Health Education Research, Vol. 15, No. 4, 435-448,
August 2000
© 2000 Oxford University Press
Stages of change in two modes of health-enhancing physical activity: methodological aspects and promotional implications
UKK Institute for Health Promotion Research, PO Box 30, 33500 Tampere, Finland
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Abstract |
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 Top Abstract IntroductionPurpose of the studySample and methodsResultsDiscussionConclusionsAppendix 1: Outdoor aerobic...Appendix 2: Everyday commuting...References |
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Measurement scales for stages of change were developed and the stages were assessed in two specific modes of Health-Enhancing Physical Activity (HEPA) in a cross-sectional survey (N = 1516); representative samples were selected from three age groups, i.e. from three phases of adult life. Outdoor Aerobic Exercise (OAE) was used as an example of fitness activity; Everyday Commuting Activity (ECA) was selected to represent lifestyle physical activity. Scales used by the Prochaska team were modified for this study, and the stages of Precontemplation and Preparation were each divided into two new stages. Consistency of the stage measurement was moderate for OAE and good for ECA. As regards content validity, consistent associations were found between stage scores and contextual variables for both behaviors. The results show that, at a given time, a person can be in different stages in different modes of HEPA. Therefore, the behavior of interest must be specified before accurate information on the stages of change in a population can be obtained. The results also indicate the importance of contextual factors in HEPA promotion.
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Introduction |
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TopAbstractIntroductionPurpose of the studySample and methodsResultsDiscussionConclusionsAppendix 1: Outdoor aerobic...Appendix 2: Everyday commuting...References |
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The health consequences of physical activity and inactivity have been widely documented. On the basis of the accumulated research data, several expert committees have recommended promotion of regular physical activity (American College of Sports Medicine, 1990
; Pate et al., 1995; NIH Consensus Development Panel, 1996; US Department of Health and Human Services, 1996). Sedentary adults are advised to accumulate 30 min or more of moderate intensity physical activity, such as brisk walking, on most, if not all, days of the week. Health-Enhancing Physical Activity (HEPA) can, in addition to exercise and sports, comprise other forms of physical activity, such as physically active commuting, running errands and physically demanding recreational activity.
The health-related arguments for the promotion of physical activity have led to interventions intended to increase physical activity in individuals, groups or the population (Blair and Morrow, 1998). The planning of reasonable and effective HEPA promotion activities calls for knowledge of the baseline distributions and natural fluctuations of the relevant behaviors in the target populations.
To achieve a firm knowledge base on HEPA behaviors, one must first understand the great complexity and versatility of physical activity as a psychological, behavioral and social phenomenon (Laitakari et al., 1996; Aarts et al., 1997; Marttila et al., 1998). New information should also be gathered on the determinants of physical activity: the environmental context, factors embedded in the living conditions of population subgroups and special conditions connected with the phases of life (Dishman et al., 1985; Godin and Shephard, 1990; Biddle, 1992; Godin, 1993, 1994; Dishman and Sallis, 1994). Consequently, studies on HEPA behavior need to be based on adequate operationalizations of physical activity (Dishman et al., 1985; Godin, 1993, 1994).
Furthermore, the inherent dynamic nature and history of physical activity in the course of life need to be elucidated (Dishman et al., 1985; Sallis and Hovell, 1990; Dishman, 1994; Dishman and Sallis, 1994). One approach to the change process in physical activity is based on the idea of stages of behavior change. One version of this was introduced as part of the Transtheoretical Model by Prochaska and DiClemente (Prochaska and DiClemente, 1983; Prochaska et al., 1994a,b; Prochaska and Velicer, 1997b).
In our own conceptual analysis of the domain of physical activity, we have identified five categories that are of relevance from the promotional point of view: occupational activities (e.g. physical activity at work), lifestyle activities (e.g. commuting or running errands on foot or by bicycle), recreational activities (e.g. hiking or dancing), fitness activities (e.g. jogging and swimming) and sports activities (e.g. sports training and competition). From the participant's point of view, the five categories differ in terms of context and psychological meaning of the activity as well as the degree of free choice regarding the timing of the activity or behavior, and the facilities and resources used (Marttila et al., 1998).
These differences between the categories of physical activity as behavior are not commonly considered in empirical studies. Physical activity has been defined as exercise in general, even in studies describing the process of adoption using stages of change (e.g. Marcus et al., 1992a–c, 1996; Marcus and Simkin, 1993; Booth et al., 1993; Ommundsen and Aaro, 1995; Cardinal, 1997; Ngyen et al., 1997).
The idea of stages of change, by Prochaska et al. (Prochaska and DiClemente, 1983, Prochaska et al., 1994a,b; Prochaska and Velicer, 1997b), combines several phenomena and processes into one continuum. The basic elements of the model are both motivational (dealing with such phenomena as intention building, decision making and attitudinal readiness) and behavioral: the adoption process goes from stages of increased motivation, through tentative performance, to regular practice of the behavior. In this process, five stages are discernible: The first two, Precontemplation (no intention to change) and Contemplation (growing intention), are motivational stages without actual performance of the behavior; the next two stages, Preparation (strong intention and possible irregular or tentative performance of the behavior) and Action (recent initiation of regular behavior), bring a crucial shift into behavioral manifestation. The final stage, Maintenance, represents the establishment of permanent behavior. Either one or two stages of regular behavior or Maintenance are commonly distinguished, by the length of the time period during which the person has persisted in the practice or behavior (Prochaska and Velicer, 1997b). The process can be stagnated at any of the stages or it can regress to a previous stage.
The Stages of Change model, although still under development and discussion (Sutton, 1997; Bandura, 1997; Prochaska and Velicer, 1997a; Weinstein et al., 1998), has been applied both to research on HEPA (e.g. Marcus and Owen, 1992; Marcus et al., 1992a,b, 1996; Armstrong et al., 1993; Booth et al., 1993; Marcus and Simkin, 1993; Prochaska and Marcus, 1994; Courneya, 1995; Wyse et al., 1995; Cardinal, 1997; Myers and Roth, 1997; Ngyen et al., 1997) and to practical health counseling (Elford et al., 1994; Mason et al., 1994; Patric et al., 1994; Calfas et al., 1996).
The majority of the studies have adopted, or slightly modified, the operationalizations of the Prochaska research team (Marcus et al., 1992c; Marcus and Owen 1992; Marcus and Simkin, 1993). However, some studies have employed a different number of stages (Marcus et al., 1992a; Booth et al., 1993) or devised separate questions for intentions and for past and current behavior (Armstrong et al., 1993; Ommundsen and Aar, 1995; Ngyen et al., 1997; Meyers and Roth, 1997). In addition, varying criteria for the intensity, duration and frequency or regularity of exercise are found in the published reports. Methodological differences make it difficult to compare the stage distributions achieved in these studies (Wyse et al., 1995; Reed et al., 1997).
The algorithm scales in population surveys seem to provide a practical method for self-assessment of the stages of change (Reed et al., 1997). However, to construct the scale, it is necessary to make the operationalizations of the behaviors of interest meet the demands of conceptual coherence and theoretical compatibility. The behavior of interest and its context should be clearly defined; the behavior must also have a shared cultural meaning for the target population (Marttila et al., 1998).
This population survey is a part of a larger project on the determinants of HEPA. The survey measures were developed especially for monitoring two special categories of physical activity: fitness activities and lifestyle physical activity.
Physical activities from both of these categories are commonly practiced in Finland. The most common modes of self-reported physical activity for fitness and health among adults are walking, jogging, cycling and skiing (Oja et al., 1994). In the National Health Survey, nearly 60% of adults (25–64 years) reported engaging in leisure-time physical activity (LTPA) at least twice a week. This activity lasted at least 30 min at a time, causing slight sweating and shortness of breath (Helakorpi et al., 1996). In the category of lifestyle activity, about one-fifth of the men and one-third of the women reported spending at least 15 min per day walking or cycling to and from work (Helakorpi et al., 1996; Oja et al., 1998).
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Purpose of the study |
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TopAbstractIntroductionPurpose of the studySample and methodsResultsDiscussionConclusionsAppendix 1: Outdoor aerobic...Appendix 2: Everyday commuting...References |
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The first objective of the study was to develop measurement scales for stages of change in two specific and common modes of HEPA and, as a part of this, to assess aspects of content validity of the scales. The selected modes of HEPA were self-reported Outdoor Aerobic Exercise (OAE), as an example of fitness activities, and self-reported Everyday Commuting Activity (ECA), representing the category of lifestyle physical activity. The second objective was to assess and describe the motivational and behavioral status of the Finnish working-age population, in three different age groups, with regard to the two modes of HEPA.
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Sample and methods |
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TopAbstractIntroductionPurpose of the studySample and methodsResultsDiscussionConclusionsAppendix 1: Outdoor aerobic...Appendix 2: Everyday commuting...References |
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Samples
The study targeted young adults (26–28 years) and two groups of middle-aged adults (41–43 and 55–57 years). These age groups represent different phases of the course of life in terms of family life, occupational career, health status and physical fitness. Earlier studies have found differences in the prevalence of exercise behavior between these age groups (Helakorpi et al., 1996
; Oja et al., 1994, 1998), and we thus expected to find different motivational and behavioral statuses in the two modes of HEPA for these three groups. Representative population samples of 800 persons, 400 men and 400 women, from each of the three age groups were selected for the study: a total of 2400 persons. The samples were drawn, with the permission of the Population Register Center, from the census data of the cities of Tampere (183 000 inhabitants) and Nokia (26 000 inhabitants), and of six municipalities (a total of 44 000 inhabitants) in the surrounding region in southern Finland. The samples were selected through stratified random sampling to make them representative of the nationwide distribution of urban (58%), semiurban (16%) and rural (26%) populations in Finland (Statistics Finland 1996).
Implementation of the survey
The survey questionnaires, with prepaid return envelopes, were mailed in March 1996 (at the end of the snowy winter season). In the covering letter, the recipient was informed about the purpose and details of the survey, confidentiality and the rights of the participant. The study has been approved by the Research Ethics Review Committee of the UKK Institute.
After one recall, the number of returned questionnaires was 1544; 10 questionnaires could not be delivered for miscellaneous reasons (wrong address, etc.). A total of 28 (1.2%) returned questionnaires were excluded from the data set due to inadequate completion. The accepted questionnaires were allowed to have data missing in sporadic questions, but not in both of the stage measures. The final response rate was 63.4% (N = 1516) for the entire sample (69.2% for women and 57.6% for men). The response rate was lowest for the age group of 41–43 (62.3% for women and 55.0% for men) and for subjects in the rural areas (66.7% for women and 50.2% for men).
Questionnaire
The self-administered questionnaire included mainly structured questions, with a smaller number of open-ended questions, on social and environmental factors, living habits, leisure-time activities, health status, and perceived symptoms. Special emphasis was placed on questions concerning the respondent's physical activity and attitudes toward it, and on the stage of change measurements in the two behaviors of interest.
In each question on physical activity, a short descriptive definition of the behavior was given in everyday language before any instructions to the respondent (Appendices 1 and 2). The final wording of these questions was based on a pilot study in a heterogeneous adult convenience sample (n = 25). Each participant first filled in the questionnaire and was then immediately interviewed about his or her subjective interpretations of the questions, preferences for wordings or choices presented, etc.
Measurement of the stages of change
Development of the measurement scale for stages of change in the two specific modes of HEPA was based on our conceptual analysis of the physical activity practices and a review of them in Finland, and also on our analyses of (1) the definitions of stages of change in the transtheoretical model and (2) of earlier uses of the model in studies of physical activity. As a result of these analyses, we divided the stages of Precontemplation and Preparation into two new stages, as follows.
People in the stage of Precontemplation, i.e. those not engaging in actual behavior and with no intention to begin to do so, make up a psychologically heterogeneous group (Prochaska and Velicer, 1997b). From the promotional point of view, two main groups can be identified. The first group consists of persons who are convinced that the behavior is out of the question in their lives (Negative Precontemplation). They may, for example, have become frustrated with the mode of behavior or demoralized due to unsuccessful attempts to change their behavior, or their ability to participate in physical activity may be limited or totally hindered due to a functional disability or some external factor. The second group consists of persons who have not considered the behavior of interest or the option of changing their current behavior (Neutral Precontemplation). They may be uninformed or underinformed about the behavior, the opportunities to perform it regularly, or the consequences of their current behavior.
At the Preparation stage, people are, by definition, planning to initiate the new behavior in the immediate future and they have typically tried it out or made some initial preparations. Although a substantial number of Finns occasionally engage in lifestyle and fitness-related physical activities, it would be highly unlikely for all of them to have the conscious intention to make their activity more regular. Therefore, we have divided the Preparation stage into two new stages. The first one is for persons who report that they occasionally engage in the physical activity specified in the question and are going to continue to do so. We call this stage, which involves no intention to change, Ongoing Occasional Activity. The second new stage, involving the intention to increase one's activity, has been named Preparation to Change. Corresponding systems of two subgroups in the Preparation stage have also been used in some of the other studies (Booth et al., 1993; Patric et al., 1994; Ngyen et al., 1997).
The final self-classification algorithm scale, for both behaviors of interest, thus consists of eight items, one for each stage (Appendices 1 and 2). In the first three stages (Negative Precontemplation, Neutral Precontemplation and Contemplation,) no behavior can be observed; however, intention building is implied in the stage of Contemplation. In the next two stages (Ongoing Occasional Activity and Preparation to Change), occasional behavior is found, combined, in the latter, with the intention to increase the frequency of the behavior. The last three stages indicate regular behavior, either of recent adoption (Action) or with a history of short-term or long-term practice (Short-term Maintenance and Long-term Maintenance).
Measurement of LTPA
Before the stages of change scales, the questionnaire had a number of questions designed to assess the frequency and modes of LTPA, and recent changes in frequency. In the question about the frequency of LTPA, a definition of physical activity was given and intensity of the activity was termed as `brisk' (moderate or vigorous) or `light'. The respondents were asked to place themselves in one of five categories on the basis of the intensity and frequency of their current LTPA (categories in Table I).
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This single-item measure of LTPA has been used earlier, in almost the same format, in several epidemiological studies in Finland. It has been found to be associated with cardiovascular fitness (Suni et al., 1999
), and to predict both the development of obesity and premature mortality in the working age population (Haapanen et al., 1996, 1997).
Analyses
In order to assess the consistency of the stages of change distributions, all responses accepted for analysis were pooled and then divided into two subpools according to the sampling criteria (gender, age, place of residence). These two halves were assumed to approximate the response distributions of two random samples of equal size, drawn from the same study population, at a given time and with an equal response rate. The hypothetical maximal sampling consistency of the stage distributions for the behaviors of interest was assessed by comparing the stage distributions in the two subcohorts.
Chi-square (
2) statistics were used to ascertain whether the distributions of classified variables were associated with the groups. The associations of gender and age with the stage distributions for the two behaviors of interest were analyzed by means of log-linear models for the multidimensional contingency tables.
The question on LTPA was used to evaluate one aspect of content validity of the OAE scale; the correspondence of these two measures was estimated by means of a modified 
coefficient (Landis and Koch, 1977). Content validity was further elucidated through the associations of the two stage measures with self-reported functional ability, environmental prerequisites and recent changes in LTPA.
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Results |
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TopAbstractIntroductionPurpose of the studySample and methodsResultsDiscussionConclusionsAppendix 1: Outdoor aerobic...Appendix 2: Everyday commuting...References |
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Consistency of the measures
The study cohort and the artificial subcohorts are described in Table I
by the three sampling criteria and selected background variables. No significant differences were observed between the subcohorts in the distribution of the background variables (Table I).
The consistency of the stage measurements was evaluated by comparing the stage distributions for the behaviors of interest in the two independent hypothetical subcohorts (Table II). The distributions in subcohorts A and B were very similar for ECA (P = 0.366). For OAE, the distributions were associated with the subcohort (P = 0.038), mainly due to a disparity in the Long-Term Maintenance stage (6.6%). However, total disparity in the sum of all physically active stage groups, from the Action stage to Long-Term Maintenance, was less than 2% and disparities were almost non-existent for the physically inactive stages from Negative Precontemplation to Contemplation, as well as for the stages of Ongoing Occasional Activity and Preparation to Change.
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Aspects of content validity
Differences in the stage distributions for the two behaviors of interest (Table II
) suggest that an assessment of actual motivational and behavioral status for one specific mode of HEPA does not substitute for assessments of status for other modes. Cross-tabulation of the stage variables revealed that about 54% of those respondents with regular OAE and 44% of those with regular ECA reported only occasional activity or no activity at all in the other mode. Consistently, 59% of those who classified themselves as Precontemplators or Contemplators in OAE placed themselves in the same inactive stages in ECA; no more than 30% of the respondents in the inactive stages of ECA reported the stage of Negative or Neutral Precontemplation or Contemplation in their OAE (Table III).
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In order to evaluate content validity of the stage measures, the responses in OAE question were cross-tabulated with the LTPA variable. Both variables were reclassified in three categories: respondents who were physically inactive, those who were occasionally active and the regularly active ones (Table IV
). The modified coefficient, 0.54, shows a moderate agreement between the two measures. As different behaviors are defined through these two variables, there is no inconsistency in reporting, for example, regular LTPA with no OAE. Cases that were clearly discordant (6.2% of all respondents) can be found in the lower left-hand corner of Table IV: these report regular OAE with no regular LTPA.
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The duration of activity is one of the dimensions included in the stages of change scale. In our questionnaire, a separate question on recent changes in physical activity behavior came immediately after the LTPA question (Table I
). A total of 60% of respondents in the Action stage and 40% of those in the Short-Term Maintenance stage in OAE reported having increased their LTPA within the last 3 months, while among the other respondents, in other stages, the corresponding proportion was about 20% or less. Further analyses showed consistent associations between the stage scores and the respondents' self-reported state of health. About 41% of the respondents in the stage of Negative Precontemplation in the OAE reported that their ability to participate in exercise or outdoor activities was considerably limited or totally hindered due to a functional disability; in the same stage of ECA, the rate was 14%. In other stages, in both behaviors of interest, less than 5% of the respondents reported such health limitations.
It is reasonable to expect ECA to be associated with the circumstances of everyday life. Nearly two-thirds of respondents in the stages of Negative and Neutral Precontemplation of ECA and 50% of the Contemplators reported a distance of at least 6 km from their residence to the service center where most of the day-to-day services were located, whereas only about 30% of respondents in the stages involving actual practice of ECA reported such long distances. Consistently, while half of the respondents in the stages from Action to Maintenance reported a distance of 2 km or less, only 25% of those in the stages of Contemplation and Preparation and about 12% of those in the Precontemplation stage reported such short distances. In addition, about 90% of respondents in the two Precontemplation stages of ECA reported that they always, or nearly always, had a car at their disposal for commuting or running errands. About 45% of men in the two stages of Maintenance of ECA had a car at their disposal, compared to only 25% of the women in those stages. No corresponding associations were found between the stages of change in OAE and the distance between the home and the service center or the availability of a private car.
Stage distributions
As expected, both of the behaviors of interest were commonly practised in the study cohort. Approximately 41% of the respondents reported occasional and 42% regular OAE; about 32% reported occasional and 35% regular ECA (Table II). The most prominent difference between the two stage distributions is found in the proportion of respondents in the stages of Negative and Neutral Precontemplation: the sum prevalence of these two Precontemplation stages is about 10% for OAE while that for ECA is about 25%.
The stage distributions for both behaviors of interest were significantly associated with gender (P < 0.001) and age (P < 0.001). The distributions are, therefore, presented separately for both genders and for each age group (Tables V and VI).
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Both behaviors of interest were more prevalent among women than among men. In OAE the sum prevalences of physically active stages, from Action to Long-Term Maintenance, was about 48% among women but only 35% among men. The prevalence of ECA was, correspondingly, 43 and 25%. Only 13% of the women reported no practice of OAE and 26% no ECA, while the corresponding figures for the men were 22 and 43%.
In OAE, the stages involving the intention to change—the stages of Contemplation and Preparation to Change—were the most prevalent in the youngest and the least prevalent in the oldest age groups for both genders. A corresponding accumulation was observed in ECA: the stage of Preparation to Change was the most prevalent among young adults.
In both OAE and ECA, the stage of Long-Term Maintenance, indicating stabilized regular behavior, was the most prevalent in the oldest age group, for both genders. The proportion of respondents in the Negative Precontemplation stage, i.e. the number of those who deliberately excluded the possibility of ECA, was also larger in the two older age groups than in young adults. Consistently, for both behaviors, the stages of Short-Term Maintenance and Action were the most prevalent in the youngest age groups, with the exception of young men in outdoor exercising.
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Discussion |
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TopAbstractIntroductionPurpose of the studySample and methodsResultsDiscussionConclusionsAppendix 1: Outdoor aerobic...Appendix 2: Everyday commuting...References |
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Methodological considerations
We have attempted to develop the concept of stages of change further, in the domain of physical activity, and to construct appropriate scales for questionnaires by distinguishing new substages. Consistency of the measurement and certain aspects of content validity of the new self-classification scales for the two behaviors specified were empirically evaluated in this study.
Consistency of the measurement of stage was estimated by comparing stage distributions in two hypothetical random samples of equal size and equal response rate from the same study population at a given time, i.e. in the two artificial subcohorts of respondents. The distributions of background variables in these subcohorts were very similar, and no difference was found between the stage distributions for ECA. The significant difference observed for OAE suggests somewhat lower consistency in this mode. The main discrepancies were found in the proportions of the stages of Action and Short-Term and Long-Term Maintenance. Thus, in our survey, consistency of the measurement of stage appears to be good for ECA and moderate for OAE.
The cross-tabulated stage distributions for the two behaviors of interest were remarkably non-overlapping. This observation is important in regard to content validity of the measurements. It shows that the respondents were able to distinguish between the behaviors while assessing their actual stage of change.
Several observations were made indicating content validity of the measurements. Moderate agreement was found between self-classifying responses to questions on OAE and overall LTPA, the former behavior overlapping conceptually with the latter one. A consistent association also prevailed between self-reported recent changes in LTPA and prevalence of the stages of Action and Short-Term Maintenance in OAE. The greatest prevalence of self-reported limitations to functional ability was found among respondents in the stage of Negative Precontemplation in both OAE and ECA. Furthermore, the stage distribution for ECA was consistently associated with environmental circumstances, such as the distance from the residence to the service center and the availability of a private car, whereas no association was found between these and the stages in OAE. Theoretically, as a leisure time activity, the latter is assumed to be associated with a higher degree of free choice and personal preference than ECA behaviors (Marttila et al., 1998).
The observations thus indicate the adequacy of the methodological solutions in this study: (1) of the measurement of the stages of change in different modes of HEPA by means of specific questions and (2) of the refinement of the scale in the stage algorithm measure. From the consistency and validity analyses, we conclude that the scales used to measure the stages of change give consistent and plausible results.
Considerable caution is required, however, in regard to making generalizations on the basis of the stage prevalences obtained among our respondents and to comparing the stage distributions in our study with those in other population surveys. The response rate in this survey, with one recall questionnaire (63%), was somewhat lower than that in the National Health Survey, with two reminders (72%) during the same spring (Helakorpi et al., 1996). This may indicate some selection bias in our study. In the National Health Survey, nearly 60% of the adults (25–64 years) reported regular LTPA at least twice a week; in our study, a figure of 50% was obtained for brisk LTPA at least twice a week, in three adult cohorts. However, even minor changes in the wording of questions on physical activity may cause remarkable changes in the responses (Uitenbroek and McQueen, 1992). In addition, our results act as a reminder of the interdependence of the conceptual definitions of the behaviors of interest and the stage distributions obtained.
Promotional implications
The results obtained indicate that, at a given time, a person can be in very different stages of change in different modes of HEPA. Accordingly, separate questions need to be asked for each specific mode of physical activity in order that accurate information can be obtained. This has important practical implications for surveys intended to provide baseline information for the planning of activities of HEPA promotion.
The three age cohorts in our study were selected to let us judge the promotional prospects for HEPA in three phases of adult life. The results show that the same stages, Long-Term Maintenance and Ongoing Occasional Activity, were the most prevalent ones in both behaviors of interest and in all three age groups. Scrutiny of the stage distributions suggests that the subgroups most likely to increase their HEPA are to be found in the young adult population.
The conditions seem to be rather favourable for promoting fitness-related leisure time physical activity in the Finnish population. Firstly, the majority of working-age adults report engaging in OAE at least occasionally. Secondly, in our study, the place of residence, from rural to urban areas, was not associated with the stages of change in OAE. Thirdly, the proportion of respondents in the stage of Negative Precontemplation was less than 5% and nearly half of these reported health-related obstacles limiting their ability to exercise. It can be concluded, therefore, that no prominent attitudinal obstacles to OAE prevail in the adult Finnish population.
In our stage items, the criterion for regular OAE was set at two weekly activity sessions, i.e. at the level of activity presented as the minimum precondition for significant beneficial effects on cardiorespiratory fitness and body composition (American College of Sports Medicine, 1990). From a behavioral point of view, the difference between the stages of Occasional Ongoing Activity and Maintenance is somewhat artificial: a substantial proportion of people in the stage of Ongoing Occasional Activity engage in regular OAE although only once a week, usually on Saturdays or Sundays. Thus, to fulfil the criterion and obtain health benefits, the people in that stage need not adopt a new behavior; they only need to carry on with their current activity with increasing frequency.
Promoting lifestyle activity has been suggested as a promising channel for promoting HEPA (e.g. NIH Consensus Development Panel, 1996; Dunn et al., 1998). In principle, lifestyle activity can constitute a basis for regular HEPA either alone or in addition to other modes of physical activity. In this study, ECA was consistently associated with circumstances. These can hardly be changed by health education targeted to individuals. Instead, measures of long-term health policy and environmental engineering may be required if lifestyle physical activity is to be increased.
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Conclusions |
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TopAbstractIntroductionPurpose of the studySample and methodsResultsDiscussionConclusionsAppendix 1: Outdoor aerobic...Appendix 2: Everyday commuting...References |
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- The study results highlight the complexity of physical activity as a behavior. Specific questions are therefore required for different modes of physical activity in order that the motivational and behavioral status of HEPA in an adult population can be assessed.
- Consistent results were obtained using the new stages of change scales for the two behaviors under study. It would thus appear that the methodological solutions adopted in developing these scales, especially in defining two substages for Precontemplation and Preparation, can be applied in population surveys.
- The differences in results obtained in the three age groups, from different phases of adult life, and the impediments to HEPA identified in this study emphasize the importance of contextual factors; these need to be considered in HEPA promotion.
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Appendix 1: Outdoor aerobic exercise |
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TopAbstractIntroductionPurpose of the studySample and methodsResultsDiscussionConclusionsAppendix 1: Outdoor aerobic...Appendix 2: Everyday commuting...References |
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By Outdoor Aerobic Exercise we mean walking, jogging, running, bicycling or skiing for the purposes of health, fitness or recreation. Please count only outdoor activity which makes you at least slightly out of breath and slightly sweaty and lasts at least 20 min.
Which alternative fits you best at present? Please circle only one alternative.
- I never do this kind of exercise and it would be out of the question in my case.
- I hardly ever do this kind of exercise and I have never really thought about it.
- I hardly ever do this kind of exercise, but I might start doing it regularly within the next 6 months.
- I occasionally do this kind of exercise and I expect to continue like this.
- I occasionally do this kind of exercise, but I intend to start doing it more regularly within the next month.
- I have started doing this kind of exercise at least twice a week, but only in the last 6 months.
- I have been doing this kind of exercise at least twice a week for longer than 6 months but less than 2 years.
- I have been doing this kind of exercise at least twice a week for longer than 2 years.
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Appendix 2: Everyday commuting activity |
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TopAbstractIntroductionPurpose of the studySample and methodsResultsDiscussionConclusionsAppendix 1: Outdoor aerobic...Appendix 2: Everyday commuting...References |
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By Everyday Commuting Activity we mean going to work, going shopping, taking a child to day care or to school, or running other errands. Please count only commuting which you do wholly or partially on foot or by bicycle and which lasts at least 10 min each time. For walking this means at least a distance of 1 km; for cycling 1.5–3 km.
Which alternative fits you best at present? Please circle only one alternative.
- I never commute on foot or by bicycle and it would be out of the question in my case.
- I hardly ever commute on foot or by bicycle and I have never really thought about it.
- I hardly ever commute on foot or by bicycle, but I might start doing it within the next 6 months.
- I occasionally commute on foot or by bicycle and I expect to continue like this.
- I occasionally commute on foot or by bicycle, but I intend to start commuting more regularly within the next month.
- I have been commuting mainly on foot or by bicycle, but only in the last 6 moths.
- I have been commuting mainly on foot or by bicycle for longer than 6 months but less than 2 years.
- I have been commuting mainly on foot or by bicycle for longer than 2 years.
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References |
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TopAbstractIntroductionPurpose of the studySample and methodsResultsDiscussionConclusionsAppendix 1: Outdoor aerobic...Appendix 2: Everyday commuting...References |
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Received on March 18, 1999; accepted on November 23, 1999
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