Reviewer's report
Title:Factors influencing adherence to regular exercise in middle-aged women: a
qualitative study to inform clinical nursing practice
Version:1Date:15 November 2013
Reviewer: Terra TM Murray
Reviewer's report:
This article was well written, and on a timely and interesting topic, examining
barriers and enablers to exercise in women, specifically mid aged women.
Please see specific comments and feedback below:
1. Discretionary Revision:
I wonder though why the article and title is particularly focused on clinical nursing
practice, as there are a host of practitioners who could benefit from the results of
the study and who counsel people with respect to physical activity/exercise.
There seemed to be nothing in the article in particular that made this paper
unique to nursing practices per se.
Background:
2. Discretionary Revision:
The authors are examining barriers and enablers to exercise/physical activity in
middle aged women. The question is clearly defined in the study. The authors
state that” little is known about effective interventions to enhance” (page 5). I
would probably be a bit more cautious with this statement. There is a
considerable amount of research on exercise interventions in general, while there
is no review for mid aged adults, other research is available that informs the topic
(e.g., see Hall & McAuley, 2010 Physical Activity in Middle-aged and Young-old
Adults: The Roles of Self-efficacy, Barriers, Outcome Expectancies,
Self-regulatory Behaviors and Social Support; van der Bij, A.K., Laurant, &
Wensing 2002. Effectiveness of physical activity interventions for older adults: A
review.).
Methods:
The methods seem appropriate and sound, although my expertise is not in this
particular methodology, so I have no specific comments here.
3. Discretionary Revision:
I do think it would be helpful to have some sample characteristics available to
help better describe your sample to your readers. For example, how much
exercise were participants in the study currently engaging in? The authors note
that they were participating in regular exercise, but no further detail is given. It
would be helpful to present more detail here. Were these women currently
meeting guidelines from CSEP, (or older Health Canada guidelines), for
example? Given that physical activity and exercise research acknowledges that
there may be different barriers or motivators for exercise at various phases
(exercise initiation /adoption versus exercise maintenance, for example), it may
be important to note the current level of activity people in the study were
engaging in. This may also play a role in your discussion, as these women all
seem to be currently active.
Discussion:
4. Discretionary Revision:
In the discussion, you state that “exercise patterns of middle aged women are
multifaceted.” What is meant by this statement? For example, what are the
patterns and how are they multifaceted?
5. Discretionary Revision:
I am not certain that the subtheme of positive feelings corresponds well with
self-efficacy? I think this subtheme needs to be better described in the discussion
section. Feelings is a very broad category, and were women specifically talking
about attitudes and/or affect (exercise making them feel good) or feelings of
confidence in exercise and the tasks associated with it, which is more analogous
to self-efficacy I think. In your Results section you discuss what could be more
analogous to self-efficacy (e.g., frustration with perceived lack of ability), but you
also discuss other feelings or mood states which I think is not reflected by
Bandura’s concept of self-efficacy, but rather mood states, and attitudes. It might
be worthwhile to tease these out form each other as they are theoretically and
conceptually distinct.
6. Discretionary Revision:
I made an earlier comment in your Methods section about providing some detail
on current level of exercise. I think that may play a role in your discussion, as one
of the aims of the study is to inform nursing practice. It is likely important than
that nurses and other practitioners are aware that barriers and enablers may be
unique to women who already have some experience with exercise, or are
currently active, and women who are initiating or taking up exercise for the first
time may experience different barriers and enablers.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests