Systematic Mapping Review of Physical Activity Factors

The assignment involves conducting a systematic mapping review of the factors influencing physical activity and sedentary behavior in ethnic minority groups in Europe. The review aims to identify the current state of knowledge on this topic, including barriers and facilitators, and provide a comprehensive overview of the existing literature. This is a significant research project that requires careful analysis and synthesis of existing studies to inform future interventions and policies aimed at promoting physical activity among ethnic minority groups.

Is Type 2 Diabetes a barrier for
exercise participation in men of
Pakistani ethnicity

ACKNOWLEDGEMENT
I am so thankful to all those persons who have given me provision, guidance as well as much
needed motivation so as to complete the current research study. Firstly, I owe my thanks to guide
who gave me chance to undertake this dissertation. Furthermore, I am thankful to my team
members, family and friends who helped me in all possible accords. This led to successful
completion of dissertation and achievement of relevant results.

ABSTRACT
Diabetes is determined to be a type of chronic disease which can not be cured. There are
various type of medications provided so that the rate of negative impact faced by people can be
reduced. Main focus of the research is carried out on assessing whether type 2 diabetes a barrier
to exercise participation in men of Pakistani (South Asia) ethnic origin. People face difficulty to
exercise due to lack of understanding. The research recommends that health care professional
should make sure that they help patients to prepare proper balance diet and type of exercise that
can be done so that type 2 diabetes can be controlled.

Contents
CHAPTER 1: INTRODUCTION.........................................................................................................
1.1 Overview................................................................................................................................5
1.2 Aim of the research................................................................................................................5
1.3 Objectives of the research......................................................................................................6
1.4 Rational of the study..............................................................................................................6
1.5 Significance of the research...................................................................................................6
1.6 Limitations of the study.........................................................................................................6
1.8 Dissertation Structure............................................................................................................7
CHAPTER 2: LITERATURE REVIEW..............................................................................................
2.1 Introduction............................................................................................................................8
2.2 Overview to diabetes.............................................................................................................8
2.3 Medical requirements of exercise for the patients suffering from type 2 diabetes................9
CHAPTER 3: SEARCH STRATEGY...............................................................................................
3.1 Introduction..........................................................................................................................14
3.2 Search strategy.....................................................................................................................14
3.3 Inclusion criteria..................................................................................................................15
Exclusion criteria.......................................................................................................................15
Search results.............................................................................................................................15
Quality Appraisal of Studies..............................................................................................................
CHAPTER 4: RESULTS...................................................................................................................
CHAPTER 5: CONCLUSION AND RECOMMENDATION..........................................................
5.1 Conclusion...........................................................................................................................22
5.2 Recommendation.................................................................................................................22
REFERENCES...................................................................................................................................

CHAPTER 1: INTRODUCTION
1.1 Overview
Diabetes is a chronic disease where it cannot be cured. However, its impact on the body
can be reduced to minimum with proper management. It is a long-life disease which carries high
blood sugar, where less insulin is secreted by pancreas. Type 2 diabetes generally occurs due to
lack of physical activity and obesity. However, some of them are genetic risk to it. Common
symptoms that are related to it are, feeling tired, increased hunger, sores that do not heal easily
etc. Long term complications that are related to this disease include, diabetic retinopathy, heart
diseases and stroke. Some extreme intensity cases of diabetes type 2 leads to, kidney failure,
blindness and amputation of limbs due to poor blood flow (Chau and et.al., 2012).
The disease can not be cured. However, it is preventable when normal body weight is kept
with diet management and adequate amount of physical activity. Exercise plays an important role
in keeping appropriate blood circulation and continuous secretion of insulin through the
pancreas. Metformin is the typical recommendation of health professionals. However, in case of
high intensity of extreme blood glucose level, injections of insulin are also suggested to the
patient. Some of the common sign and symptoms involved in this process includes, polyureic
condition, that is frequent urination, increase in thirst, increase in hinger and appetite and weight
loss.
Diabetes leads to increase the risk of cardiovascular disease by 2 to four times in people
with 20-fold increase in limb amputations. Type 2 diabetes is considered as the main cause of
renal failure and non-traumatic blindness in the patients. Scientists have stated that different bits
of DNA have been found that affect one’s body and also have larger impact on how body tends
to form insulin. Another reason can be when wrong amount of insulin information is sent by
communication carrying cells leading to high throw of glucose to the blood (Fitzpatrick, Bulsar
and Zheng, 2017). It tends to damage the cells and the process and amount in which insulin is
actually be secreted by pancreas.
1.2 Aim of the research
It is important to have a specific aim in order to conduct a research. Hence, aim for the
present research 
“To assess whether type 2 diabetes a barrier to exercise participation in men of
Pakistani (South Asia) ethnic origin”
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1.3 Objectives of the research
Based on the above aim, following objectives can be prepared for present study:
 To assess the medical requirements of exercise for the patients suffering from type 2
diabetes.
 To examine chronic condition that a patient may face due to poor management of type 2
diabetes
 To ascertain the attitude of Pakistani diabetes type 2 towards exercise.
1.4 Rational of the study
It is important that any research that has been conducted by the researcher hold certain
relevance. It helps in generating adequate amount of knowledge regarding the subject matter.
The present research will be conducted on assessing whether type 2 diabetes a barrier to exercise
participation in men of Pakistani (South Asia) ethnic origin. The researcher carries insufficient
amount of knowledge regarding the subject matter. Hence, it will help in addressing the issue
and gather the same for the investigator. Another important aspect for which the present research
has been conducted is due to understanding various aspect of type 2 diabetes and its direct
relation to exercise. Moreover, the research will also focus upon understanding the role of
physical activity in controlling blood sugar level (Haas and et.al., 2012).
1.5 Significance of the research
It is important that any research that has been conducted by the researcher holds certain
significance so that appropriate results from the same can be generated. The present research
focus upon relationship between physical exercise and type 2 diabetes. It will help reader to
gather adequate amount of knowledge where they will able to understand the important of
exercise for the patient suffering from type 2 diabetes (Murano and et.al., 2014). Another
important aspect related to it is to understand the topic in detail so that unidentified knowledge
can be gathered through proper conduction of research. In the end, it can be stated that, the
present research will also be helpful to the other scholars who are conducting research on same
or similar topic.
1.6 Limitations of the study
There are various limitations that are attached to the research which are required to be
considered by the researcher. One of the important aspect is related to time and budget
constraint. There is limited budget available to the researcher and the important aspect are
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required to be covered in it. Adequate investment is required to be considered so that each and
every activity involved in the research are measured appropriately. Moreover, effective results
outputs are generated from the same that can benefit the readers and other scholars as well.
Another aspect is related to lack of time. A prolonged research can affect the viability and
reliability of data included in it. Hence, it is important that the investigation is complete in the
specific time frame.
Since, the dissertation deals with the medical issue of diabetes, lack of secondary
information available on various modes can affect the overall conclusion and recommendations
aspect of it. In such case, unavailability of adequate information can barricade the understanding
and data related to the topic. It also affects the overall conclusion of the research. Restricted
learning is not able to generate adequate results. Hence, it is recommended that the researcher
must be careful regarding these limitations while developing any dissertation.
1.8 Dissertation Structure
It is important that before opting for completion of dissertation, it is important to prepare a
blueprint that how the same will actually be prepared. Hence, the present dissertation will follow
the following structure:
Chapter 1: Introduction: It is first and foremost chapter of dissertation that helps in discussing
regarding the basic idea of subject matter. Hence, it has helped in gathering the main aim,
objective and rationale of the research for better understanding.
Chapter 2: Literature review: It is considered to be one of the most important chapter of the
research, where, data from various sources is collected so as to develop adequate understanding
regarding the subject matter. It is also plays essential role in critically reviewing the opinion of
various researchers and reach to the specific results based on it.
Chapter 3: Research methodology: It helps in describing the research methodology that can be
used by the researcher in completing the dissertation. Hence, all the inclusion and exclusion
criteria and search strategy will be described in this chapter.
Chapter 4: Discussion and Findings: It is an important chapter where themes has been
formulated to assess the main findings of research and their direct link to aims and objectives
being framed for the research.
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Chapter 5: Conclusion: In the end, this chapter tends to conclude the over all srux of the
dissertation and data that has been collected based upon the opinions of various researchers on
the topic type 2 diabetes.
CHAPTER 2: LITERATURE REVIEW
2.1 Introduction
It is considered to be one of the most important chapter of the overall researcher where
opinions of various another researcher is critically analysed. It will help in evaluating the opinion
of other researcher with respect to type 2 diabetes, and the same will be critically assessed based
on the opinion of some other researchers as well. Thematic analysis process has been chosen to
perform this function. Hence, various themes related to aims and objectives have been prepared
so hat detailed analysis with respect to the subject matter can be gathered.
2.2 Overview to diabetes
According Powers and et.al., (2015) Diabetes is a chronic health condition where pancreas
tend to secrete less amount of insulin to the body which ultimate increases the glucose level in
blood. It is a metabolic disorder which once occurred, cannot be cured. The condition is
reversible and can be brought to control with the help of change in over lifestyle and dietary
factors. The condition is brought into consideration when the cells become insensitive to insulin
and tend to gradually produce high amount of glucose level and transferring the same to blood.
There are certain reasons due to which, diabetes is generally caused. These are, being
overweight, lack of activity, lack of exercise or other kind of physical activity, genetics, high
intake of artificial sweeteners, etc. Some common signs related to it includes, excess urination,
unintentional gain or loss of weight, fatigue, blurred vision, excess thirst etc. A blood sugar level
more than 125 when fasting and more than 200 is a simple and clear curt diagnosis of diabetes.
Diabetes have become epidemic in various countries that requires constant review to assess
that it does not affect the life of an individual. In such cases, it is generally advised to the patient
to go through blood sugar level at least once in a week so that it can be tracked and medications
can be changed and updated accordingly. The common drug that is advised by the doctor in this
scenario is Metformin. However, the dosage of drug is changed as per the intensity of diabetes
prevailing in the body. Other type of treatment that is generally recommended by the doctors
include, bringing adequate changes in the lifestyle, diet control, etc. (Sohal, Sohal and Khan,
2015). Meeting the doctor to create an effective treatment plan can help the patient to reduce its
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impact to minimum on lifestyle. The main causes of diabetes type 2 is related to unhealthy
lifestyle followed by the individual such as, major consumption of sugar and carbohydrates,
eating and drinking of food products containing artificial sweeteners, lack of physical activity,
chronic and high stress level, etc.
Long term complication of diabetes can lead the patient to strokes, cardio vascular disease,
diabetic retinopathy that can cause partial or total blindness, kidney failure, amputations of the
limbs due to lack of blood flow (Caperchione, Chau and Jennings, 2015). A sudden stroke of
hyperglycaemic state can also result in ketoacidosis in the patient and ultimately death as well.
Type 2 diabetes is quite preventable if healthy lifestyle is adopted by the individual. Staying at
normal weight as per the body mass index, eating properly and exercising regularly can help in
dealing with the issue to the core.
2.3 Medical requirements of exercise for the patients suffering from type 2 diabetes
As per the view of Haas and et.al., (2012) Medical requirement for the patents suffering
from type 2 diabetes physical activity is an important component for attention plan. It is one of
the most important factor to have a healthy plan and maintained blood glaucous level through
mediation. In this context, regular excise is most important plan for medical requirement form
type 2 diabetes person. According to Arora and et.al., (2012) to stay fit and active throughout in
life, is help to finer control on diabetes and liquid body substance glaucous level in correct way.
To control blood glaucous level for long term, abide by such as nerve pain and kidney disease.
On the other hand, exercise has so many benefits for such kind of disease. It makes easier to
control the level of types 2 diabetes. As per the view of Walton and et.al., (2012) In this way,
such kind of disease because body does not use insulin in properly. In addition, healthy diet can
help to remove such kind of problem and blood glaucous level. Exercising assistance keep heart
healthy and strong. Plus, exercise assistance keeps bang-up cholesterol and that activity avoid
arteriosclerosis.
According to Ryan and et.al., (2013) traditional benefit are better bodily function of
weight, increase the level of good HDL and stronger bones. In this context, exercise is help to
improve mood, better sleep and stress pull off. It is astute to check blood sugar with glucose
metre before and subsequently exercise to kind sure are in a safe scope. In addition, some aerobic
exercise is walking, tennis, basketball, swimming and biking remove and control the level of
types 2 diabetes. However, in contrast to this, as per the view of Arora and et.al., (2012) join
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group classes at the gym and control the level of blood glaucous. Remember of stay fit and
drinking water always have a treatment for low blood. To be focus on someone else exerciser
does make it more fun and motivated.
In the opinion of Haas and et.al., (2012) exercise is considered to be an important activity
in the treatment plan of diabetes type 2. The goal of treatment plan of individual suffering from
type 2 diabetes is to ensure optimal level of Blood glucose, Lipid, blood pressure level. It helps
in preventing the body from chronic complications of diabetes. Various people tend to opt for
effective meal plan to control their blood glucose level and blood pressure. However, others opt
for daily exercising, indulging in physical activity, losing excessive weight of the body
implementation of self-care behaviour, taking oral medication for diabetes which can be in the
form of metformin and supplemental insulin as well. Diet and physical exercise is the common
treatment plan for managing blood glucose level. Weight loss management and maintain the
same control blood pressure abnormalities. However, in contrast to this, as per the views of
Healy and et.al., (2013) maintaining blood glucose level at rest and at the time of exercise have
high dependence on coordination and integration of sympathetic nervous and endocrine systems.
Contracting muscles tend to uptake of Blood glucose. It helps in mobilization of alternative fuels
present in the form of free fatty acids. The research has been able to conclude that exercise play a
major role in prevention and control of insulin resistance in the body. Both aerobics and other
type of physical exercise helps in improvement of insulin action. Diabetes related health
complications are also reduced through the same. It has been assessed that it is also able to
manage Blood glucose levels, Cardiovascular risk and mortality, lipids, etc. It is important that
exercise is conducted on regular basis for various benefits.
According to Lawton and et.al., (2005) the researcher suggested regarding type 2 diabetes
being 4 times more common in British South Asian regions due to low level of physical exercise.
The study was conducted among 23 Pakistani and 9 Indians patients and their perception
regarding undertaking physical activities as a part of their diabetes care. Although the
respondents are aware of the importance of conducting physical exercise as a diabetes patient.
However, some of them suggested the reason of lack of time that has led them to indulge quite
less in physical exercise. It has led them to indulge in more social activities rather than exercise.
They have not been understanding its impact on their future health. Hence, the researcher has
suggested that it requires adequate amount of campaigning that can used by them to make the
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patients aware regarding importance of diabetes. A realistic and cultural sensitive approach that
can help in making them aware regarding its importance.
As per findings made by Emadian, England and Thompson, (2017) it is identified that
people from South Asia are most likely to develop 2 diabetes mellitus (T2DM) living at UK
when compared with the white British counterparts. Main reason this type of condition is
occurred due to the eating behaviour. To carry out the research, there are about 63 samples
selected and thee samples were South Asian men aged between 18 to 64 with body mass index of
over 23.0 kg/m2 and individuals who were not previously diagnosed with T2DM. The findings
show that about 54% were having healthy diet. However, the date of consumption made for oily
fish was low. Further, the body was positively associated with high added sugar with 69.8% of
men were having unhealthy intake of sugar sweetened beverages. The study shows that people
from other counties visit to other for work or any other reason, then the diet that is taken by them
is not proper. Due to such conditions, there are problems faced for health. further, it can also be
stated that there are many dietary improvement and factors that have negative affect on eating
behaviour are similar to observation that are made in general UK population. There are many
changes that have taken place in relation with the type of food that is being consumed. The rate
of as per the findings show that all the people from South Asia socially men are highly
influenced with the changes consumption that are made by them. Among the total samples that
were taken into consideration, there are many aspects in which the consumption of high sugar
related products are consumed highly.
From the findings there were made by Medagama and Galgomuwa, (2018), it can be
stated that South Asian people are highly prevalent of diabetes, low level of physical activity and
increased cardiovascular risk. There are many similar researches that are carried on similar topic
and it is identified that people who belong to this areas have low level of physical activity living
with endogenous environment. In this research about 40 of the respondents were chosen with
long standing type 2 diabetes. Majority of the respondents did not had any type of understanding
for the total time or duration for which the physical activities should be done. There are many
different type of factors that are identified through this research that limits the physical activities
and they are as follows:
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Lifestyle: In accordance with the time of lifestyle that is carried out by individuals do not
have time to consume healthy diet. With this respect, there are individuals who fail to have their
food on time. There are negative impacts over health when time for consumption of food is not
fixed.
Time management: It is required to time so that requirement of body can be satisfied.
From the findings, it is identified that people do sleep at same time daily. It is important for the
body to get proper rest. Apart from this, there are requirement of vitamins, proteins, etc. that are
needed and when a person lacks these, then they are not able to find time for themselves.
Social factors like prioritizing household activities: When talking about the South Asian
women, there are many household activities that are required to be performed by them
(McDowell and Grant, 2016). When these are done, then they are not able to get time for
physical activities. When talking about, men, they are generally busy with their office work and
thus after their work, they do not get time for doing any type of physical activities.
From research carried out by Lawton, Ahmad and Hallowell, (2006), it is identified that
Type 2 diabetes is 4 times more common among British South Asians when it is compared with
general population. Apart from this, there are risks of diabetic complications. This is a type of
situation that is linked with lower level of physical activity amongst South Asians. The type of
perception that is carried out by patients with Type 2 diabetes towards experience towards
physical activity so that they are able to reduce the negative impact of disease they are facing.
Majority of participants are not able to find time for themselves so that physical activities can be
performed. However, people do understand the importance of exercise but fail to get benefited
with it due to lack of proper management of time. More specifically, people are busy with social
expectations and cultural norms. Other than this there are other health problems that were
reported by participants due to which they fail to perform physical activities. In order to
overcome such type of issues, it is important that promotion should be done so that people
develop interest and willingness towards the roles that are performed by them. From all the
researches that are carried out, main problem that are faced by people is related with
management of time. More than half of the people know about the benefits that they will get
through physical activity but due to lack of proper planning and other social factors, individuals
fail to manage their time.
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According to the research that was carried out Casey, De Civita and Dasgupta, (2010)
there were many aspects that were considered in which it includes barriers and facilitators for the
participation towards supervised exercise programme. In order to carry out the research in
effective manner, there are three different focus groups that are taken into consideration. In total
there were about 16 participants who were led by trained moderator. To perform any type of
activities it is required to have motivation so that the person is able to perform them with their
full efficiency. All the people involved in the research appreciated encouragement,
accountability and monitoring so that they are provided by programme staff. When the trainer
took time to make each one to perform physical activities, then it helped in making sure that with
the help of exercise, individuals are able to reduce the risk that is faced by them towards their
diseases. Further, there are barriers that are faced by people. In this context, it includes lack of
time management. When a person fails to have effective time management, then it has negative
impact as they are not able to find time to perform physical activity.
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CHAPTER 3: SEARCH STRATEGY
3.1 Introduction
Literature search can be determined as vital aspect of students towards identifying most
reliable articles that will be suitable enough to provide in depth understanding for the research
topic. This is an organized search system that helps to determine information that is relevant for
the topic. Further, it plays important role in supporting clinicians to make development in
evidence based practice (Pardhan, Nakafero and Sapkota, 2018). There are many researches that
are carried out on similar research topic. However, it is not essential that all the journals are
effective enough but it is important that most suitable of them are identified. To carry out the
research on various type of educational programs to know the barriers that are exercised for the
participation of men of Pakistan. This is considered to be effective way that enables to develop
understanding regarding the subject matter and the knowledge that can be raised in which the
primary and secondary data that which are undertaken by other researchers can be focused on in
effective manner. Analysis of the study that was conducted by other researchers is considered so
as to conduct investigation in systematic manner. All the researches that are conducted by others
are analysed in which all the searches that are made can not be taken used off.
3.2 Search strategy
In order to achieve the aim and objectives of the research, there is use of systematic tool
done so that they can make interpretation of the finding made. There are different type of
database used which includes Medline and Cinahl. These type of databases have been helpful
enough to find relevant evidence that can provide solution towards the research problems set by
the investigator (Mahmood, Afshar and Tang, 2017). Apart from this, the investigator has also
made use of real facts regarding these two databases. More specifically, use of Cinahl and
Medline is done so that individuals are easily able to data regarding healthcare services,
treatments for Type 2 diabetes, etc. further, the investigator has also made use of facts from real
cases so that information presented can be reliable. in total these two databases were helpful in
providing 22 million articles among which 1924 were selected as they were articles on similar
topic. All these searches made were helpful enough to provide data that are suitable for the
research topic. Further, it can also be determined that best educational program that assists to
determine the causes or barriers that make patients facing Type 2 diabetes to do physical
activities.
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Primary search term Keywords
Type 2 diabetes Hyperglycemia, hypoglycemia, glucose level, enhance
recovery, patient safety, quality improvements
barrier to exercise among
Type 2 diabetes patients
SMART programs, DESMOND, group barriers for patients
Critical care Exercise, weight loss, injectable drugs, dietary supplements
3.3 Inclusion criteria
 Different type of educational tools and programs are done in order to support people who
have Type 2 diabetes so that manage the glucose level.
 Studies are included that consists of factors that causes people to fail in making use of
physical activities.
 All these journals are taken into considerations that are written in English language.
 In addition to this, all the articles can not be taken and can’t be considered reliable due to
time factor. Recent articles are taken so that information can be relied on.
Exclusion criteria
 Studies are considered to determine whether type 2 diabetes a barrier to exercise
participation in men of Pakistani (South Asia) ethnic origin.
Search results
The researcher has made use of PRISMA flow diagram to determine the articles that can
be used for conducting the research. Further, it has helped in identifying appropriate decision
towards the tool which can be delivered to create proper understanding able to problems that are
faced due to barriers. Number of studies that are taken or selected is about 243. Use of endnote
software is used so that elimination of duplicate articles can be done. There are some of the
articles there were excluded and these are about 30 of them due to some reasons. All these were
helpful enough to be considered and followed with the help of PRISMA flow chart.
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Quality Appraisal of Studies
This can be determined as effective approach so as to assess the relevance and reliability
to be focused on identifying studies. To carry out this type of function CASP (Critical Appraisal
Skills Program) is used. All the guidelines that are included CASP used effectively to any
review. There are into total 19 of the studies that are taken into consideration.
Fi
16
Records identified through
database searching
(n = 243 )
Screen
ing
Includ
ed
Eligibi
lity
Additional records identified
through other sources
(n = 5 )
Records after duplicates removed
(n = 198 )
Excluded some as
they were old
Records screened
(n = 95 )
Records excluded
(n = 60 )
Full-text articles
assessed for eligibility
(n = 43 )
Full-text articles
excluded, with
reasons
(n = 24)
Studies included
in review
(n = 19 )

CHAPTER 4: RESULTS
Theme 1: Effectiveness of exercise as prescribed treatment for diabetics
As per Haider, (2016) when exercise is done, then need of oxygen is required and this
may be raise up to 20 fold and the impact of exercise is high for working muscles. In this
context, to meet up the energy requirements under these type of circumstances use of skeletal
muscles is done and that also at greater increased rate. With the help of exercise a person with
type 2 diabetes is able to increase their hepatic glucose and catechol amines and these are helpful
aspect for people with these type of diseases. The rate of insulin level increase when heart pumps
up blood and this way the patient with this type of diseases are able to get benefited with the help
of exercise. However, is important for them to consider steps so that these are done regular basis
(Gupta, Aroni and Teede, 2017). In order to through exercise, insulin sensitivity gets improved
and it assists in reducing elevated blood glucose levels of in to normal range.
Theme 2: Psychological aspect of drugs is effective for Type 2 diabetes patients
According to the Vijayakumar, Brinks and Pavkov, (2017) it was included that every
patient of diabetes who is suffering from type 2 of it would be in requirement of psychological
support to throughout their life span especially at the time of diagnosis. This would also be
including the self management behaviours of the patients who are suffering from this type 2 of
diabetes patients. However, it is also noticed that they are not very much adherence of patient at
the time of therapies or drugs which would thus be leading to increase in diabetes related to
complication (Kokab, Greenfield and Gill, 2017). This could also be leading to deterioration in
the quality of their normal life and patient could be feeling the burden on their healthcare
systems as well. There are also chance of psychological deterioration of their well being or their
health would be affected their life routine could b changed like their relationship with their
family or friends.
Theme 3: Impact of medications on type 2 diabetes patients who undergo physical activities.
There are changes in glucose level and insulin sensitivity identified within 72 hours of
last exercise that are done by a person. In this context, it is important to strive to achieve
minimum cumulative total of 1000 kcal.wk1 for the physical activities. People who have type 2
of diabetes generally have low level of fitness when compared with the people who are non
diabetic individuals (Emadian, England and Thompson, 2017). With this respect, intensity of
17

exercise needs to be at a comfortable level. At the initial stage of the treatment should be
provided in which proper guidance is taken from professionals so that they provide drugs or
medications as per the total time that is spend and type of exercise that is done by the patients. It
is required to take up modification towards type of exercise for the people who have
complication of diabetes. Autonomic neuropathy is developed among patients with type 2
diabetes and this has impact over the heart rate that is respondent to exercise (Greenhalgh, Clinch
and Finer, 2015). The dose for medication is not reduced but this provided to them as per the
total time that is taken by them for physical activities but it needs to be planned by consulting
health care professionals.
Theme 4: Language is considered to be barrier for people who are not people of South Asian
descent or Pakistani.
This could be regarded to as barrier of cultural aspect that is most common if people are
migrant from their home country and they are been living into some other country as elaborated
by Fung, (2018). Then on special note it was included that if person is having type 2 diabetes and
he is been living in any South Asian part this could be causing them to as barrier as they would
not be been able to speak that language (Manikam, Shah and Lakhanpaul, 2017). Language must
be considered to be barrier for those people who are not from South Asian region or especially
not from Pakistan and they are meant to live in there. They could not be able to communicate
with the doctor or with the caretakers as well which is problematic for that patient and his or her
family. They would not be able to understand what doctor or nurse is saying to them or what
type of issue they are been facing.
Theme 5: Type 2 diabetes is reversible
The type 2 of diabetes is usually not reversible which is also one of the factor which is
causing to be the greatest challenge in its treatment as included by the Cefalu and Kahn, (2017).
In many of the study it was analysed that this type of diabetes would be prolonged into the
patient’s body once it has occurred. It would weakening the blood glucose control which would
thus be leading to weight loss to many of the patients who are suffering from this. After 10 years
of this type 2 of diabetes it was seen that about 50% of the patients are forced to use insulin in
order to control their blood glucose level. However, in one of the studies it was noted that types 2
diabetes could be controlled if the patient is taking 800 calories per day into their diet but it was
18

not included that whether this would be for longer duration of time or not (Emadian and
Thompson, 2017). So it is not still clear that whether they could be cured or freed from this
disease for all of their life or not or whether this could come again even if they follow correct
diet. Main aspect that is required to be considered is in relation with effective management of
time so that a person is able to find time for physical activities. Further, the type of medications
that are provided health care professional should be followed as per the prescription given. In
addition to this, when any type of physical activity is performed, then it is needed to be conveyed
by professional so that he/she make changes in the dose of medication provided.
Theme 6: Poor management of Type 2 diabetes causes chronic conditions and exercise has
positive impact on body.
According to Langøien, Terragni and Roos, 2017 there is time to time medication that
needs to be taken so that the rate of issues that are faced can be reduced. When proper
management of type 2 diabetes are not done in effective manner, then there are condition of
thirst and frequent urination problem. The amount of water that needs to be taken in should be
more when compared with the person who does not have this disease. Further, it increases the
hunger as lack of insulin to move sugar into cells it require high amount of energy for organs and
muscles. This way, the body get weaker and in to overcome this condition, it is becomes
important to have regular snakes. As per the proper management of consumption of food is not
done, then it has negative impact over health and this causes weight to get reduced. Apart from
this, the person with type 2 diabetes has issue in relation with getting proper sleep. It is important
to have proper sleep but it is not possible for this patients. In this context, there are areas of
darkened skin and there are patches of velvety skin in the folds and this is generally found on
neck and armpits. For proper management of people with diabetes can be reduced when there are
proper time spend for physical activities. However, it is identified that majority of South Asian
men face this problem but they are not able to take up appropriate steps to over them.
Theme 7: Diet management is an important aspect for Type 2 diabetic patients
It is suggested by healthcare professionals that patients need to have their meal on time
and this should be fixed. Apart from this, the consumption of food should be taken in such a way
that rate of sugar in the body may not increase. Both diet and physical activities are important for
the management of ABCs (A1C, Blood pressure, and Cholesterol). This is done so that proper
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management of glycated haemoglobin and blood sugar levels. With this respect, it is important to
understand how proper balance is for food need to be taken, medications and physical activities.
When choice of every day food is done properly, then it has long term and immediate effects.
With the help of proper education, assistance and practice from the side of diabetes educator, it is
important to eat well and take up steps so that control over diabetes is possible (Creamer,
Attridge and Hawthorne, 2016). As per the amount of exercise that has to be taken, it is required
to make sure that proper time of taken for exercise. More specifically, about 30 minutes should
be taken each day for exercise so that the body weight can be maintained. Apart from this
adjustment of insulin injections needs to be made in conditions when the diet taken contains high
amount of sugar.
Theme 8: Social barriers are considered to be main factors due to which people do not get time
for physical activities.
In accordance with views of Sohal, Sohal and Khan, (2015) it can be stated that South
Asian people have different type of culture and lifestyle that individuals have. In this context,
there are different issues that are faced. Further, it is identified that people face issues in relation
with total time that is taken by individuals. In accordance with the type of lifestyle people have
do not get time for them selves. When talking about Pakistani females, they are generally
occupied with house hold work and when talking about men of Pakistan, they are busy with their
work and they do not find time for performing any type of physical activity. Further, it is also
identified that South Asian men who work in other countries face problems in relation with their
diet. As per the findings that are made, it is identified that more than half of the people not have
health diet. Apart from this, there are also not able to get support from the side of hospitals to get
proper care (Caperchione, Chau and Jennings, 2015). Apart from this, it can also be stated that
people need to be conscious and take time to perform daily activities in which it consist of
physical movement made.
Theme 9: Time management and promotion of exercise enable to develop understanding among
Type 2 diabetic patients.
McDowell and Grant, (2016) to perform any type of task, it is required to have proper
time so that the activities can be perform on time. Further, level of motivation in a person also
plays vital role. When the preferences that are made by person towards an activity are not
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positive, then it causes the person to face issues related with health issues. As per different type
of research that are carried out, it is identified that majority of people do not have proper
knowledge regarding the total time that they should spend on exercise. Further, the amount of
understanding towards the strategies that are required to be followed by a patient with type 2
diabetes is also low. In such type of condition, support from the side of government is highly
important so that each person is able to follow them and risk involved can be reduced. Proper
support from the side of health care professionals should be provided so that patients are able to
take up initiatives to manage their time and get benefited (Pardhan, Nakafero and Sapkota,
2018). Thus, it can be stated that time management is possible when patients are able to prioritize
the work that are important. When more and more people get to know about the steps that can be
considered towards health, then the rate of type 2 diabetes can be reduced. As per the current rate
South Asian men have high issues faced due to this diseases.
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CHAPTER 5: CONCLUSION AND RECOMMENDATION
5.1 Conclusion
In accordance with findings made, it can be concluded that with changes in time, there
are many health related issues that are faced by people. There are different reasons for this type
of condition. With this respect, main problem identified is in relation with lack of information
that individuals have. When people have proper information regarding the risks that are involved
towards the actions that are taken, then the rate of issues related with health can reduced. People
need to have proper understanding regarding the steps that are required to be considered so that
the problems faced can be reduced for type 2 diabetes. One of the things that individuals should
understand is that this disease can not be cured and so that the rate of impact can be reduced
when time to time medication is taken. The findings show that people do not have proper
understanding that with the help of taking up balanced diet and with exercise, the rate of
problems can be reduced. Proper concern need to be taken from health care professional so that
amount of insulin can be injected. Difference is amount occurs when a person with type 2
diabetes also undergo physical activity. South Asian men need to be conscious and require to run
time to time test so that they are able to maintain balance diet. Apart for this, it also identified
that people have proper understanding regarding the benefits that they will get when they
undergo physical activity. The main issue that is faced in this aspect is that they do not get proper
time. In this context, individuals need to focus on managing time so that they can work out and
reduce the negative impact that are face due to type 2 diabetes. Thus it can be stated that with the
help of exercise people can reduce the problem due to type 2 diabetes.
5.2 Recommendation
There are certain set of recommendations that can be followed. These can help
individuals to reduce the negative impact of Type 2 diabetes. In this context below given are few
recommendations:
Promotion: The information that people have towards type 2 diabetes is low regarding
the ways through which it can be controlled. Government should take up steps so that they are
able to promote and provide information to people so that they can develop their understanding
in effective manner.
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Trainers: There are different types of exercises that are required to be followed and
people with type 2 diabetes do not have proper understanding for the same. However, by making
people trained by a professional towards the diet and exercise that should be taken will help
patients.
Developing social groups: Social groups can be developed that focus only on delivering
information regarding diabetes. When this is done, then it can help people to take up appropriate
steps to reduce the negative impact of disease.
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