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Communication
Open Access Peer-reviewed

Presenting Meaningful Lifestyle Physical Activity Images to People for a More Realistic, Doable, and Enjoyable Way to Meet Our Physical Activity Guidelines

M. Felicia Cavallini , David J. Dyck
World Journal of Preventive Medicine. 2020, 8(1), 1-6. DOI: 10.12691/jpm-8-1-1
Received June 23, 2020; Revised July 24, 2020; Accepted August 04, 2020

Abstract

Most Americans and Canadians do not meet their respective country’s physical activity (PA) guidelines of 150 minutes of moderate to vigorous activity and 2 or more strengthening activities per week. More recent studies have indicated a preference for lifestyle PA rather than traditional exercise, suggesting a need for a change of strategy in how we motivate, educate and connect people to their meaningful PA. The purpose of this study was to examine peoples’ beliefs, outlooks, and attitudes towards PA and exercise in Southern Ontario, Canada and South Carolina, United States with the overarching goal of adding a new paradigm to the already established standard of exercise. The study was conducted in two phases: first, a qualitative focus-group based phase in which feedback towards attitudes towards exercise and PA was used to generate a quantitative questionnaire which was used in phase two. Our results indicate that the majority of participants from Southern Ontario and South Carolina, ages 18-64, perceive a difference between lifestyle PA and exercise (Southern Ontario, 84% of males, 80% of females; South Carolina, 82% males, 74% females), and that engaging in lifestyle PA is a more natural, realistic and enjoyable part of their day than exercise (Southern Ontario, 83% of males, 78% of females; South Carolina, 81% males, 74% females). Additionally, participants indicated a preference towards lifestyle PA as opposed to within a gym environment. Overall, Southern Ontarians and South Carolinians were consistent in their message for a more unstructured, unregimented, natural way of being physically active throughout the day. Physical activity needs to be customized, tailored and meaningful for everyone.

1. Introduction

With the majority of Americans and Canadians still not meeting national physical activity (PA) guidelines of 150 minutes of moderate to vigorous activity and 2 or more strengthening activities per week 1, 2, 3, 4, there is little question that a change of strategy in how we motivate, educate and connect people to their meaningful PA is in order. With the rise of obesity and sedentary lifestyles, the status of our nation’s health continues to decline 5, 6. The purpose of this study was to examine peoples’ beliefs, outlooks, and attitudes towards PA and exercise in Southern Ontario, Canada and South Carolina, United States, ages 18-64 with the overarching goal of adding a new paradigm to the already established standard of exercise 1, 2, 3, 4. More recent studies have indicated a preference for lifestyle PA rather than traditional exercise 7, 8, 9, suggesting a need for a change of strategy in how we motivate, educate and connect people to their meaningful PA. It was hypothesized that most participants would prefer lifestyle PA over traditional exercises and would find lifestyle PA more realistic, doable, natural, and enjoyable to accomplish during their day. In addition, it was theorized that most Canadians and Americans would believe that they could achieve guidelines through lifestyle PA by accomplishing daily goals, tasks and responsibilities. Finally, it was hypothesized most people believe there is a difference between PA and exercise.

2. Methods

2.1. Participants

Clearance was received from the Research Ethics Board, University of Guelph, and Institutional Review Board, Limestone College. Phase I of the research study concentrated on gathering data through facilitated focus group discussions and took place in Guelph, Ontario from December of 2014 to May of 2015, and in Cherokee County, South Carolina from December of 2016 to May of 2018. Adults ages 18 years and older representing 13 diverse groups from rural and urban communities in Guelph and Wellington County in Southwestern Ontario, Canada and 13 groups from Cherokee County, South Carolina were invited to participate in this study. Some examples from Guelph and Wellington County included members of the following groups: a rural Parks and Recreation Department, Lion’s Club from a rural community, a rural Mennonite church, a women’s advocacy group called Zonta International of Guelph, the staff from the Guelph YMCA/YWCA, and the Italian Canadian Club of Guelph. Focus groups from Cherokee County in South Carolina included members from a United Methodist and Baptist church, the Board of Public Works, the City of Gaffney staff, Rotary Clubs, City of Gaffney firefighters and schoolteachers from a rural elementary school. The exclusion criteria were any health conditions that precluded a participant from being physically active.

2.2. Procedures
2.2.1. Phase I.

Focus group facilitated discussions were conducted with 234 people from Southwestern Ontario and 175 people from South Carolina representing the various groups of participants previously identified. In general, each of the thirteen groups in Southern Ontario and South Carolina included 6-15 participants. Focus group interviews were held in the preferred meeting place for each group to create a comfortable atmosphere in order to facilitate a relaxed discussion. Conversations were not recorded, and participants were reassured that the discussions would be kept confidential. Participants were urged to share their experiences and articulate their feelings regarding PA or exercise in this environment of minimum structure other than gently probing questions to allow thoughts to flow freely and allow for in-depth conversation. At the beginning of each session, participants were asked to complete a short demographic questionnaire regarding their gender, age group, and residence. The focus group discussions lasted 30 to 60 minutes. Participants were free to leave at any time. The same, trained investigator facilitated each focus group discussion following the same procedure. Guiding questions included: What do you think of when you hear the word exercise? What do you think of when you hear the word, physical activity? Do you think active transportation counts as PA? Do you prefer a more structured, regimented, repetitive way of moving? Do you prefer to move while you are gardening, landscaping, walking the dog, or playing with your children? Do you think the US PA guidelines can be reached through lifestyle PA? Is there a difference between PA and exercise? Do you find lifestyle PA to be more natural, doable, realistic and enjoyable than exercise? Further probing questions followed and were dependent upon the participants’ initial responses. Overall, the conversations were navigated to explore key motivators that contribute to partaking in PA or exercise.

Focus group discussions were facilitated by the same trained, content expert. In order to ensure consistency, the same trained core group of students for each study were present at all the focus groups to make notes of the conversation as well as an interpretation of what they heard. Upon completion of each focus group discussion, the students sent their typed notes to the group facilitator for thorough review. To understand the perspectives and interpret the experiences of the participants, the notes were meticulously reviewed for each focus group by the same trained group facilitator multiple times in corroboration with the students to allow essential ideas to emerge and to ensure there was complete agreement with the interpretation. In addition, the group facilitator consulted with two outside content experts throughout the entirety of the process. This ensured that the interpretation of the focus group feedback was never biased by one person's perception. The aim was to identify recurring themes emphasized by the participants. These themes were then categorized under separate headings. From the feedback given in phase I of the study, it became clear that many of the participants reflected a preference for lifestyle PA.


2.2.2. Phase II

Using the themes that emerged from the focus group interviews, a unique research-generated survey was created to validate the findings of the initial focus group interviews regarding their preferences to PA. With this purpose in mind, common themes and trends that emerged on peoples’ preferences to PA and exercise from the focus group interviews were identified and analyzed by three content experts with backgrounds in physical education and exercise. These themes were then used to construct a series of questions related to lifestyle PA versus exercise to reflect the responses from the focus group interviews. The team of content specialists collaborated throughout the process.

Since phase I of the study was qualitative, it was imperative the research-generated survey accurately reflected the potential key motivators to PA identified in the focus groups. All survey items reflected what was heard in the focus group discussions from phase I. There was no addition or modification of questions in the construction of the survey that did not reflect the responses of the participants nor was there any adjustments of the wording and format made in the survey in between each survey administration. This helped ensure the reliability and validity of the survey in that only the remarks made regarding their outlook, beliefs, attitude, opinions and preferences to PA were being measured and nothing else. The survey was designed to be completed in less than 10 minutes. The responses from the survey data were consistent with the information conveyed from the focus groups.

Surveys were distributed between July and September 2015 (Southern Ontario), and July 2018 to July 2019 (South Carolina) to individuals 18 years of age and older from the same community groups where the focus group data were initially collected. Data presented in this study focuses on individuals between the ages of 18 and 64 years. Informed consents from these participants were obtained and survey administration was scheduled at a convenient time and location suitable for each group. Participation in the focus group discussions was not required for completion of the survey. Basic demographic information (age, gender, place of residence) was collected again. Participants were asked to answer “yes” or “no” questions on their preferences to PA.

Data Collection: All data was collected via anonymous surveys. Data was entered into Excel worksheets. These are the same surveys and methods as we have previously used 8.

3. Results

The results indicate that the overwhelming majority of the total participants from Southern Ontario and South Carolina, ages 18-64, do perceive a difference between lifestyle PA and exercise (Southern Ontario, 84% of males, 80% of females; South Carolina, 82% males, 74% females), and that engaging in lifestyle PA is a more natural, realistic and enjoyable part of their day than exercise (Southern Ontario, 83% of males, 78% of females; South Carolina, 81% males, 74% females). Overall, 74% of the males and 57% of the females from Southern Ontario and 67% of the males and of the 63% of the females from South Carolina thought the PA guidelines which are shared by both Canada and the United States, could be achieved through lifestyle PA alone. In addition, most participants thought that PA was easier to incorporate into their day than exercise (Southern Ontario, 77% of males, 75% of females; South Carolina, 77% males, 75% females). Most Southern Ontarians, males (65%) and females (57%) and South Carolinians, males (67%) and females (64%) respondents indicated a preference to engage in PA such as energetic yard work, brisk walking or forcefully raking leaves, than traditional planned exercise sessions. Moreover, 83% of males and 89% of females from Southern Ontario and 84% of males and 90% of females from South Carolina thought that lifestyle PA and traditional exercise were both easier to do when goal-oriented or purpose driven (e.g. gardening, washing the car, walking to work). Additionally, participants preferred lifestyle PA outside the gym environment (Southern Ontario males (3.9/5), females (3.8/5) and South Carolina males (3.9/5), females (3.7/5). Overall, Southern Ontarians and South Carolinians were consistent in their message for a more unstructured, unregimented, natural way of being physically active throughout the day.

Our results from this study indicate that most adults, 18-64, want their PA to be part of their everyday living. This is also consistent with the findings of previous studies, which point to the tendency for day-to-day lifestyle PA over exercise 10, 11, 12.

  • Table 2. Male and female responses in Southern Ontario to survey questions related to physical activity and exercise. Numbers represent the percentage of total respondents answering “Yes” to the question, except for final statement (Scale 1-5)

  • Table 3. Male and female responses in South Carolina to survey questions related to physical activity and exercise. Numbers represent the percentage of total respondents answering “Yes” to the question, except for final statement (Scale 1-5)

4. Discussion

Exercise is universally acknowledged as being healthy. However, many people don’t have the desire to partake in traditional exercise, and most Americans and Canadians do not meet the PA guidelines. It is time to change how we market, motivate, educate and meaningfully connect adults to PA. Many people are not interested in traditional exercise, but typically, PA marketing is geared towards the gym work-out, weight room, boot camp, and images of six pack abdominals and the beach-ready body. The health, fitness and research community have pushed the structured, regimented, routine of exercise along with the narrative, images, and attitude of “one size fits all”. For many years, it was this position without consideration for how the public wanted to approach PA and incorporate it into their lives. In addition to the already established exercise paradigm, we absolutely need a lifestyle PA paradigm in which the medical, research, fitness and health communities can educate the public, their patients and clients about the health benefits of lifestyle PA. Walking the dog, taking the stairs multiple times during the day, moving around at home doing laundry or house responsibilities for 5, 10 or 15 minutes at a time adds up to a healthier you! The hard facts of the benefits one gains from pushing the lawn mower for 20 minutes mowing the grass for example, needs to be compared to an “exercise” activity like playing a game of racquetball. Engaging in active transportation such as walking or biking to work or running errands while at work or around the home needs to be likened to traditional exercise such as playing volleyball or flag football. The health benefits of these physical activities are well documented 13, 14, 15.

Customized, motivationally tailored print-based materials representing lifestyle PA are more effective than traditional exercise literature at motivating people to change behavior 16, 17, 18, 19, 20. Specific printed materials along with additional PA intervention strategies, combined with accessibility to parks, aesthetically pleasing bike paths, walkways, and trails, are an effective way to allow communities to move in a way that is meaningful and impactful. Figure 1 represents daily PA movements that can happen during the course of one’s day. Movements such as moving furniture, engaging in snowball fights, taking a walk along a safe trail with the baby in a stroller, vacuuming a room or the whole house, gardening and shoveling snow are all very beneficial not only health-wise, but psychologically, emotionally, socially, and mentally. In addition, providing family fun activities where all can enjoy such as dancing at the local festival, walking downtown or along the Riverwalk, biking on the railroad trail, and shopping or touring in a historic district can be enjoyable and effective 21, 22.

Instead of a “one size fits all” position, PA needs to be customized, tailored and meaningful for each individual. A connection to the person’s personality and preferences to PA is essential to maximize a meaningful relationship unique to everyone. Health promotors should listen to what each individual person enjoys in their daily life and observe their tendencies as well as their likes and dislikes. We should help patients, clients, community members determine which PA would be natural, realistic and enjoyable day to day. People need to hear that it is acceptable to embrace lifestyle PA as a means of meeting our PA guidelines. It is up to the medical community, health professionals, physical education, kinesiology and exercise science professors, physical education teachers, and researchers to take responsibility and present lifestyle PA as a viable option for many citizens. We need to help our society feel more confident about the health benefits gained from everyday movements both in and around the home and at work. If we fulfill these obligations, in time, there is a higher probability that exercise adherence among Americans and Canadians will increase with a greater sense of enjoyment and purpose.

5. Conclusions

Regardless of the geographical region (Southern Ontario, South Carolina), participants believed that there was a difference between physical activity and exercise, but importantly, that current activity guidelines can be met through daily lifestyle physical activity. The results also clearly indicate that participants feel that achieving activity goals are more easily met when they are incorporated into their daily routine. Based on these results, it is our recommendation that more effort is put into the promotion of engaging in natural daily activity, instead of the typical promotion of structured gym classes and workouts.

References

[1]  Canadian Society for Exercise Physiology, Canadian Physical Activity Guidelines. 2012.
In article      
 
[2]  Colley, R.C., et al., Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Reports, 2011. 22(1): p. 7-14.
In article      View Article
 
[3]  Shields, M., et al., Fitness of Canadian adults: Results from the 2007-2009 Canadian Health Measures Survey. Health Reports, 2010. 21(1).
In article      
 
[4]  United States Department of Health and Human Services, Center for Disease Control and Prevention, Division of Nutrition, Physical Activity and Obesity. 2018.
In article      
 
[5]  Akil, L. and H.A. Ahmad, Relationships between obesity and cardiovascular diseases in four southern states and Colorado. J Health Care Poor Underserved, 2011. 22(4 Suppl): p. 61-72.
In article      View Article  PubMed
 
[6]  Gonzalez, K., J. Fuentes, and J.L. Marquez, Physical Inactivity, Sedentary Behavior and Chronic Diseases. Korean J Fam Med, 2017. 38(3): p. 111-115.
In article      View Article  PubMed
 
[7]  Burton, N.W., A. Khan, and W.J. Brown, How, where and with whom? Physical activity context preferences of three adult groups at risk of inactivity. British Journal of Sports Medicine, 2012. 46(16): p. 1125-1131.
In article      View Article  PubMed
 
[8]  Cavallini, M.F., et al., Introducing MyHouse Activity and MyWork Activity: A Paradigm Shift towards Lifestyle Physical Activity Supported by Evidence from a Focus Group Study. Journal of Physical Activity Research, 2017. 2(1): p. 61-67.
In article      View Article
 
[9]  Salmon, J., et al., Physical activity and sedentary behavior: a population-based study of barriers, enjoyment, and preference. Health Psychology, 2003. 22(2): p. 178-188.
In article      View Article  PubMed
 
[10]  Burton, N.W., A. Khan, and W.J. Brown, How, where and with whom? Physical activity context preferences of three adult groups at risk of inactivity. British Journal of Sports Medicine, 2012. 46(16): p. 1125-31.
In article      View Article  PubMed
 
[11]  Salmon, J., et al., Physical activity and sedentary behavior: a population-based study of barriers, enjoyment, and preference. Health Psychology, 2003. 22(2): p. 178-88.
In article      View Article  PubMed
 
[12]  Booth, M.L., et al., Physical activity preferences, preferred sources of assistance, and perceived barriers to increased activity among physically inactive Australians. Preventive Medicine, 1997. 26(1): p. 131-7.
In article      View Article  PubMed
 
[13]  Ainsworth, B.E., et al., 2011 compendium of physical activities: A second update of codes and MET values. 2011.
In article      View Article  PubMed
 
[14]  Huerta, J.M., et al., Work, household, and leisure-time physical activity and risk of mortality in the EPIC-Spain cohort. Preventive Medicine, 2016. 85: p. 106-112.
In article      View Article  PubMed
 
[15]  Samitz, G., M. Egger, and M. Zwahlen, Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studies. International Journal of Epidemiology, 2011. 40(5): p. 1382-1400.
In article      View Article  PubMed
 
[16]  Calfas, K.J., et al., A controlled trial of physician counseling to promote the adoption of physical activity. Preventive Medicine, 1996. 25(3): p. 225-233.
In article      View Article  PubMed
 
[17]  Cardinal, B.J. and M.L. Sachs, Effects of mail-mediated, stage-matched exercise behavior change strategies on female adults' leisure-time exercise behavior. Journal of Sports Medicine and Physical Fitness, 1996. 36(2): p. 100-107.
In article      
 
[18]  Jarvis, K.L., et al., Older women and physical activity: Using the telephone to walk. Womens Health Issues, 1997. 7(1): p. 24-29.
In article      View Article
 
[19]  Marcus, B.H., et al., Efficacy of an individualized, motivationally-tailored physical activity intervention. Annals of Behavioral Medicine, 1998. 20(3): p. 174-180.
In article      View Article  PubMed
 
[20]  Marcus, B.H., et al., Physical activity interventions using mass media, print media, and information technology. American Journal of Preventive Medicine, 1998. 15(4): p. 362-378.
In article      View Article
 
[21]  Marcus, B.H., et al., Using the stages of change model to increase the adoption of physical activity among community participants. American Journal of Health Promotion, 1992. 6(6): p. 424-429.
In article      View Article  PubMed
 
[22]  King, A.C., Community Intervention for Promotion of Physical Activity and Fitness. Exercise and Sport Sciences Reviews, 1991. 19(1): p. 211-260.
In article      View Article  PubMed
 

Published with license by Science and Education Publishing, Copyright © 2020 M. Felicia Cavallini and David J. Dyck

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Cite this article:

Normal Style
M. Felicia Cavallini, David J. Dyck. Presenting Meaningful Lifestyle Physical Activity Images to People for a More Realistic, Doable, and Enjoyable Way to Meet Our Physical Activity Guidelines. World Journal of Preventive Medicine. Vol. 8, No. 1, 2020, pp 1-6. http://pubs.sciepub.com/jpm/8/1/1
MLA Style
Cavallini, M. Felicia, and David J. Dyck. "Presenting Meaningful Lifestyle Physical Activity Images to People for a More Realistic, Doable, and Enjoyable Way to Meet Our Physical Activity Guidelines." World Journal of Preventive Medicine 8.1 (2020): 1-6.
APA Style
Cavallini, M. F. , & Dyck, D. J. (2020). Presenting Meaningful Lifestyle Physical Activity Images to People for a More Realistic, Doable, and Enjoyable Way to Meet Our Physical Activity Guidelines. World Journal of Preventive Medicine, 8(1), 1-6.
Chicago Style
Cavallini, M. Felicia, and David J. Dyck. "Presenting Meaningful Lifestyle Physical Activity Images to People for a More Realistic, Doable, and Enjoyable Way to Meet Our Physical Activity Guidelines." World Journal of Preventive Medicine 8, no. 1 (2020): 1-6.
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  • Table 1. Survey Questions. For each of the following statements, please choose either Yes or No for your response
  • Table 2. Male and female responses in Southern Ontario to survey questions related to physical activity and exercise. Numbers represent the percentage of total respondents answering “Yes” to the question, except for final statement (Scale 1-5)
  • Table 3. Male and female responses in South Carolina to survey questions related to physical activity and exercise. Numbers represent the percentage of total respondents answering “Yes” to the question, except for final statement (Scale 1-5)
[1]  Canadian Society for Exercise Physiology, Canadian Physical Activity Guidelines. 2012.
In article      
 
[2]  Colley, R.C., et al., Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Reports, 2011. 22(1): p. 7-14.
In article      View Article
 
[3]  Shields, M., et al., Fitness of Canadian adults: Results from the 2007-2009 Canadian Health Measures Survey. Health Reports, 2010. 21(1).
In article      
 
[4]  United States Department of Health and Human Services, Center for Disease Control and Prevention, Division of Nutrition, Physical Activity and Obesity. 2018.
In article      
 
[5]  Akil, L. and H.A. Ahmad, Relationships between obesity and cardiovascular diseases in four southern states and Colorado. J Health Care Poor Underserved, 2011. 22(4 Suppl): p. 61-72.
In article      View Article  PubMed
 
[6]  Gonzalez, K., J. Fuentes, and J.L. Marquez, Physical Inactivity, Sedentary Behavior and Chronic Diseases. Korean J Fam Med, 2017. 38(3): p. 111-115.
In article      View Article  PubMed
 
[7]  Burton, N.W., A. Khan, and W.J. Brown, How, where and with whom? Physical activity context preferences of three adult groups at risk of inactivity. British Journal of Sports Medicine, 2012. 46(16): p. 1125-1131.
In article      View Article  PubMed
 
[8]  Cavallini, M.F., et al., Introducing MyHouse Activity and MyWork Activity: A Paradigm Shift towards Lifestyle Physical Activity Supported by Evidence from a Focus Group Study. Journal of Physical Activity Research, 2017. 2(1): p. 61-67.
In article      View Article
 
[9]  Salmon, J., et al., Physical activity and sedentary behavior: a population-based study of barriers, enjoyment, and preference. Health Psychology, 2003. 22(2): p. 178-188.
In article      View Article  PubMed
 
[10]  Burton, N.W., A. Khan, and W.J. Brown, How, where and with whom? Physical activity context preferences of three adult groups at risk of inactivity. British Journal of Sports Medicine, 2012. 46(16): p. 1125-31.
In article      View Article  PubMed
 
[11]  Salmon, J., et al., Physical activity and sedentary behavior: a population-based study of barriers, enjoyment, and preference. Health Psychology, 2003. 22(2): p. 178-88.
In article      View Article  PubMed
 
[12]  Booth, M.L., et al., Physical activity preferences, preferred sources of assistance, and perceived barriers to increased activity among physically inactive Australians. Preventive Medicine, 1997. 26(1): p. 131-7.
In article      View Article  PubMed
 
[13]  Ainsworth, B.E., et al., 2011 compendium of physical activities: A second update of codes and MET values. 2011.
In article      View Article  PubMed
 
[14]  Huerta, J.M., et al., Work, household, and leisure-time physical activity and risk of mortality in the EPIC-Spain cohort. Preventive Medicine, 2016. 85: p. 106-112.
In article      View Article  PubMed
 
[15]  Samitz, G., M. Egger, and M. Zwahlen, Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studies. International Journal of Epidemiology, 2011. 40(5): p. 1382-1400.
In article      View Article  PubMed
 
[16]  Calfas, K.J., et al., A controlled trial of physician counseling to promote the adoption of physical activity. Preventive Medicine, 1996. 25(3): p. 225-233.
In article      View Article  PubMed
 
[17]  Cardinal, B.J. and M.L. Sachs, Effects of mail-mediated, stage-matched exercise behavior change strategies on female adults' leisure-time exercise behavior. Journal of Sports Medicine and Physical Fitness, 1996. 36(2): p. 100-107.
In article      
 
[18]  Jarvis, K.L., et al., Older women and physical activity: Using the telephone to walk. Womens Health Issues, 1997. 7(1): p. 24-29.
In article      View Article
 
[19]  Marcus, B.H., et al., Efficacy of an individualized, motivationally-tailored physical activity intervention. Annals of Behavioral Medicine, 1998. 20(3): p. 174-180.
In article      View Article  PubMed
 
[20]  Marcus, B.H., et al., Physical activity interventions using mass media, print media, and information technology. American Journal of Preventive Medicine, 1998. 15(4): p. 362-378.
In article      View Article
 
[21]  Marcus, B.H., et al., Using the stages of change model to increase the adoption of physical activity among community participants. American Journal of Health Promotion, 1992. 6(6): p. 424-429.
In article      View Article  PubMed
 
[22]  King, A.C., Community Intervention for Promotion of Physical Activity and Fitness. Exercise and Sport Sciences Reviews, 1991. 19(1): p. 211-260.
In article      View Article  PubMed