Projects for Exercise Adherence You are responsible for completing 1 group project in this course. The project is worth 20% of your overall grade in this course. Group’s Composition The class will be divided into small groups of 4-‐5 students. The composition of each group must consist of: At least one member, who does not exercise. At least one member, who has just started to exercise (within 3-‐6 months). At least one member who presently exercises regularly (for over this year) Purposes of the Project The project will consist of two parts. Part one’s purpose is to develop and design a campaign that includes individual, group, and environmental interventions studied to promote exercise in a targeted population. Part two’s purpose is to use behavioral interventions based models of physical involvement to promote exercise adherence. Part I: Develop & Design a Campaign for a Targeted Population Each group will develop and design a campaign involving individual, group, and environmental behavioral interventions to promote exercise adherence in a targeted population. The targeted populations are (choose one): 1. 2. 3. 4. 5.
Adult Women Obese and/or overweight population Children and/or Adolescents Aged (65+)Population Diverse Population (Hispanic, Black Americans, Asian or American Indians)
The program will be delivered at a common site. The sites are (choose one): 1. 2. 3. 4. 5.
Home-‐based Private health club or Hospital based fitness center Worksite or University based fitness center Community center School
The campaign will integrate successful interventions that relate to the specific population at that site. The program will include individual, group, and environmental behavioral interventions (examples of behavioral interventions are listed below). Stage readiness motivational matched interventions (Stage-‐matching) Rewards Goal setting Personality matching
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Self-‐monitoring activities (e.g., logs, pedometer, contingency contracts, etc.) Interventions to enhance intrinsic motivation (see self-‐determination interventions) Interventions to enhance self-‐efficacy (see social cognitive interventions) Interventions that promote actual and perceived behavioral control Interventions to reduce the barriers to exercise (e.g., day care for single parent) Group interventions (e.g., class size, group composition, fitness leader, class cohesion) Environmental interventions (e.g., facilities, safety, access, outdoor spaces) Slippage control interventions (e.g., cue controls, planning ahead relapses) Successful behavioral interventions for the specific populations. Presentation: Each group will develop a poster of the campaign (template of poster will be in a power point slide) that will be presented to the class. A written paper about the interventions used in the campaign will accompany the poster. A template of the poster will be emailed to each member of the class by the professor. The poster presentation should include: 1) Title of your program and under the title each member name. 2) Program Implementation (how, when, & where of the program) 3) Program Components - Purpose - Characteristics of targeted population & delivery site(s) - Individual interventions - Environmental Interventions - Group interventions The title must be attention gaining and positive. A purpose of the program must be stated. The characteristics of targeted population and the delivery site need to be described. The intervention areas will be evaluated based on how well you integrated the behavioral and successful interventions specific to the targeted population that were studied in this class. The how, what, and where of the program (program implementation) will be evaluated based on how feasible the program can be carried out. The program needs to be realistic and not just a collection of activities. The power point slide can be easily manipulated to include all of the above contents of the program. Paper. The written paper will include the rational about the project and the following: 1) Identify each individual intervention and how each related to the targeted population and site. 2) Identify each environmental intervention and how each related to the targeted population and site.3) Identify each group intervention and how each related to the targeted population and site. The purpose of the paper is to clarify how the individual, environmental, and group interventions used in the campaign relate to the targeted population and site. Presenting and Submitting the Presentation Presentations of the campaigns per group will occur during the week following the first test. The presentation and paper is to be submitted to the professor via email as an attachment prior to the group’s presentation. 2
Part II: Exercise Adherence The second part of the group project involves the members of your group that have different exercise behaviors. At least one member does not exercise, another has just started, and one has been exercising regularly. We are going to use models and theories of physical activity in designing stage matching exercise interventions for each member of the group. Below are the assigned activities associated with part II of your project. 1. Assessment & Awareness. a. Determine your risk of non-‐adherence to exercise. Simply complete the risk of non-‐adherence inventory (RAI – see Appendix 1 of this document). b. Complete the Perception & Exercise Activity (see Appendix II of this document) Assessment & Awareness Paper. The paper will be entitled, “ Member’s Personal Exercise Behavior.” This section of the paper will discuss the member’s RAI results, their intensity, and mode of exercise they liked and disliked. Why? Did all the members of group report the same barriers to exercise, levels of self-‐efficacy, attitude toward exercise, and psychological factors that could affect their exercise behavior? The paper’s integrates and analyses the member’s RAI, intensity, mode, barriers, and other psychological factors that may affect the member’s level of exercise adherence. Do not write a paper where you cite one’s members results followed by another. For example, Bob’s results were discussed then Sally’s then Charles. Your group is to integrate all the member’s results into a paper.
*The RAI inventory can be found in Appendix 1 of this document. **The perception & intensity of exercise activity can be found in Appendix 2.
Submission of the Paper. See the course schedule when this paper is due. The paper needs to have proper margins, double spaced, and written in APA style. Include graphs and tables in the body of the paper and not as an appendix. Attach the members completed RAI and perception & exercise activity results. 2.
Exercise Adherence Strategies & Interventions a. You and your group will identify the individual and group stage matched interventions that match your stage of physical activity found in text, based on social cognitive theory, self-‐determination theory, and other models studied.
b.
The main purpose of this part of the project is to use the interventions that match your stage to progress or maintain your exercise behavior (e.g., Bob is in stage 4, the following cue controls _______and coping strategies _________to prevent relapse will be used. Self determination theory interventions that will motivate him to stay on 3
his exercise program are ____________. From social-‐cognitive theory, Bob’s interventions are ____________).
Exercise Adherence Strategies and Interventions Paper. The paper will be entitled “Adherence to Exercise Strategies and Interventions.” Identify the individual, group, and environmental interventions by their stage for each member. Here you could develop a table. If your group uses a table make sure you discuss what is in the table. Identify and discuss other interventions based on the model and theories studied in the course that you would use for each member. What interventions did your group determine to be most important? The paper’s integrates and synthesizes the member’s individual, group, and environmental interventions and strategies specific to their stage of exercise. Do not write a paper where you cite one’s member’s interventions and strategies followed by another. For example, Bob’s interventions were discussed then Sally’s then Charles. Submitting the paper. Entitle this paper, “Exercise Adherence Strategies and Interventions.” This part of the project is due the last day of regular class, not during final test week.
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APPENDIX 1 Risk of Non-Adherence Inventory (RAI) (Millslagle, 2007) Name:________________________________________ Date:______________ Introduction: The Risk of Non-‐adherence Inventory (RAI) is a collection of commonly used inventories that assess your exercise behavior that determines your risk of non-‐ adherence to physical activity or exercise. The first part of RAI is demographic information about you that relates to individual determinates about who or who does not exercise. For example, we know that men exercise more frequently and at a higher intensity level than women. The second part of RAI is about your level of exercise self-‐efficacy, stage of physical activity, and barriers to becoming physically active. Researcher have found that people who exercise regularly have a high level of exercise self-‐efficacy, indicate that they are in the maintenance stage, and have little or no perceived barriers. The third part of the RAI is about your level of stress and non-‐clinical depression within this last month. Research has proven that people who are experiencing high levels of stress and non-‐clinical depression have low involvement in exercise or physical activity. Experiencing high stress and non-‐clinical depression is also a reason why people discontinue their physical activity or exercise involvement. The lat part of RAI are the thoughts you may have about exercising during the past week. Here again, studied have indicated that positive and negative thoughts about exercise affect their perceived attainment of the exercise goals, the benefits from being physically involved and their actual exercise experiences. If one perceives that they are attaining fitness goals such as body weight loss, can do their workout will little effort, and enjoyed their workout it will result in positive thoughts and strengthen one’s intention to exercise. Once you have completed each category calculate your risk level of non-‐adherence. I provided a table at the end of each category that you should use to determine your level of risk. Below each table is space where you can indicate your level of risk as being low, moderate, or high. Part I: Demographic Information (Place an X mark in the space next to the category that applies to you and sum the numbers in bracket next to category you marked) Gender:
Male:____ (1) Female:____ (2)
Age:
20-‐45 (1) ______ 46-‐59(2) ______ 60-‐Over(3)_______
Year of education: 15-‐More (1) ______10-‐14(2)_____0-‐9(3)_______ Occupation: Smoker:
White Collar (1) _____Blue Collar (2)______
Nonsmoker (1)______ History of Smoking(2)_____Smoker(3) ______
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Perceived fitness level:
High(1) _____ Average(2) _____Low(3)_____
Do you have a disability that limits physical activity: No(1)_____ Yes(2)_____ Do you currently have a injury that limits physical activity: No(1)____Yes(2)____ Total Demographic Score:______ (add all score together) Demographic Score & Risk of Non-adherence Your total demographic score
8-‐9
10-‐15
16-‐20
Your risk of Non-‐adherence (circle one)
Low
Moderate
High
Part II: Self-Efficacy for Exercise Behavior Scale For each item, you are to rate how confident you are that you could really motivate yourself to do thing like these consistently, for at least six months. Each item is rated on scale the following scale: 1
I could not do it
2
3
4
5
Sure I could do it
Resisting Relapse: _____1. _____2. _____3. _____4. _____5.
Stick to your exercise program when your family is demanding more time from you. Stick to your exercise program when you have household chores to attend to. Stick to your exercise program even when you have excessive demands to work. Stick to your exercise program when social obligations are very time consuming. Read and study less in order to exercise more.
Relapse Sub Total:________ (Sum of your scores) Making Time for Exercise _____6.
Get up early, even on weekends, to exercise.
_____7.
Get up early to exercise.
_____8.
Stick to your exercise program after a long, tiring day at work.
_____9.
Exercise even though you are feeling depressed.
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_____10.
Set aside time for physical activity program for a least 30 minutes three times per week.
_____11.
Continue to exercise with others even though they seem too fast or too slow for you.
_____12.
Stick to your exercise program when undergoing a stressful life change (e.g. divorce, death in the family, moving)
Making Time Sub total:___________ (sum of scores) Combined Total Score: _______ (Add relapse & making time sub-‐totals together) Exercise Self-Efficacy & Risk of Non-adherence Your exercise self-‐efficacy combined total Score
>47
40-‐46
136 High stress …………………………………116-‐135 Average stress………………………………76-‐115 Low stress…………………………………..56-‐75 Very low stress……………………………...51-‐55 Life Stress Your Stress Category
Very Low & Low
Average
High & Very High
Risk of Non-‐adherence (circle one)
Low
Moderate High
Part III: Depression Inventory Complete the National Institute of Mental Health inventory about depression. Add up your points and compare with the following standard. This inventory is only a screening tool. In general, the higher score, the greater the mood disturbance.
< 1
1-‐2
3-‐4
During the past week
day
days
days
5-‐7 days
I was bothered by things that don’t usually bother me
0
1
2
3
I did not fee like eating: my appetite was poor
0
1
2
3
I felt that I could not shake off the blues even with the help of my family or friends
0
1
2
3
I felt that I was just as good as other people
3
2
1
0
I had trouble keeping my mind on what I was doing
0
1
2
3
I felt depressed
0
1
2
3
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I felt everything I did was an effort
0
1
2
3
I felt hopeful about the future
3
2
1
0
I thought my life had been a failure
0
1
2
3
I felt fearful
0
1
2
3
My sleep was restless
0
1
2
3
I was happy
3
2
1
0
I talked less than usual
0
1
2
3
I felt lonely
0
1
2
3
People were unfriendly
0
1
2
3
I enjoyed life
3
2
1
0
I had crying spells
0
1
2
3
I felt sad
0
1
2
3
I felt that people disliked me
0
1
2
3
I could not get “going”
0
1
2
3
Your total NIMH Score:_________ (add all scores together) NIMH Category High depression or mood disturbance…………………………..>22 Moderate depression or mood disturbance……………………10-‐21 Low depression or mood disburbance……………………………0-‐9 Depression Inventory Your depression or mood disruption category
Low
Moderate
High
Risk of non-‐adherence (circle one)
Low
Moderate
High
Part IV: Exercise Thoughts Questionnaire We are interested in thoughts you may have had about exercising during the past week. Below is a list of thoughts that people sometimes have when they consider whether or not
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to exercise. It is important that you read each thought carefully. Then, next to each thought, please indicate how frequently you had that thought during the past week. Use the following scale:
1
2
Not at all
3
Sometimes
4
Moderately often
5
Often All the time
_____01. I’m too tired to exercise. _____02. I need to sleep. _____03. I would rather get some sleep. _____04. There are more important things I have to do. _____05. I’m too busy. _____06. I haven’t got time. _____07. It’s not that important right now. _____08. I’d rather relax. _____09. I’d rather watch TV. _____10. I’d rather socialize. _____11. I’d rather do something else. _____12. I have social obligations. _____13. I don’t feel good enough to exercise. _____14. Exercising will only make me more tired. _____15. It will take a lot of energy. _____16. It will take too long. _____17. I’m just not motivated enough to exercise. _____18. I don’t feel like exercising. _____19. I’ll make it up later. _____20. I’ll do it tomorrow. _____21. I’ll do it later. _____22. I’ll work out extra hard tomorrow. _____23. I’ll cut down on eating instead. _____24. Missing one day won’t make that much of a difference. _____25. I can afford to miss one day. Total Attitude Score:________ (add all the scores together) Exercise Thoughts & Risk of Non-adherence Total Score
60
Risk Assessment (circle one)
Low
Moderate
High
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Your Profile of Risk Summary Record your level of risk (low, moderate, or high) for non-‐adherence for each category in Table 1. Then develop a line graph by plotting each category with a line. This should provide you a graphic illustration of your risk of non-‐adherence to exercise. Table 1: Your Profile of Risk High
Moderate
Low
Risk
Demographic
Self- efficacy
Barriers
Stage
Depression
Stress
Thoughts
Risk of Non-compliance In this section determine your risk of being a non-‐complier by checking the space next to your risk of being a non-‐complier. _____High Risk of being a Non-complier. A person is at risk of non-‐adherence to exercise if they have one or more categories that score high for non-‐adherence. This person needs one-‐to-‐one consultation related to the category(ies) that scored high for non-‐adherence. Research has indicated that this client will have difficulty in continuing their exercise or physical activity involvement. An intervention program should be immediately implemented to prevent non-‐adherence to exercise or physical activity. _____Moderate Risk of being a Non-complier. A person may be a risk of non-‐adherence to exercise if they have one at least high and several moderate scores for non-‐adherence. This person may need one-‐to-‐one consultation related to the category(ies) that scored high or moderate for non-‐adherence. Research has indicated that this client may have difficulty in continuing their exercise or physical activity involvement once the formal exercise or physical activity intervention program has ended. An intervention program to prevent non-‐adherence to exercise may or may not be needed for this client. _____Low Risk of being a Non-complier. A person is not a risk of non-‐adherence if they have all low scores across all the risk categories for non-‐adherence. This person would be an ideal candidate in continuing their exercise or physical activity involvement once the formal exercise or physical activity intervention program has concluded. Research has indicated that client who fit this profile are more likely to adhere to exercise or physical activity once the formal exercise or physical activity program has concluded.
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Appendix II
Perception & Exercise Intensity Activity Purpose: Research has indicated that people adhere to physical activity or exercise activities that are frequent, short in duration (> 20 minutes), and low to moderate in intensity, as compared to frequent, long in duration (< 40 minutes), and high in intensity. This in-class activity has two purposes: 1) perceptual awareness of what is a low, moderate, and high intense acute exercise or physical activity bout, and 2) physiological awareness of your heart rate at these different intensity levels. Procedure: First determine your exercise heart rate at low, moderate, and high intensity workout levels. Below is an easy guide to calculating your values. For exercise to be aerobic, it must be performed at your training heart rate. (also called Target Zone) . The American College of Sports Medicine recommends that you use this rate to determine the intensity of your workout. As shown in the formula below, the two factors determining your training heart rate: 1) age and 2) resting heart rate.
TO FIND YOUR TRAINING HEART RATE: Lowest Moderate Level 60 % of your max heart rate
Highest Level 90% of your max heart rate
Start with 220
Start with 220
minus your age _______
minus your age ________
= maximum HR _______
= maximum HR ________
minus resting HR. _______
minus resting HR. ________
= heart rate reserve _______
= heart rate reserve ________
x 60% (multiply .6) _______
x 90% (multiply .9) ________
+ your resting HR. _______
+ your resting HR. ________
= low end Training HR._______
= high end training HR.________
Your (T)raining (H)eart (R)ate is between ________ (Low) and ________ (High). A low intense acute exercise bout is a physical activity that is 3 METs or less. A moderate intense exercise bout is a physical activity that is between 4 to 7 METs. A high intense acute exercise bout is a physical activity that is 7 and above METs. A MET is the metabolic cost of consumption of oxygen at or over rest. So, if one is working at a 3 MET level in cycling, you are working at 3 times over rest. You will need to have a exercise machines such as treadmill, cycle, stepper or strider. Unfortunately, the Pre Core and Life Fitness exercise machines in UMD center do not have the 15
METs function. The STAR TAC strider, STAR TAC stationary cycle, and WOODWAY treadmills do have MET functions. Realize that in most health clubs some machine do or do not have the MET function. Most rehabilitative centers do because most medical exercise prescription is given in METs. Below is simple guide to follow if one does not have a MET function on the machine. Treadmills 3 mph = 3 Mets 5 mph = 5 Mets 7 mph = 7 METS
Stairmasters/Striders Level 2 = 2.5 METS Level 4 = 4.5-5.0 METS Level 7 = 7.0-7.7 METS
Stationary Bikes 4.7 mph = 3 METS 10 mph = 5 METS 13 mph = 7 METS
You are to exercise on two exercise machines (e.g., stationary cycle, striker, or treadmill) at 3 different intensity levels (low, moderate, and high) for three-5 minute periods. During the last minute of each 5 minute exercise bout assess your heart rate and your perceived rate of exertion using the following scale: 0 1 2 3 4 5 6 7 8 9 10
Nothing at all Very weak Weak (light) Moderate Somewhat strong Strong (heavy) – Very Strong – – Very,Very Strong
Attempt to maintain the prescribed MET levels indicated (see Table 1: Heart Rate & RPE recording form). Do not exceed these desired exercise intensity limits when you exercise. Table I below is only an example of you could record your heart rate and RPE. You can create your own to include more types or modes of exercise for your project. Table 1: Heart Rate & RPE Recording Form Type (e.g., cycle, strider, treadmill) 1 2 3
3 METS 5 METS 7 METS
Type: HR
RPE
Type: HR
RPE
Low Moderate High
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Discussion Questions related to this assignment: (Do not need to write out the answers.) 1. 2. 3.
4.
Which level of exercise intensity did you enjoy the most? Which level of exercise intensity did you perceived to be the most confidence and to have the highest perceived control of? Why? Did your perceived exertion and control of exercise change as the intensity of the exercise bouts increased? Please explain? In examining your heart rate across the different MET levels, did the 3, 5, or 7 met levels produce your desired training heart rate? Did the 7 Met level produce a heart rate that exceeded your training heart zone? Be specific and report your heart rate at this level of support as compared to your training heart rate. Was there anything that you learned about exercising at these different intensity levels that was a surprise or of interest to you?
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