Research article
Physical Activity in 22 African Countries: Results from the World Health Organization STEPwise Approach to Chronic Disease Risk Factor Surveillance

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Background

Baseline physical activity data are needed to effectively plan programs and policies to prevent noncommunicable diseases, but for many African countries these data are lacking.

Purpose

To describe and compare levels and patterns of physical activity among adults across 22 African countries.

Methods

Data from 57,038 individuals from 22 countries (11 national and 11 subnational samples) that participated in the STEPwise approach to chronic disease risk factor surveillance (2003–2009) were analyzed in 2010. The validated Global Physical Activity Questionnaire (GPAQ) was used to assess days and duration of physical activity at work, for transport, and during leisure time in a typical week.

Results

Overall, 83.8% of men and 75.7% of women met WHO physical activity recommendations (at least 150 minutes of moderate activity per week or equivalent). Country prevalence ranged from 46.8% (Mali) to 96.0% (Mozambique). Physical activity, both at work and for transport, including walking, had large contributions to overall physical activity, while physical activity during leisure time was rare in the analyzed countries.

Conclusions

Physical activity levels varied greatly across African countries and population subgroups. Leisure time activity was consistently low. These data will be useful to inform policymakers and to guide interventions to promote physical activity.

Introduction

The benefits of being physically active include a lower risk of cardiovascular disease, stroke, diabetes, hypertension, colon and breast cancer, and depression. Additionally, physical activity is fundamental to energy balance and weight control.1, 2

The need for physical activity data to effectively plan policies and programs to prevent chronic conditions and noncommunicable diseases (NCDs) has been recognized, and the WHO 2008–2013 Action Plan for the Global Strategy for the Prevention and Control of NCDs urges countries to strengthen surveillance systems and standardized data collection on risk factors, including physical inactivity, using existing WHO tools.3

For many African countries, baseline physical activity data have been lacking. The WHO STEPwise approach to chronic disease risk factor surveillance (STEPS) was initiated in 2000 to assist low- and middle-income countries to collect these data along with information on other risk factors.4, 5

For the assessment of physical activity within STEPS, the Global Physical Activity Questionnaire (GPAQ) is used.6 Physical activity is performed in different domains of life such as work, transport, and leisure time, and the patterns vary across different settings and cultures. Not only leisure-time physical activity but also physical activity performed in other domains provide health benefits.7 The GPAQ therefore captures physical activity at work and in the household, for transport, and during leisure time. The contributions of each of the domains to overall physical activity can then be calculated and, additionally, overall physical activity levels can be computed. The GPAQ has been tested for reliability and validity in ten countries. Reliability coefficients were of moderate to substantial strength, and criterion validity was poor to fair.8, 9 The objective of this paper is to describe and compare physical activity levels among adults across 22 countries from the WHO African Region, and to examine patterns of physical activity in these countries.

Section snippets

Study Population and Design

The analysis included 57,038 subjects aged 25–64 years from 22 African countries that conducted a cross-sectional NCD risk factor survey based on the STEPS approach between 2003 and 2009. All WHO Member States are eligible to participate in STEPS; however, participation is a country decision based on the perceived need of an NCD risk factor survey, available resources, and capacity to implement the survey. STEPS focuses on obtaining data on eight behavioral and biological risk factors that

Sample Sizes and Demographics

Final sample size ranged from 1058 (Mali) to 6709 (Benin). The overall percentage of valid records was 81.7%, with the lowest value for Sierra Leone (48.0%) and the highest for the Democratic Republic of the Congo and Seychelles (99.8%). For four countries, this percentage was lower than 70% (Madagascar, Mali, Mauritania, and Sierra Leone). Most samples were predominantly female. The mean age of the total sample was 40.4 years, with most country mean ages close to this value. The Human

Comparison with Other International Studies and Cut-Offs

About 84% of men and 76% of women in this sample of 22 African countries met WHO recommendations. When using this new definition, prevalence values were generally—as shown in other studies15—about 5% to 10% higher as compared to the “GPAQ active” definition that was based on earlier recommendations.16, 17 This difference is due to the new recommendations not including any frequency requirement for either moderate- or vigorous-intensity activity.

The GPAQ active cut-offs have been used in many

Conclusion

This study showed a wide range of physical activity levels and patterns across African countries, with leisure-time activity consistently being the least performed activity type in all settings. Insufficient physical activity is a public health problem in some countries and population subgroups in Africa. Unless action is taken in these settings, the low level of physical activity is likely to contribute to the rise of NCDs in the region.27, 49, 50 Although the burden of infectious diseases

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