Urban fitness centers: removing barriers to promote exercise in underserved communities

Socioecological Factors Associated with an Urban Exercise Prescription Program for Under-Resourced Women: A Mixed Methods Community-Engaged Research Project

One strategy to promote physical activity (PA) is for health care providers to give exercise prescriptions (ExRx) that refer to community-based facilities. However, facilitators and barriers specific to urban programs in the US for under-resourced women are unknown. Thus the purpose of this formative research was to explore ExRx barriers and facilitators specific to US under-resourced women to inform future intervention targets and strategies. This mixed-methods community-engaged research was conducted in partnership with an urban women's only wellness center that exchanged ExRx for free access (1-3 months). Qualitative semi-structured interviews and validated quantitative questionnaires (SF-12, International Physical Activity Questionnaire, Physical Activity Self-Efficacy, Physical Activity Stage of Change, and Barriers to Physical Activity, Social Support for Exercise, and Confusion, Hubbub, and Order Scale) were administered by phone and guided by the socio-ecological model. ExRx utilization was defined as number visits/week divided by membership duration. Means and percentages were compared between ≥1 visit/week vs. <1 visit/week with t-tests and chi-square, respectively. Women (n = 30) were 74% Black, 21-78 years of age, 50% had ≤ high school diploma, and 69% had household incomes ≤45,000/year. Women with ≥1 visit/week (n = 10; 33%) reported more education and higher daily activity, motivation, number of family CVD risk factors and family history of dyslipidemia compared with <1 visit/week. Facilitators among women with ≥1 visit/week were "readiness" and "right timing" for ExRx utilization. Barriers among women with <1 visit/week (n = 20; 67%) were "mismatched expectations" and "competing priorities". Common themes among all women were "sense of community" and "ease of location". ExRx utilization at an US urban wellness center may be dependent on a combination of multi-level factors including motivation, confidence, peer support, location and ease of access in under-sourced women. Additional resources may be needed to address mental and/or physical health status in additional to physical activity specific programming.

Fitness for all: how do non-disabled people respond to inclusive fitness centres?

Background

Representation of people with disabilities in fitness centres is lacking, despite initiatives to promote inclusion mainly in the UK and USA. Success creating these inclusive spaces is mixed and few were crafted taking into account attitudes and biases of non-disabled co-members. Inclusive fitness centres have not gained much attention in Denmark, and the campaign ‘Fitness for All - fitness for people with physical disabilities’ was initiated. The aim of this study was shaped by two key questions; 1) what is the ideal fitness space from the perception of non-disabled fitness users? and 2) how might their dis/ableist attitudes negate inclusion in three future pilot inclusive fitness centres across Denmark?

Method

Three focus groups involving 5–7 (total n = 18) adult non-disabled participants were conducted. Aged ranged between 19 and 75 years, both men and women were involved, with fitness centre experiences ranging from 0 to 20+ years. Interviews were transcribed and analysed using Malterud’s four-step method of systematic text condensation.

Results

Of most importance was a pleasant atmosphere which should make them feel welcome and comfortable. Good social relations within the space were also highly valued. Participants welcomed people with physical disabilities but predicted many challenges with an inclusive fitness centre and expressed unconscious ableist attitudes.

Conclusion

The current study adds essential knowledge regarding how non-disabled people perceive the ideal inclusive fitness centre. A welcoming and inviting atmosphere is essential whereas social skills, ableism, ignorance, and preconceptions are important barriers that may hinder inclusion of participants with disabilities in inclusive fitness centres.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00303-2.

Barriers to, and Facilitators of, Exercising in Fitness Centres among Adults with and without Physical Disabilities: A Scoping Review

Fitness centres are an obvious arena for performing physical activity for the general population but representation of adults with physical disabilities (AwPD) is lacking. To increase possibilities for AwPD to exercise in fitness centres together with adults without physical disabilities (AwoPD), the aim of this study was to identify, synthesise, and compare barriers to, and facilitators of, exercising in fitness centres for each group. A scoping review was conducted and data extraction of the barriers and facilitators was performed independently by two researchers on six categories of contextual factors based on the framework of Di Blasi: (1) The fitness centre setting; (2) The fitness centre user characteristics; (3) The fitness instructor/staff characteristics; (4) The fitness centre user–instructor/management relationship; and (5) The fitness/exercise characteristics. An extra category, (6) Other relationships, was added. The PRISMA Extension for Scoping Reviews was used for reporting. Of the 102 included papers, only 26 (25%) of the papers were on AwPD, which focused mainly on physical barriers (category 1: inaccessible settings). In contrast, the remaining 76 papers involving AwoPD focused primarily on facilitators (category 2: motivational factors and exercising effects). In categories 3–6, the two groups had similar results, as both groups preferred skilled instructors, a welcoming and comfortable fitness centre environment, an ability to exercise at their preferred type and level, and good social connections. Since most data were based on AwoPD, more studies on actual experiences from AwPD are needed, to reveal the facilitators/motivational factors for fitness centre use.

Beyond TTM and ABC: A Practice Perspective on Physical Activity Promotion for Adolescent Females from Disadvantaged Backgrounds

This paper builds on a growing body of literature on the promise of practice theory in understanding and promoting behavior change in society and develops upon Blue (2017) and Spotswood et al.’s (2019) rationale for evolving theories of practice into the domain of contemporary physical activity research. We begin by considering the intersectional nature of the problem. Statistics reveal that physical activity gradients exist based on gender, as well as socio-economic position. Women, girls, and disadvantaged populations report lower levels of activity than more affluent males and females. More problematic still is what StreetGames (2017) call the “double jeopardy”, where these characteristics intersect, intensifying the negative gradient. Our argument then comprises three parts. First, we provide a critical discussion of intervention studies seeking to transform exercise behavior amongst these populations. The issue we identify is that studies typically rely on behavior change models, such as the Transtheoretical Model (TTM) and the ABC framework. However, these models tend to take insufficient account of the practical and social aspects of behavior change in physical activity, and thus their subjects often succumb to value-action gaps (Shove, 2010). Second, in contrast, we propose that practice theory provides a promising alternative theoretical lens for promoting behavior change in disadvantaged and often resistant populations. Third, the paper highlights a range of conceptual considerations for exploring the relationship between young, disadvantaged women and physical activity, as well as the development of tangible solutions to improve participation.

Study of adherence to exercise in heart failure: the HEART camp trial protocol

BACKGROUND

Adherence to the Heart Failure Society of America (HFSA) 2010 guidelines recommending 30 minutes of supervised moderate intensity exercise five days per week is difficult for patients with heart failure (HF). Innovative programs are needed to assist HF patients to adhere to long-term exercise. The objective of this prospective randomized two-group repeated measures experimental design is to determine the efficacy of a behavioral exercise training intervention on long-term adherence to exercise at 18 months in patients with heart failure.

METHODS/DESIGN

A sample size of 246 subjects with heart failure will be recruited over a 3 year period. All subjects receive a cardiopulmonary exercise test and 9 supervised exercise training sessions during a 3 week run-in period prior to randomization. Subjects completing at least 6 of 9 training sessions are randomized to the HEART Camp Intervention group (HC) or to a standard care (SC) exercise group. The HC intervention group receives cognitive-behavioral strategies that address the intervention components of knowledge, attitudes, self-efficacy, behavioral self-management skills and social support. The SC group is provided access to the exercise facility and regular facility staff for the 18 month study period. The primary aim is to evaluate the effect of HEART Camp on adherence to exercise, with our central hypothesis that the HC group will have significantly better adherence to exercise at 18 months. Secondary aims include evaluating which components of the HEART Camp intervention mediate the effects of the intervention on adherence; evaluating the effect of HEART Camp on specific health outcomes; exploring selected demographic variables (race, gender, age) as potential moderators of the effect of the HEART Camp intervention on adherence; and exploring the perceptions and experiences that contextualize exercise adherence.

DISCUSSION

The HEART Camp intervention is the first to test a multi-component intervention designed to improve long-term adherence to exercise behavior in patients with HF. Improving long-term adherence to exercise is the logical first step to ensure the required dose of exercise that is necessary to realize beneficial health outcomes and reduce costs in this burdensome chronic illness.

TRIAL REGISTRATION

Clincaltrials.gov NCT01658670.

The impact of PRAISEDD on adherence and initiation of heart health behaviors in senior housing

OBJECTIVE

Building on prior theoretical work and research, we developed a community-based intervention, People Reducing Risk And Improving Strength through Exercise, Diet, and Drug Adherence (PRAISEDD), a three-phase program which was implemented in 2009. The purpose of this study was to report on Phase III, the Inoculation Phase, of the PRAISEDD program and explore participant experiences.

DESIGN AND SAMPLE

This was a descriptive, qualitative study focused on exploring participation in heart healthy PRAISEDD classes. Ten residents participated in the focus group, all of whom attended at least one PRAISEDD session.

MEASURES

Qualitative data were obtained at the end of the 12 months during which Phase III was implemented. Descriptive data were gathered to describe the number of initial PRAISEDD participants and the number of new participants who came to classes.

RESULTS

Nine codes were identified and reduced to two themes: motivators to participate in exercise classes; and factors that decrease willingness to participate. The Phase III monthly PRAISEDD inoculation classes were attended by 10-12 residents, the majority of whom participated in Phase I of PRAISEDD.

CONCLUSION

We were able to engage new participants in classes during Phase III, and qualitative findings provided important recommendations for future work.

People reducing risk and improving strength through exercise, diet, and drug adherence (PRAISEDD): a case report on long-term single site adoption

African-American and low-income older adults have heightened risk for cardiovascular disease (CVD). Culturally and socially congruent community-based programs can promote risk-reduction behaviors, including physical activity (PA), and can demonstrate durability. The purpose was to increase lifestyle PA and promote self-management of CVD risk factors in a sample of at-risk older adults and to sustain a PA program within low-income housing. Exercise and education sessions were conducted three times/week for 12 weeks. A community champion was trained to carry on the classes thereafter, with monthly inoculation visits by a nurse and exercise trainer. Outcome measures included attendance and CVD risk factor control. This ongoing community-based program, incorporating peer leadership, inoculation visits, and self-efficacy enhancement, has been sustained for over 3 years with classes one to two times per week and routine attendance of about 12-18 residents. PRAISEDD demonstrates that a community-based PA program can be maintained using within-community leadership, periodic involvement of health care experts, and social support and self-efficacy enhancement.

Motivators and barriers to participating in health promotion behaviors in Black men

There is limited research examining the health promotion behaviors (HPBs) of low-income Black men. This study examined the relationship between HPBs, and motivators and barriers to participating in these behaviors in Black men (N = 107), aged 21 to 56. Using descriptive statistics, more than 96% of the participants reported they were motivated because of the desire to be healthy. Canonical correlation analysis and conditional random forest were used to determine the importance of individual motivators and barriers. Canonical correlation analysis yielded one interpretable canonical variate that explained 39.5% of the variance in sets of motivators and barriers, and health promotion lifestyle variables. Men with fewer motivators and more barriers took less responsibility for their health, participated in less physical activity, and reported less spiritual growth. Having too many things to do and not knowing what to do best predicted participation in HPBs.