Sport Sciences for Health

, Volume 15, Issue 3, pp 595–603 | Cite as

Effects of an empowerment program for promoting physical activity in middle-aged women: an application of the health action process approach

  • Zeinab Malaijerdi
  • Hamid Joveini
  • Masoumeh HashemianEmail author
  • Rohollah Borghabani
  • Mina Maheri
  • Alireza Rohban
Original Article



Sedentary lifestyle is known to be a potential risk factor for chronic diseases. Given the vital role that physical activity plays in the prevention of chronic diseases in middle-aged women, this study was conducted to develop the intention for performing physical activity among middle-aged women based on the motivational phase constructs of the health action process approach model.


This quasi-experimental study was conducted on 160 middle-aged women of Jovein, Iran, in 2016. Subjects were randomly selected using a multi-stage sampling method, and assigned to the control (n = 80) and intervention (n = 80) groups. The motivational phase constructs of the health action process approach and physical activity intention were measured at three stages; before the intervention, immediately following the intervention, and 1 month after the intervention. Data were analyzed using SPSS 17.0 software with the Chi-square test, Pearson’s correlation, ANOVA, and Friedman tests.


One month after the intervention, the number of women with an intention to engage in physical activity was significantly higher in the intervention group (n = 56, 73.6%) compared to the control group (n = 23, 29.8%) (P < 0.001). Immediately following the intervention and 1 month after the intervention, all motivational phase constructs were significantly increased in the intervention group compared to before the intervention (P < 0.001). However, no significant change was observed in the control group. Moreover, immediately following the intervention and 1 month after the intervention, all motivational phase constructs were significantly increased in the intervention group compared to the control group (P < 0.001).


The results demonstrate the effectiveness of empowerment program based on the motivational phase constructs of the health action process approach on developing the intention for performing physical activity among middle-aged women.


Physical activity Middle-aged women Empowerment Health action process approach 



We gratefully acknowledge all respected officials and professors of the university and women who participated in this study.


This paper is part of a master’s thesis, which received financial support from the Sabzevar University of Medical Sciences (Grant No. 9423816).

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest associated with this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee (ethical committee of the Sabzevar University of Medical Sciences under the code IR.MEDSAB: REC.1396.120) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all individual participants included in the study.


  1. 1.
    WHO (2017) National strategy and action plan for non-communicable diseases prevention and control 2017–2020Google Scholar
  2. 2.
    Organization WH (2015) Global recommendations on physical activity for health. 2010Google Scholar
  3. 3.
    Tehrani H, Khanjani N, Majlessi F, Sadeghi R, Doostan F (2014) Modern media-based intervention on promotion of women’s physical activity. Wulfenia J 21(6):260–270Google Scholar
  4. 4.
    Activity P (1996) Health: a report of the surgeon general. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion 28Google Scholar
  5. 5.
    Statistics NCfH (2016) Health, United States, 2015: with special feature on racial and ethnic health disparitiesGoogle Scholar
  6. 6.
    Souza AM, Fillenbaum GG, Blay SL (2015) Prevalence and correlates of physical inactivity among older adults in Rio Grande do Sul, Brazil. Plos one 10(2):e0117060PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Myers J, McAuley P, Lavie CJ, Despres J-P, Arena R, Kokkinos P (2015) Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status. Prog Cardiovasc Dis 57(4):306–314PubMedCrossRefGoogle Scholar
  8. 8.
    McPhee JS, French DP, Jackson D, Nazroo J, Pendleton N, Degens H (2016) Physical activity in older age: perspectives for healthy ageing and frailty. Biogerontology 17(3):567–580PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Organization WH (2018) Global action plan on physical activity 2018–2030: more active people for a healthier worldGoogle Scholar
  10. 10.
    Bruno E, Roveda E, Vitale J, Montaruli A, Berrino F, Villarini A, Venturelli E, Gargano G, Galasso L, Caumo A (2018) Effect of aerobic exercise intervention on markers of insulin resistance in breast cancer women. Eur J Cancer Care 27(2):e12617CrossRefGoogle Scholar
  11. 11.
    Roveda E, Vitale JA, Bruno E, Montaruli A, Pasanisi P, Villarini A, Gargano G, Galasso L, Berrino F, Caumo A (2017) Protective effect of aerobic physical activity on sleep behavior in breast cancer survivors. Integr Cancer Ther 16(1):21–31PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Organization WH (2014) Global status report on noncommunicable diseases 2014. World Health OrganizationGoogle Scholar
  13. 13.
    Delavari A, Alikhani S, Alaadini F, Goya M (2005) Report of non communicable diseases risk factor in 30 provinces of Iran, 2005. Health Management Center, MOHME, TehranGoogle Scholar
  14. 14.
    Marshall SJ, Jones DA, Ainsworth BE, Reis JP, Levy SS, Macera CA (2007) Race/ethnicity, social class, and leisure-time physical inactivity. Med Sci Sports Exerc 39(1):44–51PubMedCrossRefGoogle Scholar
  15. 15.
    Eliassen AH, Hankinson SE, Rosner B, Holmes MD, Willett WC (2010) Physical activity and risk of breast cancer among postmenopausal women. Arch Intern Med 170(19):1758–1764PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Baer HJ, Glynn RJ, Hu FB, Hankinson SE, Willett WC, Colditz GA, Stampfer M, Rosner B (2010) Risk factors for mortality in the nurses’ health study: a competing risks analysis. Am J Epidemiol 173(3):319–329PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Mohammad Esmaiel Motlagh AF, Motahareh Allameh, Mina Tabatabaei (2016) Integrated care guidelines for middle-aged adults. Andisheh Mandegar, IranGoogle Scholar
  18. 18.
    Fakhrzadeh H, Djalalinia S, Mirarefin M, Arefirad T, Asayesh H, Safiri S, Samami E, Mansourian M, Shamsizadeh M, Qorbani M (2016) Prevalence of physical inactivity in Iran: a systematic review. J Cardiovasc Thorac Res 8(3):92PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Organization WH (2009) Interventions on diet and physical activity: what works: summary reportGoogle Scholar
  20. 20.
    Sheeran P, Webb TL (2016) The intention–behavior gap. Soc Pers Psychol Compass 10(9):503–518CrossRefGoogle Scholar
  21. 21.
    Chaudhury M, Shelton N (2010) Physical activity among 60–69-year-olds in England: knowledge, perception, behaviour and risk factors. Ageing Soc 30(8):1343–1355CrossRefGoogle Scholar
  22. 22.
    Salehi L, Eftekhar H, Mohammad K, Taghdisi MH, Shojaeizadeh D (2010) Physical activity among a sample of Iranians aged over 60 years: an application of the transtheoretical model. Arch Iran Med (AIM) 13(6):528–536Google Scholar
  23. 23.
    Schwarzer R, Sniehotta FF, Lippke S, Luszczynska A, Scholz U, Schüz B, Ziegelmann J (2003) On the assessment and analysis of variables in the health action process approach: conducting an investigation. Freie Universeitat Berlin, BerlinGoogle Scholar
  24. 24.
    Williams DM, Anderson ES, Winett RA (2005) A review of the outcome expectancy construct in physical activity research. Ann Behav Med 29(1):70–79PubMedCrossRefGoogle Scholar
  25. 25.
    Sniehotta FF, Schwarzer R, Scholz U, Schüz B (2005) Action planning and coping planning for long-term lifestyle change: theory and assessment. Eur J Soc Psychol 35(4):565–576CrossRefGoogle Scholar
  26. 26.
    Sheeran P (2002) Intention—behavior relations: a conceptual and empirical review. Eur Rev Soc Psychol 12(1):1–36CrossRefGoogle Scholar
  27. 27.
    Chow S, Mullan B (2010) Predicting food hygiene. An investigation of social factors and past behaviour in an extended model of the health action process approach. Appetite 54(1):126–133PubMedCrossRefGoogle Scholar
  28. 28.
    Sadeghisani M, Manshadi FD, Azimi H, Montazeri A (2016) Validity and reliability of the Persian version of Baecke habitual physical activity questionnaire in healthy subjects. Asian J Sports Med 7(3):1–7CrossRefGoogle Scholar
  29. 29.
    Geravandi A, Ghofranipour F, Rezaei M, Laghaei Z, Sepahi S (2014) Effect of health education on promotion of physical activity in housewives who refer to health centers of Kermanshah. J Clin Res Paramedical Sci (Persian) 3(3):205–214Google Scholar
  30. 30.
    Bandura A (2004) Health promotion by social cognitive means. Health Educ Behav 31(2):143–164PubMedCrossRefGoogle Scholar
  31. 31.
    Peyman N, Taghipour A, Mahdizadeh M, Esmaeely H (2013) The effect of educational intervention based on self-regulation strategies on physical activity in women with type 2 diabetes. Evid Based Care 2(4):7–17Google Scholar
  32. 32.
    Mehrabian F, Farmanbar R, Mahdavi Roshan M, Omidi S, Aghebati R (2018) Investigation the effect of improving physical activity based on the theory of preplanned behavior among patients with hypertension referred to rural healthcare centers of Rasht in 2014. Iran J Health Educ Health Promot 6(1):53–62CrossRefGoogle Scholar
  33. 33.
    Barg CJ, Latimer AE, Pomery EA, Rivers SE, Rench TA, Prapavessis H, Salovey P (2012) Examining predictors of physical activity among inactive middle-aged women: an application of the health action process approach. Psychol Health 27(7):829–845PubMedCrossRefGoogle Scholar
  34. 34.
    Williams RJ, Herzog TA, Simmons VN (2011) Risk perception and motivation to quit smoking: a partial test of the health action process approach. Addict Behav 36(7):789–791PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Heinrich KM, Maddock J, Bauman A (2011) Exploring the relationship between physical activity knowledge, health outcomes expectancies, and behavior. J Phys Act Health 8(3):404–409PubMedCrossRefGoogle Scholar
  36. 36.
    Perrier M-J, Sweet SN, Strachan SM, Latimer-Cheung AE (2012) I act, therefore I am: athletic identity and the health action process approach predict sport participation among individuals with acquired physical disabilities. Psychol Sport Exerc 13(6):713–720CrossRefGoogle Scholar
  37. 37.
    Scheerman JF, van Empelen P, van Loveren C, Pakpour AH, van Meijel B, Gholami M, Mierzaie Z, Van Den Braak MC, Verrips GH (2017) An application of the health action process approach model to oral hygiene behaviour and dental plaque in adolescents with fixed orthodontic appliances. Int J Pediatr Dent 27(6):486–495CrossRefGoogle Scholar
  38. 38.
    Chareonsanti J, Tiansawad S, Chanprasit C, Newburn-Cook CV, Kushner KE (2009) Health meanings and practices among midlife professional Thai women. Pac Rim Int J Nurs Res 13(1):55–67Google Scholar
  39. 39.
    Shirvani H, Sanaeinasab H, Tavakoli R, Saffari M, Me’mar S (2016) The effect of a social cognitive theory-based educational intervention on the physical activity of female adolescents. Iran J Health Educ Promot 4(4):309Google Scholar
  40. 40.
    Hazavehei MMB, Otogara M, Afshari M, Roshanaei G (2018) The effect of educational program based on BASNEF Model on performing regular physical activity among employees women in Hamadan University of Medical Sciences. J Ilam Univ Med Sci 25(5):67–78. CrossRefGoogle Scholar
  41. 41.
    Payaprom Y, Bennett P, Alabaster E, Tantipong H (2011) Using the Health Action Process Approach and implementation intentions to increase flu vaccine uptake in high risk Thai individuals: a controlled before-after trial. Health Psychol 30(4):492PubMedCrossRefGoogle Scholar
  42. 42.
    Ahmadi Tabatabaei S, Taghdisi M, Nakhaei N, Balali F (2010) Effect of educational intervention based on the theory of planned behaviour on the physical activities of Kerman Health Center’s Staff (2008). J Babol Univ Med Sci 12(2):62–69Google Scholar
  43. 43.
    Ahadian M, Ramezani O (2001) Fundamentals of educational technology. Ayeezh Publication, TehranGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2019

Authors and Affiliations

  • Zeinab Malaijerdi
    • 1
  • Hamid Joveini
    • 1
  • Masoumeh Hashemian
    • 1
    Email author
  • Rohollah Borghabani
    • 2
  • Mina Maheri
    • 3
  • Alireza Rohban
    • 4
  1. 1.Department of Health Education and Promotion, School of HealthSabzevar University of Medical SciencesSabzevarIran
  2. 2.Department of Disease ManagementSabzevar University of Medical SciencesSabzevarIran
  3. 3.Department of Public Health, School of Health, Reproductive Health Research CenterUrmia University of Medical SciencesUrmiaIran
  4. 4.Department of Rehabilitation Management, School of Rehabilitation SciencesIran University of Medical SciencesTehranIran

Personalised recommendations