School of Therapeutic Sciences (ETDs)
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Item Exercise in Ghanaian, postmenopausal women with an increased body mass index (bmi), above 25 KG/M²(University of the Witwatersrand, Johannesburg, 2023-08) Bonsu, Isaac Mensah; Myezwa, Hellen; Corlia, Brandt; Ajidahun, Adedayo TundePostmenopausal women frequently experience weight gain in addition to an increased tendency for central fat distribution. The development of metabolic syndrome and systemic inflammation caused by excess body weight (overweight and obesity), particularly in the form of visceral fat deposition in postmenopausal women, increases the risk of cardiovascular disease, diabetes, and mortality. The reported high prevalence of excess weight among Ghanaian postmenopausal women generated an inquiry into the experiences of postmenopausal women with excess weight gain. This study aimed to develop and test the effect of a culturally adapted exercise-based programme for weight loss in Ghanaian postmenopausal women. The study used a mixed-method approach with five studies to address the study's aim. A quantitative study was conducted to determine the prevalence of excess weight gain and associated socio-demographic risk factors among postmenopausal women. The results showed a high prevalence of excess weight gain of 73.2%, 91.8%, and 91.0% using body mass index (BMI), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR) respectively among 378 women. Education and ethnicity were the predictors of excess weight gain (WHR) among the participants. Despite the extensive body of research on an exercise program for weight loss, these results suggest gaps in weight management. Physical activity, lifestyle, and sociocultural levels of the women were investigated quantitatively to determine contributing factors associated with the high prevalence of excess weight gain. The results showed that the majority (55.2%) of the participants had 1 to 2 days per week of moderate physical activities for 1 to 20 minutes per day during the last 7 days. This finding showed that participants are not meeting the physical activity recommendation of 150-300 minutes of moderate-intensity per week for older adults by World Health Organization (WHO) guidelines on physical activity and sedentary behaviour. Housewives and unemployed participants had a higher risk of weight gain, especially when assessed with WHR and WHtR. Most participants (59.7%) had poor eating habits and cultural beliefs regarding body size impacts their decisions regarding weight loss. A qualitative study was conducted with the study group of postmenopausal women with excess weight, twenty-four participants, and four focus group discussions (FGD), to explore their current weight management approaches or practices. From the analysis of FGD, three major themes emerged from the study namely, (i) perception of body weight, (ii) measures to reduce body weight, and (iii) support for adherence to the weight management program. Sub-theme under the perception of body weight revealed that weight gained was viewed as the presence of diseases and admired by society as a culturally accepted body image. Diet-related changes, a combination of diet modification and physical activity, and weight management supplements emerged as measures to reduce excess weight. Support for adherence to the weight program included health education, access, affordable exercise facilities, and social support. Based on literature reviews and findings from the three studies conducted as part of the project, a culturally appropriate exercise programme for weight loss was developed and validated by the Delphi study. A Delphi consists of three rounds among international (twelve) and local (twenty-one) experts with a high participation rate of 33 (80.5%) of the 41 participants was conducted. A consensus was reached on all the thirty-two (32) items related to health assessment, pre-exercise parameters, exercise dosage and physician referral after the third round. The developed culturally informed exercise-based weight loss programme was tested using a single-blind randomized controlled trial. A total of 226 postmenopausal women were randomized into exercise (113) and control (113). Anthropometrics (BMI, WHR, WHtR WC, HC and body weight) and body composition (body fat, visceral fat, muscle mass) were measured pre and post-12-week intervention. Using a repeated-measures linear mixed model, the evidence from the analysis demonstrates that except for waist-to-hip ratio (WHR), there were statistically significant reduction in body weight, BMI, WHtR, visceral fat, and total body fat in the exercise and control groups. Muscle mass increased significantly (+0.21 kg), whereas hip circumference (-2.46 cm) and waist circumference (-1.39 cm) decreased significantly compared with the control group. Within the exercise group when stratified by BMI, there were higher reductions in BMI (1.01kg/m2 vs. 0.46kg/m2), WC (2.18cm vs. 0.22cm), body weight (2.12kg vs. 1.17kg) and body fat (1.84% vs 1.6%) in obese women compared to overweight women. Weight loss programmes should be traditionally induced within the specific setting to encourage full participation and reduce the dropout rate. Implication for health professionals to prescribe physical activity in postmenopausal women’s treatment plan. In conclusion, the findings resulting from this research may improve health providers' cultural awareness and knowledge. This project is expected to help healthcare professionals improve the care given to postmenopausal women with weight excess to decrease the incidence of morbidity and mortality. It is anticipated that this initiative could direct the development of a modified culturally-sensitive weight loss programme for women in different stage in life and use with other ethnic groups.