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
(16th May, 2017)
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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

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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 major cause of adult mortality and
morbidity worldwide (WHO, 2005).

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Figure 1: NCDs constitute more than 60% of
deaths worldwide
Injuries
9%

Cardiovascular
diseases
30%

Other conditions*
30%

Other chronic Cancer

CRD diseases 13%
7% 9%
DM
2%

* “Other conditions” comprises communicable diseases, maternal and perinatal conditions and nutritional
deficiencies.
Source: (WHO, 2005)

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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).

• A major modifiable risk factor for NCDs is Physical Inactivity (PI).

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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.

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FIGURE 2: THE PROBABILITY OF DYING
BETWEEN AGES 30 AND 70 YEARS FROM THE
FOUR MAIN NCDS (WHO, 2014)
25%

20%

15%

10%

5%

0%
Nigeria USA UK Canada

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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.

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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.

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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.

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BARRIERS TO PHYSICAL ACTIVITY
PARTICIPATION (MANAF, 2013)
EXTERNAL INTERNAL

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

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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).

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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

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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.

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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.

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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.)

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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).

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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.

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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.

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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/physicalactivity/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.

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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.

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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_recommendations/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.

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