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Why is physical activity important?

Physical activity is critical for population health. There is overwhelming evidence that physical inactivity is a risk factor for noncommunicable diseases, premature death and disability. It is responsible for 3.2 million deaths globally each year and is estimated to be the main cause of around 27% of diabetes, 30% of ischaemic heart disease and 21-25% of breast and colon cancer1. In the Eastern Mediterranean Region, the available data from countries show inactivity causes around 219 000 deaths every year. Conversely physical activity can significantly reduce the risk of such diseases; everybody can benefit from even moderate levels of physical activity.

However, 31% of the world's population is not physically active enough to prevent these serious health problems. Rates vary widely by country and gender with some countries reporting alarming rates of physical inactivity of around 70%, including in the Eastern Mediterranean Region. Despite an increase in female participation in physical activity in some countries of the Region, there continues to be a decline in women who are physically active enough. Furthermore, based on World Health Organization (WHO) estimates, the Eastern Mediterranean Region has the joint highest prevalence of insufficient physical activity among women of all the WHO Regions and the second highest overall. One out of two women and one of three men are below the minimum recommended levels for physical activity, a disturbing statistic. Of concern, less than halfofthe countries ofthe Region have systematic monitoring of levels of physical activity in adults and children, and very few have started any comprehensive action aimed at increasing levels of activity through sports, recreation, cycling and walking.

What has been done to promote physical activity?

The recognition of the importance of physical activity in light of the worrying figures has prompted calls for action on physical inactivity. Globally, WHO Member States have committed to a range of actions to reduce physical inactivity and its impact. In 2004, the World Health Assembly endorsed a global strategy on diet, physical activity and health (resolution WHA57.17), which called on Member States to develop national plans to promote physical activity. In 2011, as part of the United Nations (UN) Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control ofNoncommunicable Diseases, Heads of States and Governments renewed the call for Member States to take concrete actions to reduce physical inactivity. And in 2013, the World Health Assembly adopted a Global Action Plan for the Prevention and Control of Noncommunicable Diseases for 2013-2020, which included a specific global target for Member States to take actions to reduce by 10% (relative reduction) the prevalence of insufficient physical activity by 2025 (Resolution WHA 66.10) 2.

Regionally, at the International Conference on Healthy Lifestyles and Noncommunicable Diseases in the Arab World and the Middle East in 2012 and through the Riyadh Declaration, representatives from governments and nongovernmental organizations, research and academic centres, and various stakeholders from civil society in the Arab world and the larger Middle East called for active engagement with relevant sectors and stakeholders in countries of the Region for preventing and managing noncommunicable diseases and their risk factors, including physical activity. In the same year, at the 59th session of the WHO Regional Committee for the Eastern Mediterranean, Member States adopted a framework for action to implement the United Nations Political Declaration, which included the implementation ofthe global recommendations on physical activity. A year later, the 60th Regional Committee called for development of tools, including specific guidance for Members States, on the roles of the different ministries and relevant partners to engage in multisectoral work towards preventing noncommunicable diseases.

High-level regional forum on a life course approach to promoting physical activity

In light of the recommendations of the WHA and the UN General Assembly and given that current levels of physical activity among populations in the Region remain low, awareness of the adverse effects of physical inactivity is limited and adequate policies, programmes and initiatives to promote physical activity are lacking, focus on this issue is urgently needed.

Therefore WHO-Regional Office for the Eastern Mediterranean EMRO) with the support of Her Royal Highness, the UN Messenger of Peace and Chairperson of Dubai Healthcare City Authority, Princess Haya Bint Al Hussein organized a High-level Regional Forum on a Life Course Approach to Promoting Physical Activity in the Eastern Mediterranean Region in Dubai, United Arab Emirates, from 24 to 25 February 2014. The main objectives of the forum were to raise awareness about the importance of promoting physical activity and the global commitments, establish a Regional network to share knowledge and support action, and identify a set of multisectoral priority actions to promote physical activity in the Eastern Mediterranean Region.

The Forum was attended by decision-makers and policy advisers from Member States of the Region from various sectors including health, education, sport, youth, planning, transport and information, as well as representatives from civil society concerned with physical activity and health.

What was concluded?

The findings from a WHO Policy and Programme Mapping of physical activity in countries of the Region (undertaken during October-December 2013) revealed 10 key areas where gaps remain: 1) leadership and coordination between sectors; 2) availability of national policy; 3) funding for physical activity; 4) presence of supportive environments to integrate physical in daily activities ; 5) addressing cultural norms and traditions; 6) knowledge of the benefit of physical activity for health; 7) integration of physical activity into health systems; 8) quality of physical education in schools; 9) modifying physical activity behaviour; and 10) leaders and staff in governments due to high turnover.

The meeting concluded that there is no single approach or intervention to promote physical activity across the life course. Multiple sectors need to be involved working in partnership to develop and implement comprehensive programmes, policies and supportive environments based on country context; these could include education, health, youth and sports, urban planning and transport, labour, media and information, culture, social development, religious and women's affairs among others. These sectors need to work together around a national multisectoral plan of action for physical activity.

The way forward

Following the deliberations and discussions, the Forum set out a number of recommended priority actions directed at different sectors that could be involved in promoting physical activity (Table). Member States and WHO-EMRO were also tasked to undertake specific actions.

Later this year, the UN General Assembly, will review the progress countries are making in implementing the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, which will include action taken to promote physical activity. EMR countries must step up and make serious efforts to increase physical activity among their peoples. Appropriate, timely action as set out in the recommendations can prevent further deaths and disability from physical inactivity.

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¹Global Status Report on NCDs, 2010. Geneva: World Health Organization; 2010 (http://whqlibdoc.who.int/ publications/9789240686458/2011_eng.pdf, accessed 14 May 2014)
²United Nations. Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases. Resolution adopted by the General Assembly, New York, 19 September 2011 (A/Res/66/2); World Health Assembly resolutions WHA57.17, WHA61.14, WHA63, WHA66; and WHO Regional Committee for the Eastern Mediterranean resolutions EM/RC59/R.2, EM/RC60/R.4.
EMHJ, 2014, 20(6): 469-471