A survey of disposition of physicians towards physical activity promotion at two tertiary hospitals in north-eastern Nigeria

Background: A general presumption is that any advice from physicians would likely be taken seriously by patients, and patients are more likely to see their doctors in the event of any health complaints than any other health professionals. The perceptions and practice of Nigerian physicians on their role in physical activity promotion are not well known. This study aimed to determine the knowledge of physical activity message, confidence, role perceptions, barriers and feasibility of physical activity promotion among physicians in two tertiary health institutions in North-Eastern Nigeria.Methods: A total of 153 (84.5% response) physicians at the University of Maiduguri Teaching Hospital and Federal Medical Center Yola completed a previously developed questionnaire that elicited information on their knowledge, barrier, feasibility, role and confidence in physical activity promotion.Results: Physicians in this study reported fairly good knowledge (mean score=14.7±2.2/20), minimal or little barrier to physical activity promotion (mean score=24.4±3.5/30), perceived physical activity promotion as their role (mean score=12.9±1.6/15), were confident in their ability to discuss and recommend exercises for physical activity promotion (mean score=7.9±1.3/ 10) and believed promoting physical activity was feasible for them (mean score=15.0±2.5/20). The physicians had good disposition to physical activity promotion (Mean score=78.5±6.7/100), but male physicians showed better disposition than their female counterparts.Conclusions: Overall these cohorts of physicians are somewhat knowledgeable on physical activity promotion and are positively disposed to promoting physical activity among their patients. These findings can be leveraged upon to optimize outcome of campaigns or interventions to change physical activity behaviour in Nigerian populace.Keywords: Physical activity, Exercise promotion, Medical doctors, Disposition, Active lifestyl

A survey of physiotherapists on physical activity promotion in northern Nigeria

Tackling the menace of non-communicable diseases (NCDs) through the promotion of population participation in health enhancing physical activities requires the engagement of healthcare experts, such as physiotherapists, to make necessary assessments and individualized recommendation.The aim of this study was to determine the knowledge of physical activity message, role perception and counselling practice, and the feasibility of, and barriers to physical activity promotion among physiotherapists in Northern Nigeria.Physiotherapists in seven hospitals in Northern Nigeria (N=94) were surveyed using a questionnaire that elicited information on socio-demographic characteristics and the participants also completed a Physical Activity Promotion Questionnaire which elicited responses on knowledge of physical activity message, feasibility of physical activity promotion, and barriers to physical activity promotion.Overall, the physiotherapists in this study reported good knowledge of physical activity promotion, perceived physical activity promotion as their role, and also reported minimal or little barrier to physical activity promotion. The physiotherapists also believed promoting physical activity was feasible for them.These findings suggest that physiotherapists in Northern Nigerian have a good disposition towards promoting a physically active lifestyle among their patients and clients and they could play an important public health role in the prevention and control of NCDs in Nigeria.Keywords: Physical activity, physical activity promotion, physiotherapists, disposition, active lifestyl

Cardiovascular responses and perceived exertion of young adults to head and shoulder load carriage

Objective: To determine the cardiovascular responses and perceived exertion of young adults walking and carrying a load of 10 kg on shoulder and the head.Method: Healthy participants (n=50) between the ages of 21 and 27 were subjected to three testing sessions at self-selected normal pace without load, and carrying a 10 kg load on the shoulder and on the head for 10 minutes. Cardiovascular parameters and their ratings of perceived exertion (RPE) were measured before and after testing at each session.Results: Higher pulse pressure (correlates of stroke volume) and rate pressure product (index of myocardial oxygen uptake) values were observed following load on shoulder testing compared to no load testing values and a higher RPE value was observed for load on shoulder testing when compared to load on head testing.Conclusion: It is conceivable that carrying load on the head can potentially be more economical than carrying load on the shoulder for this cohort of young adults. Keywords: Cardiovascular responses, perceived exertion, load carrying, rural communitie

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill & Melinda Gates Foundation

Cultural adaptation, validation and reliability assessment of the Yoruba language version of the International Physical Activity Questionnaire in Nigeria

Assessment of Physical Activity (PA) is important for adequate health planning. However, self-report assessment tools for PA may be influenced by differences in language and cultural norms. The aim of this study was to cross-culturally adapt, validate and test the reliability of the Yoruba language version of International Physical Activity Questionnaire - Short-Form (IPAQ-SF). The English version of IPAQ-SF was translated to Nigerian Yoruba language following a sequence of forward translation, reconciliation and harmonization, as well as quality rating, backward translation, reconciliation of problematic items, and pilot study. The final Yoruba version of the IPAQ-SF was tested in a cross-sectional study for concurrent and construct validity as well as test-retest reliability in a sample of 351 students of Obafemi Awolowo University, Ile - Ife, Nigeria. The Yoruba IPAQ-SF showed good concurrent validity with correlation coefficients (r), ranging from 0.577 to 0.841 for moderate and vigorous PA (MET*min/week), respectively. There was good convergent and discriminant validity with total PA significantly correlating with its constructs and not substantially associated with sitting. Reliability was fair for vigorous (ICC=0.433, 95% CI=0.325-0.531), moderate (ICC=0.326, 95% CI=0.208-0.434), walking (ICC=0.311, 95% CI=0.192-0.421) and total PA (ICC=0.374, 95% CI=0.260-0.478), but poor for sitting (ICC=0.155, 95% CI=0.029-0.276). Results also yielded meaningful differences in gender-specific analyses. The Yoruba IPAQ-SF produced acceptable evidence of concurrent and convergent validity, but modest evidence of test-retest reliability in a sample of Nigerian young adults. The Yoruba IPAQ-SF could be a useful PA assessment tool among adult Yoruba speaking Nigerians. Keywords: Cultural adaptation, IPAQ, validation, reliability, Yoruba language, Nigeri

Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity-GoPA! 2015 and 2020 Surveys.

Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved. Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion