Abstract
Introduction: Physical exercise is recognized as one component of non-communicable disease prevention, but little attention has been devoted to integrating physical exercise into the Ethiopian healthcare system, with the barriers to its inclusion being unclear. 
 
 Objectives: The present study explores the bottlenecks to integrate physical exercise into the Ethiopian healthcare system to treat non-communicable disease. 
 
 Design: A mixed method sequential explanatory design. 
 
 Setting: Public referral hospitals in Ethiopia. 
 
 Methodology: Data was collected in two phases among 312 (195 males and 117 females) healthcare professionals. The participants were selected proportionately and randomly from 13 public referral hospitals. 
 
 Results: Lack of: national coordination to promote physical exercise (t (311) = 69.20, p < .0005), trained physical exercise professionals (t (311) = 14.42, p < .0005); physical exercise guidelines (t (311) = 33.25, p < .0005); training how to prescribe physical exercise by healthcare providers (t (311) = 62.94, p < .0005); information on the health benefits of physical exercise to give to their patients (t (311) = 65.62, p < .0005); and built environment that encourages physical exercise participation (t (311) = 59.64, p < .0005) were identified as barriers. Additionally, built environment, policy, healthcare professionals' lifestyle, demography of healthcare professionals, health information coverage of physical exercise and the hospital physical building were also identified as barriers.
 
 Conclusions: Physical exercise appears marginalized from the Ethiopian healthcare system. Healthcare organizations and policy makers could take the cited barriers into consideration to plan, design and integrate physical exercise into the healthcare system to prevent NCDs in Ethiopia.
Highlights
Physical exercise is recognized as one component of non-communicable disease prevention, but little attention has been devoted to integrating physical exercise into the Ethiopian healthcare system, with the barriers to its inclusion being unclear
Lack of: national coordination to promote physical exercise (t (311) = 69.20, p < .0005), trained physical exercise professionals (t (311) = 14.42, p < .0005); physical exercise guidelines (t (311) = 33.25, p < .0005); training how to prescribe physical exercise by healthcare providers (t (311) = 62.94, p < .0005); information on the health benefits of physical exercise to give to their patients (t (311) = 65.62, p < .0005); and built environment that encourages physical exercise participation (t (311) = 59.64, p < .0005) were identified as barriers
Built environment, policy, healthcare professionals' lifestyle, demography of healthcare professionals, health information coverage of physical exercise and the hospital physical building were identified as barriers
Summary
Physical exercise is recognized as one component of non-communicable disease prevention, but little attention has been devoted to integrating physical exercise into the Ethiopian healthcare system, with the barriers to its inclusion being unclear. Non-communicable diseases (NCDs), cardiovascular, diabetes, cancer, hypertension and respiratory diseases are the main causes of morbidity and mortality globally (Mensah, 2016; Fatt, 2016). NCDs are one of the main health and developmental challenges of the 21st century in relation to the social and economic consequences they cause in all countries and are overwhelming in poor and vulnerable populations. Three-quarters of all NCDs mortalities, and the majority of premature deaths, namely 28 million (82%), occur in low- and middle-income countries. Premature deaths from NCDs range from 22% among men and 35% amongst women in low-income countries, to 8% amongst men and 10% amongst women in high-income countries (WHO, 2014; WHO, 2015)
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