WK4 - Ex Adherence Flashcards
Define Behavioural Adherence
- extent to which a person acts in accordance with an agreed on, expected, desired or pre-determined standard (often professional advice)
Define Exercise non-Adherence.
- Ex behaviour is inconsistent with Ex advice recommendations or prescriptions
- also includes over performance
Define Compliance
- indicating a paternalistic and passive process, with non-compliant person seen as deviant or incapable
- adherence implies a shared responsibility for behaviour
Why are people non-adherent?
Complex interplay of multi-level factors
* social
* personal
* environmental
Why is Ex adherence important?
- 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
What are some subjective methods of collecting data?
- 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)
What are some objective methods of collecting data for adherence?
- 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
List methods that quantitatively assess Ex non-adherence.
- RPE (Ct, practitioner)
- telephone interview
- participant diary
- recall questionnaire
- observer recording (attendance/performance)
- pedometer for steps/day
- HR monitoring
What are some areas that can be used to discuss advantages/disadvantages of quantitative Ax?
- Ct/practitioner burden
- cost
- intrusiveness
- precision/accuracy
- vulnerability to bias (recall, social desirability)
- type of data provided
- Ex appropriateness
What can adherence criteria be based on?
- 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
What do measures of adherence vs non-adh. involve?
Simple dichotomy
>80% = adherence
<50% = non-adh.
51-79% = partial adh.
Define partial adherence.
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
What modifiable/non-modifiable factors
- 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
How to create understanding of client to inform development of strategies to promote Ex adherence?
- Ct conversations
- questionnaires
- telephone interviews
- observation
- info from sig. others
- Ext source
What is the MAKE-UPP Framework?
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
How does motivation/meaning affect Ex non-adherence?
- 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
What does motivation mean to a person, how dow it affect them?
- 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
What does attitude mean in the MAKE-UPP framework?
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
How are potential benefits of Ex weighed/perceived as?
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
What are the +ve and -ve responses to Ex?
+ve
* pleasure
* energy
* pride
-ve
* dislike
* frustration
* fear
* anger
* distress
* anxiety
* embarrassment
What are affective attitudes influenced by?
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.
What is Knowledge in the MAKE-UPP framework?
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
