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Abstract:
Adults who exercise regularly have better health, but only 15% of U.S. adults engage in regular exercise, with some social groups, such as people with lower incomes and women, having even lower rates. This study investigates the rate at which medically underserved patients receive exercise counseling from health care providers, characteristics of those who exercise, and barriers and motivations to exercise. The convenience sample was predominantly female and White and exclusively low-income and uninsured or underinsured. On average, participants were obese, by Federal Obesity Guidelines; 43% smoked.
Although 60% of 126 patients reported that providers discussed exercise with them, the discussions had no relationship with patients' engagement in exercise. Women and those with lung problems, diabetes, or children in the home were less likely than others surveyed to exercise. The highest rated motivations included body image and health issues. The most important barriers were time, cost, and access to exercise facilities and equipment.
In order for exercise counseling to be more effective, health care providers' interventions must consider patients' personal characteristics, health status, readiness to engage in an exercise program, and motivations and barriers to exercise.
Key words: Medically underserved, exercise, preventive health, stages of change, health promotion.
There is strong evidence that physical activity and physical fitness reduce mortality and morbidity for chronic health conditions, including cardiovascular diseases such as hypertension and coronary heart disease, obesity, diabetes, osteoporosis, and mental health disorders.1 However, only 15% of adults in the U.S. engage in the recommended amount of physical activity, and some populations (including women, those with lower incomes and less education, African Americans, and Hispanics) exercise significantly less than others.2
The U.S. Preventive Services Task Force recommends that all patients be counseled to incorporate physical activity into their daily routines and that clinicians determine each patient's physical activity level, ascertain barriers specific to that individual, and provide information on the role of physical activity in disease prevention.1
Americans in low socioeconomic status (SES) groups suffer disproportionately from almost every disease and show higher rates of mortality than those in higher strata.3,4 The medically underserved receive less necessary primary care than other populations,5,6 and when they do seek primary care, their problems tend to be complex and severe.7
When people intend to modify a...