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

Abstract

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.

Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: meta-analysis of individual participant data from randomised controlled trials

“…First, lifestyle intervention studies have used generic recommendations (i.e. based on those for the local majority population) [27], while different targets for dietary and physical activity recommendations may be necessary [27,53]. Further work is required on the mechanisms by which these interventions are having their effect, including the role and type of physical activity, diet quality, specific dietary components, cooking practices and timing of meals [54].…”

“…Further work is required on the mechanisms by which these interventions are having their effect, including the role and type of physical activity, diet quality, specific dietary components, cooking practices and timing of meals [54]. Further, we predict that larger effects on diabetes risk in South Asians might be achieved in studies aiming at larger weight reductions [55,56] and with more intense dietary and physical activity changes [53]. Reach, retention and long-term sustainability may be enhanced through improvements in targeting and delivery, and benefits in the longer term (beyond 2-3 years) should be further investigated.…”

Did the weight loss in the Prevention of Diabetes and Obesity in South Asians (PODOSA) trial differ by sex? An exploratory analysis

“…As South Asians experience more insulin resistance than White Europeans at the same level of physical activity level (10), further trials will need to focus on more intensive intervention in South Asian compared to other ethnic group to achieve beneficial health outcomes in both men and women (6;10). The literature and present analysis suggest sex differences in weight loss in prediabetic South Asian so further trials should measure the differential impact of the intervention in men and women increasing sample size to allow the detection of an interaction effect.…”

Ectopic fat and aerobic fitness are key determinants of glucose homeostasis in nonobese Asians

“…Substantial research has established the importance of ectopic fat deposition and physical inactivity in the pathogenesis of insulin resistance and beta cell dysfunction in United States and European subjects with a wide range of BMI and glycaemic control . Nevertheless, the relevance of these factors to nonobese Asians is not clear, because body fat distribution, physical activity patterns and metabolic function differ considerably between Western and Asian populations . To this end, we conducted a cross‐sectional study and used state‐of‐the‐art imaging techniques and metabolic function tests to assess the relationships between insulin sensitivity, insulin secretion, body fat distribution and physical fitness in healthy nonobese Asian subjects.…”

“…[9][10][11] Nevertheless, the relevance of these factors to nonobese Asians is not clear, 12 because body fat distribution, physical activity patterns and metabolic function differ considerably between Western and Asian populations. 13,14 To this end, we conducted a cross-sectional study and used state-of-the-art imaging techniques and metabolic function tests to assess the relationships between insulin sensitivity, insulin secretion, body fat distribution and physical fitness in healthy nonobese Asian subjects.…”