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Exercise as a Healthy Lifestyle Choice: A Review and Avenues for Future Research

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Abstract

The health benefits of exercising and the prevalent sedentary lifestyle give a strong reason for the research into the determinants of exercise behaviour. The present paper reviews several health-related behavioural theories and models that have been applied to understand the factors influencing physical activity or exercise participation and suggest avenues for future research. In particular, a review of literature provides strong empirical support for the theory of planned behaviour, yet several theoretical issues need to be resolved to aid in the development of a more comprehensive health-related model that can explain and predict exercise behaviour. The present paper highlights that there is a need to develop and empirically test a more integrative model of exercise behaviour from consumer behaviour perspective. Besides, the conceptualisation of TPB measures and sufficiency issues related to the model need to be addressed prior to the adoption of the TPB model.
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Exercise as a Healthy Lifestyle Choice:
A Review and Avenues for Future Research
Yap Sheau Fen
School of Arts & Social Sciences
KDU College Sdn Bhd
SS22/41, Damansara Jaya, 47400 Petaling Jaya
Selangor Darul Ehsan, Malaysia
Tel: 60-12-266-4262 E-mail: crystalyap@kdu.edu.my
Liew Kok Hong
Universiti Utara Malaysia
06010 UUM Sintok
Kedah Darul Aman, Malaysia
Tel: 60-12-289-6641 E-mail: kokhong_liew@yahoo.com
Abstract
The health benefits of exercising and the prevalent sedentary lifestyle give a strong reason for the research into the
determinants of exercise behaviour. The present paper reviews several health-related behavioural theories and models
that have been applied to understand the factors influencing physical activity or exercise participation and suggest
avenues for future research. In particular, a review of literature provides strong empirical support for the theory of
planned behaviour, yet several theoretical issues need to be resolved to aid in the development of a more comprehensive
health-related model that can explain and predict exercise behaviour. The present paper highlights that there is a need to
develop and empirically test a more integrative model of exercise behaviour from consumer behaviour perspective.
Besides, the conceptualisation of TPB measures and sufficiency issues related to the model need to be addressed prior
to the adoption of the TPB model.
Keywords
: Theory of Planned Behaviour, Consumer Healthy Lifestyle, Exercise
1. Introduction
There is a growing focus on health related issues in the media and an increasing government spending on health
campaigns in Malaysia. The initiative to improve public health on the part of government has undoubtedly contributed
to the increased public awareness of the importance of healthy lifestyle. Lifestyles or simply ways of living are one of
the most significant factors influencing individual health and wellness (Divine and Lepisto 2005). From the marketing
perspective, consumer healthy lifestyle creates new opportunities and driving innovation and at the same time presents
marketing challenge to marketers in the health-related industries such as fitness clubs, food, health care, insurance, and
medical. The changing consumer attitude and behaviour toward healthy lifestyle will certainly heighten their interest in
healthier products and services choices. This is evident by the extensive growth of health spas and fitness clubs business
that spread across urban cities in Malaysia recent years (Ramli 2005).
Bloch (1984) views healthy lifestyle as an orientation toward health prevention for the maximisation of personal
wellness. While healthy lifestyle encompasses a wide variety of behaviours, most healthy lifestyle research has focused
on diet and exercise (Divine and Lepisto 2005). Kraft and Goodell (1993) notice that consumer shift in exercise and
dietary behaviours have been the most visible lifestyle change. From a marketing perspective, exercise is associated
with an orientation toward consumption as they are a set of activities, interests, and opinions that are related to the
consumption of various health-related products and services (Kraft and Goodell 1993). Exercise is regarded as a
recognised component of healthy lifestyles and desired public health behaviour (Bungum and Morrow 2000). The
discussion of the present paper focuses on exercise as one of the components of healthy lifestyle behaviour.
Regular physical activity and fitness contribute to overall health and fitness (Ooyub and Omar 2002). It is widely
known that regular exercise is associated with a significant decline in the risk of cardiovascular complications, high
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blood pressure, obesity and weight management, and mortality rates. Regular exercise also helps in the reduction of
symptom of depression and anxiety (Blair 1993). Despite the facts that these positive physical and psychological
benefits of exercise are well documented and well publicised, levels of physical inactivity are increasing worldwide
(Bond and Batey 2005). Due to the various health and social problems associated with sedentary lifestyle, research into
investigating determinants affecting exercise behaviour is warrant. Analysing exercise behaviour can lead to a better
understanding of how these related factors interact and influence each other, thus building a deeper understanding of
complex consumer behaviour.
A thorough understanding of what drives Malaysian adopting healthy lifestyle is paramount. However, little research
related to exercise and fitness has been found in the marketing literature. Very few studies have examined exercise
behaviour in Malaysia. Most of these studies are commercial like survey or academic research that covers
incomprehensive analysis of the predictors of exercise behaviour. Health-related marketing is not as simple as
classifying consumers into “healthy” or “unhealthy” groups. A complex balance of appropriate factors should be taken
into account in developing a solid theoretical model to examine the underlying factors determining health-related
lifestyle behaviour.
The present paper reviews several health-related behavioural theories and models that have been applied to understand
the factors influencing physical activity or exercise behaviour participation. Several key research issues will be
identified to aid in the development of a more comprehensive health-related model that can explain and predict a
specific desired health behaviour, exercise. Such model could be useful to health care marketers in segmenting markets,
targeting promotions and positioning products and services. Armed with this knowledge, marketing practitioners can
then find potential market opportunities and to determine the appropriate marketing mix in order to develop practical
and effective marketing strategies.
2. Healthy Lifestyle and Marketing
The impact of healthy lifestyle behaviour on both consumer and society has been an issue and concern of both
marketers in the health-related industries and public policy makers for long. Healthy lifestyle promotion is associated
with consistent health conscious behaviour like quitting unhealthy behaviours such as smoking, alcohol consumption, or
sedentary behaviours; and practicing healthy behaviours like regular exercise, healthy dietary practices, weight control,
and managing stress (Nahas, Goldfine and Collins 2003). Overall, healthy lifestyle behaviours are activities
undertaken to protect, promote or maintain health (Steptoe, Wardle, Vinck, Tuomisto, Holte and Wichstrøm 1994) as
well as an orientation toward health prevention for the maximisation of personal wellness (Bloch 1984).
The spread of contagious diseases as well as the rising statistics of illnesses such as diabetes, heart attack, and cancers
have heightened the importance of maintaining healthy lifestyle. Malaysians are increasingly conscious of the food and
supplements they eat, the quality of drinking water and air as well as the general state of health, especially among
population of middle to higher social-economic class group. Many health experts and nutritionists have generally
reached consensus that that consumers can reduce the risk of illnesses such as heart disease, stroke, and cancer by
monitoring their diets and by maintaining a healthy lifestyle including regular exercise (Rimal 2002). Therefore,
promotion of health lifestyle or health seeking behaviour is an effective way to reduce or even to avoid the medical
costs of treating such preventable illnesses associated with lifestyle behaviours (Murrow and Welch 1997).
Healthy lifestyle encompasses variety of behaviours such as healthy diet, tobacco-free lifestyle, regular exercise,
substance use, cautious preventive practices, weight control and supportive environment (Omar 2002). Most researchers
work on healthy lifestyle behaviours have focused their research on diet and exercise (Divine and Lepisto 2005). In
addition, exercise and dietary behaviours have been recognised as the most visible lifestyle shift among consumers
(Kraft and Goodell 1993). Generally, people rely on regular exercise as a means to maintain both their physical health
and psychological well-being (Plante and Rodin 1990). There are increasing concerns about health and fitness among
Malaysian especially among urbanite and higher social class groups. Health conscious consumers adopt varying
strategies at different intervention levels in an attempt to adjust their lifestyle behaviours. These strategies include
healthy diet, regular exercise as well as efforts in balancing work stress. Some consumers go beyond these basic steps to
seek fast results such as consuming health supplements, slimming and low calorie diet, and the purchases of exercise
equipment.
All these trends have strong implications to both marketers and policy makers. The increased public awareness of health
lifestyles has resulted in great business opportunities for many marketers and lead to a wide range of new consumer
products and services. For instance, in the food industry, numerous low-fat, low cholesterol, low-sugar, and
low-preservative foods have come on the market and have been widely promoted. It is also evident that medical
services such as homeopathic treatment based on herbs, acupuncture and traditional massage are becoming popular in
Malaysia. The health club and various fitness programs have spread across urban areas in the country. Several fitness
trends such as the embracement of home exercise equipment; diversified forms of exercise and fitness club popularity
are evident among urbanite, more affluent and educated population (Ramli 2005).
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Marketers in the health industry also face considerable marketing challenges partly due to consumers’ unhealthy habits
and preference to sedentary lifestyle which are evident in the media reports of obesity, smoking, lack of exercise (Mohd
Shariff and Khor 2005), and poor eating habits among Malaysian (Mohamad 2000). The shifts in consumer buying
patterns have greatly altered the way many marketers in the food, healthcare and medical services industry market their
brands. Marketers start to embrace innovative marketing strategies and findings ways to differentiate themselves in the
competitive market. Those in the advertising business are also aware of the changes and making much adjustment to
make their advertisement more appealing to consumers. A comprehensive model in understanding and explaining health
behaviour will definitely contribute to the design of effective marketing strategies and programs.
3. A Review of Health Behavioural Models
Several health-related behavioural theories and models have been applied to understand the factors influencing physical
activity or exercise behaviour participation. Biddle and Nigg (2000) organise these theories and models into the
following four categories: 1) belief-attitude theories (i.e., health belief model, protection motivation theory, theory of
reasoned action TRA and planned behaviour); 2) competence-based theories (i.e., self-efficacy theory); 3) control-based
theories (i.e., locus of control, self-determination theory); and 4) decision-making theories (i.e., transtheoretical model
of stages of change). A brief review of these models will be provided in this section.
3.1 Health Belief Model (HBM)
The HBM model originated in the 1950’s based on the work of Rosenstock was developed to explain why people did or
did not engage in certain health behaviours, such as drinking, self-screening, smoking, and dietary behaviours. This
model contends that the decision to adopt the health behaviour depend on their perceived benefits and barriers related to
the implementation of the behaviour change (Rosenstock, Stretcher and Becker 1988). Within the theoretical context of
the HBM model, perceived barriers are directly related to perceived severity and susceptibility, while perceived benefits
are the perceptions that certain behaviour change will be effective in reducing a barrier (Wood 2008). The HBM
assumes that a person will adopt certain health behaviours if they feel the consequences are severe and feel susceptible
to that illness (Rosenstock, Stretcher and Becker 1988) (see Figure1).
The HBM model has been applied in the health promotion and lifestyle behaviour studies. For instance, Jayanti and
Burns (1998) develop and test a model of preventive health care behaviour basing on the HBM model. Grubbs and
Carter (2002) also modify the HBM framework in an attempt to examine current exercise habits and perceived benefits
and barriers to exercise. However, the HBM model has proven to be more valuable in understanding why people cease
certain unhealthy behaviour (e.g., smoking or drugs taking) rather than the adoption of healthy behaviour (e.g., exercise,
healthy eating) (Nahas, Goldfine and Collins 2003). In an extensive review on exercise behaviour, Biddle and Nigg
(2000) conclude that the application of HBM model to exercise or physical activity has yielded little success in
predicting the adoption or maintenance of exercise participation. In agreement with this, Wood (2008) states that the
HBM has limited application in examining motivation to exercise participation. However, Wood (2008) observes that
the addition of self-efficacy construct into the model has improved its applicability in exercise domain.
3.2 Theory of Reasoned Action (TRA) and Planned Behaviour (TPB)
The TPB is an extension of the TRA (Fishbein and Ajzen 1975). The TPB extended the TRA by adding the perceived
behavioural control (PBC) because the TRA has difficulty in explaining behaviours in which a person does not have
volitional control over it. The TPB model (see Figure 2) posits that intention to perform a given behaviour is the
immediate antecedent of that behaviour (Ajzen 1991). Behavioural intention refers to the amount of effort a person
exerts to engage in behaviour. It captures the motivation factors necessary to perform a particular behaviour (Courneya,
Bobick and Schinke 1999). That is, the more a person intends to carry out the intended behaviour, the more likely he or
she would do so (Armitage and Conner 1999a). Intention is determined by three conceptually independent variables
labelled attitude, subjective norms and PBC. Generally, the more favourable the attitude and subjective norm, and the
greater the perceived behaviour al control, the stronger should be the individual’s intention to perform a particular
behaviour (Ajzen 1991).
The efficacy of the TPB model has been demonstrated empirically in many different contexts. The TPB model has also
been widely applied to health-related behaviour such as food purchase behaviour, dietary supplement consumption and
healthy eating behaviour. Specifically, the TPB models have proven useful in explaining and predicting exercise
behaviour (e.g., Courneya, Bobick and Schinke 1999; Norman, Conner and Bell 2000; Rhodes, Blanchard and
Matheson 2006). In all these studies, the researchers have introduced a modified version of the TPB model in their
study and the results were different from those of the original TPB model.
3.3 Protection Motivation Theory (PMT)
The PMT, proposed by Rogers in the 1980s, is a model that has several similarities with the HBM (Biddle and Nigg
2000) (see Figure 3). This model contends that intention to engage in a particular health-related behaviour is influenced
by a person’s perceived severity, perceived vulnerability / probability, response efficacy, and perceived self-efficacy,
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which collectively terms as threat and coping appraisal (Wood 2008). PMT has often been implemented in experimental
manipulation studies (Milne, Orbell and Sheeran 2002) and has been applied successfully to several health-related
behaviours, including exercise, healthy lifestyle, cancer prevention, smoking and alcohol consumption, AIDs prevention,
medical treatment compliance, road safety behaviours, and environmental protection (Floyd, Prentice-Dunn, and Rogers
2000).
However, the use of PMT in an exercise context is relatively few (Biddle and Nigg 2000). Based on PMT to investigate
the use of written communications to increase exercise behaviour among 170 sedentary college women, Wurtele (1983)
found perceived self-efficacy to have the strongest direct effect on exercise intentions, indicating the important role of
self-efficacy in examining exercise participation. This is consistent with Biddle and Nigg’s (2000) extensive review on
exercise behaviour that highlight the role of self-efficacy as an important construct in physical activity motivation. The
strength of self-efficacy as a predictor of behavioural changes is evident as the construct was added to the HBM and PMT
and the Transtheoretical Model subsequently (Biddle and Nigg 2000). Another issue to be highlighted is that although
PMT has been found to predict intention to change behaviour well but the PMT is limited in explaining actual behaviour
(Floyd, Prentice-Dunn, and Rogers 2000). It is possible that a person with intention to perform a particular behaviour may
not actually do so eventually (Milne, Orbell and Sheeran (2002).
3.4 Self-efficacy Theory (SET)
The SET is sometimes referred to as Social Cognitive Theory (SCT) which is an extension of social learning theory (see
Figure 4). The concept of self-efficacy is a major construct in the SET model proposed by Bandura (1977). Specifically
in the physical activity domain, Nahas, Goldfine and Collins (2003, p. 47) define self-efficacy as the “perceptions of
personal efficacy or confidence regarding one’s ability to be active on a regular basis.” The SET explains behaviour
through two major constructs: 1) self-efficacy (i.e., the belief that one has the capabilities to perform a behaviour that
will result in an expected outcome); and 2) outcome expectancies (i.e., the expected consequences of successful
behaviour performance). The antecedents of self-efficacy and outcome expectancies are modelling, verbal persuasion,
emotional arousal, and mastery experiences (Biddle and Nigg 2000).
The concept of self-efficacy has received great attention and has subsequently been adopted and modified by other
authors as additional construct in their original model. Within the TPB framework, Ajzen (1991) argues that the PBC
construct is synonymous with self-efficacy. However, several researchers (e.g., Hagger and Chatzisarantis 2005; Rhodes
and Blanchard 2006; Rhodes, Blanchard and Matheson 2006) modelled the PBC construct as two separate components
(i.e., perceived control and self-efficacy) and have provided evidence for a distinction between self-efficacy and
perceived control. According to Biddle and Nigg (2000, p. 297), the “SET has been one of the more successful theories
in the exercise behaviour field even though there are several different conceptualisation of efficacy measurement.”
Consistent with this statement, in an attempt to identify an appropriate theoretical framework to study exercise
participation, Wood (2008) highlights that perceived self-efficacy from the social cognitive theory has been consistently
shown to be the most common factor in motivating exercise participation. Future research should consider the concept
of self-efficacy in examining exercise behaviour.
3.5 Locus of Control (LOC)
The concept of LOC is defined as “the extent that people perceive that reinforcements are within their own control, are
controlled by others or are due to chance” (Biddle and Nigg 2000, p. 298). In the TPB model, Ajzen (2002) advocates
the difference between PBC and LOC in terms of their conceptualisation. Also, while LOC is a generalised belief that
remains stable across circumstances, a person’s PBC may vary across situations and actions (Ajzen 1991). The use of
LOC in predicting fitness and exercise behaviours has been receiving weak support (Biddle and Nigg 2000). In contrast
the concept of self-efficacy and perceived control have received greater support for the prediction of fitness and
exercise behaviour.
3.6 Self-determination Theory (SDT)
Deci and Ryan's (1985) Self-determination theory (SDT) contends that individual have three primary psychological
needs (i.e., autonomy, competence, and relatedness) that lead them to seek and meet challenges in life. According to
SDT, there are three types of motivation: 1) Amotivation (i.e., lack of intention toward a behaviour); 2) extrinsic
motivation (i.e., performance of an activity to attain an outcome); and intrinsic motivation (i.e., participation in an
activity for the pure enjoyment of the activity) (Wood 2008). Among these three types of motivation, intrinsic
motivation is a key determinant of subsequent behaviour (Deci and Ryan 1985). This suggests that when a person
enjoys and feel interested in exercise activities they are more likely to engage in exercise behaviour. The SDT is quite
well known in the field of sport psychology (Biddle and Nigg 2000) and has been used as a theoretical framework to
examine exercise motivation (Wood 2008). For instance, in a cross-sectional survey utilising the Self-Determination
Theory (SDT), Wilson and Rodgers (2004) examine the relationship between perceived autonomy support, exercise
regulations and intention to continue exercising.
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3.7 Transtheoretical Model of Stages of Change (TTM)
The TTM (also called the Stages of Change) was originally proposed by Prochaska and DiClemente (1983) (see Figure
5). This model posits that individual tends to change health-related behaviours, such as smoking, exercise, healthy diet
eating, by moving through stages of behavioural change that reflect their readiness to change. The five behavioural
stages are precontemplation, contemplation, preparation, action, and maintenance (Prochaska, Diclemente, and
Norcross 1992). The Transtheoretical model has been applied to a wide variety of health-related behaviours such as
smoking cessation, dietary fat reduction, and exercise behaviours (O’Hea, Wood and Brantley 2003). For instance,
Cardinal, Tuominen and Rintala (2004) assess American and Finnish college students’ exercise behaviours on the basis
of TTM and the results generally support the use of TTM in understanding exercise behaviour among college student
population. In the exercise domain, the use of TTM was initiated with measurement development followed by scale
validation. Since then, several researchers have used the TTM to develop exercise interventions (Biddle and Nigg
2000).
Although the TTM model has been popularly used to examine exercise participation, the model has attracted criticism
for the lack of standardised procedure to categorise respondents into different stages of change (Povey, Conner, Sparks,
James and Shepherd 1999) and its inability to adequately predict behavioural change (Armitage and Arden 2002). For
example, in a study testing the ability of the TTM in predicting exercise stage transition of a random sample of
Canadian adults, Plotnikoff, Hotz, Birkett and Courneya’s (2001) findings demonstrate only partial support for the
internal validation of TTM in the exercise domain.
In comparing TPB with TTM, Courneya and Bobick (2000) argue that the TPB may be a more comprehensive and
sophisticated model for explaining health-related behavioural change despite the facts that both models share many
conceptual similarities. It is also worth highlighting that the concept of self-efficacy has been successfully incorporated
into the TTM (Biddle and Nigg 2000). In an attempt to examine adolescent’s exercise behaviour using the TTM, Nigg
and Courneya (1998) found that self-efficacy tend to increase across the stages of exercise behaviour change. These
findings again indicate the importance of self-efficacy construct in the exercise behaviour study.
4. Determinant of Exercise Behaviour
Determinants refer to those factors that potentially influence behaviour in question. Nahas, Goldfine and Collins (2003)
classify determinants of exercise behaviour into two categories: 1) facilitators (refers to determinants that promote
exercise participation); and 2) barriers (refers to determinants that discourage or restrain participation in exercise
activities). In another study, Furlong (1994) divides the factors that influence exercise behaviour into two major
categories, i.e., environmental and personal characteristics. In his study, Furlong (1994) views environmental
characteristics as physical and social environmental factors that are associated with exercise and physical activity,
which include spouse and family support, perceived available time, access to facilities, peer influence, cost, climate, etc.
Whereas, personal characteristics are defined as past or present knowledge, attitudes, behaviours, personality
characteristics, biomedical traits, and demographic factors that may influence exercise behaviour.
Over the years, much research has been conducted to examine which variables determine exercise behaviour. Whether
an individual participates in exercise behaviour depends on a variety of factors. For instance, Kerner and Grossman
(2001) state that these factors may include past program participation, high risk for coronary heart disease, perceived
health, level of education, self-motivation, self-efficacy, behavioural skills support by a significant other, perceived
available time, access to facilities, family influences, peer influences, cost and attitude toward physical activity. Nahas,
Goldfine and Collins (2003) view the performance of exercise behaviour as a complex process, which may be affected
by various intrapersonal, interpersonal, and environmental factors such as demographic and biological factors;
psychological, cognitive, and emotional factors; behavioural attributes and skills; social and cultural factors; physical
environment factors; and physical activity characteristics. It was observed that some of these determinants or factors
have been captured in a number of health-related theories and models discussed aforementioned in the previous section.
It is now evident that behavioural change isn’t a simple process. To summarise the above factors that influence exercise
behaviour, one may group them into several major categories as: (1) attitude toward exercise; (2) social or normative
influence; (3) perception of control; (4) self-efficacy; (5) motivation (6) demographic factors; (7) personality
characteristics. It is known that the TPB model contains social cognitive constructs such as attitude, subjective norm
and PBC as well as intention (which captures motivational factor). Whereas the demographic and personality factors are
background data postulated in the TPB (Ajzen and Fishbein 1980; Ajzen 1991). Hence, it seems that the TPB would be
a comprehensive and useful framework for examining exercise behaviour.
5. A Comparison between TRA and TPB
Other than the aforementioned theoretical models adopted in examining exercise behaviour, there are also
non-theoretical based studies in the domain. These studies employed no theory and often used demographic variables
and rely on more intuitive predictors in examining exercise behaviour. For example, Bungum and Morrow (2000)
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examine the differences in self-reported rationale for increased physical activity by ethnicity and gender among
randomly selected American household. Another example is Trujillo, Brougham and Walsh’s (2004) study in
examining age differences and the levels of concern for various types of exercise consequences. Nonetheless, the
understanding and promotion of health-related exercise and physical activity needs to be based on appropriate theory
(Biddle and Nigg 2000). Despite the number of social psychology theories available, there is no general consensus
exists regarding which is the best theoretical framework for the studying exercise behaviour (Wood 2008). However, a
review of literature revealed that the TPB has been successfully applied to exercise behaviour.
In terms of predictability, there are sufficient empirical evidence indicates that the addition of PBC to the original TRA
model has yielded significant improvements in the prediction of intention and behaviour (Ajzen 1991). In comparing
the predictability of TRA and TPB model, several meta-analyses have provided support that the TPB is a useful model
for predicting behavioural intentions and behaviour in variety of context. For instance, a review of 16 studies using TPB
by Ajzen (1991) revealed a considerable amount of explained variance in intentions can be accounted for by attitude,
subjective norm, and PBC; with an average correlation of .71. For health behavioural studies, Godin and Kok’s (1996)
meta-analyses found that PBC contributed a mean additional variance of 13% to the prediction of intentions and 12% to
the prediction of behaviour.
Specifically, Hausenblas, Carron and Mack (1997) report a meta-analysis on applications of the TRA and TPB to
exercise behaviour and conclude that the TPB is more useful than the TRA in the exercise domain. Further, the efficacy
of TPB also holds in experiment setting. Notably, the consistent findings across four different health behaviours in two
experimental studies conducted by McCaul, Sandgren, O’Neill and Hinsz (1993) clearly support the predictive ability of
the TPB for the performance of health behaviour. Yet in another study longitudinal study, Armitage and Conner’s
(1999b) study on food choice behaviour demonstrated that TPB constructs are stable predictors across time points.
Theoretically, the TPB model is more appropriate and comprehensive in predicting exercise behaviour compared to the
TRA. This is because whether to exercise or not is not entirely under a person’s volitional control. There are some
control factors that may affect individual’s exercise participation such as physical inability, time and money constraint,
neighbourhood security, availability of exercise equipments and so on. Hence, it is deemed to be necessary to examine
beyond the attitude and subjective norm construct in the TRA but to explore further the control factor that possibly
influence individual’s exercise participation.
6. Rationale for the Adoption of TPB Framework
As discussed, there exist many other social psychology models in health-related studies. The TPB model represents the
most appropriate theoretical framework for the study of exercise behaviour due to a number a reasons. Firstly, many
researchers agreed that TPB represents the most compelling and well-established model for the prediction of intentional
behaviour (Biddle and Nigg, 2000; Courneya and Bobick 2000; Armitage and Christian 2003; Rivis and Sheeran 2003).
For instance, in their meta-analysis, Rivis and Sheeran (2003) advocate that the TPB is the most influential theory for
the prediction of social and health behaviour. More specifically, in the exercise domain, Rhodes, Jones and Courneya
(2002) point out that the TPB is the most validated and prominent social cognitive theories for understanding and
explaining exercise behaviour.
Second, one of the main indicators of the validity of a theory is that it needs to be demonstrated that the particular
theory works under a variety of context (Bamberg, Ajzen and Schmidt 2003). Sheppard, Hartwick and Warshaw (1988,
p.338) conclude in a meta-analyses that “the TPB model has strong predictive utility, even when utilised to investigate
situations and activities that do not fall within the boundary conditions originally specified for the model”. In line with
Sheppard, Hartwick and Warshaw’s (1988) argument, it is evident that this theory has received good empirical support
in predicting a wide range of behaviours (For meta-analyses, see Sheppard, Hartwick and Warshaw 1988; Godin and
Kok 1996; Armitage and Conner 2001). Its strength in terms of broad applicability also found spanning the areas of
social psychology, sports science, nursing, health medicine, information technology, etc (Notani 1998; Armitage and
Conner 1999b). For instance, Godin and Kok’s (1996) review of the Ajzen’s TPB in the health domain indicated that
the theory performs very well for the explanation of both intention (with averaged R² of .41) and behaviour (with
averaged R² of .34). Further, in their meta-analysis reviews of the TPB and exercise literature, Hausenblas, Carron, and
Mack (1997) and Hagger and Chatzisarantis (2005) support the utility of the TPB for understanding and predicting
exercise behaviour.
Third, the TPB is a parsimonious model (Abraham and Sheeran 2003) and hence relatively small number of variables is
sufficient to ensure accurate prediction of behaviour. This theory is deemed appropriate as it covers major factors that
are important in the present study such as attitude, normative influences, perception of control over exercising, and
behavioural intention. Next, a theoretical model that can explain multidimensional determinants of exercise behaviour is
needed. In this instance, the TPB allows the investigation of personal, social and psychological influence on individual
exercise behaviour more comprehensively (Godin and Kok 1996; Hausenblaus, Carron and Mack 1997). Many theories
and models have been used to examine the multidimensional (e.g., cognitive, social, behavioural) factors that affect
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individual exercise behaviour over the years (Symons Downs and Hausenblas 2003). While all of these models have
shown some utility in understanding exercise behaviour, Biddle and Nigg (2000) claim that the TPB is still the most
comprehensive and validated theories used in examining exercise behaviour.
Fourth, the TPB provides a systematic guidelines and clearly defined structure/framework that could guide researchers
on how to measure social cognitive constructs specified by the model in achieving greater predictive accuracy (Ajzen
and Fishbein 1980). For example, Ajzen (1991) highlights the importance of adhering to the boundary condition of
correspondence within the TPB to ensure that measures of TPB construct are compatible (i.e., all refer to the same
action, target, context, and time). The guidelines on TPB questionnaire construction as well as sample questionnaires
are easily accessible online. Lastly, the model is useful for the explanation and prediction of consumer behaviour
utilising behavioural intentions as a mediator (Ryan and Bonfield 1975).
Indeed, there is no general consensus among researchers exists regarding which is the best theoretical framework for the
studying exercise behaviour (Wood 2008). Since the TPB contains social cognitive factors that are common to most of
the other behavioural theories and models, it is deemed to be a promising framework basis from which a more
integrative model of exercise behaviour may be developed. Abraham and Sheeran (2003, p. 265) state that “as a model
of the cognitive antecedents of behaviour, the TPB is parsimonious, empirically supported and can be operationalised
easily, according to available guidelines”. This quotation summarised the above rationales for using the TPB as a
framework base for the examining behavioural studies.
7. Conclusion
The Health Ministry has been putting much effort in health promotion by educating the public about the importance of
health. However, despite the fact that Malaysian general public is aware of the benefits of exercising and the potential
risks of physical inactivity especially among those in middle and higher socio-economic status, there is still low
participate rate in exercise activities. The government is concerned with the health issues that will affect the
productivity and consequently, the nation economy in view of the importance of health as an asset in the development
of human capital. However, the fact is that health awareness and knowledge have little influence on individual exercise
participation despite various health promotion campaign organised by the government agencies. In fact, an empirical
study conducted by Jayanti and Burns (1998) demonstrates that health knowledge has no significant effect on
preventive health care behaviour. There might possibly be other social and/or psychology factors that influence
individual exercise participation. With regards to the application of TPB model, several issues were observed from a
review the past exercise research applying the TPB. These research issues need to be addressed in future research and it
includes:
1.
The sufficiency of the TPB model has been questioned despite numerous empirical supports for the use of the
model. Most of the researchers approached the sufficiency issues by including additional constructs in the original TPB
model and tend to demonstrate improvement of predictive ability of their model (Armitage and Conner 2001; Hagger,
Anderson, Kyriakaki and Darkings 2007). However, Ajzen (2001) commented that most part of the improvement in
predictive ability were relatively small and hence the results are not generalisable to other behavioural domains despite
the fact that significant improvements were found in these studies.
2.
Also, relating the issue of sufficiency, most of the TPB researchers often rely on more intuitively and arbitrarily
derived predictors (Bakker, Van Der Zee, Lewig and Dollard 2006) as the additional variables in their framework. Very
few researchers have looked into a more comprehensive and integrative model which enable the examination of
predictors that influence exercise behaviour simultaneously. There is a need to develop an integrative model in order to
provide more comprehensive and coherent view points in the study of exercise behaviour.
3.
Exercise research has received great attention in the literature from various disciplines such as health science,
medicine, health and social psychology. Most of these exercise behaviour related studies were conducted in the West;
there have been very few studies examining the psychosocial predictors of exercise behaviour from consumer behaviour
and/or marketing perspective.
4.
It is generally agreed that self-efficacy has been an important construct in studying exercise and / or physical
activity (Wood 2008). Evidently, the concept of self-efficacy has been included into several social psychology models
such as TTM, HBM, and TPB (Biddle and Nigg 2000) as additional variable in predicting health behaviour. However,
Ajzen (1991) argues that the self-efficacy construct is synonymous with PBC within the TPB framework. Future
research should consider the concept of self-efficacy in examining exercise behaviour. Also, the distinctions between
PBC and self-efficacy should be made clear before conclusion can be drawn.
5.
The TPB predictors (i.e., attitude, subjective norm, and PBC) are traditionally measured as single concepts (Ajzen
1991). It has been a common practice to aggregate TPB components to form higher order TPB constructs (Armitage and
Conner 2001; Ajzen 2002) in recent years. However, some researchers argue that this higher order structure may
overlook the variation in the predictive ability of the differentiated TPB components, and hence defeat the purpose of
International Business Research January 2009
153
differentiating them in the first place (Hagger and Chatzisarantis 2005). There are also attempts to modify the original
TPB model as correlated multidimensional measures and has yielded conflicting findings regarding the optimal
conceptualisation of TPB constructs.
6.
Biddle (1992) suggests that the study of exercise behaviour should be conducted in different settings and should
also take into consideration the different types of exercise programs and physical activity. Nevertheless, it was observed
that some researchers in the exercise domain have focused on narrow and specific aspects of the exercise such as
aerobic, strength training, cardiovascular training, walking, running, jogging, and gymnasium. Also, while majority of
the TPB studies in exercise domain have used undergraduate students as their subjects with the focus on adolescent
exercise and / or physical activity behaviour, others have used specific population like clinic patient, school children
and youth, obese women, and pregnant women.
7.
Early studies in the exercise domain rely heavily on exploratory data analysis techniques such as regression
analysis. The use of structural equation modelling (SEM) techniques in examining exercise behaviour is gaining
popularity. To overcome the limitations associated with the traditional multivariate analysis (Byrne 2001), SEM
technique should be used to specify, estimate and test a hypothesised model effectively (Bentler 1990).
In view of these conflicting findings and shortcomings in the literature, there is a need to address these issues with an
attempt to advance knowledge on health-related behavioural studies and provide practical marketing implications for
health-related products or services providers. An integrative model of exercise behaviour should be proposed and
empirically tested based on the research issues identified in the present paper.
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Figure 1. Health Belief Model (HBM)
Source: Adopted from Baranowski, T., Cullen, K. W., and Baranowski, J. (1999). Psychosocial Correlates of Dietary
Intake: Advancing Dietary Intervention. Annual Review of Nutrition, 19, 17-40
Figure 2. The Theory of Planned Behaviour. Version 1 assumes PBC has an indirect effect on behaviour. Version 2
assumes PBC has a direct effect on behaviour.
Source: Adopted from Ajzen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and Human
Decision Processes, 50 (2), 179-212.
Behavioural
Intentions Behaviour
Perceived
Behavioural
Control
Subjective
Norms
Attitudes
Behavioural
Beliefs
Normative
Beliefs
Control
Beliefs
1
2
Perceived
Severity
Readiness to
Act
Perceived
Susceptibility Barriers
Benefits
Behaviour
Cues to act
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Figure 3. Protection Motivation Theory
Source: Adopted from Biddle, S. J. H., and Nigg, C. R. (2000). Theories of Exercise Behavior. International Journal of
Sport Psychology, 31, 290-304
Figure 4. Self-Efficacy Theory
Source: Adopted from Biddle, S. J. H., and Nigg, C. R. (2000). Theories of Exercise Behavior. International Journal of
Sport Psychology, 31, 290-304
Modelling
Ve rb a l
Persuasion
Emotional
Arousal
Mastery
Experiences
Self-
Efficacy
Outcome
Expectancies
Behaviour
Perceived
Severity
Perceived
Vulnerability
Efficacy of
Preventive
Behaviour
Perceived
Self-efficacy
Intention
to Protect
Protective
Behaviour
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Figure 5. Transtheoretical Model of Stages of Change (TTM)
Source: Adopted from Baranowski, T., Cullen, K. W., and Baranowski, J. (1999). Psychosocial Correlates of Dietary
Intake: Advancing Dietary Intervention. Annual Review of Nutrition, 19, 17-40
Precontemplation Contemplation Preparation Action Maintenance
Pros/Cons Self-Efficacy
Processes of Change
Relapse
Prevention
... Finally, since nonparticipation in MFIs is a behavioral activity and a social phenomenon with a mixture of subjective and objective elements, any investigation on nonparticipation in MFIs remained incomplete if it does not take into account intention of human individuals and its antecedents (Ajzen & Fishbein, 2005). Hence, it is imperative to explore the reasons behind the low participation in MFIs in Bangladesh by adopting a behavioral theory that has been widely cited and applied extensively in the social psychological research (Abraham & Sheeran, 2003;Fen & Hong, 2009). A case study has been included in later part of this book testing the postulated factors of inhibiting participation of the rural poor in MFIs. ...
... However, TPB is considered to be the most appropriate in this regard (Sommer, 2011). According to several scholars (Armitage & Christian, 2003;Biddle & Nigg, 2000;Courneya & Bobick, 2000;Fen & Hong, 2009;George, 2004;Rivis & Sheeran, 2003), TPB model exhibits the most applied and suitable theoretical construct for the study of human behavior owing to number of rationale as follows: (a) TPB was found to represent the most convincing and well-established model for the prediction of intentional human behavior; (b) the theory has been shown to effectively work under a wide variety of circumstances and in various disciplines such as social psychology (Albarracin, Johnson, Fishbein, & Muellerleile, 2001), community attitudes and market research (Ajzen, 2008), political participation (Avery, 2007;Gaeke, 2009;McCormick, 2009), sports science (Chatzisarantis & Haggar, 2008), nursing and healthcare workers (Munday & Silk, 2008), health medicine (Hyde & White, 2009), communication (Zhou, 2007), driving behaviors (Elliott, Armitage, & Baughan, 2007), smoking behavior (Brann & Suttan, 2009;Wang 2009), romantic relationships (Jang & Woo, 2009), organ donation (Siegel et al., 2008) and information technology (Armitage & Conner, 1999;Ashraf, Alam & Noor, 2010;Notani, 1998); (c) TPB is a parsimonious theoretical framework, which involves relatively a small number of variables that can accurately predict actual human behavior. Thus, any study that intends to analyze human behavior, TPB is the most appropriate theoretical framework which is based on personal, social and individual control toward intention to actual behavior (Fen and Hong, 2009). ...
... According to several scholars (Armitage & Christian, 2003;Biddle & Nigg, 2000;Courneya & Bobick, 2000;Fen & Hong, 2009;George, 2004;Rivis & Sheeran, 2003), TPB model exhibits the most applied and suitable theoretical construct for the study of human behavior owing to number of rationale as follows: (a) TPB was found to represent the most convincing and well-established model for the prediction of intentional human behavior; (b) the theory has been shown to effectively work under a wide variety of circumstances and in various disciplines such as social psychology (Albarracin, Johnson, Fishbein, & Muellerleile, 2001), community attitudes and market research (Ajzen, 2008), political participation (Avery, 2007;Gaeke, 2009;McCormick, 2009), sports science (Chatzisarantis & Haggar, 2008), nursing and healthcare workers (Munday & Silk, 2008), health medicine (Hyde & White, 2009), communication (Zhou, 2007), driving behaviors (Elliott, Armitage, & Baughan, 2007), smoking behavior (Brann & Suttan, 2009;Wang 2009), romantic relationships (Jang & Woo, 2009), organ donation (Siegel et al., 2008) and information technology (Armitage & Conner, 1999;Ashraf, Alam & Noor, 2010;Notani, 1998); (c) TPB is a parsimonious theoretical framework, which involves relatively a small number of variables that can accurately predict actual human behavior. Thus, any study that intends to analyze human behavior, TPB is the most appropriate theoretical framework which is based on personal, social and individual control toward intention to actual behavior (Fen and Hong, 2009). Besides, any theoretical model that identifies multidimensional factors in influencing human intentional behavior based on cognitive, social and psychological aspects is more desirable (Biddle & Nigg, 2000;Symons, Downs & Hausenblas, 2003) than a model that does not have such features. ...
Book
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Poverty has been a buzzword in Bangladesh since the early period of 1970s when the people of the country fought for its independence. After the independence in 1971 the country fell into the grips of a famine in 1974 which shook us all to the core of our being. News media reported horrible stories of death and starvation in remote villages and district towns across the new country, Bangladesh. At this juncture of history, Professor Muhammad Yunus came to the forefront and taught the poor how to fight against poverty with ‘microcredit’. Following this fact, the ‘Grameen Bank’ came into reality in October 2, 1983 with interest-based microcredit program which later conventionally known as ‘microfinance’ program, distinctly different from Islamic microfinance institutes. Since then the Grameen Model has been replicated by myriads of NGOs and conventional microfinance institutes (MFIs) domestically and globally to eradicate poverty from society. Though it has been about four decades since its inception as a full-fledged Bank, this turns as a legitimate question – how far are these NGO-MFIs successful to attain their core objective of poverty alleviation? Or, are there any hurdles for which they are facing challenges to reach the objectives? And what are the possible solutions or prospects that they may have? This book is primarily an inquiry into seeking the possible answers of those fundamental questions through investigating the participation of the rural poor especially rural poor women in NGO-MFIs in Bangladesh. This book explicates empirical case studies and ethnographic information on Big-Four powerful development organizations, such as BRAC (Bangladesh Rural Advancement Committee), ASA (Association for Social Advancement), Proshika (Centre for Human Development) and the Grameen Bank in Bangladesh. It examines issues of poverty alleviation through the participation of rural poor women in NGO-MFIs and the hurdles they face to participate in these NGO-MFIs. The perspective of an econometric approach is used in this book for the analysis of the empirical materials. Research findings show that there has been participation problem arising from both sides of the clients and the programs of microfinance which are not effective in alleviating rural poverty (Ashraf, 2011c; Karim, 2011; Huq, 2001; Evans et al. 1999). This book covers a wide range of socio-economic and religious contexts in order to explore a series of issues relating to the dynamics of participation and nonparticipation, intention, attitudes, social norms, perceived behavioral control of rural poor women located in six districts of Bangladesh. The study areas were selected randomly at two levels. First, six divisions were selected randomly from the total of nine divisions in Bangladesh. Then six districts were selected randomly from six divisions. The districts are Nilphamari, Bogra, Kishoreganj, Maulovibazar, Shariatpur and Satkhira. These six districts were chosen because the people of these regions are poorer and more vulnerable than those in other regions of Bangladesh (Mahmud, 2010). Due to these demographic concerns, the MFIs are operating microfinance programs there (MRA, 2011). These six districts comprised individuals of participating and nonparticipating poor in the villages who were predominantly peasants, rickshaw (3-wheel cart) or van pullers and day laborers. Recent evidence suggests that Bangladesh has done tremendously well in reducing poverty and microfinance has been trumpeted as a champion over the last three decades for attaining the global objectives of alleviating rural poverty and improving women’s socioeconomic status (Ashraf, 2013; Karim, 2011). Until now, there have been large number of empirical and quasi-empirical evidence which supports this view on a positive role of microfinance institutes (MFIs) in poverty alleviation such as Hossain (1984, 1986, 1989, 1998), Khandker (1996, 1998), Pitt and Khandker (1995, 1998), Hashemi, Schuler and Reley (1996), Zohir (2001), Khandker (2003), Razzaque (2010) and many others. However, this trumpeted role of microfinance appears to be dull to this day (Karim, 2011) because of the criticisms which stem from different issues such as economic impact (Morduch, 1998, 1999; Hulme and Mosley, 1996; Haque and Yamao, 2008; Khosa, 2007) and social impact on women’s status (Rahman, 1996; Rahman, 1999; Fernando, 2006; Muhammad, 2006). Recently, PKSF conclusively remarked that poverty in Bangladesh has not been reduced by MFIs which have some socioeconomic and religious hindrances (Osmani et al., 2015). This book is simply a single effort to unveil those factors faced by MFIs. Drawing on the evidence stated above, the present study is empirically investigating the factors that influence nonparticipation and participation of the rural poor in microfinance with intention as a mediator using theory of planned behavior. The conceptual model tested had eight explanatory variables (i.e., challenges that MFIs are facing) in addition to the original components of actual behavior, intention, attitude, subjective norms and PBC. The additional eight variables (challenges) were: (1) fear of risk associated with loans borrowed from microfinance programs, (2) individual preferences in microfinance programs, (3) religious leaders’ lecture on Islamic principles, (4) spousal dislike of female heading the household (5) friends’ advice, (6) insufficiency of resources, (7) lack of business knowledge, and (8) poor health or vulnerability to crisis. To attain its objectives, the study applied logistic regression technique along with multiple regression analyses. Results indicated that attitudes and PBC significantly influenced intention of nonparticipation of the rural poor in MFIs, while intention and nonparticipation were negatively related. Subjective norm and perceived behavioral control (PBC) were not statistically significant to influence intention. Among the external variables, it was found that several challenge factors, namely, fear of risks associated with loans, individual preference of taking loan, spousal dislike as female head of household, insufficiency of resources, and lack of knowledge have significant impact on the nonparticipation of the rural poor in MFIs in Bangladesh. Of 13 hypotheses developed, only seven received empirical support while six did not.
... Personal ideas impact the degree of worry towards own weight, wellness levels just as uneasiness related to experiencing different individuals, staff, and machinery (8) . Mental inclusion for strength, wellness impacts grades regarding movement significance towards person, degree of intrigue as well as recurrence about discernment (9) . ...
... Requirements go to rely on racial, civil along with strict elements. For instance, genuine compassion besides requirements about traditional small gatherings be equal to sum up incredibly to support an incentive to the particular customers, on the other hand considering accomplished clients, interest as well as machinery prevail vital (8) . ...
... Profoundly instilled common/physique mindfulness influences nervousness points in regards to the utilization of gym and wellness centre's (8,12) . Gender partition and additional security referred while supportive towards decreasing nervousness in order to certain clients during essential examination. ...
... Physical exercise enables a balanced lifestyle in the community through various other variables, such as the planned environment for physical exercise and sports. 23 Changes and construction of a sustainable built environment have a significant impact on sports and physical activity participation. The current study was designed to explore the role of national fitness plan in promoting physical activity and health well-being preventing NCDs under the built environment intervention. ...
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... A lack of physical exercise is directly linked to many health issues including obesity, cardiovascular diseases as well as depression and anxiety (Booth et al., 2011). Therefore, physical activities are required for a healthy lifestyle (Fen and Hong, 2009). However, performing physical exercises without proper techniques can lead to injuries (Gray and Finch, 2015). ...
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In order to detect and correct physical exercises, a Grow-When-Required Network (GWR) with recurrent connections, episodic memory and a novel subnode mechanism is developed in order to learn spatiotemporal relationships of body movements and poses. Once an exercise is performed, the information of pose and movement per frame is stored in the GWR. For every frame, the current pose and motion pair is compared against a predicted output of the GWR, allowing for feedback not only on the pose but also on the velocity of the motion. In a practical scenario, a physical exercise is performed by an expert like a physiotherapist and then used as a reference for a humanoid robot like Pepper to give feedback on a patient's execution of the same exercise. This approach, however, comes with two challenges. First, the distance from the humanoid robot and the position of the user in the camera's view of the humanoid robot have to be considered by the GWR as well, requiring a robustness against the user's positioning in the field of view of the humanoid robot. Second, since both the pose and motion are dependent on the body measurements of the original performer, the expert's exercise cannot be easily used as a reference. This paper tackles the first challenge by designing an architecture that allows for tolerances in translation and rotations regarding the center of the field of view. For the second challenge, we allow the GWR to grow online on incremental data. For evaluation, we created a novel exercise dataset with virtual avatars called the Virtual-Squat dataset. Overall, we claim that our novel architecture based on the GWR can use a learned exercise reference for different body variations through continual online learning, while preventing catastrophic forgetting, enabling for an engaging long-term human-robot interaction with a humanoid robot.
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... Malaysia is threatened by a rise in health problems that are continually taking their toll on its citizens. Statistics on heart problems (National Heart Association of Malaysia, 2010; Yap & Liew, 2009), the obesity index (Cheng, 2013;World Health Organization, 2011) and even the stress of modern-day living (Blaug, Kenyon, & Lekhi, 2007) are indicators of health warnings that can hinder a country's productivity. Malaysians find it difficult to balance daily activities with staying healthy and would very much like to incorporate a health regimen into their daily activities; one way to do so is to join a health and fitness club (Alam & Hossain, 2012). ...
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