This systematic review focused on research pertaining to perception, behavior, or attitude toward PA and SB among adults with overweight/obesity ( Table 1).

An extensive search was conducted across four electronic databases- Medline via PubMed, Web of Science, Scopus, and CINAHL- employing a varied array of keywords to maximize inclusivity and sensitivity in identifying relevant research published from 2000-2024. The search strategy was developed in consultation with the Information Specialist and subject matter expert (NB, VK, MK, AV, and AKB) through multiple rounds of brainstorming sessions. The final search in all the databases has been conducted by two independent authors (NB and MK). The search term were “overweight,” “obese,” “obesity population,” “adult,” “older adult”, “adult population”, “Physical activity,” “physical inactivity”, “exercise”, “sedentary behaviour”, “sedentary lifestyle”, “perception”, “attitude, and beliefs”, “qualitative studies”, “mixed methods study”, “perception study”. The search strategy was developed with the belief that it would capture all relevant information related to PA and SB perception in adults with overweight/obesity. Apart from electronic searches, manual exploration of the reference lists of all incorporated studies was executed to ensure the inclusion of eligible and pertinent research.

Two independent reviewers (NB and MK) conducted the eligibility evaluation using Rayyan.qcri.org software. ¹⁵ A total of 2881 records were identified, wherein 290 records were duplicated and deleted. A systematic title and abstracts (Ti-Ab) screening for 2591 records was conducted by NB and MK based on the predefined criteria. Among the 45 articles selected for full-text screening, nine met the eligibility criteria and were included in the review. Disagreements between the reviewers were resolved through consensus for two studies, with the reviewers (VK, AV, and AKB) stepping in when consensus was difficult to reach. The search and screening procedures, adhering to PRISMA guidelines, are visually depicted in Figure 1.

The authors (NB, VK, MK, AV, and AKB) prepared a data extraction tool, which underwent pilot testing to ensure relevance. Adjustments were made to the data sheet to meet the review’s objectives. Subsequently, two independent reviewers (NB and MK) manually extracted the data from included studies. Table 2 provides a comprehensive overview of study characteristics for each included study, encompassing details such as authors, publication year, study setting, sample size, and population demographics (age and cultural identification).

Each included study underwent critical appraisal using Joanna Brigg’s Institute critical appraisal tool for Qualitative studies ¹⁶ by two independent authors (NB and MK). The assessment revealed methodological quality scores surpassing seven (7/10), indicating a good classification. Any discrepancies identified during the quality assessment process were addressed through extensive discussions and mutual agreement among the reviewers. In cases where disagreements persisted, the authors (VK, AV) were consulted to facilitate resolution. The quality assessment of the articles included is summarized in Table 3.

Adults consistently link their perceptions of physical activity to both health benefits and physical appearance. They consistently view PA as the primary approach to achieving physical fitness, maintaining mental stability, and reducing the risk of chronic illnesses. Among nine studies, seven studies reported PA needs to be encouraged to ensure living healthy and disease-free17-20,22,24,25. Witnessing friends and family members coping with long-term chronic conditions serves as a significant motivator for them to engage in PA and take charge of their health. ²⁰ The relationship between PA and mental health is closely intertwined with mindfulness, happiness, stress reduction, and overall improved state of mind. ^{19 , 25} A sense of accountability, the role of being providers for the family and community, and the desire to serve as healthy role models for the children became the few most typical reasons for achieving physical fitness. ²²

An individual’s attitudes, deeply rooted in personal beliefs, perceptions, and motivators, act as influential factors that can either propel or hinder an individual’s commitment to maintaining an active and healthy lifestyle. Those with a positive attitude or experience view PA as a beneficial and enjoyable pursuit, which significantly influences PA promotion. ²² When individuals derive enjoyment and satisfaction and witness positive outcomes such as weight loss from engaging in PA, it contributes to a heightened sense of self-efficacy. ²² These positive associations foster a more favorable attitude towards exercise and motivate participants, encouraging sustained participation. Conversely, negative attitudes, such as finding exercise boring, monotony in routine activities, or experiencing dissatisfaction due to lack of perceived benefits, can lead to demotivation and hinder the adoption of regular PA. ²¹

The present scoping review identified several facilitators and barriers among adults with overweight/obesity concerning PA participation. Commonly reported facilitators included perceived health benefits for oneself and family, social interaction with peers, ^{17 , 20 , 22 , 24 , 25} weight loss goals, ^{18 , 20 , 22 , 25} improved mental well-being, and increased self-esteem and confidence. ^{22 , 25} Physical appearance and attractiveness were potential motivators for young men. ²⁵ Gender norms were observed to limit opportunities for exercise in women. ²⁰ Other barriers identified in this population included lack of safety, ²¹ motivation, ^{17 – 22 , 24 , 25} limited resources, time constraints, ^{17 – 22 , 24 , 25} overuse of technology, fatigue, ^{17 , 21} laziness, family responsibilities, and shifting cultural and social values. Moreover, increased weight and associated injuries were observed to limit PA among this population. ²¹ Recognizing these factors can help design practical and sustainable approaches to encourage PA in adults with overweight/obesity.

This review revealed few commonly reported time-saving strategies to promote PA within this population. Practical approaches identified were implementing workplace activities, ²² setting specific achievable goals, and incorporating social changes like engaging in activities with friends and family during leisure time. ^{17 , 20 , 22 , 24 , 25} Moreover, altering social activities to prioritize active pursuits and reduce sedentary time emerged as an important strategy. Participating in gym activities alongside peers may seem appealing; however, its costliness, need for a trainer, and inconvenient timings render it a subjective option for many. ²⁴ Also, self-reported interventional approaches towards PA promotion, such as the use of technology where text messages or phone calls could be used as reminders for an individual to move around and also help them to track and compare the process throughout. ¹⁷ Rewards and reinforcements or gift cards or tangible products (like clothing) were a few incentives reported by women who were overweight. ²² Women also mentioned walking, dancing, active jobs, and joining Zumba classes with friends as a few strategies to engage themselves, along with the guilt of missing those classes. ²⁰ Social media and public health campaigns were credited for enhancing the knowledge about obesity-related diseases. ¹⁷

Among the nine studies, three of them ^{17 , 21 , 22} investigated perceptions and attitudes regarding sedentary behavior, as well as the various factors influencing sedentarism. A common theme emerging across these studies are represented under the following headings.

Adults with overweight/obesity often exhibit a lack of awareness regarding sedentarism and its associated risks, primarily stemming from a deficiency in knowledge. However, few adults perceived sedentarism as a prolonged sitting period with minimal movement, ²³ whereas few perceived it as a risk factor for obesity, various chronic diseases, and other health deteriorating conditions. ¹⁹ Adults who are overweight often experience SB as a form of relaxation after extended working hours and intertwined with increased leisure time and activities.

This review identified the contributors to SB, specifically among adults with overweight/obese, categorizing them into personal, social, and environmental factors. Personal factors include daily routine activities such as prolonged periods of inactivity in bed, excessive television viewing, seeking enjoyment and relaxation, allocating personal time, and experiencing reduced productivity post-work. Social factors revolve around social events and the influence of friends and family contributing to SB. ²¹ Both work and home environments play significant roles in influencing SB, with prolonged sitting for relaxation or meeting job demands being prominent factors. Age emerges as a frequent influencer of SB, often leading to decreased PA levels and prolonged sitting. ²³

In recent decades, cultural and social lifestyles have significantly changed, leading to a surge in SB characterized by increased sitting and relaxation. The pervasive influence of technology in society has further amplified this trend, resulting in decreased levels of PA. ^{23 , 25} Additionally, social factors play a crucial role, including the prevalence of desk-bound jobs, leisure time sitting, and heavy reliance on vehicles, ^{23 , 25} computers, and cell phones at home and in the workplace, ²³ all contributing substantially to increased sedentary lifestyle in this demographic group.

It is paramount to implement strategies aimed at breaking sedentary patterns in adults with overweight/obesity to foster healthier lifestyle habits. These strategies include incorporating regular breaks during work hours, integrating PA into daily routines, transforming social activities into more active behaviors, utilizing feedback and prompts as reminders, ^{17 , 23} and seeking social support to sustain these changes. ²³ Workplace incentives can play a significant role in enhancing PA behavior and reducing SB. Among these strategies, an initial focus should be on raising awareness about the adverse effects of a sedentary lifestyle. Additionally, addressing the impact of technology-driven SB and implementing diverse approaches to adapt to prevailing work cultures are crucial steps. ^{23 , 25}