Research design and settings

A cross-sectional study was conducted Department of Physiotherapy, Thumbay Physical Therapy and Rehabilitation Center, Thumbay University Hospital, Gulf Medical University, Ajman, United Arab Emirates.

Study population and sampling

Participants enrolled in the study under the convenient sampling method and inclusion criteria: young overweight and obese individuals, male and female, aged between 18 to 30 years. Participants with acute illness and active pregnancy were excluded from the study. A total of 216 participants enrolled in the study who met the inclusion criteria after initial screening of 837 unknown participants. The sample size calculation was done for a 95% Confidence Interval and precision set as.05 based on the overall prevalence of 17% for obesity in the United Arab Emirates conducted by a recent study [15].

Study instruments

A standardized and validated digital sphygmomanometer (OMORON M7 BP monitor) with high specificity (93.8%) and sensitivity (95.5%) [16], Stadiometer with high degree of reliability of Inter-correlation coefficient (ICC = 0.999) [17], and Global Physical Activity Questionnaire (GPAQ) with reliability ranging from good to very good (r = 0.58–0.89) [18] was used for the present study.

Study procedure

An informed written informed consent was obtained from all participants. Ethical approval for the study was obtained from the Institutional Research Board (IRB) IRB-COHS-STD-110-JUNE-2023, College of Health Sciences, Gulf Medical University. The data recruitment started from July 3^rd, 2023, till January 5^th 2024. Each subject provided demographic information, such as age, gender, and occupation. Blood Pressure was measured by using a digital sphygmomanometer (OMORON M7 BP monitor) and Physical Activity was measured by using the Global Physical Activity Questionnaire (GPAQ) [19]. Body weight was measured with the participant wearing light clothing on an electronic scale, height in centimeters with a stadiometer, and BMI denoted as weight/height² (kg/m2). All variables were measured by the same physical therapist for all participants using standard clinical procedures.

Data storage and analysis

The raw data was extracted from the individual data sheet and stored in the form of Google Sheets and later analyzed using the statistical software package SPSS 22. Upon analysis, the data was stored in the drive of the researcher. The data was collected from everyone separately via personal email and password-protected for security. Descriptive analysis was used in terms of Frequencies and percentages for the calculation of demographic data. The test of normality was conducted before inferential stats. The data was not normally distributed and thus the non-parametric tests were used. The continuous variables were measured using the mean and standard deviation. The Spearman’s rank correlation coefficient was used to analyze the relationship between Physical activity and blood pressure and body mass Index with Blood Pressure. There were 10 missing data of more than 20 percent of the input and thus removed from the data analysis.

Correlation between PA and BMI

According to a recent study presented by Dalibalta S et al., young adults in the UAE have high levels of sedentary lifestyle, and PA is primarily light intensity [27]. As a result, both PA and sedentary behaviour should be closely monitored across various cohorts in this nation. When compared to young UAE males, young UAE females appear to be engaging in less moderate-to-vigorous intensity physical activity (MVPA) and daily step counts. This suggests that researchers and healthcare professionals should create targeted interventions that promote higher-intensity activity in young UAE females [27]. The result from the present study suggests that overweight individuals were found physically active in comparison to obese individuals as per the WHO recommendations for MET minutes/week [28]. The overall correlation between PA with BMI was found to be statistically insignificant (Table 4) suggesting a failure to establish a statistical correlation although clinical correlation could be present. An in-depth understanding of how PA affects weight reduction is provided by some recent systematic reviews of the research. To enumerate the impact of PA on changes in body weight, the Advisory Committee for the 2008 Physical Activity Guidelines for Americans examined the existing scientific literature [28]. The review’s findings indicated that engaging in moderate-to-intense physical exercise for at least 150 minutes a week—such as brisk walking—would result in a 1%–3% decrease in body weight [28]. Studies in the past have shown that aerobic exercise interventions raise high-density lipoprotein and decrease triglycerides. For this reason, fitness training helps in weight management for those who are obese with dyslipidemia [29].

However, without decreased energy calory intake, PA can have little effect on body weight loss as the extent of the reduction varies according to the amount of PA the individual is engaged in. It is generally acknowledged that the most effective lifestyle therapies for overweight and obese people involve combining a reduction in caloric intake with an increase in PA. In addition to the weight reduction resulting from energy restriction alone, PA also helps with weight loss [30]. It is therefore imperative that clinicians understand the role that good eating habits and sufficient PA are essential for long-term weight loss in adults who are overweight or obese. When it comes to the participation of overweight and obese people in PA, barrier identification appears to be yet another crucial issue that needs to be considered. Adults who are overweight or obese have barriers to PA which have been previously reported and the most frequently mentioned barriers are a lack of time and enthusiasm. Self-reported barriers to PA appear to be reduced by traditional behavioural weight loss programs that include both diet and PA. Therefore, health professionals should ask young adults who are overweight or obese about the obstacles they experience in their way of engaging in PA, and then use their problem-solving abilities to come up with appropriate and feasible solutions [28].

Correlation of BMI and BP

Previous studies suggest that both obesity and BMI are risk factors for hypertension [31]. Furthermore, a greater BMI percentile is linked to higher blood pressure. In consensus, a cross-sectional population-representative study conducted by Al Junaibi A et al. determined the prevalence and drivers of obesity in childhood and adolescence and their association with BP [32]. In the present study, the correlation coefficient (r-value) for BP in overweight participants and obese participants suggested a weak correlation between BMI and BP as the p-value was more than 0.05, found to be statistically insignificant (Table 5). Thus, it could be conferred that although BMI and BP were clinically correlated, they failed to establish a stronger statistical significance due to possible interactions of factors affecting both BMI and BP. However, the study conducted by Al Junaibi A et al. concluded that the BMI-BP association became stronger with time and higher percentile for obesity among school children and adolescents in Abu Dhabi [32], and could have similar effects on other parts of the Emirates.

Previous studies have observed the opposite trend of increased BMI with decreased BP, in contradiction to the findings. The mean BMI (27.0 kg/m2) in the adult population of Germany did not change, while the prevalence of obesity did slightly rise between 1998 and 2011. However, over time, both the mean SBP and the strength of the BMI-SBP connection declined, from 129.0 to 124.1 mmHg [33]. Similar findings were noted in adults in research conducted between 1989 and 2004. While the prevalence of treated hypertension significantly increased, the mean SBP and DBP in men and women respectively modestly dropped from 133/87 to 131/86 mmHg and 127/82 to 124/81 mmHg. Despite receiving hypertension medication, the mean BMI increased significantly, although the correlation between BMI and blood pressure decreased [34]. In addition, the relationship between BMI and BP may be impacted by variables like levels of PA, dietary sodium, alcohol intake, smoking, and drugs for BP [35–39]. Insufficient vasodilatation in the presence of elevated blood volume and cardiac output, which are natural outcomes of increased mass, could be the root cause of the positive association observed between BMI and BP [30]. In a country like UAE, the above-mentioned risk factor could prevail due to socioeconomic, geographic, and cultural differences attributed to the findings of the study. Further research could be done to explore these factors under a multivariate regression analysis.

Correlation between PA and BMI to BP

In the present study, results indicated that there is a weak correlation between BMI with BP and Physical activity with BP which was found to be statistically insignificant. However, 89 (43.2%) of the participants are under the high normal category of hypertension and they are more prone to develop stage-1 hypertension as per WHO classification. Also, the overall physical activity as per the GPAQ score did not meet the WHO recommendations on physical activity for health [28]. It is commonly known that PA, BMI, and BP are interrelated. According to estimations, for every 5% rise in body weight, there is a 20–30% greater chance of hypertension, and reduced PA is one of the major causes of increased body weight. Clinical research indicates that weight loss lowers blood pressure in the majority of hypertensive people and that maintaining a BMI < 25 kg/m² is beneficial in the primary prevention of hypertension [40]. Furthermore, engaging in vigorous PA that improves cardiorespiratory fitness can help lower health risks in individuals who are overweight or obese, regardless of the impact of exercise on body weight. Additionally, PA leads to decreased resistance to the vessels, reduced stiffness of the arteries, reduced oxidative stress and inflammation, increased angiogenesis and arteriogenesis, increased arterial compliance and diameter that consequently result in control of BP, and reduction in body weight or body mass leading to control of progression in overweight or obesity [12]. Hence, assessing PA among overweight and obese individuals at regular intervals is essential as a preventive measure for the risk of developing BP.

In the present study, a weaker correlation of PA with BMI and BP suggests that there could be other factors contributing to non-communicable diseases such as obesity and hypertension in the United Arab Emirates. Previous studies have reported that PA has a strong correlation with weight management and blood pressure [12] which doesn’t stand true in our study. This demands further research to explore in the context of the UAE.

Limitations

The cross-sectional study design limited to a small geographical area could be a potential limitation of the study as the findings would lack generalization to the entire Emirates. Although the sample size was calculated, the smaller sample population could again lead to difficulties in the generalization of the findings. Moreover, multiple factors could have affected the BMI, and BP could have been better studied through a multiple logistic regression analysis which was lacking in the present study.

Future recommendation

A longitudinal study could be replicated in the context of different populations and age groups using a larger sample size. Multiple factors could be explored with a logistic regression analysis. Considering the higher prevalence of obesity and overweight in the Northern Emirates, tailored interventions would be required for future studies.