PHYSICAL ACTIVITY IN THE ARAB REGION THE EFFECT OF CONDITIONS ON THE SEASONAL VARIATION OF PHYSICAL ACTIVITY

– Written by Abdulla Saeed Al-Mohannadi and Mohamed Ghaith Al-Kuwari, Qatar

Physical inactivity is considered the role on physical activity in regions with a walking, cycling and outdoor sports have fourth top risk factor for death worldwide. temperate – even on day-to-day been identified as the main source for Approximately 3.2 million of world’s basis4. accumulating the recommended amount population die each due to insufficient Several studies have investigated of daily physical activity. Studies have physical activity1. Regular physical activity obstacles to participation in physical found that time spent outdoors is highly can decrease the risk of developing activity. These studies have identified non-communicable diseases such as adverse weather conditions such as extreme hypertension, type 2 diabetes, some types , hours of daylight, , time spent of cancers and depression2. Prevalence of and wind as major barriers for participation insufficient physical activity was highest in in physical activity. Further, adverse weather outdoors is highly the World Health Organization regions of the conditions are responsible for the seasonal correlated with Americas and the Eastern Mediterranean variation observed in physical activity for (50% of women, 40% of men)2. all individuals regardless of age5. The aim of certain weather Physical environmental factors have this review is to summarise the relationship been considered contributing determinants between weather conditions and level of conditions, such of health and factors that enable or disable physical activity. as high or low individuals from participating in daily physical activity. Such environmental WEATHER CONDITIONS AND PHYSICAL , factors include facilities, access to parks, ACTIVITY safety and methods of transportation. These Epidemiological studies from different humidity, air dust, factors are unlikely to influence physical areas of the world have identified seasonal wind, rain and activity participation on a daily basis3. variation for physical activity in different However, weather plays a considerable communities. Outdoor activities such as snow

228 World Map of Köppen−Geiger Main Temperature updated with CRU TS 2.1 temperature and VASClimO v1.1 precipitation data 1951 to 2000 A: equatorial W: desert h: hot arid F: polar B: arid S: k: cold arid T: polar C: warm temperate f: fully humid a: hot Af Am As Aw BWk BWh BSk BSh Cfa Cfb Cfc Csa Csb Csc Cwa D: snow s: summer dry b: warm summer E: polar w: dry c: cool summer Cwb Cwc Dfa Dfb Dfc Dfd Dsa Dsb Dsc Dsd Dwa Dwb Dwc Dwd EF ET m: monsoonal d: extremely continental

90 −160 −140 −120 −100 −80 −60 −40 −20 020406080 100 120 140 160 180 Resolution: 0.5 deg lat/lon 80 80 Version of April 2006 ET 70 EF 70 Dfd ET Dwd Dfc 60 Dsc Dfc 60 Dfc Dfb Dwc 50 Dwb 50 Dfb Cfb Dfa BSk Dwa Csb Dfa Csb 40 BWk 40 Cfb Cfa Csa BSk Csa ET Cwa 30 30 Cfa BWh BSh Cwa Cwb BWh BSh Aw BWh BWh Csa 20 Aw 20 Am Aw Am Aw BSh Am 10 Aw Cwb 10 Af Am Aw Am 0 Af Af 0 Af Am As Af BWh Aw −10 BSh −10 Aw Cwa Aw Af Af Aw BSh −20 BSh −20 BWk Cwa BWh Cfa Cfa BWk Cwb BWh −30 Cfb Cfa Csa −30 BSk Csb Csb Csb Cfb Cfb −40 Cfb −40 BSk

−50 Cfc −50 ET −60 −60 Kottek, M., J. Grieser, C. Beck, −70 EF −70 B. Rudolf, and F. Rubel, 2006: World Map of Köppen- http://gpcc.dwd.de −80 −80 Geiger Climate Classification http://koeppen-geiger.vu-wien.ac.at updated. Meteorol. Z., 15, 259-263. −90 −160 −140 −120 −100 −80 −60 −40 −20 020406080 100 120 140 160 180

Figure 1: World map of Köppen-Geiger climate classification updated with mean monthly CRU TS 2.1 temperature and VASClimO v1.1 precipitation data for the period 1951 to 2000 on a regular 0.5 degree latitude/longitude grid23.

correlated with certain weather conditions the longer and dry days5,6. For example, The effect of weather on physical such as high or low temperature, humidity, the Canadian Community Health Survey activity may interact with certain personal air dust, wind, rain and snow5. demonstrated that the prevalence of physical characteristics such as age or medical As presented in Figure 1, weather may inactivity increased from 49% in summer conditions. For example, individuals with vary according to diverse climate zones, to 64% in winter. This epidemiological bronchial asthma need to consider weather even within the same country. This may pattern in Canada can be attributed to long conditions when they decide whether or not apply to certain large countries such as hours of darkness and adverse weather to engage in an outdoor activity to prevent Canada, the USA and . For example, conditions in winter7, which have been exacerbation of asthma attacks4. epidemiological studies demonstrate that identified as influencing even simple forms The interaction of age and weather on levels of physical activity increases in of physical activity such as walking. Studies physical activity has been investigated in a summer in the northern states of the United conducted in the USA and UK found a 10 to number of studies that found consistency States, while they decline in the southern 13% reduction in steps in winter8,9. A study in all ages with more prominent effects states, which have hot and humid summers5. on the seasonal variation of walking in the observed among preschool children This seasonal-variation pattern is Netherlands found a decrease of 1300 steps and the elderly4,5. A review of 35 studies associated with specific environmental per day during cold months10. found the presence of seasonal variation factors such as the amount of daylight The effect of weather on outdoor physical in daily physical activity of children and and extreme temperatures, which can activity may extend to indoor activities such adolescents12. Two Canadian studies found strongly promote or deter physical activity5. as exercise classes. In a study investigating a slight decline in physical activity among Most studies conducted on people living the effects of weather conditions on indoor Canadian children and adolescents in in temperate and cold regions (e.g. sports, Tu et al10 found that attendance autumn13,14. This decline becomes more America and European countries) have to indoor exercise classes on sunny days obvious in winter and specifically on days demonstrated a similar pattern of physical increased by 10 to 25% compared to days with snowfall. In addition, one of the activity levels during warm ( with adverse weather conditions such as Canadian studies found that the level of and summer), and more specifically during wind, rain and snow. physical activity declined by 2 to 4% with

HEALTHY LIFESTYLE TARGETED TOPIC 229 PHYSICAL ACTIVITY IN THE ARAB REGION

Steps 2 12000 Humidity (%) 70 every 10 mm of rainfall13. Such a pattern has also been found in the southern part of 10000 60 the world among children in New Zealand15 50 and in climates with hotter such 8000 as Cyprus. Loucaides et al16 found that 40 physical activity among Greek-Cypriot 6000 30 children ranged from 42% in winter to 51% 4000 in summer. 20

Few studies have highlighted the role Average monthly steps 2000 10

of school summer holidays in providing Average monthly humidity (%) more opportunities for physical activity 0 0 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov for children and adolescents through the increase in the time available for play. This may be considered as a confounding factor 3 Steps explaining the sharp increase in physical 12000 Temperature 40 activity in this age group during summer5. 35 10000 Moreover, schools may play role in 30 minimising the sharp decline in physical 8000 activity levels in winter found among 25 preschool children compared to primary 6000 20 school children. This is because preschool 15 children are highly dependent on outdoor 4000 10 play and have no structured activities Average monthly steps 2000 similar to that provided by the primary 5 5 school . 0 0 Average monthly temperature (C) Physical activity patterns that have Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov been found among children have also been described among older people in the UK Figure 2: Seasonality of humidity and physical activity of participants in community health 21 and Japan17,18, with studies demonstrating programme ‘Step Into Health’ in the State of Qatar . that day length, sunshine duration and Figure 3: Seasonality of temperature and physical activity of participants in community health maximum temperature were positive programme ‘Step Into Health’ in the State of Qatar21. predictors for an increase in physical activity level. It was also found that rain negatively correlated with outdoor physical activities such as walking17. females (aged 11 to 16 ) in the UAE followed up every month over a 1 year period investigated patterns of physical activity (from December 2012 to November 2013) to SEASONAL VARIATION OF PHYSICAL and levels of inactivity using a 3-day determine their average daily steps. Monthly ACTIVITY IN THE MIDDLE EAST AND THE activity diary19. The study revealed that the temperature and humidity data (monthly CASE OF QATAR amount of physical activity undertaken by minimum, maximum and average) were The effect of weather in temperate adolescent females in the UAE was very extracted from a meteorological agency climates changes extensively from to low and suggested that the extremely hot (www.wunderground.com). The effects season, and even on a daily basis depending weather is not conducive to physical activity of temperature and humidity on physical on changes in rainfall or snowfall and and plays a major role in levels of physical activity were analysed after controlling for temperature4. Similar effects can be seen inactivity; however, a seasonal data analysis age, gender and ethnicity using a mixed- (with different distribution) in the dry, hot was not undertaken. effects linear regression model. climatic regions such as in countries in the In Qatar 50% the local population does As presented in Figure 2, the average Middle East, where extreme heat (reaching not accumulate the daily recommended monthly humidity percentage ranged from to 45 to 50°C), humidity and sand-stirring amount of physical activity20. An 30 to 60% during the study period. The winds provide an environmental barrier to epidemiological study was conducted at humidity percentage was higher in the outdoor physical activity for many people Aspetar21 to determine the effect of weather winter months. The monthly average of daily for at least 5 months of the year (from the on average daily steps each month in steps of the participants was not affected by beginning of May to the end of September). a community-based online pedometer the humidity percentage. For example, in However, there are very few studies and no programme named ‘Step Into Health’. July and August when humidity rises, the clear data about the relationship between A randomly selected ethnically diverse physical activity levels remained stable. As this seasonal variation and physical activity sample of 185 adult participants (101 men a result, humidity was not associated with in this region. A study of 58 adolescent and 84 women; aged 37.7±10.9 years) were physical activity level.

230 major physical activity surveys in Middle Eastern countries are conducted at one point in time without describing the effect of the seasons on the population’s physical activity level. Information on the effect of weather could be valuable for planning interventions and events in the seasons with weather conditions that increase participation in physical activity in all age groups. Such interventions should be combined with mass-communication campaigns to convey health messages in an enabling environment. Health planners should work to reduce decreases in physical activity levels in seasons with adverse weather conditions by increasing availability and accessibility of indoor sports facilities. In addition, health and exercise experts need to provide more information about how to choose suitable physical activities for each season to allow individuals to remain physically active throughout the year. This may help exercise and sports organisations to design climate- appropriate programmes.

References Available at www.aspetar.com/journal

In contrast, Figure 3 presents a clear researchers have observed how specific effect of temperature on physical activity weather conditions can increase level. As the temperature increased during opportunities for certain outdoor activities hot months, physical activity decreased such as swimming in summer, or skiing or and as the temperature cooled in the winter skating in winter22. Obstacles for physical months, the monthly average of daily steps activity in winter such as the accessibility increased. The daily mean temperature and costs of winter activities need to be ranged from 20 to 37°C during the study investigated. period. The mean number of steps, was Moreover, research should measure significantly associated with temperature weather conditions carefully, as most after controlling for other factors such as studies have presented the weather Abdulla Saeed Al-Mohannadi B.Sc. Senior Health Promotion Researcher age, gender and ethnicity. parameters and conditions averaged over 24 hours. However, in reality, weather LIMITATIONS IN MEASURING EFFECT OF conditions at night will not affect physical Mohamed Ghaith Al-Kuwari M.D., A.B.C.M., WEATHER activity, as most physical activity is F.F.P.H. Most epidemiological studies measure performed during the day4. Acting Director General the effect of specific weather conditions Director, Healthy Lifestyle Programme on recreational activities by measuring IMPLICATIONS ON PHYSICAL ACTIVITY Aspetar – Orthopaedic and Sports the amount of physical activity using PROMOTION Medicine Hospital quantitative tools such as structured It is highly important to understand the Doha, Qatar physical activity questionnaires or more effects of weather conditions on physical objective tools such as accelerometers activity before setting physical activity Contact: and pedometers. However, very few promotion plans. For example, most of the [email protected]

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