Long Term Trends in Physical Activity

Original Editor - Wendy Walker.

Top Contributors - Wendy Walker, Tarina van der Stockt and Tony Lowe  

Establishing Global Levels of Physical Activity

Comparisons of levels of Physical Activity [PA] between different countries were not possible until a decade ago, as prior to this there were no standardised instruments suitable for this use[1]. Early methods of classifying levels of PA tended to use either occupational classifications or estimations of leisure-time physical activities[2][3].

A group of international academics created a standardised instrument for this purpose in the late 1990s[4]: the international physical activity questionnaire (IPAQ), and they tested its reliability and validity in 12 countries, publishing the results in 2003[4] and concluding " IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings". Following this, another assessment instrument was developed: the global physical activity questionnaire (GPAQ)[5].

In the past 10 years, IPAQ and GPAQ data have been collected from approximately two-thirds of countries worldwide which, for the first time, permits a comparative assessment of global patterns of physical activity to be undertaken.

The World Health Organisation [WHO] now uses GPAQ to assess levels of PA globally, as it is adaptable to incorporate cultural differences and it covers several components of physical activity (intensity, duration, and frequency) and it assesses three areas in which physical activity is performed (occupational PA, transport-related PA, and PA in leisure activities).

Trends in Sedentary Behaviour

Sedentary behaviour, (time spent sitting) has only recently been identified as a public health issue[6]. Sedentary behaviours occur at work, while commuting and during leisure time; thus as urbanisation increases globally, we may expect to see a trend towards increased sedentary behaviour when commuting. Historically, increased mechanisation in agriculture and manufacturing industries has led to in increase in sedentary behaviour in the work situation.

Trends in Physical Activity

Changes in the environment and in society have (and will continue to) major effects on population levels of PA[7]. Urbanisation, mechanisation and increased use of motorised transport lead to global changes in PA[8][9]. It is only in recent years, and in high income countries, however, where national surveillance systems have been used to assess trends in PA[7].

High Income Countries

A 2009 systematic review[10] shows that leisure PA in high income countries has increased in the past 20 to 30 years, but that during this same period work-related PA has decreased: " the literature for adults shows that leisure-time activity levels tend to be increasing over time, while occupational-related PA is decreasing over time". A US study showed that daily energy expenditure in work-related physical activity has fallen by more than 100 calories per day during the past 50 years[11].

Low and Middle Income Countries

Studies for time trends in PA in low and middle countries are few, and lack consistency[12][13]. There is very little data available for Africa, and the poorest parts of Latin America and Central Asia[7].

WHO Global Action Plan on Physical Activity

In June 2018 the World Health Organisation [WHO] launched its new "WHO Global action plan on physical activity and health 2018-2030: More active people for a healthier world." [14]

The report highlights: "Worldwide, one in five adults, and four out of five adolescents (11-17 years), do not do enough physical activity. Girls, women, older adults, poorer people, people with disabilities and chronic diseases, marginalised populations, and indigenous people have fewer opportunities to be active."

The action plan notes that "Non-Communicable Diseases (NCDs) are responsible for 71% of all deaths globally, including for the deaths of 15 million people per year aged 30 to 70."

Action Plan Aims

The action plan on PA shows how countries can reduce physical inactivity in both adults and adolescents by 15% by 2030.

It proposes four strategic objectives to be pursued by countries:

  1. Create active societies - create positive social norms and attitudes relating to PA
  2. Create active environments - create supportive spaces and places where all people can engage in PA
  3. Create active people - develop programmes and opportunities to help people to engage in regular PA
  4. Create active systems - make the investments needed to implement and coordinate actions at international, national and subnational levels

To meet these objectives, 20 policy actions are proposed, which encourage more active societies through improving the environments and opportunities for people of all ages and abilities to do more walking and cycling both as a means of Active Transport, and as leisure activities, plus increase in sport and other active recreational activities.

Resources

References

  1. Bull, FC, Armstrong, TP, Dixon, T, Ham, S, Neiman, A, and Pratt, M. Physical inactivity. in: M Ezzati, AD Lopez, A Rodgers, CJL Murray (Eds.) "Comparative quantification of health risks. Global and regional burden of disease attributable to selected major risk factors." World Health Organization,Geneva; 2004: 729–881
  2. Paffenbarger, RS Jr, Hyde, RT, Wing, AL, and Hsieh, CC.  Physical activity, all-cause mortality, and longevity of college alumni.  N Engl J Med. 1986; 314: 605–613
  3. Morris, JN, Heady, JA, Raffle, PA, Roberts, CG, and Parks, JW.  Coronary heart-disease and physical activity of work.  Lancet. 1953; 265: 1053–1057
  4. 4.0 4.1 Craig, CL, Marshall, AL, Sjostrom, M et al.  International physical activity questionnaire: 12-country reliability and validity.  Med Sci Sports Exerc. 2003; 35: 1381–1395
  5. Bull, FC, Maslin, TS, and Armstrong, T.  Global physical activity questionnaire (GPAQ): nine country reliability and validity study.  J Phys Act Health. 2009; 6: 790–804
  6. Bauman, A, Ainsworth, BE, Sallis, JF et al.  The descriptive epidemiology of sitting a 20-country comparison using the international physical activity questionnaire (IPAQ).  Am J Prev Med. 2011; 41: 228–235
  7. 7.0 7.1 7.2 Hallal PC1, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U; Lancet Physical Activity Series Working Group. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012 Jul 21;380(9838):247-5
  8. Sullivan, R, Kinra, S, Ekelund, U et al.  Socio-demographic patterning of physical activity across migrant groups in India: results from the Indian Migration Study.  PLoS One. 2011; 6: e24898
  9. Assah, FK, Ekelund, U, Brage, S, Mbanya, JC, and Wareham, NJ.  Urbanization, physical activity, and metabolic health in sub-Saharan Africa.  Diabetes Care. 2011; 34: 491–496
  10. Knuth, AG and Hallal, PC.  Temporal trends in physical activity: a systematic review.  J Phys Act Health. 2009; 6: 548–559
  11. Brownson, RC, Boehmer, TK, and Luke, DA.  Declining rates of physical activity in the United States: what are the contributors?. Annu Rev Public Health.  2005; 26: 421–443
  12. Matsudo, VK, Matsudo, SM, Araujo, TL, Andrade, DR, Oliveira, LC, and Hallal, PC.  Time trends in physical activity in the state of Sao Paulo, Brazil: 2002–2008.  Med Sci Sports Exerc. 2010; 42: 2231–2236
  13. Hallal, PC, Knuth, AG, Rombaldi, AJ et al.  Time trends of physical activity in Brazil (2006–2009). Rev Bras Epidemiol. 2011; 14: 53–60
  14. World Health Organization, 2018. Global action plan on physical activity 2018–2030: more active people for a healthier world.