What factors influence people to be active?

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Personal Barriers[edit | edit source]
Environmental barriers[edit | edit source]
Identifying barriers to physical activity[edit | edit source]
Overcoming Barriers[edit | edit source]
References[edit | edit source]

Monday, July 9, 2018

Continuing with citations from my article in Obesity Reviews on an aeteological framework for assessing obesity, we now turn to the some of the factors that can affect physical activity. Similar to the factors that can affect ingestive behaviour, there are a host of factors that can significantly affect physical activity:

Socio‐cultural factors

A wide range of socio‐cultural determinants of physical activity exist. These range from factors related to the built environment (e.g. urban sprawl, walkability, street connectivity), neighbourhood safety, social networks, and public transportation to socioeconomic limitations as well as customs and beliefs that can influence vocational or recreational physical activity. For example, being promoted from a physically active outdoor job to a sedentary indoor job, moving from a dense urban location to a rural or suburban residence, immigration to a Western country, pregnancy and change in familial status or time constraints can all promote sedentariness and increase the risk of weight gain. Indentifying and addressing the socio‐cultural barriers to physical activity can be a key to successful weight management. Patients facing significant socio‐cultural barriers to activity may specifically benefit from counselling by an occupational and/or recreational therapist.

Biomedical factors

Numerous medical conditions can lead to a reduction in or inability to engage in physical activity. These include musculoskeletal pain or immobility resulting from injury, osteoarthritis or fibromyalgia as well as any other condition that can affect physical performance such as cardiorespiratory disease, obstructive sleep apnoea, chronic fatigue, stroke or urinary incontinence. Alleviating these factors and thereby reducing immobility may be the first step in addressing weight management in these patients. Given the predominant role of musculoskeletal disorders and pain as a barrier to mobility and physical activity, these patients may benefit most from physiotherapeutic interventions and pain management.

Psychological factors and mental health

Lack of motivation, low energy levels and disinterest in exercise (especially in a previously active individual) can be a symptom of depression. Social anxiety disorder, agarophobia, sleep disorders or substance abuse can all affect physical activity levels. Body image issues and self‐efficacy can likewise pose important psychological barriers that may require specific professional counselling and intervention to promote a more active lifestyle.

Medications

Although published research on this issue is limited, it is reasonable to assume that medications, which reduce energy levels, promote drowsiness, impair coordination or limit cardiorespiratory function can pose significant barriers to physical activity.

Now that we have discussed why it is important to asses the many factors that can affect energy metabolism, ingestive behaviour, and physical activity, in coming posts, we can explore how to apply this framework to patients presenting with weight gain.

@DrSharma
Edmonton, AB

Many technological advances and conveniences that have made our lives easier and less active, many personal variables, including physiological, behavioural, and psychological factors, may affect our plans to become more physically active. Understanding common barriers to physical activity and creating strategies to overcome them may help make physical activity part of daily life. People experience a variety of personal and environmental barriers to engaging in regular physical activity.

Personal Barriers[edit | edit source]

With technological advances and conveniences, people’s lives have in many ways become increasingly easier, as well as less active. In addition, people have many personal reasons or explanations for being inactive. The most common reasons adults don't adopt more physically active lifestyles are cited as[1][2][3]:

insufficient time to exercise
inconvenience of exercise
lack of self-motivation
non-enjoyment of exercise
boredom with exercise
lack of confidence in their ability to be physically active (low self-efficacy)
fear of being injured or having been injured recently
lack of self-management skills, such as the ability to set personal goals, monitor
progress, or reward progress toward such goals
lack of encouragement, support, or companionship from family and friends
non-availability of parks, sidewalks, bicycle trails, or safe and pleasant walking
paths close to home or the workplace

The top three barriers to engaging in physical activity across the adult lifespan are[4]

In a 2013 study[5] that aimed to identify the external and internal barriers to physical activity and exercise participation among middle-aged and elderly individuals the most common external barriers among the middle-aged and elderly respondents were 'not enough time', 'no one to exercise with' and 'lack of facilities'. The most common internal barriers for middle-aged respondents were 'too tired', 'already active enough', 'do not know how to do it' and 'too lazy', while those for elderly respondents were 'too tired', 'lack of motivation' and 'already active enough'.

Other barriers include

cost
facilities
illness or injury
transportation
partner issues
skill
safety considerations
child care
uneasiness with change
unsuitable programs

Environmental barriers[edit | edit source]

The environment in which we live has a great influence on our level of physical activity. Many factors in our environment affect us. Obvious factors include the accessibility of walking paths, cycling trails, and recreation facilities. Factors such as traffic, availability of public transportation, crime, and pollution may also have an effect. Other environmental factors include our social environment, such as support from family and friends, and community spirit. It is possible to make changes in our environment through campaigns to support active transportation, legislation for safer communities, and the creation of new recreation facilities.

Identifying barriers to physical activity[edit | edit source]

The Barriers to Being Physically Active Quiz was created by the centers for disease control and prevention to help identify barriers to physical activity and steer clinician and participant's awareness and target strategies to improve compliance. It a 21-item measure assessing the following barriers to physical activity: 1) lack of time, 2) social influence, 3) lack of energy, 4) lack of willpower, 5) fear of injury, 6) lack of skill, and 7) lack of resources (eg, recreational facilities, exercise equipment). Each domain contains 3 items, with a total score range of 0 to 63. Respondents rate the degree of activity interference on a 4-point scale, ranging from 0 = “very unlikely” to 3 = “very likely.”

Overcoming Barriers[edit | edit source]

As health care professionals we can help people identify barriers to exercise and make suggestions for how they can overcome these barriers. The Centers for Disease Control and Prevention[4] makes suggestions for overcoming physical activity barriers:

Lack of time Identify available time slots.

Monitor your daily activities for one week. Identify at least three 30-minute time slots you could use for physical activity.
Add physical activity to your daily routine. For example, walk or ride your bike to work or shopping, organise school activities around physical activity, walk the dog, exercise while you watch TV, park farther away from your destination, etc.
Select activities requiring minimal time, such as walking, jogging, or stair climbing.

Social influence

Explain your interest in physical activity to friends and family. Ask them to support your efforts.
Invite friends and family members to exercise with you. Plan social activities involving exercise.
Develop new friendships with physically active people. Join a group, such as the YMCA or a hiking club.

Lack of energy

Schedule physical activity for times in the day or week when you feel energetic.
Convince yourself that if you give it a chance, physical activity will increase your energy level; then, try it.

Lack of motivation

Plan ahead. Make physical activity a regular part of your daily or weekly schedule and write it on your calendar.
Invite a friend to exercise with you on a regular basis and write it on both your calendars.
Join an exercise group or class.

Fear of injury

Learn how to warm up and cool down to prevent injury.
Learn how to exercise appropriately considering your age, fitness level, skill level, and health status.
Choose activities involving minimum risk.

Lack of skill

Select activities requiring no new skills, such as walking, climbing stairs, or jogging.
Take a class to develop new skills.

Lack of resources

Select activities that require minimal facilities or equipment, such as walking, jogging, jumping rope, or calisthenics.
Identify inexpensive, convenient resources available in your community (community education programs, park and recreation programs, worksite programs, etc.).

Weather conditions

Develop a set of regular activities that are always available regardless of weather (indoor cycling, aerobic dance, indoor swimming, calisthenics, stair climbing, rope skipping, mall walking, dancing, gymnasium games, etc.)

Travel

Put a jump rope in your suitcase and jump rope.
Walk the halls and climb the stairs in hotels.
Stay in places with swimming pools or exercise facilities.
Join the YMCA or YWCA (ask about reciprocal membership agreement).
Visit the local shopping mall and walk for half an hour or more.
Bring your mp3 player your favourite aerobic exercise music.

Family obligations

Trade babysitting time with a friend, neighbour, or family member who also has small children.
Exercise with the kids-go for a walk together, play tag or other running games, get an aerobic dance or exercise tape for kids (there are several on the market) and exercise together. You can spend time together and still get your exercise.
Jump rope, do calisthenics, ride a stationary bicycle, or use other home gymnasium equipment while the kids are busy playing or sleeping.
Try to exercise when the kids are not around (e.g., during school hours or their nap time).

Retirement years

Look upon your retirement as an opportunity to become more active instead of less. Spend more time gardening, walking the dog, and playing with your grandchildren. Children with short legs and grandparents with slower gaits are often great walking partners.
Learn a new skill you've always been interested in, such as ballroom dancing, square dancing, or swimming.
Now that you have the time, make regular physical activity a part of every day. Go for a walk every morning or every evening before dinner. Treat yourself to an exercycle and ride every day while reading a favourite book or magazine.

References[edit | edit source]

↑ Sallis JF, Hovell MF. Determinants of exercise behavior. Exercise and sport sciences reviews. 1990 Jan 1;18(1):307-30.
↑ Sallis JF, Hovell MF, Hofstetter CR. Predictors of adoption and maintenance of vigorous physical activity in men and women. Preventive medicine. 1992 Mar 1;21(2):237-51.
↑ Manaf H. Barriers to participation in physical activity and exercise among middle-aged and elderly individuals. Singapore Med J. 2013;54(10):581-6.
↑ 4.0 4.1 Centers for Disease Control and Prevention. Overcoming Barriers to Physical Activity. Physical Activity for Everyone. 22 May 2007.
↑ Manaf H. Barriers to participation in physical activity and exercise among middle-aged and elderly individuals. Singapore Med J. 2013;54(10):581-6.