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      Barriers and Facilitators Associated with Physical Activity in the Middle East and North Africa Region: A Systematic Overview

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          Abstract

          Increasing physical inactivity levels in the Middle East and North Africa (MENA) region is a public health concern. We aimed to synthesize barriers and facilitators to physical activity and make appropriate recommendations to address physical inactivity. We conducted an overview of systematic reviews on physical activity barriers and facilitators in 20 MENA countries by systematically searching MEDLINE/PubMed and Google Scholar for systematic reviews published between 2008 and 2020. Our overview included four systematic reviews and 119 primary studies with data from 17 MENA countries. Lack of suitable sports facilities, time, social support and motivation, gender and cultural norms, harsh weather, and hot climate were the most commonly reported barriers to physical activity. Socio-demographic factors negatively associated with physical activity participation include advanced age, being female, less educated, and being married. Motivation to gain health benefits, losing/maintaining weight, being male, dietary habits, recreation, and increased Body Mass Index are positively associated with increased levels of physical activity. Interventions promoting physical activity in MENA should target schoolchildren, women and girls, working parents, and the elderly. Country-specific sociocultural and environmental factors influencing physical activity should be considered in the design of interventions. Current and future policies and national interventions must be consistently evaluated for effectiveness and desired outcomes.

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          Most cited references177

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          Rayyan—a web and mobile app for systematic reviews

          Background Synthesis of multiple randomized controlled trials (RCTs) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions. Filtering of searches is time consuming, and no single method fulfills the principal requirements of speed with accuracy. Automation of systematic reviews is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making. We developed Rayyan (http://rayyan.qcri.org), a free web and mobile app, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. For the beta testing phase, we used two published Cochrane reviews in which included studies had been selected manually. Their searches, with 1030 records and 273 records, were uploaded to Rayyan. Different features of Rayyan were tested using these two reviews. We also conducted a survey of Rayyan’s users and collected feedback through a built-in feature. Results Pilot testing of Rayyan focused on usability, accuracy against manual methods, and the added value of the prediction feature. The “taster” review (273 records) allowed a quick overview of Rayyan for early comments on usability. The second review (1030 records) required several iterations to identify the previously identified 11 trials. The “suggestions” and “hints,” based on the “prediction model,” appeared as testing progressed beyond five included studies. Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements. The survey respondents reported 40% average time savings when using Rayyan compared to others tools, with 34% of the respondents reporting more than 50% time savings. In addition, around 75% of the respondents mentioned that screening and labeling studies as well as collaborating on reviews to be the two most important features of Rayyan. As of November 2016, Rayyan users exceed 2000 from over 60 countries conducting hundreds of reviews totaling more than 1.6M citations. Feedback from users, obtained mostly through the app web site and a recent survey, has highlighted the ease in exploration of searches, the time saved, and simplicity in sharing and comparing include-exclude decisions. The strongest features of the app, identified and reported in user feedback, were its ability to help in screening and collaboration as well as the time savings it affords to users. Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of reviewers.
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            World Health Organization 2020 guidelines on physical activity and sedentary behaviour

            Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.
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              Global physical activity levels: surveillance progress, pitfalls, and prospects

              The Lancet, 380(9838), 247-257
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                Author and article information

                Contributors
                Role: Academic Editor
                Role: Academic Editor
                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                09 February 2021
                February 2021
                : 18
                : 4
                : 1647
                Affiliations
                Institute for Population Health, Weill Cornell Medicine—Qatar, Education City, Doha 24144, Qatar; sonia.chaabane.phd@ 123456gmail.com (S.C.); kac2047@ 123456qatar-med.cornell.edu (K.C.); sdo4003@ 123456qatar-med.cornell.edu (S.D.); ram2026@ 123456qatar-med.cornell.edu (R.M.)
                Author notes
                [* ]Correspondence: soc2005@ 123456qatar-med.cornell.edu ; Tel.: +974-44928503; Fax: +974-44928333
                Author information
                https://orcid.org/0000-0002-4198-8065
                https://orcid.org/0000-0002-5874-4059
                Article
                ijerph-18-01647
                10.3390/ijerph18041647
                7914747
                33572229
                dd1dd8c8-d7c7-4a28-86f7-f3259210c309
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 29 November 2020
                : 05 February 2021
                Categories
                Review

                Public health
                physical activity,barriers,inactivity,systematic review,middle east,north africa
                Public health
                physical activity, barriers, inactivity, systematic review, middle east, north africa

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