Under-represented groups need physical activity: parks and recreation should be the place for non-traditional activity.

Engaging in physical activity is not an easy task for most people. A variety of reasons including personal preferences, abilities and low self-efficacy often cloud the reasons to participate or to refrain from physical activity. However, reasons to engage in physical activity are plentiful, yet many individuals still refrain from participation. Even with the abundance of information about the benefits of physical activity, many groups are still underrepresented in the realm of exercise research, and there is poor translation from research to practice.

In 1996, the Surgeon General reported that Americans could substantially improve their health and quality of life by including regular and moderate amounts of physical activity into their daily lives. Health benefits from physical activity are thus achievable for most Americans, including those who may dislike vigorous exercise, and those who previously have been discouraged by the difficulty of adhering to a time-consuming program of vigorous exercise. Regular physical activity is defined as 30 minutes, most days of the week at a moderate intensity (National Centers for Disease Prevention and Health Promotion [NCDPHP], 2005). For those who are already achieving regular moderate amounts of activity, additional benefits can be gained by further increases in activity level (U.S. Department of Health and Human Services, 1996 [USDHHS]).

Benefits of Exercise on Mood and Self-efficacy

Depression is the most common psychological problem experienced today, affecting more than 20 percent of the U.S. population (Healthy People 2010 [HP2010], 2005; USDHHS, 1999). Numerous studies have shown that exercise can provide increased positive mood and health effects (e.g. Dunn, Trivedi, Kampert, Clark, & Chambliss, 2005; King et al., 2000; McAuley, Jerome, Marquez, Elavsky, & Blissmer, 2003). A study by Dunn and colleagues (2005) tested the effectiveness of exercise as a treatment for mild to moderate depression. They found that aerobic exercise consistent with public health recommendations, such as those by the Surgeon General, the American College of Sports Medicine (ACSM), and the Centers for Disease Control and Prevention (CDC), resulted in alleviated symptoms of depression.

As researchers continue to study the changing populations and exercise adherence, low self-efficacy has come to the forefront as one of the most influential deterrents of exercise (McAuley, Jerome, Marquez, Elavsky, & Blissmer, 2003). Self-efficacy, as defined by Bandura (1986), is the belief in one's capabilities to organize and execute the sources of action required to manage prospective situations. High sell-efficacy is the belief in one's ability to accomplish certain tasks. A person with high self-efficacy will most likely believe that he or she can begin and maintain physical activity as part of a daily routine.

Individuals with low self-efficacy are more likely to believe that initiating physical activity is too difficult for them. It influences actions, attitudes and behaviors and is an assessment of competence. Long-term adherence to an exercise program is associated with high levels of self-efficacy and may positively influence mood; however, research has been lacking on how to increase self-efficacy through increased levels of physical activity.

Under-represented Groups

Despite positive results in the limited research studying the effects of physical activity in under-represented groups, certain groups have often been overlooked regarding the promotion of physical activity. Groups such as those with multiple sclerosis, HIV and caregivers could dramatically benefit and experience improved mood and self-efficacy from physical activity. However, because of a variety of reasons including life circumstances, traditional recommendations, disease symptoms including depression and low self-efficacy, these under-represented groups may experience the negative impact of little or no exercise. Knowing and understanding the positive implications of physical activity and the proper implementation of such a program may prove valuable for many people.

Multiple Sclerosis

Multiple sclerosis (MS) affects motor, visual and sensory functions. People are most often diagnosed between the ages of 20 and 50, and about two-thirds of which are women (National Multiple Sclerosis Society [NMSS], 2004). Approximately 400,000 Americans have MS, and about 200 people are diagnosed each week (NMSS, 2004).

The features of the disease are unpredictable and no two cases are alike. Symptoms of MS include loss of balance, weakness, fatigue, visual problems, walking impairments and speech problems. Those with MS may also experience higher levels of depression due to the nature of chronic disease as well as the disease process, which damages nerve fibers and myelin deep in the brain (NMSS, 2004). Although some people with MS may never experience prolonged depression, it is important to be aware of the chance of depression knowing the progression and unpredictability of the disease.

Unfortunately, those with MS traditionally have been discouraged from participating in physical activity, often citing reasons of personal safety or lack of appropriate exercise modifications and high levels of extreme fatigue. Creating a physical activity program that accounts for the needs of the individual and the uncertainty of the disease would allow for continued participation, thus achieving the physical and psychological benefits.

Research now shows that there are several benefits, especially psychologically, for those with MS (Morgan, 1997). One study by Sutherland, Andersen and Stoove (2001) suggested that physical activity for those with MS may show positive increases in energy and vigor and does not, as was once believed, result in fatigue. This study indicated that it would be best to review and reevaluate research of nontraditional thought patterns because of the psychological impact of inactivity, perceptions of incompetence and recommendations that proposed inactivity.

It appears that people with MS may experience dramatic gains in self-efficacy by engaging in physical activity, something that was once seemingly off limits that has now become possible, thus achieving increased positive mood and self-efficacy. Creating a physical activity program that accounts for the needs of the individual and the uncertainty of the disease would allow for continued participation.

HIV

The CDC (2004) reported there are approximately 850,000-950,000 people in the U.S. living with HIV, and 180,000-280,000 people who do not know they are infected. Currently, the main treatment of HIV includes taking prescription medication that can decrease or lessen the symptoms of the disease. Some symptoms of the disease include fatigue, low appetite and weight loss. Those with HIV/AIDS, as with many individuals with chronic illness, may also suffer from depressive symptoms. Because typical depressive symptoms and symptoms of HIV/ AIDS are similar, it is difficult to determine a direct relationship between the two.

While prescription medicine is a necessary form of treatment, it is also important to discover additional ways to treat some of the symptoms of the disease. Physical activity is one such option. Further, different medications may also have psychological side effects. "In advanced symptomatic HIV disease, a number of opportunistic infections (OIs) as well as HIV itself can affect the brain so as to produce symptoms of depression" (Pinksy, 2003, p.3). Therefore, HIV as a chronic disease can put individuals at a higher risk of depression, but the progression of the disease could also physically affect the brain, creating symptoms of depression.

The psychological well-being of the HIV-positive population has been studied in a variety of research settings (e.g. Lox et al., 1995; Pinsky, 2003; Rojas, Schlicht, & Hautzinger, 2003; Stringer et al., 1998). In a small study of asymptomatic but HIV-positive individuals, Rojas and colleagues (2003) showed that there was an improvement in "physical well-being and the supportive atmosphere among the participants" upon engaging in an exercise program. Perhaps most remarkable is that the participants felt an increase in their ability to cope, a sense of belonging and were better able to tackle daily tasks and emotions (Rojas et al., 2003).

Thus, exercise may be an integral part of increasing self efficacy and mood in HIV-positive individuals. As with MS, physical activity programs for people with HIV/AIDS need to be flexible and individualized because the symptoms of the disease can change from day to day. Taking control early on through increased physical activity is one of the best preventative maintenance measures as it potentially may be helpful in increasing mood and self-efficacy.

Caregivers

Another such group where there is a lack of physical activity research is informal caregivers. This area of research would prove beneficial in promoting not only the physical benefits, but perhaps more importantly, the psychological benefits. Through time, the caregiver experiences increased stress and burden, and becomes less able to take care of the patient or more importantly, their personal well-being (Burton et al., 1997; van den Heuvel et al., 2001; Van Puymbroeck, 2004).

In addition, caregiving is a full-time position with little or no time to take care of personal health concerns including anything from doctor's appointments to exercise (Castro et al., 2002). Because of these additional responsibilities, the caregiver often foregoes leisure, including physical activity, because it is seen as outside of necessary tasks. However, taking time for these activities can leave the caregiver feeling guilty or that he or she is neglecting obligation. When this occurs, some caregivers may experience symptoms of depression or low-self-efficacy.

Offering opportunities that provide for both the caregiver and the care recipient could allow for a positive and effective leisure environment. Bedini and Phoenix (1999) addressed this issue as they studied ways to meet the needs of the caregiver by promoting an environment that increased leisure and decreased feelings of guilt. Educational activities that show practical value are more likely to be worthwhile for the caregiver (Bedini & Phoenix, 1999).

Understanding that the caregiver needs special accommodations in order to engage in physical activity will help in discovering rewarding programs and experiences. By increasing appropriate physical activity opportunities for the caregiver, each individual may experience increased positive mood and feel better able to cope with the situation.

Conclusion

Because of the abundance of research and literature on physical activity, it is unfortunate that any group is being left out of the expanding research. It is clear that many groups could benefit from physical activity and its effect on mood and self-efficacy. More work needs to be done to establish modified physical activity programs and opportunities to provide for under-represented groups. Park and recreation facilities could fill a tremendous need for many individuals by providing modified physical activity programs.

Being aware of the specific needs of these groups will help in the implementation and design of programs and experiences.

The park and recreation field is primed to discover ways to make physical activity and recreation possible for individuals of all groups. Knowing the research findings and implications of physical activity on mood and self-efficacy should enhance the ability to make physical activity opportunities possible for everyone. Hopefully the information presented will become a catalyst to increasing awareness and opportunities in physical activity for under-represented populations, so that more individuals may have the chance to experience the benefits of improved mood and self-efficacy.

RESEARCH INTO ACTION: TARGETING UNDER-REPRESENTED GROUPS

Unfortunately, there is often a disconnect between academic research and practitioners. Much is known about the benefits of exercise and the adverse effects of an inactive or sedentary lifestyle, but for a variety of reasons, relevant information is not reaching those who need it and are in a position to influence the lives of many individuals. Park and recreation professionals can adopt these solutions to targeting these groups:

1. Offer education sessions to provide information on the benefits of participating in physical activity for under-represented groups.

2. Offer classes such as "gentle yoga," or beginner/introduction classes aimed to make all individuals feel comfortable.

3. Park and recreation facilities need to provide resources for employees that update physical activity recommendations and benefits.

4. Be the first in your community to reach out to underrepresented groups to increase awareness and opportunities for physical activity for individuals who may otherwise be overlooked.

5. Invest in park and recreation renovations and updates that make facilities more user-friendly for individuals of all ability levels.

To find more information on the Web, try these links:

www2.gsu.edu/~wwwfit/ benefits.htm www.nutristrategy.com/ health.htm

For a list of articles on the benefits of exercise, try this link:

www.bodytrends.com/articles/ benefits

References

Bandura, A. (1997). Self-efficacy: The exercise of control New York: Freeman & Co.

Bedini, L. A., & Phoenix, T. L. (1999). Addressing leisure barriers for caregivers of older adults: A model leisure wellness program. Therapeutic Recreation Journal, 33, 222-240.

Burton, L. C., Newsom, J. T., Schulz, R., Hirsch, C. H., & German, P. S. (1997). Preventive health behaviors among spousal caregivers. Preventive Medicine, 26, 162-169.

Castro, C. M., Wilcox, S., O'Sullivan, P., Baumann, K., & King, A. (2002). An exercise program for women who are caring for relatives with dementia. Psychosomatic Medicine, 64, 458-468.

CDC. (2004). HIV prevalence in the United States, from http://www.cdc.gov/hiv/stats.htm#hivest

Dunn, A. L., Trivedi, M. H., Kampert, J. B., Clark, C. G., & Chambliss, H. O. (2005). Exercise treatment for depression. American Journal of Preventive Medicine, 28, 1-8.

Healthy People 2010 Leading Health Indicators. Retrieved 2/21/2005, from http://www.healthypeople. gov/Document/HTML/uih/uih_4.htm

King, A. C., Pruitt, L.A., Phillips, W., Oka, R., Rodenburg, A., & Haskell, W.L (2000). Comparative effects of two physical activity programs on measured and perceived physical functioning and other health-related quality of life outcomes in older adults. Journal of Gerontology, 55A, M74-M83.

Lox, C. L., McAuley, E., & Tucker, R.S. (1995). Exercise intervention for enhancing subjective well-being in an HIV-1 population. Journal of Sport & Exercise Psychology, 17, 345-362.

McAuley, E., Jerome, G.J., Marquez, D.X., Elavsky, S., & Blissmer, B. (2003). Exercise self-efficacy in older adults: Social, affective, and behavioral influences. The Society of Behavioral Medicine, 25(1), 1-7.

Morgan, W. P. (1997). Physical activity and mental health. Washington, DC: Taylor & Francis.

NCDPHP. (2005, April 19, 2005). from http://www.cdc.gov/nccdphp/

NMSS. (2004, 2006). from http.//www.nationalms society.org/

Pinsky, L. (October, 2003). Depression and HIV, from http.//www.projinf.org/pdf/depression.pdf

Rojas, R., Schlicht, W., & Hautzinger, M. (2003). Effects of exercise training on quality of life, psychological well-being, immune status, and cardiopulmonary fitness in an HIV-1 positive population. Journal of Sport & Exercise Psychology, 25, 440-455.

Stringer, W. W., Berezovskaya, M., O'Brien, W. A., Beck, C. K., & Casaburi, R. (1998). The effects of exercise training an aerobic fitness, immune indices and quality of life in HIV+ patients. Medicine and Science in Sports and Exercise, 30, 11-16.

Sutherland, G., Andersen, M. B., & Stoove, M. A. (2001). Can aerobic exercise training affect health-related quality of life for people with multiple sclerosis. Journal of Sport & Exercise Psychology, 23(122-135).

USDHHS. (1996). Physical activity and health: report of the U.S. Surgeon General Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Promotion.

van den Heuval, E., Witte, L., Schure, L., Sanderman, R., & Jong, B. (2001). Risk factors for burn-out in caregivers of stroke patients, and possibilities for intervention. Clinical Rehabilitation, 15, 669-677.

Van Puymbroeck, M. (2004). Predictors of quality of fife for caregivers at one and six months post stroke. Unpublished Doctoral Dissertation, University of Florida, Gainesville.

Shannon Berg graduated with her master's degree from the University of Illinois in Sport Management. After completing her undergraduate degree in education, she decided to use her education background to help teach others how to implement healthier lifestyles through exercise and nutrition. Marieke Van Puymbroeck is an assistant professor at the University of Illinois Urbana Champaign in the Department of Recreation, Sport and Tourism. Her research focuses on caregiving issues related to physical activity and health.

Edited by Mary Parr, Ph.D.