Breaking barriers to rehabilitation: the role of behavior change theories in overcoming the challenge of exercise-related behavior change

Abstract

Background: Promoting exercise-related behavior change in rehabilitation is a challenge. The lack of integration between rehabilitation program prescriptions, behavior change interventions, and behavioral change theories is profound. Using behavior change theories properly is crucial for better adherence and promoting positive outcomes. Therefore, it is essential to bring theories that support the understanding of exercise-related behavioral change to the attention of rehabilitation practitioners.

Objective: This masterclass article aims to provide the theoretical background of theories and strategies for exercise behavior change within the physical therapy context based on acknowledged behavioral change theoretical models.

Methods: This is a narrative review that examines six behavior theories; five of them well-established, and a new (and promising) theory that has exhibited the most favorable outcomes in rehabilitation settings. The development process for this masterclass included conversations between authors, reviewing behavior theories, summarizing and discussing the theories' concepts and strategies for physical therapy.

Results: The included theories were self-determination theory, social-cognitive theory, the transtheoretical model, the theory of planned behavior, the health belief model, and the unifying theory of physical activity. Each theory offers a unique perspective on exercise behavior change within rehabilitation, exploring constructs such as motivation, self-efficacy, stages of change, behavioral intention, perceived threat, and the core elements of physical activity expression.

Conclusion: These theoretical models provide a foundation for understanding and developing strategies for promoting exercise behavior change in rehabilitation. Knowing and using these theories is important for respecting the patient's individuality.

Keywords: Health; Health professionals; Intervention strategies; Physical activity; Physical therapy.

Fig. 1

A) Self-determination theory classifies motivation into a continuum of self-determination, ranging from lack of intention, to controlled motivation, to autonomous motivation. These motivational types are shaped by perceived regulations and the locus of causality, influencing behavior internalization. Fulfilling autonomy, competence, and relatedness needs leads to internalized behavioral regulation. Adapted from: Deci and Ryan, 1985. B) Social cognitive theory. Self-efficacy plays a crucial role, influencing behaviors, adaptation, and change. The arrows indicate that perceived efficacy influences human behavior both directly and indirectly, through affecting other key types of determinants. Adapted from: Bandura, 2017.

Fig. 2

A) The transtheoretical model and its 5 stages of behavior change. Each stage represents a distinct phase through which individuals progress over time. The model also incorporates 10 processes of change and additional constructs, including decisional balance, self-efficacy, and temptation. Adapted from Karloh et al. B) The theory of planned behavior diagram focuses on behavioral intention as the key driver of behavior. It incorporates 3 constructs and 3 components that influence intention, which, in turn, affect behavior. Adapted from: https://people.umass.edu/aizen/tpb.diag.htm.

Fig. 3

A) The health belief model proposes that individuals' perceptions regarding health issues, their assessment of the advantages and obstacles linked to acting, and their confidence in their ability to act collectively elucidate their involvement in health-enhancing actions. Adapted from: Rosenstock, Strecher and Becker. B) The unifying theory of physical activity offers a holistic view of physical activity, emphasizing embodied practice beyond health concerns. It posits human urges as central to physical activity expression. Supportive conditions for these urges, along with contextual influences, drive meaningful and fulfilling physical activity engagement. Adapted from: Matias and Piggin, 2022.