Changing Behaviour

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Changing behaviour is a process that is involved with conscious choice, reassessment and adherence to personal goals. There are many aspects of behaviour that are either assisting or detrimental to health, making the process of change difficult at times. (Cale & Harris, 2005) Physical, social and environmental factors play a major role in determining a change in behaviour, varying in all individuals.

This report aims to analyse change in behaviour to increase cardiovascular endurance and reduce the prevalence of cardiovascular disease. The causes and risks of cardiovascular disease will be outlined and the effects physical activity has on preventing risk factors. A program will be implemented to further increase endurance, promoting a stage-by-stage behavioural model that incorporates self-help for the cessation of unwanted behaviours. (Prochaska & DiClemente, 1982) Clinical relevance will also be discussed as cardiovascular disease is the leading cause of disability in Australia and promoting behaviour change in regards to reducing risk is essential.


Cardiovascular disease is a leading cause of premature death and disability in Australia. (AIHW, 2008) Accounting for 34% of all deaths in Australia in 2007(DOHA, 2009), coronary heart disease and stroke were the leading specific causes of death. Over one million Australians are affected with conditions relating to cardiovascular disease each year, with monetary costs reaching an estimated $ 5.4 billion in the year 2001. (AIHW, 2008)

The common underlying cause of cardiovascular disease is a condition called arthrosclerosis, entailing an abnormal build-up of plaque in the inner lining of the arteries. Plaque hardens over time and narrows the artery, making it difficult for blood to travel to and from organs in the body. When arthrosclerosis affects the arteries to the heart and brain, the supply of oxygen-rich blood is reduced or blocked, causing sharp chest pains, heart attacks and strokes. (Stroke Foundation, 2007)

According to the Australian Institute of Health and Welfare(2005), it is estimated that approximately 92% of Australians are at risk of the disease. Risk factors for cardiovascular disease include smoking, excessive alcohol consumption, physical inactivity, high blood pressure and cholesterol, obesity, diabetes and genetics.

Physical Activity

Physical activity is important in regulating blood pressure and cholesterol "" two risk factors of cardiovascular disease. Regular activity boosts high-density lipoprotein ("˜good' cholesterol) and reduces "˜bad' cholesterol which is involved in the build of plaque in arteries. (Mayo Clinic, 2009)The increase of HDLs into the blood keeps it flowing smoothly and reduces the risk of cardiovascular disease.

One component of physical health is cardiovascular endurance. The main factors that influence endurance are "˜cardiac output and blood flow to the muscles'. (Karp, 2008, p. 28) Cardiac output is the product of stroke volume and heart rate, relating to the amount of blood pumped by the left ventricle per minute. Stroke volume is the amount of blood pumped by the heart with each contraction of the left ventricle. It is determined by venous return, the heart's contractility (contract quickly and forcefully), amount of pressure in the left ventricle and aorta (preload and afterload) and the size of the left ventricle. (Karp, 2008) The larger the left ventricle the more blood it can hold and pump, which is a significant physiological adaption as a result of cardiovascular training. (Naylor, 2008)

The blood supplies the muscles after leaving the heart, transporting oxygen via haemoglobin, which is used as energy for muscle contraction in the form of adenosine triphosphate (ATP). Cardiac output and the amount of oxygen extracted from the blood and used by the muscles determine VOâ‚‚max "" the maximum amount of oxygen consumed by the muscles per minute. (Karp, 2008)

According to Midgley, McNaughton and Jones (2007),VOâ‚‚max is one of the physiological determinants of long-distance running performance, along with lactate threshold and running economy. The lactate threshold is the "˜highest intensity above which lactate production begins to exceed its removal' (Karp, 2008, p. 29), pinpointing the transitional period between oxygen dependant and independent metabolism, thus indicating the highest exercise intensity that can be sustained over a long period of time. Running economy is important in the use of oxygen in sub-maximal exercise intensities. Runners with a good running economy often use less energy and oxygen than those with a poor running economy. (Saunders, et al., 2004)

These three determinants of endurance training play a vital role in determining the difference between a variance of performance and efficiency amongst runners. Whilst athletic performance is partially due to genes, athletic training to enhance these determinants provides physiological adaptations and improvements on performance. (Midgley, et al., 2007)


In this report, the primary goal of the program is to enhance VOâ‚‚max and assess it during a twelve-week endurance training program. Whilst lactate threshold and running economy are taken into consideration, VOâ‚‚max is an accurate indicator of the efficiency of a runner and the increased level of cardiovascular endurance. (Midgley, et al., 2007)


The subject to be assessed is a relatively healthy 20 year-old female with previous endurance training. The aim of the training program is to increase the subject's VOâ‚‚max in order to reduce energy use and increase speed over longer distances. The subject is aiming to complete a half-marathon sub-120 minutes and the program implemented is specifically designed to cater for this goal. The program was monitored over the twelve weeks with three VOâ‚‚max tests to test for improvement in maximal oxygen uptake.


The program (refer Appendix 1) itself was an adoption of a program designed by Ben Wisbey, a sport scientist for FitSense Australia. The program put in place demanded high intensity workouts in which according to Midgley et. al.,(2006) can enhance maximal oxygen uptake. However research shows that submaximal (Tanaka, West, Duncan, & Bassett, 1997) and supramaximal (sprinting) (Franch, Madsen, Djurhuus, & Pedersen, 1998)have both proven to be effective in regards to increase VOâ‚‚max. Midgley et al. (2007) concluded that all three approaches will have some effect on VOâ‚‚max improvement, although there has not been enough long-distance running studies done to positively clarify this evidence.

Training for a half-marathon consists of four different types of sessions, completed once every week with two days of rest. Each week the length of the sessions increase in conjunction with intensity, to enhance VOâ‚‚max and increase lactate threshold. (Wisbey, 2008) Each week consists of a long aerobic, tempo, speed and recovery session. By week seven, the subject will begin VOâ‚‚ training sessions to increase intensity and improve lactate threshold. (Midgley, et al., 2007; Wisbey, 2008)

Long aerobic runs are "˜a key to half marathon performance'(Coyle & Coyle, 2007, p. 308), aimed to develop aerobic threshold and strength performance. Tempo sessions aim to boost lactate threshold, improve running economy and provide mental conditioning as these sessions look to sustain a high intensity of a period of 5-10 minutes. . Speed sessions are important in reference to neuromuscular adaptations, improving efficiency and technique at an approximate 75% of a maximal sprint. While it is important to maintain intensity, long recovery between each set is essential in order to avoid overtraining. (Midgley, et al., 2007) VOâ‚‚ sessions involve the highest intensity, looking to improve VOâ‚‚max and maintain a sustainable running speed for an extended period of time. Performed on a track surface, these sessions should be at 85%-90% of maximal heart rate, but done so with a consistent pace.

According to Midgley et al., (2007) training intensity is a highly regarded principle that can cause variable improvements on one's VOâ‚‚max. Increasing intensity and training at rate of sub-VOâ‚‚max places extra stress on physiological structures and processes, providing an increase in adaptation. This mechanical adaption provides enhancement for maximal stroke volume, thus increasing cardiac output and cardiovascular endurance. (Midgley, et al., 2006)

Outcome Measures

A single outcome measure was used in this program to assess the subject's VOâ‚‚max. The multi-stage fitness test or "˜beep test' is a valid, reliable and inexpensive testing of maximal oxygen uptake(Leger & Lambert, 1982) comprised of a series of 20m shuttles. The test is made up of 23 levels starting at 8.5km/hr and increasing by 0.5km/hr at each level. Each level lasts approximately one minute and the aim of the test is to run the duration of the test or until you can physically not complete anymore levels. While the beep test is not an accurate indicator of precise VOâ‚‚max, it does predict aerobic capacity and shows improvement as the subject completes higher levels. (MacKenzie, 2003)


Over the course of the twelve weeks, the subject completed three multi-stage fitness tests (refer Appendix 2) with a significant increase in the level and shuttle each time. An improvement in the duration of the test is indicative of an enhancement of cardiovascular endurance as the cardiac output of the subject has increased. (Leger & Lambert, 1982) Beep test level corresponds to predicted VOâ‚‚max according to the Department of Physical Education and Sports Science Loughborough University (1987).

The subject's predicted VOâ‚‚max increased from 44.5 mls/kg/min to 50.2 mls/kg/min over the twelve-week period, reinforcing the effect of the program and its aid in increasing cardiovascular fitness.


The importance of improving physical fitness and activities for prevention of cardiovascular disease is essential as onset has been recognised as early as childhood. (Newman, Freedman, & Voors, 1986) Prevention at a young age can have positive effects of reducing risk of cardiovascular disease in later stages of life (Twisk, Kemper, & van Mechelen, 2000), with change in behaviour in regards to risk factors playing a major role.

According to Garfield (1994), individuals prefer self-help for behaviour change and this has been found consistent with physical activity. Change is described through five main stages. The first three stages, precontemplation, contemplation and preparation are involved with evoking powerful reasons for change and preparing a course of action to help change behaviour. (Cale & Harris, 2005) The two final stages involve action and maintenance, where ways are identified to support continual change and help prevent relapse.

The subject's program was based on this model as thought had already gone into what behaviour would like to be changed and what goals needed to be set. Therefore the subject's program was mainly comprised of activities and strategies to influence action and maintenance of increasing cardiovascular fitness. During these two stages, factors influencing the subject's desire and potential to change were manipulated by social and environmental determinants. These factors play an important role in giving individuals control over change and making balanced decisions to further promote behavioural change. (Cale & Harris, 2005)

Behavioural change was heavily influenced by social determinants, both positively and negatively throughout the course of the program. Factors assisting with meeting the goal were motivation, social support and outcome expectations .Motivation became a key factor in the subjects overall performance and change in behaviour when improvements were noted by the second testing of the outcome measure, attributing to the subject's increased motivation and eagerness to continue with the program. Social support from friends and family greatly influenced the subject in adhering to the program, especially when completing sessions with peers. The subject also had high expectations of the goals needed to be achieved, which helped in maintenance of the program and change, preventing relapse.

Barriers against participation in the program included lack of motivation, solitary exercise and other priorities. While motivation was at times seen as a positive influence, the subject found it difficult to stay focused in the first stages of participating in the program. This was due to the subject finding it hard to exercise alone and the high demand the program had on the body. Other priorities such as work, university and social commitments also caused strain on the dedication to the program as the subject either felt fatigued or did not have enough time to complete each session.

Environmental factors that attribute to the subject's behavioural change were concerned with access to facilities and opportunities to exercise. Running is a relatively inexpensive sport, making it easy for the subject to access sidewalks and reserves to complete sessions. However, track surfaces and flat ovals were needed to complete some of the sessions making it inconvenient at times to adhere to the program. . Also opportunities to exercise were limited due to the increased workload of university and work, which caused stress and decreased the subject's motivation to exercise due to higher priorities.

Clinical Relevance

As cardiovascular disease is a prevalent issue in today's society, behavioural change needs to be addressed in order to help prevent ramifications in the near future. Using a model in which change is self-assessed and monitored provides empowerment to the patient, resulting in a good rapport. (McAllister & Street, 2005) Identifying predisposing factors provides clinical knowledge and application to cases specific to the individual, establishing the ability to design programs to help reduce prevalence of cardiovascular disease. Looking to change the behaviour of the client and the determinants that may assist or hinder progress is beneficial in reduction of risk, relapse and symptoms occurring later on in life.


Physical activity has a positive effect on the onset of cardiovascular disease, decreasing risk of development in later life. The prevalence of the disease can be reduced by changing behaviour early on in life, especially in regards to staying fit. High volume and intensity training have a positive adaption effect on VOâ‚‚max, which increases stroke volume and cardiac output, lowering blood pressure and cholesterol which reduces the risk of cardiovascular disease.

Changing behaviour needs constant monitoring and analysis, to avoid relapse and occurrence of detrimental behaviours. Factors influencing changing behaviour are primarily concerned with social and environmental determinants that vary in each individual. Change is most efficient through self-help, as the individual has control over personal choices and behaviour. The approach to changing behaviour as a method to reducing the prevalence of disease in Western society should be put into practice frequently in order for disease to be prevented all together and not just cured.


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