ISSN: 2320-5407 Int. J. Adv. Res.

10(02), 1320-1328

Journal Homepage: - www.journalijar.com

Article DOI: 10.21474/IJAR01/14345

DOI URL: http://dx.doi.org/10.21474/IJAR01/14345

RESEARCH ARTICLE
PHYSICAL ACTIVITY PREVALENCE AND BARRIERS AMONG TYPE 2 DIABETIC PATIENTS,
KUDAI AND AL-HIJRA PRIMARY HEALTH CARE CENTER, MAKKAH, SAUDI ARABIA

Abduljabbar M. Alfetni, Mohammed A. Alqahtani, Abdulrahman M. Alhumaid, Abdullah H. Alhazmi, Bakr

A. Alqahtani, Khaled M. Alghamdi, Zeyad A. Alsaedi, Waleed T. Alsulaimani, Raad A. Alqurashi, Abdullah
M. Binhumaid, Eyad M. Shelaiuah, Olfat F. Qaffas and Moaz A. Alfattani
Makkah Healthcare Cluster, Makkah Almukarramah, Saudi Arabia.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Physical activity (PA) is an integral part of T2DM management.PA has
Received: 25 December 2021 important benefits to T2DM patients. Not only improving glycemic
Final Accepted: 30 January 2022 control and reducing glycosylated hemoglobin (4). But also reducing
Published: February 2022 patients’ mortality risks (20 to >37 % reduction). provides beneficial
cardiovascular outcomes (5) improves insulin secretion and helps
patients control their body weight.In our study we assessed the
prevalence of physical activities among patients with type 2 diabetes
mellitus and to assess the barriers that prevents them from physical
activities by using a valid questionnaire called International Physical
Activity Questionnaire (IPAQ).result: total of 157 participants included
in this study. 51.6% was involved in low level of physical activity
while 28.7% in moderate activity and 19.7% in high level of physical
activity. Commonest reported barriers of practicing physical activity
among type 2 diabetic patients were Laziness, lack of energy (40.8%),
health related issues (38.9%), lack of nearby dedicated facilities
(30.6%), lack of time (29.9%) and weather conditions (27.4%). Female
patients were more likely than males to feel uncomfortable to engage in
exercise in public areas (21.9% vs. 6.5%), Conclusion, level of physical
activity among type 2 diabetic patients was significantly related to age,
educational level, occupation and working hours/day and was generally
low in more than half of the patients.

Copy Right, IJAR, 2022,. All rights reserved.

……………………………………………………………………………………………………....
Introduction:-
Saudi Arabia (SA) has the second highest prevalence of type 2 diabetes mellitus (T2DM) in the Middle East. The
prevalence of T2DM in SA increased from 1.8% to 27.6% between 1998 and 2013. It is now the fourth leading
cause of death in SA, and the 65th leading cause of death worldwide. (1).

Physical activity (PA) is an integral part of T2DM management. It defined as any movement of the body that greatly
enhances energy expenditure (2). The current American heart association (AHA) and the American diabetes
association (ADA) guidelines recommend performing at least 150 min of moderate aerobic exercise per week.
Divided over at least 3 days. and not exceeding 2 consecutive days of inactivity(3). PA has important benefits to
T2DM patients. Not only improving glycemic control and reducing glycosylated hemoglobin (4). But also reducing
patients‟ mortality risks (20 to >37 % reduction). provides beneficial cardiovascular outcomes (5) improves insulin

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Corresponding Author:- Dr. Abduljabbar Muhammad Alfetni
Address:- Saudi Board of Family Medicine Makkah Healthcare Cluster, Saudi Arabia.
ISSN: 2320-5407 Int. J. Adv. Res. 10(02), 1320-1328

secretion and helps patients control their body weight (6). However not all patients with T2DM achieve the PA
goals. In the United States of America (USA), 60% of people with diabetes do not achieve the PA recommendations
of 150 minutes of exercise per week. And in Argentina only 51% managed to perform low level PA (7).

In the Arabian gulf region. A study in Oman reported that only 21.6% of T2DM met the PA recommendations (8).
While in the United Arab Emirates (UAE), a study reported only 3% of T2DM patients met the PA
recommendations(3).

In Saudi Arabia. a study in Riyadh reported that PA recommendations were met in 26.3% of T2DM female
patients(1). The rate of physical inactivity in Saudi Arabia in 2010 has been reported as 96.1% (5). This makes
investigating the barriers to achieve target PA important reported barriers to PA include Lack of motivation.
shortage of time. and commitment to family (6). Insufficient social support and energy. fear of injury(2).

PA overestimation has also been linked especially among young males. And individuals with low body mass index
(BMI) (9). While other patients reported physically limiting comorbidities such as arthritis and previous major
surgeries as a barrier(10).

In our study we assessed the prevalence of physical activities among patientswith type 2 diabetes mellitus and to
assess the barriers that prevents them fromphysical activities.

Design and Methods

Study design:
A cross-sectional study was conducted among type 2 diabetic patients that visited Kudai and Al-Hijra Primary
Health Care Center in Makkah city between the 15th of November and the 1st of December 2021. It was a
questionnaire-based study.

Participants:
The questionnaires were distributed among all patients whom diagnosed with type 2 diabetes mellitus according to
American Diabetes Association criteria (11). patientswho‟s their ages were between 15 and 69 and able to provide
informed consent. All patients that accepted were enrolled in the study. Pregnant women, patients who known to
have physical disability, non-arabic speakers and incomplete questionnaires were excluded.

Data collection:
The self-administrated questionnaire was distributed among all patients meeting the inclusion criteria in Arabic
language. A total of 157 patients who met the inclusion criteria completed their questionnaires, however 11 patients
were dropped out of study as they did not complete their questionnaires.

Study tool:
The survey consisted of three parts: first, the socio-demographic data including age, sex, marital status, educational
level, monthly family income, smoking status, presence of mental illnesses, employment status and working hours
per day. The second part consisted of International Physical Activity Questionnaire (IPAQ) short form to assess the
level of physical activity. The third part consisted of 11 items which represent barriers that can limit physical
activity.

International Physical Activity Questionnaire (IPAQ) short form:

IPAQ is valid and reliable questionnaire, also valid in many languages including Arabic language that has been used
in this study. IPAQ short form used to assess the level of physical activity among participants. The raw data was
processed and entered for data analysis according to IPAQ scoring protocol (Short Form). Both categorical and
continuous variables can be assessed by IPAQ questionnaire. IPAQ assess duration and frequency of 3 levels of
physical activities: walking, moderate intensity, and vigorous intensity physical activities for the last week.
Continuous variables were presented as Metabolic Equivalent of task/minute/week (METs-min/week). Walking
minute equal to 3.3 METs, moderate intensity physical activity minute equal to 4.0 METs and vigorous intensity
physical activity equal to 8.0 METs. The total MET-minutes/week was calculated by combination of walking MET-
minutes/week, moderate intensity activity MET-minutes/week and vigorous intensity activity MET-minutes/week.
Categorical variables categorised into low, moderate, and high physical activity. Low level of physical activity is
proposed if there is no activity, or some activity is reported but not enough to meet moderate or high categories.

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Moderate level of physical activity is proposed if patient meets one of the following three criteria: first, 3 or more
days of vigorous activity of at least 20 minutes per day, second, 5 or more days of moderate-intensity activity and/or
walking of at least 30 minutes per day, third, 5 or more days of any combination of walking, moderate-intensity or
vigorous-intensity activities achieving a minimum of at least 600 MET-minutes/week. High level of physical
activity is proposed if patient meets one of the following two criteria: first, vigorous-intensity activity on at least 3
days and accumulating at least 1500 MET- minutes/week, second, 7 or more days of any combination of walking,
moderate- or vigorous-intensity activities accumulating at least 3000 MET-minutes/week (12,13).

Statistical analysis:
Since all variables were categorized, they were described in the form of frequency and percentage. Analytical
statistics was performed using Chi-square test or Fischer exact test (in case of small frequencies) to test for the
association between level of physical activity and associated factors. P-value less than or equal 0.05 was considered
to determine statistical significance. Data entry and statistical analysis were performed utilizing the Statistical
Package for Social Science, version 26 software.

Results:-
A total of 157 type 2 diabetic patients were included in the present study. Their personal characteristics are
summarized in Table 1. The age of more than half of them (57.9%) ranged between 41 and 60 years whereas that of
21.7% exceeded 60 years. Males represented 59.2% of them, and 74.6% were married. More than one-third of
patients (35.1%) were university or above graduated while 12.7% were illiterates. The family income was less than
4000 SR/month among 38.9% of patients whereas it exceeded 20000 SR/month among 9.6% of them. The
prevalence of smoking was 22.9% and history of psychological diseases was observed among 8.3% of patients.
More than a third of the patients (35.7%) were employees and the number of working hours ranged between 7 and 8
years among most of them (65.6%).

Table 1:- Personal characteristics of type 2 diabetic patients, Makkah, Saudi Arabia (n=157).
Variables Frequency Percentage
Age (years)
15-30 14 8.9
31-40 18 11.5
41-50 44 28.0
51-60 47 29.9
>60 34 21.7
Sex
Male 93 59.2
Female 64 40.8
Marital status
Single 20 12.7
Married 117 74.6
Divorced 12 7.6
Widowed 8 5.1
Educational level
Illiterate 20 12.7
Primary school 16 10.2
Intermediate school 25 15.9
Secondary school 41 26.1
University 46 29.4
Postgraduate 9 5.7
Family income (Saudi Riyals/month)
<4000 61 38.9
4000-11000 56 35.6
>11000-20000 25 15.9
>20000 15 9.6
Smoking status
Smoker 36 22.9

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Non-smoker 121 77.1

History of psychological diseases
No 134 85.4
Yes 13 8.3
Don‟t know 10 6.4
Occupation
Employee 56 35.7
Business/trading 12 7.6
House wife 43 27.4
Nor working 46 29.3
Number of working hours/day
7-8 103 65.6
8 38 24.2
>8 16 10.2

Level of physical activity

Low level of physical activity, which defined as ≤600 MET min/week was observed among more than half of the
type 2 diabetic patients (51.6%) whereas moderate level, which defined as between 601 and 3000 MET min/week,
was observed among 28.7% of patients. High level of physical activity, which defined as ≥3001 MET min/week,
was observed among 19.7% of patients as evident from Figure 1.

Concerning type of physical activities, vigorous type was practiced by 16.6% of the patients whereas moderate type
was practiced by 32.5% of them while walking was reported by most of them (76.4%) as shown in Figure 2.

Regarding duration of sitting (minutes/day), Figure 3 shows that almost two-thirds of patients (68.8%) reported
sitting period ≤360 minutes/day.

31, 19.7%
Low
Moderate
81, 51.6%
45, 28.7% High

Figure 1:- Level of physical activity among type 2 diabetic patients, Makkah, Saudi Arabia.

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120

100
16.6
80 32.5

60 76.4 Yes

40 No

20

0
Walking Moderate Vigurous

Figure 2:- Type of physical activity among type 2 diabetic patients, Makkah, Saudi Arabia.

49, 31.2%
≤360 min
>360 min
108, 68.8%

Figure 3:- Duration of setting, expressed as minutes/day, among type 2 diabetic patients, Makkah, Saudi Arabia.

Factors associated with level of physical activity

The highest rate of high level of physical activity was observed among patients in the age group 15-30 years
(42.9%) whereas the lowest rate was observed among those aged over 60years (11.8%). However, the difference did
not reach the critical level of statistical significance (p=0.064). Secondary school educated patients reported the
highest rate of high level of physical activity (29.3%) compared to none among illiterates. The association between
educational level and level of physical activity was statistically significant, p=0.005. Among occupation categories,
employees had the highest rate of high physical activity level (30.4%) while workers in business and trading had the
lowest rate (8.3%), p=0.044. Almost one-third (34.2%) of patients working for average 8 hours/day compared to
12.5% of those working >hours/day expressed high level of physical activity, p=0.029. Patients` sex, marital status,
family income, smoking status and history of psychological diseases were not significantly associated with level of
physical activity. Table 2

Table 2:- Factors associated with the level of physical activity among type 2 diabetic patients, Makkah, Saudi
Arabia.
Gender Level of physical activity p-value*
Low Moderate High

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N=45 N=49 N=6

N (%) N (%) N (%)
Age (years)
15-30 (n=14) 6 (42.9) 2 (14.2) 6 (42.9)
31-40 (n=18) 5 (27.8) 10 (55.6) 3 (16.7)
41-50 (n=44) 23 (52.3) 11 (25.0) 10 (22.7)
51-60 (n=47) 25 (53.2) 14 (29.8) 8 (17.0)
>60 (n=34) 22 (64.7) 8 (23.5) 4 (11.8) 0.064
Sex
Male (n=93) 48 (51.6) 31 (33.3) 14 (15.1)
Female (n=64) 33 (51.6) 14 (21.9) 17 (26.6) 0.118
Marital status
Single (n=20) 9 (45.0) 6 (30.0) 5 (25.0)
Married (n=117) 60 (51.3) 36 (30.8) 21 (17.9)
Divorced (n=12) 5 (41.7) 3 (25.0) 4 (33.3)
Widowed (n=8) 7 (87.5) 0 (0.0) 1 (12.5) 0.345
Educational level
Illiterate (n=20) 18 (90.0) 2 (10.0) 0 (0.0)
Primary school (n=16) 7 (43.8) 7 (43.8) 2 (12.4)
Intermediate school (n=25)
Secondary school (n=41) 16 (64.0) 6 (24.0) 3 (12.0)
University (n=46)
Postgraduate (n=9) 21 (51.2) 8 (19.5) 12 (29.3)

16 (34.8) 18 (39.1) 12 (26.1)

3 (33.3) 4 (44.5) 2 (22.2) 0.005
Family income (Saudi Riyals/
month)
<4000 (n=61)
4000-11000 (n=56) 34 (55.7) 18 (29.5) 9 (14.8)
>11000-20000 (n=25) 32 (57.1) 12 (21.4) 12 (21.4)
>20000 (n=15) 9 (36.0) 8 (32.0) 8 (32.0)

6 (40.0) 7 (46.7) 2 (13.3) 0.238

Smoking status
Smoker (n=36) 18 (50.0) 14 (38.9) 4 (11.1)
Non-smoker (n=121) 63 (52.1) 31 (25.6) 27 (22.3)
0.175
History of psychological
diseases
No (n=134)
Yes (n=13) 64 (47.8) 41 (30.6) 29 (21.9)
Don‟t know (n=10) 10 (76.9) 2 (15.4) 1 (7.7)
7 (70.0) 2 (20.0) 1 (10.0) 0.223
Occupation
Employee (n=56) 21 (37.5) 18 (32.1) 17 (30.4)
Business/trading (n=12) 7 (58.3) 4 (33.3) 1 (8.3)
House wife (=43)
Nor working (n=46) 28 (65.1) 7 (16.3) 8 (18.6)
25 (54.3) 16 (34.8) 5 (10.9) 0.044
Number of working
hours/day
7-8 (n=103) 60 (58.3) 27 (26.2) 16 (15.5)
8 (n=38) 15 (39.5) 10 (26.3) 13 (34.2)
>8 (n=16) 6 (37.5) 8 (50.0) 2 (12.5) 0.029

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*Chi-square test
Barriers of physical activity
From Table 3, it is evident that the commonest reported barriers of practicing physical activity among type 2
diabetic patients were Laziness, lack of energy (40.8), health related issues (38.9%), lack of nearby dedicated
facilities (30.6%), lack of time (29.9%) and weather conditions (27.4%). Female patients were more likely than
males to feel uncomfortable to engage in exercise in public areas (21.9% vs. 6.5%), p=0.004. Other barriers showed
no significant difference between male and female patients.

Table 3:- Comparison of barriers of physical activity between male and female diabeticpatients.
Males Females Total p-value
N=93 N=64 N=157
N (%) N (%) N (%)
Health related issues 35 (37.6) 26 (40.6) 61 (38.9) 0.706*
Lack of time 28 (30.1) 19 (29.7) 47 (29.9) 0.955*
Lack of motivation 22 (23.7) 20 (31.3) 42 (26.8) 0.291*
Lack of safe place to 14 (15.1) 12 (18.8) 26 (16.6) 0.540*
exercising
Lack of nearby dedicated 26 (28.0) 22 (34.9) 48 (30.6) 0.355*
facilities.
Feeling uncomfortable to 6 (6.5) 14 (21.9) 20 (12.7) 0.004*
engage in exercise in public
areas.
Weather conditions 27 (29.0) 16 (25.0) 43 (27.4) 0.578*
Laziness, lack of energy 38 (40.9) 26 (40.6) 64 (40.8) 0.976*
High cost of dedicated 16 (17.2) 14 (21.9) 30 (19.1) 0.464*
facilities.
Others 9 (9.7) 5 (7.8) 7 (4.5) 0.687*
No barriers 3 (3.2) 4 (6.3) 14 (8.9) 0.301**
*Chi-square test **Fischer Exact test

Discussion:-
level physical activity
This study aimed to evaluate the level of physical activity among T2DM patients from Kudai and Al-Hijra primary
health care center in Makkah, Saudi Arabia, which revealed that most of our papulation performed Low level
physical activity 51.6%. Moderate level physical activity in 28.7% of patients. Followed by high level of physical
activity in 19.7% of patients which was reported similarly by Kennerly and Kirk in USA with Low PA 55.6%
Moderate PA 34.8% and High PA 9.6% (14). Shiriyedeve et alin Gaborone, Botswana reported 54.7% low PA
among T2DM patients and martin et all reported 52.3% of T2DM patients in Argentina performed low level PA
(7,15). In the other hand our study results were different To some countries like in Brazil where Low PA was 30.8%,
Moderate 60.6% and High (8.7%), also in France Low PA was 15.1%, Moderate PA 51.3% and High PA 33.6%,
which they reported a lower percentage of low PA and much higher level of Moderate PA (14).

Type of physical activity

We found that The main type of physical activity was walking (76.4%) Similar to patients from United Arab
Emirates where walking was performed in 78% of total population according to Al-Kaabi et al, Moderate type PA
represent 32.5% and Vigorous type of PA represent the lowest by 16.6% of our patients (3).

Sitting time
Regarding duration of sitting (minutes/day), almost two-thirds of our patients (68.8%) reported sitting period ≤360
minutes/day, which is in line with 348 minutes/day reported in Botswana, Nigeria (288 minutes/day) and 349.2
minutes/day in USA (14,15). Alghafri et al in Muskat, Oman reported much higher sitting time with Females sitting
time 720 min/day vs males 660 min/day (8), and Mohamed et al in Riyadh, Saudi Arabia revealed that sitting time
was 689 ±40.6 among females with T2DM (1).

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Factors associated with physical activity

In our study population we found that Educational levels was significantly associated with level of physical activity
as Total number of 46 patients had university degree and 65.2% of them had moderate to High level of physical
activity while 90% of Illiterate population had low physical activity (p=0.005). This is in agreement with a study
that conducted in the U.S that showed similar findings as college degree population were more physically active
(64.7%) than high school population (48.3%) (17). Another study was done in southwest Ethiopia revealed similar
results as they found that nonadherence to physical activity was more in Illiterate people (75.7%) compared to
higher education levels (43.6%), also a study was done in Riyadh, Saudi Arabia among females they estimated that
58.3% of high Degrees of education „university and above‟ met physical activity recommendations while only 13%
of illiterate participants met the recommended physical activity level (1,18). In regard of occupation our results
revealed significant difference in level of physical activity between employees and unemployed population (p=0.04),
whereas Employees were more physically active (62.5%) than unemployed population (45.7%). A study was done
in Botswana revealed similar findings that employees were more active with 45.5% of them had moderate physical
activity compared to unemployed population which only 29.6% of them were moderately active (15). A study from
Oman also revealed same outcomes of 50% of government employee and 37% of non-government employee were
physically active compared to unemployed who only 10% of them were active (8).

Barriers to physical activity

Among our patients we found that the most common barrier for physical activity facing patients was Laziness and
lack of energy (40.8%), among male patients this consider a barrier for 40.9% of them, while among female patients
this percentage decreased by 0.3% compared to male patients. Health related issues was the second most prevalent
barrier (38.9%), whereas the same number of female patients who consider laziness and lack of energy as a barrier
also consider health related issues a barrier for them, while this percentage decreased by 3% in male patients in
comparison with females. A study was conducted in Oman reported that the most common barrier overall is the lack
of willpower (45.5%) followed by lack of resources (30.5%), among males the most prevalent barrier was also lack
of willpower (41.5%), the same barrier was the most prevalent among females (48.6%), while the second most
common barrier in male was lack of resources (32.3%), this is in contrast with females that consider the lack of
social support was the second most prevalent barrier (35.4%) (8). Another study was conducted in Argentina
revealed different common barriers, being Lack of willpower is the most common barrier (59.6%) and Lack of
energy is the 2nd most common barrier (37.2%) (7). Our results were in contrast with study was conducted in Saudi
Arabia reported that Lack of resources is the most common barrier overall (48.4%), and the most common among
males (37%) and females (63%) (2).We found that the most significant difference in barrier between males and
female patients was Feeling uncomfortable to engage in exercise in public areas, and Female patients were more
likely than males to feel uncomfortable to engage in exercise in public areas in which 6 out of 20 males and 14 out
of 20 females (p=0.004) consider it as barrier, a study was conducted in Saudi Arabia reported unlike our study that
the lack of skills is the most significant difference in barrier between males and female patients in which 15 out of
74 males and 59 out of 74 females (p=0.0005), other statistically significant difference in barrier reported by the
study includes the Lack of willpower reported by 75 female and 32 male of 107, the Lack of energy reported by 64
female and 18 male of 82, and the Lack of social reported by 40 female and 14 male of 54 (p=0.04,0.005,0.04
respectively) (2).

Conclusion:-
In conclusion, level of physical activity among type 2 diabetic patients was significantly related to age, educational
level, occupation and working hours/day and was generally low in more than half of the patients. On the other hand,
sex, marital status, family income, smoking status and history of psychological diseases were not significantly
associated with level of physical activity. But regarding sex, female patients were more likely to feel uncomfortable
to engage in exercise in public areas, and the other barriers were not significant to differentiate between male and
female patients.

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