DOI: 10.1089/obe.2008.0115 ©Mary Ann Liebert, Inc. February 2008 Obesity Management 17

Introduction

Physical activity is a modifiable risk factor for cardio-vascular disease, stroke, cancers, and diabetes, among others. African Americans experience these condi-

tions at a higher prevalence and oftentimes have higher rates of mortality compared to many other ethnic groups. In addi-tion, rates of physical activity within this population are low. Descriptive and intervention studies have provided valuable information related to the barriers and facilitators of physical activity for African Americans. This paper contains some suggestions that healthcare providers can use in order to pro-mote physical activity in African-American adults.

CultureIn order to assist African Americans in increasing their

exercise, it is important to understand the role of culture. Culture provides a framework through which current experi-ences and information are processed. Therefore, culture also influences physical activity habits and shapes beliefs related to the value of making health-behavior changes. African-American culture is characterized by familism, role flexibil-ity, a ubiquitous strong matriarch, spirituality, folk beliefs, emotional coping, interdependence, spiritualism, harmony with nature, interconnectedness, and expressiveness (expres-sive individualism, affect vs. reason, expressive movement). Any of these ideologies can affect exercise behavior. For example, the ubiquitous strong matriarch is a caregiver and bears all burdens for family members. It is often difficult for the matriarch to find time to be active because other’s needs are attended to first.

An important fact when considering culture is that not all African Americans share the same culture. The concepts mentioned above are to be assessed, and not assumed. Once the healthcare provider understands how culture plays a role in the client’s behavior, he or she is in a better position to provide treatment. When this cultural knowledge is combined with therapeutic skill, the health professional will likely be perceived as credible. Credibil-ity allows the professional to work more effectively with

ethnically diverse clients. In viewing the patient as an individual existing within a culture, it is important for the provider to understand the patient’s specific situation before being able to recommend a viable program of exer-cise. For example, it is important to know if exercise facilities are close-by, if the patient feels that his or her street/neighborhood is safe, and if the patient has childcare. Ignoring the pragmatic aspects of a participant’s individual situation would be detrimental to developing an effective plan.

PerceptionsStudies show that most African Americans perceive

the health benefits of regular physical activity, however, they may also possess some culturally specific views of physical activity. For example, it has been shown that one of the main barriers to exercise is the belief that work provides sufficient exercise. This attitude is grounded in the belief that African Americans are relegated to labor-intensive jobs as a result of low levels of education. Other barriers include “wanting to rest after a lifetime of hard labor,” “health problems,” “possibility of messing up their hair,” and “dislike of public showers.” Physical activity has also been viewed as a “negative” physical stressor.

Furthermore, those without blue-collar jobs have indi-cated that they are constantly in motion, or busy, because of their multiple responsibilities (e.g., church, family, and fraternal associations). It is important for the healthcare provider to determine if these beliefs are held. If they are, then it is important to emphasize that more physical activ-ity is rarely harmful and usually helpful. If the patient is at risk for, or has been diagnosed with, any health condi-tion in which lack of physical activity is a risk factor, then this should be utilized as well.

African-American women may report further challenges to engaging in a regular physical activity program. Reports of

Exercise for African AmericansRobert L. Newton, Jr., Ph.D.Assistant Professor, Pennington Biomedical Research Center, Baton Rouge, Louisiana

Robert L. Newton, Jr., Ph.D.

18 Obesity Management February 2008

not wanting to engage in vigorous exercise because they fear sweating, bulking up, or having their hair “messed up” are not uncommon. One study found that “distance to an exercise facility,” “perceiving exercise as fatiguing,” “fear of walking in the neighborhood,” and feeling that “people look funny in exercise clothes” were the top deterrents to exercise.

Practical suggestions can go far in these respects. For one, moderate levels of physical activity have been found to be effective for improvements in health. With respect

to hairstyles, beauticians can provide suggestions on how to manage hairstyles in relation to exercise. Exercising at home, with friends, or at a women-only gym can help alleviate some concerns. Physical activity can be framed as a social activity that can include friends, family, church members, etc. Studies have attempted to overcome barriers to physical activity by providing supervised walks in unsafe neighborhoods, incorporating a beautician to assist with managing hairstyles, and using culturally sensitive messages (e.g., increased physical activity helps you and future genera-tions) and videotapes. The healthcare professional should be aware of the resources available to address these issues.

Social SupportThe African-American family and church are central sourc-

es of social support. Family members can provide encour-agement for exercise patterns, assist in purchasing items that support physical activity, and/or engage in physical activity with the client. Also, the close communication between fami-ly members helps to facilitate positive behavior change. Fam-ily members have been involved in studies by participating in treatment sessions and exercising in session. At least one study required pairs of individuals to enroll in the study as a way to capitalize on social support. Other studies have set aside time for participants to socialize over a meal prepared by participants. The healthcare provider should determine whether there are supportive family members who can assist the patient in increasing physical activity.

The church is also a very strong source of support and provides several benefits. First, it serves as a preexisting social support network. Second, the church will likely provide motivational health messages. Several church-based studies have capitalized on the preexisting social support structure, utilized the pastor as a central compo-nent, and incorporated Bible study and prayer as a means of delivering the program components. The healthcare provider should determine if the patient fellowships, and if so, whether the church is a source of support.

Community ResourcesIt is important for the healthcare provider to understand that

simply telling patients to begin an exercise program is unlikely to lead to success. Therefore, it is important to view increasing physical activity among African-American patients as a com-munity effort. There is an African saying, “It takes a village to raise a child.” It very well may be valid to also say, “It takes a community to improve our health.” Healthcare providers should find community resources to support physical activ-ity-change efforts for their patients. Several studies have used members within the community—rather than research staff members—to provide interventions. This strategy may be helpful in maintaining physical activity changes. In addition to local churches, the healthcare provider should find other community resources, such as gyms, healthcare advocates, other providers, politicians, shoe stores, etc., that are vested in the same goal. Partnerships may be formed that may assist the provider in developing a successful plan for physical activity promotion in African Americans.

GoalsThe standard recommendation for improvements in cardio-

vascular health is 30 minutes of moderate intensity aerobic activity per day, five days per week. Behavioral studies have shown that patients are able to adhere closely to this volume of activity and it has been shown to result in improved fit-ness and cardiovascular health. Weight loss and management are often issues for physicians treating African-American women. Several agencies providing guidelines recommend 45–60 minutes of moderate intensity exercise for individuals attempting to maintain weight loss or prevent weight gain. Therefore, it will be important for the healthcare professional to prescribe an adequate amount of activity depending on the outcome desired.

Lifestyle activity means to make active choices through-out the day. Classic examples include parking further from the store or place of employment, and using the stairs rather than the elevators. Lifestyle activity has been shown to be as

African Americans are at higher risk for

cardio-vascular disease, stroke, cancers, and

diabetes as compared to many other ethnic groups.

February 2008 Obesity Management 19

effective for producing health benefits as structured clinic-based studies after 2 years. It allows participants to increase physical activity spontaneously, does not require expensive equipment, can be conducted in shorter bouts and done vir-tually anywhere, offers a wider variety of physical activities, and allows individuals to accumulate activity throughout the day by engaging in common daily activities.

In descriptive studies, African Americans have reported experiencing many of these issues (e.g., equipment, time, facilities) as barriers to initiating and maintaining an exer-cise program. Lifestyle activity offers a potential means of overcoming many of these barriers. Thus, it may be better maintained. Although never tested empirically in African Americans, lifestyle exercise appears to have naturally occurring benefits that would help overcome some of the barriers that African Americans encounter, and therefore may lead to greater success.

Behavioral StrategiesHealthcare providers should learn behavioral strate-

gies for exercise adoption. Effective behavioral strategies have been developed to assist adults in initiating a physi-cal activity program. Furthermore, studies that have been effective in increasing physical activity in African-Ameri-can adults have been based on behavioral principles.

Therefore, the healthcare provider should be familiar with those behavioral principles that lead to success, such as self-monitoring, goal setting, problem solving, contingen-cy reinforcement, and relapse prevention. Furthermore, culturally tailored interventions are usually based on these standard behavioral principles.

African-American MenOne major caveat to the above prescriptions is that they

are primarily developed from studies on African-Ameri-can women. African-American men are very difficult to

recruit into research studies. Also, studies in which both genders are included, the sample sizes are at least 60% female and can be upwards of 90% female. This lopsided gender distribution makes gender comparisons impossible and the independent effect of exercise on African-Ameri-can males is not able to be determined.

However, African-American men share the same cul-ture as do African-American women. Therefore, most of the above overarching principles still apply, such as the role of culture, social support, perceptions of exercise, accessing community resources, and activity recommen-dations. Some differences do apply, insofar as for Afri-can-American men, walking is not usually the preferred activity, and physical appearance is less of an issue. In addition, African-American men seldom take on the responsibilities of the strong ubiquitous matriarch. When further research is conducted with African-American males, then these recommendations can be broadened and more inclusive.

ConclusionAfrican Americans face many barriers when attempting

to engage in a regular physical activity program. They experience many of the same barriers to establishing a regular physical activity routine as do individuals from other ethnic groups. However, there are some culturally held beliefs that may impose further barriers to engaging in activity. Therefore, healthcare professionals should be prepared to address not only the common barriers, but also those that are specific to African Americans. By learning about African-American culture, and taking into consideration the individuality of each patient, healthcare providers would be in a better position to effectively address this issue in African-American culture.

The top strategies that healthcare providers can utilize to increase the likelihood that they will be successful in increasing physical activity in African-American adults are:

1. Recognize the role of cultural influence on your patients’ behavior.

2. Recognize and be prepared to deal with ethnically specific perceptions related to exercise.

3. Remember that not all African Americans share the same culture.

4. Help your patient find social support for behavior change.

5. Become familiar with standard behavioral principles for exercise promotion.

6. Tell your patients how lifestyle activity may assist them to overcome some barriers to physical activity.

7. Look to establish partnerships within the community. ■

It is important for healthcare providers to understand

that simply telling patients to begin an exercise program is

unlikely to lead to success.