Patterns of Physical Activity and Associated Factors in Cubans Aged 15–69 Years

ABSTRACT

INTRODUCTION

Systematic measurement of population physical activity levels is an important component of public health surveillance.

OBJECTIVES

Describe patterns of physical activity in the Cuban population aged 15–69 years and identify factors associated with regular physical activity.

METHODS

A descriptive cross-sectional study was conducted using a complex sampling design, representative of urban and rural areas, sex and age groups, including 7915 individuals. The International Physical Activity Questionnaire (short format) was applied. The population was classified as active, irregularly active and sedentary, according to sex, age, marital status, education, skin color, employment and perception of health risk related to physical inactivity or overweight. Percentages, odds ratios (OR) and 95% confidence intervals (CI) were calculated and a multinomial regression model was fitted with active persons as the reference category.

RESULTS

Approximately 71% of the population self-classified as active, 23% as sedentary and 5.9% as irregularly active. Women had a higher probability of being sedentary (OR 2.51, CI 2.12–2.98) and irregularly active (OR 2.56, CI 95% 1.87–3.49). The probability of being sedentary increased with age (OR 1.19, CI 1.12–1.26), and also with the condition of being a homemaker, retired, or unemployed. Perceiving overweight as a high risk to health reduced likelihood of inactivity (OR 0.49, CI 0.29–0.83).

CONCLUSIONS

Some 7 of 10 Cubans are physically active. The groups with the highest probability of inactivity and irregular activity and associated factors have been identified through national application (for the first time) of the International Physical Activity Questionnaire. The results should be taken into account for implementation of specialized strategies to promote systematic physical activity.

Physical activity; physical exercise; sedentary life-style; health behavior; risk factors; chronic disease; women’s health; surveillance; Cuba

INTRODUCTION

Systematic measurement of physical activity in populations constitutes an important component in public health surveillance.[11. World Health Organization. Informe sobre la situación mundial de las enfermedades no transmisibles 2014 [Internet]. Geneva: World Health Organization; 2014 [cited 2016 Feb]. Available from: http://apps.who.int/iris/bitstream/10665/149296/1/WHO_NMH_NVI_15.1_spa.pdf?ua=1&ua=1. 16 p. Spanish.
http://apps.who.int/iris/bitstream/10665...
] Physical activity is defined as any body movement produced by skeletal muscles that requires more energy expenditure than resting.[22. U.S. Department of Health and Human Services. Physical activity and health: a report of the surgeon general. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.,33. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise and physical fitness: definitions and distinctions for health related research. Public Health Rep. 1985 Mar-Apr;100(2):126–31.] There is growing scientific evidence on the protective effect of regular physical activity in relation to risk of non-communicable chronic diseases (NCD), including heart disease, cerebrovascular diseases, hypertension, non–insulin-dependent diabetes mellitus, osteoporosis, colon cancer, anxiety and depression, and on the benefits for cognitive capacity, mood and health-related quality of life.[22. U.S. Department of Health and Human Services. Physical activity and health: a report of the surgeon general. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996. 4. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 2008. 5. World Health Organization. A guide for population-based approaches to increasing levels of physical activity: implementation of the WHO global strategy on diet, physical activity and health. Geneva: World Health Organization; 2007. 19 p. 6. Williams NH, Hendry M, France B, Lewis R, Wilkinson C. Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review. Br J Gen Pract. 2007 Dec;57(545):979–86. 9. Berlin JA, Colditz GA. A meta-analysis of physical activity in the prevention of coronary heart dis ease. Am J Epidemiol. 1990 Oct;132(4):612–28.1010. Rodríguez-Romo G, Cordente C, Mayorga J, Garrido-Muñoz M, Macías R, Ruiz J. Influencia de determinantes socio-demográficos en la adherencia a las recomendaciones de actividad física en personas de entre 15 y 74 años de Madrid, España. Rev Esp Salud Pública. 2011 Aug;85(4):351–62. Spanish.]

WHO rates physical inactivity as one of the 10 main causes of death and disability in the world. The Global Burden of Disease study estimated that physical inactivity is responsible for more than 2 million deaths annually and 1% of total disease burden (measured as disability-adjusted years of life lost, or DALY). Estimated global prevalence is 17% in adults (higher in women than in men).[1111. World Health Organization. Global Burden of Disease Study 2010. Geneva: World Health Organization; 2012 Dec 13.1212. World Health Organization. Global recommendations on physical activity for health [Internet]. Geneva: World Health Organization; 2011 [cited 2016 Jan 3]. Available from: http://www.who.int/dietphysicalactivity/pa/en/index.html
http://www.who.int/dietphysicalactivity/...
]

To produce health benefits, physical activity must meet certain requirements of intensity, duration and frequency. Current recommendations are at least 30 minutes per day of moderate physical activity 5 times or more each week, or 20 minutes per day of vigorous activity at least 3 times per week.[1313. Blair SN, La-Monte MJ, Nichaman MZ. The evolution of physical activity recommendations: how much is enough? Am J Clin Nutr. 2004 May;79(5):913S-20S.1414. World Health Organization. Estrategia mundial sobre régimen alimentario, actividad física y salud. Geneva: World Health Organization; 2004. 24 p. Spanish.]

Measuring physical activity is a complex process for which diverse instruments have been used, making it difficult to compare prevalence between and within countries. Development of a reliable and valid instrument and selection of an optimal method are pending challenges.[1515. Craig CL, Marshal AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Soc Sports Exerc. 2003 Aug;35(8):1381–95.]

The International Physical Activity Questionnaire (IPAQ), designed by an international consensus group in 1998, has been used to measure physical activity levels in multiple populations. The short-form IPAQ has been tested in international studies. Evaluations of its reliability and validity at 14 centers in 12 countries have concluded it has acceptable metric properties, can be applied in different settings and is appropriate for population prevalence studies, given its capacity to be adapted to different cultural contexts.[1515. Craig CL, Marshal AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Soc Sports Exerc. 2003 Aug;35(8):1381–95.1616. Hagströmer M, Oja P, Sjöström M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr [Internet]. 2006 Sep [cited 2016 Jan 3];9(6):755–62. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd = Retrieve&db=PubMed&list_uids=16925881&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query...
]

Cuba’s Public Health Projections for 2015[1717. Ministry of Public Health (CU). Proyecciones de la Salud Cubana hasta el año 2015 [Internet]. Havana: Ministry of Public Health (CU); 2006 [cited 2013 Oct]; [about 4 screens]. Available from: http://www.saludplaza.sld.cu/Notas/Proy2015.htm Spanish.
http://www.saludplaza.sld.cu/Notas/Proy2...
] included, among other aims, an increase in the population’s systematic physical activity and decrease in numbers of sedentary adults. National prevalence estimates of these two factors have been determined by different methods in the First and Second National Surveys on Risk Factors and Non-Communicable Chronic Diseases (1995 and 2001, respectively).[1616. Hagströmer M, Oja P, Sjöström M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr [Internet]. 2006 Sep [cited 2016 Jan 3];9(6):755–62. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd = Retrieve&db=PubMed&list_uids=16925881&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query...
,1717. Ministry of Public Health (CU). Proyecciones de la Salud Cubana hasta el año 2015 [Internet]. Havana: Ministry of Public Health (CU); 2006 [cited 2013 Oct]; [about 4 screens]. Available from: http://www.saludplaza.sld.cu/Notas/Proy2015.htm Spanish.
http://www.saludplaza.sld.cu/Notas/Proy2...
] There is no known previous national-level description of physical activity in Cuba using IPAQ. Thus, our objectives were to: (1) determine overall physical activity levels in the population aged 15–69 years; and (2) identify factors associated with regular physical activity. The results of this study will establish a baseline for surveillance of physical activity and help establish intervention requirements for population subgroups. The results will also facilitate comparison with past or future measurements in Cuba and other countries. [1717. Ministry of Public Health (CU). Proyecciones de la Salud Cubana hasta el año 2015 [Internet]. Havana: Ministry of Public Health (CU); 2006 [cited 2013 Oct]; [about 4 screens]. Available from: http://www.saludplaza.sld.cu/Notas/Proy2015.htm Spanish.
http://www.saludplaza.sld.cu/Notas/Proy2...
18. National Hygiene, Epidemiology and Microbiology Institute (CU). Informe Técnico Primera Encuesta nacional de factores de riesgo. Cuba 1995. Havana: Ministry of Public Health (CU); 1995. Spanish.1919. National Hygiene, Epidemiology and Microbiology Institute (CU). Informe Técnico Primera Encuesta nacional de factores de riesgo. Cuba 2000-2001. Havana: Ministry of Public Health (CU); 2002. Spanish.]

METHODS

A descriptive cross-sectional study was conducted based on data from the Third National Survey on Risk Factors and Non-Communicable Chronic Diseases (2010–11), conducted to determine prevalence and distribution of the main NCD risk factors (RF). The national survey included urban and rural areas with representative estimates for each by sex and age group.[2020. Gorbea M, Varona P, Chang M, García RG, Suárez Medina R, Arcia N, et al. III Encuesta de factores de riesgo y actividades preventivas de enfermedades no transmisibles. Cuba 2010-2011 [Internet]. Havana: Editorial Ciencias Médicas; 2014 [cited 2014 Oct 16]. Available from: http://www.bvs.sld.cu/libros/encuesta_nacional_riesgo/encuesta_nacional_completo.pdf Spanish.
http://www.bvs.sld.cu/libros/encuesta_na...
]

The method of three-stage stratified cluster sampling—in which the units of the first, second and third steps were districts (210 households on average), areas (minimum of 60 households) and sections (five households on average), respectively—and the selection process are described elsewhere.[2020. Gorbea M, Varona P, Chang M, García RG, Suárez Medina R, Arcia N, et al. III Encuesta de factores de riesgo y actividades preventivas de enfermedades no transmisibles. Cuba 2010-2011 [Internet]. Havana: Editorial Ciencias Médicas; 2014 [cited 2014 Oct 16]. Available from: http://www.bvs.sld.cu/libros/encuesta_nacional_riesgo/encuesta_nacional_completo.pdf Spanish.
http://www.bvs.sld.cu/libros/encuesta_na...
]

Study sample size was 7915 individuals in 415 districts, incorporating 4150 households throughout Cuba. All household members aged ≥15 years were interviewed by specialized personnel trained and certified for implementing population studies. Our research included the population aged 15–69 years, the age group for which IPAQ has been validated.[1414. World Health Organization. Estrategia mundial sobre régimen alimentario, actividad física y salud. Geneva: World Health Organization; 2004. 24 p. Spanish.]

To determine levels of the dependent variable—physical activity in the seven days prior to the survey—the short-form IPAQ was used. Overall physical activity includes four basic domains: household, job-related, transportation and leisure.[1414. World Health Organization. Estrategia mundial sobre régimen alimentario, actividad física y salud. Geneva: World Health Organization; 2004. 24 p. Spanish.]

The variable for physical activity overall was classified as:

  • active (when participants reported having walked or performed another moderately intense physical activity for an accumulated duration of at least 30 minutes per day, or in minimum efforts of 10 consecutive minutes for 5 days or more in the last 7 days, or performed vigorous activity for an accumulated duration of at least 20 consecutive minutes per session for 3 days or more in the last 7 days);

  • irregularly active (having walked or performed another moderately or vigorously intense physical activity for a daily accumulated duration of at least 10 minutes, but without meeting all criteria for regular activity); and

  • sedentary (not having walked or performed any other moderately or vigorously intense physical activity for at least 10 straight minutes in the last 7 days).[2121. Andrade DR, Andrade E, Braggion GF, Oliveira L, Maecha Matsudo SM, Araújo TL, et al. Nivel de atividade fisica da população do estado de Sao Paulo: análise de acordo com o genero, idade, nível socioeconomico, distribuição geográfica e de conhecimento. Rev Bras Cien Mov. 2002;10(4):41–50. Portuguese.]

Independent variables included in the analysi s were:

  • geographic area (rural, urban);

  • sex;

  • age group (15–24, 25–34, 35–44, 45–54 and 55–69 years);

  • education completed (none, primary, middle school, trade school, middle-level technical, high school, university);

  • marital status (single, married, partnered, widowed, separated);

  • employment (government; joint-venture company, i.e., a firm created in partnership between Cuba and foreign investors; self-employed; student; homemaker; retired; unemployed);

  • skin color (white, mestizo, black); and

  • perception of health risk associated with overweight and physical inactivity (high, moderate, low and none).

These variables were used as stratification criteria for physical activity categories and as covariants in multivariate statistical models.

Analysis

Percentages and 95% confidence intervals were calculated for categories of physical activity, total and stratified by sociodemographic variables.

To identify factors associated with regularity of practice (although not for the purpose of causal inference), a multinomial logistical regression model was fitted to calculate adjusted odds ratios (OR) and their 95% confidence intervals. Two sets of OR were estimated with their corresponding intervals: one for the category in-active and the other for the category irregularly active. The model included only those variables that appeared to show a clear pattern of association on visual inspection of the descriptive statistics in the bivariate analysis. The following reference categories were used for discrete independent variables:

  • urban geographic area

  • male sex

  • government employment

  • no perceived health risk associated with overweight

Except for perception of risk associated with overweight, selection of reference categories was subjective, on the basis of an assumption of least risk.

For age, ORs and confidence intervals were calculated per age increment (10 years, until reaching the oldest age group, which was 55–69 years, a 15-year increment). In the multinomial model, age was introduced as an ordinal variable with values 1 (ages 15–24 years) through 5 (ages 55–69 years).

SAS Version 9.11 was used for all calculations, taking into account the survey’s complex sampling design for adjustment and weighting of estimates and corresponding standard errors.[2222. Statistical Software for Windows [Internet]. North Carolina: SAS Institute Inc; c1996-2013. SAS University Edition. Pay nothing. Gain everything. Cary; [cited 2013 Oct 18]. Available from: http://www.sas.com/en_us/software/university-edition.html
http://www.sas.com/en_us/software/univer...
]

Ethics

The study was approved by the Ethics Committee of the National Hygiene, Epidemiology and Microbiology Institute of Cuba. Study participants gave written informed consent.

RESULTS

Some 76% of study participants lived in urban areas; 51% were male and 49% female. Mean participant age was 45 years (43 for men, 45 for women), with the largest group aged 35–44 years. The most populous groups for other variables were, respectively; for education, middle and high school; for marital status, married; for employment, government; and for skin color, white (Table 1).

Table 1
Participant sociodemographics

Approximately 71% of the sample reported being active, 23% as sedentary and 6% as irregularly active, with similar distributions in urban and rural areas. In both urban and rural areas, higher activity levels were reported by men. Women were more active in urban than rural areas: 63.3% (CI 60.2%–66.4%) and 48.9% (CI 43.6%–54.1%) respectively, in contrast with men: 80.8% (CI 78.2%–83.3%) and 82.7% (CI 79.3%–86.1%).

Overall, the percentage of sedentary or irregularly active people was twice as high for women as for men (Table 2).

Table 2
Physical activity by sociodemographic factors, Cuba, 2010–2011

Physical inactivity increased with age, showing modest increases for each age increment up to the group aged 45–54 years and then and a pronounced upturn in the group aged 55–69 years. It was also slightly higher among white people (Table 2). Sedentarism was substantially more frequent (more than 10 percentage points) among people with little or no schooling (primary school or less), than in the rest of the education categories, which presented similar percentages of physical inactivity (Table 2).

There was a higher percentage of inactivity among widowed men and women (32.9%). Single people presented the highest activity levels (76.4%) followed by those who reported they had a partner (71.9%) (Table 2).

For the employment variable, homemakers and retirees presented higher percentages of physical inactivity. The most active people were found in the categories of government workers, joint venture employees, students and self-employed (Table 2).

There were no noticeable differences in physical activity patterns by skin color.

Multivariate analysis revealed associations between regular physical activity and the variables sex, age, occupation, and perception of health risk associated with overweight (Table 3). The variables marital status, education, skin color, and perception of risk associated with physical inactivity showed no discernible association with physical activity (Table 2) and therefore were not included in the regression model.

Women were more likely than men to report being sedentary (OR 2.51, CI 2.12–2.98). The likelihood of physical inactivity increased (although only slightly) with age, with an OR of 1.19 (CI 1.12–1.26) for each age group increment.

The likelihood of inactivity also increased in the categories of homemaker, retired and unemployed, with respective ORs of: 1.95 (CI 1.58–2.39), 1.68 (CI 1.32–2.13) and 1.90 (CI 1.37–2.64). The odds of physical inactivity decreased, however, in the group that perceived being overweight as a high risk to health (OR 0.49, CI 0.29–0.83) (Table 3).

The pattern of association with respect to irregular physical activity was very similar to that observed in the category of physical inactivity already described above. Results are displayed in Table 3.

Table 3
Likelihood of sedentarism or irregular physical activity, regression model for selected variables, Cubans aged 15–69 years, 2010–2011

DISCUSSION

Introduction of a new metric is accompanied by certain reservations for comparisons with other studies in similar scenarios. But this shortcoming is compensated for by the possibilities it opens to establishing baselines, applying a validated instrument, and setting the foundation for monitoring and assessing trends.

This is the first national-level study to describe physical activity among Cubans using the short-form IPAQ questionnaire. It is difficult to make comparisons with other studies that used different methods, but the results provide a baseline for future assessments.

An estimated 70% or more of Cubans have high levels of physical activity, which means that almost one in three Cubans is in the group WHO considers at risk for cardiovascular disease and other disorders.[2323. Pan American Health Organization. Enfermedades No Trasmisibles en Las Américas: construyamos un futuro más saludable. Washington, D. C.: Pan American Health Organization; 2011. Spanish.]

Some studies conducted in Latin America and the Caribbean estimate that 30%–60% of the population do not meet minimum recommended activity levels. The percentage of active people reported in our study is similar to findings in Bogota, Colombia and Buenos Aires, Argentina, which reported prevalences of 36.4% and 31%, respectively, and higher than those found in Medellin, Colombia and Sao Paulo, Brazil, also using the short-form IPAQ.[2424. Pan American Health Organization. Estrategia Mundial sobre Alimentación Saludable, Actividad Física y Salud (DPAS). Plan de Implementación en América Latina y el Caribe. 2006-2007. Version 8 [Internet]. Washington, D.C.: Pan American Health Organization; 2006 Mar 10 [cited 2012 Mar 31]. Available from: http://www1.paho.org/spanish/ad/dpc/nc/dpas-plan-imp-alc.pdf 23 p. Spanish.
http://www1.paho.org/spanish/ad/dpc/nc/d...
25. Gómez LF, Duperly J, Lucumí DIS. Nivel de actividad física global en la población adulta de Bogotá (Colombia). Prevalencia y factores asociados. Gac Sanit. 2005 May-Jun;19(3):206–13. Spanish. 26. Echegaray N, Bazán N. Evaluación del nivel de actividad física mediante la aplicación del cuestionario internacional de actividad física IPAQ en una muestra de población adulta (35-69 años) de la ciudad de Buenos Aires. Rev Electrónica Cienc Aplic Deporte. 2008 Dec;1(3):1–14. Spanish.2727. Serón P, Muñoz S, Lanas F. Inactividad física en Latinoamérica. Nivel de actividad física medida a través del cuestionario internacional de actividad física en población chilena. Rev Méd Chile [Internet]. 2010 [cited 2016 Oct 1];138:1232–9. Spanish. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001100004
http://www.scielo.cl/scielo.php?script=s...
] It is important to note that our study is representative of an entire country, one with different economic and social conditions than those found in the cities where these studies were done.

Lower activity levels for women were observed in this study than in other studies using the IPAQ. Women tend to have less regular physical activity and perform less strenuous work than men. In addition, women typically shoulder a large part of domestic chores, manage the household and take care of the children, along with their employment, which can limit opportunities for other types of physical activity.[2424. Pan American Health Organization. Estrategia Mundial sobre Alimentación Saludable, Actividad Física y Salud (DPAS). Plan de Implementación en América Latina y el Caribe. 2006-2007. Version 8 [Internet]. Washington, D.C.: Pan American Health Organization; 2006 Mar 10 [cited 2012 Mar 31]. Available from: http://www1.paho.org/spanish/ad/dpc/nc/dpas-plan-imp-alc.pdf 23 p. Spanish.
http://www1.paho.org/spanish/ad/dpc/nc/d...
2727. Serón P, Muñoz S, Lanas F. Inactividad física en Latinoamérica. Nivel de actividad física medida a través del cuestionario internacional de actividad física en población chilena. Rev Méd Chile [Internet]. 2010 [cited 2016 Oct 1];138:1232–9. Spanish. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001100004
http://www.scielo.cl/scielo.php?script=s...
] Similar results were reported in the USA where adequate physical activity levels were more common among men.[2828. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and Public Health: recommendation from the American College of Sports Medicine and the American Health Association. Circulation. 2007 Aug 28;116(9):1094–1105.]

In Chile, a 2009 national survey of physical activity and sports reported 83.7% physical inactivity for men and 88.6% for women.[2929. National Sports Institute of Chile. Encuesta Nacional de Hábitos en Actividad Física y Deportiva en la población mayor de 18 Años. Informe de resultados. Santiago de Chile: National Sports Institute of Chile; 2016. Spanish.] Also in contrast to our study, Brazilian research published in 2008 found sedentarism significantly more frequent in men than in women.[3030. Siqueira F, Facchini LA, Piccini RX, Tomasi E, Thumé E, Silveira DS, et al. Atividade física em adultos e idosos residentes em áreas de abrangência de unidades básicas de saúde de municípios das regiões Sul e Nordeste do Brasil. Cad Saúde Pública. 2008 Jan;24(1):39–54. Portuguese.]

The inverse relation between physical activity and age we observed is consistent with other studies, in which physical activity steadily decreased with age in both sexes. It has been suggested that physical activity levels decline at a rate of 1%–2% per year.[3030. Siqueira F, Facchini LA, Piccini RX, Tomasi E, Thumé E, Silveira DS, et al. Atividade física em adultos e idosos residentes em áreas de abrangência de unidades básicas de saúde de municípios das regiões Sul e Nordeste do Brasil. Cad Saúde Pública. 2008 Jan;24(1):39–54. Portuguese. 31. Bezerra Alves JG, Ulises Montenegro FM, Oliveira FA, Victor Alves R. Prática de esportes durante a adolescência e atividade física de lazer na vida adulta. Rev Bras Méd Esporte. 2005 Sep-Oct;11(5):291–4. Portuguese, English.3232. Bauman A, Bull F, Chey T, Craig CL, Ainsworth BE, Sallis JF, et al. The International Prevalence Study on Physical Activity: results from 20 countries. Int J Behav Nutr Phys Act. 2009 Mar 31;6:21. DOI: 10.1186/1479-5868-6-21.
10.1186/1479-5868-6-21...
] In our study, there was a slight tendency toward increased sedentarism with age, but it was not uniform over time, with a gradual rise in early adulthood and a more dramatic upward turn in the oldest age group (coinciding with legal retirement ages in Cuba).

Our study found that a high percentage of Cuban youth self-classified as “active.” In many other countries (both developing and developed), less than one third of this group sufficiently active.[3232. Bauman A, Bull F, Chey T, Craig CL, Ainsworth BE, Sallis JF, et al. The International Prevalence Study on Physical Activity: results from 20 countries. Int J Behav Nutr Phys Act. 2009 Mar 31;6:21. DOI: 10.1186/1479-5868-6-21.
10.1186/1479-5868-6-21...
]

Educational level has been identified as a predictor variable in multiple population studies.[77. Piepoli MF, Conrads V, Corra U, Dickstein K, Francis DP, Jarsma T, et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011 Apr;13(4):347–57.] Our results clearly show two groups with different risk profiles: people with primary school or less, and people with middle school or more. In Cuba, as part of their school day, children and adolescents receive (in the years prior to and in high school, continuing in the first years of university or vocational school) physical education classes and sports at least two or three times per week, in addition to the physical activity involved in getting to and from school and any leisure-time activity.

In Colombia, a study by Uribe[88. Uribe Bustos JX. Inactividad física y factores de riesgo: Construcción de un modelo explicativo [thesis]. [Bogotá, D.C.]: Universidad Nacional de Colombia; 2010. Spanish.] showed that physical inactivity in adults with only the primary or secondary education was as high as 50%, becoming less frequent as educational level rose. A Spanish study reported a change at university level, when physical activity tended to fall off.[3333. Cancela Carral JM, Ayán Pérez C. Prevalencia y relación entre el nivel de actividad física y las actitudes alimenticias anómalas en estudiantes universitarios españoles de ciencias de la salud y la educación. Rev Esp Salud Pública. 2011 Oct;85(5):499–505. Spanish.]

Two factors might help explain less activity in widowed Cubans. First, obviously, is their older age, which can confound the association between physical inactivity and widowhood, because likelihood of both increases with age (similarly, younger age may help explain why single people are more active than married people). Second, loss of a spouse commonly creates a certain level of anxiety or depression, which can reduce motivation to be active. We did not include anxiety and depression as variables because exploring their possible relationship with physical activity was not a study objective, but it is worth noting that lack of exercise is a risk factor for anxiety and depression, which can lead to a vicious circle of negative behaviors.[3434. Kaburagi T, Hirasawa R, Yoshino H, Odaka Y, Satomi M, Nakano M, et al. Nutritional status is strongly correlated with grip strength and depression in community-living elderly Japanese. Public Health Nutr. 2011 Nov;14(11):1893–9.3535. Olmedilla Zafra A, Ortega Toro E. Práctica de la actividad física y ansiedad en mujeres: variables socio demográficas como factores moderadores. Rev Argentina Clín Psicológica. 2012 Apr;21(1):25–32. Spanish.]

It is not surprising that the highest percentages of physically active people are found among government and joint-venture workers, the self-employed, and students. Correspondingly, homemakers, the unemployed and retired are the least active. The first explanation is methodological and lies in the definition of IPAQ categories. IPAQ defines activity as walking and/or doing moderate physical activity, which is common for students and a good proportion of people who work, and not so characteristic of homemakers in our setting. The second explanation is the generally more advanced age of retirees and homemakers with respect to the more active groups.

CONCLUSIONS

This was the first application in Cuba of an instrument with demonstrated external validity adaptable to different cultural settings. With it, we were able to estimate that 7 of every 10 Cubans are active and to identify population groups that are most likely to be sedentary or irregularly physically active. These results lay the foundation for specialized strategies to promote systematic physical activity.

Although we found that Cubans have higher levels of physical activity than reported in many other countries in our geographic region, the fact that almost 3 of 10 respondents self-classify as sedentary shows that there is still great scope for action. The National Intersectoral Program with community participation is working to promote activities aimed at achieving greater incorporation and regularity of physical activity in the Cuban population. Such actions are an important component of any strategy to prevent and control non-communicable diseases.

REFERENCES

  • 1
    World Health Organization. Informe sobre la situación mundial de las enfermedades no transmisibles 2014 [Internet]. Geneva: World Health Organization; 2014 [cited 2016 Feb]. Available from: http://apps.who.int/iris/bitstream/10665/149296/1/WHO_NMH_NVI_15.1_spa.pdf?ua=1&ua=1 16 p. Spanish.
    » http://apps.who.int/iris/bitstream/10665/149296/1/WHO_NMH_NVI_15.1_spa.pdf?ua=1&ua=1
  • 2
    U.S. Department of Health and Human Services. Physical activity and health: a report of the surgeon general. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.
  • 3
    Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise and physical fitness: definitions and distinctions for health related research. Public Health Rep. 1985 Mar-Apr;100(2):126–31.
  • 4
    U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 2008.
  • 5
    World Health Organization. A guide for population-based approaches to increasing levels of physical activity: implementation of the WHO global strategy on diet, physical activity and health. Geneva: World Health Organization; 2007. 19 p.
  • 6
    Williams NH, Hendry M, France B, Lewis R, Wilkinson C. Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review. Br J Gen Pract. 2007 Dec;57(545):979–86.
  • 7
    Piepoli MF, Conrads V, Corra U, Dickstein K, Francis DP, Jarsma T, et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011 Apr;13(4):347–57.
  • 8
    Uribe Bustos JX. Inactividad física y factores de riesgo: Construcción de un modelo explicativo [thesis]. [Bogotá, D.C.]: Universidad Nacional de Colombia; 2010. Spanish.
  • 9
    Berlin JA, Colditz GA. A meta-analysis of physical activity in the prevention of coronary heart dis ease. Am J Epidemiol. 1990 Oct;132(4):612–28.
  • 10
    Rodríguez-Romo G, Cordente C, Mayorga J, Garrido-Muñoz M, Macías R, Ruiz J. Influencia de determinantes socio-demográficos en la adherencia a las recomendaciones de actividad física en personas de entre 15 y 74 años de Madrid, España. Rev Esp Salud Pública. 2011 Aug;85(4):351–62. Spanish.
  • 11
    World Health Organization. Global Burden of Disease Study 2010. Geneva: World Health Organization; 2012 Dec 13.
  • 12
    World Health Organization. Global recommendations on physical activity for health [Internet]. Geneva: World Health Organization; 2011 [cited 2016 Jan 3]. Available from: http://www.who.int/dietphysicalactivity/pa/en/index.html
    » http://www.who.int/dietphysicalactivity/pa/en/index.html
  • 13
    Blair SN, La-Monte MJ, Nichaman MZ. The evolution of physical activity recommendations: how much is enough? Am J Clin Nutr. 2004 May;79(5):913S-20S.
  • 14
    World Health Organization. Estrategia mundial sobre régimen alimentario, actividad física y salud. Geneva: World Health Organization; 2004. 24 p. Spanish.
  • 15
    Craig CL, Marshal AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Soc Sports Exerc. 2003 Aug;35(8):1381–95.
  • 16
    Hagströmer M, Oja P, Sjöström M. The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity. Public Health Nutr [Internet]. 2006 Sep [cited 2016 Jan 3];9(6):755–62. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd = Retrieve&db=PubMed&list_uids=16925881&dopt=Abstract
    » http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd = Retrieve&db=PubMed&list_uids=16925881&dopt=Abstract
  • 17
    Ministry of Public Health (CU). Proyecciones de la Salud Cubana hasta el año 2015 [Internet]. Havana: Ministry of Public Health (CU); 2006 [cited 2013 Oct]; [about 4 screens]. Available from: http://www.saludplaza.sld.cu/Notas/Proy2015.htm Spanish.
    » http://www.saludplaza.sld.cu/Notas/Proy2015.htm
  • 18
    National Hygiene, Epidemiology and Microbiology Institute (CU). Informe Técnico Primera Encuesta nacional de factores de riesgo. Cuba 1995. Havana: Ministry of Public Health (CU); 1995. Spanish.
  • 19
    National Hygiene, Epidemiology and Microbiology Institute (CU). Informe Técnico Primera Encuesta nacional de factores de riesgo. Cuba 2000-2001. Havana: Ministry of Public Health (CU); 2002. Spanish.
  • 20
    Gorbea M, Varona P, Chang M, García RG, Suárez Medina R, Arcia N, et al. III Encuesta de factores de riesgo y actividades preventivas de enfermedades no transmisibles. Cuba 2010-2011 [Internet]. Havana: Editorial Ciencias Médicas; 2014 [cited 2014 Oct 16]. Available from: http://www.bvs.sld.cu/libros/encuesta_nacional_riesgo/encuesta_nacional_completo.pdf Spanish.
    » http://www.bvs.sld.cu/libros/encuesta_nacional_riesgo/encuesta_nacional_completo.pdf
  • 21
    Andrade DR, Andrade E, Braggion GF, Oliveira L, Maecha Matsudo SM, Araújo TL, et al. Nivel de atividade fisica da população do estado de Sao Paulo: análise de acordo com o genero, idade, nível socioeconomico, distribuição geográfica e de conhecimento. Rev Bras Cien Mov. 2002;10(4):41–50. Portuguese.
  • 22
    Statistical Software for Windows [Internet]. North Carolina: SAS Institute Inc; c1996-2013. SAS University Edition. Pay nothing. Gain everything. Cary; [cited 2013 Oct 18]. Available from: http://www.sas.com/en_us/software/university-edition.html
    » http://www.sas.com/en_us/software/university-edition.html
  • 23
    Pan American Health Organization. Enfermedades No Trasmisibles en Las Américas: construyamos un futuro más saludable. Washington, D. C.: Pan American Health Organization; 2011. Spanish.
  • 24
    Pan American Health Organization. Estrategia Mundial sobre Alimentación Saludable, Actividad Física y Salud (DPAS). Plan de Implementación en América Latina y el Caribe. 2006-2007. Version 8 [Internet]. Washington, D.C.: Pan American Health Organization; 2006 Mar 10 [cited 2012 Mar 31]. Available from: http://www1.paho.org/spanish/ad/dpc/nc/dpas-plan-imp-alc.pdf 23 p. Spanish.
    » http://www1.paho.org/spanish/ad/dpc/nc/dpas-plan-imp-alc.pdf
  • 25
    Gómez LF, Duperly J, Lucumí DIS. Nivel de actividad física global en la población adulta de Bogotá (Colombia). Prevalencia y factores asociados. Gac Sanit. 2005 May-Jun;19(3):206–13. Spanish.
  • 26
    Echegaray N, Bazán N. Evaluación del nivel de actividad física mediante la aplicación del cuestionario internacional de actividad física IPAQ en una muestra de población adulta (35-69 años) de la ciudad de Buenos Aires. Rev Electrónica Cienc Aplic Deporte. 2008 Dec;1(3):1–14. Spanish.
  • 27
    Serón P, Muñoz S, Lanas F. Inactividad física en Latinoamérica. Nivel de actividad física medida a través del cuestionario internacional de actividad física en población chilena. Rev Méd Chile [Internet]. 2010 [cited 2016 Oct 1];138:1232–9. Spanish. Available from: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001100004
    » http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010001100004
  • 28
    Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and Public Health: recommendation from the American College of Sports Medicine and the American Health Association. Circulation. 2007 Aug 28;116(9):1094–1105.
  • 29
    National Sports Institute of Chile. Encuesta Nacional de Hábitos en Actividad Física y Deportiva en la población mayor de 18 Años. Informe de resultados. Santiago de Chile: National Sports Institute of Chile; 2016. Spanish.
  • 30
    Siqueira F, Facchini LA, Piccini RX, Tomasi E, Thumé E, Silveira DS, et al. Atividade física em adultos e idosos residentes em áreas de abrangência de unidades básicas de saúde de municípios das regiões Sul e Nordeste do Brasil. Cad Saúde Pública. 2008 Jan;24(1):39–54. Portuguese.
  • 31
    Bezerra Alves JG, Ulises Montenegro FM, Oliveira FA, Victor Alves R. Prática de esportes durante a adolescência e atividade física de lazer na vida adulta. Rev Bras Méd Esporte. 2005 Sep-Oct;11(5):291–4. Portuguese, English.
  • 32
    Bauman A, Bull F, Chey T, Craig CL, Ainsworth BE, Sallis JF, et al. The International Prevalence Study on Physical Activity: results from 20 countries. Int J Behav Nutr Phys Act. 2009 Mar 31;6:21. DOI: 10.1186/1479-5868-6-21
    » 10.1186/1479-5868-6-21
  • 33
    Cancela Carral JM, Ayán Pérez C. Prevalencia y relación entre el nivel de actividad física y las actitudes alimenticias anómalas en estudiantes universitarios españoles de ciencias de la salud y la educación. Rev Esp Salud Pública. 2011 Oct;85(5):499–505. Spanish.
  • 34
    Kaburagi T, Hirasawa R, Yoshino H, Odaka Y, Satomi M, Nakano M, et al. Nutritional status is strongly correlated with grip strength and depression in community-living elderly Japanese. Public Health Nutr. 2011 Nov;14(11):1893–9.
  • 35
    Olmedilla Zafra A, Ortega Toro E. Práctica de la actividad física y ansiedad en mujeres: variables socio demográficas como factores moderadores. Rev Argentina Clín Psicológica. 2012 Apr;21(1):25–32. Spanish.

  • Disclosures: None

Publication Dates

  • Publication in this collection
    Oct-Dec 2016

History

  • Received
    27 Jan 2016
  • Accepted
    4 Oct 2016
Medical Education Cooperation with Cuba Oakland - California - United States
E-mail: editors@medicc.org