This is the second article in a series examining the inactivity epidemic by Dr Jayantha Dassanayake, PGdiP (UK) MAppSc (Australia), PhD Australia, PDF (Canada). The first article in the series can be found here: https://middleeasthealth.com/medical-specialty-features/healthy-lifestyle/the-inactivity-epidemic-why-movement-is-the-missing-medicine/
Dr Dassanayake presents compelling evidence for physical inactivity as a primary modifiable risk factor in non-communicable disease development across the Middle East. Drawing upon epidemiological data and clinical research, Dr Dassanayake’s series explores evidence-based interventions to address this public health challenge. This series aims to provide healthcare professionals with practical strategies for implementing exercise prescription within clinical practice.
The Gulf region is at the epicentre of the global diabetes epidemic. Several Gulf Cooperation Council (GCC) countries rank among the highest in the world for the prevalence of type 2 diabetes, with estimates ranging from 15% to over 20% of the adult population (1). While healthcare systems across the region have invested heavily in treatment, pharmacotherapy, and specialised care, diabetes incidence continues to rise. This trajectory highlights an urgent reality: diabetes cannot be controlled by treatment alone – prevention must become the primary strategy.
The diabetes burden in the Gulf
According to the International Diabetes Federation (IDF), the Middle East and North Africa (MENA) region is projected to experience one of the fastest increases in diabetes globally, with cases expected to rise by over 80% by 2045 (1). In Saudi Arabia, the United Arab Emirates, Kuwait, Qatar, and Bahrain, diabetes prevalence is driven by rapid urbanisation, high obesity rates, physical inactivity, and energy-dense dietary patterns (2).
The economic burden is substantial. Diabetes-related healthcare expenditure in the Gulf amounts to billions of US dollars annually, largely due to complications such as cardiovascular disease, kidney failure, neuropathy, and amputations (3). These complications place considerable strain on healthcare systems and reduce workforce productivity and quality of life.
Why a treatment-centred model is failing
Modern diabetes care in the Gulf is highly advanced, with broad access to glucose-lowering medications, insulin therapies, and specialist services. However, a treatment-centred approach primarily addresses disease consequences rather than underlying causes. Evidence indicates that pharmacological control alone does not halt disease progression when lifestyle risk factors – particularly physical inactivity and obesity – are left unaddressed (4).
Furthermore, type 2 diabetes develops silently over many years. By the time individuals enter the healthcare system, insulin resistance and metabolic dysfunction are often well established. This underscores the importance of shifting the focus upstream toward primary prevention and early lifestyle interventions.
Physical inactivity as a central driver
Physical inactivity is one of the most significant modifiable risk factors for type 2 diabetes. In several Gulf countries, more than 40% of adults do not meet minimum physical activity recommendations, with particularly high inactivity levels among women and office-based workers (5). Car-dependent transport, sedentary occupations, extreme heat, and screen-based leisure have collectively reduced daily energy expenditure.
Large prospective studies demonstrate that physically inactive individuals have a 30–40% higher risk of developing type 2 diabetes compared with their more active counterparts (6). Importantly, this risk reduction occurs even in the absence of substantial weight loss, highlighting the independent metabolic benefits of physical activity.
Evidence for prevention through physical activity
Landmark trials provide compelling evidence that type 2 diabetes is preventable. The Finnish Diabetes Prevention Study and the US Diabetes Prevention Program showed that structured lifestyle interventions reduced the incidence of diabetes by approximately 58% among high-risk individuals, outperforming pharmacological therapy alone (7,8). Regular physical activity was a core component of these interventions.
Moderate-intensity aerobic activity – such as brisk walking for 30 minutes on most days – improves insulin sensitivity, reduces visceral adiposity, lowers blood glucose levels, and improves lipid profiles (9). Resistance training further enhances glucose uptake by increasing skeletal muscle mass, making combined exercise programmes particularly effective (10,12).
Moving towards a prevention-first strategy in the Gulf
A prevention-focused diabetes strategy in the Gulf must operate across multiple levels of influence. Healthcare systems should routinely screen for physical inactivity and prediabetes, integrate structured exercise prescription into routine clinical care, and establish referral pathways to supervised lifestyle and exercise programmes to reduce cardiometabolic risk (9,11).
Workplaces can play a transformative role by promoting regular movement breaks, incentivising active commuting, and implementing structured wellness programmes, particularly within sedentary office-based environments where prolonged sitting and low physical activity levels contribute significantly to diabetes risk (5,11).
Urban planning policies should prioritise walkable communities, shaded pedestrian pathways, climate-adapted indoor physical activity facilities, and safe recreational spaces that enable year-round activity despite climatic constraints common to the Gulf region (5,11).
Public health messaging must reposition physical activity as a medical necessity rather than a discretionary leisure activity, reinforcing its role in diabetes prevention and aligning population-level strategies with national development frameworks such as Saudi Vision 2030 and broader public health initiatives across Gulf Cooperation Council countries (5,11).
Exercise as preventive medicine
Treating physical activity as medicine requires both cultural and clinical change. Exercise should be prescribed with the same precision as pharmacological therapy, specifying frequency, intensity, duration, and type. Evidence confirms that structured exercise prescriptions improve glycaemic control, delay the onset of diabetes, and reduce cardiovascular risk, with minimal adverse effects (11,12).
Conclusion
The future of diabetes control in the Gulf depends on a decisive transition from treatment to prevention. By embedding physical activity into healthcare systems, workplaces, urban design, and daily life, Gulf nations can curb rising diabetes rates, reduce long-term healthcare costs, and improve population health. Preventing diabetes is not only possible – it is essential for sustainable health across the region.
References
1. International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: IDF; 2021.
2. Al-Ramadan MJ, Magliano DJ, Al-Hamdan NA, et al. Prevalence and correlates of diabetes in Saudi Arabia. Diabet Med. 2018;35(7):920–927.
doi: https://doi.org/10.1111/dme.13636
3. Bommer C, Heesemann E, Sagalova V, et al. The global economic burden of diabetes in adults. Lancet Diabetes Endocrinol. 2017;5(6):423–430.
doi: https://doi.org/10.1016/S2213-8587(17)30097-9
4. Taylor R. Type 2 diabetes: aetiology and reversibility. Diabetes Care. 2013;36(4):1047–1055. doi: https://doi.org/10.2337/dc12-1805
5. Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity. Lancet Glob Health. 2018;6(10):e1077–e1086.
doi: https://doi.org/10.1016/S2214-109X(18)30357-7
6. Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus. N Engl J Med. 2001;345(11):790–797.
doi: https://doi.org/10.1056/NEJMoa010492
7. Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by lifestyle changes. N Engl J Med. 2001;344(18):1343–1350.
doi: https://doi.org/10.1056/NEJM200105033441801
8. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention. N Engl J Med. 2002;346(6):393–403.
doi: https://doi.org/10.1056/NEJMoa012512
9. Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes. Diabetes Care. 2016;39(11):2065–2079. doi: https://doi.org/10.2337/dc16-1728
10. Sigal RJ, Kenny GP, Boulé NG, et al. Effects of aerobic and resistance training on glycaemic control. Ann Intern Med. 2007;147(6):357–369.
doi: https://doi.org/10.7326/0003-4819-147-6-200709180-00005
11. Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy. Scand J Med Sci Sports. 2015;25(S3):1–72.
doi: https://doi.org/10.1111/sms.12581
12. Dassanayake J. Move to Heal: Physical Activity and Exercise Strategies for Preventing and Managing Chronic Disease. Melbourne: Move to Heal Publications; 2025. https://middleeasthealth.com/focus/news-features/move-to-heal-using-physical-activity-to-tackle-the-middle-easts-ncd-crisis/
