Non-Communicable Diseases: Risk Factors and other Health Problems 069 Physical Activity
National Health and Morbidity Survey 2019 Technical Report − Volume I 070 Physical Activity Contributors to this section: Lim Kuang Kuay, Mohd Azahadi Omar, Muhammad Fadhli Mohd Yusoff, Thamil Arasu Saminathan, Chan Ying Ying, Nazirah Alias, Ahzairin Ahmad, Nur Hidayatun Fadillah Mohd Nor, Zanariah Zaini, Mohd Azemir Mustafa, Hazizi Abu Saad Introduction Low levels of physical activity had been identified as one of the leading risk factors for global mortality, contributing towards an estimated 6% of deaths globally [1]. In Malaysia, the National Health and Morbidity Survey (NHMS) in 2011 and 2015 revealed the prevalence of physical inactivity among the adult population aged 16 years and above were 35.7% and 33.5%, respectively [2][3]. To further improve the level of physical activity among the population, the government of Malaysia had introduced a new strategic plan known as the “National Strategic Plan for Active Living” (NASPAL) in 2017. One of the strategies in NASPAL is promoting and educating Malaysians to be physically active and to reduce sedentary lifestyle through promotion of active commuting among adults and strengthen the knowledge on physical activity in the community [4]. Objectives The objectives of this survey are:
- To determine the prevalence of physical inactivity among adults in Malaysia
- To determine the prevalence of physical inactivity of travel domain among adults in Malaysia
- To determine the prevalence of exposure to physical activity information among adults in Malaysia Methods Data on physical activity was obtained from adult respondents aged 16 years and above through face-to-face interview using the validated short version of International Physical Activity Questionnaire (IPAQ) [5]. Variable Definition There are three levels of physical activity which are categorized as: i. Inactive (CATEGORY 1)
This is the lowest level of physical activity. Those individuals who do not meet the criteria for Categories 2 or 3 are considered “insufficiently active”. ii. Minimally active (CATEGORY 2)
The minimum pattern of activity to be classified as “sufficiently active” is any one of the following 3 criteria: a. 3 or more days of vigorous activity of at least 20 minutes per day
OR b. 5 or more days of moderate-intensity activity or walking of at least 30 minutes per day OR c. 5 or more days of any combination of walking, moderate-intensity or vigorous intensity activities achieving a minimum of at least 600 MET-minutes/ week iii. HEPA active (CATEGORY 3).
A separate category labelled “HEPA” level, which is a more active category, can be computed for people who exceed the minimum public health physical activity recommendations. The two criteria for classification of “HEPA active” are: a. vigorous-intensity activity on at least 3 days achieving a minimum of at least 1500 MET-minutes/week OR b. 7 or more days of any combination of walking, moderate-intensity or vigorous intensity activities achieving a minimum of at least 3000 MET-minutes/ week
Non-Communicable Diseases: Risk Factors and other Health Problems 071 However, for the current analysis, the levels of physical activity of minimally active (CATEGORY 2) and HEPA active (CATEGORY 3) will be presented as a single category (active). The data on physical activity of travel domain among adults in Malaysia was obtained using the active travel domain questionnaire adopted from validated long version of International Physical Activity Questionnaire (IPAQ-L) [5]. The exposure to physical activity information among adults in Malaysia questionnaire was developed by investigators and pre-tested before the survey. Findings The overall prevalence of physically inactive adults was 25.1% (95% CI: 23.8, 26.6). Females [28.2% (95% CI: 26.4, 30.2)] were found to be more inactive than males [22.1% (95% CI: 20.4, 24.0)]. The level of physical inactivity gradually increased in adults from the age group of 55-59 years to 75 years and above. The urban population [26.5% (95% CI: 24.9, 28.2)] reported a higher level of physical inactivity compared to the rural population [20.3% (95% CI: 18.0, 22.7)]. The highest prevalence of physical inactivity was observed among Chinese [32.5% (95% CI: 29.0, 36.3)] followed by Malays [25.7% (95% CI: 24.1, 27.4)], and Indians [25.0% (95% CI: 20.5, 30.2)]. Widow(er) / divorcee [31.1% (95% CI: 27.5, 35.1)] or single [29.6% (95% CI: 27.1, 32.2)] adults were more inactive compared to married adults [22.1% (95% CI: 20.5, 23.9)]. With regards to the level of education, adults with no formal education [29.4% (95% CI: 24.2, 35.2)] and tertiary education [28.1% (95% CI: 25.5, 30.9)] were found to be more physically inactive than those with primary and secondary education. Not working adults [43.6% (95% CI: 39.9, 47.3)] and students [38.9% (95% CI: 33.9, 44.1)] had a higher level of physical inactivity compared to those from other occupational categories. The state of Perak [41.6% (95% CI: 36.1, 47.4)] reported the highest prevalence of physical inactivity, followed by Putrajaya [36.8% (95% CI: 31.0, 42.9)] and Melaka [33.2% (95% CI: 28.2, 38.7)]. In terms of active travel domain, the overall prevalence of physical inactivity in travel domain among adults was 83.0% (95% CI: 81.5, 84.5). Females [85.3% (95% CI: 83.6, 86.9)] were more inactive than males [80.9% (95% CI: 78.8, 82.9)]. The level of physical inactivity in this domain was most apparent in the elderly age group from the ages of 65- 69 years to 75 years and above. The highest prevalence of physical inactivity was observed among Malays [85.3% (95% CI: 83.8, 86.6)], followed by Chinese [84.4% (95% CI: 80.6, 87.6)], and Indians [81.0% (95% CI: 74.8, 85.9)]. With regards to the level of education, adults with tertiary [85.1% (95% CI: 82.6, 87.3)] and secondary education [83.7% (95% CI: 81.9, 85.3)] were found to be more physically inactive compared to those from other education categories. Regarding exposure to physical activity information disseminated through various mass media channels, the highest prevalence of adults who noticed the physical activity information was found for television [67.3% (95% CI: 65.3, 69.3)], followed by internet [61.0% (95% CI: 58.9, 63.1)], newspaper/magazine [39.5% (95% CI: 37.6, 41.5)] and radio [36.3% (95% CI: 34.2, 38.4)]. Conclusion The prevalence of physical inactivity among Malaysian adults was relatively low, with a significant decrease from NHMS 2011 and NHMS 2015. However, the prevalence of physical inactivity in travel domain among Malaysian adults was relatively high. The highest prevalence of adults noticing physical activity information was found for television and on the internet. Recommendations In view of the findings which were highlighted above, the recommendations below are suggested. i. Programs to promote a better understanding of physical activity that benefits health and functional capacity are recommended, especially among females, student and those from the older population. ii. Programs to increase the travel domain are recommended, especially among Malays, females, tertiary education group and those from the older population. iii. Promotion of physical activity to be carried out via television and internet channels to increase the awareness of the benefits of physical activity. Table 5.1: Physical Inactivity Trend in Malaysia 2011 2015 2019 Physical Inactivity 35.7 33.5 25.1 References 1. World Health Organization. Global Recommendations on Physical Activity for Health. 2010. 2. IPH (Institute for Public Health): The fourth national health and morbidity survey (NHMS IV). Kuala Lumpur: Ministry of Health Malaysia; 2011. 3. IPH (Institute for Public Health): The fifth national health and morbidity survey (NHMS V). Kuala Lumpur: Ministry of Health Malaysia; 2015. 4. Health Education Division. National strategic plan for active living (NASPAL). Kuala Lumpur: Ministry of Health Malaysia; 2018. 5. International Physical Activity Questionnaire Web site [Internet]. Guidelines for data processing and analysis of the International Physical Activity Questionnaire (IPAQ) - Short and long Forms 2005.
National Health and Morbidity Survey 2019 Technical Report − Volume I 072 Table 5.2: Prevalence of Physical Inactivity Among Respondents Aged 16 Years and Above in Malaysia by Socio-Demographic Characteristics (n=10,767) Sociodemographic Characteristics Inactive Count Estimated Population Prevalence (%) 95% CI Lower Upper MALAYSIA 2,820 5,574,818 25.1 23.77 26.56 State Johor 194 509,772 20.5 16.21 25.46 Kedah 71 168,405 12.5 9.33 16.61 Kelantan 191 340,438 28.4 23.57 33.75 Melaka 212 197,414 33.2 28.17 38.68 Negeri Sembilan 150 221,486 30.5 23.79 38.18 Pahang 168 265,754 25.0 20.62 29.87 Pulau Pinang 179 341,751 26.7 22.11 31.75 Perak 223 676,269 41.6 36.07 47.43 Perlis 141 40,253 23.8 18.44 30.22 Selangor 282 1,160,563 24.2 21.12 27.59 Terengganu 186 231,224 29.5 25.84 33.48 Sabah 149 439,229 16.0 12.30 20.47 Sarawak 196 517,986 27.4 23.32 31.82 WP Kuala Lumpur 180 426,899 32.1 26.23 38.60 WP Labuan 111 14,847 22.6 17.51 28.58 WP Putrajaya 187 22,527 36.8 31.04 42.91 Location Urban 1,843 4,577,603 26.5 24.92 28.21 Rural 977 997,215 20.3 18.00 22.72 Sex Male 1,175 2,496,904 22.1 20.41 23.96 Female 1,645 3,077,914 28.2 26.35 30.23 Age Group (Years) 15-19 272 737,941 36.2 31.47 41.17 20-24 287 767,217 26.8 22.98 31.04 25-29 245 634,458 21.4 17.93 25.25 30-34 223 538,504 20.7 16.84 25.08 35-39 209 518,566 22.3 18.04 27.19 40-44 154 291,567 16.1 12.94 19.83 45-49 175 336,231 20.4 16.92 24.48 50-54 171 283,468 18.6 15.46 22.15 55-59 198 287,625 21.9 17.83 26.70 60-64 207 310,649 28.4 23.68 33.55 65-69 204 284,265 35.8 30.07 42.03 70-74 180 203,733 37.5 31.68 43.80 75 & above 295 380,594 58.9 52.18 65.29 Ethnicity Malaya 1,910 2,951,439 25.7 24.15 27.41 Chinese 422 1,503,578 32.5 29.02 36.27 Indian 184 328,070 25.0 20.54 30.17 Bumiputera Sabah 122 288,718 20.2 16.25 24.93 Sociodemographic Characteristics Inactive Count Estimated Population Prevalence (%) 95% CI Lower Upper Bumiputera Sarawak 99 244,395 24.8 19.60 30.86 Others 83 258,618 10.9 7.57 15.49 Marital Status Single 802 2,105,150 29.6 27.11 32.23 Married 1,630 3,004,578 22.1 20.50 23.87 Widow(er)/Divorcee 388 465,090 31.1 27.47 35.06 Education Level No Formal Education 235 316,454 29.4 24.21 35.18 Primary Education 656 1,032,864 24.9 21.85 28.26 Secondary Education 1,243 2,624,921 23.3 21.65 25.06 Tertiary Education 668 1,564,012 28.1 25.45 30.89 Occupation Government Employee 248 343,433 22.2 17.93 27.16 Private Employee 624 1,696,054 20.8 18.48 23.31 Self Employed 288 593,306 16.3 13.58 19.35 Unpaid Worker/ Homemaker 475 874,021 24.0 20.60 27.70 Retiree 150 233,252 29.8 24.04 36.35 Student 244 656,320 38.9 33.94 44.12 Not Workingb 790 1,175,015 43.6 39.93 47.27 Household Income Group Less than RM 1,000 328 548,803 31.0 26.71 35.56 RM 1,000 - RM 1,999 502 923,956 21.4 18.81 24.31 RM 2,000 - RM 3,999 766 1,520,049 22.8 20.62 25.09 RM 4,000 - RM 5,999 393 887,847 25.4 22.48 28.64 RM 6,000 - RM 7,999 257 528,132 26.5 21.94 31.59 RM 8,000 - RM 9,999 119 241,568 26.2 20.05 33.51 RM 10,000 and above 218 491,758 29.6 23.73 36.12 Household Income Quintile Quintile 1 612 1,078,990 27.0 23.99 30.19 Quintile 2 466 810,541 19.2 16.64 22.09 Quintile 3 483 1,026,975 24.6 21.70 27.82 Quintile 4 428 964,149 25.0 22.20 27.97 Quintile 5 594 1,261,459 27.5 24.20 31.17 Household Income Category Bottom 40% 1,746 3,200,414 23.6 22.00 25.31 Middle 40% 606 1,369,494 25.3 22.68 28.15 Top 20% 231 572,206 30.7 25.04 36.97 a - Malay includes Orang Asli b - Not working includes Unemployed, and Old Age