Determinantes sociales de la actividad física y el sedentarismo en la población adulta europea

Abstract

Physical activity has major health benefits in the prevention and management of a wide range of chronic diseases and associated risk factors, as well as improving our sleep, life quality and well-being. Its absence -physical inactivity- is associated with a poorer life quality, and an increased risk of morbidity and all-cause mortality. On the other hand, prolonged periods in sedentary positions have similar additional health detriments. However, approximately one quarter to one third of the population does not reach the minimum requirements established by the World Health Organisation, being physical inactivity the fourth leading cause of death worldwide and declared as a pandemic which displays a growing trend since the beginning of the 21st century in developed countries such as those in the European Union, which have twice as much physical inactivity as other countries with lower levels of economic development. Regarding sedentary behaviour, Europe leads the world ranking, with half of the European population reporting at least 5 hours of sitting per day. The assessment and monitoring of the factors that produce and/or limit physical activity and sedentary behaviour are part of public health policies in the European Union to implement an active lifestyle. There are multitude of individual, biological, social, demographic, economic, environmental and political factors of physical activity and sedentary behaviour, which interact in an ecological model with different hierarchical levels of influence. In this doctoral thesis, we aimed to research in the adult population of the European Union some of these proposed -but slightly investigated- factors including the social determinants of health (educational level, occupational social class and purchasing power), the different physical activity barriers according to social class; the social inequalities on sedentary behaviour and the different types of physical activity among the population; the social gender inequality, which restricts women's living conditions, and probably women's mobility and physical activity; environmental level factors such as the type and size of the environment (urban, suburban and rural), its evolution of physical activity levels and socioeconomic differences between environments such as difference in the opportunities for physical activity; and finally, technological and digital development, and urbanisation as global factors in sedentary behaviour and physical activity, respectively. In addition, overall levels of physical activity and sedentary behaviour were assessed, stratified by different intensities and according to age, gender and type of environment. The findings showed an increase in physical inactivity in the European Union between 2002 and 2017 from 30.84% and 22.74% in women and men to 35.43% and 27.97% respectively, while sedentary behaviour presented a flattened trend, with no variation, set at 5 hours per day. Additionally, physical activity showed the same socioeconomic gradient, as the social determinants of health, across the population and between rural and urban settings with greater increases in inactivity in rural areas due to lower perceived opportunities for physical activity. Nonetheless, those with higher socioeconomic status may also be more sedentary, although with smaller differences across the population. Therefore, physical activity is a behaviour mainly determined by socioeconomic characteristics and social hierarchy, and to a lesser extent and even inversely in sedentary behaviour. Similarly, gender inequalities could be the cause of differences in physical activity between men and women. In global factors, we observed that greater digitalisation was associated with higher levels of sedentary behaviour, but, in contrast, urbanisation had negligible effects on inactivity. Finally, the groups most likely to have lower levels of physical activity were older adults, women, those with low socioeconomic status, and those living in low socioeconomic, scarce-resource and rural settings.