|Year : 2014 | Volume
| Issue : 4 | Page : 189-194
Physical activity among type-2 diabetic adult Nigerians
Olufemi O Oyewole1, Olatunde Odusan2, Kolawole S Oritogun3, Akolade O Idowu2
1 Department of Physiotherapy, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
2 Department of Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria
3 Department of Medical Microbiology and Parasitology, Olabisi Onabanjo University, Sagamu, Ogun State, Nigeria
|Date of Web Publication||7-Oct-2014|
Olufemi O Oyewole
Department of Physiotherapy, Olabisi Onabanjo University Teaching Hospital, PMB 2001, Sagamu, Ogun State
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Regular participation in physical activity (PA) programs is a key concept included in current public health guidelines. Therefore, this study was aimed to determine PA level among adult with type 2 diabetes.
Methods: A cross-section of 122 participants selected consecutively were categorized as physically inactive or active using International Physical Activity Questionnaire. Data was assessed using descriptive and inferential statistics.
Results: About 31% of the respondents were physically inactive. Residential areas were significantly associated with PA. A high proportion of those who lived in the metropolitan area were physically inactive. Less likely to be physically inactive were married (odds ratios [OR] =0.29, confidence interval [CI] =0.09-0.93) and living in an urban area (OR = 0.19, CI = 0.40-0.87). The degree holders are least physically inactive while the primary school leavers are highest. The median energy expenditure for walking, moderate and vigorous PA was 280.5, 80 and 0 MET-min/week respectively. The sedentary behavior of the respondents was 288 min/day, behavior which increases with age.
Conclusion: This study suggests that the prevalence of physical inactivity was high among type 2 diabetics and their sedentary behavior is over 4 h/day. This group of people should be encouraged to participate regularly in PA.
| Abstract in French|| |
Contexte: Participation rιguliθre aux programmes d'activitι physique (PA) est un concept clι inclus dans les lignes directrices actuelles de la santι publique. Par consιquent, cette ιtude avait pour but de dιterminer le niveau de PA chez les adultes diabιtiques de type 2.
Mιthodes: Un ιchantillon de 122 participants sιlectionnιs consιcutivement ont ιtι classιs en tant que physiquement inactive ou active ΰ l'aide de Questionnaire International de l'activitι physique. Donnιes a ιtι ιvaluιes ΰ l'aide de la statistique descriptive et infιrentielle.
Rιsultats: Environ 31 % des rιpondants ιtaient physiquement inactifs. Zones rιsidentielles ιtaient significativement associιs ΰ PA Une forte proportion de ceux qui vivaient dans la rιgion mιtropolitaine ιtaient physiquement inactifs. Moins susceptibles d'κtre physiquement inactifs s'est mariιs (odds ratio [OR] =0,29, intervalle de confiance [IC] =0.09-0.93) et vivant en milieu urbain (RC = 0,19, CI = 0.40-0.87). Les titulaires d'un diplτme sont moins sιdentaires tandis que les sortants de l'ιcole primaire sont les plus ιlevιs. La dιpense ιnergιtique mιdiane pour la marche, PA modιrι et vigoureux a ιtι MET-min 280.5, 80 et 0 / semaine respectivement. Le comportement sιdentaire des rιpondants ιtait de 288 min/jour, comportement qui augmente avec l'βge.
Conclusion: Cette ιtude suggθre que la prιvalence de l'inactivitι physique a ιtι ιlevιe chez les diabιtiques de type 2 et leur comportement sιdentaire n'est plus 4 h/jour. Ce groupe de personnes devrait κtre encouragι ΰ participer rιguliθrement ΰ PA.
Mots-clιs: Modification du mode de vie, activitι physique, un comportement sιdentaire, sociodιmographique
Keywords: Lifestyle modification, physical activity, sedentary behavior, socio-demographic
|How to cite this article:|
Oyewole OO, Odusan O, Oritogun KS, Idowu AO. Physical activity among type-2 diabetic adult Nigerians. Ann Afr Med 2014;13:189-94
| Introduction|| |
Diabetes mellitus has emerged as one of the main alarms to human health in the 21 st century and is the most common endocrine disorder. The International Diabetes Federation (IDF) estimated that in 2011, 366 million people (8.3% of the world population) had diabetes world-wide, a figure expected to reach 552 million (9.9% of the world population) by 2030, with 80% of people with diabetes living in low- and middle-income countries. Furthermore, the largest increases will take place in the regions dominated by developing economies.  Pronounced changes in the human environment, behavior and life-style with accompanied globalization, have resulted in escalating rates of both obesity and diabetes, described as diabesity. 
Regular physical activity (PA) is a key element in the prevention and management of type 2 diabetes mellitus (T2DM).  PA has been reported to have extensive benefits for people with T2DM. A technical review report on exercise and T2DM listed the benefits of PA as a reduction in incidence of T2DM in people with impaired glucose tolerance, reduced hemoglobin A1c independent of body weight, improved glycemic control in T2DM while low PA level predict increased risk of overall and cardiovascular disease mortality in people with diabetes.  In another review, health benefits of PA were enumerated to include: Increased fitness and function, enhanced feeling of well-being, reduced risk of depression, better weight control, reduction in morbidity and mortality and improvements in glucose control, blood pressure and lipids.  Regular and moderate exercise training has been reported to have anti-oxidant and anti-inflammatory systemic protective effects in T2DM. , T2DM with higher enrolment in PA programs are reported to have lower health care expenditures from the public health care system. 
Despite the numerous health benefits of PA, its promotion is often inadequate and the majority of T2DM population do not become or remain regularly active. , High prevalence of physical inactivity has been reported among T2DM in both developed and developing nations. Prevalence of physical inactivity ranges between 31% and 61% among adult American but about 30.7% among Brazilian with T2DM. ,, A recent review concluded that self-efficacy and social support from family, friends and health care providers play an important role in adoption and maintenance of regular PA in this population.  Therefore, knowing the PA level of people with T2DM would help the health professionals in the formulation of strategies to encourage exercising with directions for self-care measures to reduce hypoglycemic episodes. This study therefore, sought to assess the level of PA among people with T2DM in a tertiary health care facility also determine the association of PA with socio-demography factors.
| Methods|| |
A total of 122 adult Nigerians with type 2 diabetes attending the Dame Adebutu Diabetes Care Centre of Olabisi Onabanjo University Teaching Hospital, Sagamu were recruited using a consecutive sampling technique from 183 people attending the clinic during the study period. The Ethics Committee of the Olabisi Onabanjo University Teaching Hospital, Sagamu approved the protocol for this research and only participants diagnosed as T2DM using the IDF criteria, are above 20 years of age, clinically stable and who give informed consent participated in the study.  Excluded from the study were the acutely ill, the aged and those with obvious visual impairment, foot or leg amputation. Sample size was determined with the assumption of 5% prevalence rate of diabetes mellitus in Nigeria. 
A structured questionnaire was used to collect socio-demographic data of each participant.
It included information on age, sex, marital status, education level and residential area, type of accommodation, occupation and religion. Participant age was grouped into 20-29 years, 30-49 years, 50-69 years and 70 years or older and were regrouped into 2 for analysis, i.e., <50 years and ≥50 years of age. Marital status was classified as single, married, divorced and widow. Education level was classified into 3: Illiterate/primary, secondary/proficiency certificate and more than secondary (Ordinary National Diploma, Nigeria Certificate in Education and degree). Occupation was categorized into four groups: Artisan/trading, teaching, professionals and unemployed/retired. Residential area was classified as rural, urban and metropolitan. Type of accommodation was categorized (i) a room or room and parlor, (ii) Boys quarters or detached house and (iii) flat.
International Physical Activity Questionnaire (IPAQ) long form was used to assess PA of the participants in walking, moderate-intensity and vigorous-intensity activity within each of the work, transportation, domestic chores and gardening (yard) and leisure-time domains.  The IPAQ was self-administered by those who are literate and administered by the investigators by interview for those who are not literate in either of English or Yoruba languages.
PA levels were initially classified as low, moderate, or high intensity, defined by the IPAQ core group as either of: (a) Low - The lowest level of PA, but does not meet criteria for categories b or c, (b) Moderate - Either of the following 3 criteria: (i) 3 or more days of vigorous-intensity activity of at least 20 min/day or (ii) 5 or more days of moderate-intensity activity and/or walking of at least 30 min/day or (iii) 5 or more days of any combination of walking, moderate-intensity or vigorous-intensity activities achieving a minimum Total PA of at least 600 MET-min/weeks; (c) High - Any of these 2 criteria: (i) Vigorous-intensity activity on at least 3 days achieving a minimum Total PA of at least 1500 MET-min/week or (ii) 7 or more days of any combination of walking, moderate-intensity or vigorous-intensity activities achieving a minimum total PA of at least 3000 MET-min/week.  The three groups were thereafter categorized as physically active or physically inactive. The physically active group included participants in the moderate- or high intensity categories who met the World Health Organization (WHO) PA recommendation.
According to the new WHO global standard, satisfying the recommendations for healthy PA was deemed as engaging in at least 150 min of moderate-intensity activity per week, 75 min of vigorous-intensity activity per week, or an equivalent combination of moderate- and vigorous-intensity activity. ,
The data were analyzed with Statistical Package for Social Sciences (SPSS) version 16 (SPSS, Chicago, IL). Data were summarized using the median, inter-quartile range, mean and standard deviation with frequency expressed as a percentage while Chi-square (χ2 ) was used to determine the association of PA level with socio-demographic factors. The association and correlates of socio-demographic parameters with the category of PA levels were determined using binomial logistic regression. Level of statistical significance was set at P < 0.05.
| Results|| |
A total of 122 questionnaires were returned of the 131 distributed (93.1% response rate) with three respondents excluded from final data analysis as a result of incomplete data. The total of 119 respondents included 47 men (39.5%) and 72 women (60.5%) with a mean age of 61.8 ± 11.8 years. Most, 53.8% were aged between 50 and 69 years, living in the urban area 51.3% and were mainly primary and secondary school leavers, 53.4%.
[Table 1] shows a pattern of PA level among the participants. 31% of the participants are physically inactive. When PA level was adjusted for socio-demographic factors, only residential area was significantly associated with the level of PA (χ2 , P = 0.048). The prevalence of physical inactivity increases along the residential area. Metropolitan area had the highest while the rural area had the lowest. A higher proportion (50%) of those who lived in the metropolitan area demonstrated low level of PA, the degree holder the lowest prevalence of physical inactivity while the primary school leavers had the highest. Shown in [Table 2] is the association between prevalence of physical inactivity and socio-demographic variables (ORs, standard error of the means and confidence intervals [CIs]). Marital status and residential area were important risk factors to be physically inactive. Participants were less likely to be physically inactive if they were married (OR = 0.29, CI = 0.09-0.93) compared with widow or living in an urban area (OR = 0.19, CI = 0.40-0.87) compared with metropolitan dwellers. The median energy expenditure for walking, moderate and vigorous PA revealed that walking had the highest energy expenditure and vigorous activity, the lowest [Table 3]. The sedentary behavior of the participant was 288 min/day [Table 4] with no significant difference in the sedentary behavior of the participant when adjusted for socio-demographic factors though the sedentary behavior increased with age but decreased along residential area.
|Table 3: Total median energy expenditure (MET-minute/week) for walking, moderate and vigorous activity across domains|
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|Table 4: Sedentary (total sitting) behavior of the participants (min/day)|
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| Discussion|| |
This study indicated that 31% of adults with type 2 diabetes were physically inactive. This is less than report from a previous study in Nigeria that used the IPAQ as in our study. The previous study reported 62% of physical inactivity among Nigerians with T2DM.  Though, both studies were conducted in South-west Nigeria, the reason for the difference in prevalence of physical inactivity could be as a result of form of IPAQ used in both studies. The current study used long form of IPAQ that has been reported to produce higher prevalence of PA than the short form used in the previous study.  However, the current study prevalence of physical inactivity is similar to that of adult Brazilian with type 2 diabetes (30.7%) using long form IPAQ and in Malaysia (31.9%) using the short form. ,
The prevalence of physical inactivity seems high in this study population and could be because the general population from which they were recruited were equally physically inactive. The prevalence of level of physical inactivity in Nigerian adult living in the metropolitan area was reported to be 31.4% and 41% in young adult. , It is expected that study participants though patients should have some similarity with the general population in terms of PA levels.
When our study prevalence of physical inactivity was adjusted for socio-demographic factors, residential areas were significantly associated with the level of PA. A high proportion of those who lived in the metropolitan area demonstrated low level of PA. Our participants largely reside in urban/metropolitan area and studies on the African continent have shown that urban dwellers were largely of low PA levels. , It has been reported that inactivity is more common in the older age group, women, people with lower incomes and low education level among type 2 diabetics. , Results from this study are consistent with these established observations among adults with diabetes. The degree holder had the lowest prevalence of physical inactivity while the primary school leavers had the highest in this study. Being married was negatively associated with physical inactivity in the present study though a previous study from Nigeria had reported that being married was positively associated with sufficient PA.  Married African adults, especially men are likely to engage in more jobs and transport related PAs due to societal expectations and as breadwinners. 
The median energy expenditure for walking, moderate and vigorous PA was 280.5, 80 and 0 MET-min/week respectively in this study implying that the majority of adults with type 2 diabetes do not engage in moderate or vigorous activity. This observation was probably so because adult with type 2 diabetes are encouraged to walk as a form of exercise and discouraged to participate in vigorous activity unless they were satisfied to do so. Giving that regular PA is a key element in the prevention and management of T2DM, the low level of PA should raise concerns among clinicians.  The health workers should encourage people with type 2 diabetes to be involved in PA through individualized education, proper counseling and periodic feedback. 
The sedentary behavior of our respondents revealed an average total sitting minutes per day was 288 min (median = 240 min), behavior which increases with age. Again, this should call for concern because of numerous disadvantage of a sedentary lifestyle. Time spent sedentary is strongly and adversely associated with poor cardio-metabolic health and may be a more important indicator of poor health.  A clear dose-response relationship between daily sitting time and all-cause and cardiovascular disease mortality was evident as well as compelling evidence that sedentary behaviors such as sitting and TV viewing are related to premature mortality in diabetes. 
An important clinical strength of this study is that it has addressed the issue of socio-demographic involved in the development of low PA among type 2 diabetes which the previous studies in Nigeria did not address. This is of major importance in the clinic practice as these findings have implications for identifying the socio-demographic groups in Nigerian type 2 diabetes that need to be targeted for effective interventions promoting PA. Although the clinical relevance of this study has been highlighted, it will be important to note the obvious limitations of the study. This was a cross-sectional survey involving patients in one health facility and limits the strength of the inference that can be made from the study. The use of a self-report method of PA, with the potential for information bias, is another study limitation. However, the study result is consistent with observation in the general population. 
| Conclusion|| |
This study revealed a high prevalence of physical inactivity among T2DM subjects attending a tertiary health care facility in South-west Nigeria, was increased among metropolitan dwellers and those with low educational level. Health workers should therefore encourage people with type 2 diabetes to be involved in PA through individualized education, proper counseling and periodic feedback.
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[Table 1], [Table 2], [Table 3], [Table 4]