Sbaraglia, Melissa (2020) Improving initiation and maintenance of exercise among people with a chronic disease. PhD thesis, Victoria University.

Abstract

One in two Australians has a chronic disease, and a quarter has two or more. Despite the widely documented benefits of exercise for the prevention and management of many chronic diseases, the majority of people with a chronic disease remain insufficiently active. The examination of exercise behaviour must be guided by appropriate theoretical frameworks to improve the effectiveness of exercise interventions to support people with a chronic disease to initiate and maintain participation. In this thesis, two studies with complementary methods were used to examine the exercise behaviour change relating to people with Type 2 diabetes mellitus (T2DM) from the perspective of the participant and the practices of exercise practitioners. Study 1, a qualitative study, examined the perspective of participants with a chronic disease in an exercise efficacy trial. Five participants with Type 2 diabetes mellitus (T2DM) completed a semistructured interview 12 to 18 months following the conclusion of a 12-week exercise intervention. Two participants were male, and three participants were female, with an age range of 43 to 83 years. The length of time since diagnosis ranged from four to 26 years. The Theoretical Domains Framework (TDF) was used to code interviews deductively, and a range of strategies was identified as critical for exercise initiation and maintenance. The most commonly reported themes were: (1) reinforcement; (2) beliefs about consequences; (3) behaviour regulation; (4) beliefs about capabilities; (5) social influences; (6) environmental context and resources; (7) emotion; (8) goals, and (9) social/professional role and identity. Behaviour regulation was related to the maintenance of exercise. Study 2, a quantitative study, examined the use of behaviour change techniques (BCTs) by 54 exercise practitioners when working with clients with a chronic disease. Exercise practitioners were mostly female (72.2%) and aged between 25 and 34 years (55.6%). Most of the sample were Accredited Exercise Physiologists (81.5%) and held a postgraduate qualification (65.0%). First, the Behaviour Change Index-Exercise Practitioners (BCI-EP) was developed to measure the use of BCTs in clinical practice. The Index was based on the Coventry, Aberdeen, London-Refined (CALO-RE) taxonomy that describes 40 BCTs relevant to exercise behaviour change. Second, the Index items were grouped according to the dominant TDF domains and administered to examine the use of theory-based BCTs used in practice. BCTs related to the goals and social influences TDF domains were the most frequently reported groups of techniques used by exercise practitioners. Female gender was positively associated with more frequent use of environmental context and resources related techniques compared to male practitioners. Exercise practitioner age was negatively associated with the use of behaviour regulation and beliefs about consequences techniques. Accredited Exercise Physiologists were less likely to use reinforcement BCTs compared to fitness instructors and personal trainers when working with clients with a chronic disease. This research contributes to the body of knowledge by applying the TDF to understand the initiation and maintenance of exercise among people with T2DM. The results provide insights into the strategies that might influence the uptake and maintenance of exercise among people with T2DM. The study also adds to emerging literature about the importance of emotion as a predictor of exercise participation among people with T2DM. Emotion related BCTs could be added to taxonomies such as the CALO-RE to expand existing knowledge of exercise participation to improve T2DM management. The newly developed BCI-EP could be applied for a range of research purposes to assess other practitioner’s use of BCTs and to examine the relationship between the use of BCTs and exercise uptake and adherence in clinical practice, and exercise practitioner education and training. A range of cognitive, affective, social, and environmental theoretical domains were related to exercise behaviour change among people with T2DM. These domains theoretical domains must be integrated into the development of exercise interventions to improve the effectiveness of exercise prescription for people with T2DM.

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