International Journal of Obesity (2000) 24, 81±87 ß 2000 Macmillan Publishers Ltd All rights reserved 0307±0565/00 $15.00 www.nature.com/ijo Physical activity beliefs and behaviours among adults attempting weight control A Timperio1*, D Cameron-Smith1, C Burns1, J Salmon1 and D Crawford1 1 School of Health Sciences, Deakin University, Burwood, Victoria 3125, Australia OBJECTIVE: To compare the frequency and duration of varying intensities of physical activity performed by adults trying to lose weight, avoid gaining weight and not actively trying to control their weight, and to compare these groups' beliefs about the physical activity they should perform. METHOD: Random postal survey of 2500 Victorian adults selected from the Australian electoral roll (response 42%). rate MEASURES: One-week physical activity recall (frequency and duration of walking, other moderate activity and vigorous activity), BMI (based on self-reported height and weight) and weight-control behaviour. RESULTS: At the time of the survey, 27% of respondents were actively trying to avoid gaining weight, 23.9% trying 7.1) h walking, 5.5 to lose weight and 49.1% undertaking no weight control. Respondents spent a mean time of 4.0 ( 7.9) h in moderate activity and 3.1( 5.9) h in vigorous activity during the week prior to the survey. Women trying to ( lose weight or avoid gaining weight engaged in vigorous activity more often than women not trying to control their weight. After adjusting for age, education and BMI, women trying to avoid gaining weight were 2.4 times more likely, and women trying to lose weight 2.5 times more likely, to have met current physical activity guidelines than women 6.9) h walking, 6.5 ( 8.2) h undertaking no weight control. On average, respondents believed they should spend 5.2 ( 6.5) h in vigorous activity each week. Women trying to lose weight felt they should in moderate activity and 4.3 ( perform vigorous activity more often than other women. Weight-control behaviour was not associated with physical activity beliefs and behaviours of men. CONCLUSION: Walking is a common activity among adults attempting weight control. However, many men and women do not fully recognize the value of moderate-intensity physical activity. Future efforts should be directed at promoting the role of moderate-intensity activity in weight control, particularly activity that can be performed outside of planned activity sessions. International Journal of Obesity (2000) 24, 81±87 Keywords: obesity; prevention; weight control; physical activity Introduction Declining physical activity, particularly incidental activity, is believed to be an important contributor to the burgeoning prevalence of obesity in Western nations.1 Increasing physical activity is therefore viewed as an important component of attempts to control weight.1 ± 3 Physical activity has been shown to complement dietary restriction or changes in diet composition undertaken for weight reduction.4,5 Importantly, physical activity aids in the preservation of lean body tissue usually lost during dietary restriction, while the additional elevation of energy expenditure further enhances negative energy balance.2 Although weight loss attributable to increased physical activity may be small, physical activity has been repeatedly shown to play an important role in the maintenance of weight loss.3 In addition, there is *Correspondence: A Timperio, School of Health Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia. E-mail: [email protected]. Received 9 February; revised 16 June 1999; accepted 27 July 1999 evidence to suggest that physical activity is important in preventing weight gain over time.6 Structured and incidental physical activity can be performed at work, at home or during leisure-time.7 Most studies focus on leisure-time physical activity behaviour, and public health campaigns and interventions have typically sought to increase leisure-time physical activity participation.8 Current recommendations, however, urge people of all ages to accumulate 30 min of moderate intensity activity on most, if not all, days of the week,7,9 and include incidental activity performed at work, at home and for transport, in addition to structured leisure-time activity.7 The current physical activity guidelines were developed with a view to achieving general health improvements across the population, including improved ability to control weight and reduce body fat.7 Attempts to lose weight or avoid weight gain are highly prevalent in developed nations, particularly among women.10 ± 12 Among those trying to control their weight, 60 ± 90% commonly report using physical activity as a strategy, 10 ± 12 yet few studies have described the speci®c nature of the activity that is performed. Levy and Heaton11 and DiPietro et al13 have documented the prevalence of some speci®c Physical activity beliefs and behaviours A Timperio et al 82 leisure-time activities (such as participation in walking and aerobics) among adults attempting to lose weight. However, as far as we are aware, there have been no population-based studies that have compared the nature of physical activity in those actively seeking to lose or maintain weight with those not attempting weight control, or their beliefs about the amount of activity they should perform. An understanding of the physical activity behaviour and beliefs of these groups is important for the development of public health initiatives aimed at achieving healthy weight and preventing weight gain through increased physical activity. The aim of this study is to compare physical activity participation among adults who are trying to lose weight, avoid gaining weight or doing nothing in particular to control their weight. This study also aims to compare these groups' beliefs about the frequency, duration and intensity of activity they should perform. Methods Subjects A sample of 2500 adults was randomly selected from the Australian electoral roll for the State of Victoria (registration compulsory for all Australian citizens over 18 y). Those selected were mailed a self-administered questionnaire about their physical activity habits, dietary fat habits, and weight-control concerns and behaviours (a copy is available from the authors). Non-respondents were mailed a reminder postcard after 2 weeks, a replacement questionnaire after a further 2 weeks, and a ®nal reminder postcard 2 weeks later. Measures All variables included in this study are based on selfreport. Demographic information. Details of sex, age, education and occupation were requested. Education was collapsed into three categories: (1) never attended school, or attended only primary school or some high school; (2) completed high school or gained a technical or trade school certi®cate or apprenticeship; (3) university or tertiary quali®cation. Occupations were classi®ed into one of eight occupation groupings according to the Australian Standard Classi®cation of Occupations.14 Body mass index. Subjects were asked to report their height and weight. These self-reported measures were used to calculate body mass index (BMI weight(kg)=height2(m)). The correlation between self-reported and measured height has been reported as 0.92 ± 0.93, and the correlation between selfInternational Journal of Obesity reported and measured weight has been reported as 0.97 ± 0.98, using nationally representative Australian data.15 Four BMI categories were computed (BMI < 20 underweight; 20 BMI 25 acceptable weight; 25 < BMI 30 overweight; BMI > 30 obese) as recommended for use in the Australian population.16 The categories of `overweight' and `obese' are essentially those recommended by the World Health Organisation.1 Weight-control behaviour. Weight-control behaviour was assessed by a single question that requested subjects nominate which of the following categories best described them at that point in time: (1) actively doing things to try to gain weight; (2) actively doing things to try to avoid gaining weight; (3) actively doing things to try to lose weight; (4) not doing anything in particular for their weight. Physical activity behaviour. Three types of physical activity were assessed Ð walking, moderate activity and vigorous activity. Subjects were asked the following questions: `In the past week, how many times have you walked for recreation or exercise and=or to get to and from places for at least 10 minutes continuously?'; `In the past week, how many times did you do moderate exercise or other physical activity (around the house or at work) which did not make you breathe harder or puff and pant? (e.g. more moderate activities Ð digging in the garden, moderate cycling, raking leaves, dancing)'; `In the past week, how many times did you do vigorous exercise or other physical activity (around the house or at work) which made you breathe harder or puff and pant? (e.g. jogging or running, heavy gardening, netball, chopping wood, vigorous swimming, heavy labouring)'. For each of the three types of physical activity, subjects were also asked to estimate the total time (in hours and=or minutes) spent doing that activity in the past week. These measures were adapted from those used in a recent population survey of physical activity,17 which have been shown to have good reliability18 and validity19 over a 2-week recall period. In adapting these measures for use in the present study, leisure-time, occupational and household physical activity were combined. Subjects were classi®ed into two groups on the basis of their responses to the physical activity items. Existing physical activity guidelines recommend people accumulate 150 min of moderate-intensity activity in a week.7,9 In terms of energy expenditure, this is equivalent to 60 min of vigorous activity (where moderate-intensity activity equals 3.5 METS and vigorous-intensity activity equals 9.0 METS).20 Thus subjects were classi®ed as meeting physical activity guidelines if they reported at least 60 min of vigorous activity per week, or if the total time spent in physical activity (walking, moderate activity and vigorous activity) was at least 150 min. Physical activity beliefs and behaviours A Timperio et al Physical activity beliefs. Subjects were asked the following questions: `Do you think you should do more walking for recreation or exercise and=or to get to and from places for at least 10 minutes continuously?'; `Do you think you should do more moderate exercise or other physical activity (around the house or at work)?'; `Do you think you should do more vigorous exercise or other physical activity?'. For each of the three types of activities, subjects were asked to report the number of times they felt they should do the activity, as well as the total time (in hours and=or minutes) they thought they should spend doing the activity, over a one week period. Statistical analyses All analyses were performed using SPSS version 8.0.21 Pearson's w2 and ANOVA were used to assess sex differences, and age, education and BMI differences within each sex, across weight-control behaviour. Physical activity behaviour and beliefs (for walking, moderate-intensity activity and vigorousintensity activity), and compliance with current physical activity guidelines, were compared by sex, and weight-control behaviour within each sex, using Pearson's w2, independent t-tests and ANOVA. Forced entry multiple logistic regression analyses were performed to assess the possible contribution of age, education and BMI in addition to weight-control behaviour (independent variables) on compliance (dependent variable) among men and women. The mean difference between the frequency and the duration men and women within each category of weightcontrol behaviour believed they should perform each type of activity and the frequency and duration they reported in the week prior to the survey was assessed by paired t-test. Pregnant women, subjects trying to gain weight, and those for whom this data was missing were excluded from the analyses. The analyses reported here were based on 897 adults (375 males and 522 females). In some of the analyses (reported in the tables), a small number of cases were missing for individual variables. 83 Results Sample characteristics An overall response rate of 42% was obtained. Most respondents (58.2%) were women. The mean age of respondents was 44.8 ( 16.4) y. A majority (78.5%) were born in Australia and were currently married (62.7%). Levels of education were evenly distributed among respondents (30.3% had not completed high school, 36.5% had completed high school, a technical or trade school certi®cate, or an apprenticeship, and 33.2% had a university or tertiary quali®cation). A third of respondents (33.0%) were not employed, 11.6% were employed in managerial or administrative positions and 14.4% were professionals. Compared to Victorian census data,22,23 women, adults aged between 50 ± 59 y, Australian-born women, married adults and those employed in high status occupations were slightly over-represented in the study sample. The BMI distribution, however, when compared with self-reported measures collected in the most recent National Health Survey,24 was representative of the Victorian population. Almost a third (30.7%) of respondents were classi®ed as overweight, and a further 13.0% as obese. Among male respondents, 3.8% were classi®ed as underweight, 46.3% as acceptable, 39.3% as overweight and 10.6% as obese. Among women, 14.4% were underweight, 46.4% were acceptable, 24.5% were overweight and 14.8% were obese. Weight-control behaviour Overall, 26.2% of men and 27.5% of women reported they were trying to avoid gaining weight, 18.5% of men and 27.5% of women reported they were trying to lose weight and 55.4% of men and 45.1% of women reported not actively trying to control their weight at the time of the survey. As shown in Table 1, women trying to lose weight were younger than women in other categories of weight-control behaviour, and in both sexes those trying to lose weight had a higher mean BMI. Weight-control behaviour did not differ by education. Table 1 Mean age and BMI, and education distribution according to weight-control behaviour Males Females Weight-control behaviour Weight-control behaviour Avoid weight gain Lose weight Doing nothing Avoid weight gain (n 95) (n 67) (n 201) P-value (n 137) Agea (mean) BMIa (mean) Educationb(%) None=primary=some high High school=tech=trade University=tertiary a 48.6(16.6) 26.3(3.1){C 43.1(14.3) 27.8(3.7){* 44.3(16.5) 24.4(3.4)C* 21.1 42.1 36.8 25.4 34.3 40.3 25.4 43.8 30.8 Lose weight (n 137) Doing nothing (n 225) P-value n.s. 0.000 46.1(16.2)§ 25.3(4.9){C 39.3(14.1)§,C 26.9(5.1){* 47.3(17.5)C 23.2(5.0)C* n.s. 35.0 29.2 35.8 31.4 39.4 29.2 36.9 30.2 32.9 b 0.000 0.000 n.s. 2 One-way analysis of variance with post hoc tests; {P < 0.05, §P < 0.01, C*P < 0.001. Pearson w . n.s., not signi®cant. International Journal of Obesity International Journal of Obesity a 63.3** 2.0(2.6)*** 132.2(205.4)*** 0.008a 0.014b n.s.b 55.6 1.6(2.2)* 120.9(215.0) 72.4 2.4(2.8)* 158.5(222.3) 74.1** 2.9(4.0)*** 261.2(473.7)*** 74.6 2.6(2.5) 218.0(397.7) 78.6 2.9(3.8) 213.2(363.8) 71.6 3.1(4.5) 301.2(541.8) n.s.a n.s.b n.s.b 66.1 2.3(3.0) 123.1(167.3) 84.2 4.4(5.5)* 282.3(391.6)** n.s.a n.s.b n.s.b 82.2 3.9(4.8) 295.5(427.6) 84.2 4.9(5.6) 240.8(249.4) 88.0 5.5(8.5)* 391.1(558.1)** 85.7 4.8(7.4) 314.5(517.5) 85.7 5.1(6.2) 365.3(502.7) 89.9 6.0(9.9) 432.4(596.7) n.s.a n.s.b n.s.b 82.5 4.8(6.3) 304.5(448.1) 88.1 4.5(5.1) 207.3(352.7)* n.s.a n.s.b n.s.b 84.7 4.5(5.4) 215.8(333.8) 91.9 4.2(4.1) 195.3(263.0) 89.8 4.8(5.5) 206.2(452.4) 86.1 5.4(8.4) 284.1(508.9)* n.s.a n.s.b n.s.b 82.8 5.6(8.3) 319.8(617.9) 85.7 4.2(4.1) 201.0(267.3) 92.9 6.0(10.8) 274.6(385.6) Walking Participation (%) Frequency Duration (min) Moderate activity Participation (%) Frequency Duration (min) Vigorous activity Participation (%) Frequency Duration (min) P-value Doing nothing (n 189) Lose weight (n 123) Avoid weight gain (n 118) All malesc (n 316) Weight-control category Females P-value Doing nothing (n 169) Lose weight (n 63) Avoid weight gain (n 84) Compliance with physical activity guidelines. Most respondents met current guidelines for physical activity in the week before the survey (88.4%). A similar proportion of men (90.7%) and women (86.6%) met the guidelines. Men trying to avoid gaining weight or lose weight, and men not engaged in weight control were equally as likely to have complied. Women trying to lose weight (90.0%) and trying to avoid gaining weight (91.5%), however, were more likely to have met the guidelines compared with women not attempting weight control (81.4%) (P < 0.05). Weight-control behaviour Frequency and duration of physical activity. On average, respondents reported walking 4.9 ( 6.7) times for an average of 239.8 ( 427.3) min, they reported engaging in moderate activity 4.9 ( 7.0) times for a total of 328.4 ( 472.1) min, and reported being vigorously active 2.4( 3.3) times for a total of 186.9 ( 351.1) min, in the week preceding the survey. Table 2 shows that women reported moderate activity and vigorous activity less frequently than men, and also spent less time than men walking, in moderate activity and in vigorous activity in the week prior to the survey. The frequency and duration of walking, moderate activity and vigorous activity did not vary according to weight-control behaviour among men (Table 2). Women trying to lose weight, however, engaged in vigorous activity signi®cantly more often than women who were not attempting weight control, although all women reported spending a similar amount of time in vigorous activity. Males Participation in physical activity. Almost all respondents (97.6%) reported engaging in some form of physical activity in the week prior to the survey. Men (98.0%) and women (97.3%) were equally as likely to have been physically active. Men and women who were trying to avoid gaining weight, trying to lose weight and not engaged in weight control were equally as likely to have performed some type of physical activity. Most respondents reported they had walked for more than 10 consecutive minutes (87.3%), engaged in other moderate activity (85.8%), or performed vigorous activity (67.8%) in the week preceding the survey. There were no differences in the proportion of men and women who had walked or been moderately active (Table 2). However, men were more likely than women to have been vigorously active. There were no differences in participation in walking, moderate activity or vigorous activity between men according to their weight-control behaviour. Women trying to lose weight, however, were more likely to have been vigorously active in the week preceding the survey than women trying to avoid gaining weight and women not engaged in weight control. All femalesc (n 430) Physical activity behaviour Table 2 Prevalence (%), and frequency and duration (mean s.d.) of walking, moderate activity and vigorous activity in the week preceding the survey 84 Pearson w2, n.s. not signi®cant. bOne-way analysis of variance with post hoc tests; *P < 0.05, n.s. not signi®cant. cPearson w2 performed between sexes for participation; **P < 0.01; independent t-test performed between sexes for mean frequency and duration; *P < 0.05, **P < 0.01, ***P 0.001. Physical activity beliefs and behaviours A Timperio et al Physical activity beliefs and behaviours A Timperio et al After adjusting for age, education and BMI, weightcontrol behaviour remained a signi®cant predictor of compliance with physical activity recommendations among women. Women trying to avoid weight gain were 2.4 times more likely (95% CI 1.1 ± 5.2; P < 0.05), and women attempting weight loss were 2.5 times more likely (95% CI 1.1 ± 5.5; P < 0.05), than women doing nothing to control their weight to have met the guidelines. Physical activity beliefs Perceived adequacy of physical activity. Most respondents (73.0%) believed they should increase the amount of physical activity they perform. Women (76.6%) were more likely than men (68.4%) to believe they should do more (P < 0.05). There were no differences in the proportion of men and women who believed they should do more moderate or vigorous activity. However, women (65.8%) were more likely than men (49.7%) to believe they should increase the amount of walking they do (P 0.001). The proportion of respondents who believed they should do more physical activity varied by weightcontrol behaviour for men, but not women. Among men, 80.3% of those attempting to lose weight believed they should do more physical activity (of any kind), compared to 75.9% of men trying to avoid gaining weight and 60.5% of men who were not engaged in weight control (P < 0.01). Men trying to lose weight (52.5%) were more likely than men trying to avoid gaining weight (38.6%) and men not engaged in weight control (33.1%) to believe they should increase the amount of moderate activity they do (P < 0.05). The proportion of women who believed they should increase their walking, moderate activity and vigorous activity did not vary according to weight-control behaviour. On average, respondents believed they should walk 6.4 ( 5.6) times per week for a total of 309.6 ( 414.5) min, do moderate activity 5.9 ( 7.0) times for a total of 388.9 ( 490.3) min, and perform vigorous activity 3.8 ( 3.4) times for a total of 260.5 ( 387.0) min each week. Women believed they should walk as often as men did, but felt they should spend about one less session per week in both moderate activity (5.4 5.7 vs 6.6 8.4, P < 0.05) and vigorous activity (3.5 3.0 vs 4.2 3.9, P < 0.01) compared with men. Men also believed they should spend signi®cantly more time (min) in moderate activity (466.8 583.2 vs 330.1 396.9, P 0.001) and vigorous activity (331.7 481.8 vs 206.7 285.1, P 0.001) each week than did women. The mean frequency and duration men believed they should perform each type of activity did not vary according to their weight-control behaviour. However, women who were trying to lose weight (3.8 3.4) or avoid gaining weight (4.0 3.3) felt they should be vigorously active more often (per week) than women who weren't trying to control their weight (3.0 2.3, P < 0.01), although total time did not vary between these groups. 85 Differences between behaviours and beliefs Figure 1 shows the difference between the frequency men and women within each category of weightcontrol behaviour believed they should walk, engage in moderate activity and perform vigorous activity, and the frequency they reported in the week prior to the survey. With the exception of men who were trying to avoid gaining weight, men and women within each category of weight-control behaviour believed they should perform each type of activity signi®cantly more often than they reported performing that activity in the week prior to the survey. Men trying to avoid gaining weight did not believe they should walk more often than they currently do. Subjects within each category of weight-control behaviour also believed they should spend signi®cantly more time in each type of activity then they reported spending in the week preceding the survey (Figure 2). Again, however, men who were trying to avoid gaining weight did not believe they should signi®cantly increase the total time they spend walking. The majority of respondents indicated they should spend over an hour more in most types of activity each week. Figure 1 Mean difference between frequency respondents believed they should perform each type of activity and reported frequency each activity was performed in the week prior (paired t-test, ***P < 0.001). International Journal of Obesity Physical activity beliefs and behaviours A Timperio et al 86 Figure 2 Mean difference (mins) between time respondents believed they should spend in each activity and reported time spent in each activity in the week prior (paired t-test, ***P < 0.001). Discussion This study con®rms previous research showing that weight-loss attempts are prevalent, that there are many adults who actively take steps to avoid weight gain, and that physical activity is commonly employed as a weight-control strategy.10 ± 12 Consistent with other studies,11,13 we found walking to be the most common type of physical activity performed by men and women attempting weight control. Overall, walking was also the activity adults most often felt they should try to increase. This may be because walking is easier to maintain over time, as it is relatively inexpensive and poses less risk of injury compared to the majority of other activities.25 Our ®ndings suggest that efforts aimed at promoting walking as a means of preventing weight gain are likely to be met with widespread community support. While walking was the most common type of activity among those attempting weight control, there were in fact few differences in activity patterns by weight-control behaviour. Physical activity did not differ by weight control among men, although most believed they should perform a considerable amount of vigorous-intensity activity each week. This suggests that men hold the view that physical activity must be vigorous to be bene®cial. Women who were International Journal of Obesity trying to lose weight reported vigorous activity more frequently, and were more likely to meet current guidelines and to believe they should be doing more vigorous activity, compared with other women. These ®ndings provide support for research showing that men are generally not interested in increasing physical activity as a weight-control strategy,26 and indicate that women attempting weight control may see vigorous activity as more important than moderate-intensity activity, despite current efforts to promote the bene®ts of the latter. Overall, men in this study believed they should spend almost 19 h in physical activity each week (3.3 h=week more than they currently spend). Women felt they should spend almost 14 h in physical activity each week (3.4 h=week more than they currently spend). However, given that lack of time has been identi®ed as a major barrier to being physically active,27,28 it is doubtful that increases of this magnitude would be feasible for most people. It is also possible that the belief that one needs to perform a large amount of physical activity may act as a barrier in itself, given that lack of motivation and laziness have also been identi®ed as common barriers.27,28 Promoting small changes in physical activity performed throughout the day may be more realistic and achievable than increases in structured or planned activity sessions of a long duration. Future research should investigate opportunities to increase occupational and incidental activity, as well as public perceptions of the practicality of making such changes. A limitation of this study is the modest response rate achieved. Although the sample was generally representative in terms of socio-demographic characteristics, and the distribution of body weight re¯ected that of the population and the prevalence of weightcontrol behaviour was similar to that reported in other studies, the results must be interpreted with some caution. It is possible that respondents may have been more active than non-respondents. Participation in all types of physical activity in this study was considerably greater than has been previously reported for adults attempting weight loss 11,13 and for the Victorian population.17 While this may be a consequence of response bias or over-reporting, we consider the higher participation in physical activity observed is more likely to be attributable to the measures used to assess physical activity. Unlike previous research, we examined total physical activity, not just planned leisure-time activity. Our ®ndings suggest that occupational and incidental activity may signi®cantly contribute to total physical activity, and to maintaining energy balance. However, as there is little validated data on the contribution of occupational and incidental activities to total energy expenditure, and the accuracy of self-reported occupational and incidental activity, further research is required. This study is unique as it examined, in a population-based sample, the physical activity beliefs and behaviours of adults attempting weight control. The Physical activity beliefs and behaviours A Timperio et al data suggest that, while walking is common among those attempting weight control, many men and women may not fully recognize the potential value of moderate-intensity activity as a means of controlling their weight. Greater efforts should be made to promote moderate-intensity physical activity to those attempting weight control, particularly activity that can take place outside of the planned activity sessions. Acknowledgements This research was supported by a research grant from the Australian Research Council and Deakin University. Anna Timperio and Jo Salmon are recipients of Deakin University Postgraduate Research Awards. David Crawford is supported by a Public Health Fellowship from the National Health and Medical Research Council. The authors wish to thank Dr Sing Kai Lo for his statistical advice and Professor Adrian Bauman for his helpful comments. References 1 World Health Organisation. Obesity, preventing and managing the global epidemic: Report of the WHO consultation on obesity. World Health Organisation: Geneva, 1997. 2 Garrow JS, Summerbell CD. Meta-analysis: Effect of exercise, with or without dieting, on the body composition of overweight subjects. 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