Andrea Ramírez

The Lancet Physical Activity Observatory: promoting physical activity worldwide

2 years ago, at the time of the London 2012 Olympic and Paralympic Games, The Lancet launched a Series on the worldwide pandemic of physical inactivity. The Series showed that a third of adults and 80% of adolescents around the world do not reach recommended levels for daily physical activity (30 min and 60 min of physical activity of moderate-to-vigorous intensity per day for adults and adolescents, respectively). Physical inactivity was shown to be responsible for 5·3 million deaths per year worldwide. If inactivity decreased by only 10%, half a million deaths could be averted every year. There is reasonable understanding on why some people are active and others are not, and several interventions, within and outside the health sector, are known to be eff ective at increasing physical activity in the population. As for every pandemic, our Series identifi ed urgent action that is needed to address physical inactivity. Together with publication of the Series, we launched The Lancet Physical Activity Observatory, which aims to keep track of progress in the fi eld since publication of the Series. The Observatory defi ned four primary goals to be achieved by 2016. The fi rst is to reduce the global prevalence of inactivity in adults from 31% to 28%. The second goal is to increase the prevalence of adolescents who engage in at least 60 min per day of moderate-to-vigorous intensity physical activity from 21% to 24%. The third goal is to reduce by 10% the proportions of coronary heart disease, type 2 diabetes, breast cancer, colon cancer, and premature deaths worldwide that are attributable to physical inactivity. The fourth goal is to increase by 10% the proportion of peer-reviewed scientifi c publications on physical activity that come from low-income and middle-income countries among the total number of publications worldwide. The Observatory also prepared a list of secondary research, surveillance, and policy goals. We are now halfway through this period and have hosted the Observatory as a council of the International Society of Physical Activity and Health, and created a logo for the Observatory. We have also developed our contacts in each country using information from existing Physical Activity Regional Networks. However, our main task has been to prepare country cards on the status of physical activity in each country of the world. Country cards are to be launched in November, 2014. Each country card summarises a country’s research, surveillance, and policy on physical activity and health. The cards also present socio-demographics, alongside morbidity and mortality patterns for each country. For most indicators, we present absolute and weighted values, as well as the ranking of the country. The main indicators are summarised in the panel. The country cards will serve as the baseline for future evaluation of physical activity status in each country, so that we can follow up progress in achieving the goals of the Observatory. The information in the country cards will highlight specifi c research, surveillance, and policy gaps in each country. Additionally, the country cards will serve as an advocacy tool that will help governments, researchers, and society in each country to feel accountable for improving health through the promotion of physical activity. Another Observatory-related task was to bring together a team of researchers to develop a second Lancet Series on physical activity that will be published around the time of the Rio de Janeiro 2016 Olympic and Paralympic Games. The fi rst paper in the new Series will include an update on research, surveillance, and policy on physical activity worldwide using data from The Lancet Physical Activity Observatory.

Nutrition in Colombian pregnant women

OBJECTIVE The present study aimed to evaluate the nutritional status of pregnant women in Colombia and the associations between gestational BMI and sociodemographic and gestational characteristics. DESIGN Cross-sectional study. A secondary analysis was made of data from the 2005 Demographic and Health Survey of Colombia. SETTING Bogotá, Colombia. SUBJECTS Pregnant adolescents aged 13-19 years (n 430) and pregnant women aged 20-49 years (n 1272). RESULTS The gestational BMI and sociodemographic characteristics of the adolescents differed from those of the pregnant adult women. Thirty-one per cent of the adolescents were underweight for gestational age, compared with 14·5 % of the adult women. Eighteen per cent of adolescents were overweight for gestational age, in contrast to 37·3 % of adult women. The overall prevalence of anaemia was 44·7 % and the prevalence of low serum ferritin was 38·8 %. Women within the high quintiles of the wealth index (prevalence odds ratio (POR) = 0·56; 95 % CI 0·34, 0·91, P < 0·02) had lower odds of being underweight. Women who received prenatal care (POR = 2·17; 95 % CI 1·48, 3·09, P < 0·001) and were multiparous (POR = 2·10; 95 % CI 1·43, 3·15, P < 0·0 0 1) had higher odds of being overweight. Women in extended families (POR = 0·63; 95 % CI 0·50, 0·95, P < 0·025) had lower odds of being overweight. CONCLUSIONS Underweight in pregnant adolescents and overweight in adult women coexist as a double burden in Colombia. Factors associated with malnutrition among pregnant women and adolescents should be considered for future interventions in countries experiencing nutritional transition.

Physical activity, nutrition and behavior change in Latin America: a systematic review.

Physical activity (PA) and nutrition are key health behaviors underlying the design and implementation of prevention strategies for non-communicable diseases (NCDs) in Latin America. Nevertheless, research still reports low prevalence of PA and fruit and vegetable consumption throughout the region. This paper aims at reviewing the ways in which models of behavior change theory have been applied in study development and implementation regarding nutrition and PA in Latin America. In August 2011 we conducted a systematic literature review of the behavior change studies that targeted such NCDs risk factors published until then. Out of 4279 surveyed abstracts, only 29 corresponded to articles that met our inclusion criteria. Twenty-six articles reported the application of behavior change theory, with the trans-theoretical model (n = 12) being the most frequently used. Other theories and models included the socio-ecological model (n = 4), cognitive theory (n = 3), social cognitive theory (n = 2) and theories related to health education and counseling (n = 5). Based on this review, we recommend that the application of behavior change theory be explicitly reported in Latin American peer-reviewed articles, and that outcome evaluations include behavior change constructs so as to better assess their contribution to the effectiveness of nutrition and PA interventions in the region. Furthermore, we state the need for a better understanding of the behavior change mechanisms that may be specific to the Latin American context.

Physical activity levels among Colombian adults: inequalities by gender and socioeconomic status.

INTRODUCTION Worldwide studies show inequalities in physical activity levels related to socio-demographic characteristics. In Colombia, among the countries in Latin America with the highest inequality, the evidence related to inequalities in physical activity is limited. It is imperative to identify disparities in physical activity in the country, to guide the design of public policies aimed at promoting physical activity. OBJECTIVES 1) To estimate the prevalence and associated factors of meeting physical activity recommendations; 2) to assess inequalities by gender and socioeconomic status in meeting physical activity recommendations, and 3) to assess the trends in physical activity prevalence within a five-year period. MATERIALS AND METHODS A secondary analysis of data from the 2010 National Nutrition Survey was conducted. The sample included 27,243 adults. The International Physical Activity Questionnaire was used to measure leisure time and transport domains. Socioeconomic status was measured by the Sisben level. RESULTS Compared to men, women were less likely to meet physical activity recommendations in all domains. Compared to adults from high socioeconomic-status households, low socioeconomic-status adults had a lower prevalence of meeting physical activity recommendations during leisure time and the highest prevalence of using a bicycle for transport. The factors associated with meeting physical activity recommendations differed by gender and physical activity domain. Household and individual variables explained 13.6% of the inequalities observed by gender, and 23.2% of the inequalities by socioeconomic status. In a five-year period, the prevalence of physical activity in leisure time decreased, while the physical activity of walking for transport increased and biking for transport did not change. CONCLUSIONS Future interventions to increase physical activity levels in Colombia must consider inequalities by gender and socioeconomic status. Of special concern is the low prevalence of meeting physical activity recommendations during leisure time in both women and in the low socioeconomic status population.

127 Steps Toward a More Active World.

Pratt (michael.pratt@emory.edu) is with the Hubert Dept of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. Ramirez and Martins are students with the Post-graduate program in Epidemiology, Universidade Federal de Pelotas, Brazil. Bauman is with the Sydney School of Public Health, University of Sydney, Australia. Heath is with the University of Tennessee College of Medicine Chattanooga. Kohl is with the Dept of Kinesiology and Health Education, Michael and Susan Dell Center for Healthy Living, University of Texas at Austin. Lee is with the School of Medicine, Harvard Medical School, and the Harvard T.H. Chan School of Public Health, Brigham and Women’s Hospital, Boston, MA. Powell is with the Division of Public Health, Georgia Dept of Human Resources, Atlanta, GA. Hallal is with the Post-graduate program in Epidemiology, Universidade Federal de Pelotas, Brazil. Journal of Physical Activity and Health, 2015, 12, 1193 -1194 http://dx.doi.org/10.1123/jpah.2015-0569

Physical activity profile of Nigeria: implications for research, surveillance and policy

Appraising the status of physical activity surveillance, research and policy in Nigeria is relevant to national and regional public health actions on physical activity promotion and non-communicable disease control. This study aimed to 1) evaluate the physical activity profile of Nigeria and 2) propose strategies for improving physical activity in the country. The Global Observatory for Physical Activity-GoPA! with inputs from local experts systematically collected sociodemographic and physical activity surveillance, national policy and research indicators data for Nigeria in 2014. The Nigerian Country Card highlighting the status of these indicators was developed in 2015 and launched in 2016. Prevalence of physical activity among Nigerian adults was 78% (female=76%, male=79%). There was no physical activity surveillance system and national plan, and no empirical data on the proportion of all deaths directly due to physical inactivity in Nigeria. Few (n=7) articles related to physical activity and public health were published in 2013 and the country occupied the 38th position in the global research ranking, contributing about 0.24% to physical activity research worldwide. Implementing national physical activity plans and multi-sectorial collaborations between government and non-governmental partners are needed to improve physical activity surveillance, research and policy in Nigeria and other African countries with similar physical activity gaps.

Italy physical activity country profile: Results from the first set of country cards of the Global Observatory for Physical Activity - GoPA!

The Global Observatory for Physical Activity – GoPA! country cards were launched last Dec 4th in London [1]. GoPA! was created in response to the urgent call to action to prevent the physical inactivity pandemic described in the Lancet physical activity series back in 2012 [2,3]. These population, researcher and policy maker friendly profiles aim to contribute promoting physical activity worldwide. Each profile put together a set of prevalence, health burden, research, surveillance and policy indicators. Each country has a representative that reviews the content presented in the card. Italy was launched in the first set of cards and it has an interesting profile. Main questions that were answered: