2.18 Physical activity
Why is it important?
Physical activity can be defined as a bodily movement produced by the muscles resulting in energy expenditure, and can include organised or incidental activity (AIHW 2010a). Physical inactivity is an important modifiable risk factor associated with several potentially preventable chronic diseases that are prevalent in the Aboriginal and Torres Strait Islander population. These diseases include cardiovascular disease, cancer, stroke, hypertension and diabetes (AIHW 2012c; Gray et al. 2013; Wilmot et al. 2012). Physical inactivity is also related to overweight and obesity, another important risk factor for multiple preventable diseases.
Physical inactivity accounts for approximately 6.6% of the total burden of disease in the Australian population and 8% for the Indigenous population (Vos et al. 2007; Begg et al. 2007). Physical inactivity is the third leading risk factor in the Indigenous population, after tobacco use and high body mass. Its effect is manifested through a range of diseases, most notably ischaemic heart disease (55% of the burden attributed to physical inactivity) and diabetes (33%).
Current guidelines recommend that children aged 2–4 years are physically active for at least 3 hours every day; that children aged 5–17 years do at least 60 minutes per day of moderate to vigorous intensity physical activity; that adults aged 18–64 years accumulate 150 to 300 minutes (2 ½ to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1 ¼ to 2 ½ hours) of vigorous intensity physical activity per week; and that adults aged over 65 years accumulate at least 30 minutes of moderate intensity physical activity on most days (Department of Health 2014). The guidelines also recommend minimal time spent sitting (sedentary behaviour) for all ages. Katzmarzyk et al. (2009) found an increased risk of mortality with higher levels of sitting time regardless of whether sufficient physical activity was undertaken.
Research has established inverse associations between physical activity with fat mass and biomedical risk factors for chronic disease (Ness et al. 2007; Steele et al. 2009; White et al. 2011), and studies have confirmed that activity reduces the risk for heart disease (Stephenson et al. 2000; Bull et al. 2004; Sattelmair et al. 2011), high blood pressure (Kokkinos et al. 2001), diabetes (NHF 2006) and the symptoms of depression, anxiety and stress (WHO 2010; Moylan et al. 2013). Physical activity has physical and psychological benefits for the management and treatment of chronic conditions (Adami et al. 2009; NHF 2006; Holmes et al. 2005).
The most recent data on physical activity is from the 2012–13 Health Survey, which collected information on walking for exercise/transport and moderate and vigorous physical activity in the week prior. While information was collected in both remote and non-remote areas, results are not comparable due to differing methodologies across areas. In 2012–13, 38% of Indigenous adults in non-remote areas had undertaken a sufficient level of physical activity in the week prior (at least 150 minutes over 5 or more sessions). Rates of sufficient activity were higher for Indigenous males (43%) than for Indigenous females (33%). After adjusting for differences in the age structure of the two populations, Indigenous adults were less likely than non-Indigenous adults to have met sufficient activity levels in the last week (rate ratio of 0.8), and more likely to be inactive (rate ratio of 1.3). Younger Indigenous Australians were more likely to be sufficiently active and activity levels declined with age; 48% aged 18–24 years were sufficiently active compared with 27% aged 55 years and over.
After adjusting for differences in the age structure between the two populations, Indigenous adults spent 1.7 times the time walking for transport than non-Indigenous adults (average of 143 minutes compared with 83 minutes per week) and less time on walking for fitness (0.8 times) and moderate or vigorous physical activity (0.7 and 0.8 times respectively). Indigenous adults spent 1.3 times the time spent by non-Indigenous adults on watching television or videos and less time using a computer/internet (0.6 times) and sitting for transport (0.8 times). In the pedometer study, 17% of Indigenous adults did the required 10,000 steps per day on average. More than half (55%) of Indigenous adults in remote areas spent more than 30 minutes in the previous day undertaking physical activity/walking; 20% spent less than 30 minutes and 21% did no physical activity.
In 2012–13, 82% of Aboriginal and Torres Strait Islander children-aged 2–4 years in non-remote areas met the recommendations of at least 3 hours of physical activity per day. Average time spent in physical activity was similar for Indigenous and non-Indigenous children aged 2–4 years, although Indigenous children spent more time outdoors (3.5 hours compared with 2.8 hours per day on average). Nearly half (48%) of Indigenous children aged 5–17 years in non-remote areas met the recommended physical activity guidelines, at a much higher rate than for non-Indigenous Australians (35%). Indigenous children were 1.4 times as likely as non-Indigenous children to have met both the physical activity and screen-based guidelines in the three days prior (25% compared with 18%). One in four Indigenous children met the threshold of 12,000 steps per day (on average), similar to non-Indigenous children. In 2012–13, 82% of Aboriginal and Torres Strait Islander children aged 5–17 years in remote areas did more than 60 minutes of physical activity on the day prior (only 4.1% did no physical activity).
Aboriginal and Torres Strait Islander adults who were sufficiently active were less likely to be obese (31%) than those who were inactive (56%). Indigenous adults with educational qualifications of Year 12 or above were 1.5 times as likely to have done sufficient physical activity compared with those with below Year 10 (44% compared with 29%). Indigenous adults in non-remote areas who described their health as excellent or very good were 1.7 times as likely to have done sufficient physical activity compared with those with fair/poor self-assessed health.
Low levels of physical activity were reported by nearly 3 in 5 Aboriginal and Torres Strait Islander people aged 18 years and over in non-remote areas in 2012–13. Higher rates of sedentary behaviours are associated with an increased risk of chronic disease. Improving levels of physical activity levels presents a significant opportunity for health improvements and for reducing the health gap between Indigenous and non-Indigenous Australians. Thompson et al. (2013) found that the concept of physical activity in remote NT communities was strongly linked to land and resource management and seasonal, family and cultural activities. Several studies have shown that high levels of incidental exercise can have health benefits (Ekblom-Bak et al. 2014; Samitz et al. 2011; Duvivier et al. 2013).
To increase opportunities for physical activity, funding agreements are in place to provide access to a range of sport and physical recreation activities across Australia. These agreements include weekly sports competitions, sports carnivals, small sporting grants, sports equipment, sport and recreation officers and access to sport-specific accreditation (e.g. sports administration, umpiring, coaching). Community sports and recreation programmes have potential health, education and employment benefits along with improved social cohesion and physical and mental wellbeing (Ware et al. 2013).
The Indigenous Sport and Active Recreation Program supports community participation in sport and active recreation activities to support improved health and physical wellbeing and broader social benefits for participants and their communities. The programme's objectives are to increase the active participation of able and disabled Indigenous Australians in sport and active recreation; encourage and increase community ownership and management of sport and active recreation activities, including through skills development; and provide employment opportunities for people to support or assist in the provision of sport and active recreation activities.
Under the Australian Government's Indigenous Australians' Health Programme, a national Regional Tackling Smoking and Healthy Lifestyle workforce has been deployed in 57 regions across the country to raise awareness of the health impacts of tobacco smoking and chronic disease in Indigenous communities, to actively promote positive lifestyle changes and to assist in timely access to appropriate health services as needed. The teams facilitate culturally secure community education, health promotion, and social marketing activities to promote quitting, smoke-free environments and encourage healthy lifestyle choices, including physical activity and nutrition. A review is being undertaken to ensure programmes to address the high rates of smoking and low rates of physical activity are based on the most up-to-date evidence.
Figure 2.18-1 shows level of physical activity by Indigenous status.In 2012–13, 38% of Indigenous adults in non-remote areas had undertaken a sufficient level of physical activity in the week prior (at least 150 minutes over 5 or more sessions). Rates of sufficient activity were higher for Indigenous males (43%) than for Indigenous females (33%). After adjusting for differences in the age structure of the two populations, Indigenous adults were less likely than non-Indigenous adults to have met sufficient activity levels in the last week (rate ratio of 0.8), and more likely to be inactive (rate ratio of 1.3).
Source: 2012–13 AATSIHS (ABS 2014c)
Figure 2.18-2 shows the proportion of Indigenous Australians aged 18 years and over reporting a sufficient level of physical activity, by sex and age group. In 2012–13, the highest levels of physical activity were among Indigenous Australians aged 18–24 years, with 52% of males and 43% of females classed as sufficiently active. Sedentary or low levels of physical activity were highest among those aged 45 years and over. Indigenous males were more likely than Indigenous females to have exercised at moderate intensity (32% compared with 26%) and high intensity (14% compared with 7%).
Source: 2012–13 AATSIHS (ABS 2014c)
Figure 2.18-3 shows the proportion of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians aged 5-17 years who met the physical activity recommendations in the three days prior to interview, in 2012–13. Meeting the recommendations decreased with age, and Indigenous rates were higher in every age group (5-8 years, 9-11 years, 12-14 years and 15-17 years).
Source: 2012–13 AATSIHS (ABS 2014c)
Figure 2.18-4 shows the proportion of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians aged 5-17 years who met the screen-based activity recommendations in the three days prior to interview, in 2012–13. Meeting the recommendations decreased with age for Indigenous and non-Indigenous Australians. Rates were similar for those aged 5-8 years and 09-11 years and lower for non-Indigenous Australians for children aged 12-14 years and 15-17 years.
Source: 2012–13 AATSIHS (ABS 2014c)