Rehab and Beyond: Self- Determination to Continue

Transcription

1 Rehab and Beyond: Self- Determination to Continue Change does not happen overnight, but how do we keep clients coming back long enough to experience the benefits from exercise? Most people begin an exercise program based on doctor recommendations or results of their own research and are looking forward to the benefits, however it takes time to get results and far too often people get discouraged and stop attending the program before achieving expected benefits. Research has shown that prolonged engagement in regular physical activity provides the best results. People do things that they enjoy, they value, and that they believe they can do. Self- determination theory has been widely used in the sport and exercise field to study motivation (Standage, Sebire, & Loney; 2008). This workshop will explore facilitators to exercise adherence, self- determination theory, and strategies you can use in your program to move clients along the motivation continuum which may result in greater adherence to exercise. Adherence Regular physical activity is an important part of a healthy lifestyle. Long term adherence is essential for the maintenance of health benefits. However only 48% of the population engage in regular physical activity (Center for Disease Control, 2010). This number is even lower for people with chronic disease and disability. Researchers have been interested in identifying predictors of physical activity as well as barriers to long term engagement. Several comprehensive reviews covering over 380 studies of motivation and physical activity (Allen & Morey, 2010) culminated in the identification 25 factors associated with physical inactivity in 7 domains: demographic, health, cognitive and psychological, behavior, social, program- related, and environmental factors (Allen & Morey, 2010). This information is useful for designing programs and increasing the likelihood that participants will keep coming back week after week. Though it is not possible to design programs around every factor there are some that can be addressed quite easily. We have listed factors that will be addressed in this presentation Cognitive and psychological factors Lack of enjoyment of physical activity Low expectations of benefits from physical activity Low self- efficacy for physical activity Low self- motivation for physical activity Social factors Lack of cohesion in exercise group Program- related factors High physical activity intensity Long physical activity duration

2 There is no clear best strategy for increasing physical activity levels. Individuals, as well as providers, respond better to some strategies than others. It is important that providers have a toolbox of strategies to incorporate into their physical activity programs. One approach is to work within a framework. This presentation will describe one framework, Self- Determination Theory and provide a variety of strategies to use in your physical activity programs to optimize factors shown to increase adherence. Self- Determination Theory Self- determination was first listed in the Shorter Oxford English Dictionary On Historical Perspective in the 1683 and was defined as determination of one s mind or will be oneself or itself (1967, p. 1835). Research into self- determination began in the 1970 s and continues today. In the mid 1980s Edward Deci and Richard Ryan proposed a theory which attempted to explain intrinsically motivated behavior. Self- determination theory is a broad framework for the study of human motivation. The theory posits that humans are motivated to behave in a self- determined manner because it is an innate need; in particular, people act to fulfill the three primary and universal needs: autonomy, competence, and relatedness. Autonomy can be defined as ones effort to feel as if they originate their actions and can determine their own behavior; it is a desire to feel an internal locus of causality (Murcia, San Roman, Galindo, Alonso, & Gonzalez- Cutre, 2008). Competence is the ability to control the result and experience efficacy (the ability to produce a result (Bandura, 1997)). Relatedness refers to the effort made to relate to others and be concerned for them, as well as feeling accepted by others and experiencing satisfaction with the social world (Murcia et al., 2008). Conditions supporting an individual s experience of these three factors foster the highest quality of motivation and engagement in activities, including enhanced performance and persistence. Failure to support, or to thwart, autonomy, competence and relatedness result in poor motivation to engage in the activity. According to Deci and Ryan (1985) motivation can be described on a continuum depending on the level of self- determination experienced by the individual. The continuum goes from amotivation (lowest level and indicative of non- engagement) to several forms of external motivation to internal motivation (highest level). The higher the level of self- determined motivation possessed by an individual the more likely they are to engage in an activity.

3 Continuum of Self- determination (Deci & Ryan, 2002b, p. 16) Amotivation: No intention behind the behavior; Example: "I really feel I am wasting my time at this program". External Regulation: Motivated only by external contingencies (rewards or the threat of punishment); Example: "Without pressure from outside I would not attend as much" Introjected Regulation: Introjection of demands that pressure students, for example, to avoid feelings of guilt; Example: "I have to give myself an inner push in order to continue going" Identified Regulation: Identification with opportunities that are in accordance with the learners own goals (but are not intrinsically motivated); Example: "I am committed to my exercise, because I want to realize the goals I have set for myself" Integrated regulation. Integration occurs when identified regulations have been fully assimilated to the self. Example: I am committed to this exercise program because it is good for me, and I enjoy it also Intrinsic motivation: No regulation by extrinsic rewards (curiosity, flow, fun); Example: "I really enjoy working out here A person s motivation can move up or down the continuum as they experience support or thwarting of the three primary needs in association with an activity (Deci & Ryan, 2002). High levels of motivation occur when individuals endorse their own actions and act with a full sense of volition because they find an activity to hold inherent interest and/or personal value (Ryan & Deci 2006). A person is identified as having a high level of motivation when they fall on the continuum between identified regulation and intrinsic motivation.

4 Recent research in exercise motivation has shown that social factors that satisfy the basic psychological needs as advanced by Self Determination Theory (autonomy, competence, and relatedness) serve to facilitate high levels of motivation and well- being (Deci & Ryan, 2000). An appealing feature of Self Determination Theory is that it provides valuable insight in how to foster increments in motivation. People tend to participate in exercise for instrumental reasons such as improving their health/fitness, losing weight, managing pain, and/or enhancing appearance. Research has shown that some motives are stronger than others, for instance enjoyment is strong predictor while appearance does not foster high level motivation (Murcia et al., 2008). You can easily assess the motives of your group of exercisers using the Motives for Physical Activity Measure Revised (MPAM- R) (Ryan, Frederick, Lepes, Rubio, & Shledon, 1997), a short 30 item questionnaire that is readily available. Knowing your audience is the first step in addressing their needs. Through careful design of program, activities, and interactions it is possible for a person to increase their level of self- determined motivation. ACTIVITY: MPAM- R Programming We will explore strategies that you can incorporate into your program to promote high levels of motivation leading to increased participation and adherence. Universal Needs The need to feel Confident (autonomous, optimistic, hopeful in outlook, positive identity) The need to feel Competent (competence, capable, proficient, successful because of effort) The need to feel Connected (relatedness, safe, belonging, useful, an important part of the team) (Sagor, 2002) Needs Met - involvement increases - feel capable - included - in control POOL Needs not Met - involvement decreases - feel incapable - excluded - controlled In the pool we participants will learn to alter different elements of an activity or game to increase a clients motivation using the The Programmable C s. Programmable C s: Change, Choice, Challenge CHANGE

5 All activities have changeable parts ü Grouping ü Organizational pattern ü Equipment ü Movement ü Rules Grouping: Individual, small groups, teams, large groups Methods of separating participants into groups Organizational pattern: Everyone doing the same thing, variety of activities, stations, scattered, lines, Equipment: variety of equipment, participant choice, instructor directed Movement: Everyone performing the same pattern, choice in movement pattern, adequate instruction based on skill level, scaffolding, Rules: cooperative activities, competitive games CHOICE Always offer choices, a coerced player is no longer a player (Rohnke & Grout, 1998) Provide choice among appropriate options Options that present opportunities for genuine success a sense of autonomy (self- governed, independent) confidence in one s self CHALLENGE Activities are not sacred, participants are! Understand and manipulate an activity s degree of difficulty or appeal ACTIVITY: Facilitators will demonstrate how challenge, choice, and change work with a series of exercise and a game. Then participants will divide into small groups and apply the 3 Cs to an exercise/game of their choice. Small groups will share their ideas with the large group as time permits. References will be available upon request. References

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