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EXMD4743 > WK4 - Ex Adherence > Flashcards

WK4 - Ex Adherence Flashcards

1
Q

Define Behavioural Adherence

A
  • extent to which a person acts in accordance with an agreed on, expected, desired or pre-determined standard (often professional advice)
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2
Q

Define Exercise non-Adherence.

A
  • Ex behaviour is inconsistent with Ex advice recommendations or prescriptions
  • also includes over performance
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3
Q

Define Compliance

A
  • indicating a paternalistic and passive process, with non-compliant person seen as deviant or incapable
  • adherence implies a shared responsibility for behaviour
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4
Q

Why are people non-adherent?

A

Complex interplay of multi-level factors
* social
* personal
* environmental

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5
Q

Why is Ex adherence important?

A
  • benefits of Ex are realised after a period of time
  • limited experience in phys and psych benefits - compromise QoL, increase disease burden/healthcare cost
  • financial loss for service providers if session unattended
  • Ex adh. = dynamic process = shared responsibility, require proactive planning
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6
Q

What are some subjective methods of collecting data?

A
  • Ct self-report, behaviour logs, visual/analogue scales, interviews, questionnaires
  • Ct can provide info on Ex variables (FITT, RPE)
  • affective state, associated cognitions (feelings/thoughts)
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7
Q

What are some objective methods of collecting data for adherence?

A
  • not reliant on self-report, attendance records, observer recordings, behaviour/physiological monitoring
  • observers record Ex behaviour
  • behavioural monitors e.g. pedometers for step count
  • physiological monitors - record HR
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8
Q

List methods that quantitatively assess Ex non-adherence.

A
  • RPE (Ct, practitioner)
  • telephone interview
  • participant diary
  • recall questionnaire
  • observer recording (attendance/performance)
  • pedometer for steps/day
  • HR monitoring
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9
Q

What are some areas that can be used to discuss advantages/disadvantages of quantitative Ax?

A
  • Ct/practitioner burden
  • cost
  • intrusiveness
  • precision/accuracy
  • vulnerability to bias (recall, social desirability)
  • type of data provided
  • Ex appropriateness
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10
Q

What can adherence criteria be based on?

A
  • different requirements - maximal “dose” required to achieve benefits, formal recommendations of Ex dose, no. training sessions.
  • represent a logistic min. e.g. no. people attending Ex program to make a financially viable proposition over time // no. of sessions to be completed to receive award/price
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11
Q

What do measures of adherence vs non-adh. involve?

A

Simple dichotomy
>80% = adherence
<50% = non-adh.
51-79% = partial adh.

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12
Q

Define partial adherence.

A

Describes behaviour that reflect but not completely consistent with prescription

  • benefits still obtained but not maximised
  • examines dose-response relationships
  • reflection of Ex prescription strategies to promote adherence

E.g. if someone adheres to 1 component but no another - considering how components differ may indicate how Ex prescription could be modified to optimise engagement

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13
Q

What modifiable/non-modifiable factors

A
  • socio-demographics (age, gender, socioeconomic status, occupation, employment status)
  • health and wellbeing - meds, conditions…
  • Ex attributes - FITT, complexity, competence, interest.
  • intrapersonal factors - confiedence, enjoyment, attitude etc
  • social/relational factors - support, stigma, social cohesion.
  • environmental - access, costs, safety, climate, aesthetics, convenience, policy
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14
Q

How to create understanding of client to inform development of strategies to promote Ex adherence?

A
  • Ct conversations
  • questionnaires
  • telephone interviews
  • observation
  • info from sig. others
  • Ext source
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15
Q

What is the MAKE-UPP Framework?

A

To understand factors contributing to Ex non-adherence.
M = motivation/meaning
A = attitude
K = knowledge
E = Exexperience and attributes
U= understand competing demands
P = people
P = place

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16
Q

How does motivation/meaning affect Ex non-adherence?

A
  • Motivation is a theoretical construct to explain behaviour, reflecting desire, need, want or drive that stimulates individuals actions
  • salience of Ex motives differs by age, gender, health, personality, PA level, stage of Ex (initiation, maintenance) and personal circumstace

Salient = most noticeable/important

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17
Q

What does motivation mean to a person, how dow it affect them?

A
  • low motivation = behaviour has low personal value or personal meaning that conflicts with other needs/values
  • Ex may have personal meaning of hard work (conflicts with value of relaxation) being seen as non-competitve (conflict with achievement value) or less time with friends (conflict with social values)
  • people can action same value in different ways
18
Q

What does attitude mean in the MAKE-UPP framework?

A

Refers to thoughts, feelings, actions regarding an entity, with some degree of favour or disfavour
Salient = most noticeable/important

Insrtumental vs experiential attitudes
Instru – evaluate behaviour outcomes (consequences), involves +ve and -ve outcomes
Exper – attitudes are affective response about behaviour

19
Q

How are potential benefits of Ex weighed/perceived as?

A

Pros vs Cons
* Ex non-adherence is likely when costs outweight potential benefits

Costs –> what must be given up or an unfavourable impact e.g. financial costs!

Financial costs are highly salient with:
* socioeconomically disadvantaged
* culturally diverse/disabled
* older people
* chronic conditions

Non-financial:
* time
* energy
* pain

20
Q
A
21
Q
A
22
Q

What are the +ve and -ve responses to Ex?

A

+ve
* pleasure
* energy
* pride

-ve
* dislike
* frustration
* fear
* anger
* distress
* anxiety
* embarrassment

22
Q

What are affective attitudes influenced by?

A

Perceived competence (e..g poor fitness = predictors of dropout)
* people often expect Ex to be less pleasant than actual experience –> anticipated -ve affect is strong predictor of low PA intentions within inactive people
* low active people experience less +ve affect during Ex than active.

23
Q

What is Knowledge in the MAKE-UPP framework?

A

People know Ex is good, there can be misunderstandings about condition-specific benefits and inherent risks

EXAMPLES
1. Ex benefits ofr cancer and neuro less understood than cardio
2. benefits for serious mental illness less understood by pts and MH professionals
3. people iwth intermittment claudication unaware of Ex role in improving Sx and reducing mortality - pain during walking is harmful
4. older adults may thing RT increases heart attack/stroke risk

24
Q

What is the concept of Ex experience and attributes in MAKE-UPP framework?

A

Personal Ex experienes are major source of affective/instrumental attitudes

Ex experiences can be vicarious - learned from friends, family or online info

KEY PRINCIPLE of behaviour therapy in -ve consequences
* etiher presence of aversive event (+ve punishment) or absence of pleasure (-ve punished) - decreased behaviour repeatability

–> Ct with aversive Ex experience, who lack +ve experiences are at risk of non-adh.

25
Q

Past behaviour is predictor of future behaviour. T or F?

A

TRUE!
* PA participation in adolescence, early/mid adulthood is +ve associated with participation in later stages of life
* association stronger for many PA types and people with athletic self-concept
* Ct w limited Ex experience/poor PA self-concept are at non-adh. risk

26
Q

How does Understanding competing demands in the MAKE-UPP framework affect Ex Adh?

A

The nature and source of these barriers differs among people. E.g. work demands, irregular hours, family, study/travel requirements.

  • poor health = stress, fatigue, pain, low energy, -ve mood
  • competing demands may also occur from appealing activities - socialising, screentime, sedentary issue
  • can be episodic - holidays
  • low confidence
27
Q

How do Ex supervisoers compromise participants enjoyment, attendance, motivation, intentions?

A
  • general instruction/ feedback
  • low interaction/ encouragement
  • Ct feeling unsupported
  • lack of choice
  • lack of personal meaningfulEx rationale
  • non-individualised feedback
  • discouragement of q’s
28
Q

Ex non-adh can be categorised as intentional or non-intentional. T or F?

A

TRUE!

29
Q

What is intentional Ex non-adh?

A

Done deliberately with awareness of discrepancy between actual/desired behaviour
- may not be spiteful/malicious - may just be an informed choice due to…
* limited resoruces
* perceived risk
* aversive Ex experiences

30
Q

What is unintentional Ex non-adh?

A

Person is unaware of discrepancy between action/prescribed behaviour
* reflect issues of knoweldge, inaccuate/misunderstanding of Ex
* may be due to inaccurate or reduced capacity for Ex monitoring, poor insgiht or conflicting info.

31
Q

What is the ‘Fundamental Attribution Error’?

A
  • tendency to explain behaivour based on intrapersonal factors - personality/disposition.
    –> underestimates influence of EXT factors - social/enviro

In Ex context - ‘tendency’ would indicate intentional non-adh due to laziness or lack of motivation

May be true for some Ct, but its a narrow/unhelpful

32
Q

What are the 4 stages in determining Ex non-adh. rates?

A
  1. Defining behaviour
  2. Collecting info
  3. Calculating rates
  4. Defining criteria for non-adh.
33
Q

What is the framework for planning Ex Adh.?

A

A-SUCCESS

Action planning
Social support
Understand Ex readiness/relevance
Context
Competing demands
Efficacy
Self-regulation
Satisfaction

34
Q

What is the purpose of action planning?

A
  • help for habits, useful for ppl w est. +ve intentions/weak habits
  • demonstrates efficacy for increase PA among uni stu, gen. pop and mid/older adults w illness.

Action planning = goal setting (SMART)
–> use Goal Attainment Scale to determine achievability
–> encourages pt input
–> consider WHEN, WHERE and HOW

35
Q

What is the process of use GAS?

A
  1. identify goals
  2. Weight the goals - lvl of importance
  3. Define expected outcome
  4. Provide baseline score
  5. At end of program, provide outcome score
36
Q

What does “Social Support and COnnections” in the GAS Framekwork mean?

A
  • affect Ex adoption, adh., maintenance
  • more important than intrapersonal factors
  • relevant for those w obesity, mental illness/clinical conditions
  • source of social support: family, friends, peers, employers, staff, community
  • preferred source of support is diff by age, gender, personal style, life circumstances.
36
Q

How do practitioners contribute to social support for Ex?

A

Direct source of info, education, encouragement and feedback
*overcome anxiety, assist confidence/motivation

37
Q

What are the different types of social support?

A

Emotional
* targets affect and provides encoruagement (empathy, caring etc)

Instrumental
* material assistance (transport, resources)

Informational
* knowledge (advice, suggestions)
–> Appraisal - self-evaluation purposes (constructive feedback and affirmation)

Network
* links w other ppl (companionship, group cohesion/identity)

38
Q

What are some general approaches to increasing efficacy (not specific to Ex)?

A
  • mastery experience - successful performance
  • vicarious experiences/social modelling - learning from others and seeing similar behaviour
  • improving physical and emotion states (reduce tension/stress etc)

EXMD4743 (9 decks)

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