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BMOXXX10.1177/0145445515603704Behavior ModificationMoshier et al.

Transdiagnostic Mechanisms Underpinning Affect-Health Co-occurrence and Interplay


Behavior Modification
2016, Vol. 40(1-2) 178198
Anxiety Sensitivity The Author(s) 2015
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DOI: 10.1177/0145445515603704
Exercise Behaviors in bmo.sagepub.com

Young Adults Seeking to


Increase Physical Activity

Samantha J. Moshier1, Kristin L. Szuhany1,


Bridget A. Hearon1, Jasper A. J. Smits2,
and Michael W. Otto1

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 changeimpulsivity, grit, perceived behavioral control, and action
planningand 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

1Boston University, MA, USA


2University of Texas at Austin, USA

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

results underscore the importance of considering AS in relation to health


behavior intentions. This is particularly apt given the absence of prediction
offered by other traditional predictors of behavior change.

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
etal., 2007; Nocon etal., 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 etal.,
2013; Cooney, Dwan, & Mead, 2014; DeBoer etal., 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 modelsthat
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)

(Gollwitzer, 1999). Although consideration of these factors has been a step


forward in the prediction of exercise behavior (e.g., Scholz, Schz,
Ziegelmann, Lippke, & Schwarzer, 2008), there is much room for improve-
ment. Meta-analysis has demonstrated that TPB variables such as intention
and perceived behavioral control accounted for only 25% of the variance in
behavior (Armitage & Conner, 2001). Similarly, though action planning has
been predictive of goal attainment at the level of a moderate effect (d = .65;
Gollwitzer & Sheeran, 2006), evidence has been mixed when it is evaluated
specifically in the context of exercise (Rhodes & Dickau, 2013).
Given that models of exercise behavior change remain incomplete, it is
also important to consider psychological characteristics that may influence an
individuals tendency to set higher exercise goals and to engage in exercise
behavior. Recent findings in the health psychology literature suggest that anxi-
ety sensitivity (AS), the fear of anxiety-related sensations, may represent one
such factor predicting aversion to and avoidance of exercise. Although AS
was initially conceptualized as a vulnerability factor for anxiety disorders
(McNally, 2002), it has since been established more broadly as an index of
distress intolerance (McHugh & Otto, 2011), which has been defined as the
capacity to experience and withstand negative psychological states (Simons
& Gaher, 2005), and as a predictor of avoidance-based coping across a range
of health-related behaviors including maladaptive eating (Hearon, Quatromoni,
Mascoop, & Otto, 2014), sleep difficulties (Calkins, Hearon, Capozzoli, &
Otto, 2013), smoking (Johnson, Farris, Schmidt, Smits, & Zvolensky, 2013;
Zvolensky etal., 2004), and substance use (Buckner etal., 2011; Lejuez etal.,
2008). With regard to exercise, a number of correlational investigations have
noted an inverse relationship between AS and self-reported exercise behavior
(McWilliams & Asmundson, 2001; Moshier etal., 2013; Sabourin, Hilchey,
Lefaivre, Watt, & Stewart, 2011; Smits & Zvolensky, 2006).
It is hypothesized that AS may influence exercise engagement by increas-
ing distress due to the overlap between feared anxiety sensations and those
typically experienced during physical exertion. That is, those who fear bodily
sensations such as rapid heart rate, sweating, and chest tightness may be more
likely to experience exercise as distressing, leading to subsequent avoidance
of the behavior. In an experimental study conducted by Smits, Tart, Presnell,
Rosenfield, and Otto (2010), the investigators noted an interaction between
body mass index (BMI) and AS such that those elevated on both constructs
reported higher levels of fear during a moderate-intensity exercise challenge.
This finding highlights the importance of negative affect during exercise as a
predictor of avoidance. For example, Williams and colleagues (2008) found
that negative affect during moderate-intensity exercise among sedentary partici-
pants predicted less physical activity at 6- and 12-month assessments. This
Moshier et al. 181

may be particularly detrimental to overweight/obese individuals as research


shows they are more likely to report negative affect during exercise than those
in the normal weight range (Ekkekakis & Lind, 2006). Indeed, in the first
prospective study examining AS effects on exercise, Hearon and colleagues
(Hearon, Quatromoni, etal., 2014) also noted an AS and BMI interaction
whereby obese participants with elevated AS completed less physical activity
as measured by actigraphy over a 3-day monitoring period. However, AS
effects on exercise behavior may also depend on level of exertion, as elevated
AS predicted less self-reported exercise across all weight groups when spe-
cifically examining vigorous-intensity activity (Moshier etal., 2013).
Because studies to date have examined AS as a stand-alone predictor of
exercise behavior, the relative influence of AS in the context of other trait
variables is unknown. Within health behavior research, there is growing
focus on traits that may influence ones ability to initiate and persist with
goal-directed activity, such as negative urgency, lack of perseverance, and
grit. Each of these characteristics could potentially influence the process of
goal selection and implementation of exercise behavior. Negative urgency
and lack of perseverance are considered to be personality traits, which may
lead to impulsive behavior (Whiteside & Lynam, 2001). Negative urgency
refers to a general tendency to engage in impulsive behaviors when experi-
encing negative affect, whereas lack of perseverance is defined as having
difficulty persisting in projects, particularly in the presence of distracting
stimuli (Whiteside & Lynam, 2001). Accordingly, individuals high in nega-
tive urgency may be more likely to cancel plans to exercise or end exercise in
the face of negative emotional experiences, and lack of perseverance could
cause individuals to fail to follow through on set goals for exercise when
competing and distracting tasks are at hand. Grit, defined as the tendency to
sustain interest in and effort toward very long-term goals (Duckworth,
Peterson, Matthews, & Kelly, 2007), may be predictive of greater success in
meeting exercise goals; it may be that individuals who are motivated to stick
with a long-term goal of achieving physical fitness or health are better able to
maintain a regular exercise routine.
Research has showed initial support for the influence of these character-
istics on health behavior change. For instance, Reed (2014) found in a large
community sample that individuals who exercised regularly reported higher
levels of grit than infrequent exercisers. Although to our knowledge, studies
have not previously examined the association between exercise and negative
urgency and lack of perseverance, Churchill and colleagues have found
across a number of studies that impulsivity predicts health behaviors such as
snacking above and beyond TPB variables such as intention and planning
(Churchill & Jessop, 2010; Churchill, Jessop, & Sparks, 2008). Furthermore,
182 Behavior Modification 40(1-2)

negative urgency and lack of perseverance have been shown to be associated


with related health issues such as obesity (Mobbs, Crepin, Thiery, Golay, &
Van der Linden, 2010). Therefore, in the current study, we included exami-
nation of grit, negative urgency, and lack of perseverance as traits which, in
addition to AS, may be relevant to changing exercise behavior.
Despite emerging evidence that AS is a predictor of exercise avoidance, to
our knowledge no studies to date have examined how AS may prospectively
affect attempts at behavior change in individuals who are motivated to increase
their exercise. That is, does AS predict failure to engage in exercise even among
individuals who explicitly express a desire and motivation to increase their
time spent exercising? Accordingly, the purpose of the current investigation
was to examine the role of AS in a sample of undergraduate students who
reported intention to increase their exercise over a 1-week time frame. To deter-
mine the unique impact of AS, we also examined other variables relevant to
health behavior change models, including past exercise behavior, action plan-
ning, and perceived behavioral control. We also evaluated AS as a predictor
of exercise behavior relative to impulsivity (negative urgency and lack of
perseverance) and grittrait variables that have been posited to influence self-
regulatory behaviors (Duckworth etal., 2007; Whiteside & Lynam, 2001). We
hypothesized that AS would predict both goal setting and exercise achieve-
ment, such that those with higher AS would set goals that represented a smaller
increase in exercise behavior and would report lower exercise rates after the
goal-attainment period even when controlling for the aforementioned health
behavior change variables. We studied these issues in a young adult sample;
this age has been identified as particularly important for determining adulthood
exercise patterns (Barnekow-Bergkvist, Hedbert, Janlert, & Jansson, 1996).

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 testretest reliability and validity in multiple studies including an
extensive reliability and validity survey conducted across 12 countries (Booth
etal., 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).

Perceived behavioral control. Perceived behavioral control has been defined as


the extent to which exercise is perceived as being easy or difficult (Ajzen,
1991). Perceived behavioral control was assessed via three questions devel-
oped by Ajzen and Madden (1986), consistent with other studies examining
the intentionbehavior relationship (de Bruijn, Rhodes, & van Osch, 2012;
Rhodes, de Bruijn, & Matheson, 2010). These questions assessed participants
beliefs about their own capacity to determine whether they will meet their
behavioral intentions. The questions were as follows: For me, meeting my
exercise goal in the next week will be (with participants choosing a rating
from 1 = extremely difficult to 7 = extremely easy), How much control do
you feel you have over meeting your exercise goal in the next week? (rating
from 1 = very little control to 7 = complete control), and How much I exercise
over the next week is completely up to me (rating from 1 = strongly disagree
to 7 = completely agree).

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, & Schz, 2005;
Wiedemann, Schz, Sniehotta, Scholz, & Schwarzer, 2009).

UPPS-P Impulsive Behavior Scale. The UPPS-P (Cyders etal., 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 etal., 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 dont 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)

Table 1. Mean Scores on Study Measures.

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).

Relations Among Variables at Baseline


Correlations between all study measures are presented in Table 2. Baseline
exercise was significantly and positively associated with action planning and
perceived behavioral control, but was not significantly associated with
ASI, UPPS negative urgency, UPPS (lack of) perseverance, or grit. AS was
Table 2. Correlations Between Study Measures.

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

Note. ASI = Anxiety Sensitivity Index.


*Correlation is significant at the .05 level (two-tailed). ** Correlation is significant at the .01 level (two-tailed).

187
188 Behavior Modification 40(1-2)

positively correlated with UPPS negative urgency and negatively correlated


with grit, and was marginally positively associated with UPPS (lack of) per-
severance. Grit was significantly and negatively related to UPPS (lack of)
perseverance and UPPS negative urgency. Perceived behavioral control and
action planning were significantly correlated, but neither variable was related
to the four trait variables assessed.

Prediction of Goal Setting


Participants set an average goal of 2,658 (2,104) MET-minutes of exercise
for Time 2, an average increase of 803 (1,752) METs over their baseline
totals (i.e., an increase of approximately 100 min of vigorous activity or 200
min of moderate activity). In predictive models, exercise goals were examined
as a ranked variable reflecting the percent increase in physical activity from
baseline (expressed in terms of moderate- and vigorous-intensity METs).
Zero-order correlations of goal levels indicated that ASI total and subscale
scores were not associated with exercise goal levels. Exercise goal levels
were significantly negatively associated with action planning and positively
associated with UPPS lack of perseverance. In addition, those with higher
METs at baseline selected more conservative exercise goals relative to current
levels. In multiple regression analysis (see Table 3), which included all
significant predictors of exercise goal (baseline METs, action planning, and
UPPS lack of perseverance), only baseline METs contributed significantly to
prediction of exercise goal levels ( = .61, t = 9.08, p < .001).

Prediction of Exercise Attainment at Time 2


Bivariate correlations indicated that baseline exercise was strongly related to
Time 2 exercise. ASI total score, and the ASI Physical Symptoms and Mental
Concerns subscales were significantly negatively associated with Time
2 exercise. Furthermore, significant positive associations were found between
Time 2 exercise and both action planning and perceived behavioral control.
Negative urgency, lack of perseverance, and grit were not significantly asso-
ciated with Time 2 exercise.
We next conducted a forward stepwise regression including the variables
that had predicted Time 2 METs in bivariate analyses (baseline METs, ASI
total, perceived behavioral control, and action planning). Results are pre-
sented in Table 3. In this analysis, we first entered baseline METs ( = .67,
p < .001) and found that ASI total score offered subsequent significant pre-
diction ( = .17, p = .006), whereas action planning (p = .36) and perceived
behavioral control (p = .89) did not.
Moshier et al. 189

Table 3. Stepwise Regression Analyses for Variables Predicting Exercise Goal and
Time 2 METs.

Variable B SE (B) 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

**p < .01.

To examine the predictive value of specific ASI subscales, the forward


stepwise regression was repeated twice to include the ASI Physical Symptoms
and ASI Mental Concerns subscale scores rather than ASI total score. This
yielded similar results to when ASI total score was examined; both subscales
offered significant prediction of exercise at Time 2 (ASI Physical Symptoms:
= .15, p = .02; ASI Mental Concerns: = .19, p = .002), and action
planning and perceived behavioral control did not enter into the model sig-
nificantly in either regression.

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 intentionbehavior
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-regulationincluding action planning, per-
ceived behavioral control, grit, and impulsivityspeak 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 etal., 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

Variables thought to be associated with self-regulatory ability were not


predictive of baseline, goal target, or Time 2 exercise in our sample. For exam-
ple, grit was not a useful predictor of existing exercise levels, goal setting for
exercise, or subsequent exercise levels. Grit has shown incremental predictive
validity of important educational outcomes (e.g., grade point average, class
retention at the United States Military Academy; Duckworth etal., 2007) as well
as self-report of goal attainment over time (Sheldon, Jose, Kashdan, & Jarden,
2015). It has been less studied with regard to exercise behavior. However, one
study found that grit was a significant positive predictor of stages of change for
exercise behavior, showing an association on the order of a small effect size
(rs = .15 and .16 for moderate and vigorous exercise, respectively; Reed,
Pritschet, & Cutton, 2013). In the current study, the effect size estimate between
grit and exercise behavior was roughly half that reported by Reed etal. (2013).
It may be that grit is more closely related to exercise behavior when considering
change over longer periods of time, whereas our study examined behavior
change within an acute time frame. Consistent with this idea, the stage of change
measure used by Reed and colleagues asked participants to consider their
attitudes over the past 6-month period, raising the possibility that grit may bet-
ter reflect attributions about past rather than future exercise behavior.
In addition, lack of perseverance and negative urgency were not associated
with goal setting or baseline or future exercise behavior. These UPPS trait
variables (negative urgency in particular) have been shown to be associated
with a range of maladaptive behavioral processes, including problematic alco-
hol and substance use (e.g., Jones, Chryssanthakis, & Groom, 2014; Verdejo-
Garca, Bechara, Recknor, & Prez-Garca, 2007), nonsuicidal self-injury (C.
M. Peterson & Fischer 2012), eating pathology (C. M. Peterson & Fischer,
2012), and compulsive hoarding (Timpano etal., 2013). However, they have
been relatively unstudied in the context of achieving healthy, goal-directed
behaviors. The lack of relationship between the UPPS variables and exercise
behavior found here may suggest that these traits are more strongly predictive
of engagement in impulsive behaviors rather than the derailment of persis-
tence toward a goal. That is, individuals with high levels of urgency or low
levels of perseverance may have difficulty inhibiting a prepotent response, but
may not have difficulty acting purposefully toward a specific goal.
This study is the first to our knowledge to examine the prospective rela-
tionship between AS and exercise behavior in individuals reporting a desire
to increase their exercise behavior. A particular strength of this study is that it
considers the role of AS in the context of past behavior and relative to a number
of other trait and self-regulatory variables. However, our results need to be
considered in light of several limitations. The sample consisted of a group of
physically active college students who were predominantly female and
Caucasian, which may limit generalizability of the results. It is also
192 Behavior Modification 40(1-2)

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-
pants 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 etal., 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.

Declaration of Conflicting Interests


The author(s) declared the following potential conflicts of interest with respect to the
research, authorship, and/or publication of this article: Dr. Smits and Dr. Otto receive
royalties for books on exercise for mood and anxiety disorders for Oxford University
Press. The authors have no additional disclosures.

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.
198 Behavior Modification 40(1-2)

Kristin L. Szuhany, MA, is a doctoral student in the clinical psychology program at


Boston University. Her research focuses on novel interventions for mood and anxiety
disorders, including exercise interventions, and on the impact of distress intolerance
and neuropsychological functioning on persistence and behavior change.
Bridget A. Hearon, PhD, is a postdoctoral fellow in Boston Universitys Department
of Psychology and Brain Sciences, where she studies health behaviors, including eat-
ing, exercise, and substance use.
Jasper A. J. Smits, PhD, is professor at the University of Texas at Austin, where he
studies the treatment of anxiety and related problems (e.g., nicotine dependence, over-
eating, physical inactivity, and depression).
Michael W. Otto, PhD, is professor in the Department of Psychological and Brain
Sciences at Boston University. His clinical and translational research includes inves-
tigations of novel treatments, brainbehavior relationships in therapeutic learning,
principles underlying behavior change failures, and health behavior promotion,
including investigations of addictive behaviors, medication adherence, sleep, smok-
ing, and exercise.

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