Times are displayed in (UTC-07:00) Pacific Time (US & Canada) Change
Symposium 35: The Physial Activity and TTBCI SIG presents: Understanding Physical Activity Maintenance Theories in Behavior Change Research
Topics: Multiple Health Behavior Change , Multiple Health Behavior ChangeSpecial Interest Group: Physical Activity
Overall abstract:
Physical activity has numerous benefits for health and clinical outcomes for the general and chronic-diseased populations, but most individuals are not active enough to accrue these benefits. Understanding why and how physical activity is consistently performed over time in healthy and chronic-diseased populations are critical for health promotion efforts. Several challenges in promoting long-term physical activity maintenance may be due to inconsistencies in the conceptualization and operationalization of this terminology. This hinders the understanding of intervention components that might facilitate physical activity maintenance, and the measurement or evaluation of maintenance outcomes. Interventions that have used behavioral theory produced the largest overall effect size for behavior change. However, little is known about which intervention mediators (e.g., behavior change techniques) are responsible for physical activity maintenance. Furthermore, the role and relevance of context (e.g., social and physical environment) in physical activity maintenance is not yet clear.
In this symposium, we will highlight theory-based studies that focus on physical activity maintenance as a primary outcome which include healthy populations (i.e., college students), chronic-diseased populations (i.e., cancer survivors), and successful long-term physical activity maintainers. Specifically, we will focus on 1) the predictors of physical activity maintenance using the Multi-Process Action Control (M-PAC) framework in college-aged students; 2) the development of a theory-based intervention comparing the effects of delivering a 6-month supervised physical activity program plus standard exercise counselling versus a supervised physical activity plus motivationally-enhanced behavioral counselling (based on the M-PAC framework) on physical activity maintenance in cancer survivors; and 3) a qualitative study of what factors successful physical activity maintainers indicate are the most important to be regularly physically active over the long-term. The discussion will incorporate the importance of (further) developing and enhancing theory for physical activity maintenance interventions.
Presenter #1: Investigating Reflexive Processes as Predictors of Physical Activity Maintenance among College Students
Denver M. Y. Brown, Claire I. Groves, Carah D. Porter & Matthew Y. W. Kwan
Background: Maintaining regular physical activity (PA) engagement during college can be challenging due to academic demands and competing priorities (e.g., social activities, employment). Identifying correlates of PA maintenance among this population is therefore of importance for informing intervention development to sustain PA behavior. This study investigated the predictive utility of the reflexive processes outlined within the Multi-Process Action Control (M-PAC) model for explaining PA maintenance among college students.
Methods: This four-week prospective study included a sample of 204 college students (79% female, 63% Hispanic) who regularly wore an Apple Watch, had intentions to meet the PA guidelines (i.e., ≥ 150 min of moderate-to-vigorous PA) each week over the next month, and indicated being in the action (n = 120) or maintenance (n = 84) stage of change for PA. Participants completed the Self-Report Behavioral Automaticity Index (i.e., habit) and Exercise Identity Scale (i.e., identity) at baseline to assess the reflexive processes within the M-PAC model, and provided active minutes data derived from their Apple Watch for the subsequent 28 days. PA maintenance was characterized as consistently meeting the PA guidelines all four weeks. Logistic regression models were computed for the full sample as well as stratified by stage of change for PA, adjusted for sex and ethno-racial identity.
Results: PA maintenance was observed among 53% of the sample (action stage subgroup: 41%; maintenance stage subgroup: 75%). Among the full sample, identity was associated with greater odds of PA maintenance (OR = 1.46; 95% CI: 1.14, 1.78), whereas habit was not (OR = 0.89; 95% CI: 0.60, 1.18). Closer inspection revealed identity was associated with greater odds of PA maintenance among those in the maintenance stage of change (OR = 2.25; 95% CI: 1.59, 2.91), but not the action stage (OR = 1.11; 95% CI: 0.68, 1.54). Habit was not associated with PA maintenance among those in either the maintenance (OR = 0.66; 95% CI: 0.20, 1.12) or action (OR = 1.04; 95% CI: 0.64, 1.44) stage.
Conclusion: These findings provide partial support for the M-PAC model in that identity – but not habit – was a significant predictor of PA maintenance among college students who have met the PA guidelines consistently for an extended period (i.e., 6 months). More research is warranted, however, given that consensus regarding the operationalization of PA maintenance has yet to be achieved.
Presenter #2: Development of a Theory-Based, Randomized Controlled Trial Addressing Physical Activity Maintenance in Cancer Survivors
Linda Trinh, PhD; Kristen Campbell, PhD; Shabbir Alibhai, Ryan Rhodes, PhD; Tracey Colella, PhD; Brian Chan, PhD; David Langelier, MD; Eugene Chang, MD; Paul Oh, MD; & Edward McAuley, PhD
Background: Physical activity (PA) declines significantly after supervised PA intervention have been completed among cancer survivors. The effect of short-term supervised exercise programs on motivational outcomes and longer-term PA in cancer survivors is limited, especially theoretical approaches to identify key motivational outcomes for physical activity maintenance.
Objectives: The study aims to: 1) compare the effects of delivering a 6-month supervised PA program plus standard exercise counselling (PA+EC) versus a supervised PA plus motivationally-enhanced behavioral counselling (PA+BC) on moderate-to-vigorous PA in cancer survivors; 2) determine the effects of PA + EC vs. PA + BC on secondary outcomes including changes in motivational outcomes from the Multi-process Action Control (M-PAC) framework, physical function, and quality of life (QoL).
Methods: This study is a two-armed, single blind, multi-site randomized controlled trial. Cancer survivors will be recruited and randomized to a 6-month supervised PA program plus standard exercise counselling (PA + EC group; n = 118) or a 6-month supervised PA plus behavioral counselling based on the Multi-Process Action Control (M-PAC) model (PA + BC group; n = 118). The supervised PA classes will be delivered via synchronous Zoom classes that tapers to a home-based program at the end of the trial. The goal of both arms of the intervention is to gradually increase PA to the public health guidelines (e.g., 90 minutes of PA/week). The PA + BC group will receive twelve behavioral counselling sessions with a qualified exercise professional (QEP), and the corresponding counselling session will be delivered bi-weekly. The behavioral counselling sessions will be based on the M-PAC’s reflective, regulatory, and reflexive processes. In addition to the supervised PA sessions, the PA + EC (i.e., attention control group) will receive twelve standard PA counselling sessions based on exercise training principles. Cancer survivors will complete measures at baseline, midpoint, post-intervention (6-months), at 6-months follow-up, and 1-year follow-up. Self-reported measures include quality of life, motivational outcomes, health economics, and patient satisfaction with the trial. Objective measures include PA via accelerometry collected at all time points. Multilevel modelling will examine change in the primary (i.e., MVPA) and secondary outcomes (i.e., motivational outcomes, physical function, QoL) at the four time points.
Expected Outcomes: A PA maintenance program will be developed that can be used by clinical and community-based organizations as a low-cost, supportive care tool to improve health outcomes for cancer survivors across Canada.
Presenter #3: “Make it a Priority” – That is What Long-Term Physical Activity Maintainers say.
Livia Kellerhals1 & Claudio R. Nigg2
1. Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy
2. University of Bern, Institute of Sports Science, Department of Health Science
Background: The benefits of physical activity (PA) are maximized through maintaining regular physical activity long-term. However, the factors leading to physical activity maintenance (PAM) are not well-understood. Most studies to-date have not specifically asked individuals who are successful PA maintainers.
Objective: Therefore, this qualitative study asked individuals who have maintained the WHO PA guidelines for at least five years what factors they believe are important in PAM. Findings from this investigation have potentially direct implications for PAM interventions.
Methods: A constructivist grounded theory study was conducted to explore the phenomenon through the maintainers themselves (n=10; mean age=39 (SD=16) years old; 60% female; mean moderate-to vigorous PA=567 (SD=670) min/week; mean strength training 2.6 times per week 57 min per time; mean years of PAM=16.5 (SD=10.6, range=5-35); 50% rural, 20% agglomeration, 30% urban). Data was collected through in-depth interviews. Participants’ PA profiles ranged from individual sports such as gym workout, brisk walking, cycling, or CrossFit, to team sports like volleyball, gymnastics, and other voluntary sports club activities.
Results: Of the 1127 coded segments, 21 themes were deemed relevant to the research question. These 21 themes were organized into six broad categories for PAM: the fundamental factor of priority; three core factors for PAM that determine priority – well-being, adaptability, and enjoyment; and two supporting factors of organization and community that are a result of and support continued PAM.
Conclusion: This study importantly expands the existing literature on PAM, revealing that adaptability, enjoyment, and well-being are the foundation of priority, and that priority is the primary factor for lifelong PAM. The findings also suggest that a dynamic approach is crucial for PAM. Therefore, promoting that PA can be done in various forms across situations, choosing PA that brings enjoyment, and furthers well-being, is expected to lead to developing PA into a priority in a person’s value system and for making daily activity choices.
Authors:Physical activity has numerous benefits for health and clinical outcomes for the general and chronic-diseased populations, but most individuals are not active enough to accrue these benefits. Understanding why and how physical activity is consistently performed over time in healthy and chronic-diseased populations are critical for health promotion efforts. Several challenges in promoting long-term physical activity maintenance may be due to inconsistencies in the conceptualization and operationalization of this terminology. This hinders the understanding of intervention components that might facilitate physical activity maintenance, and the measurement or evaluation of maintenance outcomes. Interventions that have used behavioral theory produced the largest overall effect size for behavior change. However, little is known about which intervention mediators (e.g., behavior change techniques) are responsible for physical activity maintenance. Furthermore, the role and relevance of context (e.g., social and physical environment) in physical activity maintenance is not yet clear.
In this symposium, we will highlight theory-based studies that focus on physical activity maintenance as a primary outcome which include healthy populations (i.e., college students), chronic-diseased populations (i.e., cancer survivors), and successful long-term physical activity maintainers. Specifically, we will focus on 1) the predictors of physical activity maintenance using the Multi-Process Action Control (M-PAC) framework in college-aged students; 2) the development of a theory-based intervention comparing the effects of delivering a 6-month supervised physical activity program plus standard exercise counselling versus a supervised physical activity plus motivationally-enhanced behavioral counselling (based on the M-PAC framework) on physical activity maintenance in cancer survivors; and 3) a qualitative study of what factors successful physical activity maintainers indicate are the most important to be regularly physically active over the long-term. The discussion will incorporate the importance of (further) developing and enhancing theory for physical activity maintenance interventions.
Presenter #1: Investigating Reflexive Processes as Predictors of Physical Activity Maintenance among College Students
Denver M. Y. Brown, Claire I. Groves, Carah D. Porter & Matthew Y. W. Kwan
Background: Maintaining regular physical activity (PA) engagement during college can be challenging due to academic demands and competing priorities (e.g., social activities, employment). Identifying correlates of PA maintenance among this population is therefore of importance for informing intervention development to sustain PA behavior. This study investigated the predictive utility of the reflexive processes outlined within the Multi-Process Action Control (M-PAC) model for explaining PA maintenance among college students.
Methods: This four-week prospective study included a sample of 204 college students (79% female, 63% Hispanic) who regularly wore an Apple Watch, had intentions to meet the PA guidelines (i.e., ≥ 150 min of moderate-to-vigorous PA) each week over the next month, and indicated being in the action (n = 120) or maintenance (n = 84) stage of change for PA. Participants completed the Self-Report Behavioral Automaticity Index (i.e., habit) and Exercise Identity Scale (i.e., identity) at baseline to assess the reflexive processes within the M-PAC model, and provided active minutes data derived from their Apple Watch for the subsequent 28 days. PA maintenance was characterized as consistently meeting the PA guidelines all four weeks. Logistic regression models were computed for the full sample as well as stratified by stage of change for PA, adjusted for sex and ethno-racial identity.
Results: PA maintenance was observed among 53% of the sample (action stage subgroup: 41%; maintenance stage subgroup: 75%). Among the full sample, identity was associated with greater odds of PA maintenance (OR = 1.46; 95% CI: 1.14, 1.78), whereas habit was not (OR = 0.89; 95% CI: 0.60, 1.18). Closer inspection revealed identity was associated with greater odds of PA maintenance among those in the maintenance stage of change (OR = 2.25; 95% CI: 1.59, 2.91), but not the action stage (OR = 1.11; 95% CI: 0.68, 1.54). Habit was not associated with PA maintenance among those in either the maintenance (OR = 0.66; 95% CI: 0.20, 1.12) or action (OR = 1.04; 95% CI: 0.64, 1.44) stage.
Conclusion: These findings provide partial support for the M-PAC model in that identity – but not habit – was a significant predictor of PA maintenance among college students who have met the PA guidelines consistently for an extended period (i.e., 6 months). More research is warranted, however, given that consensus regarding the operationalization of PA maintenance has yet to be achieved.
Presenter #2: Development of a Theory-Based, Randomized Controlled Trial Addressing Physical Activity Maintenance in Cancer Survivors
Linda Trinh, PhD; Kristen Campbell, PhD; Shabbir Alibhai, Ryan Rhodes, PhD; Tracey Colella, PhD; Brian Chan, PhD; David Langelier, MD; Eugene Chang, MD; Paul Oh, MD; & Edward McAuley, PhD
Background: Physical activity (PA) declines significantly after supervised PA intervention have been completed among cancer survivors. The effect of short-term supervised exercise programs on motivational outcomes and longer-term PA in cancer survivors is limited, especially theoretical approaches to identify key motivational outcomes for physical activity maintenance.
Objectives: The study aims to: 1) compare the effects of delivering a 6-month supervised PA program plus standard exercise counselling (PA+EC) versus a supervised PA plus motivationally-enhanced behavioral counselling (PA+BC) on moderate-to-vigorous PA in cancer survivors; 2) determine the effects of PA + EC vs. PA + BC on secondary outcomes including changes in motivational outcomes from the Multi-process Action Control (M-PAC) framework, physical function, and quality of life (QoL).
Methods: This study is a two-armed, single blind, multi-site randomized controlled trial. Cancer survivors will be recruited and randomized to a 6-month supervised PA program plus standard exercise counselling (PA + EC group; n = 118) or a 6-month supervised PA plus behavioral counselling based on the Multi-Process Action Control (M-PAC) model (PA + BC group; n = 118). The supervised PA classes will be delivered via synchronous Zoom classes that tapers to a home-based program at the end of the trial. The goal of both arms of the intervention is to gradually increase PA to the public health guidelines (e.g., 90 minutes of PA/week). The PA + BC group will receive twelve behavioral counselling sessions with a qualified exercise professional (QEP), and the corresponding counselling session will be delivered bi-weekly. The behavioral counselling sessions will be based on the M-PAC’s reflective, regulatory, and reflexive processes. In addition to the supervised PA sessions, the PA + EC (i.e., attention control group) will receive twelve standard PA counselling sessions based on exercise training principles. Cancer survivors will complete measures at baseline, midpoint, post-intervention (6-months), at 6-months follow-up, and 1-year follow-up. Self-reported measures include quality of life, motivational outcomes, health economics, and patient satisfaction with the trial. Objective measures include PA via accelerometry collected at all time points. Multilevel modelling will examine change in the primary (i.e., MVPA) and secondary outcomes (i.e., motivational outcomes, physical function, QoL) at the four time points.
Expected Outcomes: A PA maintenance program will be developed that can be used by clinical and community-based organizations as a low-cost, supportive care tool to improve health outcomes for cancer survivors across Canada.
Presenter #3: “Make it a Priority” – That is What Long-Term Physical Activity Maintainers say.
Livia Kellerhals1 & Claudio R. Nigg2
1. Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy
2. University of Bern, Institute of Sports Science, Department of Health Science
Background: The benefits of physical activity (PA) are maximized through maintaining regular physical activity long-term. However, the factors leading to physical activity maintenance (PAM) are not well-understood. Most studies to-date have not specifically asked individuals who are successful PA maintainers.
Objective: Therefore, this qualitative study asked individuals who have maintained the WHO PA guidelines for at least five years what factors they believe are important in PAM. Findings from this investigation have potentially direct implications for PAM interventions.
Methods: A constructivist grounded theory study was conducted to explore the phenomenon through the maintainers themselves (n=10; mean age=39 (SD=16) years old; 60% female; mean moderate-to vigorous PA=567 (SD=670) min/week; mean strength training 2.6 times per week 57 min per time; mean years of PAM=16.5 (SD=10.6, range=5-35); 50% rural, 20% agglomeration, 30% urban). Data was collected through in-depth interviews. Participants’ PA profiles ranged from individual sports such as gym workout, brisk walking, cycling, or CrossFit, to team sports like volleyball, gymnastics, and other voluntary sports club activities.
Results: Of the 1127 coded segments, 21 themes were deemed relevant to the research question. These 21 themes were organized into six broad categories for PAM: the fundamental factor of priority; three core factors for PAM that determine priority – well-being, adaptability, and enjoyment; and two supporting factors of organization and community that are a result of and support continued PAM.
Conclusion: This study importantly expands the existing literature on PAM, revealing that adaptability, enjoyment, and well-being are the foundation of priority, and that priority is the primary factor for lifelong PAM. The findings also suggest that a dynamic approach is crucial for PAM. Therefore, promoting that PA can be done in various forms across situations, choosing PA that brings enjoyment, and furthers well-being, is expected to lead to developing PA into a priority in a person’s value system and for making daily activity choices.
Presenter -
Linda Trinh PhD, FSBM
Student
University of Toronto
Discussant -
Genevieve Dunton PhD, MPH, FSBM
Student
University of Southern California
Presenter -
Denver Brown PhD
Student
Kansas State University
Presenter -
Claudio Nigg PhD, FSBM
Student
University of Bern
Chair -
Linda Trinh PhD, FSBM
Student
University of Toronto
Symposium 35: The Physial Activity and TTBCI SIG presents: Understanding Physical Activity Maintenance Theories in Behavior Change Research
Time: 09:00 AM - 09:50 AMTopics: Physical Activity, Multiple Health Behavior Change
Overall abstract:
Physical activity has numerous benefits for health and clinical outcomes for the general and chronic-diseased populations, but most individuals are not active enough to accrue these benefits. Understanding why and how physical activity is consistently performed over time in healthy and chronic-diseased populations are critical for health promotion efforts. Several challenges in promoting long-term physical activity maintenance may be due to inconsistencies in the conceptualization and operationalization of this terminology. This hinders the understanding of intervention components that might facilitate physical activity maintenance, and the measurement or evaluation of maintenance outcomes. Interventions that have used behavioral theory produced the largest overall effect size for behavior change. However, little is known about which intervention mediators (e.g., behavior change techniques) are responsible for physical activity maintenance. Furthermore, the role and relevance of context (e.g., social and physical environment) in physical activity maintenance is not yet clear.
In this symposium, we will highlight theory-based studies that focus on physical activity maintenance as a primary outcome which include healthy populations (i.e., college students), chronic-diseased populations (i.e., cancer survivors), and successful long-term physical activity maintainers. Specifically, we will focus on 1) the predictors of physical activity maintenance using the Multi-Process Action Control (M-PAC) framework in college-aged students; 2) the development of a theory-based intervention comparing the effects of delivering a 6-month supervised physical activity program plus standard exercise counselling versus a supervised physical activity plus motivationally-enhanced behavioral counselling (based on the M-PAC framework) on physical activity maintenance in cancer survivors; and 3) a qualitative study of what factors successful physical activity maintainers indicate are the most important to be regularly physically active over the long-term. The discussion will incorporate the importance of (further) developing and enhancing theory for physical activity maintenance interventions.
Presenter #1: Investigating Reflexive Processes as Predictors of Physical Activity Maintenance among College Students
Denver M. Y. Brown, Claire I. Groves, Carah D. Porter & Matthew Y. W. Kwan
Background: Maintaining regular physical activity (PA) engagement during college can be challenging due to academic demands and competing priorities (e.g., social activities, employment). Identifying correlates of PA maintenance among this population is therefore of importance for informing intervention development to sustain PA behavior. This study investigated the predictive utility of the reflexive processes outlined within the Multi-Process Action Control (M-PAC) model for explaining PA maintenance among college students.
Methods: This four-week prospective study included a sample of 204 college students (79% female, 63% Hispanic) who regularly wore an Apple Watch, had intentions to meet the PA guidelines (i.e., ≥ 150 min of moderate-to-vigorous PA) each week over the next month, and indicated being in the action (n = 120) or maintenance (n = 84) stage of change for PA. Participants completed the Self-Report Behavioral Automaticity Index (i.e., habit) and Exercise Identity Scale (i.e., identity) at baseline to assess the reflexive processes within the M-PAC model, and provided active minutes data derived from their Apple Watch for the subsequent 28 days. PA maintenance was characterized as consistently meeting the PA guidelines all four weeks. Logistic regression models were computed for the full sample as well as stratified by stage of change for PA, adjusted for sex and ethno-racial identity.
Results: PA maintenance was observed among 53% of the sample (action stage subgroup: 41%; maintenance stage subgroup: 75%). Among the full sample, identity was associated with greater odds of PA maintenance (OR = 1.46; 95% CI: 1.14, 1.78), whereas habit was not (OR = 0.89; 95% CI: 0.60, 1.18). Closer inspection revealed identity was associated with greater odds of PA maintenance among those in the maintenance stage of change (OR = 2.25; 95% CI: 1.59, 2.91), but not the action stage (OR = 1.11; 95% CI: 0.68, 1.54). Habit was not associated with PA maintenance among those in either the maintenance (OR = 0.66; 95% CI: 0.20, 1.12) or action (OR = 1.04; 95% CI: 0.64, 1.44) stage.
Conclusion: These findings provide partial support for the M-PAC model in that identity – but not habit – was a significant predictor of PA maintenance among college students who have met the PA guidelines consistently for an extended period (i.e., 6 months). More research is warranted, however, given that consensus regarding the operationalization of PA maintenance has yet to be achieved.
Presenter #2: Development of a Theory-Based, Randomized Controlled Trial Addressing Physical Activity Maintenance in Cancer Survivors
Linda Trinh, PhD; Kristen Campbell, PhD; Shabbir Alibhai, Ryan Rhodes, PhD; Tracey Colella, PhD; Brian Chan, PhD; David Langelier, MD; Eugene Chang, MD; Paul Oh, MD; & Edward McAuley, PhD
Background: Physical activity (PA) declines significantly after supervised PA intervention have been completed among cancer survivors. The effect of short-term supervised exercise programs on motivational outcomes and longer-term PA in cancer survivors is limited, especially theoretical approaches to identify key motivational outcomes for physical activity maintenance.
Objectives: The study aims to: 1) compare the effects of delivering a 6-month supervised PA program plus standard exercise counselling (PA+EC) versus a supervised PA plus motivationally-enhanced behavioral counselling (PA+BC) on moderate-to-vigorous PA in cancer survivors; 2) determine the effects of PA + EC vs. PA + BC on secondary outcomes including changes in motivational outcomes from the Multi-process Action Control (M-PAC) framework, physical function, and quality of life (QoL).
Methods: This study is a two-armed, single blind, multi-site randomized controlled trial. Cancer survivors will be recruited and randomized to a 6-month supervised PA program plus standard exercise counselling (PA + EC group; n = 118) or a 6-month supervised PA plus behavioral counselling based on the Multi-Process Action Control (M-PAC) model (PA + BC group; n = 118). The supervised PA classes will be delivered via synchronous Zoom classes that tapers to a home-based program at the end of the trial. The goal of both arms of the intervention is to gradually increase PA to the public health guidelines (e.g., 90 minutes of PA/week). The PA + BC group will receive twelve behavioral counselling sessions with a qualified exercise professional (QEP), and the corresponding counselling session will be delivered bi-weekly. The behavioral counselling sessions will be based on the M-PAC’s reflective, regulatory, and reflexive processes. In addition to the supervised PA sessions, the PA + EC (i.e., attention control group) will receive twelve standard PA counselling sessions based on exercise training principles. Cancer survivors will complete measures at baseline, midpoint, post-intervention (6-months), at 6-months follow-up, and 1-year follow-up. Self-reported measures include quality of life, motivational outcomes, health economics, and patient satisfaction with the trial. Objective measures include PA via accelerometry collected at all time points. Multilevel modelling will examine change in the primary (i.e., MVPA) and secondary outcomes (i.e., motivational outcomes, physical function, QoL) at the four time points.
Expected Outcomes: A PA maintenance program will be developed that can be used by clinical and community-based organizations as a low-cost, supportive care tool to improve health outcomes for cancer survivors across Canada.
Presenter #3: “Make it a Priority” – That is What Long-Term Physical Activity Maintainers say.
Livia Kellerhals1 & Claudio R. Nigg2
1. Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy
2. University of Bern, Institute of Sports Science, Department of Health Science
Background: The benefits of physical activity (PA) are maximized through maintaining regular physical activity long-term. However, the factors leading to physical activity maintenance (PAM) are not well-understood. Most studies to-date have not specifically asked individuals who are successful PA maintainers.
Objective: Therefore, this qualitative study asked individuals who have maintained the WHO PA guidelines for at least five years what factors they believe are important in PAM. Findings from this investigation have potentially direct implications for PAM interventions.
Methods: A constructivist grounded theory study was conducted to explore the phenomenon through the maintainers themselves (n=10; mean age=39 (SD=16) years old; 60% female; mean moderate-to vigorous PA=567 (SD=670) min/week; mean strength training 2.6 times per week 57 min per time; mean years of PAM=16.5 (SD=10.6, range=5-35); 50% rural, 20% agglomeration, 30% urban). Data was collected through in-depth interviews. Participants’ PA profiles ranged from individual sports such as gym workout, brisk walking, cycling, or CrossFit, to team sports like volleyball, gymnastics, and other voluntary sports club activities.
Results: Of the 1127 coded segments, 21 themes were deemed relevant to the research question. These 21 themes were organized into six broad categories for PAM: the fundamental factor of priority; three core factors for PAM that determine priority – well-being, adaptability, and enjoyment; and two supporting factors of organization and community that are a result of and support continued PAM.
Conclusion: This study importantly expands the existing literature on PAM, revealing that adaptability, enjoyment, and well-being are the foundation of priority, and that priority is the primary factor for lifelong PAM. The findings also suggest that a dynamic approach is crucial for PAM. Therefore, promoting that PA can be done in various forms across situations, choosing PA that brings enjoyment, and furthers well-being, is expected to lead to developing PA into a priority in a person’s value system and for making daily activity choices.
Keywords: Behavior Change, Physical activityPhysical activity has numerous benefits for health and clinical outcomes for the general and chronic-diseased populations, but most individuals are not active enough to accrue these benefits. Understanding why and how physical activity is consistently performed over time in healthy and chronic-diseased populations are critical for health promotion efforts. Several challenges in promoting long-term physical activity maintenance may be due to inconsistencies in the conceptualization and operationalization of this terminology. This hinders the understanding of intervention components that might facilitate physical activity maintenance, and the measurement or evaluation of maintenance outcomes. Interventions that have used behavioral theory produced the largest overall effect size for behavior change. However, little is known about which intervention mediators (e.g., behavior change techniques) are responsible for physical activity maintenance. Furthermore, the role and relevance of context (e.g., social and physical environment) in physical activity maintenance is not yet clear.
In this symposium, we will highlight theory-based studies that focus on physical activity maintenance as a primary outcome which include healthy populations (i.e., college students), chronic-diseased populations (i.e., cancer survivors), and successful long-term physical activity maintainers. Specifically, we will focus on 1) the predictors of physical activity maintenance using the Multi-Process Action Control (M-PAC) framework in college-aged students; 2) the development of a theory-based intervention comparing the effects of delivering a 6-month supervised physical activity program plus standard exercise counselling versus a supervised physical activity plus motivationally-enhanced behavioral counselling (based on the M-PAC framework) on physical activity maintenance in cancer survivors; and 3) a qualitative study of what factors successful physical activity maintainers indicate are the most important to be regularly physically active over the long-term. The discussion will incorporate the importance of (further) developing and enhancing theory for physical activity maintenance interventions.
Presenter #1: Investigating Reflexive Processes as Predictors of Physical Activity Maintenance among College Students
Denver M. Y. Brown, Claire I. Groves, Carah D. Porter & Matthew Y. W. Kwan
Background: Maintaining regular physical activity (PA) engagement during college can be challenging due to academic demands and competing priorities (e.g., social activities, employment). Identifying correlates of PA maintenance among this population is therefore of importance for informing intervention development to sustain PA behavior. This study investigated the predictive utility of the reflexive processes outlined within the Multi-Process Action Control (M-PAC) model for explaining PA maintenance among college students.
Methods: This four-week prospective study included a sample of 204 college students (79% female, 63% Hispanic) who regularly wore an Apple Watch, had intentions to meet the PA guidelines (i.e., ≥ 150 min of moderate-to-vigorous PA) each week over the next month, and indicated being in the action (n = 120) or maintenance (n = 84) stage of change for PA. Participants completed the Self-Report Behavioral Automaticity Index (i.e., habit) and Exercise Identity Scale (i.e., identity) at baseline to assess the reflexive processes within the M-PAC model, and provided active minutes data derived from their Apple Watch for the subsequent 28 days. PA maintenance was characterized as consistently meeting the PA guidelines all four weeks. Logistic regression models were computed for the full sample as well as stratified by stage of change for PA, adjusted for sex and ethno-racial identity.
Results: PA maintenance was observed among 53% of the sample (action stage subgroup: 41%; maintenance stage subgroup: 75%). Among the full sample, identity was associated with greater odds of PA maintenance (OR = 1.46; 95% CI: 1.14, 1.78), whereas habit was not (OR = 0.89; 95% CI: 0.60, 1.18). Closer inspection revealed identity was associated with greater odds of PA maintenance among those in the maintenance stage of change (OR = 2.25; 95% CI: 1.59, 2.91), but not the action stage (OR = 1.11; 95% CI: 0.68, 1.54). Habit was not associated with PA maintenance among those in either the maintenance (OR = 0.66; 95% CI: 0.20, 1.12) or action (OR = 1.04; 95% CI: 0.64, 1.44) stage.
Conclusion: These findings provide partial support for the M-PAC model in that identity – but not habit – was a significant predictor of PA maintenance among college students who have met the PA guidelines consistently for an extended period (i.e., 6 months). More research is warranted, however, given that consensus regarding the operationalization of PA maintenance has yet to be achieved.
Presenter #2: Development of a Theory-Based, Randomized Controlled Trial Addressing Physical Activity Maintenance in Cancer Survivors
Linda Trinh, PhD; Kristen Campbell, PhD; Shabbir Alibhai, Ryan Rhodes, PhD; Tracey Colella, PhD; Brian Chan, PhD; David Langelier, MD; Eugene Chang, MD; Paul Oh, MD; & Edward McAuley, PhD
Background: Physical activity (PA) declines significantly after supervised PA intervention have been completed among cancer survivors. The effect of short-term supervised exercise programs on motivational outcomes and longer-term PA in cancer survivors is limited, especially theoretical approaches to identify key motivational outcomes for physical activity maintenance.
Objectives: The study aims to: 1) compare the effects of delivering a 6-month supervised PA program plus standard exercise counselling (PA+EC) versus a supervised PA plus motivationally-enhanced behavioral counselling (PA+BC) on moderate-to-vigorous PA in cancer survivors; 2) determine the effects of PA + EC vs. PA + BC on secondary outcomes including changes in motivational outcomes from the Multi-process Action Control (M-PAC) framework, physical function, and quality of life (QoL).
Methods: This study is a two-armed, single blind, multi-site randomized controlled trial. Cancer survivors will be recruited and randomized to a 6-month supervised PA program plus standard exercise counselling (PA + EC group; n = 118) or a 6-month supervised PA plus behavioral counselling based on the Multi-Process Action Control (M-PAC) model (PA + BC group; n = 118). The supervised PA classes will be delivered via synchronous Zoom classes that tapers to a home-based program at the end of the trial. The goal of both arms of the intervention is to gradually increase PA to the public health guidelines (e.g., 90 minutes of PA/week). The PA + BC group will receive twelve behavioral counselling sessions with a qualified exercise professional (QEP), and the corresponding counselling session will be delivered bi-weekly. The behavioral counselling sessions will be based on the M-PAC’s reflective, regulatory, and reflexive processes. In addition to the supervised PA sessions, the PA + EC (i.e., attention control group) will receive twelve standard PA counselling sessions based on exercise training principles. Cancer survivors will complete measures at baseline, midpoint, post-intervention (6-months), at 6-months follow-up, and 1-year follow-up. Self-reported measures include quality of life, motivational outcomes, health economics, and patient satisfaction with the trial. Objective measures include PA via accelerometry collected at all time points. Multilevel modelling will examine change in the primary (i.e., MVPA) and secondary outcomes (i.e., motivational outcomes, physical function, QoL) at the four time points.
Expected Outcomes: A PA maintenance program will be developed that can be used by clinical and community-based organizations as a low-cost, supportive care tool to improve health outcomes for cancer survivors across Canada.
Presenter #3: “Make it a Priority” – That is What Long-Term Physical Activity Maintainers say.
Livia Kellerhals1 & Claudio R. Nigg2
1. Zurich University of Applied Sciences, School of Health Sciences, Institute of Physiotherapy
2. University of Bern, Institute of Sports Science, Department of Health Science
Background: The benefits of physical activity (PA) are maximized through maintaining regular physical activity long-term. However, the factors leading to physical activity maintenance (PAM) are not well-understood. Most studies to-date have not specifically asked individuals who are successful PA maintainers.
Objective: Therefore, this qualitative study asked individuals who have maintained the WHO PA guidelines for at least five years what factors they believe are important in PAM. Findings from this investigation have potentially direct implications for PAM interventions.
Methods: A constructivist grounded theory study was conducted to explore the phenomenon through the maintainers themselves (n=10; mean age=39 (SD=16) years old; 60% female; mean moderate-to vigorous PA=567 (SD=670) min/week; mean strength training 2.6 times per week 57 min per time; mean years of PAM=16.5 (SD=10.6, range=5-35); 50% rural, 20% agglomeration, 30% urban). Data was collected through in-depth interviews. Participants’ PA profiles ranged from individual sports such as gym workout, brisk walking, cycling, or CrossFit, to team sports like volleyball, gymnastics, and other voluntary sports club activities.
Results: Of the 1127 coded segments, 21 themes were deemed relevant to the research question. These 21 themes were organized into six broad categories for PAM: the fundamental factor of priority; three core factors for PAM that determine priority – well-being, adaptability, and enjoyment; and two supporting factors of organization and community that are a result of and support continued PAM.
Conclusion: This study importantly expands the existing literature on PAM, revealing that adaptability, enjoyment, and well-being are the foundation of priority, and that priority is the primary factor for lifelong PAM. The findings also suggest that a dynamic approach is crucial for PAM. Therefore, promoting that PA can be done in various forms across situations, choosing PA that brings enjoyment, and furthers well-being, is expected to lead to developing PA into a priority in a person’s value system and for making daily activity choices.
Authors:
Presenter - Linda Trinh, PhD, FSBM,
PhD, FSBM,
University of Toronto
Discussant - Genevieve F. Dunton, PhD, MPH, FSBM,
PhD, MPH, FSBM,
University of Southern California
Presenter - Denver Brown, PhD,
PhD,
Kansas State University
Presenter - Claudio R. Nigg, PhD, FSBM,
PhD, FSBM,
University of Bern
Chair - Linda Trinh, PhD, FSBM,
PhD, FSBM,
University of Toronto
Symposium 35: The Physial Activity and TTBCI SIG presents: Understanding Physical Activity Maintenance Theories in Behavior Change Research
Description
Date: 3/29/2025
Start: 9:00 AM
End: 9:50 AM
Location: Franciscan C