Epidemiology of Physical Inactivity in Nigeria

According to the World Health Organization (WHO) (2022), physical inactivity is defined as failing to complete at least 150 minutes of moderate physical activity, 75 minutes of vigorous physical activity, or a mix of the two intensities per week. An individual is said to be physically inactive or sedentary when they do not  get the recommended level of regular physical activity. It has been observed that those who are not sufficiently physically active have a death risk that is 20% to 30% higher than those who are. Through the use of motorized transportation, an increase in the use of screens for work, education, and entertainment, people in Nigeria are becoming more sedentary. There is evidence that more sedentary behavior is linked to all-cause mortality, cardiovascular disease mortality, cancer mortality, and the incidence of cancer, type 2 diabetes, and cardiovascular disease (WHO, 2022). 

Views about the place and status of physical activities have been changing from primitive times to the advent of civilization and technology. These changes have been classified into the pre-agrarian Era, agrarian Era and post Agrarian Era (Otinwa, 2012). Early humans in the pre-agrarian era were predominantly hunters, food gatherers and nomads. The prevailing environment was a hostile one; thus, humans had to be extremely active in order to survive their constant battles with nature (Otinwa, 2014).

Thousands of years later, pre-historic societies advanced and human beings started to live in settlements. Along the line they discovered farming and irrigation, as well as specializing in the production of agricultural goods and their exchange. This led to reduction in nomadic activity and resulted in a gradual drop in their physical activity patterns as they gradually adopt a new way of life based on grazing of animals and planting of crops (Otinwa, 2014). This era witnessed a reduction in somatic energy expenditure but was marked by increase in food intake and more time for leisure and relaxation. Leisure activities grew from earlier survival skills and became a form of recreation (Ogini, 2018).

In today’s world, civilization has forced rapid social changes on humankind in all spheres of life. One of the major social changes was the gradual transition from pre-agrarian daily living that contained high levels of somatic energy expenditure to an increasingly sedentary lifestyle in the modern era (Adedoyin, 2014). Today in many homes, factories and offices, machines now supply the power for most work. Machines have virtually eliminated the necessity for extensive walking, running, lifting or climbing today. Therefore, for many people, the task of daily living does not provide enough vigorous exercise for them to develop and maintain a satisfactory level of cardiovascular fitness, good muscle tone or the recommended body weight. Inactivity combined with poor personal health practices such as poor diet on the part of many could pose massive physical fitness problems (Otinwa, 2014; WHO, 2020). Physical inactivity is used to refer to inability to achieve the recommended levels of physical activity for health. Some people worldwide fail to have the recommended 30 minutes of regular, moderate-intensity physical activity on most days throughout a person's life. 

Physical inactivity is now described as a pandemic that needs urgent action. Research showed that one in four adults in the world are inactive. Globally, more than 80% of the adolescent population is physically inactive. It is evidenced that physically inactive people are 20-30% times more likely at risk of death compared to active individuals (Haileamlak, 2019). Non-communicable diseases (NCDs) have remained a major public health problem globally, majorly contributing to the increase in morbidity and mortality rates especially in low-income and middle-income countries. Their devastating social, human, economic and public health impact is recognized as a global burden by all societies and economies (Gowshall & Taylor-Robinson, 2018). It has been projected that by 2030, more than 22.2 million people will die annually from CVDs, with greater impact among the developing and underdeveloped nations. Chronic non-communicable diseases (NCDs) are the leading causes of death globally (60% of all deaths), killing more people each year than all other causes combined (WHO, 2020).

Figure 1: Some stretching exercises during Unilag Walk for Life in preperation for Nigeria University Games (NUGA 2022)

Global Report on Physical Inactivity

Insufficient physical activity is one of the leading risk factors for global mortality and is on the rise in many countries, adding to the burden of NCDs and affecting general health worldwide. People who are insufficiently active have a 20% to 30% increased risk of death compared to people who are sufficiently active (WHO, 2020).

• Insufficient physical activity is one of the leading risk factors for death worldwide.

• Insufficient physical activity is a key risk factor for noncommunicable diseases (NCDs) such as cardiovascular diseases, cancer and diabetes.

• Physical activity has significant health benefits and contributes to prevent NCDs.

• Globally, 1 in 4 adults is not active enough.

• More than 80% of the world's adolescent population is insufficiently physically active. 

Recent estimates show that approximately 31% of the world's population does not undertake the recommended amount of physical activity to protect their health. Available data from the world health organization show levels of inactivity range from about 30% to as high as 70%. While countries have systematic monitoring of levels of physical activity in adults and children only a few percent of countries have commenced any comprehensive action aimed at increasing levels of activity through sports, recreation, cycling and walking (WHO, 2020). 

Physical inactivity accounts for more than 3 million deaths worldwide, and is implicated in causing 6% of coronary heart diseases, 7% of diabetes, and 10% of colon or breast cancer (Gichu et al., 2018). Physical inactivity has been reported to be associated with an increase in the occurrence of NCDs; thus, physical inactivity contributes to deaths and disabilities (Das & Horton, 2012). In particular, physical inactivity has major effects on the occurrence of coronary heart disease, type 2 diabetes and cancer, specifically breast and colon cancers. Research shows that (6-10%) of global deaths from NCDs were directly related to physical inactivity. Conversely, improvement in physical activity contributes to NCD prevention (Lee et al., 2012).

Physical Activity Report in Nigeria 

The prevalence of physical activity among Nigerian adults was at 78%. Prevalence was higher among males (79%) than females (76%). Although the proportion of Nigerian adults (78%) that met the health recommendations of at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week, or an equivalent combination was more than the global average of 76.7%, about 22% of adults' population in Nigeria still remain inactive (Sallis et al., 2016). No data exists on the proportion of all deaths directly due to physical inactivity in Nigeria. There was no physical activity surveillance system in place to monitor physical inactivity in Nigeria. Also, no national physical activity plan exists for Nigeria (Oyeyemi et al., 2018).

Figure 2: Physical Activity Country Card – Nigeria (Global Observatory for Physical Activity, 2016)

The multitude of factors that induce individuals to initiate and maintain programmes of physical activity have been divided into those that are invariable (age, gender, race, ethnicity) and those that are presumed to be modifiable (behavioural and personality characteristics, environmental circumstances and community settings). Nigeria is currently undergoing economic, technological and nutrition transitions, which have caused marked lifestyle changes characterized by physical inactivity, overweight and obesity (Pangani et al., 2016). It is also known that antecedents of obesity originate from child-hood and progress into adulthood (Musa et al., 2012), which suggest the need for immediate prevention and management of the disease (Pangani et al. 2016). In Nigeria, the prevalence of overweight individuals ranged from 20.3%–35.1%, while the prevalence of obesity ranged from 8.1%–22.2% (Toriola et al., 2017).

Currently, populations in low and middle income countries now contribute 75% of the CVD death worldwide, which leads to 7% reduction of gross domestic product in these countries (Ruan et al., 2018). According to the WHO (2016) report, cardiovascular diseases accounted for 11%, cancer 4%, chronic respiratory diseases 2%, diabetes 1% while other NCDs accounted for 12% of all mortality in Nigeria. A total of 617,300 Nigerians died from NCDs in 2016, with 293,700 being male while 323,600 being females. NCDs accounted for about 29% of all deaths in Nigeria annually (WHO, 2016). Alarming estimates suggest that NCD deaths will increase by about 15% globally over ten years. Physical inactivity has been identified as the fourth leading risk factor for global mortality (6% of deaths globally) (Filho, de Campos & Lopes, 2014).

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IMPLICATIONS FOR POLICY, RECOMMENDATIONS AND FUTURE RESEARCH

There is substantial epidemiological evidence for the protective effects of both a physically active lifestyle and of various levels of physical fitness. Physical inactivity’s increasing relevance as a public health issue is closely tied to its role relating to the obesity epidemic as well as non-communicable disease rates (NCDs), which are on the rise globally (WHO, 2019).

The WHO Global status report on non-communicable diseases reports that contrary to popular opinion, available data demonstrate that nearly 80% of Non-Communicable Diseases (NCDs) deaths occur in low and middle-income countries. NCDs are caused, to a large extent, by four behavioural risk factors that are pervasive aspects of economic transition, rapid urbanisation and 21st-century lifestyles: insufficient physical activity, tobacco use, unhealthy diet, and the harmful use of alcohol (WHO, 2018).

In conclusion, this report emphasize the importance of implementing population-wide approaches to reduce non-communicable diseases associated with increasing rate of physical inactivity and obesity in Nigeria. Future studies on the role of physical activity and their determinants in urban populations are urgently needed. Specific public health policies in Nigeria to promote awareness especially among young adults, education, nutritional interventions, improved urban neighborhood planning and increased physical activity, should be integrated in national health policies to help control this epidemic.

References

Adedoyin, R., Adeniyi, A., Akinroye, K., Alawode, A., Awotidebe, T., Oyeyemi, L., Ozomata, E. (2014). Results from Nigeria’s 2013 Report Card on Physical Activity for Children and Youth. Journal of Physical Activity & Health 11(s1). S86-S92. 

Filho, V. C., de Campos, W., & Lopes, A. S., (2014). Epidemiology of physical inactivity, sedentary behaviors, and unhealthy eating habits among Brazilian adolescents: A systematic review. Ciência & Saúde Coletiva, 19 (1). 173-193.

Gichu, M., Asiki, G., Juma, P. et al. (2018). Prevalence and predictors of physical inactivity levels among Kenyan adults (18–69 years): an analysis of STEPS survey 2015. BMC Public Health 18, 1217. 

Global Observatory for Physical Activity (2016). The Nigerian country card of physical activity profile. Retrieved on the 4th of September 2020 from http://www.globalphysicalactivityobservatory.com/card/?country=NG

Gowshall, M., & Taylor-Robinson, S. D., (2018). The increasing prevalence of non-communicable diseases in low-middle income countries: the view from Malawi. Int J Gen Med. 11. 255–264.

Haileamlak, A. (2019). Physical Inactivity: The Major Risk Factor for Non-Communicable Diseases. Ethiop J Health Sci.;29 (1). 8-10.

Lee, I-M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., & Katzmarzyk, P. T., (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet Lond Engl. 380 (9838). 219–229.

Musa DI, Toriola AL, Monyeki MA, & Lawal, B., (2012). Prevalence of childhood and adolescent overweightand obesity in Benue State, Nigeria. Trop. Med. Int. Health, 17: 1369-1375

Ogini, J., (2018). Physical Activity Intervention: A Tool to Forestall Endemic Prevalence of Noncommunicable Diseases in Nigeria. SSRN Electronic Journal. Retrieved on the 2nd of september 2020 from www.researchgate.net/publication/343059161_Physical_Activity_Intervention_A_Tool_to_Forestall_Endemic_Prevalence_of_Noncommunicable_Diseases_in_Nigeria

Otinwa, G. O., (2012). African perspective on physical education and sports. The Global Journal of Health and Physical Education Pedagogy, 1 (1). 42-49.

Otinwa, G. O., (2014). One cause, many crises the kinetic interpretation of wellness. University of Lagos Inaugural Lecture series 2014. University of Lagos Press and Bookshop Ltd. Lagos, Nigeria.

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HOW TO REFERENCE THIS ARTICLE

Ademola, V. D (2022). Epidemiology of Physical Inactivity in Nigeria. Retrieved from https://www.youdread.com/2022/11/epidemiology-of-physical-inactivity-in.html