Exercise Intervention Case Study
Subject: Nathalia Campos
Mary Rose Walker EXSS 422
Chris Covino 12-20-07
Nathalia is a middle-class 21 year old Brazilian woman. She has completed the
majority of her undergraduate education in Brazil, but is taking time off because she has
moved to Ithaca with her husband. Her husband, Marcel, enjoys soccer and plays with a
University team once a week. Nathalia participated in sports in high school but since
moving to the United States in July, she has been sedentary. A busy schedule,
unfamiliarity with the area, and lack of social support act as barriers to starting an
Regional demographics play a role in our case studies‟ lack of activity. Coming
from a tropical, warm climate like Brazil Nathalia is not too excited by the cold Ithaca
weather. She states she wants to avoid the cold as much as possible. Ithaca‟s dark,
gloomy weather also tends to generate a lethargic mood in people. These might be
reasons of why the northeast is the second highest in physical inactivity in minority
groups (Crespo, 2000).
Nathalia definitely believes she has many barriers to exercise. She is busy all day
with various activities and enjoys seeing her husband when he returns home in the
evenings. She also is not used to inclement weather and will be avoiding the impending
cold. We believe a large part of the reason she has not begun exercising is that while she
enjoys keeping busy, she focuses on school and work related activities as opposed to
physical ones. She does not recognize the benefits of fitting exercise into her schedule or
prioritizing it and feels that she is already a motivated person. What Nathalia may need
is a reminder of the social and health benefits that physical activity will bring to her life,
as well as the potential health risks that staying sedentary may entail. Her cultural
background could also play into the issue: perhaps the ideal body type is different, or
there is simply less emphasis on physical appearance. Studies have also found that
physical inactivity is more prevalent among Hispanics compared with whites (Weinberg
and Gould, 2003, p. 400). Nathalia‟s Hispanic background plays a role in her adherence
to an exercise program. Americans have an image of the ideal body type which often
encourages a healthy lifestyle. Other cultures, like those in some Hispanic countries, may
not have the same beliefs. Marquez and McAuley (2006) focused directly on the exercise
habits of Latinos, stating they are the highest among all ethnic groups to be inactive
during leisure time. Compared to other cultures, Latinos feel they have little “leisure
time”—a statement reflected in Nathalia‟s description of her busy schedule and barriers
to exercise. Because of this, it is expected they have lower levels of self-efficacy to
exercise. (Marquez & McAuley, 2006). There is little research or comparison between
individual minorities and the beliefs that, as a group, they hold about physical activity.
However, Nathalia does fit into the profile of a female member of a minority group., and
studies have shown “among women, physical inactivity is more prevalent than among
men, as it is among black and Hispanics compared to whites” (Crespo, 2000; Weinberg
and Gould, 2003, p. 400).
The Health belief model best describes Nathalia‟s exercise behavior. This theory
says that “the likelihood of an individual‟s engaging in preventive health behavior
depends on the person‟s perception of the severity of the potential illness as well as his
appraisal of the costs and benefits of taking action” (Weinberg and Gould, 2003, p. 404).
As a young and seemingly healthy woman, it is likely Nathalia does not recognize any
looming medical issues and so is not in the process of taking steps towards adopting the
target health behavior of exercising to prevent any possible health defects.
In addition, the transtheoretical model helps characterize Nathalia‟s intention to
exercise (Weinberg and Gould, 2003, p. 406). She has regularly exercised in the past, but
is currently in transition from the contemplation stage (she intends to exercise in the next
6 months) and the preparation stage (she has attended an occasional yoga class). These
lifetime shifts in Nathalia‟s levels of physical activity show cyclic movement—not linear.
The Transtheoretical model argues that different people require unique exercise
interventions depending on the stages they are in, suggesting a tailor-made intervention
addressing Nathalia‟s barriers and elaborating on the health benefits of exercise would be
the best method for the situation.
Once the proper motivation is established, it is important to track the stages of change
Nathalia is undergoing. Using the transtheoretical model, we can encourage her to
progress through contemplation, preparation, action, to maintenance. Change is not a fast
process and within each step, a different approach of intervention must be taken. We
placed Nathalia started in the contemplation stage as she was seriously intending to
exercise within the next six months. After an intervention about time management, she
moved to the preparation stage by walking a few times a week and preparing to exercise
more often. At preparation, research has shown people put more weight in the „pros‟ of
exercising than the cons. We used the health belief model to help move Nathalia into the
preparation stage by explaining the „pros‟ of exercise and increasing her perceived self-
efficacy (Weinberg & Gould , 2003, p. 64-72).
The health belief model was first introduced in the 1950‟s by social psychologists.
It was first used as a scare tactic to encourage the population to take preventative
measures against the flu virus, but is applicable to exercise adherence. Nathalia expressed
that although she knows exercise is “good”, she does not truly understand the physical,
mental, and emotional benefits of it. By explaining the severity of consequences of
inactivity to Nathalia and her perceived susceptibility to it, she will hopefully begin to
engage in a healthy behavior of exercise. The model also includes the benefits of taking
action as an additional motivator for her. Another end product of the health belief model
is a feeling of self-efficacy because Nathalia will be actively in control of the prevention
of the negative consequences we described to her (Weinberg & Gould, 2003, p. 138-144).
The intervention that we planned was based around the health belief model. This
model is based on two elements with the first being the value someone places on a health
goal, for example in our case the desire for our subject to avoid illness in the future. The
second part the belief one has in the efficacy of a specific personal health goal action to
achieve this health goal (Landry & Solmon, 2002). We felt that the health belief model
was the best strategy to base our intervention on because Nathalia has no competitive
motivation for being involved in physical activity (such as playing on a sports team) and
she is not aware of either the physical benefits of exercise or the risks from lack of
Our goal for intervention was based around educating our subject on the two
aforementioned factors. We began by going through the risks of not exercising on a
regular basis such as higher risk of developing cardiovascular disease and/or
osteoporosis—especially pertinent to Nathalia because women are at a higher risk for the
condition. Personalized it to her specific situation, we detailed the benefits of exercise.
We showed Nathalia how exercise could help increase her focus and energy throughout
her workday, improve her mood and the quality of her sleep cycles, and overall provide
general health improvements. We also discussed the definition of „exercise‟ as part of
our education plan, explaining that she didn‟t have to run six miles everyday it could be
much more simple and easy then that such as taking walks. Staying within the parameters
of the assignment, we did not formulate a regime for her: instead, we referred her to
resources that she could use to plan her exercise program.
The social cognitive theory, which stresses the use of goals to achieve a desired
behavior, was the basis of the next part of the intervention. Studies of adult goal setting
have shown promise in changing physical activity behavior (Shilts, Horowitz,
&Townsend, 2004). To implement this, we educated her about goal setting and
encouraged her to set up goals for herself that were attainable, realistic, and appropriate
for her situation. Specifically, we asked Nathalia to focus on process goals such as just
going to the gym or for a walk 3 days a week. We reviewed the strategy of “flagging the
mine field”, so she could pinpoint what issues could be potential „deal breakers‟ in
obtaining these goals.
Finally, we stressed the importance of her finding social support—for example
going for walks with a partner or exercising with her husband. Additionally, we said we
would communicate with her on a weekly basis and add our own type of social support.
This social support aspect has been identified as key to achieving success in a physical
activity program. In a metastudy done by Shilts, Horowitz, & Townsend (2004), the more
social support for a person received for their exercise program, the more successful the
Nathalia‟s survey results suggest that before beginning her six week exercise
regimen, she has felt substantial amounts of stress but also feels confident in her ability to
cope with it and keep her life under control. She showed a strong positive attitude
towards herself and her accomplishments. In addition, while she expressed some anxiety
over her physique, it was moderate at best. Nathalia does not seem to suffer from low
self-esteem and was comfortable stating that she thought, “I always think that I could
look better, but I rarely think I look bad.”
Nathalia initially cited lack of time as a substantial barrier to her adopting an
exercise regimen. In our intervention, we encouraged Nathalia to create a schedule that
helped her allot time to exercise during her busy week. Due to financial concerns, she
was unable to join a gym or participate in weekly classes, but we felt she came up with an
excellent alternative. Because she is new to the area, Nathalia wanted to become more
familiar with her surroundings and the town of Ithaca. She felt that taking long walks
would not only give her the exercise she needed for the day but also help her in getting to
know the area. In the week following the intervention, she was successful in fitting in
longer duration walks several times a week. The second week, however, Nathalia
unexpectedly got a full-time job as a preschool teacher. She reported that the lifestyle
switch was exhausting and she was unable to find time to fit in a work out. We met with
Nathalia again at the end of the second week and spoke with her about the physiological
benefits of exercise. We explained that maintaining an active lifestyle would actually
boost her energy level and help her adjust to her new schedule. She listened to our advice
and while she was not able to keep up the same routine, she did make an effort to
establish and sustain her developing good habits in the ensuing weeks. A final meeting
after the 6-week period had ended revealed that Nathalia had noticed significant changes
in her energy level and sleep patterns since adopting a minimal exercise routine. She
expressed interest in continuing what she had begun and even increasing her workouts
once she “had more time on her hands.”
Ideally, Nathalia would have picked up and continued an exercise schedule
molded around her busy life. The program we encouraged her to create would have
included 3-5 days of roughly 30 minutes each week. Her first week shows a clear effort,
especially towards the end of the week where she took two longer-duration walks. Once
she started her new job she became distracted and immediately disregarded her routine.
Our second meeting was intended to be a check-in for her, helping to track any
immediate health benefits. However, because she seemed to have lost focus on her goals,
we again discussed the health benefits of exercise with Nathalia, hoping to rejuvenate her
motivation and get her back on track. Nathalia‟s stress level seemed to have risen
substantially since our last meeting and she reported feeling overwhelmed and
overworked. “I barely have time to breathe,” she stated, “let alone fit a walk into my
day.” In response to this, we suggested Nathalia sit down and block out times she could
walk (as that was her preferred activity) during the day, such as her lunch break or before
work. While we did not supervise the actually planning, we assured her that any exercise
was better than none. She responded well to this and even spontaneously found a yoga
class that she felt would relax her when she came home from work. In the weeks
following this second meeting, Nathalia began taking short walks on her lunch break and
attending the yoga class on Wednesday afternoons. As stated above, she developed a
routine and noticed immediate health benefits, including, “more patience with the kids
and the energy to keep up with them.”
We felt our intervention was a success. Not only did Nathalia begin and continue
her exercise regime but she seemed to be doing it for her own benefit, not for ours.
Perhaps she took our counseling to heart and was faithful to her program for future health
benefits, or perhaps it was the immediate and noticeable consequences of her actions that
drove her to persist, but either way she was enthusiastic about continuing the program
past the six weeks. She even announced that she planned on keeping the exercise log as
it helped keep her on track and made her feel confident about being able to fit the walks
into her schedule.
The effectiveness of our intervention was due to several factors. The first was the
social support we provided in the form of several meetings and progress check-ups.
During these meetings we worked to solve any issues she was having in adhering to her
exercise program. Nathalia‟s primary barrier, time, continued to be a major problem. We
worked with her to break down her schedule and helped her see that it was possible to fit
short bouts of exercise in during her lunch break or before work. To reinforce elements
from our first meeting, we continued to instill the benefits of exercise and related it to her
situation, i.e. we addressed her excuse of lack of energy by telling her that exercise can
increase energy levels. This working with her and continue education specific to her was
what seemed to work.
The second and most important factor was of course Nathalia herself. She was
very receptive, did an excellent job of working with us, and listened to what we had to
say and offer. She was also very open and gave us excellent feedback about what was
causing problems with her exercise regime. This was critical because it made it so we
could work with her, altering our strategy as these issues came up. Without the
cooperation of Nathalia, this intervention could not have been as successful.
Our initial plan was not perfect, but it was designed to be flexible. If we had
simple handed Nathalia an exercise program without proper follow ups, we feel that our
intervention would have failed. Instead, we set it up to ensure we could get over potential
barriers as they came along. Nathalia‟s excellent attitude along with our ability to adapt
the intervention repeatedly to issues that she presented us with led to our success with
this intervention. We definitely enjoyed working with Nathalia and feel that we used a
good strategy for our intervention.
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Landry, J. B., & Solmon, M. A. (2002). Self-determination theory as an
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Marquez, D. X., McAuley, E. (2006). Social cognitive correlates of leisure time
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Shilts, M. K., Horowitz, M., & Townsend, M. S. (2004). Goal setting as a strategy for
dietary and physical activity behavior change: A review of literature." American
Journal of Health Promotion. 12: 81-93.
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