Understanding Transitional Shift Patterns in Physical Activity Behavior Among Women with MS

Understanding Transitional Shift Patterns in Physical Activity Behavior Among Women with Multiple Sclerosis

Bradley J. Cardinal, Kin-Kit Li, and Gianni F. Maddalozzo

Abstract

Adults with physical disabilities remain inactive at rates higher than their non-disabled counterparts (i.e., 36% vs. 56%, respectively). To better understand the determinants of their behavior, the Transtheoretical Model (TTM) of behavior change has been recommended as a guiding framework. However, as traditionally applied, TTM fails to capture the dynamic nature of change (i.e., stage of change movement or transitional shift patterns). The purpose of this study was to characterize naturally occurring physical activity behavior change observed over 1-year among women with multiple sclerosis. Through this research we hope to identify variables actually associated with "change," as this might be especially useful in conducting future intervention research. At baseline women with multiple sclerosis (M age = 50.9 yr., 90.5% Caucasian) completed TTM questionnaires including stage of change, self-efficacy, processes of change, and decisional balance. One year later, these same questionnaires were re-completed by the participants (N = 83, which represents an 80.6% study participation rate). There was no intervention. Participants were classified into a priori transitional shift patterns labeled: stable sedentary, stable active, activity adopter, activity relapser, and perpetual preparer, which were derived from Cardinal, Engels, and Smouter’s (2001) classifications scheme. A 5 (transitional shift pattern) η 2 (time) repeated measures MANCOVA was performed, with age, severity of multiple sclerosis (i.e., EDSS score), and weight all serving as covariates. The transitional shift pattern main effect ( η 2 = .22, p<0.001) and transitional shift pattern by time interaction ( η 2 = .11, p<0.01) were both significant. The main effect for self-efficacy was largest (η 2 = .47), followed by cognitive processes (η 2 = .46), decisional balance (η 2 = .29), and behavioral processes (η 2 = .22) (all p<0.001). The interaction effect for behavioral processes was largest (η 2 = .18), followed by cognitive processes (η 2 = .17), decisional balance (η 2 = .13), and self-efficacy (η 2 = .12) (all p<0.05). The results provide theoretically grounded focus points for future physical activity interventions. For example, those classified as stable active or activity adopters increased their use of the behavioral processes over time (i.e., +0.05 and +0.37, respectively), whereas those classified as activity relapsers or stable sedentary decreased their use (i.e., -0.42 and -0.05, respectively). Those in perpetual preparation (+0.02) remained nearly unchanged.

Supported by the National Multiple Sclerosis Society (Grant No. PP1026).