Morris, Felicity Anne (2008) The adoption and maintenance of physical activity for mid-life, sedentary women. PhD thesis, Victoria University.

Abstract

There is conclusive evidence that regular physical activity produces both physical and psychological benefits. People engaged in sedentary work who avoid physical activity, or have physical or psychological obstacles to being physically active, forgo the substantial benefits that being physically active provides. In Australia, many middle-aged women (45 to 59 years) are especially at risk of ill-health due to their physically inactive lifestyles. In this dissertation, I report on a mixed-method research approach that incorporated the LIFE: Live It Up (LLIU) intervention. Adopting a multi-theoretical perspective I drew on strategies from Transtheoretical Model, Social Cognitive Theory, the Theory of Planned Behaviour, and Self-Determination Theory. In the first study, participants (71, sedentary, mid-life women) were assigned to either an adoption (3-hour workshop), maintenance (3-hour workshop plus extra maintenance session at 9 months) or control (usual activity) condition. Physical activity levels, psychological well-being, and moods were assessed (pre, post and at 4, 40 & 44 weeks) using the Scottish Physical Activity Questionnaire (SPAQ); the Medical Outcome Survey (MOS) Short Form, (SF36); and the Positive and Negative Affect Scale, (PANAS). Motivational messages (Treatment condition participants only) and reflective journals (all participants) tailored to conditions were delivered to participants across the intervention year. Quantitative analyses for the LLIU intervention study involved a series of Analyses of Variance (ANOVA). High attrition, however, across conditions resulted in only 27 participants remaining in the study at 52 weeks. No significant differences were from applying ANOVA to the SPAQ data for physical activity levels. Applying ANOVA to the vitality (SF-36 subscale) gain score data (SF-36) there was evidence of significant gains in vitality at 4 and 44 weeks for the treatment condition (TC) participants compared to the control condition. Feelings and emotions (mood) were measured with the PANAS (see appendix C). Applying ANOVA revealed positive affect was stable across the intervention for TC participants. Negative affect, however, was lowered at 52 weeks for TC participants. I interpreted all results cautiously, because of high attrition rates, particularly in the control condition, and a consequent loss in statistical power. Quantitative analyses for the LLIU intervention study involved a series of Analyses of Variance (ANOVA). High attrition, however, across conditions resulted in only 27 participants remaining in the study at 52 weeks. No significant differences were indicated from results of applying ANOVA to the SPAQ data for physical activity levels. Vitality, a construct assessing energy level and fatigue, was examined and applying ANOVA to the vitality (SF-36 subscale) gain score data (SF-36) showed evidence of significant gains in vitality at 4 and 44 weeks for the treatment condition (TC) participants compared to the control condition. Feelings and emotions were measured with the PANAS (see appendix C). Applying ANOVA revealed positive affect was stable across the intervention for TC participants. Negative affect, however, was lowered at 52 weeks for TC participants. I interpreted all results cautiously, because of high attrition rates, particularly in the control condition, and a consequent loss in statistical power. Qualitative analysis of the ejournals indicated that participation in the LLIU and elements of the ejournal were motivational for physical activity response. TC participants’ reported being encouraged through the workshops to focus on physical activity. Encouragement was associated with social aspects of the workshop, enjoyment, and the kind of information provided. In addition, TC participants reported that lack of time, family demands, and energy depletion were considerable obstacles to physical activity participation. In the second study, I conducted follow-up interviews with 11 of the intervention participants, between one and four months after their LLIU involvement ended. Using thematic content analysis I identified six themes expressed by the women within the treatment conditions. These were (i) commitment; (ii) change driving forces; (iii) positivity, “licence” to change, and guilt reduction; (iv) elements of choice, control, and capacity to follow through; (v) self-efficacy expectations; and (vi) social support issues. For instance, commitment involved participants in taking specific steps toward action and generated freedom from procrastination; change driving forces were internal and external with enjoyment greatly enhancing physical activity experiences; positivity led to a sense of licence to change, followed by guilt reduction. An additional three case studies drilled down into issues that mid-life women typically face when attempting physical activity change. Findings highlighted the frustration associated with wanting to change, being caught in an attempt-fail cycle, and being assigned to control condition; how change can happen (adoption condition) even when family values are highly prioritised and illustrated how the confidence gained through the LLIU developed sustainable efficacy for exercise (maintenance condition). Identification of “double benefits” such as engaging in physical activity while encouraging children to be active can be motivational for sustainable physical activity. Guilt metaphorically paralysed physical activity changes. Strategic thinking assisted with recycling through stages of change. Autonomous behaviour change in control participants who remained in the study raised key questions for future studies. In addition, my studies added to the evidence base that intervention research with sedentary participants requires additional strategies (e.g., overrecruitment, extra attention) to ensure sustained engagement. In conclusion, high attrition in the first study reduced the veracity of quantitative evidence for the effectiveness of multi-theory approaches for increasing physical activity. Findings reported for the second study have considerably expanded the evidence base concerning the debilitating effects of guilt and the usefulness of strategic thinking on motivation for physical activity. In addition, this study represents additional evidence for motivation for physical activity change being strengthened through workshops and reflective journals. Longitudinal research is especially difficult with sedentary cohorts especially in the context of recruiting and maintaining participant samples.

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