Adherence

Many of the benefits of exercise come through sustained  participation.  Unfortunately,  it  is  difficult for sedentary individuals to start an exercise program, and of those that do approximately 50% on average  will  drop  out  in  the  first  3  to  6  months. Furthermore,  after  12  months  most  people  who started  a  new  exercise  program  will  be  sedentary again.  As  a  result,  a  large  body  of  literature  is available on the degree to which different factors contribute  to  exercise  adherence,  defined  as  the degree to which an individual is able to sustain an exercise program. Among the many psychological factors that may contribute to exercise adherence, three  broad  categories  that  have  received  extensive  research  attention  are  outcome  expectations, social influences, and perceptions of control.

Outcome Expectations

Outcome  expectations  include  the  value  that  an individual  puts  on  the  outcomes  associated  with regular exercise as well as the likelihood that the person  believes  the  outcome  will  occur.  Outcome expectations can be positive (reduce the risk of cardiovascular  disease)  or  negative  (sore  muscles  or injury). The literature is mixed on the relationship between outcome expectations and exercise adherence. Still, most literature supports the notion that having  positive  outcome  expectations  is  a  necessary, though potentially insufficient, characteristic of  exercise  adherence.  Further,  when  evaluating what  value  a  person  places  on  an  outcome,  one must take into account age and other demographics. Values vary significantly depending on the person involved. For example, older adults may place a  higher  value  on  perceived  health  and  longevity than do younger adults. Older women may place more importance on the social aspects of exercise, while  younger  women  may  find  physical  activity as an important way to control weight. Value expectations may also differ between demographic groups. For example, Caucasian women generally may  value  physical  activity  as  a  method  to  lose weight, while Latina women may positively associate  overweight  with  a  healthy  ideal  and,  therefore, not value physical activity from a weight-loss perspective.  Finally,  there  is  some  evidence  that the expected timing of the outcome is important. Specifically, if someone expects to lose 10 pounds in  1  week  because  of  a  new  exercise  program,  it will be demotivating when that outcome does not happen when one wants it to happen.

Social Influences

adherence-sports-psychologyLike  outcome  expectations,  social  influences  are included  in  most  theoretical  models  developed  to predict  exercise  adherence.  Social  influences  can include  social  support  from  a  family  member  or friend,  group  norms  or  cohesion  in  an  exercise class,  or  social  environmental  factors  related  to economic  status  or  culture.  The  way  people  perceive social support can have positive and negative influences  on  exercise  adherence.  Positive  social support  from  family  members,  friends,  and  others can include opportunities to exercise with the person,  planning  activities  around  exercise,  and giving  encouragement  for  the  person  to  continue exercising.  However,  even  these  kinds  of  activities can negatively influence exercise adherence if the  person  receiving  the  support  feels  pressured. Social norms can also have a positive or negative impact  on  exercise  adherence.  Within  an  exercise class, norms and a sense of cohesion result in increased  adherence.  Similarly,  normative  beliefs related to people who are important to us or have expertise  can  influence  adherence.  Normative beliefs are formed when a person’s perception that other  people  who  are  personally  important  think the  individual  should  engage  in  a  specific  behavior. For example, if a son believes that his mother is  convinced  track  is  the  safest  form  of  exercise for  him,  this  belief  will  influence  the  subjective norm of the son, who may be apt to run instead of playing baseball, football, or another team sport. Alternatively,  an  individual  who  lives  in  a  house full  of  other  sedentary  people  may  have  a  hard time initiating and sustaining an exercise regimen if  the  following  is  taking  place:  (1)  subtle  teasing (“Look at you wanting to be Mr. Universe”), (2)  complaints  about  the  time  spent  exercising, and (3) instances of sabotage.

Perception of Control

When  people  feel  they  have  control  over  a  situation, they are more likely to participate in a given behavior. Perceptions of control can be thought of as expectations related to one’s ability to complete a task. Self-efficacy is the most commonly studied control  belief—the  belief  that  one  has  the  ability or the competency to complete a certain action. It is predictive of attendance of exercise classes, and like value expectancy, can be influenced by demographics or age. Older adults who may be afraid of injury could have lower self-efficacy than younger adults;  however,  researchers  have  hypothesized that methods to increase self-efficacy and exercise adherence  include  (1)  having  participants  experience personal successes with their exercise regimen; (2)  providing  vicarious  experiences,  or  modeling exercise behaviors; (3) integrating social and verbal persuasion; and (4) monitoring physiological states (soreness, sickness, etc.).

Although  many  people  are  likely  to  not  stick with exercise programs and regimens, these factors may improve exercise adherence. Outcome expectations, social influences, and perceptions of control are closely related to the intentions and goals of  a  person.  Indeed,  these  broad  categories  are interrelated.  Outcome  expectations  are  typically lower  when  participants  do  not  value  the  outcomes  of  regular  exercise.  Also,  when  one’s  self-efficacy is low, the likelihood of valued outcomes also decreases. Conversely, when social influences are supportive of exercise, then perceptions of control  increase.  All  of  these  factors  interact  within the  broader  ecological  milieu.  Laws  and  policies related  to  ensuring  safe  biking,  opportunities  for children to walk to school, and traffic calming all contribute  to  exercise  adherence,  sometimes  acting  through  outcome  expectations,  social  influences, and perceptions of control and other times directly impacting an individual’s opportunities for exercise.

References:

  1. Anderson, E. S., Wojcik, J. R., Winett, R. A., & Williams, D. M. (2006). Social-cognitive determinants of physical activity: The influence of social support, self efficacy, outcome expectations, and self-regulation among participants in a church-based health promotion study. Health Psychology, 25(4), 510–520.
  2. Carron, A. V., Hausenblas, H. A., & Mack, D. (1996). Social influence and exercise: A meta-analysis. Journal of Sport & Exercise Psychology, 18(1), 1–16.
  3. Dishman, R. K. (1994). Advances in exercise adherence. Champaign, IL: Human Kinetics.
  4. Hagger, M. S., Chatzisarantis, N. L. D., & Biddle, S. J. H. (2002). A meta-analytic review of the theories of reasoned action and planned behavior in physical activity: Predictive validity and the contribution of additional variables. Journal of Sport & Exercise Psychology, 24(1), 3–32.

 

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