Much of the work that we do is housed in a
theoretical framework called social cognitive theory.
And that social cognitive theory
considers social, psychological, personal,
behavioral, and environmental influences on
on behavior.
And so this is a lot of
kind of feedback loops involved and can get quite
complex when you're considering human behavior which is itself quite
complex.
One of the central factors of that particular theory is that this is a
variable
or construct called self-efficacy.
Self-efficacy is the beliefs that one has in their capabilities to
successfully carry out courses of action.
An easier way to think of it in layman's terms is like a situation
specific self-confidence.
It differs from what we normally think of as self-confidence, which is more
trait like, disposition like,
pretty stable.
If you know a self-confident person,
they're pretty self confident most the time.
Self-efficacy is not stable.
In large part because it can differ. You could
appear to be confident in one arena
and you move to another domain and you don't have any self-efficacy for that.
So, that's important in the context of trying to predict particularly
physical activity
behavior as some of the outcomes that we associate with physical activity
behavior.
If you're highly self efficacious person,
you're likely to approach more challenging
tasks,
you're likely to put out
more effort when you're engaged in that task, particularly if things don't
go well,
and you're also likely to persevere longer
when you're faced with
aversive stimuli or setbacks or obstacles.
The important issue there is that
those are three elements that we can really associate with physical
activity.
You need to put some effort in,
there are going to be setbacks
and
there are multiple tasks and challenges
to engage in physical activity.
So,
in that context, it becomes and nice model for trying to understand the
behavior.
Now, we've taken that model and we've applied it in a number of
ways. We've used experimental trials,
in which we've brought people into our laboratories and then we've manipulated
their levels of self-efficacy
prior to exercise.
We've had them exercise and then
we've found afterwards that the manipulation of that level of
self-efficacy
has implications; it influences the extent to which they enjoyed it,
the extent to which the experience positive emotions affect, and also
the extent to which
they are willing to continue with it.
So,
it's a nice way of illustrating that this is not some
immutable
construct in terms of influencing behavior. It can be
manipulated.
And that becomes very important to us when we start to do our randomized
controlled trials, which
is the cornerstone of our work here, where we have a randomized older
adults into
various conditions and in order to suggest self-efficacy works,
we've actually
conducted a couple of trials
both with older adults with individuals with multiple sclerosis
where we've randomized them into
what we term an efficacy-laden
exercise intervention or
just your regular run-of-the-mill exercise intervention. We're clearly able
to show that
compliance levels are higher in that efficacy-laden
intervention then
just the regular
activity.
That has very important implications from
just a translation
sense. If you're putting together programs for rehabilitation
for older adults or for
adults with
disease,
then there are ways that you can
manipulate the environment and we do that
in a number of distinct ways.
We provide lots of feedback: we monitor their behavior,
we chart it,
document it, and show them how they are progressing so they have a frame of
reference with which to say 'that's what I could do, this is what I'm doing now
and that makes them more confident.
We monitor their levels of exertion
and there effect and enjoyment
to show that, that's changing. We actually monitor their physiological
responses
and give the feedback on that, so we can say 'look, you're exercising longer,
your exercising harder,
but still
your heart rate is remaining the same.
So, you're getting now some physiological benefits, your
body is
adjusting to the stress.
Compliance is
is probably the worst
issue, the biggest issue, I should say,
in modern medicine and health promotion.
We can reliably state that
more than fifty percent of people drop out of exercise programs
before the first six months.
That perfectly parallels
the compliance rate
in medication usage
or the extent to which people
follow their rehabilitation.
A good analogy there or an example of that is to simply ask
yourself,
when a physician has prescribed medication for you to take,
A) Have you taken it all?
B) Did you take it according to plan?
or C)
Did you self-perscribe?
which is what were the people do, so
adherance compliance is a small issue.
We've since gone on to use this model
to try to understand some of the outcomes associate with physical
activity.
In particular with older adults, functional limitations
because that has implications for
onset of disability
and therefore reduction or loss of independent living.
Its effects...excuse me...
the royal efficacy plays relative to
physical activity effects and quality of life.
For a long time,
people have had a relatively straightforward
understanding
based on the literature.
If you're physically active, you have fewer functional limitations.
If you're physically active, you have better quality of life.
So,
it's a one-to-one.
That's patently untrue
and what we have argued
is that there are
intermediating
variables,
intervening variables, mediating variables one of which
is self-efficacy. We know efficacy-
excuse me- physical activity influences self-efficacy
and we know
physical activities is associated with functional limitations
and having a better quality of life,
but in actuality, when u
you statistically control, you take self-efficacy out of the equation,
those relationships are either diminished dramatically,
or go away entirely.
So,
having a sense
of self relative to
your confidence and ability to carry out
activities of daily living
is tremendously important, particularly
to older adults.
We've conducted several randomized controlled trials of last year with my
long time
collaborator, Art Kramer,
where the primary outcomes have been
cognitive function,
brain structure,
brain activity.
Any hypothesis that we have had
about relationships between those things
is predicated on the fact that we can actually get people to exercise
and keep them in.
So that we show training effect and ultimately so that we show an
effect on
cognition,
brain structure,
brain activity.
We have taken our work,
using the self-efficacy model
and embedded what we have learned in a previous trials in all the trials
partner come together.
We show quite successfully
that we can
get people to stay in a program for six months to
approximately eighty five percent
retention.
That's pretty good
and it has to be good for us
in large part because
without that we can we really don't have anything.
So why is that the people don't exercise? I mean, I often tell my undergraduate
students that
if I
would have you go conduct your own little studies in Champaign-Urbana, you each
ask ten different people,
black, white, young, old, educated,uneducated,
is exercise good for you? They would rattle off ten,fifteen
answers that are completely correct.
Then you ask them and how often do you exercise?
'Oh, I don't have time for that
and that's the crux of the matter,
is time management is an incredibly
consistent
reason people you give for why they don't exercise.
So,
why is that? Well, we live in a very demanding society, we have more and more
problems all the time.
We do know that in order to get
positive health benefits,
you don't have to do too much.
Thirty minutes a day,
of light to moderate activity,
on five or more days a week
will get you health benefits that you need
and
you can get that by going and having a brisk walk.
That's all it takes.
And, of course,
participants say,'oh, I don't know if I can fit that into my day.'
So, we try
another approach and say,
'well, let's see if you could accumulate them,
three bouts of ten minutes,'
a strategy would give to people when they leave our programs as well. If
you can exercise at home, you have a
station bicycle or treadmill,
do your ten minutes while you're watching part of the news and go off and do what youve got to do.
Then,
come back do another ten minutes while you're watching
between on your favorite
television show,
when the commercials and because there's way more than twenty minutes of commercials
in an hour television program.
So, anything like that, we can get them to do that but
time management? huge problem.
Other obstacles particularly for older adults are
inaccessible facilities.
By that,
they don't have any where to
exercise.
If they live in poor neighborhoods, those neighborhoods are
environmentally unfriendly,
for a variety of reasons,
cost of exercises is for some of them,
problematic.
What we try to do is offer them alternatives, especially when they leave
our programs about
with the exercise
for free or minimum cost.
What can you do it in your own neighborhood environment...
Give them as many options
so that it negates the number of excuses that we have.
Promoting
exercise across the life span
is
actually a pretty lofty goal
when you realize that
all the population statistics will tell us that,
for adults sixty five and older,
about twenty eight percent of them meet public health guidelines for physical
activity.
That has not changed dramatically over the last last decade or so in
spite of the
much greater public
face of physical activity.
We do it through research,
obviously, but we also try to do it through public forums as well
whenever we can,
to address non-research groups
having our work
published and advertised in
non-research type journals, articles, or papers, anything we can do,
we tried to do it.
We're having a very hard time
trying to get people to be active.
Just this month the new federal guidelines for physical activity were
released by the
Department Health and Human Services
and they've changed the tact a little bit.
Now it's not
we want you to exercise thirty minutes today,
light to moderate activity,
five or more days a week. 'We want you to do that,
but we want to do it your way.' It's like a
Frank Sinatra approach to
things, 'exercise my way'.
So, suggesting that they can pick up
exercise in a lot of different ways: walking the stairs
rather than taking the elevator, parking your car
in a distant parking lot and walking there, getting a ten minute walk down to
the coffee shop during lunchtime, things like that.
We're hopeful; I see us, in the work we're doing with cognition
and brain structure activity is...
I think we've we pushed some envelopes here at Illinois.
We're setting the stage a little bit
for what we do know about those relationships with physical activity and
fitness and
the one thing we do know,
is the older people value their
cognitive abilities because it has huge implications for
independence.
So, if
our message can be gotten out there and I really mean it's a message
but
I'm not sure we're the ones that should send it...
because with the ones doing the research but we should have
a hand in this, I suppose, if we can get that
message
broadcast further about cognitive benefits,
I think, then, we will have an impact on society.
I worry greatly
that people see
games, that they can do on the computer,
to potentially influence their cognition.
And, basically, they're taking
a sedentry activity, whereas if those things work, they do get some cognitive gains,
but if they're physically active, they get the cognitive benefits but they get
all of the other
physical and mental benefits as well. In essence, it's a much bigger bang for the
buck.