Self-management Techniques to Enhance Physical Activity

Original Editor - - Justin Louie, Stuart Maytham, Dawn Williams, Paul Reen, Janelle Eisler-Carr, Ciara Wright as part of the QMU Current and Emerging Roles in Physiotherapy Practice Project

Top Contributors - Justin Louie, Ciara Wright, Stuart Maytham, Kim Jackson, Paul Reen, 127.0.0.1, Evan Thomas, Admin, Rucha Gadgil and Scott Buxton   </div>

Introduction

Learning Outcomes

This resource will enable the user to:

• Critically evaluate and synthesise the key issues regarding the physical inactivity epidemic
• Identify and justify the knowledge, skills and behaviours required by a health coach in a physiotherapy setting
• Critically evaluate the use and feasibility of current and emerging technology to enable self management and health behavior change
• Discuss the emerging online tools ultilising more intensive theory-based interventions that incorporate multiple behaviour change techniques which may assist the Physiotherapist in their emerging role as a health coach.
  
  

What is Behaviour?

Behaviour is the range of actions and mannerisms made by individuals, organisms, systems, or artificial entities in conjunction with themselves or their environment.

It is the response of the system or organism to various stimuli or inputs, whether

internal // external (being worried about your health and/or appearance // going to the gym)

conscious // subconscious (deciding you should go for a walk // associating exercise with fun and reward)

overt // covert (going out for a run // lying about exercise) voluntary // involuntary (deciding you should go for a walk // missing the bus and having to walk)

Why is the General Population so Inactive?

Social

• Sedentary behaviour is woven into society

Cultural

• As a nation seek immediate reward over flourishing

Structural

Economical

Physiological

• Malnutrition, poor sleep, higher stress, lower self-efficacy = lower energy and motivation

Learning Behaviours

Learning is the act of acquiring new, or modifying and reinforcing, existing knowledge, behaviours, skills, values, or preferences and may involve synthesizing different types of information. • Non-associative learning refers to a relatively permanent change in the strength of response to a single stimulus due to repeated exposure to that stimulus. o Habituation is a form of learning in which an organism decreases or ceases to respond to a stimulus after repeated presentations. E.g. feeling nervous/excited when you begin exercising but after a while you are unfazed by going. o Sensitisation is an example of non-associative learning in which the progressive amplification of a response follows repeated administrations of a stimulus. E.g. increased sensitivity due to a history of chronic pain when attempting to exercise. • Associative learning is the process by which an association between two stimuli or a behaviour and a stimulus is learned. o Operant conditioning is the use of consequences to modify the occurrence and form of behaviour. o Classical conditioning involves repeatedly pairing an unconditioned stimulus (which unfailingly evokes a reflexive response) with another previously neutral stimulus (which does not normally evoke the response). Following conditioning, the response occurs both to the unconditioned stimulus and to the other, unrelated stimulus (now referred to as the "conditioned stimulus").

Habits

‘Habits can be a loyal servant or a tyrannical master’ A habit is a routine of behaviour that is repeated regularly and tends to occur unconsciously. The process by which new behaviours become automatic is habit formation. Old habits are hard to break and new habits are hard to form because the behavioural patterns we repeat are imprinted in our neural pathways, but it is possible to form new habits through repetition.

Health Behaviour Change

Actions to bring about behaviour change may be delivered at individual, household, community or population levels using a variety of means or techniques. Significant events or transition points in people's lives present an important opportunity for intervening at some or all of the levels, because it is then that people often review their own behaviour and contact services. The health promoting health service approach has developed the concept that ‘Every healthcare contact is a health improvement opportunity’. This is reinforced in the National Delivery Plan for the Allied Health Professions [AHPs] in Scotland, 2012-2015. However it could strongly be argued that Physiotherapists don’t have the adequate resources or training to tackle health behaviour change effectively.

Theories and Models

Behavioural change theories are attempts to explain why behaviours change. These theories cite environmental, personal, and behavioural characteristics as the major factors in behavioural determination. Each behavioural change theory or model focuses on different factors in attempting to explain behavioural change. • Theory of reasoned action o a model for the prediction of behavioural intention, spanning predictions of attitude and predictions of behaviour. The subsequent separation of behavioural intention from behaviour allows for explanation of limiting factors on attitudinal influence • Social cognition theory o holds that portions of an individual's knowledge acquisition can be directly related to observing others within the context of social interactions, experiences, and outside media influences. • Theory of planned behaviour o states that attitude toward behaviour, subjective norms, and perceived behavioural control, together shape an individual's behavioural intentions and behaviours. • Transtheoretical model o assesses an individual's readiness to act on a new healthier behaviour, and provides strategies, or processes of change to guide the individual through the stages of change to Action and Maintenance. • Health action process approach o refers to a replacement of health-compromising behaviours (such as sedentary behaviour) by health-enhancing behaviours (such as physical exercise). • B=MAT Model o shows that three elements must converge at the same moment for a behaviour to occur: Motivation, Ability, and Trigger. When a behaviour does not occur, at least one of those three elements is missing.

Self-Efficacy

Self-efficacy is an important factor in all the theories outlined above and is defined by Bandura as the extent or strength of one's belief in one's own ability to complete tasks and reach goals i.e. the more that we believe that we can achieve a goal the more likely we will be to do so. Self-efficacy affects every area of human endeavour. By determining the beliefs a person holds regarding his or her power to affect situations, it strongly influences both the power a person actually has to face challenges competently and the choices a person is most likely to make. These effects are particularly apparent, and compelling, with regard to behaviours affecting health.

Quantified Self

‘What gets measure gets managed’ – Peter Drucker – Management Consultant and Presidential Medal of Freedom, 2002. https://www.youtube.com/watch?v=V08dWCtDyd8

Quantified self is a term coined in 2007 by Gary Wolf and Kevin Kelly. The rise of the quantified self movement means we're all living by numbers. In the past industries harped on understanding consumers and measuring their behaviour — today, consumers themselves are tracking and generating enormous amounts of data. What devices does quantified self consist of? o sensor o wireless o cloud storage o mobile o apis o externals (scales) o wearables o biosensors (tattoo) What type of data can we collect? • activity • physiology • endocrinology • behaviour • environment However… “Not everything that can be counted counts. Not everything that counts can be counted.” – Albert Einstein There are numerous examples in the literature illustrating the success of wearable technologies and online tools in increasing physical activity levels. However simply tracking an activity is not enough. Neither knowledge nor tracking alone immunizes you from an unhealthy lifestyle. The value of these devices crucially depend on the sophistication of the system it integrates with, which is highly dependent on the health knowledge of the system designer and the ability of that knowledge to translate through the system. QS has enormous potential to help us be healthy and we’re just at the beginning stages of its ability to create meaningful change for individuals and populations.

Big Data (future benefits to the NHS) vs personal data

Overall we can break this down into two categories: Big data = aggregate information on many people to yield population insights. For example if the NHS were to coagulate data from a variety of people attempting to change their physical activity levels, this may help practitioners to facilitate other people’s behaviour change efforts more efficiently. Personal data = best use is for implementing valid behaviour change modalities i.e. self-experimentation. The implementation of a smart health paradigm and then an awareness as to whether you are doing it and whether you are achieving your goals.

What does this all Mean?

As we now know self-efficacy is a key underlying factor and this requires two parts: 1. effective health paradigm e.g. ancestral health 2. effective behaviour modification techniques e.g. quantified self movement Pursuing a healthy lifestyle has and always will require personal effort. However unlike the past being healthy requires a deliberate effort, which means intelligent choices, must be made on a day to day basis. However we can’t simply hand patients a device and expect that to do the trick. Therefore in order to succeed sustainable long lasting change there must be some personal intention and value empowered by the individual into the device and tools which they use to achieve their goal. Being in a position of authority, Physiotherapists are empowered to assist patients to attribute value and in turn empower the devices and tools recommended to the patients (e.g. look at what’s happened with KT tape).

What about when the patient is on their own?

When patients are on their own it is important that they are provided by the Physiotherapist with the tools necessary to not only track their efforts but also to interpret this data in a meaningful way. Therefore the tool in question must be designed specifically to include a depth of theory which may facilitate behaviour change. Online tools and devices have been found to be an effective means of increasing physical activity levels, however there is a need for more intensive theory-based interventions that incorporate multiple behaviour change techniques and modes of delivery. Without such interventions certain products have been found to be significantly less effective after 6 months. The value of these devices crucially depend on the sophistication of the system it integrates with, which is highly dependent on the health knowledge of the system designer and the ability of that knowledge to translate through the system. Human OS is an online tool which aims to support the daily health practice of its users. Multiple behavioral influences - like persuasion, social dynamics, feedback loops, triggers - are utilized in a system aimed to simplify a person's daily health practice. For example, having a daily workout sent to a patient lowers the burden on an individual to have to come up with a workout idea on their own, it primes the activity, and when entered in the tracker system, gives that patient and the Physiotherapist feedback as to how their current physical activity level compares to their exercise recommendations.

Conclusion

Modern humans have inherited a genome programmed for movement from a time when physical activity was obligatory for survival. Inactivity sets off a chain of molecular mechanisms that affect the way our cells communicate, which leads to disease including NMSK disorders.  With the quantified self/wearable technology market growing momentum, the extremely low levels of physical activity and with the lack of resources available to Physiotherapists to assist with real tangible behaviour change; this is a hugely relevant area of potential research. Recently there has been a growing focus on preventative approaches towards increasing levels of chronic disease. Physiotherapists are considered to be in an ideal position to help with this mission during their consultations, however little training and/or resources are provided to enable them to do this in an effective way. Current literature states that there is a need for more intensive theory-based interventions that incorporate multiple behaviour change techniques. To our knowledge, Human OS is the only online tool currently available which incorporates multiple behaviour change techniques capable of supporting the daily health practice of its users in the long term. In an age where NMSK conditions linked to physical inactivity are significantly increasing, Physiotherapists will be increasingly expected to assume the role of a health coach. This page was designed to illustrate the problem at hand but more importantly the way forward.

Current tools Available

Current Apps

Currently, the NHS has started using smartphones and apps to help engage the public. Such as with the NHS Health and Symptom Checker, which allows users to to check their symptoms, get an assessement and information on their condition, and be given advice how to get better.

NHS Health Symptoms Checker app Version 2.0.5 (NHS Direct)

Future Practice

At the recent CSP Physiotherapy Conference 2014 delegates were asked: "Are physiotherapists the exercise specialists of choice for people with long-term conditions?",  With the response being a resounding yes.  Physioterapist were described as being ideal in solving the dilemma of lack of adherence to exercise programmes.

References

References will automatically be added here, see adding references tutorial.