Higher depression symptoms, measured by the CES-D, were significantly associated with higher physical activity barriers in overweight/obesity Latino adults enrolled in a weight loss trial even after controlling for other potential confounding factors. The mean BBAQ score (19.0) was slightly lower than other studies using the BBAQ in a community sample of women (median = 25.0)(21) and inactive pregnant women (mean 22.3)(34). Lack of resources for physical activity may be a particularly important barrier for this group. These results illustrate the importance of tailoring physical activity interventions for Latinos to depression levels.
Understanding how we can increase the impact of physical activity interventions for depression in Latinos is an important public health question. Though a number of studies identified physical activity as an effective treatment for depression (35, 36), some studies also observed null-effects(37), or found that the benefits minimize over time(38). The top barriers to physical activity in this sample were lack of willpower, time and energy. Several other studies in Latinos and Hispanics(16, 17), a community sample of Brazilian women (39) and inactive pregnant women (34) observed similar top barriers. Health care providers who provide physical activity education programs and researchers who design physical activity interventions should focus on helping individuals to identify and overcome their barriers. For instance, to overcome the lack of time barrier, they can help participants identify opportunities for physical activity that work within their daily schedules. To overcome the lack of energy barrier, they can include opportunities that gradually increase in intensity. Research in Hispanic and African American women showed that actual time commitments do not always predict whether participants perceive lack of time as a barrier(40). Reducing perceived physical activity barriers, for instance by using Cognitive Behavioral Therapy (CBT) approaches, could greatly increase the effectiveness of physical activity interventions(41).
Our exploratory analysis indicated that the subscale, “lack of resources” might be the driving factor in the relationship between physical activity barriers and depression in Latinos. This relationship holds after correcting for education and income, factors associated with perceived lack of resources as physical activity barriers(39). The lack of resources subscale consists of questions such as “I don’t have access to jogging trails, swimming pools, bike paths, etc.” Other research found that environmental factors such as perceived neighborhood safety and access to facilities prevent Latinos from exercising(42). These results differ from our earlier work in community-dwelling women–social influence and lack of energy were the most important subscales related to depression in this sample(21). Latinos may perceive barriers distinct to non-Latino Whites.
Our research shows that in the design phases of clinical trials, researchers should pay particular attention to the influence of depressive symptoms on participants’ barriers and motivations to engage in exercise. They could also help Latino participants to identify low-cost and safe opportunities for exercise in their environment. Perceived lack of resources may stem from a lack of information on (free) exercise opportunities in people’s homes, workplaces, and neighborhoods(42). Helping individuals identify suitable opportunities through psychological therapies such as CBT or behavioral activation(43) may lower these perceived barriers.
Higher education and employment were associated with higher perceived physical activity barriers. This is in line with previous work(44). Educated and employed participants may have more demanding jobs, and thus perceive they are less able to find the time to engage in exercise. Socioeconomic status is associated with higher leisure time, but lower job-related physical activity(45). Higher education and employment may also increase awareness of the need for, and the lack of sufficient exercise (45). For example, people who are higher educated show greater intentions to engage in physical activity(46). Participants who were more highly educated may thus have been more aware of their physical activity barriers that stand in the way of sufficient exercise.
Strengths & limitations
This is the first study to assess the relationship between depression and physical activity barriers in a Latino community sample. We previously showed a link between physical activity barriers and depression in a community sample of women who signed up for a physical activity intervention (n = 310) (21). Here we replicate this finding in a new sample.
This study also has limitations. Before removing outliers, the positive relationship between physical activity barriers and depression was not significant. Further, the participants in this study were relatively high educated (69% had bachelor’s or higher degrees, compared to 20% in the US Latino community)(47). Additionally, we were not able to assess differences between groups within the Latino population. Latinos are a diverse ethnic population, with different national origins, immigration, acculturation status, and other socioeconomic characteristics, who also differ in physical activity behavior and depression prevalence. For instance, Latinos with a Cuban background report the lowest level of physical activity and those with a Puerto-Rican background the highest levels of depressive symptoms(8). Our study needs to be replicated in other, larger and more diverse, Latino community samples with enough statistical power to detect differences between subgroups.
In addition, the BBAQ does not assess culturally specific barriers. Earlier work found that, besides resources like time and money, Latinos often cite culturally specific barriers(48). These include different views on weight and body shape, and more negative views about physical activity(48). Of note, in this study the acculturation scale was not associated with the BBAQ scale (r = 0.18, p = 0.19). Future studies should quantify these cultural barriers and assess their relationship to depressive symptoms. Qualitative work could further elucidate how to overcome culturally specific depression-related barriers. Future research should also assess how the relationship between physical activity and depression changes over time, and if it is modified by physical activity interventions.