Psychology of Physical Activity

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2 Psychology of Physical Activity In today s urbanised and technologised society, physical activity is becoming an increasingly peripheral part of our daily lives. Psychology of Physical Activity is a comprehensive account of our psychological knowledge about physical activity, covering: motivation and the psychological factors associated with activity or inactivity the feel-good factor: the psychological outcomes of exercising, including mental illnesses and clinical populations interventions and applied practice in the psychology of physical activity current trends and future directions in research and practice. This new edition is updated to reflect new findings and current research directions, and includes full textbook features. A dedicated accompanying website (www.routledge.com/ textbooks/ ) provides lecturers and students with extensive supporting materials, including slide presentations and self-test questions. Stuart J. H. Biddle is Professor of Exercise and Sport Psychology at Loughborough University, UK. Nanette Mutrie is Professor of Exercise and Sport Psychology at Strathclyde University, UK.

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4 Psychology of Physical Activity Determinants, well-being and interventions 2nd edition Stuart J. H. Biddle and Nanette Mutrie

5 First edition published 2001 This edition published 2008 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN Simultaneously published in the USA and Canada by Routledge 270 Madison Avenue, New York, NY Routledge is an imprint of the Taylor & Francis Group, an informa business This edition published in the Taylor & Francis e-library, To purchase your own copy of this or any of Taylor & Francis or Routledge s collection of thousands of ebooks please go to 2001, 2008 Stuart J. H. Biddle and Nanette Mutrie All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data Biddle, Stuart. Psychology of physical activity: determinants, well-being, and interventions / Stuart J. H. Biddle and Nanette Mutrie. -- 2nd ed. p. cm. Includes bibliographical references and index. ISBN (hardcover) -- ISBN (softcover) 1. Exercise-- Psychological aspects. 2. Clinical health psychology. 3. Health promotion. I. Mutrie, Nanette, II. Title. RA781.B dc ISBN Master e-book ISBN ISBN-10: X (hbk) ISBN-10: (pbk) ISBN-10: (ebk) ISBN-13: (pbk) ISBN-13: (hbk) ISBN-13: (ebk)

6 Contents List of figures List of tables List of boxes Preface Acknowledgements vii x xii xiii xv PART I Introduction and rationale 1 1 Introduction and rationale: why you should take your dog for a walk even if you don t have one! 3 PART II Physical activity: why we do, why we don t 33 Part II introduction 35 2 Introduction to correlates of physical activity: things that might be related to being active 39 3 Theories based on attitudes and beliefs: active people have attitude! 54 4 Motivation through feelings of control: everything s under control! 75 5 Motivation through feelings of competence and confidence: I think I can, I think I can, I know I can Stage-based and other models of physical activity: moving from thinking to doing Social and environmental correlates of physical activity: people to see and places to go 137

7 PART III Physical activity: a feel-good effect? Psychological well-being: does physical activity make us feel good? The relationship between physical activity and anxiety and depression: can physical activity beat the blues and help with your nerves? The psychology of exercise for clinical populations: exercise can be good for you even when you are ill 243 PART IV Physical activity: what works in helping people be more active Intervention strategies aimed at groups and individuals: talking the talk and walking the walk Interventions in organisations and communities: helping people become more active where they work and live 316 PART V Summary and future directions Conclusions and future developments: bringing it all together 349 References 357 Subject index 409 Author index 419

8 Figures 1.1 A behavioural epidemiological framework (Sallis and Owen 1999) Average steps per day for women and men living in a Canadian Amish community (Tudor-Locke and Bassett 2004; reprinted with permission) Relative risk for age-adjusted all-cause death rates per 10,000 person-years by physical fitness group, indicating the importance of low physical fitness as a risk factor (adapted from Blair et al. 1989) Prevalence (per cent) of obesity for English boys and girls (Stamatakis et al. 2005) Percentage of English adults in different age groups reporting no physical activity in the Allied Dunbar National Fitness Survey Time use trends for 3 12 yr olds: (Sturm 2004) 30 P2.1 Representation of the ecological framework for understanding different environments for physical activity 35 P2.2 A framework for classifying theories of physical activity Responses (percentage of people) concerning selected motivating factors for participation from the EU (an average of fifteen countries, including the UK), and the UK (Zunft et al. 1999) Percentage of English men and women reporting selected physical activity barriers from the ADNFS Percentage of three different age groups of English women reporting selected physical activity barriers from the ADNFS Percentage of three different age groups of English men reporting selected physical activity barriers from the ADNFS The three-component view of attitudes applied to physical activity A simplified version of the Health Belief Model Theories of Reasoned Action (TRA) and Planned Behaviour (TPB) Correlations (corrected for sampling and measurement error) between TRA/TPB variables from data reported by Hagger et al. (2002) The Health Action Process Approach A simplified version of Protection Motivation Theory (a, b, c) An agent means ends analysis and different types of beliefs mediating such links (adapted from Skinner 1995, 1996) Possible links between rewards, structures and intrinsic motivation in exercise settings 82

9 viii Figures 4.3 A continuum of self-determination in terms of different types of motivation Correlations between SDT constructs calculated from a meta-analysis of studies concerning physical activity (Chatzisarantis, et al. 2003) Correlations between SDT constructs and intentions and competence calculated from a meta-analysis of studies concerning physical activity (Chatzisarantis et al. 2003) A hierarchical model of intrinsic and extrinsic motivation proposed by Vallerand (1997) Physical self-perception hierarchy proposed by Fox (1990) Task and ego goal orientation scores, expressed in Z scores, for 5 clusters, showing clusters 1 and 2 with high task orientation (Wang and Biddle 2001) Sonstroem and Morgan s (1989) exercise and self-esteem model Increases in self-efficacy after treadmill running for post-mi men (data from Ewart et al. 1983) A summary of self-efficacy and physical activity, adapted from McAuley and Blissmer (2000) Prevalence estimates for stages of change by different levels of physical activity and exercise (data from Marshall and Biddle 2001) Prevalence estimates for stages of change across four countries (data from Marshall and Biddle 2001) Cyclical stages of behaviour change Changes or differences in pros and cons across stages (data from Marshall and Biddle 2001) Non-linear changes or differences in self-efficacy across stages (data from Marshall and Biddle 2001) Sallis and Hovell s (1990) natural history model of exercise Relapse prevention model applied to exercise Dishman s lifespan interaction model Changes in time, expressed as minutes per week, between 1981 and 1997, spent on activities for three age groups (data reported in Sturm (2005)) Percentage of individuals with high psychological readiness for physical activity at the age of 30 years according to indicators of sport experience at 15 years (data from Engstrom 1991) Tracking coefficients (Spearman rank order correlations) from the Cardiovascular Risk in Young Finns Study (Telama et al. 2005) Modified version of Chelladurai s multidimensional model of leadership Effect sizes from a meta-analysis of motivational climate in physical activity showing relationships between mastery (M) and performance (P) climates and positive (+) and negative ( ) psychological outcomes (Ntoumanis and Biddle, 1999) The circumplex model of affect proposed by Russell (1980) Affective responses to two bouts of physical activity, plotted in circumplex space, where the horizontal dimension represents selfrated affective valence, ranging from displeasure to pleasure, and the vertical dimension represents perceived activation 169

10 Figures 8.3 Effect sizes from McDonald and Hodgdon s (1991) meta-analysis of aerobic fitness training and mood states Effect sizes for experimental studies investigating exercise and affective ( mood ) states in older adults (Arent, Landers and Etnier 2000) Intra-individual variability in affective responses to different exercise stimuli. Data from five studies reported in Ekkekakis et al. (2005) Csikzentmihalyi s model of flow Motivational and self-enhancement approaches to self-esteem Effect sizes for exercise and self-esteem in adults (Spence, McGann and Poon 2005) Aerobic exercise increased self-esteem (Asci 2003) Mean scores for perceptions of coping assets over the course of pregnancy (Rankin 2002) Increases in antidepressant drug prescriptions in England (source: Department of Health statistics) Relationship between physical activity and depression assessed with the CES-D (Stephens 1988) Relative risk of developing depression at follow-up from different levels of baseline physical activity (Camacho et al. 1991) BDI scores pre and post 16 weeks of treatment ( from Blumenthal et al. 1999) and 6-month follow up (Babyak et al. 2000) Exercise treatment for depression: efficacy and dose response (Dunn et al. 2005) Flow of participants through physical activity trial for Type 2 diabetics (Kirk et al. 2004b) Increases in objectively measured physical activity following physical activity counselling (Kirk et al. 2004b) Improvements in glycaemic control following physical activity counselling (Kirk 2004a) Improvements in cardiovascular risk factors following physical activity counselling (Kirk 2004a) Pilot study exercise as rehabilitation during breast cancer treatment (n=22) (data from Campbell et al. 2005) Changes in maximum oxygen uptake in both lifestyle and structured groups in Project Active (data from Dunn et al. 1999) Changes in total energy expenditure in both lifestyle and structured groups in Project Active (data from Dunn et al. 1999) Study design for a postal intervention targeted at precontemplating and contemplating students (Woods, Mutrie and Scott 2002) Percentage of students at each stage of exercise behaviour change who had participated in physical education (PE) during the final two years of schooling (Woods, Mutrie and Scott 2002) Mean step-count comparison for each group at all time-points (Mutrie, Baker and Lowry under review) Design for community trial of exercise consultation versus fitness assessment (Lowther, Mutrie and Scott 1999) Percentage of the participants who opted for exercise consultation by physical activity status (Lowther, Mutrie and Scott 1999) 303 ix

11 x Figures 11.8 The difficulties encountered when trying to translate evidence into practice (Blamey and Mutrie 2004) Energy expenditure of children taught in two experimental SPARK conditions and a control group condition (data from Sallis et al. 1997) Energy expenditure of children taught either by classroom or PE teachers during the SPARK project (data from McKenzie et al. 1997) Changes in minutes of walking reported in the walk in to work out trial for contemplators and preparers (Mutrie et al. 2002) Stair-climbing before and after a promotional intervention (data from Blamey et al. 1995) 342

12 Tables 1.1 Evidence for the need for a global strategy concerning diet and physical activity Level of strength of evidence for a relationship between physical activity and contemporary chronic conditions (Department of Health 2004a)(reprinted with permission) Factors given as barriers by people aged years in the Allied Dunbar National Fitness Survey for England (Sports Council and Health Education Authority 1992) Inferring physical activity attitudes from different reponses (adapted from Ajzen 1988) Results from three meta-analyses on rewards and intrinsic motivation Example items from the Conceptions of the Nature of Athletic Ability Questionnaire 2 (CNAAQ-2) (Biddle et al. 2003; Wang et al. 2005) Competence perception/adequacy subdomains as represented in measures by Harter and colleagues Defining stages of the Transtheoretical Model Processes of change applied to physical activity (Marcus and Forsyth 2003) Example items assessing decisional balance ( pros and cons ) for exercise (Marcus and Owen 1992) Possible determinants of exercise across different stages and phases of exercise and physical activity A summary of family variables and their association with physical activity (PA). Data from reviews by Biddle et al. (2005), Trost et al. (2002), and Sallis et al. (2000) Types of social support and examples from physical activity and exercise Physical environmental factors that might influence walking (Pikora et al. 2003) Defining features of affect, emotion and mood A summary of categorical and dimensional measures of mood and affect, commonly used in physical activity research Summary of findings from British population surveys investigating the relationship between physical activity and psychological well-being 175

13 xii Tables 8.4 Affective responses to varying levels of exercise intensity, proposed by Ekkekakis and colleagues (Biddle and Ekkekakis 2005; Ekkekakis 2003) Example items from the twenty-item Physical Activity Enjoyment Scale (PACES) (Kendzierski and DeCarlo 1991) Five axes from DSM IV for classifying mental illness ICD 10 codes for mental and behavioural disorders Prevalence of common cardiovascular conditions in Scotland (Dong and Erins 1997) Classification of six levels of activity used in the Scottish Health Survey (Dong and Erins 1997) Summary results from four meta-analyses on exercise and anxiety Summary results from two meta-analyses on exercise and depression Summary of DSM IV criteria for major depressive episode Prospective longitudinal studies that include measures of physical activity and depression at two time points that show a protective effect from physical activity Prospective longitudinal studies that include measures of physical activity and depression at two time points not showing a protective effect from physical activity Changes in physical activity status and subsequent depression (Camacho et al. 1991) Published randomised controlled studies of exercise treatment for clinically defined depression The American College of Sports Medicine s classification of diseases and disabilities (American College of Sports Medicine 1997a) ICD-10 classification of dependence syndrome (World Health Organization 1993) Diagnostic criteria for exercise dependence (Veale 1987) Mechanisms for exercise-associated mood changes reviewed by La Forge (1995) Summary of evidence from review of reviews (Hillsdon et al. 2003) Goals set in minutes and in step-counts for a 4-week walking programme (Mutrie et al. 2004) Steps in a typical physical activity counselling session Advantages and disadvantages of different PHC schemes for promoting physical activity Areas of expertise required in GP-referral exercise schemes (Fox, Biddle, Edmunds et al. 1997) Physical activity guidelines for young people Recommendations for school and community promotion of physical activity for young people (Department of Health and Human Services 1997) Examples of community physical activity interventions studies (adapted from King 1994) Principles of ecological approaches to health behaviour change applied to physical activity (based on Sallis and Owen 2002) 346

14 Boxes 1.1 Living today as we did 150 years ago: the case of the Amish community Some do, some don t: observations of physical activity On the road to nowhere... more observations on physical activity Guidelines for physical activity for youth in England (Biddle, Sallis and Cavill 1998) Physical activity guidelines for adults, as recommended in the UK (Department of Health 2004a) Media portrayals and perceptions of sport and physical activity for girls Adherence or compliance? Social norms assessed through questionnaire and interview Using implementation intentions in field settings The politics of personal control and victim blaming The dos and don ts of intrinsic motivation for promoting physical activity Reconciling theory and practice: the youth fitness incentive schemes conundrum Applying self-efficacy theory to the promotion of physical activity I m not the sporty type but so what? Where have all the flowers precontemplators gone? Does becoming more habitually active predispose people to taking up structured exercise? Establishing guidelines for the promotion of physical activity: scientific proof or common sense? A negative exercise environment: exercise as punishment (last one in 10 press-ups!) Physical activity: moving from fitness freak to Norman Normal Creating the right environment for GP-referral exercise patients Geographic information systems (GIS) Can physical activity reduce anti-social behaviour? Donna s story An example of a poster format for raising awareness and offering self-help strategies for potential exercise dependents (Veale 1987; Zaitz 1989) Understanding what the consumer wants 334

15 Preface Developments in physical activity and health have been significant since the publication of our first text in 1991 (Psychology of Physical Activity and Exercise, London: Springer- Verlag). For example, there has been a huge increase in the study of physical activity and health from a psychological point of view which can be illustrated by the number of metaanalytic reviews in the sub-field of physical activity and mental health. The increase in the available evidence led to us to write a new version of the book, published in 2001 by Routledge and what you see now is our second edition of that book. One obvious factor accommodated in the current edition is the need to update the evidence again. Many of the key areas or topics attitudes, the transtheoretical model, psychological well-being, interventions now have a substantial evidence base and often significant systematic review data. In addition, since the 2001 edition, there has been a greater recognition of the bigger picture of the influences on physical activity. This has usually resulted in the use of the ecological framework whereby factors associated with, or directly influencing, physical activity are placed within a wider framework of psychological, social, environmental and policy environments. Far from diminishing the role of psychological factors, it shows how important cognitive mediation is in physical activity decision-making. For example, even when a workplace is well served with dedicated cycle routes and safe walking routes, creating an incentive system for people to cycle or walk to work still requires the development of beliefs and attitudes, as well as decision-making, choice, motivation and, ultimately, behaviour on the part of the individual. Explaining this behaviour without reference to individual or social psychological processes would be strange indeed. Conversely, to expect psychology to have all of the answers, or to expect studies of individual thoughts and beliefs to be sufficient to explain some physical or sedentary behaviours, is equally misguided. In short, in this edition of the book, we place psychological frameworks within wider social environmental frameworks we provide one piece of the jigsaw. We have expanded coverage of social and environmental influences on physical activity, although the book remains clearly focused on psychology per se. Another area of change that has continued during the period of the writing of this second edition is that of research methods. These are evolving and developing rapidly, including greater recognition of systematic review methods, sophisticated statistical techniques, such as multi-level modelling, and greater use of qualitative methods. Our plea is for all those interested in physical activity and health to recognise the appropriate use of certain methods to answer certain questions and to provide us with different kinds of evidence. To dismiss qualitative or quantitative methods because of personal bias or preference is bad research. Stuart acknowledges Loughborough University for granting a study leave during his period as Head of School. This assisted in the completion of this book. The growing physical

16 Preface xv activity and health agenda and excellent environment at Loughborough are particularly appreciated. Nanette would like to thank the University of Strathclyde and the rapidly expanding physical activity and health research team for providing a supportive environment. Finally, we thank the excellent work of the staff at Routledge for their support and encouragement. Stuart Biddle, Loughborough University Nanette Mutrie, University of Strathclyde January 2007

17 Acknowledgements Stuart would like to acknowledge colleagues, students, friends and family who have been so important during this writing period and, in some cases, made huge contributions to my thinking in the field of physical activity. During the period of revising this text I have been the Head of the School of Sport and Exercise Sciences at Loughborough and I could not have managed the task of writing the book without help and support. A study leave period granted by the university was particularly helpful, and the Loughborough environment generally is supportive and inspirational in my field. There is no better place to be! During the writing of this revision, my father, Jim, died. In addition to being a wonderful father, Jim was a great physical educator. He taught physical education teacher education students for twenty-six years and was universally recognised as a great mentor and educator. He had a love for physical activity and passed this on to generations of teachers: great intervention, great psychology! Jim, this book is for you. I hope I get close to having the impact you had. Nanette would like to acknowledge how much her colleagues, students, friends and family have contributed (even if they do not know it) to the completion of this revision of our 2001 text. There are at least three groups: colleagues with whom discussions (the best ones over a glass of wine or a game of golf!) have helped me think forwards and whose published work has helped us update this text: Stuart Biddle (of course!), Precilla Choi, Andy Smith, Adrian Taylor, Guy Faulkner, Ken Fox, Joan Duda, Amanda Daley, Frank Eves, Madeleine Grealy, Anna Campbell, Ruth Lowry, Carol Emslie, Sally Macintyre, Dan Landers, Celia Brackenridge, Avril Blamey, Fiona Crawford, Vicki Trim, David Ogilvie and the SPARColl (www.sparcoll.org.uk) advisory board current and former PhD and MSc students who have added to the knowledge base in physical activity psychology and who have been such a joy to work with over the years: Liz Marsden, Marie Donaghy, Chris Loughlan, Mathew Lowther, Alison Kirk, Adrienne Hughes, Ann McPhail, Roseanne McKee, Graham Baker, Jo Smith, Chloe Hughes, Kate Hefferon, Catherine Woods, Jean Rankin, Annemarie Wright friends and family who have provided in equal measure distraction, challenge, support and humour: Kay, Jock and Cal; the Pitlochry Six; Dog s Dinners; the families Mutrie and Munro and my squash and golf buddies. Thanks folks! I know I have been a pain in the neck to most of you constantly making you walk up stairs and count steps on your pedometer bad news I am going to continue to do that! For Kay special thanks for being a wonderfully civil partner and also for her information skills that helped me update this text. Nanette would like to dedicate this book to the memory of Precilla Choi (Krane, 2005).

18 Part I Introduction and rationale

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20 1 Introduction and rationale Why you should take your dog for a walk even if you don t have one! Purpose of the chapter The purpose of this chapter is to introduce key concepts in the study of physical activity, exercise and health as a prelude to a more extensive discussion in subsequent chapters of physical activity, psychological correlates, psychological well-being, and interventions to promote physical activity. Specifically, in this chapter we aim to: provide a brief synopsis of human evolution and history that is relevant to current physical activity and health behaviours in contemporary society define key terms highlight recent policy and position statements and guidelines on physical activity summarise the evidence linking physical activity with various health outcomes and risks review the prevalence and trends in physical activity and sedentary behaviour in selected countries. Many forms of physical activity are healthy! As a result we have been interested in the promotion of physical activity for some time and our first text on the subject was published in the early 1990s (Biddle and Mutrie 1991). It is pleasing to see that physical activity for health is now very high priority for governments and other agencies. Initially, a great deal of time was spent on identifying the biological mechanisms of the health effects of activity indeed an essential aspect of our knowledge but rather less energy was devoted to the issues of why people do or do not exercise much, what the psychological benefits might be, or the best ways of promoting physical activity. But we are glad to report a significant increase in interest in exercise psychology, behavioural interventions and related topics in the past few years. When writing our book in 1991 there were few textbooks giving more than cursory attention to the behavioural aspects of physical activity and health. Today, however, nearly all works in the field address at least some aspect of psychology, behaviour change or behavioural interventions. Even within the field of physical activity psychology, there has been a greater recognition of exercise for health whereas in the past the vast majority of the literature focused on competitive sport. For example, one of the key research journals, the Journal of Sport Psychology, became the Journal of Sport and Exercise Psychology (JSEP) in 1988 to better reflect the field, and now nearly all such journals have the word exercise in their title. Similarly, in a review of trends in sport and exercise psychology (Biddle 1997), two journals (JSEP and the International Journal of Sport Psychology) were analysed for content over the ten-year period and exercise studies were the most popular overall in comparison with sport-related

21 4 Introduction and rationale constructs and showed the most significant increase over the time period studied (nearly 250 per cent). A recently established journal Psychology of Sport and Exercise published 37 per cent of its first five volumes (2000 4) on exercise psychology. This would have been unheard of some time ago. Indeed, there are new journals emerging, covering behavioural aspects of physical activity and health, such as the International Journal of Behavioral Nutrition and Physical Activity and the Journal of Physical Activity and Health. Moreover, established journals, such as the American Journal of Preventive Medicine, Annals of Behavioral Medicine, and Preventive Medicine all give substantial coverage to physical activity research. This book, therefore, provides a review of contemporary psychological knowledge in physical activity, with the focus exclusively on physical activity for health rather than sport performance. Although usually referred to as exercise psychology, we feel that this may reflect only structured bouts of physical activity, as we discuss in the definitions section shortly. We therefore prefer to broaden the discussion to physical activity in its widest sense, at least as far as health is concerned. However, as you will see, a great deal of the literature does actually refer to exercise as this is often a behaviour that is easier to quantify and study. The behavioural epidemiological and ecological frameworks We adopt a behavioural epidemiological framework advocated by Sallis and Owen (1999). Applying this to physical activity, the framework proposes that a five-stage model in which physical activity correlates build on an understanding of the relationship between physical activity and health and the measurement of physical activity. Correlates then inform the development of interventions, the results of which are translated into action. The framework is illustrated in Figure 1.1. The five-phase behavioural epidemiological framework is a useful way of viewing various processes in the understanding of physical activity and health. Behavioural epidemiology considers the link between behaviours and health and disease, such as why some people are physically active and others are not. The five main phases are: 1 to establish the link between physical activity and health. This is now well documented for many diverse conditions as well as well-being (Bouchard, Shephard and Stephens 1994; Dishman, Washburn and Heath 2004). Many of these are described in this chapter. Psychological outcomes of physical activity are dealt with in detail in Part III Establish links between PA and health eterminants nterventions Translation into practice Measure PA Figure 1.1 A behavioural epidemiological framework (Sallis and Owen 1999)

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