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Q: Resistance to Changing Behavior to Improve Health ( Answered 5 out of 5 stars,   0 Comments )
Question  
Subject: Resistance to Changing Behavior to Improve Health
Category: Health
Asked by: victus-ga
List Price: $25.00
Posted: 21 Apr 2005 14:23 PDT
Expires: 21 May 2005 14:23 PDT
Question ID: 512400
With just a few lifestyle changes (lose weight/maintain healthy
weight, moderate exercise 3-4x/week) a person can improve their health
dramatically. Yet Americans in particular are very resistant to adopt
these lifestyle changes.

What I'm looking for is 3 academic studies that examine our resistance
to changing our behavior and suggest realistic strategies for
overcoming these objections. It would be best if the studies looked at
weight loss and exercise specifically. Smoking and/or alcohol are not
of interest at this time.

A great study would look something like this:
"A study of 5,000 men and women by the Psychology department at
Harvard and published in JAMA has identified the top 5 reasons why
people don't exercise 4 times a week as recommended by health leaders.
The five reasons are: 1)... 2)... 3)... 4)... 5)... .The authors
suggest the following strategies for overcoming these objections:  "

A study that would not be of interest would look like this:
"The Parent Teachers Association has released a study that shows
turning off the TV and forcing kids to play outside will make them
healthier."

Hope this makes sense, feel free to ask for clarification!
Answer  
Subject: Re: Resistance to Changing Behavior to Improve Health
Answered By: pinkfreud-ga on 21 Apr 2005 16:06 PDT
Rated:5 out of 5 stars
 
I have gathered some online information for you. Some of these
articles are in the form of abstracts of academic studies; the
complete studies may be obtained for a fee, or may be available
through your local library. Other items are more of a "pop" nature,
but may be of interest.

"People don't exercise because they can't think of reasons to
exercise: an examination of causal reasoning within the
Transtheoretical Model...

This study compared the accessibility of the pros (advantages) and
cons (disadvantages) of exercise in a group of non-exercisers and
regular exercisers, using the Transtheoretical Model of behaviour
change as a theoretical framework. Pre-contemplators (n = 18), and
maintainers (n = 25), were asked to generate a list of 'advantages to
taking part in exercise' (pro reasons), and a list of 'disadvantages
to taking part in exercise' (con reasons). The time to generate their
first item was recorded as well as the total number of items generated
within 60 s. The results showed that pre-contemplators provided more
con reasons relative to pro reasons; and maintainers provided more pro
reasons relative to con reasons for exercise. Pre-contemplators were
also quicker to provide their first con reason, relative to their
first pro reason, but there was no difference in pro and con latencies
in the maintainers. It was concluded that one reason pre-contemplation
individuals do not participate in regular exercise may be because they
cannot think of reasons to exercise.

IngentaConnect
http://www.ingentaconnect.com/content/carfax/cphm/2003/00000008/00000004/art00004

"Reasons for not exercising and exercise intentions: a study of
middle-aged sedentary adults...

The aims of this study were to assess why people do not participate in
exercise and physical activity, and what might lead them to become
active. More specifically, we focused on the hindrances to entering
the phase of transition from a sedentary to a more active lifestyle by
analysing the reasons 265 middle-aged Belgian adults gave for their
inactivity. Their justifications were examined in relation to the
conditions which they say would be needed for them to become more
involved in regular physical activity. Factor analysis revealed that
the reasons for inactivity referred to the adults' self-concept, to
cognitive cost-benefit based processes and to negative emotions
associated with exercise. The conditions reported to be necessary to
begin exercising referred to a perceived decrease in health and to the
appropriateness of the exercise offered. Discriminant analysis showed
that 'never-exercisers' differed from 'ex-exercisers', and that within
the subgroup of 'ex-exercisers' the long-term drop-outs differed from
the recent drop-outs. Cluster analysis revealed three types of
sedentary adults: the unconcerned, the opposed and the approachable."

PubMed Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9258845&dopt=Abstract

"Current injury or disability as a barrier to being more physically active. 

"Purpose: To assess the extent to which a current injury or disability
is a significant barrier to being more active...

Methods: Data on current injury or disability as a reported barrier to
being more physically active were extracted from an
urban-representative population survey. Multivariate logistic
regression analyses assessed the association between gender,
educational attainment, age, body mass index, and current physical
activity levels with injury or disability as a barrier.

Results: Twenty percent of the survey respondents gave current injury
or disability as a reason for not being more active. There were no
significant differences between male and female subjects. There was a
significant trend toward a higher reporting of current injury or
disability as a barrier, with increasing age (P < 0.001). High body
mass index (P < 0.001) and current physical activity levels (P < 0.05)
were significantly related to the injury or disability barrier. The
only variables significantly independently associated in multivariate
logistic regression analyses were age and body mass index.

Conclusions: Current injury or disability as a barrier to increased
physical activity was independently, and significantly, associated
with both age and body mass index, after adjusting for other
variables. The promotion of increased physical activity to older and
overweight groups should focus on safe activities that do not
aggravate previous injuries or disabilities."

American College of Sports Medicine
http://www.acsm-msse.org/pt/re/msse/abstract.00005768-200105000-00016.htm;jsessionid=ColGyhesVfOqhmt2SijaWDeQqYVAeOxZUat2i0OePl35Z1S1ilRi!430004150!-949856032!9001!-1

"Perceptions of Barriers to Healthy Physical Activity among Asian Communities...

There is clear evidence of inequalities in the health status of
minority ethnic groups in Britain. This includes a number of
conditions which may be alleviated or prevented through increased
levels of physical exercise. Other research has shown lower levels of
activity and raised body mass among Asian groups. There remains some
scope for argument about the reasons for these differences. It is, for
example, suggested that health education materials are poorly targeted
at South Asian communities, or that certain cultures discourage
involvement in recreational physical activities. It is known that both
motivation and self-image are important to physical activity
behaviour, from school age upwards. A lifestyle survey sponsored by
the Health Education Authority, and qualitative research, provide an
opportunity to examine the degree to which there are distinctive
'ethnic' barriers to exercise or other healthy physical activity
amongst communities of South Asian origin living in England. While
there are many similarities with the reasons given by members of the
white population for 'not exercising', there are some subtle
differences between communities, and a number of issues which appear
to be specific to the minority populations. Some are particular to a
religion, gender or generation. Attention to these, including
questions of modesty, gender segregation, and safety, would improve
the accessibility of recreational activities to this target group. At
the same time, it is clear that individuals from these communities are
well informed and well motivated, and do take advantage of local
facilities when they can."

Taylor & Francis Group
http://taylorandfrancis.metapress.com/app/home/contribution.asp?wasp=974c8223e1e14665952dae7a65eed244&referrer=parent&backto=issue,4,6;journal,12,12;linkingpublicationresults,1:104670,1

"Neighborhood Safety and the Prevalence of Physical Inactivity?
Selected States, 1996...

Physical inactivity is an important risk factor for premature
morbidity and mortality, especially among high-risk populations.
Although health-promotion programs have targeted high-risk groups
(i.e., older adults, women, and racial/ethnic minorities), barriers
exist that may affect their physical activity level. Identifying and
reducing specific barriers (e.g., lack of knowledge of the health
benefits of physical activity, limited access to facilities, low
self-efficacy, and environmental issues2-6) are important for efforts
designed to increase physical activity. Concerns about neighborhood
safety may be a barrier to physical activity. To characterize the
association between neighborhood safety and physical inactivity, CDC
analyzed data from the 1996 Behavioral Risk Factor Surveillance System
(BRFSS) in Maryland, Montana, Ohio, Pennsylvania, and Virginia. This
report summarizes the results of this analysis, which indicate that
persons who perceived their neighborhood to be unsafe were more likely
to be physically inactive...

The prevalence of physical inactivity among respondents was
approximately 30% (n=3967), which is similar to the levels reported
for adults in the United States.1 The prevalence of physical
inactivity was highest among adults aged 65 years, women,
racial/ethnic minorities, persons with a high school education or
less, and persons with annual household incomes of <$20,000. Overall,
higher levels of perceived neighborhood safety were associated with
lower levels of physical inactivity; the differences were greatest
among persons aged 65 years (from 38.6% [extremely safe] to 63.1% [not
at all safe]) and racial/ethnic minorities (from 29.9% [extremely
safe] to 44.6% [not at all safe]). For respondents with more than a
high school education, little difference in physical inactivity was
noted among persons who perceived their neighborhood as unsafe and
persons who perceived their neighborhood as safe (24.5% and 23.0%,
respectively)."

Journal of the American Medical Association
http://jama.ama-assn.org/cgi/content/full/281/15/1373

From a study on African-American women in the southeastern United States:

"The most commonly cited reasons for not exercising more (n892) were
personal barriers, enablers, and motivators, lack of time (36.2%,
34.5%); lack of willpower (15.0%, 10.9%); and being too tired or
lacking energy (12.2%, 9.2%). The most commonly cited factors that
would get participants to exercise more (n848) were more time (24.6%,
23.3%), greater willpower or self-motivation (19.6%, 15.4%), and
support from a friend (8.9%, 6.5%).

Women who indicated that they knew people who exercised (n784) stated
that health (81.6%, 81.7%), weight (52.3%, 57.0%), and efforts to look
better (13.1%, 15.8%) and to feel better (8.7%, 14.3%) were their
major reasons for exercising. Although the highest percentage of
participants said there were no barriers to exercise in the community
(42.9%, 47.1%), the most commonly cited barriers were lack of
recreation facilities (18.6%, 15.8%), not enough sidewalks (9.9%,
8.7%), unattended dogs (8.4%, 8.1%), and no street lighting (7.7%,
9.0%). In terms of what the community could do to best help women
exercise more (n747), the most commonly cited enablers were building
a fitness center nearby (33.5%, 34.6%), providing better street
lighting (10.1%, 10.3%), nearby organized exercise groups (11.0%,
6.8%), and more sidewalks (8.7%, 7.2%). For women employed at a work
site (n505), the most commonly cited enablers were providing exercise
facilities on site (25.4%, 28.0%), having organized group exercise
activities (11.8%, 17.0%), setting aside time for exercise, and having
longer breaks from work (11.5%, 14.3%)."

Healthy Memphis
http://www.healthymemphis.org/documents/physical-activity-aa-scarolina.pdf

Here is a lengthy paper on theoretical approaches to the promotion of
physical activity. Be sure to look at the footnotes at the end of this
document; some of the articles cited as references may be of interest
to you:

"Social-ecologic models of health promotion emphasize certain
conceptual principles that are pertinent to understanding and
influencing physical activity, and include the following:

1. Intrapersonal, interpersonal, physical environmental, and
sociocultural variables function interactively to promote or hinder
individuals? engagement in physical activity.

2. Environment?behavior relationships are transactional in nature?that
is, they are characterized by recurring cycles of reciprocal/mutual
influence between people and their surroundings, rather than by linear
(or unidirectional) effects of environmental conditions on behavior.

3. Situational influences on physical activity patterns should be
analyzed at different levels of the environment, ranging from micro to
meso to macro scales (e.g., immediate-local conditions within one?s
home or workplace; meso-scale influences at the neighborhood level;
and more distal or global features of whole communities such as the
design of transit systems, land use zoning laws, pervasive cultural
values, and widespread economic or political conditions).

4. Health promotion theorists and practitioners should strive to
identify, from among myriad contextual variables, those
?high-leverage? factors that exert the greatest influence on
individuals? physical activity patterns at each environmental scale.

5. Interventions to promote physical activity should be ?composite? or
synergistic?that is, they should address multiple high-leverage
environmental conditions situated at micro, meso, macro levels of the
environment and engage several sectors of society."

Active Living by Design
http://www.activelivingbydesign.org/fileadmin/template/documents/killingsworthpubs/King_AJPM_2002.pdf

Here is a document aimed at health professionals by the Australian
Heart Foundation. It discusses community efforts and strategies to
increase physical activity:

National Heart Foundation of Australia 
http://www.heartfoundation.com.au/downloads/Promoting%20phys%20activity%20Ten%20recs%202001.pdf

This article from the newsletter of the National Kidney Foundation
suggests some useful counter-responses that people can use in an
attempt to persuade themselves to exercise more:

"Below is a list of some of the more common reasons for not exercising
and some helpful counter responses:

Excuse: I have too many things to do.
Counter response: Yes, I am busy, but nobody is going to exercise for
me. Exercise is a commitment I have made to myself for the benefit of
my health.

Excuse: I am too tired.
Counter response: Sure, it would be easier to sit on the couch than to
go out for a walk, but exercise can help me feel better and improve my
energy level.

Excuse: I am bored with my exercise routine. 
Counter response: I don?t have to do the same thing every day; I am
going to take a different route on my walk today. There are many
different things I can do for exercise. I will try something new to
make my program refreshing."

National Kidney Foundation
http://www.kidney.org/patients/pdf/ff_fa99wi00b.pdf

Here's a summary of a study on why women don't exercise:

"In an ethnically diverse survey of 3,000 women, all of whom were age
40 and above, only 9 percent exercised regularly.

Those surveyed provided reasons ranging from logistics like childcare
to more surprising effects like living in a flat neighborhood...

Eighty-nine percent of those surveyed indicated they choose not to
exercise because they don?t see people around them who are active in
fitness or sports.

Some women surveyed said they neglect exercise because they?re too
busy helping others, or don?t have enough energy to work out.

Almost a third of those surveyed blamed the terrain of their neighborhood."

Health Surfing
http://healthsurfing.com/health/2001/03/23/

Here you'll find two "Top Ten" lists from The American Institute of
Reboundology. The first list is reasons people exercise; the second
list is reasons people do not exercise:

The American Institute of Reboundology
http://www.rebound-aerobics.com/aerobics.htm

My Google search strategy:

Google Web Search: "why * don't exercise" OR "reasons for not exercising"
://www.google.com/search?hl=en&q=%22why+*+don%27t+exercise%22+OR+%22reasons+for+not+exercising%22

Google Web Search: "promotion of physical activity"
://www.google.com/search?hl=en&q=%22promotion+of+physical+activity%22

Google Scholar: "reasons for not exercising"
http://scholar.google.com/scholar?as_q=+&num=100&btnG=Search+Scholar&as_epq=reasons+for+not+exercising&as_oq=&as_eq=&as_occt=any&as_sauthors=&as_publication=&as_ylo=&as_yhi=&hl=en&lr=&newwindow=1&safe=off&c2coff=1

Google Scholar: "promotion of physical activity"
http://scholar.google.com/scholar?q=%22promotion+of+physical+activity%22&num=100&hl=en&lr=&newwindow=1&safe=off&c2coff=1

I hope this is helpful. If anything is unclear or incomplete, please
request clarification; I'll be glad to offer further assistance before
you rate my answer.

Best regards,
pinkfreud

Request for Answer Clarification by victus-ga on 21 Apr 2005 16:32 PDT
I haven't looked at this in detail but it sure looks like the info I
need! For the abstract pulled from Medline:

"Reasons for not exercising and exercise intentions: a study of
middle-aged sedentary adults...

How can I get a full text version of this study? I didn't see an
option to download it but I've not used Medline or PubMed before.

Clarification of Answer by pinkfreud-ga on 21 Apr 2005 16:40 PDT
Thank you very much for the five-star rating and the generous tip!

Regarding the matter of obtaining the full text of the article that
you want, it can be purchased through Ingenta for $22.73. Ingenta
offers a free trial of its services; I do not know whether you could
access this article as part of the free trial, but it might be worth a
try.

http://www.ingentaconnect.com/content/tandf/rjsp/1997/00000015/00000002/art00004

~pinkfreud

Request for Answer Clarification by victus-ga on 21 Apr 2005 16:47 PDT
I think I referenced the wrong study. The Ingenta one is no problem,
and at a reasonable price. This is the other one that I'd like to see
if I can get the full text cheaply:

PubMed Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9258845&dopt=Abstract

Thanks again!

Clarification of Answer by pinkfreud-ga on 21 Apr 2005 21:57 PDT
From the PubMed abstract:

"J Sports Sci. 1997 Apr;15(2):151-65.

Reasons for not exercising and exercise intentions: a study of
middle-aged sedentary adults.

Vanden Auweele Y, Rzewnicki R, van Mele V."

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9258845&dopt=Abstract

From the Ingenta page linked in my earlier clarification:

"Reasons for not exercising and exercise intentions: A study of
middle-aged sedentary adults
Authors: Auweele Y.V.; Rzewnicki R.; Mele V.V. 

Source: Journal of Sports Sciences, 1 March 1997, vol. 15, no. 2, pp. 151-165(15) 

Publisher: Taylor and Francis Ltd"

http://www.ingentaconnect.com/content/tandf/rjsp/1997/00000015/00000002/art00004

I am certain that this is the same article.

If you (or an institution with which you are affiliated) have a
subscription to Taylor & Francis Online Journals, the article may be
obtained there:

http://www.taylorandfrancis.metapress.com/ index/GRUXL0TD5L76LKFK.pdf 

~pinkfreud

Request for Answer Clarification by victus-ga on 22 Apr 2005 12:37 PDT
Ooops! My bad, you are, of course correct! Thanks again!

Clarification of Answer by pinkfreud-ga on 22 Apr 2005 13:04 PDT
Good luck with your project! I am glad to have been able to help.

~pinkfreud
victus-ga rated this answer:5 out of 5 stars and gave an additional tip of: $10.00

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