European Commission - Public Health: healthindicators.org

Physical activity

Definition of indicator

This indicator is referring to the concept of “health-enhancing physical activity”. It is covering a whole range of physical activities including leisure time physical activities, exercises, sport, occupational activities, commuting and daily tasks. Physical activity is defined as any bodily movement produced by skeletal muscle that results in energy expenditure.

Calculation (numerator, denominator)

1) EHIS instrument (deriving from the IPAQ) to measure the proportion of population performing moderate and vigorous physical activity (days and/or hours per week), derived from questions PE.1.-6: During the past 7 days,

i) days and time devoted to vigorous physical activities?

ii) days and time devoted to moderate physical activities

iii) days and time spent walking

Precise operationalisation to be formulated.

2) The Health Behavior of School Children Survey (HBSC, the 2001/2002 survey ) includes some questions for children aged 11-13-15: % of children reporting 60 minutes or more of physical activity of at least moderate intensity on 5 or more days a week, carried out at school and/or in free-time, i) during both the previous week and ii) a typical week, derived from questions:

Over the past 7 days, on how many days were you physically active for a total of at least 60 minutes per day?

Over a typical or usual week, on how many days are you physically active for a total of at least 60 minutes per day?

The response categories for both were: 0 days, 1 day, 2 days, … 7 days..

Additional underlying concepts

Population health surveys allow to verify if the respondents have effectively performed any type of physical activity. Intensity as well as frequency of the effort is taken into account. This can be done either through direct measurements (pedometer, accelerometer) or rather based on the self-declaration of the individuals

Possible operational measures of physical activity level and pattern include:

• The total amount of activity expressed either as activity energy expenditure (kcal, Joules, MET mins, etc) or physical activity level (PAL);
• Time (mins/day or week) spent at health enhancing physical activity level (i.e. activity at moderate and vigorous intensity levels);
• Time (mins/day or week) spent sitting.
• Proportion of the population reaching the threshold level for health enhancing physical activity.

EUPASS-project stresses 4 key dimensions of physical activity: type, frequency, duration and intensity of activity. The International Physical Activity Questionnaire (IPAQ) is considered as the most advanced international approach to operationalise the dimensions of physical activity

The EHIS questions (PE.1.-6.) are an adaptation of the IPAQ but they have not been validated.

Relevant dimensions (subgroups)

Country, year, gender, age group, SES.

Preferred data sources

1) EHIS (questions PE.1.-6)

2) National HIS

3) The Health Behavior of School Children Survey , HBSC

Rationale

It has been largely recognised that physical activity has a substantial impact on health status and must be considered as one of the major behaviour to be promoted in the field of public health. Relative physical inactivity, usually together with unhealthy food habits, is associated with the development of many of the major non-communicable diseases in society, such as CVD, some cancers, obesity, diabetes and osteoporosis.

The general recommendation is for each individual to perform half an hour of physical activity of at least moderate intensity on most if not all days of the week (US Surgeon General, 1996).

WHO has included this concept in his health targets N°16 and has recommended to periodically evaluate the level of physical activities of the population.

Data availability, quality and periodicity

- Most of the EU-MSs are measuring physical activity at the population level but many different instruments are used with poor comparability. In future, the implementation of the - EHIS implemented 2007-2009, EHIS may contribute to provide comparable data.

- The EUPASS network has produced an international comparable data set in 8 MS; this could be used for analyses and monitoring purposes.

References

- IPAQ questionnaire

- HBSC survey

- Currie C. et al (eds.) 2004. Young People's Health in Context: international report from the HBSC 2001/02 survey. WHO Policy Series: Health policy for children and adolescents Issue 4, WHO Regional Office for Europe, Copenhagen. Especially chapter 3: Young people’s health and health-related behaviour

- EHIS standard questionnaire (version of 11/2006)

- European Physical Activity Surveillance System, EUPASS

- The final report of EUPASS

- The EUPHIX (European Union Public Health Information & Knowledge System, www.euphix.org); the Determinants of Health chapter dedicates a topic on physical activity among Health behaviours

- Health Indicators for People with Intellectual Disabilities, Pomona

- Monitoring Public Health Nutrition in Europe; Nutritional indicators and determinants of health status

- Indicators for monitoring COPD and asthma in the EU, IMCA

Work to do

• Rules for the calculation from EHIS questions (PE.1.-6.) are not available yet; they should be provided by Eurostat.
• How precisely are indicators calculated from the EHIS questions on physical activity? (EHIS questions PE.1.-6.). Answer: EHIS uses the IPAQ questions, slightly modified.
• Where are comparable instruments used now? How are comparable indicators calculated from these? And validated?
• For the moment there is no satisfaying instrument to measure physical activity at the population level; this should be corrected before the next EHIS in 2013.
• Further development, assessment of instruments and additional definitions are thus needed.