Research articleWorldwide Variability in Physical Inactivity: A 51-Country Survey
Introduction
Physical inactivity increases the risk of obesity, coronary heart disease and stroke, and type 2 diabetes, as well as colon and breast cancer, and is therefore recognized as one of the most important modifiable risk factors that is causing the rising global burden of chronic diseases.1, 2, 3, 4 Knowledge of the amount of physical activity performed in different populations worldwide is, however, limited.
Many developing countries lack any data on physical activity levels in their populations.1, 5 Where surveys have been performed, data are difficult, if not impossible, to compare.6, 7 Only a few (mainly European) studies have used the same instrument to assess the prevalence of inactivity or the energy expenditure in a wide range of countries.8, 9, 10, 11
To prevent death and disability from chronic disease caused by physical inactivity, these gaps in knowledge need to be filled and the populations and subgroups at risk need to be identified. Country-level baseline information on the prevalence of physical inactivity is needed for governments to be able to formulate policies and programs aiming at the reduction of physical inactivity.4, 12
This study used data from the World Health Survey to estimate the prevalence of physical inactivity for the populations of 51 countries as well as for different subgroups across the countries. The term physical inactivity was chosen because it closely reflects what has been measured, that is, whether or not a person engages in physical activity. In contrast, sedentary behaviors such as number of hours spent sitting have not been assessed.
Section snippets
Study Population and Design
The World Health Survey, a large cross-sectional study, was launched by the WHO in 2001 and conducted in 70 countries in 2002–2003.13 The included countries were selected because they had a large proportion of the world's population; a wide geographic representation across WHO regions; and a spread among high-, middle-, and low-income countries. Countries could choose from a range of questionnaire modules, one of which contained the questions on physical activity from the International Physical
Response Rates and Demographics
The overall response percentage was 81.7%. Country response percentages (Table 1) ranged from 31.0% (Mali) to 98.6% (Uruguay). The percentage of males in the sample was lowest for Guatemala and the Russian Federation (37.2%) and highest for the United Arab Emirates (72.1%). Mean age ranged from 32.4 years (Kenya) to 45.5 years (Croatia). The percentage of people living in urban areas was lowest for India (10.6%) and highest for the Republic of the Congo (94.3%). This information on setting was
Discussion
This study showed that 17.7% (15.2% of men and 19.8% of women) of a pooled sample of 212,021 individuals from 51 mainly low- and middle-income countries were physically inactive. These numbers are relatively low compared to those in other studies that used similar definitions of physical inactivity and were undertaken during the same years in high-income countries. According to results for 2003 from the Behavioral Risk Factor Surveillance System (BRFSS), 52.8% of U.S. citizens were inactive
Conclusion
This study reports, for the first time, the prevalence of physical inactivity for such a large diversity of countries. For many, physical inactivity data have never been previously reported. Results of this study are, with the exception of six countries, based on nationally representative samples from 51 countries, including 212,021 individuals.
The questionnaire used is one of the only questionnaires specifically designed for the international assessment of physical activity, and was tested for
References (50)
- et al.
Comparison of surveys used to measure physical activity
Aust N Z J Public Health
(2004) - et al.
Leisure-time physical activity in university students from 23 countries: associations with health beliefs, risk awareness, and national economic development
Prev Med
(2004) - et al.
Depression, chronic diseases, and decrements in health: results from the World Health Surveys
Lancet
(2007) - et al.
Risk factors surveillance for noncommunicable disease through telephone surveyResults in the autonomous community of Madrid from 1995–2003
Gac Sanit
(2005) - et al.
Who, when, and how much?Epidemiology of walking in a middle-income country
Am J Prev Med
(2005) - et al.
Test-retest reliability of four physical activity measures used in population surveys
J Sci Med Sport
(2004) - et al.
Can sedentary adults accurately recall the intensity of their physical activity?
Prev Med
(2001) - et al.
Physical Inactivity
Preventing chronic diseases: a vital investment
(2005)Updating the evidence that physical activity is good for health: an epidemiological review 2000–2003
J Sci Med Sport
(2004)
Global strategy on diet, physical activity and health
Assessment of physical activity: an international perspective
Res Q Exerc Sport
Prevalence of physical activity in the European Union
Soz Praventivmed
Health-enhancing physical activity across European Union countries: the Eurobarometer study
J Public Health
Distribution and determinants of sedentary lifestyles in the European Union
Int J Epidemiol
Capacity building for an integrated noncommunicable disease risk factor surveillance system in developing countries
Ethn Dis
The World Health Surveys
Compendium of physical activities: an update of activity codes and MET intensities
Med Sci Sports Exerc
World urbanization prospects: the 2003 revision
Health survey for England 2003, Volume 2: Risk factors for cardiovascular disease
The nutrition transition: worldwide dynamics and their determinants
Int J Obes
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