This pilot-study is the first study assessing effects of a holistic physical exercise training on PL among physically inactive adults, whereby PL is considered as a multifaceted construct of physical, affective and cognitive domains. The main result of the present study indicated that participating in a holistic exercise training ameliorates total PL score and selective PL domains such as physical activity behaviour and exercise self-confidence/self-efficacy among physically inactive adults. Additionally, we found that improvements of PL are positively correlated with BMI values at baseline. However, when interpreting these findings, we need to consider that this pilot-study was a first attempt to measure PL with a non-validated measurement tool in physically inactive adults. Therefore, drawing conclusions based on our findings should be done with caution.
Even though we have applied established approaches to improve compliance (see methods section), the mean compliance in our study was quite low (48 ± 29%). We suggest that the low compliance may have been due to limited experience with exercise training, conducting the training intervention in autumn and winter time (higher prevalence of illnesses), difficulties in prioritising time for exercise or to symptoms in relation to chronical diseases (e.g. tiredness), as nearly 40% of our IG participants reported to suffer from at least one chronic disease. Nevertheless, our results show that IG subsample recruited by general practitioners (IG-GP) had a higher compliance to our intervention than that, who were recruited by regional newspaper advertisement and a social media campaign (IG-nGP). The positive effects of motivational interviewing in order to increase individuals compliance are well-established [
52]. However, whether it was the motivational interviewing, or the general practitioners included in the recruitment process themselves who facilitated of the positive effect on PL cannot be distinguished. Since general practitioners are held in high reputation in Austria [
53,
54], is it likely that general practitioners’ advice has more influence on a person’s conscientiousness in terms of initiating and maintaining an action than those from other people.
Physical literacy
Evidence has highlighted that all individuals can make age-independent progress on their PL journey to become physically literate [
13,
17]. However, supporting strategies of PL have mainly targeted children and adolescents [
11,
12]. The majority of participants in the present study were physically inactive and overweight midlife-females, who showed clear physical exercise-induced improvements in PL. In particular, those participants in the IG-GP subsample, who were older, had a higher prevalence of chronical diseases and BMI values as well as lower baseline values in total PL and in the domain self-confidence/self-efficacy demonstrated a larger increase in PL increase in comparison to the IG-nGP subsample. Therefore, a holistic physical exercise training might be seen as a safe and feasible intervention to help to restart a PL journey in later adulthood. PL is considered as an antecedent of physical activity [
11] and physically literate persons are suggested to have an ameliorated capacity and commitment to a physically active lifestyle in a sustainable manner [
14]. Against this background, our finding might be important for further public health and physical activity promoting activities in western countries [
55].
The increase of the PL level was primarily explained by improvements in the domains physical activity behaviour and exercise self-confidence/self-efficacy, as no significant intervention effects for the domains exercise motivation, knowledge and attitude towards a physical active lifestyle were found. Improvements in PL were positively correlated with baseline BMI values in our study. Since it is clear that an increased BMI is inversely associated with one’s physical activity behaviour [
56] and exercise self-confidence/self-efficacy [
57], those with highest BMI might have benefited most from the intervention in terms of their PL level due to poorer baseline values in those domains. As aforementioned, the IG-GP subsample demonstrated higher BMI values and lower scores for total PL and domain self-confidence/self-efficacy at baseline compared to the IG-nGP subsample. For this reason a subsample analyses were performed, which revealed larger intervention effects for the total PL and the domain self-confidence/self-efficacy. However, it is important to note that IG-GP participants had a higher compliance than those in the IG-nGP subsample, which could have also mediated this finding. Further work is required to fully understand this improved response pattern of physical exercise-induced improvements in PL among people with increased BMI values.
The finding for the domain exercise self-confidence/self-efficacy is consistently in line with results from previous exercise training studies [
19,
20], which found also that physical exercise leads to improvements of individuals’ exercise self-confidence/self-efficacy. However, it is worth noting that not exercise training involvement per se leads automatically to positive changes in exercise self-confidence/self-efficacy. Reasons explaining the origin of our observed improvements in this domain may be found in the holistic conception of our intervention as well as in the fact that we applied well-established techniques for promoting exercise self-efficacy in our study (see methods section). Evidence has clearly shown that implementing such techniques in training sessions lead to improvements of exercise self-efficacy [
40,
41], whereby a higher exercise self-efficacy, in turn, influence individuals’ exercise self-confidence positively [
58]. With regard to the subsample analysis of this domain, we found only significant improvements for the IG-GP subsample. However, while very high improvements (large effect size) were evident for the latter mentioned group, the IG-nGP participants demonstrated already a very high level of exercise self-confidence/self-efficacy at baseline. We suggest that high baseline values did not permit a further increase in the IG-nGP subsample referring to this domain.
A stronger sense of exercise self-confidence/self-efficacy is well-known as a predictor of initiating and maintaining physical activity [
59,
60]. Unquestionable, our finding in terms of the domain physical activity behaviour may have important practical implications, because we found a significant intervention effect at an exercise dosage much lower than commonly used in previous exercise training studies [
18].
Even though there is evidence in favour of physical exercise interventions to be beneficial for exercise motivation [
61], we did not find increases in our study. This might be caused by higher baseline-values of exercise motivation in the present study in comparison to earlier studies. It is likely that participants were already well-motivated regarding physical activity at study baseline, but, for example, the absence of a local training program dedicated exclusively for physically inactive adults, might have prevented them from regular physical activity in their past.
In order to enhance exercise knowledge, we implemented exercises mixed with a physical activity knowledge transfer in the conditioning phase of all three modes of training. Nonetheless, our training program was not able to increase knowledge. It is reasonable to assume that our intervention effect on exercise knowledge was limited by the low compliance in our study in combination to the fact, that our training program took place only once a week. Moreover, we have to acknowledge that the psychometric properties of the subscale in our questionnaire might have been moderated by a limited number of items which have poor item difficulties.
In contrast to previous research [
62], we did not observe an increase of physical activity attitude in the IG. In general, attitude towards a physically active lifestyle is determined by a person’s positive or negative assessment of engaging in physical activity [
63]. In fact, perceiving benefits by participating in a training program (e.g. improved aerobic fitness) will lead to a more positive attitude. Since physiological and mental adaptations predominantly interact in a dose-response manner [
64,
65], it might be that our comparatively short intervention period, along with a low compliance, limited the degree of perceived benefits of training among our IG participants.
Some limitations of our pilot-study are important to consider when interpreting the obtained results and the used methodological approach. First, due to the nature of a pilot-study a preceding validation study with a representative sample size was not feasible. We highly recommend conducting further studies in order to support the theoretical model of our PL questionnaire (e.g. using a confirmatory factor analysis approach) as well as studies investigating the standard psychometric properties of our questionnaire i.e. convergent and divergent validity and test-retest reliability. Moreover, during the data interpretation phase of our study, doubts have been raised whether the domain exercise knowledge, has sufficient sensitivity in order to detect changes over time (i.e. responsiveness). Additional research would be necessary to revise and extent this subscale. The second important limitation refers to the scoring procedure of our questionnaire, which was adapted from the CAPL [
15]. As Corbin et al. [
10] pointed out the use of a composite score has the potential to misguide, when assessing the multidimensional nature of PL. To be precise, a person with a high score on one specific PL domain (e.g. exercise knowledge) and a low score on another (e.g. physical activity behaviour) could have a similar composite score (total PL score) than a person who had reverse scores regarding these domains (i.e. low exercise knowledge and high physical activity behaviour). This may not only be seen as a limitation of our questionnaire, but also for the CAPL itself [
14,
15]. Therefore, further studies should try to develop more appropriate assessments procedures, beyond the use of a composite score. Moreover, within our scoring procedure, each domain was equally weighted. Given the fact that PL is described as the antecedent of physical activity [
11], one can speculated that the domain physical activity behaviour is more important within the PL model than the other domains. Indeed, the CAPL gave a higher weighting to the domain physical activity behaviour. Yet, this arose due to the fact that it was objectively and subjectively measured and rather than this domain was considered as more important than the others. Applying a Delphi process in order to collate expert opinions would help to clarify if all domains should be equally weighted when only a self-reported instrument is used.
Lastly, IG participants were allowed to join one, two or all three modes of training sessions (strength, endurance and multimodal) per intervention day. Consequently, no inter group differences regarding the different modes of training on changes in PL were investigated.