Health behaviour change theories: contributions to an ICF-based behavioural exercise therapy for individuals with chronic diseases

Disabil Rehabil. 2014;36(24):2091-100. doi: 10.3109/09638288.2014.891056. Epub 2014 Feb 25.


Purpose: The purpose of this perspective is (1) to incorporate recent psychological health behaviour change (HBC) theories into exercise therapeutic programmes, and (2) to introduce the International Classification of Functioning (ICF)-based concept of a behavioural exercise therapy (BET).

Methods: Relevant personal modifiable factors of physical activity (PA) were identified based on three recent psychological HBC theories. Following the principles of intervention mapping, a matrix of proximal programme objectives specifies desirable parameter values for each personal factor. As a result of analysing reviews on behavioural techniques and intervention programmes of the German rehabilitation setting, we identified exercise-related techniques that impact the personal determinants. Finally, the techniques were integrated into an ICF-based BET concept.

Results: Individuals' attitudes, skills, emotions, beliefs and knowledge are important personal factors of PA behaviour. BET systematically addresses these personal factors by a systematic combination of adequate exercise contents with related behavioural techniques. The presented 28 intervention techniques serve as a theory-driven "tool box" for designing complex BET programmes to promote PA.

Conclusion: The current paper highlights the usefulness of theory-based integrative research in the field of exercise therapy, offers explicit methods and contents for physical therapists to promote PA behaviour, and introduces the ICF-based conceptual idea of a BET. Implications for Rehabilitation Irrespective of the clients' indication, therapeutic exercise programmes should incorporate effective, theory-based approaches to promote physical activity. Central determinants of physical activity behaviour are a number of personal factors: individuals' attitudes, skills, emotions, beliefs and knowledge. Clinicians implementing exercise therapy should set it within a wider theoretical framework including the personal factors that influence physical activity. To increase exercise-adherence and promote long-term physical activity behaviour change, the concept of a behavioural exercise therapy (BET) offers a theory-based approach to systematically address relevant personal factors with a combination of adequate contents of exercise with exercise-related techniques of behaviour change.

Keywords: Chronic non-communicable disease; integrative approach; personal factors; physical activity; physical therapy; rehabilitation.

Publication types

  • Review

MeSH terms

  • Attitude to Health
  • Behavior Therapy / methods*
  • Chronic Disease* / psychology
  • Chronic Disease* / rehabilitation
  • Exercise Therapy* / methods
  • Exercise Therapy* / organization & administration
  • Exercise Therapy* / psychology
  • Germany
  • Health Behavior
  • Humans
  • Motor Activity*
  • Psychological Techniques*
  • Psychological Theory*
  • Rehabilitation Centers
  • Social Validity, Research