Exploring needs, perceptions, and preferences towards exercise video among overweight individuals - a qualitative study

Study design and recruitment

This qualitative study involves need analysis for the exercise video among overweight individuals through an in-depth interview. The ethical approval was obtained from the Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee, Manipal Academy of Higher Education on 31^st August 2023 (IEC1: 96/2023). The study adhered to the principles outlined by the declaration of Helsinki. This study followed the standard reporting guidelines of COREQ.³³ A purposive sampling was used to recruit study participants. Participants were included in the study if they were 18 to 30 years old and categorized as Overweight with a BMI between 25-29.9kg.m^-2 according to WHO classification. We employed open recruitment strategies to ensure adequate representation within the target population by disseminating posters and flyers on the college campus, and social media platforms to reach a broader audience. Pre-participation health screening was determined using the American College of Sports Medicine (ACSM) screening algorithm and the Physical Activity Readiness Questionnaire Plus (PAR Q +). Medical clearance from a physician or other qualified health care provider was recommended if indicated during screening. Individuals with any reported or confirmed comorbidities were excluded from participation. Eligible individuals were required to be inactive or active based on the Global Physical Activity Questionnaire (GPAQ), free from comorbidities such as diabetes, hypertension, CVD, neurological, and musculoskeletal disorders. Additionally, participants needed to be able to verbally communicate in English and express a willingness to participate in the study Eligible participants were informed about the objectives and study procedure, and those who agreed to participate signed the written informed consent. The identity of the individuals has been removed to maintain confidentiality. The recruitment was carried out from October 2023 to November 2023.

Data collection

A semi-structured face-to-face in-depth interview was conducted among 40 exercising and non-exercising participants by SKB, trained in qualitative research methodology. The sample size of 40 participants was determined based on the study’s objectives and the purposive sampling approach. It was designed to ensure data saturation while allowing for comparisons between two groups. It provided an opportunity to explore variability in contextual elements such as age, fitness levels, and activity patterns. The interview process was guided by an open-ended questionnaire allowing the participants to express their views freely. Through literature reviews and discussions, an interview guide was developed. It was then validated and suitably modified following the advice provided by the experts prior to the interviews. The guide included questions regarding their exercise routine, motivations, barriers to exercise, need for the exercise video, and requirements in the video (refer to the Data set for the interview guide). Interviews were carried out over multiple sessions. Participants were interviewed at scheduled appointments to ensure convenience. The interview process was conducted for 45-60 minutes in a quiet room with only the researcher and the participant. These interviews were audio-recorded on a smartphone and transcribed verbatim. Data triangulation was performed, comprising qualitative interviews with overweight participants, observation of the interactions between participants and the interviewer, and recorded materials. This improved the validity of the qualitative study.

Analysis

The Content Validity Index (I-CVI and S-CVI) was used to analyze the interview guide’s content validity. Data was analysed manually using inductive and deductive approaches. The manual data analysis procedure consisted of some defined processes. Initially, in-depth interview verbatim transcripts were carefully recorded, and saved electronically, and a physical copy was made for the convenience of analysis. Following multiple readings of the transcripts, two team members (SKB and KV) independently coded the material. Disagreements that occurred during the coding process were resolved by consensus and discussion. Significant statements matching the study’s goals were identified and highlighted as keywords during the first coding step. These keywords were subsequently arranged using axial coding. Keywords with similar meanings were categorized and further combined to form broad themes (selective coding).

Participant characteristics

A detailed summary of the 40 participants’ characteristics is given in Table 1 of this qualitative study. The age of the participants spanned between 20 to 30 years, encompassing both male 20 and female 20 individuals with their BMIs varying between 25 and 29.9kg.m^-2. Based on their answers to the GPAQ, 20 of the participants were found to be moderately active (> 600 MET per week), and the other 20 were classed as inactive (<600 MET per week). The participants’ educational backgrounds ranged from undergraduate to Ph.D. level qualifications. Only three of the participants were employed while the majority, comprising thirty-seven individuals were students.

Content analysis

The analysis of the in-depth interview yielded 8 themes and 44 subthemes which are described in Table 2.

Theme 1- Lifestyle factors

Lifestyle factors were illuminated by participants, shedding light on both dietary patterns and exercise routines.

Regarding eating habits, participants (n=11) described that they exhibited stressful eating behaviour during challenging times. However, on the other days (non-stressful periods) they (n=22) follow a disciplined and health-conscious diet.

Participants provided insights into their activity patterns, with many (n=33) reporting extended periods of sitting ranging from 5 to 6 hours or 6 to 7 hours daily. The activity behaviours varied, encompassing a combination of sedentary and active pursuits. Some individuals (n=14) adhered to a regular exercise regimen, incorporating either strength or cardio routines or both, while others (n=6) mentioned consistent engagement in activities such as dancing, aerobics, badminton, and body weight exercises, highlighting the incorporation of enjoyable activities into their physical routines.

Theme 2- Exercise expectations

The participants expressed exercise expectations regarding mental health, appearance, fitness, and overall well-being while also emphasizing the necessity of exercise for preventing illnesses and building confidence. Their desired exercise regimen involved dedicating 10-15 minutes for 4-5 days per week, focusing on specific areas such as the arms, abdomen, hips, and thighs. While acknowledging the positive impact of exercise on their mood and satisfaction, some participants (n=12) noted potential drawbacks, mentioning feelings of boredom over time and heightened self-consciousness when exercising in the presence of others.

Theme 3- Exercise exploration

The exploration of participants’ exercise experiences revealed a spectrum of obstacles and facilitators influencing their pursuit of physical activity. These challenges were classified into personal factors, environmental factors, and opportunities.

Personal factors comprised aspects like self-discipline, the need for company during exercise, body consciousness, fatigue, challenges in working out after college hours, lack of knowledge, and concerns related to injury.

Notably, a significant number of female participants (n=10) identified the menstrual cycle as a major obstacle to regular exercise.

Environmental factors played a pivotal role, with adverse weather conditions, difficulties in commuting to the gym, and a lack of dedicated exercise space emerging as significant barriers.

Social prejudice, particularly the perceived restrictions on females exercising in gyms, was also highlighted (n= 2).

Various opportunities acted as impediments to participants (n=32) to their regular exercise, including time constraints, the cost of gym memberships, and insufficient knowledge about exercise routines.

On the flip side, facilitators to exercise encompassed personal motivations, environmental support, and available opportunities that helped participants overcome these hurdles. Personal motivations included post-exercise mood improvement, weight management goals, and the desire for overall good health.

Interestingly, some female participants (n=5) noted that a limited wardrobe served as a compelling motivation to engage in exercise.

Support from parents and friends, coupled with easy accessibility and dedicated exercise space, were identified as additional facilitators (n= 19).

Key concerns related to exercise were articulated as challenges in maintaining flexibility, and consistency, initiating exercise routines, and a lack of accurate information about various exercises by experts.

Theme 4- Preference of exercise resource

Participants (n=28) expressed a clear preference for utilizing video content as their primary exercise resource, with some also indicating a preference for personal training. They highlighted the advantages of videos, citing their ease of follow, user-friendly nature, time and cost-effectiveness, and overall convenience. Additionally, participants (n=36) shared positive experiences with past exercise videos, appreciating the sense of exercising with a companion, motivational content, animated visuals, immediate feedback, short durations, and easy accessibility compared to other resource forms.

On the downside, they (n=31) noted drawbacks such as insufficient information on techniques, unrealistic recommendations, excessively fast paced and challenging routines that could demotivate, and a lack of monitoring and proper scientific evidence. Some participants (n= 3) also expressed dissatisfaction with branding and advertisements associated with the videos.

Theme 5- Requirements in the video

This segment was meticulously crafted, focusing on various aspects such as exercise techniques, difficulty levels, duration, instructional modes, diverse exercise routines, preferred activities, and the role of music in the video. All participants (n=40) expressed a strong desire for detailed guidance, including proper form, specific numbers of repetitions and sets, and designated breaks. They emphasized the importance of a range of difficulty levels, spanning from easy to challenging, yet manageable within a shorter duration (n=25) of 10-15 minutes.

Moreover, participants (n=26) sought a flexible exercise routine that engaged all body parts, tailored to individual abilities, and visually demonstrated with a progression guide. They (n=20) specifically requested clear captions and voice-over instructions provided by an experienced instructor, outlining the muscles involved.

Additionally, some participants (n=29) expressed a preference for high-intensity music to be incorporated into the video.

Theme 6- Appealing factors

The factors that resonated with participants included their preferences for models, the approachability of the presenter, video quality, background settings, and the duration of exercise content. They (n=21) expressed a preference for an active and fit individual of a similar age, serving as the demonstrator for all exercises in the video. This person should adopt an encouraging approach that is easy to understand.

Participants (n=28) specifically favoured videos presented with bright lighting, clear sound, and visual clarity against a light-coloured background in a distraction-free space. They (n=22) emphasized the importance of the video exhibiting a moderate to high level of professionalism and featuring immersive colours.

Additionally, participants (n=25) highlighted their desire for the video to be of short duration and free from advertisements.

Theme 7- Holistic wellbeing

This explored the participant’s considerations beyond exercise and physical activity encompassing aspects of nutrition, safety precautions, exercise benefits, mode of delivery, and motivational strategies.

All participants (n=40) expressed a preference for information covering calorie and water intake, suitable attire and footwear for exercise, the exercise environment’s features such as ventilation and non-slip flooring, guidelines for the dos and don’ts of exercises, and methods for monitoring exhaustion.

Moreover, they sought insights into the health benefits of exercises and the specific muscles engaged during different activities. Particularly, female participants (n=6) indicated a keen interest in understanding the hormonal influences of exercise.

Regarding motivation, participants (n=23) indicated a preference for weekly communication, either through calls or texts, from fitness experts. Additionally, they expressed a desire to track their progress through videos or logbooks to enhance their commitment to regular exercise.

Their preference was for this information to be presented either at the beginning of a video or as a disclaimer at the end.

Theme 8- Media preferences

The featured videos are intended (n= 34) to be shared with participants through their preferred platforms, such as YouTube, WhatsApp, or email. The content will be presented as a link, which requires minimal internet usage and facilitates easy downloading.

Lifestyle factors

This theme clarified the complex interrelationships between lifestyle elements, including food habits and exercise regimens. One of the main conclusions showed that individuals’ eating habits followed a dual pattern that was influenced by stress. Those who were going through difficult situations tended to eat poorly, but during less stressful times, they ate more healthily and with discipline. This dynamic interaction between food decisions and emotional well-being highlights how differently people react to stress and its impact on lifestyle. In addition, the analysis of exercise regimens and sitting duration offered a thorough picture of the lifestyles of the participants, placing them in the range of sedentary to moderately active. Likewise, research conducted by O’Neil et al. (2012) and Cha et al. (2015) also documented widespread unhealthy lifestyle patterns.^34,35 This conclusion is also consistent with the results of a study by Kushner et al. (2010) that showed how prevalent harmful lifestyle patterns are—including poor food, exercise habits, and coping mechanisms among overweight or obese. The study found a correlation between these patterns and advancing age, and that they intensified with rising BMI.⁵ The incorporation of these findings into the broader context of existing research points to the need for a more complex understanding of the variables driving unhealthy lifestyle choices, particularly in populations dealing with weight-related issues. Identifying these trends becomes an essential first step toward developing focused interventions. According to Kushner et al (2010), interventions that target both emotional health and certain lifestyle decisions may be more successful in encouraging healthy behaviours in people who struggle with being overweight or obese.⁵ This emphasizes how important it is to take a comprehensive approach when creating therapies that are specific to the problems that unhealthy lifestyle patterns create.

Exercise expectations

The discussion on participants’ expectations for exercise demonstrates the diverse nature of perspectives on physical activity. People approach exercise with a variety of objectives in mind, highlighting the importance of customized routines. The recognition of allocating time to target body parts emphasizes a tactical approach to fitness, rejecting a one-size-fits-all paradigm. Positive recognition of exercise’s impact on mood aligns with the literature on mental health benefits.^36,37 However, it also highlights potential negative effects including boredom and self-consciousness, emphasizing the need for diversity and psychological considerations. This pattern of persistent negativity aligns with findings by Sikes et al. (2019), who highlighted boredom as the predominant factor contributing to youth’s physical inactivity.³⁸ The various expectations that participants have about their physical and mental well-being, appearance, and fitness highlight the necessity of inclusive exercise programs. Overall, the results support customized and holistic approaches to satisfy a range of needs and encourage sustained adherence to healthy lifestyle choices.

Exercise exploration

A thorough examination of the exercise experiences of the participants in our study revealed a wide variety of barriers and enablers, which we divided into three categories: opportunistic, environmental, and personal variables. In terms of personal variables, difficulties were particularly associated with discipline and body consciousness. These were mentioned by participants as the key obstacles to adhering to a regular exercise schedule. Social prejudice and unfavourable weather patterns emerged as major obstacles on the environmental side. These results resonate with the systematic analysis conducted by Peng et al. (2023) among young adult women, emphasizing the multifaceted and interconnected nature of the challenges they encounter such as time, social support, body image, and cultural beauty standards.³⁹ Enhancing physical activity among women necessitates addressing not only individual behaviours but also creating opportunities at the organizational, community, and policymaker levels. These elements add to a thorough comprehension of the challenges people have when following an exercise program.

Nevertheless, our study’s identification of individual motivations, social support, and accessible opportunities as facilitators suggests possible intervention and support strategies to increase regular exercise participation. By focusing on these facilitators, interventions can be customized to help individuals overcome obstacles and encourage long-term physical activity. Concurrently, variables such as enhanced physical attractiveness, health advantages, and favourable psychological impacts were recognized as motivators, indicating a wider agreement on significant influences. The results of this study are consistent with previous research since other studies have also brought attention to perceived motivations such as maintaining or improving physical appearance, health benefits, and togetherness, while also focusing on perceived obstacles such as dislike of exercise, a lack of motivation, a lack of support, and time constraints.^40,41

Further guiding the creation of focused exercise modules in the researched populations’ emphasis on flexibility, consistency, initiation, and the accessibility of reliable exercise information. Adopting strategies that target these specific concerns can improve the efficacy of programs intended to encourage physical activity participation.

In summary, the thorough investigation of the variables affecting exercise regimens, as demonstrated by our research, and corroborated by the body of literature, offers insightful design information for customized interventions. By comprehending the intricacies of personal experiences and addressing both obstacles and enablers, we may aid in the advancement of more potent approaches designed to encourage consistent exercise engagement across a variety of demographics.

Preference of exercise resource

In the context of fitness and weight control programs, professionals face the difficulty of creating interventions that promote health and induce behavioural change without creating a feeling of social rejection. This project highlights the real-world difficulties in creating workout programs specifically for overweight people. The importance of widely accessible and user-friendly platforms is emphasized in Theme 4, which highlights the general preference for video content as the primary source for exercise. Purcell (2010) noted a trend among younger groups toward video content consumption.⁴² Vandelanotte et al. (2011) discovered that a video-based physical activity intervention was well-received by potential users, indicating its feasibility for development. This tendency could be attributed to the influence of social norms, as younger individuals usually establish developing internet trends that later gain traction across broader groups.⁴³ Although participants find video materials engaging and convenient, they have concerns over their dependability and oversight. This dual viewpoint points out places where video-based workout tools need to be improved. The acknowledgment of video content’s advantages indicates participants’ engagement and motivation for fitness. Prioritizing accessibility and user-friendliness aligns with the modern desire for seamless experiences. However, concerns about monitoring and reliability highlight specific drawbacks and highlight the need for a more participatory and responsible experience. This insight draws attention to limitations in video-based fitness regimens and offers suggestions for improvement. In broad terms, this knowledge is essential for creating successful online workout regimens. Understanding user preferences and concerns allows fitness platforms to balance the convenience of video content with the need for reliability and monitoring. Features like progress tracking and engagement can improve the effectiveness and user happiness of online workout programs. To better address a variety of needs and encourage an active and healthy lifestyle, digital fitness solutions must be refined through ongoing user-developer conversation.

Requirements in the video

This section emphasizes the importance of making exercise videos specifically tailored for overweight people, with a focus on creating a supporting atmosphere with specially trained instructors. Fostering a positive and inclusive atmosphere can be enhanced by addressing specific needs and concerns. The exploration of participants’ preferences emphasizes the requirement to provide precise instructions on exercise methods, levels of difficulty, duration, and instructional modalities. The findings align with previous research by Manaf et al. (2021) and Othman et al. (2022). These studies indicate a preference among participants for a low to moderate-intensity structured exercise regimen that offers flexibility along with manageable duration and frequency. These findings indicate a need for participant’s favoured workouts to accommodate varying schedules and environments^40,41 Participants in our study expressed a desire for flexible routines engaging all body parts, accompanied by music, emphasizing holistic and adaptable workout experiences that consider enjoyment and diversity as factors for maintaining motivation. Bian et al. (1989) highlighted the importance of such characteristics, finding that participants favoured exercise regimens tailored for overweight individuals or beginners, emphasizing the need for instructors with expertise, a non-judgmental attitude, along with proper pacing.¹³ Citing research such as Wankel et al., (1985) highlights the valuable insights that may be gained from fitness programs by highlighting the possible influence of strong social support.⁴⁴ This realization raises the possibility that overcoming variations in individual self-motivation requires a strong sense of community and support. Finally, this area explores the preferences of the participants and provides insightful information to develop a comprehensive approach that is effective and specific to the needs of overweight individuals by emphasizing support, clear guidance, flexibility, and social components.

Appealing factors and holistic well-being

Our study delved into factors influencing participant engagement, particularly focusing on the presentation and aesthetics of exercise videos. Preferences for relatable models, an encouraging approach, and professionally produced, distraction-free shorter videos highlight the importance of creating visually appealing and immersive experiences. These insights align with Vandelanotte et al.’s 2011 study on computer-tailored interventions using online video messages to promote physical activity laying the groundwork for understanding participant preferences and openness to innovative approaches.⁴³ It is widely believed that internet-delivered interventions, particularly those with high interactivity and user appeal, promote increased participant engagement and retention. Furthermore, such interventions may offer increased and sustained effectiveness over the long term^18,45

Additionally, participants expressed a desire for comprehensive information, including details on nutrition, safety precautions, exercise benefits, and motivational strategies. Solbrig et al., (2017) in his study concluded that individuals expressed a desire for motivational support for losing weight and increasing physical activity. He stated that there exists a mismatch between available public resources and the individuals desired health information regarding lifestyle information.⁴⁶ This aligns with a holistic perspective recognizing the interconnectedness of physical and mental well-being, suggesting interventions should address both aspects.

Furthermore, information on hormonal influences and regular communication from fitness experts address participant’s broader health concerns, emphasizing the need for comprehensive support structures within intervention programs to ensure adherence. Our study contributes valuable insights for designing holistic interventions beyond exercise guidance to address various factors influencing users.

Media preferences

The media platforms that participants prefer to use, such as email, WhatsApp, and YouTube, show a wide variety of consumption patterns. While WhatsApp and email reflect a need for immediate communication and easy access to information, YouTube suggests a preference for exercise material that is primarily based on videos. The focus on connections with low internet consumption needs draws attention to the necessity of content optimization for accessibility, taking participants’ possible connectivity issues into account. Comprehending these inclinations is essential to customizing the content of exercises and maximizing the effectiveness of health promotion programs. By aligning dissemination strategies with favoured platforms, health professionals can maximize reach and impact. These results are consistent with research showing the feasibility of video-tailored interventions.^43,47,48 Such interventions are viable both in terms of user willingness to engage and technological viability. This is supported by the fact that most internet users have access to infrastructure that supports video downloads. According to Vandelanotte et al.’s (2011) findings, exercise interventions that consider participant preferences and include extensive support systems may enhance user engagement and promote long-term adherence.⁴³ The understanding also highlights the importance of providing relevant, approachable content that fits participants’ circumstances to increase engagement and encourage adherence to recommended exercise regimens.

Strengths and limitations

The methodology employed in this study was equally as important as the results. Our one-on-one interviewing approach created a comfortable and secure environment for individuals to express their ideas. Everyone might express himself without feeling compelled to by others. To the best of our knowledge, our study is the first to examine the needs, perceptions, and preferences of overweight individuals about exercise videos. The limitation of the study was it involved purposive sampling and the findings may not be easily applicable to broader more general populations beyond the ones studied. The generalizability of findings to wider populations, particularly those from diverse cultural, socioeconomic, or regional backgrounds, was limited. Despite this limitation, purposive sampling was suitable for the study’s aim, as it ensured contributions from individuals who conformed to the desired user profile and were most likely to benefit from the intervention. The study provides a valuable framework to develop tailored exercise interventions, which can guide future modifications for varied populations.