Exploring the Facilitators and Barriers to Physical Activity among Adults Experiencing Food Insecurity During the Healthy Food First Trial: A Qualitative Study

Top Things to Know

Improving food access and diet quality may not automatically increase physical activity; structural barriers such as fatigue, work demands, health limitations, safety concerns, and financial constraints may continue to limit engagement even when food insecurity improves.

Community health workers were viewed as trusted and supportive, suggesting an opportunity to integrate more intentional physical activity counseling, goal setting, self-monitoring, and problem-solving into Food Is Medicine programs.

Participants perceived strong connections between healthier eating, improved energy, and greater willingness to be active, highlighting a potential pathway for linking nutrition interventions with Exercise Is Medicine approaches in future program design.

Summary of Conclusion/Findings

This qualitative study embedded within the Healthy Food First randomized clinical trial explored perceived barriers and facilitators to physical activity (PA) among 38 adults with hypertension and food insecurity who received produce delivery or grocery subsidies, with or without community health worker (CHW) coaching. Participants consistently reported high motivation to be physically active and viewed PA as important for health, disease management, independence, and quality of life; however, sustained engagement was constrained by time scarcity, fatigue, physically demanding work, chronic health conditions, environmental safety concerns, weather, and financial barriers. Social support, access to welcoming and walkable environments, and opportunities to integrate activity into existing routines emerged as important facilitators of PA participation. Participants generally viewed CHW coaching as informative and encouraging, but many felt that coaching emphasized nutrition more than physical activity and provided limited PA-specific support. Respondents also described a bidirectional relationship between nutrition and PA, noting that access to healthier foods increased energy and willingness to be active, whereas less healthful foods contributed to fatigue and reduced motivation. The authors conclude that food insecurity interventions alone may be insufficient to increase PA and that future Food Is Medicine programs should incorporate explicit, low-burden, context-tailored PA support alongside nutrition-focused services.