The Influence of Physical Activity Behaviour of Public Fitness Centre Members on Cardiovascular Disease Risk Factors

  • Brett Staniland

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Cardiovascular disease (CVD) is the number one cause of death globally, affecting people of all ages. Many of these deaths are preventable as they are attributed to lifestyle risk factors such as smoking, diet and lack of physical activity (PA). Countries throughout Europe have reported a rise in physical inactivity and the prevalence of CVD risk factors, contributing to a rise in the number of deaths attributed to CVD. Spain in particular has witnessed an increase in deaths due to CVD, becoming one of the most physically inactive nations in the European Union. Reports from Spain outline an increase in economic spending aimed at treating CVD, as a consequence of elevated risk profiles from poor lifestyle behaviours. Public health initiatives including exercise interventions have aimed to improve CVD risk factors such as cholesterol, blood glucose, blood pressure and body composition, amongst others, to improve the CVD risk profile and overall health status. To inform initiatives aimed at improving PA levels, we rely on research to dictate the most appropriate and effective interventions for increasing PA and exercise and decreasing sedentariness and inactivity. Public fitness centres have been called upon to be the “hub” for increasing PA levels and creating active communities. Public fitness centre members are an under-used population in the literature, yet represent an ideal demographic for assessing public and community-based settings for PA. However, there is little known about members’ overall PA levels, the predictors of PA, and whether different PA approaches provide a beneficial impact on the CVD health profile of members. There is also a paucity of evidence concerning the effectiveness of type of PA undertaken by fitness centre members. Previous reports have shown combined aerobic exercise and resistance training are more effective at reducing multiple risk factors than aerobic exercise alone and hence international PA guidelines and advice often include this. However, a large body of research has focused on exercise interventions within laboratory settings and using supervised exercise programmes which may not truly reflect exercising behaviour in real-world environments. Therefore, the aim of this thesis was to investigate PA behaviour of fitness centre members, in comparison to PA behaviour of the general population, determine the predictors of greater PA levels and investigate which PA behaviour provides greater benefits to CVD risk factors; unstructured free roam exercise or a structured combined exercise programme.
    Chapter 3: Systematic Review
    An original review of literature (chapter 2) provided the rationale for chapter 3. Twenty studies, set in community-based settings investigating exercise on CVD risk factors, were included for review. Studies reported small sample sizes and mostly combined exercise programmes of AE and RT. Baseline risk profiles were elevated for most samples, and those which showed the greatest change in risk factors tended to have the most elevated risk factors. Interventions were mostly short in duration and varied in intensity. The training volume appeared to have the greatest impact on risk factors, and is supported by previous reviews, though further studies are required to substantiate this.
    Chapter 4: Comparative Analysis of Public Fitness Centre Members
    Self-reported PA, directly-measured fitness centre engagement and demographic data was obtained from a large scale survey of 12,371 public fitness centre members and compared with data from the Eurobarometer for Sport & Physical Activity for descriptive analysis. Fitness centre members were highly physically active (Mean PA from IPAQ = 3847.47 ± 2803.77 MET.Mins.Wk-1) and significantly more active than the general population of Spain and Europe following a truncation method of IPAQ results (Mean truncated PA: Fitness centre members = 3099.78 ± 2204.69 MET.Mins.Wk-1; Spain = 2537.19 ± 2414.19 MET.Mins.Wk-1; EU28 = 2355.61 ± 2331.19 MET.Mins.Wk-1, p<0.001). These results may have significance regarding reduced CVD risk as a result of the difference in PA levels between these populations.
    Chapter 5: Predictors of Behaviour in PA in Public Fitness Centre Members
    Independent and multivariate regression analyses were undertaken on the secondary data (used in chapter 4) from fitness centre members to investigate predictors of PA and fitness centre engagement. The regression model predicted PA; F(6, 3689) = 69.553, p<0.001, R2 = 0.1, consisting of 6 predictors: number of fitness centre visits, age, sex, visit duration, education level and civil status. Socioeconomic variables such as higher education level and greater income, intrinsic motives, being male and attending more group exercise classes were significant predictors of fitness centre engagement.
    Chapter 6: The Effects of Usual Exercise Behaviours and Structured Exercise at Improving Health Outcomes in Inactive Public Fitness Centre Members
    The fourth study was a randomised pilot trial in a Spanish public fitness centre. Fitness centre members who were physically inactive and had not attended the centre for at least 60 days, were randomly assigned to one of three groups. One group performed a 12-week programme of structured combined exercise based on the ACSM exercise recommendations (COMB, n=15), compared with a free-roam group (FREE, n=6) with access to facilities but no structured programme, and a non-exercising control group instructed to continue their usual behaviour (CON, n=9). None of the groups were instructed to change their diet. Measurements for body composition, blood pressure, cholesterol, triglycerides, glucose and VO2max were obtained pre- and post- intervention. Estimated marginal means and 95% confidence intervals showed a significant within-group change in the COMB group for change in Muscle Mass: +1.26kg (0.74 to 1.78kg), Body Mass Index: +0.03 (–0.34 to –0.39kg/m2), Body Fat: –1.33 (–2.2 to –0.46kg), Body Fat %: –1.7% (–2.49 to –0.93%) and Waist:Hip ratio: –0.025 (–0.039 to –0.012), Diastolic blood pressure: –4.3mmHg (79.9 to 75.6mmHg) and Cholesterol: –27mg/dL (225 to 198mg/dL). Cholesterol was also reduced in the FREE group: –29mg/dL (209 to 180mg/dL). Structured, combined exercise improved risk factors the most overall however, the free-roam group also produced positive effects to total cholesterol levels.
    Fitness centre members are significantly more active than the general population, which potentially reduces their risk of CVD. Higher education level, employment status, sex (being male) and intrinsically-derived motives (keep fit and feel good), were predictors of increased PA behaviour within fitness centre members. Further predictors of PA are related to engagement with the fitness centre such as attending more group exercise classes. The data indicate which people are most likely to achieve greater PA levels as well those who are likely to sustain long-term active lifestyles (those with higher socioeconomic profiles, attend the fitness centres more often and attend group exercise classes and are intrinsically motivated). This information can be used by fitness centres to address possible membership drop-out and non-completion of exercise interventions. Free roam (self-selected) exercise potentially improved CVD risk, though was perhaps not as effective when compared to structured exercise. Larger-scale studies in this population are necessary to explore findings further. The studies in this thesis showed that investigations set in community-based settings are important at understanding PA behaviour of fitness centre members compared with the general population. Whilst self-report data has its limitations, this project showed that methods combining self-report and objectively assessed PA, can provide a better understanding of PA behaviour. This project provides novel insight into the PA behaviour of fitness centre members, utilises a very large sample which has not previously been used in this area of literature and supports the claims that fitness centres have an important role in creating active communities.

    Date of AwardAug 2022
    Original languageEnglish
    Awarding Institution
    • Coventry University
    SponsorsGo Fit Lab Ingesport & UK active
    SupervisorAlfonso Jimenez (Supervisor), Gordon McGregor (Supervisor) & Elizabeth Horton (Supervisor)

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