Determinants physical activity in middle-aged women: application trans theoretical model | BMC Women’s Health

Regular physical activity is the first priority of a healthy lifestyle. Physical activity refers to any physical movement by voluntary muscles, which requires energy consumption. This definition includes any daily life activities, including job duties, household chores, and other daily duties to sports. The recommendation of the World Health Organization regarding the amount of physical activity required for people aged 18–65 is at least 150 min of moderate physical activity per week or 75 min of vigorous physical activity per week or a balanced combination of these moderate and vigorous physical activities. Also, muscle strengthening exercises that involve large body muscles should be done 2 or more days a week [1,2,3].

According to data from the World Health Organization, physical inactivity is responsible for approximately 2.3 million deaths annually and significantly contributes to 21–25% of breast and colon cancers, 27% of diabetes cases, and around 30% of ischemic heart diseases [3, 4]. The Eastern Mediterranean region exhibits the highest levels of inactivity globally, with over one-third of men and nearly half of women classified as physically inactive [5]. A report from the World Health Organization highlights that the prevalence of inactivity, particularly in terms of leisure-time physical activity, among Iranian individuals aged 18 to 64 years is 76.3% for women and 58.8% for men, resulting in an overall inactivity rate of 67.5% for this age group [6]. Some studies conducted in Iran have indicated even higher levels of inactivity [7, 8]. According to global and Iranian statistics, women are less active than men [8, 9]. Physical activity is a key determinant of energy intake, energy balance, and weight control. In addition, it increases life expectancy and improves the quality of life [10]. For the elderly, participation in physical activities can positively influence their quality of life and functional capabilities, helping them maintain independence in daily tasks. Conversely, elderly individuals living alone may experience challenges in their basic activities and functional abilities due to a lack of companionship, which can diminish their motivation to remain active [11]. Understanding the factors that contribute to a high level of health satisfaction among the elderly is essential. Key determinants include maintaining sufficient functional abilities, the absence of physical and mental health issues, and sustaining an adequate level of physical activity [12]. Many individuals in Iran and various other nations fail to engage in sufficient physical activity, thereby missing out on the significant advantages associated with both physical and mental health [10, 13]. Research indicates that the primary strategies to encourage middle-aged women to engage in consistent physical activity include enhancing intrinsic motivators, minimizing obstacles, and broadening access to opportunities. Several factors influencing the physical activity behaviors of middle-aged individuals in Iran encompass intrapersonal, interpersonal, cultural, environmental, and socio-economic dimensions. Additionally, the absence of structured and consistent approaches to facilitate the involvement of the elderly in physical activities and sports, along with the lack of an appropriate environment for their physical and athletic development, are identified as further challenges to promoting physical activity among the elderly population in Iran [14,15,16].

Numerous challenges and issues can impede behavior modification. The dynamics of behavior change play a crucial role in recognizing and addressing these factors while aligning them with prevailing cultural and social frameworks. Among the various theoretical models available, the transtheoretical model, developed by Prochaska, DiClemente, and colleagues, has gained prominence as a holistic and integrative approach to fostering behavioral changes that encourage participation in sports activities [17, 18]. This model posits that behavior change is a gradual process rather than a singular event, with individuals exhibiting varying degrees of motivation and readiness across five distinct stages: pre-intention (pre-contemplation), intention (contemplation), preparation, action, and maintenance [19, 20]. The pre-contemplation stage is characterized by an individual’s lack of consideration for behavior change, typically extending for at least six months. In the contemplation stage, the individual begins to contemplate the possibility of change within the next six months, although they may not yet feel prepared to act. The preparation stage involves a serious commitment to change, with intentions to initiate modifications in the near future, often within the following month. The action stage reflects a period during which the individual has actively implemented lifestyle changes over the past six months. Finally, the maintenance phase represents a prolonged period during which the individual strives to solidify and sustain these changes, requiring ongoing and deliberate effort beyond the six-month mark [20, 21].

Prochaska proposes 10 processes under the title of cognitive and behavioral processes to transition from the stages of change. Change processes include activities and strategies or processes that help a person to advance in the stages of change and include two main categories; Cognitive processes that deal with people’s thinking and feelings about behavior and are used in the initial stages of change, and behavioral processes that cause behavior change and are used in the final stages of change. The structure of balance and balance in decision-making is another structure that is formed based on the conflict pattern in decision-making and its focus is on the importance of positive (pros) and negative (cons) perceptions of a person regarding the results of his behavior or changing his behavior. In this structure, it is assumed that the person will not change his behavior unless he realizes that the benefits of changing the behavior outweigh the disadvantages. Another construct is the self-efficacy construct, which represents the confidence that people have about their ability to cope with the situation in returning to their previous habit [20, 22].

Comprehensive health centers in Iran play an important role in communicating with women and identifying risk factors in these people. Considering the lack of physical activity behavior in Iranian women and the need to determine the predictors of this behavior based on a successful theoretical framework such as the transtheoretical model. Therefore, this study was conducted with the aim of determining the relationship between the constructs of the meta-theoretical model and the physical activity behavior of middle-aged women referring to health centers and providing the most fit model.