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WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Report from the WHO Physical Activity Global Surveillance
Meeting
Regina Guthold,Technical Officer,
Surveillance and Population-based Prevention,WHO Geneva
Physical Activity SurveillancePhysical Activity Surveillance
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
OverviewOverview
� PA Surveillance and the NCD Action Plan
� GPAQ and IPAQ
� Performance of GPAQ and IPAQ and comparability of results
� Assessment of specific components of PA
� Objective measurement of PA
� Outcomes/recommendations from the global PA Surveillance meeting
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
The global response to NCDsThe global response to NCDs
Global strategy on
Diet, Physical Activity
and Health
Global Strategy for the Prevention and Control of
Noncommunicable Diseases
Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable
Diseases
A six-year Global Action Plan to address cardiovascular disease, cancer, respiratory disease and diabetes was endorsed by the WHO World Health
Assembly on 24 May 2008.
Prevention and Control of Noncommunicable
Diseases: Implementation of the
Global Strategy
2008 2000 2003 2004 2007 2013 implementation
in countries
WHO Framework Convention on
Tobacco Control
Global Strategy on Harmful Use of
Alcohol
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
The WHO NCD Action PlanThe WHO NCD Action Plan
� Heavy and growing burden of NCDs
→2007: Member States requested
WHO to translate "Global Strategy for
the Prevention and Control of NCDs"
into concrete action
→2008: WHA endorsed NCD Action
Plan
→Actions will be implemented from
2008-2013
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Objectives of the WHO NCD Action PlanObjectives of the WHO NCD Action Plan
1. Raise the priority accorded to noncommunicable disease in development workat global and national levels, and to integrate prevention of such diseases into policies across all government departments
2. Establish and strengthen national policies and plans for the prevention and control of noncommunicable diseases
3. Promote interventions to reduce the main shared modifiable risk factors for noncommunicable diseases: tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol
4. Promote research for the prevention and control of noncommunicable diseases
5. Promote partnerships for the prevention and control of noncommunicable diseases
6. Monitor noncommunicable diseases and their determinants and evaluate progress at the national, regional and global levels
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Proposed actionsProposed actions
� For each of the objectives, actions are outlined for
– Member States
– WHO
– International partners
� Surveillance of PA is included in several objectives, but mainly
objective 6 (monitor NCDs and their determinants & evaluate
progress)
– Actions for Member States include
• …strengthen standardised data collection on risk factors…
• …contribute data and information on trends on NCDs and their risk factors
http://www.who.int/nmh/Actionplan-PC-NCD-2008.pdf
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Two internationally used PA surveillance instruments: GPAQ and IPAQ
Two internationally used PA surveillance instruments: GPAQ and IPAQ
Differences
Similarities
� Used for physical activity surveillance in general population
� Developed for international use� Capture intensity, frequency and duration of overall physical activity
� Properties (validity, reliability) similar
�Captures overall physical activity: vigorous, moderate, walking – not
domain specific
� Captures overall physical activity for each domain
separately: work, transport, leisure time
IPAQ-shortGPAQ
Are GPAQ and IPAQ results comparable?
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Use of GPAQ and IPAQUse of GPAQ and IPAQ
� GPAQ– > 50 countries through the WHO STEPwise approach to
chronic disease risk factor surveillance
– 6 countries in WHO Study on Global AGEing and Adult Health
– Other national and subnational surveys (US, France, Switzerland)
� IPAQ– > 25 countries Eurobarometer 1+2
– 20 countries International Prevalence Study
– 51 countries in World Health Survey
– Other national and subnational surveys
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Performance of GPAQ and IPAQPerformance of GPAQ and IPAQ
� Both have similar properties (reliability and validity)
� Both have similar pattern for non-response
� They produce data of similar quality
� IPAQ seems to produce some more over reporting
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
IPAQ GPAQ
>=20,000
15,000-19,999
10,000-14,999
<10,000
Persons reporting extremely high total
activity: IPAQ > GPAQ
Comparing IPAQ World Health
Survey (51 countries) and GPAQ
STEPS (16 countries)
(COMPARABILITY of samples?)
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Results from IPAQ: Eurobarometer and EUPASS
Results from IPAQ: Eurobarometer and EUPASS
Activity Status high, Comparison EB I + EB II + EUPASS (in %)
0
10
20
30
40
50
60
70
80
90
Bel
gium
Den
mar
kW
est
Germ
any
Gre
ece
Ital
y
Spa
inF
ranc
eIr
eland
Nor
thern
Irel
and
Lux
embou
rgN
ethe
rland
sP
ortu
gal
Gre
at B
rita
inE
ast G
erm
any
Fin
land
Sw
eden
Aus
tria
EB I
EB II
EUPASS
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Results from STEPS surveys: PA levels, AFRO,
25-64 year olds
Results from STEPS surveys: PA levels, AFRO,
25-64 year olds
*subnational
0% 20% 40% 60% 80% 100%
Mali*
Mauritania (urban)*
DRC*
Cameroon*
Eritrea
Cote d'Ivoire*
Algeria*
Botswana
Swaziland
Niger*
Ethiopia06 (urban)*
Madagascar*
Seychelles
Cap Verde
Benin (urban)*
Ethiopia03*
Mozambique
% low levels of PA % moderate levels of PA % high levels of PA
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Results from STEPS surveys: Composition of
total PA**, AFRO, 25-64 year olds
Results from STEPS surveys: Composition of
total PA**, AFRO, 25-64 year olds
*Subnational**METs deriving from work, transport, leisure
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
DRC*
Mauritania (urban)*
Cote d'Ivoire*
Mali*
Cameroon*
Eritrea
Botswana
Cap Verde
Benin (urban)*
Seychelles
Swaziland
Algeria*
Niger*
Mozambique
%from work %from transport %from leisure
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Comparability of results from GPAQ and IPAQ (data from same country)
Comparability of results from GPAQ and IPAQ (data from same country)
74.4% - 78.4% = -4.0%19.0% - 13.1% = 5.9%Uruguay
52.1% - 58.4% = -6.3%22.2% - 39.6% = -17.4%Swaziland
55.2% - 51.2% = 4.0%8.4% - 5.2% = 3.2%Country B
80.0% - 73.1% = 6.9%36.3% - 20.4% = 15.9%Country A
95.8% - 91.5% = 4.3%16.9% - 37.7%= -20.8%Mauritania (urban)
74.1% - 65.7% = 8.4%15.6% - 11.8% = 3.8%Chad (urban)
% no vigorous activity
GPAQ-IPAQ
% inactive
GPAQ-IPAQ
Limitation: Data from same country, but not same sample and not same years
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Assessment of specific aspects of PAAssessment of specific aspects of PA
� Discussions around assessment of
– strength
– flexibility
– sitting
– environment
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Objective measurement of PAObjective measurement of PA
Two examples:
� Pedometer data from a national survey in Canada
(CANPLAY)
– 5-19 year old children
� Accelerometer data from a national survey in the US
(NHANES)
– adults
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
OutcomesOutcomes
� Confirm utility of GPAQ in population PA surveillance
– GPAQ is a short, widely used global measure
– GPAQ measurement properties are acceptable
– GPAQ is domain specific (valuable information for
interventions and characterising PA in populations)
– Works well in both developed and developing countries
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
RecommendationsRecommendations
� All countries should engage in regular PA surveillance
� Research recommendations:
– Explore the feasibility and accuracy of only assessing "PA
days" of PA to characterise total population levels of PA
– Explore possibility of data adjustment to achieve comparability
between GPAQ and existing national instruments
– Review evidence related to health effects of occupational PA
and explore existing GPAQ datasets with regards to over
reporting in occupational PA
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Recommendations, cont.Recommendations, cont.
� Research recommendations, cont.:
– Related to assessment of PA in children:
• Further validation of GSHS questions
• Explore possibilities to add objective measurement and standard expanded questions to existing questionnaire modules
– Related to objective measurement of PA:
• Review use of objective measurement in population studies
• Develop standardised protocol for use of objective measurement
• Special focus on objective measurement in children – youth
WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009
Recommendations, cont.Recommendations, cont.
� Research recommendations, cont.:
– Related to other components of physical activity:
• Explore possibility to add simple physical measures of strength and flexibility to Step 2 of STEPS (grip strength, simple balance test)
• Review literature related to flexibility and health outcomes
– Related to sitting:
• Review research on sitting and related health outcomes
• Explore patterns of sitting using existing GPAQ and IPAQ data
• Validation studies related to sitting questions
� Develop global status report on PA advocacy, surveillance and best practice