THE SOCIAL AND PHYSICAL WORK ENVIRONMENT OF THE TRADITIONAL
AND NON-TRADITIONAL FEMALE CERTIFIED ATHLETIC TRAINER AS A
MOTIVATOR OF EXERCISE PARTICIPATION
Heather M. Farwig
B.S., California State University, Sacramento, 2004
THESIS
Submitted in partial satisfaction of
the requirement for the degree of
MASTER OF SCIENCE
in
KINESIOLOGY
(Movement Studies)
at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
FALL
2009
THE SOCIAL AND PHYSICAL WORK ENVIRONMENT OF THE TRADITIONAL
AND NON-TRADITIONAL FEMALE CERTIFIED ATHLETIC TRAINER AS A
MOTIVATOR OF EXERCISE PARTICIPATION
A Thesis
by
Heather M. Farwig
Approved by:
____________________________________, Committee Chair
Jayne Willett, PhD, ATC
____________________________________, Second Reader
Lois Mattice, MS, ATC
_________________________
Date
ii
Student: Heather Marie Farwig
I certify that this student has met the requirements for format contained in the University
format manual, and that this thesis is suitable for shelving in the Library and credit is to
be awarded for the thesis.
__________________________, Graduate Coordinator
Daryl Parker, PhD
Department of Kinesiology
iii
___________________
Date
Abstract
of
THE SOCIAL AND PHYSICAL WORK ENVIRONMENT OF THE TRADITIONAL
AND NON-TRADITIONAL FEMALE CERTIFIED ATHLETIC TRAINER AS A
MOTIVATOR OF EXERCISE PARTICIPATION
by
Heather M. Farwig
It is important to identify motivators and barriers to exercise to help support
physical activity in order to combat the rising obesity rates and chronic diseases
associated with inactivity. The workplace is one setting with limited research on its
affect on exercise participation. The certified athletic trainer (ATC) works in a unique
professional setting with the potential to support exercise behavior. The profession and
work area were evaluated to determine specific exercise trends, motivations and barriers
that could be applied to other professional settings. The individuals that served as
subjects in this study identified themselves as either working in the traditional (TS), nontraditional (NTS) or traditional/non-traditional (TS/NTS) setting of athletic training.
These three groups were compared to identify any significant differences between them
in regards to specific exercise habits, motivations and barriers.
Plotnikoff (2005) described a social-ecological framework with respect to
numerous factors that affect an individual’s decision to exercise; such as: intrapersonal,
interpersonal, organizational, and the physical environment. A non-validated survey was
iv
created using the social-ecological framework to identify multiple factors related to
exercise participation of the ATC. Data gathered from this survey were used to determine
differences between the TS and NTS ATC. The two groups were compared in regards to
their hours worked per week, days spent exercising, partner exercise, physical and social
work environment motivators, and barriers to exercise. Differences between the two
groups were found in regards to three specific physical work environment motivators and
three specific barriers to exercise. This allowed the researcher to conclude that the two
groups were similar in most aspects of their exercise habits, however, had specific
differences in regards to motivators of the physical work environment and exercise
barriers. The results of the survey allowed the researcher to conclude that social and
physical work environment motivators both affected exercise participation of the TS and
NTS ATC, but that the social work environment played a stronger role in exercise
participation.
_______________________, Committee Chair
Jayne Willett, PhD, ATC
_______________________
Date
v
DEDICATION
I would like to dedicate this thesis to my parents, Lloyd and Marlene Swanson.
They have always believed in me and told me to “reach for the stars”. I am thankful for
their love and support during this process.
vi
ACKNOWLEDGEMENTS
I would like to acknowledge my husband, Rich Farwig, who has always supported
me through the good times and bad. He has listened to me complain, whine, and
whimper, but has always pushed me to keep going. I love you always.
To Lois Mattice, my reader, my friend, my mentor, you motivate me to keep
going and to be a better person and better athletic trainer. I appreciate you helping me
through this process and for always believing in me. Your undying optimism, work ethic,
and care giving remind me every day why I love athletic training and push me to be
better. Thanks for everything!
Jayne Willett, thank you for sticking with me through this process. I know it took
a while, but I finally finished. I really appreciate all that you have done.
vii
TABLE OF CONTENTS
Page
Dedication .......................................................................................................................... vi
Acknowledgements ........................................................................................................... vii
List of Tables .................................................................................................................... xii
List of Figures .................................................................................................................. xiii
Chapter
1. INTRODUCTION ........................................................................................................ 1
Statement of Purpose .............................................................................................. 3
Significance of Research......................................................................................... 4
Definition of Terms................................................................................................. 5
Limitations .............................................................................................................. 7
Delimitations ........................................................................................................... 8
Assumptions............................................................................................................ 8
Hypotheses .............................................................................................................. 9
2. REVIEW OF LITERATURE ..................................................................................... 10
Motivation ............................................................................................................. 10
Intrinsic Motivation .................................................................................. 11
Extrinsic Motivation ................................................................................. 11
Intrinsic vs. Extrinsic Motivation ............................................................. 12
Exercise Attitudes, Knowledge and Beliefs.............................................. 14
Benefits of Exercise .............................................................................................. 15
viii
Perceived Physical Benefits ...................................................................... 15
Perceived Psychological Benefits ............................................................. 16
Barriers to Exercise ............................................................................................... 16
Psychological/Personal Barriers ............................................................... 17
Social Barriers ........................................................................................... 18
Environmental Barriers ............................................................................. 20
Environmental Motivations and Influences .......................................................... 21
Social Environment ................................................................................... 21
Physical Environment ............................................................................... 23
Social-Ecological Model/Framework ....................................................... 25
The Workplace and Exercise ................................................................................ 26
The Athletic Training Profession .............................................................. 28
The Traditional Athletic Trainer. .................................................. 28
The Non-Traditional Athletic Trainer. .......................................... 29
Summary ............................................................................................................... 30
3. METHODOLOGY ..................................................................................................... 32
Subjects ................................................................................................................. 32
Procedures ............................................................................................................. 32
Data Acquisition ................................................................................................... 34
Data Analysis ........................................................................................................ 34
4. RESULTS ................................................................................................................... 36
ix
Demographics ....................................................................................................... 36
Years as a Certified Athletic Trainer and Age .......................................... 37
Hours Worked ........................................................................................... 39
Exercise Habits ..................................................................................................... 40
Days Spent Exercising .............................................................................. 40
Minutes Spent Exercising. ........................................................................ 40
Facilities Available/Use of Work Facilities .............................................. 41
Exercising with a Companion ................................................................... 42
Exercise Motivation .............................................................................................. 43
Social Work Motivators ............................................................................ 43
Physical Work Environment Motivators .................................................. 45
Exercise Barriers ................................................................................................... 48
Summary ............................................................................................................... 52
5. DISCUSSION ............................................................................................................. 55
Social-ecological Framework ............................................................................... 56
Intrinsic and Extrinsic Motivation ............................................................ 56
Social and Physical Work Environment ............................................................... 57
Exercise Barriers ................................................................................................... 58
Survey Results ...................................................................................................... 58
Social Work Environment Rankings ........................................................ 59
Physical Work Environment Rankings ..................................................... 60
Exercise Barriers ................................................................................................... 61
x
Future Research .................................................................................................... 63
Summary ............................................................................................................... 64
Appendix A. Survey: Demographics, Exercise Motivations and Barriers ..................... 67
Appendix B. Guidelines and Packet for NATA Survey Distribution ............................. 73
Appendix C. Student’s Contact Cover Letter for Survey ............................................... 80
References ......................................................................................................................... 82
xi
LIST OF TABLES
1.
Table 1 T-Test Results of Social Work Environment Motivators of the TS and
NTS ATC ................................................................................................................. 45
2.
Table 2 T-Test Results of Physical Work Environment Motivators of the TS
and NTS ATC .......................................................................................................... 46
3.
Table 3 T-Test Results for Barriers to Exercise of the TS and NTS ATC .............. 50
xii
LIST OF FIGURES
1.
Figure 1 Respondents Totals for the TS, NTS, and TS/NTS Groups (N=217) ....... 37
2.
Figure 2 Years as a Certified Athletic Trainer in the TS, NTS, and TS/NTS
(N=217).................................................................................................................... 38
3.
Figure 3 Average Age of TS, NTS, and TS/NTS (N=217) ..................................... 39
4.
Figure 4 Facilities and Equipment Available at Work TS, NTS, and TS/NTS ....... 42
5.
Figure 5 Average Rankings for Social Work Environment Motivators of the
TS, NTS, and TS/NTS ............................................................................................. 44
6.
Figure 6 Average Ranking for the Physical Work Environment Motivators of
the TS, NTS, and TS/NTS ....................................................................................... 48
7.
Figure 7 Average Barrier Rankings for TS, NTS, and TS/NTS Groups ................. 52
xiii
1
Chapter 1
INTRODUCTION
Regularly maintained exercise behavior has been identified as a major factor that
can play a positive role in preventing chronic disease and decreasing obesity, but research
finds that only few individuals are able to successfully maintain lifestyles with consistent
exercise behavior (Tiexeira et al., 2006). Exercise has also been linked to psychological
benefits such as decreases in mild depression and anxiety, better body image satisfaction,
and stress reduction (Jankauskiene, Kardelis, & Pajaujiene, 2005) Although many
benefits result from regular exercise participation, obesity rates continue to increase while
physical activity decreases (Marshall, Bauman, Patch, Wilson, & Chen, 2002). Because
of these facts it is important to understand the barriers and motivations individuals have
in regards to maintaining physically active lives in order to determine factors that support
exercise participation.
Researchers focused on the influence physical and social environments had on an
individual’s exercise participation (Ball, Bauman, Leslie, & Owen, 2001) and termed this
research “the social-ecological framework” (Ball, 2001). This framework focused on how
an individual’s interaction with their physical and social environment altered their
behavior, and was applied specifically to an individual’s exercise behavior. The socialecological framework focused on the physical surroundings that supported activity, such
as bike paths, parks, community pools and recreation centers, which motivated exercise
behavior. This framework also accounted for social interactions and norms, associated
with exercise, which may also be a motivator as individuals attempted to follow what
2
society considered acceptable. The amount of interaction an individual had with their
physical and social environment impacted the effect those environments had on their
exercise behavior. Research of the social-ecological framework had focused primarily on
physical and social environments in the home, neighborhoods and communities (Booth,
Pinkston, & Carlos Poston, 2005); which had provided little information on social and
physical environments in the workplace.
Much of the adult population spent half of their waking hours in the workplace
setting (Plotnikoff, Prodaniuk, Fein, & Milton, 2005). With so much time spent at work,
individuals must be affected by the social and physical work environment that surrounded
them through most of their day. One profession that may be influenced by the social and
physical work environment was that of the certified athletic trainer (ATC). Certified
Athletic Trainers “were health care professionals who specialized in preventing,
recognizing, managing and rehabilitating injuries that may result from physical activity”
(“What is an athletic trainer,” n.d.). Certified athletic trainers worked with a diverse
population including: high school and college athletes, professional athletes, physically
active adults, policemen, the military and pre/post-surgical patients (Arnheim, 2006).
Over the years the ATC profession had evolved to include traditional and nontraditional settings. A traditional ATC (TS) worked in high schools, colleges/universities
and professional athletic settings. The non-traditional ATC (NTS) may be employed in a
hospital, corporation and industry, clinic, law enforcement, or the Military. The variety of
job settings available to the certified athletic trainer has created a unique physical and
social work environment.
3
The surrounding environment of an ATC included exercise equipment and
physical features that supported an active lifestyle. These factors possibly created a
physical and social work environment that influenced an athletic trainer’s involvement in
regular exercise, however, other aspects of the ATC profession created exercise barriers.
For example, long hours, travel requirements, and schedule instability limited exercise
participation, even for highly motivated ATCs. It was important to identify motivational
factors of exercise participation, as well as limitations that may arise in the workplace, to
help create interventions and solutions that promote physical activity in other
professional settings.
Statement of Purpose
The purpose of this study was to determine if the physical and social work
environment of the female ATC influenced their exercise participation, and if this work
environment provided any specific exercise barriers or limitations. This study also
compared the traditional setting and non-traditional setting ATC to see if any differences
between settings encouraged or inhibited exercise participation. Little to no research has
been done on the exercise habits of female certified athletic trainers and the differences
between the TS and NTS. The unique characteristics of this profession place the ATC in
an environment that may potentially influence and inhibit exercise participation. A lack
of research specific to this group made it difficult to conclude if the ATC work
environment affected exercise behavior. The knowledge gained from this study provided
information on how the work environment, both physically and socially, affected an
4
ATCs decision to exercise, and provided specific factors that could be used in other
workplaces to promote adult exercise behavior.
Significance of Research
It was important to find new ways to promote healthier lifestyles in order to
prevent the negative effects associated with weight gain and inactivity. Research
supported the health benefits of regularly maintained exercise behaviors; however, the
“average American adult continued to gain 1-2 pounds a year” and obesity has been
considered an epidemic (Wakefield, 2004). By expanding research into multiple avenues
of life, researchers could use “a broad perspective” (Fleury & Lee, 2006) to alter
numerous factors of an individual’s lifestyle and more effectively support consistent
exercise behaviors.
The ATC has a wide variety of responsibilities that vary throughout different
settings. These responsibilities had the potential to promote or hinder exercise behavior.
Currently, no research was available to determine the exercise habits or motivations of
exercise for the ATC. By studying the social and physical work environments of ATCs
common exercise influences and motivations could be determined. Identifying exercise
motivators in the ATC workplace could help create interventions focused on promoting
regular exercise habits in other professions. Determining exercise barriers of female
ATCs revealed factors that may affect other professionals, and led to plans focused on
preventing specific barriers.
The social-ecological framework considered multiple levels of influence (Fleury
& Lee, 2006) by focusing on aspects of the physical and social environments ability to
5
influence behavior. This framework has been used to determine physical activity patterns
in neighborhoods and communities, but has limited extension into the workplace.
Although, an individual’s community and family life were a predominant aspect of life,
the workplace also effected decisions and attitudes towards exercise and physical activity.
What if an individual’s social and physical work environment could perpetuate a more
active lifestyle that included regular exercise behavior? The significance of this study was
to provide information on the influence the physical and social work environment had on
two types of female certified athletic trainers, TS or NTS, decision to exercise in order to
identify exercise motivators that could be used in the workplace to increase exercise and
adult activity levels.
Definition of Terms
1. Built Environment- “Included urban design factors, land use, and available public
transportation for a region as well as the available activity options for people
within that space” (Booth, 2005)
2. Certified Athletic Trainer (ATC)- Health care professionals specialized in
preventing, recognizing, managing and rehabilitating injuries that resulted from
physical activity (“What is an athletic trainer,” n.d.).
3. Exercise/Exercise Behavior- Organized and purposeful movement with a specific
intensity, frequency and duration. “Regular exercise was defined as engaging in
exercise at least three or more times a week for a minimum of 30 minutes each
session” (Schuler, Broxon-Hutcherson, Philipp, Ryan, Isosaari, & Robinson,
6
2004). “Planned, structured, and repetitive bodily movement done to improve or
maintain one or more components of physical fitness” (Resnick, 2006)
4. Extrinsic Motivation- External forces that altered an individual’s decision to
exercise. An individual’s desire to perform an activity for the external benefits or
outcomes that resulted from their performance.
5. Health Behaviors- Specific activities and behaviors an individual performs in an
attempt to integrate healthy habits into their lifestyle that benefited their overall
physical and psychological well being. Such behaviors included: regular exercise,
proper nutrition, and physical activity.
6. Intrinsic Motivation- An individual’s desire to perform an activity for the pure
satisfaction of that activity (Marcus, Bock, Pinto, Napolitano, & Clark, 2003)
7. Motivation- “A consequence of meaning derived from a combination of personal
and social factors, including personal goals or incentives, expectations of personal
efficacy, movement-related perceptual and affective experiences, and social and
physical features of the environment” (Lewthwaite,1990).
8. Non-Traditional Setting (NTS)- An athletic trainer who was employed in sports
medicine clinics, hospitals, the military, industrial and commercial settings, and
the performing arts.
9. Physical Activity/Activity- Any movement or activity that caused an increase in
heart rate.
10. Physical Work Environment- Facilities and/or equipment that was available and
visible at an individual’s work place.
7
11. Self-Efficacy- “Confidence in one’s ability to overcome barriers to regular
physical activity” (McDevitt, Snyder, Miller, & Wilbur, 2006)
12. Social-Ecological Framework- A multi-level view of how the physical and social
environment influenced exercise behavior (Ball, 2001).
13. Social Norm- Ideas, concepts, beliefs, and common practices within a society that
constituted as the norm for that said society. Specific trends that were acceptable
and considered normal for a specific group or cohort.
14. Social Support- “A multi-dimensional concept that described relationships
individuals maintain with each other” (Von Ah, Ebert, Ngamvitroj, Park, & Kang,
2004).
15. Social Work Environment- Interactions and relationships between employees
and/or customers/clients/athletes restricted to the work environment and did not
extend to an employee’s personal life outside the workplace.
16. Traditional Setting (TS)- An athletic trainer who was employed in secondary
schools, colleges and universities, and professional sports (“Work settings,” n.d.).
Limitations
This study was limited by the accuracy of responses provided by the chosen
subjects and the number of subjects who choose to participate. The validity of the testing
instrument (non-standardized survey) and the limited answers provided for the subjects
also provided limitations to this study. The importance of the topic, exercise, could have
influenced responses and provided further limitations to the research.
8
Delimitations
This study was delimitated to female subjects, residing in the United States, that
were National Athletic Trainers Association Board of Certification (NATABOC)
certified, in either the traditional or non-traditional setting. All subjects were current
members of the National Athletic Trainers Association (NATA).
Assumptions
It was assumed that all participants would understand and answer honestly
questions stated in the survey used for this research. It was assumed that all participants
were 21 years or older due to undergraduate pre-requisite coursework required prior to
being allowed to take the NATABOC exam. It was assumed that subjects worked either
in the traditional or non-traditional setting but not in both.
9
Hypotheses
1. There would be no significant difference in average work hours per week between
the TS and NTS ATC. (H1)
2. There would be no significant differences in exercise participation between the
traditional (TS) and non-traditional (NTS) female ATC. (H2)
3. There would be no significant difference between the TS and NTS female ATC in
regards to exercising with a companion. (H3)
4. There would be no significant difference in motivation/influence of the social
work environment between the TS and NTS female ATC. (H4)
5. There would be no significant difference in motivation/influence of the physical
work environment between the TS and NTS female ATC. (H5)
6. There would be no significant differences in barriers/limitations to exercise
between the TS and NTS female ATC. (H6)
10
Chapter 2
REVIEW OF LITERATURE
Numerous studies have shown that physical activity has positive effects on an
individual’s psychological and physical health (Tu, Stump, Damush, & Clark, 2004);
however, it has been challenging for individuals to integrate regular physical activity into
their lifestyles (Kilpatrick, Hebert, & Bartholomew, 2005). Understanding the exercise
barriers and influences of individuals could help promote regular physical activity by
defining specific motivational factors and eliminating barriers. Two possible influences
on exercise behavior were social and physical environments. By studying these two
environments, it was possible to identify specific motivators and barriers to exercise in
order to create interventions and solutions that could be instituted in other work settings.
Motivation
Motivation included many factors, both internal and external, that promoted or
limited exercise involvement. Motivation was the “critical ‘force’ or energy that led to
task engagement or sustained involvement” (Lewthwaite, 1990). Variables, such as
knowledge, attitudes and beliefs in regards to exercise benefits were considered common
motivational variables (Fleury & Lee, 2006). These variables played a strong role in an
individual’s decision to exercise, and either promoted or limited exercise behavior.
Motivation was difficult to accurately measure due to the internal and external
forces that effected individual motivations. One inventory commonly used was the
Exercise Motivations Inventory 2 (EMI-2) which “contains 14 subscales to
comprehensively measure exercise motivation” (Maltby & Day, 2001). This inventory
11
created specific subscales of motivation that were characterized as internal motivators
and external motivators. Research indicated that intrinsic and extrinsic motivation had
different effects on an individual’s psychological well-being and exercise behavior
(Maltby & Day, 2001).
Intrinsic Motivation
This type of motivation included an individual’s desire to perform an activity for
the pure satisfaction of that activity (Marcus, 2003). Intrinsic motivation was not altered
by external environmental factors, and instead was determined strictly by the individual
himself/herself. Examples of intrinsic motivation included: challenge, enjoyment,
revitalization, and stress management (Kilpatrick, 2005). Intrinsic motivation was
associated with better psychological well-being and long term exercise adherence
(Maltby & Day, 2001).
Extrinsic Motivation
Extrinsic motivation pertained to external forces that may alter an individual’s
decision to exercise. Examples of extrinsic motives included: appearance, weight
management, and social recognition (Kilpatrick, 2005). These motives were more easily
manipulated by external forces, like social and physical environments, because they were
not performed for inherent satisfaction, but instead for external reward or benefit
(Marcus, 2003).
In a study by Marshall (2002) extrinsic motivation was altered via motivational
signs. Marshall attempted to promote increases in physical activity by placing
motivational signs promoting individuals to use the stairs versus the elevator. These signs
12
included caricatures of individuals walking up stairs and statements of ‘Improve Your
Health...Use the Stairs’ (Marshall, 2002). After the first intervention of promotional
signs, there was a significant increase in stair usage well above baseline values. The signs
created an external benefit of improved health; not intrinsic benefits such as enjoyment,
revitalization, or stress management. This was one example of how the physical
environment was altered to extrinsically motivate individuals to be more active.
Intrinsic vs. Extrinsic Motivation
Intrinsic and extrinsic motivators provided very different outcomes to exercise
behavior and psychological well being. It was important to consider both types of
motivation in order to more accurately understand an individual’s decision to exercise.
Both forms of motivators played a role in the decision to exercise, and it was suggested
that intrinsic and extrinsic motivation to exercise may change over time (Maltby & Day,
2001).
Maltby and Day (2001) found that subjects with less than six months of exercise
participation had higher scores for extrinsic exercise motives; while subjects who
exercised six months or more had higher scores of intrinsic exercise motives. This
revealed that when an individual began an exercise program extrinsic motives were more
common and helped an individual begin exercise behavior. It also suggested that over
time an individual’s motives to exercise change. Maltby and Day (2001) also suggested:
“that individuals’ motivations for exercise changed over time from extrinsic motives to
more intrinsic motives” (p. 658). When beginning an exercise program subjects often
expressed external motivations as their primary reason for exercise, but during the later
13
stages of exercise subjects had stronger internal motivations, such as enjoyment,
challenge, and self-image that supported exercise adherence (Shepard, 1985). Extrinsic
motivation promoted individuals to start an exercise program, and was an important
factor in exercise behavior.
Although extrinsic motives played a positive role in an individual’s choice to start
exercising, research suggested that exercise adherence and maintenance were limited. In
the Marshall (2002) study, motivational signs were used to promote stair usage of his
subjects; however, once the signs were removed stair use went back to baseline levels
and eventually dropped below baseline scores. Only the physical environment was altered
for this study, and the subjects’ responses to both social and physical changes were not
considered. In order to permanently alter exercise behavior it was important to approach
both internal and external motivation to more adequately create permanent exercise
adherence. Focusing on social acceptance of regular physical activity coupled with
external environmental changes was a way to increase internal motivation and external
motivation simultaneously; creating stronger exercise adherence.
Exercise has been connected to having psychological benefits such as: reduced
depression, stress reduction, and heightened self-esteem (Resnick, 2006). Intrinsic and
extrinsic motivation was also be associated with psychological well-being. Maltby and
Day (2001) found that subjects with higher scores of extrinsic motivations had low selfesteem scores with high anxiety and depression scores. These findings connected poor
psychological health with external motivators, and provided evidence as to why intrinsic
motivation better promoted exercise maintenance and adherence. A study by Kilpatrick
14
(2005) also suggested that exercise adherence was associated with intrinsic motivation,
not extrinsic motivation. Teixeira et al. (2006) stated that:
Adherence to exercise in individuals participating in fitness classes was higher
when intrinsic motives related to enjoyment and feelings of competence were
reported, compared to when body-related outcomes (conceptualized as extrinsic)
were the primary motivation.
During early stages of exercise adoption, physical appearance and weight control were
more common; while later stages of exercise, i.e. maintenance stage, were more
predominately motivated by intrinsic factors such as enjoyment and fun (Teixeira et al.,
2006). Although both types of motivation were important to the start and maintenance of
exercise behavior; exercise adherence and maintenance were more commonly associated
with intrinsic motives. This supported the idea of changing social and environmental
factors to promote exercise behaviors. Individuals exercising in groups where physical
activity was socially accepted and enjoyed not only provided external motivation, i.e.
support from others, but also internal motivation, i.e. fun being with others, which
helped create long-term exercise behaviors.
Exercise Attitudes, Knowledge and Beliefs
Research supported that an individual’s attitudes and beliefs toward exercise and
its benefits affected exercise behavior (Resnick, 2006; Schutzer & Graves, 2004;
Shepard, 1985). Knowledge about the benefits of exercise and a positive attitude towards
exercise were found to significantly affect an individual’s decision to start an exercise
program or behavior (Fleury & Lee, 2006). This suggested that if an individual had
15
knowledge that exercise was good for them they were more likely to perform the
behavior. Exercise participation was effected by an individual’s attitude and beliefs as
well as their knowledge of exercise benefits.
Benefits of Exercise
According to the U.S. Department of Health and Human Services (USDHHS)
Healthy People 2010 (2001), adults should perform at least 30 minutes of moderate
physical activity most days of the week. It was suggested that adults should be more
active throughout the day and recommended exercising every day of the week. The
USDHHS has attempted to increase adult exercise participation through the Healthy
People 2010 guidelines and goals established in November 2001. These guidelines and
goals were based on the benefits associated with regular exercise participation. For the
purpose of this study, exercise benefits were categorized into two types: perceived
physical benefits and perceived psychological benefits.
Perceived Physical Benefits
Numerous physiological benefits were associated with regular participation in
moderate exercise. Resnick (2006) found physical improvements after subjects completed
a 12-week exercise program. Subjects reported “decreased pain, improved sleep,
improved blood pressure, lowered blood sugar, better balance…less shortness of breath
and improved endurance and function” (Resnick, 2006). Regular exercise participation
has also been linked to disease prevention. Coronary artery disease, osteoporosis, noninsulin dependent diabetes mellitus, heart disease and stroke (Resnick, 2006; Schutzer &
Graves, 2004) were specific diseases regular exercise was able to prevent. There were
16
also findings that associated exercise with decreased morbidity and prolonged mortality
(Schutzer & Graves, 2004).
Although exercise provided many physiological benefits, aesthetic benefits
existed as well. According to Healthy People 2010 (2001), exercise participation was a
main factor in weight loss. Unfortunately, current “mainstream ideals equated
muscularity with attractiveness rejecting a fat and untrained body” (Jankauskiene, 2005);
which led individuals towards exercise for aesthetic purposes and not health reasons.
Although exercise provided aesthetically pleasing changes to the body, it was important
to remember the physiological benefits accompanied by exercise and physical activity.
Perceived Psychological Benefits
Exercise benefits were not limited strictly to physical aspects, and played a strong
role in psychological well-being. Stress reduction, heightened self-esteem and selfefficacy, and reduced depression were all psychological factors affected by exercise
(Maltby & Day, 2001). Resnick (2006) found that subjects reported positive changes in
their mood and attitude as a result of increased activity. Further research suggested that
regular exercise participation also promoted positive changes in body image and self
concept (Schuler, 2004). This revealed a relationship between exercise and body-shape
perception that led to not only physical benefits, but also positive psychological changes.
Barriers to Exercise
Barriers limited an individual’s ability to maintain regular exercise habits. Current
research has produced many common barriers throughout populations (McDevitt, 2006;
Williams, Bezner, Chesbor, & Leavitt, 2006); which have been divided into many
17
categories. For the purpose of this study three specific types of barriers were discussed.
These barriers included: psychological/personal barriers, social barriers, and
environmental barriers.
Psychological/Personal Barriers
Psychological and personal barriers were shown to affect exercise behavior.
Examples of such barriers included: lack of motivation, low self-efficacy, fear of failing,
and thinking exercise was too difficult (McDevitt, 2006). These barriers reflected upon
how an individual feels about exercise and about themselves performing exercise
behaviors.
A major contributor to exercise participation was self efficacy. Self-efficacy was
the confidence a person had in their ability to complete a task. In regards to physical
activity and exercise, self-efficacy was the “confidence in one’s ability to overcome
barriers to regular physical activity” (McDevitt, 2006, p. 53). Individuals with low levels
of self-efficacy had a difficult time participating in exercise because they did not believe
in their ability to perform the exercise behavior. Von Ah (2004) found that subjects with
high self-efficacy scores engaged in health-promoting behaviors, such as exercise, more
often than those with lower self-efficacy scores.
Motivational variables about the health benefits of exercise were also barriers. If
an individual did not have knowledge about the benefits of exercise they were not as
motivated to perform the activity (Schutzer & Graves, 2004; Williams, 2006). Attitude
also played a role in exercise motivation. An individual with a negative outlook and
attitude towards exercise, i.e. not liking exercise, was more prone to inactivity whenever
18
possible because they did not perceive exercise as a good activity or behavior. According
to Fleury and Lee (2006), knowledge and attitudes played a significant role in initiating
an exercise program. Lacking belief in the benefits of exercise also decreased motivation
to exercise because if an individual did not believe exercise provided any benefits they
simply remained inactive (Resnick, 2005). Individuals with extrinsic motivation were
able to adopt an exercise program; however, maintenance and adherence were more
commonly associated with intrinsic motivators (Kilpatrick, 2005; Maltby & Day, 2001).
This suggested that the type of motivation plays a role in an individual’s decision to
exercise.
Williams (2006) found two predominant barriers to exercise among African
American women: lack of time and family priorities. A study by Brownson (2001), also
found lack of time to be a common factor limiting exercise. Unfortunately, time was one
alterable factor; however, some individuals felt that they were unable to do so and instead
were inactive. Family priorities created barriers to exercise, particularly for women
(Williams, 2006). These priorities included caring for offspring, multiple role
responsibilities within the home, and caring for elderly family members. A study by
Schrop et al. (2006), found that women with children younger than 18 were less likely to
exercise.
Social Barriers
Social interaction, support and norms played an important role in exercise
behavior. Von Ah (2002) stated that, “social support…has been shown to have a positive
impact on preventive behaviours and health outcomes”. Individuals lacking family and
19
friend support to exercise had difficulties beginning exercise programs and initiating
health changes (Fleury & Lee, 2006).
The external stimuli from positive reinforcement of exercise behavior and
compliments were examples of positive social interactions. If an individual lacked this
type of external stimuli it was difficult to begin an exercise program due to the role
external motives played in helping individuals start exercise behavior. Fleury and Lee
(2006) stated that “social support specific to physical activity provided the initial
motivation to increase physical activity levels”. Social support has also helped create a
strong belief system in the benefits of physical activity. Being surrounded with
individuals who live active lifestyles and believe in its benefits a social norm might be
created. This was able to help support an individual’s belief in exercise which eventually
promoted internal motivation to an active healthy lifestyle.
Another aspect of social support was companionship. Individuals who exercised
with a friend were more likely to adhere to their exercise behavior because they
associated exercise with friends and family (Fleury & Lee, 2006). In a study by Ball
(2001), individuals who reported exercising alone were 31% less likely to exercise. In
another study by Brownson (2001), subjects reported higher scores of physical activity
associated with having an exercise companion and friends who encouraged activity. This
suggested that individuals who exercised alone would not maintain regular exercise
habits due to associating exercise as an inhibitor of family/friend interaction.
20
Environmental Barriers
Environmental barriers pertained to the physical environment that surrounded an
individual in their community, workplace, or home. One main barrier to exercise was
safety. Many studies found that individuals did not exercise because their surrounding
environment lacked specific safety standards (Fleury & Lee, 2006; McDevitt, 2006;
Schutzer 2004). Safety issues included high crime rates, unleashed dogs, and poorly lit
streets (Fleury & Lee, 2006). Schutzer (2004) noted that older adults who perceived
higher safety levels in their exercise environment performed exercise behaviors more
often. Safety concerns of the surrounding environment limited an individual’s exercise
habits and were sometimes difficult to alter.
Convenience was another aspect of the physical environment that posed as an
exercise barrier. According to Fleury and Lee (2006), “access to…affordable facilities
was identified as an important correlate of participation in physical activity”. Expensive
home exercise machines and gym memberships, limited an individual’s access to exercise
facilities and equipment. An environment with free and accessible facilities provided an
individual with opportunities to exercise more frequently. Motl et al. (2005) explained
that perceived lack of accessibility, in regards to home equipment and community
facilities, limited exercise participation. Such equipment could included bicycles,
treadmills, and home exercise equipment; while community facilities included parks,
community pools, sidewalks for walking, and public recreation centers (Brownson,
2001). Brownson (2001) found that 66% of his subjects used neighborhood streets for
exercise while almost 30% used parks for exercise and 25% walked on jogging trails.
21
This research revealed that when the physical environment had accessible facilities and
equipment, individuals took advantage of those options.
Environmental Motivations and Influences
Emphasis on altering and understanding individual characteristics that influenced
physical activity has had little effect on stopping the obesity epidemic (Booth, 2005).
New research suggested using multilevel perspectives to combat inactivity and obesity
(Fleury & Lee, 2006). Two factors attributed to this perspective were the social
environment and the physical environment. One such model/framework that used both
factors to study exercise behavior was the social-ecological model. This model has been
used to create standards for exercise programs and to increase information on socialecological influences on exercise participation.
Social Environment
The social environment extended to the workplace, community, and home. It
consisted of the relationships and interactions an individual had with family, friends, coworkers, and employees. One of the most common motivators found in the social
environment was support. Fleury and Lee (2006) noted that companionship was a main
motivating factor in maintaining a structured exercise program. In a study by Resnick
(2006), subjects noted accountability to the group as a strong motivator to participate in
exercise. Spousal support has been noted as one of the main motivators to exercise;
however, if an individual lacked spousal support it could become a strong barrier to
exercise (Shepard, 1985). Social support from friends and family was a large factor of the
social environment and was described as “either direct and tangible (e.g., provided a non-
22
driver with a ride to an exercise class) or informational (e.g., talked about physical
activity and encouraged a friend to participate)” (Brownson, 2001). McDevitt (2006)
noted that limited social support inhibited exercise participation; while Fleury and Lee
(2006) found social support as a positive influence to exercise behavior.
Exercising with a group of people or with a group program could also be
considered social support. Having a group atmosphere provided accountability to
exercisers, and helped maintain exercise adherence (Resnick, 2005). Shepard (1985)
noted that group exercise programs maintained higher rates of exercise adherence than
individual exercise programs which supported the role social support played in
maintaining exercise behaviors.
The social environment also included social norms and networks. Women who
saw people exercising in their neighborhood were more likely to meet exercise
recommendations (Fleury & Lee, 2006). Seeing exercise as a social norm motivated
inactive individuals to alter their behavior. Resnick (2006) found that subjects maintained
their exercise behavior due to motivation from seeing others exercising (role modeling).
These social norms provided pressure on individuals to seek exercise in order to conform
to society, but also was a way to socialize with other individuals (Shepard, 1985). Social
norms that promoted regular exercise habits created examples of success that motivated
physical activity (Fleury & Lee, 2006; Shepard, 1985).
Social norms and views on weight management also played a role in motivating
exercise behaviors. In a study by Kilpatrick (2005) subjects who participated in exercise
behaviors did so due to appearance related motives. Social views on body physique, for
23
example musculature and slimness, influenced health behaviors (Jankauskiene, 2005;
Schuler, 2004). These social interactions, norms, and values all influenced exercise
participation at many different levels.
Physical Environment
The influence of the physical environment on exercise participation was very
limited (Brownson, 2001). The physical, or built, environment included many different
aspects such as: urban design factors, available public transportation trails and sidewalks,
exercise facilities, parks and recreation facilities, and bike paths (Booth, 2005).
Unfortunately, community planning and building trends have lead to urban areas that
support sedentary lifestyles (Lopez-Zetina, Lee, & Friis, 2004). Examples of community
planning that did not support active lifestyle were: decreases in bike paths, parks, and
recreation courses, distances between businesses and homes forcing individuals to drive
versus riding a bicycle, and lack of security/safety in community recreation areas.
Research found a relationship between exercise habits and the physical
environment (Brownson, 2001; Lopez-Zetina, 2004; Wendel-Vos, Schuit, De Niet,
Boshuizen, Saris, and Kromhout, 2004). Booth (2005) reported that individuals with
limited access to recreational facilities were 68% more likely to be obese. Booth also
found that “residents of low-walkability neighborhoods…reported higher mean body
mass indexes (BMIs)”. This suggested that limited access to facilities that promoted
exercise hindered activity participation. According to Gordon-Larsen, Nelson, Page, and
Popkin (2006) “objective and perceived access to facilities and opportunities to exercise
were consistent predictors of physical activity”. Individuals were more likely to exercise
24
if their physical environment provided the opportunity and facilities to perform the
desired behavior. Creating built environments with recreational facilities and physical
attributes supporting physical activity would decrease the amount of inactivity within the
community. Two aspects of the built environment were the freeway and the distance
between suburban areas and places of employment. Major freeways have allowed for
easier mobility and travel, but have facilitated sprawling communities far from the
workplace (Lopez-Zetina, 2004; Sallis et al., 2006). Due to sprawling urban design, the
automobile has become the major means of transportation as more individuals rely on
cars to get from place to place while limiting the use of sidewalks, bicycles, and trails
(Lopez-Zetina; 2004). Altering the built environment to support a more active means of
travel was associated with increased exercise behavior in individuals; however, this
required building smaller communities with shops and businesses closer to urban housing
and intricate sidewalk and trail systems that compliment roadways and decrease
automobile dependence (Sallis et al., 2006). Built environments providing access to
exercise facilities was an alterable factor that promoted a more physically active
population.
Two more important environmental factors were aesthetics and safety. Ball
(2001) found that subjects sighting low environmental aesthetics “were 40% less likely to
walk for exercise”. Other studies also found positive correlations between aesthetics and
exercise behavior (Craig, Brownson, Cragg, & Dunn, 2002). Having aesthetic
surroundings promoted exercise because they provided an external stimulus that was
enjoyable to watch. This external stimulus also provided a distraction from the exercise
25
behavior that could help the beginning exerciser focus more on enjoying the environment
versus the physiological strains of moderate exercise (Ball, 2001; Resnick, 2005).
Safety features were also key environmental elements that hindered or promoted
exercise. Safety factors included: crime control, adequate street lighting, and well
maintained trails and sidewalks. Wendel-Vos et. al (2004) noted safety concerns to be a
strong factor in exercise participation. Perceiving the environment as unsafe was one
exercise barrier and a main deterrent from regular physical activity (Fleury & Lee, 2006).
Women were the most common subjects affected by unsafe environments, which led to
long term reduction in fitness and exercise habits (Fleury & Lee, 2006; Williams, 2006).
Social-Ecological Model/Framework
One model that approached exercise motivations and influences on multiple levels
was the social-ecological model. The social-ecological framework took into account
interactions of the social and physical environments and its’ influences on exercise
behavior (Plotnikoff, 2005; Sallis et al., 2006). Most research has used this model to help
increase activity levels at the community level, however, more research was being done
to see if the workplace could also be affected to promote activity (Plotnikoff, 2005; Sallis
et al., 2006).
Social-ecological frameworks attempted to understand the actual and perceived
social and physical environmental factors that influenced physical activity (Ball, 2001).
Many factors influenced an individual’s decision to institute healthy behavior, and the
social-ecological framework attempted to view these numerous factors to determine
which were most influential. This allowed researchers to “expand traditional motivational
26
and behavioral theory” (Fleury & Lee, 2006) to analyze all components that effected
exercise behavior. Social-ecological frameworks were very beneficial because they
applied numerous theoretical principles that described and defined interrelations between
multiple personal and environmental factors (Plotnikoff, 2005; Sallis et al., 2006).
Common variables included in the socio-ecological model were: intrapersonal,
interpersonal, organizational, physical environment, and policy (Fleury & Lee, 2006;
Sallis et al., 2006). Studying multiple variables allowed researchers the opportunity to
understand all factors that affected exercise behavior. This model could be used to create
better programs and interventions that successfully promote exercise behavior because
multiple levels would be addressed.
The Workplace and Exercise
The workplace played a large role in the lifestyle decisions of the adult
population. The workplace affected many aspects of life including: exercise decisions and
habits, nutritional choices, stress and anxiety levels, and time spent with friends/family.
Due to the large amount of time adults spent in the workplace, research suggested that
employers and employees should promote exercise while at work (Plotnikoff, 2005).
Wakefield (2004) stated that “obese workers were almost twice as likely to be frequently
absent as people of a healthy weight”. This suggested that employers should promote a
more active workforce in order to maintain productivity and employee attendance. It
would also be beneficial for employees to have a work environment that supported
exercise and physical activity due to the rising costs of healthcare (Wakefield, 2004).
Plotnikoff (2005) stated that:
27
The workplace was an ideal setting for the promotion of physical activity because
of the established channels of communication, existing support networks,
opportunity to develop norms of behavior, and potential to reach a significant
proportion of the population .
This quote suggested that the work environment could be altered in order to more
adequately promote healthy lifestyle choices and exercise behavior. Since the work
environment has multiple levels of influence on exercise behavior it was important to
create at work programs that supported the numerous factors affecting health decisions.
This meant that employers and employees needed to address barriers and benefits to
exercise, the role motivation played in exercise, and the influence of the social and
physical work environment in order to promote long term healthy lifestyle choices, like
exercise participation.
One workplace that had the opportunity to promote physical activity was that of
the certified athletic trainer. The profession included numerous support networks, social
norms that promoted exercise, and accessibility to exercise facilities. Although the
certified athletic trainer did have the knowledge and support regarding healthy behaviors,
certain aspects of the job setting varied and promoted or inhibited exercise participation
(Arnheim, 2006). It was important to understand the different aspects and requirements of
the ATC profession prior to instituting interventions or programs to promote exercise
behavior in other professions.
28
The Athletic Training Profession
Athletic training was a specialized field that falls under the broad field of sports
medicine (Arnheim, 2006). This field primarily focused on such areas as injury care,
management, prevention, and rehabilitation. The athletic training profession required
physical activities such as: lifting items (i.e. coolers, boxes, weights, athletes),
running/jogging to injured athletes, demonstrating rehabilitation exercises, setting up
fields for practices and events, and standing for long periods of time during athletic
competition and/or coverage of similar events. Other, less physical, requirements
included: filing, coordinating doctor visits, documentation of injuries and rehabilitation,
clinical evaluation, compliance and staff meetings, coach and athlete interactions,
traveling with athletic teams, and working and/or teaching undergraduate athletic training
students.
Individuals who wanted to become an ATC completed standard educational
requirements and supervised clinical hours that were defined by the National Athletic
Trainers Association. Prior to 2004, two pathways to become a certified athletic trainer
were provided for undergraduate students. Colleges and universities would have either
the internship pathway or the accreditation pathway. Unfortunately, in 2004 the NATA
determined that a candidate could sit for the certification exam only if they had
completed a CAAHEP accredited entry-level athletic training education program
(Arnheim, 2006).
The Traditional Athletic Trainer. Traditional settings for the athletic trainer were
junior colleges, colleges, universities and professional sports (Work settings, n.d.). In
29
more recent years secondary schools were added into the traditional setting and more
certified athletic trainers were finding job opportunities working with athletic young
adults. “In 1995, the NATA established an official statement on hiring athletic trainers in
secondary schools” (Arnheim, 2006) as a way to create standard hiring practices at this
level of athletics. School districts have also extended their employment to athletic trainers
by hiring ATCs to cover various facilities and athletic teams within their district
(Arnheim, 2006).
The most common employment opportunities for the certified athletic trainer
included colleges or universities, junior colleges and professional teams. Colleges and
universities required many of the “typical” athletic trainer skills including injury
evaluation and prevention, athletic practice observation/set-up, and rehabilitation. These
athletic trainers worked primarily with athletes and have limited time working with other
physically active individuals. Professional sports also require “typical” ATC skills. The
ATC was a professional setting usually performing specific team athletic training duties
six months out of the year; while off-season conditioning and individual rehabilitation
provided the ATC with a busy schedule for the rest of the year (Arnheim, 2006).
The Non-Traditional Athletic Trainer. The non-traditional ATC continued to
work with individuals that were physically active and was possibly involved in athletics;
however, their employment provided a more diverse population of clients and patients.
Behnke and Bergfeld (1997) explained that with an “increasing emphasis on health and
the benefits of physical activity, more individuals were engaging in physical activity
30
through organized programs and other recreational endeavors”; which led to increased
need for non-traditional certified athletic trainers.
Many non-traditional certified athletic trainers worked in sports medicine clinics,
however, opportunities to work in corporate/industrial settings continued to increase. The
ATC in the corporate/industrial setting primarily focused on overseeing fitness and injury
rehabilitation programs for employees (Arnheim, 2006). This ATC must have knowledge
of workplace ergonomics, dimensions of the workplace, and specific tasks that were
performed in the workstation (Arnheim, 2006).
Two additional settings considered within the realm of non-traditional were the
Military and physician extender. Increased numbers of certified athletic trainers within
the Military were important members of the sports medicine team providing care for
troops. Other non-traditional ATC’s worked within a physician’s office as physician
extenders and provided care for the physically active. This position provided many
benefits for the ATC and included: regular work hours and reimbursement for services by
third-party payers (Arnheim, 2006). The role of the athletic trainer has grown over the
years and more non-traditional setting opportunities continue to increase.
Summary
Many factors played a role in an individual’s decision to participate in exercise. It
was important to understand the multiple influences that promoted or inhibited exercise
behavior in order to create interventions and programs that supported healthy habits. The
social-ecological model was a very helpful tool in determining the factors that affected a
person’s exercise decisions. This model focused on multiple levels, and included the role
31
of the social and physical environment in exercise behavior (Fleury & Lee, 2006, Sallis et
al., 2006; Shepard, 1985).
The workplace has become a large part of the adult populations’ life, and research
suggested that healthy habits can be promoted in the workplace (Plotnikoff, 2005;
Wakefield, 2004). One profession that provided a strong “setting for physical activity
initiation and maintenance” (Plotnikoff, 2005) was that of the certified athletic trainer.
This profession had social and physical environmental aspects that promoted exercise
behavior within the context of the social-ecological model; however, barriers did exist
that hindered ATC exercise behaviors. Studying the ATC profession would be able to
provide strong social and environmental work factors and barriers that promoted or
hindered physical activity. This information may help create programs and interventions
that could be used in other professions to promote exercise habits, identify exercise
barriers, and provide ways to promote a lifestyle with consistent exercise behavior.
32
Chapter 3
METHODOLOGY
The benefits of physical activity and exercise have been studied and reviewed;
however, many people do not meet the U.S. Department of Health and Human Services
(USDHHS) recommended daily exercise requirements to maintain a healthy lifestyle
(Marshall, 2002). Female athletic trainers often worked in a setting surrounded by
exercise and physical activity. This physical and social work environment influenced a
female athletic trainer’s exercise habits. This study was designed to determine if the
physical and social work environment of the female ATC motivated or influenced
exercise, and to identify any occupational barriers specific to the work environment.
Subjects
The participants were female athletic trainers. All subjects were NATABOC
certified and employed in the traditional or non-traditional athletic training setting. There
were no age restrictions; however, it was assumed that few individuals were 21 or
younger. All participants had a minimum of a bachelor’s degree in athletic training, or a
similar field of study, from a program acknowledged by the NATA.
Procedures
A non-validated questionnaire was created by the researcher (see Appendix A).
Subjects completed the self-reported multiple choice questionnaire. Individuals were
asked specific questions regarding their physical and social work environments and the
effects these environments had on their exercise habits. The survey was divided into two
sections: Section 1 Demographic Information and Section 2 Motivation and Barriers.
33
The first section of the survey primarily addressed demographic information, such
as: age, average work hours, years certified, job title and setting. Additional information
concerning exercise facilities and equipment at work, number of days spent exercising
per week, average time spent exercising, and social interactions associated with
exercising at work was also obtained from each subject.
The second section focused on the subjects’ physical and social work
environments. A five point Likert scale was created to determine strong and weak
exercise motivators. These motivators included physical and social aspects of the work
environment specific to the ATC. Questions regarding motivation were graded on a
Likert scale from 1-5, in which, “1” indicated the least motivating and “5” indicated the
most motivating. A second five point Likert scale was used to determine common
exercise barriers related to the athletic training work environment. These questions were
also graded on a scale from 1-5, in which, “1” was the weakest barrier to exercise and “5”
was the strongest barrier to exercise (see Appendix A).
Each number on the Likert scales was assigned a specific value. Since five was
considered the most, or best answer, it was designated a value of “5”. This continued with
the other Likert numbers, as each specific value corresponded with the Likert scale. For
example: an answer of four had a value of “4”, three had a value of “3”, two had a value
of “2”, and one had a value of “1”. These values were used for both Likert scales.
Questions regarding motivation referred to either the social or physical work
environment. There were eight questions about the social work environment and six
questions about the physical work environment. For example, average scores found for
34
the six physical work environment questions were added up and divided by the total
number of questions. This was also done for questions related to the social work
environment to compare data between these two motivating factors.
Data Acquisition
The NATA provided email directories of certified athletic trainers in the United
States to all certified athletic trainers and athletic training students. This free directory
was retrieved once the survey was approved by the NATA District 8 Secretary/Treasury
Committee (see Appendix B) and the CSUS Department of Kinesiology’s Human
Subjects Committee. A contact list request form was found on the NATA website (see
Appendix B). Once the survey was approved by the appropriate committees a disclaimer
created by the NATA must be attached to the survey to relinquish any endorsement of the
NATA (see Appendix B).
Once all steps had been performed to allow for survey dispersal 1000 female
athletic trainers were randomly selected from the contact list. The survey was
electronically sent to the subjects through online survey methods.
Data Analysis
The purpose of this study was to determine if the social and physical work
environment of the traditional and non-traditional female ATC influenced their exercise
participation. Descriptive statistics, such as percentages, frequencies, and averages, were
used to analyze the results to describe trends within the population as a whole, and to
compare differences between female certified athletic trainers working in the traditional
and non-traditional settings.
35
An independent t-test with a significance level of p<0.05 was used to compare the
means of the TS and NTS ATC. Subjects, who considered themselves as the TS and
NTS ATC, were given the title of TS/NTS ATC. A one-way Analysis of Variance
(ANOVA) was used to compare the means between the three groups. This was done
using the SPSS computer program available in the Sacramento State computer lab.
36
Chapter 4
RESULTS
One thousand surveys were sent via email to collect data regarding the traditional
and non-traditional female ATC and their exercise related habits. A web based service,
Survey Monkey, provided the necessary program to create an online survey and collect
responses. Once the online survey was formatted, the NATA sent a mass email to female
athletic trainers throughout the continental United States. The responses were collected
and statistically analyzed using the SPSS program available at Sacramento State.
Demographics
Twenty-two percent of surveys sent were answered and used to evaluate
differences and trends between the traditional setting (TS) and non-traditional setting
(NTS) female ATC. Demographic information was collected, as well as information
regarding exercise motivations and barriers. The responses identified the presence of
three distinct groups, and included individuals in the TS, NTS, or ATCs working in both
settings (TS/NTS). The largest group was the TS (n: 125), followed by the NTS (n: 53)
and the smallest group TS/NTS (n: 39). (See Table 1).
37
Figure 1
Respondents Totals for the TS, NTS and TS/NTS Groups (N=217)
140
125
120
100
80
53
60
39
40
20
0
TS
NTS
TS/NTS
Years as a Certified Athletic Trainer and Age
All ATC’s, TS, NTS, and TS/NTS, must acquire certification through the
NATABOC in order to receive the title of certified athletic trainer. All respondents were
registered with the NATA as being certified and in good standing. The NATA survey
packet (Appendix B) was used to select respondents related to this topic of study.
Individuals that were not certified but still members of the NATA were not included.
Subjects were asked about the length of time spent in the field of athletic training
as an ATC. The most common responses were 1-5 years and 6-10 years. Over thirty two
percent of the total population had worked as an ATC for 6-10 years, while thirty percent
had been in the field for 1-5 years. Once subjects reached eleven or more years the
38
number of responses dropped by nearly half. Only one subject reported working as an
ATC for 30 or more years. (See Table 2).
Figure 2
Years as a Certified Athletic Trainer in the TS, NTS, and TS/NTS (N=217)
50
Number of Respondents
45
40
35
30
25
TS
20
NTS
15
TS/NTS
10
5
0
>1
1-5
6-10
11-15 16-20 21-25 26-30
Years as an ATC
30+
Age ranged from 22-53 years. The youngest group of ATCs was the TS/NTS
category (M = 30.1 years); while the NTS group was the oldest (M = 35.2 years). The
average age of all respondents was 32.8 years, which complements the previous section
on years certified. Certified athletic trainers in the 1-5 year and 6-10 year categories
would most likely be in their early to mid thirties due to the time frame of pre-requisite
coursework needed to be eligible to sit for the NATABOC exam. (See table 3).
39
Figure 3
Average Age of TS, NTS and TS/NTS (N= 217)
TS
NTS
TS/NTS
Total Population
35.2
32.8
32.7
30.1
Hours Worked
ATCs from all settings were asked about the average hours spent a week at work.
As a whole the population averaged 42.4 hours per week. Many respondents provided a
time range when asked hours worked a week, i.e. 40-45 hours. The highest number in the
range was statistically analyzed for this question. It was hypothesized (H1) that no
significant difference would be found between the TS and NTS ATC’s average work
hours. The TS averaged 8.62 hours a day (M=43.1 hours) in a five day work week. The
NTS (M= 40.1 hours) revealed a time commitment nearly equal to the TS; while the
TS/NTS averaged 42.8 hours per week; 8.56 hours a day. An independent t-test was
40
conducted and found no significant differences between the two groups, NTS (M: 40.1
SD: 11.86) and TS (M: 43.1 SD: 14.6); t(1.44)=119.5, p=.153), regarding hours worked;
therefore, supporting H1. After analyzing all three groups with a one-way ANOVA it was
determined that no differences existed between the TS, NTS, and TS/NTS
(F(2,214)=0.954, p=0.387).
Exercise Habits
Four questions focused on exercise habits. Respondents were asked their average
days a week spent exercising, average minutes per workout, what facilities they used and
if they exercised with a companion from work.
Days Spent Exercising
Respondents were given options regarding weekly exercise habits that ranged
from zero days a week to seven. It was hypothesized (H2) that no differences would exist
between the TS ATCs and NTS ATCs in regards days a week spent exercising. The TS
group averaged 3.5 days/week; while the NTS averaged 4 days/week. This was a
difference of 0.5 days between the two groups. Both groups were compared using an
independent t-test to determine if there was a significant difference of days spent
exercising. No significant difference was found between the TS (M = 3.5, SD = 1.92) and
NTS (M = 4.07, SD =1.66); t(176) = -1.89, p = .061. Therefore hypothesis two (H2) was
supported.
Minutes Spent Exercising.
All respondents were asked how many minutes on average they spent exercising
at any one time. They were provided seven options with a range of minutes. For example,
41
an answer of a: 0 minutes, b: 15-20 minutes, c: 20-30 minutes etc. When analyzed, each
range was given a specific value to help calculate descriptive statistics. An answer of 0
equaled a quantity of 1, 15-20 a quantity of 2, and so on. This allowed for easier
calculations and streamlined the data.
Out of 221 respondents, 167 reported that they exercised on average 30 or more
minutes at any one time. The TS and TS/NTS groups averaged 30-40 minutes of
exercise; while the NTS averaged 40-50 minutes of exercise.
Facilities Available/Use of Work Facilities
Survey data showed that ATCs from all settings had very similar equipment and
facilities available for their use. For example, 69% of TS had a treadmill; while 62% of
the NTS and 88% of the TS/NTS also had a treadmill in their work setting. The most
common items between the ATCs were stationary bikes and weight rooms. Over 90
percent of the TS and TS/NTS stated that they had a stationary bike and weight room
facilities at their disposure; while over half the NTS had a stationary bike and a weight
room.
Table four provides a visual representation of what equipment and facilities were
available for the subjects used in this research. Subjects were asked how many days a
week they used their work facilities/equipment to exercise. TS ATCs used their work
facilities/equipment the most with an average of 1.2 days per week, while TS/NTS (0.75
days per week) and NTS (0.6 days per week) rarely used work facilities. While all ATCs
had some type of exercise equipment or facility available for them to use few subjects
actually chose these items as their means to exercise. (See table 4).
42
Figure 4
Number of Respondents
Facilities and Equipment Available at Work TS, NTS, and TS/NTS
100
90
80
70
60
50
40
30
20
10
0
TS
NTS
TS/NTS
Equipment/Facilities
Exercising with a Companion
The investigator hypothesized (H3) that there would be no significant difference
between the TS and NTS in regard to exercising with a companion. Each response was
given a value to allow for analysis and streamlined data. Respondents either answered:
yes I always exercise with a co-worker (value: 1), yes I sometimes exercise with a coworker (value: 2), no I exercise alone most of the time (value: 3), or I always exercise
alone (value: 4). When comparing the means between TS and NTS, an independent
samples t-test generated a p value of 0.84, finding no significant difference between
either group regarding exercising with a partner. Therefore, H3 was supported by these
data. When all three groups were compared using a one-way ANOVA, a p value of 0.95
43
was found which revealed no significant difference between the three settings and their
choice to exercise with a partner in the work setting.
Exercise Motivation
All subjects were asked to rank statements related to exercise motivators. These
statements were separated into two categories: 1. Social Work Environment Motivator 2.
Physical Work Environment Motivator. Fourteen statements were ranked using a 5 point
Likert scale. Statements 1, 3, 5, 6, 8, 10, 11, and 13 were specific social work
environment motivators, while statements 2, 4, 7, 9, 12 and 14 related to physical work
environment motivators. An independent t-test (p<0.05) was used to determine any
significant differences in the social (H4) and physical (H5) work environment motivators
between the TS and NTS, while a one way ANOVA compared the means of the TS,
NTS, and TS/NTS to identify any significant differences between the settings.
Social Work Motivators
The social work environment motivators were ranked by all ATCs using a 5 point
Likert scale. A ranking of five represented the most motivating statement and a score of
one represented the least. One statement was ranked above four in all ATC settings. This
was statement five which stated that the ATC’s knowledge and educational background
about the benefits of exercise was an exercise motivator. TS, NTS, and TS/NTS all found
statement five to be a strong motivator, and ranked this statement the highest out of all
social and physical environment motivators (TS M: 4.08, NTS M: 4.19, TS/NTS M:
4.21). (See table 5).
44
Figure 5
Average Rankings for Social Work Environment Motivators of the TS, NTS, and TS/NTS
4.5
4
Average Rankings
3.5
3
2.5
TS
2
NTS
1.5
TS/NTS
1
0.5
0
1
3
5
6
8
10
11
Social Work Environment Statements
13
The researcher analyzed the average rankings for all social work environment
motivators using an independent t-test (p<0.05) in order to determine if any significant
differences existed between the TS and NTS ATC (H4). No differences were found
between the two settings in reference to social work environment motivators. A one-way
ANOVA (p<0.05) was also completed in order to compare the means of all three groups
in regards to the social work environment. This analysis also found no significant
differences between the three settings in any category of the social work environment.
These data support H4. (See table 6).
45
Table 1
T-Test Results of Social Work Environment Motivators of the TS and NTS ATC
Statement
P (p<0.05)
1. Watching other individuals exercise
0.672
3. Exercising with co-workers @ work
0.05
5. Having the knowledge and educational background about the
0.504
benefits of exercise
6. Observing the physique of exercising individuals
0.328
8. Working and socializing with co-workers who promote
0.942
exercise
10. Having co-workers who participate in exercise
0.938
11. Rehabilitating individuals post-injury or post-surgery
0.219
13. Co-worker encouragement
0.325
Physical Work Environment Motivators
All ATCs were asked to rank six statements related to their physical work
environment. The Likert Scale employed for the social work environment motivators in
which subjects rated importance from 1-5 was also used. Some examples of the
statements ranked included: viewing exercise equipment at work, having safe exercise
facilities at work, and seeing facilities at work that allow for exercise. The researcher
hypothesized (H5) that there would be no significant difference in motivation/influence
of the physical work environment between the TS and NTS ATC. Data were collected
46
and assessed using an independent t-test (p<0.05) to determine if any significant
differences existed between the two settings in regards to the physical work environment.
Of the six ranked statements, three were found to have a significance level of less than
0.05.
When a one way ANOVA was performed to compare the three settings two
physical motivators were found to be significant. These included statement 9: seeing
facilities at work that allow for exercise (F(2,195)=3.21; p=0.42) and statement 14: being
surrounded at work by exercise in general (F(2, 194)=4.96; p=0.008). Statement 2 was
found to have a p value of 0.05, however, this finding was too close to the critical value
to deem significant for this current study. (See table 7).
Table 2
T-Test Results of Physical Work Environment Motivators of the TS and NTS ATC
Statement
P (p<0.05)
2. Seeing exercise equipment @ work
0.018*
4. Safe exercise facilities @ work
0.537
7. Having a trail or sidewalk system that allows you to walk at work 0.314
9. Seeing facilities at work that allow for exercise
0.013**
12. Having exercise equipment/facilities in close proximity to your
0.084
work space/office
14. Being surrounded @ work by exercise in general
*Denotes significance between TS and NTS (p<0.05)
**Denotes significance between TS, NTS and TS/NTS (p<0.05)
0.002**
47
All ATCs ranked the physical work environment statements as weak motivators;
however, the TS and TS/NTS ranked statement 14 as a strong motivator. Table eight
depicted the average scores for each physical work environment motivator, and revealed
that the TS and TS/NTS averaged higher rankings for the physical motivators. Although
the TS and TS/NTS averaged higher rankings for the physical motivators five out of the
six were still considered weak motivators on the Likert scale. The average ranking for
statement 14, being surrounded at work by exercise in general, for each group of ATC’s
was as follows: TS = 3.68, NTS = 3.02 and TS/NTS = 3.5 respectively, and was the most
motivating of all physical environment statements. In general, the physical work
environment motivators were not ranked as very strong motivators in any setting of the
ATC. (See Table 8).
48
Figure 6
Average Ranking for Physical Work Environment Motivators of the TS, NTS, and TS/NTS
4
3.5
Average Score
3
2.5
TS
2
NTS
1.5
TS/NTS
1
0.5
0
2*
4
7
9**
12
Physical Work Environment Statement
14**
*Denotes significant difference between TS and NTS (p<0.05)
**Denotes significant difference between TS, NTS and TS/NTS (p<0.05)
Exercise Barriers
Thirteen barriers to exercise participation were identified and scored using a five
point Likert scale. Subjects were asked to rate the barriers with one being the weakest and
five being the strongest. The researcher hypothesized (H6) that no significant differences
would be found between the TS and NTS ATC in regards to their exercise barriers. An
independent t-test (p<0.05) was used to determine differences between the TS and NTS.
Differences were found for three of the thirteen statements. Barrier statements two
(p=0.003), six (p=0.000), and eight (p=0.016) all had a p value less than 0.05 (See table
9). When comparing all three groups with a one way ANOVA (p<0.05) self conscious
49
exercising amongst other exercisers (p=0.027) and intimidated by fit individuals
(p=0.006) were also found to be significantly different between all three groups.
50
Table 3
T-Test Results for Barriers to Exercise of the TS and NTS ATC
Barrier
P (p<0.05)
1. Lack of time, as a result of hours spent at work
0.351
2. Self conscious exercising amongst other exercisers
0.003**
3. No safe place to exercise
0.417
4. No child care
0.674
5. Traveling for work
0.324
6. Intimidated by fit individuals
0.000**
7. Do not like to exercise
0.616
8. Unable to exercise due to current health limitations or injury
0.016*
9. Being surrounded by exercise/physical activity @ work makes me
0.325
not want to exercise
10. Facilities are not open when I am available to exercise
0.158
11. Discouraged to exercise by co-workers
0.270
12. Family obligations or commitments
0.061
13. Discouraged to exercise by family members/significant others
0.815
*Denotes significant finding between TS and NTS (p<0.05)
**Denotes significant finding between TS, NTS and TS/NTS (p<0.05)
Statement two, feeling self conscious exercising amongst other exercisers, had an
average score of 1.71 with TS ATCs and 1.32 with NTS ATCs. This was a difference of
0.41. Although a difference was found to exist between the TS and NTS; ATCs in both
51
settings considered statement two a weak barrier. Barrier six, intimidated by fit
individuals, had an average ranking of 1.55 with the TS and 1.15 with the NTS; while
statement eight, unable to exercise due to current health limitations or injury, averaged
1.60 with the TS and 2.08 with the NTS. All of these statements were regarded as weak
barriers based on the Likert scale used for this study; however, differences did exist
between the settings on the level of weakness each barrier maintains for that particular
setting (See table 10).
Barrier one, lack of time as a result of hours spent at work, was the strongest
barrier for all three ATC groups. Barrier one was the only statement to have received
ranking above 3 by all three settings (TS: 3.62, NTS: 3.42, and TS/NTS: 3.89). Statement
twelve, family obligations/commitments, was the only other barrier to receive a score
above 3. The average rankings for family obligations barrier were 2.73 for the TS, NTS
3.19, and the TS/NTS 2.95 (See table 10). Eleven of the thirteen barriers were ranked
below 3 and did not provide the ATC settings with strong limitations to exercise.
52
Figure 7
Average Barrier Rankings for TS, NTS, and TS/NTS Groups
4.5
4
Average Ranking
3.5
3
2.5
TS
2
NTS
1.5
TS/NTS
1
0.5
0
1 2** 3
4
5 6** 7
8*
9
10 11 12 13
Barrier Statement
*Denotes significant finding between TS and NTS (p<0.05)
**Denotes significant finding between TS, NTS, and TS/NTS (p<0.05)
Summary
Three groups were identified from this survey. The TS, NTS and TS/NTS were all
certified athletic trainers; however, the one unique factor that separated these groups was
the workplace setting. The researcher hypothesized no differences would exist between
the original groups (TS and NTS) related to their exercise behaviors, motivations, and
barriers.
The ATCs used in this study had many similarities and trends. No differences
were found between the three settings in regards to work hours a week. There were also
no differences found regarding days a week spent exercising and exercising with a
53
partner. These groups also maintained similar years in the field of athletic training,
similar equipment and facilities at the work place, and similar times spent exercising.
These trends reveal strong similarities between the TS, NTS, and TS/NTS ATC.
The TS, NTS, and TS/NTS had no differences in regards to their ranking of the
social work environment motivators. All three groups ranked statement five, having the
knowledge and education about the benefits of exercise, as their strongest social
motivator towards exercise. This statement was actually the strongest motivator of the
social and physical motivator statements.
Specific differences were noted between the three groups identified in this study.
The physical environment motivators revealed the first significant differences between
the ATC settings. Three physical environment statements were found to have differences
between the settings, and included statements: 2, 9, and 14 (see Table 7). Statement 14
was the strongest physical motivator for the TS and TS/NTS. These differences revealed
that physical environment motivators were stronger motivators for the TS and TS/NTS
than the NTS.
Differences were also found between the settings in regard to exercise barriers.
The strongest barriers to exercise for all groups were: lack of time and family obligations.
Barrier statements 2, 6, and 8 (see Table 9) all found differences between the groups.
Statements two and six were stronger barriers to the TS and TS/NTS than the NTS; while
statement eight was a stronger barrier for the NTS than the TS and TS/NTS.
Although the groups are unique regarding the workplace setting; only a few
specific differences were found. TS and NTS female ATCs vary in their rankings
54
regarding three physical work environment motivators and three exercise barriers. All
other factors analyzed from the provided data found no significant differences between
the TS and NTS female ATC.
55
Chapter 5
DISCUSSION
Numerous chronic diseases can be prevented by modifying an individual’s
physical activity level (Wendel-Vos, Schuit, De Niet et al. 2004). In order to determine
how to help perpetuate a more active population it is important to identify factors that
support and inhibit exercise participation. The social-ecological framework is a multifaceted view of the physical and social environment that may explain how physical
activity can be perpetuated in individuals by identifying specific factors that affect
physical activity decisions (Fleury & Lee, 2006). Studies have previously focused on the
effect neighborhoods and communities have on exercise participation (Booth, 2005;
Lopez-Zetina, Lee, & Friis, 2004); however, the workplace is one environment with
limited research.
The present study focused on the female certified athletic trainer and the trends,
motivations and barriers they experienced in regard to exercise activity. The purpose of
this study was to determine if the physical and social work environment of the female
ATC influenced their exercise participation, if any differences existed between the ATC
settings in regards to exercise participation, and if this work environment provided any
specific exercise barriers or limitations. Information gained from this study could be used
to create programs for other professions in an attempt to promote physical activity in the
workplace and healthy lifestyle choices.
56
Social-ecological Framework
The social-ecological framework focuses on multi-level factors that influence an
individual’s decision to exercise. This framework takes a broad perspective on different
motivational variables in order to provide the most thorough understanding of how
different interpersonal, intrapersonal, physical environments, organizations and policies
affect an individual’s decisions regarding physical activity (Fleury & Lee, 2006). This
framework was the key component of the present study and was used to create a survey
designed to identify social and physical work environment motivators as well as barriers
to exercise.
Intrinsic and Extrinsic Motivation
Intrinsic and extrinsic motivation affect exercise participation (Maltby & Day,
2001), and fall under the variables designated by the social-ecological framework (Fleury
& Lee, 2006; Sallis et al., 2006). The present study focused on both types of motivation
in order to more accurately gain specific knowledge regarding the traditional setting and
non-traditional setting certified athletic trainer’s exercise habits. Intrinsic motivators
included such things as an individual’s knowledge and beliefs in exercise, challenge,
enjoyment, and stress reduction (Kilpatrick, 2005). These motivators are affected by the
individual themselves and are not easily affected by external forces, while extrinsic
motivation, appearance, weight management, and social recognition, are more easily
affected by external forces (Kilpatrick, 2005). Both forms of motivation play a role in
exercise participation and may change over time depending on the external stimulus and
57
an individual’s personal beliefs and knowledge towards physical activity (Maltby and
Day, 2001).
Social and Physical Work Environment
Social and physical work environment motivators specific to this study were
created using the socio-ecological framework discussed by Fleury and Lee (2006).
Social motivators included: support/encouragement from others, social acceptance and
norms related to exercise/physical activity, knowledge and beliefs in exercise and seeing
others exercise (Fleury & Lee, 2006). These examples were used to create social work
environment statements specific to the TS and NTS ATC workplace. Eight social work
environment statements were ranked by the subjects to determine which social motivators
played a role in the ATCs decision to exercise and allowed the researcher to compare the
two settings of ATC, TS and NTS, in order to identify any differences.
Physical work environment motivators were also created using the descriptions
found in the Fleury and Lee study (2006). Safe equipment and facilities, convenience,
and affordability were all described as physical environmental factors that supported
exercise behavior (Fleury & Lee, 2006; Sallis et al., 2006). These examples were used to
create specific statements that described physical environments the TS and NTS ATC
may encounter in the workplace. The physical work environment statements were also
ranked by the ATCs in order to compare the two groups, and determine any physical
environment factors that motivate ATC exercise participation. A total of six physical
work environment statements were created from the descriptions found in the Fleury and
Lee study (2006).
58
Exercise Barriers
The social-ecological framework was helpful to determine exercise motivators;
however, for the purpose of this study it was also important to identify exercise barriers.
Understanding barriers that limited exercise provided another level of information that
could be used in creating programs and interventions designed to promote physical
activity. Three specific types of barriers were used to create exercise barrier statements
specific to the TS and NTS ATC. These barriers included: psychological/personal, social,
and environment. Thirteen total barriers were created by the researcher specific to the
ATC work setting. These barriers were ranked by the subjects in order to determine any
differences between the TS and NTS and to identify key barriers that affect exercise
participation.
Survey Results
A non-validated survey was created by the researcher to help identify specific
motivations and barriers in the ATC workplace. The survey was created from research
focused on a multi-level approach to exercise motivation (Fleury & Lee, 2006;
Plotnikoff, 2005; Sallis et al., 2006) and altered to relate to the chosen subjects of study.
Demographics regarding age, years as an ATC, and exercise habits were identified
regarding the TS and NTS ATC, including information which focused on exercise
motivation and barriers. Fourteen statements specific to the social and physical work
environment of the ATC were ranked by the subjects as weak or strong exercise
motivators, and thirteen barrier statements were ranked by the subjects using the same
59
ranking scale. Following an analysis of demographic data three groups emerged; the TS,
NTS and TS/NTS.
Three hypotheses related to the demographic information collected about the
ATCs in this study. An independent T-test was used to compare the means of the TS and
NTS in order to determine any differences in hours worked (H1), days a week spent
exercising (H2), and exercising with a companion (H3). No differences were found
between the TS and NTS, and no differences were found after a one-way ANOVA that
compared all three settings (TS, NTS, and TS/NTS).
Social Work Environment Rankings
The highest scoring work environment statement was a social motivator, stating
that the ATC’s knowledge and educational background about the benefits of exercise
motivated them the most. This social motivator was an aspect of the intrapersonal
variable identified in the social-ecological framework (Fleury & Lee, 2006), and plays a
strong role in the ATC’s decision to exercise. This finding was consistent with other
researchers who have found that knowledge and attitudes towards exercise may have an
effect on exercise participation (Resnick, 2006; Schutzer & Graves, 2004; Shepard,
1985). To identify any differences between the TS and NTS (H4), an independent T-test
was done to compare the means of each social work environment statement. This was
also done via one-way ANOVA to compare all three settings. No differences were found
after statistical analysis between the TS, NTS, and TS/NTS. According to the subjects
rankings, having an educational background and knowledge about the health benefits of
60
physical activity was the strongest motivator and helped to motivate all ATC’s regardless
of their work setting in their choice to participate in physical activity.
Physical Work Environment Rankings
The ATC’s knowledge and background of the human body coupled with their
external environment provides them with the ideal setting to adhere to exercise behavior.
The highest ranked physical work environment motivator, according to the subjects in
this study, was being surrounded by exercise in the workplace. This finding was
consistent with previous research. Creating living environments that support active
lifestyles and allow individuals more opportunity for activity results in more physical
activity (Brownson, 2001; Motl et al. 2005). Having exercise equipment in close
proximity to the work space and directly viewing exercise facilities resulted in a stronger
ranking for the TS and TS/NTS; however, the NTS ranked this motivator weak,
suggesting that TS and TS/NTS ATCs find the physical work environment stronger
motivators than the NTS. A possible explanation for this outcome could be the age of TS
(M: 32.7 years), NTS (M: 35.2 years), and TS/NTS (M: 30.1 years). A study by Schuler
(2004) found that as individuals age their motivations for exercise changes with more of a
focus on physical health, than body shape. While there were not large differences in age
between subjects in this study, the oldest group (NTS) ranked social work environment
motivators higher than the physical work environment motivators lending support to the
findings from the Schuler (2004) study.
Significant differences were identified between the TS, NTS, and TS/NTS in
regards to the physical work environment (H5). After an independent T-test, differences
61
were found for statement two (Seeing exercise equipment at work), nine (Seeing facilities
at work that allow for exercise) and fourteen (Being surrounded at work by exercise in
general). Differences were found for all three settings after a one-way ANOVA for
statements nine and fourteen. These differences signified that the TS and TS/NTS ranked
the physical work environment motivators stronger than the NTS. The strongest physical
motivator for all settings was being surrounded at work by exercise in general.
The social work environment motivators were ranked stronger by all ATC
settings when compared to the physical work environment. This revealed that the social
motivators played a stronger role in exercise behavior for this group of individuals than
the physical work environment. Social work environment motivators had aspects of
intrinsic and extrinsic motivation; which were both important factors in exercise
adherence (Maltby and Day, 2001). The physical work environment primarily was an
external motivator and according to a study by Marshall (2002) external motivators had a
short term effect on exercise behavior. The ATCs in this study elicited stronger
motivations from the social work environment; however, the physical work environment
also played a role in their decision to exercise. The results from the present investigation
are consistent with these findings.
Exercise Barriers
Two key barriers to exercise participation were noted by all three groups: lack of
time and family obligations. These findings were consistent with Williams (2006) who
noted two primary barriers to exercise in African American women: lack of time and
family priorities. Lack of time as a result of hours spent at work was the highest ranked
62
barrier statement. All ATCs had average work weeks ranging from 40-43 hours and had
facilities or equipment available for their use in the workplace; however, TS, NTS and
TS/NTS rarely exercise at work.
The highest ranked barrier for all three groups was lack of time; however, all of
the ATCs had equipment or facilities at work available for their use. The TS used work
facilities to exercise 1.2 days a week, while the TS/NTS and NTS used their work
facilities less than one day a week. Even though the opportunity and convenience to
exercise was available for all three ATC settings, they did not appear to take advantage of
this fact. The researcher did not question the ATCs on their reasons to use or not use their
work facilities/equipment for physical activity. This could have provided a better
understanding of why ATCs chose to not exercise at work. It may be possible that ATCs
do not want to spend extra time at work, feel distracted or stressed exercising at work, or
perceive their job as a barrier. Although it was unknown why the ATCs in this study did
not exercise at work, it can be said that having equipment available was not an assurance
that it would be used.
Significant differences were found between the TS and NTS ATCs regarding
exercise barriers. These included: self conscious exercising amongst other exercisers
(statement two), intimidated by fit individuals (statement six), and unable to exercise due
to current health limitations or injury (statement eight). An independent T-test was used
to compare the means for each barrier statement for the TS and NTS. The TS and
TS/NTS ranked self conscious exercising amongst other exercisers and intimidated by fit
individuals as stronger barriers to exercise than the NTS. This was different for barrier
63
statement: unable to exercise due to current health limitations or injury. This barrier was
ranked as a stronger deterrent to exercise by the NTS, and weak for the TS and TS/NTS.
Two significant differences were found between all three groups after a one-way
ANOVA. These differences were found for barrier statements two and six. The TS and
TS/NTS ranked statements two and six as stronger barriers than the NTS.
Family obligations was the second most common barrier, however, it was ranked
differently between all three groups. The NTS ranked family obligations as a stronger
barrier than the TS and TS/NTS. Age may be the contributing factor to this barrier. The
average age of the NTS was 35 years, giving these individuals more of an opportunity to
have children, a spouse or partner, and possibly elderly parents in need of care. Williams
(2006) found an individual’s lack of child care to be a deterrent from exercise, and
Shepard (1985) found that individuals with unsupportive spouses were more likely to
quite exercise programs. These are two possible reasons that the NTS ranked family
obligations higher than the TS and TS/NTS. The NTS was in an age category that may be
affected the most by family obligations and ranked this barrier as a stronger deterrent to
exercise than the other two ATC groups.
Future Research
Convenience of exercise was a strong factor identified in previous studies
(Brownson, 2001; Fleury & Lee, 2006; Motl et al., 2005). Availability and accessibility
to exercise facilities played a major role in an individual’s decision to be physically
active (Fleury & Lee, 2006). The subjects in this study were asked if they had exercise
facilities available for their use. All ATCs had some type of exercise equipment or
64
facility for their use. The ATCs were not asked why they chose to not exercise in the
workplace. A follow up question could have determined reasons why workplace facilities
were not used by the ATCs. This knowledge may have provided the researcher with a
better understanding of barriers the workplace itself creates. Understanding why these
groups of ATCs did not exercise at work would have helped the researcher identify
specific factors that could be addressed to help promote active lifestyle choices in the
workplace. Further researcher could focus on reasons why exercising at the workplace
may not be desired.
Studies have suggested that social support and group exercise promotes exercise
adherence (Brownson, 2001; Resnick, 2005). The ATCs in this study rarely exercised
with a partner and did not take advantage of the benefits partner exercise can bring to an
individual. It would be interesting to understand why the ATCs in this study did not
exercise more often with a partner. It is possible ATCs exercise alone often due to
personality characteristics or as a result of their job setting. This information would be
helpful because it could identify barriers to exercise that were not identified in this
current study.
Summary
Female ATCs served as subjects in this study to determine if specific social and
physical aspects of the work environment motivated exercise participation. The
educational background of the ATC was found to be the most important factor regarding
decisions to participate in exercise for all groups (TS, NTS, and TS/NTS). This finding
maybe useful in designing workplace programs to promote exercise. An employee’s
65
knowledge about the benefits of exercise may possibly provide a more positive outlook
on physical activity and promote exercise behaviors.
Another important finding in this study was the fact that although all ATCs had
convenient exercise facilities at work, they rarely used them for physical activity. This
suggests that convenience was not a strong motivator for these subjects. Having the
equipment available for individuals was only one aspect of a workplace program and
cannot be the only factor addressed when designing a program. Consideration should be
given to the social-ecological framework (Plotnikoff, 2005; Sallis et al., 2006) which
addresses exercise behavior from many avenues.
66
APPENDICES
67
APENDIX A
Survey: Demographics, Exercise Motivations and Barriers
68
Section 1
1. How many years have you been an NATABOC Certified Athletic Trainer:
a. less than 1 year
e. 16-20
b. 1-5 years
f. 21-25
c. 6-10 years
g. 26-30
d. 11-15 years
h. 30 or more years
2. Please provide your age: ________
3. On average, how many hours a week do you work? ___________________
4. In which setting do you work:
a. Traditional Athletic Trainer (high school, college, university, junior
college, professional sports)
b. Non-Traditional Athletic Trainer (hospital, the military, industrial and
commercial, performing arts, physician extender, sport rehab. clinic etc.)
c. Both
5. What is your job title:
a. Graduate assistant
b. Assistant Athletic Trainer
c. Head Athletic Trainer
d. Physician Extender
e. Physical Therapist Aid
f. Ambulatory Care Practitioner
g. On-site Occupational ATC
69
h. Hospital-based Care Practitioner ATC
i. Community Sports Team Clinical ATC
j. Other (please describe_________________________________________)
6. What exercise facilities/equipment are available for your use at the work place:
a. Treadmill
b. Stationary bike
c. Elliptical Machine
d. Stairmaster
e. Rock Climbing Wall
f. Basketball Courts
g. Indoor Gym(s) or Recreation Center
h. Weight Room (free weights/machines)
i. Track
j. Trails & walkways for walking, running, bike rides
k. Pool (lap/diving)
l. Tennis courts
m. Racquetball courts
n. Athletic/recreation fields
o. Exercise/group classes devoted to fitness (i.e. Pilates, boot camp, aerobics)
p. Other (please describe ________________________________________)
70
7. How many days a week do you exercise:
a. 0
e. 4
b. 1
f. 5
c. 2
g. 6
d. 3
h. 7
8. On average how many minutes do you exercise at a time:
a. 0
f. 40-50
b. 10-15
g. 50-60
c. 15-20
h. 60 or more
d. 20-30
e. 30-40
9. How many days a week do you use the facilities at work to exercise:
a. 0
e. 4
b. 1
f. 5
c. 2
g. 6
d. 3
h. 7
10. Do you exercise with co-workers at work:
a. Yes, I only exercise with a co-worker.
b. Yes, I exercise with co-workers most of the time.
c. No, I exercise alone most of the time.
d. I always exercise alone.
71
Section 2
1. Do any of the following motivate or influence you to exercise?
(Rate each statement on a 1-5 scale with 1 being a least
motivating/influencing and 5 being a most motivating/influencing)
Watching other individuals exercise
1 2 3 4 5
Seeing exercise equipment @ work
1 2 3 4 5
Exercising with co-workers @ work
1 2 3 4 5
Safe exercise facilities @ work (i.e. campus police & security)
1 2 3 4 5
Having the knowledge and educational background about the
1 2 3 4 5
benefits of exercise
Observing the physique of exercising individuals
1 2 3 4 5
Having a trail or sidewalk system that allows you to walk at work
1 2 3 4 5
Working and socializing with co-workers who promote exercise
1 2 3 4 5
Seeing facilities at work that allow for exercise
1 2 3 4 5
Having co-workers who participate in exercise
1 2 3 4 5
Rehabilitating individuals post-injury or post-surgery
1 2 3 4 5
Having exercise equipment/facilities in close proximity
1 2 3 4 5
to your work space/office
Co-worker encouragement
1 2 3 4 5
Being surrounded @ work by exercise in general
1 2 3 4 5
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2. Do any of the following limit you from exercising on a regular basis?
(Rate each statement on a scale of 1-5 with 1 being weakest barrier and 5
being strongest barrier)
Lack of time, as a result of hours spent at work
1 2 3 4 5
Self conscious exercising amongst other exercisers
1 2 3 4 5
No safe place to exercise at work
1 2 3 4 5
No child care
1 2 3 4 5
Traveling for work
1 2 3 4 5
Intimidated by fit individuals
1 2 3 4 5
Do not like to exercise
1 2 3 4 5
Unable to exercise due to current health limitations or injury
1 2 3 4 5
Being surrounded by exercise @ work makes me not want to
1 2 3 4 5
exercise
Facilities are not open when I am available to exercise
1 2 3 4 5
Discouraged to exercise by co-workers
1 2 3 4 5
Family obligations or commitments
1 2 3 4 5
Discouraged by family members
1 2 3 4 5
73
APPENDIX B
Guidelines and Packet for NATA Survey Distribution
74
NATA
NATA guidelines regarding lists for members conducting surveys
NATA certified members requesting lists for research purposes will be referred to their
district secretary for approval of their project. NATA will provide address lists or
email lists for approved research projects by certified members at the lowest rate (9
cents/name) – prepayment and a signed one-time use agreement required. There is
no limit to the number of contact names a certified member can request for his/her
project. NATA does not offer an email broadcast service for certified members’
research broadcasts.
Student members sending up to 1,000 surveys can be done via email: A broadcast to a
maximum of 1,000 email addresses can be provided for student members conducting
research projects. NATA has the ability to provide a random sample of the population, if
it exceeds 1,000. NATA will transmit the cover letter (containing a link to the member's
questionnaire) via email to recipients. The transmission will be labeled as coming from
the researcher. If a follow-up reminder is desired, NATA will transmit a second letter to
the same members selected for the original broadcast.
Student member surveys of more than 1,000 will be conducted via U.S. mail: Since
email lists are not available in quantities above 1,000, member research that requires a
population greater than 1,000 is handled in the following manner. NATA can provide
name and address of the population desired so the member can send the hard copy
surveys via U.S. mail. The member must sign an agreement indicating the data will be
used only one time and only for the stated purpose. NATA will forward the data
electronically to the member, who can then print the labels for the mailing. If a follow-up
reminder is desired, the member must once again sign a “one time use” agreement for the
second mailing.
Disclaimer: The NATA Board of Directors has implemented this policy in regards to
student surveys:
Graduate Student Surveys: When a graduate student asks the national office for a
mailing or email list to send a survey, s/he is referred to the relevant district secretary. If
the survey meets the District Secretaries/Treasurers Committee’s requirements, the
graduate student is given approval to receive a free list. The board was concerned the
recipients may think the surveys are NATA-sponsored. The board asked that the
graduate students be required to print a disclaimer at the beginning of the questionnaire to
alleviate this confusion. This wording was subsequently developed: “This student
75
survey is not approved or endorsed by NATA. It is being sent to you because of NATA’s
commitment to athletic training education and research.” (6/13/02)
NOTE: THIS POLICY IS SUBJECT TO CHANGE WITHOUT NOTICE.
Only NATA student members may access this service.
76
NATIONAL ATHLETIC TRAINERS’ ASSOCIATION, INC.
RESEARCH STUDY
Contact List Request Form
NATA
Request Date: ___________________________
Date Needed: _____________________
Member Making Request: ______________________________________________________
NATA Member Number ____________
__No
(Required)
Student Member? __Yes
Mailing Address: _____________________________________________________________
____________________________________________________________________________
City: ___________________ State: __________ Zip: ___________ Phone: ________
E-Mail Address: _________________________ Fax: ______________________________
Title of Study: _______________________________________________________________
____________________________________________________________________________
Purpose Statement: ___________________________________________________________
____________________________________________________________________________
Institution where Research is Being Conducted: ____________________________________
Advisor’s Signature (if applicable): _____________________________ Date:
___________
Funding Source of Study: ______________________________________________________
**
**
Please include a copy of your survey instrument, informed consent
form, and documentation of approval from your Institutional Review
Board (IRB).
Student Members: If you are requesting an email broadcast from the
National Office for notification of a web site for your survey, you MUST
provide the letter of announcement that you plan on using in the
broadcast as well as your current email address.
77
NATIONAL ATHLETIC TRAINERS’ ASSOCIATION, INC.
RESEARCH STUDY
Contact List Request Form
NATA
Labels:
________ Pressure Sensitive (“1 x 2 5/8” –
Avery 5160) Peel and Stick
________ Comma, Quote Delimited Disk-Format
________ Comma, Quote Delimited E-mail AttachmentFormat
Email Survey: _________Email broadcast service by National Office
(max. 1000 recipients)
(available to student members only)
_________Name and address file by email
attachment to accompany email
broadcast service (for second reminder)
Type of Contact:
All Districts or Specific District(s): _____________
State(s), International, Other (specify): ___________________________________________
____________________________________________________________________________
____________________________________________________________________________
Member Type:
____
____
____
____
____
____
____
____
____
All Categories
Regular Certified
Student Certified
Retired Certified
Associate
Student-Undergrad
Student-Graduate
Intl NonCertified
Intl Certified
Setting: ____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
Clinical
Clinical/Industrial
College Student
Corporate
Government
Health/Fitness
High School
HS/Clinic
Hospital
Industrial
Junior College
Law Enforcement
Middle/Jr High
Performing Arts
Pro Baseball
Pro Basketball
Pro Football
Pro Golf
Pro Hockey
Pro Soccer
Pro Tennis
Pro Sports
Rodeo
78
____ Sales/Marketing
____ Sports Club
____ Univ & College
____ Youth Sports
____ Other Professions
____ Unemployed
CONTACT LIST USE AGREEMENT
I certify that the requested NATA mailing list will be utilized by the above-mentioned
organization/individual only for mailing of the study specified. I verify that the list will
not be duplicated, copied, or reproduced in any manner, but only for the aforementioned
one-time use. One-time use does not allow the purchasing/receiving entity to provide
NATA's members with a "subscription" or any other product or service that reaches
members in any way more than once without the member's individual consent.
___________________________
Applicant Signature
______________________
Date
___________________________
Approved by (District Secretary)
______________________
Date
79
SAMPLE Contact Cover Letter for student surveys
Dear Fellow Certified Athletic Trainer:
I am a master’s degree candidate at (University Name), requesting your help to complete
part of my degree requirements. Please follow the link at the end of this letter to an
online survey titled: (Title of Project).
This student survey is not approved or endorsed by NATA. It is being sent to you
because of NATA’s commitment to athletic training education and research.
The questionnaire consists of __ demographic questions and __ Likert Scale (1-very
uncomfortable to 5 very comfortable) questions, which will take about five to seven
minutes to complete.
One thousand randomly selected certified NATA members in (Location Demographic)
with a listed email address are being asked to submit this questionnaire, but you have the
right to choose not to participate. The (University Name) Institutional Review Board
has approved this study for the Protection of Human Subjects.
This is a completely anonymous questionnaire and upon submission, neither your name
nor email address will be attached to your answers. Your information will be kept strictly
confidential.
As a fellow certified athletic trainer, your knowledge and opinions regarding this topic
makes your input invaluable. Please take a few minutes to fill out the anonymous
questionnaire you will find by clicking on this link and submit it by (Date):
(http:/__________________________________ /)
Thank you for your time and consideration.
Sincerely,
Name of Member and Credentials
Institution Name
Address
Email Address
Participants for this survey were selected at random from the NATA membership database according to
the selection criteria provided by the student doing the survey. This student survey is not approved or
endorsed by NATA. It is being sent to you because of NATA’s commitment to athletic training
education and research.
80
APPENDIX C
Student’s Contact Cover Letter for Survey
-
81
Dear Fellow Certified Athletic Trainer:
I am a master’s degree candidate at California State University, Sacramento requesting
your help to complete part of my degree requirements. Please follow the link at the end
of this letter to an online survey titled: The Social and Physical Work Environment of the
Traditional and Non-Traditional Female Certified Athletic Trainer as a Motivator of
Exercise Participation.
This student survey is not approved or endorsed by NATA. It is being sent to you
because of NATA’s commitment to athletic training education and research.
The questionnaire consists of __ demographic questions and __ Likert Scale (1-very
uncomfortable to 5 very comfortable) questions, which will take about five to seven
minutes to complete.
One thousand randomly selected certified NATA members in continental United States
with a listed email address are being asked to submit this questionnaire, but you have the
right to choose not to participate. The California State University, Sacramento
Institutional Review Board has approved this study for the Protection of Human Subjects.
This is a completely anonymous questionnaire and upon submission, neither your name
nor email address will be attached to your answers. Your information will be kept strictly
confidential.
As a fellow certified athletic trainer, your knowledge and opinions regarding this topic
makes your input invaluable. Please take a few minutes to fill out the anonymous
questionnaire you will find by clicking on this link and submit it by (Date):
(http://www.surveymonkey.survey1332934.com/)
Thank you for your time and consideration.
Sincerely,
Heather Marie Farwig, ATC
California State University, Sacramento
6000 J Street, Sacramento, Ca. 95819
hfarwig@csus.edu
Participants for this survey were selected at random from the NATA membership database according to
the selection criteria provided by the student doing the survey. This student survey is not approved or
endorsed by NATA. It is being sent to you because of NATA’s commitment to athletic training
education and research.
82
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