Self-selected exercise goals during a broader physical activity intervention for women in midlife with elevated risk for cardiovascular disease: A mixed methods evaluation.

Women's risk for cardiovascular disease (CVD) increases during midlife, partly due to limited physical activity (PA). Overall or lifestyle PA can be cardioprotective and more sustainable than structured exercise for this population, though little is known about setting exercise goals during broader PA promotion and how these relate to women's PA experiences. We used a mixed methods approach to address these questions, via secondary analysis of data from a single-arm trial (NCT06350604; N = 62, MAge = 53, MBMI = 33 kg/m2) that combined PA coaching and peer partner dyads. Women wore an activity monitor, self-selected weekly goals with their coach, and completed daily surveys and an exit interview. We identified five groups with distinct exercise goal setting patterns. Women who never set exercise goals (11%) reported higher CVD illness burden and described flexible PA approaches as helpful for overcoming health-related barriers. Those who set goals later (10%) had lower PA motivation at baseline and showed the greatest increases in PA motivation and exercise minutes (ps < 0.03, ηp2s = 0.0001). In exit interviews, these women indicated shifts from low self-efficacy and rigid PA views to gradual, lifestyle-based engagement, as well as positive partner experiences. Daily exercise satisfaction was positively associated with exercise minutes (p < 0.001, ηp2 = 0.21); this was strongest among those who set goals inconsistently (27%; p < 0.01, ηp2<0.01), who also expressed concerns about failure. Women in midlife with elevated CVD risk may benefit from shifting focus to overall PA, particularly early on. Such an approach may reduce self-critical attitudes, which are linked with aversive experiences that discourage continued goal setting and attempts at attainment.