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David French presentation- Exercise and Health conference


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“What do we know about promoting physical activity?”

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David French presentation- Exercise and Health conference

  1. 1. What do we know about promoting physical activity? Prof David French University of Manchester
  2. 2. Adrian E Bauman, Rodrigo S Reis, James F Sallis, Jonathan C Wells, Ruth JF Loos, Brian W Martin Correlates of physical activity: why are some people physically active and others not? The Lancet (2012) Correlates of Physical Activity
  3. 3. Why not just communicate risk? • Where risk appraisals were heightened across 217 studies: • Effect d=+0.23 on behaviour • Where also change response efficacy and self-efficacy, get much larger effects
  4. 4. Sheeran P, Harris PR, Epton T (2014). Does heightening risk appraisals change people’s intentions and behaviour? A meta-analysis of experimental studies. Psychol Bull 2014; 140(2): 511-543.
  5. 5. An intervention to increase walking • Doesn’t require scheduling • Free • Not too intense – If in poor health – Worried about injury • Don’t need other people • Don’t need kit • Can do it anywhere • Already do some DP French, CD Darker, FF Eves, & FF Sniehotta (2013). The systematic development of a brief intervention to increase walking in the general public using an "extended" Theory of Planned Behavior. Journal of Physical Activity and Health
  6. 6. Targeting self efficacy to alter intentions to walk • Intervention drew from Bandura’s work on self- efficacy (mastery experiences) and Motivational Interviewing • Tried to elicit participants’ own reasons for why walking (more) is under their own control • Three motivational techniques: – all describe previous instances of success – why would be easy to walk more Darker, French, Eves & Sniehotta (2010). Psychology & Health, 25, 71-88. French, Stevenson & Michie (2012). Psychology, Health & Medicine, 17, 127-135.
  7. 7. Bridging the “intention – behaviour gap” • Four volitional techniques: • Goal setting • Action planning (when, where, how, with whom) • Coping planning (anticipate barrier, make plans for how would overcome barrier) • Supportive planning
  8. 8. Effects on walking (self-report) Darker, French, Eves & Sniehotta (2010). Psychology & Health, 25, 71-88. French, Stevenson & Michie (2012). Psychology, Health & Medicine, 17, 127-135.
  9. 9. What is the best way to change self efficacy? • Systematic review of intervention studies to alter lifestyle/ recreational physical activity of non- clinical samples of adults under 60 years • Reported pre/post or between groups comparisons of self efficacy • Thereby estimated effect sizes for SE and for physical activity • Coded intervention content, using CALO-RE taxonomy of behaviour change intervention S Michie, S Ashford, FF Sniehotta, SU Dombrowski, A Bishop, & DP French (2011). A refined taxonomy of behavior change techniques to help people change their physical activity and healthy eating behaviors - The CALO-RE taxonomy. Psychology and Health 26; 1479-1498
  10. 10. Action planning (aka Implementation Intentions) p < 0.001
  11. 11. Barrier identification p < 0.01
  12. 12. Effective BCTs (changed SE and behaviour) • Action planning • Reinforcing effort or progress towards goals • Provide instruction • Set graded tasks • Barrier identification SL Williams, & DP French (2011). What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour - and are they the same? Health Education Research 26; 308-322
  13. 13. Which BCTs decreases both self-efficacy and behaviour? (over 60s)  Plan social support/ social change  Provide normative information about others’ behaviour  Relapse prevention/ coping planning  Goal setting (behaviour)  Provide feedback on performance  Prompt self-monitoring of behaviour DP French, EK Olander, A Chisholm, & J McSharry (2014). Which behavior change techniques are most effective at increasing older adults’ self-efficacy and physical activity behavior? A systematic review. Annals of Behavioral Medicine 48; 225-234.
  14. 14. What interventions/ BCTs are acceptable to older people?  Systematic review of qualitative studies of older adults’ (65+ years) experiences of physical activity interventions, i.e. what do they want from such interventions?  Based on systematic search, 14 studies identified that report some qualitative data on experiences of interventions (1 from UK)  None with low SES groups  4 themes
  15. 15. Results of meta-synthesis • ALL studies flag up that older adults want experiences that are enjoyable/ fun/ social • Valued improvements in function – being able to do things, not “health” • (initial) doubts over own competence/ concerns about injury, but credible interventions helped • Appreciated lack of pressure, going at own pace – didn’t like diaries, logs, etc • Importance of after intervention – what now?
  16. 16. What predicts objectively assessed maintenance at walking groups? • We recruited 114 walkers who already had attended WfH schemes for at least three months (range 3 to 123 months), in Coventry, Birmingham, Stoke-on-Trent, or Nuneaton & Bedworth. • They completed questionnaires assessing theories • Looked at their attendance records three months later. • Worked out what predicted continued attendance at WfH groups, after adjusting for group clustering.
  17. 17. Maintenance… • Was not predicted by: – Duration of past attendance – Level of habit. • Was predicted by: – Overall satisfaction – Satisfaction with health outcomes – Satisfaction with social outcomes – Recovery self-efficacy A Kassavou, A Turner, T Hamborg & DP French (2014. Predicting maintenance of attendance at walking groups: Testing constructs from three leading maintenance theories. Health Psychology 33: 752-756.
  18. 18. Natural experiments (effects of changing environment on physical activity)
  19. 19. In conclusion: promoting physical activity • There is a LARGE evidence base on this • Risk communication not enough • People must think they can do it • Self-regulation approaches best for working age adults (Maybe not older adults) • Fun is central to uptake – not abstract ideas about benefits • Satisfaction with consequences is key to maintenance • Environment important (but evidence is shaky)
  20. 20. Thank you