Liangruenrom et al. BMC Public Health (2018) 18:733 https://doi.org/10.1186/s12889-018-5643-y RESEARCH ARTICLE Open Access Physical activity and sedentary behaviour research in Thailand: a systematic scoping review Nucharapon Liangruenrom1,2, Kanyapat Suttikasem2, Melinda Craike1, Jason A. Bennie3, Stuart J. H. Biddle3 and Zeljko Pedisic1* Abstract Background: The number of deaths per year attributed to non-communicable diseases is increasing in low- and middle-income countries, including Thailand. To facilitate the development of evidence-based public health programs and policies in Thailand, research on physical activity (PA) and sedentary behaviour (SB) is needed. The aims of this scoping review were to: (i) map all available evidence on PA and SB in Thailand; (ii) identify research gaps; and (iii) suggest directions for future research. Methods: A systematic literature search was conducted through 10 bibliographic databases. Additional articles were identified through secondary searches of reference lists, websites of relevant Thai health organisations, Google, and Google Scholar. Studies written in Thai or English were screened independently by two authors and included if they presented quantitative or qualitative data relevant to public health research on PA and/or SB. Results: Out of 25,007 screened articles, a total of 564 studies were included in the review. Most studies included PA only (80%), 6.7% included SB only, and 13.3% included both PA and SB. The most common research focus was correlates (58.9%), followed by outcomes of PA/SB (22.2%), prevalence of PA/SB (12.4%), and instrument validation (3.2%). Most PA/SB research was cross-sectional (69.3%), while interventions (19.7%) and longitudinal studies (2.8%) were less represented. Most studies (94%) used self-reports of PA/SB, and few (2.5%) used device- based measures. Both sexes were examined in most studies (82.5%). Adults were the main target population group (51.1%), followed by older adults (26.9%), adolescents (15.7%), and children (6.3%). Clinical populations were investigated in the context of PA/SB in a relatively large number of studies (15.3%), most frequently those with cardiovascular disease, diabetes, and hypertension (22%, 21%, and 21% respectively). Conclusions: The number of Thai papers on PA published per year has been increasing, indicating a growing interest in this research area. More studies using population-representative samples are needed, particularly among children and adolescents, and investigating SB as a health risk factor. To provide stronger evidence on determinants and outcomes of PA/SB, longitudinal studies using standardised measures of PA and SB are required. Keywords: Physical activity, Sedentary behaviour, Scoping review, Thailand * Correspondence: [email protected] 1Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC 8001, Australia Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Liangruenrom et al. BMC Public Health (2018) 18:733 Page 2 of 24 Background engagement in PA since 1997 and has recently Deaths caused by non-communicable diseases (NCDs), included targets to reduce SB as ways to reduce the such as cardiovascular disease and cancer, are common burden of NCDs [17]. Moreover, a number of worldwide. Global rates of deaths attributed to NCDs national actions have been taken to help achieve the increased from 60% in 2000 to 70% in 2015 [1]. Import- World Health Organization’s (WHO) 15-year global antly, the rates of mortality caused by NCDs are increas- target, set in 2010, of 10% reduction in the prevalence ing faster in low- and middle-income countries than in of physical inactivity, defined as less than 60 minutes high-income countries [1]. In Thailand, NCD mortality of MVPA daily for adolescents and 150 minutes of rates increased from 64% in 2000 to 71% in 2015 [1]. MVPA weekly for persons aged 18 and over [17, 18]. Strong evidence has shown positive impacts of physical WHO has commended Thailand as the regional leader in activity (PA) on the prevention of NCDs [2–5]. Some developing national health policies to promote better evidence also suggests that excessive sedentary behav- health through increasing PA [19]. Many PA promoting iour (SB) (e.g. sitting) may increase the risk of several initiatives and public campaigns were introduced in common NCDs, independently of PA [6]. It should be Thailand, such as the development of new cycle noted, however, that recent methodological papers ques- paths, marathons organised all over the country, and tioned the independence of PA and SB, based on the a weekly program of aerobic exercise at workplace argument that these behaviours are co-dependent parts launched and led by the Prime Minister of Thailand of a time-use composition [7–9]. Nevertheless, the [17, 19, 20]. Further, the national strategies and prevalence of physical inactivity, defined as not meeting guidelines for increasing PA and reducing SB were the recommended level of moderate-to-vigorous physical developed [21]. Despite initiatives to increase the Thai activity (MVPA) and excessive SB, defined as sitting or population’s engagement in PA, population-based reclining with low energy expenditure for more than 7 studies suggest that the prevalence of physical inactiv- hours/day, is still high across the world, particularly in ity has increased from 18.5% in 2008 [22] to 19.2% in middle- and high-income countries [10–12]. In 2012, it 2014 [23]. This suggests that the development and was estimated that nearly three-quarters of all physical implementation of effective public health programs inactivity-related deaths occurred in low- and and policies to promote PA and decrease SB is middle-income countries [13]. In Thailand, it was esti- needed. mated that 6.3% of total mortality cases could be attrib- In PA and SB epidemiology, a number of literature re- utable to physical inactivity in 2013 [14]. Although, no views have been conducted. For example, reviews have country-specific estimates are available for Thailand, glo- examined worldwide patterns of PA and SB, and show a bal estimates suggest that excessive SB is responsible for shift from physically active to sedentary lifestyles [24– 3.4% of all-cause mortality [12]. 26]. Other reviews have examined factors associated Thailand has been affected by urbanisation, where, in with PA and SB, and the efficacy of interventions to in- search of better socioeconomic opportunities, many fluence the behaviours, especially in high-income coun- young working people move to urban areas or cities, es- tries [27–33]. However, most previous literature reviews pecially to the capital, Bangkok. According to the De- are restricted to English language studies only and, partment of Economic and Social Affairs, United therefore, studies from many low- and middle-income Nations, half of the Thai population (51.1%) is urban countries, including Thailand, have typically not been in- [13]. This increased rapidly from 1955 when only 18% of cluded. Furthermore, many previous reviews on PA and the Thai population lived in urban areas [13]. Many SB are restricted to specific, narrow topics (e.g. environ- issues have arisen as a consequence of the increasing mental determinants of PA) [27]. A comprehensive number of people living in the urban setting. An emer- assessment of epidemiological evidence on PA and SB in ging concern related to urbanisation is the increasing the Thai context is lacking. To provide directions for time spent in SB in Thai population and its negative future studies informing public health policies and health outcomes [14]. In Thailand, there has been in- actions targeted to increase PA and reduce SB, it is im- creasing focus on strategies to improve engagement in portant to map the available evidence on epidemiology PA and reduce SB. Thailand has experienced significant of PA and SB in Thailand. Scoping reviews have shown economic development over the past four decades, mov- to be a useful method for a systematic assessment of the ing from a low-income to upper-middle income econ- current body of evidence in a broad subject area [34]. In omy [15]. Since 2002, Thailand has established a this study, we conducted a systematic scoping review to “Universal Health Coverage” scheme, to provide health- assess previous Thai PA and SB research, to identify care and financial protection to all Thai nationals [16]. research gaps and provide evidence-based directions for As part of the national health promotion strategies, future research on PA and SB in Thailand to guide the the Thai Government has aimed to promote development of strategies and policies. Liangruenrom et al. BMC Public Health (2018) 18:733 Page 3 of 24 Methods development or performed an evaluation of a PA and/or Search strategy SB measurement tool or intervention; (iv) used any type This scoping review was conducted according to the of PA and/or SB measure, such as self-reports or Guidance for Conducting Systematic Scoping Reviews device-based measures; (v) were written in Thai or [35]. It included primary and secondary database English; and (vi) published as a journal article, confer- searches. The primary literature search was conducted ence paper, conference abstract, Master’s thesis, Doctoral from database inception to September 2016 through the thesis, or report.