Task Force Recommendation on Individually-Adapted Health Behavior Change Interventions
Eighteen studies that evaluated individually-adapted behavior change interventions designed to increase physical activity met the inclusion criteria for review by the Task Force on Community Preventive Services (Blair et al., 1986; Cardinal et al., 1995; Chen et al., 1998; Coleman et al., 1999; Dunn et al., 1999; Foreyt et al., 1993; Jarvis et al., 1997; Jeffry et al., 1998; Jette et al., 1999; Kanders et al., 1994; King et al., 1991; Marcus et al., 1998; Mayer et al., 1994; McAuley et al., 1994; Noland et al., 1989; Owen et al., 1987; Peterson et al., 1999; Wing et al., 1996). The studies rest largely on a foundation of theories or models such as the social cognitive theory (Bandura, 1986), the health belief model (Rosenstock, 1990), and the trans-theoretical model (Prochaska and diClemente, 1984). These theories recognize and take into account the individual variability among people, including their physical activity preferences, interests, and readiness to make behavior changes (Kahn et al., 2002). Therefore, the individually-adapted health behavior change interventions have the potential to be used in a variety of settings with diverse population subgroups.
A summary of the effects of these interventions is as follows: There was a median increase of 35.4 percent in the amount of time that study participants were physically active (interquartile range 16.7-83.3 percent) and a 64.3 percent median increase in energy expenditure (interquartile range 31.2-85.5 percent) attributed to the behavior change interventions. Studies that assessed maximal oxygen uptake resulted in a 6.3 percent median increase (interquartile range 5.1-9.8 percent) in this measure of aerobic fitness. The Community Guide also reports that individually-adapted health behavior change interventions reduced body weight and percent body fat and increased strength and flexibility of participants in studies that assessed these outcomes. Based on these findings, the Task Force on Preventive Services determined that strong evidence exists to recommend the use of individually-adapted health behavior change physical activity interventions (Kahn et al., 2002; Zaza et al., 2005).
Update on Individually-Adapted Health Behavior Change Interventions
Although not defined as a review of individually-adapted health behavior change interventions to increase physical activity per se, a Cochrane review related to this intervention category was conducted and published (Foster et al., 2005) after the Community Guide findings were reported. The authors reviewed physical activity interventions that included components related to individually-adapted health behavior change interventions as described in this chapter. The Cochrane review focused on studies that included
- one-to-one counseling, advice, or group counseling;
- self-directed or prescribed physical activity;
- home- or facility-based physical activity;
- ongoing face-to-face support;
- written educational and motivational support; and
- self-monitoring strategies.
With the exception of one study, there was no overlap between the studies that met inclusion criteria in the Community Guide and Cochrane review. Thus, the studies that are part of the Cochrane review further advance the knowledge base about this intervention category through 2005. The inclusion criteria used in the Community Guide process were more liberal than those used in the Cochrane review, which focused specifically on randomized controlled trials (RCTs). As a result, the findings reported by the Cochrane review were more conservative than those generated by the Community Guide; however, the Cochrane review authors concluded that the physical activity RCTs they reviewed have a positive and moderate effect on increasing self-reported physical activity and cardiorespiratory fitness.
The Cochrane review also points to the value of using telephone and printed educational materials in some interventions to support people in their efforts to initiate and increase physical activity. In the past decade, interventions using mediated approaches such as telephone, print, and Web site interventions to prompt individual behavior change have substantially increased (Castro and King, 2002; Humpel et al., 2004; Marcus et al., 2007; Marcus et al., 2000; Marcus, Owen, et al., 1998; Marshall et al., 2004; Napolitano and Marcus, 2002; Pinto et al., 2002; Vandelanotte et al., 2005, Vandelanotte et al., 2007; Van den Berg et al., 2007). Although it can be argued that these interventions are media-based rather than “classic” individual behavior change interventions, it is clear that theoretical approaches such as behavior theory, social cognitive theory, social learning theory, and the transtheoretical model have been successfully used beyond traditional face-to-face behavior modification and counseling efforts. Mediated approaches certainly can have their place in mass media campaigns or community-wide campaigns to increase physical activity, but they may also overlap with individually-adapted health behavior change interventions. Goal setting, feedback, monitoring of personal efforts to change physical activity behavior, reinforcement, and social support, for example, have been interwoven into a variety of mediated approaches to increase physical activity. Thus, individually-adapted health behavior change interventions have evolved with the evolution of information technology, and these strategies have tremendous potential to increase the prevalence of physical activity on a population level (see, e.g., Marcus et al., 2007).
Practical Application and Special Considerations
You may be involved in increasing physical activity behavior among members of group exercise classes or physical activity programs conducted in community-based settings such as university, work site, or senior centers. If so, you should use effective individually-adapted health behavior change interventions that use health behavior theories to assist the participants in your physical activity program gain the cognitive and behavioral skills to succeed with reaching their physical activity goals. Behavioral theories and individual behavior change interventions will provide you with a framework for guiding and evaluating the progress and success of your program participants. Your efforts in this regard may be guided by resources such as the first edition of this book (USDHHS, 1999), the National Cancer Institute’s Theory at a Glance, and a book published by Marcus and Forsyth (2009) (see sidebar).
Because your goal is to help people develop lifestyle skills to initiate and maintain greater physical activity, you may ask, What skills or strategies can I pass on or teach to others to help them manage their own efforts to be physically active? This is an important question, because these interventions, when used in a public health context (typically with people participating in a group physical activity program) are delivered to individuals in person or by mail, computer, or telephone. Lack of training, planning and coordination, or important materials and resources will be barriers to the success of an intervention.