Factors influencing physical activity behaviour in adults at risk of coronary heart disease : a quantitative and qualitative study of an exercise referral scheme
The thesis consists of a series of studies relating to physical activity in adults
resident in Wirral, North West England. The first study is a survey of the health and
lifestyles of the general adult population, which sets the context for the other studies.
The subsequent studies focus on a specific section of this population. These were
adults who were at risk of coronary heart disease who had been referred to a primary
care exercise referral scheme (called the Exercise and Lifestyle Centres or ELC).
The research adopted health locus of control (HLC) and Wallston's modified social
learning theory (MSL T) as a theoretical perspective in order to explore physical
activity behaviour (Wallston, 1992). A self-regulatory model of health behaviour
was also found to be a useful framework for explaining concepts that emerged from
the studies (Leventhal, Diefenbach & Leventhal, 1992).
The aim of the thesis was to investigate factors that are associated with, and have an
impact on physical activity behaviour. In particular, it sought to explore and
understand factors that influence the initiation and maintenance of activity in
individuals referred into the ELC scheme. It also set out to investigate the usefulness
ofHLC and Wallston's MSLT in helping to understand physical activity in this
Quantitative methods included a large scale survey of a sample of the Wirral
population, an evaluation of the ELC scheme and a study of Walls ton's MSLT.
Findings were analysed using chi square analysis, logistic regression and structural
equation modelling. Qualitative methods included semi-structured interviews with
thirty two individualswho were referred to the ELC. An adaptation of grounded
theory methodology was used as advocated by Smith (2001), Charmaz (2001) and
described by Bennett and Vidal-Hall (2000).
Factors found to influence physical activity behaviour included age; gender;
perceptions of health status; illness representations; beliefs about capability to participate in physical activity; beliefs about the pros and cons of engaging in
activity (such as health benefits, enjoyment and social interaction versus risk of
injury, lack of time and competing demands of work and family); beliefs about
whether own actions would have an influence on valued outcomes; receptivity to the
health message from General Practitioners (GPs); time perspective with respect to
illness representations and the value placed on the longer-term benefits of physical
There was a complex relationship between the factors that were found to influence
the initiation and maintenance of activity. Age was particularly influential and
appeared to have a mediating influence on health status, illness representations, selfefficacy,
health value, HLC beliefs and barriers towards activity (such as fear of
injury and perceptions of enjoyment). Gender was also a key influence on the
initiation of activity ~ Having a combination of internal HLC and powerful other
HLC beliefs was particularly important in initiating activity on the ELC. Other
factors that contributed to adherence to the ELC included enjoyment, obtaining
valued outcomes and positive perceptions of self-efficacy. However, maintenance of
activity beyond the ELC was positively influenced by a time perspective that viewed
health as a long-term valued outcome, that could be achieved via continued physical
activity behaviour, which was found to be within capabilities to carry out and
Adopting a one sizefits all strategy will not be very effective in increasing levels of
physical activity. Support needs to be focused towards the age and gender profile of
participants, their health conditions, particular barriers and concerns, as well as their
psychological preferences and perspectives (e.g. their HLC beliefs, perceptions of
capability and readiness to change). .
Physical activity behaviour is both complex and multi-determined. Constructs from
different models need to be integrated in order to understand physical activity.
Qualitative methods are particularly helpful in understanding the differences
between those who participate in a primary care exercise referral scheme and those
who do not.