Physical Activity and Exercise
Theories, Models and Interventions for Health Behaviour Change
’By equating certain types of behaviour with virtue and others with vice, the secular moralists … threaten to undermine the critical task of educating the public in general … to the very real dangers lurking behind everyday behavioural choices.’
Leichter (1997: 360—1)
Recent years have seen an increased official concern about the apparent widespread decline in the participation of people in all types of physical activity. In this chapter, we review evidence on the increasing prevalence of sedentary behaviour and its potential impact on health. We consider the social and psychological factors associated with participation, the varying meanings of different forms of physical activity, and strategies that have been used to promote greater participation.
Extent of Physical Activity
Evidence from a variety of social surveys has confirmed the increasingly sedentary lifestyle of modern society. The most recent summary of physical activity statistics in the UK (Townsend et al., 2015) found that in 2012 67% of men in England and Scotland met recommended levels of physical activity. Women were less active than men, with 55% reporting meeting recommended levels.
According to a survey of types of physical activity which adults engage in in England (Joint Health Surveys Unit, 2012), men spent only 2.7 hours per week walking and 2.1 hours per week in sports/exercise. The comparable figures for women were 2.5 and 1.2 hours.
Figure 13.1 Average hours spent per week on different activities outside the workplace, by gender, England 2012
Data from Europe suggest that the main reasons people give for engaging in sport or physical activity are to improve health, to improve fitness and to relax (European Commission, 2014). To have fun comes fourth in the list of reasons (Figure 13.2).
Variation in Participation
Evidence from national surveys in England (Carig and Mindell, 2013) confirm that physical activity is related to household income, with 76% of men in the highest income quintile reaching recommended activity levels compared with only 55% of men in the lowest quintile. It was also related to age, with only 30% of men in England over 75 years meeting recommended activity levels. These figures concealed the large amount of time that adults spend engaging in no physical activity. A total of 59% of men and 54% of women in England reported spending five plus hours a day sitting or standing (see Figure 13.3).
There are also substantial international variations, with evidence that adults in the UK are much less likely to engage in physical activity. For example, whereas 44% of adults in the Netherlands engage in physical activity outside sport, the comparable figure for the UK was 14%. One problem with many of the estimates of participation of physical activity is that they often focus on leisure time activity, especially organized sports. Attempts to measure the extent of physical activity at work and at home are more limited. The study by Cochrane et al. (2009) used the International Physical Ability Questionnaire (www.ipaq.ki.se/downloads.htm), which requires participants to complete a daily record for seven days of activity in four domains: work related, active transport, gardening and domestic, and leisure. It is then possible to obtain a measure of energy in each of these domains. In the survey of a sample of residents of an English Midlands city, they found that work accounted for 44% of reports of physical activity, compared to 32% for garden and domestic activity, and 12% for both active transport (walking and cycling) and leisure. However, the median level of physical activity at work was zero for both men and women and zero for leisure activity for women. This would suggest that many people have very sedentary working styles and most women participate little in leisure-time physical activity.
Figure 13.2 Data from the Eurobarometer on motivation for sport and physical activity
Source: European Commission (2014)
Figure 13.3 Physical activity and household income
Source: Data based on Health Survey for England - 2012, December 18, 2013
Physical Activity and Health
The reason for governmental interest in this apparent decline in physical activity is the increasing evidence of the negative impact on health. The World Health Organization (2004a) has identified the decreasing level of physical activity as a major cause of death and chronic disease worldwide. Rates of the following diseases have been found to be associated with higher rates of physical inactivity: cardiovascular disease, colon cancer, Type 2 diabetes, stroke and breast cancer. The WHO also highlighted the dose—response character of this activity—disease relationships with the greater amounts of physical activity being associated with greater levels of health.
A result of inactivity has been the increase in levels of obesity in the population. Since increased levels of obesity are due to an imbalance between energy intake and energy expenditure it is not surprising that evidence of a decrease in physical activity has been followed by evidence of an increase in rates of obesity. According to Public Health England, (Health and Social Care Information, 2013), approximately one in four adults in the country are now classified as obese. International comparisons show that while the USA has the highest rates of obesity, other industrialized nations are catching up. (For further discussion of the obesity pandemic, see Chapter 10.)
This evidence has led to a series of governmental reports recommending increased participation in physical activity. For example, in the UK the Chief Medical Officers issued a joint report (Department of Health, 2011) identifying the health risks of a sedentary lifestyle, including chronic conditions such as coronary heart disease, stroke, Type 2 diabetes, cancer, obesity, mental health problems and musculo-skeletal conditions. The report emphasized that even relatively small increases in physical activity are associated with at least some protection for all ages. However, these reports can adopt a victim-blaming stance to those who participate little in physical activity and ignore the broad social context.
Much psychological research in this field is far removed from ’rocket science’. Typically, it is based on very basic models and simple variables, and often the findings are self-evident and no more than ’common sense’. Because of the shortcomings and lack of sophistication in models and theories, our ability to provide a satisfactory account of the bigger issues remains limited. It is important to consider in a more nuanced fashion how social, environmental and psychological processes work together in explaining participation in physical activities. Of key importance is the meaning of exercise, not its actual amount.
Context of Physical Activity
As noted, an understanding of the variations in the extent of participation in physical activities requires attention to the socio-cultural and political context within which they have meaning and which promote or discourage involvement in such pursuits. We discussed in Chapter 10 the evidence that human beings traditionally required considerable energy expenditure for survival. In ancient times hunter-gatherers needed to expend substantial energy on a regular basis to ensure access to food and shelter. This need to expend significant amounts of energy remained well into the twentieth century and continues in much of the developing world. However, the rapid increase in technology in industrialized societies over the past generation has led to a much more sedentary lifestyle. This decline in physical activity is a consequence of the reduced need for energy expenditure in all spheres of human life, including work, transportation and home maintenance (Eaton and Eaton, 2003). Technological developments in entertainment have reduced the role of physical activity in leisure time (King, 1994).
Increasing attention has been paid to the influence of neoliberalism on everyday lives. One concept that has gained interest is affluenza, a combination of the concepts influenza and affluence. In modern consumer society, we are constantly persuaded that the key to success is greater consumption of commodities. Everything is offered for sale, including a certain lifestyle and a certain body shape. According to James (2007), the growth of ’affluenza’ is one of the symptoms of the broader move towards increasing social inequality. He defined ’affluenza’ as the increasing value placed on money, possessions and appearance. Part of this is the trend towards a more passive consumerist lifestyle and the belief that it is possible to purchase physical health through health supplements and membership of sports clubs. However, increasing social inequality has placed many of these products outside the reach of an increasing number of people who initially bought into this dream. Nowadays there is more evidence that people are increasingly resisting the myths peddled by advertisers (Hamilton and Denniss, 2010). While more empirical research is needed on this concept, it highlights the importance of the broader socio-cultural context.
Physical activities are also conducted within a cultural context that promotes different ideals about physicality. For example, the muscular physique is presented as the ideal male form in Western societies. As Luschen et al. (1996: 201) noted, the emergence of bodybuilding exercises aimed at building muscular strength and fitness ’reflects a bodily culture that is in line with American values of masculine prowess’. They continued: ’activities like American football, weightlifting, and boxing set a premium on brute physical force and place much less emphasis on endurance and relaxation’ (Luschen et al., 1996: 202). The ability to attain this physical shape is promised to those who participate in various fitness gyms. However, access to these somewhat elite facilities is often restricted to those with money. In addition, aggressive sporting activities are also promoted among the middle class as a training ground for developing an aggressive business attitude, not to mention the making of useful social contacts. This begins at an early age, as is illustrated in studies of school sporting activities (Wright et al., 2003).
An important aspect of culture is religion. Different religions have different concepts of the body (see Chapter 6). For example, certain forms of Christianity traditionally held a negative view of excessive concern about the body. It has been suggested that this is a reason for the poorer performance of athletes from more Catholic countries in sporting events (Curtis and White, 1992). Conversely, in more Protestant or secular societies, concern with body shape and performance is promoted. Indeed, Turner (1984) has argued that contemporary concern for the body could be described as the ’new Protestant ethic’. As health psychologists, we need to engage with research into these broad socio-cultural processes.
Environmental psychologists emphasize the importance of considering the behavioural setting, or the physical and social context within which the behaviour occurs (Stokols, 1992). This includes the built environment, the buildings in which we live and work, and the communities in which we reside. The contemporary urban environment is ’passivogenic’. Modern buildings certainly are not designed with increasing physical activity in mind. Architects have created environments that foster inactivity and obesification (see Chapter 10). For example, stairways are often more difficult to access than either escalators or elevators. Airports use ’travelators’ that allow people to stand still while being moved from A to B. Suburban bus services take shoppers directly from a nearby bus stop to superstores. Huge shopping malls have replaced high streets. Communities often have poor play facilities and unaffordable fitness centres, which is especially the case in low-income neighbourhoods. The most common means of transport is cars; cycling and walking are discouraged or dangerous (Sallis et al., 1998). In a city such as London there is a high rate of fatalities among cyclists, who still have to navigate their way on the same roads as heavy goods vehicles (HGVs). In November 2013, six cyclists were killed on London’s streets within two weeks, with 14 killed in London in that year, nine involving HGVs (BBC, 2013). In this respect, countries such as Germany and the Netherlands are more progressive.
A study of participation levels among residents of an English Midlands city helped clarify the relative importance of the physical environment. Cochrane et al. (2009) obtained environmental data from various official sources, including data on access to shops, traffic density and crime statistics, and combined this data with information from a community survey of participation in physical activity and attitudes towards physical activity. They identified environmental predictors of physical activity, including ease of access to shops and to work, suggesting that the more accessible those places the more likely people are to walk to them. Other factors of importance identified included moderate levels of road traffic and lower rates of road traffic accidents, suggesting that such environments are more conducive to walking. However, although these environmental factors were important, the researchers found that they were of lesser importance than beliefs and intentions about participation in physical activity as measured in the community survey.
An Australian study by Salmon et al. (2003) produced similar findings. They found that personal barriers, such as lack of time, other priorities, work and family commitments, predicted the extent of involvement in physical activities more than environmental barriers such as weather, cost and safety. It is worth noting that these immediate personal barriers reflect broader social demands. Another Australian study by Giles-Corti and Donovan (2002) also found that individual and social environmental factors were more important than physical environmental factors in predicting exercise participation. They found that the most important predictors of participation in recreational physical activity were perceived behavioural control, behavioural intention, habit and exercising peers. The most important environmental predictor was accessibility to recreational facilities.
In the USA, Wilson et al. (2007) conducted a telephone survey of physical activity among residents of South Carolina. They found that those residents who reported that they lived in a pleasant neighbourhood, were trusting of their neighbours and had sidewalks in their neighbourhood were less likely to report being physically inactive. A study in Chicago found that residents of suburbs and those who had elevated levels of fear about their neighbourhoods were less likely to walk (Ross, 2000).
Humpel et al. (2002) conducted a review of 19 studies that looked at the relationship between physical activity and objectively determined physical environments. They found that physical activity was greater where there was evidence of accessibility, opportunities and aesthetic features of the neighbourhood, including safety. While these studies demonstrate the importance of environmental factors, it is important to consider the limited activity-friendly features and the greater exposure to various environmental threats for residents of disadvantaged neighbourhoods.
Various social cognition models (SCMs) of health behaviour have been used to account for variations in the extent of participation in physical activity among adults. The four that have attracted most research interest are the theory of reasoned action/theory of planned behaviour, the social cognitive model, the self-determination theory and the transtheoretical model. We provided further details of these models in Chapter 8. Here we illustrate the application of the models to exercise behaviour.
Theories of Reasoned Action and Planned Behaviour
The theory of reasoned action (TRA) was developed by Ajzen and Fishbein (1980). As described in Chapter 8, this theory proposes that behaviour such as physical activity and exercise is predicted by intention to engage in such behaviour, which in turn is predicted by the individual’s attitude towards exercise and the perceived social norm. The attitudinal component is a function of the perceived consequences of participating and a personal evaluation of those consequences, while the perceived norm is a function of the perceived expectations to participate and the motivation to comply with those expectations.
The theory of planned behaviour (TPB) developed by Ajzen (1985) introduced perceived behavioural control into the basic TRA theory and suggested that, besides the attitudinal and social norm components, whether someone intended to behave in a certain way depended upon the extent to which they believed they had control over a particular behaviour. There have been several meta-analytic studies that have used the TPB to account for involvement in physical activity. In a review of more than 30 studies, Hausenblas et al. (1997) found that there were significant mean correlations between exercise intention and attitude, subjective norm and perceived behavioural control. A subsequent review by Hagger et al. (2002) also found significant but lower correlations. However, a substantial proportion of the variance in studies of physical activity remains unaccounted for.
Hamilton and White (2010) explored the role of salient behavioural, normative and control beliefs among mothers and fathers of young children, drawing on the TPB framework. Interview data were analysed using thematic content analysis. Hamilton and White identified a range of advantages (e.g., improves parenting practices), disadvantages (e.g., interferes with commitments), barriers (e.g., time) and facilitators (e.g., social support) to performing physical activity, and normative pressures.
Extensions of the TPB have investigated the role of a range of other psychological factors, such as moral norms, affect, self-efficacy and past behaviour (Conner and Armitage, 1998). An example of the use of an extended TPB is the study by Abraham and Sheeran (2004). This found that anticipated regret accounted for an additional proportion of the variance in exercise intentions besides the core TPB variables.
Social Cognitive Theory
Bandura’s (1986, 2001) social cognitive theory has been used extensively to account for participation in physical activity. Bandura’s argument that self-efficacy is the common cognitive mechanism that mediates behavioural responses has been applied. It is argued that whether a person persists in a behaviour in different circumstances depends upon his/her perception of individual mastery over the behaviour. This sense of self-efficacy develops through personal experiences of success, but also from verbal support from others and the perceived level of physiological arousal. This theory is bidirectional such that not only can self-efficacy contribute to increased behavioural effort, but also success in the behaviour can contribute to increased self-efficacy.
In physical activity and exercise research, it has been found that self-efficacy predicts greater involvement (e.g., McAuley and Jacobson, 1991). Variants of self-efficacy have been found to predict involvement. These include barrier self-efficacy, or the confidence in one’s ability to overcome barriers to regular exercise attendance (Brawley et al., 1998), scheduling self-efficacy (DuCharme and Brawley, 1995) and exercise self-efficacy (Poag-DuCharme and Brawley, 1993). Some studies have found a negative relationship such that lower levels of self-efficacy statistically predicted more physical activity. Rimal (2001), in a longitudinal study, found evidence of this and suggested that those with lower self-efficacy improved their self-efficacy over time which, in turn, led to greater exercise behaviour. Together these findings would confirm the interactive nature of self-efficacy beliefs and physical activity.
However, there remains concern about the value of self-efficacy as an explanation of the extent of involvement in physical activity. In his critical review of the evidence, French (2013) identified limitations with previous research, including the issue of generalizability from small studies. A crucial factor is whether such concepts as self-efficacy are relevant to all population groups. In a meta-analysis of studies of physical activity, Vasilijevic et al. (2016) found that the gap between self-efficacy and behaviour was greater among participants with low SES and who resided in deprived neighbourhoods. This would confirm that the ability to exert control over our behaviour is dependent upon circumstances.
Bandura distinguished between three forms of agency or efficacy: personal, collective and proxy. Proxy efficacy is the belief in the role of others in aiding the achievement of desired outcomes. Although at first this might seem to be the converse of self-efficacy, evidence suggests that it can be an important complement. The proxy is someone who will provide assistance and help a person to achieve his/her goals. A study of participants in a fitness class found that fitness instructor efficacy as well as self-efficacy beliefs were predictive of class attendance for initiates (Bray et al., 2001). However, Bandura (1997) cautioned that an over-reliance on the proxy may reduce the cultivation of personal competencies. In a study to test this possible negative effect, Shields and Brawley (2007) conducted a questionnaire study of participants in an exercise class. They found an interactive effect such that those participants who preferred proxy assistance expressed lower self-regulatory and task self-efficacy when faced with a class without a proxy. To promote sustainability of exercise behaviour, they concluded that proxy-agents (exercise instructors) should balance between helping participants and encouraging greater self-regulation.
A related factor to self-efficacy is self-determination. According to Deci and Ryan’s (1985) self-determination theory (SDT), people will engage in many activities simply because of pure enjoyment or intrinsic motivation. A study in Wales (Ingledew et al., 1998) found that participants in the initial stages of exercising attributed participation more to extrinsic motives (e.g., appearance/weight management), whereas in the later stages they referred to intrinsic motives, such as enjoyment. It was concluded that intrinsic motives are important for progression to and maintenance of the exercise.
The self-determination theory also argues that there are basic psychological needs for autonomy, competence and relatedness. It is the satisfaction of these needs that leads to feelings of well-being. Teixeira et al. (2012) conducted a systematic review of studies which explored the value of self-determination theory for explaining participation in exercise and physical activity. They found that autonomous forms of motivation were strong predictors of exercise participation over time. More specifically, they found that internalized extrinsic regulation (e.g., valuing the outcomes of exercise) was an important initial motivator, while intrinsic motivation (e.g., valuing the experience of exercise) predicted long-term adoption of exercise.
Another related factor is the extent to which people predict that some activity will make them happy. Ruby et al. (2011) found that people underestimated how much they would enjoy participating in an exercise class. This was especially so on beginning an exercise programme, suggesting that getting over that initial apprehension about the programme is crucial to promoting greater activity. Kwan et al. (2017) found in an experimental study that encouraging participants to focus on the positive outcomes of exercise contributed to a more positive affective experience but no change in actual behaviour.
The transtheoretical model (TTM) was developed by Prochaska and DiClemente (1983) to explain why anti-smoking messages were more successful for some people than others. According to the TTM, people adopting a new behaviour move through a series of stages of change within which they utilize different processes to support the changes. These stages are described in Chapter 8. Movement across the stages is dependent on decisional balance and perceived self-efficacy. Decisional balance is a cognitive assessment of the relative merits of the pros and cons of the exercise behaviour while self-efficacy is the belief in one’s ability to perform the exercise. This model has been applied to physical activity by many researchers to describe the so-called five stages of exercise behaviour change (Marcus et al., 1992):
· Pre-contemplation: sedentary, no intention of becoming active within six months.
· Contemplation: still sedentary but does not accept the value/need for physical activity.
· Preparation: person is intending to become more active in the very near future.
· Action: person is physically active but only in the last six months.
· Maintenance: person has been active for more than six months.
In addition to these five stages, an integral part of the TTM is the processes of change that describe movement from one stage to the next. Box 13.1 describes the character of the five experiential and the five behavioural processes of exercise behaviour change. Marcus et al. (1992) found that the five experiential change processes were more important in predicting progress in the initial stages of exercise behaviour change, while the five behavioural processes were more important in the later stages.
Box 13.1 Processes of Exercise Behaviour Change
Consciousness raising: gathering information about the benefits of exercise.
Dramatic relief: feelings about inactivity and its consequences.
Environmental re-evaluation: consideration of the consequences of inactivity on others.
Self re-evaluation: reconsidering the consequences of physical activity for self.
Social liberation: awareness of social norms.
Counter-conditioning: substituting alternatives to sedentary behaviours.
Helping relationships: support of others in becoming physically active.
Reinforcement management: rewards for physical activity.
Self-liberation: commitment to physical activity.
Stimulus control: avoiding environmental stimuli associated with physical activity.
Source: Derived from Marcus et al. (1992)
A Scottish study found support for the role of these processes in describing exercise behaviour change (Lowther et al., 2007). Over 300 urban residents who had volunteered to participate in an exercise programme were assessed by questionnaire prior to the programme and at various intervals after the programme. They found that self-liberation was the most important change process at every stage movement but other processes were more important at particular stage movements. Stimulus control was more important when progressing from contemplation to preparation, while social liberation and helping relationships were more important in progressing from action to maintenance. The authors recommended that exercise interventions should be matched to the particular stage of change of the participants and target specific change processes.
Moving across the stages is said to depend on ’decisional balance’, the balance of pros and cons. In a study that compared reasons for and against participation in exercise in groups of non-exercisers and regular exercisers, Cropley et al. (2003) found that the pre-contemplators provided relatively more con reasons while the maintainers provided relatively more pro reasons. It was concluded that one reason why people do not exercise is that they cannot think of good reasons to do so.
Evidence of the importance of self-efficacy was provided by Marcus et al. (1992), who found that those who were regularly participating in physical activity (action or maintenance stages) scored higher on this measure. They concluded that this suggests that those who are at the early stages (pre-contemplation and contemplation) have little confidence in their ability to exercise.
A comprehensive review of literature using the TTM to explain exercise found lots of inconsistencies (Spencer et al., 2006). It found that much of the research was conducted on white, middle-class female populations, which raised questions about the generalizability. Second, it found that specific research projects often did not assess all the components of the TTM.
Besides these operational criticisms of the TTM there have also been more conceptual criticisms. Sutton (2000a) argued that the TTM is not really a theoretical model at all but merely a description of ’pseudo stages’ that are really arbitrary steps on a continuum of motivation. Armitage (2009) is sympathetic to this critique and suggests an alternative two-stage motivational—volitional model. However, he also argued that the focus of the critique on the stages of change has diverted attention away from the more interesting processes of change. West (2005) suggested moving on to develop a more theoretically coherent approach.
Recent social cognition modellers have suggested introducing a variety of additional psychological variables. Hagger et al. (2003) suggested introducing perceived competence (like self-efficacy) and self-concept. There is evidence that there is a positive relationship between physical self-concept and participation in physical activity. It is supposed that a person who feels positively about him- or herself in one domain (physical) is more likely to perform well in that domain. Marsh (1990) argued that this relationship is reciprocal such that prior self-concept affects subsequent physical activity and vice versa. Marsh et al. (2006) confirmed this reciprocal relationship and found that physical self-concept had an independent effect in prediction of exercise intention beyond perceived control. In a study of American students, Brudzynski and Ebben (2010) found that most of them reported that the amount they exercised was related to how they felt about their body. Those who felt overweight or unattractive reported more exercise participation. In a study in Israel (Korn et al., 2013) it was found that among students, engagement in physical exercise enhanced self-reported body image. Interestingly, they concluded that future efforts to promote health promotion (including exercise) should reflect a collectivist rather than an individualistic ethos. Thus, the college health policy should promote greater opportunity for all students to engage in physical activities.
Health psychologists have tended to focus their attention on SCMs, such as those described above, as the prime determinants of physical activity. These models continue to attract substantial research interest. As noted in Chapter 8, these models have attracted criticism of their methodological and theoretical shortcomings (Sniehotta et al., 2014). Detailed meta-analyses of studies which have considered their predictive power have identified their weaknesses. For example, Rhodes and de Bruyn (2013) found that only 42% of intenders (from the TRA) successfully engaged in physical activity subsequently. From a conceptual level, cognitive models are insufficient because they rely on a restrictive individualistic and rationalistic view of humans (e.g., Marks, 1996; Mielewczyk and Willig, 2007; Murray, 2014). They locate thinking in the head of the individual rather than as something that unfolds in interaction with others, leading to an individualistic focus in health promotion. There have been recent attempts to move beyond the focus on intrapsychic processes. For example, Ranby and Aiken (2016) identified the importance of the husband’s role on wives’ physical activity. Molloy et al. (2010) found that lower levels of social support for physical activity were associated with less activity, but only for women. This effect was partly mediated by perceived behavioural control and coping with planning.
Integrating Psychological and Environmental Models
There have been increasing attempts to develop a more integrative ecological view of physical activity that combines environmental and psychosocial factors. For example, in a Canadian study, it was found that access to recreational facilities was associated with enhanced physical activity among those with elevated levels of intention to be active (Rhodes et al., 2007). In a US study, it was found that a combination of psychosocial factors (perceived social support, perceived barriers and self-efficacy) and environmental supports (walkability, aesthetics and walking facilities) was the best predictor of physical activity among older adults (Carlson et al., 2012).
In an extensive three-country study (Belgium, the USA and Australia), Van Dyck et al. (2014) examined the interaction of psychosocial and environmental factors in predicting the extent of walking and leisure time physical activity. They found that perceived social support from friends and perceived barriers were the strongest psychosocial correlates of these activities. They also found that the role of perceived social support from family was more important for women. However, even after controlling for the psychosocial attributes, environmental factors emerged as important. These included perceptions of residential density, proximity of destinations and aesthetics.
A social interactionist views the individual as part of a group and of a society. The individual’s behaviour, thoughts and beliefs can be considered as unfolding in interaction with the groups and society as a means of adapting to changing circumstances. The person’s decision to become involved in physical activity is the result of an ongoing engagement with his/her immediate social world.
Further criticisms of SCMs can be found in Chapter 8. There is increasing critical and qualitative research that considers the various meanings of physical activity and considers these within varying social and cultural contexts.
Meanings of Physical Activity among Adults
Understanding the extent of participation in physical activity requires an understanding of the different meanings of physical activity. This depends upon the character of everyday social experience.
People from diverse social backgrounds perceive physical activity differently. Calnan and Williams (1991) conducted detailed interviews with a sample of middle-aged men and women from south-east England. The participants were from different social backgrounds. They found clear social class differences in perceptions of exercise. Those from working-class backgrounds perceived exercise in relation to everyday tasks, activities and duties at home and at work. They adopted a functional definition of health and fitness. For them, their ability to ’exercise’ their everyday tasks both confirmed and reaffirmed their health. For example, one farm worker said: ’I get enough exercise when I am working on the farm shovelling corn all day, you get enough exercise. In the garden out there, I take the dog for a walk, yet I get enough exercise’ (Calnan and Williams, 1991: 518). They tended to be satisfied with their physical health, which they could enhance during their everyday activities.
Middle-class people tended to perceive exercise as not being part of their everyday activities. They preferred to define it with reference to recreational or leisure activities that they sometimes felt they could not engage in because of lack of time. Fitness for these individuals was defined in terms of athleticism, not in ability to perform everyday tasks. This group also made more reference to the health-promoting effects of exercise in terms of ’well-being’ and relief from routine daily obligations. In discussing these class differences in perceptions of exercise, Calnan and Williams (1991) referred to the work of Bourdieu (1984: 214), who suggested that whereas working-class people express an instrumental relation to their bodily practices, middle-class people engage in health practices that are ’entirely opposed to (such) total, practically oriented movements’.
In a large-scale survey of young people’s physical activity in Norway, Oygard and Anderssen (1998) also considered the importance of the meaning of exercise and the physical body. In discussing the relationship between social class and exercise, they also referred to the work of Bourdieu (1984), who suggested that this relationship derives from social class differences in attitude towards the body. In our society, the legitimized body emphasizes both inner and outer characteristics. While the former is concerned with the healthy body, the latter refers to the fit and slim body. The middle and upper classes are more able to produce this legitimized body since it requires investment in time and money. Working-class people, who have less free time, from necessity have a more instrumental view of their body and view concern with exercise and fitness as pretentious. Conversely, middle-class people with more leisure time and resources to expend promote a cult of health and a concern with physical appearance.
Men and women perceive physical activity differently depending upon their social and cultural background. In their survey, Oygard and Anderssen (1998) found that level of education was positively associated with extent of participation in physical activity among females, but not among males. In reviewing this finding, they referred to the suggestion that concern with the body is more common among those belonging to the cultural elite, who are more anxious about their appearance and their ’body for others’ (Bourdieu, 1984: 213). Oygard and Anderssen (1998: 65) concluded: ’For females in higher social positions, it may be of importance to show others who they are by developing healthy and “delicate” bodies, i.e. they are more concerned with the inner and outer body than females in lower social positions.’ However, they also added more prosaically that the lesser involvement of less educated females in physical activity may be due to them having limited access to leisure facilities. They found little evidence of a relationship between education and physical activity among males and suggest that this may reflect the greater promotion of male sporting activities and the greater integration of physical activity into male culture.
It is well established that participation in physical activity declines steadily with age. This may reflect a variety of factors, including limited socialization into physical activity among that generation to perceived social exclusion. A study in New Zealand found that older people who participated in sporting activities reported that they were often confronted by a discouraging stance from younger people (Grant, 2001). This negative social value regarding seniors and sports would seem to be internalized such that many elderly people report limited participation for fear that they might incur an injury (O’Brien Cousins, 2000). Hardy and Grogan (2009) investigated older adults’ influences and motivations to engage in physical activity in 48 52—87-year-old participants. Preventing disability through exercise was a key factor in determining physical activity participation. Other influences included enjoyment of exercise, having support from others as motivators to exercise and a perception of a limited appreciation for older people’s needs.
People from ethnic minorities participate less in various physical activities. This is due both to the social and environmental constraints and differences in the perceived nature of physical activity. Henderson and Ainsworth (2003) conducted interviews with African-American and American-Indian women about their perception of physical activity. These women emphasized not only the physiological but also the spiritual benefits of physical activity. As one woman said: ’I love being outside. Mostly I love taking walks. I love the quietness with that’ (Henderson and Ainsworth, 2003: 319). Despite this positive view of physical activity, these women identified various obstacles to participation. This included perceived lack of time, although they also wondered about the legitimacy of this perceived obstacle. As one woman said: ’I talk about lack of time, et cetera, but you know, time is the sort of thing you can make available when you want’ (Henderson and Ainsworth, 2003: 315). Other perceived constraints included job demands, tiredness, illness, family needs and safety issues. These constraints are not peculiar to women from ethnic minorities. Other studies (e.g., Verhoef et al., 1992) have identified similar constraints as being common among other groups of women.
In an intensive qualitative study of adults from the Netherlands, the USA and Korea, Lim et al. (2011) explored the importance of both individual and structural factors in sports participation and how this differed between countries. In the US sample, the participants reported involvement in team sports while at school, but this declined as they moved into adulthood. Those who continued with sports tended to be involved in more individualistic activities, such as running, working-out or golf. They recalled fondly the social aspects of youth sports (e.g., ’Probably the thing I loved most about childhood sports was [that] “the neighbourhood” played whatever sport was in season’). However, they felt that this was less obvious among modern young people (’This is long gone in today’s culture for most children and certainly for most adults’; Lim et al., 2011: 212). Among US adults the predominant form of sport experience was passive — they watched sports on television and perhaps at a stadium. This was an opportunity for social interaction since it was easier to find people who had shared fanship rather than shared sports involvement. In the Netherlands sample, there was evidence of greater continuity of sports participation from youth to adulthood. There was less evidence of the passive participation evident in the US sample. Conversely, the Korean sample was more like the US sample. Together, this cross-country comparison reveals the cultural variation in sports participation, with passive sporting participation being more extensive in the USA and Korea.
In terms of individual motivations for sports participation, there was also evidence of cultural variations. The Korean adults referred to social, business, health and entertainment factors. While the American adults also referred to the importance of social and health reasons, they referred to competition as well. In addition, they detailed more reasons for non-participation, such as career and family commitments and lack of time. This need for justifying non-participation could perhaps be interpreted as evidence of personal conflict with a great cultural expectation of participation. They also referred more to their children as a barrier to their own participation — as Lim et al. (2011: 219) put it: ’Either my child plays or I play.’ Thus, while they may be letting down national expectations, they ensured that their children were living up to them. Finally, the greater extent of passive participation in the USA and Korea could be interpreted as evidence of the importance attached to the social as opposed to the health value of sport in those societies.
There is growing interest in the concept of ’body image’ or, more precisely, ’body imaging’, and its relationship with physical activity. The term ’body image’ is defined by Grogan (2006: 524) as ’a person’s perceptions, feelings and thoughts about his or her body’. There has been extensive research exploring the relationship between exercise participation and body image. In an extensive review of over 100 studies, Hausenblas and Fallon (2006) concluded that exercise participation was associated with a more positively perceived body image. In addition, this relationship was apparent not only in correlational studies, but also in intervention studies such that those who participated in physical exercise programmes reported an enhanced body image following the programme. This led Hausenblas and Fallon (2006) to conclude that exercise programmes may be an effective intervention for people with poor body image. However, they also caution that there may be a negative effect with some sub-groups. For example, Slater and Tiggemann (2006) found that women who exercise a lot have higher levels of body dissatisfaction and a great drive for thinness. This follows the general critique of modern representations of women equating beauty with slimness. Not surprisingly, it has been found that women and girls who weigh more are more dissatisfied with their body (Healey, 2006), although this relationship depends upon various social and cultural factors.
There is less research on male body image. Most studies have investigated the dimensions of adiposity and muscularity. As expected, males have reported a greater desire than females to become more muscular (Grogan and Richards, 2002). The covers of men’s health magazines show a globalized obsession with muscularity.
Adolescents who engage in sporting activities typically report a more positive body image (Ferron et al., 1999). However, there is less investment in body image for males (Hargreaves and Tiggemann, 2006) than for females, although this is influenced by social and cultural factors.
Campbell and Hausenblas (2009) conducted a meta-analysis of the research on the effects of exercise interventions on body image. They identified 57 interventions with pre-and post-data for the exercise and control groups. There was a small random effect, indicating that exercise interventions had improved body image compared to control conditions.
In our view, body imaging is not a fixed and static, intra-psychic phenomenon; like beliefs more generally, it develops in interaction and conversation with others and is embedded within a specific socio-cultural context (for more discussion of beliefs, see Chapter 6). As Gleeson and Frith (2006: 88) emphasize, ’it is more useful to consider body imaging as a process, an activity, rather than a product’. This re-orientation away from a static definition of body image emphasizes the need for more sophisticated qualitative work to explore the connection between the evolution of body imaging and physical activity.
Exercise among Children
In the UK, it has been estimated that among 2—15-year-olds, four out of ten boys and six out of ten girls are not participating sufficiently in physical activity (Prescott-Clarke and Primatesta, 1998). As with adults, the extent of participation varies substantially. In Norway, Oygard and Anderssen (1998) found that teenage girls with higher levels of education were more physically active whereas among boys there was less evidence of a relationship with level of education.
Physical activity levels established in childhood are maintained to some degree across the lifespan. Friedman et al. (2008) extracted data from the American Terman Life-Cycle Study, which began in 1922 and collected data on participants at regular intervals in subsequent decades. People with high active levels in childhood tended to report greater participation in physical activity in adulthood. This was especially the case for males. The longevity of activity levels added to governmental concern at the evidence of a decline in recent decades of the involvement of children in physical activity and exercise.
Several studies have confirmed the importance of family and friends. Coleman et al. (2008) found that parents and siblings served as prominent role models for children’s physical activity. Wheeler (2012) found that this socialization of activity occurs through direct and indirect strategies and practices. Direct strategies include telling the child about the benefits of physical activity, while indirect strategies include parents’ modelling physical activity. Downward et al. (2014) found a gender linkage in these relationships, in particular for boys. In a longitudinal study, Bunke et al. (2013) identified the importance of social support from outside the family, including involvement in sports clubs and schools’ informal connections.
Several psychosocial factors have been associated with participation, including physical competence, social acceptance and enjoyment. One can’t help thinking that joy or fun must be the key element in participation in physical activities and exercise for people of all ages. Frederick and Ryan (1993) identified ’fun, skill development, challenge and fitness’ as influential factors. The opportunity to enhance competence and skill level were identified by Weiss and Williams (2004) as other factors in maintaining involvement in sports. Conversely, factors that deterred involvement included expense, travel, limited choice of activity, experience, adult support, familiarity with the environment and knowledge of activities (Girginov and Hills, 2008). Factors predicting drop-out included negative experiences, such as lack of fun, coach conflicts and lack of playing time (Fraser-Thomas et al., 2008).
A decline in participation in physical activities occurs as children enter adolescence. This is particularly pronounced among girls. Not to put too fine a point upon it, looking ’cool’ isn’t easy in a sweaty T-shirt, lycra shorts and trainers with your hair in a mess and your makeup all smudged! It just isn’t cool for adolescent girls to do sport (Slater and Tiggemann, 2010). The Scottish Health Survey 2012 (Rutherford et al., 2013) found that while eight out of ten 5—7-year-old children met the physical activity guideline, by 13—15 years this had dropped to 55%. The drop was most pronounced between 11—12 years (68%) and 13—15 years (55%), especially among girls, who showed a 21% drop in participation between these age groups from 66% to 45%. Reasons for a growing disinterest in physical activity among girls included perceptions of their femininity, fears about looking stupid and fears about safety (Dwyer et al., 2006).
During adolescence girls become particularly concerned with their body image. A large study of over 50,000 Australians found that concern among females about body image increased from 28% of 11—14-year-olds to 33% of 15—19-year-olds to 40% of 20—24-year-olds (Mission Australia, 2010). A survey of teenage girls by Symons et al. (2013) found that body dissatisfaction was associated with low physical activity levels and higher extrinsic motivation for physical activity. They concluded that education programmes should emphasize both the diversity of body shapes and intrinsic motivations for physical activity. Related to this is the extent that young people believe that their body shape can be changed. Lyons et al. (2015) found in a survey of female students that those who agreed with an incremental theory of the body (one that can change) were more likely to engage in physical activity than those who endorsed an entity theory of the body (one that is fixed). Research has also explored the socio-economic background of children’s physical activity. In Denmark, Nielsen et al. (2012) found that children from higher SES families were more involved in sporting activities, although there was little difference in general physical activity. The lower SES boys may have been doing their paper rounds or kicking a ball around in the back alleys. They identified differences in material, social, educational and sporting capital as being important correlates of sporting participation.
Meaning of Physical Activity for Young People
An increasing number of qualitative studies have begun to clarify the changing experiences of physical activity among young people. Kunesh et al. (1992) investigated school play activities of 11—12-year-old girls in central USA. In interviews, the girls reported that they found physically active games at home and at school enjoyable. However, in the school playground the girls preferred to stand in a group and talk while the boys participated in various games. When the girls did participate in games often they were criticized by the boys for their supposed inferior performance. To avoid this negative treatment, the girls excluded themselves. The girls reported that when playing at school they felt nervous and embarrassed. These findings suggest that while at an early age boys and girls both enjoy physical activities, by the time they reach puberty the girls feel that they are being excluded or they exclude themselves for other reasons.
As they enter adolescence the gender difference in participation in physical activities becomes more pronounced. From a series of interviews with young people living in south-east London, Coakley and White (1992) identified five factors that help explain young people’s decisions about participation in sporting activities (Box 13.2).
Box 13.2 Young People’s Decisions about Sport Participation
Consideration of the future, especially the transition to adulthood.
Desire to play and extend personal competence and autonomy.
Constraints related to money, parents and opposite-sex friends.
Support and encouragement from parents, relatives and peers.
Past experiences in school sports and physical education.
Perceived identity was a central concern in the extent and character of sports preferred. Young people actively sought out or rejected involvement in certain physical activities dependent upon a variety of factors, including previous experiences and ongoing changing circumstances. As Coakley and White (1992: 21) state, ’young people become involved in sport through a series of shifting, back-and-forth decisions made within the structural, ideological, and cultural context of their social worlds’.
Source: Coakley and White (1992). Reproduced by permission
Qualitative studies have investigated gender and social class factors associated with different forms of participation of children in various forms of physical activity. In a study of the images in teenage girls’ magazines, Cockburn and Clarke (2002) found two polarized female images: one actively involved in romantic activities versus the aberrant female involved in physical activity. The teenage girls in her study resented these stereotypical images and felt that it did not accord with the everyday conflicts they experienced. However, they also voiced concern at the increasing social restraints on their involvement in sporting activities. For example, one girl said: ’when I was at primary school I just used to go out there and I’d do anything … I wouldn’t care what other people thought, I’d just go out and enjoy it … now it’s more, “Oh my god can I do this?” And you know, like everybody’s looking at you … I hate it.’
Together, these studies confirm the importance of the various meanings associated with physical activity among children and young people. For teenagers, being cool and looking cool is the main issue.
Promoting Physical Activity
With the growing evidence on the health benefits of physical activity and exercise, governments and health authorities have become keen to promote greater participation. For example, in the UK, the Department of Health requires all health authorities to contribute to local programmes designed to promote greater physical activity (Department of Health, 2011). These have included population-, community-, school- and clinic-based interventions.
Population-based strategies are designed to promote more widespread participation in physical activity in society. The strategies range from ones with an environmental focus, such as the introduction of cycle lanes in cities and reducing traffic speed, to mass media campaigns. The impact of these interventions varies. An evaluation of an intervention designed to promote physical activity (Sallis et al., 2007) found that it had a greater impact among women in the area that reported no unattended dogs and low crime in their neighbourhood, and among men who reported often seeing people being active in their neighbourhood.
However, these environmental supports for physical activity are not equally distributed in society. In a review of the literature, Taylor et al. (2006) identified the strong inverse relationship between what they termed physical activity-friendly environments and low-income and ethnic minority groups. To promote an activity-friendly environment requires an ’environmental’ or ’social justice’ approach that aims to redress social inequalities in exposure to environmental hazards. We covered this issue in detail in Chapter 5.
In public buildings, physical strategies have been employed to promote greater physical activity. It isn’t rocket science: simply displaying posters near stairwells promotes greater usage (e.g., Anderson et al., 1998). A variant of this is the positioning of health promotion messages on the actual stair rises. A study of a shopping centre in England found that such an initiative more than doubled stair usage (Kerr et al., 2001). While these cheap and simple measures are important, the many occupational hazards in the workplace, which are again unfairly distributed, cannot be ignored. An example of a participatory approach to challenging occupational and environmental hazards is given in Box 13.3.
The third population-based strategy is mass media campaigns. A survey of European countries found that residents of those countries who perceived that public policy was promoting physical activity were more likely to report participating in such activity (Von Lengerke et al., 2004). However, moves to promote exercise through healthy public policy must be distinguished from the further promotion of the ideology of individualistic self-control (Marks, 1996). Although middle-class adults may be attracted to this message, many people from working-class and more deprived backgrounds may treat it with cynicism (Crossley, 2003). Often, there seems to be a disconnection between healthy public policies and the material circumstances of people’s everyday lives (Murray and Campbell, 2003) and it invites the same ’victim-blaming’ criticism as traditional health education (Crawford, 1985). An inactive and obese person might well feel that they are to blame, and feel more than their fair share of stigma and shame.
Box 13.3 International Case Study: Promoting Environmental Justice through ’Theatre of the Oppressed’
Environmental justice is concerned with building a campaign to challenge the environmental hazards in any community. An example of an environmental justice campaign is that developed by John Sullivan and his colleagues in several low-income communities in Texas.
The campaigns were participatory and informed by Augusto Boal’s Theatre of the Oppressed. This approach uses drama as a means of expressing the community’s dissatisfaction with current environmental arrangements and demanding improved living and working conditions. During the drama, or Forum, the participants are encouraged to reflect upon the environmental hazards and what can be done about them. The Forum is not expected to be a passive affair, but rather the spectator is transformed into a ’spect-actor’ who is prepared to take action after the Forum to campaign for environmental justice.
’There is no place for passivity at a Forum; Theatre of the Oppressed primes spectators to apply their powers to deconstruct what they see and ’prepare for action’ (Sullivan et al., 2008: 171).
Source: Sullivan et al. (2008)
Interventions that have attempted to increase participation in communities have often been based upon social cognition models (SCMs), especially the TTM. Marcus et al. (1992) designed an exercise intervention for volunteers recruited from a community. The character of the intervention was matched to the initial stage of change of the volunteers. On follow-up, there was evidence of a significant increase in involvement in exercise commensurate with the initial stage. In a subsequent randomized controlled trial, Marcus et al. (1994) found further supportive evidence. At three-month follow-up the participants in the stage-matched group showed stage progression (i.e., greater interest or involvement in exercise), while those in the standard group showed stage stability or regression.
Clarke and Eves (1997) found partial support for the TTM in describing the willingness of sedentary adults to participate in an exercise programme prescribed by their family doctor. They classified the participants into the pre-contemplation, contemplation and preparation stages, reflecting the fact that at this stage they had not begun the programme. As predicted, the cons of participation in the exercise programme decreased across the stages, although there was slight change in the pros. The barriers to participation identified were lack of support, lack of facilities, dislike of exercise and lack of time. The importance of dislike of exercise declined across the stages, while the importance of lack of facilities increased. The finding that lack of time was used as frequently by those in the pre-contemplation as those in the preparation stage was interpreted as evidence that it is more a justification for lack of participation rather than a convincing reason.
Other studies have expanded the basic TTM to consider the importance of outcome expectancies (Williams et al., 2005). For example, Fridlund et al. (2008) investigated the role of anticipated positive and negative emotions. This study was a three-month follow-up of a sample of healthy, community-dwelling adults who agreed to participate in an exercise programme. Fridlund et al. found that anticipated emotions interacted with stage of behaviour change in predicting activity adoption and maintenance. At baseline, they found that anticipated positive emotions of success were lowest in those classed in the pre-contemplation stage, while anticipated negative emotions of failure were highest in those classed in the maintenance stage. Further, anticipated positive emotions of success predicted physical activity adoption and maintenance.
Hutchison et al. (2013) presented an alternative to the dominant SCMs of physical activity promotion derived from in-depth interviews with a sample of previously sedentary adults who had successfully completed a physical activity course. This alternative model consists of cues, leading to certain cognitions and action determinants and then to behavioural responses (physical activity). Underlying this model were intervening core values that were the key to behaviour change. The most important values that were associated with uptake of physical activity were social orientation (importance of close interpersonal relations), competence orientation (importance of personal success or competence), control orientation (importance of independence of action) and health orientation (importance of health). It is argued that the derivation of this model from detailed interviews provided ecological validity. However, absent from their model is the broader socio-cultural and political context within which the values draw meaning.
A related cognitive intervention that has attracted attention is that based on control theory (Carver and Scheier, 1982). This theory argues that people self-monitor their behaviour against certain standards. When their performance drops below the standard they attempt to rectify this by increasing their activity. Based upon this theory, attempts to promote greater physical activity should promote self-monitoring, goal-setting and provide feedback. In an experimental study, Prestwich et al. (2016) examined individuals who were encouraged to self-monitor their planned physical activity and to set goals as regards their level of physical activity. Those individuals assigned to the group which promoted self-monitoring, goal-setting and received feedback reported greater physical activity.
However, these cognitive interventions continue to focus on the individual. More recent community-based approaches adopt a more critical approach, emphasizing various forms of community mobilization. For example, Campbell (2014) emphasizes the need to consider broader political issues and the power relationships. As she argues, the focus should be on developing social interventions to ’reduce power inequalities (e.g., between rich and poor) that undermine people’s opportunities to be healthy’ (Campbell, 2014: 46).
Since children and young people spend much of their daily lives at schools or colleges, they have become the focus in promoting physical activity. The two main opportunities for children to participate in physical activity at school are during less-supervised breaks and during physical education classes.
Some research has focused on the less-organized physical activity that occurs during break times. It has been found that the larger the schoolyard, the more physical activity takes place. Also, if there are playground markings indicative of sporting/play activities, children are more likely to engage in physical activity (Escalante et al., 2012).
There is a long history of physical education (PE) in schools. This tradition, especially in British schools, has been based upon a nineteenth-century model of teaching children to perform a range of very masculinist and militaristic physical exercises where discipline and stoicism are key features (Paechter, 2003). Perhaps girls and less ’macho’ or ’sporty’ boys are rather more reluctant to give their all to too many of these exercises. In their study of teenage girls, Cockburn and Clarke (2002: 654) noted that: ’Many of these traditional and stereotypical rituals in PE contradict the notion of acceptable/desirable “appearance” within the teenage feminine culture and cause conflict for girls.’ Indeed, this conflict with the dominant image of femininity can lead to a clash between what Cockburn and Clarke describe as two polarized identities. A girl can identify herself as a masculinized ’doer’ of PE (a ’tomboy’) or a feminized (’girlie’) ’non-doer’ of sport and physical activity. It is highly unlikely that girls can achieve both physically active and (heterosexually) desirable, so they are obliged to choose between these images (Cockburn and Clarke, 2002: 661). Further, in her study Paechter (2003) found that some girls demonstrate their femininity through deliberate resistance to PE.
Boys who are poor at school sporting activities also often attract ridicule from their more athletic peers. This is especially the case in those schools that emphasize the more physical sports. These games in which the boys are expected to demonstrate their strength have many similarities with military exploits (Paechter, 2003).
In a study of PE in Australian schools, Wright et al. (2003) showed how its character was clearly related to social class. Boys, especially those from affluent backgrounds, participated in organized team sports from an early age. For these boys, participation in sports was a very important part of the school ethos and identity. This led Wright et al. (2003: 25) to describe the social practices around sport as ’powerful disciplinary technologies (Foucault, 1980) whereby particular kinds of citizens, forms of masculinity and ways of interacting with physical activity are shaped’. In this setting, the young people are being trained to strongly identify with their school team and to act in a particularly aggressive way towards others. Sport thus becomes part of the training for a form of officer class and, indeed, competitions between teams representing schools, colleges or even nations take on some of the characteristics of battle or warfare.
In an Australian study of participation in sports and physical activity by rural teenage girls, Casey et al. (2009) found that the girls reported that they were more keen to participate if the activities were fun, involved being with their friends, and were supported by family and friends through role modelling and feedback.
An alternative to this technology of disciplining young people through physical activity is one that offers emancipatory potential. This approach is one informed by Freire’s (1973) pedagogy and that aims to enhance the children’s experience of themselves as physical beings in the world (Lloyd, 2008). It is an approach infused with happiness and laughter in the present as well as a questioning and curiosity about the future. This approach is designed to experiment with forms of physical activity and explore innovative ways through which the students can enhance their bodies. An example of this was the study by Holt et al. (2013) that considered the importance of after-school programmes. Their study used a participatory action design deliberately working with the children to identify the activities they liked. They found that the children especially enjoyed those activities that provided challenges and ’adventures’ and engaged with their imaginations.
Finally, in a comprehensive review of school-based physical activity programmes, Erwin et al. (2012) drew attention to the many difficulties involved in conducting comparative evaluations. They highlight the many difficulties of integrating physical activities into the school day, especially with the increasing attention to improving academic performance.
Clinic-Based Physical Activity Programmes
Exercise interventions are often targeted at certain sub-groups of the population, including people who are overweight, the elderly or those who suffer from particular health problems. The evaluations of these programmes have often been quantitative in design and have identified a limited number of social cognition variables that predict adherence to the programmes. In a review of the impact of exercise programmes for coronary heart disease, Woodgate and Brawley (2008) identified the importance of personal efficacy. They distinguished between task self-efficacy and self-regulatory efficacy.
A frequent problem with exercise programmes is that while many people sign up for such programmes, it has been estimated that 50% or more drop out after a brief period of participation (Dishman, 1986). In an exercise intervention study with older adults by Neupert et al. (2009), it was found that those who had greater self-efficacy and control beliefs at six months were more likely to continue exercise after one year. Somewhat similar findings were reported in a qualitative study of older adults in south-west England (Beck et al., 2010). This study found that all the older people interviewed searched for purpose in their lives, and for those older people who were physically active having an exercise schedule contributed to this sense of purpose. In addition, the physical activity offered a personal challenge to the older exercisers.
A wide range of techniques have been used to promote greater involvement in physical activity. Abraham and Michie (2008) identified 26 behaviour change techniques (BCTs), ranging from providing information about the behaviour—health link to providing information on others’ approval. These reflected a range of different theoretical techniques: the theory of planned behaviour, social-cognitive theory and control theory. There has also been substantial intervention work exploring the value of interventions based upon various social cognitive models of physical activity. However, these have met with limited success. For example, in their meta-analysis of interventions based on the theory of planned behaviour, Rhodes and Dickau (2012) found limited impact on intention and behaviour. A more detailed meta-analysis by McDermott et al. (2016) found some behaviour change techniques had a positive impact on physical activity, although those based more on social cognitive theory (especially self-efficacy) had a more positive effect on intention than those based on the theory of planned behaviour.
Most of the interventions targeted at enhancing physical activity have used quantitative assessments. This restricts the opportunity to clarify what the participants feel about the various interventions. Several recent evaluations that have used qualitative methods have emphasized the importance of perceived enjoyment. A study by Daley et al. (2008) included a qualitative study within the larger randomized controlled trial of an exercise intervention for obese adolescents. This revealed that the participants expressed a variety of feelings, including feeling more energetic and pleased about potential weight loss. The research emphasized the importance of positive feelings and enjoyment in the programme as being central to its success. The researchers concluded that ’it is unlikely that young people who are obese will commit to a regular active lifestyle unless they have opportunities to experience positive feelings from engagement’ (Daley et al., 2008: 816).
In an intensive study of an exercise programme with older people, Hudson et al. (2015) found two comparative narratives. The first involved a narrative of ’decelerated decline’ where, although the exercise programme was integrated into the current life narrative of the older person, there was limited personal meaning of the exercise. Conversely, the second narrative involved a re-storying of the personal narrative such that instead of the inevitable decline there was the prospect of challenging the so-called narrative foreclosure (Freeman, 2000). These two emergent narratives may depend upon the previous life-histories of the individuals.
Another qualitative study (Graham et al., 2008) explored the experiences of people with chronic illness and disability who participated in a physical exercise programme. Analysis of the interviews identified three polarized themes, which are summarized in Box 10.4. In reviewing these themes, it is apparent that the intervention is effective not just through improving physical ability. On a more social and psychological level the activity intervention also had value in enhancing mood, social connections and identity.
Box 13.4 Reactions to Participating in an Exercise Programme for Disabled People
Passive distress vs. active mood management: whereas disability can contribute to a passive inactive lifestyle, participation can enhance mood and reduce patterns of rumination. For example: ’My energy wasn’t great. I would get into the house and just sit down and say, “I can’t be bothered”, I was doing nothing at all. I was just going home, watching TV all day. I don’t do that now because I think of the exercises. … I imagine myself within the group and I do a few [exercises] at home. I’m sort of motivated now.’
Identity erosion vs. identity renewal: whereas disability and chronic illness can lead to feelings of identity loss, participation in physical activity contributed to a new identity of physical competence. For example, ’From being an outgoing, physical sort of person you were bedridden. That was mind-blowing. Terrible. Shattered. Suddenly this residual bit of fitness I had all my life was going out the window.’ The exercise programme stopped that slide into inactivity.
Detachment vs. connection: while disability can lead to detachment from familiar valued aspects of everyday life, such as friends and familiar bodily functioning, the intervention provided new connections. For example, ’Since getting so unwell I have lost contact with a lot of people I would have met when I was out and about. Now I don’t have those kinds of contacts because I’m inside most of the time. I meet people here [day centre]. It’s a bit like being exiled or being cast out — you think I’d leprosy sometimes! [laughs] Maybe I’ll get a bell to warn people off.’
Source: Graham et al. (2008). Reproduced by permission
Further, these strategies are largely focused at the individual level. They ignore the social context and the social meaning of exercise and physical activity. Social approaches attempt to widen the traditional individual change approach to include ’changes in social networks and structures, organizational norms, regulatory policies, and the physical environment as a means of enhancing long-term maintenance of the target behavior’ (King, 1994: 1406).
Alternative Forms of Physical Activity
There is increasing challenge to the dominance of the functional approaches to promoting physical activity with its attendant emphasis on physical health. Alternative strategies consider such issues as the more social, emotional and aesthetic aspects of physical activity. Three such alternative forms are dance, walking groups and lifestyle sports.
There has been a recent growth of interest in the health benefits of dance. It is considered a very non-intrusive means of promoting participation in physical activity. However, participation in dance is more than just a means of enhancing physical health. Fensham and Gardner (2005: 15) argue that within dance ’the body is not simply an object upon or through which discipline or utility must be imposed, but … through which values, meanings and pleasures are enacted and created’. Dancing can be considered a means of developing cultural capital (Bourdieu, 1986). This form of capital allows one to withdraw from the economic necessities of life and distance oneself from ’practical urgencies’.
Dance is attractive to men and women from different social backgrounds. For example, Baker (2002: 18) notes that, especially for younger people, dance is an important way of playing being sexual in which ’they try a more sexual presence on for size’. Among older people, it is a very enjoyable means of developing social interaction (Paulson, 2005).
Walking, especially in natural, semi-rural or rural settings, can be both physically and mentally exhilarating. Priest (2007) investigated what she termed the ’healing balm effect’ of using a walking group to feel better. Priest combined methods from grounded theory and ethnography to explore members’ experience of a mental-health day-service walking group. An overall model, the healing balm effect, integrated seven categories to describe the ’healing’ properties of the experience: Closer to what is more natural; Feeling safe; Being part; Striving; Getting away; Being me; and Finding meaning. Several of the features reported by Priest would not be present, or only partially present, walking in towns or cities. The most beneficial urban walking places are likely to be commons or parks.
Cauwenberg et al. (2012) used walk-along interviews to identify environmental factors that influence walking for transportation among older adults. Access to facilities, walking facilities, traffic safety, familiarity, safety from crime, social contact, aesthetics and weather were frequently mentioned as influencing walking among participants.
Kassavou et al. (2015) studied environmental factors that influence walking in groups using a walk-along interview procedure with ten leaders of walking groups. The leaders took groups to parks, city centres or did laps. Kassavou et al. identified the characteristics of place that influenced the type of walking that people do in groups and the processes used by walkers to find meaning in the places they walk. They found that the walking places were ’nodes’ where people formed social networks. They were not restricted to the specific place (e.g., the park during walks), but expanded beyond that to other places for socializing. Walking alone would seemingly serve a different function, that of reflection, problem solving and creative thinking.
Over the past 10—20 years a counter-establishment form of sporting activity has grown in popularity. A report by Tomlinson et al. (2005) collectively termed these activities as ’lifestyle sports’. They are also frequently termed extreme sports and include such activities as bungee jumping, white-water rafting, rock-climbing and surfing. These activities are especially popular among young people.
There is a growing body of research on who participates in these activities and the perceived character of the experience. Willig (2008) analysed detailed interviews with a small sample of eight extreme sports practitioners. The interviews were phenomenological in orientation and sought to grasp the meaning of the sports to the practitioners. Willig identified what she described as four constitutive themes and five other themes in these interviews. These are summarized in Box 13.5.
Box 13.5 Meanings of Extreme Sports
Context: the environment or social context within which the sport has an enhanced meaning, e.g., solitude and the experience of mountain climbing.
Challenge: the opportunity to push oneself to the limits both physically and mentally, e.g., overcoming the fear of jumping from a great height.
Suffering: the possibility of pain, injury or death.
Other people: other people being aware that they were practising these sports, e.g., being different from others.
Mastery and skill: the need for specialized knowledge and skill.
Contrasts: the presence of two apparently contradictory qualities, e.g., the beauty/calmness of the landscape and the challenge of the sport.
Being in the present: the focus on the immediate to the exclusion of other thoughts.
Compulsion: the strongly felt need to engage in these activities.
Pleasure: the enlightened feelings of pleasure and excitement.
Source: Willig (2008)
Unlike populist characterizations of these activities as reckless or sensation-seeking, it was apparent from these interviews that the participants carefully considered them. Willig suggested that participation in these activities enabled the participants to attain a state of being comparable to what Csikszentmihalyi (1997) has termed ’flow’. This is the experience of a sort of unity of the self, world and activity in which the more mundane, everyday worries and concerns become less important. As such, it could be argued that participation in these sports is a reaction to broader cultural demands on young people in our consumer society, which provides limited opportunity for such experiences. However, the individualistic nature of such activities can pose potential threats. For example, Willig cautions that while participation in these activities may be therapeutic, they may also lead to dependency.
After All That
The past generation has seen the promotion within Western societies of a neoliberal philosophy promoting greater individual responsibility and minimal government intervention together with market fundamentalism (Ayo, 2012). This is particularly apparent within the physical activity arena. Harrington and Fullagar (2013) detailed how the promotion of the active living agenda by many Western governments positions the individual as responsible and ignores the other social and material constraints on participation. They note that ’the decline of the welfare state and the rise of liberal notions of responsibility have occurred alongside an increased reliance on market forces and voluntary organizations with stretched resources to provide opportunities for active leisure and sport’ (Harrington and Fullagar, 2013: 141). In their study of Australian sport and recreation workers, they found that, while the workers were very committed to promoting enhanced participation, they were unsure of their impact in the light of limited resources. Instead people from disadvantaged backgrounds found it difficult to engage with these activities. This led to the victim-blaming of those such as overweight women, migrants, low-income families, older people, and those with disabilities, who found it difficult to participate in organized physical activities.
Ayo (2012) noted the pervasiveness of the active living agenda within Western societies. This ranges from the marketing of membership of sports clubs to sportswear. This promotion of an active health agenda contributes to what Galvin (2002) has termed a ’consumerist frenzy’. People join sports clubs and wear sports clothes but do not participate in sporting activities. Membership of elite sports clubs and purchase of expensive sportswear form part of a process of gaining enhanced social status and reinforcing social inequalities.
One final point is the role of pets in promoting physical activity. In Western society the ownership of pets is widespread. In the UK it is estimated that 40% of households have a pet. The most popular pet is a dog, owned by approximately one-quarter of households (Pet Food Manufacturers Association, 2016). There is now evidence that having a pet dog is associated with increased physical activity and a range of other psychological benefits (see Box 13.6). There is a need for further research on this phenomenon.
Box 13.6 Having a Pet Dog
Unsurprisingly, having a dog to walk contributes greater physical activity to owners. A Canadian study found that dog owners walked almost twice as much as non-dog owners (300 minutes per week compared with 168 minutes per week; Brown and Rhodes, 2006). The benefits of dog ownership can also extend beyond physical health. There is evidence that it is associated with improved psychological health (Serpell, 1991). Taking the dog for a walk also leads to greater opportunity for social interaction. There is evidence that dog owners report more social contact and having longer conversations when out walking than non-dog owners (Beck and Meyers, 1996). It has also been suggested that dog ownership strengthens commitment to weight loss programmes. While most of the evidence is for adults, there is also evidence that children in families with dogs report more time walking (Owen et al., 2010) and that they are less likely to be overweight (Timperio et al., 2008). Salmon and Timperio (2011) suggest that other social and psychological benefits of dog ownership for children include enhanced feelings of well-being and fewer feelings of loneliness. Boisvert and Harrell (2014) further suggest a range of spiritual benefits of dog ownership for children, including increased feelings of joy, creativity, hopefulness and sense of connectedness with self and others, and a sense of wholeness with the universe. They also report social and psychological benefits of dog ownership for children who are overweight.
1. Public participation in physical activity is continuing to decline, including participation of children and young people. We need to know more about why.
2. There is still a need to explore the specific impact of exercise interventions on the health of different population groups to demonstrate that increased activity improves health.
3. Research is needed to develop our understanding of the different meanings for different sub-groups of the population.
4. Participatory action research offers an opportunity to increase our understanding of different perceptions of several types of physical activity programme.
1. Interest in exercise has waxed and waned over the years. The past generation has witnessed increasing interest in the health benefits of exercise.
2. A substantial proportion of the populations of Western societies is sedentary.
3. Results of several comprehensive surveys indicate that moderate degrees of physical activity have both physical and psychological benefits.
4. There is some evidence to suggest that excessive exercise can have negative health effects. It may even prove fatal.
5. The degree of participation declines during adolescence, especially among girls.
6. In adulthood, there is less participation among females, those from poorer social positions and those from ethnic minorities.
7. Various psychological factors have been found to be associated with participation in both childhood and adulthood.
8. The meaning of exercise is linked to the varying social contexts. For young people, if it isn’t perceived as ’cool’ or as ’fun’, they are unlikely to do it.
9. Exercise participation programmes can be either population based or aimed at high-risk groups. The main problem with both forms of programme is adherence, which is generally low.
10. Alternative methods of activity, such as dance, group walking and lifestyle sports, are capable of evoking joy, excitement and pleasure, which means that the activity is more likely to be repeated.