**3. Shifting the educational approach**

Promoting participation in PA and exercise entails acquired perceptions of the body and already created associations between the body and the mind in relation

to personal attitudes, beliefs and appreciations from previous attempts to become physically active [30]. During this process, various implicit and explicit mechanisms are underway creating a unique response for the individual.

Using modern psychoanalytic views of unconscious processes representing wishful, fearful, and associated notions, Bendor [31] examined the main reasons behind exercise avoidance resulting in physical inactivity in modern society. Based on the views of practicing psychoanalysts, his results supported that exercise avoidance comes as a product of fear of identity change, learned disregard of own body, and repressed traumatic associations to exercise. Bendor's findings highlight the importance of unconscious processes over exercise adoption [29] in various populations in need and clearly call for the adaption of new exercise promotion and education methods [22, 28].

When it comes to exercise adoption, negative sentiments, fear and/or unconscious processes have been uncovered in coronary heart patients populations [32, 33], and community-dwelling osteoporotic older adults [34]. On the contrary, enjoyment and positive feelings are reported by young adult populations who actively participate in exercise behaviours [35] with positive feelings of valence and calmness supporting exercise participation in real life samples of healthy adults [36].

At the same time, very often messages calling for changing health behaviours (i.e. eating patterns, physical activity, smoking cessation) are based on appeals to personal responsibility, stigmatisation, controlling and inequality, that are ubiquitous around us [37]. This type of messages imply that illness or disable states are based on lack of responsibility, leading to blames of accusation to the sufferer (i.e. weak character) rather than social (lack of financial ability), environmental (i.e. relevant pollutants) or structural (i.e. disadvantaged working conditions) causes, contributing to the creation of stigma, fear and guilt [38]. The same type of messages are still making the most out of the exercise promotion campaigns aiming to change intentions and attitudes towards more active lifestyles based on cure and well-being rather than pleasures experienced during exercise [39].

Yet, it is not clear that those messages are capable of creating real change contributing to more active lifestyles [21]. Prioritising health over other behaviours by creating guilt and pointing out an inconsistency between personal standards and own behaviour having the goal of remorse and pointing out personal responsibility [40], seems to be successful in shifting health attitudes [41]. However, those changes are only related to initial stages of behavioural change, influencing attitudes and intentions to act towards more health-related behaviours, with their long-term effects still unexplored [40].

Criticism has been expressed in the past around the ways physical activity and exercise related concepts and resources have been conveyed to the general public in a non-understandable manner contributing to confusion as health related resources are not matching the recommended readability standards of the general public [42]. Same results were obtained from Thomas and Cardinal [43], showing that most of written PA educational resources are presented in a complicated and non-understandable format for the great majority of the American population. When it comes to PA and exercise literacy there seems to be an existing gap between what experts consider important to provide and the type of information required for the general public to change, becoming more physically active.

#### **4. The importance of health literacy**

Lack of knowledge of critical features that generate a health condition and low skills in obtaining, processing, understanding, and communicating health-related

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

information are critical components for supporting health [44]. Hence, opportunities for health-related educational sessions are important for improving health status in various population segments.

Health Literacy (HL) is related to the capacities of people to appreciate, realise, and meet the complex demands of health in modern society and its requirements. In their seminal article, Sørensen, Van den Broucke, Fullam et al. [45] defined HL as "entailing people's knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course" (p. 3). Health literate individuals are in position to contextualise and appreciate personal needs supporting their health, their close ones and their community, understanding the most influential factors for retaining wellbeing and taking steps towards meeting those. It is about taking control and responsibility of one's own health as well as the health of their loved ones and their community [46].

It can be easily confused with academic literacy and the notion of well-educated approach and familiarity with literature. However, during the second half of the 20th century the combination of literacy to health has been expanding denoting not just the potential of personal growth and individual transformation as a result of such procedure but also the contextual and social transformation with its capacity to influence economic growth, and social, political and cultural changes [47].

Four distinct abilities are being assigned to HL. These are, a. the ability to seeking, accessing and obtaining health information, b. the ability to comprehend health information that is accessed, c. the ability to interpret filter and evaluate health information and d. the ability to make a decision to maintain and improve health through conscious decision making [45]. These four types of ability highlight the importance of availability of needed resources, and the opportunity to appreciate connections among behavioural choices and health outcomes [48].

The need for HL supports recent models of health care reinforcing the importance of education and best practices starting from a micro level (self-care or else person-centred) which are based on 7 pillars of health promotion: 1. knowledge and health literacy, 2. mental well-being, self-awareness and agency, 3. physical activity, 4.healthy eating, 5. risk avoidance, 6. good hygiene, and 7. rational use of products and services [49]. One of these pillars having extended effects on quality of life, physical and mental health, reduction of premature mortality and avoidance of morbidity is regular participation in physical activity (PA) behaviours [50].

A perspective of the Rogerian proposal of HL is based on the view that a successful health education procedure needs to be mutli-dimensional, personcentred and based on a partnership between the eager professional to train and educate and the individual willing to act based on available resources while placing health as a priority [51]. An explanation of this standpoint defines that, "health education is a continuous, dynamic, complex and planned teaching-learning process throughout the lifespan and in different settings that is implemented through an equitable and negotiated client and health professional 'partnership' to facilitate and empower the person to promote/initiate lifestyle-related behavioural changes that promote positive health status outcomes" [51], (p. 133). This view suggests that boundaries and choices in each health promotion relationship are well-placed within each individual deciding the point the affiliation with the educator begins and ends, with related partnerships based on mutual responsibility, collaboration, freedom of choice, equity and autonomy [52]. When health education is lacking the above elements, is likely to fail to recognise and integrate the recipients' preferences and requests risking being ineffective in the short or long term [53].
