From behavior change theory to interventions and their implementation - what is needed to promote physical activity?

Abstract

Physical inactivity is known as a risk factor for increased mortality and numerous non-communicable diseases. Worldwide 7.2% of deaths caused by cardiovascular disease are attributable to physical inactivity. In high-income countries, the prevalence of mortality related to physical inactivity is 9.3% (Katzmarzyk et al., 2021).  In addition, low levels of physical activity are associated with the development of major depressive disorder as well as the occurrence of depressive symptoms (Schuch et al., 2018).

Despite the health-enhancing effects of physical activity on both body and mind, physical inactivity is still prevalent. It is estimated that approximately one third of the global population does not fulfill the physical activity recommendations required for a healthy lifestyle. This has been deemed a pandemic of sedentarism (Guthold et al., 2018). In line with these findings the World Health Organisation announced a “Global Action Plan on Physical Activity” in 2018, aiming to reduce global physical inactivity levels by 15% by the year 2030 (WHO, 2018).

Currently, we are also battling another pandemic caused by the Coronavirus disease-19 (COVID-19), an infectious disease leading to decreases in well-being, hospitalizations and the loss of lives worldwide. These circumstances are impacting health behaviors such as physical activity, eating habits and sleep patterns (Ammar et al., 2020). Importantly, evidence shows that regularly meeting physical activity guidelines is strongly associated with reduced risk of severe outcomes from COVID-19 infections (Sallis et al., 2021). In addition, physical activity may ameliorate some of the negative psychological effects experienced during state legislated lock-downs (Wolf et al., 2020).

Hence, physical activity has been named an option to tackle both pandemics at once. To do so, it is important to investigate new and effective ways to promote physical activity at different levels: theoretical explanations for sustained physical inactivity, effective interventions to address the issue and how to successfully implement these in existing or newly generated political and cultural settings. 

For example, dual-mode theories of behavior change including reflective and affective processes in addition to motivational capacities are being explored (Ekkekakis, 2009; Brand & Ekkekakis, 2018). These can give new insights into the mechanisms behind decisions driving physical activity behavior. Technology is providing ever-new methods with which to design and deliver interventions targeting these underlying processes. Moreover, a new definition of physical activity has been suggested. Beyond the focus on bodily movement, skeletal muscle, and energy expenditure now moving, acting and performing in different spaces and contexts taking individual influences into account is being emphasized (Piggin et al., 2020). These developments may facilitate a holistic approach involving individual, interpersonal, community and policy levels. In turn this may contribute to achieving the goal of reducing physical inactivity and reaping the much needed health-enhancing benefits during these times.