Register      Login
Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Physical activity behaviour and barriers to activity in adults at high risk of obstructive sleep apnoea

Sarah Rhodes 1 4 5 , Debra Waters 2 , Ben Brockway 3 , Margot Skinner 1 4
+ Author Affiliations
- Author Affiliations

1 School of Physiotherapy, University of Otago, 325 Great King Street, Dunedin, New Zealand

2 Department of Medicine and School of Physiotherapy, University of Otago, Dunedin, New Zealand

3 Dept of Medicine, University of Otago, Dunedin, New Zealand

4 Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand

5 Corresponding author. Email: sarah.rhodes@otago.ac.nz

Journal of Primary Health Care 12(3) 257-264 https://doi.org/10.1071/HC19102
Published: 29 September 2020

Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

Abstract

INTRODUCTION: Physical inactivity is a risk factor for disease severity among people with obstructive sleep apnoea.

AIM: To determine physical activity levels in patients at risk of obstructive sleep apnoea and explore their perceptions about barriers to participation in physical activity.

METHODS: This was a cross-sectional observational study. Eligible participants were adults with symptoms of obstructive sleep apnoea hypopnea syndrome and Epworth Sleepiness Scale score ≥11, awaiting prioritisation for a diagnostic overnight sleep study at the local sleep clinic. Sixty participants (mean age ± standard deviation: 51 ± 12 years) each attended an individual appointment. Anthropometric measurements were taken and standardised questionnaires regarding quality of life, physical activity behaviour and perceptions of physical activity were completed.

RESULTS: Over one-third of the cohort did not meet World Health Organization guidelines for weekly physical activity. Hypertension, type 2 diabetes and obesity were also more prevalent in this subgroup. Low motivation and pain were commonly reported barriers to activity in participants not meeting the physical activity guidelines. Overall, 53 (88%) participants stated they would like to be more active.

DISCUSSION: Physical inactivity represents an additional risk factor for adults at high risk of obstructive sleep apnoea. Lack of motivation and pain were the most commonly perceived barriers to participation in activity. Physical activity interventions tailored to the individual, and including a motivational component, need to be included as integral components of management to reduce cardiovascular and metabolic risk factors more effectively in this group.

KEYwords: Non-communicable diseases; sleep health; motivation; telehealth


References

[1]  World Health Organization. Non-communicable diseases and their risk factors. Geneva, Switzerland: The World Health Organization; 2018. [cited 2019 January 23]. Available from: https://www.who.int/ncds/en/

[2]  Qaseem A, Dallas P, Owens DK, et al. Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014; 161 210–20.
Diagnosis of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians.Crossref | GoogleScholarGoogle Scholar | 25089864PubMed |

[3]  World Health Organization. 10 facts on obesity. Geneva, Switzerland: The World Health Organization; 2019. [cited 2019 February 14]. Available from: https://www.who.int/features/factfiles/obesity/en/

[4]  Araghi MH, Chen YF, Jagielski A, et al. Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis. Sleep. 2013; 36 1553–62.
Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 24082315PubMed |

[5]  World Health Organization. Physical activity: key facts. Geneva, Switzerland: The World Health Organization; 2018. [cited 2019 January 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity

[6]  Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993; 328 1230–5.
The occurrence of sleep-disordered breathing among middle-aged adults.Crossref | GoogleScholarGoogle Scholar | 8464434PubMed |

[7]  Mendelson M, Tamisier R, Laplaud D, et al. Low physical activity is a determinant for elevated blood pressure in high cardiovascular risk obstructive sleep apnea. Respir Care. 2014; 59 1218–27.
Low physical activity is a determinant for elevated blood pressure in high cardiovascular risk obstructive sleep apnea.Crossref | GoogleScholarGoogle Scholar | 24282316PubMed |

[8]  Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2018; 71 e13–115.
| 29133356PubMed |

[9]  Mônico-Neto M, Moreira Antunes HK, dos Santos RVT, et al. Physical activity as a moderator for obstructive sleep apnoea and cardiometabolic risk in the EPISONO study. Eur Respir J. 2018; 52 1701972
Physical activity as a moderator for obstructive sleep apnoea and cardiometabolic risk in the EPISONO study.Crossref | GoogleScholarGoogle Scholar | 30093572PubMed |

[10]  Wen CP, Wai JPM, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011; 378 1244–53.
Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study.Crossref | GoogleScholarGoogle Scholar | 21846575PubMed |

[11]  Ministry of Health. Your health: physical activity. Wellington: Ministry of Health; 2016. [cited 2019 February 25]. Available from: https://www.health.govt.nz/our-work/preventative-health-wellness/physical-activity#adults

[12]  Hudgel DW, Patel SR, Ahasic AM, et al. The role of weight management in the treatment of adult obstructive sleep apnea. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2018; 198 e70–87.
The role of weight management in the treatment of adult obstructive sleep apnea. An official American Thoracic Society clinical practice guideline.Crossref | GoogleScholarGoogle Scholar | 30215551PubMed |

[13]  Mendelson M, Bailly S, Marillier M, et al. Obstructive sleep apnea syndrome, objectively measured physical activity and exercise training interventions: a systematic review and meta-analysis. Front Neurol. 2018; 9 –73.
Obstructive sleep apnea syndrome, objectively measured physical activity and exercise training interventions: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 29520251PubMed |

[14]  Igelström H, Martin C, Emtner M, et al. Physical activity in sleep apnea and obesity—personal incentives, challenges, and facilitators for success. Behav Sleep Med. 2012; 10 122–37.
Physical activity in sleep apnea and obesity—personal incentives, challenges, and facilitators for success.Crossref | GoogleScholarGoogle Scholar | 22468930PubMed |

[15]  Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991; 14 540–5.
A new method for measuring daytime sleepiness: the Epworth sleepiness scale.Crossref | GoogleScholarGoogle Scholar | 1798888PubMed |

[16]  Bull FC, Maslin TS, Armstrong T. Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Act Health. 2009; 6 790–804.
Global physical activity questionnaire (GPAQ): nine country reliability and validity study.Crossref | GoogleScholarGoogle Scholar | 20101923PubMed |

[17]  Ministry of Health. Annual update of key results 2014/2015: New Zealand Health Survey. Wellington: Ministry of Health; 2015.

[18]  Mendelson M, Vivodtzev I, Tamisier R, et al. CPAP treatment supported by telemedicine does not improve blood pressure in high cardiovascular risk OSA patients: a randomized, controlled trial. Sleep. 2014; 37 1863–70.
CPAP treatment supported by telemedicine does not improve blood pressure in high cardiovascular risk OSA patients: a randomized, controlled trial.Crossref | GoogleScholarGoogle Scholar | 25364081PubMed |

[19]  Stubbs RJ, Lavin JH. The challenges of implementing behaviour changes that lead to sustained weight management. Nutr Bull. 2013; 38 5–22.
The challenges of implementing behaviour changes that lead to sustained weight management.Crossref | GoogleScholarGoogle Scholar |

[20]  Martin A, Panter J, Suhrcke M, Ogilvie D. Impact of changes in mode of travel to work on changes in body mass index: evidence from the British Household Panel Survey. J Epidemiol Community Health. 2015; 69 753–61.
Impact of changes in mode of travel to work on changes in body mass index: evidence from the British Household Panel Survey.Crossref | GoogleScholarGoogle Scholar | 25954024PubMed |

[21]  Pearson AL, Bentham G, Day P, Kingham S. Associations between neighbourhood environmental characteristics and obesity and related behaviours among adult New Zealanders. BMC Public Health. 2014; 14 553
Associations between neighbourhood environmental characteristics and obesity and related behaviours among adult New Zealanders.Crossref | GoogleScholarGoogle Scholar | 24894572PubMed |

[22]  Lee C, Ory MG, Yoon J, Forjuoh SN. Neighborhood walking among overweight and obese adults: age variations in barriers and motivators. J Community Health. 2013; 38 12–22.
Neighborhood walking among overweight and obese adults: age variations in barriers and motivators.Crossref | GoogleScholarGoogle Scholar | 22811072PubMed |

[23]  Moschny A, Platen P, Klaassen-Mielke R, et al. Barriers to physical activity in older adults in Germany: a cross-sectional study. Int J Behav Nutr Phys Act. 2011; 8 121
Barriers to physical activity in older adults in Germany: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar | 22047024PubMed |

[24]  Peters M, Potter CM, Kelly L, Fitzpatrick R. Self-efficacy and health-related quality of life: a cross-sectional study of primary care patients with multi-morbidity. Health Qual Life Outcomes. 2019; 17 37
Self-efficacy and health-related quality of life: a cross-sectional study of primary care patients with multi-morbidity.Crossref | GoogleScholarGoogle Scholar | 30764833PubMed |

[25]  Bauman AE, Reis RS, Sallis JF, et al. Correlates of physical activity: why are some people physically active and others not? Lancet. 2012; 380 258–71.
Correlates of physical activity: why are some people physically active and others not?Crossref | GoogleScholarGoogle Scholar | 22818938PubMed |

[26]  Smits JAJ, Tart CD, Presnell K, et al. Identifying potential barriers to physical activity adherence: anxiety sensitivity and body mass as predictors of fear during exercise. Cogn Behav Ther. 2010; 39 28–36.
Identifying potential barriers to physical activity adherence: anxiety sensitivity and body mass as predictors of fear during exercise.Crossref | GoogleScholarGoogle Scholar |

[27]  Kulkarni K, Karssiens T, Kumar V, Pandit H. Obesity and osteoarthritis. Maturitas. 2016; 89 22–8.
Obesity and osteoarthritis.Crossref | GoogleScholarGoogle Scholar | 27180156PubMed |

[28]  Bäck M, Öberg B, Krevers B. Important aspects in relation to patients’ attendance at exercise-based cardiac rehabilitation – facilitators, barriers and physiotherapist’s role: a qualitative study. BMC Cardiovasc Disord. 2017; 17 77
Important aspects in relation to patients’ attendance at exercise-based cardiac rehabilitation – facilitators, barriers and physiotherapist’s role: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 28288580PubMed |

[29]  Kirwan JP, Sacks J, Nieuwoudt S. The essential role of exercise in the management of type 2 diabetes. Cleve Clin J Med. 2017; 84 S15–S21.
The essential role of exercise in the management of type 2 diabetes.Crossref | GoogleScholarGoogle Scholar | 28708479PubMed |

[30]  Kelly S, Martin S, Kuhn I, et al. Barriers and facilitators to the uptake and maintenance of healthy behaviours by people at mid-life: a rapid systematic review. PLoS One. 2016; 11
Barriers and facilitators to the uptake and maintenance of healthy behaviours by people at mid-life: a rapid systematic review.Crossref | GoogleScholarGoogle Scholar | 27997604PubMed |