Physical activity and cardiovascular disease among African-born people living in the US: a scoping review

Abstract

Objectives

To conduct a scoping review identifying the common forms of physical activity among African-born people in the United States (US) and the reported associations of such activities with cardiovascular risk in this population.

Design

Scoping review of published literature, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.

Data sources

A systematic literature search was conducted using Medline (Ovid), Scopus (Elsevier), CINAHL Plus (Ebsco) and PsycInfo (Ebsco) of articles published between 1990 and 2024.

Eligibility criteria

Published peer-reviewed articles were included if they focused on African-born people within the US context, included measures of physical activity via self-report or device-based measures, and mentioned cardiovascular disease (CVD)-related outcomes. Articles with no examination of physical activity, cardiovascular risk, or that were conducted outside of the US were excluded.

Data extraction and synthesis

A total of 258 articles were identified via databases and registers. However, 125 were excluded following de-duplication. The remaining 133 article abstracts were screened, and 17 articles were read for full-text review.

Results

While the percentage of African-born adults meeting the physical activity guidelines varied widely, a general pattern of inactivity was observed. Qualitative findings revealed that among African-born people who were physically active, the most salient forms of physical activities were walking, cultural or traditional dancing, and sports, particularly soccer. Of three studies examining cardiovascular risk factors, two reported significant associations between physical activity and CVD risk.

Conclusions

African-born individuals often engaged in activities that were culturally familiar to them, such as dance and soccer. While there was variation in physical activity engagement across countries of origin, empirical work among African-born populations in the US is sparse, heterogeneous and methodologically limited. Therefore, more studies are needed examining specific forms of physical activity and cardiovascular risk reduction among African-born people.

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Physical activity is a key protective behaviour for cardiovascular health, but immigrant populations show heterogeneous activity patterns influenced by culture, environment and migration-related factors.

• African-born people in the US are a rapidly growing population, yet their physical activity patterns and related cardiovascular risk have not been systematically mapped.

WHAT THIS STUDY ADDS

• This scoping review systematically maps the forms and domains of physical activity reported among African-born people in the US and summarises reported associations between physical activity and measured cardiovascular risk factors in this population.

• Evidence suggests walking, dance and soccer as notable recurring forms of physical activity among African-born individuals; however, a general pattern of insufficient activity was observed across studies.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• These findings highlight the need for greater use of objectively measured physical activity within this population, along with culturally grounded, subgroup-specific strategies to increase physical activity adherence in future studies.

• The mapped gaps can guide more rigorous research design and support more tailored prevention approaches in clinical and community cardiovascular care.

Introduction

African-born people account for a growing segment of the US population, increasing from an estimated population of 800 000 to 4.6 million people over the past four decades.^{1 2} This increase has been particularly noticeable since 2010, during which the African-born US population saw a 90% growth, a rate that was more than three times the growth of the overall US foreign-born population.³ While there has been steadfast interest in immigrant health within the US context, the nuanced experience of those born in Africa are often missed due to limited research focused on their health and health behaviours. Additionally, much of the large, nationally representative and publicly available data aggregates African-born people with other black racial groups, such as African Americans and Afro-Caribbean people. While aggregating US black adults gives significant insight into population-wide health inequities, aggregation of such a large group often limits and potentially masks significant sociocultural differences in health behaviours and outcomes.⁴

Evidence from the empirical literature has shown that new immigrants to the US have a lower risk of mortality from cardiovascular disease (CVD), cancers, respiratory diseases and several other chronic conditions.^{5 6} Yet, with greater length of residence in the US, health outcomes among immigrants begin to mirror the levels of the US-born population in what is known as the healthy immigrant effect or paradox.^{7 8} This epidemiological phenomenon is believed to be due in part to selective health screening by immigration authorities, along with screening based on education and skills, among other potential causes.^{9 10} Through these immigration policies, destination countries screen out migrants who have less formal education and wealth, contributing in part to healthier selection of immigrants upon arrival to the host nation.⁹ However, beyond the selectiveness of the immigration process, the health decline among immigrants over time has been primarily attributed to acculturation and adopting a sedentary lifestyle.^{11 12}

Physical activity, however, remains one of the foremost modifiable behaviours to reduce CVD. Higher levels of physical activity have been shown to reduce risk for all-cause mortality, CVD and several other chronic conditions.¹³ Despite these well-established benefits, longstanding inequities in physical activity engagement persist among under-resourced and racial minoritised groups.14,16 These systemic inequities work to limit opportunities for safe spaces to be physically active (eg, parks, recreational facilities), hinder access to physical activity resources, as well as segregate individuals into occupational niches that influence leisure-time physical activity.^{17 18} Presently, there is a dearth of research examining physical activity behaviours among African immigrants in the US. The limited research that has been conducted in this group has documented lower levels of self-reported physical activity among Black and sub-Saharan African-born people.19,21 Currently, there is inadequate evidence of which forms (eg, dancing, walking) and domains (eg, leisure, occupational) of physical activity African-born people engage in most frequently, and the potential role such activities may have in preventing future CVD risk.²² Thus, there is a need for comprehensive documentation on this population’s physical activity behaviours, including preferences and common forms of physical activity engagement, to inform and appropriately tailor future interventions.

Therefore, the main objective of this study was to conduct a scoping review exploring the common types of physical activity among African-born people in the US. A secondary aim was to systematically describe CVD risk assessment in such studies and the association of these risk factors with physical activity among African-born people.

Methods

We chose to conduct a scoping review, rather than a systematic review, because the body of evidence regarding physical activity among African-born people in the US is still growing. Identifying current gaps and mapping the current knowledge is needed to properly determine future research priorities. To ensure a robust approach for executing the review, we used the Arksey and O’Malley framework for scoping reviews,²³ to guide the process for performing this review. We started this review by (1) identifying the research question (“what are the common types of physical activity among African-born people” and examining associations with CVD risk), (2) identifying relevant studies from relevant scholarly databases (eg, Scopus, Ovid Medline), (3) selecting studies that fit the inclusion criteria, (4) charting the key data and information from the manuscripts and, lastly, (5) reporting and synthesising the results.

Protocol and registration

The protocol for this scoping review was drafted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) and was revised by the research team and a member of the Galter Health Science Library at Northwestern University (see online supplemental materials for checklist). The review protocol was uploaded in June 2024, but officially preregistered to Open Science Framework (OSF) on 7 May 2025 (https://doi.org/10.17605/OSF.IO/53BK2).

Literature search

The team worked together with a research librarian (QEW) to develop a comprehensive search strategy with keywords and Medical Subject Headings (MeSH) describing physical activity, African-born people, and CVD as seen in the online supplemental materials. It is important to note that the database searches rely on indexed terms within bibliographic records; therefore, studies in which relevant concepts appear only in the full text and not in the title, abstract or indexing may not be retrieved. While combining all four concept blocks (physical activity, CVD, migrants and Africa) improved specificity, some studies may not have been captured if a concept (eg, cardiovascular outcomes) were not explicitly indexed or mentioned in the title or abstract. We performed the search on Medline (Ovid), Scopus (Elsevier), CINAHL Plus with Full Text (Ebsco) and PsycInfo (Ebsco) on 18 July 2024. We limited the search to English studies published since 1990.

Inclusion criteria

Manuscripts were included in the review if they were peer-reviewed articles written in English with a focus on African-born people, included measures of physical activity, such as exercise, collected via self-report or device-based methods like accelerometry, and if they mentioned CVD-related outcomes. The term ‘African-born people’ was defined within this review as persons born in Africa, but who migrated and are now residing in the US.²⁴ African-born individuals broadly encompassed individuals who were African-born and included their second-generation children—given the limited number of studies and the general aims of a scoping review (ie, to map existing evidence). Included articles had to have been published between 1990 and 2024. The year 1990 was selected because many African-born people began arriving in larger numbers to the US during the 1990s and in subsequent years. This increase was primarily due to the Immigration Act of 1990, which brought significant changes to immigration policies. The Immigration Act notably increased the number of immigrants from countries that had historically lower immigration rates, largely through programmes such as the diversity visa system.²⁵ Manuscripts also included the duration of the physical activity measurement (eg, self-report over the last week, month, year) when stated. Quantitative, qualitative, and mixed-method studies were included to better understand physical activity related prevalence as well as contextual data regarding physical activity and cultural meanings among African-born people. CVD risk included heart disease conditions as well as risk factors such as hypertension. While not explicitly listed within the search criteria, cardiometabolic disease conditions (eg, diabetes, obesity) were incorporated into the scoping review extraction and narrative, as these conditions frequently coexist with CVD. Articles with no examination of physical activity, cardiovascular risk or that were conducted outside of the US were excluded. The total number of studies was collected by one author (QEW), and two authors independently reviewed the studies for inclusion/exclusion (TA, AJ) using a free subscription of the Rayyan platform. Rayyan is an AI-powered systematic review management platform that was used to help organise and manage citations for the review. In case of disagreement, a final decision on inclusion/exclusion was discussed until consensus was reached.

Data items and synthesis of results

Data extraction was conducted independently and by two reviewers (AJ, DO) using a standardised extraction form. Discrepancies were resolved through discussion and consensus. A predefined Excel template was created by the team prior to the extraction process. Members of the writing team met and discussed the key extraction data that should be included, and two members of the team (AJ, DO) practised/pilot tested and refined a subset of articles before full extraction. Consistent with scoping review methodology, formal inter-rater reliability statistics were not calculated; however, consensus-based reconciliation procedures were applied throughout. Data items included study title, authors and year of publication, publication type and journal name, and publication country. We also extracted information pertaining to the specific study design/type, sample description and size, participant demographics (age, sex, ethnicity, countries of origin, length of residence in the US), the type of physical activity measurement (self-report or device measure), reported forms of physical activity behaviour, mentioning of CVD or cardiometabolic disease risk factors, along with any examined associations between physical activity and CVD-related outcomes. For the scoping review analysis, we charted the included studies according to key characteristics identified pre-extraction to determine the common forms of physical activity engagement among African-born people in the US. We summarised the study results descriptively in accordance with established recommendations by Arksey and O’Malley framework.²³ We used structured narrative synthesis consistent with scoping review methodology, synthesising quantitative and qualitative findings separately and integrating them at interpretation. We operationalised ‘common’ or ‘salient’ reported forms of physical activity as those reported in multiple studies or those identified as a primary or preferred activity when stated. Physical activity levels were classified by each study’s definition or in accordance with meeting the US physical activity guidelines when such data were provided. This was done due to variation in instruments and thresholds.

Handling of mixed-population samples

Some eligible studies included heterogeneous samples containing African-born people alongside other racial/ethnic or immigrant groups. For these studies, we extracted subgroup data specific to African-born people where results were reported separately. When only aggregated multigroup results were available and could not be disaggregated, studies were retained for contextual mapping of physical activity patterns without estimates specific to African-born people. The corresponding authors of such studies were not contacted for disaggregated data because this review aimed to map the published evidence base as reported.

Patient and public involvement

Patients and members of the public were not involved in planning or conducting this research. The main goal of this work was to map the existing evidence base related to physical activity and cardiovascular risk among African-born adults using peer-reviewed literature; therefore, patient and public involvement was not applicable to this review findings.

Results

Study selection

A total of 258 records were identified via databases and registers and were exported to EndNote. Duplicates were removed through the ‘Find Duplicates’ function—an automation tool within EndNote (n=122) and manual review (n=3). This left a total of 133 records after de-duplication. Abstracts from the 133 records were screened by two reviewers (TA, AJ) using Rayyan. Of these 133 records, 114 of the abstracts were excluded for not meeting the study inclusion criteria, leaving 19 remaining records. Of these 19 records, the full text of one article was unretrievable and thus was not included among the articles retrieved. 18 articles were retrieved for full-text review; however, one article was removed upon discovering that it was a study protocol and therefore not within the scope of the review. In total, 17 articles were read for full-text review to see if they focus on the physical activity of African-born people and CVD risk (see figure 1).

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Study design

Descriptions of each of the included studies can be found in online supplemental table 1. To align with scoping review reporting standards, findings are organised below by study design, sample characteristics, physical activity measurement, physical activity forms and patterns, CVD risk outcomes and reported associations between physical activity and CVD risk. This structure supports mapping of what is known, how it has been measured, and where evidence gaps remain.

All studies included in the review were published between the years 2001 and 2024, with nearly all (88%; n=15) of the articles published from the year 2015 onwards. Most of the studies were cross-sectional studies (82%; n=14), while there were three studies that used a longitudinal study design (18%; n=3). The follow-up time for longitudinal studies was between 6 weeks and 2 years. Studies were primarily quantitative analysis (76%; n=13), while there were four studies that used qualitative research methods (24%; n=4). Sample sizes for the studies ranged from 32 to 1156 participants. Studies were conducted in several cities and regions in the US, including Rochester, Minneapolis and St. Paul, Minnesota; Sacramento, California; Baltimore-Maryland-Washington DC area; states such as Maine and the Midwest and Northeast regions.

Participants and sample characteristics

Study participants were African-born people (both children and adults), from several countries of origin. Across studies, participants were predominantly adults, with most studies including participants in their early to late adulthood. Age ranges spanned from 18 years to 90 years in adult samples. Only three studies included children and adolescents.26,28 Participants were born in several African countries; however, the most represented countries of birth among participants were Nigeria (n=5 studies),29,33 Somalia (n=7 studies)2728 34,38 and Sudan (n=4 studies).26,2834 Most studies (n=14) included mixed gender samples, often with a higher percentage of women participants than men. However, three studies included a single-gender sample,^{29 36 39} with two of the three studies conducted in an all women sample. Most studies included first-generation migrants, with most participants residing in the US for more than 10 years in studies where length of residence was provided. Lastly, six studies included mixed samples of African-born and none African-born individuals.^{27 28 36 37 39 40} None of these studies, however, disaggregated results related to physical activity and CVD risk factors within the studies.

Physical activity measurement method

Physical activity was measured solely by self-report across a vast majority of the included studies (n=14; 82%). In these studies, habitual physical activity was reported via interview or focus groups (in qualitative studies),^{29 36 38 41} using an established instrument such as the International Physical Activity Questionnaire,^{35 37 42} or a general question on weekly physical activity frequency and duration.30,3439 40 There were three studies that used device-based measurement. The device-based measures were pedometers (n=1)²⁶ and waist-worn accelerometers (n=2).^{27 28}

Forms and domains of physical activity

Specified forms of physical activity were only reported in the four qualitative studies. Among these studies, the listed forms of physical activity that were observed were walking, running, dancing, sports (primarily soccer), weightlifting/strength training, swimming, sledding and informal play. Domains of activity included occupational, leisure, and household activities. Among these listed forms of physical activity, three studies observed walking as a form of physical activity.^{29 36 38} Additionally, sports and dance were listed (sports: n=2,^{29 38} dance: n=2)^{36 38} as a common form of activity, suggesting that both walking, sports and dance are the three most salient forms of activity engagement among African-born people.

Physical activity patterns and key findings

Quantitative studies did not mention specific forms of physical activity but rather the duration and/or frequency. Among the 13 quantitative studies, only 11 studies included physical activity findings. Of these 11 studies, a consistent pattern of low adherence to the physical activity guidelines and high sedentary behaviour was observed among participants, except for 2 studies.^{27 28} Adult adherence with the recommended 150 min of moderate-to-vigorous physical activity ranged from 28% to 72% across sample cohorts, with women generally exhibiting lowered physical activity levels than men. Life stage was a key determinant, with individuals arriving to the US prior to age 20 for example, maintaining higher physical activity levels in adulthood compared with those arriving to the US in later adulthood, though this was not always consistent. While results varied by age, gender and age at arrival to the US, the heavy reliance on self-report measures, however, represents a consistent methodological limitation across the evidence base.

CVD risk findings across studies

15 of the 17 studies included reported at least one form of a traditional CVD risk factor. Overall, findings across these studies pointed to a pattern of elevated cardiometabolic risk. More specifically, results suggested a high prevalence of overweight and obesity in several studies, with multiple studies reporting obesity rates exceeding 50% and combined overweight/obesity rates reaching as high as 80% among adults. Beyond weight status, findings across studies also pointed to high rates of hypertension, diabetes, and dyslipidaemia among participants.

Physical activity associations with CVD risk among African-born people

Only three studies explicitly examined associations between physical and CVD risk.^{31 33 40} While most studies collected data on both physical activity and CVD risk, the majority of the studies did not examine associations between them. Among the three studies that did, weight status and diabetes were the two risk factors examined. More specifically, one study found that sedentary participants had significantly higher body mass indexes (BMIs) than those who had higher self-reported physical activity.⁴⁰ Meanwhile, another study observed no association between obesity and physical activity in a cohort of Nigerian-born people.³³ Lastly, in terms of diabetes, one study observed significantly higher prevalence of pre-diabetes and diabetes among those who had ≤2 days per week of moderate-intensity physical activity.³¹

Overall, the evidence base for the included studies is dominated by cross-sectional, self-report-based quantitative studies, with relatively few longitudinal or device-measured investigations. The aggregation of African- and non-African-born samples may also bias or dilute the physical activity findings across studies.

Discussion

This scoping review synthesises findings from studies exploring physical activity forms and patterns among African-born people in the US, and the reported associations of such activities with cardiovascular risk in this population. While limited studies examined forms of physical activity in this population, the studies that did report findings highlighted diverse forms of physical activity, with walking, dance and sports predominating. A general pattern of insufficient physical activity was also observed across samples, which, in turn, likely influenced the higher prevalence of CVD risk factors such as obesity observed in the review. African-born people experience physical activity within a distinct sociocultural context that shapes both opportunity and participation.

Overall, African-born people most often engaged in physical activities such as walking, dancing and soccer, reflecting patterns observed both in their countries of origin and across the African diaspora. Walking emerged as the most frequently reported form of physical activity across studies, aligning with research from other immigrant populations that identify walking as a common accessible form of physical activity, due in part to active commuting.43,45 In many African countries, walking serves as a primary mode of active transportation, contributing to routine physical activity before migration.^{41 46} In the US, however, there are environmental and social barriers, including car dependency, safety concerns and neighbourhood walkability, among other factors, which influence walking behaviours post-migration.47,49 Additionally, cultural stigma associated with walking (ie, poverty) is an additional barrier. Despite these barriers, walking remains a key form of exercise among African-born people.

Dance also plays a significant role in physical activity engagement among African-born people, often tied to cultural traditions and social gatherings, such as traditional dance at community festivals and spiritual practices at weddings and funerals.²⁹ Studies have documented how African-born people participate in dance not only for exercise but as a means to maintain cultural identity and strengthen community ties.^{36 50} The incorporation of dance into religious and social gatherings extends its significance beyond physical activity alone, emphasising its impact on mental, emotional and spiritual well-being. However, gender differences also shape participation in physical activity among African-born people, with men more frequently engaging in soccer and women in group-based activities like dance or female-only exercise classes.^{36 38} Wieland and colleagues emphasised the importance of gender-specific exercise spaces, noting that providing women-only environments encouraged greater participation in physical activity by fostering a sense of comfort and cultural appropriateness. Soccer remains one of the most popular sports across the African continent and among African-born people, reflecting deep transnational ties that connect communities across the diaspora. Its widespread appeal is evident in the formation of local leagues and community tournaments (eg, World Refugee Day soccer tournament in Chicago), which serve as both a means of physical activity and a cultural bridge that fosters social cohesion. Therefore, future behavioural interventions to increase physical activity among African-born people should leverage community sports leagues (eg, soccer leagues), incorporate traditional dance in community and faith-based settings, use gender-responsive delivery models (eg, GirlTrek) and prioritise community-based programmes over gym-based programmes. These initiatives, however, should also be interpreted and reflected within broader structural determinants, including neighbourhood safety, built environment, work demands, immigration-related stressors, and experiences of discrimination, which may further influence physical activity opportunities for African-born populations in the US.

Beyond structured exercise settings, African-born people often engage in physical activity through daily routines, occupational tasks and culturally embedded practices. Gona and colleagues, for example, noted that physical activity of a more informal sense (eg, active transportation) was more prevalent than structured gym or exercise workouts before migration.⁴¹ Additionally, evidence from the studies in the review suggests that the cultural perception of exercise differs, with many viewing physical exertion as an inherent part of daily life rather than a separate, leisure-time activity confined to gym environments. This aligns with prior work suggesting that some African-born participants perceive day-to-day and household activities as sufficient physical activity.⁵¹ Additionally, the cultural, physical and environmental barriers that inhibit individuals from going to the gym have also been previously documented,⁵² and aligned with what was observed in the included studies. Consequently, efforts to promote physical activity within this population should consider culturally relevant approaches that integrate movement into familiar social and occupational contexts.

Across studies, the proportion of African-born adults meeting the recommended physical activity guidelines or an active level of physical activity—according to study authors—varied widely. Nevertheless, a general pattern of inactivity was observed, despite the wide range of meeting or not meeting the guidelines. Using the National Health Interview Survey, it has been previously observed that only about 38% of African-born adults in the US meet the physical activity recommendations,¹⁹ a finding that generally aligns with what was observed in most of the included studies in this review. Additionally, studies pointed to women generally exhibiting lowered physical activity levels than men. The heavy reliance on self-reported physical activity and the variety of survey instruments, however, is a considerable limitation.

Many of the studies in this scoping review examined, to some degree, CVD risk factors among African-born people, with blood pressure and BMI being two commonly assessed measures. Variability in hypertension prevalence, for example, was observed among different African-born people groups.³⁴ Given the importance of exercise in CVD prevention, promoting culturally relevant physical activity may represent a promising strategy to support cardiovascular risk reduction, although causal effects cannot be established from the current evidence base. Additionally, such efforts could alleviate the healthcare burden by reducing hypertension-related complications, including heart disease and stroke, particularly in ageing foreign-born populations. Nevertheless, important evidence gaps remain, including limited longitudinal data, sparse device-based activity measurement, mixed foreign and US-born samples, and insufficient stratification by gender, region of origin and duration of US residence, underscoring the need for targeted primary research and future systematic reviews focused on this population.

Strengths and limitations

This scoping review has several strengths. First, to our knowledge this review is among the first to examine the common or salient forms of physical activity among African-born people in the US context. Additionally, this review integrates insight from both quantitative and qualitative studies to enrich our understanding of the common forms of activity among African-born people, but also to provide insight into the potential barriers, facilitators and cultural meaning of physical activity in a rapidly growing and systematically understudied group. The review also followed the PRISMA-ScR guidelines, including a pre-registered protocol, along with the assistance of a librarian to help with a comprehensive literature search strategy. However, this study is not without limitations. The number of eligible studies was small, and the evidence base was dominated by cross-sectional designs and self-reported measures of physical activity that limit temporal associations and may introduce bias, respectively. Additionally, we did not include a formal risk-of-bias/quality appraisal, and some of the included studies had varying instruments and cut-points (eg, steps/day vs meeting guideline-based categories) to define what was considered physically active, further limiting interpretive strength. Presently, we included only peer-reviewed articles published in English. Grey literature was excluded from our search because the objective of this review was to map the peer-reviewed scientific evidence on our research topic. Including non-peer-reviewed sources would further introduce inconsistencies in reporting quality and reduce the reproducibility of our search strategy. Nevertheless, we acknowledge that this exclusion may limit the evidence base of our review. Limited geographic representation in US cities and smaller sample sizes (ie, many less than 200 participants) restrict external validity and ability to detect associations, respectively. Lastly, some included studies used mixed-population samples without disaggregated estimates for African-born individuals, which may dilute or misattribute subgroup findings despite cautious interpretation.

Conclusions and future directions

Considering the role of physical activity on primary and secondary CVD prevention, understanding which forms of physical activity can be promoted or leveraged among African-born people is vital. As a scoping review without formal risk-of-bias assessment and with few heterogeneous studies, this review mapped patterns and gaps related to physical activity and CVD risk among African-born people. Now that the landscape has been mapped, examining the effectiveness of commonly observed forms of physical activity on CVD-related outcomes among African-born people in the US are appropriate candidates for future systematic reviews with formal risk-of-bias assessment. In conclusion, when creating or tailoring physical activity interventions for this group, it is important to introduce familiar activities that they could integrate into their daily lives (eg, active transportation, household activities), similar to the activities that they engaged in back in their countries of origin. Leveraging culturally familiar group activities, such as dance and soccer, could work to promote sustained physical activity among African-born people.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.