Maintaining physical activity: lessons for educators.Abstract: Despite the known risks of physical inactivity physical inactivity A sedentary state. Cf Physical activity. , a large proportion of the population lives a sedentary lifestyle
Sedentary lifestyle is a type of lifestyle most commonly found in modern (particularly Western) cultures. It is characterized by sitting or remaining inactive for most of the day (for example, in an office. . The purpose of this study was to understand how individuals maintain physical activity. Using a grounded theory approach, in-depth interviews were conducted with 15 individuals who had trained for at least one marathon. Findings demonstrated three major themes reflecting the elements participants perceived as important to maintaining physical activity. Themes included: a) a supportive environment, b) goal setting, and c) a focus on mental health. This study provides a basis for a potential future grounded theory aimed at the maintenance of physical activity.
In 2000, in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. , poor diet and physical activity accounted for an estimated 17% of total deaths (United States Department of Health and Human Services United States Department of Health and Human Services (USDHHS),
n.pr a cabinet-level government organization comprising 12 agencies, including the Food and Drug Administration and the Centers for Disease Control and Prevention. [USDHHS USDHHS,
n.pr See United States Department of Health and Human Services. ], 2004). The Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. (CDC See Control Data, century date change and Back Orifice.
CDC - Control Data Corporation ) has stated that a direct relationship exists between physical inactivity and coronary heart disease coronary heart disease: see coronary artery disease.
coronary heart disease
or ischemic heart disease
Progressive reduction of blood supply to the heart muscle due to narrowing or blocking of a coronary artery (see atherosclerosis). (USDHHS, 1996). Despite the known risks of physical inactivity, a large proportion of the population lives a sedentary lifestyle (USDHHS, 2004).
Because of the relationship between physical inactivity and various chronic diseases, several objectives of Healthy People 2010 were developed to increase physical activity (USDHHS, 2004). Numerous barriers to maintaining physical activity have been reported by the general public including time, seasonal and geographic influences, safety, increase in technology, structural factors, fatigue, lack of commitment, and access to facilities (Kohl kohl
A cosmetic preparation, such as powdered antimony sulfide, used especially in the Middle East to darken the rims of the eyelids.
[Arabic ku & Hobbs, 1998; Guggenbuhl, 2004; Conn, Tripp-Reimer, & Maas, 2003; Marcus, Rakowski, & Rossi, 1992). Approximately 50% of individuals who initiate an exercise program will drop out during the first three to six months (Marcus, Rossi, Selby, Niaura, & Abrams, 1992). A consistent theme in current literature, however, is that an exercise program will be effective to alleviate Alleviate
To make something easier to be endured.
Mentioned in: Kinesiology, Applied serious medical problems only if it is regularly followed and that casual adherence adherence /ad·her·ence/ (ad-her´ens) the act or condition of sticking to something.
immune adherence does not seem sufficient to effect beneficial change in health (Litt, Kleppinger, & Judge, 2002). "It is important, therefore, to determine what factors are most predictive of adherence to exercise, particularly in the long term, if exercise regimens are to have their optimal effects" (Litt et al., p. 84).
Development of theory-based frameworks for health education programs is included as a competency COMPETENCY, evidence. The legal fitness or ability of a witness to be heard on the trial of a cause. This term is also applied to written or other evidence which may be legally given on such trial, as, depositions, letters, account-books, and the like.
2. for Certified See certification. Health Education Specialists. Numerous health education models/theories have been applied to physical activity, including the Transtheoretical Model The transtheoretical model of change in health psychology explains or predicts a person's success or failure in achieving a proposed behavior change, such as developing different habits. It attempts to answer why the change "stuck" or alternatively why the change was not made. of Behavior Change Behavior change refers to any transformation or modification of human behavior. Such changes can occur intentionally, through behavior modification, without intention, or change rapidly in situations of mental illness. , the Theory of Planned Behavior In psychology, the theory of planned behavior is a theory about the link between attitudes and behavior. It was proposed by Icek Ajzen (his last name is sometimes spelled "Aizen") as an extension of the theory of reasoned action. It is one of the most predictive persuasion theories. , and Social Cognitive Theory Social Cognitive Theory utilized both in Psychology and Communications posits 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. (Janz, Champion, & Strecher, 2002, Maibach & Cotton, 1995; Montano & Kasprzyk, 2002; Prochaska, Redding Redding, city (1990 pop. 66,462), seat of Shasta co., N central Calif., on the Sacramento River; inc. 1872. A principal tourist center for a mountain and lake region, it also has lumbering, food-processing, and diverse manufacturing. , & Evers, 2002). Few of these models, however, have been applied to the maintenance of physical activity, and therefore, health educators attempting to apply these models/theories to initiation of physical activity most likely will struggle to keep program participants engaged over time. The basis of the Transtheoretical Model of Behavior Change is that individuals engaging in a new behavior move through a series of stages (Marcus, Rossi, et al., 1992; Marcus, Rakowski, et al., 1992). These stages include precontemplation, contemplation Contemplation
Compleat Angler, The
Izaak Walton’s classic treatise on the Contemplative Man’s Recreation. [Br. Lit.: The Compleat Angler]
sculpture by Rodin, depicting contemplative man. , preparation, action, and maintenance (Prochaska et al., 2002). Several studies have shown that people use certain processes when transitioning from the action stage to maintenance which include counter conditioning Noun 1. counter conditioning - conditioning in which a second incompatible response is conditioned to an already conditioned stimulus; "counter conditioning lies behind many of the procedures used in behavior therapy" , helping relationships, and stimulus control Stimulus control
We refer to stimulus control when a discriminative stimulus changes the probability of a behavior (operant response). The discriminative stimulus comes to control behavior when it predicts something about the consequences of that behavior. (Prochaska). There is little literature to suggest, however, if these processes are still effective in maintenance of behavior change longer than six months.
Social Cognitive Theory also has been applied to physical activity. "Social Cognitive Theory (SCT Sacrococcygeal teratoma (SCT)
A tumor occurring at the base of the fetus's tailbone.
Mentioned in: Prenatal Surgery ) describes human behavior as being reciprocally re·cip·ro·cal
1. Concerning each of two or more persons or things.
2. Interchanged, given, or owed to each other: reciprocal agreements to abolish customs duties; a reciprocal invitation to lunch. determined by internal personal factors and the environment in which a person lives" (Maibach & Cotton, 1995, p. 43). Self-efficacy, which is included in Social Cognitive Theory, as well as several other models, refers to personal beliefs about how capable one is of performing a behavior that produces favorable fa·vor·a·ble
1. Advantageous; helpful: favorable winds.
2. Encouraging; propitious: a favorable diagnosis.
3. outcomes (Bandura ban`dur´a
n. 1. A traditional Ukrainian stringed musical instrument shaped like a lute, having many strings. , 1997). Litt, Kleppinger, and Judge (2002) applied components of Social Learning Theory to initiation and maintenance of exercise behavior in older women. Results demonstrated that self-efficacy was a stronger determinant determinant, a polynomial expression that is inherent in the entries of a square matrix. The size n of the square matrix, as determined from the number of entries in any row or column, is called the order of the determinant. at 12 months than at initiation of physical activity. Rimal (2001) also studied longitudinal lon·gi·tu·di·nal
Running in the direction of the long axis of the body or any of its parts. influences on exercise behavior and found that self-efficacy was a strong predictor of maintenance.
The Theory of Planned Behavior includes constructs that are concerned with an individual's motivational factors as determinants of the likelihood of performing a specific behavior (Montano & Kasprzyk, 2002). Stiggelbout, Hopman-Rock, Lechner, and van Mechelen (2005) applied an adapted planned behavior model that included Social Learning Theory and the Theory of Planned Behavior to predict exercise maintenance among older adults. Results demonstrated that to promote maintenance of exercise participation for older adults, programs must address preventing lapses, coping with lapses, and improving attitudes towards exercise participation in planning efforts (Stiggelbout et al., 2005).
Few studies have examined predictors of maintenance of physical activity beyond the six month time period. The purpose of this study was to examine the important elements in the maintenance of physical activity. For the purposes of this study, the definition of maintenance was based on the CDC's (2005) recommendation of 30 minutes or more of physical activity that increases heart and breathing rates for three to five days per week for at least a year prior to the study.
The design for this study was qualitative using elements of a grounded theory approach. According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. Jackson and Philips (2003), "qualitative research Qualitative research
Traditional analysis of firm-specific prospects for future earnings. It may be based on data collected by the analysts, there is no formal quantitative framework used to generate projections. methods provide the best approach for collecting the lived experiences of participants in their own words" (p. 179). In this study, incorporating the language of study participants who have maintained physical activity allows readers to understand the experiences of those who have sustained physical activity. This understanding leads to findings that could realistically be applied to programs concerned with the maintenance of physical activity.
Grounded theory in qualitative research is a powerful tool used to identify theory that emerges from the researcher's observation and interviews in the real world rather than in a laboratory or other controlled environment (Patton, 2002). The intent of a grounded theory is to generate or discover a theory that relates to a particular situation (Creswell, 1998). Because one study of 15 participants may not lend itself to such a theory, this study was designed to provide a basis for future studies aimed at developing a theory for maintenance of physical activity.
In-depth interviews with questions derived from two pilot studies were conducted. The first pilot study identified major considerations with regard to initiating and maintaining physical activity. Questions were drafted and tested with a second pilot study to determine if they would bring the rich description needed to describe participants' experiences consistent with grounded theory development. Questions were revised based on these pilots and continued to be revised throughout the study. Data collection and analysis were not linear, but rather continuous and flexible. Consistent with a grounded theory approach, the primary researcher began with a set of interview questions, conducted and analyzed an·a·lyze
tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es
1. To examine methodically by separating into parts and studying their interrelations.
2. Chemistry To make a chemical analysis of.
3. a set of five interviews, formed a tentative interpretation, and then compared this interpretation with related literature (Strauss & Corbin, 1998). Specific areas that needed more exploration or confirmation were addressed in the next set of interviews (Strauss & Corbin).
The study sample included 15 individuals who had initiated training for at least one marathon. While it may appear that individuals who train for a marathon are not "average," they share with non-exercisers common barriers that must be overcome to maintain motivation and self-efficacy (Marcus et al., 1992; Masters & Ogles, 1995). Marathon runners also present a convenient group for exploring factors related to maintenance of physical activity and have obvious experience with goal setting, self-efficacy, motivation, and maintenance of physical activity.
Upon receiving human subjects' approval, a purposive pur·po·sive
1. Having or serving a purpose.
2. Purposeful: purposive behavior.
pur , snowball sampling For other uses, see Snowball (disambiguation).
In social science research, snowball sampling is a technique for developing a research sample where existing study subjects recruit future subjects from among their acquaintances. method was used to identify participants who belonged to running groups in two states. Participants were obtained from email contact through various websites. Once interviewed, participants were asked to identify additional runners who would qualify for the study. While this sampling method reduced generalizability of findings, it helped identify individuals who provided information that developed and conceptually linked emerging categories (Krefting, 1999).
Three participants who were part of the second pilot study were included in round one of interviewing because of the relevant descriptions their interviews provided. Ten participants were female. Participants' ages ranged from 24 to 52 years, with a mean age of 37.4 years. Fourteen participants were either married, dating, living with a significant other, or engaged. Seven participants had children living at home. Thirteen participants worked outside the home while two were stay-at-home mothers. All participants considered themselves average people with jobs, families, and other time commitments. In this way, the sample is reflective Refers to light hitting an opaque surface such as a printed page or mirror and bouncing back. See reflective media and reflective LCD. of past research with regard to barriers people report as hindering hin·der 1
v. hin·dered, hin·der·ing, hin·ders
1. To be or get in the way of.
2. To obstruct or delay the progress of.
v.intr. them from regular physical activity (Marcus et al., 1992; Masters & Ogles, 1995).
Typically, in qualitative research, terms such as validity and reliability are not used. Rather, the term "trustworthiness trustworthiness Ethics A principle in which a person both deserves the trust of others and does not violate that trust " is used to establish confidence the researcher has in the truth of the findings (Krefting, 1999). The following steps were taken to increase trustworthiness. All interviews were audio recorded and transcribed verbatim ver·ba·tim
Using exactly the same words; corresponding word for word: a verbatim report of the conversation.
adv. . Open coding began by marking with italics passages relevant to elements participants perceived as important to maintenance of physical activity. To establish credibility (parallel to internal validity Internal validity is a form of experimental validity . An experiment is said to possess internal validity if it properly demonstrates a causal relation between two variables  . ), member checking was used. Marked transcripts were sent via email to participants for review. Participants then were asked to expand, delete To remove an item of data from a file or to remove a file from the disk. See file wipe, trash and undelete.
1. (operating system) delete - (Or "erase") To make a file inaccessible. , or add any information they felt was important.
To further increase credibility, peer review was used. The primary researcher derived tentative thematic the·mat·ic
1. Of, relating to, or being a theme: a scene of thematic importance.
2. categories from italicized passages and assigned a symbol for coding purposes. Tentative categories, their symbols, and transcripts then were sent to three peer reviewers who were trained in the process of coding interview data (i.e., successful completion of a doctoral level interview methods course). Peer reviewers coded the transcripts using the tentative categories as a guide. If the peer reviewers felt that additional categories were warranted, they were free to identify them within the transcript A generic term for any kind of copy, particularly an official or certified representation of the record of what took place in a court during a trial or other legal proceeding.
A transcript of record .
To increase consistency (parallel to reliability), the primary researcher recoded transcripts using the tentative categories. The researcher's recoded transcripts were then compared to coded transcripts from the peer reviewers. Passages were determined to fit into a category if three of the four reviewers coded them as such.
Three rounds of interviews with five interviews in each round were conducted. Because of the nature of grounded theory and the revision of questions based on tentative analysis of the interview, interview questions were revised after each round of interviews based on deeper exploration of the established categories determined by peer review and code-recode. Deeper exploration also was determined based on a review of relevant studies regarding physical activity. Once thematic categories were determined in round one and used to revise interview questions in round two, axial coding Axial coding is the disaggregation of core themes during qualitative data analysis. References
Gatrell, A.C. (2002) Geographies of Health: an Introduction, Oxford: Blackwell. began in which the researcher began to derive sub-categories from categories. Through this process, themes were established which are described in Table 1.
Confirmability (parallel to objectivity) was established through the use of researcher reflexivity re·flex·ive
1. Directed back on itself.
a. Of, relating to, or being a verb having an identical subject and direct object, as dressed in the sentence She dressed herself. . Being a former marathon runner, the primary researcher was considered an insider (i.e., someone having shared the phenomenon of the sample). To avoid bias, the researcher reflected upon her role through use of extensive journaling to capture ideas and explore relationships among categories emerging from the data. She then compared data in her journal with actual transcript data to confirm that determined categories were based on participant experiences and not her own. Through this constant comparison, coding was verified and saturated saturated /sat·u·rat·ed/ (sach´ah-rat?ed)
1. denoting a chemical compound that has only single bonds and no double or triple bonds between atoms.
2. unable to hold in solution any more of a given substance. while themes emerged (Jack, DiCenso, & Lohfeld, 2005). Researcher reflections are included in the findings section to assist in describing this sequence of events.
The search for disconfirming Adj. 1. disconfirming - not indicating the presence of microorganisms or disease or a specific condition; "the HIV test was negative"
medical specialty, medicine - the branches of medical science that deal with nonsurgical techniques
2. evidence was a final measure used to increase confirmability. Transcripts were read again in search of evidence that either confirmed or disconfirmed established themes (Creswell & Miller, 2000). While one or two instances occurred in which a particular experience did not fit into an established theme, confirming evidence was the norm. Resulting themes were used to provide an understanding of maintenance of physical activity incorporating the language of study participants. Results of this study then were sent via email to study participants for their review and approval. In this way, findings were credible, dependable, and represented the language of study participants.
Interview data revealed three major themes, or elements, perceived as important to maintenance of physical activity. These themes were: a) a supportive environment, b) goal setting, and c) a focus on mental health.
A SUPPORTIVE ENVIRONMENT
Initially, accountability and obligation started to emerge in this area when coding transcripts during round one based on the role running partners and coaches played in participants' experiences. Participants revealed, however, the significant role non-runners played in maintenance of such an endeavor as training for a marathon. As questions were revised for round two, distinctions emerged between accountability and support and a need for socialization socialization /so·cial·iza·tion/ (so?shal-i-za´shun) the process by which society integrates the individual and the individual learns to behave in socially acceptable ways.
n. . A sense of belonging and camaraderie ca·ma·ra·der·ie
Goodwill and lighthearted rapport between or among friends; comradeship.
[French, from camarade, comrade, from Old French, roommate; see comrade. emerged as contributors to "relationship building" as a motivation for continuing to run. All the various sectors of individuals present in these runners' lives contributed to a supportive environment.
"I suppose it was a peer group thing," said Adam, a 31-year-old engineer who was training for his first marathon, "We did our long runs together and tailored our noon time, lunch time runs." Thirty-four-year-old Beth, a married mother of two, agreed. "Doing it with a friend, we bounced the positive energy off each other. If one was having a bad day, we'd say, 'Oh, we can do this.' That helps a lot."
To 32-year-old Bridget, with a family and career, relationship building was the incentive to her maintenance of a running routine.
[What I remember most about my early running days] was just developing a really good friendship with my training partner. I didn't expect that at all. I thought it was going to be work. But, with her, we kept a really good pace and we chatted the whole time. And she was very encouraging. She would always say 'Of course you can do it.' The social part of it ... really helps me keep going. I would say some of my closest friends are my running friends.
Nearly half of participants joined an established running program to meet others who were runners. Socialization and relationship building was the attraction to belonging to such a group. Fifty-two-year-old Jan discussed such a group.
As far as staying with it, I think the team aspect and the friendships that you build and the camaraderie on Saturday morning is something you can't get anywhere else. People will go through [a training] program ... [and] when it's finished you realize that you're going to lose constant contact with a group of people that have become in some ways closer to you than your own family. When you're out there for 18 weeks running next to someone you talk about things that you might not talk about with people that you're living with ... that's a lot of what brings me back.
Male participants also discussed socialization and friendships as they pertained to group runs. Gary, a 43-year-old husband and father, said, "It's a different relationship with those people because ... it's two hours, three hours ... those long runs are long, and we ran them where we could talk. And I can still remember specific conversations. I mean those [were my] guy friends but they weren't my best friends. But, some of the stuff we got into was some of my best friend talk."
The support of family and friends who were non-runners was just as vital to the success of some participants as having running friends. Jennifer, a 33-year-old, stay-at-home-mother with two children, described support she received from family that was vital to her ability to maintain her training program.
My husband doesn't understand. He doesn't quite get it but he's very supportive ... he'll do anything to help me to be able to run on the weekends. I'll say [to him] gosh, the bathroom needs to be cleaned ... thanks for not saying anything. Thanks for not complaining about it. And he's like, "I know you're busy taking care of the kids and you have to work out ... I know you'll do it, you'll get to it." And then sometimes he'll surprise me and do it.
The desire to be role models for their children was a significant motivator for some participants. Creating an environment of being physically active, for example, was important in Jerry's household.
I think I want to help [my son] be the best that he can be ... to see that all these things he's doing right now ... there's no rule that after high school's over you've got to quit being physically active. I want him to feel good about physical activity [and know] that he can be in shape for his whole life and I think that will help him have a better quality of life.
Setting a goal to increase motivation seemed obvious and the feeling of accomplishment at completion of this goal is a feeling marathoners know well. The participants' ability to recognize increased confidence in other areas of their lives appeared to be a separate category and one which seemed would evolve under a "self-efficacy" theme. While increased self-efficacy could arguably ar·gu·a·ble
1. Open to argument: an arguable question, still unresolved.
2. That can be argued plausibly; defensible in argument: three arguable points of law. be a theme, as interviewing continued, increased confidence become more closely related with accomplishment of goals. As a result, increased confidence became a sub-category of goal setting. Jerry was a 42-year-old husband and father.
I like to have a long-term goal to work towards, whatever it is. It helps me feel like there is a purpose to what I'm doing. Even though I can't sit back and [say] I've contributed to mankind in some way ... it does give me a reason, because everyday you've got to get out there and put in the miles. It's real easy to say I don't want to [run] today because my toe hurts or whatever and having that sort of underlying [goal] helps you to keep focus.
Gary emphasized, however, that the goal should not be weight loss. "I think we, as a group, tend to get too focused on weight ... I think if it's completing an event as opposed to just losing weight, that worked for me." Joe, a 24-year-old college student, training for his first marathon, agreed. "If you focus on losing weight, then you're going to give up anyway instead of sticking with it. So, you have to have alternate goals ..."
Accomplishment of goals also become more directly related to making running a priority and part of a healthy lifestyle. As running became a habit for participants, they adopted an identity of someone who was physically active. This identity then reflected back on their refinement of goals. Todd, a 30-year-old engineer, discussed his family history as it related to his desire to be physically active.
I was probably a sophomore in college [when] my dad first had the symptoms of a rapid and irregular heartbeat. He ended up in the hospital for probably about two or three weeks and basically he's been struggling ... ever since. But, seeing what he had to go through ... kind of shocked me into thinking am I doing everything right in my life? Am I taking all the proper steps to at least have things in my favor?
Sandy, a 53-year-old wife and mother, agreed. "I need to exercise. I want to be physically active when I'm 70 years old. I see people who are decrepit de·crep·it
Weakened, worn out, impaired, or broken down by old age, illness, or hard use. See Synonyms at weak.
[Middle English, from Old French, from Latin d and old and can't move around and I don't want to be in that category. I want to be able to do things with my grandchildren GRANDCHILDREN, domestic relations. The children of one's children. Sometimes these may claim bequests given in a will to children, though in general they can make no such claim. 6 Co. 16. . I mean, just look around, too many people just let themselves go and I don't want to do that."
Mental health had different meanings to different participants. Running alone meant spiritual time and problem solving problem solving
Process involved in finding a solution to a problem. Many animals routinely solve problems of locomotion, food finding, and shelter through trial and error. for some. Socialization became an avenue for stress relief and problem solving for others. For many participants, feeling strong and healthy contributed to better moods and lack of running was quickly noticed by family and friends. A focus on these aspects was key to motivation with participants regardless of their personal meaning of mental health. Therefore, mental health became a broad theme that encompassed all of these motivators.
Kay KAY Kick Ass Year
KAY Kansas Association of Youth , a 52-year-old wife, mother of two, and career woman began her story with the time her first husband divorced her. She had two small children, was jobless job·less
1. Having no job.
2. Of or relating to those who have no jobs.
n. (used with a pl. verb)
Unemployed people considered as a group. Used with the. , and was without reliable transportation.
I think I was kind of high strung; a single mother of a six and eight [year old] with a limited income. So many major things happened to me in one year that shouldn't happen to people all at once. Newly divorced, I bought this little bitty house, a new car, then a full-time job all at the same time. I found running shortly afterwards. I think I was a better parent because I ran. My kids are 20 months apart and my daughter had a terrible time being an adolescent. We got through a lot of things because I didn't just freak out and beat on them. I ran all that stress out. I've become a much more calm person. I think I was saved somehow by running.
Jan said, "That's my alone time and my way of getting my day in perspective. It's amazing a·maze
v. a·mazed, a·maz·ing, a·maz·es
1. To affect with great wonder; astonish. See Synonyms at surprise.
2. Obsolete To bewilder; perplex.
v.intr. what it will do for your head. You can solve all of your problems in an hour ... I found myself solving other people's problems because I'd gone through all of mine."
Male participants also discussed using running as time to improve mental health. "That's where I have my best thoughts, when I'm running." Gary said. "I can work things out in my head better. I think your mind goes over a lot of different things and that goes back to what I enjoy about running. It can be a work problem, it can be trouble you're having with your wife, it can be goals and dreams."
Beth, a 34-year-old stay-at-home mother of two young children, discussed her depression following the birth of her second child. A recommendation from her doctor guided her in the direction of physical activity. Beth said, "I just felt like I needed something more. I stay at home and I think I was looking for Looking for
In the context of general equities, this describing a buy interest in which a dealer is asked to offer stock, often involving a capital commitment. Antithesis of in touch with. something to get me out of the house for myself. I started exercising everyday, just [running] a mile or two on the treadmill. I needed some type of goal ..." After completing her first marathon, Beth described the change in her self-perspective.
I have self-confidence ... feeling like I'm worth something. I feel so much better about myself and I really want to do another [marathon] because I felt it was really worth the training. For a mom who stays at home, it's my outlet, my motivation, and it's really just helped me with my self-confidence.
Health professionals, as well as society, tend to focus on physical aspects of physical activity. Similar to studies regarding initiation of physical activity, an emphasis on mental health, such as enhanced confidence, feeling good about oneself, and stress relief, sustained participants' motivation (Marcus, Rakowski, et al., 1992).
For health education efforts to be effective in meeting the goals of Healthy People 2010, health educators must find ways to engage participants for extended periods of time. Health educators must not limit themselves to promoting programs that increase initiation of physical activity, but rather should place more emphasis on maintenance. At initiation of behavior change, practitioners might employ methods such as teaching participants how to develop a supportive environment, to focus on mental health, and to set achievable goals, that may contribute to maintenance of these behaviors over the long haul Long distance. Long haul implies traversing a state or a country. Contrast with short haul. .
While training for a marathon may not be considered "average," study participants were all individuals with families and careers and numerous time commitments. What better people to learn from than those who have accomplished what we are studying? Participants' messages were about surrounding themselves with motivation (i.e., people who were passionate about physical activity). Thus, an important lesson for practitioners is to address the importance of establishing a supportive environment to keep participants engaged. Health educators can facilitate this process by being a resource for local gyms or running groups, enlisting the help of family, co-workers, and friends, and helping participants strengthen their support systems.
Other implications for health education include incorporating both short- and long-term goal-setting into programs aimed at maintaining physical activity from the beginning of the program. This study corroborates research recommendations that practitioners assist participants in setting realistic, achievable goals to increase motivation and self-efficacy (Maibach & Cotton, 1995). Furthermore, continuing to refine and re-evaluate goals once achieved kept these participants motivated mo·ti·vate
tr.v. mo·ti·vat·ed, mo·ti·vat·ing, mo·ti·vates
To provide with an incentive; move to action; impel.
mo over a sustained period of time. Focusing on the mental benefits of physical activity rather than just the physical aspects is also an important element for practice.
Several models and theories have been tested and proven successful in behavior change programs. However, these prior models focus primarily on the initiation of change. Looking at new ways of combining constructs of existing models/theories to describe the process of physical activity maintenance would aid health educators in assisting clients in developing a lifestyle of physical activity and contribute to the use of theory in the field. Consider, for example, if educators included the following constructs of several models/theories:
* Creating a supportive environment by enlisting support from exercise partners, spouses and significant others, and exercise groups/classes/clubs/gyms (i.e., Social Cognitive Theory); and gaining the approval and support of significant others and surrounding oneself with others who exercise to capitalize on Cap´i`tal`ize on`
v. t. 1. To turn (an opportunity) to one's advantage; to take advantage of (a situation); to profit from; as, to capitalize on an opponent's mistakes s>. the subjective norm (i.e., Theory of Planned Behavior).
* Setting goals with concrete, achievable objectives that are celebrated along the way. Focusing on the short-term goal increases motivation and commitment. Emphasizing accomplishment of goals increases self-efficacy. Improved self-efficacy increases perceived control over one's environment and circumstances CIRCUMSTANCES, evidence. The particulars which accompany a fact.
2. The facts proved are either possible or impossible, ordinary and probable, or extraordinary and improbable, recent or ancient; they may have happened near us, or afar off; they are public or (i.e., Theory of Planned Behavior).
* Helping participants focus on more than just the physical benefits of physical activity by incorporating improved mental health as motivators, which will then influence positive attitudes towards physical activity (i.e., Theory of Planned Behavior, Transtheoretical Model).
As mentioned, one study does not typically lend itself to a true grounded theory, especially with 15 participants. Therefore, further studies are warranted with other forms of physical activity and with non-marathoners and broader samples. Further analysis is needed to differentiate between those participants who are no longer maintaining physical activity after completion of a marathon and those who are. Finally, additional studies should attempt to combine and/or test elements of existing models and theories with regard to maintenance of physical activity. Combining constructs of models, such as the Theory of Planned Behavior and Social Cognitive Theory, could help develop specific processes used to maintain physical activity, which then could contribute to the Transtheoretical Model's maintenance stage of behavior change. In this way, health educators can contribute to development of theory-based frameworks that could guide planning efforts and ensure successful health education programs.
Based on findings from this study, goal setting increased commitment to physical activity as well as a sense of accomplishment and confidence. A supportive environment such as running groups and enlisting the help of family and friends provided motivation to keep participants engaged. Participants who maintained physical activity focused on mental benefits as opposed to only physical benefits. Health educators could incorporate any and all of these elements into programs designed to maintain healthy behaviors. The study also provides a basis for future studies aimed at developing a theory of maintenance of physical activity.
Bandura, A. (1997). Self-efficacy: The exercise of self control. New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : W. H. Freeman and Company. Centers for Disease Control & Prevention. (2005). Preventing heart disease and stroke. Retrieved January 21, 2005, from http://www.cdc.gov/nccdphp/bb_heartdisease/index.htm
Conn, V. S., Tripp-Reimer, T., & Mass, M. L. (2003). Older women and exercise: Theory of Planned Behavior beliefs. Public Health Nursing, 20(2), 153-161.
Creswell, J. W. (1998). Qualitative inquiry Qualitative Inquiry is an bi-monthly academic journal on qualitative research methodology. It focuses on methodological issues raised by qualitative research, rather than the research's content or results. References
Creswell, J., & Miller, D. L. (2000). Determining validity in qualitative inquiry. Theory Into Practice, 39(3), 124-131.
Guggenbuhl, N. (2004). Obesity obesity, condition resulting from excessive storage of fat in the body. Obesity has been defined as a weight more than 20% above what is considered normal according to standard age, height, and weight tables, or by a complex formula known as the body mass index. : It's super-size mania Mania
ancient Roman goddess of the dead. [Rom. Myth.: Zimmerman, 159]
See : Death . Journal of Pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children.
Of or relating to pediatrics. Health Care, 104(3), 335-336. Jack, S. M., DiCenso, A., & Lohfeld, L. (2005). A theory of maternal MATERNAL. That which belongs to, or comes from the mother: as, maternal authority, maternal relation, maternal estate, maternal line. Vide Line. engagement with public health nurses and family visitors. Journal of Advanced Nursing, 49(2), 182-190.
Jackson, F. M., & Phillips, M. T. (2003). Collaborative research and reproductive health Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene outcomes among African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race. women. American Journal of Health Studies, 18(4), 178-187.
Janz, N. K., Champion, V. L., & Strecher, V. J. (2002). The Health Belief Model. In K. Glanz, B. K. Rimer rim·er
Variant of rhymer. , & F. M. Lewis (Eds.), Health Behavior and Health Education (3rd ed., pp. 45-65). San Francisco San Francisco (săn frănsĭs`kō), city (1990 pop. 723,959), coextensive with San Francisco co., W Calif., on the tip of a peninsula between the Pacific Ocean and San Francisco Bay, which are connected by the strait known as the Golden , CA: Jossey-Bass.
Kohl, H. W., & Hobbs, K. E. (1998). Development of physical activity behaviors among children and adolescents. Pediatrics pediatrics (pēdēă`trĭks), branch of medicine dedicated to the attainment of the best physical, emotional, and social health for infants, children, and young people generally. , 101(3), 549-554.
Krefting,L. (1999). Rigor rigor /rig·or/ (rig´er) [L.] chill; rigidity.
rigor mor´tis the stiffening of a dead body accompanying depletion of adenosine triphosphate in the muscle fibers. in qualitative research: The assessment of trustworthiness. In A. K. Milinki (Ed.), Cases in qualitative research (pp. 173-181). Los Angeles Los Angeles (lôs ăn`jələs, lŏs, ăn`jəlēz'), city (1990 pop. 3,485,398), seat of Los Angeles co., S Calif.; inc. 1850. , CA: Pyrczak Publishing.
Litt, M. D., Kleppinger, A., & Judge, J. O. (2002). Initiation and maintenance of exercise behavior in older women: Predictors from the social learning model. Journal of Behavioral Medicine behavioral medicine
The application of behavior therapy techniques, such as biofeedback and relaxation training, to the prevention and treatment of medical and psychosomatic disorders and to the treatment of undesirable behaviors, such as overeating. , 25(1), 83-95.
Maibach, E. W., & Cotton, D. (1995). Moving people to behavior change. In E. Maibach & R. L. Parrot (Eds.), Designing health messages: Approaches from Communication Theory and public health practice (pp. 41-64). Thousand Oaks, CA: Sage Publications.
Marcus, B. H., Rakowski ,W., & Rossi, J. S. (1992). Assessing motivational readiness and decision making for exercise. Health Psychology, 11(4), 257-261.
Marcus, B. H., Rossi, J. S., Selby, V. C., Niaura, R. S., & Abrams, D. B. (1992).The stages and processes of exercise adoption and maintenance in a worksite sample. Health Psychology, 11(6), 386-395.
Masters, K. S., & Ogles, B. M. (1995). An investigation of the different motivations of marathon runners with varying degrees of experience. Journal of Sports Behavior, 18, 69-80.
Montano, D. E., & Kasprzyk, D. (2002). The Theory of Reasoned Action The theory of reasoned action (TRA), developed by Martin Fishbein and Icek Ajzen (1975, 1980), derived from previous research that started out as the theory of attitude, which led to the study of attitude and behavior. and the Theory of Planned Behavior. In K. Glanz, B. K. Rimer, & F. M. Lewis (Eds.) Health Behavior and Health Education (3rd ed., pp. 67-98). San Francisco, CA: Jossey-Bass.
Patton, M. Q. (2002). Qualitative research & evaluation methods (3rd ed.). Thousand Oaks, CA: Sage Publications.
Prochaska, J. O., Redding, C. A., & Evers, K. E. (2002). The Transtheoretical Model and Stages of Change. In K. Glanz, B. K. Rimer, & F. M. Lewis (Eds.), Health Behavior and Health Education (3rd ed., pp. 99-120). San Francisco, CA: Jossey-Bass.
Rimal, R. (2001). Longitudinal influences of knowledge and self-efficacy on exercise behavior: Tests of a mutual reinforcement reinforcement /re·in·force·ment/ (-in-fors´ment) in behavioral science, the presentation of a stimulus following a response that increases the frequency of subsequent responses, whether positive to desirable events, or model. Journal of Health Psychology, 6(1), 31-46.
Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). Thousand Oaks, CA: Sage Publications.
Stiggelbout, M., Hopman-Rock, M., Crone crone
see crock. , M., Lechner, L., & van Mechelen, W. (2006). Predicting older adults' maintenance in exercise participation using an integrated social psychological model. Health Education Research, 21(1), 1-14.
United States Department of Health and Human Services. (2004). Progress review: Physical activity and fitness. Retrieved November 14, 2004, from http://www.healthypeople.gov/data/2010prog/focus22
United States Department of Health and Human Services. (1996). Physical activity and health: A report of the Surgeon General The U.S. Surgeon General is charged with the protection and advancement of health in the United States. Since the 1960s the surgeon general has become a highly visible federal public health official, speaking out against known health risks such as tobacco use, and promoting disease . Retrieved January 4, 2006, from http://www.cdc.gov/nccdphp/dnpa/physical/importance/index.htm
RESPONSIBILITIES AND COMPETENCIES IN HEALTH EDUCATION
Responsibility II--Planning Effective Health Education Programs
Competency B: Develop a logical scope and sequence plan for a health education program
1. Develop a theory-based framework for health education programs
Kerry Whipple, PhD, CHES, is an Assistant Professor of Health Education in the Department of Health and Applied Human Sciences at the University of North Carolina North Carolina, state in the SE United States. It is bordered by the Atlantic Ocean (E), South Carolina and Georgia (S), Tennessee (W), and Virginia (N). Facts and Figures
Area, 52,586 sq mi (136,198 sq km). Pop. Wilmington. Joyce Fetro, PhD, CHES, FASHA, is a Professor of Health Education in the Department of Health Education and Recreation at Southern Illinois University Carbondale Southern Illinois University Carbondale (SIUC but usually just referred to as SIU) is located in Carbondale, Illinois. The Carbondale campus is the flagship campus of the Southern Illinois University system, which includes SIU's smaller sister institution Southern Illinois . Kathleen Welshimer, PhD, MSPH MSPH Mailman School of Public Health (Columbia Universty, New York City)
MSPH Master of Science in Public Health
MSPH Mrs. Potato Head (toy) , is an Associate Professor of Health Education in the Department of Health Education and Recreation at Southern Illinois University Carbondale. Judy Drolet, PhD, CHES, FASHA, is a Professor of Health Education in the Department of Health Education and Recreation at Southern Illinois University Carbondale. Please address all correspondence to Kerry Whipple, PhD, CHES Department of Health and Applied Human Sciences, University of North Carolina Wilmington, 601 S. College Road, Wilmington, NC 28412; PHONE: (910) 962-7453; FAX (910) 962-7073; EMAIL: email@example.com.
Table 1. Explanation and Categorization of Themes Final themes with subcategories derived Tentative category by agreement between derived by primary three of four peer researcher Explanations reviewers Support/influence Significant others Supportive from significant included training environment: others partners/coaches, Significant others understanding/ Accountability supportive family Social time Mental health Mental health defined Focus on mental as stress relief, health: Stress relief problem solving, mood Mood enhancement enhancement, taking Problem solving time for oneself, Increased self-esteem spirituality Health as a priority Priority defined as Lack of agreement weight control, from peer reviewers; better sleep, more removed as theme energy Goal setting Goal setting Goal setting: increased motivation Increased motivation Achieving goals led Refining of goals to refinement of Competition goals and increased Sense of confidence accomplishment Competition served as motivator Sense of identity Identity defined as Lack of agreement personal empowerment from peer reviewers; and finding a niche' removed as theme Filling a void Role modeling for family