Increasing and maintaining exercise and physical activity

The efficacy of exercise and physical activity for promoting health, coupled with the high prevalence of sedentariness in most industrialized nations, has implications for behavior therapy. Exercise and physical activity are frequently used as adjunctive or primary interventions in behavior therapy. However, adherence is usually poor in exercise programs. To clarify past research and facilitate future research and applications in behavior therapy, 56 studies that used behavior modification or cognitive-behavior modification to increase and maintain exercise and physical activity are critically reviewed. These studies show that increases in self-reported frequency of physical activity and attendance in exercise programs accompany all the interventions used. Other conclusions cannot be drawn, because most studies have limited internal or external validity due to their non- or quasi-experimental designs, or their use of indirect estimates of exercise, physical activity and fitness, or their failure to link increased exercise or activity with fitness or therapeutic outcomes. Thus, the effectiveness and generalizability of behavior change interventions with exercise and physical activity remain unclear. To illustrate theoretical approaches to changing exercise and physical activity, the Relapse Prevention Model and the Transtheoretical Model are discussed. Personal attributes, environments, and features of physical activity associated with the adoption and maintenance of exercise and physical activity are also discussed, because they can influence behavior therapy interventions. The timeliness of studying exercise and physical activity interventions in behavior therapy is reinforced by their designation by the U.S. Public Health Service as research priorities for the year 2000.