casestudy by ashrafp


									                   Exercise Intervention Case Study

                      Subject: Nathalia Campos

Mary Rose Walker                                      EXSS 422
Chris Covino                                          12-20-07
Ashley Hogan
       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

exercise regimen.

       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

program was.

   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.

Crespo, C. J. (2000). Encouraging physical activity in minorities. The
       Physician and Sportsmedicine. 28; 10: 36.

Landry, J. B., & Solmon, M. A. (2002). Self-determination theory as an
         organizing framework to investigate women‟s‟ physical activity behavior. 54: 332-354.

Marquez, D. X., McAuley, E. (2006). Social cognitive correlates of leisure time
      physical activity among Latinos. Journal of Behavior Medicine. 29; 3:281-289.

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.

Weinberg, R, & Gould, D (2003). Foundations of Sport and Exercise Psychology.
      Miami: Human Kinetics Publishers.

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