The study participants significantly increased light, moderate, and vigorous physical activity levels, as well as total physical activity sessions and total physical activity level weighted by intensity. While many exercise intervention studies have shown increases in physical activity over the course of the intervention, a meta-analysis reported that the few studies that examined adherence during the months following the intervention generally reported small effects.9
In addition, almost 50% of Americans discontinue exercise programs before 6 months. In contrast, our results show that on average FIF participants maintained or even increased their physical activity participation in the period after the intervention ended. This suggests that FIF participants acquired new and helpful methods of remaining active and that these methods continued to be effective even after the actual intervention had ended.
These methods continued to be effective after the intervention had ended
That these results show significant intervention effects may be due to a curriculum that was specifically tailored to address barriers faced by middle-aged women. Results of the present study support previous research showing that physical activity interventions are more likely to be effective if they address the needs and interests of the target group.23
Tailoring intervention content to the sociopsychological barriers relevant to women may help middle-aged women increase and maintain higher levels of physical activity. Tailoring interventions by gender may be useful because gender differences exist for key psychological variables associated with physical activity behavior.11
It is important for people to understand the constraints on their behavior in a broader social context before they can develop strategies for changing it.14
To facilitate participants’ increased awareness about the tacit but powerful pressures women face due to gender role expectations and beauty norms, the FIF intervention employed empowerment techniques such as consciousness-raising.
Studies that have examined women's participation in exercise emphasize the importance of addressing life context (social roles, family and job responsibilities, etc.) when promoting increased physical activity levels.7
In FIF, constraints related to gender, including multiple roles and responsibilities, were discussed explicitly, and the group worked together to construct effective strategies for overcoming these types of barriers to being physically active. Helping women address their conflicts related to gender roles and gain tools for feeling comfortable with claiming time for their self-care may facilitate greater maintenance of a self-care activity like physical activity.
In addition, FIF participants discussed how normative pressures to be thin24
might detrimentally impact their approach to being physically active. A woman who has extrinsic goals such as body sculpting may be very dependent upon perceived positive outcomes and not continue to exercise if immediate gains in appearance are not achieved.25
Our quantitative data showed significant increases in taking a PBA to physical activity and in the PSC, suggesting that the discussions surrounding these gendered issues were effective. Furthermore, qualitative data showed that participants were selecting different goals for exercising and approaching being physically active in a different mindset after their participation in the intervention.
. . . significant increases in taking a pleasure-based approach to physical activity
There are several significant limitations to this evaluation of FIF. Retrospective recall of behavior and social desirability bias are possible limiting factors, because our data were obtained through self-report. Although we had an adequate response rate, an additional limitation is that our data showed that the responders at the study follow-up had lower baseline levels than the nonresponders in taking a pleasure-based approach to physical activity (PBA). It may indicate that the participants who had more negative feelings towards being active before the program received greater benefits from the intervention's focus on pleasure-based physical activity. It may be especially beneficial to help women who have negative feelings about exercise find enjoyable physical activities.
An important limitation is that we did not have a control group and cannot rule out alternative hypotheses. However, by having participants pay to attend the sessions, we more accurately simulated the way such a program might actually be implemented, although this did interfere with our ability to include a meaningful comparison group. Despite the limitations in this study, this research has some important strengths. We did collect long-term follow-up data on participants. Follow-up data are important because long-term physical activity is the ultimate goal of intervention research. However, most physical activity intervention studies do not report it, and those that do, report findings that are not encouraging regarding long-term maintenance.9
In contrast, our finding of higher activity at follow-up is notable because 78% of our participants had concluded the intervention at least 9 months before this data collection. Furthermore, we avoided some limitations common to mono-method research by using both quantitative and qualitative assessment in our evaluation.17
Caution in generalizing our findings is warranted owing to the nonprobability sample and to the homogeneity of our study participants. Not only were the majority of participants in FIF very educated, but they should also be considered highly motivated because they paid to participate. Women of different ethnic groups and socioeconomic status levels have barriers at both individual and social levels distinct from those identified in this sample. It is important to recognize that this study did not address the barriers to being physically active encountered by economically disadvantaged and marginalized women. Although this research is encouraging, an important next step is to conduct a rigorous, randomized controlled experiment in order to remove the potential alternative explanations that currently exist for the changes seen in our study's outcomes.
The six-week FIF program format is a realistic commitment for many women. Additionally, the cost may make it appealing to managed care organizations that could provide the program to their members. Furthermore, the behavioral model and approach described here can be tailored to different populations (those with chronic illnesses, differing ethnic groups, etc.) in addition to being adapted as a course offered on the Internet, a workbook, or a self-directed video educational program.