JAN
ORIGINAL RESEARCH
Group exercise mode and health-related quality of life among healthy
adults
Jennifer A. McGrath, Maureen O’Malley & Thomas J. Hendrix
Accepted for publication 6 August 2010
Correspondence to: J.A. McGrath:
e-mail: jmcgrath@gci.net
Jennifer A. McGrath MSN RN
Master of Science Student
College of Health and Social Welfare, School
of Nursing, University of Alaska Anchorage,
Anchorage, Alaska, USA
Maureen O’Malley PhD RN
Associate Professor
College of Health and Social Welfare, School
of Nursing, University of Alaska Anchorage,
Anchorage, Alaska, USA
Thomas J. Hendrix PhD RN
Associate Professor
College of Health and Social Welfare, School
of Nursing, University of Alaska Anchorage,
Anchorage, Alaska, USA
Introduction
Physical inactivity is detrimental to health and wellbeing
and contributes to the development of many illnesses. In
 2010 Blackwell Publishing Ltd
JOURNAL OF ADVANCED NURSING
M C G R A T H J . A . , O ’ M A L L E Y M . & H E N D R I X T . J . ( 2 0 1 0 ) Group exercise mode
and health-related quality of life among healthy adults. Journal of Advanced
Nursing 00(0), 000–000. doi: 10.1111/j.1365-2648.2010.05456.x
Abstract
Aim. This paper is a report of a study conducted to identify the difference between
mode of group exercise and health-related quality of life (HRQOL), to determine
the associations between mode of group exercise chosen by participants and their
demographic characteristics, and to identify themes from narrative comments for
each group exercise modality.
Background. Regular exercise has been shown to improve HRQOL in the general
population. However, few studies have compared mode of exercise – Pilates, step
aerobics, and strength training – and their impact on HRQOL.
Method. A comparison was conducted in 2009 between three groups of partici-
pants who met regularly at a fitness facility. The English version of the RAND
36-Item Health Survey (SF-36) was used to collect data. One open-ended question
was analysed by content analysis.
Results. In total, 143 adults participated in the study. There was a statistically
significant association between mode of exercise and length of time the participants
had been exercising (v2 = 33Æ42, d.f. = 4, P < 0Æ001). There was a statistically
significant difference in the Energy/Fatigue domain of the SF-36 between two modes
of exercise: Strength Training and Pilates (z = 2Æ67, d.f. = 2, P = 0Æ008). Quali-
tative data revealed two themes that motivated healthy behaviours: personal, and
interpersonal.
Conclusion. Modes of group exercise influence HRQOL domains among adults.
Healthcare providers need to understand what mode of exercise people are partic-
ipating in order to educate them to achieve a better quality of life and to motivate
those who are inactive.
Keywords: group exercise, health-related quality of life, healthy adults, nursing,
Pilates, step aerobics, strength training, survey
epidemiological studies, 36% of heart disease, 27% of
osteoporosis, 20% of stroke, hypertension, diabetes mellitus
(type 2), and colon cancer, and 11% of breast cancer are
attributable to physical inactivity. Inactivity also contributes
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J.A. McGrath et al.
to increased healthcare costs. In developed countries, physical
inactivity is associated with considerable economic burden,
with 1Æ5–3Æ0% of total direct healthcare costs attributable to
lack of physical inactivity (Oldridge 2008). Therefore,
healthcare providers should seek and emphasize tested
exercise programmes that both improve health and reduce
costs.
Healthcare providers often recommend increased physical
activity because exercise improves physical and psychological
aspects of health-related quality of life (HRQOL) (Daley
et al. 2007, Shibata et al. 2007) and is also associated with
multiple health benefits, including improved mood, better
weight management with improved metabolic control,
enhanced independence, and better management of chronic
diseases and disabilities (Department of Health and Human
Services 2009). However, not all exercise is the same, and
healthcare providers should understand the effects of various
exercise programmes on HRQOL to ensure their recommen-
dations to their clients will consider their unique needs.
Physical fitness is a concept comprising seven multi-
dimensional components: cardiovascular fitness, body
composition, flexibility, balance, speed of movement,
muscular strength and muscular endurance (CDC 2008).
Those who exercise can choose from a variety of modalities
(e.g. resistance, yoga, etc.) and, depending on their choice,
implicitly choose certain components of fitness over others. In
fact, most fitness classes focus on only one or two compo-
nents. These are typically cardiovascular fitness, muscular
strength, or flexibility. Depending on their specific attributes,
including co-morbidities, not all modes of exercise have the
same positive effects on individual HRQOL and general well-
being (Chicco 2008). Therefore, providers should know
which exercises are best for their individual clients. Advanced
Practice Nurses are versed in using a holistic approach with
clients, and should take a leadership role in translating the
research on healthy and risky behaviours into their individual
practice. The findings of the study reported here offer a basis
for considering the unique activity needs of each person, to
ensure that they adopt the exercise programme for which
they are most suited.
Background
Group fitness classes are no longer attended only by healthy
individuals. People with chronic or temporary injuries and
those with special needs also participate. The most frequently
offered group exercise classes in the United States of America
and Canada are strength training, Pilates and step aerobics
(Ryan 2005, Archer 2008), and each has a specific compo-
nent of fitness.
2  2010 Blackwell Publishing Ltd
Step aerobics is a form of aerobic exercise that uses a bench
to increase cardio-respiratory effort, and enhances cardio-
vascular health and weight loss (Olson et al. 1991). Partic-
ipants report a positive effect on mood, and a decrease in
tension, depression, fatigue, and anger (Kennedy & Newton
1997). Conversely, the most common negative results are
low-grade injuries and muscle soreness (Bryant 2009).
Pilates is a form of body conditioning and flexibility that
has recently gained popularity worldwide (Crowther 2005)
and has 49% more participants since 1999 (Archer 2008).
Participants focus on stabilizing the trunk, and then stretching,
strengthening, and balancing the body (Romani-Ruby 2007).
Pilates increases flexibility, sleep quality, mood and decreases
pain in individuals with chronic low back pain (Gladwell
et al. 2006, Caldwell et al. 2009). Risk of injury is usually
due to improper form and positioning, which can lead to or
aggravate pre-existing injuries (Romani-Ruby 2007).
Strength training classes use resistance movements to
improve muscular strength and endurance. Handheld
weights, barbells, and resistance tubing are used while
performing range-of-motion exercises. The benefits of
strength training are increased independence, functional
capability, muscular endurance, and strength (Williams et al.
2007), and the most common risk is muscle strain (Barclay
2008). Although strength training, Pilates, and step aerobics
fitness classes are popular, there has been minimal research
comparing these exercise modalities with respect to their
effect on HRQOL.
The HRQOL is a multidimensional concept that represents
an individual’s satisfaction with life by measuring functional
status in the domains of physical, cognitive, emotional and
social health (Shibata et al. 2007). Exercise also improves
HRQOL, including mood, physical functioning, and emo-
tional well-being (Bize et al. 2007, Kim & Kim 2007, Katula
et al. 2008, Caldwell et al. 2009). While it is clear that
HRQOL improves with exercise, it is not clear which
domains of HRQOL increase with specific modes of group
exercise; it is also not clear whether the increases for each
exercise modality are the same for all individuals, regardless
of health status.
Many researchers report that mind-body exercises such as
yoga, Feldenkrais (an exercise which involves gentle stretch-
ing, reaching and postural changes in a specific pattern, while
focusing on the relationship between movement and
thought), Pilates, and taiji quan (an ancient Chinese martial
art that combines the powers of meditation with physical
exercises), are associated with enhanced mood, and improved
self efficacy (Netz & Lidor 2003, Oken et al. 2006, Ho et al.
2007, Caldwell et al. 2009). Kennedy and Newton (1997)
compared similar modes of exercise with different intensities
JAN: ORIGINAL RESEARCH
and found that participants in higher intensity exercises
reported lower anger scores than their less intense counter-
parts. Kim and Kim (2007) found that individuals
participating in intense cardiovascular exercises had better
well-being, psychological distress, and fatigue scores than
those participating in body conditioning and sport exercises.
Conversely, Netz and Lidor (2003) found mood improve-
ments in less intense exercise participants. Although there is
some disagreement about the relationship between intensity
of exercise and emotional well-being, all researchers have
concluded that the less intense forms (e.g. yoga and Pilates),
(Netz & Lidor 2003, Oken et al. 2006, Caldwell et al. 2009)
and the more intense exercise modalities (e.g. aerobics, step
aerobics) result in higher psychological/emotional scores
(Oken et al. 2006, Kim & Kim 2007, Bize & Plotnikoff
2009).
Physical well-being is also improved with exercise. In a
study by Katula et al. (2008), the high intensity power
training group reported higher satisfaction with physical
functioning scores then their lower intensity strength training
group counterparts. Some researchers have reported that low
intensity exercise programs such as Pilates and taiji quan
have a positive impact on physical performance, but no
effect on strength and balance measures (Caldwell et al.
2009). Others have found that yoga improved physical
measures of health, specifically in the areas of muscular
strength and flexibility, when compared to walking and no
exercise groups (Oken et al. 2006). Finally, bench-stepping
exercises enhance cardio-respiratory fitness and improve
weight management (Olson et al. 1991). There is a growing
body of work on the effects of various modes of exercise on
the dimensions of health. Review of this literature suggests
that the more intense the exercise modality, the higher the
psychological/emotional and physiological functioning
scores.
Conceptual model
Pender’s (1975) conceptual model for preventive health
behaviour was the framework for the study. According to
Pender, the nurse identifies personal, interpersonal and
situational factors that motivate or inhibit preventive health
actions. Personal factors include the individual’s perception
of the importance of health, and perceived efficacy of action.
Interpersonal factors include the concerns of others, historical
family patterns of utilization of the specific health behaviour,
expectations from friends and informational input from
health professionals. Situational determinants include
cultural acceptance, societal group norms/pressure and
information from non-personal sources.
 2010 Blackwell Publishing Ltd
Group exercise mode and HRQOL
The study
Aims
The aims of this study were to identify the difference between
mode of group exercise and HRQOL, to determine the
associations between mode of group exercise chosen by
participants and their demographic characteristics, and to
identify themes from narrative comments for each group
exercise modality.
Design
A comparison was conducted between three groups of
participants who were meeting regularly at a local fitness
facility. Each of the groups made independent and different
choices about their choice of exercise modality. In the
quantitative part of the study, a cross-sectional comparative
descriptive survey design was used. In the qualitative part,
content analysis was used to quantify and analyse words
and concepts within text, followed by the drawing of
inferences about those concepts (Elo & Kyngas 2007,
Twycross & Shields 2008). The data were collected in
2009.
Participants
The participants were all residents of an urban, US commu-
nity who purchased membership in a community fitness
center. All participants met the following inclusion criteria:
(1) attended one of three group fitness classes: Pilates,
strength training, or step aerobics, (2) aged 18 years or older
and (3) able to read and write English. The principal
investigator (JM) described the study to attendees at the
beginning of the group exercise classes. Once the class
started, there was no attempt to recruit additional members
to the class.
To detect a difference in HRQOL subscale scores between
groups (exercise modalities) with medium effect at a signif-
icance level of 5% (two-tailed) and a power of 80%, 45
participants were required per group (Cohen 1977). Assum-
ing equal groups, the minimum size was thus determined to
be 135 participants.
Qualitative data were obtained from comments written
by participants in response to open-ended inquiry at the end
of the survey. Content analysis was not concurrent with
data collection, which precluded revision of the sample
size or characteristics during the study. Content themes
were only included when they were repeated by several
respondents.
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J.A. McGrath et al.
Data collection
Participants completed the questionnaire in the group fitness
studio prior to or after attending one of the group fitness
classes. Questionnaires were returned to the principal inves-
tigator on the same day and at the same location. The
researcher was available to answer participants’ questions or
concerns before or after class. Completion of the question-
naire took approximately 10–12 minutes.
The questionnaire used was the RAND 36-Item Short
Form Health Survey (SF-36) (RAND 2009), which is a
self-report questionnaire used for measuring HRQOL. It
consists of 36 questions with a focus on physical and mental
components of health. The eight sub-scales of health
measured with this tool are physical functioning, role
functioning/physical, role functioning/emotional, energy/fati-
gue, emotional well-being, social functioning, pain and
general health. The sub-scales are reported as scores ranging
from zero to 100. Higher scores correlate with higher levels
of functioning (RAND 2009). An additional open-ended
question was added to allow participants to convey addi-
tional thoughts on the topic of group exercise. Table 1 gives a
description of HRQOL terms.
Validity and reliability
The RAND 36-Item Health Survey has shown satisfactory
internal consistency (alpha 0Æ76–0Æ90) and construct validity
in studies of HRQOL (Bell & Kahn 1996). Cronbach’s alpha
was 0Æ725 in this study.
Table 1 Summary of RAND 36-Item Health Survey Terms
Concept/measure Definition
Physical functioning Extent to which health limits physical
activities such as self-care, walking,
climbing, bending, lifting, and
moderate and vigorous activities
Role functioning Extent to which physical or emotional
Due to physical health health interferes with usual daily
Due to emotional health activities such as work, housework,
schoolwork
Energy/fatigue Amount of time in the past 4 weeks
full of pep, energetic, worn out, tired,
had enough energy to do things
Emotional well being Feelings of depression, anxiety,
positive affect during past month
Social functioning Limitations in normal social activities
during past 4 weeks due to health
Pain Extent of bodily pain in past 4 weeks
General health Ratings of current overall health, e.g. I
have been feeling bad lately, my
health is excellent
4  2010 Blackwell Publishing Ltd
Ethical considerations
Approval for the study was obtained through a university’
institutional review board. Completion of the survey indi-
cated consent to participate.
Data analysis
Quantitative data were analysed using SPSS 18.0 (SPSS, IBM
Corp., Somers, NY, USA). Descriptive statistics were used to
examine demographics, and chi squared tests were carried
out to compare differences between demographic subgroups.
A Kruskal–Wallis test was conducted to analyse differences
among the three modes of exercise on median changes in
HRQOL. Mann–Whitney U-follow-up tests were done to
evaluate pair-wise differences for each HRQOL subscale
across the three groups. Type 1 error was controlled through
the Bonferroni approach, which adjusted alpha to 0Æ017.
Qualitative data were analysed using latent content anal-
ysis. The written answers were transcribed on to a single
document verbatim, checked for accuracy, and reviewed in
the context of the entire survey to identify the underlying
meaning (Twycross & Shields 2008). First, the answers were
read carefully and re-examined to understand the whole
meaning. The text was re-read several times. The answers
were read through line-by-line for the purpose of identifying
all the coherent statements about HRQOL and group
exercise. Key statements were highlighted and the patterns
that emerged became preliminary labels and were placed in
the margin. These labelled statements were compared with
each other within and across the document, and those with
similar meanings were grouped together. Categories were
formulated from the preliminary labelled patterns and,
finally, related meanings were grouped together as major
themes. In order to achieve trustworthiness, various steps in
the analysis, themes and categories were scrutinized by and
discussed with another researcher (Elo & Kyngas 2007).
Results
Quantitative data
One hundred and forty-seven adults met inclusion criteria
and responded to the survey. Of these, four prospective
participants were found to have participated in two modes of
exercise. To ensure group independence, these four people
were excluded. Of the remaining 143 participants, 34Æ3%
(n = 49) participated in Pilates, 33Æ6% (n = 48) in Step
Aerobics, and 32Æ2% (n = 46) in Weight Training. Most were
women (n = 130, 90Æ9%), young adults aged 18–40 (n = 69,
JAN: ORIGINAL RESEARCH Group exercise mode and HRQOL

48Æ3%), or middle-aged adults aged 41–64 (n = 69, 48Æ3%), Table 3 RAND 36-Item Health Survey Mean Scores
White (n = 109, 76Æ2%), married (n = 81, 56Æ6%), educated
All exercise
at university level (n = 58, 40Æ6%), employed (n = 116, groups
81Æ1%), exercised 2–3 times per week (n = 74, 51Æ7%), and RAND
Domain average Mean SD n
had been exercising for more than 10 years (n = 40, 28%). A
summary of the demographic data is presented in Table 2. Physical functioning 84Æ2 91Æ5 18Æ4 143
The data were analysed for associations between demo- Role functioning physical 81Æ0 89Æ5 23Æ2 143
graphics and mode of exercise. There was a statistically Role functioning emotional 81Æ3 92Æ2 22Æ1 143
Energy/fatigue 60Æ9 64Æ4 17Æ4 143
significant association between mode of exercise and length
Emotional well being 74Æ7 77Æ2 13Æ4 143
of time the participants had been exercising (v2 = 33Æ42, Social functioning 83Æ3 89Æ2 16Æ1 143
d.f. = 4, P < 0Æ001, Cramer’s V = 0Æ35, P < 0Æ001). The Pain 75Æ2 81Æ1 17Æ5 143
majority of participants who had been exercising over 5 years Overall health 72Æ0 80Æ4 14Æ9 143
engaged in step aerobics (n = 30, 21%), while a smaller
number (n = 5, 3%) of those engaging in Pilates had been (2006, p. 4), ‘The RAND-36 summary scores are T-score
exercising over 5 years. There were no other statistically norm-based scoring approaches; therefore, interpretation of
significant associations between demographics and mode of these T-scores is based on a general US population mean of
exercise. The majority of the demographic characteristics 50Æ0, with a standard deviation of 10Æ0’. The entire sample
were distributed across all three modes of exercise. It was scored highly on all subscales of the RAND 36-Item Survey
interesting that only one of six American Indian/Alaska when compared to the RAND average. Role Functioning
Native participants engaged in Pilates, and only two of 13 Emotional subscale scores were the highest in all groups
Asian American participants engaged in Weight training; (Mean = 92Æ2, SD = 22Æ1), while the Energy/Fatigue subscale
however, these subgroups were too small to meet assump- scores were lower for all groups (Mean = 64Æ4, SD = 17Æ4).
tions for further statistical analysis. However, the step aerobics and strength training group
Table 3 shows the total mean scores for all groups in subscale scores were higher than the normal average scores
comparison to the RAND average. According to Supina et al. for the RAND 36-Item Health Survey in all domains. The
Table 2 Participant demographics Pilates group scored higher than the normal average scores
for the RAND 36-Item Health Survey in most subscales,
Variable n %
except for the Energy/Fatigue subscale scores and Emotional
Gender (n = 142) Well-Being subscale scores. Figure 1 shows the HRQOL
Male 12 8Æ5
Female 130 91Æ5
Marital status (n = 147)
Overall health
Single with SO 23 16Æ1
Single without SO 25 17Æ5 Pain
Married 81 56Æ6
Separated with SO 1 0Æ7 Social functioning
Separated without SO 1 0Æ7
Divorced with SO 2 1Æ4 Emotional well being
Divorced without SO 10 7Æ0
Ethnicity (n = 147) Energy/Fatigue
African American 4 2Æ8
Role functioning emotional
American Indian/Alaska Native 6 4Æ3
Asian American 13 9Æ2
Role functioning physical
White 113 77Æ3
Hispanic/Latino 3 2Æ1 Physical functioning
Other 6 4Æ3
Education level (n = 147) 0 20 40 60 80 100 120
High school/GED 19 13Æ4
Rand average Strength training
2nd year of college 22 15Æ5
Graduated with college degree 58 40Æ8 Step aerobics Pilates
Postgraduate courses 12 8Æ5
Postgraduate degree or beyond 31 21Æ8 Figure 1 Mean scores for the RAND 36-Item Health Survey for all
exercise modes. Note: The higher the score, the higher the func-
SO, significant other; GED, General Equivalency Diploma. tioning.

 2010 Blackwell Publishing Ltd 5

J.A. McGrath et al.
subscale scores for the three groups compared to the RAND
average.
Initially, a multivariate analysis of variance (MANOVA ) was
planned to determine the relationship between items on the
HRQOL. However, after testing the items for normality
using the Kolmogorov–Smirnov (K–S) test, the distributions
were significantly different from normal and the assumptions
for parametric statistics were not met. Therefore, the
non-parametric equivalent Kruskal–Wallis test was used.
The Kruskal–Wallis test, which was corrected for tied ranks,
showed statistically significant differences between the three
groups (Pilates, strength training and step aerobics) in two of
the subscales: Energy/Fatigue (v2 = 7Æ30, d.f. = 2, P = 0Æ026)
and Physical Functioning (v2 = 6Æ49, d.f. = 2, P = 0Æ039). A
Mann–Whitney U follow-up test was conducted to evaluate
pair-wise differences among the three groups, controlling for
type 1 errors across tests by using the Holme’s sequential
Bonferroni approach as described by Field (2005). There was
a statistically significant difference in the Energy/Fatigue
domain between Pilates and Strength Training (z = 2Æ67,
d.f. = 2, P = 0Æ008). Those who participated in strength
training group reported higher Energy/Fatigue scores than
those in the Pilates group. Differences in perceived HRQOL
subscales between modes of exercise are presented in Table 4.
Qualitative data
The open-ended question, ‘Tell me anything you would like to
add about your health or your experience with group exercise’,
revealed two themes through content analysis using Pender’s
(1975) Conceptual Model of Preventive Health Behavior.
These two themes were Personal Factors and Interpersonal
Factors. Personal Factors included how the group exercise
makes one feel, i.e. more relaxed, less stressed, reduced body
weight, which in return motivated them to participate in the
group exercise modality. Interpersonal Factors included how
other participants made the individual feel about group
exercise, i.e. the group setting provided support, gave partic-
ipants more energy, and provided socialization.
Table 4 Differences in perceived health-related quality of life scores
based on mode of exercise
Energy/fatigue
Mode of exercise Mean Z P
Pilates 40Æ72 2Æ67* 0Æ008
Strength training 55Æ75
*Statistically significant at P < 0Æ017 level (two-tailed) (Mann–
Whitney U-test).
6  2010 Blackwell Publishing Ltd
Personal Factors were described in terms of physical and/or
emotional terms that promoted the individual to participate
in a group fitness class. Physical terms used reflected the effect
that group exercise had on the individual’s physical func-
tioning, which included fitness, health, and appearance.
Emotional terms reflected how group fitness activities
affected mood or emotional well-being. Physical and emo-
tional factors were expressed in the following ways:
Doing Pilates has helped my body awareness, especially in swimming
and improved posture.
Trying to cut back on alcohol consumption. Alcohol impacts my
physical and emotional health, and exercise helps to minimize that
impact.
I’m 60. Loss of flexibility—arthritis creeping in.
After a full day it is hard to get to the club, but I feel better if I come.
Interpersonal Factors reflected interactions between the
participant and members of the group. These social themes
included the atmosphere of the group setting (competitive,
diverse), and the feedback and encouragement received from
group members or the instructor (e.g. social functioning:
I enjoy group fitness for the camaraderie. It helps to share pain.
It is very rewarding and good to see such a wide diversity of people
and all ages participate.
The group atmosphere enhances my workouts because I see others
working hard too.
Having a friend meet me at the class also helps ensure that I come.
Participants expressed how group exercise enhanced their
physical and emotional health. They also expressed how the
group setting enhanced or affected their participation in the
exercise programme. The Pilates group in particular
expressed how their physical limitations (e.g. multiple
sclerosis, old injuries) affected their decision to choose this
exercise mode:
Exercise helps me relax, have more energy, work out the kinks. I also
have had MS for many years so [Pilates] really helps maintain good
health.
My activities are limited by an old back injury-but I [attend Pilates
class] on a regular basis and enjoy it and feel it greatly improves my
physical and mental health despite my injury.
There were more narrative comments reflecting that those
attending the Pilates class sought out this form of exercise
when they had an illness or injury. These findings show that
both Personal Factors (seeking to improve health and feelings
JAN: ORIGINAL RESEARCH
of well-being) and Interpersonal Factors (enjoying group
camaraderie) can motivate individuals to participate in group
exercise.
Discussion
Study limitations
The convenience sample was obtained from one fitness
facility and therefore those from lower socioeconomic strata
were probably not represented. Data on age, health, and
illness were not included in this study. Future researchers
should record age, body mass index, and co-morbidity to
illustrate the impact of exercise better. The various modes of
exercise were limited to Pilates, step aerobics and strength
training. Individuals who participate in group fitness classes
at other community centers are only offered the classes
arranged by that community center, which may not include
these exercise modalities or offer them as frequently. The
sample was self-selected, healthy, active and predominantly
female, and thus was different from the general population or
from ill patients seeking referrals. Therefore, the generaliz-
ability of the findings is limited.
Effects of fitness classes
Group fitness classes enhance several dimensions of health.
The results of this study indicate that the more intense modes
of exercise step aerobics and strength training had the highest
perceived HRQOL. This is consistent with previous results
(Oken et al. 2006, Kim & Kim 2007, Katula et al. 2008, Bize
& Plotnifkoff 2009). The more intense groups reported
higher scores in all domains of HRQOL, including physical
functioning, role functioning (emotional/physical), social
functioning, pain, energy/fatigue, emotional well-being and
general health. It could therefore be assumed that they felt
healthier and perceived more benefits from their exercise
programme. Strength training and step aerobics share a focus
on repetitive and rhythmical movement and, along with
Pilates, result in trunk stability, breathing awareness, and
body conditioning.
Choice of group exercise modality varied for several
subgroups in the sample. Participants who had exercised
for a longer than 5 years were more likely to engage in step
aerobics, which includes both simple and more complex
movement combinations. Their participants often combine
upper body and lower body movements synchronized to
music. Newcomers to group exercise should consider first
embarking on a walking programme, strength or Pilates
training. The Asian American subgroup was small (n = 13,
 2010 Blackwell Publishing Ltd
Group exercise mode and HRQOL
11%), only two of 13 of this group chose strength training,
while research (Liang et al. 2007) has identified lower bone
mineral density in this group. Providers should encourage
strength training in Asian women to promote general health
and reduce the risk of osteoporosis. In addition, the Native
American/Alaska Native subgroup did not choose the newer
Pilates core-strengthening mode of exercise. Mode of group
exercise for population subgroups needs further study.
The results of this study are consistent with those of
previous research (Kim & Kim 2007, Katula et al. 2008, and
Bize & Plotnifkoff 2009) that suggest that higher intensity
group fitness classes may be more beneficial in enhancing
both psychological/emotional and physiological dimensions
of health. Therefore, healthcare providers can promote
enhanced HRQOL by encouraging participation in more
intense modes of exercise. For example, if an individual is
currently walking three times a week, the provider could
suggest increasing the intensity of the exercise by jogging, or
by participating in a more intense exercise programme such
as step aerobics or strength training. Similarly, if clients are
sedentary, and want to enhance HRQOL, providers could
recommend starting a less intense exercise programme of
Pilates.
Considering Pender’s framework, the findings support the
importance of individual motivators that inform choice of a
mode of exercise. Characteristics of participants, both expe-
riential and biological, translate into behaviour-specific
cognitions. Specifically, those who participated in strength
and step aerobics might have perceived both self-efficacy and
benefit of action, and those who did not might have perceived
a barrier based on their experience. Some participants who
faced barriers, such as a lower perceived Energy/Fatigue
levels or pre-existing health conditions, sought out the lower
intensity Pilates classes. As a result, all groups might have
used behaviours that resulted in a personally satisfying,
health-promoting behaviour.
Our findings suggest that college-educated, employed,
White, adult women are more likely to participate in
preventive health behaviours and obtain greater perceived
HRQOL benefits. These women feel more confident, better
about their physical appearance, and feel connected with
others when participating in a group fitness programme.
These findings are consistent with exercise motives found in
previous research (Pender 1975, Lustyk et al. 2004, Glasgow
2008). Nursing effort could also focus on adult men in order
to improve their participation in group exercise programmes.
However, providers should understand that men do not
appear to be as drawn to group programmes as women.
Additionally, because these women tend to be educated at
college level, nurse educators should take advantage of their
7
J.A. McGrath et al.
What is already known about this topic
• Exercise is associated with physical and emotional
components of health.
• Health-related quality of life is considered the most
appropriate variant of quality of life for investigating
and measuring an individual’s overall satisfaction with
life.
• When people value their health, they will seek
preventive health behaviours.
What this paper adds
• Pender’s Preventive Health Behavior Model was
applicable in explaining and predicting preventive
health behaviours in adults participating in one of three
group exercise modes: Pilates, step aerobics, and
strength training in the domains of health-related
quality of life (HRQOL).
• Motivating factors for preventive health behaviour
among group fitness participants included: feeling
physically fit, feeling emotionally stable, receiving
support from group members and their instructor, and
living with certain injuries or diseases.
• High intensity exercise modes (e.g. step aerobics and
strength training) were more effective than low intensity
exercise modes (e.g. Pilates) in enhancing all domains of
perceived HRQOL in healthy adults.
Implications for practice and/or policy
• Motivating factors towards preventive health
behaviours should be addressed as part of a process of
exercise screening and prescription for adults.
• Nurses should prescribe exercise modalities based on
clients’ HRQOL values and on scientific evidence
supporting mode of exercise.
knowledge and explain the HRQOL benefits of group fitness
through various forms of communication including
pamphlets, posters, newsletters, journals, individual counsel-
ling and electronic updates.
Through the use of content analysis, we identified factors
related to perceived HRQOL and expected benefits of
preventive health behaviours, which included: (1) feeling
physically fit, and emotionally well, (2) feeling inspired by
other group participants or the fitness instructor and
(3) believing that the group exercise had a positive impact
on their specific health condition. These findings are similar
8  2010 Blackwell Publishing Ltd
to those of Lustyk et al. (2004). Healthcare providers can
promote these factors in adults by focusing on health and
fitness aspects of exercise, as well as the affect improvement
and fun experienced by participants in these activities.
Conclusion
Among adults, modes of exercise exert varying influence on
HRQOL domains; therefore, healthcare providers should
understand the impact of the most common modes of group
exercise. This would allow them to educate clients better to
achieve a more favourable quality of life and to motivate
those who are inactive to exercise. Healthcare providers
should encourage adults to increase their intensity of exercise
to benefit from higher levels of HRQOL. Finally, nurses need
to develop effective strategies to help adults improve their
motivation and achieve better overall outcomes, such as
providing education on the emotional, physical and social
benefits of group exercise.
Funding
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
No conflict of interest has been declared by the authors.
Author contributions
JM, MO and TH were responsible for the study conception
and design. JM performed the data collection. JM and MO
performed the data analysis. JM, MO and TH were respon-
sible for the drafting of the manuscript. JM, MO and TH
made critical revisions to the paper for important intellectual
content. MO and TH provided statistical expertise. MO and
TH provided administrative, technical or material support.
MO and TH supervised the study.
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J.A. McGrath et al.

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