- Physical inactivity in Sri Lankans and why we need to take a stand for our health – literally
With massive shortages in practically every direction we look, now is a more important time than ever to think about public health and how we can stay as healthy as possible.
Unfortunately for many of us, our sedentary lifestyles put us at high risk of contracting Non-Communicable Diseases (NCDs). NCDs, also known as chronic diseases, are increasing exponentially in prevalence, partly because of the change that technology and its rapid advancement have wrought in all aspects of our lifestyles.
PHOTO © BRUNO NASCIMENTO/UNSPLASH
NCDs are diseases that are not transmissible directly from one person to another. They tend to be of long duration and are the result of a combination of genetic, physiological, environmental, and behavioural factors. The main types of NCDs are cardiovascular diseases (such as heart attacks and strokes), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes.
The need to take NCDs seriously
Globally, according to the World Health Organization (WHO), NCDs kill 41 million people each year, equivalent to 71% of all deaths globally. More than 15 million of these deaths are of those between the ages of 30 and 69; 85% of these ‘premature’ deaths occur in low- and middle-income countries like Sri Lanka (of the total death toll attributed to NCDs each year, it has been found that 31.4 million happen in low- and middle-income countries).
In 2021, ChildFund Sri Lanka (CFSL) partnered with the Ministry of Health (MOH) for the ‘Global RECAP: Promoting Healthy Diets and Physical Activity in Sri Lanka’ project, which aims to conduct social mobilisation and community education activities towards minimising the occurrence of NCDs through effective regulatory measures and promotion of healthy diet and physical exercise.
Global RECAP is a collaborative programme between the International Development Law Organization (IDLO), Canada’s International Development Research Centre (IDRC), and the World Health Organization (WHO). Global RECAP is part of the ongoing global efforts to enhance multi-stakeholder engagement and dialogue to address non-communicable diseases.
As part of Global RECAP, CFSL focused on a series of physical activity promotions, in a three-way partnership between CFSL, the Ministry of Health Directorate of Non Communicable Diseases and the Sri Lanka Medical Association (SLMA) NIROGI Lanka (National Initiative to Reinforce and Organise General diabetes care In Sri Lanka) project – a project with over 12 years of experience improving public health at the grassroots level.
Through this physical activity promotion programme, Global RECAP connected with a number of civil society members and organisations in a bid to build awareness on the impact of NCDs, how Sri Lanka stands when it comes to NCDs and our lifestyle, and how to take steps to improve general public health and reduce the incidence of NCDs, with NIROGI Lanka coming on board as knowledge and content partners.
To dive a little bit deeper into NCDs and our physical lifestyles, Brunch spoke with NIROGI Lanka Chairperson Dr. Chathuranga Ranasinghe, a specialist in sports and exercise medicine and a senior lecturer at the Faculty of Medicine at the University of Colombo. Dr. Ranasinghe is also a Guidelines Development Group member of the WHO Global Physical Activity Guidelines 2020 and the Editor of the Sri Lanka Sports Medicine Association and Sri Lankan Journal of Sports and Exercise Medicine.
Building awareness on physical inactivity and its hidden cost
Speaking with us on general health, Dr. Ranasinghe highlighted that Sri Lanka had an incredibly high risk of NCDs, akin to the incidence of NCDs in countries much more affluent than ours. A large part of managing NCDs comes down to behaviour.
“There are four behavioural risk factors that cause NCDs – physical activity, diet, smoking and alcohol consumption, and behaviours in the background of genetic susceptibility will make you more prone to NCDs,” Dr. Ranasinghe said, adding that in Sri Lanka, physical inactivity played a huge part in the high incidence of NCDs.
But what is physical inactivity? Quite simply, a lack of the exercise and physical movement needed to keep the body functioning at its peak. This minimum level of activity generally translates to about 150-300 minutes of moderate exercise per week (about 30-40 minutes each day) – this could include swimming, running, aerobic activities, or simply, brisk walking, but should also be balanced with strength-building activities, which Dr. Ranasinghe explained was often overlooked in the South Asian context, with more attention paid to cardio-based activities. While this focus on cardio is not a bad thing, it is important to remember that South Asians are predisposed to less muscle mass than other Caucasians and this is why it is important to build strength exercises into our physical activity.
“Statistics say that about one in four adults is inactive (especially females) as are eight out of every 10 adolescents (80%) – adolescents because of their age, require at least 60 minutes of moderate exercise each day,” Dr. Ranasinghe said. “This is why we need to work on improving these behavioural risk factors in the public, not through drugs or medication, but through changing behaviour, through making them choose better food and increase physical activity.”
Working with CFSL, the NIROGI Lanka project, chaired by Dr. Ranasinghe, participated in a series of webinars and knowledge-building exercises with civil society members and organisations training the leaders of these actors on better health practices and how to increase physical activity in day-to-day life so that they could go on to spread this knowledge within their families and communities and form a ripple effect of healthier lifestyles.
Taking place in late 2021 and early 2022, over a number of weeks, CFSL and NIROGI Lanka conducted webinars (for Covid-19 health and safety reasons) supplemented by focus group discussions and online exercise groups to improve knowledge and provide practical insight into building physical activity into daily life as well as resources that can allow people to take steps towards better physical health. For example, a resource that many people are unaware of which Dr. Ranasinghe highlighted are the ‘Healthy Lifestyle Centres’ set up in most of the hospitals across the country that can help people in the area stay healthy.
Speaking on the impact of this physical activity promotion programme, Dr. Ranasinghe shared that measuring the impact of such interventions was not always easy and one achievement of the programme was that it had increased awareness. “We reached about 53 networks and 1,300 people through these sessions and this was because we went online. In our experience, it is normally in smaller groups that we are able to engage. Now, out of this, we’re planning to go into something bigger with the Ministry of Health and the WHO to replicate this and reach more people and wider audiences.”
What it means to be physically active
The WHO in 2022 released its latest guidelines for physical activity which indicate that adults between 18-64 years of age must engage in a minimum of 150-300 minutes of moderately intense activity per week (30-40 minutes per day), children and adolescents (5-18 years of age) should engage in at least 60 minutes each day of vigorous play.
“The main guideline is that people should just move more, not just sit. Every step counts,” Dr. Ranasinghe said. “Sri Lankans have developed a sedentary lifestyle, and this has increased a lot with the pandemic. We need to resume things like walking, standing, and running as much as possible. Older adults (over 65 years) should also engage in activities that improve their balance.”
On a national level, data shows that 30% of males and 40% of females are inactive and the Ministry of Health has pledged to reduce Sri Lanka’s inactivity by 10-15% by 2030. Dr. Ranasinghe stressed that inactivity levels of 30-40% were inordinately high and part of why this was because of Sri Lanka’s changing industrial pattern, which (until recently) had been moving away from agriculture.
Combatting inactivity at the national level is something that will require a good deal of policy change and rethinking how we approach much of our lives and Dr. Ranasinghe has been in discussion with the Ministry of Health to analyse our physical policies and how we can improve general physical activity.
“In this country, schools, workplaces, and communities are the easiest ways to cover large groups and different ministries like Health, Sports, and Education also have a huge role to play. But there are other parties who need to get involved, like road and town planners, to help build policies and environments that promote physical activity,” Dr. Ranasinghe explained.
“For example, if a school, especially a private school, doesn’t have enough space, children won’t have enough space to play, which limits their physical activity each day. The curriculum also needs to give them enough time to play.” This is especially important in the case of private schools that have more autonomy than State schools.
Dr. Ranasinghe also explained that the same kind of thinking needed to go into workplaces, towns, and cities in general – a huge part of why people don’t get enough physical activity is that they don’t believe they have enough time. However, the misconception in this regard is that physical activity needs to be batched into one time window (this is practical, yes, but for many people is simply not possible) – and this is where environments come in, to encourage physical activity during the course of the day that eventually adds up to the minimum amount of physical activity needed to reduce risk. This is where town planners and workplaces have a role to play, by developing cities in ways that encourage activity (for example, through walking paths and other spaces and buildings designed to keep people moving and not stay sedentary).
“Legislatory and fiscal measures also need to be taken, but these have to happen gradually,” Dr. Ranasinghe shared, highlighting that Sri Lanka’s lack of physical activity was another crisis in the making: “With 80% of children and adolescents inactive, this will become a big problem when they become sick in 10 or 20 years’ time. That’s the reason this needs to be thought about now and big changes need to be made.”
Doing our part as individuals
National conversations are always bigger than ourselves and slow-moving, but how can we as individuals start making a change? The key is not to overthink it.
“You can start slow and progress. Physically if you divide your 24 hours, you spend it on a transport going somewhere, at your workplace, or sleeping, with the balance being used for leisure time and to do other things. Other countries have more leisure time than us, unless you’re well off, so we have to make use of these other times to be active. The picture of being active in sports shoes and a gym kit isn’t always realistic, so the message needs to be ‘be active all the time’ and collect that 150 minutes-a-week any time and anyway you can. Take the stairs, take 10-15 minutes at least to walk, and find other small ways you can stay active. Collect that time of activity slowly.”
Addressing groups of people who need to take specific measures when increasing their physical activity, Dr. Ranasinghe said that the elderly typically needed to be active for the same amount of time as younger adults, but it was important in their case to also build in strength and balance training.
For expecting mothers, this would of course depend on each specific case, but as a general rule they can be as active as other adults, although they should always seek their doctors’ advice on anything particularly strenuous.
For the differently-abled, disability need not stand in the way of staying physically active and there are ways to work with a disability to stay physically active. For example, Dr. Ranasinghe explained that for someone in a wheelchair, wheeling themselves around would constitute physical activity and with enough time and intensity could reduce that person’s risk of developing an NCD.
Even those who have already developed NCDs like diabetes and heart disease can work towards being physically active, though their journeys will be a little more complicated because of their existing conditions and they will need to meet with their doctors, get advice, and take things slowly.
Indeed, taking things slowly was the best approach to becoming physically active, according to Dr. Ranasinghe, who explained that when starting to become more physically active, it was important to start with low-intensity activity and work up to moderate intensity, and then, if there were no contradictions, move to vigorous activity too.
As the body starts getting used to moving, it will become easier and easier to achieve this, and in turn, achieve better overall physical health. What’s important is to start moving.