ACT is a mindfulness-based cognitive-behavioural therapy. ACT has been used by
psychologists and counsellors working with people with addictions, anxiety disorders and in anger management. More recently ACT has been investigated in the health sphere as a means of helping patients manage type 2 diabetes and has been posited as an approach to improve athletic performance (Gardner & Moore, 2004; Gregg, Callaghan, Hayes, & Glenn- Lawson, 2007). Harris (2009) [pp.2] describes ACT in the following way:
ACT gets its name from one of its core messages: accept what is out of your
personal control, and commit to taking action that enriches your life. The aim of ACT is to help us create a rich, full, and meaningful life, while accepting the pain that life inevitably brings. ACT does this by:
• teaching us psychological skills to handle painful thoughts and feelings effectively, in such a way that they have much less impact and influence— these are known as mindfulness skills; and
• helping us to clarify what’s truly important and meaningful to us—that is, clarify our values—and use that knowledge to guide, inspire, and motivate us to set goals and take action that enriches our life.
An adaptation of Harris’ description for application to changes in physical activity behaviour might read; to use mindfulness training to accept any limitations out of the participant’s control and to overcome barriers by making a commitment to an activity that had value and meaning to the participant. In the health care domain Gregg et al. (2007) reported that type 2 diabetes patients who received ACT training in addition to regular diabetes education
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post intervention compared to education alone. While ACT does not appear to have been researched to date with regard to improving physical activity participation it has been successfully employed to improve the health of obese persons (Lillis, Hayes, Bunting, & Masuda, 2009) and will form the basis of an intervention aimed at enhancing positive lifestyle behaviours, including physical activity behaviours, of colorectal cancer survivors (Hawkes, et al., 2009). MI and ACT both appear to warrant further investigation as potential therapies for promoting physical activity behaviour change.
Leadership
Leadership is a vital element in creating an engaging and inviting atmosphere within which the possibilities for physical activity can be explored (Jancey, et al., 2007). As Ben (AA, 71 years) said, “Crook leader, won’t work! […] you won’t find a successful business without a successful leader, it is impossible.”
It has been reported that charismatic leaders demonstrate specific traits that help to motivate and engage their followers (Shamir, House, & Arthur, 1993). These traits are:
a) They are able to instil in followers the feeling that being involved in the effort is to stand up and be counted; that the effort itself reflects important intrinsic values
b) They express confidence in their followers’ abilities to meet high expectations
c) “Articulation of a vision and a mission by charismatic leaders presents goals in terms of the values they represent” [pp.583]. Leaders who do this are able to instil meaning into any actions that followers take toward articulated goals
d) They instil faith in a better future. Charismatic leaders tend to articulate vague and distal goals and often employ symbolism and mysticism to motivate followers knowing that a faith in a better future is a satisfying condition in itself
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e) They create a sense of personal commitment in followers. “This is a motivational disposition to continue a relationship, a role or a course of action and to invest efforts regardless of the balance of external costs and benefits and their immediate
gratifying properties” [pp.583]
Successful activity leaders employ stratagems that allow followers to engage in adult play; to experience arousal as excitement rather than anxiety (Apter, 1990; Kerr, 1997). They use stratagems such as providing arousing stimulation, presenting challenges (and expressing confidence in the followers ability to rise to these challenges), they motivate people to explore new ideas and provide a protective frame work within which challenging situations can be explored (Apter & Kerr, 1991). Successful activity leaders also allow participants to explore opportunities for self-managed change by allowing them to resolve ambiguities in their thoughts about physical activity. The findings reported in the present thesis provide support for the role of good leadership in creating an attractive and engaging environment for older people, as important for participation and participant satisfaction and as a
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Chapter 6 Summary
The work in the present thesis has sought to answer questions about the physical activity behaviours and perceptions of older Tasmanians using a mixed methods approach. This approach has enabled an exploration of those factors that might be amenable to change through promotion, counselling and leadership to maximise the engagement of older people in regular physical activity such that they might receive the inherent health and wellness benefits.
An interesting finding from the survey for this thesis was that a greater percentage of respondents were adequately physically active than reported in the extant literature. Reasons for this discrepancy are suggested as the discounting of some walking and activities of daily living from national physical activity surveys, a mode of delivery employed by those surveys that did not aid recall amongst an older population and the
inappropriateness of descriptions of moderate intensity activities in previous surveys of this population.
Participants in the survey conducted for the present thesis widely reported physical activity as being important, interesting and useful, with positive correlations between these
measures and levels of activity. Interestingly, inadequately active participants also reported that physical activity was important and interesting to them and this provides evidence for the existence of ambivalence toward being active. Additionally, inadequately active participants perceived that it took a significantly greater effort to be active and that being active was significantly less useful to them. These findings provide support for the argument that people in the early stages of behaviour change, those not thinking about be more active or thinking about it but not acting, over estimate the obstacles to change and under estimate the benefits. Counselling techniques that explore and attempt to resolve ambivalence about being physically active (such as motivational interviewing and acceptance and commitment therapy) have the potential to prompt the uptake of, and sustain long term participation in,
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physical activity. Health professionals and activity leaders versed in these methods and who display charismatic leadership traits have the potential to maximise participation rates amongst older people.
The main barriers to physical activity were reported to be health concerns, incompetence and a lack of time and while some participants were able to overcome these barriers and lead an active life others were not. The application of theories of engagement, such as adult play, reversal theory and flow may provide the environment within which people can explore new activities in a supported and engaging environment and could assist in maintaining regular participation. The proposed application of these theories is supported by the findings in this thesis that the main motivations for being active were the support of enthusiastic others, having fun and being engaged with activities.
Based on survey and interview findings a revised health action model has been developed which more comprehensively represents the ways in which a number of factors influence older people’s physical activity behaviours. Overarching this model is the effect of social engagement which from the interview data reported herein appears to positively impact on older people’s perceptions of physical activity by supporting them in their efforts to become more physically active and provides an important opportunity for health promotion to this population. Social engagement coupled with the theories of engagement and counselling techniques presented herein may also help inadequately active older people to overcome ambivalence, health fears and feelings of incompetence.