Country-level inequalities in domain-specific physical inactivity: An analysis of 50 middle-income countries

Background: Currently, the model ‘Necessity Versus Choice’ seems explain to physical
inactivity (PI) patterns in middle-income countries, where people in social disadvantage use
physical activity as only possibility of transportation or work.
Purpose: Describe physical inactivity (PI) according to domains, as well as its correlation
with two country-level socioeconomic indicators: per capita Gross domestic product (GDP)
and Fragility State Index (FSI).
Methods: Ecological analysis using data from cross-sectional surveys in 50 middle-income
countries. PI data was obtained from the World Health Organization (WHO) STEPwise
Approach to Non-communicable Disease Risk-Factor Surveillance. Our outcomes were total
and domain-specific PI. For total PI, Individuals not reaching 150 minutes/week were
considered as inactive. For domain-specific PI, individuals with zero minutes of physical
activity were considered as inactive. We correlated each PI outcome with GDP and FSI –
multidimensional measure including four domains (economic, political, social and cohesion).
Results: Total PI median prevalence was 17.2%, ranging from 1.3% in Malawi to 62.6% in
Kwait. Median prevalence according to domains were as follows: leisure-time 76.7% (33.4%
in Mongolia to 97.0% in Eritrea); transportation 27% (8.8% in Comoros to 81.3% in Kwait);
work 39.5% (3.1% in Malawi to 88.1% in Lebanon). We found a week correlation between PI
outcomes and GDP (<0.2). On the other hand, FSI was positively correlated with leisure-
time PI (0.54) and showed an inverse correlation with transportation (-0.25) and work (-0.36)
PI.
Conclusions: PI is correlated to FSI in different directions depending on domain analysed.
Practical implications: Understanding the socioeconomic dynamics of PI across its
domains in different contexts could help understanding the meaning of this behaviour at
populational level, helping to guide future policy and promotion strategies.
Funding: This project is funded by FAPERGS (Foundation for the Support of Research in
the State of Rio Grande do Sul) (grant: 21/2551-0000670-6).