Physical Activity And Health Promotion Research Paper

1. Physical Activity And Health

Disease prevention by regular physical activity has become more and more important. Its significance has been shown in various studies. Epidemiological and naturalistic as well as experimental studies demonstrate the risk-reducing and health-enhancing effects of regular physical activity. In particular, aerobic training seems to be effective in preventing cardiovascular diseases. The psychological benefits of physical activities are decreasing negative emotional states (e.g., anxiety) and increasing positive emotional states (e.g., vigor).

Whereas the effect of exercise on physical health can be explained by adaptation processes of the metabolic and cardiovascular system, the effects on mental health remain unexplained. Different kinds of hypotheses assume physiological (e.g., thermoregulation, endorphins), psychological (e.g., attention distraction, states of flow), or rather unspecific mechanisms (e.g., effort justification). Further research is needed to enlighten these mechanisms. However, it can be stated that physical exercise is an appropriate means for health promotion in most cases.

2. Physical Activity And Health Promotion: Two Complementary Strategies

Health promotion is a scientific conception to help people change their lifestyles towards a state of optimal health. Recently published theories conceive health and disease as independent dimensions. In view of such a concept, reducing cardiovascular risk by regular exercise does not lead intentionally, at the same time, to optimizal physical, mental, and social wellbeing. The strategy of health promotion therefore has been extended in the past decades. Whereas in the 1980s health promotion was defined as a disease preventing strategy, it has been supplemented by a setting-based lifestyle strategy in the 1990s. Health promotion today focuses on disease prevention and health enhancement, while also aiming at changing behavior and improving the living conditions of social groups and individuals.

2.1 Physical Activity And Health Promotion: The Behavior-Oriented Strategy

When focusing on personal behavior change without considering the environmental conditions, health promotion seems to have rather limited success. About 50 percent of the population in the USA do not adopt regular exercise and 25 percent are not active at all (USCDCP 1994). Those who begin an exercise program often fail to adhere to it. Most of them relapse to inactivity after the first six months (Marcus et al. 2000). Previous preventive interventions have often used threatening contents to convince people to give up inactivity (e.g., threat of coronary artery disease). When reviewing the literature on fear communication Leventhal (1970) described how threatening intervention practices are often provoking a negative relationship between fear and persuasion. So there is no linear relationship between threat and motivation to quit health-damaging behavior. One cause of this paradoxical effect is well documented in social psychology literature as the phenomenon of reactance (a reaction to feel a restricted liberty of behavior).

In the last decade of the twentieth century Health Psychology applies theoretical models which define the cognitive determinants of health behavior (continuum theories) and construe behavior change as a stepwise process (stage theories). Current continuum theories are the Health–Belief–Model, the Protection–Motivation–Theory, the Theory–of–Planned–Behavior and the Subjective–Expected–Utility–Theory. Empirical tests verify at least four variables as predictive for health behavior in general. A behavioral change is probable on condition that a person perceives health hazards as being likely (vulnerability) and severe (severity), and on the condition that this person is supplied with disease preventing alternatives (outcome expectancies), and has enough personal efficacy (self-efficacy) to change a risky lifestyle.

With regard to physical exercise, perceived behavior control, positive outcome expectancies, social support and severity, as well as vulnerability, define valid and reliable sociocognitive predictors determining adoption to exercise for men and women in different ways (Sallis et al. 1992). In contrast, knowledge about intervention strategies that try to foster exercise adherence or maintenance to physical activity, is at an early stage (Marcus et al. 2000).

Valid social and demographic predictors of health- related activities are mainly age, gender, neighborhood environment, school attainment, ethnicity, and in- come aside from sociocognitive variables. This means that women, elderly people, people with a lower education, low income, ethnic minorities, and persons living in an area with low recreational potential, are little active in sports.

Moreover health-related behavior (including health damaging activities) has proved to be quite stable (Sutton 1994). It is obvious that inactive people are not aware of the risks of leading a sedentary lifestyle. Continuum theories are scarcely suited to explain changes from the sedentary-oriented stage to that of readiness for physical activity.

Stage theories (Transtheoretical–Model, Precaution–Adoption–Process) seem rather adequate to deal with this phenomenon (Weinstein et al. 1998). They postulate distinguishable stages in which varying processes pass, leading to different levels of change: for example, precontemplation, contemplation, active change, maintenance, and perhaps relapse. Adoption of exercise has been investigated by various authors, most of them using a cross-sectional comparison of people believed to be in different stages (e.g., Prochaska 1994). The results indicate an increase in the perceived benefits of exercise from a pre to a postdecisional stage. More experimental and longitudinal research is needed to clarify the conditions under which people change from a sedentary to an active lifestyle.

2.2 Physical Activity And Health Promotion: The New-Public-Health Approach

Many health problems and severe diseases in modern societies are surely caused by overeating, alcohol consumption, drug abuse, and a sedentary lifestyle. Therefore, the question of how to change health-damaging lifestyles still remains important. The models and theories mentioned above help to develop efficient intervention strategies.

Physical activity is part of a health-enhancing lifestyle. The achievement of physical activity goes beyond reducing the risk of cardiovascular diseases. Contributing to social integration gives the feeling of internal control and—especially with young people—provides the conditions for learning adequate, rule-based social behavior (see Danish et al. 1996). Exercising in groups seems to promote the learning of suitable skills to mobilize social networks.

British studies especially, however (see Blaxter 1990), substantiate that particularly middle and upper-class members of modern societies cling to a health-enhancing lifestyle. Body image and its relevance to physical activity is now a subject of growing importance for those with a modern, middle-class lifestyle. As can be suspected, inequalities in exercise engagement are not only caused by personal income, though this is a premise for taking part in physical activities such as aerobics, calisthenics, and power training in fitness studios. Causes may be found more likely in the ‘social environment’ of persons. Social environment construes informal as well as formal rules and norms and it provokes attitudes and values, feelings, thoughts, and actions, which then determine the actual position of a person in a given setting (e.g., workplace, school, family). From this point-of-view a certain health-damaging behavior (e.g., inactivity) may be functional in so far as it demonstrates identity with a defined social group or class. Empirical facts show that lower-class people share a mechanistic view of the body. In general they do not expect to have personal influence on health and wellbeing. The consistent epidemiological results from USCDCP (1994) that are mentioned above, demonstrate that less physical activity participation correlates with lower educational attainment, lower income, minority status, old age, and being overweight. These factors seem to be significant barriers to exercise.

Interventions merely focusing on health-damaging behavior run the risk of ignoring the constraints and barriers of behavior change. They are liable to lead towards ‘healthism.’ They are likely to provoke moralistic attitudes such as blaming the victim (see Diekstra and Jansen 1990). Health promotion in the sense of New Public Health is a cross-disciplinary science that avoids such misinterpretation by preferring an ecological perspective. The Ottawa Charter for Health Promotion of the WHO pleads for an enlargement in the paradigm of the intervention process. Health promotion in this sense considers both personal behavior and personal environment. It includes disease prevention as well as health enhancement. Thus health promotion has the chance to look for daily life resources which are health enhancing. Those resources are, among other things, sufficient income, adequate command of work, ability to cope with daily hassles and daily uplifts, social integration and social support, self-esteem, and the feeling of internal control (Diekstra and Jansen 1990). As already mentioned, exercising in groups can contribute to the strengthening of these resources; therefore all social groups should have the opportunity to profit from these resources as well.

King et al. (1997) show that participation in an exercise program depends on its demands and type. They compared two groups of women—those who had less than 12 years of education with those who had more than 12 years. The Stanford-Sunnyvale Health-Improvement Project (SSHIP) found that the lesseducated group, which was given an adequate home-based exercise program, had relatively high rates of long-term exercise adherence (two years). So, if matched to the right program, subgroups of lower classes have the chance to do quite well. Studies like the SSHIP will help to identify those variables, which can provide information on when and why people become more or less active over the course of time.

3. Conclusions

Physical activity is an appropriate means of enhancing physical as well as psychological wellbeing. Despite the growing evidence of the health benefits of regular physical activity, about 50 percent of adult people remain sedentary, especially those in lower socioeconomic status groups. Research in Health Psychology as well as in New Public Health is challenged to clarify those conditions and program parameters which are appropriate to enhance the motivation to exercise and which bind people together in long-term regular exercise programs.

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