Improvising Cardiovascular and Neuromuscular Function among Older Adults with Non-communicable Diseases- A Study Protocol for Sports Driven Interventional Approach

BackgroundExisting physical activity guidelines predominantly focus on healthy age-stratified target groups. The objective of this study was to develop evidence-based recommendations for physical activity (PA) and PA promotion for German adults (18–65 years) with noncommunicable diseases (NCDs).MethodsThe PA recommendations were developed based on existing PA recommendations. In phase 1, systematic literature searches were conducted for current PA recommendations for seven chronic conditions (osteoarthrosis of the hip and knee, chronic obstructive pulmonary disease, stable ischemic heart disease, stroke, clinical depression, and chronic non-specific back pain). In phase 2, the PA recommendations were evaluated on the basis of 28 quality criteria, and high-quality recommendations were analysed. In phase 3, PA recommendations for seven chronic conditions were deducted and then synthesised to generate generic German PA recommendations for adults with NCDs. In relation to the recommendations for PA promotion, a systematic literature review was conducted on papers that reviewed the efficacy/effectiveness of interventions for PA promotion in adults with NCDs.ResultsThe German recommendations for physical activity state that adults with NCDs should, over the course of a week, do at least 150 min of moderate-intensity aerobic PA, or 75 min of vigorous-intensity aerobic PA, or a combination of both. Furthermore, muscle-strengthening activities should be performed at least twice a week. The promotion of PA among adults with NCDs should be theory-based, specifically target PA behaviour, and be tailored to the respective target group. In this context, and as an intervention method, exercise referral schemes are one of the more promising methods of promoting PA in adults with NCDs.ConclusionThe development of evidence-based recommendations for PA and PA promotion is an important step in terms of the initiation and implementation of actions for PA-related health promotion in Germany. The German recommendations for PA and PA promotion inform adults affected by NCDs and health professionals on how much PA would be optimal for adults with NCDs. Additionally, the recommendations provide professionals entrusted in PA promotion the best strategies and interventions to raise low PA levels in adults with NCDs. The formulation of specific PA recommendations for adults with NCDs and their combination with recommendations on PA promotion is a unique characteristic of the German recommendations.

Background and objectiveUnhealthy lifestyle behaviours are important risk factors of morbidity and mortality. This study aimed to explore the sociodemographic predictors of multiple non-communicable disease (NCD) risk factors experienced by elderly South Africans.MethodsWe conducted a national population-based cross-sectional survey with a sample of 3,840 individuals aged 50 years or above in South Africa in 2008. The outcome variable was the co-existence of multiple NCD risk factors (tobacco use, alcohol, physical inactivity, fruit and vegetable intake, overweight or obesity, and hypertension) in each individual. The exposure variables were sociodemographic characteristics, namely, age, gender, education, wealth status, population group, marital status, and residence. Multivariate linear regression was used to assess the association between sociodemographic variables and multiple NCD risk factors.ResultsThe mean number of NCD risk factors among all participants was three (95% confidence interval: 2.81–3.10). Multivariate linear regression analysis revealed that being female, being in the age group of 60–69 years, and being from the Coloured and Black African race were associated with a higher number of NCD risk factors. Marital status, educational level, wealth, and residence were not significantly associated with the number of NCD risk factors experienced.ConclusionsThe co-existence of multiple lifestyle NCD risk factors among the elderly is a public health concern. Comprehensive health-promotion interventions addressing the co-existence of multiple NCD risk factors tailored for specific sociodemographic groups are needed.

BackgroundPhysical inactivity is considered one of the main modifiable risk factors for noncommunicable diseases. It has been proven that an active lifestyle is an efficient means of preventing and managing noncommunicable diseases. Multiple barriers have been identified that hinder engagement in conventional physical activity programs and the achievement of physical activity recommendations. Digital interventions may expand opportunities to resolve these barriers and empower people with noncommunicable diseases to be physically active. This overview of systematic reviews aims to evaluate the efficacy of digital interventions on physical activity promotion among individuals with major noncommunicable diseases.MethodA protocol was registered in the PROSPERO database (CRD42022364350). A qualitative synthesis method was applied to summarize the efficacy data. The assessment of methodological quality using AMSTAR-2 for each systematic review was performed by two independent reviewers.ResultsSearches in nine databases resulted in seven systematic reviews for inclusion. Most of the primary studies included in these seven reviews were conducted in high-income countries. The reviews addressed five populations: participants with cancers, cardiovascular diseases, chronic obstructive pulmonary disease, type 2 diabetes, and osteoarthritis. Digital interventions were classified into two categories: interventions based on digital activity trackers and remote interventions via digital facilities. Additional components were identified in both categories of interventions such as motivational content, counseling, goal setting, tailored feedback/reminders, and other behavioral change techniques. The overall quality of the reviews ranged from critically low to low. The findings provided some evidence that both categories of interventions were effective in promoting physical activity.ConclusionThe findings of this overview suggest that some types of digital interventions, such as self-monitoring with digital activity trackers and remote interventions via digital facilities, may be effective means of promoting physical activity across major noncommunicable diseases. The findings should be interpreted cautiously since the methodological quality of the included reviews ranged from critically low to low, and there was no consistent assessment of the certainty of evidence. Further systematic reviews are required on efficacy of digital interventions with more rigorous conducting and reporting of systematic review methodologies.

Background: Limited evidence exists on the presence of collective non-communicable disease (NCD) risk factors among adolescents in Kerala, India. We aimed to assess the prevalence and factors associated with multiple NCD risk factors and clustering of these risk factors among adolescents in Kasaragod District, Kerala.Methods: We selected 470 adolescents (mean age 16.6 years, male 53.8%) through multi-stage cluster sampling from higher secondary schools of Kasaragod district. Self-administered questionnaires were used, and anthropometric measurements were taken using standard techniques and protocols. Tobacco use, alcohol consumption, low fruits and vegetable consumption, inadequate physical activity, extra salt intake, overweight, consumption of soft drinks and packed foods were the eight NCD risk factors included. Multinomial logistic regression analysis was done to find out the factors associated with one, two and three or more NCD risk factors.Results: Risk factor clusters with two risk factors (dyads) and three risk factors (triads) were observed in 163 (34.7%) and 102 (21.7%) of the sample, respectively. Adolescents residing in urban areas (odds ratio (OR) = 3.55; 95% confidence interval (CI) = 1.45-8.73), whose father’s education level was lower (OR = 3.54; 95% CI = 1.24-10.10), whose mother’s education was lower (OR= 4.13; 95% CI = 1.27-13.51), who had restrictions on physical activity (OR = 5.41; 95% CI = 1.20-24.30) and who did not have a kitchen garden (an area where fruits and vegetables are grown for domestic use) (OR=4.51;95% CI = 1.44-14.12) were more likely to have three or more NCD risk factors compared to their counterparts. Conclusions: Clustering of NCD risk factors was prevalent in more than half of the adolescents. Efforts are warranted to reduce multiple risk factors, focussing on children of low educated parents and urban residents. Parents of adolescents may be encouraged to have kitchen gardens and not to restrict adolescent’s physical activity.

BackgroundRegular physical activity is essential for health, yet a large proportion of the German population remains inactive, with significant health and economic consequences. As physical activity promotion spans multiple settings and political sectors, systematic overviews of available data on behaviour and promotion practices are often lacking.MethodsThis article draws on four policy briefs on physical activity promotion in Germany published by the Federal Ministry of Health (2022 – 2024). Data on physical activity behaviour (secondary analysis) and promotion practices across sectors (mixed methods approach) were analysed. A distinction was made between good practice (projects with proven effectiveness) and routine practice (large-scale programmes).ResultsBetween 1993 and 2024, eleven institutions from different political sectors collected data on physical activity behaviour in 23 larger studies. Current data show lower activity levels among older adults, women, socioeconomically disadvantaged groups, and individuals living with a non-communicable disease. In total, 43 good practice projects and 88 routine practice measures were identified. While all good practice projects demonstrated effectiveness, this was true for only 11 % of routine practices. Good practice projects were less likely to reach at least 100,000 people (12 %) compared to routine practice (25 %), and were more often limited to less than five years (33 % vs. 9 %).ConclusionsPhysical activity promotion is an intersectoral challenge requiring stronger structures and shared responsibility. To increase population-level impact, the reach of good practice should be expanded and the effectiveness of routine practice evaluated more systematically. The planned establishment of a National Competence Centre for Physical Activity Promotion offers a key opportunity to advance these goals.

The health benefits of regular physical activity and the relation between physical inactivity and chronic disease morbidity and mortality are well established. Also clear is the fact that efforts to increase physical activity at the population level will require collective action by government, nongovernment, for-profit, and nonprofit entities working together at the local, state, and national levels. The US National Physical Activity Plan (NPAP), developed by the National Physical Activity Plan Alliance, of which the American Heart Association (AHA) is a member, is designed to facilitate this collective action, to help organizations from all sectors of society work together to increase physical activity in all segments of the American population. The purposes of this advisory are to summarize the data that describe the health benefits of regular physical activity and the public health burden of low levels of physical activity, to describe the NPAP and the role it will play in increasing population levels of physical activity, and to encourage readers of Circulation to join the AHA’s efforts to promote its implementation. As summarized in Table 1, there is substantial evidence supporting the benefits of regular physical activity to prevent a wide variety of disease conditions and to enhance quality of life. Interestingly, there is less of an appreciation of noncardiovascular benefits of lifestyle physical activity and structured exercise, and this is an area of great opportunity for educating the public and healthcare practitioners. View this table: Table 1. The Health Benefits of Regular Physical Activity Physical inactivity is rapidly becoming a major global concern and is the fourth leading cause of death worldwide.2,3 As noted by Kohl and colleagues, “In view of the prevalence, global reach, and health effect of physical inactivity, the issue should be appropriately described as pandemic, with far-reaching health, economic, environmental, and social consequences.”4 According …

The first countries to develop comprehensive policy approaches to population based physical activity promotion in the modern sense were Finland and Canada. Other parts of the worlds saw comparable developments in countries or large metropolitan areas towards the end of the 20th century, examples are Australia, Sao Paulo in Brazil and Japan. The US Surgeon General's report on Physical Activity and Health of 1996 was a health policy document with important international repercussions. Around the same time, the World Healt h Organisation (WHO) began to integrate physical activity in its Active Living Strategy and a little later in its Global Strategy for the Prevention and Control of Non-Communicable Diseases (NCDs). In 2004, physical activity featured more prominently in the WHO's Global Strategy on Diet, Physical Activity and Health. In the 2008-2013 Action Plan to WHO's NCD strategy, physical inactivity was for the first time explicitly and prominently named as one of the four main NCD risk factors. In 2010, WHO issued the first Global Recommendations for Physical Activity and Health, its role for global public health was confirmed in the 2011 UN High-Level Meeting on NCDs. So physical activity is a relatively new concept in international public health. Many institutions can play an important role in physical activity promotion, but for most this is only one of their tasks amongst others. There are a limited number of organisations that focus on physical activity and health alone: the international physical activity promotion networks and the International Society for Physical Activity and Health (ISPAH). Agita Mundo, the Global Physical Activity Promotion Network, the four existing regional networks (RAFA/PANA, HEPA Europe, APPAN and AFPAN), ISPAH and its advocacy council GAPA work together not only in the dissemination of tools and information, but also in lobbying for physical activity as an important aspect of public health. Physical activity and health - from the individual to the global level

BackgroundHealth promotion for the management of risk factors for non-communicable diseases (NCDs) is an integral part of standard care in South Africa. Most persons presenting with NCDs utilise public primary health care centres for disease management. This mixed-methods study aimed at expanding current understanding of the the influence of standard clinic care (usual care) on perceptions and knowledge of risk factors for NCDs and physical activity (PA) among persons from a low-resourced community. Qualitatively the perceptions of women from a low-resourced community about risk factors for NCDs and PA were explored throughout 24-weeks of standard clinic care. Parallel quantitative data was collected to describe changes in risk factors for NCDs and trends in self-reported knowledge about risk factors of NCDs and PA.MethodA convergent-parallel mixed-methods research design was used. The study was carried out in a public primary health care setting, in the North West Province, South Africa. From a convenience sample of 100 participants, 77 African women aged between 34 and 79 years were recruited for the study. Data were collected at three time-points including baseline, 12 weeks, and 24 weeks of a standard clinic care health-promotion programme. The qualitative data was collected during focus group discussions, and the quantitative data included questionnaires on knowledge of physical activity and risk factors for NCDs as well as anthropometric and biological measurements. Qualitative and quantitative data were analysed independently for each phase and then consolidated for interpretation. All data was collected in the same setting.ResultsParticipants' initial understanding and perceptions of NCD risk factors were poor. Qualitative findings showed that participants knew little about the specific physical activity they could engage in and the role of PA in NCD management. Participants preferred low-intensity activities. Heart-disease knowledge improved significantly at 12 weeks intervention compared to baseline MD = -3.655, p < 0.001. There were improvements in PA knowledge at 12 weeks from baseline MD = -0.625 p = 0.02. There were significant weight (MD = 1.420, p = 0.002) and waist circumference reductions (MD = 0.621, p = 0.02) from baseline to 24 weeks.ConclusionStandard clinic care improved knowledge of physical activity and risk factors for NCDs, but perceptions of risk factors for NCDs and PA were unchanged. This study offers insight into the perceptions held by women from a low-resource setting and how future interventions to manage and prevent NCDs should be structured.Trial registrationPACTR201609001771813.

Burden statements on non-communicable diseases (NCDs) across the globe suggest that they pose a constant threat to human development. There are two different types of NCD interventions: population-based interventions addressing...

Noncommunicable diseases have become the main causes of death in several developing countries. There is a severe shortage of information about the risk factors for these diseases in Iraq. To explore the eating habits, physical activity, and sedentary behaviors of adolescents in Mosul City, Iraq, as risk factors for noncommunicable diseases. A multistage stratified sampling method was carried out on adolescents aged 15 to 18 years in Mosul City, Iraq. A pretested and validated questionnaire was used to obtain information on frequency of intake of certain foods, physical activity, and screen time (television, video, and computer). Weight and height were measured to obtain the body composition status. The total sample included 723 adolescents (350 boys and 373 girls). There were significant differences between boys and girls in most eating habits and activity behaviors. The frequency of skipping breakfast and the intakes of fruits and vegetables, french fries, and sweets and chocolates were significantly higher among girls than boys (p < .001). Boys were significantly more likely to consume fast foods, sugar-sweetened drinks, and energy drinks than girls. Boys spent more time in physical activity (p < .001) and looking at screens than girls. The health authorities of Iraq should focus not only on interventions for undernutrition among adolescents, but also on behavioral risk factors for diet-related noncommunicable diseases.

BackgroundThe Sahrawi people fled their homes in 1975 as the conflict in Western Sahara escalated and settled down near Tindouf, Algeria, where they still live. High prevalence of overweight and obesity and type 2 diabetes had been found in this protracted refugee setting. Scaling up national policy efforts to promote physical activity (PA) is critical to reducing the prevalence of noncommunicable diseases (NCDs) in the near future. One possible barrier to the inclusion of PA in NCD prevention strategies is the lack of research on PA level, which may reduce political support and policy development for PA. Thus, the aim of this study was to investigate the PA level among adults living in Sahrawi refugee camps and socioeconomic factors associated with PA.MethodsA cross-sectional survey was carried out in 2014 in five refugee camps near Tindouf, Algeria. A total of 180 women and 175 men were included. PA was measured using the international physical activity questionnaire short form (IPAQ-SF).ResultsThere was a large amount of variance in reported PA for both genders, ranging from 10 min of total PA per week to above 40 h. Forty-three percent of the participants had a low PA level (defined as not meeting the PA recommendations of 150 min of moderate to vigorous PA per day). The chi-square test of independence showed that males, those aged ≥ 60 years and people with higher education were more likely to be in the low PA level category. No significant relationship was found between PA level and BMI status. Most of the participants thought that engaging in PA would be wise, valuable, right and good but thought to a lesser degree that PA would be easy, comfortable and interesting.ConclusionsAlmost half of the participants were categorised as insufficiently physically active, however, most of the Sahrawi refugees express a positive attitude towards PA. PA is a low-cost approach to reducing deaths and NCDs, government initiatives to increase PA levels in refugee camps are advised.

BackgroundGhana is experiencing an epidemiological shift in public health issues toward non-communicable diseases that are underpinned by modifiable health behaviors. Physical activity rates have decreased, especially among older adults, coinciding with urbanization and an increase in sedentary work. Community-based physical activity programs are a recommended method of increasing physical activity levels; however, none currently exist in Ghana. The aim of this exploratory study was to determine older Ghanaian adults’ perceptions of physical activity and asses fit and feasibility of adapting and delivering a physical activity program for this population.MethodsThrough a concurrent exploratory mixed-methods design, data were gathered from Ghanaian older adults (N = 123) during focus groups (N = 10) conducted at one diabetes clinic and nine churches across three urban areas. Qualitative data were collected using a semi-structured script that prompted for responses related to physical activity perceptions and the fit and feasibility of physical activity program characteristics. Quantitative data were collected through a questionnaire assessing participant demographics, physical activity levels, and health rating as well as physical activity knowledge and self-efficacy.ResultsFindings indicate that older adults in Ghana have a need for and an interest in physical activity promotion. Participants had positive perceptions of being physically active, but were unaware of physical activity guidelines and how to meet them. Peer influence and health care providers’ recommendations were motivating factors for physical activity participation. As for desired physical activity program characteristics, participants expressed interest in group-based activities and becoming peer leaders and preference for a church-based program.ConclusionsThe results suggest that a group-based physical activity program encouraged by health care providers and delivered at churches through a train-the-trainer model would be well received by aging adults from three urban areas of Ghana. In addition, education on physical activity types is needed, along with better dissemination and education on Ministry of Health physical activity guidelines. This exploratory work highlights preliminary support for a group- and community-based physical activity program for the aging population in Ghana. Beginning with the end in mind, these program characteristics should be considered when adopting, adapting, and implementing an intervention with this population.

Non-communicable diseases are on the rise globally. Risk factors of non-communicable diseases continue to be a growing concern in both developed and developing countries. With significant rise in population and establishment of buildings, rapid changes have taken place in the built environment. Relationship between health and place, particularly with non-communicable diseases has been established in previous literature. This systematic review assesses the current evidence on influence of gender in the relationship between built environment and non-communicable diseases. A systematic literature search using PubMed was done to identify all studies that reported relationship between gender and built environment. All titles and abstracts were scrutinised to include only articles based on risk factors, prevention, treatment and outcome of non-communicable diseases. The Gender Analysis Matrix developed by the World Health Organization was used to describe the findings of gender differences. Sex differences, biological susceptibility, gender norms/ values, roles and activities related to gender and access to/control over resources were themes for the differences in the relationship. A total of 15 out of 214 articles met the inclusion criteria. Majority of the studies were on risk factors of non-communicable diseases, particularly cardiovascular diseases. Gender differences in physical access to recreational facilities, neighbourhood perceptions of safety and walkability have been documented. Men and women showed differential preferences to walking, engaging in physical activity and in perceiving safety of the neighbourhood. Girls and boys showed differences in play activities at school and in their own neighbourhood environment. Safety from crime and safety from traffic were also perceived important to engage in physical activity. Gender norms and gender roles and activities have shown basis for the differences in the prevalence of non-communicable diseases. Sparse evidence was found on how built environment affects health seeking behaviour, preventive options or experience with health providers. Though yet unexplored in the developing or low/middle income countries, there seems to be a major role in the gendered perception of how men and women are affected by noncommunicable diseases. Large gaps still exist in the research evidence on gender-based differences in non-communicable diseases and built environment relationship. Future research directions could bring out underpinnings of how perceived and objective built environment could largely affect the health behaviour of men and women across the globe.Significance for public healthTackling non-communicable diseases is a major hurdle for majority of the countries worldwide. Varied built environmental conditions and facilities bear differing influences on both men and women. Women in particular face difficulties more than men in access and control over resources to deal with non-communicable disease conditions. This paper tries to bring out the differences from published literature. Moreover, this paper has attempted to review articles which have delved beyond sex differences and included other axes. The Gender Analysis Matrix developed by WHO was incorporated in this paper to aid in categorising and delineating these differences. These results would be fundamental in further primary research and help in policy and planning of non-communicable diseases.

Background Physical inactivity is a risk factor for chronic noncommunicable diseases (NCDs), yet national surveillance of physical activity (PA) levels is not well defined. Though Ghana has a national health policy that emphasizes health promotion and prevention of lifestyle diseases, and an NCD policy with PA recommendations in 2012, it does not have an integrated plan of action to address widespread physical inactivity. Objective This review aims to identify the nature and extent of research in NCDs and PA in Ghana to inform the creation of an integrated action plan to address physical inactivity. The review focuses on four research questions: (1) what is the prevalence and monitoring of NCDs in Ghana from the Demographic and Health Survey (DHS) and the World Health Organization (WHO) reports, (2) what are the key risk factors of NCDs in Ghana, (3) what are the identified indicators and benchmarks that enhance or impede PA participation in Ghana, and (4) what are the active interventions and policy directives for NCDs and PA participation in Ghana. Methods Ghana-specific articles, reports, and policies related to NCDs and PA were collected traversing 2018–2020. The scoping review included: (1) reviewing articles and documents related to risk factors of NCDs in Ghana, (2) reviewing articles and documents from the Global Observatory for Physical Activity (GoPA!) monitoring and surveillance template for Ghana; (3) reviewing articles and documents on the Active Healthy Kids Global Alliance Ghana Report Card on Physical Activity; (4) the Demographic and Health Survey website and (5) specific searches for World Health Organization reports. Results A total of 1763 records were identified through keyword search. Based on eligibility criteria, 4 were relevant to question 1, 23 to question 2, 16 to question 3, and 11 to question 4. For question 1, international benchmark surveys revealed that physical inactivity accounts for 20% of NCD related deaths in Ghana. For question 2, 8 records (34.8%) focused on hypertension, 5 (21.74%) body composition and obesity, 4 (17.4%) cardiovascular diseases, 3 (13.0%) on diabetes, 1 (4.4%) on stroke, and 2 (8.7%) on other risk factors. For question 3, 6 records (37%) focused on overall PA, 3 (19%) on the built environment, 2 (12%) active transportation, 2 (12%) on physical inactivity or sedentary behaviors, 2 (12%) on influence of family and peers, and 1 (6%) on active play. For question 4, though multiple national policies exist, including a minimum weekly level of compulsory physical education per week in the school curriculum, data monitoring and surveillance on PA participation are scarce. Conclusion Based on the scoping review of articles traversing 2018–2020, this review revealed minimal research on these topics. Data on PA participation is non-existent due to lack of conscious monitoring mechanisms, integrated plan of action, intervention strategies and policy directives. A national research agenda is imperative to better understand the relationship and clear connection between physical inactivity as a risk factor of NCDs.

Introduction and Objectives: Almost two-thirds of all deaths worldwide are due to noncommunicable diseases (NCDs), which are primarily associated with tobacco-use, alcohol consumption, physical inactivity, unhealthy diet, obesity and raised blood pressure and are largely preventable. Despite the increasing burden of NCDs and their risk factors in India, information on the prevalence of preventable risk factors is restricted to some areas. This study was done to assess the prevalence and distribution of various risk factors for NCD in population of an urban area of Puducherry, in South India. Methodology: This population-based survey was conducted using the World Health Organization step-wise approach to surveillance of NCDs (steps) methodology. All the eligible subjects in systematic randomly selected households were interviewed. Standardized protocols were used to assess major behavioral risk factors (tobacco-use, alcohol consumption, unhealthy diet and physical inactivity) and physiological risk factors (overweight, abdominal obesity and raised blood pressure) for NCDs. Means and proportions were calculated for measured variables, and Chi square test was applied to find the associations. Results: Among 569 study subjects interviewed, almost half (48%) were aged <40 years and 52% (n = 295) were men. The prevalence of various risk factors was; tobacco-use (13.4%), alcohol consumption (14.2%), physical inactivity (51.5%), unhealthy diet (86.5%), overweight (36.0%), obesity (21.3%), abdominal obesity (63.3), hypertension (25.3%) and prehypertension (47.8%). Tobacco-use and alcohol consumption was significantly more prevalent among males (p < 0.05). Almost half of the study subjects had two or more risk factors. Conclusion: Present community-based study reveals the high burden of NCDs risk factors in urban population of Puducherry and the burden was particularly higher among males. This also reiterates the need to address these issues comprehensively as a part of NCDs prevention and control strategy. Further, multi-sectoral efforts like ban on sale or raising the tax on alcohol and tobacco products, health education and communication activities, enabling environment for people to engage in physical activities and other measures to lower the burden of NCDs risk factors in community have to be encouraged.