Skip to main content
SpringerLink
Log in

Psychosocial Mediators of Physical Activity and Fitness Changes in the Activity Counseling Trial

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Improved understanding of the mediators of physical activity (PA) interventions could lead to improvements in theory and programs.

Purpose

To examine the 24-month mediating effects of psychosocial variables on PA and cardiorespiratory fitness (CRF) outcomes in 878 initially sedentary adults aged 35-75 participating in the Activity Counseling Trial.

Methods

Participants were assigned to one of three intervention arms: physician advice, assistance, or counseling. MacKinnon’s product of coefficients was used to test for longitudinal and contemporaneous mediation.

Results

Changes in behavioral processes of change from baseline to 24 months significantly mediated the relationship between the active intervention arms and improvements in PA and CRF from baseline to 24 months in both men and women. None of the other psychosocial variables tested met criteria for mediation.

Conclusions

Results indicate that behavioral interventions should incorporate methods to encourage participants to use these behavioral strategies as they attempt to become more active.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Marcus BH, Williams DM, Dubbert PM, et al. Physical activity intervention studies: what we know and what we need to know: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation. 2006; 114: 2739–2752.

    Article  PubMed  Google Scholar 

  2. Baranowski T, Anderson C, Carmack C. Mediating variable framework in physical activity interventions. How are we doing? How might we do better? Am J Prev Med. 1998; 15: 266–297.

    Article  CAS  PubMed  Google Scholar 

  3. Bauman AE, Sallis JF, Dzewaltowski DA, Owen N. Toward a better understanding of the influences on physical activity: the role of determinants, correlates, causal variables, mediators, moderators, and confounders. Am J Prev Med. 2002; 23: 5–14.

    Article  PubMed  Google Scholar 

  4. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986; 51: 1173–1182.

    Article  CAS  PubMed  Google Scholar 

  5. Lewis BA, Marcus BH, Pate RR, Dunn AL. Psychosocial mediators of physical activity behavior among adults and children. Am J Prev Med. 2002; 23: 26–35.

    Article  PubMed  Google Scholar 

  6. Riemsma RP, Pattenden J, Bridle C, et al. A systematic review of the effectiveness of interventions based on a stages-of-change approach to promote individual behaviour change. Health Technol Assess. 2002; 6: 1–231.

    CAS  Google Scholar 

  7. Adams J, White M. Are activity promotion interventions based on the transtheoretical model effective? A critical review. Br J Sports Med. 2003; 37: 106–114.

    Article  CAS  PubMed  Google Scholar 

  8. Adams J, White M. Why don't stage-based activity promotion interventions work? Health Educ Res. 2005; 20: 237–243.

    Article  CAS  PubMed  Google Scholar 

  9. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol. 1992; 47: 1102–1114.

    Article  CAS  PubMed  Google Scholar 

  10. Marshall SJ, Biddle SJ. The transtheoretical model of behavior change: a meta-analysis of applications to physical activity and exercise. Ann Behav Med. 2001; 23: 229–246.

    Article  CAS  PubMed  Google Scholar 

  11. Marcus BH, Simkin LR. The stages of exercise behavior. J Sports Med Phys Fitness. 1993; 33: 83–88.

    CAS  PubMed  Google Scholar 

  12. Lewis BA, Forsyth LH, Pinto BM, Bock BC, Roberts M, Marcus BH. Psychosocial mediators of physical activity in a randomized controlled intervention trial. J Sport Exerc Psychol. 2006; 28: 193–204.

    Google Scholar 

  13. Rabin C, Pinto BM, Frierson GM. Mediators of a randomized controlled physical activity intervention for breast cancer survivors. J Sport Exerc Psychol. 2006; 28: 269–284.

    Google Scholar 

  14. Napolitano MA, Papandonatos GD, Lewis BA, et al. Mediators of physical activity behavior change: a multivariate approach. Health Psychol. 2008; 27: 409–418.

    Article  PubMed  Google Scholar 

  15. Pinto BM, Lynn H, Marcus BH, DePue J, Goldstein MG. Physician-based activity counseling: intervention effects on mediators of motivational readiness for physical activity. Ann Behav Med. 2001; 23: 2–10.

    Article  CAS  PubMed  Google Scholar 

  16. Calfas KJ, Sallis JF, Oldenburg B, Ffrench M. Mediators of change in physical activity following an intervention in primary care: PACE. Prev Med. 1997; 26: 297–304.

    Article  CAS  PubMed  Google Scholar 

  17. Fahrenwald NL, Atwood JR, Johnson DR. Mediator analysis of moms on the move. West J Nurs Res. 2005; 27: 271–291.

    Article  PubMed  Google Scholar 

  18. Smith BJ. Promotion of physical activity in primary health care: update of the evidence on interventions. J Sci Med Sport. 2004; 7: 67–73.

    Article  CAS  PubMed  Google Scholar 

  19. King AC, Sallis JF, Dunn AL, et al. Overview of the Activity Counseling Trial (ACT) intervention for promoting physical activity in primary health care settings. Activity Counseling Trial Research Group. Med Sci Sports Exerc. 1998; 30: 1086–1096.

    Article  CAS  PubMed  Google Scholar 

  20. Blair SN, Applegate WB, Dunn AL, et al. Activity Counseling Trial (ACT): rationale, design, and methods. Activity Counseling Trial Research Group. Med Sci Sports Exerc. 1998; 30: 1097–1106.

    Article  CAS  PubMed  Google Scholar 

  21. The Writing Group for the Activity Counseling Trial Research Group. Effects of physical activity counseling in primary care: the Activity Counseling Trial: a randomized controlled trial. JAMA. 2001; 286: 677–687.

    Article  Google Scholar 

  22. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995; 273: 402–407.

    Article  CAS  PubMed  Google Scholar 

  23. American College of Sports Medicine position stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc. 1990; 22: 265–274.

    Google Scholar 

  24. Simons-Morton DG, Hogan P, Dunn AL, et al. Characteristics of inactive primary care patients: baseline data from the activity counseling trial. For the Activity Counseling Trial Research Group. Prev Med. 2000; 31: 513–521.

    Article  CAS  PubMed  Google Scholar 

  25. Sallis JF, Haskell WL, Wood PD, et al. Physical activity assessment methodology in the Five-City Project. Am J Epidemiol. 1985; 121: 91–106.

    CAS  PubMed  Google Scholar 

  26. Blair SN, Haskell WL, Ho P, et al. Assessment of habitual physical activity by a seven-day recall in a community survey and controlled experiments. Am J Epidemiol. 1985; 122: 794–804.

    CAS  PubMed  Google Scholar 

  27. Dunn AL, Marcus BH, Kampert JB, et al. Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial. JAMA. 1999; 281: 327–334.

    Article  CAS  PubMed  Google Scholar 

  28. King AC, Castro C, Friedman R, et al. Ongoing physical activity advice by humans versus computers: the Community Health Advice by Telephone (CHAT) trial. Health Psychol. 2007; 26: 718–727.

    Article  PubMed  Google Scholar 

  29. Dubbert PM, Vander Weg MW, Kirchner KA, Shaw B. Evaluation of the 7-day physical activity recall in urban and rural men. Med Sci Sports Exerc. 2004; 36: 1646–1654.

    Article  PubMed  Google Scholar 

  30. Sallis JF, Saelens BE. Assessment of physical activity by self-report: status, limitations, and future directions. Res Q Exerc Sport. 2000; 71: S1–14.

    CAS  PubMed  Google Scholar 

  31. Hayden-Wade HA, Coleman KJ, Sallis JF, Armstrong C. Validation of the telephone and in-person interview versions of the 7-day PAR. Med Sci Sports Exerc. 2003; 35: 801–809.

    Article  PubMed  Google Scholar 

  32. Gross LD, Sallis JF, Buono MJ, Roby JJ, Nelson JA. Reliability of interviewers using the Seven-Day Physical Activity Recall. Res Q Exerc Sport. 1990; 61: 321–325.

    CAS  PubMed  Google Scholar 

  33. Jacobs DR Jr, Ainsworth BE, Hartman TJ, Leon AS. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc. 1993; 25: 81–91.

    Article  PubMed  Google Scholar 

  34. Washburn RA, Jacobsen DJ, Sonko BJ, Hill JO, Donnelly JE. The validity of the Stanford Seven-Day Physical Activity Recall in young adults. Med Sci Sports Exerc. 2003; 35: 1374–1380.

    Article  PubMed  Google Scholar 

  35. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982; 14: 377–381.

    CAS  PubMed  Google Scholar 

  36. American College of Sport Medicine. Guidelines for exercise testing and prescription. 5th ed. Baltimore: Williams and Wilkins; 1995.

    Google Scholar 

  37. Garcia AW, King AC. Predicting long-term adherence to aerobic exercise: a comparison of two models. J Sport Exerc Psychol. 1991; 13: 394–410.

    Google Scholar 

  38. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice Hall; 1986.

    Google Scholar 

  39. Wilcox S, Sharpe PA, Hutto B, Granner ML. Psychometric properties of the self-efficacy for exercise questionnaire in a diverse sample of men and women. J Phys Act Health. 2005; 3: 285–297.

    Google Scholar 

  40. Marcus BH, Rakowski W, Rossi JS. Assessing motivational readiness and decision making for exercise. Health Psychol. 1992; 11: 257–261.

    Article  CAS  PubMed  Google Scholar 

  41. Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport. 1992; 63: 60–66.

    CAS  PubMed  Google Scholar 

  42. Marcus BH, Rossi JS, Selby VC, Niaura RS, Abrams DB. The stages and processes of exercise adoption and maintenance in a worksite sample. Health Psychol. 1992; 11: 386–395.

    Article  CAS  PubMed  Google Scholar 

  43. MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychol Methods. 2002; 7: 83–104.

    Article  PubMed  Google Scholar 

  44. MacKinnon DP, Fritz MS, Williams J, Lockwood CM. Distribution of the product confidence limits for the indirect effect: program PRODCLIN. Behav Res Methods. 2007; 39: 384–389.

    PubMed  Google Scholar 

  45. MacKinnon DP. Introduction to statistical mediation analysis. New York: Taylor and Francis Group, LLC; 2008.

    Google Scholar 

  46. Kraemer HC, Stice E, Kazdin A, Offord D, Kupfer D. How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. Am J Psychiatry. 2001; 158: 848–856.

    CAS  PubMed  Google Scholar 

  47. Kraemer HC, Wilson GT, Fairburn CG, Agras WS. Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry. 2002; 59: 877–883.

    Article  PubMed  Google Scholar 

  48. Cerin E, Mackinnon DP. A commentary on current practice in mediating variable analyses in behavioural nutrition and physical activity. Public Health Nutr. 2008; 12: 1182–1188.

    Article  PubMed  Google Scholar 

  49. MacKinnon DP. Analysis of mediating variables in prevention and intervention research. NIDA Research Monograph Series. 1994; 139: 127–153.

    CAS  Google Scholar 

  50. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997; 12: 38–48.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The Activity Counseling Trial was supported by the National Heart, Lung, and Blood Institute through contracts: N01-HC-45135, N01-HC-45136, N01-HC-45137, and N01-HC-45138.

This study was approved by the appropriate ethics committee, therefore being conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki, and all participants gave their informed consent prior to enrolling in the ACT.

We have no financial relationship with the organization sponsoring the ACT. We have full control over all primary data and we agree to allow the Annals of Behavioral Medicine to review our data if they request to.

The investigators express their appreciation to Activity Counseling Trial (ACT) participating physicians and other health professionals, participating patients, and the Data and Safety Monitoring Board, whose members were Albert Oberman (Chair), Rod Dishman, Patricia Dubbert, Elisa Lee, I-Min Lee, and Russell Pate. The following were ACT investigators at the Institutions designated at the time of completion of the trial. Clinical Centers: Cooper Institute for Aerobics Research/University of Texas Southwestern Medical Center, Steven Blair (Principal Investigator), Andrea Dunn, Larry Gibbons, Benjamin Levine (Co-Principal Investigator), Bess Marcus (Brown University), James Sallis (San Diego State University), and Peter Snell (UT SW Medical Center); The Stanford University School of Medicine, Abby King (Principal Investigator), Cheryl Albright, William Haskell, Lisa Palmer, Leslie Pruitt, and Wayne Phillips; University of Tennessee, Memphis, Mary O’Toole (Principal Investigator), William B. Applegate Consultant), Joyce Banton, Mace Coday, Karen C. Johnson, Robert C. Klesges (University of Memphis), Stephen T. Miller, and J. Lee Taylor. Coordinating Center: Wake Forest University School of Medicine, Timothy Morgan (Principal Investigator), Roger Anderson, Stuart Cohen, Mark Espeland, Walter Ettinger, Elizabeth Mayer-Davis, Michael Miller, Jack Rejeski (Wake Forest University), Paul Ribisl (Wake Forest University), Mary Ann Sevick, and Mara Vitolins. Central Laboratory: Penn Medical Laboratories, David Robbins. Project Office: National Heart, Lung, and Blood Institute, Denise Simons-Morton (Project Officer), P. Scott Allender, Eva Obarzanek, Joanna Shih, and Carolyn Voorhees.

Author information

Authors and Affiliations

  1. Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Meghan Baruth Ph.D., Sara Wilcox Ph.D. & Steven N. Blair PED

  2. Klein-Buendel, Inc., Golden, CO, USA

    Andrea L. Dunn Ph.D.

  3. Department of Health Research and Policy and the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Abby C. King Ph.D.

  4. Behavioral and Social Sciences Section, Brown University Program in Public Health, Providence, RI, USA

    Bess H. Marcus Ph.D.

  5. Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA

    W. Jack Rejeski Ph.D.

  6. Department of Psychology, San Diego State University, San Diego, CA, USA

    James F. Sallis Ph.D.

  7. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Steven N. Blair PED

Authors
  1. Meghan Baruth Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara Wilcox Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea L. Dunn Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abby C. King Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bess H. Marcus Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. W. Jack Rejeski Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. James F. Sallis Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Steven N. Blair PED
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Meghan Baruth Ph.D..

About this article

Cite this article

Baruth, M., Wilcox, S., Dunn, A.L. et al. Psychosocial Mediators of Physical Activity and Fitness Changes in the Activity Counseling Trial. ann. behav. med. 39, 274–289 (2010). https://doi.org/10.1007/s12160-010-9178-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-010-9178-4

Keywords

Search

Navigation