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Purpose. This study examines the usefulness of using the stages and processes of change model to explore exercise adoption and maintenance over time. Design. Data for this study were collected as part of the baseline and follow-up survey of participants in a worksite health promotion project. Subjects. Three hundred fourteen employees completed exercise questionnaires. The average age was 41 years, mean body mass index was 26, average years of education were 13, and 66% were women. Setting. The study was conducted in two worksites, a retail outlet and a manufacturing company. Measures. Previously validated questionnaires to determine stages and processes of exercise adoption were administered at baseline and 6-month follow-up, along with questions about demographic variables. Results. Four patterns of stage change emerged: subjects who became more active (adopters, 26%), those who became less active (relapsers, 15%), and those who did not change over time (stable sedentary, 32%; stable active, 27%). Adopters displayed increases in use of the processes of change, whereas relapsers displayed decreases in process use. Stable profiles were associated with no change in process use. Conclusions. These findings have important implications for research on exercise adoption and maintenance. Interventions tailored specifically to subjects' stage of readiness to be active and using specific processes to help in the change process are warranted at this time.

Purpose. This study retrospectively compared subjects from three unrelated studies using eight algorithms to stage exercise behavior. Subjects and settings. Study One included 936 employees involved in a smoking cessation study at four worksites—a medical center, retail store, manufacturing firm, and a government agency. Study Two included 19,212 members of a New England HMO; and Study Three included a convenience sample of 327 adult New Englanders. Measures. The eight algorithms used different descriptions of stages based on the transtheoretical model, as well as different definitions of exercise and response formats. Results. Algorithms using longer, more precise definitions of exercise resulted in larger numbers of subjects being staged in precontemplation and contemplation in comparison to algorithms using shorter definitions, which tended to stage subjects in preparation and action. Maintenance was the most and preparation the least consistently described stage across algorithms. Conclusions. Alteration of the descriptions of stage and the definition of exercise has consequences for the staging of subjects. Definitions need to be explicit, stating all parameters needed to meet criterion, and subjects must be able to assess themselves. Either a 5-Choice or a true/false response format is effective in assessing stage.

Purpose. This study examines the utility of three theoretical models—the stages of change model, self-efficacy theory, and the decisional balance model—in understanding exercise behavior among employed women. Design. Data for this cross-sectional study were collected as part of a routine follow-up of a worksite-based smoking and health risk appraisal study. Setting. The study was conducted in three Rhode Island worksites, including one manufacturing company, one medical center, and one retail outlet. Subjects. Of a sample of 431 women who completed exercise questionnaires, 293 reported participation in a physical activity over the previous week. The average age of the sample was 41.1 years, and mean years of education was 12.8. Measures. Previously validated measures to determine stage of exercise behavior, exercise self-efficacy, exercise decisional balance, and physical activity participation were administered. Additional demographic information was also obtained. Results. Frequency counts revealed that 39% of the population was sedentary, 34% were participating in irregular activity, and 27% were active. MANOVAs followed by one way ANOVAs revealed that women in Precontemplation scored the lowest and those in Maintenance scored the highest on the self-efficacy, pro, and decisional-balance indices, with the trend reversed on the con scale. A chi-square test revealed that women with one or more young children in the home were more likely to be in a lower stage of exercise adoption. Conclusions. Most of the women in this cross-sectional study did not engage in regular activity. Presence of young children in the home was significantly related to decreased activity. The results are limited by the nonrandomized, and cross-sectional nature of the study design. Data suggest that, with multiple roles and responsibilities, women may be better served by stage-matched interventions to increase physical activity.

Purpose. This study examined the broader use of a print-media intervention, which was previously shown to be effective at promoting physical activity to participants recruited from a regional Australian community, as a strategy suitable for a more diverse statewide population sample. Methods. Participants were randomly selected adults who responded to a telephone interview conducted by the New South Wales Health Department and consented to participate in a randomized controlled trial. Consenters were allocated to either intervention (n = 361) or control (n = 358) conditions. The intervention, a personalized letter plus stage-targeted booklets, was sent 1 week postbaseline. Data were collected via telephone interview at baseline and 2 and 8 months and were analyzed using repeated measures analysis of variance (ANOVA) and χ2 statistics. Results. The groups were similar at baseline (mean age 43 ± 3 years; 64% women). Process evaluation showed high intervention recall (76% at 2 months) and high follow-up response rates (>85% at 8 months) were achieved. Nonsignificant increases in physical activity were observed (F 1,719 = 2.18, p = .14). Discussion. A single mailing of stage-targeted print materials was not effective in promoting increases in physical activity among participants selected from the statewide population. Future research could examine how the effectiveness of print media might be enhanced, possibly by using supplementary media, community-based prompts, or other incentives.

Purpose. This study examined the use of the stages of change model to design an exercise intervention for community volunteers. Design. The "Imagine Action" campaign was a community-wide event incorporating the involvement of local worksites and community agencies. Community members registering for the campaign were enrolled in a six-week intervention program designed to encourage participation in physical activity. Subjects. Six hundred and ten adults aged 18 to 82 years old enrolled in the program. Seventy-seven percent of the participants were female and the average age was 41.8 years (SD = 13.8). Setting. The campaign was conducted in a city with a population of approximately 72,000 and was promoted throughout community worksites, area schools, organizations, and local media channels. Measures. One question designed to assess current stage of exercise adoption was included on the campaign registration form as were questions about subject name, address, telephone number, birthdate, and gender. Intervention. The intervention included written materials designed to encourage participants to initiate or increase physical activity, a resource manual describing activity options in the community, and weekly "fun walks" and "activity nights." Results. A Stuart-Maxwell test for correlated proportions revealed that subjects were significantly more active after the six-week intervention. Sixty-two percent of participants in Contemplation became more active while 61 % in Preparation became more active. Conclusions. Most participants increased their stage of exercise adoption during the six-week intervention. This study provides preliminary support for use of the stages of change model in designing exercise interventions.

Purpose:To examine the effect of a prenatal exercise intervention on gestational weight gain (GWG) and to update meta-analyses.Design:Randomized controlled trial and meta-analysis.Setting:Obstetrical practices in a Western Massachusetts hospital.Patients:We analyzed 241 ethnically diverse pregnant participants at high risk for gestational diabetes in the Behaviors Affecting Baby and You (B.A.B.Y.) study. A total of 118 participants were randomized to an exercise intervention group and 123 to a comparison health and wellness intervention group.Intervention:A 12-week individually tailored, motivationally matched program designed to increase the compliance with guidelines for exercise during pregnancy (30 min/day).Measures:The GWG and compliance with 2009 Institute of Medicine (IOM) guidelines for GWG abstracted from medical records.Analysis:Unadjusted logistic regression, intent-to-treat. Results were added to the existing meta-analyses using a random effects model.Results:Women randomized to the exercise group had a lower mean GWG than the comparison group (−0.97 kg, P value = .39) and were less likely to exceed IOM guidelines (odds ratio = 0.69, 95% confidence interval [CI] 0.34-1.40), but results were not statistically significant. Meta-analyses yielded a −0.63 kg (95% CI −1.17 to −0.08, P = .02) reduction in GWG and a 20% reduction in odds of exceeding IOM guidelines (95% CI 0.73 to 0.89) for the exercise intervention.Conclusion:Findings from this randomized trial among ethnically diverse women contribute to the results of meta-analyses supporting exercise as a means of attenuating GWG.

Purpose. This study compares the efficacy of a self-help intervention tailored to the individual's stage of motivational readiness for exercise adoption with a standard self-help exercise promotion intervention. Design. Interventions were delivered at baseline and 1 month; assessments were collected at baseline and 3 months. Setting. Eleven worksites participating in the Working Healthy Research Trial. Subjects. Participants (n = 1559) were a subsample of employees at participating worksites, individually randomized to one of two treatment conditions. Intervention. Printed self-help exercise promotion materials either (1) matched to the individual's stage of motivational readiness for exercise adoption (motivationally tailored), or (2) standard materials (standard). Measures. Measures of stage of motivational readiness for exercise and items from the 7-Day Physical Activity Recall. Results. Among intervention completers (n = 903), chi-square analyses showed that, compared to the standard intervention, those receiving the motivationally tailored intervention were significantly more likely to show increases (37% vs. 27%) and less likely to show either no change (52% vs. 58%) or regression (11% vs. 15%) in stage of motivational readiness. Multivariate analyses of variance showed that changes in stage of motivational readiness were significantly associated with changes in self-reported time spent in exercise. Conclusions. This is the first prospective, randomized, controlled trial demonstrating the efficacy of a brief motivationally tailored intervention compared to a standard self-help intervention for exercise adoption. These findings appear to support treatment approaches that tailor interventions to the individual's stage of motivational readiness for exercise adoption.