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Factors determining exercise adherence.

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One of the greatest challenges in the fitness profession is keeping clients motivated, particularly when learning new exercises. Research shows nearly half of those who begin a new exercise program will quit within six months. Fortunately, studies have identified factors that contribute to--and deter--exercise adherence.

Personal Factors

Personal factors include demographic variables, psychological health, education, values, beliefs and behaviors. Characteristics negatively associated with maintenance of a new exercise program include obesity, tobacco use and mood swings. While it may seem knowledge of the benefits of exercise would promote adherence, studies show information alone does not translate to adherence. Understanding health benefits of exercise may lead to intention to exercise, but taking action requires something more. Although the Surgeon General's widely publicized guidelines suggest at least 30 minutes of daily exercise for good health, 60 percent of the population does not engage in the recommended amount of physical activity. However, increasing a person's belief in his or her ability to maintain an exercise program and achieve health and physical goals has been shown to increase adherence. This concept is termed "self-efficacy"--the belief that one is able to accomplish a particular task.

Other personal factors strongly associated with adherence are past participation and enjoyment. Individuals who participated in sports and physical activities as children are more likely to stick with an exercise plan as adults. Enjoyment, also called intrinsic motivation, may seem like a program factor, but sense of enjoyment is an individual belief and therefore falls under personal factors.

Environmental Factors

Environmental factors most strongly predicting exercise adherence include family support, social reinforcement, convenience and appearance of the exercise location and perceived availability of time. The importance of environmental factors is evident. A perceived lack of time is the single most common reason people give for not exercising. Disruption of exercise routines is another environmental factor associated with dropout. Disruptions are environmental factors because they are often outside anyone's control.

Program Factors

Also known as activity factors, program factors include intensity of the activity, perceived effort, perceived choice of activity and support of the program or activity leader. When the intensity of an activity is overwhelming and participants perceive the exertion level as uncomfortable, they are more likely to quit. A perceived lack of" choice can lead to dropout, as can a perceived lack of interest of the activity leader.

Understanding and Applying Factors

By understanding the determinants of exercise adherence and barriers to participation, fitness professionals can identify high-risk individuals and plan methods to help them stick with an exercise plan.

Personal factors appear to have the most influence on adherence. Because obesity and smoking are correlated with dropout, exercise professionals should talk to clients about diet and smoking cessation without appearing to scold. With compassion and concern, approach them with a health plan including every aspect of their lives.

Although knowledge about the benefits of exercise doesn't seem to contribute to actual adherence, it is still the exercise professional's job to educate clients about fitness. Oftentimes, the more a client understands about fitness, the more capable they feel to achieve goals. This is the concept of self-efficacy discussed earlier. As individuals properly execute exercises they have struggled with in the past, their confidence in an exercise program increases.

As mentioned, enjoyment is a personal factor because perceived enjoyment is highly individual. Increasing enjoyment is one of the most effective means of boosting adherence. People will participate in activities they find fun. Exercise professionals can increase enjoyment by discussing with clients which aspects of an exercise program they like and which they don't. One may enjoy the endorphin rush of weight training, while another enjoys the meditative effects of yoga. Although many individuals claim to enjoy the social components of exercise, leaders and trainers should not assume this is true of everyone. Be aware of the desired level of interaction among class members.

The term "dissociation" is applied to using distraction methods such as watching television, listening to music or playing games to disconnect from the discomforts of exercise. Dissociation has not proven to be effective in long-term exercise maintenance, but masks short-term discomfort. Dissociation is only appropriate when an activity does not require focus on correct biomechanics.

Exercise professionals can not control the factor of past participation, it is encouraging to know, however, that if participants stay involved with the exercise program over a significant period of time, it stands to reason that the behavior will become part of their long-term lifestyle. With each class or training appointment, participants are further along in the quest to make fitness a routine.

One of the most important determinants affecting exercise adherence is the environmental factor of perceived availability of time. We live in a time-crunched world. Everyone is in a rush. Yet, exercise professionals can assist clients by encouraging the idea that exercise is a priority. Behavioral psychologists have termed the redesigning of beliefs and values "cognitive restructuring." The idea is to replace one line of thinking with another. Instead of "I have too much to do at work today, I'll exercise later," start thinking, "If I exercise now, I'll accomplish more at work later because I'll have more energy and think more clearly." The idea that exercise comes before most aspects of daily living and enhances other aspects of life can lead to a change in thinking and help prioritize fitness.

Social support is an important environmental factor in exercise maintenance. Family support is the most important type of social reinforcement. Ask clients about the level of support they are getting from their significant others regarding exercise. If a client is concerned that exercise takes time away from family, suggest a cognitive restructuring process of understanding that exercise will help them be more relaxed and healthy and enjoy their time with their family more. Better yet, have the family participate in the exercise. Studies show married couples that exercise together are more likely to stick with an exercise program. Suggest fitness routines with children, such as jogging while children ride bikes. If they all have fun doing an activity, adherence is almost guaranteed!

Because convenience and appearance of the workout environment affect adherence, exercise professionals should pay attention to the cleanliness of their facilities. Report and address maintenance problems and keep work areas tidy. Personal appearance is part of the environment; trainers and instructors should appear professional and neat. Look for ways to make the environment more comfortable for the client. When training a client at their home, ask about ways to make the workout area enjoyable.

Changes and disruptions are a fact of life, but there are steps one can take to cope with missed workouts. Try to keep clients from becoming discouraged if they miss an appointment or class. Psychologists use relapse prevention models to keep individuals who have fallen off course from returning to an undesirable behavior or habit. These methods, developed for drug treatment programs, can be applied to the exercise realm. Most relapse prevention methods teach people to identify high-risk situations, anticipate disruptions and plan and cope with them effectively. Talk to clients about relapse situations before they happen. One of the most common reasons for exercise disruptions is injury. New exercisers who suffer injuries may become discouraged and revert to a sedentary lifestyle. Keeping participants injury-free should be the priority of every trainer and group-exercise leader.

Exercise professionals have most influence over program factors when designing a plan for increasing client retention. Remember to keep clients involved in designing their exercise programs. Not only will it increase feelings of self-efficacy, but also greatly affect perceived choice in exercise. Monitor participants in the program for excessive effort. If the activity is too intense for their comfort, they are more likely to dropout or get injured.

No factor operates in a vacuum and although research shows some factors weigh heavier than others, understanding and incorporating multiple factors into a client's exercise routine is the best bet for increasing retention.

QUESTIONS: "Factors Determining Exercise Adherence"

Code No. 0068

1. What percentage of new exercisers will return to a sedentary lifestyle within six months?

A. 10 percent

B. 30 percent

C. 50 percent

D. 80 percent

2. What percentage of Americans do not get the recommended amount of physical activity?

A. 10 percent

B. 30 percent

C. 60 percent

D. 90 percent

3. Self-efficacy is the--.

A. belief that one is able to accomplish a specific task

B. belief that one is efficient

C. same as self-confidence

D. belief in the benefits of exercise

4. The most common reason people give for not exercising is lack of

A. family support

B. enjoyment

C. time

D. support from the program leader

5. Why is enjoyment considered a personal factor?

A. the exercise leader has no control over enjoyment

B. perceived enjoyment is individual

C. nobody enjoys exercise

D. All of the above.

6. Dissociation is--.

A. using distraction methods to mask discomfort

B. an effective way to increase long-term adherence

C. best used with weight training

D. All of the above.

7. Relapse prevention teaches to--.

A. avoid disruptions in the exercise routine

B. avoid injury

C. anticipate and plan for disruptions in exercise

D. enjoy exercise

8. Understanding the health benefits of exercise usually leads to--.

A. intention to exercise

B. adherence to an exercise program

C. increased self-efficacy

D. Both A and C.

9. Which of the following factors is most likely to keep clients involved in exercise?

A. quitting smoking

B. dieting while exercising

C. seeing progress in their physique

D. enjoying the activity

10. Replacing a detrimental line of thinking with a helpful one is termed--.

A. cognitive restructuring

B. dissociation

C. relapse prevention

D. new thinking

11. Social support can increase exercise adherence. The most important social support comes from--.

A. other members of the group-exercise class

B. the trainer or group-exercise leader

C. friends and coworkers in the participant's life

D. the participant's spouse and family

12. Program factors are also referred to as--.

A. personal factors

B. activity factors

C. intrinsic motivation

D. demographics

13. Exercise professionals have most influence over--.

A. personal factors

B. environmental factors

C. program factors

D. smoking cessation

14. Keeping clients involved in the design of their own exercise program will increase--.

A. self-efficacy

B. enjoyment of the activity

C. exercise adherence

D. All of the above.

15. Why should exercise professionals monitor their clients' exertion levels?

A. excessive exertion can lead to injury

B. new exercisers who injure themselves are likely to return to a sedentary lifestyle

C. uncomfortable intensity levels can lead to drop out

D. All of the above.

References

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Bull, S.J. Adherence Issues in Sport and Exercise. West Sussex, England: Chichester, 1999.

Cain, R.E. "Effect of instruction on perceived physical ability and exercise adherence." Perceptual and Motor Skills 82 (1996): 494.

Dishman, R.K. and Buckworth, J. "Increasing physical activity: A quantitative synthesis." Medicine & Science in Sports & Exercise 28, no.6 (1996): 706-719.

Dishman, R.K. Advances in Exercise Adherence. Champaign: Human Kinetics Publishers, 1994.

Dishman, R.K. Exercise Adherence." Its Impact on Public Health. Champaign: Human Kinetics Publishers, 1988.

Leith, L.M. and Taylor, A.H. "Behavior modification and exercise adherence: A literature review." Journal of Sport Behavior 15, no. 1 (1992): 60-74.

Martin, K. A. and Fox, L.D. "Group and leadership effects on social anxiety experienced during an exercise class." Journal of Applied Social Psychology 31 (2001): 1000-1016.

Rejeski, W.J. and Kenney, E.A. Fitness Motivation: Preventing Participant Dropout. Champaign: Life Enhancement Publications, a division of Human Kinetics Publishers, 1988.

Raglin, J.S. "Factors in exercise adherence: influence of spouse participation." Quest 53 (2001): 356-361.

Roberts, G.C. Advances in Motivation in Sport and Exercise. Champaign: Human Kinetics Publishers, 2001.

Spink, K.S. and Carton, A.V. "Group cohesion and adherence in exercise classes." Journal of Sport &Exercise Psychology 14, no.1 (1992): 78-86.

Wankel, L.M. "The importance of enjoyment to adherence and psychological benefits from physical activity." International Journal of Sport Psychology 24 (1993): 151-169.

United States Department of Health and Human Services, Public Health Service. "Physical activity and health: A report of the Surgeon General." Atlanta: Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion, 1996.

Theresa Dwyre Young, MS, wrote her thesis on the role of enjoyment in exercise adherence. Located in Denver, Colorado, she has managed health clubs, focusing her attention on member retention. She writes for a number of sports and fitness publications and can be contacted at TheresaDYoung@aol.com.
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Title Annotation:CEU Corner
Author:Young, Theresa Dwyre
Publication:American Fitness
Geographic Code:1USA
Date:Jan 1, 2005
Words:2181
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