Quality of Life Research

, Volume 22, Issue 9, pp 2381–2388 | Cite as

Increases in physical activity may affect quality of life differently in men and women: the PACE project

  • Stephanie Whisnant Cash
  • Glen E. Duncan
  • Shirley A. A. Beresford
  • Anne McTiernan
  • Donald L. Patrick



Obesity is associated with impaired quality of life (QoL), but less is known about physical activity. We investigated how decreases in body mass index (BMI) and increases in activity affect obesity-specific QoL and potential gender differences in associations.


In a large worksite randomized trial of a multilevel intervention on diet and physical activity behaviors, we conducted a cohort analysis at two years of follow-up. Self-reported activity and Obesity and Weight Loss Quality of Life (OWLQOL) were analyzed for individual-level associations using linear mixed models accounting for random worksite effects.


Gender modified the BMI–OWLQOL relationship, so analyses were conducted for males and females separately. Adjusting for demographic confounders, baseline OWLQOL, and several worksite-level variables including intervention arm, a 1.9 unit decrease in BMI (the interquartile range) was associated with an OWLQOL increase of 1.7 (95 % CI: 1.2, 2.2) in males and 3.6 (95 % CI: 3.2, 4.0) in females. Similarly, a 23 unit increase in physical activity score was associated with an OWLQOL increase of 0.9 (95 % CI: 0.5, 1.4) in males and 1.6 (95 % CI: 1.0, 2.3) in females. Physical activity associations were attenuated when adjusting for change in BMI, but remained significant for women (mean BMI 27.8 kg/m2).


This is the first study to demonstrate that increasing physical activity may improve obesity-specific QoL to a greater extent in women, particularly among overweight women, independent of BMI. Results may inform the design of interventions tailored to women targeting well-being through messages of increasing physical activity.


Body mass index Physical activity Quality of life Weight loss Women 



The authors wish to acknowledge the employees at the worksites who took the time to complete the baseline survey, follow-up survey, and physical measurements for the PACE study. Their voluntary participation made our investigation possible. The research reported here was supported by the National Heart, Lung, and Blood Institute R01 HL79491 and by the NCI Biobehavioral Cancer Prevention and Control Training Program (R25CA092408). The study sponsors played no role in any of the following: study design, the collection, analysis, and interpretation of data; the writing of the report; nor the decision to submit the paper for publication.

Conflict of interest

  The authors declare that there is no conflict of interest.


  1. 1.
    U.S. Centers for Disease Control and Prevention. Overweight and Obesity: FastStats (2010). Accessed August 22 2011.
  2. 2.
    U.S. Centers for Disease Control and Prevention. Overweight and Obesity: Health Consequences (2011). Accessed August 22 2011.
  3. 3.
    Fontaine, K. R., & Barofsky, I. (2001). Obesity and health-related quality of life. Obesity Reviews, 2(3), 173–182.PubMedCrossRefGoogle Scholar
  4. 4.
    Groessl, E. J., Kaplan, R. M., Ganiats, T. G., & Barrett-Conner, E. (2002). The relationship between past body mass index and future quality of life. Quality of Life Research, 11(7), 633.Google Scholar
  5. 5.
    Kolotkin, R. L., Crosby, R. D., & Williams, G. R. (2002). Health-related quality of life varies among obese subgroups. Obesity Research, 10(8), 748–756.PubMedCrossRefGoogle Scholar
  6. 6.
    Jones, G. L., & Sutton, A. (2008). Quality of life in obese postmenopausal women. Menopause International, 14(1), 26–32.PubMedGoogle Scholar
  7. 7.
    Cameron, A. J., Magliano, D. J., Dunstan, D. W., Zimmet, P. Z., Hesketh, K., Peeters, A., et al. (2011). A bi-directional relationship between obesity and health-related quality of life: evidence from the longitudinal AusDiab study. International Journal of Obesity, doi:  10.1038/ijo.2011.103.
  8. 8.
    Karlsson, J., Taft, C., Ryden, A., Sjostrom, L., & Sullivan, M. (2007). Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: The SOS intervention study. International Journal of Obesity, 31(8), 1248–1261.PubMedCrossRefGoogle Scholar
  9. 9.
    Cash, S. W., Beresford, S. A., Henderson, J. A., McTiernan, A., Xiao, L., Wang, C. Y., et al. (2012). Dietary and physical activity behaviours related to obesity-specific quality of life and work productivity: Baseline results from a worksite trial. British Journal of Nutrition, 108(6), 1134–1142. doi: 10.1017/S0007114511006258.PubMedCrossRefGoogle Scholar
  10. 10.
    Kolotkin, R. L., Crosby, R. D., Kosloski, K. D., & Williams, G. R. (2001). Development of a brief measure to assess quality of life in obesity. Obesity Research, 9(2), 102–111. doi: 10.1038/oby.2001.13.PubMedCrossRefGoogle Scholar
  11. 11.
    Kolotkin, R. L., Crosby, R. D., Williams, G. R., Hartley, G. G., & Nicol, S. (2001). The relationship between health-related quality of life and weight loss. Obesity Research, 9(9), 564–571. doi: 10.1038/oby.2001.73.PubMedCrossRefGoogle Scholar
  12. 12.
    Plaisted, C. S., Lin, P. H., Ard, J. D., McClure, M. L., & Svetkey, L. P. (1999). The effects of dietary patterns on quality of life: A substudy of the Dietary Approaches to Stop Hypertension trial. Journal of the American Dietetic Association, 99(8 Suppl), S84–S89.PubMedCrossRefGoogle Scholar
  13. 13.
    Brown, D. W., Balluz, L. S., Heath, G. W., Moriarty, D. G., Ford, E. S., & Giles, W. H. (2001). (2003). Associations between recommended levels of physical activity and health-related quality of life. Findings from the, Behavioral Risk Factor Surveillance System (BRFSS) survey. Preventive Medicine, 37(5), 520–528.CrossRefGoogle Scholar
  14. 14.
    Brown, D. W., Brown, D. R., Heath, G. W., Balluz, L., Giles, W. H., Ford, E. S., et al. (2004). Associations between physical activity dose and health-related quality of life. Medicine and Science in Sports and Exercise, 36(5), 890–896.PubMedCrossRefGoogle Scholar
  15. 15.
    Bize, R., Johnson, J. A., & Plotnikoff, R. C. (2007). Physical activity level and health-related quality of life in the general adult population: a systematic review. Preventive Medicine, 45(6), 401–415. doi: 10.1016/j.ypmed.2007.07.017.PubMedCrossRefGoogle Scholar
  16. 16.
    Kolotkin, R. L., Head, S., Hamilton, M., & Tse, C. K. (1995). Assessing impact of weight on quality of life. Obesity Research, 3(1), 49–56.PubMedCrossRefGoogle Scholar
  17. 17.
    Katz, D. A., McHorney, C. A., & Atkinson, R. L. (2000). Impact of obesity on health-related quality of life in patients with chronic illness. Journal of General Internal Medicine, 15(11), 789–796.PubMedCrossRefGoogle Scholar
  18. 18.
    Patrick, D. L., Bushnell, D. M., & Rothman, M. (2004). Performance of two self-report measures for evaluating obesity and weight loss. Obesity Research, 12(1), 48–57. doi: 10.1038/oby.2004.8.PubMedCrossRefGoogle Scholar
  19. 19.
    Larsson, U., Karlsson, J., & Sullivan, M. (2002). Impact of overweight and obesity on health-related quality of life—a Swedish population study. International Journal of Obesity and Related Metabolic Disorders, 26(3), 417–424. doi: 10.1038/sj.ijo.0801919.PubMedCrossRefGoogle Scholar
  20. 20.
    Brown, W. J., Mishra, G., Lee, C., & Bauman, A. (2000). Leisure time physical activity in Australian women: Relationship with well being and symptoms. Research Quarterly for Exercise and Sport, 71(3), 206–216.PubMedCrossRefGoogle Scholar
  21. 21.
    Beresford, S. A., Locke, E., Bishop, S., West, B., McGregor, B. A., Bruemmer, B., et al. (2007). Worksite study promoting activity and changes in eating (PACE): design and baseline results. Obesity, 15(Suppl 1), 4S–15S.PubMedCrossRefGoogle Scholar
  22. 22.
    U.S. Census Bureau. 1987 SIC Matched to 1997 NAICS Major Groups (2-Digit). Accessed July 4 2008.
  23. 23.
    U.S. Centers for Disease Control and Prevention. How is BMI calculated and interpreted? (2008). Accessed July 28 2008.
  24. 24.
    Godin, G., & Shephard, R. J. (1997). Godin leisure-time exercise questionnaire. Medicine and Science in Sports and Exercise, June (Supplement), S36–S38.Google Scholar
  25. 25.
    Godin, G., & Shephard, R. J. (1985). A simple method to assess exercise behavior in the community. Canadian Journal of Applied Sport Sciences, 10(3), 141–146.Google Scholar
  26. 26.
    Jacobs, D. R., Jr, Ainsworth, B. E., Hartman, T. J., & Leon, A. S. (1993). A simultaneous evaluation of 10 commonly used physical activity questionnaires. Medicine and Science in Sports and Exercise, 25(1), 81–91.PubMedCrossRefGoogle Scholar
  27. 27.
    Sallis, J. F., Buono, M. J., Roby, J. J., Micale, F. G., & Nelson, J. A. (1993). Seven-day recall and other physical activity self-reports in children and adolescents. Medicine and Science in Sports and Exercise, 25(1), 99–108.PubMedCrossRefGoogle Scholar
  28. 28.
    Miller, D. J., Freedson, P. S., & Kline, G. M. (1994). Comparison of activity levels using the Caltrac accelerometer and five questionnaires. Medicine and Science in Sports and Exercise, 26(3), 376–382.PubMedCrossRefGoogle Scholar
  29. 29.
    Niero, M., Martin, M., Finger, T., Lucas, R., Mear, I., & Wild, D. (2002). A new approach to multicultural item generation in the development of two obesity-specific measures: The obesity and weight loss quality of life (OWLQOL) questionnaire and the weight-related symptom measure (WRSM). Clinical Therapeutics, 24(4), 690–700.PubMedCrossRefGoogle Scholar
  30. 30.
    Patrick, D. L., & Bushnell, D. M. (2004). Obesity-specific patient reported outcomes: Obesity and weight loss quality of life (OWLQOL) and weight-related symptoms measure (WRSM). User’s manual and scoring diskette for united states version.Google Scholar
  31. 31.
    Maslow, A. H. (1943). A Theory of Human Motivation. Psychological Reviews, 50(4), 370–396.CrossRefGoogle Scholar
  32. 32.
    Kaplan, G. A., Strawbridge, W. J., Cohen, R. D., & Hungerford, L. R. (1996). Natural history of leisure-time physical activity and its correlates: Associations with mortality from all causes and cardiovascular disease over 28 years. American Journal of Epidemiology, 144(8), 793–797.PubMedCrossRefGoogle Scholar
  33. 33.
    Berke, E. M., Koepsell, T. D., Moudon, A. V., Hoskins, R. E., & Larson, E. B. (2007). Association of the built environment with physical activity and obesity in older persons. American Journal of Public Health, 97(3), 486–492. doi: 10.2105/AJPH.2006.085837.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Stephanie Whisnant Cash
    • 1
    • 2
    • 3
  • Glen E. Duncan
    • 2
    • 4
  • Shirley A. A. Beresford
    • 2
    • 3
  • Anne McTiernan
    • 2
    • 3
  • Donald L. Patrick
    • 5
    • 2
  1. 1.The Parkinson’s Institute and Clinical CenterSunnyvaleUSA
  2. 2.Department of Epidemiology, School of Public HealthUniversity of WashingtonSeattleUSA
  3. 3.Public Health Sciences DivisionFred Hutchinson Cancer Research CenterSeattleUSA
  4. 4.Nutritional Sciences Program, School of Public HealthUniversity of WashingtonSeattleUSA
  5. 5.Department of Health Services, School of Public HealthUniversity of WashingtonSeattleUSA

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