Table 2: Main reasons for not engaging in physical activity reported by obese subjects during group sessions in our Unit, and possible strategies to increase motivation and adherence.

Reasons for not exercisingBarriersStrategies to increase adherence

“I would like to exercise, but I feel immediately tired and breathless, and my knees hurt”Low fitness, painExercising with individuals having the same limits, to reduce the intensity of exercise
“I do not like exercising, it is boring”Boredom, lack of stimuliPlanning enjoyable activities or amusing exercising (e.g., group dancing or walking)
“I do not like exercising alone, but when I go walking with friends I realize that I slow down the group, which makes me feel inadequate”Comparison with other individualsExercising with subjects having similar problems, in order to avoid competition
“Exercising in a gym or a swimming pool or even walking in a public garden makes me feel ashamed, observed, judged, mocked at”Body image dissatisfactionArranging a protected environment, and specific courses (gym or swimming pool) for obese persons
“I’d like to exercise, but I have no time. Back from work, I am too tired and I have to take care of my family”Time constraintsReorganizing daily activities fitting exercise as a priority. Turning everyday activities into exercise (using stairs, walking to work, etc.)
“The weather was horrible; I had to stay at home”Weather constraintPlanning short walk in small groups; reducing objectives but maintaining change and adherence
“I feel so bad when I exercise, that I feel as if I am going to die”Death fearIncreasing goals very slowly, to avoid any sense of breathlessness

Most patients report difficulties in engaging in physical activity and in the maintenance of behavior changes. In general, patients underline the importance of low goal setting, new stimuli, social support, and long-term contact with therapists.