Sports Medicine and Health Science 5 (2023) 59–66

Contents lists available at ScienceDirect

Sports Medicine and Health Science

journal homepage: www.keaipublishing.com/smhs

Review

Benefits and barriers to physical activity among African women: A

systematic review
Ogechi Christiana Obi a, b, *, Augustine Chibuikem Nnonyelu b, c,
Avwerosuoghene Onobrakpeya b, d, Olajumoke Joy Ogundele b, e
a
Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
b
The Parg Network, Nigeria
c
Center for Health and Allied Legal and Demographic Development Research and Training (CHALADDRAT), Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
d
Swedish Organization for Global Health, Stockholm, Sweden
e
Department of Psychology, Faculty of Social Sciences, University of Ibadan, Oyo State, Nigeria

A R T I C L E I N F O A B S T R A C T

Keywords: Black women have always been likened to being a less physically active group compared to women of other races/
Physical activity ethnicity, with reports of a high prevalence of obesity and other cardiometabolic diseases among them. The
Barriers purpose of this study is to examine the health benefits of physical activity on women of color, as well as barriers
Benefits
that inhibit their participation.
Black women
African women
We searched PubMed and Web of Science databases for relevant research articles. Included articles were:
African American women Published in the English Language from 2011 to February 2022; conducted predominantly on black women,
African women, or African American women. Articles were identified, screened, and data extracted following the
Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) guidelines.
The electronic search produced 2 043 articles, and 33 articles were reviewed after meeting the inclusion
criteria. 13 articles focused on the benefits of physical activity while 20 articles addressed the barriers to physical
activity. It was found that physical activity has various benefits for black women participants but they are being
hindered from participation by some factors. These factors were grouped into four themes, namely Individual/
Intrapersonal barriers, Socio-economic barriers, Social barriers, and Environmental barriers.
Various studies have examined the benefits and barriers of physical activity among women of different racial
and ethnic backgrounds, but there have been very few studies of African women, with the majority focusing on
one geographical area. In addition to exploring these benefits and barriers, this review offers recommendations on
the areas researchers should focus on to promote physical activity in this population.

morbidity, and mortality, hence resulting in recommendations and

guidelines for intentional participation in physical activities.3,4 People
Introduction are classified as physically active when they meet the prescribed re-
quirements for intensity and min of physical activity, and as inactive if
For ages, physical activity has been considered an elixir of life, which they do not meet the requirements. Adults aged 18–64, are expected to
is protective of various non-communicable diseases such as car- engage in at least 150–300 min of moderate-intensity aerobic physical
diometabolic diseases (CMDs) and cardiovascular diseases (CVDs) and activity per week, or 75–150 min of vigorous-intensity aerobic physical
also improves one’s quality of life (QOL). Physical activity is defined as activity per week.1 Combining moderate- and vigorous-intensity exercise
any movement of the body caused by skeletal muscles that necessitate the have significant health benefits,1 with men being more likely to follow
expenditure of energy,1 and it is distinguished by its modality, frequency, through than women.5
intensity, duration, and practice setting.2 There are various reports from researchers and international bodies
Due to the increasing rate of industrialization and the emergence of regarding the benefits of physical activity for women.1 Physical activity
sophisticated technology, there is a relative decrease in physical activity during pregnancy and postpartum is associated with a reduced risk of
and an overwhelming increase in sedentary lifestyle, chronic disease

* Corresponding author. Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, 410001, Enugu State, Nigeria.
E-mail address: Ogechi.obi.198962@unn.edu.ng (O.C. Obi).

https://doi.org/10.1016/j.smhs.2022.12.001
Received 29 June 2022; Received in revised form 27 November 2022; Accepted 2 December 2022
Available online 8 December 2022
2666-3376/© 2022 Chengdu Sport University. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
O.C. Obi et al. Sports Medicine and Health Science 5 (2023) 59–66

surprising that many past interventions have been unsuccessful and un-
List of abbreviations and definitions sustainable in addressing the low prevalence of physical activity. In-
terventions established with a clear understanding and explanation of
CMDs Cardiometabolic diseases these limiting factors and substantial stakeholder involvement in devel-
CVDs Cardiovascular diseases oping solutions are mostly going to be effective.27 It is important to have
QOL Quality of life a comprehensive outlook on the cultural, social, and contextual elements
PRISMA Preferred Reporting Item for Systematic Review and that affect physical activity behavior.26 Our systematic review aims to
Meta-Analysis assess the factors that inhibit Black/African-American women from
BMI Body Mass Index participating in physical activity and the benefits they derive as regular
HbA1c Glycosylated Hemoglobin participants. Identifying these barriers is crucial to developing, not only
SI Insulin Sensitivity an effective intervention but also a sustainable one. Also, examining the
LDL-C Low-density lipoprotein cholesterol specific benefits of physical activity and the potential to lessen the bur-
HDL-C High-density lipoprotein cholesterol dens of chronic diseases in this population will help to promote the
HIIT High Intensity Interval Training adoption and adherence to health promotion activities.
IL-7 Interleukin-7
TNF Tumor Necrotic Factor Methods
IFN Interferon
LDL Low Density Lipoprotein A systematic review of the literature was conducted. We searched
AUC Area under curve PubMed and Web of Science databases for relevant research articles.
HR Heart Rate Search keywords included physical activity, exercise, barriers, benefits,
MCP-1 Monocyte chemoattractant protein-1 black women, and African American women.
CRF Cardiorespiratory Fitness Included studies were: a) published in the English Language; b)
USA United States of America published between 2011 and 2022; c) conducted predominantly on black
N/A Not applicable women or African American women. Studies were excluded if they were:
a) Review articles; b) conducted with samples from ethnic groups other
than black women or African American women; c) conducted in/with
subgroups with special disease conditions which could interfere with or
pre-eclampsia, hypertension, gestational diabetes, excessive gestational limit engagement in physical activity.
weight gain, and delivery complications, and there are also fewer An electronic search was performed by two reviewers. Duplicate ar-
new-born complications, with no adverse effects on birthweight, and no ticles were removed using the Mendeley reference tool. Title and abstract
increase in the risk of stillbirth.1 Interestingly, there is a link between screening and selection were conducted by all four reviewers indepen-
sexual dysfunction, depression, and physical activity in women. Women dently. Further screening of the full text of selected articles was per-
with depression/anxiety symptoms have a substantially greater inci- formed by the same reviewers. The dialogue was used to reach a
dence of diminished sexual desire and a tendency toward a higher consensus following any disagreement on article selection and inclusion.
prevalence of dyspareunia than women without anxiety symptoms6 with A manual search of the reference list of included articles was also con-
physical activity having antidepressant-like effects on these depression ducted by all the reviewers to identify relevant articles not found in the
symptoms7 and also strongly linked to improved overall sexual perfor- online search.
mance.8 Menopausal women had substantial decreases in menopausal We used qualitative synthesis to extract data. Articles were grouped
symptoms such as hot flushes, sweating, anxiety, sleep difficulties, irri- into two – barriers and benefits groups. Three reviewers worked inde-
tability, and negative moods following a 24-week exercise program.9 pendently to synthesize relevant information. The author’s information,
Among healthy people, physical activities have also been linked to year of study, study settings, key findings and other relevant data
improved sleep and fewer sleep disruptions by several studies.10–17 addressing the research objectives were extracted. We categorized the
Improved sleep quality was highlighted in pregnant women that partic- identified barriers into four groups – Intrapersonal/Individual barriers
ipated in a randomized clinical trial of physical activity.18 However, in (such as body image, and hair concerns); Social Barriers (such as lack of
contrasting reports, physical activity was not closely linked with sleep role models, and peer pressure); Socio-economic barriers (such as cost,
quality and length in pregnant women.19,20 lack of exercise resources); and Environmental barriers (such as weather,
Notwithstanding the enormous benefits of physical activity, Black/ neighborhood safety).
African-American women are more likely to be less physically active The procedures are reported in the Preferred Reporting Item for
than their white counterparts. About 38% of non-Hispanic black women Systematic Review and Meta-Analysis (PRISMA)28 flow chart. See Fig. 1.
against 23% non-Hispanic white women had reported little or no
participation in leisure-time physical activity.21 As a consequence, this Results
population is burdened with high risk and prevalence of chronic diseases
such as obesity, hypertension, diabetes, and cardiovascular diseases that The initial electronic search produced 2 043 articles and was reduced
are often linked to physical inactivity.22 Considered the fourth leading to 2 038 after duplicates were removed. Following title and abstract
risk of death worldwide, physical inactivity accounts for 6% of all deaths, screening, 45 articles were selected for full-text screening. After the
and it is thought to be responsible for roughly 21%–25% of breast and screening of full-text, 33 articles met all inclusion criteria for this review.
colon cancer cases, 27% of diabetes cases, and about 30% of ischemic 13 articles focused on the benefits of physical activity, while 20 articles
heart disease cases.23 This shows the need for an intervention that is addressed the barriers to physical activity.
specifically focused on this population’s needs, and has the potential to Among the Benefit studies, 7 were randomized controlled trials, 2
effectively reduce these physical activity-related health burdens among qualitative studies, 2 prospective studies, 1 case-control study, and 1
black women. intervention study without control. The sample size ranges from 15 to
Studies have shown that several barriers, including individual, 832 and participants were between 18 and 61 years across all studies. Of
interpersonal, social, and environmental influences limit women’s the 13 studies, 8 were conducted in the United States among African
participation in physical activity.24–26 Given these factors, it is not American women, 4 in South Africa among the Black African women, and

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Fig. 1. PRISMA flow diagram for the study selection process.

1 study did not provide information about the location. Table 1 presents minimal compared to similar previous studies in other populations.
the summary of the studies and the key findings. Most of the studies in our review utilized randomized controlled trial
The Barrier studies included 8 cross-sectional studies, 5 qualitative study design.32–34,37,40,41 There is inconsistency in the evidence presented
studies, 3 case-control studies, 2 randomized controlled trials, and 2 in some of the studies. One study found no association between exercise
observational studies. Eighteen of the studies were located in the United adherence and change in body composition. This contradicts most studies
States, 1 was done in South Africa, and 1 did not provide location in- suggesting beneficial effects on body composition with higher-intensity
formation. The sample size across the studies ranges from 12 to 1 558 and physical activity over a longer duration of time. However, this study
included participants from 13 years and above. The study characteristics was conducted in a small cohort of African American women with no
and the key findings are shown in Table 2. control group and less adherence rate. These may have introduced bias
and also limit its generalization. Hence, to solidify the evidence, there is a
Discussion need for further investigation with a larger sample size.
A randomized controlled trial is the standard for effective clinical
Physical activity is an important public health strategy to lower the research and outcome measurement61 and should be utilized to generate
risk of obesity, diabetes, and other chronic diseases prevalent in African more evidence in the literature. However, in this understudied popula-
women. Several studies have highlighted the enormous benefits of being tion, other study designs such as qualitative studies are needed to better
physically active among women. Unfortunately, the majority of these understand the views of black women on the benefits they get from
studies are carried out among White women, with limited data on Black engaging in physical activity other than the effects from objective data.
women. However, due to barriers that may be categorized into intra- This would serve as a motivating factor to encourage more participation
personal, interpersonal, social, socio-economic, and environmental bar- of black women in an exercise program. Also, the majority of the studies
riers, black women rarely participate in physical activity. In this were conducted on African American women that are overweight or
systematic review, we examined recent studies on the benefits of physical obese. The few studies conducted in Africa were focused on one location,
activity for black women, as well as barriers to engaging in physical ac- presenting the need for studies including a more robust representative of
tivity among this population. black African women.
Studies that examined walking exercise intervention suggest that
walking may reduce body mass index, waist circumference, total fat
Benefits of physical activity
mass, and other cardiovascular disease risk factors.32–34,31 However,
most of the studies were conducted within 8–12 weeks period and with a
The current review found that moderate to high-intensity exercise,
small sample size. Across all studies, subjects did not achieve the 10 000
including walking, running, yoga, weightlifting, and aerobic activities
steps per day goal. To improve cardiovascular health in obese individuals
are strongly associated with improved BMI, waist circumference, body
through a walking program, 10 000 steps per day is usually recom-
weight, body shape, body satisfaction, cardiovascular health, and general
mended.62,63 However, most subjects in walking exercise program ach-
well-being. Subjects who participate more often in vigorous physical
ieve this goal after a long time of continuous walking exercise.64 This
activity are more likely to feel more confident in their body, increase the
implies that an intervention program targeted at this population should
number of steps per day and engage in other activities. Studies also show
be designed to last for a longer period than the usual 8–12 weeks that
that physical activity has a beneficial effect on insulin sensitivity in Black
most researchers use.
women who are obese. Although the effect observed in the study is

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Table 1
Summary of studies characteristics and findings on the benefits of physical activity.
Study Study Design Settings Sample Mean Age of Exercise Program Key Findings.
Size Participants

Sealy- Retrospective, Baltimore, 832 23 years old Walking for a purpose or stair climbing The rate of preterm delivery (PTD) was
Jefferson Prospective Cohort Maryland for 30 min daily 16.7%.
et al.29 Study A marked decrease in the prevalence of
PTD in women who walked for a purpose
for more than 30 min.
Joseph et al.30 Intervention study Arizona State 15 19–30 years A 3-month 30–60 min moderate- BMI significantly decreased over the study
University, USA intensity aerobic physical activity period (p ¼ 0.034), reflected by a
marginal decrease in body weight (p ¼
0.057).
Bone marrow density significantly
increased over the 3-month study (p ¼
0.011), but cortical density remained
stable (p ¼ 0.211).

Marginal significant increase in muscle

density (p ¼ 0.053).
Ingram Qualitative Chicago, USA 51 Mean Age ¼ 54 A 12-month (6 months adoption, 6 Weight loss,
et al.31 Exploratory design years months maintenance) Walking Improved body shape,
Intervention Stress reduction,
Avoiding diabetes,
Controlling the blood pressure.
Gradidge Randomized University of 115 18 years 12-week walking intervention BMI, waist circumference, and blood
et al.32 Controlled Trial Venda, Limpopo pressure were significantly reduced.
province, South
Africa.
Hornbuckle Randomized Florida State 44 39–61 years Lifestyle walking program combined Significant reduction in waist
et al.33 controlled study University, USA with resistance training for 12 weeks. circumference, total fat mass, gynoid fat
mass, and percent total body fat.

Significant decrease in HbA1c and mean

blood glucose calculated from HbA1c.

Significant increase in fibrinogen level

Hornbuckle Randomized Winston-Salem, 27 20–40 years 16-week high-intensity interval A significant decrease in waist
et al.34 controlled (Pilot North Carolina, training (treadmill exercise involving circumference, which is an important
Intervention) study USA walking and running) cardiometabolic risk factor.

A significant time effect for steps where

HIIT increased steps/day
Wharton Phase 1 Randomized Atlanta, Georgia 34 45þ years/ 20 classes of a 12 week Adapted Tango Notable reduction in inflammatory
et al.35 placebo-controlled (59.7  8.13) dance session which lasted 1.5 h long cytokines, including IL-7, TNF-, IFN-y,
clinical trials years and MCP-1.
Improved cognition, strength, and
balance in participants.
Sheppard Case-control study Washington, DC N/A 52.42–57.63 Walking for exercise and vigorous 2 h/week of vigorous physical activity
et al.36 metro area years physical activity (running, aerobics, was found to be protective against breast
etc.) cancer in postmenopausal women.
A 64% reduction in risk of breast cancer.
Mendham Randomized control N/A 45 20–35 years 12-weeks, 4 days per week, 40–60 min A small but considerable reduction in
et al.37 trial aerobic and resistance training body mass index and increased oxygen
(dancing, running, skipping, and consumption
stepping at a moderate-vigorous The increased mitochondrial function
intensity, 75%–80% peak heart rate) associated with a decrease in body fat,
Improved SI with reduced gynoid fat.
Evans.38 Qualitative Southern rural 20 40–60 years N/A The majority of women believe that
(Ethnographic) study county exercise keeps blood flow to the heart and
makes the heart strong.
Mathunjwa Prospective University of 60 Mean Age ¼ A 10-week exercise program of 30 Effective reduction in risk factors
et al.39 Experimental Study Zululand, South (25  5) years sessions of Tae-bo, 60 min per day for associated with cardiometabolic disease
Africa 3 days a week, moderate intensity for in the students that are obese or
the first five weeks and high intensity overweight.
for the last five weeks. Improvement in BMI, weight, waist
circumference, resting heart rate and
resting systolic and diastolic blood
pressure, LDL-C, HDL-C, and total
cholesterol
Fortuin-de Randomised Cape Town, 45 20–35 years 12-weeks of aerobic and resistance Improved Cardiorespiratory fitness, total
Smidt controlled trial South Africa training exercises AUC of glucose, and Insulin sensitivity.
et al.40 A small reduction in body weight and
gynoid fat.
Clamp et al.41 Randomized Western Cape, 35 20–35 years A 12-week exercise session which Relative reduction in gynoid fat mass in
Controlled study South Africa includes aerobic and resistance response to a 12-week combined aerobic
training at a vigorous intensity (> 75% and resistant exercise. There were also
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Table 1 (continued )
Study Study Design Settings Sample Mean Age of Exercise Program Key Findings.
Size Participants

peak heart rate, HRmax) advancing improved CRF with higher fat oxidation
from 40 to 60 min per day for 4 day in rate and lower resting carbohydrate
a week oxidation rates in steady-state and
baseline respectively.
a
BMI: Body Mass Index; HbA1c: Glycosylated Hemoglobin; SI: Insulin Sensitivity; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein
cholesterol; HIIT: High Intensity Interval Training; IL-7: Interleukin-7; TNF: Tumor Necrotic Factor; IFN: Interferon; LDL: Low Density Lipoprotein; AUC: Area under
curve, HR: Heart Rate; MCP-1: Monocyte chemoattractant protein-1; CRF: Cardiorespiratory Fitness.

The included studies utilized a small sample size which is a major However, introducing styling techniques to minimize the effect of
limitation. To increase the statistical power and generalize findings, sweating while physically active and empowering women in trying a
future studies should utilize a larger sample size.65 Another limitation variety of protective styles will encourage and motivate women to
found in the studies is a low adherence rate and loss of follow-up. A study participate more in physical activity.45,46
had a more than 70% dropout rate in one of the groups of the study The prevalent rate of violence in black neighborhoods may explain
despite drawing up measures to control for it.34 On average, around 45% some of the negative outcomes linked to the environmental barriers
of participants do not adhere to exercise intervention programs, and impeding black women’s participation in physical activity. It is unclear
these large dropout rates have crippled the success of physical activity from the reports of the studies whether these black women enjoy
interventions.66 Therefore, designing studies to examine the reasons for engaging in exercise activities alone, which may raise the risk to personal
dropout, as well as providing effective measures to encourage adherence safety. Group exercise participation may be advised, as participating in
would be very helpful. group dynamics-based physical activity programs may improve physical
activity behavior67 and a sense of safety. Researchers should leverage
these specific barriers to provide relevant interventions that will address
Barriers to physical activity these cultural related barriers among Africans.68
The present review had several limitations that should be noted. Only
The Barrier studies in this review employed different measurement studies conducted exclusively on black women were included. This
tools in cohorts of Black women to highlight the various barriers pre- screen out studies with women of other races alongside black Africans,
venting women from engaging in physical activity. limiting the possibility of comparing the outcomes of interest and iden-
The majority of the study was conducted among African women tifying those peculiar to African women. We also excluded studies that
living in the United States of America (USA).42,45,46,54,56,60 Studies on involved women with chronic diseases, special conditions, and geriatrics.
black women based in African countries are limited, prompting the need Therefore, the findings cannot be generalized to such groups. Even
to diversify research in this area to African countries. All study design though we conducted a manual search, we acknowledge that some
types examined one or more individual/intrapersonal barriers. However, studies relating to the benefits and barriers of physical activity in African
some inconsistencies were observed among the studies examining all women may have been unintentionally excluded in both the electronic
categories of barriers. Two quantitative studies identified a social barrier and manual searches. Also, we utilized two databases to obtain data,
to a lack of exercise partners. No qualitative study evaluated this barrier possibilities exist that more important information, from other databases,
to better understand the views and opinions of the subjects. A similar addressing the research questions were omitted.
observation was made for Religiosity, Gender norms, and Peer pressure, Despite all these limitations, this review will form the basis for future
as well as Musculoskeletal problems and weight issues associated with studies, most importantly, for designing interventions to promote phys-
walking identified in one of the qualitative studies. ical activity in women of color. To the best of our knowledge, this is the
While most of these barriers are common among people of all races, first review to systematically review all study designs on the benefits and
intrapersonal and social barriers such as Body image perception, hair barriers of physical activity in African women.
care concerns, gender norms, fear of sexual stereotypes, and family re-
sponsibilities are peculiar to African women. Black women are often Conclusion
characterized as having thick thighs, wide hips and shapes, broad
shoulders, and most times are referred to as fat because of those physical There is a substantial amount of research on the benefits and barriers
attributes. These women become conscious of their looks and weight due of physical activity among women of diverse races. In black women, only
to the cultural and social norms in their countries of residence.42,44 a few studies have been identified, with the majority focused on one
Low–income African Women who are overweight are conscious of their geographical zone. While physical activity has defined benefits on
looks and they are sensitive to teasing from people when they exercise in obesity, cardiovascular health, hypertension, and other chronic diseases
public. This can impede initial attempts at behavior change, thereby prevalent in black/African-American women, significant barriers such as
short-circuiting progress. However, maintenance enhances self-efficacy body image perception, hair care concerns, gender norms, fear of sexual
that reinforces behavior change over time.44 stereotypes, and family responsibilities particularly limit their involve-
Hair is considered an essential part of the beauty in African culture, ment in physical activity. This comprehensive review highlights these
thus priority is given to hair among black women. There seems to be an benefits and barriers, as well as provides recommendations on the area
existing link between African-American women’s experiences, societal researchers need to address to promote physical activity in this popula-
expectations about their lifestyles, and physical activity engagement. tion. In designing effective interventions, the identified barriers and the
Black women’s hair is often evaluated against the standard of beauty existing gaps in the literature should be taken into consideration. Again,
because of the texture of their hair, thereby influencing their thought research should be diversified to reach the underserved groups in Africa.
processes when trying to adopt a physically active lifestyle,60 therefore, There is also a need to incorporate the motivators, predictors and barriers
hair maintenance concerns pose as a barrier to participation in physical in future interventions to successfully improve the physical activity
activity as a result of concerns such as “Sweating out my hairstyle” and behavior of African women.
“Drying effects on the hairstyle” following a vigorous aerobic exercise.

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Table 2
Summary of studies characteristics and findings on the barriers to physical activity.
Study Study Design Settings Sample Size Mean Age of Key Findings. Barrier themes
Participants

Baruth et al.42 Case-control study Columbia, South 28 20–50 years Injuries and health conditions; Issues Intrapersonal
Carolina related to body size; Competing demands barriers
on their time and lack of energy Social barriers
Lack of motivation; Unavailability of Socio-economic
exercise partners; Rude and disrespectful barriers
comments by people.
Lack of access to facilities; High cost of a
gym membership.
Carr et al.43 Randomized controlled North Carolina 234 50 years and above Lack of willpower; General sense of role Intrapersonal
trial overwhelm; Haircare and maintenance. barriers.
Cost; Lack of exercise resources. Socio-economic
barriers
Mama et al.44 Case-control Harris, Houston and 164 25–60 years Body composition and body image; Intrapersonal
Travis Country, Motivational readiness for weight loss barriers.
Austin, Texas Environmental changes. Environmental
barriers
Huebschmann Cross-sectional study Metropolitan Denver 51 19–73 years Sweating out my hairstyle; Drying effects Intrapersonal
et al.45 area on hairstyle; Lack of self-discipline; I am barriers.
too exhausted at the end of the day Socio-economic
Lack of money; Lack of equipment. barriers.
Joseph et al.46 Case-control Phoenix, Arizona 23 24–49 years Perspiration while performing Physical Intrapersonal and
Activity; Maintaining a work-appropriate Social barriers.
and socially acceptable hairstyle that is
convenient for physical activity; Social
comparison to women of other races/
ethnicities.
Adamus-Leach Cross-sectional study Houston and Austin, 388 20–65 years Individual Income status Socio-economic
et al.47 Texas Perception of neighborhood environment barrier
Environmental
barrier
Hall et al.48 Cross-sectional survey Winston-Salem, 103 21–60 years Hair concerns and maintenance Intrapersonal
study North Carolina barriers.
Gaston et al.49 Cross-sectional study Detroit, Michigan 1 558 23–35 years Hair product use/maintenance Intrapersonal
barriers.
Robinson & Cross-sectional study Alabama 19 21–60 years Type of employment and h worked. Intrapersonal
Wicks50 Religiosity. barriers.
Social barrier.
Scott et al.51 Observational study: Not stated 113 Middle-aged. Mean Not enough time; No knowledge of Intrapersonal
Use of self-administered age: 51.3 years exercise techniques. barriers.
questionnaires No one to exercise with me. Social barrier.
Lack of access to a gym and childcare Environmental
Unsafe environment. barrier.
Gothe & Qualitative research Detroit metro area 20 Between 55 and 75 Time; physical health and age-related Intrapersonal
Kendall52 (with 3 Focus groups) and surrounding years, mean age: limitations barriers
urban communities age ¼ (63.15  4.5) Peer pressure and family responsibilities Social barriers.
years Weather and poor neighborhood Environmental
condition barriers
James et al.53 Cross-sectional survey North-central Florida, 413 Mean age: (35.63 Busy lifestyle and not having enough time; Intrapersonal
study USA  14.72) years Too much hair care barrier.
Expensive gym membership; No one to Socio-economic;
exercise with; Living in an unsafe Social and
neighborhood Environmental
barriers.
Ingram et al.31 Qualitative exploratory Chicago 33 44–69 years. Mean Family and work responsibilities; Intrapersonal
design with focus group age: 54 years Musculoskeletal problems and weight barrier.
methodology (4 focus issues associated with walking. Social barrier
groups) Lack of role models within the Environmental
community. barrier.
Weather; Neighborhood safety.
Jackson et al.54 Cross-sectional North Omaha 47 19 years and above Obesity; Fatigue; Haircare concern; Intrapersonal
descriptive study Family and friends; Lack of time. barrier.
Social support for physical activity. Social barrier.
Zenk et al.55 Correlational, Metropolitan Chicago 97 25–64 years Affect (feelings). Intrapersonal
observational research Poor weather. barrier.
design Environmental
barrier.
Schoeny et al.56 Randomized controlled Chicago, Illinois area 284 40–65 years Physical and psychological health; Pain; Intrapersonal
trial BMI; Perceived walkability; Children in barrier.
the household; Employment. Environmental
Neighborhood characteristics (Assault/ barrier.
battery rate).
Tenfelde et al.57 Qualitative Research The urban Midwest, 22 18 years and above Access to Yoga classes within the
(Focus group) study Chicago, USA community; Location of classes; Quality of
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Table 2 (continued )
Study Study Design Settings Sample Size Mean Age of Key Findings. Barrier themes
Participants

instruction. Intrapersonal barrier

The high cost of yoga classes Socio-economic
barrier.
Kinsman et al.58 Qualitative focus group Agincourt sub-district 51 13–19 years Body image ideals. Intrapersonal
study of rural Mpumalanga Poverty and associated social stigma; barrier.
province, north- Gender bias in accessing facilities and Social and Socio-
eastern competitions; Parental interference due to economic barriers.
South Africa, social violence.
Alvarado Population-based cross- Barbados 17 25–35 years Laidback mentality; Lack of opportunity to Intrapersonal
et al.59 sectional study walk to jobs, grocery stores, etc. due to a barrier.
distant residential area. Social barriers.
Gender norms; Limited indoor space for
home exercise; Limited access to group/
gym exercise
Walker.60 Qualitative Research Las Vegas, US 12 (6 Women 42–50 Body image perception; Lack of interest, Intrapersonal
Design (using grounded mothers, 6 years; Girls 12–17 knowledge, time, and transportation barriers
theory approach) daughters) years Lack of physical activity history/ Social barriers
motivation; peer pressure; Fear of sexual Environmental
stereotypes; Racial stereotypes and sports barrier
Weather.

Submission statement 6. Schnatz PF, Whitehurst SK, O’Sullivan DM. Sexual dysfunction, depression, and
anxiety among patients of an inner-city menopause clinic. J Wom Health. 2010;
19(10):1843–1849. https://doi.org/10.1089/jwh.2009.1800.
This work has not been published previously or is under consideration 7. Dinas PC, Koutedakis Y, Flouris AD. Effects of exercise and physical activity on
for publication in any journal and if accepted, will not be published depression. Ir J Med Sci. 2011;180(2):319–325. https://doi.org/10.1007/s11845-
elsewhere. All authors have read and approved this manuscript for 010-0633-9.
8. Maseroli E, Rastrelli G, Di Stasi V, et al. Physical activity and female sexual
publication. dysfunction: a lot helps, but not too much. J Sex Med. 2021;18(7):1217–1229.
https://doi.org/10.1016/j.jsxm.2021.04.004.
Authors’ contribution 9. Karacan S. Effects of long-term aerobic exercise on physical fitness and
postmenopausal symptoms with menopausal rating scale [Effets
a long terme
d’exercices de type aerobic sur la condition physique et la symptomatologie post-
A.C.N. and O.C.O conceived and designed the review protocol and menopausique]. Sci Sports. 2010;25(1):39–46. https://doi.org/10.1016/
performed the electronic search. A.C.N., O.C.O., A.O., and O.J.O. per- j.scispo.2009.07.004.
10. Kronholm E, H€arm€a M, Hublin C, Aro AR, Partonen T. Self-reported sleep duration in
formed a manual search, screening, and data extraction; We drew lots to Finnish general population. J Sleep Res. 2006;15(3):276–290. https://doi.org/
determine the co-first authorship order. Both A.C.N. and O.C.O. 10.1111/J.1365-2869.2006.00543.x.
contributed equally and have the right to list their name first in their CV. 11. Youngstedt SD. Effects of exercise on sleep. Clin Sports Med. 2005;24(2):355–365.
https://doi.org/10.1016/j.csm.2004.12.003.
All authors contributed in drafting the manuscript and approved the 12. Atkinson G, Davenne D. Relationships between sleep, physical activity and human
submitted work. health. Physiol Behav. 2007;90(2–3):229–235. https://doi.org/10.1016/
j.physbeh.2006.09.015.
13. Urponen H, Vuori I, Hasan J, Partinen M. Self-evaluations of factors promoting and
Conflict of interest disturbing sleep: an epidemiological survey in Finland. Soc Sci Med. 1988;26(4):
443–450. https://doi.org/10.1016/0277-9536(88)90313-9.
14. King AC, Oman RF, Brassington GS, Bliwise DL, Haskell WL. Moderate-intensity
All authors declare no conflict of interest.
exercise and self-rated quality of sleep in older adults: a randomized controlled trial.
JAMA. 1997;277(1):32–37. https://doi.org/10.1001/jama.1997.03540250040029.
Acknowledgement 15. Quan SF, O’Connor GT, Quan JS, et al. Association of physical activity with sleep-
disordered breathing. Sleep Breath. 2007;11(3):149–157. https://doi.org/10.1007/
S11325-006-0095-5.
The authors wish to thank the Parg Network and its executives for 16. Sherrill DL, Kotchou K, Quan SF. Association of physical activity and human sleep
giving us the platform and the opportunity to conduct this research. disorders. Arch Intern Med. 1998;158(17):1894–1898. https://doi.org/10.1001/
Special mentions include the Director – Chima Cyril Hampo, and Team archinte.158.17.1894.
17. Fogelholm M, Kronholm E, Kukkonen-Harjula K, Partonen T, Partinen M, H€arm€a M.
leaders of the Health and Nutrition subgroup – Emmanuel Njoku and Sleep-related disturbances and physical inactivity are independently associated with
Kelechi Andrew, who offered a consistent follow-up to ensure the prog- obesity in adults. Int J Obes. 2007;31(11):1713–1721. https://doi.org/10.1038/
ress of the research. sj.ijo.0803663.
18. Rodriguez-Blanque R, Sanchez-García JC, Sanchez-L opez AM, Mur-Villar N, Aguilar-
Cordero MJ. The influence of physical activity in water on sleep quality in pregnant
References women: a randomised trial. Women Birth. 2018;31(1):e51–e58. https://doi.org/
10.1016/j.wombi.2017.06.018.
1. World Health Organisation. guidelines on physical activity and sedentary behavior. 19. Borodulin K, Evenson KR, Monda K, Wen F, Herring AH, Dole N. Physical activity
World Health Organization; 2020. Accessed November 27, 2022. https://www.who.i and sleep among pregnant women. Paediatr Perinat Epidemiol. 2010;24(1):45–52.
nt/publications/i/item/9789240015128. https://doi.org/10.1111/J.1365-3016.2009.01081.x.
2. Thivel D, Tremblay A, Genin PM, Panahi S, Rivi
ere D, Duclos M. Physical activity, 20. Loprinzi PD, Loprinzi KL, Cardinal BJ. The relationship between physical activity and
inactivity, and sedentary behaviors: definitions and implications in occupational sleep among pregnant women. Ment Health Phys Act. 2012;5(1):22–27. https://
health. Front Public Health. 2018;288:6. https://doi.org/10.3389/fpubh.2018.00288. doi.org/10.1016/j.mhpa.2011.12.002.
3. Jochem C, Schmid D, Leitzmann MF. Introduction to sedentary behaviour 21. American Cancer Society. Cancer Facts & Figures for African Americans 2019-2021.
epidemiology. In: Leitzmann MF, Jochem C, Schmid D, eds. Sedentary Behaviour American Cancer Society. Accessed February 4, 2022. https://www.cancer.org/.
Epidemiology. Cham: Springer; 2018:3–29. https://doi.org/10.1007/978-3-319- 22. Centers for Disease Control and Prevention. Special Feature on Racial and Ethnic Health
61552-3_1. Disparities. Heal United States. 2015:3.
4. Levine JA. Sick of sitting. Diabetologia. 2015;58(8):1751–1758. https://doi.org/ 23. World Health Organization. Global Health Risks: Mortality and Burden of Disease
10.1007/s00125-015-3624-6. Attributable to Selected Major Risks. World Health Organization; 2009.
5. Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated 24. James DCS, Pobee JW, Oxidine D, Brown L, Joshi G. Using the health belief model to
recommendation for adults from the American College of Sports Medicine and the develop culturally appropriate weight-management materials for african-American
American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423–1434. https:// women. J Acad Nutr Diet. 2012;112(5):664–670. https://doi.org/10.1016/
doi.org/10.1249/mss.0b013e3180616b27. j.jand.2012.02.003.

65
O.C. Obi et al. Sports Medicine and Health Science 5 (2023) 59–66

25. Wendel-Vos W, Droomers M, Kremers S, Brug J, Van Lenthe F. Potential 46. Joseph RP, Coe K, Ainsworth BE, Hooker SP, Mathis L, Keller C. Hair as a barrier to
environmental determinants of physical activity in adults: a systematic review. Obes physical activity among african American women: a qualitative exploration. Front
Rev. 2007;8(5):425–440. https://doi.org/10.1111/j.1467-789X.2007.00370.x. public Heal. 2017;367:5. https://doi.org/10.3389/fpubh.2017.00367.
26. Fleury J, Lee SM. The social ecological model and physical activity in African 47. Blackman Carr LT, Nezami BT, Leone LA. Perceived benefits and barriers in the
American women. Am J Community Psychol. 2006;37(1-2):129–140. https://doi.org/ mediation of exercise differences in older black women with and without obesity.
10.1007/s10464-005-9002-7. J racial Ethn Heal disparities. 2020;7(4):807–815. https://doi.org/10.1007/s40615-
27. Kelly PJ, Lesser J, Cheng AL, et al. A prospective randomized controlled trial of an 020-00788-6.
interpersonal violence prevention program with a Mexican American community. 48. Adamus-Leach HJ, Mama SK, O’Connor DP, Lee RE. Income differences in perceived
Fam Community Health. 2010;33(3):207–215. https://doi.org/10.1097/ neighborhood environment characteristics among african american women. Environ
fch.0b013e3181e4bc34. Health Insights. 2012;6:33–40. https://doi.org/10.4137/ehi.s10655.
28. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews 49. Hall RR, Francis S, Whitt-Glover M, Loftin-Bell K, Swett K, McMichael AJ. Hair care
and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. https:// practices as a barrier to physical activity in African American women. JAMA
doi.org/10.1371/journal.pmed.1000097. dermatology. 2013;149(3):310–314. https://doi.org/10.1001/
29. Sealy-Jefferson S, Hegner K, Misra DP. Linking nontraditional physical activity and jamadermatol.2013.1946.
preterm delivery in urban african-American women. Wom Health Issues. 2014;24(4): 50. Gaston SA, James-Todd T, Riley NM, et al. Hair maintenance and chemical hair
e389–e395. https://doi.org/10.1016/j.whi.2014.04.007. product usage as barriers to physical activity in childhood and adulthood among
30. Joseph RP, Casazza K, Durant NH. The effect of a 3-month moderate-intensity african American women. Int J Environ Res Publ Health. 2020;17(24):9254. https://
physical activity program on body composition in overweight and obese African doi.org/10.3390/ijerph17249254.
American college females. Osteoporos Int. 2014;25(10):2485–2491. https://doi.org/ 51. Robinson BK, Wicks MN. Religiosity, self-efficacy for exercise, and African American
10.1007/s00198-014-2825-z. women. J Relig Health. 2012;51(3):854–864. https://doi.org/10.1007/s10943-010-
31. Ingram D, Wilbur J, McDevitt J, Buchholz S. Women’s walking program for African 9397-9.
American women: expectations and recommendations from participants as experts. 52. Scott MS, Oman RF, John R. The Benefits and Barriers Related to Regular
Women Health. 2011;51(6):566–582. https://doi.org/10.1080/ Participation in Physical Activity by African-American Women: Implications for
03630242.2011.606357. Intervention Development. Open J Prev Med. 2015;5(4):169–176. https://doi.o
32. Gradidge PJ-L, Golele PN. Walking as a feasible means of effecting positive changes rg/10.4236/ojpm.2015.54020.
in BMI, waist, and blood pressure in black South African women. Afr Health Sci. 53. Gothe NP, Kendall BJ. Barriers, motivations, and preferences for physical activity
2018;18(4):917–921. https://doi.org/10.4314/ahs.v18i4.10. among female african American older adults. Gerontol Geriatr Med. 2016:
33. Hornbuckle LM, Liu P-Y, Ilich JZ, Kim J-S, Arjmandi BH, Panton LB. Effects of 2333721416677399. https://doi.org/10.1177/2333721416677399.
resistance training and walking on cardiovascular disease risk in African-American 54. Jackson H, Yates BC, Blanchard S, Zimmerman LM, Hudson D, Pozehl B. Behavior-
women. Med Sci Sports Exerc. 2012;44(3):525–533. https://doi.org/10.1249/ specific influences for physical activity among african American women. West J Nurs
mss.0b013e31822e5a12. Res. 2016;38(8):992–1011. https://doi.org/10.1177/0193945916640724.
34. Hornbuckle LM, McKenzie MJ, Whitt-Glover MC. Effects of high-intensity interval 55. James DCS, Efunbumi O, Harville C, Sears C. Barriers and motivators to physical
training on cardiometabolic risk in overweight and obese African-American women: activity among african American women. Health Educ. 2014;46(2):28–34.
a pilot study. Ethn Health. 2018;23(7):752–766. https://doi.org/10.1080/ 56. Schoeny ME, Fogg L, Buchholz SW, Miller A, Wilbur J. Barriers to physical activity as
13557858.2017.1294661. moderators of intervention effects. Prev Med Reports. 2017;5:57–64. https://doi.org/
35. Ingram D, Wilbur J, McDevitt J, Buchholz S. Women’s walking program for African 10.1016/j.pmedr.2016.11.008.
American women: expectations and recommendations from participants as experts. 57. Zenk SN, Horoi I, Jones KK, et al. Environmental and personal correlates of physical
Women Health. 2011;51(6):566–582. https://doi.org/10.1080/ activity and sedentary behavior in African American women: an ecological
03630242.2011.606357. momentary assessment study. Women Health. 2017;57(4):446–462. https://doi.org/
36. Wharton W, Jeong L, Ni L, et al. A Pilot randomized clinical trial of adapted tango to 10.1080/03630242.2016.1170093.
improve cognition and psychosocial function in African American women with 58. Tenfelde SM, Hatchett L, Saban KL. “Maybe black girls do yoga”: a focus group study
family history of Alzheimer’s disease (ACT trial). Cereb Circ - Cogn Behav. 2021;2: with predominantly low-income African-American women. Compl Ther Med. 2018;
100018. https://doi.org/10.1016/j.cccb.2021.100018. 40:230–235. https://doi.org/10.1016/j.ctim.2017.11.017.
37. Mendham AE, Larsen S, George C, et al. Exercise training results in depot-specific 59. Kinsman J, Norris SA, Kahn K, et al. A model for promoting physical activity among
adaptations to adipose tissue mitochondrial function. Sci Rep. 2020;10(1):3785. rural South African adolescent girls. Glob Health Action. 2015;8:28790. https://
https://doi.org/10.1038/s41598-020-60286-x. doi.org/10.3402/gha.v8.28790.
38. Sheppard VB, Makambi K, Taylor T, Wallington SF, Sween J, Adams-Campbell L. 60. Walker SD. Perceptions of Barriers that Inhibit African American Women and Adolescent
Physical activity reduces breast cancer risk in African American women. Ethn Dis. Girls from Participation in Physical Activity. Dissertation. University of Nevada; 2012.
2011;21(4):406–411. Accessed November 27, 2022. https://doi.org/10.34917/4332625
39. Evans LK. Rural Black women’s thoughts about exercise. Appl Nurs Res. 2011;24(4): 61. Hariton E, Locascio JJ. Randomised controlled trials – the gold standard for
200–206. https://doi.org/10.1016/j.apnr.2009.09.005. effectiveness research: study design: randomised controlled trials. BJOG An Int J
40. Fortuin-de Smidt MC, Mendham AE, Hauksson J, et al. Effect of exercise training on Obstet Gynaecol. 2018;125(13):1716. https://doi.org/10.1111/1471-0528.15199.
insulin sensitivity, hyperinsulinemia and ectopic fat in black South African women: a 62. Hall KS, Hyde ET, Bassett DR, et al. Systematic review of the prospective association
randomized controlled trial. Eur J Endocrinol. 2020;183(1):51–61. https://doi.org/ of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia.
10.1530/eje-19-0957. Int J Behav Nutr Phys Activ. 2020;17(1):78. https://doi.org/10.1186/s12966-020-
41. Clamp LD, Mendham AE, Kroff J, Goedecke JH. Higher baseline fat oxidation 00978-9.
promotes gynoid fat mobilization in response to a 12-week exercise intervention in 63. Wattanapisit A, Wattanapisit ST, Thanamee S. Evidence behind 10,000 steps
sedentary, obese black South African women. Appl Physiol Nutr Metabol. 2020;45(3): walking. J Heal Res. 2017;31(3):241–248. https://doi.org/10.14456/jhr.2017.30.
327–335. https://doi.org/10.1139/apnm-2019-0460. 64. Alduhishy A, Baxendale R. 10,000 Step per day programme among Saudi Arabian
42. Baruth M, Sharpe PA, Parra-Medina D, Wilcox S. Perceived barriers to exercise and overweight. Physiotherapy. 2011;97:eS45–eS46. https://doi.org/10.1016/
healthy eating among women from disadvantaged neighborhoods: results from a j.physio.2011.04.002.
focus groups assessment. Women Health. 2014;54(4):336–353. https://doi.org/ 65. Boukrina O, Kucukboyaci NE, Dobryakova E. Considerations of power and sample
10.1080/03630242.2014.896443. size in rehabilitation research. Int J Psychophysiol. 2020;154:6–14. https://doi.org/
43. Mathunjwa ML, Semple SJ, du Preez C. A 10-week aerobic exercise program reduces 10.1016/j.ijpsycho.2019.08.009.
cardiometabolic disease risk in overweight/obese female African university students. 66. Marcus BH, Williams DM, Dubbert PM, et al. Physical activity intervention studies:
Ethn Dis. 2013;23(2):143–148. what we know and what we need to know. Circulation. 2006;114(24):2739–2752.
44. Mama SK, Diamond PM, McCurdy SA, Evans AE, McNeill LH, Lee RE. Individual, https://doi.org/10.1161/circulationaha.106.179683.
social and environmental correlates of physical activity in overweight and obese 67. Harden SM, McEwan D, Sylvester BD, et al. Understanding for whom, under what
African American and Hispanic women: a structural equation model analysis. Prev conditions, and how group-based physical activity interventions are successful: a
Med reports. 2015;2:57–64. https://doi.org/10.1016/j.pmedr.2015.01.001. realist review Health behavior, health promotion and society. BMC Publ Health.
45. Huebschmann AG, Campbell LJ, Brown CS, Dunn AL. “My hair or my health:” 2015;15(1):1–18. https://doi.org/10.1186/S12889-015-2270-8.
Overcoming barriers to physical activity in African American women with a focus on 68. Alvarado M, Murphy MM, Guell C. Barriers and facilitators to physical activity
hairstyle-related factors. Women Health. 2016;56(4):428–447. https://doi.org/ amongst overweight and obese women in an Afro-Caribbean population: a
10.1080/03630242.2015.1101743. qualitative study. Int J Behav Nutr Phys Activ. 2015;97:12. https://doi.org/10.1186/
s12966-015-0258-5.

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