Motivational program to promote physical activity


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Presentation on a study of a motivational program using education and pedometer to promote physical activity among women in Saudi Arabia

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  • The prevalence of phyasical inactivity is considered very high all over the world, but countries vary and we can see that the high-income and upper-middle income countries have the higher risk, including Saudi Arabia.
  • For that reason, the WHO has launched the Global strategy on Diet, physical activity and health (DPAS) in order to tackle these lifestyle modifiable issues to reduce the burden of NCD
  • Saudi Arabia is one of the EMRO countries who embraced this global strategy, and the Ministry of Health held an international conference on healthy lifestyle and NCD in the Arab world.
  • Unfortunately, numerous studies have reported low levels of physical activity among the Saudi population. Unfortunately the literature suggests an alarming level of physical inactivity among the Saudi population, predisposing our society to health problems. However, the majority of studies conducted on the Saudi society focus on either male population or children and adolescents.
  • Therefore, the primary focus of this study is females, and u are probably thinking that I am so biased, and in part I am but there is a good scientific reason to back me up and that is: The Saudi Female Population warrants special attention. To begin with, the literature suggests a specific gender-based consideration when making recommendations to promote physical activity (White et al., 2005). Thus, intervention and motivation programs should be customized to suit the individuals’ needs with gender as a primary consideration. In particular, prevalence of obesity related to sedentary life style has been escalating among Saudi females. Therefore, it is necessary to understand how social factors imposed upon Saudi women affect women’s health and wellness.
  • Subsequently, Clinical practitioners often prescribe physical activity as an essential component of managing many health conditions. And an excellent manifestation of this trend is the recently launched HILSTM.However, medical advice alone has not been effective in promoting physical activity.On the other hand, much has been published on means to promote physical activity. Yet, there is no universally accepted method due to the multiple factors that influence physical activity. And the reason is the complex and multiple factors that affect PA, in otherwords, what we refer to here as correlates of physical activity.
  • The most advocated form of physical activity is walking. Walking is suggested as the mode of activity most likely to increase physical activity at a population level, particularly for sedentary adults.Walking behavior has received recent attention based on its physical (Manson et al., 2002) and psychological (Blacklock, Rhodes, & Brown, 2007) health benefits and its lower intensity, high accessibility, ease to physically perform, and low cost in comparison to other PAs (Duncan & Mummery, 2005; Rhodes, Brown, & McIntyre, 2006).Pedometers are considered valid and reliable tools with which to measure physical activity (Tudor-Locke, 2004)Recently, the use of small electronic devices, known as pedometers, has been considered an objective measure of physical activity.
  • This poster is a source of joy and pride, because it was designed by a saudi female artist that volunteered to help us, and its release was revolutionary.
  • Workers = (administrative jobs, academics, private sector workers, etc) (e.g., heart disease) (e.g., heart disease)
  • In a comparison of five electronic pedometers, the Yamax most accurately recorded the number of steps taken (distance), had the most consistency between units, and was the most accurate (Bassett et al., 1996).
  • The intervention was in consideration with the results of preious work on correlates of physical activities among Saudi women. Focused on emphasizing self-efficacy and internal locus of control.
  • Average step count over 8 weeks period
  • Social constraints, limited places for women to practice physical activity, Hot climateOn a global level, data from the WHO have shown that physical inactivity is more prevalent among girls and women than their male counterparts, regardless of their country of origin.51 Some of the factors reported by WHO that hinder the participation of women in physical activity and their access to health care include lower income, greater workload in the home and in care-giving roles, limited mobility, and cultural restrictions
  • One-way repeated measure analysis of variance revealed that there were no significant differences between groups (experimental vs control) nor across the two assessment times (baseline and post-intervention) for either physical activity levels (i.e. step-count) or general health outcomes. The Wilks’ Lambda test indicated that there were no significant interactions between the groups and time for any variables.
  • A population-based randomized controlled trial of the effect of combining a pedometer with an intervention toolkit on physical activity among individuals with low levels of physical activity or fitness.No significant difference in all parameters More walking time among older adults study needs to be interpreted within the context of its limitations. First, the sampling frame of Riyadh may not generalize to other regions.although the samples obtained for this research were representative of the Riyadh adult population in terms of sociodemographics, the subsequent attrition rate was high. One limitation of the study is a small homogeneous self-selected sample.Subjects who volunteered were already involved in regular physical activity, were more likely to be married, more likely to have higher family income, and tended to have higher self-efficacy (Speck & Looney, 2001)
  • Motivational program to promote physical activity

    2. 2. WCPT-AWP Congress 2013
    3. 3. Saudi Women’s Health WCPT-AWP Congress 2013
    4. 4. Physical Inactivity a Major Risk Risk Factors for NCD (%) 40 35 30 25 20 15 10 5 0 WCPT-AWP Congress 2013 According to MOH / WHO 2012 - 2013
    5. 5. Non-Communicable Diseases Cause of Death WCPT-AWP Congress 2013 According to WHO 2010
    6. 6. Globally, 31% of adults aged 15+ were insufficiently active (men 28% and women 34%) (WHO 2008) WCPT-AWP Congress 2013
    7. 7. In May 2004, the 57th World Health Assembly (WHA) endorsed the World Health Organization (WHO) Global Strategy on Diet, Physical Activity and Health. The Strategy was developed through a wide-ranging series of consultations with all concerned stakeholders in response to a request from Member States at World Health Assembly 2002 (Resolution WHA55.23). WCPT-AWP Congress 2013
    8. 8. Conference on healthy lifestyle and non-communicable diseases in the Arab world and the Middle east WCPT-AWP Congress 2013
    9. 9. Relevance  Alarming level of physical inactivity among the Saudi population: inactivity prevalence 97% (Al-Nozha et al, 2007; Al-Rafaee & Al-Hazzaa, 2001)  Saudi populations studied: males, children, adolescents (Al-Hazzaa, 2002; Al-Hazzaa & Sulaiman, 1993) WCPT-AWP Congress 2013
    10. 10. Saudi Females?  The literature suggests a specific gender-based consideration when making recommendations to promote physical activity gender as a primary consideration (White et al., 2005)  Prevalence of obesity related to sedentary life style has been escalating among Saudi females (El-Hazmi & Warsy, 2000) WCPT-AWP Congress 2013
    11. 11. How active?? Step count.. 12000 10000 8000 6000 KSA Target 4000 2000 0 KSA vs Target Step count (Al-Eisa and Al-Sobayel 2012) WCPT-AWP Congress 2013
    12. 12. Step counts around the world 10000 9000 8000 KSA 7000 UK USA 6000 Canada 5000 Ger 4000 Japan 3000 Swiss 2000 Finland 1000 Aust 0 Country (Al-Eisa and Al-Sobayel 2012) WCPT-AWP Congress 2013
    13. 13. Prescribing PA There is no universally accepted method to promote physical activity due to the multiple factors that influence physical activity WCPT-AWP Congress 2013
    14. 14. Why walking? The most likely to increase physical activity: • a population level (Hillsdon & Thorogood, 1996) • for sedentary adults (Ogilvie et al, 2007) • • • • Physical & psychological health benefits Low intensity & high accessibility Ease to physically perform Low cost (Blacklock et al., 2007; Duncan & Mummery, 2005; Manson et al., 2002; Rhodes et al, 2006) WCPT-AWP Congress 2013
    15. 15. Pedometer Promote PA? Using a pedometer can provide a reminder to be more  active Pedometers when used in combination with other  strategies improved physical activity (Chan et al., 2004; Dinger et al., 2007; De Cocker et al., 2008 ) WCPT-AWP Congress 2013
    16. 16. Objective Effectiveness of the use of a pedometer, in addition to a motivational education program, in improving adherence to a walking program , and improving physical activity levels and general health parameters of Saudi women. WCPT-AWP Congress 2013
    17. 17. Methods WCPT-AWP Congress 2013
    18. 18. Inclusion criteria Exclusion criteria - History of fracture or surgery to the back, pelvis, or lower limb - Saudi females (18-45 yrs) - Contraindications to increased walking - Residing in Riyadh - Current complain of conditions affecting the ability to walk - Able to read and write - Pregnancy - Eating disorders - Conditions affecting cognitive function or communication WCPT-AWP Congress 2013
    19. 19. Measurement of walking  Pedometers are small devices that can be worn at the waist or ankle, and are capable of counting number of steps (Vitolins et al, 2000)  Pedometers are considered valid and reliable tools with which to measure physical activity (Tudor-Locke, 2004) WCPT-AWP Congress 2013
    20. 20. Measurement of Health Parameters BMI  Blood pressure  Heart rate  Blood glucose level  Percutaneous oxygen saturation (SpO2),  Fat composition  WCPT-AWP Congress 2013
    21. 21. Intervention A single 2 hour educational session:  conducted by two senior physical therapists, both of whom were experienced in patient education, and included information regarding the importance of physical activity and provision of a handout on the benefits of regular walking. Weekly motivational text messages sent to the  participants’ mobile phones. WCPT-AWP Congress 2013 
    22. 22. Procedure Study group (n=81) Control group (n=80) 2 hrs educational session  Weekly motivational text  messages Pedometer daily record  2 hrs educational session  Weekly motivational text  messages WCPT-AWP Congress 2013
    23. 23. Results WCPT-AWP Congress 2013
    24. 24. Participants WCPT-AWP Congress 2013
    25. 25. Step Count 6200 6000 Average Step Count 5800 5600 Step count 5400 5200 5000 1 2 3 4 5 Weeks WCPT-AWP Congress 2013 6 7 8
    26. 26. Low step count Step count did not improve after the  intervention The social & environmental context could be a barrier to increasing physical activities. (Mabry et al. 2010) Prevalence of physical inactivity is high among women world wide. (WHO 2009) WCPT-AWP Congress 2013
    27. 27. Environment WCPT-AWP Congress 2013
    28. 28. Effectiveness of the Intervention Adherence to the  intervention by the experimental group was significantly higher (p = 0.021) 40% Other measures: no  significant difference 90% Intervention WCPT-AWP Congress 2013 Control
    29. 29. Health outcomes No change of health outcomes:  Good health status on baseline Short term intervention   Combining pedometer with an intervention toolkit on physical activity did no difference in Denmark. (Petersen et al. 2012) WCPT-AWP Congress 2013
    30. 30. What’s Next Consider physical behavious not only physical activity “Number of steps or walking duration may not be a good estimator of time being active, and that a considerable underestimation may occur.” (Bussmann & van den Berg-Emon 2013) Need for multi-sectorial interventions Consider context and beliefs WCPT-AWP Congress 2013
    31. 31. WCPT-AWP Congress 2013
    32. 32. Acknowledgment  King Saud University  King Abdulaziz City for Science & Technology WCPT-AWP Congress 2013