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Temporal Discounting and its Effect on exercise behavior in elders

Temporal Discounting and its Effect on exercise behavior in elders. Linda M. Tate, PhD, APrN. Foundations at asu. I’m never going to do research. It starts with a passion to LEARN and possibly CHANGE something that you feel could be better EXPLORE COMMUNICATE SHARE DISCUSS

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Temporal Discounting and its Effect on exercise behavior in elders

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  1. Temporal Discounting and its Effect on exercise behavior in elders Linda M. Tate, PhD, APrN

  2. Foundations at asu

  3. I’m never going to do research • It starts with a passion to LEARN and possibly CHANGE something that you feel could be better • EXPLORE • COMMUNICATE • SHARE • DISCUSS • MAKE A FUNDAMENTAL DIFFERENCE (DO THE GREATEST GOOD FOR THE GREATEST NUMBER OF PEOPLE)

  4. Background • In the USA, 2020 the over 65 group will grow by 18% • 80% of person >65 have at least one chronic illness • As this number rises so will the rates of chronic illness • Exercise is one of the most important health behaviors to prevent chronic disease and disability in elders • Elders need to increase exercise participation and healthcare providers must understand how to successfully engage them

  5. Significance • Multiple studies have looked at exercise in elders • The Theory of Planned Behavior(TPB) has been used as a guide for multiple research inquiries and is a good predictor but does not take into account time • Measuring Delay(Temporal) Discounting along with the model will give us a temporal (time) concept and may add to the predictability of the TPB

  6. Knowledge gap • Gaps in the literature exist regarding exercise in elders and temporal discounting • Only two studies were found that addressed temporal discounting in elders • No published studies that included temporal discounting and the TPB

  7. Conceptual framework • Use the TBP as a conceptual guide to measure attitudes, subjective norm, perceived control, and intention • Measure temporal discounting along side the model to investigate possible effects on exercise behavior and the prediction of exercise

  8. A TTITUDE T EMPORAL g D ISCOUNTIN S B UBJECTIVE EHAVIORAL E XERCISE I NORM NTENTION B EHAVIOR B EHAVIORAL C ONTROL TPB with discounting

  9. Specific aims • Determine if additional variable, discounting rate, affects the predictability of the TPB among elders. • Determine if discounting rates vary between exercising and non-exercising elders.

  10. Methods • Cross sectional design with 137 community dwelling elders (60 years of age or older) • Little to no cognitive impairment based on the Six-item Memory Screener (Score of 4 or greater) • Must be able to exercise based on the (EASY) tool • Recruited from 11 churches in rural Arkansas • Church leaders were contacted and permission was obtained to attend older adult bible studies • Initial meeting, informational handouts were given and the study was explained • Second meeting, potential participants were screened and those eligible completed the remaining questionnaires • The number of Non-exercisers was obtained much quicker, then asking about exercise became part of the screening • 68 Exercisers and 69 Non-exercisers

  11. Instruments • Six-item Memory Screener • Exercise and Screening for You (EASY) tool • Demographic form • Yale Physical Activity Survey (YPAS) • Fitness attitude scale • Expectations of others scale • Perceived behavioral control scale • Intention to exercise scale • Kirby Delay-discounting Monetary Choice Questionnaire (MCQ)

  12. Analysis • Specific Aim # 1 • Determine if discounting rates affect the predictability of the TPB among elders • Path analysis • Specific Aim # 2 • Determine if discounting rates vary between exercising and non-exercising elders • t-test (Mann-Whitney), Correlation (Chi square), ANCOVA

  13. Demographics

  14. Model 1 ? A ( ) TTITUDE ? Model 2 ? T ( ) EMPORAL ? ? g ? D ISCOUNTIN ? ? S B ? ? UBJECTIVE E EHAVIORAL XERCISE ? ? ? ( ) ? I ( ) ? B ( ) NORM NTENTION EHAVIOR ? ? ? ? ? B EHAVIORAL ? C ( ) ONTROL ? Path Models

  15. Findings

  16. Path coefficients

  17. findings Correlations with Temporal Discounting

  18. REsults • T-test was used to compare discounting rates between exercisers and non-exercisers • t = 4.028, p = 0.000, 95% CI = (0.023, 0.069) • Mann-Whitney was used to compare discounting rates between exercisers and non-exercisers • W = 1679, p = 0.004 • ANCOVA was used to control for covariates • Mean discounting rates was 3.32 times higher for non-exercisers (95% CI 1.90, 5.93, p < 0.001)

  19. Limitations • Scales for measurement • Purposive sampling • Generalizability

  20. Implications • Reinforcement of TPB for exercise prediction • Focus on overlap of temporal discounting and behavioral intention for future studies • Non-exercising adults that discount at higher rates may require different strategies or rewards for participating in exercise behavior • Future research on discovering rewards that work • Other methods

  21. REferences • Agency for Healthcare Research and Quality (2009). Factsheets: Aging. U.S. Department of Health & Human Services. http://www.ahrq.gov/research/findings/factsheets/aging/index.html • Callahan C., Unverzagt F., Hui, L., Perkins,A. & Hendrie H. (2002). Six-item screener to identify cognitive impairment among potential subjects for clinical research. Medical Care. 40(9), 771-81. • Chapman, G.B., & Elstein, A.S. (1995). Valuing the future: temporal discounting of health and money. Medical Decision Making, 15(4), 373-386. • de Wit, H., Flory, J., Acheson A., McCloskey, M. & Manuck, S. (2007). IQ and nonplanning impulsivity are independently associated with delay discounting in middle-aged adults. Personality and Individual Differences, 42, 111–121. • Glanz, K., Rimer, B.K., & Lewis, F.M. (2002). Health behavior and health education: theory, research, and practice. San Francisco: Jossey-Bass. Government Printing Office. Retrieved from: http://www.census.gov/2010census/data. • Kerner, M.S. & A.H. Grossman. (2001). Scale construction for measuring attitude, beliefs, perception of control, and intention to exercise. Journal of Sports Medicine and Physical Fitness, 41(1), 124-131. • Kirby, K.N. (2009). One-year temporal stability of delay-discount rates. Psychonomic Bulletin & Review, 16(3), 457-462. • Madden, G.J., & Bickel, W.K. (2010). Impulsivity: the behavioral and neurological science of discounting. Washington, DC: American Psychological Association. • National Institute on Aging. (2015). NIHSeniorHealth. Health Benefits. Retrieved from: http://nihseniohealth.gov/exerciseforolderadults/healthbenefits/01.html. • Tate, L. M., Tsai, P. F., Rettiganti, M., Landes, R. D., Lefler, L. L. Bryant, K. (2017). Examining exercise in older adults using the Theory of Planned Behavior and Temporal Discounting. Research in Gerontological Nursing. 10 (6). 252-259. • Tate, L. M., Tsai, P., Landes, R. D., Rettiganti, M., & Lefler, L. L. (2015). Temporal discounting rates and their relation to exercise behavior in older adults. Physiology & Behavior, 152(Part A), 295-299. doi:10.1016/j.physbeh.2015.10.003 • United States Census Bureau. (2010). 2010 Date release schedules. Washington, DC:

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