Malaysian Healthy Ageing Society * Sazlina Shariff Ghazali 1,3 , - PowerPoint PPT Presentation

Organised by: Co-Sponsored: Malaysian Healthy Ageing Society

* Sazlina Shariff Ghazali 1,3 , Colette Browning 2 , Shajahan Yasin 3 1 Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia 2 Primary Care Research Unit, School of Primary Health Care, Monash University, Australia 3 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campus, Malaysia

* Regular physical activity in older persons with type 2 diabetes has many health benefits ( Sigal et al 2007, Church et al 2005, Gregg et al 2003) * However, participation rate remains poor (Shazwani et al, 2010) * Barriers to physical activity is a major contribution to non- participation * Barriers: Personal, family environment, physical environment, cultural barriers * Motivators: health related (perceived good health, social support: family, friends and healthcare providers) (Kolt et al 2006, Mier et al 2007, Shazwani et al 2010, Bird et al 2009) * Defining physical activity and its barriers has been extensively reported, very few studies explored cultural contributions to perceptions of physical activity *

To explore the cultural definition of physical activity and its barriers in older Malays with type 2 diabetes *

* A qualitative study was conducted in an urban primary care clinic in Selangor, Malaysia * Part of a RCT to promote physical activity in sedentary older adults with type 2 diabetes * Four focus groups were conducted * A total of 25 Malay participants aged ≥60 years with type 2 diabetes, who were either sedentary or did regular * exercise were purposively recruited

* They were asked to explore the meaning of physical activity and barriers to physical activity using a guiding questions * The focus groups’ duration ranged from 1 -1.5 hours * The were audio-taped, transcribed verbatim and translated * Thematic analysis was performed using QSR NVivo 8 software * This study was approved by the MUHREC & Malaysian MoH Medical Research Ethics Committee *

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* Characteristics Men (N=18) Women (N=7) Age range (years) 60 – 77 60 - 73 Mean age ± SD (years) 65.9 ± 4.3 65.3 ± 4.2 Marital status Married 18 (100%) 3 (42.9%) Widow/widower 0 4 (57.1%) Highest education Primary 5 (27.8%) 2 (28.6%) Secondary 11 (61.1%) 4 (57.1%) Tertiary 2 (11.1%) 1 (14.3%) Working status Not working 15 (83.3%) 6 (85.7%) Working 3 (16.7%) 1 (14.3%) Mean monthly income ± SD (RM) 1,750.00 ± 1,242.98 1,342.85 ± 1,688.05 Mean duration of diabetes ± SD (years) 12.2 ± 9.2 15.0 ± 12.9 Engaged in regular exercise 7 (38.9%) 2 (28.6%)

* Household related activities: * Women: household chores * Men: Yard-work ( Berkebun) * Leisure-time activities: * Sports, brisk walking, jogging * Work related activities: * Occupation which involved bodily movement such as driving a bus (Kolt et al 2006, Mier et al 2007, Bird et al 2009) * Spiritual related activities: * Prayers ( solat) *

* Spiritual related activities: * Prayers ( solat) : “From the point of view of solat, when we ruku ’ (bending forward movement with arms squared on the knees) and sujud (knealing down on the ground with forehead on the ground)for the few moments it is similar to stretching exercises. Here we do it five times a day and on top off that we exercise. So from that we already have additional exercise.” “Praying movements is one of the best exercise. Because when we ruku ’ or sujud we are doing stretching exercises.” *

* Personal: * Age, lack of energy, feeling tired, laziness, lack of awareness on benefits of PA * Health: * Diabetes, diabetes related complications, OA * Environmental: * Poorly maintained parks * Family obligations: * Family affairs takes priorities (Kolt et al 2006, Mier et al 2007, Al-Kaabi et al 2009, Bird et al2009) * Spirituality related: * Religious activities takes priorities *

* Family obligations: * Family affairs takes priorities “We have activities like marketing, sending the grandchildren to school and back. So the time is spent on matters related to family affairs.” “It’s our attitude on the priorities. Our Malay culture is rooted to family ties. So our priorities will be related to family affairs or obligations. So, exercise is a less priorities.” * Spirituality related: * Religious activities takes priorities “So the Malays as a Muslim, when we are older our mission differs. When we were younger and working we have less time to spare for religious knowledge. So when we retired we spent more time for religious knowledge. That is our priority.” “For us Muslims, we want to get closer to Allah, so we think of death. So we prepare ourselves for death and how to reach Jannah ( heaven). In Islam, the illness we have is God given. The events that happen in our lives has been pre- determined by God. There is a blessing with every circumstances. So, exercise is only an additional activity.” *

* A core theme that emerged in the defining physical activity and its barriers was spirituality * Family obligations and spiritual activities seems to deter some older Malays with type 2 diabetes from performing regular exercise * It is fundamental to emphasize in self-care management that regular exercise not only improves glycaemic control but allows them to continue with their religious affiliations healthily *

* Source of fund: * MUSC major grant (M-GPH-MG-68) * We thanked Ministry of Health Malaysia for their approval to conduct this study *

1. Gregg EW, Gerzoff RB, Caspersen CJ, Williamson DF , Narayan KMV. Relationship of Walking to Mortality Among US Adults With Diabetes. Arch Intern Med. 2003 Jun 23;163(12):1440-1447. 2. Sigal RJ, Kenny GP , Boulé NG, Wells GA, Prud’homme D, Fortier M, et al. Effects of Aerobic Training, Resistance Training, or Both on Glycemic Control in Type 2 Diabetes. Annals of Internal Medicine. 2007;147(6):357 -369. 3. Church TS, LaMonte MJ, Barlow CE, Blair SN. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Arch. Intern. Med. 2005 Oct 10;165(18):2114-2120. 4. Shazwani MNN, Suzana S, Lim CJ, Teh CS, Fauzee MZM, Lim HC, et al. Assessment of physical activity level among individuals with type 2 Diabetes Mellitus at Cheras Health Clinic, Kuala Lumpur. Mal J Nutr. 2010;16(1):101-12. 5. Kolt GS, Paterson JE, Cheung VYM. Barriers to physical activity participation in older Tongan adults living in New Zealand. Australasian Journal on Ageing. 2006 Aug;25(3):119-125. 6. Mier N, Medina AA, Ory MG. Mexican Americans with type 2 diabetes: perspectives on definitions, motivators, and programs of physical activity. Prev Chronic Dis. 2007;4(2):A24. 7. Bird SR, Radermacher H, Feldman S, Sims J, Kurowski W, Browning C, et al. Factors Influencing the Physical Activity Levels of Older People from Culturally-Diverse Communities: An Australian Experience. Ageing & Society. 2009;29(Special Issue 08):1275-1294. 8. Al-Kaabi J, Al-Maskari F , Afandi B, Parkar H, Nagelkerke N. Physical Activity and Reported Barriers to Activity Among Type 2 Diabetic Patients in the United Arab Emirates. Rev Diabet Stud. 2009;6(4):271-278. *

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