Application of theoretical domains framework to explore the enablers and barriers to physical activity among university staff and students: a qualitative study

Objectively measured moderate-to-vigorous physical activity does not attenuate prospective weight gain among African-origin adults spanning the epidemiological transition

Traditional obesity-related public health messaging often includes physical activity (PA) recommendations. However, at the population level, the data are conflicting, especially when comparing different self-reported vs measured techniques across different settings and populations. We measured the association between moderate-to-vigorous intensity PA (MVPA) and prospective weight change across five African-origin populations and the extent to which MVPA attenuated weight change over time. At baseline, 2,500 adults (median age: 37y) were recruited into the Modelling the Epidemiologic Transition Study (METS), from Ghana, South Africa, Jamaica, Seychelles, and US. 2000 participants were followed up 8 years later, with 851 participants having complete 7-day accelerometry to measure MVPA at both time points. Generalised estimating equations were used to explore the longitudinal association between weight and MVPA adjusted for several confounders. The obesity prevalence at baseline was 27.5% which increased to 38.0% at follow-up. Baseline MVPA varied from 7 (IQR: 4, 16) min/day in US women to 52 (IQR: 36, 78) min/day in South African men, and similarly at follow-up ranged from 8 min/day to 41 min/day among the same participant groups. While overall, engaging in higher MVPA levels was associated with a lower body weight, such that every additional 30 min of MVPA equalled a 600g lower body weight (p = 0.04), the interaction between time and MVPA was not statistically significant (p = 0.18). Therefore, regardless of the amount of MVPA at any time point, body weight increased over time. Despite the association between MVPA and weight, our results suggest that objectively measured longitudinal MVPA was not associated with the change in 8-year weight in African-origin adults. Our research confirms that while PA is a critical determinant of cardiovascular health, it alone may not be enough to stem the rising obesity burden.

Key influences on university students' physical activity: a systematic review using the Theoretical Domains Framework and the COM-B model of human behaviour

BACKGROUND

Physical activity is important for all aspects of health, yet most university students are not active enough to reap these benefits. Understanding the factors that influence physical activity in the context of behaviour change theory is valuable to inform the development of effective evidence-based interventions to increase university students' physical activity. The current systematic review a) identified barriers and facilitators to university students' physical activity, b) mapped these factors to the Theoretical Domains Framework (TDF) and COM-B model, and c) ranked the relative importance of TDF domains.

METHODS

Data synthesis included qualitative, quantitative, and mixed-methods research published between 01.01.2010-15.03.2023. Four databases (MEDLINE, PsycINFO, SPORTDiscus, and Scopus) were searched to identify publications on the barriers/facilitators to university students' physical activity. Data regarding study design and key findings (i.e., participant quotes, qualitative theme descriptions, and survey results) were extracted. Framework analysis was used to code barriers/facilitators to the TDF and COM-B model. Within each TDF domain, thematic analysis was used to group similar barriers/facilitators into descriptive theme labels. TDF domains were ranked by relative importance based on frequency, elaboration, and evidence of mixed barriers/facilitators.

RESULTS

Thirty-nine studies involving 17,771 participants met the inclusion criteria. Fifty-six barriers and facilitators mapping to twelve TDF domains and the COM-B model were identified as relevant to students' physical activity. Three TDF domains, environmental context and resources (e.g., time constraints), social influences (e.g., exercising with others), and goals (e.g., prioritisation of physical activity) were judged to be of greatest relative importance (identified in > 50% of studies). TDF domains of lower relative importance were intentions, reinforcement, emotion, beliefs about consequences, knowledge, physical skills, beliefs about capabilities, cognitive and interpersonal skills, social/professional role and identity, and behavioural regulation. No barriers/facilitators relating to the TDF domains of memory, attention and decision process, or optimism were identified.

CONCLUSIONS

The current findings provide a foundation to enhance the development of theory and evidence informed interventions to support university students' engagement in physical activity. Interventions that include a focus on the TDF domains 'environmental context and resources,' 'social influences,' and 'goals,' hold particular promise for promoting active student lifestyles.

TRIAL REGISTRATION

Prospero ID-CRD42021242170.