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Robert Koivula

Robert Koivula

Assistant researcher

Robert Koivula

Physical Activity in a Randomized Culturally Adapted Lifestyle Intervention


  • Faiza Siddiqui
  • Robert W. Koivula
  • Azra Kurbasic
  • Ulf Lindblad
  • Peter M. Nilsson
  • Louise Bennet

Summary, in English

Introduction: Middle Eastern immigrants exhibit high levels of physical inactivity and are at an increased risk for Type 2 diabetes. The primary aim of this study was to examine the changes in objectively assessed physical activity levels following a culturally adapted lifestyle intervention program. The secondary aim was to examine the association between objectively assessed physical activity and insulin sensitivity. Study design: RCT conducted over 4 months in 2015. Participants: Iraqi immigrants residing in Malmö Sweden, exhibiting one or more risk factors for Type 2 diabetes. Intervention: The intervention group (n=50) was offered a culturally adapted lifestyle intervention comprising seven group sessions including a cooking class. The control group (n=46) received usual care. Main outcome measures: Raw accelerometry data were processed by validated procedures and daily mean physical activity intensity, vector magnitude high-pass filtered (VM-HPF), was inferred. Further inferences into the number of hours/day spent in sedentary (VM-HPF <48 milli-Gs [mGs] where G=9.8 m/sec2) and light- (48– <163 mGs); moderate- (163– <420 mGs); and vigorous-intensity (≥420 mGs) activities were also calculated (year of analysis was 2016–2017). Results: No difference was observed between the two groups in terms of change over time in VM-HPF. There was a significant increase in the number of hours/day spent in light intensity physical activity in the intervention group compared with the control group (β=0.023, 95% CI=0.001, 0.045, p=0.037). The intervention group also increased the time spent in sedentary activities, with the highest VM-HPF (36– <48 mGs) within the sedentary behavior (B=0.022, 95% CI=0.002, 0.042, p=0.03). Higher VM-HPF was significantly associated with a higher insulin sensitivity index (β=0.014, 95% CI=0.0004, 0.025, p=0.007). Conclusions: The findings favor the culturally adapted intervention approach for addressing low physical activity levels among Middle Eastern immigrants. Replacing sedentary time with light-intensity activities could be an achievable goal and will have potential beneficial effects for diabetes prevention among this sedentary group of immigrants. Trial registration: This study was registered at NCT01420198.


  • Family Medicine and Community Medicine
  • Genetic and Molecular Epidemiology
  • Internal Medicine - Epidemiology
  • EpiHealth: Epidemiology for Health
  • EXODIAB: Excellence of Diabetes Research in Sweden

Publishing year







American Journal of Preventive Medicine





Document type

Journal article




  • Public Health, Global Health, Social Medicine and Epidemiology




  • Prevention of type 2 diabetes and poor mental health amongst immigrants from the Middle-East to Sweden
  • The MEDIM project

Research group

  • Family Medicine and Community Medicine
  • Genetic and Molecular Epidemiology
  • Internal Medicine - Epidemiology


  • ISSN: 0749-3797