Physical activity (PA) participation has been linked to numerous physical and mental health outcomes, including reduced risk of cardiovascular disease, stroke, and type 2 diabetes, as well as reduced reports of stress, anxiety, and depression.1 However, only 1 in 4 adults meet the PA guidelines.1 Research has linked this disparity in activity to limited self-efficacy to engage in PA, a lack of social support that promotes activity, and environmental barriers that limit accessibility and engagement to activity.2 Further, those who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) report increased rates of physical inactivity due to the aforementioned factors for all adults, but also the added LGBTQ+-specific barriers of societal stereotypes3 and fear of discrimination and violence.4 Importantly, LGBTQ+ individuals experience even higher rates of cardiovascular disease,5 obesity, depression, and anxiety,6 which have all been shown to improve with adequate PA. Unfortunately, sparse research has worked to promote activity among LGBTQ+ persons based on these barriers, with limited acknowledgement about the impact sexual orientation has on PA participation.
As more individuals continue to identify as a sexual minority,7 it is imperative for research to continue in this field to understand behavioral or systematic disparities that impact health. Through US government support and funding, multiple assessments are conducted to identify and examine health and nutritional status of children and adults within the nation through surveys and questionnaires, telephone interviews, and census tracking; however, there is no uniform method of measurement for both PA and sexual orientation among all national data sets. Examples of these assessment agencies include the National Health and Nutrition Examination Survey, the Behavioral Risk Factor Surveillance System, and the National Health Interview Survey. Additionally, a gold standard for PA research is to include age, race/ethnicity, and gender as confounding factors in research given the evidence that these factors uniquely impact PA participation. The slow adaptation of measurement methods and inclusion of sexual orientation in PA research has further exacerbated the physical inactivity health disparities faced by LGBTQ+ persons. This call to action is aimed at highlighting potential discrepancies of reporting sexual orientation demographic information in publicly available US national data set summary reports, with the overall goal of promoting inclusion and transparency of sexual orientation as a primary (eg, descriptive characteristics), secondary (eg, moderator), and tertiary (eg, mediator) influence on PA.8
A Need for Improved Methodologies
The societal disconnect that exists in national data collection surveys methods continues to exist where there is often no inclusion of a sexual orientation demographic variable, or there is a crude variable that does not allow for proper extrapolation among self-identified LGBTQ+ participants. LGBTQ+ classifications exist on a spectrum, with each classification experiencing different PA behaviors and health outcomes linked to PA behaviors, requiring a need to gather large data on individuals who identify in each classification (eg, gay, lesbian, bisexual). The biocultural perspective of health research, which proposes that culture and history are inextricably related to biology, assists in describing why the need for improved inclusionary demographic questions is imperative. This understanding highlights the explicit nature of individuals recognizing the pervasiveness and dynamism of biological and cultural phenomena interactions, resulting in a distinct experience for health outcomes. As social identity can be formed based on sexual orientation, the biocultural component of PA research should also be considered when discussing transparency with demographic reporting. This is an area of concern because national findings highlight the inequalities of PA that exist based on geography, age, gender, and sexual orientation,9 but researchers are reluctant to include sexual orientations influence on PA when conducting secondary analyses due to the limited data available. Research continues to highlight the specific PA disparities linked to sexual orientation; however, with limited inclusion of this variable in large, national data sets, research will continue to be slow in discovering specific PA behaviors and health-related outcomes among LGBTQ+ individuals.
Implications and Conclusion
To evoke change at the society level, improvements to national survey methodologies must be altered to include sexual orientation as a required demographic variable. As seen in health care research, patients believe that if their sexual orientation and gender identity were assessed, their provider would gain a better understanding of their situation, leading to improved health outcomes and treatments.10 This is no different for health research, as the inclusion of these measures would be pivotal in providing clinical and social advancement and understanding of LGBTQ+-specific PA behaviors and health-related outcomes associated with reduced levels of PA. Resources are available that provide survey methods for the inclusion of LGBTQ+ individuals, detailing that there is no lack of knowledge on surveying this population, rather there is a neglect to include the proper measure. Without this inclusion, we will continue to see a larger volume of health disparities in this historically minoritized population due to the outdated variables included in the current national data methodologies.
Acknowledgments
The authors would like to thank Jaime Schultz, Ph.D. for her feedback on the manuscript idea and initial draft. Declaration of Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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