Determinants of Physical Inactivity Among Men and Women From Greece: A 5-Year Follow-Up of the ATTICA Study

Objective

We sought to evaluate factors that are associated with physical activity changes among adults within a 5-year period.

Methods

From May 2001 to December 2002 we randomly enrolled 1514 men and 1528 women without any evidence of cardiovascular or any other chronic disease. The sampling was stratified by the age–gender distribution of the greater area of Athens. Weekly energy expenditure assessed by considering frequency, duration, and intensity of sports-related physical activity. During 2006, the 5-year follow-up was performed in 1955 participants, which included, among others, current physical activity status.

Results

A total of 587 (61%) men and 673 (68%) women were classified as physically inactive at baseline, whereas 661 (69%) men and 728 (73%) women were classified as physically inactive at follow-up; thus, a 13% increase in physical inactivity rate was observed in men and a 7% in women during the follow-up period (p < 0.01). Multivariate analysis revealed that male gender, being a nonsmoker, healthy eating, better self-reported quality-of-life, and lower prevalence of hypercholesterolemia and incidence of cardiovascular disease were the characteristics of people that remained physically active; advanced age, anxiety and depression, overweight, and low quality-of-life were the baseline predictors of physical inactivity among initially active participants, which also had a greater incidence of cardiovascular disease.

Conclusions

Gender, aging, psychological disorders, body mass, smoking, dietary habits, perceived health status, and quality-of-life were the most important discriminating factors of physical activity changes.

Introduction

The beneficial role of physical activity on health has been underlined many years ago. Several epidemiological studies and clinical trials suggest that any type of physical activity reduces the risk of developing coronary heart disease, stroke, as well as various metabolic disorders, like hypertension and diabetes 1, 2, 3, 4, 5. A physically active lifestyle also helps to control weight; contributes to healthy bones, muscles, and joints; reduces falls among older adults; helps to relieve the pain of arthritis; reduces symptoms of anxiety and depression; and is associated with fewer hospitalizations, physician visits, and medications (6). Moreover, it is known that the level of physical activity declines with age, the overall inactivity trend is worse in poor urban areas, whereas there are racial and ethnic differences in activity rates, particularly among women. Despite the proven benefits of physical activity, the World Health Organization estimates that more than 60% of adults are not active enough to benefit their health (7), whereas in Greece the prevalence of physical inactivity varies from 47% in men to 52% among women (8).

Several studies have investigated the relation between physical activity and different health behaviors and individual characteristics. In a recent overview of randomized and nonrandomized controlled trials (5), the authors reported that interventions tailored to people's needs, targeted at the most sedentary or at those most motivated to change, and delivered either at the level of the individual or household or through groups, can encourage people to walk more, although the sustainability, generalizability, and clinical benefits of many of these approaches are uncertain. However, despite the importance of exercise, very few studies have investigated predictors of physical inactivity at the general population level. Specifically, the authors of a a cross-sectional study of 15 countries from the European Union (9) found that old age, obesity, low level of education, widowhood/divorce, and smoking were determinants of a sedentary lifestyle; authors of another cross-sectional study from Canada found that advanced age, female gender, few friends, and poor or fair perceived health status were the strongest indicators of physical inactivity (10); the authors of a prospective study in the United States found that, in men, short-term success with exercise, weight loss, and health beliefs regarding the role of exercise in preventing cardiovascular disease were the major determinants of maintaining or adopting increased physical activity, whereas in women, short-term success with exercise and weight loss, school children's recommendation of exercise, and work outside the home predicted adoption or maintenance of increased physical activity (11). Finally, authors of a Dutch study found that less-educated participants were more likely to decrease in physical activity during the 6-year follow up (12).

To the best of our knowledge, there are no other studies that evaluated predictors of inactivity at the general population. Therefore, it is essential the identification of determinants of physical inactivity that will indicate population groups in greatest need of interventions and support. Thus, in this work we aimed to evaluate sociodemographic, lifestyle, and clinical and behavioral factors that are associated with changes in physical activity status in a prospective cohort study of the Greek adult population (i.e., the ATTICA Study) (13).