Factors influencing the exercise behavior of adults with physical disabilities

Purpose: Examine the theorized associations of transtheoretical model (TTM) of behavior change constructs (behavioral and cognitive processes of change, decisional balance, and self-efficacy), along with exercise barriers, by stage of change for exercise behavior among individuals with physical disabilities. Methods: Cross-sectional survey of 322 adults with physical disabilities residing in the United States. Most participants (84.3%) used some form of assistive device (e.g., artificial limb, wheelchair), were female (62.1%), and Caucasian (91.9%). The mean age of participants was 52.5 yr (SD = 13.9). Participants completed and returned questionnaires for each TTM construct, along with an exercise barriers measure. Results: In univariate analyses, all constructs were significantly (P < 0.001) associated with the stages of change for exercise behavior, except for dramatic relief (P > 0.005). The largest portion of variance was derived from counter conditioning (eta(2) = 0.45), followed by the five behavioral processes of change combined (eta(2) = 0.40), self-liberation (eta(2) = 0.31), self-efficacy (eta(2) = 0.30), and self-reevaluation (eta(2) = 0.28). Direct discriminant function (multivariate) analysis revealed four discriminant functions which accounted for 71.0% (P < 0.001), 20.9% (P < 0.001), 6.3% (P < 0.05), and 1.8% (P = 0.62), respectively, of the between-group (stage of change) variability. The overall stage of change classification accuracy was 70.8%. Conclusion: This was the first study to examine the stages of change for exercise behavior among adults with physical disabilities on the basis of the full TTM and exercise barriers. Overall, the results are in general agreement with existing evidence among nondisabled populations. This provides further cross-sectional support for the internal and external validity of TTM and exercise barriers among a unique and understudied population segment.