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 MartinCorrelates 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