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Physical Activity Promotion Project (PAL) Principal Investigators: Jeff
McCubbin, Ph.D.,
Oregon State University Quick Links: The benefits of physical activity and/or exercise for individuals with disabilities have been reported by an abundance of studies and governmental agencies (Blinde & Taub, 1999; Bosscher, 1993; Centers for Disease Control and Prevention, [CDC], 1999; Guthrie, 1999; Martin, 1999). Increasing the number of individuals who meet the criteria of health-related physical activity is of paramount importance for health. In a 1997-survey (Healthy People, 2010), it was reported that a high percentage (56%) of adults with disabilities do not participate in leisure-time physical activity as compared to adults without disabilities (36%). The low rate of engagement in regular physical activity among people with disabilities may be related to low motivation that seems to be associated with interconnected psychosocial dynamics such as attitudes toward equal opportunities for physical activity engagement (Kosma, Cardinal, & Rintala, 2002). Therefore, it is essential to increase motivation toward healthy, active lifestyles (Durstine et al., 2000). Motivational programs should be derived from sound theoretical models and tailored to individual needs in a friendly and contemporary way. An action-oriented motivational program, such as the one tailored on the basis of the transtheoretical model (TM), may facilitate progress in this area (Burbank & Riebe, 2002; Kosma et al., 2002). Few studies have used theory-based motivational programs toward enhancing physical activity. Specifically, it has been supported that print-based and stage-matched motivational programs derived from the TM can increase physical activity participation and reduce relapse (Cardinal & Sachs, 1995, 1996; Marcus et al., 1998; Sallis, et al., 1999). Although print-based materials have been supported as effective on behavior change, the advances and appeal of technology initiated the need to examine the efficacy of web-based materials on physical activity participation. Web-based information can reach a large number of individuals at any time and place. For example, home-based programs and individually tailored feedback can be instantly delivered eliminating the costs of face-to-face counseling and lack of information dissemination aimed at a wide range of audiences, such as people with disabilities that may avoid or cannot afford individual counseling. Information technology offers a friendly and interactive way to communicate with a wide range of people incorporating audio-visual and animated information. Also, using the advances of the Internet, individual data can be collected automatically in order to administer individually tailored programs (Dirkin, 1994; Fotheringham, Owies, Leslie, & Owen, 2000; Marcus, Nigg, Riebe, & Forsyth, 2000; Marcus, Owen, Forsyth, Cavill, & Fridinger, 1998). While few studies have used the Internet to promote physical activity, the ones that have been conducted show some promise. For example, web-based, stage-matched, and individually-tailored motivational strategies are more effective in enhancing physical activity of moderate intensity than print-based, standard, self-help materials provided by the American Heart Association (Marcus, Bock, Pinto, Forsyth, Roberts, & Traficante, 1998). In another study (Calfas, et al., 2001), a computer-based motivational program called PACE+ was directed to patients of four major health-care settings in San Diego in order to enhance moderate and/or vigorous exercise, as well as healthy nutrition habits. The results revealed that the program was effective in enhancing physical activity and healthy dietary behaviors especially in the target audience. RESEARCH OBJECTIVE/RESEARCH QUESTION The aforementioned motivational programs were directed to individuals without disabilities reinforcing the need of theory-oriented and disability-specific interventions. As indicated, such intervention programs are likely to be more successful if they are stage-matched, individually tailored (e.g., interactive) and electronically delivered following the constructs of TM. Therefore, the purpose of this study is the development and comparison of interactive vs. non-interactive one-month electronically delivered motivational materials tailored to adults with physical disabilities in the initial stages of exercise behavior change (i.e., precontemplation, contemplation, and preparation). The main focus of the motivational materials will be physical activity initiation and enhancement. The materials will de delivered in two experimental groups. The first group will receive web-based (text plus graphics) and stage-matched motivational strategies whereas the second group will receive web-based (text plus graphics), stage-matched, and interactive (i.e., discussion group) motivational materials. The control group will be a wait-list control group receiving the best motivational practices derived from the statistical analysis. Hypothesis It is hypothesized that the interactive motivational materials will be more effective in increasing physical activity participation than the non-interactive materials. Additionally, both experimental groups are expected to positively change their physical activity behavior more than the control group. Participants Measures The study variables and their measures are presented in the following table:
Procedures For this study, a web site has been developed in which the survey questionnaires and the motivational strategies will be posted for completion from the participants. At baseline, an informed consent indicating the purpose and importance of the study together with the study questionnaires will be posted on the survey web site for the participants in the early stages of change. Individuals who accept to participate in the study will be eligible to complete the survey electronically. The survey data will be automatically exported to an EXCEL file program. After completing the baseline survey, participants will be randomly assigned to three groups, two experimental and one-control with approximately 100 participants in each group. Individuals in both experimental groups will receive a one-month stage-matched, self-directed, and electronically administered motivational program. The program will be directed to initiate and enhance physical activity participation. Program strategies will vary including physical activity barrier identification and ways to overcome them such as social support, rewarding, goal setting, accessibility, attitude change, time management, and role modeling. Such strategies will be phrased in such a way to incorporate all three stages of change. Graphics will also be available to increase interest and understanding. The motivational program is currently in review from a panel of experts. There will be a structured discussion group component for only one of the experimental groups allowing the participants to share experiences (e.g., potential difficulties and/or successes) during program implementation. In this way, the program becomes interactive capturing individual needs for the posited group. The investigators will not interfere in the discussions to avoid bias. However, they will be able to follow the discussions that are taking place. The control group will be a wait list control group receiving the best practices following statistical analysis. The motivational materials for both experimental groups will be delivered four times (i.e., one time each week). Specifically, each week participants will be receiving a new lesson from a physical activity tutorial. At the end of the month, all participants will be requested to complete the study survey. The completion of the survey will be confidential. Individual results of the study will not be distributed, and access to the web site will be available only to the study participants and the investigators. Research design This is a true experimental study aimed at evaluating the most effective physical activity motivational materials among adults with physical disabilities. In particular, this is a pretest-posttest randomized control group design (Patten, 2000) with two experimental groups and one control. There is an attempt to identify potential differences in physical activity between the two experimental groups as well as between the experimental and the control groups following the intervention. Primary statistical analysis The Statistical Package for the Social Sciences (SPSS version 11) will be used to analyze all data in this study. A 3 (two experimental vs. one control) X 3 (stages of change) X 2 (time) univariate repeated measures analysis of variance will be conducted to identify potential main effects and interactions in the change pattern of exercise behavior before and after the intervention. As such, the most effective program - of the two treatments - in behavior change will be tested. Physical activity is very important for individuals with and without disabilities. It is expected that the results of this study will facilitate the identification of "best practices" toward physical activity participation for adults with physical disabilities. As a future study, the developed web site can be further expanded in length and substance incorporating different health behaviors, age and disability groups, and people of diverse ethnic backgrounds. American College of Sports Medicine. (2000). ACSM’s guidelines
for exercise testing and prescription (6th ed.). Philadelphia: Author. Bosscher, R.J. (1993). Running and mixed physical exercises with depressed psychiatric patients. International Journal of Sport Psychology, 24, 170-184. Burbank, P.M., & Riebe, D. (Eds.) (2002). Promoting exercise and behavior change in olderadults: Interventions with the transtheoretical model. New York, NY: Springer Publishing Company. Calfas, K.J., Sallis, J.F., Zabinski, M.F., Wilfley, D.E., Rupp, J., Prochaska, J.J., Thompson, S., Pratt, M., & Patrick, K. (2001). Preliminary evaluation of a multicomponent program for nutrition and physical activity change in primary care: PACE+ for Adults. Preventive Medicine, 34, 153-161. Cardinal, B.J., & Cardinal, M.K. (2000). Preparticipation physical activity screening within a racially diverse, older adult sample: Comparison of the original and revised physical activity readiness questionnaires. Research Quarterly for Exercise and Sport, 71, 302-307. Cardinal, B.J., & Sachs, M.L. (1995). Prospective analysis of stage-of-change for exercise movement following mail-delivered, self-instructional exercise packets. American Journal of Health Promotion, 9, 430-432. Cardinal, B.J., & Sachs, M.L. (1996). Effects of mail-mediated, stage-matched exercise behavior change strategies on female adults’ leisure-time exercise behavior. Journal of Sports Medicine and Physical Fitness, 36, 100-107. Centers for Disease Control and Prevention. (1999). Persons with disabilities. In Surgeon General's Report [Online]. Available: http://www.cdc.gov/nccdphp/sgr/disabhtm [2002, April 29]. Dirkin, G. (1994). Technological supports for sustaining exercise. In R.K. Dishman (Ed), Advances in exercise adherence (pp. 237-247). Campaign, IL: Human Kinetics. Durstine, J.L., Painter, P., Franklin, B.A., Morgan, D., Pitetti, K.H., & Roberts, S.O. (2000). Physical activity for the chronically ill and disabled. Sports Medicine, 30, 207-219. Fotheringham, M.J., Owies, D., Leslie, E., & Owen, N. (2000). Interactive health communication in preventive medicine: Internet-based strategies in teaching and research. American Journal of Preventive Medicine, 19, 113-120. Guthrie, S.R. (1999). Managing imperfection in a perfectionist culture: Physical activity and disability management among women with disabilities. Quest, 51, 369-381. Healthy People 2010, (2001). Healthy people with disabilities: HP2010 data on disparities. In National Center on Birth Defects and Developmental Disabilities, CDC [Online]. Available: http://www.cdc.gov/ncbddd/fact/thpfs2.htm. Kosma, M., Cardinal, B.J., & Rintala, P. (2002). Motivating individuals with disabilities to be physically active. Quest, 54, 116-132. Marcus, B.H., Banspach, S.W., Lefebvre, R.C., Rossi, J.S., Carleton, R.A., & Abrams, D.B. (1992). Using the stages of change model to increase the adoption of physical activity among community participants. American Journal of Health Promotion, 6, 424-429. Marcus, B.H., Bock, B.C., Pinto, B.M., Forsyth, L-A. H., Roberts, M.B., & Traficante, R.M. (1998). Annals of Behavioral Medicine, 20, 174-180. Marcus, B.H., Emmons, K.M., Simkin-Silverman, L.R., Linnan, L.A., Taylor, E.R., Bock, B.C., Roberts, M.B., Rossi, J.S., & Abrams, D.B. (1998). Evaluation of motivationally tailored vs. standard self-help physical activity interventions at the workplace. American Journal of Health Promotion, 12, 246-253. Marcus, B.H., Nigg, C.R., Riebe, D., & Forsyth, L-A.H. (2000).
Interactive Marcus, B.H., Owen, N., Forsyth, L-A.H., Cavill, N.A., & Fridinger, F. (1998). Physical activity interventions using mass media, print media, and information technology. American Journal of Preventive Medicine, 15, 362-378. Martin, J.J. (1999). Predictors of social physique anxiety in adolescent swimmers with physical disabilities. Adapted Physical Activity Quarterly, 16, 75-85. Nigg, C.R., Norman, G.J., Rossi, J.S., & Benisovich, S.V. (1999). Processes of exercise behavior change: Redeveloping the scale. Poster session presented at the Societal of Behavioral Medicine conference, San Diego, CA. Patten, M.L. (2000). Understanding Research Methods: An overview of the essentials (2nd ed). Los Angeles, CA: Pyrczak Publishing. Plotnikoff, R.C., Blanchard, C., Hotz, S.B., & Rhodes, R. (2001). Validation of the decisional balance scales in the exercise domain from the transtheoretical model: A longitudinal test. Measurement in Physical Education and Exercise Science, 5, 191-206. Reed, G.R., Velicer, W.F., Prochaska, J.O., Rossi, J.S., & Marcus, B.H. (1997). What makes a good staging algorithm: Examples from regular exercise. American Journal of Health Promotion, 12, 57-66. Sallis, J.F., Calfas, K.J., Nichols, J.E., Sarkin, J.A., Johnson, M.F., Caparosa, S.T., & Alcaraz, J.E. (1999). Evaluation of a university course to promote physical activity: Project GRAD. Research Quarterly for Exercise and Sport, 70, 1-10. Washburn, R.A., Zhu, W., McAuley, E., Frogley, M., & Figoni, S.F. (2002). The physical activity scale for individuals with physical disabilities: Development and evaluation. Archives of Physical Medicine and Rehabilitation, 83, 193-200. Kosma M. (2003), Interactive versus non-interactive electronically delivered motivational materials for physical activity initiation and enhancement among adults with physical disabilities. Doctoral dissertation, Oregon State University. |
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