Adult physical inactivity prevalence in the Muslim world: Analysis of 38 countries

Type 2 Diabetes and Risk Factors in an Adult Population in Oujda, Eastern Morocco: A Cross-Sectional Observational Study

Objectives The rapidly increasing prevalence of diabetes makes it a public health concern. Adopting a healthier lifestyle can prevent or delay the onset of type 2 diabetes (T2D), the most common type of diabetes, and its complications. The aim of this study is to determine the prevalence of diabetes at the level of local health centers in the prefecture of Oujda, Morocco, and its relationship with obesity, physical activity, and sociodemographic factors. Methodology In a cross-sectional study in first-line health centers, sociodemographic and bioclinical data were collected through convenient purposive sampling using anthropometric and blood glucose measurements and structured, comprehensible interview questionnaires. The International Physical Activity Questionnaire (IPAQ) questionnaire was used to measure the physical activity of the patients. The association of T2D with age, gender, education, occupation, obesity, and physical activity was analyzed. Results Out of 535 observed patients, 510 were included, mostly female with a minimum age of 18 years, with a prevalence of T2D of 16%. More than half of the patients were illiterate (56%) and 83% had no occupation. Obesity was prevalent, especially among diabetics, and only a minority were physically active according to WHO targets. Thirty-six percent of all patients and 46% of diabetics reported low levels of physical activity. Age and obesity were the main factors associated with T2D. Conclusion Obesity and T2D have a high prevalence in the Oujda region. A balanced diet and regular physical activity remain our best recommendations for preventing this disease. Special attention should be paid to women with diabetes in Arab countries so that they can actively participate in prevention activities.

Identifying risk factors and mortality rate of premature coronary artery disease in young Saudi population

Coronary artery disease is a leading cause of morbidity and mortality worldwide. It occurs due to a combination of genetics, lifestyle, and environmental factors. Premature coronary artery disease (PCAD) is a neglected clinical entity despite the rising number of cases worldwide. This study aimed to investigate the risk factors of premature coronary artery disease. In this study, we searched articles that had studied the risk factors of premature coronary artery diseases from January 2000 to July 2022 in Saudi Arabia in Web of Science, Pub Med, Scopus, Springer, and Wiley databases. The final analysis is based on seven articles. The smoking prevalence was 39%, diabetes mellitus 41%, hypertension 33%, overweight and obesity 18%, family history of coronary artery disease (CAD) 19%, dyslipidemia 37%, and the prevalence range of low-density lipoprotein cholesterol was 33.8-55.0%. The results revealed a mortality prevalence of 4% ranging from 2 to 8% which is similar to the prevalence in older patients which was 2-10%. Smoking, diabetes mellitus, hypertension, family history of CAD, dyslipidemia, and overweight/obesity are significantly and positively associated with premature coronary artery diseases. The health authorities should design and implement an intensive and effective prophylactic plan to minimize the subsequent impact of PCAD on the young population. In addition, early diagnosis of PCAD has great value in providing timely treatment, managing the patients, and minimizing the burden of the disease.

Physical activity and odds of coronary heart disease among Lebanese women

BACKGROUND

It is known that physical activity (PA) is protective against cardiovascular morbidity and mortality. However, few studies have examined the association between PA, sedentary lifestyle and coronary heart disease (CHD) in women. This case-control study investigates the relationship between PA and sedentary behavior on CHD odds in Lebanese women over forty.

METHODS

One thousand five hundred selected Lebanese women (300 cases and 1200 controls) were included between 2018-2019. Cases were hospitalized women newly diagnosed with CHD, whereas the control groups were free of any heart diseases. Data on socio-demographic, lifestyle, cardiovascular factors, PA and sedentary lifestyle were collected. Multivariate logistic regressions, adjusted for covariates, were performed to investigate the association of PA domains and sedentary behavior with CHD.

RESULTS

A sedentary lifestyle combined with low activity levels increased the odds of CHD. Among cases, 46.7% participated in moderate or vigorous PA against almost 60.3% of controls. 36.3% of coronary patients had more than 10 h/day of sedentary time, with a positive correlation with CHD (adjusted OR: 1.533, 95%CI: 1.046-2.247). Conversely, moderate and high levels (respectively 600-3000 and ≥ 3000 metabolic equivalents [MET]-minutes/week) of domestic/garden PA revealed lower CHD odds (OR: 0.566, 95%CI: 0.396-0.808 and 0.193, 0.065-0.578 respectively). The detrimental influence of sedentary lifestyle appeared to be significantly reversed by weekly moderate PA, especially as weekly sedentary time was less (OR: 0.616, 95%CI: 0.427-0.888/ 6 to10h of sedentary time and OR: 0.537, 95% CI: 0.37-0.779/ ≤ 6 h), and except sedentary time exceeding 10 h daily. Two PA patterns revealed lower CHD odds: transport-related and domestic/garden PA, as early as low amount, even after adjustment for possible confounders.

CONCLUSION

The current study highlights the importance of combating sedentary behaviors and engaging in regular, easily accessible PA to reduce the odds of coronary disease among aging women. Therefore, better information regarding the benefits of physical activities such as transportation-related activities or gardening would be helpful in enhancing the prevention of CHD in aging women.

Association of sociodemographic, anthropometric, and sleep quality factors with accelerometer-measured sitting and physical activity times among Emirati working women during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

Although a significant lack of physical activity has been linked to an increase in obesity among Emirati women, the factors associated with accelerometer-measured sitting and physical activity times in Emirati women remain unclear.

OBJECTIVES

To explore the association of accelerometer-measured sitting and physical activity times with sociodemographic, anthropometric, and sleep quality factors among Emirati working women.

DESIGN

A cross-sectional study.

METHODS

A convenience sample of 163 healthy working Emirati women aged 18-45 years was used. Sedentary and physical activity times were measured using the Fibion accelerometers worn on the thighs for 4-7 days. General demographic information, anthropometric measurements, and self-reported sleep quality (Pittsburgh sleep quality index score) were collected. Only participants who had valid data (i.e. wear time of ⩾600 min (10 h) per day for a minimum of 4-7 days) were evaluated. All values were normalized to a 16-h day to mitigate differences in wear time among the participants.

RESULTS

Overall, 110 Emirati women were included. The mean sitting time per 16-h day was 11.6 ± 1.1 h; mean moderate activity time per day, 40.88 ± 17.99 min; and mean vigorous activity time per day, 2.41 ± 1.21 min. Longer sitting time was associated with high body fat, secondary education, and divorce. Sitting time was reduced in those with good sleep quality. Moderate-to-vigorous physical activity time was increased in women with postgraduate education and was decreased in women with a longer work experience and with comorbidities. The total activity time increased with increasing age and good sleep quality, whereas it decreased with increasing body fat, presence of at least one comorbidity, secondary education, and divorce.

CONCLUSION

Certain demographic, anthropometric, and sleep quality factors were associated with accelerometer-measured sitting and physical activity times among Emirati working women. Future longitudinal studies should consider these factors when investigating predictors of physical activity levels in this population.

Physical Inactivity Prevalence in the Islamic World: An Updated Analysis of 47 Countries

BACKGROUND

Physical inactivity prevalence estimates for youth and adults have been published on a global scale and for various geographical and geopolitical permutations. Only one such study has presented estimates for adults in Muslim countries, and it is nearly 10 years old. I conducted an update of this study by incorporating newer data, refining methods, and including youth estimates.

METHODS

I identified 47 Muslim countries with physical inactivity data for youth, adults, or both. Data were extracted by country primarily from global estimates reported by Guthold et al in 2018 and 2020 and from World Health Organization surveillance data repositories. Weighted prevalence calculations for total prevalence and by sex, ethnicity (Arab vs non-Arab), and country income group accounted for country population, study sample size, and a country's proportion of Muslims. Z tests and chi-square tests, and follow-up odds ratios and percentage deviations, respectively, were used to determine differences by sex, ethnicity, and country income group.

RESULTS

Overall physical inactivity prevalence was 84.2% (youth) and 29.6% (adults). Gaps favoring males over females were observed for youth (5.6% lower prevalence) and adults (9.6% lower prevalence). Gaps favoring non-Arabs over Arabs were observed for youth (3.9% lower) and adults (3.8% lower). No pattern emerged for country income group for youth; however, prevalence for adults trended upward across income groups from low (22.7%) to high (62.0%).

CONCLUSIONS

Gaps by sex and ethnicity have narrowed since the original report and prevalence values are somewhat higher than current global estimates.

Psychosocial characteristics are associated with adherence to dietary, drugs and physical activity recommendations amongst cardiovascular disease patients in Lebanon

Cardiovascular diseases are increasing at an alarming rate worldwide, reaching epidemic proportions in countries of the Eastern Mediterranean Region, including Lebanon. Despite the growing number of patients suffering from cardiovascular diseases in Lebanon, there is scarce data on whether cardiac patients adhere to therapeutic dietary guidelines, drug prescriptions, and physical activity recommendations and whether such adherence differs according to sociodemographic, lifestyle, or psychosocial characteristics. A cross-sectional study was conducted among 367 Lebanese adult cardiovascular disease patients admitted for hospitalization at various hospital sites in Lebanon. Electronic medical records and a multi-component questionnaire were used to collect information on patients' characteristics. Dietary assessment was performed using a culture-specific validated food frequency questionnaire, and physical activity levels were assessed using the international physical activity questionnaire (IPAQ). Mental well-being was assessed based on the validated five-item well-being index (WHO-5), and drug adherence was evaluated using the Morisky medication adherence scale (MMAS-8). The majority of the patients were males (67.8%), overweight or obese (74%), smokers (62.1%), and unemployed or retired (54.5%). Almost 35% of the patients were lonely, and nearly one fourth were at a high risk of poor mental health. Approximately 43%, 70%, and 52% of the patients were found to have poor adherence to diet, drug, and physical activity recommendations, respectively. A lower sense of mental well-being was a significant predictor of low dietary and drug adherence. Surprisingly, overweight and obesity were associated with higher odds of dietary adherence. Male gender was positively associated with physical activity while loneliness was inversely associated with physical activity. This study showed that adherence to diet, drug, and physical activity recommendations was low in this patient population and identified several non-clinical characteristics that may affect adherence. These findings highlighted the need for considering patients' psychosocial characteristics in the treatment of patients with cardiovascular diseases.

Association of Sociodemographic Factors with Physical Activity and Sleep Quality in Arab and Non-Arab Individuals of Both Sexes during the COVID-19 Pandemic

We explored the association of sociodemographic and anthropometric factors with self-reported physical activity (PA) and sleep quality in Arab and non-Arab individuals of both sexes during the COVID-19 pandemic. In this cross-sectional study, 638 participants (those recovered from COVID-19 = 149, and non-infected = 489) of both sexes aged 18-55 years were recruited. Their sociodemographic and anthropometric information, PA (self-reported using the International Physical Activity Questionnaire Short-form [IPAQ-SF)]) and sleep quality (self-reported using the Pittsburgh Sleep Quality Index [PSQI]) were documented. The association between participants' characteristics, PA levels, and sleep quality were determined using the chi-squared test. Variables significantly associated with IPAQ and PSQI in bivariate analyses were included in a multivariate binary logistic regression model. Men were more active than women (odds ratio [OR] = 1.66, p = 0.010), and non-Arab participants were more active than Arab ones (OR = 1.49, p = 0.037). Participants ≥40 years, men, non-Arab participants, and those who were working were more likely to have a good sleep quality than those ≤40 years (OR 1.70, p = 0.048), women (OR 1.10, p = 0.725), Arab individuals (OR 1.95, p = 0.002), and unemployed people (OR 2.76, p = 0.007). Male and non-Arab participants seemed to have a better self-reported PA and sleep quality compared to female and Arab participants, during the pandemic.

Daily step counts before, during, and after COVID-19 pandemic: a smartphone-tracking study of university students in Egypt and Saudi Arabia

BACKGROUND

COVID-19 pandemic has drastically changed people's lifestyles and daily routines around the world. This study aimed to investigate changes in daily step counts - as an indicator of physical activity - before, during, and after the pandemic among university students in Egypt and Saudi Arabia and to identify regional and gender factors that may have influenced physical activity during these periods.

METHODS

A total of 1273 university students from Egypt (Assiut University and Zagazig University) and Saudi Arabia (Taif University, King Faisal University, and Imam AbdulRahman Bin Faisal University) provided valid data on their daily step counts recorded by a smartphone application (iPhone Health App) from January 2019 to December 2021. The data was divided and averaged based on three periods: the pre-pandemic year (January to December 2019), the first pandemic year (January to December 2020), and the second pandemic year (January to December 2021).

RESULTS

The results showed a significant decrease in daily steps from pre-pandemic to the first pandemic year, followed by an increase in the second pandemic year. However, daily step counts did not fully recover to pre-pandemic levels in male Egyptian and marginally in male Saudi participants. In both nationalities, female participants did not show a significant difference in daily steps between the pre-pandemic and second-pandemic years. Female Egyptian participants had significantly lower daily step counts than male Egyptian participants, and a gender difference in daily steps was also observed in Saudi female participants in the pre-pandemic and the second pandemic year but not during the first pandemic year.

CONCLUSION

These findings outline the need for strategies in Egypt and Saudi Arabia to promote physical activity and reduce sedentary behavior, especially among young women, to mitigate the negative consequences of COVID-19 and meet physical activity guidelines.

School-based physical activity interventions among children and adolescents in the Middle East and Arabic speaking countries: A systematic review

BACKGROUND

It is widely recognised that noncommunicable diseases are on the rise worldwide, partly due to insufficient levels of physical activity (PA). It is a particularly concerning health issue among children and adolescents in Arabic countries where cultural and environmental factors may limit their opportunity for engaging in physical activities.

AIM

This review sought to assess the effectiveness of school-based PA interventions for increasing PA among schoolchildren aged six to 18 years in Middle Eastern and Arabic-speaking countries.

METHODS

A systematic literature search was developed to identify studies reporting the evaluation of school-based PA interventions in Arabic-speaking countries. Four different databases were searched from January 2000 to January 2023: PubMed/MEDLINE, Web of Science, Scopus and CINAHL. Article titles and abstracts were screened for relevance. Full article scrutiny of retrieved shortlisted articles was undertaken. After citation searches and reference checking of included papers, full data extraction, quality assessment and narrative synthesis was undertaken for all articles that met the inclusion criteria. This review adhered to PRISMA guidelines for conducting systematic reviews.

RESULTS

Seventeen articles met the inclusion criteria. Eleven articles reported statistically significant improvements in the levels of PA among their participants. Based largely on self-reported outcomes, increases in PA between 58% and 72% were reported. The studies with a follow-up period greater than three months reported sustained PA levels. There are a limited range of types of programmes evaluated and evaluations were only identified from 30% of the countries in the region. Relatively few studies focused solely on PA interventions and most of the interventions were multi-component (lifestyle, diet, education).

CONCLUSIONS

This review adds to the existing body of research about the efficacy of school-based interventions to increase physical activity levels. To date, few evaluations assess PA specific interventions and most of the interventions were multi-component including education components on lifestyle and diet. Long-term school-based interventions combined with rigorous theoretical and methodological frameworks are necessary to develop, implement and evaluate PA interventions for children and adolescents in Arabic-speaking countries. Also, future work in this area must also consider the complex systems and agents by which physical activity is influenced.

Assessment of physical activity level, self-efficacy and perceived barriers to physical activity among adult Saudi women

Objectives

Generally, physical activity (PA) is accepted to have a crucial role in sustaining and improving individuals' health. Consequently, it is considered a viable solution to the public health challenge of chronic diseases, particularly as sedentary behaviour is becoming a considerable concern worldwide. Therefore, this study focused on PA levels among adult Saudi women, and assessed the effects of self-efficacy, socio-demographic characteristics and perceived barriers on PA level.

Methods

This study used a quantitative cross-sectional descriptive design involving a self-reported web-based survey. The sample included 509 Saudi women recruited through purposive sampling. Data were collected with validated pre-existing questionnaires. The information provided by participants included their PA levels, self-efficacy and perceived barriers to PA.

Results

The survey's completion rate was 51%. Analysis of the study sample responses indicated that the participants' had high levels of PA: 54% participated in vigorous PA, whereas 30% had insufficient PA (less than 600 MET m/week). In the sample, self-efficacy was moderate, and simple regression indicated that self-efficacy significantly affected the levels of PA (p = 0.001). The leading barriers to PA were a lack of resources and willpower. However, multiple regression indicated that only lack of willpower (p = 0.004), fear of injury (p = 0.043) and environmental barriers (p = 0.021) significantly influenced PA levels. Moreover, demographic characteristics had no significant effects on PA levels.

Conclusion

A large proportion of the study sample demonstrated sufficient levels of PA. Psychological determinants, including self-efficacy and willpower, significantly correlated with performance. The physical environment was also found to be a highly influential factor. These findings have implications for future initiatives and health promotion strategies targeted at Saudi women. The knowledge gained may be used to design theory based interventions for improving self-efficacy and willpower, while considering strategies for overcoming barriers to PA.

Determination of Multiple Cancer Risk Behaviors Among Adult Population in Turkey: A Cross-sectional Study

Background: Modifiable cancer risk behaviors are general not seen alone but in combination in individuals. Purpose: This study aims to investigate the factors associated with combinations of cancer risk behaviors, including tobacco use, obesity, and low physical activity that cause cancer in adults. Methods: A total of 720 adults were selected using the multi-stage cluster sampling method. Data were collected using the World Health Organization STEP-wise protocols. Results: It was found that 46.9% of the participants showed one, 46.3% two or more types of risk behavior. The percentage of married individuals was higher among those who engaged in one, two, or three risky behaviors than those who did not engage in risky behaviors. Among participants with two risk behaviors, the percentage of those who rated their health as very good was lower than those without risk behaviors; those who had friends or relatives with cancer were high. Those who engaged in three risk behaviors were less educated and had lower incomes than those who did not engage in risk behaviors. Conclusions: Health intervention strategies should be increased in primary health care institutions for individuals who are married, has low level of education and income and has weak perception of health.

Improvement in cardio-metabolic health and immune signatures in old individuals using daily chores (Salat) as an intervention: A randomized crossover study in a little-studied population

Background

Decline in cardio-metabolic health, immunity, and physical activity is associated with old age. Old people also find it difficult to engage in structured exercise programs. Therefore, there is a need to investigate common daily chores as an alternative for exercise that may also help in maintaining cardio-metabolic and immune health.

Objective

We aimed to investigate whether Salat, an obligatory Islamic prayer involving various physical movements and closely resembling yoga, enhances the benefits conferred by the current guidelines for physical activity.

Methods

A total of 30 overweight adults (mean (SD) age of 53.5 (8.7) years) participated in this study. For a 4-week duration, we compared the effects of Salat before/after meals (Pre-MS/Post-MS) on selected immunological and metabolic parameters in serum samples. We also compared the effects of both Pre-MS/Post-MS regimens in young and old subjects to observe any age-related effects.

Results

Most of the baseline metabolic parameters and the count of immune cells were normal. Post-MS resulted in a significant reduction in body weight and percent body fat (%BF). Overall, Post-MS resulted in a clear leukocytosis with a significant increase in granulocytes, monocytes, and lymphocytes. When analyzing the lymphocyte compartment, a clear numerical increase was noted for T, B, and NK cells. The number of CD8+ T cells showed a statistically significant increase. Similarly, Post-MS induced leukocytosis in both young and old individuals, while the increase in granulocytes, monocytes, and lymphocytes was statistically significant in old subjects only.

Conclusion

This study demonstrated that the Islamic obligatory and congressional Salat practice is capable of mimicking desirable pro-immune and pro-metabolic health effects.

Clinical trial registration

(UMIN000048901).

Significantly different roles of economic affluence in sex-specific obesity prevalence rates: understanding more modifications within female body weight management

Socioeconomic status has been associated with obesity prevalence increase in both males and females worldwide. We examined the magnitude of the difference between the two relationships and explored the independence of both relationships. Country specific data on gross domestic product (GDP) per capita, sex-specific obesity prevalence rates, urbanisation, total calories availability and level of obesity, genetic background accumulation (measured by the Biological State Index, I_bs) were obtained for 191 countries. Curvilinear regressions, bivariate and partial correlations, linear mixed models and multivariate linear regression analyses were used to examine the relationship between GDP and obesity prevalence rates in males and females respectively. Fisher’s r-to-z transformation, F-test and R² increment in multivariate regression were used to compare results for males and females. GDP significantly correlated with sex-specific obesity prevalence rates, but significantly more strongly with male obesity prevalence in bivariate correlation analyses. These relationships remained independent of calories availability, I_bs and urbanization in partial correlation model. Stepwise multiple regression identified that GDP was a significant predictor of obesity prevalence in both sexes. Multivariate stepwise regression showed that, when adding GDP as an obesity prevalence predictor, the absolute increment of R² in male fit model (0.046) was almost four (4) times greater than the absolute increment in female model fit (0.012). The Stepwise analyses also revealed that 68.0% of male but only 37.4% of female obesity prevalence rates were explained by the total contributing effects of GDP, I_bs, urbanization and calories availability. In both Pearson’s r and nonparametric analyses, GDP contributes significantly more to male obesity than to female obesity in both developed and developing countries. GDP also determined the significant regional variation in male, but not female obesity prevalence. GDP may contribute to obesity prevalence significantly more in males than in females regardless of the confounding effects of I_bs, urbanization and calories. This may suggest that aetiologies for female obesity are much more complex than for males and more confounders should be included in the future studies when data are available.

Assessment of physical activity and its facilitators and barriers among Syrian refugees living in Amman City, Jordan: a cross-sectional study

BACKGROUND

Physical inactivity is one of the major risk factors for non-communicable diseases. Few studies about physical activity have been conducted among refugees from neighbouring countries. Given changes in the situation of Syrians, assessment of physical activity among Syrian refugees is required to understand their situation. This study aimed to evaluate the degree of self-reported physical activity and to identify perceived facilitators of and barriers to physical activity among Syrian refugees living in Amman, Jordan, in 2017.

METHODS

This community-based cross-sectional study was conducted using a structured questionnaire and the short form of the International Physical Activity Questionnaire. Participants were eligible for the study if they were Syrian refugees aged 18-64 years, living in Amman city, and were either registered with the United Nations High Commissioner for Refugees, waiting for their registration, or had a service card issued by the Jordanian Ministry of Interior. The relationship between physical activity level and sex was assessed using the chi-square test and Cochran-Armitage tests. The Mann-Whitney U test was performed to assess the relationship between the median metabolic equivalent scores of physical activity and gender. Backward stepwise logistic regression analysis was used to analyse the association between predictors of physical inactivity and physical activity level.

RESULTS

Among the 173 participants, the majority (91.9%) reported moderate to a high level of physical activity, and 8.1% were physically inactive. The metabolic equivalent scores for the walking activity of males (median: 1039.5, IQR: 0, 2772) was significantly higher than that of females (median: 396, IQR: 0, 1188) (p < 0.01). "Perceived change in the amount of physical activity" was a significant predictor of physical inactivity (adjusted OR = 3.00; 95%CI: 1.27-7.26). Common facilitators of physical activity were "psychological wellbeing"(49.7%) and "prevent diseases"(46.8%). The greatest barriers to physical activity were "time limitation"(43.4%) and "high cost"(57.8%).

CONCLUSION

This study revealed the physical activity level among Syrian refugees in Amman. The perceived facilitators and barriers to physical activity identified among Syrian refugees were similar to those in previous studies conducted among non-refugees. These results provide a valuable baseline for future examinations of physical activity level and to verify its possible facilitators and barriers.

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.

Using a Socio-Environmental Approach to Explore the Determinants for Meeting the Recommended Physical Activity among Adults at Risk of Diabetes in Rural Indonesia

Moderate-to-vigorous physical activity (PA) is recommended to mitigate the risk of diabetes. This study explored the PA of adults at risk for diabetes in rural Indonesia and determined the requirements for meeting the recommended PA level. In total, 842 adults were screened using a diabetes risk test in a rural health centre; among them, 342 were at risk of diabetes. The level of PA was assessed using the International Physical Activity Questionnaire, whereas the associated factors underlying the three domains -individual, support, and environment-were determined by the Influences on Physical Activity Instrument. The data analysis included a three-step multiple linear regression (MLR) and logistic regression (LR). Overall, 40.6% of the participants met the recommended PA. According to the MLR analysis, among males, individuals who gave PA a higher priority and had enough time to perform PA were predicted to have a higher activity energy expenditure (MET-minutes per week). According to the LR analysis, men were more likely to meet the recommended PA, and people who gave PA a lower priority and had less access to space for PA were less likely to meet the recommended PA level. Strategies for promoting PA in rural Indonesia include focusing on women, people who prioritize PA less, and those who have less time and space in which to be physically active.

Efficacy of lifestyle intervention program for Arab women with prediabetes using social media as an alternative platform of delivery

AIMS/INTRODUCTION

This 6-month interventional study aimed to investigate the effectiveness of different educational programs among Saudi women with prediabetes referred by primary care.

MATERIALS AND METHODS

A total of 253 (100 group education program [GEP], 84 WhatsApp education program [WEP] and 69 control group [CG]) eligible participants were invited to take part in the study, out of whom 120 received intervention (40 GEP, 43 WEP and 37 CG). GEP participants received focused, individualized lifestyle modification advice with bimonthly support sessions, WEP participants received the same intervention, but delivered through social media (WhatsApp). The CG received standard care. Anthropometrics, biochemical profiles and macronutrient intake were measured at baseline, and 3 and 6 months. The primary end-points were glycated hemoglobin and weight, with lipids and dietary changes as secondary outcomes.

RESULTS

Glycated hemoglobin significantly improved in all groups post-intervention (GEP baseline 6.0 ± 0.2 vs 6 months 5.5 ± 0.54; P < 0.001, WEP 6.0 ± 0.26 vs 5.3 ± 0.51; P < 0.001, CG 6.0 ± 0.37 vs 5.7 ± 0.49; P < 0.001), but with no difference in between-group comparisons (P = 0.33). Within-group comparisons showed a reduction in weight, but only in the GEP group (90.6 kg ± 27.3 vs 84.8 kg ± 24.3; P < 0.01), and this was significant in between-group comparison (P = 0.003). Significant between-group comparisons with respect to energy (g) intake (P = 0.005) were also observed, as well as triglycerides (P < 0.001) and low-density lipoprotein cholesterol (P = 0.001), all in favor of the GEP group.

CONCLUSIONS

Diabetes prevention programs, whether delivered through a focused educational group, social media or standard care, are equally efficacious in improving glycated hemoglobin levels among Saudi women with prediabetes, but a focused educational group was more effective in terms of successful weight loss.

Translation, cross cultural adaptation, and construct validation of the Arabic version of the Frenchay Activities Index in people with multiple sclerosis

BACKGROUND AND PURPOSE

Assessing functional status in people with multiple sclerosis (PwMS) has a major role in determining how to help patients to reach their optimal level of living independently in the community. The Frenchay Activity Index (FAI) is a commonly used scale to evaluate functional status in rehabilitation research and practice settings. The aim of this study was to translate the FAI into the standard Arabic language through the process of cross-cultural adaptation and to explore the internal consistency and construct validity of the produced Arabic version of FAI (A-FAI) among a sample of Arabic-speaking PwMS.

METHOD

The English version of the FAI was translated into Arabic according to the published guidelines. Cronbach's α was used to assess the internal consistency of the A-FAI, and principal factor analysis was conducted to explore the construct validity.

RESULTS

Hundred and six subjects participated in the study. The A-FAI has acceptable internal consistency as Cronbach's α was 0.70. The principal factor analysis revealed that the instrument has four main factors: domestic chore, leisure, hobbies, and work, rather than the original three factors scale.

DISCUSSION

The A-FAI has acceptable internal consistency and validity. A-FAI provides essential information about the participation level in instrumental activities of daily living activities among PwMS speaking the Arabic language.

Socio-Economic and Demographic Correlates of Non-communicable Disease Risk Factors Among Adults in Saudi Arabia

Background: Over the past two decades, Saudi Arabia has made significant improvements in its population's health standards. These improvements have been coupled with an increase in risk factors related to non-communicable diseases (NCD) and a dramatic shift in the burden of disease profile. This study aims to provide empirical evidence on the socio-economic and demographic correlates of NCD risk factors among adults in Saudi Arabia.

Methods: The data used for this study is secondary data derived from the Saudi Health Interview Survey (SHIS) conducted in 2013. The SHIS used a cross-sectional survey design to derive a multistage representative sample of adults to estimate the prevalence of NCD risk factors. Risk factors considered for analyses in this study were; current tobacco use, low fruit and vegetable consumption, low physical activity, overweight/obesity and hypertension. The survey covered all regions in Saudi Arabia using probability proportional to size measures. A total of 10,735 adults aged 15 years and above completed the survey questionnaire. Logistic regression analysis was conducted to examine the socio-economic and demographic correlates of NCD risk factors among adults in Saudi Arabia.

Results: The prevalence of NCD risk factors were as follows: current tobacco use, 12.1%; low fruit and vegetable consumption, 87%; low physical activity, 94.9%; overweight/obesity 65.1%; and hypertension, 37.5%. The multivariate analysis results indicate that significant correlates of overweight/obesity and hypertension were being female, a government employee, income level, and education levels. On the other hand, current tobacco use and low fruit and vegetable consumption were generally associated with age, self-employment and being a student. For lifestyle factors, overweight/obesity was high among individuals who reported low fruit and vegetable consumption, while hypertension was high among current tobacco users and overweight/obese adults. All comparisons were statistically significant at p < 0.05.

Conclusions: This study's findings indicate a high prevalence of chronic NCD risk factors in Saudi Arabia's adult population. This study implied that there is a need for a reduction in life-damaging behaviors among the adults through the adoption of healthy lifestyles such as physical activity and nutritious diets. Moreover, a reduction in the prevalence of chronic NCD risk factors among different socio-economic groups in Saudi Arabia through healthy lifestyles will have far-reaching results.

Relationship between diabetes self-care practices and control of periodontal disease among type2 diabetes patients in Bangladesh

INTRODUCTION

The prevalence of periodontal disease is high in diabetes patients worldwide, including Bangladesh. Although associations of periodontal disease outcomes and clinical determinants of diabetes have been investigated, few studies have reported on the relationship between periodontal diseases outcomes with modifiable factors, such as self-care and oral hygiene practices, in patients with diabetes. Moreover, in order to develop targeted strategies, it is also important to estimate their aggregated contribution separately from that of the established sociodemographic and diabetics related clinical determinates. Therefore, this study was performed to elucidate 1) the relationship of diabetes patients' self-care and oral hygiene practices to periodontal disease and 2) the relative contributions of selected factors to periodontal disease outcome in type 2 diabetes patients.

METHODS

The data were obtained from the baseline survey of a multicentre, prospective cohort study. A total of 379 adult patients with type 2 diabetes from three diabetic centres in Dhaka, Rajshahi and Barishal, received periodontal examinations using the community periodontal index (CPI) probe, glycated haemoglobin examination, other clinical examinations, and structured questionnaires. Multiple logistics regression analyses were performed to assess the associations between selected factors and prevalence of any periodontal disease and its severity.

RESULTS

More than half of the participants were female (53.8%) and 66.8% of the total participants was 21-50 years old. The prevalence of any (CPI code 2+3+4; 75.7%) and severe form (CPI code 4; 35.1%) of periodontal disease were high in type 2 diabetes patients. In multivariate analysis, the odds of periodontal disease increased with unfavourable glycaemic control indicated by HbA1c ≥ 7%, and decreased by 64%, 85% and 92% with adherence to recommended diet, physical activity, and oral hygiene practices, respectively. Diabetes self-care practice explained the highest proportion of the variance (13.9%) followed by oral hygiene practices (10.9%) by modelling any periodontal disease versus no disease. Variables of diabetes conditions and oral hygiene practices explained 10.9% and 7.3% of the variance by modelling severe (CPI code 4) or moderate (CPI code 3) forms of periodontal disease versus mild form of periodontal disease. Findings also conferred that while poor diabetes control had an individually adverse association with any form of periodontal diseases and its severity, the risk of diseases was moderated by oral hygiene practices.

CONCLUSIONS

This study suggested that, in addition to diabetes-related clinical determinants, self-care practices, and oral hygiene practices must be taken into consideration for prevention and control of periodontal disease in patients with diabetes.

Sedentary Behaviour among Urban Civil Servants in Eastern Part of Southern Nations, Nationalities and Peoples' Region, Ethiopia

BACKGROUND

Active lifestyle is a determining factor for functional and clinical health that protects and maintains both physical and mental health of an individual, whereas sedentary lifestyle is a contrary vital cause for higher premature mortality, heart disease, diabetics, and poorer quality of life. This study is aimed at determining the amount of time spent on sedentary activity and identifying sedentary behaviours frequently practiced by civil servants in Southern Ethiopia in 2015.

METHODS

It was a cross-sectional study which employed both qualitative and quantitative approach. A stratified cluster sampling method was used to select 375 office workers (222 men and 153 women) from Hawassa, Wolayta Soddo, and Dilla ranging from 18-65 years old. Data were collected using harmonized self-reporting LASSA (Longitudinal Aging Study Amsterdam) questionnaires and prevalence estimates of mean sedentary time in each 12 activities per day were determined. Descriptive and inferential statistics such as Independent t-test, Uni-variate ANOVA, and Person's correlation were used to analyze association and predictability of IV on DV variables.

RESULT

The total mean time spent sitting per day was 13.39 h which was 81.5% of weak time. Collectively, screen time was dominant (6.08). About 70.7%, 23.7%, 4.8%, and 0.8% of respondents were levelled very high, high, moderate, and less sedentary, respectively. In general, women accounted higher sedentary level (96.1%) than men (93.3%) in sedentary activity. There is a weak positive correlation between age and time spent in an administrative task. Income and mealtime were statistically significant (r < 0.2, n = 375, p < 0.05).

CONCLUSION

The high level of self-reported sedentary time record suggests the need for public health policies targeted at increasing physical activity and decreasing sitting time through systemic intervention in and out of work.

Factors Associated with an Unhealthy Lifestyle among Adults in Riyadh City, Saudi Arabia

BACKGROUND

Unhealthy lifestyles are a global concern. This study measured the prevalence and factors associated with an unhealthy lifestyle in Riyadh city, Saudi Arabia.

METHODS

An interview-based, cross-sectional study was conducted with 968 males and 2029 females, aged 30-75 years, covering 18 primary health care centers in Riyadh. Multivariate logistic regression analyses were conducted to identify the significant determinants associated with an unhealthy lifestyle.

RESULTS

Overall, men were 1.49 (1.28, 1.74) times at higher risk of an unhealthy lifestyle compared to women. Men reporting unhealthy lifestyle were 2.1 (1.3, 3.4) and 1.5 (1.0, 2.6) times more likely than men with healthy lifestyle to cite not enjoying physical activity, lack of social support, and not having enough information about a healthy diet [1.5 (1.0, 2.0)], whereas those ≥ 45 years age group were 30 times less likely to report unhealthy lifestyle [0.7 (0.5, 0.9)]. In contrast, in women aged ≥ 45 years [1.3 (1.1, 1.7)], lack of motivation [1.3 (1.1, 1.7)], feeling conscious while exercising [2.0 (1.4, 2.9)], not enjoying healthy food [1.6 (1.3, 2.1)], and no family support to prepare healthy food [1.4 (1.1, 1.8)] were significantly associated with an unhealthy lifestyle.

CONCLUSIONS

In a Saudi sample, younger men and older women are at higher risk of an unhealthy lifestyle. In addition to self-motivation, combined strategies to promote physical activity and healthy eating are required to improve lifestyle.

Overweight and obesity among women of reproductive age in Mali: what are the determinants?

Background

Existing evidence suggests that there has been a surge of overweight and obesity in low- and middle-income countries around the world. In this study we investigated the prevalence and factors associated with overweight and obesity among women in Mali.

Methods

We conducted the study among 5198 women using the 2018 Mali Demographic and Health Survey data. We used binary logistic regression for the analysis and pegged statistical significance at p<0.05.

Results

The prevalence of overweight and obesity was 26.9%. The likelihood of overweight and obesity was high among women 40–44 y of age (adjusted odds ratio [AOR] 5.94 [confidence interval {CI} 4.10 to 8.60]), those who were widowed/divorced/separated (AOR 1.59 [CI 1.04 to 2.43]), those with secondary education (AOR 1.41 [CI 1.13 to 1.75]), richest women (AOR 3.61 [CI 2.63 to 4.95]), those who watched television at least once a week (AOR 1.28 [CI 1.07 to 1.52]) and those who lived in the Kidal region (AOR 10.71 [CI 7.05 to 16.25]). Conversely, the likelihood of overweight and obesity was low among women who belonged to other religions compared with Muslims (AOR 0.63 [CI 0.43 to 0.92]).

Conclusions

This study found a predominance of overweight and obesity among women in Mali. The study showed that age, marital status, education, religion, region of residence, wealth status and frequency of watching television are associated with overweight and obesity among women in Mali. It is therefore critical for public health promotion programs in Mali to sensitize people to the negative effects associated with overweight and obesity. This implies that policies aimed at controlling overweight and obesity in Mali must take these factors into consideration.

The Role of Diet on Insulin Sensitivity

Growing evidence shows that dietary composition has a marked impact on the risk of developing obesity, type 2 diabetes (T2D), cardiovascular disease (CVD), certain types of endocrine cancer and many other intertwined metabolic and reproductive disorders, all featured by insulin resistance (IR) [...].

A Qualitative Exploration of Immigrant Muslim Older Adults' Experiences and Perceptions of Physical Activity

Physical activity is essential for healthy aging; however, there has been little exploration of physical activity in Muslim older immigrants in Canada. Over one million Canadians identify as Muslim, the majority is first-generation immigrants, with increasing cohorts entering older age. A community-based participatory research project on healthy aging was conducted with 68 older adults and community members from South Asian, Arab, and African Muslim ethnocultural communities in a Canadian urban center. A combination of individual interviews and focus groups discussions were completed, followed by thematic analysis of data. Participating community groups emphasized the importance of physical activity in older age and prioritized the need for physical activity programs. The four themes highlight Muslim older immigrants' perspectives on physical activity in Canada: (a) values and approaches to staying active; (b) health factors: pain and health limitations; (c) social factors: culture, religion, and belonging; and (d) environmental factors: safety and accessibility.

Physical activity interventions promoted in the Arabic-speaking region: A review of the current literature

The Arabic-speaking region suffers from insufficient levels of physical activity (PA). Assessing the effectiveness of PA interventions presents a scientifically evaluated method to reduce and prevent the current high burden of noncommunicable diseases affecting this region. This review examined implemented PA interventions and corresponding measured health outcomes in this region. The review was limited to studies prior to January 2020 using nine electronic academic databases. Only intervention-focused articles incorporating PA as the primary intervention or as a component of a multibehavioural intervention were included. Thirty-nine PA intervention studies were identified. Published PA interventions were implemented among 50% of the countries in the region. Seventy percent of the studies were conducted in the Gulf region and 25% in North Africa. A third of the studies was designed for children and adolescents. Accordingly, 40% of interventions were for patients living with comorbidities. Seventy percent of the studies included PA as part of a multidisciplinary intervention. Most studies included body mass index as an outcome parameter. Significant improvement (P < .05) in measured health outcomes was seen in 97% of studies. Thorough analysis includes social and culturally congruent aspects of the PA interventions and discussion of resultant health outcomes. This information furthers the understanding of effective PA interventions that can be adapted to target sedentary lifestyle behaviours in this region.

Prevalence and Associations of Metabolic Syndrome in an Urban High Diabetes Risk Population in a Low/Middle-Income Country

Background: We aimed to assess the burden of metabolic syndrome (MetS), and evaluate the phenotypic variation of MetS in a population at high risk for diabetes in urban Karachi, Pakistan. Methods: This study was embedded in a lifestyle intervention trial for the prevention of type 2 diabetes mellitus. The study population comprised participants who belonged to urban households in Karachi, Pakistan. Results: Among 15,590 individuals who were screened through diabetes risk score (DRS), 3945 individuals met the criteria for a high DRS (≥60). After excluding 1780 participants due to refusals and ineligibility, 2165 were enrolled, a total of 1188 subjects (54.9%) met the International Diabetes Federation criteria for MetS, and a total of 1199 subjects (55.4%) participants met the US National Cholesterol Education Program. Raised serum triglycerides (TGs) and low high-density lipoprotein (HDL) cholesterol were significantly associated with MetS. On multivariate logistic regression, higher body mass index levels (obese category: odds ratio [OR] = 2.14, 95% confidence interval [CI] 1.56-2.95), age >44 years (OR = 2.64, 95% CI 1.93-3.60), and family history of diabetes in both parents (OR = 1.71, 95% CI 1.15-2.54) were found to be independently associated with MetS, whereas higher education (OR = 0.78, 95% CI 0.57-1.06) and physical activity levels (OR = 0.74, 95% CI 0.57-0.96) had lower odds of MetS. Conclusion: One in two individuals with a high DRS in an urban low/middle-income country setting met the criteria for MetS. Patients with atherogenic dyslipidemia defined as low HDL and high TGs represent unique subphenotypes of MetS in this population.

Adverse influence of multilevel socioeconomic status on physical activity: results from a national survey in Vietnam

BACKGROUND

This study aims to explore associations of individual- and provincial-level socioeconomic status (SES) and the combined interaction among these SES with individual physical activity (PA).

METHOD

This analyze used data of 3068 Vietnamese people aged 18-65 years from the national representative STEPS survey in 2015 (STEPS2015). The survey collected PA-related data using the Global PA Questionnaire Version 2 and those on provicial-level characteristics from two surveys in 2014, namely the Intercensal Population and Housing Survey (IPHS) and The Vietnam Household Living Standard Survey (VLSS2014). Multilevel linear analyze was performed with individual and provincial characteristics as independent variables and the metabolic equivalent (MET) score - the indicator of individual PA - as the dependent variable.

RESULTS

Male and female participants with insufficient PA accounted for 20.2 and 35.7%, respectively. Both individual- and provicial-level SES were inversely associated with the individual PA level. As the provincial-level monthly income increased by 1 million Vietnam Dongs, the total PA score of individuals residing in that province reduced by 1900 METS. A buffering effect was reported between provincial and individual SES, as the provincial average income increased, the differences in PA scores between different SES groups decreased.

CONCLUSION

Our data suggest that Vietnamese individuals in low SES groups tended to be more physically active than those in high SES groups because their PA was largely related to work.

Mediators of the association between low socioeconomic status and poor glycemic control among type 2 diabetics in Bangladesh

Although low socioeconomic status (SES) is related to poor glycemic control, the underlying mechanisms remain unclear. We examined potentially modifiable factors involved in the association between low SES and poor glycemic control using data from the baseline survey of a multicenter, prospective cohort study. Five hundred adult type 2 diabetes patients were recruited from three diabetes centers. Glycemic control was poorer in diabetic individuals with low SES than in those with higher SES. Adverse health-related behaviors, such as non-adherence to medication (adjusted odds ratio [AOR] = 1.07, 95% confidence interval [CI] 1.04–1.13) and diet (AOR = 1.04, 95% CI 1.02–1.06); existing comorbidities, such as depressive symptoms (AOR = 1.05, 95% CI 1.04–1.09); and non-adherence to essential health service-related practices concerning diabetes care, such as irregular scheduled clinic visits (AOR = 1.04, 95% CI 1.03–1.06) and not practicing self-monitoring of blood glucose (AOR = 1.05, 95% CI 1.03–1.07), mediated the relationship between social adversity and poor glycemic control specially in urban areas of Bangladesh. Those identified factors provide useful information for developing interventions to mitigate socioeconomic disparities in glycemic control.

Why Don’t People Ride Bicycles in High-Income Developing Countries, and Can Bike-Sharing Be the Solution? The Case of Qatar

Although cycling is increasing in developed regions, such as Europe and North America, high-income developing countries in the Arabian Gulf region still have low cycling activities. Limited research has investigated the barriers to cycling in these countries. In this study, the barriers and motivators in Qatar, a high-income developing country, were investigated. Respondents were asked to report their bicycle usage during the last 12 months. The results indicated that approximately 15% used a bicycle during this period, but only 1.7% bicycled for transportation purposes. The analysis revealed the different barriers to cycling and their relative strengths. The study also compared the perceived challenges of cycling between males and females. The questionnaire results indicated that both groups considered the issues related to the weather conditions, bicycle ownership, lack of paths or connections, and driver behavior as important barriers to cycling. However, the female participants identified clothing, parental consent, and cultural and societal pressure as far more important. When asked about motivators for cycling, the results revealed that improving intersections, adding additional infrastructure facilities, planting trees for shading, affordable bicycles, and campaigns targeting potential cyclists and drivers are needed in order to increase cycling. To better understand how bike-sharing will be perceived if implemented in the future, the feedback was obtained from the participants, and their opinions indicated that there is a great deal of acceptance for this type of service. The outcome of this study can be of benefit to public agencies in developing countries that have the goal of increasing cycling use among their populations.

Pattern of physical exercise practice among university students in the Kingdom of Saudi Arabia (before beginning and during college): a cross-sectional study

Background

Transition to college is characterized by change, ambiguity, and adjustment compared to the previous lifestyle before entering college. Our study aimed was to determine the pattern of students’ physical exercise practices in the Kingdom of Saudi Arabia in the period before and during college attendance.

Methods

A cross-sectional study was conducted among university students from fifteen universities in the Kingdom of Saudi Arabia on August 2017. The data were collected using an electronic questionnaire that was modified from questionnaires used in previous studies. Statistical analysis and data entry was performed with SPSS version 21. This study was approved by the Research Ethics Committee at King Abdulaziz University.

Results

417 college students completed the questionnaire and 77.2% were female. Slightly more than half of the participants (55.9%) were from King Abdulaziz University, and 59.7% were from healthcare specialties from different institutions. The mean age of the participants was 21.80 years old (SD = 2.75). The pattern of practicing physical exercise showed a significant decrease after enrollment in college (p = 0.000). The most common reason for not practicing exercise was time restrictions, accounting for 18.5% of all the reasons, while the most common reason for practicing exercise was to improve body shape, accounting for 48% of all the reasons.

Conclusions

Our research found that there was a significant decrease in doing regular exercise during one’s college years in comparison to the school years prior to college. To address the decrease in physical exercise, we recommend organizing and promoting more awareness campaigns and providing suitable sports facilities and infrastructure.

Critical Appraisal of Qualitative Studies of Muslim Females' Perceptions of Physical Activity Barriers and Facilitators

Muslim women’s perceptions of cultural, religious, and secular determinants of physical activity have been studied for many years, with information typically acquired through focus groups or interviews. Multiple reviews synthesizing the research have been published, however, individual studies have not been scrutinized for their quality/rigor. Therefore, I critically appraised the quality of the body of qualitative research studies that utilized focus groups to identify Muslim women’s perceptions of physical activity barriers and facilitators. I utilized 26 items from the Consolidated Criteria for Reporting Qualitative Research (COREQ) to assess the quality of 56 papers published between 1987 and 2016. Using crosstabulations, I also examined associations between paper quality (low vs. high) and binary categorical variables for impact factor, maximum paper length allowed, publication year, and database the paper was indexed. Overall, papers averaged only 10.5 of 26 COREQ reporting criteria and only two out of 26 items were reported in more than 75% of the papers. Paper quality was not associated with impact factor and length. High quality papers were more likely published more recently (i.e., 2011 or later) and in journals indexed in the PubMed database compared to low quality papers. There is contention among qualitative researchers about standardizing reporting criteria, and while the trend in quality appears to be improving, journal reviewers and editors ought to hold authors to greater accountability in reporting.

The Correlation Between Bladder Cancer and Obesity, Overweight, Physical Inactivity, and Tobacco Use: An Ecological Study in Asian Countries

BACKGROUND

Bladder cancer is the ninth most common cancer in the world.

OBJECTIVES

This study aimed to determine the correlation between age-standardized incidence rates of bladder cancer and some risk factors in Asian countries through an extensive ecological analysis.

METHODS

This ecological study evaluated the correlation between age-standardized incidence rates of bladder cancer and obesity, overweight, physical inactivity, and tobacco use in 30 Asian countries. To determine the factors that were significantly related to age-standardized incidence rate of bladder cancer, a univariate analysis was performed using simple linear regression. In the next step, variables with p-values less than 0.25 were entered into a multivariate linear regression model.

RESULTS

The incidence of bladder cancer was higher in countries with higher prevalence of overweight (r2 = 0.36, p < 0.001), obesity (r2 = 0.34, p = 0.001), current daily tobacco use (r2 = 0.17, p = 0.03), and physical inactivity (r2 = 0.13, p = 0.04). The results of multiple regression analysis indicated a direct correlation between the incidence of bladder cancer and overweight (β = 0.15, p < 0.001) and current daily tobacco use (β = 0.21, p = 0.001).

CONCLUSIONS

There was a significant relationship between the incidence of bladder cancer and overweight and current daily tobacco use. Further epidemiological studies are needed to confirm this relationship.

Identification of Education Models to Improve Health Outcomes in Arab Women with Pre-Diabetes

Few evaluations of interventions to delay or prevent type 2 diabetes mellitus (T2DM) in Saudi Arabia (SA) have been undertaken. The present study evaluates the impact of a 6-month intensive lifestyle modification intervention delivered in primary care. Females from SA with prediabetes, aged 18–55 years, were recruited with 190 participants eligible following screening and randomly allocated to receive a 3-month one-on-one, intensive lifestyle modification (intervention group (IG) n = 95) or standard guidance (control group (CG) n = 95). Participants completed questionnaires including demographic, dietary and physical activity data. Blood samples were collected at baseline, 3 and 6 months. A total of 123 (74 IG (age 40.6 ± 9.8 years; body mass index (BMI) 31.2 ± 7.0 kg/m²) and 49 CG (age 40.6 ± 12.7 years; BMI 32.3 ± 5.4 kg/m²)) participants completed the study. After 6 months, haemoglobin A1c (HbA1c; primary endpoint) significantly improved in the IG than CG completers in between-group comparisons (p < 0.001). Comparison between groups showed significant improvements in overall energy intake, total and high density lipoprotein (HDL)-cholesterol in favour of IG (p-values < 0.001, 0.04 and <0.001, respectively). BMI and weight change were not clinically significant in between group comparisons. A 6-month, intense one-on-one intervention in lifestyle modification significantly improves glycaemic and cardio metabolic profile of females living in SA with pre-diabetes delivered in a primary care setting. Longer duration studies, using the same intervention, may determine whether a meaningful weight loss secondary to improved diet can be achieved.

Association of Overweight and Obesity with High Fast Food Consumption by Gulf Cooperation Council Medical Students

Fast food and sugar-sweetened soft drink consumption, adiposity, and physical activity behavior were determined through a cross-sectional study with 251 medical students from the Gulf Cooperation Council countries. Approximately 38% of the students were overweight or obese, and 56.2% consumed fast food in the past 24 h. Main reasons for consuming fast foods were lack of time to cook healthy food (51%), pleasant taste (26%) and the influence of family and friends (15%). Overweight status or obesity was more prevalent among males (50%), those having greater knowledge about calories in fast-food meals (51.6%), who checked fast food calories before eating (47.7%) or overestimated the amount of sugar in a soft drink (17.82 ± 26.59 spoons). Overweight or obese participants also performed more moderate physical activity (1.73 ± 2.08 days per week) compared to those with normal weight or underweight (p = <0.05). Fast food consumption can be curtailed by improving the availability of and access to healthier foods and implementing behavior change and regulatory interventions.

Proportion of cancers attributable to major lifestyle and environmental risk factors in the Eastern Mediterranean region

Cancer is a major contributing cause of morbidity and mortality in the Eastern Mediterranean region. The aim of the current study was to estimate the cancer burden attributable to major lifestyle and environmental risk factors. We used age-, sex- and site-specific incidence estimates for 2012 from IARC's GLOBOCAN, and assessed the following risk factors: smoking, alcohol, high body mass index, insufficient physical activity, diet, suboptimal breastfeeding, infections and air pollution. The prevalence of exposure to these risk factors came from different sources including peer-reviewed international literature, the World Health Organization, noncommunicable disease Risk Factor Collaboration, and the Food and Agriculture Organization. Sex-specific population-attributable fraction was estimated in the 22 countries of the Eastern Mediterranean region based on the prevalence of the selected risk factors and the relative risks obtained from meta-analyses. We estimated that approximately 33% (or 165,000 cases) of all new cancer cases in adults aged 30 years and older in 2012 were attributable to all selected risk factors combined. Infections and smoking accounted for more than half of the total attributable cases among men, while insufficient physical activity and exposure to infections accounted for more than two-thirds of the total attributable cases among women. A reduction in exposure to major lifestyle and environmental risk factors could prevent a substantial number of cancer cases in the Eastern Mediterranean. Population-based programs preventing infections and smoking (particularly among men) and promoting physical activity (particularly among women) in the population are needed to effectively decrease the regional cancer burden.

Epidemiology of coronary artery disease and stroke and associated risk factors in Gaza community -Palestine

AIM OF STUDY

To determine the prevalence of cardiovascular disease and associated risk factors in the population of Gaza strip in Palestine.

METHODS

A cross-sectional stratified cluster sample design was applied in this study. A sample of 2240 participant (1121 males and 1119 females) aged ≥25 years participated in the study. For each individual, trained staff administered a questionnaire, where all variables of interest followed WHO's STEP wise approach to surveillance chronic disease risk factors (STEPS) (WHO, 2001). Sociodemographic data, anthropometric measure (body mass index, blood pressure), and biochemical test (blood sugar and lipids profiles) were measured. Short International Physical Activity (IPAQ) questionnaire form was used. Bivariate analysis and logistic regression were used with SPSS (version 22.0) to analyze the data.

RESULTS

The most common condition was coronary artery disease (8.3%), followed by stroke events (3%). The associated risk factors were obesity (47.8%), hypertension (28.4%), current smoking account for (23.2%), diabetes mellitus (19.1%), high cholesterol level (8.8%), and high triglycerides level (40.2%). Additionally, the proportion of being physical active was found to be low (48.3%); particularly with increasing age. More than 30% of the population has less than 4 days of consumption of fruit and vegetables per week and 65.9% has less than 2 servings per day.

CONCLUSION

The burden of CVDs and their associated risk factors is considerable in Gaza and represents a major public health concern. Effective strategies in management, education and healthcare centers are required for an accurate management and implementation of preventive measure in this area.

Motor ability and working memory in Omani and German primary school-aged children

This study investigated the motor ability and working memory performance of Omani and German primary school-aged children. One hundred eighty-five children from public schools participated in a gross motor test that integrated whole body coordination, three different ball tasks, and a 20-meter run. Furthermore, they completed four working memory tests (the Digit-Span Test forward and backwards and the Corsi Block-Tapping Test forward and backwards). Two MANOVAS with the different motor and working memory tests and one univariate analysis of the general motor ability with the between-subject factors group and gender were conducted. Additionally, correlations between motor ability and working memory scores were executed. German children outperformed Omani children in the overall measurement of motor ability, (p = .01) and all aspects of working memory, (all p< .015). There were no correlations between motor and cognitive variables, when analyzing the results for the Omani and German children separately. These findings may be a result of different educational styles or socioeconomic status and must be investigated in more detail.

Counting Footsteps with a Pedometer to Improve HMW Adiponectin and Metabolic Syndrome among Young Female Adults in the United Arab Emirates

Introduction

Physical activity (PA) may improve cardiometabolic fitness and increase high-molecular-weight adiponectin (HMW-Adip). The pedometer is an effective, user-friendly device to monitor PA with the aim of improving health. This study examined how counting footsteps, using a pedometer, might affect HMW-Adip and MetS components among young females.

Methods

Fifty-two females (21.43 ± 4.8 years) were divided into "normal" (BMI = 18-24.9 kg/m2) and "high" (BMI ≥ 25 kg/m2) BMI groups. Participants wore pedometers throughout the day for nine weeks. Pre-post intervention tests performed on anthropometric, biochemical, and nutrient intake variables were tested at p ≤ 0.05.

Results

Participants walked 7056 ± 1570 footsteps/day without a significant difference between normal (7488.49 ± 1098) and high (6739.18 ± 1793) BMI groups. After week 9, the normal BMI group improved significantly in BMI, body fat mass (BFM), and waist-hip ratio (WHR). Additionally, percent body fat, waist circumference (WC), and visceral fat area also reduced significantly in the high BMI group. A significant decrease in triglycerides (TG) (71.62 ± 29.22 vs. 62.50 ± 29.16 mg/dl, p=0.003) and insulin (21.7 ± 8.33 µU/l vs. 18.64 ± 8.25 µU/l, p=0.046) and increase in HMW-Adip (3.77 ± 0.46 vs. 3.80 ± 0.44 μg/ml, p=0.034) were recorded in the high BMI group. All participants exhibited significant inverse correlations between daily footsteps and BMI (r=-0.33, p=0.017), BFM (r=-0.29, p=0.037), WHR (r=-0.401, p=0.003), and MetS score (r=-0.49, p < 0.001) and positive correlation with HMW-Adip (r=0.331, p=0.017). A positive correlation with systolic (r=0.46, p=0.011) and diastolic (r=0.39, p=0.031) blood pressures and inverse correlation with the MetS score (r=-0.5, p=0.005) were evident in the high BMI group.

Conclusion

Counting footsteps using a pedometer is effective in improving MetS components (obesity, TG) and increasing HMW-Adip levels.

Physical Activity Programming Advertised on Websites of U.S. Islamic Centers: A Content Analysis

Previous research has found churches to be effective at delivering physical activity (PA) programs to their congregants. Mosques, however, have not been extensively studied. Therefore, we quantified U.S. Islamic centers' advertisement of PA programming and examined their programming characteristics. We conducted a content analysis of the websites of 773 eligible Islamic centers of which 206 centers in 32 states advertised PA programming. We categorized PA by program type: camping, fitness classes, sports, youth programs, and irregular offerings. We calculated descriptive statistics by program type for specific activity, frequency/duration/volume, participant/instructor sex, and instructor religion. Youth group (44%) and sports (23%) programs were most and least frequently advertised, respectively. Most centers (66%) that posted information on PA programming advertised only one program type. Men and Muslims taught most activities. Most activities-except for fitness classes-were advertised to a male audience. Islamic centers should offer and advertise additional PA programming-especially for women-and better utilize their websites for promoting such programming. Individual Islamic centers and Islamic- and non-religion based public health agencies can utilize our findings to fashion future PA offerings.

Relaxed natural selection contributes to global obesity increase more in males than in females due to more environmental modifications in female body mass

OBJECTIVE

Relaxed natural selection, measured by Biological State Index (Ibs), results in unfavourable genes/mutations accumulation in population. Obesity is partly heritable. We aim to examine and compare the effects of relaxed natural selection on male and female obesity prevalence.

METHODS

Data for 191 countries of the world were captured for this ecological study. Curvilinear regressions, bivariate and partial correlations, linear mixed models and multivariate linear regression analyses were used to examine the relationship between Ibs and sex-specific obesity prevalence. Per capita GDP, urbanization and caloric intake were controlled for as the confounding factors. Fisher r-to-z transformation, R2 increment in multivariate regression and F-test were used to compare the correlations.

RESULTS

Curvilinear regressions, bivariate and partial correlations (controlled for GDP, urbanization and calories) revealed that Ibs was significantly correlated to obesity prevalence of both sexes, but significantly stronger to male than to female obesity prevalence. Curvilinear regression models also showed strong correlations. Mixed linear models, with effects of GDP, urbanisation and caloric intake controlled for, showed that male and female average obesity prevalence rates were significantly higher in countries with greater Ibs value than their equivalents in countries with lower Ibs. Between higher and lower Ibs countries, the gap of male obesity prevalence is 60% greater than the gap of female obesity prevalence. Stepwise multiple regression identified that Ibs was a significant predictor of obesity prevalence of both sexes. Multivariate regression showed that, adding Ibs as an obesity predictor, R2 increment in male model was significantly greater than in female model.

CONCLUSIONS

Relaxed natural selection may drive males and females to accumulate metabolic faulty genes equally. Probably due to greater environmental, personal intervention in regulating female body mass, relaxed natural selection shows less contributing effects to female obesity prevalence than to male obesity prevalence. Gene therapy to prevent obesity may need to be also taken into account.

Physical inactivity, gender and culture in Arab countries: a systematic assessment of the literature

Background

Physical inactivity is associated with excess weight and adverse health outcomes. We synthesize the evidence on physical inactivity and its social determinants in Arab countries, with special attention to gender and cultural context.

Methods

We searched MEDLINE, Popline, and SSCI for articles published between 2000 and 2016, assessing the prevalence of physical inactivity and its social determinants. We also included national survey reports on physical activity, and searched for analyses of the social context of physical activity.

Results

We found 172 articles meeting inclusion criteria. Standardized data are available from surveys by the World Health Organization for almost all countries, but journal articles show great variability in definitions, measurements and methodology. Prevalence of inactivity among adults and children/adolescents is high across countries, and is higher among women. Some determinants of physical inactivity in the region (age, gender, low education) are shared with other regions, but specific aspects of the cultural context of the region seem particularly discouraging of physical activity. We draw on social science studies to gain insights into why this is so.

Conclusions

Physical inactivity among Arab adults and children/adolescents is high. Studies using harmonized approaches, rigorous analytic techniques and a deeper examination of context are needed to design appropriate interventions.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5472-z) contains supplementary material, which is available to authorized users.

The ticking time bomb in lifestyle-related diseases among women in the Gulf Cooperation Council countries; review of systematic reviews

BACKGROUND

This study aims to review all published systematic reviews on the prevalence of modifiable cardiovascular disease risk factors among women from the Gulf Cooperation Council countries (GCC). This is the first review of other systematic reviews that concentrates on lifestyle related diseases among women in GCC countries only.

METHOD

Literature searches were carried out in three electronic databases for all published systematic reviews on the prevalence of cardiovascular disease risk factors in the GCC countries between January 2000 and February 2016.

RESULTS

Eleven systematic reviews were identified and selected for our review. Common reported risk factors for cardiovascular disease were obesity, physical inactivity, diabetes, metabolic syndrome and hypertension. In GCC countries, obesity among the female population ranges from 29 to 45.7%, which is one of the highest rates globally, and it is linked with physical inactivity, ranging from 45 to 98.7%. The prevalence of diabetes is listed as one of the top ten factors globally, and was reported with an average of 21%. Hypertension ranged from 20.9 to 53%.

CONCLUSIONS

The high prevalence of lifestyle-related diseases among women population in GCC is a ticking time bomb and is reaching alarming levels, and require a fundamental social and political changes. These findings highlight the need for comprehensive work among the GCC to strengthen the regulatory framework to decrease and control the prevalence of these factors.

Cardiovascular health among two ethnic groups living in the same region: A population-based study

BACKGROUND

Poor cardiovascular health (CVH) among ethnic/racial minorities, studied primarily in the USA, may reflect lower access to healthcare. We examined factors associated with minority CVH in a setting of universal access to healthcare.

METHODS AND RESULTS

CVH behaviors and factors were evaluated in a random population sample (551 Arabs, 553 Jews) stratified by sex, ethnicity and age. More Jews (10%) than Arabs (3%) had 3 ideal health behaviors. Only one participant had all four. Although ideal diet was rare (≤1.5%) across groups, Arabs were more likely to meet intake recommendations for whole grains, but less likely to meet intake recommendations for fruits/vegetables and fish. Arabs had lower odds of attaining ideal levels for body mass index and physical activity. Smoking prevalence was 57% among Arab men and 6% among Arab women. Having four ideal health factors (cholesterol, blood pressure, glucose, smoking) was observed in 2% and 8% of Arab and Jewish men, respectively, and 13% of Arab and Jewish women. Higher prevalence of ideal total-cholesterol corresponded to lower high-density lipoprotein cholesterol among Arabs. No participant met ideal levels for all 7 metrics and only 1.8% presented with 6. Accounting for age and lower socioeconomic status, Arabs were less likely to meet a greater number of metric goals (odds ratio (95% confidence interval): 0.62 (0.42-0.92) for men, and 0.73 (0.48-1.12) for women).

CONCLUSIONS

Ideal CVH, rare altogether, was less prevalent among the Arab minority albeit universal access to healthcare. Health behaviors were the main contributors to the CVH disparity.

Women in Saudi Arabia and the Prevalence of Cardiovascular Risk Factors: A Systematic Review

Background. Cardiovascular disease (CVD) is one of the leading causes of death in Saudi Arabia. Saudi women in particular are more susceptible as there are sociocultural restrictions on female physical activities that may lead to high prevalence of CVD risks, especially obesity, and physical inactivity. This study aims to systematically review the published articles related to the prevalence of CVD risk among women in Saudi Arabia. The search strategy covers all published articles that assess the risk factor of CVD in Saudi Arabia from January 2000 to December 2015, using the following sources: Medline, Embase, and PsycINFO. A total of 61 studies were included. Results. Prevalence among Saudi women of smoking ranged from 1.1% to 9.1%, hypertension was 21.8%, diabetes ranged from 9.6% to 27.6%, overweight was 27%, and obesity was 40.23%, and physical inactivity ranged from 53.2% to 98.1%. Hypercholesterolemia prevalence on Saudi women on average was 24.5%, while metabolic syndrome ranged from 13.6% to 40.3%. Conclusion. The prevalence of CVD risk factors is high among women in Saudi Arabia especially in obesity and physical inactivity. Public health authorities must implement solutions from a gender specific aspect to reverse the trend and decrease the prevalence of CVDs among Saudi women.

Variation in population levels of physical activity in European adults according to cross-European studies: a systematic literature review within DEDIPAC

BACKGROUND

Physical inactivity is a well-known public health risk that should be monitored at the population level. Physical activity levels are often surveyed across Europe. This systematic literature review aims to provide an overview of all existing cross-European studies that assess physical activity in European adults, describe the variation in population levels according to these studies, and discuss the impact of the assessment methods.

METHODS

Six literature databases (PubMed, EMBASE, CINAHL, PsycINFO, SportDiscus and OpenGrey) were searched, supplemented with backward- and forward tracking and searching authors' and experts' literature databases. Articles were included if they reported on observational studies measuring total physical activity and/or physical activity in leisure time in the general population in two or more European countries. Each record was reviewed, extracted and assessed by two independent researchers and disagreements were resolved by a third researcher. The review protocol of this review is registered in the PROSPERO database under registration number CRD42014010334.

RESULTS

Of the 9,756 unique identified articles, twenty-five were included in this review, reporting on sixteen different studies, including 2 to 35 countries and 321 to 274,740 participants. All but two of the studies used questionnaires to assess physical activity, with the majority of studies using the IPAQ-short questionnaire. The remaining studies used accelerometers. The percentage of participants who either were or were not meeting the physical activity recommendations was the most commonly reported outcome variable, with the percentage of participants meeting the recommendations ranging from 7% to 96% across studies and countries.

CONCLUSIONS

The included studies showed substantial variation in the assessment methods, reported outcome variables and, consequently, the presented physical activity levels. Because of this, absolute population levels of physical activity in European adults are currently unknown. However, when ranking countries, Ireland, Italy, Malta, Portugal, and Spain generally appear to be among the less active countries. Objective data of adults across Europe is currently limited. These findings highlight the need for standardisation of the measurement methods, as well as cross-European monitoring of physical activity levels.