Application of the TTM in the general population

Interventions based on the TTM are effective in promoting and maintaining physical activity in the general population (Marcus, et al., 1992a; Marcus, et al., 1998a, 1998b; Bock, et al., 2001). Marcus randomised 194 sedentary adults to receive either an individualised, stage-matched intervention or a standard intervention over a six-month period (Marcus, et al., 1998a). The stage-matched intervention involved providing participants with individualised feedback about their physical activity behaviour and stage-matched self-help manuals that were designed to apply the components of the TTM. The intervention involved providing participants with typical self-help health promotion booklets to promote physical activity. At six months, a significantly greater proportion of participants in the stage-matched group were regularly active and had progressed to the action stage, compared to those receiving standard treatment. In addition, the stage-matched group were significantly more active than the standard group at six months. Six months after the intervention period had ended, a greater proportion of participants who had received the stage-matched intervention were regularly active and in action or maintenance stages, compared to subjects who received the standard intervention (Bock, et al., 2001). These findings suggest that an intervention tailored to an individual's stage of exercise behaviour change is more effective than a standard intervention to promote and maintain physical activity in a group of sedentary healthy adults. Table 8.2 describes appropriate strategies for each stage of change.

Table 8.2. Appropriate strategies to use in each stage of exercise behaviour change (Adapted from Biddle and Mutrie, 2001)

Stage of Change Suggested Strategies

Precontemplation Raise awareness of benefits of activity and risks of inactivity Contemplation Decisional balance (perceived pros and cons of activity) Preparation Decisional balance, overcoming barriers to activity, set goals for increasing activity, seeking support Action Set goals for regular activity, seeking support, rewards, relapse prevention

Maintenance Varying activities to prevent boredom, seeking support, rewards, relapse prevention

In summary, the transtheoretical model proposes that by identifying an individual's stage of exercise behaviour change, key components such as the processes of change, exercise self-efficacy and decisional balance can be influenced to encourage stage progression and relapse prevention. For example, maintaining physical activity and preventing relapse may require continued use of behavioural processes and enhancing self-efficacy. A description of how each component of the TTM is addressed during exercise consultation is provided in Table 8.3 (p. 204).

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