Sedentary behaviour and physical activity in South Asian women: time to review current recommendations?

Device-worn measures of sedentary time and physical activity in South Asian adults at high risk for type 2 diabetes in Metro-Vancouver, Canada

Background

South Asians have high incidence of chronic disease. Physical activity (PA) and sedentary time are modifiable risk factors for chronic disease but their assessment in South Asians has been primarily based on self-report. This study presents directly-measured PA and sedentary time in South Asian adults in Canada.

Methods

A subset of 100 South Asian participants from a larger study who were identified at being at a higher risk for type 2 diabetes wore Actical accelerometers for 7 days. Anthropometric measures were taken and socio-demographic factors including age, income, education level, years since immigration, presence of children under the age of 12 years in the household and employment status were self-reported.

Results

Ninety-one participants (mean age 65.6 years) provided valid accelerometer data. Participants accumulated mean 673.5 (95% CI: 656.6, 691.0) min/day sedentary time, 130.5 (95% CI: 117.3, 145.3) min/day light PA (LPA) and 2.3 (95% CI: 1.3, 4.2) min/day moderate-to-vigorous PA (MVPA). For sedentary time and LPA, sex and BMI explained 51% of variability. For MVPA, BMI, season of assessment and employment status explained 23% variability with those who were employed accumulating significantly higher mean min/day of MVPA compared to those who were unemployed; (5.8, 95% CI: 1.5, 21.7) vs (1.5, 95% CI: 5.3, 20.0) respectively.

Conclusion

High sedentary time, and low MVPA indicates the need to focus health promotion efforts on shifting sedentary time into LPA while trying to increase MVPA. Future studies need to be based on larger, representative samples of South Asians.

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.

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.

Comorbidities and Ethnocultural Factors Limit the Physical Activity of Rural Sri Lankan Patients with Diabetes Mellitus

South Asians have high prevalence of diabetes, cardiovascular risk, and physical inactivity. Reasons for physical inactivity have not been explored among Asians living within their endogenous environments. During phase 1 of the study, we assessed the physical activity (PA) of the population using a quantitative, descriptive, cross-sectional research method. During phase 2 of the study, a qualitative method with in-depth interviews was used to collect data on barriers of PA. Four hundred patients with type 2 diabetes, comprising 113 (28.2%) males and 287 (71.7%) females, were enrolled. The overall prevalence of physical inactivity was 21.5% (males: 15.9%, females: 23.7%). The majority (44.8%) of the study population was active and 33.8% were minimally active. The mean weekly MET minutes was 4381.6 (SD 4962). The qualitative study (n = 45) identified health-related issues-lifestyle and time management and social embarrassment, prioritizing household activities over PA as significant factors that limited PA.

Physical activity patterns and socio-demographic correlates of physical activity among medical undergraduates in Sri Lanka: an observational study

BACKGROUND

Physical inactivity is the fourth leading risk factor for mortality worldwide and a leading risk factor for type 2 diabetes and cardiovascular disease. Medical undergraduates are a group of young adults expected to have a sound knowledge of the benefits of physical activity (PA) and have an active lifestyle.

OBJECTIVE

To quantifyPA levels among medical undergraduates of a Sri Lankan university and to determine the socio-demographic correlates of physical inactivity.

METHODS

Medical undergraduates in their third, fourth and fifth years of study were recruited for this quantitative, descriptive, cross-sectional study using a self-administered questionnaire.

RESULTS

A total of 421 students were recruited. Overall 41% were physically inactive. Females (47%) were more inactive than males (34%). The total mean weekly metabolic equivalent (MET)-minutes was 1468.2±1873. Males (1676.2±1629) had a higher mean weekly MET minutes than females (1319±20102), p=0.05. 88% owned a portable internet device such as a smartphone or tablet. Students using health-related apps on their devices had significantly higherPA (p=0.01) and lower body mass index (BMI) (p=0.04), than those who did not. Binary logistic regression revealed physical inactivity to be significantly associated with gender (p=0.01), not using a health-promoting app on their portable device (p=0.01) and the year of study (p=0.03).

CONCLUSION

Physical inactivity is a significant problem among medical undergraduates. The use of health applications was associated with a higher PA and lower BMI. The reasons for inactivity and the discrepancy in activity levels between males and females needs to be explored in greater detail.

Examining sedentary time as a risk factor for cardiometabolic diseases and their markers in South Asian adults: a systematic review

OBJECTIVES

The objective was to systematically review the literature to determine whether sedentary time was associated with cardiometabolic diseases and their risk factors among South Asian adults.

METHODS

Six electronic databases were searched to identify all studies that examined the association between sedentary time and cardiometabolic diseases (e.g., diabetes, cardiovascular disease) and their risk factors [e.g., body mass index (BMI), waist circumference (WC), lipids, blood pressure (BP), glucose] among South Asian adults. Two independent reviewers performed abstract/full-text screening, data abstraction, and quality assessments.

RESULTS

Searching identified 1757 potential articles; 22 were used in the analysis. Greater sedentary time was associated with an increased likelihood of diabetes (n = 5), higher BMI (n = 13), WC (n = 3), BP (n = 2), and glucose (n = 4). Thirteen out of 22 studies were of higher quality.

CONCLUSION

Results identified a trend whereby greater sedentary time was associated with an increased risk for diabetes, and several other cardiometabolic risk factors among South Asian adults. High quality studies are needed to identify whether risk factors are independent of physical activity levels to inform culturally-specific interventions for South Asians.

A field tool for prediction of body fat in Sri Lankan women: skinfold thickness equation

BACKGROUND

Valid skinfold thickness (SFT) equations for the prediction of body fat are currently unavailable for South Asian women and would be a potentially robust field tool. Our aim was to assess the validity of existing SFT equations against deuterium (²H₂O) dilution and, if invalid, to develop and validate an SFT equation for % fat mass (%FM) in Sri Lankan women.

METHODS

H₂O dilution was used with Fourier transform infrared (FTIR) spectroscopy as the criterion method for the assessment of %FM in urban Sri Lankan women (30-45 years). This data was used to assess the validity of available SFT equations and to generate and validate a new SFT equation for the prediction of %FM against the criterion method. Women (n = 164) were divided into validation and cross-validation groups for the development and validation of the new equation. The level of agreement between the %FM calculated by the final derived prediction equation and the %FM obtained by ²H₂O dilution was assessed using Pearson's correlation coefficient (R) and Bland Altman plots. Student's t test was used to assess over- or underestimation, and significance was set at p < 0.05.

RESULTS

Existing equations significantly (p < 0.001) underestimated %FM compared with the ²H₂O dilution method. The final equation obtained was %FM = 19.621 + (0.237*weight) + (0.259*triceps). When compared with ²H₂O dilution, %FM by the equation was not significantly different. There was a significant (p < 0.001) correlation between %FM by the reference method and %FM by the equation. The limit of agreement by Bland Altman plot was narrow with a small mean positive bias.

CONCLUSIONS

Existing SFT equations were not applicable to this population. The new equation derived was valid. We report a new SFT equation to predict %FM in women of South Asian ancestry suitable for field use.

Should Physical Activity Recommendations for South Asian Adults Be Ethnicity-Specific? Evidence from a Cross-Sectional Study of South Asian and White European Men and Women

International public health guidelines recommend that adults undertake at least 150 min.week⁻¹ of moderate-intensity physical activity. However, the underpinning evidence has largely been obtained from studies of populations of white European descent. It is unclear whether these recommendations are appropriate for other ethnic groups, particularly South Asians, who have greater cardio-metabolic risk than white Europeans. The objective of our study was to determine the level of moderate-intensity physical activity required in South Asians adults to confer a similar cardio-metabolic risk profile to that observed in Europeans of similar age and body mass index (BMI) undertaking the currently recommended levels of 150 min.week⁻¹. 148 South Asians and 163 white Europeans aged 18 to 70 years were recruited. Physical activity was measured objectively via vertical axis accelerations from hip-worn accelerometers. Factor analysis was used to summarize the measured risk biomarkers into a single underlying latent “factor” describing overall cardio-metabolic risk. Sex did not modify the association between physical activity and the cardio-metabolic risk factor, so data for both sexes were combined and models adjusted for age, sex, BMI and accelerometer wear time. We estimated that South Asian adults needed to undertake 232 (95% Confidence interval: 200 to 268) min.week⁻¹ in order to obtain the same cardio-metabolic risk factor score as a white European undertaking 150 minutes of moderate-equivalent physical activity per week. The present findings suggest that South Asian men and women need to undertake ~230 minutes of moderate intensity physical activity per week. This equates to South Asians undertaking an extra 10–15 minutes of moderate intensity physical activity per day on top of existing recommendations.

Correlations of Physical Activity, Body Mass Index, Shift Duty, and Selected Eating Habits among Nurses in Riyadh, Saudi Arabia

Nurses are the largest group of direct health providers and can serve as role models for their patients. In this cross sectional study we assessed the relationship among physical activity and barriers, shift duty, elevated BMI, and selected eating habits among 362 non-Saudi female nurses in Riyadh, Saudi Arabia. Results showed that 46.7% were either overweight or obese. Marital status, shift duty, education level, and BMI were significant predictors of physical activity. Weather was the most frequently reported barrier to physical activity (88.3%), followed by a lack of transportation (82.6%), and a lack of time (81.3%). Nurses who worked shift duty had significantly (p = 0.004) higher BMIs compared with day shift nurses. Nurses who rarely ate breakfast (p = 0.004) and meals (p = 0.001) and often eat fast food (p = 0.001) were more likely to be overweight or obese. Nurses should be encouraged for a better healthy lifestyles.

Lifestyle patterns and dysglycaemic risk in urban Sri Lankan women

Specific dietary patterns are associated with the risk of chronic disease. An in-depth understanding more reflective of lifestyle would be possible when assessing the synergistic effects of both diet and physical activity in pattern analysis. In the present study, we examined the biochemical markers of dysglycaemia and cardiometabolic risk in relation to lifestyle patterns using principal component analysis (PCA). Urban women (n 2800) aged 30-45 years were screened for dysglycaemia using cluster sampling from the Colombo Municipal Council area. All the 272 dysglycaemic women detected through screening and 345 randomly selected normoglycaemic women were enrolled. The International Physical Activity Questionnaire and a quantitative FFQ were used to assess physical activity and diet, respectively. Anthropometric measurements, bioelectrical impedance analysis and biochemical estimations were carried out. Lifestyle patterns were identified based on dietary and physical activity data using exploratory factor analysis. PCA was used for the extraction of factors. A total of three lifestyle patterns were identified. Women who were predominantly physically inactive and consumed snacks and dairy products had the greatest cardiometabolic risk, with a higher likelihood of having unfavourable obesity indices (increased waist circumference, fat mass percentage and BMI and decreased fat-free mass percentage), glycaemic indices (increased glycosylated Hb (HbA1c) and fasting blood sugar concentrations) and lipid profile (increased total cholesterol/TAG and decreased HDL-cholesterol concentrations) and increased high-sensitivity C-reactive protein concentrations. For the first time, we report lifestyle patterns and demonstrate the synergistic effects of physical activity/inactivity and diet and their relative association with cardiometabolic risk in urban women. Lifestyle pattern analysis greatly increases our understanding of high-risk behaviours occurring within real-life complexities.

Etiology of Obesity Over the Life Span: Ecological and Genetic Highlights from Asian Countries

Obesity is a worldwide pandemic, and the prevalence rate has doubled since the 1980s. Asian countries are also experiencing the global epidemic of obesity with its related health consequences. The prevalence of overweight and obesity are increasing at an alarming rate across all age groups in Asia. These increases are mainly attributed to rapid economic growth, which leads to socio-economic, nutrition and lifestyle transitions, resulting in a positive energy balance. In addition, fat mass and obesity-associated gene variants, copy number variants in chromosomes and epigenetic modifications have shown positive associations with the risk of obesity among Asians. In this review highlights of prevalence and related ecological and genetic factors that could influence the rapid rise in obesity among Asian populations are discussed.