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The Relationship of Perceived Benefits and Barriers to Reported Exercise Behaviors in College Undergraduates

This study examines current exercise habits and perceived benefits and barriers to exercise in a sample of 147 undergraduate university students. It found a significant relationship between perceived benefits and barriers to exercise and current exercise habits. Benefits most often associated with regular exercise habits relate to physical performance and appearance. Barriers most often associated with sporadic or nonexistent exercise habits relate to physical exertion and time constraints. A greater understanding of perceived benefits and barriers to exercise may assist health care providers and educators to establish methods for promoting exercise for the improved physical and mental health of a college-age popula- tion. Key words: cardiovascular risk factors, exercise in young adults, exercise promotion, health promotion

Laurie Grubbs, PhD, ARNP Associate Professor of Nursing Florida State University Tallahassee, Florida

Jason Carter, MSN, ARNP Family Nurse Practitioner Crown Gastroenterology Presque Isle, Maine

INTRODUCTION

Regular physical activity during the childhood years is reinforced through mandatory physical education classes in elementary, intermediate, and some sec- ondary school programs. Unfortunately, many adolescents do not continue reg- ular physical activity upon completion of high school, and, perhaps, not even through middle school due to the discon- tinuation of mandatory physical educa- tion classes in many states. Correlations between physical activity during adoles- cence (13 to 18 years) and during young adulthood (21 to 35 years) are low.1 It has been suggested that the highest rate of decline in physical activity occurs in late adolescence and early adulthood in those age 18 to 24 years.2

The lack of continuation of regular physical activity from adolescence to young adulthood has had a significant im- pact on morbidity and mortality rates in the United States. Paffenbarger et al’s3

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landmark study of 16,936 college alumni showed decreased rates of mortality of up to 49% in participants who maintained regular physical activity from their college years to age 70 to 84 years. Due to the fact that Americans age 18 to 24 years display the highest rates of decline in reg- ular physical activity, targeting primary care interventions to promote exercise in this population is beneficial in decreasing morbidity and mortality. Although exten- sively studied in other populations, fac- tors influencing exercise adherence in col- lege undergraduate students have been poorly defined.

FRAMEWORK

The health promotion model (HPM), developed by Pender,4 has been used as a theoretical framework to identify behav- ioral perspectives that motivate individ- uals to engage in health-promoting be- haviors. The HPM can be conceptualized into three components:

1. individual characteristics and expe- riences

2. behavior-specific cognitions and af- fect

3. behavioral outcome Individual characteristics and experi-

ences, most notable prior related be- haviors and personal factors (biological, psychological, sociocultural), provide the baseline experience from which individu- als choose to engage in health-promoting behaviors. Behavior-specific cognitions and affect, such as perceived benefits and barriers to action, perceived self-efficacy, activity-related affect, interpersonal influ- ences, and situational influences consti-

tute central importance in the HPM, as they are components that are subject to modification.4

Perceived benefits to action represent positive or reinforcing consequences of a behavior. They may be intrinsic (such as increased alertness or decreased fa- tigue) or extrinsic (such as social accep- tance or monetary awards). The motiva- tional value of perceived benefits is based on outcomes of prior personal experi- ence or outcomes observed in others. In order for individuals to invest time and resources in an activity, they must first perceive a high probability of achieving a positive outcome from that activity.4

Perceived barriers to action are as- sociated with the obstacles encountered with undertaking a specific behavior. Per- ceived barriers are associated with un- availability, inconvenience, expense, dif- ficulty, time, or personal cost. Perceived barriers may either prevent the initiation of a new activity or decrease commitment and adherence to an existing pattern of activity.4

The influence of individual characteris- tics and experiences, as well as behavior- specific cognitions and affect such as perceived benefits/barriers to action, cul- minate in the initiation of a behavioral outcome. In this stage, the individual makes a commitment to a plan of action and identifies strategies for carrying out and reinforcing the behavior. Although the HPM functions primarily to ex- plain thought processes behind health- promoting behaviors, understanding the motivational factors behind these behav- iors is ultimately directed toward attain- ing positive health outcomes for the individual.

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METHODS

Design

This article describes a descriptive cor- relational study of college undergradu- ate students. Perceived benefits and per- ceived barriers to regular exercise were obtained through the use of a written questionnaire measuring current exercise beliefs and habits.

Population

The sample consisted of 147 college undergraduate freshmen, sophomores, juniors, and seniors aged 18 to 24 years. Subjects were selected from a conve- nience sample of those attending under- graduate classes at a large southeastern university. The Human Subjects Commit- tee of the university approved the re- search protocol.

Instrumentation

The written questionnaire in this study consisted of four sections. Section 1 con- tained demographic questions; section 2 assessed current exercise habits; and sec- tion 3 consisted of the 43-item Exer- cise Benefits/Barriers Scale (EBBS) de- veloped by Sechrist et al.5 Section 4 provided an opportunity for subjects to write in brief comments about the ques- tionnaire or beliefs about exercise not addressed by the instrument. These re- sponses provide qualitative aspects to the data set.

This instrument was developed to ex- plore perceived benefits and barriers to exercise using constructs of Pender’s HPM.4 Each of the 43 items in the EBBS

featured a 4-point, forced-choice Likert format to obtain strength of agreement with the item statements. Choices were scored at: 4 = strongly agree, 3 = agree, 2 = disagree, and 1 = strongly disagree. The authors used Cronbach’s alpha tech- niques to measure internal consistency of the entire instrument; it achieved a score of .952. The 29-item scale of perceived benefits was measured at .953 and the 14-item perceived barriers scale at .866. Test-retest reliability measures were ob- tained by the authors of the EBBS, pro- viding correlation coefficients of .889 for the entire 43-item instrument, .893 for the 29-item benefits scale, and .772 for the 14-item barriers scale.5

Data analysis

The research analysis used elements of descriptive statistical methods, such as frequency distributions of responses to different areas of the EBBS. Correlations between the most frequently cited per- ceived benefits and barriers to exercise and current exercise habits are described using analysis of variance (ANOVA), chi- square analysis, and independent t test analysis. The alpha was set at 0.05.

RESULTS

Description of the sample

A total of 147 subjects, mean age 19.9 years, provided responses to the written questionnaire. The majority of subjects were female (82%) college un- dergraduate students enrolled in either a general anatomy/physiology class of- fered through the department of biology

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Table 1. Demographic data summary (N = 147)

Number %

Gender Male 26 17.7 Female 121 82.3

Marital status Married 0 0.0 Single 147 100.0

University status Freshmen 8 5.5 Sophomore 75 51.1 Junior 44 30.0 Senior 20 13.7

Current academic workload Full time 136 92.5 Part time 11 7.5

Employment status Full time 10 6.8 Part time 56 38.1 Not employed 81 55.1

Current association with 35 23.8 intercollegiate/ intramural sports

Positive family history of 105 71.4 cardiovascular disease

or an ethics class offered through the de- partment of philosophy. All subjects re- ported an academic workload of at least 12 semester hours. See Table 1 for a summary of study demographics.

Current exercise habits

Six subjects chose not to include cur- rent exercise habits in their response. Of the 141 subjects who did, 68.8% (n = 97) reported current exercise habits that included involvement of large mus-

cle groups, featured dynamic movement for periods of 20 minutes or longer (per- formed 3 days or more per week), and was of an intensity high enough to raise heart rate to at least 60% of maximum (maximum heart rate = 220 − age). These subjects were classified as “exer- cisers.” The remaining 31.2% (n = 44) reported exercise habits that did not meet established criteria for regular exercise and were classified as “non-exercisers.”

Perceived benefits to regular physical exercise

Perceived benefits to regular exercise were examined by 29 of 43 items of the EBBS. Overwhelmingly, responses with the highest mean scores (highest agree- ment) on statements regarding perceived benefits of exercise were those related to physical performance and appearance. Subjects agreed most strongly with the statement: “Exercise increases my level of physical fitness.” The second and third highest level of agreement was with the statements: “Exercise improves the way my body looks” and “My muscle tone is improved with exercise.” A ranked list of benefit statement scores and standard de- viations is featured in Table 2.

Perceived barriers to regular physical exercise

Perceived barriers to regular exercise were tabulated by the remaining 14 of 43 items of the EBBS. Although barrier items were similar Likert-type, forced- choice statements, scoring was reversed from 1 = strongly agree to 4 = strongly disagree. Consistent with responses to

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Table 2. Top exercise benefit statements

Statement Mean SD

1. Exercise increases my 3.55 .51 level of physical fitness

2. Exercise improves the 3.53 .54 way my body looks

3. My muscle tone is 3.46 .51 improved with exercise

4. Exercise gives me a 3.45 .63 sense of personal accomplishment

5. Exercise increases 3.44 .51 my muscle strength

SD, standard deviation.

benefit items, subjects reached the high- est agreement with statements within one category. Items within the realm of phys- ical exertion were perceived as the most substantial barriers to regular exercise. A ranked list of barrier statement scores and standard deviations is featured in Table 3.

Table 3. Top exercise barrier statements

Statement Mean SD

1. Exercise tires me 2.49 .69 2. Exercise is hard work 2.58 .79

for me 3. I am fatigued by exercise 2.71 .67 4. Exercising takes too much 2.79 .66

of my time 5. My family members do 3.14 .78

not encourage me to exercise

Note: Barrier statements are reverse-scored; lower mean scores indicate stronger agreement with the statement. SD, standard deviation.

Relationship between EBBS responses and reported exercise habits

By the use of mean perceived ben- efit and barrier scale scores on the EBBS, significant differences were found among subjects who exercised regularly and those who did not. Mean score benefit scale items were 3.28 (standard deviation [SD]=0.38) for exercisers compared with 2.94 (SD=0.36) for non- exercisers. This variance was significant at p < .001 using ANOVA. Not surpris- ingly, these results show that subjects who exercised regularly perceived signifi- cantly more benefits to exercise than non- exercising subjects.

Barrier subscale mean scores also var- ied substantially among those subjects who exercised and those who did not. While the mean barrier score for exercis- ers was 3.18 (SD=0.38), non-exercisers demonstrated a mean score of 2.80 (SD=0.32), significant at p < .001.

The most significant variances in in- dividual EBBS item mean scores were among perceived barriers to regular phys- ical exercise. Response to the statement, “Exercise takes too much of my time,” showed the most significant t value vari- ance among subjects who exercised and those who did not (p < .001). In addi- tion, response to the statements, “I am

Not surprisingly, subjects who exercised regularly perceived significantly more benefits to exercise than non-exercising subjects.

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too embarrassed to exercise” and “Exer- cise takes too much time from my fam- ily responsibilities,” demonstrated signif- icant variance between exercising and non-exercising subjects (p < .001).

Among benefit items of the EBBS, re- sponse to the statement “Exercise in- creases my stamina” created the most significant variance ( p < .001) between exercising and non-exercising subjects. In addition, responses to statements, “My muscle tone is improved with exer- cise” and “Exercise increases my muscle strength” varied significantly among sub- jects who exercised and those who did not ( p < .002 and p < .003, respectively).

Ninety-two percent of the male sub- jects met established criteria to be cate- gorized as exercisers while only 63% of female subjects could be categorized as exercisers. Chi-square analysis confirmed a significant difference in activity levels of male versus female ( p < .006), suggest- ing that among the sample group male subjects had a significantly higher rate of participation in regular exercise than fe- males. Results also showed that subjects who participated in intercollegiate or in- tramural sports programs demonstrated significantly higher rates of regular exer- cise than those not involved in such pro- grams ( p < .004).

There was no correlation between em- ployment and exercise habits suggest- ing that being employed did not pose a barrier to exercise although “Exercising takes too much time” was listed as a fre- quent barrier. There was no correlation between family history of cardiac disease and exercise habits suggesting that even with a potentially increased risk for car- diac disease, exercise habits did not in-

crease. Perhaps this population was too young to place importance on risk fac- tors that may not manifest themselves un- til middle age. Prevention apparently was not seen as an important issue, or sub- jects felt that their current physical condi- tion did not warrant a change in exercise behavior.

Individual responses to the questionnaire

A number of subjects identified moti- vating factors behind their exercise habits or beliefs such as prevention of exces- sive weight gain, stress relief, or improve- ment in sense of well-being and self- esteem. The personal barrier to exercise that was mentioned most often was time constraints. Other barriers included in- juries, medical conditions, and not believ- ing it necessary to exercise.

DISCUSSION

The rate of participation in regular physical activity reported among study subjects was higher than rates reported in studies of middle-aged and older adults, which ranged from 10% to 60%, and very similar to participation rates of adoles- cent children, estimated at 66% among those age 10 to 17 years.6–8 The re- ported physical activity levels of the sub- jects in this research study are encour- aging in light of widespread reports of declining activity levels among all Ameri- cans. These findings suggest virtually no drop-off in activity levels from those es- timated in young adolescents, age 10 to 17 years (66%).

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Perceived benefits of regular exercise were strongly associated with physical performance, appearance, and personal accomplishment. These findings are in accordance with previous studies suggest- ing that among male and female college undergraduates, health/fitness manage- ment and appearance/weight manage- ment were the most important reasons to exercise.9,10 In contrast, studies fea- turing middle-aged or older adults cited perceived benefits such as chronic disease management, weight control, stress man- agement, and personal enjoyment as the most important reasons to exercise.8,11

One would expect a younger population to be more concerned with performance and appearance rather than health issues such as chronic disease prevention.

Significant differences between the groups regarding barriers were strongly associated with time constraints, family responsibilities, and embarrassment. Al- though the reasons were not explored in this study, being embarrassed to exercise may be due to a weight issue, especially for females. These individuals are likely the ones who need the exercise most. En- couraging individual, rather than group, exercise may prove more successful for some people. Walking should be encour- aged as it requires no commuting, no gym membership, no audience, and no reveal- ing clothing. Earlier studies do not iden- tify specific perceived barriers to exercise among either young adults or college stu- dents. In middle-aged or older adults, pre- vious studies6,11 suggest that factors such as lack of time to exercise, lack of nearby facilities, and fatigue with and after exer- cise are the most common cited barriers to exercise in this population.

The EBBS was found to be useful in predicting exercise habits of the sam- ple group. Significant differences in per- ceived benefit and barrier scores of the EBBS were demonstrated among sub- jects who participated in regular exercise and those who did not. Not surprisingly, subjects who exercised perceived more benefits and fewer barriers than non- exercisers. Agreement with these findings has been reported in a number of previ- ous studies.11–14

Perceived barriers to exercise proved to be the most influential factors on reg- ular exercise habits among the sample group. Indeed, the most significant vari- ances in individual EBBS item scores that could be attributed to activity level were among perceived barrier items. More- over, these findings are consistent with those reported in a study of 233 female college students in which perceived bar- riers to exercise presented the highest negative correlation with total exercise minutes per week.15 A similar study8

demonstrated that 30% of the exercise variability among non-insulin-dependent diabetics could be attributed to perceived barriers.

Associations between current exercise levels and perception of benefits/barriers to regular exercise were consistent with theoretical constructs of the HPM. Un- der HPM constructs, perception of ben- efits and barriers to health-related behav- iors are recognized as highly motivational cues to action. As expected, those who perceived more benefits and fewer barri- ers to regular physical exercise reported higher rates of exercise. Since those who exercise realize the benefits, helping peo- ple make the decision to begin exercising

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may be the most difficult task. Using the stages of change16 along with the health promotion model can assist the practi- tioner in assessing the individual’s stage of readiness and implementing strategies to move that person forward to a stage of readiness. Once he or she is exercising, it is hoped that the benefits will motivate him or her to continue.

A higher percentage of male subjects (92% versus 63.8%) than female subjects reported regular physical exercise habits. This is consistent with other research2

that reported that males are more likely than females to participate in vigorous physical activity, strengthening activities, and walking or bicycling. Although the difference in reported exercise habits did prove to be significant, the small sample of male subjects (n = 26) may limit gen- eralization of these findings. Surprisingly, this predominantly female sample listed muscle tone and strength in the top five benefits of exercise. This suggests that these issues are no longer unique to the male gender and that men and women may have very similar reasons for exer- cise and sports participation.

Participation in organized intercolle- giate or intramural sports programs was significantly associated with regular exer- cise habits. These findings establish the value of social groups and organized cam- pus activities in promoting regular exer- cise habits among college students.

IMPLICATIONS

Since data collected in this study are self-reported, they should be interpreted with that in mind. Although it has been suggested that the highest rate of

decline in physical activity occurs in late adolescence and early adulthood in those age 18 to 24 years,2 the results of this study do not support a decline in physi- cal activity level during the college years. The critical years may occur after college graduation when individuals are not in school, perhaps for the first time in their lives. Cullen et al17 explored risk behav- iors in 5,881 students graduating from high school, a time of major life transi- tion. They found a significant decrease in exercise activity among the males in this sample as well as increases in other risk behaviors. Graduation from college, establishing full-time employment, and, for many, marrying and starting a fam- ily are also major life transitions and re- quire a new set of responsibilities and time management skills. This is likely to affect risk and health-promoting behav- iors. It is this population that needs tar- geting for enhancing participation in ex- ercise. Flexible work schedules adopted by some businesses and agencies are al- lowing for exercise time during daytime work hours. Time management skills could be useful when attempting to in- corporate regular exercise into the daily schedule.

Aspects of physical performance and appearance were most widely reported as benefits of regular physical activity. In contrast, time constraints and physical exertion/exhaustion related to exercise were the most widely reported perceived barriers to regular physical activity. It is important to teach the benefits of ad- equate rest, hydration, and nutrition in order to recover between exercise ses- sions. Exercisers of all ages should be counseled on the importance of gradual

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increases in frequency, duration, and in- tensity of exercise regimens and cau- tioned against the “weekend warrior” syndrome, which could lead to exhaus- tion or injury and therefore discourage

future exercise. Associating exercise as an integral part of a healthy, balanced lifestyle must be stressed in educating our youth in order to help people of all ages incorporate exercise as a lifelong activity.

REFERENCES

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2. US Department of Health and Human Services. Healthy People 2010. 2nd ed. Understanding and improving health. Volume 1. Washington, DC: US Government Printing Office, November 2000.

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4. Pender NJ. Health Promotion in Nursing Practice. 3rd ed. Stamford, CT: Appleton & Lange; 1996.

5. Sechrist KR, Walker SN, Pender NJ. Develop- ment and psychometric evaluation of the Exercise Benefits/Barriers Scale. Res Nurs Health. 1987; 10(6):357–365.

6. Grunbaum JA, Kann L, Kinchen SA, et al. Youth Risk Behavior Surveillance—National Alterna- tive High School Youth Behavior Survey, United States, 1998. Washington, DC: National Center for Chronic Disease Prevention and Health Promotion, US Dept of Health and Human Services; 1999.

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13. Bonheur B, Young SW. Exercise as a health- promoting lifestyle choice. Appl Nurs Res. 1991; 4(1):2–6.

14. Sherwood NE, Jeffrey RW. The behavioral determi- nants of exercise: implications for physical activity interventions. Annu Rev Nutr. 2000;20:21–44.

15. Ali NS. Predictors of osteoporosis prevention among college women. Am J Health Behav. 1996;20(6): 379–388.

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