Experiences of a Walking Intervention among Obese, Working Women: A Qualitative Analysis View PDF

^*Kameron Suire
School Of Kinesiology, Auburn University, Alabama, United States

^*Corresponding Author:

Kameron Suire
School Of Kinesiology, Auburn University, Alabama, United States
Email:kbs0041@auburn.edu

Published on: 2020-12-12

Abstract

Background: Obesity continues to plague Americans, with females being impacted more than males and rural areas showing higher rates compared to urban areas. Participating in physical activity can reduce obesity, however, many women are sedentary. Walking may be a viable form of physical activity for obese women to start an exercise program, however, little is known of how working obese women experience a walking program.
Aim: The aim of this research was to better understand the experiences of females taking part in a walking intervention.
Methods: Semi-open interviews were conducted among 17 obese, women working a sedentary job in a rural area. These women completed a 10-week walking intervention alongside self-efficacy and self-regulation messages. An interpretive phenomenological approach was utilized to analyze the interview data for themes.
Results: Four major themes were found: influence of work on walking, set-backs, program help, and future.
Conclusion: Work environments defined the capability of being successful within the walking program. Women found the activity monitor and structure of the program useful, although the self-regulation and self-efficacy messaging was found to be unremarkable. The participants were also unable to handle setbacks, which often disrupted progress. Working environments can serve as a vital place for working women to increase walking behavior and reduce time spent being sedentary. More attentive strategies are needed to accompany walking programs to aid participants with various struggles.

Keywords

Qualitative; Women; Work; Obesity; Rural; Walking

Introduction

According to research conducted by the CDC in 2016, almost 40 percent of adults (93.3 million) in the United States were classified as obese; increasing the overall health burden on citizens and healthcare systems [1]. Overweight and obesity accounted for almost $114 billion dollars of healthcare cost [2] with expectations of an increase of $66 billion per year by 2030 [3]. Individuals with obesity show an increased risk for developing serious diseases and health concerns, including all causes of death, hypertension, stroke, type 2 diabetes, among others [4].

Adult women are among the groups with the highest rates of obesity. The CDC reports that the prevalence of obesity was higher in women aged 40-59 (44.7%) and in women aged 20-39 (36.5%) compared to men of the same age (40.8%, 34.8%) [1]. It also appears that two-thirds of all adult women are either overweight or obese in the United States, which is alarming [5]. Furthermore, women bear more of the economic burden with $2,646 being spent on a male person with obesity, compared to $4,879 for females with obesity [6]. This is compounded by the fact that more women fail to meet physical activity guidelines (19%) when compared to men (26%) which is related to weight control [7]. This issue is even worse among women living in rural areas with obesity and physical inactivity rates being higher [8]. Some of the issues that may contribute to this fact are educational and financial disparities [9], the built environment [10], and inactive occupations [11,12]. Focusing on occupation, over the last several decades, overall calorie expenditure at work has decreased by more than 100 calories, and it has been theorized that this has had a significant impact on the anthropometric status of Americans [13]. More evidenced based interventions that target rural, women working sedentary jobs for weight management are needed.

While there are numerous options, one form of physical activity that may be particularly appealing for obese women is walking. Walking is a form of physical activity that does not require a high amount of skill, experience, equipment, or a membership to a facility allowing participation for individuals of all fitness levels [14]. Walking has demonstrated numerous benefits such as reductions for numerous chronic health conditions, improvement of cardiovascular measures, improvement of bone and muscle health, increase in mental health, and a significant calorie burn [15]. While walking is a lower intensity form of exercise, the benefits may prove to be comparable to other more vigorous types of exercise. Walking has been shown to demonstrate similar reductions in cardiovascular events when compared to vigorous exercise across race, age, and BMI [16]. While Manson JE et al. (2002) [16], the study showed a faster pace being associated with more reduction, these results may be interpreted as a positive sign for individuals not ready for vigorous activity.

Little is known regarding starting a new exercise experience among working, obese women. In fact, to our knowledge, there has yet to be a qualitative analysis detailing obese, working women’s experience beginning an exercise program. This research will seek to begin to provide insight in understanding the mechanisms working women go through in this scenario. Therefore, the aim of this intervention is to detail the experiences of obese, working women after a 10-week walking intervention.

Methods

Human Subjects Approval

This randomized trial was approved by a University Institutional Review Board for Research Involving Human Subjects (IRB) and followed the standards set by the Declaration of Helsinki. Each participant read and signed a written informed consent and completed the Physical Activity Readiness Questionnaire (PAR-Q).

Male and female participants were recruited by word of mouth, e-mail, flyers and social network blast from a rural, south eastern community. Participants were accepted for this study if they met the following qualifications: age 25-60, healthy (as determined by the PAR-Q) agreed and able to complete a 10-week walking program, not currently engaged in any structured physical activity program, and had access to a computer and internet connection to access the account, to charge, and to download the movband data. Seventeen participants were included in this analysis as purposeful sampling was conducted to focus on obese women who were employed to an inactive occupation to better understand their experiences. The mean age for these participants was 48.33 ± 9.96 and the mean BMI was 35.63 ± 3.31.

Intervention

The intervention was a 10-week program that encouraged adults to walk on most days of the week for 20-40 minutes. Group 1 (intermittent) participants were encouraged to walk in short bouts (5 minutes each to achieve 20-40 minutes daily). Group 2 (continuous) participants were encouraged to walk the entire daily amount in one attempt. Group 1 and Group 2 were also provided with instructional videos and emails giving them tips and strategies to be successful to improve self-efficacy and self-regulation. All walking was completed on their own, around their choosing outside of the research team’s supervision. Both groups were given a wrist worn accelerometer to track steps and activity throughout the program. For complete methods see Rodriguez-Hernandez and Wadsworth (2019) [17].

Data Collection

Data collected included semi-open interviews immediately after post-testing in week 11. Interviews were conducted in-person, one-onone with one of two interventionists. Interviews typically lasted 10-20 minutes and used 8-10 questions depending on the responses. These questions focused on their experiences on the walking intervention (both positive and negative), any barriers that they overcame/faced, whether they felt the study design helped or hindered, the big takeaways from participation, and future for physical activity. Interviews were audio recorded and transcribed verbatim to be used for data analysis.

Results

Analysis of interview data revealed four major themes. They include: Influence of employment obligations on work, set-backs, program help, and takeaways.

Influence of Employment Obligations on Work

The most dominant theme, as identified by most women interviewed, was work as the biggest barrier to walking. In fact, work arose as a truly pivotal moment in the women’s walking habits. The inactive nature of their job, work demands, travel, and exhaustion after work were mentioned as barriers. P9 (participant 9) stated, “Work for sure. If we are busy, I can’t leave my desk. P7 offered similar sentiments explaining, “Work is overwhelming, you can’t ever get away from your desk that is the main reason.” Additionally, there were noticeable voice changes and often sighs and laughter while discussing work. P15 chuckled as she noted a representative comment of most women stating, “The work structured my exercise, not me”, as well as P10 who said, “I let work interfere, time management and excuses”. The atmosphere and tone signified hopelessness, as if there was nothing that could be done about work obligations. It was also evident that work obligations exacerbated other obligations and created a sense of tiredness. For example, P6 stated, “I got a full-time job with a firm in California and after work, driving 30 minutes home, cooking dinner, I didn’t have time. To be honest, I did not adhere”. To the contrary, the few participants that felt successful used fitting walking into their work hours as a key strategy. Using break times, getting up from their desk at work, among other ideas were integral for these women. P1 explained, “I work full time, but I get two 15-minute breaks that I used to walk: 1 in the morning and 1 in the evening. I also get lunch breaks that I use for 30-35 minutes.” P8 added, “I walk when I get stressed now. At work, when I get stressed, I walk.”

Setbacks

Many of these subjects had a positive start to the study once the notion of physical activity was still fresh, however, the consistency needed to adhere to the program became too much for many participants. For many of these participants, a setback was the beginning of the end in relation to their exercise habits as with P17: “Well, I got pneumonia so that made it hard.” This ties into that overwhelmed emotion that these women felt. Having an event such as a sickness or an accident often gave these women vindication for ceasing to exercise. These events often exacerbated their current feeling of being overwhelmed from work and other life obligations. This also appeared to extend to setbacks relating to progress. When these women had a hiccup in their behavior, they often had a hard time getting back on track. P11 stated: “I also tried to walk in the morning, but things got crazy”. These events appeared to lead participants to the conclusion that incorporating walking into their life was not realistic. This mindset dragged the participants down, leaving them unable to accept the setbacks and move forward.

Program Help

The participants were asked what aspects of the program aided their walking habits. Two patterns emerged including the activity monitor and the schedule given to them. Despite the program being focused on time walking, the activity monitor provided these participants with a sense of accountability. P9 stated: “I think the movant helped for sure. It helped me keep up with steps and motivated me. My goal everyday was 12,000 steps, I never made it, but I did hit 10,000”. When the number shown was lower than a previous day, it motivated them to move more. Some participants had friends with similar devices and a competitive environment was fostered resulting in more walking. The participants also felt the structure of the walking plan helped them adhere. Many of these women felt they needed guidance and a direction as with P10: “I liked the structure and the guidance.” The feasibility of the intervention was also mentioned by the participants. Having a goal really directed these women and gave them purpose in walking. One important absence in most of these interviews related to the program was the self-regulation and self-efficacy messaging. This did not appear to leave a mark on the participants in a meaningful manner which is worth mention due to the strong presence of them during the intervention.

Future Plans

These participants were given the opportunity to give thoughts on future for walking moving forward and reflect on the experience in an open-ended question. The main takeaway from this experience was that they wanted to continue walking in the future in the hopes that their health status would improve. Many of these participants had thoughts of trying to improve their diets and even try new strategies moving forward. P4 stated “Now I’m looking for more changes, like a standing desk. Also liked the movband, now I’m looking at a new one.” It is important to mention that most of the participants had wished they had done better. Looking back on the experience, many of them mentioned that this happened during a bad time. Many of them had stated that they were overwhelmed at work or had been given new work opportunities that made adhering difficult, especially during this time. They were hopeful that in the coming months, they would have more time.

Discussion

Numerous themes were noted from the semi-structured interviews and the main point was focused on work. Work dominated most interviewers and appeared to be the deciding factor of adherence for these women. These women were also overwhelmed by multiple factors and fitting in consistent physical activity appeared impossible. Work as a barrier to regular physical activity is consistent with findings from a previous study with overweight/obese, working women [21] and among rural women [22]. While this barrier was not the prevailing theme in the previous study, it was present within key findings. Another study demonstrated that people working 40 or 40+ hours a week were 40.3% (95% CI: 1.06-1.85) and 40.9% (95% CI: 1.03-1.93) more likely to be obese than those who worked less than 40 hours [23]. With the time spent at work having this impact, the authors suggested worksite wellness interventions may be worth consideration. The successful women in this intervention had the commonality of fitting physical activity into their workday. The current literature demonstrates potential in worksite physical activity and weight management programs [24,25]. Our conclusion based on the interviews in this study would mimic this takeaway and has been suggested by other qualitative studies focused on rural women [26-28].

The women stated that the activity monitors and the program structure aided them. This echoes a similar finding from previous research where the participants reported being motivated by an activity monitor as well as another intervention where participants suggested it be added to future interventions [29,30]. One surprising aspect from the interviews was the lack of mention of the self-regulation and selfefficacy messages. Previous research has stressed the importance of self-regulation and self-efficacy to long-term physical activity, however, the literature has yet to provide a standard example of how to increase these measures in a walking intervention. Self-efficacy decreased in these groups and it appears that the interviews have substantiated that the messaging had little impact on the participants [31]. It is also important to mention the lack of differences in themes between the two groups. Both the continuous and intermittent group themes were comparable and thus making the case that the experiences were not impacted by group allocation. This information also backs quantitative data found that both continuous and intermittent groups had similar results in both psychological and physiological changes aside from self-regulation and lean mass improvements found in the continuous group [17,31].

While walking is an entry level form of physical activity, many of these women had major struggles adhering. This feeling was often exacerbated by setbacks (like injury or illness) often leaving the participants in a state where they had given up completely. Previous research has also identified injury and illness as a barrier to walking among women [24,32]. One of the key factors in consistent exercise adherence is being able to handle setbacks. While walking is an entry level form of physical activity, a more attentive nature may be required for future interventions as the self-efficacy and self-regulatory strategies offered with the program were unremarkable for these women. For example, employing an additional aspect, such as motivational interviewing, may produce emotional benefits and increase adherence to an already established physical activity program. This may allow for discussion on personal struggles so that solutions can be created as the intervention progresses. Motivational interviewing has demonstrated potential in numerous weight management interventions [33-35] as well as in walking-based studies [32,36]. While more studies are needed to substantiate these findings, potential is present.

When compared to the literature of for exercise behaviors among rural women, some of the results found in this study are in unique in that there are missing aspects found in prior studies. One interesting example is the lack of social support discussion. While it came up a small number of times, other qualitative studies focused on rural adults note substantial discussion on social support from family members, pets, and peers were a factor in their adherence [22-25, 37]. It is also important to mention the lack of discussion on the absence of resources. It was clear that the participants felt that they could have done better, but it was not directed at a lack of resources other than time. This is also at odds with some of the findings from previous studies reporting barriers such as a lack of walkable areas [23,36] and access to facilities [22-25,37]. Future studies would benefit from further investigation among rural women to better understand the decisionmaking progress regarding physical activity.

Limitations

There are numerous limitations worth mentioning in regard to this study. One possible limitation is the lack of continuity during the interview process. Two researchers conducted the interviews due to the large sample, which may comprise fidelity. Interviews, while staying true to the structure, were often different depending on who conducted the interview. Time spent digging deeper into specific thoughts often varied based on the interviewee. It is also important to mention the lack of demographic information. More detail on race and income level would have provided more context.

Conclusion

Working, obese women face numerous challenges when attempting to increase physical activity. Work appears to be the largest barrier among this sample and increases the pressure from other obligations. These women also were overwhelmed by the actions required to be consistent in increasing physical activity, and often were mentally defeated by setbacks. Many of the participants felt that the activity monitor and structure was helpful, although is also important to mention the lack of discussion on the self-regulation and self-efficacy messaging aspect of the program. These women felt regret in that that they wish they had done better but do plan on exercising in the future despite their disappointment. Health professionals would benefit from keeping these struggles in mind when recommending physical activity. Future interventions may find potential in addressing the barriers of work and overwhelming nature of physical activity with more personalized strategies. Developing worksite wellness programs and employing personalized communication with the participant are examples of these future interventions.

Ethical Statements

Acknowledgments

None.

Author Contributions

Kameron Suire - Overall design of the study, independent review of transcripts, and writing/revising of the manuscript.

Mynor Rodriguez-Hernandez - Overall design of the study, independent review of transcripts, writing/revising of the manuscript.

Sheri Brock - Overall design of the study, review of themes, and writing/revising of the manuscript.

Danielle Wadsworth - Overall design of the study, review of themes, writing/revising of the manuscript.

Author Disclosure

Kameron Suire - Nothing to disclose.
Mynor Rodriguez-Hernandez - Nothing to disclose.
Sheri Brock - Nothing to disclose.
Danielle Wadsworth - Nothing to disclose.

Funding Source

No outside funding was utilized for this study.

Ethical Approval

This randomized trial was approved by Auburn University Institutional Review Board for Research Involving Human Subjects (IRB) and followed the standards set by the Declaration of Helsinki. Each participant read and signed a written informed consent.