EPIDEMIOLOGY OF PHYSICAL

ACTIVITY IN THE MIDDLE EAST. Professor Tarek Tawfik Amin

Public Health and Community Medicine, Faculty of Medicine,

Cairo University.amin55@myway.com

The second International Public Health Conference,

Cairo, Egypt.

Physical activity (PA) is defined as any bodily movement produced by skeletal muscles that requires energy expenditure.

DOMAINS OF PA

Recreational or

leisure-time PA

Active transpor

t or commuti

ng Work-

related activity, household chores

Play, games,

and sports or planned exercise sessions

INTENSITY OF PA

HEALTH BENEFITS1

• Regular moderate intensity PA (walking, cycling, or participating in sports).

- Reduce the risk of cardiovascular diseases, diabetes (type II), colon and breast cancer, and depression.

- Adequate levels of PA decrease the risk of a hip or vertebral fracture and help control weight.

1. WHO. Fact sheet N°385

Ischemic Heart Diabetes Colon cancer

Post menopuasl

BC

-35

-30

-25

-20

-15

-10

-5

0

% risk reduction of certain non-communicable diseases attributed to

regular physical activity.

Source: Global status report on non-communicable diseases 2010. Geneva: World Health Organization; 2011 (http://www.who.int/nmh/publications/ncd_report_full_en.pdf)

http://gamapserver.who.int/mapLibrary/Files/Maps/Global_NCD_deaths_2012.png

W.H.O.: RECOMMENDATIONS ON PHYSICAL ACTIVITY [PA] (ADULTS 18-64 YEARS)2

o At least 150 minutes of moderate-intensity aerobic PA/ week or at least 75 minutes of vigorous-intensity aerobic PA/week, or an equivalent combination of moderate- and vigorous-intensity activity.

o Aerobic activity: in bouts of at least 10 minutes duration.

o Muscle-strengthening activities: on 2 or more days a week.

2. WHO. Promoting physical activity in the Eastern Mediterranean Region through a life-course approach. WHO, 2014.

INSUFFICIENT PHYSICAL ACTIVITY One of the 10 leading risk factors for global

mortality, causing ≈ 3.2 million deaths each year 3.

In 2010, insufficient physical activity caused 69.3 million DALYs [2.8% of the total – globally] 3.

Adults who are insufficiently PA have a 20−30% increased risk of all-cause mortality 4.

It is a key determinant in weight control and prevention of obesity 3.

3. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224−60. doi:10.1016/S0140-6736(12)61766-8.4. Global recommendations on physical activity for health. Geneva: World Health Organization; 2010 (http:// whqlibdoc.who.int/publications/2010/9789241599979_eng.pdf, accessed 4 November 2014)

Globally1,2, around 31% of adults aged 15+ are insufficiently active in 2008 (men 28% and women 34%).

Approximately 3.2 million deaths each year are attributable to insufficient PA.

In 2008, prevalence of insufficient PA highest in Americas and EMR.

In all WHO Regions, men more active than women, with the biggest difference in EMR.

http://apps.who.int/gho/data/node.main.A893?lang=en

http://apps.who.int/gho/data/node.main.A893?lang=en

http://apps.who.int/gho/data/node.main.A893?lang=en

United

Ara

b Emira

tes

Tunis

ia

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Qatar

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43.9

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49.7

33.8

63.9

45.8

42.9

39.4

41.2

Figure 1. Insufficeintly active adult population (% preva-lence estimates by genders) year 2010, Middle East.

Insufficiently active (age-standardized estimate) MaleInsufficiently active (age-standardized estimate) Female

Source: WHO observatory 2015

SE A

sia

Afric

a

Glob

al

Euro

pe

W P

acifi

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11.3

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26.7

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24.4 26

.8

27.8

27.3

37.1

37.8

14.7

20.9 23

.3 24.5

25.2

31.1 32

.4

Figure 2. Insufficient physical activity (estimate preva-lence in %) among adults by WHO regions, 2010.

Male Female Both sexes

Source: WHO observatory 2015.

BARRIERS TO PA IN THE MIDDLE EAST 5-19.

I- INDIVIDUAL BARRIERS1. Most common are ‘lack of time’ and the

‘presence of health conditions’. 2. Some believed that exercise would be

painful.3. Fatigue and tiredness reported especially

among women.4. Lack of interest, motivation, and

information benefits, fear of injury, stress, excessive screen use and no past ‘habit’ of exercise.

5. Grooming and traditional dress for women.

II- CULTURAL/SOCIAL 1. Accompanied by a male family member reduces

opportunities for PA. 2. Traditional dress in public difficult to participate in certain

types of PA.3. Cultural norms and expectations regarding women’s role. 4. General lack of social support for exercise, especially for

women.5. Family obligations took precedence over engagement in

PA. 6. General lack of parental support and peer role modeling.7. Education is afforded higher priority than PA.8. Receiving mixed messages (concerns regarding weight

gain, but provided only conditional support for PA).9. The availability and use housemaids.

III- POLICY BARRIERS Allocation of funding for sports,

especially for women. Villages received less funding for sport

programs.

IV- ENVIRONMENTAL BARRIERS1. The ‘weather’ and ‘lack of exercise facilities’.

2. Lack of culturally appropriate and affordable

exercise facilities or outdoor spaces for activities (e.g., parks), especially for women.

3. Women’s safety.4. Daily use of private driver/cars interfered

with PA.5. lack of adequate public transport systems,

and a lack of ‘walkable’ neighborhoods.

REFERENCES 5- Al-Kaabi J, Al-Maskari F, Saadi H, Afandi B, Parkar H, Nagelkerke N. Physical activity and reported barriers to

activity among type 2 diabetic patients in the United Arab Emirates.Rev Diabet Stud. 2009;6(4):271 –278. 6- Ali HI, Baynouna LM, Bernsen RM. Barriers and facilitators of weight management: perspectives of Arab women at

riskfor type 2 diabetes. Health Soc Care Commun. 2010;18(2):219–228. 7- AlQuaiz AM, Tayel SA. Barriers to a healthy lifestyle among patients attending primary care clinics at a

universityhospital in Riyadh.Ann Saudi Med. 2009;29(1):30–35. 8- Amin TT, Suleman W, Ali A, Gamal A, Al Wehedy A. Pattern, prevalence, and perceived personal barriers toward physical activity among adult Saudis in Al-Hassa, KSA.J Phys Act Health. 2011;8(6):775–784. 9- Berger G, Peerson A. Giving young Emirati women a voice: participatory action research on physical activity.Health

Place. 2009;15(1):117–124. 10- Caperchione CM, Kolt GS, Mummery WK. Physical activity in culturally and linguistically diverse migrant groups to Western society: a review of barriers, enablers and experiences.Sports Med.2009;39(3):167–177. 11- Donnelly TT, Al Suwaidi J, Al Enazi NR, Idris Z, Albulushi AM, Yassin K, Rehman AM, Hassan AH. Qatari women

livingwith cardiovascular diseases – challenges and opportunities to engage in healthy lifestyles.Health Care Women Int.

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cultural and social factors on healthy lifestyle of Arabic women.Avicenna. 2011;2011(3):1 –13, [http://www.qscience. com/doi/full/10.5339/avi.2011.3].

14- Serour M, Alqhenaei H, Al-Saqabi S, Mustafa AR, Ben-Nakhi A. Cultural factors and patients’ adherence to lifestyle measures.Br J Gen Pract. 2007;57(537):291–295.

15- Kahan D. Arab American college students’ physical activity and body composition: reconciling Middle East-West differences using the socioecological model.Res Q Exerc Sport. 2011;82(1):118–128.

16- Shemesh AA, Rasooly I, Horowitz P, Lemberger J, Ben-Moshe Y, Kachal J, Danziger J, Clarfield AM, Rosenberg E. Health behaviors and their determinants in multiethnic, active Israeli seniors.Arch Gerontol Geriatr. 2008;47(1):63–77.

17- Shuval K, Weissblueth E, Araida A, Brezis M, Faridi Z, Ali A, Katz DL. The role of culture, environment, and religion in thepromotion of physical activity among Arab Israelis.Prev Chronic Dis. 2008;5(3):A88. [http://www.cdc.gov/pcd/issues/2008/jul/07_0104.htm].

18- Tami SH, Reed DB, Boylan M, Zvonkovic A. Assessment of the effect of acculturation on dietary and physical activity behaviors of Arab mothers in Lubbock, Texas.Ethn Dis. 2012;22(2):192–197.

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THANK YOU