The State of Qatar National Physical Activity Guidelines First Edition The State of Qatar National Physical Activity Guidelines First Edition “And your body has a right over you.” Prophet Muhammad PBUH Qatar National Physical Activity 4 Guidelines - 2014 Senior Editor Dr. Khalid Walid Al-Bibi, CETT, CHFS, CNS Director, Sport Science Professor, Health and Human Performance College of Arts and Sciences Qatar University Doha, Qatar Qatar National Physical Activity Guidelines - 2014 5 PREFACE This book was written as a practical guideline reference and not as a scientific resource. Distilled from the latest scientific evidence and driven by local realities, the intention of this book is to be an immediate and easy source of information for practitioners, physicians, educators, and individuals who wish to prescribe or engage in regular physical activity. We limited the number of beneficiary populations in the first edition of the National Physical Activity Guidelines for Qatar (NPAG-Q) to the most prevalent epidemiologies currently facing the nation. Subsequent or special e-addendums will include special populations, such as people with disabilities, cerebral palsy, Down syndrome, restrictive and obstructive pulmonary disease, spinal cord injuries, asthma, multiple sclerosis, cancer patients, etc. Behavior modification cannot be considered independently from cultural norms, local sensibilities, and environmental factors. Hence, we were careful to address social and environmental factors that are unique to Qatar. Sport scientists, epidemiologists, public health experts, health promotion specialists, health care professionals, and physicians from Qatar and the world contributed to the development of these guidelines. It is our hope that Qatari citizens and residents alike will use NPAG-Q as a guiding reference as they prepare to lead more physically active lives. It is also our hope that this text becomes ever-present in the office of every health care practitioner in Qatar and shared with patients at every appropriate opportunity. Given the strong scientific body of evidence, it is our belief that the practice of state-of-the-art health care is incomplete without the careful consideration of the physical fitness of its population. To make the guidelines as useful and as up-to-date as possible, a dedicated companion webpage (www.namat.qa/NPAG-Q) was developed to provide practitioners, educators, and citizens with an extensive array of resources, including data sheets, scientific references, screening tools, health questionnaires, warm-up and flexibility exercises, basal metabolic rate calculators, body mass index calculators, nutrition guidance, and much more. We also added two “ask the expert” blogs, one for health care practitioners (HCPs) and another for the general public. Prof. Dr. Khalid Walid Al-Bibi Professor, Health and Human Performance Director, Sport Science Qatar University Qatar National Physical Activity 6 Guidelines - 2014 ACKNOWLEDGMENTS Aspire Zone Foundation (AZF) would like to acknowledge the contributions made by various partners in the development of the first National Physical Activity Guidelines for Qatar. Among the notable ones are the Aspetar, Aspire Academy, Qatar University, the Supreme Council of Health, Primary Health Care Corporation, and Hamad Medical Corporation for providing the experts to support the development of these guidelines. Our sincere gratitude goes to our colleagues; members of the Advisory Group and the subgroups, for their valuable input in ensuring that the guidelines are matched with the latest scientific evidence and tailored towards meeting the various needs of the population of Qatar. Lastly, our appreciation is extended to Aspetar’s management for their financial support to this project as a part of their contribution to promote physical activity as a healthy lifestyle in the community. Dr. Mohamed Ghaith Al-Kuwari Preventive Medicine Consultant Director of Healthy Lifestyle Programme Aspetar Hospital Qatar National Physical Activity Guidelines - 2014 7 ADVISORY GROUP Dr. Mohamed Ghaith Al-Kuwari Dr. Izzeldin Ibrahim Preventive Medicine Consultant Preventive Medicine Consultant Director of Healthy Lifestyle Program Coordinator of Healthy Lifestyle Programme Aspetar Hospital Aspetar Hospital E-mail: [email protected] E-mail: [email protected] Dr. Stephen Targett Dr. Dennis Hatcher Sports Medicine Physician - Athlete Screening Manager, Exercise & Sport Science Department Coordination, Sports Medicine Aspetar Hospital Aspetar Hospital E-mail: [email protected] E-mail: [email protected] Dr. Paul Dijkstra Dr. Farrukh Hamid Sport Medicine Physician, Sports Medicine Musculoskeletal Pain Specialist, Sports Medicine Aspetar Hospital Aspetar Hospital E-mail: [email protected] E-mail: [email protected] Dr. Robbart Vanlinschoten Dr. Floor Groot Sport Medicine Physician, Sports Medicine Sports Medicine Fellow, Sports Medicine Aspetar Hospital Aspetar Hospital E-mail: [email protected] E-mail: [email protected] Mr. Fuad Al-Mudahka Mr. Abdulla Saeed Al-Mohannadi Exercise Physiologist, Healthy Lifestyle Researcher in Health Promotion, Healthy Programme Lifestyle Programme Aspetar Hospital Aspetar Hospital E-mail: [email protected] E-mail: [email protected] Ms. Ivana Matic Dr. Khalid W. Al-Bibi Senior Health Promotion Researcher, Healthy Professor and Director, Sport Science Lifestyle Programme College of Arts and Sciences Aspetar Hospital Qatar University E-mail: [email protected] E-mail: [email protected] Dr. Walaa Fattah Al-Chetachi Dr. Leonieke Richardson Supervisor Chronic Disease Unit Aspire Active Manager Public Health Department Aspire Active Supreme Council of Health Email: [email protected] E-mail: [email protected] Ms. Vasiliki Topalidou Dr. Veronica Bachiller Head, Events & Partnerships Lifestyle Programme Leader Aspire Academy Aspire Academy Email: [email protected] Email: [email protected] Mr. Trevor Smith Dr. Hamad Rashid Al-Madhaki Aspire MSSD Manager Head of Healthy Lifestyle Programme Aspire Academy Primary Health Care Corporation Email: [email protected] E-mail: [email protected] Dr. Madeeha Kamal Consultant Paediatrician Hamad Medical Corporation Email: [email protected] Qatar National Physical Activity 8 Guidelines - 2014 EXTERNAL EXPERT READERS We wish to thank the following experts for lending their valuable expertise in the finalisation of the guidelines: Dr. Dennis W. Koch, CHFS Associate Professor of Professional Studies Director of Health and Human Performance Canisius College Buffalo, New York United States Prof. Dr. Yahya Al-Nakeeb, FLFHE Associate Dean for Academic Affairs College of Education Qatar University Doha, Qatar Qatar National Physical Activity Guidelines - 2014 9 TABLE OF CONTENTS Evidence, Rationale, and Need 10 First Do No Harm 12 Goal Setting and Relapse Prevention 15 Goal Setting 15 Relapse Prevention 17 The General Principles of Exercise Prescription 18 Components of an ExRx for Enhancing Aerobic Fitness 19 Components of an ExRx for Enhancing Muscular Fitness 24 Healthy Adults: Asymptomatic, apparently healthy 18-64 years 27 Apparently Healthy Older Adults: Asymptomatic, 65+ Years 28 Adults with Hypertension 30 Coronary Artery Disease 31 Adults with Heart Failure 32 Diabetes Mellitus 33 Type I Diabetes 35 Type 2 Diabetes 35 Adults with Osteoarthritis 36 Adults with Metabolic Syndrome 38 Youth (12-17 years) 39 Children (5-11 years) 41 Early Years (0-4 years) 44 Recommendations for asthmatic children and children with chronic pulmonary disease: 48 Preconception, Pregnancy and Post-Partum 49 Environmental Considerations 52 Pregnancy and Heat 53 Fasting Ramadan 54 Tips for the General Public 55 Fasting and Pregnancy 56 Aspetar’s Guidelines for Exercise and Sport in Hot Weather 56 Glossary 59 Appendixes 63 Contraindications to Exercise 63 PAR-Q and You 64 Perceived Exertion for Physical Exertion (Borg’s Scale) 65 PARmed-X for Pregnancy 66 Blank ExRx Sheet 70 Qatar National Physical Activity 10 Guidelines - 2014 Evidence, Rationale, and Need Lack of regular physical activity is a significant contributing factor for many of the most prevalent acute and chronic diseases that have become alarmingly common in the State of Qatar. Evidence to support the inverse relationship between a physically active lifestyle and the incidence of cardiovascular disease, hypertension, stroke, osteoporosis, type 2 diabetes, obesity, colon cancer, breast cancer, anxiety and depression is indisputable. Over the past two decades, numerous epidemiologic studies, enrolling tens of thousands of individuals from around the world, have documented a dose-response relationship between physical activity and risk of cardiovascular disease and premature mortality. The evidence supporting the effect of exercise on the quality of life as well as affective disorders is very strong. A meta-analysis of 23 cohorts, representing over 1.2 million person-years of follow-up, showed a dose-response relationship between physical activity and the risks of cardiovascular disease. It is clear that additional amounts of physical activity or increased physical fitness levels provide added health benefits. In Qatar, deaths attributable to chronic non-communicable diseases (NCD) collectively ranked as the number one cause of death in the last 10 years. The National STEPS Survey (NSS) recently examined the health and behavior of 2,496 adults in Qatar.