Physical activity among type-2 diabetic adult Nigerians

Musculoskeletal disorders and their associated factors among individuals with diabetes mellitus in northwest Nigeria

Introduction

Diabetes mellitus (DM) is a growing public health problem causing a significant amount of disability and mortality in Nigeria. Musculoskeletal disorders (MSDs) are common complications associated with DM. However, studies on the prevalence of MSDs and their associated factors are limited in Nigeria, particularly in the northwest region. The purpose of this study was to determine the prevalence of MSDs and their associated factors among individuals with DM in northwest, Nigeria.

Material and methods

A retrospective cross-sectional survey of medical case records of all consecutive patients with DM attending a diabetic clinic in Ahmadu Bello University Teaching Hospital, Zaria was conducted between February 2015 and September 2021. Data on sociodemographic and clinical variables was collected using a researcher-designed questionnaire and analysed using descriptive statistics and logistic regression models.

Results

Four hundred eighty-nine cases (170 men [34.8%], 319 females [65.2%]; mean age: 51.4 ±12.3 years) were analysed. The majority of the participants had type 2 DM (96.7%), with a mean DM duration of 7.02 ±5.05 years. The overall prevalence of MSDs was 32.7%, with the highest prevalence found for lumbosacral spondylosis (11%) followed by knee osteoarthritis (8.4%). Among the different potential predictors examined, only duration of DM was significantly associated with overall MSDs (AOR: 1.76, 95% CI: 1.04-2.98; p = 0.035) whereas both duration of DM (AOR: 2.64, 95% CI: 1.19-5.89; p = 0.018) and body mass index (AOR: 7.461, 95% CI: 1.33-43.8; p = 0.023) were significantly associated with lumbosacral spondylosis.

Conclusions

Approximately one-third of the study participants had MSDs, with lumbosacral spondylosis being the most frequently occurring disorder. Being obese and having a longer duration of DM were associated with MSDs. Clinicians in Nigeria need to pay attention to MSDs and related factors in DM patients by conducting routine assessments and implementing early treatment.

Expert Opinions about Barriers and Facilitators to Physical Activity Participation in Ghanaian Adults with Type 2 Diabetes: A Qualitative Descriptive Study

Most adults with type 2 diabetes mellitus (T2DM) do not meet their physical activity (PA) goals despite its importance in improving their health outcomes. Our study aim was to explore the opinions of healthcare professionals regarding barriers and facilitators to PA participation in Ghanaian adults with T2DM. Using qualitative descriptive design, data were collected through semi-structured interviews with 13 healthcare professionals experienced in diabetes management in Ghana. Three main themes relating to PA barriers and facilitators were identified in a thematic analysis: health system-related factors, healthcare practitioner factors, and patient factors. Inadequate accessibility to physical therapists and therapy centres hindered the provision of PA programs. Nurses and doctors lacked sufficient knowledge and training on effective PA interventions for individuals with T2DM. Time constraints during patient consultations limited discussions on PA, while the cost associated with accessing physical therapy posed a significant challenge. Patients often disregarded PA advice from physical therapists due to their reliance on doctors, and some perceived PA as irrelevant for diabetes treatment. Despite these barriers, healthcare professionals expressed belief in PA facilitators, including integrating physical therapists and diabetes educators into diabetes care, providing structured exercise resources, improving curriculum planning to emphasise PA in health science education, and addressing knowledge gaps and misconceptions. Overall, this study highlights patient-related and healthcare system-related factors that influence PA behaviour in Ghanaian adults with T2DM. Findings from this study should inform the development of tailored PA programs for this population.

Burden of disability in type 2 diabetes mellitus and the moderating effects of physical activity

The growing diabetic epidemic has created a substantial burden, not only on the people with diabetes but also on society at large. This mini-review discussed the limitations and patterns of disability in type 2 diabetes mellitus and put forward a case for the moderating effects of physical activity (PA) in the management of diabetes. The limitations and impairments associated with diabetes include vascular, neurological, cardiac, and renal impairments. Moreover, individuals participate less in their daily lives and in their instrumental activities of daily living, which negatively impacts the quality of life of individuals with diabetes. This often leads to a loss of quality of life due to disabilities, resulting in an increased rate of disability-adjusted life years among people with type 2 diabetes mellitus. Moreover, there are psychosocial sequelae of diabetes mellitus. This necessitates looking for moderating factors that may reduce the burden of the disease. PA has been shown to be one of the factors that can mitigate these burdens. PA does this in several ways, including through the benefits it confers, such as a reduction of hemoglobin A1c, a reduction of excess fat in the liver and pancreas, and the reduction of cardiovascular risk factors, all of which favorably affect glycemic parameters. Specifically, PA regulates or moderates diabetes disability through two mechanisms: The regulation of glucolipid metabolism disorders and the optimization of body mass index and systemic conditions. Therefore, efforts should be directed at PA uptake through identified strategies. This will not only prevent diabetes or diabetes complications but will reduce its burden.

Improving Metabolic Syndrome in Ghanaian Adults with Type 2 Diabetes through a Home-Based Physical Activity Program: A Feasibility Randomised Controlled Trial

There is a high prevalence of metabolic syndrome (MetS) among people with type 2 diabetes mellitus (T2DM). Physical activity has the potential to improve health outcomes for individuals with type 2 diabetes. Our study aim was to determine the effect of a 12-week culturally appropriate home-based physical activity program on metabolic syndrome markers and quality of life in Ghanaian adults with T2DM. A secondary objective was to examine the feasibility of implementing the PA program. A feasibility randomised controlled trial (RCT) was conducted. A purposive sample of 87 adults with T2DM at the Korle-Bu Teaching Hospital, Ghana, were randomized into either the control group (CG) (n = 43) or the intervention group (IG) (n = 44). Participants in the IG received the physical activity program in addition to their usual diabetes care; those in the CG received their usual diabetes care. Measurements for feasibility, MetS markers, and quality of life (SF-12) were performed at baseline and 12-week follow-up. Following the 12-week program, participants in the IG showed a significant improvement in fasting blood glucose (2.4% vs. 0.4%, p < 0.05), waist circumference (5.4% vs. 0.4%, p < 0.05), and systolic blood pressure (9.8% vs. 1.5%, p < 0.05). There were no statistical differences between the IG and CG regarding high-density lipoprotein, triglycerides, and diastolic blood pressure at the 12-week follow-up. Classification of MetS were reduced in the IG compared to the CG (51.2% vs. 83.3%, p < 0.05). The MetS severity score improved in the IG compared to the CG (8.8% vs. 0.5%, p < 0.05). The IG improved in two of the eight SF-12 dimensions (physical function and vitality, p < 0.05) compared to the CG. Thirty-two (72.7%) participants completed all 36 exercise sessions. Another 11 (25%) participants completed 80% of the exercise sessions. No adverse events were reported. In conclusion, a 12-week home-based physical activity program is feasible and safe. The intervention has the potential to improve MetS and quality of life in Ghanaian adults with T2DM. The preliminary findings of this study need to be confirmed in a large-scale multi-centre RCT.

Prevalence and associated factors of physical inactivity among adult diabetes mellitus patients in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia

Physical inactivity has been viewed as an emerging public health problem in developing countries including Ethiopia. Diabetes mellitus (DM) is a group metabolic disorder characterized by chronic hyperglycemia resulting from defects in insulin secretion, function, or both. Its prevalence increases with changing lifestyles including physical inactivity across the globe. However, there is limited research, and not yet received attention in Ethiopia. This study aimed to assess the prevalence and associated factors of physical inactivity among adult diabetic patients in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia. An institutional-based cross-sectional study design was conducted among 308 participants from February to June 2018 at Felege Hiwot Referral Hospital. A face-to-face interview was conducted using a structured questionnaire by trained data collectors. Participants were selected through a systematic random sampling technique. Physical inactivity was assessed by the international physical activity questionnaire (IPAQ). Collected data were entered in Epi info version 7 and transferred to SPSS version 20 for analysis. A summary of descriptive statistics and multiple binary logistic regression analyses were computed to identify associated factors of physical inactivity among adult diabetic patients. P < 0.05 with 95% CI was considered statistically significant. The overall prevalence of physical inactivity among diabetic patients was 30.5% ( 95% CI: 22.8-33.5%). Gender (AOR = 1.5, 95% CI: 1.1, 3.62), Old age (AOR = 18.17, 95% CI: 22.7, 61.9) Residence (AOR = 4.24, 95% CI: 1,12,16.028), Low self-efficacy (AOR = 20.59, 95% CI: 10.598, 41.608), Poor attitude (AOR = 2.75, 95%CI: 1.44,5.28), and Lack of social support (AOR = 4.22, 95% CI: 1.28,4.07) were found significantly predictor factors of physical inactivity. The prevalence of physical inactivity in this study was high. Being female, old age, dwelling in an urban, having low efficacy, poor attitude, and lack of social support was greater risk factors for being physically inactive. Diabetic education should focus on engagement in physical activity by overcoming barriers to performing physical activity. Government and health professionals should emphasize that evidence-based physical activity important to change their attitudes and require reaching a consensus on social support by their families.

Chronic knee osteoarthritis: Relationships of body mass index and selected psychosocial factors among Nigerians

BACKGROUND

Knee Osteoarthritis is the most commonly affected joint among Africans. There is a shred of preliminary evidence that a high body mass index (BMI) is associated with high kinesiophobia. Little is known about the relationships of psychosocial factors such as Kinesiophobia, Pain Catastrophizing (PC), Self-Efficacy (SE), and BMI among Nigerians with knee OA.

OBJECTIVE

This study aims to determine the relationships between BMI and selected psychosocial factors (kinesiophobia, pain catastrophizing, and self-efficacy) among individuals with knee OA in Nigeria.

METHODS

Seventy-seven consecutively sampled patients diagnosed with knee OA from three selected public hospitals in Enugu, South-East Nigeria, participated in this cross-sectional survey. Brief Fear of Movement Scale for Osteoarthritis (BFMSO), Pain Catastrophizing Scale (PCS), and Arthritis Self-Efficacy Scale-8 item (ASES-8 item) were used to assess Kinesiophobia, PC, and SE, respectively. Also, a stadiometer and weighing scale were used to determine height and weight respectively. Data were analyzed using Pearson's correlation coefficient at p < 0 . 05 and multiple linear regression.

RESULTS

Participants were aged 58 . 04 ± 12 . 46 years. Female participants had a higher BMI (31 . 51 ± 6 . 82 ) than the males (26 . 86 ± 3 . 03 ). The mean scores for BMI of the right knee, left knee, and bilateral knees were 29 . 00 ± 5 . 35 , 24 . 78 ± 3 . 74 , and 33 . 02 ± 6 . 80 , respectively. Significant positive correlations were found between BMI and PC (r = 0 . 35 ) whereas significant negative correlations existed between BMI and SE (r =- 0 . 30 ). Significant predictive markers of BMI were PC (β = 0 . 21 ) and SE (β =- 0 . 89 ).

CONCLUSION

Body mass index, PC, and SE correlate significantly in individuals with knee OA. The results call for the routine integration of psychologically-informed physiotherapy practice in the management of knee OA.

Physical activity and sedentary time levels among Moroccan type 2 diabetes patients

BACKGROUND: Meeting physical activity (PA) guidelines and decreasing sedentary time (SED-time) are cornerstones in the management of diabetes. OBJECTIVE: This study aims to assess the level of PA, SED-time, and related factors among Moroccan diabetes patients. METHODS: From February to June 2019, 1143 patients with type 2 diabetes took part in a cross-sectional survey. PA and SED-time were assessed through a face-to-face interview using International PA Questionnaire. RESULTS: The PA recommendations were achieved by 77.7% of participants and they were significantly higher in males using oral antidiabetic alone, in normal and overweight participants, and in those with duration less than 7 years. While in females, this level was significantly higher only in participants with a family history of diabetes. The mean SED-time was high (35.66±16.88 hours/week) and increased with age, BMI, duration of diabetes, among widowers and divorced, illiterate and among those with low level of PA. CONCLUSIONS: The PA level and SED-time were high. Furthermore, participants with high SED-time have low levels of PA, which represents a combined risk of sitting and inactivity in this subgroup. As a result, patients should be encouraged to participate regularly in PA and also to minimize their SED-time.

Physical Activity Level and Factors Affecting Exercise Participation among Nigerian Adults with and Without Diabetes

Background: Diabetes presents a multifaceted challenge to health systems in Nigeria and beyond. Physical activity is a cornerstone of diabetes management but is often underutilised. Despite the positive effects of physical activity on different dimensions of health to patients with diabetes, most fail to maintain long-term adherence to physical activity programmes. Objectives: This study aimed to determine the physical activity level and factors affecting exercise participation among patients with and without diabetes. Methods: This was a cross-sectional study involving 400 participants recruited by convenience sampling. International Physical Activity Questionnaire (IPAQ) and Exercise Benefit and Barrier Scale (EBBS) questionnaires were used to measure physical activity and perceived benefits and barriers to exercise, respectively. The data collected were analysed using descriptive statistics of percentages and frequency, mean and standard deviation, and independent t-test. The level of significance was set at p<0.05. Results: The majority of the patients with diabetes (71%) had low physical activity levels while 52% of the nondiabetic group were moderately active. There was a significant difference between physical activity levels of patients with diabetes and the nondiabetic group (p<0.05). Physical exertion was reported by both patients with and without diabetes as the greatest barrier to exercise participation. Conclusion: Patients with diabetes in Nigeria have a low level of physical activity and are also faced with certain barriers which limit their participation in exercise programmes. Exercise barrier identification and public awareness on the health benefits of exercise and physical activity in the prevention and management of diabetes should thus be encouraged.

Physical Activity and Outdoor Leisure Time Physical Exercise: A Population Study of Correlates and Hindrances in a Resource-Constrained African Setting

Purpose

The study evaluated the burden of physical inactivity, its correlates, and the self-reported hindrances to outdoor leisure-time physical exercises in Enugu Nigeria. It also evaluated the prevalence of leisure-time outdoor physical exercise and its correlates in Enugu Nigeria.

Patient and Methods

This is a cross-sectional household survey involving 6628 individuals aged 20 to 60 years from 2848 households in Enugu Nigeria. Binary logistic regression and multinomial regression analyses were carried out as appropriate. Estimates were weighted to account for the actual population distribution of important sociodemographic variables and reported with the 95% confidence interval.

Results

The burden of physical inactivity was 32.68% (95% CI: 31.24–34.12%). Urban dwellers were less likely to be physically active than rural dwellers (AOR = 0.477; 95% CI = 0.410–0.555). For each year increase in age, the odds of being physically active decreases by a factor of 0.993 (AOR = 0.993; 95% CI= 0.988–0.998). Gender, income level and education did not predict physical inactivity. Physical inactivity significantly increases the odds of being obese by a factor of 1.428 (AOR: 1.428; 95% CI: 1.190–1.714). Only 6.45% (95% CI: 5.82%-7.09%) participants reported at least once a week outdoor leisure-time physical exercise. The major barriers include lack of time and lack of interest in outdoor leisure-time physical exercise.

Conclusion

The burden of physical inactivity is high, while the level of outdoor physical exercise is low in Enugu, Nigeria. Urban dwelling and increasing age are risk factors for physical inactivity. Living in urban areas, being less than 40 years of age, having a university education, and a high personal income are factors that positively drive outdoor leisure-time physical exercises. Policies that will promote awareness of the health benefits of physical activity and outdoor physical exercise are needed if Nigeria is to achieve the global mandate of reducing physical inactivity by 10% in the year 2025.

Physical activity and its associated factors in females with type 2 diabetes in Riyadh, Saudi Arabia

Despite the benefits of physical activity (PA) for the management of type 2 diabetes Mellitus (T2DM), the topic of PA is poorly addressed in Saudi Arabia (SA), especially in females with T2DM. The present study examined PA and its associated factors in females with T2DM in Riyadh, Saudi Arabia. This observational cross-sectional study was performed in a random sample of 372 women with T2DM. A face-to-face interview that covered PA, health and environmental correlates of PA was performed. Discriminant analysis was used to determine which barriers had the greatest impact on PA in these women. The results showed that approximately 26.3% of the study participants met PA recommendations. Multivariate linear regression revealed lower levels of PA were associated with women who had more than three children (β = -0.17) compared to women with no children, older age (β = -0.18), women with a duration of diabetes ≥ 6 years (β = -0.16), women who were obese (β = -0.23), women with no family support (β = -0.20), no friend support (β = -0.13) and no healthcare provider support (β = -0.14). Discriminant analysis indicated that culture and tradition, lack of skills and knowledge, safety, fatigue, lack of time, weather conditions, and lack of facilities were the barriers that differentiated between the women who met and those who did not meet the PA recommendations. The present study suggests that the prevalence of PA is low and number of children, age, duration of diabetes, Obesity, family support, friend support and healthcare provider support are identified correlates of PA. These findings are valuable and should be used to design and implement future PA interventions, especially for women with T2DM. Healthcare providers may improve exercise levels and identify the specific barriers to reaching the recommended level of PA to improve health outcomes for each patient.

Association Between Sleep Quality and Physical Activity in Saudi Arabian University Students

BACKGROUND

Many studies have documented a strong association between poor sleep quality and physical inactivity. This study evaluates the association between poor sleep quality and physical inactivity among Jazan University students in Saudi Arabia.

METHODS

An observational cross-sectional study was conducted among undergraduate students at Jazan University. Cluster random sampling was used to select 440 students. The Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire (IPAQ), and Depression Anxiety Stress Scales (DASS) were utilized for data collection.

RESULTS

According to the PSQI results, the majority of respondents (63.9%; n = 281) reported having poor sleep quality. The majority of students (62.7%; n = 276) were also physically inactive. Based on DASS-21 criteria, the majority of students (53.4%) were stressed. Sleep quality differed significantly according to participants' physical activity status (p = 0.0090). Among physically active participants, 43.9% reported having good sleep quality. Sleep duration, daytime dysfunctions, and global PSQI differed significantly according to levels of physical activity (p < 0.05 for all). Univariate analysis revealed that being physically active was significantly associated with good sleep quality (OR = 1.70, 95% CI 1.14-2.54, p < 0.001). Multivariate logistic regression models also demonstrated a significant association between physical activity and good sleep quality (OR = 1.72, 95% CI 1.15-2.56, p = 0.008).

CONCLUSION

The majority of Jazan University students had poor sleep quality and were physically inactive. Evidence-based prevention and therapeutic strategies are needed to promote physical activity among university students.

Factors associated with physical activity in type 2 diabetes mellitus patients at a public clinic in Gaborone, Botswana, in 2017

Background

Physical activity plays a significant role in the managing of type 2 diabetes and is essential in reducing morbidity and mortality associated with diabetes mellitus. A number of factors influence non-adherence to physical activity: social, personal, environmental and economic factors. Diabetes research conducted in Botswana has focused on behavioural change, treatment adherence and nutrition. The physical activity levels of type 2 diabetes patients and associated factors are not known.

Aim

The aim of this study was to assess the physical activity levels (PALs) and factors associated with physical activity in type 2 diabetes mellitus

Setting

The study was conducted at a public clinic in Gaborone, Botswana, in 2017.

Methods

An observational cross-sectional study was conducted at a public clinic in Gaborone, Botswana. An interview-administered questionnaire was used to assess the PALs and factors associated with physical activity in type 2 diabetes mellitus patients. Data were captured on Excel and exported to SPSS software version 25 for analysis. Chi-square test, Fischer’s exact test and Pearson’s moment correlation examined the relationship between participants’ characteristics and their engagement in regular exercise.

Results

The majority of the study participants had low PALs (54.7%). The results showed a non-significant negative correlation between age and PAL (r = −0.085) and between sitting time (sedentary time) and PAL (−0.098).

Conclusion

Most type 2 diabetes mellitus patients had low PALs. Health-promoting activities are needed to promote physical activity and thus prevent complications associated with physical inactivity.

Physical Activity Pattern and Its Association with Glycaemic and Blood Pressure Control among People Living with Diabetes (PLWD) In The Ho Municipality, Ghana

Background

Physical activity (PA) offers considerable health benefits for diabetic patients. However, extensive high levels of inactivity has been reported among diabetic patients. This study sought to assess the patterns of physical activity and its relationship with two management-relevant outcomes (glycaemic and blood pressure control)among people living with diabetes in the Ho Municipality, Ghana.

Methods

A hospital-based cross-sectional study was carried out from January 2017 to April 2017 among 150 purposively recruited diabetic patients who were receiving care at the diabetes clinics of the Volta Regional Hospital and the Ho Municipal Hospital. A semi-structured questionnaire was used in capturing socio-demographic information. Physical activity was assessed using the International Physical Activity Questionnaire Short Form. Glycaemic and blood pressure control were evaluated within a three-month period from patients' records.

Results

Physical activity estimates among participants were 21.33%, 48% and 30.67% for high, moderate and low PA respectively. Glycaemic control among the study participants was 33.33% and blood pressure control was 58.67%. Both glycaemic and blood pressure control were significantly associated with PA.

Conclusion

In this group of PLWD in the Ho Municipality, high levels of inactivity, uncontrolled glycaemia and blood pressure exist. However, glycaemic and blood pressure control may be modulated by moderate-intensity physical activity.

Barriers to diabetic self-care: A qualitative study of patients' and healthcare providers' perspectives

AIMS AND OBJECTIVES

To explore patient and healthcare provider (HCP) perspectives about patients' barriers to the performance of diabetic self-care behaviours in Ghana.

BACKGROUND

Sub-Saharan African urban populations are increasingly affected by type 2 diabetes due to nutrition transition, sedentary lifestyles and ageing. Diabetic self-care is critical to improving clinical outcomes. However, little is known about barriers to diabetic self-care (diet, exercise, medication taking, self-monitoring of blood glucose and foot care) in sub-Saharan Africa.

DESIGN

Qualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

METHODS

Semi-structured interviews were conducted among 23 people living with type 2 diabetes and 14 HCPs recruited from the diabetes clinics of three hospitals in Tamale, Ghana. Interviews were audiotaped and transcribed verbatim. The constant comparative method of data analysis was used and identified themes classified according to constructs of the theory of planned behaviour (TPB): attitudes/behavioural beliefs, subjective norms and perceived behavioural control.

RESULTS

Barriers relating to attitudes included misconceptions that diabetes was caused by spiritual forces or curses, use of herbal medicines, intentional nonadherence, difficulty changing old habits, and feeling or lacking motivation to exercise. Barriers relating to subjective norms were inadequate family support, social stigma (usually by spouses and other members of the community) and cultural beliefs. Perceived behavioural control barriers were poor income levels, lack of glucometers, busy work schedules, long distance to the hospital and inadequate access to variety of foods due to erratic supply of foods or seasonality.

CONCLUSIONS

Both patients and HCPs discussed similar barriers and those relating to attitude and behavioural control were commonly discussed.

RELEVANCE TO CLINICAL PRACTICE

Interventions to improve adherence to diabetic self-care should focus on helping persons with diabetes develop favourable attitudes and how to overcome behavioural control barriers. Such interventions should have both individualised and community-wide approaches.

Walking prescription of 10 000 steps per day in patients with type 2 diabetes mellitus: a randomised trial in Nigerian general practice

BACKGROUND

In clinical practice, translating the benefits of a sustained physically active lifestyle on glycaemic control in patients with type 2 diabetes mellitus (T2DM) is difficult. A walking prescription may be an effective alternative.

AIM

To examine the effect of a 10 000 steps per day prescription on glycaemic control of patients with T2DM.

DESIGN AND SETTING

Forty-six adults with T2DM attending a general outpatient clinic were randomised into two equal groups. The intervention group was given goals to accumulate 10 000 steps per day for 10 weeks, whereas the control group maintained their normal activity habits.

METHOD

Daily step count was measured with waist-mounted pedometer and baseline and endline average steps per day. Glycosylated haemoglobin (HbA1c), anthropometric, and cardiovascular measurements were also obtained. An intention-to-treat analysis was done.

RESULTS

The average baseline step count was 4505 steps per day for all participants, and the average step count in the intervention group for the last 4 weeks of the study period was higher by 2913 steps per day (95% confidence interval [CI] = 1274 to 4551, F (2, 37.7) = 18.90, P<0.001). Only 6.1% of the intervention group participants achieved the 10 000 steps per day goal. The mean baseline HbA1c was 6.6% (range = 5.3 to 9.0). Endline HbA1c was lower in the intervention group than in the control group (mean difference -0.74%, 95% CI = -1.32 to -0.02, F = 12.92, P = 0.015) after adjusting for baseline HbA1c. There was no change in anthropometric and cardiovascular indices.

CONCLUSION

Adherence to 10 000 steps per day prescription is low but may still be associated with improved glycaemic control in T2DM. Motivational strategies for better adherence would improve glycaemic control.

Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review

BACKGROUND

Non-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs.

METHODS

We searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604.

FINDINGS

After reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high socioeconomic status. High socioeconomic groups were found to be less physically active and consume more fats, salt, and processed food than individuals of low socioeconomic status. While the included studies presented clear patterns for tobacco use and physical activity, heterogeneity between dietary outcome measures and a paucity of evidence around harmful alcohol use limit the certainty of these findings.

INTERPRETATION

Despite significant heterogeneity in exposure and outcome measures, clear evidence shows that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal (SDG) 3.4-reducing premature non-communicable disease mortality by a third by 2030-should leverage their development budgets to address the poverty-health nexus in these settings. Our findings also have significance for health workers serving these populations and policy makers tasked with preventing and controlling the rise of non-communicable diseases.

FUNDING

WHO.

Association of physical activity with metabolic syndrome in a predominantly rural Nigerian population

AIMS

Physical activity is an essential determinant of health. However, there is dearth of evidence regarding prevalence of physical activity in developing countries, especially its association with metabolic syndrome risk factors. This study assessed the association of physical activity with metabolic syndrome in a Nigerian population.

MATERIALS AND METHODS

A cross-sectional study was carried out on apparently healthy persons who are ≥ 18 years old. The World Health Organisation (WHO) Global Physical Activity Questionnaire (GPAQ) was used to collect five domains of physical activity. Participants were classified as physically active or inactive based on meeting the cut-off value of 600 MET-min/week. Metabolic syndrome was diagnosed using the Joint Scientific Statement on Harmonizing the Metabolic Syndrome criteria.

RESULTS

Overall prevalence of physically active individuals was 50.1% (CI: 45.6-54.7%). Physical inactivity is significantly more in females (p<0.01) and among participants >40 years old (p<0.0001). Whereas individuals with metabolic syndrome appeared more likely to be physically active (OR=1.48, CI: 0.71-3.09); physical inactivity showed to exist more among participants who were living in urban area (OR=6.61, CI: 3.40-12.85, p<0.001). Participants with prediabetes (OR=1.69, CI: 0.62-4.61) and diabetes (OR=1.91, CI: 0.65-5.63) were more likely to be physically inactive as compared to other metabolic syndrome risk factors.

CONCLUSION

The high prevalence of physical inactivity in this study population is a clear indication that concerted efforts to improve physical activity may be required. However, it seems that metabolic syndrome is not improved by being physically active. This suggests that interventions directed at physical activity alone may not produce optimal efficacy in this study population.