Physical Activity Preferences, Preferred Sources of Assistance, andPerceived Barriers to Increased Activity among Physically

Inactive Australians1

MICHAEL L. BOOTH, PH.D.,*,2 ADRIAN BAUMAN, PH.D.,† NEVILLE OWEN, PH.D.,‡ AND CHRISTOPHER J. GORE, PH.D.§

Department of Public Health and Community Medicine, University of Sydney, Sydney, New South Wales 2006; †School of CommunityMedicine, University of New South Wales, Kensington, New South Wales 2033; ‡School of Human Movement, Deakin University,

Barwood, Victoria 3125; and §Australian Sports Commission, Adelaide, South Australia, Australia

Background. Participation in regular moderate orvigorous physical activity substantially reduces riskfor all-cause and cardiovascular-disease mortality andconfers other health benefits. Efforts to decrease thepopulation prevalence of inactivity will have a greaterimpact if they are tailored to the needs and prefer-ences of the community.Methods. In the Pilot Survey of the Fitness of Aus-

tralians, a questionnaire was administered to a ran-domlyselected sample of 2,298 adults and includedquestions on the preferred sources of assistance orsupport to become physically active, preferred activi-ties, and barriers to regular participation. The re-sponses of those who were identified as insufficientlyphysically active (n = 1,232; 53.6%) were examined formen andwomen separately and for those aged 18 to 39,40 to 59, and 60 to 78 years.Results. Themost-preferred activity was walking (38

and 68% of the youngest and oldest age groups, respec-tively). The most frequently cited barriers to more-regular participation in the youngest age group wereinsufficient time, lack of motivation and child care re-sponsibilities. Among those aged 60 to 78 years, injuryor poor health were the most frequently cited barriersto activity. The most-preferred source of advice or as-sistance changed with age: more than 50% of the oldestage group wanted advice from a health professional(compared with 22% of the youngest group) and theopportunity to exercise with a groupwas themost pre-ferred source of support for the youngest age group.Conclusions. The physical activity-related attributes

of men and women and of younger and older age

groups described in this study may be used to providemore relevant and appealing options for those whomight otherwise be missed by ‘‘one-size-fits-all’’ physi-cal activity promotion strategies. © 1997 Academic Press

Key Words: exercise, physical; health promotion;health behavior.

INTRODUCTION

Efforts to promote participation in physical activityare likely to be most effective if they address the needsand interests of particular target groups. Health pro-motion planning models emphasize the importance ofusing such information systematically [1]. Knowledgeof the types of activities in which people would prefer toparticipate is of value in planning communication cam-paigns, in planning intervention programs (for ex-ample, in worksites), in town planning and urban de-sign, and in the development of specific facilities. It isimportant to know the type of advice or support thatpeople would prefer to assist them to initiate or main-tain habitual physical activity, for informing the train-ing of professionals and for determining priorities inservice provision and public policy. Regardless of howfirmly people may believe that physical activity is ben-eficial to their health, there are many barriers thatmay limit or prevent regular activity. Whether thesebarriers are real or perceived, they represent signifi-cant potential obstructions to the adoption, mainte-nance, or resumption of participation in physical activ-ity. More comprehensive understanding of preferredactivities, preferred sources of assistance, and barriersto increased activity will improve efforts to foster in-creased participation in physical activity.There do not appear to be any reports in the litera-

ture on the preferred activities of sedentary people.Similarly, little is known about people’s preferredsources of assistance for becoming more physically ac-tive. Public health approaches to increasing participa-tion aim to activate the sedentary, but the very inac-

1 The 1990–1991 Pilot Survey of the Fitness of Australians, fromwhich the data reported here were drawn, was funded by the Com-monwealth Department of Art, Sport, the Environment, Tourismand Territories. The authors conceived the present study and con-ducted the analyses.

2 To whom reprint requests should be addressed at the Depart-ment of Public Health and Community Medicine A27, University ofSydney, New South Wales 2006, Australia. Fax: 61-2-351-7420; E-mail: mikeb@pub.health.su.oz.au.

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0091-7435/97 $25.00Copyright © 1997 by Academic Press

All rights of reproduction in any form reserved.

tive are less likely to want to attend structured orgroup-based programs [2] and may be more interestedin self-help or home-based methods [3]. Research onother health behaviors is particularly informative: forexample, a study of Australian’s preferences for assis-tance with smoking cessation found that physician ad-vice was strongly preferred and that women were morelikely than men to want to attend group-based pro-grams [4]. There exists a modest literature on the bar-riers to increased physical activity.Sallis and colleagues, in a large community-based

study, examined 24 potential determinants of physicalactivity, including a measure of the frequency withwhich different factors prevented people exercising(barriers) [5]. They found that ‘‘barriers to activity’’was most strongly and negatively associated with self-reported vigorous activity among younger men andwomen and among older men, and was the second moststrongly associated variable among older women. How-ever, when the same data were examined for correlatesof walking for exercise, barriers to activity was not asignificant factor [6]. Two years later the same re-searchers resurveyed the initial respondents and foundthat barriers to activity was strongly related to theadoption of vigorous activity over that period [7]. Thesefindings suggest that barriers to activity represents animportant determinant of participation in vigorous ac-tivity, but that barriers may be of less relevance towalking for health or exercise.Four studies, conducted on samples from three de-

veloped countries, have attempted to identify theprevalence of specific barriers to physical activity par-ticipation. Godin and colleagues examined the relativeimportance of five barriers in a community sample ofadults [8]. They found that the order of importance ofthe barriers was finding time, finding a partner to ex-ercise with, physical health problems, the financialcost, and lack of access to appropriate facilities. An-other Canadian study of barriers to activity comparedwomen who were sedentary, but who wanted to startexercise, with active women who wanted to do more [9].There were no substantial differences between the twogroups. Lack of time was the most frequently cited bar-rier to activity, followed by physical health reasons,lack of energy/motivation, child care responsibilities,and, finally, cost/access to facilities. A similar studyamong a sample of women in the United States foundthat lack of time was the most frequently identifiedbarrier followed by lack of money, lack of facilities, andlack of an exercise partner [10].Using pooled data from 17,053 participants in three

population surveys conducted in the mid-1980s, an ear-lier Australian study identified 29.7% of the sample assedentary in their recreational physical activity habits[11]. The three most commonly reported reasons forinactivity were no time (35%), physically unable (24%),and ‘‘don’t want to exercise’’ (13%). Such data sug-

gested different subgroups of the inactive, as a functionof age and gender, who may require different strategiesto encourage them to adopt regular physical activity.No time, being physically unable, and not wanting toexercise were more likely to be reported by those whowere older and who had lower incomes; the only excep-tion was that being 55 years or older was not associ-ated with having less time. Women were more likely toreport being physically unable to exercise. Lower in-come was associated with being physically unable andwith not wanting to exercise. Those with children,while wanting to exercise, were more likely to reporthaving no time. The results of these studies suggestthat perceived lack of time, poor health or injury, lackof motivation, and lack of facilities are the most preva-lent barriers. The results also suggest that the preva-lence of different barriers may vary across age groupsand between genders.The 1990–1991 Pilot Survey of the Fitness of Aus-

tralians asked respondents to a population survey (N4 2,298) to identify the physical activities in whichthey would prefer to participate, the sources of supportor assistance they would prefer to become more active,and the barriers they perceived as preventing themfrom becoming more active [12]. A self-report measureof leisure-time physical activity was used to classifyrespondents as sufficiently active (to gain the healthbenefits associated with physical activity) or as insuf-ficiently active [12,13]. We examined the activity pref-erences, the preferred sources of support, and the bar-riers to regular participation in physical activity re-ported by insufficiently active respondents to theAustralian survey, separately for men and women andfor those aged 18 to 39, 40 to 59, and 60 to 78 years.

METHODS

Survey Methods

A sample of Australian adults was drawn from met-ropolitan Adelaide, South Australia, using a two-stagesystematic random sampling procedure generated bythe Australian Bureau of Statistics (ABS) and designedto oversample older people. Stage 1 was a computer-ized random selection of Census Collectors’ Districts.Stage 2 comprised random selection of a start pointand a predetermined skip between dwellings. Within achosen dwelling every individual age 45 years andolder and every second person age 18–44 years wasselected. A more detailed description of the samplingmethods has been published elsewhere [14]. Informedconsent was obtained from all participants. The ques-tionnaire was administered in the respondents’ homesby trained interviewers employed by the ABS. Theproject was approved by the University of Adelaide Hu-man Ethics Committee.

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Measures

For the measure of leisure-time physical activity, re-spondents were presented with a list of 20 common lei-sure-time activities and asked to identify up to 5 activi-ties in which they had participated over the previous 2weeks, state the frequency, average duration, and per-ceived intensity (on a 4-point scale) of participation ineach activity. The rate of energy expenditure for eachintensity of participation for each activity, in metabolicequivalents, was multiplied by the total time engaged inthe activity over the past 2 weeks. The resultant valueswere expressed as kcal z day−1 z kg−1. These values weresummed to yield a total energy expenditure which wasused to classify respondents into one of two categories:sufficiently(ù1.8kcal zday−1 zkg−1)andinsufficiently(<1.8kcal z day−1 z kg−1). This measure of physical activity hasbeen found to have acceptable reliability and validity[15,16]. The insufficiently active group did not meet thecriterion of an equivalent of 30 min per day of moderate-intensity activity such as walking [17,18].Respondents were asked what activities they would

most like to do if they were to exercise (or to exercisemore if they were already active). A list of nine activi-ties (walking, swimming, team sports, racquet sports,jogging, gym, aerobics, cycling, and other) were avail-able to choose from andmultiple choices could be made.These activities had been found to account for mostleisure-time physical activity in earlier Australian sur-veys [19]. Respondents were also asked what type ofhelp they would prefer if they were to exercise more orto take up exercise, based on the findings of an earlierAustralian study of smokers’ preferred sources of as-sistance to quit [4] and following pretesting by theABS. Eight alternate responses were offered (abbrevia-tions used in the figures are shown in parentheses):Advice from doctor or other health professional (medadvice), a group of other people to exercise with(group), advice over the telephone (telephone), a video-tape on exercise (video), a book on how to exercise(book), an exercise ‘‘kit’’ with pamphlets and practicaltips (help kit), a course sent through the mail (mail),and no form of assistance (none).Finally, respondents were shown a list of 19 reasons

for not exercising (more) than they did currently andasked which applied to them. The barrier response op-tions were based on those used in an earlier Australianstudy [11] and were modified and extended followingpilot testing of the questionnaire, during which respon-dents were encouraged to identify barriers to physicalactivity participation. More than one reason (barrier)could be selected.

RESULTS

The data are presented for all respondents, for menand women and for 20-year age groups (18 to 39 years,40 to 59 years, and 60 to 78 years) for those who were

insufficiently active (n 4 1,232; 53.6% of the sample) toachieve most of the health benefits associated withregular physical activity.

Preferred Activities

Figure 1 (left) illustrates preferred activities for allinsufficiently active respondents and for insufficientlyactive men and women separately. More than half ofthe respondents said that their most preferred activitywas walking. The next two most popular choices wereswimming (nominated by 14% of respondents) andteam sports (nominated by 7% of respondents). Of theremaining activities, none was nominated by morethan 4% of the respondents. More women than mentended to nominate walking and aerobics and moremen than women nominated each of the other activi-ties, although the differences were not large for anyparticular activity.Figure 1 (right) illustrates the same data for the

three age groups. A large proportion (38%) of theyoungest age group selected walking as the preferredactivity, but substantial proportions also identifiedswimming (19%) and team sports (15%). Eight percentof the youngest age group nominated jogging or goingto a gym and less than 5% nominated any of the re-maining activities. Of those aged 40 to 59 years, 67%nominated walking and 10% nominated swimming.Less than 5% nominated the remaining activities. Inthe oldest age group, 68% preferred to walk for exerciseand 13% preferred swimming.

Preferred Sources of Support

Figure 2 (left) illustrates preferred sources of sup-port for all insufficiently active respondents and formen and women separately. The two most preferredsources of help were to receive advice on appropriateactivities from doctors or other health professionals(38% of all respondents) or to have the opportunity toexercise with a group (31% of all respondents). Al-though slightly more women than men wanted to ex-ercise with a group and slightly more men than womenwanted professional advice on appropriate activities,the differences were small. Approximately 20% of allrespondents did not want any advice or support.Figure 2 (right) illustrates the preferred sources of

support among the insufficiently active for three agegroups. Among those aged 18 to 39 years, more than40% wanted to be able to exercise with a group, but thiswas the case for only 27% of 40- to 59-year-olds and forfewer than 20% of those aged 60 to 78 years (x2 4 65.4,df 4 2, P < 0.01). More than 50% of those ages 60 ormore years wanted professional advice, 41% of 40- to59-year-olds wanted professional advice, but only 22%of the youngest age group preferred advice from ahealth professional (x2 4 68.6, df 4 2, P < 0.01).

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Barriers to Activity

Figure 3 (left) shows the barriers for all insufficientlyactive respondents and for men and women separately.The most frequently cited barrier to participation waslack of time (almost 40% of all respondents) and almost30% felt that they lacked motivation to exercise. Ap-proximately 20% of respondents had an injury or dis-ability that prevented them from being active and asimilar proportion perceived themselves as not being‘‘the sporty type.’’ Between 10 and 20% preferred torest, lacked company for exercise, cared for young chil-dren, had poor health, felt that they lacked persistence,lacked sufficient energy, or couldn’t afford to exercise.Each of the remaining barriers was nominated by lessthan 10% of the respondents. Substantially more menthan women wanted to rest and relax in their free time,but more women than men nominated each of the otherbarriers.Figure 3 (right) shows the barriers among insuffi-

ciently active respondents for three age groups. Thefigure illustrates large differences between differentage groups in the perceived barriers to participation inphysical activity. Approximately 45% of the two young-est age groups felt they did not have enough time forphysical activity, but only 20% of the oldest age groupfelt time to be a barrier (x2 4 70.6, df 4 2, P < 0.01).Similarly, 35% of the youngest age group and 30% of40- to 59-year-olds felt unmotivated to become active,

but only about 16% of the oldest group lacked motiva-tion (x2 4 32.3, df 4 2, P < 0.01). An injury preventedless than 20% of the youngest groups from being active,but it was a barrier for nearly 40% of the oldest agegroup (x2 4 57.4, df 4 2, P < 0.01). Similarly, a higherproportion of the oldest group (27%) reported poorhealth as a barrier to activity, compared with about10% of the two younger groups (x2 4 56.6, df 4 2, P <0.01). One-third of the youngest group reported thatresponsibility for child care was a barrier for them, butonly a small proportion of the two older groups wasconstrained by responsibility for children. Only 20% ofthose aged 60 to 78 years felt they were too old to beactive.

DISCUSSION

The most-preferred activity among those respon-dents who were insufficiently active was walking, evenin the youngest age group. Swimming was the nextmost-preferred activity for all age groups, followed byteam sports. None of the remaining activities werenominated by more than 10% of any group of respon-dents. Given these findings and the recent evidencethat regular walking (about 30 min per day) providesmost of the cardiovascular health benefits associatedwith physical activity it is clear that any public healthapproach to promoting greater participation in physi-cal activity would do well to focus on walking [18]. The

FIG. 1. Preferred activities for insufficiently active respondents: All respondents and men and women separately (left) and 20-year agecategories (right).

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very low proportions of respondents who nominatedgym, racquet sports, or aerobics as their preferred ac-tivity and that nominated lack of facilities or equip-ment as important barriers to participation indicatesthat increased public health investment in the provi-sion of such specific indoor exercise facilities may notbe warranted, at least in Australia. In countries withmore extreme climatic conditions (particularly verycold winters) this may be less likely to be the case.With regard to potential sources of assistance or sup-

port to become active, preference for advice from a doc-tor or health professional increased with increasingage and the preference to be able to exercise with agroup was common among younger people, decreasingwith increasing age. Older people were significantlyless likely to want to exercise in a group. This findingmay be of some public health importance. Group-basedapproaches for inactive older people may be a strategywhich is not generally appealing. We would even offerthe speculation that groups may attract only thoseolder people who already are active. With regard tobarriers to participation in physical activity, theyounger age groups were more likely to report thattime, motivation, and child care responsibilities werebarriers, whereas a much greater proportion of olderpeople reported that injury or poor health were barri-ers to becoming active. These findings may usefully

inform the development of strategies to promote higherlevels of participation in physical activity. Any strategywould do well to place an emphasis on walking, regard-less of whether it involves social marketing, environ-mental change, or policy development. Although hav-ing insufficient time to be active appears to be a diffi-cult barrier to overcome, people may be encouraged tointegrate walking with other daily activities such aswork, commuting, and child care. The promotion ofswimming and team sports may be worthwhile, but arelikely to have a smaller impact.Strategies which target younger people could pro-

mote walking and other activities and should seek tocreate opportunities for group activities. Strategieswhich target older people may best be promotedthrough general medical practitioners with an empha-sis on walking, but with the provision of advice on ac-tivities appropriate to the individual’s health status[20]. For example, many older people with arthritismay believe that they should remain sedentary,whereas supervised activity in warm water may bebeneficial.Comprehensive, community-wide exercise promo-

tion strategies are likely to have a greater impact ifthey are tailored to the attributes of key target groups[21]. Our findings particularly highlight how differentolder people are from those who are younger, on a num-

FIG. 2. Preferred sources of support to initiate activity for insufficiently active respondents: All respondents and men and womenseparately (left) and 20-year age categories (right).

PHYSICAL ACTIVITY PROMOTION 135

ber of attributes relevant to prompting and providingappropriate opportunities to be active. An earlier studyfound older people were much more likely to be precon-templators (not active and no intention to become ac-tive) for exercise [22]. But it should not be assumedthat these attributes of older people mean that they arenot likely to be responsive to activity campaigns or pro-grams. For example, a nationwide physical activitycampaign in Australia in 1990 had its most significantimpact on people who were older and less well edu-cated, although no such effects were apparent in a fol-low-up campaign in 1991 [23,24].The physical activity-related preferences and barri-

ers of men and women and of younger and older agegroups we have described here should not be inter-preted primarily as constraints or inherent limitations.Rather, they help to identify modifiable preferencesand perceptions, which may be used to provide morerelevant and appealing options for those who mightotherwise be missed by ‘‘one-size-fits-all’’ strategies[13,21].

APPENDIX

List of reasons (barriers) provided to respondents(abbreviations used in the figures are shown in paren-theses):I haven’t got time (no time).My health is not good enough (poor health).There’s no one to do it with (no company).I can’t afford it (can’t afford).I’m too old (too old).I have an injury or disability that stops me (injury).

I’m too shy or embarrassed (too shy).I’m not the sporty type (not sporty).There’s no suitable facilities nearby (no facilities).I need to rest and relax in my spare time (need rest).I’ve got young children to look after (children).I’m too lazy/not motivated/can’t get started (no mo-

tivation).I might get injured or damage my health (fear in-

jury).I don’t enjoy physical activity (don’t enjoy).I haven’t got the right clothes or equipment (no

equipment).I’d never keep it up (lack persistence).I’m too fat (too fat).I haven’t got the energy (no energy).Other (other).

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