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Socialpolitical predictors of exercise

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Socialpolitical predictors of exercise
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174 HEALTH PSYCHOLOGY
the sportsmen reported decreases in tension/anxiety after the maximal exercise. However,
all subjects reported increased exhilaration and increased mental vigour two minutes
after both the maximal and moderate exercise compared with the minimal condition, and
in addition, the increase in exhilaration was maintained after the 30 minutes of recovery.
Conclusion
The authors conclude that both maximal and moderate exercise results in beneficial
changes in both mental vigour and exhilaration in both sportsmen and inactive men
and suggest that ‘exercise leads to positive mood changes even among people who
are unaccustomed to physical exertion’. They also suggest that greater attention to the
immediate effects of exercise may improve adherence to exercise programmes.
WHAT FACTORS PREDICT EXERCISE?
Because of the potential benefits of exercise, research has evaluated which factors are
related to exercise behaviour. The determinants of exercise can be categorized as either
social/political or individual.
Social/political predictors of exercise
An increased reliance on technology and reduced daily activity in paid and domestic
work may have resulted in an increase in the number of people having relatively sedentary lifestyles. In addition, a shift towards a belief that exercise is good for an individual’s
well-being and is relevant for everyone has set the scene for social and political changes
in terms of emphasizing exercise. Therefore, since the late 1960s many government
initiatives have aimed to promote sport and exercise. Factors such as the availability of
facilities and cultural attitudes towards exercise may be related to individual participation. Consequently, the Sports Council launched an official campaign in 1972 in an
attempt to create a suitable climate for increasing exercise behaviour. Initiatives such as
‘Sport for All’, ‘Fun Runs’ and targets for council facilities, such as swimming pools and
sports centres, were part of this initiative. In collaboration with the Sports Council,
McIntosh and Charlton (1985) reported that the provision of council services had
exceeded the Sports Council’s targets by 100 per cent. This evaluation concluded that:
I Central government funding for sport and specific local authority allocations have
helped participation in sport.
I Despite small improvements, the Sport for All objective is far from being realized and
inequalities persist.
I Inequalities in the provision of sport facilities have diminished – especially for indoor
sport.
I The recognition of the Sports Council’s earlier emphasis on élite sports has been slow
and disproportionately large amounts of the Council’s funds are still being spent on
élite sport.
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EXERCISE 175
One recent approach to increasing exercise uptake is the exercise prescription scheme
whereby GPs refer targeted patients for exercise. Therefore, in the same way that an
overweight or depressed patient would be referred to see a counsellor, or a patient with a
suspected skin cancer would be referred to a hospital specialist, a GP can now also refer
a patient for exercise. This could take the form of vouchers for free access to the local
leisure centre, an exercise routine with a health and fitness advisor at the leisure centre,
or recommendations from the health and fitness advisor to follow a home-based exercise
programme, such as walking.
An alternative and more simple approach involves the promotion of stair rather
than escalator or lift use. Interventions to promote stair use are cheap and can target
a large population. In addition, they can target the most sedentary members of the
population who are least likely to adopt more structured forms of exercise. This is in
line with calls to promote changes in exercise behaviour which can be incorporated
into everyday life (Dunn et al. 1998). Research also indicates that stair climbing can
lead to weight loss, improved fitness and energy expenditure and reduced risk of
osteoporosis in women (e.g. Brownell et al. 1980; Boreham et al. 2000). Some
research has therefore attempted to increase stair use. For example, some research
has explored the impact of motivational posters between stairs and escalators or lifts
and has shown that such a simple intervention can increase stair walking (e.g.
Anderson et al. 1998; Russell et al. 1999; Kerr et al. 2001). In a more detailed study,
Kerr et al. (2001) explored what characteristics of poster prompts was most effective
and explored whether this varied according to message, gender and setting. The
results showed that larger posters were more effective at promoting stair use, that
effectiveness was not related overall to whether the message emphasized time and
health (i.e. ‘stay healthy, save time, use the stairs’) or just health (i.e. ‘stay healthy
use the stairs’), but that whereas the message including time was more effective
for women in the train station it was more effective for men when presented at a
shopping centre.
Therefore, these initiatives have aimed to develop a suitable climate for promoting
exercise. In addition, as a result of government emphasis on exercise, specific exercise
programmes have been established in an attempt to assess the best means of
encouraging participation. In particular it is possible to differentiate between individual
and supervised exercise programmes.
Individual versus supervised exercise programmes
King et al. (1991) carried out a study in the USA to examine the relative value of
individual versus supervised exercise programmes. Using random telephone numbers
they identified 357 adults, aged 50–65, who led relatively sedentary lifestyles. These
subjects were then randomly allocated to one of four groups:
I Group 1: the subjects were encouraged to attend a one-hour vigorous exercise session
at a local community centre at least three times a week.
I Group 2: the subjects were instructed to do some intensive exercise on their own and
were encouraged and monitored with periodic phone calls.
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176 HEALTH PSYCHOLOGY
I Group 3: the subjects were instructed to do lower intensity exercise on their own.
I Group 4: the control subjects were not instructed to do any exercise.
The results showed greater adherence in the unsupervised home-based programmes,
than in the supervised programme. However, all subjects who had been instructed to do
some exercise showed an increase in cardiovascular fitness compared with the control
group. The authors suggested that the results from this study provide insights into
the development of successful national campaigns to promote exercise behaviour that
involve a minimal and cheap intervention and argued for an emphasis on unsupervised
individual exercising.
Other factors that appear to play a role in developing successful exercise programmes
are the use of behavioural contracts, whereby the individual signs a contract with an
instructor agreeing to participate in a programme for a set period of time (e.g. Oldridge
and Jones 1983) and the use of instructor praise and feedback and flexible goal-setting
by the subject (e.g. Martin et al. 1984). These factors involve supervised exercise
and suggest that individualized exercise programmes may not be the only form of
intervention.
The social/political climate therefore has implications for predicting and promoting
exercise. However, even if councils provide the facilities and government programmes
are established, individuals have to make decisions about whether or not to participate. Research has, therefore, also examined the individual predictors of exercise
behaviour.
Individual predictors of exercise
Dishman and colleagues (Dishman 1982; Dishman and Gettman 1980) carried out a
series of studies to examine the best individual predictors of exercise and suggested that
these factors can be defined as either non-modifiable or modifiable.
Non-modifiable predictors of exercise
Dishman (1982) reported that non-modifiable factors such as age, education, smoking,
ease of access to facilities, body fat/weight and self-motivation were good predictors of
exercise. The results of a prospective study indicated that the best predictors of exercise
behaviour were low body fat, low weight and high self-motivation (Dishman and
Gettman 1980). However, whether factors such as access to facilities and self-motivation
should be regarded as non-modifiable is problematic. King et al. (1992) reported the
results of a study that evaluated the factors predicting being active in leisure time. They
described the profile of an active individual as younger, better educated, more affluent
and more likely to be male. However, it is possible that other individuals (less affluent/less
educated) may be more active at work. Research has also examined ethnic differences in
predicting exercise behaviour. Several studies indicate that blacks are less active than
whites, that black women are especially less active and that these differences persist even
when income and education are controlled (e.g. Shea et al. 1992).
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EXERCISE 177
Modifiable predictors of exercise
Dishman et al. (1985) summarized the following variables as modifiable predictors:
I Childhood exercise: individuals who exercise as children are more likely to exercise as
adults.
I Positive self-image: research also indicates that a positive self-image and confidence in
one’s ability influences future activity levels.
I No role for knowledge: interestingly the research suggests that good knowledge about
the benefits of exercise does not predict exercise behaviour.
The role of attitudes and beliefs
Research has examined the role of attitudes and beliefs in predicting exercise. Research
into beliefs has used either a cross-sectional or a prospective design. Cross-sectional
research examines the relationships between variables that co-occur, whereas
prospective research attempts to predict future behaviour.
Cross-sectional research
This type of research indicates a role for the following beliefs and attitudes:
I Perceived social benefits of exercise. Research examining the predictors of exercise
behaviour consistently suggests that the main factors motivating exercise are the
beliefs that it is enjoyable and provides social contact. In a cross-sectional study
examining the differences in attitude between joggers and non-joggers, the nonjoggers reported beliefs that exercise required too much discipline, too much time,
they did not believe in the positive effects of jogging and reported a lower belief that
significant others valued regular jogging (Riddle 1980).
I Value on health. Although many individuals exercise for reasons other than health, a
MORI poll in 1984 suggested that the second main correlate of exercising is a belief
that health and fitness are important (MORI 1984). In support of this, the nonjoggers in the study by Riddle (1980) also reported a lower value on good health than
the joggers.
I Benefits of exercise. Exercisers have also been shown to differ from non-exercisers in
their beliefs about the benefits of exercise. For example, a study of older women (aged
60–89 years) indicated that exercisers reported a higher rating for the health value
of exercise, reported greater enjoyment of exercise, rated their discomfort from exercise as lower and perceived exercise programmes to be more easily available than
non-exercisers (Paxton et al. 1997).
I Barriers to exercise: Hausenblas et al. (2001) argued that it is not only the benefits of
exercise that promote exercise but also the barriers to exercise which prevents exercise uptake. They developed a questionnaire entitled the ‘Temptation to not exercise
scale’ which measured two forms of barriers ‘affect’ and ‘competing demands’. Subjects are asked to rate a series of answers following the statement ‘please indicate how
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tempted you are not to exercise in the following situations . . .’. The answers include
‘when I am angry’ and ‘when I am satisfied’ to reflect ‘affect’ and ‘when I feel lazy’
and ‘when I am busy’ to reflect competing interests. The authors argue that
such temptations are central to understanding exercise uptake and should be used
alongside the stages of change model.
Prospective research
This has examined which factors predict the uptake of exercise. It has often been carried
out in the context of the development of exercise programmes and studies of adherence
to these programmes. Sallis et al. (1986) examined which factors predicted initiation
and maintenance of vigorous/moderate exercise for one year. The results indicated
that exercise self-efficacy, attitudes to exercise and health knowledge were the best predictors. In a further study, Jonas et al. (1993) followed up 100 men and women and
reported the best predictors of intentions to participate in the exercise programmes
and actual participation were attitudes to continued participation, perceived social
norms and perceived behavioural control. Jones et al. (1998) also examined the predictors of uptake and adherence, and used repertory grids to explore the personal constructs of those individuals who had been referred to exercise as part of an exercise
prescription scheme. They concluded that having realistic aims and an understanding
of the possible outcomes of a brief exercise programme were predictive of adherence to
the programme.
To further understand the predictors of exercise adherence, social cognition models
have been used. Riddle (1980) examined predictors of exercise using the theory of
reasoned action (Fishbein and Ajzen 1975; see Chapter 2) and reported that attitudes
to exercise and the normative components of the model predicted intentions to
exercise and that these intentions were related to self-reports of behaviour. The theory
of planned behaviour (TPB) has also been developed to assess exercise behaviour. Valois
et al. (1988) incorporated a measure of past exercising behaviour (a central variable
in the TPB) and reported that attitudes, intentions and past behaviour were the best
predictors of exercise. Similarly, Hagger et al. (2001) used the TPB to predict exercise in
children and concluded that most variables of the TPB were good predictors of
behavioural intentions and actual behaviour at follow-up. The use of TPB to predict
exercise is discussed further in Focus on research 7.2, opposite. Research has also used
the health belief model (Sonstroem 1988) and models emphasizing exercise self-efficacy
(e.g. Schwarzer 1992), task self efficacy and scheduling self efficacy (Rodgers et al.
2002).
Research has also applied the stages of change model to exercise behaviour (see
Chapters 2 and 5). This model describes behaviour change in five stages: precontemplation, contemplation, preparation, action and maintenance (e.g. DiClemente and
Prochaska 1982) and suggests that transitions between changes is facilitated by a cost
benefit analysis and by different cognitions. Marcus et al. (1992) examined the relationship between the pros and cons of exercise and stage of change in 778 men and women.
The pros and cons of exercise and decisional balance (pros versus cons) was related to
exercise adoption and that higher ratings of pros were found in those individuals closer
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