1. Physical Activity and Healthy Ageing in Uganda: Opportunities and threats. Sandra Kasoma PhD, MSc, BEd Makerere University Dept. Of Biochemistry & Sports Science Physical Activity and Sport for Health and Development in Africa 25 th – 29 th Maputo, Mozambique

2. Overview There is evidence that the no. of older people age 60+ worldwide is increasing due to: Provision of health facilities & nutrition This no. OA is expected to rise to 1.2 billion by 2025, with a bigger % of them living in developing countries (WHO,2000). Africa alone having 204 – 210 million by 2050 Most aged people in most parts of the world live sedentary lives (WHO 1998.1). Sedentary living leads to loss of muscle function and physical impairment

3. Overview contd UBOS (2010) indicates Uganda population is 32 million. A large proportion of this population is age 15 and below. Many OA have lost family members to HIV/AIDS; 12% of the children are orphans (UDHS, 2011). hence; OA left with grand children after death of parents Traditional family support system crumble Lack of awareness among Ugandans of the needs, rights and problems of OA

4. Overview contd According to UN figures, more than 80% of men aged 65+ are still working for a living in parts of Africa, including Uganda while that of women is 75%. Over 90% of these, work in informal sector. This means few people are entitled to state pension. Low or no income at all Increased vulnerability to diseases and poor conditions Neglect and rejection

5. Trends in the OA nutritional status Carbohydrate rich diet Diet lacking fruits and vegetables Plant protein rich diet Inadequate fluid intakes Irregular meal patterns – meal skipping Existing programmes for improving nutritional status exclude OA Numerous socio-economic and cultural factors influence patterns of feeding.

6. Trends in the OA PA status Weak due to a no. of factors: Deterioration in the physiological capacity and function Inactive do not meet the 150min/wk PA requirement Physical planning & architecture (buildings, pavements, walkways, public toilets..) does not favor OA – affects mobility & independence of OA ADL

7. Trends in the OA Health status Hypertensive Diabetic Disabled Untreated conditions Illnesses and degenerative conditions Impairment including physical, vision and auditory

8. Welfare of the elderly Poverty – few OA entitled to pension 64% survive on less than US $1 a day (Uganda reach the Aged, Global Activity on Aging, 2010) Promised reasonable provision for the welfare and maintenance of the aged Facing hard conditions such as queuing for services, pension and elections. (Global Activity on Aging, 2010) Abuse (mental & physical) and neglect

9. To determine the: Physical activity patterns among the OA in homes. Functional independence and health fitness levels of the OA in homes Nutritional patterns of the elderly in Uganda. Effect of the 8-week PAP intervention on the functional independence and health of the OA in homes. Objectives of the Study

10. Intervention Evaluate impact of an 8-week regular Physical Activity Programme (PAP) on the physical activity patterns, the nutritional patterns, functional independence of the OA

11. Limitations Number of homes for the elderly Availability of elderly people in the home Health conditions & disability facilities and resources.

12. Balance Sleep well Health Mobility levels Physiological capacity Flexibility levels Agility Functional Independence Phy. inactivity Active living Adult life 60+ years Conceptual framework Relationship between active & inactive lifestyle Baechle and Earle (2000), …

13. Method/s Both men and women age 60+ in the home participated in a quasi experimental PAP intervention that lasted 8 weeks. Pre tests at baseline & post tests at halftime and at end of the programme. The Community Health Intervention Programme (CHIPS) as used by Kolbe et al (2004) was adapted for use in this study.

14. Analysis use both the Statistical Programme for Social Scientist (SPSS-15.0) and STATA 9. Kruskal-Wallis analysis of ranks was used to determine differences between independent groups and The Fishers Exact Test

15. Table 4.1: Elderly at home and those who took part in the study GenderTotal No. in Home < 60 Years Uncontrolled BP / require specialized attention Eligible for PAP Did not successfully complete the PAP Completed the PAP Male2558120210 Female1523100307 Total40711220517

16. Physical activity patterns This study was limited to only establishing the routine activities. The total related energy expenditure was not calculated; the elderly persons and the caregivers could not specify amounts of time spent on most activities.

17. Descriptive statistics Mean value (SE), (N=17)KRUSKAL-WALLIS VariableBaseline4 Weeks8 WeeksX2X2 P Systolic133.4 (6.8)132.1(6.3)116.1(3.4)5.33 0.070 Diastolic78.7 (3.4)67.7(3.7)70.3(1.7)8.32 0.016 Heart Rate79.4 (6.7)63.1(3.6)65.6(3.5)4.49 0.010 Gait72.3(10.6)49.8(7.6)45.2(9.3)3.74 0.013 Sit-to-stand3.2 (0.4)5.2(0.4)5.6(0.6)14.16 0.001 Cardio end.160.6 (19.4)221.6(24.1)220.1(23.6)4.00 0.135 D. balance26.9 (5.6)26.7(5.7)23.1(5.1)5.82 0.054 S. balance26.9 (1.2)29.4(0.6)29.3(0.5)4.21 0.122

18. Frequency of attacks by timing Frequency of attacksTiming Baseline N=17 Halftime N=17 Fulltime N=17 None5.9 41.2 Rarely11.852.929.3 Frequently47.123.517.7 Always35.217.711.8 Fisher's exact Sig. = 0.012

19. Self perceived health TimingNRating % PoorGoodImproved Baseline1776.523.5. Halftime1711.80.0088.2 Fulltime1711.70.0088.3 Fisher's exact Sig. = 0.000

20. Distribution of constipation problem by timing TimingNConstipation problem % NoYes Baseline1752.947.1 Halftime1776.523.5 Fulltime1794.15.9 Fisher's exact Sig. = 0.025 Results show a significant association inactivity and prevalence of constipation problem among the OA by timing

21. Conclusion Intervention effectiveChanges not significant Gait quality & lower body strengthDynamic & static balance Heart rate & diastolic blood pressureSystolic & cardio endurance Eliminating constipation Dealing with nearly all the sleep problems Reducing the frequency of chronic illness attacks. Insufficient nutritional requirements in the diet of the elderly at the home..

22. Opportunities Existence of Govt. Policy Govts promise to support OA Many of the OA esp. now, are still functionally independent Availability of supporting partners though few e.g. HelpAge

23. Threats Crumbling of the traditional social support system / structure OA do not have regular support from their families Poor management of health related conditions due to a no. of factors Poor management of Govt programs for the OA Insufficient nutritional intakes (feeding practices) Segregation in terms of prioritization of care and support opportunities as compared to other groups of population Loss of functional dependence

24. General Conclusions Research and publication on OA required Evidence based advocacy to improve conditions of OA Sensitizing stake holders on the needs, rights and contributions of OA Need for development partners especially in order to - Strengthen the health of OA to remain active, productive. - Promote wellbeing among OA

25. Thank you for listening to me!