Self-reported physical activity behavior of a multi-ethnic adult population within the urban and rural setting in Suriname

Baldew et al. BMC Public Health Self-reported physical activity behavior of a multi-ethnic adult population within the urban and rural setting in Suriname Se-Sergio M Baldew 0 1 Ingrid SK Krishnadath Christel CF Smits Jerry R Toelsie Luc Vanhees 0 Veronique Cornelissen 0 0 Department of Rehabilitation Sciences, Research Center for Cardiovascular Rehabilitation, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven , Leuven , Belgium 1 Department of Physical Therapy, Faculty of Medical Sciences, Anton de Kom University of Suriname , Paramaribo , Suriname Background: Physical activity (PA) plays an important role in the combat against noncommunicable diseases including cardiovascular diseases. In order to develop appropriate PA intervention programs, there is a need to evaluate PA behavior. So far, there are no published data on PA available for Suriname. Therefore, we aim to describe PA behavior among the multi-ethnic population living in urban and rural areas of Suriname. Methods: The World Health Organization (WHO) STEPwise approach to chronic disease risk factor surveillance (STEPS) was conducted in a national representative sample (N = 5751; 48.6% men) aged 15-64 years between March and September 2013. Physical activity data were assessed using the Global physical activity questionnaire (GPAQ) and analyzed according to the GPAQ guidelines. The prevalence of meeting the recommended PA level and prevalence ratios (PR) were computed. Results: Only 55.5% of the overall population met the WHO recommended PA levels (urban coastal area: 55.7%, rural coastal area: 57.9%, rural interior area: 49.1%). Women were less likely to meet the recommended PA level (49% vs 62.4%; p < 0.0001) and with increasing age the PR for recommended level of PA decreased (p < 0.0001). Compared to the Hindustani's, the largest ethnic group, the Javanese reported the lowest percentage of people meeting recommended PA level (PR = 0.92; p = 0.07). Conclusion: Around half of the population meets the recommended PA level. Future lifestyle interventions aiming at increasing PA should especially focus on women and older individuals as they are less likely to meet the recommended levels of PA. Self-reported physical activity; Multi-ethnic population; WHO STEPS; Global physical activity questionnaire - Background Cardiovascular diseases (CVD) remain the number one cause of death globally, with over 80% of these deaths reported in low and middle income countries [1]. In prevention of cardiovascular and other noncommunicable diseases (NCD), physical activity (PA) plays an important role [2-4]. In contrast to what is known about PA in Europe [5,6] and North America [7] there are no published PA data available for Suriname. However, 27% of all deaths in Suriname are caused by cardiovascular diseases, making them the number one cause of mortality [8]. There is an obvious need for an adequate evaluation of PA behavior in order to initiate and implement appropriate PA intervention programs in Suriname. Since Suriname has a diverse ethnic population and the prevalence of CVD and risk behaviors associated with these diseases has been shown to differ among ethnic groups [9-11], evaluation of PA behavior across the ethnic groups needs to be taken into account. In addition to the large variability between countries with regard to the proportion of individuals meeting the recommended PA level [12,13], it has also been shown that these levels might differ within a country depending on the area [13,14]. In general, individuals living in urban areas tend to be less active compared to those living in rural areas [14-18], although one report concluded the opposite [19]. Therefore, if we aim to develop effective interventions to increase PA behavior, it is important to take all these differences, i.e. ethnicity and area into account. Thus, the main objective of this study was to describe PA behavior in a representative sample of the Surinamese population, across urban and rural areas. Secondly, we aimed to investigate whether there are differences in PA among the different ethnic groups. Methods This cross-sectional study was based on the WHO STEPwise approach to Chronic Disease Risk Factor Surveillance (STEPS) protocol. A detailed description of the study design and participant recruitment has been reported elsewhere [20]. Briefly, a sample size was calculated based on area, gender distribution and on five age groups between 15 and 64 years. Furthermore, ethnic groups were taken into account to ensure a sufficient number of participants could be drawn from each subgroup. A stratified, multi-stage, cluster, sampling design was used to select households within the different areas. From March to September 2013, 7493 individuals from urban and rural areas were invited to participate, of which 5751 agreed (response rate: 76.8%) and provided written informed consent [20]. For participants under the age of 16, parental informed consent was obtained. The study was approved by the ethical committee of the Ministry of Health in Suriname. Physical activity assessment Trained interviewers used the Global physical activity questionnaire (GPAQ) to assess PA [21]. This questionnaire was first translated into Dutch and pre-tested in a small study sample for reliability and face-validity [22,23]. Interviewers asked participants about the number of days and the time they spent doing PA in a typical week within 3 main domains: occupation, transportation and leisure time. Within the occupation domain the activity had to be performed as part of paid or unpaid work, whereas within the transportation domain, PA included walking and/or cycling in order to move from one place to another. Leisure time activities involved all activities that were not included in the occupation or transportation domain. To be considered as an activity, it had to be performed for at least 10 minutes continuously. For activities during occupation and leisure time, participants were asked if it was performed at moderate or vigorous intensity. In order to categorize the activity within the appropriate intensity, examples were given by means of illustrations. Moderate activities were described as activities that cause a small increase in breathing and heart rate, whereas vigorous activities should result in a large increase in breathing and heart rate. For activities within the transportation domain, participants were asked if they walked or cycled at a moderate intensity for at least 10 minutes continuously. We used the GPAQ analysis guide, provided by the WHO, to clean and analyze the data [24]. According to the guidelines, the data should be excluded if the time spend within a subdomain exceeds 16 hours or participants reported inconsistent or implausible values. Individuals who accumulated throughout a week at least 150 minutes of moderate or vigorous intensity physical activity or an equivalent combination over at least 5 d (...truncated)