Background
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Phase 1. Identifying relationships of physical activity and sedentary behaviour with health outcomes
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Phase 2. Measuring physical activity and sedentary behaviour
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Phase 3. Characterizing prevalence and variations of physical activity and sedentary behaviour in populations
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Phase 4. Identifying the determinants of physical activity and sedentary behaviour
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Phase 5. Developing and testing interventions to influence physical activity and sedentary behaviour
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Phase 6. Using evidence to inform public health guidelines and policy
Methods
Search strategy
Selection process
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Phase 1: Cross-sectional studies used a clearly described measure for physical activity/sedentary behaviour and prospective studies involved a physical activity intervention
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Phase 3: Studies clearly defined physical activity as meeting the recommendation of 150 min/week for adults or 60 min/day for children/adolescents.
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Phase 4: For demographic correlates, studies used a clearly described measure for physical activity/sedentary. The secondary inclusion criteria were not used for the studies examining the non-demographic articles to ensure a comprehensive review of available research in the region.
Data extraction, analysis and synthesis
Risk of bias assessment
Results
Phase of Behavioural Epidemiology Framework | Total Number of Studies | ||||||||
---|---|---|---|---|---|---|---|---|---|
Physical Activity | Sedentary Behaviour | Total | |||||||
Adult | Adolescent | Children | Total | Adult | Adolescent | Children | Total | ||
1. Associations with Health Outcome | 29 | 11 | 2 | 29 | 8 | 10 | 3 | 18 | 43 |
2. Measuring Behaviours | 2 | 1 | 3 | 1 | 1 | 3 | |||
3. Prevalence and Variation | 10 | 8 | 18 | 3 | 12 | 4 | 17 | 26 | |
4. Correlates | 25 | 9 | 1 | 35 | 35 | ||||
5. Interventions | 6 | 6 | 6 | ||||||
6. Policy | None |
Findings of studies organized within the behavioural epidemiology framework
Phase 1 (Identifying relationships with health outcomes)
Lead author Country | Study design | Health Outcomes | Association | |
---|---|---|---|---|
Physical Activity (type) | Sedentary Behaviour (type) | |||
Prospective Studies | ||||
Abdi S [50], United Arab Emirates | Diet and physical activity intervention (6 months) | HbA1c | −physical activity intervention) | |
35 adults aged 18–60 years with diabetes | ||||
Al Saif A [45], Saudi Arabia | Aerobic and anaerobic intervention (3 months) | BMI | −(Aerobic intervention) | |
Blood Pressure | ||||
40 obese adults aged 18–25 years | Heart Rate | |||
Maximum oxygen consumption | + (Aerobic intervention) | |||
Maximum voluntary ventilation | + (Aerobic and anaerobic interventions) | |||
Al-Eisa E [148], Saudi Arabia | Exercise intervention (8 weeks) | Serum cotinine | −(Exercise intervention for both smokers and non-smokers) | |
150 men aged 18–55 years | Serum cortisol | |||
Testosterone | ||||
Mood and physical symptoms scale | −(Exercise intervention for smokers) | |||
Free radicals | + (Exercise intervention for both smokers and non-smokers) | |||
Al-Eisa E [64], Saudi Arabia | Exercise intervention (3 weeks) | Insomnia | −(exercise intervention) | |
76 women university students aged 19–25 years | Depression | |||
Attention span | + (Exercise intervention) | |||
Alghadir AH [53], Saudi Arabia | Exercise intervention (12 weeks) | BMI | −(Exercise intervention) | |
100 adults aged 30–60 years | Waist-Hip ratio | |||
Serum levels of Copper, Zinc and bone-specific alkaline phosphatase | ||||
Osteoporosis T-score | ||||
Bone mineral density | + (Exercise intervention) | |||
Serum levels of Calcium and Manganese | ||||
Alghadir AH [149], Saudi Arabia | Exercise intervention (4 weeks) | Salivary cortisol, lactate and testosterone levels | + (Exercise intervention) | |
16 men students aged 15–25 years | ||||
Al-Ghimlas F [46], Kuwait | Exercise intervention (12 weeks) | Weight | −(Exercise intervention) | |
58 adults aged 15+ years | BMI | |||
Waist and hip circumferences | ||||
Diastolic blood pressure | ||||
Resting Heart Rate | ||||
HbA1c | ||||
LDL cholesterol | ||||
Body fat composition | ||||
Peak oxygen uptake Muscular strength | + (exercise intervention) | |||
Ardawi MM [37], Saudi Arabia | Exercise intervention (8 weeks) | Serum bone-formation markers: | −(exercise intervention) | |
160 women aged 20–49 years | ||||
Sclerostin | ||||
CTX | ||||
IGF-I | + (exercise intervention) | |||
OC | ||||
PINP | N (exercise intervention) | |||
bone-ALP | ||||
PTH | ||||
NTX | ||||
Kneffel Z [47], Qatar | Exercise intervention (10 weeks) | Weight | −(Exercise intervention) | |
36 students aged 18–30 years | BMI | |||
Body fat composition | ||||
Diastolic blood pressure | ||||
Rouzi AA [40], Saudi Arabia | Prospective cohort (6 years) | All fragility related fractures | −(Total PA) | |
707 healthy post-menopausal women aged 50+ years | ||||
Sadiya A [51], United Arab Emirates | Lifestyle intervention including physical activity (12 weeks) | Weight | −(Lifestyle intervention) | |
BMI | ||||
45 obese or obese with type 2 diabetes adults aged 18–50 years | Body fat composition | |||
WC | ||||
Fasting blood glucose | −(Lifestyle intervention for obese with diabetes) | |||
HbA1c | ||||
Salman RA [38], Saudi Arabia | Exercise intervention (11–year) | Hypertension | −(leisure PA) | |
916 normotensive adults with diabetes aged 20+ years | ||||
Tomar RH [52], Saudi Arabia | Exercise intervention (12 weeks) | Glycemic control | + (exercise intervention) | |
24 adult men with type 2 diabetes aged 25–55 | ||||
Cross-sectional: Adults | ||||
Al-Daghri NM [150], Saudi Arabia | Cross-sectional | Irisin levels | + (Total PA for healthy adults | |
164 adults aged 30–75 years | ||||
N (total PA for adults with diabetes) | ||||
Al-Hamdan NA [48], Saudi Arabia | Cross-sectional | Hypertension | −(Work, transport and leisure PA) | |
4758 adults aged 15–64 years | ||||
Al-Mahroos F [36], Bahrain | Cross-sectional | BMI | −(Occupational activity) | −(TV time) |
2013 adults; men aged 40–59 years and women aged 50–69 years | −(Walking and cycling, significant in only men) | |||
Almajwal MA [91] 4, Saudi Arabia | Cross-sectional | BMI | −(Total PA) | |
362 Non-Saudi hospital nurses | ||||
Al-Nozha MM [39] 3, 4, Saudi Arabia | Cross-sectional | BMI | −(Leisure PA) | |
17,395 adults aged 30–70 years | WC | −(Leisure PA) | ||
Al-Thani [151], Qatar | Cross-sectional | BMI | N (Total PA) | |
2496 adults aged 18–64 years | WC | −(Total PA) | ||
Ardawi MM [37], Saudi Arabia | Cross sectional | Serum bone-formation markers: | −(Walking or exercising) | |
1235 women aged 20–49 years | ||||
Sclerostin | ||||
FSH | ||||
CTX | ||||
IGF-I | + (Walking or exercising) | |||
OC | ||||
PINP | ||||
bone-ALP | ||||
PTH | ||||
E2 | ||||
NTX | ||||
Al-Kilani H [44], Oman | Cross-sectional | Total body fat | + (exercise and physical activity scores) | |
202 school students aged 18–25 years | ||||
Basulaiman M [67], Saudi Arabia | Cross-sectional | Hypercholesterolemia | N (Total PA) | N (Total TV/computer time) |
10735 adults aged 15+ years | ||||
Borderline Hypercholesterolemia | N (Total PA) | + (Total TV/computer time) | ||
El-Aty MA [54] 3, Oman | Cross-sectional | Metabolic Syndrome | N (Total PA) | + (Total sitting time) |
3137 adults aged 18+ years | ||||
El Bcheraoui C [49], Saudi Arabia | Cross-sectional | Hypertension | N (Total PA) | N (Total TV/computer time) |
10735 adults aged 15+ years | ||||
Borderline hypertension | + (Total PA−moderate active only) | N (Total TV/computer time) | ||
El-Ghazali S [152], Kuwait | Cross-sectional | BMI | −(Total PA) | |
320 college students, 17–26 years | ||||
Hegazy AM [153], Saudi Arabia | Cross-sectional study | Lower back pain | −(Total PA) | + Prolonged sitting |
174 women, half with lower back pain for 3+ months (20–45 years) | ||||
Mabry RM [16], Oman | Cross-sectional | The Metabolic Syndrome | −(Work PA) | + (total sedentary behavior but not significant after further adjustment for PA) |
1,335 adults age 20 years and older | −(Transport PA) | |||
N (Leisure PA) | ||||
Memish ZA [154], Saudi Arabia | Cross-sectional | BMI | −(Total PA, men only) | |
10,735 adults 15+ years | ||||
Moradi-Ladek M [68], Saudi Arabia | Cross-sectional | Self-rated health | + (TV/computer time) | |
10,735 adults 15+ years | ||||
Shah SM [35], United Arab Emirates | Cross-sectional | Hypertension | −(Walking 30+ mins/day) | |
1,375 South Asian immigrants men 18+ years | ||||
Tuffaha M [55], Saudi Arabia | Cross-sectional | Vit. D deficiency | N (Total PA) | |
10,735 adults 15+ years | ||||
Prospective: Children and adolescents | ||||
Al Saweer A [155], Bahrain | Behavioural intervention including physical activity | Weight | −(Behavioural intervention) | |
BMI | ||||
13 obese adolescents | ||||
Cross-Sectional: children and adolescents | ||||
Al Junaibi A [41], UAE | Cross-sectional | BMI | N (time spent walking, moderate activity, vigorous activity) | −(computer time in girls) |
1,541 students aged 6–19 years | ||||
+ (computer time in boys) | ||||
N (time spent sitting) | ||||
Al-Haifi AA [156], Kuwait | Cross-sectional | Sleep duration | N (Moderate and/or vigorous activity) | −(TV and computer time in boys) |
906 school students aged 14–19 years | ||||
Al-Haifi AR [60], Kuwait | Cross-sectional | BMI | −(Moderate and Vigorous PA) | N (TV and Computer time) |
906 school students aged 14–19 years | WC | |||
−(Vigorous PA) | ||||
Al-Hazzaa HM [61], Saudi Arabia | Cross-sectional | BMI | −(vigorous PA) | N (TV/screen time) |
2,906 school students aged 14–19 years | N (Total PA) | |||
WtHR | −(vigorous PA) | |||
N (Total PA) | ||||
Al-Hazzaa HM [157], Saudi Arabia | Cross-sectional | Sleep duration | + (Total PA) | + (screen time) |
2,868 secondary-school students aged 15–19 years | ||||
Al-Kilani H [44], Oman | Cross-sectional | Total body fat | + (exercise and physical activity scores) | |
202 school students aged 18–25 years | ||||
Al-Nakeeb Y [57] 3, Saudi Arabia | Cross-sectional | BMI | −(Total PA and walking) | + (computer use and total TV and computer time) |
1,138 school students aged 15–17 years | ||||
Al-Nuaim AA [58] 3, Saudi Arabia | Cross-sectional | BMI | −(Total PA) | + (sitting time) |
1,270 school students aged 15–19 years | WC | −(Total PA) | + (sitting time) | |
Alqahtani N [62], Saudi Arabia | Cross-sectional | BMI | −(Total PA, boys only) | −(Screen time) |
370 school children aged 14–19 years | ||||
Alrashidi M [59], Kuwait | Cross-section | BMI | + (TV time in boys) | |
635 children aged 11–14 years | ||||
Kerkadi A [42], UAE | Cross-sectional | BMI | N (Total PA) | + (TV time) |
900 female primary school children aged 5–14 years | ||||
Muhairi SJ [56], UAE | Cross-sectional | Vitamin D levels | + (Total PA) | |
315 healthy adolescents aged 15–18 years | ||||
Yousef S [43] 3, UAE | Cross-sectional | Childhood behavioral problems | + (TV and Video games time) | |
197 school children aged 5–15 years |
Phase 2 (Measuring physical activity and sedentary behavior)
Phase 3 (Characterizing Prevalence and variation in populations)
Author Country | Sample | Physical Activity and Sedentary Behaviour Measurement Tool | Physical Activity | Sedentary Behaviour |
---|---|---|---|---|
Adults | ||||
Al-Hazzaa HM [76] 4, Saudi Arabia | 1,064 adults aged 15–78 years | IPAQ short | Men: 56.3 % | |
Women: 65.7 % | ||||
Total: 59.4 % | ||||
Allam AR [158], Saudi Arabia | 194 medical students | IPAQ short | Men: 36.2 % | |
Women: 35.0 % | ||||
Total: 35.5 % | ||||
Al-Nozha MM [39] 2, 4, Saudi Arabia | 17,395 adults aged 30–70 years | Validated questionnaire on Leisure time physical activity and walking | Men: 6.1 % | |
Women: 1.9 % | ||||
Al Thani M [69], Qatar | 747 women aged 18–64 years | GPAQ | Women: 44.2 % | Mean total sitting time: |
183.6 ± 168.3 min/day | ||||
Awadalla NJ [72] 4, Saudi Arabia | 1257 health professional college students | IPAQ short | Men: 43.7 % | |
Women: 41.2 % | ||||
Total: 42.0 % | ||||
Banday AH [159], Saudi Arabia | 106 Primary Health care Physicians aged 27–63 years | GPAQ | Total: 65.2 % | |
Carter AO [160], UAE | 175 Medical students aged 19–27 years | Nurses’ Health Study II | Total: 67.0 % | |
El-Aty, MA [54] 2, Oman | 3137 adults aged 18+ years | GPAQ | Men: 68.0 % | Prevalence (6+ hrs/day): |
Women: 59.5 % | Men: 21.5 % | |||
Total: 63.4 % | Women: 25.6 % | |||
Total: 23.7 % | ||||
Khalaf A [161], Saudi Arabia | 663 female university students | ATLS | Women: 62.4 % | |
Koura MR [162], Saudi Arabia | 370 women college students | GPAQ | Women: 46.8 % | |
Mabry RM [70] 4, Oman | 1,335 adults aged 20 years and older | GPAQ | Prevalence (3+ hrs/day): | |
Men: 64.8 % | ||||
Women: 37.8 % | ||||
Total: 45.3 % | ||||
Children and adolescents | ||||
Al-Hazzaa HM [86] 4, Saudi Arabia | 2,866 school students aged 15–19 years | ATLS | Boys: 43.8 % | |
Girls: 20.2 % | ||||
Total: 31.5 % | ||||
Al-Hazzaa HM [78], Saudi Arabia | 2,908 secondary-school students aged 14–19 years | ATLS | Boys: 55.5 % | Computer/TV time >2 h/day: |
Girls: 21.9 % | Boys: 84.0 % | |||
Girls: 91.2 % | ||||
Al-Hazzaa HM [81], Saudi Arabia | 2,886 students aged 15–19 years | ATLS | Boys: 55.0 % | Computer/TV time >3 h/day: |
Girls: 21.7 % | Boys: 69.8 % | |||
Girls: 81.8 % | ||||
Al-Hazzaa HM [80] 4, Saudi Arabia | 1,648 students aged 14–18 years | ATLS | Boys: 53.4 % | Mean computer/TV time (hrs/day): |
Girls: 19.1 % | ||||
Total: 36.0 % | Boys: 5.31 ± 3.1 | |||
Girls: 5.89 ± 3.3 | ||||
Computer/TV time >2 h/day: | ||||
Boys: 84.2 % | ||||
Girls: 91.6 % | ||||
Total: 88.0 % | ||||
Al-Hazzaa HM [65], Saudi Arabia | 224 preschool children aged 3.4 to 6.4 years | unknown | Mean TV time (minutes/day): | |
Boys: 162.4 ± 69.9 | ||||
Girls: 147.7 ± 61.7 | ||||
Total: 154.8 ± 66.1 | ||||
Allafi A [77], Kuwait | 906 Adolescents aged 14–19 years | ATLS | Boys:70.5 % | % watch >2 h of TV/day: |
Girls: 39.2 % | Boys: 69.7 % | |||
Girls: 72.7 % | ||||
% use computers >2 h/day: | ||||
Boys: 62.1 % | ||||
Girls: 70.0 % | ||||
Al-Nakeeb Y [57]2, Saudi Arabia | 2,290 school students aged 15–17 years | ATLS | Boys: 45.8 % | Mean time watching TV (hrs/day): |
Girls: 4.5 % | ||||
Total: 26.0 % | Boys: 2.51 | |||
Girls: 2.61 | ||||
Mean computer time (hrs/day): | ||||
Boys: 2.41 | ||||
Girls: 3.18 | ||||
Al-Nuaim AA [58] 2, Saudi Arabia | 1,270 school students aged 15–19 years | ATLS | Boys: 44.5 % | Mean time watching TV (hrs/day): |
Girls: 4.0 % | ||||
Boys: 2.49 | ||||
Girls: 2.60 | ||||
Mean computer time (hrs/day): | ||||
Boys: 2.43 | ||||
Girls: 3.19 | ||||
Farghaly NF [163], Saudi Arabia | 767 students aged 7–20 years | unknown | Mean TV time (hrs/day) | |
Total: 1.0 ± 1.0 | ||||
Mean computer game time (hrs/day) | ||||
Total: 0.7 ± 0.9 | ||||
Gharib NM [164], Bahrain | 2,594 school children aged 6–18 years | Unknown | Mean hours of TV/Video/week: | |
Boys: 11.5 | ||||
Girls: 31.2 | ||||
Mean hours of computer time/week: | ||||
Boys: 3.3 | ||||
Girls: 2.7 | ||||
Kilani H [82], Oman | 802 adolescents aged 15–18 years | ATLS | Boys: 66.7 % | Mean screen time (hrs/day): |
Girls: 23.1 % | Boys: mean 2.86 SD2.3 | |||
Girls: mean 3.70 SD2.9 | ||||
Mahfouz AA [84], Saudi Arabia | 1,869 adolescent aged 11–19 years | CDC Adolescent Health adapted | Watched > 3 h TV/daily: | |
Boys: 38.0 % | ||||
Girls: 52.7 % | ||||
Mahfouz AA [83], Saudi Arabia | 2,696 adolescent school boys aged 11–19 years | Arabic version of CDC Adolescent Health Survey | Watched > 3 h TV/daily: | |
Total: 38 % | ||||
Musaiger AO [85], Saudi Arabia | 512 girl school students aged 12–19 years | unknown | ≥3 h TV time/day: | |
Girls: 60.9 % | ||||
Yousef, S [43] 2, UAE | 197 school children aged 6–10 years | Unknown | % TV viewing/Video games > 2 h/day: | |
Total: 62.9 % | ||||
Youssef RM [74], Oman | 439 secondary-school students aged 15–20 years | unknown | % TV time ≥3 h/day: | |
Boys: 21.1 % | ||||
Girls: 25.3 % | ||||
Total: 23.2 % | ||||
% computer ≥3 h/day: | ||||
Boys: 26.6 % | ||||
Girls: 31.5 % | ||||
Total: 29.2 % |
Phase 4 (Identifying the determinants)
Correlate | Association | References |
---|---|---|
Demographic | ||
Age | − | |
+ | Mabry, 2012 [70] (men only) | |
Gender (male) | + | |
Education | − | |
Marital Status (married) | + | |
− | Khalaf, 2013 [161] (women only) | |
Employment (employed) | + | Mabry, 2012 [70] |
Intrapersonal | ||
Lack of time | − | Al-Hazzaa, 2014 [86]; Al-Rafaee, 2001 [118]; Al-Otaibi, 2013 [75]; Ali, 2010 (Q) [18]; Ali, 2008 (Q) [119]; Alsubaie, 2015 [94]; Awadalla, 2014 [72] 3; Berger, 2009 (Q) [120]; Daradkeh, 2015 [95]; Hashim, 2013 [121]; Gawwad, 2008 [73]; Mabry, 2013 (Q) [17]; Musaiger, 2014 [122]; Serour, 2007 [123]; Youssef [74] |
Self-motivation | − | |
Perceived health | − | |
Limited knowledge/awareness | − | |
Consumption of fruits | + | |
Consumption of foods high in fats/salt/sugar | + | |
Knowledge PA is important | + | |
Perceived skills/fitness | − | |
Enhance appearance/muscles | + | |
Consumption of milk | + | |
Consumption of vegetables | + | |
Belief in Overweight as normal | − | Ali, 2008 (Q) [119] |
Attitude to changing diet | − | Ali, 2008 (Q) [119] |
Self efficacy | + | Al-Eisa, 2012 [63] |
Locus of control | − | Al-Otaibi, 2013 [75] |
Stage of change | + | Al-Otaibi, 2013 [75] |
Fear of criticism | − | AboZaid, 2010 [165] |
Maintain health | + | Daradkeh, 2015 [95] |
Shift duty | − | Almajwal, 2015 [91] |
Social and cultural | ||
Norms limiting women’s mobility | − | |
Norms prioritizing women’s care-taking role/limiting self-care role | − | |
Social support | − | |
Low value of PA | − | |
Norms promoting overeating | − | Ali, 2008 (Q) [119] |
Lack of role models | Berger, 2009 (Q) [120] | |
Physical Environment | ||
Availability of physical activity facilities | − | |
Weather | − | |
Safety | − | Ali, 2008 (Q) [119] |
Transportation | + | Al-Kahtani, 2015 [66]; |
Population Policy Level | ||
Ineffective health communication | − | |
Limited resources (general) allocated for physical activity promotion | − | Mabry, 2013 (Q) [17] |
Ineffective PA-supportive policies in colleges | − | Berger, 2009 (Q) [120] |
Individual-based Policy Level | ||
Lack of Time | − | |
Health personnel limited knowledge/awareness of benefits of PA | − | Al-Doghether, 2007 [127] |
Limited material resources in health centres (teaching materials, guidelines) | − | |
Lack of specialty clinics at primary health care level | − | Al-Ghawi, 2009 [128] |
Limited availability of human resources (i.e., dietitians) | − | Ali, 2008 (Q) [119] |
Phase 5 (Developing and testing interventions)
Lead Author Country | Target Group (Size) | Description of Intervention | Results |
---|---|---|---|
Abduelkarem A [99], UAE | Adults with type two diabetes visiting community pharmacies, aged 28–75 years (59) | 3-month intervention where community pharmacies dispense self-care reminders (including physical activity advise); assessment carried out at 3-month, 6-month and 24 month by interview survey (59 % response rate) | Significant increases in physical activity during intervention period; but not at 6 and 24-months |
Al-Eisa E [96], Saudi Arabia | Women university students aged 18–25 years (58) | 4-week intervention involving Instagram educational and motivational messages to exercise using a 37 min of cardio work out video (81 % response rate) | Significant difference between case and controls to adherence to programme; 17 % cases compared to 4 % controls exercised 8+ times during intervention period |
Barss P [97], UAE | 1st year medical students (41) | Lifestyle curriculum involving 5 lectures; one family lifestyle history assessment; 1 week log on dietary intake and physical activity and an oral presentation | Significant number of students reported increase in physical activity and stair usage following completion of lifestyle course including 46 % starting exercising regularly and 63 % started using stairs more frequently |
Grant N [101], Bahrain | Families (30) | 8-month family studies programme for 3rd year medical students conducted 10–12 family visits over a period of 8 months. | Two-thirds of families reported in qualitative interviews positive behaviour changes including increase in levels of physical activity |
Midhet FM [98], Saudi Arabia | Community (population size not reported) | 1 year intervention in all PHC centres involving training physicians on lifestyle counselling and regular health center-based lectures conducted by health educators and medical students | A pre-post test community-based survey found significant increase in levels of brisk walking in men after adjustment for key demographic variables |
Sharaf F [100], Saudi Arabia | Adults with hypertension, diabetes and coronary artery disease visiting PHC clinics (population size not reported) | 6-month intervention involving training of PHC physicians and health educators aimed to increase knowledge and skills on patient education with a focus on diet, smoking and physical activity | No significant change in physical activity |