Exercise Psychology Flashcards
Define physical activity
Body movement generated by the contraction of skeletal muscles that raise’s energy expenditure above resting metabolic rate
Define Exercise
Subcategory of physical activity that is planned, structured, repetitive + favours physical fitness maintenance or development
Define sport
Part of the physical activity spectrum corresponding to institutionalised and organised practice, reigned over specific rules
Define sedentary behaviour
Waking behaviour characterised by energy expenditure <1.5METs while in a sitting, lying or reclining posture
What are psychological determinants of exercise
Something that’s makes or prevents a person exercising
List 7 potential psychological determinants of exercise
Beliefs, confidence, knowledge, environment, motivation, barriers, perceived health,
List 7 potential psychological outcomes of exercise
Confidence, self-esteem, stress, body image, sleep, anxiety, concentration
Define capability
Attributes of a person that together with opportunity make a behaviour possible
Define opportunity (COM-B)
Attributes of the environment that together with capabilities make a behaviour possible
Define motivation (COM-B)
Aggregate of mental processes that energise and direct behaviour
Why is COM-B useful
Allows you to identify what needs to change in order to make a behaviour change intervention effective
Main goal of behaviour change in exercise psychology
Get inactive people to adopt + maintain regular exercise habits
(Complex to get people to exercise - many reasons why they may not want to/ don’t think they are capable)
What is recommended in national guidelines for behaviour change programmes
Programmes should have theoretical foundation (be based on a theory) to explain how changes in behaviour occur
More likely to be successful
Types of traditional behaviour change approaches
Informational
Behavioural
Social
Environmental + policy
Describe informational approaches
About improving knowledge and understanding to change people’s attitudes eg this girl can
Can access large population groups
Describe behavioural approaches
Uses behaviour management skills for adopting and maintaining certain behaviours
Eg motivational interviewing
Can be tailored to the individual
Describe social approaches to behaviour change
Using social influences and facilities in the community to help facilitate exercise eg introduction of walking football programmes
Environmental + policy approaches to behaviour change
Using the physical environment to support exercise eg having pedestrianised areas forcing people to walk more. Or using national policies eg having minimum levels of PE in school curriculum
What guidelines are there for behaviour change interventions
NICE
Medical research council (MRC)
Describe MRC behaviour change guidelines
Aimed at groups trying to develop a program with complex interventions.
Gives a step by step guide of what to do in order to increase chance of success
Why should you try to use existing resources + groups for behaviour change interventions
It means the program is more likely to become well established and therefore able to survive once initial funding ends. But need to understand target community to be able to successfully embed program
What is the importance of theory
It explains why something works - allowing you to include that in your practice
Systematic reviews show interventions underpinned by theory are more effective
What do interventions target
Something that leads to a behaviour change eg motivation, self-esteem
Should be identified as one of the barriers preventing someone from making a behaviour change
Challenges of using a theory
Frameworks don’t explain how to select a theory
Choosing 1 theoretical perspective makes intervention design easier but may limit effectiveness as it ignores key constructs from other theories
Using multiple theories makes it important to articulate links between theory and behaviour change techniques
Step 1 of creating a behaviour change intervention
Understand target population + recognise what behaviour needs to change
Talk to target group using questions formed around COM-B
Step 2 of creating a behaviour change intervention
Understand what needs to change in order for the behaviour to occur - knowledge, physical access, confidence etc
Step 3 of creating a behaviour change intervention
Characterise the things that need to change in terms of COM-B
Step 4 of creating a behaviour change intervention
Develop intervention based on behaviour change wheel
What are intervention functions
Activities and methods designed to change behaviours
List the 9 intervention functions
Education, persuasion, incentivisation, coercion, training, enablement, modelling, environmental restructuring, restrictions
Advantages of COM-B
Doesn’t prioritise individual over group or environment
Can be used to structure barriers/enablers in a given context
Incorporates context into developing interventions
Systematic analysis of how to choose what to do
What are behaviour change techniques
Active ingredients designed to change target behaviour
What is the CALO-RE taxonomy
List of 40 behaviour change techniques with standardised definitions/labels
Maps BCT to behavioural theory
BCT taxonomy advantages
Standardised BCTs make it easier to identify which ones are effective
Provides common language allowing for replication + synthesisation
Improves mapping of BCTs to constructs identified in behaviour theory
Improves implementation effectiveness
What is mechanism of action (wrt behaviour change)
A range of constructs that represent the process through which a BCT affects behaviour
Define righting reflex
Traditional approach to behaviour change with practitioner acting as expert
Focus is on info and advice giving
Limitations of righting reflex
No collab between patient and doctor so concordance less likely, may hinder behaviour change process
Define motivational interviewing
Collaborative, goal oriented style of communication with particular attention on language of change
How does motivational interviewing work
Enhances motivation for change by helping the patient clarify and resolve ambivalence about change
Goal of motivational interviewing
To create and amplify discrepancy between present behaviour and broader goals
Why use motivational interviewing
Pt centred and empowering
Honours autonomy
More effective than confrontation, info and advice giving
Evidence based best practice
What are the stages in the trans theoretical model (stages of change)
Precontemplation
Contemplation
Preparation
Action
Maintenance
Relapse
Define precontemplation
No intention of changing behaviour
Define contemplation
Aware problem exists, no commitment to action
Define preparation
Intent on taking action to address problem
Define action
Active modification of behaviour
Define maintenance
Sustained change, new behaviour replaces old
Define relapse
Fall back into old patterns
What is the upward spiral in the transtheoretical model
Learn from each relapse so change is easier
Define ambivalence
Simultaneous existence of contradictory feelings and attitudes (want to change but don’t want to change)
Define change talk
Represents movement towards changing behaviour and away from sustaining it
4 stages of motivational interviewing (MI)
Engaging
Focussing
Evoking
Planning
Describe engaging (MI)
Developing a rapport, empathy and taking time to listen to the individual’s perspective
Describe focussing (MI)
Shared idea of main focus of session (agenda setting)
Describe evoking (MI)
Bringing out individuals own agendas for change and their values + goals for future
Describe planning (MI)
Assisting with developing a change plan
Key skills for MI
Open ended questions - give pt space to talk
Affirmations - acknowledges their achievements/ effort
Reflective listening - shows your listening
Summaries - recap key content + reinforce points
Other techniques to use in MI
Scaling questions - assess importance or confidence + then dig deeper eg why a 5 not a 3
Pauses after key questions- allows it to sink in and give patient space to think + talk
What to do when giving advice
Ask permission
Give info neutrally
Elicit patient’s personal knowledge and meaning
Evidence for MI
Moderate quality evidence showing benefits for increasing activity in those with chronic conditions
But conclusions limited due to small sample sizes
Effects of MI likely greater if clinician adheres to core components
Evidence for MI
Moderate quality evidence showing benefits for increasing activity in those with chronic conditions
But conclusions limited due to small sample sizes
Effects of MI likely greater if clinician adheres to core components
Describe stage 1 of the behaviour change wheel
Behavioural analysis using COM-B
1.1 Define the problem in behaviour terms
1.2 Select target behaviour
1.3 Specify target behaviour
1.4 Identify what needs to change
Describe stage 2 of the behaviour change wheel
Systematically select appropriate behaviour change function
2.1 Identify intervention function
2.2 Identify policy categories
Describe stage 3 of the behaviour change wheel
Specify active ingredients using BCT taxonomy
3.1 Identify behaviour change techniques
3.2 Identify mode of delivery
Define physical capability
Physical skill, strength or stamina
Define psychological capability
Knowledge or psychological skill, strength or stamina to engage in necessary mental processes
Define reflective motivation
Reflective processes involving plans and evaluating (beliefs about what is good and bad)
Define automatic motivation
Automatic processes involving emotional reactions, desires, impulses, inhibitions, drive states and reflex responses
Define physical opportunity
Opportunity afforded by the environment involving time, location, resource + physical affordance
Define social opportunity
Opportunity afforded by interpersonal influences, social cues, cultural norms that influence the way we think about things
How to identify what needs to change
Look at barriers and enablers, come up with ways to remove as many barriers and insert as many enablers as possible
Code barriers and enablers using mechanisms of action
Where to find info for behaviour analysis
Systematic review of literature
Questionnaires, focus group, individual interviews
Key barriers of post natal physical activity
Lack motivation, fatigue, time constraints, poor public transport, access to activity, childcare
Describe education
Inc knowledge or understanding
Describe persuasion
Use communication to induce positive or negative feelings or to stimulate action
Describe incentivisation
Create expectation of reward
Describe coercion
Create expectation of punishment or cost
Describe training
Imparting skills
Describe restriction
Using rules to dec opportunity to engage in target behaviour
Describe modelling
Providing an example for people to aspire to or imitate
Describe enablement
Inc means or dec barriers to inc capability or opportunity
How to select an intervention function
Use michies table mapping intervention functions to COM-B
Consider if a recommended function will work in the context of your intervention
What is the APEASE criteria
Used to see if a intervention is functionally or practically viable
Describe acceptability
How acceptable is the intervention to all key stakeholders, are people likely to engage
Describe practicality
Can intervention be implemented as designed within the intended context and resources
Describe effectiveness
How effective and cost effective is it at achieving goals in target population
Describe affordability
How far can it be afforded if delivered at scale intended
Describe side effects
What unintended adverse or beneficial outcomes does it have
Describe equity
How does it Inc or dec differences between advantaged and disadvantaged sectors
Define mechanism of action
Range of theoretical constructs that represent processes through which a BCT affects behaviour
NICE individual behaviour change approaches
Goals + planning - set goals, prompt reviews, develop action + coping plans
Monitoring + feedback - self monitoring + feedback of behaviour + outcomes
Social support - appropriate practical + emotional support/praise/reward
What is self monitoring
Keeping a record of specicified behaviour +/or outcome
Methods of self monitoring
Manual - handwritten logs, spreadsheets
Wearable tech - pedometer, sports watches, fitness tracking apps
What is self regulation theory
Self monitoring enables self awareness , self reflection and self reaction learning to psychological and behavioural responses
(Responses are variable may be negative and put people off or positive + motivate them
Impact of self monitoring on physical activity
Meta analysis showed modest increase in physical activity when self monitored using wearable trackers
What are online fitness trackers based on
Gamification- have both quantification and social networking features
Quantification features
Goal setting, data monitoring, progress tracking, visualisations
Social networking features
Profiles, sharing, feedback, competition + challenges, leaderboards
What types of motivation are there for exercise + what quantification/social networking do they link to
Physical eg health + weight - quantification
Achievement eg goals and competition- both
Social - affiliation + recognition- social networking
Psychological- mood + life meaning - neither
Benefits of apps for physical activity tracking
Inc self awareness of PA behaviour
Facilitate reflection on what/how to change
Strengthen motivation through prompts, goal setting, social features
Limitations of Apps for PA tracking
Unmet goals may lead to discouragement, guilt, shame and stress
Unhealthy pre-occupation with checking data - addictive
Impact of self monitoring on enjoyment
Self monitoring increased exercise but simultaneously reduced enjoyment by making it feel like work. (Could lead to decrease in exercise LT)
Describe the dependency effect of trackers
18% of people would change behaviour based on if they were wearing tracker or not
Stronger in pts with extrinsic motivation factors
When should self monitoring be avoided
In individuals at risk of eating disorders/ excessive exercise
Describe the 2 broad types of group exercise
Connected cluster subject to group dynamics
Disconnected cluster with shared context but limited interaction
Define group cohesion
Dynamic process reflected in the tendency for a group to stick together + in its pursuit of instrumental objectives and for satisfaction of members needs
4 components of group cohesion
Attraction to group
Integration into group
Task orientation
Social orientation
Group cohesion factors - group environment
Distinctiveness- more distinctive - feel more special - Inc cohesion as more of an identity
Size - v large harder to integrate - less cohesive
Group cohesion factors - group structure
Positions - beginners area etc - have set spot - feel like they belong
Status- eg mentors - people having set roles (formal or informal) increases cohesion
Norms
Role
Group cohesion factors - group processes
Goals - shared goals bring people together
Cooperation - eg buddy system
Competition- small group games
Interaction - socials, BBQs etc
Collective efficacy- having confidence in others, everyone needs to contribute to achieve goal
Why do sports teams tend to be more cohesive than exercise classes
Both task oriented and socially oriented
Describe social identity
Defining oneself in the context of a group, identification as a group member encourages beliefs and behaviour related to group norms
Describe self identity
Defining oneself in terms of personal attributes
Voluntary behaviour is compatible with elements of self identity
Describe role identity
Defining oneself in the context of a role behaviour
Associated with role consistent behaviour
Impact of group disbandment on different identities
Eg park run disbands
Role identity as a runner - more adaptive response, more independent runs, higher exercise self-efficacy
Social identity as park run member - maladaptive response to disbandment, less likely to continue running, lower exercise self efficacy
Which identity is best for LT exercise
Role identity
Physical similarity + exercise
People more inclined to exercise with others who are physically similar to them
Shared beliefs/values and values are a non predictor for cohesion scores
Where can exercise interventions take place
Primary care
Secondary care
Community
What is an exercise referal scheme
Primary care professional refers patient to organised, community based exercise programme
A formal relationship exists between the primary care provider and exercise scheme
Typically last 12 weeks + are designed to increase exercise levels - improving pts health
Steps to start at exercise referral scheme
Primary care assessment
Referral to exercise service
Personal PA assessment
Opportunity to participate at scheme
What is a social prescriber
Link worker that local agencies/ GPS refer people to
Give people time + have a holistic approach to health + well-being
Connect people to community groups and statutory services
NICE guidance for exercise referal schemes
Endorse PA as a disease prevention approach
Schemes must incorporate key behaviour change techniques
Exercise referral should not be funded for sedentary/inactive but otherwise healthy individuals
Effectiveness of exercise referral schemes
20+ week schemes had better outcomes and interference
BP decreased in patients in cardiac related schemes
Inc PA across all disorders
ERS facilitators
Other attendees
Family support
Making exercise a habit
Session variety
Personalised sessions
ERS barriers
Inconvenient session times
Cost + location
Intimidating gym atmosphere
Lack confidence operating gym equipment
Distracted by music + TV
Psychological factors associated with ERS adherence
Intrinsic motivation
Psychological need satisfaction
Social support
Self efficacy
Lower expectations for change
Uptake + attendance of ERS
Uptake roughly 35% - huge drop out - need to tackle this - improve GP training on explaining to pts?
Attendance 12-49%
Males more likely to attend but less likely to initially uptake
Describe WeSport active partnership
ERS providing holistic social prescribing aimed at those with LT Mental/ physical health conditions +/or welfare issues
Had perceived improvements to mental + physical health
Described collaborative partnership as crucial for LT input + facilitating recruitment
Didn’t record unsuccessful aspects - bad
Factors that restrict ERS + social prescribing effectiveness
Insufficient knowledge of hcp to promote PA + behaviour change advice
Inconsistent reporting + lack of robust standardised measures limit evidence - hcps don’t know hay works
Movement pathways between primary care + community projects are tenuous + underused
Describe community exercise programmes
Active partnership with local clubs, faith groups and charities
Funded + use local facilities
Important for sport development
Community exercise program facilitators
Ease of access to high quality safe facilities
Activities based on individuals choice
Peer mentors fostering positive + enjoyable experiences
Dec pressure
Opportunity to socialise
Describe walking netball community exercise program
Collaboration between England netball and WI
Attracted inactive + at risk of I’ll health members
87% groups maintained sessions beyond initial 20 week period
Factors that Maintained walking netball initiative
Promotion within community
Sustainable funding
Inter WI competitions
Festivals + networks
Why is evaluation of ERS + community exercise programmes important
Provide evidence + make best practice available
Where programs were unsuccessful allows to see what went wrong + to prevent it happening in future schemes
