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      Correlates, facilitators and barriers of physical activity among primary care patients with prediabetes in Singapore – a mixed methods approach

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          Abstract

          Background

          Primary care patients with prediabetes is a priority group in the clinical, organisational and policy contexts. Engaging in regular physical activity is crucial to prevent diabetes for this group. The objectives of the study were to assess factors associated with meeting the recommendation of at least 150 min of moderate/vigorous physical activity weekly, and to explore facilitators and barriers related to the behaviour among primary care patients with prediabetes in Singapore.

          Methods

          This was a mixed methods study, consisting of a cross-sectional survey involving 433 participants from 8 polyclinics, and in-depth interviews with 48 of them. Adjusted prevalence ratios (aPR) were obtained by mixed effects Poisson regression model. The socio-ecological model (SEM) was applied, and thematic analysis performed.

          Results

          The prevalence of meeting the recommendation was 65.8%. This was positively associated with being male (aPR 1.21, 95%CI 1.09–1.34), living in 4–5 room public housing (aPR 1.19, 95%CI 1.07–1.31), living in executive flat/private housing (aPR 1.26, 95%CI 1.06–1.50), having family members/friends to exercise with (aPR 1.57, 95%CI 1.38–1.78); and negatively associated with a personal history of osteoarthritis (aPR 0.75, 95%CI 0.59–0.96), as well as time spent sitting or reclining daily (aPR 0.96, 95%CI 0.94–0.98). The recurrent themes for not meeting the recommendation included lacking companionship from family members/friends, medical conditions hindering physical activity (particularly osteoarthritis), lacking knowledge/skills to exercise properly, “no time” to exercise and barriers pertaining to exercise facilities in the neighbourhood. The recurrent themes for meeting the recommendation included family/peer influence, health/well-being concerns and education by healthcare professionals.

          Conclusions

          Much more remains to be done to promote physical activity among primary care patients with prediabetes in Singapore. Participants reported facilitators and barriers to physical activity at different levels of the SEM. Apart from the individual and interpersonal levels, practitioners and policy makers need to work together to address the organisational, community and policy barriers to physical activity.

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          Most cited references30

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          Metabolic syndrome and insulin resistance: underlying causes and modification by exercise training.

          Metabolic syndrome (MS) is a collection of cardiometabolic risk factors that includes obesity, insulin resistance, hypertension, and dyslipidemia. Although there has been significant debate regarding the criteria and concept of the syndrome, this clustering of risk factors is unequivocally linked to an increased risk of developing type 2 diabetes and cardiovascular disease. Regardless of the true definition, based on current population estimates, nearly 100 million have MS. It is often characterized by insulin resistance, which some have suggested is a major underpinning link between physical inactivity and MS. The purpose of this review is to: (i) provide an overview of the history, causes and clinical aspects of MS, (ii) review the molecular mechanisms of insulin action and the causes of insulin resistance, and (iii) discuss the epidemiological and intervention data on the effects of exercise on MS and insulin sensitivity.
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            Diabetes in Asia and the Pacific: Implications for the Global Epidemic.

            The last three decades have witnessed an epidemic rise in the number of people with diabetes, especially type 2 diabetes, and particularly in developing countries, where more than 80% of the people with diabetes live. The rise of type 2 diabetes in South Asia is estimated to be more than 150% between 2000 and 2035. Although aging, urbanization, and associated lifestyle changes are the major determinants for the rapid increase, an adverse intrauterine environment and the resulting epigenetic changes could also contribute in many developing countries. The International Diabetes Federation estimated that there were 382 million people with diabetes in 2013, a number surpassing its earlier predictions. More than 60% of the people with diabetes live in Asia, with almost one-half in China and India combined. The Western Pacific, the world's most populous region, has more than 138.2 million people with diabetes, and the number may rise to 201.8 million by 2035. The scenario poses huge social and economic problems to most nations in the region and could impede national and, indeed, global development. More action is required to understand the drivers of the epidemic to provide a rationale for prevention strategies to address the rising global public health "tsunami." Unless drastic steps are taken through national prevention programs to curb the escalating trends in all of the countries, the social, economic, and health care challenges are likely to be insurmountable.
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              Quantification of urbanization in relation to chronic diseases in developing countries: a systematic review.

              During and beyond the twentieth century, urbanization has represented a major demographic shift particularly in the developed world. The rapid urbanization experienced in the developing world brings increased mortality from lifestyle diseases such as cancer and cardiovascular disease. We set out to understand how urbanization has been measured in studies which examined chronic disease as an outcome. Following a pilot search of PUBMED, a full search strategy was developed to identify papers reporting the effect of urbanization in relation to chronic disease in the developing world. Full searches were conducted in MEDLINE, EMBASE, CINAHL, and GLOBAL HEALTH. Of the 868 titles identified in the initial search, nine studies met the final inclusion criteria. Five of these studies used demographic measures (such as population density) at an area level to measure urbanization. Four studies used more complicated summary measures of individual and area level data (such as distance from a city, occupation, home and land ownership) to define urbanization. The papers reviewed were limited by using simple area level summary measures (e.g., urban rural dichotomy) or having to rely on preexisting data at the individual level. Further work is needed to develop a measure of urbanization that treats urbanization as a process and which is sensitive enough to track changes in "urbanicity" and subsequent emergence of chronic disease risk factors and mortality.
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                Author and article information

                Contributors
                raymondlim1302@gmail.com
                wei_keong_wee@nhgp.com.sg
                Wei_Chek_FOR@nhgp.com.sg
                Jayalakshmy_Aarthi@nhgp.com.sg
                Ying_Hua_SOH@nhgp.com.sg
                lynette_ml_goh@nuhs.edu.sg
                dede146262@yahoo.com
                ephwml@nus.edu.sg
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                2 January 2020
                2 January 2020
                2020
                : 20
                : 1
                Affiliations
                [1 ]ISNI 0000 0001 2180 6431, GRID grid.4280.e, Saw Swee Hock School of Public Health, , National University of Singapore and National University Health System, ; Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, Singapore city, 117549 Singapore
                [2 ]Health Promotion & Preventive Care, National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, #05-10, Singapore, Singapore city, 138543 Singapore
                [3 ]ISNI 0000 0004 0451 6143, GRID grid.410759.e, Clinical Services, , National University Polyclinics and National University Health System, ; 1 Jurong East Street 21, Singapore, Singapore city, 609606 Singapore
                Article
                7969
                10.1186/s12889-019-7969-5
                6941241
                31898494
                b40a69d3-43bc-44b8-a090-43e24d43077a
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 23 April 2019
                : 19 November 2019
                Funding
                Funded by: Saw Swee Hock School of Public Health, National University of Singapore
                Award ID: War on Diabetes seed funding
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Public health
                prediabetes,physical activity,primary care,diabetes prevention,mixed methods,public health,singapore

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