Skip to main content
Log in

Adherence to structured physical exercise in overweight and obese subjects: A review of psychological models

  • Review Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Regular physical exercise is a widely accepted means of reducing mortality and improving a number of health outcomes, which is also efficacious in the treatment of obesity. Unfortunately, despite the evidence of favourable short- and long-term effects, the results seem to be affected by a lack of adherence, particularly over the long term. It is very important to evaluate and predict good adherence in order to be able to assess the real efficacy of physical activity in the treatment of various diseases. In this paper, we describe most of the psychological models used to evaluate such adherence, and investigate the physiological and psychological bases of physical activity, the most suitable type of exercise for obese patients and some useful strategies for ensuring long-term adherence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Wannamethee S.G., Shaper A.G.: Physical activity in the prevention of cardiovascular disease: an epidemiological perspective. Sports Med., 2, 101–104, 2001.

    Article  Google Scholar 

  2. Paffenbarger R.S. Jr., Hyde R.T., Wing A.L., Lee I.M.., Jung D..L, Kampert J.B.: The association of change in physical-activity level and other lifestyle characteristics with mortality among men. N. Engl. J. Med., 328, 538–545, 1993.

    Article  PubMed  Google Scholar 

  3. Miller W.C., Koceja D.M., Hamilton E.J.: A metaanalysis of the past 25 years of weight loss research using diet, exercise, or diet plus exercise intervention. Int. J. Obes. Relat. Metab. Disord., 21, 941–947, 1997.

    Article  PubMed  CAS  Google Scholar 

  4. National Institutes of Health: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Obes. Res., 6 (Suppl. 2), 51S–209S, 1998.

    Google Scholar 

  5. Pronk N.P., Wing R.R.: Physical activity and long-term maintenance of weight loss. Obes. Res., 2, 587–599, 1994.

    Article  PubMed  CAS  Google Scholar 

  6. Jakicic J.M., Clark K., Coleman E., Donnelly J.E., Foreyt J., Melanson E., Voleck J., Volpe S.L.: American College of Sports Medicine position stand. Appropriate intervention strategies for weight loss and prevention of weight regain for adults. Med. Sci. Sports Exerc., 33, 2145–2156, 2001.

    Article  PubMed  CAS  Google Scholar 

  7. Wing R.R.: Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issues. Med. Sci. Sports Exerc., 31 (Suppl. 11), S547–552, 1999.

    Google Scholar 

  8. Dishman R.K., Sallis J.F., Orenstein D.R.: The determinants of physical activity and exercise. Public Health Rep., 100, 158–171, 1985.

    PubMed  CAS  Google Scholar 

  9. Oldridge N.B.: Compliance and exercise in primary and secondary prevention of coronary heart disease: a review. Prev. Med., 11, 56–70, 1982.

    Article  PubMed  CAS  Google Scholar 

  10. Vitolins M.Z., Rand C.S., Rapp S.R., Ribisl P.M., Sevick M.A.: Measuring adherence to behavioral and medical interventions. Control Clin. Trials, 21 (5 Suppl.), 188S–194S, 2000.

    Article  PubMed  CAS  Google Scholar 

  11. Biddle S.J., Fox K.R.: Motivation for physical activity and weight management. Int. J. Obes. Relat. Metab. Disord., 22 (Suppl. 2), S39–S47, 1998.

    PubMed  Google Scholar 

  12. Sonstroem R.J.: Physical estimation and attraction scales: rationale and research. Med. Sci. Sports, 10, 97–102, 1978.

    PubMed  CAS  Google Scholar 

  13. Dishman R.K.: Medical psychology in exercise and sport. Med. Clin. North Am., 69, 123–143, 1985.

    PubMed  CAS  Google Scholar 

  14. Dishman R.K., Gettman L.R.: Psychobiologic influences in exercise adherence. J. Sport Psychol., 2, 295–310, 1980.

    Google Scholar 

  15. Dishman R.K., Ickes W.J., Morgan W.P.: Self motivation and adherence to habitual physical activity. J. Appl. Soc. Psychol., 10, 115–131, 1980.

    Article  Google Scholar 

  16. Olson J.M., Zanna M.P.: Predicting adherence to a program of physical activity: an empirical study. Government of Ontario, Ministry of Tourism and Recreation, 1982.

    Google Scholar 

  17. Knapp D., Gutman M., Foster C., Pollock M.: Self motivation among 1984 Olympic speedskating hopefuls and emotional response and adherence to training. Med. Sci. Sports Exerc., 16, 14, 1984.

    Google Scholar 

  18. Snyder G., Franklin B., Foss M., Rubenfire M.: Characteristics of compliers and non-compliers to cardiac exercise therapy programs. Med. Sci. Sports, 14, 179, 1982.

    Google Scholar 

  19. Dishman R.K., Ickes W.J., Morgan W.P.: Self motivation and adherence to therapeutic exercise. J. Behav. Med., 4, 421–438, 1981.

    Article  PubMed  CAS  Google Scholar 

  20. Rosenstock I.M.: Why people use health service. Millbank Memorial Fund Quartertly, 44, 94–124, 1966.

    Article  Google Scholar 

  21. Becker M.H., Maiman L.A.: Sociobehavioral determinants of compliance with health and medical care recommendations. Med. Care, 13, 10–24, 1975.

    Article  PubMed  CAS  Google Scholar 

  22. Lindsay-Reid E., Osborn R.W.: Readiness for exercise adoption. Soc. Sci. Med., 14A, 139–146, 1980.

    CAS  Google Scholar 

  23. Fishbein M., Ajzen I.: Belief, attitude, intention and behaviour: An introduction to theory and research. Reading, MA, Addison Wesley, 1975.

    Google Scholar 

  24. Smith R.A., Biddle S.J.: Attititudes and exercise adherence: test of the Theories of Reasoned Action and Planned Behaviour. J. Sports Sci., 17, 269–281, 1999

    Article  PubMed  CAS  Google Scholar 

  25. Soenstrem R.J.: Self-esteem and physical activity. In: Terjung R.L. (Ed.), Exercise and sport sciences reviews. Lexington, Collomore Press, 12, 1984 pp. 123–155, 1984.

    Google Scholar 

  26. Bandura A.: Self-efficacy: toward a unifying theory of behavioral change. Psychol. Rev., 84, 191–215, 1977.

    Article  PubMed  CAS  Google Scholar 

  27. Weinberg R.S., Hughes H.H., Critelli J.W., England R., Jackson A.: Effects of preexisiting and manipulated self-efficacy on weight loss in a self control program. Journal of Research in Personality, 18, 352–358, 1984.

    Article  Google Scholar 

  28. Oman R.F., King A.C.: Predicting the adoption and maintenance of exercise participation using self-efficacy and previous exercise participation rates. Am. J. Health Promot., 12, 154–161, 1998.

    Article  PubMed  CAS  Google Scholar 

  29. Harter S.: Developmental perspectives on the self system. In: Hetherington E.M. (Ed.), Handbook of child psychology. New York, John Wiley, 4, 1983, pp. 275–385.

    Google Scholar 

  30. Feltz D.L., Petlichkoff L.: Perceived competence among interscholastic sport participants and dropouts. Can. J. Appl. Sport Sci., 8, 231–235, 1983.

    PubMed  CAS  Google Scholar 

  31. Frederick C.M., Morrison C., Manning T.: Motivation to participate, exercise affect, and outcome behaviours toward physical activity. Percept. Mot. Skills, 82, 691–701, 1996.

    Article  PubMed  CAS  Google Scholar 

  32. Ward A., Morgan W.P.: Adherence patterns of healthy men and women enrolled in an adult exercise program. J. Cardiac Rehabil., 4, 143–152, 1984.

    Google Scholar 

  33. Prochaska J.O., DiClemente C.C.: Stages and processes of self-change of smoking: toward an integrative model of change. J. Consult. Clin. Psychol., 51, 390–395, 1983.

    Article  PubMed  CAS  Google Scholar 

  34. Sarkin J.A., Johnson S.S., Prochaska J.O., Prochaska J.M.: Applying the transtheoretical model to regular moderate exercise in an overweight population: validation of stages of change measure. Prev. Med., 33, 462–469, 2001.

    Article  PubMed  CAS  Google Scholar 

  35. Williams P., Lord S.R.: Predictors of adherence to a structured exercise program for older women. Psychol. Aging, 10, 617–624, 1995.

    Article  PubMed  CAS  Google Scholar 

  36. Emery C.F., Hauck E.R., Blumenthal J.A.: Exercise adherence or maintenance among older adults: 1-year follow-up study. Psychol. Aging 7, 466–470, 1992.

    Article  PubMed  CAS  Google Scholar 

  37. Brownell K.D., Kaye F.S.: A school-based behavior modification, nutrition education, and physical activity program for obese children. Am. J. Clin. Nutr. 35, 277–283, 1982.

    PubMed  CAS  Google Scholar 

  38. Dwyer T., Coonan W.E., Leitch D.R., Hetzel B.S., Baghurst R.A.: An investigation of the effects of daily physical activity on the health of primary school students in South Australia. Int. J. Epidemiol., 12, 308–313, 1983.

    Article  PubMed  CAS  Google Scholar 

  39. Knapp D.N.: Behavioral management techniques and exercise promotion. In: Dishman R.K. (Ed.), Exercise adherence: its impact on public health. Champaigne, Illinois, Human Kinetics Books, 1988, pp. 203–236.

    Google Scholar 

  40. Franklin B.A.: Program factors that influence exercise adherence: practical adherence skills for the clinical staff. In: Dishman R.K. (Ed.), Exercise adherence: its impact on public health. Champaigne, Illinois, Human Kinetics Books, 1988, pp. 237–258.

    Google Scholar 

  41. Franklin B.A.: Clinical components of a successful adult fitness program. Am. J. Health Promotion 1, 6–13, 1986.

    Article  Google Scholar 

  42. Franklin B.A.: Exercise program compliance: improvement strategies. In: Storlie J., Jordan H.A. (Eds.), Behavioral management of obesity. New York, Spectrum, 1991, pp. 105–135.

    Google Scholar 

  43. American College of Sports Medicine: Guidelines for esercise testing and presciption, 3rd ed. Philadelphia, Lea and Febiger, 1986.

    Google Scholar 

  44. Pollock M.L., Gettman L.R., Milesis C.A., Bah M.D., Durstine L., Johnson R.B.: Effects of frequency and duration of training on attrition and incidence of injury. Med. Sci. Sports, 9, 31–36, 1977.

    PubMed  CAS  Google Scholar 

  45. Kilbom A., Hartley L.H., Saltin B., Bjure J., Grimby G., Astrand I.: Physical training in sedentary middle-aged and older men. I. Medical evaluation. Scand. J. Clin. Lab. Invest., 24, 315–322, 1969.

    Article  PubMed  CAS  Google Scholar 

  46. Mann G.V., Garrett H.L., Farhi A., Murray H., Billings F.T.: Exercise to prevent coronary heart disease. An experimental study of the effects of training on risk factors for coronary heart disease in men. Am. J. Med., 46, 12–27, 1969.

    Article  PubMed  CAS  Google Scholar 

  47. Wilhelmsen L., Sanne H., Elmefeldt D., Grimby G., Tibblin G., Wedel H.: A controlled trial of physical training after myocardial infarction. Effects of risk factors, nonfatal reinfarction, and death. Prev. Med., 4, 491–408, 1975.

    Article  PubMed  CAS  Google Scholar 

  48. Pollock M.L.: Prescribing exercise for fitness and adherence. In: Dishman R.K. (Ed.), Exercise adherence: its impact on public health. Champaigne, Illinois, Human Kinetics Books, 1988, pp. 259–277.

    Google Scholar 

  49. Perri M.G., Martin A.D., Leermarkers E.A., Sears S.F., Notelavitz M.: Effects of group- versus home-based exercise in the treatment of obesity. J. Consult. Clin. Psychol., 65, 278–285, 1997.

    Article  PubMed  CAS  Google Scholar 

  50. Kesaniemi Y.K., Danforth E. Jr., Jensen M.D., Kopelman P.G., Lefèbvre P., Reeder B.A.: Doseresponse issues concerning physical activity and health: an evidence-based symposium. Med. Sci. Sports Exerc., 33 (6 Suppl.), S351–S358, 2001.

    PubMed  CAS  Google Scholar 

  51. Hakala P., Karvetti R.L., Ronnemaa T.: Group vs. individual weight reduction programmes in the treatment of severe obesity - a five year followup study. Int. J. Obes. Relat. Metab. Disord., 2, 97–102, 1993.

    Google Scholar 

  52. Heinzelmann F., Bagley R.W.: Response to physical activity programs and their effects on health behavior. Public Health Rep., 85, 905–911, 1970.

    Article  PubMed  CAS  Google Scholar 

  53. Keefe F.J., Blumenthal J.A.: The life fitness program: a behavioural approach to making exercise a habit. I. J. Behav. Ther. Exp. Psychiatry, 11, 31–34, 1980.

    Article  Google Scholar 

  54. Klesges R.C., Eck L.H., Mellon M.W., Fulliton W., Somes G.W., Hanson C.L.: The accuracy of self-reports of physical activity. Med. Sci. Sports Exerc., 22, 690–797, 1990.

    Article  PubMed  CAS  Google Scholar 

  55. Lichtman S.W., Pisarska K., Berman E.R., Pestone M., Dowling H., Offenbacher E., Weisel H., Heshka S., Metthews D.E., Heymsfield S.B.: Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. N. Engl. J. Med., 31, 327, 1893–1898, 1992.

    Article  Google Scholar 

  56. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med. Sci. Sports. Exerc., 30, 975–991, 1998.

    Article  Google Scholar 

  57. Lemura L.M., von Duvillard S.P., Mookerjee S.: The effects of physical training on functional capacity in adults. Ages 46 to 90: a meta-analysis. J. Sports Med. Phys. Fitness, 40, 1–10, 2000.

    PubMed  CAS  Google Scholar 

  58. Jakicic J.M., Winters C., Lang W., Wing R.R.: Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: a randomized trial. J.A.M.A., 282, 1554–1560, 1999.

    Article  PubMed  CAS  Google Scholar 

  59. Schoeller D.A., Shay K., Kushner R.F.: How much physical activity is needed to minimize weight gain in previously obese women? Am. J. Clin. Nutr., 66, 551–556, 1997.

    PubMed  CAS  Google Scholar 

  60. Jakicic J.M., Wing R.R., Butler B.A., Robertson R.J.: Prescribing exercise in multiple short bouts versus one continuous bout: effect on adherence, cardiorespiratory fitness, and weight loss in overweight women. Int. J. Obes. Relat. Metab. Disord., 19, 893–901, 1995.

    PubMed  CAS  Google Scholar 

  61. Pollock M.L., Wilmore J.H., Fox S.M.: Exercise behind health and disease-evaluation and prescription for prevention and rehabilitation. Philadelphia, W.B. Saunders, 1984.

    Google Scholar 

  62. Snyder K.A., Donnelly J.E., Jabobsen D.J., Hertner G., Jakicic J.M.: The effects of long-term, moderate intensity, intermittent exercise on aerobic capacity, body composition, blood lipids, insulin and glucose in overweight females. Int. J. Obes. Relat. Metab. Disord., 21, 1180–1189, 1997.

    Article  PubMed  CAS  Google Scholar 

  63. Seals D.R., Hagberg J.M., Hurley B.F., Ehsani A.A., Holloszy J.O.: Endurance training in older men and women. I. Cardiovascular responses to exercise. J. Appl. Physiol., 57, 1024–1029, 1984.

    PubMed  CAS  Google Scholar 

  64. Belman M.J., Gaesser G.A.: Exercise training above and below the lactate threshold in the elderly. Med. Sci. Sports Exerc., 23, 562–568, 1991.

    PubMed  CAS  Google Scholar 

  65. Gergen K.J.: The concept of self. In: Holt, Rinehart, Winston (Eds.), New York, 1971.

  66. Free AM: Transaction analysis for tots. Sacramento, Jalmar Press, 1977.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to V. Ricca.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Castellani, W., Ianni, L., Ricca, V. et al. Adherence to structured physical exercise in overweight and obese subjects: A review of psychological models. Eat Weight Disord 8, 1–11 (2003). https://doi.org/10.1007/BF03324983

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03324983

Key words

Navigation