Adoption of Change: A Systematic Review of the Transtheoretical Model

*Corresponding author: Caitlin Vela and Catherine Ortega*

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systematic review



Sedentary lifestyle is a risk factor for life-altering comorbidities. Though the World Health Organization (WHO) and the Centers for Disease Control (CDC) have provided guidelines, 80% of Americans do not get the recommended physical activity (PA) dose per day. Motivation continues to be an important and elusive factor to effect change.


Assess the available evidence regarding the application of the transtheoretical model and stages of change theory (TTM-SOC) in the last 10-years to behavior changes for PA.


Databases including PSYCInfo, ERIC, CINAHL, EBM, DARE, and OVID, were searched with the following key search terms: “Lifestyle Changes” OR “Lifestyle” OR “Active Living” OR “Lifestyle Changes” OR “Physical Activity” OR “Actigraphy” OR “Exercise” OR “Activity Level” AND “Transtheoretical Model” OR “Stages of Change”. Seventy-nine studies fit the inclusion criteria and were assessed for quality and validity using the PEDrO scale for experimental studies and the specialist unit for review evidence (SURE) for cohort investigations.


Of the five (5) interventional studies included, none used all four components of the TTM-SOC, namely, stages of change, decisional balance, processes of change and self-efficacy. Observational studies were assessed with eleven (11) classified as observational analytical and nineteen (19) as observational descriptive.


None of the investigations assessed the full TTM-SOC. As such, there can be no definitive conclusions with regard to the effectiveness of stage-matched interventions to promote a change from sedentary lifestyle to adoption of PA. There is a need for more rigorous research to test the application of TTM-SOC with both physiologic and quantitative measures for PA.


Systematic review; Transtheoretical model; Stage of change; Physical activity.