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Older immigrant adults’ experiences and perceptions of physical activity

      Purpose: Clinical guidelines support exercise in managing osteoarthritis. Up to 90% of people with OA do not meet the minimal levels of activity despite strong evidence that being active is effective for managing OA symptoms. Subsets of the population such as immigrants are known to be at higher risks for inactivity and sedentary behavior. With 7.5 million immigrants, Canada currently has the second highest percentage (21.9%) of foreign-born nationals in the world. Physical activity in immigrants is influenced by migration-related factors such as acculturation, stressors with settling in a new country, physical environments, and availability of resources. Interpersonal barriers including competing time demands, cultural norms and behaviours, motivation and lack of peer support have also been identified as important determinants of physical activity. Adult physical inactivity rates are high in Muslim majority countries, especially for Arab Muslims and Muslim women, irrespective of ethnicity. Physical activity varies across genders with women, and in particular visible minority women, reporting less physical activity than their male counterparts. Barriers to Muslim women participating in leisure physical activity, for example, include gendered norms of behavior, religious interpretations of women’s participation in sports, lack of access to gender-segregated spaces, lack of social support, lack of education on physical activity and competing social obligations. Many Muslim majority countries are experiencing rapid development with changes in population dietary patterns, urbanization, increased obesity and lower physical activity rates; all of which influences the health norms and behaviors of immigrants settling in Canada.
      Methods: Using a community-based participatory approach with Muslim communities, we explored the experiences of and barriers to physical activity from the perspective of South Asian, Arab, and African Muslim immigrant communities in an urban setting: Edmonton, Alberta, Canada. Purposeful sampling and theoretical sampling were used to recruit participants. Data saturation occurred when no new themes emerged from the data and identified themes included rich descriptive repetitive data from participants. Older participants chose to participate in either individual interview or focus groups based on personal preferences while all stakeholders were interviewed individually. To further explore the preliminary themes on physical activity identified in the data, two additional focus group discussions with a sample of nine older adults were completed to explore facilitators and barriers to physical activity. All interviews were completed by the first author who was experienced in immigrant health research and identified as being from the Muslim community. Community interpreters (bilingual social workers or community volunteers) were used for interviews and focus groups when older adults were not comfortable conversing in the English language. A thematic analysis was undertaken with an iterative process of multiple re-readings of the data with validation of identified preliminary codes and themes through further data collection via interviews and focus group discussions. In following an intersectional approach, we also searched for variations in experiences across gender, migration status, socioeconomic status, ethnicity, and age categories.
      Results: Of the 68 participants who took part in the study, 52 were older adults and 16 were stakeholders including service providers, community volunteers, caregivers, and faith and community leaders. Participants varied in terms of language fluency, levels of education, length of time in Canada and immigration status with almost equal numbers of long-term economic immigrants who had come to Canada as young adults and newcomer immigrants who came to Canada post-retirement. Participating community groups emphasized the importance of physical activity in older age and prioritized the need for physical activity programs. The four themes highlight Muslim older immigrants’ perspectives on physical activity in Canada: (a) values and approaches to staying active, (b) health factors: pain and health limitations, (c) social factors: culture, religion and belonging; and (d) environmental factors: safety and accessibility. Lack of effective strategies for pain management was a major concern for many participants and hindered their ability to engage in both daily living activities and more strenuous forms of exercise and recreation activities.
      Conclusions: Physical activity in older age is valued by older Muslim immigrants but financial, cultural, and environmental barriers to physical activity warrant intervention. One avenue of promoting physical activity in Muslim older immigrants is the development of local, accessible, and culturally sensitive programming that address both the physical activity, education, and socialization needs of this population.