Exercise Behavior and AdherenceExercise Behavior and Adherence
Session OutlineSession Outline
Why Study Exercise Behavior? Why Study Exercise Behavior?
Why Exercise Behavior and Adherence Are Important
Why Exercise Behavior and Adherence Are Important
Reasons to Exercise Reasons to Exercise
Reasons for Not Exercising Reasons for Not Exercising
(continued)(continued)
The Problem of Exercise Adherence The Problem of Exercise Adherence
Session OutlineSession Outline
Theories/Models of Exercise Behavior Theories/Models of Exercise Behavior
Determinants of Exercise Adherence Determinants of Exercise Adherence
Strategies for Enhancing Adherence to Exercise Strategies for Enhancing Adherence to Exercise
Settings for Exercise Interventions Settings for Exercise Interventions
Guidelines for Improving Exercise Adherence Guidelines for Improving Exercise Adherence
Despite the current societal emphasis on fitness, a small percentage of children and adults participate in regular physical activity.
Despite the current societal emphasis on fitness, a small percentage of children and adults participate in regular physical activity.
Why Study Exercise Behavior?Why Study Exercise Behavior?
50% of adults are completely sedentary. 50% of adults are completely sedentary.
50% of youth (ages 12-21) do not participate in regular physical activity.
50% of youth (ages 12-21) do not participate in regular physical activity.
25% of children and adults report doing no physical activity.
25% of children and adults report doing no physical activity.
Only 15% of adults participate in vigorous and frequent activity.
Only 15% of adults participate in vigorous and frequent activity.
Why Exercise Behaviorand Adherence Are Important
Why Exercise Behaviorand Adherence Are Important
Only 10% of sedentary adults are likely to begin a program of regular exercise within a year.
Only 10% of sedentary adults are likely to begin a program of regular exercise within a year.
(continued)(continued)
Among boys and girls, physical activity declines steadily through adolescence.
Among boys and girls, physical activity declines steadily through adolescence.
Physical inactivity is more prevalent among women, African-Americans, and Hispanics, as well as among older and less affluent adults.
Physical inactivity is more prevalent among women, African-Americans, and Hispanics, as well as among older and less affluent adults.
50% of people starting an exercise program will drop out within six months.
50% of people starting an exercise program will drop out within six months.
Daily attendance in physical education classes dropped from 42% to 25% between 1990 and 1995.
Daily attendance in physical education classes dropped from 42% to 25% between 1990 and 1995.
Why Exercise Behaviorand Adherence Are Important
Why Exercise Behaviorand Adherence Are Important
Reasons to ExerciseReasons to Exercise
Weight control Weight control
Reduced risk of cardiovascular disease Reduced risk of cardiovascular disease
Reduction in stress and depression Reduction in stress and depression
Enjoyment Enjoyment
Building self-esteem Building self-esteem
Socializing Socializing
Reasons to ExerciseReasons to Exercise
Exercise combined with proper eating habits can help people lose weight; but weight loss should be slow and steady, occurring as changes in exercise and eating patterns take place.
Exercise combined with proper eating habits can help people lose weight; but weight loss should be slow and steady, occurring as changes in exercise and eating patterns take place.
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Reasons to ExerciseReasons to Exercise
Both the physiological and psychological benefits of exercise can be cited to help persuade sedentary people to initiate exercise.
“Maintenance” as well as initiation of physical activity is critical.
Both the physiological and psychological benefits of exercise can be cited to help persuade sedentary people to initiate exercise.
“Maintenance” as well as initiation of physical activity is critical.
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Reasons for Not ExercisingReasons for Not Exercising
Lack of time Lack of time
Lack of energy Lack of energy
Lack of motivation Lack of motivation
Reasons for Not ExercisingReasons for Not Exercising
Exercise professionals should highlight the benefits of exercise and provide a supportive environment to involve sedentary people in physical activity.
Exercise professionals should highlight the benefits of exercise and provide a supportive environment to involve sedentary people in physical activity.
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People often cite time constraints for not exercising, but such constraints are more perceived than real and often reveal a person’s priorities.
People often cite time constraints for not exercising, but such constraints are more perceived than real and often reveal a person’s priorities.
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Reasons for Not ExercisingReasons for Not Exercising
Individual Barriers to Physical ActivityIndividual Barriers to Physical Activity
Lack of time, energy, or motivation Lack of time, energy, or motivation
Excessive cost Excessive cost
Illness or injury Illness or injury
Feeling uncomfortable Feeling uncomfortable
Lack of skill Lack of skill
Fear of injury Fear of injury
(See table 18.1 on p. 403 of text.)(See table 18.1 on p. 403 of text.)
The Problem of Exercise AdherenceThe Problem of Exercise Adherence
The Problem of Exercise AdherenceThe Problem of Exercise Adherence
Help those who start exercising to overcome barriers to continuing the exercise program.
Help those who start exercising to overcome barriers to continuing the exercise program.
Help exercisers develop contingency plans to overcome factors leading to relapses (not exercising).
Help exercisers develop contingency plans to overcome factors leading to relapses (not exercising).
Theories/Models of Exercise BehaviorTheories/Models of Exercise Behavior
Health Belief ModelHealth Belief Model
The likelihood of exercising depends on the person’s perception of the severity of health risks and appraisal of the costs and benefits of taking action.
The likelihood of exercising depends on the person’s perception of the severity of health risks and appraisal of the costs and benefits of taking action.
(Becker and Maiman, 1975)(Becker and Maiman, 1975)
Overall “inconsistent” support for Health Belief Model predictions of exercise behaviorOverall “inconsistent” support for Health Belief Model predictions of exercise behavior
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Theories/Models of Exercise BehaviorHealth Belief Model
Theories/Models of Exercise BehaviorHealth Belief Model
(Becker and Maiman, 1975)(Becker and Maiman, 1975)
intentions, intentions,
subjective norms and attitudes, and subjective norms and attitudes, and
Exercise behavior is made up ofExercise behavior is made up of
Theories/Models of Exercise BehaviorTheory of Planned Behavior
Theories/Models of Exercise BehaviorTheory of Planned Behavior
perceptions of ability to perform behavior. perceptions of ability to perform behavior.
(Ajzen and Madden, 1986)(Ajzen and Madden, 1986)
Normative beliefs and subjective norms
Normative belief: an individual's perception
about the particular behavior, which is
influenced by the judgment of significant
others (e.g., parents, spouse, friends, teachers.
Subjective norm: an individual's perception of
social normative pressures, or relevant others'
beliefs that he or she should or should not
perform such behavior.
The theory of planned behavior is a useful theory for predicting exercise behavior.The theory of planned behavior is a useful theory for predicting exercise behavior.
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Theories/Models of Exercise BehaviorTheory of Planned Behavior
Theories/Models of Exercise BehaviorTheory of Planned Behavior
(Ajzen and Madden, 1986)(Ajzen and Madden, 1986)
Theories/Models of Exercise BehaviorTheories/Models of Exercise Behavior
Social Cognitive TheorySocial Cognitive Theory
Exercise behavior is influenced by both personal and environmental factors, particularly self-efficacy.Exercise behavior is influenced by both personal and environmental factors, particularly self-efficacy.
(Bandura, 1986, 1997)(Bandura, 1986, 1997)
What Is Cognition?
Cognition is a term referring to the mental processes involved in gaining knowledge and comprehension, including thinking, knowing, remembering, judging and problem-solving. These are higher-level functions of the brain and encompass language, imagination, perception and planning.
Social cognitive theory has produced some of the most consistent results in predicting exercise behavior.
Social cognitive theory has produced some of the most consistent results in predicting exercise behavior.
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Theories/Models of Exercise BehaviorSocial Cognitive Theory
Theories/Models of Exercise BehaviorSocial Cognitive Theory
(Bandura, 1986, 1997)(Bandura, 1986, 1997)
Core Assumptions and Statements
The social cognitive theory explains how people acquire and maintain certain behavioral patterns, while also providing the basis for intervention strategies (Bandura, 1997). Evaluating behavioral change depends on the factors environment, people and behavior. SCT provides a framework for designing, implementing and evaluating programs.
Environment refers to the factors that can affect a person’s behavior. There are social and physical environments. Social environment include family members, friends and colleagues. Physical environment is the size of a room, the ambient temperature or the availability of certain foods. Environment and situation provide the framework for understanding behavior (Parraga, 1990). The situation refers to the cognitive or mental representations of the environment that may affect a person’s behavior. The situation is a person’s perception of the lace, time, physical features and activity (Glanz et al, 2002).
The three factors environment, people and behavior are constantly influencing each other.
Behavior is not simply the result of the environment and the person, just as the environment is not simply the result of the person and behavior (Glanz et al, 2002).
The environment provides models for behavior. Observational learning occurs when a person watches the actions of another person and the reinforcements that the person receives (Bandura, 1997). The concept of behavior can be viewed in many ways. Behavioral capability means that if a person is to perform a behavior he must know what the behavior is and have the skills to perform it.
Major Constructs in SCT and Implications for Intervention:
• Environment: Factors physically external to the person; Provides opportunities and social support
• Situation: Perception of the environment; Correct misperceptions and promote healthful forms
• Behavioral capability: Knowledge and skill to perform a given behavior; Promote mastery learning through skills training
• Expectations: Anticipatory outcomes of a behavior; Model positive outcomes of healthful behavior
• Expectancies: The values that the person places on a given outcome, incentives; Present outcomes of change that have functional meaning
• Self-control: Personal regulation of goal-directed behavior or performance; Provide opportunities for self-monitoring, goal setting, problem solving, and self-reward
Major Constructs and Implications (continued)
• Observational learning: Behavioral acquisition that occurs by watching the actions and outcomes of others’ behavior; Include credible role models of the targeted behavior
• Reinforcements: Responses to a person’s behavior that increase or decrease the likelihood of reoccurrence; Promote self-initiated rewards and incentives
• Self-efficacy: The person’s confidence in performing a particular behavior; Approach behavioral change in small steps to ensure success
• Emotional coping responses: Strategies or tactics that are used by a person to deal with emotional stimuli; Provide training in problem solving and stress management
• Reciprocal determinism: The dynamic interaction of the person, the behavior, and the environment in which the behavior is performed; Consider multiple avenues to behavioral change, including environmental, skill, and personal change.
Theories/Models of Exercise BehaviorTranstheoretical Model
Theories/Models of Exercise BehaviorTranstheoretical Model
1.Precontemplation stage (does not exercise)1.Precontemplation stage (does not exercise)
2.Contemplation stage (has fleeting thoughts of exercising)2.Contemplation stage (has fleeting thoughts of exercising)
An individual progresses through five stages of change:An individual progresses through five stages of change:
3.Preparation stage (exercises, but not regularly enough)3.Preparation stage (exercises, but not regularly enough)
(continued)(continued)(Prochaska, DiClemente, and Norcross, 1992)(Prochaska, DiClemente, and Norcross, 1992)
Theories/Models of Exercise BehaviorTranstheoretical Model
Theories/Models of Exercise BehaviorTranstheoretical Model
4.Action stage (has been exercising regularly, but for less than six months)4.Action stage (has been exercising regularly, but for less than six months)
5.Maintenance stage (has been exercising regularly for more than six months)5.Maintenance stage (has been exercising regularly for more than six months)
An individual progresses through five stages of change:An individual progresses through five stages of change:
(Prochaska, DiClemente, and Norcross, 1992)(Prochaska, DiClemente, and Norcross, 1992)
STAGE DETAILS
Stage 1: Precontemplation (Not Ready)
People at this stage do not intend to start the healthy behavior in the near future (within 6 months), and may be unaware of the need to change. People here learn more about healthy behavior: they are encouraged to think about the pros of changing their behavior and to feel emotions about the effects of their negative behavior on others.
Precontemplators typically underestimate the pros of changing, overestimate the cons, and often are not aware of making such mistakes. These individuals are encouraged to become more mindful of their decision making and more conscious of the multiple benefits of changing an unhealthy behavior.
Stage 2: Contemplation (Getting Ready)
At this stage, participants are intending to start the healthy behavior within the next 6 months. While they are usually now more aware of the pros of changing, their cons are about equal to their Pros. This ambivalence about changing can cause them to keep putting off taking action.
People here learn about the kind of person they could be if they changed their behavior and learn more from people who behave in healthy ways. They're encouraged to work at reducing the cons of changing their behavior.
Stage 3: Preparation (Ready)
People at this stage are ready to start taking action within the next 30 days. They take small steps that they believe can help them make the healthy behavior a part of their lives. For example, they tell their friends and family that they want to change their behavior.
People in this stage are encouraged to seek support from friends they trust, tell people about their plan to change the way they act, and think about how they would feel if they behaved in a healthier way. Their number one concern is: when they act, will they fail? They learn that the better prepared they are, the more likely they are to keep progressing.
STAGE 4: ACTION
People at this stage have changed their behavior within the last 6 months and need to work hard to keep moving ahead. These participants need to learn how to strengthen their commitments to change and to fight urges to slip back.
People in this stage are taught techniques for keeping up their commitments such as substituting activities related to the unhealthy behavior with positive ones, rewarding themselves for taking steps toward changing, and avoiding people and situations that tempt them to behave in unhealthy ways.
STAGE 5: MAINTENANCE
People at this stage changed their behavior more than 6 months ago. It is important for people in this stage to be aware of situations that may tempt them to slip back into doing the unhealthy behavior—particularly stressful situations.
It is recommended that people in this stage seek support from and talk with people whom they trust, spend time with people who behave in healthy ways, and remember to engage in healthy activities to cope with stress instead of relying on unhealthy behavior.
Different exercise behavior induction strategies are used during the different transtheoretical stages.
Different exercise behavior induction strategies are used during the different transtheoretical stages.
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Theories/Models of Exercise BehaviorTranstheoretical Model
Theories/Models of Exercise BehaviorTranstheoretical Model
(Prochaska, DiClemente, and Norcross, 1992)(Prochaska, DiClemente, and Norcross, 1992)
Matching the intervention to the stage of change is effective in producing high levels of regular exercise.
Matching the intervention to the stage of change is effective in producing high levels of regular exercise.
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Many factors, from demographics to physical and social environment, affect exercise participation.Many factors, from demographics to physical and social environment, affect exercise participation.
Factors Associated With Participationin Supervised Exercise Programs
Factors Associated With Participationin Supervised Exercise Programs
(See table 18.03 on p. 409 of text.)(See table 18.03 on p. 409 of text.)
Determinants of Exercise Adherence:Highlights
Determinants of Exercise Adherence:Highlights
Demographic variables (e.g., education, income, gender, socioeconomic status) have a strong association with physical activity.
Demographic variables (e.g., education, income, gender, socioeconomic status) have a strong association with physical activity.
Early involvement in sport and physical activity should be encouraged, because there is a positive relation between childhood exercise and adult physical activity patterns.
Early involvement in sport and physical activity should be encouraged, because there is a positive relation between childhood exercise and adult physical activity patterns.
Barriers to exercise are similar for white and nonwhite populations.
Barriers to exercise are similar for white and nonwhite populations.
(continued)(continued)
Self-efficacy and self-motivation consistently predict physical activity.
Self-efficacy and self-motivation consistently predict physical activity.
Spousal support is critical to enhance adher-ence rates for people in exercise programs. Spouses should be involved in orientation sessions or in parallel exercise programs.
Spousal support is critical to enhance adher-ence rates for people in exercise programs. Spouses should be involved in orientation sessions or in parallel exercise programs.
Exercise intensities should be kept at moderate levels to enhance the probability of long-term adherence to exercise programs.
Exercise intensities should be kept at moderate levels to enhance the probability of long-term adherence to exercise programs.
(continued)(continued)
Determinants of Exercise Adherence:Highlights
Determinants of Exercise Adherence:Highlights
Group exercising generally produces higher levels of adherence than exercising alone, but tailoring programs to fit individuals and the constraints they feel can help them adhere to the program.
Group exercising generally produces higher levels of adherence than exercising alone, but tailoring programs to fit individuals and the constraints they feel can help them adhere to the program.
Post-exercise participation predicts exercise behavior.
Post-exercise participation predicts exercise behavior.
(continued)(continued)
Determinants of Exercise Adherence:Highlights
Determinants of Exercise Adherence:Highlights
Exercise leaders influence the success of an exercise program. They should be knowledge-able, give lots of feedback and praise, help participants set flexible goals, and show concern for safety and psychological comfort.
Exercise leaders influence the success of an exercise program. They should be knowledge-able, give lots of feedback and praise, help participants set flexible goals, and show concern for safety and psychological comfort.
A convenient location is an important predictor of exercise behavior.
A convenient location is an important predictor of exercise behavior.
Determinants of Exercise Adherence:Highlights
Determinants of Exercise Adherence:Highlights
Strategies for EnhancingAdherence to Exercise
Strategies for EnhancingAdherence to Exercise
Behavior modification approachesBehavior modification approaches
Reinforcement approachesReinforcement approaches
Six categories of techniquesSix categories of techniques
Cognitive/behavioral approachesCognitive/behavioral approaches
Decision-making approachesDecision-making approaches
Social-support approachesSocial-support approaches
Intrinsic approachesIntrinsic approaches
Behavior Modification ApproachesBehavior Modification Approaches
PromptsPrompts
Verbal, physical, or symbolic cues that initiate behaviors (e.g., posters, running shoes by bed).Verbal, physical, or symbolic cues that initiate behaviors (e.g., posters, running shoes by bed).
Category 1Category 1
ContractingContracting
Participants enter into a contract with their exercise leader.Participants enter into a contract with their exercise leader.
Reinforcement ApproachesReinforcement Approaches
Rewards for Attendance and ParticipationRewards for Attendance and Participation
Rewards improve attendance but must be provided throughout the length of the program.Rewards improve attendance but must be provided throughout the length of the program.
Category 2Category 2
Charting attendance and participationCharting attendance and participation
(continued)(continued)
Reinforcement ApproachesReinforcement ApproachesCategory 2Category 2
FeedbackFeedback
Providing feedback to participants on their progress has positive motivational effects.Providing feedback to participants on their progress has positive motivational effects.
Self-MonitoringSelf-Monitoring
Participants keep written records of their physical activity.Participants keep written records of their physical activity.
Cognitive/Behavioral ApproachesCognitive/Behavioral ApproachesCategory 3Category 3
self-set rather than instructor-set, self-set rather than instructor-set,
flexible rather than fixed, and flexible rather than fixed, and
Exercise-related goals should beExercise-related goals should be
time based rather than distance based. time based rather than distance based.
Goal setting should be used to motivate individuals.Goal setting should be used to motivate individuals.
Cognitive/Behavioral ApproachesCognitive/Behavioral ApproachesCategory 3Category 3
Dissociative strategies emphasize external distractions and produce significantly higher levels of exercise adherence than associative strategies focusing on internal body feedback.
Dissociative strategies emphasize external distractions and produce significantly higher levels of exercise adherence than associative strategies focusing on internal body feedback.
Cognitive TechniquesCognitive Techniques
Decision-Making ApproachesDecision-Making ApproachesCategory 4Category 4
Completing a decision balance sheet to increase awareness of the costs and benefits of participating in an exercise program can enhance exercise adherence.
Completing a decision balance sheet to increase awareness of the costs and benefits of participating in an exercise program can enhance exercise adherence.
Develop Balance SheetsDevelop Balance Sheets
Involve exercisers in decisions regarding program structure.Involve exercisers in decisions regarding program structure.
A Decision Balance SheetA Decision Balance SheetCategory 4Category 4
Better physical Less time with condition hobbies
More energy
Weight loss
Better physical Less time with condition hobbies
More energy
Weight loss
GAINS TO SELF LOSSES TO SELFGAINS TO SELF LOSSES TO SELF
(continued)(continued)
A Decision Balance SheetA Decision Balance SheetCategory 4Category 4
Get healthier so I can Less time with myplay baseball family
Become more attrac- Less time to devotetive to my spouse to work
Get healthier so I can Less time with myplay baseball family
Become more attrac- Less time to devotetive to my spouse to work
GAINS TO LOSSES TO IMPORTANT OTHERS IMPORTANT OTHERSGAINS TO LOSSES TO IMPORTANT OTHERS IMPORTANT OTHERS
(continued)(continued)
A Decision Balance SheetA Decision Balance SheetCategory 4Category 4
My children would My boss thinks itlike to see me be takes time awaymore active from work
My spouse would like me to lead healthier lifestyle
My children would My boss thinks itlike to see me be takes time awaymore active from work
My spouse would like me to lead healthier lifestyle
APPROVAL OF OTHERS DISAPPROVAL OF OTHERSAPPROVAL OF OTHERS DISAPPROVAL OF OTHERS
(continued)(continued)
A Decision Balance SheetA Decision Balance SheetCategory 4Category 4
SELF-APPROVAL SELF-DISAPPROVALSELF-APPROVAL SELF-DISAPPROVAL
(continued)(continued)
Feel more confident I look foolish exer-cising
because I’m out of shape
Feel more confident I look foolish exer-cising
because I’m out of shape
Improved self-conceptImproved self-concept
Social-Support ApproachesSocial-Support ApproachesCategory 5Category 5
Social SupportSocial Support
An individual’s (e.g., spouse’s, family member’s, friend’s) favorable attitude toward another individual’s involvement in an exercise program.
An individual’s (e.g., spouse’s, family member’s, friend’s) favorable attitude toward another individual’s involvement in an exercise program.
Social support can be enhanced by participation in a small group, the use of personalized feedback and the use of a buddy system.
Social support can be enhanced by participation in a small group, the use of personalized feedback and the use of a buddy system.
Intrinsic ApproachesIntrinsic Approaches
Focus on the experience itself. Focus on the experience itself.
Take a process orientation. Take a process orientation.
Engage in purposeful and meaningful physical activity.
Engage in purposeful and meaningful physical activity.
Category 6Category 6
Settings for Exercise InterventionsSettings for Exercise Interventions
Schools Schools
Work sites Work sites
Home Home
Community Community
Health care facilities Health care facilities
Community-based approaches appear to offer the best way of reaching large numbers of people.
Community-based approaches appear to offer the best way of reaching large numbers of people.
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Settings for Exercise InterventionsSettings for Exercise Interventions
Guidelines for ImprovingExercise Adherence
Guidelines for ImprovingExercise Adherence
Match the intervention to the participant’s stage of change.
Match the intervention to the participant’s stage of change.
Provide cues for exercises (signs, posters, cartoons).
Provide cues for exercises (signs, posters, cartoons).
Make the exercises enjoyable. Make the exercises enjoyable.
(continued)(continued)
Tailor the intensity, duration, and frequency of the exercises.
Tailor the intensity, duration, and frequency of the exercises.
Guidelines for ImprovingExercise Adherence
Guidelines for ImprovingExercise Adherence
Promote exercising with a group or friend. Promote exercising with a group or friend.
Have participants sign a contract or statement of intent to comply with the exercise program.
Have participants sign a contract or statement of intent to comply with the exercise program.
Offer a choice of activities. Offer a choice of activities.
(continued)(continued)
Provide rewards for attendance and participation.
Provide rewards for attendance and participation.
Give individualized feedback. Give individualized feedback.
Guidelines for ImprovingExercise Adherence
Guidelines for ImprovingExercise Adherence
Find a convenient place for exercising. Find a convenient place for exercising.
Have participants reward themselves for achieving certain goals.
Have participants reward themselves for achieving certain goals.
Encourage goals to be a self-set, flexible, and time based (rather than distance based).
Encourage goals to be a self-set, flexible, and time based (rather than distance based).
(continued)(continued)
Remind participants to focus on environmental cues (not bodily cues) when exercising.
Remind participants to focus on environmental cues (not bodily cues) when exercising.
Guidelines for ImprovingExercise Adherence
Guidelines for ImprovingExercise Adherence
Use small-group discussions. Use small-group discussions.
Have participants complete a decision balance sheet before starting the exercise program.
Have participants complete a decision balance sheet before starting the exercise program.
Obtain social support from the participant’s spouse, family members, and peers.
Obtain social support from the participant’s spouse, family members, and peers.
Suggest keeping daily exercise logs. Suggest keeping daily exercise logs.
Help participants choose purposeful physical activity.
Help participants choose purposeful physical activity.