Protocol Document Produced for the Ministry of Health in Barbados
David Dean Ellis LL.M MBA BA / Ogeji Dottin CPT
FOREWORD
The Taskforce on Physical Activity and Exercise was officially launched in October 2009. It draws on the strengths of a diverse group of individuals from the private and public sectors and civil society. The Task Force is committed to developing well-structured programs through their specific mandate of encouraging, facilitating and promoting physical activity and exercise on a national level so as to improve the health and longevity of our citizens.
Since its inauguration the Task Force has trained community leaders in good exercise practice, sponsored outdoor mass exercise events and conducted public awareness campaigns. The guidelines represent a continuation of these efforts to increase awareness and involvement of citizens of Barbados in daily exercise and physical activity
Evidence from the Behavioral Risk Factor Survey conducted in September 2007 involving 1,290 households indicated that 51.3%, 21.4% and 22.7% of the adult population are involved in low, moderate and high levels of physical activity respectively. Women were more likely to report low levels of physical activity than men (59.0% vs.45.5%).
On average, adults spent 107.1 minutes in physical activity and exercise daily with women averaging 73.6 minutes per day and men 145.5 minutes per day. This included activities at work, activities involved in travel and activities involved in recreation. Women were 1.2 times more likely than men to report ‘no work- related physical activity and exercise’ i.e. 77.8 % vs. 59.3% respectively (all sexes 69.2%). There were 56.6% of respondents who reported no physical activity as it relates to transport e.g. walking to and from work, climbing stairs etc. Finally persons in the sample reported that they on average spent 223.7 minutes in sedentary activity during their typical day with females reporting 220.2 and males 226.7 minutes,
There was the worrisome trend of overweight/obesity with on average sixty per cent (60%) of adults being either overweight or obese. The survey also indicated a gender disparity with respect to overweight/ obesity with women one and one quarter (1 1/4) to one and one half (1½) times more likely to be overweight or obese. Trends of obesity in school children are also alarming with an estimated 25% of school aged children being reported as obese* (reference needed).
Approximately 17% of the adults over the age of 40 years are diabetic and 24% of all adults are hypertensive. Exercise and physical activity remain the cornerstone in the management of diabetes and hypertension in primary care.
Data from the Barbados National Registry in 2009 indicated that there were over 500 reported strokes averaging 204 per 100,000 populations. 26 % of persons with strokes admitted to hospital died before discharge. There were 182 cases of acute myocardial infarction reported during the first 6 months of the BNR Heart Registry, the majority of these dying before getting to hospital.
Exercise is a proven population based
strategy that can prevent chronic non communicable disease including diabetes,
hypertension, stroke and cardiovascular disease. In addition there is new
evidence to suggest that regular physical activity and exercise can prevent
some cancers from developing.
Introducing the 2012 Physical Activity Guidelines for
Barbadians
Being physically active is important for Barbadians of ALL ages. Faced with an
increasing number of Non Communicable diseases (NCD”S) on record, the Ministry of Health is leading the way with the assistance of the Ministries of Family Culture Sports and Youth and Education to provide this Physical Activity Guideline for easy use by ALL
Barbadians.
This Guideline can be used along with the ‘Food Based Dietary Guidelines for
Barbados’ [produced by the National Nutrition Centre]. Increasing physical
activity, along with considering choices relating to smoking and alcohol, are
definite proven means for improving health.
Consider the details in this booklet/guide for your easy reference/reading
towards a more active lifestyle.
Objectives
The purpose of this guide is to foster a greater awareness of the benefits of
physical activity and exercise in the population, which may be summarized
as follows:
- Lower NCDs
- Educate on exercise choices and,
- Provide all age groups with a baseline to plan their daily activity.
For us to reap the benefits of improved health and well being, we must keep
moving every day in some way and it can be exciting, fun, and very rewarding
over time.
To provide a guideline as to the suggested quantities of exercise for all age
groups and sections of the Barbadian population.
1. 0‐4 years old. Infants, toddlers and preschoolers
2. 5‐11 years old. Children and adolescents
3. 12‐17 years old. Teenagers
4. 18‐64 years old. Adults.
5. 65 + years. Retirees.
We hope these guidelines provide a helpful source of information to you on your
journey to an increased sense of wellness through movement and exercise.
Attached to this document is an appendix listing the resources available in our
communities for every citizen.
Please contact your doctor or a
certified health care professional before starting a physical activity program.
2012 Physical Activity Guidelines for Barbados
0-4 years old. Infants, Toddlers and preschoolers
Infants and children of preschool age are full of energy; they are discovering a new world of shapes, colors and possibilities. You do not need to encourage them to exercise, as they are usually restless all on their own. What the responsible parent/guardian can do is make sure their exercise is fun as well as effective by encouraging them to stretch and indulge in various forms of activity. The infant who is unable to walk for example, can be encouraged to crawl to obtain a favorite toy or object which they are fond of, or the parent/guardian may encourage that child to develop strength by playing and gently stretching the limbs of the child while he/she is in the crib or stroller. Remember that this is the age where they can develop a positive attitude toward exercise, which can be invaluable to them in later years.
For optimum health benefits, the toddler should accumulate at least 60 minutes of activity each day, but this is not limited to exercise alone. “Activities such as climbing or wrestling with dad are also acceptable forms of activity”.
The infant’s degree of excitability; when being active, determined by such signs as increased breathing and laughter, is an indication of the fact that they are getting an acceptable level of intensity while being active.
- Ideally, they should engage in vigorous activity at least four (4) to five (5) days a week and this includes playing with other young children and such structured activities as visits to playgrounds.
- Engage in activity that includes light resistance such as riding a tricycle for the development of strong bones and muscles at least three days a week.
- There is little chance of overdoing physical activity for this age group. A game of hide and seek , playing “catch” with mom and dad, playing “hop-scotch” or “musical-chairs” or climbing stairs are all examples of safe and effective physical activity.
5-11 years old. Children and Adolescents.
Children in this age group are experiencing growth as the body prepares to enter puberty. They are of school age and are learning sports, games and other physical activity. Exercise for this age group strengthens the muscles, bones and the immune reactions of their bodies. Stronger bodies mean children who are more resistant to illness and lower medical costs. Simple examples of “games” which are cardio vascular and involve resistance would be “wheelbarrow” races or “three legged races” which can incorporate an element of fun and structure to their activity. Adults who are caretakers should encourage children of this age to get out of the house and engage is games and sports with their friends. Children’s time spent watching the television, surfing the internet or playing video games should be monitored closely and a limit of three hours a day should be placed on the amount of time they engage in this activity, as this kind of activity tends to promote a sedentary lifestyle as opposed to an active one. Indications of an acceptable level of intensity for this age group while exercising would be perspiration caused by movement and a moderate increase in their rate of breathing, although excessive panting and an inability to catch their breath may indicate a problem and physical over-exertion.
For optimum health benefits, children in this age group should engage in physical activity for at least 60 minutes every day.
- At least a large part of this daily exercise should be spent on cardiovascular activity such as running or playing active games such as “Rounders” and this should be part of their routine at least 3 days a week.
- For the development of their muscles and bones, children in this age group should also engage in resistance exercises such as “tree climbing” or swimming , which help them develop bone and muscle structure for bodies that are about to make many physical changes. This kind of activity should be engaged in at least 3 times a week.
12-17 years old. Adolescents.
These young adults have different requirements than their younger counterparts. Their bodies are undergoing massive changes and their needs are more precise. This is also the age where they decide what their preferences are in terms of lifestyle and the kind of adults they intend to be. An understanding and suggestive approach, can go a long way in encouraging the rebellious teenager in developing an appreciation for the benefits of exercise. Structured activities with friends such as enrolling the teenager in a Martial Arts training program or a dance studio, participating in team and individual-play sports, such as basketball and road tennis, are all examples of areas of activity which can have long term benefits such as increased concentration and discipline for their future life. Exercise is also helpful at the onset of menstruation for girls of this age as it assists in bringing balance to their cycles.
Acceptable levels of intensity for this age group would be demonstrated by perspiration and increased respiration. A simple method of determining the level of intensity that a teenager is experiencing during exercise is to ask the teenager to sing the National Anthem immediately during a break in exercise. If the teenager is able to sing the National Anthem with proper intonation and diction and does not stop to take breaths in between, then it is possible that the intensity level of the exercise is not enough.
For optimum health benefits, teenagers should engage in 60 minutes of physical activity every day.
- At least 3 days of the week should be spent on aerobic exercises such as active dancing, jogging or running.
- Three days of the week should also be spent on more specialized resistance exercises such as learning “push ups” and “chin ups” on a bar, or “stepping” and “kicking” on a matted surface. These exercises not only help to strengthen the bones and muscles of the teenager but they also give their bodies structure and shape which can be invaluable to their sense of confidence.
18-64 years old. Adults.
Adults can make educated choices about their physical wellbeing. These decisions can determine the difference between good health and an absence of disease or illness. It is highly recommended that ALL adults engage in a moderate to high amount of physical activity. The health benefits are too numerous to mention here, but the physical changes you will observe in your own body, are worth the effort. Remember that the exercise you put in today can make the difference in the way you enter your later years. A strong trained body ages a lot slower than a weak, untrained one. Joining a fitness facility or group, or taking part in a sporting discipline can make a world of difference to your social life as well as your sense of well being. Acceptable physical intensity levels for this age group would produce results such as increased sweating and breathing and a heightened sense of excitement in their speech patterns. Shortness of breath and an inability to complete simple sentences are all signs of over exertion.
For optimum health benefits, all adults should engage in a total of 150 minutes of moderate to vigorous physical activity a week (about 30 minutes five (5) days a week).
- Adults should spend at least ten (10) to twenty (20) minutes three times a week in moderate to vigorous activity. Activities such as walking, running, aerobics or playing basketball on a public court can increase the cardiovascular health of an adult as well as lower cholesterol and reduce the risk of debilitating illnesses such as heart attacks or strokes.
- It is also beneficial to adults to spend at least 2 days a week on muscle building and bone strengthening exercises such as strength training/ resistance training. Not only do increased muscle and bone density slow down the onset of illnesses such as Osteoarthritis, they increase your sense of well-being and the confidence of knowing you have a well built and toned physique.
- To achieve weight loss and for additional fitness benefits, a goal of 300 minutes of moderate to vigorous physical activity per week is recommended, this is the equivalent of 60 minutes per day for 5 days per week.
- Remember, a balanced overall physical activity program should include activities for strength, endurance, cardio-vascular fitness, balance and flexibility
65+ years old. Retirees.
Individuals in this age group should ideally continue to move, as they get older. You are NEVER too old to exercise. Retaining functionality in later years is very important as it directly impacts on your quality of life. For individuals who are not used to exercise it is never too late to start as there are a variety of exercises, ranging from simple stretches such as forward bending on a chair to touch the ground and stretching the arms over the head to improve shoulder joint and spinal flexibility. More complex and strenuous exercise forms can be undertaken by forming a walking group and setting structured routes to follow. It is very important to be careful with the intensity of exercise for this age group, since over-exertion is a very real concern. Slight increases in body temperature as well as perspiration and a moderate increase in their breathing are all signs that an acceptable level of intensity during exercise has been reached. Retirees should avoid or cease any physical training that produces results such as shortness of breath, blurred vision or dizziness.
For optimum health adults in this age range should ideally accumulate at least 150 minutes of physical activity a week (about 30 minutes 5 days a week).
- At least 4-5 days of the week should be spent in moderate to vigorous exercise in ten (10) minute rounds and may comprise, walking on the beach, swimming or light aerobics.
- At least 2-3 days of the week should be spent engaging in muscle and bone building resistance exercises such as raking the leaves in the yard, or light weight training or body weight exercises such as squats and “push ups”.
- Retirees should also engage in activities that increase their ability to keep or maintain balance and remain grounded. Suggested activities such as Yoga and or Pilates, Poomsae or Kata dance or exercises are all viable options to promote balance and core strength and maintain co-ordination in a safe and relaxed way. Retirees should also participate in activities they enjoy and from which they derive some pleasure.
* NB. It is very important to consult your physician when undertaking a program of exercise. Individuals in this age group should pay special attention to the messages of their own bodies. Remember to stop exercising if you do not feel well.
You are active when there is a slight increase in body temperature combined with the onset of perspiration. Your body will indicate to you when you are doing moderate to strenuous exercise by increased perspiration (flowing sweat), increased respiration and a general feeling of warmth or heat throughout the body. Over exertion will be indicated by the presence of acute pain, shortness of breath, dizziness and an inability to focus.
Remember
exercise is supposed to be a fun and healthy activity but it can also be dangerous
when taken to extremes. Listen to your body!
Special populations
Individuals who are physically and mentally challenged; women who are pregnant, persons with hypertension, diabetes, chronic heart conditions and orthopedic conditions and persons with prosthetics should first consult their physicians or professional caretakers before engaging in an exercise regime. However, these special populations should make an effort to engage in physical activity. After receiving the “all clear from the doctor or health care professional, one should consult with a certified fitness professional before beginning a program. In some cases modifications to the fitness routines may be necessary; however movement and physical activity can be beneficial in most cases both as a social activity and for the many physical benefits which can be derived. Non-impact activities such as “treading water” or swimming are also viable options.
A word on Nutrition
Any exercise program or physical activity requires an individual to eat a well balanced diet to provide fuel for the body. Individuals who are active should enjoy a variety of foods from the major food groups and in the correct portion sizes if they are to maintain the best nutrition to compliment their physical efforts. The major nutrients are:
- Proteins (found mostly in meats, fish, chicken, peas)
- Carbohydrates (found mostly in rice, pasta, bread)
- Fats (found mostly in butter, oils)
- Vitamins (found mostly in fruits and vegetables)
- Minerals (from all plant and meat sources)
The Ministry
of Health has produced food based dietary guidelines for the various groups and
a copy of these guidelines may be sourced at the Ministry or Polyclinics island
wide.
Some helpful points in planning your physical activity
- Consult a physician to detect any underlying health problems that may be aggravated by exercise and to determine the right level at which to start
- Consult a certified fitness professional to help you design the right program for you based on your health status and your goals.
- Get adequate exercise gear to minimize the risk of injuries for example the right shoes are important for foot and hip safety.
- Start slowly and build gradually. Injuries come from doing too much, too soon, too hard and too fast.
- Make gradual increases and changes in activity as you become fitter. Keep the element of variety in your program; this keeps it fun and interesting.
- Listen to your body. It is the best teacher you will ever have.
- Make exercise as fun as possible. Pick an activity you like and stick to it. If it is an activity you dislike, you will most likely register it as a chore and it will weigh on your mind.
- Do not accept lack of time as an excuse. Remember that if you do not have time for your health, it will have little time for you as well. Exercise increases your life expectancy and has been scientifically shown to combat the effects of aging. Make the sacrifice to either wake up earlier or adjust your schedule to accommodate this very important activity. In addition you can try to exercise for shorter periods more frequently as opposed to larger blocks. In order to keep the experience interesting and fun. You’ll be glad you did!!!
- Exercise as a group or with your friends and family. Physical activity and exercise requires discipline and patience. Exercising as a group increases the chances that you will always be motivated and encourages you to continue your new lifestyle. Exercising with a group ensures that you receive support from the other members on the days when you lack the willpower to move.
- Play with your children. It is a very important source of physical activity with an age group that will scarcely run out of energy or lack the motivation. Playing with children also eliminates the excuse that looking after them is an impediment to exercise.
Selected sporting associations of Barbados
Professional Road Tennis Association (246) 233-8268
Barbados Cricket League
(246) 436-2092