p u b l i c h e a l t h 1 2 8 ( 2 0 1 4 ) 7 4 9 e7 5 1
Available online at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Short Communication
Barriers to leisure-time physical activity in Asian Indian men N. Singhal*, A. Siddhu Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
article info Article history:
environmental barriers to LTPA in Asian Indian men. The study has implications for planning appropriate intervention strategies for engaging Asian Indian men in LTPA.
Received 6 August 2013 Received in revised form 16 March 2014 Accepted 14 May 2014 Available online 4 July 2014
Introduction Non-communicable diseases associated with physical inactivity are the greatest public health problem in most countries around the world. Effective public health measures are needed urgently to improve physical activity behaviours in all populations. Many barriers to leisure-time physical activity (LTPA) have been reported in the literature. For instance, a community-based study in New Delhi on Asian Indian subjects found that the most common reason for nonparticipation or irregular participation in physical exercise was lack of time (63%), followed by the perception that there was no need to exercise (23%).1 Living in a non-walkable community and the absence of nearby parks and other recreation facilities are environmental barriers that have been consistently associated with lower levels of physical activity. A study in US adults found a link between non-walkable communities and inadequate park access and greater risk of overweight and obesity.2 A review article noted that traffic appears to be a barrier to physical activity.3 However, data on barriers to LTPA in Asian Indian men are lacking. Hence, this study was conducted to assess the personal, social and
Methods This analysis was part of a large cross-sectional study conducted at a tertiary care hospital in New Delhi, India. The sample was drawn from the Department of Preventive and Rehabilitative Cardiology at Fortis-Escorts Heart Institute and Research Centre using purposive sampling based on inclusion and exclusion criteria. The details of the inclusion and exclusion criteria have been reported previously.4 The final sample in the large study consisted of 603 non-diabetic urban Indian men, aged 22e64 years, with no history of coronary heart disease, stroke, myocardial infarction, type 2 diabetes mellitus, thyroid disorders or tuberculosis. Subjects were asked about their LPTA using a questionnaire. The details of the physical activity questionnaire have been reported previously.4 Sedentary subjects were asked about the barriers preventing them from undertaking any LTPA. One hundred and forty-seven subjects responded to the questions related to barriers to LTPA. Frequency data on personal, social and environmental barriers were obtained.
Results Table 1 shows the personal, social and environmental barriers to LTPA. Lack of time and lack of motivation were the strongest personal barriers to LTPA, reported by 70% and 55% of subjects, respectively. Other personal barriers to LTPA included no exercise facilities at workplace (41%) and
* Corresponding author. D-202, Roseland Residency, Pimple Saudagar, Pune 411025, India. Tel.: þ91 9818716156; fax: þ91 1166302650. E-mail address: [email protected] (N. Singhal). http://dx.doi.org/10.1016/j.puhe.2014.05.014 0033-3506/© 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
750
p u b l i c h e a l t h 1 2 8 ( 2 0 1 4 ) 7 4 9 e7 5 1
Table 1 e Barriers to leisure-time physical activity (n ¼ 147). Somewhat Strongly Percentage agree agree of subjects % (n) % (n) who agree % (n) Personal barriers Lack of time Lack of motivation No exercise facilities at workplace Tired after work Fear of injury Lack of skill Social barriers Lack of partner with whom to exercise Family/friends are not active Embarrassment Don't like people to see me when exercising Environmental barriers Unattended dogs High levels of pollution No parks/gardens/ playgrounds near home High speed of vehicles in neighbourhood Pavements are not well maintained Streets not well lit at night High crime rate No shops near home
3 (5) 8 (12) 8 (11)
67 (98) 47 (69) 33 (49)
70 (103) 55 (81) 41 (60)
4 (6) 3 (5) 2 (2)
34 (50) 3 (4) 3 (5)
38 (56) 6 (9) 5 (7)
5 (8)
53 (77)
58 (85)
4 (6)
31 (46)
35 (52)
3 (4) 3 (5)
8 (12) 8 (11)
11 (16) 11 (16)
9 (13) 9 (13) 5 (8)
15 (23) 11 (17) 15 (21)
24 (36) 20 (30) 20 (29)
5 (8)
13 (18)
18 (26)
5 (8)
13 (18)
18 (26)
5 (7) 7 (10) 0 (0)
9 (14) 7 (11) 4 (6)
14 (21) 14 (21) 4 (6)
The percentages have been rounded off to the nearest decimal place.
tiredness after work (38%) and no exercise facilities at the workplace (41%). Lack of a partner with whom to exercise and inactive family/friends were the strongest social barriers to LTPA, reported by 58% and 35% of subjects, respectively. Other social barriers to LTPA included embarrassment (11%) and a dislike of being watched whilst exercising (11%). Unattended dogs and high levels of pollution were the strongest environmental barriers to leisure-time physical activity, reported by 24% and 20% of subjects, respectively. Other environmental barriers included no parks/playgrounds/gardens near home (20%), high speed of vehicles in the neighbourhood (18%), poor maintenance of pavements (18%), streets not well lit at night (14%), high crime rate (14%) and no shops near home (4%).
Discussion This study showed that lack of time was the strongest personal barrier to LTPA. Time constraints are reported as a barrier to physical activity for both active and sedentary individuals.5,6 Similar results were reported in Colombian adults (aged 25e50 years), in whom lack of willpower (70%) and lack
of time (46%) were reported as the most important barriers to LTPA.7 In this study, unattended dogs, high levels of pollution, no parks/playgrounds/gardens near home, high speed of vehicles in neighbourhood, poor maintenance of pavements, streets not well lit at night, high crime rate and no shops near home were important environmental barriers to LTPA. Similar environmental barriers have been reported in other regions. For instance, a study on Australian adults found that those who live in more-walkable environments tend to make more frequent trips to nearby destinations such as grocery stores.8 A study on US adults who changed their residence found that activity levels tended to increase among those who moved to more walkable neighbourhoods, and activity levels tended to decrease among those who moved to less walkable neighbourhoods.9 Walking is the most common moderateintensity activity undertaken by adults and is associated with substantial health benefits. Hence, building walkable environments would encourage people to walk to nearby destinations such as grocery stores. Environmental and policy changes to promote active transport and workplace initiatives could increase overall energy expenditure through reducing prolonged sitting time. There is substantial evidence that people who live closer to a variety of recreation facilities are more physically active overall. Of the 10 review articles summarized by Bauman and Bull,10 nine recognized the value of proximity to recreation facilities for adults. Importantly, pavements can be used for walking for both recreation and transport purposes, and nearly all the reviews concluded that the availability of pavements was positively associated with physical activity and walking for adults10 and children.11 The findings of this study have cross-cultural validity as similar results have been obtained in adults and children in other regions of the world. Addressing these barriers to LTPA would increase participation in physical activity and thereby prevent an increase in non-communicable diseases in Asian Indians and other populations.
Author statements The authors wish to thank the team at the Preventive Cardiology Unit of Fortis-Escorts Heart Institute and Research Centre, particularly Dr Peeyush Jain, Dr Manisha Kaushal, Dr Neel Bhatia, Dr Arif Mustaqueem and Mr H.S. Bisht for facilitating in the recruitment of subjects. The authors would also like to thank the subjects for participation in the study.
Ethical approval The study was approved by the institutional ethics committee of Lady Irwin College, University of Delhi. Informed consent was obtained from the individuals prior to inclusion in the study.
Funding Grant-in-aid was awarded to NS under the Junior Research Fellowship Scheme [Ref. No. 3/1/3/JRF-2008/MPD-70 (31943)]
p u b l i c h e a l t h 1 2 8 ( 2 0 1 4 ) 7 4 9 e7 5 1
by the Indian Council of Medical Research, Ministry of Health and Family Welfare, Government of India. The Indian Council of Medical Research had no role in the design, analysis or writing of this article.
Competing interests None declared.
references
1. Bhasin SK, Chaturvedi S, Gupta P, Aggarwal P. Status of physical exercise and its association with obesity and hypertension in two urban assembly constituencies of East Delhi. J Indian Med Assoc 2001;99:631e3. 2. Frank LD, Andresen MA, Schmid TL. Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med 2004;27:87e96. 3. Sallis JF, Glanz K. Physical activity and food environments: solutions to the obesity epidemic. Milbank Q 2009;87:123e54. 4. Singhal N, Siddhu A. Association of leisure-time physical activity with cardiorespiratory fitness in Indian men. J Phys Act Health 2014;11:296e302.
751
5. Dishman RK, Sallis JF, Orenstein DR. The determinants of physical activity and exercise. Public Health Rep 1985;100:158e71. 6. King AC, Taylor CB, Haskell WL, DeBusk RF. Identifying strategies for increasing employee physical activity levels: findings from the Stanford/Lockheed Exercise Survey. Health Educ Behav 1990;17:269e85. ~ o FA, Quintero MA, Arenas MM. Levels of 7. Arango EF, Patin physical activity, barriers, and stage of change in an urban population from a municipality in Colombia. Colomb Med 2011;42:352e61. 8. Owen N, Cerin E, Leslie E, duToit L, Coffee N, Frank LD, Bauman AE, Hugo G, Saelens BE, Sallis JF. Neighborhood walkability and the walking behavior of Australian adults. Am J Prev Med 2007;33:387e95. 9. Handy SL, Cao X, Mokhtarian PL. The causal influence of neighborhood design on physical activity within the neighborhood: evidence from Northern California. Am J Health Promot 2008;22:350e8. 10. Bauman AE, Bull FC. Environmental correlates of physical activity and walking in adults and children: a review of reviews. London: National Institute of Health and Clinical Excellence. Available at: http://www.nice.org.uk/guidance/index.jsp? action¼download&o¼34740; 2007 (last accessed 18 February 2012). 11. Sallis J, Kerr J. Physical activity and the built environment. Pres Counc Phys Fit Sports Res Dig 2006;7.
Available online at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Short Communication
Barriers to leisure-time physical activity in Asian Indian men N. Singhal*, A. Siddhu Department of Food and Nutrition, Lady Irwin College, University of Delhi, New Delhi, India
article info Article history:
environmental barriers to LTPA in Asian Indian men. The study has implications for planning appropriate intervention strategies for engaging Asian Indian men in LTPA.
Received 6 August 2013 Received in revised form 16 March 2014 Accepted 14 May 2014 Available online 4 July 2014
Introduction Non-communicable diseases associated with physical inactivity are the greatest public health problem in most countries around the world. Effective public health measures are needed urgently to improve physical activity behaviours in all populations. Many barriers to leisure-time physical activity (LTPA) have been reported in the literature. For instance, a community-based study in New Delhi on Asian Indian subjects found that the most common reason for nonparticipation or irregular participation in physical exercise was lack of time (63%), followed by the perception that there was no need to exercise (23%).1 Living in a non-walkable community and the absence of nearby parks and other recreation facilities are environmental barriers that have been consistently associated with lower levels of physical activity. A study in US adults found a link between non-walkable communities and inadequate park access and greater risk of overweight and obesity.2 A review article noted that traffic appears to be a barrier to physical activity.3 However, data on barriers to LTPA in Asian Indian men are lacking. Hence, this study was conducted to assess the personal, social and
Methods This analysis was part of a large cross-sectional study conducted at a tertiary care hospital in New Delhi, India. The sample was drawn from the Department of Preventive and Rehabilitative Cardiology at Fortis-Escorts Heart Institute and Research Centre using purposive sampling based on inclusion and exclusion criteria. The details of the inclusion and exclusion criteria have been reported previously.4 The final sample in the large study consisted of 603 non-diabetic urban Indian men, aged 22e64 years, with no history of coronary heart disease, stroke, myocardial infarction, type 2 diabetes mellitus, thyroid disorders or tuberculosis. Subjects were asked about their LPTA using a questionnaire. The details of the physical activity questionnaire have been reported previously.4 Sedentary subjects were asked about the barriers preventing them from undertaking any LTPA. One hundred and forty-seven subjects responded to the questions related to barriers to LTPA. Frequency data on personal, social and environmental barriers were obtained.
Results Table 1 shows the personal, social and environmental barriers to LTPA. Lack of time and lack of motivation were the strongest personal barriers to LTPA, reported by 70% and 55% of subjects, respectively. Other personal barriers to LTPA included no exercise facilities at workplace (41%) and
* Corresponding author. D-202, Roseland Residency, Pimple Saudagar, Pune 411025, India. Tel.: þ91 9818716156; fax: þ91 1166302650. E-mail address: [email protected] (N. Singhal). http://dx.doi.org/10.1016/j.puhe.2014.05.014 0033-3506/© 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
750
p u b l i c h e a l t h 1 2 8 ( 2 0 1 4 ) 7 4 9 e7 5 1
Table 1 e Barriers to leisure-time physical activity (n ¼ 147). Somewhat Strongly Percentage agree agree of subjects % (n) % (n) who agree % (n) Personal barriers Lack of time Lack of motivation No exercise facilities at workplace Tired after work Fear of injury Lack of skill Social barriers Lack of partner with whom to exercise Family/friends are not active Embarrassment Don't like people to see me when exercising Environmental barriers Unattended dogs High levels of pollution No parks/gardens/ playgrounds near home High speed of vehicles in neighbourhood Pavements are not well maintained Streets not well lit at night High crime rate No shops near home
3 (5) 8 (12) 8 (11)
67 (98) 47 (69) 33 (49)
70 (103) 55 (81) 41 (60)
4 (6) 3 (5) 2 (2)
34 (50) 3 (4) 3 (5)
38 (56) 6 (9) 5 (7)
5 (8)
53 (77)
58 (85)
4 (6)
31 (46)
35 (52)
3 (4) 3 (5)
8 (12) 8 (11)
11 (16) 11 (16)
9 (13) 9 (13) 5 (8)
15 (23) 11 (17) 15 (21)
24 (36) 20 (30) 20 (29)
5 (8)
13 (18)
18 (26)
5 (8)
13 (18)
18 (26)
5 (7) 7 (10) 0 (0)
9 (14) 7 (11) 4 (6)
14 (21) 14 (21) 4 (6)
The percentages have been rounded off to the nearest decimal place.
tiredness after work (38%) and no exercise facilities at the workplace (41%). Lack of a partner with whom to exercise and inactive family/friends were the strongest social barriers to LTPA, reported by 58% and 35% of subjects, respectively. Other social barriers to LTPA included embarrassment (11%) and a dislike of being watched whilst exercising (11%). Unattended dogs and high levels of pollution were the strongest environmental barriers to leisure-time physical activity, reported by 24% and 20% of subjects, respectively. Other environmental barriers included no parks/playgrounds/gardens near home (20%), high speed of vehicles in the neighbourhood (18%), poor maintenance of pavements (18%), streets not well lit at night (14%), high crime rate (14%) and no shops near home (4%).
Discussion This study showed that lack of time was the strongest personal barrier to LTPA. Time constraints are reported as a barrier to physical activity for both active and sedentary individuals.5,6 Similar results were reported in Colombian adults (aged 25e50 years), in whom lack of willpower (70%) and lack
of time (46%) were reported as the most important barriers to LTPA.7 In this study, unattended dogs, high levels of pollution, no parks/playgrounds/gardens near home, high speed of vehicles in neighbourhood, poor maintenance of pavements, streets not well lit at night, high crime rate and no shops near home were important environmental barriers to LTPA. Similar environmental barriers have been reported in other regions. For instance, a study on Australian adults found that those who live in more-walkable environments tend to make more frequent trips to nearby destinations such as grocery stores.8 A study on US adults who changed their residence found that activity levels tended to increase among those who moved to more walkable neighbourhoods, and activity levels tended to decrease among those who moved to less walkable neighbourhoods.9 Walking is the most common moderateintensity activity undertaken by adults and is associated with substantial health benefits. Hence, building walkable environments would encourage people to walk to nearby destinations such as grocery stores. Environmental and policy changes to promote active transport and workplace initiatives could increase overall energy expenditure through reducing prolonged sitting time. There is substantial evidence that people who live closer to a variety of recreation facilities are more physically active overall. Of the 10 review articles summarized by Bauman and Bull,10 nine recognized the value of proximity to recreation facilities for adults. Importantly, pavements can be used for walking for both recreation and transport purposes, and nearly all the reviews concluded that the availability of pavements was positively associated with physical activity and walking for adults10 and children.11 The findings of this study have cross-cultural validity as similar results have been obtained in adults and children in other regions of the world. Addressing these barriers to LTPA would increase participation in physical activity and thereby prevent an increase in non-communicable diseases in Asian Indians and other populations.
Author statements The authors wish to thank the team at the Preventive Cardiology Unit of Fortis-Escorts Heart Institute and Research Centre, particularly Dr Peeyush Jain, Dr Manisha Kaushal, Dr Neel Bhatia, Dr Arif Mustaqueem and Mr H.S. Bisht for facilitating in the recruitment of subjects. The authors would also like to thank the subjects for participation in the study.
Ethical approval The study was approved by the institutional ethics committee of Lady Irwin College, University of Delhi. Informed consent was obtained from the individuals prior to inclusion in the study.
Funding Grant-in-aid was awarded to NS under the Junior Research Fellowship Scheme [Ref. No. 3/1/3/JRF-2008/MPD-70 (31943)]
p u b l i c h e a l t h 1 2 8 ( 2 0 1 4 ) 7 4 9 e7 5 1
by the Indian Council of Medical Research, Ministry of Health and Family Welfare, Government of India. The Indian Council of Medical Research had no role in the design, analysis or writing of this article.
Competing interests None declared.
references
1. Bhasin SK, Chaturvedi S, Gupta P, Aggarwal P. Status of physical exercise and its association with obesity and hypertension in two urban assembly constituencies of East Delhi. J Indian Med Assoc 2001;99:631e3. 2. Frank LD, Andresen MA, Schmid TL. Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med 2004;27:87e96. 3. Sallis JF, Glanz K. Physical activity and food environments: solutions to the obesity epidemic. Milbank Q 2009;87:123e54. 4. Singhal N, Siddhu A. Association of leisure-time physical activity with cardiorespiratory fitness in Indian men. J Phys Act Health 2014;11:296e302.
751
5. Dishman RK, Sallis JF, Orenstein DR. The determinants of physical activity and exercise. Public Health Rep 1985;100:158e71. 6. King AC, Taylor CB, Haskell WL, DeBusk RF. Identifying strategies for increasing employee physical activity levels: findings from the Stanford/Lockheed Exercise Survey. Health Educ Behav 1990;17:269e85. ~ o FA, Quintero MA, Arenas MM. Levels of 7. Arango EF, Patin physical activity, barriers, and stage of change in an urban population from a municipality in Colombia. Colomb Med 2011;42:352e61. 8. Owen N, Cerin E, Leslie E, duToit L, Coffee N, Frank LD, Bauman AE, Hugo G, Saelens BE, Sallis JF. Neighborhood walkability and the walking behavior of Australian adults. Am J Prev Med 2007;33:387e95. 9. Handy SL, Cao X, Mokhtarian PL. The causal influence of neighborhood design on physical activity within the neighborhood: evidence from Northern California. Am J Health Promot 2008;22:350e8. 10. Bauman AE, Bull FC. Environmental correlates of physical activity and walking in adults and children: a review of reviews. London: National Institute of Health and Clinical Excellence. Available at: http://www.nice.org.uk/guidance/index.jsp? action¼download&o¼34740; 2007 (last accessed 18 February 2012). 11. Sallis J, Kerr J. Physical activity and the built environment. Pres Counc Phys Fit Sports Res Dig 2006;7.
