Abstract
The desire to promote exercise-related behavioral change in physiotherapy and rehabilitation settings has accompanied healthcare professionals for some time. However, although it has been emphasized in several position statements and guidelines that promoting exercise-related behavior change is a fundamental goal in rehabilitation [1, 2], research in this area has shown how unsuccessful current practices have been in modifying and sustaining behavior toward physical activity [[3]]. Thus, the challenge of changing health behaviors continues to persist and represents a significant outcome target to be achieved by healthcare in our society today [[4]].
In recent years, many behavior/motivational theories to promote exercise maintenance have been applied in physiotherapy and rehabilitation, emphasizing strategies to increase awareness, support psychological needs, and build a sense of self-efficacy, self-worth, et cetera. Furthermore, those strategies can affect individuals' perception of congruence, such as experiencing immediate affective outcomes (e.g., enjoyment) and favoring the behavior change process [[5]]. However, these theories alone seem not to change the heavily utilitarian and instrumental approaches of most rehabilitation settings, in which the nature of the protocol (e.g., the type of exercise) can marginalize the individual [[6]]. Thus, a "unifying" theory of physical activity that elevates the discussion regarding behavior change to the fact that individuals are active, experience-oriented organisms is something to bring a paradigm change.
The Unifying Theory of Physical Activity (UTPA), published by Matias and Piggin [[6]] is a theoretical model that emphasises the importance of understanding physical activity beyond its traditional health benefits. It views physical activity as a fundamental part of human existence. It recognizes four core urges (human essences) that motivate human movement: the urge to feel, explore, transform, and connect. The UTPA model argues that the proposed physical exercises should consider a unified sense of existence and meanings that inform an embodied life, such as exploration, learning, harmony, and community, for patients continue to require basic human needs when being treated. In the context of physiotherapy and rehabilitation, UTPA offers a promising approach to managing patients. Health professionals can use the UTPA to understand what motivates their patients to be physically active and design interventions to support these urges (patients' inner essences) [[6]].
The urge to feel encompasses movement's emotional and sensory experiences. Therefore, health professionals can design interventions that promote positive emotional experiences and incorporate sensory elements to enhance patient engagement. For instance, guiding patients to work together to overcome an exercise challenge or considering a storytelling protocol may bring some joy [[6]].
The urge to explore is critical, reflecting the human desire to cross known and unknown boundaries. Health professionals can encourage patients to explore different forms of exercise and challenge themselves to try new things (bringing some adventure). It can be done by offering various exercise options and encouraging patients to find physical activities that align with their interests and values [[6]].
The urge to transform allows patients to create and recreate themselves physically, mentally, and emotionally. Therefore, health professionals can design interventions focusing on internal and external transformation, such as strength and conditioning exercises, mindfulness practices, and a high degree of learning [[6]].
Lastly, the urge to connect is an essential component of the human movement that promotes a sense of belonging and connection with others, the environment, and the self. Health professionals can design interventions that foster social relationships and encourage physical activity in group settings. Additionally, outdoor and nature-based physical activity can enhance the connection between individuals and the environment. Allowing patients to express their culture and values is also a form of fostering connection [[6]].
In conclusion, UTPA offers a holistic perspective on physical activity and its importance in human existence. In physiotherapy and rehabilitation, the UTPA provides health professionals the groundwork to facilitate the behavior change process by changing how they approach exercise choices. Physiotherapy and rehabilitation services successfully educates patients, but education alone does not put patients halfway to change. Thus, rather than adding strategies alone, health professionals can change how they approach exercise interventions to help patients achieve their physical, mental, and emotional health goals while promoting a more profound sense of purpose and meaning in their lives. The proposed question from the Theory's authors is a worthy end to this essay: "Does my intervention allow people to be authentic." (Matias and Piggin, p. 19) [[6]].
Ethical approval
Not applicable.
Conflicts of interest
None declared.