Table 1.
Definition and operationalization of maintenance according to behavioral theories.
| Behavioral theory/conceptualization | Definition and/or reference to maintenance |
|---|---|
| Social cognitive approaches | |
| Physical activity maintenance model (Nigg et al., 2008) |
No explicit definition of maintenance. Long-term maintenance is described as an active process requiring active utilization of strategies and techniques for continued adherence to physical activity. |
| Theory of planned behavior (Ajzen, 1985, 1991) | No explicit definition of maintenance or delineation between the initiation of behavior and maintenance of behavior. Successful performance of a behavior - sustained or otherwise - is a direct function of the intention to perform said behavior. |
| Protection motivation theory (Rogers, 1975; Maddux and Rogers, 1983) | No explicit definition of maintenance or delineation between the initiation of behavior and maintenance of behavior. The initiation and maintenance of a behavior (i.e., an “avoidant response” to fear) is achieved through strong intention(s) to adopt/sustain the behavior. |
| Social cognitive theory (Bandura, 1986, 2004) | No explicit definition of maintenance or delineation between the initiation of behavior and maintenance of behavior. Reference to the temporal significance of some constructs (e.g., knowledge creates the “pre-condition” for behavior change). |
| Stage models | |
| Transtheoretical model (TTM; Marcus and Simkin, 1994; Prochaska and Velicer, 1997; Marshall and Biddle, 2001) | Maintenance is described as “the stage in which people are working to prevent relapse but they do not apply change processes as frequently as do people in action” (Prochaska and Velicer, 1997). This stage is expected to occur at approximately 6 months post- action phase, and last up to 5 years. Behavior change occurs (or is discontinued/relapsed) through a series of sequential stages. These stages are: (1) precontemplation; (2) contemplation; (3) preparation; (4) action; and (5) maintenance. Within the TTM, succession from one stage to the next requires targeting certain processes of change specific to that stage. No processes of change are described specific to sustaining maintenance of behavior. |
| The four phases of the behavior change process (Rothman et al., 2011) | Maintenance of behavior is characterized by the desire and sustained effort to continue a newly established pattern of behavior. Transition into the maintenance phase is marked by consistent performance of the desired behavior and complete confidence in one's ability to perform the behavior. Similarly, the shift from concerns with performing the behavior to evaluation of satisfaction with the new behavior marks the transition from this phase into habit. |
| Humanistic approaches | |
| Self-determination theory (SDT; Deci and Ryan, 2000; Ryan et al., 2008) |
No explicit definition of maintenance or delineation between the initiation of behavior and maintenance of behavior. The constructs that aid individuals in acquiring the motivation to initiate a behavior (i.e., autonomy, competence, social relatedness) are thought to extend to the maintenance of the behavior by contributing to the process of internalization and integration. Specifically, increased internalization and integration results in a shift from the controlled motivations of behavior initiation (e.g., external regulation) to more autonomous (i.e., intrinsic) motivations expected from sustained behavior. |
| Dual-process approaches | |
| The physical activity adoption and maintenance model (PAAM; Strobach et al., 2020) |
No explicit definition of maintenance. The model focuses less on an isolated modeling of adoption and maintenance of physical activity, in favor of physical activity behavior as a product of implicit and explicit processes. Behavior development over time is thought to increasingly rely on implicit processes (e.g., habit, affect) for behavior regulation, coupled with a reciprocal decrease in reliance on explicit processes (e.g., executive functions, trait self-regulations). |
| The affective-reflective theory of physical inactivity and exercise (Brand and Ekkekakis, 2018) | No explicit definition of maintenance or delineation between the initiation of behavior and maintenance of behavior. |
| Theory of energetic cost minimization (Cheval et al., 2018; Brand and Cheval, 2019) | No explicit definition of maintenance or delineation between the initiation of behavior and maintenance of behavior. |
| 2 × 2 Matrix (Rothman et al., 2009) | The transition from behavioral initiation to behavioral maintenance is marked, in part, by a shift in decisional criteria from “what will happen” (e.g., outcome expectancies) to “what has happened” (e.g., satisfaction with outcomes). |
| Affect and health behavior framework (Williams and Evans, 2014) | No explicit definition of maintenance. Rather, both behavioral intention and maintenance are affected by automatic and reflective affective constructs. Successful repeated performances of a health behavior that elicit a positive affective response promote future behavioral performance through improving automatic affective associations and anticipated affective response(s) to the health behavior. |
| Maintain IT model (Caldwell et al., 2018) | Behavioral maintenance involves a diminished reliance upon the executive function resources involved in behavioral enactment as a result of the emergence of identities related to the behavior that facilitate swift and less effortful enactment (i.e., centered identity transformation). |
| Action control models | |
| Health action process approach (HAPA; Schwarzer, 2008; Schwarzer and Luszczynska, 2008) | No explicit definition of maintenance, but post-intentional constructs (i.e., action planning, coping planning, maintenance self-efficacy, recovery self-efficacy) are thought to be stronger amongst individuals who maintain behavior, compared to those who have only initiated a behavior. |
| Multi-Process action control approach (M-PAC; Rhodes, 2017) | No explicit definition of maintenance. Rather, maintenance is described as a result of the development of identity and habit (known as reflexive processes) and their subsequent determination of behavior over time. |
| The MoVo process model (Fuchs et al., 2012) | No explicit definition of maintenance or delineation between the initiation of behavior and maintenance of behavior. Rather, goal intention, along with volitional (i.e., post-intentional) constructs like action planning and barrier management are expected to be higher among individuals who can successfully maintain their behavior, compared to those who have only initiated physical activity. |
| Socioecological frameworks | |
| The Ecological Model of Physical Activity (Spence and Lee, 2003) | No explicit definition of maintenance or delineation between the initiation of behavior and maintenance of behavior. Rather, physical activity behavior in general is thought to be influenced by both psychological factors (e.g., attitudes, self-efficacy) and a cascading series of four ecosystems (i.e., microsystem, mesosystem, exosystem, and macrosystem), each of which encompass dimensions from increasingly distal social and physical environments to the individual. |
| Other schematics | |
| Timescale separated model (Spruijt-Metz et al., 2015) | No explicit definition of maintenance or delineation between the initiation of behavior and maintenance of behavior. Rather, long-term physical activity constructs (e.g., self-identity as an exercise, context-contingent habits) are thought to be influenced and shaped by the accrual of repeated short-term physical activity successes (e.g., meeting daily MVPA goals, daily/weekly exercise self-efficacy, momentary cues to action). |
| Lapse-recovery relationship (Kahlert, 2015) | Maintenance of physical activity is demarked by consistent “recoveries” from “lapses” of the “personal goal” of the individual, as well as a decline in the number of lapses over time. Specifically, the lapse-recovery approach views lapses and recoveries from achieving personal goals as indicators of physical activity maintenance. Demonstration of multiple lapses of personal goals without accompanying recovery may indicate that an individual is not yet maintaining physical activity, independent of time or prior behavior. |
| Successful maintenance of physical activity vs. maintenance of physical activity change (Marcus et al., 2000) | Successful physical activity maintenance is based on physical activity behavior, and distinct from successful maintenance of physical activity behavior change. Specifically, individuals who engage in physical activity at least 6 months post-intervention would have successfully maintained their physical activity change. By contrast, sedentary individuals who increase and perform regular physical activity for at least 6 months are considered to have successfully maintained their physical activity. |