Abstract

Background

The aim of this study was to assess the sociodemographic characteristics, physical activity and exercise patterns among gym-goers in Italy and their health-related behaviours at the gym after COVID-19 restrictions were lifted in Italy. In addition to that, their perception of the hygiene standards and safety of gyms, according to several individual variables, was evaluated.

Methods

A self-administered questionnaire was used to collect the data of individuals who were recruited from gyms between May and June 2023. Descriptive statistics were carried out to describe the sociodemographic and behavioural characteristics of the sample and the perceived quality of the gyms. Each association between variables was assessed by using bivariate analysis, and after verifying its statistical significance, two logistic regression models were performed using the perceived quality of the gym and the likelihood of adoption of health-preventive measures as dependent variables.

Results

The study involved 1321 participants, with a nearly equal gender distribution. Most of the sample was aged between 18 and 25, unmarried, and approximately 45% were students. Most engaged in moderate physical activity, mainly free-weight lifting and machine exercises, 3鈥�5 times a week for 1鈥�2听h in the evening. Participants generally rated the gym positively, with 34.49% considering it "Good" and 39.23% rating it "Very good." Ratings from females were slightly lower compared to those from males. The age group 18鈥�25 rated the gym higher, while higher education levels were associated with slightly lower ratings. The analysis of health-preventive behaviours, including practices such as using personal towels, sanitising equipment, respecting safety distances, revealed that approximately 41.3% of the participants were likely to adopt those measures, with an additional 23.3% categorised as "very likely." Males showed a greater inclination towards these behaviours compared to females. In particular, the perceived quality of the gym influenced individuals' likelihood of adopting health-preventive measures. This indicates that factors such as hygiene, adequacy, and safety of the environment can influence individuals' motivation to engage in health-preventive behaviours.

Conclusions

Italian gym-goers generally perceived the quality of the gyms positively, with safety and cleanliness impacting their satisfaction and the adoption of health-preventive behaviours. Sociodemographic factors significantly influence these perceptions and behaviours, highlighting the need for safer, health-focused fitness facilities to promote physical activity, public health, and sustainable fitness habits and emphasising the need to understand user preferences for enhanced customer satisfaction, loyalty, and well-being through tailored management strategies and preventive measures.

Background

Regular physical activity significantly improves quality of life, reduces the risks of disease, and enhances well-being, with the World Health Organization providing exercise guidelines for different age groups [1,2,3,4,5,6,7]. However, many Italian adults do not implement those recommendations, with Italy lagging behind the European average in promoting physical activity [8]. This discrepancy emphasises the need to investigate the factors influencing physical activity participation and identify potential barriers to adherence.

The ecological models suggest that an individual's physical activity is influenced by multiple interacting factors, including personal, social, environmental, and policy-related aspects [9]. One of the most important determinants of physical activity among adults is satisfaction with environmental factors such as the social environment, the built environment and the natural environment. In this context, the design, availability, and accessibility of places for physical activity, such as sports facilities, parks, and pedestrian-friendly neighbourhoods, play a crucial role in shaping people's choices and frequency of participation in physical activity [9]. Additionally, satisfaction with the use of sports facilities, especially gyms, can be influenced by user鈥檚 perception of the quality of different aspects, such as comfort, safety, human resources technical and psychological skills, hygienic conditions and cleanliness [10].

Le贸n-Quismondo et al. (2020) found that the importance given to the quality of different fitness centre services varies according to gender and age. For example, women seem to have higher expectations of fitness service qualities, especially with regard to the variety of activities and trainers鈥� skills, while older customers seem to pay more attention to the sanitary conditions, cleanliness and safety of premises [11]. The level of education of users may also affect the perception of the quality of several services, especially those related to health, such as hygienic conditions and safety, as demonstrated in previous studies [12].

In 2019, the most popular activities practised by Italians were fitness activities, most of which took place in a confined environment [13]. Gym use increased in Italy between the 2014 and 2019 census, with a steady growth of the gym and fitness market in terms of number of gyms opened, people joining training and those working in the fitness industry [13]. This increasing trend highlighted the growing awareness of the importance of physical activity and the role of gyms in promoting a healthier lifestyle.

However, starting from March 2020, the restrictive measures imposed by national governments to limit the spread of the SARS-CoV-2 virus worldwide, specifically in Italy, strongly affected physical activity, leading to restrictions on outdoor activities and resulting in the closure of sports facilities [14,15,16,17]. In May 2020, gyms reopened with strict safety measures applied, such as access based on bookings and limited time, social distancing, body temperature detection, use of personal protective equipment such as masks and gloves, frequent cleaning and disinfection of the environment, tools and machines, mandatory hand hygiene practices upon entrance and exit, and bags provided to store users鈥� personal belongings. On March 31, 2022, the state of health emergency for COVID-19 officially ended in Italy, thus allowing the fitness industry to slowly get back to normal [18].

After the pandemic-related restrictions eased, there has been an increasing trend in Italians practising physical activities in indoor facilities and gyms. However, some individuals still hesitate to return due to financial constraints, lingering pandemic concerns, and a preference for more customised and flexible fitness options [19]. Moreover, the people who went back to the gym may have changed, to some extent, their habits, behaviours, perception of risk, value attributed to social responsibility and trust in others [20]. As a result, the importance attached to health and safety issues, which prior to the pandemic was characterised by a lack of awareness of safety precautions and infection prevention among gym members [21], becomes an interesting aspect to investigate further, as we expect a change in behaviour and increased awareness among users during and after the pandemic. This shift reflects the increased public awareness of the role of non-pharmaceutical measures, such as improved hygiene practices, ventilation, and distancing, in mitigating the spread of infectious diseases. Indoor gyms, where increased respiratory activity during exercise raises the risk of airborne transmission, require careful attention to prevention and health protection measures. This underscores their pivotal role as important settings for targeted public health interventions.

Furthermore, sports environments such as gyms, which are mainly used for training, recreational and/or rehabilitation purposes rather than competitions, are not subject to clear national legislation regarding their construction and management, despite the fact that increased respiratory rates due to physical activity expose occupants to increased inhaled pollutant intakes [22,23,24] and potential risks related to indoor and outdoor air quality in environments used for physical activity and sports [25,26,27]. Moreover, it should be considered that several studies on COVID-19 outbreaks in sports facilities demonstrated an increased risk of infection in gyms [28]: in a 30%鈭�50% occupied gym, the risk seems to be from 2 to 3.4 times higher than that in an 80% occupied supermarket [29].

For this reason, researchers should further investigate these aspects, as well as the characteristics and behaviours of gym-goers after the pandemic, to guide gym managers on how to improve the level of service and increase the number of goers and to help them to identify strategies to promote improved hygiene and health aspects of fitness centres.

The present study aims to assess the sociodemographic characteristics of gym-goers and the type, level and frequency of their physical activity and exercise as well as their health-related behaviours when attending a fitness facility after the restrictions imposed to contain the COVID-19 pandemic in Italy were lifted. Furthermore, customers鈥� perception of hygiene and safety in the different areas of the gyms was also a subject for evaluation in order to understand whether there are differences in behaviours and perceptions according to several individual variables (sociodemographic, education, exercise patterns, etc.).

This research is particularly significant not only for its contribution to the fitness industry but also for public health, considering the importance of physically active life in preventing non-communicable diseases as well as promoting well-being. Gyms and fitness centres are among the facilities that help develop a culture of regular exercise habits and a healthy lifestyle but the COVID-19 pandemic has altered concepts and perceptions of hygiene, safety and shared environments.

Understanding how these perceptions affect behaviours and health-preventive measures amongst gym-goers can help in understanding how to design and manage environments that promote exercises and reduce health risks and how to develop effective non-pharmaceutical measures to prevent the spread of infectious diseases in fitness facilities.

Therefore, the findings of this study seek to provide actionable insights into promoting safer, healthier fitness practices by focusing on the adoption of preventive behaviours. This becomes even more relevant in Italy, where low physical activity levels remain a public health concern and where encouraging the safe use of fitness facilities could support broader public health goals.

Methods

Recruitment

The cross-sectional study sample consisted of Italian gym-goers. Participants were invited to participate in the survey by the researchers during their stay at the gym. Those interested were given access to the link to the questionnaire on Google Form platform and asked to read the detailed information on the purpose of the study and the statement on anonymous responding. In order to take part in the survey, respondents were required to provide their informed consent to the survey and sensitive data processing, as provided by the Italian law 196/2003 [30] and the GDPR UE n. 2016/679 [31], two mandatory fields had to be filled in to continue the survey. No a priori statistical sample size calculation was performed, as the study鈥檚 primary aim was to descriptively explore behaviours, perceptions, and attitudes among gym-goers. The final sample of 1321 participants reflects a demographically diverse population, enhancing the reliability and generalizability of the findings and was therefore considered sufficient to provide meaningful descriptive insights into the research objectives.

Eligible participants had to be at least 18 years old, registered gym members, and engage in regular gym activities (defined as attending the gym at least twice a week for one month or more). This ensured that participants had sufficient familiarity with the gym environment to provide meaningful insights into their behaviours and perceptions. Individuals under the age of 18 were excluded due to ethical and legal considerations. Individuals who did not use the gym facilities regularly were excluded, as well as customers who had joined the gym within the last month, to ensure an adequate level of familiarity and engagement with gym activities and the environment.

The recruitment process involved university student interns acting as data collectors, each tasked with distributing a predefined number of questionnaires (minimum 50) per gym. This approach facilitated the inclusion of gyms in both urban and suburban areas, with snowball sampling extending recruitment to additional facilities through participant referrals. The study was conducted in central Italy, including the Southern Lazio and the Northern Campania, specifically focusing on the provinces of Frosinone, Latina, and Caserta. A total of 327 gyms participated in the study, representing a substantial proportion of the eligible gyms in the region. Gyms from large franchises were not included in this study. All the gyms involved were of similar size and had a comparable number of members.

Data collection

The data collection process took place between May and June 2023. Participants were approached during their gym visits and invited to complete an online self-administered questionnaire after receiving detailed information about the study and providing informed consent. Interns provided a link to a questionnaire uploaded to Google Forms platform that participants could access and fill out directly on their mobile phones. The average time required to complete the questionnaire was approximately 15 min. Participants also had the flexibility to complete the questionnaire at home if they preferred. Participation was entirely voluntary, and no financial or material incentives were provided to ensure the authenticity of responses.

For data collection, the sampling strategy was used with a combination of convenience and snowball sampling approaches that allowed us to balance the efficiency of convenience sampling with the inclusive capacity of snowball sampling, resulting in a more heterogeneous sample. Initially, convenience sampling was used, leveraging the accessibility of gyms for university student interns who were involved in the project. The student interns, drawn from diverse areas in central Italy, were tasked with collecting a defined number of questionnaires (minimum of 50) from each gym within their reach. This facilitated the inclusion of facilities across various urban and suburban areas. While this method does not ensure full representativeness, it provides a solid foundation to build the rest of the sample.

Subsequently, the snowball sampling method was implemented to expand data collection to gyms in less accessible areas or beyond the initial operational boundaries. Through the interns鈥� social networks and the contacts provided by the initial participants, data collection was progressively extended to include a wider variety of contexts, thereby increasing the diversity of the sample.

Instrument

A self-administered online questionnaire designed explicitly by the research group was used to collect the data. The survey was structured into six sections to capture comprehensive information from gym-goers. In the first section, we collected data on sociodemographic information (sex, age, civil status, educational level, occupation and geographical location). The second section explored physical activity patterns (type, frequency, intensity, duration of exercise, perception of exertion, time of the day, and transportation to the gym). The third section evaluated gym-goers perceptions of hygiene, adequacy and safety of the gym. The fourth section focused on individual behaviours and adoption of preventive measures such as sanitising equipment, using personal towels, maintaining safety distances, and wearing gym-specific footwear. The fifth and the sixth sections of the questionnaire were not the object of this study and investigated aspects of thermo hygrometric well-being such as air quality, lighting, noise levels and health symptoms experienced during gym visits. The questionnaire included a mix of multiple-choice, Likert-scale, and open-ended questions. It was designed to be completed within 15 min, ensuring clarity and ease of response.

A short version of the International Physical Activity Questionnaire (IPAQ), which is designed to measure the duration, frequency, and intensity of various types of physical activities performed by an individual [32], was used to assess an individual's level of physical activity. Respondents were asked to recall their physical activity patterns over the previous seven days. The IPAQ established scoring guidelines that categorise the intensity and duration of different activities into metabolic equivalent task (MET) minutes to estimate the energy expenditure of physical activities, with 1 MET representing the energy expended at rest. To calculate the total physical activity score, the MET value of each activity was multiplied by the minutes spent engaging in that activity. The resulting score, known as MET-minutes, represents the total energy expenditure for that specific activity and allowed us to distribute the subjects into three different categories of PA: light (< 600 MET), moderate (600鈥�3000 MET) and vigorous (> 3000 MET) PA.

In addition to that, to have a complete picture of the physical activity and exercise characteristics of the sample, questions were asked about the type of exercise performed in the gym, the subjective perceptions of physical exertion during exercise (using the Rating of Perceived Exertion (RPE) [33], the frequency (number of days per week) and duration (hours or minutes per daily session) of physical exercise at the gym and the general motivation to perform physical activity and exercise.

Additional questions included motivation for the choice of the specific gym, the usual time of attendance at the fitness centre and comfort perception.

The gym characteristics, such as the paths to access the activity area, the reservation system, the disclosures about correct behaviours and preventive measures, the availability of products to sanitize hands, and the equipment and machines available, were also investigated by the means of several questions.

Composite Score Perceived quality of the gym (hygiene, adequacy and safety)

To assess the perceived quality of the gym (hygiene, adequacy and safety), a new variable was created. The new variable 鈥減erceived quality of the gym鈥�, was a composite score made up of twelve variables (questions) that address the perception of hygiene, adequacy and safety of different areas of the gym: level of cleanliness of activity areas, restrooms, changing rooms, showers, equipment; safety of the areas; adequate dimensions of the activity areas; adequacy of materials used in the building of the activity areas; compliance with hygiene and safety measures including COVID-19 safety requirements; compliance with hygiene standards in changing rooms and workplaces (sanitisation, daily cleaning); and general perception of the safety in the gym.

The composite score was created according to Song et al. 2013 by computing Z scores for each item, summing them, and then computing a T score with a range from 0 to 100, with higher scores indicating greater perceived quality [34]. After creating the T score, five categories of perceived quality were created: 0鈥�19.99: Very poor; 20鈥�39.99: Poor; 40鈥�59.99: Acceptable; 60鈥�79.99: Good; and 80鈥�100: Very good.

Composite score Likelihood of adoption of health-preventive measures and behaviour

Another composite variable was created to measure the likelihood of adoption of health-preventive measures and assess the behaviour of the customers at the gym, made up of 8 questions/variables: the use of sandals in the shower; the habit of wearing gloves when using equipment or machines; the habit of changing shoes when accessing the activity areas; the use of personal towels; the use of hand sanitising products before and after each activity; the respect of minimum safety distance; and the habit of cleaning the equipment and machines after use. As per the previous composite variable, the Z score and T score were calculated, and five categories of likelihood of adoption of health-preventive measures were created: 0鈥�19.99: Very unlikely; 20鈥�39.99: unlikely; 40鈥�59.99: neutral; 60鈥�79.99: likely; and 80鈥�100: Very likely.

Statistical analysis

Descriptive statistics were calculated to describe the sample鈥檚 sociodemographic and behavioural characteristics and the gyms鈥� perceived quality. Each association was assessed by means of bivariate analysis, and two logistic regression models were performed.

To investigate the factors influencing health-preventive behaviours and perceptions of hygiene and safety, we used two separate logistic regression models. For the analysis, we transformed the five-category responses into binary variables. In the first model, for the dependent variable, the likelihood of adopting health-preventive behaviours, responses were categorized as yes (including'likely'and'very likely') or no (all other responses). Similarly, in the second model, for the perception of hygiene and safety in the gym, responses were classified as satisfactory (including satisfactory and very satisfactory) or non-satisfactory (all other responses). This binary classification allowed for a focused analysis using logistic regression. The independent variables included sociodemographic factors such as age, gender, education, and occupation, as well as exercise-related behaviours including frequency, intensity, and type of physical activity.

The decision to use two separate models was guided by the conceptual distinction between the two outcomes which ensured that each dependent variable was analysed independently. This approach helped reduce the risk of overlapping predictor variables influencing both outcomes within a single model, allowing for a more precise interpretation of the results. Furthermore, we carefully reviewed the relationships between the selected variables to avoid potential issues related to overlapping explanatory power, ensuring that each model provided clear and interpretable results.

For the first logistic regression model, ORs with 95% confidence intervals of perceived quality of the gym (hygiene, adequacy and safety) were calculated and adjusted for age groups, education, PA duration, time of the day for exercise, and perception of exertion (RPE).

For the second logistic regression model, ORs with 95% confidence intervals of likelihood of adoption of health-preventive measures/behaviours were calculated adjusted for gender, time of the day for exercise, and perception of exertion (RPE).

Statistical analyses were performed using the EpiInfo 7.2 statistical package, and the level of statistical significance was set at p鈥�< 0.05.

Results

Sociodemographic characteristics and physical activity patterns of the sample

Table 1 shows the sociodemographic characteristics of the sample used in the study. The table provides information on the distribution of participants based on sex, age, marital status, educational level, and occupation.

Table 1 Sociodemographic characteristics of the sample

The sample comprises 1321 individuals well distributed by gender (females 48.2% vs males 50.9%). The age distribution shows that most participants fell into the 18鈥�25 age range (59.9). In terms of marital status, the majority of participants were not married, including 894 individuals (70.7%). Data on the education level indicate that the largest group were students with a high school education (45%).

Table 2 shows the characteristics related to the physical activity (PA) and exercise of the sample.

Table 2 Physical activity (PA) and exercise characteristics of the sample

In terms of general levels of PA, measured by the scoring of the IPAQ questions, the table shows that 18.4% of the sample engaged in light PA, 50.3% in moderate PA, and 31.3% in intense PA.

The primary type of exercise practised by our sample in the gyms taken into consideration was machine-based exercise (weight lifting, treadmill, stationary bikes, etc.) (39.21%), followed by body weight training (17%), functional training (10.79%), yoga, Pilates (5.67%), CrossFit (5.36%), personal training (4.58%), high intensity interval training (HIIT) (4.50%) and music workouts such as aerobic, Zumba, etc. (3.65%) (data not shown).

When considering the frequency of exercise in the gym, the majority of participants (62.4%) reported practising PA 3鈥�5 times a week, followed by 27.1% who practised it 2 times a week. Smaller proportions reported practising it every day (4.3%). Data showed that those who practised 3鈥�5 times a week were mostly men (70.1% vs 54.1%) and younger people (鈮� 25) (data not shown).

Concerning the time spent exercising in the gym, the table shows that 75.4% of participants engaged for 1鈥�2 h between 5 and 9 pm.

The perceived exertion level (RPE) of the exercises was calculated to indicate the intensity of the activity performed in the gym. The table shows the distribution of participants across different levels, with 33.9% reporting high exertion and 20.3% reporting very high exertion. Men experience maximal and high levels of exertion with higher percentages than women (70.4% vs 29.6%) (data not shown).

The main motivation to practise exercise and PA reported by the sample was to improve physical appearance (41.8%; women 59% vs men 43.2%; p鈥�= 0.008) (older women 61% vs younger women 31.3%; p鈥�= 0.004). This motivation was followed by improving health (33.5%; women 64% vs men 39.4%; p鈥�= 0.039), enjoyment (3.8%) and social reasons (2.6%) (women 51.2% vs men 26.7%; p鈥�= 0.005) (data not shown).

Participants were also asked the main reason for choosing that specific gym, and the answers were the proximity (21,8%; employed 43.4%; p鈥�= 0.028), good reviews from family and friends (20.5%, 54.2% youngest; p鈥�= 0.025), quality of the gym (15.1%), quality of the instructors (14.7%) and price (4.0%; unemployed 67.2%, students 52.3%; p鈥�= 0.002). Furthermore, transportation to the gym was considered, with the majority of participants (75.0%) reporting using a car/motorbike. Biking or skateboarding was chosen by a small percentage of people (5%), mostly young men (men 61.2% vs women 37.3%; p鈥�= 0.015) (older 25.8% vs younger 74.2%; p鈥�= 0.042) (data not shown).

Characteristics of the gyms and Health-Preventive Behaviours adopted

The characteristics of the gyms based on the responses of the participants were also recorded. The participants reported that for the majority of the gyms, access to the activity areas was not direct and exclusive via dressing/changing rooms (78%). Most of the gyms provide tools to sanitize equipment before and after use (74.4%) and hand sanitizers (73.7%). The sample reported that other customers disinfect the equipment but mostly only after use (10.8%) (data not shown).

The use of a mask and personal towels is recommended in most of the facilities (62.3%), and the facility staffs inform customers about correct behaviours and preventive measures to adopt in the gym (75.6%) (data not shown). The use of showers in the gyms taken into consideration was possible, but only 28.5% of the users take showers in the gym (30.2% women vs 69.5% men; p鈥�= 0.004) (young adults 74.4% vs 26.6% older adults; p鈥�= 0.04).

Even if, at the time of the survey, it was no longer required by COVID-19 preventive measures and laws in force, some of the fitness centres still used a reservation system (28.8%), and 44.5% of the gym-goers would keep the reservation system active (data not shown).

Perception of Hygiene and Safety in Gyms

Table 3 shows the perceived quality of the gym based on different factors, such as hygiene, adequacy, and safety. Based on the data presented, it can be observed that the majority of respondents rated the gym positively, with 34.49% considering it"Good"and 39.23% rating it"Very good."Only a small percentage of respondents rated the gym"Very poor"or"Poor"in terms of quality. When comparing responses based on gender, it appears that females have slightly lower ratings compared to males. The percentage of females rating the gym as"Good"or"Very good"is lower than that of males.

Table 3 Perceived quality of the gym (hygiene. adequacy and safety)

Respondents in the age groups of 18鈥�25 and 56鈥�75 generally gave higher ratings, with the majority describing the gym to be of"Good"or"Very good"quality.

Respondents with higher levels of education, such as university graduates and those with a PhD or similar qualifications, tended to rate the gym slightly lower compared to respondents with lower educational levels.

There are noticeable differences in ratings based on occupation. Students tended to rate the gym more positively, while managers and self-employed individuals gave lower ratings.

The table also includes information related to physical activity. It seems that individuals who are more active (moderate and vigorous PA) give higher ratings on the quality of the gym (62.5% and 60.7%), like the individuals who go to the gym more often (Fig.听1), for more hours (50.5%; p鈥�= 0.0071) and those who perceive higher levels of exertion. Finally, the higher the general comfort level perception was, the higher the quality perception of the gym (60%; p鈥�= 0.007).

Fig. 1

Box plot for T-score perceived quality and frequency of exercise by gender

Figure听1 represents a box plot that includes the T score for perceived quality, the frequency of exercise and gender. The figure shows that as the frequency increases, the perception of quality increases for both males and females.

Likelihood of adoption of health-preventive measures and behaviour

Table 4 presents data on the likelihood of adoption of health-preventive measures/behaviours, as well as various demographic and PA factors.

Table 4 Likelihood of adoption of health-preventive measures and behaviour

The results suggest that a significant portion of the respondents showed a likelihood of adopting health-preventive measures/behaviours. Approximately 41.3% of respondents fell into the"likely"category, with an additional 23.3% falling into the"very likely"category. This indicates a positive inclination towards engaging in health-promoting behaviours.

When analysing data by gender, it is interesting to observe that males generally expressed a slightly higher likelihood of adopting health-preventive measures compared to females (p =鈥�0.0003).

The results also highlight some variations in the likelihood of adopting health-preventive measures across the different age groups. Younger individuals (18鈥�25 and 26鈥�30) and individuals in their 50 s (51鈥�55) tended to show higher levels of likelihood, while those in their 40 s (36鈥�40 and 41鈥�45) showed slightly lower levels. With reference to education, no significant differences were observed among the different categories, even though respondents with higher levels of education, such as university graduates and those with a PhD or similar qualifications, usually demonstrated a greater likelihood of adopting health-preventive measures. With reference to occupation, individuals in managerial positions showed relatively lower levels of likelihood compared to other occupational groups. On the other hand, retired individuals appeared to have higher levels of likelihood.

When analysing physical activity-related factors, respondents who reported engaging in vigorous physical activity showed a higher likelihood of adopting health-preventive measures (p鈥�= 0.001). Moreover, those who engaged in physical activity for longer durations and preferred to exercise between 17鈥�21 pm showed slightly higher levels of likelihood (p鈥�= 0.04 and p鈥�= 0.028).

Lastly, the perceived quality of the gym also significantly influenced individuals'likelihood of adopting health-preventive measures. Respondents who rated the gym as"very good"had higher levels of likelihood compared to those who rated it as"very poor"(p鈥�= 0.001). This indicates that the quality of the gym environment, including factors such as hygiene, adequacy, and safety, can influence individual鈥檚 motivation to engage in health-preventive behaviours.

The association is also shown in Fig.听2 with a box plot generated by the analysis of the variable likelihood of adopting health-preventive measures and perceived quality of the gym by gender.

Fig. 2

Box plot for T-score likelihood of adopting healthy behaviours and perceived quality of the gym by gender

Logistic regression analysis: factors influencing perceptions of hygiene and safety

The multivariate logistic regression analysis revealed several significant factors associated with the perception of hygiene and safety in gyms. Table 5 presents the results of a multivariate logistic regression analysis taking into consideration the association between perceived quality of the gym (hygiene, adequacy, and safety) and independent variables such as age, education, duration of exercise, time of the day to go to the gym, RPE, selected based on their statistical significance in the bivariate analysis, ensuring that only the most relevant predictors were included in the final models.

Table 5 Odds Ratio (ORs) with 95% confidence interval of Perceived quality of the gym (hygiene. adequacy and safety).听from multivariate logistic regression models, adjusted for age groups, education, exercise duration, time of the day for exercise, and Rate of Perceived Exertion (RPE)

The table shows that participants in the age group of 18鈥�35 have 2.1 times higher odds of perceiving the gym quality positively compared to those in the age group of 36鈥�75 (reference category).

Participants with primary school education have 3.8 times higher odds, those with a high school education have 1.6 times higher odds, and those with a university education have 1.3 times higher odds of expressing a positive perception of the gym quality compared to the reference category.

Participants who exercise for more than 2 h in a row have 4.0 times higher odds of expressing a positive perception of the gym quality compared to those who engage for less than 2 h (reference category). Moreover, participants who exercise between 17鈥�21 (2.8 times) and who perceive their exertion level as maximal (2.2 times) have the highest odds of expressing a positive perception of the gym quality.

Logistic regression analysis: factors influencing health-preventive behaviours

The second logistic regression model identified several independent factors associated with the likelihood of adopting health-preventive behaviours.

Table 6听presents the results of a multivariate logistic regression analysis of the association between the likelihood of adopting health-preventive measures/behaviour and several independent variables chosen based on their statistical significance in the bivariate analysis, gender, time of the day to go to the gym and RPE.

Table 6 Odds Ratio (ORs) with 95% confidence interval of Likelihood of adoption of health-preventive measures/behaviourfrom multivariate logistic regression models, adjusted for gender, time of the day for exercise, Rate of Perceived Exertion (RPE)

The table shows that females have 0.5 times lower odds of adopting health-preventive measures/behaviour compared to males.

Participants who exercise between 5 and 9 pm have the highest odds (2.7 times) of adopting health-preventive measures/behaviour compared to those who exercise before 1 pm (reference category). Finally, participants with a perceived exertion level of 鈥渕aximal exertion鈥� have the highest odds (4.0 times) of adopting health-preventive measures/behaviour compared to those a perceived exertion level of 鈥渕oderate exertion鈥� (reference category).

Discussion

This study explored the characteristics, perceptions, and behaviours of Italian gym-goers following the lifting of COVID-19 restrictions, focusing on two key aspects: the perception of gym hygiene and safety, and the likelihood of adopting health-preventive behaviours. The findings reveal that younger gym-goers, those with higher education, and individuals who engage in longer or more intense exercise sessions tend to rate gym quality more positively. These findings may reflect the heightened health awareness and safety expectations of these demographic groups, particularly following the COVID-19 pandemic. Younger gym-goers and educated individuals may have a better understanding of the importance of hygiene in public spaces, which could shape their perceptions of facility quality. Similarly, those who invest more time and effort in their fitness routines may pay closer attention to the gym environment to ensure their safety and comfort during extended exercise sessions.

In our study, the likelihood of adopting health-preventive behaviours was significantly higher among males, individuals exercising during peak hours, and those reporting higher perceived exertion levels. One possible explanation for this trend is that males and highly active gym users may view health-preventive behaviours as integral to maximizing their performance and maintaining their well-being. The association with peak exercise hours suggests that busier gym environments might heighten users'awareness of hygiene practices due to increased interpersonal contact. These findings align with previous research emphasising the role of sociodemographic factors in shaping health behaviours. However, unlike other studies who focused primarily on the business implications of gym quality perceptions, our study highlights the health-related dimensions of these behaviours, particularly in the unique context of the post-pandemic period. This distinction underscores the importance of designing gym policies and practices that cater to diverse user needs while prioritizing hygiene and safety.

Our survey found that gyms attract both males and females, with a slight difference in favour of men. In general, national and European statistics show that men are more likely than women to exercise or play sports with some regularity [8]. In recent years, there has been a shift towards more inclusivity, and gyms have seen an increase in female participation. While there still may be variations depending on the specific centre and location, we found that the gender distribution is generally balanced. The data collected are also in line with the latest analysis carried out by ISTAT, the Italian National Institute of Statistics, which however shows that the gender gap is decreasing as between 2000 and 2021 the difference between men and women has shrunk by almost 30% [35]. The expansion and diversification of activities and services offered and the establishment of female-focused gyms exemplify how the fitness industry has been undergoing changes to meet the demands and the needs of women who utilise or seek out gym services [36, 37].

If gym-goers span a wide range of age groups, the present research showed that young adults in their 20 s and 30 s are the most frequent visitors, as they tend to prioritise their fitness and overall well-being, have more time and may have specific goals related to weight management, muscle building, or improved athletic performance [38]. With reference to the frequency of PA, most individuals in the sample fall into the category of moderate physical activity, with their perception of exertion being connected to frequency, and type and intensity of exercises as confirmed in previous studies [33, 39]. The most practised activities reported were in line with those identified by the ACSM Worldwide Surveys of Fitness Trends as potential fitness trends in 2023: strength training with free weights, body weight training and functional fitness training ranked 2nd, 3rd and 5鈥塼h respectively, in the list of potential fitness trends [40].

One of the main goals aimed at by a significant part of the sample was enhancing their physical appearance and overall health and well-being. Other motivations for engaging in sports or PA include enhancing fitness, controlling weight, and enjoyment. With regard to the motivation to improve performance, men showed higher percentages than women, while no significant gender differences were found in other motivations. These findings align with the data from the European Union countries participating in the Eurobarometer survey [8]. Among respondents aged 15鈥�24, the desire to have fun, improve physical performance, socialise, and enhance physical appearance seem to be the main motivation. Conversely, individuals aged 55 and above are more inclined towards pursuing physical activities to improve their health and counteract the impacts of ageing.

In terms of design, implementation, rules and management of the fitness facilities investigated, most participants in the sample reported that they found adequate the size of activity rooms, the information on correct hygiene behaviours and the availability of sanitising and cleaning products, but some construction aspects useful to promote functionality and hygiene, such as a direct access to the activity areas from changing rooms, are not respected. According to Gola et al. (2019) [22], gyms and indoor fitness centres lack well-defined and comprehensive national legislation regulating their construction and management, which is a significant drawback. Despite the efforts by some Italian regions to address the regulatory gap, there is still a lack of a primary reference point, while establishing a clear and up-to-date regulatory framework is crucial to safeguard public health, in particular in indoor environments.

The second aim of the research was to evaluate the customers鈥� perception of hygiene, cleanliness and safety standards in the different areas of the gyms, trying to understand whether there is any difference in behaviours and perceptions according to several individual variables (sociodemographic, education, PA, etc.). Several authors previously highlighted the existing relationship between service quality, perceived value, satisfaction, and loyalty in sports centres [41,42,43,44,45]. In a previous study on service quality perception in sport centre users in England, the physical environment, in particular the equipment, was considered the most important element of quality by regular customers [46].

Gyms play a significant role in encouraging and advocating for a healthy lifestyle through physical exercise and workouts and faced numerous challenges during the COVID-19 pandemic, including lockdowns, with owners and managers compelled to devise strategies to persuade customers to continue using their services despite the pandemic's impact. Data collected in March 2021 in the Philippines from Ong et al. (2021) [47] showed that the second highest attribute of quality indicated by gym users, after price, was ventilation, together with the size of the gym, thus showing how customers had become more sensitive to health-related aspects during the pandemic [47].

In the analysis of the variables influencing these perceptions, our research showed that customers鈥� sociodemographic characteristics significantly influence the value attributed to the different services and characteristics of the gym. In our study, younger users (18鈥�35) seemed to rate the gym more positively than older users, consistently with the results of Calabuig et al. (2008) [48] but in contrast with several other studies reporting the tendency of older customers to rate the quality of the gym more positively than younger customers, with lower dropout probabilities [49,50,51,52]. In the perception of gym quality, gender does not seem to be statistically significant in our study. The rating score is high for both genders, with a slightly lower rating score for women than males, in line with the results by Tsitskari and Tsitskari [53]. However, this is in contrast with other studies where women tend to rate the experience and quality of sports services more positively than men [54], therefore having more positive intentions for future behaviour and higher retention rates [55]. Nonetheless, single dimensions should also be considered as pointed out by Lee et al. (2011) [43]. Men, for example, tend to rate more positively tangible dimensions such as the physical environment, while women tend to give higher ratings to dimensions such as human resource empathy and show greater loyalty than men when they perceive a high service quality [43, 44].

Furthermore, our research showed that gym-goers who go to the gym frequently and practice activities perceiving high exertion tend to evaluate the quality of the gym more positively than their counterparts, thus confirming previous studies where retention and loyalty in fitness centres is associated with the frequent use of the gym [56]. Perception of quality showed to be also influenced by the level of education and occupation. This variation could be due to differences in preferences, expectations, or experiences and stricter evaluation criteria. Lower education levels were associated with a higher perception of quality in our sample. This finding suggests that education could be a contributing factor in promoting health-conscious behaviours. Health and education are closely correlated, and several studies investigated the influence of education on health and demonstrated a relationship between higher education and better health conditions [57,58,59], with a direct proportion between them and also associated with greater health awareness and consciousness. Individuals with higher education might prioritise health and fitness more, leading them to evaluate gyms based on the quality of services and facilities offered [60]. Moreover, those with higher education levels might have more exposure to a range of fitness facilities, potentially leading to more refined expectations in terms of cleanliness, equipment variety, amenities, and overall atmosphere.

As the behaviour of people during the COVID-19 pandemic changed, health became a priority. Exercising in a gym, pool, or fitness centre, while sharing space with others who may be contagious, can affect an individual's self-regulatory efficacy, anxiety, or fear of contagion, reinforced by physical nearness [61], as well as influence the perception of risk, the value attributed to social responsibility and the adoption of health-related behaviours [20, 62,63,64,65]. Therefore, the focus of our study was also on investigating and discussing the different and interrelated variables that influence the likelihood of adopting health-preventive measures and behaviours in gyms. Psychosocial factors, including individual attitudes, perceptions of susceptibility to health risks, and perceived benefits of preventive actions, play a pivotal role in shaping individuals'willingness to embrace health-conscious behaviours in gyms. Additionally, sociodemographic characteristics such as age, gender, education level, and socioeconomic status can significantly affect the likelihood of adopting preventive measures. The research carried out showed that males tend to adopt health-preventive measures/behaviours more often than female users. The result is surprising since several studies reported that females tend to present a higher perceived risk level of the COVID-19 pandemic than males and that female gender was positively associated with health protective behaviours [66, 67].

The frequency of attendance per week is also associated with the adoption of healthy behaviours in the gym. In our research, a higher frequency was positively associated with a reduction in unhealthy behaviours. These results are in line with those by Gall猫 et al. (2016) [68], which considered a sample of swimming pool users and reported that the probability of having some unhygienic habits increases with age and is higher among males, while it decreases with the level of parents鈥� education.

Another variable taken into consideration are the characteristics of the exercises: participants who exercise during peak hours and who perceive their exertion level as maximal seem to have the highest odds of adopting health-preventive measures/behaviours compared to their counterparts. The perceived norms within the gym community also contribute to the decision-making process. Environmental factors such as the accessibility of restrooms, availability of sanitising resources, and the overall cleanliness of the gym environment can either facilitate or hinder the adoption of health-preventive measures. The present research found out that the higher the perception of the quality of the gym, the greater the likelihood of adopting health-preventive measures and behaviours in gyms, thus suggesting that people are more likely to engage in health-preventive measures and behaviours when they have a positive attitude toward the environment in which those behaviours are performed. A gym with a higher perception of quality might therefore provide a more pleasant and motivating environment, leading individuals to experience positive emotions and attitudes towards exercise, which are proved to be associated with greater adherence to health-related behaviours [69]. Social norms and peer influence also play a significant role as people tend to align their behaviours with those around them, and being in a gym with a strong health-focused culture can encourage individuals to conform to healthy behaviours [70, 71].

As suggested by the Broken Window Theory [72], the perceived cleanliness and maintenance of an environment influence individuals鈥� behaviours and adherence to hygiene norms. This concept has been widely applied beyond criminology, its original context, including in public health research, where environmental conditions have been linked to behaviours that impact health and well-being. According to this theory, visible signs of disorder signal a lack of monitoring and social control, which can lead to further neglect of both personal and shared hygiene standards. Conversely, a dirty or neglected environment may lead to neglect personal hygiene norms and disregard common rules [73,74,75,76].

Limitations, future studies and strengths of the study

The study is subject to several limitations that should be considered when interpreting its findings. First, the reliance on self-reported data may result in recall bias and inaccuracies in participants'responses, potential subjective interpretations and memory lapses, despite the efforts to ensure accuracy. Specifically, the use of the IPAQ questionnaire, while widely recognized and validated, presents challenges in terms of reliability and manageability and can be prone to overestimation or underestimation of physical activity levels due to its reliance on participants'recall and subjective interpretation of activity intensity and duration. Furthermore, the study's cross-sectional design, capturing data from a specific point in time, restricts the establishment of causal relationships and the tracking of changes over time. The fact that data collection occurred immediately after a peak period and upon gym reopening following pandemic-related closures could have influenced participants'quality perceptions. The perceptions of quality collected at those specific time points might have been influenced by the safety measures and conditions in force in the period preceding the data collection. Future studies should consider collecting data over time to observe potential changes, and a longitudinal approach would be more effective in revealing trends and developments. Another limitation of this study could be the lack of a formal statistical power analysis or a priori sample size calculation and the convenience sampling in the recruitment process. While the final sample of 1321 participants was considered sufficient to provide meaningful descriptive insights, the absence of a predefined sample size calculation may limit the ability to generalize the findings to the broader population of gym-goers. Furthermore, an age-related bias could exist, since the majority of participants were students, probably because they were asked to participate in the study by individuals of their age.

Moreover, the study does not explore the potential impact of structural gym characteristics on participants'perceptions of quality. Factors such as gym layout, ventilation systems, and crowd management could influence these perceptions. Investigating these aspects could provide a more holistic understanding of quality perceptions. Lastly, the predominant engagement among participants in weightlifting and machine-based activities raises questions about exercise preferences and accessibility. The possibility that these activities were more easily approachable to participants because they were not restricted by specific class time frames might have influenced the observed exercise trends. Further exploration is therefore needed to understand these preferences.

Despite the abovementioned limitations, the present study has several notable strengths that underscore its significance. First, the inclusion of a substantial sample size confirms the robustness of the findings, providing comprehensive insight into the subject matter. Furthermore, the study addresses a relatively unexplored area, especially post-COVID, thereby filling a gap in the existing research landscape. While prior research, like the one by Ong et al. (2021) [46], primarily adopted a business-centric perspective, the present study is unique in its dedicated focus on evaluating perceptions of quality, hygiene, cleanliness, and safety in fitness centres following the peak of the COVID-19 pandemic, and focusing on the importance of improving quality for the betterment of health.

Conclusions and practical implications

In conclusion, this scientific study offers valuable insights into the behaviours, motivations, and characteristics of individuals engaged in gym activities, as well as their inclination towards health-preventive measures. The diverse sample of 1321 participants revealed a balanced gender distribution, with the majority falling within the 18鈥�25 age range, not being married, and with high school education, often as students. Exercise patterns indicated a preference for moderate physical activity, with machine-based exercises being the most popular choice. Participants usually went to the gym 3鈥�5 times a week for 1鈥�2 h in the evening, in particular with reference to young adults and males. Motivations for exercise varied, with improving physical appearance and health as primary drivers, influenced by gender and age disparities. Factors influencing gym selection included proximity, positive reviews, and affordability, with distinctions based on employment status and age. Transportation to the gym predominantly involved personal vehicles, while gym facilities more in general offered standard hygiene measures, albeit with underutilized shower facilities.

The overall perception of gym quality was positive, with minor variations connected to gender, age, education, and occupation. Furthermore, more active individuals and those perceiving higher exertion levels tended to rate gym quality more favourably. With regard to health-preventive measures, a substantial portion of participants displayed a propensity to adopt them, with males exhibiting a slightly higher inclination. Age, education, occupation, physical activity levels, and gym quality perception were identified as influential factors. Logistic regression analyses uncovered specific associations, highlighting the impact of age, education, exercise duration, timing, and perceived exertion on gym quality perception as influencing factors. In addition to this, gender, exercise timing, and perceived exertion influenced the likelihood of adopting health-preventive measures, emphasising the role of these factors in health-promoting behaviours.

These findings provide a comprehensive understanding of gym-goers鈥� characteristics, motivations, and behaviours, with implications for gym management strategies and public health initiatives targeting physical activity promotion and health awareness in different populations. This study highlights how gym users鈥� perceptions of the quality of the gym are related to the user鈥檚 engagement in preventive health behaviours. This finding extends the role of gyms not merely as spaces for exercising but also as spaces for promoting health behaviours and reducing health risks. Improvements in hygiene, safety, and design can have the potential to enhance compliance to preventive measures, thereby contributing to the broader goal of public health promotion. In terms of prevention, gyms can serve as pivotal sites for reinforcing healthy habits and mitigating risks associated with sedentary lifestyles and infectious diseases. In order to create safer and healthier communities, this research provides a basis for incorporating preventive health strategies into fitness industry practices and coordinating them with public health goals.

The study's findings hold valuable practical implications for fitness centre managers and operators. As a primary goal of the industry is cultivating customer loyalty, understanding the viewpoints of gym-goers emerges as pivotal in adeptly catering to their requirements, objectives, and anticipations. If such an understanding is crucial to build loyalty, it gains even greater importance, as these preferences may correspond to customers'age and demographic characteristics. From a pragmatic standpoint, the outcomes of this research aid in formulating effective management strategies and preventive measures, offering actionable insights to promote overall customer satisfaction and well-being and foster loyalty within the fitness centre environment.