The Role of Self-regulation Strategies in Physical Activity Behavior Change: Results from an Exercise Prescription Program at a Federally Qualified Health Center

Overview

Journal Psychol Health Med

Publisher Routledge

Specialties General Medicine
Health Services
Psychology

Date 2022 Nov 9

PMID 36351200

Authors

Kelly R Ylitalo

Jordan Smith

Wendy Cox

Raejone Lucas

Brock Niceler

M Renee Umstattd Meyer

Affiliations

Soon will be listed here.

Abstract

Physical activity (PA) improves quality of life and prevents chronic disease, yet many adults are inactive. Planning with health care providers in the form of exercise "prescriptions" may increase PA, but the role of individual psychosocial factors within exercise prescription programs is not well understood. Therefore, the purpose of this study is to describe the role of self-regulation strategies (e.g., goal setting, self-monitoring, reinforcements) in PA behavior change within the context of an exercise prescription program. Patients at a large, Federally Qualified Health Center with an on-site exercise facility (ie, "Wellness Center") referral were eligible to exercise with a personal fitness advisor. Self-reported PA and use of 15 self-regulation strategies were measured via survey at two time points and merged with electronic health records and attendance data. Patients (n = 151) were, on average, 50.3 ± 13.3 years and mostly female (76.8%). Almost one-third (30.5%) were Hispanic/Latino, 48.3% were non-Hispanic Black, and 20.5% were non-Hispanic white. Participants completed 10.7 ± 12.0 in-person exercise sessions with a fitness advisor. Between baseline and follow-up, the self-regulation strategies that had the largest change in frequency over time were keeping track of PA (p < 0.001), thinking about surroundings (p < 0.001), rewarding yourself for PA (p < 0.001), making PA more enjoyable (p < 0.001), setting goals (p < 0.001), and trying different kinds of PA (p < 0.001). Among exercise prescription program participants, the total self-regulation strategies score was significantly associated with physical activity at follow-up (p = 0.04). Leveraging self-regulatory skill-building activities within the context of exercise prescription programs in clinical settings may provide a personalized and multicomponent approach to PA promotion. Self-regulation strategy training for fitness advisors and/or health care providers has great potential for supporting long-term health behaviors like PA for managing chronic disease among underserved patients.

References

McMahon S, Lewis B, Oakes J, Wyman J, Guan W, Rothman A . Assessing the Effects of Interpersonal and Intrapersonal Behavior Change Strategies on Physical Activity in Older Adults: a Factorial Experiment. Ann Behav Med. 2017; 51(3):376-390. PMC: 5634530. DOI: 10.1007/s12160-016-9863-z. View

Scholes S, Bann D . Education-related disparities in reported physical activity during leisure-time, active transportation, and work among US adults: repeated cross-sectional analysis from the National Health and Nutrition Examination Surveys, 2007 to 2016. BMC Public Health. 2018; 18(1):926. PMC: 6064072. DOI: 10.1186/s12889-018-5857-z. View

Ainsworth B, Caspersen C, Matthews C, Masse L, Baranowski T, Zhu W . Recommendations to improve the accuracy of estimates of physical activity derived from self report. J Phys Act Health. 2012; 9 Suppl 1:S76-84. PMC: 3544158. DOI: 10.1123/jpah.9.s1.s76. View

Pavey T, Taylor A, Fox K, Hillsdon M, Anokye N, Campbell J . Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis. BMJ. 2011; 343:d6462. PMC: 3209555. DOI: 10.1136/bmj.d6462. View

Craig C, Marshall A, Sjostrom M, Bauman A, Booth M, Ainsworth B . International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003; 35(8):1381-95. DOI: 10.1249/01.MSS.0000078924.61453.FB. View

Stoutenberg M, Galaviz K, Lobelo F, Joy E, Heath G, Hutber A . A Pragmatic Application of the RE-AIM Framework for Evaluating the Implementation of Physical Activity as a Standard of Care in Health Systems. Prev Chronic Dis. 2018; 15:E54. PMC: 5951671. DOI: 10.5888/pcd15.170344. View

Kozey S, Lyden K, Staudenmayer J, Freedson P . Errors in MET estimates of physical activities using 3.5 ml x kg(-1) x min(-1) as the baseline oxygen consumption. J Phys Act Health. 2010; 7(4):508-16. DOI: 10.1123/jpah.7.4.508. View

Hennessy E, Johnson B, Acabchuk R, McCloskey K, Stewart-James J . Self-regulation mechanisms in health behavior change: a systematic meta-review of meta-analyses, 2006-2017. Health Psychol Rev. 2019; 14(1):6-42. PMC: 7571594. DOI: 10.1080/17437199.2019.1679654. View

Dugdill L, Graham R, McNair F . Exercise referral: the public health panacea for physical activity promotion? A critical perspective of exercise referral schemes; their development and evaluation. Ergonomics. 2005; 48(11-14):1390-410. DOI: 10.1080/00140130500101544. View

10.

Phillips E, Kennedy M . The exercise prescription: a tool to improve physical activity. PM R. 2012; 4(11):818-25. DOI: 10.1016/j.pmrj.2012.09.582. View

11.

Eynon M, Foad J, Downey J, Bowmer Y, Mills H . Assessing the psychosocial factors associated with adherence to exercise referral schemes: A systematic review. Scand J Med Sci Sports. 2019; 29(5):638-650. DOI: 10.1111/sms.13403. View

12.

Ylitalo K, Cox W, Gutierrez M, Benavidez G, Umstattd Meyer M, Niceler B . A Prescription for Wellness: Exercise Referrals at a Federally Qualified Health Center. J Prim Care Community Health. 2020; 11:2150132720942396. PMC: 7370562. DOI: 10.1177/2150132720942396. View

13.

Olson E, McAuley E . Impact of a brief intervention on self-regulation, self-efficacy and physical activity in older adults with type 2 diabetes. J Behav Med. 2015; 38(6):886-98. PMC: 4628895. DOI: 10.1007/s10865-015-9660-3. View

14.

Dishman R, Motl R, Sallis J, Dunn A, Birnbaum A, Welk G . Self-management strategies mediate self-efficacy and physical activity. Am J Prev Med. 2005; 29(1):10-8. PMC: 2435261. DOI: 10.1016/j.amepre.2005.03.012. View

15.

Joseph R, Daniel C, Thind H, Benitez T, Pekmezi D . Applying Psychological Theories to Promote Long-Term Maintenance of Health Behaviors. Am J Lifestyle Med. 2017; 10(6):356-368. PMC: 5313056. DOI: 10.1177/1559827614554594. View

16.

Marshall S, Jones D, Ainsworth B, Reis J, Levy S, Macera C . Race/ethnicity, social class, and leisure-time physical inactivity. Med Sci Sports Exerc. 2007; 39(1):44-51. DOI: 10.1249/01.mss.0000239401.16381.37. View

17.

Bandura A . Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001; 52:1-26. DOI: 10.1146/annurev.psych.52.1.1. View

18.

Morgan F, Battersby A, Weightman A, Searchfield L, Turley R, Morgan H . Adherence to exercise referral schemes by participants - what do providers and commissioners need to know? A systematic review of barriers and facilitators. BMC Public Health. 2016; 16:227. PMC: 4779205. DOI: 10.1186/s12889-016-2882-7. View

19.

McMullan I, Bunting B, Blackburn N, Wilson J, Deidda M, Caserotti P . The Mediating Role of Self-Regulation and Self-Efficacy on Physical Activity Change in Community-Dwelling Older Adults (≥65 Years): An Experimental Cross-Lagged Analysis Using Data From SITLESS. J Aging Phys Act. 2021; 29(6):931-940. DOI: 10.1123/japa.2020-0322. View

20.

Gine-Garriga M, Coll-Planas L, Guerra M, Domingo A, Roque M, Caserotti P . The SITLESS project: exercise referral schemes enhanced by self-management strategies to battle sedentary behaviour in older adults: study protocol for a randomised controlled trial. Trials. 2017; 18(1):221. PMC: 5437412. DOI: 10.1186/s13063-017-1956-x. View