Applying the Transtheoretical Model to the Study of Exercise on Prescription

Clarke, Patricia; Eves, Frank F.

doi:10.1177/135910539700200216

Cited by 30 publications

(29 citation statements)

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“…As well as collating critiques arising from well recognized sources (e.g. Bandura, 1997;Farkas et al, 1996), the report revisited established debates (Davidson, 1992) and expresses similar concerns to those voiced by some of those most closely associated with the development of the model (Marcus et al, 1996;Clarke & Eves, 1997;Lauby et al, 1998;Lechner et al, 1998;Kearney et al, 1999). Unfortunately, these concerns tend to be buried in af rmative reports, skated over or tagged passively to conclusions as proposals for future research.This paper revisits these concerns and considers them in a more explicit fashion.…”

Section: Introductionmentioning

confidence: 81%

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The ‘stages of change’ model in health promotion: Science and Ideology

Bunton¹,

Baldwin²,

Flynn³

et al. 2000

Critical Public Health

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AB S T R A C T The transtheoretical or 'stages of change' model has greatly influenced health promotion practice in the USA, Australia and the UK since the late 1980s. Application of the model has shaped service planning, provision and implementation. 'Stages of change' also has impacted on training agendas at local, regional and national levels. Associated areas of motivational interviewing and brief intervention have led health promotion initiatives in areas such as smoking cessation and alcohol-reduction policies. A number of critiques have recently challenged the 'stages of change' model and health promotion orthodoxy. This review examines these critiques, with a focus on the 'scienti c' status of 'stages of change'. The review also examines a data-based approach to stages of change, model adequacy, the social and ideological context of change theories in health promotion contexts, levels of explanation and prediction in the 'stages of change' framework. Some reasons are offered for the apparent popularity of the model amongst health promotion workers.Recommendations are made about alternative conceptual frameworks.

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Section: Introductionmentioning

confidence: 81%

“…Those people considered 'unready for change' are unlikely to access such resources (social, cultural or economic capital). When interventions are targeted exclusively at contemplators and maintainers (Clarke & Eves, 1997) this has been especially problematic.…”

Section: Discussionmentioning

confidence: 98%

The ‘stages of change’ model in health promotion: Science and Ideology

Bunton¹,

Baldwin²,

Flynn³

et al. 2000

Critical Public Health

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“…46 3. Readiness to change as measured by the transtheoretical model, 47 applying it to exercise behaviour to determine perceived barriers 48 and self-efficacy for exercise. 49 Expectations of exercise were measured with the Outcome Expectation for Exercise (OEE) scale-2, a 13-item measure with two subscales: positive and negative OEE.…”

Section: Ascertainment Of Outcomesmentioning

confidence: 99%

Multicentre cluster randomised trial comparing a community group exercise programme and home-based exercise with usual care for people aged 65 years and over in primary care

Iliffe

Kendrick

Morris

et al. 2014

Health Technology Assessment

121

168

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BackgroundRegular physical activity (PA) reduces the risk of falls and hip fractures, and mortality from all causes. However, PA levels are low in the older population and previous intervention studies have demonstrated only modest, short-term improvements.ObjectiveTo evaluate the impact of two exercise promotion programmes on PA in people aged ≥ 65 years.DesignThe ProAct65+ study was a pragmatic, three-arm parallel design, cluster randomised controlled trial of class-based exercise [Falls Management Exercise (FaME) programme], home-based exercise [Otago Exercise Programme (OEP)] and usual care among older people (aged ≥ 65 years) in primary care.SettingForty-three UK-based general practices in London and Nottingham/Derby.ParticipantsA total of 1256 people ≥ 65 years were recruited through their general practices to take part in the trial.InterventionsThe FaME programme and OEP. FaME included weekly classes plus home exercises for 24 weeks and encouraged walking. OEP included home exercises supported by peer mentors (PMs) for 24 weeks, and encouraged walking.Main outcome measuresThe primary outcome was the proportion that reported reaching the recommended PA target of 150 minutes of moderate to vigorous physical activity (MVPA) per week, 12 months after cessation of the intervention. Secondary outcomes included functional assessments of balance and falls risk, the incidence of falls, fear of falling, quality of life, social networks and self-efficacy. An economic evaluation including participant and NHS costs was embedded in the clinical trial.ResultsIn total, 20,507 patients from 43 general practices were invited to participate. Expressions of interest were received from 2752 (13%) and 1256 (6%) consented to join the trial; 387 were allocated to the FaME arm, 411 to the OEP arm and 458 to usual care. Primary outcome data were available at 12 months after the end of the intervention period for 830 (66%) of the study participants.The proportions reporting at least 150 minutes of MVPA per week rose between baseline and 12 months after the intervention from 40% to 49% in the FaME arm, from 41% to 43% in the OEP arm and from 37.5% to 38.0% in the usual-care arm. A significantly higher proportion in the FaME arm than in the usual-care arm reported at least 150 minutes of MVPA per week at 12 months after the intervention [adjusted odds ratio (AOR) 1.78, 95% confidence interval (CI) 1.11 to 2.87;p = 0.02]. There was no significant difference in MVPA between OEP and usual care (AOR 1.17, 95% CI 0.72 to 1.92;p = 0.52). Participants in the FaME arm added around 15 minutes of MVPA per day to their baseline physical activity level. In the 12 months after the close of the intervention phase, there was a statistically significant reduction in falls rate in the FaME arm compared with the usual-care arm (incidence rate ratio 0.74, 95% CI 0.55 to 0.99;p = 0.042). Scores on the Physical Activity Scale for the Elderly showed a small but statistically significant benefit for FaME compared with usual care, as did perceptions of benefits from exercise. Balance confidence was significantly improved at 12 months post intervention in both arms compared with the usual-care arm. There were no statistically significant differences between intervention arms and the usual-care arm in other secondary outcomes, including quality-adjusted life-years. FaME is more expensive than OEP delivered with PMs (£269 vs. £88 per participant in London; £218 vs. £117 in Nottingham). The cost per extra person exercising at, or above, target was £1919.64 in London and £1560.21 in Nottingham (mean £1739.93).ConclusionThe FaME intervention increased self-reported PA levels among community-dwelling older adults 12 months after the intervention, and significantly reduced falls. Both the FaME and OEP interventions appeared to be safe, with no significant differences in adverse reactions between study arms.Trial registrationThis trial is registered as ISRCTN43453770.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 18, No. 49. See the NIHR Journals Library website for further project information.

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“…However, there is some conflicting evidence on its effects. For example, in the context of an exercise prescription scheme, Clarke and Eves (1997) found self‐efficacy did not vary between stages of change, suggesting that it may be an unreliable predictor in this context. Similarly, although stage‐matched interventions have shifted stage of change, they have not always produced concomitant increases in self‐efficacy (Calfas, Sallis, Oldenburg, & Ffrench, 1997; Naylor et al 1999).…”

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confidence: 99%