Running head: DOCUMENTING EXERCISE

Documenting Exercise: Does creating a Detailed Plan Make it Easier to Follow Through? Touro University Nevada Lauren M. Hoppe, Emily E. Matthews, Kristen D. Kincaid, Jaimee D. Perea, Megan J. Lawrence, Alicia A. Ellingson

Running head: DOCUMENTING EXERCISE

Results A convenience population of first year, full time occupational therapy students were recruited for the study. All students are enrolled in a research course at Touro University Nevada. The participants recorded their personal exercise data over the period of one week spanning Thursday, September 19, 2013 to September 26, 2013. The time frame chosen included a higher percentage of days without scheduled in-class sessions. Students did not attend school during the dates of September 19-22, which provided them greater opportunity to engage in physical activity. The study began with 31 participants with no refusals. Upon completion, a 3% attrition rate was calculated. The participants were split into Group A and Group B with initial diaries including basic and detailed planning respectively. Simple random sampling was utilized to separate the participants. The two groups were unequal upon completion with a Group A of 16 participants and Group B of 15. Demographically, the population studied ranges from 22-55 years of age. However the majority, 87% of the people sampled are under the age of 30. Both genders are represented in the study, 26.6% male and 73.4% female. The majority of the students moved to Las Vegas for graduate studies at Touro University Nevada from the west and southwest United States. The participants completed a diary of their physical activity before and after exercise completion. The diaries were collected and analyzed using a seven point number scale. The diaries were analyzed by planned participant commitment versus their actual exercise outcome. Points were added for each day that proved initial commitment and follow-through, exercise or no exercise. The research team also measured the frequency of physical activity after use of an exercise plan.

Running head: DOCUMENTING EXERCISE

Two aspects were investigated to see if any relationship exists between the basic and detailed physical activity plans. The first aspect involved measuring the adherence to a set workout schedule. For example, if a participant planned to exercise on Monday, Tuesday, Thursday, their adherence to Monday, Tuesday, Thursday was measured. The second analysis focused on the frequency of exercising, despite adherence to a specific day. If the participant anticipated exercising three days in a week, and they actually worked out three days, they were rated as adhering to their plan, no matter what day they exercised. These two aspects of our research were analyzed by providing a numeric value to their respective focus (how many days were the same in pre-workout plan/ post report, frequency of weekly workout in preworkout/post report). The use of a t-test was then utilized to determine relationships among the two groups. Data Analysis Two separate aspects of the study were investigated to determine if a relationship exists between the participants physical activity plan and the exercise individuals actually engaged in. First, the researchers determined if the detailed physical activity plan increased the likelihood that subjects would participate in exercise on the specific day documented. After the data was collected, the research team used a two tailed t-test with a level of significance at the .05 level. Differences between the two groups were tested once and therefore the t-test for independent values was applied. The t value was computed to be .16 with a critical value of 2.05 as seen in Table 1 (T30= .16, p> .05). The null hypothesis for this study states there is no statistical difference between the group who completed the detailed physical activity plan and the group with the basic physical activity plan. Based on the information analyzed, the results were not significant at the .05 level, thus the null hypothesis was accepted.

Running head: DOCUMENTING EXERCISE

Next, researchers examined the results to see if the subjects who completed the detailed physical activity plan were more likely to engage in physical activity, regardless of the day specified. The null hypothesis stated that a detailed physical activity plan did not increase the frequency that participants exercised throughout the week. In order to test the null hypothesis, we completed four separate two tailed t-test with a level of significance at the .05 level. These tests compared the following: the predicted exercise frequency of the two groups prior to intervention, the actual exercise frequency of the two groups after intervention, and the frequency within each group pre-intervention and post-intervention. The null hypothesis had to be accepted after analyzing the data. The findings showed that there was no statistical difference between Group A and Group B, as seen in table 2, prior to the intervention, p=.27, or after intervention, p=.16. Furthermore, each group was analyzed internally for pre-intervention and post-intervention data. The p value for the basic physical activity plan was .27, while the detailed physical activity plan was a p of .21. This indicated that neither the basic nor detailed physical activity plan had a statistically significant effect on the frequency in which clients engaged in exercise. Consequently, we concluded the intervention did not produce any clinically significant findings.

Running head: DOCUMENTING EXERCISE

Table 1 Adherence to Exercise Plans

t-Test: Two-Sample Assuming Unequal Variances t-Test: Two-Sample Assuming Unequal Variances Variable 1 Mean Variance Observations Hypothesized Mean Difference df t Stat P(T<=t) one-tail t Critical one-tail P(T<=t) two-tail t Critical two-tail 3.625 2.25 16 0 28 1.44368 0.07996 3 1.70113 1 0.15992 5 2.04840 7 Variable 2 4.35714 3 Mean 1.63186 8 Variance 14 Observations Hypothesized Mean Difference df t Stat P(T<=t) one-tail t Critical one-tail P(T<=t) two-tail t Critical two-tail

Running head: DOCUMENTING EXERCISE

Table 2
t-Test: Two-Sample Assuming Unequal Variances Variable 1 3.6875 4.495833333 16 0 30 1.134085166 0.132870031 1.697260887 0.265740061 2.042272456 Variable 2 2.875 3.716666667 16

Mean Variance Observations Hypothesized Mean Difference Df t Stat P(T<=t) one-tail t Critical one-tail P(T<=t) two-tail t Critical two-tail

Table 3
t-Test: Two-Sample Assuming Unequal Variances Variable 1 Mean Variance Observations Hypothesized Mean Difference Df t Stat P(T<=t) one-tail t Critical one-tail P(T<=t) two-tail t Critical two-tail 4.5 2.115384615 14 0 26 1.289342504 0.104315924 1.70561792 0.208631848 2.055529439 Variable 2 3.785714286 2.181318681 14

Running head: DOCUMENTING EXERCISE Table 4 Data Analysis Between Basic and Detailed Exercise Plan Variable 1 2.875 3.716666667 16 0 28 -1.461875027 0.077454536 1.701130934 0.154909073 2.048407142 Variable 2 3.785714286 2.181318681 14

Mean Variance Observations Hypothesized Mean Difference df t Stat P(T<=t) one-tail t Critical one-tail P(T<=t) two-tail t Critical two-tail

Discussion The research team hypothesized that individuals who emphasize greater detail in their pre-planned workout activities are more likely to maintain outlined commitments. The data collected matched the hypothesis. However, there was no statistical significance found in this research study.

Running head: DOCUMENTING EXERCISE

Exercise participation provides both mental and physical benefits. Every individual can benefit from exercise no matter their age, culture, gender, size or shape. Discipline and motivation have potential to support or inhibit regular exercise. Physical activity plans have often been researched as increasing commitment to exercise. A prior study researched the generation of goals in relation to activity follow-through. It was discovered goals may not provide motivational benefit to every individual. However, setting goals appears to result in a higher level of commitment (Basset & Petrie, 1999). The purpose of this study is to measure the effectiveness of a physical activity plan in association to exercise commitment. Physical benefits of exercise include: weight control, cardiovascular health, reduced instance of type 2 diabetes and metabolic syndrome, strengthening of bones and muscles, improved abilities to do daily activities, fall prevention, and increase lifespan. Recommendation to reap these physical benefits is 150 minutes of aerobic exercise weekly with two days devoted to weight-bearing exercise (How much physical, 2011). Mental benefits of exercise include reduction in stress levels and tension, improved sleep, better focus, less anger, natural energy booster, having a sense of achievement, and a healthier appetite.
Figure 1 Rate of Perceived Exertion This figure illustrates how individuals self-rate their level of exertion during physical activity

Running head: DOCUMENTING EXERCISE

This study was designed in preparation for a double group pre-post design study. It utilized a convenience sample of occupational therapy students at Touro University Nevada. Random sampling of a convenience group compiled of Touro first year occupational therapist students were used for the study. The six members of the research group were excluded from the study. Participants were split into two groups. The first group was assigned to make a detailed physical activity plan to map their workout for the next week. This plan included day, time, location, type of workout, and if the participant planned on working out with a partner. The second group was assigned to a basic physical activity plan for the following weeks exercise. The basic physical activity plan simply required the participants to check off each day of the week they planned to engage in physical activity. Both groups were provided with groupspecific diary templates to encourage consistency. After the measured week, the participants were provided with a second template and asked to provide details of their exercise from the prior week. The commitment of planned physical activity and the exercise diary were analyzed on a seven point number scale. One point was given pertaining to individual days proving follow-through-- with or without exercise. Additionally, the research team measured the level of frequency provided by creating a workout diary. Procedures Each participant will first track their plan to work out on one of two tables table provided. Group A, the basic physical activity plan, will simply mark a box for the day(s) of the week they plan to exercise. Group B, the detailed physical activity plan, will fill out a more detailed workout plan consisting of planned time, place, duration, partner, and expected RPE. The following week, both groups will fill out the same workout diary to record the day of

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week, time, place, duration, partner, exercise type, and actual RPE reflecting their workout patterns of the previous week. The study did not find statistically significantly results to support our hypothesis that a detailed physical activity plan will increase the likelihood of working on planned days. However, results did support a clinically significant difference between the two groups. Although no studies were found that mirrored the one we performed, some studies were found with similar attributes. The research article entitled The Effect of Treatment Goals on Patient Compliance with Physiotherapy Exercise Programs was similar to this specific study. The results concluded that goals set collaboratively provide greater meaning thus leading to a higher level of treatment compliance than therapist-mandated goals (Basset & Petrie, 1999). In comparison to the aforementioned research article, the study we conducted did not result in higher compliance of exercise by the group with the detailed physical activity plan. They study concluded that no statistically significant link existed between the more detailed The pilot study of a dog walking randomized intervention: Effects of a Focus on Canine Exercise shows similarities to the exercise study. Instead of using a detailed physical activity plan for a modality to increase exercise activity, this research article uses a canine companion. This study promoted canine walking in order to improve the health of the animal, consequently increasing physical activity of the dog owner as well (Rhodes, Murray, Temple, Tuokko, & Higgins, 2012) Instead of using canine health to promote physical activity, the exercise study focused on participants providing a detailed physical activity plan of their workout. Surprising findings were discovered throughout the study. The outcomes were not as drastic as expected despite the hypothesis being correct. The participants who utilized the detailed physical activity plan showed increased commitment to the plan. However, the results

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concluded there was a statistically significant difference between Groups A and B. In addition, multiple methods were found to interpret the data which proved to be an unexpected factor. The first aim of the study was to determine whether there was a correlation between the creation of a detailed physical activity plan and commitment to exercise proposal. Participant utilization of a detailed physical activity plan showed clinical significance but not statistical significance. The research team then measured the frequency of days that participants engaged in exercise. Yet again, there was no statistical significance found. The hypothesis stated development of a detailed physical activity plan would demonstrate greater commitment to exercise. The hypothesis was verified yet lacked statistical significance. Motivation has the potential to create a barrier to implementation of a workout intervention. The study focused on adherence to a completed physical activity plan. Also, the variability of physical activity levels across participants would make it difficult to implement an effective workout intervention. The recruitment strategy of the study created another barrier. The convenience sample included students of the same cohort and furthermore the same schedule. This created similar timing and situations for all students based on the week measured thus generating risk of similar results. Limitations The participants were provided with an initial template to complete a physical activity plan for the following week. They recalled details of their personal exercise outcomes from the prior week rather than recording daily. This method required memory of the prior weeks workout history; consequently, the extra requirement may have resulted in a skewed outcome thus causing a lack of internal validity.

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Initiation of the exercise week was not clearly stated on the physical activity plan template. Therefore, many participants began their planned workout on Tuesday, September 17 instead of Thursday, September 19th which caused inconsistency of the obtained data. There was a threat of external validity due to the population studied. The sample provided was a convenience population, which provided limited diversity with the sample majority consisting of Caucasian females. Moreover, all recruits are enrolled in the same occupational therapy cohort. Due to high participant interaction, less discretion between the two groups existed. Other students in the cohort were also in the process of conducting their research. Furthermore, this created divided attention within participation. The research hypothesis was verified. However, the data did not support statistical significance of the study. There was not a strong correlation that detailed physical activity plan will increase adherence to those workout plans. There was minimal confirmation of the hypothesis resulting in potential for future research. For future research, a larger and more diverse population is suggested. Also, recruiting participants not currently partaking in other research studies simultaneously is important. It may also be beneficial to find participants who are motivated to commit to their physical activity plans. Future studies should provide the participant with a copy of their physical activity plan in order to increase commitment to exercise. Due to the demographic and size of the population, the study was limited and would not be generalizable to other populations. Furthermore, all participants are currently in an accelerated graduate program at Touro University, which does not allow a lot of free time for outside activities including physical activity. These participants were also not all looking to increase

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their participation in exercise so it may have not been a priority to increase in planned exercise. This specificity of the population may limit the generalizability to other populations.

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References Basset,S., & Petrie, K.(1999) The Effect of Treatment Goals on Patient Compliance with Physiotherapy Exercise Programs. Physiotherapy, 85(3). Retrieved from http://www.sciencedirect.com/science/article/pii/S0031940605656933 Center for Disease Control and Prevention, (2011). Physical exercise and health. Retrieved from website: http://www.cdc.gov/physicalactivity/everyone/health/ Rhodes, R. E., Murray, H., Temple, V. A., Tuokko, H., & Higgins, J.W. (2012). Pilot study of a dog walking randomized intervention: Effects of a focus on canine exercise. Preventative Medicine, 54(5), 309-312. doi: 10.1016/j.ypmed.2012.02.014 Roig, M., Skriver, K., Lundbye-Jensen, J., Kiens, B., & Nielsen, J.B. (2012). A Single Bout of Exercise Improves Motor Memory. PLoS ONE, 7(9), e44594. doi:10.1371/journal.pone.0044594 Weir, K. (2011). The Exercise Effect. American Psychological Association, 42(11), 48. Retrieved from http://www.apa.org/monitor/2011/12/exercise.aspx