Promoting Adherence to Physical Activity Advice: Difference between revisions

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There is vast evidence on the benefits of regular physical activity. Among others, it is effective in preventing cardiovascular, cerebrovascular, and cancer diseases; and in improving overall physical and mental health status<ref>Warburton DER, Nicol CW, Bredin SSD. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1402378/ Health benefits of physical activity: the evidence.] CMAJ: Canadian Medical Association Journal 2006;174(6):801-809. doi:10.1503/cmaj.051351.</ref>. There are many studies that examine the effectiveness of various clinical and community interventions to increase physical activity levels of general and specific population. However, other studies show that about 50% of adult population who start a physical activity program will drop out within a few months<ref>Dishman RK. Overview. In: Dishman RK, ed. Exercise adherence: It’s impact on public health. Champaign, IL: Human Kinetics; 1988.</ref>. This article will cover the general principles, charasteristics, examples, and evidences of interventions that promote adherence to physical activity in general population. 
There is vast evidence on the benefits of regular physical activity. Among others, it is effective in preventing cardiovascular, cerebrovascular, and cancer diseases; and in improving overall physical and mental health status<ref>Warburton DER, Nicol CW, Bredin SSD. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1402378/ Health benefits of physical activity: the evidence.] CMAJ: Canadian Medical Association Journal 2006;174(6):801-809. doi:10.1503/cmaj.051351.</ref>. There are many studies that examine the effectiveness of various clinical and community interventions to increase physical activity levels of general and specific population. However, other studies show that about 50% of adult population who start a physical activity program will drop out within a few months<ref>Dishman RK. Overview. In: Dishman RK, ed. Exercise adherence: It’s impact on public health. Champaign, IL: Human Kinetics; 1988.</ref>. This article will cover the general principles, charasteristics, examples, and evidences of interventions that promote adherence to physical activity in general population. 


== Risk Factors for Non-adherence to Physical Activity  ==
== Risk Factors for Non-adherence to Physical Activity<ref name=":0">Allen K, Morey MC. [https://www.springer.com/cda/content/document/cda_downloaddocument/9781441958655-c1.pdf?SGWID=0-0-45-943747-p174026078. Physical activity and adherence. In Improving patient treatment adherence.] 2010 (pp. 9-38). Springer, New York, NY.</ref> ==


The following table lists the factors that may lead to lower adherence to physical activity level as recommended by public health guidelines:  
The following table lists the factors that may lead to lower adherence to physical activity level as recommended by public health guidelines:  
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!
!
|-
|-
|Demographic Factors
| rowspan="4" |Demographic Factors
|older age
|older age
|
|
|
|
|-
|-
|
|female gender
|female gender
|
|
|
|
|-
|-
|
|non-white ethnicity
|non-white ethnicity
|
|
|
|
|-
|-
|
|low socioeconomic background
|low socioeconomic background
|
|
|
|
|-
|-
|Health Related Factors
| rowspan="3" |Health Related Factors
|chronic illnesses
|chronic illnesses
|
|
|
|
|-
|-
|poor general health and physical function
|
|
|-
|obesity
|
|
|-
| rowspan="8" |Cognitive and Psychological Factors
|Greater perceived barriers to physical activity
|
|
|-
|Lack of enjoyment of physical activity
|
|
|-
|Low expectations of benefits from physical activity
|
|
|-
|Poor psychological health
|
|
|-
|Low self-efficacy for physical activity
|
|
|-
|Low self-motivation for physical activity
|
|
|-
|Lack of readiness to change physical activity behaviors
|
|
|-
|Poor fitness level
|
|
|-
| rowspan="3" |Behavioural Factors
|Prior physical activity
|
|
|-
|Smoking
|
|
|-
|Type A behavior
|
|
|-
| rowspan="3" |Social Factors
|Lack of cohesion in exercise group
|
|
|-
|Lack of physician influence/advice for physical activity
|
|
|-
|Lack of social support for physical activity
|
|
|-
| rowspan="2" |Program-related Factors
|High physical activity intensity
|
|
|-
|Long physical activity duration
|
|
|-
| rowspan="2" |Environmental Factors
|Lack of access to facilities/parks/trails
|
|
|-
|Lack of neighborhood safety
|
|
|}
== General Principles of Effective Physical Activity Promotion Interventions ==
Based on the risk factors described above and the available evidence, the following general principles of an effective intervention were generated<ref name=":0" />. A program aimed to promote adherence to physical activity should
# Incorporate multiple components of intervention (which will be discussed below)
# Include cognitive-behavioural strategies to address psychological issues of non-adherence
# Provide sufficient intensity by at least providing guidance on how to start PA program and an ongoing/ follow-up support
# Be a tailored approch to suit individual cases
# Use a lifestyle approach to PA, which is associated with greater adherence. Lifestyle PA includes leisure, occupational, and household physical activities
== Intervention Components and the Evidence ==
A systematic review by Kahn et al (2002)<ref>Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, Stone EJ, Rajab MW, Corso P. [https://www.ncbi.nlm.nih.gov/pubmed/11985936 The effectiveness of interventions to increase physical activity. A systematic review.] Am J Prev Med. 2002 May;22(4 Suppl):73-107.</ref> categorized individual interventions based on their approach: informational, social-behavioural, and environmental or policy. Listed below are examples of interventions of each approach that have shown effectiveness in promoting adherence to PA. 
{| class="wikitable"
!Interventions
!Description
!
!
|-
! colspan="2" |Informational Approach
|
|
|-
|Point-of-decision prompts/signs to encourage stair use
|
|
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|Community-wide PA campaigns
|
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|-
! colspan="2" |Behavioural Approach
|
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|-
|Health risk appraisal
|
|
|
|-
|Goal-setting
|
|
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|-
|Contracts
|
|
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|-
|Self-monitoring
|
|
|
|-
|Reinforcement and incentives
|
|
|
|-
|Problem solving
|
|
|
|-
|Relapse prevention
|
|
|
|-
|Stimulus control
|
|
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|-
|Cognitive restructuring
|
|
|poor general health and physical function
|
|
|
|
|-
|-
|[[Motivational Interviewing]]
|
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|
|obesity
|-
! colspan="2" |Social Approach
|
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|-
|-
|Cognitive and Psychological Factors
|Enhancing social support
|
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|-
|-
|Modeling
|
|
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|
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|-
! colspan="2" |Environment and Policy
|
|
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|}  
|-
|Enhancing access to leisure physical activity facilities
|e.g. parks, bicycle trails, footpath
!
!
|-
|Organizing activity clubs within communities
!
!
!
|}


== Resources  ==
== Resources  ==

Revision as of 21:25, 3 May 2018

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Introduction[edit | edit source]

Physical Activity (PA) can be described as any body movements produced by skeletal muscles that requires energy expenditure[1]. Based on this definition, the level of PA ranges from sedentary to vigorous. However, public health guidelines refer to “Physical Activity” as health-enhancing physical activity[2]. Since sedentary activity has shown to adversely affect cardiometabolic markers in healthy adults[3], we can use the term “Physical Activity” to describe any non-sedentary activities that may include active recreational, occupational, and household activities as well as structured exercise regime.

There is vast evidence on the benefits of regular physical activity. Among others, it is effective in preventing cardiovascular, cerebrovascular, and cancer diseases; and in improving overall physical and mental health status[4]. There are many studies that examine the effectiveness of various clinical and community interventions to increase physical activity levels of general and specific population. However, other studies show that about 50% of adult population who start a physical activity program will drop out within a few months[5]. This article will cover the general principles, charasteristics, examples, and evidences of interventions that promote adherence to physical activity in general population. 

Risk Factors for Non-adherence to Physical Activity[6][edit | edit source]

The following table lists the factors that may lead to lower adherence to physical activity level as recommended by public health guidelines:

Factors associated with non-adherence to physical activity
Demographic Factors older age
female gender
non-white ethnicity
low socioeconomic background
Health Related Factors chronic illnesses
poor general health and physical function
obesity
Cognitive and Psychological Factors Greater perceived barriers to physical activity
Lack of enjoyment of physical activity
Low expectations of benefits from physical activity
Poor psychological health
Low self-efficacy for physical activity
Low self-motivation for physical activity
Lack of readiness to change physical activity behaviors
Poor fitness level
Behavioural Factors Prior physical activity
Smoking
Type A behavior
Social Factors Lack of cohesion in exercise group
Lack of physician influence/advice for physical activity
Lack of social support for physical activity
Program-related Factors High physical activity intensity
Long physical activity duration
Environmental Factors Lack of access to facilities/parks/trails
Lack of neighborhood safety

General Principles of Effective Physical Activity Promotion Interventions[edit | edit source]

Based on the risk factors described above and the available evidence, the following general principles of an effective intervention were generated[6]. A program aimed to promote adherence to physical activity should

  1. Incorporate multiple components of intervention (which will be discussed below)
  2. Include cognitive-behavioural strategies to address psychological issues of non-adherence
  3. Provide sufficient intensity by at least providing guidance on how to start PA program and an ongoing/ follow-up support
  4. Be a tailored approch to suit individual cases
  5. Use a lifestyle approach to PA, which is associated with greater adherence. Lifestyle PA includes leisure, occupational, and household physical activities

Intervention Components and the Evidence[edit | edit source]

A systematic review by Kahn et al (2002)[7] categorized individual interventions based on their approach: informational, social-behavioural, and environmental or policy. Listed below are examples of interventions of each approach that have shown effectiveness in promoting adherence to PA. 

Interventions Description
Informational Approach
Point-of-decision prompts/signs to encourage stair use
Community-wide PA campaigns
Behavioural Approach
Health risk appraisal
Goal-setting
Contracts
Self-monitoring
Reinforcement and incentives
Problem solving
Relapse prevention
Stimulus control
Cognitive restructuring
Motivational Interviewing
Social Approach
Enhancing social support
Modeling
Environment and Policy
Enhancing access to leisure physical activity facilities e.g. parks, bicycle trails, footpath
Organizing activity clubs within communities

Resources[edit | edit source]

The Motivate2Move website, created by Wales Deanery, has a useful section on sedentary behaviour.

Add text here...

References[edit | edit source]

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

  1. ↑ Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.  Public Health Reports 1985;100(2):126-131.
  2. ↑ Centers for Disease Control and Prevention. Physical Activity: Glossary of Terms. https://www.cdc.gov/physicalactivity/basics/glossary/index.htm. (accessed 27 April 2018)
  3. ↑ Healy GN, Matthews CE, Dunstan DW, Winkler EA, & Owen N. Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003–06. European Heart Journal 2011, 32(5), 590-597.
  4. ↑ Warburton DER, Nicol CW, Bredin SSD. Health benefits of physical activity: the evidence. CMAJ: Canadian Medical Association Journal 2006;174(6):801-809. doi:10.1503/cmaj.051351.
  5. ↑ Dishman RK. Overview. In: Dishman RK, ed. Exercise adherence: It’s impact on public health. Champaign, IL: Human Kinetics; 1988.
  6. ↑ 6.0 6.1 Allen K, Morey MC. Physical activity and adherence. In Improving patient treatment adherence. 2010 (pp. 9-38). Springer, New York, NY.
  7. ↑ Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, Stone EJ, Rajab MW, Corso P. The effectiveness of interventions to increase physical activity. A systematic review. Am J Prev Med. 2002 May;22(4 Suppl):73-107.
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