this paper focuses on physical activity ( pa ) and quality of life ( qol ) . however , focus may not be an appropriate word , as this paper takes a wide view in addressing the role of qol in pa and health promotion . to focus somewhat , this paper presents recent findings from a larger project on qol assessment and the role of qol in community - based pa and health promotion programs . to introduce the topic and provide background and context , we might ask why , what , and who questions ; that is , why focus on qol , what is qol , and whose qol are we focused on . the ' why ' question is easy to answer : qol is a key benefit of pa . much research , including recent systematic reviews and meta - analyses , confirms that pa enhances qol [ 1 - 4 ] . moreover , although there is less evidence , it appears that qol is a key motivator of pa . that is , people get into activity and stay in it because activity contributes to their qol . anecdotal reports from community activity programs and interview responses from a sub - sample of women in a larger study on activity and falls   suggest that women cite psychological values , such as maintaining cognitive function , social relations and mood , as reasons for participating . confirms that middle - age women are more motivated and likely to stay with activity with a focus on social psychological needs . moreover , this view fits with most social cognitive models , and particularly with self - determination theory . that is , as participants find that pa meets needs and contributes to qol ( enhances mood , social relationships , etc . ) that positive cycle , with pa enhancing qol , and enhanced qol motivating participation creates a positive health cycle . although the research and participant reports agree that pa and qol are related , the ' what ' question is not so easily answered . precise definitions and sound conceptual models of qol are rare , and measures are varied . before beginning our larger project , we reviewed the published research on pa and qol from 2001 to 2005 to identify the current models and measures . none of the 60 studies on pa / exercise and qol explicitly cited any qol conceptual models and the measures varied widely . the most commonly used qol measures ( e.g. , sf-36 ) in health promotion and pa interventions were developed primarily for clinical studies and do not emphasize positive health . the american college of sports medicine 's recent position stand on " exercise and physical activity for older adults " summarizes evidence for benefits , including psychological and qol benefits . the evidence statement for qol , " although physical activity seems to be positively associated with some aspects of qol , the precise nature of the relationship is poorly understood , " is graded only d , the lowest level , while most of the 29 statements are graded a / b . lack of conceptual frameworks and inconsistent qol assessment may well be major reasons for the low level of evidence . many scholars , including those who have done the major research on physical activity and qol , have noted that major shortcomings in our conceptual models and measures of qol hinder both research and health promotion programs . for example , rejeski and mihalko   identified lack of precision in the definition of qol as a barrier to consensus about the relationship between physical activity and qol , and mcauley and elavsky   argued that we can not determine whether physical activity enhances qol unless we can accurately operationalize and reliably measure this construct . everyone , including researchers , health professionals and the general public , seems to understand qol , but precise definitions are elusive . some scholars differentiate health - related qol , which focuses on perceived physical and mental health , from qol . for example , hsieh   found that perceived health was not the most important factor in qol . similarly , we are interested in participants ' views of qol without limiting those perceptions to health outcomes ; we have provided a more detailed explanation and review in our earlier report . although it is difficult to find conceptual models and definitions in the qol literature , we can find common themes . first , nearly every reference connects qol with positive health , and many cite the world health organization   definition , " health is a state of complete physical , mental , and social well - being , and not merely the absence of disease or infirmity . " that definition , which reflects positive health and moves away from the traditional medical model , is the basis for most qol definitions and measures . second , virtually all definitions and models describe qol as multidimensional , including psychological and social as well as physical domains . in addition to the themes of positive health and multidimensionality , we add that qol is an integrative or holistic construct , and based on subjective evaluations or perceptions . thus , in the earlier stages of our research , we began with a working definition of qol that reflects positive health ; quality of life is a subjective , multidimensional , integrative construct that reflects optimal well - being and positive health . gill et al .   also developed a working model to guide the development of our measure ( figure 1 ) . that model envisions the domains of social , physical , cognitive , emotional and spiritual well - being all contributing to an integrative qol . also , given our focus on physical activity , we considered that physical well - being might be sub - divided into physical health , physical fitness and physical functioning . we then developed a qol survey measure over several phases in line with that model . the resulting 32-item survey   fit the conceptual model , demonstrated logical relationships with physical activity , and has good psychometric properties . still , that survey measure was derived from existing models and measures rather than from participants . that research helps us answer the ' what ' question , and the survey fits the model and definition . however , it does not address the ' who ' question - the subjective aspect of qol . our current work attempts to go beyond the numbers and out of the boxes to find out what real people ( participants or would - be participants ) see as qol and how physical activity is related to qol . we focus on relevance , turn to participants , and ask two questions : 1 ) what is qol ? and 2 ) we first ask those questions of a large sample of university students and community participants as open - ended items on a survey , and then asked those same questions in focus groups of community participants . as part of the earlier survey development phase , a sample of university students ( n=142 ) and community participants ( n=142 ) completed a qol survey with two added open - ended items , " what is good qol " and " how does pa contribute to qol . " these open - ended responses were collected with a sub - sample of the larger survey development sample . all recruitment , methods and procedures were approved by the institutional review board , and are described in detail elsewhere . the community group was older ( m=62.5 ; range , 24 to 89 ) than the students ( m=20.8 ; range , 18 to 49 ) , but similar in gender and race / ethnicity . both groups were predominantly women ( 67% students , 74% community ) and predominantly white ( 57% , 77% ) with 34% and 20% african - american . all open - ended responses to the two questions were listed in a data file and cross - checked by a second coder to ensure all responses were included . the research team met together to resolve discrepancies in lists and grouping to finalize the coding . it should be noted that we also asked two parallel counter questions " what is poor qol " and " how does pa detract from qol , " and we also coded those responses . however , many participants left those items blank , the limited responses did not add to the findings , and thus are not reported . both student and community participants ' responses on ' good qol ' encompassed all domains of qol , but certain domains and specific responses were stronger contributors , and patterns differed between the two groups . as table 1 , which gives the frequencies of responses in the major categories , shows , physical health is important , but qol is much more than physical . both student and community groups gave similar high numbers of responses that fit the social category ( 56 , 54 ) and physical health ( 66 , 64 ) domain . for the emotional category , students gave markedly more responses ( 77 vs. 31 ) . for physical function / activities of daily living ( adl ) , community participants gave more responses than did students ( 65 vs. 19 ) . that 's logical , given that many community participants were in senior activities , but it is notable that students also gave responses indicating that physical functioning was an important part of qol . responses that reflected the cognitive and spiritual domains were also given by both students and community participants . several participants also gave responses in the environmental category , such as having what you need . notably almost no one left the open - ended item blank even though the item was at the end of a lengthy survey . we did code and analyze the counter question , " what is poor qol " but the responses were fewer and generally simply a reverse of the responses to ' good qol . ' however , the varied responses and patterns suggest that the meaning of qol varies across groups and individuals in ways that may not be picked up with survey measures . the same sample responded to open - ended items asking how pa contributes to qol and detracts from qol . as table 2 shows , nearly all participants reported positive contributions with less than 15% of both groups leaving the open - ended item blank . as expected , physical activity contributes to the physical domain , but that 's not all . both groups reported pa contributions in all qol domains , with the most responses under physical health ( 44 , 37 ) and emotion / mood ( 44 , 43 ) . for example , under the emotion domain , students reported more stress relief . within the physical domain , both groups gave many responses reflecting physical health , but community participants reported more adl contributions ; both groups reported similar numbers of responses reflecting physical fitness , but students cited staying fit whereas community participants cited flexibility and strength . the overwhelming response to the counter question " does pa detract from qol " was a clear ' no ' with very few participants responding with anything else . both students and community participants clearly see pa as contributing to qol . not only did both groups cite clear contributions to the physical domain , but similar large numbers reported contributions to the emotional domain , and several reported contributions to social , cognitive and even the spiritual domain . of particular interest , a notable number gave responses that explicitly reflect an integrative qol . both student and community participants ' responses on ' good qol ' encompassed all domains of qol , but certain domains and specific responses were stronger contributors , and patterns differed between the two groups . as table 1 , which gives the frequencies of responses in the major categories , shows , physical health is important , but qol is much more than physical . both student and community groups gave similar high numbers of responses that fit the social category ( 56 , 54 ) and physical health ( 66 , 64 ) domain . for the emotional category , students gave markedly more responses ( 77 vs. 31 ) . for physical function / activities of daily living ( adl ) , community participants gave more responses than did students ( 65 vs. 19 ) . that 's logical , given that many community participants were in senior activities , but it is notable that students also gave responses indicating that physical functioning was an important part of qol . responses that reflected the cognitive and spiritual domains were also given by both students and community participants . several participants also gave responses in the environmental category , such as having what you need . notably almost no one left the open - ended item blank even though the item was at the end of a lengthy survey . we did code and analyze the counter question , " what is poor qol " but the responses were fewer and generally simply a reverse of the responses to ' good qol . ' however , the varied responses and patterns suggest that the meaning of qol varies across groups and individuals in ways that may not be picked up with survey measures . the same sample responded to open - ended items asking how pa contributes to qol and detracts from qol . as table 2 shows , nearly all participants reported positive contributions with less than 15% of both groups leaving the open - ended item blank . as expected , physical activity contributes to the physical domain , but that 's not all . both groups reported pa contributions in all qol domains , with the most responses under physical health ( 44 , 37 ) and emotion / mood ( 44 , 43 ) . for example , under the emotion domain , students reported more stress relief . within the physical domain , both groups gave many responses reflecting physical health , but community participants reported more adl contributions ; both groups reported similar numbers of responses reflecting physical fitness , but students cited staying fit whereas community participants cited flexibility and strength . the overwhelming response to the counter question " does pa detract from qol " was a clear ' no ' with very few participants responding with anything else . both students and community participants clearly see pa as contributing to qol . not only did both groups cite clear contributions to the physical domain , but similar large numbers reported contributions to the emotional domain , and several reported contributions to social , cognitive and even the spiritual domain . of particular interest , a notable number gave responses that explicitly reflect an integrative qol . as an extension of the survey research , this phase of the project more directly focuses on the meaning of qol from the perspective of participants in community programs . the focus group study was conducted after the survey development phase , and received separate approval from the university human subjects institutional review board . through contacts with community programs , two groups came from one church , and both groups were young to middle - aged ( age 24 to 48 ) black women . the other four groups were predominantly white women , but each was distinct , including novice women runners in a training program ( age 33 to 55 ) , a clogging group ( age 18 to 55 , including the only man in the focus groups ) , an activity program for women with fibromyalgia ( age 54 to 83 ) , and a ymca senior fitness class ( age 65 to 73 ) . the focus group interviews were semi - structured , and the main guiding questions asked of the focus groups were , " what is qol " and " how does pa relate to qol . " sessions were audio - taped and transcribed ; transcripts were reviewed to identify responses related to the meaning of qol and its relationship to pa , then listed for coding . at this point our analyses are preliminary , but provide a glimpse into the meaning of qol and pa for participants . however , the numbers do not really tell us what qol means to the participants . several responses were common to all the groups , but each focus group also provided some unique responses , highlighting the subjective nature of qol , and also suggesting social - contextual influences . all of the focus groups cited responses that reflected multiple qol domains ( e.g. , physical , social , and emotional ) and all emphasized balance or integration of different aspects of qol . common responses from all groups included enjoying life , able to do things , social connections , and good health . responses reflecting the spiritual domain were cited in several groups , but most notably in the two groups that came from the church . the senior group emphasized cognitive skills and independence , and the fibromyalgia group emphasized relief of symptoms . as with the open - ended survey responses , focus group responses reflected multidimensional qol . however , varying patterns also suggest that the meaning of qol varies across groups and individuals in ways that may not be picked up with survey measures . focus groups clearly told us that the physical and emotion domains were key components of qol . physical health was cited in all groups , and the ability to stay active and function is a big factor for participants . as one participant stated , qol is " ... ability to do everything that you want to do in life . " the social is clearly very important , and groups also mentioned cognitive and spiritual dimensions of qol . participants clearly indicated that all components ( physical , social , emotional , cognitive , and spiritual ) play a part . as one stated , " i think it 's a balance of all those things , especially being able to enjoy yourself , have a level of health - not only physically ... emotionally , and so that you can have that balance ... " as reflected in the focus group findings , qol is clearly positive , multidimensional and integrative . and , the meaning of qol is subjective and socially or contextually situated . as with the responses to the meaning of qol , groups expressed many similar responses , while also presenting some unique perspectives ( figure 3 ) . of course , participants cited physical benefits , and comments referred to physical health , body , energy , and particularly the ability to do things and be active . one stated , " i have the energy to do all those things i want to do . " another comment connected physical and emotional benefits , suggesting that physical changes give confidence , " you can do all those things . " all groups cited social and emotional benefits as well as physical , and indeed , often emphasized social or emotional benefits over physical . for example , although the women runners were in a training program for a women - only 5-km run , almost no responses reflected physical condition or abilities ; instead they cited confidence , energy , stress relief , time management and feeling better . similarly , the cloggers , who were in a group purposely formed for the physical activity of clogging , clearly agreed that social benefits were primary . physical activity clearly contributes to emotional well - being for the participants in several ways . several comments reflected pa for self - confidence , self - discipline and self - acceptance , including " it motivated me to be ok with myself " and " we gain lots of dignity . " pa for enhanced mood and stress relief was another consistent theme under the emotional category . participants indicated that pa improved their emotional state with comments including , " if i 'm stressed , i go to the gym ... i can work this off , " and " running in the morning prepares the whole day for me . " interestingly , social contributions were cited several times as participants reported that pa helps them interact with different people , develop camaraderie , and improve family relationships . for example , one participant stated , " i feel closer to god ... when i 'm physically active , " and another commented , " if i 'd been inside on the couch , i would n't have paid any attention to the clouds and the sun and the trees and the nice breeze . " again , many responses emphasized balance or integration of different aspects of qol in relation to pa . when specifically asked about relative contributions many responded that that they could not rank the domains or separate them . as one participant stated , " i think exercise affects every dimension of your life " and another added , " ... all go together and impact each other , blended together . " however , the numbers do not really tell us what qol means to the participants . several responses were common to all the groups , but each focus group also provided some unique responses , highlighting the subjective nature of qol , and also suggesting social - contextual influences . all of the focus groups cited responses that reflected multiple qol domains ( e.g. , physical , social , and emotional ) and all emphasized balance or integration of different aspects of qol . common responses from all groups included enjoying life , able to do things , social connections , and good health . responses reflecting the spiritual domain were cited in several groups , but most notably in the two groups that came from the church . the senior group emphasized cognitive skills and independence , and the fibromyalgia group emphasized relief of symptoms . as with the open - ended survey responses , focus group responses reflected multidimensional qol . however , varying patterns also suggest that the meaning of qol varies across groups and individuals in ways that may not be picked up with survey measures . focus groups clearly told us that the physical and emotion domains were key components of qol . physical health was cited in all groups , and the ability to stay active and function is a big factor for participants . as one participant stated , qol is " ... ability to do everything that you want to do in life . " the social is clearly very important , and groups also mentioned cognitive and spiritual dimensions of qol . participants clearly indicated that all components ( physical , social , emotional , cognitive , and spiritual ) play a part . as one stated , " i think it 's a balance of all those things , especially being able to enjoy yourself , have a level of health - not only physically ... emotionally , and so that you can have that balance ... " as reflected in the focus group findings , qol is clearly positive , multidimensional and integrative . and , the meaning of qol is subjective and socially or contextually situated . as with the responses to the meaning of qol , groups expressed many similar responses , while also presenting some unique perspectives ( figure 3 ) . of course , participants cited physical benefits , and comments referred to physical health , body , energy , and particularly the ability to do things and be active . one stated , " i have the energy to do all those things i want to do . " another comment connected physical and emotional benefits , suggesting that physical changes give confidence , " you can do all those things . all groups cited social and emotional benefits as well as physical , and indeed , often emphasized social or emotional benefits over physical . for example , although the women runners were in a training program for a women - only 5-km run , almost no responses reflected physical condition or abilities ; instead they cited confidence , energy , stress relief , time management and feeling better . similarly , the cloggers , who were in a group purposely formed for the physical activity of clogging , clearly agreed that social benefits were primary . physical activity clearly contributes to emotional well - being for the participants in several ways . several comments reflected pa for self - confidence , self - discipline and self - acceptance , including " it motivated me to be ok with myself " and " we gain lots of dignity . " pa for enhanced mood and stress relief was another consistent theme under the emotional category . participants indicated that pa improved their emotional state with comments including , " if i 'm stressed , i go to the gym ... i can work this off , " and " running in the morning prepares the whole day for me . " interestingly , social contributions were cited several times as participants reported that pa helps them interact with different people , develop camaraderie , and improve family relationships . for example , one participant stated , " i feel closer to god ... when i 'm physically active , " and another commented , " if i 'd been inside on the couch , i would n't have paid any attention to the clouds and the sun and the trees and the nice breeze . " again , many responses emphasized balance or integration of different aspects of qol in relation to pa . when specifically asked about relative contributions many responded that that they could not rank the domains or separate them . as one participant stated , " i think exercise affects every dimension of your life " and another added , " ... all go together and impact each other , blended together . " the views of our participants on qol and the pa - qol relationship reflect the model , survey results , and literature , but adding the subjective ( real people ) views to our objective measures and results gives a much richer picture . both the open - ended responses and focus group findings suggest that qol reflects positive health and is multidimensional , subjective , and integrative . it is also quite clear that physical activity contributes to all aspects of qol - not just the physical . indeed , the social and emotional benefits may be the primary motivators for community participants . considering participants ' subjective views tell us that the meaning of qol and pa contributions varies across people and contexts . it should be noted that although our findings provide insights , our study , and particularly our focus group findings are limited in several ways . at this point , our focus group participants were nearly all women and from groups with very specific purposes and contexts . those specific contexts contribute to the findings and that individualizing and contextualizing aspect has implications for research and professional practice . more specifically , the findings suggest that we might target qol to enhance motivation and make sure that pa truly contributes to qol for participants . rather than focus on traditional physical fitness outcomes , we can target qol outcomes , and specifically target outcomes that are important and meaningful for participants and potential participants . even though physical benefits are important , participants rarely mention the typical fitness measures that we often target with typical frequency , intensity , and time prescriptions . indeed , emotional , social even physical health goals of many participants may be lost in focusing on training criteria . in as recent research article , segar et al .   concluded that we could better promote sustainable pa participation by rebranding exercise as a primary way individuals can enhance the quality of their daily lives . , i would add that we can better do that if we ask the ' who ' question and consider that subjective , contextualized meaning of qol and its relationship to physical activity for our participants and potential participants . additional studies , with participants in different activity settings and across differing cultural contexts , could add richer insights . one of our participants summed up our conclusion eloquently , " i think we should still have recess . " recess - that implies pa that is clearly positive with emotional , social and perhaps spiritual connotations - and lots of fun .
physical activity ( pa ) professionals and participants recognize enhanced quality of life ( qol ) as a benefit of and motivator for pa . 
 however , qol measures are often problematic and rarely consider the participants'perspective . 
 this paper focuses on recent findings from a larger project on the role of qol in pa and health promotion . 
 more specifically , we focus on the views of participants and potential participants to better understand the relationship of pa and qol . in earlier stages of the project we began with a conceptual model of qol and developed a survey . 
 we now focus on participants ' views and ask two questions : 1 ) what is qol ? and 2 ) how does pa relate to qol ? 
 we first asked those questions of a large sample of university students and community participants as open - ended survey items , and then asked focus groups of community participants . 
 overall , participants ' responses reflected the multidimensional , integrative qol model , but the responses and patterns provided information that may not be picked up with typical survey measures . 
 findings suggest that pa contributes to multiple aspects of qol , that social and emotional benefits are primary motivators and outcomes for participants , and that the meaning of qol and pa benefits is subjective and contextualized , varying across individuals and settings . 
 programs that directly target and highlight the multiple dimensions and integrative qol , while considering the individual participants and contexts , may enhance both pa motivation and participants ' health and qol .