Understanding Physical Inactivity in Rural and Urban Regions
Authors: Mayte Bryce-Alberti, Jose L. Avilez and J. Jaime Miranda
CRONICAS Center of Excellence in Chronic Disease
Physical inactivity presents a risk factor for non-communicable diseases in low and middle-income countries. A cross-sectional study based in Peru analyses its prevalence in different socio-demographic conditions.
We are always moving. Or, at least, we try to. We go to the park and see people jogging, walking dogs, or catching their breath after a fierce game of tag; when commuting, people ride bikes to work or walk to school. While this may be hard to believe, in Peru, tag turns to a weekly “pichanga”; we reduce a family picnic to cold beers; and joggers usually find themselves choked by the smoke emitted from “combis”. Moving around is complicated since work is usually located miles away from home and some may even have to climb down a hill just to arrive to their “local” bus stop.
Physical inactivity is the fourth leading risk factor for global mortality; ideally, we should take advantage of our leisure or transport time to be physically active. However, we do not all share the same reality. Physical inactivity can be modified through public health policies adapted to culturally appropriate forms. For instance, in Peru, a successful intervention is replacing patches of dirt regarded as football pitches with cheap cement with field marks painted on; this turns an attempt at football into a proper futsal. Urban landscapes also play a key role in the prevalence of physical inactivity. In Lima we have the districts of La Molina (suburbs) and San Borja (urbanised) which are both filled with green areas. However, bicycle-riding initiatives in San Borja are more successful than in La Molina since the former offers more places to visit and greater interconnectivity, while the latter is mostly residential. Hence, it is vital for effective urban design and allocation of resources that we take into consideration social norms, availability of safe physical activity spaces and context.
Peru is a country with diverse environments such as highlands, coastline and rainforests, with both rural and urban areas within each region that provide many socio-demographic conditions for physical inactivity. What we need are better characterised profiles, necessary to establish realistic programme targets and to contribute to international monitoring efforts such as the Global Physical Activity Questionnaire (GPAQ) and the Global Physical Activity Observatory (GoPA!).These allow us to increase the amount of information regarding NCD risk factors in resource-limited settings and encourage policies and planning that inform and support physical activity programming through a reduction in environmental and socio-economic barriers to an active lifestyle.
At CRONICAS Centre of Excellence in Chronic Diseases, we performed a cross-sectional analysis of the CRONICAS Cohort Study’s baseline assessment in four Peruvian settings that differ by degree of urbanisation: Puno (rural), Puno (urban), Lima (urban), and Tumbes (semi-urban). In this study, we chose to focus on prevalence of leisure-time and transport related physical inactivity using the International Physical Activity Questionnaire (IPAQ).
Our findings regarding leisure-time and transport related physical inactivity in the four settings
Subjects in the four study settings tended to perform more transport-related than leisure-time physical activity. Leisuretime physical inactivity rates in the rural and semi-urban sites were up to 16% higher than in both urban sites. Rural populations had both lower socio-economic statuses and a lower education, which were associated with the 5% - 6% higher prevalence of leisure-time physical inactivity. This contrast makes us wonder what leisure-time represents across socioeconomic strata and how people can take advantage of it.
Concerning transport-related physical inactivity and TV-watching rates, we did not observe a polarised rural/urban divide, as semi-urban Tumbes is in the upper range of inactivity (21%) and sedentarism (51%), contrasted with both Puno sites in the lower range. Although we did not assess why this happened, we did notice that busy traffic was a predictor of higher transport-related physical inactivity.
Hopes for the future
Our findings signal the need to establish a nationwide surveillance and monitoring system of physical inactivity across Peru’s major geographical regions. Bicycle routes in La Molina do not work, people will probably keep on associating football with beer, and nice landscapes may have to share the spotlight with combis when fighting for a jogger’s attention. Still, public policies should not be restricted to health, as it addresses only one angle of the problem. Urban planning will increase green and active-friendly environments that combine both aesthetics and practicality. Perhaps in the future, comprehensive and coordinated efforts to promote healthy habits will ensure that physical activity comes naturally and easily for those willing to try it.
CRONICAS Center of Excellence in Chronic Diseases is a health research centre specializing in non-communicable diseases, composed of a multidisciplinary team whose different career paths give them each a unique approach. It operates under the auspices of Lima’s Cayetano Heredia University (UPCH), and both are recognized among the most prestigious research institutions in South America.
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