Obesity is a contributory factor in preventable health conditions such as cancer (Argolo et al. 2018; Bhaskaran et al. 2014), diabetes (Eaton & Eaton 2017; Hamilton, Hamilton & Zderic et al. 2007), asthma (Barros et al. 2016) and cardiovascular disease (Wannamethee et al. 2005). The world is experiencing an obesity epidemic, with 2.8 million deaths a year due to being overweight or obese (WHO 2017). In the UK, NHS Digital Statistics Team (2018) reported 617’000 hospital admissions in 2016/17 where obesity was a factor. In 2015, obesity cost the NHS £4.2 billion, projections for this figure suggest it will reach £10 billion per year by 2050 (RSPH 2015).
Cassidy et al. (2017) and De Rezende et al. (2014) cite sedentary behaviour among both adult and juvenile populations as a reason for this rise in obesity. Sedentary behaviour is also a characteristic of mental illness which in turn is negatively related to obesity (Mizock 2015). Fortunately, obesity and the health risks associated with the condition are widely recognised as reversible through an increase in physical activity and reduced levels of sedentary behaviour (Laskowski 2012). There is a 30% risk reduction in all-cause mortality, 20-35% lower risk of cardio-respiratory disease and cancers in the physically active (DHHS 2008). Therefore, Department of Health (2011) guidelines recommend adults perform 150 minutes of moderate aerobic activity per week. Currently, 34% of men and 42% of women aged 19 and over are not meeting this level of physical activity. Populations reporting the least physical activity are groups aged over 55 or living in the most deprived areas of the UK (NHS 2018). The challenge for medical and physical practitioners is understanding how to assist behaviour change in individuals and groups who are not physically active. One method that works on the understanding that sustainable behaviour change occurs over a specific sequence of stages is the Trans-Theoretical Model (TTM).
Blaney et al. (2012) ; Han ; Kohl (2015) recognise TTM as an appropriate device to reduce sedentary behaviour in tailored interventions. Originally, TTM was used to aid behaviour changes such as smoking cessation (DiClemente et al. 1991; Prochaska, DiClemente ; Norcross 1992). TTM can promote change across many health behaviours including substance abuse, using sunscreen and weight reduction (Prochaska et al. 1994). Conceptually, TTM has four key variables: stages of change, decisional balance, self-efficacy and processes of change (Middelkamp ; Steenbergen 2015). There are five stages of change that form the core of TTM for exercise behaviour. These are Pre-contemplation, Contemplation, Preparation, Action and Maintenance. A sixth stage, Termination, exists but is not considered a realistic goal for most people (Prochaska ; Velicer 1997).
Questionnaires are used to ascertain which stage of change someone is in. Each stage has its own characteristics which will define the methods used to adjust behaviour moving forward. TTM recognises two categories for the process of change, cognitive and behavioural. There are five processes in each of these two categories. The first three stages of change are more likely to require cognitive processes and the latter stages make more use of behavioural processes. Individuals within the preparation, action and maintenance stages at the outset are more likely to sustain a positive behaviour change (). Studies that show consistent progress from the pre-contemplation and contemplation stages are of significant interest.
The aim of this study is to use TTM to assist gradual and sustainable behaviour change in an individual who identifies as physically inactive. The participant will receive an information sheet (appendix i). This will explain the aim of the study and describe the possible risks of an increase in physical activity. Additionally, this will inform them of their right to withdraw at any juncture. If having carefully read the information sheet, the client agrees, they will sign a voluntary consent form (appendix ii) and complete a medical history questionnaire (appendix iii).
After this agreement, the client will complete five TTM questionnaires (appendix iv). These are: Processes of change questionnaire (Marcus et al. 1992); Self efficacy questionnaire (Marcus et al. 1992); Decisional balance questionnaire (Marcus, Rakowski ; Rossi, 1992); Social support for physical activity scale (Sallis et al.1987); Physical activity stages of change (Marcus et al. 1992). Answers given to each questionnaire will be processed as directed by each author. These processed results will act as a guide for a 30-minute, semi-structured interview which the researcher will conduct with the participant. Interview topics will include, favoured activities, availability of friends or family to participate with, time pressures and facilities in the local area. Responses will be used by both parties to agree on a suitable first course of action. This plan will take the form of 4-6-week cycles. The client will log daily activity. Meetings will take place on a weekly basis to assess progress. Discussions about barriers experienced, enjoyment levels and well-being will be important in the early stages of the process. The client will have a means of communication with the researcher at any time to facilitate these conversations.