Health-Related Quality of Life, Self-Efficacy and Enjoyment Keep the Socially Vulnerable Physically Active in Community-Based Physical Activity Programs: A Sequential Cohort Study

• Published in: PloS one Vol. 11; no. 2; p. e0150025
• Main Authors: Herens, Marion, Bakker, Evert Jan, van Ophem, Johan, Wagemakers, Annemarie, Koelen, Maria
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24-02-2016; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Behavior; Biology and Life Sciences; Biometris (WU MAT); Body mass; Cohort analysis; Communities; Data collection; Dropouts; Economics; Economics of Consumers and Households; Economics of Consumers and Households Group; Economie van Consumenten en Huishoudens; Effectiveness; Exercise; Female; Gezondheid en Maatschappij; Growth models; Health and Society; Health education; Health literacy; Health psychology; Humans; Influence; Leerstoelgroep Economie van consumenten en huishoudens; Leisure; Male; Mathematical and Statistical Methods - Biometris; Medical research; Medicine and Health Sciences; Middle Aged; Motor Activity; Multilevel; Netherlands; Older people; People and Places; Physical activity; Public health; Quality of Life; R&D; Research & development; Research and Analysis Methods; Self Efficacy; Social Sciences; Society; Socioeconomic Factors; Socioeconomics; Statistical analysis; Urban Economics; WASS; Wiskundige en Statistische Methoden - Biometris; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0150025

Physical inactivity is most commonly found in socially vulnerable groups. Dutch policies target these groups through community-based health-enhancing physical activity (CBHEPA) programs. As robust evidence on the effectiveness of this approach is limited, this study investigated whether CBHEPA programs contribute to an increase in and the maintenance of physical activity in socially vulnerable groups. In four successive cohorts, starting at a six-month interval, 268 participants from 19 groups were monitored for twelve months in seven CBHEPA programs. Data collection was based on repeated questionnaires. Socio-economic indicators, program participation and coping ability were measured at baseline. Physical activity, health-related quality of life and on-going program participation were measured three times. Self-efficacy and enjoyment were measured at baseline and at twelve months. Statistical analyses were based on a quasi-RCT design (independent t-tests), a comparison of participants and dropouts (Mann-Whitney test), and multilevel modelling to assess change in individual physical activity, including group level characteristics. Participants of CBHEPA programs are socially vulnerable in terms of low education (48.6%), low income (52.4%), non-Dutch origin (64.6%) and health-related quality of life outcomes. Physical activity levels were not below the Dutch average. No increase in physical activity levels over time was observed. The multilevel models showed significant positive associations between health-related quality of life, self-efficacy and enjoyment, and leisure-time physical activity over time. Short CBHEPA programs (10-13 weeks) with multiple trainers and gender-homogeneous groups were associated with lower physical activity levels over time. At twelve months, dropouts' leisure-time physical activity levels were significantly lower compared to continuing participants, as were health-related quality of life, self-efficacy and enjoyment outcomes. BMI and care consumption scored significantly higher among dropouts. In conclusion, Dutch CBHEPA programs reach socially vulnerable, but not necessarily inactive, groups in terms of socio-economic and health-related quality of life outcomes. Our findings suggest that CBHEPA programs particularly contribute to physical activity maintenance in socially vulnerable groups, rather than to an increase in physical activity behaviour over time.