Journal of Family & Community Medicine
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contact us Login 
 

Users Online: 706 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size

 

 Table of Contents 
REVIEW ARTICLE
Year : 2004  |  Volume : 11  |  Issue : 2  |  Page : 45-51  

The public health burden of physical inactivity in Saudi Arabia


Exercise Physiology Laboratory, King Saud University, Riyadh, Saudi Arabia

Date of Web Publication30-Jun-2012

Correspondence Address:
Hazzaa M Al-Hazzaa
Director, Exercise Physiology Laboratory, King Saud University, P.O. Box 9792, Riyadh 11423
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 23012048

Rights and PermissionsRights and Permissions
   Abstract 

Because of the enormous changes in the lifestyle of Saudis in the last three decades, the risk factors of coronary heart disease (CHD), including physical inactivity, are increasingly becoming prevalent in the society. This paper provides an overview of the importance of physical activity in health promotion and disease prevention, and discusses the public health burden of physical inactivity in Saudi Arabia. Available evidence clearly indicates that physical inactivity is extremely prevalent in the different ages and sex of the Saudi population. This high prevalence of inactivity in Saudi society presents a major public health burden, as evidenced by the high risk in the Saudi population as a risk of physical inactivity compared with the populations of United States and the United Kingdom. Unless concrete steps are taken to reduce physical inactivity in the Saudi population, the future public health cost would be enormous. It is well known that physical activity is associated with numerous health benefits and plays a major role in modifying many other CHD risk factors. Finally, several recommendations for reducing physical inactivity and promoting active life in the Saudi population have been discussed.

Keywords: Physical inactivity, coronary risk factors, health promotion, public health burden, population attributable risk, Saudi Arabia.


How to cite this article:
Al-Hazzaa HM. The public health burden of physical inactivity in Saudi Arabia. J Fam Community Med 2004;11:45-51

How to cite this URL:
Al-Hazzaa HM. The public health burden of physical inactivity in Saudi Arabia. J Fam Community Med [serial online] 2004 [cited 2019 Dec 5];11:45-51. Available from: http://www.jfcmonline.com/text.asp?2004/11/2/45/97721


   Introduction Top


Cardiovascular diseases (CVD) are becoming the major cause of mortality in developing countries. [1] The 2002 World Health Report indicates that the most important risk factors for noncommunicable diseases include high blood pressure, high blood cholesterol, inadequate fruit and vegetable intake, overweight and obesity, physical inactivity and tobacco use. [2] A recent community-based national study, involving adult Saudis between the ages of 30 and 70 years, showed that the overall prevalence of coronary heart disease (CHD) in the Kingdom of Saudi Arabia is 5.5%. [3] However, the expected increase in mortality as a result of ischemic heart disease in the Middle East region in 2020 compared to 1990 was estimated as the highest of all the regions of the world (146% increase in women and 174% increase in men). [4] This is mostly attributed to the high prevalence of major CHD risk factors. The latest report involving Saudis between the ages of 30 and 70 years showed the following prevalence: 23.7% for diabetes; 26% for hypertension; 12.8% for smoking; 53.9% for hypercholesterolemia, and 35.6 for obesity. [3] This high prevalence of CHD risk factors in the Saudi population confirms many earlier findings on CHD risk factors involving different segments of the Saudi society. [5],[6],[7],[8]

Prevention of CVD depends on controlling the modifiable risk factors, such as, physical inactivity and obesity. In fact, physical inactivity represents an independent risk factor for a number of chronic diseases, including CHD, diabetes mellitus, obesity, osteoporosis. [9],[10],[11] However, physical activity has been shown to both prevent and treat many established atherosclerotic risk factors. [10],[12],[13],[14] The World Health Organization (WHO), which has long recognized the heavy burden of noncommunicable diseases on the health services, recently launched its global strategy on diet, physical activity and health. [15] The overall goal of the strategy is to improve public health through healthy eating and physical activity. This concerted effort on the part of WHO to improve global public health through physical activity is a continuation of previous actions taken during the last decade by numerous health and medical organizations, including the American Heart Association, [9],[16] the American College of Sports Medicine, [13],[17],[18] and Centers for Disease Control and Prevention. [11],[19]

The present paper, therefore, provides an overview of the importance of physical activity in health promotion and disease prevention, and discusses the public health burden of physical inactivity. It is also the aim of this paper to briefly review the status of physical inactivity in Saudi Arabia and to calculate the attributable risk of physical inactivity in the Saudi population. In addition, some preliminary findings from the longitudinal study on physical activity and cardiovascular health of the Saudi youth will be presented throughout this paper.


   Physical Activity: An Important Public Health Issue Top


Physical activity is defined as any bodily movement produced by the skeletal muscles that results in energy expenditure above the basal level. [20] Physical activity is considered a complex set of behaviors. Our ability to relate physical activity to health indicators depends on accurate, precise and dependable measures. Physical activity is commonly measured by either self-report or direct monitoring through mechanical/electronic or physiological measurements. [Table 1] presents an important distinction between the definitions of physical activity and physical fitness. It also shows the meaning of metabolic equivalent (MET), which is increasingly becoming a very common term for quantifying the intensity of physical activity or energy expenditure, especially for the purpose of exercise prescription or physical activity assessment.
Table 1 : Definitions of basic terms

Click here to view


Today, it is estimated that 60-85% of adults around the world are simply not active enough to achieve the health benefits of physical activity. [21] To deal with this epidemic of physical inactivity, WHO has recently established the Physical Activity Unit as part of the Department of Noncommunicable Disease Prevention and Health Promotion. [22] The goal of this unit is to promote higher levels of physical activity within the world population of all ages and conditions, men and women. The unit's strategic products include: (1) Developing a global strategy and database on physical activity; (2) Promoting the annual global Move for Health initiative; (3) Supporting a country's actions and facilitating the development of multisectorial national policies and programmes on physical activity; and (4) Developing partnership and networks for increasing population participation in physical activity with a special focus on young people.

Despite the fact that most medical institutions currently do not provide their graduates with the proper training and necessary skills in physical activity assessments and exercise prescription, [23] many medical organizations are now urging health care professionals to provide counseling on physical activity for their patients. The American Heart Association (AHA) for example, stated in its recent guidelines for the primary prevention of CVD and stroke, that the assessment of the risk factors in adults should commence at 20 years of age. Physical activity is a primary CHD risk factor, and should be assessed at every routine evaluation. [24] The AHA goes further in its recommendations and asks that: (a) Schools should be encouraged to teach skills required for physically active lifestyle; (b) health care professionals should be educated about exercise as a therapeutic modality, and the importance of lifelong physical activity for patients; (c) they should routinely prescribe exercise for their patients; and (d) exercise testing should be performed before vigorous exercise in selected patients with CVD or those at high risk. [24]

Furthermore, the importance of physical activity in health promotion and disease prevention strategy was evident in the "Healthy People 2010" report, published by the Centers for Disease Control and Prevention (CDC) of the United States Department of Health and Human Services. [25] In that report, 10 leading health indicators (LHI) were identified. The LHI reflect the major public health concerns in the United States, and highlight the importance of health promotion and disease prevention on the societal level. Physical activity, not surprisingly, is the first on the list of LHI, followed by obesity in the Healthy People 2010 report. Among the target goals for the Healthy People 2010 was an increase in the proportion of adults and adolescents who engage in moderate physical activity (3-6 METs) for at least 30 minutes on five or more days per week.


   The Prevalence of Physical Inactivity in Saudi Arabia Top


During the past three decades, the Kingdom of Saudi Arabia has undergone tremendous changes in lifestyle, including physical activity and eating habits. These dramatic lifestyle changes have definitely had a considerable negative impact on the health of the society. Indeed, this lifestyle transformation is thought to be responsible for the epidemic of noncommunicable diseases and their complications in the country. [3],[26],[27] Unfortunately, there exists no physical activity surveillance system in the country. However, mere observation indicates that there is a reduction in daily physical activity and energy expenditure of the Saudi people relative to earlier times. Moreover, findings from a limited number of studies on the prevalence of physical inactivity in Saudi population confirm that a sedentary life style is on the rise. [26],[28],[29] Across all segments of the Saudi population, physical inactivity ranged from 43% to 99%, depending on gender, age, location, and target population. [30] [Figure 1] presents some data for physical inactivity among Saudi children, youth and adults, conducted on samples from Riyadh. [29],[31],[32] In the studies conducted on children [26],[31] and youth, [32] continuous 12-hour heart rate telemetry was used to measure physical activity. In the adult study, [29] a self-reporting questionnaire was utilized for physical activity assessment. The overall prevalence rates of physical inactivity among Saudi children, youth and adults were roughly 60%, 70%, and 80%, respectively. The prevalence rates for inactivity among Saudis, shown in [Figure 1], agree with those estimates reported worldwide by WHO. [21]
Figure 1 : Prevalence of physical inactivity in Saudi children, youth and adults.

Click here to view


It is quite clear from the data presented in [Figure 1] that physical inactivity is prevalent among Saudi children and youth. Findings from a recent study on 12-20-year-old schoolboys living in Riyadh have also shown inactivity prevalence of about 50%. [33] Promoting physical activity among children and adolescents is very important in order to offset any decline in their activity level as they grow-up. Data from several countries indicated a decline in physical activity among the youth starting at age 12 and continuing up to 20 years. [34], [35] Preliminary findings from our own longitudinal study on Saudi youth showed a 30% increase in physical inactivity from childhood (7-12 years) to early adulthood (18-23 years). This was coupled with a three-fold increase in television viewing during the same period of time. [36] Data from our laboratory [32],[36] also demonstrated that inactivity prevalence in youth is far more pronounced than any of the other CHD risk factors, as shown in [Figure 2]. Therefore, a reduction in the prevalence of physical inactivity among Saudi youth would have a far greater impact on risk reduction than a reduction in any of the other traditional CHD risk factors. Efforts to promote physical activity among the youth depend mainly on health care providers. The council on cardiovascular disease in the youth of the AHA has issued a statement for health professionals asking them to counsel their young patients on physical activity, including physical activity assessment and exercise prescription. [37] Therefore, routine counseling by local physicians on physical activity and the health of their young patients should be initiated.
Figure 2: Prevalence of coronary heart disease (CHD) risk factors among a sample of Saudi youth

Click here to view



   The Public Health Burden of Physical Inactivity Top


The burden of mortality, morbidity and disability attributable to noncommunicable diseases, including sedentary life, is considerably high and continuing to grow. [15] According to preliminary data from a WHO study on risk factors, inactivity is one of the 10 leading global causes of death and disability. [21] Worldwide, physical inactivity was estimated to cause 1.9 million deaths and 19 million disability-adjusted life years. [2] Physical inactivity was also estimated to globally cause about 22% of ischemic heart disease and about 10-16% of cases each of diabetes mellitus, breast, colon and rectal cancer. [2] Research on the epidemiology of physical activity revealed that it appears to be a far more important risk factor than previously estimated. [38],[39],[40] Quantitative estimates from the United States indicated that sedentary life is responsible for 35% of CHD deaths, 32% of deaths from colon cancer and 35% of deaths from diabetes. [41] Furthermore, inactivity-related disease in the United States causes over 14 times more deaths annually than acquired immune deficiency syndrome (AIDS). [42]

In Saudi Arabia, the prevalence of physical inactivity is extremely high, especially in women, and may be considered among the highest in the world. [30] Recent local data also showed a high prevalence of other CHD risk factors among Saudi population. [3] In addition, type 2 diabetes mellitus is becoming increasingly more prevalent among Saudis. [3],[43] Obesity has also reached epidemic proportions, especially among Saudi females. [3],[44] It is our own belief that strong associations do exist between the high prevalence of physical inactivity in the Saudi population and the epidemic of modern chronic diseases and risk factors in Saudi Arabia. Therefore, reducing the proportion of inactive Saudis would have a tremendous impact on lowering these lifestyle-related diseases and risk factors, and thus reduce future health care costs in the Kingdom.


   Population Attributable Risk of Physical Inactivity Top


Population attributable risk (PAR) is one of the more useful methods of estimating the proportion of a public health burden resulting from a particular risk factor. [41] PAR is the risk in total population minus the risk in the unexposed group. Thus, PAR provides an estimate of how much of a particular disease could be prevented if exposure to the risk factor was eliminated. [45] It can be calculated from the estimate of relative risk (RR) and the population prevalence of the risk factor. RR is used to assess the magnitude of risk of exposed individuals to a particular disease relative to unexposed individuals. However, the societal impact of exposure depends not only on the magnitude of the relative risk but also on the prevalence of the risk factor in the population. [45]

The concept behind PAR is to help provide a balanced view between a relatively strong risk factor that affects fewer people and a relatively weaker risk factor that is more prevalent in a population. [39] [Figure 3] shows PAR for major CHD risk factors in the United States (USA) [40] and the United Kingdom (UK). [46] PAR for physical inactivity in the US and the UK were 35% and 37%, respectively. This means that approximately one third of CHD mortality could be attributed to physical inactivity in the US and the UK. In both countries, physical inactivity as a contributing risk factor to CHD deaths was next in magnitude to hypercholesterolemia.
Figure 3: Estimated population attributable risk (PAR) for major CHD risk factors in the USA and UK

Click here to view


PAR of sedentary living for mortality from CHD and diabetes to the data from Saudi population were applied. The results are shown in [Table 2]. Physical inactivity prevalence data were taken from a recent study on Saudi adult males living in Riyadh, where there were three levels of exposure and prevalence estimates. [29] For relative risk, estimates that were previously reported elsewhere were used. [40],[41] Of course, the relative risk means the number of deaths among active population divided by the number of deaths among the inactive population. As indicated in [Table 2], PAR of sedentary living for mortality from CHD and diabetes in Saudi Arabia was considerably high and much greater than what is reported in [Figure 3] for the UK and the USA since physical inactivity is much higher in Saudi Arabia than in the USA or in the UK.
Table 2: Estimated population attributable risk (PAR) of sedentary living for mortality from coronary heart disease (CHD) and diabetes mellitus in Saudi Arabia

Click here to view


[Table 3] presents the relative risk, prevalence and PAR of some major CHD risk factors applied to the Saudi population. The relative risk data were taken from Powell, et al. [47] Prevalence data for physical inactivity were taken from an earlier study on adult males in Riyadh. [29] The prevalence data of other CHD risk factors were from a newly published paper on Saudi adults between the ages of 30 and 70 years. [3] As clearly shown in [Table 3], physical inactivity represents a far more important risk factor than was previously thought. This is mainly due to the high prevalence of inactivity in Saudis. Therefore, reducing the proportion of inactive Saudi adults to 40% from the current figure of 80% would definitely reduce the burden of physical inactivity on public health. In the USA, Healthy People 2010 calls for reducing to no more than 20%, the proportion of people 18 years and older who are inactive. [25]
Table 3: Relative risk (RR), prevalence (%) and population attributable risk (PAR) of major coronary heart disease risk factors applied to Saudi population

Click here to view



   Conclusion and Recommendations Top


It was clear from the available evidence that physical inactivity is becoming more prevalent in the Saudi population of different ages and both sexes. This high prevalence of inactivity in Saudi Arabia represents a major public health burden, as evidenced by the high PAR of physical inactivity, compared with those of the USA and UK. Moreover, due to the high prevalence of other CHD risk factors among Saudis, the rate of lifestyle-related diseases (CHD, diabetes, obesity, etc…) in the society may keep escalating to epidemic proportions in the near future. Unless concrete steps are taken to reduce physical inactivity in the Saudi population, the future public health cost will be heavily burdened. Physical activity is associated with numerous health benefits and plays a major role in modifying many other CHD risk factors.

The following recommendations for reducing physical inactivity and promoting active living are made:

  1. National policy and legislative initiatives are urgently needed to encourage active lifestyle and discourage sedentary living habits. This recommendation was clearly stated as an important objective in the Global Strategy on Diet and Physical Activity, launched recently by WHO.
  2. There is a need to establish a surveillance system to monitor physical activity in the Saudi population. Monitoring physical activity of the Saudi population at regular intervals would definitely provide important database. Such a database would represent a cornerstone for any programs that would aim at combating physical inactivity and promoting active living.
  3. Medical communities and health care providers must play a leading role in promoting physical activity, by providing routine assessments and counseling on physical activity and exercise prescription for their patients. This is consistent with many recent appeals from leading medical and public health organizations, such as the American Heart Association, the American Academy of Pediatrics, the American College of Sports Medicine, the Centers for Diseases Control and Prevention, and the WHO.
  4. Implementation of daily physical education for students from kindergarten to grade 12 is necessary to promote life-long physical activity among Saudis. Emphasis should be on quality curricula and instructions that help students develop the knowledge, attitudes, motor skills and confidence needed to adopt and maintain physically active lifestyles.
  5. Opportunities for physical activity should be available for a wide range of people, including the elderly, children and women. Given that walking is acceptable across sociodemographic subgroups of the Saudi population, efforts must be made to increase outdoor as well as indoor walking trails. Promoting brisk walks as a means of physical activity could markedly increase the proportion of physically active Saudis.



   Acknowledgments Top


Research of Professor Hazzaa M. Al-Hazzaa on physical activity and cardiovascular health and fitness of Saudi children and youth has been supported in part by grants from the Research Center, College of Education, King Saud University, and King Abdulaziz City for Science and Technology (LG 6-26).

 
   References Top

1.World Health Organization. The World Health Report 2003- Shaping the future. Geneva, Switzerland: WHO, 2003.  Back to cited text no. 1
    
2.World Health Organization. The World Health Report 2002- Reducing Risks, Promoting Healthy Life. Geneva, Switzerland: WHO, 2002.  Back to cited text no. 2
    
3.Al-Nozha M, Arafah M, Al-Mazrou Y, Al-Maatouq M, Khan N, Khalil M, et al. Coronary artery disease in Saudi Arabia. Saudi Med J 2004; 25: 1165-71.  Back to cited text no. 3
    
4.Murray C, Lopez A. (eds.): The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Disease, Injuries, and Risk Factors in 1990 and Projected to 2020. Boston, Mass: Harvard School of Public Health, 1996 (As quoted in Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases. Part1. General considerations, the epidemiologic transition, risk factors and impact of urbanization. Circulation 2001; 104: 2746-53.  Back to cited text no. 4
    
5.Abalkhail B, Shawky S, Ghabrah T, Milaat W. Hypercholesterolemia and 5-year risk for developing of coronary heart disease among university and school workers in Jeddah, Saudi Arabia. Prev Med 2000; 31: 390-5.  Back to cited text no. 5
    
6.Al-Hazzaa H, Sulaiman M, Al-Mobaireek K, Al-Attass O. Prevalence of coronary artery disease risk factors in Saudi children. J Saudi Heart Assoc 1993; 5: 126-133.  Back to cited text no. 6
    
7.Al-Nuaim A. Population-based epidemiological study of the prevalence of overweight and obesity in Saudi Arabia, regional variation. Ann Saudi Med 1997; 17:195-9.  Back to cited text no. 7
    
8.Osman A, Al-Nozha M. Risk factors of coronary artery disease in different regions of Saudi Arabia. Eastern Mediterranean Health J 2000; 6: 6465-474.  Back to cited text no. 8
    
9.Fletcher G, Balady G, Blair S, Blumenthal J, Caspersen C, Chaitman B, et al. Statement on exercise: Benefits and recommendations for physical activity programs for all Americans. Circulation 1996; 94: 867-72.  Back to cited text no. 9
    
10.Leon, A. (ed.). Physical Activity and Cardiovascular Health. A National Consensus. Champaign, IL: Human Kinetics, 1997.  Back to cited text no. 10
    
11.U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention (CDC), National Centers for Chronic Disease Prevention and Health Promotion, 1996.  Back to cited text no. 11
    
12.Pescatello, S., Franklin, B., Fagard, R., Farquhar W, Kelley G, Ray C. American College of Sports Medicine Position Stand: Exercise and hypertension. Med Sci Sports Exerc 2004; 36: 533-53.  Back to cited text no. 12
    
13.Pate R, Pratt M, Blair S, Haskell W, Macera C, Bouchard C, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. J Am Med Assoc 1995; 273 (5): 402-7.  Back to cited text no. 13
    
14.Thompson P, Buchner D, Pina I, Balady G, Williams M, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. A statement from the Council on Clinical Cardiology and the Council on Nutrition, Physical Activity and Metabolism. Circulation 2003; 107: 3109-16.  Back to cited text no. 14
    
15.World Health Organization Global Strategy on Diet, Physical Activity and Health. WHA57.17. Geneva, Switzerland: WHO, 2004.  Back to cited text no. 15
    
16.Fletcher G, Blair S, Blumenthal J, Caspersen C, Chaitman B, Epistein S, et al. Statement on exercise: Benefits and recommendations for physical activity programs for all Americans. Circulation 1992; 86: 340-4.  Back to cited text no. 16
    
17.American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription. Baltimore: Lippincott Williams & Wilkins, 2000.  Back to cited text no. 17
    
18.Pollock M, Gaesser G, Butcher J, Despres J, Dishman R, Franklin B, Garber, C. ACSM Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness and flexibility in healthy adults. Med Sci Sports Exerc 1998; 30: 975-91.  Back to cited text no. 18
    
19.Centers for Disease Control and Prevention (CDC). Guidelines for school and community programs to promote lifelong physical activity among young people. Morb Mort Weekly Rep 1997; 46: 1-36.  Back to cited text no. 19
    
20.Caspersen C, Powell K, Christenson G. Physical activity, exercise and physical fitness: Definitions and distinctions for health-related research. Public Health Rep 1985; 100: 126-31.  Back to cited text no. 20
    
21.World Health Organization. Sedentary lifestyle: a global public health problem. Geneva, Switzerland: WHO 2001. http://www.who.int/hpr/physactiv/sedentary.lifestyle.shtml  Back to cited text no. 21
    
22.World Health Organization. Goals of Physical Activity Unit. http://www.who.int/hpr/physactiv/goals.shtml.  Back to cited text no. 22
    
23.Connaughton A, Weiler R, Connaughton D. Graduating medical students' exercise prescription competence as perceived by deans and directors of medical education in the United States: implications for healthy people 2010. Public Health Rep 2001; 116: 226-34.  Back to cited text no. 23
    
24.Pearson T, Blair S, Daniels S, Eckel R, et al. AHA Guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. Circulaion 2002; 106: 388-91.  Back to cited text no. 24
    
25.U.S. Department of Health and Human Services. Healthy People 2010: National Health Promotion and Disease Prevention Objectives. Washington, DC: US Department of Health and Human Services, 2000.  Back to cited text no. 25
    
26.Al-Hazzaa H. Physical activity, fitness and fatness among Saudi children and adolescents: implications for cardiovascular health. Saudi Med J 2002; 23: 144-50.  Back to cited text no. 26
    
27.Alwan A. Noncommunicable diseases a major challenge to public health in the region. Eastern Mediterranean Health J 1997; 3 (1): 6-16.  Back to cited text no. 27
    
28.Al-Hazzaa H. Patterns of physical activity among Saudi children, adolescents and adults with special reference to health. In: Musaiger A, Miladi S, eds. Nutrition and Physical Activity in the Arab Countries of the Near East. Manama: BCSR; 2000: 109-27.  Back to cited text no. 28
    
29.Al-Refaee S, Al-Hazzaa H. Physical activity profile of adult males in Riyadh city. Saudi Med J 2001, 22: 784-789.  Back to cited text no. 29
    
30.Al-Hazzaa H. Prevalence of physical inactivity in Saudi society: A brief review. East Mediterranean Health J 2004, in press.  Back to cited text no. 30
    
31.Al-Hazzaa H, Sulaiman M. Maximal oxygen uptake and daily physical activity in 7-to-12 year-old boys. Pediatr Exerc Sci 1993; 5: 357-66.  Back to cited text no. 31
    
32.Al-Hazzaa H. Tracking of physical activity, cardiorespiratory fitness, and selected coronary artery disease risk factors from childhood to adulthood: An 11 year follow-up study. Proceeding of the 9th Annual Congress of the European College of Sport Sciences, France, July, 2004.  Back to cited text no. 32
    
33.Al-Rukban M. Obesity among Saudi male adolescents in Riyadh, Saudi Arabia. Saudi Med J 2003; 24: 27-33.  Back to cited text no. 33
    
34.Caspersen C, Pereira M, Curran K. Changes in physical activity patterns in the United States, by sex and cross-sectional age. Med Sci Sports Exerc 2000; 32: 1601-9.  Back to cited text no. 34
    
35.Telama R, Yang X. Decline of physical activity from youth to young adulthood in Finland. Med Sci Sports Exerc 2000; 32: 1617-22.  Back to cited text no. 35
    
36.Al-Hazzaa H. Health-related Physical Activity and Cardiorespiratory Fitness in a Sample of Youth: A follow-up Study. Final report, Riyadh: King Abdulaziz City for Sciences and Technology; 2004 (LG-6-26).   Back to cited text no. 36
    
37.Williams C, Hayman L, Daniels S, Robinson T, Steinberger J, Paridon S, Bazzarre T. Cardiovascular health in childhood. A statement for health professionals from the committee on atherosclerosis, hypertension, and obesity in the young (AHOY) of the council on cardiovascular disease in the young, American Heart Association. Circulation 2002; 106: 143-60.  Back to cited text no. 37
    
38.Caspersen C. Physical inactivity and coronary heart disease. The Phys Sportsmed 1987; 15 (11): 43-5.  Back to cited text no. 38
    
39.Caspersen, C. Physical activity epidemiology: concepts, methods and applications to exercise science. Exerc Sports Sci Rev 1989; 17: 423-73.  Back to cited text no. 39
    
40.Powell K. Population attributable risk of physical inactivity. In: Physical Activity and Cardiovascular Health. A National Consensus. Leon, A. (ed.). Champaign, IL: Human Kinetics; 1997: 40-6.  Back to cited text no. 40
    
41.Powell K, Blair S. The public health burdens of sedentary living habits: Theoretical but realistic estimates. Med Sci Sports Exerc 1994; 26: 851-6.  Back to cited text no. 41
    
42.Booth F, Gordon S, Carlson C, Hamilton M. Waging war on modern chronic diseases: primary prevention through exercise biology. J Appl Physiol 2000; 88: 774-87.  Back to cited text no. 42
    
43.Al-Nuaim A. Prevalence of glucose intolerance in urban and rural communities in Saudi Arabia. Diabetes Med 1997; 14: 595-602.  Back to cited text no. 43
    
44.Al-Nuaim A, Bamgboye E, Al-Rubeaan K, Al-Mazrou Y. Overweight and obesity in Saudi Arabian adult population, role of sociodemographic variables. J Community Health 1997; 22: 211-23.  Back to cited text no. 44
    
45.Macera C, Powell K. Population attributable risk: Implications of physical activity dose. Med Sci Sports Exerc 2001; 33 (suppl): S 635-S 639.  Back to cited text no. 45
    
46.British Heart Foundation. Coronary Heart Disease Statistics Database. London: British Heart Foundation; 2000.  Back to cited text no. 46
    
47.Powell K, Thompson P, Caspersen C, Kendrick J. Physical activity and the incidence of coronary heart disease. Ann Rev Public Health 1987; 8: 253-287.  Back to cited text no. 47
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Physical Activit...
    The Prevalence o...
    The Public Healt...
    Population Attri...
    Conclusion and R...
   Acknowledgments
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed3025    
    Printed93    
    Emailed0    
    PDF Downloaded371    
    Comments [Add]    

Recommend this journal

Advertise | Sitemap | What's New | Feedback | Disclaimer
Journal of Family and Community Medicine | Published by Wolters Kluwer - Medknow
Online since 05th September, 2010