The Utility of the Health Action Process Approach Model for Predicting Physical Activity Intentions and Behavior in Schizophrenia

Abstract

Research is needed to develop evidence-based behavioral interventions for preventing and treating obesity that are specific to the schizophrenia population. This study is the precursor to such intervention research where we examined the utility of the social cognitions outlined within the Health Action Process Approach (HAPA) model for predicting moderate to vigorous physical activity (MVPA) intentions and behavior among individuals with schizophrenia or schizoaffective disorder. A prospective cohort design [baseline (T1), week 2 (T2), and week 4 (T3)] was used to examine the HAPA constructs and MVPA across a sample of 101 adults (Mage = 41.5 ± 11.7 years; MBMI = 31.2 ± 7.8 kg/m 2 ; 59% male). Two hierarchical regression analyses were conducted controlling for age, gender, BMI, and previous self-reported MVPA. In the first regression, intentions at T1 were regressed onto the T1 motivational HAPA constructs (risk perception, affective attitudes, task self-efficacy) and social support; MVPA status (meeting vs. not meeting the MVPA guidelines) assessed via accelerometry at T3 was regressed onto T1 social support and intentions followed by T2 action and coping planning, and maintenance self-efficacy in the second analysis. Overall, the motivational and social support variables accounted for 28% of the variance in intentions, with affective attitudes (β = 0.33, p < 0.01) and task self-efficacy (β = 0.25, p < 0.05) exhibiting significant, positive relationships. For MVPA status, the model as a whole explained 39% of the variance, with the volitional HAPA constructs explaining a non-significant 3% of this total variance. These findings suggest a need for interventions targeting self-efficacy and affective attitudes within this clinical population.Keywords: schizophrenia, physical activity, determinants, theory based, accelerometry inTrODUcTiOn Recent data indicate 13-15 years of life lost to schizophrenia compared to the general population (1). Cardiovascular death is a major contributor to this increased mortality (2). Potential causes of this excess mortality are varied, although they can be broadly categorized in terms of the iatrogenic effects of treatment (e.g., metabolic side effects of medication), greater prevalence of engagement in unhealthy behaviors (e.g., smoking, physical inactivity), and limited access to health care (3). Given the compelling evidence that physical activity prevents premature mortality, cardiovascular disease, and type 2 diabetes in the general population (4), one increasing focus of attention has been attempts to reduce physical inactivity in this population. Despite the many potential physical, psychosocial, and cognitive benefits of physical activity for individuals with schizophrenia (5), individuals with schizophrenia engage in significantly less moderate and vigorous physical activity compared to controls (6). Research is now required to inform the development of evidence-based behavioral interventions for increasing physical activity that are tailored to this population (7). Theory...

Factors prospectively associated with physical activity and dietary related outcomes in people with severe mental illness: A systematic review of longitudinal studies

“…A total of 111 articles and 16 theses were screened at full text, of which 107 articles and 15 theses were excluded. Five articles were deemed eligible for inclusion (Arbour-Nicitopoulos et al, 2017;Beebe et al, 2011;Gardner-Sood, 2015;Jakobsen et al, 2018;Nyboe et al, 2016).…”

“…We identified three longitudinal studies (Arbour-Nicitopoulos et al, 2017;Gardner-Sood, 2015;Nyboe et al, 2016); one prospective study embedded into an RCT (Jakobsen et al, 2018) and one RCT that had no effect on the outcome of walking behaviour combining treatment arms in analysis of physical activity correlates (Beebe et al, 2011). We therefore treated Beebe et al (2011) as an embedded prospective study.…”

“…We therefore treated Beebe et al (2011) as an embedded prospective study. Studies were conducted in Canada, (Arbour-Nicitopoulos et al, 2017), the United States (Beebe et al, 2011), Denmark (Jakobsen et al, 2018;Nyboe et al, 2016) and the United Kingdom (Gardner-Sood, 2015). Follow-up durations ranged from one month to 2 years.…”

“…We did not identify any studies that included people with bipolar disorder; the majority of participants were diagnosed with either schizophrenia (16-100%) and/or schizoaffective disorder (10-71%). Two studies included both inpatients and outpatients (Arbour-Nicitopoulos et al, 2017;Jakobsen et al, 2018), two studies included outpatients only (Beebe et al, 2011;Nyboe et al, 2016) and one study included inpatients only (Gardner-Sood, 2015). Patients were mostly classed as unemployed or on social security benefits across the majority of studies (62-97%).…”

“…Patients were mostly classed as unemployed or on social security benefits across the majority of studies (62-97%). In the assessment of physical activity related outcomes, three studies employed objective measures (Arbour-Nicitopoulos et al, 2017;Beebe et al, 2011;Jakobsen et al, 2018) and two studies employed subjective self-reported measures (Gardner-Sood, 2015;Nyboe et al, 2016). We did not identify any studies measuring change in physical activity related outcomes from baseline values.…”