In this inaugural article of a series examining the inactivity epidemic, Dr Jayantha Dassanayake, PGdiP (UK) MAppSc (Australia), PhD Australia, PDF (Canada), 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 establishes the foundation for subsequent articles that will explore 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.
Non-communicable diseases (NCDs) now account for over 70% of all deaths worldwide, and the Middle East is one of the regions with the fastest-growing rates of this health issue. Cardiovascular disease, type 2 diabetes, obesity, hypertension, and depression have become the leading causes of illness and premature death in Gulf Cooperation Council (GCC) countries. While genetics and aging play a role, strong evidence shows that physical inactivity is one of the most important, modifiable factors driving this epidemic.
Physical inactivity in the Middle East: A growing crisis
Recent surveillance data highlight concerning levels of physical inactivity across the Middle East. The World Health Organization estimates that 40–50% of adults in several Gulf countries do not meet minimum physical activity guidelines, with inactivity rates consistently higher among women and urban residents [1]. In Saudi Arabia, for instance, national surveys show that fewer than one in three adults engage in enough physical activity for health [2]. Similar trends are observed in the United Arab Emirates, Kuwait, Qatar, and Oman [3].
This inactivity has tangible consequences. The Middle East has one of the highest global rates of type 2 diabetes, affecting roughly one in six adults in some countries [4]. Obesity rates surpass 35–40% in several GCC nations, and physical inactivity significantly increases cardiometabolic risk regardless of body weight [5].
Sedentary work, screen time, and urban living
Rapid economic growth and urbanization have transformed daily life across the region. Air-conditioned spaces, car-dependent transportation, desk jobs, and extended screen time have greatly reduced chances for incidental movement. Office workers often spend 8-10 hours a day sitting, while children and teens more often engage in screen-based leisure rather than active play [6].
Research shows that extended periods of sitting – especially sitting time – are independently linked to higher risks of cardiovascular disease, diabetes, and overall mortality, even among those who follow exercise guidelines [7]. In the Middle East, harsh weather conditions like extreme heat often discourage outdoor activities, which reinforces sedentary habits unless environments are purposefully designed to promote movement.
Physical activity as medicine: An evidence-based solution
The scientific evidence is clear: regular physical activity is one of the most effective “medicines’ for preventing and managing NCDs. Large prospective cohort studies indicate that physically active adults have a 20-35% lower risk of cardiovascular disease, a 30-40% lower risk of type 2 diabetes, and reduced all-cause mortality compared with inactive individuals.
Importantly, these benefits are dose-responsive and can be achieved with moderate activity. Brisk walking for 30 minutes on most days greatly improves insulin sensitivity, blood pressure, lipid profiles, mental health, and functional capacity [10]. Even small increases in physical activity among previously inactive individuals lead to notable health gains [11].
Why exercise must be prescribed like medicine
Despite strong evidence, physical activity remains under-prescribed in clinical settings. Unlike medications, exercise is often recommended vaguely rather than as a structured, measurable intervention. Treating physical activity as medicine requires a shift toward formal exercise prescriptions, including clear guidance on frequency, intensity, time, and type (the FITT principle).
Clinical trials demonstrate that structured exercise prescriptions improve glycemic control in type 2 diabetes, lower blood pressure in hypertension, and decrease cardiovascular risk factors as effectively as first-line medications in some populations [12]. Additionally, exercise has minimal side effects and offers broad-ranging benefits that no single drug can match.
Healthcare systems in the Middle East are uniquely positioned to lead this change. Incorporating physical activity assessments into routine visits, establishing exercise referral programs, and training healthcare workers in exercise prescription can transform prevention and disease management strategies. Coordinating these efforts with national initiatives – like Saudi Vision 2030 and the UAE National Program for Happiness and Wellbeing – can further enhance their effectiveness.
Moving forward: A call to action
The inactivity epidemic in the Middle East is avoidable. It stems from environments and systems that favor convenience over activity. To reverse this trend, coordinated efforts are needed in healthcare, urban planning, education, and workplaces.
Prescribing movement – just like we prescribe medication – must become standard practice. When physical activity is viewed as a key therapeutic intervention rather than an optional lifestyle choice, it can transform public health, reduce healthcare costs, and improve quality of life across the region. Movement is not just for prevention; it is medicine.
About the author
Dr. Jayantha Dassanayake, PGdiP (UK) MAppSc (Australia), PhD Australia, PDF (Canada)is a Physical Activity & Chronic Disease Epidemiologist. He is the author of Move to Heal: Physical Activity and Exercise Strategies for Preventing and Managing Chronic Disease
References:
- World Health Organization. Global status report on physical activity 2022. Geneva: WHO; 2022.
- Al-Hazzaa HM. Physical inactivity in Saudi Arabia revisited: A systematic review of inactivity prevalence and perceived barriers to active living. Int J Health Sci. 2018;12(6):50-64.
- Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016. Lancet Glob Health. 2018;6(10):e1077-86.
- International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: IDF; 2021.
- Lear SA, Hu W, Rangarajan S, et al. The effect of physical activity on mortality and cardiovascular disease in 130,000 people. Lancet. 2017;390(10113):2643-54.
- Owen N, Healy GN, Matthews CE, Dunstan DW. Too much sitting: The population health science of sedentary behaviour. Exerc Sport Sci Rev. 2010;38(3):105-13.
- Ekelund U, Steene-Johannessen J, Brown WJ, et al. Does physical activity attenuate the association between sitting time and mortality? Lancet. 2016;388(10051):1302-10.
- Warburton DER, Bredin SSD. Health benefits of physical activity: A systematic review. CMAJ. 2017;174(6):801-9.
- Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide. Lancet. 2012;380(9838):219-29.
- Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes. Diabetes Care. 2016;39(11):2065-79.
- Wen CP, Wai JPM, Tsai MK, et al. Minimum amount of physical activity for reduced mortality. Lancet. 2011;378(9798):1244-53.
- Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy. Scand J Med Sci Sports. 2015;25(S3):1-72.
