We sought to describe leisure-time, aerobic, and muscle strengthening physical activity (PA) patterns in U.S. Asian Indians, in comparison to other races/ethnicities.
Design, Setting, and Sample
We utilized the 2011–2018 National Health Interview Surveys, a set of cross-sectional, nationally representative surveys of the U.S. noninstitutionalized population. Our study population included 257 652 adults who answered PA questions.
Measures
PA was classified per 2008 U.S. guidelines and continuously per estimated metabolic equivalents (METs). Race was classified into White, Black, Asian Indian, Other Asian, and American Indian/Alaskan Native/Multiracial.
Analysis
We used survey design-adjusted, multivariable logistic regression to determine odds of sufficient and highly active physical activity levels, adjusting for predisposing, enabling, need, and health care service factors as guided by the Anderson Model. We also used linear regression to determine racial differences in average MET-minutes/week. Analysis was additionally stratified by comorbidity status.
Results
While Asian Indians (N = 3049) demonstrated similar odds of sufficient aerobic PA as Whites (aOR [95% CI]: .97 [.88,1.07]), Asian Indians had 22% lower odds of meeting highly active aerobic PA levels (.78 [.71,0.87]) and 18% lower odds of meeting sufficient muscle strengthening PA levels (.82 [.73,0.91]). This translated to an average 172 (95% CI: 45 300) fewer MET-minutes. Furthermore, this decrease in MET-minutes/week was especially apparent in those without hypertension (β[95% CI]: −164 [-314,-15]) without diabetes (−185 [-319,-52]), and low/normal BMI (−422 [-623,-222]).
Conclusion
Asian Indians, especially those without comorbidities, are less likely to engage in high-intensity physical activity than Whites.
VolgmanASPalaniappanLSAggarwalNTGuptaMKhandelwalAKrishnanAV, et al.Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation. 2018 Jul 3;138(1):e1-34.
3.
AnandSSYusufSVuksanVDevanesenSTeoKKMontaguePA, et al.Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet. 2000;356:279-284.
4.
JainAPuriRNairDR. South Asians: why are they at a higher risk for cardiovascular disease?Curr Opin Cardiol. 2017;32(4):430-436.
5.
NeukamKBhaganiSRodgerAObenJ, NirmalD, JainA, et al.High prevalence of non-alcoholic fatty liver disease (NAFLD) among Gujarati Indians in North London: a population-based study. Clin Lipidol. 2017;12(1):33-39.
6.
Commodore-MensahYSelvinEAboagyeJTurkson-OcranRALiXHimmelfarbCD, et al.Hypertension, overweight/obesity, and diabetes among immigrants in the United States: an analysis of the 2010-2016 National Health Interview Survey. BMC Publ Health. 2018;18(1):773.
7.
MisraAJayawardenaRAnoopS. Obesity in south Asia: Phenotype, morbidities, and mitigation. Curr Obes Rep. 2019;8(1):43-52.
8.
LearSAHumphriesKHKohliSChockalingamAFrohlichJJBirminghamCL. Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT). Am J Clin Nutr. 2007;86:353-359.
9.
HussainSMOldenburgBWangYZoungasSTonkinAM. Assessment of cardiovascular disease risk in South Asian populations. Int J Vasc Med. 2013;2013:786801.
10.
ShahAKanayaAM. Diabetes and associated complications in the South Asian population. Curr Cardiol Rep. 2014 May 1;16(5):476.
11.
McKeiguePMShahBMarmotMG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991 Feb 16;337(8738):382-386.
12.
BilenOKamalAViraniSS. Lipoprotein abnormalities in South Asians and its association with cardiovascular disease: Current state and future directions. World J Cardiol. 2016 Mar 26;8(3):247-257.
13.
KanayaAMHerringtonDVittinghoffEEwingSKLiuKBlahaMJ, et al.Understanding the high prevalence of diabetes in U.S. south Asians compared with four racial/ethnic groups: the MASALA and MESA studies. Diabetes Care. 2014;37(6):1621-1628.
14.
RodriguezLAJinYTalegawkarSAOttoMCOKandulaNRHerringtonDM, et al.Differences in Diet Quality among Multiple US Racial/Ethnic Groups from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study and the Multi-Ethnic Study of Atherosclerosis (MESA). J Nutr. 2020 Jun 1;150(6):1509-1515.
15.
JepsonRHarrisFMBowesARobertsonRAvanGSheikhA. Physical activity in South Asians: an in-depth qualitative study to explore motivations and facilitators. PLoS One. 2012 Oct 10;7(10):e45333.
16.
KandulaNRCooperAJSchneiderJAFujimotoKKanayaAMVan HornL, et al.Personal social networks and organizational affiliation of South Asians in the United States. BMC Public Health. 2018 Dec 1;18(1):218.
17.
WilliamsEDKoonerISteptoeAKoonerJS. Psychosocial factors related to cardiovascular disease risk in UK South Asian men: a preliminary study. Br J Health Psychol. 2007 Nov;12(4):559-570.
18.
LesserIAGasevicDLearSA. The association between acculturation and dietary patterns of South Asian immigrants. PLoS One. 2014 Feb 18;9(2):e88495.
19.
KanayaAEwingSVittinghoffEHerringtonDTegelerCMillsC, et al.Acculturation and Subclinical Atherosclerosis among U.S. South Asians: Findings from the MASALA study. J Clin Exp Res Cardiol. 2014 Jun 23;1(1).
20.
IslamNKwonSCSenieRKathuriaN. Breast and cervical cancer screening among South Asian women in New York City. J Immigr Minority Health. 2006 Jul 1;8(3):211-221.
21.
ShoemakerMLWhiteMC. Breast and cervical cancer screening among Asian subgroups in the USA: estimates from the National Health Interview Survey, 2008, 2010, and 2013. Cancer Causes Control. 2016 Jun 1;201027(6):825-829.
22.
ChawlaNBreenNLiuBLeeRKagawa-SingerM. Asian American women in California: a pooled analysis of predictors for breast and cervical cancer screening. Am J Publ Health. 2015 Feb;105(2):e98-109.
23.
KhokharOKhatriNLewisJ. Colon Cancer Screening Rates and Knowledge Among South Asians in the U.S.: When Culture Clashes with Recommendations. Am J Gastroenterol. 2009;104:S572.
24.
LaneDALipGY. Ethnic differences in hypertension and blood pressure control in the UK. QJM. 2001 Jul 1;94(7):391-396.
25.
WoodSGreenfieldSMSayeed HaqueMMartinUGillPSMantJ, et al.Influence of ethnicity on acceptability of method of blood pressure monitoring: a cross-sectional study in primary care. Br J Gen Pract. 2016;66(649):e577-86.
26.
WilliamsEDStamatakisEChandolaTHamerM. Assessment of physical activity levels in South Asians in the UK: findings from the Health Survey for England. J Epidemiol Community Health. 2011 Jun 1;65(6):517-521.
27.
BhatnagarPShawAFosterC. Generational differences in the physical activity of UK South Asians: a systematic review. Int J Behav Nutr Phys Activ. 2015 Dec 1;12(1):96.
28.
PiercyKLTroianoRPBallardRMCarlsonSAFultonJEGaluskaDA, et al.The physical activity guidelines for Americans. JAMA. 2018 Nov 20;320(19):2020-2028.
29.
KatzmarzykPTLeeIMMartinCKBlairSN. Epidemiology of physical activity and exercise training in the United States. Prog Cardiovasc Dis. 2017;60(1):3-10.
30.
NystoriakMABhatnagarA. Cardiovascular effects and benefits of exercise. Front Cardiovasc Med. 2018;5:135.
31.
KandulaNRDaveSDe ChavezPJBharuchaHPatelYSeguilP, et al.Translating a heart disease lifestyle intervention into the community: the South Asian Heart Lifestyle Intervention (SAHELI) study; a randomized control trial. BMC Publ Health. 2015;15(1):1064.
32.
BhopalRSDouglasAWalliaSForbesJFLeanMEGillJM, et al.Effect of a lifestyle intervention on weight change in south Asian individuals in the UK at high risk of type 2 diabetes: a family-cluster randomised controlled trial. Lancet Diabetes Endocrinol. 2014;2(3):218-227.
33.
BureauUS. American Community Survey 1-year EstimatesBronxNew York: US. Census Bureau; 20172017.
34.
National Center for Health Statistics. National Health Interview Survey Description. 2015 National Health Interview Survey. Atlanta, Georgia: Center for Disease Control and Prevention; 2016.
35.
ParsonsVL. Design and Estimation for the National Health Interview Survey, 2006-2015. Atlanta, Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2014.
PiercyKLTroianoRP. Physical Activity Guidelines for Americans From the US Department of Health and Human Services. Circ Cardiovasc Qual Outcomes. 2018 Nov;11(11):e005263.
38.
CraigCLMarshallALSjöströmMBaumanAEBoothMLAinsworthBE, et al.International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug 1;35(8):1381-1395.
39.
AndersenRNewmanJF. Societal and Individual Determinants of Medical Care Utilization in the United States. The Milbank Memorial Fund Quarterly, 51. Health and Society; 1973 Jan 1:95-124.
40.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157-163. doi:10.1016/S0140-6736(03)15268-3.
41.
WilliamsEDStamatakisEChandolaTHamerM. Physical activity behaviour and coronary heart disease mortality among South Asian people in the UK: an observational longitudinal study. Heart. 2011 Apr 15;97(8):655-659.
42.
DaveSSCraftLLMehtaPNavalSKumarSKandulaNR. Life stage influences on U.S. South Asian women's physical activity. Am J Health Promot. 2015;29(3):e100-8.
43.
SohnEKPorchTHillSThorpeRJJr. Geography, race/ethnicity, and physical activity among men in the United States. Am J Men's Health. 2017;11(4):1019-1027.
44.
IliodromitiSGhouriNCelis-MoralesCASattarNLumsdenMAGillJM. Should physical activity recommendations for South Asian adults be ethnicity-specific? Evidence from a cross-sectional study of South Asian and white European men and women. PLoS One. 2016;11(8):e0160024.
45.
BabakusWSThompsonJL. Physical activity among South Asian women: a systematic, mixed-methods review. Int J Behav Nutr Phys Activ. 2012;9(1):150.
46.
MisraAChowbeyPMakkarBMVikramNKWasirJSChadhaD, et al.Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Phys India. 2009;57:163-170.
47.
MisraANigamPHillsAPChadhaDSSharmaVDeepakKK, et al.Consensus physical activity guidelines for Asian Indians. Diabetes Technol Therapeut. 2012;14(1):83-98.
48.
RanasingheCDevageSConstantineGRKatulandaPHillsAPKingNA. Glycemic and cardiometabolic effects of exercise in South Asian Sri Lankans with type 2 diabetes mellitus: A randomized controlled trial Sri Lanka diabetes aerobic and resistance training study (SL-DARTS). Diabetes Metab Syndr. 2021 Jan-Feb;15(1):77-85.
49.
MisraAAlappanNKVikramNKGoelKGuptaNMittalK, et al.Effect of supervised progressive resistance-exercise training protocol on insulin sensitivity, glycemia, lipids, and body composition in Asian Indians with type 2 diabetes. Diabetes Care. 2008;31(7):1282-1287.
50.
ThanawalaMSSiddiqueJSchneiderJAKanayaAMCooperAJDaveSS, et al.Association of social networks and physical activity in South Asians: The Mediators of Atherosclerosis in South Asians Living in America cohort study. J Phys Activ Health. 2020;17(2):149-155.
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