Developing a Complex Understanding of Physical Activity in Cardiometabolic Disease from Low-to-Middle-Income Countries—A Qualitative Systematic Review with Meta-Synthesis

Martin Heine, Marelise Badenhorst, Chanel van Zyl, Gabriela Lima de Melo Ghisi, Abraham Samuel Babu, John Buckley, Pamela Serón, Karam Turk-Adawi and Wayne Derman
Additional contact information
Martin Heine: Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town 8000, South Africa
Marelise Badenhorst: Sports Performance Research Institute New Zealand (SPRINZ), School of Sport and Recreation, Auckland University of Technology, Auckland 1010, New Zealand
Chanel van Zyl: Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town 8000, South Africa
Gabriela Lima de Melo Ghisi: Cardiovascular Prevention and Rehabilitation Program, KITE-Toronto Rehabilitation Institute, University Health Network, 347 Rumsey Road, Toronto, ON M4G 2R6, Canada
Abraham Samuel Babu: Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
John Buckley: The School of Allied Health Professions, Keele University, Staffordshire ST5 5AZ, UK
Pamela Serón: Department of Internal Medicine and Center of Excellence CIGES, Facultad de Medicina, Universidad de La Frontera, Temuco 4781176, Chile
Karam Turk-Adawi: Department of Public Health, College of Health Sciences, QU-Health, Qatar University, Doha P.O. Box 2713, Qatar
Wayne Derman: Institute of Sport and Exercise Medicine, Division of Orthopaedics, Department of Surgical Sciences, Faculty of Health and Medicine, Stellenbosch University, Cape Town 8000, South Africa

IJERPH, 2021, vol. 18, issue 22, 1-18

Abstract: Physical activity behaviour is complex, particularly in low-resource settings, while existing behavioural models of physical activity behaviour are often linear and deterministic. The objective of this review was to (i) synthesise the wide scope of factors that affect physical activity and thereby (ii) underpin the complexity of physical activity in low-resource settings through a qualitative meta-synthesis of studies conducted among patients with cardiometabolic disease living in low-to-middle income countries (LMIC). A total of 41 studies were included from 1200 unique citations (up to 15 March 2021). Using a hybrid form of content analysis, unique factors ( n = 208) that inform physical activity were identified, and, through qualitative meta-synthesis, these codes were aggregated into categories ( n = 61) and synthesised findings ( n = 26). An additional five findings were added through deliberation within the review team. Collectively, the 31 synthesised findings highlight the complexity of physical activity behaviour, and the connectedness between person, social context, healthcare system, and built and natural environment. Existing behavioural and ecological models are inadequate in fully understanding physical activity participation in patients with cardiometabolic disease living in LMIC. Future research, building on complexity science and systems thinking, is needed to identify key mechanisms of action applicable to the local context.

Keywords: physical activity; diabetes; cardiovascular disease; metabolic syndrome; qualitative review; systems thinking (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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