title: Physical activity in adults with and without diabetes: from the 'high-risk' approach to the 'population-based' approach of prevention.
abstract: BACKGROUND
  The prevalence rates of physical inactivity and diabetes in the MENA region are among the highest in the world. However, studies that focus on factors that influence the pattern of physical activity in the region remain very scarce. This study aimed to determine the prevalence and correlates of physical activity in the general population and among subjects with and without diabetes in Lebanon, a small middle-income country in the MENA region.
  
  
  METHODS
  We conducted a cross-sectional nation-wide study of 2,195 randomly selected adults aged 25 years and older. Participants completed a comprehensive questionnaire based on the WHO-STEPwise guidelines. Physical activity was assessed using the International Physical Activity Questionnaire. Type 2 diabetes risk factors examined were age ≥ 45 years, BMI ≥ 25 kg/m², hypertension, hyperlipidemia, cardiovascular disease and family history of diabetes.
  
  
  RESULTS
  Close to 10% of adults with diabetes were physically active versus 23·4% without diabetes. Prevalence rates of physical activity declined consistently as the number of diabetes risk factors increased. Odds ratios for physical activity were lower among the educated (0.75, 95% CI= 0.57-0.98), those who owned at least one car (0.71, 95% CI= 0.57-0.88) and those who resided in the capital city (0.62, 95% CI 0.47-0.83). Health professionals gave 'advice to exercise' most to patients with or at highest risk for diabetes, and these were more likely to engage in physical activity than those without diabetes receiving the same advice, net of the effect of other covariates (OR=3.68 and 1.17, respectively).
  
  
  CONCLUSIONS
  The inverse associations between physical activity and SES indicators suggest a negative influence of urbanization on activity levels of Lebanese adults. The missed opportunity for clinical primary preventive services for the majority non-diabetic population calls for population-based public health approaches that promote physical activity as a routine lifestyle in the general population.
authors.affiliation: Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut (AUB), PO Box: 11-0236, Riad el Solh, Beirut 1107-2020, Beirut-Lebanon. am00@aub.edu.lb.
authors.forename: Abla Mehio
authors.initials: AM
authors.lastname: Sibai
authors.forename: Christy
authors.initials: C
authors.lastname: Costanian
authors.forename: Rania
authors.initials: R
authors.lastname: Tohme
authors.forename: Shafika
authors.initials: S
authors.lastname: Assaad
authors.forename: Nahla
authors.initials: N
authors.lastname: Hwalla
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012016:Reference Values; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014507:Urbanization