestyle Intervention Group
Mean
SD
t
df
Sig. (1- Eta Squared
tailed)
Pre Self-Efficacy
6.63
1.9
-1.71
7
.0655
.295
Post Self-Efficacy
7.62
1.94
Pre Decisional Balance
2.51
0.81
-0.75
7
.240
.074
Post Decisional Balance
1.77
1.1
A paired-samples t-test evaluated the impact of the eight-week intervention on the NonExercisers in the LI group’s change from pre to post in self-efficacy and decisional balance.
There was a non-significant increase in self-efficacy from pre (M = 6.63, SD = 1.90 to post (M =
73
7.62, SD = 1.94), t (7) = -1.71, p = .0655 (one-tailed). The effect size was large (eta squared =
.295). There was a non-significant decrease in decisional balance from pre (M = 2.51, SD = 0.81)
to post (M = 1.77, SD = 1.10), t (7) = -0.75, p = .240 (one-tailed). The effect size was moderate
(eta squared = .074).
Table 28
Results of the Wilcoxon Signed Rank Test Comparing Pre and Post Stages of Change for the
Exercisers in the Lifestyle Intervention Group
Median (50th Percentile)
Z
Sig. (1-tailed)
r
Pre Stages of Change
5.0
Post Stages of Change
5.0
-1.00
.1585
.378
The Wilcoxon Signed Rank Test examined the impact of the eight-week intervention on
the change from pre to post in motivational readiness in the Exercisers in the LI group. There
was no significant difference in the stages of change, z = -1.00, p = .1585, with a medium effect
size (r = .378). The median score did not change from pre (Md = 5.0) to post (Md = 5.0).
Table 29
Results of the Wilcoxon Signed Rank Test Comparing Pre and Post Stages of Change for the
Non-Exercisers in the Lifestyle Intervention Group
Median (50th Percentile)
Z
Sig. (2-tailed)
r
Pre Stages of Change
2.5
Post Stages of Change
4.0
-2.12
.034
.750
The Wilcoxon Signed Rank Test examined the impact of the eight-week intervention on
the change from pre to post in motivational readiness in the Non-Exercisers in the LI group.
74
There was a significant improvement in the stages of change, z = -2.12, p = .034, with a very
large effect size (r = .750). The median score significantly increased from pre (Md = 2.5) to post
(Md = 4.0).
Table 30
Results of Paired-samples t-test Comparing Pre and Post Behavioral Survey Scores for the
Exercisers in the Personal Training Only Group
Mean
SD
t
df
Sig. (2- Eta Squared
tailed)
Pre Self-Efficacy
7.98
1.66
0.85
6
.427
.107
Post Self-Efficacy
7.38
1.49
Pre Decisional Balance
2.54
1.13
0.17
6
.869
.005
Post Decisional Balance
2.46
1.23
A paired-samples t-test evaluated the impact of the eight-week intervention on the
Exercisers in the PT group’s change from pre to post in self-efficacy and decisional balance.
There was a no significant difference in self-efficacy from pre (M = 7.98, SD = 1.66) to post (M
= 7.38, SD = 1.49), t (6) = 0.85, p = .427 (two-tailed). There effect size was moderate (eta
squared = .107) There was no significant difference in decisional balance from pre (M = 2.54,
SD = 1.13) to post (M = 2.46, SD = 1.23), t (6) = 0.17, p = .869 (two-tailed). There effect size
was small (eta squared = .005).
Table 31
Results of Paired-samples t-test Comparing Pre and Post Behavioral Survey Scores for the NonExercisers in the Personal Training Only Group
Mean
SD
t
df
Sig. (2- Eta Squared
tailed)
Pre Self-Efficacy
6.55
1.69
-1.01
8
.341
.113
Post Self-Efficacy
7.02
0.8
Pre Decisional Balance
1.8
0.97
-0.2
8
.845
.005
Post Decisional Balance
1.89
0.47
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A paired-samples t-test evaluated the impact of the eight-week intervention on the NonExercisers in the PT group’s change from pre to post in self-efficacy and decisional balance.
There was a non-significant increase in self-efficacy from pre (M = 6.55, SD = 1.69) to post (M
= 7.02, SD = 0.80), t (8) = -1.01, p = .341 (two-tailed). There was a moderate to large effect size
(eta squared = .113). There was non-significant increase in decisional balance from pre (M =
1.80, SD = 0.97) to post (M = 1.89, SD = 0.47), t (8) = -0.20, p = .845 (two-tailed). The effect
size was small (eta squared = .005).
Table 32
Results of the Wilcoxon Signed Rank Test Comparing Pre and Post Stages of Change for the
Exercisers in the Personal Training Only Group
Median (50th Percentile)
Z
Sig. (2-tailed)
r
Pre Stages of Change
5.0
Post Stages of Change
5.0
0.00
1.00
.000
The Wilcoxon Signed Rank Test examined the impact of the eight-week intervention on
the change from pre to post in motivational readiness in the Exercisers in the PT group. There
was no difference in the stages of change, z = 0.00, p = 1.00, with a very small effect size (r =
.000). The median score did not change from pre (Md = 5.0) to post (Md = 5.0).
Table 33
Results of the Wilcoxon Signed Rank Test Comparing Pre and Post Stages of Change for the
Non-Exercisers in the Personal Training Only Group
Median (50th Percentile)
Z
Sig. (2-tailed)
r
Pre Stages of Change
4.0
Post Stages of Change
5.0
-1.30
76
.194
.433
The Wilcoxon Signed Rank Test examined the impact of the eight-week intervention on
the change from pre to post in motivational readiness in the Non-Exercisers in the PT group.
There was no significant difference in the stages of change, z = -1.30, p = .194, with a medium
effect size (r = .433). The median score increased from pre (Md = 4.0) to post (Md = 5.0).
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CHAPTER V
DISCUSSION, RECOMMENDATIONS, AND CONCLUSIONS
Although the benefits of physical activity are well known, the majority of United States
adults do not meet the recommendations for physical activity. Less than 50% of adults meet the
2008 Physical Activity Guidelines recommended by the Centers for Disease Control and
Prevention (2012; U.S. Department of Health & Human Services, 2000). Unfortunately, of the
people that do start an exercise program, approximately half dropout from exercise programs
after only a short period of time (Buckworth & Dishman, 2002). Furthermore, long-term
adherence to exercise has been shown to be very poor (Dishman, 1988).
Several research studies have examined the effect of lifestyle intervention programs on
exercise adherence. Specific interventions have been theory-based, including but not limited to:
the Social Cognitive Theory, the Transtheoretical Model, the Health Belief Model, the SelfDetermination Theory, the Theory of Planned Behavior, and the Social Ecological Model. These
interventions include cognitive and behavioral strategies to promote physical activity and
exercise adherence. Such cognitive and behavioral strategies include goal setting, selfmonitoring, changing environmental cues, incorporating social support, problem solving,
feedback, and relapse prevention. Leith & Taylor (1992) conducted a meta-analysis reviewing 31
studies that examined the effectiveness of behavior modification in promoting exercise
adherence. Over 80% of the studies reviewed, reported improved exercise adherence with the
implementation of a behavioral modification program. These findings were generalizable across
a wide range of subjects (Leith & Taylor, 1992). A more recent meta-analysis of interventions to
increase physical activity among healthy adults by Conn, Hafdahl, and Mehr (2011), reported an
overall mean effect size (.19) for comparisons of treatment groups versus control groups. The
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most effective interventions used behavioral versus cognitive strategies, face-to-face delivery of
interventions versus mediated interventions, and targeted individuals versus communities.
A large body of evidence supports the effects of intervention programs to increase
physical activity, however, the majority of the research studies have not controlled for
nonspecific effects, such as the possibility that participants have positive outcomes for exercise
adherence and other health measures because they feel they are receiving special attention. In
addition, most of the lifestyle intervention research has been conducted in a research or clinical
setting. Thus far, no known research on the use of lifestyle interventions in the context of an
Exercise Science curriculum has been published. Therefore, this study was designed to examine
the effects of a university-based lifestyle intervention program on exercise adherence and
physical activity behavior while controlling for nonspecific effects within the context of a senior
level Exercise Prescription course.
Summary of Methods
A total of 32 adult male and female clients and 32 junior and senior students from
Exercise Prescription took part in the study. Volunteers for a university-based personal training
program were invited to participate in the study. These participants were stratified according to
current exercise behavior (“exercisers” vs. “non-exercisers”) and randomized into one of two
groups (LI or PT). Participants met with their student personal trainers for the collection of pretest data (Institute for Healthy Living Medical History Form, Demographic Data Survey, MAQ,
Decisional Balance Questionnaire, PASCQ, SEE, waist circumference, Single Stage Treadmill
Test, Sit-N-Reach, 30 Second Chair Stand, Back Scratch Test, Arm Curl Test, Shoulder
Flexibility Test, Hand Grip Test, and the Dynamic Muscular Endurance Test Battery).
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Pre-assessments included the descriptive data for age, gender, weight (lbs), BMI (kg/m2),
waist girth (in.), resting heart rate (bpm), resting systolic blood pressure (mmHg), and resting
diastolic blood pressure (mmHg) for each group (lifestyle intervention and personal training
only) as presented in Table 1. The descriptive data for baseline exercise adherence and physical
activity behavior measures for each group are presented in Table 3. Baseline fitness test scores
by treatment group are represented in Table 5. Baseline participant scores for the behavioral
measures by treatment group are presented in Table 7.
Participants then completed an eight-week intervention. Both groups received personal
training but the LI group received additional behavioral and cognitive strategies. Following the
intervention, the participants completed post test data collection repeating the same measures
taken at pre-assessment except for the Demographic Data Survey and the Institute for Healthy
Living Medical History Form to establish if there was a change from pre-intervention data.
Statistical analyses included descriptive statistics, independent-samples t-tests, pairedsamples t-tests, and Wilcoxon Singed Rank tests. The descriptive statistics examined different
demographic and health characteristics of the participants. Independent-samples t-tests were used
to analyze pre/post changes between treatment groups. Paired-samples t-tests were used to
determine pre/post changes within treatment groups. Wilcoxon Signed Rank Tests were used to
determine if there was a within-group change from pre to post in the physical activity stages of
change in both groups.
Summary of Results
The primary finding of this study is that the addition of a lifestyle intervention component
to personal training sessions significantly improved exercise adherence and self-efficacy. The
lifestyle intervention (LI) group showed significant within group differences from pre to post in
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measures of exercise adherence, the majority of fitness tests, and in motivational readiness for
change. Although, the personal training only (PT) group saw significant within group differences
from pre to post in the majority of fitness tests, this group did not demonstrate any significant
within group differences from pre to post in exercise adherence, physical activity behavior, selfefficacy, decisional balance, or stages of change.
Hypothesis 1
The first research hypothesis examined between group differences in measures of
exercise adherence and physical activity behavior. It was hypothesized that the LI group would
have improved exercise adherence and increased physical activity behavior compared to the PT
group. Results are presented in Table 9 and represented in Figures 2, 3, and 4.
There was a statistically significant (p= .029) change in the exercise minutes per week
from pre to post between groups with the lifestyle intervention (LI) group showing an increase in
exercise adherence with a mean of 44.22 minutes and the personal training only (PT) group
showing a decrease in exercise adherence with a mean of -17.67 minutes. These results show that
addition of lifestyle intervention sessions to personal training sessions significantly improved
exercise adherence. This is an important finding considering that exercise adherence is very
difficult to maintain. As Buckworth & Dishman (2002) determined, approximately 50% of the
people that do start an exercise program dropout after only a short period of time. It is interesting
to note that the PT group actually reported a decrease in exercise adherence over time even
though they were still regularly attending their weekly personal training sessions. This result
shows that specific components within the modified Diabetes Prevention Program (DPP)
modules may have given participants in the LI group ways to not only maintain but to increase
their exercise adherence over time. Although only 8 modules from the original 16 DPP modules
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were used, exercise adherence still significantly increased in the LI group. Future research
should examine, if by using less modules over a shorter period of time, exercise adherence would
still improve which could decrease program costs and time. The results of this study show that
the use of the modified DPP modules can effectively improve exercise adherence as well as selfefficacy in an apparently healthy adult population. This result also shows that it may not be
enough to just offer personal training sessions to the general population. For future
considerations, health/fitness professionals should be aware of behavioral and cognitive
strategies to help their clients maintain and possibly improve exercise adherence.
Previous studies have supported the efficacy of the DPP modules, specifically in
promoting behavior change and increasing physical activity. However, most lifestyle
intervention research has been conducted in a research or clinical setting. Thus far, no known
research on the use of lifestyle interventions in the context of an Exercise Science curriculum has
been published. Results of the current study show that a lifestyle intervention can be successfully
incorporated into a student personal training project within an educational setting. For future
research considerations, researchers should further examine the efficacy of adding a lifestyle
intervention component to student personal training projects. Long-term follow-up with the
student personal trainers would determine: a) if the students use any of the lifestyle intervention
components in their careers, and b) if the use of these components leads to success in helping
clients maintain exercise adherence.
Results from this study are consistent with the current literature. In a meta-analysis by
Leith & Taylor (1992), the majority of studies showed improved exercise adherence. Pearson,
Burkhart, Pifalo, Palaggo-Toy, & Krohn (2005) also showed improved exercise adherence in
participants who were at risk for osteoporosis. In this study, the researchers followed up with the
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participants and showed that long-term adherence was maintained at six months and two years
after the intervention had ended. Unfortunately, this current study was unable to provide followup with participants after the intervention ended. It would be beneficial for future research to
determine if long-term exercise adherence is maintained.
There was no significant difference in leisure time physical activity between groups. The
overall effect size was .04, indicating a small effect. This result is not consistent with the
hypothesis. One possible reason for this result is that the length of time of recall may have
caused inaccurate self-reports of total leisure physical activity. The Modifiable Activity
Questionnaire (MAQ) asks participants for each activity to estimate the total number of months
they participate in that activity, the average number of times per month, and the average minutes
each time for one entire year. It is possible that the length of recall as well as the way in which
participants were asked to report their total minutes of leisure time physical activity led to
inaccurate reports. Participants may not necessarily think of their leisure time physical activity as
in the number of times per month that they participate in the activity. The primary investigator
tried to minimize the likelihood of error in recall by asking participants to limit the time period
being assessed to the previous three months. However, it seems that there may have been
inaccurate self-reports of physical activity with the MAQ. Participants in the LI group showed a
mean increase of 44.22 minutes per week in exercise time but a mean decrease of -65.18 minutes
in leisure time physical activity. This presents an obvious discrepancy between the two measures
especially since total leisure time physical activity includes total minutes of exercise per week. In
a review of physical activity questionnaires, Bandmann (2008) showed that although the MAQ
has been shown to be reliable and valid, leisure time physical activity self-reported during the
past week was more strongly related to accelerometer data compared to leisure time physical
83
activity self-reported during the past year. The author stated that during the validation study of
the MAQ, the authors of the study concluded that it was very important to ensure that the MAQ
is administered the same way by each interviewer (Kriska, Knowler, LaPorte. et al., 1990). In
this current study, the student personal trainers were not given specific training on how to
implement the MAQ with their clients which might have contributed to reporting of inaccurate
data.
Another possible explanation for the unexpected scores for the participant’s MAQ is that
at the beginning of the intervention, participants may have over-estimated their total amount of
physical activity. However, over the course of the intervention, participants may have become
more aware of how much physical activity they actually participated in each week, leading to a
more accurate self-report and potentially a decrease in their reported total leisure time physical
activity from pre to post.
Although the participants were stratified to control for exercise predisposition, additional
analyses were conducted to further investigate if exercise predisposition was a factor in the
change in exercise adherence and physical activity behavior from pre to post. There were no
statistically significant differences between the Exercisers and the Non-exercisers for exercise
adherence (p = .460) and physical activity behavior (p = .328).
Hypothesis 2
The second hypothesis of the research study examined within group differences on
measures of exercise adherence and physical activity behavior. It was hypothesized that
adherence to exercise and physical activity behavior would increase from pre to post within each
group. Results are presented in Tables 11 and 12 for the LI and PT groups, respectively.
84
Results indicate a significant increase (p=.017) in the minutes of exercise per week from
pre to post in the lifestyle intervention group. The mean increase in exercise minutes per week
from pre to post was 44.22 minutes. The eta squared statistic (.267) indicated a large effect size.
This result is consistent with the hypothesis. There was no significant difference (p=.261) in the
estimated leisure time of physical activity from pre to post in the LI group. This result is not
consistent with the hypothesis. Suggestions for this discrepancy are the same as those discussed
above.
There was no significant difference (p = .248) in minutes of exercise reported per week
from pre to post or in the estimated leisure time of physical activity from pre to post (p = .19) in
the PT group. These results are not consistent with the hypothesis. It was predicted that both
groups would show improved exercise adherence and physical activity behavior because both
groups were receiving weekly personal training sessions. However for the PT group, there were
no significant differences from pre to post. The PT group actually showed a decrease in exercise
minutes per week but an increase in total leisure physical activity per week. These results
indicate a discrepancy between the two measures. Again, suggestions for this discrepancy are
addressed above.
Additional analyses were conducted to further investigate if exercise predisposition was a
factor in the within group differences in the change in exercise adherence and physical activity
behavior from pre to post. Results are reported in Tables 13-16. The Exercisers in the LI group
reported a non-significant increase (p = .1665) in exercise minutes per week. The Non-Exercisers
reported a statistically significant increase (p = .032) in exercise minutes per week, revealing that
the Non-Exercisers were the primary group responsible for the improved exercise adherence.
Future research may benefit from focusing lifestyle intervention programs on participants that
85
have the most room for improvement (non-exercisers). However, the Exercisers showed an
improvement in exercise adherence, indicating that the lifestyle intervention program was
beneficial for this group as well. In the PT group, both the Exercisers and Non-exercisers
reported a non-significant decrease in exercise minutes per week. There were no significant
differences for physical activity behavior for either the LI or PT groups.
Hypothesis 3
The third hypothesis examined between group differences on measures of physical fitness
including the following tests: Single Stage Treadmill Test, YMCA Sit-N-Reach, 30 Second
Chair Stand, Back Scratch Test, Arm Curl Test, Shoulder Flexibility Test, Hand Grip Test, and
the Dynamic Muscular Endurance Test Battery. It was hypothesized that fitness test scores
would improve from pre to post within both groups, but the total improvement between groups
would not be significant. Results are presented in Tables 17, 18, and19 and represented in
Figures 5-12.
Within the LI group, all fitness test scores significantly improved from pre to post except
for estimated V02Max and the Back Scratch Tests. All fitness test scores showed a very large
effect size, except for the estimated V02Max. The estimated V02Max increased but it was not
significant (p= .338). There may not have been a significant increase in V02Max due to errors in
measures of heart rate. The student personal trainers may not have been comfortable with
palpating their clients for measures of heart rates. Perhaps there would have been statistically
significant increases in VO2Max if there was a larger sample size as well. The Back Scratch Test
scores also showed improvement and were close to being statistically significant (p = .092). The
LI group showed significant within group improvements from pre to post in the following
measures: Sit-N-Reach, Single Stage Treadmill Test, Chair Stand Test, Arm Curl Test, Shoulder
86
Flexibility Test, Hand Grip Strength Test, and the Dynamic Muscular Endurance Test Battery.
These results are consistent with the hypothesis.
Results from this study are consistent with the results from current literature. As Conn,
Hafdahl, & Mehr (2011) reported in their meta-analysis, interventions increased overall physical
activity. In Foster, Hillsdon, Thorogood, Kaur, & Wedatilake (2012), the effects of the
interventions on cardiorespiratory fitness were examined in 11 studies. Similar to the results of
this current study, the researchers found that the treatment groups all showed increases in
physical activity from baseline to post-intervention.
In the PT group, all fitness test scores also significantly improved from pre to post,
except for the participant’s estimated V02Max and the Back Scratch Test. All fitness test scores
showed a very large effect size, except for the estimated V02Max. The estimated V02Max
increased, but it was not significant (p= .338). One participant’s data was not included in the data
analysis for V02Max due to the participant’s medication. This participant was on a beta-blocker
which reduces heart rate. Since estimated V02Max test relies on heart rate to calculate V02, this
calculation was not valid for this particular participant. Additionally, any participant who could
not complete a fitness test due to medical limitations, data on the particular fitness test was not
included in the data analysis. The Back Scratch Test scores did not show improvement, but
actually decreased by 0.81 inches. The PT group saw significant within group improvements
from pre to post in the majority of the fitness tests, including: Sit-N-Reach, Chair Stand Test,
Back Scratch Test, Arm Curl Test, Hand Grip Strength Test, and the Dynamic Muscular
Endurance Test Battery. These results are consistent with the hypothesis and are consistent with
the current literature. In Dunn, Marcus, Kampert, Garcia, Kohl, & Blair (1999), both the
87
intervention and the control groups showed improvements in physical activity, as well as
cardiorespiratory fitness.
There were no significant between group differences for any of the fitness test scores.
There was a small effect size for the all of the tests except for the YMCA Sit-N-Reach Test and
the Back Scratch Test. The YMCA Sit-N-Reach Test (eta squared = .062) and the Back Scratch
Test (eta squared = .12) both showed moderate effect sizes. These results are consistent with the
hypothesis and the current literature. In Marshall, Bauman, Owen, Booth, Crawford, & Marcus
(2004), both the intervention group and control group reported non-significant increases in
physical activity from baseline to an 8-month follow-up. Similar to the literature, this current
study reported significant increases from pre to post within groups, but non-significant
differences in the change in physical activity scores between both groups. Both the LI and PT
showed improvements in physical fitness test scores, but the between group differences were not
significant.
Hypothesis 4
The fourth hypothesis examined between group differences in the mean change in
measures of self-efficacy, perceived barriers and benefits to exercise (measured by the
Decisional Balance Questionnaire), and motivational readiness for change (measured with the
Physical Activity Stages of Change Questionnaire). It was hypothesized that the LI group would
have improved self-efficacy and decisional balance, and be placed in higher stages of
motivational readiness for change compared to the PT group. Results are presented in Table 20
and represented in Figures 13-15.
There was a significant (p=.025) between group difference in the mean change in selfefficacy with the LI group showing an improved score from pre (M = 6.61) to post-test (M =
88
8.02). The PT group did not show any significant improvement in self-efficacy from pre (M =
7.17) to post-test (M = 7.18). Figure 13 shows the difference in the change in self-efficacy from
pre to post-test between the LI and PT groups. The magnitude of the differences was moderate to
large (eta squared = .124). Self-efficacy is an extremely important factor for behavior change. If
a person perceives that they can successfully engage in regular exercise, they are more likely to
exercise on a daily basis. Several studies have shown that self-efficacy strongly relates to
physical activity behavior (Marcus & Forsyth, 2009). According to the Social Cognitive Theory,
self-efficacy is the most important mediator of behavior change (Marcus & Forsyth, 2009).
Similar to the current literature, results from this current study show that a lifestyle intervention
program can significantly improve exercise adherence and self-efficacy.
There was no significant between group difference (p = .4) for change in mean decisional
balance. The LI group’s decisional balance decreased slightly from pre (M = 2.69) to post (M =
2.60). The PT group decisional balance increased slightly from pre (M = 2.13) to post (M =
2.14). These results are not consistent with the hypothesis. It is suggested that there were no
significant differences due to the fact that the majority of the participants in both groups were
already scoring on the higher end of the decisional balance scale. Decisional balance scores can
range from -4.0, indicating that the participant sees more barriers to exercise, to 4.0, indicating
that the participant sees more benefits to exercise. At pre-assessment, the mean score for each
group already showed that the participants, on average, saw more benefits than barriers to
exercise. Since participant scores were already on the higher end of the scale, there was little
room for participants for improvement on this measure.
The pre- to post- difference in motivational readiness for change was marginally nonsignificant (p= .07) with a small effect size (eta squared = .071). The results are not consistent
89
with the hypothesis. Similar to the explanation for the non-significance in decisional balance, the
non-significance in the motivational readiness for change may have been due to the fact that the
majority of participants were already in higher stages of change. The scores for the LI group
changed from pre (Md = 4.5) to post (Md = 5.0). The median score at baseline was already above
stage four, or the action stage. The highest stage participants could have achieved was stage five,
or the maintenance stage. The scores for the PT group did not change from pre (Md = 5.0) to
post (Md = 5.0) because there was no room for participants to improve. Results from this survey
and from the decisional balance questionnaire likely demonstrate a ceiling effect, or the idea that
a dependent variable reaches a level above which variance in an independent variable is
significantly reduced. This reduced variance leads to a reduction in sensitivity for determining if
a treatment group is significantly different than the control group. In this current study, although
changes in perceived barriers and benefits and motivational readiness to change may not have
produced statistically significant differences between groups, there may have been an effect. The
effect may have escaped detection due to the mean scores for the LI group and the mean scores
for the PT group not appearing different enough.
Hypothesis 5
The fifth hypothesis examined within group differences in measures of self-efficacy,
perceived barriers and benefits, and motivational readiness for change. It was hypothesized that
both groups would show improvement in these behavioral measures from pre to post. Results are
presented in Tables 22-25. There was a significant increase (p=.0105) in the LI group’s selfefficacy from pre (M = 6.61) to post (M = 8.02) with a large effect size (eta squared = .307). This
result is consistent with the hypothesis. However, there was no significant difference (p=.374) in
the LI group’s decisional balance from pre (M = 2.69) to post (M = 2.6). The effect size was very
90
small (eta squared = .007). This result is not consistent with the hypothesis. Explanations for this
finding are the same as those discussed above. There was a significant (p=.012) improvement in
motivational readiness for change, as well as a large effect size (r = .565) for the LI group.
Although there may have been a ceiling effect when comparing the LI to the PT group for
motivational readiness, results indicate that the within LI differences from pre to post were
statistically significant. The LI group showed improvement and moved up the stages of change
ladder. The stages of change questionnaire is a valid way to assess a person’s readiness for
behavior change.
No significant within group differences were observed for self-efficacy (p=.496) or the
decisional balance (p=.483) for the PT group. Effect sizes were very small for both variables.
Similarly, there was no significant (p=.097) improvement in motivational readiness, although,
there was a medium effect size (r = .325) for this group. These results are not consistent with the
hypothesis. It was predicted that the PT group would show improvements in these behavioral
measures because they were receiving quality one-on-one time with a personal trainer and
because of this weekly interaction, their self-efficacy, perceived barriers and benefits, and
motivational readiness for change would improve. It is suggested that the PT group did not show
significant changes in self-efficacy because they did not receive the benefits of the lifestyle
intervention sessions. Although the lifestyle intervention sessions did not specifically target
improving self-efficacy, the behavioral and cognitive strategies discussed in each module may
have helped the participants in the LI group improve their self-efficacy scores. For suggestions
about why the decisional balance scores were not significant, refer to the discussion above.
Although the changes in the PT group’s motivational readiness for change scores were not
significant, they were close to significance and also showed a medium effect size. Perhaps with a
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larger sample size, the within group differences would have been statistically significant.
Consistent with previous research findings, these results suggest that it may be beneficial for
health/fitness professionals to implement behavioral and cognitive strategies with their clients to
promote successful behavior change. Often times, the psychological aspects of an individual’s
health are overlooked, despite the fact that they can be some of the most important aspects of
health and predictors of whether or not someone will engage in healthy behavior.
An additional analysis was conducted to examine if exercise predisposition was a factor
in the within group changes in the behavioral measures. Results are presented in Tables 21, and
26-33. There was a statistically significant improvement (p = .034) in stages of change for the
Non-Exercisers in the LI group. The median score increased from 2.5 to 4.0 for this subgroup.
The Exercisers in both the LI and PT groups reported a median stage of 5.0 at pre and postassessment, indicating that they were already motivated to exercise and did not have any room
for improvement in this measure. This result is consistent with the discussion of the occurrence
of a ceiling effect for this measure. This finding may indicate the need for targeting the
population of non-exercisers for future lifestyle interventions. However, both the Exercisers and
Non-Exercisers in the LI group reported non-significant improvements in self-efficacy,
suggesting that behavioral and cognitive strategies used in the lifestyle intervention program may
benefit both subgroups.
Applications and Recommendations
Despite the overwhelming amount of literature on interventions designed to improve
exercise adherence and physical activity, little is known about how to truly motivate someone to
develop and maintain long-term adherence to exercise. Although the secret to behavior change
may never be fully comprehended, research studies will continue to address this perplexing
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phenomenon. Current literature has focused on multiple aspects of behavior change and factors
that influence it, ranging from an individual’s environment to an individual’s motivation to
exercise. Research results provide support for the use of specific intervention components, such
as goal setting and self-monitoring, to improve exercise adherence and increase physical activity.
However, the majority of studies have been conducted in a research or clinical setting. No known
studies have been conducted in the context of an undergraduate student personal training project
in an Exercise Science curriculum. From this current study, it was observed that the addition of a
lifestyle intervention component (through the use of modified Diabetes Prevention Program
modules) to personal training resulted in significant improvement in short-term exercise
adherence and self-efficacy in healthy adult members from a university-based fitness center.
Based on information gathered from the results of this study and from the current literature, the
author makes the following recommendations and considerations:
1. Replication of this study is necessary using a larger sample size of both LI and PT groups but
also with a control group who does not participate in any exercise. Further investigation is
warranted to determine if there are any effects on long-term exercise adherence and physical
activity behavior.
2. Further investigation of the efficacy of the addition of a lifestyle intervention component to a
student personal training project within the context of an undergraduate Exercise Science
curriculum is warranted. Long-term follow-up with the student personal trainers would
determine: a) if the students use any of the lifestyle intervention components in their careers,
and b) if the use of these components leads to success in helping clients maintain exercise
adherence.
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3. Future research should determine if there are specific components of lifestyle interventions
that lead to successful improvements in exercise adherence and physical activity behavior.
4. Investigation of the effectiveness and the mean cost per participant for a shortened version of
the original 16 DPP modules is warranted.
5. For future considerations, health/fitness professionals should be aware of behavioral and
cognitive strategies to help their clients maintain and possibly improve exercise adherence and
self-efficacy, two very important components to maintaining a healthy lifestyle.
Conclusions
The present study provided opportunity to research the effects of the addition of a
lifestyle intervention component to personal training sessions, as part of a student personal
training project conducted within the context of an Exercise Science curriculum. This study
demonstrated that significant improvements in exercise adherence and self-efficacy can be
attained through the addition of a lifestyle intervention component in apparently healthy
participants from a university-based fitness center. Participants in the lifestyle intervention group
also saw significant improvements in their fitness and motivational readiness for change.
Although participants in the personal training only group demonstrated significant improvements
in fitness, they did not see significant improvements in exercise adherence, physical activity
behavior, or any of the behavioral measures. These study results suggest that it may not be
enough to just offer personal training sessions to the general population. For future
considerations, health/fitness professionals should be aware of behavioral and cognitive
strategies to help their clients maintain and possibly improve exercise adherence and to promote
healthy lifestyle behaviors.
94
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interventions in real-world settings that were modeled on the Diabetes Prevention
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American College of Sports Medicine. (2014). ACSM’s guidelines for exercise testing
and prescription (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Bandmann, E. (2008). Physical activity questionnaires: A critical review of methods
used in validity and reproducibility studies (Master’s thesis). Retrieved from GIH:
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Bize, R., Johnson, J. A., & Plotnikoff, R. C. (2007). Physical activity level and health-related
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Conn, V. S., Valentine, J. C., & Cooper, H. M. (2002). Interventions to increase physical activity
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diabetes with lifestyle intervention or metformin. The New England Journal of Medicine,
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and exercise. Public Health Reports, 100(2), 158-171.
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GA: Valdosta State University. Retrieved from
http://www.edpsycinteractive.org/topics/regsys/maslow.html
Kriska, A., Knowler, W., LaPorte, R., Drash, A., Wing, R., Blair, S.,...Kuller, L. (1990).
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diabetes in Prima Indians. Diabetes Care, 13(4): 401-411.
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Leith, L. M., & Taylor, A. H. (1992). Behavior modification and exercise adherence: A literature
review. Journal of Sport Behavior, 15(1), 60.
Marcus, B. H., & Forsyth, L. H. (2009). Motivating people to be physically active. Champaign,
IL: Human Kinetics.
Marshall, A. L., Bauman, A. E., Owen, N. N., Booth, M. L., Crawford, D. D., & Marcus, B. H.
(2004). Reaching out to promote physical activity in Australia: A statewide randomized
controlled trial of a stage-targeted intervention. American Journal of Health Promotion,
18(4), 283-287.
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Orchard, T., Temprosa, M., Goldberg, R., Haffner, S., Ratner, R., Marcovina, S., & Fowler,
S. (2005). The effect of metformin and intensive lifestyle intervention on the metabolic
syndrome: The Diabetes Prevention Program randomized trial. Annals of Internal
Medicine, 142(8). 611-619.
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modification intervention for the treatment of osteoporosis. American Journal of Health
Promotion, 20(1), 28-33.
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physical activity. ACSM’s Health & Fitness Journal, 14(4), 1-13.
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Physical activity in the United States measured by accelerometer. Medicine and Science
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National Center for Chronic Disease Prevention and Health Promotion. (2012). Physical
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Vuillemin, A., Oppert, J., Guillemin, F., Essermeant, L., Fontvieille, A., Galan, P.,...
Hercberg, S. (2000). Self-administered questionnaire compared with interview to assess
past-year physical activity. Medicine and Science in Sports and Exercise, 32(6), 11191124.
Wing, R. R., Crane, M. M., Thomas, J., Kumar, R., & Weinberg, B. (2010). Improving weight
loss outcomes of community interventions by incorporating behavioral strategies.
American Journal of Public Health, 100(12), 2513-2519.
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Wolin, K., Fagin, C., James, A., & Early, D. (2012). Promoting physical activity in patients with
colon adenomas: A randomized pilot intervention trial. Plos One, 7(7), e39719.
98
APPENDICES
99
APPENDIX A
IRB APPROVAL LETTER
100
101
APPENDIX B
CLIENT INFORMED CONSENT
102
Informed Consent Form
Indiana University of Pennsylvania
Primary Investigator: Danielle Ostendorf
Title of Research Study: The Effects of Behavioral Modification on Exercise Adherence and Physical
Activity Behavior
Dear Adult Fitness Member of the James G. Mill Fitness Center,
You are being invited to participate in a research study because you have signed up to participate in the
student personal training project for the Exercise Prescription class. We are doing research on how to help
clients be more successful with their exercise and lifestyle goals. Before you give your consent to
volunteer, it is important that you read the following information and ask as many questions as necessary
to be sure you understand what you will be asked to do. If you have any questions, please ask me to stop
as we go through the information. If you have any questions later, you can ask the primary investigator or
the faculty advisor, Dr. Blair.
Purpose of the research
Regular physical activity has many known positive benefits such as reducing heart disease, obesity,
diabetes, osteoporosis, etc. Although most people are aware of the positive benefits of physical activity,
many have a particularly difficult time maintaining a physically active lifestyle. The reason we are doing
this study is to investigate methods health/fitness professionals can use to teach their clients to stay
motivated and remain physically active.
Each participant in the personal training project will be randomly assigned to one of two groups. Both
groups will receive instructions from their student personal trainer and take part in a personal exercise
prescription for a total of 10 weeks. Each group will receive different kinds of instruction from their
personal student trainer.
Voluntary Participation
Your participation in this research is entirely voluntary. Whether you choose to participate or not, the
services provided by James G. Mill Fitness Center and the students from the Exercise Prescription class
will continue and nothing will change. Your participation is completely voluntary and you may withdraw
from the study at any time by notifying your student personal trainer or the primary investigator.
Procedures
Your participation in the study only requires that you give permission for the primary investigator to use
the information collected during the personal training sessions for research purposes. This includes
information from the questionnaires and physical fitness assessments. The information that we collect
from this research study will be kept confidential. Information about you that will be collected during the
research will be put away for no-one to see but the primary researchers.
Risks
You will be screened for safety using the Institute for Healthy Living Medical History Form. This form
will screen for any health problems that may put you at risk in this study. The amount of exercise you will
experience with your student trainer will be no more than what you are already agreed to participate
in for the student personal training project. However, if you experience any complications during your
exercise session, the student trainer will end your exercise session and provide first aid and/or CPR if
needed just like we do anyways for any James G. Mill Fitness Center member. You will be responsible
103
for any further medical expenses that you incur from participation in this study. To prevent illness and
injury, make sure you drink plenty of water, warm up before exercising, and cool down after exercising.
Benefits
Although there is no direct compensation for participating, you may benefit by learning helpful things
about how to improve your own exercise behavior. There may not be any benefit for you but your
participation is likely to help us learn more about ways to provide effective personal training for our
clients in the adult fitness program.
Confidentiality
The information that we collect from this research study will be kept confidential. Information about you
that will be collected during the research will be put away for no-one to see but the primary researchers.
Any information about you will have a number on it instead of your name. Only the researchers will
know what your number is. It will not be shared or given to anyone except the team of researchers. The
list of names will be stored in a locked cabinet in Zink Hall for 3 years and then all records will be
destroyed.
Sharing the Results
The general results that we get from doing this research will gladly be shared with you through the James
G. Mill Fitness Center upon request. Your student personal trainer will share your personal physical
fitness results at the end of the personal training sessions. Confidential information will not be shared.
Group results may be published in order so that other interested people and healthcare professionals may
learn from our research.
Right to Refuse or Withdraw
You are not required to participate in this research if you do not wish to do so and refusing to participate
will not affect your membership at the James G. Mill Fitness Center or your participation in the student
personal training project in any way. You will receive all the benefits that you would otherwise have at
through the fitness center and the personal training project. You may stop your participation in the study
at any time without losing your rights as a member of James G. Mill Fitness Center or a participant of the
student personal training project.
Who to Contact
If you have any questions about this study, please ask the principle investigator or the faculty advisor.
Danielle Ostendorf, B.S., Principle Investigator
Exercise Science Graduate Assistant
Health and Physical Education Department
Indiana University of Pennsylvania
Zink Hall, Human Performance Lab
Indiana, PA 15705
(815)-540-9881
[email protected]
Dr. Elaine Blair, Ph.D., Faculty Advisor
Chair of the Health and Physical Education
Department
Indiana University of Pennsylvania
Zink Hall, 225
Indiana, PA 15705
(724)-357-2770
[email protected]
104
PART II: Certificate of Consent
I have read the foregoing information, or it has been read to me. I have had the opportunity to ask
questions about it and any questions that I have asked have been answered to my satisfaction. I consent
voluntarily to participate as a participant in this research. At your request, you may keep a copy of this
consent form.
Print Name of Participant__________________
Signature of Participant ___________________
Date ___________________________
Day/month/year
THIS PROJECT HAS BEEN APPROVED BY THE INDIANA UNIVERSITY OF PENNSYLVANIA
INSTITUTIONAL REVIEW BOARD FOR THE PROTECTION OF HUMAN SUBJECTS (PHONE
724.357.7730).
105
APPENDIX C
STUDENT INFORMED CONSENT
106
Informed Consent Form
Indiana University of Pennsylvania
Primary Investigator: Danielle Ostendorf
Title of Research Study: The Effects of Behavioral Modification on Exercise Adherence and Physical
Activity Behavior
Dear Exercise Prescription Student,
You are being invited to participate in a research study because you will be completing a personal training
project for the Exercise Prescription class. We are doing research on how to help clients be more
successful with their exercise and lifestyle goals. Before you give your consent to volunteer, it is
important that you read the following information and ask as many questions as necessary to be sure you
understand what you will be asked to do. If you have any questions, please ask me to stop as we go
through the information. If you have any questions later, you can ask the primary investigator or the
faculty advisor, Dr. Blair.
Purpose of the research
Regular physical activity has many known positive benefits such as reducing heart disease, obesity,
diabetes, osteoporosis, etc. Although most people are aware of the positive benefits of physical activity,
many have a particularly difficult time maintaining a physically active lifestyle. The reason we are doing
this study is to investigate methods that health/fitness professionals can use to teach their clients to stay
motivated and remain physically active.
Each adult fitness member in the study will be randomly divided into one of two groups. Both groups will
receive instructions from you, their student personal trainer and take part in a personal exercise
prescription for a total of 10 weeks. Each group will receive different kinds of instruction from you, their
personal student trainer.
Voluntary Participation
Your participation in this research is entirely voluntary. Your participation in the study will have no
bearing on your grade for the Exercise Prescription class or any of the services you receive as a student at
Indiana University of Pennsylvania. Neither the Exercise Prescription class professor nor the primary
investigator will know if you are participating in the study. Your participation is completely voluntary
and you may withdraw from the study at any time by notifying the primary investigator.
Procedures
Your participation in the study only requires you to consent for the primary investigator to use the
information you will already be collecting for your personal training sessions. The only additional
requirement will be a short, 10 minute survey, asking you about your personal training experience.
Risks
There are no known risks for your participation in this study.
Benefits
Although there is no direct compensation for participating, you may benefit by learning helpful things
about how to improve your client’s exercise behavior. There may not be any benefit for you but your
participation is likely to help us learn more about ways to provide effective personal training for our
clients in the adult fitness program.
107
Confidentiality
The information that we collect from this research study will be kept confidential. Information about you
that will be collected during the research will be put away for no-one to see but the primary researchers.
Any information about you will have a number on it instead of your name. Only the researchers will
know what your number is. It will not be shared or given to anyone except the team of researchers. The
list of names will be stored in a locked cabinet in Zink Hall for 3 years and then all records will be
destroyed.
Sharing the Results
The knowledge that we get from doing this research will be shared with you upon request. Confidential
information will not be shared. The results may be published in order so that other interested people and
healthcare professionals may learn from our research.
Right to Refuse or Withdraw
You are not required to participate in this research if you do not wish to do so and refusing to participate
will not affect your membership at the James G. Mill Fitness Center or your participation in the student
personal training project in any way. You will receive all the benefits that you would otherwise have at
through the fitness center and the personal training project. You may stop your participation in the study
at any time without losing your rights as a member of James G. Mill Fitness Center or a participant of the
student personal training project.
Who to Contact
If you have any questions about this study, please ask the principle investigator or the faculty advisor.
Danielle Ostendorf, B.S., Principle Investigator
Exercise Science Graduate Assistant
Health and Physical Education Department
Indiana University of Pennsylvania
Zink Hall, Human Performance Lab
Indiana, PA 15705
(815)-540-9881
[email protected]
Dr. Elaine Blair, Ph.D., Faculty Advisor
Chair of the Health and Physical Education
Department
Indiana University of Pennsylvania
Zink Hall, 225
Indiana, PA 15705
(724)-357-2770
[email protected]
108
PART II: Certificate of Consent
I have read the foregoing information, or it has been read to me. I have had the opportunity to ask
questions about it and any questions that I have asked have been answered to my satisfaction. I consent
voluntarily to participate as a participant in this research. At your request, you may keep a copy of this
consent form.
Print Name of Participant__________________
Signature of Participant ___________________
Date ___________________________
Day/month/year
THIS PROJECT HAS BEEN APPROVED BY THE INDIANA UNIVERSITY OF PENNSYLVANIA
INSTITUTIONAL REVIEW BOARD FOR THE PROTECTION OF HUMAN SUBJECTS (PHONE
724.357.7730).
APPENDIX D
PERMISSION TO USE THE SEE
110
Dear Ms. Ostendorf,
Feel free to use the measure for your project. the measures were developed for older adults,
however, just so you know. they may or may not reflect all of the challenges experienced by
those who are younger.
Best of luck.
Barbara Resnick, PHD, CRNP,FAAN,FAANP
---------- Forwarded message ---------From: Danielle Ostendorf <[email protected]>
Date: Fri, Nov 2, 2012 at 8:07 PM
Subject: Geriatric Nursing Enquiry: Permission to Use the Self
Efficacy for Exercise (SEE) scale for Thesis Research
To: [email protected]
The following enquiry was sent via the Elsevier website:
-- Sender -First Name: Danielle
Last Name: Ostendorf
Email: [email protected]
-- Message -Dear Dr. Resnick,
My name is Danielle Ostendorf and I am a graduate assistant at Indiana
University of Pennsylvania. I have read your research on increasing
client motivation to engage in health behaviors. This is a topic that
I, too, am very interested in. I am currently preparing to conduct my
Master's Thesis Research Project. I plan to implement a lifestyle
intervention program for members of a university fitness center and
study how this affects their exercise adherence and physical activity
behavior. Would you be willing to grant permission for me to use the
Self Efficacy for Exercise (SEE) scale for my thesis? Thank you for
your consideration and I look forward to your response.
Sincerely,
Danielle Ostendorf, GA
Indiana University of Pennsylvania
111
APPENDIX E
PERMISSION TO USE THE DEMOGRAPHIC DATA SURVEY
112
Dear Danielle,
Thank you for your email to Dr. Linehan and your request to use the DDS. Yes, you may use the
DDS. Thank you for asking. You can find the DDS on our clinic website:
http://blogs.uw.edu/brtc/publications-assessment-instruments/
Best wishes,
Elaine Franks
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Elaine Franks
Assistant to Marsha Linehan, Ph.D.
Behavioral Research and Therapy Clinics (BRTC)
University of Washington
3935 University Way NE
Seattle, WA 98105
(206) 685-2037
[email protected]
Correspondence via e-mail is not guaranteed to be confidential. Privileged, confidential or
patient identifiable information may be contained in this message. This information is meant only
for the use of the intended recipients. If you are not the intended recipient, or if the message has
been addressed to you in error, do not read, disclose, reproduce, distribute, disseminate or
otherwise use this transmission. Instead, please notify the sender by reply e-mail, and then
destroy all copies of the message and any attachments.
113
From: Danielle Marie Ostendorf [mailto:[email protected]]
Sent: Sunday, November 25, 2012 7:07 AM
To: Marsha M. LINEHAN
Subject: Permission to Use the Demographic Data Survey (DDS)
Dear Dr. Linehan,
My name is Danielle Ostendorf and I am a graduate assistant at Indiana University of
Pennsylvania. I am currently preparing to conduct my Master's Thesis Research Project. I plan to
implement a lifestyle intervention program for members of a university fitness center and study
how this affects their exercise adherence and physical activity behavior. Would you be willing to
grant permission for me to use the Demographic Data Survey (DDS) for my study? Thank you
for your consideration and I look forward to your response.
Sincerely,
Danielle Ostendorf, GA
Indiana University of Pennsylvania
114
APPENDIX F
DEMOGRAPHIC DATA SURVEY
115
DEMOGRAPHIC DATA SURVEY
Data Entry Initials: ___________
Date: ______________________
Second Entry: _______________
Date: ______________________
Subject ID #: _________________________
Date: _________________________
Assessment: _______ Session: _______
1. Sex: Female Male
2.
3. Age:
/
/
Date of Birth
(years)
4. Were you born in the United States?
No
Yes
If you were not born in the United States:
4a In what country were you born?
4b. At what age did you move here? __________
5.
Is your ethnic background Hispanic or Latino?
1=Yes
0=Not Hispanic or Latino
6.
To what racial groups do you belong? (circle EACH main racial group)
1=White/Caucasian
2=Native American, American Indian, or Alaska Native
3=Black or African American
4=Chinese or Chinese American
5=Japanese or Japanese American
6=Korean or Korean American
7=Other Asian or other Asian American (includes India, Malaysia, Pakistan,
Philippines)
11=East Indian
12=Middle Eastern/Arab
14=Native Hawaiian or other Pacific Islander
15=North African Caucasian
13=Other (Please
specify____________________________________________)
7. ________If you belong to more than one racial or ethnic group, which one do you identify
the most with?
0=Hispanic or Latino
1=White/Caucasian
2=Native American, American Indian, or Alaska Native
3=Black or African American
4=Chinese or Chinese American
5=Japanese or Japanese American
116
6=Korean or Korean American
7=Other Asian or other Asian American
11=East Indian
12=Middle Eastern/Arab
14=Native Hawaiian or other Pacific Islander
15=North African Caucasian
13=Other (Please
specify____________________________________________)
8.
In what religion were you raised?
1. Protestantism
(Please specify
denomination________________________)
2. Catholicism
3. Judaism
4. Islam
5. Hindu
6. Buddhism
7. Agnosticism or Atheism
8. Other
(Please specify denomination________________________)
9. None
9.
What religion do you now practice?
1. Protestantism
(Please specify
denomination________________________)
2. Catholicism
3. Judaism
4. Islam
5. Hindu
6. Buddhism
7. Agnosticism or Atheism
8. Other
(Please specify
denomination________________________)
9. None
10.
Did you ever live in a foster family? 0=no 1=yes
If you lived in a foster family
11.
10a.
At what age did you first live in one?
10b.
How many different foster families did you have?
10c.
How many years altogether did you live with foster families?
Were you adopted? 0=no 1=yes
117
11a
If you were adopted: At what age were you adopted?
12. Please describe your family. If a family member is deceased, please write “deceased”
after their name and the age at which they died under the column headed “Current age.”
(The following table is numbered #12a - #12f0 and follows the variable lettering exactly)
First Name
Sex
RLSP
to you
Your ages when they Current
lived with you
Age
Current Occupation
13. Who were your two primary parents when you were growing up? That is, who are the two
people who raised you; provided the majority of your care and financial support. Please list
their first name and relationship to you (e.g. mother, father, grandparent, foster parent, sibling...).
(If you only had one, please put a line through Parent B.)
First Name
_____________
Parent A
________________
Parent B
Relationship to You
_____________
________________
How many times was: (If unknown, please write an X.)
In the following questions we ask about Parents A and B, if applicable, as well as your
biological mother and father.
14.
(The following table is numbered #14a1 - #14d3 and follows the variable lettering exactly)
Parent A
Parent B
Biological Mother
Married
Divorced
Widowed
118
Biological Father
15.
Have you ever been married?______ (Yes =1, no = 0) (If no, then #18 = 1. Skip to #19)
16.
Have you ever been divorced?______ (Yes =1, no =0) (If no, 16a – 16d = -8)
16a.
Length of first marriage
16b.
Length of second marriage
16c.
Length of third marriage
16d. ______
Length of fourth marriage
17. . Have you ever been widowed?______ (Yes = 1, no = 0) (If no then 17a – 17d = -8)
Please list your spouse’s age at death and cause of death.
17a.
17b.
17c.
17d.
18.
19.
First spouse's age at death
First spouse's cause of death
Second spouse's age at death
Second spouse's cause of death
What is your current marital status
1. Single, never married
2. Widowed
3. Married
4. Separated
5. Divorced
For each of the following people, please enter the code number that corresponds to the
highest grade of formal education completed? (If unknown, please write an X.)
19a.
19b.
19c.
19d.
19e.
19f.
Yourself
1=eight grade or less
______ Spouse/Partner
2=some high school
Parent A
3=GED
Parent B
4=high school graduate
Mother
5=business or technical
beyond high school training
Father
6=some college
7=college graduate
8=some graduate or
professional school beyond college
9=master’s degree
10=doctoral degree
119
20. For each of the following people, please estimate the gross annual income (before taxes)
for the last year and enter the corresponding code number. (If unknown, please write an X.)
1=less than $5,000
2=$5,000-9,999
3=$10,000-14,999
4=$15,000-19,999
5=$20,000-24,999
6=$25,000-29,999
7=$30,000-49,999
8=$50,000 or more
20a.
Yourself
20b. ______ Spouse/Partner
20c.
Parent A
20d.
Parent B
20e.
Mother
20f.
Father
21.
For each of the following people, please describe his/her occupation for most of last year
and also enter the code number from the list which most closely resembles his/her
occupation. If the person was unemployed, retired or deceased, use the number that
corresponds to the occupation before unemployment, retirement, or death. (If unknown,
please write an X.)
1=Professional, technical, e.g., clergy, engineer, teacher, lawyer, physician, nurse
2=Owner, manager, administrator or executive of business (non-farm); also other
business position, e.g., accountant, programmer, researcher
3=Sales, e.g., insurance, real estate, auto
4=Clerical, e.g., secretary, retail clerk, typist
5=Skilled worker, craftsperson, foreman (Non-farm)
6=Transport or equipment operator
7=Unskilled worker, laborer (non-farm)
8=Farm workers, e.g., farmer, farm laborer, farm manager or farm foreman
9=Service worker, e.g., custodian, waitress, guard, barber
10=Private household worker
11=Full-time homemaker
12=Full-time student
13=Other
120
(The following table is numbered #17a1 - #17f2 and follows the variable lettering exactly)
Occupation description
Yourself
22.
Code
____________________________
______
Spouse/partner ____________________________
______
Parent A ___________________________
______
Parent B
______
___________________________
Mother ___________________________
______
Father ___________________________
______
Please provide the name, sex and age of any children that you have (include biological, stepchildren, foster children)
(The following table is numbered #22a1 - #22c0 and follows the variable lettering exactly)
First Name
Age
Sex (Circle)
_______
M F
_______
M F
_______
M F
_______
M F
_______
M F
_______
M F
_______
M F
_______
M F
_______
M F
_______
M F
23. _____How many of your immediate family (e.g., children, brothers, parents, spouse) live in
your geographic area (within a 50-mile radius)?
121
APPENDIX G
INSTITUTE FOR HEALTHY LIVING MEDICAL HISTORY QUESTIONNAIRE
122
Institute for Healthy Living
Medical History
Date:________________________
Name:________________________________________________________________________
Address:______________________________________________________________________
_____________________________________________________________________
Phone Number:________________________________________________________________
Birthdate:_____________________________________________________________________
Primary Care Physician:__________________________________________________________
In case of emergency, please contact:
Name:_________________________________________________________________
Phone:________________________________________________________________
Address:_______________________________________________________________
Relationship:____________________________________________________________
Allergies:______________________________________________________________________
Name of medication
Dose
Reason for medication
Please list the medications that you are taking. Include name, dose and reason that you are taking these.
Has anyone in your family (parents, grandparents, siblings) had a heart attack or other heart-related
problems before the age of 50?
No
Yes, please explain _______________________________________________________
__________________________________________________________________________
Do you have any medical conditions for which a physician has currently recommended some restriction
on your physical activity?
1. No
123
2. Yes
Are you pregnant?
1. No
2. Yes
Do you smoke or have used tobacco within the last 6 months?
3.No
4.Yes
Do you drink alcoholic beverages at all?
1. No
2. Yes __________________drinks/month
Are you currently involved in any type of exercise program or routine?
1. No
Yes, please explain how often and what you
do?__________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Do you know you cholesterol level?
No
Yes
Total cholesterol ____________
HDL cholesterol _____________
LDL cholesterol _____________
Triglycerides ________________
Do you know your glucose level or has anyone ever told you it was too high?
5. No
6.Yes
Has your doctor ever told you that you have any of the following?
1. Heart disease
2. Heart attack
21. Osteoporosis
3. Heart surgery
22. Gout
4. Heart catheterization
23. Stomach ulcer
5. Balloon angioplasty
24. Thyroid problems
6. Stroke
25. Varicose veins
7. Rheumatic heart disease
26. Rectal Bleeding
8. Congenital heart disease
27. Depression
9. Diabetes
28. Lightheaded or Dizziness
10. Aneurysm
29. Hearing Impairments
11. Arthritis
30. Visual impairments
12. Asthma
31. Allergies
13. Back Pain
32. Epilepsy
14. Bone Fractures
33. Lung disease or problems
15. Cancer
34. Heart valve problems
16. Emphysema
35. Heart murmurs
17. Hernia
36. High blood pressure
18. Joint or Ligament Injuries
37. Angina
19. Muscle Injuries
38. Unusual heart beat
20. Neck Pain or Injury
124
What is your height and weight?
___________in/_________________LB
__________cm/___________________kg
________________________BMI
_______________________Category
Social History:
Are you currently employed, if yes by
whom?______________________________________________________________________________
Living Situation?
____________________________________________________________________________________
____________________________________________________________________________________
Do you currently care for elderly parents or
grandchildren?________________________________________________________________________
____________________________________________________________________________________
Other significant medical or surgical history including musculoskeletal limitations? Please
describe_____________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Total # of risk factors_________________________
ACSM Risk Stratification______________________
What are your goals for joining this program?
_____________________________________________________________________________
_____________________________________________________________________________________________
___________________________________________________
Thank you for your time in filling out this information and for your participation in our program!
Patient Signature:______________________________________________________________
Signature:_____________________________________________________________
125
APPENDIX H
MODIFIABLE ACTIVITY QUESTIONNAIRE (MAQ)
126
127
128
APPENDIX I
FITNESS TESTS DATA COLLECTION FORM
129
Data Collection
Name: ___________________
Date: ___________
Height: _______
Weight: __________
Age: ______
BMI: ________
Waist Girth: ________
Resting BP: _________
Resting HR: _________
Single Stage Treadmill Test:
Sit-N-Reach:
Gender: ______________
Trial 1: __________
Weight: __________
Trial 2: __________
Speed: __________
Trial 3: __________
Age: ________
Rank: ___________
HR: __________
Vo2max: __________
Rank: _________
30 Second Chair Stand:
Total Number of Stands: _________
Rank: ___________
Back Scratch Test:
Trial 1: _________
Trial 2: __________
Rank: ________
Arm Curl Test:
Total Number of Arm Curls: _________
Rank: _______________
130
Shoulder Flexibility Test:
Shoulder Width: _______in.__
Trial 1: _______in.__
Trial 2: _______in._
Trial 3: _________in._
Rank: __________
Grip Strength Test:
Right Hand:
Left Hand:
Trial 1: __________
Trial 1: __________
Trial 2: __________
Trial 2: __________
Trial 3: __________
Trial 3: __________
Total: __________
Rank: _____________
Dynamic Muscular Endurance Test Battery:
Exercise:
Reps:
Arm Curl: __________
Bench Press: __________
Lat Pull-Down : __________
Triceps Extension: __________
Leg Extension: __________
Bent-Knee Sit-Up: __________
Leg Curl: __________
Total Repetitions: __________
Rank: ______________
131
Single Stage Treadmill Test
Equipment:
Treadmill
Stop Watch
Procedures:
6. Record your client’s weight (kilograms) and age (years).
7. Instruct the subject regarding the specifics of walking on a treadmill.
8. Encourage the subject to stretch and warm-up on the treadmill before beginning.
9. Set the treadmill to an elevation of 5% and the speed between 2.0 and 4.5 mph. Consult with the subject
regarding the speed that would be comfortable for them.
10.
The duration of the test is 4 minutes. Immediately at the conclusion of the test, locate the subject’s pulse
and record their heart rate (bpm).
Calculations:
Use the following equation to predict your client’s maximal uptake:
V02max (ml/kg/min) = 48.3502 + 10.0651(gender) - 0.2769(age) - 0.2088(weight in kg) + 10.1168(speed in mph) 0.1635(HR in bpm)
Gender (men = 1, women = 0)
Age (years)
Weight (kilograms) (1kg = 2.2 lbs)
Speed (miles per hour)
Heart Rate (beats per minute)
Aerobic Norms on Next 2 Pages
95-99 Percentile = Superior
80-90 Percentile = Excellent
60-75 Percentile = Good
40-55 Percentile = Fair
20-35 Percentile = Poor
1-15 Percentile = Very Poor
132
AEROBIC FITNESS NORMS FOR MEN (V02 in mL/kg/min)
Percentile
(Males)
20-29
30-39
40-49
50-59
60-69
70-79
99
61.2
58.3
57
54.3
51.1
49.7
95
56.2
54.3
52.9
49.7
46.1
42.4
90
54
52.5
51.1
46.8
43.2
39.5
85
52.5
50.7
48.5
44.6
41
38.1
80
51.1
47.5
46.8
43.3
39.5
36
75
49.2
47.5
45.4
41.8
38.1
34.4
70
48.2
46.8
44.2
41
36.7
33
65
46.8
45.3
43.9
39.5
35.9
32.3
60
45.7
44.4
42.3
38.3
35
30.9
55
45.3
43.9
41
38.1
33.9
30.2
50
434.9
42.4
40.4
36.7
33.1
29.4
45
43.1
41.4
39.5
36.6
32.3
28.5
40
42.2
41
38.4
35.2
31.4
28
35
41
39.5
37.6
33.9
30.6
27.1
30
40.3
38.5
36.7
33.2
29.4
26
25
39.5
37.6
35.7
32.3
28.7
25.1
20
38.1
36.7
34.6
31.1
27.4
23.7
15
36.7
35.2
33.4
29.8
25.9
22.2
10
35.2
33.8
31.8
28.4
24.1
20.8
5
32.3
31.1
29.4
25.8
22.1
19.3
1
26.6
26.6
25.1
21.3
18.6
17.9
133
AEROBIC FITNESS NORMS FOR WOMEN (V02 in mL/kg/min)
Percentile
(Females)
Age (20-29)
30-39
40-49
50-59
60-69
70-79
99
55
52.5
51.1
45.3
42.4
42.4
95
50.2
46.9
45.2
39.9
36.9
36.7
90
47.5
44.7
42.4
38.1
34.6
33.5
85
45.3
42.5
40
36.7
33
32
80
44
41
38.9
35.2
32.3
30.2
75
43.4
40.3
38.1
34.1
31
29.4
70
41.1
38.8
36.7
32.9
30.2
28.4
65
40.6
38.1
35.6
32.3
29.4
27.6
60
39.5
36.7
35.1
31.4
29.1
26.6
55
38.1
36.7
33.8
30.9
28.3
26
50
37.4
35.2
33.3
30.2
27.5
25.1
45
36.7
34.5
32.3
29.4
26.9
24.6
40
35.5
33.8
31.6
28.7
26.6
23.8
35
34.6
32.4
30.9
28
25.4
22.9
30
33.8
32.3
29.7
27.3
24.9
22.2
25
32.4
30.9
29.4
26.6
24.2
21.9
20
31.6
29.9
28
25.5
23.7
21.2
15
30.5
28.9
26.7
24.6
22.8
20.8
10
29.4
27.4
25.6
23.7
21.7
19.3
5
26.4
25.5
24.1
21.9
20.1
17.9
1
22.6
22.7
20.8
19.3
18.1
16.4
134
YMCA Sit-N-Reach Test
Equipment:
Yardstick and Tape
a.Use a yardstick and place it on the floor with tape placed across it at a right angle to the 15
in. mark.
b.Make sure that the client has an adequate warm up. Have client sit with yardstick between
the legs and legs extended at right angles to the taped line on the floor
c.Heels of the feet should touch the edge of the taped line and be about 10-12 in. apart
d.When figuring out the scores, take the closest in. they reach to with their hands.
e.For percentiles by age groups and sex see table 4.16 in the green ACSM book (p. 101)
135
30 Second Chair Stand
Purpose: To assess lower body strength.
Equipment: Stopwatch and straight-back chair or folding chair with a seat height of 17 inches.
Procedures:
6. Place the chair against the wall to prevent it from moving during the test.
7. Have client sit in the middle of the chair with their feet flat on the floor and their arms cross at the wrist and held
against the chest.
8. Instruct the client to complete as many stands as possible in 30 seconds. Client should rise to a full stand when
you say “Go” and then return to a fully seated position. This counts as one repetition.
Scoring: The total number of stands in 30 seconds
Age (MEN)
Below
Average
Average
Above
Average
60-64
<14
14 to 19
>19
65-69
<12
12 to 18
>18
70-74
<12
12 to 17
>17
75-79
<11
11 to 17
>17
80-84
<10
10 to 15
>15
85-89
<8
8 to 14
>14
Age
(Women)
Below
Average
Average
Above
Average
60-64
<12
12 to 17
>17
65-69
<11
11 to 16
>16
70-74
<10
10 to 15
>15
75-79
<10
10 to 15
>15
80-84
<9
9 to 14
>14
85-89
<8
8 to 13
>13
136
Back Scratch Test
Purpose: To assess upper body flexibility.
Equipment: 18 in. ruler
Procedures: While standing, the participant should place the preferred hand, palm down and
fingers extended over the same shoulder, reaching down as far as possible (elbow pointing up).
The other arm is place around the back of the waist with the palm-up, reaching upward in an
attempt to touch or overlap the extended middle fingers toward each other, provided the
participant’s hands are not moved. Participants are not permitted to grab their fingers and pull.
The participant can practice to determine the preferred hand and can be given 2 practice trials
before the scoring trial.
Scoring: Administer 2 tests and record both scores to the nearest half inch. Measure the distance
of overlap or distance between the middle fingers, using the best score. If the fingers do not
touch, a minus (or negative) score is given. A zero is given if the fingers touch and a plus score is
given if the fingers overlap.
Age (Men)
Below
Average
Average
(inches)
Above
Average
60-64
< -6.5
-6.5 to 0
>0
65-69
< - 7.5
-7.5 to 1
>1
70-74
< -8
-8 to 1
>1
75-79
< -4
-4 to 2
>2
80-84
< -9.5
-9.5 to 3
>3
85-89
< -10.5
-10.5 to 4
>4
Age
(Women)
Below
Average
Average
(inches)
Above
Average
60-64
< -3
-3 to 0
>0
65-69
< -3.5
-3.5 to 1.5
> 1.5
70-74
< -4
-4 to 1
>1
75-79
< -5
-5 to 0.5
> 0.5
80-84
< -5.5
-5.5 to 0
>0
85-89
< -7
-7 to 1
>1
137
Arm Curl Test
Purpose: To assess upper-body strength
Equipment: Stopwatch, Straight back chair, 5lb dumbbell for females and an 8lb dumbbell for
males
Procedures: The client sits on the chair with back straight and feet flat on the floor. The dominant
side of the body should be close to the corresponding edge of the chair. The weight is at the
participant’s side with the arm extended, and in the dominant hand. From the down position, the
weight is curled up with the palm gradually rotating to a facing position during flexion. The
weight is then returned to the extended down position. The goal is for the participant to perform
as many curls as possible in 30 seconds. Participants start on the signal “Go.” The weight should
move through the full range of motion, with the upper arm still throughout the test.
Scoring: Total number of arm curls performed in 30 seconds.
Norms:
Age (Men)
Below
Average
Average
Above
Average
60-64
<16
16 to 22
>22
65-69
<15
15 to 21
>21
70-74
<14
14 to 21
>21
75-79
<13
13 to 19
>19
80-84
<13
13 to 19
>19
85-89
<11
11 to 17
>17
Age
(Women)
Below
Average
Average
Above
Average
60-64
<13
13 to 19
>19
65-69
<12
12 to 18
>18
70-74
<12
12 to 17
>17
75-79
<11
11 to 17
>17
80-84
<10
10 to 16
>16
85-89
<10
10 to 15
>15
138
Shoulder Flexibility Test
Purpose: To measure flexibility in shoulder rotation
Equipment: Jump rope with a handle on the end, Tape Measure
Procedures:
Instruct the client to warm-up and practice
Have the client grasp the handle with their left hand at the inner edge of the handle. They are not
allowed to change this grip during the test.
16.
Have the client grasp the rope a short distance away with their right hand. This grip is loose so
that the rope can easily slide through their fingers.
17.
Have the client extend both arms to full length in front of their chest (with their elbows locked).
Keeping arms straight, have them raise their arms and rotate them so that they can take the rope back
over their head and down in back so that the rope rests on the buttocks.
18.
To be able to do this without bending the arms or taking one arm back first, the client must allow
the rope to slide through their right hand.
19.
Have the client keep both grips intact and bring the rope back in front. They may bend their
elbows for this portion of the test.
Scoring:
14.
15.
Measure the distance to the nearest quarter-inch (.25 in or ¼ in) between the inner edge of the left
hand to the inner edge of the right hand
23.
Measure the shoulder width in back from the outside of the left deltoid to the outside of the right
deltoid.
24.
Take the best 3 trials and subtract the shoulder width from the score. Thus, the lower the score,
the better.
Example: Best trial = 30 inches
22.
Shoulder width = 19 inches
= 11 inches
Level
Men (in.)
Women (in.)
Advanced
<7
<5
Adv. Intermediate
11.5-7.25
9.75-5.25
Intermediate
14.5-11.75
13-10
Adv. Beginner
19.75-14.75
17.75-13.25
Beginner
>20
>18
139
Grip Strength Test
a.Have client stand and perform test with each hand
b.Adjust the grip bar so that the second joint of the fingers will be bent to grip the handle of the
dynamometer
c.Hold dynamometer parallel to body above head, with straight arm
d.While lowering arm, ask client to squeeze dynamometer as hard as they can
e.Record reading, resent plastic piece and switch hands
f.Avoid holding breath during this
g.Test would be repeated for a total of 3 readings for each hand. Take the highest reading from each
hand and add those values to measure handgrip strength.
h.Compare test scores to table 5.1 in ACSM’s Health-Related Physical Fitness Assessment Manual
(p. 79)
GRIP-STRENGTH NORMS FOR FEMALES
Age
15-19
20-29
30-39
40-49
50-59
60-69
Above
Average
64-70
65-70
66-72
65-72
59-64
54-59
Average
59-63
61-64
61-65
59-64
55-58
51-53
Below
average
54-58
55-60
56-60
55-58
51-54
48-50
Poor
≤53
≤54
≤55
≤54
≤ 50
≤47
GRIP-STRENGTH NORMS FOR MALES
Age
15-19
20-29
30-39
40-49
50-59
60-69
Above
Average
103-112
113-123
113-122
110-118
102-109
98-101
Average
95-102
106-112
105-112
102-109
96-101
86-92
Below
average
84-94
97-105
97-104
94-101
87-95
79-85
Poor
≤ 83
≤96
≤96
≤93
≤86
≤78
140
Dynamic Muscular Endurance Test Battery
Procedures:
Use the client’s body weight to calculate how much they should be lifting for each
23.
exercise.
For example: For women, they need to lift .25 (or 25%) of their body weight for the arm curl.
Women’s weight = 150 lbs
Arm curl weight = 150 x .25 = 37.5 lbs
% Body Mass to Be Lifted (can be modified or lowered if need be)
Exercise
Men
Women
Arm Curl
0.33
0.25
Bench Press
0.66
0.5
Lat pull-down
0.66
0.5
Triceps
Extension
0.33
0.33
Leg Extension
0.5
0.5
Leg Curl
0.33
0.33
Weight (lbs)
Repetitions
(max = 15)
Bent-knee Sit-up
Total Repetitions
=
________
Total Repetitions
Fitness Category*
91-105
Excellent
77-90
Very Good
63-76
Good
49-62
Fair
35-48
Poor
<35
Very Poor
*Based on data compiled by author for 250 college-age men and women
141
APPENDIX J
SELF-EFFICACY FOR EXERCISE SCALE (SEE)
142
Name: _____________________
Date: _________
ID#: __________
The Self-Efficacy for Exercise (SEE) Scale
How confident are you right now that you could exercise three times per week for 20
minutes if:
Not Confident
Very Confident
The weather was bothering you
0 1 2 3 4 5 6 7 8 9 10
You were bored by the program or activity 0 1 2 3 4 5 6 7 8 9 10
You felt pain when exercising
0 1 2 3 4 5 6 7 8 9 10
You had to exercise alone
0 1 2 3 4 5 6 7 8 9 10
You did not enjoy it
0 1 2 3 4 5 6 7 8 9 10
You were too busy with other activities
0 1 2 3 4 5 6 7 8 9 10
You felt tired
0 1 2 3 4 5 6 7 8 9 10
You felt stressed
0 1 2 3 4 5 6 7 8 9 10
You felt depressed
0 1 2 3 4 5 6 7 8 9 10
Developed by: Resnick, B., & Spellbring, A. (2000). Understanding what motivates older
adults to exercise. Journal of Gerontological Nursing, 26, 17-21.
Reprinted with permission from Dr. Barbara Resnick
143
APPENDIX K
DECISIONAL BALANCE QUESTIONNAIRE
144
Name: __________________________
Date: __________
ID#_________
Decisional Balance
Physical activity or exercise includes activities such as walking briskly, jogging, bicycling, swimming,
and any other activity in which the exertion is at least as intense as these activities. Please rate how
important each of these statements is in your decision of whether to be physically active. In each case,
think about how you feel right now, not how you felt in the past or would like to feel.
1= not at all important, 2=slightly important, 3= moderately important, 4= very important, 5= extremely
important
I would have more energy for my family and friends
If I were regularly physically active
1 2 3 4 5
Regular physical activity would help me relieve tension
I think I would be too tired to do my daily work after
Being physically active
1 2 3 4 5
1 2 3 4 5
I would feel more confident if I were regularly physically active
I would sleep more soundly if I were regularly physically active
I would feel good about myself if I kept my commitment to be
Regularly physically active
1 2 3 4 5
1 2 3 4 5
1 2 3 4 5
I would find it difficult to find a physical activity that I enjoy
And that is not affected by bad weather
1 2 3 4 5
I would like my body better if I were regularly physically active
It would be easier for me to perform routine physical tasks
If I were regularly physically active
1 2 3 4 5
1 2 3 4 5
I would feel less stressed if I were regularly physically active
I feel uncomfortable when I am physically active because
I get out of breath and my heart beats very fast
1 2 3 4 5
1 2 3 4 5
I would feel more comfortable with my body if I were regularly
Physically active
1 2 3 4 5
Regular physical activity would take too much of my time
Regular physical activity would help me have a more positive
Outlook on life
1 2 3 4 5
1 2 3 4 5
I would have less time for my family and friends if I were
Regularly physically active
1 2 3 4 5
At the end of the day, I am too exhausted to be physically active
1 2 3 4 5
From: B. Marcus and L Forsyth, 2009, Motivating people to be physically active, 2nd ed. (Champaign, IL:
Human Kinetics).
145
APPENDIX L
PHYSICAL ACTIVITY STAGES OF CHANGE QUESTIONNAIRE (PASCQ)
146
From: B. Marcus and L Forsyth, 2009, Motivating people to be physically active, 2nd ed. (Champaign, IL:
Human Kinetics).
147
APPENDIX M
SAMPLE EXERCISE LOG
148
Student Name: _____________________ Client Name: _______________________
Date: ____________
RHR: _________ RBP: ________
Time In: ______
Time Out: _______
THR: _____________________
Times/Week Client Exercised: __________
Average Minutes/Session:
___________
(Exercise = physical activity that is planned, structured, and repetitive)
What was client’s previous week’s behavioral goal?:
______________________________________________________________________
Was Client’s goal achieved? Yes/No
Warm Up:
______________________________________________________________________
______________________________________________________________________
Cardiovascular Workout:
Exercise HR: _______ Exercise BP: ________ EX RPE: _______ Time: _________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Resistance Training:
EX HR: _________ EX BP: ________ EX RPE: ________ Time: ________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Cool Down:
EX HR: __________ EX BP: __________ EX RPE: _______
Time: _________
______________________________________________________________________
Comments: ____________________________________________________________
______________________________________________________________________
Supervisor Signature: _________
149