32

Results
Participation in a1l aspeets of the present study, including
supplying social security numbers for identification, was voluntary. At
the physiologieal testing (PHYS)
and at each of the three psychological
testings (PSYI,
PSY2,,lnd PSY3) rhere were employees who provided a1l or
some of the informatiorr requested and their soci-a1 security numbers,
employees who provided all or some of the information requested but not
their social securitynumbers, and employees who chose not to participate.
A1so, participation or the auount of information that an individual
provided at one testinl; session did not necessarily relate to what. he or
she did at other sessj-ons. As a result, the more data from different
testing sessions that ;t given analysis required to be matched, the fewer
subjects had the necessary data and identification by social seeurity
number.
Due to the sma1l rtumber of individuals for whom there was a eomplete
set of data, subjects llere grouped according to how much information was
available that could btr matched. Results will be reported in groupings
formed by the avai-labil-ity of data, from the broadest groupings to the
narrowest groupings.
The groupings usecl in this study and their abbreviated titles, are
present.ed in Table 1. A1l tests of significance were made at the .05
alpha 1evel, Ewo-tailecl. A11 stepwise mulgiple regression analyses used a
probability of F-to-ent,er the regression equation of(.05.
33
Insert Table 1 about here
Results for A11 Subjects
(Exercj.sers
and Nonexercisers)
September 1984 Psychological Testing, (n=334) (PSYI)
The first group (PSY1)
included all those partici.pating in the first
pyschological testing. It was possible to match the different pi"eces of
information in this testing, whether the individual provided his or her
social security number or not, because the questionnaries were stapled
together in a packet. This resulted in a large number of subjects for
whom data could be analyzed.
SMI was related to other measures frou the fall 1984 psychological
testing sessions: STAI-T, Reasons for Starting a StrucEured Exercise
Program, and Reasons for Not Starting a Structured Exercise Program.
There were L27 persons who reported having started an exercise program
(STRT)
and 200 persons who reported noE having started an exercise program
(NST)
. No exercise reports were available at this time.
Reasons for starting and for not starting exercise. Of tl:,e L27
people who reported starting an exe::cise program the reasons most often
cited included
"want
to get in shape",89.07",
"exercise
feels good",
70.87",
"want
to prevent heart attacktt, 66.187",
ttyou
should take care of
yourselftt, 59.87",
ttwant
to lose weightt', 58.37", and,
ttwant
to see how fit
I am", 52.0%.
34
Of the 200 people who reported not starting an exercise program the
reasons most often cited were that
"classes
are too far from homett, 42.52,
ttclasses
at bad timerr, 38.57",
t'plan
to start 1ater", 28.52, and
"fitness
1eve1 is aeceptable'r, 26.37". The frequencies of all responses to
individual statements on the Reasons for Starti-ng a Structured Exercise
Program are presented in Table 2 ar.d the Reasons for Not St,arting a
Structured Exercise Program
j-n
Table 3.
Insert Table 2 about here
Insert Table 3 about here
Cluster analysis. Cluster analysis is a statistical process that
groups together items that covary with one another. The 17 reasons for
starting an exercise program and the 19 reasons for noE starting an
exercise program were analyzed using the average linkage between groups
method of cluster analysis,
(SPSSX
User's Guide' 1983).
Analysis revealed 4 clusters of reasons for starting that seemed
to go together, with one reason
(to
stop smoking) not
joining
any cluster.
35
Each cluster was givett a name that described its contents. Cluster 1 was
call the Health conce::n clusrer (cL1);
it is made up of wanting to
rrprevent
heart attackrt,
"reduce stress 1eve1tt, and
"lower blood pressurett.
Cluster 2 was called t:he Self-care Cluster (CtZ1;
it is made up of wanting
to
ttget
in shapert, to
ttdo
something for selftt, and statements thattryou
should take care of yourselfrr and that
ttexercise
feels goodtt. Cluster 3
was ca11ed the Externe.l Motivation cluster (cL3);
it is made up of
"the
company is providing i.ttt,
"fami.ly
encouraged",
"want to find out how fit,,,
ttfriends
are taking pa.rt", and
ttheard
the program is excellenttr. cluster
4 was called the out-of-shape cluster (cL4);
it is made up of
I'wanting
to
lose weighttt,
ttnever
able to exercise on owntt,
ttfeeling
out of shapett, and
ttdocEor'
encouragedtt.
Analysi-s revealed 4 clusters of reasons for not starting that seemed
to go together, with one reason
(fanily
opposes my exercising) not joi-ning
any cluster. Each cluster was given a name that described its contents.
cluster 1 was called the General Excuses cluster; it is composed of
t'I
plan to start laterrr,
"exercise takes too much timert,
ttsummer
is a bad
time for me to start thingstt,
ttexercise
is drudgerytt,
"r
am not mot.ivated
enough to do itrr,
"I
am afraid I will injure myselftt,
"I donrt like the
kinds of exercise offeredt',
rtl
don't like to exercisetr,
ttMy
friends are
not doing ittr, andttI smoke and donrt want to qui-ttr. Cluster 2 was called
the Logistical Probleurs Cluster; it is composed of
"the
classes are too
far from my homett and
"the
classes are at inconvenient timestt. Cluster 3
was cal1ed the Self-conscious Cluster; it is composed of
"my
doctor
advised me not to exereise'r,
"I
would feel silly running around like a
kj.d", and
"I
exercise by myself". Cluster 4 was called the
Rationalizatj.on cluster; it composed of
"my
fitness level is adequate",
36
'rI
don't need to lose weighttt, and
ttl
work so hard I canrt exercise tootr.
Relationships Between Psychological variables. The bivariate
correlations between the individual statements on the Reasons for Starting
a Structured Exercise Program form are presented in Table 4 a11d those for
the Relasons for Not St;rrting a Structured Exercise Program foTm in Table
5"
Insert Table 4 about here
Insert Table 5 about here
Pearson Product-Mcment correlations between the psychological
variables available at this stage were made i-n two parts, one for the
group that had reported, starting an exercise program (Stnt)
and the other
for the group that had reported not starting an exereise program (NSTRT).
A computed variable named START was created to indi.cate how many
reasons for starting exercise an individual had cited. START has a value
equal to the total number of reasons for starting an exercise program
cited, 0 to 17.
37
Bivariate correlaEions between the variables available at this stage
of the analysis for thr)se who reported starti-ng an exercise program are
presented in Table 6 arrd significant correlations are reported be1ow.
For those who repr:rted starting an exercise program (STRT) (N=126)
signifieant correlations were found between SMI and: STAI (a=-.38)
and the
Start External Motivat:Lon Cluster
(a=-.20);
between START and: STAI
(r=.22),
Start Health
(loncern
Cluster
(r=.57),
Start Self-care Cluster
(r="65),
and Start Extrrrnal Motj-vation Cluster
(r=.58);
and between the
Start 0ut-of-Shape Clur;ter and: STAI
(R=.21),
START
(R=.70),
Start Health
Concern Cluster
(r=.27'.t,
Start Self-care Cluster
(r=.25),
and Start
External Motivation Clrrster
(a=.30)
.
Insert Table 6 about here
For those who rep<>rted not starting an exercise program (NSTRT)
(n=200)
there were onl.r three variables available for this stage of the
analysis, SMI, STAI-T, and NST
(a
computed variable created to indicate
how many reasons for not starting exercise an i-ndividual had checked, 0
to l9). Significant correlations were found between all three variables,
SMI and: STAI
(r=-.36),,
and NST
(r=.24);
and between STAI and NST
(.23).
Differences betwer:n mean SMI scores and mean STAI-T scores for those
who started exercise arrd those who did not start exercise were analyzed
using a t-test. Those who reported starting exercise displayed
significantly higher S1{I scores
(I=148.4, S.D.=19.9) than those who
38
reported not starting ,rxgrgiss (i=t42,2,
S.D.=20.0); (t=2.69,
p(.05).
However, there was not a significant difference in STAI-T scores between
the two groups.
February 1985 Psychololtical Testing (pSy2), (n=220).
The second group of data to be aaaLyzed included all those employees
who completed the secortd psychological
testing (PSY2).
Again, comparisons
between data received lirom this group and" from other groups are limited
because inclusion in ttLis group did not require providing a social
security number.
Reasons for Continuj-ng and Disconti.nuing Exercise. At the February
1985 Psychological Testing, 92 people reported continuing a structured
exercise prograu. Their reasons for conti-nuing exerci-se included
',have
more energy when r exercisett, 88.02,
ttexercise
can prevent heart
attackrr, 71.72,
ttr
feel more relaxed. after exercisett, 68.57",
ttyou
should
Eake care of yourselfrr, 637", and
ttit
has been helping me lose weight",
56.52. The frequencies of all responses on the Reasons for Continuing
structured Exercise, February 1985 form are presented in Table 7.
Insert Table 7 about here
At the same testinl;, 35 persons reported discontlnuing structured
exerci.se. The most. of trrn cited reasons were:
t'classes
are too f ar f rom
home", "classes are at :Lnconvenient timest', and
ttl
was not motivated
39
enough to do ittt, 42.92 each,
ttl
sustained injurytt, 22.92, and
ttexercise
took too much time'r, 2\).02. The frequencies of all responses to Reasons
for Discontinuing Strur:tured Exercise, February 1985 are presented in
Table 8.
Insert Table 8 about here
June 1985 Psycholosical Testing
(PJI,3)-r--(rt?]
I.
The third group included all those employees who participated in the
third psychological testing
(PSY3). Again, inclusion in this group
required only participation in PSY3' not social security number, limi-ting
the comparisons that can be made with data from other groups.
At the June 1985 Psychological Testing
(PSY3), 85 people reported
continuing an exercise program. The reasons Bost often ci-ted included:
ttl
have more energy whr:n. I exerci-se", 88.02,
ttexercise
can prevent heart
attackfr, 68.27",
ttI
feel more relaxed after exercisett, 67.12,
ttyou
should
take care of yourself'' ,
58.87., and
ttexercise
has been helping me lose
weighttt, 58.82. The frequencies of all resPonses to reasons for
Continuing a Structured Exercise Program, June 1985 are
Presented
j-n
Table 9.
Insert Table 9 about here
40
At the same time !,1 people reported discontinuing an exercise
program. The mosE comaronly cited reasons included:
ttclasses
were at
inconvenient timesrr, 5:i.97.,
t'classes
were too far from my homett, 45.L2,
ttl
was not motivated erLough to do ittt, 37.37",
ttexercise
took too much
timetf ,
25.57., and
"exet'cise
was drudgerytt, L5.72. The frequencies of all
responses to Reasons for Discontinuing Structured Exercise, June 1985 are
presented in table 10.
Insert Table 10 about here
Fall 1984 Psychological. Testing
(PSY1) and Sumner 1984 Physiological
Testing
(PIIYS)
,
(Group I)
'
(n=104) .
Group I was formerl by including a1l those individuals who had
participated in the phl'siological testing, the first set of psychological
testing
(PSYf),
and whose information could be matched by social security
numbers. This group irrcluded 104 persons and was composed of 87 men and
16 women. Further demographic information is presented in Table 11.
Insert Table 11 about here
Bivariate correlat:ions between the variables available for this group
are presented in Table L2 al.d significant correlations that relate to
4T
this study ate rePorte,i be1ow.
stated otherwise. )
(n=104 for each correlation listed unless
Significant
Maximal Aerobie
(a=.24, n=96).
corre lations
Power
(v=.21,
were found between
n=9)-), and Maximum
SI,II and: STAI
(r=-.32)
,
Breathing CaPacitY
Insert Tab1e 12 about here
F.esults for Subjects Who
Reported Starting an Exercise Program
The present stud1.
proposed to examine exercise adherence
in persons
who had chosen to star:t an exercise
Program.
Therefore, all subsequent
groupings will include: only those employees who reported starting an
exercise
program in ttre first psychological testing
(PSY1).
(n=58) .
For those indivi,iuals
who had undergone
physiological testing and
reporLed starting
an exercise
program in the first psychological testing,
availabledatawasanalyzed'.Thisgroupwascomposedof4Tmenandll
women. Further demographic
information
is presented in Table 1l'
Subiects who took Part
in siological
testing, fall 1984 psychological
42
Bivariate Correlar:iona1 Analyses
The bivariate cor:relations beEween all of the available variables is
presented in Table 13, those related to this study are reported be1ow.
(n=58 for each correlar:ion listed unless stated otherwise.)
Significant corre.Lations were found between SMI and: the Start Health
Concern Cluster
(r=.38),
the StarE External Motivation Cluster
(r=-.38),
Resting Diastolic Bloorl Pressure
(r=-.38), Resting Systolic Blood Pressure
(r=-.37), Weight
(r=-..J8), STAI-T
(r=-.31),
Lean Body Weight
(a=-.30),
Percent Body Fat
(r=-.129), Maximal Aerobic Power
(a=.29),
and Height
(7=-.27).
Other significant correlations were found between the Start External
Motivation Cluster and; Weight
(s=.36), Maximal Aerobic Power
(r=-.29),
and Percent Body Fat (.r=.34)1 and between the Start Out-of Shape Cluster
and START
(R=.69),
Sta::t External Cluster
(r=.37); Trunk Flexion
(a=-.49),
Triglycerides
(r=.36, tr=45), Total cholesterol
(r=.32, n=48), and lu1axj-mum
Breathing Capacity
(v=.30
,
n=52) .
Insert Table 13 about here
Subjects who took
part in summer 1984 physiological testing
(PHYS),
Seprember 1984 Psychol,:gical Testing
(PSYI), June 1985 Psychological
Testing
(PSY3), and reported starting an exercise
Program,
(Group III
n=33
)
.
43
Group III includerl all employees who completed physiologi-cal resring,
the first and third pslzchological testings, reported having started
exercise, and who prov:Lded their social securi-ty number at each testing
session. This groupinl; was composed of 26 men and 7 women. Further
demographic informatiorr is presented in Table 11.
Changes in STAI-T
This grouping is t:he first one in which changes in the STAI-T scores
between two testing sesisions could be computed. To report the results of
the computations, the SiTAI-T scores will be abbreviated for the three
different testings as {'ollows: (a)
september L984, srAr, (b)
February
1985, sTArA, and (c)
Jrine 1985, sTArB. Change in STAr-T scores between
testing sessions was ccmputed by subtracting the later score from the
earlier score. The dlfference in STAI-T scores between the September 1984
and the February 1985 testings is STAI-STAIA; from September 1984 to June
1985 is STAI-STAIB: and for February 1985 to June 1985 is STAIA-STAIB.
t-Tests Between Continuers and Dropouts
SMI scores and STAI-T scores frorn both the Septenber 1984 and the
June 1985 testi.ng sessi.ons for those who reported continuing exercise and
those who reported dropping out were compared using a t-tesL. No
significant dlfferences between these two groups were found on any of the
three ueasures. Neither was there a significant difference between the
September 1984 and the June 1985 STAI-T scores for this grouping.
44
Reasons for start.Lng exercise
The most often cil:ed reasons that members of this grouping had given
for starting an exercir;e program in September 1984 were:
trI
want to get in
shapett, 90.97",
ttexercir;e
can prevent heart attackrt and
ttI
want to lose
weight" 69.77",
"I
want to see how fit I am'r 66.72, and
"I
like the way
exercisemakesme feel"., 60.67.. Frequencies for all the reasons for
starting exercise that this group had given in September 1984 are
presented in Table 2.
Bivari.ate Correlat:ional Analyses
The bivariate corr:elations between all available vari-ables in this
group are presented in Table 14 and significant correlations that relate
to the questions of thi.s study are reported below.
(n=33
for all
correlations listed unl.ess stated otherwise).
Significant correl.ations were found between SMI and: STAI
(r=-.56),
Start Health Concern Cl"uster
(a=.55),
STAIB
(1=-.41),
Start External
Cluster
(r=-.35),
I{eigtLt
(r=-.36, n=32), Weight
(r=-.36), Trunk Flexion
(r=.36, n=32); between STAI and: STAIB
(a=.71),
STAI-STAIB
(a=.39);
between STAI-STAIB and Start Self-care Cluster
(r=-.36),
Weight
(r=.36),
Total cholesterol
(r=.1r5, t=29), Glucose
(r=.38,
n=29), Forced Expiratory
Volume
(r=.41,
n=28), zrnd Maximum Breathj-ng Capacity
(r=.37,
a=29);
between the Start Healt:h Concern Cluster and: START
(a=.50),
&Be
(1=-.50)'
Years Eurployed (a=-.58, n=31), Hours per Workday
(r=.36,
n=31), Resting
Diastolic Blood Pressut'e
(r=-.42, n=32), and Shoulder Extension
(r=.35);
between the Start Self-.care cluster and: START
(r=.41),
Start Out-of-Shape
Cluster
(r=.35), PercerLt Body Fat (s=.37); and between the Start
45
Out-of-Shape Cluster arrd: START
Total Cholesterol (a=.t+0,
n=29)
and Maximum Breathing ()apacity
(r=.72),
Trunk Flexion (r=-.38,
n=32),
,
Low density Lipoproteins (r=.44,
n=29)
(r=.38,
n=29).
Insert Table 14 about here
Multiple Regressicn.
To test the hypothesis that a significant porti.on of the variance in
exercise adherence would be accounted for by the three variables percent
body fat, sMr score, and weight taken Eogether, a sEepwise multiple
regression analysis was conducted using a probability of F-to-enter the
regression equation of(.05 (sPSSx
userrs Manual, 1983). wlth rhe June
1985 exercise report (Ex2)
as dependent variable, none of the three
variables entered the regression equati.on.
Exercise Report
The final exercise report covering the period from Sept 1, 19g4, to
May 15, 1985, (Ex2)
com:rleted at rhe summer 1985 psychological
tesring,
was available for the prtrsons in this group. Reported exercise for this
group had a rnean of 22.1) weeks, a standard deviation of 14.6 weeks and a
range of 0 to 36 weeks.
subjects who took part
-Ln sunmer 1984 Physiological Testing (pHys),
September 1984 Psychological Testing (PSYI),
February 1985 Psychological
46
Testing
(PSY2), June 1985 Psychological Testing
(PSY3),
and reported
starting a structured e xercise
program, (Group IV), n=12.
Group IV included those persons who had compleEed the physiological
testing, al1 three psychological testings, reported starting an exercise
program, and had provided their social security numbers at each testing.
This group was composed. of 10 men and 2 women. Further demographic
characteristics are presented in Table 11.
Reasons for starti.ng exercise
The reasons that tLad been cited most often by this grouP for starting
an exerci-se program in Fall 1984 were
"wanting
to get i-n shape" cited by
100.02;
rlexercise
feelsi goodtt and
ttexereise
can
Prevent,
heart attacktt by
75.02; and
t'wanting
to lose weight" and
t'wanting
to. find out how fit I am"
by 66.77"" Frequencies of all reasons for starting an exercise program for
thi-s group are present<ld in Table 2.
Bivariate Correlal:ional
Analyses
The bivariate cor::e1atj-ons between all variables i.n Ehis group are
presented in Table 15 rlnd signifieant correlations that relate to the
questions of this stud:f are
Presented
below.
(n=12 for al1 correlations
listed unless stated oEherwise,)
Significant correLations were found between SMI and: STAI
(p=-'68),
STAI-STAIB
(r=.60), EXz
(r=.61), EX3
(r=.63), and Weight
(r=-.59); between
STAI and STAI-STAIB
(r=.69); betInTeen STAI-STAIA and STAI-STAIB
(r='80);
berween the Start llealth Anxiety Cluster and: I{eight
(r=-.58), Weight
47
(r=-.63), and Years Employed
(r=-.65); between the Start Self-care Cluster
and: Trunk Extension (r;=.62), Shoulder Extension
(1=.58),
and Maximal
Aerobic Power
(r=.87,
rt=9); between EX2 and:EX3
(1=.95)
and Maximum Heart
Rate
(r=.69,
n=10); bel:ween START and: Start Self-care Cluster
(t=.76),
Start Out-of-Shape Clusiter
(a=.80), and Maximal Aerobic Power
(1=.70);
between the Start Healt:h Anxiety Cluster and: Ileight
(r=-.58), Weight
(1=-.63), and Years Em1>1oyed
(r=-.65); and the Start Self-care Cluster
and: Trunk Extension
(r=.62), Shoulder Extension
(r-.58),
and Maximal
Aerobic Power
(r=.87, rr=9).
Insert Table 15 about here
t-Tes ts
No significant di:iferences were observed between those who reported
continuing and those who reported dropping out of exercise on SMI or any
of the three STAI-T sc{)res
(September L984, February 1985, and June 1985).
For this group there wits a significant difference between the STAI-T
scores from September L984
(X=31.5, S.D.=8.7) and June 1985
(X=28.7,
S.D.=6.6);
(t=2.2, p(.,J5, n=12). No significant differences were observed
between any other combination of STAI-T scores.
Multiple Regression
To test the hypothesis that a significant portion of the variance in
exercise adherence would be accounted for by the three variables percent
/+8
body fat, SMI score, arrd weight taken together, a stepwise multiple
regression was conductrrd using a probability of F-to-enter the regression
equation of(.05
(SPSSX
User's Manual, 1983). The multiple correlation
between weeks of adhere:nce to exercise reported June 1985 (EX2)
and the
three variables of ther hypothesis resulted in only SMI entering the
regression equation; Ril=.37. With the composite exercise report (EX3)
as
the dependent variable, again only SMI entered the regression equation; R2
=.40.
To further descritre the relationship between the amount of exercise
adherence and the varierbles employed, another stepwise multiple regression
analysis was conducted
(SPSSX
User's Guide, 1983) including all of the
available psychological. and physiological variables. The obtained
mu1tipl6 correlation be,tween days of adherence reported June 1985
(EX2)
and the other vari-ables
(Maximum Heart Rate, SMI, change in STAI-T from
September 1984 to June 1985r and the Health Concern Cluster) was .96,
F(4,7)=21.g7, p(.05, R?,.93. Results of the stepwise procedure using EX2
as the dependent variat le are presented in Table L6. The obtained
multiple correlation between days of adherence reported
j-n
the composite
exercise report
(EX3)
and the other variables
(SMI, Forced Expiratory
Volume, Resting Systoli.c Blood Pressure, Total Cholesterol, Weight, and
Trunk Extension) was 1.00, F(6,5)=882.64, p1.05, R2=1.00. Results of the
stepwise procedure witt. EX3 as the dependent variable are presented in Table 17
Insert Table 16 about here
Exercise Reports
Persons in this g
exercise reporting per
1985
(EX2)
the mean
15.3 weeks, and the r
from the summer 1985 a
composite report
(EX3)
number of weeks exerc
range from 0 to 36 wee
49
Insert Table 17 about here
oup have exercj-se report data avallable from both
ods. Using only the report made in the sumrner of
of weeks exercised was 24.3, standard deviation
ge from 0 to 36 weeks. Combining the information
the winter 1985 exercise reports Lo make a
and presumably getting fresher reports' the mean
ed was 26.2, standard deviation 12.2 weeks, and the
50
Discussion
Three main hypotheses were examined in this study. The first
hypothesis was that a r;ignificant portion of the variance
j-n
exercise
adherence would be accounted for by three variables: percent body fat,
Self-Motivation Inventory score, and body weight. The second hypothesis
was that the construct Self-Motivation, as defined by Dishman and Gettman
(1980),
would be suppot:ted as a major factor in exercise adherence. The
third hypothesis was that the Self-Motivation Inventory (SMI)
would be
supported as a valid merasure of Self-Motivation as defined by Dishman and
Gettman. The relaEionsrhip of the results of this study with each hypothesis
will be discussed individually.
Percent Body Fat, SMI, and Weight AccountinEi for Variance in Adherence.
The results of thj.s study do not support Dishman and Gettmanrs
(1980)
finding that a significant portion of the variance in exercise adherence
level was explained by the variables percent body fat, SMI score, and weight
taken together. The el'idence does suggest that exercise adherence
correlates with a number of variables, emotlonal and cognitive as well as
self-motivational and p,hysiological. However, with respect to accounting
for variance in adherer.ce, the results of this study and the inferenees from
those results must be treated with cauEion. First, the number of subjects
utilized in the analyses is sua11
(Group III, n=331 Group IV' n=12) and
those subjects self-selected. Second, the same analyses performed on Groups
III and IV yiqlded different resulLs.
51
For the grouping wj-th a fu11 set of data
(Group IV, n=12) multiple
correlations between the anounts of exercise reported in the two exercise
reports and percent body fat, SMI score, and body weight were obtained by
stepwise linear regressions using a probability of F-to-enter the regression
equation of(.05
(SPSSX Userrs Guide, 1983). With the June 1985 exercise
report
(EX2)
as the dependent variable, only SMI entered the equation; R2
="37.
With the composite exercise report
(EX3)
as the dependent vari-able,
only SMI entered the equation; R2=.40. These results do not support the
hypothesized psycho-biological explanation of adherence.
The results for Group IV do support roles for qelf-motivational,
physiological, emotional, and cognitive factors i-n exercise adherence.
Significant bivariate correlations were found between the June 1985 exercise
report
(EX2)
and: SMI
(i=.61) and Maximum Heart Rate
(r=-.69);
and between
the composite exercise report that combined information from both the
February 1985 report and the June 1985 report
(EX3)
and SMI
(r=.63). The
amount of exercise reported did not correlate significantly with percent
body fat, weight or any other variable than those already mentioned for
ej-ther EX2 or EX3. A multiple correlation between EX2 and Maximum Heart
Rate, SMI, the change in STAI-T scores from September 1984 to June 1985, and
the l{ealth Concern Cluster of reasons for starting exercise
(R2=.96) was
obtained by a stepwise linear regression
(SPSSX User's Guide, 1983). This
multiple correlation with EX2 as the dependent variable lends suPport to a
broader spectrum of factors than hypothesized being involved in adherence
(self-motivational, phyr;io1ogica1, emotional, and cogniEive). A multiple
correlation beLween EX3 and SMI, Forced Expiratory Volume, Resting Systolic
Blood Pressure, Total Cholesterol, Weight, and Trunk Extension 1p2=1.0)
was
obtained by stepwise linear regression
(SPSSX
Userrs Guide, 1983). This
52
Eultiple correlation wi.th EX3 as the dependenE variable supports a mix
between self-motivatiorLal and physiological factors in exercise adherence,
but the cognitive and emotional factors that appeared in the equation with
EX2 are not representec,. Perhaps an emotional factor can be inferred from
the presence of SMI in the formula since SMI and STAI-T were found to
correlate posiLi,vely in this study.
For the grouping r^rith data from PHYS, PSYI, and PSY3 (Group
rrr, n=33),
there were no significant correlati-ons bet\,reen amount of exercise and any
other variable. Because Group III did not include PSY2, the only exercise
rePort available was EX2. A multiple correlation between EX2 and percent
body fat, sMr score, and weight using a probability of F-to-enter the
regression equation of1i.05
(SPSSX
Userts Guide, 1983) resulted in none of
the three variables entering the regression equation. Not only does this
result not support the hypothesis, but it is different from that with Group
IV (n=12).
Perhaps there is such a large number of variables affecting adherence
in a variety of patterns that no speci.fic variables show up as significant
correlates with exercis3 adherence.
The variables that correlated with the two exercise reports within
Group IV and the lack oE correlations in Group III were unexpected. In a
previous study, percent body fat, SMI, and weight measured before an
exercise
Program
were sl:ovm to be major correlates with adherence and the
roles of other types of factors were dovmplayed
(Dishman
& Gettman, 1980).
A1so, the defini-tion of
rfstarting
an exercise programtt in the present study
seemed to favor the cor.relation of physiological factors with exercise. By
defining starti-ng exerc:lse as starting a program 1n line with the company
53
exercise
Program
in terms of recommended schedule, intensiEy, and duration,
it seems like1y that a number of the
were actually eontinuirLg an ongoing
should have been in betrter shape to
likely to continue to urdhere. This
physiological variablesr and exerci"se
results of the present study did not
persons counted as starting exercise
personal program. Regular exercisers
begin with and should have been more
would result in correlations between
in Group III and Group IV, but the
indicate this happened.
Differences betwee,n members of Group III (n=33)
and IV (n=12)
in
variables related Eo e:i:ercise do not seem to be responsible for the
difference in results t,etween the two groups. t-tests on common variables
between the 12 persons included in both groups and the 21 persons only in
Group IlI revealed a si.gnificant difference between the groups on only one
variable; the 21 persor:s only in Group III had a significantly higher score
1ra.05) on the STAI-T e.dministered at PSY3
(A=34.7,
S.D.=8.0) than the 12
persons in Group IV (?=,28.7, S.D.=6.6). A significant difference in the
final STAI-T score aIor.e does not seem li.kely to account for all of the
other differences in re sults between the groups.
Since significant differences in means of common variables between the
groups of participants were not found, the most 1ikely source of error in
this phase of the studf is in the exercise reports. Self-reports of
exercise have been shor,m to be accurate
(self-reports
correlating highly,
r=92, with covert spot checks by observers) when made shortly after eaeh
session
(King & Fredericksen, 1984). Ilowever, acceptable use of time at the
refinery made it necessiary in Ehe present study to include exereise reports
with the psychological testing sessions. This meant that the participants
had to remember what they had been doing over as much as 40 weeks to
54
complete Ex2, the exercise report made at the June l9g5 psychological
testing. Those persons who adhered 1002 had no difficulty in filling out
the reports, but those who dropped out or stopped and restarted ha4 a more
difficult task. compa:ring the second exercise repor! (Ex2)
and the
composite exerci-se report (EX3)
for participants 1n Group IV (n=12),
who had
both exercise reports irvailable, shows more reports of no exercise in EX2
than in EX3. Apparent-Ly when people had to remember over the longer period,
they were likely to clirim no exerci-se if they were unsure; thereby
underreporting short pt:riods of exercise. The failure to report shorter
periods of exercise in EX2 accentuated the extremes of participation, O and
36 weeks. This exagget:ati.on of the extremes is displayed in the means and
standard deviati.ons of reported exercise for both reports; EX2 (i=24.3,
s.D.=15.3) and EX3 (i=2',6.2,
s.D.=12.2). Group rrr (n=33)
had only EX2
available because membe,rship in Group III did not include PSY2 where part of
the composite report (IlX3)
was made. The mean weeks of exercise reported
in EX2 for Group rrr (1'.=22,0,
S.D.=14.6) was also less than that reported
for EX3 in Group IV. It appears very 1ike1y that the correlations relylng
upon the single report of exercise over the 36 weeks of the study
(EX2)
are
confounded by underreporting of partial adherence. The composite exercise
rePort (EX3)
seems to rnoderate this effect of underreporting sma11 amounts
of exercise, but EX3ts reports still include a largememory factor. rt
would have been preferable for all the reports to have been made much sooner
after the exercise.
55
Self-Motivation as a Factor in Exercise Adherence
Both in the preserrt study and in an earlier study (oldridge,
1980),
lack of motivation was a reason commonly cited for discontinuing an
exercise program. It cloes seem reasonable to infer that a person who has
stopped following an err.ercise program was not motivated enough to continue.
Yet, neither the litere.ture on exercise adherence and treatment compliance
nor the results of this study support self-motivation as more than one of
a number of factors in exercise adherence. Instead, the results of this
study suggest that se1{-motivational, emotional, physi-ological, and cognitive
factors all contribute to patterns of exercise adherence. One of the most
challenging factors in attaining adherence to many long term health regimens
is the lack of immediate gratification for adhering (Varni
& A11ander, 1984),
however exercj-se may be different in this regard with both physiological and
psychological rewards reported.
SMf of Starter, Nonstarters, Continuers and Dropouts.
The relationships between SMI scores and whether or not an individual
had started, not started, dropped out, or continued exercise suggest that
abilities to succeed in a given si.tuation temper the effect of self-mot.ivation"
Participants in the September 1984 psychological test sessj,on
(PSYl)
who
reported starting an exercise program exhibited significantly higher SMI
scores
(X=taA.4,
t=126) than those who reported. not starting an exercise
program (X=142.2,
n=197). However, there r^/as no significant difference
between SMI scores either for those persons in the February 1985
psychological testing session
(PSY2)
who reported continuing
(F152.0,
56
rL=24) and those who reported dropping out (1=U+q.44,
n=9)
in the June 1985 psych,logical
testing session (psy3)
who
continuing (f=159.1,n=l.0)
and. those who reported dropping
or for those
reported
out (I=131
.5,n=2)
These results with SMI scores agree with observations in the field of
treatment compliance tltat health beliefs measured before entry into treatment
are poor predictors of compliance, but health beliefs measured after
therapy has progressed are better predi-ctors (Luborsky,
et aI., 19g0).
Positive health beliefsr have been observed to increase with compliance
(Bruhn,1983)
. Perhaps in the present study the d.ecision to starr was a poorer
measure of self-uotivat ion than the decision to continue exercise.
Continuing is likely tc depend not only on the 1eve1 of self-motivation,
but also on abilities and responses specific to exercise. It is unforEunaLe
that the present study did not include retests on the SMI to see if SMf
scores responded to adherence as health beliefs have.
Reasons Ci-ted for Exercise Participation Status.
Reasons cited for starting, not starting, continuing, and discontinuing
an exercise
Program
support the concept of a mix of factors shaping exercise
behavior. Reasons for exercising were mostly participant factors and
reasons for not exercising included more program factors.
Reasons for Starting an Exercise Program. The most often cited
reasons for starting an exercise program (see
Table 2) were partici-pant
factors:
rtI
want to get in shapet',
ttl
like the way exercise makes me feelrt,
"r want to prevent hearE attackfr,
"You should take care of yourself", and
rrl
want to lose weighttt. These reasons for starting an exercise program
57
support the Health Bel.Lef Model
(Rosenstock,
1974) as a means of
explaining exercise adherence. In the IIBM format, the starters displayed
a perception of risks :hat applied the them
(Heart
attack, obesity), they
saw exercise as an act:Lon they could take to reduce the risks, and they
expected the benefits r>f exercise
(diminished
chance of heart attack,
weight loss, feeling good) to outweigh the costs
(time
and inconvenience
of exercise). The reasorls cited for starting an exercise program provi-ded
information on the cogrriti.ve processes in goal setting and expectations
involved in deciding to start exercisi.ng (Meichenbaum,
L975) that would
be expected to contribttte to decisions to continue exercise or drop out
later. As opposed to l:he most often cited reasons for starting an
exercise program, the l-east cited reasons \rere more external, including
ttlrve
heard the prograrr is excellenttt,
ttMy
doctor encouraged mett,
ttl
have
never been able to exer:cise on my owntt,
ttMy
friends are taking partrr, and
rrl
want to stop smokin6;tt.
Reasons forNot Sterrting an Exerci-se Program. Reasons cited for not
starting an exercise program differ from those cited for starting in that
each respondent tended to check fewer reasons and there was less agreement
between respondents on what the most important reasons were, but program
factors topped the list:
(see
Table 2 ar.d Table 3). The first two,
"The
classes are too far frc,m my home" and
ttThe
classes are at inconvenient
timestr simply may have been rationalizations for not parEicipating since
being unable to schedul.e exercise would be one r^ray to resolve a cognitive
di.ssonance
(Festinger,
1957) if a person thought exercise was important,
but was not going to dc,
j-t.
However, tiue is limited and exercise is not
the only important acti.vity vying for time in an adultrs 1ife. Also, the
58
respondents were not unwilling to aceept personal responsibli.ty since
t'I
was not motivated e::.ough to do itt' was the fourth most often cited
reason for not startinl3. The third most often cited reason,
ttl
exercise by myselftr wai a poorly designed choice and the results from
it were confusing. Pe:rsons who cited this reason may have thought that
they had to participat,r in the company program or some other group
exercise program to re')ort starting, when in actuality they may have had
an individual program; some who cited this reason may have had an ongoing
program and did not corrsider themselves starters; or some citing thi-s
reason may have been rr:ferring to a level of exercise that did not qualify
as aerobic exercise. .tn the first two situationsttI exercise on my owntt
would have been checkerl because the quesEionnaires were not clear
enough, in t.he last sit:uation the response night have been a way to
deal with cognitive dir;sonance over not starting by denying the need to
exercise
(Festinger,
1l)57).
Reasons for Contirruing Exercise. Reasons most often cited for
continuing exercise wer:e participant factors with program factors
apparently being of 1it:tle importance. The five most often cited reasons
were the same for both PSY2 and PSY3:
"I
have more energy when I exerciser',
t'You
should take care <>f yourself", and
t'ft
has been helping me lose
weight". The paralleL; between the reasons for starting and the reasons
for continuing suggest that those who continued r^rere meeting their
expectations in their r:xercise program.
Dishman and Gettmen
(1980)
defined self-motivation as a generaLi-zed
tendency to persist in the absence of external reinforcement including
59
skil1 in delaying gratiEi-cation. However, the most often cited reasons
for continuing exercise do not. seem to support a major role in the
exercj-se adherence observed in this study for self-motivation as
defined by Dishman and 3ettman.
"I
have more energy when I exercisett,
and
t'I
feel more relaxe:l after exercise" indicate the presence of rewards
which are intrapersonal, being psychological, physiological, or both in
origin
(Morgan,
1984), but they are both irrmediate and speci-fic to
exercise. The Utility lfode1 of Preventive Behavior
(Cohen,
1984) suggests
that continuing because
|tExercise
can prevent heart atEacktr also provides
immediate gratification through the alleviation of anxiety and again it is
specific to exercise. .r-'inally, individual perceptions of a stressful
experience
(exercise
is physiologically stressful, though it is usually
a positive stress) show marked and consistent differences that affect the
ability to persevere (Kr>riat,
et a1., L974). It is possible that the
iuportant cognitive ski.Ll in self-motivation as it relates to exercise
is not delaying gratifir:ation, but rather percei-ving the physiological
and psychological resporrses to exercise as positive.
Reasons forDroppinll Out of Exercise. The reasons for dropping out
of exercise reflected a shift from what had been said upon starti.ng to
a pattern very similar Eo that in the reasons for not st.arting, external
factors were cited more often than internal factors as reasons for
dropping out of exereis,:, but there was a mix of the two. In both PSY2
and PSY3 the most often ciLed reasons for dropping out were
"The
classes
were too far from my hornett,
ttThe
classes were at i.nconvenient timesrt,
andttl wasntt motivated enough to do ittt. Apparently the obstacles to
exercise loomed larger ;rfter dropping out. Because of the construction
of the forms, it was noE possible to determine much about how exercise
felt to those who dro
positive outcomes cite
ttExercise
was drudge
good feelings reported
177" of those reporting
"I
rdas not losing weig
respondents in PSY2 a
who later dropped out
SMI scores were not si
out and those who cont
exercise playing the
60
out, however, negative para1le1s to the
by those who continued were not chosen often.
comes close to finding a negative paral1e1 to the
by those who continued, but lt was cited by only
dropping out in PSY2 and 16Z in PSY3. Similarly,
t like Ifd hoped" rdas cited by only 9% of tt.e
4Z in PSY3. Something changed for the starters
it does not seeru to be self-motivation. That the
ificantly different between those who dropped
d exercise, lends support to the specifics of
e major role in adherence.
6L
SMI as a Measure of Self-motivation
The results of th.Ls study supported the hypothesis that SMI measures
the general-i-zed, nonspecific tendency to persevere defined by Dishman
and Gettman
(1980)
as lielf-Motivation, but there seem to be other factors
contributing to the SM.[ score as we11. Emotional and physiological
correlates of SMI suggost t.hat at least some of the broader range of
factors associated with self-motivation in exercise adherence are also
included in the SMI score.
Anxiety.
The significant correlation between SMI and STAI-T was unexpected
because it had not beerr reported in the literature. Yet, consistently a
signifiiant negative correlation between SMI and STAI-T indicated that
parti.cipants with higtLer SMI score
(and
more self-motivatj.on) tended to
have lower STAI-T scorrs
(and
less anxiety). SMI and STAI-T correlated
significantly for all of the particl-pants in PSY1
(n=334r
r=-.37) which
included those persons who reported sLarting an exercise program (r=L?7,
r=-.36). Though st.artrrs and nonstarters displayed signiflcant difference
in SMI scores, there wErs no significant difference between the starters
and the nonstarters on STAI-T scores. These results suggest that the
degree to whj-ch a persron reports an ability to persevere in the SMI is
significantly correlatrd with his or her level of anxi-ety at the time of
the SMI. Because the S|MI and the STAI-T were administered at the same
session, at the workplEice, within the context of an employer sponsored
exercise program, specj.fic situational factors were likely to be involved
62
in these results. Such faccors could have been job-related,
exercise-
related, or both. For Group rV (n=12;
the June 1985 srAr-T score was
significantly lower than the September 1984 STAI-T score which suggesrs
that lowering anxiety rdght be a factor in adherence. However, this
lowering of anxiety wari not observed in Group III (n=33)
or in comparisons
of the February 1985 SIIAI-T with either the Seprernber 1984 or the June
1985 STAI-T for Group .tV"
Reasons Cited for Starl:ing Exercise.
The reasons cited for starting exercise and the clusters formed from
those reasons support IiMr as a measure of Self-Motivat.ion, but also
suggest that other fact:ors, both general and specific, are included. A
negative correlation bertween SMI and the cluster called External Motivation
(r=-.20)
was expected si.nce citing external reasons for starting does not
fit r^rith the concept of self-motivation. A positive correlation between
STAI-T and START (SfAnl=
the total number of reasons cited for starting)
(1=.20)
implies that the more reasons a person cited for starting
exercise, the more anxious he or she was or vice versa. STAr-T and the
cluster called Out-of-Shape also had a positive correlati.on (r=.21).
The correlations between START (the
total number of reasons cited for
starting) and the STAI-T along with the correlation between SMI and STAI-T
suggest that not only dld anxiety correlate with SMr, but anxiety is
1ikely to have been correlated with specific exercise setting.
Physiological Factors.
Physiological factcrs related to being in shape correlated with SMI
in two of the larger grrupi-ngs. For the group that was in
psyl
and
63
completed the fitness irssessment (pHys) (n=104),
higher sMr scores
correlated with higher Maximal Aerobic Power (r=.21)
and a higher Maximum
Breathing capacity (r=,24).
For the group rhat completed
psy1, pHys,
and reported starting erxercise (n=58),
higher SMr scores correlated
significantly with beirLg shorter (Heightt
t=-.27), lighter (weighr,
r=-.38; Lean Body WeigtLt, r=-.30; Percent body Fatr r=-.29), having
lower blood pressure, (Resting
systolic Blood
pressurer
r=-.37; Resting
Diastolic Blood Pressure, r=-.38), and being in better shape
(Maximal
Aerobic Power, r=.29).
The SMI test was taken after most of the parti-cipants in PHYS had
been tested and had received the report of thei-r scores. rt may be
that the people who had the higher SMI scores were in better shape because
theyhadmore self-motivation. However, it might also be that higher
scores on the physiological testing increased intrinsic motivation in a
similar way to that already reported for competitive sports (tr{einberg,
L97e).
Conclusion
Summary of Findings.
The results of this study support self-motivation as a factor in
exercise adherence, but not in the form or to the degree of significance
hypothesized. Percent Body Fat, SMI score, and Weight taken together
di-d not account for a slgnifi-cant portions of the variance in exercise.
adherence as reported by Dishman and Gettman (1980).
Self-motivation
was supported as p1ayin13 a role in exerci.se adherence, but it did not
54
appear to be either inrlependent of the situation or without short-term
and immediate gratificirtion. SMI did seem to measure self-motj-vation,
but evidence of emotiorral and sj-tuation-specific influences on the SI'1I
score were also found.
Problems in Meths5!o!s&'/.
Some of the desigrr flaws of the present study were inherent in the
industrial plant settirlg. The operating schedule of the refinery
required that psychololgieal testing be conducted at regular department
meetings and include e'reryone attending those meetings. Management
recommended using Sociirl Security numbers as identification numbers
beeause time was lirnitr:d in the department meetings and they provided a
simple, reliable form r:f identification. Instead of random selection
of subjects, individua.Ls attending departmental mee-tirgs self-selected by
choosing to fill out tl:e questionnaires or not and by choosing to
identify themselves by their social security numbers or not. People who
missed the meetings whrlre the questionnaires were administered due to
job assignments, illner;sr oE vscdtion were lost from the study. Since the
testing was done at cornpany meetings and soci.al securi-ty numbers were
used as identification, Ehere \^ras concern about confidenLiality among
participants. This fo:rmat for testing meant that exercise reports were
made only twice, requiring participants to remember what they had done
over relatively long p,31ieds.
Other problems wiEh this study resulted from a more general lack of
foresight and have bee:e noted in the Discussion. The main difficulties
occurred as a result oE not explaining the purpose and methods of the
study clearly enough t3 get the parEicipants to identify themselves and
and
and
and
continue in the st
not having paralle
from continuers
Future Study.
Further investiga
a) the role playe
correlation between SM
b) whether or not
have been observed to
c) how the percep
continue and those who
65
y; not assuring confidentiality clearly enough;
information frou starters and non-starters
dropouts.
ion
by
and
SMI
t
ion
drop
is suggested into the following:
anxiety in the SMI score as implied in the
STAI.T,
increases r^lith adherence as health beliefs
of exercise differs between those who
out.
66
Aho, I^I. 1977.
their beliefs
92,65-71.
References
Relationship of wives
t
preventive health orientation to
about heirrt disease in husbands. Public Health Reports,
Allain, C., Poon, L., tlhan, C., Richmond, W., and Fu, P., L974. Enzymatic
determinaEion of total serum cholesterol. Clinical Chemistry, 20r_ 470-475.
Auerican College of Sports Medicine, L978. The recommended quantity and
quality of exercise fo:: developing and mainEai-ning fitness in healthy
adults. Medicine and licience in Sports, 10, vii-x.
Andrew, G., and Parker., J.O., 1979. Factors related to dropout of post
myocardial infarction
ltatients
from exercise programs. Medicine and Science
in Sports, 11, 376-3711.
Baekeland, F. & Lundwal-l, L., 1975. Dropping out of treatment: a critical
review. Psychological Bulletin, 82, 738-783.
Bandura, A. and Cervonrr, D., 1983. Self-evaluative and self-efficacy
mechanisms governing motivational effects of goal systems. Journal of
Personality and Social l,sychology, 45, 1017-1028.
Berger, P., Watson, S., Akil, H., Elliott, G., Rubin, R., Pfefferbaum, A.,
Davis, K., Barchas, J., and Li, C., 1980. Beta-endorphin and schizophrenia.
Archives of General Ps),ehiatry, 37, 635-640.
Behnke,A.,andWi1mort,J.,L974.Eva1uation
and Composition. Engle:wood Cliffs:
Blumenthal, J., Willianrs, S., Needels, T., and Wa11ace, A., 1982.
Psychological changes Erccompany aerobic exercise
j-n
healthy middle-aged
adults. Psychosomatic Medi.cine, 44, 5L9-527.
Bluuenthal, J., WillianLs, S., Wa1lace, A., Williams, R., and Needels, T.,
1982. Physiological ar:d psychological variables predict compliance to
prescribed exercise the,rapy in patients recovering from myocardial
infarction. Psychosome.tic Medicine, 44, 529-536.
Bruhn, J", 1983. The a.pplication of theory in childhood asthma self-help
programs. Journal of l.11ergy and Clinical lurmunology, 72, 561-577.
Center for Fitness Eval.uation, Western Washington University, 1984a.
IExplanation
of measur and individual test results of maximal aerobic
power, YOz max.l Unpublished information sheet.
(Available
from Center for
Fitness Evaluation, Western Washington University, Bellingham, Washington
98225.)
Center for Fitness Evaluation, 1984b.
IExplanation
of measure and
individual test results of hydrostatic weighing.
I
Unpublished information
sheet.
67
center for Fitness Eva--uation, 1984c.
IExplanation of measures and
individual flexibility test results.l Unpublished information sheer.
Center for Fitness Eval-uation
,
1984d.
IExplanation
of measures and
individual test results; of puluonary function analysis.
]
Unpublished
information sheet.
Cohen, D., 1984. Utilj.ty model of preventive
Epidemiology and Corrmurrity Health, 38
,
61-65 .
behavior. Journal of
Co1t, E., Wardlaw, S., and Frantz, A., 1981. The effects of running on
plasma beta-endorphin. Life Sciences, 28214, L637-L640.
Condiotte, M., and Lictrtenstein, E., I981. Self-efficacy and relapse in
smoking cessation progt'ams. Journal of Consulting and Clinical Psychology,
49, 648-658.
de Vries, H., 1981. Tranquilizer effect of exercise: a critical review.
The Physician and Sport:smedicine, 9:11, 47-55.
Deci, E., 1975. IntrirLsic motivation. New York:Plenum.
Dishman, R.
166-180.
Disharan,
R.
adherence.
Dishman, R.
to habitual
rI5-132.
Festinger,
Petersen.
,
1982. Hee.lth psychology and exercise adherence.
Quest,
33,
& Gettman, L., 1980. Psychobiologic influences on exercise
Journal of Sport Psychology, 2, 295-310.
,
Ickes, IJ., & Morgan, W., f980. Self-motivation and adherence
physical activity. Journal of Applied Social Psychology, 10,
L., L957. /. theory of cognitive dissonance. Evanston, IL:Row,
Fetsch, R. & Sprinkle, R., 1983. Effects of running on depressed adults.
American Mental llealth Counselors Association Journal. 5. 75-84.
Fink, D., L976, Tailoring the consensual regiuren. In Sackett, D. and
Haynes, R. (Eds.),
Comlliance with therapeutic regimens. Baltimore: The
Johns Hopkins University Press.
Folkins, C. & Sime, W., 1981. Physical fitness training and mental health.
American Psychologist, 36, 373-389.
Friedewald, W., Levy, X.., and Fredrickson, D., 1972. Estimation of the
concentration of low-density lipoprotein in eholesterol in plasma, without
use of the preparative ultracentrifuge. Clinical Chemistry, 18, 499-502.
Gale, J., Eckhoff, W., Mogel, S., & Rodnick, J., 1984. Factors related to
adherence to an exercise program for healthy adults. Medicine and Science
in Sport.s and Exercise, 16, 544-549.
58
Gerner, R., Catlin, D., Gorelick, D., Hui, K., Li, C., 1980. Beta-
endorphins: intravenous infusions causes behavioral change in
psychiatric patients. Archives of General Psychiatry, 37, 642-647.
Grossman, A. and Sutto:a, J., 1985. Endorphins
-
what are they
-
how are
they measured
-
what irs their role in exercise? Medicine and Science
in Sports aird Exercise, L7, 74-81.
Ilartley, L., 1985. Growth hormone and catecholamine response to exercise
in relation to physical training. Medicine and Science in Sports, 7, 34-36.
Haynes, R., 1976. A c:ritical review of the
"determinants" of patient
compliance with therapr:utic regimens. In Sackett, D. and Haynes, R. (Eds.)
Compliance with theraprrutic regimens. Baltimore: The Johns Hopkins Press.
Ilunt, W., Barnett, L., and Branch, L., Lg7l. Relapse rates in addictive
programs. Journal of
(llinica1
Psychology, 27, 455-456.
Janal
,
M., Co1t, E., C.Lark, W., and Glusman, M., 1984. Pain sensitivity,
mood, and plasma endocrine levels in man following long distance running
-
effects of naloxone. ilain, 19, 13-25.
Jenkins, C., 1979. An approach to diagnosis and treatment of problems of
health related behavio::. International Journal of Health Education, 12,
246.
Johnson, B., L977. Pra<:tical Fl"*ibility M""".."*
Portland, Texas: nrow,
Kaplan, G., and Cowles,, A., 1978. Health locus of control and health value
in prediction of smokirrg reduction. Health Edrcation Morogr"phs, 6,
L29-t37 .
Kaplan, K., Mendelson, L., & Dubroff, M., f983. The effect of a
jogging
program on psychiatric inpatients with symptoms of depression. Occupational
Therapy Journal of Reserarch, 3, 173-L75.
Katch, F., Michael, E., and Horvath, S., 1967. Estimation of body volume by
underwater weighing: clescripti-on of a simple method. Journal ol 3ppLi"4.
Physiology, 27, 96-100.
Kincey, J., 1983. Conrpliance with a behavioural weight-loss programme:
target setting and locrrs of control. Behavioural Research Journal, 21,
r09-114.
Ki-ng, A. & Frederiksen, L., 1984. Low-cost strategies for increasing
exercise behavior. Rel.apse training and social support. Behavior
Modification. 8. 3-27.
Koriat, A., Melkman, R., Averill, J., and Lazarus, R., 1972. The self-
control of emotional reractions to a stressful fi1m. Journal of Personality,
40,601-619.
69
Lefton, L., 1982. Psyr:hology, 2nd. edition. Boston:Allyn and Bacon.
Lipid Research Clinics Program, L975. Manual of Laboratory Operations,
Volume I. Lipid and Lir)oprotein Analysis.
(DHEW publication number
(NIH)
95-628). Bethesda, Ma::y1and: National Institutes of Health.
Luborsky, L., Mintz, J,, Auerbach, A., Christoph, P., Bachrach, H., Todd,
T., Johnson, M., Cohen, M., and 0rBrien, C., 1980. Predicting the outcome
of psychotherapy. Archives of General Psychiatry, 37, 471-481.
Marlatt, G., and Gordott, J.
'
1980. Determinants of relapse: implications
for maintenance of behirvior change. In Behavioral Medicine: Changing
Health Lifestyles, eds, Davidson and Davidson. Brunner/MazelzNew York.
Martin, J. & Dubbert, l?., 1982. Exercise applications and
behavioral medicine:
(:urrent
status and future directions.
Consulting and Clinica.L Psychology, 50, 1004-1017.
promotion in
Journal of
Meichenbaum,
Press.
D., 1977 . Cognitive behavior modification. New York:Plenum
Moore, M., 1982. Endo:rphins and exercise:
Physician and Sportsmerlicine, 10, 111-119.
a puzzLLng relationship.
Morgan, W., L979. Anx:Lety reduction following acute physical activity.
Psychiatric Anna1s, 9:.!, L4L-147 .
1985. Affr:cti-ve beneficence of vigorous physical activity.
Morgan, W.,
l'ledicine and Science irr Sports and Exercise, 17:1, 94-100.
Morris, A. and l{usman, B., L978. Life quality changes following an
endurance conditioning program. American Corrective Therapy Journal, 32,
3-6.
Morri.s, J., Everitt, M., Pollard, R., Chave, S., & Semmenc, A.,1980.
Vigorous exercise in 1,:isure-time:
Protection
against coronary heart
disease. Lancet, 2, l2O7-12L0.
Oldridge, N., Wicks, J., Ilanley, C., Sutton, J., and Jones, N., f978.
Noncompliance in an ex,arcise rehabilitation program men who have suffered
a myocardial-infaretio:n. Canadian Medical Association Journal, 118
361-364.
gldridge,
N., L979. Ccmpliance of post myocardial infarction patients to
exercise programs. Meclicine and Science in Sports, 11, 373'375.
Paffenbarger, R. Jr., Wing, A., and l{yde
an index of heart attack risk in college
Epidemiology, 108, L6L-175.
Rosenstock, T., 1974. The health betief model and preventive health
behavior. Ilealth Education MotoEPt
":-2,-
354-386.
,
R., L978. Physical activitY as
alumni. Arnerican Journal of
70
Ruppel, G., L982. Manual of Pulnonary Function T St. Louis:
C.V. Mosby Co.
sackett, D. and Ilaynes, R., L976. compliance with therapeutic regimens.
Baltimore: The Johns Hopkins University
presi.
Schafer, L., Glasgow, R., and McCaul, K.
,
1982. Increasing adherence in
diabetic adolescents. Journal of Behavioral Medicine, 5, 353-362.
Siri, W., 1956. Gross composition of the body. In Lawrence, J., and
Tobias, C. (Eds.)
Adva::ces in Biological and Medical Physics IV. New York:
Academi-c Press.
Spielberger, C., Gorsu,:h, R., & Lushene, R., 1970. The State-Trait Anxiety
rnventory (srAr).
Rivirrside, cA: consulring rsychoGgists-FlEss.
sPSSX userrs Guide. 19113. New York: McGraw-Hill Book company.
Tllglycerides
-
Int. tleagent Enzymatic Essay, (Beckman
Publication number
0L5-245445), 1983. Fu.Llerton, California: Beckman lnstrumlnts rrrcorporat.a.
varni, J., & wallander, J., 1984. Adherence to health-related regimens in
pediatric chronic diso::ders. Clinical Psychology Review, 4, 585-596.
Weinberg, R., 1979. Irrtrinsi-c motivation in a competiti.ve setting.
Medicine and Science irr Sports, 11, 146-L49.
weinstein, w. & Mayers,, A., 1983. Running as treatment for depression: is
it worth it? Journal of Sport Psychology, 5, 288-301.
Wilmore, J., 1969. A siimplified method for determination of residual lung
volumes. Journal of Alrplied Physiology, 27, 96-100.