Interventions For Exercise And Physical Activity

Interventions  in  the  field  of  exercise  or  physical activity (PA) psychology focus on issues related to health rather than on issues related to performance in sport. Exercise, by definition, suggests a form of PA that is often structured and undertaken with the aim of improving fitness. However, health benefits can be obtained from more incidental modes of PA that are not primarily done for fitness benefit such as  gardening,  dog  walking,  or  bicycling  to  work. Such activity may have different determinants than those that could be defined as exercise and so, to encompass  both,  the  term  PA–exercise  psychology is used in this entry. PA–exercise psychologists employ a wide range of skills, some of which overlap with the skills used by sport performance psychologists, to assist individuals and groups achieve sufficient  PA  to  gain  health  benefits.  PA–exercise psychologists  also  engage  in  research  to  further understand  what  constitutes  effective  interventions that may influence population health. When psychologists  intervene  with  individuals,  groups, or  communities,  they  use  approaches  that  have  a strong evidence base for successfully increasing PA levels. This health-related aspect of sport and exercise  psychology  (SEP)  is  growing  in  importance because of the global public health risk posed by lack  of  sufficient  PA.  This  entry  summarizes  the importance  of  PA  for  health,  discusses  the  need to  decrease  sedentary  time,  introduces  the  global call to action in the Toronto Charter for Physical Activity,  describes  a  series  of  interventions  that have  global  support  and  represent  good  investments for countries seeking to increase population levels of PA, and finally makes a recommendation that all interventions should be properly evaluated.

The Importance of Physical Activity for Health

Physical  inactivity  is  the  fourth  leading  cause  of mortality from chronic diseases such as heart disease,  stroke,  diabetes,  and  cancers,  and  inactivity  contributes  to  the  rising  obesity  levels  noted around the world. For children, the recommended minimum amount of activity shown to be beneficial  is  300  minutes  of  moderate  intensity  activity over the course of a week, and for adults, the recommended minimum is 150 minutes of moderate intensity activity over the course of a week. Public health  physical  inactivity  is  a  serious  challenge: Inactivity  is  a  risky  health  behavior  and,  because the majority of Western populations do not achieve the  minimum  amount  of  activity  for  health,  it  is also a very prevalent risk. There is also a considerable challenge in increasing the levels of PA within a country’s population. Psychologists are part of a team of professionals contributing to determining how best to increase population levels of activity.

The New Issue of Sedentary Behavior

A  new  aspect  of  this  health-related  field  is  the developing  understanding  that  lengthy  periods of  sedentary  time,  such  as  those  experienced  in many  desk  jobs  or  through  TV  viewing,  may  be detrimental  to  health  even  if  the  person  achieves the  currently  recommended  minimum  amount  of activity  for  health.  There  is  therefore  also  a  need for  interventions  to  focus  on  how  people  might decrease the number of minutes they spend in sedentary  activities.  Exercise  and  PA  psychology  has a clear role to play in the design, implementation, and  evaluation  of  interventions  that  promote  PA behavior or decrease sedentary time.

The Toronto Charter for Physical Activity

The   Toronto   Charter   for   Physical   Activity, which  was  launched  in  May  2010  by  the  Global Advocacy  Council  for  Physical  Activity  (GAPA), is an important milestone in the history of PA and public  health.  The  aim  of  the  charter  is  to  create sustainable opportunities for physically active lifestyles  for  everyone.  Within  the  Toronto  Charter there are nine guiding principles listed for a population-based approach to PA. Psychologists should use  the  charter  to  guide  their  role  in  developing interventions  to  increase  PA  and  decrease  sedentary  time.  The  charter’s  principles  identify  the importance  of  evidence-based  approaches—of embracing  equity  by  reducing  social  and  health inequalities  or  removing  disparities  in  access  to PA.  Importantly,  the  principles  acknowledge  the need  to  move  beyond  the  individual  to  include environmental and social determinants of physical inactivity.  Other  principles  identify  sustainability, a  life-course  approach  to  promoting  activity,  and the  need  to  garner  political  support  and  resource commitment at the highest level.

What Kinds of Interventions Are Appropriate?

One  common  framework  for  understanding  the various  levels  at  which  intervention  aimed  at improving health may take place is known as the socioecological  model.  This  model  suggests  that there are multiple influences on PA and sedentary behavior,  such  as  individual  psychology,  social circumstances,  the  surrounding  physical  environment,  and  wider  sociopolitical  influences  such  as culture  and  policies.  This  suggests  that  interventions aimed at increasing individuals’ activity levels must take into account these wider influences, and  psychologists  need  to  work  in  partnership with other agencies to advocate for environments that  encourage  activity,  such  as  the  creation  of foot paths and bicycle lanes. In addition, exercise psychologists  must  also  work  at  the  policy  level and advocate for the creation of local and national policies  that  lay  out  strategic  objectives  for  raising  the  level  of  PA.  However,  the  issue  of  which interventions to use for greatest effect is not easy to  resolve  because  the  evidence  base  is  relatively young,  and  one  cannot  say  with  certainty  which approaches are best. Agencies such as the Centers for Disease Control and Prevention in the United States  and  the  National  Institute  for  Health  and Care  Excellence  (NICE)  in  the  United  Kingdom issue  guidance  from  time  to  time,  which  is  based on  thorough  and  critical  reviews  of  the  available evidence,  and  these  resources  are  useful  starting points for psychologists wishing to understand the current evidence. For example, NICE issued a set of  guidelines  on  the  best  approaches  to  changing the environment to promote PA.

Which Interventions to Use?

GAPA  and  leading  academics  and  practitioners from  around  the  world  have  reviewed  evidence for  interventions  that  were  effective  in  increasing PA  levels.  This  review  led  to  the  production  of  a companion document to the Toronto charter, titled “Seven  Investments  That  Work”  (www.globalpa.org.uk/investments).  These  seven  approaches  are as follows:

  1. Whole-of-school programs. In these programs, schoolchildren of all ages are encouraged to be active in a variety of ways such as on the journey to and from school, during school break times, and after school and via quality physical education (PE) programs.
  2. Transport policies and systems. By intervening at the level of transport systems, people might be encouraged to use public transport, which is almost always a more active journey than a car, or they might be encouraged to actively commute from place to place by foot or by bicycle. Transport policies that prioritize walking and cycling and provide safe infrastructure, such as well-lit pavements and off-road cycle paths, could have a substantial impact on population levels of PA. Scandinavian countries provide good examples of this approach.
  1. Urban design regulations and infrastructure.

Towns and cities that provide for equitable and safe access to recreational PA, such as playgrounds and sports facilities, with opportunities for all ages to participate, support lifelong involvement in PA.

  1. Primary care programs. Every patient in a health service scheme, who is visiting a doctor or nurse for whatever reason, should be asked about his or her current level of activity and given encouragement and opportunities to increase activity to benefit health.
  2. Public education. Many people simply do not know the risks of inactivity nor the amount of activity needed to gain health benefits. Public education is therefore needed and might include mass media to raise awareness and change social norms around PA to help create a culture in which being physically active is normal behavior.
  3. Community-wide programs. Offering opportunities to be active in one’s local community and mobilizing community engagement and resources is seen as an effective route in helping people be more active.
  4. Sports systems and programs that promote “sport for all.” When sport is taught within schools and communities, coaches should employ a “sport for all” ethos that encourages participation across the life span in preference to an ethos that only promotes elite-level sport.

How Should Physical Activity–Exercise Psychologists Design and Evaluate Interventions?

When  PA–exercise  psychologists  intervene,  perhaps  in  one  of  the  seven  areas  listed  previously, to promote PA or reduce sedentary behavior, they should  base  their  work  on  a  recognized  theory of behavior change and use the principles of that theory  to  develop  appropriate  materials.  They must also consider a framework to guide the evaluation  of  their  intervention.  At  a  minimum,  all interventions  must  measure  PA  behavior,  ideally with an objective monitor such as a pedometer or accelerometer, to determine if improvements have occurred.

References:

  1. Biddle, S. J. H., & Mutrie, N. (2008). Psychology of physical activity: Determinants, well-being, and interventions (2nd ed.). London: Routledge.
  2. Craig, P., Dieppe, P., MacIntyre, S., Mitchie, S.,Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: The new Medical Research Council guidance. British Medical Journal,337, 979–983.
  3. Katzmarzyk, P., Church, T., Craig, C., & Bouchard, C. (2009). Sitting time and mortality from all causes,cardiovascular disease, and cancer. Medicine & Science in Sports & Exercise, 41(5), 998–1005.
  4. Sallis, J., & Owen, N. (2002). Ecological models of health behavior. In K. Glanz, F. Lewis, & B. Rimer (Eds.), Health behavior and health education: Theory, research, and practice (3rd ed., pp. 462–484). San Francisco: Jossey-Bass.

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