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What do we know about
promoting physical
activity?
Prof David French
University of Manchester
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
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
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.
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
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.
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
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.
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
Action planning (aka Implementation
Intentions)
p < 0.001
Barrier identification
p < 0.01
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
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.
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
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?
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.
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.
Natural experiments
(effects of changing
environment on physical
activity)
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)
david.french@manchester.ac.uk
Thank you

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David French presentation- Exercise and Health conference

  • 1. What do we know about promoting physical activity? Prof David French University of Manchester
  • 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. 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. 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. 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. 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. 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. 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. 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. Action planning (aka Implementation Intentions) p < 0.001
  • 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. 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. 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. 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. 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. 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.
  • 19. Natural experiments (effects of changing environment on physical activity)
  • 20. 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)