Physical inactivity is a major health risk factor in our society. Women and minority populations are especially at risk with regard to physical inactivity. This investigation was part of a larger study of physical activity patterns of African American women. In the first phase, a quantitative approach was used to investigate relationships between Self-Determination (SDT) and the Stage of Change for physical activity in a sample of 105 African American women, ages 45-70. Consistent with previous work, women who exercised were more self-determined than those who were inactive. Guided by the underlying assumption that African American women’s choices to be active or inactive can only be fully understood by carefully examining their perspectives, the purpose of this phase was to use a qualitative approach explore the reasons African American women choose to participate or not to participate in physical activity. Fifteen physically active and fifteen physically inactive women were purposively selected from the initial sample for in depth interviews. The interview questions were generated around issues specifically related to the constructs from SDT, focusing on autonomy, competence and relatedness with regard to physical activity and health behaviors. Although the open-ended interview questions were generated from underlying assumptions of SDT, ultimately the personal voices of these women allowed the meanings, experiences and understandings of African American women’s activity patterns to emerge. The core theme evident in the categorical and contextual analyses revolved around the powerful influence of participants’ perceptions of the relationship between health status and physical activity. It is important to note that an analysis of their health histories revealed the two groups of women faced similar issues with regard to their health status. For the active women, physical activity was perceived as a means of improving, regaining, or maintaining health, while for inactive women health was seen as a limiting factor in their ability to be active. Perceptions of life experiences and life circumstances were important sub themes that demonstrated and differences in how women conceptualized the relationship between health status and physical activity. The findings of this study support the use of SDT as a framework to investigate African American women’s choices about physical activity and provide insight into issues related to how women’s experiences influence their activity patterns. Further research is needed to increase our understanding of lifestyle choices and behaviors in an effort to provide effective health promotion interventions related to increasing physical activity levels.