Whether we actually do it or not, most of us know we’re supposed to be exercising. The official recommendation is that each and every week we do at least two hours and 30 minutes of moderate-intensity aerobic activity plus, on two or more days, muscle-strengthening exercises that work the legs, hips, back, abdomen, chest, shoulders, and arms. Though the guidelines are clear, women generally exercise less than men while heavier women, in many cases, are least active of all.

A new study from The Dartmouth Institute for Health Policy and Clinical Practice explores the underlying reasons for these differences in exercise levels and finds women who have a higher body mass index (BMI) face a range of barriers to physical activity.

In particular, the researchers discovered that as weight increased, the likelihood of respondents reporting injuries and depression increased, too.

“I was surprised to hear about how often women wrote about physical impediment as being a barrier to physical activity,” said lead author Dr. Anna Adachi-Mejia in a statement. She noted that injured women do not need to hear lectures about why they should be exercising, instead they need help figuring out a work-around for their impairment.

Social Status

Previously, Adachi-Mejia studied walking in micropolitan towns within the United States. “Micropolitan” describes urban areas with a population of at least 10,000 but less than 50,000. In that study, she and her co-researchers discovered low-income, Spanish-speaking Latinos reported higher amounts of walking for practical purposes than non-Latinos. Yet, as income increased, utilitarian walking decreased. Conversely, Spanish-speaking Latinos reported lower amounts of recreational walking than non-Latinos. Importantly, no real differences existed between English-speaking Latinos and English-speaking non-Latinos.

The results of this study, which were published earlier this year, suggest the ways in which walking may be linked to social status in smaller towns. Traveling to and from work by foot is uncool, yet taking a walk wearing a cute exercise outfit is OK, the study suggests. Despite the fact that practical walking is a highly efficient — and smart — way to combine exercise and travel, it is, surprisingly, frowned on. Presumably, those who can afford a car in America must get and use a car.

For her most recent study, Adachi-Mejia and her co-researcher, Dr. Karen Schifferdecker, wanted to understand why women don’t exercise as they should. They began by categorizing participants into five BMI classes: normal range, with a BMI of 18.5 to 24.99; pre-obese, with a BMI of 25 to 29.99; obese class 1, with a BMI of 30 to 34.99; obese class II, with a BMI of 35 to 39.99; and obese class III, with a BMI of 40 or greater.

Their survey combined questions requiring pre-worded answers with questions that had open-ended answers, where participants wrote responses in their own words. After collecting the completed surveys, the researchers coded the answers into six categories: physical, psychological, social, resources, time, and activity.

The survey’s double barrel approach revealed strikingly different aspects of the exercise dilemma. The pre-worded survey answers indicated certain differences according to BMI class. For those in the normal weight range, the most frequently mentioned barriers were lack of time, lack of energy, lack of company, and lack of facilities, while those in the pre-obese range mentioned lack of company most frequently. By contrast, those in all three obese classes most frequently mentioned lack of self-discipline.

The open-ended answers, meanwhile, revealed more types of physical and psychological barriers as weight class increased. While knee issues, lack of company, and lack of time were cited as reasons for not exercising in all weight classes, depression, asthma, and weight were mentioned only in the obese classes. Physical challenges, such as injuries, increased as participants’ weight class increased as well.

Knowing these issues exist now, Adachi-Mejia concluded that she hopes future interventions “can integrate more physical rehabilitation and/or occupational therapy to help people be more active,”

Source: Adachi-Mejia AM, Schifferdecker KE. A mixed-methods approach to assessing barriers to physical activity among women with class I, class II, and class III obesity. Public Health. 2016.