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:

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.
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.

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.

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.
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.
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.
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:

Biddle, S. J. H., & Mutrie, N. (2008). Psychology of physical activity: Determinants, well-being, and interventions (2nd ed.). London: Routledge.
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.
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.
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.