Promoting physical activity in sedentary older Malays with Type 2 diabetes mellitus
thesisposted on 23.02.2017, 00:46 by Shariff Ghazali, Sazlina
Type 2 diabetes mellitus (T2DM) in older people is becoming a global health problem. In Malaysia, the overall prevalence of diabetes has increased by almost 200% in a decade. Among the different ethnic groups, the Malays are reported to have the poorest control for glycaemia and other cardiovascular risk factors. Lifestyle interventions such as regular physical activity are important in the management of T2DM. Despite the many health benefits of regular physical activity, participation remains low, especially among people with T2DM. This study was conducted in three phases to explore the current situation regarding promoting physical activity in older people with T2DM. In Phase 1, a systematic review was conducted to review the scientific evidence on interventions promoting physical activity in older people with T2DM. The review found 21 studies (18 randomised controlled trials and three quasi-experimental studies) from eight countries that investigated physical activity in people with T2DM. Strategies that increased physical activity levels in people with T2DM were evident, but most of the studies focused on middle-aged rather than on older people and none were conducted in Asia. Also, these strategies varied markedly between studies and most incorporated health behaviour theories and multiple approaches to facilitate and maintain behaviour change. Further, there was a lack of well-designed trials. More studies with interventions of satisfactory methodological quality promoting physical activity in older people are required. Phase 2 reported in this thesis was a qualitative focus group study that aimed to explore the perceptions of physical activity, and the motivators for and barriers to physical activity in older Malays with T2DM. This study found that older Malays with T2DM viewed physical activity as an important aspect of the self-care management of diabetes. The conventional perceptions regarding the definition of physical activity, and the motivators for and barriers to physical activity were intertwined with social rules, and cultural and spiritual expectations in this Malay community. Spiritually related activities emerged as a theme in defining physical activity and its barriers. Therefore, emphasis on regular physical activity that not only improves glycaemic control but also allows the continuation of religious obligations is important for older Malays with T2DM. Phase 3 was a randomised controlled trial conducted to determine the effectiveness of personalised feedback about physical activity patterns alone and in combination with peer support, in addition to the usual diabetes care on physical activity levels, cardiovascular diseases risk factors, functional status, quality of life and psychosocial wellbeing. Strategies that included the constructs of social cognitive theory in personalised feedback about physical activity patterns combined with peer support assisted older Malays with T2DM to change their physical activity behaviour. The outcomes of this study could be used to inform the development of physical activity interventions for older Malays in primary care and community settings. Such interventions have the potential to improve the health of older people in Malaysia and reduce the health care burden due to diabetes related complications. This would facilitate the nation’s vision to promote active and productive ageing in Malaysia.