#PhysicalActivity4Africa – physical activity saves lives: COVID-19 pandemic drives need for policy brief on physical activity for health in Africa

COVID-19 has challenged us globally in so many ways. It has impacted our health and our economy; affected how we communicate and gather; mourn and celebrate; and, of course, travel. It has “clipped our wings” and exposed our vulnerabilities. But it has also highlighted the importance of physical activity and exercise, for our overall health and well-being, and for the well-being and social cohesion of our communities.

Some of the very diseases that place individuals with COVID-19 at much higher risk of being hospitalised or dying are the same lifestyle-related diseases that are associated with being physically inactive. In fact, the risk of dying from COVID-19 is 1.5 to 3.5 times higher for people with diseases such as: Type 2 diabetes, high blood pressure or cancer. And what is even more concerning is that there is evidence from almost 400 000 persons in the UK showing that those who were physically inactive were nearly 40% more likely to be hospitalised with COVID-19.

Even more remarkable 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.

Every year, physical inactivity accounts for more than 5.3 million deaths worldwide. These deaths are largely due to heart disease, diabetes and some cancers. 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 sufficient physical activity, which in simple terms translates to about 150 minutes of moderate physical activity, or 75 minutes of vigorous activity per week.

The response of governments to restrict population mobility to minimise the transmission of COVID-19 created a “window of opportunity”. Restrictions created “push back” from civil society, fitness centres, gyms and community organisations, clamouring to be allowed 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.

The need to message and provide guidance to governments and civil society, to implement national plans, policies and programmes to promote physical activity in the African region, both during COVID-19 and beyond, became critical. As a result, a group of more than 40 academics, researchers and implementation partners from nine countries in the African region prepared a series of policy briefs. The consortium, spear-headed by Professor Vicki Lambert from the University of Cape Town Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), and Associate Professor Rowena Naidoo, from the College of Health Sciences at the University of KwaZulu-Natal, created two policy briefs. The first targeted the general public, and the second, children in three environments – at home, at school and in communities. Endorsed by the African Physical Activity Network (AFPAN) and supported by the Western Cape Government Department of Health, the goal of the policy briefs is to guide decision-makers, planners and programme leaders, both during the COVID-19 pandemic and beyond.

In so doing, the first policy briefs:

* Address five major challenges needed to minimise the risk of community transmission while exercising during the pandemic, which include: ensuring social distancing (2m); wearing masks (non-medical, cloth masks); exercising in small groups (outdoors, with social distancing); exercising indoors (only with proper ventilation) and avoiding the use of shared equipment or sanitising in between users. These same concerns apply to children, and in particular, children in school settings. Accompanying useful infographics can be placed in prominent locations to remind participants to exercise safely.

* Adopt a policy framework created by the World Cancer Research Fund, which is aligned to the World Health Organisation Global Action Plan for Physical Activity (GAPPA).

* Introduce a four-step policy recommendation for physical activity for the general public in the African region. The four steps include:

1. The development of a national plan for physical activity for health and development, which would allow for input from multiple sectors and stakeholders resulting in co-benefits and shared responsibility.

2. 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 on Wellness (WoW!) lifestyle programme institutionalised by the Western Cape Provincial Government. Says Dr Frederick Marais, the Deputy Director of Health for Increasing Wellness: “WoW! has trained more than 600 health champions who lead community groups, promoting physical activity and public exercise programmes in underserved areas. The improvement to both the members' health and quality of life has been outstanding.”

3. Ensuring safe and enjoyable opportunities for physical activity, through urban planning, provision of parks or public spaces and low-cost programmes close to where people live. This is particularly critical in communities that lack safe and accessible facilities where they can be physically active.

4. Adopting a “whole of government” systems approach towards physical activity 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 a means to build social cohesion in communities.

Says Professor Lambert: “Physical activity is not a competing demand for our resources, or for investment in public health and development. 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.”

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. Regular physical activity saves lives, improves quality of life, physical and mental well-being, and boosts the immune system. Bold steps are needed.

For a full view of both the adult and children-specific policy briefs and further information, visit https://www.westerncape.gov.za/westerncape-on-wellness and track on social media using #PhysicalActivity4Africa.