Physical activity level and its sociodemographic correlates in a peri-urban Nepalese population: a cross-sectional study from the Jhaukhel-Duwakot health demographic surveillance site

International Journal of Behavioral Nutrition and Physical Activity

Alexandra Krettek¹  Abhinav Vaidya¹ 

[1] Nordic School of Public Health NHV, Gothenburg, Sweden

关键词: Diabetes;    Hypertension;    Smoking;    Occupation;    Ethnicity;    Cardiovascular disease;   

Others  :  803917
DOI  :  10.1186/1479-5868-11-39

 received in 2013-06-26, accepted in 2014-03-10,  发布年份 2014

【 摘 要 】

Background

Physical inactivity is a leading risk factor for cardiovascular and other noncommunicable diseases in high-, low- and middle-income countries. Nepal, a low-income country in South Asia, is undergoing an epidemiological transition. Although the reported national prevalence of physical inactivity is relatively low, studies in urban and peri-urban localities have always shown higher prevalence. Therefore, this study aimed to measure physical activity in three domains—work, travel and leisure—in a peri-urban community and assess its variations across different sociodemographic correlates.

Methods

Adult participants (n = 640) from six randomly selected wards of the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS) near Kathmandu responded to the Global Physical Activity Questionnaire. To determine total physical activity, we calculated the metabolic equivalent of task in minutes/week for each domain and combined the results. Respondents were categorized into high, moderate or low physical activity. We also calculated the odds ratio for low physical activity in various sociodemographic variables and self-reported cardiometabolic states.

Results

The urbanizing JD-HDSS community showed a high prevalence of low physical activity (43.3%; 95% CI 39.4–47.1). Work-related activity contributed most to total physical activity. Furthermore, women and housewives and older, more educated and self-or government-employed respondents showed a greater prevalence of physical inactivity. Respondents with hypertension, diabetes or overweight/obesity reported less physical activity than individuals without those conditions. Only 5% of respondents identified physical inactivity as a cardiovascular risk factor.

Conclusions

Our findings reveal a high burden of physical inactivity in a peri-urban community of Nepal. Improving the level of physical activity involves sensitizing people to its importance through appropriate multi-sector strategies that provide encouragement across all sociodemographic groups.

【 授权许可】

   
2014 Vaidya and Krettek; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, Kahlmeier S: The pandemic of physical inactivity: global action for public health. Lancet 2012, 380:294-305.
• [2]Lee I, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT: Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012, 380:219-229.
• [3]Morris JN, Heady JA, Raffle PA, Roberts CG, Parks JW: Coronary heart-disease and physical activity of work. Lancet 1953, 265(6795):1053-1057.
• [4]Fletcher GF, Blair SN, Blumenthal J, Caspersen C, Chaitman B, Epstein S, Falls H, Froelicher ES, Froelicher VF, Pina IL: Statement on exercise. Benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart association. Circulation 1992, 86(1):340-344.
• [5]Physical Activity Guidelines Advisory Committee: Physical activity guidelines advisory committee report. Washington, DC: US Department of Health and Human Services; 2008.
• [6]Nocon M, Hiemann T, Müller-Riemenschneider F, Thalau F, Roll S, Willich SN: Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 2008, 15(3):239-246.
• [7]World Health Organization: Global strategy on diet, physical activity and health. Geneva, Switzerland: WHO; 2010.
• [8]Beaglehole R, Bonita R, Alleyne G, Horton R, Li L, Lincoln P, Mbanya J, McKee M, Moodie R, Nishtar S: for The Lancet NCD Action Group. UN high-level meeting on non-communicable diseases: addressing four questions. Lancet 2011, 378:449-455.
• [9]Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U: Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012, 380:247-257.
• [10]Macniven R, Bauman A, Abouzeid M: A review of population-based prevalence studies of physical activity in adults in the Asia-Pacific region. BMC Public Health 2012, 12(1):41. BioMed Central Full Text
• [11]World Health Organization: The WHO STEPwise approach to chronic disease risk factor surveillance (STEPS). 2009. Retrieved April 13, 2011 from http://www.who.int/chp/steps/STEPS_Instrument_v2.1.pdf webcite
• [12]Armstrong T, Bull F: Development of the World Health Organization Global Physical Activity Questionnaire (GPAQ). J Public Health 2006, 14(2):66-70.
• [13]Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P: International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 2003, 195:1381-1395.
• [14]Bull F, Maslin T: Final report on reliability and validity of the Global Physical Activity Questionnaire (GPAQ v1). Geneva: World Health Organization; 2006.
• [15]Ainsworth BE: How do I measure physical activity in my patients? Questionnaires and objective methods. Br J Sports Med 2009, 43(1):6-9.
• [16]Shephard R: Limits to the measurement of habitual physical activity by questionnaires. Br J Sports Med 2003, 37(3):197-206.
• [17]Milton K, Bull F, Bauman A: Reliability and validity testing of a single-item physical activity measure. Br J Sports Med 2011, 45(3):203-208.
• [18]Wareham N, Jakes R, Rennie K, Schuit J, Mitchell J, Hennings S, Day N: Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr 2003, 6(4):407-414.
• [19]Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJ, Martin BW: Correlates of physical activity: why are some people physically active and others not? Lancet 2012, 380:258-271.
• [20]Shiroma EJ, Lee I: Physical Activity and Cardiovascular Health Lessons Learned From Epidemiological Studies Across Age, Gender, and Race/Ethnicity. Circulation 2010, 122(7):743-752.
• [21]Ministry of Health and Population Nepal: Nepal non-communicable diseases risk factor ssurvey 2007. Kathmandu: Ministry of Health and Population; 2008.
• [22]Vaidya A, Pokharel PK, Nagesh S, Karki P, Kumar S, Majhi S: Association of obesity and physical activity in adult males of Dharan Nepal. Kathmandu Univ Med J 2006, 4(2):192-197.
• [23]Sharma SK, Ghimire A, Radhakrishnan J, Thapa L, Shrestha NR, Paudel N, Gurung K, Budathoki A, Baral N, Brodie D: Prevalence of hypertension, obesity, diabetes, and metabolic syndrome in Nepal. Int J Hypertens 2011. doi:10.4061/2011/821971
• [24]Vaidya A: Tackling cardiovascular health and disease in Nepal: epidemiology, strategies and implementation. Heart Asia 2011, 3(1):87-91.
• [25]Vaidya A, Shakya S, Krettek A: Obesity prevalence in Nepal: public health challenges in a low-income nation during an alarming worldwide trend. Int J Environ Res Publ Health 2010, 7(6):2726-2744.
• [26]Vaidya A, Pokharel PK, Nagesh S, Karki P, Kumar S, Majhi S: Prevalence of coronary heart disease in the urban adult males of eastern Nepal: A population-based analytical cross-sectional study. Indian Heart J 2009, 61:341-347.
• [27]Vaidya A, Pathak RP, Pandey MR: Prevalence of hypertension in Nepalese community triples in 25 years: a repeat cross-sectional study in rural Kathmandu. Indian Heart J 2012, 64(2):128-131.
• [28]Shrestha U, Singh D, Bhattarai M: The prevalence of hypertension and diabetes defined by fasting and 2-h plasma glucose criteria in urban Nepal. Diabetic Med 2006, 23(10):1130-1135.
• [29]Limbu Y, Rai S, Ono K, Kurokawa M, Yanagida J, Rai G, Gurung N, Rai C: Lipid profile of adult Nepalese population. Nepal Med Coll J 2008, 10(1):4-7.
• [30]Vaidya A, Krettek A: Is Health Promotion the Starting Point of Primary Cardiovascular Care in Low-and Middle-Income Countries Like Nepal? Health Promot Pract 2012, 13(3):412-415.
• [31]Aryal UR, Vaidya A, Shakya-Vaidya S, Petzold M, Krettek A, Sinamangal N: Establishing a health demographic surveillance site in Bhaktapur district, Nepal: initial experiences and findings. BMC Res Notes 2012, 5(1):489. BioMed Central Full Text
• [32]Kish L: Sampling Organizations and Groups of Unequal Sizes. Am Sociol Rev 1965, 30:564-572.
• [33]Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr: Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003, 42(6):1206-1252.
• [34]World Health Organization: Global Physical Activity Questionnaire (GPAQ) Analysis Guide. Geneva, Switzerland: WHO; 2012.
• [35]World Health Organization: Global recommendations on physical activity for health. Geneva, Switzerland: WHO; 2010.
• [36]Central Bureau of Statistics: National Population and Housing Census 2011. Kathmandu: National Planning Commission Secretariat; 2012.
• [37]Guthold R, Ono T, Strong KL, Chatterji S, Morabia A: Worldwide variability in physical inactivity: a 51-country survey. Am J Prev Med 2008, 34(6):486-494.
• [38]World Health Organization: Global Health Observatory Data Repository. 2012. Retrieved December 13, 2013 from https://apps.who.int/infobase/Indicators.aspx webcite
• [39]Ng N, Hakimi M, Van Minh H, Juvekar S, Razzaque A, Ashraf A, Ahmed SM, Kanungsukkasem U, Soonthornthada K, Bich TH: Prevalence of physical inactivity in nine rural INDEPTH Health and Demographic Surveillance Systems in five Asian countries. Global Health Action 2009, 2:44-53.
• [40]van de Vijver S, Oti S, Addo J, de Graft-Aikins A, Agyemang C: Review of community-based interventions for prevention of cardiovascular diseases in low-and middle-income countries. Ethn Health 2012, 17(6):651-676.
• [41]Ng SW, Popkin B: Time use and physical activity: a shift away from movement across the globe. Obesity Reviews 2012, 13(8):659-680.
• [42]Sofi F, Capalbo A, Cesari F, Abbate R, Gensini GF: Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis of cohort studies. Eur J Cardiovasc Prev Rehabil 2008, 15(3):247-257.
• [43]Held C, Iqbal R, Lear SA, Rosengren A, Islam S, Mathew J, Yusuf S: Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study. Eur Heart J 2012, 33(4):452-466.
• [44]Wolin KY, Bennett GG: Interrelations of socioeconomic position and occupational and leisure-time physical activity in the National Health and Nutrition Examination Survey. J Phys Act health 2008, 5(2):229.
• [45]Nang EEK, Khoo EY, Salim A, Tai ES, Lee J, Van Dam RM: Patterns of physical activity in different domains and implications for intervention in a multi-ethnic Asian population: a cross-sectional study. BMC Public Health 2010, 10(1):644. BioMed Central Full Text
• [46]Panter-Brick C, Lotstein DS, Ellison PT: Seasonality of reproductive function and weight loss in rural Nepali women. Hum Reprod 1993, 8(5):684-690.
• [47]Panter-Brick C: The energy cost of common tasks in rural Nepal: levels of energy expenditure compatible with sustained physical activity. Eur J Appl Physiol Occup Physiol 1992, 64(5):477-484.
• [48]Crespo CJ, Smit E, Andersen RE, Carter-Pokras O, Ainsworth BE: Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey, 1988–1994. Am J Prev Med 2000, 18:46-53.
• [49]Bauman A, Bull F, Chey T, Craig CL, Ainsworth BE, Sallis JF, Bowles HR, Hagstromer M, Sjostrom M, Pratt M: The International Prevalence Study on Physical Activity: results from 20 countries. Int J Behav Nutr Phys Act 2009, 6:21. BioMed Central Full Text
• [50]Bryan SN, Tremblay MS, Pérez CE, Ardern CI, Katzmarzyk PT: Physical activity and ethnicity: evidence from the Canadian Community Health Survey. Can J Public Health 2006, 97(4):271-276.
• [51]Higgins V, Dale A: Ethnic differences in physical activity and obesity. In Understanding Population Trends and Processes, Volume 3: Ethnicity and Integration. Edited by Stillwell J, Finney N, van Ham M. Dordrecht, Netherlands: Springer; 2010.
• [52]Eyre ELJ, Duncan MJ: The Impact of Ethnicity on Objectively Measured Physical Activity in Children. ISRN Obesity 2013. doi:10.1155/2013/757431
• [53]Molaodi OR, Leyland AH, Ellaway A, Kearns A, Harding S: Neighbourhood food and physical activity environments in England, UK: does ethnic density matter? Int J Behav Nutr Phys Act 2012, 9(1):75. BioMed Central Full Text
• [54]Mathieu RA, Powell-Wiley TM, Ayers CR, McGuire DK, Khera A, Das SR, Lakoski SG: Physical activity participation, health perceptions, and cardiovascular disease mortality in a multiethnic population: The Dallas Heart Study. Am Heart J 2012, 163(6):1037-1040.
• [55]Dogra S, Meisner BA, Ardern CI: Variation in mode of physical activity by ethnicity and time since immigration: a cross-sectional analysis. Int J Behav Nutr Phys Act 2010, 7(1):75. BioMed Central Full Text
• [56]Gupta R, Deedwania PC, Sharma K, Gupta A, Guptha S, Achari V, Asirvatham AJ, Bhansali A, Gupta B, Gupta S: Association of Educational, Occupational and Socioeconomic Status with Cardiovascular Risk Factors in Asian Indians: A Cross-Sectional Study. PLoS One 2012, 7(8):e44098.
• [57]Ding D, Sallis JF, Hovell MF, Du J, Zheng M, He H, Owen N: Physical activity and sedentary behaviours among rural adults in suixi, china: a cross-sectional study. Int J Behav Nutr Phys Act 2011, 8(1):37. BioMed Central Full Text
• [58]Seiluri T, Lahti J, Rahkonen O, Lahelma E, Lallukka T: Changes in occupational class differences in leisure-time physical activity: a follow-up study. Int J Behav Nutr Phys Act 2011, 8:14. BioMed Central Full Text
• [59]Sullivan R, Kinra S, Ekelund U, Bharathi A, Vaz M, Kurpad A, Collier T, Reddy KS, Prabhakaran D, Ben-Shlomo Y: Socio-demographic patterning of physical activity across migrant groups in India: results from the Indian migration study. PloS One 2011, 6(10):e24898.
• [60]Thomas N, Alder E, Leese G: Barriers to physical activity in patients with diabetes. Postgrad Med J 2004, 80(943):287-291.
• [61]Steptoe A, McMunn A: Health behaviour patterns in relation to hypertension: the English Longitudinal Study of Ageing. J Hypertens 2009, 27(2):224-230.
• [62]Penn L, Moffatt SM, White M: Participants' perspective on maintaining behaviour change: a qualitative study within the European Diabetes Prevention Study. BMC Public Health 2008, 8(1):235. BioMed Central Full Text
• [63]Teo K, Lear S, Islam S, Mony P, Dehghan M, Li W, Rosengren A, Lopez-Jaramillo P, Diaz R, Oliveira G: Prevalence of a Healthy Lifestyle Among Individuals With Cardiovascular Disease in High-, Middle-and Low-Income Countries: The Prospective Urban Rural Epidemiology (PURE) Study Healthy Lifestyle and Cardiovascular Disease. JAMA 2013, 309(15):1613-1621.
• [64]Stankov I, Olds T, Cargo M: Overweight and obese adolescents: what turns them off physical activity? Int J Behav Nutr Phys Act 2012, 9(1):53. BioMed Central Full Text
• [65]International Labour Organization: Labour and Social Trends in Nepal 2010. Geneva, Switzerland: ILO; 2010.
• [66]ktm2day: Rapid urbanization takes its toll on valley land. Retrieved December 13, 2013 from http://www.ktm2day.com/2011/06/09/rapid-urbanization-takes-its-toll-on-valley-land/ webcite
• [67]Shrestha S: Status of Agricultural Mechanization in Nepal. New Delhi: United Nations Asian and Pacific Center for Agricultural Engineering and Machinery (UNAPCAEM); 2012.
• [68]Sharma KK: Status Paper on Road Safety in Nepal: The fourth meeting of the Working Group on the Asian Highway and Expert Group Meeting on Progress on Road Safety Improvement in Asia and the Pacific, 27–29 September 2011. Bangkok, Thailand: United Nations Economic and Social Commission for Asia and Pacific; 2011.
• [69]Department of Water Supply and Sewerage: History of piped water supply system development in Nepal. 2013. Retrieved December 13, 2013 from http://www.dwss.gov.np/ webcite
• [70]Rana J: Bhaktapur, Nepal's Capital of Music and Dance. Kailash 1990, 16(1–2):5-14.
• [71]Bosdriesz JR, Witvliet MI, Visscher TL, Kunst AE: The influence of the macro-environment on physical activity: a multilevel analysis of 38 countries worldwide. Int J Behav Nutr Phys Act 2012, 9:110. BioMed Central Full Text
• [72]Katzmarzyk PT, Mason C: The physical activity transition. J Phys Act Health 2009, 6(3):269-280.
• [73]Norman A, Bellocco R, Vaida F, Wolk A: Age and temporal trends of total physical activity in Swedish men. Med Sci Sports Exerc 2003, 35(4):617-622.
• [74]Orsini N, Bellocco R, Bottai M, Pagano M, Wolk A: Age and temporal trends of total physical activity among Swedish women. Med Sci Sports Exerc 2006, 38(2):240-245.
• [75]Monda KL, Gordon-Larsen P, Stevens J, Popkin BM: China's transition: the effect of rapid urbanization on adult occupational physical activity. Soc Sci Med 2007, 64(4):858-870.
• [76]Heath GW, Parra DC, Sarmiento OL, Andersen LB, Owen N, Goenka S, Montes F, Brownson RC: Evidence-based intervention in physical activity: lessons from around the world. The Lancet 2012, 380:272-281.
• [77]Lachat C, Otchere S, Roberfroid D, Abdulai A, Seret FMA, Milesevic J, Xuereb G, Candeias V, Kolsteren P: Diet and physical activity for the prevention of noncommunicable diseases in low-and middle-income countries: a systematic policy review. PLoS Med 2013, 10(6):e1001465.
• [78]Global Advocacy for Physical Activity (GAPA) the Advocacy Council of the International Society for Physical Activity and Health (ISPAH): NCD Prevention: Investments that Work for Physical Activity. Br J Sports Med 2012, 46:709-712.
• [79]Humphrey NP: Does the Built Environment Influence Physical Activity? TR News 2005, 237:32.
• [80]Sallis JF, Floyd MF, Rodriguez DA, Saelens BE: Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation 2012, 125(5):729-737.
• [81]Poudel-Tandukar K, Nakahara S, Ichikawa M, Poudel KC, Jimba M: Risk perception, road behavior, and pedestrian injury among adolescent students in Kathmandu, Nepal. Inj Prev 2007, 13(4):258-263.
• [82]Ministry of Physical Planning, Works & Transport Management: Nepal Road Safety Action Plan (2013–2020). Kathmandu: Ministry of Physical Planning, Works & Transport Management; 2013.
• [83]Sharma KK: Country Status Paper on Road Safety in Nepal. Retrieved on April 13, 2013 from http://www.unescap.org/ttdw/roadsafety/Reports2007/Nepal_RSpaper.pdf webcite
• [84]Lovasi GS, Grady S, Rundle A: Steps forward: review and recommendations for research on walkability, physical activity and cardiovascular health. Public Health Rev 2012, 33(2):484-506.
• [85]Van Holle V, Deforche B, Van Cauwenberg J, Goubert L, Maes L, Van de Weghe N, De Bourdeaudhuij I: Relationship between the physical environment and different domains of physical activity in European adults: a systematic review. BMC Public Health 2012, 12(1):807. BioMed Central Full Text
• [86]Inoue S, Ohya Y, Odagiri Y, Takamiya T, Ishii K, Kitabayashi M, Suijo K, Sallis JF, Shimomitsu T: Association between perceived neighborhood environment and walking among adults in 4 cities in Japan. J Epidemiol 2010, 20(4):277-286.
• [87]Sallis JF, Bowles HR, Bauman A, Ainsworth BE, Bull FC, Craig CL, Sjöström M, De Bourdeaudhuij I, Lefevre J, Matsudo V: Neighborhood environments and physical activity among adults in 11 countries. Am J Prev Med 2009, 36(6):484-490.
• [88]Bloomfield GS, Mwangi A, Chege P, Simiyu CJ, Aswa DF, Odhiambo D, Obala AA, Ayuo P, Khwa-Otsyula BO: Multiple cardiovascular risk factors in Kenya: evidence from a health and demographic surveillance system using the WHO STEPwise approach to chronic disease risk factor surveillance. Heart 2013, 99(18):1323-1329.
• [89]Ng N, Van Minh H, Juvekar S, Razzaque A, Bich TH, Kanungsukkasem U, Ashraf A, Ahmed SM, Soonthornthada K: Using the INDEPTH HDSS to build capacity for chronic non-communicable disease risk factor surveillance in low and middle-income countries. Global Health Action 2009., 2doi:10.3402/gha.v2i0.1984
• [90]Anand SS: Using ethnicity as a classification variable in health research: perpetuating the myth of biological determinism, serving socio-political agendas, or making valuable contributions to medical sciences? Ethn Health 1999, 4(4):241-244.
• [91]Wells J: Ethnic variability in adiposity, thrifty phenotypes and cardiometabolic risk: addressing the full range of ethnicity, including those of mixed ethnicity. Obes Rev 2012, 13(S2):14-29.
• [92]Zaman MJ, Bhopal RS: New answers to three questions on the epidemic of coronary mortality in south Asians: incidence or case fatality? Biology or environment? Will the next generation be affected? Heart 2013, 99(3):154-158.
• [93]Miranda A, Benjamin C, Gillian R, Valerie B: Reported frequency of physical activity in a large epidemiological study: relationship to specific activities and repeatability over time. BMC Med Res Methodol 2011, 11:97. BioMed Central Full Text
• [94]Ford ES, Caspersen CJ: Sedentary behaviour and cardiovascular disease: a review of prospective studies. Int J Epidemiol 2012, 41(5):1338-1353.
• [95]Sternfeld B, Goldman-Rosas L: A systematic approach to selecting an appropriate measure of self-reported physical activity or sedentary behavior. J Phys Act health 2012, 9:S19-S28.
• [96]Vaidya A, Aryal UR, Krettek A: Cardiovascular health knowledge, attitude and practice/behaviour in an urbanising community of Nepal: a population-based cross-sectional study from Jhaukhel-Duwakot Health Demographic Surveillance Site. BMJ Open 2013, 3(10):e002976.