Health behaviour change theories: contributions to an ICF-based behavioural exercise therapy for individuals with chronic diseases

Abstract

Purpose: The purpose of this perspective is (1) to incorporate recent psychological health behaviour change (HBC) theories into exercise therapeutic programmes, and (2) to introduce the International Classification of Functioning (ICF)-based concept of a behavioural exercise therapy (BET). Methods: Relevant personal modifiable factors of physical activity (PA) were identified based on three recent psychological HBC theories. Following the principles of intervention mapping, a matrix of proximal programme objectives specifies desirable parameter values for each personal factor. As a result of analysing reviews on behavioural techniques and intervention programmes of the German rehabilitation setting, we identified exercise-related techniques that impact the personal determinants. Finally, the techniques were integrated into an ICF-based BET concept. Results: Individuals' attitudes, skills, emotions, beliefs and knowledge are important personal factors of PA behaviour. BET systematically addresses these personal factors by a systematic combination of adequate exercise contents with related behavioural techniques. The presented 28 intervention techniques serve as a theory-driven “tool box” for designing complex BET programmes to promote PA. Conclusion: The current paper highlights the usefulness of theory-based integrative research in the field of exercise therapy, offers explicit methods and contents for physical therapists to promote PA behaviour, and introduces the ICF-based conceptual idea of a BET.

Implications for Rehabilitation

• Irrespective of the clients' indication, therapeutic exercise programmes should incorporate effective, theory-based approaches to promote physical activity.

• Central determinants of physical activity behaviour are a number of personal factors: individuals' attitudes, skills, emotions, beliefs and knowledge.

• Clinicians implementing exercise therapy should set it within a wider theoretical framework including the personal factors that influence physical activity.

• To increase exercise-adherence and promote long-term physical activity behaviour change, the concept of a behavioural exercise therapy (BET) offers a theory-based approach to systematically address relevant personal factors with a combination of adequate contents of exercise with exercise-related techniques of behaviour change.

• Chronic non-communicable disease
• integrative approach
• personal factors
• physical activity
• physical therapy
• rehabilitation

Acknowledgements

The authors thank Prof. Gorden Sudeck (Tübingen, Germany) and Prof. Wiebke Göhner (Freiburg, Germany) for their ideas and support regarding the conceptual development of BET. We thank Stefan Peters for carefully proofreading the manuscript and for his valuable support regarding the structure and content of the introduction and the discussion. We are also grateful to the German Pension Insurance for funding exercise therapy projects that considerably contributed to the development of this paper.