Gender-specific changes in physical activity pattern in Iran: national surveillance of risk factors of non-communicable diseases (2007–2011)

Knowledge of gendered needs among the planners and policy makers for prevention of NCDs in Bangladesh: a qualitative exploration

BACKGROUND

Globally, non-communicable diseases (NCDs) are increasingly the primary cause of mortality and morbidity among women. Like many developing countries, Bangladesh also faces a growing burden of NCDs. The "Multisectoral Action Plan for Prevention and Control of Non-communicable Diseases, 2018-2025" signifies Bangladesh's commitment to comprehensively combating the rising burden of NCDs. This study investigates the perceptions of those involved in developing the action plan and if/how a gender lens was incorporated into its implementation.

METHODS

In-depth interviews were conducted with 25 key individuals involved in a high-level committee to develop and implement Bangladesh's multisectoral action plan to address the burden of NCDs. Data were collected between July and November 2021, and thematic analysis was conducted.

RESULTS

The findings revealed that interviewees believed the multisectoral action plan adopted a population-wide approach without considering gender-specific needs. This study presents the explanations for this inattention under five themes: (1) A population-level approach to NCD prevention; (2) Understanding women's health beyond reproductive health; (3) Absence of gender-specific programs; (4) Lack of consideration of gender constraints on physical activity; and (5) Lack of collaborative efforts to address NCDs beyond the health ministry.

CONCLUSION

In conclusion, governments in countries like Bangladesh can develop more effective strategies to reduce the disease burden of NCDs among women by recognizing and addressing the gendered nature of preventive health. This can be achieved by promoting gender-responsive research, programs, and policy initiatives that consider women's specific health concerns, ultimately leading to better health outcomes for all.

Investigating the role of the built environment, socio-economic status, and lifestyle factors in the prevalence of chronic diseases in Mashhad: PLS-SEM model

Background

Chronic diseases remain a significant contributor to both mortality and disability in our modern world. Physical inactivity and an unhealthy diet are recognized as significant behavioral risk factors for chronic diseases, which can be influenced by the built environment and socio-economic status (SES). This study aims to investigate the relationship between the built environment, SES, and lifestyle factors with chronic diseases.

Methods

The current study was conducted in Mashhad's Persian cohort, which included employees from Mashhad University of Medical Sciences (MUMS). In the study, 5,357 participants from the cohort were included. To assess the state of the built environment in Mashhad, a Geographic Information System (GIS) map was created for the city and participants in the Persian Mashhad study. Food intake and physical exercise were used to assess lifestyle. A food frequency questionnaire (FFQ) was used to assess food intake. To assess food intake, the diet quality index was computed. To assess the link between variables, the structural model was created in accordance with the study's objectives, and partial least square structural equation modeling (PLS-SEM) was utilized.

Results

The chronic diseases were positively associated with male sex (p < 0.001), married (p < 0.001), and higher age (p < 0.001). The chronic diseases were negatively associated with larger family size (p < 0.05), higher SES (p < 0.001), and higher diet quality index (DQI) (p < 0.001). No significant relationship was found between chronic disease and physical activity.

Conclusion

Food intake and socioeconomic status have a direct impact on the prevalence of chronic diseases. It seems that in order to reduce the prevalence of chronic diseases, increasing economic access, reducing the class gap and increasing literacy and awareness should be emphasized, and in the next step, emphasis should be placed on the built environment.

Breast cancer incidence trends in Golestan, Iran: An age-period-cohort analysis by ethnic region, 2004-2018

BACKGROUND

We aimed to examine the effects of age, diagnosis year (calendar period) and birth year (cohort) on the incidence trends of breast cancer among Golestan women, Northeast Iran, 2004-2018.

METHODS

Incidence data were obtained by residential status (urban/rural) and ethnic region (Turkmens/non-Turkmens). We calculated age-standardized incidence rates (ASRs) per 100,000 person-years. The estimated annual percentage change (EAPC) were calculated, and age-period-cohort (APC) models fitted to assess non-linear effects of period and cohort as incidence rate ratios (IRRs).

RESULTS

The total number of female breast cancer cases in Golestan, 2004-2018, were 3853, with an overall ASR of 31.3. We found higher rates in urban population (40.5) and non-Turkmens region (38.5) compared to rural area (20.8) and Turkmens region (20.2), respectively. There were increasing trends in incidence rates overall (EAPC= 4.4; 95%CI: 2.2, 6.7), with greater changes in rural areas (EAPC=5.1), particularly among non-Turkmens (EAPC=5.8). The results of the APC analysis indicate the presence of significant non-linear cohort effects with increasing IRRs across successive birth cohorts (IRR=0.1 and IRR= 2.6 for the oldest and the youngest birth cohorts vs. the reference birth cohort, respectively).

CONCLUSION

We found increasing trends in breast cancer incidence among Golestan women over the study period, with disparities in patterns and trends by residence area and ethnic region. The observed cohort effects suggest an increasing prevalence of key risk factors for breast cancer in this Iranian population. Further investigations are warranted to clarify the relationships between determinants such as reproductive factors and ethnicity in the region.

Assessment of Questionnaire of Physical Activity at Workplace Based on the Social Cognitive Theory (PAWPQ-SCT): A Psychometric Study in Iranian Gas Refinery Workers

Background

This study aimed to develop and assess the psychometric features of the Physical Activity at Workplace Questionnaire (PAWPQ) based on the Social Cognitive Theory (SCT) to evaluate employees' physical activity (PA) behaviors at the workplace.

Methods

This psychometric cross-sectional study was conducted on 455 employees working in one of the gas refineries in Iran. The participants were selected using the proportional stratified sampling method in 2019. The data collection tools were a demographic information questionnaire, the short form of the International Physical Activity Questionnaire (IPAQ), and a questionnaire developed based on the SCT, whose psychometric features were confirmed in terms of validity and reliability. Data were analyzed using SPSS22 and AMOS20 software.

Results

The first version of PAWPQ-SCT had 74 items. After evaluating content and face validity, nine items were removed. The results of the content validity index (0.98), content validity ratio (0.86), and impact score (3.62) were acceptable for the whole instrument. In exploratory factor analysis, after removing seven items-58-item final version of the scale-six factors could explain 73.54% of the total variance. The results of structural equation modeling showed the acceptable fit of the model into the data (RMSEA = 0.052, CFI = 0.917, NFI = 0.878, TLI = 0.905, IFI = 0.917, CMIN/DF = 2.818). Cronbach's alpha coefficient and Intraclass Correlation were 0.90 and 0.86, respectively.

Conclusion

This study confirmed that the psychometric features of the 58-item final version of PAWPQ-SCT constructs were acceptable in a sample of Iranian employees. This questionnaire can be used as a valid and reliable tool to evaluate Iranian employees' PA behaviors and develop effective educational interventions for workers and managers.

Design, implementation and evaluation of an intervention based on a social cognitive theory of physical activity and nutritional behaviors in middle-aged people at the risk of coronary artery disease in Bandar Abbas: A study protocol

BACKGROUND

Coronary artery disease (CAD) is the most common cardiovascular disease (CVD) and the main cause of mortality in developed and developing countries. Physical activity and nutritional behaviors are modifiable factors in people at the risk of CAD and its risk factors; thus, the present study aimed to design, implement, and evaluate an intervention based on the social cognitive theory for physical activity and nutritional behaviors in the middle-aged population at the risk of CAD residing in Bandar Abbas city.

MATERIALS AND METHODS

The present study will be conducted in three phases: qualitative, cross-sectional, and community-based intervention. The middle-aged population with less than 150 minutes of physical activity a week with at least one other risk factor of CAD (hyperlipidemia, hypertension, diabetes, overweight and obesity, smoking) will be included in the study. In the qualitative phase of study, the participants will be selected with maximum diversity and with the aim of obtaining comprehensive information to clarify the nature and dimensions of the phenomenon in question. The cross-sectional phase aimed to determine the intensity of physical activity and nutritional behaviors. By analyzing the data obtained from the cross-sectional phase, the most important constructs of the social-cognitive theory in physical activity and nutritional behaviors will be determined, and accordingly, an effective intervention will be designed. The third phase of the pre-test-post-test intervention study will include a randomized control group. The interventions will be a combination of face-to-face meetings and the use of educational technologies. Individuals in the control group will not undergo the educational intervention. Those in the intervention group will be evaluated in two phases (before the implementation of the intervention, and 3 months after the intervention).

CONCLUSION

The findings of the present study can be used as a strategic plan to help policy makers to strengthen CVD prevention and management alternatives to include physical activity and nutritional behavior as part of their preventive measures.

Colorectal cancer incidence trends in Golestan, Iran: An age-period-cohort analysis 2004-2018

BACKGROUND

We investigated the effects of factors including age, birth year (cohort) and diagnosis year (period) on colorectal cancer (CRC) incidence trends in Golestan, Northeast of Iran, 2004-2018.

METHODS

We obtained data on incidence cases of CRC from the Golestan Population-based Cancer Registry by sex and area of residence (urban/rural). Age-standardized incidence rates (ASRs) were calculated using the World standard population and presented per 100,000 person-years. We calculated the estimated annual percentage change (EAPC) with 95 % confidence intervals (95 % CI) fitted age-period-cohort (APC) models to assess non-linear period and cohort effects as incidence rate ratios (IRRs).

RESULTS

Overall, 2839 new cases of CRC (ASR = 13.7) were registered in the GPCR over 2004-2018. Our findings suggested significantly increasing trends in CRC incidence rates from 2004 to 2018 (EAPC = 3.7; 95%CI: 0.4, 7.1), with the greatest changes occurring in rural women (EAPC= 4.7; 95%CI: 0.4, 9.2). We observed a strong cohort effect with a consistent increase in the IRR across successive birth cohorts, starting with the oldest birth cohort (1924) (IRR= 0.1 versus the reference birth cohort of 1955) through to the most recent cohort born in 1983 (IRR= 1.9). The largest cohort effects were found among rural females (IRR = 0.0, and IRR = 2.5 for the oldest and the youngest birth cohorts vs. the reference birth cohort, respectively).

CONCLUSION

The increasing trends in CRC rates in Golestan are largely driven by generational changes in exposure to underlying risk factors. Further investigations are warranted to deliver effective prevention strategies for the control of CRC in Golestan.

Physical Inactivity, Inequalities, and Disparities Across Districts of Iran: A STEPs Survey-Based Analysis

BACKGROUND

We aimed to estimate the prevalence of physical inactivity in all districts of Iran and the disparities between subgroups defined by various measures.

METHODS

Small area estimation method was employed to estimate the prevalence of physical inactivity in districts based on the remaining districts in which data on the level of physical inactivity were available. Various comparisons on the estimations were done based on socioeconomic, sex, and geographical stratifications to determine the disparities of physical inactivity among districts of Iran.

RESULTS

All districts of Iran had a higher prevalence of physical inactivity compared with the world average. The estimated prevalence of physical inactivity among all men in all districts was 46.8% (95% uncertainty interval, 45.9%-47.7%). The highest and lowest estimated disparity ratio of physical inactivity were 1.95 and 1.14 in males, and 2.25 and 1.09 in females, respectively. Females significantly had a higher prevalence of 63.5% (62.7%-64.3%). Among both sexes, the poor population and urban residents significantly had higher prevalence of physical inactivity than rich population and rural residents, respectively.

CONCLUSIONS

The high prevalence of physical inactivity among Iranian adult population suggests the urgent need to adopt population-wide action plans and policies to handle this major public health problem and avert the probable burden.

Physical Activity, Burnout, and Engagement in Latin American Students of Higher Education During the COVID-19 Pandemic

The coronavirus-disease-2019 (COVID-19) pandemic has had a devastating physical and psychological impact on society, especially on students. In this study, we describe the levels of physical activity (Physical-Activity-Questionnaire-Short-Form (IPAQ-SF)), Burnout (School-Burnout-Inventory for students (SBI-U)) and engagement (Utrecht-Work-Engagement-Scale-9 items (UWES-9S)) in a cohort of Latin American higher education students during the COVID-19 pandemic in 2020. We also determined whether physical activity, Burnout, and engagement are related according to gender and area of study. Self-reported data from 571 Latin American students (64.79% women, 34.15% men; average age 25.24 ± 5.52 years) were collected via an online survey questionnaire. Spearman correlation analyses evaluated the associations between physical activity, Burnout, and engagement. Comparative analyses by gender and field of study were also performed. The results showed no correlation or association in the linear regression between the IPAQ-SF and SBI-U scores or between the IPAQ-SF and the UWES-9S scores. By gender, men had higher IPAQ-SF scores (p < 0.05) and reported higher intensity physical activity than women, but women had higher SBI-U scores (p < 0.05). No difference was found between men and women according to the UWES-9S scores (p = 0.28). There was also no difference in IPAQ-SF scores (p = 0.29) regarding the field of study. Our results suggest that women perform less physical activity than men, which is consistent with higher Burnout. However, physical activity was not associated with Burnout or engagement overall, which indicates that it was insufficient to prevent emotional stress in Latin American higher education students during a pandemic.

Three-year weight change and risk of all-cause, cardiovascular, and cancer mortality among Iranian adults: over a decade of follow-up in the Tehran Lipid and Glucose Study

Background

We investigated the impact of weight change on mortality in a population-based cohort setting.

Methods

We conducted two weight measurements for 5436 participants aged ≥ 30 years with an approximate 3-year interval. Based on their weight change, we categorized participants to: > 5% weight loss, 3–5% weight loss, stable weight (± < 3%), 3–5% weight gain, > 5% weight gain. We followed participants for mortality annually up to March 20th 2018. We applied the multivariable Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of weight change categories for all-cause, cardiovascular (CV), and cancer mortality, considering stable weight as reference. The Cox models was adjusted for age, sex, educational level, body mass index, smoking status, hypertension, hypercholesterolemia, diabetes, and cardiovascular disease (CVD) at baseline.

Results

During a median follow-up of 14.4 years, 629 deaths (247 CV and 126 cancer deaths) have occurred. Over 5% weight loss and gain were associated with increased risk of all-cause mortality in multivariable analysis with HRs of 1.47 [95% CI: 1.17–1.85] and 1.27 [1.02–1.57], respectively; however, a 3–5% loss or gain did not alter the risk of all-cause mortality significantly. These significant risks for wight change > 5% were not modified by the presence of diabetes, obesity, and smoking status; however, the unfavorable impact of weight change on mortality events was more prominent in those older than > 65 years (P-value for interaction: 0.042). After excluding those with history of CVD, diabetes, and cancer during the weight measurements period, these associations significantly attenuated (HR: 1.29 [0.89–1.87] for > 5% weight loss and 1.12 [0.84–1.50] for > 5% weight gain). Additionally, a > 5% weight loss was also associated with about 60% higher risk for CV mortality (HR: 1.62 [1.15–2.28]), and a 3–5% weight loss was associated with about 95% higher risk of cancer mortality (HR: 1.95 [1.13–3.38]).

Conclusions

Our findings showed a U-shaped association across weight change categories for all-cause mortality risk with over 5% weight gain and loss causing higher risk. Moreover, weight loss can have adverse impact on CV and cancer mortality events.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14126-4.

A pragmatic multi-setting lifestyle intervention to improve leisure-time physical activity from adolescence to young adulthood: the vital role of sex and intervention onset time

BACKGROUND

The long-term effectiveness of healthy lifestyle interventions on improving leisure-time physical activity (LTPA) in adolescents and its factors in low- and middle-income communities is unclear. This study is the first to investigate LTPA trends in a population of Iranian adolescents who underwent a multi-setting lifestyle intervention, considering sex and the time of intervention onset.

METHODS

Participants were 2374 adolescents (57.2% girls), aged 12-18 years, who participated in the Tehran Lipid and Glucose Study (TLGS) during 1999-2001 and followed for a median follow-up of 15.9 over five data points every 3 years. Adolescent participants were assigned to the intervention or control groups based on their residential areas. Boys and girls were categorized into 12-15 or 16-18 years old to minimize participants' bio-psychological differences, facilitate environmental interventions by more compliance with the Iranian educational system and identify the best time to start the intervention. All adolescents in the intervention area received healthy lifestyle interventions via the school-, family-, and community-based programs. LTPA was assessed using the reliable and validated Iranian Modifiable Activity Questionnaire (MAQ) version over the five data points. The Generalized Estimating Equations method was used to evaluate educational intervention's effect on LTPA in adolescents during the follow-up.

RESULTS

In boys who experienced the early onset of intervention (12-15 years), the interaction effect of follow-up examinations and the intervention was significant where the impact of the intervention differed over time. In this group, LTPA was higher in the control group than in the intervention group at the first follow-up examination (β = - 1088.54). However, an increasing trend of LTPA was observed in the intervention group until the third follow-up examination (β = 1278.21, p = 0.08, and β = 1962.81, p = 0.02, respectively), with borderline significance levels at the 2nd (P = 0.08) and the 4th (P = 0.08) measurements. The interaction terms and main effects of intervention and follow-up examinations were not significant in boys with late intervention onset. Although older boys in the intervention group had higher LTPA than the control group, there were no significant differences among study groups in all follow-up examinations. Regarding girls, LTPA did not differ significantly between intervention and control groups in all follow-up examinations (P > 0.05).

CONCLUSION

Our results showed that a multi-setting practical lifestyle intervention could improve long-term energy expenditure in LTPA in adolescent boys who have experienced an early onset intervention. Findings emphasized the vital role of gender and the onset of these interventions. The current results would be valuable to plan tailored interventions to improve LTPA and community health.

TRIAL REGISTRATION

This study is registered at Iran Registry for Clinical Trials (IRCT), a WHO primary registry ( http://irct.ir ). The TLGS clinical trial was the very first registration in the IRCT (Iran Registry of Clinical Trials). it was registered on 2008-10-29 by the registration number IRCT138705301058N1 . Based on the international committee of medical journal Editors (ICMJE), "retrospective registration" is acceptable for trials that began before July 1, 2005.

The Association of Ideal Cardiovascular Health Metrics and Incident Type 2 Diabetes Mellitus Among an urban population of Iran: a decade follow-up in Tehran Lipid and Glucose Study

AIMS

To evaluate the association between ideal cardiovascular health metrics (ICVHM) and incident type diabetes (T2DM) among Iranian men and women.

METHODS

The study population included 7,488 Iranian adults aged ≥20 years (4236 women) free from diabetes at baseline. The ICVHM was defined according to the 2020-American Heart Association. The multivariable Cox proportional hazards regression analysis was used to calculate the hazard ratios (HRs) for ICVHM both as continuous and categorical variables.

RESULTS

Over the median of 9.1 years of follow-up, we identified 922 new cases of T2DM (526 women). Body mass index <30 kg/m² , untreated systolic/diastolic blood pressure <120/80 mmHg in both genders, and physical activity ≥1500 MET mins/wk (only among men) were significantly associated with a lower risk of T2DM. Each additional unit in the ICVHM was associated with a 21% and 15% lower risk of T2DM in men and women, respectively (p-values<0.05). Compared with participants having poor cardiovascular health (CVH), the HR (95% confidence interval) for T2DM risk was 0.69 (0.56-0.85) and 0.35 (0.21-0.59) for men with intermediate and ideal CVHM, respectively. The corresponding values for women were 0.79 (0.65-0.97) and 0.30 (0.15-0.60), respectively. in a subpopulation with nutritional data (n=2236), ideal and intermediate nutritional status was associated with 83% and 77% lower risk of T2DM only among women (p-values<0.05).

CONCLUSION

We found a strong inverse association between having higher global ICVHM with incident T2DM; the issue is mainly attributable to normal blood pressure, normal body weight, and intensive physical activity (only for men).

Time-varying association between physical activity and risk of diabetes in the early and late adulthood: A longitudinal study in a West-Asian country

BACKGROUND

The time-varying association between physical activity (PA) and incidence of type 2 diabetes (T2DM) is still unclear. The present study aimed to investigate this association in the early- and late-adulthood during a 9-year follow-up.

METHODS

This study was conducted on 3905 participants in early and late adulthood, using the Tehran Lipid and Glucose Study (TLGS) dataset. PA was assessed via the Iranian version of Modified Activity Questionnaire (MAQ). The association between trend of PA and incident T2DM was investigated using time-varying Cox's proportional hazard model. Variables including job, education, smoking and body mass index (BMI) were adjusted in the final model.

RESULTS

The distribution of sex- and age-specific levels of PA changed significantly over time. Compared with physically inactive women, for older women with high level of PA, the risk of T2DM was 0.64 (95% CI: 0.43-0.95, P = 0.02) in adjusted model. Moreover, hazard for low PA group was significantly higher than the moderate group, and for these two groups were significantly higher than high PA level (P < 0.05).

CONCLUSION

High PA level can postpone the incident T2DM in early-aged and elderly women, over time. Therefore, gender and age are of great importance in designing the PA modifying programs to prevent T2DM.

Translation and validation of the Persian version of Godin Leisure-Time Exercise Questionnaire in patients with multiple sclerosis

Study Design

Psychometric study.

Objective

The purpose of this study is to translate, culturally adapt and evaluate the validity and reliability of the Persian (Farsi) version of GLTEQ in patients with multiple sclerosis.

Methods

This study had three phases, including translation of the questionnaire into Persian and making cultural adaptation, evaluation of pre-final version of questionnaire’s comprehensibility in a pilot study, and investigation of reliability and validity of the final version of the translated questionnaire. Content validity, and convergent validity (correlations among the Persian version of GLTEQ and Global physical activity questionnaire (GPAQ), and international physical activity questionnaire (IPAQ)) and after all test-retest reliability were studied.

Results

The subjects were 87 MS patients. The Persian version demonstrated moderate to good convergent validity; the correlation coefficient between the Persian version and GPAQ was r=0.64 (p<0.001), and between the Persian version and IPAQ was r=0.59 (p<0.001). The test-retest reliability was strong (Intra-class Correlation (ICC) value ranged between 0.908 and 0.992). Besides, its face validity and content validity were acceptable.

Conclusions

The Persian version of GLTEQ is a valid and reliable instrument to assess physical activity in patients with MS. This questionnaire can be a step toward standardization of physical activity measurement in patients with MS. Also, in research, it provides the possibilities to carry on a comparative study across cultures using the same outcome measure.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-021-02465-5.

A national and sub-national metaregression of the trend of insufficient physical activity among Iranian adults between 2001 and 2016

Insufficient physical activity (IPA) caused approximately 5% of mortalities in 2017 in Iran, almost double its global average. Despite the relatively considerable burden, a knowledge gap exists regarding the trend of IPA in recent years. We described the trend of IPA prevalence utilizing the data from six rounds of STEPwise approach to risk factor Surveillance (STEPS) in Iran. We estimated the physical activity status of Iranian adults from 2006 to 2016 after adjusting for years of schooling, urbanization percentage, and wealth index. We used the spatiotemporal model to interpolate and extrapolate the IPA prevalence for the years in-between the series and from 2001 to 2006, respectively. We used the data of 177,910 participants from six STEPS surveys and found that the national prevalence of IPA had steadily increased over the course of 16 years and had almost doubled in this time period (23.1% in 2001 to 55.4% in 2016). The increase was persistent across all age and gender strata and in every province. Moreover, IPA was more prevalent among women than their male peers regardless of their age category or province of residence. The prevalence of IPA in Khuzestan (highest prevalence) was almost double compared to that in Lorestan (lowest prevalence) in 2016. The IPA prevalence increased considerably and almost doubled in 16 years among Iranian adults, particularly women. Policies need to target IPA as a high priority contributing to the burden of Non-communicable diseases.

Development, implementation and evaluation of the 'BELIEVE' program for improving physical activity among women: a mixed method action research study

Background

There is insufficient physical activity among women. Yet the implementation of effective, multilevel, and evidence-based interventions may address this. Since the lifestyle of individuals is formed in many different social, physical and cultural contexts, it will be necessary in designing such interventions to involve many stakeholders. Consequently, the present study took a mixed method action research approach in developing, implementing and evaluating a bespoke program to improve physical activity among women.

Methods

This study was conducted within the Khoramroudi neighborhood of Tehran between 2013 and 2015 utilizing the four main phases of action research. The Mobilizing for Action through Planning and Partnerships (MAPP) process was used to design the study. During the initial phase, participants were organized into three groups; a core support committee, a steering committee, and a study population. Qualitative and quantitative data were also collected during this first phase. During the second phase, interventions were developed and implemented. In the third phase, an evaluation was carried out using both quantitative (Designing a quasi-experimental study) and qualitative methods. During the fourth phase, an exploration of the structure and process of action research was completed with the aim of providing a conceptual model and descriptions of the context.

Results

Three strategic interventions were effective in improving physical activity among women: (1) utilization of sports assistants; (2) Local health promotion and the dissemination of an informational, motivational and culturally competent booklet entitled “Educational content for sport assistants" (3) Group-based cognitive behavioral therapy. Quantitative results [Significant difference between the total score of PA before the intervention, and 1 and 3 months after the intervention (P < 0.001)] and the results of qualitative evaluations were shown to improve physical activity among participants. The newly co-created “adjusted MAPP model” was offered within three action cycles. The structure of this was described to capture the impacts of interactions among a variety of stakeholders.

Conclusion

The comprehensive identification of problems led to the development of collaborative strategies. Strategies of action research can positively affect physical activity among women. To improve physical activity outcomes more generally, the use of MAPP principles and strategies is suggested to meet the specific needs and strengths of all community members.

Prevalence and socio-demographic associations of diet and physical activity risk-factors for cardiovascular disease in Bo, Sierra Leone

BACKGROUND

Little is known about modifiable dietary and physical activity risk factors for cardiovascular diseases (CVDs) in Sierra Leone. This information is critical to the development of health improvement interventions to reduce the prevalence of these diseases. This cross-sectional study investigated the prevalence and socio-demographic correlates of dietary and physical activity risk behaviours amongst adults in Bo District, Sierra Leone.

METHODS

Adults aged 40+ were recruited from 10 urban and 30 rural sub-districts in Bo. We examined risk factors including: ≤150 min of moderate or vigorous-intensity physical activity (MVPA) weekly, physical inactivity for ≥3 h daily, ≤5 daily portions of fruit and vegetables, and salt consumption (during cooking, at the table, and in salty snacks). We used logistic regression to investigate the relationship between these outcomes and participants' socio-demographic characteristics.

RESULTS

1978 eligible participants (39.1% urban, 55.6% female) were included in the study. The prevalence of behavioural risk factors was 83.6% for ≤5 daily portions of fruit and vegetables; 41.4 and 91.6% for adding salt at the table or during cooking, respectively and 31.1% for eating salty snacks; 26.1% for MVPA ≤150 min weekly, and 45.6% for being physically inactive ≥3 h daily. Most MVPA was accrued at work (nearly 24 h weekly). Multivariable analysis showed that urban individuals were more likely than rural individuals to consume ≤5 daily portions of fruit and vegetables (Odds Ratio (OR) 1.09, 95% Confidence Interval (1.04-1.15)), add salt at the Table (OR 1.88 (1.82-1.94)), eat salty snacks (OR 2.00 (1.94-2.07)), and do MVPA ≤150 min weekly (OR 1.16 (1.12-1.21)). Male individuals were more likely to add salt at the Table (OR 1.23 (1.20-1.27)) or consume salty snacks (OR 1.35 (1.31-1.40)) than female individuals but were less likely to report the other behavioural risk-factors examined. Generally, people in lower wealth quintiles had lower odds of each risk factor than those in the higher wealth quintiles.

CONCLUSION

Dietary risk factors for CVD are highly prevalent, particularly among urban residents, of Bo District, Sierra Leone. Our findings highlight that forthcoming policies in Sierra Leone need to consider modifiable risk factors for CVD in the context of urbanisation.

Macrosomia is a risk factor for incident maternal chronic kidney disease

Background

Gestational diabetes mellitus (GDM) and macrosomia are associated with several adverse outcomes including diabetes mellitus and cardiovascular diseases, however, the relationship between GDM/macrosomia with incident chronic kidney disease (CKD) is a matter of debate. The purpose of this study was to examine the association between the history of macrosomia with or without GDM and incident maternal CKD.

Methods

The study population includes 2669 women aged 18–50 years without known diabetes mellitus and CKD from participants of the Tehran Lipid and Glucose Study. The study population was categorized into 3 groups; group 1: GDM/macrosomia and without diabetes mellitus (n = 204), group 2: newly diagnosed incident diabetes mellitus (NDM) in the presence or abcence of GDM/Macrosomia (n = 113), and, group 3: the reference group including women without prior history of GDM/macrosomia and free of NDM (n = 2352). CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m². Multivariable Cox proportional hazard regression adjusted for baseline values of age, body mass index, waist circumference, parity numbers, smoking, educational level, gestational hypertension, eGFR, systolic and diastolic blood pressures (SBP and DBP, respectively), anti-hypertensive medication, and family history of diabetes mellitus was applied for data analyses.

Results

During a median follow-up of 11.9 years, 613 incident CKD cases were identified. The multivariable hazard ratio (HR) and 95% confidence interval (CI) on GDM/macrosomia group was [1.32 (1.02–1.72)]; the risk was more prominent among non-hypertensive women [1.41 (1.07–1.85); P for interaction: 0.046]. Moreover, the history of macrosomia alone also showed a significant risk [1.36 (1.04–1.78)]; however, history of GDM alone did not have a significant risk [0.92 (0.34–2.46)]. Age, current smoking, eGFR, and SBP remained as independent risk factors for incident CKD.

Conclusions

A history of GDM/macrosomia or macrosomia alone, independent of subsequent diabetes mellitus was associated with significant risk for incident maternal CKD. Pregnancy may provide a unique situation to identify high-risk women at risk for CKD that could benefit from regular monitoring of kidney function and providing risk modifying strategies.

A nationwide study of metabolic syndrome prevalence in Iran; a comparative analysis of six definitions

Introduction

To integrate and execute a proper preventive plan and reduce the risk of non-communicable diseases (NCDs), policy makers need to have access to both reliable data and a unique definition of metabolic syndrome (MetS). This study was conducted on the data collected by cross-sectional studies of WHO’s STEPwise approach to surveillance of NCD risk factors (STEPs) to estimate the national and sub-national prevalence rates of MetS in Iran in 2016.

Materials and methods

The prevalence of MetS was estimated among 18,414 individuals aged ≥25 years living in urban and rural areas of Iran using various definition criteria; National Cholesterol Education Program Adult Treatment Panel III 2004 (ATP III), International Diabetes Federation (IDF), American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI), Joint Interim Statement (JIS). Regional IDF (RIDF) and JIS (RJIS) were defined using ethnicity-specific values of waist circumference for the country.

Results

National prevalence rate of MetS based on ATP III, IDF, AHA/NHLBI, JIS, RIDF and RJIS criteria were 38.3% (95% CI 37.4–39.1), 43.5% (42.7–44.4), 40.9% (40.1–41.8), 47.6% (46.8–48.5), 32.0% (31.2–32.9), and 40.8% (40.0–41.7), respectively. The prevalence was higher among females, in urban residents, and those aged 65–69 years. MetS was expected to affect about 18.7, 21.3, 20.0, 23.3, 15.7, and 20.0 million Iranians, respectively, based on ATP III, IDF, AHA/NHLBI, JIS, RIDF and RJIS. The two most common components noted in this population were reduced high-density lipoprotein cholesterol (HDL-C) levels and central obesity.

Conclusion

High prevalence rate of MetS among Iranian adults is alarming, especially among females, urban residents, and the elderly. The JIS definition criteria is more appropriate to determine higher number of Iranians at risk of NCDs. Proper management and prevention of MetS is required to adopt multiple national plans including lifestyle modifications, medical interventions, and public education on NCDs risk factors.

Sex specific trajectories of central adiposity, lipid indices, and glucose level with incident hypertension: 12 years Follow-up in Tehran lipid and glucose study

Aims

To identify sex specific trajectories of waist circumference (WC),triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and fasting plasma glucose (FPG) during adulthood and examine their associations with incident hypertension.

Methods

The cohort consisted of 5030 participants (2051 males) with at least 2 repeated measurement during a median of 12 years follow up. We identified trajectory groups using latent class growth mixture model, their association with hypertension was examined using multivariate Cox-regression analysis.

Results

We found 997 cases of hypertension (483 male). For both exposures, three distinct trajectory groups were identified in both genders. For WC, in women: low-increasing, 82.4%; high-stable, 13.4%; high-increasing, 4.2% and in men: stable, 94.6%; low-increasing, 3.6% and for high- increasing, 1.7%. For TG, in women: stable, 91.3%; decreasing, 5.9%; inverse U-shape, 2.8%; in men: stable, 89.7%; inverse U- shape, 6.2% and for decreasing, 4.1%.

Regarding WC, high stable and high-increasing trajectories were associated with hypertension in the multivariate model [(hazard ratio (HR) = 1.66 (95% CI 1.26–2.20) and 2.78(1.79–3.60), respectively]. Among men, this association was shown only for the low-increasing trajectory [2.76: 1.49–5.10]. For TG, among women decreasing and inverse U-shape trajectories were significantly associated with hypertension in the multivariate model [1.32:1.01–1.76] and [2.23:1.58–3.23, respectively].

We did not find any impact of increasing trajectories of FPG and HDL-C on incident hypertension. Considering TC, all individuals followed a stable trajectory.

Conclusion

WC dynamic changes in both gender and TG trajectory among women were significantly associated with incident hypertension.

Physical activity levels and related sociodemographic factors among Iranian adults: Results from a population-based national STEPS survey

Background: Physical inactivity (PA) is one of the leading modifiable risk factors for noncommunicable diseases (NCDs) worldwide. This study aimed to determine PA levels and related sociodemographic factors as risk factors for NCDs among Iranian adults.

Methods: In this cross sectional study, data were collected from the sixth nationwide STEPS survey in 31 provinces of Iran. A total of 6100 individuals aged 18-64 years were selected by a multistage cluster sampling method, and their PA levels were assessed using the Global Physical Activity Questionnaire (GPAQ). Data were analyzed using descriptive methods and analytical tests, including chi-square, ANOVA, and independent t tests in SPSS version 21 software.

Results: The prevalence of vigorous, moderate, and low levels of PA was 36.3% (95%CI:35.1-37.5), 29.2% (95%CI:28-30.3), and 34.5% (95%CI:33.3-35.7) in participants, respectively. The mean ± SD of total MET-min/week was 1842.3±2619.3. Total mean ± SD duration of PA was 98.2 ± 115 min/week (125.8±142.6 and 77.2±84.5 min/week in men and women, respectively). Transport-related PA and severe PA at work had large and small contributions to overall PA, respectively. Urbanization, sex, age, family size, and occupation status were identified as factors associated with PA levels (p<0.001).

Conclusion: This study revealed a significant prevalence of low PA among the target population and some sociodemographic characteristics identified as factors associated with PA. Identification of these factors can develop more effective interventions to promote PA.

Long-term incidence of cardiovascular outcomes in the middle-aged and elderly with different patterns of physical activity: Tehran lipid and glucose study

Background

Following the global upward trend of cardiovascular diseases (CVD/CHD), much attention has been paid to lifestyle behaviors such as physical activity (PA). However, most of previous studies were conducted in developed countries and with just one measurement of physical activity. The aim of the current study is to assess the effect of changes in the PA on the incidence of CVD/CHD in middle-aged and older men and women in an Eastern-Mediterranean population, over a decade follow-up.

Methods

This study has been conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) including 4073 (57% women) participants without CVD/CHD at baseline. The participants were followed up for an average period of 12 years. The Iranian version of Modified Activity Questionnaire (MAQ) was used to measure PA at baseline and at the closest follow-up to the outcome. Subsequently, participants were categorized as “compliers”, “non-compliers”, “adopters” and “relapsers”, based on their adherence to the PA guideline recommendations. All analysis has been conducted in two separate age groups including middle-aged and elderly in both men and women. The effect of PA patterns on incidence of CVD/CHD was investigated using Cox proportional hazard model. Variables including marital status, job status, education, smoking, and family history of CVD/CHD were adjusted in the models.

Results

Adherence to guideline recommendation increased from 63.5 to 66.6% between the two measurements. At the second measurement of PA, the percentages of compliers, non-compliers, adopters and relapsers were 48.4, 18.3, 18.2, and 15.1%, respectively. In fully adjusted models, HRs of CVD and CHD for men aged 40–60 years in the complier group were 0.58 (95% CI: 0.38–0.87, P = 0.008) and 0.58 (95% CI: 0.38–0.89, P = 0.01), respectively. HRs of CVD and CHD for men aged 40–60 years in adopter group were 0.61 (95% CI: 0.38–0.96, P = 0.03) and 0.60 (95% CI: 0.37–0.97, P = 0.04) respectively. The corresponding values were not significant in women.

Conclusions

Adhering to established PA recommendations have a protective effect on the incidence of CVD/CHD among middle-aged men; findings which need to be considered in reducing cardiovascular outcomes in this population.

Why Physical Inactivity Level Has Increased in the Iranian Population During the Past Decade? A Delphi Technique

Background: Considering the well-established benefits of physical activity in the health domain, the economy, and environment, physical activity programs should be considered as an important agenda in public health policymaking. Objectives: The objective of this qualitative study was to identify “Why the prevalence of physical inactivity has increased during the past decade in Iran, despite having various national physical activity documents? "using a Delphi technique. Methods: The “Delphi technique” process in this study consisted of literature review, selecting the research question, selection and recruitment of panel members, pilot study and conduction of round one (using an open question), round 2 (using a 5-point Likert scale), and round three (final ranking). Results: Statements with the highest scores in round three were recognized as the most important causes of the decreased level of physical activity based on the experts’ responses in Iran. Conclusions: The absence of executive support, coordination mechanisms, and appropriate infrastructure for conducting physical activity were the top challenges in improving the physical activity level in Iran.

Correlates of sedentary behaviour in Asian adults: A systematic review

The objective of this study is to systematically review the evidence on correlates of sedentary behaviour (SB) among Asian adults. We searched for studies that examined individual, environmental, and political/cultural correlates of total and domain-specific SB (transport, occupation, leisure, and screen time) in Asian adults published from 2000 onwards in nine scientific databases. Two reviewers independently screened identified references. Following quality assessment of included studies, we performed narrative synthesis that considered differences based on SB measurements, regions, and population characteristics (PROSPERO: CRD42018095268). We identified 13 249 papers of which we included 49, from four regions and 12 countries. Researchers conducted cross-sectional analyses and most relied on SB self-report for SB measurement. Of the 118 correlates studied, the following associations were consistent: higher age, living in an urban area (East Asia), and lower mental health with higher total SB; higher education with higher total and occupational SB; higher income with higher leisure-time SB; higher transit density with higher total SB in older East Asians; and being an unmarried women with higher SB in the Middle East. We encourage more research in non-high-income countries across regions, further exploration of important but neglected correlates using longitudinal designs and qualitative research, and the use of objective instruments to collect SB data.

Metabolic health in the Middle East and north Africa

The Middle East and north Africa are home to different populations with widely varying cultures, histories, and socioeconomic settings. Hence, their health status, health management, and access to appropriate health care differ accordingly. In this Review, we examine data on the historical and prospective status of metabolic diseases in this region including obesity, diabetes, hypertension, dyslipidaemia, and non-alcoholic fatty liver disease. Women in the Middle East and north Africa have the highest risk of metabolic diseases of all women globally, whereas men rank second of all men in this respect. Metabolic risk factors are responsible for more than 300 deaths per 100 000 individuals in this region, compared with a global mean of fewer than 250. Physical inactivity, especially in women, and an unhealthy diet (ie, low consumption of whole grains, nuts, and seafoods) stand out. More than one in every three women are obese in most countries of the region. Prevention programmes have not fully been achieved in most of these countries and the projected future is not optimistic. Comprehensive surveillance and monitoring of metabolic diseases, robust multisectoral systems that support primordial and primary preventions, continuous education of health-care providers, as well as collaboration between countries for joint projects in this region are urgently needed to overcome the paucity of data and to improve the metabolic health status of inhabitants in the Middle East and north Africa.

Socioeconomic gradient in physical activity: findings from the PERSIAN cohort study

Background

The level of socioeconomic-related inequality in physical activity in Iran is largely unknown. This study investigates socioeconomic-related inequality in poor-physical activity (PPA) among Iranian adults.

Methods

A total of 129,257 adult participants enrolled in the PERSIAN (Prospective Epidemiological Research Studies in IrAN) Cohort were included in this study. Physical activity of adults was measured using metabolic equivalent rates (METs). Physical activity less than 41 METs/hour/day was considered PPA. The Concentration index (C) was used to quantify socioeconomic-related inequality in PPA. Moreover, the C was decomposed to identify the relative contribution of explanatory variables to inequality in PPA.

Results

There were significant regional variations in physical activity level among Iranian adults (29.8–76.5%). The positive value of C (0.098, 95% CI = 0.092 to 0.104) suggested that the higher concentration of PPA among higher socioeconomic status (SES) adults in Iran which was consistently observed in all cohort sites.

Conclusions

The higher prevalence of PPA among Iranian adults, especially, women and older adults, warrant further public health attention. Since PPA is concentrated more among the high-SES population in Iran, strategies for the promotion of physical activity should focus more on economically well-off population.

Geographical Patterning of Physical Activity Prevalence in Iran: Spatial Analysis of 4 Pooled National Health Surveys Among 119,560 Adults

BACKGROUND

To investigate the geographical distribution of physical activity (PA) prevalence among adults aged 15-64 years old across Iran provinces using geographic maps.

METHODS

Data from 4 consecutive national surveys conducted between 2007 and 2010 were pooled to determine the geographical distribution. Prevalence of low PA with 95% confidence interval was estimated by sociodemographic subpopulations over provinces using complex survey design.

RESULTS

In total, 119,560 participants (49.9% females) were included in the analyses. The mean (SD) age of participants was 39.5 (14.3) years. The prevalence of the low PA in the pooled 2007-2010 was 35.8% (95% confidence interval, 34.1-37.6). The 3 provinces with the highest prevalence of low PA were Sistan and Baluchestan, Yazd, and Hormozgan. The results of hot spot analysis showed that the Kerman province was a hot spot, and Ilam, Kermanshah, Hamedan, and Markazi were cold spots for low PA. Ilam, Kohgiluyeh and Boyer-Ahmad, and Mazandaran had the highest total PA volume (metabolic equivalent minutes per week). Hot spot analysis showed that Ilam and Khuzestan provinces were hot spots for the total PA volume.

CONCLUSIONS

The regions with low and high PA are predominately situated in the near center/southeast and west, respectively.

Physical activity profile of the Iranian population: STEPS survey, 2016

Background

Insufficient physical activity (IPA) is one of the leading causes of premature mortality through the increased burden of non-communicable diseases. From 1990 to 2017, the percentage of low physical activity attributable disability-adjusted life years (DALY) increased globally by 1.5 times and 2-fold in Iran, causing more than 1.2 million deaths worldwide and 18,000 deaths in Iran in 2017. Reports suggest that Iran, a developing middle-income country, suffers from a high level of IPA. Socioeconomic and cultural alterations along with the country’s developments expose the population to IPA risk. We aimed to describe IPA prevalence in Iran’s adult population, categorized by demographics, geographical region, and activity domains to assess the present pattern of physical inactivity and its domains in the country.

Methods

In 2016, in order to represent Iran’s adult population, adult participants (n: 30541) from 30 provinces were selected using systematic proportional to size cluster sampling. Physical activity (PA) was assessed via the Global Physical Activity Questionnaire, calculating the Metabolic Equivalent of Task (MET) value in minutes per week for work, recreation, and transport domains. Insufficient physical activity (IPA) was defined according to WHO’s recommendation (less than 600 METs per week). Adjusted odds ratios of IPA associates for sociodemographic, lifestyle related variables, and metabolic risk factors were reported.

Results

A high prevalence of IPA was seen in the total population (54.7%, 95%CI: 54.0–55.3) with a considerable difference between the two genders (males: 45.3% (95%CI: 44.3–46.3); females: 61.9% (95%CI: 61.0–62.7)). Work-related activity was the domain with the greatest percentage of total PA, whereas, both genders lacked recreational activities. In our findings, being female, a housekeeper, younger and living in urban areas were significantly associated with higher levels of IPA. Moreover, insufficient fruit and vegetable consumption, lack of alcohol consumption, having a personal vehicle, and finally, having a medical history of diabetes were significantly associated with the presence of IPA in our population. Among the study population, 33.6% (95%CI: 33.0–34.2) had at least 4 h of sedentary behavior in a typical day.

Conclusions

Widespread IPA among the Iranian adult population is of major concern. In our findings, we observed a considerable gap in the prevalence and pattern of IPA between the two genders. Additionally, IPA was associated with living in urban areas, unhealthy lifestyle habits and a history of other metabolic risk factors. Thus, a prompt initiative for population-specific actions should be taken.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12889-019-7592-5.

Association of Physical Activity and Screen Time with Psychiatric Distress in Children and Adolescents: CASPIAN-IV Study

BACKGROUND

There are limited studies about the association of physical activity (PA) and screen time (ST) with psychiatric distress (PD) among children and adolescents including Iranian populations.

OBJECTIVE

We aimed to examine the independent and combined associations of PA and ST with PD among children and adolescents.

METHOD

This school-based nationwide survey was carried out among 14 880 students (50.8% boys and 75.6% urban inhabitants), of age 6-18 years by cluster and the stratified multistage sampling method from 30 provinces of Iran. The students and their parents completed two sets of questionnaires obtained from Global School Health Survey with several questions about the PD. The time spent on watching TV/video and computer games and PA were assessed by self-administered validated questionnaires.

RESULTS

The study had a participation rate of 90.6%. Of the studied students, 45.85%, 83.62%, 37.81% and 23.92% had depression, anger, insomnia and worthlessness, respectively. The prevalence of confusion, anxiety and worry was reported in 19.6%, 55.17% and 75.31% of the students, respectively. The combined effect of PA and that of ST showed that students with high PA and low ST had the lowest prevalence of PD, while the highest prevalence of these PD was observed among students with low PA combined with high ST (p < 0.05 for all).

CONCLUSIONS

Increasing PA and reducing ST should both be considered for improving the mental health status of children and adolescents.

Prevalence of high blood pressure in Iranian adults based on the 2017 ACC/AHA guideline

Background: : In 2017, American College of Cardiology (ACC) and the American Heart Association (AHA) presented a new guideline for assessing blood pressure in adults. This study aimed to assess the prevalence of hypertension in Iranian adults based on ACC/AHA 2017 guideline.

Methods: Data from 9801 Iranian adults (59.2% women) aged between 20–69 years were obtained from the sixth round of National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD) performed in 2011. Blood pressure was classified as normal, elevated blood pressure, and stage 1 and 2 hypertension using a weighted analysis and 2017 ACC/AHA guidelines. Data were presented as prevalence and 95% confidence interval (95% CI). All analyses were performed in Stata/SE 14.0.

Results: Overall prevalence of hypertension in Iranian men was 52.0%. Also, 32.9% (95% CI: 29.9-36.0) and 19.1% (95% CI: 16.9-21.6) of men had stage 1 and 2 hypertension, respectively. In addition, 44.3% of women had hypertension, of whom 26.3% (95% CI: 24.5 - 28.2) had stage 1 and 18.0% (95% CI: 16.1-20.1) stage 2 hypertension. Furthermore, 16.5% (95% CI: 14.4-18.9) and 9.6% (95% CI: 7.86-11.7) of men and women had elevated blood pressure, respectively.

Conclusion: The findings of this study indicated that adopting the 2017 ACC/AHA guidelines showed a higher prevalence of adult hypertension (48.2%) in Iran. In this study, the prevalence of hypertension in men was higher than in women, which was steadily increased by age in older adults in both sexes.

Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants

BACKGROUND

Insufficient physical activity is a leading risk factor for non-communicable diseases, and has a negative effect on mental health and quality of life. We describe levels of insufficient physical activity across countries, and estimate global and regional trends.

METHODS

We pooled data from population-based surveys reporting the prevalence of insufficient physical activity, which included physical activity at work, at home, for transport, and during leisure time (ie, not doing at least 150 min of moderate-intensity, or 75 min of vigorous-intensity physical activity per week, or any equivalent combination of the two). We used regression models to adjust survey data to a standard definition and age groups. We estimated time trends using multilevel mixed-effects modelling.

FINDINGS

We included data from 358 surveys across 168 countries, including 1·9 million participants. Global age-standardised prevalence of insufficient physical activity was 27·5% (95% uncertainty interval 25·0-32·2) in 2016, with a difference between sexes of more than 8 percentage points (23·4%, 21·1-30·7, in men vs 31·7%, 28·6-39·0, in women). Between 2001, and 2016, levels of insufficient activity were stable (28·5%, 23·9-33·9, in 2001; change not significant). The highest levels in 2016, were in women in Latin America and the Caribbean (43·7%, 42·9-46·5), south Asia (43·0%, 29·6-74·9), and high-income Western countries (42·3%, 39·1-45·4), whereas the lowest levels were in men from Oceania (12·3%, 11·2-17·7), east and southeast Asia (17·6%, 15·7-23·9), and sub-Saharan Africa (17·9%, 15·1-20·5). Prevalence in 2016 was more than twice as high in high-income countries (36·8%, 35·0-38·0) as in low-income countries (16·2%, 14·2-17·9), and insufficient activity has increased in high-income countries over time (31·6%, 27·1-37·2, in 2001).

INTERPRETATION

If current trends continue, the 2025 global physical activity target (a 10% relative reduction in insufficient physical activity) will not be met. Policies to increase population levels of physical activity need to be prioritised and scaled up urgently.

FUNDING

None.

Incidence of abdominal obesity and its risk factors among Tehranian adults

OBJECTIVE

Abdominal obesity (AO) is a relative risk factor for cardiovascular events. We aimed to determine the 6-year incidence of AO and its risk factors among Tehranian adults.Design/Setting/SubjectsIn this population-based cohort study, non-abdominally obese participants, aged ≥20 years, were followed for incidence of AO. Cumulative incidence and incidence rate of AO were calculated for each sex. Cox proportional hazard regression was used to determine the association of potential risk factors including age, BMI, dysmetabolic state, smoking, marital status, educational level and physical activity (PA).

RESULTS

A total of 5044 participants (1912 men) were followed for a median of 6 years. Mean age was 37·7 (sd 13·5) years at baseline, with mean BMI of 24·3 (sd 3·1) kg/m2 (men, 23·0 (sd 2·4) kg/m2; women, 25·0 (sd 3·2) kg/m2). During follow-up, 3093 (1373 men) developed AO with total cumulative incidence of 76·02, 83·59 and 70·90 %, for the whole population, men and women, respectively. Corresponding incidence rates were 96·0, 138·7 and 77·1 per 1000 person-years. The highest incidence rate was observed during their 30s and 50s, in men and women, respectively. Subjects with dysmetabolic state in both sexes, married women, men with lower PA and higher educational levels at baseline were at higher risk of AO.

CONCLUSIONS

The incidence of AO is high among Tehranian adults, especially in young men. The risk factors for developing AO should be highlighted to halt this growing trend of AO.

12-year trends in cardiovascular risk factors (2002-2005 through 2011-2014) in patients with cardiovascular diseases: Tehran lipid and glucose study

BACKGROUND

To examine the trend of cardiovascular diseases (CVD) risk factors among a Middle Eastern population with prevalent CVD during a median follow up of 12 years.

METHODS

Patients with prevalent CVD (n = 282, men = 167), with a mean age of 60.76 years were evaluated in four study phases of the TLGS (Tehran lipid glucose study), 2002-2005, 2005-2008, 2008-2011, and 2011-2014. Trends of CVD risk factors were estimated using generalized estimation equation (GEE) models, by adjusting for gender, age and propensity scores.

RESULT

The adjusted prevalence of general and central adiposity, diabetes and physical inactivity at baseline was 25.18, 60.14, 25.03 and 43.74%, respectively and had increasing trends during the study period, reaching 41.32, 66.74, 43.20 and 50.32%, respectively, at the last visit. Although systolic, but not diastolic blood pressure, decreased from 134.88 to 129.86 mmHg, the prevalence of hypertension did not decrease (64.21% vs 68%, p value = 0.326). The prevalence of low high density lipoprotein cholesterol (HDL-C), hypertriglyceridemia and high non-HDL-C at baseline was 74.54, 59.89 and 96.53%, respectively, and showed improved trends reaching 44.87, 47.12 and 96.06% respectively; however, the favorable trend was not observed for high low density cholesterol. Significant increasing trends were observed in the consumption of anti-hypertensive, lipid and glucose lowering medications, but not for aspirin. The prevalence of current smoking (11.05 vs 16.83%, p value = 0.042) and chronic kidney disease (44.16 vs 51.65%, p value = 0.054) increased during follow up.

CONCLUSION

Except for lipid profile status, dangerous trends for other CVD risk factors were demonstrated among CVD patients, which can be a harbinger for high rates of CVD mortality; these findings highlight the need for urgent implementation of multicomponent interventions to control CVD risk factors among these patients.

National Prevalence of Self-Reported Coronary Heart Disease and Chronic Stable Angina Pectoris: Factor Analysis of the Underlying Cardiometabolic Risk Factors in the SuRFNCD-2011

BACKGROUND

Coronary heart disease (CHD) is one of the most common causes of mortality worldwide. The national prevalence remains unclear in most of the developing countries.

OBJECTIVE

This study sought to estimate national prevalence of self-reported CHD and chronic stable angina pectoris in the general adult population of Iran using data from the fourth round of the Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2011) survey.

METHODS

The analysis comprised data of 11,867 civilian, nonhospitalized and noninstitutionalized residents ages 6 to 70 years of age. The calculated prevalence of self-reported CHD and chronic stable angina pectoris were extrapolated to the Iranian adult population who were >20 years old using the complex sample analysis. The factor analysis was performed for clustering of the associated cardiometabolic risk factors among people ages >40 years of age.

RESULTS

The estimated national prevalence of self-reported CHD and chronic stable angina pectoris were 5.3% (95% confidence interval: 4.6 to 5.9) and 7.7% (95% confidence interval: 4.6 to 8.7), respectively. Higher prevalence of these conditions were observed among the older people, urban residents, and women. Factor analysis generated 4 distinct factors that were mainly indicators of dyslipidemia, hypertension, central obesity, hyperglycemia, and tobacco smoking. The factor incorporating hypertension was a significant correlate of self-reported CHD.

CONCLUSIONS

We report concerning prevalence of self-reported CHD and chronic stable angina pectoris in the adult population of Iran. The constellation of raised systolic and diastolic blood pressures was significantly predictive of the presence of self-reported CHD.

Digital Media-based Health Intervention on the promotion of Women's physical activity: a quasi-experimental study

Background

Technological advances have caused poor mobility and lower physical activity among humankind. This study was conducted to assess the impact of a digital media-based (multi-media, internet, and mobile phone) health intervention on promotion of women’s physical activity.

Methods

In this quasi-experimental study, 360 women were divided into case and control groups. The digital media-based educational intervention was conducted in two months in the case group electronically, using mail and Internet and telephone platforms. Physical activity was measured using International Physical Activity Questionnaire (IPAQ) that estimated women’s physical activity rate in the previous week. Data was analyzed using descriptive and analytical statistics (ANOVA, chi-square, paired and independent t-tests) using SPSS 20.

Results

The mean score of knowledge, attitude and level of physical activity in the control group were not significantly different before and after the intervention. While in the case group, this difference before and after the intervention was significant (p < 0.001), and mean scores of the above-mentioned factors increased after the intervention.

Conclusions

Using innovative and digital media-based health education can be effective in improving health-based behavior such as physical activity. Therefore, it seems necessary to develop user-based strategies and strengthen the behavioral change theories and hypotheses based on digital media for effective influence on behavior.

Trial registration

Iranian Registry of Clinical Trials (IRCT), IRCT20160619028529N5. Registered December 24, 2017 [retrospectively registered].

Prevalence of Chronic Neck Pain, Low Back Pain, and Knee Pain and Their Related Factors in Community-Dwelling Adults in Iran: A Population-based National Study

BACKGROUND

Chronic musculoskeletal pain (CMP) is increasing in prevalence rapidly. Over the past 2 decades low back pain has been ranked globally as the primary cause of years lived with disability. The primary objective of this study was to investigate the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and chronic knee pain (CKP) and their related risk factors in the national Iranian population.

METHODS

We analyzed data obtained through a cross-sectional, population-based survey of 7889 Iranians who were aged between 30 and 70 years.

RESULTS

The prevalence of CNP, CLBP, and CKP was 15.34%, 27.18%, and 29.97%, respectively. Female sex, aging, body mass index≥25, Lur or Arab ethnicity, illiteracy, passive smoking, positive osteoporosis history, and low or high physical activity levels were risk factors for CLBP, CNP, and CKP after adjustment for potential confounders. For example, in participants with a body mass index≥30, odds ratios for CNP, CLBP, and CKP adjusted for age, sex, ethnicity, living area, education, employment status, smoking, and physical activity levels were 1.26 (95% confidence interval [CI], 1.04-1.52), 1.37 (95% CI, 1.17-1.59), and 1.64 (95% CI, 1.41-1.91), respectively.

CONCLUSIONS

This is the first study investigating the prevalence of CNP, CLBP, and CKP in the national population of Iran. It shows some modifiable risk factors for CMP, and suggests that affordable planning for these risk factors can be valuable in preventing CMP globally. However, this is a cross-sectional study and future longitudinal studies in this field are necessary.

Socio-Behavioral Factors Associated with Overweight and Central Obesity in Tehranian Adults: a Structural Equation Model

PURPOSE

This study aimed to test a conceptual model of associations between socio-demographic and behavioral factors and obesity in the Tehran Lipid and Glucose Study (TLGS).

METHODS

Data from 2747 TLGS adult participants (58.3 % female) were analyzed. Socio-demographic and behavioral factors in the conceptual model were tested for their direct and indirect associations with overweight and central obesity, using structural equation modeling (SEM), conducted by IBM SPSS AMOS software.

RESULTS

Overweight and central obesity were found in 61.6 and 48.1 % of respondents, respectively. Fit indices were acceptable for the conceptual model. Daily energy intake had a direct association with overweight and central obesity in both genders; however, poor dietary pattern had direct associations with overweight and central obesity only in men. In women, age, marital status, and level of education had direct associations with overweight and central obesity. In men, only age and marital status had direct associations with overweight and central obesity.

CONCLUSIONS

Age and marital status in both genders and level of education only in women were among the socio-demographic factors which were directly associated with both overweight and central obesity. Among behavioral factors, daily energy intake was the most important factor that was directly associated with both overweight and central obesity in both genders. Adherence to poor diet directly was associated with overweight and central obesity only in men. The current findings provide beneficial information for designing culturally relevant and effective interventions/strategies for prevention of overweight among Tehranian adults.

Decomposing Gender Disparity in Total Physical Activity among Iranian Adults

OBJECTIVES

While gender differences in physical activity (PA) have been reported, their origin is not well understood. The present study aimed to identify factors contributing to this disparity.

METHODS

This was a population-based cross-sectional study based on the 2011 surveillance of risk factors of non-communicable diseases that was conducted among Iranian adults. Multi-staged sampling was performed to obtain the required study sample. The primary outcome was gender differences in the prevalence of sufficient physical activity (SPA). Total physical activity (TPA) was calculated as metabolic equivalents (MET) per minute during a typical week, as recommended by the World Health Organization. On this basis, achieving 600 MET-min/wk or more was defined as SPA. The nonlinear Blinder-Oaxaca decomposition technique was used to explain the disparity.

RESULTS

The predicted gap was 19.50%. About one-third of the gap was due to differences in the level of observable covariates. Among them, work status contributed the most (29.61%). A substantial portion of the gap remained unexplained by such differences, of which about 40.41% was related to unobservable variables. The differential effects of standard of living, ethnicity, and smoking status made the largest contribution, accounting for 37.36, 35.47, and 28.50%, respectively.

CONCLUSIONS

Interventions to reduce the gender gap in PA should focus on increasing TPA among housewives and women with chronic diseases, as well as those with a higher standard of living. In addition, it is essential to explore the impact of ethnicity and smoking status on women’s TPA in order to promote health.

Trend of cardiovascular risk factors in the older Iranian population: 2002-2014

AIM

Current study aimed to investigate the sex-stratified secular trend of cardiovascular disease risk factors among an older population in Iran during a median follow-up period of 8.76 years.

METHODS

A total of 1490 participants (733 women) aged ≥60 years were evaluated in four study phases of 2002-2005, 2005-2008, 2008-2011 and 2011-2014. The trends of cardiovascular disease risk factors for each sex were estimated using generalized estimating equations.

RESULTS

The age-adjusted prevalence of diabetes, hypertension, central obesity, and chronic kidney disease at the baseline was 24%, 43%, 55%, and 32% in men and 31%, 57%, 60% and 53% in women, respectively, and had noticeable upward trend during the study period to reach 35%, 56%, 61% and 51% in men, and 42%, 71%, 74% and 67% in women, respectively. However, lipid profile parameters showed favorable trends. Despite the increasing trend in drug consumption, approximately 27% of women with diabetes and 37% of men with diabetes did not use antidiabetic medication, respectively; the results were 23% and 35% for hypertensive women and men, respectively. Among men, there was a decreasing trend towards low physical activity, from 40% at baseline to 26% at the most recent follow up. The prevalence of smoking remained steady throughout follow up.

CONCLUSIONS

Despite the benefits of lipid lowering, the status of other risk factor profiles are often suboptimal in both sexes. There remains much room for improvement in risk factors management, particularly for hypertension, smoking and adiposity status, and a need for an intervention. Geriatr Gerontol Int 2018; 18: 130-137.

Prevalence of metabolic syndrome in Iran: A 2011 update

BACKGROUND

The aim of the present study was to determine the prevalence of metabolic syndrome and its individual components among the Iranian adult population in 2011 and to investigate changes between 2007 and 2011.

METHODS

Data from two rounds of the Surveillance of Risk Factors of Non-communicable Diseases national surveys conducted in 2007 and 2011 were pooled. Metabolic syndrome was defined according to International Diabetes Federation criteria.

RESULTS

In 2007, the prevalence of metabolic syndrome among adults aged 25-64 years was 35.95 (95% confidence interval [CI] 34.27-37.63), which decreased to 32.96 (95% CI 30.73-35.18) in 2011 (P = 0.0108). Despite this overall decline, the prevalence of central obesity (P = 0.1383), raised triglycerides (P = 0.3058), and reduced high-density lipoprotein cholesterol (HDL-C; P = 0.5595) remained constant. There was a trend towards a decline in the proportion of individuals with increased blood pressure (P = 0.0978), and the proportion of adults with increased fasting plasma glucose (FPG) increased (P < 0.0001). In 2011, the prevalence of central obesity, raised triglycerides, reduced HDL-C, increased blood pressure and increased FPG was 51.88 (95% CI 48.97-54.79), 36.99 (95% CI 34.52-39.45), 54.72 (95% CI 50.87-58.57), 38.92 (95% CI 36.19-41.64), and 24.97 (95% CI 22.02-27.93) respectively.

CONCLUSIONS

Over the period 2007-11, the prevalence of metabolic syndrome has decreased slightly in Iran, although prevalence of increased FPG has increased significantly. One-third of the Iranian adult population is diagnosed with metabolic syndrome.

Prevalence of physical inactivity in Iran: a systematic review

Introduction: Physical inactivity is one of the most important risk factors for chronic diseases, including cardiovascular disease, cancer, and stroke. We aim to conduct a systematic review of the prevalence of physical inactivity in Iran.

Methods: We searched international databases; ISI, PubMed/Medline, Scopus, and national databases Irandoc, Barakat knowledge network system, and Scientific Information Database (SID). We collected data for outcome measures of prevalence of physical inactivity by sex, age, province, and year. Quality assessment and data extraction has been conducted independently by two independent research experts. There were no limitations for time and language.

Results: We analyzed data for prevalence of physical inactivity in Iranian population. According to our search strategy we found 254 records; of them 185 were from international databases and the remaining 69 were obtained from national databases after refining the data, 34 articles that met eligible criteria remained for data extraction. From them respectively; 9, 20, 2 and 3 studies were at national, provincial, regional and local levels. The estimates for inactivity ranged from approximately 30% to almost 70% and had considerable variation between sexes and studied sub-groups.

Conclusion: In Iran, most of studies reported high prevalence of physical inactivity. Our findings reveal a heterogeneity of reported values, often from differences in study design, measurement tools and methods, different target groups and sub-population sampling. These data do not provide the possibility of aggregation of data for a comprehensive inference.

A Subtle Threat to Urban Populations in Developing Countries: Low Back Pain and its Related Risk Factors

STUDY DESIGN

A cross-sectional, population-based survey.

OBJECTIVE

The aim of this study was to estimate the prevalence, and biological and psychological correlates of low back pain (LBP) in large, populated urban areas.

SUMMARY OF BACKGROUND DATA

LBP is a common and costly medical problem all around the world. Currently, there are limited data available on prevalence as well as biological and psychological correlates of LBP in large urban populations in developing countries.

METHODS

Here, in a cross-sectional, population-based survey, we analyzed data obtained from 22,952 subjects living in Tehran.

RESULTS

Chronic, 1-year, and point prevalence of LBP among subjects were 12.2%, 42.1%, and 36.2%, respectively. LBP was more prevalent among older population, women, housewives, and obese people after adjustment for confounding factors using logistic regression models. In addition, persons with a general health questionnaire (GHQ-28) score ≥6 were about 2 times more likely to experience LBP in comparison with others. Both subjects with higher educational levels and those who were never married reported significantly less LBP. Furthermore, we could not find any significant correlation between smoking and physical activity level with LBP.

CONCLUSION

LBP is prevalent among the general population of Tehran. Our findings can help health care providers regarding logical assignment of limited resources, in order to create multidimensional prevention plans according to potentially modifiable associated factors.

LEVEL OF EVIDENCE

3.

Prevalence of physical activity through the practice of sports among adolescents from Portuguese speaking countries

This study evaluated the prevalence of physical activity through the practice of sports in adolescents from schools in two Brazilian cities and a Portuguese school, and its association with independent variables, such as gender and age. A cross-sectional study was conducted of schoolchildren from two cities in Brazil and one in Portugal. The total study sample was 3694 subjects (1622 males and 1872 females). Physical activity levels were assessed using Baecke's questionnaire. Body weight was measured on electronic scales and stature was measured with a portable wooden stadiometer. Numerical variables were expressed as mean, categorical variables were expressed as percentages and the chi-square test analyzed associations. The prevalence of no sport was high (39.7%), being higher in the Portuguese school than in the Brazilian schools (p < 0.001). Irrespective of being an adolescent in a Brazilian or Portuguese school, boys showed higher engagement in sports practice than girls (p < 0.001). In both, differences were identified between adolescents aged 13 to 15 (P = 0.001) and 16 to 17 (P = 0.001). The prevalence of physical inactivity among schoolchildren from two cities in Brazil and a school in Portugal was high, with the girls practicing less sport than the boys and with this imbalance likely to be higher in adolescents.

Physical Activity Status and Position of Governmental Employees in Changing Stage Based on the Trans-Theoretical Model in Hamadan, Iran

Physical inactivity is the fourth leading risk factor for death worldwide. Given the key role of employees as valuable human resources and increasing sedentary life style among them, the aim of this study was to evaluate physical activity status and position of governmental employees in changing stage based on the Trans-Theoretical Model (TTM) in Hamadan, Iran, in 2014. This descriptive-analytical study was performed on 1200 government employees selected using proportional stratified random sampling. Data collection was performed using a three-section questionnaire containing demographic characteristics, SQUASH (Short questionnaire to assess health-enhancing physical activity) questionnaire and Marcus et al’s five-part algoritm. Data were analyzed by multiple linear and logistic regression, Chi-square, T-test and ANOVA using SPSS-20.

The mean age of the participants was 38.12±8.04 years. About a half of the employees were in the preparatory stage of TTM.49.2% and 50.8% of the sample were classified as active and inactive, respectively. Associations between physical activity status and exercise stage of change were found. The associations between exercise stage of change and age, sex, work experience, education and marital status were significant (p<0.05). Work experience and education were strongly predictors of physical activity (PA) status and accounted for 31.2% of variance in PA (adjusted R²=0.312, R² change=0.01).

The results of this study showed that TTM was useful to evaluate and predict physical activity behavior among the Iranian governmental employees and can be utilized by health planners to inform appropriate intervention strategies, specifically in work place.

Theory-based interventions in physical activity: a systematic review of literature in Iran

Lack of physical activity is ranked fourth among the causes of human death and chronic diseases. Using models and theories to design, implement, and evaluate the health education and health promotion interventions has many advantages. Using models and theories of physical activity, we decided to systematically study the educational and promotional interventions carried out in Iran from 2003 to 2013.Three information databases were used to systematically select papers using key words including Iranian Magazine Database (MAGIRAN), Iran Medical Library (MEDLIB), and Scientific Information Database (SID). Twenty papers were selected and studied. Having been applied in 9 studies, The Trans Theoretical Model (TTM) was the most widespread model in Iran (PENDER in 3 studies, BASNEF in 2, and the Theory of Planned Behavior in 2 studies). With regards to the educational methods, almost all studies used a combination of methods. The most widely used Integrative educational method was group discussion. Only one integrated study was done. Behavior maintenance was not addressed in 75% of the studies. Almost all studies used self-reporting instruments. The effectiveness of educational methods was assessed in none of the studies. Most of the included studies had several methodological weaknesses, which hinder the validity and applicability of their results. According to the findings, the necessity of need assessment in using models, epidemiology and methodology consultation, addressing maintenance of physical activity, using other theories and models such as social marketing and social-cognitive theory, and other educational methods like empirical and complementary are suggested.