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‘You started something … then I continued by myself’: a qualitative study of physical activity maintenance

  • Charlotte Wahlich (a1), Carole Beighton (a1), Christina Victor (a2), Rebecca Normansell (a1), Derek Cook (a1), Sally Kerry (a3), Steve Iliffe (a4), Michael Ussher (a1), Peter Whincup (a1), Julia Fox-Rushby (a5), Elizabeth Limb (a1), Cheryl Furness (a1) and Tess Harris (a1)...

Most mid-life and older adults are not achieving recommended physical activity (PA) targets and effective interventions are needed to increase and maintain PA long-term for health benefits. The Pedometer And Consultation Evaluation (PACE-UP) trial, a three-armed primary care pedometer-based walking intervention in those aged 45–75 years, demonstrated increased PA levels at 12 months. A three-year follow-up was conducted to evaluate long-term PA maintenance, including a qualitative component.


To examine facilitators and barriers to PA maintenance in mid-life and older adults previously involved in a PA trial.


Semi-structured telephone interviews were conducted with 60 PACE-UP participants across all study arms. Interviews were audio-recorded, transcribed verbatim and coded independently by researchers, prior to thematic analysis.


Two-thirds of participants felt since the PACE-UP trial they had an awareness of PA, with the pedometer reported as ‘kick-starting’ regular activity, and then helped them to maintain regular activity. PA facilitators included: maintaining good health, self-motivation, social support and good weather. Lack of time was the most frequently cited barrier. Other barriers were often the inverse of the facilitators; for example, poor health and bad weather. Participants described the type of ‘top-up’ intervention they would find beneficial to aid PA maintenance (eg, text messages, online resources and walking groups).


A challenge for future PA interventions is to transform barriers into facilitators; for example, educating trial participants about the value of PA for many chronic health conditions to change this from inhibiting to promoting PA. Participants provided ideas for encouraging PA maintenance which could be incorporated into future interventions.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to: Charlotte Wahlich, Msc, Research Assistant, Population Health Research Institute, Cranmer Terrace, St George’s University of London, SW17 0RE. Email:
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Allender, S., Cowburn, G. and Foster, C. 2006: Understanding participation in sport and physical activity among children and adults: a review of qualitative studies. Health Education Research 21, 826835.
Alvarado, M., Murphy, M.M. and Guell, C. 2015: Barriers and facilitators to physical activity amongst overweight and obese women in an Afro-Caribbean population: a qualitative study. International Journal of Behavioral Nutrition and Physical Activity 12, 112.
Babakus, W.S. and Thompson, J.L. 2012: Physical activity among South Asian women: a systematic, mixed-methods review. International Journal of Behavioral Nutrition and Physical Activity 9, 150.
Baxter, S., Johnson, M., Payne, N., Buckley-Woods, H., Blank, L., Hock, E., Daley, A., Taylor, A., Pavey, T., Mountain, G. and Goyder, E. 2016: Promoting and maintaining physical activity in the transition to retirement: a systematic review of interventions for adults around retirement age. International Journal of Behavioral Nutrition and Physical Activity 13, 12.
Belza, B., Walwick, J., Shiu-Thornton, S., Schwartz, S., Taylor, M. and Logerfo, J. 2004: Older adult perspectives on physical activity and exercise: voices from multiple cultures. Preventing Chronic Disease 1, A09.
Berg, J.A., Cromwell, S.L. and Arnett, M. 2002: Physical activity: perspectives of Mexican American and Anglo American midlife women. Health Care for Women International 23, 894904.
Bock, B.C., Marcus, B.H., Pinto, B.M. and Forsyth, L.H. 2001: Maintenance of physical activity following an individualized motivationally tailored intervention. Annals of Behavioral Medicine 23, 7987.
Booth, M.L., Bauman, A., Owen, N. and Gore, C.J. 1997: Physical activity preferences, preferred sources of assistance, and perceived barriers to increased activity among physically inactive Australians. Preventive Medicine 26, 131137.
Boutelle, K.N., Jeffery, R.W. and French, S.A. 2004: Predictors of vigorous exercise adoption and maintenance over four years in a community sample. International Journal of Behavioral Nutrition and Physical Activity 1, 13.
Braun, V. and Clarke, V. 2006: Using thematic analysis in psychology. Qualitative Research in Psychology. 3, 77101.
Bravata, D.M., Smith-Spangler, C., Sundaram, V., Gienger, A.L., Lin, N., Lewis, R., Stave, C.D., Olkin, I. and Sirard, J.R. 2007: Using pedometers to increase physical activity and improve health: a systematic review. JAMA 298, 22962304.
Buman, M.P., Giacobbi, P.R., Dzierzewski, J.M., Aiken Morgan, A., Mccrae, C.S., Roberts, B.L. and Marsiske, M. 2011: Peer volunteers improve long-term maintenance of physical activity with older adults: a randomized controlled trial. Journal of Physical Activity & Health 8 (Suppl 2), S257S266.
Charmaz, K. 2006. Constructing grounded theory: a practical guide through qualitative analysis. Thousand Oaks, CA: Sage.
Costello, E., Kafchinski, M., Vrazel, J. and Sullivan, P. 2011: Motivators, barriers, and beliefs regarding physical activity in an older adult population. Journal of Geriatric Physical Therapy 34, 138147.
Crabtree, B. and Miller, W. 1999: A template approach to text analysis: developing and using codebooks. In B Crabtree and W Miller, editors Doing qualitative research. Newbury Park, CA: Sage, 163–1177.
Department of Health (DoH) 2011: Start active, stay active: a report on physical activity for health from the four home countries’ Chief Medical Officers. Retrieved 10 October 2016 from 10 October 2016
Evenson, K.R., Moos, M.-K., Carrier, K. and Siega-Riz, A.M. 2008: Perceived barriers to physical activity among pregnant women. Maternal and Child Health Journal 13, 364375.
Floegel, T.A., Giacobbi, P.R., Dzierzewski, J.M., Aiken-Morgan, A.T., Roberts, B., Mccrae, C.S., Marsiske, M. and Buman, M.P. 2015: Intervention markers of physical activity maintenance in older adults. American Journal of Health Behavior 39, 487499.
Harris, T., Kerry, S.M., Limb, E.S., Victor, C.R., Iliffe, S., Ussher, M., Whincup, P.H., Ekelund, U., Fox-Rushby, J., Furness, C., Anokye, N., Ibison, J., Dewilde, S., David, L., Howard, E., Dale, R., Smith, J. and Cook, D.G. 2017: Effect of a primary care walking intervention with and without nurse support on physical activity levels in 45- to 75-year-olds: the Pedometer And Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial. PLoS Medicine 14, e1002210.
Harris, T., Kerry, S.M., Victor, C.R., Ekelund, U., Woodcock, A., Iliffe, S., Whincup, P.H., Beighton, C., Ussher, M., Limb, E.S., David, L., Brewin, D., Adams, F., Rogers, A. and Cook, D.G. 2015: A primary care nurse-delivered walking intervention in older adults: PACE (Pedometer Accelerometer Consultation Evaluation)-Lift Cluster Randomised Controlled Trial. PLOS Medicine 12, e1001783.
Health Survey for England 2008: Physical activity and fitness: Summary of key findings. Retrieved 1 November 2016 from
Health Survey for England 2012: Physical activity in adults. Retrieved 20 September 2016 from
Hillsdon, M., Foster, C. and Thorogood, M. 2005: Interventions for promoting physical activity. Cochrane Database of Systematic Reviews 1, Cd003180.
Hobbs, N., Godfrey, A., Lara, J., Errington, L., Meyer, T.D., Rochester, L., White, M., Mathers, J.C. and Sniehotta, F.F. 2013: Are behavioral interventions effective in increasing physical activity at 12 to 36 months in adults aged 55 to 70 years? A systematic review and meta-analysis. BMC Medicine 11, 112.
Hooker, S.P., Wilcox, S., Rheaume, C.E., Burroughs, E.L. and Friedman, D.B. 2011: Factors related to physical activity and recommended intervention strategies as told by midlife and older African American men. Ethnicity & Disease 21, 261267.
Horne, M. and Tierney, S. 2012: What are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: a systematic review of qualitative studies. Preventive Medicine 55, 276284.
Im, E.O., Ko, Y., Hwang, H., Chee, W., Stuifbergen, A., Walker, L. and Brown, A. 2013: Racial/ethnic differences in midlife women’s attitudes toward physical activity. Journal of Midwifery & Women’s Health 58, 440450.
Kaewthummanukul, T. and Brown, K.C. 2006: Determinants of employee participation in physical activity: critical review of the literature. AAOHN Journal 54, 249261.
Kahlert, D. 2015: Maintenance of physical activity: do we know what we are talking about? Preventive Medicine Reports 2, 178180.
Kelly, S., Martin, S., Kuhn, I., Cowan, A., Brayne, C. and Lafortune, L. 2016: Barriers and facilitators to the uptake and maintenance of healthy behaviours by people at mid-life: a rapid systematic review. PLoS One 11, e0145074.
Kowal, J. and Fortier, M.S. 2007: Physical activity behavior change in middle-aged and older women: the role of barriers and of environmental characteristics. Journal of Behavioral Medicine 30, 233242.
Lee, I.M., Shiroma, E.J., Lobelo, F., Puska, P., Blair, S.N. and Katzmarzyk, P.T. 2012: Impact of physical inactivity on the world’s major non-communicable diseases. Lancet 380, 219229.
Mailey, E.L., Huberty, J., Dinkel, D. and Mcauley, E. 2014: Physical activity barriers and facilitators among working mothers and fathers. BMC Public Health 14, 19.
Marcus, B.H., Dubbert, P.M., Forsyth, L.H., Mckenzie, T.L., Stone, E.J., Dunn, A.L. and Blair, S.N. 2000: Physical activity behavior change: issues in adoption and maintenance. Health Psychology 19, 3241.
Martin, K.A. and Sinden, A.R. 2001: Who will stay and who will go? A review of older adults’ adherence to randomized controlled trials of exercise. Journal of Aging and Physical Activity 9, 91114.
Martins, J., Marques, A., Sarmento, H. and Carreiro Da Costa, F. 2015: Adolescents’ perspectives on the barriers and facilitators of physical activity: a systematic review of qualitative studies. Health Education Research 30, 742755.
Mays, N. and Pope, C. 1995. Qualitative research: Rigour and qualitative research. British Medical Journal, 311, 109112.
Mcauley, E., Jerome, G.J., Elavsky, S., Marquez, D.X. and Ramsey, S.N. 2003: Predicting long-term maintenance of physical activity in older adults. Preventive Medicine 37, 110118.
Mcgowan, L., Devereux-Fitzgerald, A., Powell, R. and French, D.P. 2017: How acceptable do older adults find the concept of being physically active? A systematic review and meta-synthesis. International Review of Sport and Exercise Psychology. DOI: 10.1080/1750984X.2016.1272705
Mckay, J., Wright, A., Lowry, R., Steele, K., Ryde, G. and Mutrie, N. 2009: Walking on prescription: the utility of a pedometer pack for increasing physical activity in primary care. Patient Education and Counseling 76, 7176.
Morris, J.N. and Hardman, A.E. 1997: Walking to health. Sports Medicine 23, 306332.
Neergaard, M.A., Olesen, F., Andersen, R.S. and Sondergaard, J. 2009: Qualitative description – the poor cousin of health research? BMC Medical Research Methodology 9, 52.
Noble, H. and Smith, J. 2015: Issues of validity and reliability in qualitative research. Evidence Based Nursing 18, 3435.
Normansell, R., Holmes, R., Victor, C., Cook, D.G., Kerry, S., Iliffe, S., Ussher, M., Fox-Rushby, J., Whincup, P. and Harris, T. 2016: Exploring non-participation in primary care physical activity interventions: PACE-UP trial interview findings. Trials 17, 178.
Normansell, R., Smith, J., Victor, C., Cook, D.G., Kerry, S., Iliffe, S., Ussher, M., Fox-Rushby, J., Whincup, P. and Harris, T. 2014: Numbers are not the whole story: a qualitative exploration of barriers and facilitators to increased physical activity in a primary care based walking intervention. BMC Public Health 14, 1272.
O’brien, N., Mcdonald, S., Araujo-Soares, V., Lara, J., Errington, L., Godfrey, A., Meyer, T.D., Rochester, L., Mathers, J.C., White, M. and Sniehotta, F.F. 2015: The features of interventions associated with long-term effectiveness of physical activity interventions in adults aged 55-70 years: a systematic review and meta-analysis. Health Psychology Review 9, 417433.
Reichert, F.F., Barros, A.J.D., Domingues, M.R. and Hallal, P.C. 2007: The role of perceived personal barriers to engagement in leisure-time physical activity. American Journal of Public Health 97, 515519.
Reiner, M., Niermann, C., Jekauc, D. and Woll, A. 2013: Long-term health benefits of physical activity – a systematic review of longitudinal studies. BMC Public Health 13, 19.
Rhodes, R.E., Plotnikoff, R.C. and Courneya, K.S. 2008: Predicting the physical activity intention-behavior profiles of adopters and maintainers using three social cognition models. Annals of Behavioral Medicine 36, 244252.
Richards, J., Hillsdon, M., Thorogood, M. and Foster, C. 2013: Face-to-face versus remote and web 2.0 interventions for promoting physical activity. Cochrane Database Syst Rev 9:CD010393.
Sharma, M., Sargent, L. and Stacy, R. 2005: Predictors of leisure-time physical activity among African American women. American Journal of Health Behavior 29, 352359.
Sørensen, M. and Gill, D.L. 2008: Perceived barriers to physical activity across Norwegian adult age groups, gender and stages of change. Scandinavian Journal of Medicine & Science in Sports 18, 651663.
Tulloch, H., Sweet, S.N., Fortier, M., Capstick, G., Kenny, G.P. and Sigal, R.J. 2013: Exercise facilitators and barriers from adoption to maintenance in the diabetes aerobic and resistance exercise trial. Canadian Journal of Diabetes 37, 367374.
World Health Organisation 2010: Global recommendations on physical activity for health. Retrieved 1 November 2016 from
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