Time to Change Habits. Physical Activity and the Transtheoretical Model of Behavioral Change   April 22nd, 2021

​Overwhelming evidence proves the notion that reduction in daily physical activity is a risk factor behind several chronic diseases (Lacombe et al., 2019) and that individuals who are more physically active have a lower risk for the development of chronic pain (Landmark et al., 2011). In addition, evidence suggests that exercise has an effect on decreasing symptoms of depression in the general population across a wide age-range (Hu et al., 2020). 

Despite evidence documenting and supporting the health benefits of physical activity, inactivity remains the biggest public health problem of the 21st century (Blair, 2009). Moreover, adherence to exercises in rehabilitation programs is a significant problem, with estimates of non-adherence as high as 50%, potentially having a detrimental effect on clinical outcomes (Argent et al., 2018). Key factors in successful long-term exercise adherence are still not well understood. However, health models that assesses an individual's readiness to act on a new healthier behavior such as the Transtheoretical Model (TTM) may provide a framework for this process.

The TTM includes four constructs: the stages of change, the processes of change, self-efficacy, and decisional balance.

The stages of change construct refers to the temporal dimension of behavioral change involving progress through a series of stages (Prochaska & Velicer, 1997). Stages include; 1) precontemplation: people in this stage have no intention of changing behavior, 2) contemplation: in this stage, people are aware of the sedentary lifestyle but intend to change in the next 6 months, 3) preparation: people now intend to take action in the immediate future, 4) action: the stage in which people have made active modifications of the intent behavior, and 5) maintenance: at this stage new behavior replaces old one and people will try to prevent relapse (Pirzadeh et al., 2015).

The second structure of the model is the processes of change consisting of ten strategies used in helping individuals move through the stages of change. Strategies such as reinforcement by suing rewards, self-liberation, and managing the environment. 

Another structure of TTM is decisional balance which reflect weighing the pros and cons of changing to new healthy lifestyle. 

However, the ultimate structure of the model is self-efficacy.  Self-efficacy is defined as the confidence one has in his/her own ability to perform a task, even in difficult situations (Bandura, 1977).

Many studies have examined the constructs of the TTM in relationship to physical activity behavior. Recent studies exploring the use of TTM for physical activity in older adults concluded that TTM is a useful and suitable behavior model in creating, developing, and evaluating interventions with the aim of acquiring and improving physical activity habits in the older adults (Jiménez-Zazo et al., 2020). Also, in youth evidence had been found that the use of TTM has a positive relation in enhancing physical activity among university’s students (Liu et al., 2018)

The success of physical therapy and rehabilitation programs depend largely on the adherence of patients to the recommended exercises. TTM provides a framework for health care providers in understanding the dynamic nature of how people change and help them to be aware that each patient can be at a different stage of the model and thus the need to individualize interventions.  

Charbel Najem

Ph.D. researcher at the Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University.

2021 Pain in Motion

References and further reading:  

Argent, R., Daly, A., & Caulfield, B. (2018). Patient Involvement With Home-Based Exercise Programs: Can Connected Health Interventions Influence Adherence? JMIR MHealth and UHealth, 6(3). https://doi.org/10.2196/mhealth.8518

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. https://doi.org/10.1037/0033-295X.84.2.191

Blair, S. N. (2009). Physical inactivity: The biggest public health problem of the 21st century. British Journal of Sports Medicine, 43(1), 1–2.

Hu, M. X., Turner, D., Generaal, E., Bos, D., Ikram, M. K., Ikram, M. A., Cuijpers, P., & Penninx, B. W. J. H. (2020). Exercise interventions for the prevention of depression: A systematic review of meta-analyses. BMC Public Health, 20(1), 1255. https://doi.org/10.1186/s12889-020-09323-y

Jiménez-Zazo, F., Romero-Blanco, C., Castro-Lemus, N., Dorado-Suárez, A., & Aznar, S. (2020). Transtheoretical Model for Physical Activity in Older Adults: Systematic Review. International Journal of Environmental Research and Public Health, 17(24). https://doi.org/10.3390/ijerph17249262

Lacombe, J., Armstrong, M. E. G., Wright, F. L., & Foster, C. (2019). The impact of physical activity and an additional behavioural risk factor on cardiovascular disease, cancer and all-cause mortality: A systematic review. BMC Public Health, 19(1), 900. https://doi.org/10.1186/s12889-019-7030-8

Landmark, T., Romundstad, P., Borchgrevink, P. C., Kaasa, S., & Dale, O. (2011). Associations between recreational exercise and chronic pain in the general population: Evidence from the HUNT 3 study. Pain, 152(10), 2241–2247. https://doi.org/10.1016/j.pain.2011.04.029

Liu, K. T., Kueh, Y. C., Arifin, W. N., Kim, Y., & Kuan, G. (2018). Application of Transtheoretical Model on Behavioral Changes, and Amount of Physical Activity Among University’s Students. Frontiers in Psychology, 9. https://doi.org/10.3389/fpsyg.2018.02402

Pirzadeh, A., Mostafavi, F., Ghofranipour, F., & Feizi, A. (2015). Applying Transtheoretical Model to Promote Physical Activities Among Women. Iranian Journal of Psychiatry and Behavioral Sciences, 9(4). https://doi.org/10.17795/ijpbs-1580

Prochaska, J. O., & Velicer, W. F. (1997). The Transtheoretical Model of Health Behavior Change. American Journal of Health Promotion, 12(1), 38–48. https://doi.org/10.4278/0890-1171-12.1.38