Implementation of a standardized “EU Monitoring system for Sport and Physical Activity” as a base for the HEPA strategy and program in the Republic of North Macedonia, EUPASMOS Plus, 2019 – 2021

The prevalence of physical inactivity and sedentary behaviour is increasing, and it’s estimated that more than half of the population in the European region does not meet the WHO recommended levels of physical activity for health and well-being (minimum moderate intensity-MPA). For that reason, increasing the level of physical activity (PALs) has become one of the priorities of public health programs in the Republic of North Macedonia. The successful promotion of national health-enhancing physical activity (HEPA) and the design, implementation, and evaluation of a cost-effective HEPA strategy, an action plan with effective short- and long-term interventions aimed at increasing PA requires authoritative information on the prevalence of population PALs.
How to develop PA monitoring is still an open question. Methods for the assessment of PA are numerous, but given the complex nature of PA, none of the currently available methods can assess all PA dimensions. Within the project “EUPASMOS Plus”, we aimed to develop PALs, sports participation, sedentary behavior, and sleeping time monitoring framework in the European region. The outcomes of the project will support the Member States, the European Commission, the WHO, and other relevant international sports organizations in the design, promotion, implementation, and monitoring of effective, evidence-based HEPA and sport strategies across the European region.
Scientific methods for determining PALs are classified as “objectively” assessed PALs (direct) and “subjectively” (indirect) assessed PALs. The basic method of assessing PALs in epidemiological studies is PA questionnaires. Developing PA monitoring systems, questionnaires are easy to apply. In recent years, some PA monitoring systems are developed on objectively estimated PALs by activity trackers (accelerometers) as a more reliable and valid method than PA questionnaires.
A harmonized approach using an international toolkit is preferred to enable cross-country comparisons. Determinants of PALs are very important for the interpretation of questions and consequently for the content validity of PA questionnaires. Both GPAQ and IPAQ are instruments, which were developed to establish standardized and culturally adaptable measurement tools for measuring PALs in different cultural areas of the world. The outcome of the IPAQ-SF is MET min/week and PALs category.
Assessment of moderate-to-vigorous physical activity levels (MVPA with GPAQ and IPAQ-SF) in the European adult population is recommended. A combination of objective measures of PA and self-report will provide the most valid and reliable results of MVPA. Further investigation of measurement characteristics of PA questionnaires should focus on studying differences in the validity of different groups of participants according to their physical fitness level. This could contribute to a more critical evaluation of PA data, assessed by PA questionnaires and related to population lifestyle and health monitoring. Keywords: lifestyle monitor, health, physical activity levels, sports, sitting, measuring, accelerometer.


Macedonia: A physical activity Country Card – Assessing and monitoring physical activity prevalence, research, and policy

Purpose: To describe the physical activity profile of Macedonia, a GoPA! Member. Methods: Using a standardized methodology GoPA! collected sociodemographic, surveillance, policy, and research data for each country around the world. A country representative, the review author, Vera Simovska, extracted and approved the data presented as a Country Card for physical activity.
Results: It was estimated that only 36% of Macedonian’s adult population was physically active. Age-standardized prevalence of insufficient physical activity in persons aged 18 years and over are defined as not meeting any of the following recommendations: 150 minutes per week of moderate to vigorous-intensity physical activity per week or 75 minutes per week of vigorous-intensity aerobic physical activity or an equivalent combination of both activities. Macedonia has 64% of physical inactivity estimated in the population aged 15 years and over, with women being more inactive compared to men.
It is critical to develop a national physical activity for the health action plan and convene a national physical activity for health committee or task force with high-level support and resources and with representation from multiple sectors, agencies, NGOs, and the private sector to provide leadership and guidance in implementing the Health-Enhancing Physical Activity Plan. A comprehensive set of policy options to improve physical activity is listed in the Global NCD Action Plan.
The First Macedonian “Move for Health” Council was established within the WHO CINDI program (World Health Organization Countrywide Intervention Noncommunicable Disease program) in 2003. In 2010 WHO developed global recommendations on physical activity for health. The Agency for Sport and Youth established the Program for Sports development during the 2013-2017 years.
The Physical Activity for Health Action Plan and national policy documents, including the Declaration “Move for Health” (2004), provided a national recommendation on HEPA, recommended counseling on physical activity as part of primary health care activities, and mandated physical education in primary and secondary schools.
NGOs’ HEPA Macedonia also contribute to developing education and health policy, research, monitoring, and other national activities related to physical activity for health.
Conclusion: As the baseline for future evaluation of physical activity status of the adult population in Macedonia, and being a national public health priority due to its impact on chronic diseases, general health, development, and well-being, we started to create a physical activity Country Card in 2014. The national evidence is the baseline for a future physical activity strategy, program, and action plan that government, communities, and families can implement to prevent and promote health and an active lifestyle.
Keywords: Monitoring, Policy, Surveillance, Physical Activity.

Author: Univ. prof. Vera Simovska, MD., PhD.