Promoting Physical Promoting Physical ActivityActivity

in Jamaicain JamaicaDr Deanna AshleyDr Deanna Ashley

Healthy Lifestyle ProgrammeHealthy Lifestyle Programme

Baseline Lifestyle Survey conducted yr Baseline Lifestyle Survey conducted yr 20002000

Healthy Lifestyle Policy andHealthy Lifestyle Policy and Strategic Plan approved yr Strategic Plan approved yr

20042004 Programme implementation initiated Programme implementation initiated

2004/052004/05 Repeat Life Style Survey conducted yr Repeat Life Style Survey conducted yr

2008 2008

BackgroundBackground Jamaican Healthy Lifestyle Survey Jamaican Healthy Lifestyle Survey

2000-2001 2000-2001 (15-74(15-74 yrs oldyrs old) showed ) showed prevalence estimate ofprevalence estimate of Hypertension 20.8%Hypertension 20.8% Diabetes mellitus 7.2% Diabetes mellitus 7.2% Obesity 19.7%Obesity 19.7% Wilks et al 2002Wilks et al 2002

These health conditions are associated These health conditions are associated with a high economic cost with a high economic cost 33

3Ward E and Grant A, 2003

Lifestyle Survey 2007/08 -Study DesignLifestyle Survey 2007/08 -Study Design Wilks et al Wilks et al

Nationally representative cross-sectional Nationally representative cross-sectional surveysurvey

Interviewer administered questionnaireInterviewer administered questionnaire Target Group: 15- 74 year oldsTarget Group: 15- 74 year olds Field Work: November 2007 - March 2008Field Work: November 2007 - March 2008 Sample size: 2914Sample size: 2914

Changes in Nutritional Changes in Nutritional Status: 2000-2008Status: 2000-2008

Nutritional StatusNutritional Status JHLS-2000JHLS-2000 JHLSII-2008JHLSII-2008Nutritional StatusNutritional Status JHLS-2000(CI)JHLS-2000(CI) JHLSII-2008(CI)JHLSII-2008(CI)

Underweight Underweight (<18.5kg/m(<18.5kg/m22)) 4.9(3.4-6.4)4.9(3.4-6.4) 4.7(3.9- 5.6)4.7(3.9- 5.6)

Normal Normal (18.5-24.99 kg/m(18.5-24.99 kg/m22)) 49.4(46.2-52.5)49.4(46.2-52.5) 43.6 (40.8- 46.3)43.6 (40.8- 46.3)

OverweightOverweight(25-29.99 kg/m(25-29.99 kg/m22)) 26.1(23.5-28.7)26.1(23.5-28.7) 26.4 (24.5- 28.6)26.4 (24.5- 28.6)

Obese Obese (≥30 kg/m(≥30 kg/m22))****** 19.7(17.4-22.0)19.7(17.4-22.0) 25.3 (22.8- 27.4)25.3 (22.8- 27.4)

Increased WCIncreased WC 35.6 (32.8-38.5)35.6 (32.8-38.5) 45.2(43.3-47.1)45.2(43.3-47.1)***P< 0.001

Changes in PAL of Changes in PAL of Jamaicans in Seven YearsJamaicans in Seven Years

Nutritional Status & Nutritional Status & Activity LevelsActivity Levels

SummarySummary Almost 40% of Jamaicans Almost 40% of Jamaicans

reported having low physical reported having low physical activity levelsactivity levels

Obesity appears to be the driver Obesity appears to be the driver of this epidemicof this epidemic

Work Place Study 2003Work Place Study 2003 Ashley Ashley D.V. et alD.V. et al

Sample taken from 2 Private Sector Sample taken from 2 Private Sector CompaniesCompanies

Public Sector Health WorkersPublic Sector Health Workers

MOH vs. Private Sector Mean BMI MOH vs. Private Sector Mean BMI and Waist Circumferenceand Waist Circumference

ANTROPOMETRYANTROPOMETRY MOHMOH Private Private sectorsector

BMI (Kg/m2)BMI (Kg/m2) 26.0026.00 25.1225.12Waist Waist CircumfereCircumferencence(cm)(cm)

FemalFemalee

84.4884.48 77.4077.40

MaleMale 88.8388.83 87.0687.06

Self – reported Frequency of Exercise Taken for Self – reported Frequency of Exercise Taken for

>30mins>30mins Frequency Vigorous (%) Moderate (%)

Daily 3.9 24.3 3-6/week 14.2 20.4

1-3 /week 18.4 19.92-4 /month 6.4 6.4

1-3 /month 5.2 6.2

Once/month 18.1 10.3Never 33.8 12.5

Physical Activity Level – Staff at Physical Activity Level – Staff at High Risk for CVDHigh Risk for CVD

0

10

20

30

40

50

60

High Moderate Low Sedentary

Level of Physical Activity

Per

cent

age

MaleFemale

Factors Influencing Physical Activity Factors Influencing Physical Activity BehaviourBehaviour

Lack of Motivation (44%)Lack of Motivation (44%)Lack of Support (34%)Lack of Support (34%)Safety (31%)Safety (31%)Lack of Time (44%)Lack of Time (44%)Affordability (43%)Affordability (43%)Lack of Habit 22%)Lack of Habit 22%)Sedentary leisure activities (88%) Sedentary leisure activities (88%)

Integrated Healthy Lifestyle Integrated Healthy Lifestyle Programme Programme

St. Ann’s Bay H/CSt. Ann’s Bay H/CDr. Calixto Orozco MuDr. Calixto Orozco Muññoz et. aloz et. al

ObjectiveObjective To assess the impact of an integrated Healthy To assess the impact of an integrated Healthy

Lifestyle Programme on the Management of Lifestyle Programme on the Management of Chronic DiseasesChronic Diseases

Integrated Healthy Lifestyle Integrated Healthy Lifestyle Programme Programme

St. Ann’s Bay H/CSt. Ann’s Bay H/C

Target group :Target group : Patients attending the Chronic Disease Patients attending the Chronic Disease

ClinicClinic No. of participants 122No. of participants 122 58% were over age of 60 yrs58% were over age of 60 yrs

Integrated Healthy Lifestyle Integrated Healthy Lifestyle Programme – St. Ann’s Bay H/CProgramme – St. Ann’s Bay H/C

Methods Methods Two Year Integrated Lifestyle Two Year Integrated Lifestyle

Programme (August 2002-September Programme (August 2002-September 2004):2004): Health PromotionHealth Promotion PreventionPrevention Curative CareCurative Care RehabilitationRehabilitation Exercise ProgrammeExercise Programme

Integrated Healthy Lifestyle Integrated Healthy Lifestyle Programme Programme

St. Ann’s Bay H/CSt. Ann’s Bay H/CMean No. Risk Factors Before and After Mean No. Risk Factors Before and After InterventionIntervention

DiseaseDisease BeforeBefore AfterAfter Mean DifferenceMean Difference(95% CI)(95% CI)

DiabetesDiabetes(N=54, (N=54, p=0.000p=0.000))

2.32.3 1.31.3 -1 (0.7 to 1.2)-1 (0.7 to 1.2)

HypertensionHypertension(N=98, (N=98, p=0.000p=0.000))

2.22.2 1.31.3 -0.9 (0.7 to 1.0)-0.9 (0.7 to 1.0)

Integrated Healthy Lifestyle Integrated Healthy Lifestyle Programme Programme

St. Ann’s Bay H/C St. Ann’s Bay H/C

Other Results:Other Results: 23% of obese patients reduced their 23% of obese patients reduced their BMI to overweight BMI to overweight

44% of overweight patients achieved 44% of overweight patients achieved normal weightnormal weight

Clinic PatientsClinic Patients

Clinic PatientsClinic Patients

Youth CampYouth Camp

Aerobics in the ParkAerobics in the Park