Levels of physical activity and barriers to exercise among family physicians at a tertiary hospital in Riyadh, Saudi Arabia

Lama Mohammed Al Saud; Ghadah Abdulrahman Algabr; Abdulkareem Alanazi

doi:10.4103/sjsm.sjsm_1_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 22 | Issue : 2 | Page : 61-65

Levels of physical activity and barriers to exercise among family physicians at a tertiary hospital in Riyadh, Saudi Arabia

Lama Mohammed Al Saud, Ghadah Abdulrahman Algabr, Abdulkareem Alanazi
Department of Family Medicine, Security Forces Hospital, Riyadh, Saudi Arabia

Date of Submission	09-Jan-2022
Date of Decision	14-Mar-2022
Date of Acceptance	23-Mar-2022
Date of Web Publication	30-Aug-2022

Correspondence Address:
Dr. Lama Mohammed Al Saud
Department of Family Medicine, Security Forces Hospital, P.O. Box 3643, Riyadh 11481
Saudi Arabia

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/sjsm.sjsm_1_22

Abstract

Introduction: To be healthy and mentally alert, physicians need to engage in physical activity, and this will improve the delivery of health care in the primary care setting.
Aim: The aim of the study is to investigate the physical activity of family physicians and determine the common reasons why they do not engage in physical activity.
Methods: We conducted a study among family physicians employed at Security Forces Hospital in Riyadh, Saudi Arabia, in the final quarter of 2021. An electronic questionnaire was distributed to all consenting participants to determine their physical activity and exercise levels during the prior 7 days. Demographic data, body mass index, and reasons they were unable to exercise were also collected.
Results: Sixty five family physicians participated in the study, 34 (52.3%) men and 31 (47.7%) women (mean age 34.8 ± 8.6 years). The average time spent on physical activity was 1–2 days per week, approximately 30 min per day. The average physically inactive time for all physicians was 9.3 ± 7.9 h per day, with 11 participants (16.9%) spending at least 12 h per day sitting. Among the perceived barriers to exercise and physical activity, insufficient time was the most common response (n = 37, 56.9%), followed by many responsibilities (n = 31, 47.7%). Unmarried family physicians spent more time engaged in vigorous physical activity (on average 1.9 ± 2.0 days per week, 53.6 ± 29.5 min per day) compared to married physicians (on average 0.8 ± 1.6 days per week, 32.9 ± 26.6 min per day).
Conclusion: Many family medicine physicians do not engage in physical activity. Those who engage in physical activity spend approximately 30 min, 1–2 days per week, which is less than the World Health Organization guidelines for physical activity. Single physicians tend to exercise more than married physicians. Lack of time to exercise was the most common reason for physical inactivity. It is necessary to institute and incorporate physical activity sessions for family physicians, as well as educational and health programs promoting increased physical activity for a better and healthier society.

Keywords: Barriers, exercise, family physicians, physical activity, Saudi Arabia

How to cite this article:
Al Saud LM, Algabr GA, Alanazi A. Levels of physical activity and barriers to exercise among family physicians at a tertiary hospital in Riyadh, Saudi Arabia. Saudi J Sports Med 2022;22:61-5

How to cite this URL:
Al Saud LM, Algabr GA, Alanazi A. Levels of physical activity and barriers to exercise among family physicians at a tertiary hospital in Riyadh, Saudi Arabia. Saudi J Sports Med [serial online] 2022 [cited 2023 May 31];22:61-5. Available from: https://www.sjosm.org/text.asp?2022/22/2/61/355188

Introduction

Physical activity refers to any activity that involves body movement, such as engaging in sports, leisure activities, moving from one place to the other, and many more.^[1] Physical inactivity is the fourth major cause of death, according to the World Health Organization (WHO).^[2] Physical inactivity has been associated with obesity, heart disease, high blood pressure, type 2 diabetes mellitus, and many other noncommunicable diseases.^[3]

The 2020 guidelines set by the Guidelines Development group convened by WHO replaced the 2010 guidelines that adults aged 18–64 years should engage in moderate-intensity physical activity for at least 1½ to 3 h, or at least 1–2 h of vigorous exercise, or moderate and vigorous-intensity activity throughout the week to benefit.^[4]

Family physicians on the frontlines of health care have a crucial role in promoting health and exercise. At present, patients listen more to physicians who are healthy, mentally alert, energetic, and confident. However, several studies have demonstrated that physically inactive physicians are least likely to promote physical activity as part of their health advice to their patients.^[5] Furthermore, many physicians lack the knowledge to advise their patients regarding physical inactivity, particularly among children.^[6] A review conducted by Lobelo and de Quevedo revealed that physicians who exercise regularly have more opportunities to provide counseling pertaining to their patients' exercise and health promotion.^[7] As a result, promoting physical activity among physicians could improve the delivery and quality of information about physical activity to patients in primary care settings.^[7]

Several studies highlight high rates of physical inactivity among family physicians in Saudi Arabia, particularly one study in the AlJouf region (34.8%) and two from the Riyadh region (63% and 68.4%).^[8],[9],[10] A further study indicated that 84% of surveyed Egyptian physicians were sedentary.^[11] These studies concur with studies that revealed physical inactivity among physicians in the United States (5.8%) and Estonia (8%).^[12],[13] Although the studies identified many barriers, lack of time for exercise (58.1%) and work commitments (22.5%) were the most common.^[10]

We conducted this study to determine the physical activity status among family physicians and understand why doctors do not exercise. The study results provide an insight into the degree of physical inactivity among family physicians and propose guidelines to enhance their physical activity.

Methods

We surveyed family physicians currently employed at our institution between September and October 2021. The sample size was not calculated since the study included all family physicians from all professional levels on active duty at the Family Medicine Center of Security Forces Hospital, Riyadh, Saudi Arabia. We did not include those on vacation and pregnant physicians who were unable to exercise for the week.

We conducted the survey electronically using a google document and included the participants' demographic and anthropometric data. The demographic domain included the participants' age and gender. We did not include identifiers such as name and contact information in the data collection. We also collected reasons why participants were unable to exercise. The physical activity questionnaire included seven open-ended questions asking participants to recall the type and intensity of physical activity in the previous 7 days. Participants self-reported using the English language. The Ethics Committee of Security Forces Hospital in Riyadh, Saudi Arabia, approved the study (Approval number: 20-412-25, dated December 24, 2019).

We analyzed the data using version 26.0 of the Statistical Package for the Social Sciences (IBM-SPSS, New York, USA). The results were expressed as numbers or percentages and means (± standard deviation) for numerical variables such as age and days or minutes of physical activity. A Chi-square test was used to test for significant differences between groups, an independent t-test for means and standard deviations for two groups, and an analysis of variance for more than two groups. Statistical significance was set at a value of P < 0.05.

Results

Sixty-five family physicians responded to the survey, of whom 52.3% were men. The mean age of the respondents was 34.8 ± 8.6 years [25–58 years old; [Table 1]].

Table 1: Detailed demographic data of 65 family phy

Click here to view

Forty-two participants (64.6%) did not engage in vigorous physical activity during the previous 7 days [Figure 1]. Of those who engaged in vigorous physical activity, the average minutes per day was 43.7 ± 29.5. Twenty-seven participants (41.5%) engaged in moderate physical activities for an average of 37.8 ± 33.7 min per day [Figure 2]. Conversely, 55 participants (84.6%) engaged in walking for at least 10 min at a time, of whom 21 (32.3%) walked on five of the previous seven days [Figure 3]. The average walking time per day of activity was 28.2 ± 23.2 min. The average physically inactive time for all physicians was 9.3 ± 7.9 h per day, with 11 participants (16.9%) spending at least 12 h per day sitting [Figure 4].

Figure 1: Participants' responses on the number of days on intense during the past 7 days

Click here to view

Figure 2: Participants' responses on the number of days on moderately intensity physical activities during the past 7 days

Click here to view

Figure 3: Participants' responses on the number of days/week spent walking at least 10 min

Click here to view

Figure 4: Number of participants according to time spent walking per day

Click here to view

Among the perceived barriers to exercise and physical activity, insufficient time was the most common response, cited by 37 (56.9%) of the participants, followed by many responsibilities (n = 31, 47.7%) and unsuitable weather for exercise [n = 24, 36.9%; [Figure 5]].

Figure 5: Perceived barriers to physical activity among 65 family medicine physicians

Click here to view

There were no significant gender differences in the time spent on rigorous physical activity. Male physicians spent an average of 1.4 ± 1.9 days each week and 46.4 ± 33.9 min per day engaged in vigorous exercise compared to 0.9 ± 1.6 days per week and 39.4 ± 22.1 min per day among female physicians (P = 0.265 and P = 0.591, respectively). There were no significant gender differences in the time spent on moderate exercise. Males spent a mean of 3.3 ± 0.9 days and 35.1 ± 38.1 min per day on moderate physical activity, compared to a mean of 2.8 ± 1.2 days per week and 43.3 ± 22.8 min per day among females (P = 0.236 and P = 0.556, respectively). Males and females also spent similar amounts of time walking (males, 25.6 ± 9.4 min versus females, 30.9 ± 32.1 min, P = 0.395). Male physicians spent more hours sitting than female physicians (males, 9.6 ± 8.5 h per day versus females, 9.0 ± 7.4 h per day, P = 0.750). The time spent performing vigorous and moderate-intensity physical exercise did not differ significantly among professional levels.

Single-family physicians spent more time performing vigorous physical activities than married physicians. Single physicians spent an average of 1.9 ± 2.0 days per week and 53.6 ± 29.5 min per day on vigorous physical activities compared to married physicians who spent an average of 0.8 ± 1.6 days per week and 32.9 ± 26.6 min per day (P = 0.026). Furthermore, single physicians spent more minutes walking on more days than married physicians. Single physicians walked for at least 10 min on an average of 4.5 ± 2.1 days with 36.4 ± 35.0 min walking per day compared to married physicians (average 4.0 ± 1.9 days per week, 23.2 ± 9.2 min walking per day, P = 0.038). The time spent on moderate physical exercise did not differ according to marital status (P > 0.05).

Discussion

We investigated how many of our family physicians engaged in physical activity and explored the reasons why they do not exercise. Previous studies have demonstrated that physicians who regularly exercise and are active are 2–5 times more likely to advocate exercise to their patients than physicians who do not exercise regularly.^[7]

This study revealed that 64.6% of our participants did not engage in vigorous-intensity exercise, whereas 58.5% participated in moderate activity. These findings are similar to those of previous studies conducted in Saudi Arabia.^[8],[9],[10] These studies were conducted more than 5 years ago, yet we obtained similar high rates of physical inactivity among family physicians.

Unexpectedly, we observed no significant differences in the number of days and amount of time spent on physical activity among male and female physicians. It could be argued that men have relatively more time to engage in physical activity since most men's commitments focus on work and family, whereas women's include not only work and family but also cooking and taking care of children.^[14]

This study also highlights the influence of marriage on physical exercise. We demonstrated that single physicians had significantly more time to engage in physical activities than married participants. Studies have correlated married status with higher body mass index (BMI) and less time for exercise than single individuals.^{[15],[16],[17],[18],[19]} Since none of our participants have functional limitations, we may attribute the lack of physical activity among some physicians, particularly women, to marriage. These factors form a compendium of barriers that participants may have been unaware of yet nonetheless limited their engagement in physical activities after a busy and stressful day at work.

Many individuals do not engage in physical exercise due to little or no time. More than half of our participants (56.9%) stated that they do not have enough time to exercise. Despite the numerous benefits of exercise, time is frequently one of the primary reasons, people do not engage in physical activities. Physicians including those in family medicine are subjected to stress and extended working hours leading, leading in exhaustion thus they do not have much enough time to engage in physical activities. When they have free time, they allocate it to other activities such as cooking, cleaning, dining, watching movies or television with family or friends, or sleeping.

We have pointed out that family physicians need to exercise. We have highlighted the importance of exercise among family physicians because they can serve as role models for their patients by being energetic, healthy, and vibrant. This study demonstrates the need to institute and incorporate physical activity sessions among family physicians and educate them about their need to exercise regularly and promote physical activity to their patients. The current rates of physical inactivity are high and have been steady for some time. Health authorities need to implement the guidelines recommended by the WHO and ensure unwavering support for enhanced and sustained physical activity. It may be difficult to draw conclusions since no promotion or awareness campaigns were relayed during the study period. However, the current situation reflects ongoing neglect of the importance of physical activity among physicians and patients who were not studied.

The sample size limits the generalizability of our findings. The study results may not reflect the general perception of physical activity and its current situation among all family physicians in Saudi Arabia. Furthermore, this study was conducted using a particular subset of the population (family physicians), and the results could vary when extended to physicians specializing in sports medicine and exercise. Future studies involving physicians from all disciplines are recommended to assess the extent of physical activity among physicians and compare physical activity in family physicians with that of colleagues in different disciplines. However, we have presented significant findings that can serve as a basis for more extensive studies in the future.

Conclusion

Many family physicians do not engage in physical activity. Those who exercise spend approximately 30 min, 1–2 days per week, which is below the time and intensity recommended by the WHO. Single physicians tend to exercise more than married physicians, and the inability to find time was the most common reason for physical inactivity. It is necessary to institute and incorporate physical activity sessions for family physicians, as well as educational and health programs promoting increased physical activity for a better and healthier society.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	HS. 2018. Physical Activity Guidelines Advisory Committee Scientific Report 2018. Available from: https://health.gov/sites/default/files/2019-09/PAG_Advisory_Committee_Report.pdf. [Last accessed on 2021 Sep 18].
2.	WHO. Global Recommendations on Physical Activity for Health: Publisher: World Health Organization, Geneva, Switzerland, 2010. p. 58.
3.	Al-Ghamdi S, Alajmi M, Al-Gonaim A, Al-Juhayyim S, Al-Qasem S, Al-Tamimi I. Perceptions and attitudes of primary healthcare providers in Riyadh City, Saudi Arabia, toward the promotion of physical activity. Int J Health Promot Educ 2018;56:105-19.
4.	Bull FC, Al-Ansar SS. Biddle S, Borodulin K, Bruman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behavior. Br J Sports Med 2020;5:1451-62.
5.	Banday AH, Wani FA, Alris FFA, Alrayes MF, Alsharari FA, et al. Physically active physicians: Do they make any difference in patient care? Med Applied Sci 2014;4:47-53.
6.	Stracciolini A, Luz J, Walker G, Edwards N, Faigenbaum AD, Myer GD. Are primary care physicians ill equipped to evaluate and treat childhood physical inactivity? Phys Sportsmed 2020;48:199-207.
7.	Lobelo F, de Quevedo IG. The evidence in support of physicians and health care providers as physical activity role models. Am J Lifestyle Med 2016;10:36-52.
8.	Banday AH, Want FA, Alris FF, Alrayes MF, Alenzi MJ. A cross-sectional study on the prevalence of physical activity among primary health care physicians in Aljouf Region of Saudi Arabia. Mater Sociomed 2015;27:263-6.
9.	Al Reshidi FS. Level of physical activity of physicians among residency training program at prince Sultan Military Medical City, Riyadh, KSA 2014. Int J Health Sci (Qassim) 2016;10:39-47.
10.	Mandil AM, Alfurayh NA, Aljebreen MA, Aldukhi SA. Physical activity and major non-communicable diseases among physicians in Central Saudi Arabia. Saudi Med J 2016;37:1243-50.
11.	Rady M, Sabbour SM. Behavioral risk factors among physicians working at Faculty of Medicine – Ain Shams University. J Egypt Public Health Assoc 1997;72:233-56.
12.	Stanford FC, Durkin MW, Stallworth JR, Blair SN. Comparison of physical activity levels in physicians and medical students with the general adult population of the United States. Phys Sportsmed 2013;41:86-92.
13.	Pechter Ü, Suija K, Kordemets T, Kalda R, Maaroos HI. Physical activity and exercise counselling: A cross-sectional study of family practice patients in Estonia. Qual Prim Care 2012;20:355-63.
14.	Caperchione CM, Vandelanotte C, Kolt GS, Duncan M, Ellison M, George E, et al. What a man wants: Understanding the challenges and motivations to physical activity participation and healthy eating in middle-aged Australian men. Am J Mens Health 2012;6:453-61.
15.	The NS, Gordon-Larsen P. Entry into romantic partnership is associated with obesity. Obesity (Silver Spring) 2009;17:1441-7.
16.	Miller J, Nelson T, Barr-Anderson DJ, Christoph MJ, Winkler M, Neumark-Sztainer D. Life events and longitudinal effects on physical activity: Adolescence to adulthood. Med Sci Sports Exerc 2019;51:663-70.
17.	Hull EE, Rofey DL, Robertson RJ, Nagle EF, Otto AD, Aaron DJ. Influence of marriage and parenthood on physical activity: A 2-year prospective analysis. J Phys Act Health 2010;7:577-83.
18.	Chung AE, Skinner AC, Maslow GR, Halpern CT, Perrin EM. Sex differences in adult outcomes by changes in weight status from adolescence to adulthood: Results from Add Health. Acad Pediatr 2014;14:448-55.
19.	Werneck AO, Winpenny EM, Foubister C, Guagliano JM, Monnickendam AG, van Sluijs EM, et al. Cohabitation and marriage during the transition between adolescence and emerging adulthood: A systematic review of changes in weight-related outcomes, diet and physical activity. Prev Med Rep 2020;20:101261.