My primary goal was to reduce sedentary behaviour (playing an iPad game ‘HeartStone’) and increase vigorous activities (going to the gym). In order to maintain health in overall, it is advised by a number of guidelines all adults should spend minimum 30 minutes of modest amount physical activity on most days of the week (Pate, Pratt and Bair, 1995). I aimed to go to gym three days a week for at least 30 minutes. Ever since I moved from Australia to the United Kingdom my gaming habit for ‘HeartStone’ has increased to two hours minimum.
U. S. Department of Health and Human Services (1996) disclosed relaxation behaviours mainly occur through activities which do not involve physical movements, such as watching the television and using computer. It is a game I played before I moved to the UK and have found it quite favourable as I use it to release stress and deal with homesickness. This is supported by King, Blair and Bild’s (1996) argument whereby other external reasons for being inactive includes lack of social support. I chose going to gym for weight training as the vigorous activity because I have done it before and enjoyed it.
Bishop and Aldana (1999) stated many interventions assume, people can easily adopt an ongoing physical activity, and prepared to proceed these actions accordingly if it was perceived as enjoyable. Similarly, tempting to exercise adoption is that the stage of change model suggests behaviour change is not an all or nothing phenomenon, and that those people who stop performing behaviour may potentially start again. Self-efficacy has been shown to be positively linked with the acceptance and maintenance of a physical behaviour and motivational willingness for physical activity involvement (Sallis, Haskell and Fortmann, 1986).
Choice of behaviour change model: Trans-theoretical Model (Stages of change) Source: (Bolanos, 2014) James Prochaska and Carlo DiClemente (1982) presented the Transtheoretical Model (TTM) for assimilating current behavioural stage with a person centred focus to change one’s behaviour. They highlighted the significance of creating programs that are tailored to the appropriate stage of change (Prochaska and DiClemente, 1982). Smoking cessation was the primary reason for the development of the stages of change model. This model has been widely used for many health behaviours and has subsequently been modified by Marcus, Selby, and Niaura (1992).
This model is applicable to the adoption of physical activity and development of vigorous programs. The TTM recommends individuals trying to remove or add a health behaviour progress through five stages of change (Prochaska and DiClemente 1982). I specifically chose this model because it targeted my purpose of increasing physical activity and decreasing sedentary behaviour. Studies using the TTM have found; self-efficacy scores highly associate with stages of change (Bolanos, 2014). In the pre-contemplation stage, self-efficacy scores will be more likely to be lower than in the maintenance stage (Herrick, Stone and Mettler, 1997).
Sallis et al (1986) stated that self-efficacy beliefs have been found to have a correlation with exercise performance. These beliefs are connected to a stage of change with pre-contemplators who have the lowest self-efficacy level; and individuals in the maintenance stage retaining the highest level of self-efficacy (Marcus and Owen, 1992). The self-efficacy theory is developed based upon one’s self-confidence and belief in self to have ability to perform a specific behaviour under particular conditions (Bandura, 1977).
Therefore it s recommended by NICE (2013) improving self-efficacy in interventions is necessary. The exercise adoption and maintenance process are examined by using the TTM of behaviour change as a theoretical framework by many researchers (Cardinal and Sachs, 1996). Marcus and Simkin (1993) indicated this model has been successfully applied in tailoring treatment to people who have a lack of interest in physical activity engagement, and has been beneficial in guiding as well as developing effective physical activity interventions.
Marcus, Owen, and Forsyth (1998) stated much research has been conducted to better understand vigorous behaviour and many interventions based upon theoretical models have been established for creating and applying programs. Calfas, Long, and Sallis, (1996) accepted TTM is one of the most favourable approaches for improving one’s physical activity. Strengths and weaknesses of TTM Advantages and disadvantages are demonstrated as reliable pointers for comprehending transition between the stages of change as a single improvement over each step (Dishman, 1994).
Outcomes of research have clearly indicated, targeting interventions to specific stage of change for vigorous activity shows promise for accomplishing increased physical activity and improved willingness to adopt it (Marcus, Emmons, and Simkin-Silverman, 1999). I found this initially was the case with me, since firstly I was focusing on little steps, gym for 30mins only, and then tried to increase, similarly decrease playing ‘HeartStone’ game as well. A specific strength in applying the stages of change model to the exercise of physical activity behaviours is it’s energetic nature (Dishman, 1994).
The model concentrates on the transitions which take place in the adoption and maintenance of behaviour with individuals progressing through the stages at varying degrees. Movement through the stages does not always occur smoothly, but may also be repeated as many people make several attempts at behaviour change before the goal is met (Marcus and Simkin, 1993). This statement confirms my experiences, since I have practiced three stages (contemplation, preparation, and action) in one, but then fell back to pre-contemplation stage on other days.
In any case, although many researchers regard stage development as a demonstration of intervention efficiency; and it should thus be regarded as a secondary conclusion, not least because stage development does not necessarily associate ultimately to behaviour change (Martin, Velicer and Fava, 1996). In the earlier periods of the stage model it is suggested by many researchers; that it only shows in one’s intention to change (Clarke and Eves, 1997; Armitage and Arden, 2002). For instance, initially TTM only helped me to build my confidence and incentive for a behaviour change.
Even though studies have occurred observing the nature of the evidence related with TTM interventions, they were found to be unsuccessful to use systematic review methods or focus on a particular behaviour. My successes in adapting TTM (See appendix for diary) I have assessed my behaviour change as recommended in the NICE (2013) guiding principles. Effectiveness – I went to Gym seven times over the 6 weeks, and reduced playing ‘HeartStone’ from 2. 5hours to 1hour in average. Acceptability – I am more productive with my day and enjoy going to the gym occasionally.
Equity – I know other people who receive health benefits from going to the gym and reducing sedentary behaviours. Safety- Although first 2 gym sessions caused my body to be sore, I have not had further pain. It has been researched to identify barriers in relation to inactivity and some of the factors were discovered to be demographic, external factors, and the way of thinking (Dunn, Garcia, and Marcus, 1998). As I was warned once by the trainer in front of others about me not doing the exercise correctly, it was resulted me not wanted to exercise.
Dunn et al (1998) reported some significant results about people’s main obstacles for not liking exercising; because those people tend to not have enough time to spend for exercising, the discomfort that they feel in the gymnasium, and simply they do not enjoy vigorous exercises. Perceived lack of time is one of the most commonly stated barriers to adherence to recovery (Slujis, Kok, and Van Der Zee, 1993). In my experience, I constantly felt that I did not have time to go to the gym and created excuses (I need to eat before gym, friends are going out, I need to study).
However, Dishman (1994) reported of those people who decided to adopt a more physically active lifestyle return to a sedentary lifestyle within three to six months. Current and future role of behaviour change models Planning to overcome problems and barriers are particularly significant for on-going maintenance of behaviour and interventions, such as a brief training period might be required to endure intentions (Ziegelmann, Lippke, and Schwarzer, 2006).
Ogden (2012) stated the goal-setting approach of CBT has been one of the supported interventions to use in implementing intentions. Particularly the content of the TTM needs more in-depth descriptions. It is reported better evaluations of intervention content would deliver responses to these. As a result, help to simplify theoretical and conceptual uncertainty, whilst also serving to explain the structure through which TTM interventions might shape an effective basis for shifting health-related behaviours.
A highly significant goal for future research should be to develop an evidence base that is not solely focused on effectiveness, but also with respect to the main propositions of the TTM. There is a genuine need for stronger evaluations of theory-based interventions that concentrates more generally than one in particular (Michie and Abraham, 2004). Additionally it has been argued, better model specification is essential, and this specification should reflect systematically rigorous evidence. Lastly, Bandura (1986) believes in order to increase one’s self-efficacy, it is important to take small and manageable steps.