**2. Recent theories of physical activity and exercise**

Within the top priority of behaviours able to counteract CID are regularly practiced physical activity and exercise. Even though exercise promotion has been at the focus of various organisations for more than thirty years [6], physical inactivity (PI) and sedentary behaviours (SB) are abundant in modern societies. It is estimated that they are the fourth contributing factor to global mortality [7, 8], causing -among other conditions- major modifiable cardiovascular diseases [9], diabetes [10], cancer [11], mental disorders [12], and specific illnesses such as Ischemic Heart Disease [13].

Further, PI and SB are currently considered among the most important modifiable factors for the prevention of cardiovascular conditions and other non-communicative conditions that contribute significantly to all-cause mortality in the global population [14]. It is estimated that 50 to 60% of selected cardiovascular conditions are currently attributed to PI [13], with the World Health Organisation (WHO) making the prevention of PI one of its key goals for reducing Noncommunicative diseases [15].

The current definition of PA is supportive of more than just the mere bodily movement that is produced by the contraction of skeletal muscles and the increases of energy expenditures resulting in significant health benefits. It is defined also by the psychological, social, political and situational phenomena related to the execution of physical movements and supporting a holistic definition of PA: "Physical activity involves people moving, acting and performing within culturally specific spaces and contexts, and influenced by a unique array of interests, emotions, ideas, instructions and relationships." (p. 5) [16]. It is important to note that when an individual is deciding to move, is far more than a travelling set of muscles, joints and energy expenditure repositioning in space, but rather a unique collection of emotions, interests, ideas, instructions, and relationships. Given the importance of regular engagement with PA for sustaining a good quality of life and maintenance of physical and mental health [17] such definition highlights novel suggestions and approaches for PA promotion and enhancement (see below).

Any PA that is planned, structured, repetitive and purposeful to increase physical fitness or its components is related to exercise behaviours [18]. Incorporating daily exercise programs in one's lifestyle is associated to reduced risks of morbidity and mortality across the lifespan [19]. Also, when exercise is part of therapeutic treatment of chronic conditions, contributes to better quality of life and prolonged duration of life [20].

Existing theoretical models are supporting a systematic approach towards the promotion of PA and exercise behaviours. In an attempt to create a better sense of those theories, their proposals and their applications, Rhodes [21] created the Multi-Process Action Control (M-PAC) Model with each theory placed at either, the reflective process (or else the intention formation phase), the regulation process (the adoption phase), or the reflexive process (the maintenance phase of exercise behaviour). Each of those phases is proposed to include separate stages of the exercise adoption, as social-cognitive theoretical applications are proposed to create an intention to become more physically active by enhancing the long-term utility of exercising, the expectation of positive emotional states during physical activity, the perception of physical and mental abilities to perform the requested exercise behaviours, and the environmental opportunity (i.e. time allocation) to perform physically active behaviours [21]. In the adoption phase, more behavioural methods are expected to create a change via techniques related to goal setting, positive

#### *Design Thinking Applications in Physical Activity and Exercise Literacy DOI: http://dx.doi.org/10.5772/intechopen.97479*

feedback, relevant environmental cues, and self-talk. Finally, in the reflexive phase, associations, repetition and maintenance of environmental cues are expected to create long-lived habits contributing to a more active identity type [21, 22].

Two main validation pathways can link to the M-PAC Model. The first one, is its ability to confirm already proposed components of the Behavioural Change Techniques (BCT) taxonomy [23], which is considered a comprehensive, hierarchical, reliable and generalizable catalogue of methods [24]. Michie et al. [23] created a catalogue of 16 separate clusters precising behaviour change interventions helping to sort out for the first time their active intervention ingredients based on interrater agreement. This catalogue provided a clearly defined set of active intervention types, which is considered complete until recently [25].

A second validation of the Rhodes [21] model was offered by the authors of the Health Action Process Approach (HAPA) [26]. Based on the HAPA model three levels of self-efficacy (SE) are needed to support behavioural change of PA and exercise behaviour: Action SE, linked to the creation of intention and preparation to engage to more active behaviours through the anticipation of positive outcomes, Maintenance SE, associated to behavioural techniques enhancing behavioural persistence and motivation over the needed behaviour change, and Recovery SE, reflected by the ability to resume behaviour after relapse and interruption. Both M-PAC and HAPA models support same stages and constructs denoting similar processes and corresponding to needed actions for optimal behavioural change.

Another important set of theories holding an ability to promote increased levels of PA and exercise behaviours are the dual-process frameworks [22]. They are models consisting on the one hand reflective processes including social-cognitive approach variables (such as intentions, expectations and values), and on the other hand non-conscious processes including other not so well tested PA determinants such as habits, automatic thinking processes and personal effectiveness evaluations [27]. The most recent addition to this type of theories is including also the emotional valence and its importance for future intentions to participate in PA and exercise behaviours (Affective-Reflective Theory, ART) [28]. This occurs through reflective and non-conscious processes based on emotions individuals acquire during their PA and exercise participation. It is a theory that uses previously psychophysiology findings and related theories such as the Dual-Mode Theory (DMT) [29] to suggest a varying core affect as a product of different sets of intensities during PA and exercise participation based on innate psychophysiology mechanisms (see [28], for details). ART enhances the motivational importance of affect in relation to exercise behaviour, and most importantly how exercise and the affective experiences they produce are encoded in associative memory (i.e. physical pain vs. pleasure when exercising) and the way such associations are gradually integrated into cognitive processes that could support regular exercise participation [28]. According to Rhodes et al. [22], the case of conflict between non-conscious (affective) and reflective (cognitive) influences, lead individuals to experience affectively charged motivational states "such as craving, desire or dread" (p.104). Even though there are points of skepticism around measurement of non-conscious processes and how those can alter via educational processes, the dual-process models like the ART theory hold important potential for the future as they are the first to challenge the significance of attitudes and self-efficacy for the change of PA behaviours [22].
