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01 (2016) Moshier
01 (2016) Moshier
research-article2015
BMOXXX10.1177/0145445515603704Behavior ModificationMoshier et al.
Abstract
Individuals with elevated levels of anxiety sensitivity (AS) may be motivated to
avoid aversive emotional or physical states, and therefore may have greater
difficulty achieving healthy behavioral change. This may be particularly true for
exercise, which produces many of the somatic sensations within the domain
of AS concerns. Cross-sectional studies show a negative association between
AS and exercise. However, little is known about how AS may prospectively
affect attempts at behavior change in individuals who are motivated to
increase their exercise. We recruited 145 young adults who self-identified as
having a desire to increase their exercise behavior. Participants completed a
web survey assessing AS and additional variables identified as important for
behavior change—impulsivity, grit, perceived behavioral control, and action
planning—and set a specific goal for exercising in the next week. One week
later, a second survey assessed participants’ success in meeting their exercise
goals. We hypothesized that individuals with higher AS would choose lower
exercise goals and would complete less exercise at the second survey. AS
was not significantly associated with exercise goal level, but significantly and
negatively predicted exercise at Time 2 and was the only variable to offer
significant prediction beyond consideration of baseline exercise levels. These
Corresponding Author:
Michael W. Otto, Department of Psychological and Brain Sciences, Boston University, 648
Beacon Street, 5th Floor, Boston, MA 02215, USA.
Email: mwotto@bu.edu
Moshier et al. 179
Keywords
anxiety sensitivity, exercise, physical activity, grit, impulsivity
The physical health benefits of regular exercise have been well documented
and include reductions in both the incidence of, and mortality from, a number
of chronic health conditions, such as cancer, cardiovascular disease, stroke,
and diabetes (Arena, Cahalin, Borghi-Silva, & Myers, 2015; Blair & Morris,
2009; Garrow & Summerbell, 1995; Goldberg & King, 2007; Leitzmann
et al., 2007; Nocon et al., 2008; Paffenbarger, Hyde, Wing, & Hsieh, 1986).
There are also substantial mental health benefits from regular exercise, with
meta-analytic reviews demonstrating reliable reductions in depression and
anxiety from programs of moderate-intensity exercise (Asmundson et al.,
2013; Cooney, Dwan, & Mead, 2014; DeBoer et al., 2012; Stathopoulou,
Powers, Berry, Smits, & Otto, 2006; Wipfli, Rethorst, & Landers, 2008).
Despite these clear benefits, less than half (48%) of American adults meet the
minimum recommendations for weekly physical activity (Center for Disease
Control and Prevention, 2014).
According to a number of behavior change theories (e.g., Ajzen, 1991;
Schwarzer, 1992), the key to increasing exercise behavior lies in changes in
intentions to exercise. Yet, despite evidence that intentions do indeed have
some influence on behavior (Webb & Sheeran, 2006), it is also clear that
many individuals fail to follow through on exercise intentions. A recent meta-
analysis of 10 studies investigating exercise intentions and subsequent exer-
cise behavior found a schism between intention and behaviors in 46% of the
sample (Rhodes & de Bruijn, 2013). In addition, of those who do adopt a
regular physical activity program, more than half discontinue within 3 to 6
months (Dishman & Buckworth, 1996; Martin & Dubbert, 1985). Theoretical
models such as the Theory of Planned Behavior (TPB) have attempted to
account for this schism by considering attitudinal variables, such as perceived
behavioral control, which is defined as the extent to which a behavior is per-
ceived as easy or difficult (Ajzen & Madden, 1986). More recently, research-
ers have also included postintentional processes in predictive models—that
is, processes which occur after one has set an intention to engage in a behavior.
For instance, action planning refers to the postintentional process of identifying
a specific plan (i.e., where, when, and how) to carry out an intended behavior
180 Behavior Modification 40(1-2)
Method
Participants
Participants were 145 young adults, mean (±SD) age of 18.8 (±1.3), who
completed this study online after identifying “increase exercise” as a goal
from among six target behaviors for potential change. All participants were
college undergraduates who received partial fulfillment of a course research
requirement. Participants were required to be at least 18 years of age and to
be a student at Boston University. The sample was 81% female, and the
majority of participants self-identified as Caucasian (61%) and Asian (26%)
with the rest identifying as African American (4%), American Indian or
Alaskan Native (1%), or Other (9%). Eleven percent of the sample identified
as of Hispanic or Latino origin.
Moshier et al. 183
Procedures
Participants enrolled in the study through an online recruitment system and
all surveys were administered online via Qualtrics. Prior to completing any
study procedures, participants were presented an informed consent form
explaining the voluntary nature of participation and alternate options for
receiving course credit. After obtaining consent, participants were instructed
to select two health behaviors they wished to change over the course of the
following week from six options (i.e., increasing exercise, increasing study
time, increasing sleep, decreasing recreational Internet use, decreasing alcohol
use, or decreasing marijuana use). Participants then completed several self-
report measures, including a demographic questionnaire (i.e., age, sex, race/
ethnicity, educational attainment, height, weight), baseline amount of exer-
cise over the past week (i.e., International Physical Activity Questionnaire
[IPAQ]), and other variables (e.g., Anxiety Sensitivity Index [ASI], negative
urgency, lack of perseverance, grit, perceived behavioral control, and action
planning). Finally, participants were asked to set a goal of amount of moder-
ate- and vigorous-intensity exercise to complete for the coming week.
One week later, participants were sent a link for a second survey to complete
via Qualtrics. On this survey, participants reported actual amount of exercise
completed over the past week via the IPAQ. Participants were then provided a
debriefing form explaining study goals and were given credit. All study proce-
dures were approved by the Boston University Institutional Review Board.
Measures
IPAQ. Baseline exercise as well as exercise at Time 2 were assessed via the
IPAQ. The IPAQ is a seven-item measure of physical activity completed over
the course of the previous week. On this measure, participants report the
amount of time engaged in vigorous- and moderate-intensity activity as well as
time spent walking and sitting over the past week (e.g., “During the last 7 days,
how much time did you spend sitting on a week day?”). The IPAQ has demon-
strated strong test–retest reliability and validity in multiple studies including an
extensive reliability and validity survey conducted across 12 countries (Booth
et al., 2003; Brown, Trost, Bauman, Mummery, & Owen, 2004). As recom-
mended by IPAQ scoring guidelines (Guidelines for data processing and analy-
sis of the International Physical Activity Questionnaire [IPAQ], 2005), scores
were calculated separately for walking, moderate, vigorous, and total physical
activity by multiplying the estimated energy expenditure for each category by
the total minutes per week engaged in each activity category. This calculation
yields a total score expressed in Metabolic equivalents (MET-minutes) per
184 Behavior Modification 40(1-2)
week. At Time 1, participants were also asked to set a goal for the amount of
moderate- and vigorous-intensity exercise to complete over the following
week, and this was converted into MET-minutes.
ASI. The ASI (R. A. Peterson & Reiss, 1993) is a 16-item self-report measure
assessing the tendency to respond fearfully to anxiety-related symptoms.
Participants rate responses on a Likert-type scale ranging from very little (0)
to very much (4). The ASI total score is calculated by summing the responses
to the 16 items. In addition, the ASI can be divided into three subscales rep-
resenting Physical Concerns (e.g., “It scares me when I feel faint”), Mental
Concerns (e.g., “When I cannot keep my mind on a task, I worry that I might
be going crazy”), and Social Concerns (e.g., “It embarrasses me when my
stomach growls”). Both the higher order general factor and the subscales
demonstrate strong internal consistency and favorable reliability and validity
(Reiss, Peterson, Gursky, & McNally, 1986; Zinbarg & Barlow, 1996; Zinbarg,
Barlow, & Brown, 1997).
Action planning. Action planning was measured using four items assessing the
extent to which participants have a plan for carrying out their specific behav-
ioral goal. Participants were asked to rate their agreement on 7-point scale
ranging from strongly disagree to strongly agree. The items were as follows:
“I have made specific plans for the coming week regarding where I will exer-
cise,” “I have made specific plans for the coming week regarding when I will
exercise,” “I have made specific plans for the coming week regarding how
often I will exercise,” and “I have made specific plans for the coming week
regarding with whom I will exercise.” These items have been utilized across
Moshier et al. 185
multiple studies of the TPB (Sniehotta, Schwarzer, Scholz, & Schüz, 2005;
Wiedemann, Schüz, Sniehotta, Scholz, & Schwarzer, 2009).
UPPS-P Impulsive Behavior Scale. The UPPS-P (Cyders et al., 2007) is a 59-item
self-report measure assessing five dimensions of personality, which may lead
to impulsive behavior: negative and positive urgency, (lack of) premeditation,
(lack of) perseverance, and sensation seeking. The UPPS-P is a modified
version of the UPPS impulsive behavior scale developed by Whiteside and
Lynam (2001). The current study utilized mean scores on the negative
urgency and (lack of) perseverance subscales. Negative urgency refers to a
general tendency to engage in impulsive behaviors when experiencing negative
affect (e.g., “When I feel rejected, I will often say things that I later regret”;
Whiteside & Lynam, 2001). Lack of perseverance is defined as having diffi-
culty persisting in projects, particularly in the presence of distracting stimuli
(e.g., “ I tend to give up easily”; Whiteside & Lynam, 2001). Participants
responded on a scale from 1 (agree strongly) to 4 (disagree strongly).
Short Grit Scale. Grit, the “tendency to sustain interest in and effort toward
very long-term goals” (Duckworth et al., 2007), was assessed via the Short
Grit Scale (Duckworth & Quinn, 2009), which consists of eight items. Items
are rated on a 5-point Likert-type scale from not like me at all to very much
like me, and includes items such as “Setbacks don’t discourage me” or “I
often set a goal but later choose to pursue a different one.” This scale demon-
strates strong psychometric properties and predictive validity of a number of
performance variables (Duckworth & Quinn, 2009) and has been assessed in
several relevant populations, including students and military trainees
(Eskreis-Winkler, Shulman, Beal, & Duckworth, 2014).
Data Analysis
Two primary outcomes were considered: exercise goal and MET-minutes at
Time 2. Exercise goal was expressed as the rank order of the percent increase
in goal exercise level over baseline level. To place findings in context, we
first examined the intercorrelations between potential predictors at baseline,
that is, baseline MET-minutes, ASI, perceived behavioral control, action
planning, UPPS negative urgency, UPPS (lack of) perseverance, and grit. We
next assessed the relationship between the predictor variables and the two
outcomes using bivariate correlations. We then conducted stepwise forward
regression analyses for each outcome (exercise goal and Time 2 METs) to
identify which predictors were nonredundant. These two regression analyses
included all variables that had demonstrated significant bivariate correlations
186 Behavior Modification 40(1-2)
Measure M (SD)
BMI 22.51 (3.49)
Baseline METs 1,818.32 (1,910.67)
Exercise goal in METs 2,658.29 (2,104.41)
Time 2 METs 2,080.56 (1,895.23)
ASI 25.03 (12.21)
Action planning 18.96 (5.09)
Perceived behavioral control 13.43 (3.13)
UPPS Negative Urgency subscale 2.06 (0.66)
UPPS Lack of Perseverance subscale 1.81 (0.42)
Short Grit Scale 3.37 (0.64)
Note. BMI = body mass index; ASI = Anxiety Sensitivity Index; MET = metabolic equivalent.
with the outcome measure of interest. If ASI subscale scores were significantly
correlated with an outcome, we conducted follow-up regression analyses that
included the ASI subscale of interest rather than ASI total scores. Statistical
significance was set at p < .05 for all analyses, with control of inflation of
alpha from the bivariate correlations addressed in the context of the stepwise
multiple regression analysis for goal selection and exercise attainment. All
analyses were conducted with SPSS.
Results
Sample Characteristics
Exercise behavior, and mean scores for AS, perceived behavioral control,
action planning, negative urgency, (lack of) perseverance, and grit are
reported in Table 1. The sample was highly active at baseline, with 75% of
participants meeting the Centers for Disease Control and Prevention (CDC)
recommendations for physical activity. Participants were on average in the
healthy weight range, and only 21% of participants had a BMI in the over-
weight or obese range (i.e., BMI ≥ 25).
Measure 1 2 3 4 5 6 7 8 9 10 11 12
Baseline METs 1
METs goal (ranked) −.61** 1
Time 2 METs .50** −.36** 1
ASI total −.07 .01 −.21* 1
ASI physical −.10 .04 −.22** .94** 1
ASI mental −.06 .02 −.22** .82** .64** 1
ASI social .07 −.10 −.00 .71** .53** .49** 1
Grit .05 −.13 .08 −.28** −.23** −.33** −.16 1
UPPS negative urgency .02 .05 −.05 .40** .34** .47** .22* −.46** 1
UPPS lack of perseverance −.11 .17* −.08 .16 .10 .28** .05 −.74** .41** 1
Action planning .25** −.17* .26** −.09 −.14 −.06 .06 .07 −.09 −.11 1
Perceived behavioral control .27** −.15 .24** −.06 −.08 −.07 .03 −.15 .03 .15 .50** 1
187
188 Behavior Modification 40(1-2)
Table 3. Stepwise Regression Analyses for Variables Predicting Exercise Goal and
Time 2 METs.
Variable B SE (B) β t
Dependent variable: Exercise goal
Model 1
Time 1 METs −0.01 0.00 −.61 −9.08**
Excluded variables
Action planning −0.29
Lack of perseverance 1.50
Dependent variable: Time 2 METs
Model 1
Time 1 METs 0.60 0.05 .68 10.96**
Model 2
Time 1 METs 0.59 0.05 .67 10.99**
ASI total score −23.29 8.40 −.17 −2.77**
Excluded variables
Exercise goal 0.98
Action planning 0.91
Perceived behavioral control 0.15
Discussion
This study was designed to evaluate the importance of AS in predicting future
exercise in a sample of individuals with high intentions for change. One hun-
dred forty-five college students who expressed desire to increase their exercise
behavior were asked to set a specific goal for exercise within the next week.
One week later, exercise behavior was assessed to evaluate goal achievement.
Consistent with the research literature documenting a large intention–behavior
gap for exercise behavior, only 37% of the sample was able to meet their goal
for exercise in the next week. Knowledge of baseline levels of exercise was
190 Behavior Modification 40(1-2)
important for understanding both goal setting and Week 2 exercise levels.
Those with higher levels of exercise at baseline tended to set a lower relative
increase in exercise goals and also achieved higher levels of subsequent exer-
cise. Contrary to our hypothesis, AS was not significantly associated with
exercise goal. However, AS was significantly and negatively predictive of
exercise behavior 1 week later. Importantly, AS was incrementally predictive
of exercise behavior above and beyond the influence of baseline exercise levels,
when other variables associated with Time 2 exercise were not.
This distinctive prediction offered by AS and the lack of prediction offered
by other measures related to self-regulation—including action planning, per-
ceived behavioral control, grit, and impulsivity—speak to the potential value
of considering distress intolerance in health behavior outcomes. Specifically
for exercise, AS may identify those individuals who are more likely to
become distressed in response to symptoms of exertion, and thereby have
increased motivation to avoid exercise. That AS predicts exercise outcomes
among a sample of young adults specifically identifying the desire to increase
exercise is noteworthy and underscores the importance of distress intolerance
in derailing goal-directed behavior. This finding for exercise is consistent
with the role of AS in predicting the failure of stated goal attainment in other
areas, such as session attendance for drug use treatment (Lejuez et al., 2008),
reductions in Internet use (Yamada, Moshier, & Otto, 2014), and smoking
cessation success (Zvolensky, Stewart, Vujanovic, Gavric, & Steeves, 2009).
In each case, AS may identify individuals for whom somatic or emotional
distress may be amplified, thereby hastening avoidance behavior and derail-
ing goal persistence. Interestingly, both the Physical Concerns and Mental
Concerns subscales of the ASI significantly predicted exercise behavior at
Time 2, suggesting that the relationship between AS and exercise is not
driven solely by distress related to physical sensations of exercise, but may
reflect the role of a more general difficulty tolerating distress.
Baseline levels of exercise were related to both action planning (r = .25)
and perceived behavioral control (r = .27), with effects approaching moder-
ate effect sizes. Individuals with a specific plan for exercise behavior, and
individuals who felt a stronger sense of control over their exercise behavior
tended to achieve more exercise. Accordingly, these variables were also
associated with the degree of increase in exercise that participants targeted
in goal setting. Nonetheless, action planning and perceived behavioral con-
trol did not offer useful prediction of goal setting or future exercise behavior
beyond that offered by knowledge of current exercise levels. This pattern is
consistent with previous work finding that such variables offer less predictive
value when considered in models that also include past behavior (Conner &
Armitage, 1998).
Moshier et al. 191
noteworthy that the mean ASI score in the sample was 25, reflecting a higher
level than what has been previously found in samples of young adults (for
instance, M = 18 on the ASI in Schmidt, Lerew, & Jackson, 1997). In the future,
diagnostic assessment of psychiatric illness would help to better characterize
study samples and add to the understanding of how depression, anxiety, and other
mental health problems may interact with the relationships examined in the
current study. In addition, it is important to note that this study focused on a
brief duration, assessing exercise behavior within a single week of the partici-
pant’s initial setting of a goal. Therefore, it remains unclear whether AS is related
to exercise behavior when individuals are attempting to make longer term
change. In addition, exercise behavior was measured via self-report, and more
recent versions of the ASI, such as the ASI-3, may have improved subscale valid-
ity (Taylor et al., 2007). Further research would benefit from examination of
objective exercise data and from the longer term study of well-characterized
clinical populations (e.g., individuals with psychiatric disorders, obesity, diabe-
tes, heart disease) for whom exercise is of particular importance.
Funding
The author(s) received no financial support for the research, authorship, and/or
publication of this article.
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Author Biographies
Samantha J. Moshier, MA, is a doctoral student at Boston University and is cur-
rently completing her predoctoral psychology internship at the Institute of Living in
Hartford, Connecticut. She conducts research investigating psychological processes
involved in health behavior change and the mechanisms and treatment of mood and
anxiety disorders.
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