All ETDs from UAB

Advisory Committee Chair

Kevin R Fontaine

Advisory Committee Members

Eric W Ford

Donald H Lein Jr

Gregory Pavela

Dorothy Pekmezi

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Education


The prevalence of chronic health conditions (CHCs) is rising across all age groups, genders, and racial/ethnic groupings, making them the main cause of death globally. The majority of CHCs deaths occur in middle-to-low-income countries, although they are also a significant health issue in developed countries. A higher risk of developing CHCs is linked to physical inactivity. Global societies are experiencing increased prevalence of CHCs, which are directly assoicated with rising healthcare costs, workforce attendance, productivity challenges, and academic success. However, increased exercise and physical activity (PA) are linked to lower odds of developing CHCs. In fact, regular PA can help reduce the risk of developing at least 20 CHCs and help with the management of these conditions. However, only 1 in 4 adults in the United States (US) meet the current PA recommendations for aerobic and muscle-strengthening activities. In addition even fewer individuals with CHCs meet current PA recommendations. To that end, the current dissertation explores factors influencing the relationship between CHCs and PA status among US adults to address this important research gap via three independent studies. In the first study (Chapter 2), and as a first step, we wanted to present an updated estimate of American adults' with CHCs adherence to the current Centers of Disease Control (CDC) recommendations for PA based on the presence or absence of CHCs using a nationally representative data (BRFSS). Specifically, we estimated the prevalence of US adults with self-reported CHCs who meet the current PA recommendations according to their sociodemographic characteristics, number of CHCs, and type of CHCs. Additionally, we identified important research gaps and proposed recommendations for future studies. Briefly, we found that only 18% of US adults with self-reported CHCs met the PA recommendations for both aerobic and muscle-strengthening, and almost 35% did not meet both PA recommendations. Another important finding is that the prevalence of American adults who do not adhere to both PA recommendations increases as the number of CHCs increases. Furthermore, after examining each CHC independently, it was found that American adults with COPD had the highest prevalence of not meeting the PA recommendations for both aerobic and muscle-strengthening exercise. In the second study (Chapter 3), we conducted two mediation analyses to test whether mental health status and then separately physical health status mediate the relationship between self-reported CHCs and self-reported PA status. Specifically, the inverse odds weighting approach (IOW) was used to estimate the total effect, the direct effect, the indirect effect, and the percent of effect related to mediation in weighted logistic regression models. Our analysis of BRFSS data showed lower odds of PA, poorer mental health, and poorer physical health among American adults with CHCs. Most importantly, we found that the relationship between CHCs and PA is due, in part, to the influence of CHC on poorer mental and physical health, which, in turn, influences physical inactivity, supporting our hypotheses. In the third study (Chapter 4), five weighted logistic regression models were performed to examine the relationship between CHCs and PA. Tests of moderation were conducted by including an interaction term between CHCs and each substance use variable (binge drinking, tobacco smoking, smokeless tobacco, marijuana, and polysubstance). We found that individuals who reported having CHCs and individuals who are current tobacco smokers had statistically significant lower odds of being physically active. CHCs management has risen to the forefront of modern medicine as our population ages, and medical costs continue to rise. Hence, there is a need for more research that prioritize CHCs preventative and mitigating strategies, such as PA behavior promotion. The findings from this dissertation may guide clinicians, public health professionals, policymakers, and researchers to better understand the factors that might influence the relationship between PA and CHCs. This information will help design more effective and evidence-based PA promotion interventions and policies aiming to help American adults (with or without CHCs) to be more physically active.

Available for download on Friday, May 09, 2025

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