“I'm a failure again I can't do it”: Attitudes towards, and experiences of, exercise participation in adults with class III obesity

Abstract

AbstractBackground Exercise is first-line treatment for class III obesity. However, living within a larger body brings unique and non-trivial challenges to exercise participation, which are not well understood. This qualitative study explored the attitudes towards, and experiences of, exercise participation in adults with class III obesity. Methods We recruited 30 adults with class III obesity (mean ± SD: age: 45.0 ± 12.5 years; body mass index: 45.8 ± 8.6 kg/m2) who were participating in a 6-month home-based aerobic and resistance exercise intervention. Participants took part in semi-structured interviews after they completed the first 3-months of the intervention. Open-ended questions were used flexibly to explore their experiences of exercise participation, encompassing perceived barriers, motivations, preferences, and benefits of exercise. Interview transcripts were analysed using reflexive thematic analysis. Results Three themes were developed that encapsulate participants’ views and experiences of exercise participation: (1) a web of barriers; (2) tailored exercise facilitates positive experiences; (3) a desire to live well. People with class III obesity have a strong perception that they are unable to do exercise; a view that is attributed to a lifetime of perceived judgement by others, restrictions in mobility, pain during every day activities, and failed weight loss attempts. These complex physical and psychosocial barriers to exercise were described as contributing to exercise avoidance. High value is placed on tailored exercise that accommodates for the unique needs of moving in a larger body. A desire to live a normal life and be free to carry out basic activities of daily living underpins motivations for exercise. Conclusions Our findings suggest that multicomponent obesity interventions should move away from generic exercise prescriptions designed to maximise energy expenditure, and instead move towards addressing the unique physical and psychosocial needs of people who have class III obesity with tailored, person-centred, and weight-neutral exercise interventions.