Design and Validation of a Questionnaire to Assess the Leisure Time Physical Activity of Adult Women in Gipuzkoa

Citation: Eizagirre-Sagastibeltza, O.; Fernandez-Lasa, U.; Yanci, J.; Romaratezabala, E.; Cayero, R.; Iturrioz, I.; Usabiaga, O. Design and Validation of a Questionnaire to Assess the Leisure Time Physical Activity of Adult Women in Gipuzkoa. Int. J. Environ. Res. Public Health 2022,19, 5736. https:// doi.org/10.3390/ijerph19095736 Academic Editor: Paul B. Tchounwou Received: 28 March 2022 Accepted: 6 May 2022 Published: 8 May 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). International Journal of Environmental Research and Public Health Article Design and Validation of a Questionnaire to Assess the Leisure Time Physical Activity of Adult Women in Gipuzkoa Olaia Eizagirre-Sagastibeltza 1, Uxue Fernandez-Lasa 2,* , Javier Yanci 2, Estibaliz Romaratezabala 2, Ruth Cayero 3, Iñaki Iturrioz 4and Oidui Usabiaga 2 1 Faculty of Education and Sport, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Spain; [email protected] 2Society, Sport and Physical Activity (GIKAFIT) Research Group, Department of Physical Education and Sports, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), Lasarteko Bidea 71, 01007 Vitoria-Gasteiz, Spain; [email protected] (J.Y.); [email protected] (E.R.); [email protected] (O.U.) 3Department of Physical Education and Sports, Faculty of Education and Sport, University of the Basque Country (UPV/EHU), 01007 Vitoria-Gasteiz, Spain; ruth.cayer[email protected] 4Diputación Foral de Gipuzkoa, Gipuzkoa Provincial Council, 20004 Donostia-San Sebastian, Spain; [email protected] *Correspondence: [email protected]; Tel.: +34-945013530 Abstract: Inactivity is higher among women than among men, and there are few specific questionnaires used to assess physical activity (PA) in women that are truly meaningful to them. This article tackles the design and validation process of an ad hoc multidimensional questionnaire to assess leisure time physical activity (LTPA) among adult women of Gipuzkoa. The questionnaire was completed by 3595 adult women (43.5 ± 12.1 years), 32% of which were inactive and 68% of which were active. Content validation, ecological validation, and internal consistency analysis results were satisfactory. The Gipuzkoa Women’s Physical Activity Questionnaire (GWPAQ) consists of four dimensions and 21 items. Barriers to PA were found related to intrapersonal, environmental, and socio-cultural aspects. The importance of family and spousal support in increasing PA levels was also observed. It is concluded that the GWPAQ is valid for obtaining evidence that can be used by public institutions to optimise women-specific PA promotion policies. Keywords: women; LTPA; questionnaire; assessment; validation 1. Introduction Physical inactivity has been found to be among the main factors that increase disease and mortality rates, causing 6–10% of major non-communicable diseases worldwide [ 1 , 2 ]. In contrast, physical activity (PA) has been found to provide many health benefits [ 3 ]—both physical [ 4 – 6 ] and psychological [ 7 – 10 ]—and contribute to the prevention and reduction of risks associated with several diseases [ 11 – 14 ]. Due to the importance of PA, the World Health Organization (WHO) has established guidelines for PA practice, with variations for different age and population groups [ 15 ]. Physical inactivity is defined as failure to accumulate at least 150 min of moderate PA or 75 min of vigorous PA or the combination of both intensities per week, whereas being physically active is related to complying the guidelines established by the WHO [16]. Globally, it is estimated that 3 out of 10 people aged 15 or more do not meet the recommendation of at least 150 min of moderate PA per week [ 17 ]. Moreover, recent research continues to find that women engage in less PA than men [ 18 , 19 ]. On the one hand, stereotypes and gender roles are among the main factors contributing to this situation and that PA remains particularly male-oriented, which in turn may lead to greater drop out among women [ 20 ]. On the other hand, women are often directed towards taking Int. J. Environ. Res. Public Health 2022,19, 5736. https://doi.org/10.3390/ijerph19095736 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2022,19, 5736 2 of 18 responsibility for caregiving tasks and putting the needs of others before their own. This often results in little room for leisure [ 21 , 22 ] or low-quality leisure [ 23 ], which may affect their level of PA. Additionally, inactivity is heightened among working-age women due to the diversity of situations that occur at that life stage, such as entering the labour market, leaving parents’ home, motherhood, or caregiving [ 24 – 27 ]. Due to the plurality of factors and the interaction between them, women should be considered a heterogeneous group with diverse realities [ 28 ]. Accordingly, in addition to the feminist perspective on leisure and active life, socio-ecological perspectives could be of great use to address and understand this complexity, as they emphasise the relationships that people have with their physical and socio-cultural environment [29,30]. Public institutions generally aim to promote PA among the entire population [ 31 , 32 ]. However, despite many existing studies regarding the factors associated with inactivity and PA among different age groups [ 33 – 35 ] and especially among adult women [ 36 , 37 ], conducting a contextualised assessment before designing, developing, and implementing public policies to promote PA among women is still necessary and beneficial [ 38 ]. While considerable progress has been made in identifying women’s PA patterns, there is still a need to develop questionnaires that are meaningful to women, culturally relevant, short, and easily understood by people from diverse backgrounds [ 39 ]. In this regard, an ad hoc questionnaire may be an appropriate tool to learn about women’s perceptions of PA. Thus, public institutions responsible for promoting PA could have accurate initial information on the needs perceived by those involved and be able to accordingly propose effective actions. However, in addition to being adapted to the context of intervention, self-administered questionnaires that assess PA in adults should be easy to fill out for the target population and yield verified validity and measurement properties [ 40 ]. The aforementioned authors note the existence of numerous scales and questionnaires that assess PA in adults but stress that it is up to the researchers themselves to determine which questionnaire best suits their purposes. Consequently, available measurement tools may not always respond to the complexity of the study context, lack evidence of reliability or validity, or simply not be useful for the institution responsible for developing and implementing PA policies [40]. Considering the above, having questionnaires to determine both inactivity and PA levels that are validated and specific for distinct population groups seems to be essential. Therefore, the aims of the study were: (a) to design an ad hoc multidimensional tool to assess leisure time physical activity (LTPA) and leisure time sedentary behaviours of adult women (18–65 years) from Gipuzkoa (Spain); (b) to analyse the questionnaire’s content validity, ecological validity, and internal consistency; and (c) to describe LTPA and sedentary behaviours of adult women from Gipuzkoa. 2. Materials and Methods 2.1. Design The present study was carried out in two phases. In the first phase, questionnaire design, content validation, and ecological validation were carried out by an expert panel. In the second phase, the questionnaire was administered to the target population to analyse item internal consistency and provide descriptive results. This work is part of a larger study called the Gipuzkoa Equitactive Study (GES). 2.2. Participants In the first phase, six researchers prepared the questionnaire, and then, a panel of five experts in PA promotion for women was selected through purposive sampling to analyse content validity. Members of the expert panel were chosen both due to their extensive research careers and their training and academic experience in Physical Activity and Sport Sciences (between 15 and 30 years). For the ecological validity, three broadly experienced (between 27 and 35 years) sport management experts participated. Their expertise was in sport departments of public, regional, and municipal institutions in the specific context where the present study was carried out. Int. J. Environ. Res. Public Health 2022,19, 5736 3 of 18 In the second phase, internal consistency of the items and data collection were analysed, for which the total population of adult women in Gipuzkoa (219,221 women) [ 40 ] was considered to estimate the minimum sample size needed (1006 women) (sampling error < 5% , 95% confidence interval, CI, α > 0.80). Furthermore, given population distribution, it was planned that the sample should be stratified by type of municipality of residence (rural: <5000 inhabitants; semi-urban: 5000–40,000; urban: >40,000) [ 41 ], participant age ( 18–24 years ; 25–44; 45–65) [ 42 ], and PA level ( >150 min/week of PA = active ; <150 min/week of PA = inactive) [ 16 ]. The inclusion criteria were: (1) female, (2) aged between 18 and 65, and (3) residing in Gipuzkoa. A total of 3595 adult women ( 43.5 ±12.1 years of age, sampling error = 1.5%, 95% CI, α > 0.95) completed the self-administered questionnaire. Of the total participants, 6.7% were aged 18–24, 45.7% were aged 25–44, and 47.7% were aged 45–65. Regarding the place of residence, 8.2% lived in rural municipalities, 50.9% in semi-urban municipalities, and 40.9% in urban municipalities. Inactive women represented 32% of the sample, whilst 68% were active. Lastly, 6.5% of the participants had no income, 3.6% had an income of less than EUR 499 per month, 7.8% between EUR 500 and 949, 20.1% between EUR 950 and 1499, 22.9% between EUR 1500 and 1999, 20.7% between EUR 2000 and 2499, 7.1% between EUR 2500 and 2999, 3.9% between EUR 3000 and 4999, and 6.6% did not answer this item. All participants in this study answered the questionnaire voluntarily and were free to withdraw from the research at any time. The study was approved by the Ethics Committee for Human Research (CEISH, cod. M10-2020-296) of the University of the Basque Country (UPV/EHU) and followed the guidelines established in the Declaration of Helsinki [43]. 2.3. Procedure The present study was requested by the Gipuzkoa Provincial Council, which commissioned the research group to carry out an assessment of the PA habits of adult Gipuzkoan women in order to optimise PA promotion policies. In an effort to conduct an evidencebased intervention, in line with Heath et al. [ 44 ], and with the proven effectiveness of a participatory and co-creative process [ 45 – 47 ], a working group was established with two researchers from the research group and three sport managers from the Gipuzkoa Provincial Council. The group identified several relevant dimensions, such as PA level, motives for participating in PA, and barriers to PA. Based on an in-depth analysis of the existing literature, the first draft of the ad hoc multidimensional questionnaire was drawn up. The content of this first version was validated by a five-person expert panel. A similar approach was taken for ecological validity, with the three sport managers suggesting several improvements. Once the experts’ contributions had been reviewed, and the final version was ready, the questionnaire was sent out by email to the 21,000 women who were registered in the databases of the requesting institution. These women were also invited to forward the message to as many women as they considered appropriate. Three days later, another message was sent to several women’s associations contacts in Gipuzkoa via an instant messaging app. 2.4. Measuring Instrument Gipuzkoa Women’s Physical Activity Questionnaire (GWPAQ): the multidimensional questionnaire in this study was developed under the postulates of the socio-ecological [48,49] and feminist perspectives of leisure and active life [ 28 , 50 , 51 ]. The GWPAQ (File S1) includes four dimensions (level of LTPA, sedentary habits, LTPA habits, and family-life balance for LTPA participation) and 21 items. The third dimension, regarding LTPA habits, is divided into two sub-dimensions: one focused on the characteristics and motives for LTPA participation among active women and the other aimed at identifying the barriers encountered by inactive women to participate in LTPA and their intention to change this situation. Most items had only one answer to choose from. However, multiple choices were admitted for the items regarding the motives or barriers to LTPA participation or the collaboration of participants’ family, friends, or acquaintances. Int. J. Environ. Res. Public Health 2022,19, 5736 4 of 18 2.5. Statistical Analysis Results are presented as mean ± standard deviation (SD), frequencies, and percentages. Cronbach’s alpha statistic was used to describe the internal consistency of the questionnaire. For each questionnaire item, an independent samples test or Pearson’s chi-square test was used to analyse differences between the active and inactive groups. Where possible, effect size (ES) of the differences was calculated [ 52 ]. ES was classified as trivial (<0.2), low (0.2–0.5), moderate (0.5–0.8), and high (>0.8) [ 52 ]. The analysis was conducted with the Statistical Package for Social Sciences (SPSS Inc., version 26.0, Chicago, IL, USA). Statistical significance was set at p< 0.05. 3. Results 3.1. Questionnaire Content Validity Listed below are the most relevant qualitative assessments made by the expert panel on the initial dimensions and items considered for the final GWPAQ design. Regarding the content, all experts answered that both a dimension focused on family-life balance for LTPA participation and another focused on sedentary habits were lacking. Likewise, regarding the adequacy of items belonging to the same dimension, they stressed the need to add other options in the questions on barriers to PA. They also suggested dividing the ages of children in the items related to motherhood into shorter brackets. Concerning item clarity, experts found it necessary to reformulate some items to increase their understandability and to add or modify some examples used in the questions on intensity level or type of LTPA. Correction of errors related to terms such as physical exercise, sport and PA, free time, and leisure time were also requested. Literature review wise, experts suggested including the contributions of several studies aimed at understanding the collaboration (or non-collaboration) of people within the close environment of women (partners, family members, and friends). 3.2. Questionnaire Ecological Validity Once the initial questionnaire had been optimised based on the experts’ contributions, the professional sport managers team of the Provincial Council of Gipuzkoa also suggested modifications, which were included in the questionnaire. They mainly requested a greater specification of PA levels in order to classify inactive and active women more clearly. They also highlighted that adding a question regarding participation in women-only PA programmes to the habits dimension might be relevant. Specifically, they suggested adding examples of programmes implemented in the context of the study. Along the same lines, they asked to add another question about inactive women’s knowledge about the Mugiment project (https://mugiment.euskadi.eus/homepage/, accessed on 24 January 2021). Lastly, they suggested adding more examples of PA types or substituting them with other locally well-known ones. Along the same lines, they found it necessary to add other barriers to PA that they had detected in their professional development as sport managers. 3.3. Questionnaire Internal Consistency Regarding between-items internal consistency of the different dimensions, Cronbach’s alpha values were: 0.634 for dimension D1 (level of PA), 0.226 for D2 (sedentary habits), 0.940 for D3 active (LTPA habits of active women), 0.813 for D3 inactive (LTPA habits of inactive women), and 0.298 for D4 (family-life balance for LTPA participation). 3.4. Questionnaire Results 3.4.1. Dimension 1. Level of LTPA Results show that 32% of the respondents (inactive group) currently perform less than 150 min of LTPA per week, while the remaining 68% (active group) performed 150 min or more per week. Mean weekly LTPA added up to a total of 281.6 ± 285.8 min, with 120.9 ± 153.6 min of low intensity PA, 108.7 ± 207.9 min of moderate intensity, and Int. J. Environ. Res. Public Health 2022,19, 5736 5 of 18 53.7 ± 98.8 min of vigorous intensity PA. Figure 1shows the results of the weekly LTPA minutes for both inactive and active women. Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 5 of 18 3.4. Questionnaire Results 3.4.1. Dimension 1. Level of LTPA Results show that 32% of the respondents (inactive group) currently perform less than 150 min of LTPA per week, while the remaining 68% (active group) performed 150 min or more per week. Mean weekly LTPA added up to a total of 281.6 ± 285.8 min, with 120.9 ± 153.6 min of low intensity PA, 108.7 ± 207.9 min of moderate intensity, and 53.7 ± 98.8 min of vigorous intensity PA. Figure 1 shows the results of the weekly LTPA minutes for both inactive and active women. Figure 1. Results of weekly LTPA minutes for both inactive (<150 min per week) and active (>150 min per week) women. ** p < 0.001, significant differences between the inactive and active groups. 3.4.2. Dimension 2. Sedentary Habits Table 1 shows the results regarding sedentary habits both for the total sample and for the two groups (inactive vs. active). The response distribution of both groups was significantly different (p < 0.01). Table 1. Sedentary habits dimension results (%): total, inactive (<150 min/week of PA), and active (>150 min/week of PA). On a typical day, how many minutes in total do you spend sitting? For example, studying, working, in meetings, commuting to school or work (car, motorbike, train, bus, or similar). On a typical day, how many minutes of your leisure time do you spend watching TV, in front of the computer, reading, or doing similar activities? Time Total Inactive Active # Total Inactive Active ** Less than 60 min (1 h) 5.2 2.1 3.1 28.3 10.3 18.0 Between 61–120 min (1–2 h) 9.4 3.1 6.3 38.9 10.4 28.5 Between 121–180 min (2–3 h) 8.8 2.3 6.5 17.9 4.8 13.0 Between 181–240 min (3–4 h) 8.0 2.3 5.7 6.5 2.3 4.3 Between 241–300 min (4–5 h) 10.5 2.9 7.6 3.1 1.4 1.7 Between 301–360 min (5–6 h) 13.1 4.0 9.1 1.7 0.6 1.0 0 100 200 300 400 500 600 700 800 Total Low intensity Moderate intensity Vigorous intensity Time (min) Leisure time physical activity Inactive Active d = -0.8** d = -0.6** d = -0.7** Figure 1. Results of weekly LTPA minutes for both inactive (<150 min per week) and active ( >150 min per week) women. ** p< 0.001, significant differences between the inactive and active groups. 3.4.2. Dimension 2. Sedentary Habits Table 1shows the results regarding sedentary habits both for the total sample and for the two groups (inactive vs. active). The response distribution of both groups was significantly different (p< 0.01). Table 1. Sedentary habits dimension results (%): total, inactive (<150 min/week of PA), and active (>150 min/week of PA). On a typical day, how many minutes in total do you spend sitting? For example, studying, working, in meetings, commuting to school or work (car, motorbike, train, bus, or similar). On a typical day, how many minutes of your leisure time do you spend watching TV, in front of the computer, reading, or doing similar activities? Time Total Inactive Active # Total Inactive Active ** Less than 60 min (1 h) 5.2 2.1 3.1 28.3 10.3 18.0 Between 61–120 min (1–2 h) 9.4 3.1 6.3 38.9 10.4 28.5 Between 121–180 min (2–3 h) 8.8 2.3 6.5 17.9 4.8 13.0 Between 181–240 min (3–4 h) 8.0 2.3 5.7 6.5 2.3 4.3 Between 241–300 min (4–5 h) 10.5 2.9 7.6 3.1 1.4 1.7 Between 301–360 min (5–6 h) 13.1 4.0 9.1 1.7 0.6 1.0 More than 360 min (more than 6 h) 45.0 14.9 30.1 3.7 1.8 1.9 # Significant differences in response distribution, Pearson’s chi-square test (p= 0.009). ** Significant differences in response distribution, Pearson’s chi-square test (p< 0.001). 3.4.3. Dimension 3. LTPA Habits Motives and types of LTPA (active group): Table 2shows the results concerning the motives for being physically active by active women (>150 min/week, 68% of total, n= 2458 women ). Figure 2A–D shows the results concerning the type and characteristics of LTPA. Int. J. Environ. Res. Public Health 2022,19, 5736 6 of 18 Table 2. Active group participant responses regarding the motives for being physically active in LTPA (n= 2458 women, total responses = 13,686). Motives for Being Physically Active Frequency % Be fit 2044 14.9 Exercise is good entertainment for me 1509 11.0 Avoid or manage health conditions 1424 10.4 Improve mood 1404 10.3 Lose or maintain weight 1268 9.3 Improve my body’s appearance 1143 8.4 Physical activity lets me have contact with friends and persons I enjoy. 1011 7.4 Improve my self-esteem 986 7.2 Physical activity gives me a sense of personal accomplishment 952 7.0 Improve athletic performance 589 4.3 Participate in social activities 453 3.3 Sharing activities with other women 359 2.6 Play with children/grandchildren/nephew/niece 257 1.9 As a consequence of the confinement during the pandemic 130 0.9 Other 100 0.7 Exercising increases my acceptance by others 35 0.3 Gain weight 22 0.2 Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 6 of 18 More than 360 min (more than 6 h) 45.0 14.9 30.1 3.7 1.8 1.9 # Significant differences in response distribution, Pearson’s chi-square test (p = 0.009). ** Significant differences in response distribution, Pearson’s chi-square test (p < 0.001). 3.4.3. Dimension 3. LTPA Habits Motives and types of LTPA (active group): Table 2 shows the results concerning the motives for being physically active by active women (>150 min/week, 68% of total, n = 2458 women). Figure 2A–D shows the results concerning the type and characteristics of LTPA. Table 2. Active group participant responses regarding the motives for being physically active in LTPA (n = 2458 women, total responses = 13,686). Motives for Being Physically Active Frequency % Be fit 2044 14.9 Exercise is good entertainment for me 1509 11.0 Avoid or manage health conditions 1424 10.4 Improve mood 1404 10.3 Lose or maintain weight 1268 9.3 Improve my body’s appearance 1143 8.4 Physical activity lets me have contact with friends and persons I enjoy. 1011 7.4 Improve my self-esteem 986 7.2 Physical activity gives me a sense o f personal accomplishment 952 7.0 Improve athletic performance 589 4.3 Participate in social activities 453 3.3 Sharing activities with other women 359 2.6 Play with children/grandchildren/nephew/niece 257 1.9 As a consequence of the confinement during the pandemic 130 0.9 Other 100 0.7 Exercising increases my acceptance by others 35 0.3 Gain weight 22 0.2 54.6 21.9 14 4.4 4.1 0.9 0 102030405060 Individual activities (without… Outdoor activities Group activities (with peers) Team-against-team situations Artistic activities One-on-one situations Percentage (%) What is the main type of physical activity you do? (A) Figure 2. Cont. Int. J. Environ. Res. Public Health 2022,19, 5736 7 of 18 Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 7 of 18 Figure 2. Active group participant responses regarding the type and characteristics of LTPA. Barriers to LTPA participation and intention to change (inactive group): The results concerning the main barriers to being physically inactive in LTPA among inactive women (<150 min/week, 32% of the total, n = 1137 women) are shown in Table 3. 54.5 31 7.6 6.9 0 102030405060 Non-competitive and non-organised activity Non-competitive and organised activity Non-federation-governed amateur competition Federation-governed competition Percentage (%) How do you do your main physical activity? (B) 81.3 15 3.7 0 20406080100 Three or more times per week Twice per week Once per week Percentage (%) How often are you physically active? (C) 41.5 26.3 18.4 9.5 4.3 0 5 10 15 20 25 30 35 40 45 On my own With friends With family members With acquaintances Other Percentage (%) With whom do you mainly engage in physical activity? (D) Figure 2. Active group participant responses regarding the type and characteristics of LTPA. Int. J. Environ. Res. Public Health 2022,19, 5736 8 of 18 Barriers to LTPA participation and intention to change (inactive group): The results concerning the main barriers to being physically inactive in LTPA among inactive women (<150 min/week, 32% of the total, n= 1137 women) are shown in Table 3. Table 3. Responses of participants in the inactive group regarding barriers to LTPA (n= 1137 women, total responses = 3815). Barriers for Not Being Physically Active Frequency % Lack of time 777 20.4 Laziness 427 11.2 Fatigue due to work or studies 426 11.2 Overwork 347 9.1 Physical activity takes too much time from family relationships and family responsibilities 293 7.7 The weather puts me off 206 5.4 Prefer to do other things 190 5.0 I have nobody to go with 173 4.5 I do not enjoy physical activity 145 3.8 Lack of confidence 101 2.6 Ill health, injury, or disability 97 2.5 Other 93 2.4 I am too embarrassed to exercise 90 2.4 I feel too fat/overweight 89 2.3 Lack of money 88 2.3 Lack of adequate facilities in my area 78 2.0 Sense of insecurity (darkness, unknown areas) 69 1.8 Feeling that my physical appearance is worse than that of others 63 1.7 I think I look ridiculous in exercise clothes 19 0.5 I do not like doing exercise 19 0.5 I am not comfortable with people exercising with me 10 0.3 Do not know/No answer 7 0.2 Lack of transport 4 0.1 Lack of suitable monitors/trainers 4 0.1 Within the inactive group, 11.7% perceived their health as very good, 63.6% as good, 20.8% as fair, 3.1% as bad, 0.0% as very bad, and 0.8% did not answer the question. The answers to question “Before you stopped, for how long were you physically active?” showed that 10.2% of the participants had never performed PA or sport before, 7.2% had done so for less than a year, 11.4% had for 1 or 2 years, 13.3% for 3–4 years, 8.1% for 5–6 years, 35.3% for over 6 years, and 14.4% did not answer the question. Responses of the inactive group participants regarding the reasons for giving up LTPA are shown in Table 4. Int. J. Environ. Res. Public Health 2022,19, 5736 9 of 18 Table 4. Inactive group participant responses concerning the motives for giving up PA (total nof responses = 1964). Which Are the Most Important Motives for Giving Up Physical Activity? Frequency % Lack of time 755 38.4 Laziness 755 38.4 Physical activity takes too much time from family relationships and family responsibilities 258 13.1 Prefer to do other things 169 8.6 Overwork 169 8.6 I have nobody to go with 133 6.8 I do not like doing exercise 133 6.8 Ill health, injury, or disability 119 6.1 Feeling that my physical appearance is worse than that of others 119 6.1 I do not enjoy physical activity 115 5.9 Lack of adequate facilities in my area 115 5.9 The weather puts me off 112 5.7 Fatigue due to work or studies 112 5.7 Lack of money 95 4.8 Lack of suitable monitors/trainers 95 4.8 Lack of confidence 72 3.7 Other 72 3.7 I feel too fat/overweight 49 2.5 I am not comfortable with people exercising with me 49 2.5 I am too embarrassed to exercise 42 2.1 Sense of insecurity (darkness, unknown areas) 31 1.6 I think I look ridiculous in exercise clothes 9 0.5 Lack of transport 5 0.3 Do not know/No answer 5 0.3 On the other hand, 36.1% of the inactive women answered that they were sure they would restart LTPA, 40.6% that it was likely, 16.2% that they did not know, 3.5% that they probably would not, 0.8% that they were sure they would not, and 2.8% did not answer the question. 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