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Compliance with physical activity guidelines in rural, black South Africans in the Limpopo Province: an energy expenditure approach
  1. Ian Cook1,
  2. Marianne Alberts2,
  3. Estelle V Lambert3
  1. 1Physical Activity Epidemiology Laboratory, University of Limpopo (Turfloop Campus), Sovenga, South Africa
  2. 2Department of Medical Sciences, University of Limpopo (Turfloop Campus), Sovenga, South Africa
  3. 3MRC/UCT Research Unit for Exercise Science and Sports Medicine, University of Cape Town Medical School, Cape Town, South Africa
  1. Correspondence to Ian Cook, Physical Activity Epidemiology Laboratory, University of Limpopo (Turfloop Campus), PO Box 459, Fauna Park, 0787, Polokwane, Limpopo Province, South Africa; ianc{at}


Objective The authors used an energy expenditure–based approach to determine the non-compliance and compliance with public health physical activity (PA) guidelines in rural, black South Africans.

Methods The authors analysed 7-day objectively measured PA data (NL-2000 pedometer) in 508 females and 267 males. Compliance was defined for the American College of Sports Medicine guideline (ACSM: ≥7.5 to <21 kcal/kg/week and ≥1.5 kcal/kg/day for ≥5 days/week) and the Institute of Medicine guideline (IOM: ≥21 kcal/kg/week and ≥3 kcal/kg/day for 7 days/week).

Results The age- and sex-adjusted prevalence for non-compliance, ACSM compliance and IOM compliance in the sample was 7.8%, 55.0% and 37.2%, respectively. Complying with IOM guidelines required substantially more ambulation (14 522 steps/day) than ACSM guidelines (10 837 steps/day) and non-compliance (6420 steps/day) (p<0.0001). Approximately 95% of IOM-compliant subjects and 51% of ACSM-compliant subjects achieved ≥10 000 steps/day on 4–7 days. Compliance with IOM or ACSM guideline was associated with an 87% (p<0.0001) and a 49% (p=0.0647) reduced risk of obesity, respectively. Partial and full IOM compliance was associated with a significantly reduced risk of obesity (OR=0.58 to 0.16, p<0.04).

Conclusions The 10 000 steps/day guideline concurs with the ACSM guideline, whereas IOM compliance required higher ambulation levels. Compared with ACSM compliance, IOM compliance was associated with a lower risk of obesity.

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  • Funding The Research Development and Administration Division of the University of Limpopo (Turfloop Campus) and the Thuthuka Programme of the National Research Foundation supported this study.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Limpopo.

  • Provenance and peer review Not commissioned; externally peer reviewed.