Psychological Models Explaining Barriers to Exercise - Term Paper Example

Discuss the relevance of psychological models to explain some of the barriers to the implementation and maintenance of exercise in the field of exercise for health. Exercise and physical activity in general have been shown to cause a significant reduction in a wide range of diseases such as cardiovascular disease, obesity, diabetes, and mental disorders (Stralen et al., 2008). Despite this positive outcome, the trend towards a sedentary lifestyle is increasing in society (Fallon, Hausenblas and Nigg, 2005; Lee, Arthur and Avis 2008; van Stralen, Lechner, Mudde, DeVries and Bolman 2008; Segar, Eccles, Richardson, 2008; Biddle and Fuchs, 2009). This has led health authorities and researchers to develop interventions based on theoretical models of behaviour change in an attempt to eradicate this prevailing trend and replace it with increased physical activity. The Transtheoretical Model (TTM; Prochaska & DiClemente, 1982, p. 83) has been used to facilitate positive behaviour change towards physical activity. The model is a combination of stages of change, self-efficacy, temptation, decisional balance and processes of change. The first stage, the stage of change, has been widely adopted by health and fitness professionals to help individuals move through the six theoretical stages: pre-contemplation, contemplation, preparation, action, maintenance, termination with a positive outcome (progression) or negative outcome (relapse). In the pre-contemplation stage the individual is not identifying the need for an exercise programme within the next 6 months. While smoothly moving to the next stage - the contemplation, the individual has begun to form an idea about exercising and eventually initiates it within the next 6 months. The preparation stage involves planning to start exercising within the next 60 days. The action period represents the first 6 months after commencing the exercise programme. In the maintenance stage a sustained exercise programme is developed which lasts no more than 6 months. The termination of the exercise program would mean that the individual has successfully changed his/her behaviour and consolidated the life-style in accordance with it. According to Prochaska & Velicer (1997) the termination stage is when an individual has embedded in himself/herself in an exercise behaviour for more than five years and has no desire for temptations and a maintains a robust self-efficacy for a healthy lifestyle. There is a possibility for a relapse phase to appear. The relapse can happen during any one of the enumerated stages. The relapse results in returning of the individual to the previous stage. According to Bandura (1997) it is vital for a theoretical stage model to include the three fundamental elements: qualitative transformations across stages, constant sequence of change, and no reversibility. Bandura (1997) further claims that the TTM disregards these three elements. Qualitative transformations are disregarded due to the fact that the first two stages (pre-contemplation and contemplation) are referred to as intentional behaviour. The intentional behaviour involves phrases such as “I may be joining the gym!” or “I am joining the gym!”. Whereas the other stages are regulated by the duration of behaviour change (6 months, 1 year, 5 years). Therefore the lack of similarity between stages makes qualitative transformation unreliable. Constant sequences of change and no reversibility are not in the TTM according to Bandura (1997) because individuals can initiate a behaviour change at any stage, they do not start at the same stage and they are able to jump a stage. According to Kraft, Sutton, and Reynolds (1999) the TTM lacks “theoretical reasoning” because to suggest that a period of six month is enough for an individual to adopt a behaviour change is an assumption that lacks evidence substantiation. Their critical view on the TTM is also supported by Sutton (2001), who suggested that the TTM time period is arbitrary and based on Individual’s judgment or preference. Marshall and Biddle (2001) suggested that the TTM is based on conclusions lacking in empirical evidence to support them. Alternatively, Rollnick, Heather and Bell (1992), suggest that ‘readiness to change’ should be seen as a continuum rather than series of changes. However, this assumption is based on the fact that the continuum is gradual rather than in leaps from one stage to another. A study by West (2005), “Time for a change: putting the Transtheoretical (Stages of Change) Model to rest” supports the criticism against the TTM model because it is centered more on theoretical assumptions and less on theoretical reasons. Bridle, Riemsma, Pattenden and et al (2005) through a systematic review of 37 studies found that there was limited evidence supporting behavioural change through stages. Rollnick Marshall and Biddle (2001) also support the idea that the TTM is based on heuristic predictions. Both Teixeira et al. (2006) and Gallagher et al. (2006) agree that the TTM has helped to overcome barriers in both weight management and exercise adherence by targeting individual self-efficacy and behavioural strategies. It is generally recognised that adherence to a programme of exercise plays a crucial role in an individual’s success in maintaining positive results both psychologically and physically. By comprehending how this can vary according to an individual’s situation and how strategies for progress can be achieved every individual should be assisted to develop and maintain the habits of a healthy lifestyle. The TTM uses the same format of stages of change for self-efficacy; temptation, decisional balance, and the process of change. Self- efficacy is one’s own perception of the ability to achieve a positive outcome (e.g. I am confident that I can improve my health) (Bandura, 1997). According to Lee, Arthur and Avis (2008) it is individual’s self-confidence/belief which leads towards a positive and sustained behavioural change. However, outcome expectations may differ (Lee, Arthur and Avis, 2008). Individuals may possess the knowledge or past experience how beneficial exercises are, however they may have lost the urge to prioritize exercise in their hectic and busy everyday life. This is also reflected by Health Education Initiative efforts to encourage and stimulate people from different backgrounds to perceive exercise as something that can be easily incorporated into their daily activities rather than a time consumer that needs to be allocated in between other important tasks. Biddle and Fuchs (2009) found a tendency for decline in physical activity with the fact that people get older. However, they noted that within small age range males were more active than females. Temptation is defined as an individual’s urge to return to an old habit. Although some studies (Hausenblas, Nigg, Dannecker and et al., 2001) discovered that the level of temptation has decreased linearly as an individual moved towards upper stages, Lee, Arthur and Avis (2008) tried to give a reasonable explanation to the question: why temptation linearly decreases as it moves along the continuum of stages. A possible interpretation might be because during the first two stages individuals did not have the chance to experience the positive results of physical activities; therefore the urge to avoid exercising activies had increased. The desire has diminished in upper stages because individuals have begun to experience the benefits of physical activities, thereby expanding the level of self-efficacy. Bandura (2005) strongly recommanded that greater emphasis is accumulated on the first two stages to aid individuals overcome the temptation and help them out to accomplish self-regulation. He introduced a Self-Regulation Model in which people are able to self-monitor their own health behavioural issues, agree goal settings, focus on small time frames which are realistic and achievable, and self-reactive stimulus to enhance motivation and therefore maintain positive behaviour change. Lee, Arthur and Avis, (2008) investigated that reducing stress and negative thoughts facilitated and encouraged the development of positive behaviour change. Decisional balance in the TTM is therefore regarded as an important tool, especially during the first two stages, where individual levels of “for and against” vary condiderable and the arguments “for” are higher than those for “against”. Fallon, Hausenblas and Nigg (2005) examined that by integrating decisional balance in the early stages of TTM the individual is better equipped to move forward to the stage of alternations. Finally, the process of changing is a combination of five cognitive operations (including changes in the way people think and feel about their inactivity and exercise) and five behavioural steps (where people eventually make changes to their behaviour in relation to an active life style which involves exercising). Cognitive techniques assist individuals to move through the early progressional changes which consist of: consciousness raising, dramatic relief, environmental re-evaluation, self re-evaluation and social liberation. Consciousness raising occurs when the individual’s level of awareness of the effects of inactivity has increased. Reading leaflets or articles which debate and refer to the direct connection between inactivity and various illnesses such as coronary vascular diseases, diabetes and obesity will encourage people to seek greater physical activity and to actively follow the patterns of a healthy life style. The dramatic relief is associated with a strong emotional response to events linked to sedentary way of life. An example can be given with a close friend or relative who has been diagnosed with diabetis as a result of obesity. Environmental re-evaluation is the process when an individual becomes aware of the impact of his/her inactivity on others (e.g. not being able to play with his children because he is too unfit to do that). Self-re-evaluation appears in the form of evaluating one’s own self-perceptions as a sedentary person (e.g. feeling unhappy because of overweight/obesity). Social liberation occurs when an individual start to notice social conditions that support change (e.g. the opening of new leisure centres). Behavioural perfomances assist individuals to move smoothly through the last stages of change which comprise of: self-liberation, helping relationships, counter-conditioning, reinforcement management and Stimulus control. Self-liberation represents the individual’s self- attitude/belief that they can change and commit to act on that belief (e.g. telling friends and family that they are willing to become physically active or that they have decided to join in the local gym). Helping relationships means to accept the aid or support of others in order to begin an exercise programme (e.g. accepting an offer from a friend to join exercise classes, or to play recreational sport). Counter-conditioning is the moment when an individual replaces inactivity with a more physically active behaviour (e.g. spending more hours gardening, going for a walk, or choosing to walk instead of driving). Reinforcement management is the stage when the person self-rewards himself for maintaining an exercise behaviour (e.g. going on holiday, buying new clothes, noticing how good-looking he has become, others reaffirming his behaviour ). Stimulus control is the pratcise of avoiding relapses or temptations (e.g. taping favourite TV programmes to watch after exercising, going to the gym straight after work instead of going home and relaxing). At every stage the individual has to make a decision based on the positive arguments (perceived advantages) and the negative arguments (perceived disadvantages) of the exercising. There are many factors that can influence the decision in each stage. However, if the cognitive processes are properly engaged then the balance can be maintained and the decision taken will be in favour of the positive behaviours. Professional intervention at the right time and stage can assure that the individual will follow the positive changes of active physical behaviour and implement them as part of his lifestyle. Therefore, it is critical that health and fitness professionals possess the understanding to discover individuals’ levels of motivation and encourage and stimulate them to overcome any obstacles on their way to perform exercising activities. In this way medical and health specialists can facilitate people in destroying these barriers. Despite the argument that psychological interventions are too theoretical, namely they help the fitness professionals to comprehend and evaluate the myriads of human complexities and ultimately to guide individuals in accomplishing and maintaining positive behavioural change. [Word count: 1,723/2000] References: 1. Bandura, A. (1997). ‘Self-efficacy: The exercise of control’. New York: Freeman, pp. 604 2. Bandura, A. (2005). ‘The Primacy of Self-Regulation in Health Promotion’. Jounal of Applied Psychology, 54 (2), 245-254. [Accessed 05/11/09] 3. Biddle, S.J.H. and Fuchs, R. (2009). ‘Exercise psychology: A view from Europe’. Psychology of Sport & Exercise, 10, 410-419. [Accessed 05/11/09] 4. Bridle, C., Riemsma, R.P., Pattenden, J., Sowden, A.J., Mather, L., Watt, I.S., Walker, A. (2005). ‘Systematic review of the effectiveness of health behavior interventions based on the transtheoretical model’. Psychol Health, 20, 283–301. [Accessed 10/11/2009] 5. Fallon, E.A., Hausenblas, H.A. 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