Exercise Modules

1. Exercise Modules SAMHSA Grant - Wellness Module Exercise

2. Contemplation Stage • Definition: Individuals that are inactive but thinking about becoming active (Napolitano, Lewis, Whiteley, and Murcus, 2006, p.546)

3. Benefits of Exercise • Exercise can improve your chances of living longer (www.gsu.edu, www.mayoclinic.com, www.cdc.gov) • Reduce of risk of developing or dying from heart disease (www.cdc.gov, www.gsu.edu) • Reduce high blood pressure or the risk of developing high blood pressure (www.gsu.edu) • Reduce high cholesterol or the risk of developing high cholesterol (www.gsu.edu) • Reduce the risk of developing colon and breast cancer (www.cdc.gov, www.gsu.edu) • Reduce the risk of developing diabetes (www.cdc.gov, www.gsu.edu) • Reduce or maintain body weight and/or body fat (www.gsu.edu) • Build and maintain healthy bones, muscles, and joints (www.cdc.gov, www.gsu.edu) • Exercise can help control your weight (www.cdc.gov, www.mayoclinic.com)

4. Benefits of Exercise • Exercise can improve your mental health and mood (www.cdc.gov, www.mayoclinic.com) • Reduce depression and anxiety (www.gsu.edu) • Improve psychological well-being (www.gsu.edu) • Improve work, recreation, and sport performance (www.gsu.edu) • Exercise can improve your ability to do daily activities, and reduce falls (www.cdc.gov) • Exercise boosts your energy level (www.mayoclinic.com) • Exercise helps you sleep better (www.mayoclinic.com) • Exercise can improve your sex life (www.mayoclinic.com) • Exercise can be fun (www.mayoclinic.com

5. HealthSelf-Assessment • Calculating your BMI (Body Mass Index) (www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html) • Measuring your Waist Circumference (link to health issues) (www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/txgd/4142.htm)

6. Physical Activity Self-Assessment Tracking your daily total physical activity (www.mypyramidtracker.gov). • Factors Associated with Regular Physical Activity Participation _(King and Castro, 2006) • Personal Factors: • Gender • Women are more likely to continue moderate intensity physical activities rather than vigorous physical activities (King and Castro, 2006). •  Age • As we get older, we prefer less vigorous physical activities and are most comfortable maintaining moderate intensity physical activities (King and Castro, 2006). •  Educational Attainment • Years of education are positively correlated with amount of physical activity (King and Castro, 2006). Thus, college educated populations are more physically active than those without a college education. •  Household Income • Household income is positively correlated with amount of physical activity (King and Castro, 2006). •  Health Factors • Persons with medical problems, disabilities, and smoking status are all associated with lower physical activity levels (King and Castro, 2006). • Overweight and obese individuals have been consistently found to be less physically active, including activities of daily living (i.e. taking stairs) (King and Castro, 2006).

7. Cognitiveand Experiential Factors: • Negatively related to physical activity (King and Castro, 2006, p.567): • Negative experiences with physical activity; • Negative perception of one’s health status; • Negative perception of one’s ability and physical skills; • Lower self-efficacy beliefs (defined as belief that you can successfully perform a specific physical activity); • Low outcome efficacy beliefs (belief that physical activity has positive health and personal wellness benefits); • Low levels of perceived physical activity enjoyment and satisfaction; • Negative perceptions related to recreational facilities’ access, convenience of the physical activity attempted, lack of time for exercise, and intensity of physical activity; • Limited understanding of how physical activity relates to short-term and long-term health and wellness benefits; • Limited perceived value of physical activity (health and wellness benefits) compared to the costs or burdens associated with physical activity.

8. Behavioral Factors (King and Castro, 2006) • Ability to manage disruptions to physical activity (i.e., plan for physical activity during holidays), known as relapse prevention. • Using a decision balance sheet to weigh the benefits and costs associated with physical activity. • Monitoring progress toward short and long-term physical activity goals, receiving ongoing feedback on progress (www.mypyramid tracker.gov), and giving oneself rewards for progress (Premack Principle). • Structuring the environment to remind oneself to be physically active (visual or auditory reminders).

9. Environmental and Program Factors (King and Castro, 2006, p.568) • Environmental and Program Factors (King and Castro, 2006, p.568) • Family influences and support • Low family support for physical activity is associated with low physical activity participation and dropout from recreation programs. • Proximity, access to, and affordability of recreational facilities (if the individual prefers a facility-based program). • Weather

10. Physical activity regimen flexibility • General public prefer to engage in physical activity programs outside of a formal group or facility. Thus, home-based physical activity programs are preferred. The following exercise program parameters should be tailored to the individual’s needs: • Type of activity (mode) • Women prefer videotaped exercise or aerobic dance more than men. • Intensity level of exercise. • Location of exercise. • Duration or length of time for each exercise session. • Frequency of exercise sessions per week.

11. Physical activity regimen flexibility • Convenience and ease of scheduling of the activity (real or perceived). • Visual or auditory cues or prompts in the environment to promote physical activity (reminders). • Immediate consequences of physical activity for the individual (i.e., discomfort). • For sedentary individuals, make sure initial physical activity is relatively pain-free (low intensity), enjoyable, and reinforcing through shaping procedures (gradual progressive increases in physical activity duration, frequency, and intensity but within the psychological and physical capabilities of the individual).

12. Exercise Planning: Early Adoption Factors & Behavioral Guidelines (King, Martin, and Castro, 2006) • Amount and type of exercise recommended (can do partial recommendation initially – or break times into segments). • Other early adoption factors and guidelines (enjoyable activities; exercise partner; use of reminders; basic warm-up and cool-down tips; initial program examples). • Personal & Behavioral Factors (King, Martin and Castro, 2006): • Misconceptions and myths about participation in physical activity should be challenged.

13. Physical Activity Myths Quiz(12 items - check your answers: )Physical Activity Myths QuizView Answer Key

14. Personal & Behavioral Factors (King, Martin and Castro, 2006): • Personal & Behavioral Factors (King, Martin and Castro, 2006):  • Sedentary individuals benefit from instruction on the proper performance of specific physical activities (insert stretching exercises instruction) so to obtain health benefits while minimizing potential injuries associated with physical activity. • Mode of activity should be consistent with the individual’s physical activity goals. • Sedentary individuals need to develop reasonable expectations for their physical activity goals (Exercise program adherence is the initial exercise goal). • Sedentary individuals should review the potential benefits associated with their exercise program as well as the potential barriers related to increasing their physical activity (checklist here is potentially helpful). • An individual’s early sense of self-efficacy is a major predictor of physical activity participation. The following behavioral strategies enhance self-efficacy: • Set realistic, measureable, small and attainable physical activity goals. • Provide individual with regular positive feedback and support for their physical activity efforts • (acknowledge small steps of progress – shaping). • Teaching an individual to monitor (self-assessment via online tracker) their physical activity • level so that they can keep track of their ongoing progress (enhances an individual’s sense of • control of their physical activity regimen).  • Helping individuals to plan for potential disruptions to their physical activity regimen (i.e., • planning for physical activity when travelling). This also enhances a sense of control of their • physical activity regimen.

15. Program-Related & Environmental Factors (King Martin, and Castro, 2006) • Convenience (King, Martin and Castro, 2006) • The greater the preparation needed to exercise (i.e. changing clothes, driving to gym), the greater the likelihood of dropping out. • Time is often the primary factor in an individual’s perception of physical activity being inconvenient. Thus, it is essential that an individual plans to adopt physical activity that can be well-integrated into their lifestyle (i.e. biking to work, taking the stairs, exercising on the way home from work). • Modes of physical activity that require special, costly, or time-consuming preparation (i.e., swimming, skiing, golf, or hockey) negatively influence physical activity program adoption and adherence.

16. Behavioral Shaping (King, Martin and Castro, 2006) • Sedentary individuals that are exposed to gradual shaping of physical activity behavior have the best chance of exercise adherence. • Individuals need to have regular opportunities for success at physical activity with limited opportunities for failure (see goals). • The risk of injury and dropout increase when beginning exercisers are prematurely exposed to increases in exercise intensity relative to their capacity, frequency (i.e. five or more days per week), or duration (i.e., 45 minutes or more per session). Individuals in the action or maintenance stages could handle the above changes in program parameters. • Exercise program adherence (start basic with gradual program increases to ensure success) is the initial goal for the first 6-12 weeks in order to establish the habit of physical activity. Optimum health goals should be avoided here. • Maintain exercise intensity where talking is possible. • Exercise intensity can be monitored by portable heart rate monitors (beginner exercisers should remain under 70% of HR max), or RPE (rate of perceived exertion – new exercisers should have at RPE of 12 or less)(see Table 1 – p.22 for RPE scale 0-20). • Utilize distraction methods (i.e., listening to music, etc.) to manage aversive aspects of activity (i.e. sweating).

17. Goal Setting (King, Martin and Castro, 2006) • Physical Activity goals should follow the acronym SMART (specific, measureable, attainable, realistic or recorded, timeframe specific). • Behavioral shaping is predicated on reasonable physical activity goals. • Enjoyability (King, Martin and Castro, 2006) • Individuals are more likely to continue physical activities that are perceived to be enjoyable.  • Physical activities should be chosen that will minimize physical discomfort or at least set reasonable expectations for each physical activity. • Methods to enhance enjoyability include tailoring physical activity program to the individual’s preferences of mode of activity (type of exercise activity) as well as format of exercise program (group vs. individual, facility vs. home). • An individual’s level of enjoyment with their physical activity should be regularly assessed (single likert question) and repeated low responses should result in prompts to change the physical activity to be more enjoyable.

18. ExternalRewards and Incentives (King, Martin and Castro, 2006) • The greater the period of inactivity prior to commencement of a physical activity program, the longer the period before physical activity becomes intrinsically rewarding (i.e. feels good). Thus, external rewards are necessary early in program adoption to encourage program adherence (King, Martin, and Castro, 2006, p.575). • The need for external rewards varies and ranges from as little as 2-3 weeks for fit individuals to 6-12 months for very unfit individuals. • Individuals should chose their own rewards (must be personally rewarding). • Social support is a powerful reward and includes instructors, exercise partners, coworkers, friends and family, and others. • Social support to increase physical activity can be verbal (in person), telephone contact, email, or letter prompts. • Praise is key to social support and praise components include: • Praise should be immediate, during or after physical activity;  • Praise should be specific; • Praise should occur consistently and frequently during the initial adoption of physical activity. • Family support is important to maintaining physical activity as long as family members do not inadvertently influence an individual to increase the intensity of their exerciseprematurely.

19. Family Support • Also, family should not use aversive control as it decrease physical activity adherence. • Positive role models (exercising and interacting with others than provide a good active model) encourages physical activity. • Feedback is an important form of social support regarding progress with physical activity: • Physical activity habit can be established through monitoring physical activity attendance, general physical activity adherence or performance results of exercise program: • Use of pedometers is helpful to provide feedback; • Other feedback methods: • Self-recording monitoring sheets;  • Activity diaries (journal);  • Graph plotting HRs, attendance, adherence over time; • Computer generated feedback (www.mypyramidtracker.gov). • All feedback needs to be predicated on reasonable physical activity goals to be effective.

20. Behavioral Contracts • Behavioral contracts can be helpful in encouraging individual responsibility and accountability for physical activity. • Early adoption contracts should emphasize program adherence or attendance as the goal rather than physical performance. • Contingency contracts utilize the Premack Principle to encourage physical activity adherence. • Contracts should specify specific physical activity goals (adherence or attendance for early adopters) that must be achieved before specific rewards that will be received – individual should date and sign contract in presence of others.

21. Behavioral Success (King, Martin and Castro, 2006) • Behavioral Success (King, Martin and Castro, 2006) • Regular behavioral success with physical activity shapes later positive beliefs and attitudes about physical exercise. Thus, beginner exercises should engage in physical activity regardless of negative subjective attitudes or feelings (illness or injury are the noted exception). • Self-Management (King, Martin and Castro, 2006) • Physical activity needs to be viewed as a life-long habit rather than a time-limited program that will end. • Physical activity is more likely to be adopted and adhered to if the individual is encouraged to take personal responsibility and accountability for their personal activity. • During early program adoption, individuals should be encouraged to successfully participate in alternate forms of physical activity in various settings and circumstances.