Barriers to Physical Activity in Women

Abstract

Despite the clear benefits of physical activity for women, few women obtain the recommended levels of physical activity. To address adherence to physical activity in this group, it is important to understand the barriers to physical activity that affect women. These barriers may include lack of time; anticipated lack of enjoyment; self-consciousness about body size, shape, and physical activity ability; and urinary incontinence. By addressing barriers to physical activity, health care providers may experience greater success in their efforts to increase physical activity in their female patients.

‘The benefits of physical activity for women are clear; however, fewer women than men engage in recommended levels of physical activity.’

The benefits of physical activity for women are clear; however, fewer women than men engage in recommended levels of physical activity. ¹ Gender differences in physical activity levels begin during the teenage years and persist in adulthood. ² As discussed in this issue by Bassuk and Manson, there are several methods that health care providers (HCPs) can use to promote physical activity in their patients. ³ These methods include the incorporation of physical activity into daily life, ⁴ goal setting, ⁵ and self-monitoring of physical activity. ⁶ However, multiple barriers to physical activity exist for women that significantly reduce the likelihood that they will engage in physical activity long term.^7,8 Though not an exhaustive list, such barriers may include lack of time; anticipated lack of enjoyment; self-consciousness about body size, shape, and physical activity ability; and urinary incontinence.

Lack of Time

Despite increased representation of women in the workplace, women continue to perform the majority of household tasks ⁹ leaving little time for extracurricular activities such as prescriptive physical act ivity. Women with children under the age of 15 are particularly at risk for low levels of physical activity,^10-12 often reporting lack of child care as a reason for inactivity. ¹³ In addition to women who work and take care of household duties being limited in their time for physical activity, many homemakers also report feeling selfish when choosing to take time away from family and household responsibilities to engage in physical activity.^11,14 A perceived lack of time and feelings of guilt present significant barriers to the promotion of physical activity in women, especially those with young children.

Predicted Lack of Enjoyment

Another common correlate of women with low levels of physical activity is the expectation that physical activity will not be enjoyable. ¹⁵ Only 7% of inactive women endorsed that exercise is an enjoyable experience compared with 60% of active women. This discrepancy may reflect a self-selective process with women who find physical activity enjoyable being more likely to engage in it compared with those who do not find it enjoyable. Alternatively, the belief that physical activity is not enjoyable may be maintained through the avoidance of physical activity. Because physical activity is known to improve mood, ¹⁶ it is likely that if inactive women could be encouraged to slowly increase their physical activity levels, they too might find physical activity more pleasurable. Regardless, HCPs may find it especially challenging to promote increased physical activity among women with negative expectations regarding the potential for enjoyment.

Self-Consciousness

The perception that one is overweight or “too fat to exercise” is associated with lower levels of physical activity, especially in women. ¹⁷ While this perception may be related to feeling physically incapable of participating in physical activity, the perception of one’s self as too fat is often related to feeling self-conscious of one’s body size, shape, and athletic ability. ¹⁷ These concerns have also been reported in healthy weight women who perceive themselves as overweight. ¹⁸ Feeling uncomfortable about the way that one’s body appears while performing physical activity and how athletic clothing fits can be a significant deterrent to engaging in certain types of physical activity that take place in public such as walking or going to the gym. This may be especially problematic because women may feel less comfortable working out with friends, thus limiting social support, which is known to promote long-term engagement in healthy lifestyles. ⁷

Urinary Incontinence

Urinary incontinence is a common problem among women. Approximately half of all women report occasional leakage of urine, and 5% to 10% report daily leakage. ¹⁹ Leaking urine during sporting activities or exercise is common among young and older women, though even more so among middle-age women. ²⁰ The increased frequency of incontinence in middle-age women is most often associated with childbirth but is also part of the natural aging process for some women.^21,22 In addition, being overweight or obese puts women at greater risk for incontinence.^23,24 Urinary incontinence has been reported to be a significant barrier to exercise, particularly among women with daily and very severe incontinence.^20,25 Although urinary incontinence is a common problem among women, many women feel embarrassed and fail to mention it to their physician. ²⁶

The Role of the HCP

These barriers present challenges for HCPs aiming to promote long-term adherence to physical activity among their female patients. By understanding the unique challenges faced by each individual, HCPs may be able to tailor recommendations for increased physical activity in a way that is more likely to be accepted and maintained by female patients.

Lifestyle Physical Activity

Lifestyle activity involves the incorporation of short bouts of moderate to vigorous physical activity into the daily routine in order to reach an overall goal of 30 or more minutes of physical activity a day.^27-31 Several short bouts of moderate to vigorous physical activity have been shown to be as effective in improving markers of health as one longer bout. ³² By making a few small changes to the daily routine, women can incorporate physical activity into their daily life. Some examples include walking around a track while waiting in the carpool line, parking in the back of the parking lot, taking the stairs, walking instead of driving to perform an errand, and playing outside with their children. Lifestyle physical activity has been shown to be efficacious in helping individuals meet a goal for physical activity, and there is evidence that a large percentage of individuals maintain these levels for at least 2 years. ⁴ Because women do not have to set aside time to go to the gym or participate in a sport, they may be more likely to start and continue a new physical activity regimen.^4,11,33 Additionally, lifestyle activity has been suggested as a method that may be successful in making small gradual increases in physical activity and improving women’s expectations regarding the enjoyment of physical activity. ³⁴ Finally, because lifestyle physical activity does not involve the need to change into workout clothing, women who are self-conscious about engaging in physical activity may be able to do so without signaling to others that they are exercising, reducing their perception of being scrutinized.

Addressing Urinary Incontinence

Because women may consider urinary incontinence to be a normal part of the aging process or may be too embarrassed to tell their HCP about the concern, it is important for the HCP to ask about incontinence. ⁷ Urine leakage is more likely to occur during vigorous activity; thus, moderate physical activity such as walking may be recommended to these individuals. ²⁵ It may also be helpful to educate women with incontinence that they are not alone and that almost half of middle-age women reported that they leaked urine during exercise. ²⁰ Providing women with practical suggestions such as wearing a pad during exercise (as done by many elite female athletes) and voiding prior to exercise may also be helpful. ³⁵

Conclusion

Overall, it is important that HCPs consider specific barriers to physical activity that women may face. Individualization of treatment recommendations is critical in lifestyle medicine. Although HCPs have limited time with patients, being aware of and inquiring about common barriers may facilitate a solution-focused discussion and increase the likelihood that patients adopt recommendations for physical activity. HCPs should consider options for physical activity outside of the traditional gym-based paradigm. Ultimately, the goal is to identify potential barriers and to increase the patient’s self-efficacy to overcome these barriers. By addressing these issues, HCPs may be more successful in their attempts to promote physical activity.