EXERCISE

The effect of an intervention combining self-efficacy theory and

pedometers on promoting physical activity among adolescents
Ling-Ling Lee, Yu-Chi Kuo, Dilw Fanaw, Shoa-Jen Perng and Ian-Fei Juang

Aim. To study the effect of an intervention combining self-efficacy theory and pedometers on promoting physical activity
among adolescents.
Background. The beneficial effects of regular physical activity on health in youths are well-documented. However, adolescence
is found to be the age of greatest decline in physical activity participation. Physical activity participation among girls was
generally less frequent and less intense than boys. Therefore, there is a strong need for effective interventions that can help
promote physical activity in this population.
Design. An experimental design.
Methods. Two classes of female junior college students (mean age = 16) were randomly sampled from a total of four classes
and, of those, one each was randomly assigned to either the intervention (n = 46) or the control group (n = 48). Self-efficacy was
used as a core theoretical foundation of the intervention design, and pedometers were provided to the students in the
intervention group. Distances between each domestic scenic spot were illustrated graphically in a walking log for students to
mark the extent of their walking or running. Students in the control group participated in a usual physical education pro-
gramme. The primary outcome was a change in the number of aerobic steps. The secondary outcomes were changes in
cardiopulmonary endurance and exercise self-efficacy.
Results. At 12-week follow-up, the mean change in aerobic steps was 371 steps and 108 steps in the intervention and control
group, respectively. The difference in mean change between the two groups was 467 steps. Effects of the intervention on changes
of cardiopulmonary endurance and perceived exercise self-efficacy scores were not found.
Conclusions. Among adolescent girls, a 12-week intervention designed on the theoretical foundation of self-efficacy theory and
provision of pedometers was found to have an effect on increasing their physical activity. The intervention, using graphs of
domestic scenic spots to represent the distance of walking or running as monitored by pedometers, might enhance motivation
regarding physical activity.
Relevance to clinical practice. It is important for health professionals, including school health nurses, involved in the care of
adolescent health, to design and provide a physical activity intervention combining self-efficacy theory and provision of
pedometer to promote physical activity.

Key words: adolescents, cardiopulmonary endurance, graphical walking log, nurses, nursing, pedometer, physical activity,
self-efficacy, Taiwan, youth

Accepted for publication: 5 July 2011

Authors: Ling-Ling Lee, BN, MSc, PhD, RN, Assistant Professor, Juang, BN, MSN, RN, Lecturer, Department of Nursing, Tzu Chi
Department of Nursing, Tzu Chi College of Technology, Hualien; College of Technology, Hualien, Taiwan
Yu-Chi Kuo, BSc, MSc, PhD, Assistant Professor, Department of Correspondence: Ling-Ling Lee, Assistant Professor, Department of
Exercise and Health Science, National Taipei University of Nursing Nursing, Tzu Chi College of Technology and School of Nursing, Tzu
and Health Sciences, Taipei; Dilw Fanaw, BSc, MSc, PhD, Associate Chi University, No. 880, Chien-Kuo Road, Section 2, Hualien, 970,
Professor, General Education Centre, Tzu Chi College of Taiwan. Telephone: +886 (0)3 8572158 ext. 638.
Technology; Shoa-Jen Perng, MEd, PhD, Associate Professor, E-mail: lllee666@gmail.com; lllee@tccn.edu.tw
Department of Nursing, Tzu Chi College of Technology; Ian-Fei

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914 Journal of Clinical Nursing, 21, 914–922, doi: 10.1111/j.1365-2702.2011.03881.x
Exercise Intervention for promoting physical activity

of health interventions that may facilitate the outcome of

Introduction
behaviour modification (van Ryn & Heaney 1992). One
Regular physical activity has a beneficial effect on health review of physical activity interventions emphasised the
(Strong et al. 2005) and was found to be crucial in importance of implementing behavioural strategies in
preventing overweight and type II diabetes among youths promoting physical activity (King et al. 1998) and hypothes-
(Kaufman 2003). Previous study also found that physical ised that improving self-efficacy for girls in combination with
activity during childhood has been associated with physical external validation and support may be crucial in promoting
activity during adulthood (Malina 2001). Various guidelines continued physical activity (Dobbins et al. 2009).
have recommended that adolescents should engage in The theory of self-efficacy, a central concept of Bandura’s
physical activity of a moderate to vigorous intensity for at Social Cognitive Theory (Bandura 1986b, 1997a), is one of
least 60 minutes daily to enhance health (Cavill et al. 2001, the most widely applied theories in predicting health
Biddle et al. 2004, Strong et al. 2005). However, the behaviour and facilitating behavioural modification. Self-
evidence shows that physical activity decreases with age efficacy refers to a person’s sense of confidence in his or her
(Sallis 2000, Boreham & Riddoch 2001, Biddle et al. 2004). ability to perform a particular behaviour in a variety of
Adolescents are known to be less active than children circumstances (Bandura 1982, 1986a, 1997b). Bandura
(Riddoch et al. 2004) and to be insufficiently physically proposed that an individual’s persistence and efforts to
active enough to achieve beneficial results (Grunbaum et al. adopt specific behaviour are closely related to his or her
2003). Adolescence was also found to be the age of greatest level of perceived self-efficacy. (Bandura 1977, Eysenck
declines (Sallis 2000, Biddle et al. 2004). There is a strong 1978). The information and feedback that an individual
need for effective interventions that could have help to obtains from the performance of a task is referred to as the
promote physical activity among this age group. sources of self-efficacy (Bandura 1977, 1982, 1986a,
1997c). These sources may take several forms, such as
positive experiences of performing a behaviour (perfor-
Background
mance accomplishments), the observation of others engaging
Physical activity participation among girls is generally less in similar behaviour (vicarious learning), being encouraged
frequent and of a lower intensity than that of boys, and to carry out the behaviour (verbal encouragement) and
therefore, the activity patterns of adolescent girls are of adopting the behaviour in a comfortable way, both phys-
particular concern (Sallis et al. 2000). In the USA, the ically and psychologically (physiological and affective
National Youth Risk Behaviour Survey found that 40% of states). A belief in one’s ability to carry out a specific
high school girls compared with 27% of high school boys behaviour successfully is likely to be fostered by being
failed to meet the modest physical activity recommendations exposed to these sources, although the importance of these
(Grunbaum et al. 2003). This level of physical activity among sources may vary according to the type of behaviour.
girls is similar to that in oriental society. In Taiwan, the This study aims to evaluate the effects of an intervention
percentage of girls who meet a moderate to high metabolic combining self-efficacy theory and pedometers to promote
equivalent of task level, a physiological concept that physical activity. The main study hypothesis was that the
expresses the energy cost of physical activities (Ainsworth intervention would result in improved physical activity
et al. 2000), is lower than that of boys (Chen et al. 2009). participation. It was further hypothesised that the interven-
Adolescent girls warrant particular attention, and interven- tion group would experience greater improvement in terms of
tion research designed to increase participation in regular their cardiopulmonary endurance and exercise confidence
physical activity is required. compared with the control group.
Because adolescents spend a major proportion of their time
in school, schools are considered the preferred environment
Methods
for promoting physical activity (Wechsler et al. 2000, Sallis
et al. 2001). Interventions designed to promote healthy
Study design
lifestyles that used a behavioural approach have found that
interventions using behavioural or cognitive-behavioural An experimental design was employed to test the effect of a
strategies were more effective than providing instruction, 12-week school-based physical activity intervention in
health education or exercise prescriptions alone (McAuley promoting physical activity among adolescent girls. The
et al. 1994, Young & King 1995, Brawley et al. 2000). The criteria for inclusion in the trial were being year 2 students
theory provides a conceptual framework for the development from a five-year junior college of nursing, who are familiar

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Journal of Clinical Nursing, 21, 914–922 915
L-L Lee et al.

with the school system. A five-year junior nursing college is a Participant’s stages of change for exercise were sought to
sort of college that recruits students who graduated from a identify in the questionnaire interview. An existing scale
three-year secondary or junior high school, whose age ranged designed by Kearney et al. (1999) was used in the measure-
from 16 (year 1) – 20 (year 5). All the four classes share a similar ment (Kearney et al. 1999). The participants were asked to
demographic, socioeconomic status. In the two classes that choose which statement best described how regularly they
were randomly selected, eligible study participants with known were undertaking exercise at the time of interview and their
cardiovascular disease were asked to request confirmation intention to exercise in the following six months. Five
from their usual doctor that they were physically well enough possible choices corresponded to the five stages of change
to undertake regular physical activity. All of the participants in exercise, which comprised the stages of precontemplation,
recruited to the trial provided written consent. Consent contemplation, preparation, action and maintenance. Data of
from their parents or guardians was obtained via telephone social support specifically to exercise behaviour from family,
contact. The trial was granted ethical approval by the National peers and teachers were collected by the Perceived Social
Dong Hwa University Institutional Review Board. Support Questionnaire developed by Sallis et al. (1987). The
Chinese version of the Perceived Social Support Question-
naire has ever been used in Lin’s study (Lin 2003). The scores
Measures
ranged from 1–5, and the higher score represents a better
The primary outcome measure was change in aerobic walking social support. The perceived stress was measured by the use
or running (i.e. walk or run continuously for at least 10 min- of a Perceived Stress Scale (Cohen et al. 1983). Chinese
utes) at 12th week. The secondary outcomes were changes in version of this scale was validated and used in previous study
cardiopulmonary endurance and perceived exercise self- (Chu & Kao 2005).
efficacy. Physical activity was assessed by using pedometers
and questionnaire. Questionnaires were also used to evaluate
Randomisation
the perceived exercise self-efficacy. Cardiopulmonary endur-
ance and other health fitness indicators were measured by a After the completion of the baseline measures, two classes
group of trained year 3 and year 4 students from the School of were randomly sampled from four eligible classes of year 2
Physical Education of a national university. students (mean age = 16Æ2 SD 0Æ41) from a five-year junior
Data about the number of weekly steps were collected by college of nursing and were then randomly allocated to either
an electronic pedometer (Omron HJ-720ITC pocket pedom- the intervention or control group. The two classes sampled
eter; Omron Scientific Technologies, Inc., Fremont, CA, were located in two blocks of different buildings to prevent
USA). It measures daily total steps, aerobic steps (i.e. information contamination because dissemination of infor-
continuously walk or run for more than 10 minutes) and mation from the intervention class to the control one would
the distance walked. Physical activity was also assessed via have the potential to dilute the effect of the outcome in the
the International Physical Activity Questionnaire (IPAQ) intervention class. The flow of the research design and
using the seven-day recall method (Craig et al. 2003, Liou participants through the study is presented in Fig. 1.
et al. 2008) to assess the self-reported physical activity.
Trained students from the School of Physical Education,
Intervention
National Dong Hwa University, measured the cardiopulmo-
nary endurance that was calculated from data about the The students in the control group continued with the original
three-minute aerobic step test. They also measured other content and activity of the physical education class. In
health fitness indicators, such as body weight, body height, addition to this original content and activity of the physical
standing long jump, sit-up and flexibility. education class, the students in intervention group partici-
Perceived self-efficacy regarding exercise was measured pated in a 12-week school-based physical activity interven-
using an existing exercise self-efficacy scale (Kao et al. 2002, tion for adolescent girls programme (SPAA-G), the design of
Marcus & Forsyth 2003). This scale consists of 17 items (e.g. which was based on behavioural modification theory. The
How much confidence do I feel about taking exercise even intervention combining the theoretical foundation of self-
when I am tired?). Each item was rated on a five-point Likert efficacy theory and provision of a pedometer was developed
scale ranging from 1 (not at all confident) – 5 (very to promote physical activity participation. The intervention
confident). A higher score represents a higher perceived self- was aimed at, but not restricted to, low-active adolescent girls
efficacy for exercise. The internal consistency for the exercise and was implemented during one semester, beginning in
self-efficacy score was 0Æ90. September 2009 and ending in December 2009. The major

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916 Journal of Clinical Nursing, 21, 914–922
Exercise Intervention for promoting physical activity

Eligible classes
(n = 4)

Block 1 Block 2
(n = 2 classes) (n = 2 classes)

Random sampled and random allocated to Random sampled and random allocated to
SPAA-G group (n = 1 class, 49 students) controlled group (n = 1 class, 50 students)

Ineligible (n = 3) Eligible for trial and Eligible for trial and Ineligible (n = 2)
baseline measures baseline measures
• Boy (n = 3) recorded recorded • Boy (n = 2)
(n = 46) (n = 48)

Lost to follow-up
Follow-up at 12 Follow-up at (n = 3):
Lost to follow-up 12 weeks
weeks
(n = 0) • Unwell (n = 1)
(n = 46) (n = 45)
• Refused (n = 2)

Figure 1 Flow of participants through study. SPAA-G, school-based physical activity intervention for adolescent girls.

goal of the intervention was to promote students’ physical Self-efficacy theory was used as a core theoretical founda-
activity amount. The intervention group was instructed to tion of the intervention design. Four sources related to
complete 12,000 steps of walking and/or 60 minutes of self-efficacy (performance accomplishment, verbal encour-
aerobic walking per day. Pedometers were provided to make agement, vicarious learning and the ways of perceiving
any changes in physical activity behaviour visible. physiological and emotional responses) were incorporated
The walking amount was downloaded bi-weekly, and an into the intervention programme, mainly through discussion
individual discussion about the experience of being involved after downloading steps from pedometer. Students in inter-
in physical activity or any difficulties encountered by the vention group were exposed to these sources according to
students was conducted following the download process. their progress in the regular walking. These included
Walking logs based on the data obtained from the pedom- identifying their own achievement in walking or running
eters were provided to and discussed with the intervention (performance accomplishments), reinforcing their sharing
group students. To enhance motivation regarding physical with classmates’ successful and enjoyable experiences in
activity, the distance between each domestic scenic spot in walking or running (vicarious learning), facilitating verbal
each county and township was illustrated graphically in the support and encouragement from significant others, such as
log for the students to mark the distance they had walked or physical education teachers and researchers (verbal encour-
run. During each discussion, the students in the intervention agement), and recognising the participant’s positive feeling
group were encouraged to ‘walk’ or ‘run’ to the next scenic and perception and correcting negative interpretations from
spot and to achieve more than one circle of the island. Goal the involvement of walking (perception of physiological and
setting was set and discussed during the face-to-face contact. emotional responses towards an activity).
A reward plan was devised to encourage the students who The intervention was tailored to the individual’s stage
had achieved either the goals of aerobic walking steps 40% of change in relation to exercise and delivered by a researcher
more than that in the previous week, achieved 12,000 steps of who is a nursing tutor with public health nursing background.
walking per day, or achieved 60 minutes of aerobic walking At baseline, all of the participants were considered to be at one
per day. Further encouragement was made when the afore- of the five stages of change according to their responses to
mentioned goals were achieved and lasting for three weeks. questions during the baseline interview. During the biweekly
Students would collect one point in their physical activity intervention contact, the intervention group participants’
achievement card when any of the aforementioned goals stages of change were assessed informally on the basis of
achieved and options from variety of stationery were their progress and performance in terms of walking or
provided according to the points they collected. running. For the individuals in the precontemplation and

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Journal of Clinical Nursing, 21, 914–922 917
L-L Lee et al.

contemplation stages, attention was focussed on increasing line with other studies of this nature, the aim was to recruit
their awareness of the benefits of exercise and encouraging 100 participants for the current study. All of the analyses
them to consider becoming more active. Information about were conducted using SPSS version 14.0 (IBM SPSS, Chicago,
the potential benefits of physical activity, possible ways of IL, USA).
engaging in walking or running regularly within the school
environment and the skills associated with using the pedom-
Results
eter was provided and discussed to encourage their initial
attempt. For them to incorporate regular walking or running Two of the four grade-two classes of the five-year junior
into their daily lives, initially, easy tasks, for example just college of nursing course were randomly sampled in this trial,
walking more or walking at a faster pace than usual, were which contain 94 girls in total with a mean age of 16Æ2 (SD
encouraged (performance accomplishment). Intervention for 0Æ411). Of these two classes, one was randomly allocated to
individuals who were in the preparation stage focussed on the the SPAA-G group (n = 46) and the other was the control
behavioural processes, encouraging individuals to begin group (n = 48) (Fig. 1). The baseline characteristics of the
regular walking or running. For the participants who had study groups are summarised in Table 1. Overall, the
started regular walking (action and maintaining stage), the physical activity of the participants in this trial fell short
discussion was focussed on the results of the regular walking, of the American College of Sports Medicine (ACSM)
such as walking steps, their perceptions about walking recommendations, they had a middle level of mean body
(physiological and psychological responses to it), personal mass index (BMI), a mean level of sit-up 30 and 60 sec-
accomplishments related to walking and goal setting. They onds and trunk flexion in sitting but had a poor level of
were also encouraged to try regular walking or running cardiopulmonary endurance and standing long jump. In the
several times a day for at least 10 minutes on each occasion by three categories of social support for adopting exercise,
introducing ‘stories’ and examples of successful cases (vicar- family support is higher than that of peers and teachers.
ious learning).
Table 1 Baseline characteristics of study groups

SPAA-G Control
Outcome measures
Characteristics group (n = 46) group (n = 48)
With the exception of social demographic factors, body (range) Mean (SD) Mean (SD)
weight, body height, standing long jump, sit-up and flexibil- Age (years) 16Æ27 (0Æ45) 16Æ16 (0Æ37)
ity, all of the baseline measures were repeated 12 weeks Steps-total/week 8103 (1538Æ06) 6941 (2274Æ72)
following intervention. All outcome measures were recorded Aerobic steps/week 539 (531Æ60) 588 (507Æ41)
during face-to-face interviews by research assistants who Cardiopulmonary 50Æ45 (6Æ90) 50Æ71 (6Æ25)
endurance (by
were trained in both questionnaire administration and health-
3-minute aerobic
related physical fitness and were blind to the study group step test)
allocation. The same procedure for measuring and calculat- Body mass index (BMI) 21Æ78 (4Æ64) 21Æ71 (4Æ50)
ing the three-minute aerobic step test for each individual was Standing long jump (cm) 147Æ48 (26Æ53) 142Æ00 (18Æ24)
used at baseline and follow-up. Sit-up 30 seconds (times) 16 (3Æ40) 15 (4Æ31)
Sit-up 60 seconds (times) 26 (7Æ52) 24 (9Æ38)
Flexibility (test by trunk 30Æ35 (7Æ63) 31Æ55 (8Æ35)
Statistical analyses flexion in sitting) (cm)
Total metabolic 2035 (3097) 2954 (5376)
The demographic data were summarised descriptively, using equivalent of tasks
mean and standard deviations for continuous data and Time of sitting 575 (201Æ48) 521 (197Æ18)
frequencies and percentages for categorical data. Outcomes (minutes/week)
Perceived health (3–9) 6Æ37 (1Æ34) 6Æ54 (1Æ27)
where follow-up data were available were analysed using
Perceived exercise 2Æ16 (0Æ78) 2Æ08 (0Æ53)
independent t-test. To assess whether the difference in the self-efficacy (1–5)
primary outcome between the two groups was affected by Social support (1–5)
random differences between them, an analysis of covariance Family 2Æ30 (0Æ752) 2Æ16 (0Æ903)
(ANCOVA ) was also undertaken. The required sample size was Peers 1Æ97 (0Æ750) 1Æ74 (0Æ614)
Teachers 1Æ68 (0Æ572) 1Æ57 (0Æ707)
determined by a power calculation using of G power
software. To have 85% power to detect effect size 0Æ6 with SPAA-G, school-based physical activity intervention for adolescent
a significance level of 5% and anticipating an attrition rate in girls.

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918 Journal of Clinical Nursing, 21, 914–922
Exercise Intervention for promoting physical activity

There was no difference in the mean age and aerobic walk p < 0Æ0001) (Table 2). During the 12-week intervention,
of the two randomised groups at baseline, but the total girls in the SPAA-G group increased about 371 aerobic
number of steps was higher and that of aerobic steps was steps, while the number of aerobic steps among the girls in
lower in the SPAA-G group. Both groups were similar at the control group decreased ( 108 steps). There were no
baseline in terms of the three-minute aerobic step test, body significant differences regarding changes in cardiopulmonary
composition (BMI and body fat), minutes of sitting per week, endurance and perceived exercise self-efficacy (p > 0Æ05)
perceived health, perceived exercise self-efficacy, social sup- (Table 2).
port from family, peers and teacher, perceived stress and
depression (Table 1).
Discussion and conclusion
Following randomisation, two of the control group
participants refused to complete the questionnaire and This study found that a 12-week SPAA-G underpinned by
another felt too ill to continue with the study (attrition self-efficacy theory and the provision of a pedometer
rate: 3%) (Fig. 1). All of the intervention group participants increases the number of aerobic walking steps. It was
(n = 46) received intervention contacts with the researcher hypothesised that the theory-based design of an activity
at which walking was discussed. At the 12-week follow-up, intervention carried out in a school environment could
the data were available from 100% (n = 46) of the improve physical activity participation among adolescent
intervention group participants and 94% (n = 45) of the girls. It was further hypothesised that the SPAA-G group
control group participants. Between the baseline and would experience a greater improvement in cardiopulmonary
12-week follow-up, a greater increase in the number of endurance and exercise confidence compared with the control
aerobic steps was observed in the intervention group than in group. However, effects of the intervention on changes in
the control group, with a mean difference of 467 steps cardiopulmonary endurance and perceived exercise self-
(95% CI, 117Æ74–816Æ77 steps, p = 0Æ009) (Table 2). efficacy scores were not found.
Change in the steps of aerobic walk was also influenced The use of pedometers has recently become popular in
by baseline characteristics. When adjustments were made promoting physical activity through providing daily step
for baseline total steps, BMI, perceived health and perceived monitoring and feedback. Several studies have tested the
stress, a greater improvement in aerobic steps was observed effectiveness of pedometers in both measuring the amount of
in the SPAA-G group than in the control group giving a physical activity, specifically ambulatory activity (Welk et al.
mean difference of 651 steps (95% CI, 605Æ59–696Æ69, 2000, Tudor-Locke et al. 2002, Cyarto et al. 2004, Schneider

Table 2 Primary and secondary study outcomes by study groups

SPAA-G group (n = 46) Control group (n = 45) Mean difference

Mean (SD) Mean (SD) (95% confidence interval) p-value

Primary outcome
Aerobic walk (steps/day)
Baseline 465 (439Æ80) 623 (521Æ73)
Follow-up 836 (832Æ03) 515 (554Æ19)
Mean change 371 (810Æ42) 108 (696Æ83) 467 (117Æ74–816Æ77) 0Æ009*
Mean change 481Æ35 (120Æ92) 169Æ79 (98Æ09) 651Æ14 (605Æ59–696Æ69) <0Æ0001

Secondary outcomes
Cardiopulmonary endurance (by 3-minute aerobic step test)
Baseline 50Æ45 (6Æ90) 50Æ71 (6Æ25)
Follow-up 49Æ52 (5Æ70) 53Æ93 (13Æ70)
Mean change 1Æ14 (6Æ98) 3Æ25 (16Æ78) 4Æ38 ( 0Æ93 to 9Æ7) 0Æ108*
Perceived exercise self-efficacy (1–5)
Baseline 2Æ16 (0Æ78) 2Æ08 (0Æ53)
Follow-up 2Æ06 (0Æ71) 2Æ14 (0Æ66)
Mean change 0Æ10 (0Æ72) 0Æ06 (0Æ55) 0Æ16 ( 0Æ10 to 0Æ42) 0Æ22*

SPAA-G, school-based physical activity intervention for adolescent girls.

*Independent t-test.

Analysis of covariance. Change in aerobic steps adjusted for baseline total steps, BMI, perceived health and perceived stress.

Score range: 1–5, a higher score represents higher perceived exercise self-efficacy.

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Journal of Clinical Nursing, 21, 914–922 919
L-L Lee et al.

et al. 2004, Lubans et al. 2009) and motivating regular self-efficacy theory and pedometers can be effective in
physical activity (Speck & Looney 2001, Talbot et al. 2003, promoting physical activity participation among adolescent
Sidman et al. 2004, Lubans et al. 2009). A trial assessing the girls. The intervention, using graphs of domestic scenic spots
function of wearing a pedometer with pretest and post-test to represent the distance of walking or running as monitored
awareness and amount of physical activity undertaken found by pedometers, might enhance motivation regarding physical
that wearing a pedometer is a simple, non-invasive way to activity. Overcoming barriers of stress from course evalua-
increase awareness of daily activity and leads to increased tions, such as examinations and reports during a semester,
physical activity (Rooney et al. 2003). The students’ behav- may further enhance physical activity motivation and self-
iours of using a pedometer may influence the study results, efficacy among adolescent girls. This is a relatively short-
although there is insufficient evidence about this. In the term physical activity intervention that could bring about an
present study, we found that the students could achieve important increase in physical activity among adolescent
the advised total number of walking steps simply shaking the girls in school. Future study to test an intervention that
pedometer, and therefore, we mainly used the index of intends to balance study loading because of academic
aerobic walking rather than total steps, which has to be evaluation and participation in physical activity is war-
recorded by only walking or running itself for at least ranted.
10 minutes consecutively.
In this group of participants, the students had less time
Relevance to clinical practice
pressure and were willing to adopt physical activity at the
beginning of the semester. However, they were under pressure Health benefits of physical activity have been well docu-
by the end of the semester, such as final-term examinations and mented, and physical activity during childhood has been
reports. The barriers of time restriction and stress caused by found to be associated with physical activity during adult-
various course evaluations at the end of the semester may have hood. It is important for healthcare professionals, including
hindered adolescents from participating in regular physical school health nurses, involved in the care of adolescent
activity. Physical activity guidelines in adolescents recommend health, to design and provide a physical activity intervention
engagement in moderate to vigorous intensity for at least combining self-efficacy theory and provision of pedometer to
60 minutes daily (Cavill et al. 2001, Strong et al. 2005). promote physical activity.
Although the number of aerobic steps increased significantly
among the intervention group participants, the intervention
Acknowledgements
tested in the current study was not effective in increasing the
proportion of students who meet these guidelines. Among The authors express their sincere gratitude to all of the
insufficiently active adolescents, however, every increase in students participating in this study; for the three research
moderate to vigorous physical activity may have been impor- assistants of Ms Zi-Rong Chen ( ), Ms Pei-Yu
tant in producing health-related benefits. Xu ( ) and Ms Yi-Jing Jian ( ); for tutors of
This study has several limitations. Effects of the physical the two classes sampled, Dr Han-Lin Chen ( ) and
activity intervention in increasing of cardiopulmonary Ms Ji-Fen Zeng ( ). We also acknowledge the financial
endurance and exercise self-efficacy were not found in the support from both Tzu-Chi College of Technology, Hualien,
present study. Future study is needed to test those effects Taiwan (Project number: TCCT-971A24) and National
when the intervention period of time is extended. Although Science Council, Taiwan (Project number: 98-2410-H-
it was impossible to blind the participants, given the nature 277-001).
of the intervention, every effort was made to blind the
trained interviewers to the groups to which the participants
Contributions
had been allocated. Additionally, because this intervention
programme was conducted in a college, it may be that the Study design: L-LL, Y-CK; data collection and analysis: L-LL,
intervention would not have the same effect when tested in Y-CK, DF, S-JP, I-FJ and manuscript preparation: L-LL, S-JP,
other schools with different environments. Further work I-FJ, Y-CK, DF.
would be warranted to examine the effect of SPAA-G on
promoting physical activity in other schools and in different
Conflict of interest
contexts.
In conclusion, this study provides evidence that a school- There are no potential conflicts of interest known to any of
based physical activity intervention programme combining the contributing authors.

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920 Journal of Clinical Nursing, 21, 914–922
Exercise Intervention for promoting physical activity

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