The findings of this study highlight the following: (a) Majority of the participants are physically active; (b) They obtain their physical activity primarily from work and transportation domains with very little participation in LTPA; (c) Most participants did not perceive a need to increase their physical activity level and (d) There is very low awareness regarding chronic disease related health benefits of physical activity.
This pattern of high work related PA and low LTPA is similar to that observed in India’s integrated disease surveillance project in which the mean time spent in work related PA ranged between 128 – 293 minutes per day and that in LTPA ranged between 4 – 67 minutes per day . This trend of low LTPA and greater work related PA is common among most LMICs . The cause of concern here is the anticipated decline in work and transportation related PA. Greater participation in work and transportation related PA in this population is likely to be due to factors other than an objective to accrue health benefits. Though current total PA levels are good in this population, there is a stark possibility of it declining due to economic and social development. A review of best practice in interventions to promote PA in developing countries by World Health Organization summarised that urbanization and economic development, in part, drive the increase in burden of chronic diseases and rise in sedentary behaviour in developing countries . The human development index of the district, of which the taluk under study is a part, is better than most other districts in the state of Karnataka and is higher than the national average [36–38]. In addition, an increase in income and purchasing power, increase in demand for household appliances and automobile like small cars and two-wheeler bikes has been well documented in this district . Increase in household appliances and automobiles would potentially translate to reduction in work and travel related PA with time. As and when this happens, there will be a greater pressure to increase LTPA. But participation in LTPA is predominantly volitional and factors like perceived health benefits of PA and intention to increase PA are likely to have an influence [40, 41].
Though it may be possible to infer that participants would not have perceived a need to increase their PA simply because they had high levels of PA, the results indicate that the association between physical activity status and need to increase PA was not significant. A sub-analysis of physically inactive participants (n = 57) highlights that the majority (77.2%, 44/57) did not perceive the need to increase their physical activity. The constructs of HBM and TTM could possibly help us understand this perceived behaviour. The results from this study indicate very low awareness of chronic disease related benefits of PA in this population and are in stark contrast to the results from other countries. In Canada, more than 75% of population across various strata strongly believed that PA helps to prevent heart diseases . Another review highlighted that about 95% of the UK population know the relationship between physical activity and health . Lack of awareness of important health benefits of PA in this study population could possibly explain their reluctance in wanting to increase their PA [19, 20].
In the absence of published data, it is not clear if there is a general lack of awareness about chronic disease risk factors or if this low awareness is specific to relationship between PA and chronic diseases. However information from an on-going study and clinical and field experiences from our institute does indicate that there is awareness about the higher burden of heart disease, diabetes and hypertension in this region and factors like smoking, obesity, cholesterol and higher fat intake are contributory to these diseases.
Carefully designed interventions to improve knowledge and positive beliefs about chronic disease related benefits of PA may have the potential to encourage PA adoption. Many countries have put in place structured public health campaigns to educate and improve awareness among the people about the health benefits of PA, its role in prevention of chronic diseases and national PA guidelines [35, 44–46]. PA interventions in developing countries have included strategies to raise awareness of importance and benefits of PA. Such intervention programs in many countries have been successful in raising awareness of the importance and benefits of PA. A few countries have even demonstrated an actual increase in PA levels of large proportion of the population . The current study highlights the need for such awareness and intervention programs in regions similar to this to counter the anticipated decline in PA and raising burden of chronic diseases.
In a population where majority are physically active, it will be a challenge to determine factors facilitating voluntary PA participation. Though many correlates of PA have been identified in western population, it is likely that the correlates are different in LMICs. As LMICs such as India are transitioning towards economic development, it is imperative to determine factors influencing PA adoption and participation. Many studies from different LMIC settings are needed to understand factors influencing PA. The role of knowledge and awareness, personal beliefs and cultural influences, gender, education, occupation, socioeconomic status, chronic disease risk status, environmental factors, social support, policies and the like on PA behaviour in LMICs needs to be studied to device effective strategies to arrest declining PA levels.
Strengths & limitations
The results of this study could be considered representative of this region due to its sampling methodology. Content validation and field testing of the questionnaire prior to the study, use of a single interviewer and training of the interviewer in the local language was done to reduce bias in administering the questionnaire. The support of the local health workers in introducing the interviewer to the participants’ family ensured familiarity and better cooperation from the participants. A few studies in the past have assessed awareness as part of intervention program but to our knowledge, there are few studies from LMICs like India that has addressed the problem of awareness of benefits of PA. Most studies on awareness of benefits of PA have used closed ended questions or a Likert-type scale. Though such a methodology has its own advantages, we felt the use of such a method could bias the participant towards positive response. Open ended question, as used in this study, on the other hand could capture the actual perception of benefit of PA among participants. Despite the strengths of this study, it has several limitations and it should be considered while interpreting its results. The PA status was assessed by a questionnaire. Though GPAQ is being used in large epidemiological studies in developing countries, like any PA questionnaire, it has inherent errors in quantifying PA. An objective measure would have been ideal but could not be used due to funding limitations. As the interview was conducted by a single investigator, time related factors could have affected the PA levels. Care was taken to avoid monsoon and summer months for this purpose. Moreover, as no active intervention targeting awareness was in progress, it is unlikely that the participants’ perceptions would have changed. Even though, use of open ended question helped in obtaining the actual perceptions of people, it limited the possibility of further analysis. Though correlation of participants PA level and awareness of benefit with other factors like their current chronic disease risk profile, educational and socioeconomic status would have added a wealth of information, such measurements were not within the scope of this study. This study was conducted in a rural population and it is not known if the same trend would be observed in the urban population.