Exercise Epidemiology Kinesiol 3H03 Lecture Notes PDF

Exercise Epidemiology KINESIOL 3H03 Dr. Jeremy Walsh Asynchronous Lecture #1 mcmaster.ca Lecture Outline Brief history of the evolution of exercise sciences Benefits of physical activity for health Evidence that in...

Exercise Epidemiology KINESIOL 3H03 Dr. Jeremy Walsh Asynchronous Lecture #1 mcmaster.ca Lecture Outline Brief history of the evolution of exercise sciences Benefits of physical activity for health Evidence that informs guidelines Defining & Measuring Exercise vs. Physical Activity Global physical (in)activity trends  Learning Objectives By the end of this lecture you should be able to… 1. Appreciate the historical roots of exercise sciences 2. Explain the difference between Physical Activity and Exercise 3. To examine the scientific evidence that informs physical activity guidelines Loading… 4. List the different approaches to measuring physical activity Identify the pros and cons of each approach 5. To evaluate global physical activity trends  How Did We Get Here? The Harvard Fatigue Laboratory (1927-1947) Part of Physiology & psychology of work Many workplace deaths / accidents Effects of fatigue, lighting, and temperature on worker productivity WWI – big lesson on the limits of human performance Exposure (cold/heat) Fatigue & Exhaustion Nutrition Loading… Source: https://www.hbs.edu/news/articles/Pages/historical-places-cool-spaces.aspx How Did We Get Here? Exhibit A: The Prison Treadmill Source: https://www.hfe.co.uk/blog/history-of-the-treadmill/  London Transport Workers Study Importance of Physical Activity 1949 – 1952 Compared rates of heart disease in bus drivers vs. ticket takers in London 31,000 people in total! Homogenous group Same work environment, hours, pay, etc. Different levels of physical activity Drivers had significantly higher incidence of heart disease compared to ticket takers Ticket takers had more mild forms of heart disease Findings confirmed in other occupations!  The Fitness Craze Is credited with the birth of the field of exercise psychology 1970’s & 80’s Source: http://content.time.com/time/covers/0,16641,19811102,00.html  Exercise vs. Physical Activity Physical Activity - Any bodily movement produced by skeletal muscles that expends energy beyond resting levels (>1.5 METs) Exercise – leisure time physical activity that is planned, structured, and repeated over time. (Caspersen et al., 1989) Movement Continuum Sleep ⟷ Sedentary ⟷ Vigorous Activity (ME T) Source: www.sedentarybehaviour.org  Loading… Source: www.eufic.org/en/healthy-living/article/9-proven-benefits-of-physical-activity  Physical Activity Improves Health The Evidence is Clear All Cause Mortality is the death rate in the population over a period of time Decreased Increased Kraus et al. 2019 Med Sci Sport Mortality Risk Mortality Risk Exer Physical Activity and Health Physical Activity Guidelines Kraus et al. 2019 Med Sci Sport Exer Physical Activity and Health Total PA Time > How PA Accumulated ( M What Matters More? o r Total physical activity time? t OR a How physical activity is accumulated? li t y Guidelines: ) >10 min bouts of PA… Emerging Research: This may not matter Saint-Maurice et al. 2018 J American Heart Brief Summary Physical activity (PA) is any bodily movement above 1.5 METs Exercise is a sub-category of PA… Leisure PA that is planned, structured, repeated Focus on PA as a health behaviour relatively recent Numerous health benefits of PA… lowers all cause mortality Guidelines = 150 min/wk of moderate-to-vigorous intensity PA At least 10 min per bout… but this recommendation change over time  Global Trends in Physical (In)Activity Men Globally, 1 in 4 adults do not meet the global recommended levels of physical activity 1.4B adults Up to 5 million deaths a year could be averted if the global population was more active People who are insufficiently active have a 20% to 30% increased risk of death compared to people who are sufficiently active More than 80% of the world's adolescent population is insufficiently physically active Women https://www.who.int/news-room/fact-sheets/detail/physical-activity Hallal et al. 2012  Lancet Global Physical (In)Activity Trends Worldwide, around 33% of women and 25% men do not meet activity guidelines Levels of inactivity are twice as high in high-income ♂ ♀ countries compared to low-income countries Consider: Why the discrepancy in PA between men and women? High income vs. lower income? Global Physical (In)Activity Trends Consider: Why regional differences? Trends across age-groups? How were measures taken?  Measuring Physical Activity or Exercise Physical Activity varies tremendously in: ◦ Mode (e.g. running, biking, weight training) ◦ Frequency (e.g. 3 days/week) ◦ Duration (45 minutes/session) ◦ Intensity (60% Max HR) 3 main approaches to measure PA / Exercise: 1. Subjective measures (self-report/survey) 2. Objective Measures (tracking devices, fitness apps, direct measurement) 3. Observation  Measuring Physical Activity or Exercise Subjective Measures Self-report/survey ◦Log (weight training) ◦Physical activity recall questionnaires Self-Report of Physical Activity Behavior Godin Leisure-time Exercise Questionnaire COPYRIGHT © HOLCOMB HATHAWAY, PUBLISHERS  Measuring Physical Activity or Exercise Objective Measures ◦ Heart rate monitor ◦ Pedometer ◦ VO2 measurements ◦ GPS / fitness apps ◦ Accelerometer “gold standard” Worn on body (wrist/thigh) → measure movement in three dimensions/planes  Measuring Physical Activity or Exercise Observation Direct ◦ View a fitness class or watch kids at play to measure intensity Indirect ◦ Take attendance to measure adherence  Brief Summary 3 main approaches to measure PA / Exercise: 1. Subjective measures (self-report/survey) 2. Objective Measures (tracking devices, fitness apps, direct measurement) 3. Observation  Theories in Exercise Psychology Part 1 KINESIOL 3H03 Dr. Jeremy Walsh Asynchronous Lecture #2 mcmaster.ca Lecture Objectives What is a theory? Theories vs. Models Why are theories important? Basic assumptions of social cognitive theories Three social cognitive theories: Self-Efficacy Theory (SET) Theory of Planned Behavior (TPB) Self-Determination Theory (SDT) Learning Outcomes For each theory you should be able to… Describe the main components of the model Explain how each theory attempts to predict behaviour Loading… Differentiate between the strengths and weakness of each theory  What is a theory? theory (the·o·ry) (thē'ə-rē, thēr'ē) noun. A systematically organized body of knowledge applicable in a relatively wide variety of circumstances, especially a system of assumptions, accepted principles, and rules of procedure devised to analyze, predict, or otherwise explain the nature or behavior of a specified set of phenomena.  What is a Theory? Theory is… A systematically organized body of knowledge, Applicable in a relatively wide variety of circumstances… Devised to analyze, predict, or otherwise explain the nature Loading… or behavior of a specified set of phenomena. 1. Key Components of a Theory It describes a behaviour 2. It makes a prediction about future behaviours An attempt to predict/explain why a behaviour or phenomenon occurs Theories are essential because they... Help us better understand and predict physical activity & exercise behaviour Provide a scientifically supported blueprint from which to formulate effective behavioural interventions (provides a logic basis for planned interventions)  Theories vs. Models What is a model? Simply, a graphic depiction of a phenomenon. Habitual Models describe the phenomenon… they do not explain why it occurs exercise Theories attempt to explain the why What is a Construct? Resumption Relapse/no A concept, label or idea… Characteristic of something that of exercise exercise isn’t directly observable Label for subjective domain of behaviour Example – motivation, intentions, self-esteem Use of Language Theories cannot be “proven” When we test theory we either support or refute Correlation vs. causation Lecture Objectives What is a theory? Theories vs. Models Why are theories important? Basic assumptions of social cognitive theories Three social cognitive theories: Self-Efficacy Theory (SET) Theory of Planned Behavior (TPB) Self-Determination Theory (SDT)  Theories of exercise behaviour are rooted in theories of human motivated behaviour A person’s future behaviour can be determined/explained by their motivation ◦ Motivation “degree of determination, desire, or drive with which someone approaches approaches behaviour” ◦ Intensity and direction of motivation Behavioural Economics – Motivation predicted by expected outcomes outcomes and value value placed on the behaviour ◦ Choices made based on: ◦ 1) Low Cost, Expectancy-Value ◦ 2) Highly reinforcing / high gain Approach ◦ Why do people NOT exercise despite knowing it’s good for your health? Delay Discounting & Expectancy Value  Behavioural Economics Delay Discounting & Expectancy-Value… Loading… Reed, Niileksela, & Kaplan (2013) Behav Analysis Source: https://medium.com/behavior-design/hyperbolic-discounting-aefb7acec46e Prac Social Cognitive Theories/Approaches Social elements Social pressures or experiences influencing behaviour E.g., family or work commitments Human cognition Cognitions that influence behaviour E.g., attitudes, expectations, beliefs, intentions  Self-Efficacy Theory Cited >25,000 times  Self-Efficacy Theory Overview Self-Efficacy – an individual’s belief in their abilities to successfully perform a task, based on the demands of the task… ◦ A situation-specific form of self-confidence. People avoid activities that they judge to exceed their abilities… but undertake and perform [with confidence] activities that they judge themselves capable of performing  Self-Efficacy Theory Model D e g r e e of I n fl u e n  c Self-Efficacy Theory Sources of Influence Past Performances: Performing same or similar activity some sort of success Degree of similarity b/w tasks determines the strength of SE D Vicarious Experiences (modelling): Seeing another person (model) perform a task successfully e The greater the perceived similarity b/w the model and the viewer, the greater the influence on SE g REPRESENTATION! r e Social Persuasion: verbal and nonverbal tactics used by others to increase a person’s SE e Most effective when a knowledgeable or significant other is persuading (spouse, personal trainer, physician, of famous athlete) I n Physiological / Affective States: physiological state (arousal & sensations) and mood fl Feelings of pain, fatigue, breathing discomfort vs. Feeling awake, energized, strong u (+) Happiness, pride, excitement vs. (-) Disappointed, sad, bored e n c e Self-Efficacy Theory Measuring Self-Efficacy Specificity of self-efficacy: Task SE Barrier SE Scheduling SE Coping SE Assess self-efficacy at different levels of challenge Assess self-efficacy strength at each level of challenge  Example: Exercise Task Self-Efficacy Measure 1 mile (Low Challenge) L e v el of C h al le 10 miles n (High Challenge)g e Strength of Self- Efficacy Example: Barrier Self-Efficacy Measure (Self-efficacy for overcoming barriers to exercise)  Limitations of Self-Efficacy Self-efficacy best predicts novel or challenging behaviours ◦Not great at predicting maintenance of habitual behaviours Increases in self-efficacy do not necessarily generalize to other behaviours E.g., running vs. cycling E.g., hockey vs. figure skating Theory of Planned Behaviour  Theory of Planned Behaviour Overview Intentions = central role in behavior Intention: person’s motivation, decision, or conscious plan to perform a behaviour Determined by 3 factors: Attitudes Subjective Norms Perceived Behavioural Control  Theory of Planned Behaviour Components of Model Attitudes: person’s evaluation of a behaviour What do I have to gain/lose? How do I expect to feel? How important are these outcomes to me? Subjective Norm: degree to which someone feels social pressure to perform behaviour Do you believe that your peer-group expects you to exercise? Are you motivated to comply w/ their expectations? Do people in your peer-group exercise & how much do you identify with these people? Perceived Behavioural Control: Your evaluation of facilitators (feeling energetic, gym membership) and barriers to performing exercise (pain, bad weather) Your power / ability to influences these factors Theory of Planned Behaviour Components of Model STRENGTH OF MOTIVATION = KEY TO INTENTION INTENTION  Theory of Planned Behaviour Strengths & Limitations TPB does a good job @ explaining intentions to exercise Attitudes have stronger impact on intentions than SM or PBC Poor job explaining actual behaviour ◦ Intention-to-Behaviour Gap = 48%  Self-Determination Theory Edward Deci & Richard  Self-Determination Theory Overview The Type or Quality of motivation is equally important as strength of motivation to determining whether a person will engage in a behaviour ◦ How self-determined / intrinsically motivated is an individual’s behaviour? Central Aspects of Self-Determination Theory: Different TYPES of motivation & Whether motivation is internally or externally regulated Motivation Behaviour Self-Determination Theory Key Components Piece # 3 Psychological Needs Motivation Piece #1 Piece #2  Piece #1: Basic Psychological Needs 1) Autonomy Feeling self-determined, independence, having choice & control 2) Competence ◦ 3) Loading… Mastery experiences, feel like you are good at something Relatedness ◦ Feeling connected to others, feeling like you matter Piece # 3 Psychological Needs Motivation Piece #1 Piece #2 Piece #2: Motivation Piece # 3 Psychological Needs Motivation Piece #1 Piece #2  Three Categories of Motivation Low Self-Determination High Self-Determination Extrinsic Intrinsic Amotivation Motivation Motivation Complete lack of motivation Motivation coming from outside Motivation comes from within the individual  4 Types of Extrinsic Motivation 1) Integrated regulation: behaviour becomes a part of who that person is 2) Identified regulation: motivated by personal goals The individual is motivated by outcomes of the activity rather than the activity itself 3) Introjected regulation: self-imposed pressure to avoid guilt 4) External regulation: motivated to achieve an external reward Motivation on a Continuum Low Self-Determination High Self-Determination External Introjected Identified Integrated Regulation Regulation Regulation Regulation Engage in Behaviour Engage in Intrinsic Amotivation Engage in behaviour influenced behaviour Motivation behaviour for reward by self- to confirm to achieve or Imposed sense of an outcome punishment pressure self Extrinsic Motivation Thanks to Sheereen Harris! Towards Joy  Theories in Exercise Psychology Part 1 KINESIOL 3H03 Dr. Ross Murray Week 2 Sept. 10th 2024 mcmaster.ca Announcement and Updates Tutorial #1 starts next week! 2 pre-tutorial readings posted on Avenue – short and easy to read Assignment #1 will be given during tutorial - Due Fri SEPT 27th (+3 days grace period) Interview with a Scientist available tomorrow. Marks for watching full video (time stamped) and correct responses to quiz Quiz BONUS marks start today - End of class 10 points for 1st, 9 for 2nd, 9 for 3rd, …..1 for 10th 1st place at the end of the semester gets 3% bonus 2nd place gets 2% 3rd place gets 1.5% bonus Anyone who completes 7 quizzes 1% Lecture Outline and Objectives The brain, prediction, and motivation Expectancy-Value Approach Social cognitive theories: Self-Efficacy Theory Theory of Planned Behavior (TPB) For each theory you should be able to… Describe the main components of the model Explain how each theory attempts to predict behaviour Differentiate between the strengths and weakness of each theory Social Cognitive Theories are Routed in Human Motivation A person’s future behaviour can be determined/explained by their motivation Behavioural Economics Motivation is predicted by expected outcomes and value placed on the behaviour ◦ Why do people make certain choices, despite knowing they are not the best, healthiest, safest for them ◦ Choices made based on: ◦ 1) Low Cost, ◦ 2) Highly reinforcing / high gain Expectancy-Value Approach  Social Cognitive Theories are Routed in Human Motivation Expectancy-Value Approach More motivated to do a behaviour 1. Low Cost As perceived by an individual 2. High gain / highly reinforcing Examples: 1. Completing a university degree 2. 2% bonus marks 3. Watching endless TikTok videos 4. Flossing your teeth Operant Conditioning BF Skinner: Reinforcement schedules Fixed Ratio (FR): Reinforcement after a set number of responses (Example: Reward after every 5 tasks completed) Variable Ratio (VR): Reinforcement after a varying number of responses (Example: Slot machines that pay out randomly) Fixed Interval (FI): Reinforcement after a fixed amount of time (Example: Paycheck every two weeks) Variable Interval (VI): Reinforcement after varying amounts of time (Example: Checking for social media notifications, which come at unpredictable times)  STRRIDE: Studies of a Targeted Risk Reduction Intervention through Defined Exercise Analysis of 947 adults who participated in exercise interventions to improve cardiometabolic health (STRRIDE Trials) 31% of participants dropped out (295 / 947) Main reason for drop-out = TIME (40%) Collins et al., (2023) Translational J ACSM Movement guidelines Canadian 24-hour movement guidelines ◦ least 150 minutes of MVPA per week (i.e., 21.4 minutes per day) ◦ less than 8 hours of SB per day Movement behaviours ◦ 7-9 hours of sleep per 24-hour period ◦ Several hours of LPA-including standing LPA All behaviours are correlated SB ◦ Time composition MVPA Sleep LPA MVPA Sleep SB (The Canadian Society for Exercise Physiology (CSEP), 2020) Drop-Out Timing… Run-In = familiarization period Ramp = progressively increasing exercise dose Months 1 to 7 = exercise intervention / maintenance period Majority of drop-out happened at the beginning of the exercise period… (ramp period) Collins et al., (2023) Translational J ACSM Self-Efficacy Theory  Self-Efficacy Theory Overview Self-Efficacy – A situation-specific form of self-confidence. Degree of Influence High state of arousal  Types of Self-Efficacy  Types of self-efficacy: Task SE Self-confidence to complete a specific task Barrier SE Self-confidence to overcome barriers that may prevent you from goal Scheduling SE Self-confidence to effectively schedule your time for your goal Coping SE Self-confidence to handle unforeseen life events that may impede progress to your goal  Measurement of Self-Efficacy 1 mile (Low Challenge) Level of Challenge Questionnaires used to measure: 1. Level of Challenge 2. Strength of SE 10 miles (High Challenge) Strength of Self-Efficacy Education vs. Exercise intervention for people with type 2 diabetes Exercise = 8-wk walking intervention & 4 workshops Workshops goal – increase 4 sources of SE Education = online diabetes and health education course  Measured Barrier SE (BARSE) – how confident… face barriers like weather, time, etc. SE for walking (SEW) – how confident… walk at a fast pace for 5 min, 10 min, 15 min Exercise SE (EXSE) - how confident… exercise for 40 min over the next 2 months, 3 months, 4 months? BARSE = barriers self-efficacy SEW = self-efficacy for walking EXSE = exercise self-efficacy Results SEW and EXSE increased after intervention, BARSE did not Physical activity increased and remained elevated after 6 months SEW and BARSE positively correlated with increased physical activity People who Walking and Barrier SE tended to increase PA levels BARSE = barriers self-efficacy SEW = self-efficacy for walking EXSE = exercise self-efficacy Limitations of Self-Efficacy?? Over time, it is not a good predictor m0 = Baseline m2 = immediately after intervention m6 = 6 months post-intervention Case Study How to Increase Self-Efficacy Amir is a 65 year old who recently started a new volunteer job and decided it’s time to get in shape However, he’s concerned that he doesn’t have the time or the physical stamina to exercise on a regular basis. He may be too tired on the job if he exercises. Amir loves nature and used to go for daily hour-long walks with his partner and their dog Develop strategies to increase Amir’s self-efficacy for exercising on a regular basis (table on next slide for reference) Source of Self-Efficacy Strategies for Enhancing Amir’s Self-Efficacy Mastery of Experience - Gradually increase intensity, volume, duration of walking -—Gradually Introduce increase small, daily activities intensity, (take volume, the of duration stairs, walk the long way between walking —Introduce small, daily activities (take the stairs, walk the long way between meetings) meetings) Vicarious Experience (modelling) - Joining a walking club with similar aged peers (men +) - —Joining a walking Amir seeing clubcouples other with similar aged peers walking their(men+) dogs in local parks —Amir seeing couples walking their dogs in local parks - Seeing how colleagues w/ similar job demands schedule walking —Seeing how colleagues W/ similar job demands schedule walking Social Persuasion - Friends and family can verbally encourage Amir - —Friends Joiningand family can a walking clubverbally createsencourage Amir a commitment / accountability to others —Joining a walking club creates a commitment / accountability to others Physiological/Affective States - Monitor energy and mood after exercise. Create positive framing of feelings —Monitor energy and mood after exercises. Create positive framing of feelings - —Teach TeachAmir Amir howhow to accurately to accurately monitormonitor his heart his heart rate, rate,muscle breathing, breathing, fatigue muscle / sorenessfatigue / soreness during exercise during exercise Theory of Planned Behaviour  Theory of Planned Behaviour Overview Intentions = central role in behavior STRENGTH OF MOTIVATION = KEY TO INTENTION How do we assess Theory of Planned Behaviour Constructs?  Mothers of young children (MYC) are at-risk for being physically inactive Parenthood associated with PA Big transition period in life, numerous barriers to physical activity 4 Intention-Activity Profiles Emerged Purpose of Study: To explore if MYC’s intention to exercise translated to actually exercising 1. Non-intenders, inactive 2. Intenders, inactive Surveyed 160 MYC and measured: 3. Intenders, active Intentions to exercise 4. Non-intenders, active Weekly PA levels Previous PA habits Active = 150 min MVPA per week Self-efficacy (barrier SE) Exercise identity (e.g., “I consider myself a physically active person”)  100% 9% Key limitation 45% 90% Intention-Behaviour Gap 80% Percent of Respondents 70% 60% 50% 25% 40% 30% 21% 20% 10% 0% Non-Intenders, Inac ve Intenders, Inac ve Intenders, Ac ve Non-Intenders, Ac ve  What might explain this gap? What was different about mothers who intended to be active, but were NOT vs. those that WERE active? Self-Efficacy – 73% Identity – 65% Habit – 67% The percentages represents how strongly each factor accounted a mother being active… Based on statistical modelling…  Summary Expectancy-Value Approach Motivation is fundamental to most exercise behaviour theories Motivation is predicted by expected outcomes and value placed on the behaviour Self-Efficacy Theory Self-confidence for a situation will predict behaviour Scheduling, overcoming barriers, performing the task, coping w/ unexpected life events Can SE by targeting 4 main sources of SE Theory of Planned Behaviour Intentions are central for predicting behaviour Strength of motivation key for intentions Intention-to-Behaviour Gap… the TBP does not do a good job in predicting PA  Theories & Models of Exercise Behaviour Part 2 Dr. Jeremy Walsh KINESIOL 3H03 Asynchronous Lecture #3 mcmaster.ca Lecture Outline and Objectives Theory/Model Disuse Transtheoretical Model Beyond the Individual Social Ecological Model  An attempt to predict/explain why Refresher a behaviour or phenomenon occurs Theory Development Loading… Cycle  The Transtheoretical Model "Stages of Change” Pre-contemplation: unaware of the problem Contemplation: aware of problem, desired to change behaviour Preparation: Intends to take action Action: practices the desired behaviour Maintenance: works to sustain behaviour change  Evidence that People Move Through Stages Shift in decisional balance (pros vs. cons) Loading… Increased self-efficacy  The Transtheoretical Model "Stages of Change” Example: Exercise Pre-contemplation: Help people understand the benefits of exercise. Contemplation: Spur contemplators to identify more advantages of being active. Preparation: Help people get organized and start planning; give them tools and info. Action: Offer tips on overcoming barriers. Maintenance: Provide info to prevent backsliding. Limitations & Disuse of the Transtheoretical Model Major limitation of the TTM is that its constructs cannot reliably predict which stage a person will move to and when. The model fails to fully explain the mechanisms by which people change their exercise behavior and move across the stages. Because of this limitation and others, the TTM has largely fallen out of use in exercise psychology research. However, it is still used by some physical activity counselors because its simple and straight forward Social Ecological Models of Physical Activity Source: https://doi.org/10.24095/hpcdp.39.5.04  Social Ecological Models From the Individual to Society At-Large Social Cognitive Theories (previous lectures) Focus on the individual How an individual THINKS & FEELS about exercise will determine future exercise behaviour Social Eco Models the individual is only 1 piece of the puzzle some responsibility Individual bears some responsibility for healthful behaviours… Individual Physical Activity Domains Interpersonal Factors Physical Environment Policy  Physical Activity Domains Areas of life where physical activities might take place Interpersonal-Level Factors Interactions and relationships b/w groups and individuals Physical Environment Features of the built and natural environment Policy Rules, regulations, and practices that may impact physical activity through a variety of mechanisms The Social Ecological Model of Physical Activity Comprised of correlates and determinants of PA Correlates Factors that are reliably associated (correlated) with PA behavior, but they do not cause changes in PA Loading… Example – owning exercise equipment Determinants Factors that are correlated with PA, but they also directly affect PA Example – weather and outdoor activity Difficult to establish what determines PA vs. what is correlated with PA For Lecture on Thursday…  Social Ecological Model Application @ Every Level - Bike lanes Physical environment - Trails in nature / preserving green space Physical environment - COVID restrictions on indoor and outdoor activities Policy - Support groups, mommy yoga, cancer survivor exercise groups Interpersonal - Company policies Policy - Drop bike availability - Pokemon Go Benefits of the Social Ecological Models A look at the “big picture” Gives us an understanding of the multiple levels of influence An environmental approach to behaviour change Limitations of the Social Ecological Models Feasibility and cost of implementation If we build it, will they come? ◦ Providing the resources does not mean that people will automatically become more physically active  Theories in Exercise Psychology Part 2 KINESIOL 3H03 Dr. Ross Murray Week 3 Sept. 17, 2024 mcmaster.ca  Announcement and Updates Tutorial #1 assignment Due Friday Sept. 27 th (plus 3-day grace period) Interview with a Scientist #1 closes on Monday Sept 30 th at 11:59pm September 30 Tutorials rescheduled Office hours (Tuesday 9:30am): Email me before Tuesday Lecture Outline and Objectives Self-Determination Theory Review assumptions of SDT Look at SDT & physical education research How do incentives impact motivation? Social Ecological Model Focus on the built environment Bike lanes & neighbourhoods  Summary of Social Cognitive Theories Self-Efficacy  situational self-confidence motivates us to perform PA behaviour Many types of SE (task, barrier, scheduling, coping, etc) 4 main sources that SE Theory of Planned Behaviour  intentions predict behaviour Strength of motivation = key to intentions 3 main sources that intentions Self-Determination Theory  Self-Determination Theory Overview Assumptions of SDT 1. Human behaviours are volitional (we have choice) Unless you have weed gummies 2. Humans strive for psychological growth and development The Type / Quality of motivation is equally important as strength of motivation to determining whether a person will engage in a behaviour Motivation Behaviour  The SDT Model Basic Psychological Needs Types of motivation Intrinsic Motivation Definition: Motivation that comes from within the individual, driven by personal satisfaction, interest, or the enjoyment of the task itself. Example: Exercising because you love the feeling of moving your body. Integrated Regulation Definition: Motivation where behaviors are fully assimilated with one's self, aligning with personal goals and values, but still tied to external outcomes. Example: Exercising regularly because staying healthy aligns with your identity and long-term life goals, Identified Regulation Definition: When individuals recognize the value of a behavior and accept it as their own, but it’s still done for external reasons. Example: Going to the gym because you know it will improve your long-term health and help prevent disease, though you might not enjoy the workout itself. Introjected Regulation Definition: Motivation that is driven by internal pressures, such as guilt or obligation, but not truly self- determined. Example: Exercising because you feel guilty about not being active. External Regulation Definition: Actions performed solely for external rewards or to avoid punishment. Example: Working out because your doctor told you to, or to lose weight for an upcoming event like a wedding.  Looked at relationships between PA, Motivation Type & Psychological Needs in school children 265 studies analyzed Relationship between Physical Activity and Intrinsic Motivation? Positive Relationship between PA and Extrinsic Motivation & Amotivation? Negative Intrinsic Motivation positively associated with supporting all 3 psychological needs Extrinsic & Amotivation negatively associated with supporting all 3 psychological needs  Basic Psychological Needs Autonomy Competency Relatedness Teachers had a strong influence on supporting… Teachers had less of an influence Creating activities that support autonomy and Connecting and relating with peers has competency increase PA greater influence  Can We Shift Motivation? Role of Incentives Low Self-Determination High Self-Determination Extrinsic Intrinsic Amotivation Motivation Motivation Complete lack of motivation Motivation coming from outside Motivation comes from within the individual Background: Frequency of self-weighing is important for weight loss and preventing weight gain Question: Will $$ increase intrinsic motivation to self-weigh and help with weight loss / maintenance? The Study: people with obesity in Weight Watchers who previously lost ≥5kg in the past 4-6 months Active Control Group: Received encouraging messaging on digital weight scales Incentive Group: given $3.98/wk if they weighed themselves 6x, also had a chance to win a lottery prizes ($110) Money incentive increased each week Also received encouraging messaging on digital weight scales 12 months 6 months $$ incentive incentive Part 1 Part 2 Behaviour = frequency of self-weighing Outcome = weight loss and maintenance  Expectancy-Value? Negative effect when incentive is taken away  $$ Incentive: - PA during intervention period - PA after intervention, when $$ has been removed Factors that Incentive Effectiveness Social Ecological Models of Physical Activity Physical Environment = Built Environment + Natural Environment  Built Environment Functional Features: structural features that influence the extent to which a person can actually use the environment Paths, sidewalks, streets, parking, wheelchair accessibility, lighting Safety Features: characteristics that keep people safe / from harm Barriers (bike lanes), fences (animals), lighting (traffic and street/path), security cameras  Protected Lane = Safer narrow = more dangerous Unprotected Lane = not safer  Built Environment Aesthetic Features: Features that are interesting and pleasing Trees and flowers, architecture, air quality Destination Features: Reflect the availability of places/destinations that people could walk or bike to in their neighborhoods (e.g., shops, bus stops, schools) as well as the proximity of gyms, playgrounds, basketball courts, and other places to be active Green spaces and blue spaces Green spaces: Parks, forests, gardens Blue spaces: Rivers, lakes, oceans Natural environments improve mental well-being Individuals living close to green/blue space are more likely to be physically active Blue space Walking Physical activity  Summary Self-Determination Theory Quality/Type and Strength of motivation equally important intrinsic motivation = PA behaviour, well-being, enjoyment Unsure HOW people move through motivation / how to shift motivation Some evidence for incentive, but details matter Social-Ecological Model The individual is ONE part of the equation Structural, environmental, political, interpersonal factors impact PA behaviour  Developing Exercise Interventions pt. 1 Dr. Jeremy Walsh KINESIOL 3H03 Asynchronous Lecture #6 mcmaster.ca  Lecture Outline and Objectives Examine approaches to developing exercise interventions Systematic Approach to developing interventions 4 stages… Today we will focus on: Stage 1: Understanding the behaviours Stage 2: Identifying intervention options Approaches to Developing Exercise Interventions ISLAGIATT – It Seemed Like A Good Idea At The Time Intervention designed without establishing a thorough understanding of the influences on physical activity for a specific population in a specific context Interventions designed without using theory. Loading… Stages for Developing an Exercise Intervention Stage 1: Understand the behavior Stage 2: Identify intervention options Stage 3: Identify intervention content and implementation options Stage 4: Evaluate the impact of the intervention Stage 1: Understand the Behaviour Step 1 – Identify Target Behaviour and Population: What specific physical activity behaviour are you trying to change? (Target Behaviour) Who is the specific target population / individual of the intervention? (Target Population) Examples Loading… Increasing active transportation to/from school in elementary school-aged children Breaking-up sitting with activity breaks in office workers Important target the BEHAVIOUR, not the OUTCOME  Stage 1: Understand the Behaviour Step 2 – Conduct a Behavioral Analysis and Diagnosis: Goal – identify what factors need to change in order for behaviour to occur Capability: Does the individual have the physical strength, knowledge, skills, and stamina to perform the behavior? Opportunity: Does the individual have a supportive physical and social environment to perform the behavior? Motivation: Does the individual want to do the behavior more than they want to do another competing behavior?  Stage 1: Understand the Behaviour Step 2 – Conduct a Behavioral Analysis and Diagnosis: Goal – identify what factors need to change in order for behaviour to occur Capability: Physical – skills, stamina, strength Psychological – mental capacity, knowledge Opportunity: Social – influences, social cues, social norms Physical – time, resources, built environment Motivation: Reflective – planning, intentions, evaluating outcomes Automatic – emotional reactions, impulses, desires COM-B Case Study Hashim has never worked out on a regular basis but thinks that lifting weights would improve his self-confidence He bought a gym membership and successfully scheduled exercise into his daily routine, but… When he tried a workout, he felt intimidated and self-conscious b/c he didn’t know how to use the equipment Hashim’s friend Jacob is an experienced weight lifter and offered to workout with Hashim and teach him some exercises  ACTIVITY AND SCENARIO FOR BEHAVIOURAL ANALYSIS COM-B Factors What needs to happen to PA to occur? Is there a need for change? Physical Capability CAPABILITY Psychological Capability Social Opportunity OPPORTUNITY Physical Opportunity Reflective Motivation MOTIVATION Automatic Motivation BEHAVIOURAL DIAGNOSIS: based on assessment state what factor(s) need to be targeted for PA to occur Stage 2: Identify Intervention Options Step 3: Select Intervention Functions - intervention activities that are designed to change behaviour by making change to capability, opportunity, and/or motivation  IMPORTANT Goal: to get college students to perform strength training Linking COM-B with Intervention Functions Stage 2: Identify Intervention Options Step 4: Select Policy Categories - Policy categories are approaches that can be used by stakeholders to support or establish interventions Stakeholder = people with interest or concern in something (context matters) Workplace PA Intervention – employees, employers, insurance providers, physicians, investors PA intervention in remote indigenous school – parents, children, elders, community and cultural leaders, physicians, teachers Exercise classes for people with dementia Opening up Main St. to pedestrians and cyclists only on weekends Policy Categories 7 policy categories and examples for promoting strength training in colleges students *Feasibility matters!! Need to take into account what categories you can influence Linking Intervention Functions w/ Policy Categories  The Behaviour Change Wheel Putting Stage 1 & 2 Together Using this approach, we can: 1. Understand the target behaviour 2. Consider the full range of options available to you 3. Have a systematic approach for selecting behaviour change techniques (Michie et al., 2014, 2011)  Developing Exercise Interventions KINESIOL 3H03 Dr. Ross Murray Week 4 Sept 23, 2024 mcmaster.ca  Announcement and Updates Test #1 - Tues Oct 8th @ 10:30 – 11:20 am in-person ~ 20 MC, True/False ~ 15 marks for short answers No classes or tutorials Monday September 30th (Truth and reconciliation day) Tuesday lecture will be asynchronous – No in person class Optional Q&A Review Session – Mon Oct. 7th @ 9:30 - 10:20 am Q&A Style – BYO Questions  Overview Designing Exercise 1. Introduction to target population and behaviour Interventions 2. Introduction to behaviour change techniques (BCTs) Adopting a Systematic Approach to Intervention Design  What do we know so far? (Stages 1-2) S1 Target population – Who is the intervention for? Target behaviour – What behaviour are we trying to change? Behavioural determinants – Why is the behaviour not currently happening? Intervention functions – What activities should be included? Policy categories – How will we implement these activities? S2  Okay… Now what? What’s been done: Intervention Behaviour content change What we want to do: Behavioural determinant(s) Intervention Behaviour content change How do we get individuals to change their behaviour? Behaviour Change Theory and the use of Behaviour Change Techniques (BCTs) 7 Build a common language to support future research 8 Behaviour Change Techniques Recipe provides sufficient information to bake a great cookie AND someone else can replicate the cookie by following the recipe 8  Stage 3: Identify Content and Implementation Options Step 5: Select behaviour change techniques (BCTs) Smallest active ingredients of an intervention Each technique is distinct and used to help bring about behaviour change Observable – involve an action or event that can be seen or measured. Replicable – able to be repeated in the same way by others to achieve the same effect. Highly detailed Irreducible – smallest unit of change, meaning it cannot be broken down further without losing its effectiveness as an intervention Behaviour Change Technique Taxonomy BCT Categories 1. Goals and planning 10. Reward and threat 2. Feedback and monitoring 11. Regulation 3. Social support 12. Antecedents 4. Shaping knowledge 13. Identity 5. Natural consequences 14. Scheduled consequences 6. Comparison of behaviour 15. Self-belief 7. Associations 16. Covert learning 8. Repetition and substitution 9. Comparison of outcomes (Michie, 2013) 8 Behaviour Change Technique Taxonomy 1. Goals and planning 1. Goal setting (behaviour) 2. Problem solving 1. Observable 3. Goal setting (outcome) 2. Replicable 4. Action planning 3. Irreducible 5. Review behaviour goal(s) 6. Discrepancy between current behaviour and goal 7. Review outcome goal(s) 8. Behavioural contract 9. Commitment (Michie, 2013) 8  Potential modes of BCT delivery Stage 3 Step 6: Select modes of BCT delivery for the intervention Booklet/informational Billboards brochure Podcasts Mass media campaigns TV ads Apps Podcasts Face to face Pre-recorded videos Virtual Social media Phone call Website  Considerations for individual vs. group interventions? Feasibility Individual: Easier to tailor to personal schedules, needs, and availability. Group: Requires coordination among multiple people, may face scheduling conflicts. Practicality Individual: Can be more flexible and adapted to specific circumstances or challenges. Group: May benefit from shared resources and time efficiency but can be less personalized. Common traits among group members Individual: Doesn't require considering group dynamics; focus is entirely on personal characteristics. Group: Important to group similar people together in terms of goals, interests, or challenges to foster cohesion and relevance. Goals Individual: Highly specific to personal aspirations and tailored strategies. Group: Common or overlapping goals are crucial to ensure everyone benefits from the same interventions. Past behaviour Individual: Interventions can be deeply reflective of an individual’s history and previous challenges. Group: Balancing past behaviors can be challenging; need to ensure interventions work broadly or for the majority  Stage 4: RE-AIM Framework for intervention evaluation Reach – What percentage of people from a given population participate? What are their characteristics / who are they? Effectiveness/efficacy – What are the positive and negative consequences as a result of the intervention? Adoption – What proportion of settings adopted the intervention? What are their characteristics? Implementation – How well was the intervention delivered in the real world? Were the instructions followed? Maintenance – How well was the intervention is sustained over time?  Summary BCTs are the smallest active ingredient of all interventions BCTs should be chosen to align with the behavioural analysis (Stages 1-2) Which behavioural determinants need to be addressed? Be mindful of individual vs. group interventions Design with the end in mind (RE-AIM framework)  Social Influences on Exercise Dr. Jeremy Walsh KINESIOL 3H03 Asynchronous Lecture #5 mcmaster.ca Lecture Outline and Objectives Social Influences on Exercise 5 types of social support Sources Family Health care practitioners Exercise leaders Exercise groups Social media Social Influence and Support Social influence: Real or imagined pressure to change one’s behavior, attitudes, or beliefs Loading… Social support: Perceived comfort, caring, assistance, and information that a person receives from others ◦Reflected in the size of one’s social network ◦Reflected in the amount/type of support received  Types of Social Support Instrumental Support Emotional Support Informational Support Companionship Support Validation Support  Instrumental Support: involves providing tangible & practical assistance that will help someone achieve their exercise goals e.g: spotting a weightlifter in the gym Emotional Support: happens by expressing encouragement, empathy, caring and concern towards another person e.g: praising your friend for completing a run and encouraging them to do it again Informational Support: providing directions, advice or suggestions about how to exercise e.g: providing feedback on someone’s progress Companionship Support: availability of friends, family and exercise groups for you to exercise with e.g: going to the gym with a friend, going for a walk with you dog Validation Support: comparing yourself to others in order to validate your thoughts, feelings & experiences as normal e.g: someone in a cardiac rehab setting had a heart attack, seeing other like them will give them validation Loading… Possible Negative Influences: Teasing/bullying Sources of Social Support Family Family consistently shown to have small, but positive impact on exercise behavior Support comes in many different forms Parents influence on children especially important Sources of Social Support Family Cardiac Rehab Example: Reduces risk of death by 25% Goal = increase adherence and completion of rehab Completed Drop-Out Rehab Exercised with Spouse 90% 10% Exercised without Spouse 66% 33%  The Family Downsides Greater pressure to exercise / perform can lead to feelings of guilt for not exercising Can have the opposite effect on exercise behaviour Behavioural Reactance: when individuals perceive significant others to be exerting social control rather than providing social support Perception of pressure (support vs. control) impacts perception of the activity Encouragement (+ support) increase exercise effort/behaviour Pressure (- support) behavioural reactance, decrease effort/behaviour  Sources of Influence: Health Care Providers Credible, preferred source of information “Practice what you preach” People more likely to be active if a doctor encourages it Why don’t all physicians prescribe PA?  ACSM’s Exercise is Medicine (EIM) Loading…  Sources of Influence: Exercise Leader/Instructor Can provide all five types of social support Influence may depend on leadership style Ratings of Perceived Exertion Training 1RM (aka (RPE) Intensity gainz) PT > no PT PT > no PT PT > no PT  Importance of Leadership Style Transformational BLAND Encouraging, positive, Neutral, no support or socially supportive encouragement Addresses participants Does not use by name participants’ names Reinforces positive Focuses on correcting behaviours, ignores negative behaviours/ mistakes mistakes Words instructions Words instructions positively negatively Transformational Leadership  Importance of Leadership Style Compared to a bland leadership style, an transformational leadership style produces greater: Exercise self-efficacy Energy and enthusiasm Enjoyment Adherence Intention to join exercise class in future And less… Post-exercise fatigue Concern about embarrassing oneself and trying new things  Exercise Groups Dynamics and Cohesion Those who are part of an exercise group are more likely to be adherent BUT, some aspects of exercise groups can undermine exercise- related thoughts, feelings, and behaviors Key aspects: Group cohesion Group size Group composition  Exercise Groups Cohesion Dynamic process reflected in the tendency of the group 2 Key Elements: ) Task – liking the group activities / goals ) Social – liking group members and interactions outside of exercise Exercise Groups Cohesion Group Size As group sizes , perceived group cohesion and exercise satisfaction Why? Smaller groups = easier to integrate people, more individual attention Bigger groups = more crowded, lower quality of interactions  Group Composition Factors People may feel more comfortable and confident exercising in groups… Where they are on an equal footing with other group members When they perceive other exercisers as physically similar Social Facilitation “Social” Technology