Abstract
Little attention has been paid to the physical activity (PA) and nutrition behaviors of middle-aged men; thus, the aim of this study was to gather information and gain insight into the PA and nutrition behaviors of these men. Six focus group sessions were undertaken with middle-aged men (
Introduction
Despite an abundance of evidence surrounding the health benefits associated with physical activity and healthy nutrition, an alarming proportion of the adult population continue to lead sedentary or low-active, unhealthy lifestyles (Allender, Foster, Scarborough, & Rayner, 2007; Brown, Bauman, & Owen, 2009; Owen, Bauman, & Brown, 2009; Tucker, Welk, & Beyler, 2011). Of particular concern are the links between physical inactivity, diet, and chronic disease for men. Men have a shorter life expectancy and experience higher rates of chronic diseases such as coronary heart disease, type 2 diabetes, obesity, and mental health issues directly related to stress, when compared with their female counterparts (Department of Health and Ageing, 2010a; Directorate-General for Health and Consumers, 2011; Griffith, Gunter, & Allen, 2011). Physical inactivity and low fruit and vegetable intake are recognized as the main modifiable risk factors that contribute to poor health and the burden of disease in men (Department of Health and Ageing, 2010a; Directorate-General for Health and Consumers, 2011; National Center for Health Statistics, 2010). In Australia, for example, less than half (48.5%) of men reported participating in sufficient levels of physical activity—that is, 150 minutes or more of moderate and/or vigorous physical activity in a 1-week period (Australian Institute of Health and Welfare, 2010). Similarly, only 46% of them met the recommended daily intake for fruit and 7% met the recommended daily intake for vegetables. Furthermore, total daily saturated fat intake contributed to 12.7% of total energy intake for men, which is much higher than the recommended amount of <8% of total energy intake (Australian Bureau of Statistics, 1998).
In a health context, males, particularly those categorized as middle aged, are a particularly hard-to-reach population group. The recently published National Male Health Policy, which was developed in consultation with Australian men to address specific priority areas in men’s health, recognizes that engaging men in preventive health measures, such as physical activity and healthy eating, is, and has always been, a major challenge (Department of Health and Ageing, 2010a). For example, it has been found that male participants are less willing than female participants to attend health education sessions, are less interested in information concerning illness prevention, and are less willing to have an annual health check or seek advice from a health professional (Deeks, Lombard, Michelmore, & Teede, 2009). This trend is not isolated to Australian men alone but is internationally widespread (Chenier, 2002; Directorate-General for Health and Consumers, 2011; National Center for Health Statistics, 2010).To effectively “reach” men and have them engage in health promotion initiatives, intervention initiatives/programs need to be tailored to their specific needs.
There is a clear gap in the research literature addressing the physical activity and healthy eating needs of males; little male-specific research has been undertaken, and best practice approaches have not being identified. The majority of research concerning sedentary lifestyles, unhealthy eating, and obesity have predominately included female samples (Kumanyika et al., 2008). Reviews have pointed out that more than 65% of participants in physical activity interventions are females, which makes it hard to translate the outcomes to males (Vandelanotte, Spathonis, Eakin, & Owen, 2007). Hence, little is known about what men want or what works for them when considering their physical activity and nutrition behaviors. Robertson (2003) emphasized the need to take time to understand how specific aspects have an impact on men’s health practices in order to generate more opportunities for engagement and to inherently identify ways to facilitate change. Thus, to inform the development of men-centered interventions, it is necessary that health professionals gain a comprehensive understanding of
Method
This study was conducted with Australian men living in the Gladstone region area of Central Queensland, Australia, which encompasses a main regional center (Gladstone City) and 17 other regional, rural, and coastal townships. The region is represented by slightly more men (51%) than women (49%), with an estimated 8,434 men classified as “middle-aged” (between the ages of 34 and 54 years; Australian Bureau of Statistics, 2011). Employment in the region tends to be in trade/laborer positions, contributing to the slightly higher proportion of men. In this study, participants included men working at a large electrical power station, a chemical manufacturing facility, and in the maintenance department at the local university campus.
With assistance from management of the local industries and organizations within the Gladstone region, middle-aged men were recruited to take part in focus group sessions between March and June 2010. Focus group research was chosen as it is recognized as the best method to draw on respondents’ attitudes, feelings, beliefs, experiences, and reactions in a way in which it would not be feasible using other methods, for example, one-to-one interviewing (Krueger, 1988). Participation was completely voluntary, and participants were informed that they could withdraw their participation at anytime throughout the session.
One researcher acted as the moderator, guiding the discussion and providing assistance where needed, while a second researcher took notes and was responsible for the audio recording of each session. Focus groups were held at a location convenient for participants (most were held in a common room at the place of employment) and ranged from 45 to 90 minutes in duration. During this time, participants were encouraged to share their opinions, perceptions, and beliefs regarding the challenges and motivations to physical activity participation and healthy eating. Questions in the focus group schedule (see the appendix) were guided by the objectives of the project and based on previous literature concerning the physical activity and nutrition behaviors of men (Burton, Walsh, & Brown, 2008; Gough & Conner, 2006). Following each of the sessions the data were professionally transcribed verbatim.
Using an inductive approach, data analysis focused on eliciting themes concerning the challenges and motivations to men’s physical activity participation and health eating behaviors. Two research team members systematically read the transcripts multiple times, highlighted segments of interest, and made annotated comments on the transcripts to identify potential themes. Emerging themes were summarized and categorized during the process of reading and rereading. Members of the research team reached consensus concerning emerging themes through a process of ongoing discussion to mutually resolve any discrepancies. Final themes were identified by the researchers and are summarized in the Results section.
Ethical approval was obtained from the Central Queensland University Human Research Ethics Committee, and all participants gave written informed consent prior to each focus group session.
Results
A total of 30 men participated in the six focus group sessions. Mean age was 43.8 (
Characteristics of Participants
Physical Activity Behaviors and Experiences
Knowledge and awareness of physical activity
The majority of participants had a very good understanding of what constitutes physical activity and were aware that guidelines for physical activity exist. Common responses from participants included “it is anything that increases your heart rate” or “expends kilojoules” and “any type of movement, sport or leisure including housework, gardening, walking, swimming, sexual activity.” Interestingly, many participants also acknowledged that being physically active also meant decreasing sedentary time. Common responses included “It’s about not being sedentary” or “It’s anything apart from sleeping or sitting down.”
When prompted to discuss how much or what type of activity was enough for health benefits, many participants acknowledged that there was a minimum recommendation, suggesting that this should include “continuous activity ranging from 20 to 30 minutes, 2 to 3 times a week” or “3 to 4 times a week of moderate activity where your heart rate begins to climb and you are feeling that you are putting effort in it.” Participants also recognized that vigorous activity should be included, indicating “some harder sessions are also needed.”
Barriers and challenges of physical activity
A key theme that resonated among the men was finding the time to be physically active, indicating that other factors took priority, in particular work, child care, and family responsibilities. Participants indicated that any “spare” or “leisure” time they may have before work, after work, or on weekends is spent on accommodating their children or family’s needs, such as taking their children to sport or extracurricular activities or spending time with other family members.
Another common barrier reported by the participants included laziness or lack of motivation to be physically active, indicating that many of the physical activity programs that are on offer (other than sport) do not appeal to their interests.
Motivations for engaging in physical activity
In addition to the barriers and challenges reported by the participants, many also outlined a number of motivations or reasons why they should engage in regular physical activity. Common responses from participants included the following: “for better health,” “to lose weight and feel better,” and “prevent disease.” More interestingly, the majority of the men indicated that they wanted to be good role models for their children and educate them about healthy living. One participant summarized the words of many, “I want to set an example for my kids and be able to keep up with them.”
Participants also acknowledge the importance of a good quality of life, recognizing that they were getting older and, thus, wanted to make sure they stayed healthy enough to undertake essential daily activities as well as continue doing other things (e.g., recreation, travel, hobbies) that they enjoyed. For example,
I think most people want to be fairly healthy when they get older. So you make some sort of effort so that by the time you’re sort of reaching 50,60,70, you’re not invalid and feel like you’ve done something positive.
Fear of becoming ill due to an unhealthy lifestyle has (or would) also motivated them to change their physical activity and nutrition behaviors. The following quote resonates with the participants’ responses:
There were a couple of things that happened at the time but it drove me to think about it. It was probably one of my first medicals that I had here. I started to realize where I was and it wasn’t looking pretty so I decided to change it.
Nutritional and Dietary Behaviors
Knowledge of healthy eating
The majority of participants could distinguish between what types of food are considered healthy and good for you and what types would be considered unhealthy. The participants suggested that they should be consuming plenty of fruit and vegetables as well as foods high in fiber. They also indicated that they should stay clear of processed foods and should limit their alcohol intake. Unlike physical activity, however, participants were not necessarily clear as to the recommended amounts or portion sizes they should be consuming. This was increasingly evident when discussing meat (red meat). Participants had mixed responses regarding the amount of meat, with some indicating that meat should be consumed one to two times a week, several suggesting two to four times a week, and others proposing every day. Although the men were not clear as to specific nutritional guidelines or recommendations, most of them did however highlight the importance of watching portion sizes, having a well-balanced diet, not overeating, and eating less unhealthy foods (such as chips, cookies, cakes, and fast foods) in moderation.
Without prompting, participants also revealed that part of their confusion regarding healthy eating, specifically with recommendations and guidelines, came from the mixed messages presented by the media, stating that “one day they say this is good, but then the next day they say it is bad, very confusing” and,
It’s not dead set straight and fixed on what’s healthy because everyone has a different opinion on it. There’s that much difference in opinion on what’s healthy out there that it becomes very confusing for one.
Barriers and challenges to healthy eating
Poor cooking skills and unfamiliarity with preparing meals restricted the majority of men from cooking healthy, well-balanced meals. For example, one participant stated, “I suppose with a lack of time over the years we’ve got to the stage where you just don’t put the time into thought about the meal and preparation of the meal.” More specifically, participants indicated that it takes more time and effort (than they are willing to put in) to prepare and make good, healthy food; hence, they would chose precooked frozen foods as a quick, easy, and more “appetizing” alternative.
The cost and availability of good foods in regional Queensland was also seen as a barrier. Participants pointed out that living in regional central Queensland, items such as fresh fruits and vegetables can be very expensive compared with the cost of these items in the southeast corner (urban area) of Queensland. A number of participants mentioned that this was exacerbated in particular male populations, such as older men who are on old age pensions and men from lower socioeconomic areas. Apart from the higher cost, limited availability of good-quality food was also considered as a barrier to healthy eating when living in a regional area.
Motivations for healthy eating
Consistently throughout all the focus groups, participants indicated that weight loss/maintenance was a motivator for healthy eating. Many also indicated that they were motivated to begin or continue eating healthily to prevent, reduce the risk of, and/or manage disease, such as cardiovascular disease. Some participants revealed that “feeling good” and “having more energy” motivated them to eat healthier more regularly and to stay clear of unhealthy food. One participant described how that once you start to eat healthy food and feel the difference, you are more motivated to choose the healthier option:
I went on a low fat diet, and for a long time after that I just didn’t find fat appealing, you just go right off it. So if you start eating a lot of fruit and veg and you cut out fat, you know, you look at the pub over there and look at the big meal, and you think I don’t want to eat that.
It was interesting to see that some participants also made the link between physical activity and healthy eating, indicating that they felt the best when they were being physically active and eating well on a regular basis. This overall well-being kept them motivated to continue practicing these healthy behaviors.
Discussion
In the area of physical activity behaviors and experiences, participant responses and discussion revolved around three themes: knowledge and awareness of physical activity, barriers and challenges to physical activity, and motivations for engaging in physical activity. With regard to knowledge and awareness, participants had a very good understanding of what constitutes physical activity, including how much and what type of activity should be undertaken for health benefits. This is not surprising given the documented success of many large mass media campaigns in creating physical activity awareness and understanding, both nationally and internationally (Bauman, Armstrong, et al., 2003; Bauman, McLean, et al., 2003; Craig, Bauman, Gauvin, Robertson, & Murumets, 2009). Recent media campaigns regarding physical activity have flooded numerous media outlets throughout Queensland (e.g., TV, radio, and newsprint), providing a clear message concerning the benefits of physical activity, what types of activities will give you these benefits, and what “dose” of these activities is needed to gain these health benefits. Campaigns such as “find your 30” (Queensland Government Department of Communities, 2009) and “measure up” (Department of Health and Ageing, 2010b) provide a clear understanding that physical activity can help prevent and reduce the risk of a number of chronic diseases, that to get these benefits you should engage in 30 minutes of moderate activity a day, and that these activities could include any movement such as sport, walking, gardening, active transport, occupational activity, and many more.
Consistent with the literature, many of the participants indicated that there are several barriers that limit them from being active, such as time to undertake physical activity, laziness, or lack of motivation and interruptions to their physical activity routine due to holidays and/or vacations (Trost, Owen, Bauman, Sallis, & Brown, 2002). It is interesting to observe that men in this study indicated that lack of time due to child care and family commitments was the number one barrier restricting them from being physically active given that the majority of literature indicates that this barrier is more consistently associated with women’s inactivity rather than that of men (Andajani-Sutjahjo, Ball, Warren, Inglis, & Crawford, 2004; Osuji, Lovegreen, Elliott, & Brownson, 2006; Reichert, Barros, Domingues, & Hallal, 2007). However, given the fact that more and more women are in full-time work, this may be a barrier that is affecting men just as much, as more dual-income families are now required to share parental and family responsibilities. According to the National Study of the Changing Workforce (Galinsky, Aumann, & Bond, 2009), employed fathers are spending more time with children today than they did three decades ago and are taking on more overall responsibility for the care of their children, limiting their time to do other things. Considering this, health professionals need to understand this shift in family responsibility when developing physical activity programs for men and develop initiatives that fit into the context of their daily lives rather than just their leisure time.
The men also indicated that laziness or a lack of motivation is a barrier to engaging in physical activity. This is not a barrier exclusive to men but is frequently reported by many populations including women (Kowal & Fortier, 2007), youth (Gyurcsik, Spink, Bray, Chad, & Kwan, 2006), older adults (Brawley, Rejeski, & King, 2003), aboriginal groups (Nelson, Abbott, & Macdonald, 2010), and those from culturally and linguistically diverse groups (Caperchione, Kolt, & Mummery, 2009). This is clearly a barrier that requires further consideration for a number of populations; however, with regard to men, one consideration might be to entice or encourage participation by means of “friendly” competition. Earlier research (King, 1998) has suggested that competition at worksites, schools, and other settings is an approach that could be used to promote physical activity participation. Findings of Burton et al. (2008) lend support to this, indicating that not only do men prefer an enjoyable level of competition, they also prefer sport-related activities (e.g., golf, tennis, cycling), team sports, (including touch football, basketball), and/or activities that involve greater intensity levels (e.g., swimming, gym-based exercise, and boxing).
Despite the barriers or challenges to physical activity, participants also recognized particular motivations to becoming, or to continue to be, physically active. Not surprisingly, the prevention of illness and the associated physical and mental health benefits provided personal motivation for the majority of participants. Participants were aware of the consequences associated with physical inactivity and the benefits associated with being physically active (cost–benefit analysis), yet several sources indicate that men have poorer health outcomes associated with physical inactivity (Department of Health and Ageing, 2010a). Thus, the utility of focusing on the benefits of activity as the sole motivating factor to increase participation is unknown. However, this approach may be enhanced when paired with benefits that a physically active lifestyle may have for other parts of men’s lives such as family (Lewis, Thomas, Hyde, Castle, & Komesaroff, 2011), as a number of participants indicated that being good role models for their children was a motivating factor to undertake physical activity. Available evidence surrounding this modeling effect on children’s behavior is equivocal (Gustafson & Rhodes, 2006), yet the male participants viewed it as an important reason to engage in healthy behaviors themselves. This may be a potential avenue to translate the good intentions and knowledge of physical activity of male parents into actions.
Similar to the physical activity behaviors and experiences area, responses and discussions around nutrition were concentrated around three themes: knowledge of healthy eating, barriers and challenges to healthy eating, and motivations for healthy eating. Participant perceptions or understandings of healthy and unhealthy food and portions sizes were consistent with previous literature (Paquette, 2005). Moreover, the misperceptions and misunderstandings around these ever-changing nutrition and dietary messages have also been continuously supported by research (van Dillen, Hiddink, Koelen, de Graaf, & van Woerkum, 2003). In the current study, participants clearly indicated that although they had some knowledge of healthy eating, they were regularly confused by the mixed messages presented by the media. This is consistent with previous research, indicating that nutritional information is often presented in a number of complex ways, which does not necessarily provide meaningful messages to the general public (Gough & Conner, 2006; van Dillen et al., 2003). Previous literature has also suggested that these misperceptions continue to be an obstacle to understanding the complexity of healthy eating, yet little research assessing the precise aspects of these perceptions has since been carried out (Gustafsson & Sidenvall, 2002; Paquette, 2005).
Participants outlined specific barriers and challenges that restricted them from healthy eating, including lack of time, poor cooking skills, unfamiliarity with preparing meals, and cost and availability of good quality foods. Lack of time is one of the most frequently reported barriers to healthy eating for both men and women (Biloukha & Utermohlen, 2001; Gough & Conner, 2006; Lappalainen et al., 1997), highlighting that their time is most often constrained by work commitments and other lifestyle choices (Gough & Conner, 2006). With changes in the global structure, both economically and politically, time will continue to be a constraint for daily living. Thus, finding more time is not the solution, but rather managing one’s time in order to prioritize and to carry out daily necessities is crucial. In Australia, both parents work in 65% of households, making it more difficult to find time to select healthy foods and prepare healthy meals (Department of the Prime Minister and Cabinet, 2008). Given that this will not likely change in the near future, health professionals need to develop strategies in which important tasks, such as healthy food preparation, fit into the context of daily living. Equal task sharing among all household residents when it comes to food selection and preparation and the willingness to learn new time-saving cooking techniques are potential avenues for consideration.
Consistent with the current study, poor cooking skills and unfamiliarity with preparing meals has previously been linked to men’s poor eating habits (van der Horst, Brunner, & Siegrist, 2010). In particular, researchers have highlighted that due to poor cooking skills, men are more likely to consume readymade meals and fast food, leading to their poor dietary behaviors. Traditionally, cooking has been predominately regarded as a female practice, suggesting that cooking is “women’s business” while performing more male-like duties such as mowing the lawn would be considered “men’s business” (Roos, Prattala, & Koski, 2001). As a consequence of such conceptualizations, it is possible that men do not value the skill of cooking and thus are reluctant to learn the skills associated with cooking. However, with the launch of new cooking books, websites, and television shows devoted to the male chef/cook, the skill of cooking may become more appealing to the male audience. For instance, Chefs such as Gordon Ramsey, Curtis Stone, and Jamie Oliver are putting a masculine spin on cooking and showing male audiences simple, quick, and easy recipes that are appetizing and healthy. These celebrity chefs and the many books and websites catering to the food interests and preferences of men may have the potential to shift the way men think about cooking and get them interested in learning more about food and how to prepare it.
The cost and availability of good-quality foods is not isolated to men alone, but has consistently been revealed as a barrier to many households (Waterlander, de Mul, Schuit, Seidell, & Steenhuis, 2010), in particular to those living in low socioeconomic (John & Ziebland, 2004) and rural/remote areas (Burns, Gibbon, Boak, Baudinette, & Dunbar, 2004). Although many of the participants in this study do not fit into the lower socioeconomic category, they do, however, live in what would be considered a regional area, surrounded by more remote townships. As a consequence, access to quality foods is sometimes challenging and the foods that are accessible tend to be priced higher than more urban centers. One potential solution for overcoming this barrier is the use of pricing strategies. In particular, providing price-cuts and discounts on healthier foods more often, while making unhealthier foods more expensive, has recently been suggested by food experts (Waterlander, Steenhuis, de Vet, Schuit, & Seidell, 2011). However, this is a solution that will need to be supported by local government and food retailers. Working in partnership with these organizations to develop such solutions may be a good starting point.
The concern with weight/overweight and other health issues, resulting from unhealthy eating, was the main motivator to undertaking a healthy diet. Gough and Conner (2006) observed that men were prompted to undertake a healthy diet by their potential vulnerability to health problems, in particular health problems associated with being overweight. More interesting is that participants in Gough and Conner’s study believed that they could overlook healthy eating if they replaced this behavior with more appealing ways to maintain their health, such as sport or physical activity. This was not supported by the current study as participants made a clear link between the need for both physical activity and proper nutrition, with many perceiving that both behaviors would have the greatest effect on their overall health; however, findings from Gough and Conner’s (2006) study indicated that men did not see the relevance of undertaking both. Most recently, Lewis et al. (2011) indicated that at the most basic level, men did associate inactivity and diet with weight gain and obesity; however, they emphasized that the primary cause for their weight gain over the years was an increase in sedentary behaviors rather than a change in eating behaviors. These mixed results warrant further investigation at an intervention level.
A particular strength of this research was the ability to extract valuable information from a very hard-to-reach population, middle-aged men. Little male-specific research has been undertaken and best practice approaches have not being identified; thus, the insights gained from the current study provide some much needed insight into the physical activity and nutrition behaviors for this population.
Although this study has made a significant contribution to the literature, the inclusion of only six focus groups makes it difficult to generalize the findings across the greater spectrum of middle-aged men in Australia. Future work should focus on large representative sampling, throughout all states in Australia. Moreover, the sample in this study included educated men with an above average income; thus, future sampling should also include men of different sociodemographics (such as education and income) and men of other ages as the barriers and challenges to physical activity and good nutrition behaviors may vary depending on these factors. For instance, older aged men often struggle with their health due to a fixed income, poor dietary practices, and taking many medications; thus, they are a subpopulation that may benefit from further study.
Last, with limited research concerning physical activity and nutrition for this population, the aim of this study was exploratory in nature and thus a broad approach was taken to gain preliminary insight of the perceptions of middle-aged men. More comprehensive methodologies, such as intervention research, are needed to provide greater detail surrounding some of the outcomes initially revealed by the current study.
Footnotes
Appendix
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Queensland Health provided funding to conduct this project. Vandelanotte is supported by National Health and Medical Research Council of Australia (#519778) and National Heart Foundation of Australia (#PH 07B 3303) postdoctoral research fellowship.