A Case Study to Overcome Barriers and Enhance Motivations Through Experience of a Variety of Exercises: Theory-Based Intervention on an Overweight and Physically Inactive Adult

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  • 1 Nanyang Technological University

A 5-month exercise intervention using self-determination theory was conducted for a physically inactive male adult with a body mass index >25 kg/m2 to overcome perceived exercise barriers and increase autonomous motivation to exercise through a variety of exercise programs. The participant underwent three different forms of exercise programs: trainer guided, self-guided via YouTube channels, and accustomed exercises for 3 hr weekly. The participant completed a questionnaire and body mass index measurement at baseline and during the second, fourth, and fifth months of intervention and kept an exercise log throughout the 5 months. Consultations were conducted during the second and fourth months. At the end of the program, a semistructured interview was conducted. The data showed that psychological needs satisfaction, autonomous motivation, and exercise behavior had improved, while perceived barriers had decreased. This case study provides insight into how a theory-based intervention could effectively promote exercise behavior by targeting psychological factors.

Physical inactivity and obesity are major risk factors for chronic diseases such as cardiovascular diseases, cancer, and Type 2 diabetes (Booth et al., 2012, 2017). Research has shown that physically inactive and overweight individuals have a variety of perceived barriers to exercise participation. These perceived barriers are physical, psychological, and environmental (Jakicic & Gallagher, 2003; Lovell et al., 2010; McIntosh et al., 2016), making it difficult to devise efficient solutions to address all of them collectively. Thus, a need exists to target the various perceived barriers through theoretically sound constructs. One such convincing construct would be motivation, with self-determination theory (SDT; Deci & Ryan, 1985, 2002; Ryan & Deci, 2017) potentially able to provide a sound theoretical framework for addressing the links between perceived exercise barriers and exercise behavior.

The SDT focuses on the quality of an individuals’ motivation in a given context and the environmental factors that affect motivation in that context (Deci & Ryan, 1985, 2002; Ryan & Deci, 2017). Within SDT, motivation exists along a continuum with two broad categories of motivation: autonomous and controlled motivation. A sense of choice, volition, and freedom from external pressure characterizes autonomous motivation. Individuals who are autonomously motivated tend to act for personally endorsed reasons. Controlled motivation is used to describe acting for external rewards, demands, or coercion. Individuals with controlled motivation tend to act for others or for externally referenced reasons.

Autonomous motivation refers to engaging in behavior due to perceived intrinsic goals or outcomes and is derived from the self (Hagger et al., 2014). Notably, Sevil et al.’s (2015) study implied the possibility that autonomous motivation may govern the relationship between exercise barriers and behavior. This study found a positive relationship between greater autonomous motivation and moderate to vigorous physical activity (PA) levels. As barriers to exercise are negatively related to PA levels and greater autonomous motivation, it has been suggested that developing autonomous motivation could act as a primary step in removing various barriers to exercise.

The SDT also explicitly endorses the role of a set of global psychological needs in determining motivation and specific motivational styles (Deci & Ryan, 1985, 2002; Ryan & Deci, 2017). SDT postulates that, for a person to be intrinsically motivated and have a sense of autonomous motivation, three innate and fundamental basic psychological needs must be satisfied: autonomy, competence, and relatedness. Autonomy reflects a desire to experience a sense of choice and where behavior originates. Competence refers to the individual’s need to interact effectively with their environment and experience a sense of effectiveness in producing desired outcomes. Relatedness is the need to feel connected to and be accepted by others in a social milieu.

Satisfying psychological needs is often cited as a critical factor in the processes of internalization and integration, through which a person comes to self-regulate and sustain behavioral changes (Ryan et al., 2008). Research has endeavored to find ways to satisfy psychological needs for a population that was either uninterested or did not have ample opportunities to participate in exercise (Hsu et al., 2013; Silva et al., 2010). However, difficulties often occurred when attempting to raise and sustain exercise participation rates. As the transtheoretical model outlines, behavioral change occurs in five stages: precontemplation, contemplation, preparation, action, and maintenance (Prochaska & Velicer, 1997). Critical reviews (Adams & White, 2003; Kleis et al., 2020) showed that intervention programs initiated to pursue preparation and action stages in individuals to increase their motivation had resulted in significant improvements in exercise participation within a short period. Yet, participants often failed to remain in the preparation and action stages and instead regressed to the precontemplation and contemplation stages (Adams & White, 2003; Kleis et al., 2020). This result suggests that there are difficulties in sustaining and maintaining exercise participation postintervention. Concerning the difficulties, intervention programs should seek ways to sustain autonomous motivation by satisfying psychological needs from exercise participation. Sheldon (2011) suggested that, other than the three needs, individuals’ psychosocial experiences needed to be considered in explaining variance in behavioral outcomes. One psychosocial experience is the perception of variety (Sheldon et al., 2012; Sheldon & Lyubomirsky, 2012; Sylvester et al., 2018; Sylvester, Standage, Ark, et al., 2014; Sylvester, Standage, Dowd, et al., 2014).

Variety refers to the pursuit and experience of various activities, behaviors, and opportunities in one’s given circumstance (Sheldon & Lyubomirsky, 2012). A variety of exercises might lead individuals to perceive the exercise as stimulating, exciting, fun, interesting, and novel (Etkin & Mogilner, 2016). In the exercise psychology field, the provision of opportunities for people to experience variety was found to be related to their enjoyment and intrinsic motivation (Dimmock et al., 2013). Dimmock et al. (2013) found that the expectation of variety was also shown to be positively associated with a greater internal perceived locus of causality in exercise settings through increased intrinsic and internalized forms of extrinsic behavioral regulation. Moreover, the perception of variety was positively associated with increased exercise and exercise-related behaviors through increased motivation (Dimmock et al., 2013; Glaros & Janelle, 2001; Juvancic-Heitzel et al., 2013; Sylvester et al., 2018; Sylvester, Standage, Ark, et al., 2014; Sylvester, Standage, Dowd, et al., 2014). For example, Sylvester, Standage, Ark, et al. (2014) found that perceived variety satisfied the needs for competence and relatedness and were indirect positive predictors of exercise behaviors through increased autonomous motivation. The satisfaction of the need for autonomy was found to negatively predict controlled motivation. Interestingly, a stronger relationship existed between perceived variety in exercise and exercise behavior via motivation in individuals with low psychological needs satisfaction (Sylvester, Standage, Ark, et al., 2014). Individuals seek ways to satisfy their psychological needs when they are unmet. Perhaps when these psychological needs are unmet, variety has a stronger role in diverting their interest and attention in the short term, as variety offers a change in monotony, hence, satisfying someone’s psychological needs (Sylvester et al., 2018).

The findings like those of Dimmock et al. (2013), Glaros and Janelle (2001), and Sylvester et al. (2018) regarding exercise provided a persuasive body of knowledge for intervention programs to incorporate variety. From the literature, variety was found to improve motivation and psychological need satisfaction to boost exercise behavior, which helped to increase exercise behaviors in the long run. Variety could also enhance psychological needs satisfaction through increased autonomous motivation as physically inactive and overweight adults gain a more holistic view of exercise. The use of variety in an exercise intervention program helps to enhance exercise participation by reducing the notion of limited choice, which, in turn, helps to reduce perceived barriers to exercise through enhanced autonomous motivation and satisfaction of psychological needs.

The present study proposed to overcome perceived exercise barriers and increase autonomous motivation to exercise for a physically inactive adult through a variety of exercises. A 5-month exercise intervention was conducted on a single individual as a case study to examine this theory building and test a model practically.

Philosophy

Our research team consisted of faculty who are experts in the sports and exercise field. Two of the team specialized in sports and exercise psychology, and the other specialized in sports and exercise physiology. Our skills and expertise in both areas are essential for designing an appropriate research design and methodology. In addition, our expertise allowed us to gain a deeper understanding of the physiological and psychological factors that may affect our target population, the overweight and physically inactive, when undergoing the intervention. Two of the team members work in the Motivation in Education Research Laboratory, which focused primarily on motivational issues grounded in SDT and other major motivational theories, such as basic psychological needs theory (Ryan & Deci, 2017), possibly elaborate the concept of evolved psychological needs and their relations to psychological health and well-being based on three needs: autonomy, competence, and relatedness. This SDT-based research environment made it suitable for conducting the intervention program, where the fulfillment of the basic psychological needs based on the SDT forms the basis of the intervention philosophy (Ryan & Deci, 2017). This fulfillment was achieved through introducing variety into an exercise program in hopes of increasing self-determined motivation. Self-determined motivation acts upon the individual’s belief, knowledge, and skills without other external pressures or reinforcements (Brown & Ryan, 2003). This intervention’s effectiveness requires that the participant’s motivation be made known and void of extrinsic outcomes, pressures, and incentives.

Besides the SDT theoretical consideration, we considered enhancing the participant’s motivation for exercise through adapting mindfulness. Mindfulness has been defined as “paying attention in a particular way, on purpose, in the present moment, and nonjudgmentally” (Kabat-Zinn, 1994, p. 4). Mindfulness during exercise can create a stronger connection to one’s body (De Bruin et al., 2017). By focusing on each exercise, the muscles that are working, and the objectives of the exercise, one can feel more from each movement through a greater awareness of the movements. Through conscious efforts to be mindful during a workout, one can understand and become aware of the area that is being worked on and, thereafter, feel fulfillment in knowing that the effort has been made.

As this intervention is important to obtain a holistic view regarding the various psychological factors embedded in SDT, a single case study is applicable. A single case method was chosen to provide empirically rich, context-specific, holistic accounts, contributing to theory building and theory testing (Bennett & Elman, 2007; Yin, 1984). We seek to provide insights on theory-based exercise interventions promoting long-term exercise behavior by targeting psychological factors, perceived exercise barriers, autonomous motivation, and basic psychological needs satisfaction.

Methodology

Protocol

A 5-month exercise intervention was conducted on a single individual as a case study. The 5-month protocol included a 4-month intervention period and a 1-month follow-up period. The participant was invited to four face-to-face sessions.

The first session was a briefing on the study protocol and baseline measures (i.e., questionnaire and body mass index [BMI]). The briefing covered the aim of the intervention, the procedures to be undertaken, an explanation of the types of exercise, and a demonstration of the exercises.

The second and third sessions occurred in the second and fourth months of the study, respectively. The participant’s responses to the questionnaire and BMI were measured; consultations were also provided to the participant at these visits. The purpose of these consultations was to check on and resolve any issues the participant faced and review personal expectations. During each consultation, the benefits of mindfulness were highlighted, and the participant was reminded to focus on his movements and how his body felt while exercising. The participant was also guided to celebrate small accomplishments and was reminded that it was all right to take a break and restart again. Each session took approximately 20 to 30 min and covered various discussion points such as, but not limited to, potential future PA, reinforcing the advantages of increasing activity levels, overcoming barriers to exercise participation, sources of support and motivation, reducing chances of exercise deterrence, and goal setting.

After the fourth month, there was a month-long follow-up period during which no exercise programs were prescribed, but the participant was encouraged to continue the routines acquired thus far. A concluding session and debriefing were then conducted. At that time, the participant was asked to rate his satisfaction with his exercise levels and provide overall thoughts about the intervention program. The participant was also invited to take part in a semistructured interview at the end of the program. Figure 1 shows the overall protocol of the intervention.

Figure 1
Figure 1

—Overall protocol.

Citation: Case Studies in Sport and Exercise Psychology 5, 1; 10.1123/cssep.2020-0029

Description of the Exercise Program

After the baseline assessment, the participant was guided through an exercise program that combined three types of exercises: (a) trainer-guided exercise, (b) self-guided exercise, and (c) accustomed exercise.

For trainer-guided learning, the participant was encouraged to participate in a campus-organized exercise program, SparksHealth. The program offered a wide variety of exercises: Zumba, yoga, Muay Thai, kickboxing, high-intensity interval training, and total body resistance exercise. There were various timeslots available for the classes, which provided some flexibility for the participant to attend the exercise based on his schedule. Each class size was limited to three to seven people. The small size allowed the instructor to pay more attention and provide better guidance to each individual. This was an important factor in ensuring that the participant felt secure while trying out a new form of exercise, as the instructors did not have to spread their attention over a large class. In total, the participant was provided free access to 20 campus-organized classes over the 4-month intervention period. The research program fully covered the cost of the classes.

Second, for self-guided exercise, the participant was given a list of YouTube channels and URL links and was encouraged to watch and follow those guided exercise videos. A variety of exercise channels was given to the participant, such as yoga, Pilates, boxing, and Zumba. The main benefit of self-guided exercise via YouTube channels was the flexibility it offered both in terms of the time and duration of exercise, as well as the form of exercise. For example, the participant had the freedom to choose how many types of exercise to perform and allocate how much time he wanted to spend on each form of exercise instead of having to stick to a fixed exercise class time. The YouTube channels were selected using the following criteria: (a) existed for more than 2 years, (b) various levels of content from beginner to intermediate, and (c) had more than 50 different content types. The research team reviewed all of the channels, and an example video was played and demonstrated to the participant during the briefing session.

Third, accustomed exercise was unrestrictive in the nature of the exercise so as long as it was convenient and accessible, such as jogging, walking, hiking, and cycling. It was composed of common types of exercises that could be easily performed without assistance. For this category of exercise, the participant was not restricted by any form of activity. The participant was free to perform any exercise form as long as it was convenient and accessible.

The Case

A single-subject case was selected from a larger campus exercise intervention program targeting overweight and physically inactive adults via flyers around campus (university institutional review board: IRB 2019-02-001). The eligibility criterion for this program was physical inactivity (<150 min of moderate-intensity PA per week in the last 6 months) and individuals aged 21–55 years, with BMI above 25 kg/m2. The exclusion criteria included any heart problems or chest pain during periods of activity or rest, pregnancy, or loss of consciousness based on the Physical Activity Readiness Questionnaire. Furthermore, to ensure safety when they undertook self-guided exercise, individuals with prior basic experience in fitness workouts were recruited to ensure that they understood any technical terms and would practice proper posture when following the YouTube videos on their own.

The overall profile of the selected case from the larger group was as follows: 23 years old, male, PhD student, BMI = 25.6 kg/m2. The participant had prior experiences with exercise (e.g., jogging, soccer, and swimming) but had become sedentary over the past 1–2 years due to a hectic schedule associated with his PhD. The participant took part in the present exercise intervention program, hoping to regain his motivation to exercise and establish a routine. In addition, the participant had expectations of losing some weight through the intervention. However, as the intervention’s primary focus was not to promote weight loss but rather to develop autonomous motivation, we reminded the participant of the study’s goals and objectives. We focused on realigning his controlled goals (e.g., weight loss) to more autonomous ones (e.g., enjoying the exercise itself, better health).

The reason for selecting this individual for the single case study was that he had completed the 5-month intervention before the commencement of a COVID-19 lockdown, which started on April 7, 2020. All nonessential workplaces were closed, including campus exercise spaces and facilities in the lockdown period. Hence, this participant underwent the intervention program’s full duration without being affected by the lockdown restrictions, unlike the other potential participants who could not complete it before the lockdown.

Measures

Data on basic psychological needs satisfaction, perception of exercise variety, perceived exercise barriers, autonomous motivation, and exercise behavior were collected four times via questionnaire over four separate sessions. In addition, the participant was guided to fill in a log whenever he had completed an exercise to monitor the participant’s engagement in the required exercise program. After the program ended, a semistructured interview was conducted by one of the team members. The semistructured interview consisted of asking about his expectations at the beginning of the program and his thoughts and feelings regarding the types of exercise barriers he faced, motivation levels, variety of exercises performed, and exercise levels before and after the program. The participant was also encouraged to provide feedback on the program’s efficiency and suggestions for improvement. The interview lasted about 30 min and was audio-recorded and then transcribed.

Basic Psychological Needs Satisfaction

The Psychological Needs Satisfaction in Exercise questionnaire (Wilson et al., 2006) was used to measure satisfaction of need for competence, relatedness, and autonomy in the context of exercise. The Psychological Needs Satisfaction in Exercise is an 18-item instrument with each of the three psychological needs measured via six items. Responses to each item were anchored on a scale that ranges from 1 (false) to 6 (true). Higher scores reflect greater satisfaction of the needs for perceived competence, relatedness, and autonomy in exercise. In a previous study, ordinal composite reliability was ≥.87 (Sylvester et al., 2018).

Perceived Exercise Variety

The Perceived Variety in Exercise Scale (Sylvester, Standage, Dowd, et al., 2014) was used to assess exercise variety. The participant was asked to “Please answer the following questions by considering how you typically feel while you are exercising.” The questionnaire includes five items, such as “I feel like my exercise program is varied,” and is anchored on a 6-point Likert scale with response options ranging from 1 (false) to 6 (true). Higher scores reflect greater levels of perceived variety in exercise. Sylvester et al. (2018) reported ordinal composite reliability from 0.91 to 0.94.

Perceived Exercise Barriers

A modified version (Mailey et al., 2016) with 10 items from the original Exercise Barriers Scale (Sechrist et al., 1987) was chosen to assess perceived barriers to exercise. The participant indicated the extent to which each barrier interfered with his exercise routine, on a scale from 1 (not at all) to 5 (always). In a previous study, barriers were summed to yield a total score (range: 10–50) with adequate internal consistency (α = .83; Mailey et al., 2016).

Autonomous Motivation

The Behavioral Regulations in Exercise Questionnaire-2 (Markland & Tobin, 2004) was used to assess autonomous motivation to exercise. Items were scored on a 5-point Likert scale ranging from 0 (not true for me) to 4 (very true for me), with 19 items. The Behavioral Regulations in Exercise Questionnaire-2 includes five subscales: intrinsic, identified, introjected, and external regulations, and amotivation. The internal reliability for the introjected regulation subscale in the study (Longbottom et al., 2012) was suboptimal (α = .77), but was acceptable for the external regulation (α = .81), identified regulation (α = .80), intrinsic motivation (α = .87), and amotivation (α = .86) measures. The Behavioral Regulations in Exercise Questionnaire-2 was scored by computing a one-dimensional index of the degree of autonomous motivation, called the Relative Autonomy Index (RAI: Grolnick & Ryan, 1987; Vallerand & Ratelle, 2002). The RAI is a single score representing the overall degree of self-determination. It is obtained by weighting each behavioral subscale (i.e., amotivation × [−3], external regulation × [−2], introjected regulation × [−1], identified regulation × [+2], intrinsic regulation × [+3]) followed by the summing of these weighted scores.

Exercise Behavior

Exercise behavior was measured in two different ways. The first was through self-report, using the International Physical Activity Questionnaire—long form (IPAQ: Craig et al., 2003), which has been shown to have acceptable reliability and validity (Craig et al., 2003; Hagstromer et al., 2006). The IPAQ is a subjective measure of an individual’s PA recall from the previous 7 days. The IPAQ assesses PA undertaken across a comprehensive set of domains, including leisure-time PA, domestic and gardening activities, work-related PA, and transport-related PA. The IPAQ data are converted to metabolic equivalent of task (MET) scores (MET-minutes/week) for each type of activity. The MET score weighs each type of activity by its energy expenditure, using one MET for sitting, 3.3 METs for walking, four METs for moderate activity, and eight METs for vigorous activity.

Participation in PA (i.e., the volume of PA) is categorized into three levels: low, moderate, and high. To be classified as low, individuals must not have met the criteria for levels two or three. For moderate, an individual must meet any one of the following three criteria: (a) 3 or more days of vigorous activity of at least 20 min a day, (b) more than 5 days of moderate-intensity activity or walking, or (c) more than 5 days of any combination of walking, moderate-intensity activities, or vigorous-intensity activities achieving at least 600 MET-min/week. To be classified as high, an individual must meet either of the following two criteria: (a) at least 3 days of vigorous-intensity activity accumulating at least 1,500 MET-min/week or (b) 7 or more days of any combination of walking, moderate-intensity activities, or vigorous-intensity activities accumulating a minimum of 3,000 MET-min/week. Total PA was calculated using MET-minutes/week, which was the sum of the total MET-minutes/week scores from walking, moderate-intensity activities, and vigorous-intensity activities.

In the second session, the participant was guided to record his exercise activity by indicating the time in and out and the type of exercises performed using the designated exercise log via a Google form and reporting any adverse symptoms or pain experienced during or after exercise.

Body Mass Index

Height was measured in the first baseline session, and weight was measured using an InBody 720 (Biospace, Seoul, South Korea) during each of the four sessions. BMI was calculated as weight in kilograms/height in meters squared.

Data Analysis

Quantitative data were analyzed using visual inspection guided by Kazdin (2011). Main variables (i.e., perceived exercise variety, the three basic psychological needs satisfaction, exercise barriers, autonomous motivation, exercise behavior, and BMI) were analyzed. The percentage of data points exceeding the baseline phase was included to match the visual inspection of changes in the level and trend between the baseline and treatment period, followed by the percentage of data points exceeding the median of the baseline phase approach (Kazdin, 2011; Ma, 2006). In the visual inspection, the baseline scores were used as reference points for changes in scores for all measured variables during the course of the intervention. The percentage of treatment data points above the baseline score (i.e., perceived exercise variety, the three basic psychological needs satisfaction, autonomous motivation, exercise behavior) or below the baseline score (i.e., exercise barriers and BMI) was considered. The criteria for interpretation were the following: 90–100% below or above the baseline score signified a strong effect, 70–90% a moderate effect, and <70% a questionable or no effect (Ma, 2006; Scruggs et al., 1986). As measurements were taken only four times during the intervention, there could be limitations in its interpretation. Therefore, we focused on comparing follow-up scores with the baseline scores.

Data from the exercise log were extracted to obtain the frequencies and types of exercises participated in. For qualitative data analysis, the recorded interview was transcribed verbatim. The data were sorted and categorized based on patterns connected with predetermined themes based on the quantitative variables measured (i.e., perceived exercise variety, the three basic psychological needs satisfaction, perceived exercise barriers, autonomous motivation, and exercise behavior). To recognize main themes and categories from the participant’s reflection of the program, both directed and conventional content analysis were guided by Hsieh and Shannon (2005). Some transcription quotations were used to increase the research’s trustworthiness and improve readers’ evaluation (Patton, 2002).

Results

The participant successfully completed the 5-month intervention program. In line with Hussey et al. (2020), quantitative data were reported, along with each measured factor and description from the interview. The results of the visual inspection are shown in Figure 2. Overall, the participant showed improvement in all measurement factors except BMI.

Figure 2
Figure 2

—Visual inspection throughout all main variables. PVE = Perceived Variety in Exercise Scale; EBS = Exercise Barrier Scale; RAI = Relative Autonomy Index; IPAQ–long form = International Physical Activity Questionnaire–long form; MET = metabolic equivalent of task; BMI = body mass index.

Citation: Case Studies in Sport and Exercise Psychology 5, 1; 10.1123/cssep.2020-0029

Basic Psychological Needs Satisfaction

The three factors in basic psychological needs showed gradual improvement across all four measurement times. Competence (12→23→30→31) and autonomy (12→22→27→33) showed notable enhancement, and relatedness showed gradual enhancement (19→23→25→27). The baseline scores of his competence and autonomy level were low. In the interview, he mentioned that he was stressed from his PhD studies and did not feel in command of his lifestyle: “I was eating too much and was lazy, I did not have complete control over my routine.” During the intervention period, some on-campus classes were rescheduled, which led the participant to replace those classes with YouTube exercise videos such as Zumba. At the end of the intervention period, he reported confidence in making exercise a daily habit and did not once report any feelings of laziness throughout the intervention. His source of relatedness came from participating in team sports: “I used to play a lot of soccer, that’s a team sport, and I used to find joy in that. I only did simple walking during my Ph.D. time and was mostly working alone, so I was feeling a bit lonely.” His relatedness was satisfied once he attended a Muay Thai campus class. He said, “Especially when I went to Muay Thai, I found new friends, and all of them were new to Muay Thai, and I feel that doing in a group motivates me to do more.”

Perceived Exercise Variety

The participant’s perceived exercise variety scores improved overall (10→17→22→21). Specifically, there was a greater increase between the baseline and the second month of the intervention. At the baseline, he described his exercise pattern: “I typically go for a walk or play soccer. Those were the only two things I used to do.” However, after the first follow-up session, on top of the required amounts of exercise for the intervention program, the participant also signed up for Zumba classes on the Community Health Board’s website.

Perceived Exercise Barriers

At the baseline, the score in perceived exercise barriers was 26. At the 2-month intervention, the score increased to 30, and after 4 months, it decreased to 20. At the follow-up, the score was 18. The difference in the score was only 67%, which could be in the range of a questionable or no effect. However, before the intervention program, the participant’s main exercise barrier was a lack of motivation and stress from work. However, during the first 2 months of intervention, the barriers to exercise came from a lack of time and stress from studying for his PhD test. Throughout the intervention, consultations revealed that the frequency of the barriers mentioned was reduced.

Autonomous Motivation

The RAI score gradually improved over the course of the program: −1.3→7→11→14.6. The maximum possible RAI score is 20, and the minimum is −24. When asked about his motivation level at the baseline, the participant rated the following on a scale: “I would say on a scale of one to ten, I would choose either two or three.” As he started to adopt 3 hr of weekly exercise, his sedentary PhD life changed to become more active and healthier. As he regained more control of his exercise routine, he became more self-driven in exercising. He rated his motivation level again after the follow-up: “My motivation is high, so maybe I would say ten.”

Exercise Behavior

IPAQ—Long Form

At baseline, self-reported physical activity based on the IPAQ–Long Form was 1,242.0 MET-min/week. The second measurement was 1,138.5 MET-min/week, followed by a further improvement at the third measurement to 3,035.0 MET-min/week. The participant’s activity level was higher during the follow-up period, at 3,157.5 MET-min/week. PA improvement was only recorded at the final two follow-up sessions (67% of the sessions displaying questionable or no effect). Nevertheless, there was still an overall 2.5-fold increase in total PA from the baseline to the final follow-up measurement.

Exercise Log

The participant fulfilled the exercise requirements of 3 hr/week. In the exercise logs, the participant reported his exercise patterns. In the first 2 months of the intervention, he mostly completed easy-access exercises, such as outdoor jogging and outdoor swimming, followed by trainer-guided exercises, such as Muay Thai, and self-guided videos via YouTube, such as Zumba. As the intervention proceeded, the participant started to engage in badminton and soccer by his own will. At the end of the follow-up period, the participant frequently played soccer. When starting to play soccer, the participant’s overall exercise duration increased, especially in the follow-up month. Overall, no unexpected symptoms or pains were reported.

Body Mass Index

The participant’s BMI slightly increased after the intervention compared with the baseline (25.6→25.6→26.3→26.2 kg/m2). Overall, the change was trivial.

Discussion

Reflections and Recommendations

Overall, the effectiveness of the program is supported via data on self-reported PA. At baseline, the participant’s self-reported PA was 1,242.0 MET-min/week. This activity gradually increased to 3,157.5 MET-min/week at the final follow-up measure—a 2.54-fold increase in self-reported PA.

Despite being a single-subject case study, the outcomes observed here align with previous cross-sectional research studies (Dimmock et al., 2013; Glaros & Janelle, 2001; Juvancic-Heitzel et al., 2013; Sylvester et al., 2018; Sylvester, Standage, Ark, et al., 2014; Sylvester, Standage, Dowd, et al., 2014), which found that perceptions of variety in exercise were positively related with both autonomous motivation and exercise behavior. Greater perceived variety in exercise tasks results in the satisfaction of the three basic psychological needs, which might lead to autonomous motivation and behavioral engagement. In the present study, the scores on the three psychological needs progressively increased together with the scores on the perceived variety of exercise. Although not causal, the possibility exists that having a variety of exercises could bring about an environment that satisfies the three psychological needs. The intervention itself exposed the participant to the three types of exercise platforms—trainer-guided organized exercise classes, self-guided exercises via YouTube channels, and accustomed exercises. The participant was given various options within each form of exercise, which allowed him to choose the types of exercises to engage in according to his preferences and time. In accordance with SDT (Deci & Ryan, 1985, 2002; Ryan & Deci, 2017), the ability to choose the types of exercises performed afforded the participant the opportunity to satisfy his basic needs for autonomy. Perceived competence could be met via accomplishing challenging tasks and through success in meeting goals. An example of an exercise form that the participant had expressed interest in was Zumba. Zumba was available in both trainer-guided and self-guided exercise forms. The provision of Zumba via two platforms allowed the participant a greater opportunity to improve his Zumba proficiency, aiding fulfillment of the need for competence. However, the participant had a lower score for relatedness than competence and autonomy. This could be due to limited engagement with others during the trainer-guided exercises, as well as self-guided YouTube exercises. His relatedness scores increased since starting to play soccer; the change in scores suggested that his need for relatedness would be fulfilled after experiencing companionship during soccer play. Overall, the participant showed impressive changes in his exercise barriers, autonomous motivation, and PA levels. Through these developmental experiences that engendered competence, autonomy, and relatedness, the participant advanced toward high-quality forms of exercise motivation and removed the exercise barriers.

In the second and third sessions, the participant expressed his concerns and difficulties faced. The research team provided advice and suggestions to tackle and mitigate his concerns during the consultations. The participant regularly reported his exercise through the exercise log and reported his feelings regarding the exercises and progress. The use of mindfulness was particularly useful in this intervention. The participant said that he felt dejected for having shown no significant weight loss. At that time, we reemphasized the importance of this intervention program to increase exercise behaviors and motivation. We suggested that he reroute his goal to strengthen muscle or reduce fat percentages rather than the absolute weight.

During the second and third consultations and the concluding session, the participant described his feelings toward the variety of exercises. He was mostly happy with the exercises; however, he also expressed difficulties, as he felt lonely when exercising alone. Although the intervention provided a variety of exercises, there were no team sports. The participant would rather participate in team exercise, where there was more interaction with others. He thus decided to join his friends for badminton and join the campus soccer club for his weekly training. Doing so allowed the participant to continue feeling positive during and after his workout time, as the need for companionship had been addressed.

During the second and third consultations, the participant also expressed difficulties regarding the trainer-guided lessons. For instance, if there were only a few participants who signed up for a Zumba class, the class would be canceled. Thus, the participant often faced difficulties signing up for his preferred activity and sought the advice of the research team. In response to his situation, we offered him alternative options, such as similar classes on YouTube channels that he could follow instead.

In order to promote mindfulness, emphasis was placed on the process and progress of the physical activities. We again encouraged the participant to celebrate mini-victories and take each workout as an accomplishment. This encouragement was offered so that the participant would feel good about making an effort to exercise and be stimulated to continue with such efforts. In addition, we conveyed to the participant the importance of providing feedback to us regarding adverse reactions from muscle soreness and breathlessness. This is so that we might continue to motivate him with his activities, such as explaining to him not to overexercise to “compensate” for the lack of fitness, as overtraining may result in injuries, demoralization, and more setbacks.

When asked for suggestions for improvement, the participant mentioned his preference for more team-based exercise. This intervention exposed the participant to a variety of exercises; however, the exercises were mostly individual and lacked the “team” element. Having interactions with other exercisers may influence one’s psychological state, as the presence of social support changes the exercise environment and experience. In particular, team-based exercises may affect one’s “relatedness” as one forms bonds with teammates. The participant recommended improving the program in the future. He said, “It would be good if you can group up two or three persons to do the YouTube exercise or maybe jog together. I think at least that there will be a little more motivation for certain people.” Perhaps future studies can explore team-based activities in programs addressing exercise motivations.

Limitations

This study had several limitations. The first was the monetary incentive provided to the participant. Although the incentive was only 50 Singapore dollars, the incentive could have impacted the participant’s controlled motivation to undertake the program and follow through with the study. Second, the participant’s exercise barriers might be considered relatively easy to overcome. He was not severely overweight and had previously engaged in some sports activities before his inactivity/increased sedentary behavior during his PhD. Thus, he might have been more likely to undertake the intervention program in the first place. Moreover, the increase in his activity levels could have been due to the influence of having more free time.

Finally, the research team was available to support and advise the participant when he faced difficulties/challenges which could potentially undermine his autonomous motivation. When, for instance, the participant expressed disappointment in his stagnation in weight loss, we tried to reroute him to a new goal, to strengthen his muscles and achieve fat loss instead of focusing on overall weight loss.

Conclusion

This intervention program offered a chance to overcome barriers to exercise and increase self-determined motivation and basic psychological needs via various exercise platforms. The case study showed that psychological needs satisfaction for autonomy, competence and relatedness, autonomous motivation, and exercise behavior improved, while perceived barriers decreased. The reflections and lessons learned have informed and will continue to inform our operating practices in integrating and promoting such initiatives, while also enhancing our research practices by detailing the process of providing ongoing support to sustain exercise changes for the physically inactive and overweight population.

Acknowledgments

This research is supported by the Ministry of Education, Singapore, under its Academic Research Fund Tier 1 (2018-T1-002-047). All procedures performed in studies involving human participants were in accordance with the institutional and/or national research committee’s ethical standards and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

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    • Export Citation
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  • Hussey, J., Weinberg, R., & Assar, A. (2020). Mindfulness in sport: An intervention for a choking-susceptible athlete. Case Studies in Sport and Exercise Psychology, 4(1), 110. https://doi.org/10.1123/cssep.2019-0025

    • Crossref
    • Search Google Scholar
    • Export Citation
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    • Crossref
    • Search Google Scholar
    • Export Citation
  • Juvancic-Heitzel, J.A., Glickman, E.L.& Barkley, J.E. (2013). The effect of variety on physical activity: A cross-sectional study. Journal of Strength and Conditioning Research, 27(1), 244251. https://doi.org/10.1519/jsc.0b013e3182518010

    • Crossref
    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
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    • Crossref
    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
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    • Search Google Scholar
    • Export Citation
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    • Export Citation
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The authors are with the Physical Education and Sports Science Academic Group, National Inst. of Education, Nanyang Technological University, Singapore.

Kang (heonjin.kang@nie.edu.sg) is corresponding author.
  • View in gallery

    —Overall protocol.

  • View in gallery

    —Visual inspection throughout all main variables. PVE = Perceived Variety in Exercise Scale; EBS = Exercise Barrier Scale; RAI = Relative Autonomy Index; IPAQ–long form = International Physical Activity Questionnaire–long form; MET = metabolic equivalent of task; BMI = body mass index.

  • Adams, J., & White, M. (2003). Are activity promotion interventions based on the transtheoretical model effective? A critical review. British Journal of Sports Medicine, 37(2), 106114. PubMed ID: 12663350 https://doi.org/10.1136/bjsm.37.2.106

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bennett, A., & Elman, C. (2007). Case study methods in the international relations subfield. Comparative Political Studies, 40(2), 170195. https://doi.org/10.1177/0010414006296346

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Booth, F.W., Roberts, C.K., & Laye, M.J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology, 2(2), 11431211. PubMed ID: 23798298 https://doi.org/10.1002/cphy.c110025

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Booth, F.W., Roberts, C.K., Thyfault, J.P., Ruegsegger, G.N., & Toedebusch, R.G. (2017). Role of inactivity in chronic diseases: Evolutionary insight and pathophysiological mechanisms. Physiological Reviews, 97(4), 13511402. PubMed ID: 28814614 https://doi.org/10.1152/physrev.00019.2016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brown, K.W., & Ryan, R.M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822848. PubMed ID: 12703651 https://doi.org/10.1037/0022-3514.84.4.822

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Craig, C.L., Marshall, A.L., Sjostrom, M., Bauman, A.E., Booth, M.L., Ainsworth, B.E., Pratt, M., Ekelund, U., Yngve, A., Sallis, J.F., & Oja, P. (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine & Science in Sports & Exercise, 35(8), 13811395. PubMed ID: 12900694 https://doi.org/10.1249/01.MSS.0000078924.61453.FB

    • Crossref
    • Search Google Scholar
    • Export Citation
  • De Bruin, E.I., Formsma, A.R., Frijstein, G., & Bögels, S.M. (2017). Mindful2Work: Effects of combined physical exercise, yoga, and mindfulness meditations for stress relieve in employees. A proof of concept study. Mindfulness, 8(1), 204217. PubMed ID: 28163797 https://doi.org/10.1007/s12671-016-0593-x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Deci, E.L., & Ryan, R.M. (1985). Intrinsic motivation and self-determination in human behavior. Plenum.

  • Deci, E.L., & Ryan, R.M. (2002). Handbook of self-determination research. The University of Rochester Press.

  • Dimmock, J., Jackson, B., Podlog, L., & Magaraggia, C. (2013). The effect of variety expectations on interest, enjoyment, and locus of causality in exercise. Motivation and Emotion, 37(1), 146153. https://doi.org/10.1007/s11031-012-9294-5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Etkin, J., & Mogilner, C. (2016). Does variety among activities increase happiness? Journal of Consumer Research, 43(2), 210229. https://doi.org/10.1093/jcr/ucw021

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Glaros, N., & Janelle, M. (2001). Varying the mode of cardiovascular exercise to increase adherence. Journal of Sport Behavior, 24(1), 4262.

    • Search Google Scholar
    • Export Citation
  • Grolnick, W.S., & Ryan, R.M. (1987). Autonomy in children’s learning: An experimental and individual difference investigation. Journal of Personality and Social Psychology, 52(5), 890898. PubMed ID: 3585701 https://doi.org/10.1037/0022-3514.52.5.890

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hagger, M.S., Hardcastle, S.J., Chater, A., Mallett, C., Pal, S., & Chatzisarantis, N.L.D. (2014). Autonomous and controlled motivational regulations for multiple health-related behaviors: Between- and within-participants analyses. Health Psychology and Behavioral Medicine, 2(1), 565601. PubMed ID: 25750803 https://doi.org/10.1080/21642850.2014.912945

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hagstromer, M., Oja, P., & Sjostrom, M. (2006). The international physical activity questionnaire (IPAQ): A study of concurrent and construct validity. Public Health Nutrition, 9(6), 755762. PubMed ID: 16925881 https://doi.org/10.1079/phn2005898

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hsieh, H., & Shannon, S. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 12771288. PubMed ID: 16204405 https://doi.org/10.1177/1049732305276687

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hsu, Y.-T., Buckworth, J., Focht, B.C., & O’Connell, A.A. (2013). Feasibility of a self-determination theory-based exercise intervention promoting healthy at every size with sedentary overweight women: Project CHANGE. Psychology of Sport and Exercise, 14(2), 283292. https://doi.org/10.1016/j.psychsport.2012.11.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hussey, J., Weinberg, R., & Assar, A. (2020). Mindfulness in sport: An intervention for a choking-susceptible athlete. Case Studies in Sport and Exercise Psychology, 4(1), 110. https://doi.org/10.1123/cssep.2019-0025

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jakicic, J.M., & Gallagher, K.I. (2003). Exercise considerations for the sedentary, overweight adult. Exercise and Sport Sciences Reviews, 31(2), 9195. PubMed ID: 12715973 https://doi.org/10.1097/00003677-200304000-00007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Juvancic-Heitzel, J.A., Glickman, E.L.& Barkley, J.E. (2013). The effect of variety on physical activity: A cross-sectional study. Journal of Strength and Conditioning Research, 27(1), 244251. https://doi.org/10.1519/jsc.0b013e3182518010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kabat-Zinn, J. (1994). Mindfulness meditation for everyday life. Hyperion.

  • Kazdin, A.E. (2011). Single-case research designs (2nd ed.). Oxford University Press.

  • Kleis, R.R., Hoch, M.C., Hogg-Graham, R., & Hoch, J.M. (2020). The effectiveness of the transtheoretical model to improve physical activity in healthy adults: A systematic review. Journal of Physical Activity and Health, 18(1), 115. https://doi.org/10.1123/jpah.2020-0334

    • Search Google Scholar
    • Export Citation
  • Longbottom, J., Grove, J.R., & Dimmock, J.A. (2012). Trait perfectionism, self-determination, and self-presentation processes in relation to exercise behavior. Psychology of Sport and Exercise, 13(2), 224235. https://doi.org/10.1016/j.psychsport.2011.11.003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lovell, G.P., El Ansari, W., & Parker, J.K. (2010). Perceived exercise benefits and barriers of non-exercising female university students in the United Kingdom. International Journal of Environmental Research and Public Health, 7(3), 784798. PubMed ID: 20617003 https://doi.org/10.3390/ijerph7030784

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ma, H. (2006). An alternative method for quantitative synthesis of single-subject researches: Percentage of data points exceeding the median. Behavior Modification, 30(5), 598617. PubMed ID: 16894232 https://doi.org/10.1177/0145445504272974

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mailey, E.L., Phillips, S.M., Dlugonski, D., & Conroy, D.E. (2016). Overcoming barriers to exercise among parents: A social cognitive theory perspective. Journal of Behavioral Medicine, 39(4), 599609. PubMed ID: 27108160 https://doi.org/10.1007/s10865-016-9744-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Markland, D., & Tobin, V. (2004). A modification to the behavioural regulation in exercise questionnaire to include an assessment of amotivation. Journal of Sport & Exercise Psychology, 26(2), 191196. https://doi.org/10.1123/jsep.26.2.191

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McIntosh, T., Hunter, D.J., & Royce, S. (2016). Barriers to physical activity in obese adults: A rapid evidence assessment. Journal of Research in Nursing, 21(4), 271287. https://doi.org/10.1177/1744987116647762

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Patton, M.Q. (2002). Qualitative research and evaluation methods (3rd ed.). SAGE Publishing.

  • Prochaska, J.O., & Velicer, W.F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 3848. PubMed ID: 10170434 https://doi.org/10.4278/0890-1171-12.1.38

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ryan, R.M., & Deci, E.L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. Guilford Publications.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ryan, R.M., Patrick, H., Deci, E.L., & Williams, G.C. (2008). Facilitating health behaviour change and its maintenance: Interventions based on self-determination theory. European Health Psychologist, 10(1), 25.

    • Search Google Scholar
    • Export Citation
  • Scruggs, T.E., Mastropieri, M.A., Cook, S.B., & Escobar, C. (1986). Early intervention for children with conduct disorders: A quantitative synthesis of single-subject research. Behavioral Disorders, 11(4), 260271. https://doi.org/10.1177/019874298601100408

    • Crossref
    • Search Google Scholar
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  • Sechrist, K.R., Walker, S.N., & Pender, N.J. (1987). Development and psychometric evaluation of the exercise benefits/barriers scale. Research in Nursing and Health, 10(6), 357365. PubMed ID: 3423307 https://doi.org/10.1002/nur.4770100603

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