Obesity and diabetes threaten the health care of the nation.  Each is estimated to contribute to more than 100 billion dollars in health care cost annually.  Physical activity is the protective armor necessary to fight against both conditions which contribute to heart disease. (1, 2)  In the American Journal of Preventive Medicine, Jones (2003) writes that understanding barriers to physical activity is a first step in removing them, and that racial and ethnic minority women report lower levels of physical activity than do white women. (4)

A major goal of the Healthy People 2010 objectives is to increase the quality of life for all Americans and to decrease health disparities that exist between ethnic groups. Over the past two decades, there has been a tremendous increase in the number of people of Hispanic descent in major cities throughout the country.  The United States has been referred to as the “melting pot.”  The implication is that America does not discriminate but accepts different ethnic groups into the country and assists them in obtaining the resources that are needed for prosperity and health.  Physical activity, overweight and obesity are two of the major leading health indicators identified in the Healthy People 2010 objectives.  Two of the four pillars of Healthier US focus on being physically active and eating a nutritious diet.  The remaining two are: getting preventive screenings and making healthy choices.  Being physically active reduces the risk of coronary heart disease, diabetes, colon cancer, high blood pressure and relieves the pain of arthritis and the symptoms of anxiety and depression.  Physical activity helps build and maintain healthy bones, muscles, and joints, helps control weight, build lean muscle, and reduce fat.  Seven out of ten deaths in the United States are caused by behavior patterns that can be modified. A sedentary lifestyle is a major risk factor across the spectrum of preventable diseases that lower the quality of life and results in premature death.  In addressing the issue of physical activity among Hispanic women, it is important to consider the influence of their culture as well as acculturation. 

Current Status of Physical Activity among Hispanic Women
As reported in the Healthy People 2010 report related to physical activity and fitness, more Hispanics (54%) than African Americans (52%) or American Indians (46%) reported having no leisure time physical activity. (5)  Women in all ethnic groups had fewer leisure time physical activities than men. Latinos are reported to be highest among all ethnic groups in leisure time inactivity. Mexican-American women had the highest rate of no leisure time physical activity when compared to Mexican-American men and non-Hispanic black women. Mexican-American women and other women of color, over the age of 40 and without a college education had the lowest levels of participation in leisure time physical activity when compared to white women. (6)  Gardening and/or yard work and walking were cited as the most frequent leisure time physical activity in almost all subpopulations. (7)

Hispanic women are more likely to be sedentary than the general population. Factors that influence physical activity in Hispanic women include self-efficacy, having concern for own and family health, social support and social norms for physical activity, serving as a role model to others, and perceived neighborhood resources. (8)

Evenson et al. examined the association between acculturation and physical activity among first generation Latina (Hispanic women) immigrants from North Carolina. (9) Forty-one point nine percent of  the Hispanic women surveyed reported insufficient physical activity, 37.4% met recommendations for physical activity and 20.7% reported no moderate or vigorous activity.  However, Hispanic women with a higher English language acculturation were more likely to be physically active than women with lower English language acculturation. Mexican American women had a higher prevalence of physical inactivity than Mexican American men even after adjusting for age, education and income. (10)

Lack of time is a reason that is often given by women for not engaging in non- work related physical activity. Heesch & Masse examined the time commitments of African American and Hispanic women and assessed the relationship between time commitments and perceived lack of time for physical activity. (11)  The results revealed that these women spent 28 hours per week in sedentary leisure-time activity.  The inference is that physical activity is associated with the role of worker, housekeeper, mother and wife and that there is no time or energy left for leisure-time physical activity.  An investigation of the lifelong physical activity patterns of sedentary Mexican American women revealed a lifelong pattern of low occupational and leisure activity and low to moderate household activity.  The prevailing life-style consisted of sedentary occupations and no leisure activities.  Household, occupational, and leisure activity is considered sufficient physical activity. (12)

Social cognitive correlates of leisure time physical activity among Latinos were examined by Marquez & McAuley. (13)  Latinos high in leisure time physical activity whether male or female, received more social support from friends to exercise, and placed greater importance on physical activity outcomes than male or female Latinos who were low in leisure time physical activity.

Barriers that Need to be Addressed
1.  Focus on the overall health benefits of physical activity, not just weight loss.  Cultural differences exist related to weight and body image. Hispanics and other ethnic groups may associate physical activity more with weight loss which may not be viewed as important.  Emphasis should be placed on the benefits of physical activity as it relates to wellness, disease prevention, increased vitality and mood enhancement.

2.  Examine cultural influences and the impact of acculturation.  The Hispanic culture may place more value on rest and relaxation and hence view leisure as a sedentary activity.  In the acculturation process, it is important to value the importance of both.

3.  Stressing the importance of physical activity in the aging process is essential to the education of Hispanic girls and women. Osteoporosis, arthritis and other bone and joint problems are sometimes viewed as synonymous with aging.  It is well documented that regular physical activity is especially important for people with joint and bone problems and that weight bearing exercise and walking helps to strengthen bones.

4.  Promoting the value of life-long physical activity for Hispanic girls. Cultural influences may deter girls from leisure time physical activity.  This issue needs to be addressed so that girls learn skills related to physical activity that can be carried over into adulthood and old age.      

Summary and Conclusions
There is a reason to be concerned about the levels of inactivity and obesity found in Hispanic women.  Overwhelming evidence links obesity to a number of diseases, including diabetes mellitus, hypertension, dyslipidemia and ischemic heart disease. (14)

Lastly, it is important for policy makers to have accurate information regarding the levels of physical inactivity and obesity within the Hispanic community, and to understand how values vary across different ethnic and racial groups.

References
1.  U.S. Department of health and Human Services, Office of the Asistant Secreatary for Planning and Evaluation.  Physical activity: fundamental to preventing disease.  June 20, 2002.  Available at http://aspe.hhs.gov/health/reports/physicalactivity/. Accessed April 4, 2003.
2.  Hu FB, Li TY, Colditz. GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA 2003;289:1785-91.
3.  Jones, W.K. (2003).  Understanding Barriers to Physical Activity is a First Step in Removing Them.  American Journal Preventive Medicine. 25 (3Si).
4.  Schoenborn CA, Barnes PM.  Leisure-time physical activity among adults: United States, 1997-1998.  Advance data from vital and health statistics; no. 325.  Hyattsville, MD: National Center for health Statistics, 2002.
5.  U.S. Department of Health and Human Services.  Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000.
6.  Ransdell, L.B. & Wells, C.L. (1998). Physical Activity in urban white, African-American, and Mexican-American women. Medicine Science in Sports and Exercise, 30(11); 1608-15.
7. Crespo, C.J., Keteyian, S.J., Heath, G.W. & Sempros, C.T. (1996). Leisure-time physical activity among US adults. Results from the Third National Health and Nutrition Examination Survey. Archives of Internal Medicine, 156(1); 93-8.
8.  Keller, C. & Fleury, J. ( 2006) Factors related to physical activity in Hispanic women. Journal of Cardiovascular Nursing, 21(2); 142-5.
9. Evenson, K.R., Sarmiento, O.L. & Ayala, G.X. (2004) Acculturation and physical activity among North Carolina Latina immigrants. Social Science Medicine, 59(12); 2509-22.
10. Crespo, C.J., Smit, E.; Carter-Pokras, O., Andersen, R. (2001)  Accultration and leisure-time physical inactivity in Mexican American Adults:Results from NHANES III, 1988-1994. American Journal of Public Health, 91(8);1254-1257.
11.  Heesch, K.C. & Masse, L.C. (2004) Lack of time for physical activity: perception or reality for African American and Hispanic women? Women Health, 39(3);45-62.
12. Cromwell, S.L. & Berg, J.A. (2006) Lifelong physical activity patterns of sedentary Mexican American women. Geriatric Nursing, 27(4);209-13.
13.  Marquez, D.X. & McAuley, E. (2006) Social cognitive correlates of leisure time physical activity among Latinos. Journal of Behavioral Medicine, 29(3);281-9.
14.  Solomon, C.G., & Manson, J.E. (1997). Obesity and mortality: a review of the epidemiologic data.  American Journal of Clinical Nuturition. 66:1044S – 1050S.