Adherence to physical activity among people living with type 2 diabetes attending clinics in regional referral hospitals in Dar es Salaam, Tanzania: a cross-sectional study

Adherence to physical activity among people living with type 2 diabetes attending clinics in regional referral hospitals in Dar es Salaam, Tanzania: a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Adherence to physical activity among people living with type 2 diabetes attending clinics in regional referral hospitals in Dar es Salaam, Tanzania: a cross-sectional study Joseph Matemba, Emmy Metta, Johnson Mshangila, Alma Damasy, Christopher Mankaba, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8298896/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background In Tanzania, about 10.3% of the people aged 20 to 79 are living with type 2 diabetes and the prevalence is rising. Effective management of type 2 diabetes relies on adherence to self-care behaviors, including physical activity. However, information on physical activity adherence among people living with type 2 diabetes in Tanzania is scarce. This study aimed to determine the adherence levels to physical activity among people living with type 2 diabetes in Dar es Salaam, Tanzania. Methods A cross-sectional study among people living with type 2 diabetes attending clinics at regional referral hospitals in Dar es Salaam was conducted in June 2023. Respondents were recruited through systematic sampling, and their physical activity levels measured using the WHO STEPwise method for NCD risk factor surveillance. Data were analyzed using STATA version 15. Results The overall physical activity adherence rate was 47% among the 264 respondents in the study, indicating that a significant proportion of people living with type 2 diabetes did not adhere to the recommended activity levels. Specifically, only 16.7% engaged sufficiently in work-related activities, 30.3% in transport-related activities, and 13.3% in leisure-based activities, while 24.6% had a sedentary lifestyle. Conclusion Less than half of people living with type 2 diabetes in Dar es Salaam meet the WHO-recommended physical activity levels. The lowest participation was in leisure-related activities compared to travel and work-related activities. Targeted urban interventions are needed to enhance well-being and improve physical activity adherence by increasing awareness and access to leisure activities. Adherence Physical activity Type 2 Diabetes mellitus Metabolic Equivalent of Task (MET) Non-communicable diseases (NCD) Tanzania What is already know on this topic Regular physical activity is crucial for managing type 2 diabetes, improving glycaemic control, reducing cardiovascular risks, and enhancing overall health. Previous studies in rural Tanzanian regions have shown high adherence rates to physical activity, attributed to physically demanding activities like farming and fishing. What this study adds The study provides the most recent data on adherence level to physical activities among people living with type 2 diabetes in urban Tanzania. The study highlights the significant gap in physical activity adherence among urban people living with type 2 diabetes, emphasizing the need for targeted interventions in similar settings. This research adds to the ongoing scholarly discussion on this relevant topic. Introduction Diabetes mellitus is a metabolic disorder arising from deficiencies in insulin production, function, or both, leading to elevated blood sugar levels and disruptions in lipid, protein, and carbohydrate metabolism [ 1 ]. It is one of the four major non-communicable diseases that have emerged as significant global public health concerns, alongside hypertension and kidney diseases, collectively contributing to the substantial disease burden from non-communicable illnesses [ 2 , 3 ]. Diabetes manifests in three primary forms: type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes mellitus (GDM); however, T2D accounts for approximately 90% of all diabetic cases [ 1 ]. Currently, Africa has the world’s lowest diabetes prevalence at 4.5%, but it is projected to surge by 129% by 2045, marking the highest increase globally [ 2 ]. Tanzania has a diabetes prevalence of 10.3%, making it one of the countries in Africa with a significant burden of the disease, just below South Africa’s prevalence of 11.3% and this is equivalent to 2.9 million individuals aged 20–79 living with diabetes in Tanzania [ 4 ]. This increase in developing countries, including Tanzania, is associated with factors such as age, alcohol consumption, urbanization, sedentary lifestyles, obesity, smoking, cholesterol levels, and hypertension [ 5 , 6 ]. Effective self-care practices are vital non-pharmacological therapies for managing diabetes, aiming to control blood sugar levels and prevent other associated non-communicable diseases, such as cardiovascular diseases and obesity [ 7 ]. These practices encompass medication adherence, adherence to dietary recommendations [ 8 ]. However, physical activity adherence among people living with type 2 diabetes in African countries is consistently reported low, ranging from 26.7% in Ghana, 41% in Kenya to 51% in Rwanda and [ 9 – 11 ]. Physical activity is crucial in managing type 2 diabetes as it enhances insulin sensitivity, aiding in more effective blood sugar control. Regular exercise strengthens the cardiovascular system, improving heart health and circulation, which helps prevent complications such as heart disease. It also supports weight management by burning calories and building muscle, thereby reducing the risk of obesity. Additionally, physical activity helps lower inflammation and oxidative stress, which are significant contributors to the development of chronic conditions [ 12 ]. Despite strong recommendations from diabetic clinics, there is scant information available regarding the adherence to physical activities among people living with type 2 diabetes. Therefore, this study aimed to assess the extent of physical activity adherence among people living with type 2 diabetes in Dar es Salaam, Tanzania. Methods Study design This descriptive cross-sectional study involved people living with type 2 diabetes attending clinics at three regional referral hospitals in the Dar es Salaam region in June 2023. Study setting The study was conducted at Amana, Temeke, and Mwananyamala regional referral hospitals in the Dar es Salaam region. These hospitals are publicly owned and each of them houses a specialized diabetes clinic that cater diverse diabetic healthcare services to needs of the respective population. The selection of these three regional referral hospitals in Dar es Salaam (Temeke, Mwananyamala, and Amana) was based on their representation as the highest-level public health facilities in the region, located in distinct councils: Temeke, Kinondoni, and Ilala, respectively. Dar es Salaam was selected as the study location due to its status as Tanzania’s primary business hub. The city is characterized by a vibrant urban lifestyle and a significant prevalence of sedentary habits. Unlike other regions, the occupational landscape of Dar es Salaam is predominantly white-collar, with fewer physically demanding jobs such as agriculture, cattle keeping, or fishing [ 13 ]. Additionally, the city’s modern transportation infrastructure promotes individual modes of commuting rather than walking, distinguishing it from other regions in Tanzania. Study population The study population comprised adult men and women living with type 2 diabetes attending diabetic clinics at Amana, Temeke, and Mwananyamala regional referral hospitals at metropolitan areas in Dar es Salaam. Sample size The study’s sample size was determined using Cochran’s formula, with a 95% confidence level and a precision of 6%. Based on prior research indicating a 33% adherence rate to physical activity among people living with type 2 diabetes [ 14 ], an initial estimate of 236 people living with type 2 diabetes was obtained. To mitigate potential non-response, the sample size was adjusted by 10%, yielding a final minimum sample size of 264 people living with type 2 diabetes selected to participate in the study. Sampling methods Probability proportional sampling (PPS) was employed to ensure the desired sample size was obtained proportionately from Mwananyamala, Temeke, and Amana regional referral hospitals. The monthly average attendance at these hospitals Mwananyamala, Amana, and Temeke was 400, 189, and 205 people living with type 2 diabetes, respectively, totaling 794 across all three. To determine the sample size for each hospital, the total sample size (264 people living with type 2 diabetes) was distributed based on the monthly attendance figures, resulting in 63 people living with type 2 diabetes from Amana regional referral Hospital, 68 from Temeke regional referral Hospital, and 133 from Mwananyamala regional referral Hospital. A systematic sampling approach was utilized, where the sampling interval (k th ) 3 was obtained by dividing the monthly attendance (N) by the desired sample size (n). This interval was then used to select respondents systematically, starting with a random selection of the first participant and subsequently selecting every third person living with type 2 diabetes until the required number of respondents was reached for each hospital. Inclusion and Exclusion criteria Adult men and women diagnosed with type 2 diabetes who had been on diabetic treatment for at least six months were specifically targeted. Exclusions applied to those who were severely ill or non-ambulatory. Variables The primary variable examined was adherence to physical activity among people living with type 2 diabetes using World Health Organization (WHO) STEPwise. Adherence was categorized into two groups: “sufficient physical activity”, defined as achieving equal to or greater than 600 Metabolic Equivalent of Task (METs) per week, and “insufficient physical activity”, defined as achieving less than 600 METs per week. Physical activity was assessed across three domains: work-related activities, transport-related activities, and recreational or leisure-time-based activities. In each domain, adherence was determined based on whether people living with type 2 diabetes achieved the threshold of equal to or greater than 600 METs per week, with levels below this threshold classified as insufficient. Data collection tool The Global Physical Activity Questionnaire from the WHO STEPWISE method for non-communicable diseases surveillance was used [ 15 ]. To ensure validity and comprehension, the English versions were accurately translated into Swahili before undergoing a pre-testing phase at a hospital in a metropolitan area in Tabata ward Dar es salaam, which share geographical similarities with the study sites. This process aimed to enhance clarity and ensure consistency in the questionnaire's understanding among respondents. Data collection The first author collected the data with the support of the principal investigator and enlisted three research assistants who had medical training backgrounds in nursing and general medicine (general physician). The assistants were chosen for their expertise in type 2 diabetes management and health counseling skills related to diabetes mellitus. Before the data collection, the team underwent a one-day training session conducted by the principal investigator to familiarize them with the research aims, objectives, and the Open Data Kit (ODK) tool. The training focused on providing clarity and guidance for conducting interviews and administering the tools to ensure accurate and comprehensive data collection. Additionally, the team received instructions on research ethics and logistical considerations to uphold ethical standards throughout the study. Data management and analysis Data collected using the ODK tool was extracted into Microsoft Excel format and then exported to STATA version 15 software for data cleaning and analysis. Descriptive statistics were then applied to summarize key characteristics of the study respondents, as well as their adherence to physical activity. The distribution of physical activity in each domain was presented, with frequencies and percentages used to illustrate categorical characteristics. The regularity of physical activity was assessed using the global physical activity questionnaire, modified from the WHO STEPwise method for non-communicable disease risk factor surveillance [ 15 ]. The questionnaire categorized physical activity into four parameters: work-related, traveling to and from places, recreational or leisure-time-based activities, and sedentary lifestyle. Time spent on each type of physical activity was summed to obtain the total time spent per week, and this was coded into metabolic equivalent tables. One MET was defined as the energy consumed while sitting quietly for about 1 hour, equating to approximately 3.5 mL of oxygen/kg body weight/min, with MET figures sourced from the Compendium of Physical Activity [ 16 ]. For vigorous-intensity work-related activities, a value of 8.0 METs per minute was assigned, while moderate-intensity work-related physical activity was assigned a value of 4.0 METs per minute. Transport-related activities were given a value of 4.0 METs per minute. Similarly, vigorous-intensity leisure-related physical activity was assigned 8.0 METs, and moderate-intensity leisure-related physical activity was assigned 4.0 METs. The total METs per week for all physical activities were calculated by multiplying the duration (minutes) of activity per week by its corresponding METs and summed for each physical activity type. Adherence to physical activity was defined as achieving ≥ 600 METs per week [ 15 , 16 ]. Results General description of study respondents A total of 264 people living with type 2 diabetes were approached from three referral regional hospitals in the Dar es Salaam region, namely Temeke, Amana, and Mwananyamala Regional Referral hospitals. Almost two-thirds (64%) were diagnosed with diabetes less than five years before the date of data collection and 67% of the respondents were female. The mean age of the study respondents was 55 years. The study population ranged in age from 18 to 81 years, with a majority aged over 55 years, and a standard deviation of ± 11.5 years. Youths below 25 years of age comprised only 1.0% while elderly above 65 years of age were less than quarter of the population. Half of the respondents (50%) had primary education and very few (8.0%) did not have any formal education, Table 1 display study respondent’s socio-demographic characteristics. Table 1 Study respondents’ socio-demographic characteristics. Variables Categories Frequency(n) Percentages (%) Age categories < 25 years 2 1 25–34 years 7 3 35–44 years 40 15 45–54 years 82 31 55–64 years 76 29 ≥ 65 years 57 21 Sex Female 178 67 Male 86 33 Education level No formal education 22 8 Primary school 133 50 Secondary school 79 30 University/ college 30 12 Marital status Single 21 8 Married 186 70 Divorced 13 5 Co-habit 23 9 Widow 21 8 Occupation Employed 37 14 Self-employed 127 48 Unemployed 100 38 Diabetic duration 0–5 years 168 64 6–10 years 50 19 11–15 years 20 7 ≥ 15 years 26 10 Household members Less than 2 members 169 64 3–4 members 85 32 More than 4 members 10 4 Physical activity levels varied across socio-demographic characteristics of respondents. It was higher among males (57%) than females and increased with level of education changing from 23% among those with no formal education to over 63% among respondents with university education. It was also higher among self-employed individuals (65%) compared to the unemployed (24%) and higher among those with diabetes for less than 6 years (54%) compared to those with longer durations of illness. Moreover, it was higher in households with more than four members (70%) than in households with 3–4 members (40%) and less than 2 members (49%). Table 2 describe the variation of socio-demographic characteristics in relation to adherence to physical activities. Table 2 Socio-demographic variation in relation to adherence to physical activities. Variables Categories Sufficient PA n (%) Insufficient PA n (%) P-Value Age categories < 25 years 0 (0) 2 (100) 0.000** 25–34 years 2 (29) 5 (71) 35–44 years 15 (38) 25 (62) 45–54 years 30 (37) 52 (63) 55–64 years 49 (65) 27 (35) ≥ 65 years 44 (77) 13 (23) Sex Female 75 (42) 103 (58) 0.024* Male 49 (57) 37 (43) Education level No formal education 5 (23) 17 (77) 0.017* Primary school 58 (44) 75 (56) Secondary school 42 (53) 37 (47) University/ college 19 (63) 11 (37) Marital status Single 11 (52) 10 (48) 0.012** Married 91 (49) 95 (51) Divorced 9 (69) 4 (31) Co-habit 10 (43) 13 (57) Widow 3 (14) 18 (86) Occupation Employed 18 (49) 19 (51) 0.000* Self-employed 82 (65) 45 (35) Unemployed 24 (24) 76 (76) Diabetic duration 0–5 years 90 (54) 78 (46) 0.005* 6–10 years 17 (34) 33 (66) 11–15 years 11 (55) 9 (45) > 15 years 6 (23) 20 (77) Household members ≤ 2 members 83 (49) 86 (51) 0.132** 3–4 members 34 (40) 51 (60) ˃4 members 7 (70) 3 (30) Key: PA = Physical activity *chi-square test **fisher exact test. Level of adherence to physical activities The findings of this study showed that only 47% of people living with type 2 diabetes attending diabetic clinics in Dar es Salaam were adherent to physical activity. A significant proportion of people living with type 2 diabetes fail to meet the recommended levels of physical activity across various domains. Specifically, when it comes to work-related activities, a mere 16.7% of people living with type 2 diabetes reached a sufficient level of engagement. On transport-related activities, the situation was somewhat better than other domains but remains far from ideal, with only 30.3% of people living with type 2 diabetes meeting the required level of physical activity. Only 13.3% of people living with type 2 diabetes met the sufficient levels of physical activity through leisure activities. Table 3 display participant’s engagement across all physical activity’s domains. Table 3 Respondents’ different levels of physical activities. (N = 264) Variable Frequency Percentage Work related Vigorous intensity Sufficient 4 1.5 Insufficient 260 98.5 Moderate intensity Sufficient 40 15.2 Insufficient 224 84.8 Total work related Sufficient 44 16.7 Insufficient 220 83.3 Transport related Sufficient 80 30.3 Insufficient 184 69.7 Leisure related Vigorous intensity Sufficient 7 2.7 Insufficient 257 97.3 Moderate intensity Sufficient 28 10.6 Insufficient 236 89.4 Total Leisure related Sufficient 35 13.3 Insufficient 229 86.7 Sedentary related Sedentary lifestyle Non-sedentary lifestyle 65 199 24.6 75.4 Overall PA level Sufficient 124 47 Insufficient 140 53 Key: Sufficient levels of PA are equivalent to ≥ 600 METs. METs, metabolic equivalents; PA, physical activity. Discussion The study revealed that only 47% of people living with type 2 diabetes achieved the WHO-recommended level for overall sufficient physical activities, highlighting a notable gap in adherence to these guidelines. The findings of this study are consistent with a systematic review spanning 22 African countries, which reported physical activity adherence rates ranging from 46.8% to 96%, with specific rates of 51% in Rwanda and 41% in Kenya [ 17 ]. This consistency can be attributed to the urban settings in which these studies were conducted. Urban environments often pose challenges to physical activity adherence, such as limited access to open spaces, time constraints due to work and other commitments, and a culture that promotes sedentary lifestyles. These factors collectively contribute to the difficulty in meeting WHO-recommended physical activity levels. This level of adherence contrasts with previous studies conducted in the Mwanza and Kilimanjaro regions of Tanzania, where adherence rates were substantially higher at 96% and 94.3% [ 14 , 16 ]. The studies conducted in rural Mwanza and Kilimanjaro involved populations predominantly engaged in physically demanding activities such as farming, fishing, and cattle keeping. These occupations inherently promote higher levels of physical engagement compared to urban settings, likely contributing to the observed higher rates of physical activity adherence among people living with type 2 diabetes in those regions. These findings highlight the importance of implementing targeted interventions to improve physical activity levels among people living with type 2 diabetes, especially in urban areas. Such interventions should consider the unique challenges faced by urban dwellers and seek to promote accessible and practical ways to engage in regular physical activities. This study reveals a concerning trend among people living with type 2 diabetes, with only 16.7% of them achieving sufficient levels of work-related physical activity. This percentage is significantly lower when compared to studies conducted in rural areas, where as much as 74.9% of individuals reported achieving sufficient levels of work-related physical activity [ 14 , 16 ]. This difference can be explained by the fact that rural areas often involve occupations that inherently require more vigorous to moderate physical activities, such as agricultural work and fishing. These types of occupations not only demand more physical exertion but also create a conducive environment for individuals to engage in physical activity during their workday. The lower prevalence of sufficient physical activity among this population underscores the pressing need for targeted interventions to promote physical activity in urban workplaces. These interventions may include the implementation of workplace wellness programs, offering incentives for physical activity during breaks, or making ergonomic modifications to encourage movement throughout the workday. The study also found a lower prevalence of sufficient physical activity levels related to transportation 30.3%. This figure contrasts with studies conducted in rural Tanzania, which reported around 55.6% achieving sufficient transportation-related activity levels [ 14 , 16 ]. This difference can be attributed to varying levels of transport modernization. In urban Tanzania, buses and motorcycles are the primary means of transport, encouraging less physical activity compared to rural areas where bicycles and walking are more common modes of transportation, naturally promoting higher physical activity levels. This study has revealed that 13.3% of people living with type 2 diabetes achieved sufficient levels of physical activity performance through leisure-time based activities. This percentage is notably higher than the results of studies conducted in the rural regions of Kilimanjaro and Mwanza in Tanzania, where the participation rate in leisure activities among individuals was reported to be as low as 10% [ 14 , 16 ]. The difference in physical activity levels may be due to rural environments. Unlike urban areas, rural regions often lack access to recreational facilities and organized leisure activities, potentially resulting in lower participation rates. Additionally, the daily activities and priorities of rural individuals may differ, leading to less engagement in leisure activities recommended by organizations like the WHO. This study revealed that 24.6% of people living with type 2 diabetes had a sedentary lifestyle regarding their time spent on physical activities. This percentage is lower than a systematic review conducted in northern African countries and Uganda, which reported sedentary behavior rates of 54% and 68.7%, respectively [ 18 , 19 ]. This finding underscores the need for continued promotion and support of physical activity initiatives to further reduce sedentary behavior and improve health outcomes for people with type 2 diabetes. Study limitation One limitation is potential recall bias due to reliance on patient self-reports. To minimize this, structured questionnaires were structured to collect responses from the events conducted in the nearest 7 days (within a week) from the day of interview to improve response accuracy. The generalizability of the study findings may be limited due to a narrow geographic scope, which focused solely on an urban setting. To address this, future research should adopt a broader approach, offering a more comprehensive representation of the Tanzanian population. A larger-scale study encompassing diverse settings, including urban, semi-urban, and rural areas across the entire country, is recommended. This approach would generate findings that are more representative of Tanzanian society, enabling broader generalizations applicable to the nation. Conclusion This study highlights a concerning statistic, with less than half of people living with type 2 diabetes attending clinics in Dar es Salaam, Tanzania adhering to WHO-recommended physical activity levels. This underscores the urgent need for targeted interventions in urban areas, specifically tailored to promote physical activity among people living with type 2 diabetes. By implementing customized interventions based on these insights, there is a significant opportunity to enhance the well-being of people living with type 2 diabetes and improve adherence to physical activity recommendations. Ultimately, such interventions have the potential to yield better health outcomes for this population. Recommendations To enhance physical activity adherence among people living with type 2 diabetes in Tanzanian clinics, collaboration between employers and workplaces should be encouraged to implement workplace wellness initiatives. These initiatives could include flexible schedules and on-site exercise facilities, fostering a culture of regular physical activity among employees, including those with diabetes, and contributing to their overall well-being. Additionally, recognizing the influence of age on physical activity levels and integrating physical activity promotion into routine diabetes management programs are crucial steps. Healthcare providers should regularly discuss the benefits of physical activity during patient consultations and develop personalized activity plans. Community organizations and local authorities should also play a role by creating accessible spaces for physical activity. Educational campaigns can further raise awareness among people living with type 2 diabetes about the importance of regular physical activity for better diabetes management and overall health, motivating them to incorporate exercise into their daily routines. Declarations Other information. Funding statement This study was self-funded by the authors, and no external financial support was received for the design, data collection, analysis, interpretation, or manuscript preparation. All study expenses were solely covered by the authors, and there are no conflicts of interest related to the funding of this research. Ethical approval and Accordance Ethical clearance for this study was granted by the Muhimbili University of Health and Allied Sciences Institutional Review Board (Ref. No. DA 282/298/01.C/1739), with additional permissions obtained from the district medical offices of Ilala, Temeke, and Kinondoni municipal councils, as well as from the selected health facilities. Eligible participants received detailed information about the study’s purpose and procedures, including assurance of voluntary participation, confidentiality, and the right to decline or withdraw at any time without consequences. To protect privacy, participants were identified only by their initials and informed consent was obtained prior to data collection. The study was conducted in full compliance with the ethical principles of the Declaration of Helsinki. Consent to Participate declaration: Informed consent was obtained from all participants included in the study. Both written and verbal consent procedures were used, as approved by the ethics committee. Consent to Publish declaration: Not applicable Clinical trial number: Not applicable Competing interests The author(s) declare that they have no competing interests. Author’s contributions Joseph Matemba: Conceptualization, drafting, data analysis, interpretation, manuscript writing and approval of the final version to be published Emmy Metta: Conceptualization, designing, revising and approval of the final version to be published. Johnson Mshangila: Conceptualization, data analysis, manuscript writing and approval of the final version to be published. Daniel Joshua: Conceptualization, manuscript writing and approval of the final version to be published. Christopher Mankaba: Conceptualization, manuscript revising, approval of the final version to be published. Winfrida Kaaya: Conceptualization, manuscript writing, approval of the final version to be published. Alma Damasy: Conceptualization, manuscript revising, final approval of the version to be published Melchizedek Leshabari: Conceptualization, designing, revising and approval of the final version to be published. References World Health Organization (WHO). 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Mboya Knowledge, attitude and practice of physical activity among patients with diabetes in Kilimanjaro region, Northern Tanzania: a descriptive cross-sectional study. BMJ Open, 11, 9, e046841, Sep. 2021, doi: 10.1136/BMJOPEN-2020-046841. https://www.paho.org/en/documents/pahowho-step-wise-approach-noncommunicable-disease-ncd-risk-factor-surveillance-steps . B. John, J. Todd, I. Mboya, M. Mosha, M. Urassa, T. Mtuy Physical activity and associated factors from a cross-sectional survey among adults in northern Tanzania. BMC Public Health, 17, 1, 1–8, Jun. 2017, doi: 10.1186/S12889-017-4512-4/TABLES/4. R. Guthold, Physical activity in 22 African countries: results from the World Health Organization STEPwise approach to chronic disease risk factor surveillance, Am J Prev Med , 41, 1, pp. 52–60, Jul. 2011, 10.1016/J.AMEPRE.2011.03.008 S. Chaabane, K. Chaabna, A. Abraham, R. Mamtani, S. Cheema, Physical activity and sedentary behaviour in the Middle East and North Africa: An overview of systematic reviews and meta-analysis, Scientific Reports 2020 10:1 , 10, 1, pp. 1–24, Jun 2020, 10.1038/s41598-020-66163-x B. Twinamasiko, Sedentary Lifestyle and Hypertension in a Periurban Area of Mbarara, South Western Uganda: A Population Based Cross Sectional Survey, Int J Hypertens , vol. 2018, 1, p. 8253948, Jan. 2018, 10.1155/2018/8253948 Additional Declarations No competing interests reported. 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(MUHAS)","correspondingAuthor":false,"prefix":"","firstName":"Emmy","middleName":"","lastName":"Metta","suffix":""},{"id":561820444,"identity":"daf1484e-1e91-42a9-8042-5a1d61131eb4","order_by":2,"name":"Johnson Mshangila","email":"","orcid":"","institution":"Korea Foundation for International Healthcare","correspondingAuthor":false,"prefix":"","firstName":"Johnson","middleName":"","lastName":"Mshangila","suffix":""},{"id":561820446,"identity":"9b077f06-4e55-435b-ad61-7f99ed01f963","order_by":3,"name":"Alma Damasy","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences (MUHAS)","correspondingAuthor":false,"prefix":"","firstName":"Alma","middleName":"","lastName":"Damasy","suffix":""},{"id":561820448,"identity":"d247d1e3-0cd3-4962-b4f8-fe1ead392061","order_by":4,"name":"Christopher Mankaba","email":"","orcid":"","institution":"Tarime Town Council","correspondingAuthor":false,"prefix":"","firstName":"Christopher","middleName":"","lastName":"Mankaba","suffix":""},{"id":561820449,"identity":"eae03522-fd0f-4f3e-8c5e-c4f5fa72eda5","order_by":5,"name":"Winfrida Kaaya","email":"","orcid":"","institution":"Comitato Europeo di Formazione Agraria (CEFA)","correspondingAuthor":false,"prefix":"","firstName":"Winfrida","middleName":"","lastName":"Kaaya","suffix":""},{"id":561820450,"identity":"8e04c594-d866-4714-9e8f-fcdf4e339fba","order_by":6,"name":"Daniel Joshua","email":"","orcid":"","institution":"Zanzibar Health Research Institute","correspondingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Joshua","suffix":""},{"id":561820451,"identity":"e33cc018-190e-435e-a0b9-80f911593488","order_by":7,"name":"Melkizedeck Leshabari","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences (MUHAS)","correspondingAuthor":false,"prefix":"","firstName":"Melkizedeck","middleName":"","lastName":"Leshabari","suffix":""}],"badges":[],"createdAt":"2025-12-07 09:38:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8298896/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8298896/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98537706,"identity":"a8e34f39-8a72-4304-923b-2de27471be03","added_by":"auto","created_at":"2025-12-18 16:56:48","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":158539,"visible":true,"origin":"","legend":"","description":"","filename":"ManuscripttoDiscoverPublicHealthDr.JosephMatemba20251213.docx","url":"https://assets-eu.researchsquare.com/files/rs-8298896/v1/f8e8c0d99755f51c4a423805.docx"},{"id":98537614,"identity":"55633792-57db-4477-a592-aa84459ce71f","added_by":"auto","created_at":"2025-12-18 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16:57:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":968966,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8298896/v1/b58d063c-99dc-4d2b-9ff2-a62914313ef2.pdf"},{"id":98537613,"identity":"7aee30b1-f7b1-454e-8591-c486c2487adc","added_by":"auto","created_at":"2025-12-18 16:56:33","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22579,"visible":true,"origin":"","legend":"","description":"","filename":"STROBECHECKLIST.docx","url":"https://assets-eu.researchsquare.com/files/rs-8298896/v1/f37b230e8767eb6e505048b6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adherence to physical activity among people living with type 2 diabetes attending clinics in regional referral hospitals in Dar es Salaam, Tanzania: a cross-sectional study","fulltext":[{"header":"What is already know on this topic","content":"\u003col\u003e\n \u003cli\u003eRegular physical activity is crucial for managing type 2 diabetes, improving glycaemic control, reducing cardiovascular risks, and enhancing overall health.\u003c/li\u003e\n \u003cli\u003ePrevious studies in rural Tanzanian regions have shown high adherence rates to physical activity, attributed to physically demanding activities like farming and fishing.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this study adds\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eThe study provides the most recent data on adherence level to physical activities\u0026nbsp;among people living with type 2 diabetes in urban Tanzania.\u003c/li\u003e\n \u003cli\u003eThe study highlights the significant gap in physical activity adherence among urban people living with type 2 diabetes, emphasizing the need for targeted interventions in similar settings.\u003c/li\u003e\n \u003cli\u003eThis research adds to the ongoing scholarly discussion on this relevant topic.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Introduction","content":"\u003cp\u003eDiabetes mellitus is a metabolic disorder arising from deficiencies in insulin production, function, or both, leading to elevated blood sugar levels and disruptions in lipid, protein, and carbohydrate metabolism [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is one of the four major non-communicable diseases that have emerged as significant global public health concerns, alongside hypertension and kidney diseases, collectively contributing to the substantial disease burden from non-communicable illnesses [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Diabetes manifests in three primary forms: type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes mellitus (GDM); however, T2D accounts for approximately 90% of all diabetic cases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, Africa has the world\u0026rsquo;s lowest diabetes prevalence at 4.5%, but it is projected to surge by 129% by 2045, marking the highest increase globally [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Tanzania has a diabetes prevalence of 10.3%, making it one of the countries in Africa with a significant burden of the disease, just below South Africa\u0026rsquo;s prevalence of 11.3% and this is equivalent to 2.9\u0026nbsp;million individuals aged 20\u0026ndash;79 living with diabetes in Tanzania [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This increase in developing countries, including Tanzania, is associated with factors such as age, alcohol consumption, urbanization, sedentary lifestyles, obesity, smoking, cholesterol levels, and hypertension [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEffective self-care practices are vital non-pharmacological therapies for managing diabetes, aiming to control blood sugar levels and prevent other associated non-communicable diseases, such as cardiovascular diseases and obesity [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These practices encompass medication adherence, adherence to dietary recommendations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, physical activity adherence among people living with type 2 diabetes in African countries is consistently reported low, ranging from 26.7% in Ghana, 41% in Kenya to 51% in Rwanda and [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePhysical activity is crucial in managing type 2 diabetes as it enhances insulin sensitivity, aiding in more effective blood sugar control. Regular exercise strengthens the cardiovascular system, improving heart health and circulation, which helps prevent complications such as heart disease. It also supports weight management by burning calories and building muscle, thereby reducing the risk of obesity. Additionally, physical activity helps lower inflammation and oxidative stress, which are significant contributors to the development of chronic conditions [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Despite strong recommendations from diabetic clinics, there is scant information available regarding the adherence to physical activities among people living with type 2 diabetes. Therefore, this study aimed to assess the extent of physical activity adherence among people living with type 2 diabetes in Dar es Salaam, Tanzania.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis descriptive cross-sectional study involved people living with type 2 diabetes attending clinics at three regional referral hospitals in the Dar es Salaam region in June 2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy setting\u003c/h3\u003e\n\u003cp\u003e The study was conducted at Amana, Temeke, and Mwananyamala regional referral hospitals in the Dar es Salaam region. These hospitals are publicly owned and each of them houses a specialized diabetes clinic that cater diverse diabetic healthcare services to needs of the respective population. The selection of these three regional referral hospitals in Dar es Salaam (Temeke, Mwananyamala, and Amana) was based on their representation as the highest-level public health facilities in the region, located in distinct councils: Temeke, Kinondoni, and Ilala, respectively.\u003c/p\u003e \u003cp\u003eDar es Salaam was selected as the study location due to its status as Tanzania\u0026rsquo;s primary business hub. The city is characterized by a vibrant urban lifestyle and a significant prevalence of sedentary habits. Unlike other regions, the occupational landscape of Dar es Salaam is predominantly white-collar, with fewer physically demanding jobs such as agriculture, cattle keeping, or fishing [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Additionally, the city\u0026rsquo;s modern transportation infrastructure promotes individual modes of commuting rather than walking, distinguishing it from other regions in Tanzania.\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe study population comprised adult men and women living with type 2 diabetes attending diabetic clinics at Amana, Temeke, and Mwananyamala regional referral hospitals at metropolitan areas in Dar es Salaam.\u003c/p\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eThe study\u0026rsquo;s sample size was determined using Cochran\u0026rsquo;s formula, with a 95% confidence level and a precision of 6%. Based on prior research indicating a 33% adherence rate to physical activity among people living with type 2 diabetes [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], an initial estimate of 236 people living with type 2 diabetes was obtained. To mitigate potential non-response, the sample size was adjusted by 10%, yielding a final minimum sample size of 264 people living with type 2 diabetes selected to participate in the study.\u003c/p\u003e\n\u003ch3\u003eSampling methods\u003c/h3\u003e\n\u003cp\u003e Probability proportional sampling (PPS) was employed to ensure the desired sample size was obtained proportionately from Mwananyamala, Temeke, and Amana regional referral hospitals. The monthly average attendance at these hospitals Mwananyamala, Amana, and Temeke was 400, 189, and 205 people living with type 2 diabetes, respectively, totaling 794 across all three. To determine the sample size for each hospital, the total sample size (264 people living with type 2 diabetes) was distributed based on the monthly attendance figures, resulting in 63 people living with type 2 diabetes from Amana regional referral Hospital, 68 from Temeke regional referral Hospital, and 133 from Mwananyamala regional referral Hospital.\u003c/p\u003e \u003cp\u003eA systematic sampling approach was utilized, where the sampling interval (k\u003csup\u003eth\u003c/sup\u003e) 3 was obtained by dividing the monthly attendance (N) by the desired sample size (n). This interval was then used to select respondents systematically, starting with a random selection of the first participant and subsequently selecting every third person living with type 2 diabetes until the required number of respondents was reached for each hospital.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and Exclusion criteria\u003c/h2\u003e \u003cp\u003eAdult men and women diagnosed with type 2 diabetes who had been on diabetic treatment for at least six months were specifically targeted. Exclusions applied to those who were severely ill or non-ambulatory.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eThe primary variable examined was adherence to physical activity among people living with type 2 diabetes using World Health Organization (WHO) STEPwise. Adherence was categorized into two groups: \u0026ldquo;sufficient physical activity\u0026rdquo;, defined as achieving equal to or greater than 600 Metabolic Equivalent of Task (METs) per week, and \u0026ldquo;insufficient physical activity\u0026rdquo;, defined as achieving less than 600 METs per week. Physical activity was assessed across three domains: work-related activities, transport-related activities, and recreational or leisure-time-based activities. In each domain, adherence was determined based on whether people living with type 2 diabetes achieved the threshold of equal to or greater than 600 METs per week, with levels below this threshold classified as insufficient.\u003c/p\u003e\n\u003ch3\u003eData collection tool\u003c/h3\u003e\n\u003cp\u003eThe Global Physical Activity Questionnaire from the WHO STEPWISE method for non-communicable diseases surveillance was used [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. To ensure validity and comprehension, the English versions were accurately translated into Swahili before undergoing a pre-testing phase at a hospital in a metropolitan area in Tabata ward Dar es salaam, which share geographical similarities with the study sites. This process aimed to enhance clarity and ensure consistency in the questionnaire's understanding among respondents.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eThe first author collected the data with the support of the principal investigator and enlisted three research assistants who had medical training backgrounds in nursing and general medicine (general physician). The assistants were chosen for their expertise in type 2 diabetes management and health counseling skills related to diabetes mellitus. Before the data collection, the team underwent a one-day training session conducted by the principal investigator to familiarize them with the research aims, objectives, and the Open Data Kit (ODK) tool. The training focused on providing clarity and guidance for conducting interviews and administering the tools to ensure accurate and comprehensive data collection. Additionally, the team received instructions on research ethics and logistical considerations to uphold ethical standards throughout the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData management and analysis\u003c/h2\u003e \u003cp\u003eData collected using the ODK tool was extracted into Microsoft Excel format and then exported to STATA version 15 software for data cleaning and analysis. Descriptive statistics were then applied to summarize key characteristics of the study respondents, as well as their adherence to physical activity. The distribution of physical activity in each domain was presented, with frequencies and percentages used to illustrate categorical characteristics.\u003c/p\u003e \u003cp\u003eThe regularity of physical activity was assessed using the global physical activity questionnaire, modified from the WHO STEPwise method for non-communicable disease risk factor surveillance [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The questionnaire categorized physical activity into four parameters: work-related, traveling to and from places, recreational or leisure-time-based activities, and sedentary lifestyle. Time spent on each type of physical activity was summed to obtain the total time spent per week, and this was coded into metabolic equivalent tables. One MET was defined as the energy consumed while sitting quietly for about 1 hour, equating to approximately 3.5 mL of oxygen/kg body weight/min, with MET figures sourced from the Compendium of Physical Activity [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor vigorous-intensity work-related activities, a value of 8.0 METs per minute was assigned, while moderate-intensity work-related physical activity was assigned a value of 4.0 METs per minute. Transport-related activities were given a value of 4.0 METs per minute. Similarly, vigorous-intensity leisure-related physical activity was assigned 8.0 METs, and moderate-intensity leisure-related physical activity was assigned 4.0 METs. The total METs per week for all physical activities were calculated by multiplying the duration (minutes) of activity per week by its corresponding METs and summed for each physical activity type. Adherence to physical activity was defined as achieving\u0026thinsp;\u0026ge;\u0026thinsp;600 METs per week [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eGeneral description of study respondents\u003c/h2\u003e \u003cp\u003eA total of 264 people living with type 2 diabetes were approached from three referral regional hospitals in the Dar es Salaam region, namely Temeke, Amana, and Mwananyamala Regional Referral hospitals. Almost two-thirds (64%) were diagnosed with diabetes less than five years before the date of data collection and 67% of the respondents were female. The mean age of the study respondents was 55 years. The study population ranged in age from 18 to 81 years, with a majority aged over 55 years, and a standard deviation of \u0026plusmn;\u0026thinsp;11.5 years. Youths below 25 years of age comprised only 1.0% while elderly above 65 years of age were less than quarter of the population. Half of the respondents (50%) had primary education and very few (8.0%) did not have any formal education, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e display study respondent\u0026rsquo;s socio-demographic characteristics.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudy respondents\u0026rsquo; socio-demographic characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentages (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eAge categories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;44 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;54 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u0026ndash;64 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;65 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity/ college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCo-habit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDiabetic duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHousehold members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 2 members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;4 members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 4 members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePhysical activity levels varied across socio-demographic characteristics of respondents. It was higher among males (57%) than females and increased with level of education changing from 23% among those with no formal education to over 63% among respondents with university education. It was also higher among self-employed individuals (65%) compared to the unemployed (24%) and higher among those with diabetes for less than 6 years (54%) compared to those with longer durations of illness. Moreover, it was higher in households with more than four members (70%) than in households with 3\u0026ndash;4 members (40%) and less than 2 members (49%). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e describe the variation of socio-demographic characteristics in relation to adherence to physical activities.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic variation in relation to adherence to physical activities.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSufficient PA\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInsufficient PA\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eAge categories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;34 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (71)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;44 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;54 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u0026ndash;64 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;65 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e103 (58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.024*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.017*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75 (56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity/ college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.012**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCo-habit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (57)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76 (76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDiabetic duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78 (46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.005*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (77)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHousehold members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2 members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86 (51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.132**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;4 members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e˃4 members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (30)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eKey: PA\u0026thinsp;=\u0026thinsp;Physical activity *chi-square test **fisher exact test.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLevel of adherence to physical activities\u003c/h2\u003e \u003cp\u003eThe findings of this study showed that only 47% of people living with type 2 diabetes attending diabetic clinics in Dar es Salaam were adherent to physical activity. A significant proportion of people living with type 2 diabetes fail to meet the recommended levels of physical activity across various domains. Specifically, when it comes to work-related activities, a mere 16.7% of people living with type 2 diabetes reached a sufficient level of engagement.\u003c/p\u003e \u003cp\u003eOn transport-related activities, the situation was somewhat better than other domains but remains far from ideal, with only 30.3% of people living with type 2 diabetes meeting the required level of physical activity.\u003c/p\u003e \u003cp\u003eOnly 13.3% of people living with type 2 diabetes met the sufficient levels of physical activity through leisure activities. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e display participant\u0026rsquo;s engagement across all physical activity\u0026rsquo;s domains.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRespondents\u0026rsquo; different levels of physical activities. (N\u0026thinsp;=\u0026thinsp;264)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork related\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVigorous intensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate intensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal work related\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTransport related\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeisure related\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVigorous intensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate intensity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Leisure related\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSedentary related\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSedentary lifestyle\u003c/p\u003e \u003cp\u003eNon-sedentary lifestyle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003cp\u003e199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.6\u003c/p\u003e \u003cp\u003e75.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall PA level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eKey: Sufficient levels of PA are equivalent to \u0026ge;\u0026thinsp;600 METs.\u003c/p\u003e \u003cp\u003eMETs, metabolic equivalents; PA, physical activity.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e The study revealed that only 47% of people living with type 2 diabetes achieved the WHO-recommended level for overall sufficient physical activities, highlighting a notable gap in adherence to these guidelines. The findings of this study are consistent with a systematic review spanning 22 African countries, which reported physical activity adherence rates ranging from 46.8% to 96%, with specific rates of 51% in Rwanda and 41% in Kenya [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This consistency can be attributed to the urban settings in which these studies were conducted. Urban environments often pose challenges to physical activity adherence, such as limited access to open spaces, time constraints due to work and other commitments, and a culture that promotes sedentary lifestyles. These factors collectively contribute to the difficulty in meeting WHO-recommended physical activity levels.\u003c/p\u003e \u003cp\u003eThis level of adherence contrasts with previous studies conducted in the Mwanza and Kilimanjaro regions of Tanzania, where adherence rates were substantially higher at 96% and 94.3% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The studies conducted in rural Mwanza and Kilimanjaro involved populations predominantly engaged in physically demanding activities such as farming, fishing, and cattle keeping. These occupations inherently promote higher levels of physical engagement compared to urban settings, likely contributing to the observed higher rates of physical activity adherence among people living with type 2 diabetes in those regions.\u003c/p\u003e \u003cp\u003eThese findings highlight the importance of implementing targeted interventions to improve physical activity levels among people living with type 2 diabetes, especially in urban areas. Such interventions should consider the unique challenges faced by urban dwellers and seek to promote accessible and practical ways to engage in regular physical activities.\u003c/p\u003e \u003cp\u003eThis study reveals a concerning trend among people living with type 2 diabetes, with only 16.7% of them achieving sufficient levels of work-related physical activity. This percentage is significantly lower when compared to studies conducted in rural areas, where as much as 74.9% of individuals reported achieving sufficient levels of work-related physical activity [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis difference can be explained by the fact that rural areas often involve occupations that inherently require more vigorous to moderate physical activities, such as agricultural work and fishing. These types of occupations not only demand more physical exertion but also create a conducive environment for individuals to engage in physical activity during their workday. The lower prevalence of sufficient physical activity among this population underscores the pressing need for targeted interventions to promote physical activity in urban workplaces. These interventions may include the implementation of workplace wellness programs, offering incentives for physical activity during breaks, or making ergonomic modifications to encourage movement throughout the workday.\u003c/p\u003e \u003cp\u003eThe study also found a lower prevalence of sufficient physical activity levels related to transportation 30.3%. This figure contrasts with studies conducted in rural Tanzania, which reported around 55.6% achieving sufficient transportation-related activity levels [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This difference can be attributed to varying levels of transport modernization. In urban Tanzania, buses and motorcycles are the primary means of transport, encouraging less physical activity compared to rural areas where bicycles and walking are more common modes of transportation, naturally promoting higher physical activity levels.\u003c/p\u003e \u003cp\u003eThis study has revealed that 13.3% of people living with type 2 diabetes achieved sufficient levels of physical activity performance through leisure-time based activities. This percentage is notably higher than the results of studies conducted in the rural regions of Kilimanjaro and Mwanza in Tanzania, where the participation rate in leisure activities among individuals was reported to be as low as 10% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe difference in physical activity levels may be due to rural environments. Unlike urban areas, rural regions often lack access to recreational facilities and organized leisure activities, potentially resulting in lower participation rates. Additionally, the daily activities and priorities of rural individuals may differ, leading to less engagement in leisure activities recommended by organizations like the WHO.\u003c/p\u003e \u003cp\u003eThis study revealed that 24.6% of people living with type 2 diabetes had a sedentary lifestyle regarding their time spent on physical activities. This percentage is lower than a systematic review conducted in northern African countries and Uganda, which reported sedentary behavior rates of 54% and 68.7%, respectively [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This finding underscores the need for continued promotion and support of physical activity initiatives to further reduce sedentary behavior and improve health outcomes for people with type 2 diabetes.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitation\u003c/h2\u003e \u003cp\u003eOne limitation is potential recall bias due to reliance on patient self-reports. To minimize this, structured questionnaires were structured to collect responses from the events conducted in the nearest 7 days (within a week) from the day of interview to improve response accuracy.\u003c/p\u003e \u003cp\u003eThe generalizability of the study findings may be limited due to a narrow geographic scope, which focused solely on an urban setting. To address this, future research should adopt a broader approach, offering a more comprehensive representation of the Tanzanian population. A larger-scale study encompassing diverse settings, including urban, semi-urban, and rural areas across the entire country, is recommended. This approach would generate findings that are more representative of Tanzanian society, enabling broader generalizations applicable to the nation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights a concerning statistic, with less than half of people living with type 2 diabetes attending clinics in Dar es Salaam, Tanzania adhering to WHO-recommended physical activity levels. This underscores the urgent need for targeted interventions in urban areas, specifically tailored to promote physical activity among people living with type 2 diabetes. By implementing customized interventions based on these insights, there is a significant opportunity to enhance the well-being of people living with type 2 diabetes and improve adherence to physical activity recommendations. Ultimately, such interventions have the potential to yield better health outcomes for this population.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eTo enhance physical activity adherence among people living with type 2 diabetes in Tanzanian clinics, collaboration between employers and workplaces should be encouraged to implement workplace wellness initiatives. These initiatives could include flexible schedules and on-site exercise facilities, fostering a culture of regular physical activity among employees, including those with diabetes, and contributing to their overall well-being. Additionally, recognizing the influence of age on physical activity levels and integrating physical activity promotion into routine diabetes management programs are crucial steps. Healthcare providers should regularly discuss the benefits of physical activity during patient consultations and develop personalized activity plans. Community organizations and local authorities should also play a role by creating accessible spaces for physical activity. Educational campaigns can further raise awareness among people living with type 2 diabetes about the importance of regular physical activity for better diabetes management and overall health, motivating them to incorporate exercise into their daily routines.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eOther information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was self-funded by the authors, and no external financial support was received for the design, data collection, analysis, interpretation, or manuscript preparation. All study expenses were solely covered by the authors, and there are no conflicts of interest related to the funding of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and Accordance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance for this study was granted by the Muhimbili University of Health and Allied Sciences Institutional Review Board (Ref. No. DA 282/298/01.C/1739), with additional permissions obtained from the district medical offices of Ilala, Temeke, and Kinondoni municipal councils, as well as from the selected health facilities. Eligible participants received detailed information about the study\u0026rsquo;s purpose and procedures, including assurance of voluntary participation, confidentiality, and the right to decline or withdraw at any time without consequences. To protect privacy, participants were identified only by their initials and informed consent was obtained prior to data collection. The study was conducted in full compliance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants included in the study. Both written and verbal consent procedures were used, as approved by the ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJoseph Matemba: Conceptualization, drafting, data analysis, interpretation, manuscript writing and approval of the final version to be published\u003c/p\u003e\n\u003cp\u003eEmmy Metta: Conceptualization, designing, revising and approval of the final version to be published.\u003c/p\u003e\n\u003cp\u003eJohnson Mshangila: \u0026nbsp;Conceptualization, data analysis, manuscript writing and approval of the final version to be published.\u003c/p\u003e\n\u003cp\u003eDaniel Joshua: \u0026nbsp;Conceptualization, manuscript writing and approval of the final version to be published.\u003c/p\u003e\n\u003cp\u003eChristopher Mankaba: \u0026nbsp;Conceptualization, manuscript revising, approval of the final version to be published.\u003c/p\u003e\n\u003cp\u003eWinfrida Kaaya: \u0026nbsp;Conceptualization, manuscript writing, approval of the final version to be published.\u003c/p\u003e\n\u003cp\u003eAlma Damasy: \u0026nbsp;Conceptualization, manuscript revising, final approval of the version to be published\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMelchizedek Leshabari: Conceptualization, designing, revising and approval of the final version to be published.\u003c/p\u003e"},{"header":"References ","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (WHO). 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Twinamasiko, Sedentary Lifestyle and Hypertension in a Periurban Area of Mbarara, South Western Uganda: A Population Based Cross Sectional Survey, \u003cem\u003eInt J Hypertens\u003c/em\u003e, vol. 2018, 1, p. 8253948, Jan. 2018, 10.1155/2018/8253948\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adherence, Physical activity, Type 2 Diabetes mellitus, Metabolic Equivalent of Task (MET), Non-communicable diseases (NCD), Tanzania","lastPublishedDoi":"10.21203/rs.3.rs-8298896/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8298896/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn Tanzania, about 10.3% of the people aged 20 to 79 are living with type 2 diabetes and the prevalence is rising. Effective management of type 2 diabetes relies on adherence to self-care behaviors, including physical activity. However, information on physical activity adherence among people living with type 2 diabetes in Tanzania is scarce. This study aimed to determine the adherence levels to physical activity among people living with type 2 diabetes in Dar es Salaam, Tanzania.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study among people living with type 2 diabetes attending clinics at regional referral hospitals in Dar es Salaam was conducted in June 2023. Respondents were recruited through systematic sampling, and their physical activity levels measured using the WHO STEPwise method for NCD risk factor surveillance. Data were analyzed using STATA version 15.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall physical activity adherence rate was 47% among the 264 respondents in the study, indicating that a significant proportion of people living with type 2 diabetes did not adhere to the recommended activity levels. Specifically, only 16.7% engaged sufficiently in work-related activities, 30.3% in transport-related activities, and 13.3% in leisure-based activities, while 24.6% had a sedentary lifestyle.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eLess than half of people living with type 2 diabetes in Dar es Salaam meet the WHO-recommended physical activity levels. The lowest participation was in leisure-related activities compared to travel and work-related activities. Targeted urban interventions are needed to enhance well-being and improve physical activity adherence by increasing awareness and access to leisure activities.\u003c/p\u003e","manuscriptTitle":"Adherence to physical activity among people living with type 2 diabetes attending clinics in regional referral hospitals in Dar es Salaam, Tanzania: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-18 16:55:15","doi":"10.21203/rs.3.rs-8298896/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-09T07:59:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-05T10:34:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-29T07:53:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296496071272877342445998111469395146443","date":"2026-01-26T10:37:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"127172464845399962903136990674216906645","date":"2026-01-24T10:46:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-18T21:04:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-14T12:15:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"245767282515984988174196992059543773262","date":"2026-01-09T11:25:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"48958175754453266869753349303852708369","date":"2026-01-05T16:09:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294076188616371237521075242533332133336","date":"2026-01-04T14:54:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"327673770400265594989406058986014243683","date":"2025-12-18T14:20:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-16T13:09:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-13T14:10:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-13T05:42:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-12-12T23:31:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3a847ad5-dd1c-4fa3-958a-e5861ef30e43","owner":[],"postedDate":"December 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T05:55:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-18 16:55:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8298896","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8298896","identity":"rs-8298896","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}