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

Abstract

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

Physical Activity Research in the Gulf Cooperation Council Countries: Progress Made but Work Still to Do

“…20 Environmental factors can be one of the important barriers to PA in the GCC countries, as the long months of summer in most of the GCC countries is quite harsh with typical daytime temperatures well above 40 °C. 21 However, people in this region are trying to be physically active by resorting to indoor facilities, such as home exercise, fitness centers, or just walking in air-conditioned malls. Also, urbanization in this region can promote higher dependence on motor vehicles and leads to decreased PA. 21 Some countries, but not all, of the GCC have produced national policies/strategies for promoting PA.…”

“…21 However, people in this region are trying to be physically active by resorting to indoor facilities, such as home exercise, fitness centers, or just walking in air-conditioned malls. Also, urbanization in this region can promote higher dependence on motor vehicles and leads to decreased PA. 21 Some countries, but not all, of the GCC have produced national policies/strategies for promoting PA. However, their comprehensiveness and implementation are generally low.…”

A comparison of physical activity, muscle strength, and sleep between people with type 2 diabetes in Kuwait and the UK: A cross-sectional study

“…While, to the best of our knowledge, there are no physical activity interventions in people with type 2 diabetes in Kuwait, a recent meta-analysis of interventions to promote physical activity among adults and children across Gulf countries found that interventions encouraging step counting and walking increased daily step count; however, the number of studies was limited. However, multicomponent interventions, including physical activity that targeted obesity and people with type 2 diabetes, did not increase physical activity ( 30 ). Thus, interventions developed in other countries, such as the UK, are unlikely to be directly transferable due to differences in factors such as climate, transport policy, social traditions, and physical activity infrastructure.…”

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

“…Hence, there is a need for community-based and culturally acceptable interventions in Arab countries [26][27][28]. To date, only a few review-based studies have been conducted in Arab countries, focusing on interventional programs, limited to physical activity only [25,29,30] or interventions led by specific healthcare providers such as pharmacists [31], and targeting different NCDs. However, such studies could not determine whether physical activity alone had a considerable impact on the reported health outcomes or if it had an impact when combined with other aspects of a multicomponent intervention, such as dietary changes [25,[29][30][31].…”

“…To date, only a few review-based studies have been conducted in Arab countries, focusing on interventional programs, limited to physical activity only [25,29,30] or interventions led by specific healthcare providers such as pharmacists [31], and targeting different NCDs. However, such studies could not determine whether physical activity alone had a considerable impact on the reported health outcomes or if it had an impact when combined with other aspects of a multicomponent intervention, such as dietary changes [25,[29][30][31]. Henceforth, this narrative review discusses the effectiveness of lifestyle interventions focusing on diet and physical activity in the prevention and management of NCDs, such as type-2 diabetes and obesity, among adults in Arab countries.…”