Household physical activity

Overall, women reported doing more household physical activity than men. In both urban and rural settings, women appeared to take the lead in housework and preparing meals:

As a woman you are supposed to do physical activities which are household chores. We sweep around the surrounding, we prepare breakfast, we mop the house, then we go to the market to buy relish and some other things. When you come back, time is already up for lunch, you start preparing lunch… (Female, 50-59, urban, hypertension reported)

Rural women also described carrying wood, collecting food from their farms for meals and pounding maize or cassava for flour. Likewise, rural men reported undertaking vigorous household activities, including digging and cutting wood:

As for me, I am physically active in the morning, such as cutting wood, weeding [gardening] at home […] In the afternoon, I rest. And thereafter, around 4 pm, I start again clearing outside the house… (Male, 70-79, rural, hypertension reported)

By comparison, urban men described less strenuous household activities, such as car washing and maintenance. Some also described involvement in household chores and cooking:

I sweep the surrounding, I mop, I cook.

Facilitator: Do you stay alone?

No, I live with my relatives, but I help them [with] household chores. (Male, 40-49, urban, no health conditions reported)

Occupational physical activity

For rural participants, most work appeared to involve effortful physical activity. Both women and men reported daily involvement in farming activities, including planting, weeding and harvesting their crops. One woman said:

A person has a lot of work to do, like in this rainy season, we do farming. Instead of sleeping, you think of going to the garden to do farming activities […]. In the afternoon, if you left some ridges which you didn’t plant the seeds, you go back and plant the stems. (Female, 50-59, rural, no health condition reported)

As this extract indicates, there was some overlap between household and occupational physical activity in the accounts of rural participants. Similarly, many rural men described fishing on Lake Malawi, both to provide food for their families and to sell to make money. (Like farming, fishing involves vigorous physical activity, including launching and rowing boats, and landing catches.) In contrast, urban men talked about running shops and market stalls, working in the service industry and having office jobs, which, as one man described, were often largely sedentary:

Mostly I do my work while seated working on the computer. If I move around, that means I’m just delivering files to my boss’s office. When I knock off from work, I use a car… (Male, 50-59, urban, no health condition reported)

Many urban women did not work outside the home. The exceptions were two women who had their own businesses. One of these described how running her market stall involved heavy physical work:

…I sell timber at [local] market. I cut the timber myself, I bought an electric saw blade. I have a wheelbarrow, I use it to carry sand when the rains fall. I push it myself as part of exercise. (Female, 40-49, urban, no health condition reported)

Transport-related physical activity

Most rural participants reported that walking was still their main mode of getting from place to place. Many described walking to work (to their farm or to go fishing), to the market and to visit friends or family. Urban participants also reported walking as part of their daily routines, but to a lesser extent than their rural counterparts. Many preferred to use public transport, taxis (including bicycle taxis) or their own cars instead of walking:

I cannot go to some places by foot while I have a car. I would prefer to fill my car with fuel than walking, despite that we are making our bodies not to be physically active. (Male, 50-59, urban, no health condition reported)

Importantly, despite motorised transport often being less available outside towns and cities in Malawi, some rural participants also described avoiding walking where possible:

Nowadays it’s different from the past. In the past, our parents could walk by foot from here to South Africa. But currently if I am going to Jetty [less than 5 km], I prefer to use a car. (Male, 50-59, rural, hypertension reported)

Recreational physical activity

Both rural and urban participants reported involvement in a range of recreational physical activities, including traditional dancing (apart from urban men); jogging (apart from rural women), cycling (men only), playing with their children (mainly women, but also mentioned by men) and team sports (eg, netball for women and football for men). Football was highly popular among both urban and rural men, and its importance as a recreational activity is illustrated by this account from one younger rural man describing how he and his friends often improvise so they can enjoy a game of football after work:

During rainy season we like playing football in a club. But in the summer season we do farming in marsh gardens, and after that we play football using a ball made from plastic papers and rubbers. (Male, 20-29, rural, no health condition reported)

A number of urban (but not rural) participants described going to the gym or attending exercise classes. As one woman highlighted, involvement in formal types of exercising helped to compensate for the largely inactive lifestyles that people living in towns and cities often led:

… here in town we find the gym to be our solution in making our bodies active, while in the villages they work, hence making their bodies active…. (Female, 60-69, urban, hypertension reported)

Decline in physical activity in Malawi over time

In general, people living in rural areas reported doing more strenuous physical activity within the home and at work, and also walking more than those living in the city. However, most participants felt that physical activity levels within the general population were decreasing in Malawi. They were also aware that being less active placed them at a disadvantage compared with previous generations:

Our parents were walking long distances with heavy luggage on their heads, up to 10 km on foot. Even farming they could do by themselves without employing other people to help them. But nowadays we can’t manage all these. Our bodies are weak while our parents were strong. (Female, 30-39, urban, no health condition reported)

Health

Participants in all focus groups agreed that being physically active was important for their general health and well-being. Some participants described how their diagnosis as being prediabetic in the 2013-16 NCD survey had acted as a catalyst for them to become more active:

As for me, I started to do exercises regularly when I was told that I am pre-diabetic. And each time I go to the hospital, diabetes [blood sugar] is high[er] - this motivated me to do more exercises to reduce my BP and blood sugar level. (Female, 50-59, urban, hypertension reported)

Discussions within all focus groups also raised the role of physical activity in losing weight. One man directly attributed the health improvements he had experienced following his diagnosis to the weight he had lost through being active:

Before I was diagnosed with diabetes, I was overweight, but after the physical activities - I do activities such as digging, working in rice farm, and I found that my weight has been reduced. But also sugar level has gone down, and I was told not to continue testing my sugar. So, I realize that it’s because of exercises. (Male, 60-69, rural, diabetes and hypertension reported)

Others described how being physically active helped with releasing tension and maintaining flexibility. Importantly, as the following extract illustrates, there was general agreement in all focus groups about the need to do physical activity to remain strong:

When a person is doing physical exercise, the body gains strength if the body was weak and doesn’t feel good. But after doing exercise the body feels well. (Female, 60-69, rural, no health conditions reported)

Facilitator: Is there anything else on the reasons we are told to do physical exercise? […]

… if you just stay idle, you don't have strength in your body (Female, 60-69, rural, hypertension reported)

Motivations and barriers to being physically active

In addition to the consensus around health benefits, rural participants described necessity - having to provide and care for their families - as their main motivator for being physically active. As one woman explained, livelihood and physical activity are still often inextricably linked in rural communities:

The reason we are physically active especially here on earth, it’s because we want to eat. Without this, there won’t be anything to eat. (Female, 50-59, rural, diabetes reported)

Family and work responsibilities also featured in the urban focus group discussions, but here their negative impact on physical activity was the dominant discourse. For example, urban men agreed the multiple competing pressures they experienced in their daily lives left little time for recreational physical activity. As one participant suggested, making money is the number one priority for many men living in towns and cities:

Being physically active is a very good thing and it helps a lot of things in our bodies, but it seems here in town we are busy making money. Taking care of family and feeding our parents make us forget everything about ourselves, we can’t have time to do exercises, which is very bad. (Male, 50-59, urban, no health condition reported)

The move from active to more sedentary occupations and lifestyles, and the pressure to work hard to make money to provide for the family, were therefore major barriers to being physically active among urban participants. Other common barriers that were mentioned in all focus groups included poor diet, age and fear of injury, which, as one rural participant explained, prevented some older women from taking part in local recreational activities:

All these things we do at home, because we are aged and we can’t participate in netball which the young ladies are doing. We can’t play with them because we fear to be pulled down. (Female, 60-69, rural, hypertension reported)

In addition, the view that people who were experiencing ill-health should avoid being active was widespread, particularly, as the following extract illustrates, when illness was combined with age:

I was leaving everything for my father to do, while I was just staying. But after some time he was diagnosed with high blood pressure and other diseases. So I said to my father that he should not work anymore, but I should be the one doing physical work while he should be resting. (Male, 30-39, rural, no health condition reported)

However, some participants admitted they could not always blame external factors for their inactivity. Many talked about ‘laziness’ and ‘developing laziness’ as their only excuse:

Facilitator: What do you think would stop you from doing [exercises] regularly?

Laziness. (Female, 50-59, urban, no health conditions reported)

Same… laziness (Female, 40-49, urban, no health conditions reported)

Interestingly, this tendency to describe oneself as ‘lazy’, which appeared to have negative connotations and to be associated with risk of disease and weakness, was evident across all focus groups, even among rural men and women whose daily physical activity levels were often extremely high.

Technology

The negative influence of technological advancements on physical activity emerged as an independent theme in our analysis. With the exception of the increased availability of motorised transport (which is discussed further in the next section), technology mainly seemed to be having an impact in rural areas. Rural men described how new tools and machinery had taken some of the hard work out of farming, and rural women reported how being able to take their maize for processing at the local mill, instead of doing it themselves at home, was a symbol of their social standing:

…at present I can take 50 kgs of maize and start pounding, but people will get surprised of me - why I am doing such activity while am having maize mill closer to me? So instead of doing such activity, I try hard to get money and take the maize to the maize mill. (Female, 50-59, rural, diabetes reported)

Social norms

The societal value of wealth generation was discussed in all focus groups, and, as the previous extract suggests, having money in Malawi is associated with social expectations that further limit people’s opportunities for physical activity. For example, those who can afford it, tend to employ other people to do the physical work (eg, household chores and farming) that they and their family previously had to do for themselves. This trend was particularly evident in the urban discussions:

… maybe the only difference [from people living in rural areas] is farming, they use their own hands… we living here in town, we will search for piece-work [casual work] men to do that for us and then pay them later, that’s why our life seems to be weak. (Female, 30-39, urban, no health condition reported)

It was also evident that walking from place to place is not something that Malawians who can afford other forms of transport do through choice. One urban man clearly described how, as he earned more money, the amount of physical activity he expended in getting to work gradually declined:

I was walking to and from [work], then I got a promotion and I started using public transport when going to work. Because I had managed to get another promotion, I started going to work using company car and now that I have my own car, I use it as well. I have completely forgotten walking, just because I have money and everything, and this has contributed to my low level of physical activity. (Male, 50-59, urban, no health condition reported)

Expectations of what other people would think or say emerged as a strong influence on the amount and types of physical activity people did, particularly among urban participants. One man described how being made fun of because of his weight had put him off cycling:

I take my bike to the market. People laugh at me sometimes because I am overweight. And when they see me riding a bicycle, they say I will break the bike… because they’re used in seeing me in the car. What people say, it can discourage you from doing exercises. (Male, 20-29, urban, no health condition reported)

Likewise, some urban women described how gender and age-related norms limited the types of physical activity that were appropriate for women to do, and how the predominantly (younger) male clientele in many gyms made them feel uncomfortable:

In [local gym] women cannot manage. It is full of the youths and men. (Female, 40-49, urban, no health condition reported)

Children were also reported as having a negative influence on people’s (mainly women’s) physical activity. Some women recounted experiences of children laughing when they engaged in recreational physical activity. Others described strong social expectations that children should help with physical household chores:

My neighbors asked me why I draw water by myself when I have children. I tell them it’s part of my exercises. (Female, 50-59, urban, no health conditions reported).

Social support

Despite children’s negative impact on some aspects of physical activity, many participants (particularly women) spoke about how their children and grandchildren helped them be active by playing sports and other (traditional) games with them:

I invite my grandchildren to play Jingle [traditional physical game], because if I just sit down, I feel like my legs are tied up. So I jump a little bit, and my grandchildren also do the same. (Female, 60-69, rural, no health condition reported)

Similarly, involvement in sports (eg, football, netball) organised by local community groups, including churches, was seen as beneficial by participants in all focus groups. One urban woman said knowing that other people were depending on her was far more motivational than doing physical activity alone:

I think doing on our own is what makes us fail to exercise. Whenever we feel tired, we stop the routine. But creating groups in our locations can strengthen the desire of doing exercises. If we can just be 15, we can always be meeting, and one may feel bad to be absent a single day because you feel your friends will be missing your part, if it is a team. (Female, 40-49, urban, no health condition reported)