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Perceived Barriers to Excercise and Weight Control Practices in Community Women a
b
Cheryl A. Johnson PhD , Sheila A. Corrigan , Patricia M. c
Dubbert & Sandra E. Gramling PhD
d
a
Assistant Professors, The Department of Psychiatry, University of Mississippi b
Assistant Professors, Department of Psychiatry, University of Mississippi c
Associate Professor, Jackson Veterans Affairs Medical Center, University of Mississippi d
Assistant Professor, Department of Psychology, Virginia Commonwealth University Published online: 26 Oct 2008.
To cite this article: Cheryl A. Johnson PhD , Sheila A. Corrigan , Patricia M. Dubbert & Sandra E. Gramling PhD (1990) Perceived Barriers to Excercise and Weight Control Practices in Community Women, Women & Health, 16:3-4, 177-191, DOI: 10.1300/J013v16n03_10 To link to this article: http://dx.doi.org/10.1300/J013v16n03_10
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Perceived Barriers to Exercise and Weight Control Practices in Community Women Cheryl A. Johnson, PhD Sheila A. Corrigan, PhD Patricia M. Dubbert, PhD Sandra E. Gramling, PhD
ABSTRACT. A sample of community women was surveyed to determine exercise habits, weight control methods, and perceived barriers to sustaining and initiating exercise and weight management pro rams. Lack of time was reported to be the most significant factor &rniting exercise, while lack of willpower and time constraints were the most frequently reported obstacles to weight management. Suggestions to aid adherence to exercise and werght control programs among women are outlined.
Few laypersons or health care professionals would deny the salubrious effects of regular exercise and weight maintenance. Despite the "fitness boom," surveys show that few Americans are active enough to achieve the benefits of exercise (Stephens, 1987). A number of studies indicate that the majority of those who begin exercise programs do not exercise long enough to attain their health and fitness goals (Martin & Dubbert, 1982a). Cheryl A. Johnson and Sheila A. Corrigan are Assistant Professors, the Department of Psychiatry and Human Behavior, University of Mississippi School of Medicine, 2500 North Slate St., Jackson, MS 39216. Patricia M. Dubbert is Associate Professor, Jackson Veterans Affairs Medical Center and the University of Mississippi School of Medicine. Sandra E. Gramling is Assistant Professor, Department of Psychology, Virginia Commonwealth University, Richmond, VA. Women & Health, Vol. 16(3/4)1990 O 1990 by The Haworth Press, Inc. All rights resewed. 177
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Surveys of health practices in the U.S. have consistently found differences between groups defined by sex, racelethnicity, and socioeconomic factors. Results from the National Health Interview Survey (Schoenborn, 1986), for example, showed that males were more likely to exercise, but also more likely to drink and smoke. Compared with white females, black females were more likely to be greater than 20% overweight, despite the lack of differences in rates of physical activity (Belloc & Breslow, 1972; Belloc & Enstrom, 1980). In other studies, education (Cockerham, Lueschen, Kunz, & Spaeth, 1986; Gottleib & Baker, 1986) and income (Gottleib & Baker, 1986) were found to be positively associated with regular exercise and sports involvement. Studies have also shown that women are much more likely to be diagnosed with eating disorders associated with dieting (Halmi, Falk, & Schwartz, 1981; Hsu, 1989; Striegel-Moore, Silberstein, & Rodin, 1986). In a survey of college students, Corrigan, Mangialetti, and Evans (1984) found that men reported they exercised in order to lose weight, while women reported they decreased their caloric intake to achieve the same end. Although women's lower rates of exercise and their efforts to maintain their weights have been documented, few studies have addressed perceived barriers to and dieting practices for community women or subgroups of women defined by age, racelethnicity, and employment status. Iverson, Fielding, Crow and Christensen (1985) observed that male and female Canadian adults reported that the major barriers to regular exercise were lack of time and laziness. Siegel, Johnson, and Newhof (1988) found that college women who continued in an exercise program reported that participation in the program was more socially rewarding, recreational, and conducive to skill development relative to those who dropped out of the program. The perceived health and fitness benefits of exercise were not different for the two groups. Several barriers to initiating and sustaining an exercise program have been summarized (Dishman, Sallis, & Orenstein, 1985; Martin & Dubbert, 1982a). Factors related to dropping out of exercise programs include: lack of time due to family, work, and social obligations; low personal motivation; limited spouse and family support; inconvenient exercise facilities; high intensity exercise; obe-
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sity, and smoking. Sechrist, Walker, and Pender (1987) developed an exercise benefits and barriers scale in which they statistically identified four factors which represent barriers to exercise: Exercise Milieu, Time Expenditure, Physical Exertion, and Family Encouragement. While these factors appear similar to those summarized by Martin and Dubbert (1982a), Sechrist et al. (1987) do not address the relationship of these factors to actual exercise behaviors. Health care professionals have minimal information regarding the barriers to and incentives for changing exercise and dietary habits in women. Exercise and diet practices in minority women need to'be explored further, as minority women may experience additional problems related to socioeconomic disadvantages and are at a greater risk of developing chronic disorders such as hypertension and cardiovascular diseases (Lin-Fu, 1987). Given the increasing numbers of women in the work force, many with young children, it is important to determine the reasons why women are not engaging in healthy exercise and weight control practices. These reasons may be largely due to demands for their time, as opposed to dislike of physical activity, health problems, or perceived financial barriers. The present study was intended to examine women's perceptions of the major barriers to their own exercise participation. This study was designed to address the following questions: (1) What percent of women report engaging in regular exercise? (2) What kinds of exercise are preferred? (3) Among women who desire to increase their physical activity level, what are the perceived barriers to increased activity? (4) Are there difference~in subgroups of women defined by race, age, and employment status in exercise practices and perceived barriers to increasing exercise? (5) What are the preferred weight control strategies reported by women? ( 6 ) What are the perceived barriers to weight control? METHOD
A 25-item paper and pencil' survey (available upon request) was developed by the authors to assess exercise and diet practices and perceived barriers to exercise and diet behaviors. Items were selected based on factors which most frequently appeared in the avail-
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able literature as related to adherence to diet and exercise programs (cf. Dishman et al., 1985; Martin & Dubbert, 1982a). The survey was administered in two shopping malls in a medium sized southeastern city (population of metropolitan area = 403,000). One mall was located in a predominantly black, working-class neighborhood and the other in a white, middle-class area. The sampling period was four weekends (Saturday and Sunday) in the spring. Potential participants were approached by white female investigators who followed a standardized script inviting participants to complete the survey anonymously. Participants completed the survey in 5 to 10 minutes. A total of 300 surveys were distributed, approximately 150 in each setting. Over 250 surveys were returned, of which 226 (75%) contained sufficient responses to the demographic and the exercise and diet information to be included in the analyses. Data Analysis
The primary concern of this investigation was to examine the prevalence of exercise and diet habits, as well as the perceived barriers to these behaviors. Descriptive statistics are presented to this end. Chi-square analyses were employed to examine differences in exercise and diet habits between subgroups of women based on age, race, and employment status. Due to the number of chi-square analyses conducted, an alpha of .O1 was adopted for significance.
RESULTS
Survey Participants Participants ranged in age from 18 to 72 years (M = 32.5, SD = 10.8) with approximately 80%under 40 years of age. Women were categorized according to age, less than 40 years and older than 40 years. The racial composition of the sample, 48% black, 52% white, reflected the goal of recruiting equal numbers of black and white participants. With regard to marital status, 46.5% were currently married, 36.3% single and 17.2%were divorced, separated or widowed. The respondents' occupations were classified according to the Hollingshead occupational categories (Hollingshead & Redlich, 1957) into professional and managerial (34.8%), clerical
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and service (36%) and housewives, students, and unemployed (28.1%). According to self-reported height and weight, body mass indices (kglm2) ranged from 16.3 to 42.06 (M = 24.07, SD = 4.66). Thirty-five percent of the sample were greater than 20% overweight and 49.2% were within 10% of their ideal weight (Metropolitan Life Insurance Company, 1977). Consistent with previous reports (Calloway, 1987; Schoenborn, 1986), black women were more likely to be greater than 20% overweight than white women, X 2(1, N = 223) = 19.73, p < .001. As expected, significantly more black participants were surveyed from the mall in the black, working-class neighborhood and significantly more white participants were surveyed from the white, middle-class neighborhood mall, X 2(1, N = 226) = 107.60,~< ,001. No significant differences were apparent between the two locations with regard to age or occupation. Survey responses from the two locations were combined for all analyses. The present sample reflects the racial composition of the larger community (46% black, 53% white and 1% other; US Department of Commerce, Bureau of Census, 1980). However, the number of professional and managerial women in our sample is greater than that of the community (34.8% vs. 15%) and the present sample underrepresents the number of women who are employed in service and clerical positions (36% vs. 48%). In addition, the present sample is comprised of 80% of women under age 40. Although, the present sample does not represent the demographics of the larger community from which it was drawn, based on 1980 census information, the goal of the investigation was to sample an equivalent number of black and white women. Q p e s and Frequency of Exercise
In response to the question "Do you currently engage in a regular exercise program?," 37.2% (84) answered in the affirmative. There were no differencesbetween the subgroups of women, blackjwhite, workinghon-working, or younger/older, in the percent who reported regular exercise. Of the 142 non-exercisers, 105 (73%) indicated a desire to begin a regular exercise program. Thus, 189
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(83.6%) of the 226 respondents either were exercising or expressed the desire to do so. The most common type of exercise reported was walking (4l.6%), followed by aerobics (36.4%), racquet sports (11.7%), and jogging (10.4%). Forty percent of regular exercisers reported exercising an average of 2 to 3 hours per week and 18.7% exercised 1 to 2 hours weekly; however, 15% of the "regular exercisers" reported less than 60 minutes of exercise per week.
Perceptions of Personal Fitness and Need for Exercise Participants' responses to questions regarding perceptions of their health status and the importance of regular exercise indicated that 13.9% felt that they were in "good shape," 69.6% perceived themselves to be in adequate physical condition, and only 16.1% thought they were in less than adequate condition. While only 37.2% reported engaging in a regular exercise program, 84% of the respondents felt they were in at least adequate physical condition. To the question "Do you believe that engaging in a regular exercise program is important to an individual's health?," less than 3% felt it was not very important, 23.6% endorsed moderately important and 74% indicated it was very important. Participants' responses to how important regular exercise was to their own overall health status were similar. Regarding enjoyment of exercise and physical activity, the large majority of respondents (94%) indicated they at least moderately enjoyed physical activity. Only 4.3% rated it as not very enjoyable. Given the participants' stated enjoyment of exercise, perceptions of its importance for physical health, and the desire to engage in a regular exercise program, factors which impede exercise would seem to be very important to explore.
Barriers to Exercise Respondents were provided with a list of barriers to exercise and instructed to indicate all those which applied to themselves. There were no significant differences in perceived barriers among women on the basis of race, age, or employment status. Table 1 displays
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Table 1 Percent of Won~enE n d o r s i n g u s h ExercisesgFunctin_n B_ Exercise
2&a.b
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Exercise Status Barrier
Exercise Morea
Like to Start
Work/School
653
59.4
47.1
Household
22.7
17.8
12.6
Stopped ExerciseC
Lack of time due to:
Children
20.0
25.7
17.2
Social
16.0
8.9
103
Lock of nioney
26.6
35.6
6.9
Lack of facilities
19.7
21.8
8.1
Lack of pnrtner
18.7
20.8
12.6
Exercise boring
93
9.9
10.6
Health problenis
6.7
3.9
8.1
Lost interest
N/A
N/A
20.0
responses according to current exercise status. Participants who were currently exercising but wanted to increase their exercise most frequently endorsed lack of time. Many of these participants also endorsed: not enough money, lack of facilities, and lack of exercise partner. Respondents who stated a desire to begin regular exercise endorsed essentially the same barriers with similar frequencies. The responses of participants who were not currently exercisers, but who had exercised in the past were similar to the above groups,
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with lack of time as the mostfrequently endorsed barrier. Additionally,'loss of interest in exercise was endorsed by more than 20% of this group. Finally, 13.3% of our sample reported that they were not currently exercising and did not want to begin an exercise program. Again, the most frequently endorsed reason was related to time (46.7%); other reasons were "don't like to exercise" (33.3%) and "I get enough exercise in my daily routine" (26.7%). In contrast to expectation, occupational status was not differentially related to the endorsement of "lack of money" as a barrier to exercise for those who want to exercise more, those who quit exercising, and those who wish to begin an exercise program.
Current Dieting Practices While 35.7% of the sample was greater than 20% overweight, only 23.3% reported that they were presently on a weight loss or weight maintenance diet. In total, 46% of our sample reported that they had dieted within the past two years. Participants were presented with a number of common weight loss strategies and asked to indicate those strategies which they employed. Cutting back on intake and exercising were endorsed most frequently. Few women endorsed strategies such as laxatives, diet pills, fad diets, and fasting (see Table 2).
Barriers to Dieting Participants were asked to indicate those barriers which they perceived impeded their efforts to lose or maintain weight by dieting. Only those individuals who indicated that they had dieted within the past two years or were currently on a diet responded to these questions. The most frequently endorsed barriers were: "no willpower," "no time for meal planning" and "cooking for family and eating what they eat7' (see Table 3). The relationship between perceived weight status and exercise was explored. Interestingly, those women who perceived thernselves as slightly overweight (N = 97) tended to report regular exercise, as compared to women who perceived themselves as very overweight (N = 50) or within normal limits (N = 77), X 2(4, N =
Johnson et al. Table 2
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Percent of Women E
m Weicht
Method
%
Cut back on intake
743
Exercise
713
Dr. prescribed plan
17.6
Fasting
9.6
Over-the-counter diet pills
6.9
Fad diets
3.7
Laxatives
2.7
Methods
223) = 10.65, p = .03. Furthermore, compared to women who reported dieting at the time of the survey, women who reported that they were not currently dieting were twice as likely to state that they were also not currently exercising (117 nonexercisers vs. 54 exercisers), X 2(1, N = 223) = 11.58, p = .001.
DISCUSSION The results of this surviy suggest that although the large majority of the women reported that they enjoyed exercise and perceived it to be importapt to physical health, relatively few engaged in regular exercise. This observation is consistent with the findings of Siegel et al. (1988), that exercise behavior is not predominantly mediated by health and fitness goals. Lack of time was the most frequently endorsed barrier to initiating and sustaining a regular exercise program. Disinterest in exercise, lack of facilities, lack of money, and lack of partners were much less important than the multiple demands for a woman's time. Importantly, there were no significant
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Barrier
%
No willpower
40.7
Meal planning requires time
'
.
30.6
Cooking for family
30.6
Eat out alot
28.7
High cost of diet foods Eat forbidden foods Don't like diet foods Time required to shop and prepare
15.7
Dieting lends to fatigue
14.8
differences in perceived barriers to diet and exercise programs among women based on age, race, or employment status. Lack of time due to family, social, and work responsibilities has been cited as a barrier to initiating and sustaining exercise programs (Dishman, 1982; Martin & Dubbert, 1982a; Oldridge, 1982). These data suggest that programs to increase women's exercise participation are unlikely to succeed unless they address women's perceptions that they do not have enough time to exercise. This notion is particularly critical for women under age 40, who comprised the majority of our sample. Two basic strategies should be considered. First, time management training may be helpful to some women. Although several studies have demonstrated that various cognitive and behavioral strategies can improve short-term adherence to an exercise program (e.g., Dubbert & Martin, 1988;
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King, Taylor, Haskell, & DeBusk, 1988), to our knowledge none have included a time management component. While King, Winett, and Lovett (1986) did not specifically target exercise behaviors, they found that women who received time-management training reported increasing the number of pleasurable activities in which they engaged. These findings suggest that interventions focusing on scheduling and maintaining time for regular exercise in an already busy week could be an important addition to exercise programs. In time management terms, a regular exercise program would be assigned a high priority. A second strategy is to encourage employers to provide facilities and equipment for improving fitness in the workplace. In our study, lack of time due to work or school was indicated as an impediment to exercise by at least fifty percent of respondents. Providing exercise breaks and eliminating the time required to travel to another facility might decrease the negative influence of work, school, or child care responsibilities. It should be noted that while fitness programs are among the most popular type of worksite health promotion programs, data regarding the efficacy and their associated costs are mixed (Glasgow & Terborg, 1988). While worksite health promotion programs may decrease the impact of lack of time, facilities and money as significant barriers to exercise, further work is needed to maximize the benefits of these programs,.particularly for female employees. . . Another avenue by which to increase exercise and dietary compliance may be to encourage participants to involve significant others or friends in their exercise and diet programs. Evidence is available which suggests that individuals with supportive spouses are more likely to continue in their exercise programs than individuals with spouses who were not supportive of the exercise habit (Martin & Dubbert, 1982b). Further, Heinzelmann and Bagley (1970) found that the majority of exercisers would prefer to exercise with others. In the present study, lack of partner was reported to be a factor for 13% to 21% of respondents. With regard to diet behaviors, data are available suggesting that spouse support and participation in weight loss programs results in improved outcome (Dubbert &Wilson, 1984; Murphy, Williamson, Buxton, Moody, Absher, & Warner, 1982). However, the data are not totally supportive of this
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finding (Black & Lantz, 1984). While a direct measure of social support was not included in our study, social support may be inferred from the barrier "cooking for family." Thirty-one percent of the participants reported that cooking for their families represented a major barrier to their weight control efforts. Sallis, Grossman, Pinski, Patterson, and Nader (1987) developed a measure to assess social support for diet and exercise behaviors. Positive verbal support appears to be important for diet behaviors, while active participation appears to be important for exercise behaviors. Interestingly, social support for diet and exercise behaviors was not related to a measure of general social support. An alternative interpretation of our data is that women lack sufficient motivation to engage in regular exercise. It may be that lack of time was the most convenient and socially desirable response available to our survey participants. Anecdotally, it has been reported that preparation for and clean-up after exercise is seen as an obstacle. In this case, focusing on time management strategies may not be sufficient to increase women's exercise participation. Instead, attention may be directed toward cognitive reformulations of the reasons for exercise. Exercise functions as a social activity, a recreational activity, and a stress management technique, in addition to its more obvious physical health promoting goals. Long and Haney (1988) used exercise and relaxation training as stress-reduction interventions in a group of working women. Both interventions resulted in decreased levels of trait anxiety and increased self-efficacy. Therefore, exercise may be viewed as a stress-management technique, as well as promoting physical health. In support of this view, Siegel et al. (1988), found that women who continued in an exercise program were more likely to view exercise as social and recreational than those women who dropped out. .. The failure to find differential exercise patterns between subgroups of women may be due to limitations of the study methodology. The survey instrument contained only nominal responses, therefore restricting data analyses to nonparametric statistical tests, which have less statistical power than parametric statistical tests. Furthermore, the vast majority of respondents were under age 40, thus limiting our power to detect age differences. However, the equivalent numbers of women in racial and occupational categories
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allowed a more adequate determination of the influence of these variables. The sample studied was not representative of the larger community, but did include approximately equivalent numbers of women in racial and occupational categories. Differences between various subgroups of women defined by age, employment status, and race, in their exercise status, rates of exercise, or barriers to exercise were not evident. Time constraints were reported as significant barriers to exercising and preparing healthy foods for all subgroups of women. The importance of exercise and increased physical activity in a weight loss or weight maintenance program is well documented. Guidelines for weight control programs include both dietary and physical activity prescriptions (Weinsier, Wadden, Ritenbaugh, Harrison, Johnson, & Willmore, 1984). Inclusion of exercise in weight control programs has been found to result in enhanced weight loss (Perri, McAdoo, McAllister, Lauer, & Yancey, 1986), particularly when the exercise has been conducted as an integral part of the program (Craighead & Blum, 1989). Our data show that many women rely upon increased activity and decreased intake to regulate weight. Yet, most women who were attempting to regulate their weight were faced with time constraints that impede their exercise and weight management efforts. It would be important for future research to examine cognitive and environmental factors associated with maintenance of exercise in a sample of community women who are exercising on a regular basis. In addition, it may be fruitful to examine short term and long term exercise adherence problems within the context of a relapse model (Dubbert, Terre, Rowland, & Krug, 1988). Currently, the available data on the efficacy of relapse prevention as part of a multi-component exercise adoption and adherence program is positive (King et al., 1988), and further research is needed. REFERENCES Belloc, N.B., & Breslow, L. (1972). Relationship of physical health status and health practices. Preventive Medicine, 1, 409-421. Belloc, N.B., & Enstrom, J.E. (1980). Persistence of health habits and their relationship to mortality. Preventive Medicine, 9, 469-483. Black, D.R. & Lantz, C.E. (1984). Spouse involvement and a possible long-term follow-up trap in weight loss. Behavior Research and Therapy, 22, 557-562.
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Calloway, C.A. (1987). Women's health: Nutrition, obesity. Public Health Reports, 101, (Supplement), 26:29. Cockerham, W.C., Lueschen, G., Kunz, G., & Spaeth, J.L. (1986). Social stratification and self-management of health. Journal of Health and Social Behavior, 27, 1-14. Corrigan, S.A., Mangialetti, N., & Evans, I.M. (May, 1984). implications of epidemiological data on bulimia for assessment and treatment. Presented at the meeting of the Society of Behavioral Medicine, Philadelphia, PA. Craighead, L.W., & Blum, M.D. (1989). Supervised exercise in behavioral treatment for moderate obesity. Behavior Therapy, 20,49-59. Dishman, R.K. (1982). Complianceladherence in health-related exercise. Health Psychology, 1 , 237-267. Dishman, R.K., Sallis, J.F., & Orenstein, D.R. (1985). The determinants of physical activity and exercise. Public Health Reports, 100, 158-171. Dubbert, P.M., & Martin, J.E. (1988). Exercise. In E.A. Blechman & K.D. Brownell (Eds.), Handbook o/ behavioral medicine for women. New York: Pergamon. Dubbert, P.M., Terre, L., Rowland, A.K., & Krug, L.M. (August, 1988). Cardiovascular risk modification for women: Is exercise a viable intervention?
Paper presented at the meeting of the American Psychological Association, Atlanta, GA. Dubbert, P.M. & Wilson, G.T. (1984). Goal-setting and spouse involvement in the treatment of obesity. Behavior Research and Therapy, 22, 227-242. Glasgow, R.E., & Terborg, J.R. (1988). Occupational health promotion programs to reduce cardiovascular risk. Journal of Comulting and Clinical P J ~ chologv, 56, 365-373. Gottleib, N.H., & Baker, J.A. (1986). The relative influence of health beliefs, parental and peer behaviors and exercise program participation on smoking, alcohol use and physical activity. Social Science and Medicine, 22, 915-927. Halmi, K.A., Falk, J.R., & Schwartz, E. (1981). Binge eating and vomiting: A survey of a college population. Psychological Medicine, 11, 697-706. Hollingshead, A.B. (1957). Two facror index of social position. Unpublished manuscript available from 1965 Yale Station, New Haven, CT. Hsu, L.K.G. (1989). The gender gap in eating disorders: Why are the eating disorders more common among women? Clinical Psychology Review, 9, 393407.
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in at risk populations: The effects of time management instruction and social support in women from dual-earner families. Behavior Therapy, 17, 57-66. Lin-Fu, J.S. (1987). Specialty health concerns of ethnic minority women. Public Health Reports, 101, (Supplement), 12-14. Long, B.C., & Haney, C.J. (1988). Coping strategies for working women: Aerobic exercise and relaxation interventions. Behavior Therapy, 19, 75-83. Martin, J.E., & Dubben, P.M. (1982a). Exercise and health: The adherence problem. Behavioral Medicine Update, 4, 17-24. Martin, J.E., & Dubbert, P.M. (1982b). Exercise applications and promotion in behavioral medicine: Current status and future directions. Journal of Comulfing and Clinical Psycholofy, 50, 1004-1017. Metropolitan Life Insurance Company (1977). Trends in average weights and heights among insured men and women. Statistical Bulletin of the Metropolifan Life Insurance Company, 58, October, 2-6. Murphy, J.K., Williamson, D.A., Buxton, A.E., Moody, S.C., Absher, N., & Warner, M. (1982). The long-term effects of spouse involvement upon weight loss and maintenance. Behavior Research and Therapy, 13, 681-693. Oldridge, N.B. (1982). Compliance and exercise in primary and secondary prevention of coronary heart disease: A review. Preventive Medicine, 11, 56-70. Perri, M.G., McAdoo, W.G.,McAllister, D.A., Lauer, J.B., & Yancey, D.Z. (1986). Enhancing the efficacy of behavior therapy for obesity: Effects of aerobic exercise and a multicomponent maintenance program. Journal of Clinical and Consulting psycho lo^, 54, 670-675. Sallis, J.F., Grossman, R.M., Pinski, R.B., Patterson, T.L., & Nader, P.R. (1987). The development of scales to measure social support for diet and exercise behaviors. Preventive Medicine, 16, 825-836. Schoenborn, C.A. (1986). Health habits of U.S. adults, 1985: The "Alameda 7" revisited. Public Health Reports, 101, 571-580. Sechrist, K.R., Walker, S.N., & Pender, N.J. (1987). Development and psychometric evaluation of the exercise benefitsharriers scale. Research in Nursing and Health, 10, 357-365. Siegel, D., Johnson, J., & Newhof, C. (1988). Adherence to exercise and sports classes by college women. Journal of Sports Medicine and Physical Fitness, 28, 181-188. Stephens, T. (1987). Secular trends in adult physical activity: Exercise boom or bust? Research Quanerly for Exercise and Spott, 58, 94-105. Striegel-Moore, R.H., Silberstein, L.R., & Rodin, J. (1986). Toward an understanding of risk factors for bulimia. American Psychologist, 41, 246-263. US Department of Commerce, Bureau of the Census (1980). General social and economic characferistics of Mississippi 1980 census of popularion., Part 26. US Government Printing Office: Washington D.C. Weinsier, R.L., Wadden, T.A., Ritenbaugh, C., Harrison, G.G., Johnson, F.S., & Willmore, J.H. (1984). Recommended therapeutic guidelines for professional weight control programs. American Journal of Clinical Nutririon, 40, 865-872.
Women & Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wwah20
Perceived Barriers to Excercise and Weight Control Practices in Community Women a
b
Cheryl A. Johnson PhD , Sheila A. Corrigan , Patricia M. c
Dubbert & Sandra E. Gramling PhD
d
a
Assistant Professors, The Department of Psychiatry, University of Mississippi b
Assistant Professors, Department of Psychiatry, University of Mississippi c
Associate Professor, Jackson Veterans Affairs Medical Center, University of Mississippi d
Assistant Professor, Department of Psychology, Virginia Commonwealth University Published online: 26 Oct 2008.
To cite this article: Cheryl A. Johnson PhD , Sheila A. Corrigan , Patricia M. Dubbert & Sandra E. Gramling PhD (1990) Perceived Barriers to Excercise and Weight Control Practices in Community Women, Women & Health, 16:3-4, 177-191, DOI: 10.1300/J013v16n03_10 To link to this article: http://dx.doi.org/10.1300/J013v16n03_10
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Perceived Barriers to Exercise and Weight Control Practices in Community Women Cheryl A. Johnson, PhD Sheila A. Corrigan, PhD Patricia M. Dubbert, PhD Sandra E. Gramling, PhD
ABSTRACT. A sample of community women was surveyed to determine exercise habits, weight control methods, and perceived barriers to sustaining and initiating exercise and weight management pro rams. Lack of time was reported to be the most significant factor &rniting exercise, while lack of willpower and time constraints were the most frequently reported obstacles to weight management. Suggestions to aid adherence to exercise and werght control programs among women are outlined.
Few laypersons or health care professionals would deny the salubrious effects of regular exercise and weight maintenance. Despite the "fitness boom," surveys show that few Americans are active enough to achieve the benefits of exercise (Stephens, 1987). A number of studies indicate that the majority of those who begin exercise programs do not exercise long enough to attain their health and fitness goals (Martin & Dubbert, 1982a). Cheryl A. Johnson and Sheila A. Corrigan are Assistant Professors, the Department of Psychiatry and Human Behavior, University of Mississippi School of Medicine, 2500 North Slate St., Jackson, MS 39216. Patricia M. Dubbert is Associate Professor, Jackson Veterans Affairs Medical Center and the University of Mississippi School of Medicine. Sandra E. Gramling is Assistant Professor, Department of Psychology, Virginia Commonwealth University, Richmond, VA. Women & Health, Vol. 16(3/4)1990 O 1990 by The Haworth Press, Inc. All rights resewed. 177
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Surveys of health practices in the U.S. have consistently found differences between groups defined by sex, racelethnicity, and socioeconomic factors. Results from the National Health Interview Survey (Schoenborn, 1986), for example, showed that males were more likely to exercise, but also more likely to drink and smoke. Compared with white females, black females were more likely to be greater than 20% overweight, despite the lack of differences in rates of physical activity (Belloc & Breslow, 1972; Belloc & Enstrom, 1980). In other studies, education (Cockerham, Lueschen, Kunz, & Spaeth, 1986; Gottleib & Baker, 1986) and income (Gottleib & Baker, 1986) were found to be positively associated with regular exercise and sports involvement. Studies have also shown that women are much more likely to be diagnosed with eating disorders associated with dieting (Halmi, Falk, & Schwartz, 1981; Hsu, 1989; Striegel-Moore, Silberstein, & Rodin, 1986). In a survey of college students, Corrigan, Mangialetti, and Evans (1984) found that men reported they exercised in order to lose weight, while women reported they decreased their caloric intake to achieve the same end. Although women's lower rates of exercise and their efforts to maintain their weights have been documented, few studies have addressed perceived barriers to and dieting practices for community women or subgroups of women defined by age, racelethnicity, and employment status. Iverson, Fielding, Crow and Christensen (1985) observed that male and female Canadian adults reported that the major barriers to regular exercise were lack of time and laziness. Siegel, Johnson, and Newhof (1988) found that college women who continued in an exercise program reported that participation in the program was more socially rewarding, recreational, and conducive to skill development relative to those who dropped out of the program. The perceived health and fitness benefits of exercise were not different for the two groups. Several barriers to initiating and sustaining an exercise program have been summarized (Dishman, Sallis, & Orenstein, 1985; Martin & Dubbert, 1982a). Factors related to dropping out of exercise programs include: lack of time due to family, work, and social obligations; low personal motivation; limited spouse and family support; inconvenient exercise facilities; high intensity exercise; obe-
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sity, and smoking. Sechrist, Walker, and Pender (1987) developed an exercise benefits and barriers scale in which they statistically identified four factors which represent barriers to exercise: Exercise Milieu, Time Expenditure, Physical Exertion, and Family Encouragement. While these factors appear similar to those summarized by Martin and Dubbert (1982a), Sechrist et al. (1987) do not address the relationship of these factors to actual exercise behaviors. Health care professionals have minimal information regarding the barriers to and incentives for changing exercise and dietary habits in women. Exercise and diet practices in minority women need to'be explored further, as minority women may experience additional problems related to socioeconomic disadvantages and are at a greater risk of developing chronic disorders such as hypertension and cardiovascular diseases (Lin-Fu, 1987). Given the increasing numbers of women in the work force, many with young children, it is important to determine the reasons why women are not engaging in healthy exercise and weight control practices. These reasons may be largely due to demands for their time, as opposed to dislike of physical activity, health problems, or perceived financial barriers. The present study was intended to examine women's perceptions of the major barriers to their own exercise participation. This study was designed to address the following questions: (1) What percent of women report engaging in regular exercise? (2) What kinds of exercise are preferred? (3) Among women who desire to increase their physical activity level, what are the perceived barriers to increased activity? (4) Are there difference~in subgroups of women defined by race, age, and employment status in exercise practices and perceived barriers to increasing exercise? (5) What are the preferred weight control strategies reported by women? ( 6 ) What are the perceived barriers to weight control? METHOD
A 25-item paper and pencil' survey (available upon request) was developed by the authors to assess exercise and diet practices and perceived barriers to exercise and diet behaviors. Items were selected based on factors which most frequently appeared in the avail-
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able literature as related to adherence to diet and exercise programs (cf. Dishman et al., 1985; Martin & Dubbert, 1982a). The survey was administered in two shopping malls in a medium sized southeastern city (population of metropolitan area = 403,000). One mall was located in a predominantly black, working-class neighborhood and the other in a white, middle-class area. The sampling period was four weekends (Saturday and Sunday) in the spring. Potential participants were approached by white female investigators who followed a standardized script inviting participants to complete the survey anonymously. Participants completed the survey in 5 to 10 minutes. A total of 300 surveys were distributed, approximately 150 in each setting. Over 250 surveys were returned, of which 226 (75%) contained sufficient responses to the demographic and the exercise and diet information to be included in the analyses. Data Analysis
The primary concern of this investigation was to examine the prevalence of exercise and diet habits, as well as the perceived barriers to these behaviors. Descriptive statistics are presented to this end. Chi-square analyses were employed to examine differences in exercise and diet habits between subgroups of women based on age, race, and employment status. Due to the number of chi-square analyses conducted, an alpha of .O1 was adopted for significance.
RESULTS
Survey Participants Participants ranged in age from 18 to 72 years (M = 32.5, SD = 10.8) with approximately 80%under 40 years of age. Women were categorized according to age, less than 40 years and older than 40 years. The racial composition of the sample, 48% black, 52% white, reflected the goal of recruiting equal numbers of black and white participants. With regard to marital status, 46.5% were currently married, 36.3% single and 17.2%were divorced, separated or widowed. The respondents' occupations were classified according to the Hollingshead occupational categories (Hollingshead & Redlich, 1957) into professional and managerial (34.8%), clerical
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and service (36%) and housewives, students, and unemployed (28.1%). According to self-reported height and weight, body mass indices (kglm2) ranged from 16.3 to 42.06 (M = 24.07, SD = 4.66). Thirty-five percent of the sample were greater than 20% overweight and 49.2% were within 10% of their ideal weight (Metropolitan Life Insurance Company, 1977). Consistent with previous reports (Calloway, 1987; Schoenborn, 1986), black women were more likely to be greater than 20% overweight than white women, X 2(1, N = 223) = 19.73, p < .001. As expected, significantly more black participants were surveyed from the mall in the black, working-class neighborhood and significantly more white participants were surveyed from the white, middle-class neighborhood mall, X 2(1, N = 226) = 107.60,~< ,001. No significant differences were apparent between the two locations with regard to age or occupation. Survey responses from the two locations were combined for all analyses. The present sample reflects the racial composition of the larger community (46% black, 53% white and 1% other; US Department of Commerce, Bureau of Census, 1980). However, the number of professional and managerial women in our sample is greater than that of the community (34.8% vs. 15%) and the present sample underrepresents the number of women who are employed in service and clerical positions (36% vs. 48%). In addition, the present sample is comprised of 80% of women under age 40. Although, the present sample does not represent the demographics of the larger community from which it was drawn, based on 1980 census information, the goal of the investigation was to sample an equivalent number of black and white women. Q p e s and Frequency of Exercise
In response to the question "Do you currently engage in a regular exercise program?," 37.2% (84) answered in the affirmative. There were no differencesbetween the subgroups of women, blackjwhite, workinghon-working, or younger/older, in the percent who reported regular exercise. Of the 142 non-exercisers, 105 (73%) indicated a desire to begin a regular exercise program. Thus, 189
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(83.6%) of the 226 respondents either were exercising or expressed the desire to do so. The most common type of exercise reported was walking (4l.6%), followed by aerobics (36.4%), racquet sports (11.7%), and jogging (10.4%). Forty percent of regular exercisers reported exercising an average of 2 to 3 hours per week and 18.7% exercised 1 to 2 hours weekly; however, 15% of the "regular exercisers" reported less than 60 minutes of exercise per week.
Perceptions of Personal Fitness and Need for Exercise Participants' responses to questions regarding perceptions of their health status and the importance of regular exercise indicated that 13.9% felt that they were in "good shape," 69.6% perceived themselves to be in adequate physical condition, and only 16.1% thought they were in less than adequate condition. While only 37.2% reported engaging in a regular exercise program, 84% of the respondents felt they were in at least adequate physical condition. To the question "Do you believe that engaging in a regular exercise program is important to an individual's health?," less than 3% felt it was not very important, 23.6% endorsed moderately important and 74% indicated it was very important. Participants' responses to how important regular exercise was to their own overall health status were similar. Regarding enjoyment of exercise and physical activity, the large majority of respondents (94%) indicated they at least moderately enjoyed physical activity. Only 4.3% rated it as not very enjoyable. Given the participants' stated enjoyment of exercise, perceptions of its importance for physical health, and the desire to engage in a regular exercise program, factors which impede exercise would seem to be very important to explore.
Barriers to Exercise Respondents were provided with a list of barriers to exercise and instructed to indicate all those which applied to themselves. There were no significant differences in perceived barriers among women on the basis of race, age, or employment status. Table 1 displays
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Table 1 Percent of Won~enE n d o r s i n g u s h ExercisesgFunctin_n B_ Exercise
2&a.b
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Exercise Status Barrier
Exercise Morea
Like to Start
Work/School
653
59.4
47.1
Household
22.7
17.8
12.6
Stopped ExerciseC
Lack of time due to:
Children
20.0
25.7
17.2
Social
16.0
8.9
103
Lock of nioney
26.6
35.6
6.9
Lack of facilities
19.7
21.8
8.1
Lack of pnrtner
18.7
20.8
12.6
Exercise boring
93
9.9
10.6
Health problenis
6.7
3.9
8.1
Lost interest
N/A
N/A
20.0
responses according to current exercise status. Participants who were currently exercising but wanted to increase their exercise most frequently endorsed lack of time. Many of these participants also endorsed: not enough money, lack of facilities, and lack of exercise partner. Respondents who stated a desire to begin regular exercise endorsed essentially the same barriers with similar frequencies. The responses of participants who were not currently exercisers, but who had exercised in the past were similar to the above groups,
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with lack of time as the mostfrequently endorsed barrier. Additionally,'loss of interest in exercise was endorsed by more than 20% of this group. Finally, 13.3% of our sample reported that they were not currently exercising and did not want to begin an exercise program. Again, the most frequently endorsed reason was related to time (46.7%); other reasons were "don't like to exercise" (33.3%) and "I get enough exercise in my daily routine" (26.7%). In contrast to expectation, occupational status was not differentially related to the endorsement of "lack of money" as a barrier to exercise for those who want to exercise more, those who quit exercising, and those who wish to begin an exercise program.
Current Dieting Practices While 35.7% of the sample was greater than 20% overweight, only 23.3% reported that they were presently on a weight loss or weight maintenance diet. In total, 46% of our sample reported that they had dieted within the past two years. Participants were presented with a number of common weight loss strategies and asked to indicate those strategies which they employed. Cutting back on intake and exercising were endorsed most frequently. Few women endorsed strategies such as laxatives, diet pills, fad diets, and fasting (see Table 2).
Barriers to Dieting Participants were asked to indicate those barriers which they perceived impeded their efforts to lose or maintain weight by dieting. Only those individuals who indicated that they had dieted within the past two years or were currently on a diet responded to these questions. The most frequently endorsed barriers were: "no willpower," "no time for meal planning" and "cooking for family and eating what they eat7' (see Table 3). The relationship between perceived weight status and exercise was explored. Interestingly, those women who perceived thernselves as slightly overweight (N = 97) tended to report regular exercise, as compared to women who perceived themselves as very overweight (N = 50) or within normal limits (N = 77), X 2(4, N =
Johnson et al. Table 2
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Percent of Women E
m Weicht
Method
%
Cut back on intake
743
Exercise
713
Dr. prescribed plan
17.6
Fasting
9.6
Over-the-counter diet pills
6.9
Fad diets
3.7
Laxatives
2.7
Methods
223) = 10.65, p = .03. Furthermore, compared to women who reported dieting at the time of the survey, women who reported that they were not currently dieting were twice as likely to state that they were also not currently exercising (117 nonexercisers vs. 54 exercisers), X 2(1, N = 223) = 11.58, p = .001.
DISCUSSION The results of this surviy suggest that although the large majority of the women reported that they enjoyed exercise and perceived it to be importapt to physical health, relatively few engaged in regular exercise. This observation is consistent with the findings of Siegel et al. (1988), that exercise behavior is not predominantly mediated by health and fitness goals. Lack of time was the most frequently endorsed barrier to initiating and sustaining a regular exercise program. Disinterest in exercise, lack of facilities, lack of money, and lack of partners were much less important than the multiple demands for a woman's time. Importantly, there were no significant
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Barrier
%
No willpower
40.7
Meal planning requires time
'
.
30.6
Cooking for family
30.6
Eat out alot
28.7
High cost of diet foods Eat forbidden foods Don't like diet foods Time required to shop and prepare
15.7
Dieting lends to fatigue
14.8
differences in perceived barriers to diet and exercise programs among women based on age, race, or employment status. Lack of time due to family, social, and work responsibilities has been cited as a barrier to initiating and sustaining exercise programs (Dishman, 1982; Martin & Dubbert, 1982a; Oldridge, 1982). These data suggest that programs to increase women's exercise participation are unlikely to succeed unless they address women's perceptions that they do not have enough time to exercise. This notion is particularly critical for women under age 40, who comprised the majority of our sample. Two basic strategies should be considered. First, time management training may be helpful to some women. Although several studies have demonstrated that various cognitive and behavioral strategies can improve short-term adherence to an exercise program (e.g., Dubbert & Martin, 1988;
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King, Taylor, Haskell, & DeBusk, 1988), to our knowledge none have included a time management component. While King, Winett, and Lovett (1986) did not specifically target exercise behaviors, they found that women who received time-management training reported increasing the number of pleasurable activities in which they engaged. These findings suggest that interventions focusing on scheduling and maintaining time for regular exercise in an already busy week could be an important addition to exercise programs. In time management terms, a regular exercise program would be assigned a high priority. A second strategy is to encourage employers to provide facilities and equipment for improving fitness in the workplace. In our study, lack of time due to work or school was indicated as an impediment to exercise by at least fifty percent of respondents. Providing exercise breaks and eliminating the time required to travel to another facility might decrease the negative influence of work, school, or child care responsibilities. It should be noted that while fitness programs are among the most popular type of worksite health promotion programs, data regarding the efficacy and their associated costs are mixed (Glasgow & Terborg, 1988). While worksite health promotion programs may decrease the impact of lack of time, facilities and money as significant barriers to exercise, further work is needed to maximize the benefits of these programs,.particularly for female employees. . . Another avenue by which to increase exercise and dietary compliance may be to encourage participants to involve significant others or friends in their exercise and diet programs. Evidence is available which suggests that individuals with supportive spouses are more likely to continue in their exercise programs than individuals with spouses who were not supportive of the exercise habit (Martin & Dubbert, 1982b). Further, Heinzelmann and Bagley (1970) found that the majority of exercisers would prefer to exercise with others. In the present study, lack of partner was reported to be a factor for 13% to 21% of respondents. With regard to diet behaviors, data are available suggesting that spouse support and participation in weight loss programs results in improved outcome (Dubbert &Wilson, 1984; Murphy, Williamson, Buxton, Moody, Absher, & Warner, 1982). However, the data are not totally supportive of this
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finding (Black & Lantz, 1984). While a direct measure of social support was not included in our study, social support may be inferred from the barrier "cooking for family." Thirty-one percent of the participants reported that cooking for their families represented a major barrier to their weight control efforts. Sallis, Grossman, Pinski, Patterson, and Nader (1987) developed a measure to assess social support for diet and exercise behaviors. Positive verbal support appears to be important for diet behaviors, while active participation appears to be important for exercise behaviors. Interestingly, social support for diet and exercise behaviors was not related to a measure of general social support. An alternative interpretation of our data is that women lack sufficient motivation to engage in regular exercise. It may be that lack of time was the most convenient and socially desirable response available to our survey participants. Anecdotally, it has been reported that preparation for and clean-up after exercise is seen as an obstacle. In this case, focusing on time management strategies may not be sufficient to increase women's exercise participation. Instead, attention may be directed toward cognitive reformulations of the reasons for exercise. Exercise functions as a social activity, a recreational activity, and a stress management technique, in addition to its more obvious physical health promoting goals. Long and Haney (1988) used exercise and relaxation training as stress-reduction interventions in a group of working women. Both interventions resulted in decreased levels of trait anxiety and increased self-efficacy. Therefore, exercise may be viewed as a stress-management technique, as well as promoting physical health. In support of this view, Siegel et al. (1988), found that women who continued in an exercise program were more likely to view exercise as social and recreational than those women who dropped out. .. The failure to find differential exercise patterns between subgroups of women may be due to limitations of the study methodology. The survey instrument contained only nominal responses, therefore restricting data analyses to nonparametric statistical tests, which have less statistical power than parametric statistical tests. Furthermore, the vast majority of respondents were under age 40, thus limiting our power to detect age differences. However, the equivalent numbers of women in racial and occupational categories
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allowed a more adequate determination of the influence of these variables. The sample studied was not representative of the larger community, but did include approximately equivalent numbers of women in racial and occupational categories. Differences between various subgroups of women defined by age, employment status, and race, in their exercise status, rates of exercise, or barriers to exercise were not evident. Time constraints were reported as significant barriers to exercising and preparing healthy foods for all subgroups of women. The importance of exercise and increased physical activity in a weight loss or weight maintenance program is well documented. Guidelines for weight control programs include both dietary and physical activity prescriptions (Weinsier, Wadden, Ritenbaugh, Harrison, Johnson, & Willmore, 1984). Inclusion of exercise in weight control programs has been found to result in enhanced weight loss (Perri, McAdoo, McAllister, Lauer, & Yancey, 1986), particularly when the exercise has been conducted as an integral part of the program (Craighead & Blum, 1989). Our data show that many women rely upon increased activity and decreased intake to regulate weight. Yet, most women who were attempting to regulate their weight were faced with time constraints that impede their exercise and weight management efforts. It would be important for future research to examine cognitive and environmental factors associated with maintenance of exercise in a sample of community women who are exercising on a regular basis. In addition, it may be fruitful to examine short term and long term exercise adherence problems within the context of a relapse model (Dubbert, Terre, Rowland, & Krug, 1988). Currently, the available data on the efficacy of relapse prevention as part of a multi-component exercise adoption and adherence program is positive (King et al., 1988), and further research is needed. REFERENCES Belloc, N.B., & Breslow, L. (1972). Relationship of physical health status and health practices. Preventive Medicine, 1, 409-421. Belloc, N.B., & Enstrom, J.E. (1980). Persistence of health habits and their relationship to mortality. Preventive Medicine, 9, 469-483. Black, D.R. & Lantz, C.E. (1984). Spouse involvement and a possible long-term follow-up trap in weight loss. Behavior Research and Therapy, 22, 557-562.
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