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Motivational program to promote physical activity
1. COMBINED MOTIVATION PROGRAM
AND PEDOMETER USE TO PROMOTE
PHYSICAL ACTIVITY: A RANDOMIZED
CONTROLLED TRIAL
Hana Al-Sobayel, MSc, PhD
Einas Al-Eisa, MSc, PhD
KING SAUD UNIVERSITY
RIYADH, SAUDI ARABIA
WCPT-AWP Congress 2013
6. Globally, 31% of adults aged 15+ were insufficiently
active (men 28% and women 34%)
(WHO 2008)
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7. In May 2004, the 57th World Health Assembly (WHA) endorsed the World
Health Organization (WHO) Global Strategy on Diet, Physical Activity
and Health. The Strategy was developed through a wide-ranging series of
consultations with all concerned stakeholders in response to a request from
Member States at World Health Assembly 2002 (Resolution WHA55.23).
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8. Conference on healthy lifestyle and non-communicable
diseases in the Arab world and the Middle east
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9. Relevance
Alarming level of physical inactivity among the
Saudi population: inactivity prevalence 97%
(Al-Nozha et al, 2007; Al-Rafaee & Al-Hazzaa, 2001)
Saudi populations studied:
males, children, adolescents
(Al-Hazzaa, 2002; Al-Hazzaa & Sulaiman, 1993)
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10. Saudi Females?
The literature suggests a specific gender-based
consideration when making recommendations
to promote physical activity
gender as a primary consideration
(White et al., 2005)
Prevalence of obesity related to sedentary life
style has been escalating among Saudi females
(El-Hazmi & Warsy, 2000)
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11. How active?? Step count..
12000
10000
8000
6000
KSA
Target
4000
2000
0
KSA vs Target Step count
(Al-Eisa and Al-Sobayel 2012)
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12. Step counts around the world
10000
9000
8000
KSA
7000
UK
USA
6000
Canada
5000
Ger
4000
Japan
3000
Swiss
2000
Finland
1000
Aust
0
Country
(Al-Eisa and Al-Sobayel 2012)
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13. Prescribing PA
There is no universally accepted method to
promote physical activity due to the multiple
factors that influence physical activity
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14. Why walking?
The most likely to increase physical activity:
• a population level
(Hillsdon & Thorogood, 1996)
• for sedentary adults (Ogilvie et al, 2007)
•
•
•
•
Physical & psychological health benefits
Low intensity & high accessibility
Ease to physically perform
Low cost
(Blacklock et al., 2007; Duncan & Mummery, 2005; Manson et al., 2002; Rhodes et al, 2006)
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15. Pedometer Promote PA?
Using a pedometer can provide a reminder to be more
active
Pedometers when used in combination with other
strategies improved physical activity
(Chan et al., 2004; Dinger et al., 2007; De Cocker et al., 2008 )
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16.
17. Objective
Effectiveness of the use of a pedometer, in
addition to a motivational education program, in
improving adherence to a walking program , and
improving physical activity levels and general
health parameters of Saudi women.
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19. Inclusion criteria
Exclusion criteria
- History of fracture or surgery to
the back, pelvis, or lower limb
- Saudi females (18-45 yrs)
- Contraindications to increased
walking
- Residing in Riyadh
- Current complain of conditions
affecting the ability to walk
- Able to read and write
- Pregnancy
- Eating disorders
- Conditions affecting cognitive
function or communication
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20. Measurement of walking
Pedometers are small devices that can be worn
at the waist or ankle, and are capable of
counting number of steps
(Vitolins et al, 2000)
Pedometers are considered valid and reliable
tools with which to measure physical activity
(Tudor-Locke, 2004)
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21. Measurement of Health Parameters
BMI
Blood pressure
Heart rate
Blood glucose level
Percutaneous oxygen saturation (SpO2),
Fat composition
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22. Intervention
A single 2 hour educational session:
conducted by two senior physical therapists, both of whom were
experienced in patient education, and included information
regarding the importance of physical activity and provision of a
handout on the benefits of regular walking.
Weekly motivational text messages sent to the
participants’ mobile phones.
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23. Procedure
Study group (n=81)
Control group (n=80)
2 hrs educational session
Weekly motivational text
messages
Pedometer daily record
2 hrs educational session
Weekly motivational text
messages
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27. Low step
count
Step count did not improve after the
intervention
The social & environmental context
could be a barrier to increasing
physical activities.
(Mabry et al. 2010)
Prevalence of physical inactivity is high
among women world wide.
(WHO 2009)
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29. Effectiveness of the Intervention
Adherence to the
intervention by the
experimental group was
significantly higher (p =
0.021)
40%
Other measures: no
significant difference
90%
Intervention
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Control
30. Health
outcomes
No change of health outcomes:
Good health status on baseline
Short term intervention
Combining pedometer with an
intervention toolkit on physical activity
did no difference in Denmark.
(Petersen et al. 2012)
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31. What’s Next
Consider physical behavious not only physical activity
“Number of steps or walking duration may not be a good
estimator of time being active, and that a considerable
underestimation may occur.”
(Bussmann & van den Berg-Emon 2013)
Need for multi-sectorial interventions
Consider context and beliefs
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33. Acknowledgment
King Saud University
King Abdulaziz City for Science & Technology
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Notas do Editor
The prevalence of phyasical inactivity is considered very high all over the world, but countries vary and we can see that the high-income and upper-middle income countries have the higher risk, including Saudi Arabia.
For that reason, the WHO has launched the Global strategy on Diet, physical activity and health (DPAS) in order to tackle these lifestyle modifiable issues to reduce the burden of NCD
Saudi Arabia is one of the EMRO countries who embraced this global strategy, and the Ministry of Health held an international conference on healthy lifestyle and NCD in the Arab world.
Unfortunately, numerous studies have reported low levels of physical activity among the Saudi population. Unfortunately the literature suggests an alarming level of physical inactivity among the Saudi population, predisposing our society to health problems. However, the majority of studies conducted on the Saudi society focus on either male population or children and adolescents.
Therefore, the primary focus of this study is females, and u are probably thinking that I am so biased, and in part I am but there is a good scientific reason to back me up and that is: The Saudi Female Population warrants special attention. To begin with, the literature suggests a specific gender-based consideration when making recommendations to promote physical activity (White et al., 2005). Thus, intervention and motivation programs should be customized to suit the individuals’ needs with gender as a primary consideration. In particular, prevalence of obesity related to sedentary life style has been escalating among Saudi females. Therefore, it is necessary to understand how social factors imposed upon Saudi women affect women’s health and wellness.
Subsequently, Clinical practitioners often prescribe physical activity as an essential component of managing many health conditions. And an excellent manifestation of this trend is the recently launched HILSTM.However, medical advice alone has not been effective in promoting physical activity.On the other hand, much has been published on means to promote physical activity. Yet, there is no universally accepted method due to the multiple factors that influence physical activity. And the reason is the complex and multiple factors that affect PA, in otherwords, what we refer to here as correlates of physical activity.
The most advocated form of physical activity is walking. Walking is suggested as the mode of activity most likely to increase physical activity at a population level, particularly for sedentary adults.Walking behavior has received recent attention based on its physical (Manson et al., 2002) and psychological (Blacklock, Rhodes, & Brown, 2007) health benefits and its lower intensity, high accessibility, ease to physically perform, and low cost in comparison to other PAs (Duncan & Mummery, 2005; Rhodes, Brown, & McIntyre, 2006).Pedometers are considered valid and reliable tools with which to measure physical activity (Tudor-Locke, 2004)Recently, the use of small electronic devices, known as pedometers, has been considered an objective measure of physical activity.
This poster is a source of joy and pride, because it was designed by a saudi female artist that volunteered to help us, and its release was revolutionary.
In a comparison of five electronic pedometers, the Yamax most accurately recorded the number of steps taken (distance), had the most consistency between units, and was the most accurate (Bassett et al., 1996).
The intervention was in consideration with the results of preious work on correlates of physical activities among Saudi women. Focused on emphasizing self-efficacy and internal locus of control.
Average step count over 8 weeks period
Social constraints, limited places for women to practice physical activity, Hot climateOn a global level, data from the WHO have shown that physical inactivity is more prevalent among girls and women than their male counterparts, regardless of their country of origin.51 Some of the factors reported by WHO that hinder the participation of women in physical activity and their access to health care include lower income, greater workload in the home and in care-giving roles, limited mobility, and cultural restrictions
One-way repeated measure analysis of variance revealed that there were no significant differences between groups (experimental vs control) nor across the two assessment times (baseline and post-intervention) for either physical activity levels (i.e. step-count) or general health outcomes. The Wilks’ Lambda test indicated that there were no significant interactions between the groups and time for any variables.
A population-based randomized controlled trial of the effect of combining a pedometer with an intervention toolkit on physical activity among individuals with low levels of physical activity or fitness.No significant difference in all parameters More walking time among older adultshttp://www.ncbi.nlm.nih.gov/pubmed/22200586This study needs to be interpreted within the context of its limitations. First, the sampling frame of Riyadh may not generalize to other regions.although the samples obtained for this research were representative of the Riyadh adult population in terms of sociodemographics, the subsequent attrition rate was high. One limitation of the study is a small homogeneous self-selected sample.Subjects who volunteered were already involved in regular physical activity, were more likely to be married, more likely to have higher family income, and tended to have higher self-efficacy (Speck & Looney, 2001)