Epidemiology of physical activity in the Middle East

1. 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.

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

3. Recreational or leisure- time PA Active transport or commuting Work- related activity, household chores Play, games, and sports or planned exercise sessions

4. • 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

5. -35 -30 -25 -20 -15 -10 -5 0 Ischemic Heart Diabetes Colon cancer Post menopuasl BC % 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)

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

7. 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.

8.  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)

9.  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.

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

13. 32.2 19.7 53.2 33.4 43.9 49.2 52.8 24.1 25.1 27.7 44.6 27.3 68.7 49.7 33.8 63.9 45.8 42.9 39.4 41.2 United Arab Emirates Tunisia Saudi Arabia Qatar Lebanon Kuwait Iraq Iran Egypt Algeria Figure 1. Insufficeintly active adult population (% prevalence estimates by genders) year 2010, Middle East. Insufficiently active (age-standardized estimate) Male Insufficiently active (age-standardized estimate) Female Source: WHO observatory 2015

14. 11.3 17.3 19.8 20.9 23.1 25.6 26.7 18.1 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 SEAsia Africa Global Europe WPacific EMR Americas Figure 2. Insufficient physical activity (estimate prevalence in %) among adults by WHO regions, 2010. Male Female Both sexes Source: WHO observatory 2015.

15. 1. 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.

16. 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.

17.  Allocation of funding for sports, especially for women.  Villages received less funding for sport programs.

18. 1. 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.

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