By Heather O’Donnell
Moderate-to-vigorous physical activity (MVPA) aids in the prevention of premature mortality and chronic diseases, such as coronary and heart disease, type 2 diabetes, and breast and colon cancers (Garber et al., 2011; Lee et al., 2012). However, most people living in upper-middle and high-income countries do not engage in an adequate amount of MVPA, leading to increased morbidity and premature mortality rates (Lee et al., 2012). Underserved populations, including individuals with low socioeconomic status, individuals belonging to racial and ethnic minority groups, and individuals with physical disabilities are more likely than other groups to not engage in an adequate amount of MVPA (Conn et al., 2016; Cooper et al., 2015; Heath et al., 2012; Taylor et al., 1998). These populations should be targeted in MVPA health promotion interventions to reduce health disparities and promote health equity.
Individuals with low socioeconomic status face several barriers to MVPA, including financial constraints, time constraints stemming from work commitments, high levels of stress, low educational attainment, low motivation, and perceptions of lack of safety (Pedersen et al., 2021). They also experience low literacy rates and lack access to transportation and facilities where they would be able to participate in MVPA (Mendoza-Vasconez et al., 2016).
Recruitment strategies to promote MVPA and reduce barriers to access have included advertising messaging through mass media, social marketing, traditional marketing, and simple mobile features, such as text messaging and mobile phones (Mendoza-Vasconez et al., 2016). Successful interventions for individuals with low socioeconomic status should emphasize making MVPA a part of everyday life and communicating knowledge about health and health behaviors (Cleland et al., 2012; Heath et al., 2006; Sallis et al., 1998; Yancey et al., 2006).
Individuals with physical disabilities, such as Parkinson’s disease, cerebral palsy, spinal cord injury, cancer, multiple sclerosis, and stroke, also struggle to engage in MVPA. They commonly experience fatigue, pain, and weakness, as well as difficulty finding disability-friendly MVPA opportunities (Rimmer et al. 2004; Wilhite et al., 2016). Recruitment strategies for these individuals should include more flexible inclusion criteria, multiple marketing platforms, the maintenance of regular contact, and the involvement of community gatekeepers (Mendoza-Vasconez et al., 2016). MVPA promotion programs should include fall prevention education, incorporate technology for personalized, interactive, at-home interventions, and address psychosocial barriers and social support (Mendoza-Vasconez et al., 2016).
Compared to non-Hispanic White individuals, individuals from racial and ethnic minority backgrounds engage in a lower amount of MVPA (West, 2023). African Americans and Latinos experience some of the lowest levels of physical activity and highest levels of chronic diseases of all races (Larsen et al., 2015). Women from these backgrounds are especially likely to engage in an inadequate amount of MVPA (Sternfeld et al., 1999). Suggested recruitment strategies to target these individuals should include advertising messaging on multiple marketing platforms, providing free transportation to improve attendance, partnering with community health centers, and hiring research staff members that reflect the participants’ cultural backgrounds (Mendoza-Vasconez et al., 2016). Physical activity promotion interventions should include the use of linguistically appropriate materials for non-English speakers and cultural adaptations through the inclusion of values that pertain to specific cultures (Mendoza-Vasconez et al., 2016).
Addressing MVPA among underserved populations is one part of the comprehensive effort to address the social determinants of health (SDOHs), the conditions in which people are born, grow, live, work, and play that influence health (WHO, 2018). The SDOHs encompass a variety of social, economic, and environmental factors, such as socioeconomic status, education, employment, social support networks, and neighborhood and physical environments (Artiga and Hinton, 2018). Intervening on these social determinants of health will improve health outcomes and decrease longstanding disparities in health and healthcare for underserved populations.
Heather O’Donnell is a recent graduate of the Bloustein School of Planning and Public Policy, having earned a bachelor of science degree in Public Health.
Artiga, S., & Hinton, E. (2018, Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/
Cleland, C. L., Tully, M. A., Kee, F., & Cupples, M. E. (2012). The effectiveness of physical activity interventions in socio-economically disadvantaged communities: A systematic review. Preventive Medicine, 54(6), 371-380. 10.1016/j.ypmed.2012.04.004
Conn, V. S., Ph.D, & Coon Sells, T. G., Ph.D. (2016). Effectiveness of Interventions to Increase Physical Activity Among Minority Populations: An Umbrella Review. Journal of the National Medical Association, 108(1), 54-68. 10.1016/j.jnma.2015.12.008
Cooper, J., Stetson, B., Bonner, J., Spille, S., Krishnasamy, S., & Mokshagundam, S. P. (2015). Self-Reported Physical Activity in Medically Underserved Adults With Type 2 Diabetes in Clinical and Community Settings. Journal of Physical Activity & Health, 12(7), 968-975. 10.1123/jpah.2013-0475
Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I., Nieman, D. C., & Swain, D. P. (2011). American College of sports medicine position stand. quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and Science in Sports and Exercise, 43(7), 1334-1359. 10.1249/MSS.0B013E318213FEFB
Heath, G. W., Brownson, R. C., Kruger, J., Miles, R., Powell, K. E., & Ramsey, L. T. (2006). The Effectiveness of Urban Design and Land Use and Transport Policies and Practices to Increase Physical Activity: A Systematic Review. Journal of Physical Activity & Health, 3(s1), S55-S76. 10.1123/jpah.3.s1.s55
Heath, G. W., Parra, D. CSarmiento, O. L., Andersen, L. B., Owen, N., Goenka, S., Montes, F., & Brownson, R. C. (2012). Physical Activity 3 Evidence-based intervention in physical activity: lessons from around the world. The Lancet (British Edition), 380(9838), 272-281. https://search-proquest-com.proxy.libraries.rutgers.edu/docview/1029874678
Larsen, B. A., Martin, L., & Strong, D. R. (2015). Sedentary behavior and prevalent diabetes in Non-Latino Whites, Non-Latino Blacks and Latinos. Journal of Public Health (Oxford, England), 37(4), 634-640. 10.1093/pubmed/fdu103
Lee, I., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., & Katzmarzyk, P. T. (2012). Impact of Physical Inactivity on the World’s Major Non-Communicable Diseases10.1016/S0140-6736(12)61031-9
Mendoza-Vasconez, A. S., Linke, S., Muñoz, M., Pekmezi, D., Ainsworth, C., Cano, M., Williams, V., Marcus, B. H., & Larsen, B. A. (2016a). Promoting Physical Activity among Underserved Populations. Current Sports Medicine Reports, 15(4), 290-297. 10.1249/JSR.0000000000000276
Mendoza-Vasconez, A. S., Linke, S., Muñoz, M., Pekmezi, D., Ainsworth, C., Cano, M., Williams, V., Marcus, B. H., & Larsen, B. A. (2016b). Promoting Physical Activity among Underserved Populations. Current Sports Medicine Reports, 15(4), 290-297. 10.1249/JSR.0000000000000276
Pedersen, M. R. L., Hansen, A. F., & Elmose-Østerlund, K. (2021). Motives and Barriers Related to Physical Activity and Sport across Social Backgrounds: Implications for Health Promotion. International Journal of Environmental Research and Public Health, 18(11), 5810. 10.3390/ijerph18115810
Rimmer, J. H., Riley, B., Wang, E., Rauworth, A., & Jurkowski, J. (2004). Physical activity participation among persons with disabilities: Barriers and facilitators. American Journal of Preventive Medicine, 26(5), 419-425. 10.1016/j.amepre.2004.02.002
Sallis, J., Bauman, A., & Pratt, M. (1998a). Environmental and policy interventions to promote physical activity. American Journal of Preventive Medicine, 15(4), 379-397. 10.1016/S0749-3797(98)00076-2
Sallis, J., Bauman, A., & Pratt, M. (1998b). Environmental and policy interventions to promote physical activity. American Journal of Preventive Medicine, 15(4), 379-397. 10.1016/S0749-3797(98)00076-2
Social Determinants of Health. (2018). World Health Organization. https://www.who.int/teams/social-determinants-of-health
Sternfeld, B., Ainsworth, B. E., & Quesenberry, C. P. (1999). Physical Activity Patterns in a Diverse Population of Women. Preventive Medicine, 28(3), 313-323. 10.1006/pmed.1998.0470
Taylor, W. C., Baranowski, T., & Young, D. R. (1998). Physical activity interventions in low-income, ethnic minority, and populations with disability. American Journal of Preventive Medicine, 15(4), 334-343. 10.1016/S0749-3797(98)00081-6
West, M., 2023. Division of Nutrition, Physical Activity, and Obesity (CDC), Trust for America’s Health. United States of America. https://policycommons.net/artifacts/3856760/division-of-nutrition-physical-activity-and-obesity-cdc/4662715/ on 18 Aug 2023. CID: 20.500.12592/d3p07w.
Wilhite, B., Martin, D., & Shank, J. (2016). Facilitating Physical Activity among Adults with Disabilities. Therapeutic Recreation Journal, 50(1), 33. 10.18666/TRJ-2016-V50-I1-6790
Yancey, A. K., Ory, M. G., & Davis, S. M. (2006). Dissemination of Physical Activity Promotion Interventions in Underserved Populations. American Journal of Preventive Medicine, 31(4), 82-91. 10.1016/j.amepre.2006.06.020