A Mixed Methods Comparison of Perceived Benefits and Barriers to Exercise Between Obese and Non-obese Women

Lucia Andrea Leone and Dianne S. Ward

Abstract
Background: Obese women have lower levels of physical activity than nonobese women, but it is unclear
what drives these differences. Methods: Mixed methods were used to understand why obese women have
lower physical activity levels. Findings from focus groups with obese white women age 50 and older (N = 19)
were used to develop psychosocial items for an online survey of white women (N = 195). After examining
the relationship between weight group (obese vs. nonobese) and exercise attitudes, associated items (P < .05)
were tested for potential mediation of the relationship between weight and physical activity. Results: Obese
women were less likely than nonobese women to report that they enjoy exercise (OR = 0.4, 95% CI 0.2–0.8)
and were more likely to agree their weight makes exercise difficult (OR = 10.6, 95% CI 4.2–27.1), and they
only exercise when trying to lose weight (OR = 3.8, 95% CI 1.6–8.9). Enjoyment and exercise for weight loss
were statistically significant mediators of the relationship between weight and physical activity. Conclusions:
Exercise interventions for obese women may be improved by focusing on exercise enjoyment and the benefits
of exercise that are independent of weight loss.

Colorectal Cancer Screening and Physical Activity Promotion Among Obese Women: An Online Evaluation of Targeted Messages

LUCIA A. LEONE, MARCI K. CAMPBELL, AND MARLYN ALLICOCK, MICHAEL PIGNONE

Abstract
Obese women are at higher risk for several cancers, but are less likely than normal weight women to engage in cancer prevention behaviors such as screening and physical activity. Targeted health messages may help increase healthy behaviors among vulnerable groups such as obese women. Using findings from focus groups with obese women, the authors created targeted messages to promote colorectal cancer screening and physical activity among obese women. The messages addressed psychosocial constructs, such as benefits and barriers to colorectal cancer screening and exercise, which were relevant to the target population. Messages were tested online with women age 50 years and older (N 1⁄4 181). Participants were stratified by weight (obese vs. nonobese) and randomized to review either 10 targeted (intervention) or 10 generic (control) messages. Study outcomes included elaboration about the messages, message relevance and trustworthiness, and behavioral intentions. The authors used moderation and subgroup analyses to determine whether the intervention messages were better received by certain women. They found no differences in elaboration, behavioral intentions, relevance, or trustworthiness between intervention and control for either weight group. However, exercise intentions increased more (p 1⁄4 .06) among inactive obese women who received intervention messages (þ2.9) compared with those who were in the control group (þ1.2). Intervention messages also produced more elaboration among women who viewed their weight
as a barrier to screening or exercise. Tailoring intervention messages for obese women on the basis of behavior and barriers may improve outcomes more than giving the same messages to all obese women.

​Perceived Benefits and Barriers in the Mediation of Exercise Differences in Older Black Women with and Without Obesity

Loneke T. Blackman Carr, Brooke T. Nezami & Lucia A. Leone

Abstract
Objectives: Weight control is an exercise benefit, important for older Black women, a group experiencing obesity disparities. We compared perceived exercise benefits and barriers between Black women with and without obesity and determined which mediated the weight group-exercise relationship. Methods A survey (n = 234) was administered to determine attitudinal agreement between weight groups (obese or non-obese). Multiple mediation analysis was used to investigate if attitudes mediated the weight group-exercise relationship. Results High agreement with all exercise benefits was observed between women with and without obesity. Compared with women without obesity, women with obesity were more likely to report the barriers of only exercising to lose weight (OR = 2.52, 95% CI 1.40–4.55), lack of will power (OR = 1.82, 95% CI 1.05–3.19), weight (OR = 3.04, 95% CI 1.34–6.83), and cost (OR = 2.14, 95% CI 1.02–4.47). Exercising to lose weight and lack of will power mediated the weight group-exercise relationship. Conclusions Women largely agreed on the exercise benefits. Lack of will power and engaging in exercise only for weight loss were barriers that were more common among older Black women with obesity. The barriers partially explained the lower exercise engagement in women with obesity. Future work may address these barriers to increase exercise in older Black women.

​Cluster Randomized Trial of a Church-Based Peer Counselor and Tailored Newsletter Intervention to Promote Colorectal Cancer Screening and Physical Activity Among Older African Americans

Lucia A. Leone, PhD; Marlyn Allicock, PhD, MPH; Michael P. Pignone, MD, MPH; Joan F. Walsh, PhD; La-Shell Johnson, MA; Janelle Armstrong-Brown, PhD, MPH; Carol C. Carr, MA; Aisha Langford, PhD, MPH; Andy Ni, PhD; Ken Resnicow, PhD; and Marci K. Campbell, PhD, MPH, RD

Abstract
Action Through Churches in Time to Save Lives (ACTS) of Wellness was a cluster randomized controlled trial developed
to promote colorectal cancer screening and physical activity (PA) within urban African American churches. Churches were
recruited from North Carolina (n = 12) and Michigan (n = 7) and were randomized to intervention (n = 10) or comparison (n =
9). Intervention participants received three mailed tailored newsletters addressing colorectal cancer screening and PA behaviors over approximately 6 months. Individuals who were not up-to-date for screening at baseline could also receive motivational calls from a peer counselor. The main outcomes were up-to-date colorectal cancer screening and Metabolic Equivalency Task (MET)-hours/week of moderate–vigorous PA. Multivariate analyses examined changes in the main outcomes controlling for church cluster, gender, marital status, weight, and baseline values. Baseline screening was high in both intervention (75.9%, n = 374) and comparison groups (73.7%, n = 338). Screening increased at follow-up: +6.4 and +4.7 percentage points for intervention and comparison, respectively (p = .25). Baseline MET-hours/week of PA was 7.8 (95% confidence interval [6.8, 8.7]) for intervention and 8.7 (95% confidence interval [7.6, 9.8]) for the comparison group. There were no significant changes (p = .15) in PA for intervention (−0.30 MET-hours/week) compared with the comparison (−0.05 MET-hours/week). Among intervention participants, PA increased more for those who participated in church exercise programs, and screening improved more for those who spoke with a peer counselor or recalled the newsletters. Overall, the intervention did not improve PA or screening in an urban church population. These findings support previous research indicating that structured PA opportunities are necessary to promote change in PA and churches need more support to initiate effective peer counselor programs.