Refining index to measure physical activity inequality: which group of the population is the most vulnerable?

Abstract

Background The existing body of research mostly discusses inequality in physical activity (PA) based on the difference in the level of moderate-to-vigorous physical activity (MVPA). Evidence is lacking on the quantified inequality measures (e.g., how big the inequality is, and the distribution) in order to identify the most vulnerable groups of a population. This study measured PA inequality among Thai adults by using three parameters to construct an inequality index: (1) Proportion of the population with sufficient MVPA; (2) Cumulative minutes of MVPA; and (3) The Gini coefficient. Methods This study employed three rounds of data from Thailand’s Surveillance on Physical Activity (SPA) 2019–2021. In each round, over 6,000 individuals age 18–64 years were selected as nationally-representative samples, and were included in the analysis. PA inequality was constructed by using three parameters, with a combination of the three as the final measure, to identify the sub-groups of the Thai adults who are most vulnerable: groups with the least MVPA, highest insufficiency, and highest inequality index (Gini). Results Covid-19 containment measures have widened the gap in PA inequality, as shown by a declining proportion of the population meeting the recommended guidelines, from 74.3% in 2019 to 56.7% in 2020 and 65.5% in 2021. PA inequality existed in all sub-populations. However, by combining three parameters, the most vulnerable groups during the Covid-19 epidemic were identified as follows: (1) Those with no income; (2) The unemployed; (3) Those who have no access to PA facilities; (4) Older adults aged 60 + years; and (5) Those earning < 3,500 baht per month. Further, residents of Bangkok, young adults aged 18–24, individuals who attained primary level education or less, those who had no exposure to a PA awareness campaign and those who have a debilitating chronic disease also had elevated risk of PA insufficiency. Conclusion A concerning level of PA inequality existed in all sub-populations. The use of combined indicators in measuring PA inequality should aid in determining the most vulnerable groups of the population with a refined procedure. This method can be applied in many settings since the baseline data used to measure inequality (i.e., percent sufficient and cumulative minutes of MVPA) are widely available.

Recovery shape of physical activity after COVID-19 pandemic

“… 4 The high recession of PA and slow recovery were generally caused by harsh measures meant to contain the virus and the closure of PA amenities. 18 Unemployed individuals were among the most vulnerable during the pandemic (high recession and slow recovery), as they suffered from economic deprivation and were exposed to an elevated risk of infection due to their crowded living conditions. PA was likely not a priority for this group given their struggle to survive and cover daily expenses.…”

“…PA was likely not a priority for this group given their struggle to survive and cover daily expenses. 18 Finally, those who already had a negative attitude toward PA were further demotivated during the COVID-19 pandemic. 40 , 41 …”

“…Rural areas had less restriction of movement than Bangkok and many other urban areas, which increased confinement measures due to high infection rates. 4 , 18 In addition, individuals who worked in agriculture were more likely to be able to carry out their routine farming and maintain their work-related PA during 2020–2021.…”

“…Men may have been especially slow to recover because of their “outdoor nature”—that is, because they are more likely to look for outdoor PA opportunities, which were limited by periods of confinement and the need to practice social distancing. 18 …”

“…Studies show that PA participation is largely determined by the differences in individual–biological (i.e., age, sex), 7 , 8 , 9 socioeconomic, 10 and community–environmental factors. 11 , 12 Inequalities in access and PA opportunity are consistently found to be the predominant factors affecting an individual's participation in PA. 13 , 14 , 15 , 16 , 17 , 18 A bulk of evidence also documents the adverse effects of the COVID-19 pandemic on a population's PA. 3 , 19 , 20 , 21 However, there is a lack of evidence regarding how and to what extent PA inequality may affect PA recovery.…”