Physical Activity and Healthy Ageing in Uganda: Opportunities and threats.

Sandra Kasoma PhD, MSc, BEd

Makerere University Dept. Of Biochemistry & Sports Science

Physical Activity and Sport for Health and Development in Africa

25th – 29th Maputo, Mozambique

Overview

There is evidence that the no. of older people age 60+ worldwide is increasing due to:

Provision of health facilities & nutrition This no. OA is expected to rise to 1.2 billion by

2025, with a bigger % of them living in developing countries (WHO,2000).

Africa alone having 204 – 210 million by 2050 Most aged people in most parts of the world live

sedentary lives (WHO 1998.1). Sedentary living leads to loss of muscle function

and physical impairment

Overview cont’d

UBOS (2010) indicates Uganda population is 32 million. A large proportion of this population is age 15 and below.

Many OA have lost family members to HIV/AIDS; 12% of the children are orphans (UDHS, 2011). hence;

OA left with grand children after death of parents Traditional family support system crumble Lack of awareness among Ugandans of the

needs, rights and problems of OA

Overview cont’d

According to UN figures, more than 80% of men aged 65+ are still working for a living in parts of Africa, including Uganda while that of women is 75%. Over 90% of these, work in informal sector. This means few people are entitled to state pension.

Low or no income at all Increased vulnerability to diseases and poor

conditions Neglect and rejection

Trends in the OA nutritional status

Carbohydrate rich diet Diet lacking fruits and vegetables Plant protein rich diet Inadequate fluid intakes Irregular meal patterns – meal skipping Existing programmes for improving nutritional

status exclude OA Numerous socio-economic and cultural

factors influence patterns of feeding.

Trends in the OA PA status

Weak due to a no. of factors: Deterioration in the physiological capacity and function

Inactive do not meet the 150min/wk PA requirement

Physical planning & architecture (buildings, pavements, walkways, public toilets..) does not favor OA – affects mobility & independence of OA

ADL

Trends in the OA Health status

Hypertensive Diabetic Disabled Untreated conditions Illnesses and degenerative conditions Impairment including physical, vision

and auditory

Welfare of the elderly Poverty – few OA entitled to pension 64%

survive on less than US $1 a day (Uganda reach the Aged, Global Activity on Aging, 2010)

Promised reasonable provision for the welfare and maintenance of the aged

Facing hard conditions such as queuing for services, pension and elections. (Global Activity on Aging, 2010)

Abuse (mental & physical) and neglect

To determine the: Physical activity patterns among the OA in

homes. Functional independence and health fitness

levels of the OA in homes Nutritional patterns of the elderly in Uganda. Effect of the 8-week PAP intervention on the

functional independence and health of the OA in homes.

Objectives of the Study

Intervention

Evaluate impact of an 8-week regular Physical Activity Programme (PAP) on the physical activity patterns, the nutritional patterns, functional independence of the OA

Limitations

Number of homes for the elderly Availability of elderly people in the home Health conditions & disability facilities and resources.

BalanceSleep wellHealthMobility levelsPhysiological capacityFlexibility levelsAgilityFunctional Independence

Phy. inactivity

Active living

Adult life 60+ years

Conceptual framework

Relationship between active & inactive lifestyle Baechle and Earle (2000), …

Method/s

Both men and women age 60+ in the home participated in a quasi experimental PAP intervention that lasted 8 weeks.

Pre tests at baseline & post tests at halftime and at end of the programme.

The Community Health Intervention Programme (CHIPS) as used by Kolbe et al (2004) was adapted for use in this study.

Analysis

use both the Statistical Programme for Social Scientist (SPSS-15.0) and STATA 9.

Kruskal-Wallis analysis of ranks was used

to determine differences between independent groups and

The Fisher’s Exact Test

Table 4.1: Elderly at home and those who took part in the study

Gender Total No. in Home

< 60 Years

Uncontrolled BP / require specialized attention

Eligible for PAP

Did not successfully complete the PAP

Completed the PAP

Male 25 5 8 12 02 10

Female 15 2 3 10 03 07

Total 40 7 11 22 05 17

Physical activity patterns This study was limited to only establishing

the routine activities. The total related energy expenditure was

not calculated; the elderly persons and the caregivers could not specify amounts of time spent on most activities.

Descriptive statistics

Mean value (SE), (N=17) KRUSKAL-WALLIS

Variable Baseline 4 Weeks 8 Weeks X2 P

Systolic 133.4 (6.8) 132.1(6.3) 116.1(3.4) 5.33 0.070

Diastolic 78.7 (3.4) 67.7(3.7) 70.3(1.7) 8.32 0.016

Heart Rate 79.4 (6.7) 63.1(3.6) 65.6(3.5) 4.49 0.010

Gait 72.3(10.6) 49.8(7.6) 45.2(9.3) 3.74 0.013

Sit-to-stand 3.2 (0.4) 5.2(0.4) 5.6(0.6) 14.16 0.001

Cardio end. 160.6 (19.4) 221.6(24.1) 220.1(23.6) 4.00 0.135

D. balance 26.9 (5.6) 26.7(5.7) 23.1(5.1) 5.82 0.054

S. balance 26.9 (1.2) 29.4(0.6) 29.3(0.5) 4.21 0.122

Frequency of attacks by timing

Frequency of attacks Timing

BaselineN=17

HalftimeN=17

FulltimeN=17

None 5.9 5.9 41.2

Rarely 11.8 52.9 29.3

Frequently 47.1 23.5 17.7

Always 35.2 17.7 11.8

Fisher's exact Sig. = 0.012

Self perceived healthTiming N Rating %

Poor Good Improved

Baseline 17 76.5 23.5 .

Halftime 17 11.8 0.00 88.2

Fulltime 17 11.7 0.00 88.3

Fisher's exact Sig. = 0.000

Distribution of constipation problem by timing

Timing N Constipation problem %

No Yes

Baseline 17 52.9 47.1

Halftime 17 76.5 23.5

Fulltime 17 94.1 5.9

Fisher's exact Sig. = 0.025

Results show a significant association inactivity and prevalence of constipation problem among the OA by timing

Conclusion

Intervention effective Changes not significant

Gait quality & lower body strength Dynamic & static balance

Heart rate & diastolic blood pressure Systolic & cardio endurance

Eliminating constipation

Dealing with nearly all the sleep problems

Reducing the frequency of chronic illness attacks

.

Insufficient nutritional requirements in the diet of the elderly at the home..

Opportunities

Existence of Gov’t. Policy Govt’s promise to support OA Many of the OA esp. now, are still

functionally independent Availability of supporting partners

though few e.g. HelpAge

Threats Crumbling of the traditional social support system /

structure OA do not have regular support from their families Poor management of health related conditions due to a no.

of factors Poor management of Gov’t programs for the OA Insufficient nutritional intakes (feeding practices) Segregation in terms of prioritization of care and support

opportunities as compared to other groups of population Loss of functional dependence

General Conclusions

Research and publication on OA required Evidence based advocacy to improve conditions of OA Sensitizing stake holders on the needs, rights and

contributions of OA Need for development partners especially in order to

- Strengthen the health of OA to remain active, productive.

- Promote wellbeing among OA

Thank you for listening to me!