Report from the WHO Physical Activity Global Surveillance ... · WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009 Overview PA Surveillance and the NCD Action

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


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


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


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


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


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


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?


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


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?)


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


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


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


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


Assessment of specific aspects of PAAssessment of specific aspects of PA

� Discussions around assessment of

– strength

– flexibility

– sitting

– environment


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


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


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


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


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

Documents

Report from the WHO Physical Activity Global Surveillance ... · WHO Physical Activity Global Surveillance Meeting | Geneva, Feb. 2009 Overview PA Surveillance and the NCD Action