Global Issues Around Physical Activity

Original Editor - Karen Wilson

Top Contributors - Karen Wilson, Mariam Hashem and Michelle Lee  

Introduction

Physical inactivity is an issue that needs to be addressed on a global scale. It is a problem that affects countries regardless of income[1] and is poised to have an increasingly negative impact on rates of obesity, non-communicable disease, and overall health.[1] In order to understand physical inactivity at a systemic level, it's important to understand the global issues at play.

Global Determinants of Physical Activity

Several worldwide trends are thought to have a negative impact on physical activity participation.

Population Ageing

As life expectancy increases and fertility rates decline, the world's population is experiencing an unprecedented rise in adults aged 60 and older.[2] With this trend has come an increased burden of  non-communicable diseases that typically develop in middle and old ages.[3] Despite the positive impact of physical activity (PA) on ageing and the prevention of chronic conditions, such as type 2 diabetes and heart diseases, older adults represent the least physically active age group.[4] This trend is especially true in industrialised nations where both occupational and leisure time PA may be limited.[5]

From an ecological perspective, the barriers to physical activity in older adults are varied. On an individual level, impaired physical & cognitive function and low perceived importance pose barriers to participation.[5] Obstacles at the social/cultural level include limited social support, lack of employment/volunteer opportunities, economic insecurity, and non-conducive cultural norms. The built environment, climate & seasonal changes, and transportation represent environmental/policy barriers that may have increased weight for older adults.

Source: Pixabay, License: CC0 Creative Commons

Urbanisation

Over the past 50 years, large segments of the global population have experienced rapid urbanisation. Urbanisation often entails violence, high-density traffic, low air quality, and pollution.[1] In many places, these problems are also accompanied by a lack of sidewalks and poor access to parks and other sports/recreation facilities. Taken together, many experts posit that the environmental changes related to urban living discourage physical activity.[1]

The evidence surrounding these assumptions is mixed. Assah et al.[6] found that living in an urban area was associated with lower levels of physical activity energy expenditure and a higher prevalence of metabolic syndrome compared to rural dwelling adults in Cameroon. Similar differences in physical activity were found in urban versus rural dwelling minors in the United States[7] [8][9], and female adolescents in Portugal.[10] Other studies have demonstrated no[11][12][13] or an inverse relationship[14][15][13] between PA & the degree of urbanisation. Perhaps in areas where (1) rural life continues to entail strenuous domestic & occupational activities and (2) urban planning has had little regard for encouraging active lifestyles, intuitive assumptions about the effects of urbanisation hold true; however, care should be taken to not extend such generalisations to countries or regions in which these conditions do not apply.

Mechanisation

Mechanisation is the process of replacing manual labor with machinery. Although technology can improve task efficiency, personal safety, and ease of mobility, it also minimises the physical effort required for self-transport and the performance of occupational and domestic activities. In doing so, mechanisation may inadvertently contribute to declining physical activity levels in the case that commensurate increases in leisure time PA do not take place.[16]

Gender Equality

Men are more physically active than women across all age groups.[1] Findings from Balish et al.[17] suggest that levels of female empowerment, or gender equality, may play a role is this population pattern. Specifically, study results indicated that women living in countries with high gender equality were more likely to participate in leisure time PA than their counterparts living in countries with low gender equality. Interestingly, the same results were true for men.[17] The authors hypothesised that increased female empowerment results in later marriages, delayed childbearing, and decreased overall birth rate. In turn, these changes allow both genders to invest more time in leisure time PA for their children and themselves.

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However, even in countries with high gender equality, differences in the needs of men and women exist. Particularly in the case of outdoor activities, living alone,[18] fear of sexual assault,[18][19] fear of verbal harassment,[19] insecurities regarding body image,[20] and familial time constraints[21] more negatively influence participation in physical activity among women compared to men. Consequently, physical activity promotion among women should account for their unique concerns as well as the social, cultural, and religious norms that may engender them.

Climate Change

At present, cold, extreme heat and precipitation are all associated with reduced physical activity.[22] Over time, global warming is poised to play a growing influence on physical activity levels.[22][23] Rising temperatures may decrease physical inactivity in locations affected by cold climate.[22] On the other hand, an increase in physical inactivity is projected in locations that already experience high temperatures.[22][23] For these high temperature regions, further decreases in physical activity have devastating implications for population health and should be accounted for in factoring the costs of climate change and the justification for mitigation efforts.[23]

Future Directions

Going forward the World Health Organisation recommends national level adoption of global physical activity guidelines, that should then be adapted to country-specific contexts.[16] Apart from the global issues mentioned previously, the following factors should be considered on a regional/local basis:

  • Social norms
  • Language
  • Religious values
  • Security situation
  • Geography
  • Existing infrastructure
  • Local government leadership
  • Existing patterns in physical activity

Perhaps the greatest need for future directions is the improved surveillance of physical activity worldwide.[24] Particularly in low- and middle-income countries, data regarding levels of physical activity is limited. Such data is essential for tailoring global physical activity promotion to population specific needs/trends.

References

  1. 1.0 1.1 1.2 1.3 1.4 WHO. Physical inactivity: a global public health problem. 2018. Accessed April 19, 2018: http://www.who.int/dietphysicalactivity/factsheet_inactivity/en/
  2. United Nations. Ageing. Accessed May 2, 2018: www.un.org/en/sections/issues-depth/ageing/index.html
  3. Benziger CP, Roth GA, Moran AE. The global burden of disease study and the preventable burden of NCD. Global heart. 2016 Dec 1;11(4):393-7.
  4. Sun E, Norman I, While A. Physical activity in older people: a systematic review. BMC Public Health. 2013; 13: 449
  5. 5.0 5.1 King A, King D. Physical Activity for an Aging Population. Public Health Reviews. 2010;32:401–26.
  6. Assah FK, Ekelund U, Brage S, Mbanya JC, Wareham NJ. Urbanization, physical activity, and metabolic health in sub-Saharan Africa. Diabetes Care. 2011 Feb 1;34(2):491-6.
  7. Springer, A. E., Hoelscher, D. M. and Kelder, S. H. (2006) Prevalence of physical activity and sedentary behaviors in US high school students by metropolitan status and geographic region. Pediatric Exercise Science, 3, 365 – 380.
  8. Liu, J., Bennett, K. J., Harun, N. and Probst, J. C. (2008) Urban-rural differences in overweight status and physic- al inactivity among US children aged 10 – 17 years. The Journal of Rural Health, 24, 407–415.
  9. Joens‐Matre RR, Welk GJ, Calabro MA, Russell DW, Nicklay E, Hensley LD. Rural–urban differences in physical activity, physical fitness, and overweight prevalence of children. The Journal of rural health. 2008 Jan 1;24(1):49-54.
  10. Machado-Rodrigues AM, Coelho-E-Silva MJ, Mota J, Padez C, Martins RA, Cumming SP, Riddoch C, Malina RM. Urban–rural contrasts in fitness, physical activity, and sedentary behaviour in adolescents. Health promotion international. 2012 Oct 19;29(1):118-29.
  11. Robertson MC, Song J, Taylor WC, Durand CP, Basen‐Engquist KM. Urban‐Rural Differences in Aerobic Physical Activity, Muscle Strengthening Exercise, and Screen‐Time Sedentary Behavior. The Journal of Rural Health. 2018 Feb 16.
  12. Fan JX, Wen M, Kowaleski-Jones L. Peer Reviewed: Rural–Urban Differences in Objective and Subjective Measures of Physical Activity: Findings From the National Health and Nutrition Examination Survey (NHANES) 2003–2006. Preventing chronic disease. 2014;11.
  13. 13.0 13.1 Cicognani, E., Albanesi, C. and Zani, B. (2008) The impact of residential context on Adolescent’s subjective well being. Journal of Community & Applied Social Psychology, 18, 558–575.
  14. Van Dyck D, Cardon G, Deforche B, De Bourdeaudhuij I. Urban–rural differences in physical activity in Belgian adults and the importance of psychosocial factors. Journal of Urban Health. 2011 Feb 1;88(1):154-67.
  15. Trivedi T, Liu J, Probst J, Merchant A, Jhones S, Martin AB. Obesity and obesity-related behaviors among rural and urban adults in the USA. Rural Remote Health. 2015 Oct 13;15(4):3267.
  16. 16.0 16.1 World Health Organization. Global Recommendations on Physical Activity for Health; Switzerland: WHO Press; 2010
  17. 17.0 17.1 Balish SM, Deaner RO, Rathwell S, Rainham D, Blanchard C. Gender equality predicts leisure-time physical activity: Benefits for both sexes across 34 countries. Cogent Psychology. 2016 Dec 31;3(1):1174183.
  18. 18.0 18.1 Sjögren K and Stjernberg L. A gender perspective on factors that influence outdoor recreational physical activity among the elderly. BMC Geriatr. 2010; 10: 34
  19. 19.0 19.1 Kilgour L and Parker A. Gender, physical activity and fear: women, exercise and the great outdoors. Qualitative Research in Sport, Exercise and Health. 2013; 5: 43-57
  20. Choi, P.Y.L., 2000. Femininity and the physically active woman. London: Routledge.
  21. Mutrie, N. and Choi, P.Y.L., 2000. Is fit a feminist issue? Dilemmas for exercise psychology. Feminism and psychology, 10 (4), 544–551.
  22. 22.0 22.1 22.2 22.3 Obradovich N, Fowler JH. Climate change may alter human physical activity patterns. Nature Human Behaviour. 2017 May;1(5):0097.
  23. 23.0 23.1 23.2 Townsend M, Mahoney M, Jones JA, Ball K, Salmon J, Finch CF. Too hot to trot? Exploring potential links between climate change, physical activity and health. Journal of science and medicine in sport. 2003 Sep 1;6(3):260-5.
  24. Knuth AG, Hallal PC. Temporal trends in physical activity: a systematic review. Journal of Physical Activity and Health. 2009 Sep;6(5):548-59.