title: Exploring non-participation in primary care physical activity interventions: PACE-UP trial interview findings.
abstract: BACKGROUND
  Trials in primary care to increase physical activity (PA) typically experience poor recruitment rates and may not recruit those with lower PA levels and who are most in need of the intervention. Despite the well-publicised benefits of physical activity, the majority of adults in the UK remain inactive and, therefore, at greater risk of many health problems. Our aim was to investigate the reasons for non-participation in the PACE-UP trial, which is a primary care pedometer-based walking intervention. This is important for successful recruitment and retention in future PA trials and programmes.
  
  
  METHODS
  We conducted semi-structured audio-recorded telephone interviews with 30 participants, aged 45-75 years, purposively sampled from those declining participation in the PACE-UP trial. Recruitment continued until data saturation and a demographically balanced sample was achieved. Interviews were transcribed verbatim, coded and subjected to thematic analysis.
  
  
  RESULTS
  Interviewees supported walking as suitable exercise for most people in this age group, recognised the importance of this type of research and general practice as an appropriate setting. Key reasons for declining were: the perception of being already 'too active'; existing medical conditions; work; travel and other commitments. Less frequently cited reasons included reluctance to be randomised, the intervention's duration, wearing a pedometer, perceived inappropriateness of trial literature and a preference for a different kind of PA or for a group activity.
  
  
  CONCLUSIONS
  Whilst most interviewees perceived themselves to be sufficiently active, an important minority did not participate due to existing medical conditions and other commitments. Recruitment to future PA trials might be improved by tailoring activity to compensate for medical problems, and adapting PA interventions to fit around work and travel commitments. Ensuring that patient-targeted literature is succinct and inclusive and that equipment is user-friendly are also important. Primary care is seen as an appropriate setting for PA trials and programmes.
  
  
  BACKGROUND
  ISRCTN98538934 .
authors.affiliation: Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK. rnormans@sgul.ac.uk.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Normansell
authors.affiliation: Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Holmes
authors.affiliation: Gerontology and Health Services Research Unit, Brunel University, London, UB8 3PH, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Victor
authors.affiliation: Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK.
authors.forename: Derek G
authors.initials: DG
authors.lastname: Cook
authors.affiliation: Pragmatic Clinical Trials Unit, Queen Mary University of London, London, E1 2AT, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Kerry
authors.affiliation: Research Department of Primary Care and Population Health, University College, London, NW3 2PF, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.affiliation: Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Ussher
authors.affiliation: Health Economics Research Group, Brunel University, London, UB8 3PH, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Fox-Rushby
authors.affiliation: Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Whincup
authors.affiliation: Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 ORE, UK.
authors.forename: Tess
authors.initials: T
authors.lastname: Harris
mesh_terms: D056044:Actigraphy / Q000295:instrumentation; D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise; D005081:Exercise Therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D010465:Perception; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D035842:Research Subjects / Q000523:psychology*; D006113:United Kingdom; D016138:Walking
keywords: Exercise; Non-participation; Primary Health Care; Qualitative; Randomised controlled trial; Walking