National physical activity policy for COVID-19 and beyond

COVID-19 has highlighted the need for a multi-faceted national plan for physical activity to underpin the country’s health development. Some of the diseases that increase the risk of individuals with COVID-19 being hospitalised or dying are the same lifestyle-related diseases associated with being physically inactive, said the University of Cape Town’s (UCT) Professor Vicki Lambert. These include diabetes, hypertension and obesity.

Critical to this plan is recognising that physical activity is a vital component both in preventive healthcare and building social cohesion in communities during and after the pandemic, said Professor Lambert.

Lambert, who is from UCT’s Health through Physical Activity, Lifestyle and Sport Research Centre, is spearheading the African Academic Consortium on Physical Activity for Health with Associate Professor Rowena Naidoo from the University of KwaZulu-Natal’s College of Health Sciences.

The consortium, a group of more than 40 academics, researchers and implementation partners from nine African countries, has developed two policy briefs for government. These are part of a series planned for release. The first brief targets the general public and the second targets children in three environments: at home, school and in their communities.

Endorsed by the African Physical Activity Network and supported by the Western Cape Government Department of Health, the policy briefs will guide decision makers, planners and programme leaders during the COVID-19 pandemic and beyond, said Lambert.

The first two policy briefs focus on three areas:

• Addressing five major challenges to minimise the risk of community transmission during exercise. These are ensuring social distancing (2 m); wearing masks (non-medical, cloth masks); exercising in small groups (outdoors, with social distancing); exercising indoors (with proper ventilation); and avoiding the use of shared equipment or sanitising in between users. These same concerns apply to children, particularly in school settings. Accompanying useful infographics can be placed in prominent locations to remind people to exercise safely.
• Adopting a policy framework created by the World Cancer Research Fund International, which is aligned to the World Health Organization Global Action Plan for Physical Activity.
• Introducing a four-step policy recommendation for physical activity for the general public in the African region.

Four-step policy recommendations

The four-step policy recommendations are:

• Developing a national plan for physical activity for health and development – this would include input from multiple sectors and stakeholders resulting in co-benefits and shared responsibility.
• Training a cadre of health professionals, educators, sports coaches and community members to promote physical activity for health – an exemplar of this is already in action with the Western Cape Provincial Government’s Western Cape on Wellness (WoW!) lifestyle programme.
• Ensuring safe and enjoyable opportunities for physical activity – this will happen through urban planning, parks or public spaces and low-cost programmes close to where people live, for safety.
• Adopting a “whole of government” systems approach towards physical activity – this would be embedded in multiple sectors, devising flexible, agile and cost-effective solutions. Critical to this is recognising physical activity as a vital component both in preventive healthcare and as a means of building social cohesion in communities.

Higher risks

The current situation regarding physical inactivity and health during the COVID-19 pandemic is concerning, said Lambert. The risks of dying are 1.5 to 3.5 times higher for those with diseases such as type 2 diabetes, high blood pressure or cancer.

“There is alarming evidence from almost 400 000 people in the United Kingdom showing that those who were physically inactive were nearly 40% more likely to be hospitalised with COVID-19.”

Even more remarkable, she said, is that regular, moderate physical activity has been associated with reduced death from infectious diseases, a strengthened immune response, reduced inflammation and a lower incidence of viral respiratory infections.

“It also reduces depression and anxiety, both of which have escalated during the COVID-19 pandemic. Physical activity also improves quality of life and delays the cognitive decline associated with ageing.”

Dire global stats

Global figures back this up. Annually, physical inactivity accounts for more than 5.3 million deaths worldwide.

“18% of men and 25% of women are not getting enough physical activity.”

“These deaths are largely due to heart disease, diabetes and some cancers,” said Lambert. “But in sub-Saharan Africa, there are major concerns, with nearly half of adults experiencing high blood pressure, 20% who are obese and 5% with type 2 diabetes. And 18% of men and 25% of women are not getting enough physical activity, which in simple terms translates to about 150 minutes of moderate physical activity or 75 minutes of vigorous activity per week.”

But COVID-19 has also presented new opportunities to change this, Lambert said. The response of governments in restricting population mobility to minimise COVID-19 transmission created a “window of opportunity”.

“Restrictions created pushback from civil society, fitness centres, gyms and community organisations – all clamouring for responsible access for physical activity and to create ‘activity-supportive’ environments.

“Government clearly recognised that physical activity was important for health and well-being and that access to physical activity was seldom equitable.”

Physical activity is not a competing demand for resources or for investment in public health and development, she added.

“It plays a vital role for well-being during the current pandemic and in creating a healthy future for the African region, where in some countries, more than half of all adults do not reach the recommended levels of physical activity.”

Lambert added: “We are witnessing an exciting era where for the first time, healthcare providers and policymakers are acknowledging the importance of physical activity for health and development in the African region.

“But bold steps are needed.”

View the adult-specific policy brief

View the children-specific policy brief