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Introduction
“My PhD was spent in a blur of bipolar mania, which left me bald from stress, very
overweight and completely exhausted. I am still recovering.” (Let’s get this straight,
2015).
Exercise may be one of the most beneficial activities an individual can take
part in to promote their wellbeing. Alongside the physical and cardiovascular
benefits, exercise has a positive effect on general mental health (Kim et al., 2012),
can help reduce anxiety (Jayakody, Gunadasa & Hosker, 2014) and can increase
longevity, helping individuals preserve physical functioning into older age (Gremeaux
et al., 2012).
Despite the benefits of exercise, western societies are facing a crisis with the
increasing prevalence of obesity. Recent statistics show that over a third of adults in
the U.S. are obese (Ogden, Carroll, Kit & Flegal, 2012) and worldwide costs to
health providers reaching $2 trillion (Dobbs et al., 2014). Negative consequences of
obesity include higher risk of Type 2 Diabetes, higher blood pressure and risk of
early death, as well as heightened rates of depression and lowered wellbeing
(Obesity - Complications, 2014).
Recent research into the field of obesity has highlighted sedentary behaviour
as a factor, noting a decreasing trend in moderate physical activity in adults, and an
increasingly sedentary workplace (Padwal, 2014). Exercise is a potential solution to
the rising obesity crisis.
In addition to physical health, exercise can be beneficial to mental health. The
mental health of university students is a growing problem, with campuses nationwide
struggling to provide student bodies with effective interventions. Student
3. 3 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
organisations such as the National Union of Students (NUS) have conducted
research into this issue. One such study, “Silently Stressed”, investigated distress
and health seeking behaviour in students. Results show that up to 70% of students
reported financial distress that interferes with their study and 90% of students found
exams and assessments to be stressful (NUS Scotland, 2010). The report stated
that it is a universities’ responsibility to invest in and protect their student’s mental
wellbeing (NUS Scotland, 2010).
Academic research has also investigated mental health at universities. Cross
sectional research by Macaskill (2013) stated that anxious symptoms, including
somatic, depressive, social and insomniac issues spiked in the second year of study,
with few students receiving treatment (Macaskill, 2013). Further research states that
from starting university, wellbeing drops as the first year continues, with wellbeing
slightly increasing as a student’s academic career continues (Bewick et al., 2010).
However, wellbeing does not reach the height of levels seen in participants prior to
their registration (Bewick et al., 2010). Similarly, depression scores steadily increase
over all three years, with students in their final semester reporting depression scores
twice as high as they were pre-registration (Bewick et al., 2010).
Although exercise interventions can be effective, they are only beneficial if
participants adhere to the routine and take part regularly (Biddle and Mutrie, 2008),
and this is where a problem with exercise intervention lies. Adherence to exercise
programs can be poor, with literature reviews putting dropout rates of exercise
referrals as high as 80% (Gidlow, Halley Johnston, Crone & James, 2005). This
means that the majority of participants are not receiving any benefit from exercise,
and may be experiencing distress and health complications because of this.
4. 4 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
Intervention dropout rates further complicate adherence because the people
dropping out are the ones most likely to benefit from exercise. Research
investigating the subject has shown how older individuals and those with
cardiovascular or orthopaedic illnesses are more likely to drop out of exercise
interventions (Tobi et al., 2012). If the individuals who could benefit most from
exercise interventions are dropping out, the interventions require revision. Tobi et
al.’s (2012) research offered recommendations for this problem, one of which is
understanding the factors that influence adherence, allowing future interventions to
be suited best to their client’s needs.
This paper rests on the hypothesis that an individual’s adherence is affected
by personal factors which can be revealed through data collection and analysis. The
research is designed to explore exercise motivation and adherence, and to discover
potential factors that can guide future research.
Factors that may affect adherence in a non-clinical population were
investigated using a mixed methods approach. This provided data from different
perspectives to thoroughly explore the problem. A series of qualitative interviews that
aimed to understand the reasons behind exercise adherence were performed.
Analysis will be carried out using survey data, highlighting factors that significantly
affected whether or not participants adhered to an exercise program.
Material and Methods
This research was conducted with the help of Motivate Generate Activate
(MGA). MGA is a charity on Plymouth University campus that offers free or
discounted exercise based activities to students. Funding is provided through the
charities Sport England and the Plymouth University Student Union as well as fees
5. 5 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
for attending exercise sessions. The scheme is designed to enhance wellbeing of the
student body through exercise, enjoyment and social contact. Activities offered
constitute a range of sports, from traditional running to alternative sports such as
surfing and skateboarding. MGA provided adherence data for their participants, and
aided in distributing questionnaires. Prior to data being collected, ethical clearance
was obtained from Plymouth University’s Faculty of Health and Human Sciences
Ethics Committee.
For collecting quantitative data, an online form including demographic and
EMI-2 questions was distributed via email to all student members of the MGA. The
qualitative data was supplied by semi-structured interviews with MGA participants. A
sheet of questions exploring exercise motivation and adherence was created as a
frame for the interviews. Interviews were recorded using a Dictaphone and were fully
transcribed for use in data analysis. After the interview, participants were
compensated the standard amount stated by Plymouth University’s research
guidelines.
A problem identified in the literature is that there is no agreed upon definition
of “exercise program adherence”. In the exercise literature, adherence has been
defined from as little as 2 months up to 2 years (Huberty et al., 2008). Due to this
variability and the close working relationship this research has with MGA, Sport
England’s definition of adherence will be used. Based on Sport England’s previous
exercise intervention programs, adherence will be operationally defined as having
attended at least 8 separate sessions in an academic year (H. Bibby, personal
communication, November 11, 2015).
6. 6 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
Measures
The survey consisted of demographic questions and the EMI-2, used to
investigate reasons why participants exercise. The EMI-2 contains 51 individual
questions that create 14 main factors for investigating motivations (Markland, 1999).
Participants responded to questions using a 7 point Likert Scale from 0 (not true at
all for me) – 6 (very true for me). The covered factors included questions
investigating physical motivations (“Q15 – To lose weight”) to cognitive and social
motivations (“Q42 – To develop personal skills”). The EMI-2 has been used
previously in adherence and exercise research and scored high in reliability using
Cronbach’s Alpha test (α m =.82) (Kilpatrick, Herbert & Bartholomew, 2010).
Participants for the qualitative data collection were recruited from MGA activity
groups, and interviews were held in quiet, soft rooms on Plymouth University
campus. Interviews lasted between 20 and 40 minutes, and were recorded using a
Dictaphone. The main interview questions focused on motivations and barriers for
exercise and were followed by targeted probes. After the interviewing phase was
over, interviews were transcribed verbatim.
Data Analysis
Qualitative data was analysed using thematic analysis. The process was
performed in steps of reviewing the data and forming thematic codes (Braun and
Clarke, 2006). With successive readings, major themes became apparent and were
coded.
Data from the EMI-2 was entered into SPSS and raw data was calculated into
the separate motivation factors. Using MGA’s adherence database for the 2015-
2016 academic year, participant’s EMI-2 results and adherence frequency were
7. 7 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
paired. Adherence was made into a binary measure by counting participant’s
attended sessions. Participants were defined as adhering if the frequency of
attendance met or exceeded the definition provided by Sport England. These paired
results were entered into SPSS for further analysis. Quantitative data analysis was
carried out in the form of a one-way ANOVA using adherence as the main factor.
Results
After quantitative response data was collected and cleaned, data from 29
participants was taken forward for analysis. Of these participants, 3 identified as
male, and the remaining 26 as female. According to the operational definition of
adherence, 9 participants were classed as adherers, the remaining 20 were defined
as not adhering. Qualitative data from 1 man and 5 women was taken forward for
thematic analysis.
Qualitative Results
Thematic analysis of the interview transcriptions showed 3 main categories of
themes – motivations, mood and barriers. Each major theme had accompanying
distinct subthemes.
Motivations – These are the feelings that drive individuals to exercise. These
motivations are important to each individual, and are the reasons why they continue
to adhere to an exercise program.
Fitness “Greater endurance or more cardio capacity ... motivates me to
stay on track and do these things, on a long term on a regular basis.”
Fitness was a frequent motivation for continuing to exercise. Participants
focused on aerobic fitness and flexibility as a part of overall health. When discussing
8. 8 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
fitness, participants focused on the future outcome of their exercise routine as a
reason to continue.
Fitness also included an aspect of appearance focused goals. Being
physically fit was often equated with physical attractiveness. The idea of being
physically fit and losing weight served as a motivation for continuing to exercise.
Social “I think it’s important to try and make it sociable as well.”
Exercise can be a very social experience, particularly in the group based
activities offered by MGA. Participants discussed attending sessions with friends and
how this is a motivator to maintain attendance. Even if participants did not have
friends on the session, the idea that other people would be attending helped
motivate participants to adhere. Social aspects were discussed as if they were a
core part of the exercise experience.
Social aspects were also mentioned as a way to overcome barriers to
exercise. The fact that individuals are struggling together gave a sense of
comradery, and helped overcome possible obstacles.
Enjoyment “If you’re not enjoying something, then you’re not going to stick
at it.”
Participants discussed joining an exercise session because they found it fun,
regardless of the physical benefits. Enjoyment also served to aid participants in
overcoming barriers. Participants discussed continuing to adhere to an exercise that
made them physically uncomfortable because of their enjoyment for the activity.
Medical/Health “To try and get more flexible. I get knee pain.”
9. 9 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
Participants discussed medical conditions that were eased by exercise. For
example, stiff joints which can be aided by low intensity exercise like yoga.
Participants discussed choosing and adhering to an activity because of its specific
health benefit. The idea of long term wellbeing was also discussed, participants
exercised with the long term goal of better functioning in older age.
Mood – Exercise can have an effect on emotions and mood. Participants reported
having altered mood states after exercise, which appeared to be important
components of the experience.
Calm “It gives me some kind of calmness and I can keep more
focused … some kind of balance in my life.”
Participants discussed activities that led to a more balanced and focused
mood after exercise. Calm moods were associated with lower intensity activities,
such as yoga. Calm moods were mentioned as an escape from academic or work
stresses, or a way to feel revitalised before returning to study.
Exercise was discussed in an almost therapeutic way when talking about
anxiety. Participants who had experienced anxiety in the past discussed doing
exercise as a way to calm anxious feelings. Both high and low intensity exercises
were mentioned as effective for dealing with anxiety.
Achievement “I’m sat there in the gym being smug that I can do
something better than someone”.
Exercise can have an internally motivating aspect. Participants mentioned the
feeling of personal pride after an exercise session, particularly in high intensity
10. 10 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
activities. A less competitive mood was described in comparing one’s current
progress to past ability, and feeling proud of what has been accomplished.
Positive “All of a sudden I’m in a lot more positive mindset”.
Participants also reported a positive mood after exercise. The experience was
not specific, and participants had difficulty attempting to put the feelings into words.
Participants described a general positive outlook. Any follow up probes were met
with an inability to describe a specific feeling or reason for the mood.
It was often described as a release from a negative situation, such as
enjoying physical exercise after working inside. The elevated mood always occurred
after the activity had finished, but was mentioned separately from feelings of
achievement.
Barriers – Life events and situations can hinder attempts to exercise by reducing
available time or capability. However, participants mentioned factors that enabled
them to overcome barriers and continue to adhere to exercise programs.
Time/Schedule “Getting up in the morning on Monday at 8am, this is not
really easy for me.”
Participants discussed how time pressures hindered or prevented their
attempts to adhere to an exercise routine. These included starting a new job or
placement, but factors such as a very early morning exercise class also impacted
participant’s attendance.
Additionally, academic stress from university was discussed as a barrier.
Some participants felt unable to attend activities due to academic pressure such as
approaching deadlines or exams.
11. 11 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
Skill “You’re in a class and you see someone like, folded in half and you
can’t even touch your toes.”
Participants felt their skill or proficiency made it harder to take part in
activities. In group based activities, a perceived lack of skill made participants feel
out of place. Moreover, in activities such as long distance running participants felt a
lack of skill gated their progress and prevented them from reaching their goals.
Health “I can’t do those, because it’s too painful afterwards”.
Participants reported that health issues reduced their ability to exercise, as
well as participate in certain sports. Participants discussed joint pain making it
impossible to do high impact sports such as running.
Personal “It gets repetitive and boring and that’s when my motivation
drops”.
There was a category of barriers that were personal to each participant.
These included internal factors such as attention span or a dislike for certain
activities. These factors altered which activities were chosen, as well as participant’s
motivations to adhere.
Quantitative Results
The Cronbach’s Alpha for the EMI-2 was .74, marking it as reliable. In
analysis, 2 factors, “Ill-Health Avoidance” and “Weight Management” were omitted
from the ANOVA, due to insufficient data. Final analysis included a total of 12 factors
and the sum total of results. The one-way ANOVA displayed no significant results
(table 1). The only factor that approached significance was a total sum of the EMI-2 x
adherence (F(1,27) = 3.41, p = .08).
12. 12 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
Descriptive statistics for EMI-2 factors and adherence groups showed that
participants who adhered to exercise programs had higher average EMI-2 scores
than non-adherers (table 2).
Table 2.
Descriptive statistics for EMI-2 factors
Factor Adherence N Mean Std. Deviation
Stress Management Did Not Adhere 20 10.70 5.61
Adhered 9 12.89 4.54
Revitalisation Did Not Adhere 20 8.25 4.39
Adhered 9 10.11 3.86
Enjoyment Did Not Adhere 20 13.50 4.25
Adhered 9 15.67 4.06
Table 1.
One way ANOVA for EMI-2 factors x adherence
Factor df F Sig.
Stress Management 1 1.05 .31
Revitalisation 1 1.19 .28
Enjoyment 1 1.66 .21
Challenge 1 1.45 .24
Social Recognition 1 .09 .76
Affiliation 1 .81 .38
Competition 1 1.69 .21
Health Pressures 1 .36 .85
Positive Health 1 .13 .72
Appearance 1 .87 .36
Strength & Endurance 1 .61 .44
Nimbleness 1 1.43 .24
EMI-2 Total 1 3.41 .08
13. 13 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
Challenge Did Not Adhere 20 10.80 3.87
Adhered 9 12.78 4.55
Social Recognition Did Not Adhere 20 9.55 6.51
Adhered 9 10.33 6.12
Affiliation Did Not Adhere 20 11.70 5.42
Adhered 9 13.67 5.54
Competition Did Not Adhere 20 6.35 5.82
Adhered 9 9.67 7.48
Health Pressures Did Not Adhere 20 7.55 4.51
Adhered 9 7.89 4.40
Positive Health Did Not Adhere 20 10.10 4.63
Adhered 9 10.78 4.74
Appearance Did Not Adhere 20 11.50 5.09
Adhered 9 13.33 4.36
Strength & Endurance Did Not Adhere 20 14.30 5.13
Adhered 9 15.89 4.86
Nimbleness Did Not Adhere 20 6.15 5.14
Adhered 9 8.67 4.78
EMI-2 Total Did Not Adhere 20 135.65 34.93
Adhered 9 160.00 27.29
Discussion
This research aimed to investigate participant’s motivation and adherence to
exercise. Multiple themes and subthemes that affected participant’s motivation were
discerned through data analysis.
The quantitative data did not show any significant effects, which makes
extracting information about participant’s motivations and adherence difficult. The
ANOVA focused on EMI-2 results displayed no significant results for any individual
factor. The descriptive statistics showed higher average EMI-2 results for the
14. 14 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
adhering group, but due to highly uneven group sizes and small sample these
cannot be interpreted for meaningful conclusions.
Analysis of qualitative data showed 3 major diverse themes affecting
adherence and motivation, supporting the idea that an individual’s motivation to
exercise can take multiple forms. Both motivations and participant’s focus on mood
shows that exercise is performed for reasons beyond physical fitness, the identified
themes could be taken into account in future marketing and promotion of sport
programs.
Participants highlighted the importance of the calm or positive mood after an
exercise session and this could be an effective non-fitness centred approach for
marketing activities. The effect of exercise on mood has gained traction in the mental
health field, with the NHS offering an “exercise prescription” to patients with mild to
moderate depression (“Prescription for Exercise”, 2014). Whilst the physical health
benefits of exercise are well known and well marketed, the benefits to mental health
might appeal to a different population.
Student organisations like the NUS are pressuring universities to provide
more support for student’s mental wellbeing. The results show that participants take
part in exercise for the effect it has on their mood, and feel calmer and less anxious
after an activity session. With these results, and research such as Jayakody et al.
(2014) supporting exercise as a viable method for reducing stress and anxiety, long
term exercise intervention could be a method university campuses use for promoting
student wellbeing.
Future research could investigate the effects of exercise intensity and their
efficacy for aiding mental wellbeing. Participants referred to low intensity activities
15. 15 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
such as yoga for feelings of calm, and higher intensity activities such as running for
positive moods. Research could investigate the specific effects on mood from
different exercise, and their potential applications for mental wellbeing. This could
help tailor exercise interventions towards specific people, for example if an individual
experienced a low mood then a specific activity in a specific social setting could be
recommended.
An important barrier to adherence is time and schedule, as participants felt
less able to exercise due to their academic schedule and assessments. However,
time management and deadlines were identified as the most common sources of
stress (NUS Scotland, 2010). Moreover, research has supported exercise’s ability to
reduce anxiety and stress (Jayakody et al., 2014), but it will have no benefit if
participants do not feel they can exercise.
As a topic of future research, investigating the specific time factors that
prevent exercise could help guide future interventions. These could involve quick
exercise routines that can be done without leaving the room, or mindful interventions
that include both a physical routine and meditative aspects. Research has examined
the role of stress and workplace exercise, reporting better stress management in
staff who took part in a twice weekly health program (Tveito & Erikson, 2009).
Barriers to adherence create a negative feedback loop, demonstrated here
with low mood (figure 1). The barriers to exercise prevent the individual from taking
part in activities. This means the participant cannot experience the benefits exercise
has, so mood may lower further. Then the cycle may repeat with barriers being
harder to overcome. This research shows the barriers that sports intervention
participants may encounter, and motivations they used to overcome them.
16. 16 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
Sports interventions should focus on reducing barriers, which will allow
participants to take part in exercise. With the negative feedback loop broken,
participants will be more able to adhere to an exercise program and make future
barriers easier to overcome, and a negative feedback loop less likely to occur.
Social factors were very important for participants to overcome barriers.
Participants felt more able to attend classes they might otherwise miss due to the
group dynamics and the presence of friends. This has potential to help interventions
that include an exercise “buddy”. Research could examine the long term adherence
patterns for those who exercise individually and those with friends or a buddy who
attends with them. There is also a skill barrier to adherence, with participants feeling
excluded from their exercise group due to a lack of competency. Experimental
research could examine self-awareness and embarrassment with participants in a
group of friends as opposed to strangers.
The qualitative data led to some conflicting results. Some individuals found
the idea of challenge to be positive and led to a proud mood after exercising.
Barriers to
Exercise
Low Mood
Lack of
exercise
Figure 1. Negative feedback loop caused by barriers to exercise. Adherence to an exercise routine is
prevented, leading to a lack of exercise and no benefit to the participant.
17. 17 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
However, other participants found lacking skill to be a barrier that made adhering
harder. These may be due to personal factors, or depend on the nature of the
exercise. Many sports include an element of competition that is missing in non-
competitive activities such as Zumba. It could be that competition in non-competitive
activities are interpreted differently than in competitive sports.
Aspects of personality traits could be included in future research. For
example, placing competitive individuals in non-competitive sports, and vice versa,
then measuring their self-awareness and how comfortable they felt as part of the
group.
Future research should investigate motivations for disabled people.
Participants discussed health barriers in interviews, but none were physically
disabled. For wheelchair users, the scope of available activities is significantly
narrowed and heath barriers may have a larger effect on their exercise experience.
This research could guide charities such as MGA in helping exercise
programs to be more inclusive and aid a wider population. As of May 2016, a search
of available sports clubs at Plymouth University shows no wheelchair or disability
focused sports, (UPSU Sports Clubs, 2016) or any mention of local wheelchair
sports, despite there being 61 registered sports clubs for disabled people within a
10-mile radius of the university campus (Find A Club, 2016).
Conclusions
It can be concluded from the quantitative data analysis that there are many
groupable factors that can affect an individual’s motivation and ability to adhere to an
exercise program. With the increasing concern about growing rates of obesity and
18. 18 R. Toynbee / Psychology of Sport and Exercise 25 (2016) 1-21
poor mental health, exercise may be an excellent method to alleviate these problems
and help those whose lives are affected.
This and future research in the field will help reinvent exercise interventions
improving their inclusiveness. A deeper understanding of why participants take part,
and why they may drop out could also be gained. From this and similar research,
exercise interventions can start to become more individualised and tailored to best
aid specific clients, instead of a more generally prescribed model that is currently
used. This may give interventions the greatest chance to help individuals that are in
need.
Limitations of the Study
The research carried out represents individuals from an atypical population.
All participants were attending Plymouth University, and were selected from an
exercise program. Additionally, the groups that were interviewed were highly skewed
and unrepresentative of both the student body and the general population. It is
therefore difficult to generalise these results or apply any conclusions made to a
wider population due to the low sample number and poor representation.
Due to the non-experimental nature of this paper, cause and effect cannot be
established or empirically tested. Data trends were discerned through thematic
content analysis, but specific and causal relationships will require future controlled
experimentation.
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