Observational Trial

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Perceived Benefits and Barriers to Physical

Activity among LGBTQ+ College Students
Ginny M. Frederick,1 Kristen L. Bub,2 and Ellen M. Evans3

by leaving the family home to attend col-

ABSTRACT lege, is associated with poorer health habits
Introduction/Purpose: Members of the lesbian, gay, bisexual, transgender, and that may be more pronounced in LGBTQ+
queer (LGBTQ+) community experience health disparities in part due to health be- persons, worsening health disparities (3,4).
haviors, including physical activity (PA). This cross-sectional study explored per- Habitual physical activity (PA) positively
ceived benefits and barriers to PA, an important health behavior for both physical impacts many of the health outcomes in
and mental health, among LGBTQ+ college students using quantitative and qual- which disparities are seen for LGBTQ+ in-
itative methods. Methods: College students identifying as LGBTQ+ (n = 47) were dividuals, such as decreased risk of chronic
assessed for PA via accelerometry and completed the Exercise Benefits and Bar- disease and reduced anxiety and depres-
riers Scale (EBBS). Six focus groups (4–8 participants each) provided qualitative sion, both of which are notably higher
descriptions of perceived benefits and barriers to PA. Results: PA guidelines (aer- among LGBTQ+ college students (5,6).
obic and resistance training) were met by ~30% of participants. Qualitative de- Fewer than half of US college students
scriptions aligned with EBBS subscales of general benefits and barriers to PA. meet public health guidelines for PA, and
General minority stress, perceived stigma, internalized homophobia, and discrim-
adherence rates among LGBTQ+ college
ination and violence emerged as themes related to the experienced barriers. Fur-
students are even lower (3,7–12). Al-
thermore, effects of PA on body shape, focus on aesthetics in the LGBTQ+ com-
though many studies demonstrating differ-
munity, the importance of physically active LGBTQ+ role models, deviance from
social or gender norms related to PA, and same-sex relationships and body image ences in rates of PA participation based on
were additional concerns related to LGBTQ+ identity. Conclusions: Qualitative re- sexual orientation and gender identity ex-
sponses indicate that LGBTQ+ college students perceive general benefits and bar- ist (3,8,10,12–14), very few have exam-
riers to PA. Barriers to engaging in sufficient PA due to minority stress and con- ined underlying reasons for this discrep-
cerns related to identity as LGBTQ+ were evident. These findings can be used to ancy (15). One factor contributing to PA
develop tailored health promotion programs on college campuses to address the behavior among members of the LGBTQ
barriers to PA faced by LGBTQ+ students. More research is needed in the + community is perception of the benefits
college-aged LGBTQ+ community to build robust PA health promotion efforts to and barriers associated with engagement
enhance inclusivity and reduce health disparities. 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
INTRODUCTION non-LGBTQ+ counterparts (9). Moreover, in addition to gen-
Members of the lesbian, gay, bisexual, transgender, and eral barriers to PA (e.g., lack of time, motivation), individuals
queer (LGBTQ+) community experience disparities in health identifying as LGBTQ+ may perceive unique benefits and bar-
outcomes across the life span, prompting calls for further re- riers that are not adequately captured using standard quantita-
search to characterize these disparities and their causes (1,2). tive measures such as the Exercise Benefits and Barriers Scale
The transition from adolescence to adulthood, often marked (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
1
perceptions and experiences (23), has suggested equivocal re-
Department of Exercise Science, Mercer University, Macon, GA; 2Department
3 sults regarding LGBTQ+ identity and PA benefits and barriers,
of Educational Psychology, University of Georgia, Athens, GA; and Department
of Kinesiology, University of Georgia, Athens, GA with some individuals reporting barriers to PA related to their
identity as LGBTQ+ and others finding no impact of LGBTQ+
Address for correspondence: Ginny M. Frederick, Ph.D., University of Georgia, status on PA participation (15,17–19,21,24). Because of this
300 River Road, Athens, GA 30603 (E-mail: Ginny.Frederick@uga.edu). lack of consensus, further qualitative exploration of the PA ex-
2379-2868/0704/e000216
perience of college students identifying as LGBTQ+ is war-
Translational Journal of the ACSM ranted. Specifically, the elucidation of perceived benefits and
Copyright © 2022 by the American College of Sports Medicine barriers to PA among LGBTQ+ college students could inform

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 health promotion programming to increase participation in
this health-enhancing behavior.
In this context, the purpose of this study was to quantita-
tively 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
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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 stu-
dents at a large southeastern university (9). In a subgroup of in-
dividuals who identified as LGBTQ+, qualitative methodology
complimented quantitative survey data to provide context re-
garding PA benefits and barriers. Thus, data collection had
two parts. In part 1, all students at a large southeastern univer-
sity (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 per-
ceptions (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 en-
gagement in PA. During part 2 visit 1, body mass index was de-
termined, and accelerometer devices and instructions were
provided. During visit 2, (7–10 d after visit 1), participants re-
turned 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 in-
dicated that minimal new response themes were being gener-
ated (i.e., 15 of the 18 themes were evident in the first or sec-
ond focus group and thereafter; 2 new themes in the fifth
group; no new themes in the sixth). Thus, the remaining partic-
ipants only completed anthropometric measures and objective
PA monitoring.
All study procedures were reviewed and approved by the in-
stitutional review board at the University of Georgia
(STUDY00006483), and informed consent was obtained elec-
tronically 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
2 Volume 7 • Number 4 • Fall 2022
Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
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 be-
sides “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+ acceler-
ometers (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 de-
vice 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, re-
spectively). Two participants were excluded from analysis be-
cause 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 RTwere clas-
sified as not meeting guidelines.
QUALITATIVE ASSESSMENT OF BENEFITS AND BARRIERS TO PA
Based on previous experience assessing perceptions and at-
titudes toward health behaviors, specifically PA, the research
team decided to use focus groups as a means to capture mean-
ingful dialogue about perceptions of PA among LGBTQ+ col-
lege 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 under-
standing 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
LGBTQ+ Students’ Physical Activity
 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, http://links.lww.com/TJACSM/A192).
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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 con-
ducted 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 tran-
scribed, and pseudomyns were randomly assigned to partici-
pants. To become familiar with the data and therefore the anal-
ysis 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 expendi-
ture) as categories (29,30). The choice to code deductively was
made specifically to determine if participant responses en-
dorsed 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 re-
view 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 frame-
work used in health research in the LGBTQ+ community. Sub-
sequently, 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 re-
sponses that did not fit within the processes of minority stress
remained but were still related to LGBTQ+ identity. These re-
sponses 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.
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.
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Qualitative Perceptions of Benefits and Barriers to PA
Themes and representative illustrative quotes are shown in
Tables 3–5. As expected, participants described perceived ben-
efits and barriers to PA in alignment with almost all of the
EBBS subscales (Table 3).
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 minor-
ity stress, discrimination and violence, internalized homopho-
bia, and perceived stigma were supported (Table 4).
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 ex-
ample, “I think a lot of people in the LGBT et cetera commu-
nity 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 par-
ticipants 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 equip-
ment 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 be-
cause 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 as-
sumptions. 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 impor-
tance 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, specifi-
cally 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 behav-
iors as a coping mechanism: for example, “Here at [the cam-
pus recreation center], it’s my assumption that it’s a mostly
male, straight kind of environment. And that can be intimidat-
ing 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 la-
beled 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
Translational Journal of the ACSM 3
 TABLE 1. TABLE 1.
Participant Characteristics (n = 47). (Continued)

% or Mean ± SD % or Mean ± SD
Demographic characteristics Meet aerobic 91.5
Gender Identity Meet muscle strengthening 29.8
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Man 23.4 Perceptions of PA

Woman 61.7 Total EBBS score 129.0 ± 15.9
Transgender female 2.1 Benefits scale score 87.9 ± 10.3
Nonbinary 8.5 Physical performance 3.3 ± 0.4
Genderqueer 2.1 Preventive health 3.2 ± 0.4
Agender 2.1 Psychological outlook 3.1 ± 0.6
Sexual orientation Life enhancement 3.0 ± 0.5
Lesbian 17.0 Social interaction 2.2 ± 0.6
Gay 21.3 Barriers scale score 28.9 ± 7.5
Bisexual 34.0 Physical exertion 2.8 ± 0.6
Queer 27.7 Time expenditure 1.9 ± 0.6
Race Exercise milieu 1.9 ± 0.6
Asian 12.8 Family discouragement 1.7 ± 0.7
White 85.1 BMI, body mass index (in kilograms per meter squared).

Multiracial 2.1
concealment was expressed because of the other three minority
Year in school stress themes. Participants discussed concealing their sexual
orientation or gender identity to avoid negative outcomes or
Freshman 23.4
situations related to discrimination or stigma. For example,
Sophomore 10.6 concealment as a result of perceived stigma is evidenced from
a participant who said, “In this [physical education] class,
Junior 17.0 I’m still like, ‘Oh God, what if they know [about my LGBTQ
Senior 12.8 + identity]? They’re gonna treat me differently!’”
A final round of coding beyond the EBBS and Minority
Graduate student 36.2 Stress Framework led to the emergence of six unique PA bene-
fit and barrier themes (Table 5).
Age (yr) 23.1 ± 6.8 As a benefit, the theme of the effects of PA on body shape re-
Weight status lated to the way in which individuals can control the appear-
ance of their bodies through PA. Thus, PA is an affirming prac-
Underweight (BMI <18.5) 4.3 tice for transgender and nonbinary individuals: for example,
“Especially as a trans person, one of the benefits is feeling com-
Normal (18.5 ≤ BMI < 25) 57.4
fortable in your body and kind of recognizing what physical
Overweight (25 ≤ BMI < 30) 27.7 activity you’re able to participate in.” Alternatively, as a per-
ceived barrier, this theme referred to the idea that engaging in
Obese (BMI ≥30) 10.6 PA can result in physical changes that may hinder affirmation
or expression of gender: for example, “I think it’s really com-
PA behavior
mon in the trans community for people to be like overweight
MPA (min·d−1) 46.3 ± 18.7 and plus-sized because I think it’s easier to kind of de-gender
your body if you have extra body weight.”
VPA (min·d−1) 5.0 ± 5.7 The theme of the focus on aesthetics in the LGBTQ+ com-
Total MVPA (min·d −1
) 51.3 ± 21.5 munity represented perceptions of additional pressures to meet
a certain set of standards regarding body shape and physique:
RT (d·wk−1) 1.1 ± 1.7 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
Meeting PA guidelines 29.8 certain body type is intense.”

4 Volume 7 • Number 4 • Fall 2022 LGBTQ+ Students’ Physical Activity

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 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
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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.

to PA represented the idea of not conforming to or fitting into
typical gender categories or roles when engaging in PA: for ex-
ample, “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 de-
scribed 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
The high prevalence of participants meeting the aerobic
portion of PA guidelines is encouraging; however, there are ca-
veats 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 cam-
puses 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 re-
ported sufficient RT to meet current guidelines (5). Consistent
with previous research in this community, this may be influ-
enced by barriers related to minority stress and LGBTQ+ iden-
tity, because RT is typically completed in a fitness facility with
equipment (3,10). Also beyond the scope of the current inves-
tigation, 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 guide-
lines (33). Thus, the high proportion of individuals meeting the
aerobic portion without meeting the RT portion may be par-
tially explained by the fact that over 50% of the participants

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* —

−1
MVPA (min·d ) 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.

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 TABLE 3.
Qualitative Themes and Illustrative Quotes Related to Exercise Benefits and Barriers Subscales among LGBTQ+ College Students.
Qualiative Themes
Perceived benefits
Physical performance
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Preventive health
Psychological outlook
Life enhancement
Social interaction
Perceived barriers
Physical exertion
Time expenditure
Exercise milieu
6 Volume 7 • Number 4 • Fall 2022
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Illustrative Quotes
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
LGBTQ+ Students’ Physical Activity
 TABLE 3.
(Continued)

Qualiative Themes Illustrative Quotes

• 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
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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

in this study identified as women. Even with this caveat, our levels of PA among LGBTQ+ students and individuals com-
findings are consistent with previous research regarding lower pared with their non-LGBTQ+ counterparts (3,8–11).

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 LGBTet 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 LGBTor 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 • I don’t know if it’s fear of being judged or fear of being “the other.” Um…the first thing that comes
stigma 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

http://www.acsm-tj.org Translational Journal of the ACSM 7

Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 TABLE 5.
Qualitative Themes and Illustrative Quotes Related to Additional LGBTQ+-Specific Concerns.
Qualitative Themes
Effects of PA on body shape—benefit
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Effects of PA on body shape—barrier
Focus on aesthetics in
LGBTQ+ community
Importance of physically active
LGBTQ+ role models
Deviance from social or gender
norms related to PA
Same-sex relationships and
body image
8 Volume 7 • Number 4 • Fall 2022
Copyright © 2022 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Illustrative Quotes
• 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
• 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
• 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
• 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
• 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
• 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
LGBTQ+ Students’ Physical Activity
 TABLE 5.
(Continued)

Qualitative Themes Illustrative Quotes

• 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
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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

The EBBS data indicate that this sample of LGBTQ+ stu-
dents 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. Bar-
riers 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 in-
sufficiently 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 re-
ported 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 ex-
istence of the themes related to the Minority Stress Framework
(Table 4) and additionally the LGBTQ+ identity (Table 5) indi-
cate that students identifying as LGBTQ+ face different bar-
riers than their counterparts. This means that, in addition to
the perceived barriers related to the EBBS constructs, addi-
tional 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 quali-
tative approaches to supplement or bolster quantitative
methods. This approach allowed us to elucidate perceived PA
benefits and barriers specific to members of the LGBTQ+ com-
munity, expanding upon our previous work that determined
that EBBS scores differ for LGBTQ+ students compared with
their non-LGBTQ+ counterparts (9). Furthermore, these con-
textualized 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 recommenda-
tions 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 cre-
ate 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, sugges-
tions 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 devi-
ating from gender norms and how that influences the per-
ceived 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+ commu-
nity regardless of age or life stage.
In conclusion, LGBTQ+ college students perceive more
than the general barriers to engaging in PA. Much like the con-
cept 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 ori-
entation. However, when using standard instruments, such as
the EBBS, these concerns become largely invisible and therefore
cannot be assessed or addressed by health promotion program-
ming 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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LGBTQ+ Students’ Physical Activity