1. Introduction
The World Health Organization defines an adequate level of physical activity (PA) as 150 min/wk of moderate PA, 75 min of vigorous PA, or an equivalent combination [
1]. There are many benefits from regular participation in PA, including risk reduction of some cancers, cardiovascular disease, diabetes, and metabolic syndrome [
2]. Yet 23% of adults and 80% of school-going adolescents are considered to be physically inactive [
3]. Physical inactivity disparities exist on a global level, including those based on wealth, urbanicity, sex, and age [
1,
4]. Physical inactivity disparity based on religion also exists: 38 Muslim countries were 1.2 times more likely to be physically inactive than 94 non-Muslim countries, and within the Muslim countries, women’s physical inactivity prevalence (35.5%) was 1.4 times greater than men’s [
5]. Insufficient PA is a risk factor for overweight, diabetes, and cardiovascular disease, and (perhaps) consequently their prevalence is alarmingly and disproportionately high among various ethnic groups of Muslims and Muslim women living in the United States (U.S.) [
6,
7,
8,
9].
In the U.S., Muslims currently number approximately 3.45 million persons, and in 2012, permanent resident status was granted to 100,000 Muslim immigrants [
10]. A number of studies conducted in the U.S. collectively suggest that Muslims, particularly women, generally face more barriers to participation in PA compared to non-Muslims and to conditions encountered in their Islamic birth/heritage country including issues related to access, scheduling, clothing, gender roles, normative beliefs, self-efficacy, knowledge, social support, neighborhood conditions, and others [
11,
12,
13,
14,
15,
16,
17,
18,
19,
20,
21]. Cultural factors, including level of community and familial social support for Muslim women engaging in PA, may dictate the environmental/structural conditions necessary for their unimpeded access to PA (e.g., need for modest dress, discrete changing spaces, and single-sex PA classes, instructors, and supervision) [
19,
20,
22,
23].
The National Physical Activity Plan (NPAP) addresses many barriers to PA, and a key aspect of the NPAP is its focus on strategies, tactics, and objectives across nine sectors—one of which is faith-based settings [
24]. Faith-based settings are thought to possess “unique social systems, environments and physical structures (e.g., fellowship halls), communication channels, policies and practices, and often, health-related goals and supports (i.e., health ministries), which make them particularly conducive to promoting physical activity” [
24].
Among U.S. Muslims, 55% attend religious services at least once monthly [
25]. It is thus reasonable to infer that an even greater percentage attend mosques for any reason over the same time span. Thus, multiple persons are theoretically available to support a congregant’s PA directly (e.g., co-participation) and indirectly (e.g., policy, programs) including co-religionists, clergy, and the congregation itself. A mosque’s clergy, known as imams, occupy a key position for promoting community health through role modeling, involvement in communal decision-making, and gatekeeping on relevant social and cultural issues [
26]. In the U.S. specifically, Muslims may view “imams, and thereby mosques, [as] a venue through which community health may be enhanced, trust established, and healthcare disparities reduced” ([
27], p. 368). As well, the Friday sermon, known as the khutbah, can be an effective medium for delivering health promotion messages [
28]. Furthermore, a mosque’s physical environment and adjoining grounds may offer venues and equipment for performing PA.
While the argument for and appeal of mosques for promoting health seems tenable, there is little evidence to support this idea in western societies. Smoking cessation educational programs delivered by religious teachers at seven mosques in the United Kingdom were evaluated [
29], but for PA behavior, we found only one program evaluation of a mosque-based exercise program [
30]. Specifically, scores on self-efficacy, importance of engaging in regular PA, participation in PA, peak aerobic capacity, and functional quality of life improved among 62 Muslim women who participated in a 1-h, 3-times/wk, 6-month-long class that offered walking, resistance training, relaxation, and chair exercises held in the Sisters prayer area of one mosque [
30].
Because intervention evidence is scant, we believe it imperative to collect additional data in order to better profile to what degree and how Muslim religious institutions in the U.S. advertise their PA programming. Such an endeavor is important given the: (1) ascribed potential for faith-based organizations in general to influence health behavior, (2) large role Islam plays in the lives of a majority of U.S. Muslims, (3) growing population of Muslims in the U.S., (4) plausibility of mosques to provide PA programming, and (5) barriers to PA that many Muslims, particularly women, face. Our research also aligns with NPAP Faith-Based Settings Strategy 1 Tactic 4: “Create an environment supportive of physical activity by delivering evidence-based physical activity messaging and programs that are consistent with the faith community’s religious beliefs” [
24].
Contemplating a survey of Muslim religious institutions’ advertisement of PA programming made us aware of challenges facing religious and cultural outsiders working with this population. U.S. Muslims can be mistrustful of researchers outside the community and be reluctant to participate in research, and finding the contact person in the mosque with direct knowledge of the research topic under study can be difficult even for insiders [
31]. Moreover, we wanted to obtain a complete national picture of the PA programming advertised, which necessitates high response rates. For these reasons, we chose the Internet as the preferred medium for data collection. There is consensus among American scholars of Islam that Internet use is permissible [
32], and U.S. Muslim women use Internet media in the acculturative process [
33]. Relying on web pages as the data source eliminates recall bias and social desirability of human respondents. (Previously, Internet webpages were content analyzed to examine the health promotion efforts of an entire country’s local health authorities [
34].)
Our study’s primary purpose was to analyze U.S. Islamic centers’ web page content to ascertain the number and types of programs and PA advertised to their communities. Secondarily, we were interested in program availability (by sex), context, and dosage (minutes of PA offered), and demographics of program leaders for the various types of programs advertised.
4. Discussion
U.S. religious institutions occupy a key role in promoting and providing PA to their congregants [
24]. Mosques, in particular, may draw women who are reluctant to exercise in mixed-sex settings because they: (1) are already a part of such persons’ lifestyle, (2) may readily configure PA programming to abide by cultural/religious norms, and (3) offer socializing—through such programs—that strengthens social bonds and reinforces righteous behavior [
40]. Our findings—based on analysis of 773 US Islamic centers’ webpage content—suggest that a large majority (73%) elected not to advertise PA programming on their websites. We are unsure why so many did not advertise PA programming on their websites but possibilities include (1) not offering any PA programs, (2) subordinating PA relative to other content (e.g., prayer times,
salat (how to pray), FAQs about Islam), and (3) posting events with PA on members-only media platforms such as Facebook.
For the 206 Islamic centers that advertised PA programming, we found a large variety of PA options of varying frequency/duration. PA in camp settings included many moderate-to-vigorous PA (MVPA) options such as sports, soccer, swimming, and hiking. This finding was encouraging because camps are acknowledged for increasing summertime PA and decreasing sedentary behavior among youth [
41]. PA in fitness class settings included many martial arts forms, which have become more popular, especially among females, within the Muslim community in recent years in response to anti-Islamic sentiment [
42]. Along with fitness and pilates/yoga classes, however, the median cumulative PA volume of 120 min/wk fell short of the recommendation of 150 min/wk of MVPA [
1]. The fitness class setting was the only one for which postings of single-sex classes for women outnumbered those for men (i.e., 2 to 1), yet twice as many men vs. women taught fitness classes. It is important to consider the sex of class relative to overcoming barriers to participation—particularly for women [
22]. Over 90% of listed instructors were Muslim, which may attract participants as well as offer co-religionist modelling of and motivation for a physically active lifestyle.
PA in sports settings primarily consisted of basketball and soccer but others, such as badminton and cricket, are popular in South Asian countries, which represent the origins of 35% of foreign-born U.S. Muslims [
25]. As stated, we found similar issues related to coach sex and coach religion. Unlike fitness classes, median cumulative PA volume for sport practices and games of 180 min/wk exceeded the recommendation of 150 min/wk of MVPA [
1]. Websites advertised 1.8 times more sport opportunities for men than women. The growth of and interest in Muslim women’s sport worldwide [
43] suggests that Islamic centers should promote additional sport opportunities for women as well as make accommodations to their physical environment and spaces in order to foster more equitable access.
PA in youth group settings included several sports found in other categories, outdoor activities such as hiking and canoeing/kayaking, as well as bowling. Websites advertised 1.4 times more youth program PA opportunities for boys than girls and similar recommendations proposed for sport programs should be considered. Out of 18 aspects of the mosque, U.S. imams assigned the lowest performance grade to involvement in youth activities and 61% listed increasing youth activities among their top three priorities [
44]. Overall, youth vs. adult participation in mosque activities is lower, and U.S. Islamic centers have been encouraged to expand program offerings in order to bridge a cultural and generational divide for attracting and retaining youth engagement [
45]. From a health perspective, Islamic centers are enjoined to provide PA opportunities to their youth [
46] and some mosques have provided youth PA/sport opportunities to attract youth and create socialization opportunities for them [
19].
For irregular programs, sport activities and run/walk activities were typically advertised in the context of tournaments and greater community health and wellness events, respectively. Websites advertised 1.4 times more irregular programs for men than women and similar recommendations proposed for sport and youth programs should be considered. Irregular programs were most frequently associated with Eid and Ramadan observances, which draw a larger segment of the Muslim community to an Islamic center.
National organizations such the U.S. Council of Muslim Organizations, American Muslim Health Professionals, and Islamic Medical Association of North America, as well as relevant regional and community organizations should consider developing targeted messaging, and workshops and trainings that assist Islamic centers in PA program development and promotion in general, which in turn could be advertised on websites. Doing so is particularly important in light of our findings and the prevalence of morbidity associated with insufficient PA found among Muslims in the U.S. [
6,
7,
8,
9]. As well, imams, who play a major role in matters related to Muslim community health, should also receive training for how to incorporate PA promotion into day-to-day ministry and chaplaincy activities [
26,
27,
47] and ensure that PA programming is sufficiently advertised. Most U.S. mosques are not considered women-friendly; thus, it is important moving forward that women are purposely included in decisions related to governance and development of women’s and family PA programs [
48]. To the degree required by a local Islamic community in general, and particularly its women, individual centers should strive to offer conditions that facilitate women’s unfettered involvement in PA programs such as providing women-only classes, female instructors, and discrete spaces for PA [
22,
23].
Strengths of the study include its national scope and its analysis of websites, which allows for public scrutiny of PA content that may not be accessible to community outsiders vis-à-vis standard questionnaire/interview protocol. Our analysis was limited to the PA programs advertised on websites, which may have resulted in missing programs that were not specifically advertised on websites. Capturing non-advertised PA programs would entail access to social media platforms and Islamic center personnel, which could have posed logistical challenges. Meanwhile, for informational and health promotion purposes, we encourage more Islamic centers to post PA programs on their websites.
Our study is the first to examine the content and characteristics of PA programming offered by U.S. Islamic centers as advertised on their websites. Future studies can use our data as a baseline to determine changes over time with respect to the variables studied. We recommend that Islamic center personnel and community health organizations working with this data: (1) comprehensively audit center websites for inclusion of PA programming, and (2) systematically devise, offer, and promote additional PA programming.
Specific Recommendations
Multiple mechanisms for achieving recommendation (2) in the previous paragraph are available. For example, Islamic centers could form a health and wellness council comprised of youth, men, and women charged with advising on, developing, and implementing PA programming. Additionally, it is important to build PA programming into the natural cycle of events in the Islamic calendar and at Islamic centers, which could include PA programming before/after the weekly Friday Jummah prayer, youth Sunday school, and Ramadan Iftar meals. The month of Rabi’ al-awwal (Prophet Muhammad’s birth month) could be designated for multiple month-long PA programs in accordance with hadith (collection of the sayings attributed to the Prophet) that ascribe his promotion of swimming, archery, and horseback riding.
When an Islamic center is limited in physical space, funds, or expertise to organize/lead PA programs multiple resolutions may be available. For example, in locales with large Muslim populations, putting on joint programming with other Islamic centers may be feasible. Also, universities may offer community-based participatory research opportunities to the Muslim community that target PA [
49]. Nonprofit community organizations such as the YMCA may also offer culturally tailored programming—such as women-only swims for Muslims [
50]. Lastly, community-based cultural organizations whose membership may include Muslims may offer PA programming solely or in partnership with other community organizations. For example, in San Diego, the Dunya Women’s Health Collaborative offers women-only yoga and swimming classes and a girls-only basketball league at the neighborhood YMCA [
51]. For these and other examples, it is imperative for imams to promote and publicize them to congregants, on websites, and on social media.