Review
The barrier-belief approach in the counseling of physical activity

https://doi.org/10.1016/j.pec.2014.10.003Get rights and content

Highlights

  • PA is inhibited by barrier-beliefs (BBs).

  • A new theoretical framework is presented of three types of BBs.

  • Different theory-based strategies are developed preventing of BBs.

  • Findings contribute to increase the chance on long lasting lifestyle changes.

  • Findings contribute to increase the effectiveness of counseling interventions.

Abstract

Objective

To understand inactivity and relapse from PA, and to develop theory-based behavior change strategies to stimulate and support maintenance of PA.

Methods

We conducted a literature search to explore barriers to PA. Social cognitive theories and empirical evidence were evaluated and guided the process developing a theoretical framework and counseling strategies.

Results

A theoretical framework is presented to understand why people do not engage in PA and often relapse once they started PA. A distinction is made between three related types of BBs. In PA counseling these three beliefs are addressed using four different BB behavior change strategies.

Conclusion

BB counseling aims to develop an individual pattern of PA for the long term that is adapted to the (often limited) motivation of the client, thereby preventing the occurrence of BBs. The client will learn to cope with factors that may inhibit PA in the future.

Practice implications

The BBs approach composes a way of counseling around the central construct of barrier-beliefs to stimulate engagement in PA independently, in the long term.

Introduction

Physical inactivity is a worldwide growing problem with one out of five adults being physically inactive [1]. Physical inactivity is a risk factor for chronic diseases such as diabetes and cardiovascular diseases, overweight and several cancers [2]. Regular physical activity (PA) is positively associated with fitness and health related benefits and related to an estimated 30% reduction in risk for all-cause mortality among adults [3]. Engaging in regular, moderate-intensity PA is important for the promotion of physical and mental well-being [4], and the prevention and management of many chronic diseases [5], [6], [7]. In addition, stopping or markedly reducing PA can result in a significant reversal of initial health improvements [8], [9]. Thus, to improve physical and mental health and to prevent illness, it is important that people engage in PA on a regular basis. However, despite the well-known benefits of PA and the availability of effective PA interventions, many people do not engage in sufficient PA. For example, around the world percentages of physical inactivity vary from 20% up to 70% in different countries, with about 40% in the United States of America, and over 60% in the United Kingdom [10].

In addition, when people start engaging in PA, they often relapse to inactivity, even when they take part in PA interventions [11]: Results of systematic reviews and meta-analyses of long-term effects indicate that a majority of individuals relapse to a less active or to an inactive status when intervention support is no longer provided [12], [13], [14], [15]. However, only sustained PA can have relevant effects on health and the prevention of illness. For a sustainable behavioral change, Greaves’ review [20] suggests that future interventions should add behavior maintenance strategies. These strategies should target the most influential determinants of PA maintenance [17], [18], [19], [20], [21].

In conclusion, PA interventions can lead to higher levels of PA, which is related to several beneficial physical outcomes. However, many people do not engage in sufficient levels of PA and do not use these interventions, and when they do use PA interventions, they often relapse. Therefore, there is a need for understanding inactivity and relapse from PA, and for theory-based behavior change strategies to stimulate and support maintenance of PA.

Section snippets

Barriers inhibit PA

In research on PA, the general term barrier is often used to refer to very different factors that hold people from initiating PA or that cause relapse from PA. In summary, these studies mention barriers such as, lack of time, high financial costs, health complaints, lack of safety, lack of facilities, bad weather, no transport, no family assistance or child care support [22], [23], [24], [25], [26], [27], [28], [29], [30]. In these studies barriers are often seen as more or less fixed factors

The barrier-beliefs counseling

In barrier-beliefs counseling PA is stimulated by addressing the BBs. The novelty of this counseling lies in the various ways it addresses BBs to lower their PA inhibiting effect. These ways can be conceptualized as behavior change strategies [56]. The behavior change strategies comprise clusters and sequences of actions of the counsellor (questions, decisions, etc.) with the goal to: (1) design means to reach the goal; (2) change goals to change BBs; (3) restructure/change BBs, and (4) accept

Discussion and conclusion

The presented barrier-belief approach to counseling PA is based on contemporary theoretical models of behavior and on empirical evidence. The theoretical background is social-cognitive and the applied behavior change strategies that target BBs are already used in different change perspectives and therapies. However, in the barrier-belief approach these proven behavior change strategies – change means reach goals, set (different) goals, restructure beliefs, induce acceptance – are all applied to

Conflict of interest

The authors declare that there is no conflict of interest.

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