Barriers and facilitators to the initiation and maintenance of exercise training for women with clinically severe obesity before, during and after participation in a weight loss study: a qualitative investigation

Women with clinically severe obesity are at risk of poor physical and mental health. Lifestyle interventions must be developed to support exercise participation for this group. The factors influencing the involvement of women with clinically severe obesity in such programmes require investigation. This study aimed to identify barriers and facilitators to the initiation and maintenance of exercise training for women with severe obesity before, during and after participation in a weight loss study. Women with obesity were recruited for participation in a randomised controlled trial (n=60) investigating the effects of energy restriction (ER) with (energy restriction plus exercise (EXER): n=30) and without (ER: n=30) the addition of exercise. Following the 12-month intervention, n=11 (all from the EXER group) women agreed to participate and were interviewed to retrospectively explore their experiences of exercise engagement before, during and after the programme. Participants also provided their own suggestions for improving future exercise and weight loss programmes. Data were then transcribed verbatim, and reflective thematic analysis was used. Five themes related to intrapersonal and social components of the social ecological model were constructed and included: 'weight', 'concerns about physical limitations' and 'exercise confidence and enjoyment'. Social themes were 'work and family commitments' and 'accountability and support'. Women with clinically severe obesity most commonly reported intrapersonal and social influences of exercise participation. This study's results may help inform the exercise programme development of practitioners and further intervention development at a population level.