ADAPTED PHYSICAL ACTIVITY QUARTERLY, 2006, 23, 148-162 2006 Human Kinetics, Inc.

Applying Physical Activity Motivation Theories to People With Brain Injuries

Simon Driver
University of North Texas
The purpose of the paper is to provide specialists with theoretical frameworks that can be used to guide the creation of physical activity interventions as well as facilitating participation for people with traumatic brain injuries. Two frameworks for examining the physical activity motivation of people with brain injuries are presented. The theories include Banduras (1986) self-efcacy theory and Harters (1987) mediational model of self-worth. The constructs within both theories are explained and then applied to people with brain injuries. Suggestions for practitioners are also provided about how to manipulate the physical activity environment to promote physical activity participation.

For the past 20 years, research has consistently linked physical activity participation to a variety of physical and psychosocial benets. Physical activity can be dened as any form of planned exercise or movement (e.g., walking, lifting weights, playing soccer, or other sports) or as activities of daily living (e.g., household chores, working in the garden; United States Department of Health and Human Services, 2002). Conversely, physical inactivity is considered a signicant risk factor for disease in children, adults, and older adults (American College of Sports Medicine, 2000). However, despite the overwhelming evidence regarding the benets of physical activity, participation rates are low, especially in people with disabilities, as only 23% of this population are regularly active (United States Department of Health and Human Services, 2000). Thus, identifying the determinants of physical activity and the mechanisms associated with physical activity motivation has become an important area of research (McAuley & Blissimer, 2000). Consequently, the aim of this paper is to review and apply concepts of two motivational theories to the physical activity behaviors of individuals with brain injuries. Theories include Banduras (1986) self-efcacy theory, and Harters (1987) mediational model of global self-worth. Both theories are based on a social cognitive paradigm of motivation where there is an interaction between social, cognitive, behavioral, and physiological factors (Bandura, 1986; Standage & Duda, 2003). While there are several other theoretical frameworks that attempt to explain physical activity behaviors (e.g., Transtheoretical Model, Theory of Planned Behavior, Expectancy Value Model, Self-Determination Theory), Banduras theory and Harters model
The author is with the University of North Texas, Department of Kinesiology, Health Promotion, and Recreation, Denton, Texas 76203-0769. E-mail: SDriver@coe.unt.edu.

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were selected as they each include constructs that research has consistently shown to be central to motivation, including perceived competence, or belief in ability, and affect, or enjoyment (McAuley & Blissimer, 2002; Weiss & Williams, 2003). Also, the aim of the paper was to provide a detailed account of two theoretical frameworks rather than a brief discussion of multiple theories. Therefore, specialists working with adults with brain injuries will have an increased understanding of how to implement them to facilitate physical activity participation, based on the United States Department of Health and Human Services (2002) denition. Also, the intent of the article is to provide a theoretical framework for specialists with different areas of expertise (e.g., sport, exercise, rehabilitation) to structure physical activity programs. Banduras theory has been used extensively within an exercise context (McAuley & Blissimer, 2002), while Harters model is relatively new to the physical activity domain (Weiss & Williams, 2003), thus potential applications will be discussed. Each theoretical framework will be explained separately in relation to physical activity participation and individuals with brain injuries. Brain injuries occur due to a variety of reasons (e.g., motor accidents, falls, neglect, violence) and can result in physical, cognitive, and psychosocial impairments (Dault & Dugas, 2002; Driver, Harmon, & Block, 2003). Consequently, brain injuries are a highly individualized disability that can result in a myriad of impairments. Also, due to the high incidence of brain injuries within the United States, this acquired disability has become a serious public health issue (National Institute of Health, 1999). Consequently, specialists are presented with a considerable challenge to meet the unique needs of this growing population.

Physical Activity and Individuals With Brain Injuries

The relationships between the constructs within self-efcacy theory (Bandura, 1986) and Harters model of self-worth (1987) are important to examine among people with brain injuries because of low physical activity rates (National Institute of Health, 1999; United States Department of Health and Human Services, 2000). Consequently, it is imperative that researchers understand how different social, cognitive, and behavioral factors interact to inuence behavior, in an attempt to facilitate participation. Also, the constructs within each model are highly relevant to this population because of the physical and psychosocial impairments that result from the traumatic injury. Research has shown that after brain injuries, individuals experience decreases in several of the variables central to each theory. For example, studies have found decreases in self-worth (Baker-Roth, McLaughlin, Weitzenkamp, & Womeldorff, 1995) and social support (Finset, Dyrnes, Krogstad, & Berstad, 1995; Kennedy et al., 2000), as well as increases in negative affect (Armstrong, 1991; Driver, in press; Kennedy et al., 2000; Kersel, Marsh, Havill, & Sleigh, 2001). Driver (in press) found that individuals with brain injuries had higher levels of depression, tension, anger, and fatigue and lower levels of vigor and friendliness than the general population. However, after participation in an eight-week exercise intervention (e.g., resistance training and aquatics), participants mood states were positively inuenced so that they were not statistically different to the general population. This included increases in feelings of vigor and friendliness and

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decreases in tension, anger, depression, and fatigue. Participants also experienced signicant increases in self-worth after completing the program. This highlights the important role that physical activity can play in enhancing self-worth and affective states. Numerous other studies have been completed examining the effect of physical activity (e.g., aquatic exercise, resistance training) on psychosocial functioning of adults with brain injuries. For example, physical activity interventions that consisted of 8-12 week programs (e.g., one hour session, three sessions per week) have been shown to result in signicant increases in positive affect (Driver & OConnor, 2003), health promoting behaviors (Driver, Rees, OConnor, & Lox, 2006), physical tness (Driver, OConnor, Lox, & Rees, 2004), and self-esteem (Driver, OConnor, Lox, & Rees, 2003). These results again highlight the role that physical activity can play in the physical and psychosocial rehabilitation of individuals with brain injuries. However, although these studies showed that psychosocial functioning can be enhanced through physical activity participation, results did not identify what social, cognitive, or behavioral factors interacted to result in the reported changes. Thus, it is essential that future studies examine the relationship among these variables to understand how these changes in psychosocial functioning occur. Also, to ensure that meaningful results are obtained from this research, it is important that researchers use valid and reliable measures of the different constructs appropriate for people with brain injuries (Driver, 2006). Thus, Banduras self-efcacy theory (1986) and Harters (1987) model of self-worth will be used as frameworks to discuss physical activity participation in people with brain injuries.

Self-Efcacy Theory
Although self-efcacy theory was originally developed to examine the effect of clinical interventions on symptoms of anxiety (Bandura, 1986), numerous researchers have adopted the framework within a physical activity context (e.g., Lox & Freehill, 1999; Martin, 2002; McAuley, 1993; McAuley & Blissimer, 2000; McAuley, Lox, & Duncan, 1993). This was due to self-efcacy playing an important role in the adoption and maintenance of health behaviors (Nahas, Goldne, & Collins, 2003). Consequently, self-efcacy theory has considerable utility for describing, explaining, and predicting physical activity behaviors. This has implications for people with brain injuries, as research using a self-efcacy framework may improve our understanding of the physical activity behaviors of this population. Self-efcacy theory states that different antecedents of efcacy and consequences of efcacy judgments interact to inuence behavior (see Figure 1; Bandura, 1986). For example, according to self-efcacy theory an individuals past performances, vicarious experiences, social persuasion, and physiological states inuence an individuals feelings of efcacy. Their feelings of efcacy then shape their affect, cognitions, and actual behavior. Central to this relationship is self-efcacy, which can be broken into task selfefcacy and self-regulatory efcacy. Task self-efcacy is dened as an individuals belief that he can complete a specic activity, based on the skills he has and the situation in which he nds himself (Bandura, 1986). Thus, task self-efcacy is considered a situation-specic form of self-condence (Lox, Martin, & Petrezzello, 2003). For example, individuals who have experienced brain injuries may have high task self-efcacy during aquatic therapy sessions when they work with

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Figure 1Banduras Self-Efcacy Theory (1986).

a rehabilitation therapist who provides support (e.g., instruction, physical support) and equipment (e.g., otation devices). These feelings of efcacy may then increase enjoyment (e.g., affect) and motivation (e.g., cognitions) to participate. Self-regulatory efcacy, however, refers to individuals belief that they can complete a specic task in the face of barriers (Bandura, 1997). For example, if swimmers had to complete their sessions independently at the local swimming pool when faced with barriers (e.g., lack of instructor/equipment/transport), then they would have low feelings of self-regulatory efcacy. Consequently, individuals may avoid going to the pool as swimming without supports will exceed their coping abilities (Bandura, 1986). Evidence indicates that barriers to participation play a critical role in shaping an individuals feelings of efcacy. Research from the physical activity literature concerning people with disabilities and older adults indicates that as the severity of the disability or chronological age increases, then people are faced with a greater number of barriers that impede efcacy levels (e.g., medical contraindications, lack of experience, disability, transportation needs, stafng ratios, nancial resources; Driver, 2005; Messent, Cooke, & Long, 1998; Pescatello & DiPietro, 1993; Standage & Duda, 2003). Specic to people with brain injuries, Driver (2005) found that there were numerous barriers to physical activity participation. A sample of 384 adults with brain injuries (males = 244, females = 140) were presented with a list of 10 potential barriers to participation. Participants were asked to identify the barriers they faced. The list was a modied version of the barriers to physical activity scale for individuals with physical disabilities (Heller, Rimmer, & Rubin, 2001). Results indicated that the most frequent barriers to participation included (a) lack of a personal care assistant (48% of sample), (b) lack of education about the reasons/benets of physical activity participation (44%), (c) lack of transportation (40%), and (d) cost of a physical activity program (38%). These results have implications for the general population of people with brain injuries, as individuals may be faced with a greater number of barriers (e.g.,

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transport, cost, lack of support/education), thus decreasing their feelings of selfregulatory efcacy. Consequently, the individual may become even less physically active, further decreasing self-efcacious expectations and exacerbating the negative physical (e.g., decreased strength and exibility) or psychosocial impairments (e.g., greater isolation and depression). Research examining the role of self-efcacy in physical activity participation will now be reviewed. Focus will center on the role of self-efcacy as a determinant and consequence of physical activity participation (Bandura, 1997; McAuley & Blissimer, 2002). Research has consistently identied that self-efcacy plays a dual role within a physical activity context, as a consequence of participation and antecedent in predicting participation and adherence. For example, increases in feelings of efcacy have been reported as a consequence of participation in different modes of physical activity including Tai Chi (Li, McAuley, Harmer, Duncan, & Chaumeton, 2001), resistance training and aerobic exercise (McAuley et al., 1999). Self-efcacy is also a determinant in predicting physical activity adoption (McAuley, 1993) and adherence (Duncan & McAuley, 1993; McAuley, Lox, & Duncan, 1993). Specic to people with physical disabilities, Martin (2002) examined the relationship between training and performance self-efcacy, affect, and outcome expectations in 51 wheelchair athletes. Training efcacy was related to individuals belief that they could train in a variety of adverse conditions, whereas performance efcacy assessed their belief that they could complete the race in a certain time (Martin, 2002). Results indicated that individuals with greater feelings of self-efcacy (training and performance) thought they were going to nish higher in the race (e.g., 3rd as opposed to 7th, higher outcome expectations) and had greater positive affect compared to individuals who felt less efcacy. This emphasizes the important relationship between feelings of efcacy and affect within self-efcacy theory. In summary, ndings indicate that self-efcacy plays a central role in the adoption and maintenance of physical activity behaviors. Research also indicates that individuals with increased self-efcacious feelings display greater effort and persistence, whereas people with low feelings of efcacy are more likely to discontinue participation (Bandura, 1997; McAuley et al., 1993). Thus, it is suggested that self-efcacy theory offers potential as an appropriate theoretical framework to understand the physical activity behaviors of people with brain injuries. Attention now focuses on the different antecedents of efcacy information (see Figure 1), and relevant studies will be used to support the predictions of the theory. The inuence of each antecedent on self-efcacy, affect, and motivation will also be discussed. Self-efcacy theory predicts that there are four main antecedents to an individuals feelings of self-efcacy, including past performance accomplishments, vicarious experiences, social persuasion, and physiological arousal (see Figure 1; Bandura, 1986). These sources are listed in order of their impact on self-efcacy with past performance exerting the strongest inuence followed by vicarious experience, and so forth (Lox et al., 2003). The rst antecedent is past performance, which refers to the amount of success or failure an individual has previously experienced with a particular activity (e.g., using a treadmill). The individuals appraisal of previous events will then inuence expectations for future success as they perceive that they did it once, so they can do it again. Research has shown that positive previous experiences enhance feelings of self-efcacy (Feltz, 1982; McAuley, 1985). McAuley (1985) examined the relationship between performance accomplishments,

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self-efcacy, and subsequent performance in elite divers and gymnasts without disabilities. Results suggested that individuals who had successful prior experiences were more self-efcacious and also performed better. Findings from this study highlight how different components of the model interact to inuence behavior as an individuals feelings of self-efcacy, positively impacted participants affect, and behavior (e.g., greater motivation). The second antecedent, vicarious experiences (modeling), involves watching someone else complete the activity. When the model is successful then self-efcacy is increased, but if the model is unsuccessful then self-efcacy beliefs decrease. Findings from the modeling literature indicate that self-efcacy and performance can be increased through the use of successful models (George, Feltz, & Chase, 1992; McCullagh & Weiss, 2002; Weiss, McCullagh, Smith, & Berlant, 1998). Weiss and associates (1998) examined the role of peer modeling on self-efcacy and performance in youth swimmers. Participants were exposed to a peer model (demonstrating swimming skills) or a control group (watch cartoons). Results indicated that individuals exposed to the peer model group were more self-efcacious and performed better at post intervention and follow-up swimming assessments. Findings from the modeling literature also indicate that the impact of the model is increased when there is a similarity between the model and viewer (e.g., ability, age, gender; Weiss, 1991). For example, a male with brain injuries will relate better to a male model that has similar disabilities (e.g., spasticity, balance issues) than to a female without a disability. Thus, if individuals view a similar model completing a task successfully (e.g., lifting weights in a gym) then their feelings of efcacy to complete the same task will be increased. This will cause them to feel greater enjoyment (positive affect) and motivation to complete the activity. Research reinforces this tenet of the model as older adult exercisers have been shown to experience greater condence when exercising with other older adults and less comfortable when around young exercisers (Biddle, Fox, & Edmunds, 1994; Fox, Biddle, Edmunds, Bowler, & Killoran, 1997). The third antecedent, verbal persuasion, involves verbal or nonverbal cues from a signicant other (Bandura, 1986). Persuasion can be either positive or negative and both statements have a differential effect on an individuals self-efcacy, affect, and motivation. For example, if individuals receive negative persuasion from a family member (e.g., You should not exercise because of your disability), then they will have lower feelings of efcacy. Consequently, they will not participate because they do not think (cognition) or feel (affect) that they can exercise. Conversely, individuals who receive encouragement from a friend (e.g., Lets go to the gym together) will have higher feelings of self-efcacy and thus be more likely to exercise. Research has shown a link between positive persuasion, self-efcacy, and behavior (e.g., exercise and medication compliance) in people with diabetes (Clark & Dodge, 1999), arthritis (Lorig & Holman, 1993), epilepsy (Dilorio, Hennessy, & Manteuffel, 1996), and asthma (Bosley, Fosbury, & Cochrane, 1995). In each study, self-efcacy was shown to mediate the impact of verbal persuasion on exercise and medication compliance, with positive persuasion being associated with greater feelings of efcacy and exercise participation. However, the credibility, expertise, and assumed knowledge of the source of persuasion will also impact the interpretation of the statement (Bandura, 1997). For example, a doctor or therapist may have a greater inuence on the physical activity behaviors of a

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person with brain injuries because they are considered an expert, compared to a family member or friend (Lox et al., 2003). The fourth inuence on feelings of efcacy is physiological states, which include somatic symptoms in response to a stimulus (e.g., increase in heart rate thinking about running on the treadmill). Links between an individuals physiological state and feelings of self-efcacy have been reported for younger populations (Treasure, Monson, & Lox, 1996) and clinical populations (Lox & Freehill, 1999). Lox and Freehill (1999) examined the relationship between self-efcacy, fatigue, and dyspnea (breathlessness) in 40 patients with chronic obstructive pulmonary disease. Results revealed that regardless of disease severity, individuals who reported lower levels of dyspnea and fatigue had increased self-efcacy beliefs about exercising. Although physiological states are postulated as having the least inuence on self-efcacy, the signicance may be increased for people with brain injuries due to movement and mobility problems. For example, a person with spasticity in the limbs (e.g., legs, arms, hands) may nd it painful and awkward to be moved out of a wheelchair to be physically active. Due to the increase in pain the individuals feelings of efcacy and motivation to participate may decrease. Subsequently, physiological states may have a greater impact on the feelings of efcacy of individuals with brain injuries compared to the other antecedents due to the physical impairments associated with the disability (e.g., spasticity, ataxia, apraxia). In conclusion, considerable research exists that supports the use of self-efcacy theory as a tool for understanding physical activity behaviors. Self-efcacy theory also appears to have utility as a method for understanding the physical activity behaviors of people with brain injuries. Harters (1987) model of global self-worth has been used less frequently within a physical activity context, especially with adults, but has great potential as a theoretical framework.

Harters (1987) Mediational Model of Global Self-Worth

In an attempt to understand an individuals motivational patterns and behaviors in specic achievement domains (e.g., academic, social, physical), Harter (1978) developed competence motivation theory. Competence motivation theory (CMT) proposes that an individual is intrinsically motivated to interact with the environment (e.g., physical activity) and does so by engaging in mastery attempts (e.g., walking around the block). If the individual is successful at the mastery attempt, intrinsic pleasure (e.g., enjoyment), perceptions of competence, control, and motivation (e.g., desire to be physically active again) will be increased. Conversely, failure at the mastery attempt (e.g., felt uncomfortable and could not walk around the block) will lead to decreased intrinsic motivation, perceptions of competence, control, and motivation (e.g., stop being physically active). Research adopting a CMT framework has consistently found motivation to be a determinant of perceived competence, social support, self-worth (or self-esteem), and affective experiences (Babkes & Weiss, 1999; Harter, 1978; Weiss, Ebbeck, & Horn, 1997). Consequently, Harter developed a model that included elements found central to motivation, thus creating the mediational model of global self worth (see Figure 2; Harter, 1987). Specically, the model considers self-worth to be the

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Figure 2Harters Mediational Model of Global Self-Worth (1987).

central construct as it mediates the relationship between perceived competence and social support on affect and motivation. Thus, the model synthesizes components of CMT (e.g., perceptions of competence, signicant others) with global self-worth and emotional responses (affect). Each component of the model will now be dened and related to people with brain injuries. Central to Harters (1987) model is global self-worth, or self-esteem, which is considered an overall evaluation of the self (e.g., How much do I value myself?). Previous research has indicated that self-concept is best explained using a hierarchical model (Fox & Corbin, 1989; Horn, 2003), placing global self-worth at the apex and domain specic self-assessments at the second level (e.g., physical versus academic self-worth; Horn, 2003). Thus, an individuals self-worth within a specic domain contributes to global self-worth. The third level is comprised of perceptions of competence within a particular domain. Accordingly, Harters (1987) model proposes that an individuals self-worth will be shaped by their perceived competence, which refers to belief in ability within a specic domain (Harter, 1978). For example, an individual with brain injuries may feel different about their ability when swimming compared to running. Consequently, perceived competence is considered a less global construct than self-worth because it is a specic judgment within a particular context. Also, whereas self-worth is considered a stable construct (does not uctuate over time or situation), perceived competence is expected to change across domains. For example, after brain injuries, a high school student may have high perceptions of ability in math (academic) but low belief in ability for athletics (physical). Harter (1987) also stipulates that an individuals perceived competence will have a greater inuence on global self-worth in domains that are considered important. Thus, had athletics been important to the high school student with brain injuries, low perceived competence would have resulted in lower feelings of global self-worth. Conversely, had math been important and athletics unimportant, global self-worth would have been higher due to high perceptions of ability in math. The second antecedent of self-worth is perceived social regard or support from signicant others (e.g., coaches, family, friends; Harter, 1987). The model

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predicts that individuals who perceive high social support or regard will have greater self-worth. For example, if the student with brain injuries was to receive encouragement from peers and instructors during athletics, higher self-worth would be experienced. In contrast, if the student perceived not receiving support, then self-worth would have been lower. According to Harters (1987) model, there are two consequences of global selfworth, including affect and motivation. Affective reactions (e.g., happy, nervous) occur in response to an individuals feelings of self-worth. For example, if the student with brain injuries has low self-worth about athletics at school, they may get nervous or fearful about participation (e.g., negative affect). Had self-worth been higher, they may have felt enjoyment or excitement about athletics (e.g., positive affect). The model indicates that affect will then predict an individuals motivation, such that had the student associated positive feelings with athletics, they would have been more motivated to participate. Although extensive research has been completed testing the model within an academic context, few studies have tested the model within the physical domain. However, the studies that have been completed will now be reviewed and ndings will be applied to people with brain injuries. Harters research (1987, 1999) has indicated four consistent ndings for children through older adults without disabilities. These results support the relationship between the variables outlined in Harters model (Figure 2). First, both perceived competence in areas of importance and social support are equally strong determinants of self-worth. Second, within each of these determinants, perceived physical appearance (e.g., part of perceived competence) and social support are the strongest predictors of self-worth. Third, support from peers (e.g., classmates, coworkers, friends) is the strongest source of social support across the lifespan. Finally, a strong link has been found between self-worth and affect (e.g., positive and negative). These ndings are supported and extended by research from the physical activity domain. For example, Ebbeck and Stuart (1996) examined the relationship between perceived physical competence and importance on global self-worth among 8-13 year old youth basketball participants. Results indicated that global self-worth was best predicted by perceptions of physical competence, especially if individuals considered the activity important. Ebbeck and Stuart (1993) reinforced these ndings within high school football players as they found that perceived football competence accounted for 44% of the variance in self-worth. Ebbeck and Weiss (1998) extended this line of research by examining the relationship between perceived physical competence, global self-worth, and affect in 8-13 year old children attending an instructional sports camp. Results indicated that positive affect (e.g., enjoyment, excitement) mediated the inuence of perceived physical competence on global self-worth and emphasizes the potential role of affect as a precursor to self-worth as well as an outcome. This result differs from Harters (1987) prediction where affect is solely an outcome of self-worth. While this poses some interesting questions regarding the revision of the model, considerable research is required to replicate and conrm ndings (Ebbeck & Weiss, 1998). Results may have supported Harters predictions had a different model been tested, whereby affect was an outcome of self-worth. Harters (1987) complete model was tested by Smith (1999) who investigated the relationship among perceptions of peer relationships, physical self-worth, and

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affective responses toward physical activity motivation. Participants included 418 middle school students who ranged in age from 12 to 15 years old. Results from structural equation modeling supported the model and indicated that perceptions of peer acceptance were positively related to adolescents perceptions of physical self-worth. Physical self-worth was then found to inuence affect and motivation. Findings highlight the mediational role of self-worth and importance of peer relationships to adolescent physical activity motivation. Overall, these studies emphasize the impact that perceptions have on competence and social support relative to an individuals self-worth, affect, and motivation. Although few studies have been completed examining components of Harters (1987) model within a physical activity context, the model provides a promising framework for future motivation research (Weiss & Ebbeck, 1996; Weiss & Ferrer-Caja, 2002; Weiss & Williams, 2003). This is because research has shown each of the constructs included in the model to be central to understanding an individuals motivation. Consequently, there are several similarities between self-efcacy theory (Bandura, 1986) and Harters model of global self worth. For example, research has shown that both models involve an interaction among belief in ability (e.g., self-efcacy or self-worth), affect, and behavior (e.g., motivation). Thus, even though no studies have used either theory to explain the physical activity behaviors of people with brain injuries, each framework offers considerable promise. Research has shown that constructs central to both theories decrease after traumatic brain injuries. Therefore, it is important to understand how perceived competence, social support, self-esteem, and affect interact to inuence physical activity behaviors. Based on previous research establishing the relationships between the variables in both frameworks, it is hypothesized that decreased levels of social support/verbal persuasion, self-efcacy, self-worth, and affect (e.g., greater depression, anxiety) will have a negative impact on an individuals physical activity motivation. For example, if individuals experience negative social inuences about being physically active (e.g., decreased social support, negative social persuasion), then belief in ability will decrease (e.g., global self-worth, self-efcacy) and they will not consider participating. As a result, motivation to initiate involvement will decline. As specialists indicate that psychosocial impairments are the most difcult to positively inuence post injury (Finset et al., 1995), it is important that researchers understand how these factors interact to inuence physical activity participation. Individuals involved in the rehabilitation process of people with brain injuries can then devise interventions that manipulate components of both models to increase physical activity participation.

Physical Activity Interventions

Interventions using a self-efcacy framework are frequently used during the rehabilitation of cardiac patients (Ewart, 1989), and these principles have also been modied to apply to older adults (Standage & Duda, 2003). Thus, there is potential for the principles to be modied for people with brain injuries. The original program developed for cardiac patients consists of four recommendations that are based on each of the different antecedents of self-efcacy theory (Ewart, 1989). The rst recommendation involves ensuring that people have successful

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experiences during initial exercise so that their efcacy beliefs are increased. Specic to people with brain injuries, this could include beginning an exercise program at a lower intensity with gradual increases over time (e.g., 10 min versus 40 min). During this initiation phase it is also important that practitioners encourage individuals to use a current frame of reference regarding ability (e.g., with disability), rather than comparing ability before the injury (e.g., without disability). This will decrease the chance of the individual experiencing a discrepancy between past performance and current ability level, which would have a negative impact on self-efcacy and motivation. The second guideline stipulates the provision of similar models to allow individuals to see someone with similar skills complete the same activity. Interventions within a rehabilitation center could include having group physical activity classes consisting solely of people with brain injuries or physical disabilities, instructional videos that show individuals with physical impairments successfully participating in physical activity, or a buddy system where individuals with similar ability levels work together. The third recommendation is based on verbal persuasion, whereby interventions would involve having respected healthcare professionals offer encouragement, reassurance, and praise regarding physical activity participation. Different signicant others specic to people with brain injuries (e.g., family, friends, caregivers) could be informed about the benets of participation and encouraged to offer support. Individuals could also focus on restructuring their self-talk from negative to positive statements to improve their own verbal persuasion. The nal guideline suggests that the environment should induce a relaxed but upbeat mood. Practitioners could inform an individual about activities to be completed as well as how the body will respond to physical activity (e.g., increased heart rate, sweating, muscular soreness). This should reduce anxiety about being physically active (Lox et al., 2003). If each of these recommendations is followed, an individuals efcacious beliefs will increase during initiation to the program. As one progresses through the program (behavior), belief in ability will continue to grow (cognitions) and one will feel more enjoyment and less anxiety (affect) about being physically active. Each of these factors will then have a reciprocal inuence on the individuals feelings of efcacy, as indicated by the bi-directional arrows in Figure 1. Although Harters (1987) model has not been used as a framework for devising interventions within a physical activity setting, strategies to enhance self-worth and perceived competence exist. These strategies target the different antecedents of motivation within Harters model. For example, Weiss (1991) recommends that interventions should be based on facilitating mastery experiences and increasing social support and positive affective experiences. Mastery experiences are likely to occur when individuals are presented with optimal challenges and will result in increased perceptions of competence. Thus activities should be difcult, but attainable, and customized to the individuals skill level. Another means of enhancing perceptions of competence would be to have individuals judge their performance using a self-referenced form of assessment. For example, in a physical activity program, individuals can be encouraged to assess progress in terms of their own ability instead of comparing their performance to that of other people. This is especially applicable to people with brain injuries, where the injury is highly individualized, and generalization across the population is difcult (Driver et al., 2003, 2003).

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Consequently, exercise goals, equipment, and activities should be specic to the individual, and feedback should be given after desirable performances and errors to facilitate mastery and enhance perceptions of competence. The second strategy involves increasing social support, which has considerable overlap with several of the interventions discussed within the self-efcacy framework due to the similarities in the denition of social support and verbal persuasion. For example, Weiss (1991) suggests that social support can be increased through the use of a similar model (modeling) as well as increased positive reinforcement or support (verbal persuasion). Thus, workout partners, group physical activity classes, and positive support from signicant others are all potential interventions. The third strategy involves maximizing positive affect, which can be achieved by creating a fun and enjoyable environment as well ensuring individuals are setting achievement-oriented goals. For example, physical activity classes could involve group sessions or a buddy system with an instructor who was available to provide positive emotional support. During these sessions, individuals will also be working toward achieving their own goals rather than comparing performance with other members of the group (He did 15 repetitions, so must I). If each of these recommendations is followed then an individuals perceived social support and competence would be increased, thus positively inuencing self-worth. In turn, increased self-worth would result in feelings of happiness, pride, and satisfaction (affect), which will encourage persons with brain injuries to seek optimal challenges, exert greater effort, and persist over time (greater motivation).

Conclusion
In conclusion, research has shown that both theories are suitable frameworks for understanding and explaining the physical activity behaviors of people without disabilities. It is also apparent that each theory has potential as a theoretical framework to examine the physical activity behaviors of people with brain injuries. If successful physical activity programs are to be developed that facilitate participation and increase adherence, then it is important that specialists create an environment that enhances belief in ability (e.g., perceived competence/self-worth/self-efcacy), social support, and positive affective feelings. Due to the important physical and psychosocial benets that accompany physical activity participation, it is essential that adapted physical activity researchers adopt theoretical frameworks to better understand the hows and whys of physical activity participation and to evaluate rehabilitation activity program approaches and outcomes among individuals with brain injuries. It is also essential that researchers use measures that are valid and reliable for people with brain injuries (Driver, 2006).

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