Facilitators and barriers to physical activity among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda: A cross-sectional study

Facilitators and barriers to physical activity among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Facilitators and barriers to physical activity among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda: A cross-sectional study Edward Muteesasira, Night Atwongyeire, Anna Maria Ssewanyana, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8960791/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Physical activity is a proven non-pharmacological intervention in the management of hypertension significantly reducing the risk of cardiovascular complications. Despite its benefits, adherence to physical activity remains low among patients with hypertension in sub-Saharan Africa. This study aimed to determine the facilitators and barriers to physical activity among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda. Methods This was a facility-based cross-sectional study conducted among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda. Data was collected using an interviewer administered questionnaire assessing socio-demographic characteristics, physical activity levels(The International Physical Activity Questionnaire), facilitators(The Motivation for Physical Activity Questionnaire) and barriers(Barriers to Being Active Quiz) to physical activity among patients with hypertension. Descriptive statistics were used to summarize the socio-demographic characteristics of age, gender, place of residence, monthly income, occupation, marital status, level of education, duration of hypertension, awareness of physical activity (heard of physical activity),source of information, motivators and barriers to physical activity among patients with hypertension. Fischer’s exact test was used to test for association between physical activity, facilitators and barriers to physical activity among patients with hypertension at a 95% confidence interval. Results 141 participants participated in the study. Median age of the participants was 58 years (IQR = 14).Females accounted for 67.4% (95/141) of the participants while males accounted for 32.6% (46/141). Less than a half of the participants (45.4%) were physically active, 92.2% of the physically active participants reported to be autonomously motivated to engage in physical activity. Lack of skill, social influence and lack of willpower were the most reported barriers to physical activity. Using the Fischer’s exact test, social influence was significantly associated with physical activity (p-value = 0.026 0.05). Conclusion Approximately half of the physically inactive participants were also sedentary. This is a double disaster especially for adults with hypertension. Therefore, there is an urgent need to integrate and consider the four strategic policy areas for action recommended by World Health Organization ( 1 ) which include active societies, active environments, active people and active systems. Hypertension Physical Activity Facilitators Barriers Mbarara City Southwestern Uganda Cross-sectional study Introduction Hypertension has been identified to affect about 33% of the adult population( 2 ) and is one of the major causes of premature mortality globally and is on top of the list for modifiable risk factors for cardiovascular diseases worldwide ( 3 , 4 ). There is an increasing prevalence of hypertension globally with most of the increase being reported in low and middle income countries compared to high income countries ( 4 ). More so, a number of systematic analyses of hypertension in adults and in adolescents conducted in Africa have stipulated a pooled prevalence of about 30.8% in Africa ( 5 ) and 30.0% − 31.1% in Sub-Saharan Africa ( 6 , 7 ). In Uganda, the prevalence of hypertension reported from a national survey was found to be 26.4% ( 8 ). In 2016, another study reported a higher prevalence of 31.5% in adults, which noted that the highest number of hypertensive participants were in the Central region (34.3%), followed by Western (32.5%), Eastern (32.3%), Northern (22.0%) and lastly West Nile (24.1%), and it was also found that hypertension was prevalent in males than females ( 9 ). Despite the known benefits of physical activity, physical inactivity especially among individuals with hypertension is still high across the globe ranging from 23% in adults to 81% in adolescents ( 10 ). It is important to note that the prevalence of physical inactivity varies across various regions and countries and may be high as 80% among some adult populations( 11 ).The major facilitator to physical activity adherence has been reported to be autonomous motivation ( 12 ). Additionally,( 13 ) found that autonomous regulation was the main predictor of exercise intensity, frequency and time among males and females. According to ( 14 ) reported that social support and self-efficacy were the main facilitators to physical activity .The major barriers that have been reported include inadequate information about physical activity, fear of physical activity, health illiteracy and fear of changing lifestyle ( 15 ). Another study done among the underserved African Americans indicated that financial issues, fear of injury, lack of motivation were the main barriers to physical activity ( 16 ). Relatedly, there is inadequate information on the facilitators and barriers to physical activity among patients with hypertension within the Ugandan context. Therefore, this study aimed to determine the facilitators and barriers to physical activity among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda. Methods Study design and setting A descriptive, cross-sectional study was conducted among patients with hypertension in Mbarara City, Southwestern Uganda from March,2022 to March,2023. The study was carried out at selected hypertension clinics that included, DMA Diagnostics and Laboratory Limited and Mbarara Medical Specialist Clinic. These facilities provide specialized care and routine follow-up for patients with hypertension within the urban and peri-urban catchment areas of Mbarara. Study Population and Sampling The study population consisted of adult patients (aged 18 years and above) with a confirmed diagnosis of hypertension attending the selected clinics during the study period. Participants were recruited using consecutive sampling or proportionate sampling to ensure representative coverage across the two clinics. Patients with severe physical disabilities, cognitive impairments or acute illnesses that prevented physical activity were excluded from participating in the study. Sample size determination The sample size for this study was 232 patients with hypertension and was determined using the Kish Leslie formula for determining sample sizes for cross sectional studies( 17 ) as follows; N = p(1-p) Z2 /d2 Were; N = Number of respondents needed, p = Estimated proportion of patients with hypertension who are physically active = 0.836 ( 18 ) Z = 1.96 (the Z score corresponding to 95% confidence interval), d = Maximum error the researcher is willing to allow = 0.05 Therefore, from the formula, N = 0.836(1-0.836) (1.96)2 / (0.05)2 N = 211 Study participants The sample size was adjusted by 10% to cater for non-response bias (10%*211) = 21.1 Therefore, the sample size was 211 + 21=232 study participants. Data management Data collection instruments Data was collected using an interviewer administered questionnaire that was translated into the local language(Runyankore). The questionnaire was adopted from the socio-demographic profile, International Physical Activity Questionnaire(IPAQ), Barriers to Being Active Quiz(BBAQ) and Motivation for Physical Activity Questionnaire(RM4-FM). The socio-demographic profile included the socio-demographic characteristics of our study participants that were, age, gender, place of residence, monthly income, occupation, marital status, level of education), duration of hypertension, awareness of physical activity, source of information about physical activity. The International Physical Activity Questionnaire long form (IPAQ)( 19 ) is a questionnaire that assesses the types of intensity of physical activity that people do as part of their daily lives in four different domains; job related physical activity, transportation physical activity, housework and house maintenance physical activity, recreation, sport and leisure time physical activity as well as time spent sitting. The assessment of these measures is considered to estimate the total physical activity and sedentary behavior (construct of average sitting time). The Motivation for Physical Activity Questionnaire ( 20 ) is a questionnaire concerning the reasons why a person engages in physical activity. It is a 7-point Likert scale with 16 items subdivided into four factors: External regulation (4 items), Introjected regulation (4 times), Identified regulation (4 times), and Intrinsic motivation (4 times). It is structured so that it asks one question and provides responses that represent the degree to which one feels autonomous with respect to exercising or engaging in physical activity. This questionnaire was used to assess the motivators to physical activity among patients with hypertension. Barriers to Being Active Quiz ( 21 ) is a 4-point Likert scale with 21 items subdivided into lack of time (3 items), social influence (3 items), fear of injury (3 items), lack of energy (3 items), lack of willpower (3 items), lack of skill (3 items) and lack of resources (3 items) that was used to assess barriers to physical activity among patients with hypertension. This questionnaire was used to investigate the barriers to physical activity. Data entry and cleaning A data entry screen was created in Microsoft Excel. Single data entry and validation was conducted while cross-checking with the source questionnaire to minimize data entry errors. After entry, data was backed up on an external hard drive. The data set created with excel was then exported to STATA version 13. The data in STATA was cleaned by correcting errors and out of range values. Data was cleaned thoroughly using the physical activity data analysis guidelines ( 22 ). Out of the 232 participants that were recruited,141 were included in the final analysis. The remaining 91 were excluded based on the International Physical Activity Questionnaire(IPAQ) data cleaning guidelines because they reported a total time of over 16 hours of physical activity per day which was an outlier. This was done to ensure the integrity of the metabolic equivalents(METs) calculations. Data analysis Data were analyzed using STATA software version 13. Physical activity was computed in metabolic equivalents (METs) in accordance to the IPAQ Physical activity guidelines for data analysis 2005( 23 ). Individuals were categorized as physically active if they were found to be involved in activities that accumulated ≥ 600 METs over a period of 5 days or more per week. Descriptive statistics were used to summarize the socio-demographic characteristics of age, gender, place of residence, monthly income, occupation, marital status, level of education, duration of hypertension, awareness of physical activity (heard of physical activity),source of information (from whom),motivators and barriers to physical activity among patients with hypertension. Cross-tabulations were used to determine the relationship between the barriers and facilitators and the level of physical activity among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda. Given that the total study sample size was small, Fischer’s exact test was used to test for association between physical activity, facilitators and barriers to physical activity among patients with hypertension at a 95% confidence interval. Results Demographic characteristics of the study participants Overall, 141 participants participated in the study. Median age of the participants was 58 years (IQR = 14). Table 1 shows that females accounted for 67.4% (95/141) of the participants while males accounted for 32.6% (46/141) and the age categories were: less than 35 years 3.6% (5/141), 35–49 years 18.4% (26/141) and 50 years above 78.0% (110/141). The place of residence of the participants was: Mbarara 44.0% (62/141), Greater Bushenyi 15.6% (22/141), Isingiro 13.5% (19/141) and others 27.0% (38/141). The different occupations for the participants were: Farming 27.0% (38/141), business 23.4% (33/141), housewife 10.6% (15/141), retired 9.2% (13/141) and others 29.8% (42/141). The monthly income of the participants was 0-500,000UGX 55.3% (78/141), 500,000-1M UGX 31.9% (45/141), 1M UGX or more 12.8% (18/141) while the marital status of the participants was: Married 73.8% (104/141), single 6.4% (9/141), divorced 5.7% (8/141) and others 14.2% (20/141). The duration of hypertension among the participants was: less than one year 14.2% (20/141), 1–5 years 38.3% (54/141) and more than 6 years 47.5% (67/141). The level of education of participants was; Completed primary 22.0% (31/141), secondary 19.9% (28/141), tertiary 34.0% (48/141) and no formal education 24.1% (34/141). Those who had heard of physical activity were 85.8% (121/141) and those who never heard of physical activity were 14.2% (20/141). Source of information (from whom) included friends and family 17.7% (25/141), health workers 56.0% (79/141), mass media 12.1% (17/141). Motivators to physical activity This study categorized motivation into three groups. First the autonomous motivation category whose indicators included: "I enjoy physical activities”, “it is a challenge to accomplish my goal”, “it's fun”, “it is interesting to see my own improvement”, “feeling healthier is an important value for me”, “I feel it’s the best way to help myself”, “I believe physical activity helps me feel better”. Second the controlled motivation category whose included “others make me do it”, “I want others to acknowledge that I am doing what I have been told I should do”, “I feel guilty if I do not exercise regularly”, “people would think I’m a weak person if I did not”. The third category include a combination of the indicators in the first two motivation categories. Out of the 141 participants, 89.4% (126/141) participants were categorized with autonomous motivation, 7.1% (10/141) with controlled motivation and 3.5% (5/141) with both autonomous and controlled motivation. Table 2 presents a cross-tabulation between motivation and extent of physical activity. Of the 77/141 participants who had low levels of physical activity, 6.5% (5/77) had controlled motivation, 6.5% (5/77) had both autonomous and controlled motivation while 87.0% (67/77) had autonomous motivation for physical activity. Out of the 57/141 participants who had moderate levels of physical activity, 7.0% (4/57) had controlled motivation, 92.9% (53/57) were autonomously motivated and no participants was motivated by both autonomous and controlled motivation. Lastly, among the 7/141 participants who had high levels of physical activity, 14.3% (1/7) had controlled motivation, 85.7% (6/7) were autonomously motivated and no participant was motivated by both controlled and autonomous motivation. There was no significant association between physical activity and the categories of motivation (p-value > 0.05) using the Fischer’s exact test. Table 2 Motivators and physical activity Frequencies % Physical activity score Physical activity score p-value Motivation categories Low Moderate High Total Low Moderate High Autonomous motivation 67 53 6 126 87.0 93.0 85.7 0.436 Controlled motivation 5 4 1 10 6.5 7.0 14.3 0.600 Both autonomous and controlled motivation 5 0 0 5 6.5 0.0 0.0 0.140 Total All 77 57 7 141 54.6 40.4 5.0 Notes: The percentages are column percentages The p-values are reported from the Fischer’s exact Barriers to physical activity. The barriers that deterred participants from being physically active were lack of willpower 45.39% (64/141), social influence 38.30% (54/141), lack of skill 31.21% (44/141) lack of time 27.66% (39/141), fear of injury 25.33% (36/141), lack of energy 20.57% (29/141) and lack of resources 19.86% (28/141). Table 3 presents the barriers by extent of physical activity. Of the 39/141 participants that are affected by a lack of time, 51.3% (20/39) have low physical activity levels, 41.0% (16/39) have moderate physical activity levels and 7.7% (3/39) have high physical activity levels. No significant association was found between lack of time and physical activity with the Fischer’s exact test(p-value = 0.868 > 0.05). Of the 54/141 participants that are affected by social influence, 57.4% (31/54) have low physical activity levels, 38.9% (21/54) have moderate physical activity levels and 3.7% (2/54) have high physical activity levels. Using the Fischer’s exact test, social influence was significantly associated with physical activity (p-value = 0.026 < 0.05). Of the 29/141 participants that are affected by lack of energy, 37.9% (11/29) have low physical activity levels, 48.3% (14/29) have moderate physical activity levels, 13.8% (4/29) have high physical activity levels. There was no significant association between lack of energy and physical activity(p-value = 0.242 > 0.05) with the Fischer’s exact test. Of the 64/141 participants that are affected by lack of willpower, 53.1% (34/64) have low physical activity levels, 45.3% (29/64) have moderate physical activity levels and 1.6% (1/64) have high physical activity levels. Using the Fischer’s exact test, there was no significant association between lack of will power and physical activity(p-value = 0.363 > 0.05). Of the 36/141 participants that are affected by a fear of injury, 55.6% (20/36) have low physical levels, 41.7% (15/36) have moderate physical activity levels and 2.8% (1/36) have high physical activity levels. No significant association was found between fear of injury and physical activity(p-value = 0.452 > 0.05) with the Fischer’s exact test. Of the 44/141 participants that are affected by lack of skill, 63.6% (28/44) have low physical activity levels, 34.1% (15/44) have moderate physical activity levels and 2.3% (1/44) have high physical activity levels. Using the Fischer’s exact test, there was no significant association between lack of skill and physical activity(p-value = 0.721 > 0.05). Of the 28/141 participants that are affected by a lack of resources, 35.7% (10/28) have low physical activity levels, 57.1% (16/28) have moderate physical activity levels and 7.1% (2/28) have high physical activity levels. There was no significant association between lack of resources and physical activity(p-value = 0.205 > 0.05) with the Fischer’s exact test. Table 3 Barriers and physical activity Frequencies % Physical activity score Physical activity score p-value Barriers Low Moderate High Total Low Moderate High Total Lack of time 20 16 3 39 51.3 41.0 7.7 100 0.868 Social influence 31 21 2 54 57.4 38.9 3.7 100 0.026 Lack of energy 11 14 4 29 37.9 48.3 13.8 100 0.242 Lack of willpower 34 29 1 64 53.1 45.3 1.6 100 0.363 Fear of injury 20 15 1 36 55.6 41.7 2.8 100 0.452 Lack of skill 28 15 1 44 63.6 34.1 2.3 100 0.721 Lack of resources 10 16 2 28 35.7 57.1 7.1 100 0.205 Total All 77 57 7 141 54.6 40.4 5.0 100.0 Notes: The percentages are row percentages The p-values are reported from the Fischer’s exact Discussion No significant association was found between physical activity and the categories of motivation (autonomous motivation, controlled motivation, both autonomous and controlled motivation) (p-value > 0.05), but majority of the participants who are physically active in our study reported to be autonomously motivated. This means that participants were engaging in physical activity either because they enjoyed it, physical activity helped them feel better, being healthy was important to them or physical activity was a challenge to accomplish a goal. Studies from ( 24 ) and ( 25 ) also revealed a need to be healthy as a common facilitator for physical activity among patients with hypertension.( 18 ) further noted that apart from the need to be healthy, the need to lose weight, was also a common facilitator for physical activity among these individuals.Another study reported that individuals who were autonomously motivated were more likely to make strategic efforts towards engaging in physical activity for example preparing and scheduling time for physical activity ( 26 ). On the other hand, controlled motivation has also facilitated physical activity among individuals meaning that individuals engage in physical activity, because others make them do it, fear of others getting angry at them if they don't, need of acknowledgment from others that they are doing what they have been told to do, fear of shame or guilt. A study by ( 27 ) reported fear of guilt as a strong significant predictor of exercise among females. ( 28 ) further revealed that appearance and stress management were also great motivators for physical activity. However, controlled motivation may be a less stable form of motivation hence may not be effective in ensuring long-term adherence to physical activity ( 29 ). Controlled motivation therefore may be used to initiate physical activity with later progression into use of. autonomous motivation to maintain physical activity ( 28 ). Most reported barriers to physical activity in the present study are lack of skill, lack of willpower and social influence. ( 30 ) also reported lack of willpower and social support as common barriers to physical activity among patient with hypertension. ( 31 ) and ( 32 ) also found lack of skill as a common barrier to physical activity. The exercise component of physical activity does require some skill to perform it. Lack of knowledge about adequate physical activity for a particular age group may limit people’s ability to perform the activity and perceive it to be lacking in skill. Perception of lack of skill may compromise one’s willpower, and the lack of social influence may be excused with lack of skill, hence a combination of these three factors can be a vicious cycle leading to limited participation in physical activity. In addition, there was a statistically significant association between social influence and physical activity (p-value = 0.026 < 0.05) using the Fischer’s exact test in our study. Social influence has been mentioned to affect physical activity in a number of ways for example through negative feedback from close people or even close people being physically inactive that is, if one observes that people close to them are physically inactive, they may more likely be inactive ( 33 ). Individuals may also engage in the same behaviors as others such as physical activity because these behaviors provide opportunity for them to spend time together or may even build conversation topics ( 34 ). This would mean that if one is close with people that don't enjoy physical activities, in order to spend more time with them, one may look at other activities that these people would rather enjoy, hence this individual may likely be inactive. The lack of adequate knowledge about physical activity in hypertension management can therein affect the value one attaches to physical activity therefore an individual may less likely be active. Social influence was among the most reported barriers to physical activity among these patients. On the other hand, ( 35 ) found “lack of motivation” and “lack of knowledge of the benefits of exercise” as common barriers to physical activity among patients with hypertension. Another study by ( 36 ) in Kuwait, revealed “time constraints”, “lack of desire” and “not being convinced of the benefits” as main barriers to physical activity among these patients. Limitations This study used subjective study tools in which self-reported information was recorded to establish the extent of physical activity in the study population and therefore the results were subject to recall bias. The study tools only asked about information about the participants’ physical activity in the past seven days; therefore, the results may not be generalized. The study tool that was adopted has been verified to measure physical activity of individuals aged 18–69 years only, leaving out the rest of the population. This means that our results cannot be used to inform possible interventions and recommendations for improving physical activity among patients younger than 18 years and older than 69 years of age. Conclusion Less than a half of the participants (45.4%) were physically active, 92.2% of the physically active participants reported to be autonomously motivated for physical activity. Lack of skill, social influence and lack of willpower were the most reported barriers to physical activity. Approximately half of the physically inactive participants were also sedentary. Therefore, there is an urgent need to integrate and consider the four strategic policy areas for action recommended by World Health Organization ( 1 ) which include active societies, active environments, active people and active systems. This can be through educating the public on the benefits of physical activity and making more physical activity options available that engage people with varying age groups, income status, location and occupations. Declarations Ethics approval The study was conducted according to the declaration of Helsinki. Ethical approval was obtained from the Mbarara University of Science and Technology, Department of Physiotherapy, Research Ethics committee on 21 st March,2022 and site clearance was obtained from the respective administrators of the two hypertension clinics. Consent to participate Informed written consent was obtained from all participants. Consent to Publish Not applicable. Availability of data Data sets are available upon reasonable request from the corresponding author. Supporting materials SM1 :English and Runyankore version of the study questionnaire Competing interests The authors declare no competing interests. Funding The authors did not obtain any specific funding for this study. Author’s contributions. All authors approve submission and contributed as follows: E.M,N.A,A.M.S,R.N,F.J (conceptualization,writing);E.M,N.A,A.M.S,R.N,F.J(datacuration,analysis);E.M(review, editing). Acknowledgements Not applicable. References Kario K, Okura A, Hoshide S, Mogi M. The WHO Global report 2023 on hypertension warning the emerging hypertension burden in globe and its treatment strategy. Hypertens Res. 2024;47(5):1099–102. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67–492. 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Zalewski KR, Dvorak L. Barriers to physical activity between adults with stroke and their care partners. Top Stroke Rehabil. 2011;18(sup1):666–75. Booth ML, Owen N, Bauman A, Clavisi O, Leslie E. Social–cognitive and perceived environment influences associated with physical activity in older Australians. Prev Med. 2000;31(1):15–22. Darlow SD, Xu X. The influence of close others’ exercise habits and perceived social support on exercise. Psychol Sport Exerc. 2011;12(5):575–8. Umuvandimwe B. Factors associated with participation in physical activity among adults with hypertension in Kigali, Rwanda. 2011. Al Sairafi M, Alshamali K, Al-rashed A. Effect of physical activity on controlling blood pressure among hypertensive patients from Mishref area of Kuwait. Eur J Gen Med. 2010;7(4):377–84. Table 1 Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8960791","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":596512115,"identity":"fd78b7a7-7bb4-44e6-a448-ba443877e715","order_by":0,"name":"Edward Muteesasira","email":"data:image/png;base64,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","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Edward","middleName":"","lastName":"Muteesasira","suffix":""},{"id":596512116,"identity":"d8522d7e-ab7c-428c-9e03-0c49f77cc671","order_by":1,"name":"Night Atwongyeire","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Night","middleName":"","lastName":"Atwongyeire","suffix":""},{"id":596512117,"identity":"e517955f-94bd-4e3b-a1d5-7ef3debe661a","order_by":2,"name":"Anna Maria Ssewanyana","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"Maria","lastName":"Ssewanyana","suffix":""},{"id":596512118,"identity":"8b27d299-6f26-41a9-b790-85a035d0339e","order_by":3,"name":"Racheal Namukwaya","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Racheal","middleName":"","lastName":"Namukwaya","suffix":""},{"id":596512119,"identity":"7081fd9d-4708-498a-b00d-5beea84bbdcd","order_by":4,"name":"Fred Jjunju","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Fred","middleName":"","lastName":"Jjunju","suffix":""}],"badges":[],"createdAt":"2026-02-24 20:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8960791/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8960791/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103812186,"identity":"22509d7e-1be1-41fb-ba28-e043071bbeef","added_by":"auto","created_at":"2026-03-03 08:28:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":858012,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8960791/v1/a3f95af6-ee0f-4592-b1c5-003e803041bb.pdf"},{"id":103393225,"identity":"f0e5b90c-eec5-41df-9c3e-339ab9587aaf","added_by":"auto","created_at":"2026-02-25 08:20:39","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18804,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8960791/v1/cbd7e73d597152ea1c50bc53.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Facilitators and barriers to physical activity among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda: A cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHypertension has been identified to affect about 33% of the adult population(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) and is one of the major causes of premature mortality globally and is on top of the list for modifiable risk factors for cardiovascular diseases worldwide (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). There is an increasing prevalence of hypertension globally with most of the increase being reported in low and middle income countries compared to high income countries (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMore so, a number of systematic analyses of hypertension in adults and in adolescents conducted in Africa have stipulated a pooled prevalence of about 30.8% in Africa (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and 30.0% \u0026minus;\u0026thinsp;31.1% in Sub-Saharan Africa (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In Uganda, the prevalence of hypertension reported from a national survey was found to be 26.4% (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In 2016, another study reported a higher prevalence of 31.5% in adults, which noted that the highest number of hypertensive participants were in the Central region (34.3%), followed by Western (32.5%), Eastern (32.3%), Northern (22.0%) and lastly West Nile (24.1%), and it was also found that hypertension was prevalent in males than females (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the known benefits of physical activity, physical inactivity especially among individuals with hypertension is still high across the globe ranging from 23% in adults to 81% in adolescents (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). It is important to note that the prevalence of physical inactivity varies across various regions and countries and may be high as 80% among some adult populations(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).The major facilitator to physical activity adherence has been reported to be autonomous motivation (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Additionally,(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) found that autonomous regulation was the main predictor of exercise intensity, frequency and time among males and females. According to (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) reported that social support and self-efficacy were the main facilitators to physical activity .The major barriers that have been reported include inadequate information about physical activity, fear of physical activity, health illiteracy and fear of changing lifestyle (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Another study done among the underserved African Americans indicated that financial issues, fear of injury, lack of motivation were the main barriers to physical activity (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRelatedly, there is inadequate information on the facilitators and barriers to physical activity among patients with hypertension within the Ugandan context. Therefore, this study aimed to determine the facilitators and barriers to physical activity among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eA descriptive, cross-sectional study was conducted among patients with hypertension in Mbarara City, Southwestern Uganda from March,2022 to March,2023. The study was carried out at selected hypertension clinics that included, DMA Diagnostics and Laboratory Limited and Mbarara Medical Specialist Clinic. These facilities provide specialized care and routine follow-up for patients with hypertension within the urban and peri-urban catchment areas of Mbarara.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population and Sampling\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of adult patients (aged 18 years and above) with a confirmed diagnosis of hypertension attending the selected clinics during the study period. Participants were recruited using consecutive sampling or proportionate sampling to ensure representative coverage across the two clinics. Patients with severe physical disabilities, cognitive impairments or acute illnesses that prevented physical activity were excluded from participating in the study.\u003c/p\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eThe sample size for this study was 232 patients with hypertension and was determined using the Kish Leslie formula for determining sample sizes for cross sectional studies(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) as follows;\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;p(1-p) Z2 /d2\u003c/p\u003e \u003cp\u003eWere;\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;Number of respondents needed,\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;Estimated proportion of patients with hypertension who are physically active\u0026thinsp;=\u0026thinsp;0.836 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1.96 (the Z score corresponding to 95% confidence interval),\u003c/p\u003e \u003cp\u003ed\u0026thinsp;=\u0026thinsp;Maximum error the researcher is willing to allow\u0026thinsp;=\u0026thinsp;0.05\u003c/p\u003e \u003cp\u003eTherefore, from the formula,\u003c/p\u003e\n\u003ch3\u003eN = 0.836(1-0.836) (1.96)2 / (0.05)2\u003c/h3\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;211 Study participants\u003c/p\u003e \u003cp\u003eThe sample size was adjusted by 10% to cater for non-response bias\u003c/p\u003e\n\u003ch3\u003e(10%*211) = 21.1\u003c/h3\u003e\n\u003cp\u003eTherefore, the sample size was 211\u0026thinsp;+\u0026thinsp;21=232 study participants.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData management\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eData collection instruments\u003c/h2\u003e \u003cp\u003eData was collected using an interviewer administered questionnaire that was translated into the local language(Runyankore). The questionnaire was adopted from the socio-demographic profile, International Physical Activity Questionnaire(IPAQ), Barriers to Being Active Quiz(BBAQ) and Motivation for Physical Activity Questionnaire(RM4-FM).\u003c/p\u003e \u003cp\u003eThe socio-demographic profile included the socio-demographic characteristics of our study participants that were, age, gender, place of residence, monthly income, occupation, marital status, level of education), duration of hypertension, awareness of physical activity, source of information about physical activity.\u003c/p\u003e \u003cp\u003eThe International Physical Activity Questionnaire long form (IPAQ)(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) is a questionnaire that assesses the types of intensity of physical activity that people do as part of their daily lives in four different domains; job related physical activity, transportation physical activity, housework and house maintenance physical activity, recreation, sport and leisure time physical activity as well as time spent sitting. The assessment of these measures is considered to estimate the total physical activity and sedentary behavior (construct of average sitting time).\u003c/p\u003e \u003cp\u003eThe Motivation for Physical Activity Questionnaire (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) is a questionnaire concerning the reasons why a person engages in physical activity. It is a 7-point Likert scale with 16 items subdivided into four factors: External regulation (4 items), Introjected regulation (4 times), Identified regulation (4 times), and Intrinsic motivation (4 times). It is structured so that it asks one question and provides responses that represent the degree to which one feels autonomous with respect to exercising or engaging in physical activity. This questionnaire was used to assess the motivators to physical activity among patients with hypertension.\u003c/p\u003e \u003cp\u003eBarriers to Being Active Quiz (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) is a 4-point Likert scale with 21 items subdivided into lack of time (3 items), social influence (3 items), fear of injury (3 items), lack of energy (3 items), lack of willpower (3 items), lack of skill (3 items) and lack of resources (3 items) that was used to assess barriers to physical activity among patients with hypertension. This questionnaire was used to investigate the barriers to physical activity.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eData entry and cleaning\u003c/h3\u003e\n\u003cp\u003eA data entry screen was created in Microsoft Excel. Single data entry and validation was conducted while cross-checking with the source questionnaire to minimize data entry errors. After entry, data was backed up on an external hard drive. The data set created with excel was then exported to STATA version 13. The data in STATA was cleaned by correcting errors and out of range values. Data was cleaned thoroughly using the physical activity data analysis guidelines (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Out of the 232 participants that were recruited,141 were included in the final analysis. The remaining 91 were excluded based on the International Physical Activity Questionnaire(IPAQ) data cleaning guidelines because they reported a total time of over 16 hours of physical activity per day which was an outlier. This was done to ensure the integrity of the metabolic equivalents(METs) calculations.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using STATA software version 13. Physical activity was computed in metabolic equivalents (METs) in accordance to the IPAQ Physical activity guidelines for data analysis 2005(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Individuals were categorized as physically active if they were found to be involved in activities that accumulated\u0026thinsp;\u0026ge;\u0026thinsp;600 METs over a period of 5 days or more per week.\u003c/p\u003e \u003cp\u003eDescriptive statistics were used to summarize the socio-demographic characteristics of age, gender, place of residence, monthly income, occupation, marital status, level of education, duration of hypertension, awareness of physical activity (heard of physical activity),source of information (from whom),motivators and barriers to physical activity among patients with hypertension. Cross-tabulations were used to determine the relationship between the barriers and facilitators and the level of physical activity among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda.\u003c/p\u003e \u003cp\u003eGiven that the total study sample size was small, Fischer\u0026rsquo;s exact test was used to test for association between physical activity, facilitators and barriers to physical activity among patients with hypertension at a 95% confidence interval.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003eDemographic characteristics of the study participants\u003c/h2\u003e\n \u003cp\u003eOverall, 141 participants participated in the study. Median age of the participants was 58 years (IQR = 14). Table 1 shows that females accounted for 67.4% (95/141) of the participants while males accounted for 32.6% (46/141) and the age categories were: less than 35 years 3.6% (5/141), 35–49 years 18.4% (26/141) and 50 years above 78.0% (110/141). The place of residence of the participants was: Mbarara 44.0% (62/141), Greater Bushenyi 15.6% (22/141), Isingiro 13.5% (19/141) and others 27.0% (38/141). The different occupations for the participants were: Farming 27.0% (38/141), business 23.4% (33/141), housewife 10.6% (15/141), retired 9.2% (13/141) and others 29.8% (42/141). The monthly income of the participants was 0-500,000UGX 55.3% (78/141), 500,000-1M UGX 31.9% (45/141), 1M UGX or more 12.8% (18/141) while the marital status of the participants was: Married 73.8% (104/141), single 6.4% (9/141), divorced 5.7% (8/141) and others 14.2% (20/141). The duration of hypertension among the participants was: less than one year 14.2% (20/141), 1–5 years 38.3% (54/141) and more than 6 years 47.5% (67/141). The level of education of participants was; Completed primary 22.0% (31/141), secondary 19.9% (28/141), tertiary 34.0% (48/141) and no formal education 24.1% (34/141). Those who had heard of physical activity were 85.8% (121/141) and those who never heard of physical activity were 14.2% (20/141). Source of information (from whom) included friends and family 17.7% (25/141), health workers 56.0% (79/141), mass media 12.1% (17/141).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\"\u003e\n \u003ch2\u003eMotivators to physical activity\u003c/h2\u003e\n \u003cp\u003eThis study categorized motivation into three groups. First the autonomous motivation category whose indicators included: \"I enjoy physical activities”, “it is a challenge to accomplish my goal”, “it's fun”, “it is interesting to see my own improvement”, “feeling healthier is an important value for me”, “I feel it’s the best way to help myself”, “I believe physical activity helps me feel better”. Second the controlled motivation category whose included “others make me do it”, “I want others to acknowledge that I am doing what I have been told I should do”, “I feel guilty if I do not exercise regularly”, “people would think I’m a weak person if I did not”. The third category include a combination of the indicators in the first two motivation categories. Out of the 141 participants, 89.4% (126/141) participants were categorized with autonomous motivation, 7.1% (10/141) with controlled motivation and 3.5% (5/141) with both autonomous and controlled motivation.\u003c/p\u003e\n \u003cp\u003eTable\u0026nbsp;2 presents a cross-tabulation between motivation and extent of physical activity. Of the 77/141 participants who had low levels of physical activity, 6.5% (5/77) had controlled motivation, 6.5% (5/77) had both autonomous and controlled motivation while 87.0% (67/77) had autonomous motivation for physical activity. Out of the 57/141 participants who had moderate levels of physical activity, 7.0% (4/57) had controlled motivation, 92.9% (53/57) were autonomously motivated and no participants was motivated by both autonomous and controlled motivation. Lastly, among the 7/141 participants who had high levels of physical activity, 14.3% (1/7) had controlled motivation, 85.7% (6/7) were autonomously motivated and no participant was motivated by both controlled and autonomous motivation. There was no significant association between physical activity and the categories of motivation (p-value \u0026gt; 0.05) using the Fischer’s exact test.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eMotivators and physical activity\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eFrequencies\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003ePhysical activity score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003ePhysical activity score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMotivation categories\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAutonomous motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.436\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControlled motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.600\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBoth autonomous and controlled motivation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNotes: The percentages are column percentages\u003c/p\u003e\n \u003cp\u003eThe p-values are reported from the Fischer’s exact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eBarriers to physical activity.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe barriers that deterred participants from being physically active were lack of willpower 45.39% (64/141), social influence 38.30% (54/141), lack of skill 31.21% (44/141) lack of time 27.66% (39/141), fear of injury 25.33% (36/141), lack of energy 20.57% (29/141) and lack of resources 19.86% (28/141).\u003c/p\u003e\n \u003cp\u003eTable\u0026nbsp;3 presents the barriers by extent of physical activity. Of the 39/141 participants that are affected by a lack of time, 51.3% (20/39) have low physical activity levels, 41.0% (16/39) have moderate physical activity levels and 7.7% (3/39) have high physical activity levels. No significant association was found between lack of time and physical activity with the Fischer’s exact test(p-value = 0.868 \u0026gt; 0.05).\u003c/p\u003e\n \u003cp\u003eOf the 54/141 participants that are affected by social influence, 57.4% (31/54) have low physical activity levels, 38.9% (21/54) have moderate physical activity levels and 3.7% (2/54) have high physical activity levels. Using the Fischer’s exact test, social influence was significantly associated with physical activity (p-value = 0.026 \u0026lt; 0.05).\u003c/p\u003e\n \u003cp\u003eOf the 29/141 participants that are affected by lack of energy, 37.9% (11/29) have low physical activity levels, 48.3% (14/29) have moderate physical activity levels, 13.8% (4/29) have high physical activity levels. There was no significant association between lack of energy and physical activity(p-value = 0.242 \u0026gt; 0.05) with the Fischer’s exact test.\u003c/p\u003e\n \u003cp\u003eOf the 64/141 participants that are affected by lack of willpower, 53.1% (34/64) have low physical activity levels, 45.3% (29/64) have moderate physical activity levels and 1.6% (1/64) have high physical activity levels. Using the Fischer’s exact test, there was no significant association between lack of will power and physical activity(p-value = 0.363 \u0026gt; 0.05).\u003c/p\u003e\n \u003cp\u003eOf the 36/141 participants that are affected by a fear of injury, 55.6% (20/36) have low physical levels, 41.7% (15/36) have moderate physical activity levels and 2.8% (1/36) have high physical activity levels. No significant association was found between fear of injury and physical activity(p-value = 0.452 \u0026gt; 0.05) with the Fischer’s exact test.\u003c/p\u003e\n \u003cp\u003eOf the 44/141 participants that are affected by lack of skill, 63.6% (28/44) have low physical activity levels, 34.1% (15/44) have moderate physical activity levels and 2.3% (1/44) have high physical activity levels. Using the Fischer’s exact test, there was no significant association between lack of skill and physical activity(p-value = 0.721 \u0026gt; 0.05).\u003c/p\u003e\n \u003cp\u003eOf the 28/141 participants that are affected by a lack of resources, 35.7% (10/28) have low physical activity levels, 57.1% (16/28) have moderate physical activity levels and 7.1% (2/28) have high physical activity levels. There was no significant association between lack of resources and physical activity(p-value = 0.205 \u0026gt; 0.05) with the Fischer’s exact test.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eBarriers and physical activity\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eFrequencies\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003ePhysical activity score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003ePhysical activity score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBarriers\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLack of time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.868\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSocial influence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLack of energy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.242\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLack of willpower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFear of injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLack of skill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.721\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLack of resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.205\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eNotes: The percentages are row percentages\u003c/p\u003e\n \u003cp\u003eThe p-values are reported from the Fischer’s exact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eNo significant association was found between physical activity and the categories of motivation (autonomous motivation, controlled motivation, both autonomous and controlled motivation) (p-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05), but majority of the participants who are physically active in our study reported to be autonomously motivated. This means that participants were engaging in physical activity either because they enjoyed it, physical activity helped them feel better, being healthy was important to them or physical activity was a challenge to accomplish a goal. Studies from (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) and (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) also revealed a need to be healthy as a common facilitator for physical activity among patients with hypertension.(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) further noted that apart from the need to be healthy, the need to lose weight, was also a common facilitator for physical activity among these individuals.Another study reported that individuals who were autonomously motivated were more likely to make strategic efforts towards engaging in physical activity for example preparing and scheduling time for physical activity (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the other hand, controlled motivation has also facilitated physical activity among individuals meaning that individuals engage in physical activity, because others make them do it, fear of others getting angry at them if they don't, need of acknowledgment from others that they are doing what they have been told to do, fear of shame or guilt. A study by (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) reported fear of guilt as a strong significant predictor of exercise among females. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) further revealed that appearance and stress management were also great motivators for physical activity. However, controlled motivation may be a less stable form of motivation hence may not be effective in ensuring long-term adherence to physical activity (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Controlled motivation therefore may be used to initiate physical activity with later progression into use of. autonomous motivation to maintain physical activity (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMost reported barriers to physical activity in the present study are lack of skill, lack of willpower and social influence. (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) also reported lack of willpower and social support as common barriers to physical activity among patient with hypertension. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) and (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) also found lack of skill as a common barrier to physical activity. The exercise component of physical activity does require some skill to perform it. Lack of knowledge about adequate physical activity for a particular age group may limit people\u0026rsquo;s ability to perform the activity and perceive it to be lacking in skill. Perception of lack of skill may compromise one\u0026rsquo;s willpower, and the lack of social influence may be excused with lack of skill, hence a combination of these three factors can be a vicious cycle leading to limited participation in physical activity.\u003c/p\u003e \u003cp\u003eIn addition, there was a statistically significant association between social influence and physical activity (p-value\u0026thinsp;=\u0026thinsp;0.026\u0026thinsp;\u0026lt;\u0026thinsp;0.05) using the Fischer\u0026rsquo;s exact test in our study. Social influence has been mentioned to affect physical activity in a number of ways for example through negative feedback from close people or even close people being physically inactive that is, if one observes that people close to them are physically inactive, they may more likely be inactive (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Individuals may also engage in the same behaviors as others such as physical activity because these behaviors provide opportunity for them to spend time together or may even build conversation topics (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). This would mean that if one is close with people that don't enjoy physical activities, in order to spend more time with them, one may look at other activities that these people would rather enjoy, hence this individual may likely be inactive.\u003c/p\u003e \u003cp\u003eThe lack of adequate knowledge about physical activity in hypertension management can therein affect the value one attaches to physical activity therefore an individual may less likely be active. Social influence was among the most reported barriers to physical activity among these patients. On the other hand, (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e) found \u0026ldquo;lack of motivation\u0026rdquo; and \u0026ldquo;lack of knowledge of the benefits of exercise\u0026rdquo; as common barriers to physical activity among patients with hypertension. Another study by (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) in Kuwait, revealed \u0026ldquo;time constraints\u0026rdquo;, \u0026ldquo;lack of desire\u0026rdquo; and \u0026ldquo;not being convinced of the benefits\u0026rdquo; as main barriers to physical activity among these patients.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study used subjective study tools in which self-reported information was recorded to establish the extent of physical activity in the study population and therefore the results were subject to recall bias.\u003c/p\u003e \u003cp\u003eThe study tools only asked about information about the participants\u0026rsquo; physical activity in the past seven days; therefore, the results may not be generalized.\u003c/p\u003e \u003cp\u003eThe study tool that was adopted has been verified to measure physical activity of individuals aged 18\u0026ndash;69 years only, leaving out the rest of the population. This means that our results cannot be used to inform possible interventions and recommendations for improving physical activity among patients younger than 18 years and older than 69 years of age.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eLess than a half of the participants (45.4%) were physically active, 92.2% of the physically active participants reported to be autonomously motivated for physical activity. Lack of skill, social influence and lack of willpower were the most reported barriers to physical activity. Approximately half of the physically inactive participants were also sedentary. Therefore, there is an urgent need to integrate and consider the four strategic policy areas for action recommended by World Health Organization (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) which include active societies, active environments, active people and active systems. This can be through educating the public on the benefits of physical activity and making more physical activity options available that engage people with varying age groups, income status, location and occupations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted according to the declaration of Helsinki. Ethical approval was obtained from the Mbarara University of Science and Technology, Department of Physiotherapy, Research Ethics committee on 21\u003csup\u003est\u003c/sup\u003e March,2022 and site clearance was obtained from the respective administrators of the two hypertension clinics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed written consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData sets are available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupporting materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSM1\u003c/strong\u003e:English and Runyankore version of the study questionnaire\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not obtain any specific funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors approve submission and contributed as follows: E.M,N.A,A.M.S,R.N,F.J (conceptualization,writing);E.M,N.A,A.M.S,R.N,F.J(datacuration,analysis);E.M(review, editing).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKario K, Okura A, Hoshide S, Mogi M. 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J Clin Hypertens. 2016;18(8):714.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRodgers WM, Hall CR, Duncan LR, Pearson E, Milne MI. Becoming a regular exerciser: Examining change in behavioural regulations among exercise initiates. Psychol Sport Exerc. 2010;11(5):378\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuncan MJ, Eyre EL, Bryant E, Seghers J, Galbraith N, Nevill AM. Autonomous motivation mediates the relation between goals for physical activity and physical activity behavior in adolescents. J Health Psychol. 2017;22(5):595\u0026ndash;604.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIdowu O, Adeniyi A, Atijosan O, Ogwumike O. Physical inactivity is associated with low self efficacy and social support among patients with hypertension in Nigeria. Chronic Illn. 2013;9(2):156\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee G-Y, Kim K-O, Ryu J-H, Park S-H, Chung H-R, Butler M. Exploring Perceived Barriers to Physical Activity in Korean Older Patients with Hypertension: Photovoice Inquiry. Int J Environ Res Public Health. 2022;19(21):14020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRimando M. Perceived barriers to and facilitators of hypertension management among underserved African American older adults. Ethn Dis. 2015;25(3):329.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKish L. Sampling organizations and groups of unequal sizes. American sociological review. 1965:564\u0026thinsp;\u0026ndash;\u0026thinsp;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eApio T. Physical activity and associated factors among hypertensive patients aged 18\u0026ndash;45 years attending care at Kiruddu hospital. A hospital based cross-sectional study: Makerere University; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSebastiao E, Gobbi S, Chodzko-Zajko W, Schwingel A, Papini C, Nakamura P, et al. The International Physical Activity Questionnaire-long form overestimates self-reported physical activity of Brazilian adults. Public Health. 2012;126(11):967\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUimonen M, Repo JP, Gr\u0026ouml;nroos K, H\u0026auml;kkinen A, Walker S. Validity and reliability of the motivation for physical activity (RM4-FM) questionnaire. J Exerc rehabilitation. 2021;17(2):103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlanco-Mart\u0026iacute;nez N, Montes-Montes R, Ay\u0026aacute;n-P\u0026eacute;rez C, Berlier-Cea AB, Delgado-Lobete L. Assessment of Barriers to Physical Activity Practice: Spanish Cross-Cultural Adaptation, Reliability and Validity of the Barriers to Being Active Quiz. Evaluation \u0026amp; the Health Professions. 2025:01632787251399197.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePastuszak A, Lisowski K, Lewandowska J, Busko K. Level of physical activity of physical education students according to criteria of the IPAQ questionnaire and the recommendation of WHO experts. Biomedical Hum Kinetics. 2014;6(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHagstr\u0026ouml;mer M, Oja P, Sj\u0026ouml;str\u0026ouml;m M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr. 2006;9(6):755\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUmuvandimwe B. Factors Associated with Participation in Physical Activity Among Adults with. University of the Western Cape; 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMbambo S, Tlou B, Dlungwane T. Factors associated with physical activity amongst patients with hypertension in two community health centres in uMgungundlovu health district, KwaZulu-Natal, 2018. South Afr Family Pract. 2019;61(6):234\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHagger MS, Chatzisarantis NL. The trans-contextual model of autonomous motivation in education: Conceptual and empirical issues and meta-analysis. Rev Educ Res. 2016;86(2):360\u0026ndash;407.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuncan LR, Hall CR, Wilson PM, Jenny O. Exercise motivation: a cross-sectional analysis examining its relationships with frequency, intensity, and duration of exercise. Int J Behav Nutr Phys Activity. 2010;7(1):7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEgli T, Bland HW, Melton BF, Czech DR. Influence of age, sex, and race on college students\u0026rsquo; exercise motivation of physical activity. J Am Coll Health. 2011;59(5):399\u0026ndash;406.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorseuil M, Schneider I, d'Orsi E. 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Top Stroke Rehabil. 2011;18(sup1):666\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBooth ML, Owen N, Bauman A, Clavisi O, Leslie E. Social\u0026ndash;cognitive and perceived environment influences associated with physical activity in older Australians. Prev Med. 2000;31(1):15\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDarlow SD, Xu X. The influence of close others\u0026rsquo; exercise habits and perceived social support on exercise. Psychol Sport Exerc. 2011;12(5):575\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUmuvandimwe B. Factors associated with participation in physical activity among adults with hypertension in Kigali, Rwanda. 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Sairafi M, Alshamali K, Al-rashed A. Effect of physical activity on controlling blood pressure among hypertensive patients from Mishref area of Kuwait. Eur J Gen Med. 2010;7(4):377\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hypertension, Physical Activity, Facilitators, Barriers, Mbarara City, Southwestern Uganda, Cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-8960791/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8960791/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePhysical activity is a proven non-pharmacological intervention in the management of hypertension significantly reducing the risk of cardiovascular complications. Despite its benefits, adherence to physical activity remains low among patients with hypertension in sub-Saharan Africa. This study aimed to determine the facilitators and barriers to physical activity among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis was a facility-based cross-sectional study conducted among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda. Data was collected using an interviewer administered questionnaire assessing socio-demographic characteristics, physical activity levels(The International Physical Activity Questionnaire), facilitators(The Motivation for Physical Activity Questionnaire) and barriers(Barriers to Being Active Quiz) to physical activity among patients with hypertension. Descriptive statistics were used to summarize the socio-demographic characteristics of age, gender, place of residence, monthly income, occupation, marital status, level of education, duration of hypertension, awareness of physical activity (heard of physical activity),source of information, motivators and barriers to physical activity among patients with hypertension. Fischer\u0026rsquo;s exact test was used to test for association between physical activity, facilitators and barriers to physical activity among patients with hypertension at a 95% confidence interval.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003e141 participants participated in the study. Median age of the participants was 58 years (IQR\u0026thinsp;=\u0026thinsp;14).Females accounted for 67.4% (95/141) of the participants while males accounted for 32.6% (46/141). Less than a half of the participants (45.4%) were physically active, 92.2% of the physically active participants reported to be autonomously motivated to engage in physical activity. Lack of skill, social influence and lack of willpower were the most reported barriers to physical activity. Using the Fischer\u0026rsquo;s exact test, social influence was significantly associated with physical activity (p-value\u0026thinsp;=\u0026thinsp;0.026\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no significant association between physical activity and the categories of motivation (p-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eApproximately half of the physically inactive participants were also sedentary. This is a double disaster especially for adults with hypertension. Therefore, there is an urgent need to integrate and consider the four strategic policy areas for action recommended by World Health Organization (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) which include active societies, active environments, active people and active systems.\u003c/p\u003e","manuscriptTitle":"Facilitators and barriers to physical activity among patients with hypertension attending selected hypertension clinics in Mbarara City, Southwestern Uganda: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-25 08:20:33","doi":"10.21203/rs.3.rs-8960791/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ab109e1a-aeed-4a51-bf2c-950e17dff693","owner":[],"postedDate":"February 25th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-03T08:28:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-25 08:20:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8960791","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8960791","identity":"rs-8960791","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}