Description | Specific Indicators |  Ontario Public Health Standards (OPHS) | Corresponding Health Indicator from Statistics Canada and CIHI | Data Sources | Survey Questions | Analysis Check List | Method of Calculation |  Basic Categories | Indicator Comments | Definitions | Cross-References to Other Indicators | Cited References | Changes Made | Acknowledgements


Description

• Proportion of the population, aged 12 and over, by level of energy expenditure during leisure-time physical activity.

Specific Indicators

• Proportion of the population aged 12 and over who were active during leisure time
• Proportion of the population aged 12 and over who were moderately active during leisure time
• Proportion of the population aged 12 and over who were inactive during leisure time
• Proportion of the population aged 12 and over who were active or moderately active during leisure time

Ontario Public Health Standards (OPHS)

The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.   

Outcomes Related to this Indicator

• Societal Outcome (Chronic Disease Prevention): An increased proportion of the population lives, works, plays, and learns in healthy environments that contribute to chronic disease prevention.
• Societal Outcome (Chronic Disease Prevention): There is increased adoption of behaviours and skills associated with reducing the risk of chronic diseases of public health importance.

Assessment and/or Surveillance Requirements Related to this Indicator

• The board of health shall conduct epidemiological analysis of surveillance data...in the area of physical activity (Chronic Disease Prevention).

http://www.ontario.ca/publichealthstandards

Corresponding Health Indicator from Statistics Canada and CIHI

• Leisure-Time Physical Activity: Population aged 12 and over who reported a level of physical activity, based on their responses to questions about the frequency, nature and duration of their participation in leisure-time physical activity.  Respondents are classified as active, moderately active or inactive based on an index of average daily physical activity over the past 3 months.

http://www.statcan.gc.ca/start-debut-eng.html

Click on "Publications"
Type "Health Indicators" into search box
Scroll down and click on the html version of "Health Indicators"
Click on "Data tables and maps" and then "Leisure-Time Physical Activity"

Data Sources

Numerator & Denominator: Canadian Community Health Survey (CCHS)
Original source: Statistics Canada
Distributed by:
1. Ontario Ministry of Health and Long-Term Care
2. Statistics Canada
Suggested citation (see Data Citation Notes):
1. Canadian Community Health Survey [year], Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care.
2. Canadian Community Health Survey [year], Statistics Canada, Public Use Microdata File, Statistics Canada.

Survey Questions

The CCHS has a Physical Activities module that consists of a series of questions about participation in various types of leisure physical activities in the previous three months, as well as the frequency and duration of each activity. The interviewer enters the reporting unit (per day, week, month, year, or never) and the number of times per reporting unit.  Respondents were categorized into three physical activity levels according to energy expenditure (EE): active (EE of 3.0 kcal/kg/day or more); moderately active (EE 1.5-2.9 kcal/kg/day); inactive (EE less than 1.5 kcal/kg/day).  More details on the derivation can be found in the Indicator Comments. 

Analysis Check List

CCHS  

• It is recommended that public health units use the Share File provided by the Ministry of Health and Long-Term Care rather than public use file (PUMF) provided by Statistics Canada. The Share File has a slightly smaller sample size because respondents must agree to share their information with the province to be included; however, the share file has more variables and fewer grouped categories within variables. The Share File is a cleaner dataset for Ontario analysis because all variables that were not common content, theme content or optional content for Ontario have been removed.
• There may be slight differences between results from the share file and data published on the Statistics Canada website for the Health Indicators because rates calculated for Health Indicators use the master CCHS data file.
• Moderately active and active may be combined together as a specific indicator.
• Users need to consider whether or not to exclude the ‘Refusal, 'Don't Know' and ‘Not Stated' response categories in the denominator. Rates published in most reports, including Statistics Canada's publication Health Reports generally exclude these response categories.  In removing not stated responses from the denominator, the assumption is that the missing values are random, and this is not always the case.  This is particularly important when the proportion in these response categories is high. In Ontario, 1.8% of respondents were "not stated" for this indicator in CCHS 2005.
• Estimates must be appropriately weighted (generally the share weight for the CCHS) and rounded.
• Users of the CCHS Ontario Share File must adhere to Statistics Canada's release guidelines for the CCHS data when publishing or releasing data derived from the file in any form. Refer to the appropriate user guide for guidelines for tabulation, analysis and release of data from the CCHS. In general, when calculating the CV from the share file using the bootstrap weights, users should not use or release weighted estimates when the unweighted cell count is below 10. For ratios or proportions, this rule should be applied to the numerator of the ratio.  Statistics Canada uses this approach for the tabular data on their website. When using only the Approximate Sampling Variability (CV) lookup tables for the share file, data may not be released when the unweighted cell count is below 30. This rule should be applied to the numerator for ratios or proportions.  This provides a margin of safety in terms of data quality, given the CV being utilized is only approximate.
• Before releasing and/or publishing data, users should determine the CV of the rounded weighted estimate and follow the guidelines below:
• Acceptable (CV of 0.0 - 16.5) Estimates can be considered for general unrestricted release. Requires no special notation.
• Marginal (CV of 16.6 - 33.3) Estimates can be considered for general unrestricted release but should be accompanied by a warning cautioning subsequent users of the high sampling variability associated with the estimates. Such estimates should be identified by the letter E (or in some other similar fashion).
• Unacceptable (CV greater than 33.3) Statistics Canada recommends not to release estimates of unacceptable quality. However, if the user chooses to do so then estimates should be flagged with the letter F (or in some other fashion) and the following warning should accompany the estimates: "The user is advised that...(specify the data)...do not meet Statistics Canada's quality standards for this statistical program. Conclusions based on these data will be unreliable and most likely invalid". These data and any consequent findings should not be published. If the user chooses to publish these data or findings, then this disclaimer must be published with the data.
• Caution should be taken when comparing the results from 2000/01 (Cycle 1.1) to subsequent years of the survey, due to a change in the mode of data collection.  The sample in Cycle 1.1 had a higher proportion of respondents interviewed in person, which affected the comparability of some key health indicators.  Please refer to http://www.statcan.gc.ca/imdb-bmdi/document/3226_D16_T9_V1-eng.pdf for a full text copy of the Statistics Canada article entitled "Mode effects in the Canadian Community Health Survey: a Comparison of CAPI and CATI".

Method of Calculation

Weighted population aged 12+ active during leisure time  Weighted total population aged 12+

X 100

Weighted population aged 12+ moderately active during leisure time Weighted total population aged 12+

X 100

Weighted population aged 12+ inactive during leisure time Weighted total population aged 12+

X 100

Weighted population aged 12+ active or moderately active during leisure time Weighted total population aged 12+

X 100

Basic Categories

• Age groups for age-specific rates: 12-19, 20-44, 45-64, 65+
• Sex: male, female
• Geographic areas: CCHS - all 36 Public Health Units in Ontario

Indicator Comments

• Physical activity reduces the risk of premature morbidity and mortality, particularly in relation to cardiovascular disease, hypertension, cancer¹ and osteoporosis. Physical activity is also associated with positive mental health, leading to increased self-confidence and an improved sense of well-being. Physical inactivity is an important risk factor for overweight and obesity.²
• Leisure-time physical activity was assessed in the CCHS by asking respondents about their participation in various types of leisure activities in the previous three-month period, as well as the frequency and duration of each activity.  The following activities were included: walking for exercise, gardening or yard work, swimming, bicycling, popular or social dance, home exercises, ice hockey, ice skating, in-line skating or rollerblading, jogging or running, golfing, exercise class or aerobics, downhill skiing, bowling, baseball or softball, tennis, weight-training, fishing, volleyball, basketball and up to three other activities.³
• Each type of activity was assigned a MET (metabolic equivalent) value in order to derive a physical activity index that estimated the energy expenditure of respondents. The MET is a value of metabolic energy cost expressed as a multiple of the resting metabolic rate; thus, an activity of four (4) METS requires four times the amount of energy as compared to when a person is at rest. More intense activities were assigned higher MET values. Based on the activity type, frequency and duration, energy expenditure (EE) values were estimated. The index is calculated as the sum of the average daily energy expenditures of all activities.
• The physical activity index uses energy expenditures to categorize individuals as being active, moderately active or inactive. Active applies to those who average 3.0+kcal/kg/day of energy expenditure from leisure-time physical activity. This is approximately the amount of exercise that is required for cardiovascular health benefit. Moderately active includes those who average 1.5-2.9 kcal/kg/day from leisure-time physical activity. Those who are moderately active might experience some health benefits but little cardiovascular benefit. People categorized as inactive are those with energy expenditure levels less than 1.5 kcal/kg/day from leisure-time physical activity.
• Respondents may have difficulty accurately recalling their activities in the past three months.
• There are concerns about the accuracy and consistency of using the leisure-time physical activity index to estimate the levels of physical activity, especially when series of surveys are used to monitor trends. Levels of energy expenditure are grouped into categories using the above cutoffs; this approach does not capture changes in the total volume of physical activity or the overall distribution of energy expenditure within each category.  Katzmarzyk and Tremblay (2007) have suggested that it is possible that leisure-time physical activity levels in the population are decreasing, even though a greater proportion of individuals are meeting a pre-defined cutoff.⁴
• Modifications to the list of activities may make it difficult to discern true temporal trends.  For example, in CCHS 2000/01 participation in soccer was not included in the list of activities.  All "other" activities were assigned an average intensity value.  Consequently, as a high intensity activity, soccer now yields a higher calculated physical activity score than when reported as an "other" activity.⁴
• Trends in physical activity may be influenced by many aspects of life such as the activities of daily living, commuting, occupational physical activity and leisure-time physical activity. Leisure-time physical activity accounts for a relatively small part of total daily physical activity levels. There is substantial variation in the energy expended to earn a living (occupational physical activity), domestic chores and active transportation. Occupational physical activity often plays a large role in explaining individual differences in health-related outcomes.⁴
• Both respondent and response bias may influence physical activity surveillance.  For example, the social desirability of reporting "healthy" behaviours may have increased over time as the benefits of physical activity have been publicized.⁴
• Health Canada's Physical Activity Guide recommends engaging in endurance activities 4-7 days a week, flexibility activities 4-7 days a week, and strength activities 2-4 days a week, accumulating 60 minutes of physical activity daily. Time needed depends on effort - as one progresses to moderately intensive activities, the time can be cut down to 30 minutes, 4 days per week.⁵
• Physical activity levels tend to decrease with increasing age and are lower in women than men.⁶
• Physical activity increases with income and highest level of education achieved.⁷
• Based on the CCHS 2005 Share File, 28% of Ontarians aged 12 and older were ‘active', 25% were ‘moderately active' and 47% were ‘inactive'.  Not stated were excluded.
• The Rapid Risk Factor Surveillance System (RRFSS) has a Physical Activity Module which asks about number of days and amount of time spent participating in vigorous activity, moderate activity, walking and sitting in the previous 7 days. This format is not comparable to the CCHS module.
• In 2011, Cancer Care Ontario started using a new definition for physical activity that includes both leisure time physical activity and active transportation.  The following definitions are now being employed:
  • Adult: Proportion of adults (aged 18+) who were moderately active (expending 1.5-2.9 kcal/kg/day) or active (expending ge 3.0 kcal/kg/day) in their transportation and leisure time physical activity.
  • Youth: Proportion of youth (aged 12 to 17) who were moderately active (expending 1.5-2.9 kcal/kg/day) or active (expending ge 3.0 kcal/kg/day) in their transportation and leisure time physical activity.

Definitions

• Active - respondents who average 3.0+ kcal/kg/day of energy expenditure during leisure-time physical activity
• Moderately active - respondents who average 1.5-2.9 kcal/kg/day during leisure-time physical activity
• Inactive - respondents with energy expenditure levels less than 1.5 kcal/kg/day during leisure-time physical activity

Cross-References to Other Indicators

• Chronic Health Problems Prevalence (Section 4A: Chronic Diseases)
• Adult Body Mass Index (Section 5D: Nutrition and Healthy Weights)
• Adolescent Body Mass Index (Section 5D: Nutrition and Healthy Weights)

Cited References

1. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective: The Continuous Update Project. Available from: http://www.dietandcancerreport.org/cu/ (Accessed November 2008).
2. Flynn MA, McNeil DA, Maloff B, Mutasingwa D, Wu M, Ford C, et al. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations. Obesity Reviews 2006; 7(Suppl-66).
3. Statistics Canada. Canadian Community Health Survey (CCHS) Cycle 3.1 (2005) Public Use Micro Data File (PUMF) Integrated Derived Variable (DV) and Grouped Variable Specification. Ottawa, ON: Statistics Canada, 2006.
4. Katzmarzyk PT, Tremblay MS. Limitations of Canada's physical activity data: implications for monitoring trends. Can J Public Health. 2007; 98 Suppl 2:S185-94.
5. Health Canada. Canada's Physical Activity Guide to Healthy Active Living. 2003.
6. Gilmour H. Physically active Canadians. Health Rep 2007; 18(3): 45-65.  Available from: http://www.statcan.gc.ca/pub/82-003-x/2006008/article/phys/10307-eng.pdf (Accessed March 2009).
7. Vanasse A, Demers M, Hemiari A, Courteau J. Obesity in Canada: where and how many? International Journal of Obesity 2006; 30(4):677-83.

Changes Made

Acknowledgements