Highlights from wave I of the National Survey of Personal
Health Practices and Consequences: United States, 1979.
Vital and Health Statistics, series 15, No. 1. DHHS publica-
tion No. (PHS) 81-1162. National Center for Health Statis-
tics, Hyattsville, MD, June 1981.
Canada Fitness Survey: Fitness and lifestyle in Canada.
Canada Fitness Survey, Ottawa, May 1983.
Bradstock, M. K., et al.: Behavioral Risk Factor Surveil-
lance, 1981-1983. CDC Surveillance Summaries. MMWR
33 (No. ISS): ISS-4SS (1984).
The Miller Lite report on American attitudes toward
sports. Miller Brewing Co., Milwaukee, 1983.
Kannel, W. B.: Habitual level of physical activity and risk
ofcoronary heart disease: the Framingham study. Can Med
Assoc J 96: 811-812 (1967).
Berkman, L. F., and Breslow, L.: Health and ways of
living: the Alameda County study. Oxford University
Press, New York, 1983.
Montoye, H. J.: Physical activity and health: an epidemi-
ologic study of an entire community. Prentice-Hall, Inc.,
Englewood Cliffs, NJ, 1975.
Taylor, H. L., et al.: A questionnaire for the assessment of
leisure time physical activities. J Chronic Dis 31: 741-755
Haskell, W. L., Montoye, H. J., and Orenstein, D. R.:
Physical activity and exercise to achieve health-related
components of physical fitness. Public Health Rep 100:
202-212, March-April 1985.
Chubb, M., and Chubb, H. R.: One third of our time? An
introduction to recreation behavior and services. John
Wiley and Sons, Inc., New York, 1981, p. 95.
Canada Fitness Survey: Canadian youth and physical activ-
ity. Canada Fitness Survey, 506-294 Albert St., Ottawa,
KIP 6E6, October 1983.
Powell, K. E., and Paffenbarger, R. S.: Summary of the
workshop on epidemiologic and public health aspects of
physical activity and exercise. Public Health Rep 100:
118-126, March-April 1985.
The Gallup Poll: Six of 10 adults exercise daily. Los
Angeles Times Syndicate, Los Angeles, May 1984.
18.Contemporary Research Centre, Ltd.: Behaviour and at-
titude toward physical activity among Canadians. Results
of a national survey conducted for PARTICIPaction.
Toronto, Canada M5H2A4, Toronto, May 1982. Mimeo-
Canada Fitness Survey: Exercise and sports: age is not a
barrier. Canada Fitness Survey Highlights No. 14, October
The use of time, edited by A. Szalai. Mouton, The Hague,
A dictionary of epidemiology, edited by J. M. Last. Oxford
University Press, New York, 1983.
Department of Health and Human Services: Promoting
health/preventing disease: objectives for the nation. U.S.
Government Printing Office, Washington, DC, fall 1980, (a)
Paffenbarger, R. S., Hyde, R. T., Wing, A. L., and Stein-
metz, C. H.: A natural history ofathleticism and cardiovas-
cular health. JAMA 252: 491-495, July 27, 1984.
Laporte, R. E., Montoye, H. J., and Caspersen, C. J.:
Assessment of physical activity in epidemiologic research:
problems and prospects. Public Health Rep 100: 131-146,
Montoye, H. J.: Estimation of habitual physical activity by
questionnaire and interview. Am J Clin Nutr 24: 1113-1118
Bouchard, C., et al.: A method to assess energy expenditure
in children and adults. Am J Clin Nutr 37: 461-467 (1983).
Sallis, J. F., et al.: Physical activity assessment methodol-
ogy in the Five-City Project. Am J Epidemiol 121: 91-106
Furrie, A. D., and Stephens, T.: Energy expenditure pat-
terns in the Canadian population. In Health risk estimation,
risk reduction and health promotion, edited by F. Landry.
Proceedings of the 18th annual meeting of the Society for
Prospective Medicine, 1982. The Canadian Public Health
Association, Ottawa, pp. 103-114, 1983.
The Determinants of Physical
Activity and Exercise
ROD K. DISHMAN, PhD
JAMES F. SALLIS, PhD
DIANE R. ORENSTEIN, PhD
Dr. Dishman is an Associate Professor, Department of Physi-
cal Education, University ofGeorgia, Athens, GA 30602. He was
formerly the Associate Director, Adult Fitness and Cardiopul-
monary Rehabilitation Exercise Programs, University of Cali-
fornia at Davis. Dr. Sallis is Assistant Adjunct Professor, Divi-
sion ofGeneral Pediatrics, University of California at San Diego,
La Jolla. Dr. Orenstein is a Research Psychologist in the Behav-
ioral Epidemiology and Evaluation Branch, Division of Health
Education, Center for Health Promotion and Education, Centers
for Disease Control, Atlanta, GA 30333.
Tearsheet requests to Dr. Dishman.
Evaluation and delivery ofphysical activity and
exercise programs appear impeded by the substan-
tial numbers of Americans who are unwilling or
unable to participate regularly in physical activity.
As a step toward identifying effective interventions,
we reviewed available research on determinants re-
lating to the adoption and maintenance ofphysical
activity. We categorized determinants as personal,
environmental, or characteristic ofthe exercise. We
have considered supervised participation
rately from spontaneous activity in the general
A wide variety ofdeterminants, populations, and
settings have been studied within diverse research
traditions and disciplines. This diversity and the
Public Health Reports
varied interpretation of the data hinder our clearly
summarizing the existing knowledge. Although we
provide some directions for future study and pro-
gram evaluation, there is a need for research that
tests hypotheses derived from theoretical models
and that has clear implications for intervention
programs. We still need to explore whether general
theories of health behavior or approaches relating
to specific exercises or activities can be used to
predict adoption and maintenance ofphysical activ-
NATIONAL GOALS call for participation in regular
and vigorous physical activity by 90 percent of
youth and 60 percent of adults by 1990 (1). At this
time, however, best estimates indicate that 41 per-
cent to 51 percent of adults are sedentary (2,3)
while only one-third of all adults participate in exer-
cise on a weekly basis. Just 15 percent are believed
to expend an energy equivalent (1,500 kcal per
week) ofknown epidemiologic significance (3,4). Of
those already regularly engaged in either group or
solitary exercise, about 50 percent will discontinue
activity at some time in the coming year (5-7).
Moreover, less than 10 percent of sedentary adults
are likely to begin a program of regular exercise
within a year (James F. Sallis, unpublished observa-
tions, November 18, 1982, and reference 3).
Estimates (reference 8 and Steven N. Blair, Insti-
tute for Aerobics Research, Dallas, TX, unpub-
lished observations, May 26, 1984) do show recent
increases in participation in activity that develops
However, these increases seem to occur in certain
population segments only-notably young adults,
the well educated, and members of high socioeco-
nomic groups (3,4).
These findings are similar to recent Canadian es-
timates (9); however, the U.S. increases are not as
high as the Canadian increases. According to avail-
able figures, our nationwide participation in all
types ofphysical activity has increased only slightly
(from 4 percent to 14 percent) during the past de-
cade (3,9,10). Although we cannot precisely iden-
tify the current nationwide rate (8), it seems un-
likely that the 1990 goals for the nation for participa-
tion in physical activity and exercise can be met
One barrier to developing effective methods to
encourage physical activity among all segments of
the population is lack of knowledge of the determi-
nants of regular physical activity. It appears that the
public health potential ofphysical activity and exer-
cise cannot be defined or fulfilled until the behav-
ioral determinants ofparticipation are identified and
subsequently managed; yet these determinants re-
main poorly understood.
Goals of This Review
The first goal of this paper is to review the scien-
tific literature on known determinants of regular
exercise and physical
activity. We categorized
these determinants by focusing on (a) characteris-
tics of the person and his or her lifestyle habits, (b)
characteristics of environments, and (c) charac-
teristics of the activity itself. This approach helped
to organize the review and to identify domains that
may account for the wide range of determinants
contributing to participation in physical activity.
Identifying these areas may also help specify seg-
ments of the population we need to target and im-
portant variables for future interventions.
The second goal is to identify what appear to be
the most important determinants in each of the
three categories previously described. Because any
single factor can be influential under certain condi-
tions, we present each individually. It is important
to note, however, that these factors probably inter-
act in complex ways and that their relative impor-
tance can vary. Few factors have shown behavioral
uniformity across settings, populations, and time
Our final goal is to recommend specific study
areas that could help us understand what motivates
people to become physically active and help us de-
velop ways to increase activity. Effective exercise
interventions will probably require that both ab-
stract (for example, beliefs) and concrete (for
example, disability) determinants be addressed in
complementary ways to (a) diminish or compensate
for psychological and physical or environmental
barriers to activity; (b) provide knowledge, skills,
and reinforcements that augment the willingness
and ability to be active; and (c) permit selection of
appropriate forms and intensities ofactivity. Under-
lying our recommendations is the need to integrate
the efforts of epidemiology, behavioral medicine,
health psychology, and exercise science under a
public health umbrella. In the past, the purpose,
methods, and scope of the various study ap-
proaches have not assured an orderly progression of
theoretical and practical knowledge. The disparities
March-April 1985, Vol. 100, No. 2
quantified and reconciled, to allow researchers to
examine whether the results of studies ofbehavioral
patterns and determinants can be generalized across
settings, activities, and population segments. Stan-
dardized questions concerning determinants should
be added to population surveys.
4. Most studies have been guided by applied con-
cerns rather than by theory. Although some at-
tempts to conceptualize existing evidence (7,13,14)
have helped form predictive hypotheses, there is a
need to continue bridging applied questions with
theory. This is important if physical activity, exer-
cise, and fitness are to be examined in relation to
other health behaviors and outcomes. Standardized
theories and technologies will allow us to determine
ifcommon determinants exist or ifmodels unique to
physical activity are needed. Although previous
tests ofgeneralized behavior models (such as health
locus of control, the health belief model, theory of
reasoned action, and self-efficacy or competence
motivation) have not been encouraging (18,27,
52,53,67,68), further efforts are warranted. This con-
clusion seems timely, since recent public health re-
views ofbehavioral change have not discussed theo-
ries within which exercise and physical activity are
target behaviors (69-72).
Department of Health and Human Services, Office of Dis-
ease Prevention and Health Promotion: Prevention '82.
DHHS Publication No. (PHS) 82-50157. U.S. Government
Printing Office, Washington, DC, 1982.
National Center for Health
Washington, DC, 1980.
The Perrier study: fitness in America. Perrier-Great Waters
of France, Inc., New York, 1979.
The General Mills American family report, 1978-1979:
Family health in an era of stress. Yankelovich, Skelly and
White, Inc., New York, 1979.
Morgan, W. P.: Involvement in vigorous physical activity
with special reference to adherence. In National College of
G. I. Gedvilas and M. E. Kneer. University ofIllinois Press,
Oldridge, N. B.: Compliance and exercise in primary and
secondary prevention of coronary heart disease: a review.
Prev Med 11: 56-70 (1982).
Dishman, R. K.: Compliance/adherence in health-related.
exercise. Health Psychol 1: 237-267 (1982).
Stephens, T., Jacobs, D. R., and White, C. C.: The descrip-
tive epidemiology of leisure-time physical activity. Public
Health Rep 100: 147-158, March-April 1985.
Canada Fitness Survey. Fitness and lifestyle in Canada.
Fitness Canada, Ottawa, 1983.
Clarke, H. H., editor: National adult physical fitness sur-
vey. President's Council on Physical Fitness and Sports
Newsletter, Washington, DC, special edition, May 1973.
Statistics: Health, United
Dishman, R. K.: Motivation and exercise adherence. In
Psychological foundations of sport, edited by J. Silva and
R. Weinberg. Human Kinetics Publications, Champaign,
IL, 1984, pp. 416-430.
Cox, M. H.: Fitness and lifestyle programs for business and
industry: problems in recruitment and retention. J Cardiac
Rehabil 4: 136-142 (1984).
Dishman, R. K.: Exercise adherence and habitual physical
activity. In Coping with mental stress: the potential and
limits ofexercise intervention, edited by W. P. Morgan and
S. N. Goldston. National Institute of Mental Health,
Rockville, MD. In press.
Martin, J. E., and Dubbert, P. M: Exercise applications and
promotion in behavioral medicine: current status and future
directions. J Consult Clin Psychol 50: 1004-1017 (1982).
Dishman, R. K.: Biologic influences on exercise adherence.
Res Q Exerc Sport 52: 143-159 (1981).
Dishman, R. K.: Prediction of adherence to habitual physi-
cal activity. In Exercise in health and disease, edited by
F. J. Nagle and H. J. Montoye, Charles C Thomas, Spring-
field, IL, 1981.
Harris, D. V.: Physical activity history and attitudes of
middle-aged men. Med Sci Sports 2: 203-208 (1970).
Dishman, R. K., and Ickes, W.: Self-motivation and adher-
ence to therapeutic exercise. J Behav Med 4: 421-438
Brownell, K., and Stunkard, A. J.: Physical activity in the
development and control of obesity. In Obesity, edited by
A. J. Stunkard. W. B. Saunders and Company, Inc.,
Philadelphia, PA, 1980.
Brownell, K., Stunkard, A. J., and Albaum, J.: Evaluation
and modification of exercise patterns in the natural envi-
ronment. Am J Psychol 137: 1540-1545 (1980).
Rejeski, W. J., Morley, D., and Miller, H. S.: The Jenkins
Activity Survey: exploring its relationship with compliance
to exercise prescription and MET gain within a cardiac
rehabilitation setting. J Cardiac Rehabil 4: 90-94 (1984).
Shephard, R. J., and Cox, M.: Some characteristics of
participants in an industrial fitness programme. Can J Appl
Sport Sci 5: 69-76 (1980).
Teraslinna, P., et al.: Characteristics affecting willingness
of executives to participate in an activity program aimed at
coronary heart disease prevention. J Sports Med Phys Fit-
ness 9: 224-229 (1969).
Morgan, P. P., Shephard, R. J., and Finucane, R.: Health
beliefs and exercise habits in an employee fitness pro-
gramme. Can J Appl Sport Sci 9: 87-93 (1984).
Shephard, R. J.: Physical activity and aging. Croom Helm,
Andrew, G. M., et al.: Reasons for dropout from exercise
programs in post coronary patients. Med Sci Sports Exerc
13: 164-168 (1981).
Lindsay-Reid, E., and Osborn, R. W.: Readiness for exer-
cise adoption. Soc Sci Med 14: 139-146 (1980).
MacKeen, P. C., Franklin, B. A., and Nicholas, W. C.:
Body composition, physical work capacity and physical
18-month follow-up of middle-aged
women participating in an exercise intervention program.
Int J Obes 7: 61-71 (1983).
Ward, A., and Morgan, W. P.: Adherence patterns of
healthy men and women enrolled in an adult exercise pro-
gram. J Cardiac Rehabil 4: 143-152 (1984).
Blumenthal, J. A., et al.: Physiological and psychological
variables predict compliance to prescribed exercise therapy
Public Health Reports
in patients recovering from myocardial infarction. Psychol
Med 6: 519-527 (1982).
Lobstein, D. D., Mosbacher, B. J., and Ismail, A. H.:
Depression as a powerful discriminator between physically
active and sedentary middle-aged men. J Psychosom Res
27: 69-76 (1983).
Collingwood, T. R., et al.: Caronical correlation analysis of
clinical and psychological data in 4,351 men and women. J
Cardiac Rehabil 3: 706-711 (1983).
Heinzelmann, F., and Bagley, R. W.: Response to physical
activity programs and their effects on health behavior. Pub-
lic Health Rep 86: 905-911 (1970).
Martin, J. E., et al.: The behavioral control of exercise in
sedentary adults: studies
Psychol. In press.
Wankel, L. M.: Decision-making and social-support strate-
gies for increasing exercise involvement. J Cardiac Rehabil
4: 124-135 (1984).
Stalonas, P. M., Johnson, W. G., and Christ, M.: Behavior
modification for obesity: the evaluation of exercise, con-
tingency management, and program adherence. J Consult
Clin Psychol 46: 463-469 (1978).
King, A. L., and Frederiksen, L. W.: Low-cost strategies
for increasing exercise behavior: relapse preparation train-
ing and social support. Behav Mod. In press.
Marlatt, G. A., and Gordon, J. R.: Determinants ofrelapse:
implications for the maintenance of behavior change. In
Behavioral medicine: changing health lifestyles, edited by
P. Davidson and S. Davidson. Brunner-Mazel, New York,
1980, pp. 410-452.
Oldridge, N. B., and Jones, N. L.: Improving patient com-
pliance in cardiac rehabilitation: effects of written agreement
and self-monitoring. J Cardiac Rehabil 3: 257-262 (1983).
Epstein, L. H., et al.: Attendance and fitness in aerobics
exercise: the effects of contract and lottery procedures.
Behav Mod 4: 465-479 (1980).
Wysocki, T., et al.: Behavioral management of exercise:
contracting for aerobic points. J Appl Behav Anal 12: 55-64
Keefe, F. J., and Blumenthal, J. A.: The life fitness pro-
gram: a behavioral approach to making exercise a habit. J
Behav Ther Exp Psychiatry 11: 31-34 (1980).
Epstein, L. H., Koeske, R., and Wing, R. R.: Adherence to
exercise in obese children. J Cardiac Rehabil 4: 185-195
Wilhelmson, L., et al.: A controlled trial of physical train-
ing after myocardial infarction. Prev Med 4: 491-508
Loy, J. W., McPherson, B., and Kenyon, G.: Sport and
social systems. W. B. Saunders and Company,
Philadelphia, PA, 1978.
The Miller Lite report on American attitudes toward sports.
Research & Forecasts, Inc., New York, 1983.
Greendorfer, S. L.: Shaping the female athlete: the impact
of the family. In The sporting woman, edited by M.
Boutslier and L. San Giovani. Human Kinetics Publishers,
Champaign, IL, 1983, 135-155.
Butcher, J.: Socialization of adolescent girls into physical
activity. Adolescence 18: 753-766 (1983).
Engstrom, L. M.: Physical activity of children and youth.
Acta Paediatr Scand [Suppl] 283: 101-105 (1980).
Sonstroem, R. J.: Attitudes and beliefs in the prediction of
exercise participation. In Sports medicine, sports science:
bridging the gap, edited by R. L. Cantu and W. J. Gillespie.
The Collamore Press, Lexington, MA, 1982, 3-16.
1 through 6. J Consult Clin
Sallis, J. F., et al.: Physical activity assessment methodol-
ogy in the Five City Project. Am J Epidemiol. In press.
demiological study of an entire community. Prentice-
Hall, Inc., Englewood Cliffs, NJ, 1975.
Gettman, L. R., Pollock, M. L., and Ward, A.: Adherence
exercise. Phys Sportsmed
Meyer, A., et al.: Skills training in a cardiovascular health
education campaign. J Consult Clin Psychol 48: 129-142
McIntosh, P.: "Sport for All" programs throughout the
world. Report prepared for UNESCO (Contract No.
207604). UNESCO, New York, 1980.
Fitness Ontario: The relationship between physical activity
and other health-related lifestyle behaviors. A research re-
port from the Ministry of Culture and Recreation, Sports
and Fitness Branch, Government of Ontario, Toronto,
Blair, S. N., Jacobs, D. R., and Powell, K. E.: Relation-
ships between exercise or physical activity and other health
behaviors. Public Health Rep 100: 172-180, March-April
Iverson, D. C., Fielding, J. E., Crow, R. S., and Christen-
son, G. M.: The promotion of physical activity in the U.S.
population: the status of programs in medical, worksite,
community, and school settings. Public Health Rep 100:
212-224, March-April 1985.
Fielding, J. E.: Effectiveness of employee health improve-
ment programs. J Occup Med 24: 907-916 (1982).
Sacks, M. H., and Sachs, M. L., editors: Psychology of
running. Human Kinetics Publishers, Champaign, IL, 1981.
Pollock, M. L., et al.: Effects offrequency and duration of
training on attrition and incidence of injury. Med Sci Sports
9: 31-36 (1977).
Oldridge, N. B., et al.: Predictive indices for dropout: the
Ontario Exercise Heart Collaborative Study Experience.
Am J Cardiol 51: 70-74 (1983).
Inger, F., and Dahl, H. A.: Dropouts from an endurance
training program. Scand J Sports Sci 1: 20-22 (1979).
Morgan, W. P.: Negative addiction in runners. Physician
Sports Med 7: 57-70 (1979).
Taylor, C. B., Sallis, J. F., and Needle, R.: The relationship
between physical activity and exercise and mental health.
Public Health Rep 100: 195-202, March-April 1985.
Dishman, R. K.: Medical psychology in exercise and sport.
Med Clin North Am. In press.
LaPorte, R. E., et al.: The spectrum of physical activity,
perspective. Am J Epidemiol 120: 507-517 (1984).
Godin, G., and Shephard, R. J.: Physical fitness promotion
programmes: effectiveness in modifying exercise behavior.
Can J Appl Sport Sci 8: 104-113 (1983).
Owen, N., and Lee, C.: Why people do and do not exer-
cise: recommendations for initiatives to promote regular,
vigorous physical activity in Australia. Department of Rec-
reation and Sport, South Australia, Sport and Recreation
Minister's Council, Adelaide, 1984.
Benfari, R. C., Eaker, E., and Stoll, J. G.: Behavioral
interventions and compliance to treatment regimes. Annu
Rev Public Health 2: 421-471 (1981).
Green, L. W.: Modifying and developing health behavior.
Annu Rev Public Health 5: 215-236 (1984).
Fielding, J. E.: Health promotion and disease prevention at
the worksite. Annu Rev Public Health 5: 237-265 (1984).
J.: Physical activity and health: an epi-
March-April 1985, Vol. 100, No. 2