Is physical activity a part of who I am? A review and meta-analysis of identity, schema and physical activity

The relationship between habit and identity in health behaviors: A systematic review and three-level meta-analysis

Habit and identity are two key determinants of health behavior maintenance. However, the relationship between habit and identity remains inconsistently interpreted, with empirical findings showing varying correlations. This meta-analytic review aimed to synthesize the effect sizes of the relationship between habit and identity in health behaviors and to further explore the moderators that influence this relationship. A search of eight databases (PubMed, Web of Science, Scopus, MEDLINE, CINAHL, PsycArticles, PsycINFO, and SPORTDiscus) was conducted up to October 9, 2024. Nineteen articles related to physical activity, healthy eating, and drinking were identified based on eligibility criteria, including 32 effect sizes and a total of 13,340 participants. The results indicated a significant positive correlation between habit and identity with a large effect size (r = 0.55, 95% CI [0.49, 0.74]). A multiple moderator analysis revealed that effect sizes were larger when identity was measured using explicit tests. The moderating effects of different types of health behaviors and geographic location were not sufficiently supported. Limited predictive studies imply that the relationship between habit and identity might not be unidirectional. Finally, this review calls for the integration of knowledge of habit and identity to facilitate the practice of health behavior change.

When a #Selfie is Healthy: How Self-Persuasion Through User-Generated Content Influences Intentions

As user-generated content (UGC) increasingly shapes the digital communication landscape, this study explored how message creators may persuade themselves to engage in healthier activities. In an online experiment, participants (N = 404) were asked to select a topic (healthy eating or exercising) and view a screenshot from a fictitious health organization. Afterward, participants were randomly assigned (based on topic) to: (a) create a video, (b) watch a video, or (c) a control group, and answer a questionnaire. A mediation analysis showed that message-creation was associated with more positive attitudes, self-identity, and self-efficacy. In turn, these variables were associated with greater intentions to adopt healthy practices. Merely watching a video (or doing nothing) was less influential. The data suggest specific mechanisms by which self-persuasion may affect behavior in digital health contexts, particularly via self-efficacy. Results also suggest recommendations for practitioners to leverage the persuasive influence of UGC in health-promotion campaigns.

Predicting sport and physical activity commitment and participation during early parenthood

Despite considerable benefits of regular moderate-to-vigorous intensity physical activity (MVPA) and sport participation, adult participation rates remain low. Drawing from the sport commitment model (SCM), the purpose of this study was to examine predictors of sport commitment and MVPA, among parents of children (<13 years of age) across 3-months. Participants were randomly assigned to a team sport (n = 58, asked to select and participate in an adult team sport program), individual PA (n = 60, asked to select and participate in individual PA) or control (n = 66, asked to select a "date-night" activity) group and completed measures of the SCM (commitment, enjoyment, involvement opportunities, social constraints, investment, involvement alternatives) and self-reported MVPA at baseline, and post-randomization at six weeks and three months. Commitment and investment were significant predictors of MVPA over time, and enjoyment, involvement alternatives, and investment predicted commitment over time, controlling for group assignment. Individuals assigned to the team sport group reported greater commitment and investment at week 6 compared to the control group and higher investment partly mediated the relationship with MVPA. Interventions fostering enjoyment, and that can help support parents to make an investment to build commitment in sport and PA may be particularly effective when promoting MVPA in this population.

Dynamic representations of theory testing in physical activity using ecological momentary assessment: an example guide utilizing multi-process action control

Behavioral theories are essential in understanding physical activity (PA) and developing effective intervention strategies, yet most theories have been developed alongside common research methods available at their inception. Contemporary data collection methods such as intensive longitudinal designs (e.g., Ecological Momentary Assessment; EMA) are beginning to facilitate more advanced approaches to theorizing. One of the primary challenges in applying traditional behavior change theories, however, relates to measurement, as traditional multi-item measures are not practical nor may they accurately capture the dynamic elements of the construct sought in intensive longitudinal sampling. The purpose of this paper was to provide a user's guide of measures of the Multi-Process Action Control (M-PAC) Framework for use in EMA, followed by preliminary working examples. EMA offers opportunities to sample and obtain real-time (or near real-time) information that include processes that are more automatically or immediately activated in response to environmental stimuli or informational cues. As a result, we propose a slight re-operationalization of M-PAC as it relates to the interacting psychological systems in determining PA. We outline some of the measurement challenges with M-PAC using EMA, and the opportunities to blend more traditional and contemporary real-time approaches to advance theory and our understanding of PA. Together, this paper is intended to be a starting point, acknowledging the need to adapt traditional behavioral theories to incorporate the dynamic factors in determining PA. By doing so, we can advance our understanding of PA and develop more effective, and theory-based, interventions tailored to individual needs and contexts.

Intervention effects on physical activity identity: a systematic review and meta-analysis

Physical activity (PA) identity (i.e., categorisation of oneself in a particular role) has been linked to PA behaviour in observational research, yet experimental research has seen less attention. The purpose of this meta-analysis was to examine the effectiveness of interventions to change identity and subsequent PA. Eligible studies were published in a peer-reviewed journal in English, included an experimental or quasi-experimental design in the PA domain with a measure of identity as the dependent variable, among an adult (>18 yrs.) sample. A literature search was completed in March 2024 using five common databases. The search yielded 40 independent effect sizes, representing 4939 participants. Random-effects meta-analysis showed positive changes in identity favouring the intervention over the control group g = 0.18 (95% CI = 0.11-0.24) and positive changes in a sub-sample (k = 30) of these studies that also measured PA g = 0.61 (95% CI = 0.41-0.81). Changes in identity did not have significant (Q = 43.08, p = 0.30) heterogeneity, yet changes in PA showed heterogeneity (Q = 204.62, p < .001) and follow-up moderator analyses found potential publication bias, and differences by methods (comparison group, length of intervention) and theoretical approach. Overall, PA identity can change as a result of interventions, but the effect may be smaller than changes in behaviour in these interventions.

Comparing Barriers and Facilitators to Physical ActivityAmong Underrepresented Minorities: Preliminary Outcomes from a Mixed-Methods Study

Physical activity (PA)'s benefits are well established, yet many U.S. adults fail to meet PA guidelines. This is especially true for minorities facing social inequities. This study explored PA's barriers and facilitators among urban Midwestern minorities using a mixed-methods approach framed on the socio-ecological model. A cross-sectional survey was conducted between January and June 2024 among community-dwelling minorities. Participants were grouped as completing low (LLPA) or high (HLPA) weekly leisure-time PA for comparison. Quantitative analysis included MANOVA, follow-up ANOVAs, and calculation of effect sizes. Qualitative data were assessed using inductive thematic analysis. Twenty-nine adults (44.83% Black, 41.37% Latino) participated in the study. The HLPA group (n = 18) reported higher leisure-time PA (p = 0.001, d = 2.21) and total PA (p = 0.02, d = 1.00) compared to the LLPA group (n = 11). LLPA participants faced more personal barriers to PA (p = 0.02, d = -0.92). Common barriers identified in the interviews included a lack of time and financial costs. Facilitators included social support and available PA facilities. Both groups achieved the USPA guidelines through different PA domains. Increasing social support and lowering PA-related costs could enhance participation. Addressing barriers and leveraging existing facilitators are crucial to increasing PA among minorities.

The Value of an Informal Before-School Exercise Opportunity for Adolescent Girls Living in a Low-Socioeconomic Community

BACKGROUND

Physical activity is beneficial to physical, social, and emotional well-being, and schools are required to provide opportunities to engage in physical activity. While physical education and school sport have been extensively researched, little is known about the value of informal, unstructured, exercise opportunities.

METHODS

This study involved interviews with 19 adolescent girls who attended "extra" exercise opportunities provided by their school. The 3 opportunities were: (1) informal before-school exercise sessions at school, (2) before-school sport training, and (3) externally provided exercise sessions in a community setting during school hours.

RESULTS

Students perceived all opportunities as valuable with benefits to confidence, social well-being, and emotional well-being. The informal exercise sessions held greater benefits to confidence as confidence transferred from the physical activity context into the academic classroom more so than for those participating in sport. Social benefits were greater for those exercising before school as this opportunity created new relationships with teachers and with students from other classes and year groups.

CONCLUSIONS

The opportunity to engage in informal exercise with peers before school widened social networks, increased confidence, changed the overall school climate, and increased attendance.

Changes in identity and habit formation during 3 months of sport and physical activity participation among parents with young children

Understanding factors that might contribute to sustained moderate-to-vigorous intensity physical activity (MVPA) after the initial start of participation is important. The purpose of this study was to examine the changes in PA habit and identity, two constructs purported to drive behavioral maintenance, among parents of young (< 13 years of age) children participating in a PA intervention across 3 months. Parents (team sport n = 58; individual PA n = 60; control n = 66) completed measures of PA habit, PA identity, and self-reported MVPA at baseline, and post-randomization at 6 weeks and 3 months. Identity and habit showed an increase across time, and these changes interacted with group condition assignment. Identity increased for participants in the team sport condition and was significantly different from a stable profile among those assigned to the control condition. Participants in the individual PA condition increased identity from 6 weeks to 3 months. Habit had a more attenuated change across time, with participants in the team sport condition showing an increase from 6 weeks to 3 months compared with the other conditions. The findings contribute to our understanding of maintenance processes and represent the first exploration of how involvement in team sport might shape subsequent habit and identity development.

Explaining the self-regulatory role of affect in identity theory: The role of self-compassion

OBJECTIVES

According to Stets and Burke's Identity Theory, people experience negative affect when their behaviour deviates from their identity standards, which drives the regulation of identity-relevant behaviour. Guilt and shame represent unique forms of negative affect. Self-compassion may influence guilt and shame responses about identity-behaviour inconsistencies. Relative to exercise identity, we examined the associations between (1) guilt and shame, behavioural intentions, and perceptions of identity-behaviour re-alignment after an identity-inconsistent situation and (2) whether self-compassion moderates the relationship between these forms of negative affect and both behavioural intentions and identity-behaviour re-alignment.

DESIGN

Prospective, online, quantitative.

METHODS

N = 274 exercisers (Mage = 32.5 years, SDage = 10.8 years, 50.2% women) who engaged in less exercise in the past week than their identity standard were recruited from Prolific.com. At baseline, self-compassion, state and trait guilt and shame, and exercise intentions were measured. One week later, participants reported the extent to which their past week's exercise aligned with their identity standard (i.e., identity-consistent perceptions).

RESULTS

Neither state shame nor guilt related to exercise intentions nor identity-consistent perceptions. Self-compassion moderated the relationship between state guilt and identity-consistent perceptions (b = 2.524, SE = .975, t = 2.588, p = .010); state guilt was related to identity-behaviour consistency when self-compassion was high, but not when it was low. No other moderations were significant.

CONCLUSIONS

This study adds nuance to Identity Theory and its propositions about negative affect and self-regulation; self-compassion may create the conditions necessary for negative affect to drive identity-relevant behaviour as proposed by identity theory.

Developing an Evidence- and Theory-Informed Mother-Daughter mHealth Intervention Prototype Targeting Physical Activity in Preteen Girls of Low Socioeconomic Position: Multiphase Co-Design Study

BACKGROUND

Preteen girls of lower socioeconomic position are at increased risk of physical inactivity. Parental support, particularly from mothers, is positively correlated with girls' physical activity levels. Consequently, family-based interventions are recognized as a promising approach to improve young people's physical activity. However, the effects of these interventions on girls' physical activity are often inconsistent, with calls for more rigorous, theory-informed, and co-designed family-based interventions to promote physical activity in this cohort.

OBJECTIVE

This study aimed to use co-design methods to develop an evidence- and theory-informed mother-daughter mobile health intervention prototype targeting physical activity in preteen girls.

METHODS

The intervention prototype was developed in accordance with the United Kingdom Medical Research Council framework, the Behaviour Change Wheel, the Theoretical Domains Framework, and the Behaviour Change Techniques Ontology. The Behaviour Change Intervention Ontology was also used to annotate the intervention characteristics. The co-design process incorporated three phases: (1) behavioral analysis, (2) the selection of intervention components, and (3) refinement of the intervention prototype. Throughout these phases, workshops were conducted with preteen girls (n=10), mothers of preteen girls (n=9), and primary school teachers (n=6), with additional input from an academic advisory panel.

RESULTS

This 3-phase co-design process resulted in the development of a theory-informed intervention that targeted two behaviors: (1) mothers' engagement in a range of supportive behaviors for their daughters' physical activity and (2) daughters' physical activity behavior. Formative research identified 11 theoretical domains to be targeted as part of the intervention (eg, knowledge, skills, and beliefs about capabilities). These were to be targeted by 6 intervention functions (eg, education, persuasion, and modeling) and 27 behavior change techniques (eg, goal setting and self-monitoring). The co-design process resulted in a mobile app being chosen as the mode of delivery for the intervention.

CONCLUSIONS

This paper offers a comprehensive description and analysis of using co-design methods to develop a mother-daughter mobile health intervention prototype that is ready for feasibility and acceptability testing. The Behaviour Change Wheel, Theoretical Domains Framework, and Behaviour Change Techniques Ontology provided a systematic and transparent theoretical foundation for developing the prototype by enabling the identification of potential pathways for behavior change. Annotating the Behaviour Change Intervention Ontology entities represents the intervention characteristics in a detailed and structured way that supports improved communication, replication, and implementation of interventions.

Predicting implicit and explicit exercise identity from descriptive social norms regarding exercise

OBJECTIVES

Exercise identity may promote exercise maintenance. However, less is known about factors that affect exercise identity. Whether descriptive social norms are potential intervention targets for identity development was evaluated.

DESIGN

A cross-sectional design using data from the Attitudes, Identities, and Individual Differences (AIID) study was employed - with additional cases collected to increase sample size and power - to evaluate whether descriptive social norms regarding exercise are related to implicit and explicit exercise identities.

MAIN OUTCOME MEASURES

Participants completed measures of proximal and distal descriptive social norms regarding exercise, explicit and implicit exercise identity, physical activity behavior, and demographics. Multiple regression was used to assess whether social norms regarding exercise predict exercise identities.

RESULTS

Only proximal descriptive social norms were significantly associated with explicit exercise identity, whereas neither proximal nor distal descriptive social norms were associated with implicit exercise identity. The slopes for explicit and implicit identity differed when predicted by distal (but not proximal) descriptive social norms.

CONCLUSIONS

Proximal descriptive social norms may be associated with explicit exercise identity and may be a worthy intervention targeting alongside identity to influence change in exercise behavior. More research is needed to further understand these relationships.

An online delivered running and walking group program to support low-active post-secondary students' well-being and exercise behavior during the COVID-19 pandemic: a pilot randomized controlled trial

OBJECTIVE

Examine the feasibility and acceptability of a social identity-informed, online delivered, running and walking group program to support low-active post-secondary students' exercise behavior and well-being during the COVID-19 pandemic.

METHODS

A two-arm, non-blinded, parallel pilot randomized controlled trial was conducted whereby low-active post-secondary students at a Canadian university were equally randomized to an online delivered running/walking group program or an attention control condition. Primary feasibility and acceptability outcomes included program interest, study enrolment and retention, questionnaire completion, program attendance, program satisfaction, and affective exercise attitudes. Post-program interviews were conducted to ascertain participants' experiences with the program. Secondary outcomes included well-being, exercise behavior, social identity, social support, and exercise identity.

RESULTS

Ninety-two individuals were screened for eligibility, and 72 were equally randomized to the online group program or attention control condition. Recruitment exceeded the target sample size (60), study adherence and questionnaire completion were above 90%, program attendance was moderate (M = 5.03/8), self-report program satisfaction was moderate-to-high (M = 4.13/5), and there was no condition effect for affective attitudes. During interviews, participants expressed satisfaction with the program. They also discussed challenges with developing a shared sense of identity and social connection with group members via online platforms. There were small condition effects for exercise-related well-being and exercise identity and no condition effects for the remaining secondary outcomes. Social identity scores were moderate (M = 4.63/7).

CONCLUSIONS

The STRIDE program was feasible and acceptable but should be delivered and piloted in-person before a full-scale efficacy trial is conducted.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04857918; 2021-04-20.

Evaluating the Psychometric Properties of a Physical Activity and Sedentary Behavior Identity Scale: Survey Study With Two Independent Samples of Adults in the United States

BACKGROUND

Emerging evidence suggests a positive association between relevant aspects of one's psychological identity and physical activity engagement, but the current understanding of this relationship is primarily based on scales designed to assess identity as a person who exercises, leaving out essential aspects of physical activities (eg, incidental and occupational physical activity) and sedentary behavior.

OBJECTIVE

The goal of this study is to evaluate the validity of a new physical activity and sedentary behavior (PA/SB) identity scale using 2 independent samples of US adults.

METHODS

In study 1, participants answered 21 candidate items for the PA/SB identity scale and completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Study 2 participants completed the same PA/SB identity items twice over a 1-week interval and completed the IPAQ-SF at the end. We performed factor analyses to evaluate the structure of the PA/SB identity scale, evaluated convergent validity and test-retest reliability (in study 2) of the final scale scores, and examined their discriminant validity using tests for differences in dependent correlations.

RESULTS

The final PA/SB identity measure was comprised of 3 scales: physical activity role identity (F1), physical activity belief (F2), and sedentary behavior role identity (F3). The scales had high test-retest reliability (Pearson correlation coefficient: F1, r=0.87; F2, r=0.75; F3, r=0.84; intraclass correlation coefficient [ICC]: F1: ICC=0.85; F2: ICC=0.75; F3: ICC=0.84). F1 and F2 were positively correlated with each other (study 1, r=0.76; study 2, r=0.69), while both were negatively correlated with F3 (Pearson correlation coefficient between F1 and F3: r=-0.58 for study 1 and r=-0.73 for study 2; F2 and F3: r=-0.46 for studies 1 and 2). Data from both studies also demonstrated adequate discriminant validity of the scale developed. Significantly larger correlations with time in vigorous and moderate activities and time walking and sitting assessed by IPAQ-SF with F1, compared with F2, were observed. Significantly larger correlations with time in vigorous and moderate activities with F1, compared with F3, were also observed. Similarly, a larger correlation with time in vigorous activities and a smaller correlation with time walking were observed with F2, compared with F3.

CONCLUSIONS

This study provided initial empirical evidence from 2 independent studies on the reliability and validity of the PA/SB identity scales for adults.

The Role of Intention, Behavioral Regulation, and Physical Activity Behavior in the Prediction of Physical Activity Identity across Time

Physical activity identity represents an important determinant of sustained physical activity behavior. The purpose of this investigation was to examine whether intention, behavioral regulation, and moderate-to-vigorous physical activity (MVPA) behavior explain significant variation in physical activity identity across time. Using a repeated measures observational design, lower-active adults new or returning to physical activity participation (N = 66) completed measures of study variables every three weeks over the course of a nine-week period (four assessments total). Based on the results of mixed-effects regression modelling, there was a small, non-significant increase in physical activity identity across time (b = 0.07, p = 0.13). Intention, MVPA, and behavioral regulation mostly had significant (ps < 0.05) bivariate correlations with physical activity identity at the same time point of assessment. Behavioral regulation explained significant variation in physical activity identity across time (b = 0.26, p < 0.0001), but intention and MVPA were non-significant (ps > 0.05) after including a random intercept and controlling for behavioral regulation. Identity was resistant to change among new physical activity initiates in this study and longer time frames of assessment are needed (e.g., six months). Behavioral regulation should be examined as a determinant of physical activity identity in future investigations.

How Perceptions of Aging Influence Physical Activity and Exercise in Older Age: Exploring the Behavior of People Aged 70+ Years Engaged in Fall Prevention Activities

For older people, physical inactivity increases fall risk as well as other preventable health conditions. Despite the well-documented benefits of physical activity, uptake and adherence continue to challenge efforts aimed at increasing physical activity and reducing falls. Nested within a randomized controlled trial, this study reports on the factors influencing the physical activity behavior of people, aged between 70 and 90 years, engaged in StandingTall, a home-based balance exercise program proven to reduce falls in the community. The perception of aging, physical activity in older age, and the delivery of exercise were identified as major themes, with the perception of aging an overarching theme influencing both preferences for physical activity in older age and exercise delivery. Findings demonstrate the importance of considering the role of aging, the influence aging has on physical activity and exercise behavior, and how aging influences the delivery and design of exercise programs including falls prevention activities for older people.

Predictive Utility of the Multi-Process Action Control Framework for Self-Reported and Device-Measured Physical Activity Behavior of Adolescents

Understanding the correlates of physical activity behavior is imperative for informing the development of interventions to address the low rates of physical activity guideline adherence among adolescents living in the United States. This cross-sectional study examined the predictive utility of the Multi-Process Action Control (M-PAC) framework for explaining self-reported and device-measured physical activity behavior among a Hispanic-majority sample of adolescents. A total of 1849 high school students (mean age = 16.0 ± 1.22 SD years; 52.3% women; 87.8% Hispanic) enrolled in one school district in south-central Texas completed a survey including instruments to assess M-PAC framework constructs (instrumental and affective attitudes, perceived capability and opportunity, behavioral regulation, habit, identity) and moderate-to-vigorous physical activity (MVPA) behavior. A subsample (n = 435) wore accelerometers for seven days. The results from robust linear regression models revealed role identity and habit were significant predictors of self-reported MVPA. Role identity was a significant predictor of accelerometer-derived daily MVPA and raw acceleration in the most active hour but not daily raw acceleration. The findings indicated reflexive processes are robust predictors of adolescent physical activity and should be the focus of interventions designed to promote adoption and maintenance of physical activity during this developmental life stage.

Psychological needs and exercise behaviour: a comparison of two psychological needs models

OBJECTIVE

Psychological need satisfaction, from a self-determination theory (SDT) perspective, has been applied extensively to understand predictors of exercise behaviour. Dweck proposed a psychological needs framework that includes basic needs (optimal predictability, competence, acceptance), compound needs derived from combinations of basic needs (self-esteem/status, trust, control), and a superordinate compound need for self-coherence that includes identity and meaning. The purpose was to examine whether psychological needs operationalized within Dweck's model account for variance in exercise behaviour in ways that the SDT model does not.

METHODS AND MEASURES

A community sample of 403 adults completed measures of demographics, psychological needs, and exercise motivation at Time 1, and self-reported moderate-to-vigorous minutes of exercise at both Times 1 and 2 four weeks later.

RESULTS

Two structural equation models operationalizing Dweck's needs framework and SDT (basic needs and motivation) were examined in relation to exercise behaviour. In both models, exercise identity and integrated regulation (conceptually similar) were the most salient correlates of prospectively measured exercise behaviour, and both accounted for the relationship between competence and exercise behaviour.

CONCLUSION

The results support the importance of identity in the context of exercise behaviour. Future research should investigate factors associated with adopting and maintaining an exercise identity.

"You are either sporty or you are not" a qualitative exploration of pre-teen girls of low-socioeconomic position experiences of being physically active

BACKGROUND

Eighty one percent of adolescents do not meet the recommended physical activity (PA) guidelines with levels of physical activity declining steadily with age and more pronounced in girls of low socioeconomic position (SEP). Furthermore, early adolescence is a time when the rate of decline in PA is most severe amongst girls, placing them at an increased likelihood of developing negative health outcomes associated with physical inactivity. In response, the aim of this study was to explore low-SEP pre-teen girls' experiences of being physically active and to understand their perceptions of the individual, social and environmental factors that influence these experiences.

METHODS

Focus groups were conducted with 107 girls aged 10-12 years from four urban and three rural primary schools. Reflexive thematic analysis was used to analyse the data, with themes mapped to the relevant domains of the Theoretical Domains Framework (TDF).

RESULTS

Themes highlighted how skills and confidence underpin girls' self-identity for PA. Girls described how their social network (i.e., peers, family, coaches and teachers) shaped their experiences of being active. Girls recognised how being active was impacted by the challenges and opportunities in their local community (e.g., lack of facilities and anti-social behaviour).

CONCLUSION

This study provides insight into low-SEP pre-teen girls' experiences of being physically active in both rural and urban locations, while highlighting the complex interplay of individual, social and environmental factors. Additionally, the use of the TDF presents an in-depth behavioural diagnosis which can be used to inform future theory-based interventions to promote low-SEP pre-teen girls PA.

Evaluation of socioecological factors on health behaviors and weight change during major life event: A cross-sectional study using data collected during the COVID-19 pandemic

Background

Socioecological factors are associated with key health behaviors that are critical for weight management, and major life events may disrupt engagement in these behaviors. However, the influence of socioecological factors on health behaviors in the midst of major life events is not clear and is difficult to study due to the random and sporadic nature of their occurrence. The COVID-19 pandemic provided a unique opportunity to study a major life event and its impacts on diet, physical activity, and body weight.

Objective

This cross-sectional study aimed to investigate associations between socioecological factors (environmental, interpersonal, and individual) and self-reported weight change during a major life event using data collected during the COVID-19 pandemic, and whether the associations were mediated through self-reported changes in eating and physical activity behaviors.

Methods

Participants self-reported socioecological factors, weight change, and changes in eating behaviors (EB) and physical activity (PA) via online questionnaires between December 2020 and October 2021. Changes in EB and PA were measured using scales with higher scores reflecting more positive changes during the COVID-19 pandemic.

Results

Participants (n = 1283) were mostly female (84.9%) with age 52.1 ± 14.1 years (mean ± SD) and BMI of 32.9 ± 8.2 kg/m2. Stronger healthy eater and exercise identities (individual factors) were associated with higher EB scores (EBS) and PA scores (PAS), respectively (p's < 0.00001). Less discouragement for healthy eating by family/friends (interpersonal factor) was associated with higher EBS (p = 0.002). Higher EBS and PAS were associated with weight loss. The indirect effect of healthy eater identity (-0.72; 95% CI: -0.90, -0.55) and discouragement for diet (0.07; 95% CI: 0.03, 0.12) on weight change through EBS were significant, as was the indirect effect of exercise identity (-0.25; 95% CI: -0.35, -0.15) on weight change through PAS.

Conclusions

Stronger identities and less discouragement from family/friends may support health promoting behaviors and weight loss during a major life event, as well as identify additional behavioral targets for lifestyle interventions.

Clinical Trial Registration

IWCR was registered at ClinicalTrials.gov (NCT04907396).

"I have to get up and exercise because that's how I'm going to get over this": a qualitative exploration of exercise identity and behavior in early cancer survivorship

PURPOSE

Exercise is beneficial for people living with and beyond cancer (LWBC); however, many people LWBC fail to meet the exercise guidelines. Having an identity related to exercise, a component of one's self-concept, correlates with exercising more frequently in general adult populations. Understanding how exercise identity influences exercise behaviors in people LWBC is warranted due to the many barriers people LWBC face in relation to physical activity. The purpose of this study was to explore the perceived impact of an exercise identity of the exercise behaviors and motivations among people LWBC.

METHODS

Thirteen participants of mixed diagnoses (Mage = 60.8 ± 10.8 years) in the early survivorship period (i.e., within five years of primary treatment completion or diagnosis) participated in semi-structured interviews to identify influences of exercise identity on exercise behavior. Interviews were transcribed verbatim and analyzed using thematic analysis.

RESULTS

Findings demonstrated that people LWBC with a strong exercise identity engage in high and varied exercise behaviors. Despite barriers such as changes in motivations and ability to engage in exercise, participants maintained exercise throughout cancer by constant adaptation of their outlook and behaviors related to exercise. These results demonstrate a maintenance of physical activity in relation to a strong exercise identity.

IMPLICATIONS FOR CANCER SURVIVORS

Results of this study have implications for the design and implementation of exercise behavior change programs for people LWBC as it provides insights into predictors of sustained exercise behavior during and following cancer treatment.

Implementing a free lending of sports and leisure equipment service: a cross-sectional survey exploring user characteristics, utilization patterns, and significance among children and youth

BACKGROUND

The escalating costs of sports equipment, coupled with socioeconomic disparities, hinder children's participation in physical activities. The Leisure Equipment Library (LEL), a unique service in Sweden, addresses this challenge by providing free equipment lending. This study investigated the significance of providing free lending of sports and recreational equipment for children's and youth's opportunities to engage in physical activities during leisure time.

METHOD

Utilizing a cross-sectional survey during the summer-2022 period, the study is based on data from 427 LEL users aged 7 to 25 years. User characteristics (demography, socioeconomic status, physical activity profiles), equipment usage patterns and perceived significance are also analyzed. The findings are discussed using the concept of consumer-brand identification.

RESULTS

The results showed that LEL reaches a broad and diverse group of children and young people in terms of gender, age, socioeconomic status, and physical activity profile. The borrowed equipment, primarily used for play and recreation, serves as an essential resource for children and youths and, in particular, for those with low socioeconomic status. LEL is considered highly important by all user groups, with a majority emphasizing its significance in facilitating leisure activities.

CONCLUSIONS

The study suggests LEL's success lies in its accessibility and that users identify with the brand of LEL. Users perceive LEL as a service catering to various recreational needs rather than sports, fostering inclusivity. The localization of stores in various types of areas, combined with high-quality products, enable children and young people from different socioeconomic areas to use the service. LEL's success hinges on maintaining a positive brand image and promoting a recreation-oriented identity. Opportunities exist to strengthen emotional bonds with users, enhance branding strategies, and position LEL as a valuable resource for inclusive recreational activities. In conclusion, this study highlights the potential of free lending services, such as LEL, to bridge socioeconomic gaps in the promotion of physical activity among children and young people.

Exercise identity and physical activity behavior during late adolescence: A four wave cross-lagged panel model

Research has shown that physical activity behavior tends to decline across adolescence before stabilizing in adulthood. Identifying salient factors underlying these behavioral changes is therefore imperative for informing intervention development. This study explored the temporal nature of the relationship between exercise identity and physical activity behavior during the transition out of high school. An analysis of data from the Application of integrated Approaches to understanding Physical activity during the Transition to emerging adulthood (ADAPT) prospective cohort study was conducted, involving 1451 Canadian adolescents (Mage = 15.93 ± 0.53 years; 52.4% female). Participants completed the International Physical Activity Questionnaire-Short Form to report weekly moderate-to-vigorous physical activity and an abbreviated version of the Exercise Identity Scale yearly for four years beginning in Grade 11. A four-wave cross-lagged panel model was used to test bi-directional associations between exercise identity and physical activity behavior. Significant auto-regressive effects for exercise identity and physical activity were observed across all four time points. Significant positive cross-lagged paths were observed for exercise identity predicting future physical activity at all time points; however, none of the cross-lagged paths with physical activity predicting future exercise identity were significant. Collectively, these findings support existing theory that emphasizes the role that identity plays in physical activity behavior. Interventions seeking to attenuate the physical activity declines typically observed during the transition to emerging adulthood should therefore consider adopting behavior change techniques that target identity, as it appears to be an important psychological determinant underlying future physical activity engagement.

Feasibility of Intervention Program to Prevent Adolescent Health-Compromising Behaviors

Most people start experimenting with and/or initiating health-compromising behaviors and establishing behavioral patterns during adolescence. Possible selves and episodic future thinking have been used to foster behavioral changes. In this study, we aimed to (1) develop a program incorporating possible selves and episodic future thinking to decrease the risks associated with health-compromising behaviors, and (2) examine the feasibility and fidelity of implementing this intervention among Taiwanese adolescents. A novel combination of existing intervention approaches tailored for the Taiwanese context was applied to develop a school-based intervention, which we named the Future Mapping Master program. This program contains four core units: exploring the self, setting goals, developing strategies and problem solving, and understanding the threats of health-compromising behaviors. It includes daily episodic future thinking visualization exercises. The feasibility evaluation was conducted with 88 adolescents aged 12-14 years. Feedback from teachers and students supported the proposed program's feasibility and revealed favorable reactions to the intervention. The Future Mapping Master program is feasible and offers promising strategies for implementation in Taiwanese school settings.

"It's what mothers do." A qualitative exploration of mothers' experiences of supporting their daughter to be physically active

OBJECTIVE

Girls are more at risk than boys of the non-communicable diseases associated with insufficient levels of physical activity (PA), therefore it is important to explore the reasons why girls maintain or cease to be physically active. Maternal support plays an important role in girl's PA, yet the factors influencing mothers' support of their PA have received limited exploration. In response, the aim of this study was to explore, mothers' experiences of supporting their daughters to be physically active and their perceptions of the factors that might influence these experiences.

METHOD

Semi-structured interviews were conducted with a purposive sample of mothers (n = 29) of girls (Mean age = 10.9 years; SD = 0.6). Reflexive Thematic Analysis was used to analyse the data, with themes mapped to the relevant domains of the Theoretical Domains Framework.

RESULTS

Themes highlighted how mothers described providing PA support as an inherent part of their parental role and how their role was influenced by their own PA identity. Mothers recognised that the type and amount of support they provided was impacted by the community setting in which they lived. Mothers acknowledged how the role of others (e.g., partners, grandparents, peers) added a layer of complexity to supporting their daughters to be active.

CONCLUSION

This study advances our understanding of maternal PA support behaviours recognising the complex interplay of individual, social and environmental factors. Additionally, the use of the Theoretical Domains Framework presents an in-depth behavioural diagnosis which can be used to inform future theory-based interventions to promote parent support of children's PA.

Massage Therapy as a Self-Management Strategy for Musculoskeletal Pain and Chronic Conditions: A Systematic Review of Feasibility and Scope

Background: Musculoskeletal pain and chronic conditions are associated with deteriorating pain, stress, anxiety, and health-related quality of life (HR-QOL). There is emerging evidence that performing massage therapy as self-management (MTSM) is a viable approach to alleviate these symptoms across various clinical populations. However, a significant gap remains on the effectiveness and limitation of MTSM usage as no systematic review has been conducted to comprehensively evaluate and synthesize the scope, feasibility, and efficacy of MTSM. This systematic review aimed to investigate the effect of MTSM on common symptoms of musculoskeletal and chronic conditions, followed by identifying characteristics of MTSM dosage, setting, and adherence for formulating themes. Methods: A systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, which involved searching seven electronic databases, including Medline (OVID), CINAHL (EBSCO), PEDro, Web of Science (Clarivate), PsycINFO (EBSCO), Google Scholar, and EMBASE (Elsevier) from inception to January 2023. Clinical studies were eligible if they included MTSM, and massage treatment was more than 50% of the intervention. The quality of studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool. Target variables were extracted, including study design, participants' characteristics, outcome measures, massage dosage (duration, frequency, and timing), training setting, provider of massage training, adherence to the MTSM intervention, comparator, and key findings. Results: A total of 17 studies were evaluated and included 770 participants (female: N = 606) with musculoskeletal pain or chronic conditions. The emerged themes for MTSM utilization consisted of arthritis pain (knee, n = 3; neck, n = 1, hand, n = 2), neck and back pain (n = 4), and stress and anxiety (n = 3). Prescribed self-administered massage duration ranged from a single session to a maximum of 8-12 weeks, where 4 weeks (n = 8) was the most commonly prescribed duration. Out of 11 studies that used MTSM as a solo modality, 7 studies (41.2%) showed significant improvement in the outcome measures such as chronic neck and back pain, stress or anxiety, fatigue, quality of sleep, and HR-QOL. In addition, health benefits, including anxiety, depression, pain intensity, and pain threshold, were observed in six studies (35.3%) where MTSM was applied as a coadjuvant modality, which was combined with therapist-applied massage and physiotherapy. Conclusions: These findings support that MTSM is a viable approach to enhance the benefit of therapist-applied massage or as a solo modality for symptom management of musculoskeletal pain and chronic conditions. The review provides suggestions for design improvement, such as reporting participants' adherence to the prescribed massage regimen, that would be informative for providing a robust understanding of the magnitude or the extent to which MTSM is effective. Future studies on MTSM intervention are encouraged to use a theoretical framework and validated measures for determining and facilitating treatment fidelity.

Wearable device adherence among insufficiently-active young adults is independent of identity and motivation for physical activity

Wearable devices are increasingly being integrated to improve prevention, chronic disease management and rehabilitation. Inferences about individual differences in device-measured physical activity depends on devices being worn long enough to obtain representative samples of behavior. Little is known about how psychological factors are associated with device wear time adherence. This study evaluated associations between identity, behavioral regulations, and device wear adherence during an ambulatory monitoring period. Young adults who reported insufficient physical activity (N = 271) were recruited for two studies before and after the SARS-COVID-19 pandemic declaration. Participants completed a baseline assessment and wore an Actigraph GT3X + accelerometer on their waist for seven consecutive days. Multiple linear regression indicated that wear time was positively associated with age, negatively associated with integrated regulation for physical activity, and greater after (versus before) the pandemic declaration. Overall, the model accounted for limited variance in device wear time. Exercise identity and exercise motivation were not associated with young adults' adherence to wearing the physical activity monitors. Researchers and clinicians can use wearable devices with young adults with minimal concern about systematic motivational biases impacting adherence to device wear.

Psychometric validation of four-item exercise identity and healthy-eater identity scales and applications in weight loss maintenance

BACKGROUND

Identifying as someone who engages in health promoting behaviors like healthy eating and exercising may be associated with sustained engagement in those behaviors, but reliable and valid instruments are needed to improve the rigor of this research. Two studies were conducted to (1) examine the psychometric properties of a four-item exerciser identity measure (4-EI) and an adapted healthy-eater identity measure (4-HEI) and (2) examine differences in identity strengths across categories of weight loss success.

METHODS

Data from 1,709 community dwelling adults in the International Weight Control Registry (IWCR) were used. A random half of the sample was used to assess the proposed unidimensional factor structure of the 4-EI and 4-HEI and examine convergent and discriminant validity using Spearman rank-order correlations. One-way ANOVA was used in the other random half of the sample to compare 4-EI and 4-HEI scores (-3 to + 3) across three self-defined weight loss categories ('Successful', 'Regain', and 'Unsuccessful') and those maintaining ≥ 5% weight loss for > 1 year vs. not.

RESULTS

Results support the unidimensional factor structure with all four items (eigenvalue scores > 2.89) as well as convergent and discriminant validity for both measures. Exercise identity was strongly correlated with self-reported physical activity (r (735) = 0.52, p <.001) and measures of autonomous motivation. Healthy eating identity was moderately correlated with cognitive restraint in eating (r (744) = 0.42, p <.001) and other measures predictive of eating behavior. 4-EI and 4-HEI are stronger in Successful (4-EI: M = 0.90, SD = 1.77; 4-HEI: M = 1.56 SD = 1.37) vs. Regain (4-EI: M=-0.18, SD = 1.68; 4-HEI: M =.57, SD = 1.48) and Unsuccessful (4-EI:M=-0.28, SD = 1.62; 4-HEI: M = 0.51, SD = 1.33) and those maintaining ≥ 5% weight loss (4-EI:M = 0.47, SD = 1.78; 4-HEI: M = 1.13, SD = 1.49) vs. not (4-EI:M=-0.27, SD = 1.66; 4-HEI: M = 0.53, SD = 1.47), p's < 0.001.

CONCLUSIONS

The 4-EI and 4-HEI have acceptable psychometric properties and can advance understanding of the role of identity in exercise and dietary behaviors and weight loss maintenance.

TRIAL REGISTRATION

The parent observational study, International Weight Control Registry (IWCR), for these sub-studies is registered in ClinicalTrials.gov (NCT04907396).

Differential correlates for aerobic physical activity and resistance training: a systematic review

Worldwide, physical inactivity is a major public health concern. Both aerobic physical activity (PA) and resistance training (RT) are forms of exercise that provide numerous health benefits. The present systematic review aimed to examine the evidence among studies that have formally compared the correlates of both aerobic PA and RT in the same sample. Literature searchers were concluded in April 2022 using four common databases. Eligible studies were selected from English language peer-reviewed journals which reported at least a bivariate correlation between the correlate and aerobic PA and RT. Findings were grouped by the correlate in accordance with the capability, opportunity, motivation, behavior (COM-B) model. The analysis identified 18 studies with 16 independent samples. Overall, evidence suggest that there are many similarities between aerobic PA and RT participation. There were positive associations for both aerobic PA and RT for physical and psychological capabilities, reflective and reflexive motivation. There were mixed associations for environmental opportunities, and social opportunities had no association for aerobic PA but mixed evidence for RT. The analyses emphasized that comparative research is lacking in certain areas, principally for environmental opportunity and reflexive motivation.

Perceived importance of moderate-to-vigorous physical activity as a weight control strategy in behavioral weight loss

Background

Previous research has established the importance of moderate-to-vigorous physical activity (MVPA) for weight control. One area of unexplored investigation is the relationship between individuals' perceptions of the importance of MVPA for weight control and MVPA engagement. This study examined the associations between the perceived importance of MVPA and MVPA engagement, weight loss, barriers to PA, and exercise enjoyment in adults enrolled in a long-term behavioral weight loss (BWL) intervention.

Methods

Adults (N = 301) with overweight/obesity (BMI = 27-45 kg/m2) completed an 18-month BWL intervention, followed by a no-intervention 18-month follow-up. At baseline, 6 months, 18 months (i.e., post-treatment), and 36 months (i.e., follow-up), participants ranked the importance of six strategies for weight control: keeping a food record, MVPA, light PA, self-weighing, small portions, and low-calorie diet. Observed MVPA (measured by accelerometer), percent weight loss, perceived barriers to PA, and exercise enjoyment were also measured at each assessment.

Results

Results showed that most participants perceived MVPA as a primary weight control strategy (first, second, or third most important) throughout the intervention, regardless of the weight control goal (weight loss vs. maintenance). Individuals who ranked MVPA as a primary strategy for weight control at concurrent time points, compared to those who did not, engaged in significantly more MVPA at post-treatment, had greater weight loss at follow-up, endorsed fewer barriers to PA at post-treatment and follow-up, and reported greater exercise enjoyment at baseline and post-treatment.

Conclusion

Perceived importance of MVPA was related to subjective experiences of MVPA, MVPA adherence, and weight loss in a long-term BWL intervention.

Making sense of a myocardial infarction in relation to changing lifestyle in the five months following the event: An interpretative phenomenological analysis

OBJECTIVE

Previous research has shown that experiencing an acute cardiac event, such as a myocardial infarction (MI), can lead to lifestyle changes. This study aimed to explore the potential of a MI as a 'teachable moment' (TM) for positive lifestyle changes and to identify psychosocial sensemaking processes that facilitate or hinder the presence of a TM.

METHOD

We conducted semi-structured interviews with 14 patients who suffered their first MI and were hospitalized in a larger Dutch city. Participants were interviewed twice, respectively one and five months after their hospitalization. They were encouraged to explain how they experienced their MI and how this had affected their lifestyle. We used an Interpretative Phenomenological Analysis approach to the data collection and analysis.

FINDINGS

The participants varied in their willingness to adopt a healthy lifestyle due to their MI. Most participants experienced their event as a TM for changing specific health behaviors, for example facilitated by reflecting on self-concept or social roles and by constructing and comprehending a personal narrative of their MI. Some participants struggled to follow through on their intentions to change their behavior, for example because of a negative attitude towards a healthy behavior or because they perceived it as incongruent to their identity. Only three participants maintained most former health behaviors, for example because they failed to acknowledge their MI as severe or because of earlier life events that elicited more blunted cognitive responses.

CONCLUSION

Cardiac patients may experience a TM, which is the consequence of interrelated processes of psychosocial sensemaking. As this does not occur at a singular time point, we suggest using the term 'teachable window' rather than 'moment'. Given these findings, there is a window of opportunity to provide continuous psychosocial and lifestyle support during and after hospitalization for acute cardiac events.

Predictors of changes in running and smoking identity among individuals in the Run to Quit smoking cessation program

OBJECTIVES

Multiple health behaviour change is a viable strategy to promote health outcomes. An example is the use of running behaviour to support smoking cessation in the group-mediated Run to Quit program. On the basis that changes in running and smoking identity were related to changes in running and smoking behaviour among individuals in the Run to Quit program, the purpose of this study was to extend these findings by examining key predictors of change in both running and smoking identity.

METHODS

We analyzed data collected from 450 adult individuals (70.67% female, and 92.44% white) during the program evaluation of Run to Quit from 2016 to 2018. Participants completed assessments at week 1 (baseline), week 3 (mid-program), and week 10 (follow-up) of the program. Relevant predictor variables for change in identity were identified by drawing from theory (identity theory, identity control theory, physical activity self-definition model, social identity theory) and past research regarding exercise and smoking identity. Potential predictors of changes in running and smoking identity included changes in behaviour, self-efficacy, perceptions of the social environment (task and social cohesion, descriptive norms), as well as smoking identity and running identity, respectively. Two regression models, using residualized change scores (for each variable) and relative Pratt indices, were constructed for both running and smoking identity.

RESULTS

Changes in running self-efficacy, running frequency, and individual attractions to the group exercise tasks were significant and meaningful predictors of change in running identity, whereas changes in objectively measured smoking behaviour and running identity were significant and meaningful predictors of change in smoking identity.

CONCLUSION

Consistent with identity theories and past research, ensuring individuals develop a sense of efficacy and enjoy group exercise tasks both represent viable strategies to enhance exercise identity. Including an exercise component within smoking cessation programs may help individuals replace their existing smoking identity with a healthier exercise identity.

Anxiety, body dissatisfaction, and exercise identity: Differentiating between adaptive and compulsive exercise

OBJECTIVE

Little is known about psychosocial variables that may be differentially associated with compulsive exercise versus adaptive exercise. The current study simultaneously examined associations of exercise identity, anxiety, and body dissatisfaction with both compulsive and adaptive exercise behaviors and investigated which construct may account for the most unique variance in compulsive and adaptive exercise. Hypotheses were that: 1) body dissatisfaction, anxiety, and exercise identity would be significantly associated with compulsive exercise and 2) exercise identity would be significantly associated with adaptive exercise.

METHOD

A total of 446 individuals (50.2 % female) completed reports of compulsive exercise, adaptive exercise, body dissatisfaction, exercise identity, and anxiety via an online survey. Multiple linear regression and dominance analyses were used to test hypotheses.

RESULTS

Exercise identity, body dissatisfaction, and anxiety were all significantly associated with compulsive exercise. Only exercise identity and anxiety were significantly associated with adaptive exercise. Dominance analyses suggested that exercise identity accounted for the largest proportion of variance in compulsive (Dominance R² = 0.27) and adaptive exercise (Dominance R² = 0.45).

CONCLUSION

Exercise identity emerged as the strongest predictor of both compulsive and adaptive exercise. The simultaneous presence of exercise identity, body dissatisfaction, and anxiety may contribute to high risk for engagement in compulsive exercise. Incorporating exercise identity into established eating disorder preventions and treatments may contribute to the reduction of compulsive exercise behaviors.

Correlates of Physical Activity Participation among Individuals Diagnosed with Cancer: An Application of the Multi-Process Action Control Framework

BACKGROUND

The purpose of this study was to test Multi-Process Action Control (M-PAC) processes as correlates of physical activity (PA) intention formation and translation (i.e., action control) in individuals diagnosed with cancer.

METHODS

This study was a cross-sectional survey, completed from July to November of 2020 during the COVID-19 pandemic. PA and M-PAC processes were self-reported using the Godin Leisure-Time Exercise Questionnaire and questionnaires for reflective (instrumental/affective attitudes, perceived opportunity/capability), regulatory (e.g., goal-setting, planning), and reflexive processes (habit, identity). Separate hierarchical multinomial logistic regression models determined correlates of intention formation and action control.

RESULTS

Participants (n = 347; M_age= 48.2 ± 15.6) were primarily diagnosed with breast cancer (27.4%) and at a localized stage (85.0%). Most participants intended to perform PA (70.9%), yet only 50.4% met guidelines. Affective judgements (p < 0.001) and perceived capability (p < 0.01) were significantly associated with intention formation. Preliminary models indicated employment, affective judgements, perceived capability, and self-regulation to be significant (ps < 0.05) correlates of action control, but in the final model, only surgical treatment (p = 0.02) and PA identity (p < 0.001) were significantly associated with action control.

CONCLUSION

Reflective processes were associated with PA intention formation, while reflexive processes were associated with PA action control. Behavior change efforts for individuals diagnosed with cancer should extend beyond social-cognitive approaches to include regulatory and reflexive processes of PA behavior (i.e., PA identity).

An individualized mobile health intervention to promote physical activity in adults with obstructive sleep apnea: An intervention mapping approach

Objective

Combining continuous positive airway pressure with physical activity (PA) might be a promising strategy to treat obstructive sleep apnea (OSA). This article describes how intervention mapping (IM) can guide the development, content, and mechanisms of action of a mobile application to promote PA in adults with OSA.

Methods

To develop the program, the IM approach was followed. This article presents the first three steps of IM to develop a mixed intervention (with interventionists and a digital application) aiming to: (1) assess patients' health problems and needs in a literature review to determine their expectations and perceived facilitators and barriers to PA behavior change and thus select the determinants of behavior; (2) formulate the expected intervention outcomes and objectives to be met to achieve the overall program goals; and (3) select and implement the behavior change techniques (BCTs) to achieve the change objectives.

Results

The literature review identified the relevant determinants (e.g., self-efficacy, coping, planning, and habit) of PA behavior using the health action process approach and multiprocess action control. These results were used to specify the program outcomes for PA adapted to physical, psychological, and social parameters. Overall, 11 performance objectives and 30 change objectives were defined. Lastly, BCTs and practical applications were identified.

Conclusions

The study provides a theoretical and methodological basis for researchers and practitioners given the current paucity of evidence-based PA interventions for adults with OSA. It addresses the lack of BCTs (framing and prompts/cue techniques) and meaningful behavioral determinants (identity and habit) in most interventions.

3D-Printing Physical Activity in Youth: An Autotopographical Approach to Behaviour Change

The conceptualisation and visualisation of physical activity through 3D-printed objects offers a unique means by which to elicit positive behaviour change. This study aimed to explore whether 3D-printed models of physical activity obtain autotopographical meaning in youths and the influence of such models on their sense of personal and social identity. Following participation in a seven-week faded intervention, whereby habitual physical activity was measured and used to create individual 3D models, the views of 61 participants (36 boys; 10.9 ± 3.0 years) were explored via semi-structured focus groups. Within the over-arching theme of '3D-Printed Models', key emergent sub-themes were structured around 'Autotopography', 'Reflection', 'In-group norms', and 'Significant others'. Investing meaning in the material representations facilitated social activation and self-reflection on their own behaviour, both of which are key elements of identity formation. The influential role of significant others (familial and peers) within initial model interpretation and their potential long-term efficacy as a behaviour change approach was highlighted. 3D-printed models present a novel concept and intervention approach and may represent a useful component within behaviour change engagement strategies in children and adolescents.

Reflecting on physical activity across 2 years of the COVID-19 pandemic: Predictors of intention-behavior profiles

The COVID-19 pandemic has affected how many people engage in regular moderate-to-vigorous intensity physical activity (MVPA). The purpose of this study was to predict current and dynamic (across 2 years of the pandemic) intention and MVPA profiles using the multi-process action control (M-PAC) framework. A representative sample of 977 English-speaking Canadians (18 + years) completed measures of reflective (instrumental attitude, affective attitude, perceived capability, and opportunity), regulatory (planning and self-monitoring), and reflexive (habit and identity) processes, intention, and MVPA. These measures included current assessments and reflections prior to the COVID-19 restrictions. Three current intention-behavior profiles (nonintenders, unsuccessful intenders, and successful intenders) and five dynamic intention-MVPA by prepandemic MVPA profiles (consistent nonintenders, relapsed nonintenders, consistent unsuccessful intenders, relapsed unsuccessful intenders, and consistent successful intenders) emerged from these data, showing few increased MVPA across the pandemic. The current and dynamic profiles were subsequently predicted by changes in specific reflective, regulatory, and reflexive processes across the pandemic; however, only change in identity was the critical predictor of successful MVPA engagement in the dynamic 2-year MVPA profiles. Collectively, the findings support the joint promotion of reflective, regulatory, and reflexive processes in the choice of behavior change techniques to promote postpandemic MVPA intention and behavior.

The utility of the integrated behavior change model as an extension of the theory of planned behavior

Introduction

There are several widely used theories of health behavior change, which mostly utilize the social cognitive approach. These theories tend to posit that intention is a direct predictor of behavior, do not include automatic influences on behavior, and propose a one-size-fits-all theory for both initiators and maintainers. However, the intention-behavior gap is a well-observed phenomenon, researchers have highlighted that both automatic and reflective factors promote behavioral engagement, and predictors of behavior have been shown to differ between initiators and maintainers-three issues that necessitate theory advancement. To that end, the present research compares the utility of the Integrated Behavior Change Model (IBCM) - a social cognitive model that includes automatic factors involved in behavioral engagement and a moderator of the intention-behavior gap - to its theoretical predecessor, the Theory of Planned Behavior (TPB). Further, the relevance of the IBCM factors for predicting exercise behavior is compared in initiators versus maintainers.

Method

Participants were 494 US undergraduates. Participants reported on variables from the IBCM (and TPB) at baseline and reported on their exercise behavior in two surveys at seven- and 14-days post-baseline.

Results

Findings supported the first hypothesis that the IBCM would be more relevant for initiators in comparison with maintainers, using structural equation modeling. Specifically, only the paths between intrinsic motivation and affective attitude, affective attitude and intention, and intention and behavior were reliably found for maintainers. For initiators, the aforementioned paths were also reliably supported and the additional following paths were also supported: intrinsic motivation and perceived behavioral control, perceived behavioral control and intention, and intention and action planning. However, results did not support the second hypothesis that the IBCM would predict significantly more variance in behavior than its theoretical predecessor, the TPB. Specifically, the addition of action planning, implicit attitude, implicit motivation, and the interaction between intention and action planning only predicted an additional 0.3% (p < 0:05) of the variance in exercise behavior above and beyond intention.

Conclusion

Results highlight the continued need for theoretical refinement in terms of delineating mechanisms of initiation and maintenance and the need for further development in terms of improving upon current predictions of behavior engagement and change.

Mapping the evidence on identity processes and identity-related interventions in the smoking and physical activity domains: a scoping review protocol

INTRODUCTION

Smoking and insufficient physical activity (PA), independently but especially in conjunction, often lead to disease and (premature) death. For this reason, there is need for effective smoking cessation and PA-increasing interventions. Identity-related interventions which aim to influence how people view themselves offer promising prospects, but an overview of the existing evidence is needed first. This is the protocol for a scoping review aiming to aggregate the evidence on identity processes and identity-related interventions in the smoking and physical activity domains.

METHODS

The scoping review will be guided by an adaption by Levac et al of the 2005 Arksey and O'Malley methodological framework, the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Extension for Scoping Review (PRISMA-ScR) and the 2017 Joanna Briggs Institute guidelines. It will include scientific publications discussing identity (processes) and/or identity-related interventions in the context of smoking (cessation) and/or physical (in)activity, in individuals aged 12 and over. A systematic search will be carried out in multiple databases (eg, PubMed, Web of Science). Records will be independently screened against prepiloted inclusion/exclusion criteria by two reviewers, using the Active Learning for Systematic Reviews machine learning artificial intelligence and Rayyan QCRI, a screening assistant. A prepiloted charting table will be used to extract data from included full-text articles. Findings will be reported according to the PRISMA-ScR guidelines and include study quality assessment.

ETHICS AND DISSEMINATION

Ethical approval is not required for scoping reviews. Findings will aid the development of future identity-related interventions targeting smoking and physical inactivity.

Understanding Changes in Adolescent Physical Activity Behaviors and Cognitions Prior to and During the COVID-19 Pandemic

Despite accumulating evidence that has found significant negative declines in physical activity (PA) as a result of the COVID-19 pandemic, little work has sought to understand how PA cognitions have changed during this period and in relation to behavior change during the pandemic. The purpose of the current study was to investigate the changes in adolescents' PA behaviors and cognitions associated with COVID-19 and prospective predictors of PA using the Multi-Process Action Control (M-PAC) framework. Adolescents were recruited from a large school board and a total of 588 participants (M_age = 15.87 ± 0.43 years, 60% female) completed data collection in both Fall 2019 and 2020—prior to and during the COVID-19 pandemic. Participants completed self-reported measures of moderate-to-vigorous PA (MVPA), participation in organized activities, and variables derived from the M-PAC framework. Mixed effects models were computed to examine longitudinal changes in MVPA and cognitions as well as whether cognitions prior to COVID-19 predict MVPA during COVID-19. A generalized estimating equations model was computed to examine longitudinal changes for participation in organized activities. Findings indicated that MVPA (B = −56.41, p < 0.01) and participation in organized activities (OR = 0.33, p < 0.01) significantly decreased during the COVID-19 pandemic. Correspondingly, there were significant decreases in intentions (B = −0.34), identity (B = −0.19), and habit (B = −0.20), though there were increases in behavioral regulation (B = 0.18). No significant changes were found in affective attitudes, instrumental attitudes, perceived opportunity, and perceived capability. Among the baseline M-PAC cognitions, habit (B = 46.28) was the lone significant predictor of MVPA during COVID-19. Overall results suggest that adolescents' PA behaviors and cognitions were negatively impacted by the COVID-19 pandemic, along with promising evidence that restrictions prompted adaptive utilization of behavioral regulation skills. Moreover, habit appears to play a salient role in predicting PA behaviors during uncertain times involving major life disruptions. These findings highlight the need to dedicate additional attention to PA promotion as COVID-19 moves toward an endemic phase, and that interventions targeting habit formation may be critical for helping adolescents better sustain healthy active lifestyles during major life changes.

Identifying as someone who avoids virus transmission strengthens physical distancing habit-behaviour relationships: A longitudinal multi-national study during the COVID-19 pandemic

Physical distancing remains an important initiative to curb COVID-19 and virus transmission more broadly. This exploratory study investigated how physical distancing behaviour changed during the COVID-19 pandemic and whether it was associated with identity with virus transmission avoidance and physical distancing habit strength. In a longitudinal, multinational study with fortnightly repeated-assessments, associations and moderation effects were considered for both overall (person-level means) and occasion-specific deviations in habit and identity. Participants (N = 586, M age = 42, 79% female) self-reported physical distancing behavioural frequency, physical distancing habit strength, and identity with avoiding virus transmission. Physical distancing followed a cubic trajectory, with initial high engagement decreasing rapidly before increasing again near study end. Physical distancing was associated with both overall and occasion-specific virus transmission avoidant identity and physical distancing habit strength. People with strong virus transmission avoidant identity engaged in physical distancing frequently regardless of fluctuations in habit strength. However, for those with weaker virus transmission avoidant identity, physical distancing was strongly aligned with fluctuations in habit strength. To enhance engagement in physical distancing, public health messaging might fruitfully target greater or more salient virus-transmission avoidance identity and stronger physical distancing habit.

Seminary Students and Physical Health: Beliefs, Behaviors, and Barriers

As an occupational group, clergy exhibit numerous physical health problems. Given the physical health problems faced by clergy, understanding where physical health falls within the priorities of seminary students, the ways students conceptualize physical health, and how seminary students do or do not attend to their physical health in the years immediately prior to becoming clergy, can inform intervention development for both seminary students and clergy. Moreover, understanding and shaping the health practices of aspiring clergy may be particularly impactful, with cascading effects, as clergy serve as important role models for their congregants. Drawing on 36 in-depth, qualitative interviews with first-year seminary students, this study examines the complex dynamics between religious frameworks related to physical health, explicit intentions to maintain healthy practices, and reported physical health behaviors. Our findings suggest that even students who deploy religious frameworks in relation to their physical health-and who, as a result, possess positive intentions to implement and maintain healthy behaviors-often report being unable to live up to their aspirations, especially in the face of barriers to health practices posed by the seminary program itself. After reviewing these findings, we offer suggestions for physical health focused interventions, including action and coping planning, which could be implemented at seminaries to reduce the intention-behavior gap and improve clergy health.

Application of the Multi-Process Action Control Model to Predict Physical Activity During Late Adolescence

The aim of this study was to apply the Multi-Process Action Control model to examine how the additions of regulatory and reflexive processes predict physical activity (PA) behaviors among adolescents. Our sample included 1,176 Grade 11 students (Mage = 15.85 ± 0.38) recruited from a large school board in Southern Ontario. Participants completed a questionnaire including measures of self-reported PA and PA cognitions derived from the Multi-Process Action Control model. Results found the reflective process explaining 16.5% of the variance in PA, with the additions of regulatory and reflexive processes significantly improving the explained variance by 5.1% and 8.2%, respectively. Final models revealed coping planning (estimate = 45.10, p = .047), identity (estimate = 55.82, p < .001), and habit (estimate = 64.07, p < .001) as significant predictors of PA. Findings reinforce the need for integrative models to better understand PA, with coping planning, habit formation, and development of an active identity to be salient targets for intervention during adolescence.

Measuring Physical Activity Regulatory Styles and Identity Among Adults 55 Years or Older

Objectives. The purpose of this study was to examine the psychometric properties of modified versions of the Behavioral Regulation in Exercise Questionnaire and Exercise Identity Scale for use with adults ages ≥55 years to measure regulatory styles and identity related to physical activity. Methods. Participants [M_age = 66.29 years (SD = 7.06)] answered an online questionnaire twice across a four-week timescale. We assessed measurement invariance and convergent and divergent validity based on relations between regulatory styles, identity, and physical activity. Results. Both measures were invariant across gender and time, and findings support the convergent and divergent validity of the scales. Notably, a two-factor model of identity representing role identity and physical activity beliefs provided the best fit, and physical activity beliefs was more strongly related to introjected regulation. Discussion. Taken together, there is evidence that these modified scales are suitable for use with adults ages ≥55 years.

Relationships Between University Students' Gender and Physical Activity (PA) and Their Exercise Self-Schemas, Processing of PA-Related Information, and PA Decision-Making

In the current study, we investigated the effects of gender and regular physical activity (PA) on PA decision-making and speed of information processing. We enrolled 110 university students (Mage = 20.91, SD =2.28 years) in an experiment involving two tasks and a questionnaire. One of the two tasks assessed how much participants agreed with presented PA words and phrases and the other task predicted behavior and responses to future situations. We collected and measured the participants' choices and the time they took to make them. The questionnaire, the International Physical Activity Questionnaire (IPAQ), consisted of exercise self-schema and PA questions. We conducted a 2 (gender: male or female) ×2 (regular PA or not) multivariate analysis of variance (MANOVA) and found statistically significant differences between variables as a function of participants' gender (λ = .66, p < .001) and regular PA engagement (λ = .51, p < .001). In a regression analysis, we also found gender differences [males showed relationships between agreement with PA information and information processing speed for decisions on future behavior (R² = .31, F = 12.50); females showed relationships between their exercise self-schema (R² = .26, F = 18.18) and regular PA such that, in the non-regular PA group, exercise self-schema was related to reaction time in making decisions on future behavior (R² = .29, F = 11.23), and in the regular PA group, agreement with PA information was related to reaction time for PA-related words, and agreement with non-PA information (R² = .29, F = 8.91)]. These results highlight the need to consider participant characteristics when designing exercise interventions, and we present supplementary data regarding exercise self-schemas, decision-making, and the speed of processing PA information.

Multi-Process Action Control in Physical Activity: A Primer

The gap between the decision to engage in physical activity and subsequent behavioral enactment is considerable for many. Action control theories focus on this discordance in an attempt to improve the translation of intention into behavior. The purpose of this mini-review was to overview one of these approaches, the multi-process action control (M-PAC) framework, which has evolved from a collection of previous works. The main concepts and operational structure of M-PAC was overviewed followed by applications of the framework in physical activity, and concluded with unanswered questions, limitations, and possibilities for future research. In M-PAC, it is suggested that three layered processes (reflective, regulatory, reflexive) build upon each other from the formation of an intention to a sustained profile of physical activity action control. Intention-behavior discordance is because of strategic challenges in goal pursuit (differences in outcome vs. behavioral goals; balancing multiple behavioral goals) and automatic tendencies (approach-avoidance, conservation of energy expenditure). Regulatory processes (prospective and reactive tactics) are employed to hold the relationship between reflective processes and behavior concordant by countering these strategic challenges and automatic tendencies until the development of reflexive processes (habit, identity) begin to co-determine action control. Results from 29 observational and preliminary experimental studies generally support the proposed M-PAC framework. Future research is needed to explore the temporal dynamic between reflexive and regulatory constructs, and implement M-PAC interventions in different forms (e.g., mobile health), and at different levels of scale (clinical, group, population).

Mediators and moderators of physical activity changes in a school-based intervention targeting childhood obesity

This study identifies mediators and moderators of changes in physical activity (PA) following a school-based pilot intervention. Students from two Lebanese schools were randomly allocated into intervention (n = 191) and control (n = 183) groups. The multiple-mediation analysis revealed that active self-identity and perceived barriers mediated the intervention's effect on PA changes. Baseline intention, attitude, PBC, and age moderated PA changes at post-intervention. The youngest participants and those reporting the lowest PA scores at baseline benefited most from the intervention. Future interventions with students should target these mediators and moderators to promote positive change in PA behavior.

Marketing Physical Activity? Exploring the Role of Brand Resonance in Health Promotion

Social marketing campaigns promoting moderate to vigorous physical activity (MVPA) may be more successful when associated with strong brands. Little is known regarding how brand constructs such as brand resonance may be related to MVPA and its antecedents (e.g., having a physical activity identity). A better knowledge of these constructs and their relationships can reveal how to strengthen brands to make them more useful for interventions. The purpose of this study was to test a model linking ParticipACTION (a Canadian social marketing organization) brand constructs (brand affective attitude, identification, resonance), MVPA antecedents (behavioral affective attitude, identity), and MVPA. This study used a cross-sectional online survey design with a representative Canadian adult sample of 1,475 people (M age = 49.36; 49.1% female). Path analysis was conducted to test the model. Overall, the model fit the data well, demonstrating positive associations between brand affective attitude and identification, identification and resonance, resonance and both behavioral affective attitude and identity, behavioral affective attitude and both identity and MVPA, and identity and MVPA. The results suggest that building brand resonance is important for linking branding to MVPA variables. Brand management activities designed to target brand affective attitude may be crucial to helping people feel strong resonance with a brand in a way that supports behavior change.

"Getting Used to It, but Still Unwelcome": A Grounded Theory Study of Physical Identity Development in Later Life

Given the global trends toward an aging society and the increased desire for healthy aging in late life, this study examines older adults' perceptions of aging and their physical identity through their engagement in physical activities. Adopting a grounded theory, we interviewed 15 individuals aged 65 years and older, who were involved in physical activities on a regular basis. This study provided a final model depicting (a) divergent and convergent modes of strategies and socioemotional aspects of physical identity development in later life and (b) different strategies employed between younger-old versus older-old age groups and between participants who have underlying health conditions and those who do not. These findings add a contextual explanation of identity development in later life and stress the recurring process of physical identity development.

A Systematic Review and Meta-analysis of the Outcome Expectancy Construct in Physical Activity Research

BACKGROUND

Cognition-based theories dominate physical activity (PA) research, and many include a construct broadly defined as "beliefs about the consequences of behavior" (e.g., outcome expectancies, perceived benefits) hereafter referred to as perceived consequences.

PURPOSE

With the quantity of available research on this topic, it is important to examine whether the literature supports perceived consequences as a predictor of PA.

METHODS

A meta-analysis examining longitudinal associations between perceived consequences and PA in adults was conducted. Studies were eligible if (a) perceived consequences were measured at a time point prior to PA, and (b) the target behavior was a form of PA. An omnibus meta-analysis estimating the mean effect of all included studies, and separate meta-analyses for perceived consequences content categories were conducted.

RESULTS

This search yielded 6,979 articles, of these, 110 studies met inclusion criteria. Studies were published between 1989 and 2020, with sample sizes ranging from 16 to 2,824. All studies were evaluated as moderate to high quality. A small positive bivariate association was identified (r = 0.11; 95% CI [0.09, 0.13]) between perceived consequences and PA. Significant associations were identified for time, health, self-evaluative, psychological, and affective consequences. There was no association between perceived weight-related consequences and PA.

CONCLUSIONS

The findings emphasize the variability with which existing studies have examined perceived consequences in the PA literature. Future research might examine whether these are important distinctions for understanding PA. Overall, the results suggest utility in examining perceived consequences as a predictor of PA, but constructs with more robust associations may require priority.