Cognitive and Behavioral Aspects for Overall Health and Well-Being

WHAT: An after-school program is being implemented for overweight middle school students through a community grant.  The program goals are to reduce risk for cardiovascular disease and diabetes, through promoting physical activity.  Student participants don’t need to pay for this program and the program will utilize facilities within the school.  Most of the students involved are in early stages of exercise, such as contemplation and preparation.  The challenge will be to move these students from early exercise stages into the action and hopefully maintenance phase of exercise by the end of the program.  The student intern and program staff will need to use cognitive-based approaches for those in the earlier stages of exercise, and then focus on behavioral-based approaches for those in the preparation or action stage of exercise.  Enhancing participant’s self-efficacy is one approach for cognitive changes that will help them be ready to engage in physical activity.  Social support and reminders to exercise are behavioral approaches that should be utilized for those in the preparation or action stage of exercise.

SO WHAT: This program will be utilizing cognitive and behavioral approaches to improve the health and well-being of overweight middle school children through physical activity.  Since reducing cardiovascular disease and diabetes are the main goals, promotion and maintenance of physical activity is essential for this program.  As noted by Gill and Williams (2008), physical inactivity is associated with major health problems, including heart disease and diabetes, as discussed in the current program goals.  It is assumed that the majority of students attending this program are in early stages of the Transtheoretical model; likely contemplation and preparation.  Since the TTM will be used as guidance during the program, incorporation of self-determination will be important to tailor to the participants.  As participants move from one stage to another, such as contemplation to action, intrinsic motivation plays a factor.  Focusing on intrinsic motivation in exercise settings is a hopeful approach for such programs (Gill and Williams, 2008).  Aside from the individual level, the larger socio-environment is important as well.  Participants as well as their parents or guardians may not have knowledge of environmental resources which can contribute to an active lifestyle (e.g. walking trails or parks) in or nearby their neighborhoods.  The actual program is a great example of an environmental approach to physical activity because it provides access to a facility (the school) at no cost to the participants.  The cognitive challenges of participants in early exercise stages will be addressed through enhancement of self-efficacy, while the behavioral challenges will address social support, goal setting, and generalization training.

NOW WHAT: According to Gillison, Standage, and Skevington (2006), exercise goals relating to improving health, enjoyment of physical activity, and improving fitness levels represent intrinsic goals.  On the other end, goals focused on weight loss or changes in appearance are more extrinsically focused.  Although a goal of the program may be to help children lose weight, the children will not be exposed to this goal because it would take away from the purpose of the program.  Rather, the goals will focus on enjoyment, gaining friendships through social support, and improving overall health.  This way, intrinsic motivation can be represented and therefore help children transition from one exercise stage to another.  For those children who are in contemplation or action stages, the assistant and staff will work with improvement of self-efficacy as related to exercise.  Working with the children through exercises and helping them improve skill and ability will help them believe they are capable of accomplishing the task.  Participants will be asked which activities they prefer individually and then divided to help promote self-determination and intrinsic motivations for exercise.  For those participants in an action phase, the goal will be to get them into a maintenance phase.  Generalization training will be used toward the end of the program.  Generalization training is “the difficult transition from a structured to an unstructured setting” (Gill and Williams, 2008, p. 154).  Instructors will also use reinforcement with social support and appraisal throughout the program to encourage participants to continue exercising and help transition them into the maintenance stage of the TTM.  To encourage intrinsic motivation, participants will write out individual goals at the beginning of the program.  In a study on adolescent weight perceptions and exercise, Gillison, Standage, and Skevington (2006) found that intrinsic goals predicted self-determination, and that higher self-determination positively associated with higher physical activity and quality of life.  Finally, a focus on the overall social environment will be incorporated through providing access to the community recreation center to program participants with a 50% discount coupon.  Those participants who complete the program will be given rec-center discount coupons to continue exercising at the center.  Also, printed map hand-outs of local walking/cycling trails and parks will be distributed to participants to increase knowledge and awareness of existing facilities that are accessible to everyone in the community.  These approaches will help participants move to the maintenance phase and encourage healthy lifestyles that will hopefully reduce cardiovascular disease and diabetes risk in their future.

CONCLUSION: This after school program is tailored for overweight middle school children and hopes to reduce risk of cardiovascular disease, diabetes, and promote overall health.  The participants are in early stages of the TTM (contemplation or action) and are in need of cognitive and behavioral approaches as well as environmental aspects to promote transition into higher exercise stages.  Cognitive approaches will focus on increasing self-efficacy by working through exercises and increasing individual skill level and belief in exercise engagement.  Behavioral approaches will focus on self-determination (intrinsic motivation), social support, and utilize generalization training to promote the maintenance stage of physical activity.  Environmental factors addressed will be a discounted recreational center membership and community maps of walking/biking trails and parks in the local community.  Previous research supports the use of intrinsic motivation and goal setting to increase self-determination, exercise duration, and quality of life.  Utilizing these 3 approaches will make this program effective at helping participants progress through the stages of change in the TTM and encourage continuous exercise.  Participants in the maintenance stage of exercise will live more active lifestyles and therefore reduce their risk of cardiovascular disease and diabetes later in life.

REFERENCES:

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL: Human Kinetics.

Gillison, F.B., Standage, M., & Skevington, S.M. (2006). Relationships among adolescents’ weight      perceptions, exercise goals, exercise motivation, quality of life and leisure-time exercise behavior: A       self-determination theory approach. Health Education Research, 21 (6), 836-847.