Motivation and emotion/Book/2020/Sedentary behaviour change

Overview


Sedentary behaviour is acknowledged to be a rising trend in society due to the advancements in technology and evolution of lifestyle leisure and accessibility. Whilst amazing, it has been noted humans are becoming accustomed to living a lifestyle requiring minimal effort and increased sedentary acts (see Figure 1). Therefore, no longer possess the motivation to change these sedentary behaviours (Owen et al., 2010).

This book chapter explores four motivational theories which can help change sedentary behaviour. Motivation and sedentary behaviour are further defined, to provide clarification when reading this book chapter. This chapter also discusses the aversive physical and mental health effects associated with prolonged sedentary behaviours, and how bringing these to light, highlighting the perceived barriers and perceived benefits helps motivation to change (Janz & Becker, 1984). When working with an individual who is seeking to change their sedentary behaviour, it is important to work on building an individual's autonomy, self-efficacy and intrinsic motivation. Through motivational theories, it is discussed how strengthening these are important for seeing long-term sedentary behaviour change. The most popular intervention in changing sedentary behaviour is through wearable devices and smartphone apps (Lupton, 2016).

At the end of this chapter, it is hoped the reader is able to understand the value of each individual motivational theory, apply it to their own sedentary behaviours, and take an interest in the technologies they currently have to assess their own sedentary data.

Focus Questions
 * What are examples of Sedentary Behaviour?
 * What are the different types of Motivation?
 * What are the four motivational theories which help explain how to change sedentary behaviour?
 * What are the different populations motivational theories can be applied to?
 * What are the real world applications?

Sedentary Behaviour


Sedentary behaviour refers to individuals who display low levels of activity, exert minimal energy expenditure, or who do not meet the criteria of the https://www1.health.gov.au/internet/main/publishing.nsf/content/F01F92328EDADA5BCA257BF0001E720D/$File/brochure%20PA%20Guidelines_A5_18-64yrs.pdf Australian guidelines of physical activity] (refer to Figure 2). Due to advancements in technologies and a subsequent ease in lifestyle accessibility, sedentary behaviours are more common than ever before (Owen et al., 2010). Sedentary behaviours are classified as ‘sitting’ or ‘lying down’ tendencies most commonly associated with:

- Smart phone/tablet use

- Online games

- Television

- Desk jobs

- Talking on the phone

- Motorised transport such as cars, buses or motorbikes (Biddle et al., 2011).

A study by Kozey-Keadle et al. (2011) found positive associations with sedentary behaviours are linked with higher risk of obesity, metabolic syndrome, diabetes, cardiovascular disease and mortality.

Not only do sedentary behaviours link with aversive physical health outcomes, but also mental. Research by Kessler et al. (2007) states adolescence who indicate longer duration of sedentary behaviours such as screen time are at higher risk of mental health disorders such as depression, self-harm, low self-esteem or anxiety.

Sedentary behaviour is viewed as more of a habit than a conscious choice. So, how do we break these habits and be motivated to change sedentary behaviours? (Biddle et al., 2011)

What is motivation?
When initially thinking of motivation, one may think about big life events or extreme stories such as training two years in advance for the Iron Man or becoming a volunteer firefighter in peak Australian bushfire season. However, motivation is actually more common in everyday life. What has made you read this book chapter - will you get a good mark on your assignment because of it? Why did you walk your dog this morning - do you enjoy the morning sunshine?

Motivation can be defined as having the energy, either physical and/or mental energy, to perform a desired action or behaviour. Motivation has the ability to energise, direct and sustain the desired action or behaviour. It is also multidimensional, meaning there are more than one categories of motivation (Ryan & Deci, 2000).

Intrinsic motivation, extrinsic motivation and amotivation
Intrinsic motivation is performing an action/behaviour because it is enjoyable, interesting and satisfactory to the individual.

Extrinsic motivation refers to performing an action/behaviour to obtain a more tangible outcome such as rewards, instrumental value, or to avoid punishment.

Amotivation is essentially a lack of motivation. An amotivated individual does not have the fundamental foundations commonly seen in a motivated individual (Ryan & Deci, 2000).

Health Belief Model
Motivation is considered vital in the Health Belief Model (HBM). Motivation in respect to HBM can be defined as goal-oriented behaviour where the specific goal is maintaining the individual’s health (Rosenstock, 1974). HBM looks at decision making and explains the action taken in a choice situation. When applying the HBM to changing behaviour from sedentary to engaging in physical activity, there are two main motives that can effect an individuals motivation to engage: the value an individual places on a specific outcome, and the individuals belief in the likelihood certain actions will result in that specific outcomes (Gristwood, 2011).

HBM has six concepts:


 * 1) Perceived Susceptibility
 * 2) Perceived Severity
 * 3) Perceived Benefits
 * 4) Perceived Barriers
 * 5) Self-Efficacy
 * 6) Cues to Action

Research by Janz & Becker (1984) shows that ‘perceived barriers’ is the most powerful dimension in the model which negatively effects behaviours. Those who perceive more barriers to changing sedentary behaviours and lower perceived benefits will not be motivated to change. However, if individuals perceive higher benefits than barriers to changing sedentary behaviour, behaviour is more likely to be changed. This statement is further supported by Noorbakhsh et al. (2017) who did an intervention on overweight male adolescent students. The intervention provided knowledge about the long-term effects of sedentary behaviour, the benefits of physical activity, nutritional behaviours and the barriers to each. Post-intervention data showed perceived barriers around changing sedentary behaviour decreased significantly (P <0.05) and data on perceived benefits increased. Therefore, there is benefit for the motivational theory of HBM to be accessible to individuals through educational programs and taught by educational experts to change sedentary behaviours.

Case study demonstrating application of HBM

Rachel wants to swap her daily 'Gossip Girl' television sitting to some form of exercise. However, Rachel is worried about going to the gym and not ‘fitting in’ and is nervous about it being too hard. Rachel looks into a personal trainer to help guide her. The trainer assesses Rachel’s barriers, ensures their sessions are done outside in a private park, reassures Rachel the sessions will be light and eventually increase in intensity as her fitness strengthens. Not only does the trainer combat Rachel’s perceived barriers, the trainer reminds Rachel of the benefits she will gain by doing this such as increased physical performance, better psychological health, and reduced likelihood of health related diseases.

By determining the individuals perceived barriers, and increasing HBM factors such as self-efficacy, benefits and susceptibility, the individual is more likely to increase motivation and therefore change sedentary behaviours (Carpenter, 2010).

Self-Determination Theory


Self-determination theory (SDT) explores amotivation, autonomous (intrinsic) and controlled (extrinsic) motivation. SDT aims to provide tools to help identify, internalise and maintain the motivation to change behaviour.

There are three basic psychological needs (refer to Figure 2) as to why an individual does or does not engage in a behaviour such as sedentary behaviour (Gagne & Deci, 2005).


 * 1) Autonomy: feeling a sense of self-directness over one's behaviour.
 * 2) Competence: knowing they have the ability to successfully master a task.
 * 3) Relatedness: having a meaningful connection (Wilson et al., 2008)

SDT argues if these three psychological needs are maximised as an enjoyable experience, behaviours such as physical activity will become autonomous, and therefore are more likely to be maintained. If an individual does not possess these three psychological needs, an individual is said to be amotivated, or sedentary in this instance. Sedentary behaviour will not be extinct, just decreased. However the individual will be more likely to make positive health choices as opposed to sedentary. Therefore, SDT is a motivational theory used to create change in sedentary behaviour (Knittle et al., 2018)

When changing sedentary motivation, autonomy support is giving an individual a choice with ways they can change sedentary behaviour, acknowledge to the individual that changing sedentary behaviour can be challenging, ensure the authority figure provides meaningful justifications for changes in behaviour and listen with empathy to the individual. Wilson et al. (2008) found those who feel they have autonomy support through friends and authority exercise leaders, such as personal trainer or instructors, are more self-determined and change their sedentary behaviour to participate in exercise activities.

A study by Jensen (2020) examines the relationship between SDT and technology aimed at changing sedentary behaviour. Eighty-four participants aged 20 to 60 years participated in a survey examining four key features: reminders, rewards, social corporation, competition. It was hypothesised if technologies such as smartphone applications or wearable devices are viewed as interesting, enjoyable and satisfactory and the individual’s autonomy, competence and relatedness is enhanced, motivation is said to prolong and therefore support a long-term sedentary behaviour change. The study found devices promoting perceived competence through rewards and perceived relatedness through social corporation showed a positive but not significant relationship. Devices promoting perceived autonomy through reminders had a negative correlation. Devices promoting perceived relatedness through competition showed a statistically significant positive relationship in motivation for sedentary behaviour change.

Therefore, devices promoting a sense of relatedness through competition is most effective in significantly increasing intrinsic motivation for individuals to change their sedentary behaviour. Practical applications of this will be discussed further.

Case study demonstrating application of SDT

Client A vs Client B

Client A:

- Told what to do, what intensity to perform at

- Must only complete sprints

- Trainer says session is easy and not hard at all

- Client does not come back to session and resumes sedentary behaviour.

Client B:

- Given a choice what activity to do

- Asked how long they are prepared to perform activity for

- Trainer acknowledges during session it is tough but to keep pushing

- Client’s data is accessible to her friend who is also completing a training program

- Client enjoyed session, realised she did x10 extra burpees than friend, and is likely to come back next day (Daley & Duda, 2006)

Goal Setting Theory
Goal setting theory (GST) is another intervention used to enhance motivation. GST examines the relationship between setting goals and performance attainment. A goal is defined as what an individual aims to accomplish. The theory has shown an individual's performance is maximised when a specific, difficult and realistic goal is set. Vague goals such as ‘do your best’ are not sufficient when changing behaviours. Motivation is enhanced when the individual understands the behaviours that will ultimately lead to the goal, and feels competent performing that behaviour (Tosi et al., 1991).

Latham & Locke (1991) state two individuals could have the same sedentary behaviours, have access to the same knowledge about changing behaviours, have the same financial accessibility, same motivational level and are equal in ability, yet one individual can still perform better than the other. This is a result of having different performance goals.

There are five guidelines to follow when trying to effectively set goals. This is commonly known as the SMART goal framework. In order to change sedentary behaviour, goals must be specific, measurable, attainable, relevant and time bound. Overtime, the value of SMART goals was recognised and evolved to SMARTER goals (refer to Table 1) (Macleod, 2013).

Table 1

SMARTER goals acronym

GST can be further enhanced when feedback is present. Feedback is important when associated with sustaining motivation because it can encourage or deter an individual from achieving their goals. Feedback assists individuals understand how well they are doing, can increase self-efficacy and encourage individuals to set higher goals (Lunenberg, 2011).

It is important goals remain challenging, but not to the point of non-fulfillment. GST predicts drop at high goal difficulty if there is a large decrease in goal commitment. In relation to changing sedentary behaviour, ensure intrinsic and extrinsic motivators stay high to achieve goals (Tosi et al., 1991).

A study by Lewis et al. (2016) examined a goal setting intervention called ‘Small Steps’, aimed to decrease sedentary time in older adults. Twenty-seven participants chose six ways to change their sedentary behaviour and formulated a goal to correlate with each. Similar to the SMART goal framework, the goals had to be attainable, reduce sedentary time by at least 15 minutes per day (measurable), and given six weeks to complete the program (time bound). Participants had weekly check-ins to review each goal. Results showed significant reductions in total time sitting, with 81% of participant’s reporting they achieved their goals. Although the sample size is small, this study shows promising and effective goal-setting intervention which can help motivate individuals to change their sedentary behaviour. In future studies, Small Steps can be applied to older adults in a variety of retirement and nursing homes to evaluate the effectiveness of the intervention.

Case study demonstrating application of GST

Tom recently had an ACL operation and has not been following his rehab program. Instead of doing his exercises, Tom has engaged more in video games and watches TV for longer durations. Tom’s physiotherapist takes a different approach to help motivate Tom to change his sedentary behaviours into time spent doing his rehab.

S:Increase adherence to rehabilitation program

M:4 x 30-minute sessions per week. Use a reminder system and timer through phone app to track and measure.

A:This is attainable because the duration is short, and Tom is spending time at home most days so will have access to equipment

R:Rehabilitation program is relevant to Tom’s ACL surgery and post-operative recovery and will benefit him long-term when returning back to sport.

T:Continue this rehabilitation for 6 weeks then meet back together for a review

E:Tom chooses the music playlist each session

R:When Tom completes twenty-one days of rehabilitation, he can buy a new exercise shirt

Social Learning Theory and Social Cognitive Learning Theory
Social learning theory (SLT), now known as Social Cognitive Learning Theory (SCLT), was introduced by Albert Bandura.

The foundations of SLT theory are we learn by observing, imitating and modelling through others. Building on from SLT, SCLT emphasises self-efficacy is the foundation of an individual believing they are capable of producing behaviour change. Self-efficacy is the motivation an individual needs to believe they have the capability to produce change through their actions (Bandura, 1965).

SLT is most effective if an individual’s experience is positive or includes rewards. These two factors are said to maintain motivation when changing sedentary behaviour (Muro & Jeffrey, 2008).

In SLT, Bandura (1965) conducted an experiment called the ‘Bobo Doll Experiment’. Children were asked to observe an adult model perform a behaviour, and subsequently the children would then go on to imitating and modelling the behaviour of the observed adult. Today, it is important children are exposed to positive behaviours surrounding physical activities and habits to reduce sedentary behaviour. Using SLT and SCLT, children who have positive role models to observe, are more likely to imitate and model those non-sedentary behaviours. Strengthening a child’s self-efficacy during this time will lead to more positive behaviours and the instil motivation to continue this. Ways to increase motivation through SLT/SCLT are direct reinforcement after performing the desired behaviour, vicarious reinforcement when seeing others reinforced for the same behaviour, and self-produced when the behaviour is seen as valuable or intrinsic (Artino, 2007).

Literature by Muro & Jeffrey (2008) states experiences involving learning through observing, imitating or modelling do not always result in changed behaviour. Therefore, it is important to tailor your behaviour modification program for a sedentary individual which includes aspects of each motivational theory as stated above.

Daley & Duda (2006) have shown health behaviours established during individuals’ younger years often transfer into middle and later adulthood. Therefore, would it not make sense to establish a strong foundation of health behaviours in infancy and childhood?

Case study demonstrating application of SLT/SCLT A primary school teacher notices all her grade four students sit, talk and play on their devices during lunchtime instead of running around playing games.

To increase motivation to change their sedentary behaviour, the teacher invites a group of grade six students to play a game of ‘tips’. Grade six students are chosen because they are viewed as the role models of the school.

The teacher gives positive encouragement to each grade six throughout the duration of the game (vicarious reinforcement) and each player is rewarded at the end of the game with an extra 10 minutes of lunchtime play (direct reinforcement).

The grade 4 class observe all of this, and they start imitating some of the moves shown by the grade sixes. Eventually, the grade fours decide to participate in the game and model the behaviours previously observed and imitated.

Throughout the game, the teacher and grade six students say positive words of encouragement to each grade four student to build their self-efficacy. The next day, the grade four students look forward to playing their new lunchtime game together.

Self-tracking
Self-tracking, either digital or non-digital has become an increasingly popular tool used to promote healthy behaviours and sustain motivation. It is a way to record, analyse and compare behaviours including bodily functions such as steps per day, distance travelled per day, heart rate and atrial fibrillation, duration, frequency and intensity of exercise, calories consumed, number of minutes spent inactive/sedentary, and even positive feedback. Digital self-tracking devices include Garmin watches (refer to Figure 5), Apple watches, FitBit’s, and smartphone health apps (Lupton, 2016).

A study by Haile et al. (2020) examines a digital Welbot intervention aimed at increasing healthy lifestyle behaviours and reducing sedentary behaviours at the workplace. The nudge technique is designed to remind individuals at work to have a break from their screen, to hydrate, to stretch, make a cup of tea or encourage breathing exercises for 1-3 minutes at regular intervals during the working day. Results from the intervention indicate less seated (sedentary) time and more standing time compared to baseline data. However, results did not continue during the second week of the intervention. Future studies could try incorporating the SMART goal approach, or provide a form of extrinsic motivation to keep individuals motivated during the intervention.

Applying self-tracking to motivational theories
Self-tracking can apply aspects of each motivational theory previously discussed to enhance motivation to change sedentary behaviour:

GST: the individual can set their target steps for the day as their goal. Devices allow individuals to personalise their goals and can be periodically reminded throughout the day/week to strive to achieve their goal.

SDT: the individual can choose what activity they would like to participate in (autonomy), data can be synchronised with other devices to share with friends which can be viewed as a friendly form of competition (relatedness), and devices/apps are able to provide feedback when a task is started, halfway complete, and successfully completed (competence). By providing feedback, not only is an individual’s competence increased, the motivation to finish their task is increased.

SLT/SCLT: the individual is able to observe, imitate and model a video demonstration of physical activity.

Therefore, to successfully change sedentary behaviour through motivational theories, self-tracking interventions would be useful in supporting behaviour change (Lupton, 2016).

Conclusion
Prolonged and health-detrimental sedentary behaviours are becoming a common feature in daily life and have been shown to affect, to some degree, a large variety of populations; children, young adults, and older adults. Whilst some sedentary behaviours are out of our control such as the expected seated hours per week at desk jobs, there are motivational theories, tools and techniques accessible to change sedentary behaviours whilst considering individual situations.

Motivational theories such as the health belief model, self determination theory, goal setting theory and social learning theory/social cognitive learning theory.

The HBM has provided the initial step in changing sedentary behaviour through motivation by determining 6 important concepts – specifically determining the perceived barriers which is shown to be the biggest deterrent to changing behaviour. By determining barriers and increasing self-efficacy, sedentary behaviours can change.

Through SDT, motivation is increased when the three concepts of autonomy, competence and relatedness are satisfied. Jensen’s (2020) study specifically found if relatedness through the form of competition is achieved, this form of intrinsic motivation will positively change sedentary behaviour.

When changing and trying new behaviours, goal setting is effective in keeping individuals on track and accountable. By following the SMART framework and ensuring intrinsic and extrinsic motivations stay high, sedentary behaviours can be changed.

SLT/SCLT has a strong foundation and body of research thanks to Albert Bandura. The behaviours we observe in our environment are the behaviours we will see most imitation of. If individuals are exposed to positive observations, imitations and models of behaviour, sedentary behaviour is likely to change, especially if there is a form of motivational reward associated with this change.

Taking advantage of today’s technology, using smartphone apps or devices such as Garmin watches are valuable and motivating self-tracking tools to sustain a behaviour change and hold individual’s accountable.

By combining these motivation theories together, there is a recipe for successful sedentary behavioural change. To achieve the most effective results, it is important to ensure you tailor to the individual’s specific needs, get to know them, establish a sense of autonomy and self-efficacy, and aim to reach intrinsic motivational status to prolong change in sedentary behaviour.