Physical activity among South Asian women: a systematic, mixed-methods review

Factors facilitating and hindering South Asian immigrant adults from engaging in exercise and physical activity - a qualitative systematic review

BACKGROUND

Exercise and physical activity are key components of management in patients with rheumatic musculoskeletal diseases (RMD), but people of the South Asian communities have a lower level of engagement with these activities compared to their Caucasian counterparts. The aim of this qualitative systematic review was to determine the barriers and facilitators of exercise and physical activity in South Asian communities who have migrated and live in western countries, particularly in those who have RMD.

METHODS

Qualitative studies, published in English between 1999 and 2021 and including evaluation of barriers and/or facilitators to exercise or physical activity behaviour in people of South Asian adult communities who have migrated and/or lived in western countries were identified from Embase, MEDLINE, CINAHL, PsycINFO, Google Scholar and manual searches. The studies were appraised using the CASP checklist. Inductive thematic synthesis was used to identify common and global themes.

RESULTS

A total of 32 studies that discussed barriers and facilitators of physical activity in South Asian communities who have migrated and lived in western countries were used for this review but there were no studies identified that focussed specifically on those with RMD. Following appraisal of the reporting of the studies, 30 studies were included in the pooling of the results. The facilitators and barriers to physical activities were broadly categorized into 'extrinsic' and 'intrinsic' factors. Extrinsic factors such as 'opportunity' included environmental factors such as weather and safety; socioeconomic factors such as education, language and literacy, and support in the form of social, psychological and resources. Intrinsic factors included cultural factors, such as life stages and family influence, beliefs and knowledge, which impacted attitudes and skills.

CONCLUSIONS

This review has synthesised evidence of barriers or facilitators and identified potentially modifiable factors influencing physical activity and exercise engagement, which could form the basis of evidence-based interventions to promote participation in healthy behaviour change. Provision of a safe, comfortable and culturally acceptable environment together with culturally-aligned cognitive strategies to facilitate acquisition of exercise-efficacy skills could help engagement.

REGISTRATION

The systematic review was registered on PROSPERO, registration no. 289,235.

Understanding the spectrum of cardiovascular risk in women - A primer for prevention

Cardiovascular disease (CVD) is the leading cause of death in women worldwide and the lifetime risk of CVD in women is similar to men. However, the pathophysiology of CVD varies between women and men necessitating a sex-specific understanding of cardiovascular (CV) risk. A belief that women have a lower CVD risk than men, and an underrepresentation in clinical research for many years has led to a paucity of evidence in the prevention and management of CVD in women. Many recent efforts have tried to bridge the gap. As a result, we now know that traditional risk factors impact CVD risk differently in women when compared with men. There are also numerous sex-specific and pregnancy related risk factors that modify the risk and can predict the future development of CVD in women. This is important as risk calculators, in general, tend to misclassify risk in young women with nontraditional CVD risk factors. To address this, guidelines have introduced the concept of risk enhancers that can suggest a higher risk. The use of coronary artery calcium score can further accurately delineate risk in these women, leading to an appropriate matching of therapy to underlying risk. This review discusses implementation strategies that are essential to mitigate disparities in CVD outcomes and optimizing CVD risk in women.

Characterizing Technology Use and Preferences for Health Communication in South Asian Immigrants With Prediabetes or Diabetes: Cross-Sectional Descriptive Study

BACKGROUND

Type 2 diabetes disproportionately affects South Asian subgroups. Lifestyle prevention programs help prevent and manage diabetes; however, there is a need to tailor these programs for mobile health (mHealth).

OBJECTIVE

This study examined technology access, current use, and preferences for health communication among South Asian immigrants diagnosed with or at risk for diabetes, overall and by sex. We examined factors associated with interest in receiving diabetes information by (1) text message, (2) online (videos, voice notes, online forums), and (3) none or skipped, adjusting for sociodemographic characteristics and technology access.

METHODS

We used baseline data collected in 2019-2021 from two clinical trials among South Asian immigrants in New York City (NYC), with one trial focused on diabetes prevention and the other focused on diabetes management. Descriptive statistics were used to examine overall and sex-stratified impacts of sociodemographics on technology use. Overall logistic regression was used to examine the preference for diabetes information by text message, online (videos, voice notes, or forums), and no interest/skipped response.

RESULTS

The overall sample (N=816) had a mean age of 51.8 years (SD 11.0), and was mostly female (462/816, 56.6%), married (756/816, 92.6%), with below high school education (476/816, 58.3%) and limited English proficiency (731/816, 89.6%). Most participants had a smartphone (611/816, 74.9%) and reported interest in receiving diabetes information via text message (609/816, 74.6%). Compared to male participants, female participants were significantly less likely to own smartphones (317/462, 68.6% vs 294/354, 83.1%) or use social media apps (Viber: 102/462, 22.1% vs 111/354, 31.4%; WhatsApp: 279/462, 60.4% vs 255/354, 72.0%; Facebook: Messenger 72/462, 15.6% vs 150/354, 42.4%). A preference for receiving diabetes information via text messaging was associated with male sex (adjusted odds ratio [AOR] 1.63, 95% CI 1.01-2.55; P=.04), current unemployment (AOR 1.62, 95% CI 1.03-2.53; P=.04), above high school education (AOR 2.17, 95% CI 1.41-3.32; P<.001), and owning a smart device (AOR 3.35, 95% CI 2.17-5.18; P<.001). A preference for videos, voice notes, or online forums was associated with male sex (AOR 2.38, 95% CI 1.59-3.57; P<.001) and ownership of a smart device (AOR 5.19, 95% CI 2.83-9.51; P<.001). No interest/skipping the question was associated with female sex (AOR 2.66, 95% CI 1.55-4.56; P<.001), high school education or below (AOR 2.02, 95% CI 1.22-3.36; P=.01), not being married (AOR 2.26, 95% CI 1.13-4.52; P=.02), current employment (AOR 1.96, 95% CI 1.18-3.29; P=.01), and not owning a smart device (AOR 2.06, 95% CI 2.06-5.44; P<.001).

CONCLUSIONS

Technology access and social media usage were moderately high in primarily low-income South Asian immigrants in NYC with prediabetes or diabetes. Sex, education, marital status, and employment were associated with interest in mHealth interventions. Additional support to South Asian women may be required when designing and developing mHealth interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03333044; https://classic.clinicaltrials.gov/ct2/show/NCT03333044, ClinicalTrials.gov NCT03188094; https://classic.clinicaltrials.gov/ct2/show/NCT03188094.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-019-3711-y.

Barriers and enablers to engagement in exercise and physical activity in non-English speaking South Asian people with chronic musculoskeletal disease

BACKGROUND

Exercise and physical activity (EPA) are recommended for people with chronic musculoskeletal disease; however, lower levels of engagement with EPA has been consistently reported in people from the South Asian community across a range of diseases. As language can pose a significant barrier in healthcare, this study aimed to understand the enablers and barriers to the acceptance of EPA among non-English speaking South Asian people who attended rheumatology clinics.

METHODS

12 non-English speaking individuals from the South Asian community who had chronic musculoskeletal disease with significant pain scores were interviewed via telephone or face-to-face in their spoken languages. The audio recordings of the interviews were translated into English and transcribed verbatim. Data was analysed using thematic analysis implemented in the NVivo 12 Pro software program.

RESULTS

The mean age was 52 years (9 women and 2 men). One main theme was identified: 'Enablers and barriers to exercise and physical activity'. Enablers to EPA were having knowledge about the benefits of EPA, being given resources in a language that they understood, and supportive environments such as having access to community facilities for those who could not undertake EPA in their houses. Barriers included physical health such as pain and fatigue, lack of time, difficulties with transportation to exercise venues, dislike of group exercises and lack of understanding of what and how to do exercise and be physically active. Participants' beliefs about EPA and whether they impacted their physical health seemed to influence whether they were undertaken or not. There was a perception that their culture shaped their compatriots' beliefs about EPA, and it was not normal practice for people from their country of birth to engage in it.

CONCLUSIONS

This is the first qualitative study to explore the barriers and enablers to engagement in EPA in non-English speaking South Asian people with chronic musculoskeletal disease. Modifiable factors such as addressing the level of knowledge on the benefits of EPA in the management of chronic joint and muscle pain; aiding the development of the skills required to exercise safely and confidently despite chronic pain and providing information and services in the native language could promote the EPA engagement of non-English speaking South Asian individuals with chronic musculoskeletal disease. The findings may inform improvements within clinical services to promote the benefits, impact and self-efficacy of engagement with EPA as part of chronic musculoskeletal disease management.

ETHICS APPROVAL

The West Midlands-Edgbaston Research Ethics Committee (reference:20/WM/0305).

Cross-Cultural Contact and Norwegian Language Skills Among Ethnic Minority Women in Norway, and Relationship with Physical Activity in Pregnancy and Postpartum: The STORK-Groruddalen Cohort Study

There are few studies of the migration context factors and physical activity (PA) level among minority ethnic women in Europe. We investigated the association between migration context factors and moderate to vigorous physical activity (MVPA) among minority ethnic women. Objectively recorded MVPA were obtained from 487 minority ethnic women included in the STORK-Groruddalen Cohort Study at three time points in pregnancy/postpartum. We investigated the associations between (a) contact with ethnic Norwegians and (b) Norwegian language skills and. No associations were observed in pregnancy. Postpartum, women who reported contact with ethnic Norwegians accumulated 17 MVPA min/day (95% CI: -.60, 34.54) more than women with no contact. In complete case analyses, this difference was significant (27 MVPA min/day (95% CI: 8.60, 44.54)). In early postpartum women with contact with ethnic Norwegians seems to be more physically active than women without contact. No associations were observed in pregnancy.

Reallocating time between device-measured 24-hour activities and cardiovascular risk in Asian American immigrant women: An isotemporal substitution model

The 24-hour day consists of physical activity (PA), sedentary behavior, and sleep, and changing the time spent on one activity affects the others. Little is known about the impact of such changes on cardiovascular risk, particularly in Asian American immigrant (AAI) women, who not only have a higher cardiovascular risk but also place greater cultural value on family and domestic responsibilities compared to other racial/ethnic groups. The purpose of this study was to evaluate the effects of reallocating 30 minutes of each 24-hour activity component for another on BMI, waist circumference, and blood pressure in AAI women. Seventy-five AAI women completed 7 days of hip and wrist actigraphy monitoring and were included in the analysis (age = 61.5±8.0 years, BMI = 25.5±3.6 kg/m2, waist circumference = 85.9±10.2 cm). Sleep was identified from wrist actigraphy data, and moderate-to-vigorous PA (MVPA), light PA, and sedentary behavior identified from hip actigraphy data. On average, the women spent 0.5 hours in MVPA, 6.2 hours in light PA, 10 hours in sedentary activities, and 5.3 hours sleeping within a 24-hour day. According to the isotemporal substitution models, replacing 30 minutes of sedentary behavior with MVPA reduced BMI by 1.4 kg/m2 and waist circumference by 4.0 cm. Replacing that same sedentary time with sleep reduced BMI by 0.5 kg/m2 and waist circumference by 1.4 cm. Replacing 30 minutes of light PA with MVPA decreased BMI by 1.6 kg/m2 and waist circumference by 4.3 cm. Replacing 30 minutes of light PA with sleep also reduced BMI by 0.8 kg/m2 and waist circumference by 1.7 cm. However, none of the behavioral substitutions affected blood pressure. Considering AAI women's short sleep duration, replacing their sedentary time with sleep might be a feasible strategy to reduce their BMI and waist circumference.

Culturally Tailored Strategies for Prenatal Physical Activity for South Asian Women: A Scoping Review

Low levels of physical activity (PA) are reported in South Asian pregnant women. This scoping review summarizes culturally tailored strategies in prenatal PA studies for South Asian women and identifies barriers and facilitators. A search strategy was developed with the keywords "Physical Activity" AND Pregnant AND "South Asian" and was carried out on Medline, SportDiscus, EMBASE, Web of Science and Proquest Theses and Dissertations. Primary research studies were included. Forty-six studies were included of which 40 were from South Asian countries. No interventions were identified outside of South Asian countries. Offering material in different languages was the most common tailoring strategy. Reported barriers were possible social norms favouring inactivity, lack of awareness on safe exercises, and physical symptoms (e.g., fatigue). Facilitators included social support and relief from physical symptoms. Future PA interventions for South Asian pregnant women should account for population-specific barriers and facilitators to increase PA initiation and maintenance.

Effect of Autonomy and Physical Activity on Self-Rated Health of Older Adults in India: Gendered Analysis Using Structural Equation Models

The gendered expectations and responsibilities placed upon women can impede their ability to participate in social activities and engage in physical leisure pursuits, ultimately having a negative impact on their health. Our study investigates the mechanisms through which gender influences individuals' engagement with physical activity during free time and how this relates to self-rated health outcomes among adults aged 45 years or older living in India. Using cross-sectional analysis and Structural Equation Modelling, we analyzed data stratified by gender and age from the Longitudinal Ageing Study of India to examine these conceptual pathways. We found that compared to men, women face greater limitations related to decision-making autonomy, experience more functional impairments, have weaker social networks that provide less support for engaging in leisure-time physical activity, leading them to report lower levels of overall wellbeing than men. Further analyses demonstrated distinct pathways through which each gender's level of social network connectivity shapes behavior - strong connections increase opportunities for women specifically to engage positively with both peers and physically active pursuits supporting overall wellness goals.

Qualitative Insights on the Importance of Sociocultural Contexts on Asian Indian Migrant Participation in Physical Activity and Sedentary Behavior

BACKGROUND

Influences on physical activity and sedentary behavior may differ for migrants moving from their country of origin to a new country. This study aimed to explore the range of contextual factors that influence physical activity and sedentary behavior among Indian migrants, making comparisons with India.

METHODS

Semistructured interviews were conducted with 21 Indian migrants (10 men and 11 women) aged between 18 and 65 years living in Melbourne, Australia. Data were analyzed thematically, coded inductively, and managed with NVivo.

RESULTS

Participants perceived a lack of social connection as a key barrier to physical activity participation. Group-based physical activity fostered social connections. Cultural associations were sites to engage in cultural physical activity and integrate with other Indians. Australia's physical contexts (eg, availability of facilities and built environment) facilitated physical activity behavior. Workplace environments (eg, the nature of the job) prompted sedentary behavior. Other contextual shifts with migration related to activities of daily living (eg, shifts in transport [walking] behavior in India to a greater reliance on cars in Australia) and migrant-friendly health communication (messaging from Australian health/allied health practitioners).

CONCLUSIONS

Sociocultural contexts remain key influences on migrant physical activity participation. Prioritizing integrated approaches and engaging insider codesign are important in tailoring and promoting migrant physical activity and limiting sedentary behavior.

Women's experiences with yoga after a cancer diagnosis: a qualitative meta-synthesis-part I

BACKGROUND

Qualitative research on women's experiences participating in yoga after a cancer diagnosis is growing; systematic synthesis and integration of results are necessary to facilitate the transfer and implementation of knowledge among researchers and end-users. Thus, the purpose of this meta-synthesis was to: (1) integrate findings from qualitative studies, (2) compare and contrast findings to elucidate patterns or contradictions in conclusions, and (3) develop an overarching interpretation of women's experiences participating in yoga after a cancer diagnosis.

METHODS

Using meta-study methodology, six electronic databases were searched using a sensitive search strategy in November 2020, a supplemental scan of reference lists was conducted in August 2021, and the database search was replicated in October 2021. Two reviewers independently screened titles/abstracts and full-texts to determine eligibility.

RESULTS

The searches yielded 6804 citations after de-duplication. Data from 24 articles meeting the eligibility criteria were extracted, and the results, methods, and theoretical approach(es) were analyzed. The analysis revealed that there was a predominant focus on two focal points in the primary articles: (1) women's well-being and quality of life (QoL; part I) and (2) intervention preferences (part II). Five overarching categories emerged related to well-being and QoL: (1) yoga can support improvements in multiple dimensions of QoL in women diagnosed with cancer, (2) women diagnosed with cancer experience an interaction between QoL dimensions, (3) elements of yoga that support improvements in QoL dimensions, (4) breathwork and meditation are integral elements of yoga, and (5) yoga practice may support lifestyle behavior change. The articles reviewed had notable limitations related to: (1) reporting about instructor(s), content of the intervention, and environmental characteristics of the setting, (2) identifying and incorporating optimal features in the intervention design, (3) incorporating theory and real-world considerations into the study procedures, and (4) including positive and negative conceptualizations of QoL as an interconnected and multidimensional concept.

CONCLUSION

Moving forward, it remains critical to identify the ideal structure and content of yoga programs for promoting well-being and QoL among women diagnosed with cancer, as well as to explore barriers and facilitators to sustainable program implementation.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021229253.

Youth-onset type 2 diabetes mellitus: an urgent challenge

The incidence and prevalence of youth-onset type 2 diabetes mellitus (T2DM) and its complications are increasing worldwide. Youth-onset T2DM has been reported in all racial and ethnic groups, but Indigenous peoples and people of colour are disproportionately affected. People with youth-onset T2DM often have a more aggressive clinical course than those with adult-onset T2DM or those with type 1 diabetes mellitus. Moreover, the available treatment options for children and adolescents with T2DM are more limited than for adult patients. Intermediate complications of youth-onset T2DM, such as increased albuminuria, often develop in late childhood or early adulthood, and end-stage complications, including kidney failure, develop in mid-life. The increasing frequency, earlier onset and greater severity of childhood obesity in the past 50 years together with increasingly sedentary lifestyles and an increasing frequency of intrauterine exposure to diabetes are important drivers of the epidemic of youth-onset T2DM. The particularly high risk of the disease in historically disadvantaged populations suggests an important contribution of social and environmental factors, including limited access to high-quality health care, healthy food choices and opportunities for physical activity as well as exposure to stressors including systemic racism and environmental pollutants. Understanding the mechanisms that underlie the development and aggressive clinical course of youth-onset T2DM is key to identifying successful prevention and management strategies.

Barriers and facilitators to physical activity for young adult women: a systematic review and thematic synthesis of qualitative literature

BACKGROUND

Physical activity (PA) has many benefits in preventing diseases and maintaining physical and mental health. Women, in particular, can benefit from regular PA. However, women's PA did not increase over the past decade globally, and the situations faced by women are often gender-specific. Healthy young adult women's PA does not receive as much attention as older women and adolescent girls, yet, they face the same situation of low level of PA. This review aims to explore and synthesise the self-identified barriers and facilitators to young adult women's participation in PA from qualitative research studies and offer suggestions for future studies and programs designed for this population.

METHODS

A systematic search was conducted in Pubmed, Web of Science, Scopus, Medline, and SPORTDiscus for studies published between January 2000 to February 2022 to identify qualitative studies on the barriers and facilitators of young adult women's PA between ages 18 to 40. The search yielded 694 studies initially, of which 23 were included. The research quality of included studies was appraised using the Critical Appraisal Skills Programme (CASP) tool. Data were extracted and thematically analysed based on the tenets of the social-ecological model (SEM).

RESULTS

Identified barriers and facilitators were grouped into different levels of the SEM, with the most frequently cited factors being time, body image and societal beauty standards, family duty and social support, religious and cultural norms, organisation and community facilities and environment, safety issues and physical environment. Descriptive data were thematically analysed and synthesised in line with the five levels: body image, health and beauty; multiple roles, support, and PA; religious identity, cultural identity, and PA; safety issues and women's fears.

CONCLUSIONS

This qualitative synthesis revealed in-depth information on barriers and facilitators influencing young adult women's PA. It highlighted that the factors young adult women face are diverse at different levels yet holistic and intertwined. Future studies on young adult women's PA should address the social-cultural influence and would benefit from applying multilevel strategies employing the SEM model. It is critical to create an open and inclusive environment and offer more opportunities for women.

TRIAL REGISTRATION

PROSPERO CRD42021290519.

Correlations between physical activity and quality of life in entrepreneurs from Wrocław, Poland

BACKGROUND

Limited physical activity is one of the main reasons for the rapid increase in the prevalence of diseases of affluence, which can lead to premature deaths in adults. Quality of life may be one of potential determinants of physical activity. The aim of this article is to identify the relationships between physical activity and quality of life in entrepreneurs from Wroclaw, Poland.

METHODS

A cross-sectional study was conducted on a group of 616 entrepreneurs (216 women and 400 men). A diagnostic survey method was used with a direct interview technique. The research tools included the International Physical Activity Questionnaire Short Form and the World Health Organization Quality of Life Questionnaire.

RESULTS

Among the studied entrepreneurs, along with their higher ratings of overall quality of life, the odds of high rather than low levels of physical activity increased nearly fivefold (OR 4.86, CI 3.34-7.07). Entrepreneurs with higher assessment levels of their perceived health condition were nearly twice as likely to report high rather than low physical activity levels (OR 1.92, CI 1.42-2.59). The conditional probability of high rather than low levels of physical activity also increased in the entrepreneurs with higher assessments of quality of life in the physical, psychological, social, and environmental domains, by 34%, 11%, 5%, and 6%, respectively.

CONCLUSION

Programs promoting physical activity among entrepreneurs, which focus on moderate and high intensity exercise, should be considered desirable in the context of the study findings. Activities aimed at improving quality of life in the physical and psychological domains as a potential determinant of the level of physical activity of entrepreneurs are also worth recommending.

Person-centered care for diverse women: Narrative review of foundational research

Despite advocacy and recommendations to improve health care and health for persons who identify as women, women continue to face inequities in access to and quality of care. Person-centered care for women is one approach that could reduce gendered inequities. We conducted a series of studies to understand what constitutes person-centered care for women and how to achieve it. The overall aim of this article is to highlight the key findings of those studies that can inform policy, practice, and ongoing research. We conducted a narrative review of all studies related to person-centered care for women conducted in our group starting in 2018 over a 5-year period, which was general at the outset, and increasingly focused on racialized immigrant women who constitute a large proportion of the Canadian population. We organized study summaries by research phase: synthesis of person-centered care for women research, exploration of existing person-centered care for women guidance, consultation with key informants, consensus survey of key informants to prioritize strategies to achieve person-centered care for women, and consensus meeting with key informants to prioritize future research. We conducted the reported research in collaboration with an advisory group of diverse women and managers of community agencies. Our research revealed that little prior research had fully established what constitutes person-centered care for women, and in particular, how to achieve it. We also found little acknowledgment of person-centered care for women or strategies to support it in medical curriculum, clinical guidelines, or healthcare policies. We subsequently consulted women who differed by age, ethno-cultural group, health issue, education and geography, and clinicians of different specialties, who offered considerable insight on strategies to support person-centered care for women. Other diverse women, clinicians, healthcare managers, and researchers prioritized issues that warrant future research. We hope that by compiling a summary of our completed research, we draw attention to the need for person-centered care for women and motivate others to pursue it through policy, practice, and research.

Young South Asian women in the United Kingdom show evidence of blunted endothelium-dependent dilatation: implications for future cardiovascular disease

INTRODUCTION

Prevalence of cardiovascular disease (CVD) is higher in South Asians than white Europeans. The offspring of hypertensive parents (OH) have greater risk of hypertension than offspring of normotensive parents (ON). We hypothesized that endothelium-dependent dilatation is already blunted in young South Asians, relative to young white European women, particularly in South Asian OH women.

METHODS

In young white European ON, South Asian ON and OH women (18-25 years old; 10 per group) who were normotensive, we recorded cutaneous perfusion by laser Doppler fluximetry during reactive hyperaemia and iontophoresis of acetylcholine (ACh), before and after inhibiting NO synthesis (NOS) or/and cyclooxygenase (COX). In these and an additional 135 age-matched South Asian and white European women, physical activity and life-style factors were assessed by questionnaire.

RESULTS

ACh-evoked dilatation was blunted in young South Asians, relative to white European women. It was attenuated by NOS or COX inhibition in white European ON; by NOS inhibition only in South Asian ON, but not OH women. After combined NOS and COX inhibition, ACh-evoked dilatations were similar to control ACh responses. Similar findings were made for reactive hyperaemia. Questionnaire data indicated young South Asians have lower physical activity levels, fresh fruit and vegetable intake than white European women, South Asian OH being lower than white European ON, or OH women.

CONCLUSION

Endothelium-dependent dilatation is blunted in young South Asians, relative to white European women, especially in South Asian OH in whom NO-dependent and prostaglandin-dependent dilatation is blunted. We suggest improved diet and greater physical activity could be particularly effective in improving endothelium-dependent dilatation and reducing future CVD risk in young South Asian OH women.

A multi-trial, retrospective analysis of the antihypertensive effects of high-resistance, low-volume inspiratory muscle strength training

Above-normal blood pressure (BP) is a primary risk factor for cardiovascular diseases. In a retrospective analysis of five pilot trials, we assessed the BP-lowering effects of high-resistance inspiratory muscle strength training (IMST) in adults aged 18-82 years and the impact of IMST on maximal inspiratory pressure (PIMAX), a gauge of inspiratory muscle strength and independent disease risk factor. Participants were randomized to high-resistance IMST (75% PIMAX) or low-resistance sham (15% PIMAX) training (30 breaths/day, 5-7 days/wk, 6 wk). IMST (n = 67) reduced systolic BP (SBP) by 9 ± 6 mmHg (P < 0.01) and diastolic BP (DBP) by 4 ± 4 mmHg (P < 0.01). IMST-related reductions in SBP and DBP emerged by week 2 of training (-4 ± 8 mmHg and -3 ± 6 mmHg; P ≤ 0.01, respectively) and continued across the 6-wk intervention. SBP and DBP were unchanged with sham training (n = 61, all P > 0.05). Select subject characteristics slightly modified the impact of IMST on BP. Greater reductions in SBP were associated with older age (β = -0.07 ± 0.03; P = 0.04) and greater reductions in DBP associated with medication-naïve BP (β = -3 ± 1; P = 0.02) and higher initial DBP (β = -0.12 ± 0.05; P = 0.04). PIMAX increased with high-resistance IMST and low-resistance sham training, with a greater increase from high-resistance IMST (+20 ± 17 vs. +6 ± 14 cmH2O; P < 0.01). Gains in PIMAX had a modest inverse relation with age (β = -0.20 ± 0.09; P = 0.03) and baseline PIMAX (β = -0.15 ± 0.07; P = 0.04) but not to reductions in SBP or DBP. These compiled findings from multiple independent trials provide the strongest evidence to date that high-resistance IMST evokes clinically significant reductions in SBP and DBP, and increases in PIMAX, in adult men and women.NEW & NOTEWORTHY In young-to-older adult men and women, 6 wk of high-resistance inspiratory muscle strength training lowers casual systolic and diastolic blood pressure by 9 mmHg and 4 mmHg, respectively, with initial reductions observed by week 2 of training. Given blood pressure outcomes with the intervention were only slightly altered by subject baseline characteristics (i.e., age, blood pressure medication, and health status), inspiratory muscle strength training is effective in lowering blood pressure in a broad range of adults.

Inspiratory muscle strength training for lowering blood pressure and improving endothelial function in postmenopausal women: comparison with “standard of care” aerobic exercise

Background: High blood pressure (BP), particularly systolic BP (SBP), is the major modifiable risk factor for cardiovascular diseases and related disorders of aging. SBP increases markedly with aging in women such that the prevalence of above-normal SBP (i.e., ≥120 mmHg) in postmenopausal women exceeds rates in age-matched men. This increase in SBP is associated with vascular endothelial dysfunction, mediated by excessive reactive oxygen species-induced oxidative stress and consequent reductions in nitric oxide bioavailability. Moderate-intensity aerobic exercise is a recommended lifestyle strategy for reducing SBP. However, adherence to aerobic exercise guidelines among postmenopausal women is low (<30%) and aerobic exercise does not consistently enhance endothelial function in estrogen-deficient postmenopausal women. High-resistance inspiratory muscle strength training (IMST) is a time-efficient, adherable lifestyle intervention that involves inhaling against resistance through a handheld device (30 breaths/day). Here, we present the protocol for a randomized controlled trial investigating the efficacy of 3 months of high-resistance IMST compared to guideline-based, “standard-of-care” aerobic exercise training for decreasing SBP and improving endothelial function in estrogen-deficient postmenopausal women with above-normal SBP (120–159 mmHg) at baseline (ClinicalTrials.gov Identifier: NCT05000515).

Methods: A randomized, single-blind, parallel-group design clinical trial will be conducted in 72 (36/group) estrogen-deficient postmenopausal women with above-normal SBP. Participants will complete baseline testing and then be randomized to either 3 months of high-resistance IMST (30 breaths/day, 6 days/week, 75% maximal inspiratory pressure) or moderate-intensity aerobic exercise training (brisk walking 25 min/day, 6 days/week, 40–60% heart rate reserve). Outcome measures will be assessed after 3 months of either intervention. Following end-intervention testing, participants will abstain from their assigned intervention for 6 weeks, after which BP and endothelial function will be assessed to evaluate the potential persistent effects of the intervention on the primary and secondary outcomes.

Discussion: This study is designed to compare the effectiveness of time-efficient, high-resistance IMST to guideline-based aerobic exercise training for lowering SBP and improving endothelial function, and interrogating potential mechanisms of action, in estrogen-deficient postmenopausal women.

Clinical Trial Registration:ClinicalTrials.gov, Identifier: NCT05000515.

South Asians Active Together (SAATH): Protocol for a multilevel physical activity intervention trial for South Asian American mother and daughter dyads

South Asian (SA), including Asian Indian and Pakistani Americans, have a high burden of cardiometabolic risk factors and low levels of physical activity (PA). Increasing PA in the U.S. population is a national priority; however, SA American women and girls experience unique barriers to PA that are not addressed by current promotion efforts. To address this gap, our community-based participatory research partnership developed the South Asians Active Together (SAATH) intervention. This study is a two-arm randomized clinical trial to evaluate the effects, mediators, and implementation of the 18-week SAATH intervention. A total of 160 mother-daughter dyads will be randomized in a 1:1 ratio to the SAATH intervention and control groups. The intervention was designed for mother-daughter dyads and targets individual, interpersonal, and family levels through (1) group exercise classes, (2) mother-daughter discussions, and (3) peer group discussions. The intervention targets the environment level through community partner meetings aimed at creating environment changes to enhance PA opportunities for SA women and girls. The control group will receive PA education materials. We hypothesize that dyads who receive the intervention will have significantly greater increases in moderate- and vigorous-intensity PA (MVPA) from baseline to 4 months, compared to the control group. MVPA will be measured at 12 months in intervention participants to examine if changes are sustained. A process evaluation will use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. This study will fill knowledge gaps about the effectiveness and implementation of culturally adapted, community-based PA interventions for SA women and girls.

Promoting healthy cardiovascular aging: emerging topics

The development of age-related cardiovascular (CV) dysfunction increases the risk of CV disease as well as other chronic age-associated disorders, including chronic kidney disease, and Alzheimer's disease and related dementias. Major manifestations of age-associated CV dysfunction that increase disease risk are vascular dysfunction, primarily vascular endothelial dysfunction and arterial stiffening, and elevated systolic blood pressure. Declines in nitric oxide bioavailability secondary to increased oxidative stress and inflammation are established mechanisms of CV dysfunction with aging. Moreover, fundamental mechanisms of aging, termed the "hallmarks of aging" extend to the CV system and, as such, may be considered "hallmarks of CV aging". These mechanisms represent viable therapeutic targets for treating CV dysfunction with aging. Healthy lifestyle behaviors, such as regular aerobic exercise and certain dietary patterns, are considered "first-line" strategies to prevent and/or treat age-associated CV dysfunction. Despite the well-established benefits of these strategies, many older adults do not meet the recommended guidelines for exercise or consume a healthy diet. Therefore, it is important to establish alternative and/or complementary evidence-based approaches to prevent or reverse age-related CV dysfunction. Targeting fundamental mechanisms of CV aging with interventions such as time-efficient exercise training, food-derived molecules, termed nutraceuticals, or select synthetic pharmacological agents represents a promising approach. In the present review, we will highlight emerging topics in the field of healthy CV aging with a specific focus on how exercise, nutrition/dietary patterns, nutraceuticals and select synthetic pharmacological compounds may promote healthy CV aging, in part, by targeting the hallmarks of CV aging.

Translational Potential of High-Resistance Inspiratory Muscle Strength Training

Age-associated cardiovascular (CV) dysfunction increases the risk for CV diseases. Aerobic exercise training can improve CV function, but only a minority of adults meet aerobic exercise guidelines. High-resistance inspiratory muscle strength training is a time-efficient lifestyle intervention that may promote adherence and improve CV function. However, further investigation is needed to translate inspiratory muscle strength training into the public health domain.

Motivational Factors and Barriers Towards Initiating and Maintaining Strength Training in Women: a Systematic Review and Meta-synthesis

Strength training (ST) or resistance training is important in the development and maintenance of musculoskeletal and cardiovascular health in women of all ages; however, uptake of ST amongst women is low. To improve female musculoskeletal health, it is vital that more women are encouraged to participate in ST to maintain musculoskeletal integrity. This systematic review aimed to identify motivators and barriers to women initiating and maintaining ST. Following protocol registration and systematic search, studies were included if they were primary qualitative or mixed-method studies reporting participant verbatim quotes, included adult women, and focused on motivators and barriers for ST. Searches generated 2534 articles from 3 databases, with 20 studies (N = 402 participants) meeting eligibility criteria. Participant quotes and authors' interpretations were analysed using thematic synthesis. The most frequently observed barriers were gender-based stigmas, discouragement, and negative comments, particularly in women currently engaging in ST. Other factors associated with poor adherence included boredom, poor knowledge of ST, poor gym accessibility, lack of supervision or routine, and difficulty in balancing work and family life. Social support from friends and family, words of affirmation, and accompaniment facilitated ST, particularly in older women. Women who saw expected results such as weight loss were motivated to continue ST. Interventions aimed at increasing participation in ST amongst women should focus on the specific benefits valued by women and the dissemination of accurate information to counter misconceptions and increase knowledge. The adaptation of gym environments to make them more welcoming to women, and reduce gender-focused criticism, is especially important.

Cardiovascular and Cerebrovascular Disease Mortality in Asian American Subgroups

BACKGROUND

Asian American individuals comprise the fastest-growing race and ethnic group in the United States. Certain subgroups may be at disproportionately high cardiovascular risk. This analysis aimed to identify cardiovascular and cerebrovascular disease mortality trends in Asian American subgroups.

METHODS

Age-standardized mortality rates (ASMR), average annual percent change of ASMR calculated by regression, and proportional mortality ratios of ischemic heart disease, heart failure, and cerebrovascular disease were calculated by sex in non-Hispanic Asian American subgroups (Chinese, Filipino, Asian Indian, Japanese, Korean, and Vietnamese), non-Hispanic White, and Hispanic individuals from US death certificates, 2003 to 2017.

RESULTS

Among 618 004 non-Hispanic Asian American, 30 267 178 non-Hispanic White, and 2 292 257 Hispanic deaths from all causes, ASMR from ischemic heart disease significantly decreased in all subgroups of Asian American women and in non-Hispanic White and Hispanic women; significantly decreased in Chinese, Filipino, Japanese, and Korean men and non-Hispanic White and Hispanic men and remained stagnant in Asian Indian and Vietnamese men. The highest 2017 ASMR from ischemic heart disease among Asian American decedents was in Asian Indian women (77 per 100 000) and men (133 per 100 000). Heart failure ASMR remained stagnant in Chinese, Korean, and non-Hispanic White women, and Chinese and Vietnamese men. Heart failure ASMR significantly increased in both sexes in Filipino, Asian Indian, and Japanese individuals, Vietnamese women, and Korean men, with highest 2017 ASMR among Asian American subgroups in Asian Indian women (14 per 100 000) and Asian Indian men (15 per 100 000). Cerebrovascular disease ASMR decreased in Chinese, Filipino, and Japanese women and men between 2003 and 2017, and remained stagnant in Asian Indian, Korean, and Vietnamese women and men. The highest cerebrovascular disease ASMR among Asian American subgroups in 2017 was in Vietnamese women (46 per 100 000) and men (47 per 100 000).

CONCLUSIONS

There was heterogeneity in cardiovascular and cerebrovascular mortality among Asian American subgroups, with stagnant or increasing mortality trends in several subgroups between 2003 and 2017.

Maintenance of Exercise Habit and Its Impact on Cardiovascular Risk Factors in Previously Sedentary People: A 7-Year Follow-Up

The aim of the study was to assess whether the level of physical activity in daily life in previously sedentary adults had been sustained 7 years beyond a 1-year supervised walking program. One hundred ten participants (63 females, 57.5 ± 8.4 years; 47 males, 66.4 ± 7.9 years) were recalled and assessed for physical activity in daily life, weight, body mass index, blood pressure, and walking speed. Fifty-nine percentage of the participants measured met and exceeded the World Health Organization physical activity guidelines (Group 1), while 41% did not (Group 2). In both groups, we observed a significant decrease of weight (72.0 ± 14.0 kg vs. 69.7 ± 14.0 kg in Group 1; 77.4 ± 19.5 kg vs. 75.4 ± 18.6 kg in Group 2) and body mass index (25.9 ± 3.7 vs. 25.1 ± 3.9 in Group 1; 27.9 ± 5.6 vs. 27.2 ± 5.4 in Group 2). Group 1 showed a significant increase in walking speed (5.8 ± 0.7 km/hr vs. 6.2 ± 0.8 km/hr), while systolic pressure did not change from the baseline. In Group 2, systolic pressure significantly increased (131.3 ± 13.5 mmHg vs. 138.0 ± 15.5 mmHg), while walking speed did not change. A guided walking program seems to have been effective in educating sedentary people to remain physically active over time.

Physical Activity Experiences of South Asian Migrant Women in Western Australia: Implications for Intervention Development

The benefits of physical activity are widely recognised; however, physical activity uptake remains low in South Asian populations. South Asian migrant women face health risks as they adapt to new cultures, and these risks are often intensified through their limited participation in physical activity as one of the behaviours that promote positive health outcomes. Three focus group discussions with sixteen South Asian migrant women aged between 33 and 64 years, with a median age of 48 years and who live in Western Australia, were conducted. Thematic analysis of the transcribed qualitative data was completed to explore and uncover South Asian women’s experiences with physical activity, as well as their motivation, beliefs, attitudes, and knowledge about physical activity. Five major themes emerged after coding and analysing the data. The themes included the women’s knowledge of physical activity, their general attitudes and beliefs surrounding physical activity, the advantages and disadvantages of participation in physical activity, their experiences with physical activity, and the barriers, challenges, and facilitators surrounding physical activity. Recommendations are proposed to increase physical activity among this group to improve overall health and wellbeing and implications for intervention development are discussed.

A Qualitative Exploration of Facilitators and Barriers to Physical Activity Participation among Chinese Retired Adults in Hong Kong

The purpose of this study was to identify facilitators and barriers associated with physical activity participation among retired Chinese adults in Hong Kong. This study adopts an interview research design in order to generate an in-depth understanding and insights into the participants' thoughts, motivators and experiences of physical activity participation. Independent, semi-structured interviews with 10 retired participants (aged 54-74) were conducted based on an interview protocol with open-ended questions prompting the participants to describe their experiences. Transcribed texts were analysed using thematic analysis, combining both deductive and inductive analysis techniques. Common physical activities reported were walking, stretching exercise and jogging/running. Participants responded that their physical activity level increased since their retirement. We report the interview results according to the themes which emerged from the analysis: (1) physical and mental health, (2) socio-emotional factors, (3) environmental context, (4) family responsibilities. We found that the themes (1), (2) and (3) act either as a facilitator or a barrier for the participants interviewed, while theme (4) family responsibilities act as a barrier. The findings suggested that future physical activity interventions for retired Chinese adults should include more physical activity knowledge, such as the benefits to physical and mental health brought by physical activity and social elements, considering the specific challenges that participants are confronted with (from the family side).

The design and impact of culturally-safe community-based physical activity promotion for immigrant women: descriptive review

BACKGROUND

Immigrant women have low rates of physical activity (PA), placing them at risk for chronic diseases. Some research suggests that strategies targeting this group must be culturally-safe and community-based. This study aimed to identify the design (i.e. characteristics) and impact of culturally-safe community-based PA promotion for immigrant women.

METHODS

We conducted a descriptive review by searching MEDLINE, EMBASE, SPORTDiscus, CINAHL, SCOPUS, Cochrane Library and Joanna Briggs Institute Database of Systematic Reviews from inception to June 9, 2021 for English language studies that assessed community-based PA promotion strategies targeting adult immigrants and involved at least 50% women. We compiled findings in a preliminary context-mechanisms-outcomes conceptual framework.

RESULTS

We included 13 studies published from 2004 to 2020. Three included women-only; the remainder included a median of 63% women (range 50 to 98%). Studies included immigrants from Brazil, Dominican, Columbian, Haiti, Mexico, China, Vietnam, Bangladesh, India, Pakistan, Somalia, Sudan and Turkey. All but one study (89%) significantly improved one or more outcomes: PA knowledge, PA participation and anthropometric measures (e.g. weight, BMI, blood pressure). Most (89%) strategies were multi-faceted: in-person group educational sessions reinforced by take-home educational material and/or follow-up reminder phone calls. Single strategies (e.g. mailed educational material, group educational session) also achieved beneficial outcomes. We identified 17 culturally-safe characteristics of PA promotion strategies: language of choice, based in community settings or organizations, led by lay health workers, reflected ethno-cultural linguistic expressions and PA norms, and recognized and offered solutions to barriers of PA. Findings were captured in a preliminary theory of how contextual factors (gender, intersectionality) and mechanism (culturally-safe PA promotion) may influence PA-related outcomes (PA knowledge, self-efficacy and participation; anthropometric measures, quality of life).

CONCLUSIONS

This study revealed the characteristics of PA promotion strategies that significantly improved PA-related outcomes among immigrants. Given that few studies focused solely on immigrant women or reported sub-analyses, the conceptual framework generated by this study can be used in future research to more definitively establish the design and impact of culturally-safe, community-based PA promotion for immigrant women.

Hypertension in Women: A South-Asian Perspective

Introduction

Hypertension is an important contributor to cardiovascular disease related morbidity and mortality. Despite the magnitude of its negative impact on cardiovascular outcomes, treatment and control of hypertension remain suboptimal in both men and women.

Materials and Methods

Numerous databases, i.e., PubMed, ScienceDirect, etc., were searched using keywords to identify relevant studies to our narrative review. The findings from the most pertinent articles were summarized and integrated into our narrative review on hypertension in women.

Results

The pathophysiology of essential hypertension is still being delineated in both men and women; there are multiple sex specific factors in association with the development of hypertension in women, including age, combined oral contraceptives (COCs), polycystic ovarian syndrome (PCOS), preeclampsia, etc. There are several sex specific considerations in antihypertensives drug choices.

Discussion

Despite the magnitude of its negative impact on cardiovascular outcomes, treatment and control of hypertension remain suboptimal in women. Medical treatment and adherence is uniquely challenging for South Asian women due to a variety of socio-cultural-economic factors. Further research is warranted to identify optimal sex-specific treatment options that will improve the control of hypertension and decrease the risk of subsequent cardiovascular disease in both genders.

Time for themselves: Perceptions of physical activity among first and second-generation Pakistani women living in the Raval, Barcelona

Objectives:

Pakistani women experience higher-than-average rates of certain chronic diseases, including diseases related to sedentary lifestyles. The aim of this study is to explore how first and second-generation Pakistani women living in the Raval, Barcelona, conceive of physical activity, and their barriers and facilitators around participating in physical activity, with the goal of increasing physical activity in this group.

Methods:

Qualitative research with an intersectional approach. Nine informal interviews with key community informants were conducted from November 2018 to January 2019 to gain background on the topic, using snowball sampling. Eleven individual interviews were conducted from February to June 2019. Seven were with Pakistani women having lived, or currently living, in the neighborhood of the Raval, Barcelona. Four additional interviews were conducted with non-Pakistani women key community informants who have worked extensively with this community. Thematic content analysis was carried out using ATLAS.ti.

Results:

First-generation Pakistani women generally did not have physical activity present in their daily lives, but by most accounts wished to. Areas that shed light on this included the following: limited economic opportunities and associated living conditions, barriers to social integration, health concepts and access to information, and cultural norms and related gender roles. For the first-generation, gender-related divisions of labor as well as the absence of the concept of self-care were particularly relevant barriers to their participation in physical activity. The experience of immigration-related grief emerged as a transversal theme which overlapped with multiple areas. While both generations expressed a need for the separation of genders during physical activity—as per their cultural interpretation of Islam—the lack of such spaces was highlighted as a principal barrier in physical activity among the second generation.

Conclusion:

These findings shed light on distinct elements that exert influence in Pakistani women immigrants’ participation in physical activity—among them: social and living conditions, access to public space, and gender-related work distribution and cultural norms—which are in turn influenced by first or second-generation immigration status. Considering the specific needs of both groups when proposing politics and health programs to encourage physical activity is paramount in order to successfully partner with these populations.

Low Amount and Intensity of Leisure-time Physical Activity in Asian Indian Adults

PURPOSE

We sought to describe leisure-time, aerobic, and muscle strengthening physical activity (PA) patterns in U.S. Asian Indians, in comparison to other races/ethnicities.

DESIGN, SETTING, AND SAMPLE

We utilized the 2011-2018 National Health Interview Surveys, a set of cross-sectional, nationally representative surveys of the U.S. noninstitutionalized population. Our study population included 257 652 adults who answered PA questions.

MEASURES

PA was classified per 2008 U.S. guidelines and continuously per estimated metabolic equivalents (METs). Race was classified into White, Black, Asian Indian, Other Asian, and American Indian/Alaskan Native/Multiracial.

ANALYSIS

We used survey design-adjusted, multivariable logistic regression to determine odds of sufficient and highly active physical activity levels, adjusting for predisposing, enabling, need, and health care service factors as guided by the Anderson Model. We also used linear regression to determine racial differences in average MET-minutes/week. Analysis was additionally stratified by comorbidity status.

RESULTS

While Asian Indians (N = 3049) demonstrated similar odds of sufficient aerobic PA as Whites (aOR [95% CI]: .97 [.88,1.07]), Asian Indians had 22% lower odds of meeting highly active aerobic PA levels (.78 [.71,0.87]) and 18% lower odds of meeting sufficient muscle strengthening PA levels (.82 [.73,0.91]). This translated to an average 172 (95% CI: 45 300) fewer MET-minutes. Furthermore, this decrease in MET-minutes/week was especially apparent in those without hypertension (β[95% CI]: -164 [-314,-15]) without diabetes (-185 [-319,-52]), and low/normal BMI (-422 [-623,-222]).

CONCLUSION

Asian Indians, especially those without comorbidities, are less likely to engage in high-intensity physical activity than Whites.

Exploring the physical activity of Iranian migrant women in the United Kingdom: a qualitative study

PURPOSE

This article explores the role migration has on the physical activity of Iranian migrant women living in the United Kingdom.

METHOD

This qualitative study includes 22 first-generation Iranian migrant women, aged 24-64, residing in London. Data was collected through in-depth, semi-structured, individual interviews and was analyzed thematically.

RESULTS

The findings show that for those women from traditional backgrounds, migration corresponds with liberation from social and cultural pressures experienced in Iran and greater motivation to adopt a physically active lifestyle. However, for Iranian women who had arrived in the UK more recently and had a higher social standing in Iran, migration was associated with the loss of their careers, sources of income, and social networks. These issues were compounded by a lack of cohesion in Iranian migrant communities and poor access to local physical activity resources. This resulted in diminishing motivation and the subsequent de-prioritisation of the women's physical activity, even though they had regularly engaged in physical activity in Iran.

CONCLUSION

Despite migration leading to improving physical activity for some Iranian women, for others, migration leads to marginality in Britain. Local authorities and Iranian community organizations need to adopt innovative strategies to reach out to recent Iranian migrant women.

Barriers and facilitators to physical activity in second-generation British Indian women: A qualitative study

AIM

To understand the barriers to and motivations for physical activity among second-generation British Indian women.

SUBJECT

Approximately 50% of British South Asians are UK-born, and this group is increasing as the second-generation also have children. Previous research into the barriers to and facilitators for physical activity has focused on migrant, first-generation populations. Qualitative research is needed to understand a) how we might further reduce the gap in physical activity levels between White British women and British Indian women and b) the different approaches that may be required for different generations.

METHODS

Applying a socioecological model to take into account the wider social and physical contexts, we conducted semi-structured interviews with 28 Indian women living in Manchester, England. Interviews with first-generation British Indian women were also included to provide a comparator. Interviews were audio-recorded, transcribed, thematically coded and analysed using a grounded theory approach.

RESULTS

Ways of socialising, concerns over appearance while being physically active, safety concerns and prioritising educational attainment in adolescence were all described as barriers to physical activity in second-generation British Indian women. Facilitators for physical activity included acknowledging the importance of taking time out for oneself; religious beliefs and religious groups promoting activity; being prompted by family illness; positive messages in both the media and while at school, and having local facilities to use.

CONCLUSIONS

Barriers to physical activity in second-generation Indian women were very similar to those already reported for White British women. Public health measures aimed at women in the general population may also positively affect second-generation Indian women. First-generation Indian women, second-generation children and Muslim women may respond better to culturally tailored interventions.

The Assessment of Functional Movement in Children and Adolescents: A Systematic Review and Meta-Analysis

Background

The Functional Movement Screen™ (FMS™) is an assessment of human movement that may signal potential deficits that could predispose an otherwise healthy person to injury risk. FMS™ scores are well reported in both athletic and adult samples. However, to date, there has been no comprehensive systematic review and meta-analysis of FMS™ data among school-aged children and adolescents.

Objective

We aimed to systematically review and analyse functional movement proficiency of children and adolescents, specifically when assessed using the FMS™, and to establish initial normative values for the FMS™ in this population group and to further estimate differences in functional movement proficiency between the sexes, by school level (i.e., between primary and secondary school-level children and adolescents), and based on differences in child and adolescent body mass index (BMI).

Methods

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, prospective studies were identified from searches across eight databases (MEDLINE, SPORTDiscus, CINAHL, Web of Science, EMBASE, ERIC, PsychINFO and PubMed), without any date restrictions, up to December 2020. The primary meta-analysis estimated the overall FMS™ score for school-aged children and adolescents across published studies. An additional three subgroup meta-analyses estimated comparisons for FMS™ data with school level, sex, and BMI across published studies. FMS™ data were meta-analysed using a number of different meta packages (Schwarzer et al. in Meta-Analysis with R, 1st ed, Springer International Publishing, Berlin, 2015), available in R Studio.

Results

A total of 19 articles were included in the systematic review. Meta-analysis revealed a weighted FMS™ mean score of 14.06, with a standardised Tau value of 0.56, signalling a moderate-to-large degree of variability in FMS™ means between studies. The difference in FMS™ means between samples of males (weighted FMS™ mean 13.91) and females (weighted FMS™ mean 14.56) was compatible with a possible small effect size (standardised mean difference − 0.27). The variability in FMS™ means between studies was approximately five times greater in samples of secondary school children (factor difference in Tau values 5.16). The final meta-regression identified a negative association between BMI and FMS™ scores (r =  − 0.42), which signalled a moderate-to-large difference in FMS™ scores between healthy weight and overweight children/adolescents.

Conclusion

This systematic review and meta-analysis represents a novel and important synthesis of published FMS™ data from groups of children and adolescents. The study signals possible sex- and age-related differences in FMS™ scores, as well as a clear negative relationship between BMI and functional movement proficiency. More longitudinal research is needed to better understand the developmental trajectory and the effects of maturation milestones on FMS™ proficiency. Additional research is also needed to identify the types of interventions that could improve functional movement proficiency among ‘at risk’ groups, who are susceptible to functional movement deficiency, and whether changes in body composition mediate the relationship between these interventions and the improvement of FMS™ scores.

Exploring the social-ecological factors related to physical activity participation among Black, Asian and minority ethnic immigrants

Purpose

Despite the health benefits of physical activity (PA), participation rates Black, Asian and minority ethnic (BAME) adults in the United Kingdom (UK) are low in comparison to the general population. This study aimed to explore the social-ecological factors related to PA participation among BAME immigrants.

Design/methodology/approach

Semi-structured interviews were carried out with 12 purposively selected adults from the BAME populace residing in one postcode district of a city in southern England.

Findings

The three main themes that developed from this study demonstrated that the barriers to PA participation among BAME were perceived to exist at intrapersonal, and environmental (social and physical) levels.

Research limitations/implications

Understanding these unique social-ecological factors may assist in intervention development.

Originality/value

Prominent barriers included intrapersonal factors such as deportation fear and cultural beliefs; and environmental factors such as the cost of accessing PA facilities. Length of residency appeared to be related to increased PA.

Time-efficient, high-resistance inspiratory muscle strength training for cardiovascular aging

Cardiovascular diseases (CVD) remain the leading cause of death in developed and developing societies and aging is the primary risk factor for CVD. Much of the increased risk of CVD in midlife/older adults (i.e., adults aged 50 years and older) is due to increases in blood pressure, vascular endothelial dysfunction and stiffening of the large elastic arteries. Aerobic exercise training is an effective lifestyle intervention to improve CV function and decrease CVD risk with aging. However, <40% of midlife/older adults meet guidelines for aerobic exercise, due to time availability-related barriers and other obstacles to adherence. Therefore, there is a need for new lifestyle interventions that not only improve CV function with aging but also promote adherence. High-resistance inspiratory muscle strength training (IMST) is an emerging, time-efficient (5 min/day) lifestyle intervention. Early research suggests high-resistance IMST may promote adherence, lower blood pressure and potentially improve vascular endothelial function. However, additional investigation will be required to more definitively establish high-resistance IMST as a healthy lifestyle intervention for CV aging. This review will summarize the current evidence on high-resistance IMST for improving CV function with aging and will identify key research gaps and future directions.

Socio-ecological influences of leisure-time physical activity among Nepalese adults: a qualitative study

Background

With economic and social changes, participation in occupational and transport-related physical activity is declining among Nepalese adults, highlighting the growing importance of leisure-time physical activity. However, limited information is available to guide public health policies and interventions to promote leisure-time physical activity in Nepal. This study aimed to qualitatively explore the socioecological influences of participation in leisure-time physical activity among Nepalese adults aged 40 years and above.

Methods

A total of 51 adults (30 females and 21 males) participated in one of the nine focus groups conducted in Kathmandu, Nepal. A semi-structured guide based on the social-ecological model of physical activity was used to facilitate these focus groups. Data were analysed using a reflexive thematic analysis approach in NVivo 12.

Results

Participation in leisure-time physical activity was minimal and leisure time was mostly spent resting, socialising, or engaging in sedentary activities such as watching television. Walking was the most common form of leisure-time physical activity, and men reported being more active than women. Individual-level barriers included lack of knowledge, lack of skill, lack of motivation, considering oneself as sufficiently active and engagement in sedentary screen activities. Family and household responsibilities, lack of support and fear of being judged constituted the interpersonal barriers while environmental barriers included an absence of a supportive social norm, lack of open spaces, weather conditions and perceived lack of safety. Health benefits, prioritising physical activity, social support, provision of group-based activities and age-appropriate public exercise facilities were identified as major facilitators.

Conclusion

Critical issues that need to be addressed to increase leisure-time physical activity among Nepalese adults include traditional gender roles, family and social support, and social norms. Modifications of the built environment, such as public exercise facilities, offer further opportunities and will require coordination beyond the health sector.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11484-3.

Time-Efficient Inspiratory Muscle Strength Training Lowers Blood Pressure and Improves Endothelial Function, NO Bioavailability, and Oxidative Stress in Midlife/Older Adults With Above-Normal Blood Pressure

Background High-resistance inspiratory muscle strength training (IMST) is a novel, time-efficient physical training modality. Methods and Results We performed a double-blind, randomized, sham-controlled trial to investigate whether 6 weeks of IMST (30 breaths/day, 6 days/week) improves blood pressure, endothelial function, and arterial stiffness in midlife/older adults (aged 50-79 years) with systolic blood pressure ≥120 mm Hg, while also investigating potential mechanisms and long-lasting effects. Thirty-six participants completed high-resistance IMST (75% maximal inspiratory pressure, n=18) or low-resistance sham training (15% maximal inspiratory pressure, n=18). IMST was safe, well tolerated, and had excellent adherence (≈95% of training sessions completed). Casual systolic blood pressure decreased from 135±2 mm Hg to 126±3 mm Hg (P<0.01) with IMST, which was ≈75% sustained 6 weeks after IMST (P<0.01), whereas IMST modestly decreased casual diastolic blood pressure (79±2 mm Hg to 77±2 mm Hg, P=0.03); blood pressure was unaffected by sham training (all P>0.05). Twenty-four hour systolic blood pressure was lower after IMST versus sham training (P=0.01). Brachial artery flow-mediated dilation improved ≈45% with IMST (P<0.01) but was unchanged with sham training (P=0.73). Human umbilical vein endothelial cells cultured with subject serum sampled after versus before IMST exhibited increased NO bioavailability, greater endothelial NO synthase activation, and lower reactive oxygen species bioactivity (P<0.05). IMST decreased C-reactive protein (P=0.05) and altered select circulating metabolites (targeted plasma metabolomics) associated with cardiovascular function. Neither IMST nor sham training influenced arterial stiffness (P>0.05). Conclusions High-resistance IMST is a safe, highly adherable lifestyle intervention for improving blood pressure and endothelial function in midlife/older adults with above-normal initial systolic blood pressure. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03266510.

Factors Influencing Physical Activity Participation among Midlife Immigrant Women: A Systematic Review

Immigrant women are less likely to be physically active and face many barriers to participation in physical activity. This systematic review aims to identify the influencing factors and adaption approaches of physical activity interventions among midlife immigrant women. A systematic literature search was performed using various databases, such as MEDLINE, PsycINFO, and CINAHL, in February 2021. Studies were included if they investigated midlife immigrant women participating in physical activity interventions and were published in an English peer-reviewed journal in or after 2000. Twenty-two papers were included in this review. Guided by the Ecosocial theory, thematic analysis was utilized for data analysis. Among midlife immigrant women, influencing factors associated with physical activity participation included individual factors (a lack of time, current health status, motivation, and a lack of proficiency in various life skills), familial factors (familial support and seasonality), and community factors (social support and neighbourhood environment). The appropriate adaptation of physical activity interventions included adjustments in language, physical activity intensity, physical activity duration, logistical intervention adjustments and other potential technology-based adjustments. The findings can inform community stakeholders, healthcare professionals and researchers to design appropriate physical activity interventions that meet the needs of midlife immigrant women and improve their health outcomes.

Analysis of Korean Fencing Club Members' Participation Intention Using the TPB Model

This study aims to investigate effects of three factors from the Theory of Planned Behavior (TPB)—attitude, subjective norms, and perceived behavioral control—on 233 fencing club members’ intention to continue participation, while considering fencing’s low popularity as a sport in Korea. This study analyzed data from members of fencing clubs in Seoul, Gyeonggi, Daegu, and Busan, using frequency analysis, exploratory factor analysis, reliability analysis, correlational analysis, and multiple regression with SPSS Windows 25.0 software. Results indicate that selected TPB model factors—specifically attitude and subjective norms—positively affected intention to continue participating. Moreover, significant influences of attitude and subjective norms were found in both men and women. Attitude significantly influenced intention in participants in their twenties, thirties, and forties or over; subjective norms significantly influenced intention in participants in their twenties and forties or over; and perceived behavioral control significantly influenced intention in participants in their thirties. Lastly, attitude and subjective norms significantly influenced intention when subjects participated once a week or twice a week and at least three times a week, and perceived behavioral control significantly influenced intention only when they participated at least three times a week. This suggests that members perceived their participation in fencing favorably and that the people around them encouraged them to continue participation in fencing and viewed it as a positive activity. The findings may be useful for understanding how to further popularize fencing in Korea and encourage current club members to maintain or increase their participation levels.

Are there associations between religious affiliation and drive for muscularity? A cross-sectional survey of young Muslim women, Christian women and atheist women from Germany

BACKGROUND

Over the last 20 years, society's perception of the ideal female body size in Western cultures has changed from thin to athletic, and many women practice sports to achieve well-toned bodies. However, to date, no study has investigated whether Muslim women who live in a Western country and veil their bodies strive for lean or muscular bodies too. The current cross-sectional survey therefore addressed this question.

METHODS

Veiled Muslim women (n = 70), unveiled Muslim women (n = 50), Christian women (n = 79), and atheist women (n = 68) living in Germany answered several questionnaires assessing engagement in sports, body appreciation, and drive for leanness and muscularity. Univariate and multivariate analyses were conducted to compare the four groups.

RESULTS

The results of univariate and multivariate analyses showed that Muslim women engaged less in sports and veiled Muslim women reported higher body appreciation than did Christian and atheist women. Although the groups did not differ significantly in drive for muscularity, Muslim women showed lower levels of drive for leanness than did Christian and atheist women.

CONCLUSION

Given that Muslim women engaged less in sports and strived less for a lean body compared to Christian and atheist women, a well-toned body might be less important for them. Nevertheless, as being active is beneficial for general health, barriers that prevent Muslim women from engaging in sports should be diminished.

Genetic and Environmental Factors Contributing to Visceral Adiposity in Asian Populations

Obesity-associated metabolic illnesses are increasing at an alarming rate in Asian countries. A common feature observed in the Asian population is a higher incidence of abdominal obesity-the "skinny-fat" Asian syndrome. In this review, we critically evaluate the relative roles of genetics and environmental factors on fat distribution in Asian populations. While there is an upward trend in obesity among most Asian countries, it appears particularly conspicuous in Malaysia. We propose a novel theory, the Malaysian gene-environment multiplier hypothesis, which explains how ancestral variations in feast-and-famine cycles contribute to inherited genetic predispositions that, when acted on by modern-day stressors-most notably, urbanization, westernization, lifestyle changes, dietary transitions, cultural pressures, and stress-contribute to increased visceral adiposity in Asian populations. At present, the major determinants contributing to visceral adiposity in Asians are far from conclusive, but we seek to highlight critical areas for further research.

Which Neighborhood Destinations Matter in the Asian Context? The Role of Destinations in Older Adults' Physical Activity and Sedentary Behaviors

Background

Neighborhood destinations play important roles in daily activity levels of older adults. However, little is known about how specific destinations are associated with these activities and/or sedentary behaviors, especially in Asia. This study investigated how neighborhood destinations were associated with physical activity recommendations and excessive sedentary time among older adults.

Methods

A telephone-based survey was conducted to collect cross-sectional data on the sociodemographic variables, residential neighborhoods, physical activities, and sedentary behaviors of 1,040 adults aged 65 years and above. Using data derived from Geographic Information Systems (GIS), an adjusted logistic regression was performed to examine the relationships between five neighborhood destination types (i.e., recreational facilities, utilitarian destinations, transit stops, temples, and schools) and both overall physical activity level and sedentary behavior.

Results

Significant interactions related to physical activity and sedentary behavior were observed based on both gender and neighborhood destinations. After adjusting for potential confounders, older men living in neighborhoods containing higher numbers of temples were more likely to achieve physical activity recommendations (OR = 1.85; 95% CI: 1.16-2.96). On the other hand, older women living in neighborhoods containing higher numbers of utilitarian destinations were more likely to engage in excessive sedentary time (OR = 1.70; 95% CI: 1.12-2.56).

Conclusions

In Asia, the presence of favorable local neighborhood temples may support physical activity levels for older men, while utilitarian destinations (which have previously been found to support activeness) may be related to excessive sedentary behaviors in older women.

Objective measurement of physical activity and sedentary behavior among South Asian adults: A systematic review

Background

South Asians are one of the fastest growing ethnic groups in western countries with a high incidence of chronic diseases like metabolic syndrome and cardiovascular disease occurring at younger ages and lower body weight compared with white Europeans. Physically active lifestyle and reduced sedentary time are modifiable risk factors that can decrease burden of chronic diseases. Population-level surveys based on self-report show South Asians engage in low levels of physical activity. Because of known limitations with self-report data, we aimed to synthesize available evidence to generate a physical activity /sedentary time profile of South Asians from studies using accelerometry.

Methods

We systematically searched Medline, EMBASE, CINAHL, PsycINFO, and SportDiscus. We included studies applying accelerometry to measure physical activity /sedentary time under free-living. Studies with an exclusive focus on drugs or including participants with health conditions/physical disability, and special populations (athletes/pregnant women) were excluded. Two authors independently adjudicated inclusion of citations at title/abstract and full text. We applied a standardized data abstraction form to extract relevant data. We evaluated methodological quality using Newcastle Ottawa Quality Assessment Scale. Due to variability and inconsistencies in measurement and reporting of physical activity /sedentary time, we only provide a narrative synthesis.

Findings

We identified only 14 studies(n = 1,338). Despite using similar accelerometry assumptions, we noted variability in reported outcomes for physical activity and sedentary time. Sedentary time ranged from 482(98) to 587 min/day. Mean light physical activity ranged from 211.69(67. 38) to 574(227) min/day. Moderate to vigorous physical activity among South Asian women ranged from 17–41 min/day and among men, 32–43 min/day.

Conclusion

South Asians exhibited higher levels of physical activity when compared to the Canadian population level survey but not when compared to the American population level survey. Overall, fewer studies, and small sample sizes led to considerable variability limiting any effective comparisons. Results highlight the importance of conducting methodologically robust studies based on random sampling to advance the field, and to capture true levels of sedentary time and physical activity in the South Asian population.

Cultural adaptation of self-management of type 2 diabetes in Saudi Arabia (qualitative study)

Background

Saudi Arabia is continuously working on developing its health care system, however with the high prevalence of type 2 diabetes and comorbidities, such as cardiovascular diseases, self-management education programmes are essential. As part of a planned series of studies to develop a culturally sensitive type 2 diabetes self-management programme, this study explores the need versus barriers and facilitators relevant to implementing a national programme for type 2 diabetes self-management education within the community and health care system in Saudi Arabia.

Methods

A qualitative methodology was used to explore the views of a multidisciplinary group of diabetes health professionals and adult patients with type 2 diabetes. The views of nine health professionals working at a specialised diabetes care centre were gathered at two focus groups (four and five) that included doctors, nutritionists, health educators and nurses. Individual interviews with 12 patients with type 2 diabetes (six females and six males) attending the centre were also carried out. Recurring themes through the translated transcripts were studied and treated by the research group under pre-set protocols.

Results

Focus groups with health professionals revealed three main themes. 1. Resources: availability of resources and how they impacted on performance and patients’ care; 2.Familiarity with self-management education programmes: educating patients and raising awareness among them; and 3. Lifestyle: patients’ lifestyle and how it could affect their compliance with self-management programmes. Interviews with patients also revealed three main themes. 1. Habits: post diagnosis changes in patients’ attitudes and behaviours towards diet and physical activity; 2. Health education: awareness of managing type 2 diabetes through health centre advice or self-education; and 3. Culture and society: a lack of cultural or social support created by some social practices or conventions.

Conclusion

The findings from this study highlight a gap in type 2 diabetes care system that can be breached through the development of a Saudi specific self-management programme for type 2 diabetes. The identified barriers and facilitators can be used for adapting a self-management programme to the Saudi context. However, initial training is needed for local health professionals to understand the mechanisms of self-management programmes. Such programmes will need to infiltrate to the society, and the patients’ families, in particular to tackle the rising prevalence of type 2 diabetes in Saudi Arabia and provide a friendlier, more supportive environment for the current patients to self-manage their diabetes.

A descriptive cross sectional study comparing barriers and determinants of physical activity of Sri Lankan middle aged and older adults

BACKGROUND

Benefits of physical activities are numerous. Barriers for physical exercise may differ among middle aged and older adults. Therefore, identifying and comparing the barriers for participating in regular physical exercises among middle aged and older adults will be useful in designing age specific physical exercise programmes.

METHODS

This descriptive cross sectional study was carried out among 206 Sri Lankan adults in the age range of 40-84 years in the Colombo North region of Sri Lanka using culturally validated questionnaires to determine and compare the barriers and factors associated with regular physical activity participation. Majority were males (56%) and 54% were < 60 years. People in the age range of 40-59 years were considered as middle age and ≥ 60 years as older adults. Bivariate analysis and multivariate analysis was carried out to determine the significant factors that are associated with regular physical activity participation.

RESULTS

Lack of free time (52%), feeling too lazy (26%) and bad weather (29%) were the main barriers for the participants. In < 60 years, high level of income (p = 0.008) and in ≥ 60 years, being a male (p = 0.016), having a high level of education (P = 0.002) and a high BMI (p = 0.002) had a significant negative association with the level of physical activities.

CONCLUSIONS

Contrary to findings from surveys in several developed countries, this study showed that having a high level of education and being a male were strongly related with lack of physical activity participation.

Association of Social Networks and Physical Activity in South Asians: The Mediators of Atherosclerosis in South Asians Living in America Cohort Study

BACKGROUND

Eliminating racial/ethnic disparities in physical activity remains a challenge in the United States. South Asian immigrants in the United States have particularly low physical activity levels, and evidence suggests that social context may be important. This study examined associations between personal social networks and moderate to vigorous leisure-time physical activity (MVPA) among South Asians in the United States.

METHODS

We used cross-sectional data (2014-2017) from 689 South Asians (aged 43-85 y) who participated in the Mediators of Atherosclerosis in South Asians Living in America study. Self-reported physical activity and egocentric network data were collected from participants about their network members. Regression models were used to determine associations between social network characteristics and participants' MVPA.

RESULTS

Participants were on average 59 years old (SD = 9) and reported 1335 metabolic equivalent minutes per week of MVPA (interquartile range = 735, 2212). Having network members who exercised or who were exercise partners associated with increased MVPA in men (β coefficient = 241 MET min/wk [95% confidence interval, 63 to 419] and β = 520 MET min/wk [95% confidence interval, 322 to 718], respectively). For women, the association was only significant if the exercise partner was a spouse.

CONCLUSION

Physical activity interventions utilizing network members as exercise partners may have potential in South Asians but must consider gender differences.

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.

Culturally Tailored Resources for South Asian Immigrant Women With Gestational Diabetes: Do They Work and What's Missing? A Qualitative Study

OBJECTIVES

Gestational diabetes mellitus (GDM) increases the risk of pregnancy complications. South Asian immigrant women have among the highest rates of GDM in Canada and they also have the highest lifelong risk of developing type 2 diabetes after a GDM pregnancy. Diabetes Canada has been developing diabetes education material that accounts for the cultural preferences of South Asians. However, there is uncertainty to whether South Asian immigrants are aware of these resources or trust them, or if other factors influence their uptake of advice.

METHODS

In this study, we conducted qualitative interviews to explore, among South Asian immigrant women with GDM: 1) their awareness of diabetes education resources, 2) their attitudes toward information from different resources and varying health-care providers and 3) their barriers and facilitators for GDM management recommendations. Gender theory is embedded in this study, as culturally specific gender roles regarding motherhood have been shown to be important to South Asian immigrant women and their perceptions of health.

RESULTS

There was an emergence of 3 main themes. First, awareness of culturally tailored educational resources is low. Second, there is an overabundance of GDM management information, which leads to variability among participants of how they rank accuracy of informational sources. Finally, there is a gender role reversal present, where women are being taken care of by their families instead of being the providers of care.

CONCLUSIONS

These results indicate that better dissemination strategies for GDM educational material are needed for health-care providers and patients, and may require additional consideration of family involvement during GDM education sessions.

Factors influencing women in physical activity programs in Malaysia

The majority of research on factors associated with women participation in physical activity (PA) has been in developed countries with limited research in developing countries. Few women in Malaysia are active at the recommended levels for health, and activity rates are less than developed countries. Little research has focused specially on physically active Malaysian women and the factors that contribute to them becoming and staying active in PA programs. This lack of knowledge hinders the tailored development and implementation of PA programs to meet their needs. The aim of this study was to identify the factors of participation in PA programs for Malaysian women. The social-ecological model was used to investigate and theme the factors. Focus group discussion was conducted with participants in six PA programs targeted specifically to women. Thirty-seven women were involved in the focus group discussion, with ages ranging from 19 to 82 years. Inductive and deductive content analysis was conducted from verbatim transcripts using NVivo. Inductive content analysis allowed raw data and second-order themes to emerge. Findings revealed social support structures, tailored programs for women, and location were key contributors that encouraged women to participate in these programs. The similarity in contributors between women in non-western and western countries signifies a prime opportunity for bi-lateral relationships to be formed to enable the enhancement of program development relevant to different ethnicities and cultures within or across countries.

Perceptions and Factors Influencing Eating Behaviours and Physical Function in Community-Dwelling Ethnically Diverse Older Adults: A Longitudinal Qualitative Study

Ethnic minorities have a high prevalence of non-communicable diseases relating to unhealthy lifestyle practices. Several factors have been identified as influencing unhealthy lifestyle practices among this population; however, there is little evidence about how these factors differ among a heterogeneous sample living in a super-diverse city. This study aimed to: (1) identify and compare factors influencing eating behaviours and physical function among ethnic older minorities living in Birmingham, United Kingdom; and (2) understand how these factors and their association with healthy eating and physical function changed over 8-months. An in-depth interviewing approach was used at baseline (n = 92) and after 8-months (n = 81). Interviews were transcribed verbatim and analysed using directed content analysis. Healthy eating was viewed as more important than, and unrelated to, physical function. Personal, social and cultural/environmental factors were identified as the main factors influencing eating behaviours and physical function, which differed by ethnicity, age, and sex. At 8-month interviews, more men than women reported adverse changes. The study provides unique and useful insights regarding perceived eating behaviours and physical function in a relatively large and diverse sample of older adults that can be used to design new, and adapt existing, culturally-tailored community interventions to support healthy ageing.

Biological determinants of physical activity across the life course: a "Determinants of Diet and Physical Activity" (DEDIPAC) umbrella systematic literature review

BACKGROUND

Despite the large number of studies and reviews available, the evidence regarding the biological determinants of physical activity (PA) is inconclusive. In this umbrella review, we summarized the current evidence on the biological determinants of PA across the life course, by pooling the results of the available systematic literature reviews (SLRs) and meta-analyses (MAs).

METHODS

We conducted an online search on MEDLINE, ISI Web of Science, Scopus, and SPORTDiscus databases up to January 2018. SLRs and MAs of observational studies that investigated the association between biological determinants of PA and having PA as outcome were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence, and the methodological quality.

RESULTS

We identified 19 reviews of which most were of moderate methodological quality. Determinants that were studied most frequently among all ages and demonstrated evidence suggesting a positive association to PA were younger age, being male, higher health status, and higher physical fitness levels. Among adults, normal birth weight was found to be positively associated to PA with convincing strength of evidence, while findings among adolescents were inconsistent and with limited strength of evidence.

CONCLUSIONS

Different social or behavioral factors may contribute to the decrease of PA with age and among females versus males, and creating programmes targeted at diverse ages, female population, and adults with abnormal birth weight is recommended. Future studies should use prospective study designs, standardized definitions of PA, and objective measurement methods of PA assessment.