Self-Regulatory Processes and Exercise Adherence in Older Adults: Executive Function and Self-Efficacy Effects

doi:10.1016/j.amepre.2011.04.014

American Journal of Preventive Medicine

Volume 41, Issue 3, September 2011, Pages 284-290

https://doi.org/10.1016/j.amepre.2011.04.014 Get rights and content

Background

Self-efficacy and the use of self-regulatory strategies are consistently associated with physical activity behavior. Similarly, behavioral inhibition and cognitive resource allocation—indices of executive control function—have also been associated with this health behavior.

Purpose

The purpose of this study was to examine the hypothesis that self-efficacy mediates the relationship between self-regulatory processes, such as executive function, and sustained exercise behavior.

Methods

Older adults (N=177, mean age=66.44 years) completed measures of executive function, self-reported use of self-regulatory strategies, and self-efficacy prior to and during the first month of a 12-month exercise intervention. Percentage of exercise classes attended over the following 11 months was used to represent adherence. Data were collected from 2007 to 2010 and analyzed in 2010–2011. Structural equation models were tested examining the effect of executive function and strategy use on adherence via efficacy.

Results

As hypothesized, results showed significant direct effects of two elements of executive function and of strategy use on self-efficacy and of efficacy on adherence. In addition, there were significant indirect effects of strategy use and executive function on adherence via self-efficacy.

Conclusions

Higher levels of executive function and use of self-regulatory strategies at the start of an exercise program enhance beliefs in exercise capabilities, which in turn leads to greater adherence.

Trial registration number

This study is registered in Clinicaltrials.gov (NCT 00438347).

Introduction

Maintaining a health regimen on a long-term basis is extremely difficult.1, 2, 3 Successful adherence often requires one to self-regulate one's behavior by overriding a well established response (e.g., watching TV) and replacing it with a less common but more desirable response (e.g., going for a brisk walk).⁴ There have been two approaches to examining self-regulatory processes relative to behavior change. The most common method in the social/health psychology literatures is to assess self-reported goal setting and intentions. The neurocognitive literature, however, takes a more biological perspective by assessing individuals' abilities to arrange, integrate, and control cognitive actions such as planning, decision making, error correction, troubleshooting, and resisting temptation.5, 6 Collectively, these abilities are termed executive function.

Hall et al.⁷ examined the associations among self-reported intentions, physical activity, and executive function in a small sample of college students. Executive function accounted for variance in physical activity levels independent of self-reported intentions, and the interaction between intention and executive function contributed additional unique variance. Although physical activity was assessed over a very short period, thereby limiting our understanding of the role that executive function might play in long-term maintenance of physical activity, this study represents an important foundation for examining the role of executive function in lifestyle health behaviors.

Social cognitive theory (SCT)8, 9 suggests that behavior change stems from changes in motivation and self-regulation.⁹ The core construct of SCT is self-efficacy: the belief one has in one's capabilities to successfully carry out a course of action.8, 10 Self-efficacy is one of the most consistent determinants of many health behaviors,⁸ including physical activity.¹¹ Bandura⁸ has proposed that SCT integrates both cognitive and motivational elements of self-regulated behavior. Self-regulatory strategies such as planning, scheduling, and self-monitoring, operating within the SCT framework,¹⁰ may have both direct and indirect effects on health behavior. For example, Bates et al¹² reported that self-efficacy mediated executive function effects on substance abuse and Blume and Marlatt¹³ have suggested that studying the relationship between executive function and self-efficacy may be necessary for effectively modifying interventions and behavior change practices. Given that adherence to structured exercise programs is consistently associated with higher exercise-related self-efficacy,¹¹ the effects of executive function on adherence should work, at least in part, through self-efficacy.

In this article, secondary outcomes data are presented from a 12-month exercise trial designed to examine exercise effects on brain structure and function in older adults. Importantly, older adults have more compromised executive function than their younger counterparts14, 15, 16 and they exhibit low levels of physical activity.¹⁷ The purpose of the present study was to examine the potential for executive function processes to predict adherence to physical activity. It was hypothesized that executive function performance and self-reported use of self-regulation strategies would influence older adults' adherence to a 12-month exercise intervention through the mediation of exercise-specific self-efficacy.

Section snippets

Participants and Procedure

Participants (N=177, men=61, women=116; mean age=66.44±5.69 years) were community-dwelling older adults who volunteered to participate in a 12-month organized exercise intervention. Recruitment procedures, full inclusion–exclusion criteria, and study details have been described elsewhere.14, 15, 16 Briefly, participants were recruited via local media outlets. Inclusion criteria pertinent to the present data included being inactive (i.e., defined as a lack of regular involvement in exercise

Preliminary Analysis

Characteristics of the sample have been described elsewhere.¹⁹ Briefly, participants in the current study ranged in age from 58 to 81 years (M=66.44, SD=5.69) and 65.5% were women. The majority of the sample was white (91%) and had also completed at least 1 year of college or more (79.6%). Percentage attendance was 69.85% (SD=26.42) in the walking condition and 68.55% (SD=26.74) in the FTB condition for the 11-month period; these levels were not statistically different from each other, t

Discussion

The results suggest that higher levels of some types of executive function (i.e., task coordination and inhibition of habitual response) and greater use of self-regulatory strategies were associated with higher levels of exercise self-efficacy at 3 weeks into the trial. In turn, higher efficacy was associated with better adherence to weekly exercise classes for the subsequent 11 months. Thus, individuals who regularly engage in strategies such as self-monitoring, eliciting social support, and

Conclusion

These findings suggest that elements of self-regulatory capacity, such as executive function and strategy use, influence adherence to exercise behavior in older adults through the mediation of self-efficacy. Such findings highlight the importance of executive function and self-efficacy in one's ability to self-regulate challenging health behaviors. Finally, they may also suggest that baseline assessment of executive function prior to the beginning of exercise programs may identify individuals

References (37)

A. Miyake et al.
The unity and diversity of executive functions and their contributions to complex “Frontal Lobe” tasks: a latent variable analysis
Cognitive Psychol
(2000)
R.S. Prakash et al.
Age-related differences in the involvement of the prefrontal cortex in attentional control
Brain Cogn
(2009)
K. Erickson et al.
Training-induced plasticity in older adults: effects of training on hemispheric asymmetry
Neurobiol Aging
(2007)
R. Dishman
Introduction: consensus, problems, and prospectsAdvances in exercise adherence
M. Dansinger et al.
Comparison of the Atkins, ornish, weight watchers, and zone diets for weight loss and heart disease risk reduction: a randomized trial
JAMA
(2005)
S. Van Dulmen et al.
Patient adherence to medical treatment: a review of reviews
BMC Health Serv Res
(2007)
R. Baumeister et al.
Self-regulation and the executive function: the self as controlling agentSocial psychology: handbook of basic principles
D. Norman et al.
Attention to action: willed and automatic control of behavior
D. Stuss et al.
Executive functions and the frontal lobes: a conceptual view
Psychol Res
(2000)
P.A. Hall et al.
Executive function moderates the intention-behavior link for physical activity and dietary behavior
Psychol Health
(2008)

A. Bandura

Self-efficacy: the exercise of control

(1997)

A. Bandura

Health promotion by social cognitive means

Health Educ Behav

(2004)

A. Bandura

The explanatory and predictive scope of self-efficacy theory

J Clin Soc Psychol

(1986)

E. McAuley et al.

Self-efficacy determinants and consequences of physical activity

Exerc Sport Scie Rev

(2000)

M.E. Bates et al.

Cognitive impairment influences drinking outcome by altering therapeutic mechanisms of change

Psychol Addict Behav

(2006)

A.W. Blume et al.

The role of executive cognitive functions in changing substance use: what we know and what we need to know

Ann Behav Med

(2009)

M. Voss et al.

Plasticity of brain networks in a randomized intervention trial of exercise training in older adults

Front Aging Neurosci

(2010)

K.I. Erickson et al.

Aerobic fitness is associated with hippocampal volume in elderly humans

Hippocampus

(2009)

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Research articleSelf-Regulatory Processes and Exercise Adherence in Older Adults: Executive Function and Self-Efficacy Effects

Background

Purpose

Methods

Results

Conclusions

Trial registration number

Introduction

Section snippets

Participants and Procedure

Preliminary Analysis

Discussion

Conclusion

Cognitive Psychol

Brain Cogn

Neurobiol Aging

Introduction: consensus, problems, and prospectsAdvances in exercise adherence

Comparison of the Atkins, ornish, weight watchers, and zone diets for weight loss and heart disease risk reduction: a randomized trial

JAMA

Patient adherence to medical treatment: a review of reviews

BMC Health Serv Res

Self-regulation and the executive function: the self as controlling agentSocial psychology: handbook of basic principles

Attention to action: willed and automatic control of behavior

Executive functions and the frontal lobes: a conceptual view

Psychol Res

Executive function moderates the intention-behavior link for physical activity and dietary behavior

Psychol Health

Self-efficacy: the exercise of control

Health promotion by social cognitive means

Health Educ Behav

The explanatory and predictive scope of self-efficacy theory

J Clin Soc Psychol

Self-efficacy determinants and consequences of physical activity

Exerc Sport Scie Rev

Cognitive impairment influences drinking outcome by altering therapeutic mechanisms of change

Psychol Addict Behav

The role of executive cognitive functions in changing substance use: what we know and what we need to know

Ann Behav Med

Plasticity of brain networks in a randomized intervention trial of exercise training in older adults

Front Aging Neurosci

Aerobic fitness is associated with hippocampal volume in elderly humans

Hippocampus

Research article
Self-Regulatory Processes and Exercise Adherence in Older Adults: Executive Function and Self-Efficacy Effects