Perceived Benefits and Barriers to Physical Activity among LGBTQ+ College Students : Translational Journal of the American College of Sports Medicine

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Observational Trial

Perceived Benefits and Barriers to Physical Activity among LGBTQ+ College Students

Frederick, Ginny M.1; Bub, Kristen L.2; Evans, Ellen M.3

Author Information
Translational Journal of the ACSM: Fall 2022 - Volume 7 - Issue 4 - e000216
doi: 10.1249/TJX.0000000000000216

Abstract

INTRODUCTION

Members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community experience disparities in health outcomes across the life span, prompting calls for further research to characterize these disparities and their causes (1,2). The transition from adolescence to adulthood, often marked by leaving the family home to attend college, is associated with poorer health habits that may be more pronounced in LGBTQ+ persons, worsening health disparities (3,4). Habitual physical activity (PA) positively impacts many of the health outcomes in which disparities are seen for LGBTQ+ individuals, such as decreased risk of chronic disease and reduced anxiety and depression, both of which are notably higher among LGBTQ+ college students (5,6).

Fewer than half of US college students meet public health guidelines for PA, and adherence rates among LGBTQ+ college students are even lower (3,7–12). Although many studies demonstrating differences in rates of PA participation based on sexual orientation and gender identity exist (3,8,10,12–14), very few have examined underlying reasons for this discrepancy (15). One factor contributing to PA behavior among members of the LGBTQ+ community is perception of the benefits and barriers associated with engagement in PA (16,17). Our research indicates that perceptions of PA are associated with PA behavior, and LGBTQ+ students perceive fewer benefits and more barriers to engaging in PA than their non-LGBTQ+ counterparts (9). Moreover, in addition to general barriers to PA (e.g., lack of time, motivation), individuals identifying as LGBTQ+ may perceive unique benefits and barriers that are not adequately captured using standard quantitative measures such as the Exercise Benefits and Barriers Scale (EBBS), thus precluding the elucidation of factors contributing to suboptimal PA participation (15,17–22). Previous research using qualitative methodology, a useful tool to characterize perceptions and experiences (23), has suggested equivocal results regarding LGBTQ+ identity and PA benefits and barriers, with some individuals reporting barriers to PA related to their identity as LGBTQ+ and others finding no impact of LGBTQ+ status on PA participation (15,17–19,21,24). Because of this lack of consensus, further qualitative exploration of the PA experience of college students identifying as LGBTQ+ is warranted. Specifically, the elucidation of perceived benefits and barriers to PA among LGBTQ+ college students could inform health promotion programming to increase participation in this health-enhancing behavior.

In this context, the purpose of this study was to quantitatively assess objective PA behaviors and perceived benefits and barriers to PA among LGBTQ+ students, and to use a qualitative approach to further characterize perceived benefits and barriers to PA to identify salient themes unique to the LGBTQ+ college-student population.

METHODS

Study Procedures

Data used in the current study are derived from a parent study that assessed differences in PA and diet perceptions and behaviors among LGBTQ+ and non-LGBTQ+ college students at a large southeastern university (9). In a subgroup of individuals who identified as LGBTQ+, qualitative methodology complimented quantitative survey data to provide context regarding PA benefits and barriers. Thus, data collection had two parts. In part 1, all students at a large southeastern university (n = 38,390) were invited and eligible to participate in an online survey from January to May 2019. Part 1 provided 1) quantitative survey data which would be used to compare PA perceptions and behaviors among LGBTQ+ and non-LGBTQ+ students and 2) a subgroup of students identifying as LGBTQ+ for subsequent recruitment into the qualitative study of PA perceptions (part 2).

Of the 1060 part 1 participants who completed surveys, 165 identified as LGBTQ+ and were invited to participate in part 2, with 52 subsequently being enrolled. Eligibility criteria for part 2 included the following: 1) self-identified as LGBTQ+ and 2) was free from any limitations that would prevent engagement in PA. During part 2 visit 1, body mass index was determined, and accelerometer devices and instructions were provided. During visit 2, (7–10 d after visit 1), participants returned the accelerometer and wear time log and participated in a focus group. Six 2-h focus groups (6–8 participants per group; total n = 32) were led by a trained facilitator and video- and voice-recorded. Upon conclusion of the sixth focus group, a thorough evaluation of the notes from each group indicated that minimal new response themes were being generated (i.e., 15 of the 18 themes were evident in the first or second focus group and thereafter; 2 new themes in the fifth group; no new themes in the sixth). Thus, the remaining participants only completed anthropometric measures and objective PA monitoring.

All study procedures were reviewed and approved by the institutional review board at the University of Georgia (STUDY00006483), and informed consent was obtained electronically for part 1 and via signature in part 2.

Part 1 Measures: Online Questionnaires

Demographic Information

Participants reported the following: age, race, year in school, sex assigned at birth (response options: “male,” “female,” or “prefer not to answer”), current gender identity (response options: “woman,” “man,” “transgender female (male-to-female),” “transgender male (female-to-male),” “nonbinary,” “genderqueer,” “prefer not to answer,” and “another” with the option of describing further), and sexual orientation (response options: “straight or heterosexual,” “lesbian,” “gay,” “bisexual,” “queer,” “same-gender loving,” “prefer not to answer,” or “another” with the option of describing further). Participants were considered LGBTQ+ if they selected 1) a response other than “woman” or “man” for current gender identity, and/or 2) any option besides “straight or heterosexual” for their sexual orientation.

Perceived Benefits and Barriers to pa

Perceived benefits and barriers to PA were assessed using the 43-item EBBS, which uses a 4-point Likert-type scale (1 = strongly disagree to 4 = strongly agree) to rate the level of agreement with perceived exercise benefits (29 items) and barriers (14 items) statements (22). Detailed scoring procedures for this analysis have been reported previously (9).

Total EBBS (Cronbach’s α = 0.93) and subscales (Cronbach’s α range = 0.72–0.90) had acceptable reliability, except for the Family Discouragement subscale (Cronbach’s α = 0.42), which was likely influenced by relationship status (i.e., no “spouse or significant other”); however, the latter was included to align with scoring procedures and previous research using EBBS (9,25).

Resistance Training Activity

Resistance training (RT) was self-reported via a question on the number of days RT activities were completed using various programs (i.e., strength, endurance) and equipment (e.g., free weights, machines). Responses were analyzed as the number of days reported.

Part 2 Measures: Objective PA Monitoring and Focus Groups

Physical Activity

Objective PA was assessed using ActiGraph GT3X+ accelerometers (Pensacola, FL). Conventional instructions included 1) wearing the device at the waist during all waking hours for 7 d, 2) recording wear time on a paper log, and 3) removing the device during water-based activities (e.g., swimming, bathing) and high-contact sports. Participants with at least 4 valid days (10+ h of wear time per day) of accelerometer data were included in analyses. Troiano et al. (26) cut points, based on 10-s epochs, determined time spent in moderate-, vigorous-, and combined moderate-to-vigorous intensity PA (MPA, VPA, and MVPA, respectively). Two participants were excluded from analysis because of incomplete accelerometer data.

Using accelerometer data and the RT question, participants were categorized as meeting guidelines if they had ≥150 min·wk−1 of MVPA and two or more days per week of RT (5). Those with <150 min·wk−1 of MVPA or fewer than 2 d·wk−1 of RT were classified as not meeting guidelines.

Qualitative Assessment of Benefits and Barriers to PA

Based on previous experience assessing perceptions and attitudes toward health behaviors, specifically PA, the research team decided to use focus groups as a means to capture meaningful dialogue about perceptions of PA among LGBTQ+ college students (23,27). Focus groups are useful for bringing about discussions of topics that are not yet clearly elucidated and have been used in previous research to gain a better understanding of LGBTQ+ adults’ experiences in the realm of PA (17). Thus, the use of focus groups allows for the development and identification of themes that can be further examined in future studies using more in-depth approaches (23).

Participants were asked to self-select into a focus group based on scheduling preferences rather than being organized into groups based on gender identities or sexual orientations, which could risk marginalizing or excluding individuals with specific unique identities and reducing the variety of voices heard. Focus group participants discussed perceived benefits and barriers to PA by responding to question prompts (see Table, Supplemental Content 1, https://links.lww.com/TJACSM/A192).

Data Analysis

Statistical analyses were performed using SPSS (version 24.0; IBM, Armonk, NY). Descriptive statistics were computed for each variable of interest. Bivariate correlations were conducted on the variables of MPA, VPA, MVPA, RT, total EBBS score, benefits scale score, barriers scale score, and each of the subscales. Statistical significance was determined at P ≤ 0.05.

Audio and video recordings of each focus group were transcribed, and pseudomyns were randomly assigned to participants. To become familiar with the data and therefore the analysis process, each transcript was read once by a study author (G.M.F.) (23). Next, using a deductive process whereby a predefined list of codes is generated as a coding framework (28,29), each transcript was coded line-by-line a single time using the EBBS subscales (e.g., life enhancement, time expenditure) as categories (29,30). The choice to code deductively was made specifically to determine if participant responses endorsed the preexisting subscales of the EBBS and has been used in previous qualitative research on PA in those identifying as LGBTQ+ (17,29). It was apparent that some responses were specific to the LGBTQ+ aspect of the participants’ identities and did not fit into the EBBS subscales. Thus, upon further review of research evaluating PA perceptions among LGBTQ+ individuals (31), it was surmised that these LGBTQ+-specific responses might align with the Minority Stress Framework proposed by Meyer (20), a popular and well-respected framework used in health research in the LGBTQ+ community. Subsequently, the three processes of minority stress (internalized homophobia, discrimination and violence, and perceived stigma) were used deductively in a second round of line-by-line coding similar to the EBBS process described prevously (20,29). After the application of this framework, additional responses that did not fit within the processes of minority stress remained but were still related to LGBTQ+ identity. These responses were coded using an inductive process by which the discussion points were labeled with representative key words or short phrases that produced themes specific to LGBTQ+ identities, again, an approach that has been used previously in this area (17,28,29). Notably, these last themes expanded the EBBS and Minority Stress Framework in unexpected but important ways.

RESULTS

PA Behavior and Perceived Benefits and Barriers to PA

Participant characteristics, PA behaviors, and EBBS scores are shown in Table 1. Although ~90% of participants met the aerobic portion of the PA guidelines, only 30% reported enough RT, meeting overall PA guidelines.

TABLE 1 - Participant Characteristics (n = 47).
% or Mean ± SD
Demographic characteristics
 Gender Identity
  Man 23.4
  Woman 61.7
  Transgender female 2.1
  Nonbinary 8.5
  Genderqueer 2.1
  Agender 2.1
 Sexual orientation
  Lesbian 17.0
  Gay 21.3
  Bisexual 34.0
  Queer 27.7
 Race
  Asian 12.8
  White 85.1
  Multiracial 2.1
 Year in school
  Freshman 23.4
  Sophomore 10.6
  Junior 17.0
  Senior 12.8
  Graduate student 36.2
 Age (yr) 23.1 ± 6.8
 Weight status
  Underweight (BMI <18.5) 4.3
  Normal (18.5 ≤ BMI < 25) 57.4
  Overweight (25 ≤ BMI < 30) 27.7
  Obese (BMI ≥30) 10.6
PA behavior
 MPA (min·d−1) 46.3 ± 18.7
 VPA (min·d−1) 5.0 ± 5.7
 Total MVPA (min·d−1) 51.3 ± 21.5
 RT (d·wk−1) 1.1 ± 1.7
 Meeting PA guidelines 29.8
  Meet aerobic 91.5
  Meet muscle strengthening 29.8
Perceptions of PA
 Total EBBS score 129.0 ± 15.9
 Benefits scale score 87.9 ± 10.3
  Physical performance 3.3 ± 0.4
  Preventive health 3.2 ± 0.4
  Psychological outlook 3.1 ± 0.6
  Life enhancement 3.0 ± 0.5
  Social interaction 2.2 ± 0.6
 Barriers scale score 28.9 ± 7.5
  Physical exertion 2.8 ± 0.6
  Time expenditure 1.9 ± 0.6
  Exercise milieu 1.9 ± 0.6
  Family discouragement 1.7 ± 0.7
BMI, body mass index (in kilograms per meter squared).

Although causation cannot be established, overall small to moderate correlations in expected directions (i.e., higher perceived benefits and lower barriers were linked to higher PA levels) were observed (Table 2), supporting that LGBTQ+ students’ perceptions of PA are associated with their PA behaviors.

TABLE 2 - Correlations between PA Behaviors and Perceptions of PA.
MPA (min·d−1) VPA (min·d−1) MVPA (min·d−1) RT (d·wk−1)
MPA (min·d−1)
VPA (min·d−1) 0.39*
MVPA (min·d−1) 0.97* 0.60*
RT (d·wk−1) 0.34** 0.52* 0.43*
Total EBBS score 0.37** 0.29 0.39* 0.27
Benefit score 0.31** 0.25 0.34** 0.25
 Life enhancement 0.25 0.21 0.27 0.12
 Physical performance 0.06 0.14 0.09 0.20
 Psychological outlook 0.31** 0.30** 0.35** 0.33**
 Social interaction 0.33** 0.08 0.31** 0.18
 Preventive health 0.09 0.03 0.09 −0.07
Barrier score −0.35** −0.26 −0.37* −0.23
 Exercise milieu −0.33** −0.33** −0.37** −0.29**
 Time expenditure −0.39** −0.33** −0.43* −0.23
 Physical exertion −0.23 −0.09 −0.22 −0.09
 Family discouragement −0.15 −0.04 −0.12 −0.01
*P < 0.01.
**P < 0.05.

Qualitative Perceptions of Benefits and Barriers to PA

Themes and representative illustrative quotes are shown in Tables 3–5. As expected, participants described perceived benefits and barriers to PA in alignment with almost all of the EBBS subscales (Table 3).

TABLE 3 - Qualitative Themes and Illustrative Quotes Related to Exercise Benefits and Barriers Subscales among LGBTQ+ College Students.
Qualiative Themes Illustrative Quotes
Perceived benefits
 Physical performance • The whole physical activity thing…I mostly, I don’t really care about what I look like. I do it just to feel stronger and as a dancer, being stronger is going to help me perform better.—Taylor (18 yr), queer nonbinary
• I mean, superficially, you just, aesthetically look better. I feel like I look better when I’m more toned, more fit.—Jess (21 yr), bisexual woman
• Over the summer I’m going to be going on a long hiking trip, hiking every day, miles and miles. And I need to, I don’t want to be the one person who has to stay behind in the group saying, “I can’t do this.” I want to be able to participate as much as I can because it’s probably a once in a lifetime opportunity.—Liz (20 yr), bisexual woman
 Preventive health • I like that, you know, I can, I’m also like prolonging my health because my family’s had health issues. Being physically active helps me live a better life. Live a better, longer life.—Jess (21 yr), bisexual woman
• So definitely like working out and eating healthy, those are habits I want to sustain throughout the rest of my life because I want to live longer than like, 60.—Jess (21 yr), bisexual woman
• It might not be an option where I have a partner to help take care of me. Or children to look after me. And that’s a real possibility. Um, I don’t want to be in a position where I, you know, would require care that I can’t manage myself.—Matt (45 yr), gay man
 Psychological outlook • When I’m exercising, then I do feel mentally better and the stress kind of goes away.—Taylor (18 yr), queer nonbinary
• So when I go to the gym and feel like I’ve accomplished, or, done “that thing” for today, it adds to my success of what this day has brought.—Ken (28 yr), gay man
• But also, your mood increases. I always feel better if I’ve exercised.—Sophie (20 y), bisexual woman
 Life enhancement • You get a lot more energy. I do. I feel a lot more, I get up earlier, my heart rate is lower, I eat better, I have more energy, I feel more motivated, I feel better about myself. I mean it’s just a big feedback loop. So it’s really good to, when you do workout and eat better, then you tend to be more productive too. Kind of amazing.—Jill (56 yr), lesbian woman
• I was an insomniac in high school and it wasn’t until I started running really early in the mornings that I started being able to like, sleep at night.—Karen (21 yr), queer nonbinary
• So, and also like celebrating my body, like what I can do physically.—Jess (21 yr), bisexual woman
 Social interaction • And that’s how I met all of my great friends now who got me into rock climbing. So now I’m doing like all the physical activity that I never thought possible.—Kat (21 yr), queer woman
• Honestly I just got a lot out of the camaraderie that came from the high school fencing team.—Kate (18 yr), bisexual woman
• That’s why I joined [campus PA group for women/females], you know, cause like, I have some friends now.—Mckenna (21 yr), bisexual woman
Perceived barriers
 Physical exertion • I find that it drains a lot of my energy. Like school definitely does, but then, having to do exercise at the end of your day. It’s just a lot.—Dan (19 yr), gay man
• If I’m in a bad mood, or if I’m like, feeling lethargic, I know working out would probably help me, but I don’t have the energy to go and work out.—Will (20 y), gay man
 Time expenditure • If I don’t have like a really productive day, it’s hard to go workout because I feel like I lose two hours basically between, you know, going home, getting ready, going to the gym, working out, getting back home. And you know, at that point you’re not going to get anything else done that night.—Jill (56 yr), lesbian woman
• Definitely scheduling. That’s probably my biggest barrier is scheduling.—Jess (21 yr), bisexual woman
 Exercise milieu • So, the fact that you have to pay extra for the fitness classes at [campus recreation center] is insane.—Mario (27 yr), gay man
• Yeah, they’re very intense in there [campus recreation center] working out and I just didn’t feel like that was my space. So it almost felt like that space wasn’t for me because I wasn’t at their level I guess, of, understanding exercise and working out.—Ken (28 yr), gay man
• I know the person is at the front desk, but like even if you get them to come over and show you [how to use a piece of equipment], that’s really embarrassing.—Jenna (20 y), bisexual woman
• I don’t go in there [campus recreation center] because I don’t want to look dumb.—Julia (22 yr), bisexual woman
• I’ll also say there’s no easy way to get here [campus recreation center]. Like, I had to take two buses to get here, I didn’t want to pay for parking.—Mario (27 yr), gay man
• I think for me it’s also kind of tied to location. So, how far away the gym is from my current space, I guess.—Ken (28 yr), gay man

TABLE 5 - Qualitative Themes and Illustrative Quotes Related to Additional LGBTQ+-Specific Concerns.
Qualitative Themes Illustrative Quotes
Effects of PA on body shape—benefit • So I feel like with people in the trans community, working out can be a good thing, like to help with body dysmorphia and things like that. Because they can have more control over like, what their physical, secondary attributes look like.—Kristi (20 yr), bisexual woman
• There’s um, like things you can do and working out a certain way is one of those just to look more gay or bi or queer or whatever.—Jenna (20 yr), bisexual woman
• Because like, you know, I present as like a very feminine person and then, I want to be like, those gendered exercises, I want the slim waist with bigger hips, look like a Kardashian, kind of thing. And I’m sure, I can’t speak for like, butch people, but I’m sure it’s very different for them.—Jess (21 yr), bisexual woman
• Especially as a trans person, one of the benefits is feeling comfortable in your body and kind of recognizing what physical activity you’re able to participate in. Like, through physical fitness and exercise, kind of, you know, setting new records for yourself.—Karen (21 yr), queer nonbinary
Effects of PA on body shape—barrier • I know, um, trans guys who haven’t gotten top surgery, they don’t try as hard to get slim because they’re afraid it will show off their chest.—Jamie (26 yr), queer genderqueer
• I think it’s really common in the trans community for people to be like overweight and plus-sized because I think it’s easier to kind of de-gender your body if you have extra body weight.—Karen (21 yr), queer nonbinary
Focus on aesthetics in LGBTQ+ community • If you’re at all plugged into the community, you know what you’re “supposed” to look like…the pressure to fit a certain body type is, intense.—Karen (21 yr), queer nonbinary
• I can think of like gay cruises for men. Oh my gosh, if you don’t have like the perfect body, you’re just not going to be a part of that.—Matt (45 yr), gay man
• Within the community itself, the standards of how you think you should look are a lot higher just because, I don’t really know how to explain it, but it’s a more…limited field.—Will (20 yr), gay man
• People who are not binary or trans, being such a big part of that community that like, it is kind of body-focused. Not, I don’t think it’s too body focused but I think that’s naturally more of a thing that this community has to face than the heterosexual community.—Amy (21 yr), lesbian agender
Importance of physically active LGBTQ+ role models • I think that in and of itself is a barrier, not seeing people like you being physically active. I think it’s really common for queer folks…We don’t have a ton of role models. And some of the role models that we do have, most of the time they’re not athletes.Karen (21 yr), queer nonbinary
• I think also in sports, it’s not seen. Cause there are not really a lot of openly queer athletes.—Adam (23 yr), queer man
• When I wanted to join a triathlon club, I purposefully did not join the LGBTQ tri club…. I was thinking about the children of some of my teammates. Their parents didn’t care and that kind of gives a potentially, you know, a kid who’s gay, a chance to see a gay athlete.—Matt (45 yr), gay man
Deviance from social or gender norms related to PA • In terms of group sports, most sports are gendered, you know? And I have no idea what team to join. And that’s been an issue for a really long time.—Karen (21 yr), queer nonbinary
• At least here in [campus recreation center], there’s these very rigid roles of what you’re supposed to look like and be like. You’re either the testosterone guy or you’re the really sexy girl that has a perfect body.—Amy (21 yr), lesbian agender
• When you do dance, everything is really gendered because guys have certain roles and girls have certain roles when they’re dancing. And as a nonbinary person, that is really weird.—Taylor (18 yr), queer nonbinary
Same-sex relationships and body image • It’s something that I didn’t experience when I was in a relationship with a guy. There is, in some ways, like a comparative thing.—Terry (21 yr), queer woman
• If you both identify as the same gender, yeah there’s these ideal standards that you believe you want to kind of get to. Then personally I think it’s a little weird too because you don’t want to mirror each other either. So there’s a battle there kind of. You both want to look good for each other but then not look the same.—Jenna (20 yr), bisexual woman
• You want to appeal to everyone else but you’re attracted to your same gender so you are also trying to be that pinnacle of attraction as well. So there’s that kind of friction between wanting someone who looks like this but also being that because you’re attracted to that too.—Adam (23 yr), queer man
• Dating women, there’s competition and they compare themselves a lot and it almost disincentivizes working out. It’s like I wish we didn’t have to compare ourselves on this.—Amy (21 yr), lesbian agender

Participants also expressed a variety of benefits and barriers to PA uniquely related to their LGBTQ+ identities (20). Using the Minority Stress Framework, the themes of general minority stress, discrimination and violence, internalized homophobia, and perceived stigma were supported (Table 4).

TABLE 4 - Qualitative Themes and Illustrative Quotes Related to LGBTQ+-Specific Minority Stress Barriers to PA among LGBTQ+ College Students.
Qualitative Themes Illustrative Quotes
General minority stress • A lot of stress that goes along with making kind of healthier decisions from, because, you know, I’m already different and now I have to, I have the choice of going and putting myself in a situation where I’ll feel even more different than if I just stayed at home.—Amy (21 yr), lesbian agender
• I think a lot of people in the LGBT et cetera community, just in general, feel a lot of extra stress from deviating from accepted norms and that can make it harder to eat healthy and exercise regularly and just be healthy.—Kate (18 yr), bisexual woman
• I think we should be proud of the resources we have, but realizing that just because we have an awesome gym…like it doesn’t necessarily mean you’re reaching everybody and that there might be systematic groups that are left out from that.—Amy (21 yr), lesbian agender
Minority stress—discrimination and violence • One thing I’ve noticed is that the personal trainers that are available [at campus recreation center] are not Safe Space trained. So they don’t know how to interact with LGBT individuals, but also, they could maybe work together with the LGBT Resource Center with building a way for, building like fitness plans specifically for like LGBT or trans and gender non-conforming folk.—Adam (23 yr), queer man
• There are some women I know that are very open about and it’s very obvious that, their sexuality is very obvious. You know, people who wear binders and they have short hair, and it’s, people make assumptions, whether or not they’re true or not. They make assumptions. And I’ve had friends who feel a little bit unsafe [at the campus recreation center].—Kara (20), bisexual woman
• I always go with my friends. Like, I don’t come here [campus recreation center] by myself.—Taylor (18 yr), queer nonbinary
• I think in general, like in terms of outside of the team [club sports team through the university], I’m not really out. We have a lot of sponsors that are politically or socially leaning one way. Um, and I don’t really want to jeopardize the team that way.—Jenna (20), bisexual woman
Minority stress—internalized homophobia • For working out, it’s kind of a split between my friends. Some are very, um, sometimes to a point, over-active and working out too much. To the other side where some of them do have that very self-deprecating, “I’m not gonna work out, but I’m trash so it doesn’t really matter,” sort of thing.—Adam (23), queer man
• You feel like no matter what you’re doing, you always think like, “Is this really me?” Like, “Ok, so I checked out that person in the gym who was the same gender as me. Am I a fraud, though?” Like, “Am I really part of this community? Am I not? Am I in like hetero-space, and should I just try and shut-down whatever’s going on?”—Carly (19), “not sure” woman
Minority stress—perceived stigma • I don’t know if it’s fear of being judged or fear of being “the other.” Um…the first thing that comes to mind is like, that perception that they may find out I’m different, you know? Or almost like this, secret agenda kind of…I have kind of like an assimilation kind of thing. Like I’ve integrated into their society and they’re going to find me out or something, you know?—Ken (28 yr), gay man
• So it’s like, certain times, I never wanted to talk about my martial arts because I didn’t want people to assume something about me. And then I started feeling ashamed about working out, or being toned, or whatever.—Carly (19), “not sure” woman
• I wanted to tell my friends on my cross-country team, but we had morning practices on Wednesday and Friday so we would literally shower together…I didn’t run it [cross country] freshman year because I knew they had morning practices! I was like, it stresses me out too much, like I can’t do it…I was just convinced someone would find out!—Sophie (20 yr), bisexual woman

General minority stress, a theme related to the additive stress associated with identifying as a member of the LGBTQ+ community, was specifically related to additional stressors encountered when making healthy choices about PA: for example, “I think a lot of people in the LGBT et cetera community just in general feel a lot of extra stress just from deviating from accepted norms and that can make it harder to eat healthy and exercise regularly and just be healthy.”

The theme of discrimination and violence emerged as participants discussed fear for their physical and psychological safety when trying to be active in the campus recreation center, which they saw as one of the only places to access the equipment needed to be active. Fear of prejudice and discriminatory action from other groups with which they were associated was also described as feeling they were an “other” and that the campus recreation center was not a place meant for them because of their LGBTQ+ status: for example, “There are some women I know that are very open about, and it’s very obvious that, their sexuality is very obvious. You know, people who wear binders and they have short hair, and it’s, people make assumptions, whether or not they’re true or not. They make assumptions. And I’ve had friends who feel a little bit unsafe [at the campus recreation center].”

The theme of internalized homophobia was evident in the ways in which LGBTQ+ students downplayed the importance of their health and well-being and internalized blame for their perceived barriers to PA as a result of their LGBTQ+ status: for example, “Some of them do have that very self-deprecating, ‘I’m not gonna work out, but I’m trash so it doesn’t really matter,’ sort of thing.”

Feelings of discomfort and stress as a result of being found out to be LGBTQ+ aligned with the theme of perceived stigma. Participants described increased anxiety in PA spaces, specifically the campus recreation center and organized sports, due to feeling the need to conceal their LGBTQ+ status to avoid significant discomfort and engaging in constant vigilant behaviors as a coping mechanism: for example, “Here at [the campus recreation center], it’s my assumption that it’s a mostly male, straight kind of environment. And that can be intimidating because I don’t just want to project being gay in a way that might make somebody else uncomfortable or even critical.” In addition, some participants indicated that the fear of being labeled LGBTQ+ or having their LGBTQ+ status revealed and the social implications of those situations influenced their PA behaviors: for example, “So it’s like…I never wanted to talk about my martial arts because I didn’t want people to assume something about me. And then I started feeling ashamed about working out, or being toned, or whatever.”

Interestingly, although Meyer (20) posits concealment and disclosure as another important component of the Minority Stress Framework, our data indicate that the idea of concealment was expressed because of the other three minority stress themes. Participants discussed concealing their sexual orientation or gender identity to avoid negative outcomes or situations related to discrimination or stigma. For example, concealment as a result of perceived stigma is evidenced from a participant who said, “In this [physical education] class, I’m still like, ‘Oh God, what if they know [about my LGBTQ+ identity]? They’re gonna treat me differently!’”

A final round of coding beyond the EBBS and Minority Stress Framework led to the emergence of six unique PA benefit and barrier themes (Table 5).

As a benefit, the theme of the effects of PA on body shape related to the way in which individuals can control the appearance of their bodies through PA. Thus, PA is an affirming practice for transgender and nonbinary individuals: for example, “Especially as a trans person, one of the benefits is feeling comfortable in your body and kind of recognizing what physical activity you’re able to participate in.” Alternatively, as a perceived barrier, this theme referred to the idea that engaging in PA can result in physical changes that may hinder affirmation or expression of gender: for example, “I think it’s really common in the trans community for people to be like overweight and plus-sized because I think it’s easier to kind of de-gender your body if you have extra body weight.”

The theme of the focus on aesthetics in the LGBTQ+ community represented perceptions of additional pressures to meet a certain set of standards regarding body shape and physique: for example, “If you’re at all plugged into the community, you know what you’re ‘supposed’ to look like…the pressure to fit a certain body type is intense.”

The theme of the importance of physically active LGBTQ+ role models was expressed as the lack of current LGBTQ+ role models in PA, as well as the idea of serving as or becoming a role model for PA in the community: for example, “I think that in and of itself is a barrier, not seeing people like you being physically active.”

The theme of deviance from social or gender norms related to PA represented the idea of not conforming to or fitting into typical gender categories or roles when engaging in PA: for example, “In terms of group sports, most sports are gendered, you know? And I have no idea what team to join. And that’s been an issue for a really long time.”

The challenge of same-sex relationships and body image described how, in a same-sex couple, it may be tempting to compare body shapes between partners in relation to what is considered ideal. Furthermore, this theme represented the struggle to balance achieving a certain body shape and also being attracted to that body shape in others of the same sex: for example, “If you both identify as the same gender, there’s these ideal standards that you believe you want to kind of get to. Then personally I think it’s a little weird too because you don’t want to mirror each other either. So there’s a battle there kind of. You both want to look good for each other but then not look the same.”

DISCUSSION

The novelty of this study lies in the use of quantitative and qualitative methods to 1) assess PA behaviors (using objective measures) and perceptions of PA, and 2) explore both general and sexual minority-related perceived benefits and barriers to PA among LGBTQ+ college students. Overall, beyond reinforcing that this cohort has low adherence rates for PA guidelines, our findings suggest that, in addition to general perceived benefits and barriers to PA, concerns related specifically to the LGBTQ+ aspect of identity are present.

The high prevalence of participants meeting the aerobic portion of PA guidelines is encouraging; however, there are caveats to this finding. Although beyond the scope of our data, these levels typically decline once students leave the university setting because active transportation to and on college campuses is reduced and many occupations are sedentary and screen-based (32). Notably, disparities in MVPA are known to exist for adult members of the LGBTQ+ community (16,19). Furthermore, less than one-third of our participants reported sufficient RT to meet current guidelines (5). Consistent with previous research in this community, this may be influenced by barriers related to minority stress and LGBTQ+ identity, because RT is typically completed in a fitness facility with equipment (3,10). Also beyond the scope of the current investigation, research indicates that individuals who identify as women are more likely to meet the aerobic portion of the guidelines and not the RT portion, whereas those who identify as men are more likely to meet both the aerobic and RT guidelines (33). Thus, the high proportion of individuals meeting the aerobic portion without meeting the RT portion may be partially explained by the fact that over 50% of the participants in this study identified as women. Even with this caveat, our findings are consistent with previous research regarding lower levels of PA among LGBTQ+ students and individuals compared with their non-LGBTQ+ counterparts (3,8–11).

The EBBS data indicate that this sample of LGBTQ+ students perceived levels of benefits and barriers to PA similar to other inactive subgroups of the college student population, with the exception of social interaction (25,34–37). Contrary to previous research indicating that college students use PA for social opportunities (9,34,38), these LGBTQ+ participants did not necessarily view this as a benefit of engaging in PA. Barriers related to LGBTQ+ identity may reduce the appeal of PA spaces as places for positive social interactions for this cohort (17,39). The current sample aligned with other groups of insufficiently active college students in their endorsement of physical exertion and time expenditure as the largest perceived barriers to PA (25,36). However, in addition to commonly reported barriers to PA, LGBTQ+ students cite definitive aspects of minority stress and population-specific barriers that prevent them from engaging in this important health behavior. The existence of the themes related to the Minority Stress Framework (Table 4) and additionally the LGBTQ+ identity (Table 5) indicate that students identifying as LGBTQ+ face different barriers than their counterparts. This means that, in addition to the perceived barriers related to the EBBS constructs, additional perceived barriers must be overcome by students who identify as LGBTQ+. Further investigation on how to address, reduce, or remove such barriers will decrease the burden on these students and allow them to more fully participate in health-enhancing PA during their college years and beyond.

Although standard instruments such as the EBBS are useful to understand general perceived benefits and barriers to PA, our data suggest that the EBBS has limitations among certain minority groups. As shown here, LGBTQ+ college students perceive additional barriers and concerns related specifically to their LGBTQ+ identities, which are not captured via the EBBS instrument. Rather, these gender- and sexual minority–specific concerns only became evident through the application of the Minority Stress Framework (20); even then, several population-specific concerns remained. Therefore, it is likely that similar issues may occur when attempting to understand perceptions among other underrepresented individuals (e.g., due to race/ethnicity, socioeconomic status, or disability status).

This research also highlights the importance of using qualitative approaches to supplement or bolster quantitative methods. This approach allowed us to elucidate perceived PA benefits and barriers specific to members of the LGBTQ+ community, expanding upon our previous work that determined that EBBS scores differ for LGBTQ+ students compared with their non-LGBTQ+ counterparts (9). Furthermore, these contextualized ideas about perceptions of benefits and barriers (e.g., deviance from social or gender norms) could inform PA health promotion programming tailored for those identifying as LGBTQ+. In fact, recent qualitative work among a sample of LGBTQ+ adults (ages 18–67 yr) identified recommendations for how to make PA spaces more inclusive, many of which aligned with the barriers identified in our college student cohort (39). For example, the general recommendation to create safe(r) spaces suggests that perceived physical, mental, and emotional safety is a barrier to accessing PA spaces for the LGBTQ+ community as a whole (39). Furthermore, suggestions for increasing representation of LGBTQ+ individuals in PA spaces indicate that there is a lack of PA role models, which was also a theme from our study (39). Finally, the theme of challenging the gender binary aligns with some of our LGTBQ+-specific barriers related to the consequences of deviating from gender norms and how that influences the perceived ability to participate in PA (39). Continued study of these barriers is needed to more fully inform efforts to create inclusive programming for members of the LGBTQ+ community regardless of age or life stage.

In conclusion, LGBTQ+ college students perceive more than the general barriers to engaging in PA. Much like the concept of minority stress itself, these perceived barriers, specific to their LGBTQ+ identity, are additive to general barriers faced by college students regardless of gender identity or sexual orientation. However, when using standard instruments, such as the EBBS, these concerns become largely invisible and therefore cannot be assessed or addressed by health promotion programming efforts. Future research should utilize both quantitative and qualitative methods reported here to explore concerns specific to LGBTQ+ students to attenuate such barriers and encourage participation in PA for all students.

The results of this study do not constitute endorsement by the American College of Sports Medicine.

The authors have no conflicts of interest and no outside funding to disclose.

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