Research AppraisalSystematic Review

Burden and predisposing factors of physical inactivity among adults in Africa: Systematic review and Meta-analysis

PloS oneBelete, Aychew Kassa, Yirsaw, Bantie Getnet, Taye, Birhan AmbachewDOI

Clinical Snapshot

70CEBM
Evidence: WeakSystematic Review

PICO Framework

P — PopulationAdults in Africa (41,521 participants across 34 studies)
I — InterventionNot applicable (observational meta-analysis)
C — ComparatorVarious demographic and clinical characteristics
O — OutcomesPrevalence of physical inactivity and associated predisposing factors

Bottom Line

This meta-analysis of 34 studies involving over 41,000 African adults found a pooled physical inactivity prevalence of 45%. Key risk factors included female gender (OR=1.87), age ≥60 years (OR=2.18), obesity (OR=3.52), and urban residence (OR=1.91). However, the extremely high heterogeneity (I²=98.4%) significantly limits confidence in these pooled estimates. The wide variation in prevalence (28-57%) across studies suggests substantial methodological differences that weren't adequately addressed. While the identified risk factors align with global patterns, the lack of GRADE assessment and the African-specific context limit direct applicability to Australian practice. The findings may inform targeted interventions for high-risk populations but should be interpreted cautiously given the statistical heterogeneity. Australian clinicians should consider these patterns when developing culturally appropriate physical activity interventions, particularly for elderly patients, women, and those with obesity, while recognizing the need for local validation studies.

Evidence: Weak

Key Findings

  • P Value: Not specified in abstract

  • Effect Size: Various odds ratios for predisposing factors

  • Primary Outcome: Pooled prevalence of physical inactivity: 45% (95% CI: 35%-55%)

  • Nnt Or Sensitivity: Strongest predictor: Obesity (OR=3.52; 95% CI: 2.26-5.49)

  • Confidence Interval: 95% CI: 35%-55% for primary outcome

Clinical Application

Findings may inform targeted interventions for high-risk groups (elderly, women, obese individuals) Results may guide RACGP preventive care guidelines and inform PBS-funded lifestyle intervention programs, though cultural adaptation required Limited direct applicability to Australian adults due to different socioeconomic and cultural contexts

Abstract

INTRODUCTION: Physical inactivity is a primary driver of global mortality, data on its specific impact in Africa remains fragmented. We conducted this study to provide the first comprehensive pooled prevalence and identify predisposing factors contributing to physical inactivity among African adults. METHOD: We searched PubMed, Scopus, Embase, and Google Scholar for studies published between March 1, 2010, and March 31, 2025. A quality assessment of the studies was performed through the Newcastle-Ottawa Scale (NOS). The random-effect (DerSimonian) model was used to calculate the aggregated rates of physical inactivity among adults and their predisposing factors. Heterogeneity was assessed using the I2 statistic, along with subgroup and sensitivity analyses. Publication bias was evaluated using Egger's test, and all analyses were performed in STATA, version 17. RESULTS: This systematic review and meta-analysis included 34 studies with a total of 41,521 participants. The pooled prevalence of physical inactivity was 45% (95% CI: 35%-55%), and there was considerable heterogeneity (I2 = 98.4%). The highest prevalence of 57% (95% CI: 0.33, 0.81) I2 = 97.7 seen in 2013 and the lowest prevalence 28% (95% CI: 0.03, 0.53) I2 = 94.3%) observed in 2011. This study identified that, being female (OR = 1.87; 95% CI: 1.55, 2.25), Adults aged ≥ 60, (OR=2.18; 95% CI:1.98,4.77), being obese (OR=3.52; 95% CI: 2.26,5.49), urban dweller (OR=1.91, 95% CI:1.24,2.95), being overweight (OR=2.03; 95% CI: 1.61,2.68), depression symptom (OR= 1.34;95% CI: 1.07,1.68) and more drinking of alcohol (OR=1.73; 95% CI: 1.18,2.64), were significant predisposing factors associated with prevalence of physical inactivity. CONCLUSION: A high level of physical inactivity was observed amongst the African adults. Our findings indicate that female gender, older age, being overweight and obese, high levels of alcohol consumption and depression are significant predictors of physical inactivity in the African population. Promoting awareness about the positive impacts of regular exercise on health among women and an elderly age group could effectively lower the chances of hypokinetic diseases.

References

  1. 1.Belete, A., Yirsaw, B. G., & Taye, B. A. (2026). Burden and predisposing factors of physical inactivity among adults in Africa: Systematic review and Meta-analysis. PLoS One. https://doi.org/10.1371/journal.pone.0348786
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