Dynamics and diversity in adolescents’ experienced barriers and facilitators for physical activity maintenance

Timothy A Houtman; Froukje Sleeswijk Visser; Amy van Grieken; Valentijn Visch

doi:10.1371/journal.pone.0333120

. 2025 Sep 23;20(9):e0333120. doi: 10.1371/journal.pone.0333120

Dynamics and diversity in adolescents’ experienced barriers and facilitators for physical activity maintenance

Timothy A Houtman ^1,^*, Froukje Sleeswijk Visser ¹, Amy van Grieken ², Valentijn Visch ¹

Editor: Hidetaka Hamasaki,³

PMCID: PMC12456830 PMID: 40986530

Abstract

Despite the well-documented health benefits of physical activity (PA), over 80% of adolescents worldwide fail to meet recommended daily levels. This study identified experienced barriers and facilitators for PA maintenance among Dutch adolescents, examine how they form barrier and facilitator profiles, and explore how barriers and facilitators evolve over time. First, we conducted 21 interviews with adolescents (13–16 years) to uncover relevant barriers and facilitators. Then, we developed and applied a card sorting task based on Q methodology, and examined barrier and facilitator configurations with 30 adolescents (aged 13–18 years) who had maintained a physical activity for ≥2 years, followed by interviews. Factor analysis revealed five facilitator profiles: Mental and physical health benefits, A way to be myself around others, Pursuing health goals, Developing confidence and strength, and Developing along my own path. Four barrier profiles emerged: Low motivation and energy, Not a good fit for me, Balancing act, and Proximity, possibility and perception. Facilitator profiles ranged from immediate characteristics of the activity, such as enjoyment, social connection, and mental well being, to more future-oriented drivers such as autonomy and self-development. Barriers profiles varied from predominantly internal (e.g., low motivation) to external (e.g., distance, weather) or mixed influences linking life demands to reduced personal resources. Across participants, enjoyment was the most consistent facilitator, but perceived influences often shifted with time, from immediate, activity-based facilitators related to competence and relatedness, toward motivations tied to autonomy, identity and coping with growing responsibilities characteristic of this life stage. These results highlight the diversity and dynamic nature of barriers and facilitators in adolescent PA maintenance. Tailoring PA promotion programs to adolescents’ evolving motivations and constraints can increase their effectiveness, supporting sustained active lifestyles into adulthood.

Despite well-documented physical and psychological benefits, such as cardiovascular health and stress regulation [1,2], over 80% of adolescents worldwide fail to meet daily PA recommendations [3]. Specifically, 77.6% of boys and 84.7% of girls aged 11–17 are insufficiently active, and activity levels often drop further as they transition into adulthood [3–6]. Although many interventions can increase PA levels during the intervention period these short-term gains typically erode within six to twelve months [7–10], highlighting the need to understand what enables and hinders long-term maintenance of healthy behaviors in adolescence.

Current PA promotion programs tend to emphasize intervention outcomes, often focusing on risk‐reduction metrics such as BMI improvement and minutes of moderate‐to‐vigorous activity [11]. Although these evidence‐ and theory‐based interventions (e.g., using behavior‐change techniques) can produce short‐term PA increases, a key limitation is that their design tends to be static and is not adapted to the rapid physical, psychological and social changes that characterize this life stage.

A person‐based, developmental approach offers an alternative by treating adolescents as active agents whose goals and constraints can change over time. Drawing from self-determination theory [12] and developmental science, the person‐based, developmental approach considers adolescents’ subjective experiences and values as well as how their motives and barriers shift throughout their development [11]. As adolescents explore new social roles and identities, their motivations and social surroundings change and become increasingly diverse. Given the strong links between intrinsic motivation, identity congruence, and long-term PA maintenance [13,14], interventions that incorporate adolescents’ own experiences are more likely to foster sustainable health behavior change. Accordingly, this paper has two aims: (1) to identify profiles of experienced barriers and facilitators for PA maintenance among adolescents and (2) to examine how experienced barriers and facilitators are perceived to change over time.

Facilitators are factors that enable or motivate a behavior, whereas barriers are factors that obstruct or demotivate it. Prior research has identified a wide array of PA facilitators and barriers including individual, social, and environmental factors [15]. For example, adolescents often cite enjoyment and social support as primary reasons for participation, while lack of time, low motivation, or access often prevent PA participation [15,16].

However, barriers and facilitators are not isolated but interact within each adolescent’s life. Yet most research treats barriers and facilitators as general characteristics of adolescents, aggregated across large groups (e.g., all adolescents) [15,16] or simple subgroups (e.g., by gender) [17,18] thereby obscuring the unique configurations that drive individual PA. Because motivation and experience around PA are made up from multiple connected personal and contextual influences [19], PA behavior may be better understood as profiles of barriers and facilitators. These combinations create a more holistic picture than single indicators alone. Moreover, facilitators can reinforce one another but also compete with other life motivations. For example, Strömmer and colleagues [20] show that while adolescents tend to value their health, their motivations for engaging in health behavior, like PA, can be at odds with their growing desires for autonomy or social belonging. This finding highlights the importance of recognizing how barriers and facilitators are interconnected and how they sometimes compete with or enhance each other in shaping adolescents’ PA experiences.

Barriers and facilitators for PA not only interact within an individual’s life but also evolve over time. Especially during adolescence, a developmental period marked with major life changes in which their goals and priorities can shift [21]. For example, adolescents often experience shifts in motivation and attitudes towards PA during key transitions such moving from primary to secondary school [17,22]. As they gain new experiences, they explore different interests, form new peer groups, and exercise increasing autonomy in their decision making, all of which shapes their active lifestyle trajectories [19].

Theoretical perspectives also suggest that the motives and capacities driving early PA engagement differ from those needed to maintain PA [14]. These initial facilitators must change and adapt over time to support long-term PA maintenance. Research on adolescent PA adherence shows that a passion for the activity, perceived positive outcomes, identity alignment with the activity, and continued support from friends and parents are key determinants for sustained PA engagement [17,19,22,23]. These findings aligns with behavior maintenance theories, which emphasize intrinsic motivation, identity, and habit formation (built through repeated practice in stable contexts), as essential for long‐term health behavior maintenance [13]. However, these facilitators of PA maintenance may not be present in the early phases of PA engagement and need to be cultivated over time. Even among adolescent PA “maintainers”, the barriers and facilitators are expected to shift over time both because of the changes associated with this developmental period and also the facilitators of PA maintenance differ from those of earlier PA engagement. Understanding these dynamics can inform how health promotion programs can support adolescents’ changing barriers and facilitators.

This paper examines adolescents’ experienced barriers and facilitators for PA maintenance with two aims. The first aim is to examine profiles of experienced barriers and facilitators associated with PA maintenance and how these vary across adolescents. The second aim is to investigate how PA barriers and facilitators are perceived to change during adolescence. By examining these profiles and perceived dynamics, we will gain richer insights into adolescents’ experiences with PA maintenance. These findings can support the design of interventions that resonate with young people’s own perspectives and aim to promote sustained PA engagement.

Methods

We employed a mixed methods approach over two main phases to gain a rich understanding of adolescents’ experienced barriers and facilitators of PA maintenance. In phase 1, we conducted semi-structured interviews to explore adolescents’ perceptions and views on barriers and facilitators of PA. In phase 2, we translated these insights into a card sorting activity based on Q methodology to gain insights into personal profiles of barriers and facilitators and how they can change over time.

Q methodology combines quantitative and qualitative techniques to investigate the range of possible perspectives on a topic [24,25]. Its purpose is to uncover subjectivity by identifying the extent to which perspectives are shared or differ across people. In a Q-sort, participants rank a structured set of items, which forces prioritization and trade-offs rather than evaluating each item in isolation. These ranked configurations are then analyzed using by-person factor analysis to identify shared profiles of participants, which are then interpreted qualitatively using participants’ explanations from interviews.

This approach is well suited to our aim of understanding adolescent experience as configurations of interrelated influences rather than isolated barriers or facilitators. Because participants rank the items themselves and confirm they reflect their experiences, the resulting profiles offer a holistic view of how multiple influences shape PA maintenance experiences according to adolescents. The combination of the quantitative structure with qualitative insights enables the systematic identification and interpretation of shared patterns in our sample.

Ethics

Ethical approval for the study was obtained from the Human Research Ethics Committee of Delft University of Technology (submission number 1790). Permission was granted by four secondary schools in the Rotterdam area, the Netherlands to approach their student on school premises. After approval from a designated school staff member, a digital information letter was sent to parents and guardians at least one week before approaching participants. The letter outlined the study and explained that their child might be approached on school premises. On the day of data collection, researchers approached students during free periods (breaks, mentor classes, or after school), explained the study verbally, and obtained written informed consent. Each participant received a physical follow-up letter to their parents confirming their participation and reminding the parents about the study and the right to withdraw their child. Participants were also given a €5 cinema voucher for their participation. Only non-identifying demographic data (age and gender) was recorded. The consent procedure was developed in collaboration with the legal department of Delft University of Technology.

Recruitment

The data collection for phase 1 took place in October 2021 the data collection on phase 2 took place the second half of 2022. With approval from the school, the first author and a research assistant (acknowledgements) visited each school. In phase 1, we invited any student interested in sharing their views on health and PA, in phase 2, we approached students who had engaged in a specific physical activity for at least two years. Students were approached during gap hours, breaks, after school, or, when arranged, during mentor class sessions with permission of the teacher.

Phase 1: Exploratory interviews

To identify barriers and facilitators relevant to our local target group, we conducted interviews with 21 adolescents aged 13–16 (M_age = 14.2). During the interviews, we used generative methods to elicit personal experiences around health behavior [26]. We used objects and visuals (S1 Fig) were used to engage participants and prompt discussion about what an active lifestyle means to them. For example, we presented illustrated characters and asked participants to indicate which they perceived as the most and least fit. We also asked them to rank various objects (e.g., a ball for exercise, a toy bed for sleep, fruit for food) according to their importance for the participants’ fitness. These objects and images, selected by the researchers, were intended to evoke different dimensions of health (exercise, diet, sleep, etc.). Furthermore, we asked participants the barriers and facilitators they have faced when trying to change or maintain their health behavior. Their choices and statements were written down and the interviews lasted approximately 30 minutes.

Phase 2: Card sorting

Based on the insights of the interviews we developed a card sorting activity based on Q methodology. Following this method, we asked participants to rank a series of statement cards, called a Q-set, about the topic according to their personal views. This ranking process, called Q-sorting, allowed us to understand the subjective viewpoints of the participants. Consequently, participants were interviewed about their Q-sorts. The Q-sorts were then used to perform a by-person factor analysis revealing shared perspectives on the topic [27].

Step 1. Q-set development.

Based on the exploratory interviews, two Q-sets were developed: one for barriers and one for facilitators. The interview results were analyzed using the barrier and facilitator themes identified by Martins and colleagues as a guide [16], which resulted in 41 barriers and 49 facilitators. The two lists were reviewed within the research team and the redundancy between statements was reduced by removing ones with overlapping themes, resulting in two balanced Q-sets. The two sets consisted of 31 barriers and 36 facilitators (S2 Table).

Step 2. Q-sorting.

Q-sorting was conducted with 30 adolescents aged 13–18 (M_age = 15.1, 16 male). Each Q-sorting lasted approximately 30 minutes and consisted of asking each participant to:

select a physical activity that they had maintained for at least two years and are still doing currently.
respond to the facilitator Q-set statements, which were shown one by one, and to categorize the statements as ‘not important’, ‘a little important’ or ‘very important’ for maintaining their physical activity.
select the top 10 from the ‘very important’ stack and sort them in the ranking structure based on personal importance (Fig 1).
confirm that they were satisfied with the configuration and that it reflected their experience, before explaining each sorting choice they had made and its role in their PA maintenance.
reflect on any changes in their facilitators over time, and if applicable, re-sort them in line with their experiences from two years ago
explain how and why their facilitators had changed over time.
repeat steps 2–6 with the Q-set about PA barriers.

Step 3. Analyses.

Using the data obtained in step 2, we investigated the descriptive statistics to identify the most important barriers and facilitators based on cumulative ranked scores for all adolescents in our sample. The types of PA that adolescents had maintained can be seen in S3 Table.

We then conducted a by-person factor analysis (PCA involving varimax rotation) of the facilitator and barrier Q-sorts using the qmethod package in R (version: 1.3.1093) [28,29]. The number of factors was determined using visual inspection of the screeplot, the Eigen-value criteria > 1, and at least 3 participants per factor which are commonly used criteria for this method [27]. Next, we developed weighted average z-score tables for displaying the ideal Q-sort and focused our interpretation of the factors, which we will also call profiles, on the statements ranked +2 or above, as determined by these tables (S4 Table).

Perceived changes over time were examined by calculating the change in rank order score of each barrier and facilitator for participants who indicated a change. These rank order changes were summed for each barrier and facilitator to identify the influences that shifted most between participants’ past and current PA experiences.

The profiles and largest retrospective shifts were analyzed and interpreted qualitatively, utilizing participants’ explanations and anecdotes about their choices, and guided by the themes described by Martins. Participant quotes were visually organized on statement cards within the relevant profiles and for the largest barriers and facilitators changes. Throughout the analysis, researchers stayed closely aligned with participants’ own words to ensure a faithful representation of their experiences.

Results

Descriptive statistics

Table 1 presents the overall highest scoring facilitators and barriers of the group based on rank scores. Results suggest that having fun was the most important facilitator. The most important barriers were related to having other responsibilities or too little time or more related to personal factors such as having too much on one’s mind and too little energy.

Table 1. The total scores of most important barriers and facilitators in our sample, n = 30.

Facilitators	Type	Total ranked score (out of possible 120)
Having fun	Activity	60
Clearing the mind	Individual	36
Being able to be yourself	Individual	33
Wanting to maintain something	Life	29
Barriers
Other responsibilities	Life	45
Too little energy	Individual	44
Too little time	Life	41
Having too much on one’s mind	Individual	38

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Factor analysis

Facilitator profiles.

Two to seven factors were considered, and a five-factor solution was selected based on our criteria as described in the methods section. The final five factors included 20 (out of 30) participants and explained 53.7% of the total variance each representing a distinct profiles (see Fig 2).

Profile A – “Mental and physical health benefits”

These adolescents placed significant value on the mental and physical advantages of engaging in physical activity, while emphasizing the importance of enjoying these activities with others. For these individuals, participation in physical activity served as a coping mechanism for managing stress and energy, enabling them to clear their mind.

Profile B – “A way to be myself around others”

This factor of adolescent girls placed great value on authenticity, fun, and self-expression in their engagement with PA. Participants emphasized the significance of being able to be their authentic self when doing physical activities in social groups, which significantly contributed to their enjoyment of the activity.

Profile C – “Pursuing health goals”

These adolescents were driven by goal achievement, such as earning diplomas and acquiring specific skills, and maintaining their physical fitness for their future wellbeing. They seek to grow personally through facing challenges while also working on their overall health and wellbeing. Overall, they regarded their PA as a fundamental component of a well balanced lifestyle.

Profile D – “Developing confidence and strength”

These adolescents articulated the significance of personal growth and self-identity, while also recognizing the positive impact of physical activity on their overall wellbeing. A central aspect was the value placed on the importance of expressing their true selves openly, even in public settings. Personal development held considerable importance, with individuals finding joy in their own transformative journeys and progress.

Profile E – “Developing along my own path”

The adolescent boys in this profile emphasized personal development, not only through progress in their chosen activity but also by enhancing their ability to handle other life situations. They place great importance on autonomy, valuing the freedom to make their own choices, for example, in selecting of their preferred activity or club. Enjoyment was also a significant influence, with participants recognizing fun as essential to both performance and personal growth.

Barrier profiles.

Three to five factors were considered, and the four-factor solution was selected based on our criteria. The four factors included 27 participants and explained 53% of the total variance each representing a distinct profile (see Fig 3).

Profile A – “Low motivation and energy”

Adolescents in this profile expressed difficulties such as feeling physically or mentally unwell, which hindered their motivation for PA. Additionally, lack of time and the burden of other obligations like school and work occupied their minds, further impeding their enthusiasm to participate in physical activities.

Profile B – “Not a good fit for me”

These adolescents struggled most with the at times physically and emotionally unsafe environments in which their PA took place. Time constraints posed a significant challenge for this group, as they strived to balance their school commitments with engaging in physical activities. The compatibility of the activity with their preferences was also crucial, as it boosted their enjoyment and motivation to participate regularly. Financial burdens of the activity also played a role, arising from, for example, regular contributions and the cost of necessary equipment.

Profile C – “Balancing act”

These adolescents attributed their challenges to multiple competing responsibilities particularly involving schoolwork and part-time jobs, which often take sometimes take priority over engaging in physical activities. Falling out of their exercise routine was a recurring occurrence among this group, and they sometimes struggle to get back on track after moments of laziness. Distractions, such as mobile phones or other leisure activities, also interfered with their physical activity plans.

Profile D – “Proximity, possibility and perception”

These adolescents faced challenges in overcoming environmental barriers, particularly distance, adverse weather conditions, and competing commitments such as school obligations, which hindered their engagement in physical activities. Feelings of discomfort exacerbate their reluctance to participate, as they were concerned about their performance level and the fear of judgement from others.

Perceived changes over time

After the initial sorting of the cards, participants were asked whether and how their barriers and facilitators for the same activity had changed compared to two years earlier. 21 out of 30 (70%) adolescents indicated that their facilitators had changed over time (13 male, 8 female, ages 13–18). 17 out of 30 (56.7%) indicated changes in their barriers (10 male, 7 female, ages 13–18). The most notable shifts, which were shared by at least four participants, are shown in Fig 4.

Fig 4 — Δ indicates change in ranked score.

Participants who reported changes in either barriers or facilitators were slightly older on average (15.3 years) than to non-changers (14.3 years). The age range for changers was also slightly wider (ages 13–18) compared to non-changers (ages 13–16). Those who reported changes in both barriers and facilitators were the oldest on average (15.7, n = 14), compared to those reporting changes in facilitators only (15.1 years, n = 7) or in barriers only (14.0 years, n = 3). These patterns suggest that older participants were more likely to report changes in their perceived barriers and facilitators.

In the past, enjoyment stood out as a primary motivator for engaging in PA for the participants. Additionally, having a good physical conditioning and being a part of a team and were important facilitators in the past. In contrast, present facilitators were more self-directed, including both the ability to be true to themselves and to pursue their self-development. Moreover, PA has turned into a mechanism that can regulate both mental and physical wellbeing such as mental clarity and energy levels.

Past barriers centered more on the activity itself or adolescents’ physical and mental states, with the prospect of not enjoying the activity as the primary barrier for PA engagement. In addition, feelings of personal discomfort and moments of laziness were common obstacles. In contrast, present barriers predominantly revolved around external factors and obligations. Adolescents now grapple with balancing responsibilities, which contributes to feelings of mental overload and a perceived depletion of time and energy from doing other tasks.

Discussion

This study employed a mixed methods approach combining interviews and card sorting based on Q-methodology to study how adolescent experience their PA maintenance. For our first research aim, we identified barrier and facilitators profiles which represent different adolescent perspectives on PA maintenance. For our second research aim, we identified how barriers and facilitators for PA were perceived to change over time.

Barrier & facilitator profiles

Factor analysis on the card sorting task resulted in five facilitator and four barrier factors, showing that adolescents’ experienced barriers and facilitators to PA maintenance are not uniform but can be grouped into distinct profiles. Profile A (Mental and physical health benefits) and B (A way to be myself around others) were grounded in the direct, immediate characteristics of the activity. Profile A emphasized fun and direct physical and mental health outcomes, while B, the most distinct factor and composed exclusively of girls, highlighted the importance of social context and support. In contrast, profiles C, D, and E were more goal-driven and future-oriented. Profile C prioritized health goals and performance milestones, D emphasized developing strength and confidence, and E combined forward-looking self-development with enjoyment. However, our factor solution did not capture all variation, as ten participants did not fit any facilitator factor, indicating additional unrepresented perspectives exist beyond these profiles.

The barrier profiles showed less overlap than the facilitator profiles, making them more distinct. They differed in the degree to which they emphasized internal versus external influences. Profile A was positioned firmly at the internal end of the spectrum, focusing almost exclusively on barriers such as low motivation, limited energy, or feelings of laziness. At the opposite end, profile D centered almost entirely on environmental obstacles unrelated to the activity’s content (e.g., weather, travel distance). Profiles B and C combined internal and external barriers. Profile C connected external life demands to depleted internal resources, while Profile B emphasized the fit between the activity and the individual (e.g., questioning whether the activity feels right or safe).

Together, these findings indicate that adolescents’ PA maintenance experiences are shaped by multiple influences and can be grouped into distinct profiles. This is consistent with prior work showing that youth construct their own meanings, values, and perceptions around health behaviors, and that these subjective configurations shape maintenance [19,20]. However, the profiles we identified are unlikely to represent the full spectrum of adolescent experiences. The explained variance of the factor solutions was relatively low (below 60%), and could be explained by other contributors to maintenance, such as self-regulation skills, habit strength, and environmental resources [13], were only indirectly captured in our card set. Although most profiles emphasize intrapersonal influences, adolescents’ accounts also point to external demands from the environment, showing the interaction between context individual characteristics.

Perceived changes over time

Our results show that adolescents perceived both barriers and facilitators for PA to change over time. In the past, facilitators were more tied to the direct characteristics of the activity (e.g., team atmosphere, having fun, and feeling physically capable). Over time, these changed towards more “higher order” goals related to self-development and self-expression, for example, gaining benefits beyond the context of the activity and becoming who they want to be. This change suggests that earlier PA engagement depends more on immediate, experiential qualities, whereas current engagement (among our sample of PA maintainers for at least two years) is supported by motives more aligned with identity and self-directed goal pursuit. Viewed through a self-determination theory lens, earlier motivation appeared to be connect more to relatedness and competence needs (e.g., connection in a team setting and feeling capable), whereas current facilitators increasingly reflect autonomy (developing myself, able to be myself). Furthermore, adolescents also seem to develop a broader conception of wellbeing (energy balance, feeling good, clearing my mind), suggesting that their understanding of what PA affords now also includes psychological and self-regulatory benefits, not just physical ones.

Barriers followed a complementary pattern. Earlier in adolescence, obstacles tended to be more internal and immediate (e.g., boredom, low mood, or not feeling well). In contrast, present barriers were more often due to new external demands, driven by increasing responsibilities from school, work and family, and consequently by reduced available time or energy for PA. This shift reflects a broader life context in which adolescents constrained not only by internal factors such as low motivation or boredom, but also by the need to juggle multiple demands from their surroundings.

The changes in barriers and facilitators echo findings from other studies and align with developmental psychology theories [17,19,22]. Adolescence is a period of identity exploration and formation, occurring alongside new academic, familial, and social responsibilities and interests [30,31]. These transitions require continual reprioritization and trade-offs in how limited time and cognitive resources are allocated. Our sample of maintainers appears to counteract these life demands by drawing increasingly on motivation grounded in autonomy and positive outcomes, which can contribute to their sustained engagement. Notably, while most participants reported changes, some reported no change in their barriers (n = 12) or facilitators (n = 9), indicating that these shifts are not universal. Participants who reported changes over time were one year older on average, suggesting that such shifts may become more likely as adolescents progress along their developmental pathways. However, the age ranges of changers and non-changers overlapped substantially (ages 13–16 vs. 13–18), indicating that age alone does not fully explain these differences. Moreover, across the sample, “having fun” remained the most consistent facilitator, underscoring that immediate enjoyment continues to be a core motivator for PA, even as other motives evolve.

The primary strength of this research is the investigation of subjective perspectives and experiences of adolescents around maintained PA. Our findings have several implications for promoting sustained physical activity from a person-based developmental perspective. First, interventions should treat adolescents as evolving agents, not static targets. Priorities, motivations, and constraints change over time, and simply encouraging more physical activity among adolescents without acknowledging competing demands can increase friction rather than support engagement. Second, because enjoyment remains a core driver, especially earlier in PA engagement, PA should be framed not merely as a health imperative but primarily as an intrinsically enjoyable experience, a point often secondary in health promotion programs. Third, PA interventions must be adaptive and reflective. Although the immediate experiences of the physical activity are most important, for maintained PA, other goals also become important such as self-development, regulating energy balance, and feeling like you can be yourself. These more future-oriented influences should be given space to develop within PA interventions and actively encouraged, for example by embedding periodic reflection opportunities to reassess how PA also contributes to other goals. As several participants commented: ‘I knew all these things already, but it is good to get an overview of it like this.’ Health promoting programs could provide adolescents with tools to create an overview of their barriers and facilitators can help guide autonomous decision-making as their needs evolve with shifting life contexts, supporting them in renegotiating how PA fits alongside growing responsibilities and changing identities.

Limitations & future research

This study is not without limitations. First, the study took place in a Dutch adolescent population in an urban area of the Netherlands, which comes with culture-specific considerations at both contextual and developmental levels. The Netherlands is a high-income country with relatively good access to PA opportunities, but most adolescents don’t meet the recommended amount of PA [32]. Furthermore, none of the researchers were adolescents, so the selection of the stimuli used during interviews, the creation of the card set, and the interpretation of interviews necessarily reflect adult perspectives. Our assumptions and consequent study design decisions may have shaped participants’ responses and may not fully capture how adolescents themselves conceptualize PA. These points make the generalizability of these research harder to other contexts. Future research could involve adolescents as co-researchers and by conducting similar studies in different cultural contexts. Second, we are unable to link our findings to actual PA data of our participants (e.g., accelerometer measures or activity logs). While engaging in one physical activity for at least two years was an inclusion criteria of the study, but we did not measure actual PA levels during the data collection. Consequently, we cannot determine how perceived changes in barriers and facilitators relate to actual PA engagement or predict long-term adherence. Future research could integrate objective PA data with experiential insights to examine how subjective experiences interact with measured activity levels. Third, we compared changes across a wide age range (13–18 years). Within this range, developmental stages differ substantially in cognitive, social, and physical ways. Future studies could focus on narrower age ranges to clarify how developmental transitions influence PA maintenance profiles.

Conclusions

This study provides valuable insights into adolescents’ PA maintenance experiences by identifying distinct profiles of barriers and facilitators and showing how these can change over time. It highlights that adolescents’ experiences are diverse and dynamic, with differences linked to internal versus external influences and to immediate versus more distal characteristics of PA. By capturing these patterns, our research deepens understanding of lived experiences around PA maintenance in adolescence. These findings point to new directions for designing tailored, person-based interventions that account for developmental changes and support sustainable PA among adolescents.

Supporting information

S1 Fig. Materials used during interviews to sensitize adolescents about their active lifestyle.

(PDF)

pone.0333120.s001.pdf^{(321.1KB, pdf)}

S2 Table. Final list of facilitators and facilitators used during Q-sorting.

(PDF)

pone.0333120.s002.pdf^{(137.8KB, pdf)}

S3 Table. The different types of physical activities that adolescents had maintained.

(PDF)

pone.0333120.s003.pdf^{(106.1KB, pdf)}

S4 Table. Weighted average z-scores per facilitator and barrier factor.

(PDF)

pone.0333120.s004.pdf^{(166.9KB, pdf)}

Acknowledgments

We would like to thank S. Loos and S. Hondmann for their time and energy in helping with the data collection process.

Data Availability

Data cannot be shared publicly because no informed consent was obtained from participants and their guardians for sharing their data publicly, even in anonymized form. Data are available from 4TU.ResearchData (contact via https://data.4tu.nl/) for researchers who meet the criteria for access to confidential data.

Funding Statement

This research was funded by a grant awarded to dr. V.T. Visch from the Dutch Research Council (NWO). File Number: 403.19.246.

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PLoS One. doi: 10.1371/journal.pone.0333120.r001

Decision Letter 0

Hidetaka Hamasaki

19 May 2025

PONE-D-24-54299Dynamics and Diversity of Adolescent Perceptions of Barriers and Facilitators for Physical Activity MaintenancePLOS ONE

Dear Dr. Houtman,

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: No

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is an interesting piece of work, using interesting methods of engaging with young people. The exploration of PA maintenance is important. Below are some more specific comments I think need to be addressed to strengthen the manuscript. I have selected major revision purely because some points may need some time and consideration to be addressed. Especially regarding clarity and including important information and considerations I think are currently missing. I have uploaded a document with specific points to be addressed.

Reviewer #2: I would like to appretiate the efforts of the authors in implementing the project and writing this article “Dynamics and Diversity of Adolescent Perceptions of Barriers and Facilitators for Physical Activity Maintenance”.

The aim of this very study is The aim is to understand how barriers and facilitators for PA maintenance change during adolescence. The second aim is to examine how these barriers and facilitators act within adolescents and how they differ between them.

The study is very interesting and beneficial for practice.

I have the following comments and questions:

Methods:

- The methodology is innovative.

- I recommend adding age ± SD years

- It would be useful to provide data on the socioeconomic status or ethnicity of the participants.

- It is not clear from the methodology how the authors arrived at the claim of "development with age". This claim seems speculative without longitudinal data.

- For better transparency it would be useful to specify the cluster analysis procedure (algorithm, validation metrics).

Discussion:

- I recommend discussing the effect of the Covid-19 pandemic on the results

Reviewer #3: I read this paper with great interest. This is an ambitious study that deeply explores the dynamics and diversity of perceptions regarding barriers and facilitators to physical activity (PA) maintenance during adolescence using a mixed-methods approach. The approach of addressing the crucial issue of adolescent PA maintenance from two perspectives—'temporal changes' in factors and 'inter-individual diversity'—is highly commendable. This perspective is likely to contribute to the development of more effective interventions. Furthermore, the mixed-methods approach combining exploratory interviews and Q-methodology-based card sorting is appropriate for capturing the complex perceptions and experiences of individuals from multiple angles. Moreover, the discussion links these findings to adolescent developmental characteristics and prior research, making the content rich in both theoretical and practical implications. Below, I offer some suggestions for further improvement.

Results:

Regarding the description 'most notable shifts' in the 'Changing dynamics over time' subsection of the Results section, clarifying the specific criteria for 'notability' (e.g., items reported as changed by a larger number of participants?) within the text would enhance reader understanding.

Methods:

In the 'Q-set development' subsection of the Methods section, the developed barriers (31 items) and facilitators (36 items) are mentioned. To help readers grasp the study's content without needing to refer to the appendix, perhaps consider providing a few representative examples of these items within the main text.

Discussion:

The limitation regarding the lack of consideration for the influence of the 'type of activity' being maintained is mentioned, and I believe this is a very important point. It might be beneficial to expand the discussion or speculation on how the identified clusters and temporal changes could potentially be influenced by differences in activity types, such as individual vs. team sports, or structured sports vs. free-form exercise. This would also be valuable for making the implications for future research more concrete.

While Q-methodology allows for capturing the diversity of perspectives even with relatively small samples, from the perspective of the stability and generalizability of the cluster analysis results, it might be appropriate to mention the sample size as a limitation.

Reviewer #4: PONE-D-24-54299: Dynamics and Diversity of Adolescent Perceptions of Barriers and Facilitators for Physical Activity Maintenance

The title clearly reflects the content and purpose of the article. The abstract clearly summarizes the background, purpose, method, and main findings of the study. Practical implications of the results are also included in the abstract; this allows the reader to see the application area of the research.

In order for the summary to be more effective, the names and basic characteristics of the “five different facilitator clusters and four barrier clusters” presented can be briefly included, albeit superficially. In addition, the number of participants and age range can be presented more concisely in a single sentence in the method section.

Introduction

Current literature and research needs on the subject are clearly stated. The difficulties of maintaining physical activity behavior and current deficiencies are emphasized. The problem definition and the objectives of the article are well structured. The study effectively identified an important gap in the existing literature on physical activity maintenance in adolescents. The argument that physical activity maintenance behavior is different from initiation behavior is strongly supported. The literature review is comprehensive and integrates relevant theoretical frameworks and previous studies well. An understanding of the developmental stages of adolescents is successfully integrated into the conceptual framework of the study.

In the introduction, the gaps in the existing literature can be supported with more concrete data (statistical values or examples). In addition, the distinction between “behavioral maintenance” and “behavioral initiation” could be given in a clearer.

The research objectives could be stated in a clearer and more structured manner. In particular, more specific information could be provided on how to examine change over time and individual differences.

An operational definition for the concept of physical activity “maintenance” should be provided. The authors asked participants to recall “a physical activity that they have done for at least 2 years and are still doing,” but it is not explained how this definition of maintenance relates to the literature.

The importance of the person-centered (idiographic) approach is emphasized, but more theoretical background on this concept could be provided.

Method

Research Design

The selection of a mixed method approach is appropriate for the complex nature of the subject. Both qualitative (interviews) and quantitative (Q methodology and card sorting) applications are explained in detail.

Participant selection criteria and the sampling process can be specified in more detail. In particular, providing information about the socioeconomic characteristics of the school(s) where the interviews were conducted or the diversity in the sample is important for the generalizability of the study.

Data Collection Tools and Procedure

The creative techniques used in the interviews (such as object/character selection and sorting) are innovative and increase participant interaction. The study adopted a mixed methodological approach that successfully integrated both qualitative and quantitative methods. The two-stage research design (exploratory interviews and card sorting) is well structured.

The use of Q methodology is an appropriate choice for understanding the subjective perspectives of individuals.

The data collection process and ethical procedures are explained in detail.

Examples of the cards used and the selection process (reference to the “appendix” files should be provided, but a brief explanation should be added in the main text) can be presented as a summary in the main text. Replication would be easier if the reason and how the cards were selected were explained more clearly.

More information about the sample selection and sample size determination process would be useful.

More methodological details could be provided about the cluster analysis used in the data analysis process.

More information about the demographic characteristics of the participants (socioeconomic status, ethnicity, etc.) would be useful to assess the generalizability of the results.

The analytical steps in the transition from exploratory interviews to the card sorting activity could be more clearly stated.

Results

The most frequently highlighted barriers and facilitators are presented clearly and in a tabular form. How change occurs with age or over time is presented in a clear manner.

The findings are presented in a well-organized manner that is consistent with the research objectives.

The analysis of changes over time provides important insights into understanding developmental changes in adolescents’ motivation to pursue physical activity.

The cluster analysis successfully reveals different perspectives on adolescents’ motivation to pursue physical activity.

The detailed descriptions of the clusters for both facilitators and barriers contribute to the depth of presentation and analysis.

A more comprehensive visualization of the five facilitators and four barrier clusters obtained from the cluster analysis may help interpret the results.

Additional analyses can be provided on the relationship of the clusters to demographic characteristics, types of physical activity, or other relevant variables.

Figure/table references (e.g. Figure 2) should be explained further in the text. The reader should be provided with brief explanations of what the key tables and figures support in the text.

The relationship or interaction between barriers and facilitators can be examined in more detail.

There is no clear time frame defined for "past" and "present", which can make it difficult to interpret changes over time.

Clustering

The clustering for both barriers and facilitators provides a good picture of the diversity of young people's experiences. The basic characteristics/criteria and representative views of each cluster are explained in detail.

The number of people in the clusters and the distribution of the clusters should be given more clearly in numerical terms. In some clusters, gender/etc. characteristics (e.g. girls' group, boys' group) should be emphasized but are omitted.

Discussion

The results obtained are interpreted by comparing them with the existing views in the literature. The practical implications of the results and personalized intervention suggestions are valuable. The study limitations are honestly addressed and directions for future research are offered. Practical implications for developing interventions are presented. The study successfully highlights the dynamic and diverse nature of physical activity maintenance behavior in adolescents.

The limitations regarding the generalizability of the sample covered by the study (local/Dutch context) should be discussed more clearly. In addition, the limitations of the study include data types/distribution, risk of bias, small sample size and weaknesses of the Q methodology, which can be discussed with examples.

The discussion could be strengthened by a more comprehensive situating of physical activity maintenance behavior in light of different theoretical frameworks.

More emphasis could be placed on the implications of the study for the broader public health and behavior change arena.

More specific and actionable recommendations could be provided for intervention design.

Further discussion could be provided on the generalizability of the findings of this study among adolescents in the Netherlands to different cultural contexts.

Conclusion and Contributions

The conclusion is concise; implications of the findings for interventions for youth are clearly stated.

Recommendations for policy makers and practitioners can be summarized in short bullet points.

References

References are up-to-date and consistent with the literature in the field. Ethics statement, funding, and conflict of interest statements are properly included.

References contain some minor spelling/formatting errors; careful review for adherence to standard journal style.

Writing and Organization

The article is well structured and clearly written.

References are up-to-date and relevant.

Tables and figures are well integrated with the findings.

The abstract effectively summarizes the main components of the study.

Aspects that Need Improvement The language flow could be improved and more concise expressions could be used.

The data collection and analysis processes could be more clearly separated by using more subheadings in the Methodology section.

The legends of the figures could be more detailed.

Additional visual elements could be added to the Results section to better illustrate the results from the cluster analysis.

General Assessment and Recommendations

This article is an innovative study that provides valuable insights into adolescents’ physical activity maintenance behaviors. The mixed methodology approach and the use of Q methodology contribute significantly to the in-depth understanding of the topic. The findings on how adolescents’ motivation to maintain physical activity changes over time are particularly striking and have important implications for intervention design.

Considering the points that need to be corrected above, the overall quality of the article will further improve and provide a stronger foundation for the development of effective interventions for promoting physical activity in adolescents. In particular, strengthening the methodological explanations, presenting the findings with richer visualizations, and establishing stronger connections to theoretical frameworks will increase the impact of the article.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

Reviewer #4: Yes: Cihan Aygün

**********

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Attachment

Submitted filename: comments to authors.pdf

pone.0333120.s005.pdf^{(72.1KB, pdf)}

PLoS One. 2025 Sep 23;20(9):e0333120. doi: 10.1371/journal.pone.0333120.r002

Author response to Decision Letter 1

14 Aug 2025

Dear reviewer and editor,

Thanks for you effort and time. We think the manuscript has significantly improved by incorporating the feedback. The made changes are described and detailed and the newly uploaded documents.

Attachment

Submitted filename: PlosOne response letter_TAH.docx

pone.0333120.s007.docx^{(23.1KB, docx)}

PLoS One. doi: 10.1371/journal.pone.0333120.r003

Decision Letter 1

Hidetaka Hamasaki

10 Sep 2025

Dynamics and Diversity in Adolescents’ Experienced Barriers and Facilitators for Physical Activity Maintenance

PONE-D-24-54299R1

Dear Dr. Houtman,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Hidetaka Hamasaki

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewer #3:

Reviewer #4:

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #3: Yes

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

Reviewer #3: Yes

Reviewer #4: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

Reviewer #3: Yes

Reviewer #4: Yes

**********

6. Review Comments to the Author

Reviewer #3: I have reviewed the revised manuscript.

I find that the quality of the paper has been significantly improved through the authors' revisions. I recommend that the manuscript be accepted for publication.

As a note for the future, the response letter appeared to group comments from multiple reviewers, which made it somewhat difficult to follow the responses to individual points. For future submissions, responding to each reviewer's comments individually in the response letter would contribute to a smoother and more constructive review process.

Reviewer #4: The authors carefully addressed all comments and criticisms from the peer reviewer and made comprehensive improvements in the methodology, analysis, and discussion sections. The results are clearly presented, the discussion is well-aligned with the literature, and the limitations are thoroughly described.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #3: No

Reviewer #4: Yes: Cihan Aygün

**********

PLoS One. doi: 10.1371/journal.pone.0333120.r004

Acceptance letter

Hidetaka Hamasaki

PONE-D-24-54299R1

PLOS ONE

Dear Dr. Houtman,

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on behalf of

Dr. Hidetaka Hamasaki

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PLOS ONE

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

S1 Fig. Materials used during interviews to sensitize adolescents about their active lifestyle.

(PDF)

pone.0333120.s001.pdf^{(321.1KB, pdf)}

S2 Table. Final list of facilitators and facilitators used during Q-sorting.

(PDF)

pone.0333120.s002.pdf^{(137.8KB, pdf)}

S3 Table. The different types of physical activities that adolescents had maintained.

(PDF)

pone.0333120.s003.pdf^{(106.1KB, pdf)}

S4 Table. Weighted average z-scores per facilitator and barrier factor.

(PDF)

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Data Availability Statement

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PERMALINK

Dynamics and diversity in adolescents’ experienced barriers and facilitators for physical activity maintenance

Timothy A Houtman

Froukje Sleeswijk Visser

Amy van Grieken

Valentijn Visch

Roles

Abstract

Methods

Ethics

Recruitment

Phase 1: Exploratory interviews

Phase 2: Card sorting

Step 1. Q-set development.

Step 2. Q-sorting.

Fig 1. Research protocol during Q-sorting.

Step 3. Analyses.

Results

Descriptive statistics

Table 1. The total scores of most important barriers and facilitators in our sample, n = 30.

Factor analysis

Facilitator profiles.

Fig 2. Identified facilitator profiles for physical activity maintenance.

Barrier profiles.

Fig 3. Identified barrier profiles for physical activity maintenance.

Perceived changes over time

Fig 4. The largest perceived shifts in barriers and facilitators for physical activity maintenance between past and present experiences.

Discussion

Barrier & facilitator profiles

Perceived changes over time

Limitations & future research

Conclusions

Supporting information

Acknowledgments

Data Availability

Funding Statement

References

Decision Letter 0

Hidetaka Hamasaki

Roles

Author response to Decision Letter 1

Decision Letter 1

Hidetaka Hamasaki

Roles

Acceptance letter

Hidetaka Hamasaki

Roles

Associated Data

Supplementary Materials

Data Availability Statement

ACTIONS

PERMALINK

RESOURCES

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