title: Chronic physical conditions, multimorbidity and physical activity across 46 low- and middle-income countries.
abstract: There are no nationally representative population-based studies investigating the relationship between physical activity, chronic conditions and multimorbidity (i.e., two or more chronic conditions) in low- and middle-income countries (LMICs), and studies on a multi-national level are lacking. This is an important research gap, given the rapid increase in the prevalence of chronic diseases associated with lifestyle changes in these countries. This cross-sectional study aimed to assess the association between chronic conditions, multimorbidity and low physical activity (PA) among community-dwelling adults in 46 LMICs, and explore the mediators of these relationships.
  
  
  
  World Health Survey data included 228,024 adults aged ≥18 years from 46 LMICs. PA was assessed by the International Physical Activity Questionnaire (IPAQ). Nine chronic physical conditions (chronic back pain, angina, arthritis, asthma, diabetes, hearing problems, tuberculosis, visual impairment and edentulism) were assessed. Multivariable logistic regression and mediation analyses were used to assess the association between chronic conditions or multimorbidity and low PA.
  
  
  
  Overall, in the multivariable analysis, arthritis (OR = 1.12), asthma (1.19), diabetes (OR = 1.33), edentulism (OR = 1.46), hearing problems (OR = 1.90), tuberculosis (OR = 1.24), visual impairment (OR = 2.29), multimorbidity (OR = 1.31; 95% CI = 1.21-1.42) were significantly associated with low PA. More significant associations were observed in individuals aged ≥50 years. In older adults, depression mediated between 5.1% (visual impairment) to 23.5% (angina) of the association between a chronic condition and low PA. Mobility difficulties explained more than 25% of the association for seven of the eight chronic conditions. Pain was a strong mediator for angina (65.9%) and arthritis (64.9%), while sleep problems mediated up to 43.7% (angina) of the association.
  
  
  
  In LMICs, those with chronic conditions and multimorbidity are significantly less physically active (especially older adults). Research on the efficacy and effectiveness of PA in the management of chronic diseases in LMICs is urgently needed. Targeted promotion of physical activity to populations in LMICs experiencing chronic conditions may ameliorate associated depression, mobility difficulties and pain that are themselves important barriers for initiating or adopting an active lifestyle.
authors.affiliation: Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Leuven, 3001, Belgium. davy.vancampfort@uc-kortenberg.be.|KU Leuven, University Psychiatric Center KU Leuven, Leuvensesteenweg 517, Kortenberg, 3070, Belgium. davy.vancampfort@uc-kortenberg.be.
authors.forename: Davy
authors.initials: D
authors.lastname: Vancampfort
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 0883, Spain.|Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid, 28029, Spain.
authors.forename: Ai
authors.initials: A
authors.lastname: Koyanagi
authors.affiliation: School of Psychiatry, UNSW, Sydney, Australia.|Schizophrenia Research Institute, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia.
authors.forename: Philip B
authors.initials: PB
authors.lastname: Ward
authors.affiliation: Exercise Physiology Department, School of Medical Sciences, UNSW Australia, Sydney, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Rosenbaum
authors.affiliation: Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.|Programa de Pós Graduação em Ciências Médicas: Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Felipe B
authors.initials: FB
authors.lastname: Schuch
authors.affiliation: Kyambogo University, Kampala, Uganda.|Butabika National Referral and Mental Health Hospital, Kampala, Uganda.
authors.forename: James
authors.initials: J
authors.lastname: Mugisha
authors.affiliation: School of Public Health & Charles Perkins Centre, University of Sydney, Sydney, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Richards
authors.affiliation: School of Health Sciences, Division of Psychology & Mental Health, University of Manchester, Manchester, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Firth
authors.affiliation: Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.|Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box SE5 8AF, De Crespigny Park, London, UK.
authors.forename: Brendon
authors.initials: B
authors.lastname: Stubbs
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000517:prevention & control; D001168:Arthritis / Q000517:prevention & control; D002908:Chronic Disease / Q000517:prevention & control; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000517:prevention & control; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000517:prevention & control; D015444:Exercise / Q000523:psychology; D005260:Female; D014943:Global Health; D006306:Health Surveys; D006801:Humans; D007182:Income; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010146:Pain / Q000150:complications; D011203:Poverty; D015995:Prevalence; D012890:Sleep; D055815:Young Adult
keywords: Angina pectoris; Arthritis; Depression; Diabetes mellitus; Mobility limitation; Multimorbidity; Pain; Physical activity; Sleep