LMICs are seeing a rise in NCDs, with variable burdens associated with lifestyle choices and governmental policies. Nonetheless, few LMICs have developed national policies that promote physical activity, indicating that they are ill-prepared to combat the epidemic. For those 25 years of age and older, physical inactivity is a risk factor for 1.3 million fatalities.(Bytyci et al., 2022) Engaging in physical exercise is a practice that promotes health and has been linked to a lower risk of certain chronic illnesses, such as heart disease, stroke, type 2 diabetes, osteoporosis, depression, and some types of cancer.(Dinger et al., 2018) Needless to say, Increasing physical activity (PA) is essential for improving population health (Bauman et al., 2009).
This study aimed to compare physical activity and its associated factors among rural and urban Malawians. In general, the study found that 29864 (97.7%) of the study participants met the WHO criteria for physical activity. The findings of our study are higher than previous reports (Bauman et al., 2009). The difference could be in the definition and measurement of physical activity as a concept among the two studies. Our study measured PA as defined by the WHO where this study utilized international physical activity questionnaires depicting different measurement constructs. The findings of our study, highlight the fact that numerous Malawians acknowledge the need for physical exercise and its positive effects on health, particularly the way it keeps people strong and enables them to retain their physical functions.
According to residential area, more people in the rural areas met the WHO recommendation of PA compared to people in the urban areas in agreement with a study conducted by Msyambodza and colleagues (Msyambodza et al.,2011 ). In contrast, Malambo et al. (2016) found that the proportion of physical inactivity was higher in the rural areas, unlike the urban settings in South Africa. The finding of our study is in tandem with a previous qualitative study assessing the attitudes of rural and urban dwellers toward physical activity in Malawi (Banda et al., 2023). The study found that those from rural areas reported more strenuous physical activity. The results of our study could be attributed to conflicting objectives among people in urban settlements. Furthermore, it can be attributed to the nature of the occupation urban dwellers engage in. This study has shown that there is a significant difference in occupation among rural and urban settlers where a larger number of people in rural areas engage in farming activities whereas the majority of urban settlers are unemployed compared to rural dwellers. Some of the documented obstacles to physical activity that are more noticeable in urban areas have to do with urbanization, notably the built environment, congestion, sedentary jobs, and safety concerns that encourage a sedentary way of life (Bytyci et al., 2022). The findings of this report suggest that efforts towards increasing physical activities should target urban areas to ensure equity.
In this review, drinking was significantly associated with PA in urban areas but not in rural areas. The findings of this study can be explained by the different sociological factors that influence the relationship between alcohol drinking and PA (Dinger et al., 2018). Moreover, the results can be explained by the larger number of participants who drank more than 8 bottles in the urban than in the rural areas. The finding of this study could suggest greater economic productivity in urban areas leading to the availability of disposable income hence excessive drinking in urban areas which could in turn result in leisure time and less physical activity.
Surprisingly, more women than men met the WHO recommendation for PA in this study despite the lack of access to facilities that promote PA. This is in contrast to a previous study by Msyambodza et al., (2012) and Guthold et al., (2016)who found that the levels of physical inactivity were higher in females than males. The results of our study can be explained by increased domestic tasks among Malawian women (Banda et al., 2023). According to the cultural norm, women are in charge of household chores such as cleaning, sweeping, fetching water, going to the market, and doing laundry for the whole family. Furthermore, it can be attributed to the increased use of motorcycles among men in Malawi. The results of this paper highlight the gender inequality that exists in physical activity-disadvantaged men calling for concerted efforts to improve men’s utilization of physical activity facilities.
In this paper, having diabetes and hypertension was associated with low uptake of PA. The finding of this paper is daunting since diabetes and hypertension can easily be managed with a healthy lifestyle including physical exercise. The results of our study are in contrast with previous reports that Malawians with chronic conditions were more willing to adopt self-management initiatives such as exercise (Ogunrinu et al., 2017). According to a study conducted elsewhere, lack of adherence to PA among patients with hypertension and diabetes can be attributed to three main themes including lack of infrastructure, lack of social support, and health reasons (Bytyci et al., 2022). A study conducted by Mphwanthe et al., (2021) among type 2 diabetes patients in Malawi found that social and family ties are important factors for adherence to PA. This paper did not classify the patients according to type of diabetes hence it remains a conundrum whether there is a relationship between type of diabetes and PA.
Worldwide smoking is a recognized public health concern. This review found that there was a difference in smoking between rural and urban areas similar to previous research (Msyambodza et al., 2011. Nevertheless, the study found that there was no significant association between smoking and physical activity in urban areas and rural areas. Interaction effects can explain the findings of this study. The observed correlations may be influenced by intricate interactions between smoking and physical activity and other factors. Smoking and physical activity may not be significantly correlated if these interactions are not sufficiently considered in the research. for instance, research has shown a significant correlation between smoking and obesity including alcohol consumption. Research on the mediating role of smoking in the relationship between PA and obesity as well as physical activity and alcohol consumption. (Cabrera-Barona et al., 2019) Furthermore, the accuracy of the results might be impacted by problems with measurement inaccuracy or bias in determining smoking status and levels of physical activity. Self-reported data could contain inaccurate behavior reports due to recollection or social desirability bias.
Limitations
The study is not without drawbacks. First, the study did not distinguish the two types of physical activity, moderate intensity and vigorous intensity PA. In addition, the study did not engage other rural and urban locations therefore the results cannot be generalized across the country. Furthermore, the nature of the study design including the subjective nature of the data collection predisposes the study to recall bias.