The prevalence of chronic disease such as type 2 diabetes and cardiovascular diseases is increasing rapidly in Oman. While physical inactivity and prolonged sitting time are key behavioral risk factors for these chronic diseases, the majority of the published evidence comes from developed countries. Limited evidence is available from Oman and other countries of the Gulf Cooperation Council (GCC; Bahrain Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) about the associations of physical inactivity and sitting time with health outcomes or the determinants of these health risk behaviors. There is an urgent need for such evidence to better inform public health strategies and policy initiatives in Oman and the other countries of the GCC.
Using an Omani population-based health survey dataset, this Thesis examines the associations of domain-specific physical inactivity and prolonged sitting time with the metabolic syndrome, and identifies the socio-demographic, anthropometric and behavioral correlates of these behaviors. The Thesis also examines the perceptions of key health managers about the kinds of public health policies and programs that can best address physical inactivity and sitting time. The findings are organized according to the Behavioral Epidemiology Framework and are intended to provide evidence that can inform relevant public health initiatives in Oman.
Methods and Results
A systematic review of the available evidence from Oman and other countries of the GCC, published as a peer reviewed paper during the PhD candidature, showed a high prevalence of the metabolic syndrome, particularly among women. A second systematic review, also published as a peer reviewed paper, showed a high prevalence of physical inactivity; again, particularly among women. Building on these findings, two empirical studies were conducted based on an analysis of a population-based survey of Omani adults living in Sur, a major city in Oman.
The first empirical study, published in a peer-reviewed journal, examined the associations of physical activity and sitting time with the metabolic syndrome. Using pooled regression models, lower odds of the metabolic syndrome were observed among those with higher work activity (0.60; 95% CI: 0.45, 0.80) and transport activity (0.69; 95% CI: 0.47, 1.00) compared to those with the least physical activity. These associations were not observed for leisure activity (0.91; 95% CI: 0.64, 1.32). Odds of the metabolic syndrome were higher in those who sat for > 6 hours daily compared to < 3 hours daily (OR=1.60, 95% CI: 1.04, 2.44), but not after further adjustment for physical activity.
The second empirical study, also published in a peer-reviewed journal, explored the demographic, anthropometric and behavioral correlates of physical inactivity and prolonged sitting time using the same population-based survey dataset. Using gender-stratified logistic regression models the statistically significant correlates of inactivity (in one or more domains) were: age, work status and fruit and vegetable intake in women; age, education, work status, marital status and BMI in men. Using gender-stratified linear regression models, the statistically significant correlates of sitting time were: age, work status and BMI in women and education in men.
Based on these findings, a semi-structured interview survey with mid-level public health managers was conducted to identify public health strategies to address physical inactivity and prolonged sitting time in Oman. Based on thematic content analysis guided by an ecological model, the proposed solutions focused on culturally-sensitive interventions at physical environment and policy levels. These were in response to the four main barriers the respondents identified: intrapersonal (lack of motivation, awareness and time), social (norms restricting women’s participation in outdoor activity, low value of physical activity), environment (lack of places to be active, weather) and policy barriers (ineffective health communication, limited resources).
Overall, the set of studies reported in this Thesis identified the importance of addressing physical inactivity and prolonged sitting time as a public health response to the increasing prevalence of chronic disease in Oman. The Discussion chapter suggests how the findings from this Thesis can inform public health policy in Oman (and potentially for other GCC countries) following the recommendations outlined in the Toronto Charter for Physical Activity. Support from key sectors is needed to ensure coordinated multi-level action to reduce physical inactivity and sitting time that is culturally relevant for the Omani context and focuses on supportive policies and the built environment. Additional research on these health risk behaviors is required to fill the knowledge gaps that exist and provide better guidance to policy makers.