"Going for a Walk as the Only Option": Are Medical Diabetes Guidelines Relevant to People with Diabetes in Pakistan When It Comes to Physical Activity?

Background: It is recommended that people living with type 2 diabetes (PLwD) increase their levels of physical activity to help manage their condition. Previous studies have reported on strong family ties in South Asian culture. However, understanding of family involvement in relation to diabetes is South Asian culture is limited.

Objective: To explore the influence of family roles within South Asian culture on physical activity by PLwD.

Methods: 30 PLwD (13 men; aged 30-70 years), 17 family members of PLwD (4 men; 22-61 years) and nine doctors were recruited in metropolitan Lahore, Pakistan who mostly used state health services for relatively disadvantaged populations. Interviews were analyzed using thematic analysis.

Results: Three themes were identified: (1) Going for a walk as (the only) convenient physical activity; (2) The role of family members in influencing physical activity; (3) Cultural acceptance of walking as physical activity. Across all themes gender and age create flexibilities or constraints for the choices of physical activity, available to PLwD. Intersections of gender, age and in addition family roles appear to create most flexibility for younger men, e.g., going for a run instead of just walking, and the constraints for a younger woman who may need to find another woman so as to not walk on her own. For an older woman these constraints are less severe, as it is acceptable to her, her family and the wider culture to be seen walking on her own.

Conclusion: These complex pattern of flexibilities and constraints for urban dwellers who would not be able to afford or be permitted to use a fee charging sports facilities are not recognised by PROMPT, a recently published diabetes guideline for Pakistan. The findings suggest an urgent need to develop guidance which recognise familial expectations and propose lifestyle adjustments, acceptable to urban dwellers in a country like Pakistan.