BARRIERS TO PHYSICAL ACTIVITY

PARTICIPATION
AMONG ADULTS
AN END OF OBSTETRICS AND
GYNAECOLOGY/HEALTH PROMOTION
POSTING PRESENTATION

BY

AYODELE, AYOBAMI EMMANUEL

Presented at the Department of

Physiotherapy University of Abuja Teaching
Hospital Gwagwalada, Abuja
18/05/2017
(16th May, 2017)
Ayodele Ayobami Emmanuel 1
CONTENTS

• Introduction - NCDs
• Physical Inactivity
• Global recommendations for Physical Activity
• Benefits of physical activity
• Barriers to physical activity participation
• Role of physiotherapists in the promoting
awareness
• Assessing barriers to physical activity
• Suggestions for overcoming physical activity barriers
• References

18/05/2017 Ayodele Ayobami Emmanuel 2

INTRODUCTION

• Non-communicable diseases (NCDs) impose a large burden

on human health worldwide.
• Currently, more than 60% of all deaths worldwide stem from
NCDs
(WHO, 2005) (Figure 1).
• Moreover, what were once considered “diseases of
affluence” have
now encroached on developing countries (Bloom et al, 2011).
• In 2008, roughly 4 out of 5 NCD deaths occurred in low- and
middle-
income countries (WHO, 2011), from just under 40% in 1990
(Murray
& Lopez, 1997).
• NCDs are defined as diseases of long duration, generally slow
progression and they are the
18/05/2017 major
Ayodele cause of adult mortality
Ayobami Emmanuel 3
Figure 1: NCDs constitute more than 60% of
deaths worldwide
Injuries
9%

Cardiovascular
diseases
30%

Other conditions*
30%

CRD Other chronic Cancer

7% diseases 13%
9%
DM
2%

* “Other conditions” comprises communicable diseases, maternal and perinatal conditions and
nutritional
deficiencies.
Source: (WHO, 2005)
18/05/2017 Ayodele Ayobami Emmanuel 4
NCDs
• Four main diseases are generally considered to be dominant in NCD
mortality and morbidity: cardiovascular diseases (including heart
disease and stroke), diabetes, cancer and chronic respiratory
diseases (including COPD and asthma)

• A shift toward more sedentary lifestyles, which has accompanied

economic growth, the shift from agricultural economies to
service- based economies, and urbanization in the developing
world.

• Spreading of the fast food culture, sedentary lifestyle and increase

in bodyweight has led some to coin the emerging threat a
“globesity” epidemic (Bifulco & Caruso, 2007; Deitel, 2002;
Schwartz, 2005).

•18/05/2017
A major modifiable risk factor
Ayodelefor NCDs
Ayobami is Physical Inactivity (PI).
Emmanuel 5
PHYSICAL INACTIVITY
• PI (achieving less than 30 minutes of moderate intensity physical
activity per week) is now identified as the fourth leading risk
factor for global mortality (WHO, 2010).

• PI levels are rising in many countries with major implications for

the prevalence of NCDs and the general health of the population
worldwide.

• WHO determined that approximately 31% of adults over 15 years

old were insufficiently active in 2008, with males being slightly more
active than females.

• PI increases the risk of coronary heart and CVD, T2DM,

hypertension,
several cancers, osteoporosis/fractures and dementia, among
others.
18/05/2017 Ayodele Ayobami Emmanuel 6
FIGURE 2: THE PROBABILITY OF
DYING BETWEEN AGES 30 AND 70
YEARS FROM
FOUR MAIN THE (WHO,
NCDS
2014)
25%

20%

15%

10%

5%

0%
Nigeria USA UK Canada

18/05/2017 Ayodele Ayobami Emmanuel 7

RECOMMENDED LEVELS OF PHYSICAL ACTIVITY
FOR ADULTS AGED 18 - 64 YEARS (WHO, 2012)
• Adults aged 18–64 should do at least 150 minutes of moderate-
intensity aerobic physical activity throughout the week or do at
least 75 minutes of vigorous-intensity aerobic physical activity
throughout the week.
• Aerobic activity should be performed in bouts of at least 10
minutes duration.
• For additional health benefits, adults should increase their
moderate- intensity aerobic physical activity to 300 minutes per
week, or engage in 150 minutes of vigorous-intensity aerobic
physical activity per week.
• Muscle-strengthening activities should be done involving
major muscle groups on 2 or more days a week.

18/05/2017 Ayodele Ayobami Emmanuel 8

BENEFITS OF PHYSICAL ACTIVITY

• PA clearly leads to ↑ physical fitness, exercise capacity, and

risk reduction of a wide variety of pathological diseases &
clinical disorders.

• Resulting in lower rates of morbidity, mortality, and ↑

life expectancy.

• Even among the very old “not only continuing but also initiating”
PA is associated with better survival and function.

18/05/2017 Ayodele Ayobami Emmanuel 9

BARRIERS TO PHYSICAL ACTIVITY
PARTICIPATION
• Given the health benefits of regular PA, adults
insufficiently participate in it.

• This reality clearly points to the need to help adults become

more physically active.

• There are barriers that keep adults from being, or

becoming, physically active regularly.

• Understanding common barriers to PA and creating strategies

to overcome them may help make it part of daily life.

18/05/2017 Ayodele Ayobami Emmanuel 10

BARRIERS TO PHYSICAL
ACTIVITY
EXTERNAL INTERNAL
PARTICIPATION (MANAF, 2013)
Not enough time Too tired

No one to exercise with Too lazy

Causes too much pain Ashamed

Exercise interferes with work Do not know how to do it

Cost Already active enough

Lack of facilities Injury

Lack of transportation Limiting health problem

Limiting Culture Lack of motivation

18/05/2017 Ayodele Ayobami Emmanuel 11

ROLE OF PHYSIOTHERAPISTS
• PA can take the form of a structured exercise programme or the
accumulation of activities of daily living or leisure exercise (Abaraogu et
al, 2016).

• Whatever form it takes, a health promotion intervention focusing on PA

would help reduce inactivity as a way of decreasing the incidence of NCDs
or their sequelae.

• It has been argued that physiotherapists are ideally placed to promote PA

to combat the impact of chronic diseases of lifestyle (Frantz & Ngambare,
2013).

• Physiotherapists take health promotion as an integral role as it is

currently one of the core competencies expected from the physiotherapy
profession (Whitehead, 2003).

18/05/2017 Ayodele Ayobami Emmanuel 12

ASSESSING BARRIERS TO PHYSICAL
ACTIVITY
• A number of methods have been used to assess the barriers to
physical activity in various studies among the adult
populations.
• They include:

• International Physical Activity Questionnaire (IPAQ)

• Influences on Physical Activity Instrument (IPAI)

• Exercise Benefits/Barriers Scale (EBBS)

• Pender’s Health Promotion Model

18/05/2017 Ayodele Ayobami Emmanuel 13
SUGGESTIONS FOR OVERCOMING PHYSICAL
ACTIVITY BARRIERS (CDC)
• Lack of time
• Identify available time slots. Monitor daily activities for one week. Identify
at least three 30-minute time slots that could be use for physical activity.
• Add physical activity to daily routine. For example, walk or ride bike to work
or shopping, organize school activities around physical activity, walk the
dog, exercise while watching TV, park farther away from the destination,
etc.
• Select activities requiring minimal time, such as walking, jogging, or stair
climbing.
• Lack of energy
• Schedule physical activity for times in the day or week when
feeling energetic.
• Convincing self that if giving it a chance, physical activity will
increase energy level.
18/05/2017 Ayodele Ayobami Emmanuel 14
SUGGESTIONS

• Lack of motivation
• Plan ahead. Make physical activity a regular part of daily or
weekly schedule and write it on a calendar.
• Invite a friend to exercise on a regular basis and write it on
both calendars.
• Join an exercise group or class.

• Fear of injury
• Learn how to warm up and cool down to prevent injury.
• Learn how to exercise appropriately considering your age,
fitness level, skill level, and health status.
• Choose activities involving minimum risk.

18/05/2017 Ayodele Ayobami Emmanuel 15

SUGGESTIONS

• Lack of resources
• Select activities that require minimal facilities or equipment, such as
walking, jogging, skipping rope.
• Identify inexpensive, convenient resources available in your
community (community education programs, park and
recreation programs, worksite programs, etc.).

• Weather conditions
• Develop a set of regular activities that are always available
regardless of weather (indoor cycling, aerobic dance, indoor
swimming, stair climbing, rope skipping, mall walking, dancing,
gymnasium games, etc.)

18/05/2017 Ayodele Ayobami Emmanuel 16

SUGGESTIONS

• Family obligations
• Trade babysitting time with a friend, neighbour, or family member
who also has small children.
• Exercise with the kids-go for a walk together, play tag or other
running games, get an aerobic dance or exercise tape for kids
(there are several on the market) and exercise together. Spend
time together and still get your exercise.
• Jump rope, ride a stationary bicycle, or use other home gymnasium
equipment while the kids are busy playing or sleeping.
• Try to exercise when the kids are not around (e.g., during
school hours or their nap time).

18/05/2017 Ayodele Ayobami Emmanuel 17

SUGGESTIONS

• Social influence
• Explain interest in physical activity to friends and family. Ask to
support efforts.
• Invite friends and family members to exercise. Plan social
activities involving exercise.
• Develop new friendships with physically active people. Join a group,
a hiking club.
• Lack of skill
• Select activities requiring no new skills, such as walking,
climbing stairs, or jogging.
• Take a class to develop new skills.

18/05/2017 Ayodele Ayobami Emmanuel 18

SUGGESTIONS

• Travel
• Jump rope in suitcase and jump rope.
• Walking the halls and climb the stairs in hotels.
• Stay in places with swimming pools or exercise facilities.
• Joining a local gym/club
• Visit the local shopping mall and walk for half an hour or
more.
• Mp3 player for favourite aerobic exercise music.

18/05/2017 Ayodele Ayobami Emmanuel 19

REFERENCES
• Abaraogu, U.O., Edeonuh, J.C. and Frantz, J., 2016. Promoting Physical Activity
and Exercise in Daily Practice: Current Practices, Barriers, and Training Needs of
Physiotherapists in Eastern Nigeria. Physiotherapy Canada, 68(1), pp.37-45.
• Bifulco, M., & Caruso, M. G. (2007). From the gastronomic revolution to the new
globesity epidemic. J Am Diet Assoc,107(12), 2058-2060.
• Bloom, D.E., Cafiero, E.T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R.,
Fathima, S., Feigl, A.B., Gaziano, T., Mowafi, M., Pandya, A., Prettner, K.,
Rosenberg, L., Seligman, B., Stein, A.Z., & Weinstein, C. (2011). The Global
Economic Burden of Noncommunicable Diseases. Geneva: World Economic
Forum.
• Centers for Disease Control and Prevention. “Overcoming Barriers to Physical
Activity.” Physical Activity for Everyone. Available @ https://www.cdc.gov/physic
alactivity/basics/adding-pa/barriers.html Accessed on 13/04/2017
• Deitel, M. (2002). The International Obesity Task Force and “globesity”. Obes
Surg, 12(5), 613-614.

18/05/2017 Ayodele Ayobami Emmanuel 20

REFERENCES
• Frantz, J.M. and Ngambare, R., 2013. Physical activity and health promotion
strategies among physiotherapists in Rwanda. African health sciences, 13(1), pp.17-
23.
• Manaf, H., 2013. Barriers to participation in physical activity and exercise among
middle-aged and elderly individuals. Singapore Med J, 54(10), pp.581-586.
• Muhic, E., Thomas, E. and Lee, M., Physical Inactivity.
http://www.physio- pedia.com/Physical_Inactivity Accessed on
13/05/2017
• Murray, C. J., & Lopez, A. D. (1997). Mortality by cause for eight regions of the
world: Global Burden of Disease Study. Lancet, 349(9061), 1269-1276.
• Schwartz, I. D. (2005). “Globesity” and units of measurements. J Pediatr, 146(4),
577;
author reply 577.
• Whitehead D. Evaluating health promotion: a model for nursing practice. Journal
of Advanced Nursing. 2003;41(5):490–498
• World Health Organization. (WHO 2005). Preventing chronic diseases: a
vital investment. WHO global report. Geneva: World Health Organization.
18/05/2017 Ayodele Ayobami Emmanuel 21
REFERENCES
• World Health Organization. (WHO 2011). Global status report on non-
communicable diseases 2010. Geneva: World Health Organization.
• World Health Organization, author. Global Recommendations on Physical activity
for Health. 2010. Available @ www.who.int/dietphysicalactivity/factsheet_recom
mendations/en/index.html Accessed on 13/05/2017
• World Health Organization, 2012. Recommended levels of physical activity for
adults aged 18–64 years.
• World Health Organization, 2014. Noncommunicable diseases country profiles
2014.

18/05/2017 Ayodele Ayobami Emmanuel 22