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

The Effects of the Mamanet Cachibol League Intervention Program on Perceived Health Status, Mental Health, and Healthy Lifestyle Among Arab Women

Background: The Israeli Mamanet Cachibol League (MCL) is a community-oriented athletic program serving mothers through non-competitive recreational sports participation. This study aimed to assess the effects of the MCL on perceived health status, mental health (happiness, depression, social capital), and healthy lifestyle behaviors (physical activity and nutrition). Methods: This is an experimental study with a sample of 231 women (174 in the experimental group and 57 in the control). Participants completed questionnaires in November 2023 (T1) and then in August 2024 (T2). The questionnaire included questions on sociodemographic characteristics, perceived health status, mental health (happiness, depression, social capital), and healthy lifestyle behaviors (physical activity and nutrition). Results: At T1, the MCL participants reported better mental health (higher subjective happiness and social capital and lower depressive symptoms) than the control group. Over time, participation in the MCL led to significant improvements in mental health (reductions in depression and increases in subjective happiness and social capital). The participants showed substantial improvements in healthy lifestyle behaviors, with moderate effect sizes (effects size > 0.5) observed across these areas. Sociodemographic factors influenced the outcomes, with variations in health perception and physical activity linked to marital status and education level. Conclusions: Participation in the MCL program was associated with better mental health at baseline and significantly improved over time compared to the control group. The MCL participants also showed gains in healthy lifestyle behaviors, highlighting the importance of tailored interventions.

Effectiveness of nutrition interventions targeting university-level student populations across the League of Arab States: a systematic scoping review

The university setting is an ideal setting to implement nutrition education interventions. Because the transition to college life often overlaps with young adults' increase in independence in food choice and nutrition related behavior, this is an optimal time to target this population and several models exist to best utilize the college setting to support nutrition education interventions. This review aimed to examine the effectiveness of nutrition interventions in university student populations across the League of Arab States. A scoping review following the PRISMA-ScR guidelines was conducted across 14 databases for relevant publications published through May 2023 to find studies conducted across Arab countries. Quality assessment was conducted using the Effective Public Health Practice Project tool. Seven primary studies were included in this review. Although the interventions and outcome measures were disparate, there were positive impacts of the interventions, including improved nutrition knowledge and nutrition habits, knowledge of nutrient sources, and knowledge about the relationship between diet and disease. Recommendations to maximize the efficacy of nutrition interventions conducted across the League of Arab States include purposeful design of the intervention based on a theoretical framework, the use of a control group in the research design, and follow-up measures to examine post-intervention effects. Consideration should also be given to intervention duration and availability in college-students' schedules. Adaptation of intervention materials, measures and delivery methodologies should emphasize local foods, food culture and dietary practices.

Perceptions of Arabian Gulf Residents and Citizens about Physical Activity and Social Media Awareness Campaigns: A Qualitative Study

Physical activity (PA) is crucial for preventing chronic diseases, but in Gulf Cooperation Council (GCC) countries (Oman, Bahrain, Kuwait, Qatar, Saudi Arabia, and the United Arab Emirates), PA levels are lower than in developed countries. The Gulf Health Council's social media PA awareness campaign responded to the public's need for discussion and motivation on this topic. A qualitative study was conducted using semi-structured Zoom interviews with 19 participants from GCC countries between 21 September and 21 October 2021. It aimed to explore PA barriers, facilitators, and perceptions of awareness campaigns. Interviews were transcribed, coded, and analyzed thematically. Facilitators for PA included health value, self-efficacy, persistence, variety, familiar consequences, social support, behavior change techniques, time management, starting at young age, and enjoyment. Barriers encompassed outdoor restrictions, limited amenities, age and weight biases, gym-centric views, lack of proficiency, and injury risk. The study also examined social media awareness campaigns' effectiveness, identifying themes like engagement, acceptability, reach, design, presentation, and perceived outcomes. Results underscore the complexity of PA facilitators and barriers in the GCC, highlighting the need for campaigns addressing values, perceptions, social connections, and practical challenges, emphasizing the role of research and public policy in boosting PA levels.

Dietary Patterns and Fertility

Diet has a key role in the reproductive axis both in males and females. This review aims to analyze the impacts of different dietary patterns on fertility. It appears that the Mediterranean diet has a predominantly protective role against infertility, while the Western diet seems to be a risk factor for infertility. Moreover, we focus attention also on dietary patterns in different countries of the World (Middle Eastern diet, Asian diet). In particular, when analyzing single nutrients, a diet rich in saturated fatty acids, cholesterol, animal proteins, and carbohydrates with high glycemic index is highly associated with male and female infertility. Finally, we evaluate the effects of vegetarian, vegan, and ketogenic diets on fertility, which seem to be still unclear. We believe that comprehension of the molecular mechanisms involved in infertility will lead to more effective and targeted treatments for infertile couples.

A systematic review of school-based weight-related interventions in the Gulf Cooperation Council countries

BACKGROUND

The prevalence of childhood overweight and obesity has increased at alarming levels in the Gulf Cooperation Council (GCC) countries (Saudi Arabia, United Arab Emirates (UAE), Kuwait, Bahrain, Oman, and Qatar). Weight-related interventions are urgently required in these countries to tackle childhood overweight and obesity and their-related consequences. To date, no systematic review has synthesised school-based weight-related interventions in the six GCC countries. This study aims to systematically review school-based, weight-related interventions conducted in the GCC countries, investigating the intervention characteristics, components, and outcomes.

METHODS

Medline, Scopus, and ProQuest databases were searched for peer-reviewed literature published in English without date restriction and Google Scholar for grey literature using combined Medical Subject Heading (MeSH) terms and keywords under five relevant concepts including population, setting, interventions, outcomes, and geographical location. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), records were identified, screened for eligibility, and included in this review. Using the Effective Public Health Practice Project tool, the methodological quality of the included studies was assessed independently by two authors.

RESULTS

Out of 1303 initially identified records, eight peer-reviewed articles and three doctoral theses were included in this review. The age of the students in the included studies ranged between 5 to 19 years, and the sample sizes between 28 and 3,967 students. The studies included between one and thirty public and private schools. Of the included studies, six were randomised controlled trials, four pre-post studies and one used a post-study design. Only four of the eleven studies were theory based. The included studies reported various improvements in the students' weight or weight-related lifestyle behaviours, such as healthier dietary choices, increased physical activity, and decreased sedentary behaviour.

CONCLUSIONS

This review suggests the potential effectiveness of school-based interventions in the GCC countries. However, a thorough evaluation of these studies revealed significant methodological limitations that must be acknowledged in interpreting these results. Future studies in this field should be theory-based and use more rigorous evaluation methods.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42020156535.

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.

Virtual Behavioral Intervention to Promote Healthy Lifestyle Behaviors: A Feasibility RCT during COVID-19 Pandemic

BACKGROUND

the COVID-19 pandemic has had a substantial impact on human health, affecting many lifestyle behaviors such as physical activity, sedentary behavior, dietary habits and sleep.

PURPOSE

to assess the feasibility of six sessions of a virtual behavioral intervention to promote healthy lifestyle practices during a stay-at-home advisory phase of the COVID-19 pandemic.

METHODS

A participant-blinded randomized controlled trial was performed through a virtual platform setting. Participants were randomly assigned into two groups. They were assigned to a motivational interviewing (MI) intervention or attention group, with pre- and postintervention assessments. The MI treatment consisted of six sessions (twice each week). The same number of virtual structured sessions were provided for the attention group, and they provided brief advice to promote healthy lifestyles. The study was conducted from April to June 2020.

RESULTS

The feasibility outcomes indicated that 39 of the 50 participants (78%) completed the trial. The dropout rate was 21.7% for the attention group and 22.2% for the intervention group. Participating in MI had a significant positive interventional effect on physical activity level, distress and fear of COVID-19.

CONCLUSIONS

It is feasible to deliver behavioral change interventions virtually. Further, MI can be used as a useful strategy for the favorable promotion of a healthy lifestyle.

TRIAL REGISTRATION

NCT05392218 (26/05/2022).

Lifestyle Interventions for Prevention and Management of Diet-Linked Non-Communicable Diseases among Adults in Arab Countries

The increased incidences of diet-related non-communicable diseases (NCDs) such as diabetes, obesity, and cardiovascular diseases among adults are becoming the chief public health concern in most Arab countries. Economic expansion has contributed to a nutrition shift from a traditional seasonal diet to Westernized eating habits coupled with a sedentary lifestyle. Despite the rising concern for NCD mortality, public health policies are inadequately addressed. This narrative review aims to discuss the effectiveness of nutritional interventions focusing on diet and physical activity in the management of NCDs among Arab adults. A comprehensive literature search was performed using different database platforms such as Cochrane reviews, Scopus, and PubMed for articles published between 1 December 2012 and 31 December 2021. Fifteen recent research articles addressing NCDs, mainly diabetes and obesity, from different Arab countries were included in this review. Structured lifestyle interventions involving behavioral therapy approaches and personalized goals for diet and physical activity were found to improve specific health outcomes in most studies. Significant improvements in health outcomes were reported for longer-duration interventions with follow-ups. A combination of both online and face-to-face sessions was found to be effective. It is important to identify barriers to physical activity for a culturally acceptable lifestyle intervention and conduct further studies to evaluate interventions for the long-term maintenance of health outcomes.

A systematic review of interventions to promote physical activity in six Gulf countries

Physical activity (PA) levels are low in Gulf Cooperation Council countries (GCC; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates). We carried out a systematic review (PROSPERO registration number 131817) to assess the effect of interventions to increase PA levels in this region. We also assessed their effects on anthropometry and cardiovascular risk. A systematic search of six databases (Medline, EMBASE, SPORTDiscus, CINAHL, Cochrane, Web of Science) was performed to identify randomized and non-randomized intervention studies performed in adults and children published between January 1985 and November 2020. We included studies published in English or Arabic, and included PA interventions regardless of setting, delivery, and duration. The primary outcomes were changes in PA duration and intensity. Secondary outcomes included anthropometric measures (e.g., weight, body mass index) and cardiovascular risk profiles (e.g., lipid measures, blood glucose). Two independent reviewers screened studies in accordance with pre-determined criteria, extracted data, assessed risk of bias (Cochrane Risk of Bias 2 and Newcastle Ottawa Scale) and undertook a narrative synthesis. From 13,026 records identified, 14 studies were included. Nine studies focussed exclusively on changing PA behaviour, resulting in statistically significant increases in step count ranging from an additional 757 steps/day (95% confidence interval [CI] 0-1,513) to 3,853 steps/day (95% CI 3,703-4,002). Five identified studies were multi-component lifestyle interventions, targeting people at higher risk (due to obesity or type 2 diabetes). Evidence for increases in PA from multi-component studies was limited, although improvements were seen in outcomes e.g. body weight and blood lipid levels. In conclusion, relatively few studies have focussed on changing PA behaviour, despite the urgent need in the GCC. Limited evidence suggested that pedometer-based programmes encouraging step counting and walking were effective in promoting PA, at least in the short term. Policies to roll out such interventions should be implemented and evaluated.

Measurement and prevalence of adult physical activity levels in Arab countries

OBJECTIVES

This study aims to examine the reported prevalence of sufficient physical activity among adults in Arab countries and to determine the use of validated instruments for assessing physical activity.

STUDY DESIGN

This is a systematic literature review.

METHODS

This review follows recommendations outlined in the Meta-Analysis of Observational Studies in Epidemiology guidelines. The protocol for this study was preregistered with PROSPERO. Cross-sectional, cohort and intervention studies with a minimum of 300 adults aged ≥18 years assessing physical activity using a questionnaire or other self-report measure in the Arabic language were identified from seven electronic databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SPORTDiscu and PubMed). Databases were searched from 1st January 2008 to 17th September 2018. Descriptive analysis was performed using frequency and percentages. The prevalence of physical activity was calculated as the average prevalence for the reported percentages from the studies with similar tools.

RESULTS

Fifty studies involving 298,242 participants were included in this review. The mean (range) sample size was 5964.8.1 (323-197,681). Data were collected from participants in 16 of the 22 Arab countries. Great variation exists across the studies in determining whether adults were sufficiently active or not. Twenty studies reported usable data from the Global Physical Activity Questionnaire and the International Physical Activity Questionnaire (moderate & high categories). In these studies, prevalence of physical activity ranged from 34.2 to 96.9%. It was not possible to compare the other studies owing to variation in instruments used to assess physical activity and in the case definition used for 'physically active'.

CONCLUSIONS

This study highlights the need for wider reporting of physical activity and the adoption of valid and reliable instruments to support the development of evidence-informed policy and programmes at both country and regional level. International tools need to be correctly validated, or context-specific tools must be developed to accurately measure physical activity.

A systematic review of randomized controlled trials of dietary interventions for weight loss in adults in the Middle East and north Africa region

The prevalence and incidence of obesity, and associated complications, such as type 2 diabetes, in the Middle East and north Africa (MENA) region rank among the highest in the world. Little is known about the effectiveness of dietary weight loss interventions conducted in the MENA region. We conducted a systematic review of randomized clinical trials aiming to assess the effectiveness of dietary interventions for weight loss in the adult population originating from and residing in the MENA region. In accordance with PRISMA guidelines, PubMed, CINAHL, Cochrane, and EMBASE were systematically searched for randomized controlled trials (RCT) using dietary interventions for weight loss conducted in the MENA region. RCTs examining weight loss as an outcome in adults (≥ 18 years old) were included. The Cochrane Collaboration tool for assessing risk of bias was used to ascertain the quality of the eligible RCTs and the Template for Intervention Description and Replication for population health and policy interventions (TIDieR-PHP) checklist was used to evaluate the reporting of the interventions. Twenty-nine RCTs including 2792 adults from five countries in the MENA region met the search criteria. Study participants were predominantly middle-aged females. Duration of follow up was mostly 3 months or less. Weight loss ranged from -0.7 to 16 kg across all intervention groups and the average weight loss was 4.8 kg. There was paucity of description of the weight loss interventions and variations amongst studies did not allow a meta-analysis of findings. It was not possible to draw firm conclusions on the effectiveness of dietary weight loss interventions in the region. High quality studies using more structured interventions of longer duration with standardized outcome measures are needed in the MENA region to support clinical practice with evidence-based interventions for obesity.

A Qualitative Study of Barriers and Enablers of Physical Activity among Female Emirati University Students

Interventions to promote physical activity participation should reflect social and culturally relevant influences of the target demographic. The aim of this study was to explore perceptions of barriers to and enablers of physical activity participation among female Emirati university students. Five semi-structured focus groups were conducted (n = 25). Participants were asked open-ended questions about benefits, barriers and enablers of physical activity, and recommendations to promote participation. Emergent themes were identified using Nvivo software. Commonly identified benefits included improved health, weight management, improved mood, and stress reduction. The main barriers were low family support, competing time demands from domestic and academic activities, lack of convenient access to women-only facilities, and hot weather. The main enablers and recommendations related to social support from family and friends, accessible and low-cost women-only facilities, and structured supervised sessions. Findings suggest that there are specific social-cultural influences of physical activity among female Emirati university students. Approaches to promote participation could include identifying benefits consistent with family and cultural values, using social media for education, support and modelling, on campus supervised physical activity sessions integrated with the academic timetable, low-cost women-only opportunities in the local residential area, and support for home-based activities.