Background Within physiotherapy, patients' exercise adherence is often insufficient, despite its positive effects on treatment outcomes. An “action planning” intervention may increase physical activity, according to meta-analyses, but most studies did not take parameters for effectiveness or co-occurrence of intervention methods into account. Therefore, it remains unclear under which circumstances action planning is most effective.
Objectives Present research will examine the influence of behavioural intentions, self-efficacy, confidence in plans and the presence of coping planning on the effectiveness of an action planning intervention with regard to increasing exercise adherence behaviour.
Methods In patients in rehabilitation centres in the Netherlands, Belgium and Norway, behavioural intentions, self-efficacy and confidence in plans were measured after receiving home exercise recommendations by physiotherapists. Both action and coping planning were manipulated at two levels. One week later, exercise adherence ratio was measured.
A pilot of ten patients was used prior to data collection to test the feasibility of the questionnaires and informed consent was obtained from all participants. The control group received relaxation exercises as placebo intervention and participants were assigned to one of four interventions based on order of study entry.
Results 247 Patients were approached, of whom 167 (62% female; mean age 59 years) completed the entire study. Multiple regression analyses showed that both intentions (β=-0.23) and coping planning (β=-0.25) interacted significantly and negatively with action planning in predicting exercise adherence and that both action planning (β=0.24) and intentions (β=0.49) significantly and positively predicted adherence. Correlation analysis indicated that within people receiving action planning, confidence in plans was significantly associated with adherence (r=0.23).
Figure 1 displays the interaction between action planning and intentions and shows that while the effectiveness of action planning is bigger when intentions are lower, intentions remain positively correlated with adherence.
Conclusions Based on these results, action planning appears useful in increasing exercise adherence, especially when intentions are low and when coping planning is not present, since these acted as parameters for effectiveness. High intentions and confidence in plans seem beneficial for optimizing adherence and action planning appears to compensate a lack of intentions. Current study only measured adherence once and confidence in plans could not be measured in the control group, hence nothing could be concluded about behaviour maintenance or moderating effects of confidence in plans on action planning effectiveness. Future studies should focus on longer term effects and ways to increase intentions and confidence in plans. Similar studies into other behavioural change techniques are needed to expand our knowledge in their parameters for effectiveness.
Present study covers a relatively new area within rheumatology, namely improving exercise adherence behaviour, which might increase physiotherapeutic treatment effectiveness significantly. Current study also provides a first step towards a much needed updated evidence base of behavioural change methods taking parameters for effectiveness into account.
Disclosure of Interest None declared
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